Brain charts for the human lifespan

Over the past few decades, neuroimaging has become a ubiquitous tool in basic research and clinical studies of the human brain. However, no reference standards currently exist to quantify individual differences in neuroimaging metrics over time, in contrast to growth charts for anthropometric traits such as height and weight1. Here we assemble an interactive open resource to benchmark brain morphology derived from any current or future sample of MRI data ( http://www.brainchart.io/ ). With the goal of basing these reference charts on the largest and most inclusive dataset available, acknowledging limitations due to known biases of MRI studies relative to the diversity of the global population, we aggregated 123,984 MRI scans, across more than 100 primary studies, from 101,457 human participants between 115 days post-conception to 100 years of age. MRI metrics were quantified by centile scores, relative to non-linear trajectories2 of brain structural changes, and rates of change, over the lifespan. Brain charts identified previously unreported neurodevelopmental milestones3, showed high stability of individuals across longitudinal assessments, and demonstrated robustness to technical and methodological differences between primary studies. Centile scores showed increased heritability compared with non-centiled MRI phenotypes, and provided a standardized measure of atypical brain structure that revealed patterns of neuroanatomical variation across neurological and psychiatric disorders. In summary, brain charts are an essential step towards robust quantification of individual variation benchmarked to normative trajectories in multiple, commonly used neuroimaging phenotypes.

Electrocardiographic findings in true acute left main coronary total occlusion a subanalisys from ATOLMA registry

INTRODUCTION

Acute total occlusion of the left main coronary artery (ATOLMA) usually leads to a catastrophic presentation. Prediction of ATOLMA by electrocardiogram (ECG) may contribute to early detection and reperfusion. Limited data have been reported previously. This study aims to identify the admission 12‑leads ECG features that can predict the presence of ATOLMA and in-Hospital mortality in these patients.

METHODS

The admission ECGs findings in 24 patients from the previously reported ATOLMA multicenter registry were compared to the ECGs findings in 15 patients with an acute subtotal occlusion of the left main (ASOLMA) and to 15 patients with anterior ST-elevation myocardial infarction of the proximal left anterior descending (LADp-STEMI).

RESULTS

Some ECG features at presentation can predict an ATOLMA: QRS left axis deviation (-61.17 ± 9 degrees); ST-segment elevation in aVL (1.9 ± 0.65 mm); absence of ST-segment elevation in V1 (0.0 ± 0.6 mm); bifascicular block (58%); fragmented QRS (62.5%); prolongation of QTc interval (465 ± 19 ms) and of QRS interval (136 ± 12 mm). The multivariate analysis found that the independent predictors to distinguish ATOLMA from ASOLMA were aVL ST-segment deviation (OR 5.6(95% CI 1.5-21), p = 0.01) and absence of V1 ST-segment elevation (OR 27(95% CI 1.4-52), p = 0.01); and from LADp-STEMI was QRS width (OR 1.1(95% CI 1.02-1.2), p = 0.02). Fragmented QRS was the only independent predictor of in-hospital mortality in ATOLMA (OR 0.125(95% CI 0.01-0.81), p = 0.03).

CONCLUSIONS

aVL ST-segment elevation, the absence of V1 ST-segment elevation, left axis deviation, the presence of bifascicular block, and prolongation of QRS and QTc interval are predictors of ATOLMA. Fragmented QRS predicts in-hospital mortality in ATOLMA.

P905 Value of global longitudinal strain (GLS) in the short term prognosis of geriatric patients with asymptomatic severe aortic stenosis

Funding Acknowledgements

VII Convocatoria del Banco de Santander and Alfonso X el Sabio University.

Background

Detection of symptoms in geriatric population with aortic stenosis (AS) is challenging, especially when they associate other comorbidities or frailty. Left ventricular global longitudinal strain (GLS) occurs before left ventricular ejection fraction impairment and could be useful for risk stratification and management of these patients.

Purpose

We sought to analyze the usefulness of GLS for predicting major cardiovascular adverse events (MACEs) in geriatric patients with asymptomatic severe AS.

Material and Methods:

Prospective study on 54 patients older than 70 years old with severe asymptomatic AS. Patient evaluation included biochemistry tests, electrocardiogram and echocardiography. We use a GLS cut-off point of 18% to dichotomize patients. Outcomes were defined as the composite of MACEs – occurrence of death from any cause, hospitalization for heart failure, appearance of symptoms or change in treatment.

