Pre-eclampsia during pregnancy and risk of endometrial cancer: a systematic review and meta-analysis.

BACKGROUND: Pre-eclampsia may be associated with the development of endometrial cancer; however, previous findings have been conflicting. OBJECTIVES: To investigate if pre-eclampsia is associated with an increased risk of endometrial cancer. METHOD: Two independent reviewers screened titles and abstracts of studies identified in MEDLINE, Embase, and Web of Science databases from inception until March 2022. Studies were included if they investigated pre-eclampsia and subsequent risk of endometrial cancer (or precursor lesions). Random-effects meta-analysis was used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between pre-eclampsia during pregnancy and endometrial cancer risk. MAIN RESULTS: There were seven articles identified which investigated endometrial cancer, of which one also investigated endometrial cancer precursors. Overall, the studies include 11,724 endometrial cancer cases. No association was observed between pre-eclampsia and risk of endometrial cancer with moderate heterogeneity observed (pooled HR 1.07, 95% CI 0.79-1.46, I2 = 34.1%). In sensitivity analysis investigating risk of endometrial neoplasia (atypical hyperplasia, carcinoma in situ, or cancer), there was some evidence that pre-eclampsia was associated with an increased risk (HR 1.34, 95% CI 1.15-1.57, I2 = 29.6%). CONCLUSIONS: Pre-eclampsia was not associated with an increased risk of endometrial cancer. Additional large studies with information on pre-eclampsia sub-type aiming to investigate endometrial cancer precursor conditions are merited.

Dominant Power and the Concept of Caste: Implications for Dentistry and Oral Health Inequality.

This paper explores the issues of caste and casteism in the U.S. as described by Pulitzer Prize winning journalist Isabel Wilkerson in her 2020 book "Caste: The Origin of Our Discontents". Wilkerson argues that a caste system not only exists in the U.S. but operates as a hidden force affecting social inequality. The paper draws on Wilkerson's work to explore caste as an analytical concept. It begins by defining caste and casteism in contrast with racism, the eight pillars of a caste system, the consequences of casteism, and the psychological drivers of casteism. The paper then applies to concept of caste to understanding power, dentistry, and oral health inequality. The paper concludes by emphasizing that the concept of caste and its relationship to oral health inequality must be understood it if we want to create real social change.

California Dentists' Engagement in Media Advocacy for Sugar Restriction Policies.

OBJECTIVES: Increasing dentists' visibility in the media to make the case for sugary beverage taxes can help advance public policy that improves oral health outcomes. We assessed California dentists' media engagement behaviors related to sugar restriction policies for dental caries prevention and correlates of engaging in such behavior. METHODS: Survey items related to sugar policies and media engagement were embedded in an electronically distributed statewide survey of dentists' tobacco cessation counseling behaviors. Descriptive statistics were calculated for respondent characteristics, perceived professional responsibility to discuss selected topics with patients, and attitudes and behaviors related to sugar restriction policy and media communication. Multivariable models identified independent correlates of media engagement. RESULTS: Of 624 respondents, most had never talked to traditional media (78%) or posted to social media (64%) about sugar or sugar policies for dental caries prevention. Respondents with the highest level of media engagement were more likely to agree that sugary beverage taxes are effective at reducing dental caries, that they had support from dental professional organizations to talk to the media, that it is realistic for patients to reduce their sugar consumption, and that sugar and sugary drinks are extremely harmful to health. CONCLUSIONS: Efforts to increase dentists' media engagement related to sugar restriction policies for dental caries prevention should address dentists' negative attitudes toward the effectiveness of sugar restriction policies and may require increased support from dental professional societies. KNOWLEDGE TRANSFER STATEMENT: Study findings identify dentists' low engagement in media advocacy to support sugar restriction policy adoption. The results identify correlates of media engagement and of dentists' willingness and confidence to act, which could serve to inform interventions to support and enhance engagement.

Neoliberalism and Indigenous oral health inequalities: a global perspective.

