The association of new-onset diabetes with subsequent diagnosis of pancreatic cancer-novel use of a large administrative database.

BACKGROUND: Screening options for pancreatic ductal adenocarcinoma (PDAC) are limited. New-onset type 2 diabetes (NoD) is associated with subsequent diagnosis of PDAC in observational studies and may afford an opportunity for PDAC screening. We evaluated this association using a large administrative database. METHODS: Patients were identified using claims data from the OptumLabs® Data Warehouse. Adult patients with NoD diagnosis were matched 1:3 with patients without NoD using age, sex and chronic obstructive pulmonary disease (COPD) status. The event of PDAC diagnosis was compared between cohorts using the Kaplan-Meier method. Factors associated with PDAC diagnosis were evaluated with Cox's proportional hazards modeling. RESULTS: We identified 640 421 patients with NoD and included 1 921 263 controls. At 3 years, significantly more PDAC events were identified in the NoD group vs control group (579 vs 505; P < 0.001). When controlling for patient factors, NoD was significantly associated with elevated risk of PDAC (HR 3.474, 95% CI 3.082-3.920, P < 0.001). Other factors significantly associated with PDAC diagnosis were increasing age, increasing age among Black patients, and COPD diagnosis (P ≤ 0.05). CONCLUSIONS: NoD was independently associated with subsequent diagnosis of PDAC within 3 years. Future studies should evaluate the feasibility and benefit of PDAC screening in patients with NoD.

De novo subacute cutaneous lupus erythematosus-like eruptions in the setting of programmed death-1 or programmed death ligand-1 inhibitor therapy: clinicopathological correlation.

Immune checkpoint inhibitors (ICI) may cause eruptions resembling cutaneous autoimmune diseases. There are six cases of immunotherapy-associated subacute cutaneous lupus erythematosus (SCLE) in the literature. We present details of five patients referred to the Skin Toxicity Program at the Dana-Farber Cancer Institute/Brigham and Women's Cancer Center who developed de novo immunotherapy-associated SCLE-like eruptions, along with clinicopathological correlation and highlight potential mechanistic features and important diagnostic points. Two patients were maintained on topical corticosteroids, antihistamines and photoprotection. One had complete clearance and two had improvement with addition of hydroxychloroquine. Four patients continued their immunotherapy uninterrupted, while one had immunotherapy suspended for a month before restarting at full dose. Histopathologically, this series illustrates the temporal evolution of ICI-induced immune cutaneous reactions with SCLE subtype. Looking beyond the universally present lichenoid infiltrate, features of evolving SCLE were evident. We hypothesize that programmed death-1 blockade may induce immunological recognition of previously immunologically tolerated drug antigens, leading to epitope spreading and the SCLE phenotype.

Comportamiento del semen bovino sexado congelado-descongelado en fertilización in vitro (FIV) capacitado mediante BO en dos concentraciones versus percoll / Behavior of sexed frozen-thawed bovine semen on in vitro fertilization (IVF) capacitated with two concentrations of BO versus percoll

RESUMEN: El objetivo fue comparar la tasa de división (TD) y desarrollo embrionario (DE) con semen sexado X (SX) en FIV capacitado con Percoll vs. BO, y evaluar el efecto de dos concentraciones (5x106 vs. 10x106 espermatozoides/ml), capacitado con BO, comparado con el semen no-sexado (NS). Un avance importante es predeterminar el sexo en bovinos, es posible obtener mayor proporción de terneras a partir del citómetro de flujo con la capacidad de seleccionar los espermatozoides X por la diferencia del ADN (4 %, bovinos), con confiabilidad del 90 %. El SX aumenta la eficiencia reproductiva, permite la selección de hembras e incrementa la ganancia genética. Se obtuvieron complejos ovocito cúmulus (COC), de ovarios de matadero, se cultivaron para maduración en gotas de 100 µl de TCM-199 + 5 % de suero fetal bovino + 0.005 U/ml de (FSH-p) + 10 IU hCG/ml + 1µg Estradiol (E2)/ml, 15 COC/gota, cubiertas con aceite mineral, en incubadora (38,5 ºC, 5 % de CO2 y 95 % de humedad), 22 h. Posmaduración se dividieron en 4 grupos (G1, G2, G3, G4) y se realizaron dos experimentos simultáneamente: I) G1: NS a 5x106, G2: SX a 5x106, G3: SX a 10x106 espermatozoides/ml capacitados con BO. II) G2: SX a 4,5x106 espermatozoides/ml capacitados con BO y G4: SX capacitado con Percoll a 5x106 espermatozoides/ ml. Se colocaron 15 COC/gota de semen cubiertas con aceite mineral, en incubadora, 18 h. Para el desarrollo se colocaron en gotas de CR1aa, en incubadora. Se aplicó el test de χ2. La TD a las 48 h entre G1 y G3 no presentó diferencias significativas (p<0,05), sin embargo, en ambos grupos fue significativamente mayor al G2. En el DE al día 7 hubo diferencias significativas (p<0,05) a favor del G4. Se obtuvo mayor DE con el SX capacitado con Percoll respecto al BO y no hubo diferencias entre ambas concentraciones de semen.

