Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Co-localisation of the Kir6.2/SUR1 channel complex with glucagon-like peptide-1 and glucose-dependent insulinotrophic polypeptide expression in human ileal cells and implications for glycaemic control in new onset type 1 diabetes.

Abstract: OBJECTIVE The ATP-dependent K+-channel (K(ATP)) is critical for glucose sensing and normal glucagon and insulin secretion from pancreatic endocrine alpha- and beta-cells. Gastrointestinal endocrine L- and K-cells are also glucose-sensing cells secreting glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotrophic polypeptide (GIP) respectively. The aims of this study were to 1) investigate the expression and co-localisation of the K(ATP) channel subunits, Kir6.2 and SUR1, in human L- and K-cells and 2) investigate if a common hyperactive variant of the Kir6.2 subunit, Glu23Lys, exerts a functional impact on glucose-sensing tissues in vivo that may affect the overall glycaemic control in children with new-onset type 1 diabetes. DESIGN AND METHODS Western blot and immunohistochemical analyses were performed for expression and co-localisation studies. Meal-stimulated C-peptide test was carried out in 257 children at 1, 6 and 12 months after diagnosis. Genotyping for the Glu23Lys variant was by PCR-restriction fragment length polymorphism. RESULTS Kir6.2 and SUR1 co-localise with GLP-1 in L-cells and with GIP in K-cells in human ileum tissue. Children with type 1 diabetes carrying the hyperactive Glu23Lys variant had higher HbA1C at diagnosis (coefficient = 0.61%, P = 0.02) and 1 month after initial insulin therapy (coefficient = 0.30%, P = 0.05), but later disappeared. However, when adjusting HbA1C for the given dose of exogenous insulin, the dose-adjusted HbA1C remained higher throughout the 12 month study period (coefficient = 0.42%, P = 0.03). CONCLUSIONS Kir6.2 and SUR1 co-localise in the gastrointestinal endocrine L- and K-cells. The hyperactive Glu23Lys variant of the K(ATP) channel subunit Kir6.2 may cause defective glucose sensing in several tissues and impaired glycaemic control in children with type 1 diabetes.

Subintimal angioplasty in lower limb ischaemia

Abstract: Subintimal angioplasty has been around for 18 years but has become popular only in the last 2 to 3 years, following a number of publications from various centres in Europe and the USA. After its initial successes in the femoropopliteal segment, the techniques has been extended to the infrapopliteal segment. Recanalization of long tibial occlusions and the possibility of reconstituting the trifurcation has proved to be most useful in the treatment of patients with critical limb ischaemia. Primary success rates of between 80 and 90% can be expected in the infrainguinal and the infrapopliteal segment. Patencies of 64% at 5 years in the superficial femoral artery for claudication has been reported. Limb salvage rates have been consistently high at around 85 to 90% at 1 year. Subintimal angioplasty has proved to be a useful and inexpensive way to treat intermittent claudication. For critical limb ischaemia, it has proved to be very effective.

Laparoscopic repair of perforated peptic ulcers. The role of laparoscopy in generalised peritonitis.

Abstract: This non-randomised concurrent cohort study conducted in two teaching hospital Departments of Surgery examined the assumption that the benefits of elective laparoscopic upper gastrointestinal surgery would apply to those with generalised peritonitis due to perforated peptic ulcers. It compared 20 consecutive laparoscopic repairs of perforated peptic ulcers with a concurrent group of 16 consecutive open repairs. There were no differences pre-operatively between the two groups. The mean duration of surgery was similar (P = 0.46). There were no differences in the rate of GI tract recovery, but opiate analgesia requirement in the laparoscopic group was significantly less (P < 0.0001). Intensive care was required in three patients in the laparoscopic group (two with renal failure) and two in the open (no renal failure). Two patients in the laparoscopic and one in the open group died. The median duration of stay was five days in the laparoscopic group and six in the open. This comparison shows that the patho-physiological insult of laparoscopy in the setting of generalised peritonitis does not obviously increase the peri-operative risk of organ failure but objective benefits are small.