The long-term effects of faecal #microbiota transplantation for gastrointestinal symptoms and general health in patients with recurrent #Clostridium difficile infection
http://onlinelibrary.wiley.com/doi/10.1111/apt.14443/abstract
Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection. In short-term the treatment has been shown to be safe, however, there are no large, long-term follow-up studies looking into the potential adverse effects There was no difference in the incidence of severe diseases (inflammatory bowel disease, cancer, autoimmune disease, allergy, neurological diseases) between the patient groups. In addition, weight gain did not differ between treatment groups. The FMT treated patients reported that their bowel habits improved significantly faster, they had less irregular bowel function and less symptoms of upper GI-tract when compared to the patients treated with antibiotics. Significantly more patients in FMT-group reported that their mental health improved after the treatment. The willingness to receive FMT treatment for potential new C. difficile infection was significantly higher in both treatment groups compared to other treatment options.
Conclusion
Our study highlights that FMT is a durable, safe and acceptable treatment option for patients with recurrent C. difficile infection also in long term, and it shows potential benefits over antimicrobial treatment
http://onlinelibrary.wiley.com/doi/10.1111/apt.14443/abstract
Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection. In short-term the treatment has been shown to be safe, however, there are no large, long-term follow-up studies looking into the potential adverse effects There was no difference in the incidence of severe diseases (inflammatory bowel disease, cancer, autoimmune disease, allergy, neurological diseases) between the patient groups. In addition, weight gain did not differ between treatment groups. The FMT treated patients reported that their bowel habits improved significantly faster, they had less irregular bowel function and less symptoms of upper GI-tract when compared to the patients treated with antibiotics. Significantly more patients in FMT-group reported that their mental health improved after the treatment. The willingness to receive FMT treatment for potential new C. difficile infection was significantly higher in both treatment groups compared to other treatment options.
Conclusion
Our study highlights that FMT is a durable, safe and acceptable treatment option for patients with recurrent C. difficile infection also in long term, and it shows potential benefits over antimicrobial treatment
Wiley
The long‐term effects of faecal microbiota transplantation for gastrointestinal symptoms and general health in patients with recurrent…
Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection. In short‐term the treatment has been shown to be safe, however, there are no large, long‐term...
Risk of posttransplant #hepatocellular carcinoma recurrence is greater in recipients with higher #platelet counts in living donor liver transplantation
http://onlinelibrary.wiley.com/doi/10.1002/lt.24961/abstract
Platelets interact with tumor cells and promote metastasis. The importance of platelets in posttransplant hepatocellular carcinoma (HCC) recurrence is unclear. Thus, we aimed to evaluate the association between preoperative platelet count (PLT) and HCC recurrence after living donor liver transplantation. Of 359 recipients of livers from living donors for HCC, 209 of 240 patients who had preoperative PLT ≤75 × 109/L were matched with 97 of 119 patients who had preoperative PLT >75 × 109/L using propensity score matching, with an unfixed matching ratio based on factors such as tumor biology. The cutoff value of 75 × 109/L was set based on optimum stratification analysis. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence. The median follow-up time was 59 months. Before matching, recurrence probability at 1, 2, and 5 years after transplantation was 4.7%, 9.2%, and 11.3% for the low platelet group and 14.5%, 23.0%, and 30.5% for the high platelet group. Recurrence risk was significantly greater in the high platelet group in both univariate (hazard ratio HR = 3.09; 95% confidence interval CI, 1.86-5.14; P < 0.001) and multivariate analyses (HR = 2.10; 95% CI, 1.23-3.60; P = 0.007). In the matched analysis, recurrence risk was also greater in the high platelet group in both univariate (HR = 2.33; 95% CI, 1.36-4.01; P = 0.002) and multivariate analyses (HR = 1.90; 95% CI, 1.02-3.54; P = 0.04). Preoperative PLT had no interaction with the Milan criteria, alpha-fetoprotein level, Edmonson grade, microvascular invasion, or intrahepatic metastasis. Incorporation of preoperative PLT into the Milan criteria significantly improved predictive power. Inflammation-based scores including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the inflammation-based index did not show superiority to preoperative PLT in predicting HCC recurrence. In conclusion, preoperative PLT appears to be an important host factor affecting HCC recurrence after living donor liver transplantation
http://onlinelibrary.wiley.com/doi/10.1002/lt.24961/abstract
Platelets interact with tumor cells and promote metastasis. The importance of platelets in posttransplant hepatocellular carcinoma (HCC) recurrence is unclear. Thus, we aimed to evaluate the association between preoperative platelet count (PLT) and HCC recurrence after living donor liver transplantation. Of 359 recipients of livers from living donors for HCC, 209 of 240 patients who had preoperative PLT ≤75 × 109/L were matched with 97 of 119 patients who had preoperative PLT >75 × 109/L using propensity score matching, with an unfixed matching ratio based on factors such as tumor biology. The cutoff value of 75 × 109/L was set based on optimum stratification analysis. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence. The median follow-up time was 59 months. Before matching, recurrence probability at 1, 2, and 5 years after transplantation was 4.7%, 9.2%, and 11.3% for the low platelet group and 14.5%, 23.0%, and 30.5% for the high platelet group. Recurrence risk was significantly greater in the high platelet group in both univariate (hazard ratio HR = 3.09; 95% confidence interval CI, 1.86-5.14; P < 0.001) and multivariate analyses (HR = 2.10; 95% CI, 1.23-3.60; P = 0.007). In the matched analysis, recurrence risk was also greater in the high platelet group in both univariate (HR = 2.33; 95% CI, 1.36-4.01; P = 0.002) and multivariate analyses (HR = 1.90; 95% CI, 1.02-3.54; P = 0.04). Preoperative PLT had no interaction with the Milan criteria, alpha-fetoprotein level, Edmonson grade, microvascular invasion, or intrahepatic metastasis. Incorporation of preoperative PLT into the Milan criteria significantly improved predictive power. Inflammation-based scores including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the inflammation-based index did not show superiority to preoperative PLT in predicting HCC recurrence. In conclusion, preoperative PLT appears to be an important host factor affecting HCC recurrence after living donor liver transplantation
Trial of Contralateral Seventh Cervical #Nerve Transfer for #Spastic Arm Paralysis
http://www.nejm.org/doi/full/10.1056/NEJMoa1615208
Spastic limb paralysis due to injury to a cerebral hemisphere can cause long-term disability. We investigated the effect of grafting the contralateral C7 nerve from the nonparalyzed side to the paralyzed side in patients with spastic arm paralysis due to chronic cerebral injury
The mean increase in Fugl–Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft.
