Behavioural weight management interventions consistently produce 8–10% reductions in body weight, yet most participants regain weight after treatment ends. One strategy for extending the effects of ...behavioural interventions has been the provision of extended care. The current study is a systematic review and meta‐analysis of the literature on the effect of extended care on maintenance of weight loss. Through database searches (using PubMED, PsychInfo and Cochrane Reviews) and manual searches through reference lists of related publications, 463 studies were identified. Of these, 11 were included in the meta‐analysis and an additional two were retained for qualitative analysis. The average effect of extended care on weight loss maintenance was g = 0.385 (95% confidence interval: 0.281, 0.489; P < 0.0001). This effect would lead to the maintenance of an additional 3.2 kg weight loss over 17.6 months post‐intervention in participants provided extended care compared with control. There was no significant heterogeneity between studies, Q = 5.63, P = 0.845, and there was minimal evidence for publication bias. These findings suggest that extended care is a viable and efficacious solution to addressing long‐term maintenance of lost weight. Given the chronic disease nature of obesity, extended care may be necessary for long‐term health benefits.
Background The vascular safety of electronic cigarettes (e-Cigarettes) must still be clarified. We compared the impact of e-Cigarettes vs traditional tobacco cigarettes on oxidative stress and ...endothelial function in healthy smokers and nonsmoker adults. Methods A crossover, single-blind study was performed in 40 healthy subjects (20 smokers and 20 nonsmokers, matched for age and sex). First, all subjects smoked traditional tobacco cigarettes. One week later, the same subjects smoked an e-Cigarette with the same nominal nicotine content. Blood samples were drawn just before and after smoking, and markers of oxidative stress, nitric oxide bioavailability, and vitamin E levels were measured. Flow-mediated dilation (FMD) was also measured. Results Smoking both e-Cigarettes and traditional cigarettes led to a significant increase in the levels of soluble NOX2-derived peptide and 8-iso-prostaglandin F2α and a significant decrease in nitric oxide bioavailability, vitamin E levels, and FMD. Generalized estimating equation analysis confirmed that all markers of oxidative stress and FMD were significantly affected by smoking and showed that the biologic effects of e-Cigarettes vstraditional cigarettes on vitamin E levels ( P = .413) and FMD ( P = .311) were not statistically different. However, e-Cigarettes seemed to have a lesser impact than traditional cigarettes on levels of soluble NOX2-derived peptide ( P = .001), 8-iso-prostaglandin F2α ( P = .046), and nitric oxide bioavailability ( P = .001). Conclusions Our study showed that both cigarettes have unfavorable effects on markers of oxidative stress and FMD after single use, although e-Cigarettes seemed to have a lesser impact. Future studies are warranted to clarify the chronic vascular effects of e-Cigarette smoking.
Physical activity is essential for chronic disease prevention, yet <40% of overweight/obese adults meet the national activity recommendations. For time-efficient counseling, clinicians need a brief, ...easy-to-use tool that reliably and validly assesses a full range of activity levels, and, most importantly, is sensitive to clinically meaningful changes in activity. The Stanford Leisure-Time Activity Categorical Item (L-Cat) is a single item comprising six descriptive categories ranging from inactive to very active. This novel methodological approach assesses national activity recommendations as well as multiple clinically relevant categories below and above the recommendations, and incorporates critical methodological principles that enhance psychometrics (reliability, validity and sensitivity to change).
We evaluated the L-Cat's psychometrics among 267 overweight/obese women who were asked to meet the national activity recommendations in a randomized behavioral weight-loss trial.
The L-Cat had excellent test-retest reliability (κ=0.64, P<0.001) and adequate concurrent criterion validity; each L-Cat category at 6 months was associated with 1059 more daily pedometer steps (95% CI 712-1407, β=0.38, P<0.001) and 1.9% greater initial weight loss at 6 months (95% CI -2.4 to -1.3, β=-0.38, P<0.001). Of interest, L-Cat categories differentiated from each other in a dose-response gradient for steps and weight loss (Ps<0.05) with excellent face validity. The L-Cat was sensitive to change in response to the trial's activity component. Women increased one L-Cat category at 6 months (M=1.0±1.4, P<0.001); 55.8% met the recommendations at 6 months whereas 20.6% did at baseline (P<0.001). Even among women not meeting the recommendations at both baseline and 6 months (n=106), women who moved 1 L-Cat categories at 6 months lost more weight than those who did not (M=-4.6%, 95% CI -6.7 to -2.5, P<0.001).
Given strong psychometrics, the L-Cat has timely potential for clinical use such as tracking activity changes via electronic medical records, especially among overweight/obese populations who are unable or unlikely to reach national recommendations.
