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Abstract

Background: Environmental enteropathy (EE) is subclinical, diffuse villous atrophy characterized by T cell infiltration of the small intestinal mucosa associated with nutrient malabsorption and stunting. EE is assessed by the lactulose:mannitol (L:M) test, whereby nonmetabolized sugars are ingested and quantified in the urine. Multiple micronutrient (MN) deficiency morphologically mimics EE, and ω-3 (n–3) polyunsaturated fatty acids reduce mucosal inflammation in Crohn disease.

Background:

Objective: We tested the hypothesis that supplementary MNs, with or without fish oil (FO), would improve L:M in rural Malawian children aged 1–3 y compared with a control (C) group receiving a placebo.

Objective:

Methods: The MNs and FO provided the Recommended Dietary Intake for 26 vitamins, minerals, eicosapentaenoic acid, and docosahexaenoic acid. This was a 3-arm, randomized, double-blind, placebo-controlled clinical trial, with the primary outcomes being the change in L:M (ΔL:M) after 12 and 24 wk of supplementation. Comparisons were made for ΔL:M after 12 and 24 wk within each group by using a Wilcoxon matched pairs signed rank test, because the data are not normally distributed.

Methods:

Results: A total of 230 children had specimens adequate for analysis; all had an abnormal baseline L:M, defined as >0.10. After 12 wk, children who received MNs + FO had a ΔL:M [mean (95% CI)] of −0.10 (−0.04, −0.15; P = 0.001), and children receiving only MNs had ΔL:M of −0.12 (−0.03, −0.21; P = 0.002). After 24 wk, children who received MNs + FO had a ΔL:M of −0.09 (−0.03, −0.15; P = 0.001); children receiving only MNs had a ΔL:M of −0.11 (−0.02, −0.20; P = 0.001), and the C group had ΔL:M of −0.07 (0.02, −0.16); P = 0.002). Linear growth was similar in all groups, ∼4.3 cm over 24 wk.

Results:

Conclusion: Although the effect was modest, these data suggest MNs can transiently ameliorate EE in rural African children. The trial was registered at Sale Sale Explore broderie anglaise denim shorts Pink amp; Purple Isabel Marant Free Shipping Cheap Price Free Shipping Latest YeBSQJQW
as NCT01593033.

Conclusion:
, , , ,
Topic:
Issue Section:

Environmental enteropathy (EE) 8 also referred to as environmental enteric dysfunction, is characterized by diffuse small bowel villous atrophy with T cell infiltration and is associated with nutrient malabsorption ( 1 5 ). EE is commonly observed in preschool age Malawian children living in poverty and is associated with stunting ( 6 ). The cause of EE is likely multifactorial; microbial contamination of food and poor hygiene practices are associated with EE ( 4 , 7 ). Previous attempts to ameliorate EE by alteration of bacterial populations in the intestinal tract have been unsuccessful, suggesting the nutritional and inflammatory status of the host modulates the severity of EE ( 8 , 9 ).

Implantable cardioverter defibrillator indications in patients with unexplained syncope and arrhythmogenic right ventricular cardiomyopathy

ARVC = arrhythmogenic right ventricular cardiomyopathy; ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; SCD = sudden cardiac death.

a

Unexplained (or uncertain) syncope is defined any syncope that does not meet class I diagnostic criteria defined in the tables of recommendations in section 4. In the presence of clinical features described in this section, unexplained syncope is considered a risk factor for ventricular tachyarrhythmias.

b
c

Implantable cardioverter defibrillator indications in patients with unexplained syncope and arrhythmogenic right ventricular cardiomyopathy

ARVC = arrhythmogenic right ventricular cardiomyopathy; ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; SCD = sudden cardiac death.

a
b
c

Syncopal events in long QT syndrome (LQTS) are associated with an increased risk of subsequent cardiac arrest. The annual rate of SCD in patients with untreated LQTS is around 0.9% overall and 5% for those with syncope. 352 , 364 Beta-blocker therapy substantially reduces the risk of syncope and SCD, but presentation with cardiac arrest and recurrent syncope during beta-blocker therapy is associated with the same risk of fatal events as in untreated patients. 46 For this reason, ICD treatment should be considered in patients with LQTS and recurrent unexplained syncope despite beta-blocker therapy, especially in cases of good treatment compliance, in the absence of precipitating factors, and in LQT2 and LQT3 syndromes. Left cardiac sympathetic denervation should also be considered in this situation, particularly in LQT1. 46

Implantable cardioverter defibrillator indications in patients with unexplained syncope and long QT syndrome

ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; LQTS = long QT syndrome; SCD = sudden cardiac death.

a

Unexplained (or uncertain) syncope is defined as any syncope that does not meet class I diagnostic criteria defined in the tables of recommendations in section 4. In the presence of clinical features described in this section, unexplained syncope is considered a risk factor for ventricular tachyarrhythmias.

b
c

Implantable cardioverter defibrillator indications in patients with unexplained syncope and long QT syndrome

ICD = implantable cardioverter defibrillator; ILR = implantable loop recorder; LQTS = long QT syndrome; SCD = sudden cardiac death.

a
b
c

A history of syncope may increase the risk of arrhythmic events up to two- to three-fold compared with that in asymptomatic patients. In the largest registry (1029 patients), the incidence of arrhythmic events (sustained VT or VF, appropriate ICD therapy, or sudden death) in patients with Brugada syndrome was 7.7% per year in those with a history of sudden cardiac arrest, 1.9% per year with syncope, and 0.5% per year in asymptomatic patients. 353 However, in a second study, the rate of appropriate ICD shocks was similar in asymptomatic patients and in those with syncope, a difference possibly explained by patient selection and a high rate of non-arrhythmic syncope. 355

In his three seasons, Abdullah has averaged 3.8 yards per carry. He has never rushed for more than 600 yards in a single campaign, and injuries have limited him to just 16 games over the last two years.

In 2017, Abdullah produced a paltry 3.3 yards per carry and never looked like a major offensive threat. With the Lions adding both Kerryon Johnson and LeGarrette Blount this offseason, 2017 may have represented his last chance to become one.

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12 of 32

The Green Bay Packers invested heavily in their secondary at the top of this year's draft. The did the same thing back in 2015, drafting cornerbacks Damarious Randall and Quinten Rollins in the first two rounds.

Hopefully, this year's additions of Jaire Alexander and Josh Jackson prove to be more fruitful.

Randall was traded away this offseason (and moved back to his college position of safety). Rollins remains on the roster but hasn't lived up to expectations. Injuries have limited the Miami (Ohio) product to just 33 games over three seasons, and he's also coming off a torn Achilles.

In his three seasons, Rollins has produced just 85 tackles and three interceptions.

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13 of 32

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entered the league as a fourth-round selection of the Miami Dolphins in 2012. After several promising seasons in Miami, Miller parlayed them into a four-year, $26 million deal with the Houston Texans in the 2016 offseason.

Miller's first season in Houston was solid (1,073 yards, 4.0 yards per carry). However, he was a disappointment last season, especially considering his contract. Miller appeared in all 16 games but rushed for just 888 yards and 3.7 yards per carry—a career worst—with three touchdowns. That's not what the Texans want out of a guy making nearly $7 million a year.

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The fact remains, however, that Miller isn't playing up to the level his contract would suggest.

14 of 32

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