Chicken Meat Loaf Florentine

Ingredients

1 tbsp extra-virgin olive oil
1 leek (white and light green parts only), quartered and thinly sliced
4 cups lightly packed baby spinach
2 cloves garlic, minced
1 tsp Italian herb seasoning
1/2 tsp each salt and pepper
pinch hot pepper flakes
1 cup fresh bread crumbs
1 egg, lightly beaten
3/4 cup shredded Fontina cheese
1 tsp Dijon mustard
450 g extra-lean ground chicken
1/3 cup bottled strained tomatoes (passata)

Method

1. In skillet, heat oil over medium heat. Cook leek, stirring occasionally, until softened, about 6 minutes.
2. Stir in spinach, garlic, Italian herb seasoning, salt, pepper and hot pepper flakes. Cook, stirring occasionally, until spinach is wilted and no liquid remains, about 3 minutes. Transfer to large bowl and let stand for 10 minutes.
3. Stir in bread crumbs, egg, 1/2 cup of the Fontina and mustard. Mix in chicken. Shape into 7- x 4-inch log.
4. Place on foil-lined rimmed baking sheet. Brush all over with strained tomatoes.
5. Bake in 375°F (190°C) oven until instant-read thermometer inserted in centre reads 165°F (74°C), about 45 minutes.
6. Sprinkle with remaining Fontina and let stand for 10 minutes before slicing.

Makes 4 servings.

Source: The Complete Chicken Cookbook

Pandemic Sets Off Future Wave of Worsening Mental Health Issues

Laurie Fickman wrote . . . . . . . . .

Long after a COVID-19 vaccination is developed and years after the coronavirus death toll is tallied, the impact on mental health will linger, continuing to inflict damage if not addressed, according to new research. Michael Zvolensky, University of Houston Hugh Roy and Lillie Cranz Cullen Distinguished University Professor of Psychology and director of the Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, has published two papers discussing the psychological, addictive and health behavior issues related to the COVID-19 pandemic from a behavioral science perspective.

“The impact of COVID-19 on psychological symptoms and disorders, addiction and health behavior is substantial and ongoing and will negatively impact people’s mental health and put them at greater risk for chronic illness and drug addiction,” reports Zvolensky in Behaviour Research and Therapy. “It will not equally impact all of society. Those at greater risk are those that have mental health vulnerabilities or disorders.”

For instance, those who ‘catastrophize’ the pandemic amplify the actual stress impact, increasing their symptoms and creating the possibility for substance abuse.

“That sets in motion a future wave of mental health, addiction and worsening health problems in our society. It’s not going to go away, even with a vaccination, because the damage is already done. That’s why we’re going to see people with greater health problems struggling for generations,” said Zvolensky

Zvolensky offers a model of how the COVID-19 stress burden may be associated with addictive problems and health behaviors, and how these may be associated with later chronic illness and psychological problems.

In Psychiatry Research, Zvolensky presents findings linking worry and fear about the pandemic to drug use and abuse.

Zvolensky evaluated a group of 160 participants to find if COVID-19-related worry and fear differed between substance abstainers, pre-COVID-19 users and those who initiated drug use for the first time during the pandemic.

“Results generally suggest the persons using substance experience the highest levels of COVID-19-related worry and fear,” said Zvolensky. “Additionally, worry about COVID-19 is related to coping motives for substance use.”

These results provide preliminary evidence that COVID-19-related worry and fear may be putative risk factors for substance use initiation in the face of COVID-19, and these results may provide critical clinical information for helping individuals cope with this pandemic,” he said.

Source: University of Houston

Newer Type 2 Diabetes Medications Have Heart and Kidney Disease Benefits, Too

Two newer groups of medications prescribed primarily for Type 2 diabetes treatment (SGLT2 inhibitors and GLP-1 receptor agonists) could significantly reduce risks associated with chronic kidney disease (CKD) and heart disease. Based on analyses of the clinical trials through March 2020, a group of leading experts in diabetes, heart failure, kidney disease and cardiometabolic disease believe the medicines should be considered for people with CKD and Type 2 diabetes to protect against heart and kidney disease and their serious complications, according to a new Scientific Statement from the American Heart Association, “Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease,” published today in the AHA’s flagship journal, Circulation.

