CD36 expression and lipid metabolism following an oral glucose challenge in South Asians

AIM:To investigate lipid metabolism and the relationship with monocyte expression of the fatty acid translocase CD36 in South Asians.METHODS:An observational study of South Asians whom as an ethnic group have-a higher risk of developing diabetes.The susceptibility to diabetes is coupled with an earlier and more rapid progression of micro-,and macro-vascular complications.Twentynine healthy South Asian participants [mean age 34.6(8.9) years,76.2% male,mean body-mass index 25.0(5.2) kg/m2] were recruited from an urban residential area of central Birmingham(United Kingdom).The main outcomes measured were post prandial(30 min) and post absorptive(120 min) changes from fasting(0 min) in circulating lipoproteins,lipds and hormones,andmonocyte expression of CD36 post injection of a 75 g oral glucose challenge.The inducements of variations of monocyte CD36 expression were analysed.RESULTS:Our results showed evident changes in monocyte CD36 expression following the glucose challenge(P < 0.001).Non-esterified fatty acids(NEFA) levels decreased progressively during the challenge(P < 0.001),in contrast to increased cholesterol(but not triglyceride) concentrations within very low density lipoprotein(VLDL) and low density lipoprotein subfractions(P < 0.01).Levels of,glucose,serum triglycerides and high density lipoprotein cholesterol remained largely unchanged.Variations of monocyte CD36 were negatively(r =-0.47,P = 0.04) associated to fat from the diet and positively to carbohydrate from the diet(r = 0.65,P < 0.001).CONCLUSION:These data suggest that the initiation of VLDL genesis follows the consumption of glucose within this population,inferring that the sequestration of NEFA from these particles happens due to the increased availability of CD36 receptors.While these are preliminary results,it would appear that lifestyle exposures have a role in moderating the expression of CD36.

Tipping the balance:Haemoglobinopathies and the risk ofdiabetes

AIM: To establish a link between the risk of diabetes with haemoglobinopathies by examining available evidence of the effects of iron and blood glucose homeostasis from molecular to epidemiological perspectives.METHODS: A systematic literature search was performed using electronic literature databases using various search terms. The International Diabetes Federation World Atlas was used to generate a list of populations with high rates of diabetes. Pub Med, Scopus and Google Scholar were used to identify which of these populations also had a reported prevalence of haemoglobin abnormalities.RESULTS: Abnormalities in iron homeostasis leads to increases in reactive oxygen species in the blood. This promotes oxidative stress which contributes to peripheral resistance to insulin in two ways:(1) reduced insulin/insulin receptor interaction; and(2) β-cell dysfunction. Hepcidin is crucial in terms of maintaining appropriate amounts of iron in the body and is in turn affected by haemoglobinopathies. Hepcidin also has other metabolic effects in places such as the liver but so far the extent of these is not well understood. It does however directly control the levels of serum ferritin. High serum ferritin is found in obese patients and those with diabetes and a meta-analysis of the various studies shows that high serum ferritin does indeed increase diabetes risk.CONCLUSION: From an epidemiological standpoint, it is plausible that the well-documented protective effects of haemoglobinopathies with regard to malaria may have also offered other evolutionary advantages. By contributing to peripheral insulin resistance, haemoglobinopathies may have helped to sculpt the so-called "thrifty genotype", which hypothetically is advantageous in times of famine. The prevalence data however is not extensive enough to provide concrete associations between diabetes and haemoglobinopathies- more precise studies are required.

Spontanous Remission of PAN

Polyarteritis nodosa (PAN) affects mostly medium-sized arteries and sometimes small ones as well. The primary methods used to make the diagnosis are through physical examinations, biopsies of organs that are affected, and/or angiographic studies. Immunosuppressants like glucocorticoids and cyclophosphamide are usually started as soon as possible after a diagnosis. So, it’s not clear if sudden remission of PAN happens or not. Here we present a 42-year-old male who presented with right upper quadrant, right flank pain and fever. CT angiogram Aorta revealed soft tissue rind around the small to medium sized vessel in the abdomen and bilateral cortical renal infarcts of variable age in the right more than the left. A diagnosis of polyarteritis nodosa was made and the patient achieved spontaneous remission with no need for corticosteroids or immunosuppressive therapy.

Meta-analysis of transanal vs laparoscopic total mesorectal excision of low rectal cancer:Importance of appropriate patient selection

BACKGROUND Achieving a clear resection margins for low rectal cancer is technically challenging.Transanal approach to total mesorectal excision(TME)was introduced in order to address the challenges associated with the laparoscopic approach in treating low rectal cancers.However,previous meta-analyses have included mixed population with mid and low rectal tumours when comparing both approaches which has made the interpretation of the real differences between two approaches in treating low rectal cancer difficult.AIM To investigate the outcomes of transanal TME(TaTME)and laparoscopic TME(LaTME)in patients with low rectal cancer.METHODS A comprehensive systematic review of comparative studies was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.Intraoperative and postoperative complications,anastomotic leak,R0 resection,completeness of mesorectal excision,circumferential resection margin(CRM),distal resection margin(DRM),harvested lymph nodes,and operation time were the investigated outcome measures.RESULTS We included twelve comparative studies enrolling 969 patients comparing TaTME(n=969)and LaTME(n=476)in patients with low rectal tumours.TaTME was associated with significantly lower risk of postoperative complications(OR:0.74,P=0.04),anastomotic leak(OR:0.59,P=0.02),and conversion to an open procedure(OR:0.29,P=0.002)in comparison with LaTME.Moreover,the rate of R0 resection was significantly higher in the TaTME group(OR:1.96,P=0.03).Nevertheless,TaTME and LaTME were comparable in terms of rate of intraoperative complications(OR:1.87;P=0.23),completeness of mesoractal excision(OR:1.57,P=0.15),harvested lymph nodes(MD:-0.05,P=0.96),DRM(MD:-0.94;P=0.17),CRM(MD:1.08,P=0.17),positive CRM(OR:0.64,P=0.11)and procedure time(MD:-6.99 min,P=0.45).CONCLUSION Our findings indicated that for low rectal tumours,TaTME is associated with better clinical and short term oncological outcomes compared to LaTME.More randomised controlled trials are required to confirm these findings and to evaluate long term oncological and functional outcomes.

