MicroRNAs in lung cancer

MicroRNAs have become recognized as key players in the development of cancer. They are a family of small non-coding RNAs that can negatively regulate the expression of cancer-related genes by sequence-selective targeting of mRNAs, leading to either mRNA degradation or translational repression. Lung cancer is the leading cause of cancer-related death worldwide with a substantially low survival rate. MicroRNAs have been confirmed to play roles in lung cancer development, epithelial-mesenchymal transition and response to therapy. They are also being studied for their future use as diagnostic and prognostic biomarkers and as potential therapeutic targets. In this review we focus on the role of dysregulated microRNA expression in lung tumorigenesis. We also discuss the role of microRNAs in therapeutic resistance and as biomarkers. We further look into the progress made and challenges remaining in using microRNAs for therapy in lung cancer.     

Repeat antenatal glucocorticoids for women at risk of preterm birth: a Cochrane Systematic Review

Administration of antenatal glucocorticoids to women at risk of preterm birth has major benefits for infants but the use of repeat dose(s) is controversial. We performed a systematic review of randomized trials, using standard Cochrane methodology, to assess the effectiveness and safety of 1 or more repeat doses given to women at risk of preterm birth 7 or more days after an initial course. Ten trials were included involving over 4730 women and 5700 infants. Treatment with repeat dose(s) compared with no repeat treatment reduced the risk of respiratory distress syndrome (risk ratio, 0.83; 95% confidence interval, 0.75-0.91) and serious neonatal morbidity (risk ratio, 0.84; 95% confidence interval, 0.75-0.94). At 2- to 3-year follow-up (4 trials, 4170 children), there was no evidence of either significant benefit or harm. Repeat doses of glucocorticoids should be considered in women at risk of preterm birth 7 or more days after an initial course, in view of the neonatal benefits.     

Women with diagnosed diabetes across the life stages: underuse of recommended preventive care services

Diabetes is a common and costly disease. In 2007, an estimated 24 million people in the United States had diabetes, with almost half of these being women. Diabetes increases the risk of morbidity and mortality from several conditions, including cardiovascular disease, several types of cancers, influenza and pneumococcal infection, and kidney, eye, and periodontal diseases. The aim of this study was to examine the quality of care that women with diabetes receive and to assess how receipt of some clinical preventive services and screening for common conditions associated with diabetes vary according to socioeconomic factors. Our findings indicate that use of diabetes-specific preventive care among women is low, with the youngest women (< or =45 years) and those with low educational levels being the least likely to receive the recommended services. Women with diabetes were less likely than women without diabetes to receive a Pap smear, with the oldest women (> or =65 years) being the most vulnerable. Women with diabetes who were poor and nonwhite were less likely than more affluent and white women to receive a pneumococcal vaccination. This study's findings suggest that having a chronic disease may serve as a barrier to the receipt of recommended preventive care among women. Effective interventions should be designed to meet the needs of the most vulnerable women with diabetes, in particular, those who are at the extremes of the life cycle, are poor, and have low levels of education. Programs should use a life stage approach to address the unique needs of women with diabetes.     

Qualitative research and the politics of knowledge in an age of evidence: developing a research-based practice of immanent critique

This paper offers an expository discussion of an approach to qualitative health research we call immanent critique. The central analytic move of immanent critique, as we have practiced it, is to explore how claims that are internal to authoritative discourse are experienced by those who have been excluded from their formulation. This paper contributes to the discussion of the politics of qualitative research methods in an age of evidence. We do so by responding to a recent call to move beyond the micro-politics of the qualitative research encounter to consider the overall political effects of qualitative research. We argue that the political effects of research are partly enabled by mundane practices internal to the research process. We explore how this is so by considering one formulation of immanent critique--a qualitative study of the introduction of continuous quality improvement in Ontario hospitals. We emphasize how practices internal to our research--trade union collaboration, our orientation to authoritative claims, and procedures for generating and representing health care workers' experiences--helped shape the political effects of our research. The latter include challenges to managerial claims about neo-liberal health reform and broadening the evidentiary terrain upon which interlocutors can participate in public debate about health care restructuring.     

Weight regain after Roux-en-Y: a significant 20% complication related to PYY

OBJECTIVE: Roux-en-Y gastric bypass (RYGB) produces rapid and dramatic weight loss in very heavy obese patients. Up to 20% cannot sustain their weight loss beyond 2 to 3 y after surgery. METHODS: To identify putative etiologic factors producing post-RYGB weight regain, a literature survey of metabolic changes in very obese and a review of our diet-induced obese RYGB rat model data was done. RESULTS: Weight regain suggests an imbalance in physiologic mechanisms regulating appetite and metabolic rate. Weight regain occurred in 25% of our rats, produced by return to presurgical energy intake levels. The 75% of rats that sustained weight loss secreted a significantly larger amount of peptide YY (PYY) while suppressing leptin secretion; those that failed were unable to develop or sustain a sufficiently large plasma PYY:leptin ratio. Metabolic consequences of this failure included reversal of initial postsurgical increases in peripheral fatty acid oxidation, anorexigenic activity in the hypothalamic arcuate nucleus and paraventricular nucleus, and the expression of uncoupling protein-2 in adipose tissues, and decreases in hepatic lipogenesis, free tri-iodothyronine secretion, expression of orexigenic activity in the arcuate nucleus and paraventricular nucleus, expression of adenosine monophosphate kinase in adipose tissues, skeletal muscle mitochondrial mass, and endocannabinoid content and appetite. CONCLUSION: Weight regain after RYGB occurs in approximately 20% of patients and constitutes a serious complication. Weight regain-promoting consequences are attributed to a failure to sustain elevated plasma PYY concentrations, indicating that combining RYGB with pharmacologic stimulation of PYY secretion in patients after RYGB who exhibit inadequate PYY concentration may increase long-term success of surgical weight reduction in morbidly obese adults.