Serum Fatty Acid Binding Protein 4 (FABP4) Predicts Pre-eclampsia in Women with Type 1 Diabetes

OBJECTIVE To examine the association between fatty acid binding protein 4 (FABP4) and pre-eclampsia risk in women with type 1 diabetes. RESEARCH DESIGN AND METHODS Serum FABP4 was measured in 710 women from the Diabetes and Pre-eclampsia Intervention Trial (DAPIT) in early pregnancy and in the second trimester (median 14 and 26 weeks’ gestation, respectively). RESULTS FABP4 was significantly elevated in early pregnancy (geometric mean 15.8 ng/mL [interquartile range 11.6–21.4] vs. 12.7 ng/mL [interquartile range 9.6–17]; P &amp;lt; 0.001) and the second trimester (18.8 ng/mL [interquartile range 13.6–25.8] vs. 14.6 ng/mL [interquartile range 10.8–19.7]; P &amp;lt; 0.001) in women in whom pre-eclampsia later developed. Elevated second-trimester FABP4 level was independently associated with pre-eclampsia (odds ratio 2.87 [95% CI 1.24–6.68], P = 0.03). The addition of FABP4 to established risk factors significantly improved net reclassification improvement at both time points and integrated discrimination improvement in the second trimester. CONCLUSIONS Increased second-trimester FABP4 independently predicted pre-eclampsia and significantly improved reclassification and discrimination. FABP4 shows potential as a novel biomarker for pre-eclampsia prediction in women with type 1 diabetes. </jats:sec

Changes of Hydration Measures in Elite National Collegiate Athletic Association Division I Wrestlers

Purpose: To evaluate the changes in the state of hydration in elite National Collegiate Athletic Association (NCAA) Division I college wrestlers during and after a season. Methods: Ohio State University wrestling team members (N = 6; mean [SD] age = 19.6 [1.1] y; height = 171.6 [2.9] cm; body mass = 69.5 [8.1] kg) gave informed consent to participate in the investigation with measurements (ie, body mass, urine-specific gravity [USG; 2 methods], Visual Analog Scale thirst scale, plasma osmolality) obtained during and after the season. Results: Measurements for USG, regardless of methods, were not significantly different between visits, but plasma osmolality was significantly (P = .001) higher at the beginning of the season—295.5 (4.9) mOsm·kg−1 compared with 279.6 (6.1) mOsm·kg−1 after the season. No changes in thirst ratings were observed, and the 2 measures of USG were highly correlated (r \u3e .9, P = .000) at each time point, but USG and plasma osmolality were not related. Conclusions: A paradox in the clinical interpretation of euhydration in the beginning of the season was observed with the USG, indicating that the wrestlers were properly hydrated, while the plasma osmolality showed they were not. Thus, the tracking of hydration status during the season is a concern when using only NCAA policies and procedures. The wrestlers did return to normal euhydration levels after the season on both biomarkers, which is remarkable, as previous studies have indicated that this may not happen because of the reregulation of the osmol-regulatory center in the brain

Cardiorespiratory Progression Over 5 Years and Role of Corticosteroids in Duchenne Muscular Dystrophy: A Single-Site Retrospective Longitudinal Study

