Summary

Background
Cephalosporins are recommended as first-line antibiotic prophylaxis in total joint replacement surgery. Studies have shown an increased risk for periprosthetic joint infection (PJI) when non-cephalosporin antibiotics have been used. This study examines the effect of non-cephalosporin antibiotic prophylaxis on the risk for PJI.

Methods
Patients with a primary hip or knee replacement performed from 2012 to 2020 were identified (27 220 joint replacements). The primary outcome was the occurrence of a PJI in a one-year follow-up. The association between perioperative antibiotic prophylaxis and the outcome was examined using logistic regression analysis.

Discussion
Cefuroxime was used as prophylaxis in 26,467 operations (97.2%), clindamycin in 654 (2.4%) and vancomycin in 72 (0.3%). The incidence of PJI was 0.86% (228/26,467) with cefuroxime and 0.80% (6/753) with other prophylactic antibiotics. There was no difference in the risk for PJI with different prophylactic antibiotics in the univariate (OR 1.06, 95% CI 0.47–2.39) or multivariable analysis (OR 1.02, 95% CI 0.45–2.30).

Conclusion
Non-cephalosporin antibiotic prophylaxis in primary total joint replacement surgery was not associated with an increased risk for PJI.

Introduction

Periprosthetic joint infection (PJI) is one of the most feared complications after prosthetic joint surgery and therefore it is essential to prevent them. Perioperative antibiotic prophylaxis has a well-established role in the prevention of surgical site infections (SSIs) related to prosthetic joint surgery. First- or second-generation cephalosporins are recommended as first-line prophylactic antibiotics. [1].

The most common reasons to use non-cephalosporin prophylactic antibiotics are reported penicillin allergy and carriage of methicillin resistant Staphylococcus aureus (MRSA) [1]. The prevalence of a reported penicillin allergy among patients with prosthetic joint surgery has been between 2.5–17% [[2], [3], [4], [5]]. Cephalosporins are often avoided and other prophylactic antibiotics, such as clindamycin or vancomycin, are given prior to joint replacement surgery to patients with a reported penicillin allergy [2,4].

Studies have shown an association between a reported penicillin or beta-lactam allergy and an increased risk of SSI after joint replacement surgery [5], even though this association has not been evident in all studies [2]. The increased risk for SSI associated with reported penicillin allergy is postulated to be due to the use of non-cephalosporin prophylactic antibiotics [6]. The risk for infection after prosthetic joint surgery has been shown to be higher when clindamycin has been compared with cloxacillin [7] and when vancomycin has been compared with cefazolin [4,8]. Wyles et al. showed that the risk for infection after prosthetic joint surgery was significantly higher when non-cefazolin prophylactic antibiotics were used [3].

Results

The study population consisted of 27,220 primary joint replacement surgeries performed on 22,497 patients. Of these surgeries, 12,452 (46%) were hip replacements and 14 768 (54%) were knee replacements. In addition, 1450 (5%) of the joint replacement surgeries were bilateral.

vvCefuroxime was used as prophylaxis in 26,467 operations (97.2%), other antibiotics were used as follows: clindamycin 654 (2.4%), vancomycin 72 (0.3%) and other antibiotics in 27 (0.1%) operations. The proportion of women was higher, and patients were slightly younger, had a higher BMI and higher ASA scores among those receiving non-cefuroxime antibiotic prophylaxis than those receiving cefuroxime (Table I). Surgeries with non-cefuroxime antibiotic prophylaxis were longer in duration than those with cefuroxime prophylaxis (Table I).

Highlights

Abstract

Keywords

1. Background

2. Gender and mental health in the Arab world

3. Women’s mental health services in Qatar

4. Developments following the steering committee report submission

5. Future directions

Declarations of conflict of interest

Author contributions

Financial disclosure

Acknowledgements

Data Availability

References

Abstract

Investigations into gender differences in the epidemiology of common mental disorders have highlighted the fundamental role of socio-economic factors as the key determinants in experiencing mental ill health and access to treatment. Women are almost always at a socio-economic disadvantage across cultures throughout the world and as a result experience mental health inequality. This disparity in control over their socio-economic determinants is even more stark in the Middle Eastern and North African region. This region has additionally also cultural and legal conditions that make women empowerment and access to health difficult. Qatar launched an ambitious National Health Strategic program and identified women’s mental health as a priority. This paper describes the development of a gender aware mental health service in Qatar, first of its kind in the region. It describes the challenges that exist in the region when attempting to develop such a service and some challenges that are unique to Qatar. This paper sets out a template of important principles that will be valuable for countries in the MENA region and beyond to develop evidence-based gender aware service that focuses on female empowerment and better mental health outcomes.

