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Aims/hypothesis: We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes. Methods: Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs). Results: There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002). Conclusions/interpretation: Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia. [ABSTRACT FROM AUTHOR]

Introduction: Low‐molecular weight heparin, such as dalteparin, is an alternative anticoagulation method in conventional hemodialysis (HD). However, there are limited studies on its use in quotidian and nocturnal HD. We assessed the optimal dose, treatment efficacy, and patient safety of dalteparin in quotidian and nocturnal HD populations. Methods: This study included 10 quotidian (7 in‐center and 3 home) and 8 nocturnal home HD patients. Dalteparin was initiated and titrated based on clotting score in these patients. Trough anti‐Xa levels were measured. The dalteparin dose, the dialyzer and HD circuit clotting scores, and bleeding episodes were recorded at 4 weeks. Patients who continued dalteparin were followed to 12 months. Findings: For the 10 quotidian HD patients, the median dalteparin dose was 1875 units [1250, 2500] after 4 weeks. For nocturnal HD patients, five of the eight patients switched back to heparin due to high clotting scores while on dalteparin within 4 weeks. However, three patients continued on dalteparin at 4 weeks. After 12 months, one maintained on 5000 units and the other two maintained on 7500 units of dalteparin. All the clotting scores at month 12 were ≤2. One patient died due to an unrelated cause. For all patients who continued on dalteparin, only 9% of the HD treatments had circuit clotting score >2 after reaching stable dose. All trough anti‐Xa levels were <0.1 IU/mL. There were no episodes of bleeding. Fistula compression times were not increased. Discussion: This small pilot study suggests that dalteparin can be used effectively and relatively safety in quotidian HD. However, its use in nocturnal HD was only successful in a small proportion of patients. Alternative methods, including second dalteparin bolus after 4 hours of HD treatment, should be assessed for efficacy and practicality. [ABSTRACT FROM AUTHOR]

An optimized one‐pot recipe has been developed to synthesize a surfactant molecule, referred to as OMID, consisting of an imidazoline head group and aliphatic tail, which is an exemplar corrosion inhibitor for carbon steel in acidic solutions. As evidenced by gas chromatography, 1H and 13C nuclear magnetic resonance, and Fourier‐transform infrared data, a high‐purity product was achieved without the use of either a solvent or catalyst. Critical micelle concentration values and corrosion inhibition efficiencies (η%) were determined in aqueous solutions of hydrochloric acid and sulfuric acid using surface tensiometry and linear polarization resistance measurements, respectively. Hydrolysis of the imidazoline head group as a function of pH (0–11) was explored with ultraviolet–visible absorption spectroscopy. In addition, N 1s and C 1s X‐ray photoelectron spectroscopy data were acquired from both surface‐adsorbed OMID and a multilayer of the imidazoline head group of OMID. These latter data are highly relevant to those attempting to understand OMID inhibition chemistry. [ABSTRACT FROM AUTHOR]

This article reviews the use of estrogen in the prevention and treatment of osteoporosis. Dosage levels, interactions with other factors, side effects, and the mechanism of estrogen action are discussed. (Author/MT)

Background: Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM. Methods and Findings: The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥ 20 years in 2005-2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non diabetic population was higher in women (3.0: 95% CI 2.4-3.8, p < 0.001) than men (2.3: 2.0-2.7, p < 0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2-3.0, p < 0.001) in men and 2.7 (2.2-3.4, p < 0.001) in women. Between 2005-2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were < 40 years and 37 of 907 deaths among 12,739 who were [greater than or equal to] 40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60-69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target [HbA.sub.1c] of < 7% and 37% had very poor (≥9%) glycaemic control. Among those aged ≥ 40, 37% had blood pressures above even conservative targets (≥ 140/90 mmHg) and 39% of those ≥ 40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used. Conclusions: Although the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed. Please see later in the article for the Editors' Summary., Introduction Type 1 diabetes (T1DM) is associated with an elevation in the risk of cardiovascular disease (CVD) and all-cause mortality [1]. Almost two decades ago the landmark Diabetes Care and [...]