Search

Microneedle‐based electrodes have attracted significant attention due to their potential applications in high‐quality, long‐term electrophysiological monitoring. In this study, micromoulding technology is used to develop a flexible, conductive fabric microneedle (CF–MN) electrode by bonding a conductive textile to polymeric microneedle arrays. The resulting electrode conforms to the curved surfaces of the body, and the use of a conductive textile backing reduces metallization time and costs by 50% over double‐sided dry electrodes. The electrode‐skin impedance of the CF–MN electrodes is significantly lower than that of gel electrodes over a wide frequency range, and tests on healthy volunteers, both at rest and under a range of ambulatory conditions, showed that the electrodes are capable of acquiring electrocardiography (ECG) and electromyography (EMG) signals that have a comparable kurtosis and signal‐to‐noise ratio to those recorded using conventional electrodes, but without the need for skin preparation or the use of a wet gel. The biomechanical properties of the electrode are also characterized. This is the first demonstration of CF–MN electrodes that can ultimately be integrated into clothing, which in turn can facilitate personalized cardiac health management by enabling continuous, long‐term ECG/EMG monitoring during daily activities. [ABSTRACT FROM AUTHOR]

Objective: It is urgent to diagnose giant cell arteritis (GCA) as quickly as possible to prevent irreversible blindness. The traditional gold standard for diagnosing GCA is temporal artery biopsy (TAB). However, TAB lacks diagnostic performance and carries out risks of surgical intervention. The noninvasive color Doppler ultrasound (CDU) seems to be a promising alternative. This study is designed to assess the diagnostic value of CDU in daily clinical practice. Methods: In this prospective cohort study, patients with a clinical suspicion of active GCA were included and underwent a CDU of the temporal arteries. If deemed necessary by the referrer, a TAB and/or 18F‐fluorodeoxyglucose positron emission tomography with computed tomography was performed. The retrospective clinical diagnosis was determined 1 year after inclusion by two physicians experienced in the field of vasculitis. Results: 242 patients were included and GCA was diagnosed in 73 (30%) patients by the defined retrospective clinical diagnosis. Compared with the retrospective diagnosis, CDU has a sensitivity of 60% (48–72), specificity of 94% (89–97), positive predictive value (PPV) of 81% (70–89), negative predictive value (NPV) of 85% (80–88), and an accuracy of 84% (78–88). A total of 84 (35%) patients underwent TAB. TAB has a sensitivity of 66% (51–79), specificity of 100% (90–100), PPV of 100% (100), NPV of 67% (58–75), and an accuracy of 80% (70–88). Conclusion: This study shows comparable diagnostic performance for CDU and TAB and even better CDU results with a bilateral halo present. Considering the advantages of the noninvasive CDU, it is the diagnostic tool of choice. [ABSTRACT FROM AUTHOR]

Hyperhomocysteinemia is a risk factor for cardiovascular disease and occurs frequently in end-stage renal disease (ESRD), but its pathogenesis is poorly understood. We aimed to evaluate one-carbon flux rates of methionine and homocysteine (Hcy) in ESRD patients and healthy controls. Transmethylation (TM), remethylation (RAM), and transsulfuration (TS), as well as Hcy clearance by TS (i.e., TS/plasma total Hcy concentration) and by RM (i.e., RM/plasma total Hcy concentration) were evaluated in relation to body composition, vitamins, and S-adenosylhomocysteine (AdoHcy) and S-adenosylmethionine (AdoMet) levels. After a fixed protein diet for 3 days, primed-continuous infusion of [[sup.2][H.sub.3]methyl-1-[sup.13]C]methionine was performed in the postabsorptive state in 12 hemodialysis patients and 16 healthy volunteers. Hcy clearance by TS (-80%, P < 0.001) and by RM (-77%, P < 0.001) in ESRD patients was decreased compared with healthy controls. The absolute flux rates of TM (-27%, P < 0.01) and RM (-28%, P = 0.02) were lower in the ESRD patients. After adjustment for age, TS was not significantly reduced. Whole blood AdoHcy was significantly elevated in ESRD and was a significant determinant of TM (standardized [beta] = - 1.24, P - 0.01) and RM (standardized [beta] = - 1.43, P = 0.03). In conclusion, patients with ESRD have impaired Hey clearance by TS and RM. Elevated whole blood AdoHcy levels are associated with impaired RM and TM flux rates in these patients, and AdoHcy may be a key regulatory compound in one-carbon flux. stable isotopes; S-adenosylmethionine; transsulfuration; remethylation; transmethylation