Results

The mean age was 83.2 ± 7.1, with 60.4% of women. 24.5% showed atrial fibrillation. At 6 months of follow-up, 33% of patients reached the endpoint: 5.6% CHF, 11.1% death, 3.7% symptoms without changes in management and 13% were referred to an invasive treatment. The event-free survival rate at 6 months for the global population was 83%. 41.5 % of the subjects had GLS < 18%. Kaplan Meier analysis showed that the probability of freedom from MACEs was not significant in patients with lower GLS (Log Rank p = 0.39). In the multivariate analysis only AVA was an inverse predictor of events (AVA) HR 0.05 (95% CI 0.007- 0.471, p < 0.05).

Conclusions

The value of GLS was not a predictor of short term events in geriatric patients. Only assessment of AVA was an independent marker of MACES and in this kind of subjects.

Charasteristics of the global population Global N = 53 (%) GLS ≥ 18 N = 31 (58.5%) GLS < 18 N = 22 (41.5%) (p) HBP 42 (79.2) 27 (87.1) 19 (82.6) 0.09 Atrial fibrillation 13 (24.5) 6 (19.4) 7 (31.8) 0.29 CVD 6 (11.3) 1 (3.2) 5 (22.7) 0.02 LVEF: Normal >50% 48 (92) 31 (100) 17 (77.2) 0.05 Peak velocity 3.72 ± 0.72 3.81 ± 0.71 3.60 ± 0.74 0.315 Mean gradient 34.01 ± 14.06 35.61 ± 13.54 32.09 ± 15.07 0.29 Integral ratio 0.25 ± 0.08 0.26 ± 0.09 0.25 ± 0.08 0.83 AVA 0.8 ± 0.26 0.78 ± 0.27 0.83 ± 0.26 0.651 Indexed AVA 0.48 ± 0.16 0.48 ± 0.17 0.48 ± 0.16 0.9 AVA Aortic valve area; CVD: cerebro vascular disease; HBP: High blood presure; LVEF: left ventricule ejection fraction.

Abstract P905 Figure. Kapplan-Meier event-free survival curves

P225 Carcinoid heart disease: report of a case in a patients with trombocytopenia absent radius

Background

The carcinoid syndrome is characterized by extensive and several clinical manifestations. The diarrhea, the cutaneous flushing are the most frequents symptoms while cardiac manifestations (carcinoid heart disease) (CHD) occurs in a mean of 40%. Nowadays, the number of cases of CHD is lower than 20%, as a consequence of the widespread use of somatostatin analogues. At present, there is a mean delay in diagnosis of CHD of 1.5 years from the time of carcinoid syndrome detection. Hence, CHD is associated with a poor prognosis for clinical management.

Case report

We present a case of 45-years-old active woman, with Thrombocytopenia absent radius (TAR). This is characterized by a bilateral absence of the radio with the presence of both thumbs and thrombocytopenia. Our patient was attended for dyspnea of medium efforts, history of diarrhea, cutaneous flushing with tachycardia and elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) (89,6 mg/24 (2,0-9,0)). The Transthoracic echocardiography showed morphologic changes that affected the tricuspid valve: diminished curvature of the leaflets, altered dynamic motion of the leaflets during diastole, fused and shortened chordae retraction and reduced excursion of the valve. A moderate to severe tricuspid regurgitation and tricuspid stenosis with gradient media de 5 mmHg was observed. In addition, the right ventricle was dilated, a severe pulmonary hypertension, a right pleural effusion and a minor pericardial effusion circumference were detected. All these findings were consistent with CHD.

Conclusions

This report describes an unusual case of CHD in TAR patient. In fact, the interest of this case is the role played by the echocardiogram in the differential diagnosis for tricuspid valve diseases. Tricuspid stenosis is an infrequent condition and it is usually related with rheumatic disease associated with mitral valve disease. Although the carcinoid syndrome is infrequent, any changes in the anatomical structure of the tricuspid valve (thickening, fibrosis and rigidity associated with stenosis and tricuspid regurgitation) should alert us to the suspicion of CHD

Abstract P225 Figure.

P1439 Familial dilated cardiomyopathy: assessment of left ventricular systolic and diastolic function by echocardiogram in asymptomatic patients

Funding Acknowledgements

Alfonso X El Sabio University

Introduction

Familial dilated cardiomyopathy (fDCM) represents 20% to 30% of idiopathic DCM (iDCM) ethiology. The assessment of cardiac function of these patients is awfully complex. Usually, myocardial fiber damages can not be detected in the early DCM stages. In this sense echocardiogram could be useful to detect incipient changes.