1. Background

Epidemiological data from across the world have reiterated that there exists a gender-based difference in mental health morbidity between men and women (Kessler et al., 1995; Leibenluft, 1999). From a summary of evidence in an epidemiological review by, Weissman and Klerman (1977) showing higher prevalence of mood and anxiety disorders among women, these findings have been replicated by subsequent community based epidemiological studies over the subsequent decades (Weissman et al., 1996, Kessler et al., 2005; Piccinelli and Gomez Homen, 1997).

However, studies conducted in societies or groups with socially homogenous gender roles and empowerment did not always support these findings (Egeland and Hostetter, 1983; Jenkins, 1985; Loewenthal et al., 1995). More specifically, these studies underlined the role of social factors underpinning these differences rather than the traditionally understood genetic basis (Parker and Brotchie, 2010). Over time, accumulating evidence for a social model as the variable that explains gender differences came to be seen as the only viable framework within which the evidence could be properly examined (Pan American Health Organization, 1995; World Health Organization, 1998).

It has been increasingly recognized that gender determines how the individual will interact with, have access to and have control over the socio-environmental determinants of mental health with the women universally having less control and access (WHO, 2000). The social position of women and their economic condition tends to be different from men and varies across the countries and has been shown to impact mental health (WHO, 2000). States economic policies and access to resources including those of health vary according to gender and most countries have their Gender Development Indices (GDI) lower for women than men (United Nations Women white paper 2018).

Abstract

Keywords

Funding

Declaration of competing interest

References

Abstract

Coronavirus disease (COVID-19) has become a global pandemic threat. Although there are huge impacts on health care, the influences of medical educations are less discussed. Our brief communication is the first-hand discussions of the measures of medical schools of Taiwan facing COVID-19 and the influences of medical education.

The coronavirus disease (COVID-19) pandemic has raised global awareness on the need for epidemic control and has significantly affected people’s lifestyles. The effects of COVID-19 on college education have been well discussed.1, 2, 3, 4 However, there is a lack of discussion on COVID-19 influence on medical education and corresponding plans to gradually lift restrictions on in-person interactions. Herein, we present the strategies taken by Taiwanese medical schools to continue in-person medical education on campus when COVID-19 first occurred.

Taiwanese medical schools defended themselves against COVID-19 in three ways. First, social distancing was implemented. To do this, seating arrangements were adjusted in most indoor spaces on campus, including classrooms, library study rooms, and food courts. Seats were marked as available with stickers, a constant reminder of social distancing. In addition, some events, including performance events, service-learning, and medical camp preparation meetings, were canceled to avoid large crowds.

Second, school authorities helped students and staff to keep track of their health conditions. Upon entering campus, students and the faculty members had their temperatures taken and hands sanitized with alcohol. Temperature measures served as a filter to prevent those with abnormal temperatures from coming into contact with others. As a new implemented daily routine, this also reminded people of the normal body temperature range, raising awareness on the disease. Alcohol sanitization kept hands and various surfaces clean. Furthermore, students and staff members were required to fill out online questionnaires concerning recent travel and exposure history. These mandatory measures kept everyone on their toes, attentive to health and hygiene at all times.

Highlights

Abstract

Keywords

Introduction

The role of the Mediterranean diet in human health

The sustainability of the Mediterranean diet for the environment

Environmental pollution negatively impacts on human health and aging but can be reduced by wider use of the Mediterranean DP

Conclusions

Funding

Author contributions

Declaration of Competing Interest

References

Abstract

Successful aging results from a lifetime of interaction between a range of factors, including those that are inherited (age, genetics), and those related to lifestyle (diet, exercise). In this brief communication, we examine the role of the Mediterranean-style diet in human health. Diet is one of the major pillars of healthy aging, and accumulating evidence supports the health benefits of the Mediterranean diet. We also discuss the lifelong effect of exposure to environmental pollution. Thus, there is an intricate relationship between health, diet and environment, which together represent a trilemma that must be addressed with a holistic, life-course, population-level approach.

