Incidence and determinants of hypophosphatemia in diabetic ketoacidosis:an observational study

Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) characterized by hyperglycemia and metabolic acidosis. Hypophosphatemia in DKA often occurs during hospital admittance for DKA. Literature on the magnitude, determinants and consequences of hypophosphatemia in DKA is scarce. Primary aim of this study was to investigate the incidence and consequences of hypophosphatemia during hospitalisation for DKA. Research design and methods Cohort study among individuals with T1DM who were admitted for DKA between 2005 and 2020 in an academic and a non-academic hospital. Multivariate regression models were performed to investigate determinants of the lowest phosphate during the treatment of DKA. Results A total of 127 episodes of DKA among 80 individuals were identified. Age at DKA presentation was 28 (22-46) years, 45% of the cases was female, diabetes duration was 13.2 (8.9-25.5) years with glycosylated hemoglobin levels of 91.9 +/- 26.2 mmol/mol. In 9% of all cases, DKA was the first presentation of T1DM. Lowest phosphate levelss reported during the treatment phase were 0.54 (0.32-0.83) mmol/L and hypophosphatemia was present in 74% (62/84). The time to lowest phosphate was 16 (8-23) hours. In multivariate analysis, baseline bicarbonate and hemoglobin at admission were significantly associated with the lowest phosphate level reported. No adverse effects of hypophosphatemia on hospital stay duration, morbidity or mortality were found, even if left untreated. Conclusions Hypophosphatemia during DKA is common and increases with severe acidosis. However, in this study it was not related to adverse outcomes. Although limitations of this retrospective study should be taken into account, the routine and repeated measurement of phosphate levels in DKA could be reconsidered, provided that possible symptoms related to hypophosphatemia are monitored

Volume and diagnosis: an approach to cross-border care in eight European countries

Objectives: Mobility of patients is a pertinent issue on the European Union's agenda. This study aimed to estimate the volume and main diagnoses of cross-border care in eight European countries, in order to provide policy makers with background information about the nature of patient mobility in Europe. Methods: This article reports the combined findings from three independent studies that compiled self-reported information on admissions data and main diagnoses from more than 200 hospitals in eight European countries. Results: The average volume of cross-border patients accounted for less than 1% of total admissions in the hospitals studied here. Diseases of the circulatory system (mainly acute myocardial infarction) and fractures were the most common reasons for hospitalisation of European patients abroad. Deliveries and other diagnoses related to pregnancy, pneumonia, appendicitis and other diseases of the digestive system, aftercare procedures, and disorders of the eye and adnexa were also common diagnoses for this population. Conclusions: Hospitals should reinforce their efforts to adapt the care provided to the needs of foreign patients in treatment areas that cover the most frequent pathologies identified in this populatio

Supercooling of the disordered vortex lattice in Bi_2Sr_2CaCu_2O_8+d

Time-resolved local induction measurements near to the vortex lattice order-disorder transition in optimally doped Bi$_{2}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$ single crystals shows that the high-field, disordered phase can be quenched to fields as low as half the transition field. Over an important range of fields, the electrodynamical behavior of the vortex system is governed by the co-existence of the two phases in the sample. We interpret the results in terms of supercooling of the high-field phase and the possible first order nature of the order-disorder transition at the ``second peak''.Comment: 4 pages, 3 figures. Submitted to Nature, July 10th, 1999; Rejected August 8th for lack of broad interest Submitted to Physical Review Letters September 10th, 199

Vortex fluctuations in underdoped Bi2Sr2CaCu2O8+d crystals

Vortex thermal fluctuations in heavily underdoped Bi2Sr2CaCu2O8+d (Tc=69.4 K) are studied using Josephson plasma resonance (JPR). From the data in zero magnetic field, we obtain the penetration depth along the c-axis, lambda_{L,c}(0) = 229 micrometers and the anisotropy ratio gamma(0) = 600. The low plasma frequency allows us to study phase correlations over the whole vortex solid (Bragg-glass) state. The JPR results yield a wandering length r_{w} of vortex pancakes. The temperature dependence of r_{w} as well as its increase with applied dc magnetic field can only be explained by the renormalization of the tilt modulus by thermal fluctuations, and suggest the latter is responsible for the dissociation of the vortices at the first order transition.Comment: 4 pages, 5 figures. Submitted to Phys. Rev. Let

The evaluation of SCIAMACHY CO and CH_4 scientific data products, using ground-based FTIR measurements

