IntroductionCognitive dysfunction is a key component of addictive disorders. With heroin addiction, specific deficits in salience attribution and inhibitory control emerge during long-term drug abuse and promote heroin relapse during withdrawal.1 Although most heroin-dependent individuals are willing to quit, available interventions for heroin addiction have shown only limited efficacy so far. Methadone maintenance treatment programs (MMTPs) are a common treatment approach thought to be effective for heroin addiction; however, the heroin-dependent patients in MMTPs are at high risk for relapse, with about 70% of individuals relapsing once they leave such a program.2 Despite the high relapse rate, few neuroimaging studies so far have addressed the neural predictors of risk for heroin relapse. Studies using task-related functional MRI (fMRI) have shown some usefulness in identifying relapse predictors 3-5 or quitting predictors. 6,7 For example, a previous study by our group showed that drugrelated cues induced activity of the nucleus accumbens/ subcallosal cortex and that the cerebellum was associated with subsequent relapse in heroin-dependent individuals. 3Brain activity associated with error processing was shown to predict relapse in cocaine-dependent patients.4 Disrupted ventromedial prefrontal function was shown to be associated with relapse in alcohol-dependent patients.5 Greater response of the medial prefrontal cortex and precuneus to self-related tailored smoking-cessation messages was shown to be associated with quitting. 6 And pretreatment medial prefrontal cortical response to heroin-related cues was shown to be associated with greater adherence to injectable extended-release naltrexone.7 However, more effective imaging markers that We conducted a prospective resting-state functional MRI study comparing the functional connectivity strength among healthy controls and heroin-dependent men who had either relapsed or were in early remission. Men were considered to be either relapsed or in early remission based on urine drug screens during a 3-month follow-up period. We also examined how the coupling of large-scale networks correlated with relapse behaviour among heroin-dependent men. Results: We included 20 controls and 50 heroin-dependent men (26 relapsed and 24 early remission) in our analyses. The relapsed men showed greater connectivity than the early remission and control groups between the dorsal anterior cingulate cortex (key node of the SN) and the dorsomedial prefrontal cortex (included in the DMN). The relapsed men and controls showed lower connectivity than the early remission group between the left dorsolateral prefrontal cortex (key node of the left ECN) and the dorsomedial prefrontal cortex. The percentage of positive urine drug screens positively correlated with the coupling between the dorsal anterior cingulate cortex and dorsomedial prefrontal cortex, but negatively correlated with the coupling between the left dorsolateral prefrontal cortex and dorsomedial prefrontal cortex. Limitations:...

BackgroundThe problem of population aging is a critical public health concern in modern China, and more tuberculosis (TB) control efforts are needed to reach elderly people at high priority. In this study, we aim to determine the prevalence and identify the risk factors of TB among elderly people in China.MethodsA multistage cluster-sampled cross-sectional survey was conducted in 2013, and 27 clusters were selected from 10 counties of 10 provinces in China. All consenting participants greater than or equal to 65 years of age were screened for pulmonary TB with a chest X-ray (CXR) and a symptom questionnaire. Three sputum specimens for bacteriological examination by microscopy and culture were collected from those whose screening was positive. Prevalence was calculated, a multiple logistic regression model was performed to confirm the risk factors, and population attributable fraction (PAF) of each risk factor was calculated to indicate the public health significance.ResultsOf 38 888 eligible people from 27 clusters, 34 269 participants finished both questionnaire and physical examination. There were 193 active pulmonary TB cases, 62 of which were bacteriologically confirmed. The estimated prevalence of active pulmonary TB and bacteriologically confirmed TB in those 65 years of age and older was 563.19 per 100 000 (95% CI: 483.73–642.65) and 180.92 per 100 000 (95% CI: 135.89–225.96), respectively. Male sex, older age, living in rural areas, underweight, diabetes, close contact of pulmonary TB (PTB) and previous TB history are all risk factors for TB. The risk of TB increased with increasing age and decreasing body mass index (BMI) after adjusting for other factors, and there is a positive dose–response relationship.ConclusionsIn China, active case finding (ACF) could be implemented among elderly people aged 65 and above with underweight, diabetes, close contact history and previous TB history as a priority, which will get significant yields and be cost-effective.Electronic supplementary materialThe online version of this article (10.1186/s40249-019-0515-y) contains supplementary material, which is available to authorized users.

Limited evidence exists concerning the impact of particulate pollution on acute respiratory distress syndrome (ARDS). We examined the effects of particulate pollution on emergency ambulance dispatches (EAD) for ARDS in Guangzhou, China. Daily air pollution concentrations for PM, PM, and PM, as well as PM chemical compositions, were available from a central air monitoring station. The association between incident ARDS and air pollution on the concurrent and previous 5 days was estimated by an over-dispersed Poisson generalized additive model controlling for meteorological factors, temporal trends, public holidays and day of the week. We identified a total of 17,002 EADs for ARDS during the study period. There were significant associations between concentrations of PM, PM, PM and ARDS; corresponding excess risk (ER) for an interquartile range IQR increase in 1-day lagged concentration was 5.45% [95% confidence interval (CI): 1.70%, 9.33%] for PM (45.4 μg/m), 4.71% (95% CI: 1.09%, 8.46%) for PM (31.5 μg/m), and 4.45% (95% CI: 0.81%, 8.23%) for PM (28.8 μg/m), respectively. For PM chemical compositions, we found that OC, EC, sulfate and ammonium were significantly associated with ARDS. The observed effects remained even after adjusting for potentially confounding factors. This study suggests that PM, PM and PM, as well as chemical constituents from combustion and secondary aerosols might be important triggers of ARDS in Guangzhou.

IntroductionCognitive deficits caused by heroin‐induced white matter (WM) impairments hinder addicts' engagement in and benefit from treatment. The predictive value of WM integrity in heroin addicts during methadone maintenance treatment (MMT) for future relapse is unclear.MethodsForty‐eight MMT patients were given baseline diffusion tensor imaging scans and divided into heroin relapsers (HR, 25 cases) and abstainers (HA, 23 cases) according to the results of 6‐month follow‐up. Intergroup comparisons were performed for fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). The correlation between diffusion tensor imaging indices and the degree of heroin relapse was analyzed.ResultsCompared with HA group, HR group had reduced FA in the right retrolenticular part, left anterior and posterior limb of internal capsule, bilateral anterior corona radiata, and right external capsule. Three out of the six regions showed increased RD, with no changes in AD. The FA and AD values in the left posterior limb of internal capsule correlated negatively with the heroin‐positive urinalysis rate within follow‐up.ConclusionsLower WM integrity in MMT patients may add to neurobiological factors associated with relapse to heroin use. Strategies for improving WM integrity provide a new perspective to prevent future relapse to heroin abuse.

Our findings suggest that abnormal functional connectivity within the anterior subnetwork of DMN in heroin-dependent individuals is associated with basal heroin craving, and it may serve as neural underpinnings for the mechanism of heroin addiction.