Progression to microalbuminuria in patients with type 1 diabetes: a seven-year prospective study

<p>Abstract</p> <p>Background</p> <p>The presence of microalbuminuria can be associated with overt nephropathy and cardiovascular disease in patients with type 1 diabetes (T1D). We aimed to determine the incidence and evaluate the baseline predictors for the development of microalbuminuria in patients with T1D.</p> <p>Methods</p> <p>This study is a longitudinal cohort study of 122 normoalbuminuric patients with T1D who were receiving routine clinical care at baseline. A detailed medical history was taken, and a physical examination was performed at baseline. All of the patients were regularly examined for diabetes-associated complications. An analysis of predictors was performed using the Cox regression.</p> <p>Results</p> <p>Over 6.81 (3.59-9.75) years of follow-up, 50 (41%) of the patients developed microalbuminuria. The incidence density was 6.79/100 people per year (95% CI 5.04-8.95), and the microalbuminuria developed after 5.9 (2.44-7.76) and 11 (5-15) years of follow-up and diabetes duration, respectively. After an individual Cox regression, the baseline variables associated with the development of microalbuminuria were age, age at diagnosis, duration of diabetes, systolic and diastolic blood pressure, fasting glycemia, body mass index (BMI), total cholesterol and triglycerides levels, cholesterol/HDL ratio and a family history of type 2 diabetes.After a multivariate Cox regression, the only independent factors associated with the development of microalbuminuria were BMI [HR 1.12 (1.03-1.21)] and cholesterol/HDL ratio [HR 1.32 (1.05-1.67)].</p> <p>Conclusions</p> <p>A higher BMI and cholesterol/HDL ratio increased the risk of developing microalbuminuria in young patients with T1D after a short follow-up. Both risk factors are modifiable and should be identified early and followed closely.</p

Tuberculum sellae meningiomas: surgical considerations

We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.Apresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites

ERAS in Spine Surgery

Enhanced recovery after surgery (ERAS) programs afford the opportunity to remedy several challenges within spine surgery. Increasing surgical demand, rising costs, and variability in outcomes favor the need for development of ERAS recommendations in spine surgery. Therefore, official guideline recommendations will likely be published in the coming year. These guidelines were completed following a comprehensive literature search for each of 16 enhanced recovery topics. The majority of interventions remain similar to ERAS recommendations in other subspecialties, consisting primarily of preoperative education and health optimization strategies, multimodal medication protocols during the intraoperative and postoperative periods, and early mobilization with rehabilitation following surgery. Prior to the advent of published ERAS recommendations in spine surgery, several programs have already successfully implemented elements of enhanced recovery for a variety of spine procedures. The success of these programs provides stronger evidence for the utility of ERAS within spine surgery and demonstrates that full implementation of an ERAS program will likely improve recovery for these patients. International and multidisciplinary collaboration will serve to guide ERAS implementation into the future of spine surgery

<em>Ecpagloxylon mathiesenii</em> gen. nov. et sp. nov., a Jurassic wood from Greenland with several primitive angiosperm features

International audienceFossil wood specimens from the late Early-early Middle Jurassic of Jameson Land, Eastern Greenland, have several unexpected features: tracheids of irregular size and shape, thinly pitted ray cell walls, heterogeneous rays, partially scalariform radial pitting, both areolate and simple pits, and pitted elements associated with rays. These characters diverge markedly from those typical of Jurassic wood, which usually conform to those of modern conifers. Although this combination of features is not encountered in any extant angiosperm, each has been documented in one or several extant homoxylous angiosperms, particularly Amborella, Trochodendron, and Tetracentron. As these wood specimens are not found in connection with any reproductive part, it is impossible to confidently assign them to the angiosperms. If a Jurassic angiosperm did exist, however, it might well have had a similar wood. This material is an early bench-mark in the evolution that led from homoxylous conifer-like wood to that of the angiosperms. Its particular biogeography (Arctic) could renew the discussion about the area of origin of the angiosperm