Revealing Individual Neuroanatomical Heterogeneity in Alzheimer Disease Using Neuroanatomical Normative Modeling

BACKGROUND AND OBJECTIVES: Alzheimer's Disease (AD) is highly heterogeneous, with marked individual differences in clinical presentation and neurobiology. To explore this, we employed neuroanatomical normative modelling to index regional patterns of variability in cortical thickness. We aimed to characterise individual differences and outliers in cortical thickness in patients with AD, people with mild cognitive impairment (MCI) and controls. Furthermore, we assessed the relationships between cortical thickness heterogeneity and cognitive function, amyloid-beta, phosphor-tau, ApoE genotype. Finally, we examined whether cortical thickness heterogeneity was predictive of conversion from MCI to AD. METHODS: Cortical thickness measurements across 148 brain regions were obtained from T1-weighted MRI scans from 62 sites of the Alzheimer's Disease Neuroimaging Initiative. AD was determined by clinical and neuropsychological examination with no comorbidities present. MCI participants had reported memory complaints, and controls were cognitively normal. A neuroanatomical normative model indexed cortical thickness distributions using a separate healthy reference dataset (n= 33,072), employing hierarchical Bayesian regression to predict cortical thickness per region using age and sex, whilst adjusting for site noise. Z-scores per region were calculated, resulting in a z-score 'brain map' per participant. Regions with z-scores <-1.96 were classified as outliers. RESULTS: Patients with AD (n=206) had a median of 12 outlier regions (out of a possible 148), with the highest proportion of outliers (47%) in the parahippocampal gyrus. For 62 regions, over 90% of these patients had cortical thicknesses within the normal range. Patients with AD had more outlier regions than people with MCI (n=662) or controls (n=159) [F(2, 1022) = 95.39), P = 2.0×10-16]. They were also more dissimilar to each other than people with MCI or controls [F(2, 1024) = 209.42, P = 2.2×10-16]. A greater number of outlier regions was associated with worse cognitive function, CSF protein concentrations and an increased risk of converting from MCI to AD within three years (HR = 1.028, 95% CI[1.016,1.039], P =1.8×10-16). DISCUSSION: Individualised normative maps of cortical thickness highlight the heterogeneous impact of AD on the brain. Regional outlier estimates have the potential to be a marker of disease and could be used to track an individual's disease progression or treatment response in clinical trials

An Investigation Into Physical Frailty as a Link Between the Gut Microbiome and Cognitive Health

The preservation of cognitive abilities with aging is a priority both for individuals and nations given the aging populations of many countries. Recently the gut microbiome has been identified as a new territory to explore in relation to cognition. Experiments using rodents have identified a link between the gut microbiome and cognitive function, particularly that low microbial diversity leads to poor cognition function. Similar studies in humans could identify novel targets to encourage healthy cognition in an aging population. Here, we investigate the association of gut microbiota and cognitive function in a human cohort considering the influence of physical frailty. We analyzed 16S rRNA gene sequence data, derived from fecal samples obtained from 1,551 individuals over the age of 40. Cognitive data was collected using four cognitive tests: verbal fluency (n = 1,368), Deary-Liewald Reaction Time Test (DLRT; n = 873), Mini Mental State Examination (recall; n = 1,374) and Paired Associates Learning from the Cambridge Neuropsychological Test Automated Battery (CANTAB-PAL; n = 405). We use mixed effects models to identify associations with alpha diversity, operational taxonomic units (OTUs) and taxa and performed further analyses adjusting for physical frailty. We then repeated the analyses in a subset of individuals with dietary data, also excluding those using medications shown to influence gut microbiome composition. DLRT and verbal fluency were negatively associated with alpha diversity of the gut microbiota (False-Discovery Rate, FDR, p &lt; 0.05). However, when considering frailty as a covariate, only associations between the DLRT and diversity measures remained. Repeating analyses excluding Proton pump inhibitor (PPI) and antibiotic users and accounting for diet, we similarly observe significant negative associations between the DLRT and alpha diversity measures and a further negative association between DLRT and the abundance of the order Burkholderiales that remains significant after adjusting for host frailty. This highlights the importance of considering concurrent differences in physical health in studies of cognitive performance and suggests that physical health has a relatively larger association with the gut microbiome. However, the frailty independent cognitive-gut microbiota associations that were observed might represent important targets for further research, with potential for use in diagnostic surveillance in cognitive aging and interventions to improve vitality

