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Association of High Intakes of Vitamins #B6 and #B12 From Food and Supplements With Risk of Hip #Fracture Among Postmenopausal Women in the Nurses’ Health Study
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733176
..Median (interquartile range) cumulative average intakes of total vitamins B6 and B12 were 3.6 (4.8) mg/d and 12.1 (11.7) μg/d, respectively. Both vitamin B6 (RR, 1.29; 95% CI, 1.04-1.59 for an intake of ≥35 vs <2 mg/d; P = .06 for linear trend) and vitamin B12 (RR, 1.25; 95% CI, 0.98-1.58 for an intake of ≥30 vs <5 μg/d; P = .02 for linear trend) were associated with increased fracture risk. Risk was highest in women with a combined high intake of both vitamins (B6 ≥35 mg/d and B12 ≥20 μg/d), exhibiting an almost 50% increased risk of hip fracture (RR, 1.47; 95% CI, 1.15-1.89) compared with women with a low intake of both vitamins (B6 <2 mg/d and B12 <10 μg/d).
Conclusions and Relevance In this cohort study, a combined high intake of vitamins B6 and B12 was associated with an increased risk of hip fracture. The intakes were far higher than the recommended dietary allowances. These findings add to previous studies suggesting that vitamin supplements should be used cautiously because adverse effects can occur.
Association of High Intakes of Vitamins #B6 and #B12 From Food and Supplements With Risk of Hip #Fracture Among Postmenopausal Women in the Nurses’ Health Study
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733176
..Median (interquartile range) cumulative average intakes of total vitamins B6 and B12 were 3.6 (4.8) mg/d and 12.1 (11.7) μg/d, respectively. Both vitamin B6 (RR, 1.29; 95% CI, 1.04-1.59 for an intake of ≥35 vs <2 mg/d; P = .06 for linear trend) and vitamin B12 (RR, 1.25; 95% CI, 0.98-1.58 for an intake of ≥30 vs <5 μg/d; P = .02 for linear trend) were associated with increased fracture risk. Risk was highest in women with a combined high intake of both vitamins (B6 ≥35 mg/d and B12 ≥20 μg/d), exhibiting an almost 50% increased risk of hip fracture (RR, 1.47; 95% CI, 1.15-1.89) compared with women with a low intake of both vitamins (B6 <2 mg/d and B12 <10 μg/d).
Conclusions and Relevance In this cohort study, a combined high intake of vitamins B6 and B12 was associated with an increased risk of hip fracture. The intakes were far higher than the recommended dietary allowances. These findings add to previous studies suggesting that vitamin supplements should be used cautiously because adverse effects can occur.
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Controlled Trial of #Budesonide– #Formoterol as Needed for Mild #Asthma
https://www.nejm.org/doi/full/10.1056/NEJMoa1901963
In double-blind, placebo-controlled trials, budesonide–formoterol used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting β2-agonist (SABA); the risk was similar to that of budesonide maintenance therapy plus as-needed SABA..
..The number of severe exacerbations was lower in the budesonide–formoterol group than in both the albuterol group (9 vs. 23; relative risk, 0.40; 95% CI, 0.18 to 0.86) and the budesonide maintenance group (9 vs. 21; relative risk, 0.44; 95% CI, 0.20 to 0.96). The mean (±SD) dose of inhaled budesonide was 107±109 μg per day in the budesonide–formoterol group and 222±113 μg per day in the budesonide maintenance group. The incidence and type of adverse events reported were consistent with those in previous trials and with reports in clinical use.
CONCLUSIONS
In an open-label trial involving adults with mild asthma, budesonide–formoterol used as needed was superior to albuterol used as needed for the prevention of asthma exacerbations.
Controlled Trial of #Budesonide– #Formoterol as Needed for Mild #Asthma
https://www.nejm.org/doi/full/10.1056/NEJMoa1901963
In double-blind, placebo-controlled trials, budesonide–formoterol used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting β2-agonist (SABA); the risk was similar to that of budesonide maintenance therapy plus as-needed SABA..
..The number of severe exacerbations was lower in the budesonide–formoterol group than in both the albuterol group (9 vs. 23; relative risk, 0.40; 95% CI, 0.18 to 0.86) and the budesonide maintenance group (9 vs. 21; relative risk, 0.44; 95% CI, 0.20 to 0.96). The mean (±SD) dose of inhaled budesonide was 107±109 μg per day in the budesonide–formoterol group and 222±113 μg per day in the budesonide maintenance group. The incidence and type of adverse events reported were consistent with those in previous trials and with reports in clinical use.
CONCLUSIONS
In an open-label trial involving adults with mild asthma, budesonide–formoterol used as needed was superior to albuterol used as needed for the prevention of asthma exacerbations.
