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Simple Drug Packaging Change Could Save Toddlers' Lives

Title: Simple Drug Packaging Change Could Save Toddlers' Lives
Category: Health News
Created: 5/3/2018 12:00:00 AM
Last Editorial Review: 5/3/2018 12:00:00 AM




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AHA News: How Pregnant Woman's High Blood Pressure Can Change Shape of Baby's Heart

Title: AHA News: How Pregnant Woman's High Blood Pressure Can Change Shape of Baby's Heart
Category: Health News
Created: 4/30/2020 12:00:00 AM
Last Editorial Review: 5/1/2020 12:00:00 AM




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AHA News: Nearly Killed in OKC Bombing, She Vowed to Change Her Life

Title: AHA News: Nearly Killed in OKC Bombing, She Vowed to Change Her Life
Category: Health News
Created: 4/16/2020 12:00:00 AM
Last Editorial Review: 4/17/2020 12:00:00 AM




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Could the Weather Swings of Climate Change Make Flu Seasons Worse?

Title: Could the Weather Swings of Climate Change Make Flu Seasons Worse?
Category: Health News
Created: 2/20/2020 12:00:00 AM
Last Editorial Review: 2/21/2020 12:00:00 AM




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Have a Hangover? Try This Herbal Remedy

Title: Have a Hangover? Try This Herbal Remedy
Category: Health News
Created: 5/1/2020 12:00:00 AM
Last Editorial Review: 5/4/2020 12:00:00 AM




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Spring Time Change Tied to More Fatal Car Crashes

Title: Spring Time Change Tied to More Fatal Car Crashes
Category: Health News
Created: 1/30/2020 12:00:00 AM
Last Editorial Review: 1/31/2020 12:00:00 AM




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CDK9 Blockade Exploits Context-dependent Transcriptional Changes to Improve Activity and Limit Toxicity of Mithramycin for Ewing Sarcoma

There is a need to develop novel approaches to improve the balance between efficacy and toxicity for transcription factor–targeted therapies. In this study, we exploit context-dependent differences in RNA polymerase II processivity as an approach to improve the activity and limit the toxicity of the EWS-FLI1–targeted small molecule, mithramycin, for Ewing sarcoma. The clinical activity of mithramycin for Ewing sarcoma is limited by off-target liver toxicity that restricts the serum concentration to levels insufficient to inhibit EWS-FLI1. In this study, we perform an siRNA screen of the druggable genome followed by a matrix drug screen to identify mithramycin potentiators and a synergistic "class" effect with cyclin-dependent kinase 9 (CDK9) inhibitors. These CDK9 inhibitors enhanced the mithramycin-mediated suppression of the EWS-FLI1 transcriptional program leading to a shift in the IC50 and striking regressions of Ewing sarcoma xenografts. To determine whether these compounds may also be liver protective, we performed a qPCR screen of all known liver toxicity genes in HepG2 cells to identify mithramycin-driven transcriptional changes that contribute to the liver toxicity. Mithramycin induces expression of the BTG2 gene in HepG2 but not Ewing sarcoma cells, which leads to a liver-specific accumulation of reactive oxygen species (ROS). siRNA silencing of BTG2 rescues the induction of ROS and the cytotoxicity of mithramycin in these cells. Furthermore, CDK9 inhibition blocked the induction of BTG2 to limit cytotoxicity in HepG2, but not Ewing sarcoma cells. These studies provide the basis for a synergistic and less toxic EWS-FLI1–targeted combination therapy for Ewing sarcoma.




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Climate Change as a Social Determinant of Health




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Fluorescence-Reported Allelic Exchange Mutagenesis-Mediated Gene Deletion Indicates a Requirement for Chlamydia trachomatis Tarp during In Vivo Infectivity and Reveals a Specific Role for the C Terminus during Cellular Invasion [Cellular Microbiology: Pat

The translocated actin recruiting phosphoprotein (Tarp) is a multidomain type III secreted effector used by Chlamydia trachomatis. In aggregate, existing data suggest a role of this effector in initiating new infections. As new genetic tools began to emerge to study chlamydial genes in vivo, we speculated as to what degree Tarp function contributes to Chlamydia’s ability to parasitize mammalian host cells. To address this question, we generated a complete tarP deletion mutant using the fluorescence-reported allelic exchange mutagenesis (FRAEM) technique and complemented the mutant in trans with wild-type tarP or mutant tarP alleles engineered to harbor in-frame domain deletions. We provide evidence for the significant role of Tarp in C. trachomatis invasion of host cells. Complementation studies indicate that the C-terminal filamentous actin (F-actin)-binding domains are responsible for Tarp-mediated invasion efficiency. Wild-type C. trachomatis entry into HeLa cells resulted in host cell shape changes, whereas the tarP mutant did not. Finally, using a novel cis complementation approach, C. trachomatis lacking tarP demonstrated significant attenuation in a murine genital tract infection model. Together, these data provide definitive genetic evidence for the critical role of the Tarp F-actin-binding domains in host cell invasion and for the Tarp effector as a bona fide C. trachomatis virulence factor.




