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Background Asthma epidemics associated with thunderstorms have had catastrophic impacts on individuals and emergency services. Seasonal allergic rhinitis (SAR) is present in the vast majority of people who develop thunderstorm asthma (TA), but there is little evidence regarding risk factors for TA among the SAR population. Objective We sought to identify risk factors for a history of TA and hospital presentation in a cohort of individuals with SAR. Methods This multi-centre study recruited adults from Melbourne (Australia) with a past diagnosis of TA and/or self-reported SAR. Clinical information, spirometry, white blood-cell count, ryegrass pollen specific IgE (RGP-spIgE) and fractional exhaled nitric oxide (FeNO) were measured to identify risk factors for a history of TA in individuals with SAR. Results From a total of 228 individuals with SAR, 35% (80/228) reported SAR only (I-SAR), 37% (84/228) reported TA symptoms but had not attended hospital for treatment (O-TA) and 28% (64/228) had presented to hospital for TA (H-TA). All H-TA patients reported a previous asthma diagnosis. Logistic regression analysis of factors associated with O-TA and H-TA indicated that lower forced expiratory volume in one second (FEV1) and asthma control questionnaire (ACQ) score >1.5 were associated with H-TA. Higher blood RGP-spIgE, eosinophil counts, and FeNO were significantly associated with both O-TA and H-TA. Receiver-operating curve (ROC) analysis showed RGP-spIgE >10·1 kU/L and pre-bronchodilator FEV1 ≤90% to be biomarkers of increased H-TA risk. Conclusion Clinical tests can identify risk for a history of TA in individuals with SAR and thereby inform patient-specific treatment recommendations.

Background and ObjectivesNaming decline after left temporal lobe epilepsy (TLE) surgery is common and difficult to predict. Preoperative language fMRI may predict naming decline, but this application is still lacking evidence. We performed a large multicenter cohort study of the effectiveness of fMRI in predicting naming deficits after left TLE surgery.MethodsAt 10 US epilepsy centers, 81 patients with left TLE were prospectively recruited and given the Boston Naming Test (BNT) before and ≈7 months after anterior temporal lobectomy. An fMRI language laterality index (LI) was measured with an auditory semantic decision–tone decision task contrast. Correlations and a multiple regression model were built with a priori chosen predictors.ResultsNaming decline occurred in 56% of patients and correlated with fMRI LI (r= −0.41,p< 0.001), age at epilepsy onset (r =−0.30,p= 0.006), age at surgery (r= −0.23,p= 0.039), and years of education (r= 0.24,p= 0.032). Preoperative BNT score and duration of epilepsy were not correlated with naming decline. The regression model explained 31% of the variance, with fMRI contributing 14%, with a 96% sensitivity and 44% specificity for predicting meaningful naming decline. Cross-validation resulted in an average prediction error of 6 points.DiscussionAn fMRI-based regression model predicted naming outcome after left TLE surgery in a large, prospective multicenter sample, with fMRI as the strongest predictor. These results provide evidence supporting the use of preoperative language fMRI to predict language outcome in patients undergoing left TLE surgery.Classification of EvidenceThis study provides Class I evidence that fMRI language lateralization can help in predicting naming decline after left TLE surgery.

Posterior cortical atrophy (PCA) is one of the atypical Alzheimer's disease variants, characterized by predominant visuospatial and visuoperceptual deficits, with established dorsal and ventral subtypes. A third primary occipital (caudal) variant has been suggested. We aimed to determine its demographics, clinical manifestations, and biomarker findings.Fifty-two PCA patients were investigated. Patients underwent neuropsychological assessment, magnetic resonance imaging, and fluorodeoxyglucose (FDG)-, amyloid-, and tau-positron emission tomography (tau-PET) scans. Normalized regional FDG-PET values were represented as z-scores relative to a control population. Patients were divided into "primary occipital" and "other PCA" subgroups according to FDG-PET-defined criteria, with primary occipital defined as patients in which the z-scores for occipital subregions were at least one standard deviation lower (SD) (i.e., more abnormal) than the z-scores in all other brain regions. Global amyloid-PET, temporo-parietal FDG-PET, and temporal tau-PET regions-of-interest (ROIs) were calculated.Nine patients were classified as primary occipital; they were older (p = 0.034) and had more years of education (p = 0.007) than other PCA patients. The primary occipital group performed worse on the Ishihara test for color perception (p 0.001), while other PCA patients performed worse on the Western Aphasia Battery (WAB) praxis scale (p = 0.005). Overall neuropsychiatric symptom burden was lower in the primary occipital group (p 0.001). The FDG-PET meta-ROI was higher in the primary occipital subtype (p = 0.006), but no differences were observed in amyloid- and tau-PET.Our findings suggest that primary occipital PCA is characterized by an older age at onset, more color perception dysfunction, less severe ideomotor apraxia, and less hypometabolism in temporo-parietal meta-ROI compared to established phenotypes.

