Med J Aust. 2021 Nov 11. doi: 10.5694/mja2.51335. Online ahead of print.
NO ABSTRACT
PMID:34763362 | DOI:10.5694/mja2.51335
Dig Dis. 2021 Nov 11. doi: 10.1159/000520829. Online ahead of print.
ABSTRACT
Background Colonoscopy surveillance guidelines set the surveillance schedule based on polyp characteristics. Polyps with high-grade dysplasia (HGD) require 3 years of follow-up regardless of size. However, it is unclear whether patients with diminutive polyps (≤5 mm) with HGD have a higher risk. We evaluated the effect of diminutive adenoma with HGD on adenoma occurrence. Methods From Jan 2015 to Dec 2017, patients who underwent index and surveillance colonoscopy were retrospectively screened. The patients were grouped into no adenoma group, low-risk (patients with ≤2 low-grade dysplasia (LGD)), diminutive HGD and high-risk (HGD >5 mm, ≥3 adenomas) groups according to the index colonoscopy results. Each group was analyzed using logistic analysis. Results The mean follow-up period was 22.47 months. Altogether, 610 (50.45%) patients had LGD and 152 (12.5%) had HGD. Among them, 61(5.0%) patients had a diminutive polyp with HGD. Analysis of the risks of developing advanced adenoma in the surveillance colonoscopy showed that compared to no adenoma group, the diminutive HGD group did not show a significant risk (odds ratio [OR]=1.503 [0.449-5.027], p=0.509), while the high-risk group showed a significant risk (odds ratio [OR]=2.044 [1.015-4.114], p=0.045). Conclusions Diminutive adenoma with HGD increased the risk of adenoma on surveillance colonoscopy, In the case of advanced adenoma, the risk was increased, but it was not statistically significant.
PMID:34763334 | DOI:10.1159/000520829
Nutrition. 2021 Sep 30;93:111504. doi: 10.1016/j.nut.2021.111504. Online ahead of print.
ABSTRACT
OBJECTIVES: We sought to investigate the effects of time-restricted feeding (TRF) and a traditional weight-loss method on body composition and cardio-metabolic risk factors in middle-aged women.
METHODS: In a single-center, randomized, open-label, parallel-group design, women ages 40 to 65 y with body mass index ≥ 24 kg/m2 or waist circumference > 80 cm were recruited. They were guided to a daily low-calorie diet of 1400 kcal and randomly assigned into a TRF group (limit 8 h of eating time and fasting for 16 h) or a non-TRF group (traditional weight-loss method, unrestricted eating time) for 8 wk. Body composition, blood pressure, blood biochemical variables, and insulin resistance status were measured before and after intervention.
RESULTS: Body weight, body mass index, waist circumference, and body fat mass decreased significantly in both groups after 8 wk of intervention (P < 0.05). Body weight decreased more in the TRF group than the non-TRF group (-4.1% ± 2.8% versus -2.4% ± 2.5%; P = 0.012), as did diastolic blood pressure (75.3 ± 11.2 mm Hg versus 70.5 ± 9.4 mm Hg; P = 0.012). There were no statistical differences between the two groups in total cholesterol, triacylglycerols, high- or low-density lipoprotein cholesterol, and fasting insulin level. However, fasting glucose and insulin resistance status increased significantly for the TRF group after the intervention (respectively, 88.3 ± 7.6 mg/dL versus 92.6 ± 9.6 mg/dL, P = 0.003; 1.7 ± 0.7 versus 2.1 ± 1.0, P = 0.048).
CONCLUSION: The weight loss and reduction in diastolic blood pressure using the TRF method were better than with the traditional weight-loss method. However, this method may increase fasting glucose levels and adverse insulin resistance status.
PMID:34763309 | DOI:10.1016/j.nut.2021.111504
Parkinsonism Relat Disord. 2021 Nov 5;93:19-26. doi: 10.1016/j.parkreldis.2021.10.030. Online ahead of print.
ABSTRACT
BACKGROUND: The association between nonalcoholic fatty liver disease (NAFLD) and Parkinson’s disease (PD) remains uncertain. This study sought to assess the sex-specific association between NAFLD and PD risk considering that sex is an important factor in both conditions.
