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Introduction: Psoriasis is a chronic immune-mediated skin disease with several comorbidities and a considerable influence on quality of life. Many patients with moderate-to-severe psoriasis are undertreated and have a substantial disease duration before effective treatment is started. This study analyzed patient and disease characteristics and time to effective treatment of patients with psoriasis who consulted PsoPlus. It also examined whether a treat-to-target (T2T) approach, which is implemented in PsoPlus, has an impact on treatment choice and disease progression. Methods: Through a single center, retrospective study, 170 patients in the PsoPlus dedicated clinic were compared at moment of enrollment in PsoPlus and at the last recorded consultation in 2021. Results: Median disease duration at the first PsoPlus consultation was 16.0 (interquartile range (IQR) 19.0) years. There was a significant difference in Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) between the first and the last recorded PsoPlus consultation (PASI 6.0 (IQR 6.4) vs. 0.6 (IQR 2.6); DLQI 11 (IQR 11) vs. 2 (IQR 6); p < 0.001). A weak positive Spearman correlation (rs) was found between disease duration and PASI at the first PsoPlus consultation (rs = 0.175; p = 0.034), while a weak negative correlation (rs = − 0.2; p = 0.013) was found at the last registered PsoPlus consultation. Patients with a disease duration of more than 20 years had significantly more switches of treatment than those with a shorter disease duration (p < 0.001). Median time from psoriasis onset until PASI ≤ 2 was 16.0 years. Median time from the first PsoPlus consultation until PASI ≤ 2 was 7.0 months. Conclusion: The PsoPlus program with its T2T approach effectively improves clinical outcomes and quality of life for patients with psoriasis in a relatively short period, emphasizing the value of a structured, personalized treatment plan for long-term management. [ABSTRACT FROM AUTHOR]

Abstract Introduction Psoriasis is a chronic immune-mediated skin disease with several comorbidities and a considerable influence on quality of life. Many patients with moderate-to-severe psoriasis are undertreated and have a substantial disease duration before effective treatment is started. This study analyzed patient and disease characteristics and time to effective treatment of patients with psoriasis who consulted PsoPlus. It also examined whether a treat-to-target (T2T) approach, which is implemented in PsoPlus, has an impact on treatment choice and disease progression. Methods Through a single center, retrospective study, 170 patients in the PsoPlus dedicated clinic were compared at moment of enrollment in PsoPlus and at the last recorded consultation in 2021. Results Median disease duration at the first PsoPlus consultation was 16.0 (interquartile range (IQR) 19.0) years. There was a significant difference in Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) between the first and the last recorded PsoPlus consultation (PASI 6.0 (IQR 6.4) vs. 0.6 (IQR 2.6); DLQI 11 (IQR 11) vs. 2 (IQR 6); p

Purpose. The purpose of the presented review is to analyse the spread of the red mark syndrome (RMS) in rainbow trout (Oncorhynchus mykissWalbaum, 1792) from countries neighbouring Ukraine and summarise the ways and mechanisms of the spread of this disease in order to prevent the potential spread of this disease in specialized farms in Ukraine. Findings.The article provides data on the spread of red mark syndrome in rainbow trout from Europe, and methods of its prevention at fish farms. Special attention is paid to the spread of the disease in countries neighbouring Ukraine, which causes concern about the possible penetration of the pathogen into the territory of Ukraine. Geographic proximity to countries with confirmed RMS outbreaks, as well as the presence of developed aquaculture, in particular rainbow trout farming, increase the risk of introducing this disease. The cause-and-effect relationship of RMS is still unknown. A midichlorine-like organism (MLO) is considered the most likely causative agent, as all other possible agents lack sufficient evidence to associate them with RMS. Future studies should focus on confirming the causal relationship ofMLO with RMS and developing prevention strategies. The latent period of the disease is an important aspect that needs to be studied in detail.The use of new highly sensitive methods, such as polymerase chain reaction (PCR), will allow more accurate control of the dynamics of infection and determine the optimal time frame for taking fish samples for the purpose of isolating the pathogen.The hypothesis of the host’s hypersensitivity reaction to MLO as one of the reasons for the development of RMS requires further investigation. Understanding the factors that contribute to the development of RMS and efforts to isolate MLO are important for the development of targeted solutions to control the disease. Strategies may focus on helping to build up the host’s natural immunity against RMS, thereby avoiding the use of antibiotics. The risk of developing RMS in fish is thought to be multifactorial, with certain farming practices and environmental factors making some fish populations more susceptible to the condition.The role of water, eggs, environment, invertebrates and parasites as possible vectors of MLO requires additional research. Collection of up-to-date data on the incidence of RMS is important for a more accurate determination of its economic impact on trout aquaculture. Disease surveillance and broader data on the prevalence of RMS in Europe and the world should be implemented by conducting large-scale studies combining data from different institutions.This will increase the level of biosecurity and help develop effective risk management strategies, which will contribute to maintaining the stability of aquaculture in Ukraine. The potential economic consequences of RMS can be significant for Ukraine. Despite the low mortality, treatment and management costs can significantly affect the economics of aquaculture by increasing production costs. It is important to implement biosecurity measures, including control of live fish imports, regulation of aquaculture systems and increased biosecurity on farms. It is also necessary to conduct a study to assess the potential economic impact of RMS on the industry, which will help to develop effective risk management strategies and maintain the stability of aquaculture in Ukraine. Practical Value. Monitoring of salmon diseases in fish farming enterprises of Ukraine will allow determining the ecological niches of these pathogens and establish the potential risks of epizootics, primarily in the conditions of aquaculture.

Abstract Background Psoriasis, a common chronic inflammatory skin disease with major impact on quality of life, is associated with several comorbidities. A better understanding of the pathogenesis of psoriasis has led to the development and approval of new therapeutic strategies such as biologics of different classes (targeting tumour necrosis factor‐α, interleukin (IL) 17 and IL12/23), phosphodiesterase‐4 inhibitors, and janus kinase inhibitors. Objectives The objective of this project was to investigate the evolution of baseline patient characteristics, disease characteristics and outcomes in Phase 3 trials. We hypothesized that the uptake of more effective drugs in the management of patients is reflected in the patient profile considered eligible for clinical trials. Methods A search in PubMed for Phase 3 trials of biologics, apremilast and deucravacitinib was performed. Forty trials were included and divided into five periods. The first three periods correspond with the chronological development of biologics, Period 4 contains trials of apremilast and Period 5 of deucravacitinib. For each trial, demographics and outcomes were extracted and mean values per period were calculated. Statistical analysis was performed in the biologics group and in the oral therapies group. Results Between Periods 1, 2 and 3: the mean percentage of patients with prior phototherapy (p

Objective: To improve our understanding of systemic lupus erythematosus (SLE)‐macrophage activation syndrome (MAS). Methods: A systematic review was performed, to retrieve all those papers on patients with SLE‐MAS, in individual or aggregated form. The data in each of these medical records were extracted and analyzed to identify the characteristics of SLE‐MAS. Results: A total of 86 SLE‐MAS patients were included (25 males and 61 females. The mean (±standard error of the mean) age was 31.21 ± 1.694 years. MAS occurred as the initial presentation of SLE in 47 people (54.65%) and during the course of SLE in 39 (45.35%). A coinfection was reported in 23 (26.74%) patients. The mean Lupus Erythematosus Disease Activity Index 2000 (SLEDAI‐2K) score was 16.54 ± 0.9462. Overall, 10 patients (11.63%) died. The SLEDAI‐2K score was higher in patients with MAS as an initial manifestation of SLE than in those where MAS occurred during the course of SLE. The proportion of patients receiving steroid pulse therapy was lower in patients with coinfections. The deceased group demonstrated lower platelet and ferritin levels. Multiple regression analysis revealed that age and thrombocytopenia were independent factors associated with poor prognosis. In receiver operating characteristic analysis, a platelet count cutoff value of ≤47 × 109/L was a predictor of poor outcome. Conclusions: SLE‐MAS patients demonstrated high lupus activity, and lupus activity was especially higher in patients with MAS as an initial manifestation. Lupus activity was the predominant trigger of lupus MAS. Thrombocytopenia was an independent factor for poor prognosis. Highlights: Lupus activity was especially high in patients with macrophage activation syndrome (MAS) as an initial manifestation.Lupus activity is the predominant trigger for lupus‐MAS.Thrombocytopenia is a predictor of poor prognosis in patients with systemic lupus erythematosus‐MAS. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of the presented review is to analyse the spread of the red mark syndrome (RMS) in rainbow trout (Oncorhynchus mykiss Walbaum, 1792) from countries neighbouring Ukraine and summarise the ways and mechanisms of the spread of this disease in order to prevent the potential spread of this disease in specialized farms in Ukraine. Findings. The article provides data on the spread of red mark syndrome in rainbow trout from Europe, and methods of its prevention at fish farms. Special attention is paid to the spread of the disease in countries neighbouring Ukraine, which causes concern about the possible penetration of the pathogen into the territory of Ukraine. Geographic proximity to countries with confirmed RMS outbreaks, as well as the presence of developed aquaculture, in particular rainbow trout farming, increase the risk of introducing this disease. The cause-and-effect relationship of RMS is still unknown. A midichlorine-like organism (MLO) is considered the most likely causative agent, as all other possible agents lack sufficient evidence to associate them with RMS. Future studies should focus on confirming the causal relationship of MLO with RMS and developing prevention strategies. The latent period of the disease is an important aspect that needs to be studied in detail. The use of new highly sensitive methods, such as polymerase chain reaction (PCR), will allow more accurate control of the dynamics of infection and determine the optimal time frame for taking fish samples for the purpose of isolating the pathogen. The hypothesis of the host's hypersensitivity reaction to MLO as one of the reasons for the development of RMS requires further investigation. Understanding the factors that contribute to the development of RMS and efforts to isolate MLO are important for the development of targeted solutions to control the disease. Strategies may focus on helping to build up the host's natural immunity against RMS, thereby avoiding the use of antibiotics. The risk of developing RMS in fish is thought to be multifactorial, with certain farming practices and environmental factors making some fish populations more susceptible to the condition. The role of water, eggs, environment, invertebrates and parasites as possible vectors of MLO requires additional research. Collection of up-to-date data on the incidence of RMS is important for a more accurate determination of its economic impact on trout aquaculture. Disease surveillance and broader data on the prevalence of RMS in Europe and the world should be implemented by conducting large-scale studies combining data from different institutions. This will increase the level of biosecurity and help develop effective risk management strategies, which will contribute to maintaining the stability of aquaculture in Ukraine. The potential economic consequences of RMS can be significant for Ukraine. Despite the low mortality, treatment and management costs can significantly affect the economics of aquaculture by increasing production costs. It is important to implement biosecurity measures, including control of live fish imports, regulation of aquaculture systems and increased biosecurity on farms. It is also necessary to conduct a study to assess the potential economic impact of RMS on the industry, which will help to develop effective risk management strategies and maintain the stability of aquaculture in Ukraine. Practical Value. Monitoring of salmon diseases in fish farming enterprises of Ukraine will allow determining the ecological niches of these pathogens and establish the potential risks of epizootics, primarily in the conditions of aquaculture. [ABSTRACT FROM AUTHOR]