CONCLUSIONS
In this single-center trial involving patients who had had unilateral arm paralysis due to chronic cerebral injury for more than 5 years, transfer of the C7 nerve from the nonparalyzed side to the side of the arm that was paralyzed was associated with a greater improvement in function and reduction of spasticity than rehabilitation alone over a period of 12 months. Physiological connectivity developed between the ipsilateral cerebral hemisphere and the paralyzed hand
http://www.nejm.org/doi/full/10.1056/NEJMoa1615208
Spastic limb paralysis due to injury to a cerebral hemisphere can cause long-term disability. We investigated the effect of grafting the contralateral C7 nerve from the nonparalyzed side to the paralyzed side in patients with spastic arm paralysis due to chronic cerebral injury
The mean increase in Fugl–Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft.
CONCLUSIONS
In this single-center trial involving patients who had had unilateral arm paralysis due to chronic cerebral injury for more than 5 years, transfer of the C7 nerve from the nonparalyzed side to the side of the arm that was paralyzed was associated with a greater improvement in function and reduction of spasticity than rehabilitation alone over a period of 12 months. Physiological connectivity developed between the ipsilateral cerebral hemisphere and the paralyzed hand
Effectiveness of #ravidasvir plus #sofosbuvir in interferon-naïve and treated patients with chronic hepatitis #C genotype-4
http://www.journal-of-hepatology.eu/article/S0168-8278(17)32286-9/fulltext
•Ravidasvir is a new NS5A inhibitor for HCV.
•Sofosbuvir + Ravidasvir with or without RBV has achieved very high SVR rates.
•Results are comparable for both patients with and without cirrhosis.
•Serious adverse events were noticed in very few treated patients.
A total of 298 patients were enrolled: 149 in Group 1, 79 in Group 2 and 70 in Group 3. SVR12 was achieved in 95.3% of all patients who started the study, including 98% of patients without cirrhosis and 91% of patients with cirrhosis, whether treatment-naïve or interferon-experienced. Ribavirin intake and history of previous interferon therapy did not affect SVR12 rates. No virologic breakthroughs were observed and the study treatment was well tolerated.
Conclusions
Treatment with ravidasvir plus sofosbuvir, with or without ribavirin, was well tolerated and associated with high sustained virologic response rate for HCV-GT4 infected patients with and without cirrhosis, regardless of previous interferon-based treatments
http://www.journal-of-hepatology.eu/article/S0168-8278(17)32286-9/fulltext
•Ravidasvir is a new NS5A inhibitor for HCV.
•Sofosbuvir + Ravidasvir with or without RBV has achieved very high SVR rates.
•Results are comparable for both patients with and without cirrhosis.
•Serious adverse events were noticed in very few treated patients.
A total of 298 patients were enrolled: 149 in Group 1, 79 in Group 2 and 70 in Group 3. SVR12 was achieved in 95.3% of all patients who started the study, including 98% of patients without cirrhosis and 91% of patients with cirrhosis, whether treatment-naïve or interferon-experienced. Ribavirin intake and history of previous interferon therapy did not affect SVR12 rates. No virologic breakthroughs were observed and the study treatment was well tolerated.
Conclusions
Treatment with ravidasvir plus sofosbuvir, with or without ribavirin, was well tolerated and associated with high sustained virologic response rate for HCV-GT4 infected patients with and without cirrhosis, regardless of previous interferon-based treatments
#Erectile dysfunction in the trajectory of #cardiovascular disease
http://journals.sagepub.com/doi/full/10.1177/1358863X17744038 .
The study findings advance our knowledge regarding the connection between ED and vascular dysfunction. The association of ED with endothelial dysfunction and early atherosclerosis provides evidence that ED may serve as a marker of early vascular disease that is easily ascertained by clinical history taking. The connection may reflect shared underlying mechanisms leading to ED and CVD. Similar pathophysiology contributes to both endothelial dysfunction and ED, including loss of nitric oxide bioavailability and increased inflammatory activation
The present study emphasizes the relevance of ED to understanding the trajectory of CVD. A simple standardized ED screening may identify early vascular dysfunction. Similarly, vascular dysfunction may serve as a surrogate marker to evaluate the efficacy of cardiovascular targeted therapies in men with ED. The presence of ED portends a higher risk of future cardiovascular events, particularly in intermediate risk men, and may serve as an opportunity for intensification of cardiovascular risk prevention strategies.2 The findings add to the growing evidence supporting additional trials to determine the clinical impact of ED screening and the appropriate cardiovascular-directed evaluation and treatment of men with ED
http://journals.sagepub.com/doi/full/10.1177/1358863X17744038 .