The purpose of this study was to investigate the psychometric characteristics (content validity, internal consistency, and subscale structure) of the Hematology Information Needs Questionnaire-62 (HINQ-62), a patient reported outcome measure (PROM) for assessing the need for information among patients with hematological malignancies (HM-patients). Baseline data were used from a prospective study on the need for information which 336 newly diagnosed HM-patients had completed. In phase 1 (design phase), data from the first 135 patients were used and in phase 2 (validation phase), data from the remaining 201 HM patients were used. Content validity was analyzed by examining irrelevance of items. Items were considered irrelevant if more than 10% of the patients scored totally disagree on that item. The subscale structure of the HINQ-62 was investigated with Factor analysis (FA) (exploratory FA in phase 1 and confirmatory FA in phase 2). Cronbach’s α was computed for the different subscales and >.70 was considered as good internal consistency. None of the 62 HINQ-items were irrelevant. Exploratory FA identified five subscales: “Disease, symptoms, treatment and side-effects”, “Etiology, sleep and physical changes”, “Self-care”, “Medical tests and prognosis”, and “Psychosocial”. Root Mean Square Error of Approximation (RMSEA) among patients was 0.037 in phase 1 and 0.045 in phase 2. The comparative fit index (CFI)/Tucker-Lewis index -non-normed fit index among patients was 0.984/0.983 and 0.948/0.946, in phase 1 and 2 respectively. The internal consistency of the subscales was good, with Cronbach’s α 0.82–0.99. The HINQ is a valid PROM for assessing the need for information among Dutch HM-patients at diagnosis. [ABSTRACT FROM AUTHOR]

Lung transplantation is a necessary step for the patients with the end stage of chronic obstructive pulmonary disease. The use of artificial lungs is a promising alternative to natural lung transplantation which is complicated and is restricted by low organ donations. For successful lung engineering, it is important to choose the correct combination of specific biological cells and a synthetic carrier polymer. The focus of this study was to investigate the interactions of human lung epithelial cell line NCl-H292 that is involved in lung tissue development with the biodegradable poly(ε-caprolactone) before and after its chemical modification to evaluate potential for use in artificial lung formation. Also, the effect of polymer chemical modification on its mechanical and surface properties has been investigated. The poly(ε-caprolactone) surface was modified using aminolysis followed by immobilization of gelatin. The unmodified and modified polymer surfaces were characterized for roughness, tensile strength, and NCl-H292 metabolic cell activity. The results showed for the first time the possibility for NCI-H292 cells to adhere on this polymeric material. The resazurin assay showed that the metabolic activity at 24 h postseeding of 80% in the presence of the unmodified and greater than 100% in the presence of the modified polymer was observed. The roughness of the poly(ε-caprolactone) increased from 4 to 26 nm and the film strength increased from 0.01 to 0.045 kN when the material was chemically modified. The results obtained to date show potential for using modified poly(ε-caprolactone) as a scaffold for lung tissue engineering. [ABSTRACT FROM PUBLISHER]

Parylene is commonly used as thin film polymer for MEMS devices and smart materials. This paper investigates the impact on bulk properties due to annealing various types of Parylene films. A thin film of Parylene N, C and a hybrid material consisting of Parylene N and C were deposited using a standard Gorham process. The thin film samples were annealed at varying temperatures from room temperature up to 300 °C. The films were analyzed to determine the mechanical and crystallinity effects due to different annealing temperatures. The results demonstrate that the percentage of crystallinity and the full-width-half-maximum value on the 2θ X-ray diffraction scan increases as the annealing temperature increases until the melting temperature of the Parylene films was achieved. Highly crystalline films of 85% and 92% crystallinity were achieved for Parylene C and N respectively. Investigation of the hybrid film showed that the individual Parylene films behave independently to each other, and the crystallinity of one film had no significant impact to the other film. Mechanical testing showed that the elastic modulus and yield strength increase as a function of annealing, whereas the elongation-to-break parameter decreases. The change in elastic modulus was more significant for Parylene C than Parylene N and this is attributed to the larger change in crystallinity that was observed. Parylene C had a 112% increase in crystallinity compared to a 61% increase for Parylene N, because the original Parylene N material was more crystalline than Parylene C so the change of crystallinity was greater for Parylene C. [ABSTRACT FROM AUTHOR]

