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24-year-old man presented with drowsiness, worsening cognitive impairment and a mixed movement disorder. He was adopted as a child and was reported to be independent and working one year before admission, but progressively slow and unable to self-care since. On examination, he was cognitively impaired on all domains. He had increased tone, brisk reflexes and extensor plantars. There were dysto- nia-parkinsonian features of dystonic tremor and bradykinesia, slow saccades and oculomotor apraxia, along with motor impersistence. After exclusion of chronic infections, the working diagnosis was of a neurodegenerative movement disorder. Whilst there was no overt chorea, the differentials for juvenile Huntingdon’s disease (HD) were explored, and HD ultimately confirmed on genetic testing.Learning PointsJuvenile HD patients may not have chorea but may be rigid or parkinsonian.Slow saccades are most prominent in juvenile HD patients, even early.Involuntary movements are often partially suppressible, and mild chorea is easily overlooked. Look for involuntary head turns, fidgety movements of the fingers and toes, frequent blinking and odd facial expressions.Test for motor impersistence in these individuals.Gait may appear normal but tandem walk may bring out chorea, imbalance, or other problems.katieyoganathan@gmail.com

IntroductionStrategy, evidence and anticipation should underpin workforce-planning.AimTo estimate a sustainable patient-caseload (PCL) for a full-time equivalent MS specialist neurologist (FTE-MSologist).MethodsHypothetically, an FTE-MSologist refers to 10-MSology-related programmed activities per week. We considered three service models (core, aspirational, alternative/DGH) with differing frequency, duration and content of patient consultations and monitoring. We computed the ideal number of new patients and existing patients, for each scenario, from detailed qualitative interviews with 4 MSologists at different NHS Trusts. Computations assumed all 3 scenarios had common support from MS nurses (@315 PLwMS/FTE MS nurse), MS coordinators, neuroradiology, neuropharmacist and administration.ResultsEstimates for 1-FTE-MSologist/year/service model were: Core: new-PCL=81 (range=46–115); existing- PCL=798 (range=672–923). Aspirational: new-PCL=21 (range=28–69); existing-PCL=481 (range=401–561). Alternative/DGH: new-PCL=89 (range=51–126); existing-PCL=874 (range=733–1015).ConclusionsThese MS PCL/FTE-MSologist estimates enable future NHS manpower planning to optimally staff specialist MS services. It is notable that few (if any) UK MS services have the support considered pre- requisite. Much of the direct clinical care work undertaken is “unseen” and not formally job-planned. These results have significant implications formal time and motion studies may be required to improve estimates’ accuracy.Support.Karen Bateman was supported by Novartis. Disclosures: See poster g.giovannoni@qmul.ac.uk

The success of endodontic treatment depends on the correct use of materials during the cleaning and filling of the root canal system. The field of endodontics is constantly evolving with the introduction of new procedures and materials. Despite the continuous development of a wide range of chemical solutions and the introduction of new materials in endodontics, driven by the advances in state-of-the-art technologies, there is still a lack of data on how these advances are adapted to the daily practice of Romanian dentists in this field. The aim of this cross-sectional questionnaire-based study was the evaluation of current trends in endodontic practice, focusing on the materials used by dentists throughout Romania, performed by a number of dentists who graduated from universities in the Northern, Southern, Eastern, Western, and Central zones of Romania. The questions were about the irrigants used, the interim medication, the type of sealant, the filling technique, and the number of endodontic treatment sessions. The majority of participants in the research were general practitioners and endodontists, with some dentists of different specialties performing endodontic treatments in their practices. Statistical analyses were performed using DATAtab version 2024 software. The results obtained from this study provide a valuable resource and database for researchers to access a wide range of information and an apparent trend towards high-performance endodontic materials used in Romania.

