Multi-element analysis of food dyes and assessment of consumer's health

The present study assessed metallic contaminants levels in food colourings using an inductively coupled plasma mass spectrometry (ICP-MS) in 51 samples of food dyes marketed in Algeria. The analysed samples were contaminated with lead (0.77 ± 0.034), arsenic (0.008 ± 0.006), cadmium (0.102 ± 0.047), cobalt (0.017 ± 0.008), copper (0.025 ± 0.011), chromium (0.820 ± 0.051), and nickel (0.022 ± 0.009) µg g-1. Mercury constituted a minor contaminant (<0.001 to 0.002 µg g-1). Turmeric and saffron were the most contaminated with Pb, As, Cd, Co, Cu, Cr, and Ni (p < 0.05). Health risk assessment revealed that infant population presents adverse non-carcinogenic effects (THQ = 4.25) and carcinogenic risk (HI = 4.65) linked to the consumption of food dyes contaminated with Cr.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Two-layer compression hosiery for patients with venous leg ulceration

Patients may experience a recurrence of leg ulceration if they do not wear prescribed compression hosiery when ulcers have healed. This article examines the use of compression hosiery kits, which can be used for the treatment of active ulceration as well as prevention of recurrence. For some patients, the stockings may be easier to apply than traditional compression hosiery, thereby enabling them to benefit from continued wear.

Experimental and theoretical studies on the thermal decomposition of heterocyclic nitrosimines

A series of substituted 2-nitrosiminobenzothiazolines (2) were synthesized by the nitrosation of the corresponding 2-iminobenzothiazolines (6). Thermal decomposition of 2a--f and of the seleno analogue 7 in methanol and of 3-methyl-2-nitrosobenzothiazoline (2a) in acetonitrile, 1,4-dioxane, and cyclohexane followed first-order kinetics. The activation parameters for thermal deazetization of 2a were measured in cyclohexane (Delta H(++) = 25.3 +/- 0.5 kcal/mol, Delta S(++) = 1.3 +/- 1.5 eu) and in methanol (Delta H(++) = 22.5 +/- 0.7 kcal/mol, Delta S(++) = -12.9 +/- 2.1 eu). These results indicate a unimolecular decomposition and are consistent with a proposed stepwise mechanism involving cyclization of the nitrosimine followed by loss of N(2). The ground-state conformations of the parent nitrosiminothiazoline (9a) and transition states for rotation around the exocyclic C==N bond, electrocyclic ring closure, and loss of N(2) were calculated using ab initio molecular orbital theory at the MP2/6-31G* level. The calculated gas-phase barrier height for the loss of N(2) from 9a (25.2 kcal/mol, MP4(SDQ, FC)/6-31G*//MP2/6-31G* + ZPE) compares favorably with the experimental barrier for 2a of 25.3 kcal/mol in cyclohexane. The potential energy surface is unusual; the rotational transition state 9a-rot-ts connects directly to the orthogonal transition state for ring-closure 9aTS. The decoupling of rotational and pseudopericyclic bond-forming transition states is contrasted with the single pericyclic transition state (15TS) for the electrocyclic ring-opening of oxetene (15) to acrolein (16). For comparison, the calculated homolytic strength of the N--NO bond is 40.0 kcal/mol (MP4(SDQ, FC)/6-31G*//MP2/6-31G* + ZPE).

Mechanisms of female urinary continence under stress: frequency spectrum analysis

Intravesical and urethral pressure signals during cough and Valsalva maneuvers for 15 continent women were analyzed with frequency spectrum analysis. Clear modulation of the urethral pressure changes by the intravesical pressure rise during stress maneuvers was demonstrated in the frequency bands of 14 and 7 Hz for cough and Valsalva, respectively. The linearity between the urethral and intravesical pressure signals was strong for cough, but relatively weaker for Valsalva. The observed linearity lead to the formulation of a modified continence equation to mathematically quantify stress leak point pressure (sLPP): sLPP=MUCP/(1-alpha1)+RBP. This algebraic equation demonstrated that sLPP depends on pressure transmission, resting bladder pressure, and maximum urethral closure pressure. The equation was validated with excellent theoretical predictions for the 15 continent subjects (R(2)=0.98 and 0.97 for cough and Valsalva leak point pressure, respectively) and good but somewhat weaker predictions for 46 stress incontinent women (R(2)=0.79 and 0.48, respectively). It has been shown that pressure transmission plays the most important role in female continence function, while it may be attributable to passive structural origin as evidenced by the minimal time delay between the two pressure signals, in the order of a few milliseconds. It can be concluded that coughing seems to have a more mechanical, rather than neuromuscular basis for its signal dynamics. This study suggests that a complete assessment of female stress continence function requires comprehensive urodynamic information in terms of pressure transmission, maximum urethral closure pressure, and resting bladder pressure.

Physical activity surveillance in the 21(st) century

PURPOSE: The 1996 Surgeon General's Report on Physical Activity and Health emphasized the health-related benefits of moderate-intensity physical activities, especially everyday activities. Unfortunately most surveillance systems in the U.S. primarily measure sports-related activities, particularly vigorous intensity sports. This report describes a new physical activity surveillance instrument designed to go beyond our current measures and include moderate-intensity everyday activities.METHODS: Data were collected from a nationally representative sample of adults (n = 5010). Questions were asked about occupational activity (mostly sitting; mostly walking; mostly heavy labor); walking (for exercise, transportation, or any other reason); moderate-intensity activities (brisk walking, yard work, vacuuming); vigorous-intensity activities (running, aerobics, heavy yard work); and strengthening activities (lifting weights, pull-ups, sit-ups). Questions included frequency and duration of activities. Respondents were defined as recommended if they participated in either moderate-intensity activities >/=30 min/day for >/=5 days/wk OR vigorous-intensity activities >/=20 min/day for >/=3 days/wk. Insufficient was defined as not meeting recommended levels while inactive was defined as no leisure-time activity.RESULTS: Overall 40% of adults were in the recommended group, 44% were in the insufficient group and 16% were inactive. Among working adults 37% had jobs that involved mostly walking or heavy labor and about 50% of those also were in the recommended group. Among the 63% of working adults who report mostly sitting at work, 39% were in the recommended group.CONCLUSIONS: These results suggest that measuring only leisure-time physical activity may under represent the physical activity experience of many U.S. adults. Broadening the concept of physical activity beyond traditional sports-related vigorous "exercise" may provide a more accurate picture of the prevalence of health-related physical activity.

