ObjectiveTo evaluate the effect of aerobic exercise training on asthma control, lung function and airway inflammation in adults with asthma.DesignSystematic review and meta-analysis (PROSPERO-ID: CRD42019130156)MethodsEligibility criteria: Randomised controlled trials investigating the effect of at least 8 weeks of aerobic exercise training on outcomes for asthma control, lung function and airway inflammation in adults with asthma. Information sources: Medline, EMBase, CINAHL, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to 3 April 2019. Risk of bias: Risk of bias was assessed by the “Cochrane Risk of Bias Tool”.ResultsIncluded studies: We included 11 studies with a total of 543 adults with asthma. Participants' mean age was 36.5 years (range: 22 to 54 years); 74.8% of participants were women and the mean body mass index (BMI) was 27.6 kg·m−2 (range: 23.2 to 38.1 kg·m−2). Interventions had a median duration of 12 weeks (range: 8 to 12 weeks) and included walking, jogging, spinning, treadmill running and other unspecified exercise training programmes. Synthesis of results: Exercise training improved asthma control with a standard mean difference (SMD) of −0.48 (−0.81 to −0.16). Lung function slightly increased with an SMD of −0.36 (−0.72 to 0.00) in favour of exercise training. Exercise training had no apparent effect on markers of airway inflammation [SMD: −0.03 (−0.41 to 0.36)].ConclusionsIn adults with asthma, aerobic exercise training has potential to improve asthma control and lung function but not airway inflammation.

Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may cause adverse events, and potential consequences for patients' safety call for further investigation.

Experimental and clinical data have suggested that abnormalities in the serotonergic neurotransmissions in frontal-subcortical circuits are involved in Tourette's syndrome. To test the hypothesis that the brain's 5-HT2A receptor binding is increased in patients with Tourette's syndrome, PET imaging was performed. Twenty adults with Tourette's syndrome and 20 healthy control subjects were investigated with PET-[18F]altanserin using a bolus-infusion protocol. Regions of interest were delineated automatically on co-registered MRI images, and partial volume-corrected binding parameters were extracted from the PET images. Comparison between control subjects and Tourette's syndrome patients showed increased specific [18F]altanserin binding, not only in the a-priori selected brain regions hypothesized to be involved in Tourette's syndrome, but also post-hoc analysis showed a global up-regulation when testing for a overall difference with a randomization test (p<0.03). Increased 5-HT2A receptor binding was found not only in regions closely related to subcortical regions in patients with Tourette's syndrome, but also in most other brain regions. Our data suggest that the serotonergic transmitter system is pathophysiologically involved in Tourette's syndrome and that a clinical trial with 5-HT2A receptor antagonists may be justified.

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The effectiveness of drugs that have a specific effect on the activity of the serotonergic neurotransmitter systemhas changed the outlook for patients suffering from obsessive-compulsive disorder (OCD). With a response rate of about 70% to such compounds and the great amount of brain imaging studies conducted over the past decades, an understanding of the biochemical nature and origins of OCD is beginning to unfold. Convergent data including ethological and experimental observations, clinico-pathological findings and different imaging methods have implicated the basal ganglia along with the cortical and related thalamic structures to be involved in the pathophysiology of OCD. In a previous study using the quantitative electroencephalographic (QEEG) method known as neurometrics, in which QEEG data from OCD patients were compared statistically with those from an age-appropriate normative population, two subtypes within a clinically homogeneous patient group were classified. Patients with relative excess theta activity, especially in the frontal regions, were nonresponders to treatment with serotonin reuptake inhibitors (SSRI), while those with increased relative power in alpha activity were responders to pharmacological treatment. These findings suggested at least two subgroups in a patient population with similar symptoms but differential responses to treatment. In the present study we used neurometric QEEG to subtype a group of 20 non-depressed OCD patients, fulfilling DSM-R-III criteria, treated with paroxetine, of whom 18 were responders to treatment. Of the treatment responders, 94.4% were predicted by subtype membership to be SSRI responsers. In these subjects there was a strong relative alpha baseline activity; after successful treatment through at least 3 months this activity decreased, looking more normal. The group average topographic maps showed none of the characteristics seen in the nonresponder cluster (no excess relative power in theta). As in the previous investigation, baseline QEEG profile membership points to a predictive value with regard to therapeutic response.

Several neuroimaging studies of patients with OCD have pointed to basal ganglia and the frontal cortical regions being relevant for an understanding of the pathophysiology and therapy of OCD. In a search for the neural substrate underlying the therapeutic action of paroxetine in the therapy of OCD we measured regional glucose metabolism in a PET study of 20 OCD patients before and after at least 3 months of treatment. We used 18-fluoro-deoxyglucose PET-scanning to measure regional cerebral glucose metabolic rate (rCMRglc) in 20 non-depressed patients fulfilling DSM-IV criteria for OCD. Patients were studied before and after 12-20 wk of treatment with the serotonin re-uptake inhibitor paroxetine. Clinical assessment rating with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was performed before the first and after the second study. The PET data was analysed regionally using statistical parametric mapping (SPM-96). A clinical improvement was indicated by a mean decrease of 55 % in the Y-BOCS score. There was no difference in global cerebral metabolism before and after treatment whereas a post-treatment reduction in normalized rCMRglc was found in the right caudate nucleus. This finding also showed a significant positive correlation with symptom severity. Our results support hypotheses regarding a malfunction of the cortico-striato-thalamic system in the pathophysiology of OCD and particularly point to the caudate nucleus playing an important role for the therapeutic action of paroxetine in the treatment of OCD.

IntroductionPatients with obstructive lung diseases are possibly at risk of developing severe outcomes of COVID-19. Therefore, the aim with this study was to determine the risk of severe outcomes of COVID-19 among patients with asthma and COPD.MethodsWe performed a nationwide cohort study including patients with COVID-19 from February 1 to July 10, 2020. All patients with COVID-19 registered in the Danish registers were included. With ICD-codes and medication history, patients were divided into asthma, COPD or no asthma or COPD. Primary outcome was a combined outcome of severe COVID-19, intensive care or death.ResultsAmong 5104 patients with COVID-19 (median age 54.8 years (25–75th% 40.5 to 72.3); women, 53.0%), 354 had asthma and 432 COPD. The standardised absolute risk of the combined endpoint was 21.2% (95% CI 18.8 to 23.6) in patients with COPD; 18.5% (95% CI 14.3 to 22.7) in patients with asthma and 17.2% (95% CI 16.1 to 18.3) in patients with no asthma or COPD. Patients with COPD had slightly increased risk of the combined endpoint compared with patients without asthma or COPD (Risk difference 4.0%; 95% CI 1.3 to 6.6; p=0.003). In age standardised analyses, there were no differences between the disease groups. Low blood eosinophil counts (<0.3×10^9 cells·liter−1) were associated with increased risk of severe outcomes among patients with COPD.ConclusionPatients with COPD have slightly increased risk of developing severe outcomes of COVID-19 compared with patients without obstructive lung diseases. However, in age standardised analysis, the risk difference disappears.

Gastrostomy feeding tube placement was associated with a high rate of postoperative complications of various grades when the pull-through method was the standard procedure. A consensus on how to report and grade complications arising from this procedure is warranted.