Medicine by Alexandros G.Sfakianakis: 07/29/16

Παρασκευή 29 Ιουλίου 2016

Sustainability, Vol. 8, Pages 716: Supply Chain Cooperation with Price-Sensitive Demand and Environmental Impacts

In this paper, we consider a two-echelon sustainable supply chain with price-sensitive demand. The government taxes the carbon footprint of each item caused by producing, transporting, and consuming the products. Both the supplier and retailer can exert efforts to reduce the carbon footprint. In a non-cooperative setting, the government only taxes the supplier, so that the retailer has no incentive to exert any effort to reduce the carbon footprint and the supplier merely decides on the selling price to maximize its own profit. We develop a centralized supply chain and show that there is an optimal solution to maximize the channel profit. Since the centralized policy may not be always not practical, we propose a tax-sharing contract, where both parties profit from the carbon footprint reduction. This problem is modeled as the Stackelberg game and Nash game. The results show that the leader has more power than the follower, which results in more profit. The Stackelberg game provides boundaries for both parties' profits in the Nash game. Although the tax-sharing contract does not result in full cooperation, its efficiency is still much higher than that of the non-cooperative case. The results are illustrated with some numerical experiments.

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Sustainability, Vol. 8, Pages 729: Network Analysis of Open Innovation

The way people innovate and create new ideas and bring them to the market is undergoing a fundamental change from closed innovation to open innovation. Why and how do firms perform open innovation? Firms' open innovation is measured through the levels of firms' joint patent applications. Next, we analyze network structures and characters of firms' joint patent applications such as betweenness and degree centrality, structure hole, and closure. From this research, we drew conclusions as follows. First, the structure of collaboration networks has both direct and indirect effects on firms' innovative performance. Second, in the process of joint patent applications, there is a long tail phenomenon in networks of joint patent applications. Third, the number of patents and International Patent Classification (IPC) subclasses together constitute a meaningful measure of the innovation performance of firms.

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IJMS, Vol. 17, Pages 1231: SMA Human iPSC-Derived Motor Neurons Show Perturbed Differentiation and Reduced miR-335-5p Expression

Spinal Muscular Atrophy (SMA) is a neuromuscular disease caused by mutations in the Survival Motor Neuron 1 gene, resulting in very low levels of functional Survival of Motor Neuron (SMN) protein. SMA human induced Pluripotent Stem Cells (hiPSCs) represent a useful and valid model for the study of the disorder, as they provide in vitro the target cells. MicroRNAs (miRNAs) are often reported as playing a key role in regulating neuronal differentiation and fate specification. In this study SMA hiPSCs have been differentiated towards early motor neurons and their molecular and immunocytochemical profile were compared to those of wild type cells. Cell cycle proliferation was also evaluated by fluorescence-activated cell sorting (FACS). SMA hiPSCs showed an increased proliferation rate and also higher levels of stem cell markers. Moreover; when differentiated towards early motor neurons they expressed lower levels of NCAM and MN specific markers. The expression of miR-335-5p; already identified to control self-renewal or differentiation of mouse embryonic stem cells (mESCs); resulted to be reduced during the early steps of differentiation of SMA hiPSCs compared to wild type cells. These results suggest that we should speculate a role of this miRNA both in stemness characteristic and in differentiation efficiency of these cells.

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IJMS, Vol. 17, Pages 1237: VEGF and FGF2 Improve Revascularization, Survival, and Oocyte Quality of Cryopreserved, Subcutaneously-Transplanted Mouse Ovarian Tissues

This study was conducted to investigate the effect of the vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF2) on revascularization, survival, and oocyte quality of cryopreserved, subcutaneously-transplanted mouse ovarian tissue. Autologous subcutaneous transplantation of vitrified-thawed mouse ovarian tissues treated with (experimental group) or without (control group) VEGF and FGF2 was performed. After transplantation to the inguinal region for two or three weeks, graft survival, angiogenesis, follicle development, and oocyte quality were examined after gonadotropin administration. VEGF coupled with FGF2 (VEGF/FGF2) promoted revascularization and significantly increased the survival rate of subcutaneously-transplanted cryopreserved ovarian tissues compared with untreated controls. The two growth factors did not show long-term effects on the ovarian grafts. In contrast to the untreated ovarian grafts, active folliculogenesis was revealed as the number of follicles at various stages and of mature oocytes in antral follicles after gonadotropin administration were remarkably higher in the VEGF/FGF2-treated groups. Although the fertilization rate was similar between the VEGF/FGF2 and control groups, the oocyte quality was much better in the VEGF/FGF2-treated grafts as demonstrated by the higher ratio of blastocyst development. Introducing angiogenic factors, such as VEGF and FGF2, may be a promising strategy to improve revascularization, survival, and oocyte quality of cryopreserved, subcutaneously-transplanted mouse ovarian tissue.

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Sensors, Vol. 16, Pages 1201: Maximum Data Collection Rate Routing Protocol Based on Topology Control for Rechargeable Wireless Sensor Networks

In Rechargeable Wireless Sensor Networks (R-WSNs), in order to achieve the maximum data collection rate it is critical that sensors operate in very low duty cycles because of the sporadic availability of energy. A sensor has to stay in a dormant state in most of the time in order to recharge the battery and use the energy prudently. In addition, a sensor cannot always conserve energy if a network is able to harvest excessive energy from the environment due to its limited storage capacity. Therefore, energy exploitation and energy saving have to be traded off depending on distinct application scenarios. Since higher data collection rate or maximum data collection rate is the ultimate objective for sensor deployment, surplus energy of a node can be utilized for strengthening packet delivery efficiency and improving the data generating rate in R-WSNs. In this work, we propose an algorithm based on data aggregation to compute an upper data generation rate by maximizing it as an optimization problem for a network, which is formulated as a linear programming problem. Subsequently, a dual problem by introducing Lagrange multipliers is constructed, and subgradient algorithms are used to solve it in a distributed manner. At the same time, a topology controlling scheme is adopted for improving the network's performance. Through extensive simulation and experiments, we demonstrate that our algorithm is efficient at maximizing the data collection rate in rechargeable wireless sensor networks.