The New England Journal of Medicine
Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma | NEJM
In double-blind, placebo-controlled trials, budesonide–formoterol used on an as-needed
basis resulted in a lower risk of severe exacerbation of asthma than as-needed use
of a short-acting β2-agonis...
basis resulted in a lower risk of severe exacerbation of asthma than as-needed use
of a short-acting β2-agonis...
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Association Between #Statin Use and Risk of #dementia After a Concussion
https://jamanetwork.com/journals/jamaneurology/article-abstract/2733673
Concussions are an acute injury that may lead to chronic disability, while statin use might improve neurologic recovery.
This study identified 28 815 patients diagnosed as having a concussion (median age, 76 years; 61.3% female), of whom 7058 (24.5%) received a statin, and 21 757 (75.5%) did not receive a statin. A total of 4727 patients subsequently developed dementia over a mean follow-up of 3.9 years, equal to an incidence of 1 case per 6 patients. Patients who received a statin had a 13% reduced risk of dementia compared with patients who did not receive a statin (relative risk, 0.87; 95% CI, 0.81-0.93; P < .001). The decreased risk of dementia associated with statin use applied to diverse patient groups, remained independent of other cardiovascular medication use, intensified over time, was distinct from the risk of subsequent depression, and was not observed in patients after an ankle sprain.
Conclusions and Relevance In this study, older adults had a substantial long-term risk of dementia after a concussion, which was associated with a modest reduction among patients receiving a statin.
Association Between #Statin Use and Risk of #dementia After a Concussion
https://jamanetwork.com/journals/jamaneurology/article-abstract/2733673
Concussions are an acute injury that may lead to chronic disability, while statin use might improve neurologic recovery.
This study identified 28 815 patients diagnosed as having a concussion (median age, 76 years; 61.3% female), of whom 7058 (24.5%) received a statin, and 21 757 (75.5%) did not receive a statin. A total of 4727 patients subsequently developed dementia over a mean follow-up of 3.9 years, equal to an incidence of 1 case per 6 patients. Patients who received a statin had a 13% reduced risk of dementia compared with patients who did not receive a statin (relative risk, 0.87; 95% CI, 0.81-0.93; P < .001). The decreased risk of dementia associated with statin use applied to diverse patient groups, remained independent of other cardiovascular medication use, intensified over time, was distinct from the risk of subsequent depression, and was not observed in patients after an ankle sprain.
Conclusions and Relevance In this study, older adults had a substantial long-term risk of dementia after a concussion, which was associated with a modest reduction among patients receiving a statin.
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Risks and clinical predictors of #cirrhosis and #hepatocellular #carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1321-x
Non-alcoholic fatty liver disease (NAFLD) is a common condition that progresses in some patients to steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC)..
Coded NAFLD/NASH patients were more likely to have diabetes, hypertension and obesity than matched controls. HR for cirrhosis in patients compared to controls was 4.73 (95% CI 2.43–9.19) and for HCC, 3.51 (95% CI 1.72–7.16). HR for either outcome was higher in patients with NASH and those with high-risk Fib-4 scores. The strongest independent predictor of a diagnosis of HCC or cirrhosis was baseline diagnosis of diabetes.
Conclusions
Real-world population data show that recorded diagnosis of NAFLD/NASH increases risk of life-threatening liver outcomes. Diabetes is an independent predictor of advanced liver disease diagnosis, emphasising the need to identify specific groups of patients at highest risk.
Risks and clinical predictors of #cirrhosis and #hepatocellular #carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1321-x
Non-alcoholic fatty liver disease (NAFLD) is a common condition that progresses in some patients to steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC)..
Coded NAFLD/NASH patients were more likely to have diabetes, hypertension and obesity than matched controls. HR for cirrhosis in patients compared to controls was 4.73 (95% CI 2.43–9.19) and for HCC, 3.51 (95% CI 1.72–7.16). HR for either outcome was higher in patients with NASH and those with high-risk Fib-4 scores. The strongest independent predictor of a diagnosis of HCC or cirrhosis was baseline diagnosis of diabetes.
Conclusions
Real-world population data show that recorded diagnosis of NAFLD/NASH increases risk of life-threatening liver outcomes. Diabetes is an independent predictor of advanced liver disease diagnosis, emphasising the need to identify specific groups of patients at highest risk.
BioMed Central
Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study…
Background Non-alcoholic fatty liver disease (NAFLD) is a common condition that progresses in some patients to steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC). Here we used healthcare records of 18 million adults to estimate risk of acquiring…
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Identifying Changepoints in #Biomarkers During the Preclinical Phase of #Alzheimer’s Disease
https://www.frontiersin.org/articles/10.3389/fnagi.2019.00074/full
A single measure, CSF t-tau, had an early changepoint (34 years prior to symptom onset). A group of measures, including the remaining CSF measures (CSF Abeta and phosphorylated tau) and all cognitive tests had changepoints 10–15 years prior to symptom onset. A second group is formed by medial temporal lobe shape composite measures, with a 6-year time difference between the right and left side (respectively nine and 3 years prior to symptom onset).