We present a comprehensive statistical analysis of Swift X-ray light curves of gamma-ray bursts (GRBs) collecting data from more than 650 GRBs discovered by Swift and other facilities. The ...unprecedented sample size allows us to constrain the rest-frame
X-ray properties of GRBs from a statistical perspective, with particular reference to intrinsic time-scales and the energetics of the different light-curve phases in a common rest-frame 0.3-30 keV energy band. Temporal variability episodes are also studied and their properties constrained. Two fundamental questions drive this effort: (i) Does the X-ray emission retain any kind of 'memory' of the prompt γ-ray phase? (ii) Where is the dividing line between long and short GRB X-ray properties? We show that short GRBs decay faster, are less luminous and less energetic than long GRBs in the X-rays, but are interestingly characterized by similar intrinsic absorption. We furthermore reveal the existence of a number of statistically significant relations that link the X-ray to prompt γ-ray parameters in long GRBs; short GRBs are outliers of the majority of these two-parameter relations. However and more importantly, we report on the existence of a universal three-parameter scaling that links the X-ray and the γ-ray energy to the prompt spectral peak energy of both long and short GRBs: E
X, iso∝E
1.00 ± 0.06
γ, iso/E
0.60 ± 0.10
pk.
Abstract
We report the discovery of the unusually bright long-duration gamma-ray burst (GRB), GRB 221009A, as observed by the Neil Gehrels Swift Observatory (Swift), Monitor of All-sky X-ray Image, ...and Neutron Star Interior Composition Explorer Mission. This energetic GRB was located relatively nearby (
z
= 0.151), allowing for sustained observations of the afterglow. The large X-ray luminosity and low Galactic latitude (
b
= 4.°3) make GRB 221009A a powerful probe of dust in the Milky Way. Using echo tomography, we map the line-of-sight dust distribution and find evidence for significant column densities at large distances (≳10 kpc). We present analysis of the light curves and spectra at X-ray and UV–optical wavelengths, and find that the X-ray afterglow of GRB 221009A is more than an order of magnitude brighter at
T
0
+ 4.5 ks than that from any previous GRB observed by Swift. In its rest frame, GRB 221009A is at the high end of the afterglow luminosity distribution, but not uniquely so. In a simulation of randomly generated bursts, only 1 in 10
4
long GRBs were as energetic as GRB 221009A; such a large
E
γ
,iso
implies a narrow jet structure, but the afterglow light curve is inconsistent with simple top-hat jet models. Using the sample of Swift GRBs with redshifts, we estimate that GRBs as energetic and nearby as GRB 221009A occur at a rate of ≲1 per 1000 yr—making this a truly remarkable opportunity unlikely to be repeated in our lifetime.
The identification of special types of breast cancer might be of value in assessing prognosis and predicting response to therapy.
A total of 7372 consecutive patients with immunohistochemically ...defined luminal invasive breast cancer operated at the European Institute of Oncology between 1997 and 2005 were included. We then explored patterns of recurrence by histological type. Median follow-up was 5.8 years.
Tumors from 5707 patients were classified as invasive ductal cancer (IDC) not otherwise specified (NOS), 851 lobular, 338 mixed ductal and lobular, 250 cribriform, 143 mucinous and 83 tubular carcinomas. Compared with IDC NOS disease-free survival (DFS) was significantly longer in patients with cribriform tumors 5-year DFS 97.9% versus 87.4%; hazard ratio (HR) = 0.48; P = 0.015) and in pooled cribriform plus tubular carcinomas (5-year DFS 98.7% versus 87.4%; HR = 0.45; P = 0.005). Mucinous tumors presented similar DFS if compared with IDC (5-year DFS 93 % versus 87.4%; HR = 1.03; P = 0.91). Conversely, DFS was poorer for patients with lobular carcinoma (5-year DFS 86.8% versus 87.4%; HR = 1.27; P = 0.01).
The diagnosis of tubular, cribriform and lobular carcinomas carry distinct prognostic implications. The identification of these special types has a significant utility in luminal breast cancer and should be considered in therapeutic algorithms.
PurposeTo investigate the efficacy of early therapeutic deep anterior lamellar keratoplasty (DALK) in eradicating fungal keratitis that is poorly responsive to medical treatment.Patients and ...methodsTwenty-three eyes (23 patients) underwent early therapeutic DALK within 15 to 50 days from the onset of symptoms. The adopted eligibility criteria for early DALK included the following: active fungal keratitis affecting the optical zone with ulcer confined in the 6.00 mm central cornea; deeper than 150 μm but not exceeding 300 μm; and poorly responsive to medical treatment.ResultsThe big bubble technique was accomplished in 74% (17) of eyes, whereas manual dissection was performed in the remaining 26% (6) of eyes. Histopathological examination did not show any sign of fungal colonization in the peripheral and deep stromal lamellae in any case. All grafts were transparent postoperatively, and no recurrence of infection occurred. Median best spectacle corrected visual acuity significantly improved from 2.0 (1.0 interquartile range) logMAR to 0.1 (0.1 interquartile range) logMAR (P<0.01). The mean follow-up was 32±10 months. Neither episode of rejection nor graft failure was noted during the follow-up period.ConclusionEarly DALK could represent a safe therapeutic approach to eradicate fungal keratitis that affects the optical zone and is poorly responsive to medical treatment.
