Miracle-dz/UniFAR-FTUs huggingface dataset:
Response to Comment on Khunti et al. Clinical Inertia in People With Type 2 Diabetes: A Retrospective Cohort Study of More Than 80,000 People. Diabetes Care 2013;36:3411–3417

We would like to thank Esposito et al. (1) for their interest in and comment on our article (2), in particular their recognition of the importance of the study and the significance of our results. Regarding their concern surrounding the definition of clinical inertia, there are several points that we would like to expand upon. First, we acknowledge that individualizing HbA1c targets may be needed for certain patients (e.g., the elderly) for whom balancing good glycemic control against the risk of hypoglycemia is even more important (3). HbA1c targets in treatment guidelines are only a recommendation. However, these clinical guidelines are used by physicians in practice, and as the …
Changes in blood leukocytes, erythrocyte sedimentation rate and interleukin-6 following knee arthrotomy in dogs.

Summary Ajadi, R. A. , A. A. Adeniyi, O. S. Gazal & O. B. Kasali, 2013. Changes in blood leukocytes, erythrocyte sedimentation rate and interleukin-6 following knee arthrotomy in dogs. Bulg. J. Vet. Med. , 16, No 1, 37 −42. Changes in leukocyte parameters, erythrocyte sedimentation rate (ESR) and interleukin-6 (IL-6) were determined in ten mongrel dogs following knee arthrotomy. About 5 mL of blood was collected from each dog before knee arthrotomy, 2 hours, 24 hours and 3 days after knee arthrotomy for determination of white blood cell counts (WBC), neutrophil counts (NEUT), lymphocyte counts (LYM), neutrophil-lymphocyte ratio (N/L), ESR and IL-6. The data were expressed as mean ± standard deviation and differences compared using analysis of variance (ANOVA) at level of significance P<0.05. The results of this study showed that following knee arthrotomy, WBC, NEUT and ESR were significantly (P<0.05) increased 24 hours after surgery, while there were no significant change in LYM and N/L. Increase in ESR persisted up to three days following arthrotomy. In addition, IL-6 was significantly (P<0.05) increased two hours after knee arthrotomy up to 24 hours after arthrotomy and then decreased significantly by the 3 rd day. It was concluded that acute inflammation following knee surgery in dogs induced changes in leukocyte parameters, ESR and IL-6. These changes can be used to monitor prognosis following knee surgery in dogs.
Response to Comment on Heianza et al. Effect of Postmenopausal Status and Age at Menopause on Type 2 Diabetes and Prediabetes in Japanese Individuals: Toranomon Hospital Health Management Center Study 17 (TOPICS 17). Diabetes Care 2013;36:4007–4014

We thank Akter et al. (1) for their interest in our study (2). While we agree that the mean age was higher in the postmenopausal women than in the premenopausal women, results of our additional analysis of the 10,878 women showed that independently of older age (≥50 years) and demographic and metabolic factors (BMI, parental history of diabetes, physical activity habit, smoking habit, hypertension, log-transformed triglycerides, and HDL cholesterol) the postmenopausal state was associated with a 1.50 (95% CI 1.30–1.74) higher probability of the presence of dysglycemia (either type 2 diabetes or prediabetes) compared with premenopausal women. Admittedly, and as Akter et al. suggested, the association was attenuated (odds …
Comment on Zhang et al. Second-Line Agents for Glycemic Control for Type 2 Diabetes: Are Newer Agents Better? Diabetes Care 2014;37:1338–1345

Given the increasing burden of diabetic disease worldwide and the high number of available medications, the objective of the research by Zhang et al. (1) is praiseworthy. The study design is straightforward and, in our opinion, there are no particular points of concern from a clinical perspective. However, we do believe the study suffers from a number of inconsistencies that might reflect methodological errors or require further elucidation to reinforce the scientific value of the results. It is well known that pharmacoeconomic analyses using quality-adjusted life-years (QALYs) should have an incremental design. In 2012, Stein (2) observed that “the absolute cost-effectiveness ratio (cost divided …
Comment on Kramer et al. Glucagon Response to Oral Glucose Challenge in Type 1 Diabetes: Lack of Impact of Euglycemia. Diabetes Care 2014;37:1076–1082