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Sustainability, Vol. 8, Pages 730: Research on the Participant Behavior Selections of the Energy Performance Contracting Project Based on the Robustness of the Shared Savings Contract

The profits of the ESCO (Energy Services Company) and EU (Energy Using Organization) in the EPCP (energy performance contracting project) rely on the signing of the shared savings contract and the successful operation of the project, and the probability of the project's success is decided by the complementary efforts of the ESCO and EU. However, the effort selection of the two sides face the bidirectional moral hazard caused by asymmetric information. Based on the robustness of shared savings contract, this paper establishes a bidirectional moral hazard model under asymmetric information to analyze the complementary efforts selection of the ESCO and EU with the given revenue sharing rules, and analyzes the differences of the complementary efforts under symmetric and asymmetric information conditions and the impacts of those efforts on the shared savings contract's robustness by using a numerial simulation. The results show that compared with information symmetry, the bidirectional moral hazard will erode the project's value under information asymmetry, the project's success probability and the level of the parties' efforts will decrease, which reveals the negative impact of asymmetric information on the robustness of the shared savings contract, and the significance of eliminating information asymmetry effectively as well as incentivizing the parties to increase the degree of complementary efforts to enhance the probability of the project's success. Finally, policy recommendations regarding the introduction of incomplete contracts, promoting guaranteed savings contracts, and improving energy savings audits for the enhancement of the robustness of the shared savings contract are provided. This research will be helpful to improve the theoretical research on the contract's robustness, perfect the design of the energy service contract, and formulate the related support policies.

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IJMS, Vol. 17, Pages 1231: SMA Human iPSC-Derived Motor Neurons Show Perturbed Differentiation and Reduced miR-335-5p Expression

IJMS, Vol. 17, Pages 1237: VEGF and FGF2 Improve Revascularization, Survival, and Oocyte Quality of Cryopreserved, Subcutaneously-Transplanted Mouse Ovarian Tissues

Sensors, Vol. 16, Pages 1202: Dynamic Calibration and Verification Device of Measurement System for Dynamic Characteristic Coefficients of Sliding Bearing

The identification accuracy of dynamic characteristics coefficients is difficult to guarantee because of the errors of the measurement system itself. A novel dynamic calibration method of measurement system for dynamic characteristics coefficients is proposed in this paper to eliminate the errors of the measurement system itself. Compared with the calibration method of suspension quality, this novel calibration method is different because the verification device is a spring-mass system, which can simulate the dynamic characteristics of sliding bearing. The verification device is built, and the calibration experiment is implemented in a wide frequency range, in which the bearing stiffness is simulated by the disc springs. The experimental results show that the amplitude errors of this measurement system are small in the frequency range of 10 Hz–100 Hz, and the phase errors increase along with the increasing of frequency. It is preliminarily verified by the simulated experiment of dynamic characteristics coefficients identification in the frequency range of 10 Hz–30 Hz that the calibration data in this frequency range can support the dynamic characteristics test of sliding bearing in this frequency range well. The bearing experiments in greater frequency ranges need higher manufacturing and installation precision of calibration device. Besides, the processes of calibration experiments should be improved.

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The impact of early environmental interventions on structural plasticity of the axon initial segment in neocortex

Abstract

Plasticity of the axon initial segment (AIS) is a newly discovered type of structural plasticity that regulates cell excitability. AIS plasticity has been reported to happen during normal development of neocortex and also in a few pathological conditions involving disruption of the inhibition/excitation balance. Here we report on the impact of early environmental interventions on structural plasticity of AIS in the mouse neocortex. C57BL/6 mice were raised in standard or enriched environment (EE) from birth up to the time of experiments and were injected with saline or MK-801 [N-Methyl-D-Aspartate (NMDA) receptor antagonist, 1 mg/kg] on postnatal days (P) 6–10. We used Ankyrin G immunoreactivity to mark the AIS of cortical neurons in two sub-regions of frontal cortex (frontal association area, FrA and secondary motor cortex, M2) and in the secondary visual cortex (V2). In 1-month-old mice, the mean AIS length differed between three areas, with the shortest AISs being observed in V2. Postnatal MK-801 or EE led to shortening of AIS only in the frontal areas. However, exposure to EE restored AIS shortening induced by MK-801. Chronic postnatal MK-801 results in structural plasticity of AIS exclusive to the frontal cortex. EE may modify underlying neuronal mechanisms resulting in restoration of AIS length.

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Infant hair cortisol: associations with salivary cortisol and environmental context

Abstract

Early chronic stress has enduring implications for physical and mental health outcomes. Hair cortisol concentration (HCC) has emerged as a marker of cumulative cortisol exposure, yet HCC in infants is not well understood. We examined how infant HCC relates to widely used basal salivary cortisol measures, maternal HCC, and environmental context in 111 infants assessed at 6 and 12 months of age. Maternal HCC at 6 and 12 months was correlated with infant HCC at 12 months. At 12 months, infant HCC was positively associated with waking salivary cortisol concentration (SCC), evening SCC, and area under the curve (AUC), but was independent of diurnal slope. Breastfeeding was associated with lower HCC, whereas increased sleep disruption was related to flatter slope. Reduced nighttime sleep duration was related both to higher HCC and to flatter slope. A person-focused analysis indicated that the combination of high HCC and flattened slope was associated with more environmental risks, highlighting the importance of investigating the interplay between HCC and diurnal cortisol slope. Results support the validity of HCC as a marker of cumulative cortisol exposure in infancy, while emphasizing the value of including multiple cortisol measures assessing distinct aspects of hypothalamic–pituitary–adrenal (HPA) function.