The study findings advance our knowledge regarding the connection between ED and vascular dysfunction. The association of ED with endothelial dysfunction and early atherosclerosis provides evidence that ED may serve as a marker of early vascular disease that is easily ascertained by clinical history taking. The connection may reflect shared underlying mechanisms leading to ED and CVD. Similar pathophysiology contributes to both endothelial dysfunction and ED, including loss of nitric oxide bioavailability and increased inflammatory activation
The present study emphasizes the relevance of ED to understanding the trajectory of CVD. A simple standardized ED screening may identify early vascular dysfunction. Similarly, vascular dysfunction may serve as a surrogate marker to evaluate the efficacy of cardiovascular targeted therapies in men with ED. The presence of ED portends a higher risk of future cardiovascular events, particularly in intermediate risk men, and may serve as an opportunity for intensification of cardiovascular risk prevention strategies.2 The findings add to the growing evidence supporting additional trials to determine the clinical impact of ED screening and the appropriate cardiovascular-directed evaluation and treatment of men with ED
Potential effect modifiers of the association between physical #activity patterns and #joint symptoms in middle aged women
http://onlinelibrary.wiley.com/doi/10.1002/acr.23430/abstract
To examine whether body mass index (BMI), menopausal status and hormone therapy (HT) use modify the association between physical activity (PA) patterns throughout middle age and incidence and prevalence of joint symptoms in later middle age in women
The groups representing ‘fluctuating’ (odds ratio [OR]=1.34, 99% confidence interval [CI]=1.04-1.72) and ‘none-or-low’ physical activity (OR=1.60, CI =1.08-2.35) had higher odds of incident joint symptoms than those ‘meeting guidelines-at-all-times’. Stratification by BMI showed that this association was statistically significant in the obese group only. No evidence was found for effect modification by menopausal status or HT use. The findings were similar for prevalent joint symptoms.
Conclusions
Maintaining at least low levels of physical activity throughout middle age was associated with lower prevalence and incidence of joint symptoms in later life. This apparent protective effect of physical activity on joint symptoms was stronger in obese women than in under or normal weight women, and not related to menopause and HT status
http://onlinelibrary.wiley.com/doi/10.1002/acr.23430/abstract
To examine whether body mass index (BMI), menopausal status and hormone therapy (HT) use modify the association between physical activity (PA) patterns throughout middle age and incidence and prevalence of joint symptoms in later middle age in women
The groups representing ‘fluctuating’ (odds ratio [OR]=1.34, 99% confidence interval [CI]=1.04-1.72) and ‘none-or-low’ physical activity (OR=1.60, CI =1.08-2.35) had higher odds of incident joint symptoms than those ‘meeting guidelines-at-all-times’. Stratification by BMI showed that this association was statistically significant in the obese group only. No evidence was found for effect modification by menopausal status or HT use. The findings were similar for prevalent joint symptoms.
Conclusions
Maintaining at least low levels of physical activity throughout middle age was associated with lower prevalence and incidence of joint symptoms in later life. This apparent protective effect of physical activity on joint symptoms was stronger in obese women than in under or normal weight women, and not related to menopause and HT status
Wiley
Potential effect modifiers of the association between physical activity patterns and joint symptoms in middle aged women
To examine whether body mass index (BMI), menopausal status and hormone therapy (HT) use modify the association between physical activity (PA) patterns throughout middle age and incidence and prevalence...
Comparative effect of #statins on the risk of incident #Alzheimer disease
http://n.neurology.org/content/early/2017/12/15/WNL.0000000000004818
Over the 18-year study period, we identified 465,085 statin users, including 7,669 patients who developed AD during 2,891,268 person-years of follow-up (incidence rate 2.65 95% CI 2.59–2.71 per 1,000 person-years). Compared to synthetic, fungus-derived statins were associated with an increased risk of AD (HR 1.09, 95% CI 1.03–1.15). Lipophilic statins also were associated with higher AD risk (HR 1.18, 95% CI 1.09–1.27) compared to hydrophilic statins, while statin potency did not modify the risk of AD (adjusted HR 1.03, 95% CI 0.98–1.08). The risk was further reduced in sensitivity analyses.
Conclusion Fungus-derived and lipophilic statins were not associated with decreased incidence of AD compared to synthetic and hydrophilic statins. The modest variations in the risk of incident AD observed between statin characteristics needs to be evaluated in future studies on their possible heterogeneous neuroprotective effect
http://n.neurology.org/content/early/2017/12/15/WNL.0000000000004818
Over the 18-year study period, we identified 465,085 statin users, including 7,669 patients who developed AD during 2,891,268 person-years of follow-up (incidence rate 2.65 95% CI 2.59–2.71 per 1,000 person-years). Compared to synthetic, fungus-derived statins were associated with an increased risk of AD (HR 1.09, 95% CI 1.03–1.15). Lipophilic statins also were associated with higher AD risk (HR 1.18, 95% CI 1.09–1.27) compared to hydrophilic statins, while statin potency did not modify the risk of AD (adjusted HR 1.03, 95% CI 0.98–1.08). The risk was further reduced in sensitivity analyses.
Conclusion Fungus-derived and lipophilic statins were not associated with decreased incidence of AD compared to synthetic and hydrophilic statins. The modest variations in the risk of incident AD observed between statin characteristics needs to be evaluated in future studies on their possible heterogeneous neuroprotective effect
Association of Gastroesophageal #Reflux With #Malignancy of the Upper Aerodigestive Tract in Elderly Patients
https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2666578?redirect=true
A total of 13 805 patients (median range age, 74 66-99 years; 3418 women 24.76% and 10 387 men 75.24%) with malignancy of the UADT were compared with 13 805 patients without disease and were matched for sex, age group, and year of diagnosis. GERD was associated with a greater odds of developing malignancy of the larynx (adjusted odds ratio aOR, 2.86; 95% CI, 2.65-3.09), hypopharynx (aOR, 2.54; 95% CI 1.97-3.29), oropharynx (aOR, 2.47; 95% CI, 1.90-3.23), tonsil (aOR, 2.14; 95% CI, 1.82-2.53), nasopharynx (aOR, 2.04; 95% CI, 1.56-2.66), and paranasal sinuses (aOR, 1.40; 95% CI, 1.15-1.70).
