bluuebunny/crossref_metadata_2025 huggingface dataset:
Celiotomy by plastrotomy in a yellow-footed tortoise (Geochelone denticulata)
Authors: Rodrigues Marcelo C. , Lima Wagner C. , Quessada Ana M. , Silva Filipi A.N. , Silva Laís M.C. , Souza André B. de , Moura Charlys R.C. de , Lima Dayanne A.S.D.
Published: June 2015

One herein reports a successful case of celiotomy by plastrotomy for removal of foreign bodies in yellow-footed tortoise (Geochelone denticulata). The animal was treated at the Veterinary Hospital of the Federal University of Piaui, with appetite loss, regurgitation, constipation, lethargy, reluctance to walk and slightly reddish ocular mucous membranes. Radiographic examination was performed, confirming the presence of foreign bodies in the stomach. The tortoise underwent celiotomy by plastrotomy for the removal of the foreign bodies. The opening of the plastron was performed through the abdominal shields, with the aid of a circular mini grinding saw. One performed an incision in the midline between the two abdominal veins to access the abdominal cavity. A gastrotomy for removal of the foreign bodies (nails, toothpicks, stones, pieces of plastic, glass and crockery pieces) was performed after the location of the stomach. The surgery was successful and confirmed with radiographic evaluation in the immediate postoperative period. The celiotomy by plastrotomy for removal of foreign bodies in that animal proved to be a viable, very important and safe technique to the survival of chelonians.
Monitoramento do ciclo estral de cutias (Dasyprocta leporina Lichtenstein, 1823) através de citologia esfoliativa vaginal e ultrassonografia
Authors: Campos Lívia B. , Peixoto Gislayne C.X. , Lima Gabriela L. , Castelo Thibério S. , Souza Ana L.P. , Oliveira Moacir F. , Silva Alexandre R.
Published: June 2015

O objetivo deste estudo foi monitorar o ciclo estral em cutias (Dasyprocta leporina) criadas em cativeiro no semiárido brasileiro. Durante 70 dias, cinco cutias foram diariamente submetidas a citologia esfoliativa vaginal, e o monitoramento ultrassonográfico ovariano foi realizado a cada três dias. Um total de 8 ciclos estrais foi completamente monitorado, com duração de 28,2±0,7 dias, variando de 24 a 31 dias. Pela citologia esfoliativa vaginal, houve uma predominância de células superficiais nas fases de proestro e estro (P<0,05), seguida da predominância de células intermediárias no metaestro (P<0,05) e de células parabasais no diestro (P<0,05). Por ultrassonografia, não houve diferenças na morfologia ovariana durante as diferentes fases do ciclo estral (P>0,05). Os folículos foram identificados durante as fases estrogênicas (proestro e estro), com diâmetro médio de 1±0,5mm. Em apenas 12,5% das fases luteais, corpos lúteos medindo 1,4±0,9mm foram identificados. Conclui-se que a associação da citologia vaginal e da ultrassonografia ovariana constitui uma alternativa viável para o monitoramento de ciclos estrais e identificação das fases estrogênicas em cutias da espécie Dasyprocta leporina
Morfologia e morfometria da traqueia da preguiça (Bradypus variegatus): conhecimentos para procedimentos de emergência
Authors: Faro Thamirys A.S. , Lima Ana Rita de , Messias Antonio C. , Cabral Rosa , Giese Elane G. , Matos Edilson R. , Branco Érika
Published: June 2015

Por ser uma espécie pouco estudada, principalmente do ponto de vista morfológico, objetivou-se conhecer a anatomia da traqueia da preguiça (Bradypus variegatus) a fim de fornecer informações para facilitar a eleição de tubo endotraqueal adequado, máscara laríngea ou cânula de traqueostomia para anestesia e procedimentos de emergência, uma vez que a mesma revelou-se possuidora de uma morfologia especial. Foram investigados 11animais jovens de idades diferentes, sendo quatro machos e sete fêmeas, provenientes do Museu Emilio Goeldi e doados a UFRA. Os exemplares foram perfundidos via intramuscular com solução aquosa de formol a 10% para fins de conservação e posteriormente foram dissecados em nível cervico-torácico, por meio de mesoscopia, expondo-se desde a laringe até os brônquios principais direito e esquerdo ao nível do hilo pulmonar. As traqueias foram divididas em cinco regiões (região cervical, região da primeira flexura, região da segunda flexura, região da terceira flexura e região da carina) as quais foram mensuradas altura e largura, assim como o comprimento traqueal total e parte do material foi submetido à técnicas de rotina histológica. Macroscopicamente, destacou-se a presença de sinuosidades acentuadas em porção médio caudal, contemplando a carina. O comprimento médio traqueal foi de 14,6cm. Microscopicamente, a traqueia era constituída por placas separadas de cartilagem hialina constituindo cada anel, sendo revestido por epitélio estratificado ciliado. Apesar da traqueia da preguiça comum apresentar revestimento padrão encontrado na traqueia de outros animais, na literatura não há registros de outras espécies que tenham morfologia macroscópica nas condições descritas, o que nos leva a sugerir, quando necessário acesso para ventilação de emergência, a prática da IOT e não a de traqueostomia.
Demandas de Professores Decorrentes da Inclusão Escolar
Authors: MATOS Selma Norberto , MENDES Enicéia Gonçalves
Published: June 2015

