Morbidity, Including Fatal Morbidity, throughout Life in Men Entering Adult Life as Obese

Background: The association between obesity in adults and excess morbidity and mortality is well established, but the health impact throughout adult life of being obese in early adulthood needs elucidation. We investigated somatic morbidity, including fatal morbidity, throughout adulthood in men starting adult life as obese. Methods: Among 362,200 Danish young men, examined for military service between 1943 and 1977, all obese (defined as BMI$31.0 kg/m 2), and, as controls, a random 1 % sample of the others was identified. In the age range of 18–25 years, there were 1,862 obese, which encompass the men above the 99.5 percentile, and 3,476 controls. Information on morbidity was obtained via national registers. Cox regression models were used to estimate the relative morbidity assessed as first incidence of disease, occurrence of disease in the year preceding death and prevalent disease at time of death. Results: From age 18 through 80 years the obese had an increased risk of becoming diseased by or die from a broad range of diseases. Generally, the incidence of first event, occurrence in the year prior to death, and prevalence at time of death showed the same pattern. As an example, the relative hazard of type 2 diabetes was constant throughout life at 4.9 (95% confidence intervals [CI]: 4.1–5.9), 5.2 (95 % CI: 3.6–7.5), and 6.8 (95 % CI: 4.6–10.1), respectively. Conclusions: Our findings strongly support the continued need to avoid beginning adult life as obese, as obese young me

Changes in energy expenditure associated with ingestion of high protein, high fat versus high protein, low fat meals among underweight, normal weight, and overweight females

Background: Metabolic rate is known to rise above basal levels after eating, especially following protein consumption. Yet, this postprandial rise in metabolism appears to vary among individuals. This study examined changes in energy expenditure in response to ingestion of a high protein, high fat (HPHF) meal versus an isocaloric high protein, low fat (HPLF) meal in underweight, normal weight, or overweight females (n = 21) aged 19–28 years. Methods: Energy expenditure, measured using indirect calorimetry, was assessed before and every 30 minutes for 3.5 hours following consumption of the meals on two separate occasions. Height and weight were measured using standard techniques. Body composition was measured using bioelectrical impedance analysis. Results: Significant positive correlations were found between body mass index (BMI) and baseline metabolic rate (MR) (r = 0.539; p = 0.017), between body weight and baseline MR (r = 0.567; p = 0.011), between BMI and average total change in MR (r = 0.591; p = 0.008), and between body weight and average total change in MR (r = 0.464; p = 0.045). Metabolic rate (kcal/min) was significantly higher in the overweight group than the normal weight group, which was significantly higher than the underweight group across all times and treatments. However, when metabolic rate was expressed per kg fat free mass (ffm), no significant difference was found in postprandial energy expenditure between the overweight and normal groups. Changes in MR (kcal/min and kcal/min/kg ffm) from the baseline rate did not significantly differ in the underweight (n = 3) or in the overweight subjects (n = 5) following consumption of either meal at any time. Changes in MR (kcal/min and kcal/min/kg ffm) from baseline were significantly higher in normal weight subjects (n = 11) across all times following consumption of the HPHF meal versus the HPLF meal. Conclusion: There is no diet-induced thermogenic advantage between the HPHF and HPLF meals in overweight and underweight subjects. In contrast, in normal weight subjects, ingestion of a HPHF meal significantly increases MR (69.3 kcal/3.5 hr) versus consumption of a HPLF meal and provides a short-term metabolic advantage

Wingless Signalling Alters the Levels, Subcellular Distribution and Dynamics of Armadillo and E-Cadherin in Third Instar Larval Wing Imaginal Discs

