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The importance of measuring hand and foot #function over the disease course in #rheumatoid arthritis: An eight‐year follow‐up study
https://onlinelibrary.wiley.com/doi/10.1002/acr.23764
To assess function using the Signals of Functional Impairment (SOFI) instrument over eight years and to study clinical variables associated with the change. Also to study change over time of the SOFI items.
During the first year, there was a mean improvement in SOFI of 2.7 (SD 5.7) (p<0.001). Worse scores in DAS28 and HAQ at baseline were associated with this improvement (r2≤ 0.11). During the next seven years, there was a mean deterioration in SOFI of 1.5 (SD 4.9) (p<0.001). Based on change scores, finger flexion, pincer grip, and toe‐standing were the most important items to measure, explaining 58–61% of the total SOFI score and were also associated with radiographic changes at the eight‐year follow‐up.
Conclusion
Function as assessed with SOFI improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot tasks were associated with joint destruction at the eight‐year follow‐up. Measures of hand and foot function will complement self‐reported and medical data both in clinical work and in long‐term research studies.
The importance of measuring hand and foot #function over the disease course in #rheumatoid arthritis: An eight‐year follow‐up study
https://onlinelibrary.wiley.com/doi/10.1002/acr.23764
To assess function using the Signals of Functional Impairment (SOFI) instrument over eight years and to study clinical variables associated with the change. Also to study change over time of the SOFI items.
During the first year, there was a mean improvement in SOFI of 2.7 (SD 5.7) (p<0.001). Worse scores in DAS28 and HAQ at baseline were associated with this improvement (r2≤ 0.11). During the next seven years, there was a mean deterioration in SOFI of 1.5 (SD 4.9) (p<0.001). Based on change scores, finger flexion, pincer grip, and toe‐standing were the most important items to measure, explaining 58–61% of the total SOFI score and were also associated with radiographic changes at the eight‐year follow‐up.
Conclusion
Function as assessed with SOFI improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot tasks were associated with joint destruction at the eight‐year follow‐up. Measures of hand and foot function will complement self‐reported and medical data both in clinical work and in long‐term research studies.
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Reassessment of risk for #stroke During Follow-up of Patients With Atrial #Fibrillation
http://annals.org/aim/article-abstract/2720037/reassessment-risk-stroke-during-follow-up-patients-atrial-fibrillation?doi=10.7326%2fM18-1177
Background: International guidelines suggest that oral anticoagulants (OACs) can be omitted for patients with atrial fibrillation (AF) without a CHA2DS2-VASc score greater than 0 (men) or 1 (women) (1, 2). However, stroke risk is not static among patients with AF, and about 90% develop at least 1 new risk factor before presentation with ischemic stroke (3). Therefore, patients with AF who have a CHA2DS2-VASc score of 0 (men) or 1 (women) at baseline and acquire more comorbidities over time would no longer be “low-risk.”
Objective: To investigate incidence of an increase in CHA2DS2-VASc score to at least 1 (men) or 2 (women) among patients with newly diagnosed AF and a baseline score of 0 (men) or 1 (women).
Reassessment of risk for #stroke During Follow-up of Patients With Atrial #Fibrillation
http://annals.org/aim/article-abstract/2720037/reassessment-risk-stroke-during-follow-up-patients-atrial-fibrillation?doi=10.7326%2fM18-1177
Background: International guidelines suggest that oral anticoagulants (OACs) can be omitted for patients with atrial fibrillation (AF) without a CHA2DS2-VASc score greater than 0 (men) or 1 (women) (1, 2). However, stroke risk is not static among patients with AF, and about 90% develop at least 1 new risk factor before presentation with ischemic stroke (3). Therefore, patients with AF who have a CHA2DS2-VASc score of 0 (men) or 1 (women) at baseline and acquire more comorbidities over time would no longer be “low-risk.”
Objective: To investigate incidence of an increase in CHA2DS2-VASc score to at least 1 (men) or 2 (women) among patients with newly diagnosed AF and a baseline score of 0 (men) or 1 (women).
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#ACTH Gel in Resistant Focal Segmental #Glomerulosclerosis After Kidney Transplantation.
https://www.ncbi.nlm.nih.gov/pubmed/29894413
Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab.
RESULTS:
We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission.
CONCLUSIONS:
Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.
#ACTH Gel in Resistant Focal Segmental #Glomerulosclerosis After Kidney Transplantation.
https://www.ncbi.nlm.nih.gov/pubmed/29894413
Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab.
RESULTS:
We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission.
CONCLUSIONS:
Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.
www.ncbi.nlm.nih.gov
ACTH Gel in Resistant Focal Segmental Glomerulosclerosis After Kidney Transplantation. - PubMed - NCBI
Transplantation. 2019 Jan;103(1):202-209. doi: 10.1097/TP.0000000000002320.