com a implementação das políticas públicas em inclusão escolar, cresce o número de alunos com Necessidades Educacionais Especiais (NEEs) em classes comuns, fato que ajuda a compor um cenário nas escolas que tem desvelado limitações e contradições do sistema educacional brasileiro. Atores e autores educacionais são desafiados a construir saberes capazes de responder às demandas do cotidiano escolar relacionadas à convivência e aprendizagem na diversidade. Considerando que este processo inclusivo é novo nas escolas, o estudo teve como objetivo analisar as demandas dos professores decorrentes da inclusão escolar. A pesquisa foi qualitativa do tipo exploratório, participando seis professoras, seus alunos com NEEs e três profissionais do Núcleo de Educação Inclusiva da Secretaria Municipal de Educação. Para coleta de dados, foram utilizados: técnica de observação participante, diário de campo, entrevista semiestruturada, questionário e, para discussão dos dados, análise de conteúdo. Os resultados indicam que existem conquistas e contradições na realidade das escolas que se propõem inclusivas; avanços e limitações resultantes da política municipal, e que o modelo de atuação da equipe de educação especial no contexto analisado pode ser revisto ou ampliado. Indicam que os professores apresentam demandas no domínio da política pública, da formação, e demandas dirigidas ao psicólogo.
Possibilidades da Tutoria de Pares para Estudantes com Deficiência Visual no Ensino Técnico e Superior
Authors: FERNANDES Woquiton Lima , COSTA Carolina Severino Lopes da
Published: June 2015

a inclusão escolar pode trazer benefícios incontestáveis para o desenvolvimento da pessoa com deficiência, desde que sejam realizadas adequações e adaptações na dinâmica escolar e nas propostas pedagógicas a fim de atender as necessidades educacionais dos mesmos. Estudos sobre teorias e práticas que contribuam para uma educação inclusiva e de maior qualidade passaram a ser o desafio dos pesquisadores e profissionais da área. Desse modo, esse estudo objetivou analisar e descrever a percepção de estudantes com deficiência visual e sem deficiência (tutores) sobre a atividade de tutoria de pares. A pesquisa ocorreu em um Instituto Federal de Educação, Ciência e Tecnologia do interior do Nordeste Brasileiro. Participaram do estudo sete estudantes com deficiência visual na condição de tutorados, seis na função de tutores e a coordenadora responsável pelas tutorias. Para a coleta de dados foi utilizado um roteiro de entrevista semiestruturada, versões para tutor, tutorado e coordenação. Os dados foram analisados por meio da categorização temática da análise de conteúdo com a utilização do softwareAtlas-Ti. Os resultados mostraram que as díades tutor-tutorado, na condição de colegas de mesma classe, apresentaram um maior grau de satisfação com relação à tutoria, tanto na visão dos tutorados, quanto na concepção dos próprios tutores. Concluiu-se, de acordo com os resultados, que a tutoria de pares se configura como uma estratégia promissora para dar apoio a inclusão de estudantes com deficiência visual no ensino técnico e superior.
Professores do Atendimento Educacional Especializado e a Organização do Ensino para o Aluno com Deficiência Intelectual
Authors: FANTACINI Renata Andrea Fernandes , DIAS Tárcia Regina da Silveira
Published: June 2015

a educação inclusiva é um processo em construção e diante desse novo cenário, são questionadas as condições de ensino organizadas nas escolas comuns para esses alunos, pois elas, em geral, não correspondem às especificidades que os mesmos apresentam. Este estudo teve como objetivo geral conhecer e refletir sobre a organização da educação inclusiva para o atendimento do aluno com deficiência intelectual nos diferentes espaços educacionais na rede municipal de uma cidade de pequeno porte do interior paulista; buscando-se conhecer a percepção de professores especialistas sobre as condições de ensino organizadas para os alunos com deficiência intelectual nas escolas comuns. Participaram desta pesquisa, as professoras que atuam na equipe de AEE no município. O método utilizado foi a aplicação de entrevistas semiestruturadas aos professores do AEE para conhecer as suas percepções sobre a educação de alunos com deficiência intelectual. A análise dos dados foi articulada com a fundamentação teórica a partir de estudos disponíveis na literatura da área. Os resultados apresentados indicam que é preciso conhecer como estão ocorrendo às práticas inclusivas. Conclui-se que este estudo é uma amostra de uma experiência que está caminhando e espera-se que possa contribuir para a organização do ensino dos alunos com deficiência intelectual.
A Formação de Conceitos em Alunos com Deficiência Intelectual: o Caso de Ian
Authors: BRAUN Patricia , NUNES Leila Regina d'Oliveira de Paula
Published: June 2015

este artigo apresenta um recorte de uma pesquisa de doutorado, com alunos que apresentam deficiência intelectual, matriculados em uma escola regular da rede pública do Rio de Janeiro, entre os anos de 2009 e 2012. A pesquisa-ação colaborativa e a abordagem histórico-cultural foram as bases teórico-metodológicas para investigar a elaboração dos processos de ensino e aprendizagem e a formação de conceitos por um aluno com deficiência intelectual. Os episódios da interação professor aluno, filmados na sala de aula e na sala de recursos, indicaram possibilidades de ações pedagógicas com vistas a situações de ensino conducente à construção de conceitos pelo aluno com deficiência intelectual. Além disso, constatou-se que a abordagem teórico-metodológica foi favorável à organização, de forma colaborativa, das atividades de ensino, pelas professoras de sala de aula e da sala de recursos, com procedimentos de ensino mais adequados ao processo de aprendizagem do aluno com deficiência intelectual, na escola regular.Tal proposta se coaduna com a perspectiva de ensino de qualidade para todos.
Comportamentos de Crianças do Espectro do Autismo com seus Pares no Contexto de Educação Musical
Authors: NASCIMENTO Paulyane Silva do , ZANON Regina Basso , BOSA Cleonice Alves , NOBRE João Paulo dos Santos , DeFREITAS JÚNIOR Áureo Déo , SILVA Simone Souza da Costa
Published: June 2015

