What's the best treatment for gestational diabetes?

There is no single approach to glycemic control that is better than another for reducing neonatal mortality and morbidity. Glycemic control--regardless of whether it involves diet, glyburide, or insulin--leads to fewer cases of shoulder dystocia, hyperbilirubinemia requiring phototherapy, nerve palsy, bone fracture, being large for gestational age, and fetal macrosomia (strength of recommendation: A)

Cathepsin S Signals via PAR2 and Generates a Novel Tethered Ligand Receptor Agonist

Protease-activated receptor-2 is widely expressed in mammalian epithelial, immune and neural tissues. Cleavage of PAR2 by serine proteases leads to self-activation of the receptor by the tethered ligand SLIGRL. The contribution of other classes of proteases to PAR activation has not been studied in detail. Cathepsin S is a widely expressed cysteine protease that is upregulated in inflammatory conditions. It has been suggested that cathepsin S activates PAR2. However, cathepsin S activation of PAR2 has not been demonstrated directly nor has the potential mechanism of activation been identified. We show that cathepsin S cleaves near the N-terminus of PAR2 to expose a novel tethered ligand, KVDGTS. The hexapeptide KVDGTS generates downstream signaling events specific to PAR2 but is weaker than SLIGRL. Mutation of the cathepsin S cleavage site prevents receptor activation by the protease while KVDGTS retains activity. In conclusion, the range of actions previously ascribed to cysteine cathepsins in general, and cathepsin S in particular, should be expanded to include molecular signaling. Such signaling may link together observations that had been attributed previously to PAR2 or cathepsin S individually. These interactions may contribute to inflammation

Studi Potensi Energi Listrik dari Tanaman Hia dengan Metode Plant Microbial Fuell Cell (P-MFC)

Daya yang dihasilkan dari ketiga jenis tanamn ini adalalah pot I yaitu kadaka (Asplenium nidus) sebesar 1.88 mW dan minimum sebesar 0.03 mW. Pot II yaitu tanaman Sri Rezki daya maksimum sebesar 3.41 mW dan minimum sebesar 0.46 mW. Pot III yaitu tanaman Lidah Mertua daya maksimum sebesar 3.47 mW dan daya minimum sebesar 0.07 mW. Penelitian ini dilakukan selama 15 hari dengan pengukuran 12 kali 24 jam. Hasil uji sifat setiap tanaman menunjukkan nilai yang berbeda-beda selama 15 hari waktu penelitian, hasil ini membuktikan bahwa jenis tanaman hias berpengaruh terhadap nilai arus, tegangan dan daya yang dihasilkan. Semakin cepat sistem pertumbuhan suatu tanaman maka proses fotosintesis tanaman juga semakin meningkat yang akan berdampak pada produksi elektron didalam tanah yang semakin baik dan energi yang dihasilkan dengan metode Plant Microbial Fuel Cell (P-MFC)

What's the best treatment for CIN 2 or 3?

Excision or ablation of the transformation zone are equally effective for treating an initial diagnosis of cervical intraepithelial neoplasia (CIN) grades 2 or 3 in women with a satisfactory colposcopy and no suggestion of microinvasive or invasive disease (strength of recommendation [SOR]: A, based on randomized controlled trials [RCTs])

PENERAPAN SKEPTISISME PROFESIONAL AUDITOR INTERNAL PEMERINTAH DALAM MENDETEKSI KECURANGAN (Studi Kasus pada Auditor Perwakilan BPKP Provinsi Jawa Tengah)

Penelitian ini bertujuan untuk mendeskripsikan penerapan skeptisisme profesional auditor internal pemerintah di Perwakilan BPKP Provinsi Jawa Tengah dalam mendeteksi kecurangan. Penerapan skeptisisme profesional akan dipahami berdasarkan karakteristik sikap yang membentuknya sebagaimana dinyatakan oleh Hurtt (2010) antara lain questioning mind, suspension on judgment, search for knowledge, interpesonal understanding, self-confidence, dan self-determination. Penelitian menggunakan pendekatan kualitatif dan mengacu pada proposisi teori. Pengumpulan data dilakukan dengan teknik wawancara kepada auditor investigasi dari setiap jabatan fungsional tim audit. Responden wawancara ditentukan dengan teknik purposive sampling yaitu auditor investigasi yang pernah menerima gugatan terkait hasil audit. Hasil penelitian menunjukkan bahwa auditor investigasi Perwakilan BPKP Provinsi Jawa Tengah memiliki pemahaman yang memadai terkait skeptisisme profesional. Auditor investigasi Perwakilan BPKP Provinsi Jawa Tengah juga telah menerapkan skeptisisme profesional dalam mendeteksi kecurangan. Kata Kunci: skeptisisme profesional, auditor internal pemerintah, deteksi kecuranga

Social determinants of health in the setting of hypertrophic cardiomyopathy.

