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JAMA Pediatrics Dec 2015There is a well-described association between maternal diabetes mellitus and risk of congenital heart disease (CHD) in offspring. Although the clinical diagnoses of type...
IMPORTANCE
There is a well-described association between maternal diabetes mellitus and risk of congenital heart disease (CHD) in offspring. Although the clinical diagnoses of type 2 diabetes or gestational diabetes are strong risk factors for CHD, subclinical abnormalities of glucose and insulin metabolism are common within the general population and could also confer risk for CHD. We hypothesize that continuous measures of blood analytes related to maternal diabetes are related to odds of cardiac malformations.
OBJECTIVE
To explore the potential association of 2 different CHD phenotypes in offspring with maternal midpregnancy measures of glucose and insulin.
DESIGN, SETTING, AND PARTICIPANTS
Case-control study from a population-based cohort of 277 pregnant women in southern and central California carrying infants with tetralogy of Fallot (TOF) (n = 55), dextrotransposition of the great arteries (dTGA) (n = 42), or healthy infants without CHD (n = 180). Serum samples were collected from 2003 through 2007. The analysis was conducted from March through June 2015.
MAIN OUTCOMES AND MEASURES
Blood analytes related to maternal glucose metabolism were measured from random nonfasting second-trimester blood samples. We measured serum insulin levels by a validated radioimmunoassay, and we measured glucose levels. Multivariable logistic regression models estimated the association between these levels and case status.
RESULTS
Serum glucose values were elevated in the maternal samples for offspring with TOF (median, 97.0 mg/dL [to convert to millimoles per liter, multiply by 0.0555]) relative to controls (median, 91.5 mg/dL) (P = .01, Wilcoxon rank sum test), a phenomenon not observed in the maternal samples for offspring with dTGA (median, 90.0 mg/dL) relative to controls (P = .18, Wilcoxon rank sum test). Serum insulin levels were significantly different between controls (median, 18.8 μIU/mL [to convert to picomoles per liter, multiply by 6.945]) and maternal samples for offspring with dTGA (median, 13.1 μIU/mL; P = .048, Wilcoxon rank sum test) but not with TOF (median, 14.3 μIU/mL; P = .35, Wilcoxon rank sum test). Relative to maternal blood glucose levels of infants without cardiac malformations, we observed that maternal blood glucose levels in models including insulin were strongly associated with odds of TOF (adjusted odds ratio = 7.54; 95% CI, 2.30-24.69) but not with dTGA (adjusted odds ratio = 1.16; 95% CI, 0.28-4.79).
CONCLUSIONS AND RELEVANCE
These results represent a direct correlation of glucose as a continuous variable to odds of specific cardiac malformations. The association between serum glucose and odds of TOF indicates the need for additional epidemiological and mechanistic investigations into the risk conferred by insulin signaling and glucose metabolism during early pregnancy.
Topics: Adult; Blood Glucose; California; Case-Control Studies; Diabetes Mellitus, Type 2; Diabetes, Gestational; Female; Heart Defects, Congenital; Humans; Insulin; Odds Ratio; Pregnancy; Risk Factors; Young Adult
PubMed: 26457543
DOI: 10.1001/jamapediatrics.2015.2831 -
JAMA Cardiology Apr 2017Cardiovascular disease affects 1 in 3 patients and remains the leading cause of death in the United States. Severe elevation of low-density lipoprotein cholesterol...
Cardiovascular disease affects 1 in 3 patients and remains the leading cause of death in the United States. Severe elevation of low-density lipoprotein cholesterol (LDL-C) levels is a modifiable risk factor for developing premature cardiovascular disease, and elevation levels of 190 mg/dL or greater (to convert LDL-C values to millimoles per liter, multiply by 0.0259) may indicate a monogenic etiology such as familial hypercholesterolemia. Treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins is recommended (class IA) for all adults 21 years or older with an LDL-C of 190 mg/dL or greater. Statin treatment appears to reduce mortality and result in cost savings for health systems. Therefore, we sought to examine rates of statin prescription in patients screened for dyslipidemia to identify treatment gaps in a real-world contemporary setting.
