Antihypertensive Medications and Risk of Melanoma and Keratinocyte Carcinomas: A Systematic Review and Meta-Analysis

Some antihypertensive medications are photosensitizing. The implications for skin cancer risk remain unclear because results from prior studies are inconsistent and as new evidence is published. We performed a systematic review and meta-analysis to evaluate the association between antihypertensives and common skin cancers (cutaneous squamous cell carcinoma, basal cell carcinoma, and melanoma) and to evaluate dose-response relationships. Forty-four articles met inclusion criteria, and 42 could be meta analyzed. Increased risks were seen for basal cell carcinoma with calcium channel blockers (relative risk [RR] = 1.17, 95% confidence interval [CI] = 1.11-1.22), diuretics (RR = 1.06, 95% CI = 1.03-1.10), and thiazides (RR = 1.10, 95% CI = 1.04-1.16); for squamous cell carcinoma with calcium channel blockers (RR = 1.08, 95% CI = 1.01-1.14), diuretics (RR = 1.29, 95% CI = 1.17-1.43), and thiazides (RR = 1.36, 95% CI = 1.15-1.61); and for melanoma in angiotensin-converting enzyme inhibitors (RR = 1.09, 95% CI = 1.03-1.14), calcium channel blockers (RR = 1.08, 95% CI = 1.03-1.12), and thiazides (RR = 1.09, 95% CI = 1.02-1.17). The quality of evidence was low or very low. We observed evidence for dose-response for thiazides with basal cell carcinoma; angiotensin-converting enzyme inhibitors, diuretics, and thiazides with squamous cell carcinoma; and angiotensin-converting enzyme inhibitors, diuretics, and thiazides with melanoma. Our meta-analysis supports a potential causal association between some antihypertensives, particularly diuretics, and skin cancer risk

Organic farming provides reliable environmental benefits but increases variability in crop yields: a global meta-analysis

To promote food security and sustainability, ecologically intensive farming systems should reliably produce adequate yields of high-quality food, enhance the environment, be profitable, and promote social wellbeing. Yet, while many studies address the mean effects of ecologically intensive farming systems on sustainability metrics, few have considered variability. This represents a knowledge gap because producers depend on reliable provisioning of yields, profits, and environmental services to enhance the sustainability of their production systems over time. Further, stable crop yields are necessary to ensure reliable access to nutritious foods. Here we address this by conducting a global meta-analysis to assess the average magnitude and variability of seven sustainability metrics in organic compared to conventional systems. Specifically, we explored the effects of these systems on (i) biotic abundance, (ii) biotic richness, (iii) soil organic carbon, (iv) soil carbon stocks, (v) crop yield, (vi) total production costs, and (vii) profitability. Organic farms promoted biotic abundance, biotic richness, soil carbon, and profitability, but conventional farms produced higher yields. Compared to conventional farms, organic farms had lower variability in abundance and richness but greater yield variability. Organic farms thus provided a “win-win” (high means and low variability) for environmental sustainability, while conventional farms provided a “win-win” for production by promoting high crop yields with low variability. Despite lower yields, and greater yield variability, organic systems had similar costs to conventional systems and were more profitable due to organic premiums. Our results suggest certification guidelines for organic farms successfully promote reliable environmental benefits, but greater reliance on ecological processes may reduce predictability of crop production

Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project.

Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs

Identifying Farming Strategies Associated With Achieving Global Agricultural Sustainability

Sustainable agroecosystems provide adequate food while supporting environmental and human wellbeing and are a key part of the United Nations Sustainable Development Goals (SDGs). Some strategies to promote sustainability include reducing inputs, substituting conventional crops with genetically modified (GM) alternatives, and using organic production. Here, we leveraged global databases covering 121 countries to determine which farming strategies—the amount of inputs per area (fertilizers, pesticides, and irrigation), GM crops, and percent agriculture in organic production—are most correlated with 12 sustainability metrics recognized by the United Nations Food and Agriculture Organization. Using quantile regression, we found that countries with higher Human Development Indices (HDI) (including education, income, and lifespan), higher-income equality, lower food insecurity, and higher cereal yields had the most organic production and inputs. However, input-intensive strategies were associated with greater agricultural greenhouse gas emissions. In contrast, countries with more GM crops were last on track to meeting the SDG of reduced inequalities. Using a longitudinal analysis spanning 2004–2018, we found that countries were generally decreasing inputs and increasing their share of agriculture in organic production. Also, in disentangling correlation vs. causation, we hypothesize that a country's development is more likely to drive changes in agricultural strategies than vice versa. Altogether, our correlative analyses suggest that countries with greater progress toward the SDGs of no poverty, zero hunger, good health and wellbeing, quality education, decent work, economic growth, and reduced inequalities had the highest production of organic agriculture and, to a lesser extent, intensive use of inputs

Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population.