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One in 10 adults in US has #food #allergy, but nearly 1 in 5 think they do
https://www.eurekalert.org/pub_releases/2019-01/arh-oi1122718.php
..Researchers discovered that only half of adults with convincing food allergy had a physician-confirmed diagnosis, and less than 25 percent reported a current epinephrine prescription.
Researchers also found that nearly half of food-allergic adults developed at least one of their food allergies as an adult.
"We were surprised to find that adult-onset food allergies were so common," says Dr. Gupta. "More research is needed to understand why this is occurring and how we might prevent it."
The study data indicate that the most prevalent food allergens among U.S. adults are shellfish (affecting 7.2 million adults), milk (4.7 million), peanut (4.5 million), tree nut (3 million), fin fish (2.2 million), egg (2 million), wheat (2 million), soy (1.5 million), and sesame (.5 million).
Our data show that shellfish is the top food allergen in adults, that shellfish allergy commonly begins in adulthood, and that this allergy is remarkably common across the lifespan," says Dr. Gupta. "We need more studies to clarify why shellfish allergy appears to be so common and persistent among U.S. adults.
One in 10 adults in US has #food #allergy, but nearly 1 in 5 think they do
https://www.eurekalert.org/pub_releases/2019-01/arh-oi1122718.php
..Researchers discovered that only half of adults with convincing food allergy had a physician-confirmed diagnosis, and less than 25 percent reported a current epinephrine prescription.
Researchers also found that nearly half of food-allergic adults developed at least one of their food allergies as an adult.
"We were surprised to find that adult-onset food allergies were so common," says Dr. Gupta. "More research is needed to understand why this is occurring and how we might prevent it."
The study data indicate that the most prevalent food allergens among U.S. adults are shellfish (affecting 7.2 million adults), milk (4.7 million), peanut (4.5 million), tree nut (3 million), fin fish (2.2 million), egg (2 million), wheat (2 million), soy (1.5 million), and sesame (.5 million).
Our data show that shellfish is the top food allergen in adults, that shellfish allergy commonly begins in adulthood, and that this allergy is remarkably common across the lifespan," says Dr. Gupta. "We need more studies to clarify why shellfish allergy appears to be so common and persistent among U.S. adults.
EurekAlert!
One in 10 adults in US has food allergy, but nearly 1 in 5 think they do
Over 10 percent of adults in the US -- over 26 million -- are estimated to have food allergy.
Peer #victimization and its impact on adolescent #brain development and psychopathology
https://www.nature.com/articles/s41380-018-0297-9
Chronic peer victimization has long-term impacts on mental health; however, the biological mediators of this adverse relationship are unknown. We sought to determine whether adolescent brain development is involved in mediating the effect of peer victimization on psychopathology.. Repeated measures ANOVA revealed time-by-victimization interactions on left putamen volume (F = 4.38, p = 0.037). Changes in left putamen volume were negatively associated with generalized anxiety (t = −2.32, p = 0.020).
Notably, peer victimization was indirectly associated with generalized anxiety via decreases in putamen volume (95% CI = 0.004–0.109). This was also true for the left caudate (95% CI = 0.002–0.099). These data suggest that the experience of chronic peer victimization during adolescence might induce psychopathology-relevant deviations from normative brain development. Early peer victimization interventions could prevent such pathological changes.
https://www.nature.com/articles/s41380-018-0297-9
Chronic peer victimization has long-term impacts on mental health; however, the biological mediators of this adverse relationship are unknown. We sought to determine whether adolescent brain development is involved in mediating the effect of peer victimization on psychopathology.. Repeated measures ANOVA revealed time-by-victimization interactions on left putamen volume (F = 4.38, p = 0.037). Changes in left putamen volume were negatively associated with generalized anxiety (t = −2.32, p = 0.020).
Notably, peer victimization was indirectly associated with generalized anxiety via decreases in putamen volume (95% CI = 0.004–0.109). This was also true for the left caudate (95% CI = 0.002–0.099). These data suggest that the experience of chronic peer victimization during adolescence might induce psychopathology-relevant deviations from normative brain development. Early peer victimization interventions could prevent such pathological changes.
Nature
Peer victimization and its impact on adolescent brain development and psychopathology
Molecular Psychiatry - Peer victimization and its impact on adolescent brain development and psychopathology
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#Commensals Suppress Intestinal Epithelial Cell #Retinoic Acid Synthesis to Regulate Interleukin-22 Activity and Prevent Microbial Dysbiosis
https://www.cell.com/immunity/fulltext/S1074-7613(18)30526-0?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1074761318305260%3Fshowall%3Dtrue
Retinoic acid (RA), a vitamin A metabolite, regulates transcriptional programs that drive protective or pathogenic immune responses in the intestine, in a manner dependent on RA concentration. Vitamin A is obtained from diet and is metabolized by intestinal epithelial cells (IECs), which operate in intimate association with microbes and immune cells.
