Elevated troponin i levels but not low grade chronic inflammation is associated with cardiac-specific mortality in stable hemodialysis patients

Background: Elevated cardiac troponin I (TnI) levels are associated with all-cause mortality in stable hemodialysis patients. Their relationship to cardiac-specific death has been inconsistent, and the reason for their elevation is not well understood. We hypothesized that elevated TnI levels in chronic stable hemodialysis patients more specifically track with cardiac mortality, and this mechanism is independent of other contributors of cardiac mortality, such as inflammation. Methods. We conducted a single-centre, cohort study of prevalent hemodialysis patients at a tertiary care hospital. Plasma TnI levels were measured with routine monthly blood tests in clinically stable patients for two consecutive months. Plasma TnI was measured by immunoassay and a value above the laboratory reference range (0.06 μg/L) was considered elevated. The primary outcome of death was adjudicated separately for this study, and classified as cardiac, non-cardiac, or unknown. Cox proportional hazard models were used to examine the association of TnI with the all-cause and cardiac-specific mortality, adjusting for potential confounders, including C-reactive protein (CRP) as a marker of inflammation. Results: Of 133 patients followed for a median of 1.7 years, there were 38 deaths (58% non-cardiac, 39% cardiac, 3% unknown). Elevated TnI was associated with adjusted HR for all-cause mortality of 2.57 (95% CI 1.30-5.09) and an adjusted HR for cardiac death of 3.14 (95% CI 1.07-9.2), after accounting for age, time on dialysis, diabetes status, prior coronary artery disease history, and C-reactive protein. Although CRP was also independently associated with all-cause mortality, it did not add prognostic information to TnI for cardiac-specific death. Conclusion: Elevated TnI levels are independently associated with cardiac and all-cause mortality in asymptomatic hemodialysis patients. The mechanism for this risk is likely independent of inflammation, but may reflect chronic subclinical myocardial injury or unmask those with subclinical atherosclerotic heart disease. Whether those with elevated TnI levels may benefit from additional investigations or more aggressive therapies to treat cardiovascular disease remains to be determined. © 2013 Alam et al.; licensee BioMed Central Ltd

Has multiculturalism failed in Britain?

This paper subjects the criticisms advanced against multiculturalism to empirical test. It asks whether ethno-religious groups lead ?parallel lives? and, in consequence, fail to integrate with the wider society. It looks in particular at the alleged corrosive effects of multiculturalism, specifically at the maintenance of an ethnic rather than a British identity, social distance from white people and willingness to contemplate violent protest, but finds that all groups alike have displayed major change across the generations in the direction of a British identity and reduced social distance. It finds no evidence that rates of intergenerational change have been slower among ethno-religious groups that have made successful claims for cultural recognition. In contrast, lower levels of integration are associated with perceptions of individual or group discrimination

Identifying coherent patterns of environmental change between multiple, multivariate records: an application to four 1000-year diatom records from Victoria, Australia

Empirical orthogonal functions (EOFs) of indirect archives of environmental change are increasingly used to identify coherent trends between palaeoclimate records, to separate externally forced patterns from locally driven idiosyncrasies. Lake sediments are particularly suited to such syntheses: they are abundant in most landscapes and record a wide array of information, yet local complexities often conceal or confuse the climate signal recorded at individual sites. Lake sediment parameters usually exhibit non-linear, multivariate and indirect responses to climate, therefore identifying coherent patterns between two or more lake records presents a complex challenge. Ideally, the selection of representative variables should be non-subjective and inclusive of as many different variables as possible, allowing for unexpected correlations between sites. In order to meet such demands, we propose a two-tier ordination procedure whereby site-specific (local) ordinations, obtained using Detrended Correspondence Analysis (DCA), are nested within a second, regional EOF. Using the local DCAs as representative variables allows the retention of a larger fraction of variance from each site, removes any subjectivity from variable selection and retains the potential for observing multiple, coherent signals from within and between each dataset. We explore this potential using four decadally resolved diatom records from volcanic lakes in Western Victoria, Australia. The records span the 1000 years prior to European settlement in CE 1803. Our analyses reveal at least two coherent patterns of ecological change that are manifest in each of the four datasets, patterns which may have been overlooked by a single-variable, empirical orthogonal function approach. This intra-site coherency provides a valuable step towards understanding multi-decadal hydroclimate variability in southeastern Australia