Conclusions and Relevance GERD is associated with the presence of malignancy of the UADT in the US elderly population. This epidemiological association requires further examination to determine causality and diagnostic utility
https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2666578?redirect=true
A total of 13 805 patients (median range age, 74 66-99 years; 3418 women 24.76% and 10 387 men 75.24%) with malignancy of the UADT were compared with 13 805 patients without disease and were matched for sex, age group, and year of diagnosis. GERD was associated with a greater odds of developing malignancy of the larynx (adjusted odds ratio aOR, 2.86; 95% CI, 2.65-3.09), hypopharynx (aOR, 2.54; 95% CI 1.97-3.29), oropharynx (aOR, 2.47; 95% CI, 1.90-3.23), tonsil (aOR, 2.14; 95% CI, 1.82-2.53), nasopharynx (aOR, 2.04; 95% CI, 1.56-2.66), and paranasal sinuses (aOR, 1.40; 95% CI, 1.15-1.70).
Conclusions and Relevance GERD is associated with the presence of malignancy of the UADT in the US elderly population. This epidemiological association requires further examination to determine causality and diagnostic utility
Long-Acting Beta agonists (LABAs) and Inhaled Corticosteroids (ICS): Drug Safety Communication - Boxed #Warning About #Asthma-Related Death Removed
https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm590001.htm
FDA's most prominent warning, the Boxed Warning, about asthma-related death has been removed from the drug labels of medicines that contain both an ICS and LABA. A FDA review of four large clinical safety trials shows that treating asthma with long-acting beta agonists (LABAs) in combination with inhaled corticosteroids (ICS) does not result in significantly more serious asthma-related side effects than treatment with ICS alone. A description of the four trials is now also included in the Warnings and Precautions section of the drug labels. These trials showed that LABAs, when used with ICS, did not significantly increase the risk of asthma-related hospitalizations, the need to insert a breathing tube known as intubation, or asthma-related deaths, compared to ICS alone.
https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm590001.htm
FDA's most prominent warning, the Boxed Warning, about asthma-related death has been removed from the drug labels of medicines that contain both an ICS and LABA. A FDA review of four large clinical safety trials shows that treating asthma with long-acting beta agonists (LABAs) in combination with inhaled corticosteroids (ICS) does not result in significantly more serious asthma-related side effects than treatment with ICS alone. A description of the four trials is now also included in the Warnings and Precautions section of the drug labels. These trials showed that LABAs, when used with ICS, did not significantly increase the risk of asthma-related hospitalizations, the need to insert a breathing tube known as intubation, or asthma-related deaths, compared to ICS alone.
www.fda.gov
Long-Acting Beta agonists (LABAs) and Inhaled Corticosteroids (ICS): Drug Safety Communication - Boxed Warning About Asthma-Related…
FDA review of clinical safety trials shows that treating asthma with LABAs in combination with ICS does not result in significantly more serious asthma-related side effects than treatment with ICS alone.
The mediating role of sleep in the #fish consumption – #cognitive functioning relationship: a cohort study
https://www.nature.com/articles/s41598-017-17520-w
Greater fish consumption is associated with improved cognition among children, but the mediating pathways have not been well delineated. Improved sleep could be a candidate mediator of the fish-cognition relationship. This study assesses whether 1) more frequent fish consumption is associated with less sleep disturbances and higher IQ scores in schoolchildren, 2) such relationships are not accounted for by social and economic confounds, and 3) sleep quality mediates the fish-IQ relationship. In this cohort study of 541 Chinese schoolchildren, fish consumption and sleep quality were assessed at age 9–11 years, while IQ was assessed at age 12. Frequent fish consumption was related to both fewer sleep problems and higher IQ scores. A dose-response relationship indicated higher IQ scores in children who always (4.80 points) or sometimes (3.31 points) consumed fish, compared to those who rarely ate fish (all p < 0.05). Sleep quality partially mediated the relationship between fish consumption and verbal, but not performance, IQ. Findings were robust after controlling for multiple sociodemographic covariates. To our knowledge, this is the first study to indicate that frequent fish consumption may help reduce sleep problems (better sleep quality), which may in turn benefit long-term cognitive functioning in children
https://www.nature.com/articles/s41598-017-17520-w
Greater fish consumption is associated with improved cognition among children, but the mediating pathways have not been well delineated. Improved sleep could be a candidate mediator of the fish-cognition relationship. This study assesses whether 1) more frequent fish consumption is associated with less sleep disturbances and higher IQ scores in schoolchildren, 2) such relationships are not accounted for by social and economic confounds, and 3) sleep quality mediates the fish-IQ relationship. In this cohort study of 541 Chinese schoolchildren, fish consumption and sleep quality were assessed at age 9–11 years, while IQ was assessed at age 12. Frequent fish consumption was related to both fewer sleep problems and higher IQ scores. A dose-response relationship indicated higher IQ scores in children who always (4.80 points) or sometimes (3.31 points) consumed fish, compared to those who rarely ate fish (all p < 0.05). Sleep quality partially mediated the relationship between fish consumption and verbal, but not performance, IQ. Findings were robust after controlling for multiple sociodemographic covariates. To our knowledge, this is the first study to indicate that frequent fish consumption may help reduce sleep problems (better sleep quality), which may in turn benefit long-term cognitive functioning in children
Scientific Reports
The mediating role of sleep in the fish consumption – cognitive functioning relationship: a cohort study
The mediating role of sleep in the fish consumption – cognitive functioning relationship: a cohort study
Dietary #antioxidants and 10-year #lung function decline in adults from the ECRHS survey
http://erj.ersjournals.com/content/50/6/1602286
In 2002, adults from three participating countries of the European Community Respiratory Health Survey (ECRHS) answered a questionnaire and underwent spirometry (forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)), which were repeated 10 years later. Dietary intake was estimated at baseline with food frequency questionnaires (FFQ). Associations between annual lung function decline (mL) and diet (tertiles) were examined with multivariable analyses. Simes’ procedure was applied to control for multiple testing.
