si Too Few Psychiatric Beds: Psychiatrists' Group Takes Aim at Ongoing Crisis By www.medicinenet.com Published On :: Thu, 18 Aug 2022 00:00:00 PDT Title: Too Few Psychiatric Beds: Psychiatrists' Group Takes Aim at Ongoing CrisisCategory: Health NewsCreated: 8/17/2022 12:00:00 AMLast Editorial Review: 8/18/2022 12:00:00 AM Full Article
si Pious Parasites: Medieval Monks Battled Nasty Gut Germs By www.medicinenet.com Published On :: Fri, 19 Aug 2022 00:00:00 PDT Title: Pious Parasites: Medieval Monks Battled Nasty Gut GermsCategory: Health NewsCreated: 8/19/2022 12:00:00 AMLast Editorial Review: 8/19/2022 12:00:00 AM Full Article
si 84 People Now Sickened in E. Coli Outbreak Tied to Wendy's Restaurant Lettuce By www.medicinenet.com Published On :: Fri, 26 Aug 2022 00:00:00 PDT Title: 84 People Now Sickened in E. Coli Outbreak Tied to Wendy's Restaurant LettuceCategory: Health NewsCreated: 8/26/2022 12:00:00 AMLast Editorial Review: 8/26/2022 12:00:00 AM Full Article
si 12 Best Compression Leggings in 2022 By www.medicinenet.com Published On :: Tue, 16 Aug 2022 00:00:00 PDT Title: 12 Best Compression Leggings in 2022Category: Health and LivingCreated: 8/16/2022 12:00:00 AMLast Editorial Review: 8/16/2022 12:00:00 AM Full Article
si Scientists Design Skin Patch That Takes Ultrasound Images By www.medicinenet.com Published On :: Fri, 29 Jul 2022 00:00:00 PDT Title: Scientists Design Skin Patch That Takes Ultrasound ImagesCategory: Health NewsCreated: 7/29/2022 12:00:00 AMLast Editorial Review: 7/29/2022 12:00:00 AM Full Article
si Want That Pill to Work Fast? Your Body Position Matters By www.medicinenet.com Published On :: Wed, 17 Aug 2022 00:00:00 PDT Title: Want That Pill to Work Fast? Your Body Position MattersCategory: Health NewsCreated: 8/17/2022 12:00:00 AMLast Editorial Review: 8/17/2022 12:00:00 AM Full Article
si Lamisil (terbinafine) vs. Lotrimin (clotrimazole) By www.medicinenet.com Published On :: Wed, 10 Aug 2022 00:00:00 PDT Title: Lamisil (terbinafine) vs. Lotrimin (clotrimazole) Category: MedicationsCreated: 6/10/2019 12:00:00 AMLast Editorial Review: 8/10/2022 12:00:00 AM Full Article
si 7 Surprising Goat Milk Soap Benefits By www.medicinenet.com Published On :: Fri, 12 Aug 2022 00:00:00 PDT Title: 7 Surprising Goat Milk Soap BenefitsCategory: Health and LivingCreated: 8/12/2022 12:00:00 AMLast Editorial Review: 8/12/2022 12:00:00 AM Full Article
si Nerve Block Plus Lidocaine Clears Psoriasis in Small Study By www.medicinenet.com Published On :: Tue, 16 Aug 2022 00:00:00 PDT Title: Nerve Block Plus Lidocaine Clears Psoriasis in Small StudyCategory: Health NewsCreated: 8/15/2022 12:00:00 AMLast Editorial Review: 8/16/2022 12:00:00 AM Full Article
si What Are the 5 Warning Signs of Bladder Cancer? By www.medicinenet.com Published On :: Wed, 8 Jun 2022 00:00:00 PDT Title: What Are the 5 Warning Signs of Bladder Cancer?Category: Diseases and ConditionsCreated: 4/22/2021 12:00:00 AMLast Editorial Review: 6/8/2022 12:00:00 AM Full Article
si COVID Crisis Has Stalled Fight Against HIV/AIDS By www.medicinenet.com Published On :: Fri, 29 Jul 2022 00:00:00 PDT Title: COVID Crisis Has Stalled Fight Against HIV/AIDSCategory: Health NewsCreated: 7/28/2022 12:00:00 AMLast Editorial Review: 7/29/2022 12:00:00 AM Full Article
si Does Menopause Make You More Sensitive to Pain? By www.medicinenet.com Published On :: Wed, 11 May 2022 00:00:00 PDT Title: Does Menopause Make You More Sensitive to Pain?Category: Diseases and ConditionsCreated: 5/11/2022 12:00:00 AMLast Editorial Review: 5/11/2022 12:00:00 AM Full Article
si High Blood Pressure Drugs (Hypertension) By www.medicinenet.com Published On :: Fri, 1 Jul 2022 00:00:00 PDT Title: High Blood Pressure Drugs (Hypertension)Category: MedicationsCreated: 8/16/2006 12:00:00 AMLast Editorial Review: 7/1/2022 12:00:00 AM Full Article
si MS (Multiple Sclerosis) vs. ALS (Amyotrophic Lateral Sclerosis) By www.medicinenet.com Published On :: Thu, 4 Aug 2022 00:00:00 PDT Title: MS (Multiple Sclerosis) vs. ALS (Amyotrophic Lateral Sclerosis)Category: Diseases and ConditionsCreated: 6/16/2017 12:00:00 AMLast Editorial Review: 8/4/2022 12:00:00 AM Full Article
si Motion Sickness By www.medicinenet.com Published On :: Mon, 8 Aug 2022 00:00:00 PDT Title: Motion SicknessCategory: Diseases and ConditionsCreated: 5/30/1999 12:00:00 AMLast Editorial Review: 8/8/2022 12:00:00 AM Full Article
si Who Fares Worse After Multiple Sclerosis Strikes? By www.medicinenet.com Published On :: Fri, 12 Aug 2022 00:00:00 PDT Title: Who Fares Worse After Multiple Sclerosis Strikes?Category: Health NewsCreated: 8/11/2022 12:00:00 AMLast Editorial Review: 8/12/2022 12:00:00 AM Full Article
si Is It Parkinson's? These 10 Signs Could Tell By www.medicinenet.com Published On :: Fri, 19 Aug 2022 00:00:00 PDT Title: Is It Parkinson's? These 10 Signs Could TellCategory: Health NewsCreated: 8/19/2022 12:00:00 AMLast Editorial Review: 8/19/2022 12:00:00 AM Full Article