Neoliberalism is the dominant ideology underpinning the operation of many governments. Its tenets include policies of economic liberalization such as privatization, deregulation, free trade and reduced public expenditures on infrastructure and social services. Champions of neoliberalism claim that expansion of global trade has rescued millions from abject poverty and that direct foreign investment successfully transfers technology to developing economies. However, critics have urged governments to pay greater attention to how neoliberalism shapes population health. Indigenous populations experience inequalities in ways that are unique and distinct from the experiences of other marginalised groups. This is largely due to colonial influences that have resulted in sustained loss of lands, identity, languages and the control to live life in a traditional, cultural way that is meaningful. Oral health is simultaneously a reflection of material circumstances, structural inequities and access to health services. Indigenous populations carry a disproportionate burden of oral health inequalities at a global level. In this commentary, we contend that neoliberalism has overwhelmingly contributed to these inequities in three ways: (1) increased dominance of transnational corporations; (2) privatization of health and; (3) the neoliberal emphasis on personal responsibility.

Transnational corporations and oral health: examples from the sugar industry.

This paper seeks to describe the political behavior of transnational corporations (TNCs) related to sugars and dental caries. The paper begins by exploring dental caries as a political issue. It then provides a brief overview of key actors (expanders--e.g. public health advocates working to make policy action on sugar likely, and containers--e.g. TNC's working to prevent policy action on sugar) and the importance of problem definition in public policy making. The paper then compares how expanders and containers frame the problem of sugars and dental caries. Based upon a policy analysis framework, categories used to frame problems include incidence, causality, severity, crisis, characteristics of the problem population, values, and solutions. These categories are discussed with application to debates about public policy solutions to the problem of dental caries. It then concludes by highlighting some tensions that remain in tackling dental caries through legislation and regulation.

Social media for dissemination and public engagement in neurosurgery-the example of Brainbook.

BACKGROUND: Public engagement has become one of the most effective tools in gaining feedback and perspectives from members of the public, involving patients with decisions, and inspiring young people to carry the medical profession forwards. Brainbook is a multi-platform, social media-based resource that was created specifically to enhance public engagement in neurosurgery and results from one of its case discussions will be reported in this paper. METHODS: A Brainbook case was created in collaboration with the NIHR Global Health Research Group on Neurotrauma and presented over 3 days (23-25 February 2018). YouTube videos were created depicting the management of an acute subdural haematoma using patient interviews, medical illustration, consultant-led discussion and operative footage. Content was shared across all Brainbook social media platforms and analytics were gathered through social media applications. RESULTS: Over a 72-hour time period, and across multiple social media accounts, 101,418 impressions were achieved (defined as penetrance onto individual media feeds and total views of the content), with active discussion on social media. CONCLUSIONS: Neurosurgical content published across multiple social media outlets represents an encouraging and exciting potential for global engagement across multiple audiences. Social media can be an effective method of not only disseminating neurosurgical knowledge, but activating and engaging the public, allied healthcare professionals, medical students and neurosurgeons.

The interdigitating Y-plasty procedure for the correction of transverse vaginal septa.

Transverse vaginal septa are rare congenital abnormalities of the female genital tract, the surgical management of which is hardly described in the literature. While thicker septa might require complex reconstructive surgery, this paper proposes a simple technique for the surgical management of thin septa, utilising two interdigitating Y-plasties, without the need for excision of any septal tissue. The authors also present their series of eight consecutive cases where this technique was used, with no major complications or any cases of vaginal re-stenosis. This technique can also be used in imperforate hymen correction, therefore it might also be of interest to the general gynaecologist. TWEETABLE ABSTRACT: Interdigitating Y-plasties in transverse vaginal septa: presentation of a new technique.

Harmonizing influenza primary-care surveillance in the United Kingdom: piloting two methods to assess the timing and intensity of the seasonal epidemic across several general practice-based surveillance schemes.