Here we found that commensal bacteria belonging to class Clostridia modulate RA concentration in the gut by suppressing the expression of retinol dehydrogenase 7 ( Rdh7) in IECs. Rdh7 expression and associated RA amounts were lower in the intestinal tissue of conventional mice, as compared to germ-free mice. Deletion of Rdh7 in IECs diminished RA signaling in immune cells, reduced the IL-22-dependent antimicrobial response, and enhanced resistance to colonization by Salmonella Typhimurium.
Our findings define a regulatory circuit wherein bacterial regulation of IEC-intrinsic RA synthesis protects microbial communities in the gut from excessive immune activity, achieving a balance that prevents colonization by enteric pathogens
#Commensals Suppress Intestinal Epithelial Cell #Retinoic Acid Synthesis to Regulate Interleukin-22 Activity and Prevent Microbial Dysbiosis
https://www.cell.com/immunity/fulltext/S1074-7613(18)30526-0?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1074761318305260%3Fshowall%3Dtrue
Retinoic acid (RA), a vitamin A metabolite, regulates transcriptional programs that drive protective or pathogenic immune responses in the intestine, in a manner dependent on RA concentration. Vitamin A is obtained from diet and is metabolized by intestinal epithelial cells (IECs), which operate in intimate association with microbes and immune cells.
Here we found that commensal bacteria belonging to class Clostridia modulate RA concentration in the gut by suppressing the expression of retinol dehydrogenase 7 ( Rdh7) in IECs. Rdh7 expression and associated RA amounts were lower in the intestinal tissue of conventional mice, as compared to germ-free mice. Deletion of Rdh7 in IECs diminished RA signaling in immune cells, reduced the IL-22-dependent antimicrobial response, and enhanced resistance to colonization by Salmonella Typhimurium.
Our findings define a regulatory circuit wherein bacterial regulation of IEC-intrinsic RA synthesis protects microbial communities in the gut from excessive immune activity, achieving a balance that prevents colonization by enteric pathogens
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How ‘#Dry January’ is the secret to better sleep, saving money and losing weight
https://m.sussex.ac.uk/news/all?id=47131
“The simple act of taking a month off #alcohol helps people drink less in the long term: by August people are reporting one extra dry day per week. There are also considerable immediate benefits: nine in ten people save money, seven in ten sleep better and three in five lose weight.
“Interestingly, these changes in alcohol consumption have also been seen in the participants who didn’t manage to stay alcohol-free for the whole month - although they are a bit smaller. This shows that there are real benefits to just trying to complete Dry January.”
The University of Sussex research showed that:
93% of participants had a sense of achievement;
88% saved money;
82% think more deeply about their relationship with drink;
80% feel more in control of their drinking;
76% learned more about when and why they drink;
71% realised they don’t need a drink to enjoy themselves;
70% had generally improved health;
71% slept better;
67% had more energy;
58% lost weight;
57% had better concentration;
54% had better skin.
The brilliant thing about Dry January is that it’s not really about January. Being alcohol-free for 31 days shows us that we don’t need alcohol to have fun, to relax, to socialise. That means that for the rest of the year we are better able to make decisions about our drinking, and to avoid slipping into drinking more than we really want to.
How ‘#Dry January’ is the secret to better sleep, saving money and losing weight
https://m.sussex.ac.uk/news/all?id=47131
“The simple act of taking a month off #alcohol helps people drink less in the long term: by August people are reporting one extra dry day per week. There are also considerable immediate benefits: nine in ten people save money, seven in ten sleep better and three in five lose weight.
“Interestingly, these changes in alcohol consumption have also been seen in the participants who didn’t manage to stay alcohol-free for the whole month - although they are a bit smaller. This shows that there are real benefits to just trying to complete Dry January.”
The University of Sussex research showed that:
93% of participants had a sense of achievement;
88% saved money;
82% think more deeply about their relationship with drink;
80% feel more in control of their drinking;
76% learned more about when and why they drink;
71% realised they don’t need a drink to enjoy themselves;
70% had generally improved health;
71% slept better;
67% had more energy;
58% lost weight;
57% had better concentration;
54% had better skin.
The brilliant thing about Dry January is that it’s not really about January. Being alcohol-free for 31 days shows us that we don’t need alcohol to have fun, to relax, to socialise. That means that for the rest of the year we are better able to make decisions about our drinking, and to avoid slipping into drinking more than we really want to.
