Associations between acute glucose control and peripheral nerve structure and function in type 1 diabetes.

AIM: To examine the associations between continuous overlapping net glycaemic action (CONGA), percentage time in hyperglycaemia (%HG) or normoglycaemia (%NG) and peripheral nerve structure and function in type 1 diabetes. METHODS: Twenty-seven participants with type 1 diabetes underwent continuous glucose monitoring followed by corneal confocal microscopy and nerve excitability assessments. CONGA, %HG (> 10.0 mmol/l) and %NG (3.9-10.0 mmol/l) were correlated against corneal nerve fibre length and density in the central cornea and inferior whorl region, corneal microneuromas, and a nerve excitability score while controlling for age, sex, diabetes duration and HbA1c . RESULTS: An increase in CONGA [median 2.5 (2.0-3.1) mmol/l] or %HG (mean 46 ± 18%) was associated with a worse nerve excitability score (r = -0.433, P = 0.036 and r = -0.670, P = 0.0012, respectively). By contrast, greater %NG (51 ± 17%) correlated with better nerve excitability scores (r = 0.672, P = 0.0011). Logistic regression revealed that increasing %HG increased the likelihood of abnormal nerve function [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.01-1.23; P = 0.037). An increase in CONGA and %HG were associated with worsening nerve conduction measures, whereas longer %NG correlated with improved nerve conduction variables. CONGA and %HG were associated with inferior whorl corneal nerve fibre length (r = 0.483, P = 0.034 and r = 0.591, P = 0.021, respectively) and number of microneuromas (r = 0.433, P = 0.047 and r = 0.516, P = 0.020, respectively). CONCLUSIONS: Short-term measures of glucose control are associated with impaired nerve function and alterations in corneal nerve morphology.

Plate augmentation for femoral nonunion: more than just a salvage tool?

OBJECTIVE: The aim of the current study was to determine whether plate augmentation was a successful treatment algorithm for selected femoral nonunions initially managed with intramedullary nailing. MATERIALS AND METHODS: A total of 30 femoral nonunion cases were managed using the plate augmentation strategy with 13 primary cases and 17 multi-operated femurs (avg 2.8 ineffective procedures). Adjunctive strategies included autologous bone grafting and/or BMP for atrophic/oligotrophic and bone defect cases. Deformity correction was performed when required. RESULTS: Osseous union occurred in 29 of 30 cases. One multi-operated case with bone defect and prior infection required repeat autologous grafting prior to union. CONCLUSION: Plate augmentation should be added to the armamentarium for management of selected femoral nonunion that have failed initial intramedullary nailing.

Animal study of phoenix total artificial heart implantation.

BACKGROUND: It is well accepted that a total artificial heart (TAH) can be used as a bridge to heart transplantation during the waiting period for organ donation. A series of combined studies, conducted by the Kaohsiung Veterans General Hospital, National Yang-Ming Medical College and Municipal Tainan Hospital, has been performed to improve the Phoenix artificial heart developed by Dr. Kevin Kuo-Tsai Cheng. METHODS: In growing calves (weighed about 80 kg), standard procedures were used to remove the hearts and replace them with the TAHs. Records were made of hemodynamic data, physiological responses, blood biochemistry data and physical activities after operation and until the death of the calves. Finally, autopsies were used to determine the causes of death. RESULTS: A total of 23 calves were studied. Twenty-two of them survived 1 to 12 days, or an average 4.95 days. One survived more than 30 days. All the calves could breathe, stand, eat and void by themselves two hours after operation. Respiratory failure was the major cause of death. CONCLUSIONS: No thrombus within the TAH was noted in the last five cases, meaning that turbulent flow or dead space of the TAH was improved. Better intensive care and prevention of infection will be the next challenge for long-term use of TAH.