General Practitioner consultation rates for influenza-like illness (ILI) are monitored through several geographically distinct schemes in the UK, providing early warning to government and health services of community circulation and intensity of activity each winter. Following on from the 2009 pandemic, there has been a harmonization initiative to allow comparison across the distinct existing surveillance schemes each season. The moving epidemic method (MEM), proposed by the European Centre for Disease Prevention and Control for standardizing reporting of ILI rates, was piloted in 2011/12 and 2012/13 along with the previously proposed UK method of empirical percentiles. The MEM resulted in thresholds that were lower than traditional thresholds but more appropriate as indicators of the start of influenza virus circulation. The intensity of the influenza season assessed with the MEM was similar to that reported through the percentile approach. The MEM pre-epidemic threshold has now been adopted for reporting by each country of the UK. Further work will continue to assess intensity of activity and apply standardized methods to other influenza-related data sources.

Age-specific vaccine effectiveness of seasonal 2010/2011 and pandemic influenza A(H1N1) 2009 vaccines in preventing influenza in the United Kingdom.

An analysis was undertaken to measure age-specific vaccine effectiveness (VE) of 2010/11 trivalent seasonal influenza vaccine (TIV) and monovalent 2009 pandemic influenza vaccine (PIV) administered in 2009/2010. The test-negative case-control study design was employed based on patients consulting primary care. Overall TIV effectiveness, adjusted for age and month, against confirmed influenza A(H1N1)pdm 2009 infection was 56% (95% CI 42-66); age-specific adjusted VE was 87% (95% CI 45-97) in <5-year-olds and 84% (95% CI 27-97) in 5- to 14-year-olds. Adjusted VE for PIV was only 28% (95% CI -6 to 51) overall and 72% (95% CI 15-91) in <5-year-olds. For confirmed influenza B infection, TIV effectiveness was 57% (95% CI 42-68) and in 5- to 14-year-olds 75% (95% CI 32-91). TIV provided moderate protection against the main circulating strains in 2010/2011, with higher protection in children. PIV administered during the previous season provided residual protection after 1 year, particularly in the <5 years age group.

Age related decreases in thermoregulation and cardiovascular function in horses.

REASON FOR PERFORMING STUDY: Older horses have an increased risk of hyperthermia due to impaired cardiovascular function. While many studies have investigated thermoregulation in horses during exercise, none have investigated the effects of ageing. OBJECTIVE: To test the hypothesis that there is a difference in thermoregulation during exercise and plasma volume (PV) in young and old horses. METHODS: Study 1: 6 young (Y, 7.7 ± 0.5 years) and 5 old (O, 26.0 ± 0.8 years) unfit Standardbred mares (507 ± 11 kg, mean ± s.e.) ran on a treadmill (6% grade, velocity calculated to generate a work rate of 1625 watts) until core temperature reached 40 °C. Core (CT), skin (ST), rectal temperature (RT) and heart rate (HR) were measured every min until 10 min post exertion. Packed cell volume (HCT), lactate (LA) and plasma protein (TP) were measured in blood samples collected before, at 40 °C and every 5 min until 10 min post exercise. Sweat loss was estimated using bodyweight. Study 2: Plasma volume was measured in 26 young (8.2 ± 0.7 years) and 8 old (26.6 ± 0.7 years) Standardbred mares (515 ± 12 kg) using Evans Blue dye. Pre-exercise blood (rBV) and red cell (rRCV) volumes were calculated using PV and HCT. Data analysis utilised repeated measures ANOVA and t tests and data are expressed as mean ± s.e. RESULTS: Old horses reached 40 °C faster (998 ± 113 vs. 1925 ± 259 s; P < 0.05) with a greater HR at 40 °C (184 ± 6 vs. 140 ± 5 beats/min; P < 0.05) and greater sweat losses (P < 0.05). Heart rate did not differ (P > 0.05) post exercise. Age did not alter (P > 0.05) CT, ST, RT, LA, HCT or TP. Plasma volume was greater in Y vs. O horses (P < 0.05, 28.5 ± 1.4 vs. 24.1 ± 1.6 l) as was rBV (41.3 ± 2.0 vs. 35.3 ± 2.3 l) and rRCV (13.3 ± 0.6 vs. 11.1 ± 0.8 l). CONCLUSION: Ageing compromises the ability to handle the combined demand of exercise and thermoregulation in part due to decreased absolute pre-exercise PV.