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Computer-based tools for assessing micro-longitudinal patterns of cognitive function in older adults

Abstract

Patterns of cognitive change over micro-longitudinal timescales (i.e., ranging from hours to days) are associated with a wide range of age-related health and functional outcomes. However, practical issues with conducting high-frequency assessments make investigations of micro-longitudinal cognition costly and burdensome to run. One way of addressing this is to develop cognitive assessments that can be performed by older adults, in their own homes, without a researcher being present. Here, we address the question of whether reliable and valid cognitive data can be collected over micro-longitudinal timescales using unsupervised cognitive tests.In study 1, 48 older adults completed two touchscreen cognitive tests, on three occasions, in controlled conditions, alongside a battery of standard tests of cognitive functions. In study 2, 40 older adults completed the same two computerized tasks on multiple occasions, over three separate week-long periods, in their own homes, without a researcher present. Here, the tasks were incorporated into a wider touchscreen system (Novel Assessment of Nutrition and Ageing (NANA)) developed to assess multiple domains of health and behavior. Standard tests of cognitive function were also administered prior to participants using the NANA system.Performance on the two "NANA" cognitive tasks showed convergent validity with, and similar levels of reliability to, the standard cognitive battery in both studies. Completion and accuracy rates were also very high. These results show that reliable and valid cognitive data can be collected from older adults using unsupervised computerized tests, thus affording new opportunities for the investigation of cognitive function.

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IJMS, Vol. 17, Pages 1228: Urinary Dopamine as a Potential Index of the Transport Activity of Multidrug and Toxin Extrusion in the Kidney

Dopamine is a cationic natriuretic catecholamine synthesized in proximal tubular cells (PTCs) of the kidney before secretion into the lumen, a key site of its action. However, the molecular mechanisms underlying dopamine secretion into the lumen remain unclear. Multidrug and toxin extrusion (MATE) is a H+/organic cation antiporter that is highly expressed in the brush border membrane of PTCs and mediates the efflux of organic cations, including metformin and cisplatin, from the epithelial cells into the urine. Therefore, we hypothesized that MATE mediates dopamine secretion, a cationic catecholamine, into the tubule lumen, thereby regulating natriuresis. Here, we show that [3H]dopamine uptake in human (h) MATE1-, hMATE-2K- and mouse (m) MATE-expressing cells exhibited saturable kinetics. Fluid retention and decreased urinary excretion of dopamine and Na+ were observed in Mate1-knockout mice compared to that in wild-type mice. Imatinib, a MATE inhibitor, inhibited [3H]dopamine uptake by hMATE1-, hMATE2-K- and mMATE1-expressing cells in a concentration-dependent manner. At clinically-relevant concentrations, imatinib inhibited [3H]dopamine uptake by hMATE1- and hMATE2-K-expressing cells. The urinary excretion of dopamine and Na+ decreased and fluid retention occurred in imatinib-treated mice. In conclusion, MATE transporters secrete renally-synthesized dopamine, and therefore, urinary dopamine has the potential to be an index of the MATE transporter activity.

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IJMS, Vol. 17, Pages 1235: Biological Effect of a Hybrid Anticancer Agent Based on Kinase and Histone Deacetylase Inhibitors on Triple-Negative (MDA-MB231) Breast Cancer Cells

We examined the effects of the histone deacetylase inhibitor (HDACi) suberoylanilide hydroxamic acid (SAHA) combined with the vascular endothelial growth factor receptor-1/2 inhibitor (3Z)-5-hydroxy-3-(1H-pyrrol-2-ylmethylidene)-2,3-dihydro-1H-indol-2-one on MDA-MB-231 breast cancer cells (triple-negative) in the form of both a cocktail of the separate compounds and a chemically synthesized hybrid (N-hydroxy-N'-[(3Z)-2-oxo-3-(1H-pyrrol-2-ylmethylidene)-2,3-dihydro-1H-indol-5-yl]octanediamide). Comparative flow cytometric and Western blot analyses were performed on cocktail- and hybrid-treated cells to evaluate cell cycle distribution, autophagy/apoptosis modulation, and mitochondrial metabolic state in order to understand the cellular basis of the cytotoxic effect. Cell cycle analysis showed a perturbation of the rate of progression through the cycle, with aspects of redistribution of cells over different cycle phases for the two treatments. In addition, the results suggest that the two distinct classes of compounds under investigation could induce cell death by different preferential pathways, i.e., autophagy inhibition (the cocktail) or apoptosis promotion (the hybrid), thus confirming the enhanced potential of the hybrid approach vs. the combination approach in finely tuning the biological activities of target cells and also showing the hybrid compound as an additional promising drug-like molecule for the prevention or therapy of "aggressive" breast carcinoma.

