Citations

Background: Interstitial lung disease (ILD) encompasses several pulmonary disorders associated with scarring and fibrosis of pulmonary tissue. People with idiopathic pulmonary fibrosis, a subset of ILD, have greater central airway luminal area compared to age- and sex-matched healthy controls when evaluated using microcomputed tomography, a process examining the luminal area of ex-vivo lung tissue. In this study we aimed to confirm these findings using a different method of airway assessment, three-dimensional (3D) reconstruction of computed tomography (CT) scans. Moreover, in health, males have larger central airways than height-matched females, but it remains unknown if there are sex differences in airway area among people with ILD. We hypothesized that sex differences observed in healthy people would persist among people with ILD. Methods: A cohort of 399 patients with lung CT scans were screened, of which 19 people (7 females) with ILD were included in analyses after exclusions. People with ILD were matched based on sex, age, and height to 19 healthy controls. We assessed cross-sectional luminal area at the midpoint of seven conducting airways (trachea, left and right main bronchus, intermediate bronchus, left and right upper lobe, and left lower lobe). Results from pulmonary function tests were also abstracted, as available. To examine sex differences, we compared airway luminal area, normalized to participant height, between males and females with ILD. Sex differences were analyzed using a univariate ANOVA test. Results: People with ILD had a preserved ratio of forced expiratory volume in the first second to forced vital capacity (101 ±12%predicted) and decreased diffusing capacity for carbon monoxide (55 ±23%predicted). People with ILD had airways that were between 19.6%-45.0% larger than controls (p<0.05). Composite physiologic index, a marker of ILD severity, was not different between sexes (p=0.07). Males with ILD had significantly larger, luminal areas than females in two central airways - right main bronchus (1.46±0.41 vs. 1.07±0.22 mm2/cm, p=0.04) and left upper lobe (0.54±0.10 vs. 0.43±0.08 mm2/cm, p=0.02). However, luminal area of other central airways, including: trachea (2.15±0.57 vs. 1.65±0.32 mm2/cm, p=0.051), bronchus intermediate (0.77±0.23 vs. 0.61±0.13 mm2/cm, p=0.12), right upper lobe (0.47±0.15 vs. 0.40±0.06 mm2/cm, p=0.26), left main bronchus (0.93±0.33 vs. 0.69±0.16 mm2/cm, p=0.09), and left lower lobe (0.41±0.13 vs. 0.40±0.08 mm2 /cm, p=0.79) were not different between sexes in people with ILD. Conclusion: Sex differences observed in healthy people are potentially preserved in ILD, but a more robust sample is required to fully elucidate these findings. Illuminating any sex differences in ILD pathophysiology may provide knowledge to treat and improve clinical outcomes in ILD. Funding: National Heart, Lung, and Blood Institute (F32HL154320 to JWS; 5R35HL139854 to MJJ). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Purpose: The present work was performed to provide an updated and comprehensive systematic review and meta-analysis on the potential ergogenic effects associated with ischemic preconditioning (IPC). In this context, this systematic review and meta-analysis aimed to determine the magnitude of the potential ergogenic effect of IPC and the influence of descriptive factors that contribute to the variability of its potential ergogenic effect. We hypothesized that IPC would be associated with improved exercise performance, and putative factors would modulate this association. Methods: On October 17, 2022, a systematic search of three databases (PubMed, Scopus, and Web of Science) was performed. The electronic search yielded 2,876 unique records, of which 79 were included in analyses after abstract and full-text screening. Eligible study designs included within subjects cross-over, sham controlled study, with a randomized or counter balanced study design. Prespecified analyses aimed to determine whether the ergogenic effect of IPC is influenced by: 1) exercise parameters (type of exercise, fraction of inspired oxygen, and muscle group(s) involved in exercise) and 2) IPC parameters (dosage, duration, and timing before onset of exercise). Results: The meta-analysis model demonstrated that exercise performance was improved with IPC compared to the sham control (pooled standard paired difference (SPD), 0.156; 95% confidence interval (CI), 0.084 to 0.227; Z = 4.258; P < 0.001; n = 105). Both remote IPC (pooled SPD, 0.219; 95% CI, 0.071 to 0.368; Z = 2.894; P = 0.004) and local IPC (pooled SPD, 0.159; 95% CI, 0.088 to 0.231; Z = 4.386; P < 0.001) demonstrated ergogenic effects on performance. Subgroup analyses based on the fraction of inspired oxygen level revealed improved exercise performance in normoxic (pooled SPD, 0.169; 95% CI, 0.100 to 0.237; Z = 4.805; P < 0.001) but not hypoxic (pooled SPD, 0.160; 95% CI, -0.029 to 0.349; Z = 1.659; P = 0.097) conditions. The most notable improvement in exercise performance following IPC was demonstrated during cycling (pooled SPD, 0.116; 95% CI, 0.023 to 0.209; Z = 2.454; P = 0.014), running (pooled SPD, 0.180; 95% CI, 0.056 to 0.303; Z = 2.847; P = 0.004), and leg press (pooled SPD, 0.421; 95% CI, 0.034 to 0.808; Z = 2.131; P = 0.033) performance tests. Conclusion: Overall, IPC demonstrated a clear ergogenic effect on exercise performance across various exercise modalities under normoxic environmental conditions. The enhanced exercise performance following IPC was most pronounced in aerobic tests of performance which predominantly recruited large muscle groups in the lower extremities: cycling, running, and leg press. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract Introduction Sleep markers can assess prodromal risk for neurodegenerative disorders (NDD). In a recent study conducted by the Mayo Clinic, most isolated REM sleep behavior disorder patients preferred knowing about their risk for parkinsonism or dementia. In their email survey, patients indicated a strong preference for disclosure of prognostic NDD risk in order to spur family discussions and plan for the future. For this pilot study, the Mayo questions were modified in order to investigate the perspectives and preferences of community-based adults about potentially being at-risk of a NDD and how it might impact their lives. Methods A brief survey was administered to Rotary Club attendees prior to a presentation on sleep and neurodegenerative disease. Each question offered five responses: strongly disagree, disagree, neutral, agree, or strongly agree. Personal identifiers were not obtained. Thirty-four surveys were completed from approximately equal numbers of older men and women with estimated ages above 50 years. Personal information were not obtained (e.g., age and sex). Results When asked whether it was important to know their NDD risk given the fact that there are no known methods to prevent or cure the disease, most (83%) strongly agreed or agreed, while only 18% preferred not to know their NDD risk. The majority felt they would be more pessimistic about their future if identified as being at risk of NDD the (62% strongly agreed/agreed). Most believed their priorities and plans for living life would change (68% strongly agreed/agreed). Further, the vast majority felt that knowing NDD risk would help them plan for the future (89% strongly agreed/agreed), including planning for health resources and support (88% strongly agreed/agreed). Conclusion Eighty-three percent of those surveyed reported they would benefit from knowing if they were at risk of NDD, even though the majority would feel more pessimistic about their future. The vast majority (89%) responded that knowing their NDD risk would help them plan for the future. These results suggest that most community adults might be receptive to future sleep screening for NDD with results. Investigations are underway to confirm these findings in a broader community-based study. Support (if any) NIA-R44AG050326