Background:Amyloid-β plaques can co-occur with Lewy-related pathology in patients with dementia with Lewy bodies (DLB), but amyloid-β load at prodromal stages of DLB still needs to be elucidated. We investigated amyloid-β load on PET throughout the DLB continuum, from an early prodromal stage of isolated REM sleep behavior disorder (iRBD) to a stage of mild cognitive impairment with Lewy bodies (MCI-LB), and finally DLB.Methods:We performed a cross-sectional study in patients with a diagnosis of iRBD, MCI-LB, or DLB from the Mayo Clinic Alzheimer’s Disease Research Center. Amyloid-β levels were measured by Pittsburgh compound B (PiB) PET and global cortical standard uptake value ratio (SUVr) was calculated. Global cortical PiB SUVr values from each clinical group were compared to each other and to cognitively unimpaired individuals (CU; n=100) balanced on age and sex using ANCOVA. We used multiple linear regression testing for interaction to study the influences of sex andAPOEε4 status on PiB SUVr along the DLB continuum.Results:Of the 162 patients, 16 had iRBD, 64 had MCI-LB, and 82 had DLB. Compared to CU, global cortical PiB SUVr was higher in DLB (p <0.001) and MCI-LB (p=0.012). The DLB group included the highest proportion of amyloid-β positive patients (60%), followed by MCI-LB (41%), iRBD (25%), and finally CU (19%). Global cortical PiB SUVr was higher inAPOEε4 carriers compared toAPOEε4 non-carriers in MCI-LB (pp=0.049). Women had higher PiB SUVr with older age compared to men across the DLB continuum (βeta estimate=0.014,p=0.02).Conclusion:In this cross-sectional study, levels of amyloid-β load was higher further along the DLB continuum. Whereas amyloid-β levels were comparable to cognitively unimpaired individuals in iRBD, a significant elevation in amyloid-β levels was observed in the pre-dementia stage of MCI-LB and in DLB. Specifically,APOEε4 carriers had higher amyloid-β levels thanAPOEε4 non-carriers and women tended to have higher amyloid-β levels than men as they got older. These findings have important implications in targeting patients within the DLB continuum for clinical trials of disease-modifying therapies.

IntroductionThe widespread deposition of amyloid beta (Aβ) plaques in late-stage Alzheimer’s disease (AD) is well defined and confirmed byin vivopositron emission tomography (PET). However, there are discrepancies between which regions contribute to the earliest topographical Aβ deposition within the neocortex.MethodsThis study investigated Aβ signals in the peri-threshold SUVr range using Pittsburgh compound B (PiB) PET in a population-based study cross-sectionally and longitudinally. PiB-PET scans from 1,088 participants were assessed to determine the early patterns of PiB loading in the neocortex.ResultsEarly-stage Aβ loading is seen first in the temporal, cingulate, and occipital regions. Regional early deposition patterns are similar in both Apolipoprotein ε4 (APOE) carriers and non-carriers. Hierarchical clustering analysis shows groups with different patterns of early amyloid deposition.DiscussionThese finding of initial Aβ deposition patterns may be of significance for diagnostics and understanding the development of different AD phenotypes.

Evolutionary perspectives on the deployment of immune factors following infection have been shaped by studies on a limited number of biomedical model systems with a heavy emphasis on vertebrate species. Although their contributions to contemporary immunology cannot be understated, a broader phylogenetic perspective is needed to understand the evolution of immune systems across Metazoa. In our study, we leverage differential gene expression analyses to identify genes implicated in the antiviral immune response of the acorn worm hemichordate, Saccoglossus kowalevskii, and place them in the context of immunity evolution within deuterostomes—the animal clade composed of chordates, hemichordates, and echinoderms. Following acute exposure to the synthetic viral double-stranded RNA analog, poly(I:C), we show that S. kowalevskii responds by regulating the transcription of genes associated with canonical innate immunity signaling pathways (e.g., nuclear factor κB and interferon regulatory factor signaling) and metabolic processes (e.g., lipid metabolism), as well as many genes without clear evidence of orthology with those of model species. Aggregated across all experimental time point contrasts, we identify 423 genes that are differentially expressed in response to poly(I:C). We also identify 147 genes with altered temporal patterns of expression in response to immune challenge. By characterizing the molecular toolkit involved in hemichordate antiviral immunity, our findings provide vital evolutionary context for understanding the origins of immune systems within Deuterostomia.