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IJMS, Vol. 17, Pages 1238: Navicula sp. Sulfated Polysaccharide Gels Induced by Fe(III): Rheology and Microstructure

A sulfated polysaccharide extracted from Navicula sp. presented a yield of 4.4 (% w/w dry biomass basis). Analysis of the polysaccharide using gas chromatography showed that this polysaccharide contained glucose (29%), galactose (21%), rhamnose (10%), xylose (5%) and mannose (4%). This polysaccharide presented an average molecular weight of 107 kDa. Scanning electron microscopy (SEM) micrographs showed that the lyophilized Navicula sp. polysaccharide is an amorphous solid with particles of irregular shapes and sharp angles. The polysaccharide at 1% (w/v) solution in water formed gels in the presence of 0.4% (w/v) FeCl3, showing elastic and viscous moduli of 1 and 0.7 Pa, respectively. SEM analysis performed on the lyophilized gel showed a compact pore structure, with a pore size of approximately 150 nm. Very few studies on the gelation of sulfated polysaccharides using trivalent ions exist in the literature, and, to the best of our knowledge, this study is the first to describe the gelation of sulfated polysaccharides extracted from Navicula sp.

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Forests, Vol. 7, Pages 163: Functional Diversity of Small and Large Trees along Secondary Succession in a Tropical Dry Forest

Functional Diversity is considered an important driver of community assembly in environmental and successional gradients. To understand tree assembly processes in a semideciduous tropical forest, we analyzed the variation of Functional Richness (FRic), Functional Divergence (FDiv), and Functional Evenness (FEve) of small vs. large trees in relation to fallow age after slash-and-burn agriculture and topographical position (flat sites vs. hills). FRic of small trees was lower than null model predicted values across the successional gradient, and decreased unexpectedly in older successional ages. FRic of large trees was higher than null model predictions early in succession and lower in late-successional stands on hills. Dominant species were more similar (low FDiv) in early and intermediate successional stands for small trees, and on hills for large trees, suggesting that species that are best adapted to harsh conditions share similar traits. We also found evidence of competitive exclusion among similar species (high FEve) for small trees in early successional stands. Overall, our results indicate that community assembly of small trees is strongly affected by the changing biotic and abiotic conditions along the successional and topographical gradient. For large trees, hills may represent the most stressful conditions in this landscape.

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Forests, Vol. 7, Pages 165: Forest Stand Inventory Based on Combined Aerial and Terrestrial Close-Range Photogrammetry

In this article we introduce a new method for forest management inventories especially suitable for highly-valued timber where the precise estimation of stem parameters (diameter, form, and tapper) plays the key role for market purposes. The unmanned aerial system (UAS)-based photogrammetry is combined with terrestrial photogrammetry executed by walking inside the stand and the individual tree parameters are estimated. We compare two automatic methods for processing of the point clouds and the delineation of stem circumference at breast height. The error of the diameter estimation was observed to be under 1 cm root mean square error (RMSE) and the height estimation error was 1 m. Apart from the mentioned accuracy, the main advantage of the proposed work is shorter time demand for field measurement; we could complete both inventories of 1 hectare forest stand in less than 2 h of field work.

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Materials, Vol. 9, Pages 643: Compatibilized Immiscible Polymer Blends for Gas Separations

Membrane-based gas separation has attracted a great deal of attention recently due to the requirement for high purity gasses in industrial applications like fuel cells, and because of environment concerns, such as global warming. The current methods of cryogenic distillation and pressure swing adsorption are energy intensive and costly. Therefore, polymer membranes have emerged as a less energy intensive and cost effective candidate to separate gas mixtures. However, the use of polymeric membranes has a drawback known as the permeability-selectivity tradeoff. Many approaches have been used to overcome this limitation including the use of polymer blends. Polymer blending technology synergistically combines the favorable properties of different polymers like high gas permeability and high selectivity, which are difficult to attain with a single polymer. During polymer mixing, polymers tend to uncontrollably phase separate due to unfavorable thermodynamics, which limits the number of completely miscible polymer combinations for gas separations. Therefore, compatibilizers are used to control the phase separation and to obtain stable membrane morphologies, while improving the mechanical properties. In this review, we focus on immiscible polymer blends and the use of compatibilizers for gas separation applications.

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RNA-binding protein HuR and the members of miR-200 family play an unconventional role in the regulation of c-Jun mRNA [ARTICLE]

Post-transcriptional gene regulation is a fundamental step for coordinating cellular response in a variety of processes. RNA-binding protein (RBPs) and microRNAs (miRNAs) are the most important factors responsible for this regulation. Here we report that different components of the miR-200 family are involved in c-Jun mRNA regulation with the opposite effect. While miR-200b inhibits c-Jun protein production, miR-200a tends to increase the JUN amount through a stabilization of its mRNA. This action is dependent on the presence of the RBP HuR that binds the 3'UTR of c-Jun mRNA in a region including the mir-200a binding site. The position of the binding site is fundamental; by mutating this site, we demonstrate that the effect is not micro-RNA specific. These results indicate that miR-200a triggers a microRNA-mediated stabilization of c-Jun mRNA, promoting the binding of HuR with c-Jun mRNA. This is the first example of a positive regulation exerted by a microRNA on an important oncogene in proliferating cells.

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Identification of new branch points and unconventional introns in Saccharomyces cerevisiae [ARTICLE]

Spliced messages constitute one-fourth of expressed mRNAs in the yeast Saccharomyces cerevisiae, and most mRNAs in metazoans. Splicing requires 5' splice site (5'SS), branch point (BP), and 3' splice site (3'SS) elements, but the role of the BP in splicing control is poorly understood because BP identification remains difficult. We developed a high-throughput method, Branch-seq, to map BPs and 5'SSs of isolated RNA lariats. Applied to S. cerevisiae, Branch-seq detected 76% of expressed, annotated BPs and identified a comparable number of novel BPs. We performed RNA-seq to confirm associated 3'SS locations, identifying some 200 novel splice junctions, including an AT-AC intron. We show that several yeast introns use two or even three different BPs, with effects on 3'SS choice, protein coding potential, or RNA stability, and identify novel introns whose splicing changes during meiosis or in response to stress. Together, these findings show unanticipated complexity of splicing in yeast.

