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Lumbar puncture is a common procedure performed by emergency physicians and trainees. The optimal patient positioning for lumbar puncture procedures has not been studied adequately. We performed a prospective randomized study in an urban, level I academic trauma center. Patients of all ages were included. Patients were randomized to either lateral decubitus or upright positioning. Patient demographic characteristics, level of physician training and experience, number of needle insertions and redirections, need for repositioning, alternative operator use, and laboratory results of the cerebrospinal fluid were recorded. We compared the success rate of each position as our primary outcome measure. We also evaluated number of needle insertions and re-directions and success rates based on experience and patient age. A total of 116 patients were enrolled, with 55 patients assigned to lateral decubitus and 61 to upright position for initial lumbar puncture attempt. Spinal fluid was obtained successfully in 47 of the lateral decubitus group (85.5%; 95% CI 73.8–92.4%) vs. 49 (80.3%; 95% CI 68.7–88.4%) in the upright assignment group. Comparable results were also obtained for first-pass success, number of failures, and number of bloody taps. Postgraduate year 2 residents or those with 31–50 previous lumbar punctures had the highest success rates at 94.3% (95% CI 81.2–98.4%) and 90.3% (95% CI 75.1–96.7%), respectively. Lateral decubitus and upright positioning for emergency lumbar puncture yielded equal success rates in emergency physicians and trainees. [ABSTRACT FROM AUTHOR]

Introduction: Some studies report that assessing regional 123I-cardiac MIBG uptake can aid in the diagnosis of Lewy body disease, but others report heterogeneity in healthy controls. We aimed to evaluate regional cardiac MIBG uptake patterns in healthy older adults and patients with dementia.Methods: 31 older adults with normal cognition, 15 Alzheimer's disease (AD), and 17 Dementia with Lewy bodies (DLB) patients were recruited. 5 individuals had previous myocardial infarction. Participants with sufficient cardiac uptake for regional SPECT analysis (29/31 controls, 15/15 AD, 5/17 DLB) had relative uptake pattern recorded. Controls were assessed for risk of future cardiovascular events using QRISK2, a validated online tool.Results: In controls uptake was reduced in the inferior wall (85%), apex (23%), septum (15%), and lateral wall (8%). AD and DLB showed similar patterns to controls. Lung or liver interference was present in 61% of cases. Myocardial infarction cases showed regional reductions in uptake, but normal/borderline planar uptake. In controls, there was no relationship between cardiovascular risk score and uptake pattern.Conclusions: Significant variability of regional cardiac 123I-MIBG uptake is common in cases with normal planar cardiac uptake. Heterogeneity of regional uptake appears non-specific and unlikely to aid in the diagnosis of Lewy body disease. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to investigate the expression of genes in Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), both at the mild cognitive impairment (MCI) and dementia stages, to improve our understanding of disease pathophysiology and investigate the potential for diagnostic and prognostic biomarkers based on mRNA expression.Design: Cross-sectional observational study.Setting: University research center.Participants: People with MCI with Lewy bodies (MCI-LB, n=55), MCI-AD (n=19), DLB (n=38), AD (n=24) and a cognitively unimpaired comparison group (n=28).Measurements: Ribonucleic acid sequencing of whole blood. Differentially expressed genes (DEGs) were identified and gene set enrichment analysis was carried out.Results: Compared with the cognitively unimpaired group, there were 22 DEGs in MCI-LB/DLB and 61 DEGs in MCI-AD/AD. DEGS were also identified when comparing the two disease groups. Expression of ANP32A was associated with more rapid cognitive decline in MCI-AD/AD. Gene set enrichment analysis identified downregulation in gene sets including MYC targets and oxidative phosphorylation in MCI-LB/DLB; upregulation of immune and inflammatory responses in MCI-AD/AD; and upregulation of interferon-α and -γ responses in MCI-AD/AD compared with MCI-LB/DLB.Conclusion: This study identified multiple DEGs in MCI-LB/DLB and MCI-AD/AD. One of these DEGs, ANP32A, may be a prognostic marker in AD. Genes related to mitochondrial function were downregulated in MCI-LB/DLB. Previously reported upregulation of genes associated with inflammation and immune responses in MCI-AD/AD was confirmed in this cohort. Differences in interferon responses between MCI-AD/AD and MCI-LB/DLB suggest that there are key differences in peripheral immune responses between these diseases. [ABSTRACT FROM AUTHOR]

Mycotoxins are toxins produced by toxigenic fungi and are potentially present in different feed and foodstuffs, including animal products, with the latter typically resulting from carry-over from feedstuffs. These toxins have been linked to various human health issues, including reduced immunity and liver cancer. The production of these toxins is dependent on several factors, including weather conditions like temperature and precipitation, which in turn may be influenced by climate change. This review undertakes a systematic approach to identify scientific studies that assess mycotoxin production in feed and cereals which may be influenced by weather variables or climate change scenarios. It also looks at human health risk assessments carried out in the past 20 years related to mycotoxins detected in animal products and the degree to which climate change influences are captured in these risk assessments. This review presents a state of the art with regards to risk assessment and modelling approaches to managing mycotoxin contamination in the light of climate change influences. There are very limited human health risk assessments looking at mycotoxin contamination of animal products under climate change influences, whereas a few predictive crop-toxin models considered future climate change scenarios. Predictive crop-toxin models can be used in conjunction with health risk assessments to evaluate mycotoxin risk in animal products under future climate change scenarios. The review identifies scientific gaps including the need for better integration of mycotoxin predictive models, risk assessment and climate change variables to better understand potential climate change influences on food safety. • Climate change is expected to impact mycotoxin levels in animal feed and products. • Climate change effects on risk assessments and prediction models are reviewed. • Mycotoxin contamination in cereals is expected to increase in the future. • Risk to human health from aflatoxin contamination in milk may increase. • Integration of risk assessment and predictive models is required. [ABSTRACT FROM AUTHOR]

Objective: We explored whether the mild cognitive impairment (MCI) stages of dementia with Lewy bodies (DLB) and Alzheimer disease (AD) differ in their cognitive profiles, and longitudinal progression.Design: A prospective, longitudinal design was utilized with annual follow-up (Max 5 years, Mean 1.9, standard deviation 1.1) after diagnosis. Participants underwent repeated cognitive testing, and review of their clinical diagnosis and symptoms, including evaluation of core features of DLB.Setting: This was an observational study of independently living individuals, recruited from local healthcare trusts in North East England, UK.Participants: An MCI cohort (n = 76) aged ≥60 years was utilized, differentially diagnosed with MCI due to AD (MCI-AD), or possible/probable MCI with Lewy bodies (MCI-LB).Measurements: A comprehensive clinical and neuropsychological testing battery was administered, including ACE-R, trailmaking tests, FAS verbal fluency, and computerized battery of attention and perception tasks.Results: Probable MCI-LB presented with less impaired recognition memory than MCI-AD, greater initial impairments in verbal fluency and perception of line orientation, and thereafter demonstrated an expedited decline in visuo-constructional functions in the ACE-R compared to MCI-AD. No clear diagnostic group differences were found in deterioration speeds for global cognition, language, overall memory, attention or other executive functions.Conclusion: These findings provide further evidence for differences in severity and decline of visuospatial dysfunctions in DLB compared with AD; further exploration is required to clarify when and how differences in attention, executive, and memory functions emerge, as well as speed of decline to dementia. [ABSTRACT FROM AUTHOR]