We have read the study by Kramer et al. (1) concerning glucagon response to oral glucose challenge in type 1 diabetes with great interest. Although a paradoxical increase in glucagon in response to oral glucose may be one of the significant causes of hyperglycemia in patients with type 1 diabetes, its results should be carefully interpreted …
THE SIGNIFICANCE OF ANHYDREMIA IN EXTENSIVE SUPERFICIAL BURNS

The adequate management of a serious burn demands the skill and knowledge of both the physician and the surgeon. By reason of the emergent character of most burn cases and because of lack of knowledge relative to the newer conceptions of the nature of the processes underlying a burn, treatment is usually regarded as exceedingly difficult and unsatisfactory. With the advance of industry, burns are becoming of greater frequency and consequently of greater importance to the practitioner. Their increased occurrence lays an obligation on the medical profession to become conversant with the fundamental conditions induced by a burn and to become familiar with the most efficient methods of treatment. It is not sufficient to treat the wounded area only. Much more important is the recognition of systemic effects and the immediate institution of proper treatment to combat these effects. "What does it profit a man if he dresses the wound
Validation of diffusion tensor imaging measures of nigrostriatal neurons in macaques

Objective Interpretation of diffusion MRI in the living brain requires validation against gold standard histological measures. We compared diffusion values of the nigrostriatal tract to PET and histological results in non-human primates (NHPs) with varying degrees of unilateral nigrostriatal injury induced by MPTP, a toxin selective for dopaminergic neurons. Methods Sixteen NHPs had MRI and PET scans of three different presynaptic radioligands and blinded video-based motor ratings before and after unilateral carotid artery infusion of variable doses of MPTP. Diffusion measures of connections between midbrain and striatum were calculated. Then animals were euthanized to quantify striatal dopamine concentration, stereologic measures of striatal tyrosine hydroxylase (TH) immunostained fiber density and unbiased stereologic counts of TH stained nigral cells. Results Diffusion measures correlated with MPTP dose, nigral TH-positive cell bodies and striatal TH-positive fiber density but did not correlate with in vitro nigrostriatal terminal field measures or in vivo PET measures of striatal uptake of presynaptic markers. Once nigral TH cell count loss exceeded 50% the stereologic terminal field measures reached a near zero floor effect but the diffusion measures continued to correlate with nigral cell counts. Conclusion Diffusion measures in the nigrostriatal tract correlate with nigral dopamine neurons and striatal fiber density, but have the same relationship to terminal field measures as a previous report of striatal PET measures of presynaptic neurons. These diffusion measures have the potential to act as non-invasive index of the severity of nigrostriatal injury. Diffusion imaging of the nigrostriatal tract could potentially have diagnostic value in humans with Parkinson disease or related disorders.
A Preliminary Investigation of the Food Intake Patterns and Beliefs Among Independent Living Elderly Residents in a Continuing Care Retirement Center

Abstract A study investigating the food intake patterns and beliefs among independent living residents in one continuing care retirement community in the Pacific Northwest, in which resident meals are provided. Three hundred and fifty-five participants were surveyed using a food frequency instrument and a series of questions about meal patterns and beliefs. Data gathered represented an 85% response rate and indicates that food intakes among the residents are good when compared to other studies of older Americans. The results suggest similar or better intakes among the very old (85+) in this community.
Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis

OBJECTIVE Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS Medline and Embase were searched (2004–2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type. RESULTS Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08–2.25], two studies), cardiovascular events (1.98 [1.39–2.82]), and retinopathy (2.11 [1.54–2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15–1.57], two studies), macrovascular events (1.21 [1.06–1.38]), ulceration/gangrene (1.50 [1.06–2.12]), cardiovascular disease (1.27 [1.15–1.40]), and mortality (1.34 [1.18–1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability. CONCLUSIONS HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment.
Comment on Krul-Poel et al. Effect of Vitamin D Supplementation on Glycemic Control in Patients With Type 2 Diabetes (SUNNY Trial): A Randomized Placebo-Controlled Trial. Diabetes Care 2015;38:1420–1426

Krul-Poel et al. (1) provided elegant evidence that vitamin D supplementation had no significant effect on insulin secretion, insulin sensitivity, and glycemic control in patients with type 2 diabetes. This randomized controlled trial (RCT) enrolled subjects with type 2 diabetes and vitamin D insufficiency, i.e., a cohort that according to previous studies should take advantage from vitamin D treatment (2). Although the findings of Krul-Poel et al. clearly did not show any effect of vitamin D supplementation on diabetes management, it must be highlighted that these data are of paramount importance regarding vitamin …
Effect of the GLP-1 Receptor Agonist Lixisenatide on Counterregulatory Responses to Hypoglycemia in Subjects With Insulin-Treated Type 2 Diabetes

OBJECTIVE Counterregulatory responses are critical to prevent hypoglycemia in subjects with type 2 diabetes. This is particularly important in insulin-treated patients. This study explored the effect of the glucagon-like peptide 1 receptor agonist lixisenatide on the hormonal counterregulatory responses to insulin-induced hypoglycemia when added to basal insulin therapy in subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS The study was a single-center, double-blind, randomized, placebo-controlled crossover study involving 18 subjects with type 2 diabetes (11 males) with a mean age of 55 years, diabetes duration of 12 years, HbA1c level of 7.7%, fasting blood glucose (FBG) concentration of 9.7 mmol/L, and a BMI of 33 kg/m2, who were treated with basal insulin (mean duration 7 years, daily dose 39 units/day) and metformin (mean daily dose 2.1 g). Subjects received treatment with lixisenatide or placebo for 6 weeks in random order, with a 4-week washout period in between. After 6 weeks of treatment, subjects underwent a two-step hyperinsulinemic hypoglycemic clamp at 3.5 and 2.8 mmol/L. RESULTS After 6 weeks of treatment, HbA1c and FBG levels were lower after lixisenatide therapy than after placebo therapy. At the hypoglycemic level of 3.5 mmol/L, glucagon and epinephrine levels were significantly lower during lixisenatide treatment than during placebo treatment, whereas at 2.8 mmol/L glucagon and epinephrine levels did not differ between the subjects. Cortisol, pancreatic polypeptide, and norepinephrine levels did not differ significantly between the treatments. CONCLUSIONS Glucagon and epinephrine levels are reduced by lixisenatide at a concentration of 3.5 mmol/L, but their counterregulatory responses to deep hypoglycemia at a concentration of 2.8 mmol/L are sustained during treatment with lixisenatide in combination with basal insulin.
Evaluation of Efficacy and Safety of the Glucagon Receptor Antagonist LY2409021 in Patients With Type 2 Diabetes: 12- and 24-Week Phase 2 Studies