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Bottleneck Size-Dependent Changes in the Genetic Diversity and Specific Growth Rate of a Rotavirus A Strain [Genetic Diversity and Evolution]

RNA viruses form a dynamic distribution of mutant swarms (termed "quasispecies") due to the accumulation of mutations in the viral genome. The genetic diversity of a viral population is affected by several factors, including a bottleneck effect. Human-to-human transmission exemplifies a bottleneck effect, in that only part of a viral population can reach the next susceptible hosts. In the present study, two lineages of the rhesus rotavirus (RRV) strain of rotavirus A were serially passaged five times at a multiplicity of infection (MOI) of 0.1 or 0.001, and three phenotypes (infectious titer, cell binding ability, and specific growth rate) were used to evaluate the impact of a bottleneck effect on the RRV population. The specific growth rate values of lineages passaged under the stronger bottleneck (MOI of 0.001) were higher after five passages. The nucleotide diversity also increased, which indicated that the mutant swarms of the lineages under the stronger bottleneck effect were expanded through the serial passages. The random distribution of synonymous and nonsynonymous substitutions on rotavirus genome segments indicated that almost all mutations were selectively neutral. Simple simulations revealed that the presence of minor mutants could influence the specific growth rate of a population in a mutant frequency-dependent manner. These results indicate a stronger bottleneck effect can create more sequence spaces for minor sequences.

IMPORTANCE In this study, we investigated a bottleneck effect on an RRV population that may drastically affect the viral population structure. RRV populations were serially passaged under two levels of a bottleneck effect, which exemplified human-to-human transmission. As a result, the genetic diversity and specific growth rate of RRV populations increased under the stronger bottleneck effect, which implied that a bottleneck created a new space in a population for minor mutants originally existing in a hidden layer, which includes minor mutations that cannot be distinguished from a sequencing error. The results of this study suggest that the genetic drift caused by a bottleneck in human-to-human transmission explains the random appearance of new genetic lineages causing viral outbreaks, which can be expected according to molecular epidemiology using next-generation sequencing in which the viral genetic diversity within a viral population is investigated.




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Single-cell O2 exchange imaging shows that cytoplasmic diffusion is a dominant barrier to efficient gas transport in red blood cells [Physiology]

Disorders of oxygen transport are commonly attributed to inadequate carrying capacity (anemia) but may also relate to inefficient gas exchange by red blood cells (RBCs), a process that is poorly characterized yet assumed to be rapid. Without direct measurements of gas exchange at the single-cell level, the barriers to O2...




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Factors Influencing Uptake of Changes to Clinical Preventive Guidelines

Background:

Despite widespread recognition that adherence to clinical preventive guidelines improves patient outcomes, clinicians struggle to implement guideline changes in a timely manner. Multiple factors influence guideline adoption and effective implementation. However, few studies evaluate their collective and inter-related effects. This qualitative study provides a comprehensive picture of the interplay between multiple factors on uptake of new or changed preventive guidelines.

Methods:

Semistructured interviews conducted in 2018 with a diverse sample of clinicians and practice leaders sought to understand patient, clinician, practice, health system, environment, and guideline factors of influence. An immersion-crystallization approach was used to identify emergent themes.

Results:

Interviewees expressed motivation to adhere to guidelines but also valued sharing decisions with patients. Personal biases and fears affected both clinician and patient guideline adoption. Practices facilitated implementation through workflow optimization and encouraging a culture of evidence-based practice while a key health system function was to maintain electronic health record alerts. More traditional environmental factors, such as insurance coverage or transportation, were less of a barrier to guideline adoption and implementation than the influence of media and specialists. Various specific guideline characteristics also affected ease of adoption and implementation. Different settings expressed greater health system, practice, or clinician-centric approaches to guideline implementation.

Conclusions:

Guideline uptake is influenced by a complex interplay of multiple levels of factors including the patient, clinician, practice, health system, environment, and guideline levels. Comprehensively understanding all levels of influence for each specific clinical setting may help to determine the optimal intervention(s) for improving uptake of evidence-based guidelines.




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In vitro insulin treatment reverses changes elicited by nutrients in cellular metabolic processes that regulate food intake in fish [RESEARCH ARTICLE]

Ayelen M. Blanco, Juan I. Bertucci, Jose L. Soengas, and Suraj Unniappan

This research assessed the direct effects of insulin on nutrient-sensing mechanisms in the brain of rainbow trout (Oncorhynchus mykiss) using an in vitro approach. Cultured hypothalamus and hindbrain were exposed to 1 µmol l–1 insulin for 3 h, and signals involved in appetite regulation and nutrient-sensing mechanisms were measured. Additionally, the involvement of the phosphatidylinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in the actions of insulin was studied by using the inhibitor wortmannin. Treatment with insulin alone did not elicit many changes in the appetite regulators and nutrient-sensing-related genes and enzymes tested in the hypothalamus and hindbrain. However, we found that, when insulin and nutrients were added together, insulin reversed most of the effects exerted by nutrients alone, suggesting that insulin changes responsiveness to nutrients at the central level. Effects reversed by insulin included expression levels of genes related to the sensing of both glucose (slc2a2, slc5a1, gck, pck1, pklr, g6pcb, gys1, tas1r3 and nr1h3 in the hindbrain, and slc2a2, pklr and pck1 in the hypothalamus) and fatty acid (cd36 in the hindbrain, and cd36 and acly in the hypothalamus). Nutrient-induced changes in the activity of Acly and Cpt-1 in the hindbrain and of Pepck, Acly, Fas and Hoad in the hypothalamus were also reversed by insulin. Most of the insulin effects disappeared in the presence of wortmannin, suggesting the PI3K/Akt pathway is a mediator of the effects of insulin reported here. This study adds new information to our knowledge of the mechanisms regulating nutrient sensing in fish.




