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]).

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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%).

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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.

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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.

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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