Purpose

The aim of this study was to characterize the systolic function of asymptomatic fDCM, compared within iDCM and control patients.

Material and methods

This study was carried out in 33 fDCM patients. A total of 4 fDCM families with LMNA gene mutation and 3 fDCM families with BLC2-associated athanogene 3 (BAG3) mutation were recruited. Moreover, a total of 30 iDCM and 66 healthy matched controls were enrolled in the study.

Results

58.14% were male. The average age was 45.3 ± 17 years. 72% showed sinus rhythm. Left bundle branch block (LBBB) was observed in 7.8% of patients. The LV ejection fraction (LVEF), sphericity index and mitral annular plane systolic excursion (MAPSE), were significantly improved in the fDCM patients compared to iDCM subjects. However, these parameters were aggravated compared with healthy controls. LVEF was enhanced in fDCM in contrast to iDCM (56% versus 35%; P < 0.001). Nevertheless, LVEF value was deteriorated in fDCM compared to healthy controls (56% versus 65%; P < 0.001). The values of septal and lateral annulus early diastolic velocity measured by DTI, were also diminished. All results are presented in Table 1.

Conclusions

Asymptomatic fDCM shown an intermediate value of LVEF between the iDCM and the control group. This ventricular remodeling process could be the consequence of a slight increase in the end-systolic diameter.

Patients Characteristics Patients Characteristics iDCM 30 patients fDCM 33 patients Control Group 66 Healthy P LVEF 32 (29.78-40) 56.0 (39.7-64.2) 65 (62-69.5) 0.001 EDD 62.5 (59.2-65.7) 53.7 (45.7-57.6) 45.50 (43-48.8) 0.001 ESD 53 (47-58.75) 36 (30.9-54.2) 27.9 (24-31) 0.001 MAPSE 11 (10-12.50) 14 (14-18) 19 (17-20) 0.001 Sphericity index 0.70 (0.66–0.79) 0.69 (0.66-0.79) 0.53 (0.48-58) 0.001 LA volume 61.5 (57-75.1) 32 (23-46.5) 17 (14.2-20) NS Septal annulus Early diastolic Velocity (cm/s) DTI 3.5 (3-4.2) 7.5 (1.6-8.8) 9 (7.9-11) 0.001 Lateral annulus Early diastolic Velocity (cm/s) DT 7.2 (5-8.9) 9.5 (1.8-11.8) 13 (10.37-15) 0.001 Table1. Echocardiografic findings in patients. LVEF: left ventricular ejection fraction; EDD: end-diastolic diameter; ESD: end systolic diameter; MAPSE:mitral annular plane systoluc excursion; LA: left atrium; TDI: Tissue Doppler imagin.

Abstract P1439 Figure. Familial dilated cardiomyopathy

Care in patients with epidermal necrolysis in burn units. A nursing perspective

OBJECTIVE

To describe how nursing care is delivered to patients with epidermal necrolysis in burn units/specialized units in Spain and a selection of countries.

METHOD

Descriptive cross-sectional study. Data were collected through a structured questionnaire which was sent to nurse managers in all burn units in Spain and a selection of countries. Descriptive statistics was used to summarize the results.

RESULTS

All BU/SUs in Spain (n=12) and seven BU/SUs from a selection of countries completed the questionnaire. A lack of specific nursing protocols on Epidermal Necrolysis was observed in most burn units in Spain. Skin cleansing techniques such as showering were only reported by participants from Spain. Use of antiseptics was less frequent in other countries. Conservative skin management was the most extended practice reported by all participants. The use of vaginal molds to prevent synechiae and coverage of the ocular surface with amniotic membrane to minimize sequelae were rarely reported. Pain assessment was not always documented in sedated patients and few participants reported the use of specific scales for this purpose. All nurses agreed in the need for consensus nursing care guidelines on the disease.

CONCLUSIONS

Nursing care in patients with epidermal necrolysis varied between burn units in Spain. Differences and similarities were observed when compared with burn units in other countries. Genital and ocular care were outdated in all BU/SUs. Pain assessment documentation was suboptimal. Evidence-based nursing care guidelines were generally demanded by all participants to help reduce mortality and morbidity of this rare and often devastating disease.

