Background
Autoimmune tracheitis is a rare condition where the immune system attacks the lining of the trachea, causing inflammation and swelling. It can lead to symptoms such as chronic cough, hoarseness, difficulty breathing, and, in rare cases, hemoptysis. The exact cause of autoimmune tracheitis is unclear, but it is thought to involve genetic and environmental factors. Diagnosing the condition can be challenging due to its rarity and overlapping symptoms with other respiratory conditions. 

Case Presentation
We present the case of an 82-year-old female with a history of well-controlled rheumatoid arthritis on methotrexate and a chronic tracheostomy inserted in childhood for vocal cord paralysis . The patient presented to the emergency department with a 6-month history of hemoptysis, weight loss, and loss of appetite. Physical examination and chest X-ray did not reveal any notable findings. Chest CT scan showed circumferential thickening of the mid trachea, including diffuse involvement of the posterior tracheal membrane. This area was also avid on PET scan, suggestive of ongoing inflammation. Rigid bronchoscopy revealed tracheitis and diffuse thickening of tracheal mucosa, resulting in severe narrowing of the tracheal lumen.
Biopsy results from the procedure were negative for malignancy but demonstrated the presence of plasma cells, complement deposition, and immunoglobulins suggestive of an autoimmune etiology. There was no evidence of granulomas and Congo Red Stain for amyloidosis was also negative. Microbiology, including Acid Fast Bacilli cultures, were negative as well.
Extensive autoantibody testing was performed to identify possible autoimmune conditions, and other than elevated rheumatoid factor, testing was unrevealing. Therefore, clinical diagnosis of autoimmune tracheitis was established. Treatment was initiated with prednisone therapy, followed by infusion of Adalimumab. The prednisone dosage was gradually tapered over time, and repeat bronchoscopy showed significant reduction of inflammation. During a six month follow up period, the patient remains asymptomatic. .


Discussion
Autoimmune tracheitis presents a significant diagnostic and management challenge due to its rarity and lack of specific criteria. There is paucity of literature on this topic. Guttman et al described a patient with Crohn's disease who developed tracheal cartilage inflammation successfully treated with anti TNF therapy. To our knowledge this is the first case report of autoimmune tracheitis in a patient with rheumatoid arthritis. It is important to be aware of this condition in patients with autoimmune disorders presenting with respiratory complaints.

A Rare Case of Autoimmune Tracheitis In A Patient With Rheumatoid Arthritis Successfully Treated With TNF-a Inhibitor

Background
Systemic lupus erythematosus (SLE) is a chronic, multi-systemic autoimmune disorder that presents in a myriad of ways. However, lupus enteritis is a rare initial manifestation. 

Case Presentation
A 30-year-old female with PMH DM2 and obesity presented with periumbilical pain for one day associated with nausea, NBNB vomiting, and fatigue. She denied rashes, skin changes, fever, arthralgias, oral ulcers or hair loss. On examination, temperature 97.7°F, BP 138/69, HR 121, RR 22, and O2 saturation 99% on room air; bowel sounds were normal and there was diffuse abdominal tenderness and distension without rebound/guarding. Notable labs included creatinine 1.2 and a urinalysis showing protein 300, RBCs (6-10), and protein/creatinine ratio 2304. A CT abdomen revealed moderate ascites and an approximately 42 cm segment of moderate small bowel wall thickening, predominately of the proximal jejunum, concerning for infectious or inflammatory enteritis. Ascitic fluid studies revealed SAAG <1.1 g/dL. A subsequent MRI abdomen showed possible mid-small bowel obstruction and targetoid mucosal and serosal enhancement. The obstruction was managed conservatively with NGT placement; however, her abdominal pain persisted even though she had bowel movements and had no radiographic worsening of the obstruction. During the hospitalization, her renal function did not improve; an autoimmune work-up revealed positive ANA, dsDNA, anti-smith Ab, RNP Ab, chromatin Ab, ribo protein IgG, and SM RNP Ab; C3 and C4 complement levels and serum albumin were low. She was transferred to a tertiary care center and a kidney biopsy revealed Class III lupus nephritis. She was started on pulse-dose steroids and hydroxychloroquine. She improved clinically, her renal function improved and she was discharged home on azathioprine, hydroxychloroquine and prednisone.