METHODS: We included 2,651,169 men and 2,998,904 women (≥40 years of age) who underwent health examinations in 2009 using database of the Korean National Health Insurance Service. To define NAFLD, the Fatty Liver Index (FLI) was used and a score of at least 60 points was regarded as suggesting the presence of NAFLD. Cox proportional hazards analyses were performed to evaluate the association between the presence of NAFLD/each component of FLI and the risk of PD. All analyses were stratified by sex.
RESULTS: The median follow-up duration was 7.3 years in both men and women. Of the total study population, 23,233 patients with PD (10,578 men and 12,655 women) were identified. Among men, a decreased risk of PD was observed in those with NAFLD [adjusted hazard ratio (aHR): 0.86, 95% confidence interval (CI): 0.82-0.91]. In contrast, among women, an increased risk of PD was observed in those with NAFLD (aHR: 1.09, 95% CI: 1.02-1.16). This different association according to sex was more prominent among younger participants but was not significant in the old age group.
CONCLUSIONS: NAFLD defined by FLI is differently associated with the risk of PD by sex (i.e., low risk of PD in men with NAFLD vs. high risk of PD in women with NAFLD).
PMID:34763304 | DOI:10.1016/j.parkreldis.2021.10.030
Complement Ther Clin Pract. 2021 Oct 26;46:101502. doi: 10.1016/j.ctcp.2021.101502. Online ahead of print.
ABSTRACT
BACKGROUND: and purpose: There is limited evidence from randomised controlled trials (RCTs) regarding the use of yoga and Pilates for the management of urinary incontinence (UI) in women. This study aims to investigate the preliminary effects of using Pilates and yoga to manage UI.
MATERIALS AND METHODS: An assessor-blinded, prospective, three-arm parallel-group randomised controlled pilot trial was conducted in three elderly care centres in Hong Kong. Thirty women aged 60 years or above were included in the study. Study centres were randomly assigned to each of the three interventions (yoga, Pilates and pelvic floor muscle training [PFMT; standard care control]). Study interventions were provided once a week for four weeks, followed by unsupervised CD-guided home exercises for eight weeks. Outcomes included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), 1-h pad test, and feasibility measures such as adherence to the intervention programme, recruitment and retention rates and safety. Outcomes were assessed at baseline, 4 and 12 weeks. Statistical analysis was performed using two-way repeated measures analysis of covariance.
RESULTS: All three interventions demonstrated a statistically significant effect on ICIQ-SF scores from baseline to weeks 4 and 12. Significant effects in UI were reported for yoga compared with Pilates (mean: -2.93, 95% CI -5.35, -0.51; p = 0.02).
CONCLUSION: Yoga poses intended to address the pelvic floor and core muscles were found to have superior benefits over Pilates exercises in terms of improved continence measured with the ICIQ-SF.
PMID:34763295 | DOI:10.1016/j.ctcp.2021.101502
J Hazard Mater. 2021 Oct 22;424(Pt C):127540. doi: 10.1016/j.jhazmat.2021.127540. Online ahead of print.
ABSTRACT
Monitored Natural Attenuation (MNA) is a preferred remedy for sites contaminated with 1,4-dioxane due to its low cost and limited environmental impacts compared to active remediation. Having a robust estimate of the rate at which biodegradation occurs is an essential component of assessing MNA. In this study, an assay was developed using 14C-labeled 1,4-dioxane to measure rate constants for biodegradation based on accumulation of 14C products. Purification of the 14C-1,4-dioxane stock solution lowered the level of 14C impurities to below 1% of the total 14C activity. This enabled determination of rate constants in groundwater as low as 0.0021 yr-1, equating to a half-life greater than 300 years. Of the 54 groundwater samples collected from 10 sites in the US, statistically significant rate constants were determined with the 14C assay for 24. The median rate constant was 0.0138 yr-1 (half-life = 50 yr); the maximum rate constant was 0.367 yr-1 (half-life = 1.9 yr). The results confirmed that biodegradation of 1,4-dioxane is occurring at 9 of the 10 sites sampled, albeit with considerable variability in the level of activity. The specificity of the assay was confirmed using acetylene and the absence of oxygen to inhibit monooxygenases.
PMID:34763286 | DOI:10.1016/j.jhazmat.2021.127540
Breast. 2021 Nov 2;60:230-237. doi: 10.1016/j.breast.2021.11.002. Online ahead of print.