A total of 680 individuals (baseline mean age 43.8±6.6 years) were included. A per-tertile increase in apple and banana intake was associated with a 3.59 mL·year−1 (95% CI 0.40, 7.68) and 3.69 mL·year−1 (95% CI 0.25, 7.14) slower decline in FEV1 and FVC, respectively. Tomato intake was also associated with a slower decline in FVC (4.5 mL·year−1; 95% CI 1.28, 8.02). Only the association with tomato intake remained statistically significant after the Simes’ procedure was performed. Subgroup analyses showed that apple, banana and tomato intake were all associated with a slower decline in FVC in ex-smokers.
Intake of fruits and tomatoes might delay lung function decline in adults, particularly in ex-smokers.
http://erj.ersjournals.com/content/50/6/1602286
In 2002, adults from three participating countries of the European Community Respiratory Health Survey (ECRHS) answered a questionnaire and underwent spirometry (forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)), which were repeated 10 years later. Dietary intake was estimated at baseline with food frequency questionnaires (FFQ). Associations between annual lung function decline (mL) and diet (tertiles) were examined with multivariable analyses. Simes’ procedure was applied to control for multiple testing.
A total of 680 individuals (baseline mean age 43.8±6.6 years) were included. A per-tertile increase in apple and banana intake was associated with a 3.59 mL·year−1 (95% CI 0.40, 7.68) and 3.69 mL·year−1 (95% CI 0.25, 7.14) slower decline in FEV1 and FVC, respectively. Tomato intake was also associated with a slower decline in FVC (4.5 mL·year−1; 95% CI 1.28, 8.02). Only the association with tomato intake remained statistically significant after the Simes’ procedure was performed. Subgroup analyses showed that apple, banana and tomato intake were all associated with a slower decline in FVC in ex-smokers.
Intake of fruits and tomatoes might delay lung function decline in adults, particularly in ex-smokers.
The Effects of Physical #Exercise and Cognitive Training on #Memory and Neurotrophic Factors
https://www.mitpressjournals.org/doi/abs/10.1162/jocn_a_01164?journalCode=jocn
This study examined the combined effect of physical exercise and cognitive training on memory and neurotrophic factors in healthy, young adults. Ninety-five participants completed 6 weeks of exercise training, combined exercise and cognitive training, or no training (control). Both the exercise and combined training groups improved performance on a high-interference memory task, whereas the control group did not. In contrast, neither training group improved on general recognition performance, suggesting that exercise training selectively increases high-interference memory that may be linked to hippocampal function. Individuals who experienced greater fitness improvements from the exercise training (i.e., high responders to exercise) also had greater increases in the serum neurotrophic factors brain-derived neurotrophic factor and insulin-like growth factor-1. These high responders to exercise also had better high-interference memory performance as a result of the combined exercise and cognitive training compared with exercise alone, suggesting that potential synergistic effects might depend on the availability of neurotrophic factors. These findings are especially important, as memory benefits accrued from a relatively short intervention in high-functioning young adults
https://www.mitpressjournals.org/doi/abs/10.1162/jocn_a_01164?journalCode=jocn
This study examined the combined effect of physical exercise and cognitive training on memory and neurotrophic factors in healthy, young adults. Ninety-five participants completed 6 weeks of exercise training, combined exercise and cognitive training, or no training (control). Both the exercise and combined training groups improved performance on a high-interference memory task, whereas the control group did not. In contrast, neither training group improved on general recognition performance, suggesting that exercise training selectively increases high-interference memory that may be linked to hippocampal function. Individuals who experienced greater fitness improvements from the exercise training (i.e., high responders to exercise) also had greater increases in the serum neurotrophic factors brain-derived neurotrophic factor and insulin-like growth factor-1. These high responders to exercise also had better high-interference memory performance as a result of the combined exercise and cognitive training compared with exercise alone, suggesting that potential synergistic effects might depend on the availability of neurotrophic factors. These findings are especially important, as memory benefits accrued from a relatively short intervention in high-functioning young adults
MIT Press Journals
The Effects of Physical Exercise and Cognitive Training on Memory and Neurotrophic Factors
This study examined the combined effect of physical exercise and cognitive training on memory and neurotrophic factors in healthy, young adults. Ninety-five participants completed 6 weeks of exercise training, combined exercise and cognitive training, or…
Association of Short-term Exposure to Air #Pollution With #Mortality in Older Adults
https://jamanetwork.com/journals/jama/article-abstract/2667069
.. The baseline daily mortality rates were 137.33 and 129.44 (per 1 million persons at risk per day) for the entire year and for the warm season, respectively. Each short-term increase of 10 μg/m3 in PM2.5 (adjusted by ozone) and 10 parts per billion (10−9) in warm-season ozone (adjusted by PM2.5) were statistically significantly associated with a relative increase of 1.05% (95% CI, 0.95%-1.15%) and 0.51% (95% CI, 0.41%-0.61%) in daily mortality rate, respectively. Absolute risk differences in daily mortality rate were 1.42 (95% CI, 1.29-1.56) and 0.66 (95% CI, 0.53-0.78) per 1 million persons at risk per day. There was no evidence of a threshold in the exposure-response relationship.
