To summarize recent findings regarding the characterization of lipoprotein disturbances in nonalcoholic fatty liver disease (NAFLD) and their relationship with cardiovascular disease (CVD) and make ...recommendations for the management of this situation.
Advanced lipoprotein profile (using NMR spectroscopy) has shown profound lipoprotein derangements which are overlooked with conventional analyses: increased number and size of very low-density lipoproteins particles, increased number of low-density lipoprotein particles (especially small sized), smaller high-density lipoprotein particles, and an increase in the triglyceride content of all these lipoproteins. Other changes such as impaired functionality of high-density lipoprotein particles have also been observed. Beyond low-density lipoprotein-related parameters, the importance of triglyceride-rich lipoproteins in the pathogenesis of atherosclerosis has recently gained interest. Several studies suggest that these lipoproteins may have an independent role in CVD in NAFLD populations. Although outcome studies with lipid-lowering drugs in NAFLD are lacking, treatment with both statins, and especially, triglyceride-lowering drugs could be promising for these populations at high residual cardiovascular risk.
In addition to being the main determinant of dyslipidemia, disturbances in triglyceride-rich lipoproteins are thought to be the key factor of increased CVD risk in NAFLD. Treatments specifically aimed at modifying these derangements warrant further study in this high-risk population.
Objectives: To estimate the efficacy of computer-based cognitive interventions for improving cognition in people with dementia (PWD).
Method: Online literature databases were searched for relevant ...studies. Interventions were categorised as follows: cognitive recreation, cognitive rehabilitation, cognitive stimulation or cognitive training. A systematic review, quality assessment and meta-analyses were conducted.
Results: Twelve studies were identified. Their methodological quality was acceptable according to Downs & Black criteria, the weakest methodological area being the external validity. The meta-analyses indicated cognitive interventions lead to beneficial effects on cognition in PWD (SMD −0.69; 95% CI = −1.02 to −0.37; P < 0.0001; I
2
= 29%), depression (SMD 0.47; 95% CI = 0.16 to 0.78; p = 0.003; I
2
= 0%) and anxiety (SMD 0.55; 95% CI = 0.07 to 1.04; P < 0.03; I
2
= 42%). They benefited significantly more from the computer-based cognitive interventions than from the non-computer-based interventions in cognition (SMD 0.48; 95% CI = 0.09 to 0.87; P = 0.02; I
2
= 2%).
Conclusion: Computer-based cognitive interventions have moderate effects in cognition, and anxiety and small effects in depression in PWD. No significant effects were found on activities of daily living. They led to superior results compared to non-computer-based interventions in cognition. Further research is needed on cognitive recreation and cognitive stimulation. There is also a need for longer-term follow-up to examine the potential retention of treatment effects, and for the design of specific outcome measures.
Arbuscular mycorrhizas are one of the most frequent mutualisms in terrestrial ecosystems. Although studies on plant mutualistic interaction networks suggest that they may leave their imprint on plant ...community structure and dynamics, this has not been explicitly assessed. Thus, in the context of plant‐fungi interactions, studies explicitly linking plant‐mycorrhizal fungi interaction networks with key ecological functions of plant communities, such as recruitment, are lacking.
In this study, we analyse, in two Mediterranean forest communities of southern Iberian Peninsula, how plant‐arbuscular mycorrhizal fungi (AMF) networks modulate plant‐plant recruitment interaction networks. We use a new approach integrating plant‐AMF and plant recruitment networks into a single multilayer structure. We also develop a new metric (Interlayer Node Neighbourhood Integration, INNI) to explore the impact of a given node on the structure across layers.
The similarity of plant species in their AMF communities is positively related to the observed frequency of recruitment interactions in the field. Results reveal that properties of plant‐AMF networks, such as plant degree and centrality, can explain about the properties of plant recruitment network, such as in‐ and out‐degree (i.e. sapling bank and canopy service) and its modular structure. However, these relationships differed between the two forest communities. Finally, we identify particular AMF that contribute to integrate the neighbourhood of recruitment interactions between plants.
This multilayer network approach is useful to explore the role of plant‐AMF interactions on recruitment, a key ecosystem function enhanced by fungi. Results provide evidence that the complex structure of plant‐AMF interactions impacts functional and structurally plant‐plant interactions, which in turn may potentially influence plant community dynamics, through their effects on the structure of the recruitment network.
Read the free Plain Language Summary for this article on the Journal blog.
Read the free Plain Language Summary for this article on the Journal blog.
To evaluate the concordance between the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD (ESC/EASD-2019) and the Steno T1 Risk ...Engine (Steno-Risk) cardiovascular risk scales for individuals with type 1 diabetes (T1D) without cardiovascular disease (CVD) and to analyze the relationships of their use with identification of preclinical atherosclerosis.
