A single dose of mifepristone (200 mg) in the immediate preovulatory phase offers contraceptive potential without cycle disruption

A single dose of mifepristone is an effective emergency contraceptive and has potential as a regular "once-a-month" pill. If given in the early luteal phase, the formation of a secretory endometrium is inhibited or delayed and implantation of the embryo prevented. We have explored the effect of giving the mifepristone just prior to ovulation on the ovarian and endometrial cycle. Seven women with regular menstrual cycles were studied during a control cycle and then in a second cycle when 200 mg mifepristone was given within 24 h of ovulation, i.e., when luteinizing hormone (LH) in serum was >15 IU/L and the dominant follicle was >18 mm. Ovulation was confirmed within 48 h by ultrasound in five of the seven women. The remaining two women had luteinized unruptured follicle. Following mifepristone, menses occurred after a normal luteal phase compared to control cycle (13.7 +/- 0.7 vs. 13.7 +/- 0.9 days). In all subjects the endometrium on LH + 6 in the treatment cycle showed no, or very little, secretory changes, suggesting it was unlikely that pregnancy would have occurred. We conclude that mifepristone could be given as a "once-a-month" contraceptive pill without causing significant disruption in the menstrual cycle in the majority of women for a 4-day period from just prior to ovulation until LH + 3.     

停供碘盐后水源性高碘地区人群每日饮食碘摄入量调查

目的了解停供碘盐3年后水源性高碘地区人群每日饮食碘的摄入量及其构成,为制定水源性高碘地区干预策略提供依据。方法采用两阶段抽样方法,分别从水碘含量为50.01～150μg/L、150.01～300μg/L、300.01～500μg/L、500.01μg/L以上的4个层次的行政村中选定335名对象进行调查,采用入户调查的方法进行饮水量和膳食调查,并采集居民户生活饮用水、粮食和蔬菜样本,检测碘含量。结果当地居民户生活饮用水碘含量中位数为431.5μg/L;三组人群每日饮食碘的摄入量均远高于碘的推荐摄入量,水碘含量在300μg/L以上的人群每日饮食碘的摄入量超过了碘的可耐受最高摄入量,三组人群每日饮食碘的摄入量在不同水碘水平下的差异均有统计学意义(P<0.01),且随着水碘含量的升高而升高;三组人群每日饮食碘摄入量的构成有83.2%～98.7%来自饮水,1.3%～16.8%来自食物;饮食碘的摄入量与居民户生活饮用水水碘含量之间存在高度正相关关系(等级相关系数为0.953,P<0.01)。结论水是水源性高碘地区居民碘摄入量的主要来源,占80%以上。对于水碘含量在300μg/L以上的人群仅仅单靠停供碘盐的干预措施来减少碘的摄入是远远不够的,还必需采取改水降碘等综合干预措施,预防控制高碘的危害。     

Investigation of variations in energy,macronutrients and sodium intake based on the places meals are provided: Using the Korea National Health and Nutrition Examination Survey (KNHANES, 1998-2009)

This study was conducted to investigate nutrient consumption by Korean adults in various places. To accomplish this, we used the 1998-2009 Korea National Health and Nutrition Examination Survey (KNHANES). Subjects of this investigation were over 19 years and the study included 37,160 people. The meals were categorized as breakfast, lunch, dinner, and snacks consumed at home, or while eating-out. Investigation of the rate of consumption at serving places based on daily meals and years showed that eating-out generally increased with time. The consumption of meals prepared at home was higher than that of meals consumed anyplace else in 1998, 2001, 2005, and 2007-2009. However, the rate of consumption of home meals decreased from 1998 to 2007-2009, while the rate of eating-out increased during this period. Annual nutrient intake according to serving places with respect to meals, energy, fat, and sodium were significantly lower in home meals than those consumed elsewhere in 2007-2009 relative to 1998. The sodium intake and energy distribution ratio of fat in meals consumed while eating-out increased significantly from 1998 to 2007-2009. The energy, fat and sodium intake and energy contribution ratio of fat consumed in meals at institutions was significantly higher in 2007-2009 than in 1998. Based on these results, additional research is required to develop guidelines for dietary life improvement at each serving place and to address education and policies for balanced nutrition intake.     