Circulating long-non coding RNAs as biomarkers of left ventricular diastolic function and remodelling in patients with well-controlled type 2 diabetes

Contractile dysfunction is underdiagnosed in early stages of diabetic cardiomyopathy. We evaluated the potential of circulating long non-coding RNAs (lncRNAs) as biomarkers of subclinical cardiac abnormalities in type 2 diabetes. Forty-eight men with well-controlled type 2 diabetes and 12 healthy age-matched volunteers were enrolled in the study. Left ventricular (LV) parameters were measured by magnetic resonance imaging. A panel of lncRNAs was quantified in serum by RT-qPCR. No differences in expression levels of lncRNAs were observed between type 2 diabetes patients and healthy volunteers. In patients with type 2 diabetes, long intergenic non-coding RNA predicting cardiac remodeling (LIPCAR) was inversely associated with diastolic function, measured as E/A peak flow (P < 0.050 for all linear models). LIPCAR was positively associated with grade I diastolic dysfunction (P < 0.050 for all logistic models). Myocardial infarction-associated transcript (MIAT) and smooth muscle and endothelial cell-enriched migration/differentiation-associated long noncoding RNA (SENCR) were directly associated with LV mass to LV end-diastolic volume ratio, a marker of cardiac remodelling (P < 0.050 for all linear models). These findings were validated in a sample of 30 patients with well-controlled type 2 diabetes. LncRNAs are independent predictors of diastolic function and remodelling in patients with type 2 diabetes.

Genomic architecture of human neuroanatomical diversity

Human brain anatomy is strikingly diverse and highly inheritable: genetic factors may explain up to 80% of its variability. Prior studies have tried to detect genetic variants with a large effect on neuroanatomical diversity, but those currently identified account for <5% of the variance. Here, based on our analyses of neuroimaging and whole-genome genotyping data from 1765 subjects, we show that up to 54% of this heritability is captured by large numbers of single-nucleotide polymorphisms of small-effect spread throughout the genome, especially within genes and close regulatory regions. The genetic bases of neuroanatomical diversity appear to be relatively independent of those of body size (height), but shared with those of verbal intelligence scores. The study of this genomic architecture should help us better understand brain evolution and disease.

[Father involvement in childbirth]

INTRODUCTION

Recent initiatives have promoted the participation of fathers in the early care of their children.

OBJECTIVE

To assess the results of a program to encourage parental involvement in childbirth. Parents of healthy term newborns were randomly allocated to participate either in the birth experience or control.

PATIENTS AND METHODS

The protocol included: to dry the skin, umbilical cord cutting off, weight, height, and finally give him/her to the mother for the skin-to-skin contact. Heart rate (HR), respiratory (RR) and temperature were evaluated one hour later. In the first outpatient clinic assessment, mothers completed a questionnaire. 127 fathers participated either in the birth experience or control.

RESULTS

62 followed the protocol and 65 the control. Both newborn groups were comparable. Also were fathers in age, education and rurality; mothers in primiparity. Significant differences: night care (37/62, 10/65 59.6% vs 15.4%, p<0.01); post prandial assistance (50/62, 14/65 80.6% vs 21.5%, p<0.01); participation in bathing (38/62, 61.3% vs 15/65, 23.1%, p<0.01); newborn visit upon arrival at home (46/62, 74.2% vs 22/65, 33.8%, p<0.01); helping in crying episodes (42/62, 67.7% vs 17/65, 26.1%, p<0.01). There was stability in HR, RR and temperature one hour postpartum. Only one case of complication among parents (fainting).

CONCLUSIONS

There were more cases of early care behaviors among participating fathers at birth, even belonging to a discouraging socio cultural environment.

Single nucleotide polymorphism in the neuroplastin locus associates with cortical thickness and intellectual ability in adolescents

Despite the recognition that cortical thickness is heritable and correlates with intellectual ability in children and adolescents, the genes contributing to individual differences in these traits remain unknown. We conducted a large-scale association study in 1583 adolescents to identify genes affecting cortical thickness. Single-nucleotide polymorphisms (SNPs; n=54,837) within genes whose expression changed between stages of growth and differentiation of a human neural stem cell line were selected for association analyses with average cortical thickness. We identified a variant, rs7171755, associating with thinner cortex in the left hemisphere (P=1.12 × 10(-)(7)), particularly in the frontal and temporal lobes. Localized effects of this SNP on cortical thickness differently affected verbal and nonverbal intellectual abilities. The rs7171755 polymorphism acted in cis to affect expression in the human brain of the synaptic cell adhesion glycoprotein-encoding gene NPTN. We also found that cortical thickness and NPTN expression were on average higher in the right hemisphere, suggesting that asymmetric NPTN expression may render the left hemisphere more sensitive to the effects of NPTN mutations, accounting for the lateralized effect of rs7171755 found in our study. Altogether, our findings support a potential role for regional synaptic dysfunctions in forms of intellectual deficits.

