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1.
Int J Mol Sci ; 21(7)2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32235485

RESUMO

Aceruloplasminemia is a rare autosomal recessive genetic disease characterized by mild microcytic anemia, diabetes, retinopathy, liver disease, and progressive neurological symptoms due to iron accumulation in pancreas, retina, liver, and brain. The disease is caused by mutations in the Ceruloplasmin (CP) gene that produce a strong reduction or absence of ceruloplasmin ferroxidase activity, leading to an impairment of iron metabolism. Most patients described so far are from Japan. Prompt diagnosis and therapy are crucial to prevent neurological complications since, once established, they are usually irreversible. Here, we describe the largest series of non-Japanese patients with aceruloplasminemia published so far, including 13 individuals from 11 families carrying 13 mutations in the CP gene (7 missense, 3 frameshifts, and 3 splicing mutations), 10 of which are novel. All missense mutations were studied by computational modeling. Clinical manifestations were heterogeneous, but anemia, often but not necessarily microcytic, was frequently the earliest one. This study confirms the clinical and genetic heterogeneity of aceruloplasminemia, a disease expected to be increasingly diagnosed in the Next-Generation Sequencing (NGS) era. Unexplained anemia with low transferrin saturation and high ferritin levels without inflammation should prompt the suspicion of aceruloplasminemia, which can be easily confirmed by low serum ceruloplasmin levels. Collaborative joint efforts are needed to better understand the pathophysiology of this potentially disabling disease.

2.
N Engl J Med ; 382(13): 1219-1231, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32212518

RESUMO

BACKGROUND: Patients with transfusion-dependent ß-thalassemia need regular red-cell transfusions. Luspatercept, a recombinant fusion protein that binds to select transforming growth factor ß superfamily ligands, may enhance erythroid maturation and reduce the transfusion burden (the total number of red-cell units transfused) in such patients. METHODS: In this randomized, double-blind, phase 3 trial, we assigned, in a 2:1 ratio, adults with transfusion-dependent ß-thalassemia to receive best supportive care plus luspatercept (at a dose of 1.00 to 1.25 mg per kilogram of body weight) or placebo for at least 48 weeks. The primary end point was the percentage of patients who had a reduction in the transfusion burden of at least 33% from baseline during weeks 13 through 24 plus a reduction of at least 2 red-cell units over this 12-week interval. Other efficacy end points included reductions in the transfusion burden during any 12-week interval and results of iron studies. RESULTS: A total of 224 patients were assigned to the luspatercept group and 112 to the placebo group. Luspatercept or placebo was administered for a median of approximately 64 weeks in both groups. The percentage of patients who had a reduction in the transfusion burden of at least 33% from baseline during weeks 13 through 24 plus a reduction of at least 2 red-cell units over this 12-week interval was significantly greater in the luspatercept group than in the placebo group (21.4% vs. 4.5%, P<0.001). During any 12-week interval, the percentage of patients who had a reduction in transfusion burden of at least 33% was greater in the luspatercept group than in the placebo group (70.5% vs. 29.5%), as was the percentage of those who had a reduction of at least 50% (40.2% vs. 6.3%). The least-squares mean difference between the groups in serum ferritin levels at week 48 was -348 µg per liter (95% confidence interval, -517 to -179) in favor of luspatercept. Adverse events of transient bone pain, arthralgia, dizziness, hypertension, and hyperuricemia were more common with luspatercept than placebo. CONCLUSIONS: The percentage of patients with transfusion-dependent ß-thalassemia who had a reduction in transfusion burden was significantly greater in the luspatercept group than in the placebo group, and few adverse events led to the discontinuation of treatment. (Funded by Celgene and Acceleron Pharma; BELIEVE ClinicalTrials.gov number, NCT02604433; EudraCT number, 2015-003224-31.).


