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The COVID-19 pandemic confronted humans with high uncertainty and lockdowns, which severely disrupted people’s daily social and health lifestyles, enhanced loneliness, and reduced well-being. Curiosity and information-seeking are central to behavior, fostering well-being and adaptation in changing environments. They may be particularly important to maintain well-being during the pandemic. Here, we investigated which motives drive information-seeking, and whether and how curiosity and information-seeking related to well-being and mood (excitement, anxiety). Additionally, we tested whether daily diet contributed to this relationship during lockdown. Participants ( N  = 183) completed questionnaires measuring curiosity, information-seeking, social and mental health. Using a smartphone app, participants submitted their daily food intake and lifestyle ratings for a week. We found participants had highest motivation to seek positive (vs. negative) information, concerning themselves more than others. Both trait curiosity and information-seeking predicted higher well-being, mediated by loneliness. Trait curiosity also predicted well-being and excitement days later. Considering diet, participants with lower trait curiosity ate food containing more tyrosine (i.e., dopamine precursor). Furthermore, participants consuming food high in sugar reported higher anxiety, which was specifically found in participants with relatively low, but not high, trait curiosity. Taken together, curiosity and information-seeking may benefit well-being and mood in high uncertain and challenging times, by interacting with lifestyle measures (loneliness and nutrition).

Although deep brain stimulation of the subthalamic nucleus is an effective surgical treatment for Parkinson’s disease, it may expose patients to non-motor side effects such as increased impulsivity and changes in decision-making behavior. Even if several studies have shown that stimulation of the subthalamic nucleus increases the incentive salience of food rewards in both humans and animals, temporal discounting for food rewards has never been investigated in patients who underwent STN-DBS. In this study, we measured inter-temporal choice after STN-DBS, using both primary and secondary rewards. In particular, PD patients who underwent STN-DBS (in ON medication/ON stimulation), PD patients without STN-DBS (in ON medication) and healthy matched controls (C) performed three temporal discounting tasks with food (primary reward), money and discount vouchers (secondary rewards). Participants performed also neuropsychological tests assessing memory and executive functions. Our results show that STN-DBS patients and PD without DBS behave as healthy controls. Even PD patients who after DBS experienced weight gain and/or eating alterations did not show an increased temporal discounting for food rewards. Interestingly, patients taking a higher dosage of dopaminergic medications, fewer years from DBS surgery and, unexpectedly, with better episodic memory were also those who discounted rewards more. In conclusion, this study shows that STN-DBS does not affect temporal discounting of primary and secondary rewards. Furthermore, by revealing interesting correlations between clinical measures and temporal discounting, it also shed light on the clinical outcomes that follow STN-DBS in patients with PD.

Canada has historically been among the world leaders in hypertension care, but hypertension treatment and control rates have regressed in recent years. This guideline is intended to provide pragmatic primary care–focused recommendations to improve hypertension management in adults at the population level. We employed Grading of Recommendations Assessment, Development and Evaluation and ADAPTE frameworks in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards to develop recommendations on managing hypertension for adults aged 18 years and older. We used the HEARTS framework — a model of care developed by the World Health Organization to improve hypertension control and reduce cardiovascular burden — to integrate these recommendations into streamlined, pragmatic, and evidence-based algorithms. The guideline committee predominantly comprised primary care providers and also included patient, methodology, and hypertension specialist representatives. Our process for managing competing interests adhered to Guidelines International Network principles. The 9 recommendations for managing hypertension in adults are grouped under the categories of diagnosis and treatment. Diagnostic recommendations include a standardized approach to measuring blood pressure (BP) and confirming hypertension, as well as providing a uniform definition for hypertension of BP ≥ 130/80 mm Hg. Treatment recommendations include targeting a systolic BP < 130 mm Hg, implementing healthy lifestyle changes, and providing stepwise guidance on optimal medication choices for patients requiring pharmacotherapy. Our aim is to enhance the standard of hypertension care in the Canadian primary care setting. Accurate diagnosis and optimal treatment of hypertension can reduce adverse cardiovascular events and risk of death.

Jain et al discuss the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline. C-CHANGE produces a guideline that is a subset of recommendations chosen from guidelines developed by Canada's cardiovascular-focused guideline groups. It is designed to help clinicians formulate comprehensive treatment plans for use by all members of the health care team to address multimorbidity, as recommended by the Canadian Heart Health Strategy and Action Plan. C-CHANGE specifically chooses implementable or actionable recommendations for primary care and helpful tools to organize how patient care is approached in clinic during periodic health and episodic visits. The recommendations are organized to address and individualize the management of patients with multiple comorbidities.

