Hypertension is a chronic cardiovascular disease of extreme and important global concern. It has been established as a leading cause of death especially in humans. The aim of this study was to ...evaluate the possible antihypertensive effect of a common locally available plant Morinda lucidaagainst L‐Nitro‐Arginine‐Methyl‐Ester (L‐NAME)‐induced hypertension in male Wistar rats.
Forty‐eight rats were used for the experiment. They were divided into six groups labelled A‐F, each containing eight animals. The animals were dosed for six weeks with group A being the control group (normotensive) given feed and water ad libitun; Group B animals were administered L‐NAME only, 40 mg/kg (hypertensive); Groups C, D and E were simultaneously treated with L‐NAME (40 mg/kg) and Morinda lucida extract in increasing doses of 100 mg/kg, 200 mg/kg and 400 mg/kg, respectively, while Group F were given lisinopril at 20 mg/kg for a period of 6 weeks. From the result, there was significant increase in systolic, diastolic, and mean arterial blood pressure in the hypertensive group compared to the normotensive group and hypertensive treated groups. Hypertension caused significant (p<0.05) increases in oxidative stress markers, including malondialdehyde (MDA), protein carbonyl (PC), hydrogen peroxide (H2O2), while reducing the activities of superoxide dismutase (SOD), and serum nitric oxide (NO) levels. Also, serum myeloperoxidase (MPO), blood urea nitrogen and creatinine were increased with high expression of cardiac injury biomarkers such as cardiac troponin and angiotensin 2 type 1 receptor. These indicated oxidative stress, cardiac damage because of hypertension, most especially in the untreated hypertensive group. The co‐treatment of hypertensive rats with Morinda lucida extract caused reduction in markers of oxidative stress and inflammation and normalized blood pressure parameters. The findings from this study suggest the possibility of using Morinda lucida extract as a novel antihypertensive agent.
Background
Adherence to cancer screening is important for cancer survivors because they are at high risk of subsequent cancer diagnoses or recurrence. We assessed adherence to breast, cervical, and ...colorectal cancer‐(CRC)‐screening guidelines and evaluated demographic disparities among a population‐based sample of survivors.
Methods
A representative sample of Utah survivors diagnosed from 2012–2018 with any reportable invasive cancer was selected from central cancer registry records for a survey about survivorship needs. We estimated the proportion of eligible survivors adhering to U.S. Preventive Services Task Force screening guidelines and calculated risk ratios and 95% confidence intervals. Analyses were age‐adjusted and weighted to account for sample design and nonresponse.
Results
And 1421 survivors completed the survey (57.2% response rate). Screening adherence was 74.4% for breast, 69.4% for cervical, and 79.7% for CRC. Rural residents were more likely to adhere to breast cancer screening than urban residents (86.1% vs. 72.7%; adjusted RR = 1.19, CI = 1.05, 1.36). Higher educational attainment was associated with increased adherence to cervical and colorectal cancer screening. Younger age was associated with greater adherence to cervical cancer screening (p = 0.006) but lower adherence to CRC screening (p = 0.003). CRC screening adherence was lower among the uninsured and those without a primary care provider (45.6%) compared to those with a regular provider (83.0%; adjusted RR = 0.57, CI = 0.42, 0.79).
Conclusions
Surveys based on samples from central cancer registries can provide population estimates to inform cancer control. Findings demonstrate work is needed to ensure all Utah cancer survivors obtain recommended cancer screenings. Efforts should focus particularly on increasing uptake of breast and cervical cancer screening and reducing demographic disparities in CRC screening.
Precis
Despite high risk for subsequent cancer diagnosis, Utah cancer survivors are not all obtaining recommended breast, cervical, and colorectal cancer screenings. This presents a significant healthcare gap.
In this paper, we examine adherence to breast, cervical, and colorectal cancer screening guidelines using a population‐based sample survey of cancer survivors in Utah. Our findings indicate additional work is needed to ensure all Utah cancer survivors obtain recommended cancer screenings and reduce demographic disparities in screening.