ABSTRACT Typically, electroresponsive hydrogels have either a high electrical conductivity with little swelling or large swelling with low conductivity. This paper investigates a method of maintaining high swelling capabilities and increasing electrical conductivity by infusing multiwalled carbon nanotubes (MWCNTs) into a hydrolyzed polyacrylamide hydrogel. Various concentrations of MWCNT and Nafion solutions infused into the hydrogel were investigated. Optical microscopy analysis showed aggregates of carbon nanotube bundles at the macroscale, whereas electron microscopy revealed homogeneous dispersion of carbon nanotube in the polymer matrix at the microscale. Electrical conductivity measurements demonstrated an increase from 0.02 to 0.11 mS cm-1 with infused MWCNT. The MWCNT-infused hydrogels demonstrated a 400% increase in deswelling capabilities during an applied electrical stimulus compared to a noninfused hydrogel. In conclusion, infusing the MWCNT into the hydrogel increased its electrical conductivity, which allows the hydrogel to deswell more rapidly with an applied electrical bias without compromising its mechanical or swelling properties. [ABSTRACT FROM AUTHOR]

For patients with haematological malignancies, information on disease, prognosis, treatment and impact on quality of life is of the utmost importance. To gain insight into the perceived need for information in relation to sociodemographic and clinical parameters, comorbidity, quality of life (QoL) and information satisfaction, we compiled a questionnaire based on existing validated questionnaires. A total of 458 patients diagnosed with a haematological malignancy participated. The perceived need for information was moderate to high (40-70%). Multivariate regression analyses showed that a higher need for information was related to younger age, worse QoL, being member of a patient society and moderate comorbidity. The need for disease and treatment-related information was higher than the need for psychosocial information. A higher need for disease and treatment-related information was associated to being diagnosed with multiple myeloma. A higher need for psychosocial information was related to a lower educational level. The information provision could be improved according to 41% of the patients. Higher satisfaction with provided information was associated with better QoL. Most patients (62%) reported that they wanted to be fully informed about their illness and actively involved in treatment decision-making. The results contribute to improving patient-tailored information provision and shared decision-making in clinical practice. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Electro-responsive hydrogels (ERH) are highly researched materials for biomedical applications. However, most of the research is concentrated on the synthesis of novel hydrogels for various applications, and little effort has been made to investigate electrode configuration and optimization of electrical stimulation parameters. This article used a three-dimensional interdigitated (IDT) electrode configuration device to investigate the optimization of electrical actuation parameters in order to radially deswell an ERH. A Pluronic-bismethacrylate hydrogel modified with hydrolyzed methacrylic acid was used as the ERH material. This article reports on using novel electro-actuation parameters and electrode configurations to maximize radial deswelling of an ERH for biomedical applications. The optimal waveform was assessed for, varying electrode spacing's, voltages, duty cycles, and frequencies. The results show that a maximum deswelling occurred with a DC pulsed monophasic waveform, with IDT electrodes spaced close enough to create a relatively uniform electric field, with a peak voltage of 5 V at 1 kHz, and 50% duty cycle. This resulted in a deswelling of 320% in Krebs solution. Electrochemical impedance spectroscopy results show that the impedance is dependent on the ionic concentration of the fluid environment and that the impedance decreases with increasing frequency. © 2014 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015, 132, 41687. [ABSTRACT FROM AUTHOR]