si New Multiple Sclerosis Treatment Shows Promise in Trial By www.medicinenet.com Published On :: Fri, 26 Aug 2022 00:00:00 PDT Title: New Multiple Sclerosis Treatment Shows Promise in TrialCategory: Health NewsCreated: 8/25/2022 12:00:00 AMLast Editorial Review: 8/26/2022 12:00:00 AM Full Article
si U.S. HPV Vaccination Rates Rising, Even Among Boys By www.medicinenet.com Published On :: Thu, 23 Jun 2022 00:00:00 PDT Title: U.S. HPV Vaccination Rates Rising, Even Among BoysCategory: Health NewsCreated: 6/22/2022 12:00:00 AMLast Editorial Review: 6/23/2022 12:00:00 AM Full Article
si silver sulfadiazine By www.medicinenet.com Published On :: Tue, 2 Aug 2022 00:00:00 PDT Title: silver sulfadiazineCategory: MedicationsCreated: 8/2/2022 12:00:00 AMLast Editorial Review: 8/2/2022 12:00:00 AM Full Article
si 'Virtual' Museum Visits Are Good Medicine for Seniors By www.medicinenet.com Published On :: Tue, 16 Aug 2022 00:00:00 PDT Title: 'Virtual' Museum Visits Are Good Medicine for SeniorsCategory: Health NewsCreated: 8/16/2022 12:00:00 AMLast Editorial Review: 8/16/2022 12:00:00 AM Full Article
si Bedsores Can Cause Serious Harm — Are U.S. Nursing Homes Hiding Cases? By www.medicinenet.com Published On :: Thu, 18 Aug 2022 00:00:00 PDT Title: Bedsores Can Cause Serious Harm — Are U.S. Nursing Homes Hiding Cases?Category: Health NewsCreated: 8/17/2022 12:00:00 AMLast Editorial Review: 8/18/2022 12:00:00 AM Full Article
si You Could Live 9 Years Longer in Hawaii Than in Mississippi, New Data Shows By www.medicinenet.com Published On :: Tue, 23 Aug 2022 00:00:00 PDT Title: You Could Live 9 Years Longer in Hawaii Than in Mississippi, New Data ShowsCategory: Health NewsCreated: 8/23/2022 12:00:00 AMLast Editorial Review: 8/23/2022 12:00:00 AM Full Article
si Salicylate Sensitivity Causes, Symptoms, and Foods to Avoid By www.medicinenet.com Published On :: Fri, 8 Jul 2022 00:00:00 PDT Title: Salicylate Sensitivity Causes, Symptoms, and Foods to AvoidCategory: Health and LivingCreated: 7/8/2022 12:00:00 AMLast Editorial Review: 7/8/2022 12:00:00 AM Full Article
si SIBO (Small Intestinal Bacterial Overgrowth) By www.medicinenet.com Published On :: Mon, 8 Aug 2022 00:00:00 PDT Title: SIBO (Small Intestinal Bacterial Overgrowth)Category: Diseases and ConditionsCreated: 10/28/2005 12:00:00 AMLast Editorial Review: 8/8/2022 12:00:00 AM Full Article
si Kidneys' Resilience May Depend on Your Gender, Study Finds By www.medicinenet.com Published On :: Mon, 22 Aug 2022 00:00:00 PDT Title: Kidneys' Resilience May Depend on Your Gender, Study FindsCategory: Health NewsCreated: 8/22/2022 12:00:00 AMLast Editorial Review: 8/22/2022 12:00:00 AM Full Article
si Pot Users Are Less Prone to Sinus Problems By www.medicinenet.com Published On :: Tue, 2 Aug 2022 00:00:00 PDT Title: Pot Users Are Less Prone to Sinus ProblemsCategory: Health NewsCreated: 8/1/2022 12:00:00 AMLast Editorial Review: 8/2/2022 12:00:00 AM Full Article
si How Do I Get Rid of Winter Depression? By www.medicinenet.com Published On :: Wed, 27 Apr 2022 00:00:00 PDT Title: How Do I Get Rid of Winter Depression?Category: Diseases and ConditionsCreated: 4/27/2022 12:00:00 AMLast Editorial Review: 4/27/2022 12:00:00 AM Full Article
si Smoking Rates Drop for Americans Battling Depression, Substance Abuse By www.medicinenet.com Published On :: Wed, 27 Apr 2022 00:00:00 PDT Title: Smoking Rates Drop for Americans Battling Depression, Substance AbuseCategory: Health NewsCreated: 4/27/2022 12:00:00 AMLast Editorial Review: 4/27/2022 12:00:00 AM Full Article
si Postpartum Depression Can Hit Both Mom & Dad, Sometimes at Same Time By www.medicinenet.com Published On :: Tue, 28 Jun 2022 00:00:00 PDT Title: Postpartum Depression Can Hit Both Mom & Dad, Sometimes at Same TimeCategory: Health NewsCreated: 6/27/2022 12:00:00 AMLast Editorial Review: 6/28/2022 12:00:00 AM Full Article
si Most Post-Stroke Depression Still Goes Untreated By www.medicinenet.com Published On :: Mon, 25 Jul 2022 00:00:00 PDT Title: Most Post-Stroke Depression Still Goes UntreatedCategory: Health NewsCreated: 7/25/2022 12:00:00 AMLast Editorial Review: 7/25/2022 12:00:00 AM Full Article
si Study Casts Doubt on 'Chemical Imbalance' Theory of Depression By www.medicinenet.com Published On :: Tue, 9 Aug 2022 00:00:00 PDT Title: Study Casts Doubt on 'Chemical Imbalance' Theory of DepressionCategory: Health NewsCreated: 8/9/2022 12:00:00 AMLast Editorial Review: 8/9/2022 12:00:00 AM Full Article
si Treating central sleep apnoea in heart failure: progressing one step at a time By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Extract We read with great interest the correspondence by T. Bitter and co-workers in the European Respiratory Review, about our recently published review entitled "Central sleep apnoea: not just one phenotype" [1]. We first want to express our gratefulness to the authors for their support and appreciation of our work, particularly regarding the urgent need for an increasingly differentiated view of central sleep apnoea (CSA) in the context of precision medicine. Full Article