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Near equal compressibility of liver oil and seawater minimises buoyancy changes in deep-sea sharks and chimaeras [RESEARCH ARTICLE]

Imants G. Priede, Rhoderick W. Burgass, Manolis Mandalakis, Apostolos Spyros, Petros Gikas, Finlay Burns, and Jim Drewery

Whereas upper ocean pelagic sharks are negatively buoyant and must swim continuously to generate lift from their fins, deep-sea sharks float or swim slowly buoyed up by large volumes of low-density oils in their livers. Investigation of the Pressure, Volume, Temperature (PVT) relationships for liver oils of 10 species of deep-sea Chondrichthyes shows that the density difference between oil and seawater, remains almost constant with pressure down to full ocean depth (11 km, 1100 bar); theoretically providing buoyancy far beyond the maximum depth of occurrence (3700 m) of sharks. However, , does change significantly with temperature and we show that the combined effects of pressure and temperature can decrease buoyancy of oil by up to 10% between the surface and 3500 m depth across interfaces between warm southern and cold polar waters in the Rockall Trough in the NE Atlantic. This increases drag more than 10 fold compared with neutral buoyancy during horizontal slow swimming (0.1 m s–1) but the effect becomes negligible at high speeds. Chondrichthyes generally experience positive buoyancy change during ascent and negative buoyancy change during descent but contrary effects can occur at interfaces between waters of different densities. During normal vertical migrations buoyancy changes are small, increasing slow-speed drag by no more than 2–3 fold. Equations and tables of density, pressure and temperature are provided for squalene and liver oils of Chimaeriformes (Harriotta raleighana, Chimaera monstrosa, Chimaera monstrosa), Squaliformes (Centrophorus squamosus, Deania calcea, Centroscymnus coelolepis, Centroscyllium fabricii, Etmopterus spinax) and Carcharhiniformes (Apristurus laurussonii, Galeus murinus).




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Esophageal Pressure Versus Gas Exchange to Set PEEP During Intraoperative Ventilation

BACKGROUND:Pneumoperitoneum and Trendelenburg position affect respiratory system mechanics and oxygenation during elective pelvic robotic surgery. The primary aim of this randomized pilot study was to compare the effects of a conventional low tidal volume ventilation with PEEP guided by gas exchange (VGas-guided) versus low tidal volume ventilation tailoring PEEP according to esophageal pressure (VPes-guided) on oxygenation and respiratory mechanics during elective pelvic robotic surgery.METHODS:This study was conducted in a single-center tertiary hospital between September 2017 and January 2019. Forty-nine adult patients scheduled for elective pelvic robotic surgery were screened; 28 subjects completed the full analysis. Exclusion criteria were American Society of Anesthesiologists physical status ≥ 3, contraindications to nasogastric catheter placement, and pregnancy. After dedicated naso/orogastric catheter insertion, subjects were randomly assigned to VGas-guided (FIO2 and PEEP set to achieve SpO2 > 94%) or VPes-guided (PEEP tailored to equalize end-expiratory transpulmonary pressure). Oxygenation (PaO2/FIO2) was evaluated (1) at randomization, after pneumoperitoneum and Trendelenburg application; (2) at 60 min; (3) at 120 min following randomization; and (4) at end of surgery. Respiratory mechanics were assessed during the duration of the study.RESULTS:Compared to VGas-guided, oxygenation was higher with VPes-guided at 60 min (388 ± 90 vs 308 ± 95 mm Hg, P = .02), at 120 min after randomization (400 ± 90 vs 308 ± 81 mm Hg, P = .008), and at the end of surgery (402 ± 95 vs 312 ± 95 mm Hg, P = .009). Respiratory system elastance was lower with VPes-guided compared to VGas-guided at 20 min (24.2 ± 7.3 vs 33.4 ± 10.7 cm H2O/L, P = .001) and 60 min (24.1 ± 5.4 vs 31.9 ± 8.5 cm H2O/L, P = .006) from randomization.CONCLUSIONS:Oxygenation and respiratory system mechanics were improved when applying a ventilatory strategy tailoring PEEP to equalize expiratory transpulmonary pressure in subjects undergoing pelvic robotic surgery compared to a VGas-guided approach. (ClinicalTrials.gov registration NCT03153592).




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Geology of the Chang 7 Member oil shale of the Yanchang Formation of the Ordos Basin in central north China

We present a review of the Chang 7 Member oil shale, which occurs in the middle–late Triassic Yanchang Formation of the Ordos Basin in central north China. The oil shale has a thickness of 28 m (average), an area of around 30 000 km2 and a Ladinian age. It is mainly brown-black to black in colour with a laminar structure. It is characterized by average values of 18 wt% TOC (total organic carbon), 8 wt% oil yield, a 8.35 MJ kg–1 calorific value, 400 kg t–1 hydrocarbon productivity and kerogen of type I–II1, showing a medium quality. On average, it comprises 49% clay minerals, 29% quartz, 16% feldspar and some iron oxides, which is close to the average mineral composition of global shale. The total SiO2 and Al2O3 comprise 63.69 wt% of the whole rock, indicating a medium ash type. The Sr/Ba is 0.33, the V/Ni is 7.8, the U/Th is 4.8 and the FeO/Fe2O3 is 0.5, indicating formation in a strongly reducing, freshwater or low-salinity sedimentary environment. Multilayered intermediate-acid tuff is developed in the basin, which may have promoted the formation of the oil shale. The Ordos Basin was formed during the northwards subduction of the Qinling oceanic plate during the Ladinian–Norian in a back-arc basin context. The oil shale of the Ordos Basin has a large potential for hydrocarbon generation.