Generalised Anxiety Disorder – A Twin Study of Genetic Architecture, Genome-Wide Association and Differential Gene Expression

Generalised Anxiety Disorder (GAD) is a common anxiety-related diagnosis, affecting approximately 5% of the adult population. One characteristic of GAD is a high degree of anxiety sensitivity (AS), a personality trait which describes the fear of arousal-related sensations. Here we present a genome-wide association study of AS using a cohort of 730 MZ and DZ female twins. The GWAS showed a significant association for a variant within the RBFOX1 gene. A heritability analysis of the same cohort also confirmed a significant genetic component with h2 of 0.42. Additionally, a subset of the cohort (25 MZ twins discordant for AS) was studied for evidence of differential expression using RNA-seq data. Significant differential expression of two exons with the ITM2B gene within the discordant MZ subset was observed, a finding that was replicated in an independent cohort. While previous research has shown that anxiety has a high comorbidity with a variety of psychiatric and neurodegenerative disorders, our analysis suggests a novel etiology specific to AS

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mapping Individual Differences in the Neuroanatomy of Dementia

Dementia is a highly heterogeneous disorder, with marked individual differences in clinical presentation and neurobiology. Neuroanatomical normative modelling is an emerging statistical technique which captures individual-level variability across the brain by comparing individuals to a predetermined ‘normative’ distribution of a neuroimaging measure. This thesis presents the first application of neuroanatomical normative modelling to dementia. A previously curated large independent dataset (~33-58k) was used to measure the normative distribution of brain volume and cortical thicknesses within ~150 brain regions. Dementia patients were then compared to these regional models to ascertain how they differ, quantified using Z-scores. In this thesis, novel brain-wide maps of Z-scores are generated for dementia clinical groups and for individual patients. These Z-scores are also explored in relation to disease phenotypes and presenting symptoms in dementia – specifically, observations are made within patients with sporadic Alzheimer's Disease (AD), familial AD and people with mild cognitive impairment. The influence of AD disease progression on neuroanatomical heterogeneity was also explored using longitudinal data, and survival analyses were conducted that predicted progression from MCI to AD using Z-scores. Moreover, comparisons are made between different diseases and their presenting phenotypes. Furthermore, the relationship between amyloid and tau markers, genetic mutations and neuroanatomical heterogeneity are assessed. Together these studies present neuroanatomical normative modelling as a quantitative tool for measuring neuroanatomical variability in dementia, and highlight the differences in atrophy patterns between individual patients

Grain yield and agronomic traits in soybean according to crop rotation systems

The effects of crop rotation systems (CRS) on soybean yield and agronomic characteristics were evaluated from 1996/1997 to 2010/2011 at Embrapa Trigo, Passo Fundo (RS), Brazil. Four soil management systems (SMS) were compared, namely: 1) no tillage, 2) minimum tillage, 3) conventional tillage using a disk plow and a disk harrow, and 4) conventional using a moldboard and a disk harrow - and three CRS: system I (wheat/soybean), system II (wheat/soybean and common vetch/corn or sorghum) and system III (wheat/soybean, white oats/soybean and common vetch/corn or sorghum). This is a split-plot, randomized, complete block design with three replications. SMS were assigned in the main plot and CRS systems in the split-plots. This work addressed only data on crop rotation systems. There were no significant differences between the CRS for number of grains per plant, 1,000 grain weight and first pod height in soybean. The crop rotation for a summer, with corn or sorghum, propitiates a higher soybean yield compared with the other systems and monoculture soybean. The combination of conservation systems (no tillage and minimum tillage) and CR resulted in a higher soybean yield. The lowest grain yield and grain weight per plant were obtained in monoculture soybean

Gut microbiota associations with common diseases and prescription medications in a population-based cohort

The human gut microbiome has been associated with many health factors but variability between studies limits exploration of effects between them. Gut microbiota profiles are available for >2700 members of the deeply phenotyped TwinsUK cohort, providing a uniform platform for such comparisons. Here, we present gut microbiota association analyses for 38 common diseases and 51 medications within the cohort. We describe several novel associations, highlight associations common across multiple diseases, and determine which diseases and medications have the greatest association with the gut microbiota. These results provide a reference for future studies of the gut microbiome and its role in human health