Assuntos
Receptores de Activinas Tipo II/uso terapêutico , Transfusão de Eritrócitos/estatística & dados numéricos , Hematínicos/uso terapêutico , Fragmentos Fc das Imunoglobulinas/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Talassemia beta/tratamento farmacológico , Receptores de Activinas Tipo II/efeitos adversos , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Ferritinas/sangue , Hematínicos/efeitos adversos , Humanos , Fragmentos Fc das Imunoglobulinas/efeitos adversos , Análise de Intenção de Tratamento , Análise dos Mínimos Quadrados , Masculino , Pessoa de Meia-Idade , Razão de Chances , Proteínas Recombinantes de Fusão/efeitos adversos , Esplenectomia , Adulto Jovem , Talassemia beta/genética , Talassemia beta/cirurgia , Talassemia beta/terapia
3.
Pediatrics ; 145(3)2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32079719

RESUMO

BACKGROUND AND OBJECTIVES: National guidelines recommend against routine use of chest radiography (CXR) for community-acquired pneumonia (CAP) diagnosis in the pediatric emergency department (ED). Given that CXR is often used to exclude the diagnosis of CAP, a reduction in CXR use may result in overdiagnosis of CAP. We sought to evaluate trends in CXR use and assess the association between CXR performance and CAP diagnosis among children discharged from pediatric EDs. METHODS: Children 3 months to 18 years of age discharged from 30 US EDs with (1) CAP or (2) fever or respiratory illness between 2008 and 2018 were included. Temporal trends in CXR use and rates of CAP diagnoses among patients with fever or respiratory illness were assessed. Correlation between hospital-level CXR use and CAP diagnosis rates were evaluated by using Spearman's correlation weighted by hospital volume. RESULTS: CXR usage decreased from 86.6% to 80.4% (P < .001) for patients with CAP and from 30.4% to 18.6% (P < .001) for children with fever or respiratory illness over the 10-year study period. CAP diagnosis rates also declined from 7.8% to 5.9% (P < .001). Hospital-level CXR use was correlated with pneumonia diagnosis rates (correlation coefficient 0.58; P < .001). CONCLUSIONS: Over the past decade, there has been a decline in CXR use in the ED among children with pneumonia and respiratory illnesses, with a decrease in pneumonia diagnoses over the same time period. Future studies are needed to assess the role of CXR in the evaluation of children with possible pneumonia in the ED setting.

4.
Food Funct ; 11(1): 932-943, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31950948

RESUMO

The most important cause of death in ß-thalassemia major patients is organ dysfunction due to iron deposits. Non-transferrin bound iron (NTBI), labile plasma iron (LPI) and labile iron pool are redox-active forms of iron found in thalassemia. Iron chelation therapy is adopted to counteract the resulting iron overload. Extracts of green tea (GTE) and curcumin exhibit iron-chelating and antioxidant activities in iron-loaded cells and ß-thalassemic mice. We have used our GTE-CUR drink to investigate the potential amelioration of iron overload and oxidative stress in transfusion-dependent ß-thalassemia (TDT) patients. The patients were enrolled for a control group without and with GTE-CUR treatments (17.3 and 35.5 mg EGCG equivalent). Along with regular chelation therapy, they were daily administered the drink for 60 d. Blood samples were collected at the beginning of the study and after 30 d and 60 d for biochemical and hematological tests. Interestingly, we found a decrease of blood urea nitrogen levels (P < 0.05), along with a tendency for a decrease of NTBI and LPI, and a delay in increasing lipid-peroxidation product levels in the GTE-CUR groups. The findings suggest that GTE-CUR could increase kidney function and diminish redox-active iron in iron overloaded ß-thalassemia patients.

5.
Appl Spectrosc ; 74(2): 233-240, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31517522

RESUMO

The detection and identification of materials from a distance is highly desirable for applications where accessibility is limited or there are safety concerns. Raman spectroscopy can be performed remotely and provides a very high level of confidence in detection of chemicals through vibrational modes. However, the remote Raman detection of chemicals is challenging because of the very weak nature of Raman signals. Using a remote Raman system, we performed fast remote detection of various solid and liquid chemicals from 1752 m during afternoon hours on a sunny day in Hawaii. Remote Raman systems with kilometer target range could be useful for chemical detection of volcanic gases, methane clathrate icebergs or fire ice, toxic gas clouds and toxic waste, explosives, and hazardous chemicals. With this successful test, we demonstrate the feasibility of developing future mid-size remote Raman systems suitable for long range chemical detection using helicopters and light airplanes.

