Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004-9.

Objective: To determine whether ethnic group differences in glycated haemoglobin (HbA1c) changed over a 5-year period in people on medication for type 2 diabetes.

Design: Open cohort in 2004-9.

Setting: Electronic records of 100 of the 101 general practices in two inner London boroughs.

Conservative management of testicular germ-cell tumors.

Cure rates of germ-cell cancer have been greater than 95% for the last decade; therefore, over the past few years there has been a greater focus on 'conservative' approaches to treatment. The increased incidence of late non-germ-cell cancers in the era of radiotherapy and the incidence of subclinical testicular deficiency and metabolic syndrome in cured patients have accelerated this trend. Taking account of the increase in cure rates of primary chemotherapy failures from 5% to 60% with intensification of chemotherapy and surgery, this Review focuses on three areas: lessons from the initial failed trials of less-intensive treatment (i.

Legitimizing the shameful: end-of-life ethics and the political economy of death.

This paper explores one of the most politically sensitive and intellectually neglected issues in bioethics--the interface between the history of contemporary end-of-life ethics and the economics of life and death. It suggests that contrary to general belief, economic impulses have increasingly become part of the conditions in which contemporary end-of-life ethics continues to evolve. Although this conclusion does not refute the philosophical justifications provided by the ethics for itself, it may cast new light upon its social role.

Contribution of the cheeks to the intraoral manipulation of food.

The role of the teeth in chewing has been studied extensively; however, less attention has been paid to soft tissue function. In this study the process of mixing within the bolus and the contribution of the cheeks to this process were investigated using a test food constructed from two differently colored chewing gums. A cheek guard was placed into either the left the or right buccal sulcus.

The pathology of ageing: concepts and mechanisms.

The rising numbers and proportion of aged individuals in the population is a global demographic trend. The diseases associated with ageing are becoming more prevalent, and the associated healthcare costs are having a significant economic impact in all countries. With these changes have come great advances in our understanding of the mechanisms of ageing.

Renal ageing.

The function of the kidney, as well as its morphology, changes markedly with age. The glomerular filtration rate falls progressively, independent of overt pathology. Glomerular, vascular and accompanying parenchymal changes occur and other disorders associated with ageing, such as diabetes and hypertension, have a stochastic deleterious effect on both form and function.

The reproductive significance of human Fallopian tube cilia.

Effective tubal transport of ova, sperm and embryos is a prerequisite for successful spontaneous pregnancy. Although there is much yet to be discovered about the mechanisms involved, it is evident that tubal transit is a far more complicated process than initially thought. Propulsion of gametes and embryos is achieved by complex interaction between muscle contractions, ciliary activity and the flow of tubal secretions.

Selenium in critical illness.

Purpose Of Review: Selenium is a trace element essential to human health. Critical illness is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Supplementing critically ill patients with antioxidant nutrients may improve survival.

Airway and systemic inflammation and decline in lung function in patients with COPD.

Study Objectives: Patients with COPD experience lower airway and systemic inflammation, and an accelerated decline in FEV1. There is no evidence on whether this inflammation changes over time, or if it is associated with a faster decline in FEV1.

Patients And Design: A cohort of 148 COPD patients (100 men) was monitored daily for a median of 2.

The effect of ovarian follicular fluid and peritoneal fluid on Fallopian tube ciliary beat frequency.

Background: The Fallopian tube undergoes well-recognized changes during the ovarian cycle. Ciliary beat frequency (CBF) increases during the secretory phase of the cycle. The stimulus is unknown, although CBF is known to be hormone responsive.

The frequency of intratubular embryonal carcinoma: implications for the pathogenesis of germ cell tumours.

Aims: To define the frequency and distribution of intratubular embryonal carcinoma (IEC) in an attempt to shed light on the pathogenesis of non-seminomatous germ cell tumours (NSGCTs). Intratubular germ cell neoplasia of unclassified type (IGCNU) is common in NSGCT; however, IEC is rarely described.

Methods And Results: Sixty-two germ cell tumours were reviewed.

Three-dimensional assessment of treatment outcomes on the face.

Objectives: To investigate the effect on the face of treatment involving extractions.

Design: A prospective study of the effects of extraction and non-extraction treatment on two groups of patients was undertaken.

Setting And Sample Population: Initially there were 16 non-extraction and 18 extraction patients but at the end of treatment there were only 12 in each group.

Airway epithelial inflammatory responses and clinical parameters in COPD.

This study examined inflammatory responses from primary cultured human bronchial epithelial cells in chronic obstructive pulmonary disease (COPD) and the clinical factors modulating them. Epithelial cells from bronchoscopic biopsies from 14 patients with COPD ((mean +/- SD) age 74.6 +/- 5.

Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial.

Background: Many patients admitted to acute hospital services are underweight or harbour vitamin deficiencies.