Angioleiomyoma (ALM) is a rare benign perivascular (pericytic) tumor primarily composed of well-differentiated smooth muscle and vascular components. Its clinical and radiological features lack specificity, making diagnosis challenging and prone to misdiagnosis. This report summarizes the clinical data of a patient treated at our hospital who was preoperatively misdiagnosed with rectal cancer but was subsequently found to have perirectal ALM. Additionally, a review of the relevant literature is provided.

Abstract Background Rheumatic diseases can seriously impact children’s general health, development, and growth. However, due to a lack of resources, paediatric rheumatology is a largely underdeveloped speciality in many African nations. Children with rheumatic disorders face obstacles in accessing specialized medical care, including lack of specialists, care centres, medication access, and limited research and education to increase understanding of paediatric rheumatic disease among healthcare practitioners. This study described the disease characteristics, prevalence, and challenges faced by paediatric rheumatic disease patients receiving care at a teaching hospital in Accra, Ghana. Methods A retrospective record-based study was conducted among all paediatric cases presenting to the rheumatology clinic of the Korle Bu Teaching Hospital (KBTH) from January 2011 to December 2021. Data collected include clinical features, laboratory findings at disease presentation, andtherapeutic regimens prescribed per standard guidelines and experiences. Results A total of 121 cases were identified as of 2021, indicating a point prevalence of 0.0011%. The majority (73%) were females with a mean age of 13.4 ± 3.2 years. The mean duration of symptoms in months experienced by patients before being successfully referred to a rheumatologist was 18 months. There were significant differences between referred and confirmed diagnoses, especially in cases involving mixed connective tissue diseases (MCTD), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM), suggesting that these conditions may be under-recognised. Arthralgia and arthritis were the most common presenting symptoms. More than three-quarters (86.8%) of the cases studied were treated with steroids (oral or intravenous). In cases requiring immunosuppressive therapy, methotrexate was the most commonly prescribed in 33.9% of instances. Mortality was recorded at 8.3%, with the majority involving SLE cases. Most (95.7%) of the primary caregivers expressed positive experiences regarding care received at the adult rheumatology clinic. Conclusion There were significant delays in diagnosis and diagnostic accuracy for patients with paediatric rheumatic disease (PRD). This highlights the pressing need for strengthening paediatric rheumatology services in Africa, including increasing awareness about these conditions among the public and healthcare providers to improve early diagnosis and quality of life for children with these conditions.

Background: Rheumatic diseases can seriously impact children's general health, development, and growth. However, due to a lack of resources, paediatric rheumatology is a largely underdeveloped speciality in many African nations. Children with rheumatic disorders face obstacles in accessing specialized medical care, including lack of specialists, care centres, medication access, and limited research and education to increase understanding of paediatric rheumatic disease among healthcare practitioners. This study described the disease characteristics, prevalence, and challenges faced by paediatric rheumatic disease patients receiving care at a teaching hospital in Accra, Ghana. Methods: A retrospective record-based study was conducted among all paediatric cases presenting to the rheumatology clinic of the Korle Bu Teaching Hospital (KBTH) from January 2011 to December 2021. Data collected include clinical features, laboratory findings at disease presentation, andtherapeutic regimens prescribed per standard guidelines and experiences. Results: A total of 121 cases were identified as of 2021, indicating a point prevalence of 0.0011%. The majority (73%) were females with a mean age of 13.4 ± 3.2 years. The mean duration of symptoms in months experienced by patients before being successfully referred to a rheumatologist was 18 months. There were significant differences between referred and confirmed diagnoses, especially in cases involving mixed connective tissue diseases (MCTD), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM), suggesting that these conditions may be under-recognised. Arthralgia and arthritis were the most common presenting symptoms. More than three-quarters (86.8%) of the cases studied were treated with steroids (oral or intravenous). In cases requiring immunosuppressive therapy, methotrexate was the most commonly prescribed in 33.9% of instances. Mortality was recorded at 8.3%, with the majority involving SLE cases. Most (95.7%) of the primary caregivers expressed positive experiences regarding care received at the adult rheumatology clinic. Conclusion: There were significant delays in diagnosis and diagnostic accuracy for patients with paediatric rheumatic disease (PRD). This highlights the pressing need for strengthening paediatric rheumatology services in Africa, including increasing awareness about these conditions among the public and healthcare providers to improve early diagnosis and quality of life for children with these conditions. [ABSTRACT FROM AUTHOR]

Abstract Objective To improve our understanding of systemic lupus erythematosus (SLE)‐macrophage activation syndrome (MAS). Methods A systematic review was performed, to retrieve all those papers on patients with SLE‐MAS, in individual or aggregated form. The data in each of these medical records were extracted and analyzed to identify the characteristics of SLE‐MAS. Results A total of 86 SLE‐MAS patients were included (25 males and 61 females. The mean (±standard error of the mean) age was 31.21 ± 1.694 years. MAS occurred as the initial presentation of SLE in 47 people (54.65%) and during the course of SLE in 39 (45.35%). A coinfection was reported in 23 (26.74%) patients. The mean Lupus Erythematosus Disease Activity Index 2000 (SLEDAI‐2K) score was 16.54 ± 0.9462. Overall, 10 patients (11.63%) died. The SLEDAI‐2K score was higher in patients with MAS as an initial manifestation of SLE than in those where MAS occurred during the course of SLE. The proportion of patients receiving steroid pulse therapy was lower in patients with coinfections. The deceased group demonstrated lower platelet and ferritin levels. Multiple regression analysis revealed that age and thrombocytopenia were independent factors associated with poor prognosis. In receiver operating characteristic analysis, a platelet count cutoff value of ≤47 × 109/L was a predictor of poor outcome. Conclusions SLE‐MAS patients demonstrated high lupus activity, and lupus activity was especially higher in patients with MAS as an initial manifestation. Lupus activity was the predominant trigger of lupus MAS. Thrombocytopenia was an independent factor for poor prognosis.

Abstract Background Pediatric myelodysplastic syndromes (MDS) are rare disorders with an unrevealed pathogenesis. Our aim is to explore the role of genetic factors in the pathogenesis of MDS in children with different outcomes and to discover the correlation between genetic features and clinical outcomes as well as disease characteristics. Methods We conducted an analysis of archived genetic data from 26 patients diagnosed with pediatric MDS at our institution between 2015 and 2021, examining the association between different genetic characteristics and clinical manifestations as well as prognosis. Additionally, We presented three cases with distinct genetic background and outcomes as examples to elaborate the role of genetic factors in pediatric MDS with different prognoses. Results Genetic variations were detected in 13 out of the 26 patients, including 8 patients with co-occurrence of somatic and germline mutations (CSGMs) and 5 patients with somatic mutations alone. Our analysis revealed that advanced MDS (4/8, 50% vs. 1/5, 20% and 4/11, 36.4%), PD (3/8, 37.5% vs. 1/5, 20% and 1/11 9.1%), and TD (6/8, 75% vs. 2/5, 40% and 2/11, 18.2%) were more common in patients with CSGMs than those with somatic mutations alone or without any mutations. We also found out in our study that 8 patients with CSGMs had evidently different clinical outcomes, and we presented 3 of them as examples for elaboration. Case 1 with germline and somatic mutations of unknown significance had a relatively slow disease course and a good prognosis. Case 2 with compound heterozygous germline SBDS variants and somatic mutations like del20q had a stable disease course and a reversed outcome. Case 3 with a germline GATA2 variant and somatic mutations including − 7 had a rapidly progressive disease course and a worst prognosis. Conclusion Our findings indicate that genetic background of pediatric MDS is closely linked with disease characteristics as well as outcomes and that CSGMs may lead to disease progression. It should be emphasized that the interaction between certain germline variants and somatic mutations, such as SBDS and del20q, may result in hematopoietic stem cell adaptation (improved hematopoiesis) and reversed clinical outcomes, which can facilitate the development of targeted therapy.