o Transtorno do espectro do autismo (TEA) é marcado por prejuízos nas áreas de interação social, comunicação, comportamento e processamento sensorial. Aspectos relacionados a prejuízos no repertório de interação social, bem como estratégias para torná-la mais adequada têm sido amplamente estudados. Dentre estas estratégias, as que utilizam música têm recebido atenção. O presente estudo tem como objetivo investigar os benefícios da educação musical ao desenvolvimento da interação social de crianças com seus pares, focando-se na qualidade e na frequência da apresentação de tais comportamentos. Participaram duas crianças com TEA, com idades de cinco e seis anos, em aulas de percussão em grupo. Os instrumentos utilizados foram a Ficha de dados sociodemográficos e de desenvolvimento, para traçar os perfis dos participantes; e o Protocolo de observação de comportamentos de crianças com TEA com seus pares, para a análise comportamental, durante oito aulas/percussão (240 minutos). Os resultados sugerem que ambos apresentaram tendência ao aumento de iniciativas e respostas espontâneas e à diminuição de comportamentos não funcionais. Verificou-se a ocorrência do uso de estereotipias para tentativas de/e interações, embora esporadicamente. Destacaram-se os papéis do contexto, dos perfis das crianças, e do manejo comportamental por adultos, na promoção de interações.
As Formas de Comunicação e de Inclusão da Criança Kaiowá Surda na Família e na Escola: um Estudo Etnográfico
Authors: BRUNO Marilda Moraes Garcia , LIMA Juliana Maria da Silva
Published: June 2015

atualmente a etnografia está consolidada como método de pesquisa no campo das ciências sociais, contudo ganha gradativamente mais espaço no cenário educacional. Este estudo configurou-se pelo delineamento do objeto a partir do viver dentro, na tentativa de compreender a experiência cultural dos povos indígenas surdos Guarani-Kaiowá. Assim, tem como objetivo geral investigar as formas de comunicação e de inclusão da criança surda no contexto familiar e escolar das comunidades indígenas das Aldeias Bororó e Jaguapiru, em Dourados, MS. Os objetivos específicos foram: a) compreender como a criança indígena surda se relaciona e se comunica com a família e a escola; b) identificar as facilidades e as dificuldades encontradas na forma de comunicação e na inclusão; e c) descrever as ações e as estratégias utilizadas pela família e pela escola para a comunicação e a efetivação da inclusão da criança nesses sistemas. As análises têm bases conceituais dos estudos culturais, dos estudos surdos e das premissas do desenvolvimento humano ecológico, pautadas na interdependência entre as culturas familiares e os diferentes contextos de socialização, fatores estes determinantes para o desenvolvimento humano. Os resultados do estudo permitiram: conhecer um sistema incipiente de comunicação utilizado pelos familiares da criança; identificar os irmãos como mediadores da comunicação na família e na escola; e reconhecer, nas falas dos professores, o papel do intérprete de Libras como estratégia pedagógica e comunicativa para a inclusão da criança indígena surda. Por fim, a pesquisa etnográfica permitiu uma investigação a partir dos olhares de dentro, apontando indícios para o estabelecimento de um diálogo intercultural.
Aprendizaje Basado en Juegos Digitales en Niños con TDAH: un Estudio de Caso en la Enseñanza de Estadística para Estudiantes de Cuarto Grado en Colombia
Authors: MORENO Julián , VALDERRAMA Verónica
Published: June 2015

La situación actual de innovación tecnológica en educación introduce una nueva visión del juego digital, resaltando su valor pedagógico. Considerando este panorama proponemos el aprendizaje basado en juegos digitales, más específicamente de tipo multi-jugador masivos en línea, como un escenario propicio para lograr que los niños con TDAH (Trastorno por Déficit de Atención y/o Hiperactividad) mejoren su aprendizaje y fortalezcan significativamente sus habilidades sociales, así como la autorregulación de sus emociones. Para ello llevamos a cabo un estudio de caso en el Colegio Santa Bertilla Boscardin de la ciudad de Medellín, Colombia, con estudiantes del grado cuarto de primaria en la asignatura de estadística, los cuales se dividieron en 17 niños como grupo experimental y 40 como control. Los resultados obtenidos mediante una prueba estandarizada demostraron, con una significancia estadística (valor p< 0.005), no solo los estudiantes con TDAH lograron igualar el rendimiento académico de los estudiantes de control, sino que incluso fueron ligeramente superiores.
Hyperthermic Intraperitoneal Chemotherapy Following Cytoreductive Surgery Improves Outcome in Patients With Primary Appendiceal Mucinous Adenocarcinoma: A Pooled Analysis From Three Tertiary Care Centers
Authors: Shaib Walid L. , Martin Ludmila Katherine , Choi Minsing , Chen Zhengjia , Krishna Kavya , Kim Sungjin , Brutcher Edith , Staley Charles , Maithel Shishir K. , Philip Philip , Abdel-Misih Sherif , Bekaii-Saab Tanios S. , El-Rayes Bassel F.
Published: June 2015

Purpose.