Seed coating technology combined with biopolymers offers an alternative method to reduce environmental contamination. However, when biological agents are incorporated, biopolymers would have diverse properties and effects. This underscores the necessity of exploring the optimal dosages and formulations of biopolymers to ensure the survival of beneficial microorganisms, seed quality, and proper storage. This study aimed to explore the effects of different sodium alginate and chitosan coating formulations on Trichoderma harzianum viability and canola seeds quality. The coating process involved mixing T. harzianum powder with sodium alginate, talc and chitosan in different doses, sequences and formulations. Trichoderma harzianum viability was assessed through colony-forming units per ml over time. Canola seed quality was evaluated by measuring radicle emergence, germination percentage, seedling growth, and field emergence. Sodium alginate, both alone and in combination with talc, improved T. harzianum viability immediately after treatment and during storage. These coatings did not impair seed germination and improved canola root growth. Among the different chitosan formulations, a 1 : 100 ratio in talc improved strain survival and root growth without affecting germination, radicle, and field emergence. Coating canola seeds is a practical alternative to the application of T. harzianum, sodium alginate and talc, as it preserves their viability over time and improves seedling performance. Chitosan formulations in acetic acid should be carefully developed to prevent negative effects on seeds or biological agents.

In recent decades, there has been significant growth in research focused on biocompatible materials, particularly in the field of materials science and engineering. The primary advantages of these materials are their biocompatibility, bioactivity, and antibacterial properties. Consequently, there has been a growing utilization of bioceramic sealers in the field of endodontics. This study investigated the amounts of bioactive elements in dentin in contact with the AH Plus® Bioceramic Sealer (Dentsply, Konstanz, Germany). The results were qualitatively evaluated by examining scanning electron microscopy (SEM) images and elemental mapping and quantitatively by determining element weight (wt%) and atomic (at%) percentages obtained from EDX analysis. The AH Plus® Bioceramic Sealer demonstrated notable bioactivity through its dynamic contact with dentin at the root level.

Vaccination is one of the most effective and cost-efficient methods for protecting people with multiple sclerosis (MS) from infections. However, use of vaccines has often been problematic because of misguided concerns that they may exacerbate the disease and/or that some disease-modifying therapies may influence the immune response to immunisations and/or their safety. People with MS risk higher morbidity and mortality from vaccine-preventable infections. It is, therefore, important to address any patient’s reluctance to accept vaccination and to provide clear guidance for clinicians on which vaccinations to consider proactively. We have reviewed the current literature and provide recommendations regarding vaccines in adults with MS, including specific advice regarding vaccination safety in patients receiving—or going to receive—disease-modifying therapies, vaccination during pregnancy, pretravel counselling and patient education.

Predicting clinical outcome in multiple sclerosis (MS) remains challenging, and biomarkers capable of providing prognostic information would be valuable in shaping therapeutic decisions. Neurofilament light (NfL) measurements have shown promise in predicting clinical outcomes in MS. We evaluated the relationship between serum NfL (sNfL), measured at diagnosis in 164 people with MS, with contemporary disability, short-term (1-year) and medium-term (5-year) clinical outcomes. Analyses were adjusted for relevant confounders. sNfL concentration at diagnosis was modestly but significantly associated with baseline EDSS score (B=0.264, 95% CI 0.043 to 0.485, p=0.020). However, no significant associations were found between baseline sNfL and the incidence of relapse at 12-months, time to sustained accumulation of disability or 5-year change in EDSS. Dichotomising baseline sNfL according to previously cited cut-offs ( 14.2pg/ml and 90th percentile for age) did not change these results. sNfL appears to be of limited clinical utility in predicting future irreversible neurological disability, in a largely treated population, and remains insufficiently validated to shape treatment decisions at the time of diagnosis. Further studies exploring the value of sequential sNfL measurement and developing valid, universally accepted cut-offs are needed before sNfL can be incorporated as a prognostic marker in the clinic.tallantyreec@cardiff.ac.uk