Carbon dioxide (CO2) is the most important anthropogenic greenhouse gas contributing to about half of the total anthropogenic change in the Earth's radiation budget. And about half of the ...anthropogenic CO2 emissions stay in the atmosphere, the remainder is taken up by the biosphere. It is of paramount importance to better understand CO2 sources and sinks and their spatio-temporal distribution. In the context of climate change this information is needed to improve the projections of future trends in carbon sinks and sources. Since the terrestrial carbon and water cycles are tightly coupled by biological plant processes, i.e. through the stomatal gas exchange with the atmosphere, it is expected that information on the soil moisture state will help to constrain terrestrial carbon fluxes. In the present feasibility study we employ the Carbon Cycle Data Assimilation System CCDAS to pioneer the assimilation of the SMOS L3 soil moisture product together with another biophysical data set — in this case atmospheric CO2 flask samples. The two data streams are assimilated into a process-based model of the terrestrial carbon cycle over two years. CCDAS aims to optimise model process parameters and subsequently land surface CO2 exchange fluxes. We find that the assimilation of SMOS data improves the agreement with independent soil moisture data from the active ASCAT instrument. In both cases the assimilation also improves the fit of modelled atmospheric CO2 to the observations at flask sampling sites which have not been used in the assimilation. Reduction of uncertainty relative to the prior is generally high for both regional net ecosystem productivity and net primary productivity and considerably higher than for assimilating CO2 only, which quantifies the added value of SMOS observations as a constraint on the terrestrial carbon cycle. The study demonstrates a high potential for a SMOS L4 carbon flux product.
•Simultaneous assimilation of atmospheric CO2 and SMOS soil moisture observations•Significant added value (uncertainty reduction in C fluxes) compared to CO2 only•Validation against independent data shows improvement of model results.•Potential for SMOS L4 carbon product when SMOS data is assimilated jointly with CO2.
Purpose
Race and Hispanic ethnicity data can be challenging for central cancer registries to collect. We evaluated the accuracy of the race and Hispanic ethnicity variables collected by the Utah ...Cancer Registry compared to self-report.
Methods
Participants were 3,162 cancer survivors who completed questionnaires administered in 2015–2022 by the Utah Cancer Registry. Each survey included separate questions collecting race and Hispanic ethnicity, respectively. Registry-collected race and Hispanic ethnicity were compared to self-reported values for the same individuals. We calculated sensitivity and specificity for each race category and Hispanic ethnicity separately.
Results
Survey participants included 323 (10.2%) survivors identifying as Hispanic, a lower proportion Hispanic than the 12.1% in the registry Hispanic variable (sensitivity 88.2%, specificity 96.5%). For race, 43 participants (1.4%) self-identified as American Indian or Alaska Native (AIAN), 32 (1.0%) as Asian, 23 (0.7%) as Black or African American, 16 (0.5%) Pacific Islander (PI), and 2994 (94.7%) as White. The registry race variable classified a smaller proportion of survivors as members of each of these race groups except White. Sensitivity for classification of race as AIAN was 9.3%, Asian 40.6%, Black 60.9%, PI 25.0%, and specificity for each of these groups was > 99%. Sensitivity and specificity for White were 98.8% and 47.4%.
Conclusion
Cancer registry race and Hispanic ethnicity data often did not match the individual’s self-identification. Of particular concern is the high proportion of AIAN individuals whose race is misclassified. Continued attention should be directed to the accurate capture of race and ethnicity data by hospitals.
Introduction/Purpose:
Increasing attention is being paid to the costs associated with various orthopedic surgeries. Here, we studied the factors that influence costs associated with surgically ...treated acute Achilles tendon tears.
Methods:
We retrospectively identified patients with surgically repaired acute Achilles tendon tears, excluding insertional ruptures or chronic tendon issues. Using the Value Driven Outcome (VDO) tool from our institution, we assessed total direct costs as well as facility costs. Briefly, the VDO tool includes an item-level database that can capture granular-level cost data – costs are then reported as relative mean data. Cost variables were adjusted to 2022 US dollars, and total direct cost was compared with patient characteristics using gamma regressions to report cost ratios with 95% confidence intervals (CIs).