The University of Sussex
How ‘Dry January’ is the secret to better sleep, saving money and losing weight
New research from the University of Sussex shows that taking part in Dry January has many benefits.
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Factors Associated With #Recurrence of Primary Biliary #Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival
https://www.gastrojournal.org/article/S0016-5085(18)35089-3/fulltext
PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis <50 years (hazard ratio HR, 1.79; 95% CI, 1.36–2.36; P < .001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02–1.90; P = .04), use of tacrolimus (HR, 2.31; 95% CI, 1.72–3.10; P < .001), and biochemical markers of severe cholestasis (bilirubin ≥100 μmol or alkaline phosphatase >3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16–2.76; P = .008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46–0.82; P = .001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16–3.51; P = .01) and death (HR, 1.72; 95% CI, 1.11–2.65; P = .02).
Conclusions
Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.
Factors Associated With #Recurrence of Primary Biliary #Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival
https://www.gastrojournal.org/article/S0016-5085(18)35089-3/fulltext
PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis <50 years (hazard ratio HR, 1.79; 95% CI, 1.36–2.36; P < .001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02–1.90; P = .04), use of tacrolimus (HR, 2.31; 95% CI, 1.72–3.10; P < .001), and biochemical markers of severe cholestasis (bilirubin ≥100 μmol or alkaline phosphatase >3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16–2.76; P = .008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46–0.82; P = .001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16–3.51; P = .01) and death (HR, 1.72; 95% CI, 1.11–2.65; P = .02).
Conclusions
Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.
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Microglia and #amyloid precursor protein coordinate control of transient #candida cerebritis with memory deficits
https://www.nature.com/articles/s41467-018-07991-4#ref-CR4
Bloodborne infections with Candida albicans are an increasingly recognized complication of modern medicine. Here, we present a mouse model of low-grade candidemia to determine the effect of disseminated infection on cerebral function and relevant immune determinants.
We show that intravenous injection of 25,000 C. albicans cells causes a highly localized cerebritis marked by the accumulation of activated microglial and astroglial cells around yeast aggregates, forming fungal-induced glial granulomas. Amyloid precursor protein accumulates within the periphery of these granulomas, while cleaved amyloid beta (Aβ) peptides accumulate around the yeast cells..
Mice infected with C. albicans display mild memory impairment that resolves with fungal clearance. Our results warrant additional studies to understand the effect of chronic cerebritis on cognitive and immune function
Microglia and #amyloid precursor protein coordinate control of transient #candida cerebritis with memory deficits
https://www.nature.com/articles/s41467-018-07991-4#ref-CR4
Bloodborne infections with Candida albicans are an increasingly recognized complication of modern medicine. Here, we present a mouse model of low-grade candidemia to determine the effect of disseminated infection on cerebral function and relevant immune determinants.
We show that intravenous injection of 25,000 C. albicans cells causes a highly localized cerebritis marked by the accumulation of activated microglial and astroglial cells around yeast aggregates, forming fungal-induced glial granulomas. Amyloid precursor protein accumulates within the periphery of these granulomas, while cleaved amyloid beta (Aβ) peptides accumulate around the yeast cells..
Mice infected with C. albicans display mild memory impairment that resolves with fungal clearance. Our results warrant additional studies to understand the effect of chronic cerebritis on cognitive and immune function
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Knee #osteoarthritis and #menopausal hormone therapy in postmenopausal women
a nationwide cross-sectional study
https://journals.lww.com/menopausejournal/Abstract/publishahead/Knee_osteoarthritis_and_menopausal_hormone_therapy.97442.aspx
The incidence of osteoarthritis (OA) increases after menopause, and may be related to hormonal changes in women. Estrogen deficiency is known to affect the development of OA, and menopausal hormone therapy (MHT) is suggested to be related to the development of OA. However, the relationship between knee OA and MHT remains controversial. The association between knee OA prevalence and MHT was investigated using large-scale national data.
Results: In the multiple logistic regression models, the OA odds ratio was 0.70 for the MHT group (95% confidence interval 0.50-0.99), compared with the non-MHT group.
Conclusions: The prevalence of knee OA was lower in participants with MHT than in those without MHT
Knee #osteoarthritis and #menopausal hormone therapy in postmenopausal women
a nationwide cross-sectional study
https://journals.lww.com/menopausejournal/Abstract/publishahead/Knee_osteoarthritis_and_menopausal_hormone_therapy.97442.aspx
The incidence of osteoarthritis (OA) increases after menopause, and may be related to hormonal changes in women. Estrogen deficiency is known to affect the development of OA, and menopausal hormone therapy (MHT) is suggested to be related to the development of OA. However, the relationship between knee OA and MHT remains controversial. The association between knee OA prevalence and MHT was investigated using large-scale national data.