IntroductionCladribine tablets (Mavenclad®) are licensed for treating people with relapsing multiple sclerosis (pwRMS). We treated people with relapsing (pwRMS) and progressive MS (pwPMS) using sub- cutaneously administered cladribine (SCAC) since 2014. Here, we present up to five year follow-up on safety and efficacy.MethodsSCAC 10mg was given on 3–4 days during week 1. 0–3 doses were administered at week 5, according to week 4 lymphocyte count. A second cycle of SCAC was administered 11 months later. Follow-up included clinical outcome evaluation and pharmacovigilance. The proportion of pwMS with no evidence of (i) disease activity (NEDA) and (ii) progression or active disease (NEPAD) was calculated.Results211 pwMS received SCAC. 154/211 completed two treatment cycles. At baseline age was 44 (17–72) years, EDSS 1–8.5. Tolerability was good. One myocardial infarction and one breast cancer occurred. Two severely disabled pwMS died (one of influenza, one of encephalitis). Lymphopenia grade 3 was detected in <3%. At 2 years, 71% (CI 54%, 85%) of pwRMS had NEDA; 38% (CI 23%, 54%) of pwPMS had NEPAD.ConclusionsSCAC was well tolerated. Frequency of significant lymphopenia was low. Efficacy in pwRMS corresponds with trial data. NEPAD rates in pwPMS were similar to licensed DMT.k.allen-philbey@nhs.net

Recent knowledge concerning the role of non-coding RNAs (ncRNAs) in myocardial ischemia/reperfusion (I/R) injury provides new insight into their possible roles as specific biomarkers for early diagnosis, prognosis, and treatment. MicroRNAs (miRNAs) have fewer than 200 nucleotides, while long ncRNAs (lncRNAs) have more than 200 nucleotides. The three types of ncRNAs (miRNAs, lncRNAs, and circRNAs) act as signaling molecules strongly involved in cardiovascular disorders (CVD). I/R injury of the heart is the main CVD correlated with acute myocardial infarction (AMI), cardiac surgery, and transplantation. The expression levels of many ncRNAs and miRNAs are highly modified in the plasma of MI patients, and thus they have the potential to diagnose and treat MI. Cardiomyocyte and endothelial cell death is the major trigger for myocardial ischemia–reperfusion syndrome (MIRS). The cardioprotective effect of inflammasome activation in MIRS and the therapeutics targeting the reparative response could prevent progressive post-infarction heart failure. Moreover, the pharmacological and genetic modulation of these ncRNAs has the therapeutic potential to improve clinical outcomes in AMI patients.

Colorectal cancer remains one of the most frequent malignancies (third place at both genders) worldwide in the last decade, owing to significant changes in modern dietary habits. Approximately half of the patients develop metastases during the course of their disease. The available therapeutic armamentarium is constantly evolving, raising questions regarding the best approach for improving survival. Bevacizumab remains one of the most widely used therapies for treating metastatic colorectal cancer and can be used after progression. This study aimed to identify the best chemotherapy partner for bevacizumab after progression. We performed a retrospective analysis of patients with metastatic colorectal cancer who were treated with bevacizumab as first- and second-line chemotherapy. Data were collected for 151 patients, 40 of whom were treated with double-dose bevacizumab after the first progression. The two standard chemotherapy regimens combined with bevacizumab were FOLFIRI/CAPIRI and FOLFOX4/CAPEOX. The initiation of first-line treatment with irinotecan-based chemotherapy improved progression-free survival and time to treatment failure but not overall survival. After the first progression, retreatment with the same regimen as that used in the induction phase was the best approach for improving overall survival (median overall survival: 46.5 vs. 27.0 months for the same vs. switched strategy, respectively). No correlations were observed between the dose intensity of irinotecan, oxaliplatin, 5-fluorouracil, or bevacizumab and the overall survival, progression-free survival in the first-/second-line treatment, and time to treatment failure. Interaction between an irinotecan-based regimen as a second-line treatment and double-dose bevacizumab after progression was associated with an improved overall survival (p = 0.06). Initiating systemic treatment with an irinotecan-based regimen in combination with bevacizumab improved the progression-free survival in the first-line treatment and time to treatment failure. In terms of overall survival, bevacizumab treatment after the first progression is better partnered with the same regimen as that used in the induction phase.