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Millions of people worldwide suffer from chronic kidney disease. Lifestyle factors, including diet, are considered to be involved in the pathogenesis of the disease; however previous studies on dried fruit intake and the health of kidneys have been limited by confounders and bias. Using a technique known as Mendelian randomization (MR), this study aimed to clarify the causal relationship between dried fruit intake and markers of kidney function.

A two-sample MR approach was utilized by the researchers. They sought to investigate whether there was an association, and most importantly, a possible causal one between the consumption of dried fruit and six markers of kidney function that included BUN, creatinine, uric acid, cystatin C, hematuria, and microalbuminuria. Inverse variance weighting was the analytical approach most often used in estimating associations, while other methods-MR Egger and weighted median-were used as supplementary approaches to investigate result robustness. MVMR was conducted with adjustment for smoking and alcohol use to determine if the effect of dried fruit consumption on kidney function may be confounded by smoking and alcohol use.

• Higher intake of dried fruit was significantly associated with a lower BUN level (β = -0.171, 95% CI: -0.239 to -0.102, p = 1.063 × 10⁻⁶).

• Positive consumption of dried fruit was linked with lowering creatinine (β = -0.205, 95% CI: -0.311 to -0.099, p = 1.455 × 10⁻⁴).

• In uric acid as well, a similar association was obtained with β = -0.317, 95% CI: -0.384 to -0.249, p = 4.439 × 10⁻²⁰, that is to say a greater consumption of dried fruits may be associated with the lowering effect of UA.

• In increased cystatin C, decreased intake of dried fruits is observed with β = -0.323, 95% CI: -0.384 to -0.249, p = 1.074 × 10⁻¹¹.

• No meaningful association between dried fruit consumption with hematuria or microalbuminuria, which are two of the most common used markers in examinations of renal health,

• Intake of dried fruit was inversely related to UA and CyC levels, though the association became attenuated; still, it remained significant for both UA (β = -0.296, 95% CI: -0.523 to -0.068, p = 1.094 × 10⁻²) and CyC (β = -0.238, 95% CI: -0.465 to -0.011, p = 4.024 × 10⁻²).

• For BUN and creatinine, the causal association completely disappeared in smokers and alcoholics (BUN: β = -0.038, 95% CI: -0.215 to 0.138, p = 6.698 × 10⁻¹; CR: β = -0.038, 95% CI: -0.431 to 0.046, p = 1.347 × 10⁻¹).

This study suggests that consumption of dried fruits may be an intervention that improves markers for kidney function in abstainers from smoking and alcohol. Dried fruit can, therefore, be added to a healthy diet for people at risk of kidney disease as a potential additive strategy for preserving renal health and delaying the onset of chronic kidney disease when smoking and alcohol are avoided.

Reference:

Gao Y, Yue X, Zhao W and Yuan F (2024) Association between dried fruit intake and kidney function: research from univariate and multivariate Mendelian randomized studies. Front. Nutr. 11:1440896. doi: 10.3389/fnut.2024.1440896

Homelessness has significant implications for maternal, infant, and child health (MCH) and health inequities.Studies using International Classification of Diseases codes indicate that the number of postpartum people recorded as being affected by homelessness at the time of delivery is increasing over time. A multistate study using self-reported housing status demonstrated that experiencing homelessness is associated with behaviors known to affect pregnancy health (eg, smoking), but used data from 2000 to 2007.

In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a multi-state cross-sectional survey designed to be representative of individuals with live births. Through mail and telephone questionnaires, and linked birth certificate data, PRAMS collects information on health, sociodemographic characteristics, and behavior. Results: In a weighted sample of 146 943 postpartum people representing a population of 8 249 272, 2.4% (95% CI 2.3%-2.5%) reported homelessness in the year before birth. Compared with those without homelessness experiences, postpartum people who experienced homelessness were more likely to report their race as Black (34.0% [95% CI, 31.8%-36.2%] vs 14.9% [95% CI, 14.7%-15.1%]), be unmarried, and have high school education or less

This cross-sectional analysis found associations between homelessness and MCH. While PRAMS data are only representative of included states, applying the 2.4% homelessness rate to all US births in 2023 implies 70 000 babies would be born within 12 months of maternal homelessness.

Reference:

McGovern ME, Treglia D, Eliason EL, Spishak-Thomas A, Cantor JC. Homelessness and Maternal and Infant Health. JAMA Netw Open. 2024;7(11):e2442596. doi:10.1001/jamanetworkopen.2024.42596

Keywords:

Homelessness, during, pregnancy, linked, worse, maternal, outcomes, including hypertension, diabetes, JAMA, McGovern ME, Treglia D, Eliason EL, Spishak-Thomas A, Cantor JC.