In the framework of the European EVERGREEN project, three scientific algorithms, namely WFM-DOAS, IMAPDOAS and IMLM, have been developed to retrieve the total column amounts of key atmospheric trace gases including CO and CH_4 from SCIAMACHY nadir observations in its near-infrared channels. These channels offer the capability to detect trace gases in the planetary boundary layer, potentially making the associated retrieval products suited for regional source-sink studies. The retrieval products of these three algorithms, in their present status of development, have been compared to independent data from a ground-based quasi-global network of Fourier-transform infrared (FTIR) spectrometers, for the year 2003. Comparisons have been made for individual data, as well as for monthly averages. To maximize the number of coincidences that satisfy the temporal and spatial collocation criteria, the individual SCIAMACHY data points have been compared with a 3rd order polynomial interpolation of the ground-based data with time. Particular attention has been paid to the question whether the products reproduce correctly the seasonal and latitudinal variabilities of the target species. We present an overall assessment of the data quality of the currently available latest versions of the CO and CH4 total column products from the three scientific retrieval algorithms

Recommendations on scuba diving in Birt-Hogg-Dubé syndrome

Introduction: Although very uncommon, severe injury and death can occur during scuba diving. One of the main causes of scuba diving fatalities is pulmonary barotrauma due to significant changes in ambient pressure. Pathology of the lung parenchyma, such as cystic lesions, might increase the risk of pulmonary barotrauma. Areas covered: Birt–Hogg–Dubé syndrome (BHD), caused by pathogenic variants in the FLCN gene, is characterized by skin fibrofolliculomas, an increased risk of renal cell carcinoma, multiple lung cysts and spontaneous pneumothorax. Given the pulmonary involvement, in some countries patients with BHD are generally recommended to avoid scuba diving, although evidence-based guidelines are lacking. We aim to provide recommendations on scuba diving for patients with BHD, based on a survey of literature on pulmonary cysts and pulmonary barotrauma in scuba diving. Expert opinion: In our opinion, although the absolute risks are likely to be low, caution is warranted. Given the relative paucity of literature and the potential fatal outcome, patients with BHD with a strong desire for scuba diving should be informed of the potential risks in a personal assessment. If available a diving physician should be consulted, and a low radiation dose chest computed tomography (CT)-scan to assess pulmonary lesions could be considered.</p

Heterogeneity in liquid shaken cultures of Aspergillus niger inoculated with melanised conidia or conidia of pigmentation mutants

AbstractBlack pigmented conidia of Aspergillus niger give rise to micro-colonies when incubated in liquid shaken medium. These micro-colonies are heterogeneous with respect to gene expression and size. We here studied the biophysical properties of the conidia of a control strain and of strains in which the fwnA, olvA or brnA gene is inactivated. These strains form fawn-, olive-, and brown-coloured conidia, respectively. The ΔolvA strain produced larger conidia (3.8 μm) when compared to the other strains (3.2–3.3 μm). Moreover, the conidia of the ΔolvA strain were highly hydrophilic, whereas those of the other strains were hydrophobic. The zeta potential of the ΔolvA conidia in medium was also more negative when compared to the control strain. This was accompanied by the near absence of a rodlet layer of hydrophobins. Using the Complex Object Parametric Analyzer and Sorter it was shown that the ratio of individual hyphae and micro-colonies in liquid shaken cultures of the deletion strains was lower when compared to the control strain. The average size of the micro-colonies of the control strain was also smaller (628 μm) than that of the deletion strains (790–858 μm). The size distribution of the micro-colonies of the ΔfwnA strain was normally distributed, while that of the other strains could be explained by assuming a population of small and a population of large micro-colonies. In the last set of experiments it was shown that relative expression levels of gpdA, and AmyR and XlnR regulated genes correlate in individual hyphae at the periphery of micro-colonies. This indicates the existence of transcriptionally and translationally highly active and lowly active hyphae as was previously shown in macro-colonies. However, the existence of distinct populations of hyphae with high and low transcriptional and translational activity seems to be less robust when compared to macro-colonies grown on solid medium

Bog bodies in context: developing a best practice approach

YesBog bodies are among the best-known archaeological finds worldwide. Much of the work on these often extremely well-preserved human remains has focused on forensics, whereas the environmental setting of the finds has been largely overlooked. This applies to both the ‘physical’ and ‘cultural’ landscape and constitutes a significant problem since the vast spatial and temporal scales over which the practice appeared demonstrate that contextual assessments are of the utmost importance for our explanatory frameworks. In this article we develop best practice guidelines for the contextual analysis of bog bodies after having assessed the current state of research and presented the results of three recent case studies including the well-known finds of Lindow Man in the United Kingdom, Bjældskovdal (Tollund Man and Elling Woman) in Denmark, and Yde Girl in the Netherlands. Three spatial and chronological scales are distinguished and linked to specific research questions and methods. This provides a basis for further discussion and a starting point for developing approaches to bog body finds and future discoveries, while facilitating and optimising the re-analysis of previous studies, making it possible to compare deposition sites across time and space.The Home Turf Project of Wageningen University and Research Centre, financed by the Dutch Organisation for Scientific Research (NWO Vidi Project, no. 276-60-003)