#Mortality risk during and after #opioid substitution treatment: systematic review and meta-analysis of cohort studies

http://www.bmj.com/content/357/bmj.j1550

Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.

#Brain changes in overweight/obese and normal-weight adults with type 2 #diabetes mellitus
https://link.springer.com/article/10.1007/s00125-017-4266-7

Global mean cortical thickness was lower in the overweight/obese type 2 diabetes group than in the normal-weight type 2 diabetes group (z = −2.96, p for group effect = 0.003). A negative correlation was observed between disease duration and global mean white matter integrity (z = 2.42, p for interaction = 0.02) in the overweight/obese type 2 diabetes group, but not in the normal-weight type 2 diabetes group. Overweight/obese individuals with type 2 diabetes showed a decrease in psychomotor speed performance related to disease duration (z = −2.12, p for interaction = 0.03), while normal-weight participants did not.

Conclusions/interpretation

The current study attempted to uncouple the effects of overweight/obesity from those of type 2 diabetes on brain structures and cognition. Overweight/obese participants with type 2 diabetes had more severe and progressive abnormalities in brain structures and cognition during early stage type 2 diabetes compared with normal-weight participants.

Clinical Utility of a Precision Medicine #Test Evaluating Outpatients with Suspected Obstructive #Coronary Artery Disease
http://www.sciencedirect.com/science/article/pii/S0002934316312359

A blood-based age/sex/gene expression score (ASGES) incorporating key features of precision medicine has shown clinical validity with a 96% negative predictive value and 89% sensitivity in estimating a symptomatic patient's current likelihood of obstructive coronary artery disease. In this community-based cardiovascular registry, the ASGES demonstrated clinical utility in the evaluation of patients with suspected obstructive coronary artery disease. Low-score patients were less likely to undergo cardiac referral, were unlikely to have positive findings on further cardiac work-up, and had a low rate of adverse cardiovascular events in 1-year follow-up. Our work provides evidence supporting the value of using precision medicine in the delivery of cardiovascular care.

Single dose #testosterone administration impairs #cognitive reflection in men
http://authors.library.caltech.edu/77049/

Building on a dual-process framework, we propose a mechanism underlying testosterone’s behavioral effects in humans: reducing cognitive reflection. In the largest behavioral testosterone administration study to date, 243 men received either testosterone or placebo and took the Cognitive Reflection Test (CRT), that estimated their capacity to override incorrect intuitive judgments with deliberate correct responses. Testosterone administration reduced CRT scores. The effect was robust to controlling for age, mood, math skills, treatment expectancy and 14 other hormones, and held for each of the CRT questions in isolation. Our findings suggest a mechanism underlying testosterone’s diverse effects on humans’ judgments and decision-making, and provide novel, clear and testable predictions.

#Women Benefit More Than Men in Response to College-based #Meditation Training http://journal.frontiersin.org/article/10.3389/fpsyg.2017.00551/full

Compared to men, women showed greater decreases in negative affect and greater increases on scales measuring mindfulness and self-compassion. Women’s improvements in negative affect were correlated to improvements in measures of both mindfulness skills and self-compassion. In contrast, men showed non-significant increases in negative affect, and changes in affect were only correlated with ability to describe emotions, not any measures of experiential or self-acceptance.

Conclusion: These findings suggest that women may have more favorable responses than men to school-based mindfulness training, and that the effectiveness of mindfulness-based interventions may be maximized by gender-specific modifications.

Systematic review with meta-analysis: the efficacy and safety of #tenofovir to prevent mother-to-child transmission of hepatitis #B virus
http://onlinelibrary.wiley.com/doi/10.1111/apt.14068/abstract

For pregnant women with high hepatitis B virus DNA levels, tenofovir administration in the second or third trimester can prevent mother to child transmission when combined with hepatitis B immunoglobulin and the hepatitis B vaccine. Tenofovir is safe and tolerable for both the mother and foetus.

Silent hippocampal #seizures and spikes identified by foramen ovale electrodes in #Alzheimer's disease
http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.4330.html

We directly assessed mesial temporal activity using intracranial foramen ovale electrodes in two patients with Alzheimer's disease (AD) without a history or EEG evidence of seizures. We detected clinically silent hippocampal seizures and epileptiform spikes during sleep, a period when these abnormalities were most likely to interfere with memory consolidation. The findings in these index cases support a model in which early development of occult hippocampal hyperexcitability may contribute to the pathogenesis of AD.

Comparative Effectiveness of Routine Invasive #Coronary Angiography for Managing #Unstable Angina
http://annals.org/aim/article/2624285/comparative-effectiveness-routine-invasive-coronary-angiography-managing-unstable-angina

Non–ST-segment elevation acute coronary syndromes include unstable angina and non–ST-segment elevation myocardial infarction. Most randomized controlled trials of routine versus selective invasive coronary angiography have high rates of crossover from control to intervention groups and do not include subgroup analysis for unstable angina. Consequently, no clear, specific recommendations exist regarding the use of angiography in unstable angina. Conclusion:
Patients with unstable angina benefit from an invasive management pathway initiated by invasive coronary angiography during their hospitalization and up to 2 months after discharge.

#Thalamic amplification of #cortical connectivity sustains attentional control
http://www.nature.com/nature/journal/vaop/ncurrent/full/nature22073.html

Consistent with this notion, broadly enhancing prefrontal cortex (PFC) excitability diminishes rule specificity and behavioural performance, whereas enhancing mediodorsal excitability improves both. Overall, our results define a previously unknown principle in neuroscience; thalamic control of functional cortical connectivity. This function, which is dissociable from categorical information relay, indicates that the thalamus has a much broader role in cognition than previously thought.

Effect of Alternate-Day #Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy #Obese Adults
A Randomized Clinical Trial
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2623528

The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL 95% CI, 0.1-12.4 mg/dL), but not at month 12 (1.0 mg/dL 95% CI, –5.9 to 7.8 mg/dL), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL 95% CI, 1.9-21.1 mg/dL) compared with those in the daily calorie restriction group.

Conclusions and Relevance Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction.

Long term #gluten consumption in adults without celiac disease and risk of #coronary heart disease: prospective cohort study

http://www.bmj.com/content/357/bmj.j1892

Long term dietary intake of gluten was not associated with risk of coronary heart disease. However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk. The promotion of gluten-free diets among people without celiac disease should not be encouraged.