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1.
Diabet Med ; 37(1): 138-146, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31529717

RESUMEN

AIMS: To determine if in-target intrapartum glucose control is associated with neonatal hypoglycaemia in women with type 1, type 2 or gestational diabetes. METHODS: This was a retrospective cohort study of pregnant women with diabetes and their neonates. The primary exposure was in-target glucose control, defined as all capillary glucose values within the range 3.5-6.5 mmol/l during the intrapartum period. The primary outcome, neonatal hypoglycaemia, was defined as treatment with intravenous dextrose therapy. Multiple logistic regression was used to examine the association between maternal intrapartum glycaemic control and neonatal hypoglycaemia, adjusting for covariates. RESULTS: Intrapartum glucose testing was available for 157 (86.3%), 267 (76.3%) and 3256 (52.4%) women with type 1, type 2 and gestational diabetes, respectively. In the univariate analysis, in-target glycaemic control was significantly associated with neonatal hypoglycaemia in women with gestational diabetes, but not in women with type 1 or 2 diabetes. However, after adjustment for important neonatal factors (large for gestational age, preterm delivery and infant sex), intrapartum in-target glycaemic control was not significantly associated with neonatal hypoglycaemia in women regardless of diabetes type [adjusted odds ratios 0.4 (95% CI 0.1, 1.4), 0.7 (95% CI 0.3, 1.3) and 0.7 (95% CI 0.5, 1.0) for women with type 1, type 2 and gestational diabetes, respectively]. CONCLUSIONS: There was no significant association between in-target glycaemic control and neonatal hypoglycaemia after adjustment for neonatal factors. Given the high risk of maternal hypoglycaemia and the resources required, future trials should consider whether more relaxed intrapartum glycaemic targets may be safer and yield similar neonatal outcomes.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Gestacional , Hipoglucemia/etiología , Adulto , Estudios de Cohortes , Femenino , Edad Gestacional , Control Glucémico , Humanos , Hiperglucemia , Recién Nacido , Enfermedades del Recién Nacido , Embarazo , Estudios Retrospectivos
2.
Diabet Med ; 36(2): 237-242, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30499197

RESUMEN

AIMS: To assess the association between vascular complications of diabetes and the risk of congenital malformations in pregnant women with Type 1 diabetes. METHODS: We conducted an observational retrospective cohort study in women with Type 1 diabetes who received care consecutively from three tertiary care diabetes-in-pregnancy clinics in Calgary, Alberta, Canada. Multivariable logistic regression was used to assess the association between vascular complications (retinopathy, nephropathy and pre-existing hypertension) and congenital malformations in offspring of women with Type 1 diabetes. RESULTS: Of 232 women with Type 1 diabetes, 49 (21%) had at least one vascular complication and there were 52 babies with congenital malformations. Maternal age (31.8 ± 5.0 vs. 29.4 ± 4.7 years, P < 0.01), diabetes duration (20.9 ± 6.7 vs. 11.2 ± 7.4 years, P < 0.01) and pre-eclampsia rate (12.5% vs. 1.3%, P < 0.01) were higher in mothers with vascular complications than in those without. Multivariable analyses showed that vascular complications were not associated with an increased risk of congenital malformations (odds ratio 1.16, 95% confidence interval 0.46 to 2.88). CONCLUSIONS: Vascular complications are common, occurring in one-fifth of pregnant women with Type 1 diabetes, and in this study do not appear to be associated with an increased risk of congenital malformations in children.


Asunto(s)
Anomalías Congénitas/etiología , Diabetes Mellitus Tipo 1/complicaciones , Angiopatías Diabéticas/complicaciones , Complicaciones Cardiovasculares del Embarazo , Embarazo en Diabéticas , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Edad Materna , Embarazo , Estudios Retrospectivos , Factores de Riesgo
3.
Diabet Med ; 36(8): 1046-1053, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31107983

