Rivastigmine reduces “likely to use methamphetamine” in methamphetamine-dependent volunteers

We previously reported that treatment with the cholinesterase inhibitor rivastigmine (3 mg, PO for 5 days) significantly attenuated “Desire for METH”. Given that higher dosages of rivastigmine produce greater increases in synaptic ACh, we predicted that 6 mg should have more pronounced effects on craving and other subjective measures. In the current study, we sought to characterize the effects of short-term exposure to rivastigmine (0, 3 or 6 mg) on the subjective and reinforcing effects produced by administration of methamphetamine (METH) in non-treatment-seeking, METH-dependent volunteers. This was a double-blind, placebo-controlled, crossover study. Participants received METH on day 1, and were then randomized to placebo or rivastigmine on day 2 in the morning and treatment continued through day 8. METH dosing was repeated on day 6. The data indicate that METH (15 and 30 mg), but not saline, increased several positive subjective effects, including “Any Drug Effect”, “High”, “Stimulated”, “Desire METH”, and “Likely to Use METH” (all p's < 0.0001). In addition, during self-administration sessions, participants were significantly more likely to choose METH over saline (p < 0.0001). Evaluating outcomes as peak effects, there was a trend for rivastigmine to reduce “Desire METH” (p = 0.27), and rivastigmine significantly attenuated “Likely to Use METH” (p = 0.01). These effects were most prominent for rivastigmine 6 mg when participants were exposed to the low dose (15 mg, IV), but not high dose (30 mg, IV), of METH. The self-administration data reveal that rivastigmine did not alter total choices for METH (5 mg, IV/choice). Overall, the results indicate some efficacy for rivastigmine in attenuating key subjective effects produced by METH, though additional research using higher doses and longer treatment periods is likely needed. These data extend previous findings and indicate that cholinesterase inhibitors, and other drugs that target acetylcholine systems, warrant continued consideration as treatments for METH dependence.     

Risk factors for failure of limb salvage among veterans with foot ulcers

BackgroundThere is limited available information to guide early discussions involving limb salvage for patients with non-traumatic foot ulcers. We hypothesized patient, wound and treatment factors identifiable at initial operative treatment would be associated with failure of attempted limb salvage.MethodsWe retrospectively assessed United States military veterans treated operatively for non-traumatic foot ulcers at a Veteran’s Administration (VA) hospital from 2008 to 2018. Cox proportional hazard analysis assessed for independent associations with eventual above ankle amputation.ResultsLimb salvage failed for 52 of 461 patients (11.0%). Univariable associations included initial wound area ≥1 cm (p < .001), immediate TMA (p < .001), diagnosis of PVD (p < .001) or diabetes (p = .005), nonpalpable pulse (p = .006), CKD (p = .023), creatine ≥ 1.5 (p = .004), and HgA1c ≥ 6.2 (p < .001). Independent associations consisted of initial wound area ≥1 cm (HR 6.0, 95% CI 1.4–25.1, p = .014), immediate TMA (HR 3.5, 95% CI 1.9–6.4, p < .001), and PVD (HR 3.5, 95% CI 1.6–7.5, p = .001). When <2 risk factors were present, 99.1% and 96.8% retained their hindfoot at 5 and 10 years, respectively. However, this decreased to 87.3% and 80.1% with two risk factors and fell to 63.3% and 43.3% with three risk factors.ConclusionFailure of limb salvage was increasingly likely as the number of identified independent risk factors increased. These results may assist in prognostication and shared decision making between patients and providers.Level of evidencePrognostic, Level III.     

Frequency of Surveillance and Impact of Surveillance Colonoscopies in Patients With Ulcerative Colitis Who Developed Colorectal Cancer

Background

The risk of developing colorectal cancer (CRC) in patients with chronic ulcerative colitis (UC) is increased. The aim of this study was to evaluate if patients who developed CRC in the setting of UC were undergoing guideline-recommended surveillance colonoscopies and to determine the impact of surveillance on the staging of CRC.

A review of Agent Orange and its associated oncologic risk of genitourinary cancers

Agent Orange is an herbicide sprayed widely in Vietnam that is linked to a variety of malignancies in as early as 1991.Since then, there has been concern for, and subsequent interest in studying, the potential connection between Agent Orange and other malignancies. In the past 2 decades, there have been significant changes in the opinion of the National Academy of Science regarding Agent Orange and certain genitourinary malignancies. Herein, we review the literature regarding the potential link between Agent Orange and various urological cancers, including prostate, bladder, testicular, and renal cancers.     

