Measure of the Rate at which Mortality in Type 2 Diabetes Mellitus Occurs: Protocol for a Systematic Review.

Introduction: Type 2 diabetes is the third largest cause of mortality in the United Kingdom, with about 50% of patients’ having developed complications at time of diagnosis. We consider that the evidence which explores the actual hazard ratios of mortality has not been consistent. n this paper we discuss methodology and review the most recent accurate data on mortality in type 2 diabetes. Methods: A systematic review will be undertaken aimed at synthesis of evidence of relative risk of mortality in type 2 diabetes, using the Centre for Reviews and Dissemination guidelines. We will explore conflicting and unanswered questions in relation to mortality. The primary outcome is all-cause, overall-cause or total mortality expressed as hazard ratios. Sub-groups will also be explored; age, gender, socio-economic factors and causes of death. We will review abstracts published after 1990 in the English language. Our data source will include electronic databases; the Cochrane library, the Centre for Reviews and Dissemination, Medline/PubMed, and other grey literature. The study populations are type 2 diabetes patients whose mortality outcome, expressed as hazard ratio, has been evaluated. Data extraction will be undertaken by one reviewer and triangulated by the second and third reviewer. The quality of the included studies will be evaluated in accordance with the inclusion/exclusion criteria; methodological quality that meets the critical appraisal framework and the relevance to the research questions. Evidence from data will be synthesised through a descriptive epidemiological review from included studies; meta-analysis will be used if appropriate. Result & Conclusion: We expect to pool homogenous studies of large population cohorts which explore the hazard ratio of mortality, and to summarise the evidence of the actual mortality risk in type 2 diabetes, with limited bias. This will help direct future research in areas of unanswered questions and may influence healthcare policy decisions.

Efficacy of a Lay Health Worker Led Group Antiretroviral Medication Adherence Training Among Non-Adherent HIV-Positive Patients in KwaZulu-Natal; South Africa: Results from a Randomized Trial

There is a lack of theory-based randomized controlled trials to examine the effect of antiretroviral adherence in sub-Saharan Africa. We assessed the effectiveness of a lay health worker lead structured group intervention to improve adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in South Africa. A total of 152 adult patients on ART and with adherence problems were randomized 1:1 to one of two conditions; a standard adherence intervention package plus a structured three session group intervention or to a standard adherence intervention package alone. Self-reported adherence was measured using the Adult AIDS Clinical Trials Group adherence instrument prior to; post intervention and at follow-up. Baseline characteristics were similar for both conditions. At post-intervention; adherence information knowledge increased significantly in the intervention condition in comparison to the standard of care; while adherence motivation and skills did not significantly change among the conditions over time. There was a significant improvement in ART adherence and CD4 count and a significant reduction of depression scores over time in both conditions; however; no significant intervention effect between conditions was found. Lay health workers may be a useful adjunct to treatment to enhance the adherence information component of the medication adherence intervention; but knowledge may be necessary but not sufficient to increase adherence in this sample. Psychosocial informational interventions may require more advanced skill training in lay health workers to achieve superior adherence outcomes in comparison standard care in this resource-constrained setting

Sexual Risk Reduction among Zambian Couples

Zambia has over 1 million HIV infections nation wide and an urban prevalence rate of 23This study compared the impact of male involvement in multiple and single session risk reduction interventions among inconsistent condom users in Zambia and the role of serostatus among HIV-seropositive and serodiscordant couples. Couples (N=392) were randomised into intervention arms. Among inconsistent condom users at baseline (N=83); condom use increased in both conditions and this increase was maintained over a 12- month period. At 12 months; seronegative men in the multiple session condition increased sexual barrier (male and female condoms) use in comparison with those in the single session condition (F=16.13; p=0.001) while seropositive individuals increased sexual barrier use regardless of condition. Results illustrate the importance of both single and multiple session risk reduction counselling among seronegative men in serodiscordant couples in Zambia; and highlight the differing perception of risk between seropositive and serodiscordant persons

Adult mesenchymal stem cells: differentiation potential and therapeutic applications.

Adult mesenchymal stem cells (MSCs) are a population of multipotent cells found primarily in the bone marrow. They have long been known to be capable of osteogenic, adipogenic and chondrogenic differentiation and are currently the subject of a number of trials to assess their potential use in the clinic. Recently, the plasticity of these cells has come under close scrutiny as it has been suggested that they may have a differentiation potential beyond the mesenchymal lineage. Myogenic and in particular cardiomyogenic potential has been shown in vitro. MSCs have also been shown to have the ability to form neural cells both in vitro and in vivo, although the molecular mechanisms underlying these apparent transdifferentiation events are yet to be elucidated. We describe here the cellular characteristics and differentiation potential of MSCs, which represent a promising stem cell population for future applications in regenerative medicine.

Indispensable benefits and unavoidable costs of unattended sound for cognitive functioning.

Critical to survival, and also to the organism's efficient management of the flow of information in the brain, is attentional selectivity; the ability to select one source of information to guide action whilst ignoring others that are irrelevant to the current behavioural goal. But such selectivity is not merely the inclusion of the relevant information and the complete neglect of irrelevant information. We discuss in this paper the way that all sound is processed in an obligatory fashion--whether relevant or irrelevant--and discuss the fate of sound in the case when it is irrelevant to the immediate mental task. Using the so-called irrelevant sound paradigm we show that unattended information is both registered and organised. This obligatory process of organisation compromises the efficiency of particular types of mental activity. We discuss how such interference comes about but the key emphasis is upon the possible beneficial effects of such processing-of-the-irrelevant, in allowing the switching of attention to be more facile and intelligent and in allowing the accumulation of evidence about statistical regularities in the auditory world (such as those helpful to the efficient perception, acquisition and use of language). In sum, we describe how purposeful processing based on directed attention is in a state of tension with the obligatory, automatic processing of the unattended. One of the consequences of this tension is typically manifested in auditory distraction, but the benefits of processing of the attended may considerably outweigh this disadvantage.

