Depression in Alzheimer''s Disease: A Delphi Consensus on Etiology, Risk Factors, and Clinical Management

Background: Alzheimer''s disease (AD) and other forms of dementia are among the most common causes of disability in the elderly. Dementia is often accompanied by depression, but specific diagnostic criteria and treatment approaches are still lacking. This study aimed to gather expert opinions on dementia and depressed patient management to reduce heterogeneity in everyday practice. Methods: Prospective, multicenter, 2-round Modified Delphi survey with 53 questions regarding risk factors (11), signs and symptoms (7), diagnosis (8), and treatment (27) of depression in dementia, with a particular focus on AD. The questionnaire was completed by a panel of 37 expert physicians in neurodegenerative diseases (19 neurologists, 17 psychiatrists, and 1 geriatrician). Results: Consensus was achieved in 40 (75.5%) of the items: agreement in 33 (62.3%) and disagreement in 7 (13.2%) of them. Among the most relevant findings, depression in the elderly was considered an early sign (prodromal) and/or a dementia risk factor, so routine cognitive check-ups in depressed patients should be adopted, aided by clinical scales and information from relatives. Careful interpretation of neuropsychological assessment must be carried out in patients with depression as it can undermine cognitive outcomes. As agreed, depression in early AD is characterized by somatic symptoms and can be differentiated from apathy by the presence of sadness, depressive thoughts and early-morning awakening. In later-phases, symptoms of depression would include sleep-wake cycle reversal, aggressive behavior, and agitation. Regardless of the stage of dementia, depression would accelerate its course, whereas antidepressants would have the opposite effect. Those that improve cognitive function and/or have a dual or multimodal mode of action were preferred: Duloxetine, venlafaxine/desvenlafaxine, vortioxetine, tianeptine, and mirtazapine. Although antidepressants may be less effective than in cognitively healthy patients, neither dosage nor treatment duration should differ. Anti-dementia cholinesterase inhibitors may have a synergistic effect with antidepressants. Exercise and psychological interventions should not be applied alone before any pharmacological treatment, yet they do play a part in improving depressive symptoms in demented patients. Conclusions: This study sheds light on several unresolved clinical challenges regarding depression in dementia patients. Further studies and specific recommendations for this comorbid patient population are still needed.

Tracking bluefin tuna cohorts from east Atlantic Spanish fisheries since the 1980s

Relative abundance and mean size at age analyses were performed for the catches of three Atlantic Spanish fisheries, in search of an exceptionally abundant cohort in the recent history of the eastern Atlantic and Mediterranean bluefin tuna stock. Length distributions of baitboat fisheries, both in the Bay of Biscay and areas close to the Strait of Gibraltar as well as trap catches from the Spanish Atlantic coast were converted to age distributions using age length keys from calcified structures. Results do validate indirectly the ageing method. The 1994 cohort was clearly tracked for juveniles and young adults, 3 to 7 years old, in baitboat catches, and also for older specimens, 9 to 11 years old, in the trap fisheries. Based on these results, it is suggested that the juvenile and young adults fisheries in the western part of the Iberian Peninsula are interconnected between one another and with the Balearic Islands area of the western Mediterranean, as it is the nearest spawning ground described and because it is also supported by tagging and other studies.Afin de trouver une cohorte exceptionnellement abondante dans la récente histoire du stock de ton rouge de l’Atlantique Est et de la Méditerranée, on a procédé à une analyse de l’abondance relative et de la taille moyenne par âge des captures réalisées par trois pêcheries espagnoles de l’Atlantique. Les distributions par tailles de deux pêcheries de canneurs dans le Golfe de Gascogne et dans les eaux proches du Détroit de Gibraltar, ainsi que les prises des madragues de la côte atlantique espagnole, ont été converties en âges à l’aide des clefs taille-âge obtenues à partir de la lecture de structures calcifiées. Les résultats valident indirectement la méthode de détermination de l’âge. La cohorte de 1994 affiche une forte indication présente chez les juvéniles et les jeunes adultes, de 3 à 7 ans, capturés dans les pêcheries de canneurs ainsi que chez les spécimens d’âge plus avancé, de 9 à 11 ans, pêchés à la madrague. Ces résultats suggèrent que les pêcheries de juvéniles et de jeunes adultes de la partie occidentale de la péninsule ibérique sont interconnectées entre elles ainsi qu’avec la zone des îles Baléares, en Méditerranée occidentale, étant donné qu’il s’agit de la zone de frai la plus proche et qu’il existe des indices de cette relation d’après les études de marquage et d’autres études.Para encontrar una cohorte excepcionalmente abundante en la historia reciente del stock de atún rojo del Atlántico este y Mediterráneo, se realizó un análisis de la abundancia relativa y la talla media por edad de las capturas de tres pesquerías atlánticas españolas. Las distribuciones de tallas de dos pesquerías de cebo vivo, en el Golfo de Vizcaya y en aguas próximas al Estrecho de Gibraltar, así como las capturas de las almadrabas de la costa atlántica española, fueron convertidas a edades mediante el uso de claves talla edad, obtenidas a partir de la lectura de piezas esqueléticas. Los resultados validan indirectamente el método de determinación de la edad. La cohorte de 1994 presenta una fuerte señal que pudo ser encontrada en los juveniles y adultos jóvenes, 3 a 7 años, capturados en las pesquerías de cebo vivo y también en especimenes mayores, 9 a 11 años, pescados con las almadrabas. Con esto resultados se sugiere que las pesquerías de juveniles y adultos jóvenes de la parte occidental de la península Ibérica están interconectadas entre ellas y con el área de las Islas Baleares, en el Mediterráneo occidental, puesto que es la zona de puesta más próxima y porque también hay evidencias de esta relación mediante el marcado y otros estudios