Neurofibromatosis type 1 (NF1) is a genetic disease that can lead to impaired social adaptation and functioning, thus affecting quality of life. To date, studies of these children's social cognition abilities have been scant and far from exhaustive. Therefore, the purpose of the present study was to assess the ability of children with NF1, compared with controls, to process facial expressions of emotions – not only including the usual primary emotions (happiness, anger, surprise, fear, sadness and disgust), but secondary emotions, too. To do so, the links between this ability and the characteristics of the disease (mode of transmission, visibility, and severity) were examined. A total of 38 children with NF1 aged 8-16 years 11 months (mean = 11.4, SD = 2.3) and 43 sociodemographically comparable control children performed the emotion perception and recognition tests of a social cognition battery. Results confirmed that the processing of primary and secondary emotions is impaired in children with NF1, but there were no significant links with either mode of transmission, severity, or visibility. These results encourage further comprehensive assessments of emotions in NF1, and suggest that investigations should be extended to higher level social cognition skills, such as theory of mind and moral judgments. [ABSTRACT FROM AUTHOR]

Background: Pediatric myelodysplastic syndromes (MDS) are rare disorders with an unrevealed pathogenesis. Our aim is to explore the role of genetic factors in the pathogenesis of MDS in children with different outcomes and to discover the correlation between genetic features and clinical outcomes as well as disease characteristics. Methods: We conducted an analysis of archived genetic data from 26 patients diagnosed with pediatric MDS at our institution between 2015 and 2021, examining the association between different genetic characteristics and clinical manifestations as well as prognosis. Additionally, We presented three cases with distinct genetic background and outcomes as examples to elaborate the role of genetic factors in pediatric MDS with different prognoses. Results: Genetic variations were detected in 13 out of the 26 patients, including 8 patients with co-occurrence of somatic and germline mutations (CSGMs) and 5 patients with somatic mutations alone. Our analysis revealed that advanced MDS (4/8, 50% vs. 1/5, 20% and 4/11, 36.4%), PD (3/8, 37.5% vs. 1/5, 20% and 1/11 9.1%), and TD (6/8, 75% vs. 2/5, 40% and 2/11, 18.2%) were more common in patients with CSGMs than those with somatic mutations alone or without any mutations. We also found out in our study that 8 patients with CSGMs had evidently different clinical outcomes, and we presented 3 of them as examples for elaboration. Case 1 with germline and somatic mutations of unknown significance had a relatively slow disease course and a good prognosis. Case 2 with compound heterozygous germline SBDS variants and somatic mutations like del20q had a stable disease course and a reversed outcome. Case 3 with a germline GATA2 variant and somatic mutations including − 7 had a rapidly progressive disease course and a worst prognosis. Conclusion: Our findings indicate that genetic background of pediatric MDS is closely linked with disease characteristics as well as outcomes and that CSGMs may lead to disease progression. It should be emphasized that the interaction between certain germline variants and somatic mutations, such as SBDS and del20q, may result in hematopoietic stem cell adaptation (improved hematopoiesis) and reversed clinical outcomes, which can facilitate the development of targeted therapy. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to analyze the clinical characteristics and prognosis of children with retinoblastoma (RB) in a single center in China with a large sample collection spanning 17 years. Methods: The clinical data of 2790 children with RB treated in Beijing Tongren Hospital from 2005 to 2021 were collected, and a retrospective analysis was conducted. Results: The median age of the participants was 28.3 months. There were 3624 affected eyes, 12.4% of which were in groups A–C, 67.1% in groups D–E and 16.2% were not specified. The primary symptom observed in most cases was a white pupil, accounting for 66.5%, followed by strabismus (12.8%). The median follow-up time was 59.7 months. The enucleation rate was 71.3% (703/986) in a single left eye and 72.5% (702/968) in a single right eye. The overall survival (OS) rate was 95.8% (2444/2552) because 237 patients dropped out, and 109 died. Kaplan‒Meier survival analysis showed that the median survival time (MST) was 125.92 months [95% confidence interval (CI) = 124.83–127.01]. Cox multivariate survival analysis showed that trilateral RB (P = 0.017), metastasis site (P = 0.001), and combined distant tissue metastasis (P = 0.001) were independent prognostic factors for RB. The OS of 44 cases of familial RB was 93.2% (41/44), with an MST of 80.62 months (95% CI = 67.70–93.54). Conclusions: The timing of eye protection treatment and enucleation should be comprehensively judged to avoid worsening prognosis due to operation time delay. More importantly, the promotion and popularization of diagnosis and treatment technologies are necessary to further improve RB prognosis. E4PcSvZkzAG-n1U_2P1icm [ABSTRACT FROM AUTHOR]

Introduction: Vitiligo is a chronic skin disorder in which immune dysregulation has been reported as one of the major etiopathological factors. Interleukin-12 (IL-12), IL-23 and IL-27 of IL-12 cytokine family were identified as critical cytokines in the pathogenesis of many autoimmune and inflammatory skin diseases including vitiligo. IL-35 is one of the newest member of IL-12 cytokine family. Objectives: The purpose of our study was to examine serum IL-35 levels in addition to serum IL-12, IL-23, IL-27 levels in the vitiligo patients and control group, and to investigate the relationship of these cytokines with the characteristics of vitiligo. Methods: Serum IL-12, IL-23, IL-27 and IL-35 levels of 78 vitiligo patients and 70 healthy volunteers were analyzed using the enzyme-linked immunosorbent assay (ELISA). We compared the IL-12 cytokine family levels in the patient and control groups, and investigated the relationship of these levels with the characteristics of vitiligo. Results:Patients had higher levels of IL-12 (31.2 versus 20.1, P < 0.001) and IL-35 (9.6 versus 8.1, P = 0.031). Patient and control groups had similar levels of IL-23 (P = 0.78) but were correlated with the Vitiligo Area Scoring Index (VASI) (P = 0.022, r = 0.35). Patients had lower levels of IL-27 (207.6 versus 258.7, P < 0.001). In addition, the levels of serum IL-27 were correlated negatively with the Vitiligo Disease Activity (VIDA), and positively with disease duration (P = 0.007, r = 0.30). Conclusions: Differences of serum levels between Vitiligo patients and healthy controls, significant relationships with the characteristics of vitiligo suggest that the IL-12 cytokine family may play a role in the pathogenesis of vitiligo.

Summary: Background: Duchenne muscular dystrophy (DMD) is a disabling and life-threatening, X-linked recessive disorder caused by mutations in dystrophin. Natural history studies can inform the disease characteristics of DMD, and data from these studies can be used to plan and design clinical trials and as external controls for long-term studies. We report 12-month results from the largest natural history study of individuals with DMD in China receiving standard of care treatment. Methods: This ongoing, multicentre, prospective, single-cohort study (ClinicalTrials.gov: NCT03760029) was conducted in Chinese male participants with DMD (ambulatory aged

ObjectiveTwo phase 3 galcanezumab trials were conducted in Europe and North America to analyze the reduction of weekly cluster headache (CH) attack frequency in populations with episodic and chronic CH. The current study aims to illustrate prospectively recorded baseline clinical data from these trials and to identify possible predictors of response.MethodsPatients (aged 18–65 years) met The International Classification of Headache Disorders 3rd edition-beta criteria for CH. Attacks were evaluated using an electronic headache diary for 7-day (episodic) or 14-day (chronic) eligibility assessments before patients were randomized 1:1 to monthly subcutaneous galcanezumab 300 mg or placebo.ResultsData were collected from 106 patients with episodic and 237 with chronic CH. Overall, the mean age [standard deviation] was 45.4 [11.0] years; patients were predominantly White (84.5%), male (75.8%), and European (77.6%). Patients with episodic CH reported 17.5 [10.0] attacks/week; patients with chronic CH reported 18.8 [10.2] attacks/week. The average pain severity score (range 0–4) was 2.5 [0.7] for episodic CH and 2.7 [0.7] for chronic CH. Higher attack frequency was a possible predictor of response to galcanezumab; potential negative predictors of response were greater attack severity and duration.ConclusionThis large dataset of patients with CH provides reliable systematically and prospectively collected information on disease characteristics. The analysis in episodic CH underscores potential predictors of response worth considering for future CH trial design.Clinical Trial RegistrationClinicalTrials.gov, identifiers: NCT02397473 and NCT02438826.

Abstract Introduction We sought insights into the classification of and factors associated with relapse severity and disease stability in neuromyelitis optica spectrum disorder (NMOSD) clinical practice worldwide. Methods Neurologists recruited from six countries (the USA, Germany, Italy, Brazil, South Korea, and China) participated in a 30–60 minute online survey and submitted two to four clinical records for aquaporin-4-immunoglobulin G (AQP4-IgG)-seropositive adults with NMOSD, which included patient demographics, diagnosis, maintenance treatment history, relapse occurrence, and severity. Separately, patients with NMOSD receiving maintenance therapy were interviewed over the telephone about their treatment journey, as well as perceptions of relapse severity and disease stability, and their potential influence on treatment decisions. Results Clinical records for 1185 patients with AQP4-IgG-seropositive NMOSD were provided by 389 neurologists (July–August 2020); 33 patients were interviewed (October–November 2020). There was no clear consensus on how relapse severity was defined in clinical practice, with geographical variations in relapse classification also found. Neurologists tended to rely on clinical assessments when determining severity, viewing each relapse in isolation, whereas patients had a more subjective view based on the changes in their daily lives and comparisons with prior relapses. Similarly, there was a disconnect in the definition of disease stability: the complete absence of relapses was more important for patients than for neurologists. Conclusion A clear consensus on how to assess relapse severity and disease stability is needed to ensure that patients receive appropriate and timely treatment. In the future, clinical measures should be combined with patient-focused assessments.

