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Diabetic complications in the lower extremity are associated with significant morbidity and mortality, and impact heavily upon the public health system. Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction and amputation. Following careful clinical assessment, radiological imaging is central to the diagnostic and follow-up process. We aim to provide a comprehensive review of diabetic lower limb complications designed to assist radiologists and to contribute to better outcomes for these patients.

Background: Data on outcomes of atrioventricular (AV) valve surgical procedures in patients with Fontan circulation are limited., Methods: We conducted a retrospective review of all children with Fontan circulation who underwent AV valve operations., Results: From 1981 to 2014, 581 patients underwent Fontan operations, and 9.3% (54/581) of them required AV valve operations. The first AV valve operation was performed before (n = 32), during (n = 15), or after (n = 7) the Fontan operation. The mean follow-up time was 9.8 ± 7.1 years (range, 6 months to 32 years). Operative mortality for the initial AV valve operation was 1.9% (1/54) and occurred in a patient who had the initial valve operation concomitantly with the Fontan. Late mortality was 5.7% (3/53). Heart transplantation was performed in 13.0% (7/54) of patients. Freedom from death or transplantation after the first AV valve operation was 89.8 ± 4.4% at 5 years (95% confidence interval [CI], 77.1 to 95.6) and 81.0 ± 6.2% at 10 years (95% CI, 65.0 to 90.2). Reoperation on the AV valve was performed in 44.4% (24/54) of patients. The median time to initial valve reoperation was 3.1 years (interquartile range, 0.8 to 7.4 years). Freedom from reoperation or transplantation was 63.4 ± 7.0% at 5 years (95% CI, 48.2 to 75.3) and 48.9 ± 7.9% at 10 years (95% CI, 32.8 to 63.2). Freedom from moderate or more regurgitation in patients who had not undergone reoperation or transplantation was 74.0 ± 6.9% (95% CI, 57.5 to 84.8) at 5 years and 67.5 ± 7.7% (95% CI:,50.0 to 80.0) at 10 years. After initial valve operation, thromboembolic events occurred in 13.0% (7/54) of patients, stroke occurred in 24.1% (13/54) of patients, pacemaker insertion was required in 16.7% (9/54) of patients, and protein-losing enteropathy was diagnosed in 7.4% (4/54) of patients. Of the 43 surviving transplant-free patients, 62.8% (27/43) were in New York Heart Association (NYHA) class I, 34.9% (15/43) were in NYHA class II, and 1 patient was in NYHA class III., Conclusions: The AV valve operation done before, during, or after the Fontan operation is associated with low operative mortality but a high reoperation rate with significant risk of late death, transplantation, and persistent AV valve regurgitation., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

In a group of 20 college subjects, the fasting serum chromium level was found to correlate with the fasting serum insulin level (r = 0.512, p less than 0.05), with the percentage of ideal body weight (r = 0.637, p less than 0.01), and with the triceps skinfold thickness (r = 0.525, p less than 0.02). The relative chromium response at insulin peak was inversely correlated with the total insulin (r = -0.451, p less than 0.05) as well as with the ratio of the total insulin to the total glucose (r = -0.554, p less than 0.02). In order to examine the close relationship between chromium and insulin, the 20 subjects were divided into age- and sex-matched lower insulin secretors and higher insulin secretors based on individuals' total insulin levels calculated as the sum of six measurements in microunits/ml during a 3-h oral glucose tolerance test. The 10 subjects in LI had total insulin levels less than 500, and the 10 subjects in HI had total insulin levels equal to or greater than 500. The means (+/- SEM) of total insulin for LI and HI were 354 +/- 39 and 740 +/- 46, respectively (p less than 0.001). The relative chromium response was significantly higher in LI than that in HI (198.0 +/- 31.0% and 76.2 +/- 18.0%, respectively; p less than 0.005); and the ratio of the total insulin to the total glucose was significantly lower in LI than that in HI (0.585 +/- 0.067 and 1.286 +/- 0.094, respectively; p less than 0.001).

The complete DNA sequence of the Hind III M fragment of vaccinia virus (VV) Tian Tan strain genome was determined by the dideoxynucleotide chain termination method. Three open reading frames (ORFs) were identified in the complementary strand of the sequence, comprised of 2218bp. Among them, ORF K1 initiates its transcription at -45 of the Hind III K fragment. The deduced peptide encoded by K1 contains 284 amino acids with a calculated molecular weight of 32.48 KDa. Its sequence is homologous to the host range protein of VV Copenhagen strain; the variation is only 2.46% at the amino acid level. ORF M2 could encode a peptide of 21.94 KDa with 196 amino acids. This gene was shown to be homologous to that of the 23 KDa peptide of herpes simplex virus type I. A non-coding region of 204bp located between K1 and M2 is rich in palindromic structures. ORF M1 extends its 3' terminus into the Hind III N fragment. Within the M fragment, M1 can only encode 212 amino acids. The major part of ORF M1 is very similar to the M portion of a possible alpha-amanitin resistance gene isolated from VV-WR strain. This work provides a molecular foundation in the construction of a new insertion vector for the preparation of a recombinant vaccinia virus to be used as a polyvalent live vaccine.

Twenty-seven women ages 40 to 75 were divided into normal (n = 15) and hyperglycemic (n = 12) groups on the basis of 3-hr glucose tolerance tests. Each subject received 5 g of brewer's yeast extract containing 4 microgram of chromium daily for 3 months. Glucose, insulin, and chromium levels were analyzed by oxidase, radioimmunoassay, and radiochemical neutron activation analysis methods, respectively. The fasting and 1-hr serum chromium levels (ng/ml) changed from 1.67 and 1.43 to 1.46 and 1.86 in the normal group, and from 1.89 and 1.03 to 0.94 and 1.03 in the hyperglycemic group. Considerable changes occurred in the relative chromium response (RCR) at the 1-hr point. RCR is defined as (1-hr serum chromium level/fasting serum chromium level) X 100. Among the normal subjects, 73% showed an improved RCR after the supplementation: mean RCR was 107% before and 140% after. Among the hyperglycemic subjects, 75% showed an improved RCR: mean RCR was 81% before and 149% after the supplementation. The increased RCR was associated with decreased serum insulin and glucose levels. This is interpreted as reflecting an improved chromium status for the majority of individuals in both groups after the supplementation. The observations suggest that 1) in response to a glucose load, serum chromium levels drop in subjects with presumably inadequate chromium storage; 2) a low value of relative chromium response at the 1-hr point indicates a suboptimal chromium nutritional status.