The Baker Heart and Diabetes Institute, commonly known as the Baker Institute, is an Australian independent medical research institute headquartered in Melbourne, Victoria. Established in 1926, the institute is one of Australia's oldest medical research organisations with an historical focus on cardiovascular disease. In 2008, it became the country's first medical research institute to target diabetes, heart disease, obesity and their complications at the basic, clinical and population health levels. The Institute is located adjacent to The Alfred Hospital within the Alfred Research Alliance Precinct. The Institute also has a national Aboriginal Health program, with a research facility in Alice Springs in the Northern Territory.
Loss of islet beta cell function and mass are critical in the pathogenesis of type 2 diabetes, a disease in which 90
Myocardial infarction (MI) represents a major component of cardiovascular disease, primarily due to severe energy depletion in ischemic tissue. Extracellular vesicles (EVs) have recently emerged as promising cell-free nanocarriers capable of targeted delivery and intercellular communication. Leveraging these advantages, engineered EVs were investigated in this study as a direct ATP-delivery platform to cardiomyocytes. EVs were functionalized with an anti-myosin antibody to form targeted extracellular vesicles (T-EVs) and subsequently loaded with ATP, generating T-ATP-EVs for selective energy transfer to damaged myocardium. We study viability and apoptosis of ischemia cells by alamar Blue and flowcytometry (annexin-PI) under hypoxic condition in vitro also we use cardiac function, infarct size, and the expression of troponin and α-actin four weeks after MI on MI rat model in vivo for assessment cardiac repair. The results indicate that, compared with no treatment, the use of T-ATP-EVs enhances the viability of hypoxic cells by 46 T-ATP-EVs increase cardiomyocyte viability by 46
Chronic kidney disease (CKD) complicates insulin dosing and increases glycaemic instability in diabetes. We aimed to compare feasibility, safety and efficacy of automated insulin delivery (AID) with usual care in people with diabetes and advanced CKD. We conducted a prospective, open-label, randomised crossover trial at five tertiary hospitals in Australia and one tertiary centre in Denmark. Adults aged ≥18 years with type 1 diabetes or insulin-treated type 2 diabetes and advanced CKD (stage 3b or higher, including dialysis) were eligible. Participants were randomly assigned in a 1:1 sequence to receive either AID followed by usual care with real-time continuous glucose monitoring (CGM), or the reverse sequence, each for 8 weeks. Allocation was generated centrally using computerised randomisation. Due to the nature of the intervention, participants and clinicians were aware of treatment assignment. The primary outcome was percentage time in range (3.9–10.0 mmol/l) during the final 3 weeks of each treatment period. Forty participants (24 type 1 diabetes, 16 type 2 diabetes; median [IQR] age 60 [55, 69] years; HbA1c 64 [54, 73] mmol/mol [8.0
AimsStroke prevention in patients with atrial fibrillation (AF) requires both estimation of risk and the initiation of anticoagulation treatment where indicated. Rapid access atrial fibrillation (RAAF) clinics are an accepted model of multidisciplinary care to reduce time at risk of stroke, but their clinical outcomes and cost-effectiveness are uncertain. This study aimed to perform a cost-effectiveness evaluation, from a healthcare system perspective, of an RAAF clinic within a large regional health service in Australia.MethodsWe developed a microsimulation model using a cohort of 274 individuals referred to the RAAF clinic between 2022 and 2023. Clinic data were used to determine risk of stroke, major bleeding and death from the GARFIELD equation. A comparator was designed by duplicating the cohort and changing the time from referral to consultation to a general cardiology clinic within the same health service (i.e. standard of care). The model ran in daily cycles over a 2-year time horizon, with individuals replicated 1000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALYs) and healthcare costs for the RAAF compared with standard of care, which were used to determine incremental cost-effectiveness ratios (ICER), with 5% annual discounting.ResultsThe RAAF clinic participants experienced fewer strokes (5198 versus 5303), bleeding events (5369 versus 5491) and deaths (14,158 versus 14,413). There were marginal increases in QALYs gained (1.67 versus 1.66 QALYs/person), and cost savings of AUD$74 per person (AUD$14,187 versus AUD$14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.ConclusionsRAAF clinics are likely to prevent strokes and bleeding, are cost-saving and could lead to returns on investment. Adoption of this model of care by policy-makers can ensure the delivery of safe, effective and cost-saving care that reduces stroke, bleeding and death in people with atrial fibrillation.