si Treating central sleep apnoea in heart failure: is positive airway pressure and adaptive servo-ventilation in particular the gold standard? By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Extract We read with great interest the review article by Randerath et al. [1] recently published in the European Respiratory Review. We would like to congratulate the authors on this clearly structured review, which emphasises the urgent need for an increasingly differentiated view of central sleep apnoea (CSA) in the context of precision medicine. Full Article
si Impaired lung function and associated risk factors in children born prematurely: a systematic review and meta-analysis By err.ersjournals.com Published On :: 2024-10-09T00:15:15-07:00 Background Immature lung development and respiratory morbidity place preterm-born children at high risk of long-term pulmonary sequelae. This systematic review and meta-analysis aims to quantify lung function in preterm-born children and identify risk factors for a compromised lung function. Methods We searched MEDLINE, Embase, Cochrane Library, Web of Science and Scopus for relevant studies published on preterm cohorts born since 1990. Studies comparing forced expiratory volume in 1 s (FEV1) in preterm-born children aged ≥5 years to term-born controls or normative data were included. Study quality was assessed using the Newcastle–Ottawa Scale for cohort studies. Standardised mean differences in FEV1 and secondary spirometry outcomes per study were pooled using meta-analysis. The impact of different demographic and neonatal variables on studies’ FEV1 effect sizes was investigated by meta-regression analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Results We identified 42 studies with unique cohorts including 4743 preterm children and 9843 controls. Median gestational age in the studies was 28.0 weeks and age at assessment ranged from 6.7 to 16.7 years. Preterm children had lower FEV1 than controls (–0.58 sd, 95% CI –0.69– –0.47 sd, p<0.001) resulting in a relative risk of 2.9 (95% CI 2.4–3.4) for abnormal outcome, with high certainty of evidence. FEV1 was significantly associated with gestational age, birthweight, bronchopulmonary dysplasia and invasive mechanical ventilation in univariate meta-regression analyses (R2=36–96%). Conclusion This systematic review shows robust evidence of impaired lung function in preterm-born children with a high certainty of evidence. Full Article
si Epidemiology of severe asthma in children: a systematic review and meta-analysis By err.ersjournals.com Published On :: 2024-10-09T00:15:15-07:00 Background Severe asthma significantly impacts a minority of children with asthma, leading to frequent symptoms, hospitalisations and potential long-term health consequences. However, accurate global data on severe asthma epidemiology is lacking. This study aims to address this gap, providing data on severe asthma epidemiology, regional differences and associated comorbidities. Methods We conducted a rigorous systematic review and meta-analysis following a registered protocol (PROSPERO CRD42023472845). We searched PubMed, Scopus and Web of Science for cohort or cross-sectional studies published since 2003, evaluating severe asthma incidence and prevalence in children. Study quality and risk of bias were assessed using STROBE guidelines. Results Nine studies investigating European children with asthma (aged 5–18 years) were included in the meta-analysis. No significant publication bias was found. The overall severe asthma prevalence in children with asthma was 3% (95% CI 1–6; I2=99.9%; p<0.001), with no significant difference between males and females. Prevalence estimates varied significantly depending on the diagnostic criteria used (Global Initiative for Asthma: 6%; European Respiratory Society/American Thoracic Society: 1%; other: 3%). Because none of the examined studies were prospectively designed, incidence rates could not be determined. Conclusions This systematic review and meta-analysis provide the first robust assessment of severe asthma prevalence among European children. Our findings underscore the need for comprehensive research to address knowledge gaps in severe asthma, including determining incidence rates, standardising definitions, investigating regional differences and evaluating comorbidities and treatment strategies. Full Article