Introduction: We sought insights into the classification of and factors associated with relapse severity and disease stability in neuromyelitis optica spectrum disorder (NMOSD) clinical practice worldwide. Methods: Neurologists recruited from six countries (the USA, Germany, Italy, Brazil, South Korea, and China) participated in a 30–60 minute online survey and submitted two to four clinical records for aquaporin-4-immunoglobulin G (AQP4-IgG)-seropositive adults with NMOSD, which included patient demographics, diagnosis, maintenance treatment history, relapse occurrence, and severity. Separately, patients with NMOSD receiving maintenance therapy were interviewed over the telephone about their treatment journey, as well as perceptions of relapse severity and disease stability, and their potential influence on treatment decisions. Results: Clinical records for 1185 patients with AQP4-IgG-seropositive NMOSD were provided by 389 neurologists (July–August 2020); 33 patients were interviewed (October–November 2020). There was no clear consensus on how relapse severity was defined in clinical practice, with geographical variations in relapse classification also found. Neurologists tended to rely on clinical assessments when determining severity, viewing each relapse in isolation, whereas patients had a more subjective view based on the changes in their daily lives and comparisons with prior relapses. Similarly, there was a disconnect in the definition of disease stability: the complete absence of relapses was more important for patients than for neurologists. Conclusion: A clear consensus on how to assess relapse severity and disease stability is needed to ensure that patients receive appropriate and timely treatment. In the future, clinical measures should be combined with patient-focused assessments. [ABSTRACT FROM AUTHOR]

Abstract Background Eosinophilia is a significant factor in asthma severity; however, the prevalence of severe eosinophilic asthma in Saudi Arabia is largely unknown. We aimed to determine the prevalence of the eosinophilic (defined in this study as ≥ 300 cells/mm3 in blood), atopic (atopic phenotype 1, defined in this study as > 100 IU/mL total serum IgE; atopic phenotype 2, defined in this study as > 150 IU/mL), and overlap phenotypes among patients with severe asthma in Saudi Arabia. Methods A cross-sectional study was conducted in centers specialized in severe asthma management. Patients aged ≥ 12 years with severe asthma were enrolled. Study patients responded to the Global Initiative for Asthma 2018 assessment of asthma control questionnaire and provided study investigators with current information related to the study objectives. Additional medical record data and a blood sample for total serum IgE and complete blood count were collected. Results A total of 101 patients were enrolled; 83% were female and the mean (standard deviation) age was 48.7 (13.2) years. Forty-five (45%) patients had the eosinophilic phenotype, 50 (50%) had atopic phenotype 1, and 25 (25%) had phenotypic overlap (eosinophilic and atopic 1). Forty-one (41%) patients had atopic phenotype 2 and 23 (23%) had phenotypic overlap (eosinophilic and atopic 2). Asthma control and oral corticosteroid use patterns were similar and there were no significant differences in number of asthma exacerbations across phenotypes. Conclusions In Saudi Arabia, 45% of patients with severe asthma had the eosinophilic phenotype, which is most likely an underestimation as no clinical features of eosinophilia were taken into account in the definition of eosinophilia. Approximately half of them had phenotypic overlap with the atopic phenotype. Trial registration NCT03931954; ClinicalTrials.gov, April 30, 2019.

Yan-Fen Tang,1,2,&ast; Yu Wang,1,2,&ast; Tian-Jiao Xue,1,2 Gang Liu,1,2 Qi Chen,1,2 Wen Zhao,1,2 Yan-Yan Liu,1,2 Rong-Qian Chen,1,2 Li Chen,1,2 Jing Liu1,2 1Department of Respiratory, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China; 2Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yan-Fen TangDepartment of Respiratory, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun Dongjie, Chaoyang District, Beijing, 100015, People’s Republic of ChinaTel +86 10 84322963Fax +86 10 84322146Email yanfenttang@163.comObjective: This study aims to analyze the clinical characteristics of HIV-infected patients complicated with venous thromboembolism (VTE).Methods: Seventy HIV-infected patients complicated with VTE were enrolled from Beijing Ditan Hospital Capital Medical University from October 2009 to December 2020 and divided into two groups according to CD4+. The clinical data of 70 patients were observed, including general conditions, laboratory indexes, viral load, antiretroviral therapy (ART) before the diagnosis of VTE, and thrombus treatment.Results: The patients were divided into two groups according to the CD4+ T lymphocyte count. There were 27 patients with a CD4+ T lymphocyte count ≥ 200 cells/ul, classified as group A (27/70, 38.6%), and there were 43 patients with a CD4+ T lymphocyte count < 200 cells/ul, classified as group B (43/70, 61.4%). In group B, these patients included 37 males and 6 females. The average age was 47.1± 12.1 years old. The average levels of the following indexes were: D-dimer, 3.5 mg/L (0.7, 6.9); total cholesterol, 4.4 mmol/L (3.3, 5.5); triglycerides, 1.4 mmol/L (0.9, 2.0); low density lipoprotein, 1.9 mmol/L (1.5,2.5); albumin, 31.8± 6.4 g/L; CD4+, 66 cells/ul (18, 127); viral load, 12347 copies/mL (27, 203936). Sixty-three patients (63/70, 90%) had started highly active ART (HAART) before VTE was diagnosed, 37 patients (37/70, 52.9%) were complicated with bacterial pneumonia, 16 patients had Mycobacterium tuberculosis (16/70, 22.9%), 13 patients had Pneumocystis carinii pneumonia (PCP) (13/70, 18.6%), and eight patients were complicated with cytomegalovirus (CMV) infection (8/70, 11.4%). Twenty-four patients had tumors, and 15 patients had HIV-related tumors (15/70, 21.4%). There were significant differences between the two groups in the time from the diagnosis of HIV to the discovery of thrombosis, the time from ART to the discovery of thrombosis and bacterial pneumonia, and the differences in WBC, PLT, Hb, CRP, PTA, INR, TCHO, LDL-C, ALB, and viral load were statistically significant.Conclusion: The prevalence of VTE in HIV-infected people in the last 11 years was 1.4%. In patients with a high viral load, CRP, D-dimer levels, and low CD4+ and albumin levels, 11.4– 22.9% were complicated with an opportunistic infection, and 21.4% had HIV-related tumors. There were significant differences between the two groups in high viral load, CRP, D-dimer, and low albumin.Keywords: HIV-infected persons, venous thromboembolism, CD4+ T lymphocytes, disease characteristics

Objective: Adult patients with the genetic disease neurofibromatosis type 1 (NF1) frequently report social difficulties. To date, however, only two studies have explored whether these difficulties are caused by social cognition deficits, and these yielded contradictory data. The aim of the present study was to exhaustively assess social cognition abilities (emotion, theory of mind, moral reasoning, and social information processing) in adults with NF1, compared with a control group, and to explore links between social cognition and disease characteristics (mode of inheritance, severity, and visibility)., Method: We administered a social cognition battery to 20 adults with NF1 (mean age = 26.5 years, SD = 7.4) and 20 healthy adults matched for sociodemographic variables., Results: Patients scored significantly lower than controls on emotion, theory of mind, moral reasoning, and social information processing tasks. No effects of disease characteristics were found., Conclusions: These results appear to confirm that adults with NF1 have a social cognition weaknesses that could explain, at least in part, their social difficulties, although social abilities are not all impaired to the same extent. Regarding the impact of the disease characteristics, the patient sample seemed slightly insufficient for the power analyses performed. Thus, this exploratory study should form the basis of further research, with the objective of replicating these results with larger and more appropriately matched samples.