Kaolin-induced hydrocephalus in the hamster: temporal sequence of changes in intracranial pressure, ventriculomegaly and whole-brain specific gravity

The development of kaolin-induced hydrocephalus in adult hamsters was monitored by measuring changes in intracranial pressure (ICP), ventriculomegaly (VG) and whole-brain specific gravity (SG). Controls were intact or sham operated animals. Relative to controls, ICP of experimental animals increased at 24 h post intracisternal kaolin injection (by approximately 7-fold), reached a maximum on day 6 (by approximately 12-fold) and remained markedly elevated through day 15 (by approximately 5-fold). Ventricles differed in time of onset of distension (third: day 1, lateral: day 2, fourth: day 4) and in time of maximum ventriculomegaly (fourth: day 6; third: day 7; and lateral: day 9). Ventricular distension resulted in alterations in the ependyma; cilia were lost and apical cell surfaces were distorted. The ependyma was ruptured and the subjacent neuropil was exposed to the cerebrospinal fluid in some regions. Whole-brain SG remained constant in controls but declined in hydrocephalic hamsters after day 3 post-kaolin injection and reached its nadir on day 9 when whole-brain water content was 18% greater than in controls. Consistent with the fact that causal relationships exist between increased ICP, ventricular distension and brain edema, the alterations in each parameter occurred sequentially rather than simultaneously, and the time-course of each manifestation of hydrocephalus differed. The data suggest that the pathophysiology of kaolin-induced hydrocephalus in the hamster is tri-phasic: an initial period of rapid change, a brief interval of maximum alteration, and a subsequent period of compensation.

Chemical meningitis from bile reflux in a lumbar-gallbladder shunt

OBJECTIVE AND IMPORTANCE

The gallbladder is used to divert cerebrospinal fluid (CSF) in patients with hydrocephalus when all other sites have been exhausted. This is seen in hydrocephalic patients who have reached teenage years but have undergone multiple shunt revisions, abdominal operations and repeated neck vein cannulations during childhood. One complication of the lumbar-gallbladder shunt is discussed as well as its pathophysiologic theory and management.

CLINICAL PRESENTATION

A case of a patient with a lumbar-gallbladder shunt who developed chemical meningitis from reflux of bile into the CSF space is presented. The patient presented with generalized seizures.

INTERVENTION

Included: ventilatory support, externalization of the shunt, correction of the metabolic abnormalities and administration of anticonvulsants and steroids.

CONCLUSION

This case illustrates an unusual occurrence of reflux of bile into the CNS through a lumbar-gallbladder shunt in a patient with long-term complex communicating hydrocephalus. It also demonstrates its mode of presentation and successful management. To our knowledge, this is the first case report of its kind.

Rumen motility during induced hyper- and hypocalcaemia

Rumen motility was recorded on an experimental cow by means of telemetric signal transfer from strain gauge force transducers fixed surgically on the peritoneal surface of the rumen wall in the left flank. The normocalcaemic cow was given a standard milk fever treatment with calcium borogluconate (400 ml with 14 mg Ca/ml) intravenously. Transient clinical signs were: decreased rumination, muscle ticks, salivation and a heart rate reduction of 20%. Rectal temperature remained unaltered. Frequency of rumen contractions was reduced up to 40% whereas amplitude of contractions did not deviate from baseline values. Hypocalcaemia was induced in a second experiment by iv infusion of Na2EDTA. At 0.60 mmol/l ionized blood calcium periods of no motility were recorded whereas inactivity of rumen activity was persistent at 0.55 mmol/l ionized blood calcium. The cow went down at 0.45-0.48 mmol/l ionized blood calcium at which point the heart rate was increased by 40%. The high sensitivity of the method employed allowed the conclusion that already at a concentration of ionized blood calcium at 1.0 mmol/l both frequency and amplitude of rumen contractions decreased rapidly although eating behaviour and rumination appeared unaffected during the short term observation periods. Implications of this finding towards health and production in transition cows are discussed.

Scanning electron microscopy of central nervous system cerebrospinal-fluid-contacting surfaces: a bibliography (1963-1995)

This bibliography is compiled to assist in locating papers related to the application of scanning electron microscopy (SEM) to cerebrospinal-fluid-contacting surfaces in vertebrates. The use of SEM by neuroscientists has continued apace since the publication of the first bibliography in 1980. SEM studies now include more than 50 species of vertebrates and range from cyclostomes to humans; they encompass development from embryo to senescence and concern both normal and pathologic morphology. Although remarkable strides have been made toward a greater understanding of many aspects of the structure and function of cerebrospinal-fluid-contacting surfaces, many significant problems await the judicious application of scanning electron microscopy.

Personality and scientific promise

This study examined personality characteristics of 21 boys and 11 girls, children gifted in science and attending a junior high school. Differences between these boys and girls in Grade 6 were noted. Implications for teaching and directions for future research are noted.