Aims
To determine the proportion of people with diabetes who have HbA1c measured, what proportion achieve an HbA1c level of < 58 mmol/mol (7.5%), the frequency of testing and if there was any change ...in HbA1c level in the year before and the year after an incident stroke.
Methods
This study used the Secure Anonymised Information Linkage (SAIL) databank, which stores hospital data for the whole of Wales and ~ 65% of Welsh general practice records, to identify cases of stroke in patients with diabetes between 2000 and 2010. These were matched against patients with diabetes but without stroke disease. We assessed the frequency of HbA1c testing and change in HbA1c in the first year after stroke. Estimation was made of the proportion of patients achieving an HbA1c measurement ≤ 58 mmol/mol (7.5%).
Results
There were 1741 patients with diabetes and stroke. Of these, 1173 (67.4%) had their HbA1c checked before their stroke and 1137 (65.3%) after their stroke. In the control group of 16 838 patients with diabetes but no stroke, 8413 (49.9%) and 9288 (55.1%) had their HbA1c checked before and after the case‐matched stroke date, respectively. In patients with diabetes and stroke, HbA1c fell from 61–56 mmol/mol (7.7–7.3%) after their stroke (P < 0.001). Before the study, 55.0% of patients with stroke had an HbA1c ≥ 58 mmol/mol compared with 65.2% of control patients, these figures were 62.5% and 65.3% after the stroke.
Conclusions
The frequency of diabetes testing was higher in patients who had experienced a stroke before and after their incident stroke compared with control patients but did not increase after their stroke. Glucose control improved significantly in the year after a stroke.
What's new?
This is the first description of HbA1c assessment in the year before and the year after an incident stroke.
The study considers the Secure Anonymized Information Linkage (SAIL) databank, which is a large epidemiological resource, representative of the Welsh population.
HbA1c levels were found to decrease in the year after a stroke by 4 mmol/mol (0.4%).
Despite falls in HbA1c levels the frequency of HbA1c testing did not change in the year after a stroke.
How the visual cortex responds to specific stimuli is strongly influenced by visual experience during development. Monocular deprivation, for example, changes the likelihood of neurons in the visual ...cortex to respond to input from the deprived eye and reduces its visual acuity. Because these functional changes are accompanied by extensive reorganization of neurite morphology and dendritic spine turnover, genes regulating neuronal morphology are likely to be involved in visual plasticity. In recent years, Notch1 has been shown to mediate contact inhibition of neurite outgrowth in postmitotic neurons and implicated in the pathogenesis of various degenerative diseases of the CNS. Here, we provide the first evidence for the involvement of neuronal Notch1 signaling in synaptic morphology and plasticity in the visual cortex. By making use of the Cre/Lox system, we expressed an active form of Notch1 in cortical pyramidal neurons several weeks after birth. We show that neuronal Notch1 signals reduce dendritic spine and filopodia densities in a cell-autonomous manner and limit long-term potentiation in the visual cortex. After monocular deprivation, these effects of Notch1 activity predominantly affect responses to visual stimuli with higher spatial frequencies. This results in an enhanced effect of monocular deprivation on visual acuity.
Models of the chemical evolution of the Milky Way suggest that the observed abundances of elements heavier than helium ('metals') require a continuous infall of gas with metallicity (metal abundance) ...about 0.1 times the solar value. An infall rate integrated over the entire disk of the Milky Way of ∼1 solar mass per year can solve the 'G-dwarf problem'-the observational fact that the metallicities of most long-lived stars near the Sun lie in a relatively narrow range. This infall dilutes the enrichment arising from the production of heavy elements in stars, and thereby prevents the metallicity of the interstellar medium from increasing steadily with time. However, in other spiral galaxies, the low-metallicity gas needed to provide this infall has been observed only in associated dwarf galaxies and in the extreme outer disk of the Milky Way. In the distant Universe, low-metallicity hydrogen clouds (known as 'damped Lyα absorbers') are sometimes seen near galaxies. Here we report a metallicity of 0.09 times solar for a massive cloud that is falling into the disk of the Milky Way. The mass flow associated with this cloud represents an infall per unit area of about the theoretically expected rate, and ∼0.1-0.2 times the amount required for the whole Galaxy.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In September 2002, facsimiles were sent to 360 primary-care physicians alerting them to a local outbreak of Q fever. The physicians subsequently submitted serology samples on significantly more ...patients than in a previously comparable period in 2001. Facsimile cascade assists effective communication with primary-care physicians in an outbreak investigation.
