Exercise mitigates flow recirculation and activates metabolic transducer SCD1 to catalyze vascular protective metabolites.

Exercise promotes pulsatile shear stress in the arterial circulation and ameliorates cardiometabolic diseases. However, exercise-mediated metabolic transducers for vascular protection remain under-investigated. Untargeted metabolomic analysis demonstrated that wild-type mice undergoing voluntary wheel running exercise expressed increased endothelial stearoyl-CoA desaturase 1 (SCD1) that catalyzes anti-inflammatory lipid metabolites, namely, oleic (OA) and palmitoleic acids (PA), to mitigate NF-κB-mediated inflammatory responses. In silico analysis revealed that exercise augmented time-averaged wall shear stress but mitigated flow recirculation and oscillatory shear index in the lesser curvature of the mouse aortic arch. Following exercise, endothelial Scd1-deleted mice (Ldlr-/- Scd1EC-/-) on high-fat diet developed persistent VCAM1-positive endothelium in the lesser curvature and the descending aorta, whereas SCD1 overexpression via adenovirus transfection mitigated endoplasmic reticulum stress and inflammatory biomarkers. Single-cell transcriptomics of the aorta identified Scd1-positive and Vcam1-negative endothelial subclusters interacting with other candidate genes. Thus, exercise mitigates flow recirculation and activates endothelial SCD1 to catalyze OA and PA for vascular endothelial protection.

Exercise Mitigates Flow Recirculation and Activates Mechanosensitive Transcriptome to Uncover Endothelial SCD1-Catalyzed Anti-Inflammatory Metabolites.

Exercise modulates vascular plasticity in multiple organ systems; however, the metabolomic transducers underlying exercise and vascular protection in the disturbed flow-prone vasculature remain under-investigated. We simulated exercise-augmented pulsatile shear stress (PSS) to mitigate flow recirculation in the lesser curvature of the aortic arch. When human aortic endothelial cells (HAECs) were subjected to PSS ( τ ave = 50 dyne·cm -2 , ∂τ/∂t = 71 dyne·cm -2 ·s -1 , 1 Hz), untargeted metabolomic analysis revealed that Stearoyl-CoA Desaturase (SCD1) in the endoplasmic reticulum (ER) catalyzed the fatty acid metabolite, oleic acid (OA), to mitigate inflammatory mediators. Following 24 hours of exercise, wild-type C57BL/6J mice developed elevated SCD1-catalyzed lipid metabolites in the plasma, including OA and palmitoleic acid (PA). Exercise over a 2-week period increased endothelial SCD1 in the ER. Exercise further modulated the time-averaged wall shear stress (TAWSS or τ ave) and oscillatory shear index (OSI ave ), upregulated Scd1 and attenuated VCAM1 expression in the disturbed flow-prone aortic arch in Ldlr -/- mice on high-fat diet but not in Ldlr -/- Scd1 EC-/- mice. Scd1 overexpression via recombinant adenovirus also mitigated ER stress. Single cell transcriptomic analysis of the mouse aorta revealed interconnection of Scd1 with mechanosensitive genes, namely Irs2 , Acox1 and Adipor2 that modulate lipid metabolism pathways. Taken together, exercise modulates PSS ( τ ave and OSI ave ) to activate SCD1 as a metabolomic transducer to ameliorate inflammation in the disturbed flow-prone vasculature.

COVID-19 Hospitalization Trends in Rural Versus Urban Areas in the United States.

Since the summer of 2020, the rate of coronavirus cases in the United States has been higher in rural areas than in urban areas, raising concerns that patients with coronavirus disease 2019 (COVID-19) will overwhelm under-resourced rural hospitals. Using data from the University of Minnesota COVID-19 Hospitalization Tracking Project and the U.S. Department of Health and Human Services, we document disparities in COVID-19 hospitalization rates between rural and urban areas. We show that rural-urban differences in COVID-19 admission rates were minimal in the summer of 2020 but began to diverge in fall 2020. Rural areas had statistically higher hospitalization rates from September 2020 through early 2021, after which rural-urban admission rates re-converged. The insights in this article are relevant to policymakers as they consider the adequacy of hospital resources across rural and urban areas during the COVID-19 pandemic.

Income shock and food insecurity prediction Vietnam under the pandemic.

As COVID-19 threatens the food security of vulnerable populations across the globe, there is an increasing need to identify places that are affected most in order to target aid. We propose a two-step approach to predict changes in food insecurity risk caused by income shocks at a granular level using existing household-level data and external information on aggregate income shocks. We apply this approach to assess changes in food insecurity risk during the pandemic in Vietnam. Using national household survey data between 2010 and 2018, we first estimate that a 10% decrease in income leads to a 3.5% increase in food insecurity. We then use the 2019 national Labor Force Survey to predict changes in the share of food-insecure households caused by the income shocks during the pandemic for 702 districts. We find that the small, predicted change in food insecurity risk at the national level masks substantial variation at the district level, and changes in food insecurity risk are larger among young children. Food relief policies, therefore, should prioritize a small number of districts predicted to be severely affected.

