Relationship between HbA1c and cancer in people with or without diabetes: a systematic review.

AIM: To identify the relationship between HbA1c and cancers in people with or without diabetes. BACKGROUND: Cancer is a major public health problem, accounting for 8.2 million deaths worldwide in 2012. HbA1c level has been associated with the risk of developing certain cancers, although the existing evidence is conflicting. METHODS: EMBASE, MEDLINE, CINAHL and the Cochrane Library were searched. Eligible articles included randomized controlled trials, cohort studies, case-control studies, systematic reviews and meta-analyses. Participants of either sex, with or without Type 1 or 2 diabetes, were included. The studies were assessed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria by two independent assessors. No meta-analysis was performed because of the heterogeneity of results. RESULTS: A total of 19 studies from 1006 met the inclusion criteria, of which 14 were cohort studies and five were nested case-control studies. Eight studies investigated outcomes for all cancer sites. Four of these studies reported that higher HbA1c levels were associated with higher incidence and/or mortality risk for all cancers. One study observed a U-shaped relationship between HbA1c and cancer incidence and mortality. Increasing HbA1c levels were associated with increasing risk of developing colorectal, pancreatic, respiratory and female genital tract cancers. No increased risk was observed for breast cancer, gastrointestinal or urological malignancies. CONCLUSION: HbA1c appears to be associated with cancer incidence and/or cancer mortality, but further studies are needed to fully understand the complex relationship between HbA1c and cancer.

Secreted effectors in Toxoplasma gondii and related species: determinants of host range and pathogenesis?

Recent years have witnessed the discovery of a number of secreted proteins in Toxoplasma gondii that play important roles in host-pathogen interactions and parasite virulence, particularly in the mouse model. However, the role that these proteins play in driving the unique features of T. gondii compared to some of its nearest apicomplexan relatives (Hammondia hammondi and Neospora caninum) is unknown. These unique features include distinct dissemination characteristics in vivo and a vast host range. In this review we comprehensively survey what is known about disease outcome, the host response and host range for T. gondii, H. hammondi, and N. caninum. We then review what is presently known about recently identified secreted virulence effectors in these three genetically related, but phenotypically distinct, species. Finally we exploit the existence of genome sequences for these three organisms and discuss what is known about the presence, and functionality, of key T. gondii effectors in these three species.

Control of the attosecond synchronization of XUV radiation with phase-optimized mirrors.

We report on the advanced amplitude and phase control of attosecond radiation allowed by specifically-designed multilayer XUV mirrors. We first demonstrate that such mirrors can compensate for the intrinsic chirp of the attosecond emission over a large bandwidth of more than 20 eV. We then show that their combination with metallic foils introduces a third-order dispersion that is adjustable through the mirror's incidence angle. This results in a controllable beating allowing the radiation to be shaped from a single to a series of sub-100 as pulses.

Excited ions in intense femtosecond laser pulses: laser-induced recombination.

Electron-ion recombination in a laser-induced electron recollision is of fundamental importance as the underlying mechanism responsible for the generation of high-harmonic radiation and hence for the production of attosecond pulse trains in the extreme ultraviolet and soft x-ray spectral regions. By using an ion beam target, remotely prepared to be partially in long-lived excited states, the recombination process has for the first time been directly observed and studied.

Lactoferrin supplementation to Holstein calves during the preweaning and postweaning phases.

Sixty Holstein calves (30 bulls, 30 heifers) were used to examine the effects of supplemental lactoferrin on feed intake, growth, and health during the preweaning and postweaning periods. One of 3 levels of lactoferrin was supplemented from 3 to 56 d in either whole milk or water to produce 3 dietary treatments: 1) 0 g/d, 2) 0.5 g/d, and 3) 1 g/d. Whole milk (3.8 L/d) containing lactoferrin supplements was fed from bottles until weaning at 35 d. From d 36 to 56, lactoferrin supplements were added to water (15 to 25 mL) and fed from bottles. Lactoferrin supplementation had no effect on feed intake, body weight, average daily gain, heart girth, body temperature, fecal scores, respiratory scores, or haptoglobin concentrations. Calves were housed in individual pens in either an open-sided barn or hutches. Calves raised in the barn consumed more calf starter and therefore grew better than calves raised in hutches. Under the conditions of this study, lactoferrin supplementation was not beneficial. Further research is needed to fully elucidate the role of lactoferrin, and possible benefits during different feeding conditions or milk sources.