Background: Duchenne muscular dystrophy (DMD) boys treated with corticosteroids (CS) have prolonged survival and respiratory function when compared to CS-naïve. /\ud Research question: The differential impact of frequently used corticosteroids and their regimens on long-term (>5 years) cardiorespiratory progression in DMD children is unknown. / Study Design and Methods: Retrospective longitudinal study including DMD children followed at Dubowitz Neuromuscular Centre (Great Ormond Street Hospital London), May 2000-June 2017. Patients enrolled in any interventional clinical trials were excluded. We collected patients’ anthropometrics, respiratory (forced vital capacity, FVC% predicted and absolute FVC, non-invasive ventilation requirement, NIV) and cardiac (left ventricular shortening function, LVFS%) function. CS-naïve patients had never received CS. CS-treated took either deflazacort or prednisolone, daily or intermittently (10 days on/10 days off) for >1 month. Average longitudinal models were fitted for yearly respiratory (FVC%P) and cardiac (LVFS%) progression. A time-to-event analysis to FVC%P<50%, NIV start and cardiomyopathy (LVFS<28%) was performed in CS-treated (daily and intermittent) vs CS-naïve patients. / Results: There were 270 patients, mean age at baseline 6.2 (±2.3) years. Median follow-up 5.6 (± 3.5) years. At baseline, 263 were ambulant. Sixty-six were CS-daily, 182 CS-intermittent >60% treatment, 22 CS-naïve. Yearly FVC%P declined similarly from 9 years (5.9% and 6.9%/year, p=0.27) in CS-daily and CS-intermittent. CS-daily declined from a higher FVC%P than CS-intermittent (p2 years later than CS-treated. LVFS% declined by 0.53%/year in CS-treated irrespective of CS regimen, significantly slower (p<0.01) than CS-naïve progressing by 1.17%/year. Age at cardiomyopathy was 16.6 in CS-treated (p<0.05) irrespective of regimen and 13.9 years in CS-naïve. / Interpretation: CS irrespective of their regimen significantly improved respiratory function and delayed NIV requirement and cardiomyopathy

Rationale and preclinical efficacy of a novel anti-EMP2 antibody for the treatment of invasive breast cancer

Despite significant advances in biology and medicine, the incidence and mortality due to breast cancer worldwide is still unacceptably high. Thus, there is an urgent need to discover new molecular targets. In this article, we show evidence for a novel target in human breast cancer, the tetraspan protein epithelial membrane protein-2 (EMP2). Using tissue tumor arrays, protein expression of EMP2 was measured and found to be minimal in normal mammary tissue, but it was upregulated in 63% of invasive breast cancer tumors and in 73% of triple-negative tumors tested. To test the hypothesis that EMP2 may be a suitable target for therapy, we constructed a fully human immunoglobulin G1 (IgG1) antibody specific for a conserved domain of human and murine EMP2. Treatment of breast cancer cells with the anti-EMP2 IgG1 significantly inhibited EMP2-mediated signaling, blocked FAK/Src signaling, inhibited invasion, and promoted apoptosis in vitro. In both human xenograft and syngeneic metastatic tumor monotherapy models, anti-EMP2 IgG1 retarded tumor growth without detectable systemic toxicity. This antitumor effect was, in part, attributable to a potent antibody-dependent cell-mediated cytotoxicity response as well as direct cytotoxicity induced by the monoclonal antibody. Together, these results identify EMP2 as a novel therapeutic target for invasive breast cancer.Fil: Fu, Maoyong. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Maresh , Erin L.. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Helguera, Gustavo Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina. Universidad de Buenos Aires; ArgentinaFil: Kiyohara, Meagan. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Qin, yu. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Ashki, Negin. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Daniels Wells, Tracy R.. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Aziz, Najib. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Gordon, Lynn K.. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Braun, Jonathan. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Elshimali, Yahya. Charles Drew University. Department of Pathology; Estados UnidosFil: Soslow, Robert A.. Memorial Sloan-Kettering Cancer Center. Department of Pathology; Estados UnidosFil: Penichet, Manuel L.. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Goodglick, Lee. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados UnidosFil: Wadehra, Madhuri. University of California Los Angeles. David Geffen School of Medicine at UCLA; Estados Unido

Relationships of Physical Performance Tests to Military-relevant Tasks in Women

Purpose: This investigation sought to determine the most predictive measures of performance on a repetitive box lifting task (RBLT) and load bearing task (LBT) among 123 women (aged 23±4 years, height 165±7 cm, body mass 64±10 kg). Methods: To determine the relationship of various predictors to performance on the RBLT and LBT, multiple regression analysis was conducted on body mass, height, leg cross-sectional area, upper and lower body muscular strength, lower body explosive power, upper and lower body local muscular endurance, and aerobic capacity. Results: The mean±SD (range) number of repetitions for the RBLT was 86±23 (20-159). The mean±SD (range) time to complete the LBT was 2,054±340 seconds (1,307-3,447). The following equations were generated: RBLT (number of repetitions)=57.4 + 0.2(peak jump power) + 0.4(number of pushups in 2 minutes) + 0.15(number of repetitions during the squat endurance test) + 1.39(one repetition maximal strength boxlift (kg)) – 0.04(2-mile run time (2MR) in seconds), R=0.81; standard error of the estimate (SEE)=14; LBT (in seconds)=1,831 – 4.28(number of repetitions during the squat endurance test) + 0.95(2MR in seconds) – 13.4(body mass), R=0.73; SEE=232. Conclusions: We found that the 2MR and squat endurance test were signifi cant predictive factors for performance on both load carriage tasks. These data also imply that women’s performance in combat-related tasks can be improved with training that targets muscular strength, power, and local muscular endurance in addition to aerobic capacity

