Salud en el horizonte tardío: pastores y agricultores de pueblo viejo-Pucará y Huamanmarca (Perú)

Biological markers considered as nonspecific indicators of “stress” were used to evaluate the health and nutritional status of two Andean settlements of the Late Horizon (1430-1532 AD.) from the coast and highland of Lima, Pueblo ViejoPucara and Huamanmarca respectively. A total of nine dental and health indicators were measured: enamel hypoplasia (LEH), carious lesions, tooth wear, dental calculus, criba orbitalia, porotic and trauma. The results indicate that in both the likelihood of a disease linked to one of the biological markers like periostitis, anaemia or infectious diseases, was low, enjoying many of the inhabitants a good health status. However, the difference in the percentage of cases affected in both varied markedly between one sector and another, showing a direct between the frequency of an indicator of nonspecific stress and (a) the social status, (b) the sector of origin, and (c) the of an occupational activity of its inhabitants.Marcadores biológicos considerados indicadores de estrés no específico se usaron para evaluar el estatus de salud y nutricional de dos asentamientos andinos del Horizonte Tardío (1430-1532 DC.) procedentes de la costa y sierra de Lima, Pueblo Viejo-Pucará y Huamanmarca respectivamente. Un total de nueve indicadores dentales y óseos fueron medidos: hipoplasia de esmalte (LEH), caries dental, desgaste oclusodental, sarro dental, hipercementosis, criba orbitalia, hiperostosis porótica, periostitis y trauma óseo. Los resultados sugieren que en ambas comunidades la propensión a padecer enfermedades vinculadas a los marcadores biológicos tales como periostitis, anemia o infecciosas fue baja, gozando gran parte de sus pobladores de un buen estado de salud. Sin embargo, en ambas poblaciones arqueológicas la diferencia en el porcentaje de casos afectados varió significativamente entre un sector residencial y otro, observándose una estrecha relación entre la frecuencia de un indicador de estrés óseo y dental, y (a) el estatus social, (b) el sector de procedencia, y (c) la actividad ocupacional de sus habitantes

Adipose Inflammation and Macrophage Infiltration After Binge Ethanol and Burn Injury

Ethanol exposure prior to traumatic injury, such as a burn, elevates systemic and local inflammatory responses and increases morbidity and mortality. Adipose is a large tissue mass that is often inflamed during obesity or other stresses which disturbs metabolic homeostasis. To date, there has been little investigation into the inflammatory response of adipose tissue after combined ethanol exposure and burn injury

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

<p>Abstract</p> <p>Background</p> <p>Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows.</p> <p>Methods</p> <p>Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex.</p> <p>Results</p> <p>Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1^st(7.4 μg/m³) to the 25^th(17.2 μg/m³), 50^th(33.8 μg/m³), 75^th(108.3 μg/m³), and 90^th(180.8 μg/m³) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage.</p> <p>Conclusions</p> <p>The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.</p

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A pernicious sort of woman : quasi-religious women and canon lawyers in the later Middle Ages /

Includes bibliographical references (p. 151-160) and index.Academic commentary : lawyers interpret the law -- Consilia, and decisiones : practical application of legal theory -- Assessment and reassessment

Large-Scale Cryosectioning Technique Allows in Vitro Correlation of Magnetic Resonance Imaging and Gross Histologic Findings in the Wrist

To enhance the usefulness of magnetic resonance imaging (MRI) in the clinical assessment of wrist joint pathology, we correlated findings from consecutive MRIs of cadaver wrists with findings from gross histologic sections of these wrists, using the sections as the standard of reference. The study required a sectioning technique that allowed preparation of large-scale sections closely matching corresponding MRIs in size and sectioning plane. We adapted a large-scale cryosectioning technique for undecalcified bone, previously described in the literature, to our study of 16 formalin fixed cadaver wrists. After subjecting each wrist to MR imaging with a wrist coil, we cryosectioned the entire wrist joint, from the distal ulna and radius to the proximal metacarpals, in the frontal plane, which corresponded to the MR images. The cryostat's tissue stage was mounted on a ball and socket-like joint that allowed corrections of the sectioning plane, enabling us to obtain sections in a plane closely resembling the corresponding MRIs. We stained the cryosections by a safranin-O fast green method modified to minimize hydration. When cryosections whose portions detached from the slide during staining were eliminated, morphologic comparison of the remaining coverslipped sections with photos of the corresponding tissue block surface taken before sectioning revealed that the sections were accurate representations of the wrist. The sections were deemed suitable as a standard of reference for comparison of the corresponding MRIs. The large-scale sectioning technique and modified staining method can be used in further comparison studies aimed at refining MRI techniques to permit greater differentiation of joint structures on the MRI. (The J Histotechnol. 21:225-229, 1998