ET nursing education in Australia.

Australia is comparable in size to the United States, but its population is far smaller, approximately 17 million. Australia is technologically advanced and has a high standard of health care, in which ET nursing has always been considered a specialist nursing role. Although Australia is historically linked with England, formation of closer ties with geographic neighbors, such as Southeast Asia, New Zealand, and the Pacific nations, is ongoing. This article describes some relevant aspects of the Australian context and considers the past, present, and expected future trends for ET nurse education in Australia, from the first program in 1971 to current World Council of Enterostomal Therapy-recognized programs teaching students from as far away as Japan, Israel, Singapore, Malaysia, New Zealand, China, Russia, and New Guinea. The content of the programs has progressively broadened in recognition of the expanded scope of practice, and this trend will undoubtedly continue. ET nursing should remain, however, a distinct nursing specialty practice in Australia.

Propionyl-L-carnitine limits chronic ventricular dilation after myocardial infarction in rats.

To determine whether propionyl-L-carnitine (PLC) administration ameliorates ventricular remodeling after myocardial infarction, we performed coronary occlusion in rats and examined the long-term effects of the drug 19-24 wk after surgery. In view of the well-established role of angiotensin-converting enzyme (ACE) inhibitors in the reduction of ventricular dilation after infarction, the therapeutic impact of oral PLC (60 mg/kg) was compared with that of enalapril (1 mg/kg). Infarct size measured planimetrically was found to be comparable in untreated, PLC-treated, and enalapril-treated rats, averaging 40-46% of the left ventricular free wall. Heart weight was increased 14, 16, and 11% with no treatment, with PLC, and with enalapril, respectively. The relationship between left ventricular filling pressure and chamber volume demonstrated that PLC and enalapril significantly prevented the expansion in cavitary size after infarction. These protective influences were observed throughout the range of filling pressures measured, from 0 to 30 mmHg. At a uniform reference point of filling pressure of 4 mmHg, untreated infarcted hearts showed an expansion in ventricular volume of 2.17-fold (P < 0.0001). Corresponding increases in this parameter after PLC and enalapril were 36 and 43%, respectively, both not statistically significant. Moreover, PLC was capable of reducing the alterations in myocardial compliance associated with myocardial infarction. In conclusion, PLC reduces the magnitude of decompensated eccentric hypertrophy produced by myocardial infarction in a manner similar to that found with ACE inhibition.

Hemodynamic and metabolic activities of propionyl-L-carnitine in rats with pressure-overload cardiac hypertrophy.