The statement reviews evidence from multiple, large, international, randomized controlled trials of two classes of blood sugar control medications — sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1 RAs) — in patients with Type 2 diabetes, chronic kidney disease and those who were either at risk for or already had cardiovascular disease. The composite results of the trials found that SGLT2 inhibitors and GLP-1 RAs can safely and significantly reduce the risk of cardiovascular events and death, reduce hospitalization and slow the progression of chronic to end-stage kidney disease including the risks of dialysis, transplantation or death.

“A collaborative treatment approach among primary care doctors and specialists in diabetes, cardiology and kidney disease that, when indicated, includes treatment with these two classes of medications could add more heart- and kidney disease-free years and greatly extend survival for people with Type 2 diabetes,” said chair of the statement writing committee Janani Rangaswami, M.D., FACP, FAHA, associate chair of research in the department of medicine at Einstein Medical Center and associate clinical professor at the Sidney Kimmel College of Thomas Jefferson University, both in Philadelphia.

Chronic kidney disease (CKD) is a common long-term complication of Type 2 diabetes and represents a major public health problem in the U.S. The two leading causes of chronic kidney disease are Type 2 diabetes and hypertension. There are 26 million people in the U.S. diagnosed with diabetes and an additional 9.45 million are undiagnosed. In the U.S., 108 million (45%) adults have hypertension (130/80 mmHg or higher) or are taking blood pressure medications. An estimated 37 million American adults have kidney disease. Most patients with end stage kidney disease have Type 2 diabetes, and people with Type 2 diabetes are at increased risk for high blood pressure, cardiovascular disease (CVD) including heart attacks and heart failure, and stroke. Although there are established standards of care, a disproportionately high burden of kidney and cardiovascular disease exists in this population, leading to concerning levels of avoidable death, illness and health care costs, as well as poor quality of life.

The scientific statement provides detailed, practical guidance for health care professionals to recognize and treat patients who may benefit from SGLT2 inhibitor and GLP-1 RA medications.

Analysis of the clinical trials results yielded these recommendations:

• Early and ongoing assessment of risks for kidney and heart disease can help identify patients who may benefit from the protective and preventive effects of these medicines.
• Tailor medication choices to meet the needs of each individual patient.
• Monitoring and control of high blood pressure.
• Identify risks for hypoglycemia (low-blood sugar) and educate patients on the signs so they can seek treatment quickly.
• Adjust all medications in tandem with these medicines and consider the burden of “polypharmacy” – meaning taking 5 or more medications daily for multiple conditions, which is common among people with Type 2 diabetes.
• Patients should be counseled about the risks and symptoms of “euglycemic” diabetic ketoacidosis (DKA), when taking SGLT2 inhibitors as well as “classic” DKA (when blood sugar is very high and acidic substances called ketones build up in the body), which is serious and can be fatal.
• The health care professional team should regularly screen and counsel patients about regular foot care to prevent foot ulcers or blisters that can quickly become infected and lead to amputation.

The writing group identified two additional patient subgroups who may benefit from SGLT2 inhibitors and GLP-1 RAs: people with heart failure with reduced ejection fraction (HFrEF) with or without Type 2 diabetes; and people with chronic kidney disease who do not have Type 2 diabetes. The writing group anticipates more data emerging to validate the use of SGLT2 inhibitors and GLP-1 RA medications for these at-risk patients.

GLP-1 RAs received initial FDA approval for use in glycemic control in 2005, and SGLT2 inhibitors were approved in 2013, and they were approved for treating people with Type 2 diabetes. Medications within the two classes work in different ways: SGLT2 inhibitors decrease blood sugar by causing the kidneys to remove sugar from the body through the urine. Research on medicines in this class have shown they also can reduce the risk of heart failure, slow the progression of chronic kidney disease and reduce risk of cardiovascular death. GLP-1 RAs work by simulating the functions of the body’s natural incretin hormones that help lower post-meal blood sugar levels. The medicines in this group have been shown to reduce the risks of heart attack, ischemic stroke and/or cardiovascular death.

Recent studies show these newer medications are not widely prescribed, especially among patients with higher risks for cardiovascular disease and chronic kidney disease. A recent nationwide study of over one million commercially insured and Medicare Advantage adult beneficiaries showed that 7% of patients with Type 2 diabetes were treated with an SGLT2 inhibitor medication.