Conclusion: These findings highlight the long period of time prior to symptom onset during which AD pathology is accumulating in the brain. There are several significant findings, including the early changes in cognition and the laterality of the MRI findings. Additional work is needed to clarify their significance.
Identifying Changepoints in #Biomarkers During the Preclinical Phase of #Alzheimer’s Disease
https://www.frontiersin.org/articles/10.3389/fnagi.2019.00074/full
A single measure, CSF t-tau, had an early changepoint (34 years prior to symptom onset). A group of measures, including the remaining CSF measures (CSF Abeta and phosphorylated tau) and all cognitive tests had changepoints 10–15 years prior to symptom onset. A second group is formed by medial temporal lobe shape composite measures, with a 6-year time difference between the right and left side (respectively nine and 3 years prior to symptom onset).
Conclusion: These findings highlight the long period of time prior to symptom onset during which AD pathology is accumulating in the brain. There are several significant findings, including the early changes in cognition and the laterality of the MRI findings. Additional work is needed to clarify their significance.
Frontiers
Identifying Changepoints in Biomarkers During the Preclinical Phase of Alzheimer’s Disease
Objective: Several models have been proposed for the evolution of Alzheimer’s disease (AD) biomarkers. The aim of this study was to identify changepoints in a range of biomarkers during the preclinical phase of AD.Methods: We examined nine measures based…
Association Between Parental Medical Claims for #Opioid Prescriptions and Risk of #Suicide Attempt by Their Children
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2733148
Of the children with parents who did not use opioids, 212 (0.14%) attempted suicide; of the children with parents who did use opioids, 678 (0.37%) attempted suicide. Parental use of opioids was associated with a doubling of the risk of a suicide attempt by their offspring (odds ratio OR, 1.99; 95% CI, 1.71-2.33). The association remained significant after adjusting for child age and sex (OR, 1.85; 95% CI, 1.58-2.17), addition of child and parental depression and diagnoses of substance use disorder (OR, 1.46; 95% CI, 1.24-1.72), and addition of parental history of suicide attempt (OR, 1.45; 95% CI, 1.23-1.71). Geographical variation in opioid use did not change the association (OR, 2.00; 95% CI, 1.71-2.34).
Conclusions and Relevance Children of parents who use prescription opioids are at increased risk for suicide attempts, which could be a contributing factor to the time trend in adolescent suicidality. The care of families with a parent who uses opioids should include mental health screening of their children.
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2733148
Of the children with parents who did not use opioids, 212 (0.14%) attempted suicide; of the children with parents who did use opioids, 678 (0.37%) attempted suicide. Parental use of opioids was associated with a doubling of the risk of a suicide attempt by their offspring (odds ratio OR, 1.99; 95% CI, 1.71-2.33). The association remained significant after adjusting for child age and sex (OR, 1.85; 95% CI, 1.58-2.17), addition of child and parental depression and diagnoses of substance use disorder (OR, 1.46; 95% CI, 1.24-1.72), and addition of parental history of suicide attempt (OR, 1.45; 95% CI, 1.23-1.71). Geographical variation in opioid use did not change the association (OR, 2.00; 95% CI, 1.71-2.34).
Conclusions and Relevance Children of parents who use prescription opioids are at increased risk for suicide attempts, which could be a contributing factor to the time trend in adolescent suicidality. The care of families with a parent who uses opioids should include mental health screening of their children.
Jamanetwork
Association Between Parental Medical Claims for Opioids and Risk of Suicide Attempt by Their Children
This pharmacoepidemiologic study explores the possible association between parental use of prescription opioids and the increasing rate of youth suicide.
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Sex Differences in the Relationship Between #Inflammation and Reward Sensitivity: A Randomized Controlled Trial of #Endotoxin
https://www.sciencedirect.com/science/article/pii/S2451902219300795?via%3Dihub
There are robust sex differences in the prevalence of depression. Inflammation and anhedonia may play a role in understanding these sex differences. Indeed, sex differences in inflammation-induced neural responses to reward may provide insight into the sex gaps in depression, but no study has examined this question.
As such, the current study examined whether there were sex differences in reward-related neural activity (i.e., ventral striatum VS activity) in response to an experimental inflammatory challenge.
Results
Results demonstrated that endotoxin (vs. placebo) led to reduced VS activity in anticipation of reward and that there were sex differences in this effect. Specifically, in female participants, endotoxin (vs. placebo) led to decreased VS activity in anticipation of reward, but this effect was not present in male participants. In addition, within the endotoxin condition, decreases in VS activity in anticipation of reward were related to increases in inflammation for female but not male participants.
