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Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis.
Sartorius, K, Sartorius, B, Madiba, TE, Stefan, C
BMJ open. 2018;8(2):e018449
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As overweight and obesity is rising globally, better understanding its cause is important to help with prevention and management of disease. The objective of this meta-analysis is to investigate the relationship between carbohydrate intake and obesity, particularly at the differences between low and high carbohydrate diets. Based on 22 articles that met the inclusion criteria, a high-carbohydrate diet, or increased proportion of energy intake in the form of carbohydrates, does not increase the risk of being obese. Based on these results, the authors iterate further studies are required to better understand obesity risk with regards different carbohydrate groups including refined versus unrefined carbohydrates.
Abstract
OBJECTIVES The present study aimed to test the association between high and low carbohydrate diets and obesity, and second, to test the link between total carbohydrate intake (as a percentage of total energy intake) and obesity. SETTING, PARTICIPANTS AND OUTCOME MEASURES We sought MEDLINE, PubMed and Google Scholar for observation studies published between January 1990 and December 2016 assessing an association between obesity and high-carbohydrate intake. Two independent reviewers selected candidate studies, extracted data and assessed study quality. RESULTS The study identified 22 articles that fulfilled the inclusion and exclusion criteria and quantified an association between carbohydrate intake and obesity. The first pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased risk of obesity. The second pooled strata (increasing percentage of total carbohydrate intake in daily diet) showed a weak decreased risk of obesity. Both these pooled strata estimates were, however, not statistically significant. CONCLUSIONS On the basis of the current study, it cannot be concluded that a high-carbohydrate diet or increased percentage of total energy intake in the form of carbohydrates increases the odds of obesity. A central limitation of the study was the non-standard classification of dietary intake across the studies, as well as confounders like total energy intake, activity levels, age and gender. Further studies are needed that specifically classify refined versus unrefined carbohydrate intake, as well as studies that investigate the relationship between high fat, high unrefined carbohydrate-sugar diets. PROSPERO REGISTRATION NUMBER CRD42015023257.
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Cancer of childhood in sub-Saharan Africa.
Stefan, C, Bray, F, Ferlay, J, Liu, B, Maxwell Parkin, D
Ecancermedicalscience. 2017;:755
Abstract
Measurement of incidence rates of childhood cancer in Africa is difficult. The study 'Cancer of Childhood in sub Saharan Africa' brings together results from 16 population-based registries which, as members of the African Cancer Registry Network (AFCRN), have been evaluated as achieving adequate coverage of their target population. The cancers are classified according to the third revision of the International Classification of Childhood Cancer (ICCC-3) and recorded rates in Africa are compared with those in childhood populations in the UK, France, and the USA. It is clear that, in many centres, lack of adequate diagnostic and treatment facilities leads to under-diagnosis (and enumeration) of leukaemias and brain cancers. However, for several childhood cancers, incidence rates in Africa are higher than those in high-income countries. This applies to infection-related cancers such as Kaposi sarcoma, Burkitt lymphoma, Hodgkin lymphoma and hepatocellular carcinoma, and also to two common embryonal cancers - retinoblastoma and nephroblastoma. These (and other) observations are unlikely to be artefact, and are of considerable interest when considering possible aetiological factors, including ethnic differences in risk (and hence genetic/familial antecedents). The data reported are the most extensive so far available on the incidence of cancer in sub Saharan Africa, and clearly indicate the need for more resources to be devoted to cancer registration, especially in the childhood age range, as part of an overall programme to improve the availability of diagnosis and treatment of this group of cancers, many of which have-potentially-an excellent prognosis.
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Chromovitrectomy.
Musat, O, Stefan, C, Boariu, AM, Colta, D, Cernat, C, Alexandru, L, Georgescu, RD, Patoni, IS, Timaru, CM, De Algerino, S
Romanian journal of ophthalmology. 2016;(2):59-62
Abstract
The term "chromovitrectomy" has been coined to define the use of vital dyes in vitreoretinal surgery. The basic concept for the application of vital dyes during vitreoretinal surgery is to assist in highlighting preretinal membranes and tissues which are very thin and semitransparent and thus difficult to detect. Various dyes are currently being used in routine clinical procedures, however, the ideal staining agent has not yet been found. The vital dyes indocyanine green, infracyanine green, and brilliant blue stain the internal limiting membrane, trypan blue and triamcinolone acetonide help to visualize the epiretinal and vitreous membranes. New dyes with a better safety profile than the synthetic ones are important for optimizing the outcome of modern ophthalmic surgery and natural dyes, such as lutein, offer a potentially safer and more efficient method of identifying intraocular structures such as vitreous and ILM. Any dye, which is intravitreally injected has the potential to become toxic.
