[Analysis of Vegetation Change and Influencing Factors in Southwest Alpine Canyon Area].

The southwest alpine canyon area is a typical ecologically fragile area. Understanding the characteristics of vegetation change here and its influencing factors can provide a theoretical basis for formulating countermeasures for ecological environment construction in the southwest alpine canyon area and has practical significance for realizing the harmonious and unified development of the regional economy, environment, and ecology. Based on the data set of NDVI, socio-economic factors, and natural factors from 2000 to 2019, the spatial and temporal variation and stability characteristics of NDVI in the southwest alpine canyon area were analyzed by using the methods of unary linear regression, Hurst index, geographic detector model, and coefficient of variation, and the influencing factors of the spatial differentiation of NDVI were also discussed. The results showed that:① in terms of spatial distribution, the vegetation was high in the southeast and low in the northwest. The area covered by medium and high vegetation accounted for 71.71%, and the vegetation cover was at a relatively high level. From the perspective of time, the area of vegetation showing an improvement trend accounted for 85.90%, and the recovery effect was obvious, and the future vegetation change trend will continue to be improved. ② Elevation, vegetation type, and soil type were the main factors affecting the spatial differentiation of NDVI, and the q value was no less than 0.40. Temperature and rainfall were secondary factors, with q values of 0.274 and 0.225, respectively. The dual-factor interaction enhanced the single factor influence, which was manifested as the dual-factor enhancement and nonlinear enhancement relationship. The highest q value was 0.714 for the combination of altitude ∩ vegetation, followed by 0.688 for the combination of altitude ∩ soil. ③ The overall stability of NDVI during the study period was good, and the proportion of the regional area with low fluctuating changes and slightly low fluctuating changes was 89.95%. The area with moderate fluctuation accounted for 10.05%, concentrated in the relatively fragile ecological environment with factors such as high altitude, low temperature, little rainfall, barren soil, and sparse vegetation. Vegetation change is the result of a combination of multiple factors, so it is necessary to adapt to local conditions and adopt different strategies to restore the ecological environment of the southwest alpine canyon area.

Targeted Degradation of XIAP is Sufficient and Specific to Induce Apoptosis in MYCN-overexpressing High-risk Neuroblastoma.

XIAP, the most potent mammalian inhibitor of apoptosis protein (IAP), critically restricts developmental culling of sympathetic neuronal progenitors, and is correspondingly overexpressed in most MYCN-amplified neuroblastoma tumors. Because apoptosis-related protein in the TGFß signaling pathway (ARTS) is the only XIAP antagonist that directly binds and degrades XIAP, we evaluated the preclinical effectiveness and tolerability of XIAP antagonism as a novel targeting strategy for neuroblastoma. We found that antagonism of XIAP, but not other IAPs, triggered apoptotic death in neuroblastoma cells. XIAP silencing induced apoptosis while overexpression conferred protection from drug-induced apoptosis. From a screen of IAP inhibitors, first-in-class ARTS mimetic A4 was most effective against high-risk and high XIAP-expressing neuroblastoma cells, and least toxic toward normal liver- and bone marrow-derived cells, compared with pan-IAP antagonists. On target engagement assays and nuclear magnetic resonance spectroscopy, A4 was observed to degrade rather than inhibit XIAP, catalyzing rapid degradation of XIAP through the ubiquitin-proteasome pathway. In MYCN-amplified neuroblastoma patient-derived xenografts, A4 significantly prolonged survival as a single agent, and demonstrated synergism with standard-of-care agents to reduce their effective required doses 3- to 6-fold. Engagement and degradation of XIAP by ARTS mimetics is a novel targeting strategy for neuroblastoma that may be especially effective against MYCN-amplified disease with intrinsically high XIAP expression. First-in-class ARTS mimetic A4 demonstrates preclinical efficacy and warrants further development and study. SIGNIFICANCE: XIAP degradation is sufficient to kill MYCN-amplified neuroblastoma which overexpresses and relies on XIAP as a brake against cell death, without affecting normal cells.

Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

BACKGROUND: Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy (MT). Most patients undergoing MT are also given thrombolysis. Antiplatelet agents are contraindicated within 24 hours of thrombolysis. We evaluated outcomes and complications of patients stented with and without intravenous aspirin during MT. METHODS: All patients who underwent emergent extracranial stenting during MT at the Royal Stoke University Hospital, UK between 2010 and 2020, were included. Patients were thrombolysed before MT, unless contraindicated. Aspirin 500 mg intravenously was given intraoperatively at the discretion of the operator. Symptomatic intracranial haemorrhage (sICH) and the National Institutes for Health Stroke Scale score (NIHSS) were recorded at 7 days, and mortality and functional recovery (modified Rankin Scale: mRS ≤2) at 90 days. RESULTS: Out of 565 patients treated by MT 102 patients (median age 67 IQR 57-72 years, baseline median NIHSS 18 IQR 13-23, 76 (75%) thrombolysed) had a stent placed. Of these 49 (48%) were given aspirin and 53 (52%) were not. Patients treated with aspirin had greater NIHSS improvement (median 8 IQR 1-16 vs median 3 IQR -9-8 points, p=0.003), but there were no significant differences in sICH (2/49 (4%) vs 9/53 (17%)), mRS ≤2 (25/49 (51%) vs 19/53 (36%)) and mortality (10/49 (20%) vs 12/53 (23%)) with and without aspirin. NIHSS improvement (median 12 IQR 4-18 vs median 7 IQR -7-10, p=0.01) was greater, and mortality was lower (4/33 (12%) vs 6/15 (40%), p=0.05) when aspirin was combined with thrombolysis, than for aspirin alone, with no increase in bleeding. CONCLUSION: Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes, even when combined with intravenous thrombolysis.

Explainable artificial intelligence for searching frequency characteristics in Parkinson's disease tremor.

The distinction between Parkinson's disease (PD) and essential tremor (ET) tremors is subtle, posing challenges in differentiation. To accurately classify the PD and ET, BiLSTM-based recurrent neural networks are employed to classify between normal patients (N), PD patients, and ET patients using accelerometry data on their lower arm (L), hand (H), and upper arm (U) as inputs. The trained recurrent neural network (RNN) has reached 80% accuracy. The neural network is analyzed using layer-wise relevance propagation (LRP) to understand the internal workings of the neural network. A novel explainable AI method, called LRP-based approximate linear weights (ALW), is introduced to identify the similarities in relevance when assigning the class scores in the neural network. The ALW functions as a 2D kernel that linearly transforms the input data directly into the class scores, which significantly reduces the complexity of analyzing the neural network. This new classification method reconstructs the neural network's original function, achieving a 73% PD and ET tremor classification accuracy. By analyzing the ALWs, the correlation between each input and the class can also be determined. Then, the differentiating features can be subsequently identified. Since the input is preprocessed using short-time Fourier transform (STFT), the differences between the magnitude of tremor frequencies ranging from 3 to 30 Hz in the mean N, PD, and ET subjects are successfully identified. Aside from matching the current medical knowledge on frequency content in the tremors, the differentiating features also provide insights about frequency contents in the tremors in other frequency bands and body parts.

Tocotrienol-Rich Fraction Attenuates Blue Light-Induced Oxidative Stress and Melanogenesis in B16-F1 Melanocytes via Anti-Oxidative and Anti-Tyrosinase Properties.

Our skin is constantly exposed to blue light (BL), which is abundant in sunlight and emitted by digital devices. Prolonged exposure to BL can lead to oxidative stress-induced damages and skin hyperpigmentation. For this study, we used a cell line-based model to examine the protective effects of tocotrienol-rich fraction (TRF) on BL-induced oxidative stress and hyperpigmentation in B16-F1 melanocytes. Alpha-tocopherol (αTP) was used as a comparator. Molecular assays such as cell viability assay, flow cytometry, western blotting, fluorescence imaging, melanin and tyrosinase analysis were performed. Our results showed that TRF effectively suppressed the formation of reactive oxygen species and preserved the mitochondrial membrane potential. Additionally, TRF exhibited anti-apoptotic properties by reducing the activation of the p38 mitogen-activated protein kinase molecule and downregulating the expression of cleaved caspase-3. Moreover, TRF modulated tyrosinase activity, resulting in a lowered rate of melanogenesis and reduced melanin production. In contrast, αTP did not exhibit significant protective effects against skin damages and pigmentation in BL-induced B16-F1 cells. Therefore, this study indicates that TRF may offer superior protective effects over αTP against the effects of BL on melanocytes. These findings demonstrate the potential of TRF as a protective natural ingredient that acts against BL-induced skin damages and hyperpigmentation via its anti-oxidative and anti-melanogenic properties.

Oncologic outcomes after breast-conserving surgery with radiotherapy versus mastectomy in patients with Paget's disease of the breast: systematic review and meta-analysis.