Conclusions
These findings may have implications for understanding how inflammation may contribute to sex differences in rates of depression
Sex Differences in the Relationship Between #Inflammation and Reward Sensitivity: A Randomized Controlled Trial of #Endotoxin
https://www.sciencedirect.com/science/article/pii/S2451902219300795?via%3Dihub
There are robust sex differences in the prevalence of depression. Inflammation and anhedonia may play a role in understanding these sex differences. Indeed, sex differences in inflammation-induced neural responses to reward may provide insight into the sex gaps in depression, but no study has examined this question.
As such, the current study examined whether there were sex differences in reward-related neural activity (i.e., ventral striatum VS activity) in response to an experimental inflammatory challenge.
Results
Results demonstrated that endotoxin (vs. placebo) led to reduced VS activity in anticipation of reward and that there were sex differences in this effect. Specifically, in female participants, endotoxin (vs. placebo) led to decreased VS activity in anticipation of reward, but this effect was not present in male participants. In addition, within the endotoxin condition, decreases in VS activity in anticipation of reward were related to increases in inflammation for female but not male participants.
Conclusions
These findings may have implications for understanding how inflammation may contribute to sex differences in rates of depression
Sciencedirect
Sex Differences in the Relationship Between Inflammation and Reward Sensitivity: A Randomized Controlled Trial of Endotoxin
There are robust sex differences in the prevalence of depression. Inflammation and anhedonia may play a role in understanding these sex differences. I…
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Effects of #antiplatelet therapy after stroke due to intracerebral #haemorrhage (RESTART): a randomised, open-label trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30840-2/fulltext
Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear
Participants were followed for a median of 2·0 years (IQR 1·0– 3·0; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 95% CI 0·25–1·03; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 0·39–1·30; p=0·27), and 39 15% participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 14% allocated to avoid antiplatelet therapy (1·02 0·65–1·60; p=0·92).
Interpretation
These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention.
Effects of #antiplatelet therapy after stroke due to intracerebral #haemorrhage (RESTART): a randomised, open-label trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30840-2/fulltext
Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear
Participants were followed for a median of 2·0 years (IQR 1·0– 3·0; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 95% CI 0·25–1·03; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 0·39–1·30; p=0·27), and 39 15% participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 14% allocated to avoid antiplatelet therapy (1·02 0·65–1·60; p=0·92).
Interpretation
These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention.
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#Vision impairment and subjective #cognitive decline- related functional limitations
https://www.cdc.gov/mmwr/volumes/68/wr/mm6820a2.htm?s_cid=mm6820a2_w
Vision impairment often co-occurs with cognitive decline, which can be associated with functional limitations. The association between vision impairment and functional limitations related to subjective (self-reported) cognitive decline (SCD) has not been well characterized.
Analysis of 2015–2017 Behavioral Risk Factor Surveillance System data determined that, after adjusting for age and other demographic and smoking characteristics, 18% of adults who reported vision impairment also reported SCD-related functional limitations, compared with only 4% of those without vision impairment.
What are the implications for public health practice?
Prevention or correction of vision impairment might be important in in reducing functional limitations related to cognitive decline in adults aged ≥45 years.
#Vision impairment and subjective #cognitive decline- related functional limitations
https://www.cdc.gov/mmwr/volumes/68/wr/mm6820a2.htm?s_cid=mm6820a2_w
Vision impairment often co-occurs with cognitive decline, which can be associated with functional limitations. The association between vision impairment and functional limitations related to subjective (self-reported) cognitive decline (SCD) has not been well characterized.
Analysis of 2015–2017 Behavioral Risk Factor Surveillance System data determined that, after adjusting for age and other demographic and smoking characteristics, 18% of adults who reported vision impairment also reported SCD-related functional limitations, compared with only 4% of those without vision impairment.
What are the implications for public health practice?
Prevention or correction of vision impairment might be important in in reducing functional limitations related to cognitive decline in adults aged ≥45 years.
Centers for Disease Control and Prevention
Vision Impairment and Subjective Cognitive Decline–Related Functional
Analysis of 2015–2017 Behavioral Risk Factor Surveillance System data determined that 18% of adults who reported vision impairment also reported subjective cognitive decline–related functional ...
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#Neurocognitive development in perinatally #HIV-infected adolescents on long-term treatment compared to healthy matched controls: a longitudinal study
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz386/5492020
Cross-sectional analysis of the NOVICE cohort showed significant cognitive impairment in combination antiretroviral therapy (cART)-treated perinatally HIV-infected adolescents (PHIV+) compared to age-, sex-, ethnicity- and socioeconomic status (SES)-matched HIV-negative controls (HIV-).
Processing speed, working memory, learning ability and visual-motor function trajectories were not statistically different between groups. Univariately, those who had started cART at older age deviated more in executive functioning (-0.13 z-score, 95%CI -0.24 to -0.02, p=0.043). The prevalence of cognitive impairment by MNC was similar in both groups at both time-points.