RESUMEN

AIMS: To examine the relationship between maternal glycaemic control and risk of neonatal hypoglycaemia using conventional and continuous glucose monitoring metrics in the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT) participants. METHODS: A secondary analysis of CONCEPTT involving 225 pregnant women and their liveborn infants. Antenatal glycaemia was assessed at 12, 24 and 34 weeks gestation. Intrapartum glycaemia was assessed by continuous glucose monitoring measures 24 hours prior to delivery. The primary outcome was neonatal hypoglycaemia defined as glucose concentration < 2.6 mmol/l and requiring intravenous dextrose. RESULTS: Neonatal hypoglycaemia occurred in 57/225 (25.3%) infants, 21 (15%) term and 36 (40%) preterm neonates. During the second and third trimesters, mothers of infants with neonatal hypoglycaemia had higher HbA1c [48 ± 7 (6.6 ± 0.6) vs. 45 ± 7 (6.2 ± 0.6); P = 0.0009 and 50 ± 7 (6.7 ± 0.6) vs. 46 ± 7 (6.3 ± 0.6); P = 0.0001] and lower continuous glucose monitoring time-in-range (46% vs. 53%; P = 0.004 and 60% vs. 66%; P = 0.03). Neonates with hypoglycaemia had higher cord blood C-peptide concentrations [1416 (834, 2757) vs. 662 (417, 1086) pmol/l; P < 0.00001], birthweight > 97.7th centile (63% vs. 34%; P < 0.0001) and skinfold thickness (P ≤ 0.02). Intrapartum continuous glucose monitoring was available for 33 participants, with no differences between mothers of neonates with and without hypoglycaemia. CONCLUSIONS: Modest increments in continuous glucose monitoring time-in-target (5-7% increase) during the second and third trimesters are associated with reduced risk for neonatal hypoglycaemia. While more intrapartum continuous glucose monitoring data are needed, the higher birthweight and skinfold measures associated with neonatal hypoglycaemia suggest that risk is related to fetal hyperinsulinemia preceding the immediate intrapartum period.


Asunto(s)
Diabetes Mellitus Tipo 1/prevención & control , Hipoglucemia/etiología , Embarazo en Diabéticas/prevención & control , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 1/sangre , Femenino , Hemoglobina Glucada , Humanos , Hipoglucemia/sangre , Recien Nacido Prematuro , Embarazo , Resultado del Embarazo , Embarazo en Diabéticas/sangre , Atención Prenatal , Efectos Tardíos de la Exposición Prenatal/sangre , Efectos Tardíos de la Exposición Prenatal/etiología , Factores de Riesgo
4.
Sensors (Basel) ; 19(5)2019 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-30818807

RESUMEN

The Geostationary Lightning Mapper (GLM) instrument onboard the GOES 16 and 17 satellites can be used to detect bolides in the atmosphere. This capacity is unique because GLM provides semi-global, continuous coverage and releases its measurements publicly. Here, six filters are developed that are aggregated into an automatic algorithm to extract bolide signatures from the GLM level 2 data product. The filters exploit unique bolide characteristics to distinguish bolide signatures from lightning and other noise. Typical lightning and bolide signatures are introduced and the filter functions are presented. The filter performance is assessed on 144845 GLM L2 files (equivalent to 34 days-worth of data) and the algorithm selected 2252 filtered files (corresponding to a pass rate of 1.44%) with bolide-similar signatures. The challenge of identifying frequent but small, decimeter-sized bolide signatures is discussed as GLM reaches its resolution limit for these meteors. The effectiveness of the algorithm is demonstrated by its ability to extract confirmed and new bolide discoveries. We provide discovery numbers for November 2018 when seven likely bolides were discovered of which four are confirmed by secondary observations. The Cuban meteor on Feb 1st 2019 serves as an additional example to demonstrate the algorithms capability and the first light curve as well as correct ground track was available within 8.5 hours based on GLM data for this event. The combination of the automatic bolide extraction algorithm with GLM can provide a wealth of new measurements of bolides in Earth's atmosphere to enhance the study of asteroids and meteors.

