OBJECTIVEMedical nutrition therapy based on the control of the amount and distribution of carbohydrates (CHO) is the initial treatment for gestational diabetes mellitus (GDM), but there is a need for randomized controlled trials comparing different dietary strategies. The purpose of this study was to test the hypothesis that a low-CHO diet for the treatment of GDM would lead to a lower rate of insulin treatment with similar pregnancy outcomes compared with a control diet.RESEARCH DESIGN AND METHODSA total of 152 women with GDM were included in this open, randomized controlled trial and assigned to follow either a diet with low-CHO content (40% of the total diet energy content as CHO) or a control diet (55% of the total diet energy content as CHO). CHO intake was assessed by 3-day food records. The main pregnancy outcomes were also assessed.RESULTSThe rate of women requiring insulin was not significantly different between the treatment groups (low CHO 54.7% vs. control 54.7%; P = 1). Daily food records confirmed a difference in the amount of CHO consumed between the groups (P = 0.0001). No differences were found in the obstetric and perinatal outcomes between the treatment groups.CONCLUSIONSTreatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes.

q RSNA, 2015 Purpose:To assess the relationship between total, calcified, and noncalcified coronary plaque burdens throughout the entire coronary vasculature at coronary computed tomographic (CT) angiography in relationship to cardiovascular risk factors in asymptomatic individuals with low-to-moderate risk. Materials and Methods:This HIPAA-compliant study had institutional review board approval, and written informed consent was obtained. Two hundred two subjects were recruited to an ongoing prospective study designed to evaluate the effect of HMG-CoA reductase inhibitors on atherosclerosis. Eligible subjects were asymptomatic individuals older than 55 years who were eligible for statin therapy. Coronary CT angiography was performed by using a 320-detector row scanner. Coronary wall thickness and plaque were evaluated in all epicardial coronary arteries greater than 2 mm in diameter. Images were analyzed by using dedicated software involving an adaptive lumen attenuation algorithm. Total plaque index (calcified plus noncalcified plaque) was defined as plaque volume divided by vessel length. Multivariable regression analysis was performed to determine the relationship between risk factors and plaque indexes. Results:The mean age of the subjects was 65.5 years 6 6.9 (standard deviation) (36% women), and the median coronary artery calcium (CAC) score was 73 (interquartile range, 1-434). The total coronary plaque index was higher in men than in women (42.06 mm 2 6 9.22 vs 34.33 mm 2 6 8.35; P , .001). In multivariable analysis controlling for all risk factors, total plaque index remained higher in men than in women (by 5.01 mm 2 ; P = .03) and in those with higher simvastatin doses (by 0.44 mm 2 /10 mg simvastatin dose equivalent; P = .02). Noncalcified plaque index was positively correlated with systolic blood pressure (b = 0.80 mm 2 /10 mm Hg; P = .03), diabetes (b = 4.47 mm 2 ; P = .03), and low-density lipoprotein (LDL) cholesterol level (b = 0.04 mm 2 /mg/dL; P = .02); the association with LDL cholesterol level remained significant (P = .02) after additional adjustment for the CAC score. Conclusion:LDL cholesterol level, systolic blood pressure, and diabetes were associated with noncalcified plaque burden at coronary CT angiography in asymptomatic individuals with low-to-moderate risk.q RSNA, 2015

Purpose:To determine the relationship between coronary plaque detected with coronary computed tomographic (CT) angiography and clinical parameters and cardiovascular risk factors in asymptomatic patients with diabetes. Materials and Methods:All patients signed institutional review board-approved informed consent forms before enrollment. Two hundred twenty-four asymptomatic diabetic patients (121 men; mean patient age, 61.8 years; mean duration of diabetes, 10.4 years) underwent coronary CT angiography. Total coronary artery wall volume in all three vessels was measured by using semiautomated software. The coronary plaque volume index (PVI) was determined by dividing the wall volume by the coronary length. The relationship between the PVI and cardiovascular risk factors was determined with multivariable analysis. Results:The mean PVI (6standard deviation) was 11.2 mm 2 6 2.7. The mean coronary artery calcium (CAC) score (determined with the Agatston method) was 382; 67% of total plaque was noncalcified. The PVI was related to age (standardized b = 0.32, P , .001), male sex (standardized b = 0.36, P , .001), body mass index (BMI) (standardized b = 0.26, P , .001), and duration of diabetes (standardized b = 0.14, P = .03). A greater percentage of soft plaque was present in younger individuals with a shorter disease duration (P = .02). The soft plaque percentage was directly related to BMI (P = .002). Patients with discrepancies between CAC score and PVI rank quartiles had a higher percentage of soft and fibrous plaque (18.7% 6 3.3 vs 17.4% 6 3.5 [P = .008] and 52.2% 6 7.2 vs 47.2% 6 8.8 [P , .0001], respectively). Conclusion:In asymptomatic diabetic patients, BMI was the primary modifiable risk factor that was associated with total and soft coronary plaque as assessed with coronary CT angiography.q RSNA, 2014 Clinical trial registration no. NCT00488033