Results:
Our cohort consisted of 224 patients with Achilles tendon tears surgically repaired by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographics, total direct costs, or facility costs based on positioning (prone N =156, supine N =68). Total direct costs were 9% higher in males (N =182) compared to females (N =42) (p=0.023, 95% CI: 1.01-1.17) in an unadjusted analysis. Mini-open repairs (N =215), compared to percutaneous techniques (N =9), had 32% less total direct costs (p < 0.001; 95% CI: 0.60-0.78). Compared to surgery at a main academic hospital (N =15), procedures at an ambulatory care center (N =207) had 25% lower total direct costs (p < 0.001; 95% CI: 0.67-0.83) and 44% lower reduced facility costs (p < 0.001; 95% CI: 0.51-0.61). Significance was maintained in multivariable analysis except for sex.
Conclusion:
Improving cost-effective orthopedic care remains an increasingly important goal. Patient positioning for Achilles tendon repair does not appear to have meaningful effects on cost. Surgery at an ambulatory center was significantly less costly than repairs performed at an academic hospital. When clinically appropriate, considering surgery location at an ambulatory center appears to reduce surgical costs.
Hypertension is a condition with chronic elevation of blood pressure and a common preventable risk factor for cardiovascular disease with attendant global morbidity and mortality. The present study ...investigated the novel antihypertensive action of Naringenin on NƱ‐Nitro‐L‐arginine Methyl Ester (L‐NAME)‐induced hypertension together with possible molecular mechanism of action. Rats were divided into four groups. Rats in Group A were normotensive. The hypertensive group (Group B) received 40 mg/kg) of L‐NAME alone while Groups C and D were concurrently administered Naringenin (50 mg/kg) or Lisinopril (10 mg/Kg) together with L‐NAME orally for 3 weeks. Blood pressure parameters, markers of oxidative stress and renal damage were measured. The immunohistochemistry of kidney injury molecule 1, mineralocorticoid receptor and angiotensin converting enzyme were also determined. Results indicated significant increase in oxidative stress markers and decrease in serum nitric oxide bioavailability in hypertensive rats. Furthermore, there were significant increases in serum myeloperoxidase activity, urinary creatinine, albumin, and blood urea nitrogen levels in hypertensive rats in comparison to hypertensive rats treated with Naringenin. Immunohistochemistry revealed higher expression of kidney injury molecule 1, mineralocorticoid receptor and angiotensin converting enzyme in hypertensive rats. However, co‐treatment with Naringenin mitigated renal oxidative stress, normalized blood pressure and lowered the expression of kidney injury molecule 1, mineralocorticoid receptor, and angiotensin converting enzyme. Combining all, Naringenin offered a novel antihypertensive action through the down regulation of kidney injury molecule 1, deactivation of mineralocorticoid receptor and inhibition of angiotensin converting enzyme.
We examined the course of maternal depressive symptoms and children's attachment security at 36 months in a large sample of mother-child pairs from 10 sites across the country participating in the ...NICHD Study of Early Child Care (N = 1077). Maternal depressive symptoms predicted higher rates of insecure attachment. Women who reported intermittent symptoms across the first 36 months had preschoolers who were more likely to be classified as insecure C or D; women with chronic symptoms were more likely to have preschoolers who were classified as insecure D. Symptoms reported only during the first 15 months were not associated with elevated rates of later insecurity. After controlling for potentially confounding demographic variables, maternal sensitivity (observed at 6, 15, 24, and 36 months) did not meaningfully account for links between attachment security and patterns of depressive symptoms. However, the course and timing of maternal depressive symptoms interacted with maternal sensitivity to predict insecurity. Women with late, intermittent, or chronic symptoms who were also low in sensitivity were more likely to have preschoolers who were insecure, in contrast to symptomatic women who were high in sensitivity. These data have implications for understanding the combined impact of maternal depressive symptoms and maternal sensitivity on children's socioemotional development.
Increasing attention is being paid to the costs associated with various orthopaedic surgeries. Here, we studied the factors that influence costs associated with surgically treated acute Achilles ...tendon tears.
We retrospectively identified patients with surgically repaired acute Achilles tendon tears, excluding insertional ruptures or chronic tendon issues. Using the Value Driven Outcome (VDO) tool from our institution, we assessed total direct costs as well as facility costs. Briefly, the VDO tool includes an item-level database that can capture detailed cost data-costs are then reported as relative mean data. Cost variables were adjusted to 2022 US dollars, and total direct cost was compared with patient characteristics using gamma regressions to report cost ratios with 95% CIs.