Appendiceal mucinous neoplasms (AMN) are a rare heterogeneous group of diseases. In the absence of randomized trials, AMN management is controversial. The goal of this study was to evaluate the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery on survival in AMN patients.

Patients and Methods.

Patient data including demographics, pathology, type of therapy, and outcomes were collected from Emory University, the Ohio State University, and Wayne State University databases. One of the three centers did not use HIPEC. Statistical analysis evaluating overall survival (OS) of AMN patients was performed.

Results.

Between 1990 and 2010, 163 AMN patients were identified. Histology showed 60 patients had diffuse peritoneal adenomucinosis, 88 had peritoneal mucinous carcinomatosis (PMCA), and 15 had PMCA with indeterminate or discordant features. Complete surgical resection was achieved in 76 patients. HIPEC was used in 79 patients. The median OS was 77 months for patients who received HIPEC compared with 25 months for patients who did not (p < .001). In multivariable analysis, histopathologic subtype (p < .001), complete surgical resection (p < .001), and HIPEC (p < .001) were independent predictors for improved OS. A survival advantage for AMN patients treated at HIPEC-treating centers was observed (p = .0026). After adjusting for HIPEC therapy, no significant survival difference was observed between the non-HIPEC-treating center and the HIPEC-treating centers (p = .094).

Conclusion.

The addition of HIPEC to cytoreductive surgery likely provides a survival advantage and should be considered in the treatment strategy for AMN.

Implications for Practice:

The use of heated chemotherapy applied in the abdomen after removal of the appendiceal mucinous cancer by surgery lengthens survival of patients having this disease.
Key Issues in the Clinical Management of Gastrointestinal Stromal Tumors: An Expert Discussion
Authors: Maki Robert G. , Blay Jean-Yves , Demetri George D. , Fletcher Jonathan A. , Joensuu Heikki , Martín-Broto Javier , Nishida Toshirou , Reichardt Peter , Schöffski Patrick , Trent Jonathan C.
Published: June 2015

After the revelation of kinase targeting with orally available small molecules, the use of imatinib in chronic myelogenous leukemia and in gastrointestinal stromal tumor (GIST) has now become commonplace and just two of many examples of the use of kinase inhibitors in cancer. In this article, we discuss important practice points that may impact upon questions of therapy of primary and metastatic GIST, with the hope that the questions addressed in this rare solid tumor can serve as examples of what can be achieved with kinase-directed therapies in other cancers. We present cases that highlight some of the key issues in GIST management and afterward discuss both points of consensus and controversial issues in what is now recognized as one of the most common forms of sarcoma.

Implications for Practice:

The treatment of gastrointestinal stromal tumor (GIST) has become sophisticated with the availability of three approved agents in many countries and 15 years of experience with primary and metastatic disease. Important lessons from tyrosine-kinase inhibitors in GIST can be gleaned from this experience and will impact implementation of similar agents for other cancers.
U.S. Food and Drug Administration Approval Summary: Enzalutamide for the Treatment of Patients With Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer
Authors: Ning Yang-Min , Brave Michael , Maher V. Ellen , Zhang Lijun , Tang Shenghui , Sridhara Rajeshwari , Kim Geoffrey , Ibrahim Amna , Pazdur Richard
Published: June 2015

The U.S. Food and Drug Administration approved enzalutamide for the treatment of patients with chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). At the prespecified interim analysis, a statistically significant improvement in overall survival was demonstrated for patients in the enzalutamide arm compared with patients in the placebo arm. The overall benefit-risk profile supports the expanded indication for enzalutamide. On September 10, 2014, the U.S. Food and Drug Administration approved enzalutamide for the treatment of patients with chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). Enzalutamide was initially approved in 2012 for use in patients with mCRPC who had previously received docetaxel. The current approval was based on the results of a randomized, placebo-controlled, double-blind trial conducted in 1,717 asymptomatic or minimally symptomatic patients with chemotherapy-naïve mCRPC. Patients were assigned to receive either enzalutamide 160 mg or placebo orally once daily. The coprimary endpoints were overall survival (OS) and radiographic progression-free survival (rPFS), which was assessed by independent central radiology review. At the prespecified interim analysis, a statistically significant improvement in OS was demonstrated for patients in the enzalutamide arm compared with patients in the placebo arm (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.60–0.84). The median OS was 32.4 and 30.2 months in the enzalutamide and placebo arms, respectively. A statistically significant prolongation of rPFS was observed in patients in the enzalutamide arm (HR, 0.17; 95% CI, 0.14–0.21). In addition, the time to initiation of cytotoxic chemotherapy was prolonged in the enzalutamide arm (HR, 0.35; 95% CI, 0.30–0.40), with median times of 28.0 and 10.8 months in the enzalutamide and placebo arms, respectively. The safety profile was similar to that previously reported for enzalutamide. Adverse reactions of interest included seizure, hypertension, and falls. Enzalutamide should be discontinued if a seizure occurs during treatment. The overall benefit-risk profile supports the expanded indication for enzalutamide.