si Noninvasive diagnostic modalities and prediction models for detecting pulmonary hypertension associated with interstitial lung disease: a narrative review By err.ersjournals.com Published On :: 2024-10-09T00:15:15-07:00 Pulmonary hypertension (PH) is highly prevalent in patients with interstitial lung disease (ILD) and is associated with increased morbidity and mortality. Widely available noninvasive screening tools are warranted to identify patients at risk for PH, especially severe PH, that could be managed at expert centres. This review summarises current evidence on noninvasive diagnostic modalities and prediction models for the timely detection of PH in patients with ILD. It critically evaluates these approaches and discusses future perspectives in the field. A comprehensive literature search was carried out in PubMed and Scopus, identifying 39 articles that fulfilled inclusion criteria. There is currently no single noninvasive test capable of accurately detecting and diagnosing PH in ILD patients. Estimated right ventricular pressure (RVSP) on Doppler echocardiography remains the single most predictive factor of PH, with other indirect echocardiographic markers increasing its diagnostic accuracy. However, RVSP can be difficult to estimate in patients due to suboptimal views from extensive lung disease. The majority of existing composite scores, including variables obtained from chest computed tomography, pulmonary function tests and cardiopulmonary exercise tests, were derived from retrospective studies, whilst lacking validation in external cohorts. Only two available scores, one based on a stepwise echocardiographic approach and the other on functional parameters, predicted the presence of PH with sufficient accuracy and used a validation cohort. Although several methodological limitations prohibit their generalisability, their use may help physicians to detect PH earlier. Further research on the potential of artificial intelligence may guide a more tailored approach, for timely PH diagnosis. Full Article
si Epidemiology of bronchiectasis By err.ersjournals.com Published On :: 2024-10-09T00:15:15-07:00 Bronchiectasis is a chronic respiratory disease characterised by permanent enlargement of the airways associated with cough, sputum production and a history of pulmonary exacerbations. In the past few years, incidence and prevalence of bronchiectasis have increased worldwide, possibly due to advances in imaging techniques and disease awareness, leading to increased socioeconomic burden and healthcare costs. Consistently, a mortality increase in bronchiectasis patient cohorts has been demonstrated in certain areas of the globe, with mortality rates of 16–24.8% over 4–5 years of follow-up. However, heterogeneity in epidemiological data is consistent, as reported prevalence in the general population ranges from 52.3 to more than 1000 per 100 000. Methodological flaws in the designs of available studies are likely to underestimate the proportion of people suffering from this condition worldwide and comparisons between different areas of the globe might be unreliable due to different assessment methods or local implementation of the same method in different contexts. Differences in disease severity associated with diverse geographical distribution of aetiologies, comorbidities and microbiology might explain an additional quota of heterogeneity. Finally, limited access to care in certain geographical areas is associated with both underestimation of the disease and increased severity and mortality. The aim of this review is to provide a snapshot of available real-world epidemiological data describing incidence and prevalence of bronchiectasis in the general population. Furthermore, data on mortality, healthcare burden and high-risk populations are provided. Finally, an analysis of the geographical distribution of determinants contributing to differences in bronchiectasis epidemiology is offered. Full Article
si Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause. This review consolidates the existing evidence on patient-managed interventions for adults with bronchiectasis, while also outlining areas for future research. Airway clearance techniques and hyperosmolar agents are key components of the bronchiectasis management and consistently recommended for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear. Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain whether strategies employed in other respiratory conditions can be safely and effectively adapted to bronchiectasis, particularly through identifying patient responder populations and criteria where cough may not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve research methodologies and increase research funding are needed to further advance our understanding of these interventions, and their role in optimising patient care and outcomes. Full Article