OBJECTIVE Type 2 diabetes pathophysiology is characterized by dysregulated glucagon secretion. LY2409021, a potent, selective small-molecule glucagon receptor antagonist that lowers glucose was evaluated for efficacy and safety in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS The efficacy (HbA1c and glucose) and safety (serum aminotransferase) of once-daily oral administration of LY2409021 was assessed in two double-blind studies. Phase 2a study patients were randomized to 10, 30, or 60 mg of LY2409021 or placebo for 12 weeks. Phase 2b study patients were randomized to 2.5, 10, or 20 mg LY2409021 or placebo for 24 weeks. RESULTS LY2409021 produced reductions in HbA1c that were significantly different from placebo over both 12 and 24 weeks. After 12 weeks, least squares (LS) mean change from baseline in HbA1c was –0.83% (10 mg), –0.65% (30 mg), and –0.66% (60 mg) (all P < 0.05) vs. placebo, 0.11%. After 24 weeks, LS mean change from baseline in HbA1c was –0.45% (2.5 mg), –0.78% (10 mg, P < 0.05), –0.92% (20 mg, P < 0.05), and –0.15% with placebo. Increases in serum aminotransferase, fasting glucagon, and total fasting glucagon-like peptide-1 (GLP-1) were observed; levels returned to baseline after drug washout. Fasting glucose was also lowered with LY2409021 at doses associated with only modest increases in aminotransferases (mean increase in alanine aminotransferase [ALT] ≤10 units/L). The incidence of hypoglycemia in the LY2409021 groups was not statistically different from placebo. CONCLUSIONS In patients with type 2 diabetes, glucagon receptor antagonist treatment significantly lowered HbA1c and glucose levels with good overall tolerability and a low risk for hypoglycemia. Modest, reversible increases in serum aminotransferases were observed.
A comparison of patient and proxy symptom assessments in advanced cancer patients

The purpose of this study was to compare patient and proxy (physician and nurse) assessments of symptoms in advanced cancer patients. The sample consisted of 49 patients with advanced cancer admitted to an acute palliative care unit. Three independent assessments were completed for each patient on two occasions within 11 days of admission. On each occasion, symptoms were rated independently by the patient and two proxies (treating physician and nurse), using the Edmonton Symptom Assessment System (ESAS). The ESAS is a nine-item visual analogue scale (VAS) for assessing pain, activity, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath. Symptom ratings were compared using a repeated-measures ANOVA procedure and correlations. Average physician ratings were generally lower than average patient ratings for both occasions. Average nurse ratings agreed more closely with patient ratings, with a trend towards lower ratings on occasion 1 and higher ratings on occasion 2. There was a significant rater (person rating the effects) effect (P < 0.01) for three of the nine symptoms: physicians rated drowsiness, shortness of breath and pain significantly lower than patients. For drowsiness and shortness of breath, these differences were clinically relevant, representing a difference of more than 12 mm on a 100-mm VAS. The accuracy of assessments amongst those rating the symptoms did not improve over time. Proxy assessments of symptom intensity, particularly by physicians, were significantly lower than patient assessments for three of the nine symptoms. Further research regarding the reliability of patient and proxy assessments is needed to assess and manage symptoms in advanced cancer effectively.
Bariatric Surgery in Obese Patients With Type 1 Diabetes

OBJECTIVE There is a paucity of data on the impact of bariatric surgery in type 1 diabetes (T1D). The aim of this review was to quantify the overall effects of bariatric surgery in obese patients with T1D. METHODS We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar from their inception to December 2015 to identify all relevant studies of bariatric surgery in adult obese patients with T1D. RESULTS The review included 17 studies with 107 individuals, including 10 case series and 7 case reports. Overall, the dominant procedure was gastric bypass (n = 70; 65%). All studies reported a significant reduction in excess weight. A significant reduction in weight-adjusted daily insulin requirements was shown in all case series except one. Pooled mean ± SD of pre- and postoperative glycated hemoglobin (HbA1c) for the entire cohort with available data (n = 96) was 8.4 ± 1.3% and 7.9 ± 1.1%, respectively (P = 0.01). In addition to common postoperative complications, profound glycemic changes (diabetic ketoacidosis and hypoglycemia) and gastrointestinal dysmotility symptoms (prolonged ileus and acute gastric remnant dilation) have been reported. No surgical mortality was reported. CONCLUSIONS Bariatric surgery leads to significant weight loss in severely obese patients with T1D and results in a significant improvement in insulin requirements and glycemic status. The favorable metabolic effects of bariatric surgery may facilitate medical management of and cardiovascular risk reduction in T1D in the setting of severe obesity. Diabetic ketoacidosis and hypoglycemia are potentially serious complications. Short-term results of bariatric surgery in patients with T1D are encouraging, but larger and longer-term studies are needed.
Assertive Community Treatment for the Severely Mentally Ill in West Lambeth