BACKGROUND: The conventional approach to treatment for Paget's disease of the breast has been mastectomy, but there is an increasing trend to consider breast-conserving surgery (BCS) followed by radiotherapy (RT) in these patients. This study aimed to provide an updated systematic review and meta-analysis comparing outcomes after BCS with RT versus mastectomy in the treatment of Paget's disease of the breast. METHODS: Studies before May 2021 were included. Primary outcomes were overall survival and local recurrence. Separate analyses of Paget's disease associated with ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) were undertaken. Meta-regression was used to adjust for imbalance in the proportion of IDC among patients selected to undergo BCS versus mastectomy. RESULTS: Overall survival in patients with Paget's disease who underwent BCS with RT was higher than for those who underwent mastectomy with pooled mortality hazard ratio (HR) of 0.68, (95% per cent c.i. 0.45 to 1.01). Patients with Paget's disease with DCIS had higher overall survival after BCS with or without RT versus mastectomy, with adjusted HR of 0.14 (0.10 to 0.20) and 0.28 (0.22 to 0.36), respectively. For patients with Paget's disease and IDC, overall survival was lower for BCS with or without RT versus mastectomy, with adjusted HR of 0.84 (0.57 to 1.25) and 1.64 (1.04 to 2.58), respectively. In Paget's disease and IDC, local recurrence risk was much higher for BCS with RT, RR 26.8 (1.60 to 456) versus without RT, RR 51.8 (6.80 to 391). In patients with Paget's disease and DCIS, risk of local recurrence versus mastectomy was lower for BCS with RT 0.72 (0.11 to 4.50) but slightly higher for BCS alone 1.38 (0.09 to 21.20). CONCLUSION: BCS with RT may be a comparable treatment alternative to mastectomy for patients with Paget's disease with DCIS, and for selected patients with Paget's disease and IDC.

Decreasing appointment waiting days for first consultation for patients attending adult weight management clinic in a tertiary hospital.

Adult weight management (AWM) clinic at our tertiary institution is a clinical service run for overweight or obese adult women, who are also under the care of gynaecologists for subfertility or menstrual irregularities. Unfortunately, the appointment waiting days for the first consultation at AWM clinic were long, which affected the timeliness of care given to our patients. We suspect that the referred patients are more likely to forget or lose motivation during the long waiting days, resulting in higher non-attendance rates.Baseline data confirmed that average of median appointment waiting days for the first consultation was 74 days. A multidisciplinary team of weight management clinic stakeholders was created to address this issue. Following a root cause analysis, the team implemented two interventions to improve appointment waiting days.The first intervention was offering video consultation to new cases for AWM clinic. This increased the clinic capacity without requiring additional physical clinic space. The referral criteria were refined to target patients who are most likely to benefit from the services provided at our institution. The second intervention was creating AWM clinic appointments only after patients completed the required laboratory investigations for obesity workup.A run chart demonstrated average of median appointment waiting days decreased from 74 days to 34 days after implementation of the second intervention (p=0.0104). The team successfully decreased and sustained the lower appointment waiting days through innovative interventions that increased clinic capacity and improved patient selection, with the potential to further increase clinic capacity if the demand surges.

Targeting mutant dicer tumorigenesis in pleuropulmonary blastoma via inhibition of RNA polymerase I.

DICER1 mutations predispose to increased risk for various cancers, particularly pleuropulmonary blastoma (PPB), the commonest lung malignancy of childhood. There is a paucity of directly actionable molecular targets as these tumors are driven by loss-of-function mutations of DICER1. Therapeutic development for PPB is further limited by a lack of biologically and physiologically-representative disease models. Given recent evidence of Dicer's role as a haploinsufficient tumor suppressor regulating RNA polymerase I (Pol I), Pol I inhibition could abrogate mutant Dicer-mediated accumulation of stalled polymerases to trigger apoptosis. Hence, we developed a novel subpleural orthotopic PPB patient-derived xenograft (PDX) model that retained both RNase IIIa and IIIb hotspot mutations and recapitulated the cardiorespiratory physiology of intra-thoracic disease, and with it evaluated the tolerability and efficacy of first-in-class Pol I inhibitor CX-5461. In PDX tumors, CX-5461 significantly reduced H3K9 di-methylation and increased nuclear p53 expression, within 24 hours' exposure. Following treatment at the maximum tolerated dosing regimen (12 doses, 30 mg/kg), tumors were smaller and less hemorrhagic than controls, with significantly decreased cellular proliferation, and increased apoptosis. As demonstrated in a novel intrathoracic tumor model of PPB, Pol I inhibition with CX-5461 could be a tolerable and clinically-feasible therapeutic strategy for mutant Dicer tumors, inducing antitumor effects by decreasing H3K9 methylation and enhancing p53-mediated apoptosis.