Salivary testosterone and immunoglobulin A were increased by resistance training in adults with Down syndrome

This study was designed to assess the influence of resistance training on salivary immunoglobulin A (IgA) levels and hormone profile in sedentary adults with Down syndrome (DS). A total of 40 male adults with DS were recruited for the trial through different community support groups for people with intellectual disabilities. All participants had medical approval for participation in physical activity. Twenty-four adults were randomly assigned to perform resistance training in a circuit with six stations, 3 days per week for 12 weeks. Training intensity was based on functioning in the eight-repetition maximum (8RM) test for each exercise. The control group included 16 age-, gender-, and BMI-matched adults with DS. Salivary IgA, testosterone, and cortisol levels were measured by ELISA. Work task performance was assessed using the repetitive weighted-box-stacking test. Resistance training significantly increased salivary IgA concentration (P=0.0120; d=0.94) and testosterone levels (P=0.0088; d=1.57) in the exercising group. Furthermore, it also improved work task performance. No changes were seen in the controls who had not exercised. In conclusion, a short-term resistance training protocol improved mucosal immunity response as well as salivary testosterone levels in sedentary adults with DS.

III-V quantum light source and cavity-QED on silicon

Non-classical light sources offer a myriad of possibilities in both fundamental science and commercial applications. Single photons are the most robust carriers of quantum information and can be exploited for linear optics quantum information processing. Scale-up requires miniaturisation of the waveguide circuit and multiple single photon sources. Silicon photonics, driven by the incentive of optical interconnects is a highly promising platform for the passive optical components, but integrated light sources are limited by silicon's indirect band-gap. III–V semiconductor quantum-dots, on the other hand, are proven quantum emitters. Here we demonstrate single-photon emission from quantum-dots coupled to photonic crystal nanocavities fabricated from III–V material grown directly on silicon substrates. The high quality of the III–V material and photonic structures is emphasized by observation of the strong-coupling regime. This work opens-up the advantages of silicon photonics to the integration and scale-up of solid-state quantum optical systems.

Denitration of peroxynitrite-treated proteins by 'protein nitratases' from rat brain and heart

Putative 'protein nitratases,' which catalyze denitration of peroxynitrite (PN)-treated proteins, were detected in the homogenate/crude extract of rat brains and hearts. Nitratase activity was monitored by the decreased intensity of nitrotyrosine immunoreactive-bands in Western blot and increased nitrate level in dialysate of incubation mixture, which contained homogenate/crude extract, protease inhibitors and a PN-treated substrate, such as treated histone (III-S), BSA or invertase. Enhanced activity of nitratases was noted by preincubating crude extract with Ca2+. In addition, at least two types of nitratases may occur: type I, reductant-dependent, and type II, reductant- independent. Furthermore, upon denitration, the activity of PN-treated invertase increased to the same activity level of the untreated invertase. The overall reaction catalyzed by nitratases for denitration of nitrotyrosine residues in protein could be as follows: Protein-Tyr-NO2 + H2O --> Protein-Tyr-H + H+ + NO3-. The nitration/denitration of protein-tyrosine may be crucial in regulating signal transduction.

Inhibition of tau phosphorylating protein kinase cdk5 prevents beta-amyloid-induced neuronal death

The key target of this study was the tau protein kinase II system (TPK II) involving the catalytic subunit cdk5 and the regulatory component p35. TPK II is one of the tau phosphorylating systems in neuronal cells, thus regulating its functions in the cytoskeletal dynamics and the extension of neuronal processes. This research led to demonstration that the treatment of rat hippocampal cells in culture with fibrillary beta-amyloid (Abeta) results in a significant increase of the cdk5 enzymatic activity. Interestingly, the data also showed that the neurotoxic effect of 1-20 microM Abeta on primary cultures markedly diminished with co-incubation of hippocampal cells with the amyloid fibers plus the cdk5 inhibitor butyrolactone I. This inhibitor protected brain cells against Abeta-induced cell death in a concentration dependent fashion. Moreover, death was also prevented by a cdk5 antisense probe, but not by an oligonucleotide with a random sequence. The cdk5 antisense also reduced neuronal expression of cdk5 compared with the random oligonucleotide. The studies indicate that cdk5 plays a major role in the molecular path leading to the neurodegenerative process triggered by the amyloid fibers in primary cultures of rat hippocampal neurons. These findings are of interest in the context of the pathogenesis of Alzheimer's disease.