Background: The electronic health record (EHR) is integral to improving healthcare efficiency and quality. Its successful implementation hinges on patient willingness to use it, particularly in Germany where concerns about data security and privacy significantly influence usage intention. Little is known about how specific characteristics of medical data influence patients' intention to use the EHR., Objective: This study aims to validate the privacy calculus model (PCM) regarding EHRs and to assess how personal and disease characteristics, namely disease-related stigma and disease time course, affect PCM predictions., Methods: An online survey was conducted to empirically validate the PCM for EHR, incorporating a case vignette varying in disease-related stigma (high/low) and time course (acute/chronic), with N  = 241 participants, aged 18 years and older residing in Germany with no previous experience with the diseases mentioned in the respective medical reports. Participants were randomized (single-blinded) into four groups in parallel: high stigma and acute time course ( n  = 74), high stigma and chronic time course ( n  = 56), low stigma and acute time course ( n  = 62) and low stigma and chronic time course ( n  = 49). The data were analyzed using structural equation modeling with partial least squares., Results: The model explains R ² = 71.8% of the variance in intention to use. The intention to use is influenced by perceived benefits, data privacy concerns, trust in the provider, and social norms. However, only the disease's time course, not stigma, affects this intention. For acute diseases, perceived benefits and social norms are influential, whereas for chronic diseases, perceived benefits, privacy concerns, and trust in the provider influence intention., Conclusions: The PCM validation for EHRs reveals that personal and disease characteristics shape usage intention in Germany. The need for tailored EHR adoption strategies that address specific needs and concerns of patients with different disease types. Such strategies could lead to a more successful and widespread implementation of EHRs, especially in privacy-conscious contexts., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Aim: We aimed to review our experience of managing Wilms tumor in our center over a period of fifteen years with regards to disease characteristics, outcome and see how well we are doing as compared to rest of the world. Methods: All children admitted at King Abdullah Specialist Children's Hospital, Riyadh from Jan 2001 to Dec 2015 with the diagnosis of Wilms tumor were included. Out of 39 eligible patients, 36 were included for final analysis whose treatment and follow up details were available. Results: Median age at diagnosis was 3 years, median duration of follow up was 7.2 years and 44% were male. Two (6%) patients had underlying hereditary predisposition syndromes. Abdominal distension was the most common symptom in 35(97%) patients and hypertension in 12(33%). Ten (28%) patients had stage I disease, 2(6%) had stage II, 13 (36%) had stage III, 8(22%) had stage IV while 3(8%) patients presented with stage V disease. Lung was the commonest metastatic site. Thirty-one (86%) patients had upfront nephrectomy. Anaplasia was present in 5(14%) of nephrectomy specimens. One patient had positive LOH for chromosomes 1p and 16q. All 6(17%) patients died of disease progression. Five year OS and EFS was 83% and 74% respectively. Anaplasia showed strong association with risk of relapse (p 0.0003). Conclusions: OS and EFS are comparable with rest of the developing world but we need to adopt modern tumor genetics based risk stratification to match the survival figures reported from developed world.

Alopecia areata (AA) is an autoimmune disease where autoimmune dysregulations along with genetic susceptibility are hypothesized to play a role in pathogenesis. The aim of this study in to evaluate HLA-A, HLA-B, HLA-C, HLA-DQB1, and HLA-DRB1 profile and its relationship with clinical features in AA patients. Ninety-eight patients with AA and 100 healthy controls were included in the study. HLA-A, HLA-B, HLA-C, HLA-DQB1, and HLA-DRB1 frequencies were analyzed using polymerase chain reaction-sequence specific primers (PCR-SSP). HLA-B*39 and HLA-HLA-DRB1*15 allele frequencies were increased (p =.022 and p =.023, respectively), HLA-A*11 and HLA-B*35 frequencies were decreased (p =.006 and p =.014, respectively) in AA patients. HLA-B*13 and HLA-DRB1*11 were associated with poor prognostic factors. A class I allele, HLA-B*13 was associated with recurrence (p =.023) and presence of nevus flammeus (p =.022), while the class II allele HLA-DRB1*11 was associated with widespread hair loss (diffuse or universal alopecia) (p =.026), presence of ophiasis (p =.049) and juvenile onset (p =.018). Belonging to two different classes of HLA family, HLA-B*13 and HLA-DRB1*11 alleles identified separate set of risk factors. In addition to increasing the risk of AA, HLA alleles may affect the prognosis of the disease. [ABSTRACT FROM AUTHOR]

Objective To study the changes of pituitary-related hormones in patients with prolonged disorders of consciousness (pDOC) and its influence on the prognosis of patient in order to explore the risk factor of hormone levels with consciousness level and prognosis of patients. Methods The clinical data of 87 pDOC patients admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University and the Department of Neurosurgery of the Seventh Medical Center of Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively. According to the improvement of patients' consciousness, they were divided into consciousness recovery group (n=39) and consciousness non-recovery group (n=48). The secretion levels of pituitary related hormones were measured in the 2 groups, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), growth hormone (GH) and cortisol and prolactin (PRL). According to Coma Recovery Scale-Revised (CSR-R) score, the patients were assigned into vegetative state VS group (n=61) and minimal consciousness state MCS group (n=26). The relationship between the changes of pituitary hormones and consciousness of pDOC patients was analyzed. According to the normal standard of hormone level, the patients were divided into normal hormone level group (n=25) and abnormal hormone level group (n=62). Univariate analysis and logistic regression model were used to explore the influencing factors (age, sex, cause of injury, course of disease, preoperative CRS-R score and injured location, etc.) of pDOC patients. Results Among the 87 pDOC patients, 62 (71.3%) had abnormal pituitary hormones, including 42 cases of single hormone abnormality (67.7%), and 20 cases of more than 2 changes (32.3%). The types and proportions of abnormal pituitary hormones were: GH 18 cases (29.0%), TSH and FT3/FT4 19 cases (30.6%), PRL 11 cases (17.7%), ACTH 8 cases (12.9%), and COR6 cases (9.7%). In the comparison of the differences of pituitary hormone levels between the VS group and MCS group, there were significant differences in GH, TSH, PRL and ACTH between the 2 groups (P < 0.01). Compared with the normal hormone level group, the abnormal hormone level group has an older onset age (P=0.001), a lower proportion of MCS patients (P=0.001), a lower CRS-R score (P < 0.001), a longer ICU stay (P < 0.001), and a higher proportion of paroxysmal sympathetic hyperexcitability syndrome (PSH). Multivariate analysis indicated that age (OR=1.316, P=0.006), CRS-R score (OR=0.200, P=0.037), ICU stay time (OR=3.991, P=0.040) and PSH symptoms (OR=11.874, P=0.040) were major influencing factors for abnormal hormone levels. Conclusion The pDOC patients have a high proportion of abnormal pituitary hormones, which is positively correlated with CRS-R score of patients' consciousness level. ICU stay time and PSH symptoms are risk factors of abnormal pituitary hormones.

Objective To investigate the characteristics and related factors of prediabetes residents in Chengguan district of Lanzhou. Methods A cross-sectional study was conducted to investigate the Han residents living in 6 communities in Chengguan district, Lanzhou city, Gansu province, from December 2019 to December 2020. The height and weight were collected and the body mass index (BMI) was calculated. The age, waist circumference, neck circumference, systolic blood pressure, erythrocyte, leukocyte, hemoglobin (Hb), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), fasting plasma glucose (FPG) and 1 h-postprandial plasma glucose (1hPG), 2 h-postprandial plasma glucose (2hPG) after oral glucose tolerance test (OGTT) and glycosylated hemoglobin (HbA1c) were collected. According to the guideline for prevention and treatment of type 2 diabetes in China (2020 Edition), the subjects were divided into prediabetes (PreDM) [including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT] group and normal glucose tolerance (NGT) group. t-test and analysis of variance (ANOVA) were used to compare the groups. Pearson′s correlation analysis was used to analyze the correlation among FPG, 1hPG and 2hPG and clinical indexes in PreDM patients. Results A total of 479 residents were enrolled. There were 131 patients in NGT group, 348 in PreDM group (193, 52 and 103 patients with IGT, IFG and IGT+IFG respectively). Compared with NGT group, BMI, leukocyte, ALT, AST, TG, HbA1c, FPG, 1hPG and 2hPG in PreDM group were all higher (P<0.05). IGT, IFG and IGT+IFG accounted for 55.5% (193/348), 14.9% (52/348) and 29.6% (103/348) respectively. The results of Pearson′s correlation analysis showed that FPG was positively correlated with BMI, TC, HbA1c and Hb in the patients of PreDM group (r values were 0.14, 0.21, 0.15 and 0.14, respectively, all P<0.001), and 1hPG was positively correlated with BMI, AST, ALT, TC, HbA1c, Hb, erythrocyte and leukocyte (r values were 0.25, 0.10, 0.17, 0.08, 0.30, 0.13, 0.18 and 0.20, respectively, all P<0.05); 2hPG was positively correlated with BMI, AST, ALT, HbA1c and leukocyte (r values were 0.16, 0.15, 0.21, 0.22 and 0.13, all P<0.05), and FPG, 1hPG and 2hPG correlated with HDL-C negatively (r values were -0.12, -0.18, -0.21, respectively, all P<0.001). Conclusions There were great differences in lipid metabolism, liver function and blood cell level between PreDM and NGT patients in Chengguan district of Lanzhou city. IGT accounted for the highest proportion among the PreDM patients. [ABSTRACT FROM AUTHOR]

