Hyperinsulinemia, an overlooked clue and potential way forward in metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease is closely associated with other features of the metabolic syndrome such as type 2 diabetes. The progression of the disease may lead to liver fibrosis, which is the main predictor of major adverse liver outcomes. Insulin resistance plays a major role in the pathogenesis of the disease. A component of fasting hyperinsulinemia is a failure of the liver to adjust the peripheral level of insulin due to reduced clearance. The associated fasting hyperinsulinemia has been independently associated as a predictor of major adverse liver outcomes and major adverse cardiovascular events. In this review, we discuss the potential mechanism and entanglement between liver fibrosis and hyperinsulinemia, and we hypothesize that the measure of fasting insulin could become a hepatic functional test within the armamentarium of noninvasive tests for the assessment of Metabolic dysfunction-associated steatotic liver disease.

Diagnostic tools in Sezary syndrome

Primary cutaneous T-cell lymphomas (CTCL) mycosis fungoides (Mf) and Sézary syndrome (SS) belong to the group of non-Hodgkin lymphomas which are characterized by clonally proliferating CD4+ cells localized in the skin. SS is a leukemic variant of CTCL and is characterized by erythroderma, generalized lymphadenopathy, and circulating atypical T-cells with cerebriform nuclei, so-called Sézary cells. Palmoplantar hyperkeratosis, generalized alopecia, and severe pruritus are additional symptoms that are associated with SS. Patients have a poor prognosis with an estimated five year survival of 12.5 to 27 percent and estimated median survival of 14.5 to 18 months. The incidence of MF and also SS has increased with time and may be in part due to improved clinical awareness and especially advances in diagnostic testing.

Bootstrapping the estimated latent distribution of the two-parameter latent trait model

This paper focuses on the two-parameter latent trait model for binary data. Although the prior distribution of the latent variable is usually assumed to be a standard normal distribution, that prior distribution can be estimated from the data as a discrete distribution using a combination of EM algorithms and other optimization methods. We assess with what precision we can estimate the prior from the data, using simulations and bootstrapping. A novel calibration method is given to check that near optimality is achieved for the bootstrap estimates. We find that there is sufficient information on the prior distribution to be informative, and that the bootstrap method is reliable. We illustrate the bootstrap method for two sets of real data.

Characteristics and outcomes of patients receiving chemotherapy in a cancer center ICU: A 5 year retrospective

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Background: Administration of chemotherapy is traditionally guided by functional status, and chemotherapy is commonly withheld from very sick people. In our ICU, we observed that we customarily administered chemotherapy to patients in multisystem organ failure. Very little has been published in the literature on this topic, therefore we sought to characterize patients who received chemotherapy during their intensive care unit (ICU) admission in a cancer hospital over a 5-year period. Methods: We evaluated all ICU admissions receiving chemotherapy between October 1998 and September 2003. If patients had multiple admissions, only the first was included. We analyzed age, gender, MPM-II scores, and ICU and hospital length of stay (LOS). Additionally, we identified patients who were on mechanical ventilation, vasopressors or were treated with renal replacement therapy at the initiation of chemotherapy. Mortality at ICU discharge, hospital discharge, and at 6 months and one year post hospital discharge were also determined. Results: During the study period, 4.2% (111/2,645) of all ICU admissions received chemotherapy, averaging 22.2 administrations per year. Only first admissions (a total of 103 patients; 60 men and 43 women) were analyzed. Average age was 51.4 years, with an MPM-II score of 53%, an ICU LOS of 9.1 days and a hospital LOS of 30.6 days. Although over a third of patients were on mechanical ventilation when chemotherapy was initiated, ICU mortality was only 23%. In contrast, all in hospital mortality was 46%. ( Table ) Conclusions: Most patients were critically ill when chemotherapy was administered but survived to ICU discharge. However, only 24% of patients were alive at one year. Whether chemotherapy should be considered a useful component of ICU care for cancer patients requires further study.

[Table: see text]

No significant financial relationships to disclose.

Novel and Mediterranean β thalassemia mutations in the indigenous Northern Ireland population

beta thalassemia is one of the most common genetic diseases worldwide resulting from aberrant beta-globin chain production. It is highly prevalent in regions with endemic malaria, but it is also present at low frequency in the indigenous populations of non-tropical areas such as Britain. Screening beta thalassemia trait individuals from Northern Ireland has detected 2 Mediterranean mutations, 39 (C --> T) and IVS-I-110 (G --> A); the previously reported IVS-II-850 (G --> A) mutation originally described in individuals of Scottish/English ancestry; and 2 novel mutations, initiation codon A --> C and 109 delG. Haplotype analysis indicates that the Mediterranean mutations are present on previously described haplotypes, suggesting that they have arisen due to migration. It remains to be established whether the novel mutations have arisen de novo in Northern Ireland.

Phase coexistence in colloidal suspensions: an analytic Poisson-Boltzmann treatment

We solve the linearized Poisson-Boltzmann equation analytically, subject to justifiable approximations, for a suspension containing a large number of identical spherical macroions under conditions of constant surface charge and zero added salt, in order to investigate the phase behavior of charge-stabilized colloidal suspensions. Our results for the electrostatic part of the Helmholtz free energy lead to an interaction which resembles the intermolecular interaction in the theory of molecular fluids. When combined with the ideal gas free energy of the counterions, this produces a van der Waals loop in the pV diagram, indicating coexistence between phases with different densities, for certain values of the macroion radius and charge. We also derive an expression for the surface potential of the macroions, and clarify the interpretation of the Poisson-Boltzmann equation.

Help or hindrance? Single, unsupported mothers' perceptions of health visiting

Although there have been studies of clients' perceptions of health visiting, the views of single, unsupported mothers about the health visiting service have been under-researched. Therefore, this study investigated their views using semi-structured interviews with 12 single, unsupported mothers identified by health visitors within one National Health Service Community Trust. The data were analysed using Burnard's (1991) thematic content analysis, which enabled a number of identifiable themes to emerge. Findings showed that the participants perceived the health visiting service as being concerned almost exclusively with babies and there was a general lack of understanding about the broader role of the health visitor. Clinics were seen as places to visit to weigh the baby but not as a contact point with a health visitor. Some health visitors were perceived as being judgemental in attitude and not necessarily interested in the clients as individuals. Participants considered that health visitors should be friendly, interested, able to promote their confidence and offer individualized advice. Overall the study suggests that health visitors may not be utilizing all dimensions of their role with single, unsupported mothers and may not be communicating effectively with them about this. The study also shows that single, unsupported mothers wish to be treated in the same way as other mothers but at present some feel that they are stigmatized and treated differently. The paper concludes with an outline of the implications of the findings and recommendations for practice and future research.

Evaluation of bovine perinatal nitrate accumulation in western Nebraska

Nitrate-nitrite toxicosis causes numerous cattle deaths every year in western Nebraska. Its role in fetal abortions is complex and still speculative. This paper reports composite fetal nitrate diagnostic levels, fetal abattoir nitrate levels and observations of bovine perinates from cow-calf livestock units.

Topical cryotherapy-use for relief of pain and spasticity

Cold applications are sometimes of pronounced symptomatic benefit in some rheumatic disorders such as acute myalgia; in the temporary relief of spasticity; in helping to release tight structures in poliomyelitis and allied diseases; and in temporary recovery of energy in multiple sclerosis.