Asthma does not have a clear cause and may represent a cluster of diseases. We propose that asthma in house dust mite sensitive patients may be caused by recurrent inhalation of live dust mites which ...are able to live for some time in the bronchioles of the lung. To provide themselves with a food source, the mites may purposefully excrete proteolytic enzymes, including Der p1, which increase epithelial shedding by freeing cells from the basement membrane. The mites then feed on the shed respiratory epithelial cells. Consequent loss of an intact respiratory epithelium exposes underlying tissues to dust mite protein and other allergens triggering sensitisation to these proteins. Later, repeated infestation provokes an allergic response which manifests itself as asthma attacks.
The evidence for this hypothesis was tested against the Bradford–Hill criteria for causation; consistency, strength, temporal association and dose response. Potential areas for further research were also identified. The association between asthmatic symptoms and pulmonary acariasis was consistent across a number of studies. Determining the strength of the association and any dose response requires more work which is dependent on the development of better tests for the detection of mites in sputum. There was tentative evidence of a temporal association in the published studies identified. Biological plausibility and experimental evidence was available for pulmonary acariasis in primates and arsenic treatment was effective in humans.
Better tests for mites in sputum are needed, as is work to assess more modern anti-acaricidal drugs in dust mite sensitive asthmatics.
This paper estimates point prevalence of renal replacement therapy (RRT) utilization within population strata defined by geography and deprivation in south and mid Wales. It investigates spatial ...accessibility of main and satellite renal units by comparing population and patient numbers within bands of travel time.
Prevalence study based on patient registers.
From a list of patient and renal unit locations, geocoded at the level of unit postcodes, and electoral division-level denominator population data, we calculated RRT point prevalence for the 16 unitary authorities in the study area, fifths of small area deprivation, and three bands of travel time from the nearest main renal unit and any (main or satellite) unit.
Overall point prevalence was 633 per million population (pmp) and this varied from 256 to 780 pmp across unitary authorities. RRT prevalence was lower in more deprived areas. Sixty-nine percent of the population and 73% of patients lived within 30
min of a main renal unit. Eighty-four percent of the population and 88% of patients lived within 30
min of a main or satellite renal unit.
The provision of satellite renal units has significantly improved spatial accessibility of RRT services. However, a substantial proportion of the population remains geographically distant from renal units. This has important implications for planning of future provision of RRT, given the inverse relationship between RRT acceptance and travel time, and the impact on quality of life of patients who travel frequently to renal units.
Summary
A retrospective study was undertaken in a district general hospital to identify factors associated with vaginal delivery, as opposed to caesarean section, in women undergoing induction of ...labour after a previous caesarean section. The study was undertaken over 9 years (April 1994 - May 2003) and included patients in their second or subsequent pregnancy who had previously had one lower segment caesarean delivery and in whom labour had been induced. Records were extracted from a database and anonymised. Vaginal delivery after induction of labour was attempted in 81 patients of whom 64 (79.0%) subsequently delivered vaginally. There were few complications and no cases of uterine rupture. Two factors had a statistical significant relationship with vaginal birth after induction of labour; occipito-anterior position (OR 10.18, 95% CI 1.42 - 112.7, Yates corrected χ2; p = 0.001) and more than one previous birth (OR 4.76, 95% CI 1.28 - 21.67, p = 0.017). Other associations were explored but were not statistically significant. This paper contributes to the literature on factors associated with vaginal delivery after induction of labour and previous caesarean section, which may inform the selection of cases, and consequent success rates for vaginal delivery.
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