Conclusions and Relevance In the US Medicare population from 2000 to 2012, short-term exposures to PM2.5 and warm-season ozone were significantly associated with increased risk of mortality. This risk occurred at levels below current national air quality standards, suggesting that these standards may need to be reevaluated
https://jamanetwork.com/journals/jama/article-abstract/2667069
.. The baseline daily mortality rates were 137.33 and 129.44 (per 1 million persons at risk per day) for the entire year and for the warm season, respectively. Each short-term increase of 10 μg/m3 in PM2.5 (adjusted by ozone) and 10 parts per billion (10−9) in warm-season ozone (adjusted by PM2.5) were statistically significantly associated with a relative increase of 1.05% (95% CI, 0.95%-1.15%) and 0.51% (95% CI, 0.41%-0.61%) in daily mortality rate, respectively. Absolute risk differences in daily mortality rate were 1.42 (95% CI, 1.29-1.56) and 0.66 (95% CI, 0.53-0.78) per 1 million persons at risk per day. There was no evidence of a threshold in the exposure-response relationship.
Conclusions and Relevance In the US Medicare population from 2000 to 2012, short-term exposures to PM2.5 and warm-season ozone were significantly associated with increased risk of mortality. This risk occurred at levels below current national air quality standards, suggesting that these standards may need to be reevaluated
Jamanetwork
Association of Short-term Exposure to Air Pollution With Mortality in Older Adults
This case-crossover study estimates the association between short-term exposures to ambient fine particulate matter and ozone and mortality in the continental United States.
This time it’s personal: the #memory benefit of #hearing oneself
http://www.tandfonline.com/doi/full/10.1080/09658211.2017.1383434
The production effect is the memory advantage of saying words aloud over simply reading them silently. It has been hypothesised that this advantage stems from production featuring distinctive information that stands out at study relative to reading silently. MacLeod (2011) (I said, you said: The production effect gets personal. Psychonomic Bulletin & Review, 18, 1197–1202. doi:10.3758/s13423-011-0168-8) found superior memory for reading aloud oneself vs. hearing another person read aloud, which suggests that motor information (speaking), self-referential information (i.e., “I said it”), or both contribute to the production effect. In the present experiment, we dissociated the influence on memory of these two components by including a study condition in which participants heard themselves read words aloud (recorded earlier) – a first for production effect research – along with the more typical study conditions of reading aloud, hearing someone else speak, and reading silently. There was a gradient of memory across these four conditions, with hearing oneself lying between speaking and hearing someone else speak. These results imply that oral production is beneficial because it entails two distinctive components: a motor (speech) act and a unique, self-referential auditory input.
http://www.tandfonline.com/doi/full/10.1080/09658211.2017.1383434
The production effect is the memory advantage of saying words aloud over simply reading them silently. It has been hypothesised that this advantage stems from production featuring distinctive information that stands out at study relative to reading silently. MacLeod (2011) (I said, you said: The production effect gets personal. Psychonomic Bulletin & Review, 18, 1197–1202. doi:10.3758/s13423-011-0168-8) found superior memory for reading aloud oneself vs. hearing another person read aloud, which suggests that motor information (speaking), self-referential information (i.e., “I said it”), or both contribute to the production effect. In the present experiment, we dissociated the influence on memory of these two components by including a study condition in which participants heard themselves read words aloud (recorded earlier) – a first for production effect research – along with the more typical study conditions of reading aloud, hearing someone else speak, and reading silently. There was a gradient of memory across these four conditions, with hearing oneself lying between speaking and hearing someone else speak. These results imply that oral production is beneficial because it entails two distinctive components: a motor (speech) act and a unique, self-referential auditory input.
Association Between #Calcium or Vitamin #D Supplementation and #Fracture Incidence in Community-Dwelling Older Adults A Systematic Review and Meta-analysis
https://jamanetwork.com/journals/jama/article-abstract/2667071?resultClick=1&redirect=true
A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 95% CI, 0.97 to 2.42; ARD, 0.01 95% CI, 0.00 to 0.01; vitamin D: RR, 1.21 95% CI, 0.99 to 1.47; ARD, 0.00 95% CI, −0.00 to 0.01. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 95% CI, 0.85 to 1.39; ARD, 0.00 95% CI, −0.00 to 0.00). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.
Conclusions and Relevance In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
https://jamanetwork.com/journals/jama/article-abstract/2667071?resultClick=1&redirect=true
A total of 33 randomized trials involving 51 145 participants fulfilled the inclusion criteria. There was no significant association of calcium or vitamin D with risk of hip fracture compared with placebo or no treatment (calcium: RR, 1.53 95% CI, 0.97 to 2.42; ARD, 0.01 95% CI, 0.00 to 0.01; vitamin D: RR, 1.21 95% CI, 0.99 to 1.47; ARD, 0.00 95% CI, −0.00 to 0.01. There was no significant association of combined calcium and vitamin D with hip fracture compared with placebo or no treatment (RR, 1.09 95% CI, 0.85 to 1.39; ARD, 0.00 95% CI, −0.00 to 0.00). No significant associations were found between calcium, vitamin D, or combined calcium and vitamin D supplements and the incidence of nonvertebral, vertebral, or total fractures. Subgroup analyses showed that these results were generally consistent regardless of the calcium or vitamin D dose, sex, fracture history, dietary calcium intake, and baseline serum 25-hydroxyvitamin D concentration.
Conclusions and Relevance In this meta-analysis of randomized clinical trials, the use of supplements that included calcium, vitamin D, or both compared with placebo or no treatment was not associated with a lower risk of fractures among community-dwelling older adults. These findings do not support the routine use of these supplements in community-dwelling older people.
