The role of very low calorie ketogenic diet in sympathetic activation through cortisol secretion in male obese population

Adipose tissue is considered an endocrine organ, and its excess compromises the immune response and metabolism of hormones and nutrients. Furthermore, the accumulation of visceral fat helps to increase the synthesis of cortisol. The hypothalamus-pituitary-adrenal (HPA) axis is a neuroendocrine system involved in maintaining homeostasis in humans under physiological conditions and stress, and cortisol is the main hormone of the HPA axis. It is known that a stress-induced diet and cortisol reactivity to acute stress factors may be related to dietary behavior. In obesity, to reduce visceral adipose tissue, caloric restriction is a valid strategy. In light of this fact, the aim of this study was to assess the effects of a commercial dietary ketosis program for weight loss on the sympathetic nervous system and HPA axis, through evaluation of salivary cortisol and GSR levels. Thirty obese subjects were recruited and assessed before and after 8 weeks of Very Low Calorie Ketogenic Diet (VLCKD) intervention to evaluate body composition and biochemical parameters. Salivary cortisol levels and GSR significantly decreased after dietary treatment; in addition, body composition and biochemical features were ameliorated. The VLCKD had a short-term positive effect on the SNS and HPA axes regulating salivary cortisol levels. Finally, the effects of the VLCKD on the SNS and HPA axis may lead to more individualized treatment strategies that integrate obesity and stress and support the usefulness of such therapeutic interventions in promoting the reduction of the individual disease burden

“We don’t have up to date knowledge about the disease” Practical challenges encountered in the delivery of cervical cancer screening in Iraq

Objective: This qualitative study explored the lived experience of medical doctors in delivering cervical cancer screening in a city in Iraq. Methods: An applied grounded theory approach explored the reported experiences of doctors in the field. A purposive sample of 12 gynaecologists and one general practitioner (GP) working in two main hospitals participated: Semi-structured interviews took place from June to September 2015. Thematic coding of data was peer reviewed and included participant reading of transcripts and translations from Arabic to English. Theory generation involved synthesis of a prior literature review and interview findings. Results: Gynaecologist and GP experiences showed overwhelming gaps in cervical cancer experience and screening. Iraqi women mainly presented for help with late stage cancer. Practical barriers included cultural stigma, low priority for women’s health needs, lack of knowledgeable leadership and perceived shortage of adequately trained staff. Conclusion: There is an urgent need for culturally appropriate cervical cancer prevention policies and strategies in Iraq, focused on evidence-based population-based cervical screening to identify and prevent advanced cervical cancer among women. Regional educational initiatives should be encouraged and primary health care systems supported to undertake screening. Key words: Cervical cancer, Screening, Health system, Barriers, Iraq, Medical education

Cervical cancer screening: target age bracket, screening frequency and screening method: review of recent evidence and comparison with the Portuguese performance indicator

Esta revisão teve por objetivo avaliar a força de evidência do indicador de desempenho português relativo ao rastreio do Câncer do Colo do Útero (CCU): (1) limites etários das mulheres da população geral que o devem realizar, a (2) periodicidade com que deve ser realizado e (3) qual o melhor exame de rastreio. Foram pesquisados os seguintes termos MeSH: vaginal smears, age groups, periodicity, methods, uterine cervical cancer. Foram excluídos os artigos que não abordavam o objetivo da investigação ou que não fossem redigidos em Inglês, Português ou Espanhol. Para interpretar os artigos selecionados foi utilizada a classificação SORT. Foram encontrados 197 artigos, dos quais seleccionados 9: 1 revisão sistemática (RS), 1 estudo clínico controlado aleatorizado, 2 estudos observacionais retrospectivos e 5 normas de orientação clínica (NOC). Os autores optaram por incluir nesta revisão mais 4 NOCs e 2 RSs por considerarem ser relevantes para a população Portuguesa, apesar de não resultarem da pesquisa efectuada. Os estudos sugerem realização do rastreio entre os 21 e 25 até aos 65 anos, com uma periodicidade trienal usando a citologia convencional. Existe ainda controvérsia no que toca aos 3 objetivos deste artigo (limites etários, frequência e método).The scope of this review was to assess the strength of evidence of Portuguese performance indicators on Cervical Cancer screening: (1) age group of the women that should be screened for cervical cancer; (2) frequency of screening; and (3) the best method for screening. The following MeSH terms were searched: vaginal smears, age groups, periodicity, methods, uterine cervical cancer. Articles not reflecting the study objectives or not available in English, Portuguese or Spanish were excluded. The SORT classification was used to rate the articles selected.Of the 197 articles found, 9 that met all study criteria were selected for inclusion in this review. These included 1 systematic review, 1 randomized controlled clinical trial, 2 retrospective studies and 5 clinical guidelines. The authors also chose to include 4 clinical guidelines and two systematic reviews relevant to the Portuguese population even though they did not appear in the initial search of the literature. The studies suggest screening women between the ages of 21 to 25 years and 65 years of age, once every three years using conventional cytology. There is still controversy regarding the three objectives of this study (target age bracket, screening frequency and screening method)

