Search

Objectives: Compelling animal data exists examining the impact of the gut microbiome on the brain, but work is required to translate these findings in a clinical population. We sought to do this by exploring the effects of antidepressant medications on the gut microbiota, and establishing a baseline Major Depressive Disorder (MDD) gut phenotype. Methods: Participants with a primary diagnosis of MDD (n = 15) who were nonmedicated were recruited and followed over 6 months. Stool samples were collected prior to treatment initiation and 3 and 6 months following treatment. 16S rRNA sequencing was employed in order to analyze the gut microbial community profile. Symptom severity was measured by the Beck Depression Inventory. Alpha diversity metrics revealed no significant difference in the community diversity across any of the time-points. Results: Comparison of within-group versus between-group distances revealed a lack of clustering of samples based on time-point, suggesting no significant change in the microbiota across treatment duration. When analyzed based on treatment response, however, patients in the responder group exhibited greater phylogenetic diversity than non-responders (Mann-Whitney U = 5, p = 0.026). At 3-months, 35 Operational Taxonomic Units (OTUs) were significantly different between groups and at 6-months, 42 OTUs were significantly different between responders and non-responders. Conclusions: These observations indicate that antidepressant medications alter the gut microbiota of patients with MDD, with disparate effects in responders versus non responders. This supports the concept of a microbiota phenotype associate with treatment response in MDD.

Pathological alterations of inspiratory capacity (IC) have been observed in pulmonary hypertension. However, the clinical significance of IC in operable chronic thromboembolic pulmonary hypertension (CTEPH) without other pulmonary diseases remains unknown. CTEPH patients scheduled for pulmonary endarterectomy were prospectively screened. Despite being associated with functional capacity, pathological alterations of IC were not observed.

This study aimed to investigate computer and internet access and education attained in patients with chronic obstructive pulmonary disease (COPD) as potential barriers to implementation of telemedicine. We prospectively assessed 98 patients admitted with an acute exacerbation of COPD (mean age: 70.5 ± 9.3 years; force expired volume in the first second: 0.75 ± 0.39 L; 59% male) recording educational level attained and home computer and internet access. Hospital readmission surveillance occurred up to 2.7 (2.6-2.8) years following the index hospital admission. Only 16% of patients had a computer and only 14% had internet access; this group were younger and more educated than those without a computer. There was no difference in hospital readmissions over 2 years between those with and without access to a computer or internet. Only 12% of the whole cohort were educated to a school leaving age of 16 years and this group were more likely to be still working. School leaving age was directly associated with fewer hospital readmissions ( r = 0.251, p = 0.031). In conclusion, these data highlight the current challenges to the widespread implementation of telehealth in COPD patients as there is limited availability of computer and internet access with such patients demonstrating a lower level of education achievement.

Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. We studied the clinical and hemodynamics effects of transitioning 12 pulmonary hypertension patients from Phosphodiesterase type 5 inhibitor (PDE5i) to riociguat, and demonstrated a significant increase in cardiac index, fall in pulmonary vascular resistance, and improvement in functional class with this switch. Switch from PDE5i to riociguat appeared to be safe and fairly well tolerated in most patients.

There are indications that screen time is associated with symptoms of anxiety in adolescents, but from a longitudinal perspective, the magnitude, specificity, and temporal precedence in this association are relatively under-explored. To address this gap, over the course of 4 years, we annually surveyed adolescents assessing their usage of various types of screen time per day and symptoms of anxiety.

The use of oral methotrexate for refractory eosinophilic asthma in a tertiary asthma referral centre, Glenfield Hospital, Leicester, was evaluated between January 2006 and December 2014. The patients ( n = 61) were carefully phenotyped at baseline with markers of airway inflammation. In addition, a structured oral methotrexate proforma was utilized to evaluate response to therapy and adverse events. Oral steroid withdrawal was attempted 3 months after commencing treatment. Several outcomes were evaluated at 12 months, including both efficacy and adverse effects; 15% ( n = 9/61) responded by achieving a decrease in daily oral corticosteroid dose (mean 8.43 (±8.76) mg), although we were unable to identify factors that predicted a treatment response. There were no other significant changes in any other clinical outcome measures. There was a high rate of adverse events (19/61 (31%)), primarily gastrointestinal/hepatitis. Our findings support the use of biological agents in preference to using oral methotrexate as a steroid sparing agent at the first instance. In the event of failure of these agents, oral methotrexate remains a therapeutic option, which can be considered in highly specialist severe asthma centres.

We set out to assess the relative age effect (RAE)on UK Nobel laureates in physics, chemistry andphysiology or medicine. The academic year ofthe UK begins in September; therefore, childrenin one classroom may have an entire year’s dif-ference in age (i.e. children born in Septemberand those born in August of different years).This relative age difference could cause a disad-vantage in the younger students compared tothe older students within one classroom.

There was no evidence of osteonecrosis in the specimens analysed. The hydroxyapatite-coating was present to a variable degree on the specimens with good evidence of bony ongrowth under the CoChrome cap. Ongrowth was examined in five different zones with the greatest seen in the middle of the stem. Direct contact between newly formed bone and the hydroxyapatite layer was observed on light and back-scattered electron microscopy. Histomorphometric analysis quantified the mean bone-implant contact ranging from 11.1 to 33.6% between the specimens. DECLARATIONS

We looked into gallbladder histology over one year to see whether those who have had pancreatitis have any difference in their reports compared to those who have had cholecystitis.

XRD and EDX analyses confirmed the presence of Ag in all coatings deposited using electrochemical method and silver. The mean thickness coating was noted to be highest in EHA/AG group (102.20 4.20 um) followed by PHA (76.40 2.20 um). Mean coating thicknesses in other groups were: PHA/AgNO3 (76.20 1.29 um); EHA (32.98 2.50 um); EHA/ Ag/2-layers (30.70 2.40 um); EHA/AgNO3 (8.60 0.60 um). The average silver content measured was highest with 6.55% in EHA/Ag/2-layer followed by 3.92% in EHA/AgNO3, 0.38% in EHA/Ag and 0.10% in PHA/AgNO3. The electrochemical technique deposited a uniform coating onto the disc surface with clearly defined microcrystals as compared to the PHA-coated discs where the surface appeared smoother. The EHA coating, however, appeared less dense when compared with the PHA coating. DECLARATIONS