Smart hydrogels for biomedical applications are highly researched materials. However, integrating them into a device for implantation is difficult. This paper investigates an integrated delivery device designed to deliver an electro-responsive hydrogel to a target location inside a blood vessel with the purpose of creating an occlusion. The paper describes the synthesis and characterization of a Pluronic/methacrylic acid sodium salt electro-responsive hydrogel. Application of an electrical bias decelerates the expansion of the hydrogel. An integrated delivery system was manufactured to deliver the hydrogel to the target location in the body. Ex vivo and in vivo experiments in the carotid artery of sheep were used to validate the concept. The hydrogel was able to completely occlude the blood vessel reducing the blood flow from 245 to 0 ml/min after implantation. Ex vivo experiments showed that the hydrogel was able to withstand physiological blood pressures of > 270 mm·Hg without dislodgement. The results showed that the electro-responsive hydrogel used in this paper can be used to create a long-term occlusion in a blood vessel without any apparent side effects. The delivery system developed is a promising device for the delivery of electro-responsive hydrogels. [ABSTRACT FROM PUBLISHER]

ABSTRACT Stimuli-responsive hydrogels are continuing to increase in demand in biomedical applications. Occluding a blood vessel is one possible application which is ideal for a hydrogel because of their ability to expand in a fluid environment. However, typically stimuli-responsive hydrogels focus on bending instead of radial uniform expansion, which is required for an occlusion application. This article focuses on using an interdigitated electrode device to stimulate an electro-responsive hydrogel in order to demonstrate a uniform swelling/deswelling of the hydrogel. A Pluronic-bismethacrylate (PF127-BMA) hydrogel modified with hydrolyzed methacrylic acid, in order to make it electrically responsive, is used in this article. An interdigitated electrode device was manufactured containing Platinum electrodes. The results in this paper show that the electrically biased hydrogels deswelled 230% more than the non-biased samples on average. The hydrogels deswelled uniformly and showed no visual deformations due to the electrical bias. © 2013 Wiley Periodicals, Inc. J. Polym. Sci., Part B: Polym. Phys. 2013, 51, 1523-1528 [ABSTRACT FROM AUTHOR]

Wide-bandgap materials such as silicon carbide enable power electronics to face increasing demands for greater power density and high-temperature capability at the chip level. However, new packaging solutions have yet to be found to replace Pb solders in high-temperature applications. In this paper, the applicability of electrodeposited Ag thin film as a novel high-temperature die-attach material to connect power chips to direct-bonded copper substrates is investigated. Ag films were obtained by electrochemical deposition on the backmetallization of Si chips. The joint was then produced by thermocompression bonding at 350^\circC with a 40-N force applied for 10 min in air. A die shear strength of 1.70 MPa (twice the MIL standard) was achieved. The assembly demonstrated satisfactory resistance to thermomechanical fatigue when subjected to thermal aging and thermal cycling tests in high-temperature environments. The proposed bonding technology is thus a suitable solution for the provision of strong and reliable joints for power devices which have to operate in extreme temperature conditions (>200^\circC). [ABSTRACT FROM AUTHOR]

Patients with an elevated erythrocyte sedimentation rate (ESR) and non-specific symptoms often pose a diagnostic dilemma. PET/CT visualises infection, inflammation and malignancy, all of which may cause elevated ESR. The objective of this study was to determine the contribution of 18F-fluorodeoxglucose positron emission tomography (PET/CT) in the diagnostic work-up of referred patients with an elevated ESR, in whom initial routine evaluation did not reveal a diagnosis. We conducted a combined retrospective (A) and prospective (B) study in elderly (>50 years) patients with a significantly elevated ESR of≥50 mm/h and non-specific complaints. In study A, 30 patients were included. Malignancy (8 patients), auto-inflammatory disease (8 patients, including 5 with large-vessel vasculitis) and infection (3 patients) were suggested by PET/CT. Two scans showed non-specific abnormalities and 9 scans were normal. Of the 21 abnormal PET/CT results, 12 diagnoses were independently confirmed and two alternative diagnosis were made. Two diagnoses were established in patients with a normal scan. In study B, 58 patients in whom a prior protocolised work-up was non-diagnostic, were included. Of these, 25 PET/CT-scans showed suspected auto-inflammatory disease, particularly large-vessel vasculitis (14 cases). Infection and malignancy was suspected in 5 and 3 cases, respectively. Seven scans demonstrated non-specific abnormalities, 20 were normal. Of the 40 abnormal PET/CT results, 22 diagnoses were confirmed, 3 alternative diagnoses were established. Only one diagnosis was established in the 20 patients with a normal scan. In both studies, the final diagnosis was based on histology, clinical follow-up, response to therapy or additional imaging. In conclusion, PET/CT may be of potential value in the diagnostic work-up of patients with elevated ESR if routine evaluation reveals no diagnosis. In particular, large-vessel vasculitis appears to be a common finding. A normal PET/CT scan in these patients suggests that it is safe to follow a wait-and-see policy. [ABSTRACT FROM AUTHOR]

