The purpose of this study is to assess the prevalence of diabetic retinopathy (DR) world-wide from articles published since 2015 where the assessment of the presence and severity of DR was based on ...retinal images.
A total of 4 databases were searched for the MESH terms diabetic retinopathy and prevalence. Of 112 publications 32 studies were included and individual data pooled for analysis. The presence of any DR or diabetic macular edema (DME) was recorded and severity as mild, moderate or severe non-proliferative DR (NPDR), proliferative DR (PDR) and DME and/or clinically significant macular edema (CSME). The level of severity of DR reported refer to persons with diabetes and not individual eyes.
The global prevalence of DR and DME, for the period 2015 to 2019 were 27.0% for any DR comprising of 25.2%, NPDR, 1.4% PDR and 4.6% DME. The lowest prevalence was in Europe at 20.6% and South East Asia at 12.5% and highest in Africa at 33.8%, Middle East and North Africa 33.8%, and the Western Pacific region at 36.2%.
This study illustrated difficulties in deriving a meaningful global prevalence rate for DR and DME due to the lack of uniformity in defining the study populations, methodological differences, retinal image capture and grading criteria. Therefore, international consensus is required using a minimal data set for future studies.
The epidemiology of traumatic shoulder dislocations is poorly understood. The aim of the current study was to determine the incidence of shoulder dislocations presenting to hospital emergency ...departments in the United States and define demographic risk factors for these injuries.
The National Electronic Injury Surveillance System, a probability sample of all injuries presenting to emergency departments in the United States, was queried for shoulder dislocations from 2002 through 2006. Patient and injury characteristics were analyzed. United States Census data were utilized to calculate incidence rates for the United States population and subgroups. Incidence rate ratios were then calculated with respect to age, sex, and race.
A total of 8940 shoulder dislocations were identified, resulting in an overall incidence rate in the United States of 23.9 (95% confidence interval, 20.8 to 27.0) per 100,000 person-years. The male incidence rate was 34.90 (95% confidence interval, 30.08 to 39.73) per 100,000 person-years, with an incidence rate ratio of 2.64 (95% confidence interval, 2.39 to 2.88) relative to the female incidence rate. It was found that 71.8% of the dislocations were in males. Stratified by decade, the maximum incidence rate (47.8 95% confidence interval, 41.0 to 54.5) occurred in those between the ages of twenty and twenty-nine years; 46.8% of all dislocations were in patients between fifteen and twenty-nine years of age. There were no significant differences based on race. Dislocations most frequently resulted from a fall (58.8%) and occurred at home (47.7%) or at sites of sports or recreation (34.5%). Overall, 48.3% of injuries occurred during sports or recreation.
The estimated incidence rate of shoulder dislocations in the United States is 23.9 per 100,000 person-years, which is approximately twice the previously reported value. A young age and male sex are risk factors for shoulder dislocation in the United States population.
Summary Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the ...incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. The incidence of SSIs may be as high as 20%, depending on the surgical procedure, the surveillance criteria used, and the quality of data collection. In many SSIs, the responsible pathogens originate from the patient's endogenous flora. The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus , coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli . Numerous patient-related and procedure-related factors influence the risk of SSI, and hence prevention requires a ‘bundle’ approach, with systematic attention to multiple risk factors, in order to reduce the risk of bacterial contamination and improve the patient's defences. The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasise the importance of good patient preparation, aseptic practice, and attention to surgical technique; antimicrobial prophylaxis is also indicated in specific circumstances. Emerging technologies, such as microbial sealants, offer the ability to seal and immobilise skin flora for the duration of a surgical procedure; a strong case therefore exists for evaluating such technologies and implementing them into routine clinical practice as appropriate.
Environmental stimuli are known to contribute to psoriasis pathogenesis and that of other autoimmune diseases, but the mechanisms are largely unknown. Here we show that the aryl hydrocarbon receptor ...(AhR), a transcription factor that senses environmental stimuli, modulates pathology in psoriasis. AhR-activating ligands reduced inflammation in the lesional skin of psoriasis patients, whereas AhR antagonists increased inflammation. Similarly, AhR signaling via the endogenous ligand FICZ reduced the inflammatory response in the imiquimod-induced model of skin inflammation and AhR-deficient mice exhibited a substantial exacerbation of the disease, compared to AhR-sufficient controls. Nonhematopoietic cells, in particular keratinocytes, were responsible for this hyperinflammatory response, which involved upregulation of AP-1 family members of transcription factors. Thus, our data suggest a critical role for AhR in the regulation of inflammatory responses and open the possibility for novel therapeutic strategies in chronic inflammatory disorders.
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•Physiological AhR signals reduce psoriasis gene expression in patient biopsies•Blocking AhR signals exacerbates psoriasis gene expression in patient biopsies•AhR-deficient mice show exacerbated skin inflammation in imiquimod model•Absence of AhR on mouse or human keratinocytes causes excessive inflammation
The aryl hydrocarbon receptor (AhR), a transcription factor that responds to environmental signals, interacts with a wide range of genes involved in inflammatory responses. Di Meglio et al. show that physiological stimulation of AhR ameliorates skin inflammation in mice and humans.