美国“百万老兵计划”大数据管理及其启示

通过网络调查法和文献调查法对美国“百万老兵计划”(Million Veteran Program,MVP)大数据管理实践的调研,归纳了“百万老兵计划”多来源、多类型大数据管理实践的具体内容,包括大规模数据采集、数据管理组织结构、数据集成平台、数据隐私与安全4个方面,并从设置合理组织管理构架、实施数据流程规范管理、搭建数据管理平台系统、重视个人数据隐私保护、实现数据安全多级管控等5个方面总结分析了其对我国精准医学大数据管理的启示。     

Startle amplitude during unpleasant pictures is greater in veterans with a history of multiple‐suicide attempts and predicts a future suicide attempt

Recent studies demonstrate that veterans exhibit higher suicide risk compared with the general U.S. population. A prior suicide attempt is a well‐documented predictor of suicide death. Despite increased attention to clinical risk factors of suicide and efforts to develop psychosocial interventions to reduce suicide risk, the underlying biological factors that confer this risk are not well understood. This study examined affect‐modulated startle (AMS) during a series of intermixed unpleasant, neutral, and pleasant pictures in a sample of 108 demographically‐matched veterans at low (passive ideators: n = 26) and high risk (active ideators: n = 29; single attempters: n = 28; and multiple attempters: n = 25) for suicide based on the Columbia Suicide Severity Rating Scale. An exploratory aim involved a longitudinal component in a subset of the high‐risk sample that went on to participate in a randomized 6‐month clinical trial. We investigated whether baseline AMS predicts a subsequent suicide attempt at 12‐month follow‐up. Compared with the other three groups, multiple attempters showed greater startle potentiation during unpleasant pictures and deficient overall startle habituation from early to later trials. The groups did not differ in startle during neutral or pleasant pictures, or self‐reported picture valence. Greater startle during unpleasant pictures was associated with greater emotion dysregulation as measured by the Difficulties in Emotion Regulation Scale and a future suicide attempt assessed prospectively at 12‐month follow‐up. These findings suggest that startle potentiation during unpleasant pictures in multiple‐suicide attempters is a promising psychophysiological biomarker of suicide risk and underscore the clinical importance of targeting emotion dysregulation in the treatment of patients at‐risk for suicide.     

Coronary artery disease in athletes: An adverse effect of intense exercise?

Regular physical exercise is responsible for various health benefits, and is recommended for primary and secondary cardiovascular (CV) prevention. Despite these recognized benefits, various clinical events can occur in athletes, including acute myocardial infarction and sudden cardiac death (SCD); the main cause of SCD in veteran athletes is coronary artery disease (CAD). The relationship between intense exercise training and CAD is controversial, and a U-shaped association has been hypothesized. If this is the case, screening for subclinical CAD in older athletes may be justified, and various different methodologies have been proposed. However, the methodology for screening veteran athletes is not consensual, and several markers of CAD, in addition to clinical CV risk factors, could improve risk stratification in this population. In the present paper we review the published data on CAD in athletes, focusing on the relationship between the dose of exercise and CAD, as well as the implications for pre-participation screening of veteran athletes.     

慢性支气管炎对离退休干部生活功能的影响

目的　探讨驻皖部队离退休干部中慢性支气管炎的发病和对日常生活功能的影响 ,为其生活质量的改善提供科学依据。方法　采用问卷调查和体格检查相结合的方法随机调查驻皖部队离退休干部 767例。结果　 767例中有 2 3 9例患有慢性支气管炎 ,占 3 1.16% ,位于其调查的老年慢性疾病患病率的第 5位 ,且慢性支气管炎患者的日常生活功能损伤较对照组显著 (P <0 .0 1)。调查者的年龄、吸烟状况、睡眠时间、文化程度及娱乐活动等与老年慢性支气管炎的发病密切相关。结论　慢性支气管炎对老年人日常生活功能的损害较严重 ,普及健康教育及改变生活习性有利于提高患者的生活质量。     

住院退伍军人精神分裂症患者生存质量调查研究

目的 探讨住院退伍军人精神分裂症患者的生存质量及相关影响因素.方法 采用MOS健康状况调查问卷(SF36)、简明精神病评定量表(BPRS)、副反应量表(TESS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)等对56例男性住院退伍军人精神分裂症患者进行评定,并与56名健康男性进行对照.结果 患者组SF-36评分显著低...