“Currently in the U.S., primary care professionals or endocrinologists typically initiate the use of these medications in patients with Type 2 diabetes, yet a more multi-specialty approach that includes kidney and heart specialists could help more patients benefit from treatment,” noted the statement authors.

“The most important question that needs to be addressed in the future is the actual implementation of these medicines in clinical practice,” said Rangaswami. “When multidisciplinary teams can identify high-risk patients and ensure targeted delivery of these therapies, as appropriate, we could greatly reduce the burden of heart and kidney disease for millions of people with Type 2 diabetes. Improving the cardiovascular and kidney health of as many people as possible – reducing morbidity, mortality and health care expenditures – are the primary goals.”

Source: American Heart Association

Breast and Ovarian Cancer Drug Extend Prostate Cancer Survival

Marla Paul wrote . . . . . . . . .

Men with metastatic, hormone-resistant prostate cancer, who were treated based on the genetic makeup of their cancer, survived significantly longer than those treated with traditional hormone treatments, according to a large, international phase 3 clinical trial co-led by investigators from Northwestern Medicine, The Institute of Cancer Research in London and The Royal Marsden NHS Foundation Trust.

The study will be published in the New England Journal of Medicine.

“Our results show genetically targeted treatment can extend the lives of patients with advanced prostate cancer that has progressed after several types of therapies, including hormone therapy,” said Northwestern Medicine oncologist Dr. Maha Hussain, co-leader of the PROfound trial, which investigated the drug olaparib. “We are now entering a new era of personalized care and precision medicine for metastatic prostate cancer. This will change clinical care for prostate cancer.”

Hussain is the Genevieve E. Teuton Professor of Medicine at Northwestern University Feinberg School of Medicine. She also is deputy director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Olaparib, currently used to treat breast, ovarian and pancreatic cancer, was used successfully to treat prostate cancers with an inability to repair damaged DNA.

“This marks a significant advance for prostate cancer treatment, which has lagged behind other common cancers with regard to precision therapy, now the standard of care in many cancers including breast, ovarian, pancreatic and lung cancers,” Hussain said.

The trial treated men with metastatic prostate cancer that had progressed after several types of prior standard therapies, including hormone therapy.

The trial preselected patients who have genetic alterations in the genes that enable cells to repair themselves from damage. Those most commonly known are the BRACA 1, BRACA 2 and ATM genes, but there are several others. Patients were randomly assigned to receive olaparib, which has been used in other cancers with similar genetic alterations, or standard hormone therapy with either abiraterone and prednisone or enzalutamide.

There were two cohorts of patients based on their cancer genetic mutations. The median duration of overall survival in patients in cohort A with mutations on BRCA1, BRCA2 or ATM genes was 19.1 months with olaparib compared to 14.7 months with control therapy, a number considered clinically and statistically significant.

In cohort B patients (those with other genetic mutations) the median overall survival was 14.1 months with olaparib and 11.5 months with control therapy, but this was not statistically significant.

In 2020, there will be an estimated 191,930 new cases of prostate cancer and about 33,330 deaths from it. Prostate cancer continues to be the second leading cause of cancer death in men in the United States. In 2016, there were an estimated 3,100,000 men living with prostate cancer in the U.S.

The trial had previously reported a delay in disease progression for this group of men with DNA repair faults in their tumors — but these final published results offer a longer follow-up and conclusively demonstrate an improvement in survival for men who were given olaparib.

Olaparib blocks PARP, a protein that helps damaged cells repair themselves. Some cancer cells rely on PARP to keep their DNA healthy. When PARP is stopped from repairing DNA damage, the cancer cells die.

“We want to prevent those renegade cancer cells from repairing themselves,” Hussain said.

Source: Northwestern University

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Today’s Comic

How to Make Dry-fried Beef Rice Noodles – a Hong Kong Favourite

Susan Yung wrote . . . . . . . . .

Gon chow ngau ho – dry-fried beef rice noodles – is a beloved dish in Hong Kong, where you can find it anywhere from dai pai dongs to high-end restaurants. “Dry-fried” doesn’t mean the ingredients are cooked without liquid or oil; it’s just a term that differ­entiates this version of beef ho fun (rice noodles with beef) from another that is wetter and saucier.