Neurosciences intensive care medicine in initial neurosurgical training.

The authors describe a novel 4-month clinical placement in neurosciences intensive care medicine (NICM) undertaken in the first specialty registrar (ST1) year of neurosurgical training as part of a clinical neurosciences themed training year. Neurosurgery is unique among British surgical specialties in having pioneered themed early years in run-through training to replace basic surgical training in general surgical specialties as part of Modernising Medical Careers. After describing events leading to the new neurosurgical training, the knowledge, skills and attitudes acquired in NICM are highlighted alongside discussion of logistic aspects and future directions from an inaugural experience.

Plasma beta-endorphin, cortisol and immune responses to acute exercise are altered by age and exercise training in horses.

REASONS FOR PERFORMING STUDY: Ageing appears to affect immune and neuroendocirne function in horses and response to acute exercise. No studies have examined the combined effects of training and ageing on immune and neuroendocirne function in horses. HYPOTHESIS: To ascertain whether training and age would affect the plasma beta-endorphin (BE) and cortisol (C) as well as immune function responses to acute exercise in Standardbred mares. METHODS: Graded exercise tests (GXT) and simulated race tests (SRT) were performed before and after 12 weeks training at 60 % HRmax. BE and C were measured at rest and at 5, 10, 20, 40, 60 and 120 min post GXT. Leucocyte cell number, CD4+ and CD8+ lymphocyte subsets, and mitogen stimulated lymphoproliferative response (LPR), were measured in jugular blood before and after the SRTs. RESULTS: Cortisol rose by 5 min post GXT in young (Y) and middle-age (MA) mares (P<0.05) and remained elevated until 40 and 60 min post GXT, respectively during both pre- and post training GXT. There was no rise in C in old (0) mares after either GXT (P>0.05). Pretraining BE rose (P<0.05) by 5 min post GXT in all mares. After training, BE was higher in Y and O vs. MA (P<0.05) at 5 min post GXT. Post training BE was higher at 5 min post GXT in Y and O vs. pretraining (P<0.05). After SRT, lymphocyte number rose in all mares (P<0.05); however, lower lymphocyte numbers (P<0.05) were seen in MA vs. Y and O vs. MA (P<0.05). The O had reduced LPR to Con A and PHA stimulation (P<0.05) compared to Y and MA after the SRT after both pre- and post training SRT. LPR to PWM was lower (P<0.05) in O vs. Y and MA after the pretraining SRT. Training caused an increase in resting LPR to PWM in MA only (P<0.05). CONCLUSION: Both age and training altered the plasma beta-endorphin and cortisol responses as well as and immune responses to acute exercise. POTENTIAL RELEVANCE: This study provides important information on the effects of ageing and training that will aid in the management and care of an increasing number of active older horses.

Muscle, tendon, and somatotropin responses to the restriction of muscle blood flow induced by KAATSU-walk training.

OBJECTIVE: The efficacy of KAATSU training has been demonstrated in human athletes, both as a therapeutic method as well as a training aid. The purpose of this study was to investigate the effects of slow walk training combined with restriction of muscle blood flow (KAATSU) on muscle and tendon size. METHODS: Six healthy, unfit Standardbred mares performed walking (240 m/min for 10 min and then 5 min recovery) with KAATSU, and 6 mares performed walking without KAATSU. A specially designed elastic cuff1 was placed at the most proximal position of the forelegs and inflated to a pressure of 200-230 mmHg throughout the walking and recovery sessions. The training was conducted once a day, 6 days/week for 2 weeks. Skeletal muscle thickness and tendon thickness were measured using B-mode ultrasound at baseline and after 2 weeks of training. Venous blood samples were obtained before the first acute exercise and 5, 15 and 60 min afterwards. Serum somatotropin concentration was determined using a commercially available equine-specific ELISA kit. RESULTS: The acute increase in plasma somatotropin was 40% greater (P<0.05) in the KAATSU-walk group than in the Control-walk group 5 min after exercise and remained elevated (P<0.05) at 15 and 60 min post exercise compared with the Control-walk group. After 2 weeks of training, muscle thickness increased (P<0.05) 3.5% in the KAATSU-walk group but did not change in the Control-walk group (0.7%). Tendon thickness did not change (P>0.05) in either group. CONCLUSIONS: These data demonstrate that KAATSU training can induce muscle hypertrophy in horses and suggest that KAATSU training may provide significant therapeutic/ rehabilitative value in horses, as has been shown in man.