Results: In the multiple logistic regression models, the OA odds ratio was 0.70 for the MHT group (95% confidence interval 0.50-0.99), compared with the non-MHT group.
Conclusions: The prevalence of knee OA was lower in participants with MHT than in those without MHT
LWW
Knee osteoarthritis and menopausal hormone therapy in... : Menopause
ionship between knee OA and MHT remains controversial. The association between knee OA prevalence and MHT was investigated using large-scale national data.
Methods:
Data were collected from 4,766 postmenopausal women from the Korea National Health and…
Methods:
Data were collected from 4,766 postmenopausal women from the Korea National Health and…
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Draft Recommendation Statement
Hepatitis #B Virus Infection in Pregnant #Women: Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-b-virus-infection-in-pregnant-women-screening
Importance
Screening for HBV infection during pregnancy identifies women whose infants are at risk of perinatal transmission. Data from a nationally representative sample showed a prevalence of maternal HBV infection of 85.8 cases per 100,000 deliveries from 1998 to 2011 (0.09% of live-born singleton deliveries in the United States).1, 2 Although there are guidelines for universal infant HBV vaccination, rates of maternal HBV have increased annually by 5.5% since 1998.1, 2 Persons infected with HBV during infancy or childhood are more likely to progress to chronic infection. Chronic HBV infection increases long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.
USPSTF Assessment
Using a reaffirmation process, the USPSTF concludes with high certainty that the net benefit of screening for HBV infection in pregnant women is substantial.
Draft Recommendation Statement
Hepatitis #B Virus Infection in Pregnant #Women: Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-b-virus-infection-in-pregnant-women-screening
Importance
Screening for HBV infection during pregnancy identifies women whose infants are at risk of perinatal transmission. Data from a nationally representative sample showed a prevalence of maternal HBV infection of 85.8 cases per 100,000 deliveries from 1998 to 2011 (0.09% of live-born singleton deliveries in the United States).1, 2 Although there are guidelines for universal infant HBV vaccination, rates of maternal HBV have increased annually by 5.5% since 1998.1, 2 Persons infected with HBV during infancy or childhood are more likely to progress to chronic infection. Chronic HBV infection increases long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.
USPSTF Assessment
Using a reaffirmation process, the USPSTF concludes with high certainty that the net benefit of screening for HBV infection in pregnant women is substantial.
www.uspreventiveservicestaskforce.org
Draft Recommendation Statement: Hepatitis B Virus Infection in Pregnant Women: Screening - US Preventive Services Task Force
This is a webpage on the US Preventive Services Task Force USPSTF site
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Predictors of Clinically Significant #Echocardiography Findings in Older Adults with #Syncope: A Secondary Analysis
https://www.journalofhospitalmedicine.com/jhospmed/article/175074/hospital-medicine/predictors-clinically-significant-echocardiography
Regression analysis identified five predictors of significant findings: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%).
CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography.
Predictors of Clinically Significant #Echocardiography Findings in Older Adults with #Syncope: A Secondary Analysis
https://www.journalofhospitalmedicine.com/jhospmed/article/175074/hospital-medicine/predictors-clinically-significant-echocardiography
Regression analysis identified five predictors of significant findings: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%).
CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography.
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Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type #Calcium Channel Antagonists, and Biguanides With Rates of #Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2719703
Drug repurposing is potentially cost-effective, low risk, and necessary in psychiatric drug development. The availability of large, routine data sets provides the opportunity to evaluate the potential for currently used medication to benefit people with serious mental illness (SMI).
To determine whether hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides are associated with reduced psychiatric hospitalization and self-harm in individuals with SMI.
Conclusions and Relevance This study provides additional evidence that exposure to HMG-CoA RIs, LTCC antagonists, and biguanides might lead to improved outcomes for individuals with SMI. Given the well-known adverse event profiles of these agents, they should be further investigated as repurposed agents for psychiatric symptoms.
Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type #Calcium Channel Antagonists, and Biguanides With Rates of #Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2719703
Drug repurposing is potentially cost-effective, low risk, and necessary in psychiatric drug development. The availability of large, routine data sets provides the opportunity to evaluate the potential for currently used medication to benefit people with serious mental illness (SMI).
To determine whether hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides are associated with reduced psychiatric hospitalization and self-harm in individuals with SMI.
Conclusions and Relevance This study provides additional evidence that exposure to HMG-CoA RIs, LTCC antagonists, and biguanides might lead to improved outcomes for individuals with SMI. Given the well-known adverse event profiles of these agents, they should be further investigated as repurposed agents for psychiatric symptoms.