The findings of a new study extended the evaluation of relugolix CT up to 104 weeks, showcasing its potential to provide sustained relief from the pain associated with endometriosis. The study showed that women receiving relugolix CT experienced a significant reduction in pain symptoms, including dysmenorrhea (painful periods), non-menstrual pelvic pain (NMPP), and dyspareunia (pain during intercourse). This marks a substantial improvement in managing one of the most debilitating aspects of endometriosis.

Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside the uterus, causing severe pain, irregular bleeding, and potential fertility issues. For many women, endometriosis-associated pain severely impacts daily functioning and overall well-being.

Against the above background, Sawsan As-Sanie, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, and colleagues aimed to evaluate the impact of relugolix combination therapy (relugolix CT; 40 mg relugolix, 1 mg estradiol, and 0.5 mg norethisterone acetate) over up to two years in the SPIRIT long-term extension study. They focused on its effects on functioning and health-related quality of life (QoL), as measured by the Endometriosis Health Profile (EHP)-30 questionnaire, and examined how changes in QoL domains correlated with improvements in dysmenorrhea and nonmenstrual pelvic pain.

For this purpose, the researchers conducted a long-term extension study of the SPIRIT phase 3 trials involving premenopausal women with moderate-to-severe endometriosis pain who had previously completed the randomized SPIRIT trials. The women enrolled in an 80-week extension, receiving relugolix combination therapy (40 mg relugolix, 1 mg estradiol, 0.5 mg norethindrone acetate).

The study assessed changes in health-related quality of life using the EHP-30 questionnaire, with results analyzed through a mixed-effects model. The researchers also examined how improvements in dysmenorrhea and nonmenstrual pelvic pain (NMPP) correlated with changes in QoL scores.

The following were the key findings of the study:

• In the 277 women treated with relugolix combination therapy, the least squares (LS) mean EHP-30 pain domain scores improved by 57.8% at week 24 (LS mean change: −32.8), 66.4% at week 52 (LS mean change: −37.7), and 72.2% at week 104 (LS mean change: −41.3).
• At weeks 24, 52, and 104, respectively, clinically meaningful improvements in pain were seen in 75.9%, 83.6%, and 88.6% of women. Non-pain EHP-30 domain and total scores also showed improvement.
• A positive correlation was observed between changes in dysmenorrhea/NMPP and all EHP-30 domain scores.
• Similar results were seen in the delayed relugolix CT and placebo → relugolix CT groups.

The findings showed that sustained reduction in endometriosis-associated pain observed with relugolix combination therapy over 104 weeks was accompanied by improvements in functioning and health-related quality of life.

“These results further support the findings of the pivotal SPIRIT trials, which demonstrated that relugolix CT significantly reduced dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia compared to placebo in premenopausal women with endometriosis-related pain,” the researchers concluded.

Reference:

As-Sanie, S., Abrao, M. S., Reznichenko, G., Wilk, K., Zhong, Y., Perry, J., Hunsche, E., Soulban, G., & Becker, C. M. (2024). Impact of relugolix combination therapy on functioning and quality of life in women with endometriosis-associated pain. Fertility and Sterility, 122(4), 687-695. https://doi.org/10.1016/j.fertnstert.2024.06.009

The results, published in BMC Gastroenterology, revealed no significant difference in diagnostic accuracy between the two techniques, with a p-value of 0.82, indicating comparable performance. Both methods demonstrated a high consistency in their findings, reflected by a Kappa value of 0.70, which signifies a strong agreement between the two diagnostic approaches.

The findings imply that the selection of a diagnostic method for detecting postoperative residual bile duct stones should be tailored to the individual patient’s circumstances.

T-tube cholangiography and choledochoscopy are methods for identifying residual bile duct stones after biliary surgery. However, the effectiveness of routine cholangiography before T-tube removal requires further exploration. With this in mind, Yamin Zheng, Capital Medical University, Xicheng District, Beijing, China, and colleagues set out to assess the diagnostic efficacy of different techniques for detecting residual calculi following biliary procedures.

For this purpose, the researchers retrospectively analyzed the clinical data of 287 adult patients who underwent common bile duct exploration with T-tube drainage, followed by T-tube cholangiography and choledochoscopy at the Department of General Surgery, Xuanwu Hospital, Capital Medical University, from 2017 to 2022. Patients were excluded if they had bile duct tumors, incomplete medical records, were lost to follow-up, or had contraindications to T-tube or choledochoscopy. The McNemar and Kappa tests were utilized to compare the results and consistency between the two diagnostic methods. All patients underwent both cholangiography and choledochoscopy six to eight weeks after laparoscopic cholecystectomy combined with common bile duct exploration and T-tube drainage. T-tube cholangiography and choledochoscopy findings were documented, analyzed, and compared for each patient.