Evidence has been put forth that a number of human and experimental cardiomyopathies are associated with a lower myocardial carnitine content. This study was performed to test the hypothesis that the correction of carnitine derivative, propionyl-L-carnitine (PLC), may improve cardiac function. Repeated administration of PLC was compared to saline with respect to cardiac function in rats with pressure-overload cardiac hypertrophy and low myocardial carnitine levels. Cardiac hypertrophy was induced by abdominal aorta constriction in rats. Separate groups of rats were used for (a) determination of myocardial carnitine content, (b) evaluation of in vivo hemodynamics, and (c) evaluation of performance and metabolic state of Langendorff perfused hearts. Results showed the following: (i) The myocardial carnitine content was inversely correlated to cardiac hypertrophy (r = 0.68, p less than 0.05) and PLC treatment (50 mg/kg i.a. for 4 days) restored it to normal values (ii) The PLC effect on cardiac function was significantly and directly related to cardiac hypertrophy [correlations between heart weight and percent changes in cardiovascular parameters: cardiac output (CO), p less than 0.001; cardiac work (CW), p less than 0.01, stroke volume (SV) and stroke work (SW), p less than 0.02]. In animals with heart weight greater than 1,400 mg, the effect of PLC on CO, CW, SV, SW, and total peripheral resistance (TPR) was significantly different from that of saline (CO, CW, SV, and SW, p less than 0.005 each; TPR, p less than 0.05). The effect was observed 24 h after the first PLC administration and significantly diminished following a 4 day suspension of the treatment. (iii) Perfused hearts from PLC-treated rats displayed a significantly lower left ventricular end-diastolic pressure (p less than 0.01) and greater relaxation rate (p less than 0.05) than those from control rats. Moreover, in PLC-treated hearts, the content of creatine phosphate, ATP, and total adenine nucleotides (ATP+ADP+AMP; TAN) was significantly increased (CP, p less than 0.05; ATP and TAN, p less than 0.01 vs. control). These data show that PLC exerts a stimulatory activity on hearts with hypertrophy and low carnitine content, implying that carnitine deficiency may contribute to the depression of cardiac function in this model.

LSU Medical Center initiates family medicine clerkship program for third year medical students.

This article takes note of the family physician shortage in Louisiana and the continuing need to inform medical students of the career choice in family medicine. Drs English, Gatipon, and Catlin describe the planning stages, the training of clinical teachers, and the implementation of a third (junior) year required clerkship in family medicine at LSU School of Medicine in New Orleans. The students who participated in the pilot year of the program have been enthusiastic about the value of the experience in their total medical education.

Effects of intravenous endothelin on hemodynamics and cardiac contractility in conscious Milan normotensive rats.

The effects of endothelin-1 (ET-1) on hemodynamics and cardiac contractility were compared with the responses to angiotensin I (AI) and phenylephrine (PE) in Milan normotensive rats. Intravenous (i.v.) injection of ET-1 (0.8 nmol/kg) initially decreased mean blood pressure (MBP), total peripheral resistance (TPR), and dP/dt (-28 +/- 2, -34.8 +/- 3.7, and -9.4 +/- 1.3%, p less than 0.01, respectively), and increased heart rate (HR), cardiac output (CO), and the velocity of myocardial anterior wall shortening (dL/dt) (11.8 +/- 2.1, 10.4 +/- 2.9, and 28.3 +/- 8.3% p less than 0.05, respectively). These effects were followed by a sustained increase in MBP and TPR and a decrease in CO. As compared with AI (0.25 nmol/kg) and PE (35 nmol/kg), which produced a similar degree of increase in TPR, the reduction in CO induced by ET-1 was more prominent (-25 +/- 2 by ET-1 vs. -14 +/- 2 by AI and -14 +/- 3% by PE, p less than 0.05, respectively). Moreover, ET-1 induced a significant decrease in dP/dt, shortening fraction (SF), and dL/dt (-6.1 +/- 1.6, -35.0 +/- 3.8, and -38.6 +/- 5.5%, p less than 0.01, respectively), whereas these indexes of left ventricle performance were not affected by either AI or PE. Furthermore, the reduction in SF induced by ET-1 was mainly due to the decrease in myocardial diastolic segment length, suggesting reduction in diastolic filling volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia.

Abnormalities in the routine blood count alert the physician to hematologic problems. The most common of these are red cell abnormalities as reflected in decreased levels of hemoglobin and hematocrit together with changes in mean corpuscular volume and red cell morphology. When the history and physical examination are not diagnostic, systematic use of laboratory tests can determine the category of anemia present. An approach for the laboratory workup of anemia is discussed. Particular attention is paid to the differential diagnosis of the most common anemias in which iron is the limiting factor in erythropoiesis.

The early results of porous-coated total shoulder arthroplasty.