Effect of chronic clenbuterol administration and exercise training on immune function in horses.

Effects of longitudinal exercise training and acute intensive exercise (simulated race test) on immune function have not been reported in horses. Clenbuterol, a beta2-adrenergic agonist, is used to manage inflammatory airway disease in horses. This study investigated the interaction of 8 wk of exercise training with or without 12 wk of clenbuterol administration in horses. Twenty-three untrained standardbred mares (10 +/- 3 yr, Mean +/- SE) were used and divided into four experimental groups. Horses given clenbuterol plus exercise (CLENEX; n = 6) and clenbuterol alone (CLEN; n = 6) received 2.4 microg/kg BW of clenbuterol twice daily (in an average volume of 20 mL) on a schedule of 5 d on and 2 d off for 12 wk. The CLENEX group was also aerobically trained 3 d/wk. Mares given exercise alone (EX; n = 5) were aerobically trained for 3 d/wk, and the control group (CON; n = 6) remained sedentary. Both EX and CON horses were administered similar volumes (approximately 20 mL) of molasses twice daily. A simulated race test (SRT) resulted in an elevation in lymphocyte number postexercise (P < 0.05). There was no significant difference after acute exercise in either monocyte or granulocyte number. Acute exercise resulted in a decrease (P < 0.05) in the percentage of CD4+ and an increase (P < 0.05) in the percentage of CD8+ cells. The SRT resulted in a decreased lymphoproliferative response to pokeweed mitogen (P < 0.05). A SRT had no effect on antibody production in response to equine influenza vaccine. The EX group demonstrated greater cortisol concentrations at rest and at all other time points postexercise after completing the training regimen compared with CLENEX horses (P < 0.05). Preexercise (SRT) peripheral blood monocyte number was lower in CLENEX horses than in other treatment groups (P < 0.05). Clenbuterol and exercise training did not significantly affect post-SRT changes in leukocyte numbers. Exercise training resulted in a decrease (P < 0.05) in the percentage of CD8+ cells post-SRT compared with other groups, but the percentage of CD4+ cells was not altered by either clenbuterol or exercise conditioning. Lymphocyte proliferative response was not affected by clenbuterol or exercise treatment. Horses demonstrated responses to bouts of acute exercise as noted with other species, namely humans and rodents.

Whole body muscle hypertrophy from resistance training: distribution and total mass.

OBJECTIVE: To examine the absolute and relative changes in skeletal muscle (SM) size using whole body magnetic resonance imaging (MRI) in response to heavy resistance training (RT). METHOD: Three young men trained three days a week for 16 weeks. RESULTS: MRI measured total SM mass and fat free mass (FFM) had increased by 4.2 kg and 2.6 kg respectively after resistance training. CONCLUSIONS: RT induces larger increases in SM mass than in FFM. RT induced muscle hypertrophy does not occur uniformly throughout each individual muscle or region of the body. Therefore the distribution of muscle hypertrophy and total SM mass are important for evaluating the effects of total body RT on muscle size.

Evaluation of an absorbed ELISA and an agar-gel immuno-diffusion test for ovine paratuberculosis in sheep in Australia.