Objective: To quantify the environmental component of aetiology of overweight and obesity by examining the relationship between the degree of overweight in dogs and cats and the degree of overweight in their owners. Design: Cross-sectional study. Main outcome measures of the owners were weight, height (stature) and BMI. Of the animals, weight and divergence from ideal weight were measured by a veterinarian. Setting: Three veterinary clinics in Amsterdam, The Netherlands. Subjects: Dogs and cats, together with their owners, who visited the veterinary clinic. Dogs and cats had to be older than 1 year, and their owners had to be at least 21 years old. After exclusion, there remained forty-seven pairs of dogs and their owners and thirty-six pairs of cats and their owners. Results: We found a significant relationship between the degree of overweight of dogs and the BMI of their owners (r=0·31). Correction for length of ownership, gender and age of the animal, and gender, age, education level and activity score of the owner did not materially affect this relationship. However, after correction for the amount of time the dog was being walked each day, this relationship disappeared. No significant relationship was found between the degree of overweight of cats and the BMI of their owners. Conclusions: The degree to which dogs are overweight is, in contrast to the degree to which cats are overweight, related to the BMI of their owners. [ABSTRACT FROM AUTHOR]

This randomised double-blind, placebo-controlled, clinical trial investigated the effect of 3 months of treatment with calcium dobesilate on endothelium-dependent vasodilation, markers of endothelial function, blood pressure, and markers of oxidation in obese, male smokers. Vascular effects may depend on the type of vessel and we, therefore, investigated both smaller arteries, i.e. resistance arteries and small arterioles, and large conduit arteries. Vascular function was measured by acetylcholine- and sodium-nitroprusside-mediated vasodilation, and capillary recruitment, in the skin microcirculation; by forearm blood flow (FBF) responses to several agonists and to N-G-monomethyl l-arginine (l-NMMA) in the forearm vascular bed; by flow-mediated vasodilation in the brachial artery; and by determination of soluble levels of vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1) and E-selectin. Twenty-eight individuals received dobesilate and 24 placebo. No effect of calcium dobesilate on endothelial function, blood pressure or markers of oxidation was observed compared with placebo. The difference in acetylcholine-mediated vasodilation in the microcirculation was −52.1%-point (95% confidence interval −132.8 to 28.1); in sodium-nitroprusside-mediated vasodilation in the microcirculation, 2.6%-point (−95.1 to 100.2); in capillary recruitment, 2.5%-point (−6.8 to 11.7); in acetylcholine-induced increases in FBF (n=28), 23%-point (−173 to 126); in l-NMMA-induced reduction of basal FBF, −2.8%-point (−29.3 to 23.8); in flow-mediated vasodilation of the brachial artery, 0.3%-points (−2.7 to 3.3); in 24-h systolic blood pressure, 2.1 mmHg (−1.3 to 5.5); in soluble VCAM-1, 54 ng/ml (−8 to 115); in soluble ICAM-1, 9 ng/ml (−49 to 67); in sE-selectin, −17 ng/ml (−44 to 11); in ketocholesterol 5 nM (−17 to 26); and in oxidised LDL −1.6 U/l (−6.7 to 3.5). We have shown that endothelial function, blood pressure, and markers of oxidation were not affected by 3 months of treatment with calcium dobesilate in mildly obese, smoking men. Thus, our data provide no evidence of an effect on vascular function of calcium dobesilate in humans. [Copyright &y& Elsevier]

Presents information on a study which described a power cycling in-test monitoring system to assess the reliability of different lead-free surface mount assemblies. Experimental details; Results and discussion; Conclusions.