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Roles for Ca2+ mobilization and its regulation in mast cell functions: recent progress.
Holowka, D, Wilkes, M, Stefan, C, Baird, B
Biochemical Society transactions. 2016;(2):505-9
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Abstract
Ca(2+)mobilization in response to cross-linking of IgE bound to its high affinity receptor, FcεRI, on mast cells is central to immune allergic responses. Stimulated tyrosine phosphorylation caused by this cross-linking activates store-operated Ca(2+)entry that results in sustained Ca(2+)oscillations dependent on Rho family GTPases and phosphoinositide synthesis. Coupling of the endoplasmic reticulum (ER) Ca(2+)sensor, stromal interaction molecule 1 (STIM1), to the Ca(2+)-selective channel, Orai1, is regulated by these elements and depends on membrane organization, both at the plasma membrane and at the ER. Mitochondria also contribute to the regulation of Ca(2+)mobilization, and we describe recent evidence that the ER membrane protein vesicle-associated membrane protein-associated protein (VAP) plays a significant role in the coupling between ER and mitochondria in this process. In addition to granule exocytosis, Ca(2+)mobilization in these cells also contributes to stimulated outward trafficking of recycling endosomes and to antigen-stimulated chemotaxis, and it is pathologically regulated by protozoan parasitic invasion.
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Carbohydrate intake, obesity, metabolic syndrome and cancer risk? A two-part systematic review and meta-analysis protocol to estimate attributability.
Sartorius, B, Sartorius, K, Aldous, C, Madiba, TE, Stefan, C, Noakes, T
BMJ open. 2016;(1):e009301
Abstract
INTRODUCTION Linkages between carbohydrates, obesity and cancer continue to demonstrate conflicting results. Evidence suggests inconclusive direct linkages between carbohydrates and specific cancers. Conversely, obesity has been strongly linked to a wide range of cancers. The purpose of the study is to explore linkages between carbohydrate intake and cancer types using a two-step approach. First the study will evaluate the linkages between carbohydrate intake and obesity, potentially stratified by metabolic syndrome status. Second, the estimated attributable fraction of obesity ascribed to carbohydrate intake will be multiplied against obesity attributable fractions for cancer types to give estimated overall attributable fraction for carbohydrate versus cancer type. METHODS AND ANALYSIS We will perform a comprehensive search to identify all possible published and unpublished studies that have assessed risk factors for obesity including dietary carbohydrate intake. Scientific databases, namely PubMed MEDLINE, EMBASE, EBSCOhost and ISI Web of Science will be searched. Following study selection, paper/data acquisition, and data extraction and synthesis, we will appraise the quality of studies and risk of bias, as well as assess heterogeneity. Meta-weighted attributable fractions of obesity due to carbohydrate intake will be estimated after adjusting for other potential confounding factors (eg, physical inactivity, other dietary intake). Furthermore, previously published systematic reviews assessing the cancer-specific risk associated with obesity will also be drawn. These estimates will be linked with the attributability of carbohydrate intake in part 1 to estimate the cancer-specific burden that can be attributed to dietary carbohydrates. This systematic review protocol has been developed according to the 'Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015'. ETHICS AND DISSEMINATION The current study will be based on published literature and data, and, as such, ethics approval is not required. The final results of this two part systematic review (plus multiplicative calculations) will be published in a relevant international peer-reviewed journal. TRIAL REGISTRATION NUMBER PROSPERO CRD42015023257.
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[Coats disease].
Cerbulescu, BJ, Stefan, C
Oftalmologia (Bucharest, Romania : 1990). 2003;(3):21-5
Abstract
Coats disease is an idiopathic disorder characterized by an abnormal development of retinal vessels (telangiectasia), with a progressive deposition of intraretinal or subretinal exudates, leading to exudative retinal detachment. Classically is isolated, unilateral and affects mainly boys between 4 to 8 years. The diagnostic methods include direct and indirect opthalmoscopy, fluorescein angiography, ultrasonography, CT scan, MR imaging, especially în the advanced stages of disease, when is difficult to differentiate from retinoblastoma. The treatment includes laser therapy of abnormal leaking retinal vessels and cryotherapy în early stages, more advanced stages require surgical techniques of retinal reattachment. Stabilization of the disease course or clinical improvement can be achieved using a carefully selected therapy.