Topics: Adult; Aged; Drug Prescriptions; Dyslipidemias; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lipids; Male; Middle Aged; Severity of Illness Index; Young Adult
PubMed: 28052161
DOI: 10.1001/jamacardio.2016.5162 -
Journal de Gynecologie, Obstetrique Et... 1997Despite many international conferences, there is no consensus on gestational diabetes mellitus and many groups only screen those women who present risk factors or who... (Review)
Review
Despite many international conferences, there is no consensus on gestational diabetes mellitus and many groups only screen those women who present risk factors or who present during pregnancy complications attributable to this condition. Nevertheless, complications secondary to gestational diabetes are equally frequent whether the mother presents risk factor or not, and these risk factors are only present in 30 to 45% of gestational diabetes. Therefore, all pregnant women should be screened ... or none at all. The type of screening test to be used is just as controversial. The test proposed by the WHO alone allows screening and diagnosing simultaneously, but the cut-off value at 7.8 millimoles for post-charge glycemia seems to be too low for a pregnant woman, at the end of the second trimester. The real question of whether screening for and treating gestational diabetes will actually decrease perinatal morbidity and long-term complications for the mother and the infant cannot be answered as of yet. A large prospective study would be needed, including a control group that would not be treated despite pathological glucose levels, which is ethically inconceivable.
Topics: Diabetes, Gestational; Female; Humans; Mass Screening; Patient Selection; Pregnancy; Pregnancy Outcome; Risk Factors; Sensitivity and Specificity; Time Factors; World Health Organization
PubMed: 9509316
DOI: No ID Found -
Journal of Clinical and Experimental... 2022Potential indications for surgery frequently arise in patients awaiting liver transplantation. There is a risk of hepatic decompensation and death triggered by surgical...
BACKGROUND
Potential indications for surgery frequently arise in patients awaiting liver transplantation. There is a risk of hepatic decompensation and death triggered by surgical trauma, but this has not been studied in detail in this unique population. We aimed to quantify the impact of surgical interventions in patients awaiting liver transplantation on hepatic function and identify risk factors for decompensation.
METHODS
All surgeries between 2000 and 2018 in patients awaiting liver transplantation in a highvolume German liver transplant center were analyzed retrospectively. Change in liver function measured as indicated by MELD score was assessed and complication rates recorded. The primary endpoint was a composite of an increase in MELD score by > 5 points or death. A logistic regression model was used for multivariate analysis to identify risk factors.
RESULTS
In total, 177 surgical procedures in 148 patients were analyzed. The primary endpoint was reached in 42 cases (23.7%). The overall in-hospital complication rate (including death) was 44.1%. Multivariate analysis identified elevated leukocyte count, perioperative blood transfusion, preoperative presence of ascites, and preoperative circulatory support as independent risk factors for a decline in liver function or death.
CONCLUSION
Surgery in patients awaiting liver transplantation carries a relevant risk of hepatic decompensation and death that needs to be considered when deciding whether to perform elective surgery prior to or defer until after liver transplantation.
PubMed: 35068787
DOI: 10.1016/j.jceh.2021.03.011 -
AJNR. American Journal of Neuroradiology Aug 2017In patients with metastatic brain tumors after gamma knife radiosurgery, the superiority of PET using C-methionine for differentiating radiation necrosis and recurrent... (Comparative Study)
Comparative Study
Differentiation between Treatment-Induced Necrosis and Recurrent Tumors in Patients with Metastatic Brain Tumors: Comparison among C-Methionine-PET, FDG-PET, MR Permeability Imaging, and MRI-ADC-Preliminary Results.
BACKGROUND AND PURPOSE
In patients with metastatic brain tumors after gamma knife radiosurgery, the superiority of PET using C-methionine for differentiating radiation necrosis and recurrent tumors has been accepted. To evaluate the feasibility of MR permeability imaging, it was compared with PET using C-methionine, FDG-PET, and DWI for differentiating radiation necrosis from recurrent tumors.
MATERIALS AND METHODS
The study analyzed 18 lesions from 15 patients with metastatic brain tumors who underwent gamma knife radiosurgery. Ten lesions were identified as recurrent tumors by an operation. In MR permeability imaging, the transfer constant between intra- and extravascular extracellular spaces (/minute), extravascular extracellular space, the transfer constant from the extravascular extracellular space to plasma (/minute), the initial area under the signal intensity-time curve, contrast-enhancement ratio, bolus arrival time (seconds), maximum slope of increase (millimole/second), and fractional plasma volume were calculated. ADC was also acquired. On both PET using C-methionine and FDG-PET, the ratio of the maximum standard uptake value of the lesion divided by the maximum standard uptake value of the symmetric site in the contralateral cerebral hemisphere was measured (C-methionine ratio and FDG ratio, respectively). The receiver operating characteristic curve was used for analysis.
RESULTS
The area under the receiver operating characteristic curve for differentiating radiation necrosis from recurrent tumors was the best for the C-methionine ratio (0.90) followed by the contrast-enhancement ratio (0.81), maximum slope of increase (millimole/second) (0.80), the initial area under the signal intensity-time curve (0.78), fractional plasma volume (0.76), bolus arrival time (seconds) (0.76), the transfer constant between intra- and extravascular extracellular spaces (/minute) (0.74), extravascular extracellular space (0.68), minimum ADC (0.60), the transfer constant from the extravascular extracellular space to plasma (/minute) (0.55), and the FDG-ratio (0.53). A significant difference in the C-methionine ratio ( < .01), contrast-enhancement ratio ( < .01), maximum slope of increase (millimole/second) ( < .05), and the initial area under the signal intensity-time curve ( < .05) was evident between radiation necrosis and recurrent tumor.
