Background Higher 25(OH)D3 levels are associated with lower HbA1c, but there are limited UK interventional trials assessing the effect of cholecalciferol on HbA1c. Aims (1) To assess the baseline 25(OH)D3 status in a Manchester cohort of children with type 1 diabetes (T1D). (2) To determine the effect of cholecalciferol administration on HbA1c. Methods Children with T1D attending routine clinic appointments over three months in late winter/early spring had blood samples taken with consent. Participants with a 25(OH)D3 level <50 nmol/L were treated with a one-off cholecalciferol dose of 100,000 (2–10 years) or 160,000 (>10 years) units. HbA1c levels before and after treatment were recorded. Results Vitamin D levels were obtained from 51 children. 35 were Caucasian, 11 South Asian and 5 from other ethnic groups. 42 were vitamin D deficient, but 2 were excluded from the analysis. All South Asian children were vitamin D deficient, with mean 25(OH)D3 of 28 nmol/L. In Caucasians, there was a negative relationship between baseline 25(OH)D3 level and HbA1c (r = −0.484, P < 0.01). In treated participants, there was no significant difference in mean HbA1c at 3 months (t = 1.010, P = 0.328) or at 1 year (t = −1.173, P = 0.248) before and after treatment. One-way ANCOVA, controlling for age, gender, ethnicity, BMI and diabetes duration showed no difference in Δ HbA1c level. Conclusion We report important findings at baseline, but in children treated with a stat dose of cholecalciferol, there was no effect on HbA1c. Further studies with larger sample sizes and using maintenance therapy are required.

Background Intensive glycaemic control in type one diabetes (T1D) reduces progression of complications (DCCT and EDIC). In clinical practice, glycosylated haemoglobin (Hba1c) levels reflect control. Previous studies show that higher 25(OH)D3 levels are associated with lower Hba1c (US SEARCH study). However, there are limited interventional trials assessing the effect of cholecalciferol on Hba1c. Aims. 1. To assess the baseline 25(OH)D3 status in a paediatric cohort of patients with T1D. 2. To determine the effect of cholecalciferol administration on Hba1c. Methods Children with T1D attending routine clinic appointments from February to April 2011 had blood samples taken with consent, and patients with a 25(OH)D3 level <20ng/ml were treated with a one-off stat cholecalciferol dose of 100 000 (2–10 years) or 160 000 (>10 years) units. Hba1c levels from the year preceding treatment and the year after treatment were recorded. Results Vitamin D levels were obtained from 51 patients (30 male, 21 female). 35 were Caucasian, 11 South Asian and 5 from other ethnic groups. 42 subjects were vitamin D deficient, but 2 were excluded from the analysis (one moved away, one was non-compliant). All South Asian patients were vitamin D deficient, with mean 25(OH)D3 of 11.2 ng/ml. In Caucasians, there was a negative relationship between baseline 25(OH)D3 level and HbA1C (r= –0.484, p < 0.01), but not in South Asians. In treated patients, paired t tests showed no significant difference in mean Hba1c at 3 months (t=1.010, p 0.328) or at 1 year (t=-1.173, p = 0.248) before and after treatment. One way ANCOVA, controlling for age, gender, ethnicity, BMI and diabetes duration showed no difference in change in Hba1c level between those treated and not treated, at 3m and at 1 year before and after treatment. Conclusion We confirmed a high prevalence of vitamin D deficiency in this clinic cohort of children with T1D, and found a negative relationship between baseline 25(OH)D3 level and HbA1C in Caucasians. However, in patients treated with a stat dose of cholecalciferol there was no effect on Hba1c. Further studies with larger sample sizes, and using maintenance 25(OH)D3 therapy rather than stat therapy are required.

Objective: To compare low dose (0.05 units/kg/h) with standard dose (0.1 units/kg/h) intravenous insulin infusion for the treatment of diabetic ketoacidosis (DKA) in children with type 1 diabetes.Study design: Data from five paediatric centres were compared in children who received 0.05 (41 episodes) or 0.1 units/kg/h (52 episodes).Results: In the low vs. standard dose group, at 6 h following admission, the fall in blood glucose levels [11.3 (95% confidence interval 8.6 to 13.9) vs. 11.8 (8.4 to 15.2) mmol/L, p = 0.86] and rise in pH [0.13 (0.09 to 0.18) vs. 0.11 (0.07 to 0.15), p = 0.78] were similar. These changes were comparable between doses in relation to: severity of initial acidosis, children newly diagnosed with diabetes or aged less than 5 years. After adjustment for other clinical and biochemical covariates, insulin dose was unrelated to the change in pH and blood glucose levels at 6 h following admission. Comparisons of safety data, particularly in relation to abnormal Glasgow Coma Score, were inconclusive.Conclusion: In this observational study, low dose was as effective as standard dose intravenous insulin infusion in the initial treatment (less than 6 h) of DKA in children with type 1 diabetes. A randomised controlled trial is required to show true equivalence between doses and to evaluate potential safety benefits.