A porous-coated total shoulder arthroplasty of the authors' design was investigated over a period of six years. Thirteen of the first 21 arthroplasties, with an average follow-up period of three years, revealed the difficulty of proving stability by either bony or fibrous tissue ingrowth or both. With the exception of two patients (one glenoid and one humeral component), there was no gross evidence of radiographic loosening. Clinically, the early results were encouraging, but long-term follow-up observations are necessary before definitive conclusions are possible.

The Canadian experience with pulsed magnetic fields in the treatment of ununited tibial fractures.

A clinical survey of 56 patients was conducted at four different centers in Canada to evaluate the effect of extremely low frequency pulsed magnetic fields (PMF) on ununited fractures of the tibia. All ten patients with delayed union and 84% of the 44 patients with nonunion healed. One case with a traumatic pseudarthrosis and one with a congenital pseudarthrosis failed to respond to treatment. These results compare favorably to those reported by others using a system with different pulse characteristics. Prolonged immobilization is necessary and poses problems of rehabilitation. Nonunions with a gap between the tibial fragments and pseudarthroses are better treated with bone grafting and internal fixation prior to electrical stimulation.

Syme's amputation in adults: a long-term review.

A retrospective study was undertaken in two patient populations to establish the failure rate of Syme's amputation. Failure was defined as an amputation requiring revision to a more proximal level. For traumatic lesions of the foot the failure rate was 29% and for dysvascular lesions it was 41%. The long-term functional results in 55 patients who underwent Syme's amputation for traumatic, dysvascular or congenital lesions were studied. Overall, 73% had good function. The ideal Syme's stump, where the fat pad is centred securely over the distal tibia, was noted in only 22% of patients. The authors conclude that, in the past, technical details may have been overemphasized, because in this study the functional results of Syme's amputation were more dependent on prosthetic fitting. This type of amputation is not recommended for patients with dysvascular lesions because of the high failure rate.

Childbirth preparation and outcomes of labor and delivery in primiparous women.

Preparation for childbirth (Lamaze classes) is becoming an increasingly popular addition to patient education. This retrospective study investigates its effect on 64 primiparas in comparison with a control group who had not taken classes. The two groups were matched for age, antenatal risk scores, ethnic derivation, and socioeconomic status. No difference was found in the use of analgesia and anesthesia, the length of labor, type of delivery, incidence of fetal distress, infant birth weights, Apgar scores, or maternal and neonatal complications. However, there was a statistically significant increase in the use of oxytocin for augmentation of labor (P less than 0.01) in the prepared group.

Fractures and soft tissue injuries of the feet and ankle.

An accurate clinical diagnosis of foot and ankle pain can be made by a history, physical examination and routine X-rays of the affected part. Each problem has a specific treatment; however, fractures and dislocations around the foot and ankle can be thought of in an organized fashion by proper physical examination and then the appropriate treatment. Fractures and soft tissue injuries can be treated rationally by understanding the mechanism of injury and the possibility of subsequent deformity. This article classifies specific injuries as a group and indicates a treatment program for each problem.

Suction curettage.

In the decade after the legalization of elective abortion by a Supreme Court decision in January 1973, suction curettage has been widely used and accepted as a safe outpatient procedure for first-trimester abortion. Evaluation of the patient for feasibility of the procedure requires careful assessment of gestational age and the determination of the absence of an ectopic pregnancy and conditions that might contraindicate local anesthesia. Counseling clarifies the patient's options and ensures her understanding of the implications of abortion so that she can give an informed consent. Suction curettage is performed under local anesthesia using a sterile plastic cannula or curette inserted through a progressively dilated cervix with aspiration of the uterine contents by an electric pump. The procedure is completed by the physician's examination of the aspirate for the presence of placental villi. Postoperative instructions include contraception and monitoring for hemorrhage and infection prior to a return visit in 10 to 14 days. Complications can be reduced by careful selection of patients with appropriate duration of pregnancy, the use of gentle operative technique, antibiotics for prophylaxis of infection, and a continued maintenance of experience and procedural skill by the physician.