Estimation of vitamin K intake in Koreans and determination of the primary vitamin K-containing food sources based on the fifth Korean National Health and Nutrition Examination Survey (2010-2011)

There is little information on dietary vitamin K intake and nutritional status of daily requirements of vitamin K in Korea. The objective of this study was to investigate the vitamin K intake and major food sources of Vitamin K in Koreans. The survey data from the 2010-2011 Korean National Health and Nutrition Examination Survey of 7,792 subjects (aged 19-64 years) were examined. Total vitamin K intake was calculated from 24-hour dietary recall using a vitamin K food database, Computer Aided Nutritional analysis Program and the United States Department of Agriculture database. The geometric mean of vitamin K was estimated as 322.40 ± 6.33 ug/day for men and 271.20 ± 4.92 ug/day for women. Daily vitamin K intake increased significantly with age (p for trend < 0.001). The main food source of vitamin K was vegetables (72.84%), including cabbage kimchi (19.26%), spinach (17.38%), sesame leaves (7.11%), radish leaves (6.65%), spring onions (6.28%), and laver (4.82%), followed by seaweed, seasonings, and fat and oils. We observed that the vitamin K intake of Koreans was relatively higher than that reported by other studies in Western countries and differed depending on age.     

Sodium Intake and Incidence of Diabetes Complications in Elderly Patients with Type 2 Diabetes—Analysis of Data from the Japanese Elderly Diabetes Intervention Study (J-EDIT)

This study investigates the associations between sodium intake and diabetes complications in a nationwide cohort of elderly Japanese patients with type 2 diabetes aged 65–85. Data from 912 individuals regarding their dietary intake at baseline is analyzed and assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes are times to diabetic retinopathy, overt nephropathy, cardiovascular disease (CVD), and all-cause mortality during six years. We find that mean sodium intake in quartiles ranges from 2.5 g to 5.9 g/day. After adjustment for confounders, no significant associations are observed between sodium intake quartiles and incidence of diabetes complications and mortality, except for a significant trend for an increased risk of diabetic retinopathy (p = 0.039). Among patients whose vegetable intake was less than the average of 268.7 g, hazard ratios (HRs) for diabetic retinopathy in patients in the second, third, and fourth quartiles of sodium intake compared with the first quartile were 0.87 (95% CI, 0.31–2.41), 2.61 (1.00–6.83), and 3.70 (1.37–10.02), respectively. Findings indicate that high sodium intake under conditions of low vegetable intake is associated with an elevated incidence of diabetic retinopathy in elderly patients with type 2 diabetes.     

Serologic response to meningococcal vaccination in patients with cold agglutinin disease (CAD) in the novel era of complement inhibition

Cold agglutinin disease (CAD) is a rare, potentially life-threatening acquired autoimmune hemolytic anemia characterized by hemagglutination and hemolysis due to immunoglobulin-mediated (usually IgMκ) classic complement pathway activation. Complement inhibition (CI) represents a novel treatment option to control hemolysis. Due to CI patients (pts) are susceptible to encapsulated bacteria e.g. N. meningitidis. Therefore, meningococcal vaccination on CI is mandatory. In this study serologic response to the tetravalent conjugate vaccine Menveo® was analyzed in CAD pts on eculizumab treatment (DECADE trial) using rabbit serum as complement source (rSBA). Protective rSBA titers varied for meningococcal serogroups and over time reflecting an early decline to even non-protective rSBA titers. These data highlight the importance of serologic analyses under chronic CI. Currently, re-vaccination with a tetravalent meningococcal conjugate vaccine every 3 years is recommended on chronic CI. However, re-vaccination on CI might further rely on serologic analyses, implying even early booster vaccinations similar to adults with (functional) asplenia.     

CYP7A1, NPC1L1, ABCB1, and CD36 Polymorphisms Associated with Coenzyme Q10 Availability Affect the Subjective Quality of Life Score (SF-36) after Long-Term CoQ10 Supplementation in Women

The single nucleotide polymorphisms (SNPs) rs3808607, rs2072183, rs2032582, and rs1761667 are associated with coenzyme Q₁₀ (CoQ₁₀) bioavailability in women after long-term CoQ₁₀ supplementation. However, the beneficial aspects of the association between these SNPs and CoQ₁₀ supplementation remain unknown. We investigated their relationship using the subjective quality of life score SF-36 by reanalyzing previous data from 92 study participants who were receiving ubiquinol (a reduced form of CoQ₁₀) supplementation for 1 year. Two-way repeated-measures analysis of variance revealed a significant interaction between rs1761667 and the SF-36 scores of role physical (p = 0.016) and mental health (p = 0.017) in women. Subgrouping of participants based on the above four SNPs revealed significant interactions between these SNPs and the SF-36 scores of general health (p = 0.045), role emotional (p = 0.008), and mental health (p = 0.019) and increased serum CoQ₁₀ levels (p = 0.008), suggesting that the benefits of CoQ₁₀ supplementation, especially in terms of psychological parameters, are genotype-dependent in women. However, significant interactions were not observed in men. Therefore, inclusion of SNP subgrouping information in clinical trials of CoQ₁₀ supplementation may provide conclusive evidence supporting other beneficial health effects exerted by the association between these SNPs and CoQ₁₀ on women.     

