Background Lipid disorders are now considered causal for atherosclerotic cardiovascular disease (ASCVD) which remains one of the most important contributors to morbidity and mortality in the developed world. Identification and early treatment of lipid disarrays remains the cornerstone of good clinical practice to prevent, halt and even reverse ASCVD. Guidelines for lipid management are imperative to help promote good clinical practice. Given the detail involved in comprehensive guidelines and the multiple areas of knowledge required by clinical practitioners, abbreviated, easy to understand, practical versions of guidelines are required to ensure dissemination of the most important information. The recent ESC lipid guidelines 2019 and the ESC guidelines on CVD prevention in clinical practice 2021 (1,2), provide an excellent detailed summary of all the latest evidence supporting lipid interventions that reduce ASCVD. Method We therefore developed a single-page document with hyperlinks to help practitioners gain easy access to practical information on lipid management. It has been developed for future electronic use in clinical practice. Conclusion It is presented here in a tabular format together with printable versions of the associated hyperlinks that provide the additional information required in decision making. It is hoped to audit the impact of this approach to help guide future ways of disseminating the latest clinical guideline updates.

Development of unconventional reservoirs in North America has increased significantly over the past decade. The increased activity in this space has provided significant data with respect to through-tubing drillouts which had previously not been attainable. This paper is focused on using the field data from the Montney and Duvernay formations along with laboratory data and numerical modeling to understand the hole cleanout associated with through-tubing drillouts of frac plugs. Initially, an extensive full-scale flow loop laboratory testing program was conducted to obtain data on debris transportation for hole cleanout during through-tubing applications. The testing was conducted on various coiled tubing (CT)-production tubing configurations using various solid particles. The laboratory data was used to develop empirical correlations needed for a transient debris transport model. This model was then used for frac plug drillouts to ensure successful hole cleaning in actual field applications. Computational fluid dynamics (CFD) modelling was also used to further understand and quantify the differences between the laboratory data, field data and transient debris transport model results. The objective of the work conducted was to gain a better understanding of debris transport and validate the empirical modelling approach developed for hole cleaning. The validation process was conducted in several stages. The first stage was to validate the laboratory data against the Montney and Duvernay field data. The second stage was to verify the results obtained from the empirical model against the results obtained from a computational fluid dynamic model. The results from both modelling approaches were lastly compared to the field data. All these results challenge the current industry's understanding and best practices for through-tubing drillouts in the Montney and Duvernay formations. With the contentious increase of lateral lengths and higher stage counts, the process of drilling out frac plugs has become more complex. This study explicitly benefits all operators in their ever-increasing need to understand their frac plug drillout operations to ensure efficient, cost effective, and most importantly, consistent and repeatable results. While efficient results for frac plug drillout operations have been accomplished to date, the on-going feedback from the field has been the requirement to produce repeatable drillouts. This paper is the first to show a holistic approach for obtaining a transient debris transport model used for through-tubing drillouts of frac plugs. The novelty also consists of the transient debris transport model validation through laboratory data and actual Montney and Duvernay field data.

PURPOSE:The influence of pharmacist intervention on the prescribing of angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), and aspirin for patients with diabetes was evaluated.METHODS:A retrospective chart review was performed for diabetic patients seen in a family medicine clinic. Patients were included in the analyses if they were 18-88 years old, had a diagnosis of type 1 or type 2 diabetes, had been seen in the family medicine clinic between July 2006 and October 2008, and had received a consultation by pharmacy services. All selected charts were reviewed to assess appropriate use of ACE inhibitor, ARB, and aspirin therapy, as recommended by American Diabetes Association (ADA) guidelines, before and after pharmacist intervention. Typical pharmacist interventions consisted of direct consultation with the prescriber and therapeutic education sessions conducted by pharmacy personnel. All patients were seen and evaluated by pharmacy personnel before meeting with the prescriber.RESULTS:Before pharmacist intervention, 41 (59%) of 70 patients were receiving appropriate ACE inhibitor or ARB therapy and 24 (34%) of 71 patients were receiving appropriate aspirin therapy as recommended by ADA. After pharmacist intervention, 63 (90%) of 70 patients were receiving appropriate ACE inhibitor or ARB therapy and 48 (68%) of 71 patients were receiving appropriate aspirin therapy as recommended by ADA (p < 0.0001 for both differences).CONCLUSION:A pharmacy intervention program in a primary care setting was associated with a significant increase in prescriber adherence to ADA guidelines for ACE inhibitor or ARB therapy and for aspirin therapy in diabetic patients.