Discussion
SLE can affect numerous systems but rarely involves the gastrointestinal system as an initial manifestation. Lupus enteritis is only present in about 0.2 – 5.8% of cases with SLE. It is thought to be related to immune complex deposition and complement activation leading to submucosal bowel wall edema and mostly affects the Jejunum and the Ileum. The clinical presentation is often nonspecific, however frequent complaints include abdominal pain, nausea, and vomiting. CT abdomen/pelvis is the diagnostic modality of choice as pathology is low yield. Common imaging features include Target sign, Combs sign, Mesenteric fat stranding and ascites. Due to its rarity, there are no established guidelines for management, however prior case reports have demonstrated a positive response to steroids.



Lupus Enteritis: An Uncommon Manifestation of Systemic Lupus Erythematosus that Coalesced with Cryptogenic Lupus Nephritis

The ability to represent and reason about other people’s perspectives (‘social cognition’, or ‘Theory of Mind’ [ToM]) plays an important role in daily life. It is not currently clear how different types of interaction may impact subsequent perspective taking, and whether this differs with age. Here, we examine how experiences of social inclusion vs. social exclusion (manipulated using the Cyberball task) influence later perspective-taking efficiency, in younger (19-30 years; N = 100; M = 24.69) and older (65-80 years; N = 100; M = 69.63) participants. As expected, significant age differences were found in perspective-taking abilities, with younger participants out-performing older participants. This was specific to false-belief trials, with no difference in memory trials performance. Counter to hypothesized, no interaction between impact of social experience (inclusion vs. exclusion) and age was found, indicating that both younger and older adults are similarly impacted by social experiences. Implications will be discussed.

The Impact of Social Inclusion vs. Exclusion on Subsequent Social Cognition Abilities in Younger and Older Adults

Older adults can experience declines in their cognitive abilities, which could affect their ability to engage in daily activities such as driving. Here, we compare the driving habits of older adults across different cognitive groups: cognitively healthy older adults (control), Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD). We analyzed data from the large-scale Comprehensive Assessment of Neurodegeneration and Dementia study (COMPASS-ND, Chertkow et al., 2019). Results revealed that the AD group drove the least often and shortest distances. Interestingly, on several measures, the SCD group was more like the MCI group than the control group (driving frequency, restrictions), suggesting that even subjective declines were associated with differences in driving habits. We will further discuss how these results are influenced by sensory and demographic factors. Driving-related limitations could reduce older adults’ participation and access to essential resources, in turn, negatively affecting their physical and mental health.

Driving Habits of a Cohort of Older Canadians: A COMPASS-ND Study

Background: Resistance exercise (RE) is increasingly acknowledged as a primary countermeasure to age related chronic disease and represents an effective strategy for counteracting age-associated declines in muscle strength and physical performance. However, as training induced adaptation is primarily driven by the physiological stress imposed (i.e. the internal training response), eliciting a consistent and standardised training dose is necessary to maximise the potential of RE. Method: Thirty community-dwelling - older adults (71.7 ± 3.6 years; 12 female) naïve to RE, performed 6 weeks of twice weekly, machine-based progressive RE involving a combination of upper- and lower-body exercises (leg press, leg curl, chest press, upright row). RE programming - Participants performed 2-3 sets of 8-10 repetitions for each exercise per session with intensity set at 70% of estimated 1RM in session 1. Load was increased when participants completed the prescribed number of repetitions in the final set while maintaining proper form in two consecutive workouts. Quantification of training response - Internal training response was quantified using ratings of perceived exertion (RPE). Following each RE session, participants provided an overall rating of perceived exertion (sRPE) and differential ratings of perceived exertion for upper-body muscle exertion (sRPE-U) and lower-body muscle exertion (sRPE-L) using the CR100 scale3 . External load was quantified as relative volume load (no. of sets x no. of reps x %1RM). Data were analysed using mixed linear models. Results: Twenty-nine participants completed the intervention with an overall attendance of 97%. Conclusions: RE induced a substantial internal training response. There was no systematic change, but large interindividual variability in response, across the duration of the intervention. These metrics should be validated against objective measures of RE response such as improved muscle function.