Background
Basophils, eosinophils and monocytes may be involved in BCG-induced immune responses and be associated with outcomes of bladder cancer patients receiving intravesical BCG. Our objective ...was to explore the association of baseline counts of basophils, eosinophils and monocytes with outcomes of patients with high-grade T1 bladder cancer receiving a standard course of intravesical BCG.
Methods
We retrospectively reviewed medical records of patients with primary T1 HG/G3 bladder cancer. After re-TURBT, patients were treated with a 6-week course of intravesical BCG induction followed by intravesical BCG every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months from initiation of therapy The analysis of potential risk factors for recurrence, muscle invasion and cancer-specific and overall survival was performed using univariable Cox regression models. Those factors that presented, at univariate analysis, an association with the event at a liberal
p
< 0.1, have been selected for the development of a multivariable model.
Results
A total of 1045 patients with primary T1 HG/G3 were included. A total of 678 (64.9%) recurrences, 303 (29.0%) progressions and 150 (14.3%) deaths were observed during follow-up. Multivariate analysis showed that logarithmic transformation of basophils count was associated with a 30% increment in the hazard of recurrence per unit increase of logarithmic basophils count (HR 1.30; 95% confidence interval 1.09–1.54;
p
= 0.0026). Basophil count modeled by quartiles was also significantly associated with time to recurrence second vs. lower quartile HR 1.42 (1.12–1.79);
p
= 0.003, third vs. lower quartile HR 1.26 (1.01–1.57);
p
= 0.041; upper vs. lower quartile HR 1.36 (1.1–1.68);
p
= 0.005. The limitations of a retrospective study are applicable.
Conclusion
Baseline basophil count may predict recurrence in BCG-treated HG/G3 T1 bladder cancer patients. External validation is warranted.
The role of walking, as compared with vigorous exercise, in the prevention of cardiovascular disease remains controversial. Data for women who are members of minority racial or ethnic groups are ...particularly sparse.
We prospectively examined the total physical-activity score, walking, vigorous exercise, and hours spent sitting as predictors of the incidence of coronary events and total cardiovascular events among 73,743 postmenopausal women 50 to 79 years of age in the Women's Health Initiative Observational Study. At base line, participants were free of diagnosed cardiovascular disease and cancer, and all participants completed detailed questionnaires about physical activity. We documented 345 newly diagnosed cases of coronary heart disease and 1551 total cardiovascular events.
An increasing physical-activity score had a strong, graded, inverse association with the risk of both coronary events and total cardiovascular events. There were similar findings among white women and black women. Women in increasing quintiles of energy expenditure measured in metabolic equivalents (the MET score) had age-adjusted relative risks of coronary events of 1.00, 0.73, 0.69, 0.68, and 0.47, respectively (P for trend, <0.001). In multivariate analyses, the inverse gradient between the total MET score and the risk of cardiovascular events remained strong (adjusted relative risks for increasing quintiles, 1.00, 0.89, 0.81, 0.78, and 0.72, respectively; P for trend <0.001). Walking and vigorous exercise were associated with similar risk reductions, and the results did not vary substantially according to race, age, or body-mass index. A brisker walking pace and fewer hours spent sitting daily also predicted lower risk.
These prospective data indicate that both walking and vigorous exercise are associated with substantial reductions in the incidence of cardiovascular events among postmenopausal women, irrespective of race or ethnic group, age, and body-mass index. Prolonged sitting predicts increased cardiovascular risk.
Hard X-ray observations are crucial to study the non-thermal jet emission from high-redshift, powerful blazars. We observed two bright z > 2 flat-spectrum radio quasars (FSRQs) in hard X-rays to ...explore the details of their relativistic jets and their possible variability. S50014+81 (at z = 3.366) and B0222+185 (at z = 2.690) have been observed twice by the Nuclear Spectroscopic Telescope Array (NuSTAR) simultaneously with Swift X-ray Telescope, showing different variability behaviors. We found that NuSTAR is instrumental to explore the variability of powerful high-redshift blazars, even when no gamma-ray emission is detected. The two sources have proven to have respectively the most luminous accretion disc and the most powerful jet among known blazars. Thanks to these properties, they are located at the extreme end of the jet-accretion disc relation previously found for gamma-ray detected blazars, to which they are consistent.
PDF