Introduction

Individual health and lifestyle choices may create fertile ground for disease to develop. However, social, environmental and biological factors also jointly influence health. A life-course approach to health involves preventing and controlling diseases at key stages of life, from preconception to adulthood. Non-communicable diseases (NCDs) and disability share common risk factors whose combined presence over the life-course may initiate disease and/or disability in later life, namely poor diet, physical inactivity, environmental pollution, etc. These exposures over the cumulative life-course contribute to an increasing burden of ill health, justifying the need for effective prevention strategies.

The role of the Mediterranean diet in human health

Among the many lifestyle determinants of later health, one of the major pillars of healthy aging is diet. Among the oldest dietary patterns ever described is the Mediterranean diet, an umbrella term that actually encompasses a wide range of diets common to several countries around the Mediterranean basin, which share certain common features but also present wide variety in the actual composition. The whole could more correctly be described as a dietary pattern (DP). The Mediterranean DP is recognized as the healthiest lifestyle by UNESCO and the Council of the European Union, and recommended by the US Department of Health in its Dietary Guidelines for Americans 2015–2020 [1]. It is of vital importance to implement these recommendations at national level in every country as an investment in the future health of the population, since societal and economical changes have revolutionized our lives in the last few decades, and moved away from traditional family structures and working patterns. This has led to a “westernization” of DPs, with a greater tendency to eat quick meals while working, or looking at a telephone, and less adherence to the traditional model of family dining, with its associated communication and conviviality, resulting in an overall decline in adherence to the Mediterranean dietary pattern [2].

 Keywords

Problem

Approach

Outcomes

Discussion

References

Article Info

Related Articles

The Children’s Mercy Kansas City Neurology Division has 113 division members (23 faculty, 16 advanced practice nurses (APRNs), five residents/fellows, 27 nurses, and 42 other learners) across five locations, which creates obstacles for engaging learners in educational conferences. Although previously some conferences were live-streamed, lectures were not recorded, and most were attended solely by trainees and a few select faculty. However, coronavirus disease 2019 (COVID-19) and social distancing prompted rapid development and implementation of a complete virtual curriculum.

Approach

We created a neurology education group using Microsoft Teams, including all clinical and nonclinical members in our division. Within one week of beginning social distancing, we offered an average of four live virtual lectures per week, increased from two weekly lectures before COVID-19. Leaders promoted participation of all neurology division members, and decreased clinical load (secondary to COVID-19 restrictions) facilitated time for lecture preparation and attendance. Lectures covered diverse topics, including quality improvement and leadership development, in addition to clinical neurology. We tracked attendance and recorded and stored all lectures and supplementary materials in Microsoft Teams. We emailed a REDCap survey1,2 at the end of the third and fourth weeks of virtual education, and again after three months, with personalized reminders to complete the survey every two days for one week. Questions addressed participation and contribution to education, as well as perceived benefits and drawbacks of the curriculum.

Highlights

Abstract

Keywords

Introduction

Disciplinary differences in the theoretical approach to IPV

Differences in expertise and objectives in conducting impact evaluations

Differences in analytic approaches, data sources, and indicator construction

Safety and ethical considerations

Forging a cross-disciplinary path

Funding and acknowledgements

CRediT authorship contribution statement

Declaration of competing interest

References

Abstract

Research on intimate partner violence (IPV) has progressed in the last decade in the fields of public health and economics, with under-explored potential for cross-fertilisation. We examine the theoretical perspectives and methodological approaches that each discipline uses to conceptualise and study IPV and offer a perspective on their relative advantages. Public health takes a broad theoretical perspective anchored in the socio-ecological framework, considering multiple and synergistic drivers of IPV, while economics focuses on bargaining models which highlight individual power and factors that shape this power. These perspectives shape empirical work, with public health examining multi-faceted interventions, risk and mediating factors, while economics focuses on causal modelling of specific economic and institutional factors and economic-based interventions. The disciplines also have differing views on measurement and ethics in primary research. We argue that efforts to understand and address IPV would benefit if the two disciplines collaborated more closely and combined the best traditions of both fields.

