Prospective Cohort Study

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(00)02490-9.pdf

The importance of selenium to human health

The essential trace mineral, selenium, is of fundamental importance to human health. As a constituent of selenoproteins, selenium has structural and enzymic roles, in the latter context being best-known as an antioxidant and catalyst for the production of active thyroid hormone. Selenium is needed for the proper functioning of the immune system, and appears to be a key nutrient in counteracting the development of virulence and inhibiting HIV progression to AIDS. It is required for sperm motility and may reduce the risk of miscarriage. Deficiency has been linked to adverse mood states. Findings have been equivocal in linking selenium to cardiovascular disease risk although other conditions involving oxidative stress and inflammation have shown benefits of a higher selenium status. An elevated selenium intake may be associated with reduced cancer risk. Large clinical trials are now planned to confirm or refute this hypothesis. In the context of these health effects, low or diminishing selenium status in some parts of the world, notably in some European countries, is giving cause for concern.

The importance of selenium to human health.

Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/216320/ira30040_2433_2445.pdf

Depression and pain comorbidity: a literature review.

Stroke is a major cause of morbidity and mortality in Taiwan, where it is the leading cause of disability and the third leading cause of death. Close to a quarter of the nearly 800,000 strokes that occur annually in the United States are recurrent events. Thus, it is important to reduce the risk of recurrent stroke in patients that have suffered a prior stroke event. Platelet activation plays a vital role in arterial thrombosis, such as in cardiovascular disease, peripheral arterial disease, and ischemic stroke, for which such thrombosis accounts for 70% of the strokes in Taiwan. Arterial thrombosis is commonly treated and prevented by administration of antiplatelet agents. Of these, aspirin remains the most widely used agent for the prevention of noncardioembolic ischemic stroke. The relative risk reduction for recurrent stroke is 22%, leaving some patients (30e40%) to develop new strokes despite taking aspirin. Such recurrent events in aspirin-treated patients represent a significant treatment challenge. Aspirin works by irreversibly acetylating the cyclooxygenase (COX)-1 enzyme, thus suppressing the formation of thromboxane A2 (TXA2), a potent agonist of platelet aggregation. 7 The term “aspirin resistance” (AR) has been used to describe the various manifestations of aspirin’s insufficient inhibitory effects on platelet function, due to AR or persistently high platelet reactivity in laboratory tests, such as short bleeding time and/or persistently high levels of TXA2 production. Patients are considered to have biochemical (laboratory-defined) AR when their in vitro platelet reactivity is not properly blocked despite the use of aspirin, and are considered to have clinical AR or “treatment failure” when thrombotic events occur even while they are taking aspirin. The mechanisms underlying AR are uncertain. Several pharmacodynamic and pharmacokinetic factors are likely to play a role in the variability of platelet inhibition observed with aspirin treatment, including bioavailability, patient compliance, genetic polymorphisms, activation of alternate platelet-stimulation pathways, accelerated platelet turnover, and factors associated with antiplatelet resistance. The prevalence of biochemical AR in stroke patients is highly variable, ranging from 3% to 85% in different studies. This high variance can be attributed, at least in part, to the use of noncorrelated measurement techniques, such as the Platelet Function Analyzer (PFA)-100 assay, the VerifyNowAspirin assay, and light transmittance aggregometry (LTA). In theory,

Aspirin resistance and ischemic stroke outcome: fact or fiction?

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(99)80013-0.pdf

Colour doppler imaging for diagnosis of intracranial hy p o t e n s i o n

ObjectiveThe current study explored whether the chances of having migraine are influenced by a youth’s friendship with a migraineur.MethodsThe study was centered on a community-based non-referral c...

The influence of friendship on migraine in young adolescents: A social network analysis.

Objective: The aim of the present study was to calculate the time sequence of different brain MRI findings in spontaneous intracranial hypotension (SIH). Background: SIH commonly caused by spinal CSF leakage is typically presented as severe orthostatic headaches. Accurate diagnosis of SIH depends largely on brain MRI findings. However, the emergences of brain MRI findings in different disease durations have not been systemically described. Design/Methods: We retrospectively reviewed the medical records and brain MRI findings of consecutive patients with SIH in Taipei Veterans General Hospital. The disease duration was measured as the interval between the onset of the first SIH symptom and the appearance of specified brain MRI findings. We divided our patients into quartiles based on their disease duration. Associations between disease duration and incidences of brain MRI signs were analyzed using chi-square, linear-by-linear association, or exhaustive CHAID algorithms (decision tree analysis). Results: Between January 2007 and December 2016, 176 SIH patients admitted to our hospital were recruited. Except for the venous distension sign, which has an incidence ≥75% in all quartiles, timings of ≥ 40% incidence rate of MRI signs followed a stepwise fashion: diffuse pachymeningeal enhancement ( Conclusions: Our study showed the brain MRI findings in SIH were associated with the disease duration and occurred sequentially. Our findings can be used to help clinicians make accurate diagnosis of SIH in different durations. Disclosure: Dr. Wu has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Hseu has nothing to disclose. Dr. Fuh has nothing to disclose. Dr. Lirng has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Wang has nothing to disclose.

Jong Ling Fuh

Papers

Aspirin resistance and ischemic stroke outcome: fact or fiction?

Colour doppler imaging for diagnosis of intracranial hy p o t e n s i o n

The influence of friendship on migraine in young adolescents: A social network analysis.

The Time Sequences of Brain MRI Findings in Spontaneous Intracranial Hypotension (S20.004)

Global cognitive dysfunction and β-amyloid neuropathology in late-life and treatment-resistant major depression