Pollen analysis of Australian honey

Pollen analysis is widely used to verify the geographic origin of honeys, but has never been employed in Australia. In this study, we analysed the pollen content of 173 unblended honey samples sourced from most of the commercial honey producing regions in southern Australia. Southern Australian vegetation is dominated by Eucalyptus (Myrtaceae) forests and, as expected, most Australian honeys are palynologically dominated by Eucalyptus, while other important components include Myrtaceae taxa such as Corymbia/Angophora and the tribe Leptospermeae; plus Brassicaceae, Echium, Macadamia, and Acacia. An important feature of the honeys is the number of Myrtaceae pollen morphotypes per sample, which is generally high (mean = 4.6) compared to honeys produced outside of Australia, including Eucalyptus honeys produced in the Mediterranean region, and honeys produced in South America, which has its own rich indigenous Myrtaceae flora. In the latter regions, the number of Myrtaceae morphotypes is apparently generally 2. A high number of Myrtaceae morphotypes may be a feasible criterion for authenticating the origin of Australian honeys, since most Australian honey is produced by honey bees mainly working indigenous floral resources. Myrtaceae morphotype diversity is a convenient melissopalynological measure that could be applied even where detailed knowledge of the pollen morphology of the many component genera and species is absent. Palynological criteria developed in Europe for authenticating Eucalyptus honeys should not be relied upon for Australian honeys, since those criteria are not based on samples of Australian honey.This study was funded by the Australian Government Rural Industries Research and Development Corporation (now AgriFutures Australia, www.agrifutures.com.au), Grant PRJ-009770 to JMKS. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. However, the funders and two industry partners commented on the manuscript

A study of prognostic factors in Chinese patients with diabetic foot ulcers

Objective: Few studies have identified factors as predictors of clinical prognosis of patients with diabetic foot ulcers (DFUs), especially of Chinese patients. In this study, we assessed the prognostic factors of Chinese patients with DFUs. Methods and materials: This was a retrospective study (January 2009–January 2011) of 194 DFUs conducted in an inpatient population at PLA 454 Hospital in Nanjing, China, to determine the prognostic influential factors of DFUs in Chinese patients. All of the studied patients were grouped into an amputation group, a non-healing group, and a cured group, according to the clinical prognosis. Patient parameters, including gender, age, smoking habits, education level, family history of diabetes mellitus, medical history, duration of foot lesions and complications, ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), urinary albumin/creatinine ratio (Alb/Cr), fundus oculi, electrocardiogram, DFU characteristics, bacterial nature, and neuropathy, were cross-studied among the three groups. Results: Compared with the other two groups, the amputation group showed a higher number of males, older in age, lower ABI and TcPO2 levels, higher Wagner wound grading and size, and significantly higher urinary Alb/Cr ratio, blood urea nitrogen, serum creatinine, white blood cell count, and erythrocyte sedimentation rate. Compared to the cured group (162 patients), more patients with an older age, smoking, family history of diabetes mellitus, medical history of foot ulcerations, lower ABI and TcPO2 levels, higher urine Alb/Cr ratio, and serum creatinine were found in the non-healing group. Regression analysis was used to study the correlation between various factors and clinical prognosis, and the results were as follows: age, Wagner wound classification, and heel ulcerations were negatively correlated to the DFU prognosis, whereas the female population, ABI, and TcPO2 were positively correlated with DFU prognosis. Conclusion: In this retrospective study, we conclude that the DFU prognosis may be related to age, gender, wound location (heel), Wagner wound classification, ABI, and TcPO2 levels in the Chinese population

ApoB100-LDL Acts as a Metabolic Signal from Liver to Peripheral Fat Causing Inhibition of Lipolysis in Adipocytes

