Pregnancy outcome in women with gestational diabetes mellitus – a study from Eastern India

Introduction: Hyperglycemia first detected in pregnancy during screening test (often between 24-28 weeks) which does not meet the criteria for overt diabetes is called gestational diabetes mellitus (GDM). The International Association of Diabetes in Pregnancy Study group (IADPSG) recommended a new diagnostic criteria and protocol. Objective: To find out the prevalence, the need for insulin therapy, any short term maternal or fetal adverse effect of metformin therapy and maternal and fetal outcome of gestational diabetes mellitus in eastern part of India.  Methods: This observational study was conducted in a tertiary care semi urban private hospital from October 2018 to September 2019 for a period of twelve months. All women with normal fasting blood sugar at booking underwent oral glucose tolerance test between 24-28 weeks using 75 grams glucose drink. All GDM cases were managed by a multidisciplinary team. Pregnancies complicated with known type 1 or type 2 DM, preexisting hypertension and multiple pregnancies, were excluded from this study. Results: Out of 581 total deliveries 70 cases was GDM (12%). All cases received dietary modifications; metformin was needed in 62 (88.5%) and insulin required in 8 (11.5%) cases. 7 cases (10%) detected to have growth between 50 th and 90 th centile, interestingly 3(4.2%) cases growth was between 5th and 50th centile. 4 patients (5.7. %) delivered between 32 to 34 weeks and 15 (21.4%) between 34-36 weeks. 67 (95.7%) were delivered by caesarean section. There was no perinatal loss. Conclusion: This study indicates that majority of the patients with GDM can be managed without insulin. Metformin use has reduced the need for insulin therapy. Universal screening and proper vigilance can result in optimal outcom

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Folate-Targeted Polymeric Nanoparticle Formulation of Docetaxel Is an Effective Molecularly Targeted Radiosensitizer with Efficacy Dependent on the Timing of Radiotherapy

Nanoparticle (NP) chemotherapeutics hold great potential as radiosensitizers. Their unique properties, such as preferential accumulation in tumors and their ability to target tumors through molecular targeting ligands, are ideally suited for radiosensitization. We aimed to develop a molecularly targeted nanoparticle formulation of docetaxel (Dtxl) and evaluate its property as a radiosensitizer. Using a biodegradable and biocompatible lipid-polymer NP platform and folate as a molecular targeting ligand, we engineered a folate-targeted nanoparticle (FT-NP) formulation of Dtxl. These NPs have sizes of 72±4 nm and surface charges of −42±8 mV. Using folate receptor over-expressing KB cells and folate receptor low HTB-43 cells, we showed folate-mediated intracellular uptake of NPs. In vitro radiosensitization studies initially showed FT-NP is less effective than Dtxl as a radiosensitizer. However, the radiosensitization efficacy is dependent on the timing of radiotherapy. In vitro radiosensitization conducted with irradiation given at the optimal time (24 hours) showed FT-NP Dtxl is as effective as Dtxl. When FT-NP Dtxl is compared to Dtxl and non-targeted nanoparticle (NT-NP) Dtxl in vivo, FT-NP was found to be significantly more effective than Dtxl or NT-NP Dtxl as a radiosensitizer. We also confirmed that radiosensitization is dependent on timing of irradiation in vivo. In summary, FT-NP Dtxl is an effective radiosensitizer in folate-receptor over-expressing tumor cells. Time of irradiation is critical in achieving maximal efficacy with this nanoparticle platform. To the best of our knowledge, our report is the first to demonstrate the potential of molecularly targeted NPs as a promising new class of radiosensitizers

Arctic Energy Technology Development Laboratory

The Arctic Energy Technology Development Laboratory was created by the University of Alaska Fairbanks in response to a congressionally mandated funding opportunity through the U.S. Department of Energy (DOE), specifically to encourage research partnerships between the university, the Alaskan energy industry, and the DOE. The enabling legislation permitted research in a broad variety of topics particularly of interest to Alaska, including providing more efficient and economical electrical power generation in rural villages, as well as research in coal, oil, and gas. The contract was managed as a cooperative research agreement, with active project monitoring and management from the DOE. In the eight years of this partnership, approximately 30 projects were funded and completed. These projects, which were selected using an industry panel of Alaskan energy industry engineers and managers, cover a wide range of topics, such as diesel engine efficiency, fuel cells, coal combustion, methane gas hydrates, heavy oil recovery, and water issues associated with ice road construction in the oil fields of the North Slope. Each project was managed as a separate DOE contract, and the final technical report for each completed project is included with this final report. The intent of this process was to address the energy research needs of Alaska and to develop research capability at the university. As such, the intent from the beginning of this process was to encourage development of partnerships and skills that would permit a transition to direct competitive funding opportunities managed from funding sources. This project has succeeded at both the individual project level and at the institutional development level, as many of the researchers at the university are currently submitting proposals to funding agencies, with some success