Conclusions
cART-treated PHIV+ adolescents appear to have similar global cognitive development compared to healthy peers. Executive functioning trajectory appears to deviate, potentially explained by earlier brain damage.
#Neurocognitive development in perinatally #HIV-infected adolescents on long-term treatment compared to healthy matched controls: a longitudinal study
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz386/5492020
Cross-sectional analysis of the NOVICE cohort showed significant cognitive impairment in combination antiretroviral therapy (cART)-treated perinatally HIV-infected adolescents (PHIV+) compared to age-, sex-, ethnicity- and socioeconomic status (SES)-matched HIV-negative controls (HIV-).
Processing speed, working memory, learning ability and visual-motor function trajectories were not statistically different between groups. Univariately, those who had started cART at older age deviated more in executive functioning (-0.13 z-score, 95%CI -0.24 to -0.02, p=0.043). The prevalence of cognitive impairment by MNC was similar in both groups at both time-points.
Conclusions
cART-treated PHIV+ adolescents appear to have similar global cognitive development compared to healthy peers. Executive functioning trajectory appears to deviate, potentially explained by earlier brain damage.
OUP Academic
Neurocognitive development in perinatally HIV-infected adolescents on long-term treatment compared to healthy matched controls:…
AbstractBackground. Cross-sectional analysis of the NOVICE cohort showed significant cognitive impairment in combination antiretroviral therapy (cART)-treated
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Association of #Frailty and Postoperative Complications With Unplanned Readmissions After Elective Outpatient #Surgery
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734068
length of stay (LOS)
.. In multivariate analysis, frailty doubled the risk of unplanned readmission (LOS = 0: adjusted relative risk RR, 2.1; 95% CI, 2.0-2.3; LOS ≥ 1: adjusted RR, 1.8; 95% CI, 1.6-2.1). Complications occurred in 3.1% of the entire cohort, and frailty was associated with increased risk of complications (unadjusted RR, 2.6; 95% CI, 2.4-2.8). Mediation analysis confirmed that complications are a significant mediator in the association between frailty and readmissions; however, it also indicated that the association of frailty with readmission was only partially mediated by complications (LOS = 0, 22.8%; LOS ≥ 1, 29.3%).
Conclusions and Relevance These findings suggest that frailty is a significant risk factor for unplanned readmission after elective outpatient surgery both independently and when partially mediated through increased complications. Screening for frailty might inform the development of interventions to decrease unplanned readmissions, including those for outpatient procedures.
Association of #Frailty and Postoperative Complications With Unplanned Readmissions After Elective Outpatient #Surgery
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734068
length of stay (LOS)
.. In multivariate analysis, frailty doubled the risk of unplanned readmission (LOS = 0: adjusted relative risk RR, 2.1; 95% CI, 2.0-2.3; LOS ≥ 1: adjusted RR, 1.8; 95% CI, 1.6-2.1). Complications occurred in 3.1% of the entire cohort, and frailty was associated with increased risk of complications (unadjusted RR, 2.6; 95% CI, 2.4-2.8). Mediation analysis confirmed that complications are a significant mediator in the association between frailty and readmissions; however, it also indicated that the association of frailty with readmission was only partially mediated by complications (LOS = 0, 22.8%; LOS ≥ 1, 29.3%).
Conclusions and Relevance These findings suggest that frailty is a significant risk factor for unplanned readmission after elective outpatient surgery both independently and when partially mediated through increased complications. Screening for frailty might inform the development of interventions to decrease unplanned readmissions, including those for outpatient procedures.
Jamanetwork
Frailty, Postoperative Complications, and Unplanned Readmissions After Elective Outpatient Surgery
This cohort study uses National Surgical Quality Improvement Program (NSQIP) data to examine the association between frailty and 30-day unplanned readmissions after elective outpatient surgical procedures.
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#Plastic leachates impair growth and oxygen production in Prochlorococcus, the ocean’s most abundant #photosynthetic bacteria
https://www.nature.com/articles/s42003-019-0410-x
Plastic pollution is a global threat to marine ecosystems. Plastic litter can leach a variety of substances into marine environments; however, virtually nothing is known regarding how this affects photosynthetic bacteria at the base of the marine food web.
..We show leachate exposure strongly impairs Prochlorococcus in vitro growth and photosynthetic capacity and results in genome-wide transcriptional changes. The strains showed distinct differences in the extent and timing of their response to each leachate.
Consequently, plastic leachate exposure could influence marine Prochlorococcus community composition and potentially the broader composition and productivity of ocean phytoplankton communities
#Plastic leachates impair growth and oxygen production in Prochlorococcus, the ocean’s most abundant #photosynthetic bacteria
https://www.nature.com/articles/s42003-019-0410-x
Plastic pollution is a global threat to marine ecosystems. Plastic litter can leach a variety of substances into marine environments; however, virtually nothing is known regarding how this affects photosynthetic bacteria at the base of the marine food web.
