Our previous studies showed that a soy-protein diet prevents ovariectomy-induced bone loss. The purpose of this study was to determine whether isoflavones in soy protein are responsible for this bone-protective effect. Forty-eight 95-d-old Sprague-Dawley rats were divided into 4 groups: sham-operated fed a casein-based diet (SHAM), ovariectomized fed a casein-based diet (OVX+CASEIN), ovariectomized fed soy protein with normal isoflavone content (OVX+SOY), and ovariectomized fed soy protein with reduced isoflavone content (OVX+SOY-). The OVX+SOY group had significantly greater femoral bone density (in g/cm3 bone vol) than the OVX+CASEIN group, whereas OVX+SOY- was similar to OVX+CASEIN (mean +/- SD; SHAM, 1.522 +/- 0.041; OVX+CASEIN, 1.449 +/- 0.044; OVX+SOY, 1.497 +/- 0.030; OVX+SOY-, 1.452 +/- 0.030). Ovariectomy resulted in greater bone turnover as indicated by higher serum alkaline phosphatase activity, serum insulin-like growth factor I and insulin-like growth factor binding protein 3 concentrations, and urinary hydroxyproline. These increases were not affected by soy with either normal or reduced isoflavone content. Similarly, histomorphometry revealed a greater bone formation rate with ovariectomy, and this was not altered by the soy diets. The findings of this study suggest that isoflavones in soy protein are responsible for its bone-sparing effects. Further studies to evaluate the mechanism of action of isoflavones on bone are warranted.

Soy protein, a rich source of isoflavones, fed immediately after an ovariectomy prevents bone loss in rats. Reports of the effectiveness of natural and synthetic isoflavones in preventing or treating osteoporosis led us to examine the effect of soy protein in reversing established bone loss. Seventy-two 95-d-old female Sprague-Dawley rats were assigned to 6 groups. The rats were either sham operated (SHAM; 2 groups) or ovariectomized (OVX; 4 groups) and then fed a casein-based, semipurified diet. Thirty-five days after surgery, 1 SHAM and 1 OVX group were killed to examine the occurrence of bone loss. Thereafter, the other SHAM and 1 OVX groups continued to receive the casein-based diet. Whereas the remaining 2 OVX groups received diets in which casein was replaced by soy protein with normal (OVX+SOY) or reduced (OVX+SOY-) isoflavone content for 65 days. The OVX control group had significantly lower femoral and fourth lumbar vertebral bone densities than the SHAM group. Femoral density of rats fed SOY or SOY- diets were not significantly different from SHAM or OVX controls. This suggests a slight reversal of cortical bone loss that may be partially due to higher femoral insulin-like growth factor I mRNA transcripts resulting from both the SOY and SOY- diets. The ovariectomy-induced increases in indexes of bone turnover were not ameliorated by either of the soy diets, suggesting that any positive effect of soy was achieved through enhanced bone formation rather than slowed bone resorption. Long-term consumption of soy or its isoflavones may be needed to produce small but continued increments in bone mass.

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Aims Cardiovascular (CV) complications are the leading cause of maternal morbidity and mortality. The objective was to estimate trends in the incidence of peripartum CV complications in the USA between 2010 and 2016. Methods and results This was a retrospective analyses using data from the Healthcare Cost and Utilization Project. We included women with delivery codes consistent with delivery, weighted to a national estimate. The primary outcome was the age-adjusted incidence of CV complications among all deliveries, including complications that occurred during re-hospitalizations. Complications were identified using International Classification of Diseases (ICD) codes. Joinpoint regression was used to evaluate time trends and complications were stratified by type. The secondary outcome was in-hospital maternal death among women with a CV complication. We identified a weighted estimate of 27 408 652 women hospitalized for delivery from 2010 to 2016. Including all years, the complication incidence was 7.36/1000 births [95% confidence interval (CI) 7.18–7.54], with an estimated annual percentage change of 5.8% (95% CI 3.7–7.8%). Cardiac dysrhythmia was the most common complication [3.98/1000 births (95% CI 3.88–4.08)] and acute myocardial infarction was the least common complication [0.11/1000 births (95% CI 0.10–0.11)]. The incidence of hypertension, acute myocardial infarction, and cardiac arrest increased over time, the incidence of congestive heart failure and acute cerebrovascular disease remained stable, the incidence of pulmonary heart disease increased from 2015 onward, and the incidence of cardiac dysrhythmia decreased in 2016. Complications during re-hospitalization accounted for 13.6% (95% CI 13.2–14.1%) of all complications and was highest for acute myocardial infarction [28.1% (95% CI 23.2–33.1)]. Among women with any complication, the mortality rate was 1.20 (95% CI 1.11–1.29) per 100 complications. Conclusion Our analyses suggest the rate of peripartum CV complications are increasing in the USA, which highlights the need for active efforts in research and prevention.

Inpatient management of diabetes mellitus (DM) often involves substituting oral medications with insulin which can result in unnecessary insulin use. Attempting to address unnecessary insulin use, a quality improvement initiative implemented a newly developed evidence-based care pathway for inpatient diabetes management focused on patients with recent hemoglobin A1c values , 8% and no prescription of outpatient insulin. This retrospective observational preintervention and postintervention and interrupted time series analysis evaluates this intervention. Over a 21-month time period, there was a significant decrease in mean units of insulin administered per day of hospitalization from 2.7 (2.2-3.3) in the preintervention group to 1.7 (1.2-2.3) in the postintervention group (p 5 .017). During the initial 72 hours after admission, a significant downward trend in mean glucose values and mean insulin units per day was seen after the intervention. There was no significant change in hypoglycemic or hyperglycemic events between the two groups. The proportion of patients who received zero units of insulin during their admission increased from 27.7% to 52.5% after the intervention (p , .001). An evidence-based pathway for inpatient management of DM was associated with decreased insulin use without significant changes in hypoglycemic or hyperglycemic events.