European Journal of PainVolume 13, Issue S1 p. S246b-S246 864 AN AUDIT OF THE CLINICAL OUTCOME OF INTERVENTIONAL PAIN TREATMENT OVER 12 MONTHS S. Tordoff, S. Tordoff Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this authorM. Bone, M. Bone Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this authorL. Stevens, L. Stevens Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this authorK. Tordoff, K. Tordoff Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this author S. Tordoff, S. Tordoff Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this authorM. Bone, M. Bone Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this authorL. Stevens, L. Stevens Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this authorK. Tordoff, K. Tordoff Pain Management Clinic, University Hospitals of Leicester, United KingdomSearch for more papers by this author First published: 12 January 2012 https://doi.org/10.1016/S1090-3801(09)60867-3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume13, IssueS1September 2009Pages S246b-S246 RelatedInformation

Aims: To study the influence of insulin treatment on growth and lung function in children with CF who had an abnormal OGTT but normal fasting glucose. Methods: The study included CF patients who had an abnormal OGTT (2 h glucose >7.8retool/i) but normal fasting glucose: 14 given insulin glargine (Gp A) owing to clinical deterioration and 13 not given insulin (Gp B). They were compared to 55 CF patients with normal OGTT (NGT). Height (Ht), weight (Wt) and BMI (expressed as SDS), and best FEV1% at diagnosis and treatment (tO), and changes in the 12too before (Awe) and 12mo after (Apost) were compared. Median values shown and nonparametric analysis taking account of repeated measures used. Results: Gp A differed from B in the following: higher 2 h plasma glucose (11.9 vs 9.5 retool/l, P 0.01) and significant decline in Wt in preceding 12 mo (P 0.02). Gp A had lowest Wt tO and BMI tO ( 0.6 SDS; B: 0.1 SDS; NGT: 0.3 SDS). Compared to NGT, gp A and B had lower Ht tO (P 0.03), FEV1 tO (P 5%) before tO in 8/14 gp A patients and improved in 6 of these. It declined in 7/13 gp B patients and improved in 5 of these.

The environment is implicated as a source of healthcare-associated infections (HAIs) and there is a need for evidence-based approaches to environmental sampling to assess cleanliness and improve infection prevention and control. We assessed, in vitro, different approaches to sampling the environment for meticillin-resistant Staphylococcus aureus (MRSA). In a laboratory-based investigation, the recovery of MRSA from two common hospital environments using six different sampling methods was evaluated, with a wild-type strain of MRSA. A 100 cm2 section of mattress and a laboratory bench surface were contaminated with known inocula of MRSA. Bacteria were recovered by sampling at 30 min after inoculation, using either saline-moistened cotton swabs, neutralising buffer swabs, eSwabs or macrofoam swabs, which were all enriched in tryptone soya broth, or by sampling with direct contact plates or chromogenic ‘sweep’ plates. The sensitivity (i.e. the minimum number of bacteria inoculated on to a surface which subsequently produced a positive result) of each method was determined for each surface. The most sensitive methods were eSwabs and macrofoam swabs, requiring 6.1 × 10−1 and 3.9 × 10−1 MRSA/cm2, respectively, to produce a positive result from the bench surface. The least sensitive swabbing method was saline-moistened cotton swabs, requiring 1.1 × 103 MRSA/cm2 of mattress. The recovery of bacteria from environmental samples varies with the swabs and methodology used and negative culture results do not exclude a pathogen-free environment. Greater standardisation is required to facilitate the assessment of cleanliness of healthcare environments.

This controlled trial used a prospective, randomised open design to compare the effectiveness of acupuncture and intra-articular injections in reducing chronic pain associated with osteoarthritis of the hip. Thirty two patients awaiting hip arthroplasty with chronic pain of more than twelve months duration were included. Group A received acupuncture using a standardised technique of periosteal needling to the greater trochanter of the femur with three acupuncture needles. The treatment was repeated on three occasions at weekly intervals. Group B received an intra-articular/peri-articular hip injection of 20ml of 1% lignocaine + 80mg Depo-Medrone. Patients were assessed for pain intensity, mobility and pattern of analgesia usage pre-treatment and at one, two and four week intervals thereafter. Both groups experienced a decrease in pain intensity and analgesic usage following treatment. This decrease was greater in the acupuncture group. However, mobility remained unchanged in both groups. From the results of this study, periosteal acupuncture appears to be as effective as an intra-articular injection in relieving the pain associated with osteoarthritis of the hip. However, due to the small numbers involved, statistical significance was not achieved.

