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Second-Look #Endoscopy in Hospitalized Severe Ulcerative #Colitis: A Retrospective Cohort Study

https://academic.oup.com/ibdjournal/advance-article-abstract/doi/10.1093/ibd/izy282/5094888?redirectedFrom=fulltext

Our study included 49 patients (mean age, 42 years; 52% women). Just under one-third of patients (30%) were noted to have improved endoscopic appearance at the second sigmoidoscopy, at a median of 9 days after initial exam. None of the patients who had improvement on the second endoscopy underwent in-hospital colectomy, compared with 46% of those with worsening or persistent disease (P = 0.002). Similar differences in the improved group persisted at 3 months (P = 0.007) and 6 months (P = 0.027). Histologic severity at the first endoscopy was associated with increased risk of colectomy in-hospital (odds ratio, 3.8; 95% confidence interval, 1.02–14.21) and at 3 and 6 months.

Conclusions
After a median interval of 9 days, endoscopic improvement was noted in 30% of patients with ASUC undergoing a second sigmoidoscopy, which predicted lower rates of colectomy in-hospital and at 3 and 6 months.

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Effect of #smoking cessation on the risk of #dementia: a longitudinal study

https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.633

Compared to continual smokers, long‐term quitters and never smokers had decreased risk of overall dementia (hazard ratio, HR 0.86 95% CI, confidence interval 0.75–0.99 and HR: 0.81; 95% CI: 0.71–0.91, respectively). Never smokers had decreased risk of Alzheimer's disease (HR: 0.82; 95% CI: 0.70–0.96) compared to continual smokers. Finally, both long‐term quitters (HR: 0.68; 95% CI: 0.48–0.96) and never smokers (HR: 0.71; 95% CI: 0.54–0.95) had decreased risk of vascular dementia compared to continual smokers.

Interpretation
Smoking was associated with increased risk of dementia. Smokers who quit for a prolonged period of time may benefit from reduced risk of dementia. Therefore, smokers should be encouraged to quit in order to reduce the risk of developing dementia, especially in the elderly population who are already at risk.

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Intensification of older adults’ outpatient blood #pressure treatment at hospital #discharge: national retrospective cohort study

https://www.bmj.com/content/362/bmj.k3503

Overall, 2074 (14%) patients were discharged with intensified antihypertensive treatment, more than half of whom (1082) had well controlled blood pressure before admission. After adjustment for potential confounders, elevated inpatient blood pressure was strongly associated with being discharged on intensified antihypertensive regimens. Among patients with previously well controlled outpatient blood pressure, 8% (95% confidence interval 7% to 9%) of patients without elevated inpatient blood pressure, 24% (21% to 26%) of patients with moderately elevated inpatient blood pressure, and 40% (34% to 46%) of patients with severely elevated inpatient blood pressure were discharged with intensified antihypertensive regimens. No differences were seen in rates of intensification among patients least likely to benefit from tight blood pressure control (limited life expectancy, dementia, or metastatic malignancy), nor in those most likely to benefit (history of myocardial infarction, cerebrovascular disease, or renal disease).

Conclusions One in seven older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment. More than half of intensifications occurred in patients with previously well controlled outpatient blood pressure. More attention is needed to reduce potentially harmful overtreatment of blood pressure as older adults transition from hospital to home

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Analgesic Use and Ovarian Cancer Risk: An Analysis in the #Ovarian Cancer Cohort Consortium

https://academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djy100/5026198?redirectedFrom=fulltext

Women who used #aspirin almost daily (≥6 days/wk) vs infrequent/nonuse experienced a 10% reduction in ovarian cancer risk (rate ratio RR = 0.90, 95% confidence interval CI = 0.82 to 1.00, P = .05). Frequent use (≥4 days/wk) of aspirin (RR = 0.95, 95% CI = 0.88 to 1.03), nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs; RR = 1.00, 95% CI = 0.90 to 1.11), or acetaminophen (RR = 1.05, 95% CI = 0.88 to 1.24) was not associated with risk. Daily acetaminophen use (RR = 1.28, 95% CI = 1.00 to 1.65, P = .05) was associated with elevated ovarian cancer risk. Risk estimates for frequent, long-term (10+ years) use of aspirin (RR = 1.15, 95% CI = 0.98 to 1.34) or nonaspirin NSAIDs (RR = 1.19, 95% CI = 0.84 to 1.68) were modestly elevated, although not statistically significantly so.