Quantifying the internal training response to resistance exercise in older adults: findings from the Milk Intervention Muscle AgeiNg (MIlkMAN) pilot study

Background: Patients with single, large-scale mitochondrial DNA (mtDNA) deletions often present with mitochondrial myopathy for which no treatment is available. Exercise intervention induces beneficial effects in mitochondrial myopathy; however, we do not yet understand the mechanism for this. Aim of the project: This study investigates biochemical, genetic and molecular changes triggered by resistant exercise training to identify exercise modulators on a molecular level in mitochondrial myopathy patients. Material and methods: Pre- and post-exercise vastus lateralis biopsies were taken from a cohort of single, large-scale mtDNA deletion patients (n = 5) after 16 weeks of supervised high-intensity resistant exercise training. Biopsies were assessed for changes in oxidative phosphorylation, mtDNA deletion level, fibre type and size, and differentially expressed (DE) genes (Figure 1). Conclusions: Resistance exercise training was safe and effective for our cohort of single, large-scale mtDNA patients. After exercise: • mitochondrial mass increase correlates with aerobic capability, • complex IV OXPHOS defect ameliorates in all patients, • fibre type I undergo hypertrophy mechanism in 4 patients, • there is differential gene expression. Future investigations of DE genes on SKM tissue with IMC will allow us to characterize their function on a protein level and to highlight potential exercise modulator(s) in mitochondrial myopathy patients.

The effects of resistant exercise training in mitochondrial myopathy patients

Background: Sarcopenia • low muscle quality and quantity • can potentially be represented with psoas muscle area (PMA) Lower PMA associated with adverse outcomes in multiple surgical populations Lower PMA in EVAR population – more conflicting results. Study question: • What are the associations between PMA and mortality in patient’s older than 65 year old with asymptomatic infrarenal AAA undergoing EVAR? • What are the associations between PMA and length of stay, complications, discharge destination and readmissions within 30 days? Methods: Retrospective observational study in single centre tertiary metropolitan hospital Inclusion criteria: Asymptomatic infrarenal AAA from 1/1/13-31/12/17, >65yo Exclusion criteria: Connective tissue disease, mycotic or inflammatory AAA, emergency / non elective cases Primary outcome: Survival from day of operation (in days) Secondary outcomes: 30-day readmissions related to EVAR, Discharge destination (home, residential care, rehabilitation), Complications post surgery (including delirium, infection, post operative bleeding, DVT/PE), Length of stay (days). Results: 122 patients had an EVAR for infrarenal AAA 5 patients excluded as symptomatic 18 patients did not have PMA data (could not find imaging) – no significant differences found between the 2 groups 97 patients in total assessed Characteristics of patients in final analysis as per Table 1. Association found between 5-year mortality and the lowest tertile of PMA, strengthened by adjusting for age, sex and BMI (Figure 1, Table 2) Length of stay appears to be associated with PMA – unlikely clinically significant No significant associations between PMA and complications, discharge destination and readmissions within 30 days – minimal data in other studies to compare to.