..We show leachate exposure strongly impairs Prochlorococcus in vitro growth and photosynthetic capacity and results in genome-wide transcriptional changes. The strains showed distinct differences in the extent and timing of their response to each leachate.
Consequently, plastic leachate exposure could influence marine Prochlorococcus community composition and potentially the broader composition and productivity of ocean phytoplankton communities
Nature
Plastic leachates impair growth and oxygen production in Prochlorococcus, the ocean’s most abundant photosynthetic bacteria
Communications Biology - Sasha Tetu et al. have examined the effects of plastic leachate exposure on the marine bacteria Prochlorococcus, the most abundant photosynthetic organism on Earth. They...
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Low plasma #adropin concentrations increase risks of #weight gain and metabolic dysregulation in response to a high-sugar diet in male nonhuman primates
http://m.jbc.org/content/early/2019/04/15/jbc.RA119.007528
Mouse studies linking adropin, a peptide hormone encoded by the energy homeostasis associated (ENHO) gene, to biological clocks and to glucose and lipid metabolism suggest a potential therapeutic target for managing diseases of metabolism. However, adropin’s roles in human metabolism are unclear.
ENHO expression is abundant in brain, including ventromedial and lateral hypothalamic nuclei regulating appetite and autonomic function. Lower ENHO expression is present in liver, lung, kidney, ileum, and some endocrine glands. Hepatic ENHO expression associates with genes involved in glucose and lipid metabolism.
During consumption of a high sugar (fructose) diet which induced 10% weight gain, animals with low adropin had larger increases of plasma leptin and more severe hyperglycemia. Declining adropin concentrations were correlated with increases of plasma APOC3 and triglycerides.
In summary, peripheral ENHO expression associates with pathways related to epigenetic and neural pathways, and carbohydrate and lipid metabolism, suggesting co-regulation in nonhuman primates. Low circulating adropin predicts increased weight gain and metabolic dysregulation during consumption of a high-sugar diet.
Low plasma #adropin concentrations increase risks of #weight gain and metabolic dysregulation in response to a high-sugar diet in male nonhuman primates
http://m.jbc.org/content/early/2019/04/15/jbc.RA119.007528
Mouse studies linking adropin, a peptide hormone encoded by the energy homeostasis associated (ENHO) gene, to biological clocks and to glucose and lipid metabolism suggest a potential therapeutic target for managing diseases of metabolism. However, adropin’s roles in human metabolism are unclear.
ENHO expression is abundant in brain, including ventromedial and lateral hypothalamic nuclei regulating appetite and autonomic function. Lower ENHO expression is present in liver, lung, kidney, ileum, and some endocrine glands. Hepatic ENHO expression associates with genes involved in glucose and lipid metabolism.
During consumption of a high sugar (fructose) diet which induced 10% weight gain, animals with low adropin had larger increases of plasma leptin and more severe hyperglycemia. Declining adropin concentrations were correlated with increases of plasma APOC3 and triglycerides.
In summary, peripheral ENHO expression associates with pathways related to epigenetic and neural pathways, and carbohydrate and lipid metabolism, suggesting co-regulation in nonhuman primates. Low circulating adropin predicts increased weight gain and metabolic dysregulation during consumption of a high-sugar diet.
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Blood #Pressure-Lowering by the Antioxidant #Resveratrol is Counterintuitively Mediated by Oxidation of cGMP-Dependent Protein Kinase
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.037398
The polyphenolic rings of resveratrol enable it to react with and detoxify otherwise injurious oxidants. Whilst the protective actions of resveratrol are commonly ascribed to its antioxidant activity, here we show that this is a misconception
Oxidation of the phenolic rings of resveratrol paradoxically leads to oxidative modification of proteins, explained by formation of a reactive quinone that oxidises the thiolate side chain of cysteine residues - events that were enhanced in cells under oxidative stress. Consistent with these observations and its ability to induce vasodilation, resveratrol induced oxidative activation of PKG1α and lowered blood pressure in hypertensive wild-type mice, but not C42S PKG1α knock-in mice that are resistant to disulfide activation.
Conclusions: Resveratrol mediates lowering of blood pressure by paradoxically inducing protein oxidation, especially during times of oxidative stress, a mechanism that may be a common feature of 'antioxidant' molecules.
Blood #Pressure-Lowering by the Antioxidant #Resveratrol is Counterintuitively Mediated by Oxidation of cGMP-Dependent Protein Kinase
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.037398
The polyphenolic rings of resveratrol enable it to react with and detoxify otherwise injurious oxidants. Whilst the protective actions of resveratrol are commonly ascribed to its antioxidant activity, here we show that this is a misconception
Oxidation of the phenolic rings of resveratrol paradoxically leads to oxidative modification of proteins, explained by formation of a reactive quinone that oxidises the thiolate side chain of cysteine residues - events that were enhanced in cells under oxidative stress. Consistent with these observations and its ability to induce vasodilation, resveratrol induced oxidative activation of PKG1α and lowered blood pressure in hypertensive wild-type mice, but not C42S PKG1α knock-in mice that are resistant to disulfide activation.
