MicroRNA regulation of islet and enteroendocrine peptides: Physiology and therapeutic implications for type 2 diabetes.

The pathogenesis of type 2 diabetes (T2D) is associated with dysregulation of glucoregulatory hormones, including both islet and enteroendocrine peptides. Microribonucleic acids (miRNAs) are short noncoding RNA sequences which post transcriptionally inhibit protein synthesis by binding to complementary messenger RNA (mRNA). Essential for normal cell activities, including proliferation and apoptosis, dysregulation of these noncoding RNA molecules have been linked to several diseases, including diabetes, where alterations in miRNA expression within pancreatic islets have been observed. This may occur as a compensatory mechanism to maintain beta-cell mass/function (e.g., downregulation of miR-7), or conversely, lead to further beta-cell demise and disease progression (e.g., upregulation of miR-187). Thus, targeting miRNAs has potential for novel diagnostic and therapeutic applications in T2D. This is reinforced by the success seen to date with miRNA-based therapeutics for other conditions currently in clinical trials. In this review, differential expression of miRNAs in human islets associated with T2D will be discussed along with further consideration of their effects on the production and secretion of islet and incretin hormones. This analysis further unravels the therapeutic potential of miRNAs and offers insights into novel strategies for T2D management.

In vitro study investigating post neck surgery haematoma airway obstruction.

OBJECTIVES: To investigate whether the possible pressure produced by a haematoma in the neck would be sufficient to directly compress the trachea to the point of airway obstruction. STUDY DESIGN: In vitro study. METHODS: Varying pressures were applied over the second and third cartilaginous rings of 10 pig tracheas in vitro and the anterior-posterior compression was measured. RESULTS: At pressures of 257 mmHg, equivalent to the maximum possible pressure in the neck (i.e. systolic blood pressure), there was an average compression of 20.8 per cent of the original anterior-posterior tracheal diameter. CONCLUSIONS: This study suggests that the pressures in haematomas observed after neck surgery would not be sufficient to cause airway obstruction due to direct pressure on the trachea. Therefore, the most likely cause of airway obstruction would be supraglottic oedema secondary to venous obstruction.

Can parathyroidectomy for primary hyperparathyroidism be carried out as a day-case procedure?

INTRODUCTION: Surgery for primary hyperparathyroidism has traditionally involved a bilateral neck exploration performed as an in-patient procedure. We present a feasibility study to demonstrate whether, with a focused surgical exploration, the procedure can be carried out as a day case. METHOD: Eighty-seven patients had pre-operative sestamibi and ultrasound scans of the neck. When the results of these scans agreed, a unilateral neck exploration was carried out. RESULTS: Sixty-seven patients received a focused approach parathyroidectomy. Ninety-seven per cent of these patients were normocalcaemic after the first operation. All patients who fitted the day-case criteria left hospital the following morning. DISCUSSION: When pre-operative imaging results agree, a parathyroidectomy can be carried out using a unilateral neck exploration, avoiding the increased risks associated with a bilateral exploration. CONCLUSION: Parathyroidectomy can be safely carried out as a day-case procedure in selected patients.

Audit of doctors' knowledge of major incident policies.

INTRODUCTION: The aim of this study was to audit doctors' knowledge of their hospital's major incident policy. MATERIALS AND METHODS: Pre- and post-intervention interviews were conducted with doctors selected at random in a central London teaching hospital on where to report to in a major incident. Doctors working in hospitals with accident and emergency departments within the M25 motorway were asked if they had read or received training on their hospital's major incident policy. RESULTS: Pre-intervention, 4.4% of doctors knew where to report to in a major incident. A 1-sided information sheet on the major incident policy was distributed to doctors and posted in areas frequented by doctors. Following this intervention, 78% of doctors knew where to report to in a major incident. Doctors in only 2 out of 38 hospitals with accident and emergency departments within the M25 corridor had read or received training on their major incident policy. CONCLUSIONS: More needs to be done by hospitals to ensure that doctors have a better awareness of their hospital major incident policy.

'Surgical skills box': a new training aid for surgical trainees.

INTRODUCTION: Surgical trainees now receive less operating experience with the reduction in junior doctor hours. DESIGN: We designed a simple, portable, versatile 'surgical skills box' which allowed surgical trainees to practise vascular anastomosis, suturing, tonsil ties, hand ties and grommet insertion. DISCUSSION: With surgical trainees now receiving reduced operating experience it is more important than ever for them to practise their surgical skills outside the operating theatre environment.