Lower Psoas Muscle Area (PMA) is associated with increased mortality after endovascular aneurysm repair in older adults

Background: There is a paucity of cross-sectional research on muscle morphology, function, and functional capability in all age-bands of healthy adults. Therefore, age-related differences in indices of skeletal muscle health across the adult lifespan is unknown. Aim: To evaluate indices of muscle morphology, function and functional capability in a sample of healthy adults aged 18-70yrs. Methods: Study design: Cross sectional study included 274 healthy adults completed the study (mean ± SD: age = 41.9yrs ± 16.1; height = 169.3cm ± 10.2; weight = 72.4kg ± 15.2). Measurements: B mode Ultrasonography and Tensiomyography were used to measure muscle thickness, pennation angle, fascicle length, tissue composition and contractile properties in the vastus lateralis. Measurements of grip strength (handheld dynamometry) and functional capability (1-minute chair rise test) were also undertaken for each participant. Physical activity levels of each participant were recorded (self reported) via the International Physical Activity Questionnaire (short form) to categorise participants physical activity levels as high, moderate or low. Data analysis: Descriptive statistics, correlations, one-way ANOVAs, and multiple regressions were performed (SPSS v25). Results: Descriptive statistics: Age-related characteristics (mean ± standard deviation) per age band are displayed in table 1. Generally indices of skeletal muscle health were lower in the 60-70yr age band compared to the younger age bands. ANOVA and post hoc analysis: Differences in muscle morphology, function and functional capability between the 18-29 age band and the 50-59 and 60- 70 age bands. Physical activity: The mean total MET-min/week (across 7 days) was smaller for the 50-59yr adults (2660.7) compared to the younger groups (18- 29 = 4420.5; 30-39 = 2884.1 and 40-49 = 3232.5). Summary and conclusion: Younger adults (18-29 years) had larger measurements of muscle morphology, strength and functional capability compared to the older adults (60-70 years). Assuming linearity, after 50 years, the difference between decades is equivalent to -0.9% per decade for muscle thickness and strength and -0.5% per decade for muscle architecture. This led to a subsequent difference in functional capability of -1.0% per decade after 50 years of age. Physical activity likely acts to abate detrimental differences in indices of muscle health and maintain functional capacity for activities of daily living. A longitudinal study is required in a sample of healthy female and male adults aged 18-70 years of age to understand the true decline in indices of muscle health due to age.

Age-related characteristics of skeletal muscle health across 18-70 years

Background: Visual impairment is common in older adults. The most common causes of age-related visual impairment are presbyopia, cataracts, macular degeneration, and glaucoma, which affect visual acuity. Only two studies have shown that visual impairment can be a predictor of low muscle mass and low muscle strength, indicating a potential correlation between visual impairment and sarcopenia. Methods: Older adults were recruited from the community, and their sarcopenia status was identified using the SARCF questionnaire. Visual acuity was assessed through smartphone-based visual acuity measurement (Smart Optometry) (Figure 1), and values were presented in decimal form. The visual acuity level was categorised into normal visual function (≥0.8), mild visual loss (0.3–0.8), and moderate to severe visual loss (<0.3). Pearson correlation test was performed to measure the association between the SARC-F score and visual acuity. An analysis of variance with a post hoc Bonferroni test was conducted to compare SARC-F scores among different visual acuity levels. This study was approved by the Taipei Medical University Joint Institutional Review Board (N202002009) and registered on clinical.trials.gov (NCT04702828). Results: In total, 100 community-dwelling older adults were recruited. A significant association was noted between SARC-F score and visual acuity (p < 0.001, r = −0.348). Old people with moderate to severe visual loss had significantly higher SARC-F scores relative to those with normal visual function (p = 0.049, 95% confidence interval [CI] = −4.695 to −0.011) and mild vision loss (p = 0.025, 95% CI = −2.379 to −0.117). Conclusions: Sarcopenia is associated with vision loss in older adults. Only when visual acuity reaches a moderate level does it exert a large effect on sarcopenia. This may be due to the reduction of muscle function in visually impaired older adults who restrict themselves from engaging in physical activities. The improvement of visual impairment, such as through prescription glasses or surgical intervention, are required to prevent sarcopenia. Older adults with visual impairment should be advised to undergo sarcopenia assessment.