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Dietary intake in young adults born small or appropriate for gestational age: data from the Haguenau cohort

Objectives

Compare the dietary intake of young adults born small for gestational age (SGA) versus those born appropriate for gestational age (AGA).

Design

Cross-sectional analysis.

Setting

Data at the 8-year follow-up Haguenau cohort (France). Data from 229 AGA-born adults and 172 SGA-born adults with available dietary information are presented.

Methods

Dietary intake was based on a food questionnaire including 19 items. The ² test was run to compare intake between SGA-born and AGA-born individuals. An a priori score was calculated based on the adherence to recommendations from the French Nutrition and Health Program and included 8 components with the lowest value indicating a lower adherence to recommendations. The score was then divided into quartiles. Relative risks and 95% CIs, controlling for age and sex in multivariate analysis, were calculated in order to determine the risk of belonging to the first versus the second to the fourth quartiles in SGA-born and AGA-born individuals.

Results

Intakes of SGA-born adults indicated that they consumed more meat, sugar and less fish than AGA-born individuals (all p<0.05). Multivariate analyses with adjustment for age and sex showed that the relative risk of belonging to the first quartile versus the other three quartiles did not disclose any significant difference in SGA-born versus AGA-born participants: RR=0.92 (95% CI 0.65 to 1.30).

Conclusions

Aside from the differences found by univariate analyses, no significant differences were obtained in multivariate analyses. Findings suggest that parameters of fetal programming are more associated with the development of metabolic syndrome in adulthood rather than dietary patterns.

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Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa

Objectives

South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa.

Design

A cross-sectional analytical study.

Setting

Primary healthcare setting in OR Tambo district, South Africa.

Participants

Patients treated for T2DM for 1 or more years (n=327).

Primary outcome measure

Prevalence of uncontrolled T2DM.

Secondary outcome measure

Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%).

Results

Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c.

Conclusions

We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.

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Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

Objectives

Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients.

Setting/participants

We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention.

Primary and secondary outcome measures

Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies.

Results

After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2.

Conclusions

There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence was limited by their quality and size. Larger, better-designed trials in hospitalised adults are needed.

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Retrospective observational study to assess the clinical management and outcomes of hospitalised patients with complicated urinary tract infection in countries with high prevalence of multidrug resistant Gram-negative bacteria (RESCUING)

Introduction

The emergence of multidrug resistant (MDR) Gram-negative bacteria (GNB), including carbapenemase-producing strains, has become a major therapeutic challenge. These MDR isolates are often involved in complicated urinary tract infection (cUTI), and are associated with poor clinical outcomes. The study has been designed to gain insight into the epidemiology, clinical management, outcome and healthcare cost of patients with cUTI, especially in countries with high prevalence of MDR GNB.

Methods and analysis

This multinational and multicentre observational, retrospective study will identify cases from 1 January 2013 to 31 December 2014 in order to collect data on patients with cUTI as a cause of hospital admission, and patients who develop cUTI during their hospital stay. The primary end point will be treatment failure defined as the presence of any of the following criteria: (1) signs or symptoms of cUTI present at diagnosis that have not improved by days 5–7 with appropriate antibiotic therapy, (2) new cUTI-related symptoms that have developed within 30 days of diagnosis, (3) urine culture taken within 30 days of diagnosis, either during or after completion of therapy, that grows ≥10⁴ colony-forming unit/mL of the original pathogen and (4) death irrespective of cause within 30 days of the cUTI diagnosis.

Sample size

1000 patients afford a power of 0.83 (α=0.05) to detect an absolute difference of 10% in the treatment failure rate between MDR bacteria and other pathogens. This should allow for the introduction of about 20 independent risk factors (or their interaction) in a logistic regression model looking at risk factors for failure.

Ethics and dissemination

Approval will be sought from all relevant Research Ethics Committees. Publication of this study will be considered as a joint publication by the participating investigator leads, and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE).

Trial registration number

NCT02641015; Pre-results.

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Evaluation of a programme for 'Rapid Assessment of Febrile Travelers (RAFT): a clinic-based quality improvement initiative

Background

Fever in the returned traveller is a potential medical emergency warranting prompt attention to exclude life-threatening illnesses. However, prolonged evaluation in the emergency department (ED) may not be required for all patients. As a quality improvement initiative, we implemented an algorithm for rapid assessment of febrile travelers (RAFT) in an ambulatory setting.

Methods

Criteria for RAFT referral include: presentation to the ED, reported fever and travel to the tropics or subtropics within the past year. Exclusion criteria include Plasmodium falciparum malaria, and fulfilment of admission criteria such as unstable vital signs or significant laboratory derangements. We performed a time series analysis preimplementation and postimplementation, with primary outcome of wait time to tropical medicine consultation. Secondary outcomes included number of ED visits averted for repeat malaria testing, and algorithm adherence.

Results

From February 2014 to December 2015, 154 patients were seen in the RAFT clinic: 68 men and 86 women. Median age was 36 years (range 16–78 years). Mean time to RAFT clinic assessment was 1.2±0.07 days (range 0–4 days) postimplementation, compared to 5.4±1.8 days (range 0–26 days) prior to implementation (p<0.0001). The RAFT clinic averted 132 repeat malaria screens in the ED over the study period (average 6 per month). Common diagnoses were: traveller's diarrhoea (n=27, 17.5%), dengue (n=12, 8%), viral upper respiratory tract infection (n=11, 7%), chikungunya (n=10, 6.5%), laboratory-confirmed influenza (n=8, 5%) and lobar pneumonia (n=8, 5%).