Supplementary material: Tables of oil-shale geochemical composition, proximate and organic matter analyses from the Chang 7 Member oil shale, the Ordos Basin, Central north China are available at https://doi.org/10.6084/m9.figshare.c.4411703




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Mid-Eocene giant slope failure (sedimentary melanges) in the Ligurian accretionary wedge (NW Italy) and relationships with tectonics, global climate change and the dissociation of gas hydrates

Upper Lutetian–Bartonian sedimentary mélanges, corresponding to ancient mud-rich submarine mass transport deposits, are widely distributed over an area c. 300 km long and tens of kilometres wide along the exhumed outer part of the External Ligurian accretionary wedge in the Northern Apennines. The occurrence of methane-derived carbonate concretions (septarians) in a specific tectonostratigraphic position below these sedimentary mélanges allows us to document the relationships among a significant period of regional-scale slope failure, climate change (the Early and Mid-Eocene Optimum stages), the dissociation of gas hydrates and accretionary tectonics during the Ligurian Tectonic Phase (early–mid-Lutetian). The distribution of septarians at the core of thrust-related anticlines suggests that the dissociation of gas hydrates was triggered by accretionary tectonics rather than climate change. The different ages of slope failure emplacement and the formation of the septarians support the view that the dissociation of gas hydrates was not the most important trigger for slope failure. The latter occurred during a tectonic quiescence stage associated with a regressive depositional trend, and probably minor residual tectonic pulses, which followed the Ligurian Tectonic Phase, favouring the dynamic re-equilibrium of the External Ligurian accretionary wedge. Our findings provide useful information for a better understanding of the factors controlling giant slope failure events in modern accretionary settings, where they may cause tsunamis.




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Single-cycle rituximab-induced immunologic changes in children: Enhanced in neuroimmunologic disease?

Objective

To investigate the immunologic impact of a single cycle of rituximab (RTX) in children and adolescents with immune-mediated disorders, we evaluated B cells and immunoglobulin levels of 20 patients with neuroimmunologic, nephrologic, dermatologic, and rheumatologic disorders treated under recommended guidelines.

Methods

Retrospective study of immunologic changes in children (aged ≤18 years) diagnosed with immune-mediated disorders in which RTX was prescribed between June 2014 and February 2019. Patients were excluded if they had prior diagnosis of malignant disease or primary immunodeficiency. Patients were clinically and immunologically followed up every 3 months. Only patients having received a single cycle of RTX and with a follow-up greater than 12 months were included in the analysis of persistent dysgammaglobulinemia.

Results

Twenty children were included. Median age at RTX treatment was 12.8 years (interquartile range [IQR] 6.6–15.5 years). Median follow-up was 12.6 months (IQR 10.2–24 months). Of the 14 patients eligible for persistent dysgammaglobulinemia analysis (3 had received RTX retreatment, 2 had <12 months post-RTX follow-up, and in 1 data for this time point was missing), 2/14 (14%) remained with complete B-cell depletion, and 5/14 (36%) had dysgammaglobulinemia. Patients with dysgammaglobulinemia were younger (7.8 vs 15.6 years, p = 0.072), had more underlying neuroimmunologic diseases (5/5 vs 0/9, p < 0.001), and had received more frequently concentrated doses of RTX (3/5 vs 1/9, p = 0.05) than patients without dysgammaglobulinemia. Kinetics of immunoglobulins in the 20 patients revealed a decrease as early as 3 months after RTX in patients with neuroimmunologic disorders.

Conclusion

In our cohort, single-cycle RTX-induced dysgammaglobulinemia was enhanced in patients with neuroimmunologic diseases. Further studies are needed to confirm this observation.




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Impact of Changes in Clinical Microbiology Laboratory Location and Ownership on the Practice of Infectious Diseases [Epidemiology]

The number of onsite clinical microbiology laboratories in hospitals is decreasing, likely related to the business model for laboratory consolidation and labor shortages, and this impacts a variety of clinical practices, including that of banking isolates for clinical or epidemiologic purposes. To determine the impact of these trends, infectious disease (ID) physicians were surveyed regarding their perceptions of offsite services. Clinical microbiology practices for retention of clinical isolates for future use were also determined. Surveys were sent to members of the Infectious Diseases Society of America’s (IDSA) Emerging Infections Network (EIN). The EIN is a sentinel network of ID physicians who care for adult and/or pediatric patients in North America and who are members of IDSA. The response rate was 763 (45%) of 1,680 potential respondents. Five hundred forty (81%) respondents reported interacting with the clinical microbiology laboratory. Eighty-six percent of respondents thought an onsite laboratory very important for timely diagnostic reporting and ongoing communication with the clinical microbiologist. Thirty-five percent practiced in institutions where the core microbiology laboratory has been moved offsite, and an additional 7% (n = 38) reported that movement of core laboratory functions offsite was being considered. The respondents reported that only 24% of laboratories banked all isolates, with the majority saving isolates for less than 30 days. Based on these results, the trend toward centralized core laboratories negatively impacts the practice of ID physicians, potentially delays effective implementation of prompt and targeted care for patients with serious infections, and similarly adversely impacts infection control epidemiologic investigations.




