Depression is common in patients presenting to cognitive clinics, but prevalence estimates are varied. While there are many self-report screening tools for depression, there is no clear consensus on the best instruments for this patient population. Data were prospectively collected as part of a larger cohort called the Neurological Disease and Depression Study (NEEDS). Participants were recruited from the cognitive neurology outpatient clinics at the University of Calgary from March 2014 to June 2017. All patients had to have a confirmed diagnosis of subjective cognitive decline, mild cognitive impairment (MCI), or mild or moderate dementia. Patient reported depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies Depression Scale (CES-D). The reference standard was the Structured Clinical Interview for the DSM-IV (SCID). 202 participants completed both the questionnaire and SCID. The point prevalence of major depression in our cohort using the SCID as the gold standard was 12.4% (n=25). The prevalence of depression according to the PHQ-9, HADS-D, and CES-D was 29.8%, 28.4% and 43.3% respectively at traditional cut-points for the general population. The mean MMSE score was 25.5 (n=192) and 13.0 for the MOCA (n=197). At traditional cut-points, all 3 scales performed well in the ROC analysis with all AUC > 80% (Figure 1). The PHQ-9 and HADS performed better at lower cut-point in this population than at the traditional cut-points. The CES-D maintained 100.0% sensitivity from cut-points 13-21, but the cut-points that maintained the best overall accuracy was 18-21. The optimal cut-point of the CES-D in this population is higher than the recommended cut-point in the general population.

Stays at high altitude induce alterations in cardiovascular control and are a model of specific pathological cardiovascular derangements at sea level. However, high-altitude alterations of the complex cardiovascular dynamics remain an almost unexplored issue. Therefore, our aim is to describe the altered cardiovascular complexity at high altitude with a multiscale entropy (MSE) approach. We recorded the beat-by-beat series of systolic and diastolic blood pressure and heart rate in 20 participants for 15 min twice, at sea level and after arrival at 4554 m a.s.l. We estimated Sample Entropy and MSE at scales of up to 64 beats, deriving average MSE values over the scales corresponding to the high-frequency (MSEHF) and low-frequency (MSELF) bands of heart-rate variability. We found a significant loss of complexity at heart-rate and blood-pressure scales complementary to each other, with the decrease with high altitude being concentrated at Sample Entropy and at MSEHF for heart rate and at MSELF for blood pressure. These changes can be ascribed to the acutely increased chemoreflex sensitivity in hypoxia that causes sympathetic activation and hyperventilation. Considering high altitude as a model of pathological states like heart failure, our results suggest new ways for monitoring treatments and rehabilitation protocols.

Presence of psychiatric comorbidities, which were common in our incident MS cohort, increased the severity of subsequent neurologic disability. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.

Successful PVI may lead to transient autonomic alterations reflected by a reduction in pulse interval variability and BRS, with more prolonged changes in the Valsalva ratio. The efficacy of PVI in preventing atrial fibrillation recurrence seems to be related to transient parasympathetic atrial denervation.

Neprilisin and angiotensin receptor inhibition (Sacubitril/Valsartan, i.e. ARNI) is recommended in heart failure guidelines for patients in NYHA class II-III with reduced left ventricular ejection fraction (LVEF). ARNI increase survival and quality of life; due to their hemodynamic effects, ARNI could also affect exercise tolerance. We studied the effects of ARNI on cardiopulmonary test (CPET) after six months of treatment in 35 patients [67 ± 11 years; LVEF 31 ± 6%; NT-proBNP 1822 ± 1651 pg/ml; ICD/CRT since at least 6 months in 26/35], treated with increasing doses of Sacubitril/Valsartan up to 318 ± 36 mg/die. In addition, levels of NT-proBNP, renal function, electrolytes, and echocardiocolorDoppler were assessed in the same time periods. No variations of renal function and/or potassium levels were observed; NT-proBNP decreased. Most CPET variables were improved by ARNI (<i>p</i> < .05): peak VO₂ and O₂ pulse increased (from 15.8 ± 3.4 to 17.0 ± 4.0 ml/kg/min and from 11.5 ± 2.5 to 12.6 ± 2.4 ml/beat, respectively), while VEVCO₂ slope decreased from 35.2 ± 11.2 to 33.1 ± 12.3. A significant relationship (<i>p</i> < .05) was observed between the amount of increase in LVEF and that of O₂ pulse in all patients, and between the amount of decrease in PAPs and that of VEVCO₂ slope in patients showing pulmonary hypertension in baseline. In a subgroup of 22 patients who already completed A 1 year follow-up, overall CPET improvement was maintained. In conclusion, already in the short term ARNI favourably affect cardiopulmonary response to exercise in heart failure patients; such a change seems to be preserved on a longer period.

aPL show a low prevalence in COVID-19 patients and are not associated with major thrombotic events. aPL in COVID-19 patients are mainly directed against β₂GPI but display an epitope specificity different from antibodies in antiphospholipid syndrome.

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Objective We estimated the incidence and prevalence of depression, anxiety disorder, bipolar disorder, and schizophrenia in a population‐based cohort with rheumatoid arthritis ( RA ) as compared to an age‐, sex‐, and geographically matched cohort without RA . Methods Using population‐based administrative health data from Manitoba, Canada, we identified persons with incident RA between 1989 and 2012, and a cohort from the general population matched 5:1 on year of birth, sex, and region of residence. We applied validated algorithms for depression, anxiety disorder, bipolar disorder, and schizophrenia to determine the annual incidence of these conditions after the diagnosis of RA , and their lifetime and annual period prevalence. We compared findings between cohorts using negative binomial regression models. Results We identified 10,206 incident cases of RA and 50,960 matched individuals. After adjustment for age, sex, socioeconomic status, region of residence, number of physician visits, and year, the incidence of depression was higher in the RA cohort over the study period (incidence rate ratio [ IRR ] 1.46 [95% confidence interval (95% CI ) 1.35–1.58]), as was the incidence of anxiety disorder ( IRR 1.24 [95% CI 1.15–1.34]) and bipolar disorder ( IRR 1.21 [95% CI 1.00–1.47]). The incidence of schizophrenia did not differ between groups ( IRR 0.96 [95% CI 0.61–1.50]). Incidence rates of psychiatric disorders declined minimally over time. The lifetime and annual period prevalence of depression and anxiety disorder were also higher in the RA than in the matched cohort over the study period. Conclusion The incidence and prevalence of depression, anxiety disorder, and bipolar disorder are elevated in the RA population as compared to a matched population.

Objective: Colon cancer (CC) and cardiovascular (CV) diseases are highly coprevalent due to major risk factors common to both conditions. Hypertension is the most frequent comorbidity in oncologic patients with significant incidence of new onset hypertension associated with chemotherapy, leading to worse treatment effects and often being a trigger of related cardiotoxicity. Although blood pressure (BP) control should play an important role in the monitoring of oncologic therapy in patients with CC, available data shows that such patients are frequently overlooked compared to subjects without cancer and, consequently, BP targets are not achieved. Available studies on BP control in CC are very scarce, suffer from imperfect methodology and are limited only to traditional BP measurements. Design and method: On this background we started the registry aimed to gather the information about BP control and levels in newly diagnosed CC patients before and after starting anticancer therapy. In consecutive patients with new CC diagnosis 24-h BP monitoring and traditional BP measurements will be performed at the beginning and after 1 year of standard care. Additionally, clinical data including the type of oncologic therapy and echocardiographic data will be collected. Results: The increasing prevalence of CC diagnosis and improving long term survival imposes the need of adequate cardiovascular monitoring and prevention, including blood pressure assessment and management. At the moment the results of the just started registry are not yet available. Conclusions: In the future we expect that the collected data will provide evidence concerning hypertension prevalence in CC, out-of-office BP control and their correlations to oncologic treatment methods over one year observation. This may favour improved CV risk management in these patients.

<sec> <title>Introduction</title> Several regions in Canada have recently experienced sharp increases in opioid overdoses and related hospitalizations and deaths. This paper describes opioid-related mortality and disability from opioid use disorder in Canada from 1990 to 2014 using data from the Global Burden of Disease (GBD) study. </sec> <sec> <title>Methods</title> We used data from the GBD study to describe temporal trends (1990–2014) in opioid-related mortality and disability from opioid use disorder using common metrics: disability-adjusted life years (DALY), deaths, years of life lost (YLL) and years lived with disability (YLD). We also compared age-standardized YLL and DALY rates per 100 000 population between Canada, the USA and other regions. </sec> <sec> <title>Results</title> The age-standardized opioid-related DALY rate in Canada was 355.5 per 100 000 population in 2014, which was higher than the global rate of 193.2, but lower than the rate of 767.9 in the United States. Between 1990 and 2014, the age-standardized opioid-related YLL rate in Canada increased by 142.2%, while globally this rate decreased by 10.1%. In comparison with YLL, YLD accounted for a larger proportion of the overall opioid-related burden across all age groups. Health loss was greater for males than females, and highest among those aged 25 to 29 years. </sec> <sec> <title>Conclusion</title> The health burden associated with opioid-related mortality and disability from opioid use disorder in Canada is significant and has increased dramatically from 1990 to 2014. These data point to a need for public health action including enhanced monitoring of a range of opioid-related harms. </sec>

The results indicate that there is a gap between recommendations made and the implementation of treatments. However, its size varies substantially across treatments.

Chronic conditions requiring long-term rehabilitation therapies, such as hypertension, stroke, or cancer, involve complex interactions between various systems/organs of the body and mutual influences, thus implicating a multiorgan approach. The dual-flow IVTech LiveBox2 bioreactor is a recently developed inter-connected dynamic cell culture model able to mimic organ crosstalk, since cells belonging to different organs can be connected and grown under flow conditions in a more physiological environment. This study aims to setup for the first time a 2-way connected culture of human neuroblastoma cells, SH-SY5Y, and Human Coronary Artery Smooth Muscle Cells, HCASMC through a dual-flow IVTech LiveBox2 bioreactor, in order to represent a simplified model of nervous-cardiovascular systems crosstalk, possibly relevant for the above-mentioned diseases. The system was tested by treating the cells with 10nM angiotensin II (AngII) inducing PKCβII/HuR/VEGF pathway activation, since AngII and PKCβII/HuR/VEGF pathway are relevant in cardiovascular and neuroscience research. Three different conditions were applied: 1- HCASMC and SH-SY5Y separately seeded in petri dishes (static condition); 2- the two cell lines separately seeded under flow (dynamic condition); 3- the two lines, seeded in dynamic conditions, connected, each maintaining its own medium, with a membrane as interface for biohumoral changes between the two mediums, and then treated. We detected that only in condition 3 there was a synergic AngII-dependent VEGF production in SH-SY5Y cells coupled to an AngII-dependent PKCβII/HuR/VEGF pathway activation in HCASMC, consistent with the observed physiological response in vivo. HCASMC response to AngII seems therefore to be generated by/derived from the reciprocal cell crosstalk under the dynamic inter-connection ensured by the dual flow LiveBox 2 bioreactor. This system can represent a useful tool for studying the crosstalk between organs, helpful for instance in rehabilitation research or when investigating chronic diseases; further, it offers the advantageous opportunity of cultivating each cell line in its own medium, thus mimicking, at least in part, distinct tissue milieu.

In our study, depression was not associated with poor clinical outcomes. However, using the antidepressant mirtazapine was associated with decreased mortality, decompensated cirrhosis and liver transplantation in PBC patients. These findings support further assessment of mirtazapine as a potential treatment for PBC patients.

Overall the PHQ-9 is a valid screening tool for SI in IBD patients, and routine implementation of this tool would support screening for depression and SI effectively and efficiently in clinical practice.