In restaurants, chefs cook this dish in a large wok over an enormous gas fire. At home, where we use a smaller wok over a regular gas range, it’s important that you don’t cook too much at once – it’s best to stir-fry enough for a maximum of two people at a time, or the rice noodles will get soggy. Still, even using a household gas range, the ingredients take just a few minutes to cook.

Fresh rice noodles are different from dried rice noodles, which I don’t recommend for this dish. Fresh rice noodles are oiled and stacked before being sliced into strips (about 6cm-8cm wide). When you get them home, separate the stacked noodles into individual single-noodle strips while they are at room temperature; if you try to separate them after they have been refrigerated they will break apart.

If they were refrigerated when you bought them, and there­fore hard, put the noodles – still in the plastic bag – in the microwave and zap for about 30 seconds before checking to see if they are soft enough, or, after squeezing out the air, tie the top of the bag so water can’t leak in, and submerge it in hot water until the noodles are soft, then separate them.

You don’t want to put the noodles directly into hot water, or they will become soggy. The noodles should also be pliable when you cook them, so, again, if necessary, warm them, in the bag, in the microwave or in hot water.

This dish is primarily about the noodles; the beef is there to flavour them. Because of that, I’ve used a fairly small amount of meat. If you like a beefier dish, double the amount of meat and the marinade ingredients. The cooking time should be about the same. Choose a tender cut of beef, such as sirloin, oyster blade or flank.

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For the rice noodles:

300-350 grams fresh rice noodles
20 ml dark soy sauce
15 grams kecap manis (Indonesian dark soy sauce)
1 tsp granulated sugar
1/2 tsp fine sea salt, plus more as necessary

For the beef and vegetables:

2-3 thin slices peeled ginger
100 grams boneless beef
1-1/2 tsp light soy sauce
1-1/2sp rice wine
1/2 tsp granulated sugar
1/4 tsp fine sea salt
1/4 tsp finely ground white pepper
1 tsp oyster sauce
1/2 tsp sesame oil
5 grams cornstarch
1/2 medium-sized onion, about 100 grams, peeled
20 grams spring onions
25 grams flat Chinese chives
30 grams bean sprouts
about 40ml cooking oil, divided

To serve:

chilli sauce to taste

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1. If the noodles are hard, heat them until pliable, either in the microwave or by submerging the tightly sealed bag in hot water. Unwrap the noodles, separate them and put them into a bowl.
2. In a small bowl, stir the dark soy sauce with the kecap manis, sugar and salt. Pour this over the rice noodles and mix so they are coated evenly, then take them out of the bowl and lay them on a plate to air-dry while preparing the other ingredients. Save the liquid in the bowl.
3. Thinly slice the beef across the grain into strips. Put the pieces in a bowl and add the light soy sauce, rice wine, sugar, salt, white pepper, oyster sauce and sesame oil. Mix thoroughly, then add the cornstarch and mix again.
4. Thinly slice the onion. Cut the spring onions and chives into 3cm lengths.
5. Place a well-seasoned wok over a high flame. When the wok is hot, pour in about 10 ml of oil. Swirl the wok so it is coated with the oil, and when it’s hot, add the onion and stir-fry until lightly wilted (about 30 seconds). Add the spring onions and chives and stir-fry for about 15 seconds. Transfer the ingredients to a bowl, leaving behind as much oil as possible.
6. Heat the wok again over a high flame, then pour in about 10 ml of cooking oil. Add the ginger and stir-fry for about 10 seconds. Stir the beef in the bowl to recombine the ingredients, then add the beef and marinade to the wok. Stir-fry for about 30 seconds, or until the beef starts to lose its pink colour. Take the beef from the wok and add it to the vegetables.
7. Heat the wok again over a high flame and add 20 ml of oil, swirling it to coat the pan. When the oil is starting to smoke, add the noodles and a light sprinkling of salt. Stir gently so the noodles are coated with oil, then spread them to the sides of the wok so they heat evenly. After about 20 seconds, stir the noodles, then again spread them along the sides of the wok and leave for about 20 seconds.
8. Stir the noodles, then push them to the centre of the wok. Add the vegetables and beef and stir well.
9. Pour the liquid used to season the noodles into the wok along the sides of the pan. Add the bean sprouts and stir well.
10. Taste some of the rice noodles for seasoning, and if needed, stir in a little more salt and/or light soy sauce.
11. Transfer the ingredients to two dinner plates and serve immediately, with chilli sauce.

Source: SCMP