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Association of #Statin Therapy With Prevention of Vision-Threatening Diabetic #Retinopathy
https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2720491
Patients in the statin group had a significantly lower rate of diabetic retinopathy nonproliferative diabetic retinopathy (HR, 0.92; 95% CI, 0.86-0.99), proliferative diabetic retinopathy vitreous hemorrhage (HR, 0.62; 95% CI, 0.54-0.71), tractional retinal detachment (HR, 0.61; 95% CI, 0.47-0.79), and macular edema (HR, 0.60; 95% CI, 0.46-0.79) than the nonstatin group, as well as lower rates of interventions such as retinal laser treatment (HR, 0.71; 95% CI, 0.65-0.77), intravitreal injection (HR, 0.74; 95% CI, 0.61-0.89), and vitrectomy (HR, 0.58; 95% CI, 0.48-0.69), along with a smaller number of the interventions (retinal lasers: rate ratio, 0.61; 95% CI, 0.59-0.64; intravitreal injections: rate ratio, 0.68; 95% CI, 0.61-0.76; and vitrectomies: rate ratio, 0.54; 95% CI, 0.46-0.63). Statin therapy was also associated with lower risks of major adverse cardiovascular events (HR, 0.81; 95% CI, 0.77-0.85), new-onset diabetic neuropathy (HR, 0.85; 95% CI, 0.82-0.89), and new-onset diabetic foot ulcers (HR, 0.73; 95% CI, 0.68-0.78).
Conclusions and Relevance Statin therapy was associated with a decreased risk of diabetic retinopathy and need for treatments for vision-threatening diabetic retinopathy in Taiwanese patients with type 2 diabetes and dyslipidemia.
Association of #Statin Therapy With Prevention of Vision-Threatening Diabetic #Retinopathy
https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2720491
Patients in the statin group had a significantly lower rate of diabetic retinopathy nonproliferative diabetic retinopathy (HR, 0.92; 95% CI, 0.86-0.99), proliferative diabetic retinopathy vitreous hemorrhage (HR, 0.62; 95% CI, 0.54-0.71), tractional retinal detachment (HR, 0.61; 95% CI, 0.47-0.79), and macular edema (HR, 0.60; 95% CI, 0.46-0.79) than the nonstatin group, as well as lower rates of interventions such as retinal laser treatment (HR, 0.71; 95% CI, 0.65-0.77), intravitreal injection (HR, 0.74; 95% CI, 0.61-0.89), and vitrectomy (HR, 0.58; 95% CI, 0.48-0.69), along with a smaller number of the interventions (retinal lasers: rate ratio, 0.61; 95% CI, 0.59-0.64; intravitreal injections: rate ratio, 0.68; 95% CI, 0.61-0.76; and vitrectomies: rate ratio, 0.54; 95% CI, 0.46-0.63). Statin therapy was also associated with lower risks of major adverse cardiovascular events (HR, 0.81; 95% CI, 0.77-0.85), new-onset diabetic neuropathy (HR, 0.85; 95% CI, 0.82-0.89), and new-onset diabetic foot ulcers (HR, 0.73; 95% CI, 0.68-0.78).
Conclusions and Relevance Statin therapy was associated with a decreased risk of diabetic retinopathy and need for treatments for vision-threatening diabetic retinopathy in Taiwanese patients with type 2 diabetes and dyslipidemia.
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Changes in #Kidney Function Do Not Differ between Healthy Adults Consuming #Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis
https://academic.oup.com/jn/article/148/11/1760/5153345
Higher-protein (HP) diets are advocated for several reasons, including mitigation of sarcopenia, but their effects on kidney function are unclear
Methods
We conducted a systematic review and meta-analysis of trials comparing HP (≥1.5 g/kg body weight or ≥20% energy intake or ≥100 g protein/d) with normal- or lower-protein (NLP; ≥5% less energy intake from protein/d compared with HP group) intakes on kidney function.
The post-only comparison showed a trivial effect for GFR to be higher after HP intakes standardized mean difference (SMD): 0.19; 95% CI: 0.07, 0.31; P = 0.002. The change in GFR did not differ between interventions (SMD: 0.11; 95% CI: −0.05, 0.27; P = 0.16). There was a linear relation between protein intake and GFR in the post-only comparison (r = 0.332, P = 0.03), but not between protein intake and the change in GFR (r = 0.184, P = 0.33). The main limitation of the current analysis is the unclear risk of selection bias of the included trials.
Conclusions
Postintervention GFR comparisons indicate that HP diets result in higher GFRs; however, when changes in GFR were compared, dietary protein had no effect. Our analysis indicates that HP intakes do not adversely influence kidney function on GFR in healthy adults.