Background: Armadillo, the Drosophila orthologue of vertebrate beta-catenin, plays a dual role as the key effector of Wingless/Wnt1 signalling, and as a bridge between E-Cadherin and the actin cytoskeleton. In the absence of ligand, Armadillo is phosphorylated and targeted to the proteasome. Upon binding of Wg to its receptors, the "degradation complex'' is inhibited; Armadillo is stabilised and enters the nucleus to transcribe targets. Methodology/Principal Findings: Although the relationship between signalling and adhesion has been extensively studied, few in vivo data exist concerning how the "transcriptional'' and "adhesive'' pools of Armadillo are regulated to orchestrate development. We have therefore addressed how the subcellular distribution of Armadillo and its association with E-Cadherin change in larval wing imaginal discs, under wild type conditions and upon signalling. Using confocal microscopy, we show that Armadillo and E-Cadherin are spatio-temporally regulated during development, and that a punctate species becomes concentrated in a subapical compartment in response to Wingless. In order to further dissect this phenomenon, we overexpressed Armadillo mutants exhibiting different levels of activity and stability, but retaining E-Cadherin binding. Arm(S10) displaces endogenous Armadillo from the AJ and the basolateral membrane, while leaving E-Cadherin relatively undisturbed. Surprisingly, Delta NArm(1-155) caused displacement of both Armadillo and E-Cadherin, results supported by our novel method of quantification. However, only membrane-targeted Myr-Delta NArm(1-155) produced comparable nuclear accumulation of Armadillo and signalling to Arm(S10). These experiments also highlighted a row of cells at the A/P boundary depleted of E-Cadherin at the AJ, but containing actin. Conclusions/Significance: Taken together, our results provide in vivo evidence for a complex non-linear relationship between Armadillo levels, subcellular distribution and Wingless signalling. Moreover, this study highlights the importance of Armadillo in regulating the subcellular distribution of E-CadherinPublisher PDFPeer reviewe

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Determinants of Growth During Early Infancy

Growth velocity was studied in 161 well nourished infants of normal length during the first four months of life in relation to sex, birth size, genetic and pregnancy characteristics and nutritional factors, including feeding practice and introduction time of supplementary feeding (beikost). Prepregnancy weight of the mother and gestational age and weight gain during pregnancy were positively related to birth weight. Smoking habits of the mother were inversely related to birth weight. These relations remained significant after multiple regression analysis. Girls and breast-fed infants had a significantly lower energy intake at 4 months compared to boys and bottlefed infants. The main determinants of growth velocity were sex, birth weight, smoking habits of the mother and energy intake. Boys and infants of smoking mothers grew significantly faster than girls and infants of nonsmoking mothers. Birth weight was inversely related to growth velocity, and energy intake showed a positive association with growth velocity. The considered variables in a model of linear structural relationships accounted for 38% of the variance in birth weight and 24% of the variance in growth velocity

Unified Criterion for Clear‐Water Local Scour Induced by Junction Flows and Wall Jets

Local scour in a sediment bed varies depending on the type, size and shape of hydraulic structures, and the properties of approach flow and sediment particles. Published studies are hitherto confined primarily to empirical experiments based on particular types of hydraulic structure and there is almost no comparison of scour amongst different types of hydraulic structures. This study aims to provide an attempt to unify different types of clear-water scour based on a new length scale, which is proposed to characterize the size of the large-scale flow structure that governs scouring processes. The new length scale serves as a generalized hydraulic radius, which is applicable for all types of clear-water scour related to junction flows at bridge piers and abutments, and wall jets including culverts. The analysis indicates that when normalized with the new length scale, the equilibrium scour depths can be described with a unified function of the densimetric Froude number, regardless of different scour types. In addition, this study also shows that the proposed function varies with the scour efficiency, in a fashion resembling the bedload function in the range of low to high transport regimes. This finding, which is founded on solid physical grounds, reveals that different kinds of local scour phenomena can be interpreted in unison rather than based on the individual type of hydraulic structures.Published versionThe authors would gratefully acknowl-edge the financial support from the National Natural Science Foundation of China (Grant No. 51979242)

Benchmarking of Low-Field MR-Linacs in a Multi-Institutional International Consortium