Background: Eosinophilia is a significant factor in asthma severity; however, the prevalence of severe eosinophilic asthma in Saudi Arabia is largely unknown. We aimed to determine the prevalence of the eosinophilic (defined in this study as ≥ 300 cells/mm3 in blood), atopic (atopic phenotype 1, defined in this study as > 100 IU/mL total serum IgE; atopic phenotype 2, defined in this study as > 150 IU/mL), and overlap phenotypes among patients with severe asthma in Saudi Arabia.Methods: A cross-sectional study was conducted in centers specialized in severe asthma management. Patients aged ≥ 12 years with severe asthma were enrolled. Study patients responded to the Global Initiative for Asthma 2018 assessment of asthma control questionnaire and provided study investigators with current information related to the study objectives. Additional medical record data and a blood sample for total serum IgE and complete blood count were collected.Results: A total of 101 patients were enrolled; 83% were female and the mean (standard deviation) age was 48.7 (13.2) years. Forty-five (45%) patients had the eosinophilic phenotype, 50 (50%) had atopic phenotype 1, and 25 (25%) had phenotypic overlap (eosinophilic and atopic 1). Forty-one (41%) patients had atopic phenotype 2 and 23 (23%) had phenotypic overlap (eosinophilic and atopic 2). Asthma control and oral corticosteroid use patterns were similar and there were no significant differences in number of asthma exacerbations across phenotypes.Conclusions: In Saudi Arabia, 45% of patients with severe asthma had the eosinophilic phenotype, which is most likely an underestimation as no clinical features of eosinophilia were taken into account in the definition of eosinophilia. Approximately half of them had phenotypic overlap with the atopic phenotype. Trial registration NCT03931954; ClinicalTrials.gov, April 30, 2019. [ABSTRACT FROM AUTHOR]

aims to analyze the clinical characteristics of HIV-infected patients complicated with venous thromboembolism (VTE). Methods: Seventy HIV-infected patients complicated with VTE were enrolled from Beijing Ditan Hospital Capital Medical University from October 2009 to December 2020 and divided into two groups according to CD4+. The clinical data of 70 patients were observed, including general conditions, laboratory indexes, viral load, antiretroviral therapy (ART) before the diagnosis of VTE, and thrombus treatment. Results: The patients were divided into two groups according to the CD4+ T lymphocyte count. There were 27 patients with a CD4+ T lymphocyte count ≥ 200 cells/ul, classified as group A (27/70, 38.6%), and there were 43 patients with a CD4+ T lymphocyte count < 200 cells/ul, classified as group B (43/70, 61.4%). In group B, these patients included 37 males and 6 females. The average age was 47.1± 12.1 years old. The average levels of the following indexes were: D-dimer, 3.5 mg/L (0.7, 6.9); total cholesterol, 4.4 mmol/L (3.3, 5.5); triglycerides, 1.4 mmol/L (0.9, 2.0); low density lipoprotein, 1.9 mmol/L (1.5,2.5); albumin, 31.8± 6.4 g/L; CD4+, 66 cells/ul (18, 127); viral load, 12347 copies/mL (27, 203936). Sixty-three patients (63/70, 90%) had started highly active ART (HAART) before VTE was diagnosed, 37 patients (37/70, 52.9%) were complicated with bacterial pneumonia, 16 patients had Mycobacterium tuberculosis (16/70, 22.9%), 13 patients had Pneumocystis carinii pneumonia (PCP) (13/70, 18.6%), and eight patients were complicated with cytomegalovirus (CMV) infection (8/70, 11.4%). Twenty-four patients had tumors, and 15 patients had HIV-related tumors (15/70, 21.4%). There were significant differences between the two groups in the time from the diagnosis of HIV to the discovery of thrombosis, the time from ART to the discovery of thrombosis and bacterial pneumonia, and the differences in WBC, PLT, Hb, CRP, PTA, INR, TCHO, LDL-C, ALB, and viral load were statistically significant. Conclusion: The prevalence of VTE in HIV-infected people in the last 11 years was 1.4%. In patients with a high viral load, CRP, D-dimer levels, and low CD4+ and albumin levels, 11.4– 22.9% were complicated with an opportunistic infection, and 21.4% had HIV-related tumors. There were significant differences between the two groups in high viral load, CRP, D-dimer, and low albumin. [ABSTRACT FROM AUTHOR]

South Asian American (SA) women are diagnosed with more aggressive breast cancer than non-Hispanic White (NHW) women. Understanding the factors associated with the types of surgery received by these women sheds light on disease management in these culturally distinct populations. We used data on age at diagnosis, stage, grade, estrogen and progesterone receptors, and surgery from 4,590 SA and 429,030 NHW breast cancer cases in the Surveillance, Epidemiology and End Results (SEER) program. We used logistic regression with surgery as the binary outcome (subcutaneous, total, or radical mastectomy (STRM) versus partial mastectomy, no, unknown or other (PNUM)) and included additive effects of all the variables and interactions of age, stage, grade, and estrogen and progesterone receptors with race/ethnicity. Type I error of 5% was used to assess statistical significance of the effects. SA were significantly more likely than NHW cases to receive STRM relative to PNUM surgery among women diagnosed at or after age 50 years and having localized stage disease (Odds Ratio (OR) = 1.27, 95% Confidence Interval (CI) = 1.06 - 1.52). Further, SA were significantly less likely than NHW cases to receive STRM relative to PNUM surgery among those diagnosed before age 50 years and having regional or distant stage disease (OR = 0.75, 95% CI = 0.59 - 0.95 for age at diagnosis < 40 years; OR = 0.77, 95% CI = 0.62 - 0.95 for age at diagnosis 40-49 years). The type of surgery received by SA and NHW women differ according to age at diagnosis and disease stage. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the progression manifestations and characteristics of pulmonary lesions in patients with COVID-19 by bed-side pulmonary ultrasonography. Methods: A total of 20 COVID-19 patients admitted to the hospital from January to March in 2020 were retrospectively recruited. All cases were diagnosed according to the "Novel Coronavirus Pneumonia Treatment Protocol (Trial 7th edition)". The imaging characteristics of bed-side pulmonary ultrasonography were analyzed and summarized during the different disease stages. Results: The average course of disease was 21.2 days, including 10.5 days of the progression period and 10.7 days of the recovery period. The ultrasound images of the patients were mainly presented as unsmoothed or interrupted pleural line, and B-line distribution was observed in all cases (20/20,100%). The "inflatable signs" in the consolidation lesion were visualized in 16 cases (16/20, 75.00%). In progressive stage, the ultrasound image changed from B-line sign to sieve-like consolidation, then the consolidation aggravated from patchy to chunk-like gradually, with the decreasing air bronchogram sign within the consolidation lesion. While the imaging characteristics of the ultrasound in the recovery stage were opposite to the progress stage, Color mode showed that the perfusion in the lesions of consolidation gradually increased as well. Conclusion: The ultrasonic manifestations of COVID-19 patients had certain characteristics in the different disease stages. The application of ultrasound in these patients could provide imaging evidence in evaluation of the disease courses and therapeutic efficacy.

Bo Ding,1 Lee Kallenbach,2 Lukas Slipski,2 Alan Wilk,2 Dan O’Brien,2 Deniz Guranlioglu3 1AstraZeneca, Gothenburg, Sweden; 2Practice Fusion, San Francisco, CA, USA; 3AstraZeneca, Cambridge, UKCorrespondence: Bo DingAstraZeneca, Pepparedsleden 1, Gothenburg SE 431 83, Mölndal, SwedenTel +46 31 776 2406Email Bo.Ding@astrazeneca.comIntroduction: This retrospective, observational cohort study utilized an integrated dataset from an electronic health records system and a claims database to describe demographic and clinical characteristics, healthcare resource utilization (HCRU), and treatment patterns in COPD patients initiating long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) fixed-dose combination (FDC) treatment in the USA.Methods: Patients were aged ≥ 40 years and had a COPD diagnosis (Practice Fusion system) and ≥ 1 prescription of LAMA/LABA FDC therapy, with an index date (first prescription) 1 May 2014– 31 December 2017. For the HCRU analysis, patients had ≥ 2 claims from the Symphony Health database within 12 months before index. All analyses of outcomes relating to demographic and clinical characteristics, HCRU, and treatment patterns were descriptive.Results: Patients initiating LAMA/LABA FDCs (n=8224) had a mean age of 67.9 years, 52.8% were female, and mean BMI was 29.2 kg/m2. The most common comorbidities were cardiovascular disease (74.3%), hypertension (64.0%), and hyperlipidemia (45.6%). In the 12 months prior to index, 53.1% of patients had used inhaled therapy: 23.4% short-acting therapy only, 16.7% short-acting and maintenance therapy, and 13.1% maintenance therapy only. Amongst users of inhaled therapies, the pMDI was the most frequently used device (64.3%, n=2812/4370). Of 7050 patients included in the HCRU analysis, 79.8% had COPD-related costs; mean cost/patient was $4174. Mean COPD-related costs per patient for moderate and severe exacerbations were $910 and $23,208, respectively. Per-patient costs included $23,032 for inpatient visits, $2358 for emergency visits, $4432 for outpatient visits, and $1989 for pharmacy claims.Conclusion: This observational study is the first to describe the real-world demographic and clinical characteristics and HCRU of patients initiating LAMA/LABA FDC treatment in the USA. Patients were generally elderly and overweight, with comorbidities of CVD, hypertension, and hyperlipidemia. Inpatient visits were the largest contributor to COPD-related costs per patient in the year prior to initiation of LAMA/LABA FDCs.Keywords: muscarinic antagonist, β2-agonist, demographic characteristics, disease characteristics, cost

Abstract Background Since December 2019, the 2019 coronavirus disease (COVID-19) has expanded to cause a worldwide outbreak that more than 600,000 people infected and tens of thousands died. To date, the clinical characteristics of COVID-19 patients in the non-Wuhan areas of Hubei Province in China have not been described. Methods We retrospectively analyzed the clinical characteristics and treatment progress of 91 patients diagnosed with COVID-19 in Jingzhou Central Hospital. Results Of the 91 patients diagnosed with COVID-19, 30 cases (33.0%) were severe and two patients (2.2%) died. The severe disease group tended to be older (50.5 vs. 42.0 years; p = 0.049) and have more chronic disease (40% vs. 14.8%; p = 0.009) relative to mild disease group. Only 73.6% of the patients were quantitative polymerase chain reaction (qPCR)-positive on their first tests, while typical chest computed tomography images were obtained for each patient. The most common complaints were cough (n = 75; 82.4%), fever (n = 59; 64.8%), fatigue (n = 35; 38.5%), and diarrhea (n = 14; 15.4%). Non-respiratory injury was identified by elevated levels of aspartate aminotransferase (n = 18; 19.8%), creatinine (n = 5; 5.5%), and creatine kinase (n = 14; 15.4%) in laboratory tests. Twenty-eight cases (30.8%) suffered non-respiratory injury, including 50% of the critically ill patients and 21.3% of the mild patients. Conclusions Overall, the mortality rate of patients in Jingzhou was lower than that of Wuhan. Importantly, we found liver, kidney, digestive tract, and heart injuries in COVID-19 cases besides respiratory problems. Combining chest computed tomography images with the qPCR analysis of throat swab samples can improve the accuracy of COVID-19 diagnosis.

