A plethora of studies comparing the metabolic benefits of bariatric surgery with usual medical management of obese patients has increased the focus on surgical management.

These studies initially focused on enhanced insulin sensitivity, improved glucose regulation, and a higher likelihood of reversing prediabetes and diabetes.

A strong relationship was seen in both women and men, irrespective of the presence of PFO.

Previous studies have evaluated some of the complex relationships among cryptogenic stroke, migraine, and patent foramen ovale (PFO) and suggested the following:

In cognitively intact individuals with late-life depression, cortical amyloid burden predicted poor antidepressant response.

Accumulation of cortical amyloid-β (Aβ) has been associated with greater depressive symptoms in cognitively intact older adults.

A 45-year longitudinal study shows that mental illness is astonishingly common and that it’s better to be a “lumper” than a “splitter” when thinking diagnostically.

Cross-sectional epidemiological surveys have documented high rates of lifetime psychiatric disorders (about 40%–50%) and substantial comorbidity.

A retrospective analysis of cases shows that smooth meningeal thickening provides an additional diagnostic clue differentiating POEMS syndrome from chronic immune demyelinating polyneuropathy.

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin lesions) is a rare but treatable paraneoplastic disorder of plasma cells associated with sensorimotor polyneuropathy.

Understanding and knowledge of atrial fibrillation (AF) treatment continues to expand in 2020.

The EAST-AFNET 4 trial, recently published in the New England Journal of Medicine, showed that an aggressive early approach to maintaining normal sinus rhythm.

Combining usual care with a guided program using cognitive-behavioral therapy reduced major depressive episodes by 52% in patients with chronic back pain.

Consistent with the move toward remote interventions for mental disorders, researchers assessed whether a web-based cognitive-behavioral therapy.

Aerobic exercise improves cognitive, cardiovascular, and cerebrovascular outcomes in healthy older adults.

In this single-group intervention study, researchers examined the effects of aerobic exercise on cognition, cardiovascular fitness, and cerebrovascular regulation in 206 healthy adults

An algorithm developed with artificial intelligence was applied to electrocardiograms of patients presenting with dyspnea to the emergency department.

New articles about artificial intelligence–related decision-support tools are being published at a rapid pace.

Risks for suicide attempts are strongly transmitted, with nature and nurture contributing equally, whereas the modest intergenerational transmission of completed suicide is largely genetic.​

Suicide attempts and suicides have long been known to run in families, but questions remain about the genetic versus environmental contributions to these phenomena.

Earlier age at first episode and personal or family history of migraine were associated with greater risk.

Transient global amnesia (TGA) is a benign but highly distressing event of antegrade amnesia that usually lasts a few hours.

Meta-analyses of studies of both surgical and nonsurgical patients confirm the long-suspected association.

Delirium is common in postoperative and critically ill hospitalized patients and has been estimated to occur in 25% of postsurgical patients and up to 82% of patients admitted to intensive care units. 

Código de aprobación:PP-CNS-PEB-0093

During 2 years of follow-up, most cases resolved, but one quarter developed into chronic inflammatory disease.

The differential diagnosis of recent-onset monoarthritis is broad and includes early presentation of what eventually is identifiable as chronic inflammatory rheumatic disease (CIRD)

Código de aprobación:PP-PPF-PEB-0042

The widely accepted pooled cohort equations overestimate 5-year risk in a cohort of Veterans Affairs patients, with implications for statin eligibility.

The pooled cohort equations (PCE) were developed to estimate the risk for an initial atherosclerotic cardiovascular disease (ASCVD) event.

Código de aprobación:PP-CVP-PEB-0071

In a prospective 4-year study, more of those with elevated cytokine levels had evidence of disease activity.

Although multiple sclerosis (MS) is often considered a disease of the white matter, appreciation is growing that pathology also directly affects the cortex.

Código de aprobación:PP-CNS-PEB-0076

Letter from the Editor

Access to medical care varies tremendously around the globe. It is especially in advanced technology that this variability exists, and particularly between underdeveloped and developed countries.

Código de aprobación:PP-CVP-PEB-0061

Letter from the Editor

Clinicians and their patients with Parkinson disease await advances that will improve symptoms and quality of life. This year, we saw the emergence of several important clinical and research developments.

Código de aprobación:PP-CNS-PEB-0074

Long-term associations between mental and physical health are examined in a prospective study.

To address the relationship between health and affective symptoms (anxiety or depression), researchers analyzed data from a British prospective study of 3001 people followed repeatedly since birth in 1946.

Código de aprobación:PP-CNS-PEB-0052

A study suggests that asking about pain tolerability has advantages over using a 0-to-10–point numerical rating.

The common practice of asking patients to rate their pain on a 10-point scale might suggest that the goal of pain therapy always is to achieve a score of 0.

Código de aprobación:PP-PPF-PEB-0020

Letter from the Editor

The late Dr. Willet Whitmore, long-serving Chair of Urology at Memorial Sloan Kettering Cancer Center, noted in his 1973 treatise on the natural history of prostate cancer that “Appropriate treatment implies that therapy be applied neither to those patients for whom it is unnecessary nor to those for whom it will prove ineffective.”

Código de aprobación:PP-MHP-PEB-0029

Auditory hallucinations are common in women with severe PTSD, especially among those who were younger at the initial trauma.

