Obesity, Type 2 Diabetes and Bone in Adults.

In an increasingly obese and ageing population, type 2 diabetes (T2DM) and osteoporotic fracture are major public health concerns. Understanding how obesity and type 2 diabetes modulate fracture risk is important to identify and treat people at risk of fracture. Additionally, the study of the mechanisms of action of obesity and T2DM on bone has already offered insights that may be applicable to osteoporosis in the general population. Most available evidence indicates lower risk of proximal femur and vertebral fracture in obese adults. However the risk of some fractures (proximal humerus, femur and ankle) is higher, and a significant number fractures occur in obese people. BMI is positively associated with BMD and the mechanisms of this association in vivo may include increased loading, adipokines such as leptin, and higher aromatase activity. However, some fat depots could have negative effects on bone; cytokines from visceral fat are pro-resorptive and high intramuscular fat content is associated with poorer muscle function, attenuating loading effects and increasing falls risk. T2DM is also associated with higher bone mineral density (BMD), but increased overall and hip fracture risk. There are some similarities between bone in obesity and T2DM, but T2DM seems to have additional harmful effects and emerging evidence suggests that glycation of collagen may be an important factor. Higher BMD but higher fracture risk presents challenges in fracture prediction in obesity and T2DM. Dual energy X-ray absorptiometry underestimates risk, standard clinical risk factors may not capture all relevant information, and risk is under-recognised by clinicians. However, the limited available evidence suggests that osteoporosis treatment does reduce fracture risk in obesity and T2DM with generally similar efficacy to other patients

Protein concentration and composition in wheat flour mill streams

Protein concentration and composition varies in different part of the wheat grain and also in different mill streams. This investigation aimed at determining protein concentration, composition and disulfide crosslinkings in different wheat flour mill streams. Flour mill streams were obtained by milling grains of two Slovakian bread wheat cultivars in a Brabender Quadromat Senior test mill. Protein concentration, amount of protein groups, amount and size distribution of polymeric and monomeric proteins, free thiol groups and disulfide crosslinkings were measured. The results showed that the break flour contained high amounts of gliadins and glutenin subunits, SDS-extractable large polymeric proteins and disulfide crosslinkings. The shorts contained high amounts of SDS-extractable and SDS-unextractable smaller monomeric proteins, SDS-unextractable larger monomeric proteins and free thiol groups. The bran contained high protein concentration, high amounts of high-molecular-weight glutenin subunits, SDS-extractable and SDS-unextractable smaller monomeric proteins and SDS-unextractable larger monomeric proteins

Economic analysis of complementary, alternative, and integrative medicine: considerations raised by an expert panel

BACKGROUND: An international panel of experts was convened to examine the challenges faced in conducting economic analyses of Complementary, Alternative and Integrative Medicine (CAIM). METHODS: A one and a half-day panel of experts was convened in early 2011 to discuss what was needed to bring about robust economic analysis of CAIM. The goals of the expert panel were to review the current state of the science of economic evaluations in health, and to discuss the issues involved in applying these methods to CAIM, recognizing its unique characteristics. The panel proceedings were audiotaped and a thematic analysis was conducted independently by two researchers. The results were then discussed and differences resolved. This manuscript summarizes the discussions held by the panel members on each theme. RESULTS: The panel identified seven major themes regarding economic evaluation that are particularly salient to determining the economics of CAIM: standardization (in order to compare CAIM with conventional therapies, the same basic economic evaluation methods and framework must be used); identifying the question being asked, the audience targeted for the results and whose perspective is being used (e.g., the patient perspective is especially relevant to CAIM because of the high level of self-referral and out-of-pocket payment); the analytic methods to be used (e.g., the importance of treatment description and fidelity); the outcomes to be measured (e.g., it is important to consider a broad range of outcomes, particularly for CAIM therapies, which often treat the whole person rather than a specific symptom or disease); costs (e.g., again because of treating the whole person, the impact of CAIM on overall healthcare costs, rather than only disease-specific costs, should be measured); implementation (e.g., highlighting studies where CAIM allows cost savings may help offset its image as an “add on” cost); and generalizability (e.g., proper reporting can enable study results to be useful beyond the study sample). CONCLUSIONS: The business case for CAIM depends on economic analysis and standard methods for conducting such economic evaluations exist. The challenge for CAIM lies in appropriately applying these methods. The deliberations of this panel provide a list of factors to be considered in meeting that challenge

Structured illumination microscopy using a photonic chip

Structured illumination microscopy (SIM) enables live-cell super-resolution imaging of subcellular structures at high speeds. At present, linear SIM uses free-space optics to illuminate the sample with the desired light patterns; however, such arrangements are prone to misalignment and add cost and complexity to the microscope. Here, we present an alternative photonic chip-based two-dimensional SIM approach (cSIM) in which the conventional glass sample slide in a microscope is replaced by a planar photonic chip that importantly both holds and illuminates the specimen. The photonic chip reduces the footprint of the light illumination path of SIM to around 4 × 4 cm2. An array of optical waveguides on the chip creates standing wave interference patterns at different angles, which illuminate the sample via evanescent fields. High-refractive-index silicon nitride waveguides allow a 2.3 times enhancement in imaging spatial resolution, exceeding the usual 2 times limit of SIM. In summary, cSIM offers a simple, stable and affordable approach for performing two-dimensional super-resolution imaging over a large field of view

Chip-based wide field-of-view nanoscopy

Present optical nanoscopy techniques use a complex microscope for imaging and a simple glass slide to hold the sample. Here, we demonstrate the inverse: the use of a complex, but mass-producible optical chip, which hosts the sample and provides a waveguide for the illumination source, and a standard low-cost microscope to acquire super-resolved images via two different approaches. Waveguides composed of a material with high refractive-index contrast provide a strong evanescent field that is used for single-molecule switching and fluorescence excitation, thus enabling chip-based single-molecule localization microscopy. Additionally, multimode interference patterns induce spatial fluorescence intensity variations that enable fluctuation-based super-resolution imaging. As chip-based nanoscopy separates the illumination and detection light paths, total-internal-reflection fluorescence excitation is possible over a large field of view, with up to 0.5 mm × 0.5 mm being demonstrated. Using multicolour chip-based nanoscopy, we visualize fenestrations in liver sinusoidal endothelial cells