5.
Death Stud ; 43(1): 62-69, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29474116

RESUMEN

BACKGROUND: Risk minimization in research with bereaved parents is important. However, little is known about which research methods balance the sensitivity required for bereaved research participants and the need for generalizable results. AIM: To explore parental experiences of participating in mixed method bereavement research via a pilot study. DESIGN: A convergent parallel mixed method design assessing bereaved parents' experience of research participation. SETTING/PARTICIPANTS: Eleven parents whose child was treated for cancer at The Royal Children's Hospital, Brisbane completed the questionnaire/interview being piloted (n = 8 mothers; n = 3 fathers; >6 months and <6 years bereaved). Of these, eight parents completed the pilot study evaluation questionnaire, providing feedback on their experience of participation. RESULTS: Participants acknowledged the importance of bereaved parents being central to research design and the development of bereavement programs. Sixty-three per cent (n = 5/8) of parents described completion of the questionnaire as 'not at all/a little bit' of a burden. Seventy-five per cent (n = 6/8) of parents opting into the telephone interview described participation as 'not at all/a little bit' of a burden. When considering the latest timeframes for participation in bereavement research 63% (n = 5/8) of parents indicated 'no endpoint.' Findings from the pilot study enabled important adjustments to be made to a large-scale future study. CONCLUSIONS: As a research method, pilot studies may be utilized to minimize harm and maximize the potential benefits for vulnerable research participants. A mixed method approach allows researchers to generalize findings to a broader population while also drawing on the depth of the lived experience.


Asunto(s)
Aflicción , Padres/psicología , Proyectos de Investigación , Sujetos de Investigación/psicología , Adulto , Actitud Frente a la Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Gestión de Riesgos , Encuestas y Cuestionarios
6.
Diabet Med ; 35(2): 173-183, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29117445

RESUMEN

AIMS: To examine whether, in neonates of mothers with Type 1, Type 2 and gestational diabetes, in-target intrapartum glycaemic control was associated with a lower risk of neonatal hypoglycaemia compared with out-of-target glycaemic control. METHODS: We searched PubMed and EMBASE for all available publications, regardless of year, based on a published protocol (PROSPERO CRD42016052439). Studies were excluded if they did not report original data or were animal studies. Data were extracted from published reports in duplicate using a prespecified data extraction form. The main outcome of interest was the association between in-target intrapartum glycaemic control and neonatal hypoglycaemia. RESULTS: We screened 2846 records for potential study inclusion; 23 studies, including approximately 2835 women with diabetes, were included in the systematic review. Only two of those studies specifically examined in-target vs out-of-target intrapartum glycaemic control. Of the studies included, six showed a relationship between intrapartum glucose and neonatal hypoglycaemia, five others showed a relationship in at least one of the analyses performed and 12 did not find a significant relationship. Only one study was identified as having a low risk of bias. CONCLUSIONS: There is a paucity of high-quality data supporting the association of glucose during labour and delivery with neonatal hypoglycaemia in pregnancies complicated by diabetes. Further studies are required to examine the impact of tight glycaemic targets in labour.


Asunto(s)
Diabetes Mellitus Tipo 1/prevención & control , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Gestacional/prevención & control , Hiperglucemia/congénito , Embarazo en Diabéticas/prevención & control , Glucemia/metabolismo , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Gestacional/sangre , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/prevención & control , Recién Nacido , Embarazo , Embarazo en Diabéticas/sangre , Atención Prenatal , Factores de Riesgo
7.
Diabet Med ; 34(1): 27-36, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27150509

RESUMEN

AIM: To assess the short- and long-term maternal and fetal impact of metformin in pregnancy compared with insulin. METHODS: We performed a comprehensive literature search of MEDLINE, EMBASE, BIOSIS, Cochrane Database of Systematic Reviews and ClinicalTrials.gov. Eligible studies were randomized control trials (RCTs) or follow-up of an RCT that: (1) compared metformin with insulin in pregnancy in women with gestational diabetes mellitus or Type 2 diabetes; and (2) reported maternal or fetal outcomes of interest. Two reviewers extracted the data, evaluated study quality and calculated pooled estimates. RESULTS: Sixteen studies (n = 2165 in quantitative analysis) were included. Metformin lowered the risk of neonatal hypoglycaemia [risk ratio (RR) = 0.63; 95% confidence interval (95% CI), 0.45 to 0.87], large for gestational age babies (RR = 0.80; 95% CI, 0.64 to 0.99), pregnancy-induced hypertension (RR = 0.56; 95% CI, 0.37 to 0.85) and total maternal pregnancy weight gain [mean difference (MD) -2.07; 95% CI -2.88 to -1.27]. Metformin did not increase preterm delivery (RR = 1.18; 95% CI 0.67 to 2.07), small for gestational age babies (RR = 1.20; 95% CI, 0.67 to 2.14), perinatal mortality (RR = 0.82; 95% CI, 0.17 to 3.92) or Caesarean section (RR = 0.97; 95% CI, 0.80 to 1.19). Long-term outcome information is limited. CONCLUSIONS: Our review found that metformin had no short-term adverse effects on pregnancy, potential benefits in the neonatal period, but limited long-term follow-up information. Prior to routine use, we recommend further follow-up studies of offspring exposed to metformin in utero.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Gestacional/tratamiento farmacológico , Desarrollo Fetal/efectos de los fármacos , Insulina/efectos adversos , Metformina/efectos adversos , Embarazo en Diabéticas/tratamiento farmacológico , Efectos Tardíos de la Exposición Prenatal , Adulto , Diabetes Mellitus Tipo 2/fisiopatología , Diabetes Gestacional/fisiopatología , Femenino , Humanos , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Metformina/uso terapéutico , Embarazo , Resultado del Embarazo , Embarazo en Diabéticas/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Diabet Med ; 34(6): 781-785, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-27743395