Supplementary Table 3. Baseline TTR and changes after SBRT predict outcomes in oligometastatic CRPC. Median event-free survival survival (in months) and hazard ratio for each outcome and group is given, stratified by baseline TTR levels (left) or change in TTR levels from baseline to day 14 post-SBRT. ns not significant; N/A not applicable

Supplementary Table 1. PSA progression by number of sites treated. 1Kaplan-Meier method; 2Cox model; 3Logrank test; 4Wald Chi-Square test.

Supplementary Figure 2. Flow cytometry gating strategies. (A) Flow cytometry gating strategies of central memory (TCM), effector memory (TEM), effector (TEF), and naïve (TN) T-cells populations. (B) Flow cytometry gating strategies of tumor reactive (TTR, CD8+CD11ahigh) T cell population analysis.

Supplementary Figure 1. PSA and distant progression by number of radiation-treated sites. (A) PSA progression by number of sites treated. (B) Distant radiographic progression by number of sites treated.

Supplementary Figure 3. Changes in CD8+CD11ahigh populations from baseline to days 1, 7, and 14.

Purpose:Outcomes for resistant metastatic castration-resistant prostate cancer (CRPC) are poor. Stereotactic ablative radiotherapy (SABR) induces antitumor immunity in clinical and preclinical studies, but immunologic biomarkers are lacking.Patients and Methods:Eighty-nine patients with oligometastatic CRPC were identified by 11C-Choline-PET (Choline-PET) from August 2016 to December 2019 and treated with SABR. Prespecified coprimary endpoints were 2-year overall survival (OS) and PSA progression. Secondary endpoints included 2-year SABR-treated local failure and 6-month adverse events. Correlative studies included peripheral blood T-cell subpopulations before and after SABR.Results:128 lesions in 89 patients were included in this analysis. Median OS was 29.3 months, and 1- and 2-year OS were 96% and 80%, respectively. PSA PFS was 40% at 1 year and 21% at 2 years. Local PFS was 84.4% and 75.3% at 1 and 2 years, respectively, and no grade ≥3 AEs were observed. Baseline high levels of tumor-reactive T cells (TTR; CD8+CD11ahigh) predicted superior local, PSA, and distant PFS. Baseline high levels of effector memory T cells (TEM; CCR7−CD45RA−) were associated with improved PSA PFS. An increase in TTR at day 14 from baseline was associated with superior OS.Conclusions:This is the first comprehensive effector T-cell immunophenotype analysis in a phase II trial before and after SABR in CRPC. Results are favorable and support the incorporation of immune-based markers in the design of future randomized trials in patients with oligometastatic CRPC treated with SABR.

Supplementary Table 2. Distant radiographic progression by number of sites treated. 1Kaplan-Meier method; 2Cox model; 3Logrank test; 4Wald Chi-Square test.

Objective:In response to the 2014–2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We sought to determine the ongoing sustainability of ETCs and to identify how ETC capabilities have affected hospital, local, and regional coronavirus disease 2019 (COVID-19) readiness and response.Design:An electronic survey included both qualitative and quantitative questions and was structured into 2 sections: operational sustainability and role in the COVID-19 response.Setting and participants:The survey was distributed to site representatives from the 56 originally designated ETCs, and 37 (66%) responded.Methods:Data were coded and analyzed using descriptive statistics.Results:Of the 37 responding ETCs, 33 (89%) reported that they were still operating, and 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but 1 ETC reported that existing capabilities (eg, trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (eg, ETC trained staff, donated supplies, and shared developed protocols).Conclusions:Existing high-level isolation capabilities and expertise developed following the 2014–2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and to support responses by other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.