si The ageing of people living with cystic fibrosis: what to expect now? By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 The prognosis of people with cystic fibrosis (pwCF) has improved dramatically with the introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators (CFTRm). The ageing of the cystic fibrosis (CF) population is changing the disease landscape with the emergence of different needs and increasing comorbidities related to both age and long-term exposure to multiple treatments including CFTRm. Although the number of pwCF eligible for this treatment is expected to increase, major disparities in care and outcomes still exist in this population. Moreover, the long-term impact of the use of CFTRm is still partly unknown due to the current short follow-up and experience with their use, thus generating some uncertainties. The future spread and initiation of these drugs at an earlier stage of the disease is expected to reduce the systemic burden of systemic inflammation and its consequences on health. However, the prolonged life expectancy is accompanied by an increasing burden of age-related comorbidities, especially in the context of chronic disease. The clinical manifestations of the comorbidities directly or indirectly associated with CFTR dysfunction are changing, along with the disease dynamics and outcomes. Current protocols used to monitor slow disease progression will need continuous updates, including the composition of the multidisciplinary team for CF care, with a greater focus on the needs of the adult population. Full Article
si Multicomponent services for symptoms in serious respiratory illness: a systematic review and meta-analysis By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Background People living with serious respiratory illness experience a high burden of symptoms. This review aimed to determine whether multicomponent services reduce symptoms in people with serious illness related to respiratory disease. Methods Electronic databases were searched to identify randomised controlled trials (RCTs) evaluating multicomponent services that enrolled patients due to symptoms, rather than underlying disease, and provided at least one nonpharmacological intervention. The primary outcome was chronic breathlessness and secondary outcomes were health-related quality of life (HRQoL), cough, fatigue and adverse events. At least two authors independently screened studies, assessed risk of bias and extracted data. Results Five RCTs, involving 439 patients, were included. In comparison to usual care, multicomponent services improved breathlessness mastery (Chronic Respiratory Questionnaire (CRQ) mastery scale, mean difference (MD) 0.43 points, 95% CI 0.20–0.67, three RCTs, 327 participants) and HRQoL (CRQ total score, MD 0.24 points, 95% CI 0.04–0.40, two RCTs, 237 participants). Fatigue did not improve with multicomponent services and no studies evaluated cough. No serious adverse events were reported. The one study evaluating mortality found increased survival in those accessing a multicomponent service. The certainty of evidence was very low, mainly due to detection and reporting bias. Conclusion Multicomponent services improve breathlessness mastery and HRQoL, with minimal risk. These findings support the use of multicomponent symptom-directed services for people living with serious respiratory illness. Full Article
si Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis By err.ersjournals.com Published On :: 2024-10-09T00:15:15-07:00 Background People living with serious respiratory illness experience a high burden of distressing symptoms. Although opioids are prescribed for symptom management, they generate adverse events, and their benefits are unclear. Methods We examined the efficacy and safety of opioids for symptom management in people with serious respiratory illness. Embase, MEDLINE and the Cochrane Central Register of Controlled Trials were searched up to 11 July 2022. Reports of randomised controlled trials administering opioids to treat symptoms in people with serious respiratory illness were included. Key exclusion criteria included <80% of participants having a nonmalignant lung disease. Data were extracted regarding study characteristics, outcomes of breathlessness, cough, health-related quality of life (HRQoL) and adverse events. Treatment effects were pooled using a generic inverse variance model with random effects. Risk of bias was assessed using the Cochrane Risk of Bias tool version 1. Results Out of 17 included trials, six were laboratory-based exercise trials (n=70), 10 were home studies measuring breathlessness in daily life (n=788) and one (n=18) was conducted in both settings. Overall certainty of evidence was "very low" to "low". Opioids reduced breathlessness intensity during laboratory exercise testing (standardised mean difference (SMD) –0.37, 95% CI –0.67– –0.07), but not breathlessness measured in daily life (SMD –0.10, 95% CI –0.64–0.44). No effects on HRQoL (SMD –0.42, 95% CI –0.98–0.13) or cough (SMD –1.42, 95% CI –3.99–1.16) were detected. In at-home studies, opioids led to increased frequency of nausea/vomiting (OR 3.32, 95% CI 1.70–6.51), constipation (OR 3.08, 95% CI 1.69–5.61) and drowsiness (OR 1.37, 95% CI 1.01–1.86), with serious adverse events including hospitalisation and death identified. Conclusions Opioids improved exertional breathlessness in laboratory exercise studies, but did not improve breathlessness, cough or HRQoL measured in daily life at home. There were significant adverse events, which may outweigh any benefits. Full Article