Under various dietary and physiological conditions, carbon from α-linolenic acid (ALA) is extensively recycled into saturated and monounsaturated fatty acids. In this study we investigated whether carbon is still recycled from ALA when a dietary source of saturated and monounsaturated fatty acids is provided in excess.13C-labeled ALA was given to rats consuming a high-fat ketogenic diet and to rats consuming a low-fat control diet. In rats on the ketogenic diet,13C recycling from α-linolenate into several, but not all, saturated and monounsaturated fatty acids matched or exceeded that in the controls (P<0.05). We conclude that carbon recycling into saturated and monounsaturated fatty acids persists when the main end products of ALA recycling are provided in excess, using a ketogenic diet.

BACKGROUND:Road deaths fell initially after the introduction of the penalty points but despite this, the rate of spinal injuries remained unchanged.AIMS:We report a patient with a dramatic spinal injury, though without neurological deficit. We discuss the classification, management and economic impact of these injuries.METHODS:We describe the management of a patient with a comminuted thoracic spinal fracture without neurological injury. We conducted a literature review with regard to the availability of literature of the management of these injuries.RESULTS:This 17-year-old female was managed surgically and had a good functional outcome. There is no clear consensus in the published literature on the management of these injuries.CONCLUSIONS:Comminuted thoracic spinal factures are potentially devastating. Such a patient presents challenges in determining the appropriate treatment.

Docosahexaenoate is usually considered to be the principal endpoint of α-linolenate metabolism in mammals. Nevertheless, several studies over the past 30 y have shown that more carbon from α-linolenate is recycled into newly synthesized lipids than is used to make docosahexaenoate. Our objective in this study was to assess carbon recycling from α-linolenate in suckling rats made deficient in n-3 polyunsaturated fatty acids (PUFA). Female Long-Evans rats were given a diet deficient in n-3 PUFA at weaning and then bred 8 wk later. Pups from the second generation were nursed by their respective dams and gavaged with 1 mg [U-13C]-α-linolenate at 10 d old. Brain and liver were obtained 24 h later, and the fatty acid profiles and 13C enrichment analyzed. Docosahexaenoate was markedly depleted in brain (−82%) and liver (−97%) of the n-3 PUFA–deficient rats. In the controls, 13C enrichment in products of carbon recycling (cholesterol and fatty acids other than n-3 PUFA) exceeded that in docosahexaenoate by 2.4-fold (liver) and 7.5-fold (brain). n-3 PUFA deficiency reduced the ratio of 13C enrichment in products of carbon recycling compared with 13C incorporated into docosahexaenoate by 63% in the brain but not in the liver. Despite severe n-3 PUFA deficiency, carbon recycling still consumed 50% more 13C from α-linolenate than went into docosahexaenoate in the liver and 2.8-fold more in the brain. We conclude that carbon recycling is an integral part of neonatal metabolism of α-linolenate and is not simply an overflow pathway arising from excess availability of preformed docosahexaenoate.

BACKGROUND:Postprandial hypertriglyceridaemia is common in diabetes. Fatty acids are regulators of gene expression and may play an important role in regulatingthe postprandial lipoprotein cascade.AIM:To examine postprandial lipoprotein differences between diabetic and control subjects on polyunsaturated (linoleic) and monounsaturated (oleic) fat diets.METHODS:A randomised, crossover study.RESULTS:LDL was greater and HDL less (p < 0.05) in diabetic patients compared to controls on the linoleic acid diet. Apo E per particle was significantly lower in the diabetic patients compared to control subjects on both linoleic (p < 0.05) and oleic acid diets (p < 0.01). HDL apo E was also significantly lower in the diabetic patients compared to controls on the linoleic acid diet (p < 0.02).CONCLUSION:A change from linoleic to oleic acid diet resulted in an improvement in LDL and HDL in the diabetic patients. We suggest that the reduced apo E/particle in the diabetic patients may be an explanation for the delayed lipoprotein clearance.

This chapter presents contemporary financial issues in student housing programs framed through the topical areas of occupancy management, facilities, new construction, residential life programs, technology, and residential dining.

