ABSTRACT:Background:Little is known about the potential systemic effects of ankylosing spondylitis (AS) on the nervous system. We designed a study aiming to assess the frequency and clinical predictors of cognitive impairment in AS patients.Methods:We carried out a cross-sectional case–control study composed of consecutive patients with AS. Trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire. Cognitive impairment was evaluated with the Brief Cognitive Screening Battery, the Montreal Cognitive Assessment, and the Clinical Dementia Rating, while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale. Healthy controls were matched for age, educational attainment, sex, and comorbidities. We compared the neurological outcomes between case and controls, and we determined the clinical predictors of cognitive decline.Results:We included 40 patients (mean: 49.3 years) with AS and 40 healthy controls (mean: 48.8 years) in our study. In Brief Cognitive Screening Battery, patients with AS presented a statistically significant poor performance in the clock drawing test and in the verbal fluency. The mean Montreal Cognitive Assessment (MoCA) scores were significantly lower in AS subjects compared to the control group. Also, the prevalence of subjects classified as cognitively impaired according to MoCA was significantly higher in the AS group (90.0% vs. 57.5%, p = 0.02). Moreover, neuropsychiatric symptoms were more prevalent in AS patients. Worse functional limitations were associated with poor cognitive performance as well.Conclusions:Patients with AS might be more vulnerable to cognitive decline.

e13530 Background: Pediatric hematology and oncology (PHO) facilities are not all equally equipped to diagnose and treat the full range of childhood cancers. Proposed facility tier models have been published to facilitate the context-based adaptation of PHO diagnostic and treatment guidelines. However, a tool to assist facilities in identifying their level of PHO care does not exist. We assessed the feasibility of using the St. Jude Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool to identify (1) facility levels as defined by the International Society of Pediatric Oncology (SIOP) and the Lancet Oncology Commission (LOC) for sustainable care for children with cancer, and (2) treatment strata in the Adapted Resource and Implementation Application (ARIA) Guide. Methods: This study employed a multi-step mapping approach. We mapped the 1,279 PrOFILE tool variables to the nine SIOP service lines, ten LOC domains, and ten ARIA resource groups. Mapping was performed by two teams and carried out in two different rounds. The first round aimed to define if an indicator was fully or partially covered by PrOFILE. Multiple PrOFILE variables could be assigned to each concept to meet its content specificity. Various cut-offs were applied when necessary to assign mutually exclusive responses to each tier. The second round consisted of expert validation for each indicator previously identified. Results: Most (97%) of SIOP’s indicators were partially or fully covered in the PrOFILE tool (Table). Radiation therapy tools and appointment scheduling and call back system could not be mapped. Of the LOC indicators, 89% were covered (Table). Pathology technical staff, chemotherapy complexity (low, moderate, and high), lymph node biopsy, organ preservation, liver transplantation, intensity-modulated radiotherapy, and research infrastructure could not be mapped. Finally, 77% of the indicators used by the ARIA Guide were covered (Table). The ophthalmology resource group could not be fully mapped. Conclusions: This exercise demonstrates the feasibility of using PrOFILE tool variables to identify facility PHO care levels as defined by SIOP and LOC. The tool also contains most of the variables necessary to apply the ARIA Guide to diagnose, treat, and manage childhood cancer. Future PrOFILE versions will address concepts that are not covered or are partially covered in its current version.[Table: see text]

Introduction: World population has an increased risk of developing basic neurological deterioration and mild cognitive impairment (MCI). Currently, there is no cure or disease-modifying drug for MCI. Thus, non-pharmacological interventions such as physical activity (PA) and behavioral activation (BA) arise as potential treatment options. This study will assess if a program of combined PA and BA (PABA) reduces disease progression in patients over 60 years old with MCI.Methods: This is a randomized, controlled, phase II, parallel, single-blinded, multicenter, superiority trial with two groups. In total, 184 patients will be randomized at a 1:1 ratio and stratified by age, center, and level of education via permuted block sizes to receive: 1) a combination of moderate-to-high intensity PABA or 2) sham intervention (low-intensity PA) plus psychological support (active control). The primary outcome will be a change in cognitive function assessed by Montreal Cognitive Assessment (MoCA) from baseline to 12 months. Secondary outcomes include changes in MoCA at 3, 6, and 9 months. Furthermore, at 0, 3, 6, 9, and 12 months, subjects will be tested with the Barthel Index, Short-Form 12 Health Survey (SF-12), and Geriatric Depression Scale (GDS-15).

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Background: psoriasis is an in ammatory disease of the skin, characterized by erythematous plaques. It is rather common, affecting 2-4% of the population in western countries. Psoriasis' etiology encompasses both genetic and environmental factors. Evidence suggests that the latter re ect the importance of changes in the microbiome for developing the disease. Thus, it is hypothesized that gut microbiome manipulation may arise as a way of treating psoriasis. However, few trials assessed the use of probiotics in psoriasis, although promising results were detected in small studies.Objectives: to assess the e cacy of adjuvant probiotics (Lactobacillus rhamnosus) in treating plaque psoriasis patients.Design, Setting and Participants: this was a randomized, parallel, placebo-controlled, double-blind trial with two arms: experimental (n=50) and control (n=53). Inclusion of subjects and data gathering lasted from November 2020 to August 2021. Subjects were consecutive plaque psoriasis patients under regular follow-up in the Dermatology unit of a university-a liated, tertiary-referral hospital in São Paulo (Brazil).Eligibility criteria included being over 18 years old, having plaque psoriasis and not having other skin diseases, neoplasms nor systemic in ammatory diseases.Interventions: subjects received standard-of-care plus probiotics (Lactobacillus rhamnosus formula). Controls received standard-of-care plus placebo.Main Outcome Measure: primary outcome was skin lesion improvement as assessed by Psoriasis Area of Severity Index (PASI) at six months. Secondary outcome was quality-of-life as assessed by Dermatology Life Quality Index (DLQI) at six months.Results: regarding within-group analyses, changes in both PASI and DLQI were non-signi cant for the experimental group (mean PASI decreased by 1.58, p=0.105, and mean DLQI increased by 0.05, p=0.873) and signi cant for controls (mean PASI decreased by 1.90, p=0.019, and mean DLQI decreased by 3.33, p=0.031). Between-group analyses returned non-signi cant results (p=0.620).Conclusions: our ndings do not support the hypothesis that gut microbiome modulation via ingestion of Lactobacillus rhamnosusproduces clinical improvement in psoriasis patients. Further research is encouraged.Trial Registration: retrospectively registered at the Brazilian Clinical Trials Registry (RBR-8js7t83) on 08/02/2022.