RESUMEN

AIM: To examine the validity of International Classification of Disease, version 10 (ICD-10) codes for gestational diabetes mellitus in administrative databases (outpatient and inpatient), and in a clinical perinatal database (Alberta Perinatal Health Program), using laboratory data as the 'gold standard'. METHODS: Women aged 12-54 years with in-hospital, singleton deliveries between 1 October 2008 and 31 March 2010 in Alberta, Canada were included in the study. A gestational diabetes diagnosis was defined in the laboratory data as ≥2 abnormal values on a 75-g oral glucose tolerance test or a 50-g glucose screen ≥10.3 mmol/l. RESULTS: Of 58 338 pregnancies, 2085 (3.6%) met gestational diabetes criteria based on laboratory data. The gestational diabetes rates in outpatient only, inpatient only, outpatient or inpatient combined, and Alberta Perinatal Health Program databases were 5.2% (3051), 4.8% (2791), 5.8% (3367) and 4.8% (2825), respectively. Although the outpatient or inpatient combined data achieved the highest sensitivity (92%) and specificity (97%), it was associated with a positive predictive value of only 57%. The majority of the false-positives (78%), however, had one abnormal value on oral glucose tolerance test, corresponding to a diagnosis of impaired glucose tolerance in pregnancy. CONCLUSIONS: The ICD-10 codes for gestational diabetes in administrative databases, especially when outpatient and inpatient databases are combined, can be used to reliably estimate the burden of the disease at the population level. Because impaired glucose tolerance in pregnancy and gestational diabetes may be managed similarly in clinical practice, impaired glucose tolerance in pregnancy is often coded as gestational diabetes.


Asunto(s)
Técnicas de Laboratorio Clínico/normas , Diabetes Gestacional/diagnóstico , Tamizaje Masivo/organización & administración , Tamizaje Masivo/normas , Diagnóstico Prenatal/normas , Adolescente , Adulto , Glucemia/análisis , Canadá/epidemiología , Niño , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Diabetes Gestacional/sangre , Diabetes Gestacional/epidemiología , Femenino , Intolerancia a la Glucosa/diagnóstico , Intolerancia a la Glucosa/epidemiología , Prueba de Tolerancia a la Glucosa , Humanos , Clasificación Internacional de Enfermedades , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Embarazo , Diagnóstico Prenatal/estadística & datos numéricos , Sensibilidad y Especificidad , Adulto Joven
9.
Diabet Med ; 32(3): 295-304, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25381964

RESUMEN

BACKGROUND: The idea that exposure to hyperglycaemia in utero is an important factor in the development of obesity and diabetes in the offspring has become entrenched as popular belief. AIM: To appraise the literature supporting this hypothesis in the light of recent studies that have clarified the main drivers of obesity in children and adolescents. METHODS: A review of published evidence from animal studies, human observational studies, systematic reviews and experimental trials that address the impact of diabetes (Types 1 and 2, genetic or gestational) on the future risk of obesity and/or glucose intolerance in the offspring. RESULTS: Some animal studies support a relationship between exposure to hyperglycaemia in utero and future development of obesity and diabetes, but the results are inconsistent. Most of the human studies claiming to show a relationship have not taken into account important known confounders, such as maternal and paternal BMI. Evidence supporting a dose-response relationship between maternal hyperglycaemia exposure and obesity and diabetes in the offspring is weak, and there is no convincing evidence that treating gestational diabetes reduces the later risk of offspring obesity or glucose intolerance. CONCLUSIONS: Exposure to hyperglycaemia in utero has minimal direct effect on the later risk of obesity and Type 2 diabetes. The increased risk of obesity in the offspring of women with Type 2 or gestational diabetes can be explained by confounding factors, such as parental obesity.