Basal insulin provides an effective method for initiating insulin therapy in people with Type 2 diabetes, resulting in significant improvements in glycaemic control, lower rates of hypoglycaemia and ...less weight gain than either prandial or premixed insulin regimens. However, the progressive nature of Type 2 diabetes and the inability of basal insulin to correct excessive postprandial glucose excursions mean that insulin therapy will eventually need to be intensified, typically by adding prandial insulin as part of a basal–bolus or premixed insulin regimen. The aim of this review is to summarize recent clinical evidence for a staged ‘basal‐plus’ strategy for insulin intensification where one, two or three prandial insulin injections are added to basal insulin according to individual need. In the early stages of insulin therapy, most individuals seem to achieve favourable glycaemic control with basal insulin alone, or in combination with a single prandial insulin injection. The addition of a single prandial insulin injection at the largest meal is well tolerated and associated with significant improvements in glycated haemoglobin (HbA1c), low rates of hypoglycaemia and limited weight gain. More people achieve recommended HbA1c targets with a basal‐plus strategy, compared with twice‐daily premixed insulin therapy, with lower rates of hypoglycaemia. The data indicate that a step‐by‐step approach with the basal‐plus strategy is a promising alternative method of insulin intensification that allows for individualization of treatment and may delay progression to a full basal–bolus insulin replacement therapy for many individuals.
Objectif Évaluer l’intensité et la fréquence du phénomène de l’aube dans le diabète de type 2 et étudier son impact sur l’exposition totale au glucose. Patients et méthodes 248 patients diabétiques ...de type 2 non traités par l’insuline ont bénéficié d’un enregistrement glycémique continu. Le phénomène de l’aube a été quantifié par la différence entre la glycémie précédant le petit déjeuner et le nadir nocturne. Sa fréquence a été mesurée pour 2 valeurs seuils : ∂ glucose > 10 ou 20 mg/dl. Les participants ont été séparés sur la présence ou l’absence d’un phénomène de l’aube dont le seuil a été fixé à 10 (n = 146) ou à 20 mg/dl (n = 136) puis appariés sur le nadir glycémique. L’impact du phénomène de l’aube a été évalué sur l’HbA1c et sur la moyenne glycémique des 24 heures. Résultats Chez les 248 sujets, la médiane du ∂ glucose intervalle inter-quartile était égale à 16,0 0–31,5 mg/dl et les fréquences à 10 et 20 mg/dl étaient respectivement égales à 58,1 % et 40,7 %. Aucune différence n’a été observée entre les groupes sélectionnés sur l’HbA1c et les traitements. L’impact moyen sur l’HbA1c était le même à 10 et 20 mg/dl (0,36 ± 0,13 et 0,39 ± 12 % respectivement) mais plus marqué sur la moyenne glycémique des 24 heures quand le seuil était fixé à 20 mg/dl (12,4 ± 2,4 mg/dl) comparativement à un seuil fixé à 10 mg/dl (7,5 ± 3,2 mg/dl). Conclusion Un seuil de 20 mg/dl correspond à une meilleure définition du phénomène de l’aube que 10 mg/dl. A 20 mg/dl l’impact sur l’équilibre global du diabète (environ 0,4 % sur l’HbA1c) reste modeste mais suffisamment marqué pour ne pas être négligé.
In the first half of the twentieth century, Black hemispheric culture grappled with the legacies of colonialism, U.S. empire, and Jim Crow. As writers and performers sought to convey the terror and ...the beauty of Black life under oppressive conditions, they increasingly turned to the labor, movement, speech, sound, and ritual of everyday "folk." Many critics have perceived these representations of folk culture as efforts to reclaim an authentic past. Imani D. Owens recasts Black creators' relationship to folk culture, emphasizing their formal and stylistic innovations and experiments in self-invention that reach beyond the local to the world.Turn the World Upside Down explores how Black writers and performers reimagined folk forms through the lens of the unruly-that which cannot be easily governed, disciplined, or managed. Drawing on a transnational and multilingual archive-from Harlem to Havana, from the Panama Canal Zone to Port-au-Prince-Owens considers the short stories of Eric Walrond and Jean Toomer; the ethnographies of Zora Neale Hurston and Jean Price-Mars; the recited poetry of Langston Hughes, Nicolás Guillén, and Eusebia Cosme; and the essays, dance work, and radio plays of Sylvia Wynter. Owens shows how these figures depict folk culture-and Blackness itself-as a site of disruption, ambiguity, and flux. Their works reveal how Black people contribute to the stirrings of modernity while being excluded from its promises. Ultimately, these works do not seek to render folk culture more knowable or worthy of assimilation, but instead provide new forms of radical world-making.