CONCLUSIONS
The present study suggests that PET using C-methionine may be superior to MR permeability imaging, ADC, and FDG-PET for differentiating radiation necrosis from recurrent tumors after gamma knife radiosurgery for metastatic brain tumors.
Topics: Adult; Aged; Brain Neoplasms; Carbon Radioisotopes; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Neuroimaging; Positron-Emission Tomography; ROC Curve; Radiation Injuries; Radiosurgery
PubMed: 28619837
DOI: 10.3174/ajnr.A5252 -
Journal of Trace Elements in Medicine... May 2023The iron concentration increases during normal brain development and is identified as a risk factor for many neurodegenerative diseases, it is vital to monitor iron...
BACKGROUND
The iron concentration increases during normal brain development and is identified as a risk factor for many neurodegenerative diseases, it is vital to monitor iron content in the brain non-invasively.
PURPOSE
This study aimed to quantify in vivo brain iron concentration with a 3D rosette-based ultra-short echo time (UTE) magnetic resonance imaging (MRI) sequence.
METHODS
A cylindrical phantom containing nine vials of different iron concentrations (iron (II) chloride) from 0.5 millimoles to 50 millimoles and six healthy subjects were scanned using 3D high-resolution (0.94 ×0.94 ×0.94 mm) rosette UTE sequence at an echo time (TE) of 20 μs.
RESULTS
Iron-related hyperintense signals (i.e., positive contrast) were detected based on the phantom scan, and were used to establish an association between iron concentration and signal intensity. The signal intensities from in vivo scans were then converted to iron concentrations based on the association. The deep brain structures, such as the substantia nigra, putamen, and globus pallidus, were highlighted after the conversion, which indicated potential iron accumulations.
CONCLUSION
This study suggested that T-weighted signal intensity could be used for brain iron mapping.
Topics: Humans; Iron; Magnetic Resonance Imaging; Brain; Brain Mapping; Contrast Media
PubMed: 36871432
DOI: 10.1016/j.jtemb.2023.127146 -
Cancers Mar 2022Low- and moderate-intensity exercise is safe and feasible during childhood cancer treatment. The feasibility of a bout of high-intensity interval training (HIIT) in this...
Low- and moderate-intensity exercise is safe and feasible during childhood cancer treatment. The feasibility of a bout of high-intensity interval training (HIIT) in this population has not been analyzed to date. Pediatric cancer patients aged between 6 and 18 years were selected based on clinical conditions to perform ten sets of 15 s HIIT (>90% of estimated maximal heart rate (HRmax)) and 1 min active recovery on a bicycle ergometer within the first three chemotherapy courses. We assessed safety and feasibility criteria and the following parameters: perceived exertion rate, heart rate, and lactate and adrenaline concentrations. Out of 212 eligible patients, 11 patients aged 13.9 ± 3.6 years (n = 7 ♂) with lymphoma, leukemia, rhabdomyosarcoma, nephroblastoma, and synovial sarcoma completed the bout of HIIT without serious adverse events. During exercise, patients reached a BORG value maxima of 16 ± 1.2, and their heart rates rose from 78 ± 17 beats per minute (bpm) at rest to 178 ± 12 bpm after exercise (90 ± 6% estimated HRmax). The power-to-weight ratio was 2 ± 0.5 W/kg (watt per kilogram). Blood lactate concentrations increased from 1.09 ± 0.50 mmol/L (millimole per liter) at rest to 5.05 ± 1.88 mmol/L post-exercise. Our preliminary data suggest that HIIT is applicable only in a small number of childhood cancer patients. Individually adapted exercise protocols for patients with multiple impairments are needed.
PubMed: 35326619
DOI: 10.3390/cancers14061468 -
The Journal of Physical Chemistry. A Jul 2020The methionine-iodine reaction was reinvestigated spectrophotometrically in detail monitoring the absorbance belonging to the isosbestic point of iodine at 468 nm, at =...