Sarcopenia and Vision Loss in Community-Dwelling Older Adults

Introduction: Sarcopenia has been defined as a progressive and generalised skeletal muscle disorder that occurs in advanced ageing (1). Sarcopenia is associated with increased mortality, disability, risk of falls and increased cost of care during hospital admissions (1-4). In 2019, European Working Group of Sarcopenia in Older People updated their definition of sarcopenia (EWGSOP2) (5) and placed a greater emphasis on the importance of muscle strength. In the last decade, Ireland has experienced an increase in the number of older adults (>65) and the Central Statistics Office has predicted that, by 2030, one in five Irish people will be over the age of 65 (6). Currently, the prevalence of sarcopenia in older adults in Ireland is not known. In community dwelling older adults, the prevalence of sarcopenia is widely debated, ranging from 0-50% (7). The early identification of sarcopenia in older adults is important for preventing the adverse outcomes associated with the muscle disease. One essential component of the model of care of older adults in Ireland is the day hospital service (8). Those attending a day hospital receive medical care and multidisciplinary intervention, due to a change or decline in their health or function. Methods: A consecutive series of older adults attending the Robert Mayne Day Hospital (RMDH) in St James’s Hospital (SJH) Dublin, Ireland were invited to take part in the study between October 2019 and March 2020. Due to limited resources, not all participants could be prescribed a physical accelerometer. However, every third participant was prescribed a physical accelerometer. All accelerometers were worn on the participant’s non-dominant wrist for a 7-day period. Results: A total of 134 participants were recruited to the study. The participants had a mean age of 81.7 (SD 7.1), with a range from 65-98. Sixty-one percent (N=82) were female. Conclusion: This is the first study to apply the EWGSOP2 criteria to older adults living in the community in an Irish day hospital setting. The findings highlight the feasibility of applying the EWGSOP2 screening process easily and safely in this setting. The method of strength test influenced the prevalence as well as which variables were independently associated with sarcopenia, potentially highlighting different pathophysiological changes between the two types of sarcopenia. To appropriately manage sarcopenia, the assessment of sarcopenia needs be more consistent regarding the use of the EWGSOP2 guidelines, as seen with the assessment of muscle strength in this study. More routine assessment of sarcopenia using the EWGSOP2 criteria and consistent assessment tools, would enable a greater understanding of the factors that influence sarcopenia (i.e. falls or hospitalisation) and changes in sarcopenia after hospitalisation or acute illness.

Prevalence of Sarcopenia and Assocaited Factors in Older Adults Attending a Day Hospital Service in Ireland

Background: Association of dietary intake and serum level of polyunsaturated-fatty-acids (omega-3 PUFA) with physical function and body composition in older adults remained inconclusive. Method: Study subjects were 554 women from the Osteoporosis-Risk-Factor-and-PreventionFracture Prevention-Study, with dietary intake assessed with 3-day food record at baseline. Total omega-3 PUFA and DHA blood concentrations were analysed using a highthroughput proton (1H) NMR spectrometry metabolomics platform at the University of Eastern Finland. Multiple physical function tests and short physical performance battery (SPPB) was calculated at the baseline and 3-year followup. Results: The multivariable adjusted models showed statistically-significant associations for ALA with higher SPPB (β= 0.118, P=0.024), knee-extension-force at baseline (β= 0.075, P=0.037) and lower fat mass (β= - 0.081, P=0.034), as well as longer one-leg-stance (βbaseline= 0.119, βfollw-up=0.090, P<0.023), higher walking speed (βbaseline= 0.113, βfollw-up=0.144, P<0.047), and ability to squat to the ground (βbaseline= 0.110, βfollwup=0.096, P<0.047) at baseline and follow-up. Total omega-3 PUFA was statistically-significantly associated with better SPPB (βbaseline= 0.108, P=0.039), one-leg-stance (βbaseline= 0.102, P=0.041), walking speed (βbaseline= 0.110, βfollw-up=0.128, P<0.028) and ability to squat (βbaseline= 0.110, P=0.028). Associations for dietary EPA and DHA, serum omega-3 PUFA and DHA with physical function and body composition was not significant.