Folic acid supplementation: The new dawn for postmenopausal women with hot flushes

Hot flushes, experienced by 75% of menopausal women, are associated with estrogen deprivation. Estrogen was shown to ameliorate hot flushes by interacting with monoamine neurotransmitters in the brain; reducing noradrenaline and increasing serotonin. Hormone replacement therapy(HRT), the first treatment option, causes concerns over possible increased risks particularly breast cancer. Folic acid is involved in the biosynthesis of serotonin and nordrenaline, which is responsible for its effects on mood and cognition, and degrees of folate inadequacy, not severe enough to produce megaloblastic anaemia, were found to be associated with depression and cognitive malfunctioning. Also, increased age was observed to relate to reduced serum and cerebrospinal fluid folic acid levels. There is emerging evidence that folic acid supplementation ameliorates hot fl ushes by the same mechanism as estrogen. To explore this hypothesis, a multi-centre, double-blind, placebo-controlled randomized is being set up to compare the effect of 5 mg folic acid vs placebo in reducing the frequency and severity of hot fl ushes in postmenopausal women, and on the blood level of serotonin and noradrenaline. If folic acid supplementation is demonstrated to be effective, this will be a turning point in the clinical practice since it represents a cheap, safe and well-tolerated alternative to HRT.

未登记的视力损害现状:登记系统是否正在失去作用

Background/aims: To assess the current level of under-registration of blindne ss and partial sight among patients attending a large teaching hospital, and to determine any risk factors for under-registration. Methods: Medical records of all patients attending general ophthalmology outpatient clinics over a 3 month p eriod were included in a retrospective analysis of registration rates; questionn aire survey assessing the level of knowledge of registration practices among 35 ophthalmologists working in theWest Midlands. Results: 146/2161 (7%) patients w ere eligible for blind or partial sight registration, or were in possession of a completed BD8 form. Of these 146 patients, 65 (45%) were unregistered with 18 fulfilling the criteria for blind and 47 for partially sight. In addition, 32/81 (40%) registered patients appeared to have been inappropriately registered. Pa rtially sighted patients were more likely to be unregistered than blind patients (OR 2.31, 95%CI 1.15 to 4.63, p=0187), and patients from ethnic minorities wer e more than three times more likely to be unregistered than white patients (OR 3 .23, 95%CI 1.56 to 6.65, p=0.0015). A patient with a treatable condition was mo re likely to be unregistered than a patient with an unbeatable condition (OR 4.8 7, 95%CI 2.10 to 11.33, p=0.0002). The overall level of knowledge of registrati on practices among doctors was found to be low and there was no indication of in creasing knowledge with increasing experience. Conclusions: There has been littl e improvement in registration rates of visually impaired patients over the past decade. Ophthalmologists lack the necessary knowledge to cater for visually impa ired patients’needs.

The diagnostic conundrum in necrotizing otitis externa

Necrotizing otitis externa(NOE)is an aggressive and fast‐evolving infection of the external auditory canal.Late diagnoses and untreated cases can lead to severe,even fatal consequences and so early diagnosis and treatment are paramount.NOE is a notoriously challenging diagnosis to make.It is therefore important to understand what diagnostic modalities are available and how otolaryngologists can use them to accurately treat such an aggressive disease.This review aims to evaluate the different diagnostic options available in NOE and discuss their advantages and limitations,thus,providing an up‐to‐date picture of the multimodal approach required in the diagnosis of this disease.

帕金森病的初始药物治疗

患者为一名69岁的退休司机，既往无特殊病史，主要表现为右手震颤，活动变缓，夜间翻身、系纽扣以及使用刀叉困难，上述症状进行性加重，遂于门诊就诊。患者诊治意愿强烈。

卵巢癌的诊断

卵巢癌是全球女性第七位最常见的癌症，2012年，有23．9万新发病例。和许多其他类型的癌症一样，不同地区卵巢癌的发病率和病死率差异很大，经济发达地区的发病率更高。卵巢癌发病率最高的年龄组是50-70岁，75％的病例发生在55岁以后3080％的病例在出现症状时已处于疾病晚期，5年生存率很低。在英国，各分期卵巢癌总的5年生存率为46％。

Biodegradable magnesium alloys for orthopaedic applications

There is increasing interest in the development of bone repair materials for biomedical applications.Magnesium(Mg)-based alloys have a natural ability to biodegrade because they corrode in aqueous media;they are thus promising materials for orthopaedic device applications in that the need for a secondary surgical operation to remove the implant can be eliminated.Notably,Mg has superior biocompatibility because Mg is found in the human body in abundance.Moreover,Mg alloys have a low elastic modulus,close to that of natural bone,which limits stress shielding.However,there are still some challenges for Mg-based fracture fixation.The degradation of Mg alloys in biological fluids can be too rapid,resulting in a loss of mechanical integrity before complete healing of the bone fracture.In order to achieve an appropriate combination of bio-corrosion and mechanical performance,the microstructure needs to be tailored properly by appropriate alloy design,as well as the use of strengthening processes and manufacturing techniques.This review covers the evolution,current strategies and future perspectives of Mg-based orthopaedic implants.