The retinal electrophysiology is reported in four patients with type II mesangiocapillary glomerulonephritis and partial lipodystrophy with associated fundus abnormalities and no visual symptoms. The histological hallmark of the condition is that of widespread electron dense deposits in the renal glomerulus and in the choriocapillaris and Bruch's membrane of the eye. Three of the four patients had the typical fundal appearance of multiple, yellow, drusen-like lesions at the posterior pole of the eye with normal visual acuity. These three patients had abnormally low Arden ratios on electro-oculography with normal electroretinography responses. This is the first clinical model of disease known to be isolated to the choriocapillaris and Bruch's membrane causing an electro-oculographic abnormality without any clinically detectable deficit in visual function.

The present paper describes a non-linear levels numerical model. The model is written in the semi-staggered grid with the forward-backwards numerical scheme. It is applied to reproduce the bora-driven circulation on the Adriatic shelf in order to relate to previous numerical studies where processes of advection of momentum and local generation of turbulence were not considered. Starting from a hydrostatic state the wind-stress produces a marked seiche and inertial oscillation in the numerical solutions. These oscillations are discussed with regard to the theory of the Adriatic seiche.

conforms with all the criteria required by a recent position paper of which he is a coauthor': because it is a heavy powder, thorough vacuuming (part of integrated allergen avoidance) is necessary unlike with other acaricidal products except for liquid nitrogen. In addition, Sergeant's Dust Mite Patrol has the least residual action and safest toxicity profile of all acaricides. Of all the clinical trials quoted by Colloff et al, only six resulted in significant clinical improvement in patients, and three of those used some form of acaricide.24 As Sergeant's Dust Mite Patrol kills mites effectively and the necessary vacuuming will remove allergen by removing the dead bodies and mite faeces, the product must offer the possibility of relief of symptoms for people sensitive to dust mites when used as part of integrated allergen avoidance, which we have always advocated.

We investigated whether conception soon after cessation of use of oral contraceptives affects the chance of bearing twins. Unpublished data from a large sample survey of contraceptive practice in Scotland were used to derive oral contraceptive discontinuation rates by month over the decade 1972-82 and these were related to estimated monozygotic and dizygotic twin birth rates and proportions by month in Scotland from 1974-82, using regression techniques. The results provide some support for the hypothesis that there is an increased risk of conceiving monozygotic twins within a year of ceasing to use oral contraceptives.

Accumulation and toxicity of Cd, Zn, Ag, and Hg were measured in the diatom Thalassiosira pseudonana, the chlorophyte Dunaliella tertiolecta, the coccolithophore Emiliania huxleyi, and the cyanophyte Oscillatoria woronichinii.Bioaccumulation of the metals was measured over a wide (up to lo5) range of metal concentrations, using gamma-emitting radioisotopes of each metal.Metal content of cells was related to total external metal concentration in all cases, in accordance with Freundlich adsorption isotherms.Dead cells accumulated metals comparably to living cells, indicating that the initial association of metal with the cell is governed by adsorption.Volume/volume concentration factors computed at equilibrium ranged from 3 X 10' for Cd in T. pseudonana to 9.5 X lo4 for Hg in E. huxleyi.Metal toxicity, as measured by depression of cell division rate, could generally be described as an exponential function of the log of the external (or cellular) metal concentration, consistent with the concept of cell thresholds of safe metal accommodation.Regression analyses of the data were used to calculate EC5,, and ECo metal concentrations for each alga/metal combination.The general order of accumulation and metal toxicity vs. external metal concentration was Hg > Ag > Zn 2 Cd.Expressed on a cellular metal basis, Hg was usually the most toxic, but there was no clear trend for the other metals for all species.Upon normalizing cellular metal data on the basis of cellular weight, volume, and surface area, interspecific comparisons revealed that these algal species can have markedly different surface affinities for metals and that cellular ECso values ranged from 7.9 X l o 5 M for Hg in 0. woronichinii cells to 0.2 M for Zn in D. tertiolecta cells.The most resistant species to Zn, Ag and Hg was D. tertiolecta.Enhanced metal tolerance in D. tertiolecta was partly attributable to metal exclusion, however these cells were able to tolerate cellular metal concentrations of up to 10 (Zn) or 100 (Ag and Hg) times those in the other species.Since the toxicity of any metal was correlated with its concentration factor in a given cell, these data may provide a basis for predicting the toxicity of other metals to algae from metal concentration factors in the cells.

Fifty-six consecutive patients with sarcoidosis, 31 subacute and 25 chronic, were investigated for abnormalities of calcium and phosphate metabolism with particular reference to parathyroid function. No abnormality of serum calcium, phosphate, creatinine or alkaline phosphatase was found. Serum levels of 25-OH cholecalciferol were normal and parathyroid hormone levels were normal in all but one patient. Maximum renal tubular reabsorption capacities for calcium and phosphate (TmCa/GFR, TmP/GFR) in relation to glomerular filtration rate in the fasting state, were abnormal in some patients but this did not correlate with any other abnormality in parathyroid function. There was significant hypercalciuria (greater than 10 mmol calcium per 24 hours) in 7.5% of our patients and this is believed to be due to increased calcium flow.