Diabet. Med. 28, 508–515 (2011)
The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in ...full at:
(i)
http://www.diabetes.org.uk/About_us/Our_Views/Care_recommendations/The‐Management‐of‐Diabetic‐Ketoacidosis‐in‐Adults;
(ii)
http://www.diabetes.nhs.uk/publications_and_resources/reports_and_guidance;
(iii)
http://www.diabetologists‐abcd.org.uk/JBDS_DKA_Management.pdf.
This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations.
The key points are:
Monitoring of the response to treatment
(i)
The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter.
(ii)
If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response.
(iii)
Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers.
(iv)
Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only.
Insulin administration
(i)
Insulin should be infused intravenously at a weight‐based fixed rate until the ketosis has resolved.
(ii)
When the blood glucose falls below 14 mmol/l, 10% glucose should be added to allow the fixed‐rate insulin to be continued.
(iii)
If already taking, long‐acting insulin analogues such as insulin glargine (Lantus®, Sanofi Aventis, Guildford, Surry, UK) or insulin detemir (Levemir®, Novo Nordisk, Crawley, West Sussex, UK.) should be continued in usual doses.
Delivery of care
(i)
The diabetes specialist team should be involved as soon as possible.
(ii)
Patients should be nursed in areas where staff are experienced in the management of ketoacidosis.
Abstract
Natural variability in menstrual cycle length, coupled with rapid changes in endometrial gene expression, makes it difficult to accurately define and compare different stages of the ...endometrial cycle. Here we develop and validate a method for precisely determining endometrial cycle stage based on global gene expression. Our ‘molecular staging model’ reveals significant and remarkably synchronised daily changes in expression for over 3400 endometrial genes throughout the cycle, with the most dramatic changes occurring during the secretory phase. Our study significantly extends existing data on the endometrial transcriptome, and for the first time enables identification of differentially expressed endometrial genes with increasing age and different ethnicities. It also allows reinterpretation of all endometrial RNA-seq and array data that has been published to date. Our molecular staging model will significantly advance understanding of endometrial-related disorders that affect nearly all women at some stage of their lives, such as heavy menstrual bleeding, endometriosis, adenomyosis, and recurrent implantation failure.
In this article, we describe the Mid-Infrared Imager Module (MIRIM), which provides broadband imaging in the 5-27 μm wavelength range for the James Webb Space Telescope. The imager has a pixel scale ...and a total unobstructed view of 74″ × 113″. The remainder of its nominal 113″ × 113″ field is occupied by the coronagraphs and the low-resolution spectrometer. We present the instrument optical and mechanical design. We show that the test data, as measured during the test campaigns undertaken at CEA-Saclay, at the Rutherford Appleton Laboratory, and at the NASA Goddard Space Flight Center, indicate that the instrument complies with its design requirements and goals. We also discuss the operational requirements (multiple dithers and exposures) needed for optimal scientific utilization of the MIRIM.
Plasma parcels are observed propagating from the Sun out to the large coronal heights monitored by the Heliospheric Imagers (HI) instruments onboard the NASA STEREO spacecraft during September 2007. ...The source region of these out‐flowing parcels is found to corotate with the Sun and to be rooted near the western boundary of an equatorial coronal hole. These plasma enhancements evolve during their propagation through the HI cameras' fields of view and only becoming fully developed in the outer camera field of view. We provide evidence that HI is observing the formation of a Corotating Interaction Region (CIR) where fast solar wind from the equatorial coronal hole is interacting with the slow solar wind of the streamer belt located on the western edge of that coronal hole. A dense plasma parcel is also observed near the footpoint of the observed CIR at a distance less than 0.1AU from the Sun where fast wind would have not had time to catch up slow wind. We suggest that this low‐lying plasma enhancement is a plasma parcel which has been disconnected from a helmet streamer and subsequently becomes embedded inside the corotating interaction region.
Severely elevated serum homocysteine is a rare cause of ischaemic stroke and extra-cranial arterial and venous thrombosis. Several factors can lead to mild elevation of homocysteine including dietary ...folate and B12 deficiency, and genetic variants of the methylenetetrahydrofolate reductase (MTHFR) enzyme. The use of Anabolic androgenic steroid (AAS) is under-reported, but increasingly linked to ischaemic stroke and can raise homocysteine levels.
We present a case of a man in his 40s with a large left middle cerebral artery (MCA) territory ischaemic stroke and combined multifocal, extracranial venous, and arterial thrombosis. His past medical history was significant for Crohn's disease and covert use of AAS. A young stroke screen was negative except for a severely elevated total homocysteine concentration, folate and B12 deficiencies. Further tests revealed he was homozygous for the methylenetetrahydrofolate reductase enzyme thermolabile variant (MTHFR c.667 C > T). The etiology of this stroke was a hypercoagulable state induced by raised plasma homocysteine. Raised homocysteine in this case was likely multifactorial and related to chronic AAS use in combination with the homozygous MTHFR c.677 C > T thermolabile variant, folate deficiency and, vitamin B12 deficiency.
In summary, hyperhomocysteinemia is an important potential cause of ischaemic stroke and may result from genetic, dietary, and social factors. Anabolic androgenic steroid use is an important risk factor for clinicians to consider, particularly in cases of young stroke with elevated serum homocysteine. Testing for MFTHR variants in stroke patients with raised homocysteine may be useful to guide secondary stroke prevention through adequate vitamin supplementation. Further studies looking into primary and secondary stroke prevention in the high-risk MTHFR variant cohort are necessary.