Conclusions: Resveratrol mediates lowering of blood pressure by paradoxically inducing protein oxidation, especially during times of oxidative stress, a mechanism that may be a common feature of 'antioxidant' molecules.
Circulation
Blood Pressure–Lowering by the Antioxidant Resveratrol Is Counterintuitively Mediated by Oxidation of cGMP-Dependent Protein Kinase
Background: The health-promoting and disease-limiting abilities of resveratrol, a natural polyphenol, has led to considerable interest in understanding the mechanisms of its therapeutic actions. The
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Human Hippocampal #Neurogenesis Persists in Aged Adults and #Alzheimer’s Disease Patients
https://www.sciencedirect.com/science/article/pii/S1934590919302073?via%3Dihub
Whether hippocampal neurogenesis persists throughout life in the human brain is not fully resolved. Here, we demonstrate that hippocampal neurogenesis is persistent through the tenth decade of life and is detectable in patients with mild cognitive impairments and Alzheimer’s disease
The number of DCX+PCNA+ cells is reduced in mild cognitive impairments, and higher numbers of neuroblasts are associated with better cognitive status. The number of DCX+PCNA+ cells correlates with functional interactions between presynaptic SNARE proteins.
Our results suggest that hippocampal neurogenesis persists in the aged and diseased human brain and that it is possibly associated with cognition.
Human Hippocampal #Neurogenesis Persists in Aged Adults and #Alzheimer’s Disease Patients
https://www.sciencedirect.com/science/article/pii/S1934590919302073?via%3Dihub
Whether hippocampal neurogenesis persists throughout life in the human brain is not fully resolved. Here, we demonstrate that hippocampal neurogenesis is persistent through the tenth decade of life and is detectable in patients with mild cognitive impairments and Alzheimer’s disease
The number of DCX+PCNA+ cells is reduced in mild cognitive impairments, and higher numbers of neuroblasts are associated with better cognitive status. The number of DCX+PCNA+ cells correlates with functional interactions between presynaptic SNARE proteins.
Our results suggest that hippocampal neurogenesis persists in the aged and diseased human brain and that it is possibly associated with cognition.
Sciencedirect
Human Hippocampal Neurogenesis Persists in Aged Adults and Alzheimer’s Disease Patients
Whether hippocampal neurogenesis persists throughout life in the human brain is not fully resolved. Here, we demonstrate that hippocampal neurogenesis…
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Characteristics of Waveform Shape in #Parkinson’s Disease Detected with Scalp #Electroencephalography
http://www.eneuro.org/content/early/2019/05/10/ENEURO.0151-19.2019
Neural activity in the beta frequency range (13-30 Hz) is excessively synchronized in Parkinson’s Disease (PD). Previous work using invasive intracranial recordings and non-invasive scalp electroencephalography (EEG) has shown that correlations between beta phase and broad-band gamma amplitude (i.e., phase amplitude coupling) are elevated in PD, perhaps a reflection of this synchrony.
Here we show, using scalp electroencephalography (EEG), that the nonsinusoidal shape of beta (13-30 Hz) oscillations over sensorimotor cortex distinguishes PD patients on and off medication and patients off medication from controls. This change in waveform shape may reflect hypersynchronous input, possibly originating from basal ganglia. Thus, waveform shape is a putative non-invasive electrophysiology biomarker of PD state with potential utility for assessing treatments, monitoring disease, or diagnosis. This signature can be detected with a safe, affordable, and available method (i.e. EEG).
Characteristics of Waveform Shape in #Parkinson’s Disease Detected with Scalp #Electroencephalography
http://www.eneuro.org/content/early/2019/05/10/ENEURO.0151-19.2019
Neural activity in the beta frequency range (13-30 Hz) is excessively synchronized in Parkinson’s Disease (PD). Previous work using invasive intracranial recordings and non-invasive scalp electroencephalography (EEG) has shown that correlations between beta phase and broad-band gamma amplitude (i.e., phase amplitude coupling) are elevated in PD, perhaps a reflection of this synchrony.
Here we show, using scalp electroencephalography (EEG), that the nonsinusoidal shape of beta (13-30 Hz) oscillations over sensorimotor cortex distinguishes PD patients on and off medication and patients off medication from controls. This change in waveform shape may reflect hypersynchronous input, possibly originating from basal ganglia. Thus, waveform shape is a putative non-invasive electrophysiology biomarker of PD state with potential utility for assessing treatments, monitoring disease, or diagnosis. This signature can be detected with a safe, affordable, and available method (i.e. EEG).
eNeuro
Characteristics of Waveform Shape in Parkinson’s Disease Detected with Scalp Electroencephalography
Neural activity in the beta frequency range (13-30 Hz) is excessively synchronized in Parkinson’s Disease (PD). Previous work using invasive intracranial recordings and non-invasive scalp electroencephalography (EEG) has shown that correlations between beta…
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Daily Self‐#Weighing to Prevent Holiday‐Associated #Weight Gain in Adults
https://onlinelibrary.wiley.com/doi/10.1002/oby.22454
Holiday weight gain is reported to be 0.4 to 1.5 kg and may contribute to annual weight gain. The objective of this study was to test the efficacy of daily self‐weighing (DSW) using visual graphical feedback (GF) to prevent holiday weight gain.