Introduction

Intimate partner violence (IPV) is a major global public health challenge with one in three women ever experiencing lifetime physical and/or sexual IPV (World Health Organization, 2021). In addition to causing physical injury and adverse health outcomes (Bacchus, Ranganathan, Watts, & Devries, 2018), IPV has been associated with adverse social and economic outcomes for women, households and communities (Heise, 2012). In the last decade, significant theoretical and empirical advances have been made (Wu, Chen, Fang, & Wan, 2020) that improve understanding of global IPV prevalence (Devries et al., 2013), underlying drivers (Yakubovich et al., 2018) and prevention (Ellsberg et al., 2015). IPV research has historically been undertaken by public health or feminist scholars, conceptualising IPV as a phenomenon driven by complex socio-ecological factors and using mixed methodologies (Heise, 1998; Jewkes, 2002). In particular, public health researchers often study complex interventions to shift individual attitudes, alongside factors at the community level (e.g., social norms condoning male authority) (Abramsky et al., 2014) or at the interpersonal level (e.g., poor communication, conflict negotiation skills; and alcohol abuse) (Dunkle, Stern, Chatterji, & Heise, 2020). However, IPV is increasingly being studied by diverse disciplines, including economics.

Economic literature on IPV emerged in the early 1990s, with an initial focus on developing and empirically testing theoretical models of the family that conceptualised how interactions between partners could lead to IPV and how economic or institutional factors affect these interactions and hence IPV (Farmer & Tiefenthaler, 1997; Tauchen, Witte, & Long, 1991). These inquiries have gradually expanded to evaluations of how diverse policies, institutions, and economic factors affect IPV, such as employment and wages (Aizer, 2010; Anderberg, Rainer, Wadsworth, & Wilson, 2016), divorce laws (Bowlus & Seitz, 2006), dowry (Bloch & Rao, 2002), or cash and asset transfers (Buller et al., 2018), with a continuing focus on the empirical estimation of quantitative relationships.

Declaration of Competing Interest

References

Background: A novel coronavirus (2019-nCoV) associated with human to human transmission and severe human infection has been recently reported from the city of Wuhan in China. Our objectives were to characterize the genetic relationships of the 2019-nCoV and to search for putative recombination within the subgenus of sarbecovirus.

Methods: Putative recombination was investigated by RDP4 and Simplot v3.5.1 and discordant phylogenetic clustering in individual genomic fragments was confirmed by phylogenetic analysis using maximum likelihood and Bayesian methods.

Results: Our analysis suggests that the 2019-nCoV although closely related to BatCoV RaTG13 sequence throughout the genome (sequence similarity 96.3%), shows discordant clustering with the Bat_SARS-like coronavirus sequences. Specifically, in the 5′-part spanning the first 11,498 nucleotides and the last 3′-part spanning 24,341–30,696 positions, 2019-nCoV and RaTG13 formed a single cluster with Bat_SARS-like coronavirus sequences, whereas in the middle region spanning the 3′-end of ORF1a, the ORF1b and almost half of the spike regions, 2019-nCoV and RaTG13 grouped in a separate distant lineage within the sarbecovirus branch.

Conclusions: The levels of genetic similarity between the 2019-nCoV and RaTG13 suggest that the latter does not provide the exact variant that caused the outbreak in humans, but the hypothesis that 2019-nCoV has originated from bats is very likely. We show evidence that the novel coronavirus (2019-nCov) is not-mosaic consisting in almost half of its genome of a distinct lineage within the betacoronavirus. These genomic features and their potential association with virus characteristics and virulence in humans need further attention.

