Hepatic oxidative stress promotes insulin-STAT-5 signaling and obesity by inactivating protein tyrosine phosphatase N2.

Hepatic insulin resistance is a key contributor to the pathogenesis of obesity and type 2 diabetes (T2D). Paradoxically, the development of insulin resistance in the liver is not universal, but pathway selective, such that insulin fails to suppress gluconeogenesis but promotes lipogenesis, contributing to the hyperglycemia, steatosis, and hypertriglyceridemia that underpin the deteriorating glucose control and microvascular complications in T2D. The molecular basis for the pathway-specific insulin resistance remains unknown.

Medical emergency response in a sub-acute hospital: improving the model of care for deteriorating patients.

Objective: To assess the frequency, characteristics and outcomes of medical emergency response (MER) calls in a sub-acute hospital setting.

Methods: The present study was a retrospective observational study in a sub-acute hospital providing aged care, palliative care, rehabilitation, veteran's mental health and elective surgical services. We assessed annual MER call numbers between 2005 and 2011 in the context of contemporaneous changes to hospital services.

High-resolution in vivo imaging of bone and joints: a window to microarchitecture.

Imaging is essential to the evaluation of bone and joint diseases, and the digital era has contributed to an exponential increase in the number of publications on noninvasive analytical techniques for the quantification of changes to bone and joints that occur in health and in disease. One such technique is high-resolution peripheral quantitative CT (HR-pQCT), which has introduced a new dimension in the imaging of bone and joints by providing images that are both 3D and at high resolution (82 μm isotropic voxel size), with a low level of radiation exposure (3-5 μSv). HR-pQCT enables the analysis of cortical and trabecular properties separately and to apply micro-finite element analysis for calculating bone biomechanical competence in vivo at the distal sites of the skeleton (distal radius and distal tibia).

Hepatic contrast-enhanced ultrasound: impact of its introduction in the Australian context.

Introduction: Contrast-enhanced ultrasound (CEUS) is a relatively new imaging modality in Australia. We discuss our early experience with CEUS at Royal Melbourne Hospital in assessment of focal liver lesions and its clinical impact.

Method: Radiology department and hospital computerised information systems were used to identify and collate information regarding the indication, previous and follow-up imaging, CEUS findings and subsequent final diagnoses of patients who underwent hepatic CEUS from 12/12/2007 to 20/4/2012.

Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease--the role of transient elastography and plasma cytokeratin-18 fragments.

Background: Non-alcoholic fatty liver disease (NAFLD) affects 15-40% of the general population. Some patients have non-alcoholic steatohepatitis (NASH) and progressive fibrosis, and would be candidates for monitoring and treatment.

Aim: To review current literature on the use of non-invasive tests to assess the severity of NAFLD.

Axonal excitability in X-linked dominant Charcot Marie Tooth disease.

Objective: We investigated peripheral nerve function in X-linked Charcot-Marie-Tooth disease type 1 (CMTX1), and considered the functional consequences of mutant connexin-32.

Methods: Twelve subjects (9 female, 3 male) were assessed clinically, by nerve conduction and excitability studies. A model of myelinated axon was used to clarify the contributing changes.

Among vitamin B12 deficient older people, high folate levels are associated with worse cognitive function: combined data from three cohorts.

Background: Folate fortification of food aims to reduce the number of babies born with neural tube defects, but has been associated with cognitive impairment when vitamin B12 levels are deficient. Given the prevalence of low vitamin B12 levels among the elderly, and the global deployment of food fortification programs, investigation of the associations between cognitive impairment, vitamin B12, and folate are needed.

Objective: To investigate the associations of serum vitamin B12, red cell folate, and cognitive impairment.

A Leydig cell tumor of the ovary resulting in extreme hyperandrogenism, erythrocytosis, and recurrent pulmonary embolism.

Context: Secondary erythrocytosis due to androgens is most commonly seen in the context of T replacement therapy in men. Leydig cell ovarian tumors are a rare cause of virilization, erythrocytosis, and thromboembolism.

Patient Case: We describe the case of a 55-year-old postmenopausal woman who presented with a 3-year history of frontal balding and virilization and a 5-year history of obstructive sleep apnea.

Activation of the MAS receptor by angiotensin-(1-7) in the renin-angiotensin system mediates mesenteric vasodilatation in cirrhosis.

Background & Aims: Splanchnic vascular hypocontractility with subsequent increased portal venous inflow leads to portal hypertension. Although the renin-angiotensin system contributes to fibrogenesis and increased hepatic resistance in patients with cirrhosis, little is known about its effects in the splanchnic vasculature, particularly those of the alternate system in which angiotensin (Ang) II is cleaved by the Ang-converting enzyme-2 (ACE2) to Ang-(1-7), which activates the G-protein-coupled Mas receptor (MasR). We investigated whether this system contributes to splanchnic vasodilatation and portal hypertension in cirrhosis.

Meeting the nutritional needs of elderly residents in aged-care: are we doing enough?

Objectives: [corrected] Institutionalized elderly are at high risk of malnutrition, including those residing in low-level aged-care and able to self-feed. We used comprehensive dietary intake assessments to determine the nutritional adequacy of food served to residents and if food waste contributed to insufficient nutrient intakes.

Design: Cross sectional.