6.
J Surg Res ; 245: 373-376, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425878

RESUMO

BACKGROUND: Recently, there has been an increase in the usage of dirt bikes and all-terrain vehicles in urban environments. Previously, it has been shown that crashes involving these urban off-road vehicles (UORVs) resulted in different injury patterns from crashes that occurred in rural environments. The aim of this study was to compare injury patterns of patients involved in crashes while riding UORVs versus motorcycles (MCs). METHODS: A retrospective review (2005-2016) of patients who presented to our urban level I trauma center as a result of any MC or UORV crash was performed. Patients who presented after 48 h from the time of accident were excluded. A P < 0.05 was considered significant. RESULTS: We identified 1556 patients who were involved in an MC or UORV crash resulting in injury (MC: n = 1324 [85%]; UORVs: n = 232 [15%]). Patients in UORV crashes were younger (26.2 y versus 39.6 y), less likely to be helmeted (39.6% versus 90.2%), required fewer emergent trauma bay procedures (28.4% versus 36.7%), and needed fewer operative interventions (45.9% versus 54.2%) (all P < 0.05). Both groups had a similar Injury Severity Score (12.2 versus 12.6; P = 0.54) and Glasgow Coma Score (13.8 versus 13.5; P = 0.46). UORV patients had a lower mortality (0.9% versus 4.7%; P < 0.05) compared to MC crash patients despite similar injury patterns. CONCLUSIONS: Our data demonstrate that patients sustaining UORV injuries were younger and less likely to be helmeted but have a lower mortality rate after a crash, despite sustaining similar injuries as motorcyclists. This study provides an overview of how crashes involving UORV usage is a unique phenomenon and not entirely comparable to MC crashes.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Veículos Off-Road/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Feminino , Humanos , Masculino , New Jersey/epidemiologia , Estudos Retrospectivos
7.
PLoS One ; 14(12): e0226433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841556

RESUMO

OBJECTIVE: To describe temporal trends and factors associated with opioid administration among children discharged from the emergency department (ED) after a trauma visit. METHODS: This was a cross-sectional study of ED visits for children <19 years old who received a trauma-related diagnosis and were discharged from the ED. Data were obtained from the National Hospital Ambulatory Medical Care Survey 2006-2015. OUTCOME MEASURES: Administration of an opioid medication either during the ED visit or as a discharge prescription. Survey-adjusted regression analyses were used to determine the probability of a patient receiving an opioid medication. RESULTS: During the study period, there were 19,241 pediatric trauma visits discharged from the ED, of which 14% were associated with an opioid. Opioid administration decreased by nearly 30% during the study period (p<0.001 for trend). In multivariable analysis, patient factors associated with opioid administration were adolescent age, evening visit, region of the country, and severe pain score. The diagnosis associated with the most opioids was ankle sprain and the diagnosis with the highest rate of opioid administration was radius fracture. The most common opioid administered to children under 12 years of age was acetaminophen-codeine. CONCLUSIONS: Opioid administration appears to be decreasing among pediatric patients presenting to the ED with trauma, but a high number of children continue to be exposed to opioids every year. Further education on opioid sparing pain management strategies may be warranted to decrease opioid exposure, including the inappropriate use of codeine, in this low risk trauma population.

8.
Appl Opt ; 58(32): 8971-8980, 2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31873679

RESUMO

We report the remote Raman spectra of natural igneous, metamorphic, and sedimentary rock samples at a standoff distance of 5 m. High-quality remote Raman spectra of unprepared rocks are necessary for accurate and realistic analysis of future Raman measurements on planetary surfaces such as Mars. Our results display the ability of a portable compact remote Raman system (CRRS) to effectively detect and isolate various light- and dark-colored mineral phases in natural rocks. The CRRS easily detected plagioclase and potassium feldspar end members, quartz, and calcite in rocks with high fluorescence backgrounds. Intermediate feldspars and quartz, when found in rocks with complex mineralogies, exhibited band shifts and broadening in the ${504{-}510}\,\,{{\rm cm}^{ - 1}}$504-510cm-1 and ${600{-}1200}\,\,{{\rm cm}^{ - 1}}$600-1200cm-1 regions. A good approximation of intermediate plagioclase feldspars was possible by using overall Raman spectral shape and assigning other minor Raman peaks in addition to the $ 504{-}510\,\,{{\rm cm}^{ - 1}}$504-510cm-1 peaks. Detection of olivine and pyroxene in mafic rocks allowed for compositional characterization.