Liver #resection of #hepatocellular carcinoma in patients with portal #hypertension and multiple tumors
http://onlinelibrary.wiley.com/doi/10.1111/hepr.13047/abstract
Liver resection for hepatocellular carcinoma (HCC) has been recommended only for patients with a single tumor without portal hypertension. We aimed to validate this treatment strategy that is based on by the Barcelona Clinic Liver Cancer staging system The median overall and recurrence-free survival periods of patients in Group 1 (N= 695) were 8.5 years (95% confidence interval CI 6.6−9.0) and 2.4 years (2.2−2.7), respectively, and were significantly longer compared with those of patients in Group 2 (N = 197) (5.6 years 95% CI, 4.8−6.7, P = 0.001, and 1.9 years 1.6−2.1, P < 0.001). On multivariate analysis, the independent factors for overall survival were hepatitis C virus infection (HR 1.29 95% CI, 1.02−1.65, P = 0.032), multiple tumors (1.42 1.01−1.98, P = 0.040), and vascular invasion (1.66 1.31−2.10, P < 0.001). On the other hand, frequency of morbidities (23 3.3% patients vs 11 5.5% patients, P = 0.143) and mortalities (3 0.4% patients vs 2 1.0% patients, P = 0.305) was not significantly different between the two groups.
Conclusions
Patients with HCC with portal hypertension and/or multiple tumors could be the candidates for liver resection due to the safety of the procedure
http://onlinelibrary.wiley.com/doi/10.1111/hepr.13047/abstract
Liver resection for hepatocellular carcinoma (HCC) has been recommended only for patients with a single tumor without portal hypertension. We aimed to validate this treatment strategy that is based on by the Barcelona Clinic Liver Cancer staging system The median overall and recurrence-free survival periods of patients in Group 1 (N= 695) were 8.5 years (95% confidence interval CI 6.6−9.0) and 2.4 years (2.2−2.7), respectively, and were significantly longer compared with those of patients in Group 2 (N = 197) (5.6 years 95% CI, 4.8−6.7, P = 0.001, and 1.9 years 1.6−2.1, P < 0.001). On multivariate analysis, the independent factors for overall survival were hepatitis C virus infection (HR 1.29 95% CI, 1.02−1.65, P = 0.032), multiple tumors (1.42 1.01−1.98, P = 0.040), and vascular invasion (1.66 1.31−2.10, P < 0.001). On the other hand, frequency of morbidities (23 3.3% patients vs 11 5.5% patients, P = 0.143) and mortalities (3 0.4% patients vs 2 1.0% patients, P = 0.305) was not significantly different between the two groups.
Conclusions
Patients with HCC with portal hypertension and/or multiple tumors could be the candidates for liver resection due to the safety of the procedure
Evaluating the risk factors for #hospital-onset #Clostridium difficile infections in a large healthcare system
https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/cix1112/4767819
In this multicenter retrospective cohort study of over 1 million patients at 150 US hospitals, proton pump inhibitors increased the odds of a patient having hospital-onset Clostridium difficile infection as did third and fourth generation cephalosporins, carbapenems, and piperacillin/tazobactam. These findings support appropriate prescribing of acid-suppression therapy and high-risk antibiotics.
https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/cix1112/4767819
In this multicenter retrospective cohort study of over 1 million patients at 150 US hospitals, proton pump inhibitors increased the odds of a patient having hospital-onset Clostridium difficile infection as did third and fourth generation cephalosporins, carbapenems, and piperacillin/tazobactam. These findings support appropriate prescribing of acid-suppression therapy and high-risk antibiotics.
OUP Academic
Evaluating the risk factors for hospital-onset Clostridium difficile infections in a large healthcare system | Clinical Infectious…
In this multicenter retrospective cohort study of over 1 million patients at 150 US hospitals, proton pump inhibitors increased the odds of a patient having hospital-onset Clostridium difficile infection as did third and fourth generation cephalosporins,…
Incidence of End-Stage #Renal Disease in Patients With Type 1 #Diabetes
http://care.diabetesjournals.org/content/early/2017/12/19/dc17-2364
The patients were followed up for a median of 20 years. During 616,403 patient-years, 1,543 ESRD cases and 4,185 deaths were recorded. The cumulative risk of ESRD was 2.2% after 20 years and 7.0% after 30 years from the diabetes diagnosis. The relative risk of ESRD was 0.13 (95% CI 0.08–0.22) among patients diagnosed in 1995–2011 compared with those diagnosed in 1965–1979. Patients <5 years old at the time of diagnosis had the lowest risk of ESRD after diagnosis. With the cumulative risk of ESRD estimated from time of birth, the patients aged 5–9 years at diabetes diagnosis were at highest risk.
CONCLUSIONS The cumulative risk of ESRD has decreased markedly during the past 5 decades. This highlights the importance of modern treatment of diabetes and diabetic nephropathy
http://care.diabetesjournals.org/content/early/2017/12/19/dc17-2364
The patients were followed up for a median of 20 years. During 616,403 patient-years, 1,543 ESRD cases and 4,185 deaths were recorded. The cumulative risk of ESRD was 2.2% after 20 years and 7.0% after 30 years from the diabetes diagnosis. The relative risk of ESRD was 0.13 (95% CI 0.08–0.22) among patients diagnosed in 1995–2011 compared with those diagnosed in 1965–1979. Patients <5 years old at the time of diagnosis had the lowest risk of ESRD after diagnosis. With the cumulative risk of ESRD estimated from time of birth, the patients aged 5–9 years at diabetes diagnosis were at highest risk.
CONCLUSIONS The cumulative risk of ESRD has decreased markedly during the past 5 decades. This highlights the importance of modern treatment of diabetes and diabetic nephropathy
Deprescribing #antihyperglycemic agents in #older persons
Evidence-based clinical practice guideline
http://www.cfp.ca/content/63/11/832?
