Understanding the pathogenesis of type 2 diabetes: can we get off the metabolic merry-go-rounds?

The aetiology of non-insulin-dependent diabetes mellitus (NIDDM) is not known. The concordance of NIDDM in identical twins and differences in the prevalence rate of NIDDM between different racial groups suggest a genetic cause. Hyperglycaemia in established diabetes is caused by a combination of hepatic insulin resistance, impaired peripheral (muscle and fat) glucose uptake and a defect in glucose-mediated insulin secretion. However, it is not known if these defects are all inherited or if one can cause the others. This uncertainty is due to the fact that hyperglycaemia per se can cause defects in insulin action and insulin secretion that resemble those found in NIDDM. Furthermore the elevated free fatty acid (FFA) levels found when NIDDM is associated with obesity are known to cause both peripheral and hepatic insulin resistance. Recently we have demonstrated the mechanism by which elevated FFA levels can cause hepatic insulin resistance. However, we also have evidence that the converse holds in that genetically engineered hepatic insulin resistance in a transgenic rat model leads to obesity. Thus an understanding of the pathogenesis of NIDDM is complicated by the fact that hyperglycaemia and obesity can be both causes and consequences of insulin resistance. To overcome these difficulties, studies in young, euglycaemic diabetes-prone subjects have been conducted. Results suggest that there may be different causes for NIDDM in different racial groups.     

Sensitivity of Entamoeba histolytica and Entamoeba dispar patient isolates to human complement

Twenty-one Entamoeba histolytica and 56 Entamoeba dispar patient isolates were investigated for their sensitivity to the classical and alternative pathway of human complement. E. histolytica and E. dispar patient isolates were differentiated by polymerase chain reaction and hexokinase isoenzyme typing. It was found that 90.3% (±12.0%) of the trophozoites of E. histolytica were lysed after 30 min by the alternative pathway of complement in the presence of 50% human serum (19 isolates showed lysis rates higher than 80%), whereas E. dispar cells were less susceptible to the alternative pathway as 68.8% (±28.2%) of lysis occurred. However, 23 of the E. dispar isolates were lysed between 100 and 80% (90.9%±9.1%), demonstrating that about half of the tested E. dispar isolates were highly sensitive to complement lysis. Only 11 of the E. dispar isolates were proven to be 'resistant' to the alternative pathway of complement and were lysed less than 40%. These results are in conflict to earlier publications, describing resistance of E. dispar to complement lysis (Hamelmann et al. 1992, 1993).     

Creating conditions for good nursing by attending to the spiritual

biro a.l. (2012) Journal of Nursing Management  20, 1002–1011
Creating conditions for good nursing by attending to the spiritual Aim To note similarities, differences, and gaps in the literature on good nursing and spiritual care. Background Good nursing care is essential for meeting patient health needs. With growing recognition of the role of spirituality in health, understanding spiritual care as it relates to good nursing is important, especially as spiritual care has been recognized as the most neglected area of nursing care. Methods Nursing research, reports and discussion articles from a variety of countries were reviewed on the topics of good nursing, spiritual care and spirituality. Key issues A nurse’s spirituality and the nurse–patient relationship are integral to spiritual care and good nursing. Conclusions There are many commonalities between good nursing and spiritual care. Personal attributes of the nurse are described in similar terms in research on spiritual care and good nursing. Professional attributes common to good nursing and spiritual care are the nurse–patient relationship, assessment skills and communication skills. Implications for nursing management Good nursing through spiritual care is facilitated by personal spirituality, training in spiritual care and a culture that implements changes supportive of spiritual care. Further research is needed to address limitations in the scope of literature.     

Mapping Guided Laser Catheter Ablation of the Atrioventricular Conduction in Dogs

Safety and efficacy of mapping guided laser catheter ablation of the AV junction was tested in a canine model. A total of 43 laser pulses (continuous wave, Nd:YAG, 1,064 nm, 30 W, irradiated spot diameter 2.0–2.5 mm) were delivered in 15 dogs (2–5 per dog) via a novel laser catheter system. Pulses were selectively aimed at: (1) the AV node: (2) the His bundle; and (3) the bundle branches. Laser pulses of 9.7 ± 1.1 seconds (n = 31) produced reversible conduction disturbances in the targeted segment of the AV conduction system, while pulses of 28.6 ± 7.9 seconds (n = 9) resulted in chronic block. The dogs survived the procedure without complications. Follow-up was 6.5–10.5 months. Histopathologically, lesions showed clear-cut oval-shaped areas of fibrosis of 0.5–18.0 mm in diameter and 0.5–3.5 mm (transmural) in depth, depending on the irradiation time. Pervenous mapping guided laser catheter irradiation of the AV junction can produce AV block consistently and selectively in the targeted segment of the right ventricular conduction system in dogs. The method is safe and can be performed in a controllable manner by using the catheter system presented.     