Conclusions
This large, prospective analysis suggests that women who use aspirin daily have a slightly lower risk of developing ovarian cancer (∼10% lower than infrequent/nonuse)—similar to the risk reduction observed in case–control analyses. The observed potential elevated risks for 10+ years of frequent aspirin and NSAID use require further study but could be due to confounding by medical indications for use or variation in drug dosing

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Early life #experiences and social cognition in major #psychiatric disorders: A systematic review

https://www.sciencedirect.com/science/article/pii/S0924933818301305?via%3Dihub

A total of 25 studies were included in the systematic review with the quality assessment scores ranging from 3 to 6 (out of 6). The vast majority of the studies reviewed showed a significant association between early childhood social experience, including both insecure attachment and adversity relating to neglect or abuse, and poorer social cognitive performance.

Conclusion
We discuss these findings in the context of an attachment model, suggesting that childhood social adversity may result in poor internal working models, selective attention toward emotional stimuli and greater difficulties with emotional self-regulation. We outline some of the steps required to translate this understanding of social cognitive dysfunction in major psychiatric disorders into a target for interventions that mitigate the adverse effects of childhood maltreatment and poor parental attachment on social cognition

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Association of Use of #Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of #Anxiety Symptoms
A Systematic Review and Meta-analysis

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2702216

In total, 1203 participants with omega-3 PUFA treatment (mean age, 43.7 years; mean female proportion, 55.0%; mean omega-3 PUFA dosage, 1605.7 mg/d) and 1037 participants without omega-3 PUFA treatment (mean age, 40.6 years; mean female proportion, 55.0%) showed an association between clinical anxiety symptoms among participants with omega-3 PUFA treatment compared with control arms (Hedges g, 0.374; 95% CI, 0.081-0.666; P = .01). Subgroup analysis showed that the association of treatment with reduced anxiety symptoms was significantly greater in subgroups with specific clinical diagnoses than in subgroups without clinical conditions. The anxiolytic effect of omega-3 PUFAs was significantly better than that of controls only in subgroups with a higher dosage (at least 2000 mg/d) and not in subgroups with a lower dosage (<2000 mg/d).

Conclusions and Relevance This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. Further well-designed studies are needed in populations in whom anxiety is the main symptom

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Health Check: why do I get a #headache when I haven’t had my #coffee?

https://theconversation.com/health-check-why-do-i-get-a-headache-when-i-havent-had-my-coffee-100163

Caffeine is a stimulant. It quickly enters our brain and blocks the (adenosine) receptors that are responsible for dulling brain activity. By blocking the dulling of our brain, we feel a sense of invigoration, focus and subtle euphoria. These feelings can also enhance our performance of certain focused tasks, like driving or staying awake through the whole lecture.

By far the most common symptom of caffeine withdrawal is headaches. These are typically mild and short-lived, usually only lasting for a day or two, although they can sometimes last for up to week. They usually feel a bit like a tense band wrapped across your head and are sometimes called tension-type headaches as a result. However, caffeine withdrawal can also trigger a full-on migraine in some sufferers.

However, withdrawal can happen even in people who usually drink just a single cup every day who then forego caffeine. Equally, only three days of continuous coffee drinking is enough to make you feel bad when the coffee runs out..

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The associations of subclinical #atherosclerotic cardiovascular disease with hip #fracture risk and bone mineral density in elderly adults

https://link.springer.com/article/10.1007%2Fs00198-018-4611-9

There were 494 hip fractures during follow-up. Among persons without clinical CVD, an average standard-deviation increase in a composite score of maximal common and internal carotid artery intimal medial thickness (cIMT) was associated with increased risk of hip fracture (HR 1.18 [1.04, 1.35), even though cIMT was positively associated with BMD. Neither aortic wall thickness nor ABI were associated with hip fracture risk or BMD. Among participants with clinical CVD, cIMT and aortic wall thickness, but not ABI, were associated with increased hip fracture risk.

Conclusion
Subclinical cIMT is associated with an increased risk of hip fractures despite being associated with increased BMD. This finding suggests that vascular health, even in its early stages, is linked to bone health, by pathways other than BMD

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ANP32A regulates ATM expression and prevents #oxidative stress in cartilage, brain, and #bone

http://stm.sciencemag.org/content/10/458/eaar8426

Osteoarthritis is the most common joint disorder with increasing global prevalence due to aging of the population.
Current therapy is limited to symptom relief, yet there is no cure. Its multifactorial etiology includes oxidative stress and overproduction of reactive oxygen species, but the regulation of these processes in the joint is insufficiently understood.