SUMMARY: The objective of this study was to evaluate the in vitro fertility of bovine sexed semen (SX) capacitated with Percoll vs. BO. The division rate (DR), embryo development (ED) were evaluated in two concentrations 5x106 vs. 10x106 sperm/ml, capacitated with BO and compared with non-sexed semen (NS). Offspring sexing represents an important advance for livestock production. Flow cytometry separates X and Y spermatozoa by difference in DNA content (4 % greater in X) with 90 % effectiveness. The SX increases the reproductive efficiency, allows the selection of females and increases the genetic gain. Cumulusoocytes complexes (COC) were obtained from slaughterhouse ovaries. They were then cultured 22 hours for maturation in TCM199 + 5 % fetal calf serum + 0.005 IU/ml (FSH-p) + 10 IU hCG/ml + 1 mg Estradiol (E2)/ml, in 100 µl drops with mineral oil, in incubator (38.5 ºC, 5 % CO and 95 % humidity). Post maturation, 4 groups were randomly assigned (G1, G2, G3, G4) and were performed two experiments simultaneously: I) G1 was inseminated with NS at 5x106 sperm/ml, G2: SX at 5x106, G3: SX at 10x106 sperm/ml capacitated with BO. II) G2: SX at 5x106 sperm/ml capacitated with BO and G4: SX capacitated with Percoll at 5x106 sperm/ml. 15 COC/drop of capacitated semen covered with mineral oil and placed in an incubator for 18 hours. For development, they were placed in drops of CR1aa, in an incubator. Results were analyzed with the c square test. At 48 hours, there were no significant differences (p<0.05) in DR between G1 and G3, however, in both groups it was significantly greater than G2. At day 7 there were significant differences (p <0.05) in ED, greater in G4. At 48 hours, there were no significant differences (p<0.05) in DR between G1 and G3, however, in both groups it was significantly greater than G2. At day 7 there were significant differences (p <0.05) in ED, greater in G4. A higher ED was obtained with the SX capacitated with Percoll, with respect to BO and there was no difference between the two semen concentrations.

Semen bovino sexado congelado-descongelado en producción de embriones in vitro / In vitro embryo production with frozen-thawed bovine semen sexed

El objetivo de este trabajo fue evaluar la fertilidad in vitro del semen bovino sexado (SX) vs. no sexado (NS) congelado-descongelado de dos toros Holstein, cada uno de la misma partida. Determinar el sexo de las crías significa un avance importante para la producción. El citómetro de flujo separa los espermatozoides X e Y por diferencia de ADN (4 % mayor en X), con 90 % de efectividad. Los complejos ovocito-cúmulus (COC) se obtuvieron de folículos de 2 a 8 mm de ovarios de frigorífico, se cultivaron para maduración 22 h en TCM-199 + 5 % de SFB + 10 % licor folicular bovino (LFB), en gotas de 100 µl, cubiertos con aceite mineral, en incubadora (38,5 C, 5 % CO2 y 95 % de humedad). Posmaduración, se formaron al azar 4 grupos de COC los cuales fueron inseminados con NS y SX de los toros 1 y 2. Los COC se incluyeron en gotas de 100 ml a razón de 10 COC por gota de semen capacitado a una concentración de 2x106 espermatozoides/ml en todos los grupos, incubados durante 6 h. Posteriormente se cultivaron en CR1aa + 5 % SFB, en incubadora. A las 48 h se evaluó el clivaje y al día 7 el desarrollo embrionario. Los resultados fueron analizados con el Test de c2. Se encontró diferencias significativas en el toro 1 en el desarrollo embrionario a favor del NS (p<0,05). En el toro 2 no se encontró diferencias significativas en el clivaje ni en el desarrollo (p<0,05).

The objective of this study was to evaluate the in vitro fertility of sexed (SX) vs. non-sexed (NS), frozen-thawed bovine semen from two Holstein bull, from the same batch each one. Offspring sexing represents an important advance for livestock production. Flow cytometry separates X and Y spermatozoa by difference in DNA (4 % greater in X) with 90 % effectiveness. Cumulus-oocytes complexes (COC) were obtained from follicles measuring between 2 and 8 mm collected from slaughterhouse ovaries; they were then cultured 22 h for maturation in TCM-199 + 5 % BFS + 10 % bovine follicular fluid (BFF) in 100 µl drops with mineral oil, in incubator (38.5 C, 5% CO2 and 95 % humidity). Postmaturation, 4 groups were randomly formed and inseminated with NS and SX of the 1 and 2 bulls, including them in 100 µl drops at 10 COC per drop of capacitated semen diluted to a concentration of 2x106 sperms/ml in all groups, incubated during 6 h. They were then cultured in CR1aa + 5% BFS in an incubator. At 48 h cleavage and at day 7 embryonic development, were assessed. Results were analyzed with c2 square Test. There were significant differences (P<0.05) in the embryonic development in bull 1, grater in NS. In bull 2 there were not significant differences in cleavage neither in embryo development.