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ProPSMA: A Callout to the Nuclear Medicine Community to Change Practices with Prospective, High-Quality Data




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Managing Excipient Supplier Name and Address Changes in the Pharmaceutical Quality System

It is important to identify, assess, and address current barriers to implementation of post-approval changes that are intended to ensure continued (uninterrupted) operations and drive innovation and continual improvement in a maximally efficient, agile, and flexible pharmaceutical manufacturing sector. Leveraging the International Conference for Harmonisation Quality Guideline Q10 provides regulatory relief when it comes to addressing changes related to excipients, specifically excipient supplier's name and address changes, which will ensure a sustainable, reliable global supply and the availability of high quality product to patients through the entire commercial lifecycle of a product without extensive regulatory oversight.




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Increase in Endogenous Glucose Production With SGLT2 Inhibition Is Unchanged by Renal Denervation and Correlates Strongly With the Increase in Urinary Glucose Excretion

OBJECTIVE

Sodium–glucose cotransporter 2 (SGLT2) inhibition causes an increase in endogenous glucose production (EGP). However, the mechanisms are unclear. We studied the effect of SGLT2 inhibitors on EGP in subjects with type 2 diabetes (T2D) and without diabetes (non-DM) in kidney transplant recipients with renal denervation.

RESEARCH DESIGN AND METHODS

Fourteen subjects who received a renal transplant (six with T2D [A1C 7.2 ± 0.1%] and eight non-DM [A1C 5.6 ± 0.1%) underwent measurement of EGP with [3-3H]glucose infusion following dapagliflozin (DAPA) 10 mg or placebo. Plasma glucose, insulin, C-peptide, glucagon, and titrated glucose-specific activity were measured.

RESULTS

Following placebo in T2D, fasting plasma glucose (FPG) (143 ± 14 to 124 ± 10 mg/dL; P = 0.02) and fasting plasma insulin (12 ± 2 to 10 ± 1.1 μU/mL; P < 0.05) decreased; plasma glucagon was unchanged, and EGP declined. After DAPA in T2D, FPG (143 ± 15 to 112 ± 9 mg/dL; P = 0.01) and fasting plasma insulin (14 ± 3 to 11 ± 2 μU/mL; P = 0.02) decreased, and plasma glucagon increased (all P < 0.05 vs. placebo). EGP was unchanged from baseline (2.21 ± 0.19 vs. 1.96 ± 0.14 mg/kg/min) in T2D (P < 0.001 vs. placebo). In non-DM following DAPA, FPG and fasting plasma insulin decreased, and plasma glucagon was unchanged. EGP was unchanged from baseline (1.85 ± 0.10 to 1.78 ± 0.10 mg/kg/min) after DAPA, whereas EGP declined significantly with placebo. When the increase in EGP production following DAPA versus placebo was plotted against the difference in urinary glucose excretion (UGE) for all patients, a strong correlation (r = 0.824; P < 0.001) was observed.

CONCLUSIONS

Renal denervation in patients who received a kidney transplant failed to block the DAPA-mediated stimulation of EGP in both individuals with T2D and non-DM subjects. The DAPA-stimulated rise in EGP is strongly related to the increase in UGE, blunting the decline in FPG.




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Possible Modifiers of the Association Between Change in Weight Status From Child Through Adult Ages and Later Risk of Type 2 Diabetes

OBJECTIVE

We investigated the association between changes in weight status from childhood through adulthood and subsequent type 2 diabetes risks and whether educational attainment, smoking, and leisure time physical activity (LTPA) modify this association.

RESEARCH DESIGN AND METHODS

Using data from 10 Danish and Finnish cohorts including 25,283 individuals, childhood BMI at 7 and 12 years was categorized as normal or high using age- and sex-specific cutoffs (<85th or ≥85th percentile). Adult BMI (20–71 years) was categorized as nonobese or obese (<30.0 or ≥30.0 kg/m2, respectively). Associations between BMI patterns and type 2 diabetes (989 women and 1,370 men) were analyzed using Cox proportional hazards regressions and meta-analysis techniques.

RESULTS

Compared with individuals with a normal BMI at 7 years and without adult obesity, those with a high BMI at 7 years and adult obesity had higher type 2 diabetes risks (hazard ratio [HR]girls 5.04 [95% CI 3.92–6.48]; HRboys 3.78 [95% CI 2.68–5.33]). Individuals with a high BMI at 7 years but without adult obesity did not have a higher risk (HRgirls 0.74 [95% CI 0.52–1.06]; HRboys 0.93 [95% CI 0.65–1.33]). Education, smoking, and LTPA were associated with diabetes risks but did not modify or confound the associations with BMI changes. Results for 12 years of age were similar.

CONCLUSIONS

A high BMI in childhood was associated with higher type 2 diabetes risks only if individuals also had obesity in adulthood. These associations were not influenced by educational and lifestyle factors, indicating that BMI is similarly related to the risk across all levels of these factors.




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The STELVIO trial, a game changer for bronchoscopic lung volume reduction in patients with severe emphysema

Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and airflow limitation, which is caused by small airway disease (bronchiolitis) and alveolar destruction (emphysema) [1]. Patients primarily suffering from severe emphysema are often limited in exercise capacity due to the consequences of hyperinflation [2].