We consecutively selected patients with T1D, without CVD, age ≥40 years, with nephropathy, and/or with ≥10 years of T1D evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated in accord with ESC/EASD-2019 risk groups (moderate/high/very high) and the Steno-Risk (<10%, low; 10-20%, moderate; ≥20%, high), as T1D-specific scores. In an exploratory analysis, we also evaluated the non-T1D-specific 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (ACC/AHA-2013) pooled cohort equation for individuals between 40 and 79 years of age.
We included 501 patients (53% men, mean age 48.8 years, median T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (κ = 0.19). A stepped increase in the presence of plaques according to Steno-Risk category was seen (18.4%, 38.2%, and 64.1%, for low, moderate, and high risk, respectively; P for trend <0.001), with no differences according to ESC/EASD-2019 (P = 0.130). Steno-Risk identified individuals with plaques, unlike ESC/EASD-2019 (area under the curve AUC 0.691, P < 0.001, vs. AUC 0.538, P = 0.149). Finally, in polynomial regression models (with adjustment for lipid parameters and cardioprotective treatment), irrespective of the ESC/EASD-2019 category, high risk by Steno-Risk was directly associated with atherosclerosis (in moderate/high-risk by ESC/EASD-2019 odds ratio 2.91 95% CI 1.27-6.72 and 4.94 2.35-10.40 for the presence of plaque and two or more plaques). Similar results were obtained with discordant higher Steno-Risk versus ACC/AHA-2013 (P < 0.001).
Among T1D patients undergoing primary prevention, use of Steno-Risk seems to result in better recognition of individuals with atherosclerosis in comparison with ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk.
Although plant–soil feedback (PSF) is being recognized as an important driver of plant recruitment, our understanding of its role in species coexistence in natural communities remains limited by the ...scarcity of experimental studies on multispecies assemblages. Here, we experimentally estimated PSFs affecting seedling recruitment in 10 co‐occurring Mediterranean woody species. We estimated weak but significant species‐specific feedback. Pairwise PSFs impose similarly strong fitness differences and stabilizing‐destabilizing forces, most often impeding species coexistence. Moreover, a model of community dynamics driven exclusively by PSFs suggests that few species would coexist stably, the largest assemblage with no more than six species. Thus, PSFs alone do not suffice to explain coexistence in the studied community. A topological analysis of all subcommunities in the interaction network shows that full intransitivity (with all species involved in an intransitive loop) would be rare but it would lead to species coexistence through either stable or cyclic dynamics.
Plant–soil feedbacks (PSFs) impose similarly strong fitness differences and stabilizing‐destabilizing forces, most often impeding species coexistence. At the community level, PSFs alone do not explain coexistence in species‐rich communities. A topological analysis of the PSF interactions network shows that full intransitivity would be rare in the studied community, but is certainly required to guarantee species coexistence.
Bilirubin is a potent antioxidant that has been inversely related to cardiovascular disease. There is little information on serum total bilirubin (TB) in relation to atherosclerosis in familial ...dyslipidemia. We assessed the association between TB and carotid and femoral atherosclerosis in this high-risk group.
We evaluated 464 individuals with familial dyslipidemia (56% men; median age, 48 years), 322 with familial hypercholesterolemia, and 142 with familial combined hyperlipidemia. Carotid and femoral arteries were imaged bilaterally with a standardized ultrasonographic protocol. Mean and maximum intima-media thickness and plaque presence (≥1.2 mm) and height were recorded. Cross-sectional associations between TB and atherosclerosis variables were investigated in multivariable-adjusted models, including lipid values and hypolipidemic drug use. Inflammatory markers (C-reactive protein, total leukocyte count, and lipoproteina) were also determined. Increasing TB levels were associated with decreasing intima-media thickness of all carotid segments (
<0.05, all). TB also related to carotid plaque, present in 78% of individuals, and to plaque burden (≥3 plaques), with odds ratios (95% confidence interval) 0.59 (0.36-0.98) and 0.57 (0.34-0.96) for each increase of 0.5 mg in TB, respectively. Findings were confirmed in a validation cohort of 177 subjects with nonfamilial dyslipidemia. Only the familial combined hyperlipidemia group, with higher inflammation-related markers, showed an inverse association between TB and femoral plaque height (β=-0.183;
=0.030).
TB was inversely and independently associated with carotid plaque burden in familial and nonfamilial dyslipidemia. These findings support the use of TB as a biomarker of atherosclerosis in this high-risk group.
Seed dispersal by frugivores plays a key role in structuring and maintaining tree diversity in forests. However, little is known about how the spatial legacy of seed dispersal and early recruitment ...shapes spatial patterns and the spatial interaction network of plant species in mature forest communities.
We analysed two fully mapped mixed Pine–Oak forest communities using spatial point pattern analysis to determine (a) the detailed structure of the intraspecific spatial patterns of saplings and adults, (b) the intra‐ and interspecific spatial interaction of saplings, adults and saplings relative to adults, (c) the spatial patterns of species richness at the community level and (d) whether seed dispersal mechanisms affect the plant–plant interaction networks and the ratio of adult to sapling neighbourhood densities used as surrogate for spatial self‐thinning.