9.
Nat Commun ; 10(1): 5795, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31857588

RESUMO

Tumour necrosis factor (TNF) is a cytokine belonging to a family of trimeric proteins; it has been shown to be a key mediator in autoimmune diseases such as rheumatoid arthritis and Crohn's disease. While TNF is the target of several successful biologic drugs, attempts to design small molecule therapies directed to this cytokine have not led to approved products. Here we report the discovery of potent small molecule inhibitors of TNF that stabilise an asymmetrical form of the soluble TNF trimer, compromising signalling and inhibiting the functions of TNF in vitro and in vivo. This discovery paves the way for a class of small molecule drugs capable of modulating TNF function by stabilising a naturally sampled, receptor-incompetent conformation of TNF. Furthermore, this approach may prove to be a more general mechanism for inhibiting protein-protein interactions.

10.
PLoS Med ; 16(11): e1002922, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31689290

RESUMO

BACKGROUND: Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults. METHODS AND FINDINGS: This was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12-17 years of age) and 28,213 young adults (18-25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0-28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4-21.6) of adolescents and 32.2% (95% CI 31.4-33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5-4.0) and 2,207 young adults (7.8%; 95% CI 7.3-8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals. CONCLUSIONS: Results from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.


Assuntos
Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/uso terapêutico , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
11.
J Food Prot ; 82(12): 2038-2043, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31692393

RESUMO

It is estimated that nontyphoidal Salmonella causes approximately 1 million illnesses and 378 deaths per year in the United States. Reduction of Salmonella-related foodborne infections can be achieved through application of food antimicrobials. Essential oils in combination with other antimicrobials can be added to food products to reduce the levels of the organism below the infectious dose for healthy individuals. The purpose of this study was to investigate the antimicrobial efficacy of white mustard essential oil (WMEO) against serovars of Salmonella and its potential to be used with carvacrol or thymol to control Salmonella. Results showed that WMEO at the highest concentration of 0.84% (v/v) compared with the positive control had approximately a 6- to 7-log reduction for all serovars. It was found that no difference in susceptibility existed among the serovars tested (P > 0.05). In addition, the MICs were determined to be 0.5, 0.02, and 0.02% for WMEO, carvacrol, and thymol, respectively, against Salmonella Typhimurium. The fractional inhibitory concentration index was calculated. A score of 1 indicated an additive effect occurred when WMEO was combined with thymol or carvacrol. Combining WMEO with carvacrol or thymol indicated that the concentration of individual essential oils needed to inhibit Salmonella can be reduced using these combinations and warrants further study to determine potential use in controlling Salmonella in commercial food products.

14.
J Trauma Acute Care Surg ; 87(5): 1035-1041, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31389912

RESUMO

BACKGROUND: Cold-stored whole blood (CWB) provides a balance of red blood cells, plasma, and platelets in less anticoagulant volume than standard blood component therapy (BCT). We hypothesize that patients receiving CWB along with BCT have improved survival compared with patients receiving only BCT. METHODS: We performed a dual-center case-match study of trauma patients who received CWB and BCT at two urban, Level-I Trauma Centers. Criteria to receive CWB included boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 0.05 was significant. RESULTS: Between both institutions, a total of 107 patients received CWB during the study period with 91 being matched to 182 BCT patients for analysis. Hemodynamic parameters of the patients in both groups at the time of presentation were similar. The CWB patients had higher mean hemoglobin (10 ± 2 g/dL vs. 11 ± 2 g/dL; p < 0.001) and hematocrit (29.2 ± 6.1% vs. 32.1 ± 5.8%; p < 0.001) at 24 hours. Importantly, trauma bay mortality was less in CWB patients (8.8% vs. 2.2%;p = 0.039). Thirty-day mortality was not different in CWB patients, and there were no differences in the total amount of blood products transfused at the 4-hour and 24-hour periods. CONCLUSION: Cold-stored whole blood offers the benefit of a balanced resuscitation with improved trauma bay survival and higher mean hemoglobin at 24 hours. A larger, prospective study is needed to determine whether it has a longer-term survival benefit for severely injured patients. LEVEL OF EVIDENCE: Therapeutic, level III.

15.
Artigo em Inglês | MEDLINE | ID: mdl-31306260

RESUMO

The use of direct oral anticoagulants is increasing rapidly, because of perceived benefits over older agents, such as predictable pharmacokinetics and a reduced risk of bleeding. Elderly patients, who are more likely to be prescribed these drugs, are also presenting for neurosurgical procedures more often. The combination of these factors will result in neurosurgeons and neuroanesthesiologists encountering patients prescribed direct oral anticoagulants on an increasingly frequent basis. This review provides a summary of the current evidence pertaining to the perioperative management of these drugs, in the context of elective and emergency intracranial surgery. It highlights emerging therapies, including specific antidotes, as well as areas where the evidence base is likely to improve in the future.