We summarize here the evidence indicating that carbon from α-linolenate and linoleate is readily recycled into newly synthesized lipids. This pathway consumes the majority of these fatty acids that is not β-oxidized as a fuel. Docosahexaenoate undergoes less β-oxidation and carbon recycling than do α-linolenate or linoleate, but is it still actively metabolized by this pathway? Among polyunsaturates, arachidonate appears to undergo the least β-oxidation and carbon recycling, an observation that may help account for the resistance of brain membranes to loss of arachidonate during dietary deficiency of n−6 polyunsaturates. Preliminary evidence suggests that de novo lipid synthesis consumes carbon from α-linolenate and linoleate in preference to palmitate, but this merits systematic study. Active β-oxidation and carbon recycling of 18-carbon polyunsaturates does not diminish the importance of being able to convert α-linolenate and linoleate to long-chain polyunsaturates but suggests that a broad perspective is required in studying the metabolism of polyunsaturates in general and α-linolenate and linoleate in particular.

Journal Article The Practice of History Get access Journal of American History, Volume 90, Issue 2, September 2003, Pages 576–611, https://doi.org/10.2307/3659445 Published: 01 September 2003

BJOG: An International Journal of Obstetrics & GynaecologyVolume 109, Issue 7 p. 844-846 Pyruvate kinase deficiency in pregnancy complicated by iron overload Lucia M. Dolan, Corresponding Author Lucia M. Dolan*Dr L. Dolan, Department of Women's Services, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE 1 4LP, UK.Search for more papers by this authorMary Ryan, Mary Ryan Altnagelvin Area Hospital, Londonderry, UKSearch for more papers by this authorJames Moohan, James Moohan Altnagelvin Area Hospital, Londonderry, UKSearch for more papers by this author Lucia M. Dolan, Corresponding Author Lucia M. Dolan*Dr L. Dolan, Department of Women's Services, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE 1 4LP, UK.Search for more papers by this authorMary Ryan, Mary Ryan Altnagelvin Area Hospital, Londonderry, UKSearch for more papers by this authorJames Moohan, James Moohan Altnagelvin Area Hospital, Londonderry, UKSearch for more papers by this author First published: 22 December 2003 https://doi.org/10.1111/j.1471-0528.2002.01083.xCitations: 9Read 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 onFacebookTwitterLinkedInRedditWechat Citing Literature Volume109, Issue7July 2002Pages 844-846 RelatedInformation

BACKGROUND:The US Food and Drug Administration (FDA) approved health claims for 2 dietary fibers, beta-glucan (0.75 g/serving) and psyllium (1.78 g/serving), on the assumption that 4 servings/d would reduce cardiovascular disease risk.OBJECTIVE:We assessed the efficacy of this dose of fibers in reducing serum lipid risk factors for cardiovascular disease.DESIGN:Sixty-eight hyperlipidemic adults consumed a test (high-fiber) and a control low-fat (25% of energy), low-cholesterol (<150 mg/d) diet for 1 mo each in a randomized crossover study. The high-fiber diet included 4 servings/d of foods containing beta-glucan or psyllium that delivered 8 g/d more soluble fiber than did similar, unsupplemented foods in the control diet. Fasting blood samples and blood pressure readings were obtained at baseline and weeks 2 and 4, and the subjects' weight was monitored weekly.RESULTS:Compared with the control diet, the high-fiber diet reduced total cholesterol (2.1 +/- 0.7%; P = 0.003), total:HDL cholesterol (2.9 +/- 0.8%; P = 0.001), LDL:HDL cholesterol (2.4 +/- 1.0%; P = 0.015), and apolipoprotein B:A-I (1.4 +/- 0.8%; P = 0.076). Applying the Framingham cardiovascular disease risk equation to the data confirmed a reduction in risk of 4.2 +/- 1.4% (P = 0.003). Small reductions in blood pressure were found after both diets. The subjects reported no significant differences in palatability or gastrointestinal symptoms between the diets.CONCLUSIONS:The reduction in serum lipid risk factors for cardiovascular disease supports the FDA's approval of a health claim for a dietary fiber intake of 4 servings/d. Although relatively small in terms of patient treatment, the reduction in cardiovascular disease risk is likely to be significant on a population basis.