Prevalence, clinical characteristics, and management of irritable bowel syndrome in Vietnam: A scoping review.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders worldwide. Its prevalence varies significantly from country to country, largely due to heterogeneity in the available data. Recent studies show that the prevalence of IBS in Asia is on the rise. However, there are very limited data regarding its prevalence in the Vietnamese population. This review aims to offer an overview of the prevalence and clinical characteristics of IBS in the Vietnamese population; and to discuss the current management of IBS in Vietnam-taking into account the available medical resources and the local spectrum of lower gastrointestinal disorders that may mimic IBS.

Uptake of evidence by physicians: De-adoption of erythropoiesis-stimulating agents after the TREAT trial.

BACKGROUND: Variation in de-adoption of ineffective or unsafe treatments is not well-understood. We examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning. METHOD: We used a segmented regression approach to estimate changes in use of epoetin alfa (EPO) and darbepoetin alfa (DPO) in the commercial, Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. We also examined how changes in both trends and levels of use were associated with physicians' characteristics. RESULTS: Use of DPO and EPO declined over the study period. There were no consistent changes in DPO trend across insurance groups, but the level of DPO use decreased right after the FDA revision in all groups. The decline in EPO use trend was faster after the TREAT trial for all groups. Nephrologists were largely more responsive to evidence than primary care physicians. Differences by physician's gender, and age were not consistent across insurance populations and types of ESA. CONCLUSIONS: Physician specialty has a dominant role in prescribing decision, and that specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.

How do insurance firms respond to financial risk sharing regulations? Evidence from the Affordable Care Act.

Many insurance markets have reinstated premium stabilization programs to ensure financial protection from market volatility. In this paper, we focus on one such regulation-risk corridors (RCs)-in the context of the Health Insurance Marketplaces established under the Affordable Care Act. We develop a model to show how the program provided incentives for some insurers to lower their premiums. The RCs program was defunded unexpectedly for coverage year 2016, before its legislated end in 2016. Consistent with the model, we find that making a RCs claim before the program ended is associated with higher premium growth after the program's demise. The model and empirical evidence are consistent with the view that the end of the RCs program contributed to premium growth in the Marketplaces.

Prevalence and treatment of hyperlipidemia in patients with chronic hepatitis C infection.

BACKGROUND: Patients with chronic hepatitis C (HCV) infection can also have hyperlipidemia. Glucose intolerance has been associated with HCV infection and treating hyperlipidemia in this and other high-risk groups is warranted. We hypothesized that hyperlipidemia is common in patients with hepatitis C and that it is under-treated for fear of worsening liver function. DESIGN: From the Stratton Veterans Affairs Medical Center computerized database, we collected information on patients with HCV infection enrolled in hepatology clinic. We collected information on age, sex, duration of HCV infection, concomitant diagnoses, medications they were on, laboratory values including hepatic function, glucose, and lipid levels. We collected information on the lipid levels and various cardiovascular risk factors. METHODS: This is a retrospective study involving record review. We analyzed the data collected from the records for prevalence of high cholesterol (as defined by the National Cholesterol Education Program) and for prevalence of various cardiovascular risk factors. We analyzed prevalence of treatment of hyperlipidemia in various risk groups. In the patients who were treated for hyperlipidemia, we collected information on any worsening hepatic function that led to treatment discontinuation. RESULTS: Six hundred and twenty-eight (70.5%) out of 891 patients with hepatitis C had hyperlipidemia. Of the 628 patients who had hyperlipidemia, 81 (12.7%) had positive antibody and RNA not tested; 162 (25.4%) had positive antibody but negative RNA testing; and 385 (61.3%) had positive testing for viral RNA. Two hundred and eighty-four (45.2%) of 628 patients with hyperlipidemia were eligible for treatment to lower it. Of 146 patients with hyperlipidemia and diabetes mellitus or arterial disease who were qualified for treatment (LDL >99), 95 (65.1%) were treated with lipid-lowering medication. Of 148 patients with hyperlipidemia and without diabetes or arterial disease who were qualified for treatment, 64 (43.3%) were treated with lipid-lowering medication. CONCLUSION: A high prevalence of hyperlipidemia in patients infected with HCV is observed. Prevalence is highest among those who are positive for viral RNA. About half the patients with hyperlipidemia were eligible for treatment with drugs to lower it. Treatment of hyperlipidemia with medication though surprisingly common could improve.