Asunto(s)
Glucemia , Diabetes Mellitus Tipo 2/epidemiología , Hiperglucemia/complicaciones , Salud Materna , Obesidad/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Adolescente , Animales , Índice de Masa Corporal , Niño , Complicaciones de la Diabetes/complicaciones , Diabetes Gestacional , Modelos Animales de Enfermedad , Femenino , Intolerancia a la Glucosa/epidemiología , Humanos , Hiperglucemia/sangre , Embarazo , Factores de Riesgo
10.
Diabet Med ; 32(2): 164-73, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25407209

RESUMEN

AIMS: To examine the association between gestational diabetes mellitus (GDM) and high maternal weight and the risk of development of chronic disease. METHODS: Women with singleton deliveries between April 1999 and March 2010 in Alberta, Canada, were categorized according to pre-pregnancy weight (overweight ≥ 91 kg) and GDM status. Obstetric and neonatal outcomes, as well as the long-term incidence of maternal diabetes, hypertension and cardiovascular disease were examined. RESULTS: Of 240 083 women, 213 765 (89%) had no GDM and were not overweight (reference group), 17 587 (7.3%) were overweight only, 7332 (3%) had GDM only and 1399 (0.6%) had GDM and were overweight. Significant differences in Caesarean section rates, induction rates and birthweight were observed across the four groups. During a median follow-up of 5.3 years, diabetes incidence was 36% in the GDM and overweight, 18.8% in the GDM only, 4.8% in the overweight only and 1.1% in the reference group. With respect to hypertension and cardiovascular disease, the GDM and overweight group had the highest rates (26.8% and 3.1%, respectively) and the reference group had the lowest rates (5.8% and 1.0%, respectively). However, rates were similar in the GDM only (14.9% and 1.9%, respectively) and overweight only groups (14.9% and 1.5%, respectively). CONCLUSIONS: Not surprisingly, the presence of both high maternal weight and GDM compounds the risk of developing diabetes. However, the association between overweight alone and GDM alone and hypertension and cardiovascular disease appears similar suggesting a need for effective interventions to manage both these conditions to improve the health of these patients.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Diabetes Mellitus/etiología , Diabetes Gestacional/fisiopatología , Hipertensión/etiología , Fenómenos Fisiologicos Nutricionales Maternos , Sobrepeso/fisiopatología , Complicaciones del Embarazo/fisiopatología , Adolescente , Adulto , Alberta/epidemiología , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Incidencia , Estudios Longitudinales , Persona de Mediana Edad , Sobrepeso/complicaciones , Embarazo , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
11.
Macromol Rapid Commun ; 36(1): 60-4, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25393938

RESUMEN

Wide-angle X-ray scattering (WAXS) and temperature-dependent Fourier transform infrared spectroscopy (FTIR) spectroscopy are used to study hydrogen bonding interactions of a hydroxyl-functionalized polyethylene (PE) prepared by acyclic diene metathesis (ADMET) chemistry. The hydroxyl polymer exhibits an orthorhombic unit cell structure with characteristic reflection planes at (110) and (200), comparable to pure crystalline PE. These data unequivocally demonstrate that the OH branch is excluded from the PE lamellae. Furthermore, the polymer melts 100 °C higher than all previous analogous polymers possessing precision placed long aliphatic branches that also are excluded from PE lamellae. Temperature-dependent FTIR spectroscopy from ambient to 150 °C, followed by cooling to 125 °C supports exclusion of the hydroxyl group from the crystalline lattice. It is concluded that these hydroxyl groups form stable physical networks in the amorphous region via hydrogen bonding and are important for the overall morphology of such polymers.