The use of simulation has traditionally required a great deal of expertise. Simulation Interfaces to General Purpose Simulation Languages made simulation easier to use. However, for successfully building simulation models, modelling expertise is still required.Macros have been proposed as a tool within Simulation Interfaces which simplify the building of models. A macro in this context should be seen as a group of SimulationLanguage statements with a data interface to the user.The questions to be answered were: "What should a macro do and how should it be implemented?" The first objective of the work was to specify the macro functionality more tightly and then develop some macros.The wide range of macro applications allows categorising. An attempt was made to classify the different types of macros in a hierarchical structure. Implementation of macros inSIMAN® [1],showed difficulties such as nesting, attribute sharing, and code connectivity. To make data input for complete models less laborious, generic data interfaces were proposed. A simple model of a manufacturing cell is discussed, to show some of the above mentioned aspects. It became clear that macros could considetably speed up model building. However, bigger macros could reduce modelling flexibility to some extent. [ABSTRACT FROM PUBLISHER]

A patient who bred exotic turtles as a hobby presented with 2 episodes of severe diarrhea, the second of which was proven to be caused by turtle-associated salmonellosis that was contracted during treatment with a proton-pump inhibitor. The literature about reptile-associated salmonellosis is briefly reviewed. [ABSTRACT FROM AUTHOR]

Abstract: This paper describes the electrochemical characterisation of a range of gold and platinum microelectrode arrays (MEAs) fabricated by standard photolithographic methods. The inter-electrode spacing, geometry, numbers and dimensions of the electrodes in the arrays were found to influence the voltammetric behaviours obtained. Excellent correlation was found between experimental data and theoretical predictions employing published models of microelectrode behaviour. Gold MEAs were evaluated for their applicability to copper determination in a soil extract sample, where agreement was found between the standard analytical method and a method based on underpotential deposition—anodic stripping voltammetry (UPD-ASV) at the MEAs, offering a mercury-free alternative for copper sensing. [Copyright &y& Elsevier]

Objective: Type 1 diabetes (T1D) is characterised by islet autoimmunity and beta cell destruction. A gut microbiota-immunological interplay is involved in the pathophysiology of T1D. We studied microbiota-mediated effects on disease progression in patients with type 1 diabetes using faecal microbiota transplantation (FMT)., Design: Patients with recent-onset (<6 weeks) T1D (18-30 years of age) were randomised into two groups to receive three autologous or allogenic (healthy donor) FMTs over a period of 4 months. Our primary endpoint was preservation of stimulated C peptide release assessed by mixed-meal tests during 12 months. Secondary outcome parameters were changes in glycaemic control, fasting plasma metabolites, T cell autoimmunity, small intestinal gene expression profile and intestinal microbiota composition., Results: Stimulated C peptide levels were significantly preserved in the autologous FMT group (n=10 subjects) compared with healthy donor FMT group (n=10 subjects) at 12 months. Small intestinal Prevotella was inversely related to residual beta cell function (r=-0.55, p=0.02), whereas plasma metabolites 1-arachidonoyl-GPC and 1-myristoyl-2-arachidonoyl-GPC levels linearly correlated with residual beta cell preservation (rho=0.56, p=0.01 and rho=0.46, p=0.042, respectively). Finally, baseline CD4 +CXCR3+T cell counts, levels of small intestinal Desulfovibrio piger and CCL22 and CCL5 gene expression in duodenal biopsies predicted preserved beta cell function following FMT irrespective of donor characteristics., Conclusion: FMT halts decline in endogenous insulin production in recently diagnosed patients with T1D in 12 months after disease onset. Several microbiota-derived plasma metabolites and bacterial strains were linked to preserved residual beta cell function. This study provides insight into the role of the intestinal gut microbiome in T1D., Trial Registration Number: NTR3697., Competing Interests: Competing interests: MN and WMDV are founders and in the Scientific Advisory Board of Caelus Health, the Netherlands. WMDV is Founder and in the Scientific Advisory Board of A-Mansia, Belgium. MN is in the Scientific Advisory Board of Kaleido Biosciences, USA., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

An 82-year-old woman attended our outpatient clinic because of a swollen right arm and hoarseness. Upon raising both arms, the patient developed a red and swollen face (Pemberton's sign). An MRI of the thorax showed a large intrathoracic goitre, which compressed venous structures and limited blood flow even when she lowered her arms.