The study led to the following findings:

• Out of 287 patients, T-tube cholangiography identified residual stones in 38 cases. Choledochoscopy confirmed residual stones in 29 cases.
• Among the 249 patients who showed no signs of residual stones on T-tube cholangiography, 11 were later found to have retained stones via choledochoscopy.
• There was no significant difference in the results between T-tube cholangiography and choledochoscopy.
• The two methods demonstrated a high level of agreement, with a Kappa value of 0.70.

The researchers concluded that a study assessing the diagnostic value of T-tube cholangiography and choledochoscopy for detecting residual bile duct stones after biliary surgery revealed a strong agreement between the two methods, with no significant difference in their overall effectiveness.

“However, choledochoscopy identified some stones that were missed by T-tube cholangiography. Therefore, diagnostic technique selection should be customized based on the patient’s specific circumstances,” they wrote.

Reference:

Li, S., Wang, Z., Li, Z. et al. Diagnostic value of T-tube cholangiography and choledochoscopy in residual calculi after biliary surgery. BMC Gastroenterol 24, 383 (2024). https://doi.org/10.1186/s12876-024-03474-7

Corticosteroids are among the few effective treatments for knee osteoarthritis, but short duration of action limits their utility. EP-104IAR, a long-acting formulation of fluticasone propionate for intra-articular injection, optimises the action of fluticasone propionate through novel diffusion-based extended-release technology. The SPRINGBOARD trial assessed the efficacy, safety, and pharmacokinetics of EP-104IAR in people with knee osteoarthritis. SPRINGBOARD was a randomised, vehicle-controlled, double-blind, phase 2 trial done at 12 research sites in Denmark, Poland, and Czech Republic. We recruited adults aged 40 years or older with primary knee osteoarthritis (Kellgren–Lawrence grade 2–3) who reported Western Ontario and McMaster Universities Osteoarthritis Arthritis Index (WOMAC) pain scores of at least 4 and no more than 9 out of 10. Participants were randomly assigned (1:1) to receive one intra-articular dose of 25 mg EP-104IAR or vehicle control. Randomisation was done via interactive web-based access to a central predefined computer-generated list with block size of six (allocated by clinical site). Participants and assessors were masked to treatment allocation. Participants were followed up for 24 weeks. The primary outcome was the difference between groups in change in WOMAC pain score from baseline to week 12, analysed in all participants who were randomly assigned and received treatment. Safety, including laboratory analyses, and pharmacokinetics from quantification of fluticasone propionate in peripheral blood were assessed in all participants who received a dose of randomly assigned treatment. A person with lived experience of knee osteoarthritis was involved in study interpretation and writing of the report. Findings: Between Sept 10, 2021, and Nov 16, 2022, 1294 people were screened for eligibility, and 319 were randomly assigned to EP-104IAR (n=164) or vehicle control (n=155). One participant in the EP-104IAR group was excluded from all analyses because treatment was not administered due to an adverse event. 318 participants (135 [42%] male and 183 [58%] female, 315 [99%] White) received randomly assigned treatment and were included in the primary analysis and safety analysis (EP-104IAR, n=163; vehicle control, n=155). At week 12, least squares mean change in WOMAC pain score from baseline was –2·89 (95% CI –3·22 to –2·56) in the EP-104IAR group and –2·23 (–2·56 to –1·89) in the vehicle control group, with a between-group difference of –0·66 (–1·11 to –0·21; p=0·0044); a significant between-group difference persisted to week 14. 106 (65%) of 163 participants in the EP-104IAR group had one or more treatment-emergent adverse event compared with 89 (57%) of 155 participants in the vehicle control group. Effects on serum glucose and cortisol concentrations were minimal and transient. There were no treatment-emergent deaths or treatment-related serious adverse events. Plasma concentrations of fluticasone propionate showed a blunted initial peak with terminal half-life of approximately 18–20 weeks. These phase 2 results suggest that EP-104IAR has the potential to offer clinically meaningful pain relief in knee osteoarthritis for an extended period of up to 14 weeks, longer than published data for currently marketed corticosteroids. There were minimal effects on glucose and cortisol, and stable fluticasone propionate concentrations in plasma. The safety and efficacy of EP-104IAR will be further evaluated in phase 3 trials, including the possibility of bilateral and repeat dosing with EP-104IAR.

Reference:

Efficacy and safety of a diffusion-based extended-release fluticasone propionate intra-articular injection (EP-104IAR) in knee osteoarthritis (SPRINGBOARD): a 24-week, multicentre, randomised, double-blind, vehicle-controlled, phase 2 trial

Malone, Amanda et al. The Lancet Rheumatology, Volume 0, Issue 0

Keywords:

Long, acting, injection, Fluticasone, promising, knee, osteoarthritis, The Lancet Rheumatology, multicentre, randomised, double-blind, vehicle-controlled