Methods

Results

Discussion

References

Abstract

Background The bioreactance technique is a relatively new, totally non-invasive technique used to measure cardiac output that is easy to use. Non Invasive Cardiac Output Monitor (NICOM) is one such system (Cheetah Medical Inc). Although approved by FDA for measurement of stroke volume, there is a paucity of literature validating this technology in decompensated heart failure and cardiogenic shock (CS). Methods and Results Fifty patients admitted to our cardiac intensive care unit (CICU) for CS and Swan Ganz catheter guided therapy were prospectively enrolled in the study after informed consent. Simultaneous measurements of cardiac output (CO) were obtained using NICOM, indirect Fick (IF) and bolus thermodilution (TD). Intraclass correlation coefficient (ICC) was used to assess the precision of NICOM for CO using the three repeated measurements of CO over the pooled data. The agreement of the NICOM device in the defined clinical population compared to IF and TD, was evaluated by comparing the Pearson Correlation Coefficient, the Bland-Altman plot, and Lin’s Concordance Correlation Coefficient. ICC for cardiac output measured by NICOM showed excellent repeatability (ICC = 0.93, 95% CI = 0.92 – 0.94, n = 262) in the pooled data. Pearson Correlation Coefficient for cardiac output measured by NICOM was poor when compared to IF (n = 263, r = 0.132, p = 0.033) and TD (n = 258, r = 0.275, p < 0.001). Conclusions NICOM technology is not a reliable method of measuring CO in patients with decompensated heart failure and CS.

Introduction

Invasive nature of pulmonary artery catheter (PAC) is often cited as an added risk to the patients with unclear mortality benefit among critically ill patients. [1,2] Eisenberg et al. and Mimoz et al. demonstrated that physicians could predict cardiac output with only 50% accuracy in the absence of direct hemodynamic data [3, 4], indicating the need for hemodynamic monitoring in critically ill patients. Current guidelines support the use of invasive hemodynamic monitoring in selected patients in whom a clinical evaluation does not provide sufficient data to determine optimal medical therapy. [5] For these reasons, measurement of cardiac output (CO) using non-invasive or minimally invasive devices has gained popularity. The bioreactance technique is a relatively new, non-invasive technique used to measure CO. Non Invasive Cardiac Output Monitor (NICOM) is one such system (Cheetah Medical Inc).

1. Introduction

2. Methods

3. Results

4. Discussion

Acknowledgements

References

Abstract

2019-nCoV is a newly identified coronavirus with high similarity to SARS-CoV. We performed a structural analysis of the receptor binding domain (RBD) of spike glycoprotein responsible for entry of coronaviruses into host cells. The RBDs from the two viruses share 72% identity in amino acid sequences, and molecular simulation reveals highly similar ternary structures. However, 2019-nCoV has a distinct loop with flexible glycyl residues replacing rigid prolyl residues in SARS-CoV. Molecular modeling revealed that 2019-nCoV RBD has a stronger interaction with angiotensin converting enzyme 2 (ACE2). A unique phenylalanine F486 in the flexible loop likely plays a major role because its penetration into a deep hydrophobic pocket in ACE2. ACE2 is widely expressed with conserved primary structures throughout the animal kingdom from fish, amphibians, reptiles, birds, to mammals. Structural analysis suggests that ACE2 from these animals can potentially bind RBD of 2019-nCoV, making them all possible natural hosts for the virus. 2019-nCoV is thought to be transmitted through respiratory droplets. However, since ACE2 is predominantly expressed in intestines, testis, and kidney, fecal-oral and other routes of transmission are also possible. Finally, antibodies and small molecular inhibitors that can block the interaction of ACE2 with RBD should be developed to combat the virus.

Introduction

A mysterious pneumonia illness was first reported in late December 2019 in Wuhan, China, and has rapidly spread to a dozen of countries including the United States with thousands of infected individuals and hundreds of deaths within a month [1]. Scientists in China have isolated the virus from patients and determined its genetic code. The pathogen responsible for this epidemic is a new coronavirus designated 2019-nCoV by the World Health Organization. 2019-nCoV belongs to the same family of viruses as the well-known severe acute respiratory syndrome coronavirus (SARSCoV) and Middle East respiratory syndrome coronavirus (MERSCoV), which have killed hundreds of people in the past 17 years.