Implications for Practice:

This new approval expands the enzalutamide indication, allowing health care providers and patients to use enzalutamide for the treatment of metastatic castration-resistant prostate cancer either before or after cytotoxic chemotherapy.
Managing road transport in a world of changing climate and land use
Authors: Hearn Gareth
Published: June 2015

Natural hazards of river flooding, erosion, landslides and high sediment loads in streams and rivers continue to pose a significant threat to the management of infrastructure, particularly road transport, in most parts of the world. In Asia and Africa, especially, these hazards are considered to be on the increase in response to climate and land use-related factors. Recent studies in Africa and especially Ethiopia lead to the conclusion that complex and poorly understood interactions between geology, climate change and land use change have given rise to increased levels of damage and disruption to transport infrastructure. The prognosis for the future is that these trends will continue and perhaps accelerate. Current policies tend to focus on the ‘proofing’ of infrastructure against future climate change, possibly without due regard to other factors that may be more important in the short–medium term. This is possibly counterproductive in situations where existing and future risks are determined more by geohazard uncertainty and design deficiencies, and the sometimes overriding effects of land use change and land management practices.
Diabetes in Sub-Saharan Africa – Overview of a Looming Health Challenge
Authors: Assah Felix K , Mbanya Jean-Claude ,   Doctoral Student, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke舗s Hospital, Cambridge,   Professor of Medicine and Endocrinology, Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I
Published: June 2015

The number of people living with diabetes in the world is increasing rapidly. Most of the increase will occur in developing countries such as those in sub-Saharan Africa. Diabetes is currently recognised as a real and imminent threat to social and economic development globally and is set to be a major public health challenge in the 21st century. In sub-Saharan Africa, the challenge posed by diabetes is even more overwhelming since diabetes will have to share scarce resources with infections and malnutrition. Even worse, diabetes still has to gain sufficient political and social recognition in order to warrant aggressive national policies for prevention and treatment. In this article we present an overview of the burden of diabetes in sub-Saharan Africa and the specificities of care and control, and highlight the importance of developing effective national diabetes programmes.
Thymus Dysfunction in the Development of Type 1 Diabetes and Endocrine Autoimmune Diseases
Authors: Geenen Vincent , Dardenne Olivier ,   Director of Research,   Research Associate, Centre of Immunoendocrinology, Institute of Pathology, University of Liège
Published: June 2015

The discovery that thymic epithelium from many species expresses a large repertoire of genes encoding neuroendocrine and other tissuerestricted antigens has radically changed our knowledge of the pathogenic mechanisms underlying the development of organ-specific autoimmune diseases such as type 1 diabetes and autoimmune endocrine diseases. Rather than a breakdown of immunological selftolerance in periphery, there is mounting evidence that the diabetogenic autoimmune response may first arise from a thymus dysfunction in the central programming of β-cell self-tolerance. Insulin-like growth factor 2 (IGF-2) is the dominant member of the insulin gene/protein family expressed in thymic epithelial cells (TECs) from different species, and Igf2-/- mice fail to programme complete tolerance to insulin. Based on the homology between insulin, the primary and immunogenic auto-antigen of type 1 diabetes, and IGF-2, the tolerogenic selfantigen of the insulin family, the design of a regulatory/negative self-vaccination for prevention against type 1 diabetes has been proposed and is under development.
Gene Variants for Obesity and Type 2 Diabetes – A Shared Aetiology?
Authors: Elbers Clara C , Wolfs Marcel GM , van Haeften Timon W ,   Complex Genetics Section, Department of Biomedical Genetics, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht,   Department of Medical Biology, University of Groningen,   University Medical Centre Utrecht
Published: June 2015

The incidence of type 2 diabetes is rising rapidly worldwide, mainly due to the increase in the incidence of obesity. Both obesity and type 2 diabetes are complex genetic traits, but they share some non-genetic risk factors. Hence, it is tempting to speculate that susceptibility to type 2 diabetes and obesity may also involve shared underlying genetic factors acting on common molecular mechanisms. Recent genome-wide association (GWA) studies identified 17 common loci for obesity and 19 common loci for type 2 diabetes. This article explores whether the susceptibility loci for type 2 diabetes and obesity can indicate potential overlapping mechanisms in the disorders. In addition, we touch on the challenges regarding follow-up of confirmed GWA signals, as well as alternative approaches to analysing GWA data to a fuller potential.
Liraglutide – A Once-daily Human Glucagon-like Peptide-1 Analogue Treatment for Type 2 Diabetes
Authors: Mathieu Chantal ,   Professor of Medicine, Catholic University Leuven, and Head of Endocrinology, University Hospital Gasthuisberg
Published: June 2015

Type 2 diabetes is a progressive disease characterised by deteriorating β-cell function and glycaemic control. To counter this, affected individuals require regular intensification of their antidiabetes treatments to provide appropriate metabolic control. However, current treatment options – such as sulphonylureas, thiazolidinediones and insulins – induce weight gain, which can reduce patient acceptance and/or compliance with treatment and may have significant health implications. In addition, many of the antidiabetic therapies raise the risk of hypoglycaemic episodes. Therefore, patients, physicians and healthcare providers are looking for new therapeutic options to address this large and growing burden of diabetes. Incretin-based therapies – including glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors – are becoming a popular treatment option for patients with type 2 diabetes because they offer many benefits compared with other antidiabetic therapies. First, incretin-based therapies are associated with significant reductions in glycated haemoglobin (HbA1c) with a low inherent risk of hypoglycaemic events. In addition, GLP-1 receptor agonists are associated with reductions in bodyweight and systolic blood pressure. Incretin-based therapies such as liraglutide also offer the potential to improve β-cell function, an important underlying mechanism of type 2 diabetes.
Cardiovascular Risk in Type 2 Diabetes – Reflecting on the ADVANCE Study
Authors: Zoungas Sophia , Chalmers John , Patel Anushka ,   Senior Research Fellow, Cardiovascular and Renal Divisions, The George Institute for International Health, University of Sydney, and School of Public Health, Monash University, Melbourne,   Director, Professorial Unit, The George Institute for International Health, University of Sydney,   Director, Cardiovascular Division, The George Institute for International Health, University of Sydney
Published: June 2015