The sensitivities and specificities of an absorbed enzyme-linked immunosorbent assay (ELISA) and an agar-gel immuno-diffusion (AGID) test for the detection of Johne's disease in sheep were estimated using data from six known infected and 12 assumed uninfected sheep flocks. Sensitivities were estimated for all histologically positive sheep, as well as by histological lesion score, lesion type (paucibacillary or multibacillary) and sheep body-condition score, with ELISA sensitivities estimated at 95 and 99% specificity. Logistic-regression analysis was used to test for significant effects of lesion score and condition score, with flock included in the model as a random effect. Estimated specificities were 95% (95% CI: 93.4, 95.6%) and 99% (98.4, 99.4%) for ELISA cut-point ratios of 2.4 and 3.6, respectively, and 100% (99.7, 100.0%) for the AGID. Estimated sensitivities for all infected sheep were 41.5% (35.0, 48.3%), 21.9% (16.6, 27.9%) and 24.6% (19.1, 30.7%) for ELISA cut-point ratios of 2.4 and 3.6 and for AGID, respectively. Sensitivities of all tests and cut-points varied significantly between flocks and between categories of lesion score and condition score. Sensitivity ranged from 25 to 73, 10 to 47 and 9.2 to 63% between flocks, for the ELISA with cut-points of 2.4 and 3.6, and for the AGID, respectively. Sensitivity was highest in thin sheep and in sheep with multibacillary lesions. The effects of lesion type and condition score on test sensitivity were significant in the logistic regressions for the AGID and ELISA at both cut-points and the flock effect was significant for the AGID but not for the ELISA at either cut-point.

Sex differences in whole body skeletal muscle mass measured by magnetic resonance imaging and its distribution in young Japanese adults.

OBJECTIVES: To determine sex differences in the distribution of regional and total skeletal muscle (SM) using contiguous whole body magnetic resonance imaging (MRI) data, and to examine the relations between fat free mass (FFM) and total and regional SM masses. METHODS: A total of 20 Japanese college students (10 women and 10 men) volunteered for the study. FFM was measured by two compartment densitometry. Whole body MRI images were prepared using a 1.5 T scanner. Contiguous transverse images with 1.0 cm slice thickness were obtained from the first cervical vertebra to the ankle joints. All MRI scans were segmented into four components (SM, subcutaneous adipose tissue, bone, and residual tissues). In each slice, the SM tissue cross sectional areas (CSAs) were digitised, and the muscle tissue volume per slice was calculated by multiplying muscle CSA by slice thickness. SM volume units (litres) were converted into mass units (kg) by multiplying the volumes by the assumed constant density (1.041 mg/ml) for SM. RESULTS: The SM distribution pattern (shape of curve) from the contiguous whole body slices was essentially similar for the two sexes, with two large peaks and three smaller peaks (arms excluded). However, the largest peak was observed at the upper portion of the thigh for women and at the level of the shoulder for men. Men had larger (p<0.01) total and regional SM mass than women. All regional SM masses correlated highly (r=0.90-0.99, p<0.01) with total SM mass. A strong positive correlation was observed between FFM and total and regional SM masses in both sexes (women, r=0.95; men, r=0.90; all p<0.01). As FFM increased, there was a corresponding increase in SM/FFM ratio for all subjects (r=0.86, p<0.01). CONCLUSIONS: Sex differences in total SM/FFM ratio and regional SM distributions are associated with the degree of absolute FFM accumulation in men and women.

False-positive tuberculin skin tests in a state prison system.

OBJECTIVE: To assess the existence and extent of false-positive tuberculin skin test (TST) results in a regularly tested population subsequent to switching to a different skin testing product. METHOD: Over 9300 state prison inmates were tuberculin skin tested as part of a routine annual testing program. A shortage of Tubersol caused the prison system to purchase and test with Aplisol. Prison health services staff reported an apparent increase in skin test positivity using Aplisol compared to Tubersol. Record reviews were conducted in 34 prisons where inmates read as positive (> or = 5 mm) were retested with Tubersol. RESULTS: Among 368 inmates recorded as positive (> or = 5 mm) with Aplisol who were retested with Tubersol, 150 (40.8%) were read as negative (0-4 mm). CONCLUSION: The tuberculin skin test is a valuable tool in evaluating patients for TB infection. However, variations in planting and reading the test, and in the consistency between lots and manufacturers, can contribute to errors in determining an individual's infection status. The entire clinical and epidemiological picture for each patient must always be evaluated using the TST as a tool, and not an indisputable answer.