Pain and the administration of analgesia: what nurses say

? Pain of moderate to severe intensity continues to be an important problem for many hospitalized patients. ? Nurses spend more time with patients than any other health professional group and have a key role to play in the management of patients' pain. ? This paper reports the findings from a series of focus group interviews which were undertaken to explore nurses' perceptions regarding pain and the administration of narcotic analgesia. ? Themes identified from participants' comments related to (1) the pivotal role of nurses in pain management; (2) nursing assessment and pain management decisions (3) individual factors influencing nurses' pain management decisions and (4) the influence of others on nurses' pain management decisions. ? These findings have implications for further research and the development of innovative educational strategies.     

Edward Martin (1859–1938). The founding father of modern clinical andrology

Edward Martin (1858-1938) was the first surgeon to treat successfully the problem of obstructive azoospermia, a feat that he first described in 1902. He subsequently carried out a total of 11 such operations that resulted in seven patencies and three pregnancies. He also demonstrated that the epididymis was the major site of these obstructive lesions. He pointed out the need for semen analysis in diagnosis and also demonstrated that azoospermia could have two causes, namely spermatogenic failure and ductal obstruction. He also made some important observations on sperm movement. He was probably the first clinician to demonstrate surgically ejaculatory duct obstruction, vasal atrophy and congenital absence of the vas. Most important of all, he demonstrated the need for accurate diagnosis in the treatment of male infertility. An argument is put forward that Edward Martin deserves the title of the 'Founding Father of Modern Clinical Andrology'.     

Aural symptoms and hearing loss in patients with lupus

OBJECTIVE: Systemic lupus erythematosus causes widespread tissue injury from deposition of immune complexes. The prevalence of aural symptoms in this disease was evaluated. METHODS: The presence of tinnitus, hearing loss, and fluctuating hearing was evaluated by a self-directed questionnaire in patients aged 65 or less from a lupus clinic. Patients reporting aural symptoms were compared with those reporting none, by use of demographics and disease duration. Comparison was also made with historic serologic data. Audiometry was offered to all patients with lupus reporting aural symptoms and was completed in 10. RESULTS: Twenty-six (31%) of 84 patients with lupus reported aural symptoms. Patients reported a combination of symptoms: unilateral hearing loss with or without tinnitus in 13 (15%) of 84 and bilateral hearing loss with or without tinnitus in 14 (17%) of 84. No statistical difference was measured between symptomatic and asymptomatic patients when compared by average age, duration of disease, history of noise exposure, head trauma, and infectious ear diseases. Statistically significant differences were detected only when comparing average creatinine and C3 levels. Of those patients tested by audiometry, 7 of 10 had abnormal pure-tone thresholds. Asymmetric findings were present in 6 of these 7 patients tested. CONCLUSION: Aural symptoms are prevalent among patients with lupus. Asymmetric symptoms and hearing loss are most common. The cause may relate to immune-complex disease and/or vasculitis. (Otolaryngol Head Neck Surg 1998;118:762-5.)     

A New Electrohydraulic Energy Converter for a Left Ventricular Assist Device

Abstract: An energy converting system that can function for years without maintenance is required for the drive of a left ventricular assist device (LVAD). To meet the requirements of safety, the energy converter should have a simple design with few moving elements. The design applied herein has only one moving part and thus has greater inherent safety than competing systems. The only moving part is the rotor unit, comprised of the impeller of a centrifugal pump, the rotor of an electric motor, and the rotor of an electric axial actuator. A reversal of flow of the transmitter fluid can be achieved with an axial shift of this rotor unit. This fluid acts on the outer surface of a blood chamber and enables it to draw in blood and to expel it. Valves direct the flow of blood. The energy converter performs a flow of 12 L/min at a motor speed of 6, 000 rpm against a pressure head of 115 mm Hg according to an output of the pulsatile blood pump of 5 L/min.     

The use of Roy's adaptation model applied to a patient with breast cancer

Roy's adaptation model provides a framework for holistic oncology nursing practice. In this article an overview of Roy's model is provided, and the model is applied to a patient with breast cancer for an assessment of behaviour and the stimuli influencing behaviour, and for the planning and evaluation of nursing care. Also, a comprehensive list of nursing diagnoses is categorized according to Roy's four adaptive modes.