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What happens when laboratory reference ranges change? [Commentary]




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Levothyroxine prescribing and laboratory test use after a minor change in reference range for thyroid-stimulating hormone [Research]

BACKGROUND:

Prescribing of levothyroxine and rates of thyroid function testing may be sensitive to minor changes in the upper limit of the reference range for thyroid-stimulating hormone (TSH) that increase the proportion of abnormal results. We evaluated the population-level change in levothyroxine prescribing and TSH testing after a minor planned decrease in the upper limit of the reference range for TSH in a large urban centre with a single medical laboratory.

METHODS:

Using provincial administrative data, we compared predicted volumes of TSH tests with actual TSH test volumes before and after a planned change in the TSH reference range. We also determined the number of new levothyroxine prescriptions for previously untreated patients and the rate of changes to the prescribed dose for those on previously stable, long-term levothyroxine therapy before and after the change in the TSH reference range.

RESULTS:

Before the change in the TSH reference range, actual and predicted monthly volumes of TSH testing followed an identical course. After the change, actual test volumes exceeded predicted test volumes by 7.3% (95% confidence interval [CI] 5.3%–9.3%) or about 3000 to 5000 extra tests per month. The proportion of patients with newly "abnormal" TSH results almost tripled, from 3.3% (95% CI 3.2%–3.4%) to 9.1% (95% CI 9.0%–9.2%). The rate of new levothyroxine prescriptions increased from 3.24 (95% CI 3.15–3.33) per 1000 population in 2013 to 4.06 (95% CI 3.96–4.15) per 1000 population in 2014. Among patients with preexisting stable levothyroxine therapy, there was a significant increase in the number of dose escalations (p < 0.001) and a total increase of 500 new prescriptions per month.

INTERPRETATION:

Our findings suggest that clinicians may have responded to mildly elevated TSH results with new or increased levothyroxine prescriptions and more TSH testing. Knowledge translation efforts may be useful to accompany minor changes in reference ranges.




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Epigenetic Therapy Can Suppress Premetastatic Changes in the Lung [Metastasis]

Low-dose adjuvant epigenetic therapy (AET) reduced metastasis and promoted survival in mouse models.




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Establishment of the T1D Exchange Quality Improvement Collaborative (T1DX-QI)

The T1D Exchange established a learning platform by evaluating the current state of care and engaging 10 diabetes clinics in collaborative quality improvement (QI) activities. Participating clinics are sharing data and best practices to improve care delivery for people with type 1 diabetes. This article describes the design and initial implementation of this platform, known as the T1D Exchange Quality Improvement Collaborative. This effort has laid a foundation for learning from variation in type 1 diabetes care delivery via QI methodology and has demonstrated success in improving processes through iterative testing cycles and transparent sharing of data.




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Operative Intervention Does Not Change Pain Perception in Patients With Diabetic Foot Ulcers

Researchers investigated pain perception in patients with diabetic foot ulcers (DFUs) by analyzing pre- and postoperative physical function (PF), pain interference (PI), and depression domains of the Patient-Reported Outcome Measurement Information System (PROMIS). They hypothesized that 1) because of painful diabetic peripheral neuropathy (DPN), a majority of patients with DFUs would have high PROMIS PI scores unchanged by operative intervention, and 2) the initially assessed PI, PF, and depression levels would be correlated with final outcomes. Seventy-five percent of patients with DFUs reported pain, most likely because of painful DPN. Those who reported high PI and low PF were likely to report depression. PF, PI, and depression levels were unchanged after operative intervention or healing of DFUs.




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Race May Not Impact Endocrine Therapy-Related Changes in Breast Density

Background:

Reduction in breast density may be a biomarker of endocrine therapy (ET) efficacy. Our objective was to assess the impact of race on ET-related changes in volumetric breast density (VBD).

Methods:

This retrospective cohort study assessed longitudinal changes in VBD measures in women with estrogen receptor–positive invasive breast cancer treated with ET. VBD, the ratio of fibroglandular volume (FGV) to breast volume (BV), was measured using Volpara software. Changes in measurements were evaluated using a multivariable linear mixed effects model.

Results:

Compared with white women (n = 191), black women (n = 107) had higher rates of obesity [mean ± SD body mass index (BMI) 34.5 ± 9.1 kg/m2 vs. 30.6 ± 7.0 kg/m2, P < 0.001] and premenopausal status (32.7% vs. 16.7%, P = 0.002). Age- and BMI-adjusted baseline FGV, BV, and VBD were similar between groups. Modeled longitudinal changes were also similar: During a follow-up of 30.7 ± 15.0 months (mean ± SD), FGV decreased over time in premenopausal women (slope = –0.323 cm3; SE = 0.093; P = 0.001), BV increased overall (slope = 2.475 cm3; SE = 0.483; P < 0.0001), and VBD decreased (premenopausal slope = –0.063%, SE = 0.011; postmenopausal slope = –0.016%, SE = 0.004; P < 0.0001). Race was not significantly associated with these longitudinal changes, nor did race modify the effect of time on these changes. Higher BMI was associated with lower baseline VBD (P < 0.0001). Among premenopausal women, VBD declined more steeply for women with lower BMI (time x BMI, P = 0.0098).

Conclusions:

Race does not appear to impact ET-related longitudinal changes in VBD.

Impact:

Racial disparities in estrogen receptor–positive breast cancer recurrence and mortality may not be explained by differential declines in breast density due to ET.