Chicken fillets, predominantly encased in disposable plastic packaging, represent a common perishable commodity frequently found in the shopping baskets of British consumers, with an annual slaughter ...exceeding 1.1 billion chickens. The associated environmental implications are of considerable significance. However, a noticeable gap exists concerning the household-level ramifications of chicken meat consumption, which remains a prominent driver (165 kg CO2eyr−1 per capita) of environmental impacts in the United Kingdom (UK). This study's primary objective is to integrate Life Cycle Assessment (LCA) methodology with insights derived from a spectrum of interventions simulated within the Household Simulation Model (HHSM). The interventions that are simulated are influenced by various consumer behaviours related to the purchase, consumption, storage and disposal of chicken fillets. The overarching aim is to provide a comprehensive understanding of the environmental consequences associated with each intervention.
The research encompasses eight distinct household archetypes and the UK average, with a focus on discerning differences in their environmental influence. The introduction of shelf-life extension measures leads to a reduction in the overall environmental impacts (in μPt), with reductions ranging from 1 % to 18 %. Concurrently, waste treatment's environmental burdens can be curtailed by 9 % to 69 % for the UK average. Of the 12 interventions tested, the intervention that combines a one-day extension in the shelf life of open packs and a three-day extension for unopened packs leads to the greatest reduction in environmental impacts, at 18 % for the entire process and 69 % for the waste treatment. This intervention is estimated to yield annual reductions of 130,722 t of CO2 emissions across the entire process and 34,720 t of CO2 emissions from waste treatment, as compared to the default scenario. These findings demonstrate the importance of integrating consumer behaviour, food waste, and packaging considerations within the domain of food LCA research.
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•Life cycle assessment is integrated with the household simulation model.•Environmental performance of household consumption and disposal is involved.•Disposal phase encompasses both food and packaging waste.•Impact of consumer behaviours driven by various interventions is discussed.•Environmental impacts of UK households' behavioural variances are studied.
Gephyrin (GPHN) is an organizational protein that clusters and localizes the inhibitory glycine (GlyR) and GABA A receptors to the microtubular matrix of the neuronal postsynaptic membrane. Mice ...deficient in gephyrin develop a hereditary
molybdenum cofactor deficiency and a neurological phenotype that mimics startle disease (hyperekplexia). This neuromotor
disorder is associated with mutations in the GlyR α 1 and β subunit genes ( GLRA1 and GLRB ). Further genetic heterogeneity is suspected, and we hypothesized that patients lacking mutations in GLRA1 and GLRB might have mutations in the gephyrin gene ( GPHN ). In addition, we adopted a yeast two-hybrid screen, using the GlyR β subunit intracellular loop as bait, in an attempt
to identify further GlyR-interacting proteins implicated in hyperekplexia. Gephyrin cDNAs were isolated, and subsequent
RT-PCR analysis from human tissues demonstrated the presence of five alternatively spliced GPHN exons concentrated in the central linker region of the gene. This region generated 11 distinct GPHN transcript isoforms, with 10 being specific to neuronal tissue. Mutation analysis of GPHN exons in hyperekplexia patients revealed a missense mutation (A28T) in one patient causing an amino acid substitution (N10Y).
Functional testing demonstrated that GPHN N10Y does not disrupt GlyR-gephyrin interactions or collybistininduced cell-surface clustering. We provide evidence that GlyR-gephyrin
binding is dependent on the presence of an intact C-terminal MoeA homology domain. Therefore, the N10Y mutation and alternative
splicing of GPHN transcripts do not affect interactions with GlyRs but may affect other interactions with the cytoskeleton
or gephyrin accessory proteins.
Near-miss SIDS due to Brugada syndrome Skinner, J R; Chung, S-K; Montgomery, D ...
Archives of disease in childhood,
05/2005, Volume:
90, Issue:
5
Journal Article
Peer reviewed
Open access
A 19 day old infant was successfully resuscitated from ventricular fibrillation. The 12 lead ECG was normal, with a normal QT interval, and remains so over three years follow up. DNA analysis ...revealed a missense mutation (R1193Q) in the SCN5A gene, previously linked with familial sudden unexpected nocturnal death syndrome, also known as Brugada syndrome.
This paper describes the evolutionary changes in morphology and orientation of the PFJ using species present through our ancestry over 340 million years.
37 specimens from the Devonian period to ...modern day were scanned using a 64-slice CT scanner. 3D geometries were created following routine segmentation and anatomical measurements taken from standardised bony landmarks.
Findings are described according to gait strategy and age. The adoption of an upright bi-pedal stance caused a dramatic change in the loading of the PFJ which has subsequently led to changes in the arrangement of the PFJ. From Devonian to Miocene periods, our sprawling and climbing ancestors possessed a broad knee with a shallow, centrally located trochlea. A more rounded knee was present from the Paleolithic period onwards in erect and bipedal gait types (aspect ratio 0.93 vs 1.2 in late Devonian), with the PFJ being placed lateral to the midline compared to the medial position in quadrapeds. The depth of the trochlea groove was maximal in the Miocene period of the African ground apes with associated acute sulcus angles in Gorilla (117°) becoming more flattened towards the modern human (138°).
The evolving bipedal gait lead to anteriorisation of the patellofemoral joint, flattening of the trochlea sulcus, in a more lateral, dislocation prone arrangement. Ancestral developments might help explain the variety of presentations of anterior knee pain and patellofemoral instability.
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