Associations of state-level rates of depression and fatal opioid overdose in the United States, 2011-2015.

PURPOSE: To assess the relationship between state-level depression and opioid overdose deaths between 2011 and 2015 in the United States. METHODS: We assessed the association between percent of state populations reporting depression diagnoses and number of opioid analgesic-related deaths using negative binomial generalized estimating equations. RESULTS: A 1% point increase in state-level depression diagnoses was associated with a 26% (95% CI 1-58%) increase in opioid analgesic-related deaths. CONCLUSIONS: Addressing depression in the provider-patient relationship may be important, as may be addressing the mental health provider shortage in the United States.

IL-6 in spinal cord injury: could immunomodulation replace immunosuppression in the management of acute traumatic spinal cord injuries?

Traumatic spinal cord injuries (SCI) result in devastating impairment to an individual's functional ability. The pathophysiology of SCI is related to primary injury but further propagated by secondary reactions to injury, such as inflammation and oxidation. The inflammatory and oxidative cascades ultimately cause demyelination and Wallerian degeneration. Currently, no treatments are available to treat primary or secondary injury in SCI, but some studies have shown promising results by lessening secondary mechanisms of injury. Interleukins (ILs) have been described as key players in the inflammation cascade after neuronal injury; however, their role and possible inhibition in the context of acute traumatic SCIs have not been widely studied. Here, we review the relationship between SCI and IL-6 concentrations in the CSF and serum of individuals after traumatic SCIs. Furthermore, we explore the dual IL-6 signaling pathways and their relevance for future IL-6 targeted therapies in SCI.

A need to tailor surveillance based on family history: describing a highly penetrant familial paraganglioma kindred with an SDHD pathogenic variant.

Pathogenic variants (PVs) in the SDHD gene increase risk for paragangliomas (PGL)/pheochromocytomas, renal cell carcinomas, and gastrointestinal stromal tumors. Penetrance in individuals with SDHD PVs varies in reported research from 40-70%, and there is limited evidence of specific genotype risks. This study aims to characterize a multi-generational family with SDHD p.Trp43* PVs and potential genotype-phenotype considerations for surveillance. Individuals with a paternally inherited SDHD p.Trp43*(c.129G > A) PV were identified. Genetic, medical and family histories were abstracted, including clinical characteristics, tumor histories, and treatment approaches. Eleven individuals with the SDHD PV in the same kindred were diagnosed with 41 SDHx-related tumors across all family members. Eight individuals developed 27 head and neck PGL of varying origins, and seven individuals developed tumors outside of the head and neck region. Many individuals had multiple tumors, and age of first tumor diagnosis ranged from age 10 to age 45 years old. Individuals with SDHD p.Trp43* variants may have higher risks for SDHx related tumors than other SDHD variants. Prioritizing identification of at-risk individuals and initiating surveillance tailored to family history is recommended given the rate of multiple tumors found in one familial branch of individuals under 18 years old. Individuals with strong family histories of PGL at young ages with this PV will benefit from tailored surveillance recommendations.

One man's swordfish story: The link between Alzheimer's disease and mercury exposure.

It is well-documented that when mercury levels surpass the permissible value, individuals experience a myriad of symptoms that include chronic fatigue, dizziness, and loss of appetite. Mercury is also known to be one of the most potent neurotoxins. This case study depicts a 91- year-old who presented with cognitive decline diagnosed as Alzheimer's disease. This patient was found to have severely elevated mercury levels caused by consuming high mercury containing fish. Following diet adjustment and detoxification, this patient's cognitive impairment significantly improved in proportion to the decline in methylmercury level. One year later, his cognition and functional status rapidly and unexpectedly declined. A computed tomography (CT) scan revealed multiple new lacunar subacute strokes. Thus, it is critical to address biological etiologies such as mercury toxicity in the elderly population diagnosed with Alzheimer's, but end organ damage may not be reversible.