Effect of Tdap when administered before,with or after the 13-valent pneumococcal conjugate vaccine (coadministered with the quadrivalent meningococcal conjugate vaccine) in adults: A randomised controlled trial

Sequential or co-administration of vaccines has potential to alter the immune response to any of the antigens. Existing literature suggests that prior immunisation of tetanus/diphtheria-containing vaccines can either enhance or suppress immune response to conjugate pneumococcal or meningococcal vaccines. We examined this interaction among adult Australian travellers before attending the Hajj pilgrimage 2014. We also investigated tolerability of these vaccines separately and concomitantly. We randomly assigned each participant to one of three vaccination schedules. Group A received adult tetanus, diphtheria and acellular pertussis vaccine (Tdap) 3–4 weeks before receiving CRM197-conjugated 13-valent pneumococcal vaccine (PCV13) and CRM197-conjugated quadrivalent meningococcal vaccine (MCV4). Group B received all three vaccines on one day. Group C received PCV13 and MCV4 3–4 weeks before Tdap. Blood samples collected at baseline, each vaccination visit and 3–4 weeks after vaccination were tested using the pneumococcal opsonophagocytic assay (OPA) and by ELISA for diphtheria and tetanus antibodies. Funding for meningococcal serology was not available. Participants completed symptom diaries after each vaccination. A total of 111 participants aged 18–64 (median 40) years were recruited. No statistically significant difference was detected across the three groups in achieving OPA titre ⩾1:8 post vaccination. However, compared to other groups, Group A had a statistically significant lower number of subjects achieving ⩾4-fold rise in serotype 3, and also significantly lower geometric mean titres (GMTs) to six (of 13) pneumococcal serotypes (3, 5, 18C, 4, 19A and 9V). Group C (given prior PCV13 and MVC4) had statistically significant higher pre-Tdap geometric mean concentration (GMC) of anti-diphtheria IgG; however, there was no difference across the three groups following Tdap. Anti-tetanus IgG GMCs were similar across the groups before and after Tdap. No serious adverse events were reported. In conclusion, Tdap vaccination 3–4 weeks before concomitant administration of PCV13 and MCV4 significantly reduced the antibody response to six of the 13 pneumococcal serotypes in adults.The trial is registered at the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000536763.     

Effect of Tdap upon antibody response to meningococcal polysaccharide when administered before,with or after the quadrivalent meningococcal TT-conjugate vaccine (coadministered with the 13-valent pneumococcal CRM197-conjugate vaccine) in adult Hajj pilgrims: A randomised controlled trial

Hajj pilgrims are susceptible to several serious infections and are required to receive multiple vaccinations. Polysaccharide-protein conjugate vaccines contain carrier proteins such as tetanus toxoid (TT), diphtheria toxoid or a mutant of diphtheria toxoid (CRM197). These carrier proteins may interact with other conjugate or combination vaccines containing tetanus or diphtheria on concurrent or sequential administration. We examined the immune interaction of separate and concomitant administration of a tetanus/diphtheria/acellular pertussis (Tdap) vaccine with a TT-conjugated quadrivalent meningococcal vaccine (MCV4) (coadministered with 13-valent pneumococcal CRM197-conjugate vaccine [PCV13]) in adult Australian pilgrims before attending Hajj in 2015.We randomly assigned each participant to one of three vaccination schedules. Group 1 received Tdap 3–4 weeks before receiving MCV4 coadministered with PCV13. Group 2 received all three vaccines concomitantly. Group 3 received MCV4 and PCV13 3–4 weeks before Tdap. Blood samples were collected at baseline, at each vaccination visit and 3–4 weeks after vaccination and tested for response to meningococcal serogroups C, W and Y using a serum bactericidal antibody (rSBA) assay with baby rabbit complement, and to diphtheria and tetanus toxoid, measuring IgG antibodies by ELISA. Participants completed symptom diaries after each vaccination. A total of 166 participants aged 18–64 (median 42) years were recruited, of whom 160 completed the study. Compared to the other groups, Group 1 (given Tdap first) had significantly lower proportion of subjects achieving a ≥4-fold rise in rSBA for serogroup W. No difference was detected across the three groups in achieving protection threshold (rSBA ≥8 post vaccination) or SBA geometric mean titre (GMT) post vaccination.Group 3, which was given MCV4/PCV13 first, had high levels of antibody against diphtheria and tetanus than the other groups, when tested prior to receipt of Tdap; Only the anti-tetanus responses remained significantly higher after Tdap administration. No serious adverse events were reported.In conclusion, when multiple vaccination is required for Hajj pilgrims, administering Tdap concurrently with MCV4/PCV13 produces adequate immune responses, and avoids meningococcal immune interference, in the convenience of a single consultation. However, giving Tdap 3–4 weeks after MCV4/PCV13 has the advantage of an enhanced tetanus toxoid response.The trial is Trials Registry (ANZCTR): ACTRN12613000536763.