The world is facing an unprecedented increase in type 2 diabetes. Most disability and premature mortality experienced by patients with diabetes is related to vascular disease and, in particular, macrovascular disease (such as coronary heart disease and stroke) and microvascular disease (such as retinopathy, nephropathy and neuropathy). Indeed, around 1.9 million cardiovascular deaths worldwide are attributable to high blood glucose levels and diabetes, as well as to their associated dangerous companions of high blood pressure and abnormal lipid levels. The global economic costs of diabetes, including foregone economic growth and increasing healthcare expenditure, are substantial and are anticipated to grow. Therefore, strategies to reduce disease burden have continued to focus on reducing cardiovascular risk. Recently, a number of large-scale clinical trials have evaluated approaches for managing cardiovascular risk in patients with type 2 diabetes. Among them the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) trial has reported the effects of blood pressure lowering and intensive glucose control on major vascular events in patients with established type 2 diabetes. In this article we summarise the findings of the ADVANCE trial and discuss its relevance to the management of cardiovascular risk in patients with type 2 diabetes worldwide.
Advances in Our Understanding of Acromegaly – Is There an Optimal Management Regimen?
Authors: Higham Claire E , Trainer Peter J ,   Diabetes and Endocrinology Specialist Registrar,   Consultant Endocrinologist, Department of Endocrinology, Christie Hospital, Manchester
Published: June 2015

The two- to three-fold increased mortality associated with active acromegaly can be significantly decreased and even normalised with effective treatment to reduce growth hormone (GH) and insulin-like growth factor-I (IGF-I) levels to within normal limits. This article addresses the advances in surgical techniques, new approaches in radiotherapy and the choice of medical treatments that make it possible to achieve biochemical remission and improve signs and symptoms of disease in almost every patient with acromegaly. The literature is reviewed with regard to the relative merits of each treatment method, recent controversies such as the role of radiotherapy and primary octreotide therapy are discussed and a treatment algorithm is proposed to provide a guide to management.
Familial Isolated Pituitary Adenomas
Authors: Chahal Harvinder S , Kumar VK Ajith , Korbonits Márta ,   ManaginSpecialist Registrar in Endocrinology, Centre for Endocrinology, Barts and the London Medical School,   Consultant in Clinical Genetics, Clinical Genetics Department, Great Ormond Street Hospital,   Professor of Endocrinology and Metabolism, Centre for Endocrinology, Barts and the London Medical School
Published: June 2015

Over the last century several families have been described with familial isolated pituitary adenomas (FIPAs). Most commonly, family members have acromegaly or prolactinoma, but other types of pituitary adenomas can also occur. Recently, mutations in theAIP(aryl hydrocarbon receptor interacting protein) gene have been found to occur in 30–50% of FIPA patients, while for the rest of the patients the gene causing the disease is currently unknown and is a topic of intense research. Tumours in patients withAIPmutations are diagnosed at significantly younger ages and tend to be larger. Often the response to medical therapy in these patients is poor. This article discusses the clinical and genetic characteristics of this relatively recently recognised disease.
Focus on Primary Hyperparathyroidism – Diagnosis, Management and the Role of Calcimimetics
Authors: Symposium Satellite ,   Held during the 11th European Congress of Endocrinology on 26 April 2009, Istanbul, Turkey
Published: June 2015

Primary hyperparathyroidism (HPT) is an endocrine disorder characterised by increased serum calcium and inappropriately high parathyroid hormone (PTH). Although identified historically by overt bone disease and kidney stones, following the introduction of routine calcium screening, many patients are now asymptomatic or mildly symptomatic at diagnosis. Diagnosis and management of asymptomatic primary HPT has been addressed by recent guidelines, which note the importance of excluding other potential aetiologies and also present updated surgical criteria for parathyroidectomy. Calcimimetics, such as cinacalcet, are a new option for patients in whom parathyroidectomy is not clinically appropriate or is contraindicated. Clinical trials have shown that cinacalcet can achieve sustained reductions in serum calcium levels in patients with primary HPT. An improved understanding of the pathophysiology of this disorder and new guidelines and pharmacological options have greatly improved the prospects for successful management.
Prelox® for Improvement of Erectile Quality
Authors: Lamm Steven ,   Clinical Assistant Professor of Medicine, New York University School of Medicine
Published: June 2015