'Education, education, education' : legal, moral and clinical

This article brings together Professor Donald Nicolson's intellectual interest in professional legal ethics and his long-standing involvement with law clinics both as an advisor at the University of Cape Town and Director of the University of Bristol Law Clinic and the University of Strathclyde Law Clinic. In this article he looks at how legal education may help start this process of character development, arguing that the best means is through student involvement in voluntary law clinics. And here he builds upon his recent article which argues for voluntary, community service oriented law clinics over those which emphasise the education of students

Translating HbA1c measurements into estimated average glucose values in pregnant women with diabetes

Aims/hypothesis This study aimed to examine the relationship between average glucose levels, assessed by continuous glucose monitoring (CGM), and HbA1c levels in pregnant women with diabetes to determine whether calculations of standard estimated average glucose (eAG) levels from HbA1c measurements are applicable to pregnant women with diabetes. Methods CGM data from 117 pregnant women (89 women with type 1 diabetes; 28 women with type 2 diabetes) were analysed. Average glucose levels were calculated from 5–7 day CGM profiles (mean 1275 glucose values per profile) and paired with a corresponding (±1 week) HbA1c measure. In total, 688 average glucose–HbA1c pairs were obtained across pregnancy (mean six pairs per participant). Average glucose level was used as the dependent variable in a regression model. Covariates were gestational week, study centre and HbA1c. Results There was a strong association between HbA1c and average glucose values in pregnancy (coefficient 0.67 [95% CI 0.57, 0.78]), i.e. a 1% (11 mmol/mol) difference in HbA1c corresponded to a 0.67 mmol/l difference in average glucose. The random effects model that included gestational week as a curvilinear (quadratic) covariate fitted best, allowing calculation of a pregnancy-specific eAG (PeAG). This showed that an HbA1c of 8.0% (64 mmol/mol) gave a PeAG of 7.4–7.7 mmol/l (depending on gestational week), compared with a standard eAG of 10.2 mmol/l. The PeAG associated with maintaining an HbA1c level of 6.0% (42 mmol/mol) during pregnancy was between 6.4 and 6.7 mmol/l, depending on gestational week. Conclusions/interpretation The HbA1c–average glucose relationship is altered by pregnancy. Routinely generated standard eAG values do not account for this difference between pregnant and non-pregnant individuals and, thus, should not be used during pregnancy. Instead, the PeAG values deduced in the current study are recommended for antenatal clinical care

Emerging technologies for the management of Type 1 diabetes in pregnancy

Purpose of Review: The purpose of the study is to discuss emerging technologies available in the management of type 1 diabetes in pregnancy. Recent Findings: The latest evidence suggests that continuous glucose monitoring (CGM) should be offered to all women on intensive insulin therapy in early pregnancy. Studies have additionally demonstrated the ability of CGM to help gain insight into specific glucose profiles as they relate to glycaemic targets and pregnancy outcomes. Despite new studies comparing insulin pump therapy to multiple daily injections, its effectiveness in improving glucose and pregnancy outcomes remains unclear. Sensor-integrated insulin delivery (also called artificial pancreas or closed-loop insulin delivery) in pregnancy has been demonstrated to improve time in target and performs well despite the changing insulin demands of pregnancy. Summary: Emerging technologies show promise in the management of type 1 diabetes in pregnancy; however, research must continue to keep up as technology advances. Further research is needed to clarify the role technology can play in optimising glucose control before and during pregnancy as well as to understand which women are candidates for sensor-integrated insulin delivery