Recombinant pre-pro-Concanavalin A (jack bean) is stable but of low solubility.

The cDNA for pre-pro-Concanavalin A (pre-pro-ConA) was cloned into the cytoplasmic expression vector pKK233-2 to give rise to pCONEXP2 which was used to express the lectin precursor. Pre-pro-ConA is stable and is not transposed and ligated to form the mature protein. No signal peptide removal is observed. The solubility of pre-pro-ConA could not be increased by guanidine hydrochloride denaturation/dilution treatment.

Interaciones entre nutrientes y factores peptidos de crecimiento, en el desarrollo reparacion y funcionamiento de la mucosa intestinal / Nutrition and restitution of bowel mucosa

Diversas evidencias demuestran que el estado nutricional general, de ciertos nutrientes (zinc y glutamina, por ejemplo) y algunos factores tróficos de crecimiento (como la hormona de crecimiento, el factor de crecimiento 1 similar a la insulina, el factor de crecimiento de los queratinocitos y el péptido 2 similar al glucagón), tienen interacciones que son importantes para el desarrollo y funcionamiento de la mucosa intestinal. Un estado nutricionai adecuado es indispensable para la síntesis del factor endógeno de crecimiento en el intestino y otros tejidos, y es también mediador importante de la respuesta orgánica a la administración de factor exógeno de crecimiento. Los factores de crecimiento, tanto el sintetizado de modo endógeno, como el administrado en forma exógena, regulan en forma positiva la captación y utilización de nutrientes en la mucosa intestinal, el músculo esquelético y otros órganos, los datos que surgen de estudios, tanto en animales como en seres humanos indican, que la combinación de algunos factores de crecimiento con ciertos nutrientes pueden incrementar el desarrollo, adaptación y reparación de la mucosa intestinal. Se requieren estudios adicionales para determinar cuáles son los mecanismos básicos de las interacciones entre nutrientes y factores de crecimiento, así como la seguridad y eficacia de tratamientos con combinaciones específicas de nutrientes y factores de crecimiento recombinantes. Los resultados de tales investigaciones deberán definir nuevos métodos para el soporte del tracto intestinal en casos de síndrome de intestino corto (SUS, sigla en inglés), enfermedad catabólica y desnutrición

Artroplastias bilaterais simultâneas do quadril / Hip simultaneous bilateral arthroplasties

Vinte pacientes submetidos a artroplastias totais simultâneas dos quadris pela técnica de Charnley säo revistos. Os resultados säo mostrados e comparados com os de 100 pacientes que se submeteram à mesma cirurgia unilateral no mesmo hospital. As complicaçöes säo analisadas a fim de avaliar o risco do procedimento biliateral

The effect of sulphasalazine on the in vitro activation of human peripheral blood mononuclear cells by phytohemagglutinin P

The in vitro action of sulphaslazine, BW 755-C and indomethacin on phytohemaglutinin P-induced human peripheral brood mononuclear cell activation was studied. Sulphasalazine increased, while indomethacin and BW 755-C decreased, prostaglandin E2 (PGE2) accumulation in activated cultures. When used together with indomethacin or BW 755-C, sulpjasalazine did not counteract the inhibiton of PGE2 caused by the other two. Sulphasalazine inhibited phytohemagglutinin P-induced cell activation in a concentration-dependent manner even when used together with indomethacin or BW 755-C. BW 755-C inhibited cell activation at 350 micronM, wehreas at 11, whereas at 11 micronM only increased sulphasalazine-induced inhibition. The implications of these findings on the etiopathology of inflammatory bowel disease are discussed

La crisis de hipertermia maligna en porcinos susceptibles está asociada a un inchemento en la [Ca2+]i / Crisis of malignant hyperthermia in susceptible swines is associated with an increase in [Ca2+]i

La Hipertermia Maligna (HM) es un síndrome farmacogenético iniciado generalmente por la exposición del individuo susceptible a agentes anestésicos volátiles y/o relajantes musculares despolarizantes. Nosotros hemos usado los microelectrodos selectivos a calcio preparados y calibrados como ha sido previamente descrito para medir in vivo la concentración de calcio libre intracelular en fibras musculares de porcinos susceptibles a la HM (Poland China) y en porcinos control (Yorkshire). Los animales fueron anestesiados con tiopental y fentanil y ésta se mantuvo con 66% NO2 y 34% O2; como relajante muscular no despolarizante se utilizó pancuronium. El potencial de membrana y la concentración de calcio obtenidos sobre las fibras superficiales del músculo peroneus longus en los animales susceptibles fue de -82 + ou - 1,76 mV y 0,47 + ou - 0,06 micronM (Media + ou - EEM, n = 27), mientras que en los controles fue de -83,3 + ou - 1,06 mV y 0,12 + ou - 0,01 micronM. La exposición de los animales susceptibles a halothane o succinilcolina disparó la crisis hipertérmica la cual se acompañó de un incremento en la [Ca2+]i libre alcanzando un valor de 10,62 + ou - 3,16 micronM (Media + ou - EEM, n=8) y 8 + ou - 1,07 micronM (Media + ou - EEM n=6). La administración del relajante muscular dantrolene disminuyó sustancialmente la concentración de calcio libre a 0,35 + ou - 0,01 micronM (n=6). Estos resultados muestran que la crisis de Hipertermia Maligna está acompañada de un incremento en los niveles de concentración de calcio libre intracelular y también se muestra que el efecto del dantrolene en el tratamiento de este mal está asociado con una disminución en la concentración de este catión