Coronaviruses consist of a large diverse family of viruses. They can be classified into four genera: Alpha-, Beta-, Gamma-, and Delta coronavirus [2,3]. Representative alphacoronaviruses include human coronavirus NL63 (HCoV-NL63), while the betacoronaviruses include the best-known SARS-CoV and MERS-CoV. Based on nucleic acid sequence similarity, the newly identified 2019-nCoV is a betacoronavirus. The entry of all coronaviruses into host cells is mediated by spike glycoprotein that gives coronaviruses a crownlike appearance by forming spikes on their surface. The amino acid sequence of spike glycoprotein consists of a large ectodomain, a single-pass transmembrane anchor, and a short C-terminal intracellular tail [3]. The ectodomain contains a receptor-binding unit S1 and a membrane-fusion unit S2. Electron microscopic imaging illustrated that spike glycoprotein forms a clove-shaped spike with three S1 heads and a trimeric S2 stalk. For a virus to enter a host cell, S1 binds to a specific cell surface receptor via its receptorbinding domain (RBD), and S2 fuses the host cell and viral membranes, enabling the entry of viral genomes into host cells. Specific RBD-receptor binding determines if a cell or animal can be infected and also serves as a target for therapeutic inventions to treat diseases caused by coronaviruses. Previous studies have identified angiotensin converting enzyme 2 (ACE2) as a functional receptor for SARS-CoV [4,5]. In this study, we analyzed the structure of spike glycoprotein RBD of 2019-nCoV and identified a unique feature that potentially allows a high affinity binding to ACE2 in human cells. We further discussed potential candidates for natural hosts of 2019-nCoV, routes of transmission, and strategies to inhibit virus entry for therapeutic applications.

1- Introduction

2- Materials and methods

3- Results

4- Discussion

References

Abstract

Family history of tobacco use and use of e-cigarettes have both been associated with increased tobacco use among young adults. However, to our knowledge, these variables have not been considered simultaneously. This study was designed to evaluate the hypothesis that family history of tobacco use would predict tobacco product use over time among young adult e-cigarette users with limited combustible tobacco use experience. A sample of 124 participants were recruited online from across the United States, completed five surveys over 12 months, and reported use of nicotine and tobacco products over the previous two weeks at each survey. Family history of nicotine and tobacco use was reported at the 6-month assessment, and data were collected in 2017 and 2018. Regression models indicated that family history was associated with likelihood of cigarette use (odds ratio = 1.02 [95% confidence interval = [1.00, 1.04]). Significant interactions between family history and linear (OR = 1.05 [1.01, 1.10]) and quadratic (OR = 0.99 (0.98, 1.00)] time terms indicated that the association between family history and likelihood of combustible product use shifted over time. In both cases, more extensive family histories predicted greater use frequency, and follow-up analyses showed that more extensive family history was associated with greater combustible tobacco product use 3, 6, and 9 months following baseline. Family history of nicotine/tobacco use may promote initiation of tobacco use among e-cigarette users. These results suggest family history of tobacco use may comprise a risk factor for combustible tobacco use within the evolving tobacco product landscape.

Introduction

Recent research has indicated that e-cigarette use is becoming increasingly common among young adults (Ramo et al., 2015). Although long-term health consequences of using e-cigarettes remain uncertain, some studies suggest that using e-cigarettes is associated with respiratory disorders and exposure to chemicals that can promote respiratory disease (Farsalinos et al., 2015; Wills et al., 2019). Although some data characterize e-cigarettes as a healthier alternative to tobacco cigarettes (Choi and Forster, 2013; Sutfin et al., 2013), other findings suggest that e-cigarette use could promote tobacco use, especially within younger populations (Leventhal et al., 2015; Primack et al., 2015). Research has also shown that individuals with a family history of smoking tobacco cigarettes are more likely to smoke cigarettes themselves (Peterson et al., 2006). However, little is known about whether family history of nicotine and tobacco product use is associated with subsequent combustible tobacco use among young adults. It is possible that e-cigarette use and family history of combustible tobacco use might work synergistically to promote transitions to use of combustible tobacco products. This analysis was intended to evaluate the hypothesis of an association between family history of using nicotine/tobacco products and transitions to use of combustible tobacco products among young adult e-cigarette users. More specifically, we expected that participants with more family members with histories of nicotine/tobacco use would be more likely to begin using cigarettes and other combustible tobacco products.