16.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31138669

RESUMO

BACKGROUND: Adolescents and young adults are at high risk for opioid misuse after exposure from medical treatment. However, the epidemiology of opioid prescribing among outpatient adolescents and young adults remains poorly described. We aimed to characterize opioid prescribing in adolescents and young adults receiving care in emergency departments (EDs) and outpatient clinics. METHODS: We analyzed National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey data from 2005 to 2015. We included visits to EDs and outpatient clinics for adolescents (13-17 years old) and young adults (18-22 years old). Rates of opioid prescribing were calculated with 95% confidence intervals (CIs), and linear trends over time were examined with logistic regression models. RESULTS: Nearly 57 million visits (5.7%; 95% CI 5.4% to 6.0%) by adolescents and young adults were associated with an opioid prescription. The rate of opioid prescribing was 14.9% (95% CI 14.4% to 15.6%) for ED visits and 2.8% (95% CI 2.5% to 3.1%) for outpatient clinic visits. There was a small but significant decrease in the rate of opioid prescriptions among ED visits (odds ratio 0.96; 95% CI 0.95 to 0.98); no change was seen for outpatient clinic visits. Among ED visits, opioid-prescribing rates were highest among adolescents and young adults with dental disorders (59.7% and 57.9%, respectively), followed by adolescents with clavicle (47.0%) and ankle fractures (38.1%). CONCLUSIONS: Rates of opioid prescribing in EDs and outpatient clinics remain high for adolescents and young adults, especially for certain emergency conditions. These findings inform targeted educational campaigns aiming to ensure judicious use of opioids in this high-risk population.


Assuntos
Assistência Ambulatorial/tendências , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos , Serviço Hospitalar de Emergência/tendências , Pesquisas sobre Serviços de Saúde/tendências , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
17.
Pancreas ; 48(5): 636-643, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091209

RESUMO

OBJECTIVES: We have investigated the efficacy of mono- and combined therapy with green tea extract (GTE) in mobilizing redox iron, scavenging reactive oxygen species (ROS), and improving insulin production in iron-loaded pancreatic cells. METHODS: Rat insulinoma pancreatic ß-cells were iron-loaded using culture medium supplemented with either fetal bovine serum or ferric ammonium citrate and treated with various doses of GTE for epigallocatechin-3-gallate (EGCG) equivalence and in combination with iron chelators. Cellular iron, ROS, and secretory insulin were measured. RESULTS: The rat insulinoma pancreatic cells took up iron from fetal bovine serum more rapidly than ferric ammonium citrate. After treatment with GTE (0.23-2.29 µg EGCG equivalent), cellular levels of iron and ROS were dose dependently decreased. Importantly, secretory insulin levels were increased nearly 2.5-fold with 2.29 µg of EGCG equivalent GTE, indicating a recovery in insulin production. CONCLUSIONS: Green tea EGCG ameliorated oxidative damage of iron-loaded ß-cells by removing redox iron and free radicals and attenuating insulin production. The impact can result in the restoration of pancreatic functions and an increase in insulin production. Green tea extract exerts iron-chelating, free-radical scavenging, and pancreato-protective effects in the restoration of ß-cell functions, all of which we believe can increase insulin production in diabetic ß-thalassemia patients.


Assuntos
Catequina/análogos & derivados , Secreção de Insulina/efeitos dos fármacos , Células Secretoras de Insulina/efeitos dos fármacos , Ferro/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Chá/química , Animais , Catequina/farmacologia , Linhagem Celular Tumoral , Complicações do Diabetes/metabolismo , Insulina/metabolismo , Células Secretoras de Insulina/metabolismo , Células Secretoras de Insulina/patologia , Fitoterapia/métodos , Extratos Vegetais/farmacologia , Ratos , Talassemia beta/complicações , Talassemia beta/metabolismo
18.
Glob Chang Biol ; 25(8): 2518-2529, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31095820