Models of Care - End of Life Pathways.

Resuscitation status and Advance Care Plans need to be discussed and clearly documented The Liverpool Care Pathway is a recognized model of EOL care in, and has been adapted for patients with end stage renal disease Recognition of a dying patient allows initiation of a multidisciplinary EOL pathway such as the Liverpool Care Pathway for hospital inpatients, and for support for families if a home death is planned. A fall in performance status is an indicator of decline.

Aspects of communication in Alzheimer's disease: clinical features and treatment options.

Background: During the course of Alzheimer's disease (AD), cognitive processes, including language and communication, become increasingly impaired. The aim of this review was to highlight the impact of communication deficits in AD, and discuss the need for effective treatments.

Method: PubMed was searched for studies relating to language and communication in AD.

Effect of a vascular access surveillance program on service provision and access thrombosis.

Establishing and maintaining hemodialysis access are major challenges in dialysis patient care. The impact of implementing guideline recommendations around vascular access surveillance, which lacks strong evidence, is poorly understood. We report the results of a vascular access surveillance and early intervention program upon hemodialysis thrombosis rates for all patients hemodialyzing in a single center between January 2005 and March 2011.

A retrospective case review of isolated sinonasal amyloidosis.

Objective: We report an extremely rare case of isolated primary sinonasal amyloidosis.

Method: A case report and comprehensive literature review are presented. Common symptoms, signs and treatment options are examined, and used to derive an algorithm with which the practising otolaryngologist can diagnose and manage this condition.

Social perspective coordination in youth with borderline personality pathology.

This study investigated social perspective coordination (SPC) in youth (15-24-year-olds) with first-presentation borderline personality disorder (BPD). SPC is defined as the capacity to differentiate and integrate the perspective of the self with the perspectives of others (Selman, Beardslee, Schultz, Krupa, & Podorefsky, 1986). Two groups: patients with full or sub-syndromal BPD (n = 30) and patients with major depressive disorder (MDD; n = 30) completed measures of SPC derived from the interpersonal negotiation strategies (INS) model (Selman et al.

Action plans and case manager support may hasten recovery of symptoms following an acute exacerbation in patients with chronic obstructive pulmonary disease (COPD).

Question: In patients with COPD, does an action plan (AP) with support from a case manager lead to earlier contact with healthcare professionals and faster recovery from an exacerbation?

Design: Randomised, controlled trial with concealed allocation. Patients were unaware of the study aims.

Setting: 8 regional hospitals and 5 general practices in Europe.

Estimating dual-energy X-ray absorptiometry-derived total body skeletal muscle mass using single-slice abdominal magnetic resonance imaging in obese subjects with and without diabetes: a pilot study.

Background/objectives: Single-slice abdominal computed tomography or magnetic resonance imaging (MRI) performed to measure visceral adipose tissue in individuals with obesity and diabetes mellitus can also image skeletal muscle. The aim of this study was to validate a method developed in cancer patients using a single abdominal cross-sectional image to estimate fat-free mass (FFM) and appendicular lean tissue mass index (LTMI), a total body skeletal muscle mass surrogate, in an obese cohort of subjects with and without type 2 diabetes.

Subjects/methods: In total, 49 obese subjects (22 with diabetes) recruited into a weight loss study underwent dual-energy X-ray absorptiometry (DXA) and abdominal MRI at baseline.

Less fat reduction per unit weight loss in type 2 diabetic compared with nondiabetic obese individuals completing a very-low-calorie diet program.

The objective was to compare weight loss and change in body composition in obese subjects with and without type 2 diabetes mellitus during a very-low-calorie diet (VLCD) program. Seventy weight-matched subjects with diabetes or normal fasting glucose (controls) participated in a 24-week VLCD study. Primary end points were changes in anthropometry, body composition, and fasting plasma insulin and β-hydroxybutyrate concentrations.

A comparison of nurses' perceptions of elective laparoscopic or elective open colorectal resections.

The purpose of this study was to develop an instrument to measure the perceived benefits nurses observe in the recovery of patients who have undergone elective laparoscopic colorectal resections vs. traditional open elective colorectal resections. Secondly, to determine if there are perceived differences in the intensity of nursing required to care for these patients.

Mechanisms behind early life nutrition and adult disease outcome.

Obesity is increasing around the globe. While adult lifestyle factors undoubtedly contribute to the incidence of obesity and its attendant disorders, mounting evidence suggests that programming of obesity may occur following under- and over-nutrition during development. As hypothalamic control of appetite and energy expenditure is set early in life and can be perturbed by certain exposures such as undernutrition and altered metabolic and hormonal signals, in utero exposure to altered maternal nutrition and inadequate nutrition during early postnatal life may contribute to programming of obesity in offspring.

Oxygen tension assessment: an overlooked tool for prediction of delayed healing in a clinical setting.

Successful wound healing requires adequate transcutaneous oxygen tension (tcpO(2) ). TcpO(2) may not commonly be incorporated in clinical assessments because of variable measurement response at different sensory temperatures. This study aims to assess the relationship between changes in tcpO(2) , measured under basal (39°C) and stimulated (44°C) conditions and healing rate of chronic wounds over 4 weeks, to determine whether tcpO(2) measurement can predict delayed wound healing.