Background: This US claims-based study aimed to identify and characterize temporal trends in diagnostic pathways for patients likely to have neuromyelitis optica spectrum disorder (NMOSD). Methods: Patients were identified from IBM MarketScan Commercial Databases if, within 1 year, they had two NMOSD claims separated by ≥ 60 days; two transverse myelitis (TM) or optic neuritis (ON) claims separated by ≥ 60 days, and one additional symptom (TM, ON, or area postrema syndrome); or one NMOSD claim and one additional symptom. The first NMOSD or TM/ON claim was the index date, and the second claim was the diagnosis date. Similar methodology was used in temporal trend and incidence and prevalence analyses. Results: Among 1,901 patients with NMOSD, 34.2% were identified by two NMO claims, 53.2% by ON or TM þ1 symptom, and 12.6% by one NMOSD claim þ1 symptom. Anti-aquaporin-4 immunoglobin G (AQP4-IgG) autoantibody tests and magnetic resonance imaging was used for 23.0% and 71.9% of cases, respectively. Across cohorts, 21.4-49.1% had multiple sclerosis (MS) diagnosis claims prior to index date, and 37.3-60.6% had an MS diagnosis, 14.9-31.0% had MS disease-modifying therapy (DMT) claims and 6.3-44.8% had immunosuppressive therapy (IST) claims <1 year after diagnosis. Over time, there were slight changes in MS diagnosis claims, AQP4-IgG autoantibody testing, and DMT and IST use before and after NMOSD diagnosis. Limitations: This study is limited by the information available in US claims databases, which included the potential for misclassification of NMOSD based solely on claims codes and lack of reimbursement for AQP4-IgG testing by insurance companies. Conclusions: Among patients likely to have NMOSD, low AQP4-IgG testing rates, IST use, frequent MS diagnosis claims, and DMT use highlight the need for a diagnostic algorithm and timely treatment of NMOSD. [ABSTRACT FROM AUTHOR]

Introduction: The EyeCOPE study characterized noninfectious intermediate posterior, or panuveitis (NIIPPU) before biologic agents were widely available. Methods: This retrospective, observational study included adults with NIIPPU attending a routine ophthalmological visit. Data were collected from the study visit and medical records. Results: Of 565 patients, 58.8% were female, and the mean age was 41.3 years; 33.8% had idiopathic uveitis and 45.8% had panuveitis. The median time from symptom onset to diagnosis and treatment was 27.0 and 30.5 days, respectively. Patients received immunosuppressants and systemic/local corticosteroids. Most patients experienced substantial decline in ocular function (mean best corrected visual acuity, 0.4 logMAR). Mean total work productivity impairment among employed patients was 31.0%. Most patients reported ocular complications (70.8%) such as vision loss and cataracts. Conclusions: Despite treatment, most patients with NIIPPU experienced a decline in ocular function and ocular complications. There is an unmet need for additional NIIPPU treatment, such as targeted monoclonal antibodies. [ABSTRACT FROM AUTHOR]

Objective: The relationship between autoimmune rheumatic diseases, inflammatory bowel diseases, and carpal tunnel syndrome is unclear. We aimed to survey the occurrence and characteristics of carpal tunnel syndrome in autoimmune rheumatic diseases and inflammatory bowel diseases, compared with the general population. Methods: We used the Longitudinal Health Insurance Database 2015 from Taiwan's National Health Insurance Research Database. Patients diagnosed with autoimmune rheumatic diseases/inflammatory bowel diseases were identified. The incidence rates and surgical rates of carpal tunnel syndrome among individual diseases were calculated. The hazard ratios when compared with age and sex matched, and 1: 1 ratio control groups were surveyed. Results: A total of 2591 women and 701 men were identified. The incidence rate of carpal tunnel syndrome was highest in Crohn disease (1001 per 100,000 person-years, 95% confidence interval = 0-2747), followed by scleroderma and Sjögren syndrome. The incidence rate in the control group was 571 per 100,000 person-years (95% confidence interval = 314-829). Significantly increased adjusted hazard ratios were seen in Sjögren syndrome (1.44, 95% confidence interval = 1.09-1.90) and rheumatic arthritis (1.33, 95% confidence interval = 1.05-1.70). The overall surgical rate was 0.2% in patients with autoimmune rheumatic diseases/inflammatory bowel diseases and 0.3% in the control group, without a significant difference (P = 0.85). Conclusions: Patients with Sjögren syndrome and rheumatic arthritis are susceptible to carpal tunnel syndrome. Patients with autoimmune rheumatic diseases/inflammatory bowel diseases have similar surgical rates as general population. [ABSTRACT FROM AUTHOR]

To determine the clinical profile of axial psoriatic arthritis (PsA) in a worldwide setting. Secondly, to identify factors associated with the development of axial involvement in patients with PsA. Data from 3684 patients with axial spondyloarthritis (axSpA) or PsA from the ASAS-perSpA study were analysed. The ASAS-perSpA is a cross-sectional study that recruited consecutive patients with SpA (as diagnosed by their rheumatologist) from 68 centers worldwide and collected patient and disease data. First, 2651 axSpA patients and 367 PsA patients with any history of axial involvement (axPsA) were compared using logistic regression to later identify predictive factors for rheumatologist diagnosis of axPsA. Secondly, 367 axPsA patients were compared with 666 PsA patients lacking axial involvement (peripheral PsA [pPsA]) and the characteristics associated with axial manifestations were explored by logistic regression analysis. Patients with axPsA were older and less frequently males or HLA*B27 positive in comparison with axSpA patients. Additionally, while patients with axPsA had more peripheral manifestations and psoriasis, other extra-musculoskeletal manifestations (IBD and uveitis) were more frequent in those with axSpA. In the multivariable analysis, older age at diagnosis (OR = 1.04), peripheral arthritis (OR = 7.32) and dactylitis (OR = 2.82) were significantly associated with the diagnosis of axPsA. However, uveitis (OR = 0.22), IBD (OR = 0.12), HLA*B27 carriership (OR = 0.26) or sacroiliitis on imaging (OR = 0.5) were inversely associated with axPsA diagnosis as compared to axSpA. Axial involvement in patients with PsA was significantly associated with male gender (OR = 1.68), elevated CRP (OR = 2.87) and the absence of psoriasis (OR = 0.33). In this worldwide setting axPsA was defined by rheumatologists as a unique phenotype, with disease features lying between axSpA and pure pPsA. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany. Methods Using combined DPV/DIVE registry data, the analysis included patients with T2DM at least ≥ 18 years old who had an estimated glomerular filtration rate (eGFR) value available. CKD was defined as an eGFR 5.5 mmol/L: 3.7% vs. 1.0%). Comorbidities were more common among CKD patients (p

Abstract Background Niemann-Pick disease Type C (NP-C) is a lysosomal lipid storage disorder characterized by progressive neurodegenerative symptomatology. The signs and symptoms of NP-C vary with age at disease onset, and available therapies are directed at alleviating symptoms and stabilizing disease progression. We report the characteristics and factors related to disease progression, and analyze the effect of miglustat treatment on disease progression and patient survival using NP-C disability scales. Methods This retrospective, observational chart review included patients with NP-C from five expert NP-C centers. Patient disability scores were recorded using three published NP-C disability scales, and a unified disability scale was developed to allow comparison of data from each scale. Disease progression was represented by scores on the unified NP-C disability scale. Patients were stratified as infantile (

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The concept of axial spondyloarthritis (axSpA) encompasses both non-radiographic (nr-axSpA) and traditional radiographic axSpA (r-axSpA) forms. The former was conceived following the establishment of the ASAS classification criteria for axSpA, which for the first time included the use of magnetic resonance imaging of the sacroiliac joints. This facilitated the classification of patients with axSpA who did not present substantial structural damage. This conception of nr-axSpA revolutionized the classical understanding of axSpA opening new doors for research and broadening the scope of treatment to the entire spectrum of axSpA. In this sense, epidemiologic patterns of the disease were viewed anew, and early diagnosis became a primary objective in the management of the disease. However, despite these advances, this new axSpA subtype led to some concerns within the scientific community. These issues have been addressed by several studies that set out to clarify the concept of nr-axSpA. In this review, we summarize the findings of the most relevant studies including nr-axSpA and then discuss recent advances in understanding disease clinical patterns, burden of disease, and treatment effects. Current scientific research has shown subtle differences between nr-axSpA and r-axSpA. In the near future, these advances will allow for better management of individual patients across the axSpA spectrum. [ABSTRACT FROM AUTHOR]

