6 research outputs found
Advancements in the use of blood tests for cancer screening in women at high risk for endometrial and breast cancer
No full textSeveral years ago, it was argued that the identification of serum biomarkers is one of the most promising approaches for the detection of early-stage malignant or even premalignant lesions. In this review, the need to establish better monitoring protocols is described for obese women who are at higher risk for the development of malignancies commonly associated with excess weight; specifically endometrial and postmenopausal breast cancer. These cancers have been chosen for this review article as our aim was to focus on female cancers that have been linked with obesity. Cancer screening is essential in detecting disease in its earliest stage in order to reduce morbidity and mortality; however, effective screening is not available for many cancer types. Even for cancers that have effective screening protocols available, there are barriers to screening in obese individuals, such as reduced mobility and embarrassment. These barriers often delay screening in these vulnerable population groups, leading to detection of the disease at a more advanced stage and ultimately leading to a poorer prognosis. As of today, biomarkers do not replace but augment imaging and other existing screening approaches. Future development of blood- or urine-based biomarkers as a way to screen individuals at high risk for certain cancers may prove to be an excellent method for overcoming the barriers that individuals at high risk are facing today. The overall purpose of this manuscript is to provide an overview of screening techniques and to identified barriers and alternate biomarker-based approaches for improvement of endometrial and breast cancer screening in obese women.</jats:p
Associations Between Weight Loss and Regain, Cytokine Concentration, and Insulin Resistance Among Overweight/Obese Adults
No full textObesity is a problem of great public health significance, with over one-third of individuals in the U.S. being obese; it is also associated with an increased risk for cardiometabolic diseases. Abnormal cytokine secretion of pro-inflammatory (IL-6 and TNF-α) and anti-inflammatory (adiponectin and IL-10) cytokines is a hallmark of obesity, linking it to the development of insulin resistance (IR). Weight maintenance after intentional weight loss is difficult to achieve, and individuals often regain weight, entering into a pattern of weight cycling. Little is known on the associations between weight cycling, cytokines, and IR. This dissertation, comprising three research papers, aimed to examine these associations among non-diabetic, overweight/obese adults (N=66) enrolled in the Self-Monitoring And Recording using Technology (SMART) Trial, a 24-month clinical trial of behavioral weight loss treatment.
The first paper examined patterns of weight loss and regain and its effect on pro- and anti-inflammatory cytokines from baseline to 24 months. An interaction between gender and percent change in weight on percent change in adiponectin over time was detected [b(se)=0.9(0.2), p=.0003]. There was an association with increases in IL-6 [b(se)=0.9(0.3), p=.001]. The second paper examined patterns of weight loss and regain and their effect on metabolic measures from baseline to 24 months. Weight change was positively associated with changes in insulin [b(se)=0.5(0.1), p≤.0001] and HOMA-IR [b(se)=0.8(0.2), p≤.0001] over time. The third paper examined polymorphisms in genes encoding IL-6, TNF-α, adiponectin, and IL-10 and their association with cytokine concentration and IR. C allele carriers in IL-10 polymorphism rs1800896 had higher HOMA-IR compared to TT carriers [b(se)=1.0(0.4), p=0.02]. Variant allele carriers in IL-10 polymorphisms rs1800871 and rs1800872 had lower HOMA-IR compared to individuals homozygous for the wild type allele [for both polymorphisms: b(se)=-1.2(0.4), p=.01]. There was a significant within-group decrease in HOMA-IR from baseline to 24 months among individuals with the rs1800872 GG genotype but not for T allele carriers.
These findings reveal weight loss to be an important tool in reducing inflammation and improving insulin sensitivity; however, weight regain can attenuate these improvements. Moreover, the association between IL-10 polymorphisms and IR suggests that cytokine genes play a role in metabolic outcomes
Recommended from our members
Objective sleep and cardiometabolic biomarkers: results from the community of mine study.
