Physical Activity and Risk of Metabolic Phenotypes of Obesity: A Prospective Taiwanese Cohort Study in More Than 200,000 Adults

ObjectiveTo examine the association between physical activity (PA) and the risk for metabolically unhealthy obesity (MUO) or metabolically healthy obesity (MHO) in Asian adults.Patients and MethodsData were obtained from 205,745 healthy individuals 18 years or older. Individuals were classified as inactive, lower or upper insufficiently active, active, and high active. Metabolically unhealthy was defined as having 1 or more of the metabolic syndrome criteria, excluding the abdominal obesity criterion.ResultsThe percentages of metabolically healthy normal-weight (MHNW), metabolically healthy overweight (MHOW), MHO, and MUO in our cohort were 30.8% (63,408 of 205,745), 5.8% (12,002 of 205,745), 4.1% (8329 of 205,745), and 20.7% (42,564 of 205,745), respectively. During a mean follow-up of 6 (range, 0.5-19) years, among 63,408 MHNW participants, 1890 (3.0%) and 1174 (1.9%) developed MUO and MHO, respectively. Among 12,002 MHOW participants, 3404 (28.4%) developed MUO and 2734 (22.8%) developed MHO. A total of 5506 of 8329 (66.1%) participants moved from MHO to MUO, and 5675 of 42,564 (13.3%) moved from MUO to MHO. Compared with being inactive, MHNW individuals who were active or high active showed lower risk for MUO. Among those with MHOW, being high active was associated with reduced risk for MUO and MHO. Although among MHO participants, PA was not associated with incident MUO, being active or high active was linked to a greater likelihood of moving from MUO to MHO.ConclusionPA may prevent the development of both MHO and MUO. PA also helps increase the transition from MUO to MHO, which may contribute to reduce the subsequent development of type 2 diabetes mellitus and major cardiovascular disease complications.     

Can we rely on public data as a source of information for cancer registry in developing countries?

BACKGROUND/AIMS: Although a "hospital-based cancer registry" is important in improving patient care, a "population-based cancer registry" with emphasis on epidemiology is important in allocating health care resources and prioritizing public health programs. Because of its reliance on retrieved clinical and para-clinical documents, there is some limitation in registering all cancer incidents in this system, especially in developing countries. In this study we examined the possibility of using public data as a complementary source of information for recording cancers in a population-based cancer registry. METHODS: Along with the annual census in rural areas, a survey was performed in Golestan province in March 2004 to identify public awareness about cancer incidents in the community. Individuals were questioned about history of cancer in their close relatives during the last two years. Those who reported cancer in their relatives were also asked to name the main organ of involvement. A similar list was retrieved from the cancer registry at the Ministry of Health in Gorgan, and cases with upper GI (esophagus and gastric) cancer diagnosis from 21 March 2002 through 20 March 2004 were selected for this study. Finally, these two lists were compared for examining accuracy of the collected data. RESULTS: We included 137 cases in our study with rural residence and known addresses. Only 35 (25.5%) cases were reported by the relatives and among them only 20 (57.1%) relatives correctly reported the tumor location. Although we found a difference in accurate reporting of cancer incidents by year of diagnosis (more correct cases reported during the second versus the first year), the difference was not statistically significant between the two years. CONCLUSION: In this study, we examined the possibility of using public awareness about cancer incidents as a complementary source of information for a population-based cancer registry. We found that this approach is not ideal for reducing limitations. Therefore, we recommend a nationwide cancer registry to record all cancer-related information at the time of diagnosis. This strategy will reduce the need for performing retrospective surveys in collecting cancer-related information.     

Oral polio vaccine response in breast fed infants with malnutrition and diarrhea

Oral vaccines for polio (OPV) and rotavirus are less effective in children in the developing world. The reasons for this are not well understood. We tested for risk factors for poor response to OPV in infants from an urban slum of Dhaka, Bangladesh. Diminished serum neutralizing response to OPV, but not failure of intramuscularly administered vaccines, was associated with malnutrition, diarrhea, and shorter breastfeeding duration. Children with malnutrition (WAZ <−2) had significantly lower OPV 3 titers (p = 0.029). Children who had 2 or more diarrhea episodes during the 1st months of life were more than twice as likely to experience OPV failure as those who had 1 diarrhea episode or no diarrhea (p = 0.0245). In contrast, each additional month in exclusive breastfeeding was associated with an increase in OPV 3 titer by 0.41 (p = 0.0072) and 0.16 (p = 0.0065) at the 25th and 50th percentiles of OPV 3 titers respectively. These data are consistent with a defect in induction of immunity in the gut for OPV but not parenteral vaccines, a defect that may be amenable to intervention in part via promotion of exclusive breastfeeding.     