ABSTRACT
PURPOSE: To assess whether contralateral parenchymal enhancement (CPE) on MRI is associated with gene expression pathways in ER+/HER2-breast cancer, and if so, whether such pathways are related to survival.
METHODS: Preoperative breast MRIs were analyzed of early ER+/HER2-breast cancer patients eligible for breast-conserving surgery included in a prospective observational cohort study (MARGINS). The contralateral parenchyma was segmented and CPE was calculated as the average of the top-10% delayed enhancement. Total tumor RNA sequencing was performed and gene set enrichment analysis was used to reveal gene expression pathways associated with CPE (N = 226) and related to overall survival (OS) and invasive disease-free survival (IDFS) in multivariable survival analysis. The latter was also done for the METABRIC cohort (N = 1355).
RESULTS: CPE was most strongly correlated with proteasome pathways (normalized enrichment statistic = 2.04, false discovery rate = .11). Patients with high CPE showed lower tumor proteasome gene expression. Proteasome gene expression had a hazard ratio (HR) of 1.40 (95% CI = 0.89, 2.16; P = .143) for OS in the MARGINS cohort and 1.53 (95% CI = 1.08, 2.14; P = .017) for IDFS, in METABRIC proteasome gene expression had an HR of 1.09 (95% CI = 1.01, 1.18; P = .020) for OS and 1.10 (95% CI = 1.02, 1.18; P = .012) for IDFS.
CONCLUSION: CPE was negatively correlated with tumor proteasome gene expression in early ER+/HER2-breast cancer patients. Low tumor proteasome gene expression was associated with improved survival in the METABRIC data.
PMID:34763270 | DOI:10.1016/j.breast.2021.11.002
Epilepsy Res. 2021 Oct 26;178:106796. doi: 10.1016/j.eplepsyres.2021.106796. Online ahead of print.
ABSTRACT
OBJECTIVE: Patients with epilepsy, mainly drug-resistant, have reduced heart rate variability (HRV), linked to an increased risk of sudden death in various other diseases. In this context, it could play a role in SUDEP. Generalized convulsive seizures (GCS) are one of the most consensual risk factors for SUDEP. Our objective was to assess the influence of GCS in HRV parameters in patients with drug-resistant epilepsy.
METHODS: We prospectively evaluated 121 patients with refractory epilepsy admitted to our Epilepsy Monitoring Unit. All patients underwent a 48-hour Holter recording. Only patients with GCS were included (n = 23), and we selected the first as the index seizure. We evaluated HRV (AVNN, SDNN, RMSSD, pNN50, LF, HF, and LF/HF) in 5-min epochs (diurnal and nocturnal baselines; preictal – 5 min before the seizure; ictal; postictal – 5 min after the seizure; and late postictal – >5 h after the seizure). These data were also compared with normative values from a healthy population (controlling for age and gender).
RESULTS: We included 23 patients, with a median age of 36 (min-max, 16-55) years and 65% were female. Thirty percent had cardiovascular risk factors, but no previously known cardiac disease. HRV parameters AVNN, RMSSD, pNN50, and HF were significantly lower in the diurnal than in the nocturnal baseline, whereas the opposite occurred with LF/HF and HR. Diurnal baseline parameters were inferior to the normative population values (which includes only diurnal values). We found significant differences in HRV parameters between the analyzed periods, especially during the postictal period. All parameters but LF/HF suffered a reduction in that period. LF/HF increased in that period but did not reach statistical significance. Visually, there was a tendency for a global reduction in our patients’ HRV parameters, namely AVNN, RMSSD, and pNN50, in each period, comparing with those from a normative healthy population. No significant differences were found in HRV between diurnal and nocturnal seizures, between temporal lobe and extra-temporal-lobe seizures, between seizures with and without postictal generalized EEG suppression, or between seizures of patients with and without cardiovascular risk factors.
SIGNIFICANCE/CONCLUSION: Our work reinforces the evidence of autonomic cardiac dysfunction in patients with refractory epilepsy, at baseline and mainly in the postictal phase of a GCS. Those changes may have a role in some SUDEP cases. By identifying patients with worse autonomic cardiac function, HRV could fill the gap of a lacking SUDEP risk biomarker.