Spelling as a way to classify poor Chinese-English literacy skills in Hong Kong Chinese children.

Previous work has predominantly focused on word reading in studying literacy difficulties; very little work has focused on spelling difficulty instead. The present study adopted spelling (dictation) as the criterion to classify poor literacy skills in Hong Kong Chinese-English bilingual children. We examined the cognitive-linguistic skills profiles across four groups of children with different spelling abilities. Based on performances on Chinese and English dictation (criterion = below 25% in a larger sample), four groups were identified, 21 poor spellers of Chinese (PC), 18 poor spellers of English (PE), 27 poor spellers of both languages (PB), and 30 good spellers of both scripts (GB). Measures on language-specific tests of cognitive-linguistic skills (phonological awareness, lexical decision, morphological awareness, rapid naming, and delayed copying) were included to compare the degree of deficit exhibited by each group. With age, grade, and non-verbal intelligence controlled, one-way ANCOVA results revealed that, compared to GB, PC manifested significant deficits in Chinese-delayed copying but scored similarly on all English cognitive-linguistic skills. PE and PB showed significant deficits in Chinese and English phonological awareness compared to PC; they were significantly weaker in English-delayed copying, morphological awareness, and rapid naming (RAN). The PB group was significantly slower in both Chinese and English RAN compared to GB. Findings highlight the critical role of delayed copying in distinguishing poor spellers in both Chinese and English, the importance of phonological awareness for spelling in English but not in Chinese, and the role of automaticity in bilingual spelling difficulties.

Construct validity of international literacy measures: implications for dyslexia across cultures.

Construct validity is essential to evaluate the generalizability of findings on literacy and dyslexia. Operational definitions of reading literacy determine the measurement method, yielding territory or country-wide literacy rates. This practice echoes the norm in diagnosis and prevalence estimates of dyslexia. International Large-Scale Assessments (ILSA) of literacy such as the Programme for International Student Assessment (PISA) compare countries' performances in relation to how well their students are reading. In this paper, we reexamine the validity claims and evidence using the examples of countries in Southeast Asia-Indonesia, Malaysia and Thailand, purported to have high proportions of poor readers. The challenge of characterizing reading performance and designing suitable measures for valid international comparisons is similar across phases of reading development and proficiency. The importance of the specificity of scripts and languages for reading abilities and impairments is highlighted. We suggest ways in which researchers can approach the assessment of reading proficiency from a cross-cultural and an interdisciplinary perspective. These can foster contextual caveats for generating and interpreting evidence.

Activation function 1 of progesterone receptor is required for progesterone antagonism of oestrogen action in the uterus.

BACKGROUND: Progesterone receptor (PGR) is a master regulator of uterine function through antagonistic and synergistic interplays with oestrogen receptors. PGR action is primarily mediated by activation functions AF1 and AF2, but their physiological significance is unknown. RESULTS: We report the first study of AF1 function in mice. The AF1 mutant mice are infertile with impaired implantation and decidualization. This is associated with a delay in the cessation of epithelial proliferation and in the initiation of stromal proliferation at preimplantation. Despite tissue selective effect on PGR target genes, AF1 mutations caused global loss of the antioestrogenic activity of progesterone in both pregnant and ovariectomized models. Importantly, the study provides evidence that PGR can exert an antioestrogenic effect by genomic inhibition of Esr1 and Greb1 expression. ChIP-Seq data mining reveals intermingled PGR and ESR1 binding on Esr1 and Greb1 gene enhancers. Chromatin conformation analysis shows reduced interactions in these genes' loci in the mutant, coinciding with their upregulations. CONCLUSION: AF1 mediates genomic inhibition of ESR1 action globally whilst it also has tissue-selective effect on PGR target genes.

Poor sleep quality is associated with fatigue and depression in early Parkinson's disease: A longitudinal study in the PALS cohort.