Clinically, auditory hallucinations are most often linked to psychotic disorders, such as schizophrenia, severe bipolar disorders, drug-induced psychoses, and neurodegenerative diseases.

Código de aprobación:PP-CNS-PEB-0050

Greater BP variability in early adulthood correlated with worse echocardiographic features at middle age.

Visit-to-visit blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, independent of BP level. To understand if BPV in early adulthood is associated with later subclinical alterations in cardiac structure and function, researchers used data from a U.S.-based community cohort study (CARDIA) in which participants aged 18 to 30 at enrollment underwent eight BP evaluations over 25 years of follow-up and an echocardiogram at year 25.

Código de

Long-term elevated blood pressure was responsible for greater cognitive decline in black Americans than in white Americans.
Black people, on average, experience earlier onset of elevated blood pressure (BP) and poorer control of BP throughout life than do white people. To establish whether blood pressure is associated with the observed earlier onset of cognitive impairment and faster decline in cognition in black patients, investigators performed a pooled cohort study of almost 20,000 patients (median age at study entry, 55; 20% black [self-reported]).

Código de

A study using a Mendelian randomization design finds causal associations between elevated total cholesterol and LDL levels and AS.
To date, aortic stenosis (AS) has no recommended prevention strategies, and statins have failed to slow disease progression in randomized trials. However, questions remain about whether dyslipidemia is associated with the condition.

Using MRI to score cerebral small-vessel disease may help predict dementia.
Cerebrovascular disease increases the risk for dementia. To determine whether an MRI score for cerebral small vessel disease (SVD) can assist in the prediction of dementia, investigators examined MRI scans from participants in three longitudinal cohorts. Participants’ SVD ranged from mild and asymptomatic to severe and symptomatic. Each cohort underwent cognitive testing, and conversion to dementia was determined by published criteria or screening mental status examination cutoff scores.

Outcomes at 5 years were not different.

In the previously published METEOR study (NEJM JW Gen Med May 1 2013 and N Engl J Med 2013; 368:1675), researchers randomized 350 patients with meniscal tears and mild-to-moderate osteoarthritis (OA) to physical therapy (PT) alone or meniscectomy followed by PT.

Código de aprobación:PP-UPA-PEB-0004

Letter from the Editor
In the past decade, there has been a powerful shift toward the use of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis.

Can transcranial magnetic stimulation distinguish among dementia types?
Biomarkers have been useful tools in the diagnosis and management of dementia. Researchers analyzed data from participants at four centers to determine if transcranial magnetic stimulation (TMS) can be used to identify and distinguish among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD).

Código de aprobación:PP-CNS-PEB-0027

Brain regions showing consistent alterations in migraineurs converge to a common brain network, which includes areas with a pivotal role in migraine pathophysiology.
Neuroimaging studies have shown functional and structural alterations of different brain areas in migraine patients, raising new questions. How do these regions interact with each other? Does a unique network enclose all these brain areas? Are these neuroimaging findings migraine specific?

Código de aprobación:PP-CNS-PEB-0023

Although overall mortality has changed little between 2002 and 2013, noncardiovascular mortality has increased, especially among the oldest old.
We have made substantial progress in improving outcomes for patients with ischemic heart disease, but what about for patients with heart failure? Investigators examined a clinical database of about 7% of the U.K. population to assess trends in 1-year mortality and hospital admissions among 86,833 patients with a diagnosis of incident heart failure from 2002 through 2013 (aged ≥80, 48%; ≥3 comorbidities, 79%; women, 49%).

Código de

All eight evaluated endoscopic modalities were safer than transurethral resection of prostate in men with benign prostatic hyperplasia.
For decades, monopolar transurethral resection of prostate (TURP) has been the mainstay surgical treatment for men with benign prostatic hyperplasia (BPH). During monopolar TURP, the prostate adenoma is removed, piece by piece, with a monopolar electrode. In this network meta-analysis of 109 randomized controlled trials, researchers compared the efficacy and safety of monopolar TURP with eight newer endoscopic surgical modalities for BPH.

Código

Favorable-risk patients undergoing prostatectomy had worse sexual function at 3 years and worse urinary incontinence at 5 years than those managed with active surveillance.
Because the optimal treatment for men with localized prostate cancer remains undefined — given the great heterogeneity of the disease and a lack of prospective comparative studies — gaining a better understanding of the short- and long-term adverse effects associated with interventions is critical.

Código de aprobación:PP-MHP-PEB-0006

1+1=3: Autism significantly increases risks for both mood and anxiety disorders.
When Kanner described autistic disturbances of affective contact in 1943, he observed that one of the hallmark clinical features was an “anxiously obsessive desire for the maintenance of sameness.” Many studies since have documented the prevalence of co-occurring psychiatric disorders in patients with autism spectrum disorder (ASD). In this population-based study, investigators leveraged a cohort of 31,220 individuals born from 1976 to 2000 in Olmsted County, Minnesota, to ascertain the prevalence of bipolar

Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.
Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatchbased irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days.

Código de aprobación:

Improvement with 1 week of treatment with transcranial direct current stimulation is sustained for 12 weeks.
Because negative symptoms of schizophrenia have been associated with low activity in the prefrontal cortex (PFC), researchers in a sham-controlled, Brazilian study examined the effects of transcranial direct current stimulation (tDCS) in 95 schizophrenia patients with prominent negative symptoms. The device is commercially available but does not have FDA approval.

Código de aprobación: PP-MHP-PEB-0009