HbA1c variability as an independent correlate of nephropathy, but not retinopathy, in patients with type 2 diabetes: The renal insufficiency and cardiovascular events (RIACE) Italian Multicenter Study

OBJECTIVE: To examine the association of hemoglobin (Hb) A1c variability with microvascular complications in the large cohort of subjects with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. RESEARCH DESIGN AND METHODS: Serial (3-5) HbA1c values collected in a 2-year period before enrollment were available from 8,260 subjects from 9 centers (of 15,773 patients from 19 centers). HbA1c variability was measured as the intraindividual SD of 4.52 \ub1 0.76 values. Diabetic retinopathy (DR) was assessed by dilated funduscopy. Chronic kidney disease (CKD) was defined based on albuminuria, as measured by immunonephelometry or immunoturbidimetry, and estimated glomerular filtration rate (eGFR) was calculated from serum creatinine. RESULTS: Median and interquartile range of average HbA1c (HbA1c-MEAN) and HbA1c-SD were 7.57% (6.86-8.38) and 0.46% (0.29-0.74), respectively. The highest prevalence of microalbuminuria, macroalbuminuria, reduced eGFR, albuminuric CKD phenotypes, and advanced DR was observed when both HbA1c parameters were above the median and the lowest when both were below the median. Logistic regression analyses showed that HbA1c-SD adds to HbA1c-MEAN as an independent correlate of microalbuminuria and stages 1-2 CKD and is an independent predictor of macroalbuminuria, reduced eGFR, and stages 3-5 albuminuric CKD, whereas HbA1c-MEAN is not. The opposite was found for DR, whereas neither HbA1c-MEAN nor HbA1c-SD affected nonalbuminuric CKD. CONCLUSIONS: In patients with type 2 diabetes, HbA1c variability affects (albuminuric) CKD more than average HbA1c, whereas only the latter parameter affects DR, thus suggesting a variable effect of these measures on microvascular complications

Factors influencing the adoption of artificial nests in Polistes dominulus (Christ)

Nest recognition is critical to the sociality of wasps. Studies on Polistes have shown that is essentially based on chemoreception. Moreover, wasps are also able to recognise the nest's contents and this could also participate in nest recognition, By the method of the artificial nest adoption, we examined which natural nest stimuli (hydrocarbons from paper nests, hydrocarbons from immature broods or eggs, and the physical presence of both) act consistently in nest recognition. Since these stimuli change with the age of colony, we also considered its maturity. Our results show that the presence of eggs have a stronger effect to induce artificial nest adoption. Surprisingly, the paper nest hydrocarbons alone were weakly attractive. On the contrary, paper nest hydrocarbons combined with immature brood hydrocarbons, increased significantly the adoption of artificial nests. Finally, previous experiences of the wasps and the maturity of the nest they come from appear as influential factors in adoption and probably in nest recognition. In conclusion, some biological and practical implications of these results are discussed that underlined the necessary combination of various nests features to insure nest recognition. (C) 2001 Published by Elsevier Science B.V

Cystic malformations of the posterior cranial fossa originating from a defect of the posterior membranous area. Mega cisterna magna and persisting Blake's pouch: Two separate entities

Cystic malformations of the posterior cranial fossa are all but arachnoid cysts contained within the general context of the Dandy-Walker complex and may be further classified in two groups on the basis of their embryological origin: anomalies of the anterior membranous area (AMA) and anomalies of the posterior membranous area (PMA). Whether the latter group of malformations can be regarded as separate entities is still quite controversial. The present authors give a detailed account of the various embryological stages in the formation of the posterior cranial fossa and its contents and propose the identification of two anomalies derived from a defect of the PMA: the mega cisterna magna (MCM) and the persisting Blake's pouch, a new entity with different MRI features from MCM. Criteria for their recognition are discussed, stressing the capital importance of a differential diagnosis in view of the radically different therapeutic approach

Acute varicella-zoster virus necrotizing meningoencephalomyelitis with sudden visual loss and paraparesis in an HIV-infected patient

We describe a case of acute varicella-zoster virus (VZV) hemorrhagic meningoencephalomyelitis in an HIV-infected patient. On admission the patient's CSF was mild haemorrhagic and xanthochromic after centrifugation and he had thoracic skin blisters. VZV DNA was isolated from both the thoracic blisters and CSF. Treatment consisted of aggressive antiviral, steroid and immunoglobulin therapy, which was able to stop disease progression. The patient survived but was left blind and paretic. In conclusion, a diagnosis of CNS infection caused by VZV, based upon CSF analysis and examination of the skin for typical blisters, requires aggressive empiric antiviral therapy in order to maximise patient survival