Changes in #Kidney Function Do Not Differ between Healthy Adults Consuming #Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis
https://academic.oup.com/jn/article/148/11/1760/5153345
Higher-protein (HP) diets are advocated for several reasons, including mitigation of sarcopenia, but their effects on kidney function are unclear
Methods
We conducted a systematic review and meta-analysis of trials comparing HP (≥1.5 g/kg body weight or ≥20% energy intake or ≥100 g protein/d) with normal- or lower-protein (NLP; ≥5% less energy intake from protein/d compared with HP group) intakes on kidney function.
The post-only comparison showed a trivial effect for GFR to be higher after HP intakes standardized mean difference (SMD): 0.19; 95% CI: 0.07, 0.31; P = 0.002. The change in GFR did not differ between interventions (SMD: 0.11; 95% CI: −0.05, 0.27; P = 0.16). There was a linear relation between protein intake and GFR in the post-only comparison (r = 0.332, P = 0.03), but not between protein intake and the change in GFR (r = 0.184, P = 0.33). The main limitation of the current analysis is the unclear risk of selection bias of the included trials.
Conclusions
Postintervention GFR comparisons indicate that HP diets result in higher GFRs; however, when changes in GFR were compared, dietary protein had no effect. Our analysis indicates that HP intakes do not adversely influence kidney function on GFR in healthy adults.
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#Carbohydrate quality and human #health: a series of systematic reviews and meta-analyses
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31809-9/fulltext
Observational data suggest a 15–30% decrease in all-cause and cardiovascular related mortality, and incidence of coronary heart disease, stroke incidence and mortality, type 2 diabetes, and colorectal cancer when comparing the highest dietary fibre consumers with the lowest consumers
Clinical trials show significantly lower bodyweight, systolic blood pressure, and total cholesterol when comparing higher with lower intakes of dietary fibre. Risk reduction associated with a range of critical outcomes was greatest when daily intake of dietary fibre was between 25 g and 29 g. Dose-response curves suggested that higher intakes of dietary fibre could confer even greater benefit to protect against cardiovascular diseases, type 2 diabetes, and colorectal and breast cancer. Similar findings for whole grain intake were observed.
Findings from prospective studies and clinical trials associated with relatively high intakes of dietary fibre and whole grains were complementary, and striking dose-response evidence indicates that the relationships to several non-communicable diseases could be causal.
Implementation of recommendations to increase dietary fibre intake and to replace refined grains with whole grains is expected to benefit human health. A major strength of the study was the ability to examine key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomised trials in a single study. Our findings are limited to risk reduction in the population at large rather than those with chronic disease.
#Carbohydrate quality and human #health: a series of systematic reviews and meta-analyses
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31809-9/fulltext
Observational data suggest a 15–30% decrease in all-cause and cardiovascular related mortality, and incidence of coronary heart disease, stroke incidence and mortality, type 2 diabetes, and colorectal cancer when comparing the highest dietary fibre consumers with the lowest consumers
Clinical trials show significantly lower bodyweight, systolic blood pressure, and total cholesterol when comparing higher with lower intakes of dietary fibre. Risk reduction associated with a range of critical outcomes was greatest when daily intake of dietary fibre was between 25 g and 29 g. Dose-response curves suggested that higher intakes of dietary fibre could confer even greater benefit to protect against cardiovascular diseases, type 2 diabetes, and colorectal and breast cancer. Similar findings for whole grain intake were observed.
Findings from prospective studies and clinical trials associated with relatively high intakes of dietary fibre and whole grains were complementary, and striking dose-response evidence indicates that the relationships to several non-communicable diseases could be causal.
Implementation of recommendations to increase dietary fibre intake and to replace refined grains with whole grains is expected to benefit human health. A major strength of the study was the ability to examine key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomised trials in a single study. Our findings are limited to risk reduction in the population at large rather than those with chronic disease.
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Multicomponent #Frailty Assessment Tools for Older People with #Psychiatric Disorders: A Systematic Review
https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15710
Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM‐5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48).
Conclusions
Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM‐5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population.
Multicomponent #Frailty Assessment Tools for Older People with #Psychiatric Disorders: A Systematic Review
https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15710
Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM‐5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48).
Conclusions
Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM‐5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population.
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Para- #cresol production by #Clostridium difficile affects microbial diversity and membrane integrity of Gram-negative bacteria
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1007191
C. difficile is transmitted by spores, which are able to survive in harsh environments for long periods of time. After initial treatment for C. difficile, up to 35% of patients develop the disease again, thus requiring additional and more successful treatment.
Here, we use novel techniques to show that C. difficile produces a compound, p-cresol, which has detrimental effects on the natural protective gut bacteria. We show that p-cresol selectively targets certain bacteria in the gut and disrupts their ability to grow.