Critical Analysis of Compositions and Protective Efficacies of Oral Killed Cholera Vaccines

Two cholera vaccines, sold as Shanchol and Dukoral, are currently available. This review presents a critical analysis of the protective efficacies of these vaccines. Children under 5 years of age are very vulnerable to cholera and account for the highest incidence of cholera cases and more than half of the resulting deaths. Both Shanchol and Dukoral are two-spaced-dose oral vaccines comprising large numbers of killed cholera bacteria. The former contains Vibrio cholerae O1 and O139 cells, and the latter contains V. cholerae O1 cells with the recombinant B subunit of cholera toxin. In a field trial in Kolkata (India), Shanchol, the preferred vaccine, protected 45% of the test subjects in all of the age groups and only 17% of the children under 5 years of age during the first year of surveillance. In a field trial in Peru, two spaced doses of Dukoral offered negative protection in children under 5 years of age and little protection (15%) in vaccinees over 6 years of age during the first year of surveillance. Little is known about Dukoral''s long-term protective efficacy. Both of these vaccines have questionable compositions, using V. cholerae O1 strains isolated in 1947 that have been inactivated by heat and formalin treatments that may denature protein. Immunological studies revealed Dukoral''s reduced and short-lived efficacy, as measured by several immunological endpoints. Various factors, such as the necessity for multiple doses, poor protection of children under 5 years of age, the requirement of a cold supply chain, production costs, and complex logistics of vaccine delivery, greatly reduce the suitability of either of these vaccines for endemic or epidemic cholera control in resource-poor settings.     

Using web‐based training to improve accuracy of blood pressure measurement among health care professionals: A randomized trial

Accurate blood pressure measurement is crucial for proper screening, diagnosis, and monitoring of high blood pressure. However, providers are not aware of proper blood pressure measurement skills, do not master all the appropriate skills, or miss key steps in the process, leading to inconsistent or inaccurate readings. Training in blood pressure measurement for most providers is usually limited to a one‐time brief demonstration during professional education coursework. The American Medical Association and the American Heart Association developed a 30‐minute e‐Learning module designed to refresh and improve existing blood pressure measurement knowledge and clinical skills among practicing providers. One hundred seventy‐seven practicing providers, which included medical assistants, nurses, advanced practice providers, and physicians, participated in a multi‐site randomized educational study designed to assess the effect of this e‐Learning module on blood pressure measurement knowledge and skills. Participants were randomized 1:1 to either the intervention or control group. The intervention group followed a pre‐post assessment approach, and the control group followed a test‐retest approach. The initial assessment showed that participants in both the intervention and control groups correctly performed less than half of the 14 skills considered necessary to obtain an accurate blood pressure measurement (mean scores 5.5 and 5.9, respectively). Following the e‐Learning module, the intervention group performed on average of 3.4 more skills correctly vs 1.4 in the control group (P < .01). Our findings reinforce existing evidence that errors in provider blood pressure measurements are highly prevalent and provide novel evidence that refresher training improves measurement accuracy.     

地尔硫(艹卓)与西地兰-D对心房颤动心室率的控制及其对房室传导的影响

目的:比较地尔硫革(Diltiazem)及西地兰-D对心房颤动(房颤)心室率控制的安全性和有效率以及对传导系统的影响。方法:对43例房颤患者随机地接受0.4mg西地兰-D(n-22)或0.25mg/kg地尔硫(?)(n=21)。120 min时无效者重复同剂量地尔硫(?)或0.2 mg西地兰-D。记录用药前后5、10、20、30、60 min的心室率及血压。无效者观察120 min及第2次用药者180 min的心室率及血压。19例窦性心律患者随机分为西地兰-D(n=10)和地尔硫(?)(n=9)组行希氏束电图检查测量PA、AH、HV间期而评估西地兰-D及地尔硫(?)对传导系统的影响。记录药物注射前及注射后的5、10、20、30 min的希氏束电图。结果:地尔硫(?)及西地兰-D组中180min内能有效控制心室率分别为20及15例(95.2％:68.2％,P<0.05)。地尔硫(?)及西地兰-D均延长AH间期,但对PA、HV问期无影响。结论:地尔硫(?)及西地兰-D均能减慢房颤心室率,但地尔硫(?)的有效率、心室率下降幅度优于西地兰-D。地尔硫(?)对心室率快的房颤伴充血性心力衰竭患者是一种较为合适的药物,在密切监护下应是安全的。两药均不影响HV、PA间期而通过延长AH间期减慢心室率。     