Asunto(s)
Alquenos/química , Polietilenos/química , Cristalización , Enlace de Hidrógeno , Conformación Molecular , Espectroscopía Infrarroja por Transformada de Fourier , Difracción de Rayos X
12.
Clin Auton Res ; 25(4): 267-70, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26264837

RESUMEN

PURPOSE: Electronic cigarettes are growing in popularity, but the physiological consequences of vaporized nicotine are unknown. METHODS: Twenty healthy non-smokers inhaled vaporized nicotine and placebo (randomized). RESULTS: Nicotine inhalation was associated with higher arterial pressures in the seated position, and increased arterial pressures in the head-up positions with no other effects on autonomic control. CONCLUSIONS: Our results show that vaporized nicotine inhalation is not innocuous. Longitudinal studies in otherwise healthy non-smokers should be conducted.


Asunto(s)
Presión Arterial/efectos de los fármacos , Sistemas Electrónicos de Liberación de Nicotina/efectos adversos , Nicotina/administración & dosificación , Administración por Inhalación , Presión Arterial/fisiología , Sistemas Electrónicos de Liberación de Nicotina/tendencias , Femenino , Humanos , Hipertensión/inducido químicamente , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Masculino , Proyectos Piloto , Pruebas de Mesa Inclinada/métodos , Volatilización , Adulto Joven
13.
Diabet Med ; 31(3): 319-31, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24528230

RESUMEN

AIMS: To assess different diagnostic thresholds for gestational diabetes on outcomes for mothers and their offspring in the absence of treatment for gestational diabetes. This information was used to inform a National Institutes of Health consensus conference on diagnosing gestational diabetes. METHODS: We searched 15 electronic databases from 1995 to May 2012. Study selection was conducted independently by two reviewers. Randomized controlled trials or cohort studies were eligible if they involved women without known pre-existing diabetes mellitus and who did not undergo treatment for gestational diabetes. One reviewer extracted, and a second reviewer verified, data for accuracy. Two reviewers independently assessed methodological quality. RESULTS: Thirty-eight studies were included. Three large, methodologically strong studies showed a continuous positive relationship between increasing glucose levels and the incidence of Caesarean section and macrosomia. When data were examined categorically (i.e. women meeting or not meeting specific diagnostic thresholds), women with gestational diabetes across all glucose criteria had significantly more Caesarean sections, shoulder dystocia, macrosomia (except for International Association of Diabetes in Pregnancy Study Groups' criteria) and large for gestational age. Higher glucose thresholds did not consistently demonstrate greater risk for all outcomes. CONCLUSIONS: Higher glucose thresholds did not consistently demonstrate greater risk, possibly because studies did not compare mutually exclusive groups of women. A pragmatic approach for diagnosis of gestational diabetes using Hyperglycemia and Adverse Pregnancy Outcome Study odds ratio 2.0 thresholds warrants further consideration until additional analysis of the data comparing mutually exclusive groups of women is provided and large randomized controlled trials investigating different diagnostic and treatment thresholds are completed.


Asunto(s)
Cesárea/estadística & datos numéricos , Diabetes Gestacional/diagnóstico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hiperglucemia/diagnóstico , Garantía de la Calidad de Atención de Salud/normas , Peso al Nacer , Cesárea/efectos adversos , Diabetes Gestacional/fisiopatología , Femenino , Macrosomía Fetal , Humanos , Hiperglucemia/complicaciones , Recién Nacido , Tamizaje Masivo/métodos , Embarazo , Resultado del Embarazo
14.
Macromol Rapid Commun ; 35(2): 123-132, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24317938

RESUMEN

The morphological changes of polyethylenes bearing precisely spaced "defects" are reviewed, focusing on the effects of defect frequency, size, and functionality on crystallization and crystalline structure. The precise defect interval is imparted through acyclic diene metathesis polymerization of structurally symmetric diene monomers. Studies have included structural characterization by differential scanning calorimetry, wide-angle X-ray scattering, small-angle X-ray scattering (SAXS), and infrared spectroscopy. The collective results are presented separately for functionalized polyethylenes and for those containing alkyl chain branches, as these two classes of polymers vary greatly in morphology.


