C-13 Sex Differences in Cognitive and Neurobiological Markers of Alzheimer's Disease

Objective

Previous work has demonstrated that intra-individual cognitive variability (IICV) has predictive power similar to traditional Alzheimer’s disease (AD) biomarkers, such as CSF or hippocampal volume (HV) loss. Genetic factors, such as sex, have been identified as predictors of cognitive decline. Analysis of sex differences in IICV and other biomarkers may elucidate additional dimensions of this metric.

Method

Baseline neurocognitive test and neuroimaging data from 335 participants with ≥2 visits enrolled in the Wisconsin Alzheimer’s Disease Research Center Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to determine IICV. Characteristics by sex were compared using Mann-Whitney and Fisher’s Exact tests. Spearman’s Rho was calculated to compare IICV and HV (relative to intercranial volume).

Results

At baseline (Table 1): (1) Males had more education than females; (2) females had both higher relative HV and IICV; and (3) in females, relative HV demonstrated a weak positive correlation with baseline IICV (Figure 1).

Conclusions

IICV has previously demonstrated potential as a cost-effective non-invasive marker of preclinical AD. In females, larger relative HV and its correlation with IICV may be due to differences in metabolic brain age or concurrent progression of HV and IICV through the AD process. Analyses of other biopsychosocial factors are needed.

C-12 Race and Sex Differences in Cognitive and Neurobiological Markers of Alzheimer's Disease

Objective

Intra-Individual Cognitive Variability (IICV) previously demonstrated predictive power similar to AD biomarkers (i.e., CSF and hippocampal volume (HV) loss). Previous work suggested sex differences in relative HV and IICV. Additionally, IICV differs in whites and underrepresented racial groups (URG). Our objective was to analyze these sex differences in white and URG participants.

Method

Baseline neurocognitive test and neuroimaging data from 335 cognitively healthy participants with ≥2 visits enrolled in the Wisconsin ADRC Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to determine IICV. Characteristics by race and sex were compared using Mann-Whitney, Fisher’s Exact, and Kruskal-Wallis tests. Spearman’s Rho was calculated to compare baseline IICV and relative HV.

Results

At baseline (Table 1), differences across racial groups in age, years of education, relative HV, and IICV were identified. Sex and racial group differences were identified (Table 2). A weak positive correlation between HV and IICV was seen in white females (Figure 1).

Conclusions

IICV has potential to become a cost-effective, non-invasive marker of preclinical AD. Again, correlation between HV and IICV was seen, but only in white females. Analyses suggest group differences between white and URG males and females. However, more data is needed to further explore these differences.

Strategies to optimize the performance of Robotic-assisted laparoscopic hysterectomy

A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL(®) Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary -significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed. In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy.

Safety and efficacy of pegfilgrastim administration on the same day as myelosuppressive chemotherapy (CT) in women with ovarian or primary peritoneal cancer

16009

Background: According to prescribing information, pegfilgrastim should not be administered within 14 days prior to, or within 24 hours after, the administration of cytotoxic CT. However, little data exist to support this recommendation. The purpose of the current study is to determine the safety and efficacy of administering pegfilgrastim on the same day as myelosuppressive CT in patients with ovarian or primary peritoneal carcinoma. Methods: A retrospective review was conducted of all ovarian and primary peritoneal cancer patients that received prophylactic pegfilgrastim on the same day as CT from May 2003 to June 2006. Results: Forty-six patients (mean age: 57, range: 21–82) were treated for the following malignancies: 35 (76%) epithelial ovarian, 6 (13%) primary peritoneal, and 5 (11.0%) ovarian germ cell or stromal cell carcinoma. Twenty-six patients (56%) had primary cancers and 20 (44 %) had recurrent disease. All patients met the ASCO or NCCN recommendations of using colony-stimulating factors for prophylaxis against febrile neutropenia (FN) (Risk of FN > 20%). A total of 269 cycles of CT were administered including 125 cycles (46.5%) docetaxel + carboplatin, 39 cycles (14.5%) gemcitabine + platinum, 30 cycles (11.1%) intravenous paclitaxel + carboplatin, 28 cycles (10.4%) liposomal doxorubicin, 19 cycles (7.1%) paclitaxel + intraperitoneal platinum, 6 cycles (2.2%) docetaxel, 6 cycles (2.2%) liposomal doxorubicin + cisplatin, 5 cycles (2%) bleomycin + etoposide + cisplatin, 4 cycles (1.5%) topotecan, 3 cycles (1.1%) of paclitaxel, 2 cycles (0.7%) vincristine + actinomycin-D + cyclophosphamide, and 2 cycles (0.7%) docetaxel + gemcitabine. All patients received pegfilgrastim within one hour of the completion of CT administration. Grade 1 or 2 neutropenia developed in 10 cycles (3.7%) out of the 269 cycles, mean absolute neutrophil count = 4926 (range, 1293 -24300). No patients had FN episodes, hospitalizations or antibiotic use secondary to neutropenia, or dose-reductions and CT delays due to neutropenia. Conclusions: Administration of pegfilgrastim on the same day as CT in ovarian and primary peritoneal cancer patients is more convenient to the patient and appears safe and effective.