si Dynamic dysregulation of retrotransposons in neurodegenerative diseases at the single-cell level [RESOURCES] By genome.cshlp.org Published On :: 2024-10-29T06:46:08-07:00 Retrotransposable elements (RTEs) are common mobile genetic elements comprising ~42% of the human genome. RTEs play critical roles in gene regulation and function, but how they are specifically involved in complex diseases is largely unknown. Here, we investigate the cellular heterogeneity of RTEs using 12 single-cell transcriptome profiles covering three neurodegenerative diseases, Alzheimer's disease (AD), Parkinson's disease, and multiple sclerosis. We identify cell type marker RTEs in neurons, astrocytes, oligodendrocytes, and oligodendrocyte precursor cells that are related to these diseases. The differential expression analysis reveals the landscape of dysregulated RTE expression, especially L1s, in excitatory neurons of multiple neurodegenerative diseases. Machine learning algorithms for predicting cell disease stage using a combination of RTE and gene expression features suggests dynamic regulation of RTEs in AD. Furthermore, we construct a single-cell atlas of retrotransposable elements in neurodegenerative disease (scARE) using these data sets and features. scARE has six feature analysis modules to explore RTE dynamics in a user-defined condition. To our knowledge, scARE represents the first systematic investigation of RTE dynamics at the single-cell level within the context of neurodegenerative diseases. Full Article
si Seamless, rapid, and accurate analyses of outbreak genomic data using split k-mer analysis [METHODS] By genome.cshlp.org Published On :: 2024-10-29T06:46:08-07:00 Sequence variation observed in populations of pathogens can be used for important public health and evolutionary genomic analyses, especially outbreak analysis and transmission reconstruction. Identifying this variation is typically achieved by aligning sequence reads to a reference genome, but this approach is susceptible to reference biases and requires careful filtering of called genotypes. There is a need for tools that can process this growing volume of bacterial genome data, providing rapid results, but that remain simple so they can be used without highly trained bioinformaticians, expensive data analysis, and long-term storage and processing of large files. Here we describe split k-mer analysis (SKA2), a method that supports both reference-free and reference-based mapping to quickly and accurately genotype populations of bacteria using sequencing reads or genome assemblies. SKA2 is highly accurate for closely related samples, and in outbreak simulations, we show superior variant recall compared with reference-based methods, with no false positives. SKA2 can also accurately map variants to a reference and be used with recombination detection methods to rapidly reconstruct vertical evolutionary history. SKA2 is many times faster than comparable methods and can be used to add new genomes to an existing call set, allowing sequential use without the need to reanalyze entire collections. With an inherent absence of reference bias, high accuracy, and a robust implementation, SKA2 has the potential to become the tool of choice for genotyping bacteria. SKA2 is implemented in Rust and is freely available as open-source software. Full Article
si Rapid SARS-CoV-2 surveillance using clinical, pooled, or wastewater sequence as a sensor for population change [METHODS] By genome.cshlp.org Published On :: 2024-10-29T06:46:08-07:00 The COVID-19 pandemic has highlighted the critical role of genomic surveillance for guiding policy and control. Timeliness is key, but sequence alignment and phylogeny slow most surveillance techniques. Millions of SARS-CoV-2 genomes have been assembled. Phylogenetic methods are ill equipped to handle this sheer scale. We introduce a pangenomic measure that examines the information diversity of a k-mer library drawn from a country's complete set of clinical, pooled, or wastewater sequence. Quantifying diversity is central to ecology. Hill numbers, or the effective number of species in a sample, provide a simple metric for comparing species diversity across environments. The more diverse the sample, the higher the Hill number. We adopt this ecological approach and consider each k-mer an individual and each genome a transect in the pangenome of the species. Structured in this way, Hill numbers summarize the temporal trajectory of pandemic variants, collapsing each day's assemblies into genome equivalents. For pooled or wastewater sequence, we instead compare days using survey sequence divorced from individual infections. Across data from the UK, USA, and South Africa, we trace the ascendance of new variants of concern as they emerge in local populations well before these variants are named and added to phylogenetic databases. Using data from San Diego wastewater, we monitor these same population changes from raw, unassembled sequence. This history of emerging variants senses all available data as it is sequenced, intimating variant sweeps to dominance or declines to extinction at the leading edge of the COVID-19 pandemic. Full Article