There was no change in weight with DSW + GF, whereas the control group gained weight from v1 to v2 (−0.13 ± 0.27 kg vs. 2.65 ± 0.33 kg, P < 0.001, respectively). In the control group, weight change was similar between individuals with overweight or obesity (OW/OB) versus individuals with normal weight (2.71 ± 0.48 kg vs. 2.62 ± 0.43 kg, not significant, respectively)...
Conclusions
DSW + GF was a successful approach to prevent holiday weight gain, with those with OW/OB responding most favorably to DSW + GF.
Daily Self‐#Weighing to Prevent Holiday‐Associated #Weight Gain in Adults
https://onlinelibrary.wiley.com/doi/10.1002/oby.22454
Holiday weight gain is reported to be 0.4 to 1.5 kg and may contribute to annual weight gain. The objective of this study was to test the efficacy of daily self‐weighing (DSW) using visual graphical feedback (GF) to prevent holiday weight gain.
There was no change in weight with DSW + GF, whereas the control group gained weight from v1 to v2 (−0.13 ± 0.27 kg vs. 2.65 ± 0.33 kg, P < 0.001, respectively). In the control group, weight change was similar between individuals with overweight or obesity (OW/OB) versus individuals with normal weight (2.71 ± 0.48 kg vs. 2.62 ± 0.43 kg, not significant, respectively)...
Conclusions
DSW + GF was a successful approach to prevent holiday weight gain, with those with OW/OB responding most favorably to DSW + GF.
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Association of Nonfasting vs Fasting #Lipid Levels With Risk of Major #Coronary Events in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2733560
Recent guidelines have recommended nonfasting for routine testing of lipid levels based on comparisons of nonfasting and fasting populations
Among the 8270 participants (82.1% male; mean SD age, 63.4 8.5 years), nonfasting samples had modestly higher triglyceride levels and similar cholesterol levels compared to fasting samples. Associations of nonfasting lipid levels with coronary events were similar to those for fasting lipid levels
Results were consistent by randomized treatment arm (atorvastatin calcium, 10 mg/d, or placebo) and similar for ASCVD events. Concordance of fasting and nonfasting lipid levels for classifying participants into appropriate ASCVD risk categories was high (94.8%).
Conclusions and Relevance Measurement of nonfasting and fasting lipid levels yields similar results in the same individuals for association with incident coronary and ASCVD events. These results suggest that routine measurement of nonfasting lipid levels may help facilitate ASCVD risk screening and treatment, including consideration of when to initiate statin therapy.
Association of Nonfasting vs Fasting #Lipid Levels With Risk of Major #Coronary Events in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2733560
Recent guidelines have recommended nonfasting for routine testing of lipid levels based on comparisons of nonfasting and fasting populations
Among the 8270 participants (82.1% male; mean SD age, 63.4 8.5 years), nonfasting samples had modestly higher triglyceride levels and similar cholesterol levels compared to fasting samples. Associations of nonfasting lipid levels with coronary events were similar to those for fasting lipid levels
Results were consistent by randomized treatment arm (atorvastatin calcium, 10 mg/d, or placebo) and similar for ASCVD events. Concordance of fasting and nonfasting lipid levels for classifying participants into appropriate ASCVD risk categories was high (94.8%).
Conclusions and Relevance Measurement of nonfasting and fasting lipid levels yields similar results in the same individuals for association with incident coronary and ASCVD events. These results suggest that routine measurement of nonfasting lipid levels may help facilitate ASCVD risk screening and treatment, including consideration of when to initiate statin therapy.
Jamanetwork
Association of Nonfasting vs Fasting Lipid Levels With Risk of Major Coronary Events in the ASCOT-LLA
This secondary analysis of a randomized clinical trial compares the association of nonfasting vs fasting lipid levels with coronary and vascular outcomes and assesses differences in calculated risk among participants undergoing both measurements.
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Estimating the Attributable #cost of Physician #Burnout in the United States
https://annals.org/aim/article-abstract/2734784/estimating-attributable-cost-physician-burnout-united-states
On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States. This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year
Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.
Estimating the Attributable #cost of Physician #Burnout in the United States
https://annals.org/aim/article-abstract/2734784/estimating-attributable-cost-physician-burnout-united-states
On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States. This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year
Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.