Our cohort consisted of 224 patients with Achilles tendon tears surgically repaired by one of 4 fellowship-trained orthopaedic foot and ankle surgeons. There were no differences in demographics, total direct costs, or facility costs based on surgical positioning (prone n = 156, supine n = 68). Open repairs (n = 215), compared with percutaneous techniques (n = 9) that used commercially available instrumentation, had 37% less total direct costs (
< .001, 95% CI 0.55-0.72). Compared with surgery at a main academic hospital (n = 15), procedures at an ambulatory care center (n = 207) had 19% lower total direct costs (
= .040, 95% CI 0.66-0.99) and 41% lower facility costs (
< .001, 95% CI 0.5-0.7).
Improving cost-effective orthopaedic care remains an increasingly important goal. Patient positioning for Achilles tendon repair does not appear to have meaningful impacts on cost. When clinically appropriate, considering surgery location at an ambulatory center appears to reduce surgical costs.
Level III, retrospective comparative study.
Describe material financial hardship (e.g., using savings, credit card debt), insurance, and access to care experienced by Utah cancer survivors; investigate urban-rural differences in financial ...hardship.
Cancer survivors were surveyed from 2018 to 2021 about their experiences with financial hardship, access to healthcare, and job lock (insurance preventing employment changes). Weighed percentage responses, univariable and multivariable logistic regression models for these outcomes compared differences in survivors living in rural and urban areas based on Rural-Urban Commuting Area Codes.
The N = 1793 participants were predominantly Non-Hispanic White, female, and 65 or older at time of survey. More urban than rural survivors had a college degree (39.8% vs. 31.0%, p = 0.04). Overall, 35% of survivors experienced ≥ 1 financial hardship. In adjusted analyses, no differences were observed between urban and rural survivors for: material financial hardship, the overall amount of hardship reported, insurance status at survey, access to healthcare, or job lock. Hispanic rural survivors were less likely to report financial hardship than Hispanic urban survivors (odds ratio (OR) = 0.24, 95%CI = 0.08-0.73)). Rural survivors who received chemo/immune therapy as their only treatment were more likely to report at least one instance of financial hardship than urban survivors (OR = 2.72, 95%CI = 1.08-6.86).
The relationship between rurality and financial hardship among survivors may be most burdensome for patients whose treatments require travel or specialty medication access.
The impact of living rurally on financial difficulties after cancer diagnoses is complex. Features of rurality that may alter financial difficulty after a cancer diagnosis may vary geographically and instead of considering rurality as a stand-alone factor, these features should be investigated independently.
Background
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare tumor for which there are few evidence‐based guidelines. The aim of this study was to define current management strategies ...and outcomes for these patients using a multi‐institutional dataset curated by the Pediatric Surgical Oncology Research Collaborative.
Methods
Data were collected retrospectively for patients with UESL treated across 17 children's hospitals in North America from 1989 to 2019. Factors analyzed included patient and tumor characteristics, PRETEXT group, operative details, and neoadjuvant/adjuvant regimens. Event‐free and overall survival (EFS, OS) were the primary and secondary outcomes, respectively.
Results
Seventy‐eight patients were identified with a median age of 9.9 years interquartile range IQR): 7–12. Twenty‐seven patients underwent resection at diagnosis, and 47 patients underwent delayed resection, including eight liver transplants. Neoadjuvant chemotherapy led to a median change in maximum tumor diameter of 1.6 cm IQR: 0.0–4.4 and greater than 90% tumor necrosis in 79% of the patients undergoing delayed resection. R0 resections were accomplished in 63 patients (81%). Univariate analysis found that metastatic disease impacted OS, and completeness of resection impacted both EFS and OS, while multivariate analysis revealed that R0 resection was associated with decreased expected hazards of experiencing an event hazard ratio (HR): 0.14, 95% confidence interval (CI): 0.04–0.6. At a median follow‐up of 4 years IQR: 2–8, the EFS was 70.0% 95% CI: 60%–82% and OS was 83% 95% CI: 75%–93%.
Conclusion
Complete resection is associated with improved survival for patients with UESL. Neoadjuvant chemotherapy causes minimal radiographic response, but significant tumor necrosis.