Le Canada a longtemps figuré parmi les leaders mondiaux de la prise en charge de l’hypertension artérielle (HTA), mais ses taux de traitement et de maîtrise de l’HTA ont régressé ces dernières années. Le présent guide de pratique clinique vise à fournir des recommandations pragmatiques axées sur les soins de première ligne afin d’améliorer la prise en charge de l’HTA chez les adultes à l’échelle de la population. Conformément aux normes de qualité et de présentation du guide AGREE II (Appraisal of Guidelines for Research and Evaluation), nous avons utilisé la méthode GRADE (Grading of Recommendations Assessment, Development and Evaluation) et le processus ADAPTE pour formuler des recommandations sur la prise en charge de l’HTA chez les adultes de 18 ans et plus. Nous avons ensuite intégré ces recommandations dans des algorithmes simplifiés, pragmatiques et fondés sur les données probantes en nous appuyant sur le guide technique HEARTS — un modèle de soins mis au point par l’Organisation mondiale de la Santé (OMS) afin d’améliorer la maîtrise de l’HTA et de réduire le fardeau des maladies cardiovasculaires (MCV). Le comité qui a préparé ce guide de pratique clinique se composait principalement de prestataires de soins de première ligne, mais aussi de patients et patientes, de spécialistes de la méthodologie et de spécialistes de l’HTA. Notre processus de gestion des intérêts concurrents a respecté les principes du Guidelines International Network. Les 9 recommandations pour la prise en charge de l’HTA chez les adultes sont regroupées sous les rubriques « Diagnostic » et « Traitement ». Les recommandations diagnostiques comportent une méthode standardisée de mesure de la pression artérielle (PA) et de confirmation de l’HTA, ainsi qu’une définition uniforme de l’HTA, soit une PA ≥ 130/80 mm Hg. Les recommandations thérapeutiques comprennent l’établissement d’une cible de pression artérielle systolique (PAS) < 130 mm Hg, l’adoption de saines habitudes de vie, de même qu’une démarche par étapes pour guider un choix optimal de médicaments lorsqu’une pharmacothérapie est nécessaire. Notre objectif consiste à améliorer la norme de soins de l’HTA en soins de première ligne au Canada. Un diagnostic exact et un traitement optimal de l’HTA peuvent réduire le nombre d’événements cardiovasculaires indésirables ainsi que le risque de décès.

Chronic myelomonocytic leukemia (CMML) is a complex clonal hematological disorder classified among myelodysplastic (MDS)/myeloproliferative neoplasms. Prognosis is poor and there is a lack of effective treatments. The hypomethylating agent decitabine has shown activity against MDS and elderly acute myeloid leukemia, but there is little data focusing specifically on its efficacy in CMML. In this prospective, phase 2 Italian study, CMML patients received intravenous decitabine 20 mg/m2 per day on Days 1-5 of a 28-day treatment cycle. Response was evaluated after four and six cycles; patients responding at the end of six cycles could continue treatment with decitabine. Forty-three patients were enrolled; >50% were high-risk according to four CMML-specific scoring systems. In the intent-to-treat population (n=42), the overall response rate after six cycles was 47.6%, with seven complete responses (16.6%), eight marrow responses (19%), one partial response (2.4%) and four hematological improvements (9.5%). After a median follow-up of 51.5 months (range: 44.4-57.2), median overall survival was 17 months, with responders having a significantly longer survival than non-responders (P=0.02). Grade 3/4 anemia, neutropenia and thrombocytopenia occurred in 28.6%, 50% and 38% of patients, respectively. Decitabine appears to be an effective and well-tolerated treatment for patients with high-risk CMML.

Osteoporosis, a disorder that affects millions of people worldwide, is characterized by decreased bone mass and microstructural alterations giving rise to an increased risk of fractures. Osteoporotic fractures can cause acute and chronic pain that mainly affects elderly patients with multiple comorbidities and commonly on different drug regimens. The aim of this paper is to summarize the pathogenesis and systemic treatment of osteoporotic pain. This narrative review summarizes the main pathogenetic aspects of osteoporotic pain and the cornerstones of its treatment. Osteoporotic fractures induce both acute and chronic nociceptive and neuropathic pain. Central sensitization seems to play a pivotal role in developing and maintaining chronicity of post-fracture pain in osteoporosis. Antiosteoporosis drugs are able to partially control pain, but additional analgesics are always necessary for pain due to bone fractures. Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors reduce acute pain but with a poor effect on the chronic neuropathic component of pain and with relevant side effects. Opioid drugs can control the whole spectrum of acute and chronic bone pain, but they differ with respect to their efficacy on neuropathic components, their tolerability and safety. Chronic pain after osteoporotic fractures requires a multifaceted approach, which includes a large spectrum of drugs (antiosteoporosis treatment, acetaminophen, NSAIDs, selective COX-2 inhibitors, weak and strong opioids) and non-pharmacological treatment. Based on a better understanding of the pathogenesis of osteoporotic and post-fracture pain, a guided stepwise approach to post-fracture osteoporotic pain will also better meet the needs of these patients.

Xylan is the principal type of hemicellulose. It is a linear polymer of β-D-xylopyranosyl units linked by (1–4) glycosidic bonds. In nature, the polysaccharide backbone may be added to 4-O-methyl-α-D-glucuronopyranosyl units, acetyl groups, α-L-arabinofuranosyl, etc., in variable proportions. An enzymatic complex is responsible for the hydrolysis of xylan, but the main enzymes involved are endo-1,4-β-xylanase and β-xylosidase. These enzymes are produced by fungi, bacteria, yeast, marine algae, protozoans, snails, crustaceans, insect, seeds, etc., but the principal commercial source is filamentous fungi. Recently, there has been much industrial interest in xylan and its hydrolytic enzymatic complex, as a supplement in animal feed, for the manufacture of bread, food and drinks, textiles, bleaching of cellulose pulp, ethanol and xylitol production. This review describes some properties of xylan and its metabolism, as well as the biochemical properties of xylanases and their commercial applications.

Many area book stores are now hosting a variety of reading groups, and people like Stone and Irons are getting together on their own to discuss books. Participants are often inspired by Oprah Winfrey, who in the past several years has trumpeted books and books club through her media empire, but all share a common factor: a love of reading.