No full textSTUDY OBJECTIVES: Examining multiple dimensions of sleep health may better capture associations between sleep and health risks, including cardiometabolic disease (CMD). Hispanics have elevated risk for inadequate sleep and CMD biomarkers. Few studies have explored whether associations between sleep and CMD differ by Hispanic ethnicity. METHODS: Leveraging data from the Community of Mine (CoM) study, a cross-sectional investigation of 602 ethnically diverse participants, we derived accelerometer-measured sleep duration and efficiency, and self-reported sleep quality. Accelerometer-measured sleep exposures were analyzed both as continuous and categorical variables. Multivariate and quantile regression models were used to assess associations between sleep and CMD biomarkers (insulin resistance, systolic blood pressure, and low-density-lipoprotein cholesterol), controlling for age, sex, ethnicity, education, smoking status, and body mass index. We examined the potential effect modification of Hispanic ethnicity. RESULTS: We observed mixed results based on CMD biomarkers and sleep exposure. Increased sleep duration was significantly related to low-density lipoprotein cholesterol in adjusted models (estimate = 0.06; 95% CI: 0.02, 0.11). Poor sleep efficiency was associated with greater insulin resistance in the adjusted quantile (estimate = 0.20; 95% CI: 0.04, 0.36) model at the 90th percentile. Self-reported sleep quality was not associated with CMD outcomes. There was no evidence of effect modification by Hispanic ethnicity. CONCLUSIONS: In this cohort, sleep health measures were found to have mixed and at times opposing effects on CMD outcomes. These effects did not demonstrate an interaction with Hispanic ethnicity
Low vertebral ano-rectal cardiac tracheo-esophageal renal limb screening rates in children with anorectal malformations
No full text© 2016 Elsevier Inc. Background The aim of this study was to establish the rate of screening for associated cardiac, vertebral, spinal cord, urologic, and limb anomalies vertebral ano-rectal cardiac tracheo-esophageal renal limb (VACTERL) in children with anorectal malformation (ARM). Methods We performed a retrospective cohort study using the Medicaid Analytic eXtract database which contains enrollment and utilization claims and demographic information from all Medicaid enrollees. Patients born between January 2005 and December 2008 with International Classification of Diseases, Ninth Revision codes for a diagnosis of ARM within 30 days of life, an ARM procedure code during the first year of life, and a minimum of 12 months of continuous enrollment were included. VACTERL screening was determined using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes for diagnostic tests used to detect these anomalies. Results A total of 406 patients were identified (231 males). Evaluation of the spinal vertebrae was performed in 94% of patients (381 of 406). Spinal cord evaluation was performed in 57% (231 of 406): 52% (121 of 231) received spinal ultrasound (US), 24% (56 of 231) received spinal magnetic resonance imaging, and 23% (54 of 231) received both. Sacral radiographs were performed in 8% (32 of 406) and 77% (313 of 406) underwent an echocardiogram. Genitourinary evaluation was performed in 84% (341 of 406): 67% (229 of 341) received renal US, 8% (27 of 341) received abdominal US, and 25% (85 of 341) received both. Limb evaluation was recorded in 19% (76 of 406). Multiple screening including an echocardiogram, spinal radiograph, spinal cord evaluation, and renal evaluation was performed in 45% (181 of 406); 2% (7 of 406) did not receive any screening tests. Conclusions Low VACTERL screening in children with ARM suggests that associated anomalies may be undiagnosed which may lead to increased long-term morbidity
EFFECTIVENESS OF PATIENT CHOICE IN NONOPERATIVE VS SURGICAL MANAGEMENT OF PEDIATRIC UNCOMPLICATED ACUTE APPENDICITIS
No full textАктуальность. Имеющиеся доказательства позволяют считать, что консервативное лечение неосложненного аппендицита безопасно. Однако суммарная эффективность лечения детей определяется сочетанием медицинских исходов с ожиданиями как самих пациентов, так и членов их семьи.Цель исследования. Определить эффективность1 выбора пациентом между консервативным и хирургическим способами лечения неосложненного острого аппендицита у детей.Дизайн, условия и участники исследования. Прове дено проспективное когортное исследование среди детей и подростков в возрасте от 7 до 17 лет с острым неосложненным аппендицитом. Исследование проводили на базе отдельно взятой высокоспециализированной детской больницы скорой неотложной помощи в период с 1 октября 2012 по 6 марта 2013 г. Пациенты и члены их семей подтверждали свое участие в иссле- довании информированным согласием, выбирая между консервативным способом лечения и неотложной аппендэктомией.Вмешательства. Неотложная аппендэктомия так же, как и консервативное лечение, подразумевает наблюдение в стационаре в течение по крайней мере 24 ч с введением антибиотиков внутривенно и, при улучшении симптомов, завершение лечения курсом приема антибиотиков в течение 10 сут.Основные исходы. Основным (первичным) исходом считали случаи (частоту) консервативного лечения, не потребовавшие оперативного вмешательства в течение 1 года после включения в исследование. В качестве дополнительных (вторичных) исходов анализировали частоту случаев осложненного аппендицита, число дней, в течение которых пациент имел ограничения жизнедеятельности (disability days), а также расходы на медицинские услуги в сравниваемых группах (консервативное лечение в сравнении с хирургическим).Результаты. В исследовании приняли участие 102 пациента; 65 пациентов/семей выбрали аппендэктомию [медиана возраста пациентов 12 лет; межквартильный размах — 9–13 лет; 45 (69%) пациентов мужского пола], 37 пациентов/семей выбрали консервативное лечение [возраст 11 (10–14) лет; 24 (65%) пациента мужского пола]. Исходные характеристики групп не различались. Основной исход исследования в группе консервативного лечения был достигнут в 89% случаев (95% ДИ 75–97) по истечении 30 сут (33 из 37 детей) и в 76% (95% ДИ 59–88) — по истечении 1 года (28 из 37 детей). Частота случаев осложненного аппендицита составила 2,7% в группе консервативного лече- ния (1 из 37 детей) и 12,3% — в группе с хирургическим вмешательством (8 из 65 детей; p = 0,150). По прошествии 1 года дети из группы консервативного лечения имели меньше дней ограничения жизнедеятельности, чем дети из группы с хирургическим вмешательством [Me 8 (5–18) и 21 (15–25) день, соответственно; p < 0,001]. Ниже в группе консервативного лечения были и расходы, связанные с лечением основного заболевания и уходом за пациентами [Me 4219 (2514–7795) и 5029 (4596–5482) долл. США, соответственно; p = 0,010].Выводы и клиническая значимость. При согласии семьи консервативное лечение является эффективным способом лечения детей с неосложненным острым аппендицитом, характеризуется меньшим риском осложнений при меньшей стоимости лечения по сравнению с хирургическим вмешательством