Objective: To investigate alterations of language networks and their relation to impaired naming performance in temporal lobe epilepsy (TLE) using functional MRI. Methods: Seventy-two adult TLE patients (41 left) and 36 controls were studied with overt auditory and picture naming fMRI tasks to assess temporal lobe language areas, and a covert verbal fluency task to probe frontal lobe language regions. Correlation of fMRI activation with clinical naming scores, and alteration of language network patterns in relation to epilepsy duration, age at onset and seizure frequency, were investigated with whole-brain multiple regression analyses. Results: Auditory and picture naming fMRI activated the left posterior temporal lobe, and stronger activation correlated with better clinical naming scores. Verbal fluency MRI mainly activated frontal lobe regions. In left and right TLE, a later age of epilepsy onset related to stronger temporal lobe activations, while earlier age of onset was associated with impaired deactivation of extratemporal regions. In left TLE patients, longer disease duration and higher seizure frequency were associated with reduced deactivation. Frontal lobe language networks were unaffected by disease characteristics. Conclusions: While frontal lobe language regions appear spared, temporal lobe language areas are susceptible to dysfunction and reorganisation, particularly in left TLE. Early onset and long duration of epilepsy, and high seizure frequency, were associated with compromised activation and deactivation patterns of task-associated regions, which might account for impaired naming performance in individuals with TLE. [ABSTRACT FROM AUTHOR]

Background: Gastric adenosquamous carcinoma (gasc) is a rare entity with distinctive characteristics that are not fully understood. In the present study, we evaluated the characteristics of this rare disease. Methods: The U.S. Surveillance, Epidemiology, and End Results program database was searched to determine the clinicopathologic features, prognostic factors, and treatments for 246 patients with gasc and 42,735 patients with gastric adenocarcinoma (gac).Results: Relative to gac, gasc is associated with higher proportions of cardia involvement, high-grade tumours, deep tumour invasion, metastatic lymph nodes, and chemotherapy treatment. In patients who underwent potentially curative surgery (pcs), gasc was associated with a higher proportion of radiotherapy use and poorer overall survival (p < 0.001), although no significant difference (p = 0.802) was observed after propensity score matching (psm). Multivariate analysis after psm revealed that the independent prognostic factors for gasc were TNM stage [hazard ratio (hr): 1.512; p = 0.021] and regional nodes examined (hr: 0.588; p = 0.02). In patients with advanced disease, no significant difference in survival between gasc and gac was observed (p = 0.212), although survival was significantly poorer for gasc after psm (p = 0.019). Multivariate analysis after psm revealed that the independent prognostic factors for gasc were invasion depth (hr: 1.303; p = 0.036) and chemotherapy (hr: 0.444; p < 0.001). Conclusions: Relative to gac, gasc was associated with more aggressive features, although survival outcomes were similar after pcs. Chemotherapy remains a mainstay of treatment for patients with advanced gasc, but its role remains unclear for patients who are undergoing pcs. [ABSTRACT FROM AUTHOR]

Conventional AlexNet has the problems of slow training speed, single characteristic scale and low recognition accuracy. To solve these problems, a convolutional neural network identification model based on Inception module and dilated convolution is proposed in this study. The inception module combined with dilated convolution, could extract disease characteristics at different scales and increase the receptive field. By setting different parameters, six improved models were obtained. They were trained to identify 26 diseases of 14 different crops; then the authors selected optimal recognition model. On this basis, the segmented dataset and the grey‐scaled dataset were trained as comparative experiments to explore the influence of background and colour features on the recognition results. After only two training epochs, the improved optimal model could achieve an accuracy of over 95%. Moreover, the final average identification accuracy reached 99.37%. Contrast experiments indicate that colour and background features may influence the recognition effect. The improved model can extract disease information from different scales in the feature map to identify diverse diseases of different crops. The proposed model has faster training speed and higher recognition accuracy than the traditional model, and thus it can provide a reference for crop disease identification in actual production. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of ulcerative colitis (UC) has been reported to be rising in newly industrialised regions, such as Latin America. Here, we review data from published studies reporting demographics and clinical aspects of UC in Latin America to further understand epidemiology and disease burden. The incidence and prevalence of UC in Latin America varied between regions and studies, ranging between 0.04 to 8.00/100,000 and 0.23 to 76.1/100,000, respectively, and generally increased over the period from 1986 to 2015. The majority of patients with UC were female (53.6–72.6%) and urban residents (77.8–97.4%). Extraintestinal manifestations were reported in approximately 26–89.4% of patients. Use of biologic therapies was generally low (0.8–16.2%), with the exception of Mato Grosso do Sul, Brazil, with a greater proportion of patients tending to receive 5-aminosalicylates, immunosuppressants or corticosteroids; colectomy rates varied between studies (1.5–22%). A high proportion of patients had moderate to severe UC (45.9–73.0%) and, in 11 of 19 studies, the greatest proportion of patients had extensive disease (pancolitis). Colorectal cancer (0–1.7%) and mortality rates (0–7.6%) were low. This evaluation of published studies may influence therapeutic approaches and the development of strategies to improve healthcare access and patient outcomes, although further high-quality studies are required in patients with UC in Latin America. [ABSTRACT FROM AUTHOR]

Background: Since December 2019, the 2019 coronavirus disease (COVID-19) has expanded to cause a worldwide outbreak that more than 600,000 people infected and tens of thousands died. To date, the clinical characteristics of COVID-19 patients in the non-Wuhan areas of Hubei Province in China have not been described.Methods: We retrospectively analyzed the clinical characteristics and treatment progress of 91 patients diagnosed with COVID-19 in Jingzhou Central Hospital.Results: Of the 91 patients diagnosed with COVID-19, 30 cases (33.0%) were severe and two patients (2.2%) died. The severe disease group tended to be older (50.5 vs. 42.0 years; p = 0.049) and have more chronic disease (40% vs. 14.8%; p = 0.009) relative to mild disease group. Only 73.6% of the patients were quantitative polymerase chain reaction (qPCR)-positive on their first tests, while typical chest computed tomography images were obtained for each patient. The most common complaints were cough (n = 75; 82.4%), fever (n = 59; 64.8%), fatigue (n = 35; 38.5%), and diarrhea (n = 14; 15.4%). Non-respiratory injury was identified by elevated levels of aspartate aminotransferase (n = 18; 19.8%), creatinine (n = 5; 5.5%), and creatine kinase (n = 14; 15.4%) in laboratory tests. Twenty-eight cases (30.8%) suffered non-respiratory injury, including 50% of the critically ill patients and 21.3% of the mild patients.Conclusions: Overall, the mortality rate of patients in Jingzhou was lower than that of Wuhan. Importantly, we found liver, kidney, digestive tract, and heart injuries in COVID-19 cases besides respiratory problems. Combining chest computed tomography images with the qPCR analysis of throat swab samples can improve the accuracy of COVID-19 diagnosis. [ABSTRACT FROM AUTHOR]

This paper studied the algorithm of drug repositioning based on collaborative filtering. Considering the great influence of data sparsity on collaborative filtering algorithm, it proposed a hybrid recommendation algorithm based on the association of drug and disease characteristics. The algorithm not only used the data of drug and disease, but also used the information of drug structure, target protein, side effect and drug-disease feature matrix to calculate the similarity between drugs, which reduced the influence of data sparsity to the recommendation effect and improved the precision of recommendation. The results of contrastive experiment show that the algorithm has a good recommendation effect, and can explore the drug-disease combinations which have po tential relationship, and further verified that the algorithm can be effectively applied to drug repositioning. [ABSTRACT FROM AUTHOR]

• Clinical and radiological presentation of early-onset multiple sclerosis (EOMS) differs from late-onset and very late-onset multiple sclerosis (LOMS and VLOMS). • While LOMS and VLOMS share similarities in clinical and radiological characteristics at presentation, they differ in some features. • The current classification of LOMS may benefit from revision to better align with chronological age classification for old age >60. Previous studies suggested possible differences in clinical and radiologic characteristics between early-onset multiple sclerosis (EOMS) and late-onset MS (LOMS). However, differences between LOMS and very late onset MS (VLOMS) are largely unknown. We performed a retrospective review of medical records of patients diagnosed with MS between 8/1/2017 and 3/1/2022 at the comprehensive MS center of the Froedtert and Medical College of Wisconsin. We included adult patients with MS diagnosis who were 60 years or older - VLOMS, 50–59 years old at diagnosis – LOMS, or were 18–30 years old at diagnosis – EOMS and had complete imaging and clinical records. Clinical presentation and location of demyelinating lesions at the onset of diagnosis were extracted and compared using the chi-square test, p <0.05. A total of 246 newly diagnosed patients were identified. Of which 54 were EOMS, 29 were LOMS, and 35 were VLOMS. The sex ratio was not different between groups. EOMS had a higher percentage of patients who self-identified as black, while LOMS had a higher percentage of patients who self-identified as white. LOMS and VLOMS showed significant differences in the presence of tremors and lesion distribution at the onset. Older onset patients were more likely to present with motor symptoms, sphincter dysfunction, fatigue, and tremor. EOMS was more likely to present with cerebellum and occipital lobe lesions, and lesions were more likely to show contrast enhancement on MRI at diagnosis. Our findings revealed novel clinical and imaging characteristics differences between VLOMS and LOMS. The current classification of LOMS may benefit from revision to better align with chronological age classification for old age >60 instead of the current standard in the literature of >50 years. [ABSTRACT FROM AUTHOR]