Drug eluting biliary stents to decrease stent failure rates: A review of the literature

Biliary stenting is clinically effective in relieving both malignant and non-malignant obstructions. However, there are high failure rates associated with tumor ingrowth and epithelial overgrowth as well as internally from biofilm development and subsequent clogging. Within the last decade, the use of prophylactic drug eluting stents as a means to reduce stent failure has been investigated. In this review we provide an overview of the current research on drug eluting biliary stents. While there is limited human trial data regarding the clinical benefit of drug eluting biliary stents in preventing stent obstruction, recent research suggests promise regarding their safety and potential efficacy.     

Chemical,Pharmacological and Computerized Molecular Analysis of Stem’s Extracts of Bauhinia scandens L. Provide Insights into the Management of Diarrheal and Microbial Infections

Bauhinia scandens L. (Family: Fabaceae) is commonly used to treat cholera, diarrhea, asthma, and diabetes disorder in integrative medicine. This study aimed to screen the presence of phytochemicals (preliminary and UPLC-QTOF–M.S. analysis) and to examine the pharmacological activities of Bauhinia scandens L. stems (MEBS) stem extracts. Besides, in silico study was also implemented to elucidate the binding affinity and drug capability of the selected phytochemicals. In vivo anti diarrheal activity was investigated in mice models. In vitro, antibacterial and antifungal properties of MEBS against several pathogenic strains were evaluated using the disc diffusion method. In addition, in silico study has been employed using Discovery studio 2020, UCFS Chimera, PyRx autodock vina, and online tools. In the anti-diarrheal investigation, MEBS showed a significant dose-dependent inhibition rate in all three methods. The antibacterial and antifungal screening showed a remarkable zone of inhibition, of the diameter 14–26 mm and 12–28 mm, by MEBS. The present study revealed that MEBS has remarkable anti-diarrheal potential and is highly effective in wide-spectrum bacterial and fungal strains. Moreover, the in silico study validated the results of biological screenings. To conclude, MEBS is presumed to be a good source in treating diarrhea, bacterial and fungal infections.     

DL-3-n-butylphthalide ameliorates diabetes-associated cognitive decline by enhancing PI3K/Akt signaling and suppressing oxidative stress

DL3-n-Butylphthalide(DLNBP),a small molecular compound extracted from the seeds of Ap/um graveo/ens Linn(Chinese celery),has been shown to exert neuroprotective effects due to its anti-inflammatory,anti-oxidative and anti-apoptotic activities.DL-NBP not only protects against ischemic cerebral injury,but also ameliorates vascular cognitive impairment in dementia patients including AD and PD.In the current study,we investigated whether and how DL-NBP exerted a neuroprotective effect against diabetes-associated cognitive decline(DACD)in db/db mice,a model of type-2 diabetes,db/db mice were orally administered DL-NBP(20,60,120 mg·kg^-1·d^-1)for 8 weeks.Then the mice were subjected to behavioral test,their brain tissue was collected for morphological and biochemical analyses.We showed that oral administration of DL-NBP significantly ameliorated the cognitive decline with improved learning and memory function in Morris water maze testing.Furthermore,DL-NBP administration attenuated diabetes-induced morphological alterations and increased neuronal survival and restored the levels of synaptic protein PSD95,synaptophysin and synapsin-1 as well as dendritic density in the hippocampus,especially at a dose of 60 mg/kg.Moreover,we revealed that DL-NBP administration suppressed oxidative stress by upregulating Nrf2/HO-1 signaling,and increased brain-derived neurotrophic factor(BDNF)expression by activating PI3K/Akt/CREB signaling in the hippocampus.These beneficial effects of DL-NBP were observed in high glucose-treated PC12 cells.Our results suggest that DL-NBP may be a potential pharmacologic agent for the treatment of DACD.