We report that ANP32A protects the cartilage against oxidative stress, preventing osteoarthritis development and disease progression. ANP32A is down-regulated in human and mouse osteoarthritic cartilage. Microarray profiling revealed that ANP32A protects the joint by promoting the expression of ATM, a key regulator of the cellular oxidative defense.

Antioxidant treatment reduced the severity of osteoarthritis, osteopenia, and cerebellar ataxia features in Anp32a-deficient mice, revealing that the ANP32A/ATM axis discovered in cartilage is also present in brain and bone. Our findings indicate that modulating ANP32A signaling could help manage oxidative stress in cartilage, brain, and bone with therapeutic implications for osteoarthritis, neurological disease, and osteoporosis.

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Influence of Varying Quantitative #Fecal Immunochemical Test Positivity Thresholds on #Colorectal Cancer Detection: A Community-Based Cohort Study

http://annals.org/aim/article-abstract/2702473/influence-varying-quantitative-fecal-immunochemical-test-positivity-thresholds-colorectal-cancer

Of 640 859 persons who completed a baseline FIT and were followed for 2 years, 481 817 (75%) had at least 1 additional FIT and 1245 (0.19%) received a CRC diagnosis. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 822 in 1245 (66.0%) at 30 µg/g to 925 (74.3%) at 20 µg/g and 987 (79.3%) at 10 µg/g; the number of positive test results per cancer case detected increased from 43 at 30 µg/g to 52 at 20 µg/g and 85 at 10 µg/g. Reducing the positivity threshold from 20 to 15 µg/g would detect 3% more cancer cases and require 23% more colonoscopies. At the conventional FIT threshold of 20 µg/g, programmatic sensitivity decreased with increasing age (79.0%, 73.4%, and 68.9% for ages 50 to 59, 60 to 69, and 70 to 75 years, respectively; P = 0.009) and was higher in men than women (77.0% vs. 70.6%; P = 0.011)

Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources

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Effect of #Aspirin on Disability-free Survival in the Healthy #Elderly

https://www.nejm.org/doi/full/10.1056/NEJMoa1800722

.. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval CI, 0.92 to 1.11; P=0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001).

CONCLUSIONS
Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate

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Transmission of Mobile #Colistin Resistance (mcr-1) by #Duodenoscope

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciy683/5094756

Two patients had highly related mcr-1-positive K. pneumoniae isolated from clinical cultures; a duodenoscope was the only identified epidemiological link. Screening tests for mcr-1 in 20 healthcare contacts and 2 household contacts were negative. K. pneumoniae and E. coli were recovered from the duodenoscope; neither carried mcr-1. Evaluation of the duodenoscope identified intrusion of biomaterial under the sealed distal cap; devices were recalled to repair this defect.

Conclusions
We identified transmission of mcr-1 in a United States acute care hospital that likely occurred via duodenoscope despite no identifiable breaches in reprocessing or infection control practices. Duodenoscope design flaws leading to transmission of multidrug-resistant organsisms persist despite recent initiatives to improve device safety. Reliable detection of colistin resistance is currently challenging for clinical laboratories, particularly given the absence of an FDA-cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr-carrying bacteria in healthcare settings

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Postnatal exposure to household #disinfectants, infant gut microbiota and subsequent risk of #overweight in children

http://www.cmaj.ca/content/190/37/E1097

Among 757 infants, the abundance of specific gut microbiota was associated with household cleaning with disinfectants and eco-friendly products in a dose-dependent manner. With more frequent use of disinfectants, Lachnospiraceae increasingly became more abundant (highest v. lowest quintile of use: adjusted odds ratio AOR 1.93, 95% confidence interval CI 1.08 to 3.45) while genus Haemophilus declined in abundance (highest v. lowest quintile of use: AOR 0.36, 95% CI 0.20 to 0.65). Enterobacteriaceae were successively depleted with greater use of eco-friendly products (AOR 0.45, 95% CI 0.27 to 0.74). Lachnospiraceae abundance significantly mediated associations of the top 30th centile of household disinfectant use with higher body mass index (BMI) z score (p = 0.02) and with increased odds of overweight or obesity (p = 0.04) at age 3. Use of eco-friendly products was associated with decreased odds of overweight or obesity independently of Enterobacteriaceae abundance (AOR 0.44, 95% CI 0.22 to 0.86), with no significant mediation (p = 0.2).