Dietary omega-3 polyunsaturated fatty acid and alpha-linolenic acid are associated with sarcopenia indices in older women 65-72 years.
Masoud Isanejad 1, 2, Toni Rikkonen 3, Behnam Tajik 4, Joonas Sirola

Background: Population of elderly in Indonesia is predicted to increase to 36 million in 2025. Increasing in life expectancy will be followed by health problem, one of which is sarcopenia. Screening and diagnosis are required to identify sarcopenia especially in community, so that early and comprehensive management can be applied for elderly. Method: This study is a cross sectional study in elderly population in Sarirejo village office. Total 29 elderly met inclusion criteria were involved in this study. Mini-Cog assessment was performed to screen cognitive impairment. Furthermore database were collected followed by MNA. Examination of lower extremities muscle mass was performed by dual x-ray absorptiometry (DXA) using General Electric health bone health. Physical performance was examined by time up and go (TUG) test. Data result were analyzed and statistically test using Pearson correlation and Ranged Spearman. Results: 27 (93,1%) women and 2 (6,9%) man involved in this study, with educational level of 10,3% (3 sample) have no education level, 48,3% (14 sample) have elementary level, 13,8% (4 sample) have junior high school level, 27,6% (8 sample) have senior high school level. Total of 93,1% (27 sample) were married, and 6,9% (2 sample ) were unmarried. From 29 sample, they were divided into 3 ranged group of age, according to WHO classification. Variable analysis result of TUG score with ranged group of age showed positive correlation with increasing age, F= 3.277, P=0,005. Correlation between age (in common) and TUG score showed result with increasing age (in common), followed by decreasing physical performance (P=0,009; r=0,477). Correlation between body mass index (BMI) score with DXA score showed result with increasing BMI score, followed by higher DXA score (P=<0,001; r=0,838). BMI was also showed positive correlation with sarcopenia group with P=<0,001. There was no correlation between MNA score with sarcopenia (P=0,419) and TUG test with sarcopenia (P=0,674). Conclusion: There was no correlation between MNA score, physical performance with sarcopenia.

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A Rare Case of Autoimmune Tracheitis In A Patient With Rheumatoid Arthritis Successfully Treated With TNF-a Inhibitor

Lupus Enteritis: An Uncommon Manifestation of Systemic Lupus Erythematosus that Coalesced with Cryptogenic Lupus Nephritis

The Impact of Social Inclusion vs. Exclusion on Subsequent Social Cognition Abilities in Younger and Older Adults

Driving Habits of a Cohort of Older Canadians: A COMPASS-ND Study

Quantifying the internal training response to resistance exercise in older adults: findings from the Milk Intervention Muscle AgeiNg (MIlkMAN) pilot study

The effects of resistant exercise training in mitochondrial myopathy patients

Lower Psoas Muscle Area (PMA) is associated with increased mortality after endovascular aneurysm repair in older adults

Age-related characteristics of skeletal muscle health across 18-70 years

Sarcopenia and Vision Loss in Community-Dwelling Older Adults

Prevalence of Sarcopenia and Assocaited Factors in Older Adults Attending a Day Hospital Service in Ireland

Dietary omega-3 polyunsaturated fatty acid and alpha-linolenic acid are associated with sarcopenia indices in older women 65-72 years. Masoud Isanejad 1, 2, Toni Rikkonen 3, Behnam Tajik 4, Joonas Sirola

Correlation Between Sarcopenia and Tug, and Sarcopenia With Physical Performance in Elderly Subjects in Sarirejo Village Semarang

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