Conclusions

In addition to provision of more timely care to ambulatory febrile returned travellers, we reduced ED bed-usage by providing an alternate setting for follow-up malaria screening, and treatment of infectious diseases manageable in an outpatient setting, but requiring specific therapy.

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Association between passive smoking and mental distress in adult never-smokers: a cross-sectional study

Objective

Many studies have suggested exposure to secondhand smoke (SHS) is a risk factor for various somatic diseases, but only few studies based on small sample size or specific groups have explored the association between passive smoking and mental distress. We performed this study to examine the relationship between passive smoking and mental distress in adult never-smokers of north-east China.

Methods

Multistage, stratified random cluster sampling design was used in this cross-sectional study in 2012. A total of 12 978 never-smokers from Jilin, north-east China, were included. Data on passive smoking and baseline characteristics were collected by face-to-face interviews. The 12-item General Health Questionnaire (GHQ-12) was used to measure mental health status. Rao-Scott ² tests were used to compare the prevalence between different groups; multivariable logistic regression was used to assess the association between passive smoking and mental distress, and Spearman rank analysis was employed to assess the correlation between passive smoking and GHQ-12 scores.

Results

The estimated prevalence of mental distress among never-smokers in Jilin province is 24.5%, and the estimated prevalence of passive smoking among the mental distressing group is 65.0%. After adjusting for gender, age, region, body mass index (BMI), occupation, marriage, education, drinking status and family monthly income per capita, passive smoking conferred a risk for mental distress (adjusted OR=1.26, 95% CI 1.13 to 1.40). A high proportion of adults, especially women, were passive smokers at home, but for men, passive smoking was more common at workplace. The more frequently participants exposed to SHS, the higher GHQ-12 scores they got.

Conclusions

Passive smoking is an important risk factor for mental distress in never-smokers of Jilin province, which reminds Chinese government of increasing the awareness of public health and take measure to prevent SHS, especially with regard to SHS exposure at home and workplace.

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Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement

Objectives

Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.

Methods

We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.

Results

72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.

Conclusions

There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.

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Assessing sex-differences and the effect of timing of vaccination on immunogenicity, reactogenicity and efficacy of vaccines in young children: study protocol for an individual participant data meta-analysis of randomised controlled trials

Introduction

Disease incidence differs between males and females for some infectious or inflammatory diseases. Sex-differences in immune responses to some vaccines have also been observed, mostly to viral vaccines in adults. Little evidence is available on whether sex-differences occur in response to immunisation in infancy even though this is the age group in which most vaccines are administered. Factors other than sex, such as timing or coadministration of other vaccines, can also influence the immune response to vaccination.

Methods and analysis

Individual participant data meta-analysis of randomised controlled trials of vaccines in healthy infants and young children will be conducted. Fully anonymised data from ~170 randomised controlled trials of vaccines for diphtheria, tetanus, Bordetella pertussis, polio, Haemophilus influenzae type B, hepatitis B, Streptococcus pneumoniae, Neisseria meningitidis, measles, mumps, rubella, varicella and rotavirus will be combined for analysis. Outcomes include measures of immunogenicity (immunoglobulins), reactogenicity, safety and disease-specific clinical efficacy. Data from trials of vaccines containing similar components will be combined in hierarchical models and the effect of sex and timing of vaccinations estimated for each outcome separately.

Ethics and dissemination

Systematic reviews of published estimates of sex-differences cannot adequately answer questions in this field since such comparisons are never the main purpose of a clinical trial, thus a large degree of reporting bias exists in the published literature. Recent improvements in the widespread availability of individual participant data from randomised controlled trials makes it feasible to conduct extensive individual participant data meta-analyses which were previously impossible, thereby reducing the effect of publication or reporting bias on the understanding of the infant immune response.

Preliminary results will be available in 2016 with final results available in 2019. No ethics review is required for secondary analyses of anonymised data.

http://ift.tt/2aygNrR

The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment

Objectives

To examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors.

Setting

Controlled laboratory environment with well-appointed, quiet rooms and video and audio equipment.

Participants

Clinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions.

Interventions

Participants engaged in one of three team tasks, and their performance was video-recorded and assessed.

Primary and secondary measures

Primary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants' individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted.

Results

At baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43).

Conclusions

Once clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals' or professions' characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.

http://ift.tt/2ayhzoq

IJMS, Vol. 17, Pages 1228: Urinary Dopamine as a Potential Index of the Transport Activity of Multidrug and Toxin Extrusion in the Kidney

Children, Vol. 3, Pages 12: Effects of Cardiorespiratory Fitness and Obesity on Salivary Secretory IgA and Alpha-Amylase in South African Children

This study examined whether cardiorespiratory fitness (CRF) and body composition are associated with salivary secretory immunoglobulin A (SIgA), a mucosal immunity marker, and salivary alpha-amylase (sAA), a marker of stress-related sympathetic nervous system (SNS) activity, in South African children. Morning (7:30–8:00 a.m.) saliva samples were collected from 132 children (10.05 ± 1.68 years old, 74 females, 58 males). Body composition, resting blood pressure, and predicted maximal aerobic capacity (VO2max) were determined, and SIgA and sAA were quantified. Obese children had significantly higher sAA compared with overweight and normal weight children (p < 0.01). SIgA secretion rate was significantly lower in obese and overweight vs. normal weight children (p < 0.01). Multiple-linear regression analysis revealed that body mass index (BMI) (p < 0.05) and diastolic blood pressure (DBP) (p < 0.05) were independent predictors of sAA with CRF acting as a mitigator. Age and BMI predicted SIgA secretion rate (p < 0.05) with BMI (p < 0.001) found to be an independent predictor of SIgA secretion rate. Obesity, based on BMI, was associated with elevated SNS activity and lowered mucosal immunity. CRF-mitigated sympathetic activation was not associated with mucosal immunity.