Background: Sleep disorders are common in Parkinson's disease (PD). However, the longitudinal relationship between sleep quality and the other non-motor symptoms of PD has not been well characterized, especially in early PD. Objective: To explore the value of baseline sleep quality in predicting the progression of other non-motor symptoms in early PD. Methods: 109 early PD patients were recruited to the study. Patients were stratified into good and poor sleepers using the Pittsburgh Sleep Quality Index (PSQI). Assessments performed at baseline and 1 year follow-up included the Epworth Sleepiness Scale, Fatigue Severity Scale, Non-Motor Symptom Scale, Geriatric Depression Scale, Hospital Anxiety and Depression Scale, Apathy Scale, Montreal Cognitive Assessment and detailed neuropsychological assessments. Multivariable linear regression was performed at baseline to investigate differences in clinical scores between poor and good sleepers, while multivariable regression models were used to investigate associations between sleep quality and progression of test scores at 1 year follow-up. Results: 59 poor sleepers and 50 good sleepers were identified. At baseline, poor sleepers had greater HADS anxiety scores (p = 0.013) [2.99 (95% CI 2.26, 3.73)] than good sleepers [1.59 (95% CI 0.75, 2.42)]. After 1 year, poor sleepers had greater fatigue (FSS scores +3.60 as compared to -2.93 in good sleepers, p = 0.007) and depression (GDS scores +0.42 as compared to -0.70, p = 0.006). Conclusion: This study shows a longitudinal association between sleep quality, fatigue, and depression in early PD patients, independent of medication effect and disease severity, this may support the hypothesis that a common serotonergic pathway is implicated in these non-motor symptoms.

One year clinical outcomes of Rutherford 6 chronic limb threatening ischemia patients undergoing lower limb endovascular revascularisation from Singapore.

BACKGROUND: Percutaneous transluminal angioplasty (PTA) is widely used as a first-line revascularisation option in patients with chronic limb threatening ischemia (CLTI). This study aimed to evaluate the short-term endovascular revascularisation treatment outcomes of a cohort of Rutherford 6 (R6) CLTI patients, from a multi-ethnic Asian population in Singapore. Patients with R6 CLTI who underwent endovascular revascularisation from June 2019 to February 2020 at Singapore General Hospital, a tertiary vascular centre in Singapore, were included and followed up for one year. Primary outcome measures included number and type of reinterventions required, 3-, 6- and 12-month mortality, 6- and 12-month amputation free survival (AFS), wound healing success and changes in Rutherford staging after 3, 6 and 12 months. RESULTS: Two hundred fifty-five procedures were performed on 86 patients, of whom 78 (90.7%) were diabetics, 54 (62.8%) had coronary artery disease (CAD) and 54 (62.8%) had chronic kidney disease (CKD). 42 patients (48.8%) required reintervention within 6 months. Multivariate analysis revealed that the presence of CAD was a significant independent predictor for reintervention. Mortality was 15.1%, 20.9% and 33.7% at 3, 6 and 12 months respectively. AFS was 64.0% and 49.4% at 6 and 12 months. Inability to ambulate, congestive heart failure (CHF), dysrhythmia and CKD were significant independent predictors of lower 12-month AFS. CONCLUSIONS: PTA for R6 CLTI patients was associated with relatively high mortality and reintervention rates at one year. CAD was an independent predictor of reintervention. More research is required to help risk stratify which CLTI patients would benefit from an endovascular-first approach versus conservative treatment or an immediate major lower extremity amputation policy.

Activation function 1 of progesterone receptor is required for mammary development and regulation of RANKL during pregnancy.

Progesterone receptor (PGR) is a member of the nuclear receptor superfamily of transcription factors. It is critical for mammary stem cells expansion, mammary ductal branching and alveologenesis. The transcriptional activity of PGR is mainly mediated by activation functions AF1 and AF2. Although the discovery of AF1 and AF2 propelled the understanding of the mechanism of gene regulation by nuclear receptors, their physiological roles are still poorly understood. This is largely due to the lack of suitable genetic models. The present study reports gain or loss of AF1 function mutant mouse models in the study of mammary development. The gain of function mutant AF1_QQQ exhibits hyperactivity while the loss of function mutant AF1_FFF shows hypoactivity on mammary development. However, the involvement of AF1 is context dependent. Whereas the AF1_FFF mutation causes significant impairment in mammary development during pregnancy or in response to estrogen and progesterone, it has no effect on mammary development in nulliparous mice. Furthermore, Rankl, but not Wnt4 and Areg is a major target gene of AF1. In conclusion, PGR AF1 is a pivotal ligand-dependent activation domain critical for mammary development during pregnancy and it exerts gene specific effect on PGR regulated genes.

Modified compression therapy in mixed arterial-venous leg ulcers: An integrative review.

Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt identification of concomitant arterial occlusive disease is critical to determine underlying aetiology and subsequent management. This integrative review presents the current evidence to establish the role of modified compression therapy (MCT) in treatment of mixed arterial venous leg ulcers (MAVLU). A literature search was conducted using the electronic databases CINAHL, MEDLINE, PUBMED, and Embase. Ten studies met the eligibility criteria and were subsequently analysed. Our review concludes that MCT, with compression pressures between 20 and 30 mmHg, can promote healing in MAVLU with moderate arterial insufficiency (0.5 ≤ ABPI ≤0.8). If ABPI is <0.5, MCT can be considered once restoration of acceptable ABPI is achieved. Intolerance, lack of response or further deterioration of disease within 3 months should prompt further arterial imaging and intervention. MCT is generally well tolerated with no adverse outcomes reported. A holistic yet individualised approach is vital in order to account for all factors influencing this patient-led decision-making process, ultimately ensuring effective treatment, which improves patient's quality of life and reduces socioeconomic burden of the disease.

A first-principles study on strain engineering of monolayer stanene for enhanced catalysis of CO2 reduction.

Using first-principles calculations, we investigated the changes in the lattice structure, electronic structures and catalytic performance for CO2 reduction reaction (CO2RR) of stanene under applied strain. Our calculations showed that the initial buckled honeycomb structure of free-standing stanene becomes increasingly flat upon the increase of tensile strain. Stanene remains its gapless semiconductor characteristic within the strain range of -2% and 2%, beyond which a semiconductor-to-metal transition occurs. Under strain, the adsorption of CO is weakened, which can facilitate the desorption of product CO, enabling a strained stanene to be a better catalyst for CO2RR to CO than strain-free stanene. In particular, the stanene with 4% strain may give rise to the best performance because of the weakest CO adsorption (Eadsorp= -0.15 eV). The adsorption of intermediate product COOH on stanene is tunable with strain. We also evaluated the overall catalytic performance of the strained stanene based on the adsorption of CO and COOH and the selectivity against HER. If the reduction of COOH is governed by adsorption of the intermediate, a 10% strain may give a stronger COOH adsorption, weaker CO adsorption and better selectivity against HER, leading to an enhanced catalytic performance for CO2RR to CO. On the other hand, if the reduction of COOH is governed by desorption, a tensile strain higher than 4% may result in an enhanced catalytic performance. Our study here suggests that strain-tuned stanene might serve as an optimal electrocatalyst for CO2RR to CO with a high activity and selectivity.

Subjective cognitive Complaints in early Parkinson's disease patients with normal cognition are associated with affective symptoms.

INTRODUCTION: Subjective cognitive complaints (SCC) and affective symptoms are highly prevalent in Parkinson's Disease (PD). In early PD, SCC prevalence and its affective correlates, using recommended Movement Disorders Society (MDS) Level II Criteria to define the underlying cognitive impairment, has not been previously explored. METHODS: We recruited 121 participants with early PD from two tertiary hospitals in Singapore. The presence of SCC was defined using a Non-Motor Symptoms Scale Domain-5 Score ≥1. Comprehensive neuropsychological testing was conducted with Mild Cognitive Impairment (PD-MCI) defined using recommended MDS Level II Criteria. Affective symptoms were assessed using the Hospital Anxiety Depression Scale (HADS), Geriatric Depression Scale (GDS) and Apathy Scale (AS). Analysis using multivariable linear regression model was performed. RESULTS: In our early PD cohort, SCC prevalence independent of underlying cognitive status was 38.8%. Prevalence of SCC in cognitively impaired and cognitively normal participants was 10.7% and 28.1% respectively (р = 0.241). In cognitively normal PD participants, multivariable linear regression analysis revealed that SCC was significantly associated with anxiety (ß = 0.28, 95% CI = 0.09-0.79, p = 0.014), depression (ß = 0.31, 95% CI = 0.10-0.59, p = 0.006) and apathy (ß = 0.32, 95% CI = 1.15-5.98, p = 0.004). Such an association was not found in cognitively impaired PD participants. CONCLUSION: SCC is highly prevalent even in early PD. Its implications in early PD differ depending on underlying cognitive status. SCC in cognitively impaired participants underestimates the true prevalence of PD-MCI. In contrast, SCC in cognitively normal participants is suggestive of an underlying affective disorder.

Strategies for Management of Peritoneal Dialysis Patients in Singapore during COVID-19 Pandemic.

Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory.