The role of nanosystems in the delivery of glucose-lowering drugs for the preemption and treatment of diabetes-associated atherosclerosis.

Diabetes is one of the most prevalent diseases worldwide. In recent decades, type-2 diabetes has become increasingly common, particularly in younger individuals. Diabetes leads to many vascular complications, including atherosclerosis. Atherosclerosis is a cardiovascular disease characterized by lipid-rich plaques within the vasculature. Plaques develop over time, restricting blood flow, and can, therefore, be the underlying cause of major adverse cardiovascular events, including myocardial infarction and stroke. Diabetes and atherosclerosis are intrinsically linked. Diabetes is a metabolic syndrome that accelerates atherosclerosis and increases the risk of developing other comorbidities, such as diabetes-associated atherosclerosis (DAA). Gold standard antidiabetic medications focus on attenuating hyperglycemia. Though recent evidence suggests that glucose-lowering drugs may have broader applications, beyond diabetes management. This review mainly evaluates the role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as liraglutide and semaglutide in DAA. These drugs mimic gut hormones (incretins), which inhibit glucagon secretion while stimulating insulin secretion, thus improving insulin sensitivity. This facilitates delayed gastric emptying and increased patient satiety; hence, they are also indicated for the treatment of obesity. GLP-1 RAs have significant cardioprotective effects, including decreasing low-density lipoprotein (LDL) cholesterol and triglycerides levels. Liraglutide and semaglutide have specifically been shown to decrease cardiovascular risk. Liraglutide has displayed a myriad of antiatherosclerotic properties, with the potential to induce plaque regression. This review aims to address how glucose-lowering medications can be applied to treat diseases other than diabetes. We specifically focus on how nanomedicines can be used for the site-specific delivery of antidiabetic medicines for the treatment of diabetes-associated atherosclerosis.

Feasibility and acceptability of the use of flash glucose monitoring encountered by Indigenous Australians with type 2 diabetes mellitus: initial experiences from a pilot study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is highly prevalent within the Indigenous Australian community. Novel glucose monitoring technology offers an accurate approach to glycaemic management, providing real-time information on glucose levels and trends. The acceptability and feasibilility of this technology in Indigenous Australians with T2DM has not been investigated. OBJECTIVE: This feasibility phenomenological study aims to understand the experiences of Indigenous Australians with T2DM using flash glucose monitoring (FGM). METHODS: Indigenous Australians with T2DM receiving injectable therapy (n = 8) who used FGM (Abbott Freestyle Libre) for 6-months, as part of a clinical trial, participated in semi-structured interviews. Thematic analysis of the interviews was performed using NVivo12 Plus qualitative data analysis software (QSR International). RESULTS: Six major themes emerged: 1) FGM was highly acceptable to the individual; 2) FGM's convenience was its biggest benefit; 3) data from FGM was a tool to modify lifestyle choices; 4) FGM needed to be complemented with health professional support; 5) FGM can be a tool to engage communities in diabetes management; and 6) cost of the device is a barrier to future use. CONCLUSIONS: Indigenous Australians with T2DM had positive experiences with FGM. This study highlights future steps to ensure likelihood of FGM is acceptable and effective within the wider Indigenous Australian community.

Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis.

OBJECTIVE: Pandemics negatively impact healthcare workers' (HCW's) mental health and well-being causing additional feelings of anxiety, depression, moral distress and post-traumatic stress. A comprehensive review and evidence synthesis of HCW's mental health and well-being interventions through pandemics reporting mental health outcomes was conducted addressing two questions: (1) What mental health support interventions have been reported in recent pandemics, and have they been effective in improving the mental health and well-being of HCWs? (2) Have any mobile apps been designed and implemented to support HCWs' mental health and well-being during pandemics? DESIGN: A narrative evidence synthesis was conducted using Cochrane criteria for synthesising and presenting findings when systematic review and pooling data for statistical analysis are not suitable due to the heterogeneity of the studies. DATA SOURCES: Evidence summary resources, bibliographic databases, grey literature sources, clinical trial registries and protocol registries were searched. ELIGIBILITY CRITERIA: Subject heading terms and keywords covering three key concepts were searched: SARS-CoV-2 coronavirus (or similar infectious diseases) epidemics, health workforce and mental health support interventions. Searches were limited to English-language items published from 1 January 2000 to 14 June 2022. No publication-type limit was used. DATA EXTRACTION AND SYNTHESIS: Two authors determined eligibility and extracted data from identified manuscripts. Data was synthesised into tables and refined by coauthors. RESULTS: 2694 studies were identified and 27 papers were included. Interventions were directed at individuals and/or organisations and most were COVID-19 focused. Interventions had some positive impacts on HCW's mental health and well-being, but variable study quality, low sample sizes and lack of control conditions were limitations. Two mobile apps were identified with mixed outcomes. CONCLUSION: HCW interventions were rapidly designed and implemented with few comprehensively described or evaluated. Tailored interventions that respond to HCWs' needs using experience co-design for mental health and well-being are required with process and outcome evaluation.

Mechanical thrombectomy for perioperative ischemic stroke following elective inpatient surgery in the United States.

Perioperative ischemic stroke significantly increases morbidity and mortality in patients undergoing elective surgery. Mechanical thrombectomy can improve ischemic stroke outcomes, but frequency and trend of its utilization for treatment of perioperative ischemic stroke is not studied. We identified adults who underwent elective inpatient surgery from 2008 to 2018 and suffered from a perioperative ischemic stroke from the Premier Healthcare Database. The difference in mechanical thrombectomy usage before and after the updated recommendation inacute stroke guidelines was assessed in a univariate analysis using a chi-squared test. A segmented regression model was created to assess the change in rate over time.Of 6,349,668 patients with elective inpatient surgery, 12,507 (0.2%) had perioperative ischemic stroke. Mean age (and standard deviation) was 69.5 (11.7) years, and 48.8% were female. Mechanical thrombectomy was used in 1.7% patients and its use increased from 0.0% in 3rd quarter, 2008 to 4.4% in 4th quarter, 2018. Significant increase in the use of mechanical thrombectomy was seen after 3rd quarter, 2015 when its use was incorporated in acute stroke treatment guideline (1.14% before 3rd quarter, 2015 versus 3.07% after; p < 0.0001). Amongst patients with perioperative ischemic stroke, patients who received mechanical thrombectomy were more likely to have their surgery performed at a teaching institute (67.3% versus 53.9%). Although a significant increase in rates of utilization of mechanical thrombectomy was observed, rates of utilization remain low, especially in non-teaching hospitals. This highlights improvements in the management of perioperative ischemic strokes and further opportunities to improve outcomes.

The Role of the Intestinal Epithelium in the "Weep and Sweep" Response during Gastro-Intestinal Helminth Infections.

Helminths are metazoan parasites infecting around 1.5 billion people all over the world. During coevolution with hosts, worms have developed numerous ways to trick and evade the host immune response, and because of their size, they cannot be internalized and killed by immune cells in the same way as bacteria or viruses. During infection, a substantial Th2 component to the immune response is evoked which helps restrain Th1-mediated tissue damage. Although an enhanced Th2 response is often not enough to kill the parasite and terminate an infection in itself, when tightly coordinated with the nervous, endocrine, and motor systems it can dislodge parasites from tissues and expel them from the gut. A significant role in this "weep and seep" response is attributed to intestinal epithelial cells (IEC). This review highlights the role of various IEC lineages (enterocytes, tuft cells, Paneth cells, microfold cells, goblet cells, and intestine stem cells) during the course of helminth infections and summarizes their roles in regulating gut architecture and permeability, and muscle contractions and interactions with the immune and nervous system.

Is chronic ankle instability associated with impaired muscle strength? Ankle, knee and hip muscle strength in individuals with chronic ankle instability: a systematic review with meta-analysis.

OBJECTIVE: Determine whether impairments in lower limb muscle strength exist in individuals with chronic ankle instability (CAI) compared with uninjured controls. DESIGN: Systematic review with meta-analysis. DATA SOURCE: A comprehensive search of PubMed, Cochrane, CINAHL, Web of Science and EMBASE electronic databases from inception to 10 February 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Cross-sectional and case-control studies were included if they objectively measured lower limb muscle strength in individuals with CAI compared with controls. Risk of bias and quality of included studies were assessed. Data of included studies were extracted, and meta-analysis was conducted where appropriate. RESULTS: 12 397 unique studies were identified, of which 20 were included and 16 were eligible for meta-analysis. Reviewed studies clearly described the aim/hypothesis and main outcome measure, but most lacked sample size calculation and assessor blinding. Meta-analyses showed individuals with CAI had lower eccentric and concentric evertor strength (30 and 120°/s; Nm; standardised mean difference (SMD) between -0.73 and -0.95), eccentric invertor strength (60 and 120°/s; both Nm and Nm/kg; SMD between -0.61 and -1.37), concentric invertor strength (60 and 120°/s; Nm; SMD=-0.7) and concentric knee extensor strength (SMD=-0.64) compared with control participants. Ankle eccentric dorsiflexor strength was not different between groups. Although pooling was not possible, data from three separate studies indicated that hip flexor, abductor and external rotator strength, but not hip adductor and extensor strength, was lower in individuals with CAI than in control participants. CONCLUSION: Individuals with CAI have ankle inversion and eversion strength deficits. Our data also point to differences between individuals with CAI and controls in hip and knee strength. These elements of the kinetic chain should be evaluated by clinicians who rehabilitate individuals with CAI. PROSPERO REGISTRATION NUMBER: CRD42016037759.

Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy.

PURPOSE: This study aimed to investigate the effect of unsupervised isometric exercise compared with a wait-and-see approach on pain, disability, global improvement, and pain-free grip strength in individuals with lateral elbow tendinopathy. METHODS: Forty participants with unilateral lateral elbow tendinopathy of at least 6 wk duration were randomized to either wait-and-see (n = 19) or a single supervised instruction session by a physiotherapist, followed by an 8-wk unsupervised daily program of progressive isometric exercise (n = 21). Primary outcomes were Patient-Rated Tennis Elbow Evaluation, global rating of change on a six-point scale (dichotomized to success and no success) and pain-free grip strength at 8 wk. Secondary outcomes were resting and worst pain on an 11-point numerical rating scale, and thermal and pressure pain thresholds as a measure of pain sensitivity. RESULTS: Thirty-nine (98%) participants completed 8-wk measurements. The exercise group had lower Patient-Rated Tennis Elbow Evaluation scores compared with wait-and-see at 8 wk (standardized mean difference [SMD], -0.92; 95% confidence interval [CI], -1.58 to -0.26). No group differences were found for success on global rating of change (29% exercise vs 26% wait-and-see (risk difference, 2.3%; 95% CI, -24.5 to 29.1)), or pain-free grip strength (SMD, -0.33; 95% CI, -0.97 to 0.30). No differences were observed for all secondary outcomes except for worst pain, which was moderately lower in the exercise group (SMD, -0.80; 95% CI, -1.45 to -0.14). CONCLUSIONS: Unsupervised isometric exercise was effective in improving pain and disability, but not perceived rating of change and pain-free grip strength when compared with wait-and-see at 8 wk. With only one of the three primary outcomes being significantly different after isometric exercises, it is doubtful if this form of exercise is efficacious as a sole treatment.

Cholinesterase as an inflammatory marker of subclinical infection of dairy cows infected by Neospora caninum and risk factors for disease.

The aim of this study was to evaluate the seroprevalence of Neospora caninum in dairy cows, as well as to verify the risk factors for N. caninum infection and inflammatory response in dairy cows. Using the indirect immunofluorescence reaction, the seroprevalence of neosporosis was determined to be 32.82%. Based on regression analysis, the presence of dogs at a farm increased the probability of a cow testing positive for N. caninum (OR = 20.01 [5.21-123.12]). These data suggest that N. caninum has a relevant prevalence in dairy cows of the Microregion of Rio do Sul (Brazil), with elevated frequencies of anti-N. caninum IgG. The data also suggest that the parasite is widely distributed in dairy herds of the micro-region, because 94.4% of properties screened had at least one seropositive animal. The principal risk factors for disease maintenance in herds may be considered the presence of dogs and absence of a diagnostic test when introducing new animals. Blood from these cows was used to measure variables related to the inflammatory response. Serum cholinesterase activity, as well as serum levels of globulins and C-reactive protein were higher in seropositive to N. caninum than in seronegative cows. Furthermore, the infection by parasite causes an intense inflammatory process, contributing to disease pathophysiology.

Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels.

BACKGROUND: Peripheral low-grade inflammation in depression is increasingly seen as a therapeutic target. We aimed to establish the prevalence of low-grade inflammation in depression, using different C-reactive protein (CRP) levels, through a systematic literature review and meta-analysis. METHODS: We searched the PubMed database from its inception to July 2018, and selected studies that assessed depression using a validated tool/scale, and allowed the calculation of the proportion of patients with low-grade inflammation (CRP >3 mg/L) or elevated CRP (>1 mg/L). RESULTS: After quality assessment, 37 studies comprising 13 541 depressed patients and 155 728 controls were included. Based on the meta-analysis of 30 studies, the prevalence of low-grade inflammation (CRP >3 mg/L) in depression was 27% (95% CI 21-34%); this prevalence was not associated with sample source (inpatient, outpatient or population-based), antidepressant treatment, participant age, BMI or ethnicity. Based on the meta-analysis of 17 studies of depression and matched healthy controls, the odds ratio for low-grade inflammation in depression was 1.46 (95% CI 1.22-1.75). The prevalence of elevated CRP (>1 mg/L) in depression was 58% (95% CI 47-69%), and the meta-analytic odds ratio for elevated CRP in depression compared with controls was 1.47 (95% CI 1.18-1.82). CONCLUSIONS: About a quarter of patients with depression show evidence of low-grade inflammation, and over half of patients show mildly elevated CRP levels. There are significant differences in the prevalence of low-grade inflammation between patients and matched healthy controls. These findings suggest that inflammation could be relevant to a large number of patients with depression.

Fasciola Hepatica Isolates Induce Different Immune Responses in Unmaturated Bovine Macrophages.

INTRODUCTION: Fasciola hepatica (liver fluke) is a parasite of great socioeconomic importance. A number of fluke isolates have been identified; however, to date the differences between the immunomodulatory properties of different parasite isolates have not been sufficiently investigated. The aim of this study was to explore differences between the immunomodulatory properties of two F. hepatica isolates using unmaturated bovine macrophages. MATERIAL AND METHODS: A cell line of bovine macrophages was stimulated with excretory/secretory products released by adult flukes from either a laboratory (Fh-WeyES) or wild (Fh-WildES) strain and subsequently subjected to microarray and ELISA analyses. Results: Both Fh-WeyES and Fh-WildES dampened the release of interleukin-10 by bovine macrophages, but only Fh-WildES dampened the release of proinflammatory tumour necrosis factor-α. Microarray analysis revealed that Fh-WildES down- and upregulated 90 and 18 genes, respectively, when compared to Fh-WeyES. CONCLUSION: The results indicated different impacts of the isolates on macrophages. A number of researchers use flukes obtained from local slaughterhouses for experiments. Our findings may explain some discrepancies between published results arising from parasite strain choice. The findings indicate that consideration should be given to the use of different strains, and open new and currently unexplored avenues in parasitology for controlling the parasite.

A Peninsular Structure Coordinates Asynchronous Differentiation with Morphogenesis to Generate Pancreatic Islets.

The pancreatic islets of Langerhans regulate glucose homeostasis. The loss of insulin-producing ß cells within islets results in diabetes, and islet transplantation from cadaveric donors can cure the disease. In vitro production of whole islets, not just ß cells, will benefit from a better understanding of endocrine differentiation and islet morphogenesis. We used single-cell mRNA sequencing to obtain a detailed description of pancreatic islet development. Contrary to the prevailing dogma, we find islet morphology and endocrine differentiation to be directly related. As endocrine progenitors differentiate, they migrate in cohesion and form bud-like islet precursors, or "peninsulas" (literally "almost islands"). α cells, the first to develop, constitute the peninsular outer layer, and ß cells form later, beneath them. This spatiotemporal collinearity leads to the typical core-mantle architecture of the mature, spherical islet. Finally, we induce peninsula-like structures in differentiating human embryonic stem cells, laying the ground for the generation of entire islets in vitro.

Excretory/secretory products from two Fasciola hepatica isolates induce different transcriptional changes and IL-10 release in LPS-activated bovine "BOMA" macrophages.

Fasciola hepatica are trematodes that reside in the bile ducts of mammals. Infection causes US$3 billion in losses annually in animal production and is considered a zoonosis of growing importance. An under-represented area in F. hepatica research has been the examination of the different immunomodulatory abilities of various parasite isolates on the host immune system. In this paper, this issue was explored, with the bovine macrophage cell line "BOMA". The cells were matured by LPS treatment and stimulated with excretory/secretory antigens (ES) from two Fasciola hepatica isolates: a laboratory isolate "Weybridge" (Fh-WeyES) and a wild isolate (Fh-WildES). As expected, stimulation with antigen mixtures with highly similar compositions resulted in mild transcriptomic differences. However, there were significant differences in cytokine levels. Compared to Fh-WeyES, exposure to Fh-WildES upregulated 27 and downregulated 30 genes. Fh-ES from both isolates diminished the release of TNF-α, whereas only Fh-WildES decreased IL-10 secretion. Neither Fh-WeyES nor Fh-WildES had an impact on IL-12 release. Our results indicate that various isolates can have different immunomodulatory abilities and impacts on the bovine immune system.

Outcomes in adult congenital heart disease patients undergoing heart transplantation: A systematic review and meta-analysis.

BACKGROUND: Studies assessing mortality and morbidity in adult transplant recipients with congenital heart disease (CHD) are limited. We conducted a systematic review and meta-analysis comparing post-transplant outcomes in these 2 populations. METHODS: After conducting an electronic database search, we selected studies evaluating mortality, cause-specific mortality, and risk of reoperation and dialysis in adult CHD vs non-CHD patients. We used random-effects models for the meta-analysis. RESULTS: Thirty-day mortality was significantly higher in CHD vs non-CHD patients (risk ratio [RR], 2.18; 95% confidence interval [CI], 1.62-2.93; I2 = 41%). This was influenced by increased mortality in Fontan/Glenn patients compared with non-CHD patients (RR, 3.3; 95% CI, 1.89-5.77; I2 = 0%). Mortality at 1 and 5 years was higher in the CHD population, although neither achieved statistical significance. Ten-year mortality was significantly lower in CHD patients (RR, 0.75; 95% CI, 0.60-0.95, I2 = 42%). Deaths caused by malignancy, infection, rejection, and cardiac allograft vasculopathy were decreased in CHD patients, although only death from malignancy achieved significance. Death secondary to primary graft failure, stroke, and hemorrhage was significantly higher in CHD patients. Risk of reoperation and dialysis were not statistically different between the 2 groups. CONCLUSIONS: Although adult CHD patients have higher early mortality, post-transplantation long-term survival is superior to non-CHD recipients. The challenge is to identify the CHD patients who will benefit from transplantation vs those who are higher risk.

Is synergistic organisation of muscle coordination altered in people with lateral epicondylalgia? A case-control study.

BACKGROUND: Lateral epicondylalgia is a common musculoskeletal disorder and is associated with deficits in the motor system including painful grip. This study compared coordination of forearm muscles (muscle synergies) during repeated gripping between individuals with and without lateral epicondylalgia. METHODS: Twelve participants with lateral epicondylalgia and 14 controls performed 15 cyclical repetitions of sub-maximal (20% maximum grip force of asymptomatic arm), pain free dynamic gripping in four arm positions: shoulder neutral with elbow flexed to 90° and shoulder flexed to 90° with elbow extended both with forearm pronated and neutral. Muscle activity was recorded from extensor carpi radialis brevis/longus, extensor digitorum, flexor digitorum superficialis/profundus, and flexor carpi radialis, with intramuscular electrodes. Muscle synergies were extracted using non-negative matrix factorisation. FINDINGS: Analysis of each position and participant, demonstrated that two muscle synergies accounted for >97% of the variance for both groups. Between-group differences were identified after electromyography patterns of the control group were used to reconstruct the patterns of the lateral epicondylalgia group. A greater variance accounted for was identified for the controls than lateral epicondylalgia (p=0.009). This difference might be explained by an additional burst of flexor digitorum superficialis electromyography during grip release in many lateral epicondylalgia participants. INTERPRETATION: These data provide evidence of some differences in synergistic organisation of activation of forearm muscles between individuals with and without lateral epicondylalgia. Due to study design it is not possible to elucidate whether changes in the coordination of muscle activity during gripping are associated with the cause or effect of lateral epicondylalgia.

Improving the understanding of the link between cognition and functional capacity in schizophrenia and bipolar disorder.

OBJECTIVE: Deficits in cognitive functioning are related to functional disability in people with serious mental illness. Measures of functional capacity are commonly used as a proxy for functional disabilities for cognitive remediation programs, and robust linear relationships between functional capacity and cognitive deficits are frequently observed. This study aimed to determine whether a curvilinear relationship better approximates the association between cognitive functioning and functional capacity. METHOD: Two independent samples were studied. Study 1: participants with schizophrenia (n=435) and bipolar disorder (n=390) aged 18-83 completed a neuropsychological battery and a performance-based measure of functional capacity. Study 2: 205 participants with schizophrenia (age range=39-72) completed a brief neuropsychological screening battery and a performance-based measure of functional capacity. For both studies, linear and quadratic curve estimations were conducted with cognitive performance predicting functional capacity scores. RESULTS: Significant linear and quadratic trends were observed for both studies. Study 1: in both the schizophrenia and bipolar participants, when cognitive composite z-scores were >0 (indicating normal to above normal performance), cognition was not related to functional capacity. Study 2: when neuropsychological screening battery z-scores were >-1 (indicating low average to average performance), cognition was not related to functional capacity. CONCLUSIONS: These results illustrate that in cognitively normal adults with serious mental illness, the relationship between cognitive function and functional capacity is relatively weak. These findings may aid clinicians and researchers determine who may optimally benefit from cognitive remediation programs, with greater benefits possibly being achieved for individuals with cognitive deficits relative to individuals with normal cognition.

Diagnostic ultrasound imaging for lateral epicondylalgia: a case-control study.

INTRODUCTION: Lateral epicondylalgia (LE) is clinically diagnosed as pain over the lateral elbow that is provoked by gripping. Usually, LE responds well to conservative intervention; however, those who fail such treatment require further evaluation, including musculoskeletal ultrasound. Previous studies of musculoskeletal ultrasound have methodological flaws, such as lack of assessor blinding and failure to control for participant age, sex, and arm dominance. The purpose of this study was to assess the diagnostic use of blinded ultrasound imaging in people with clinically diagnosed LE compared with that in a control group matched for age, sex, and arm dominance. METHODS: Participants (30 with LE and 30 controls) underwent clinical examination as the criterion standard test. Unilateral LE was defined as pain over the lateral epicondyle, which was provoked by palpation, resisted wrist and finger extension, and gripping. Controls without symptoms were matched for age, sex, and arm dominance. Ultrasound investigations were performed by two sonographers using a standardized protocol. Grayscale images were assessed for signs of tendon pathology and rated on a four-point ordinal scale. Power Doppler was used to assess neovascularity and rated on a five-point ordinal scale. RESULTS: The combination of grayscale and power Doppler imaging revealed an overall sensitivity of 90% and specificity of 47%. The positive and negative likelihood ratios for combined grayscale and power Doppler imaging were 1.69 and 0.21, respectively. CONCLUSIONS: Although ultrasound imaging helps confirm the absence of LE, when findings are negative for tendinopathic changes, the high prevalence of tendinopathic changes in pain-free controls challenges the specificity of the measure. The validity of ultrasound imaging to confirm tendon pathology in clinically diagnosed LE requires further study with strong methodology.

Association of obesity and treated hypertension and diabetes with cognitive ability in bipolar disorder and schizophrenia.

OBJECTIVES: People with bipolar disorder or schizophrenia are at greater risk for obesity and other cardio-metabolic risk factors, and several prior studies have linked these risk factors to poorer cognitive ability. In a large ethnically homogenous outpatient sample, we examined associations among variables related to obesity, treated hypertension and/or diabetes and cognitive abilities in these two patient populations. METHODS: In a study cohort of outpatients with either bipolar disorder (n = 341) or schizophrenia (n = 417), we investigated the association of self-reported body mass index and current use of medications for hypertension or diabetes with performance on a comprehensive neurocognitive battery. We examined sociodemographic and clinical factors as potential covariates. RESULTS: Patients with bipolar disorder were less likely to be overweight or obese than patients with schizophrenia, and also less likely to be prescribed medication for hypertension or diabetes. However, obesity and treated hypertension were associated with worse global cognitive ability in bipolar disorder (as well as with poorer performance on individual tests of processing speed, reasoning/problem-solving, and sustained attention), with no such relationships observed in schizophrenia. Obesity was not associated with symptom severity in either group. CONCLUSIONS: Although less prevalent in bipolar disorder compared to schizophrenia, obesity was associated with substantially worse cognitive performance in bipolar disorder. This association was independent of symptom severity and not present in schizophrenia. Better understanding of the mechanisms and management of obesity may aid in efforts to preserve cognitive health in bipolar disorder.

Aqueous calcium sulphate as bone graft for voids following open curettage of bone tumours.

INTRODUCTION: Reported strategies for void filling in bone include autograft, allograft, synthetic bone substitutes or various combinations of these materials, but poor response rates and donor morbidity have created a desire to find a better option. Calcium sulphate as a stand-alone graft material reconstruct bone following curettage has not been previously reported. The purpose of this study was to assess the efficacy and radiological quality of healing, the time to healing, the functional outcomes and the complications following curettage and grafting using an injectable aqueous calcium sulphate (BonePlast; Biomet, Warsaw, IN, USA) as the sole grafting strategy. METHODS: The procedure of curettage and grafting with an aqueous solution of calcium sulphate was undertaken. The patients were regularly reviewed clinically and radiologically for a minimum of 12 months (range: 12-85 months). Forty-six procedures in 46 patients were reviewed. Radiological outcomes of healing were established and functional outcomes were obtained from each patient at annual follow-up review. RESULTS: A complete response was seen in 38 patients (83%) at a median of 6 months following the procedure (range: 1-24 months). Seven patients (15%) displayed only a partial response after a median of 13 months post-surgery (range: 12-53 months). There was one non-response to treatment (2%) after 40 months of follow-up. The mean functional score was 99%. DISCUSSION: Aqueous calcium sulphate as a sole grafting agent for void management after curettage simplifies current treatment practices and displays good bone reconstruction in a comparatively short time frame, with excellent functional results and acceptable complication rates in the setting of tumour surgery.

Determinants of occupational and residential functioning in bipolar disorder.

BACKGROUND: Bipolar disorder is associated with reduced rates of employment and residential independence. The influence of cognitive impairment and affective symptoms on these functional attainments has received little previous attention and is the focus of this study. METHOD: A total of 229 adult outpatients with bipolar disorder without active substance use disorders and with an average of mild severity of affective symptoms were included in the analyses. After adjusting for sociodemographic and illness history covariates, univariate and multivariate analyses were used to evaluate the independent and interactive associations of neurocognitive ability, performance-based functional capacity, and affective symptom severity with residential independence, occupational status and number of hours worked. RESULTS: A total of 30% of the sample was unemployed and 18% was not independently residing. Neurocognitive ability was the strongest predictor of any employment, but depressive symptom severity was the only variable significantly related to hours worked. The strongest predictor of residential independence was performance-based functional capacity. Affective symptoms and neurocognitive ability were independent (non-interactive) predictors of occupational and residential status. LIMITATIONS: This is a cross-sectional study and thus causal direction among variables is unknown. The sample was ethnically homogeneous and thus the results may not generalize to ethnically diverse samples. CONCLUSIONS: This study confirmed elevated rates of unemployment and residential non-independence in adults with bipolar disorder. Interventions targeting cognitive deficits and functional capacity may increase the likelihood of any employment or residential independence, respectively. Interventions targeting depressive symptoms may be most influential on work outcomes among those already employed.