Conventional Chemotherapy Followed By Consolidation With Autologous Hematopoietic Transplantation vs Chemotherapy Alone In HIV+ Patients With Large B Cell Lymphoma (LBCL) In First Complete Remission (CR). A Retrospective Analysis On Behalf Of The EBMT Lymphoma Working Party And The GESIDA/PETHEMA Registry Of HIV+ Patients With Non-Hodgkin's Lymphoma (NHL)

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Correction: Atlantic Bluefin Tuna (Thunnus thynnus) Biometrics and Condition

Correction: Atlantic Bluefin Tuna (Thunnus thynnus) Biometrics and ConditionPostprint4,411

Atlantic Bluefin Tuna (Thunnus thynnus) Biometrics and Condition

The compiled data for this study represents the first Atlantic and Mediterranean-wide effort to pool all available biometric data for Atlantic bluefin tuna (Thunnus thynnus) with the collaboration of many countries and scientific groups. Biometric relationships were based on an extensive sampling (over 140,000 fish sampled), covering most of the fishing areas for this species in the North Atlantic Ocean and Mediterranean Sea. Sensitivity analyses were carried out to evaluate the representativeness of sampling and explore the most adequate procedure to fit the weight-length relationship (WLR). The selected model for the WLRs by stock included standardized data series (common measurement types) weighted by the inverse variability. There was little difference between annual stock-specific round weight-straight fork length relationships, with an overall difference of 6% in weight. The predicted weight by month was estimated as an additional component in the exponent of the weight-length function. The analyses of monthly variations of fish condition by stock, maturity state and geographic area reflect annual cycles of spawning and feeding behavior. We update and improve upon the biometric relationships for bluefin currently used by the International Commission for the Conservation of Atlantic Tunas, by incorporating substantially larger datasets than ever previously compiled, providing complete documentation of sources and employing robust statistical fitting.WLRs and other conversion factors estimated in this study differ from the ones used in previous bluefin stock assessments.Postprint4,411

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

Risk of type 2 diabetes according to traditional and emerging anthropometric indices in Spain, a mediterranean country with high prevalence of obesity: results from a large-scale prospective cohort study

Background: Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). A proper anthropometric characterisation of T2DM risk is essential for disease prevention and clinical risk assessement. Methods: Longitudinal study in 37 733 participants (63% women) of the Spanish EPIC (European Prospective Investigation into Cancer and Nutrition) cohort without prevalent diabetes. Detailed questionnaire information was collected at baseline and anthropometric data gathered following standard procedures. A total of 2513 verified incident T2DM cases occurred after 12.1 years of mean follow-up. Multivariable Cox regression was used to calculate hazard ratios of T2DM by levels of anthropometric variables. Results: Overall and central obesity were independently associated with T2DM risk. BMI showed the strongest association with T2DM in men whereas waist-related indices were stronger independent predictors in women. Waist-to-height ratio revealed the largest area under the ROC curve in men and women, with optimal cut-offs at 0.60 and 0.58, respectively. The most discriminative waist circumference (WC) cut-off values were 99.4 cm in men and 90.4 cm in women. Absolute risk of T2DM was higher in men than women for any combination of age, BMI and WC categories, and remained low in normal-waist women. The population risk of T2DM attributable to obesity was 17% in men and 31% in women. Conclusions: Diabetes risk was associated with higher overall and central obesity indices even at normal BMI and WC values. The measurement of waist circumference in the clinical setting is strongly recommended for the evaluation of future T2DM risk in women

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true