Sexual desire typically persists when men grow older although their ability to attain and maintain erections sufficient to permit satisfactory sexual intercourse gradually declines. Decreasing erectile quality is a common age-related problem affecting the lives of both men and their partners. Lifestyle plays an important role in the onset of erectile quality problems, and timely improvements such as a healthier diet and exercise may significantly slow the progression to erectile dysfunction with increasing age. Essentially, all cardiovascular risk factors – including hypertension, dyslipidaemia, hyperglycaemia, obesity and cigarette smoking – impair endothelial function, which in turn directly translates into declining erectile function. In this regard a man’s penis does indeed represent a barometer indicating his cardiovascular health status. Once endothelial function has declined to a point where its restoration is not feasible, pharmacological interventions with phosphodiesterase-5 (PDE5) inhibitors may temporarily bypass physiological processes so that affected men may still enjoy sexual intercourse. A timely intervention that helps to restore endothelial function will have the advantage of preserving a man’s ability to spontaneously respond to sexual arousal. Prelox®, a patented complex formulation consisting of Pycnogenol® and L-arginine aspartate, has been demonstrated in four clinical trials to naturally restore healthy erectile quality in men presenting with moderate erectile problems. Pycnogenol, a key component of Prelox, was shown in human pharmacological studies to act as a catalyst on endothelial nitric oxide (NO) synthase for amplified synthesis of NO, the initial mediator for triggering an erection. Its combination with the enzyme’s substrate, L-arginine, synergistically increases synthesis of NO, the key component involved in vasodilatation for improved blood flow to engorge the penis. According to reviewed clinical trials, Prelox will help men with moderate erectile problems to regain healthy erectile function, greater confidence to initiate and sustain erections and more frequent morning erections. As a result of higher intercourse frequency, men taking Prelox developed significantly higher plasma testosterone values. Prelox is a safe, well-tolerated and efficacious treatment for mild to moderate cases of declining erectile quality.
Diabetes-associated Erectile Dysfunction
Authors: Vendeira Pedro , Costa Carla , Virag Ronald ,   Department of Urology, S. João Central Hospital, Porto; Association for the Advanced Study of Human Sexuality (iSEX),   Association for the Advanced Study of Human Sexuality (iSEX); Department of Biochemistry, Faculty of Medicine, University of Porto; Laboratory for Molecular Cell Biology, Faculty of Medicine, University of Porto,   Centre d’Explorations et Traitements de l’Impuissance, Paris
Published: June 2015

Erectile dysfunction (ED) is a common complication of diabetes, with a prevalence ranging from 15 to 55%. The basis underlying diabetesassociated ED is multifactorial, involving changes in peripheral nerve activity and alterations in endothelial cell function. Due to the complexity of this pathology, the development of experimental models has been crucial in evaluating and translating fundamental results into clinical diabetes-associated ED. The concept of hard-to-treat patients, such as men with diabetes, is now fully accepted due to the complex mechanisms involved. In these men, the response to common oral treatments with phosphodiesterase type 5 inhibitors (PDE5Is) is far from desired, and maximal doses of the drugs are often needed. In addition, diabetes is commonly associated with other co-morbidities, such as hypertension, hypercholesterolaemia and obesity, clusters of the metabolic syndrome (MetS). ED is considered an early warning sentinel for coronary artery disease, just as endothelial dysfunction is seen as a major risk factor for ED. Testosterone deficiency syndrome, a very common syndrome in diabetes and MetS, has been shown to be an independent determinant of endothelial dysfunction, thus contributing to vascular pathology, including ED. This syndrome should be identified among patients, and therapeutic intervention may be required. PDE5Is may improve erectile function with or without the help of other second- or third-line treatments. Other strategies to maximise the response to PDE5Is include risk factor modification and daily dosing of the drugs, instead of on-demand treatment. However, better understanding of the fundamental molecular mechanisms underlying diabetes-associated ED is essential to improving and developing more effective therapies.
Pathophysiological Aspects of Human Obesity – What We Know in 2010
Authors: Clément Karine , Basdevant Arnaud ,   Professor of Nutrition,   Professor of Nutrition, and Head, Department of Endocrinology and Nutrition, Pitié Salpêtrière Hospital, INSERM U872 and Cordeliers Research Centre, Pierre and Marie Curie University
Published: June 2015

Obesity, a disease of both developed and developing countries, is spreading at an epidemic pace. According to the World Health Organization (WHO), obesity is defined as an increase or abnormal accumulation of body fat mass to the extent that an individual’s health will be negatively affected. Overweight (i.e. body mass index [BMI] >25kg/m2) is considered to be a significant risk factor for the development of many chronic diseases. Environmental, behavioural, genetic and biological factors interact to cause obesity, which can be viewed as a set of phenotypes that evolve over time in stages that need to be precisely measured. This article provides a clinical viewpoint on some biological processes that may explain some of the stages in the development of human obesity, its chronic maintenance and the occurrence of complications, with a focus on brain structures, genetics, the profound alterations in adipose tissue biology and the recent revival in thinking in terms of brown adipose tissue.
Glucose and Glycated Haemoglobin Point-of-care Testing and Early Diagnosis of Diabetes and Pre-diabetes
Authors: Schindhelm Roger K , Lenters-Westra Erna , Fokkert Marion J , Slingerland Robbert J ,   Epidemiologist, and Resident in Clinical Chemistry,   Research Technician,   Point-of-care Testing Co-ordinator,   Clinical Chemist, Department of Clinical Chemistry, Isala klinieken
Published: June 2015

