Murphy Goodman (orchidbun9)

Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation, which is progressive and not fully reversible. In patients with COPD, body mass index (BMI) is an important parameter associated with health outcomes, e.g. mortality and health-related quality of life. However, so far no study evaluated the association of BMI and health care expenditures across different COPD severity grades. We used claims data and documentation data of a Disease Management Program (DMP) from a statutory health insurance fund (AOK Bayern). Patients were excluded if they had less than 4 observations in the 8 years observational period. Generalized additive mixed models with smooth functions were used to evaluate the association between BMI and health care expenditures, stratified by severity of COPD, indicated by GOLD grades 1-4. We included 30,682 patients with overall 188,725 observations. In GOLD grades 1-3 we found an u-shaped relation of BMI and expenditures, where patients with a BMI of 30 or slightly above had the lowest and underweight and obese patients had the highest health care expenditures. Contrarily, in GOLD grade 4 we found an almost linear decline of health care expenditures with increasing BMI. In terms of expenditures, the often reported obesity paradox in patients with COPD was clearly reflected in GOLD grade 4, while in all other severity grades underweight as well as severely obese patients caused the highest health care expenditures. Reduction of obesity may thus reduce health care expenditures in GOLD grades 1-3.Antibiotics have been widely used (mainly mixed with feed) in aquaculture, while few studies have evaluated the interactions between feed composition and antibiotics. Sulfamethoxazole (SMX) is a fat-soluble antibiotic, an eight weeks feeding trial was conducted to investigate the interactions between dietary lipid levels and chronic exposure of legal aquaculture dose of sulfamethoxazole in juvenile largemouth bass Micropterus salmoides, and evaluated the possible human health risk. Six practical diets were formulated to three levels of crude lipid (11, 14.5, 18 %) and two levels of SMX (0 and 0.3 %), namely low fat (LF), moderate fat (MF), high fat (HF), low fat and SMX (LFS), moderate fat and SMX (MFS), high fat and SMX (HFS), respectively. Each diet was assigned to three tanks (20 fish per tank, average weight 30.65 ± 0.02 g). Growth and organ indices were increased by SMX. Higher malformation rate and lower hypoxia stress resistance were found in fish exposed to SMX than those not exposed. Cholesterol and bile acid synthesis related gene expressions were down-regulated by SMX exposure. Oxidative stress, inflammation and apoptosis were increased in fish exposed to SMX. Significant interactions between dietary lipid levels and SMX on renal immune response of fish were observed. Remarkable damage of intestinal histology was observed in fish fed the diet HFS. In addition, dietary SMX exposure increased pathogen susceptibility of largemouth bass and induced dysbiosis of gut microbiota. The concentrations of SMX in muscle of fish fed diets containing SMX were higher than those fed other diets, and close to the maximum residue limit (MRL) in China and international organizations. Although chronic legal aquaculture dose of dietary SMX also increased the target hazard quotient (THQ) and estimated daily intake (EDI), there is no health risk in adults and children consuming fish filet.In natural ecosystems, living organisms are always subjected to a mixture of multiple heavy metals exposure, yet it is more common to study the effect of individual, rather than combined exposure. This study assessed the impacts of single or combined exposure to Cr and Cu on embryonic development, oxidative stress, lipid metabolism and apoptosis in the early development of Bufo gargarizans embryos. The total length, development stage and malformations of embryos were measured, and the