RESUMO

Since 1990, the Intergovernmental Panel on Climate Change (IPCC) has produced five Assessment Reports (ARs), in which agriculture as the production of food for humans via crops and livestock have featured in one form or another. A constructed database of the ca. 2,100 cited experiments and simulations in the five ARs was analyzed with respect to impacts on yields via crop type, region, and whether adaptation was included. Quantitative data on impacts and adaptation in livestock farming have been extremely scarce in the ARs. The main conclusions from impact and adaptation are that crop yields will decline, but that responses have large statistical variation. Mitigation assessments in the ARs have used both bottom-up and top-down methods but need better to link emissions and their mitigation with food production and security. Relevant policy options have become broader in later ARs and included more of the social and nonproduction aspects of food security. Our overall conclusion is that agriculture and food security, which are two of the most central, critical, and imminent issues in climate change, have been dealt with an unfocussed and inconsistent manner between the IPCC five ARs. This is partly a result of not only agriculture spanning two IPCC working groups but also the very strong focus on projections from computer crop simulation modeling. For the future, we suggest a need to examine interactions between themes such as crop resource use efficiencies and to include all production and nonproduction aspects of food security in future roles for integrated assessment models.


Assuntos
Agricultura , Mudança Climática , Animais , Produtos Agrícolas , Abastecimento de Alimentos , Humanos , Gado
19.
Sci Total Environ ; 675: 642-650, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31035202

RESUMO

Grassland ecosystems are one of the most important terrestrial ecosystems in the world, producing essential both goods and ecosystem services (ES) for human beings. The Inner Mongolian steppe is a major grassland ecosystem in Northern China, covering 13.5% of the northern Chinese grassland area, and playing important ecological roles for the adjacent region of the capital Beijing-Tianjin-Hebei. Quantification of grassland ES under the different utilization patterns is vital for the maintenance of multiple ES and mitigation against ES loss in this region. We made a manipulative experiment with four grazing intensities (grazing exclusion, GE; light grazing intensity, LG; medium grazing intensity, MG; heavy grazing intensity, HG). We then quantified the intensities of eight different grassland ES (1. herbage intake, HT; 2. biodiversity conservation, BI; 3. soil nutrient retention, SN; 4 soil carbon stocks SC; 5. soil erosion prevention, SEP; 6. soil water storage, SWC; 7. potential nutrient recycling, PNC; 8. carbon sequestration from atmosphere. CS) and total ES via a series of field measurements. Pearson coefficients and trade-offs index were used to access the above ES relationships and degree of trade-offs between ES. Grazing intensities significantly (p < 0.05) affected the grassland intensities of 'regulating', 'culture' and 'provisioning' services, but the 'supporting' services. We found three types of relationships (trade-offs, synergy or neutral) have been found in this study. Trade-offs occurred between 'provisioning' and 'regulating' services. Although GE management presented significantly higher intensity of total ES (0.64) than LG (0.52), LG management significantly weakened the trade-offs between 'provisioning' and 'regulating' services (Trade-offs index 0.22) in comparison with GE (Trade-offs index 11.02). Our study suggests, therefore, that LG is the most suitable grassland utilization practice in the Inner Mongolian steppe.

20.
Pediatr Emerg Care ; 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30624420

RESUMO

OBJECTIVES: National guidelines for routine pediatric acute asthma care recommend providing corticosteroids, and discourage routinely obtaining chest radiographs (CXRs) and using antibiotics. We examined rates of adherence to all 3 of these aspects during emergency department (ED) visits and compared performance between pediatric and general EDs. METHODS: Using the National Hospital Ambulatory Medical Care Survey, we included all nontransfer ED visits for patients younger than 19 years with a diagnosis of asthma and treatment with albuterol from 2005 to 2015. Guideline-based care, defined as (1) corticosteroids, (2) no antibiotics, and (3) no CXR, was assessed for each visit. Hospitals were categorized as pediatric or general and compared according to rates of guideline-based care. Multivariable analyses were used to identify demographic and hospital-level characteristics associated with guideline-based care. RESULTS: More than 7 million ED visits met eligibility criteria. Antibiotic provision and CXR acquisition were significantly higher in general EDs (20% vs 11%, 40% vs 26%, respectively), while steroid provision was similar (63% vs 62%). Overall, 34% of visits involved guideline-based care, with a higher rate for pediatric EDs compared with general EDs (42% to 31%). Visit at a pediatric ED (odds ratio, 1.62 [confidence interval 1.17-2.25]) and black race (odds ratio, 1.48 [confidence interval 1.07-2.02]) were independently associated with guideline-based care in a multivariate analysis. CONCLUSIONS: Guideline-based care was more common in pediatric EDs, although only one-third of all pediatric-age visits met the definition of guideline-based care. Future policy and education efforts to reduce unnecessary antibiotic and CXR use for children with asthma are warranted.

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