Pre-conception and antenatal care in type 2 diabetes.

The UK is experiencing a dramatic increase in prevalence of type 2 diabetes mellitus (T2DM). Consequently there is a corresponding increase in T2DM in pregnancy, with 27% of pregnant women with pre-existing diabetes having T2DM. Although the risks to mother and baby are similar to type 1 diabetes mellitus (T1DM), the approach and management often differ. Pregnant women with T2DM are more likely to be older, multiparous and live in deprived areas. Certain ethic groups are more prone to T2DM and there is a strong association with being overweight and obesity. Furthermore, some surveys have shown that women with T2DM often receive suboptimum care prior to conception and in early pregnancy, particularly in primary care. This paper presents an overview of the multidisciplinary management of T2DM in pregnancy and identifies areas where care may be improved for these women

Tropical forager gastrophagy and its implications for extinct hominin diets

Reconstruction of extinct hominin diets is currently a topic of much interest and debate, facilitated by new methods such as the analysis of dental calculus. It has been proposed, based on chemical analyses of calculus, that Neanderthals self-medicated, yet this conclusion has been questioned. Gastrophagy has been suggested as an alternative explanation for the Neanderthal data, based on ethnographic analogies, which show this practice to have been widespread in traditional extant Homo sapiens diets, and nutritional evidence for its benefits at high latitudes. Here we expand the discussion of the potential importance of gastrophagy in human evolution by considering its role for an extant group of tropical foragers, the Hadza of Tanzania, and questioning its role in the diets of extinct tropical hominin species. Gastrophagy is frequently practiced among the Hadza and adult men in particular consume substantial, seasonally variable, amounts of prey guts. In addition to the important fact that gastrophagy is not a rare event, this demographic information may be useful in interpreting evidence from archaeological samples. The consumption of semi-digested chyme would have allowed extinct hominins to gain calories from plant sources without the cost of digesting them, possibly contributing to the encephalisation and shrinking of the gut in genus Homo. As an easy to process food-source, chyme could have likewise been an important food source for the old and the young, potentially playing a part in reducing inter-birth intervals and increasing reproductive success in our lineage. Thus gastrophagy may have played a key part in human evolution and its potentially confounding signal should be considered in future dietary reconstructions.We would like to thank The Calleva Foundation (LTB & CBS), The Human Origins Research Fund, NHM (LTB & CBS), The Leakey Foundation (JCB & BMW), Wenner-Gren Foundation (BMW), & the National Science Foundation (BMW) for funding.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.jasrep.2015.09.02

The multidisciplinary management of type 2 and gestational diabetes in pregnancy

The UK is experiencing a dramatic increase in the prevalence of type 2 diabetes mellitus (T2D). Consequently, there is a corresponding increase in diabetes in pregnancy, with 87.5% of pregnancies in the UK complicated by diabetes due to gestational diabetes mellitus (GDM), and 27% of those with pre-existing diabetes having T2D (National Centre for Health and Clinical Excellence (NICE), 2008a). Although the risks to mother and baby are similar to type 1 diabetes (T1D), the approach and management often differ. Women with GDM and T2D are more likely to be older, multiparous and live in deprived areas. Certain ethnic groups are more prone to GDM and T2D, and there is a strong association between being overweight or obese and diabetes. Women who develop GDM in pregnancy also have an increased risk of T2D in later life (Diabetes UK, 2011a). Some surveys, such as the Confidential Enquiry into Maternal and Child Health (CEMACH, 2007a) have shown that women with T2D often receive suboptimum care prior to conception and in early pregnancy. This paper presents an overview of the multidisciplinary management of T2D and GDM in pregnancy and identifies areas where care may be lacking for these women

How early can myocardial iron overload occur in Beta thalassemia major?