The methionine-iodine reaction was reinvestigated spectrophotometrically in detail monitoring the absorbance belonging to the isosbestic point of iodine at 468 nm, at = 25.0 ± 0.1 °C, and at 0.5 M ionic strength in buffered acidic medium. The stoichiometric ratio of the reactants was determined to be 1:1 producing methionine sulfoxide as the lone sulfur-containing product. The direct reaction between methionine and iodine was found to be relatively rapid in the absence of initially added iodide ion, and it can conveniently be followed by the stopped-flow technique. Reduction of iodine eventually leads to the formation of iodide ion that inhibits the reaction making the whole system autoinhibitory with respect to the halide ion. We have also shown that this inhibitory effect appears quite prominently, and addition of iodide ion in the millimole concentration range may result in a rate law where the formal kinetic order of this species becomes -2. In contrast to this, hydrogen ion has just a mildly inhibitory effect giving rise to the fact that iodine is the kinetically active species in the system but not hypoiodous acid. The surprisingly complex kinetics of this simple reaction may readily be interpreted via the initiating rapidly established iodonium-transfer process between the reactants followed by the subsequent hydrolytic decomposition of the short-lived iodinated methionine. A seven-step kinetic model to be able to describe the most important characteristics of the measured kinetic curves is established and discussed in detail.
PubMed: 32585091
DOI: 10.1021/acs.jpca.0c04271 -
Acta Endocrinologica (Bucharest,... 2020The published data showed the importance of metabolic control in preventing complications in metabolic syndrome (MS) and the role of nutritional medical therapy in...
INTRODUCTION
The published data showed the importance of metabolic control in preventing complications in metabolic syndrome (MS) and the role of nutritional medical therapy in glycemic control and in the control of dyslipidemia, hypertension, weight loss/normalization (in overweight or malnourished subjects).
OBJECTIVES
This study follows the evolution of sarcopenic index (SI) and other clinical parameters (body mass index (BMI), homeostasis evaluation index (HOMA index)) correlated with MS after diet therapy or diet therapy combined with sports, in patients with MS.
PATIENTS AND METHODS
Our research was conducted during 12 months, on 110 patients >18 years of age, with HOMA index>2, divided into three groups: control group (CG, N=20), diet therapy group (DTG, N=58), diet therapy and sports group (DTSG, N=32). HOMA index for insulin resistance was calculated as the product of resting plasma insulin (in microunits/milliliter) and plasma glucose (in millimoles/liter), divided by 22.5. SI was determined using BIA, as being the ratio between muscle mass and fat mass, measured in cm/m.
RESULTS
A significant decrease of BMI (p<0.05) in DTG (from 31.63 to 24.50) and DTSG (from 30.18 to 24.17) vs. CG was observed (Pearson coefficient r=0.281, p<0.001). Weight status changed significantly (p<0.05) in the high-risk patients. There was a significant decrease of HOMA index (p<0.05) in DTG (from 5.93 to 2.57), DTSG (from 3.93 to 2.23), and in CG an increase was observed (from 3.15 to 3.37).
CONCLUSION
The best results in the prevention/ treatment of sarcopenia in MS patients were obtained for DTSG, which benefited from both the positive effect of diet and physical activity.
PubMed: 34084239
DOI: 10.4183/aeb.2020.470 -
Preventive Medicine Reports Aug 2022Socio-demographic correlates with oral hygiene practices are commonly investigated. The present study aimed to determine whether alcohol and/or tobacco use and...
How alcohol and/or tobacco use and raised glycemia are associated with oral hygiene practices among Burkinabè adults: Evidence from the first national non-communicable disease risk factors survey.
Socio-demographic correlates with oral hygiene practices are commonly investigated. The present study aimed to determine whether alcohol and/or tobacco use and hyperglycemia were associated with oral hygiene practices among Burkinabè adults. This descriptive, cross-sectional study included 4550 adults selected through multistage cluster sampling performed during the first WHO STEPS survey conducted in 2013 in Burkina Faso. The practices we considered were the frequencies of tooth cleaning, the fluoridated toothpaste use and the dentist visit within the past-six months. We collected data on self-reported alcohol and tobacco use and measured fasting blood glucose (FBG). About 82.8% of respondent reported they cleaned their teeth at least once a day, 31.5% cleaned them at least twice a day, 25.4% used fluoridated toothpaste, 2.2% had visited a dentist in the past six months, 38.8% used either alcohol or tobacco and 8.4% had raised FBG. After adjusting for socio-demographic factors, alcohol and/or tobacco use was an unfavorable factor for tooth cleaning at least once a day [aOR = 0.7 (0.6-0.8) p < 0.001], or at least twice a day [aOR = 0.6 (0.5-0.7) p < 0.001]. Moreover, raised FBG was negatively associated with cleaning tooth at least twice a day [aOR = 0.7 (0.5-0.9) p < 0.01] or the use of fluoridated toothpaste [aOR = 0.7 (0.6-0.9) p < 0.05]. Oral health education in addition to cardiovascular risk factor reduction should be efficiently integrated in the behavioral lifestyle interventions' strategies for the non-communicable diseases' prevention.
PubMed: 35757578
DOI: 10.1016/j.pmedr.2022.101854