The prime duty of specialist mental health services is to provide effective care to often non-compliant and unstable severely mentally ill (SMI) patients. Society expects such care to be humane and effective, but also demands that the severely ill are closely supervised to minimise risk to the public. Sadly, specialist services all too often fail on both counts. In part, this is due to the sheer complexity of care that is needed, going far beyond purely medical or therapeutic interventions. SMI patients have profound difficulties accessing and using everyday services and opportunities. Negative symptoms of apathy, self-neglect and low motivation, coupled with irrational beliefs and compounded by inadequately resourced and tightly rationed provision of social care, require mental health care services to be constantly active across areas of both medical and social provision. Services that ignore the importance of long-term, integrated care do so at their peril. A steady stream of disasters has been blamed on a lack of communication and coordination between agen cies (Spokes, 1988;Ritchie et al, 1994),and follow-up studies of SMI patients managed by traditional hospital out-patient services repeatedly note a mis match between levels of need and service uptake, with the least needy consuming the greater amount of service (Goering et al, 1984;Melzer et al, 1991).
2. Classification and Diagnosis of Diabetes

1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency) 2. Type 2 diabetes (due to a progressive insulin secretory defect on the background of insulin resistance) 3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes) 4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drugor chemical-induced diabetes (such as in the treatment of HIV/AIDS or after organ transplantation)
Non-alcoholic fatty liver disease is a strong predictor of coronary artery calcification in metabolically healthy subjects: A cross-sectional, population-based study in middle-aged subjects

Objectives This study aims to estimate the relationship between non-alcoholic fatty liver disease (NAFLD) and measures of atherosclerotic cardiovascular disease (ASCVD), and to determine to what extent such relationships are modified by metabolic risk factors. Methods The study was conducted in the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) pilot cohort (n = 1015, age 50–64 years, 51.2% women). NAFLD was defined as computed tomography liver attenuation ≤40 Hounsfield Units, excluding other causes of liver fat. Coronary artery calcification score (CACS) was assessed using the Agatston method. Carotid plaques and intima media thickness (IMT) were measured by ultrasound. Metabolic status was based on assessments of glucose homeostasis, serum lipids, blood pressure and inflammation. A propensity score model was used to balance NAFLD and non NAFLD groups with regards to potential confounders and associations between NAFLD status and ASCVD variables in relation to metabolic status were examined by logistic and generalized linear regression models. Results NAFLD was present in 106 (10.4%) of the subjects and strongly associated with obesity-related traits. NAFLD was significantly associated with CACS after adjustment for confounders and metabolic risk factors (OR 1.77, 95% CI 1.07–2.94), but not with carotid plaques and IMT. The strongest association between NAFLD and CACS was observed in subjects with few metabolic risk factors (n = 612 [60% of all] subjects with 0–1 out of 7 predefined metabolic risk factors; OR 5.94, 95% CI 2.13–16.6). Conclusions NAFLD was independently associated with coronary artery calcification but not with measures of carotid atherosclerosis in this cohort. The association between NAFLD and CACS was most prominent in the metabolically healthy subjects.
12. Management of Diabetes in Pregnancy

c Provide preconception counseling that addresses the importance of tight control in reducing the risk of congenital anomalies with an emphasis on achieving A1C ,7%, if this can be achieved without hypoglycemia. B c Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reliable contraception. B c GDM should be managed first with diet and exercise, and medications should be added if needed. A c Women with pregestational diabetes should have a baseline ophthalmology exam in the first trimester and then be monitored every trimester as indicated by degree of retinopathy. B c Due to alterations in red blood cell turnover that lower the normal A1C level in pregnancy, the A1C target in pregnancy is,6% if this can be achieved without significant hypoglycemia. B c Medications widely used in pregnancy include insulin, metformin, and glyburide; most oral agents cross the placenta or lack long-term safety data. B