By removing the ability of C. difficile to produce p-cresol, we show that it makes C. difficile less able to recolonise after an initial infection. This is linked to significant alterations in the natural healthy bacterial composition of the gut. Our study provides new insights into the effects of p-cresol production on the healthy gut microbiota and how it contributes to C. difficile survival and pathogenesis.
Para- #cresol production by #Clostridium difficile affects microbial diversity and membrane integrity of Gram-negative bacteria
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1007191
C. difficile is transmitted by spores, which are able to survive in harsh environments for long periods of time. After initial treatment for C. difficile, up to 35% of patients develop the disease again, thus requiring additional and more successful treatment.
Here, we use novel techniques to show that C. difficile produces a compound, p-cresol, which has detrimental effects on the natural protective gut bacteria. We show that p-cresol selectively targets certain bacteria in the gut and disrupts their ability to grow.
By removing the ability of C. difficile to produce p-cresol, we show that it makes C. difficile less able to recolonise after an initial infection. This is linked to significant alterations in the natural healthy bacterial composition of the gut. Our study provides new insights into the effects of p-cresol production on the healthy gut microbiota and how it contributes to C. difficile survival and pathogenesis.
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Enhancement of the #gut barrier integrity by a microbial metabolite through the Nrf2 pathway
https://www.nature.com/articles/s41467-018-07859-7
The importance of gut #microbiota in human health and pathophysiology is undisputable. Despite the abundance of metagenomics data, the functional dynamics of gut microbiota in human health and disease remain elusive. Urolithin A (UroA), a major microbial metabolite derived from polyphenolics of berries and pomegranate fruits displays anti-inflammatory, anti-oxidative, and anti-ageing activities. Here, we show that UroA and its potent synthetic analogue (UAS03) significantly enhance gut barrier function and inhibit unwarranted inflammation.
Cumulatively, the results highlight how microbial metabolites provide two-pronged beneficial activities at gut epithelium by enhancing barrier functions and reducing inflammation to protect from colonic diseases.
Enhancement of the #gut barrier integrity by a microbial metabolite through the Nrf2 pathway
https://www.nature.com/articles/s41467-018-07859-7
The importance of gut #microbiota in human health and pathophysiology is undisputable. Despite the abundance of metagenomics data, the functional dynamics of gut microbiota in human health and disease remain elusive. Urolithin A (UroA), a major microbial metabolite derived from polyphenolics of berries and pomegranate fruits displays anti-inflammatory, anti-oxidative, and anti-ageing activities. Here, we show that UroA and its potent synthetic analogue (UAS03) significantly enhance gut barrier function and inhibit unwarranted inflammation.
Cumulatively, the results highlight how microbial metabolites provide two-pronged beneficial activities at gut epithelium by enhancing barrier functions and reducing inflammation to protect from colonic diseases.
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Emergency and Urgent #Hospitalizations Linked to Accelerated #Cognitive Decline in Older Adults
https://neurosciencenews.com/cognitive-decline-hospitalization-10521/
We found that those who have non-elective (emergency or urgent) hospitalizations and who have not previously been diagnosed with dementia or Alzheimer’s disease had a rapid decline in cognitive function (i.e., thinking abilities) compared to the prehospital rates
The data emerged from a study of 777 older adults (81 years old on average, 75 percent of them women) enrolled in the Rush Memory and Aging Project (MAP) in Chicago. The study involved annual cognitive assessments and clinical evaluations.
We saw a clear distinction: non-elective admissions drive the association between hospitalization and long-term changes in cognitive function in later life, while elective admissions do not necessarily carry the same risk of negative cognitive outcomes,” James said. “These findings have important implications for the medical decision making and care of older adults.
“While recognizing that all medical procedures carry some degree of risk, this study implies that planned hospital encounters may not be as dangerous to the cognitive health of older persons as emergency or urgent situations.
Emergency and Urgent #Hospitalizations Linked to Accelerated #Cognitive Decline in Older Adults
https://neurosciencenews.com/cognitive-decline-hospitalization-10521/
We found that those who have non-elective (emergency or urgent) hospitalizations and who have not previously been diagnosed with dementia or Alzheimer’s disease had a rapid decline in cognitive function (i.e., thinking abilities) compared to the prehospital rates
The data emerged from a study of 777 older adults (81 years old on average, 75 percent of them women) enrolled in the Rush Memory and Aging Project (MAP) in Chicago. The study involved annual cognitive assessments and clinical evaluations.
We saw a clear distinction: non-elective admissions drive the association between hospitalization and long-term changes in cognitive function in later life, while elective admissions do not necessarily carry the same risk of negative cognitive outcomes,” James said. “These findings have important implications for the medical decision making and care of older adults.
“While recognizing that all medical procedures carry some degree of risk, this study implies that planned hospital encounters may not be as dangerous to the cognitive health of older persons as emergency or urgent situations.