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Chemosensors, Vol. 4, Pages 13: Guanine Quadruplex Electrochemical Aptasensors

Guanine-rich nucleic acids are able to self-assemble into G-quadruplex four-stranded secondary structures, which are found at the level of telomeric regions of chromosomes, oncogene promoter sequences and other biologically-relevant regions of the genome. Due to their extraordinary stiffness and biological role, G-quadruples become relevant in areas ranging from structural biology to medicinal chemistry, supra-molecular chemistry, nanotechnology and biosensor technology. In addition to classical methodologies, such as circular dichroism, nuclear magnetic resonance or crystallography, electrochemical methods have been successfully used for the rapid detection of the conformational changes from single-strand to G-quadruplex. This review presents recent advances on the G-quadruplex electrochemical characterization and on the design and applications of G-quadruplex electrochemical biosensors, with special emphasis on the G-quadruplex aptasensors and hemin/G-quadruplex peroxidase-mimicking DNAzyme biosensors.

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IJMS, Vol. 17, Pages 1235: Biological Effect of a Hybrid Anticancer Agent Based on Kinase and Histone Deacetylase Inhibitors on Triple-Negative (MDA-MB231) Breast Cancer Cells

IJMS, Vol. 17, Pages 1238: Navicula sp. Sulfated Polysaccharide Gels Induced by Fe(III): Rheology and Microstructure

Nutrients, Vol. 8, Pages 468: Usual Intake of Key Minerals among Children in the Second Year of Life, NHANES 2003–2012

Iron, calcium, and zinc are important nutrients for the young, developing child. This study describes the usual intake of iron, calcium, and zinc among US children in the second year of life using two days of dietary intake data from the National Health and Nutrition Examination Survey 2003–2012. Estimates were calculated using PC-SIDE to account for within and between person variation. Mean usual iron, calcium, and zinc intakes were 9.5 mg/day, 1046 mg/day, and 7.1 mg/day, respectively. Over a quarter of children had usual iron intakes less than the Recommended Dietary Allowance (RDA) (26.1%). Eleven percent of children had usual calcium intakes below the RDA and over half of children had usual intakes of zinc that exceeded the tolerable upper intake level (UL). Two percent or less had usual intakes below the Estimated Average Requirement (EAR) for iron, calcium, and zinc. Our findings suggest that during 2003–2012, one in four children and one in ten children had usual intakes below the RDA for iron and calcium, respectively. Children who are not meeting their nutrient requirements could be at increased risk for developing deficiencies such as iron deficiency or could lead to a shortage in adequate nutrients required for growth and development. One in every two children is exceeding the UL for zinc, but the interpretation of these estimates should be done with caution given the limited data on adverse health outcomes. Continued monitoring of zinc intake and further assessment for the potential of adverse health outcomes associated with high zinc intakes may be needed.

http://ift.tt/2akSAni

Sensors, Vol. 16, Pages 1199: A Portable Real-Time Ringdown Breath Acetone Analyzer: Toward Potential Diabetic Screening and Management

Breath analysis has been considered a suitable tool to evaluate diseases of the respiratory system and those that involve metabolic changes, such as diabetes. Breath acetone has long been known as a biomarker for diabetes. However, the results from published data by far have been inconclusive regarding whether breath acetone is a reliable index of diabetic screening. Large variations exist among the results of different studies because there has been no "best-practice method" for breath-acetone measurements as a result of technical problems of sampling and analysis. In this mini-review, we update the current status of our development of a laser-based breath acetone analyzer toward real-time, one-line diabetic screening and a point-of-care instrument for diabetic management. An integrated standalone breath acetone analyzer based on the cavity ringdown spectroscopy technique has been developed. The instrument was validated by using the certificated gas chromatography-mass spectrometry. The linear fittings suggest that the obtained acetone concentrations via both methods are consistent. Breath samples from each individual subject under various conditions in total, 1257 breath samples were taken from 22 Type 1 diabetic (T1D) patients, 312 Type 2 diabetic (T2D) patients, which is one of the largest numbers of T2D subjects ever used in a single study, and 52 non-diabetic healthy subjects. Simultaneous blood glucose (BG) levels were also tested using a standard diabetic management BG meter. The mean breath acetone concentrations were determined to be 4.9 ± 16 ppm (22 T1D), and 1.5 ± 1.3 ppm (312 T2D), which are about 4.5 and 1.4 times of the one in the 42 non-diabetic healthy subjects, 1.1 ± 0.5 ppm, respectively. A preliminary quantitative correlation (R = 0.56, p < 0.05) between the mean individual breath acetone concentration and the mean individual BG levels does exist in 20 T1D subjects with no ketoacidosis. No direct correlation is observed in T1D subjects, T2D subjects, and healthy subjects. The results from a relatively large number of subjects tested indicate that an elevated mean breath acetone concentration exists in diabetic patients in general. Although many physiological parameters affect breath acetone, under a specifically controlled condition fast (<1 min) and portable breath acetone measurement can be used for screening abnormal metabolic status including diabetes, for point-of-care monitoring status of ketone bodies which have the signature smell of breath acetone, and for breath acetone related clinical studies requiring a large number of tests.

http://ift.tt/2ajZc28

Cancers, Vol. 8, Pages 72: Human Papillomavirus Genotype Distribution in Invasive Cervical Cancer in Pakistan