Abstract Introduction Most older adults with isolated REM sleep behavior disorder (iRBD) are men, yet in younger adults there is greater parity between the sexes. Whether the clinical characteristics between women and men with iRBD may differ remains unclear. We aimed to analyze presenting clinical and demographic characteristics of iRBD in men and women. Methods We identified 130 women and 130 men with PSG confirmed iRBD who were matched for time of polysomnographic diagnosis, abstracted their clinical histories, and comparatively analyzed clinical characteristics between the sexes. Results RBD symptom onset average age (50.4 ± 20.0 vs. 55.4 ±16.9 years, p=0.03) and age at diagnosis (56.4 ±16.7 vs. 62.5 ± 13.3 years, p&lt; 0.01) were younger in women than in men. Injury frequency was similar between groups. Antidepressant use prior to diagnosis (80.8% vs 53.0%, p&lt; 0.01), psychiatric comorbidity (79.8% vs. 50.8%, p&lt; 0.01) and chronic pain syndrome (39.2% vs. 17.4%, p&lt; 0.01) diagnoses were more frequent in women than men. Insomnia (31.5% vs. 18.2%, p= 0.01), hypersomnoence (50.8% vs 37.9%, p=0.04) and overlap parasomnia disorder (13.8% vs 9.8%, p=0.06) were more frequent in women than men, while sleep apnea (43.1% vs. 70.5%, p &lt; 0.01.) and vascular co-morbidity (62.3% vs 83.3%, p&lt; 0.01) occurred more frequently in men than women. Autoimmunity was similar between sexes. Conclusion Women were younger when diagnosed, and had more frequent psychiatric diagnoses and antidepressant use, with different comorbid sleep disturbances and comorbidities than men with iRBD. Key sex differences in iRBD could imply different etiologies and aid accurate and timely diagnosis. Support (if any)