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Adiposity Change Over the Life Course and Mammographic Breast Density in Postmenopausal Women

Mammographic breast density is a strong risk factor for breast cancer. We comprehensively investigated the associations of body mass index (BMI) change from ages 10, 18, and 30 to age at mammogram with mammographic breast density in postmenopausal women. We used multivariable linear regression models, adjusted for confounders, to investigate the associations of BMI change with volumetric percent density, dense volume, and nondense volume, assessed using Volpara in 367 women. At the time of mammogram, the mean age was 57.9 years. Compared with women who had a BMI gain of 0.1–5 kg/m2 from age 10, women who had a BMI gain of 5.1–10 kg/m2 had a 24.4% decrease [95% confidence interval (CI), 6.0%–39.2%] in volumetric percent density; women who had a BMI gain of 10.1–15 kg/m2 had a 46.1% decrease (95% CI, 33.0%–56.7%) in volumetric percent density; and women who had a BMI gain of >15 kg/m2 had a 56.5% decrease (95% CI, 46.0%–65.0%) in volumetric percent density. Similar, but slightly attenuated associations were observed for BMI gain from ages 18 and 30 to age at mammogram and volumetric percent density. BMI gain over the life course was positively associated with nondense volume, but not dense volume. We observed strong associations between BMI change over the life course and mammographic breast density. The inverse associations between early-life adiposity change and volumetric percent density suggest that childhood adiposity may confer long-term protection against postmenopausal breast cancer via its effect of mammographic breast density.




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Vinhomes Ba Son Q1, CH đa năng giá phải chăng, 1PN 16tr, 2PN 20tr, 3PN 28tr, 4PN 60tr. 0903049288

Vinhomes Golden River.- 1PN 50m2 có bồn tắm nằm giá 16tr - 17tr/th bao phí. - 2PN 70 - 87m2 có bồn nằm giá 20tr - 25tr/th bao phí. - 3PN 100 - 121 m2 có bồn nằm giá 29tr - 42tr/th bao phí. - 4PN 154m2 - 159m2 giá 70 - 80tr/th không bao phí.Lưu Ý: Giá trên là giá thực tế, thương l...




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Mở bán đất nền dự án tại Làng Chuyên Gia Phú Uy Khang, DA trọng điểm tỉnh Bình Dương 0978636388

Vị trí đắc địa mặt tiền đường 22/12, An Phú, Thuận An, Bình Dương. + Mua đất giá gốc tối đa hóa lợi nhuận. + Có sổ hồng riêng từng nền có thể sang tên ngay. + Ngân hàng MBBank hỗ trợ 70%. + Đất nền thổ cư 100%. + Đã có giấy phép xây dựng đầy đủ và miễn phí.Tiện ích: + Vòng xoay A...




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Công Ty TNHH tư vấn BĐS Khang Điền Nam

Công ty BĐS Khang Điền Nam, thành lập tháng 03 năm 2014

Lĩnh vực hoạt động: môi giới bất động sản Khu Nam, chủ yếu môi giới đất nền về dự án, thổ cư.

Danh sách các dự án bất động sản đã môi giới thành công: Đại Phúc, T30, Phong Phú 4, 6B Intresco, và một số căn hộ khu vực Bình Chánh...

Khu vực môi giới tốt nhất: Bình Chánh, Quận 7, Quận 8 (TP. Hồ Chí Minh); Bến Lức (Long An)

Liên hệ:

Địa chỉ: 142/34 Đường Nguyễn Thị Thập, Phường Bình Thuận, Quận 7, TP. Hồ Chí Minh.

Văn phòng giao dịch: 10 đường số 10, KDC T30, Bình Hưng, Bình Chánh, TP. Hồ Chí Minh.

Hotline: 0908260209

Hotmail: tamnguyen.khangdiennam@gmail.com

Trân trọng cảm ơn quý khách và hy vọng sự hợp tác tốt đẹp!
 




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Thăng Long City

Thăng Long City (Chung cư B32 Đại Mỗ) là dự án nhà ở xã hội gồm căn hộ, nhà liền kề, biệt thự do TP. Hà Nội cấp suất cho những cán bộ chiến sỹ công an Cục B32 Đại Mỗ.




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Thăng Long Green City

Thăng Long Green City là dự án nhà ở xã hội do Liên danh Tổng công ty Đầu tư và Phát triển nhà Hà Nội (HANDICO) và Tổng công ty Viglacera – CTCP làm chủ đầu tư. Dự án được xây dựng trên ô đất CT3, CT4 thuộc KĐTM Kim Chung, huyện Đông Anh, Hà Nội.




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Loạt vách ngăn cầu thang bằng kính đẹp tuyệt cho không gian sống hiện đại

Trong những ngôi nhà ở hay tòa nhà văn phòng, vách ngăn cầu thang bằng kính luôn là chi tiết kiến trúc thu hút mọi ánh nhìn dù hiện diện ở bất cứ vị trí nào. Nhưng bạn có nhận thấy rằng, chúng sẽ càng đặc biệt thú vị hơn khi kết hợp cùng một số vật liệu thô mộc, chẳng hạn như gỗ hay bê tông?




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Mang cả thiên nhiên vào không gian sống với 10 ý tưởng làm vườn thẳng đứng

Làm vườn thẳng đứng hay làm vườn tường hiểu đơn giản là trồng cây theo chiều thẳng đứng, khác hẳn với kiểu trồng cây truyền thống. Chính nhờ cấu trúc thẳng đứng nên khu vườn có thể được bố trí dọc theo ngôi nhà, hành lang, bức tường... mà không chiếm dụng quá nhiều diện tích, rất phù hợp với những không gian khiêm tốn như nhà phố.