Kellogg, E, Cantacessi, C, McNamer, O, Holmes, H, von Bargen, R, Ramirez, R, Gallagher, D, Vargas, S, Santia, B, Rodriguez, K, and Astorino, TA. Comparison of psychological and physiological responses to imposed vs. self-selected high-intensity interval training. J Strength Cond Res XX(X): 000-000, 2018-High-intensity interval training elicits similar physiological adaptations as moderate intensity continuous training (MICT). Some studies report greater enjoyment to a bout of high-intensity interval exercise (HIIE) vs. MICT, which is surprising considering that HIIE is more intense and typically imposed on the participant. This study compared physiological and perceptual responses between imposed and self-selected HIIE. Fourteen adults (age = 24 ± 3 years) unfamiliar with HIIE initially performed ramp exercise to exhaustion to measure maximal oxygen uptake (V[Combining Dot Above]O2max) followed by 2 subsequent sessions whose order was randomized. Imposed HIIE consisted of eight 60 seconds bouts at 80 percent peak power output (%PPO) separated by 60 seconds recovery at 10 %PPO. Self-selected HIIE (HIIESS) followed the same structure, but participants freely selected intensity in increments of 10 %PPO to achieve a rating of perceived exertion (RPE) ≥7. During exercise, heart rate, V[Combining Dot Above]O2, blood lactate concentration (BLa), affect (+5 to -5), and RPE were assessed. Physical Activity Enjoyment Scale was measured after exercise. Results showed higher V[Combining Dot Above]O2 (+10%, p = 0.013), BLa (p = 0.001), and RPE (p = 0.001) in HIIESS vs. HIIEIMP, and lower affect (p = 0.01), and enjoyment (87.6 ± 15.7 vs. 95.7 ± 11.7, p = 0.04). There was a significantly higher power output in self-selected vs. imposed HIIE (263.9 ± 81.4 W vs. 225.2 ± 59.6 W, p < 0.001). Data suggest that intensity mediates affective responses rather than the mode of HIIE performed by the participant.

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El desconocimiento, actitudes y practicas relacionadas con las enfermedades crónicas no transmisibles, la escasa información sobre la diabetes gestacional y los factores de riesgos asociados a la enfermedad en las mujeres puede causar diversos riesgos para la madre y el producto esperado (bebe), se estableció como objetivo principal “Identificar los factores de riesgo asociados a diabetes por embarazo en pacientes atendidas en el Centro de Salud Jipijapa”. El estudio fue cuantitativo, descriptivo y analítico con respecto a los conocimientos, actitudes sobre los factores de riesgos asociados a la diabetes gestacional. Se estudiaron 75 mujeres en embarazo entre las semanas 28 y 36 de gestación, se utilizó una encuesta para evaluar los conocimientos de las gestantes en cuanto a diabetes gestacional, la misma encuesta fue aplicada con la finalidad de identificar en las mujeres embarazadas los principales factores de riesgo relacionados a la diabetes gestacional. Como resultado se obtuvo que el 81% de la población encuestada no conocen que es la diabetes gestacional, el 95% no realizaron asesoría preconcepcional es decir son embarazos no planificados y no cuentan con un control preconcepcional donde se logre identificar las posibles complicaciones que se pueden presentar en el embrazo y poder prevenirlas con anterioridad, se logró identificar como principales factores de riesgo: la obesidad, la multiparidad, los antecedentes familiares relacionados con diabetes y la macrosomía en embarazos anteriores. En conclusión, se determinó que la falta de controles preconcepcionales, la falta de conocimiento relacionados a diabetes gestacional, la gran cantidad de factores de riesgo en las mujeres en estado de gestación que se atienden en el Centro de Salud Jipijapa representan una problemática de gran proporción y aumenta el riesgo de padecer diabetes gestacional, además la demora de atención al inicio del embarazo, controles durante el embarazo no periódicos y falta de ecografías oportunas no permiten un diagnóstico oportuno de diabetes gestacional.

Introduction: Coronary computed tomography angiography (CCTA) directly characterizes composition of plaque in coronary heart disease (CHD). Although the use of CCTA has been established in clinical CHD, no study to date has ever examined how psoriasis (PSO), a chronic inflammatory skin disease associated with increased risk for myocardial infarction (MI), affects CHD by CCTA. Therefore, our goal was to understand whether psoriasis increases CHD detected by CCTA and establishes CHD plaque characteristics compared to subjects with clinical coronary disease and healthy volunteers. Methods: Subjects with PSO (N=54), CHD (N=75) and healthy controls (N=5) underwent quantitative coronary CCTA imaging (Toshiba MDCT). Total coronary plaque was assessed using QAngioCT (Medis, Netherlands) as the total coronary artery wall volume. Furthermore, to better understand the determinants of CHD [total burden (TB) and non-calcified plaque burden (NCB)], we performed deep phenotyping for lipid markers including lipid particle size and numbers, HDL efflux, and metabolic parameters of insulin resistance such as Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) in psoriasis. Results: Our study showed that PSO was associated with higher TB and NCB of CHD when compared to both CHD and control groups (See Table 1). These findings were robust to adjustment for CHD risk factors (Framingham risk score) and luminal density (TB β=7.6, p<0.001 & NCB β=5.1, p=0.001). NCB was strongly associated with BMI (β=0.38, p<0.01), HDL efflux capacity (β=-10.9, p<0.05) and insulin resistance estimated by HOMA-IR (β=0.53, p<0.05) in psoriasis. Conclusions: This is the first study to show that psoriasis increases total burden of CHD which is non-calcified providing compelling evidence for the association between psoriasis and MI. Determinants of this NCB suggest focusing therapies on lipid and metabolic derangement in psoriasis may reduce this risk of future events.

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