The National Cancer Institute’s Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned

We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities

Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts

Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. Materials and methods: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) – true population of interest, anastomosis performed with a three-row circular stapler; group (B) – control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Results: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15–0.73; P = 0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17–0.87; P = 0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24–0.91; P = 0.026). Conclusion: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage

Didattica in presenza e Didattica a Distanza. Elementi per una prima comparazione ai tempi del Covid-19.

In seguito al D.P.C.M. 4 marzo 2020, contenente disposizioni disciplinanti da applicare in modo uniforme sull’intero territorio nazionale al fine di contrastare e contenere il diffondersi del virus COVID-19, le Università italiane hanno digitalizzato la loro offerta formativa. La “rete”, nell’eccezionale fase dell’emergenza, è stata “rete” anche in senso metaforico educativo: salvaguardando il diritto allo studio degli studenti in un ambiente di apprendimento costruttivista. Ogni studente ha vissuto un’esperienza didattica “personale”: la mediazione è stata re-inventata e ritrascritta forzatamente attraverso il web dentro uno spazio comune (Cope, Kalantzis 2008) in cui si sono inseriti anche vissuti ed emozioni connessi alla reclusione indotta dalle prescrizioni sanitarie. Si presenteranno gli esiti di uno studio di caso sulla “flessibilità” nella mediazione a distanza in cui, attraverso il paradigma dell’analisi di pratica (Damiano 2013; Altet 1988; Perla, 2010, 2012; Perla, Agrati, Vinci 2019) sono stati indagati vantaggi e limiti connaturati a questa formazione e alle sue implicazioni didattiche. Sono stati studiati tre tipi di flessibilità (inerente il tempo, lo spazio, la trasposizione dei contenuti; comparando le percezioni degli studenti rispetto ai mediatori usati in attività in presenza e in attività a distanza. Lo studio presentato, effettuato con gli studenti dei corsi di laurea in Scienze della Formazione Primaria e Scienze dell’Educazione e Formazione, ha permesso di evidenziare tre tipologie differenti di mediazione nella dad: Shallow learning, Deep learning, Profound learning (Sonna 2006) e fatto emergere alcune interessanti evidenze circa le potenzialità integrative e migliorative della didattica universitaria

Passive control of combustion instability in a low emissions aeroderivative gas turbine

This paper describes the conceptual ideas, the theoretical validation, the laboratory testing and the field trials of a recently patented fuel-air mixing device for use in high-pressure ratio, low emissions, gaseous-fueled gas turbines. By making the fuel-air mixing process insensitive to pressure fluctuations in the combustion chamber, it is possible to avoid the common problem of positive feedback between mixture strength and the unsteady combustion process. More specifically, a mixing duct has been designed such that fuel-air ratio fluctuations over a wide range of frequencies can be damped out by passive design means. By scaling the design in such a way that the range of damped frequencies covers the frequency spectrum of the acoustic modes in the combustor, the instability mechanism can be removed. After systematic development, this design philosophy was successfully applied to a 35:1 pressure ratio aeroderivative gas turbine yielding very low noise levels and very competitive NOx and CO measurements. The development of the new premixer is described from conceptual origins through analytic and CFD evaluation to laboratory testing and final field trials. Also included in this paper are comments about the practical issues of mixing, flashback resistance and autoignition