OBJECTIVE: Do MRI-based metrics of a CSF-dynamics disorder, disproportionately enlarged subarachnoid-space hydrocephalus (DESH), correlate with discordant amyloid biomarkers (low CSF β-amyloid 1–42, normal Aβ-PET scan)? METHODS: Individuals ≥50 years from the Mayo Clinic Study of Aging, with MRI, (11)C-Pittsburgh compound B (Aβ) PET scans, and CSF phosphorylated-tau protein and Aβ42, were categorized into four groups: normal/ abnormal by CSF β-amyloid 1–42 and Aβ amyloid PET. Within groups, we noted MRI patterns of CSF-dynamics disorders; categorization into low-CSF β-amyloid 1–42/normal Aβ-PET scan versus normal-CSF and PET groups; and Aβ-PET accumulation-change rate. RESULTS: 100 participants (21%) in the abnormal-CSF/normal-PET group had highest DESH-pattern scores and lowest CSF-phosphorylated-tau levels. Among normal amyloid-PET individuals, a one-unit DESH-pattern score increase correlated with 30%-greater odds of abnormal amyloid CSF after age and sex adjustment. Mean rate over time of amyloid-PET accumulation in abnormal-CSF/normal-PET individuals approximated individuals with normal amyloid values. Adjusting for phosphorylated-tau, abnormal CSF-amyloid/normal amyloid-PET individuals had higher mean amyloid-PET accumulation rates than normal individuals. CONCLUSIONS: CSF dynamics disorders confound β-amyloid and phosphorylated-tau CSF-biomarker interpretation.

Background: Age is the most common risk factor for Alzheimer’s disease (AD), a neurodegenerative disorder characterized by the hallmarks of toxic amyloid-β (Aβ) plaques and hyperphosphorylated tau tangles. Moreover, sub-physiological brain insulin levels have emerged as a pathological manifestation of AD. Objective: Identify age-related changes in the plasma disposition and blood-brain barrier (BBB) trafficking of Aβ peptides and insulin in mice. Methods: Upon systemic injection of 125I-Aβ40, 125I-Aβ42, or 125I-insulin, the plasma pharmacokinetics and brain influx were assessed in wild-type (WT) or AD transgenic (APP/PS1) mice at various ages. Additionally, publicly available single-cell RNA-Seq data [GSE129788] was employed to investigate pathways regulating BBB transport in WT mice at different ages. Results: The brain influx of 125I-Aβ40, estimated as the permeability-surface area product, decreased with age, accompanied by an increase in plasma AUC. In contrast, the brain influx of 125I-Aβ42 increased with age, accompanied by a decrease in plasma AUC. The age-dependent changes observed in WT mice were accelerated in APP/PS1 mice. As seen with 125I-Aβ40, the brain influx of 125I-insulin decreased with age in WT mice, accompanied by an increase in plasma AUC. This finding was further supported by dynamic single-photon emission computed tomography (SPECT/CT) imaging studies. RAGE and PI3K/AKT signaling pathways at the BBB, which are implicated in Aβ and insulin transcytosis, respectively, were upregulated with age in WT mice, indicating BBB insulin resistance. Conclusion: Aging differentially affects the plasma pharmacokinetics and brain influx of Aβ isoforms and insulin in a manner that could potentially augment AD risk.

We present the case of a cognitively unimpaired 77-year-old man with elevated, asymmetric, and longitudinally increasing Flortaucipir tau PET despite normal (visually negative) amyloid PET. His atypical tau PET signal persisted and globally increased in a follow-up scan five years later. Across eight years of observations, temporoparietal atrophy was observed consistent with tau PET patterns, but he retained the cognitively unimpaired classification. Altogether, his atypical tau PET signal is not explained by any known risk factors or alternative pathologies, and other imaging findings were not remarkable. He remains enrolled for further observation.

Wave energy converters (WECs) will have to be arranged into arrays of many devices to extract commercially viable amounts of energy. To understand the potential coastal impacts of WEC arrays, most research to date has relied on wave-averaged models given their computational efficiency. However, it is unknown how accurate wave-averaged model predictions are given a lack of validation data and their inherent simplifications of various hydrodynamic processes (e.g., diffraction). This paper compares the predictions of coastal wave farm impacts from a coupled wave-averaged and flow model (Delft3D-SNL-SWAN), to a wave-resolving wave-flow model (SWASH) that intrinsically accounts for more of the relevant physics. Model predictions were compared using an idealized coastal bathymetry over a range of wave conditions and wave farm geometries. Both models predicted the largest impacts (changes to the nearshore hydrodynamics) for large and dense wave farms located close to the shore (1 km) and the smallest impacts for the small and widely spaced farm at a greater offshore distance (3 km). However, the wave-resolving model generally predicted somewhat larger impacts (i.e., changes to the nearshore wave heights, mean velocities and mean water levels). We also found that coupling the wave-averaged model to a flow model resulted in more realistic downstream predictions than the stand-alone wave-averaged model.