No significant financial relationships to disclose.

Anatomy of pelvic arteries adjacent to the sacrospinous ligament: importance of the coccygeal branch of the inferior gluteal artery

OBJECTIVE

To describe the arterial vascular anatomy in the area of the sacrospinous ligament.

METHODS

Cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament with emphasis on vascular and neuroanatomy. Flexible rulers were used to measure the coccygeal branch in five hemipelvises.

RESULTS

The pudendal vessels and nerve pass immediately medial and inferior to the ischial spine (within 0.5 cm of the spine) and behind the sacrospinous ligament. The pudendal artery lies anterior to the sacrotuberous ligament, which passes behind the ischial spine to its attachment at the posterior ischial tuberosity. The inferior gluteal artery originates from the posterior or the anterior branch of the internal iliac artery to pass behind the sciatic nerve and the sacrospinous ligament. There is a 3- to 5-mm window in which the inferior gluteal vessel is left uncovered above the top of the sacrospinous ligament and below the lower edge of the main body of the sciatic nerve plexus. The coccygeal branch of the inferior gluteal artery passes immediately behind the midportion of the sacrospinous ligament and pierces the sacrotuberous ligament in multiple sites. The main body of the inferior gluteal artery leaves the pelvis by passing posterior to the upper edge of the sacrospinous ligament and following the inferior portion of the sciatic nerve out of the greater sciatic foramen.

CONCLUSION

Sutures placed through the sacrospinous ligament at least 2.5 cm from the ischial spine along the superior border of the sacrospinous ligament and without transgressing the entire thickness are in an area generally free of arterial vessels.

Dose-intensive approaches to ovarian cancer

Increasing the total dose or the dose intensity of platinum does not improve survival in women with ovarian cancer. High-dose chemotherapy with hematologic support has not been shown to be more effective than standard-dose chemotherapy. Regional dose intensity, through intraperitoneal chemotherapy, may have a role in the treatment of advanced ovarian cancer. Further studies are needed to identify the optimal combination of agents, in addition to a platinum and a taxane, to be used in primary therapy for ovarian cancer.

[The ophthalmologist B. Adamandiadis and the history of the "Adamandiadis-Behçet syndrome"]

This article presents the scientific and social work of Benedikt Adamandiadis and the history of the "Adamandiadis-Behçet syndrome". The authors also attempt to describe the inestimable contribution to modern Greek ophthalmology. It is not the authors' intention to underscore Adamandiadis' importance as the discoverer of the syndrome - for him, the fulfillment of his duties as a scientist and a human being was always more important than personal fame -, but merely to correct an historical injustice.

[Is the postoperative course following goniotrepanation modified by the age of the patient?]

The authors tried to establish whether the patient's age has any bearing on the postoperative course of goniotrepanation. A total of 150 eyes operated on, which had been regularly followed up for more than 10 years, were classified in three age groups, each comprising 50 eyes. The following parameters were evaluated: indication for the operation, behavior of the postoperative I.O.P., behaviour of the filtering bleb, behavior of the visual functions, and late complications. The comparative investigations produced the following findings: (1) The postoperative mean IOP value is independent of the patient's age; (2) visual functions were adversely affected to a significant degree postoperatively in older patients, and (3) a cystic configuration of the filtering bleb was significantly more common in older individuals. On the basis of these findings the authors recommend covered sclerectomy procedures, even in younger individuals suffering from chronic simple glaucoma, because the prognosis for the functions and the ultimate fate of the eye is reasonably good.

[The role of the parathalamus in covered sclerectomy]

Twenty-six eyes in which IOP had been regulated at a mean 14 mmHg by goniotrepanation were operated on for cataract after an interval of at least 4 years. On exposing the scleral flap the authors discovered gray-black funiculi on the two unsutured vertical sides, representing new fluid-permeable membranous tissue. Beneath them was a fairly small fluid-filled space, the " parathalmus " - a kind of secondary anterior chamber.

[The significance of the scleral flap for the surgery of glaucoma (author's transl)]

The importance of the scleral flap used in the covered fistulising operations is reported. The authors describe in detail significant observations contributing to the successful outcome of these operations. They make the hypothesis, supported by their microsurgical observations, for the formation of a slit-like space under the scleral flap, named "Parathalamus", which is an extension of the anterior chamber. This space communicates with the anterior chamber through the trephination hole. The aquous humor flows to the subconjunctival space through a fine membraneous tissue, formed on the surface of the lips of the "parathalamus".

[Local prophylactic measures to prevent postoperative infection after cataract operations (author's transl)]

The Allen procedure to prevent postoperative endophthalmitis has been applied in cataract operations since 1973. Postoperative endophthalmitis has been observed through the years 1965--1973 in 0.49% of registered cases, while the infection rate has now been lowered to 0.067%.

[A modified goniotrephination technique (procedure to secure more permanent drainage) (author's transl)]

Two modified operative techniques using non-absorbable synthetic material based on the goniotrephination are described. The material used is embedded under the scleral flap at the trephination site. The procedure aims at creating a more stable and eventually a more permanent drainage. Both techniques are dealt with in detail, and the clinical results regarding the first twelve cases are reported covering an observation period of one to six months.