These recommendations apply to all elderly (> 65 y) adults taking ≥ 1 antihyperglycemic medications to treat type 2 diabetes and meeting ≥ 1 of the following criteria:
at risk of hypoglycemia (eg, owing to advancing age, overly intense glycemic control, multiple comorbidities, drug interactions, hypoglycemia history or lack of awareness, impaired renal function, or taking a sulfonylurea or insulin);
at risk of other antihyperglycemic adverse effects; or
in whom benefit is uncertain owing to frailty, dementia, or limited life expectancy
We recommend the following:
Deprescribing antihyperglycemic agents that are known to contribute to hypoglycemia (strong recommendation, very low-quality evidence)
Deprescribing antihyperglycemic agents in patients experiencing or at risk of adverse effects (good practice recommendation)
Individualizing glycemic targets to goals of care and time to benefit according to the Canadian Diabetes Association guidelines and other guidelines that specifically address frailty, dementia, and the end of life (good practice recommendation), and deprescribing accordingly (strong recommendation, very low-quality evidence)
Evidence-based clinical practice guideline
http://www.cfp.ca/content/63/11/832?
These recommendations apply to all elderly (> 65 y) adults taking ≥ 1 antihyperglycemic medications to treat type 2 diabetes and meeting ≥ 1 of the following criteria:
at risk of hypoglycemia (eg, owing to advancing age, overly intense glycemic control, multiple comorbidities, drug interactions, hypoglycemia history or lack of awareness, impaired renal function, or taking a sulfonylurea or insulin);
at risk of other antihyperglycemic adverse effects; or
in whom benefit is uncertain owing to frailty, dementia, or limited life expectancy
We recommend the following:
Deprescribing antihyperglycemic agents that are known to contribute to hypoglycemia (strong recommendation, very low-quality evidence)
Deprescribing antihyperglycemic agents in patients experiencing or at risk of adverse effects (good practice recommendation)
Individualizing glycemic targets to goals of care and time to benefit according to the Canadian Diabetes Association guidelines and other guidelines that specifically address frailty, dementia, and the end of life (good practice recommendation), and deprescribing accordingly (strong recommendation, very low-quality evidence)
Serum #Albumin as a Prognostic Marker for Serious Non- #AIDS Endpoints in the Strategic Timing of Antiretroviral Treatment (START) Study
https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jix350/4736314
Among 4576 participants, 71 developed a serious non-AIDS event, 788 were hospitalized, and 63 experienced an AIDS event. After adjusting for a range of variables associated with hypoalbuminemia, higher baseline serum albumin (per 1 g/dL) was associated with a decreased risk of serious non-AIDS events (hazard ratio, 0.37 [95% confidence interval, .20–.71]; P = .002). Similar results were obtained in a time-updated model, after controlling for interleukin 6, and after excluding initial follow-up years. Serum albumin was independently associated with hospitalization but not with risk of AIDS.
Conclusions
A low serum albumin level is a predictor for short- and long-term serious non-AIDS events, and may be a useful marker of risk of noncommunicable diseases, particularly in resource-limited settings
https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jix350/4736314
Among 4576 participants, 71 developed a serious non-AIDS event, 788 were hospitalized, and 63 experienced an AIDS event. After adjusting for a range of variables associated with hypoalbuminemia, higher baseline serum albumin (per 1 g/dL) was associated with a decreased risk of serious non-AIDS events (hazard ratio, 0.37 [95% confidence interval, .20–.71]; P = .002). Similar results were obtained in a time-updated model, after controlling for interleukin 6, and after excluding initial follow-up years. Serum albumin was independently associated with hospitalization but not with risk of AIDS.
Conclusions
A low serum albumin level is a predictor for short- and long-term serious non-AIDS events, and may be a useful marker of risk of noncommunicable diseases, particularly in resource-limited settings
OUP Academic
Serum Albumin as a Prognostic Marker for Serious Non-AIDS Endpoints in the Strategic Timing of Antiretroviral Treatment (START)…
BackgroundSerum albumin may be used to stratify human immunodeficiency virus (HIV)–infected persons with high CD4 count according to their risk of serious non-AIDS endpoints.MethodsCox proportional hazards models were used to analyze the risk of serious non…
Association of #Cardiovascular Risk With Inhaled Long-Acting #Bronchodilators in Patients With Chronic Obstructive Pulmonary Disease
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2666790?redirect=true
During a mean follow-up of 2.0 years, 37 719 patients with CVD (mean age, 75.6 years; 71.6% men) and 146 139 matched controls (mean age, 75.2 years; 70.1% men) were identified. New LABA and LAMA use in COPD was associated with a 1.50-fold (95% CI, 1.35-1.67; P < .001) and a 1.52-fold (95% CI, 1.28-1.80; P < .001) increased cardiovascular risk within 30 days of initiation, respectively, whereas the risk was absent, or even reduced with prevalent use. Individual LABA agents, LAMA dosage forms, and concomitant COPD regimens did not differ in the CVD risks. The risk persisted in an alternative case-crossover study and remained across subgroups without CVD history or prior exacerbations.
Conclusions and Relevance New initiation of LABAs or LAMAs in patients with COPD is associated with an approximate 1.5-fold increased severe cardiovascular risk, irrespective of prior CVD status and history of exacerbations
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2666790?redirect=true
During a mean follow-up of 2.0 years, 37 719 patients with CVD (mean age, 75.6 years; 71.6% men) and 146 139 matched controls (mean age, 75.2 years; 70.1% men) were identified. New LABA and LAMA use in COPD was associated with a 1.50-fold (95% CI, 1.35-1.67; P < .001) and a 1.52-fold (95% CI, 1.28-1.80; P < .001) increased cardiovascular risk within 30 days of initiation, respectively, whereas the risk was absent, or even reduced with prevalent use. Individual LABA agents, LAMA dosage forms, and concomitant COPD regimens did not differ in the CVD risks. The risk persisted in an alternative case-crossover study and remained across subgroups without CVD history or prior exacerbations.
Conclusions and Relevance New initiation of LABAs or LAMAs in patients with COPD is associated with an approximate 1.5-fold increased severe cardiovascular risk, irrespective of prior CVD status and history of exacerbations