BACKGROUND: Myocardial siderosis is the most common cause of death in patients with beta thalassemia major(TM). This study aimed at investigating the occurrence, prevalence and severity of cardiac iron overload in a young Chinese population with beta TM. METHODS AND RESULTS: We analyzed T2* cardiac magnetic resonance (CMR), left ventricular ejection fraction (LVEF) and serum ferritin (SF) in 201 beta TM patients. The median age was 9 years old. Patients received an average of 13 units of blood per year. The median SF level was 4536 ng/ml and 165 patients (82.1%) had SF>2500 ng/ml. Myocardial iron overload was detected in 68 patients (33.8%) and severe myocardial iron overload was detected in 26 patients (12.6%). Twenty-two patients ≤10 years old had myocardial iron overload, three of whom were only 6 years old. No myocardial iron overload was detected under the age of 6 years. Median LVEF was 64% (measured by CMR in 175 patients). Five of 6 patients with a LVEF<56% and 8 of 10 patients with cardiac disease had myocardial iron overload. CONCLUSIONS: The TM patients under follow-up at this regional centre in China patients are younger than other reported cohorts, more poorly-chelated, and have a high burden of iron overload. Myocardial siderosis occurred in patients younger than previously reported, and was strongly associated with impaired LVEF and cardiac disease. For such poorly-chelated TM patients, our data shows that the first assessment of cardiac T2* should be performed as early as 6 years old

Controlled variation of monomer sequence-distribution in the synthesis of aromatic poly(ether ketone)s

The effects of varying the alkali metal cation in the high-temperature nucleophilic synthesis of a semi-crystalline, aromatic poly(ether ketone) have been systematically investigated, and striking variations in the sequence-distributions and thermal characteristics of the resulting polymers were found. Polycondensation of 4,4'-dihydroxybenzophenone with 1,3-bis(4-fluorobenzoyl)benzene in diphenylsulfone as solvent, in the presence of an alkali metal carbonate M2CO3 (M= Li, Na, K, or Rb) as base, affords a range of different polymers that vary in the distribution pattern of 2-ring and 3-ring monomer units along the chain. Lithium carbonate gives an essentially alternating and highly crystalline polymer, but the degree of sequence-randomisation increases progressively as the alkali metal series is descended, with rubidium carbonate giving a fully random and non-thermally-crystallisable polymer. Randomisation during polycondensation is shown to result from reversible cleavage of the ether linkages in the polymer by fluoride ions, and an isolated sample of alternating-sequence polymer is thus converted to a fully randomised material on heating with rubidium fluoride

Deferasirox (Exjade®) significantly improves cardiac T2* in heavily iron-overloaded patients with β-thalassemia major

Noninvasive measurement of tissue iron levels can be assessed using T2* magnetic resonance imaging (MRI) to identify and monitor patients with iron overload. This study monitored cardiac siderosis using T2* MRI in a cohort of 19 heavily iron-overloaded patients with β-thalassemia major receiving iron chelation therapy with deferasirox over an 18-month period. Overall, deferasirox therapy significantly improved mean ± standard deviation cardiac T2* from a baseline of 17.2 ± 10.8 to 21.5 ± 12.8 ms (+25.0%; P = 0.02). A concomitant reduction in median serum ferritin from a baseline of 5,497 to 4,235 ng/mL (−23.0%; P = 0.001), and mean liver iron concentration from 24.2 ± 9.0 to 17.6 ± 12.9 mg Fe/g dry weight (−27.1%; P = 0.01) was also seen. Improvements were seen in patients with various degrees of cardiac siderosis, including those patients with a baseline cardiac T2* of <10 ms, indicative of high cardiac iron burden. These findings therefore support previous observations that deferasirox is effective in the removal of myocardial iron with concomitant reduction in total body iron

Harmonic maps into the orthogonal group and null curves

We find algebraic parametrizations of extended solutions of harmonic maps of finite uniton number from a surface to the orthogonal group O(n) in terms of free holomorphic data which lead to formulae for all such harmonic maps. Our work reveals an interesting correspondence between certain harmonic maps and the free Weierstrass representation of null curves and minimal surfaces in 3- and 4-space