Neuroinflammation remains a central piece in Parkinson’s disease (PD) pathophysiology. However, mechanisms by which PD links to the neuroinflammation remain elusive. Here, for the first time, we report that lower dose of niacin in PD patients may affect macrophage polarization from M1 (pro-inflammatory) to M2 (counter-inflammatory) profile through the niacin receptor GPR109A. Skew in the peripheral macrophages were accompanied by improved quality of life assessments in patients. Low dose niacin supplementation may be beneficial in PD, boosting anti-inflammatory processes and suppressing inflammation. Varied niacin dosages for longer durations may further reveal the potential role of anti-inflammatory interventions in PD progression.

Introduction

Parkinson’s disease is a progressive neurodegenerative disorder. Aging, genetic susceptibility and environmental factors play pivotal roles in its initiation, and progression. The main cause of PD still remains unknown and there is no cure (Moehle and West, 2015). Among all mechanisms and factors proposed to be involved in PD pathology, inflammation is universally thought to play a central role in the initiation and progression of PD (Moehle and West, 2015; Bartels et al., 2010). Acute inflammatory responses may initially be beneficial, however, chronic inflammation exacerbates brain damage. As a part of innate immunity, macrophages and neutrophils are known to cross the leaky blood brain barrier, secrete cytokines (e.g., interleukins, tumor necrosis factor, interferon gamma) that in turn can initiate and regulate inflammatory responses leading to neurodegenerative damage. Due to lineage proximity to microglia, macrophages have attracted increasing attention in relation to the onset and progression of PD (Moehle and West, 2015; Lee et al., 2017; Zhao et al., 2014). Macrophages can be divided into two classes of M1 (pro-inflammatory) and M2 (counterinflammatory) subtypes. The notion of macrophage polarization and skewing from M1 to M2 type may be a plausible modality in containing the chronic inflammation and slowing the progression of PD (Moehle and West, 2015). Our previous studies have demonstrated that niacin supplementation may influence the course of PD (Wakade et al., 2014; Wakade and Chong, 2014). Niacin can play a significant role in triggering and boosting anti-inflammatory immune responses in humans and animal models (Feingold et al., 2014). Niacin is a ligand for hydroxycarboxylic acid receptor 2 (HCAR2, also known as GPR109A). The counter inflammatory role of GPR109A has been already proposed (Salem and Wadie, 2017). Several studies have suggested that niacin’s effects maybe mediated via GPR109A/HCA2, which is highly expressed in adipose tissue and macrophages (Blad et al., 2012; Ganapathy et al., 2013; Singh et al., 2014a). Here in this study we demonstrated for the first time in PD patients, that niacin supplementation through its receptor, GPR109A, may alter the macrophages polarization from M1 to M2 profile. Most importantly, our findings indicated an improvement in quality of life for PD patients.

Research has consistently shown that regular physical activity may protect against the development and maintenance of depression and anxiety, whereas sedentary behavior may exacerbate depression and anxiety. However, much of the past research in this area has focused on non-clinical populations. Therefore, the goal of this study was to examine the relations of physical activity and sedentary behavior to depression and anxiety symptom severity among an understudied patient population, patients in residential substance use disorder (SUD) treatment. This study also sought to determine the extent to which physical activity and sedentary behavior relate to depression and anxiety symptom severity above and beyond an established transdiagnostic risk factor for depression and anxiety, emotion dysregulation. A sample of 41 patients from a residential SUD treatment facility completed a variety of self-report measures focused on physical activity, sedentary behavior, emotion dysregulation, and depression and anxiety symptom severity. Physical activity, but not sedentary behavior, was found to significantly predict depression symptom severity above and beyond emotion dysregulation. Physical activity and sedentary behavior did not significantly predict anxiety symptom severity above and beyond emotion dysregulation. In addition to providing additional support for the relevance of emotion dysregulation to depression and anxiety symptom severity, results suggest that physical activity may be another factor to consider in evaluating risk for depression among patients with SUDs. Although additional research in this area is warranted, results also suggest the potential utility of targeting physical activity in reducing risk for depression among patients with SUDs.

Introduction

Increasing attention has been paid toward both the benefits of regular physical activity and the disadvantages of sedentary behavior for mental health. Research has generally shown that moderate to high levels of physical activity are associated with lower levels of depression, whereas no physical activity and sedentary behavior may exacerbate depression (Dunn, Trivedi, & O’Neal, 2001; Martinsen, 2008; Ströhle, 2009; Teychenne, Ball, & Salmon, 2008). Although the cross-sectional nature of most of the studies in this area precludes determination of the temporal direction of this relation, a recent review of studies examining the prospective relation between physical activity and depression (see Mammen & Faulkner, 2013) provided evidence that physical activity may prevent future depression (although not all studies included in this review demonstrated such a relation). Whereas similar findings have also been obtained for anxiety (e.g., Petruzzello, Landers, Hatfield, Kubitz, & Salazar, 1991), less research has been conducted on the relation of physical activity to anxiety and, thus, conclusions regarding a dose-response relation between physical activity and anxiety severity are premature (Dunn et al., 2001; Ströhle, 2009). Research indicates that the relations between physical activity and sedentary behavior and depression and anxiety are found within both clinical and nonclinical populations. For example, the relation between physical activity and depression has been studied among inpatient military veterans (Davidson, Babson, Bonn-Miller, Souter, & Vannoy, 2013) and inpatients and outpatients with mood and anxiety disorders (Harris, Cronkite, & Moos, 2006; Martinsen, Hoffart, & Solberg, 1989; Sexton, Maere, & Dahl, 1989). Yet, the majority of the research in this area has focused on non-clinical populations (Teychenne et al., 2008). Consequently, there is a need to examine these relations within clinical populations at particularly high risk for the experience of depression and anxiety, such as individuals with substance use disorders (SUD).

Introduction: LRRK2 G2019S mutation carriers with Parkinson’s disease (PD) have been generally indistinguishable from those with idiopathic PD, with the exception of variable differences in some motor and non-motor domains, including cognition, gait, and balance. LRRK2 G2019S is among the most common genetic etiologies for PD, particularly in Ashkenazi Jewish (AJ) populations. Methods: This cross-sectional data collection study sought to clarify the phenotype of LRRK2 G2019S mutation carriers with PD. Primary endpoints were the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) and Montreal Cognitive Assessment (MoCA). Other motor and non-motor data were also assessed. The Mann-Whitney U Test was utilized to compare LRRK2 G2019S carriers with PD (LRRK2+) with non-carrier PD controls who were matched for age, gender, education, and PD duration. Survival analyses and log rank tests were utilized to compare interval from onset of PD to development of motor and non-motor complications. Results: We screened 251 subjects and 231 completed the study, of whom 9 were LRRK2+, including 7 AJ subjects. 22.73% of AJ subjects with a family history of PD (FH) and 12.96% of AJ subjects without a FH were LRRK2+. There were no significant differences between the 9 LRRK2+ subjects and 19 matched PD controls in MDS-UPDRS, MoCA, or other motor and non-motor endpoints. Conclusion: Prevalence of the LRRK2 G2019S mutation in AJ and non-AJ subjects in our study population in Cleveland, Ohio was comparable to other clinical studies. There were no significant motor or non-motor differences between LRRK2+ PD and matched PD controls.

Introduction

The autosomal dominant G2019S mutation in the leucine-rich repeat kinase 2 (LRRK2) gene is among the most common genetic mutations associated with PD.[1] This mutation is responsible for 4% of familial PD and 1% of sporadic cases of PD,[2] with a higher frequency of up to 18% of PD in Ashkenazi Jews (and up to 30% of familial cases).[3] The clinical manifestations of PD in LRRK2 mutation carriers were generally similar to those of sporadic PD,[4, 5] although some studies found a milder motor phenotype in carriers.[2, 6] Some authors found that G2019S carriers were more likely to display the postural instability-gait difficulty (PIGD) phenotype with falls.[7, 8] The International LRRK2 Consortium found a higher incidence of tremor as the presenting symptom, prevalence of dystonia, slower motor progression, and lower incidence of cognitive impairment in carriers.[2] Some authors,[9, 10] but not others,[11-14] found less cognitive impairment in G2019S carriers compared to non-carriers with PD. This cross-sectional data collection study sought to compare motor Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and other characteristics between LRRK2 G2019S-positive subjects and matched PD controls without the mutation recruited from an academic medical center in Cleveland, Ohio.