PMID:34763267 | DOI:10.1016/j.eplepsyres.2021.106796
Epilepsy Res. 2021 Sep 24;178:106772. doi: 10.1016/j.eplepsyres.2021.106772. Online ahead of print.
ABSTRACT
BACKGROUND: Depression, being the most frequent psychiatric comorbidity, has always been closely linked with epilepsy. However, there is a lack of screening for depressive symptoms resulting in failure to detect depression among people with epilepsy (PWE). While many studies have described the risks associated with depression in epilepsy, very few have elaborated whether these risks are similar for undiagnosed depression, especially in a multiethnic community.
METHODS: We aim to investigate the prevalence and associated risk factors of undiagnosed depression in PWE through a cross-sectional study at a tertiary teaching hospital. Epilepsy patients aged between 18 and 65 years old were recruited after excluding those with background illnesses, which may contribute to depressive symptoms. A total of 129 participants were recruited. We collated their demographic and clinical details before interviewing them using two questionnaires; the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Beck’s Depression Inventory-II (BDI-II). Subsequently, if a participant is screened positive for depression, the diagnosis is confirmed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) questionnaire and a psychiatric clinic referral is offered.
RESULTS: Among the 129 participants, 9.3 % had undiagnosed major depressive disorder (MDD), which had a female preponderance (66.7 %). Risk factors of undiagnosed depression among PWE include low socioeconomic backgrounds (p = 0.026), generalized epilepsy (p = 0.036) and temporal lobe epilepsy (p = 0.010). Otherwise, while some variables such as being underweight and unmarried may be seen in a higher proportion in those who were depressed; we did not find a statistically significant relationship among them.
CONCLUSION: The prevalence of undiagnosed depression among PWE is higher when compared to population-based studies carried out in Western countries. While questionnaires to screen for depression are widely available, their infrequent use would lead to failure in identifying patients who may benefit from psychosocial support and treatment, which would subsequently improve their disease outcomes and quality of life. This study recommends the use of screening questionnaires to identify undiagnosed depression in PWE.
PMID:34763265 | DOI:10.1016/j.eplepsyres.2021.106772
Clin Nutr. 2021 Oct 22;40(12):5764-5770. doi: 10.1016/j.clnu.2021.10.012. Online ahead of print.
ABSTRACT
BACKGROUND & AIMS: Body weight changes reflect and impact several health conditions in older age, but little is known about its relationship with multimorbidity. We aimed to study the association of long-terms trajectories of body mass index (BMI) with contemporaneous changes in multimorbidity -and multimorbidity type- development in a population-based cohort of older adults.
METHODS: Twelve-year BMI trajectories (2001-2013) were identified in subjects aged 60+ years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) using growth mixture models (N = 2189). Information on 60 chronic diseases and multimorbidity was ascertained based on clinical examinations, lab tests, medications, and inpatient and outpatient medical records. Linear mixed models were used to study the association between BMI trajectories and the speed of chronic disease accumulation, in general and by groups of cardiovascular and neuropsychiatric diseases.
RESULTS: Eighty percent of the study population was included in what we defined a stable BMI trajectory, 18% in a slow-decline trajectory with an accelerated BMI decline from age 78 onwards, and 2% in a fast-decline trajectory that reached underweight values before age 85. A significantly higher yearly rate of chronic disease accumulation was observed in the fast-decline versus stable trajectory (β = 0.221, 95% CI 0.090-0.352) after adjusting the model for age cohort, sex, education and time to death. Subjects in the slow-decline trajectory showed a significantly higher yearly rate of cardiovascular disease accumulation (β = 0.016, 95% CI 0.000-0.031); those in the fast-decline trajectory showed a faster accumulation of both cardiovascular (β = 0.020, 95% CI -0.025, 0.064) and neuropsychiatric diseases (β = 0.102, 95% CI 0.064-0.139), even if the former association did not reach statistical significance.
CONCLUSION: Our results provide further evidence of the importance of carefully monitoring older adults with sustained weight loss, which is an early indicator of accelerated health deterioration, reflected in our study by a faster accumulation of chronic -especially neuropsychiatric- diseases.
PMID:34763261 | DOI:10.1016/j.clnu.2021.10.012