Harmonic maps and shift-invariant subspaces

With the help of operator-theoretic methods, we derive new and powerful criteria for finiteness of the uniton number for a harmonic map from a Riemann surface to the unitary group U(n). These use the Grassmannian model where harmonic maps are represented by families of shift-invariant subspaces of L2(S1,Cn); we give a new description of that model

Dietary fatty acids amplify inflammatory responses to infection through p38 MAPK signaling

Copyright © 2019 by the American Thoracic Society. Obesity is an important risk factor for severe asthma exacerbations, which are mainly caused by respiratory infections. Dietary fatty acids, which are increased systemically in obese patients and are further increased after high-fat meals, affect the innate immune system and may contribute to dysfunctional immune responses to respiratory infection. In this study we investigated the effects of dietary fatty acids on immune responses to respiratory infection in pulmonary fibroblasts and a bronchial epithelial cell line (BEAS-2B). Cells were challenged with BSA-conjugated fatty acids (v-6 polyunsaturated fatty acids [PUFAs], v-3 PUFAs, or saturated fatty acids [SFAs]) 1/2 the viral mimic polyinosinic:polycytidylic acid (poly[I:C]) or bacterial compound lipoteichoic acid (LTA), and release of proinflammatory cytokines was measured. In both cell types, challenge with arachidonic acid (AA) (v-6 PUFA) and poly(I:C) or LTA led to substantially greater IL-6 and CXCL8 release than either challenge alone, demonstrating synergy. In epithelial cells, palmitic acid (SFA) combined with poly(I:C) also led to greater IL-6 release. The underlying signaling pathways of AA and poly(I:C)- or LTA-induced cytokine release were examined using specific signaling inhibitors and IB. Cytokine production in pulmonary fibroblasts was prostaglandin dependent, and synergistic upregulation occurred via p38 mitogen-activated protein kinase signaling, whereas cytokine production in bronchial epithelial cell lines was mainly mediated through JNK and p38 mitogen-activated protein kinase signaling. We confirmed these findings using rhinovirus infection, demonstrating that AA enhances rhinovirus-induced cytokine release. This study suggests that during respiratory infection, increased levels of dietary v-6 PUFAs and SFAs may lead to more severe airway inflammation and may contribute to and/or increase the severity of asthma exacerbations

Conceptualizing cultures of violence and cultural change

The historiography of violence has undergone a distinct cultural turn as attention has shifted from examining violence as a clearly defined (and countable) social problem to analysing its historically defined 'social meaning'. Nevertheless, the precise nature of the relationship between 'violence' and 'culture' is still being established. How are 'cultures of violence' formed? What impact do they have on violent behaviour? How do they change? This essay examines some of the conceptual aspects of the relationship between culture and violence. It brings together empirical research into nineteenth-century England with recent research results from other European contexts to examine three aspects of the relationship between culture and violence. These are organised under the labels 'seeing violence', 'identifying the violent' and 'changing violence'. Within a particular society, narratives regarding particular kinds of behaviour shape cultural attitudes. The notion 'violence' is thus defined in relation to physically aggressive acts as well as by being connected to other kinds of attitudes and contexts. As a result, the boundaries between physical aggression which is legitimate and that which is illegitimate (and thus 'violence') are set. Once 'violence' is defined, particular cultures form ideas about who is responsible for it: reactions to violence become associated with social arrangements such as class and gender as well as to attitudes toward the self. Finally, cultures of violence make efforts to tame or eradicate illegitimate forms of physical aggression. This process is not only connected to the development of new forms of power (e.g., new policing or punishment strategies) but also to less tangible cultural influences which aim at changing the behaviour defined as violence (in particular among the social groups identified as violent). Even if successful, this three-tiered process of seeing violence, identifying the violent and changing violence continues anew, emphasising the ways that cultures of violence develop through a continuous process of reevaluation and reinvention