Asunto(s)
Polietileno/química , Rastreo Diferencial de Calorimetría , Cristalización , Nanopartículas , Dispersión de Radiación , Espectrofotometría Infrarroja
15.
Lung Cancer ; 191: 107543, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38569279

RESUMEN

BACKGROUND: Interest in hereditary lung cancer is increasing, in particular germline mutations in the Epidermal Growth Factor Receptor (EGFR) gene. We review the current literature on this topic, discuss risk of developing lung cancer, treatment and screening options and describe a family of 3 sisters with lung cancer and their unaffected mother all with a rare EGFR germline mutation (EGFR p.R776H). METHODS: We searched PubMed, Medline, Embase, the Cochrane Library, Google Scholar and scanned reference lists of articles. Search terms included "EGFR germline" and "familial lung cancer" or "EGFR familial lung cancer". We also describe our experience of managing a family with rare germline EGFR mutant lung cancer. RESULTS: Although the numbers are small, the described cases in the literature show several similarities. The patients are younger and usually have no or light smoking history. 50% of the patients were treated with a tyrosine kinase inhibitor (TKIs) with OS over six months. CONCLUSION: Although rare, germline p.R776H EGFR lung cancer mutations are over-represented in light or never smoking female patients who often also possess an additional somatic EGFR mutation. Treatment with TKIs appears suitable but further research is needed into the appropriate screening regime for unaffected carriers or light/never smokers.


Asunto(s)
Receptores ErbB , Mutación de Línea Germinal , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Receptores ErbB/genética , Femenino , Persona de Mediana Edad , Adulto , Inhibidores de Proteínas Quinasas/uso terapéutico , Predisposición Genética a la Enfermedad , Linaje , Masculino , Anciano , Mutación
16.
Genes (Basel) ; 15(3)2024 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-38540339

RESUMEN

Popeye domain-containing (POPDC) proteins selectively bind cAMP and mediate cellular responses to sympathetic nervous system (SNS) stimulation. The first discovered human genetic variant (POPDC1S201F) is associated with atrioventricular (AV) block, which is exacerbated by increased SNS activity. Zebrafish carrying the homologous mutation (popdc1S191F) display a similar phenotype to humans. To investigate the impact of POPDC1 dysfunction on cardiac electrophysiology and intracellular calcium handling, homozygous popdc1S191F and popdc1 knock-out (popdc1KO) zebrafish larvae and adult isolated popdc1S191F hearts were studied by functional fluorescent analysis. It was found that in popdc1S191F and popdc1KO larvae, heart rate (HR), AV delay, action potential (AP) and calcium transient (CaT) upstroke speed, and AP duration were less than in wild-type larvae, whereas CaT duration was greater. SNS stress by ß-adrenergic receptor stimulation with isoproterenol increased HR, lengthened AV delay, slowed AP and CaT upstroke speed, and shortened AP and CaT duration, yet did not result in arrhythmias. In adult popdc1S191F zebrafish hearts, there was a higher incidence of AV block, slower AP upstroke speed, and longer AP duration compared to wild-type hearts, with no differences in CaT. SNS stress increased AV delay and led to further AV block in popdc1S191F hearts while decreasing AP and CaT duration. Overall, we have revealed that arrhythmogenic effects of POPDC1 dysfunction on cardiac electrophysiology and intracellular calcium handling in zebrafish are varied, but already present in early development, and that AV node dysfunction may underlie SNS-induced arrhythmogenesis associated with popdc1 mutation in adults.


Asunto(s)
Bloqueo Atrioventricular , Calcio , Adulto , Animales , Humanos , Calcio/metabolismo , Pez Cebra/genética , Pez Cebra/metabolismo , Nodo Atrioventricular/metabolismo , Técnicas Electrofisiológicas Cardíacas/efectos adversos , Bloqueo Atrioventricular/complicaciones , Arritmias Cardíacas/genética , Trastorno del Sistema de Conducción Cardíaco
18.
Aviat Space Environ Med ; 82(12): 1104-9, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22195390

RESUMEN

INTRODUCTION: Fatigue degrades cognitive performance, yet there is no universally accepted objective measure of fatigue. We tested whether fatigue arising from sleep deprivation can be quantified objectively using heart rate variability (HRV). METHODS: There were 35 male subjects (mean +/- SD; age = 21.4 +/- 2.6 yr) who were assigned to one of two experimental groups: (1) control (N = 16), or (2) 48-h sleep-deprived (N=19). Using 3-h sampling intervals, we simultaneously tracked fatigue level, cognitive performance, and HRV. Linear mixed-effects (LME) models were used to evaluate linear relationships between fatigue level and cognitive performance, as well as between fatigue level and HRV. RESULTS: Significant negative slopes were observed in LME models of cognitive performance and fatigue level. Of the several HRV parameters examined during standing and supine rest, the ratio of low-frequency to high-frequency R-R interval in the supine position had the clearest significant relationship when modeled against fatigue level. DISCUSSION: In summary, our results suggest that HRV tracks fatigue arising from sleep deprivation. This noninvasive, objective tool can quantify fatigue in real time.