Background: Besides the classical role of vitamin D on calcium and bone homeostasis, vitamin D deficiency has recently been identified as a contributing factor in the onset of insulin resistance in type 2 diabetes mellitus. However, it is uncertain whether vitamin D deficiency and poor glycaemic control are causally interrelated or that they constitute two independent features of type 2 diabetes mellitus. There are limited clinical trials carried out which measured the effect of vitamin D supplementation on glycaemic control.The objective of this study is to investigate the effect of vitamin D supplementation on glycaemic control and quality of life in patients with type 2 diabetes mellitus., Methods/design: In a randomised double-blind placebo-controlled trial conducted in five general practices in the Netherlands three hundred patients with type 2 diabetes mellitus treated with lifestyle advises or metformin or sulphonylurea-derivatives are randomised to receive either placebo or 50,000 IU Vitamin D3 at monthly intervals. The primary outcome measure is the change in glycated haemoglobin level between baseline and six months. Secondary outcome measures include blood pressure, anthropometric parameters, lipid profile, insulin resistance, quality of life, advanced glycation end products and safety profiles. Quality of life will be measured by The Short Form (SF-36) Health Survey questionnaire. Advanced glycation end products are measured by an AGE-reader., Discussion: This trial will be the first study exploring the effect of vitamin D supplementation on both glycaemic control and quality of life in patients with type 2 diabetes mellitus. Our findings will contribute to the knowledge of the relationship between vitamin D status and insulin resistance in patients with type 2 diabetes mellitus., Trial Registration: The Netherlands trial register: NTR3154.

In a 79-year-old female, a markedly elevated alkaline phosphatase level was found by chance. She had noticed her hats had become too small. Clinical examination revealed a large skull with frontal bossing. Bone scintigraphy showed increased activity of bone metabolism in the skull. These three findings combined are considered a classic example of Paget's disease.

A 56-years-old woman was admitted to the emergency department because of fatigue since 6 weeks. Laboratory investigation revealed pancytopenia with teardrop cells and hypersegmentation. Teardrop cells are a characteristic finding in myelofibrosis, but in this case they were caused by severe vitamin B12 deficiency.

In patients with hyperglycaemia plus obesity and cardiovascular disease, the diagnosis of type 2 diabetes mellitus is likely to be made and this is usually followed by the start of antihyperglycaemic therapy. This pragmatic approach, however, does not always turn out to be the correct one. We describe two patients with occult conditions that had caused or aggravated diabetes mellitus (DM): a 46-year-old man with acromegaly and a 41-year-old woman with Cushing's disease. After neurosurgeries were performed, the requirement for antihyperglycaemic treatment markedly decreased (case 2) or even disappeared (case 1). Physicians treating patients with DM should ask themselves what the cause of the disease could be; the recognition and treatment of that underlying condition may substantially decrease the amount of insulin required and may even cause the disappearance of DM altogether.

Hyperglycemia upon admission of myocardial infarction patients predicts inferior clinical outcomes. Current strategies investigating hyperglycemia correction mostly use glucose-driven protocols. Implementation of these often labor-intensive protocols might be facilitated with the approach of a clinical pathway. Therefore, we evaluated the implementation of our glucose-driven protocol.We adapted a protocol for use in our coronary care unit (CCU), which was implemented according to the steps of a clinical pathway. To compensate for carbohydrates in meals we additionally developed a regimen of subcutaneous insulin.Protocol adherence was facilitated with a Web-based insulin calculator. All hyperglycemic patients admitted to the CCU were eligible for treatment according to this protocol.In a 4-month period, 643 glucose measurements were obtained in hyperglycemic patients admitted to our CCU. Patients were treated intensively with IV insulin for 35 hours and had 23 glucose measurements in this time span on average. This regimen achieved a median glucose of 6.2 mmol/L. Severe hypoglycemia occurred in only 1.1% of measurements and was without severe clinical side effects.Introduction of new intensive insulin protocol according to the steps of a clinical pathway is safe and feasible. The presence of a clinical pathway coordinator and sound communication are important conditions for successful introduction, which can be further aided with a computerized calculator.