peer reviewedBACKGROUND: The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liege Scale (GLS) in the evaluation of consciousness in severely brain-damaged patients. We compared the FOUR and GLS/GCS in intensive care unit patients who were admitted in a comatose state. METHODS: FOUR and GLS evaluations were performed in randomized order in 176 acutely (<1 month) brain-damaged patients. GLS scores were transformed in GCS scores by removing the GLS brainstem component. Inter-rater agreement was assessed in 20% of the studied population (N = 35). A logistic regression analysis adjusted for age, and etiology was performed to assess the link between the studied scores and the outcome 3 months after injury (N = 136). RESULTS: GLS/GCS verbal component was scored 1 in 146 patients, among these 131 were intubated. We found that the inter-rater reliability was good for the FOUR score, the GLS/GCS. FOUR, GLS/GCS total scores predicted functional outcome with and without adjustment for age and etiology. 71 patients were considered as being in a vegetative/unresponsive state based on the GLS/GCS. The FOUR score identified 8 of these 71 patients as being minimally conscious given that these patients showed visual pursuit. CONCLUSIONS: The FOUR score is a valid tool with good inter-rater reliability that is comparable to the GLS/GCS in predicting outcome. It offers the advantage to be performable in intubated patients and to identify non-verbal signs of consciousness by assessing visual pursuit, and hence minimal signs of consciousness (11% in this study), not assessed by GLS/GCS scales

Organic Farming Provides Reliable Environmental Benefits but Increases Variability in Crop Yields: A Global Meta-Analysis

To promote food security and sustainability, ecologically intensive farming systems should reliably produce adequate yields of high-quality food, enhance the environment, be profitable, and promote social wellbeing. Yet, while many studies address the mean effects of ecologically intensive farming systems on sustainability metrics, few have considered variability. This represents a knowledge gap because producers depend on reliable provisioning of yields, profits, and environmental services to enhance the sustainability of their production systems over time. Further, stable crop yields are necessary to ensure reliable access to nutritious foods. Here we address this by conducting a global meta-analysis to assess the average magnitude and variability of seven sustainability metrics in organic compared to conventional systems. Specifically, we explored the effects of these systems on (i) biotic abundance, (ii) biotic richness, (iii) soil organic carbon, (iv) soil carbon stocks, (v) crop yield, (vi) total production costs, and (vii) profitability. Organic farms promoted biotic abundance, biotic richness, soil carbon, and profitability, but conventional farms produced higher yields. Compared to conventional farms, organic farms had lower variability in abundance and richness but greater yield variability. Organic farms thus provided a “win-win” (high means and low variability) for environmental sustainability, while conventional farms provided a “win-win” for production by promoting high crop yields with low variability. Despite lower yields, and greater yield variability, organic systems had similar costs to conventional systems and were more profitable due to organic premiums. Our results suggest certification guidelines for organic farms successfully promote reliable environmental benefits, but greater reliance on ecological processes may reduce predictability of crop production

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Opioid suppression of conditioned anticipatory brain responses to breathlessness

Opioid painkillers are a promising treatment for chronic breathlessness, but are associated with potentially fatal side effects. In the treatment of breathlessness, their mechanisms of action are unclear. A better understanding might help to identify safer alternatives. Learned associations between previously neutral stimuli (e.g. stairs) and repeated breathlessness induce an anticipatory threat response that may worsen breathlessness, contributing to the downward spiral of decline seen in clinical populations. As opioids are known to influence associative learning, we hypothesized that they may interfere with the brain processes underlying a conditioned anticipatory response to breathlessness in relevant brain areas, including the amygdala and the hippocampus. Healthy volunteers viewed visual cues (neutral stimuli) immediately before induction of experimental breathlessness with inspiratory resistive loading. Thus, an association was formed between the cue and breathlessness. Subsequently, this paradigm was repeated in two identical neuroimaging sessions with intravenous infusions of either low-dose remifentanil (0.7ng/ml target controlled infusion) or saline (randomised). During saline infusion, breathlessness anticipation activated the right anterior insula and the adjacent operculum. Breathlessness was associated with activity in a network including the insula, operculum, dorsolateral prefrontal cortex, anterior cingulate cortex and the primary sensory and motor cortices. Remifentanil reduced breathlessness unpleasantness but not breathlessness intensity. Remifentanil depressed anticipatory activity in the amygdala and the hippocampus that correlated with reductions in breathlessness unpleasantness. During breathlessness, remifentanil decreased activity in the anterior insula, anterior cingulate cortex and sensory motor cortices. Remifentanil-induced reduction in breathlessness unpleasantness was associated with increased activity in the rostral anterior cingulate cortex and nucleus accumbens, components of the endogenous opioid system known to decrease the perception of aversive stimuli. These findings suggest that in addition to effects on brainstem respiratory control, opioids palliate breathlessness through an interplay of altered associative learning mechanisms. These mechanisms provide potential targets for novel ways to develop and assess treatments for chronic breathlessness

The Set3/Hos2 Histone Deacetylase Complex Attenuates cAMP/PKA Signaling to Regulate Morphogenesis and Virulence of Candida albicans

Candida albicans, like other pleiomorphic fungal pathogens, is able to undergo a reversible transition between single yeast-like cells and multicellular filaments. This morphogenetic process has long been considered as a key fungal virulence factor. Here, we identify the evolutionarily conserved Set3/Hos2 histone deacetylase complex (Set3C) as a crucial repressor of the yeast-to-filament transition. Cells lacking core components of the Set3C are able to maintain all developmental phases, but are hypersusceptible to filamentation-inducing signals, because of a hyperactive cAMP/Protein Kinase A signaling pathway. Strikingly, Set3C-mediated control of filamentation is required for virulence in vivo, since set3Δ/Δ cells display strongly attenuated virulence in a mouse model of systemic infection. Importantly, the inhibition of histone deacetylase activity by trichostatin A exclusively phenocopies the absence of a functional Set3C, but not of any other histone deacetylase gene. Hence, our work supports a paradigm for manipulating morphogenesis in C. albicans through alternative antifungal therapeutic strategies