High-fat ketogenic diets are used to treat intractable seizures in children, but little is known of the mechanism by which these diets work or whether fats rich in n−3 polyunsaturates might be beneficial. Tissue lipid and fatty acid profiles were determined in rats consuming very high fat (80 weight%), low-carbohydrate ketogenic diets containing either medium-chain triglyceride, flaxseed oil, butter, or an equal combination of these three fat sources. Ketogenic diets containing butter markedly raised liver triglyceride but had no effect on plasma cholesterol. Unlike the other fats, flaxseed oil in the ketogenic diet did not raise brain cholesterol. Brain total and free fatty acid profiles remained similar in all groups, but there was an increase in the proportion of arachidonate in brain total lipids in the medium-chain triglyceride group, while the two groups consuming flaxseed oil had significantly lower arachidonate in brain, liver, and plasma. The very high dietary intake of α-linolenate in the flaxseed group did not change docosahexaenoate levels in the brain. Our previous report based on these diets showed that although ketosis is higher in rats consuming a ketogenic diet based on medium-chain triglyceride oil, seizure resistance in the pentylenetetrazol model is not clearly related to the degree of ketosis achieved. In combination with our present data from the same seizure study, it appears that ketogenic diets with widely differing effects on tissue lipids and fatty acid profiles can confer a similar amount of seizure protection.

Abnormalities in endothelial function may be associated with increased cardiovascular risk in diabetic patients. We examined the effect of an oleic-acid-rich diet on insulin resistance and endothelium-dependent vasoreactivity in type 2 diabetes. Eleven type 2 diabetic patients were changed from their usual linoleic-acid-rich diet and treated for 2 months with an oleic-acid-rich diet. Insulin-mediated glucose transport was measured in isolated adipocytes. Fatty acid composition of the adipocyte membranes was determined by gas-liquid chromatography and flow-mediated endothelium-dependent and -independent vasodilatation were measured in the superficial femoral artery at the end of each dietary period. There was a significant increase in oleic acid and a decrease in linoleic acid on the oleic-acid-rich diet (p<0.0001). Diabetic control was not different between the diets, but there was a small but significant decrease in fasting glucose/insulin on the oleic-acid-rich diet. Insulin-stimulated (1 ng/ml) glucose transport was significantly greater on the oleic- acid-rich diet (0.56+/-0.17 vs. 0.29+/-0.14 nmol/10(5) cells/3 min, p<0.0001). Endothelium-dependent flow-mediated vasodilatation (FMD) was significantly greater on the oleic-acid-rich diet (3.90+/-0.97% vs. 6.12+/-1.36% p<0.0001). There was a significant correlation between adipocyte membrane oleic/linoleic acid and insulin-mediated glucose transport (p<0.001) but no relationship between insulin-stimulated glucose transport and change in endothelium-dependent FMD. There was a significant positive correlation between adipocyte membrane oleic/linoleic acid and endothelium-dependent FMD (r=0.61, p<0.001). Change from polyunsaturated to monounsaturated diet in type 2 diabetes reduced insulin resistance and restored endothelium-dependent vasodilatation, suggesting an explanation for the anti-atherogenic benefits of a Mediterranean-type diet.

OBJECTIVE:The present study was undertaken to examine the effect of a polyunsaturated fat diet compared with an isocaloric Mediterranean-style monounsaturated fat diet.RESEARCH DESIGN AND METHODS:This was a randomized 2-week crossover study on either a high-polyunsaturated or a high-monounsaturated fat diet in 11 well-controlled diabetic men. Blood was taken fasting and for up to 8 h after a high fat meal. Lipoproteins were isolated by sequential ultracentrifugation. Apolipoprotein (apo) B48 and apo B100 were separated by PAGE. Fatty acids were analyzed by gas-liquid chromatographyRESULTS:Fasting blood glucose and insulin levels were significantly higher on the linoleic acid diet compared with the oleic acid diet (P < 0.01 and P < 0.002, respectively). Plasma cholesterol and LDL cholesterol levels were also significantly higher on the linoleic acid diet (P < 0.001). Likewise, fasting chylomicron apo B48 and apo B100 (P < 0.05) and postprandial chylomicron and VLDL apo B48 and B100 (P < 0.05) were also higher on the linoleic acid diet.CONCLUSIONS:This study suggests that, in type 2 diabetes, an oleic acid-rich Mediterranean-type diet versus a linoleic acid-enriched diet may reduce the risk of atherosclerosis by decreasing the number of chylomicron remnant particles.