INTERPRETATION: Exposure to household disinfectants was associated with higher BMI at age 3, mediated by gut microbial composition at age 3–4 months. Although child overweight was less common in households that cleaned with eco-friendly products, the lack of mediation by infant gut microbiota suggests another pathway for this association

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#CKD in Patients with Bilateral #Oophorectomy

https://cjasn.asnjournals.org/content/early/2018/09/19/CJN.03990318

Women who underwent bilateral oophorectomy had a higher risk of eGFR-based CKD (211 events for oophorectomy and 131 for referent women; adjusted hazard ratio, 1.42; 95% confidence interval, 1.14 to 1.77; absolute risk increase, 6.6%). The risk was higher in women who underwent oophorectomy at age ≤45 years old (110 events for oophorectomy and 60 for referent women; adjusted hazard ratio, 1.59; 95% confidence interval, 1.15 to 2.19; absolute risk increase, 7.5%).

Conclusions Premenopausal women who undergo bilateral oophorectomy, particularly those ≤45 years old, are at higher risk of developing CKD, even after adjusting for multiple chronic conditions and other possible confounders present at index date.

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Association between maternal #gluten intake and type 1 #diabetes in offspring: national prospective cohort study in Denmark

https://www.bmj.com/content/362/bmj.k3547

The study comprised 101 042 pregnancies in 91 745 women, of whom 70 188 filled out the food frequency questionnaire. After correcting for multiple pregnancies, pregnancies ending in abortions, stillbirths, lack of information regarding the pregnancy, and pregnancies with implausibly high or low energy intake, 67 565 pregnancies (63 529 women) were included. The average gluten intake was 13.0 g/day, ranging from less than 7 g/day to more than 20 g/day. The incidence of type 1 diabetes among children in the cohort was 0.37% (n=247) with a mean follow-up period of 15.6 years (standard deviation 1.4). Risk of type 1 diabetes in offspring increased proportionally with maternal gluten intake during pregnancy (adjusted hazard ratio 1.31 (95% confidence interval 1.001 to 1.72) per 10 g/day increase of gluten). Women with the highest gluten intake versus those with the lowest gluten intake (≥20 v <7 g/day) had double the risk of type 1 diabetes development in their offspring (adjusted hazard ratio 2.00 (95% confidence interval 1.02 to 4.00)).

Conclusions High gluten intake by mothers during pregnancy could increase the risk of their children developing type 1 diabetes. However, confirmation of these findings are warranted, preferably in an intervention setting

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Racial and ethnic estimates of #Alzheimer's disease and related dementias in the United States (2015–2060) in #adults aged ≥65 years

https://www.alzheimersanddementia.com/article/S1552-5260(18)33252-7/fulltext?mobileUi=0

The burden of ADRD in 2014 was an estimated 5.0 million adults aged ≥65 years or 1.6% of the population, and there are significant disparities in ADRD prevalence among population subgroups defined by race and ethnicity. ADRD burden will double to 3.3% by 2060 when 13.9 million Americans are projected to have the disease.

Discussion
These estimates can be used to guide planning and interventions related to caring for the ADRD population and supporting caregivers.

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Gastro-Esophageal #Reflux Disease After Laparoscopic Mini-Gastric #Bypass and Roux-en-Y Gastric Bypass: Is There a Difference?

https://www.liebertpub.com/doi/10.1089/bari.2018.0018

The operative time was significantly longer in RYGB group compared to MGB group (p < 0.001). The percentage of excess weight loss was slightly higher in the MGB group after 6 months (p = 0.096). There were no cases of leakage or mortalities in the two groups. Complications were recorded in 30% of the MGB group and 40% of the RYGB group. Biliary reflux was detected endoscopically in 11 patients (36.6%) in the MGB group and none of the RYGB group. GERD symptoms were exaggerated in MGB group after 1 month compared to RYGB group (p = 0.008). At 12 months, symptoms improved significantly in the two groups; the scores were nonsignificantly higher in MGB group (p = 0.088). Esophagitis was more common in the MGB group than RYGB group (p = 0.008).

Conclusion: Laparoscopic Roux-en-Y gastric bypass and laparoscopic mini-gastric bypass appear to be equally effective in the treatment of morbid obesity regarding weight loss and resolution of obesity-related metabolic complications. On short-term follow-up, MGB exaggerated GERD symptoms, but in the long run, symptoms decreased markedly.