The intraspecific spatial patterns of saplings and adults showed in general complex nested cluster structures that were similar for sapling and adult stages, despite substantial self‐thinning in some dry‐fruited species. The spatial network of saplings was characterized by positive spatial interactions. Adults of several tree species facilitated saplings in their proximity; however, adults of dry‐fruited species, but not those of fleshy‐fruited ones, lost almost all positive interactions that occurred at the sapling stage. Besides, interaction strength between adults was positive and often significantly stronger if both species were fleshy‐fruited. At the community level, the forests were structured into multispecies clumps across all life stages.
Synthesis. Our analyses highlight the importance of the spatial legacy of seed dispersal and early recruitment in the assembly of plant communities. Particularly, animal seed dispersal can lead to multispecies clusters and positive spatial associations across life stages in Mediterranean forests, with surprisingly little signatures of negative interactions. Our analysis suggests that changes of the spatial structure across plant life stages are driven by seed dispersal mechanisms and subsequent spatial self‐thinning, generating a spatial footprint at the sapling stage that conditions the long‐term interactions between adult plants. Combining spatial point pattern analysis with network analysis and species traits is a promising way to disentangle the processes underlying observed patterns of local diversity.
Our analyses highlight the importance of the spatial legacy of seed dispersal and early recruitment in the assembly of plant communities. Particularly, animal seed dispersal can lead to multispecies clusters and positive spatial associations across life stages in Mediterranean forests, with surprisingly little signatures of negative interactions. Our analysis suggests that changes of the spatial structure across plant life stages are driven by seed dispersal mechanisms and subsequent spatial self‐thinning, generating a spatial footprint at the sapling stage that conditions the long‐term interactions between adult plants. Combining spatial point pattern analysis with network analysis and species traits is a promising way to disentangle the processes underlying observed patterns of local diversity.
The excess risk of fatal and non-fatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes (T1D).
To evaluate the impact of preeclampsia and parity on sex-based ...discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale.
Cross-sectional study.
Single tertiary hospital.
728 T1D (48.5% women) without cardiovascular disease and age ≥40 years, nephropathy, and/or ≥10 years of diabetes duration with another risk factor.
Standardized carotid ultrasonography.
Carotid plaque determined by ultrasonography and cardiovascular risk estimated according to the Steno T1 Risk Engine (Steno-Risk).
Nulliparous women and parous women without previous preeclampsia had a lower risk for carotid plaque than men (adjusted odds ratio OR: 0.48, 95% confidence interval 0.28-0.82; adjusted OR: 0.51 0.33-0.79, respectively), without differences in the preeclampsia group. The prevalence of carotid plaque increased as the estimated cardiovascular risk increased in all subgroups except for preeclampsia group. The area under the curve (AUC) of the Steno-Risk for identifying ≥2 carotid plaques was lower in the preeclampsia group (men: 0.7886, nulliparous women: 0.9026, women without preeclampsia: 0.8230, preeclampsia group: 0.7841; p between groups=0.042). Neither the addition of parity nor preeclampsia in the Steno-Risk led to a statistically significant increase in the AUC.
The risk for carotid plaque in women compared to men decreased as exposure to obstetric factors diminished. However, the addition of these factors did not improve the prediction of the Steno-Risk.
People with type 1 diabetes (T1D) have a high cardiovascular disease (CVD) risk, which remains the leading cause of death in this population. Despite the improved control of several classic risk ...factors, particularly better glycaemic control, cardiovascular morbidity and mortality continue to be significantly higher than in the general population. In routine clinical practice, estimating cardiovascular risk (CVR) in people with T1D using scales or equations is often imprecise because much of the evidence comes from pooled samples of people with type 2 diabetes (T2D) and T1D or from extrapolations of studies performed on people with T2D. Given that T1D onsets at a young age, prolonged exposure to the disease and its consequences (e.g., hyperglycaemia, changes in lipid metabolism or inflammation) have a detrimental impact on cardiovascular health. Therefore, it is critical to have tools that allow for the early identification of those individuals with a higher CVR and thus be able to make the most appropriate management decisions in each case. In this sense, atherosclerosis is the prelude to most cardiovascular events. People with diabetes present pathophysiological alterations that facilitate atherosclerosis development and that may imply a greater vulnerability of atheromatous plaques. Screening for subclinical atherosclerosis using various techniques, mainly imaging, has proven valuable in predicting cardiovascular events. Its use enables the reclassification of CVR and, therefore, an individualised adjustment of therapeutic management. However, the available evidence in people with T1D is scarce. This narrative review provides and updated overview of the main non-invasive tests for detecting atherosclerosis plaques and their association with CVD in people with T1D.
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