The regulated dephosphorylation of mitogen-activated protein kinases (MAPKs) plays a key role in determining the magnitude and duration of kinase activation and hence the physiological outcome of ...signalling. In mammalian cells, an important component of this control is mediated by the differential expression and activities of a family of 10 dual-specificity (Thr/Tyr) MAPK phosphatases (MKPs). These enzymes share a common structure in which MAPK substrate recognition is determined by sequences within an amino-terminal non-catalytic domain whereas MAPK binding often leads to a conformational change within the C-terminal catalytic domain resulting in increased enzyme activity. MKPs can either recognize and inactivate a single class of MAP kinase, as in the specific inactivation of extracellular signal regulated kinase (ERK) by the cytoplasmic phosphatase DUSP6/MKP-3 or can regulate more than one MAPK pathway as illustrated by the ability of DUSP1/MKP-1 to dephosphorylate ERK, c-Jun amino-terminal kinase and p38 in the cell nucleus. These properties, coupled with transcriptional regulation of MKP expression in response to stimuli that activate MAPK signalling, suggest a complex negative regulatory network in which individual MAPK activities can be subject to negative feedback control, but also raise the possibility that signalling through multiple MAPK pathways may be integrated at the level of regulation by MKPs.
Background:
There is no consensus on the optimal method of stabilization (arthroscopic or open) in collision athletes with anterior shoulder instability.
Purpose:
To examine the effect of ...“subcritical” bone loss and football-specific exposure on the rate of recurrent shoulder instability after arthroscopic stabilization in an intercollegiate American football population.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Fifty intercollegiate football players underwent primary arthroscopic stabilization for anterior shoulder instability and returned to football for at least a single season. Preoperatively, 32 patients experienced recurrent subluxations, and 18 patients experienced a single or recurrent dislocation. Shoulders with glenoid bone loss >20%, an engaging Hill-Sachs lesion, an off-track lesion, and concomitant rotator cuff repair were excluded from the study. The primary outcome of interest was the ability to return to football without subsequent instability. Patients were followed for time to a subsequent instability event after return to play using days of exposure to football and total follow-up time after arthroscopic stabilization.
Results:
Fifty consecutive patients returned to American football for a mean 1.5 seasons (range, 1-3) after arthroscopic stabilization. Three of 50 (6%; 95% CI, 1.3%-16.5%) patients experienced recurrent instability. There were no subsequent instability events after a mean 3.2 years of military service. All shoulders with glenoid bone loss >13.5% (n = 3) that underwent arthroscopic stabilization experienced recurrent instability upon returning to sport, while none of the shoulders with <13.5% glenoid bone loss (n = 47) sustained a recurrent instability event during football (X2 = 15.80, P < .001). Shoulders with >13.5% glenoid bone loss had an incidence rate of 5.31 cases of recurrent instability per 1000 athlete-exposures of football. In 72,000 athlete-exposures to football with <13.5% glenoid bone loss, there was no recurrent instability. Significantly more anchors were used during the primary arthroscopic stabilization procedure in patients who experienced multiple preoperative instability events (P = .005), and lesions spanned significantly more extensive portions along the circumference of the glenoid (P = .001) compared with shoulders having a single preoperative instability event before surgical stabilization.
Conclusion:
Arthroscopic stabilization of anterior shoulder instability in American football players with <13.5% glenoid bone loss provides reliable outcomes and low recurrence rates.
The assessment of glycaemic variability (GV) remains a subject of debate with many indices proposed to represent either short- (acute glucose fluctuations) or long-term GV (variations of HbA1c). For ...the assessment of short-term within-day GV, the coefficient of variation for glucose (%CV) defined as the standard deviation adjusted on the 24-h mean glucose concentration is easy to perform and with a threshold of 36%, recently adopted by the international consensus on use of continuous glucose monitoring, separating stable from labile glycaemic states. More complex metrics such as the Low Blood Glucose Index (LBGI) or High Blood Glucose Index (HBGI) allow the risk of hypo or hyperglycaemic episodes, respectively to be assessed although in clinical practice its application is limited due to the need for more complex computation. This also applies to other indices of short-term intraday GV including the mean amplitude of glycemic excursions (MAGE), Shlichtkrull's M-value and CONGA. GV is important clinically as exaggerated glucose fluctuations are associated with an enhanced risk of adverse cardiovascular outcomes due primarily to hypoglycaemia. In contrast, there is at present no compelling evidence that elevated short-term GV is an independent risk factor of microvascular complications of diabetes. Concerning long-term GV there are numerous studies supporting its association with an enhanced risk of cardiovascular events. However, this association raises the question as to whether the impact of long-term variability is not simply the consequence of repeated exposure to short-term GV or ambient chronic hyperglycaemia. The renewed emphasis on glucose monitoring with the introduction of continuous glucose monitoring technologies can benefit from the introduction and application of simple metrics for describing GV along with supporting recommendations.
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