Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Priming food intake with weight control cues: systematic review with a meta-analysis

Background A growing number of studies suggest that exposure to cues which are associated with weight control can prime or prompt controlled food intake in tempting food environments. However, findings are mixed and understanding which types of cues and for whom such cues may be most effective is needed to inform subsequent research and societal applications. A systematic review and meta-analysis were conducted to evaluate the effects of exposure to weight control cues compared with control cues on food intake. Methods PsycINFO, Medline, Embase and Web of Science were searched using key terms. Hedge’s g was used to calculate effect sizes based on mean food intake, standard deviations and sample sizes extracted from relevant publications and, a random effects model was used for the meta-analysis. Results Twenty-five articles consisting of 26 studies were eligible. Data from 25 studies (31 effect sizes) were available for the meta-analysis. Overall, weight control cues reduced food intake, albeit to a trivial effect (ES: -0.149, 95% CI: -0.271 to − 0.027). Subgroup analyses when studies which induced negative affect were removed showed that for individuals with strong weight control goals the effect was small-to-moderate (ES: -0.440, 95% CI: -0.718 to − 0.163), whereas for individuals with weak weight control goals this effect was trivial and non-significant (ES: 0.014, 95% CI: -0.249 to 0.278). Cue type and level of engagement did not significantly moderate the effect; however, specific cues (low-calorie foods and thin models) and attended engagement yielded significant effects. Caution is needed interpreting these findings as most studies were rated with high risk of bias and a number of studies could not be included in the subgroup analyses. Conclusions Based on the data available, weight control cues reduce food intake in individuals with strong weight control goals. Further research is needed to explore longer term effects of cue exposure and confirm underlying mechanisms. PROSPERO registry#CRD42016052396

Grader agreement, and sensitivity and specificity of digital photography in a community optometry-based diabetic eye screening program

Luckni Sellahewa,1,2 Craig Simpson,2 Prema Maharajan,2 John Duffy,2 Iskandar Idris3 1Diabetic Medicine Department, Nottingham University Hospitals, 2North Nottinghamshire Eye Screening Service, Sherwood Forest Hospitals Foundation Trust, 3Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK Background: Digital retinal photography with mydriasis is the preferred modality for diabetes eye screening. The purpose of this study was to evaluate agreement in grading levels between primary and secondary graders and to calculate their sensitivity and specificity for identifying sight-threatening disease in an optometry-based retinopathy screening program.Methods: This was a retrospective study using data from 8,977&nbsp;patients registered in the North Nottinghamshire retinal screening program. In all cases, the ophthalmology diagnosis was used as the arbitrator and considered to be the gold standard. Kappa statistics were used to evaluate the level of agreement between graders.Results: Agreement between primary and secondary graders was 51.4% and 79.7% for detecting no retinopathy (R0) and background retinopathy (R1), respectively. For preproliferative (R2) and proliferative retinopathy (R3) at primary grading, agreement between the primary and secondary grader was 100%. Where there was disagreement between the primary and secondary grader for R1, only 2.6% (n=41) were upgraded by an ophthalmologist. The sensitivity and specificity for detecting R3&nbsp;was 78.2% and 98.1%, respectively. None of the patients upgraded from any level of retinopathy to R3&nbsp;required photocoagulation therapy. The observed kappa between the primary and secondary grader was 0.3223&nbsp;(95% confidence interval 0.2937&ndash;0.3509), ie, fair agreement, and between the primary grader and ophthalmology for R3&nbsp;was 0.5667&nbsp;(95% confidence interval 0.4557&ndash;0.6123), ie, moderate agreement. Conclusion: These data provide information on the safety of a community optometry-based retinal screening program for screening as a primary and as a secondary grader. The level of agreement between the primary and secondary grader at a higher level of retinopathy (R2&nbsp;and R3) was 100%. Sensitivity and specificity for R3&nbsp;were 78.2% and 98.1%, respectively. None of the false-negative results required photocoagulation therapy. Keywords: retinopathy, screening, public health, community, optometry, diabete

Stimulation of lactate production in human granulosa cells by metformin and potential involvement of adenosine 5' monophosphate-activated protein kinase

Context: production of 3-carbon units (as lactate) by granulosa cells (GCs) is important in follicular and oocyte development and may be modulated by metformin.Objective: the aim of the study was to examine the action of metformin on GC lactate production and potential mediation via AMP-activated protein kinase (AMPK).Design: GCs were prepared from follicular aspirates. After exposure to metformin and other potential modulators of AMPK in culture, aspects of cellular function were examined.Setting: the study was conducted in a private fertility clinic/university academic center.Patients: women undergoing routine in vitro fertilization participated in the study.Interventions: all agents were added in culture.Main outcome measures: lactate output of GCs was measured. Cell extracts were prepared after culture, and phosphorylated forms of AMPK and acetyl CoA carboxylase (ACC) were assayed using Western analysis.Results: metformin led to a rapid increase in lactate production by GCs [minimum effective dose, 250 mu M; maximum dose studied, 1 mM (1.22-fold; P &lt; 0.01)]. This dose range of metformin was similar to that required for stimulation of phospho-AMPK in GCs [minimum effective dose, 250 mu M; maximum effect, 500 mu M (2.01-fold; P &lt; 0.001)]. Increasing phospho-ACC, as a representative downstream target regulated by AMPK, was apparent over a lower range (minimum effective dose, 31 mu M; maximum effect, 250 mu M; P &lt; 0.001). A level of metformin (125 mu M) insufficient for the stimulation of lactate output when used alone potentiated the effects of suboptimal doses of insulin on lactate production. Adiponectin (2.5 mu g/ml) had a small but significant effect on lactate output.Conclusions: metformin activates AMPK in GCs, stimulating lactate production and increasing phospho-ACC. Metformin also enhances the action of suboptimal insulin concentrations to stimulate lactate production. (J Clin Endocrinol Metab 94: 670-677, 2009<br/

The role of food science and technology in humanitarian response

Background: In humanitarian contexts, ensuring access to safe, nutritious, good quality and culturally appropriate food in the right quantity at the right time and place during an emergency or a protracted crisis is an enormous challenge, which is likely to increase given uncertainties such as climate change, global political and economic instability and emerging pandemics like COVID-19. Several international organizations and non-government organizations have well established systems to respond to food security emergencies. However, the role of food science and technology in humanitarian response is not well understood and is seldom considered in humanitarian circles. Scope and approach: The role of food science and technology in humanitarian response and the importance of addressing the requirements of the local consumers within the local food systems are discussed. Key findings and conclusions: Humanitarian food aid policies focus on immediate and short-term assistance to save lives. The implementation of emergency programs and projects tends to induce dependency on aid, rather than strengthening local food systems and ensuring resilience. Transformative change must embrace innovation across the whole food system with an increased emphasis on food science and technology that addresses local food security, generates employment and contributes to the local economy. There needs to be a move beyond rehabilitating and increasing agricultural production to addressing the whole food system with a view to link humanitarian assistance and longer-term support to sustainable livelihoods and resilience