Associations of Dietary Patterns and Nutrients with Glycated Hemoglobin in Participants with and without Type 1 Diabetes

Background: Diet has been associated with poor glycemic control in diabetes. Few studies have examined this association in people with type 1 diabetes (T1D), who are at a higher risk for cardiovascular disease than people without diabetes. Methods: We report data from cross-sectional and longitudinal analyses from a coronary artery calcification in type 1 diabetes (CACTI) study (n = 1257; T1D: n = 568; non-diabetic controls: n = 689) collected between the years 2000 and 2002. Participants completed a validated food frequency questionnaire, a physical examination, and biochemical analyses. Dietary patterns based on variations in food group intake were created with principal components analysis. Linear regression was used to examine the associations of dietary patterns, macronutrients, and food groups with HbA1c in a model adjusted for relevant covariates and stratified by diabetes status. Results: Three dietary patterns were identified: “fruits, veggies, meats, cereal”, “baked desserts” and “convenience foods and alcohol” patterns. At baseline, a higher intake of the “baked dessert” pattern was significantly associated with higher HbA1c in T1D at baseline as well at year 6 of the study when adjusted for age, sex, BMI, total calories, and diabetes duration. No such associations were observed in the case of non-diabetic controls. Dietary saturated fats and animal fats were also positively associated with HbA1c in adults with T1D at baseline and/or at year 6. Conclusions: The habitual intake of a dietary pattern that is characterized by an increased intake of added sugar and saturated fats, such as in baked desserts, may increase risks of poor glycemic control in T1D.     

Kidney recipients with allograft failure,transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers

Kidney allograft failure and return to dialysis carry a high risk of morbidity. A practice survey was developed by the AST Kidney Pancreas Community of Practice workgroup and distributed electronically to the AST members. There were 104 respondents who represented 92 kidney transplant centers. Most survey respondents were transplant nephrologists at academic centers. The most common approach to immunosuppression management was to withdraw the antimetabolite first (73%), while only 12% responded they would withdraw calcineurin inhibitor (CNI) first. More than 60% reported that the availability of a living donor is the most important factor in their decision to taper immunosuppression, followed by risk of infection, risk of sensitization, frailty, and side effects of medications. More than half of respondents reported that embolization was either not available or offered to less than 10% as an option for surgical intervention. Majority reported that ≤50% of failed allograft patients were re-listed before dialysis, and less than a quarter of transplant nephrologists performed frequent visits with their patients with failed kidney allograft after they return to dialysis. This survey demonstrates heterogeneity in the care of patients with a failing allograft and the need for more evidence to guide improvements in clinical practice related to transition of care.     

MUC1 (CD227) interacts with lck tyrosine kinase in Jurkat lymphoma cells and normal T cells

MUC1 (CD227) is a large transmembrane epithelial mucin glycoprotein, which is aberrantly overexpressed in most adenocarcinomas and is a target for immune therapy for epithelial tumors. Recently, MUC1 has been detected in a variety of hematopoietic cell malignancies including T and B cell lymphomas and myelomas; however, its function in these cells is not clearly defined. Using the Jurkat T cell lymphoma cell line and normal human T cells, we demonstrate that MUC1 is not only expressed in these cells but is also phosphorylated upon T cell receptor (TCR) ligation and associates with the Src-related T cell tyrosine kinase, p56lck. Upon TCR-mediated activation of Jurkat cells, MUC1 is found in the low-density membrane fractions, where linker of T cell activation is contained. Abrogation of MUC1 expression in Jurkat cells by MUC1-specific small interfering RNA resulted in defects in TCR-mediated downstream signaling events associated with T cell activation. These include reduction in Ca2+ influx and extracellular signal-regulated kinase 1/2 phosphorylation, leading to a decrease in CD69 expression, proliferation, and interleukin-2 production. These results suggest a regulatory role of MUC1 in modulating proximal signal transduction events through its interaction with proteins of the activation complex.     

Hospital service areas and Medicaid access in Maryland

The study defines a service area (rather than a market area) of an individual hospital. Based on patient origin data, algorithms have been developed to select zip codes on the basis of their contributions to a hospital's discharges, and their ability to fulfill a contiguity principle along with a dependence criterion. The service area concept is also used to evaluate the performances of hospitals in terms of the access to care for Medicaid patients. The analysis shows that the hospital's performance in serving Medicaid patients does not significantly depend on its location, nor does it matter whether it is the only hospital in its jurisdiction.     

Juvenile dermatomyositis associated with autoantibodies to small ubiquitin-like modifier activating enzyme: a report of 4 cases from North India and a review of literature

Immunologic Research - Juvenile dermatomyositis (JDM) is the commonest inflammatory myositis in children. The clinical phenotype is often characterized by the presence of myositis-specific...     

Medicare spending by state: the border-crossing adjustment

As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze the spending patterns of State residents by studying the inflow and outflow rates and the netflow ratios of expenditures incurred by Medicare patients. The report also provides per capita expenditure estimates with residence-based adjustments and evaluates the impact of the border-crossing adjustment for individual services and States.     