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Cho thuê mặt tiền 171 - 173 - 175 Phan Xích Long, 12 x 16m=192m2 (920m2 sàn) có thang máy

- căn 1: dt 8 x 16 kết cấu 1 trệt 1 lửng 4 lầu nhà có thang máy. - tổng 22 phòng lớn và sảnh chính trống suốt. - thiết kế phù hợp làm khách sạn, karaoke. massage, phòng khám, trường học...vv. - vị trí đối diện với khu đường hoa cao cấp( vị trí căn nhà rất đẹp và thông thoáng)...




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Cho thuê nhà 120m2, 4 tầng mặt phố Nguyễn Khang, MT 7,8m, rất tiện kinh doanh. LH ngay 0968844633

Tôi có căn nhà 4 tầng, MT 7.8m tại Nguyễn Khang, Cầu Giấy cần cho thuê. Nhà mới xây 1 năm, 120m2, 4 tầng để thông sàn, MT 7.8m, có thang máy. Khu dân cư đông đúc, sầm uất rất tiên kinh doanh buôn bán, làm văn phòng đều thích hợp. Giá chỉ 75 triệu/tháng. LH ngay chính chủ chị Hằng...




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Phòng có gác ngay KDC Làng Đại Học khu B, gần ĐH Tôn Đức Thắng, giảm 700k tiền thuê nhà tháng 5

Cho thuê căn hộ dịch vụ có gác tại Làng Đại Học, khu B, gần trường Tôn Đức Thắng. Căn hộ mini diện tích sử dụng 50 - 60m2. Vị trí đường nội bộ 1023/5 Lê Văn Lương. - Nằm ngay khu B Làng Đại Học, có thang máy, thoáng mát, an ninh, cách Phú Mỹ Hưng 1km, cách trường đại học Tôn Đức ...




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Cầu thang gỗ đa năng trong nhà phố nhỏ ở Nhật

Diện tích nhà nhỏ nhưng vẫn cần có không gian để trưng bày tranh, ảnh và đồ trang trí. Bằng cách thiết kế cầu thang gỗ đa năng, vừa giữ vai trò giao thông, vừa để lưu trữ và trưng bày, kiến trúc sư đã khiến gia chủ hài lòng 100%.




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Chính chủ cần bán gấp tòa nhà 92m2, 5 tầng, thang máy gần Ngã Tư Sở chỉ 18 tỷ

Mô tả: + Hướng: Đông Nam. + Nhà thuộc khu liền kề gần Ngã Tư Sở, hoàn thiện năn 2015 nên còn khá mới, khách mua chỉ xách vali về ở ngay không phải sửa chữa gì; tầng 2 phòng ngủ, 1wc, thang máy và thang bộ giữa. + Sổ đỏ 92m2 nhưng thực tế phía sau còn 80cm ngang ngoài sổ làm giếng...




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Cần cho thuê tầng 1 shophouse Vinhomes Thăng Long giá rẻ thích hợp làm văn phòng, cửa hàng

Cho thuê tầng 1 shophouse Vinhomes Thăng Long, An Khánh, Hoài Đức, Hà Nội. Diện tích 90m2, có đầy đủ điện, nước, điều hoà, WC thích hợp làm văn phòng, showroom, cửa hàng... Mặt tiền 5m, riêng biệt với chủ nhà, khu vực an ninh tốt do Vinhomes quản lý. Giá 6 tr/tháng. Liên hệ chính...




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15 mẫu bàn ghế ăn chất liệu gỗ chẳng sợ lỗi mốt

Những loại gỗ bền đẹp như xoan đào, óc chó, thông, căm xe... thường được chọn để làm bàn ghế ăn. Không chỉ tạo ra sức hút kỳ lạ, loại bàn ghế này còn giúp gia chủ yên tâm sử dụng lâu dài vì không phải lo lỗi mốt.




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Đèn hình cầu - vật dụng trang trí nhà chẳng bao giờ lỗi mốt

Những mẫu đèn hình cầu dù nhỏ bé nhưng tinh tế và đa dạng vẫn luôn là một vật dụng trang trí nhà không thể thiếu được.




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Vị trí bàn làm việc giúp bạn thăng tiến không ngừng

Chọn vị trí đặt bàn làm việc trong văn phòng hợp phong thủy là một điều rất quan trọng bởi nó có liên quan đến sự nghiệp của bạn, sự thăng tiến và tiền tài của bạn.




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18 quy tắc phong thủy chốn công sở giúp sự nghiệp thăng tiến

Công việc sẽ luôn "thuận buồm xuôi gió", có nhiều cơ hội thăng tiến nếu bạn áp dụng một số quy tắc về phong thủy văn phòng dưới đây.




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Sự nghiệp thăng tiến nhờ chọn bàn làm việc hợp mệnh

Bàn làm việc có chất liệu phù hợp, đặt tại vị trí phong thủy tốt sẽ giúp thu hút được nhiều nguồn năng lượng tích cực để giúp sự nghiệp của bạn nhanh thăng tiến.




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Cách sắp xếp không gian làm việc để sự nghiệp thăng tiến

Phong thủy văn phòng sẽ ít nhiều ảnh hưởng đến công danh sự nghiệp của bạn. Bước sang năm mới, để công việc được thuận lợi, thăng tiến, bạn nên sắp xếp lại phòng làm việc sao cho hợp phong thủy.