si Theoretical framework for the difference of two negative binomial distributions and its application in comparative analysis of sequencing data [METHODS] By genome.cshlp.org Published On :: 2024-10-29T06:46:08-07:00 High-throughput sequencing (HTS) technologies have been instrumental in investigating biological questions at the bulk and single-cell levels. Comparative analysis of two HTS data sets often relies on testing the statistical significance for the difference of two negative binomial distributions (DOTNB). Although negative binomial distributions are well studied, the theoretical results for DOTNB remain largely unexplored. Here, we derive basic analytical results for DOTNB and examine its asymptotic properties. As a state-of-the-art application of DOTNB, we introduce DEGage, a computational method for detecting differentially expressed genes (DEGs) in scRNA-seq data. DEGage calculates the mean of the sample-wise differences of gene expression levels as the test statistic and determines significant differential expression by computing the P-value with DOTNB. Extensive validation using simulated and real scRNA-seq data sets demonstrates that DEGage outperforms five popular DEG analysis tools: DEGseq2, DEsingle, edgeR, Monocle3, and scDD. DEGage is robust against high dropout levels and exhibits superior sensitivity when applied to balanced and imbalanced data sets, even with small sample sizes. We utilize DEGage to analyze prostate cancer scRNA-seq data sets and identify marker genes for 17 cell types. Furthermore, we apply DEGage to scRNA-seq data sets of mouse neurons with and without fear memory and reveal eight potential memory-related genes overlooked in previous analyses. The theoretical results and supporting software for DOTNB can be widely applied to comparative analyses of dispersed count data in HTS and broad research questions. Full Article
si Evolutionary dynamics of polyadenylation signals and their recognition strategies in protists [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 The poly(A) signal, together with auxiliary elements, directs cleavage of a pre-mRNA and thus determines the 3' end of the mature transcript. In many species, including humans, the poly(A) signal is an AAUAAA hexamer, but we recently found that the deeply branching eukaryote Giardia lamblia uses a distinct hexamer (AGURAA) and lacks any known auxiliary elements. Our discovery prompted us to explore the evolutionary dynamics of poly(A) signals and auxiliary elements in the eukaryotic kingdom. We use direct RNA sequencing to determine poly(A) signals for four protists within the Metamonada clade (which also contains G. lamblia) and two outgroup protists. These experiments reveal that the AAUAAA hexamer serves as the poly(A) signal in at least four different eukaryotic clades, indicating that it is likely the ancestral signal, whereas the unusual Giardia version is derived. We find that the use and relative strengths of auxiliary elements are also plastic; in fact, within Metamonada, species like G. lamblia make use of a previously unrecognized auxiliary element where nucleotides flanking the poly(A) signal itself specify genuine cleavage sites. Thus, despite the fundamental nature of pre-mRNA cleavage for the expression of all protein-coding genes, the motifs controlling this process are dynamic on evolutionary timescales, providing motivation for future biochemical and structural studies as well as new therapeutic angles to target eukaryotic pathogens. Full Article
si De novo genome assemblies of two cryptodiran turtles with ZZ/ZW and XX/XY sex chromosomes provide insights into patterns of genome reshuffling and uncover novel 3D genome folding in amniotes [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 Understanding the evolution of chromatin conformation among species is fundamental to elucidate the architecture and plasticity of genomes. Nonrandom interactions of linearly distant loci regulate gene function in species-specific patterns, affecting genome function, evolution, and, ultimately, speciation. Yet, data from nonmodel organisms are scarce. To capture the macroevolutionary diversity of vertebrate chromatin conformation, here we generate de novo genome assemblies for two cryptodiran (hidden-neck) turtles via Illumina