Few studies have assessed the burden of human papillomavirus (HPV) infection in Pakistan. We aim to provide specific information on HPV-type distribution in invasive cervical cancer (ICC) in the country. A total of 280 formalin-fixed paraffin-embedded tissue blocks were consecutively selected from Shaukat Khanum Memorial Cancer Hospital and Research Centre (Lahore, Pakistan). HPV-DNA was detected by SPF10 broad-spectrum PCR followed by DNA enzyme immunoassay and genotyping by LiPA25. HPV-DNA prevalence was 87.5% (95%CI: 83.0–91.1), with 96.1% of cases histologically classified as squamous cell carcinoma. Most of the HPV-DNA positive cases presented single infections (95.9%). HPV16 was the most common type followed by HPV18 and 45. Among HPV-DNA positive, a significantly higher contribution of HPV16/18 was detected in Pakistan (78.4%; 72.7–83.3), compared to Asia (71.6%; 69.9–73.4) and worldwide (70.8%; 69.9–71.8) and a lower contribution of HPVs31/33/45/52/58 (11.1%; 7.9–15.7 vs. 19.8%; 18.3–21.3 and 18.5%; 17.7–19.3). HPV18 or HPV45 positive ICC cases were significantly younger than cases infected by HPV16 (mean age: 43.3, 44.4, 50.5 years, respectively). A routine cervical cancer screening and HPV vaccination program does not yet exist in Pakistan; however, the country could benefit from national integrated efforts for cervical cancer prevention and control. Calculated estimations based on our results show that current HPV vaccine could potentially prevent new ICC cases.

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Little Leaguer's Shoulder - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the condition of little leaguer's shoulder.

Become a friend on facebook:
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Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC

Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
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https://www.youtube.com/watch?v=2UNvuAf28VM

Ultrasensitive Fluorescent Probes Reveal an Adverse Action of Dipeptide Peptidase IV and Fibroblast Activation Protein during Proliferation of Cancer Cells

TOC Graphic

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b02231

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CCL2, CCL5, IL4 and IL15 Gene Polymorphisms in Women with Gestational Diabetes Mellitus

Horm Metab Res
DOI: 10.1055/s-0042-111436

Gestational diabetes mellitus (GDM) is a glucose intolerance that occurs during pregnancy. Several studies suggest that inflammation contributes to pregnancy-induced insulin resistance and the development of glucose intolerance. The aim of this study is to examine the association between the CCL2, CCL5, IL4 and IL15 gene polymorphisms and the development of GDM. This study included 411 pregnant women who underwent a 75 g oral glucose tolerance test at 24–28 weeks of gestation. Participants were categorised into 2 groups according to results of the oral glucose tolerance test (OGTT). The GDM group included 204 pregnant women who were diagnosed with GDM. The normal glucose tolerance group included 207 pregnant women with normal values in the OGTT. To discriminate the CCL2 rs1024611 and rs4586, CCL5 rs2107538, IL4 rs2243250, IL15 rs2857261 and rs2254514 alleles, TaqMan® Pre-Designed SNP Genotyping Assays were used. GDM was significantly associated with genotypes and alleles of the CCL2 rs1024611 and rs4586 polymorphisms, while there was no statistically significant association between the CCL5 rs2107538, IL4 rs2243250, IL15 rs2857261, and rs2254514 gene polymorphisms and GDM. In a multivariate regression analysis, age and BMI before pregnancy were independent significant predictors of a higher risk of GDM, while a lower number of G alleles CCL2 rs1024611 was protective against GDM. Moreover, women with the GG CCL2 rs1024611 and CC rs4586 genotype tended to have lower body mass and BMI increases during pregnancy, as well as lower newborn body mass. The results of our study suggest an association between CCL2 gene polymorphisms and GDM.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Second Trimester Fetal and Maternal Epicardial Fat Thickness in Gestational Diabetic Pregnancies

Horm Metab Res
DOI: 10.1055/s-0042-111435

Our aim was to evaluate the association between gestational diabetes mellitus and sonographically measured fetal epicardial fat thickness between 24–28 weeks' gestation. This was a cross-sectional study that included 40 pregnancies with gestational diabetes mellitus, matched with 40 normal pregnancies with similar maternal age, body-mass index, gestational age, fetal gender, and fetal abdominal circumference on ultrasound. Fetal epicardial fat thickness was measured and recorded during ultrasonography at 24–28 weeks of gestation. Maternal evaluation included measurement of maternal epicardial fat thickness, using echocardiography. Fetal and maternal epicardial fat thickness values were compared across the groups. Ultrasound views of fetal epicardial fat thickness were evaluated independently by 3 perinatology fellows to determine inter- and intra-observer variability. Partial and intraclass correlation analyses were used. Fetal and maternal epicardial fat thickness measurements were moderately correlated (r=0.63). Mean fetal and maternal epicardial fat thickness values were higher in gestational diabetes mellitus pregnancies (p=0.004 and p<0.0001, respectively) compared to controls. Fetal epicardial fat thickness was positively correlated (r=0.43) with postchallenge 2-h glucose values. Inter- and intra-observer agreement was high, demonstrated by strong correlations (r=0.99 and r=0.99, respectively) across fetal epicardial fat thickness measurements of the examiners. Fetuses from gestational diabetes mellitus pregnancies have significantly higher fetal and maternal epicardial fat thickness values compared to nongestational diabetes mellitus pregnancies. Fetal epicardial fat thickness obtained during second trimester fetal anatomy ultrasound may potentially be a reliable indicator for gestational diabetes mellitus. However, clinical validation studies are needed.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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