Objectives: To determine the effect on patient throughput of a policy of routine vitamin supplementation, and of early routine sipfeed supplementation in 'thin' patients (5-10% weight loss or body mass index 18-22).

Design: Factorial randomized placebo controlled trial of oral multivitamins from the first day of admission, and, after nutritional screening, of a nutritionally complete sipfeed from the second day in 'thin' patients.

Fallopian tube ciliary beat frequency in relation to the stage of menstrual cycle and anatomical site.

Background: The cyclical changes in ciliary structure and motion within the human Fallopian tube are well documented. Previous investigators have studied ciliary beat frequency (CBF) in relation to menstrual cycle and anatomical site, but with conflicting results.

Methods: Using a technique that records variations in light intensity, we have studied the changes in CBF in relation to the menstrual cycle and anatomical site.

Gender and achievement in clinical medical students: a path analysis.

Background And Purpose: Men and women interact differently with the learning environment. Women's standards and goals are responsive to social and environmental influences. Men seem relatively indifferent but check their performance against strongly internalized standards.

Truncation of the Mll gene in exon 5 by gene targeting leads to early preimplantation lethality of homozygous embryos.

The mixed lineage leukemia gene (MLL) was originally identified through its involvement in reciprocal translocations in leukemias. MLL codes for a large multidomain protein and bears homology to the Drosophila developmental control gene trithorax in two small domains in the amino terminal region, the central zinc finger domain and the carboxy SET domain. Like the Drosophila trx, MLL has also been shown to be a positive regulator of Hox gene expression.

Targeting tumour necrosis factor in the treatment of rheumatoid arthritis.

Inflammation in rheumatoid arthritis (RA) is associated with an imbalance between pro- and anti-inflammatory factors, which leads to a persistent chronic inflammatory state in the joint. Molecular studies of the physiology of the inflammatory response have identified a hierarchy of cytokine activities. The identification of this hierarchy has provided new potential therapeutic targets for the treatment of RA.

An overview of the immune system.

We are continually exposed to organisms that are inhaled, swallowed, or inhabit our skin and mucous membranes. Whether these organisms penetrate and cause disease is a result of both the pathogenicity of the organism (the virulence factors at its disposal) and the integrity of host defence mechanisms. The immune system is an interactive network of lymphoid organs, cells, humoral factors, and cytokines.

Testosterone: its role in development of prostate cancer and potential risk from use as hormone replacement therapy.

Evidence from studies in patients with prostate cancer of intermittent hormone therapy combined with results from rechallenge of hormone resistant patients with testosterone demonstrate that the majority of prostate cancers retain a similar degree of dependence on male sex hormone milieu as normal prostate cells. Yet there has so far been no conclusive evidence, despite 34 studies, that levels of circulating testosterone in individuals developing prostate cancer are higher than in controls. The aim of this article was to critically evaluate this evidence and seek clues to other mechanisms whereby sex hormones could influence the development of prostate cancer.

Autologous transplantation with Philadelphia-negative progenitor cells for patients with chronic myeloid leukaemia (CML) failing to attain a cytogenetic response to alpha interferon.

Between October 1993 and March 1999, 29 patients with CML who were ineligible for allogeneic BMT underwent PBSC harvest using idarubicin, cytarabine and G-CSF. In 9/29 (31%) patients all collected stem cells were Ph-negative, and 15/29 patients' (52%) collections were substantially (>95%) Ph-negative. The proportion of patients from whom Ph-negative stem cells were obtained was similar between patients who had, or had not, received prior alphaIFN.

Wnt-16a, a novel Wnt-16 isoform, which shows differential expression in adult human tissues.

The WNT genes encode a large family of secreted glycoprotein signalling molecules important from the earliest stages of development through to the adult. We have identified a novel isoform of the recently described WNT family member, Wnt16, following analysis of chromosome 7q31 genomic sequence. We find differential organisation of Wnt16 with the generation of two mRNA isoforms, Wnt16a and Wnt16b.

The influence of the hormonal system on pediatric rheumatic diseases.

The role of NEI interactions in children with chronic inflammatory rheumatic disorders has not been systematically studied to the same extent as in adults. The data that are currently available suggest that NEI mechanisms are involved in the pathophysiology of some of the diseases. These include JRA, JSLE, and JAS.

Reciprocal interactions between the neuroendocrine and immune systems during inflammation.

The neuroendocrine and immune responses to inflammatory stress represent important integrated physiologic circuits for the regulation of inflammation whose basis has been reviewed. Proinflammatory cytokines such as IL-1 beta, TNF alpha, and IL-6 released from inflammatory foci initiate a local inflammatory response and travel by way of the blood-stream to the central nervous system, where they trigger a variety of neuroendocrine counterregulatory mechanisms. There is an important NEI loop.