The number of individuals with impaired glucose metabolism (‘pre-diabetes’) and type 2 diabetes is reaching epidemic proportions. This increase is associated with higher cardiovascular morbidity and mortality. Early screening for diabetes and pre-diabetes (i.e. elevated glucose and/or glycated haemoglobin [HbA1c]) may aid in the reduction of diabetes-related complications. Point-of-care testing, defined as testing at or near the site of the patient, is able to bring diagnostic tests and its associated therapeutic actions immediately to the patient and may aid in the detection of diabetes and the reduction of complications. However, the majority of available point-of-care testing devices for glucose and HbA1cdo not meet generally accepted analytical performance criteria and may underestimate the true risk of diabetes. Until these analytical performance issues have been addressed properly, caution should be exercised in the use of point-of-care testing of glucose and HbA1c in the diagnosis of and screening for pre-diabetes and diabetes.
Hypoglycaemia in Type 2 Diabetes – Clinical Consequences and Impact on Treatment
Authors: Mathieu Chantal , Filozof Claudia , Barnett Anthony H ,   Professor of Medicine, Catholic University Leuven, and Head of Endocrinology, University Hospital Gasthuisberg,   Diabetes Principal Medical Scientific Expert, Novartis Pharma AG,   Professor of Medicine, and Honorary Consultant Physician, Division of Medical Sciences, University of Birmingham and Heart of England NHS Foundation Trust
Published: June 2015

For patients with diabetes, hypoglycaemia can present a number of risks ranging from mild to life-threatening in severity. Frequently occurring hypoglycaemia is associated with increased morbidity and mortality. Recent studies have found associations between intensive glycaemia treatment and an increased incidence of hypoglycaemia, prompting much discussion concerning the clinical significance of hypoglycaemia in the treatment of diabetes, especially considering that many hypoglycaemic episodes are subclinical and unrecognised. Hypoglycaemia has also been linked to an increased probability of developing dementia and, not surprisingly, poor quality of life as well. It may be helpful to try to prevent hypoglycaemic episodes through careful monitoring of patients with risk factors that predispose them to hypoglycaemia, while also selecting therapies that can minimise the incidence of hypoglycaemic episodes
The Diabetes Interactive Diary – A Useful Tool for Diabetes Management?
Authors: Rossi Maria CE , Nicolucci Antonio , Bartolo Paolo Di , Horwitz David , Vespasiani Giacomo ,   Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Maria Imbaro,   Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Maria Imbaro,   Diabetes Unit, Department of Digestive and Metabolic Diseases, Ravenna District Local Health Unit,   Medical and Clinical Affairs, LifeScan, Inc,   Diabetes Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto
Published: June 2015

Adoption of a flexible diet and insulin therapy for people with type 1 diabetes reduces the daily burden of the disease. In particular, carbohydrate counting and insulin dose adjustment at each meal promote dietary freedom, quality of life and glycaemic control, without worsening severe hypoglycaemia or cardiovascular risk. To overcome the complex education required to adopt this method, the Diabetes Interactive Diary (DID) represents an automatic carbohydrate/insulin bolus calculator in a mobile phone. It also works as a telemedicine system based on communication between patient and physician via text messages. To avoid methodological flaws found in previous studies on similar devices, DID is undergoing a process of evaluation similar to that usually adopted for pharmacological products: first, its feasibility, acceptability and safety were documented in a phase I study; second, its effectiveness on metabolic control, weight loss and quality of life were preliminarily highlighted in a phase II randomised study; and third, a confirmatory phase III randomised trial is currently under way to investigate the DID’s impact on glycaemic variability. If the DID’s effectiveness is confirmed, it will increase the proportion of patients who may benefit from flexible diabetes management.
The Role of Group Care in the Management of Type 2 Diabetes
Authors: Trento Marina , Porta Massimo ,   Senior Technician, and Head, Laboratory of Clinical Pedagogy,   Associate Professor of Internal Medicine, Department of Internal Medicine, University of Turin
Published: June 2015

‘Group Care’ is a clinical pedagogic model aimed at offering continuing structured education and care to people with diabetes. The hypothesis is that patients are best helped to become self-sufficient and self-reliant, and consequently to improve clinically, by seeing them in groups rather than using the traditional one-to-one approach. The Group Care programme is articulated over seven sessions held over two years, with one session every three months, which can be repeatedad libitum. Each session lasts up to one hour and methodologies facilitate learning through cognitive and psychomotor abilities such as simulations, role-playing games, debates, workshops and working groups. A pragmatic randomised, controlled clinical trial proved that Group Care improves knowledge of diabetes, health behaviour and quality of life along with bodyweight, glycated haemoglobin (HbA1c) and high-density lipoprotein (HDL) cholesterol. In addition, Group Care encourages team work by motivating health operators and helps empower patients and build strategies enabling them to cope with diabetes.
Treatment Options for Charcot Neuroarthropathy
Authors: Cheer Kelly , Jude Edward B ,   Speciality Trainee in Diabetes and Endocrinology,   Consultant Physician and Endocrinologist, Diabetes Centre, Tameside Hospital NHS Foundation Trust
Published: June 2015

Charcot neuroarthropathy is a complex and often under-detected problem in patients with diabetes complicated by peripheral neuropathy. Physicians must have a high index of suspicion to consider its diagnosis. Initial management involves offloading the foot, ideally with a totalcontact cast. Intravenous bisphosphonates are used as medical therapy, and have been shown to reduce bone turnover markers and skin temperature. Surgery may be needed to address abnormal bone formation during the remodelling phase and produce a more stable foot. At all stages, a multidisciplinary approach is required for management.