International audienceBACKGROUND: Free fatty acids released from adipose tissue affect the synthesis of apolipoprotein B-containing lipoproteins and glucose metabolism in the liver. Whether there also exists a reciprocal metabolic arm affecting energy metabolism in white adipose tissue is unknown. METHODS AND FINDINGS: We investigated the effects of apoB-containing lipoproteins on catecholamine-induced lipolysis in adipocytes from subcutaneous fat cells of obese but otherwise healthy men, fat pads from mice with plasma lipoproteins containing high or intermediate levels of apoB100 or no apoB100, primary cultured adipocytes, and 3T3-L1 cells. In subcutaneous fat cells, the rate of lipolysis was inversely related to plasma apoB levels. In human primary adipocytes, LDL inhibited lipolysis in a concentration-dependent fashion. In contrast, VLDL had no effect. Lipolysis was increased in fat pads from mice lacking plasma apoB100, reduced in apoB100-only mice, and intermediate in wild-type mice. Mice lacking apoB100 also had higher oxygen consumption and lipid oxidation. In 3T3-L1 cells, apoB100-containing lipoproteins inhibited lipolysis in a dose-dependent fashion, but lipoproteins containing apoB48 had no effect. ApoB100-LDL mediated inhibition of lipolysis was abolished in fat pads of mice deficient in the LDL receptor (Ldlr(-/-)Apob(100/100)). CONCLUSIONS: Our results show that the binding of apoB100-LDL to adipocytes via the LDL receptor inhibits intracellular noradrenaline-induced lipolysis in adipocytes. Thus, apoB100-LDL is a novel signaling molecule from the liver to peripheral fat deposits that may be an important link between atherogenic dyslipidemias and facets of the metabolic syndrome

Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study

BACKGROUND: Although mortality due to COVID-19 has been reportedly low among children with cancer, changes in health-care services due to the pandemic have affected cancer care delivery. This study aimed to assess the effect of the COVID-19 pandemic on childhood cancer care worldwide. METHODS: A cross-sectional survey was distributed to paediatric oncology providers worldwide from June 22 to Aug 21, 2020, through the St Jude Global Alliance and International Society for Paediatric Oncology listservs and regional networks. The survey included 60 questions to assess institution characteristics, the number of patients diagnosed with COVID-19, disruptions to cancer care (eg, service closures and treatment abandonment), adaptations to care, and resources (including availability of clinical staff and personal protective equipment). Surveys were included for analysis if respondents answered at least two thirds of the items, and the responses were analysed at the institutional level. FINDINGS: Responses from 311 health-care professionals at 213 institutions in 79 countries from all WHO regions were included in the analysis. 187 (88%) of 213 centres had the capacity to test for SARS-CoV-2 and a median of two (range 0-350) infections per institutution were reported in children with cancer. 15 (7%) centres reported complete closure of paediatric haematology-oncology services (median 10 days, range 1-75 days). Overall, 2% (5 of 213) of centres were no longer evaluating new cases of suspected cancer, while 43% (90 of 208) of the remaining centers described a decrease in newly diagnosed paediatric cancer cases. 73 (34%) centres reported increased treatment abandonment (ie, failure to initiate cancer therapy or a delay in care of 4 weeks or longer). Changes to cancer care delivery included: reduced surgical care (153 [72%]), blood product shortages (127 [60%]), chemotherapy modifications (121 [57%]), and interruptions to radiotherapy (43 [28%] of 155 institutions that provided radiotherapy before the pandemic). The decreased number of new cancer diagnoses did not vary based on country income status (p=0·14). However, unavailability of chemotherapy agents (p=0·022), treatment abandonment (p<0·0001), and interruptions in radiotherapy (p<0·0001) were more frequent in low-income and middle-income countries than in high-income countries. These findings did not vary based on institutional or national numbers of COVID-19 cases. Hospitals reported using new or adapted checklists (146 [69%] of 213), processes for communication with patients and families (134 [63%]), and guidelines for essential services (119 [56%]) as a result of the pandemic. INTERPRETATION: The COVID-19 pandemic has considerably affected paediatric oncology services worldwide, posing substantial disruptions to cancer diagnosis and management, particularly in low-income and middle-income countries. This study emphasises the urgency of an equitably distributed robust global response to support paediatric oncology care during this pandemic and future public health emergencies. FUNDING: American Lebanese Syrian Associated Charities. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section

Beyond the Dutch "Multicultural Model": The Coproduction of Integration Policy Frames in The Netherlands

The Netherlands has been internationally known for its multicultural approach to immigrant integration. The aim of this article is to delve into the "coproduction" by researchers and policy makers of this so-called Dutch "multicultural model". As this article shows, researchers and policy makers have in The Netherlands been joined in several discourse coalitions. Indeed, one of these discourse coalitions supported an integration paradigm with multicultural elements, but at least two other types of discourses can be identified in The Netherlands, one of more liberal-egalitarian nature and one more assimilationist. In spite of the persistent image of The Netherlands as a representative of the multicultural model, it is in fact this multiplicity of discourses that characterizes the Dutch case. Moreover, labeling Dutch integration p