Abstract Introduction In a recent study, most patients diagnosed with isolated REM sleep behavior disorder (iRBD) preferred their physician discussed their risk for developing a future neurodegenerative disorder (NDD) such as parkinsonism or dementia (PD). In the Mayo Clinic email survey, 75% would lose trust in their physician if PD-risk was not discussed following an iRBD diagnosis. For this survey, questions were designed to investigate preferences for how sleep physicians might communicate to community-based adults about risk of a NDD. Methods A survey was administered to Rotary Club attendees prior to a sleep and neurodegenerative disease presentation, with options for responses being either strongly disagree, disagree, neutral, agree, or strongly agree. Thirty-four surveys were obtained from approximately equal numbers of men and women with estimated ages above 50 years. Personal information were not obtained (i.e., sex and age). Results The vast majority of respondents wanted their physician to ask their preference prior to sharing NDD risk (86% strongly agreed or agreed), while virtually all would lose trust in their physician if he/she did not discuss their NDD risk (97% strongly agreed/agreed). If identified with NDD risk, responders would seek out information about medications and adaptive therapies that could delay onset (97% strongly agreed/agreed), while only about half currently had a good understanding of lifestyle patterns that might help delay onset (47% strongly agreed/agreed and 47% disagreed/strongly disagreed). Not knowing when memory problems might begin would cause most responders to feel anxious (85% strongly agreed/agreed). Conclusion Those surveyed wanted their physician to ask their preference prior to sharing NDD risk, but virtually all would lose trust in their health care provider if the information was known but not shared. There appears to be a role for physicians in educating those who may be at NDD risk about interventions that could delay onset of NDD, given approximately half have a limited understanding of lifestyle patterns that could help delay onset. Further, routine follow-up for changes in prodromal NDD biomarker severity might help to reduce anxiety in the 85% of those concerned about when memory problems might begin. Support (if any) NIA-R44AG050326

Abstract Introduction Nightshifts represent a substantial proportion of time dedicated to working in the inpatient setting, particularly among ICU staff. Our institution implemented a 24/7 in-person ICU attending model more than a decade ago. With practice growth and more than 200 ICU beds across disciplines, there are now at least 8 ICU attendings in-hospital all night. Yet, little is known about attending staff perceptions and desires about night work, so we began an exploratory analysis. Methods An online survey of 13 multiple-choice, slider scale, and open-ended questions were sent via email to critical care staff physicians of different disciplines within our institution. Results 69 out of 150 physicians completed the survey (46% response rate). Half were between 35 and 45 years old; 29% were age 45 to 55 years old. About half self-identified as a morningness chronotype. Most (84%) work 3- or 4-night shifts consecutively. Most viewed night shift work as having a negative influence on their quality of life (48% “somewhat negative” and 22% “very negative”) and on their health (51% “somewhat negative” and 24% “very negative”). Most would choose to work less nightshifts (37%) or none (29%). During nightshift assignments, about half (53%) self-report an average of 5 hours of sleep per 24-hour period; 18% self-report ≤ 4hours. Only 6% reported 7 or 8 hours of sleep. Mitigating strategies utilized during series of night shifts include use of caffeine (78%), naps (66%) and use of sleeping aids (21%). Outside of the nightshift series, more than half (56%) reported no sleep difficulties while 21% reported onset or maintenance insomnia. Conclusion At our large tertiary hospital employing an in-house nightshift model across multiple ICUs, most staff ICU physicians have a negative perception of night shift work on their quality of life and health. The majority of respondents would choose to work less or no night shifts. How self-reports of limited sleep (average 5 hours) per 24-hour period compare to objectively measured sleep duration in this population remains to be determined in the next phase of this study. Support (if any)