Painless osteoid osteoma in a metacarpal

Osteoid osteoma is a benign primary tumour of bone occurring in the first two decades of life. It presents with pain and is uncommon in the hand, particularly so in the metacarpals. We report a painless osteoid osteoma affecting a metacarpal.     

Perinatal vitamin D and calcium status of northern Canadian mothers and their newborn infants

OBJECTIVE: This study was undertaken to examine the vitamin D and calcium status of mothers and their newborns. METHODS: The intakes of vitamin D and calcium were determined prenatally in 121 women including 33 Caucasians, 51 Inuits, and 37 Native Indians, living in the Inuvik zone of the Northwest Territories. Plasma concentrations of 25-(OH)-D and calcium were also measured in mothers as well as in their offspring at delivery. RESULTS: The daily mean vitamin D intake of native mothers, including Inuits and Indians, with (8.1+/-5.5 microg) and without supplements (3.4+/-2.5 microg) was significantly lower than that of non-native mothers (13.2+/-5.9 microg and 5.8+/-4.3 microg, respectively). According to the predicted prevalence of low vitamin D intake, there existed a higher risk of vitamin D deficiency without supplementation in both native (88.6% vs 48.4%) and non-native (63.5% vs. 15.1%) mothers. The trend for calcium intakes with and without supplementation was similar to vitamin D intake. At the point of delivery, the plasma levels of 25-(OH)-D were lower in native mothers (50.1 19.3 nmol/L) and their offspring (34.2+/-13.1 nmol/L) than their counterparts (59.8+/-29.4 nmol/L and 41.4+/-23.5 nmol/L, respectively). Its plasma levels in newborn infants averaged only 67% of their mothers. None of these infants showed clinical evidence of vitamin D deficiency. In fact, their plasma calcium levels were significantly higher than their mothers. CONCLUSIONS: Plasma 25-(OH)-D concentrations of 60 to 70% of maternal levels may represent a "normal" range for newborn infants. However, a supplementation in native northern Canadian mothers during pregnancy and in their neonates during infancy may have a role to play in the prevention of vitamin D deficiency.     

Use of small mammals (voles) to assess a hazardous waste site at Love Canal,Niagara Falls,New York

Voles (Microtus pennsylvanicus) were trapped in the immediate area of Love Canal (I), in an area very close to Love Canal (II), and in a reference area (III) about one km from Love Canal. The population densities were low in I, intermediate in II, and high in III. Using ages estimated on the basis of dry lens weights, mean life expectancy from weaning was 23.6 days in I, 29.2 days in II, and 48.8 days in III. Survivorship curves had significantly steeper slopes in I and II than in III. Thus, voles in I and II experienced a higher mortality rate than those in III. Liver and adrenal weights in females and seminal vesicle weights in males were significantly reduced in I compared to III. A fat pool from voles from I and II contained hexachlorocyclohexane and other chlorinated hydrocarbons that were not found in voles from III. These results suggest that relatively sedentary small native mammals may be of use in assessing environments with hazardous contamination.     

A gender more vulnerable

The greater risks of death faced by females in India are discussed in terms of the differences between the norther and southern regions of India, culture compounding inequality, and intervention strategies. When the assumption of a sex ratio of equality of 950/1000 is make, every region in the north is below (ranging from 874-913), and every region in the south above (ranging from 960-1040). The same north/south division remains for the male probability of dying by age 5 as a proportion of female probability (rural) in 1981. 2 explanations are given for female's greater survival changes in the south. 1) Marriage and kinship systems are different. Girls in the north typically marry earlier; many times marriage is to a stranger in a distant area so that family contact is reduced. The consequence is a reduction in female autonomy and status in both her father's and her husband's home. 2) Economic roles are different. Research has revealed that male/female survival equality occurs in states with high female labor force participation rates. At the micro level, working women's children tend to have more equal death rates. Physical devaluation is not only evidenced in death and survival, but also in the disparity in schooling. The states with the greatest gender differentials in mortality also have the greatest differences in literacy. This has been interpreted as household resources are disproportionately invested in males. Cultural inhibitions about the physical freedoms of girls also are involuntary reasons for the sex differential. The example is given of the apprehension generated for a male doctor's examination of a girl, a coeducational school environment, or a school located a distance from the home. There is the tradition of female seclusion and inhibition. In combination with the dependence on sons to limit the choices open to women, and to limit the growth and development, the product is inequality. Amniocentesis has lead to the increase in numbers of sex determination and abortion clinics. There is evidence that aborted fetuses are primarily female. Without change in these practices, there will not be a reversal in the sex ratio. Interventions suggested include increasing the number of facilities for the equal development of girls and women. There must be increases in female medical staff, more girl's schools in villages, and more nutrition programs for girls, Women's economic independence must be enhanced.