Food security is related to adult type 2 diabetes control over time in a United States safety net primary care clinic population.

BACKGROUND/OBJECTIVES: Successful Type 2 diabetes management requires adopting a high nutrient-density diet made up of food items that both meet dietary needs and preferences and can be feasibly obtained on a regular basis. However, access to affordable, nutrient-dense foods often is lacking in poorer neighbourhoods. Therefore, low food security should directly impair glucose control, even when patients have full access to and utilize comprehensive medical management. The present study sought to determine whether food security is related longitudinally to glucose control, over-and-above ongoing medication management, among Type 2 diabetes patients receiving comprehensive care at a Midwestern multi-site federally qualified health centre (FQHC). SUBJECTS/METHODS: In this longitudinal observational study, we completed a baseline assessment of patients' food security (using the US Household Food Security Module), demographics (via Census items), and diabetes history/management (using a structured clinical encounter form) when patients began receiving diabetes care at the health centre. We then recorded those patients' A1C levels several times during a 24-month follow-up period. Three hundred and ninety-nine patients (56% with low food security) had a baseline A1c measurement; a subsample of 336 (median age=52 years; 56% female; 60% Hispanic, 27% African American, and 9% White) also had at least one follow-up A1c measurement. RESULTS: Patients with lower (vs higher) food security were more likely to be on insulin and have higher A1c levels at baseline. Moreover, the disparity in glucose control by food security status persisted throughout the next 2 years. CONCLUSIONS: Although results were based on one multi-site FQHC, potentially limiting their generalizability, they seem to suggest that among Type 2 diabetes patients, low food security directly impairs glucose control-even when patients receive full access to comprehensive medical management-thereby increasing their long-term risks of high morbidity, early mortality, and high health-care utilization and cost.

Tirofiban administration attenuates platelet and platelet-neutrophil conjugation but not neutrophil degranulation during in vitro VAD circulation.

Ventricular Assist Devices (VADs) have been used as bridges to heart transplantation. However, VAD circulation is complicated by the incidence of thromboembolism, prolonged bleeding, and activation of the inflammatory cascade. We hypothesize that platelet and neutrophil activation are interrelated and linked to the activation of the glycoprotein (GP) IIb/IIIa platelet receptor. The purpose of this study is to evaluate the effects of Tirofiban, a platelet GP IIb/IIIa receptor inhibitor, on platelet and neutrophil activation during simulated VAD circulation. Two groups of five in vitro VAD circuits were simulated with and without Tirofiban using 450 cc of human blood. Blood samples were drawn at specific time intervals up to 72 hours, measuring leukotriene C4 (LTC4), platelet factor four (PF4), and neutrophil elastase. Tirofiban decreased serum levels of PF4 and LTC4 during VAD circulation. Neutrophil elastase secretion was not affected by Tirofiban administration. Preconditioning of VAD circulation with Tirofiban attenuated platelet activation as demonstrated by a decrease in serum PF4 levels. Tirofiban administration ameliorates the inflammatory response by altering platelet-neutrophil interaction as demonstrated by a decrease in LTC4 production. Continued elastase secretion indicates that the inflammatory response is not completely inhibited by Tirofiban administration. These results suggest that neutrophils may be activated by alternative mechanisms. Early complement activation has been demonstrated during in vivo and in vitro VAD circulation and may play a role in mediating inflammatory and thromboembolic reactions during VAD use.

Bell flap nipple reconstruction--a new wrinkle.

This single-stage nipple reconstruction technique is designed to produce a properly pigmented nipple-areolar complex that projects well above the breast mound without the need of skin grafts. The basic design of this technique consists of a bell-shaped random pattern flap within a circular subcutaneous island flap. The bell-shaped flap is incised, undermined, elevated, and folded into the shape of an inverted box, forming the new nipple. The remainder of the circular island flap is circumferentially incised, partially undermined, and sutured into a flat cone, forming the new areola. The nipple is inset in the center of this cone, completing the new nipple-areolar complex. This complex is then squeezed and pushed forward by the closure of a purse string suture placed on the raw edge of the outer skin circle. Predetermined pigments are tattooed immediately prior to the skin incisions and Montgomery's tubercles can be added after the pursestring closure by high-temperature cautery or biopsy punch. This technique has been attempted on six nipples in 5 patients for breast mounds reconstructed by musculocutaneous flaps or from breast reductions with satisfactory-to-good results in the past 2 1/2 years. However, at this time, it has not been, nor should it be attempted on breast mounds reconstructed solely by implants, due to unpredictable subcutaneous blood supply.