AbstractOBJECTIVEInvestigation of learning slopes in early‐onset dementias has been limited. The current study aimed to highlight the sensitivity of learning slopes to discriminate disease severity in cognitively normal participants and those diagnosed with early‐onset dementia with and without β‐amyloid positivityMETHODData from 310 participants in the Longitudinal Early‐Onset Alzheimer's Disease Study (aged 41 to 65) were used to calculate learning slope metrics. Learning slopes among diagnostic groups were compared, and the relationships of slopes with standard memory measures were determinedRESULTSWorse learning slopes were associated with more severe disease states, even after controlling for demographics, total learning, and cognitive severity. A particular metric—the learning ratio (LR)—outperformed other learning slope calculations across analysesCONCLUSIONSLearning slopes appear to be sensitive to early‐onset dementias, even when controlling for the effect of total learning and cognitive severity. The LR may be the learning measure of choice for such analyses.Highlights Learning is impaired in amyloid‐positive EOAD, beyond cognitive severity scores alone. Amyloid‐positive EOAD participants perform worse on learning slopes than amyloid‐negative participants. Learning ratio appears to be the learning metric of choice for EOAD participants.

Transient global amnesia (TGA) is a neurological condition characterized by temporary memory loss and classically associated with a reversible unilateral punctate focus of restricted diffusion in the cornu ammonis 1 (CA1) region of the hippocampus. Historically, the lesions were considered to be transient in nature with no long-term imaging abnormality. However, more recent studies have challenged the concept that there are no long-term neurological sequelae. In line with this evidence, we explore the role of ultra-high-resolution imaging using 7 Tesla MRI to evaluate for long-term imaging abnormalities in a 63-year-old woman with a typical clinical course and acute TGA imaging findings. The 7 Tesla MRI revealed a residual lesion on susceptibility-weighted imaging (SWI) with evidence of gliosis and volume loss at the site of the acute lesion in CA1 eight months after the acute episode. This case challenges the traditional mantra of TGA as a fully reversible condition with no long-term imaging findings, suggesting the need for further research using ultra-high-field MRI to determine TGA's potential long-term imaging sequelae and any association with neurocognitive sequelae.

High-grade neuroendocrine neoplasms are a rare disease entity and account for approximately 10% of all neuroendocrine neoplasms. Because of their rarity, there is an overall lack of prospectively collected data available to advise practitioners as to how best to manage these patients. As a result, best practices are largely based on expert opinion. Recently, a distinction was made between well-differentiated high-grade (G3) neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas, and with this, pathologic details, appropriate imaging practices and treatment have become more complex. In an effort to provide practitioners with the best guidance for the management of patients with high-grade neuroendocrine neoplasms of the gastrointestinal tract, pancreas, and gynecologic system, the North American Neuroendocrine Tumor Society convened a panel of experts to develop a set of recommendations and a treatment algorithm that may be used by practitioners for the care of these patients. Here, we provide consensus recommendations from the panel on pathology, imaging practices, management of localized disease, management of metastatic disease and surveillance and draw key distinctions as to the approach that should be utilized in patients with well-differentiated G3 neuroendocrine tumors vs poorly differentiated neuroendocrine carcinomas.