Purpose: Recently, MR-linacs have been integrated into clinical practice, introducing new needs for QA and baseline machine characterization. This work summarizes a multi-institutional evaluation 12 low-field MR-linacs with the overarching goal of benchmarking machine performance. Methods: Acceptance and commissioning data were analyzed for 12 0.35 T ViewRay MRIdian linacs equipped with double-focused MLCs (4 mm aperture resolution). MRI-radiation isocenter accuracy was assessed. Couch transmission was measured at various beam angle incidences. Dosimetric evaluation included 6XFFF photon beam spot size, profiles, PDD curves, chamber-corrected Monte-Carlo derived relative photon OFs (0.83-25.6 cm2 field sizes), temporal output factor stability, and MLC transmission/leakage. End-to-end testing and IMRT performance were evaluated. MRI benchmarking included spatial integrity, magnetic field homogeneity (MFH) using spectral peak analysis (5-12 gantry angles), and image quality evaluation via ACR/NEMA standards. Clinical integration including QA timelines, staffing, and equipment were summarized. Results: MRI/laser/radiation isocenter coincidence was ≤0.8 mm for all MR-linacs. Couch transmission ranged from 13% to 17% (180° and 140°, respectively) requiring inclusion in treatment planning. Excellent agreement in PDD(10)x was observed (64.1 ± 0.4%) with spot sizes of 0.15 ± 0.03 mm. The largest discrepancy in corrected OFs was 0.72 ± 0.03 (0.83 cm2 field size) while all other OFs were in close agreement. Average output values within 2-18 months of initial calibration were \u3c1% of nominal; four institutions adjusted output at ∼90 days. On average, MLC transmission and leakage were \u3c0.3% and all IMRT plans were within 99% agreement of expected (3%/3 mm). MRI ACR and vendor-specified limits were met for all image quality metrics. Gantryangle dependence of MFH was observed (2.93 ± 1.82 ppm) with 3/12 institutions exceeding 5 ppm at a subset of angles, warranting a dynamic gantry angle-dependent shim. Conclusion: Overall, excellent agreement in multiinstitutional commissioning data was observed, providing important comparison data to others embarking on MR-linac commissioning

Vigilância nutricional em adultos: experiência de uma unidade de saúde atendendo população favelada Nutritional surveillance of adults: the experience of a health service for an urban slum population

O sistema de vigilância nutricional de adultos (idade > 20 anos), realizado no Centro de Saúde Escola Germano Sinval Faria (CSEGSF), registra diariamente dados de massa corporal (kg), estatura (m) e morbidades, além de dados sócio-econômicos de sua clientela, que são moradores de sete favelas da região de Manguinhos, RJ. Esse sistema tem como objetivo o controle permanente, a níveis individual e epidemiológico, da situação nutricional desta população. O presente trabalho apresenta dados relativos à demanda espontânea de 1.352 indivíduos (1.111 mulheres e 241 homens) maiores de 20 anos de idade atendidos entre agosto e dezembro de 1989. O estado nutricional (EN) foi determinado a partir do índice de massa corporal (IMC = kg.(m²)-1): baixo peso (BP; IMC < 20), normal (20 < IMC < 25), sobrepeso (SP; 25 < IMC < 30) e obeso (IMC > 30). A freqüência (%) do EN para mulheres e homens, respectivamente, foi: BP = 9,5 e 17,5; normal = 37,2 e 46,9; SP = 31,3 e 29,0; obesidade = 22,0 e 6,6. Estes dados demonstram que, nesta população ambulatorial de baixa renda, pelo menos 50% das mulheres apresentam SP. Os autores especulam que essa alta freqüência de SP pode estar relacionada com fatores alimentares, qualitativos e quantitativos, além da influência do número de gravidezes, e mais remotamente, a possibilidade de haver adaptação à baixa ingestão energética na infância. Com relação ao serviço, houve uma proposta de utilização de um nomograma para o cálculo do IMC pelos profissionais do Paisa (Programa de Atenção Integral a Saúde do Adulto), o que facilitará a implantação da vigilância nutricional no serviço.<br>The nutritional surveillance team of the Centro de Saúde Escola Germano Sinval Faria (CSEGSF) collects anthropometric (body mass and stature) as well as socioeconomic and morbidity data of low-income adults (age > 20 years) from seven slums in Manguinhos, Rio de Janeiro. This report presents data on 1352 people (1111 women and 241 men) seen between August and December 1989. Nutritional status (NS) was determined according to the value of body mass index (BMI = Kg.(m²)-1): underweight (UW; EMI < 20), normal (20 < BMI < 25), overweight (OW; 25 < BM < 30) and obesity (BMI > 30). The frequency (%) of NS was: UW = 9.5 e 17.5; normal = 37.2 and 46.9; OW = 31.3 e 29.0; obesity = 22.0 e 6.6 for women and men, respectively. These data indicate that among these low-income women at least 50% are OW. The authors speculate that this high frequency of OW may be associated not only with dietary intake (quality and quantity) but also with the number of pregnancies and maybe an adaptation to low energy intake during infancy. As far as the service is concerned, a nomogram to calculate BMI was introduced in the routine to be used by the professionals of the PA1SA (Adult Health Program)