Social determinants of health play an important role in explaining poor health outcomes across many chronic disease states. The impact of the social gradient in the setting of an inherited heart disease, hypertrophic cardiomyopathy (HCM), has not been investigated. This study sought to profile the socioeconomic status of patients attending a specialized multidisciplinary clinic and to determine the impact on clinical factors, psychosocial wellbeing and adherence to medical advice

Cathepsin S Signals via PAR2 and Generates a Novel Tethered Ligand Receptor Agonist

Abstract Protease-activated receptor-2 is widely expressed in mammalian epithelial, immune and neural tissues. Cleavage of PAR2 by serine proteases leads to self-activation of the receptor by the tethered ligand SLIGRL. The contribution of other classes of proteases to PAR activation has not been studied in detail. Cathepsin S is a widely expressed cysteine protease that is upregulated in inflammatory conditions. It has been suggested that cathepsin S activates PAR2. However, cathepsin S activation of PAR2 has not been demonstrated directly nor has the potential mechanism of activation been identified. We show that cathepsin S cleaves near the N-terminus of PAR2 to expose a novel tethered ligand, KVDGTS. The hexapeptide KVDGTS generates downstream signaling events specific to PAR2 but is weaker than SLIGRL. Mutation of the cathepsin S cleavage site prevents receptor activation by the protease while KVDGTS retains activity. In conclusion, the range of actions previously ascribed to cysteine cathepsins in general, and cathepsin S in particular, should be expanded to include molecular signaling. Such signaling may link together observations that had been attributed previously to PAR2 or cathepsin S individually. These interactions may contribute to inflammation

Systemic Racism and Health Disparities: A Statement from Editors of Family Medicine Journals

The year 2020 has been marked by historic protests across the United States and the globe sparked by the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, and so many other Black people. The protests heightened awareness of racism as a public health crisis and triggered an antiracism movement. The editors of several North American family medicine publications have come together to address this call to action and share resources on racism across our readerships.http://deepblue.lib.umich.edu/bitstream/2027.42/163331/1/Final Statement on Systemic Racism- with acknowledgements.pdf-1Description of Final Statement on Systemic Racism- with acknowledgements.pdf : Main ArticleSEL

Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide

Cytokine release syndrome (CRS) represents a life-threatening side effect after haploidentical stem cell transplantation (Haplo-SCT) with posttransplant cyclophosphamide (PT-Cy). Factors predictive of CRS development is still a matter of debate. We retrospectively analyzed 102 consecutive patients receiving a bone marrow (BM) (n = 42) or peripheral blood stem cells (PBSC) (n = 60) Haplo-SCT with PT-Cy. The two cohorts were similar in main patients' characteristics besides disease type (P = .02). Cumulative incidence of grades 1, 2, and 653 CRS was 80%, 52%, and 15% at a median of 2, 4, and 7 days, respectively. Moderate/High-grade fever (39\ub0-41\ub0), grade 1 and grade 653 CRS occurred more frequently after PBSC relative to BM grafts (68% vs 33%, P = .0005; 87% vs 71%, P = .009; 20% vs 7%, P = .07). Only patients experiencing grade 653 CRS had a worse outcome in terms of 1-year overall survival (OS) and nonrelapse mortality (NRM): 39% vs 80% (P = .002) and 40% vs 8% (P = .005), respectively. By univariate analysis the only factors associated with the increased risk of 653 CRS were pretransplant disease status (8% for complete remission, 11% for partial remission, and 38% for active disease, P = .002), HLA-DRB1 mismatching (57% vs 14%, P = .007), and PBSC graft (P = .07). By multivariable analysis, only pretransplant disease status (hazard ratio, HR: 6.84, P = .005) and HLA-DRB1 mismatching (HR: 17.19, P = .003) remained independent predictors of grade 653 CRS. Only grade 653 CRS is clinically relevant for the final outcome of patients receiving Haplo-SCT with PT-Cy, is more frequent after a PBSC graft and is associated with pretransplant active disease and HLA-DRB1 mismatching