sequencing, chromosome conformation capture, and RNA-seq: Apalone spinifera (ZZ/ZW, 2n = 66) and Staurotypus triporcatus (XX/XY, 2n = 54). We detected differences in the three-dimensional (3D) chromatin structure in turtles compared to other amniotes beyond the fusion/fission events detected in the linear genomes. Namely, whole-genome comparisons revealed distinct trends of chromosome rearrangements in turtles: (1) a low rate of genome reshuffling in Apalone (Trionychidae) whose karyotype is highly conserved when compared to chicken (likely ancestral for turtles), and (2) a moderate rate of fusions/fissions in Staurotypus (Kinosternidae) and Trachemys scripta (Emydidae). Furthermore, we identified a chromosome folding pattern that enables "centromere–telomere interactions" previously undetected in turtles. The combined turtle pattern of "centromere–telomere interactions" (discovered here) plus "centromere clustering" (previously reported in sauropsids) is novel for amniotes and it counters previous hypotheses about amniote 3D chromatin structure. We hypothesize that the divergent pattern found in turtles originated from an amniote ancestral state defined by a nuclear configuration with extensive associations among microchromosomes that were preserved upon the reshuffling of the linear genome. Full Article
si Mutational scanning of CRX classifies clinical variants and reveals biochemical properties of the transcriptional effector domain [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 The transcription factor (TF) cone-rod homeobox (CRX) is essential for the differentiation and maintenance of photoreceptor cell identity. Several human CRX variants cause degenerative retinopathies, but most are variants of uncertain significance. We performed a deep mutational scan (DMS) of nearly all possible single amino acid substitutions in CRX using a cell-based transcriptional reporter assay, curating a high-confidence list of nearly 2000 variants with altered transcriptional activity. In the structured homeodomain, activity scores closely aligned to a predicted structure and demonstrated position-specific constraints on amino acid substitution. In contrast, the intrinsically disordered transcriptional effector domain displayed a qualitatively different pattern of substitution effects, following compositional constraints without specific residue position requirements in the peptide chain. These compositional constraints were consistent with the acidic exposure model of transcriptional activation. We evaluated the performance of the DMS assay as a clinical variant classification tool using gold-standard classified human variants from ClinVar, identifying pathogenic variants with high specificity and moderate sensitivity. That this performance could be achieved using a synthetic reporter assay in a foreign cell type, even for a highly cell type-specific TF like CRX, suggests that this approach shows promise for DMS of other TFs that function in cell types that are not easily accessible. Together, the results of the CRX DMS identify molecular features of the CRX effector domain and demonstrate utility for integration into the clinical variant classification pipeline. Full Article
si AGAP duplicons associate with structural diversity at Chromosome 10q11.22 [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 The 10q11.22 chromosomal region is a duplication-rich interval of the human genome and one of the last to be fully assembled. It carries copy number–variable genes associated with intellectual disability, bipolar disorder, and obesity. In this study, we characterized the structural diversity at this locus by analyzing 64 haploid assemblies produced by the Human Pangenome Reference Consortium. We identified 11 alternative haplotypes that differ in the copy number and/or orientation of large genomic segments, ranging from hundreds of kilobase pairs (kbp) to over one megabase pair (Mbp). We uncovered a 2.4 Mbp size difference between the shortest and longest haplotypes. Breakpoint analysis revealed that genomic instability results from nonallelic homologous recombination between segmental duplication (SD) pairs with varying similarity (94.4%–99.6%). Nonetheless, these pairs generally recombine at positions where their identity is higher (>99.6%). Recurrent inversions occur with different breakpoints within the same inverted SD pair. Inversion polymorphisms shuffle the entire SD arrangement, creating new predispositions to copy-number variations. The SD architecture is associated with a catarrhine-specific subgroup of the AGAP gene family, which likely triggered the accumulation of SDs at this locus over the past 25 million years of human evolution. Our results reveal extensive structural diversity and genomic instability at the 10q11.22 locus, and expand the general understanding of the mutational mechanisms behind SD-mediated rearrangements. Full Article