Asunto(s)
Fatiga/fisiopatología , Frecuencia Cardíaca/fisiología , Privación de Sueño/fisiopatología , Adolescente , Adulto , Afecto , Sistema Nervioso Autónomo/fisiología , Humanos , Modelos Lineales , Masculino , Adulto Joven
19.
Plant Mol Biol ; 74(4-5): 503-18, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20865301

RESUMEN

Sterol C24 methyltransferase (SMT2) genes governing the pattern of phytosterols synthesized in higher plants have been studied in Glycine seedlings and wild-type and engineered Arabidopsis thaliana plants. The SMT2 genes of soybean (SMT2-1 and SMT2-2) previously cloned and characterized (Neelakandan et al. 2009) were shown to complement the SMT deficient cvp1 mutant Arabidopsis plants, consistent with their role in regulation of 24-alkyl sterol-controlled plant physiology. Further analysis of these genes showed that environmental cues, including dehydration, cold, and abscisic acid induced differential changes in transcript levels of the SMT2 during soybean seedling growth. Sterol analyses of transgenic Arabidopsis seeds originating in variant constructs of AtHMGR1, GmSMT1, and GmSMT2 engineered in seeds showed relevant modifications in the ratio of 24-methyl to 24-ethyl sterol in the direction of sitosterol formation. To provide insight into the structural features of the sterol gene that affects transcript regulation, the upstream promoter sequences of soybean SMT2 genes were cloned and characterized. Sequence analysis revealed several important cis-elements and transcription factor binding sites. The analysis of promoter-GUS fusions in transgenic Arabidopsis plants revealed shared and distinct expression features in different developmental stages and tissues. The data are interpreted to imply that SMT2 is an important contributor to normal plant growth and development.


Asunto(s)
Glycine max/enzimología , Metiltransferasas/fisiología , Fitosteroles/biosíntesis , Proteínas de Plantas/fisiología , Ácido Abscísico/farmacología , Secuencia de Aminoácidos , Arabidopsis/genética , Clonación Molecular , Frío , Regulación de la Expresión Génica de las Plantas/efectos de los fármacos , Metiltransferasas/química , Metiltransferasas/genética , Datos de Secuencia Molecular , Fitosteroles/química , Proteínas de Plantas/química , Proteínas de Plantas/genética , Plantas Modificadas Genéticamente/metabolismo , Regiones Promotoras Genéticas , Semillas/metabolismo , Alineación de Secuencia , Análisis de Secuencia de ADN , Análisis de Secuencia de Proteína , Cloruro de Sodio/farmacología , Glycine max/efectos de los fármacos , Glycine max/fisiología , Estrés Fisiológico , Agua/metabolismo
20.
J Evol Biol ; 23(4): 805-16, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20210826

RESUMEN

Hybrid speciation is thought to be facilitated by escape of early generation hybrids into new habitats, subsequent environmental selection and adaptation. Here, we ask whether two homoploid hybrid plant species (Helianthus anomalus, H. deserticola) diverged sufficiently from their ancestral parent species (H. annuus, H. petiolaris) during hybrid speciation so that they are more fit than the parent species in hybrid species habitats. Hybrid and parental species were reciprocally transplanted into hybrid and parental habitats. Helianthus anomalus was more fit than parental species in the H. anomalus actively moving desert dune habitat. The abilities to tolerate burial and excavation and to obtain nutrients appear to be important for success in the H. anomalus habitat. In contrast, H. deserticola failed to outperform the parental species in the H. deserticola stabilized desert dune habitat, and several possible explanations are discussed. The home site advantage of H. anomalus is consistent with environmental selection having been a mechanism for adaptive divergence and hybrid speciation and supports the use of H. anomalus as a valuable system for further assessment of environmental selection and adaptive traits.


Asunto(s)
Ecosistema , Helianthus/genética , Hibridación Genética/fisiología , Adaptación Fisiológica/genética , Especiación Genética , Selección Genética
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