Enhanced pneumocystis carinii activity of new primaquine analogues.

New analogues of the venerable antimalarial drug primaquine have been synthesized and bioassayed in vivo against Pneumocystis carinii, a life-threatening infection common among immunosuppressed patients. Two of these new compounds are significantly more active than primaquine itself, and provide new information for future drug design and development in this area.

Adaptive hepatic changes in mild stenosis of the common bile duct in the rat.

Adaptive hepatic changes were investigated in rats with mild stenosis of the common bile duct and in sham-operated controls. The studies were performed 24 h and 7-12 days postoperatively. A continuous intravenous infusion of taurocholic acid at stepwise-increasing rates was performed to explore the responses to bile acid effects. During the infusion, bile flow and the outputs of bile acids, phospholipids, cholesterol, alkaline phosphatase and gamma glutamyl transpeptidase were studied. At the end of the infusion, hepatic morphometric measurements were performed. In other experimental sets, biliary excretions of horseradish peroxidase, a marker of microtubule-dependent vesicular transport in the hepatocyte, and sulphobromophthalein, a well-known organic anion model, were studied. In other rats, bile acid pool size and composition were determined by depletion of bile. The results in rats with mild stenosis maintained for 24 h showed a greater susceptibility to the toxicity of taurocholic acid, as revealed by the abrupt decrement in bile flow at high rates of infusion, and increased outputs of phospholipids and canalicular enzymes. Conversely, rats with mild stenosis maintained for 7-12 days showed decreased bile acid maximum secretory rate and biliary outputs of phospholipids and canalicular enzymes, as well as hepatocyte hypertrophy. These findings may explain the limited hepatic and systemic repercussion of experimental mild stenosis of the common bile duct and help us to understand the early stages of constriction of the common bile duct in man.

Medical history and risk assessment.

The "graying" of America has resulted in dentists treating increased numbers of elderly patients, 60% of whom are dentate. Since the majority of elderly persons has at least one chronic disease, this chapter addresses critical aspects of history taking and risk assessment for the geriatric dental patient. Self-administered questionnaires have limitations in the geriatric population and the medical history must emphasize functional status, medication use, social support, and financial considerations. Common chronic diseases which potentially increase the risk of adverse events for the geriatric patient undergoing dental care are discussed. Effective dentist-physician communication is pivotal to the successful management of the elderly dental patient.

Synthesis and in vitro and in vivo activity of a hybrid composed of ricin B chain-barley ribosome-inactivating protein.

In our continued studies on hybrid proteins for use as cytotoxins and possible suicide transport agents, we have begun to investigate the use of ribosome-inactivating proteins (RIP) isolated from grain. The RIP from barley has been purified to homogeneity by modifications of the methods of Roberts and Selitrennikoff and crosslinked to the binding subunit B of the seed toxin ricin (RTB). The resulting hybrid was purified by a combination of gel filtration and affinity chromatography on acid-washed Sepharose 4B. This model suicide transport agent was assayed in vitro against K-562 cells and was found to be cytotoxic in a dose-dependent manner (ID50 = 0.15 micrograms/ml). Lactose inhibited the toxicity of the hybrid, indicating that cytotoxicity was dependent on the cell binding property of the ricin B moiety. In addition, free RIP and free ricin B, either alone or in combination, were nontoxic over this concentration range. The in vivo effects of the RTB-RIP hybrid were assessed by pressure microinjection into the vagus nerves of rats. Injection of 0.18 to 6.5 micrograms of conjugate resulted in death of vagal sensory but not motor neurons after 3-17 days. The cytotoxic changes in vagal sensory neurons were identical to those previously observed with a variety of RIP toxins such as ricin.

Monoclonal anti-Thy 1 antibody (OX7) is axonally transported in rat nervous system.

Monoclonal anti-Thy 1 antibody (OX7) was pressure microinjected into vagus nerve, tongue or caudate nucleus of rats. Indirect anti-IgG immunoperoxidase staining showed that OX7 was axonally transported antero- and/or retrogradely from all injection sites. Histological examination and behavioral observations did not reveal neurotoxicity from these single OX7 injections. We conclude OX7 may prove useful as a carrier for selectively targeting molecules at neurons via endocytosis and axonal transport.