Royal Devon and Exeter Hospital

About: Royal Devon and Exeter Hospital is a healthcare organization based out in Exeter, United Kingdom. It is known for research contribution in the topics: Population & Randomized controlled trial. The organization has 2282 authors who have published 2526 publications receiving 78866 citations. The organization is also known as: RD&E.

Antenatal Diagnosis of Fetal Genotype Determines if Maternal Hyperglycemia due to a Glucokinase Mutation Requires Treatment

Abstract: OBJECTIVE In women with hyperglycemia due to heterozygous glucokinase ( GCK ) mutations, the fetal genotype determines its growth. If the fetus inherits the mutation, birth weight is normal when maternal hyperglycemia is not treated, whereas intensive treatment may adversely reduce fetal growth. However, fetal genotype is not usually known antenatally, making treatment decisions difficult. RESEARCH DESIGN AND METHODS We report two women with gestational diabetes mellitus resulting from GCK mutations with hyperglycemia sufficient to merit treatment. RESULTS In both women, DNA from chorionic villus sampling, performed after high-risk aneuploidy screening, showed the fetus had inherited the GCK mutation. Therefore, maternal hyperglycemia was not treated. Both offspring had a normal birth weight and no peripartum complications. CONCLUSIONS In pregnancies where the mother has hyperglycemia due to a GCK mutation, knowing the fetal GCK genotype guides the management of maternal hyperglycemia. Fetal genotyping should be performed when fetal DNA is available from invasive prenatal diagnostic testing.

Preservation of the original femoral cement mantle during the management of infected cemented total hip replacement by two-stage revision

Abstract: The removal of all prosthetic material and a two-stage revision procedure is the established standard management of an infected total hip replacement (THR). However, the removal of well-fixed femoral cement is time-consuming and can result in significant loss of bone stock and femoral shaft perforation or fracture. We report our results of two-stage revision THR for treating infection, with retention of the original well-fixed femoral cement mantle in 15 patients, who were treated between 1989 and 2002. Following partial excision arthroplasty, patients received local and systemic antibiotics and underwent reconstruction and re-implantation at a second-stage procedure, when the infection had resolved. The mean follow-up of these 15 patients was 82 months (60 to 192). Two patients had positive microbiology at the second stage and were treated with six weeks of appropriate antibiotics; one of these developed recurrent infection requiring further revision. Successful eradication of infection was achieved in the remaining 14 patients. We conclude that when two-stage revision is used for the treatment of peri-prosthetic infection involving a THR, a well-fixed femoral cement mantle can be safely left in situ , without compromising the treatment of infection. Advantages of this technique include a shorter operating time, reduced loss of bone stock and a technically more straightforward second-stage procedure.

A meta-analysis of the utility of the neutrophil-to-lymphocyte ratio in predicting survival after pancreatic cancer resection.

Abstract: Background The neutrophil-to-lymphocyte ratio (NLR) is thought to reflect cancer disease burden. To assess the prognostic ability of the NLR on overall survival in patients with resectable, pancreatic cancer a meta-analysis of published literature was undertaken. Method A systematic review was performed independently by two authors using PubMed, Ovid MEDLINE and Embase databases. Included studies detailed the pre-operative NLR and overall survival of pancreatic cancer patients. Results Of the 214 studies retrieved using the search strategy, 8 studies involving 1519 patients were included in the meta-analysis. Only one study did not find a statistically significant association between a high NLR and OS. The pooled Hazard Ratio was 1.77 (95% CI [1.45–2.15]; p Conclusions A high pre-operative NLR indicates a worse prognosis than in patients with a low NLR. There is potential to use the NLR to direct therapies. A specific cut-off value has not been established from this study and so further research is required.

Does telephone follow-up improve blood pressure after minor stroke or TIA?

Abstract: Background: hypertension is a common risk factor for stroke/transient ischaemic attack (TIA) and there is good evidence that blood pressure (BP) control prevents recurrent stroke. We investigated whether telephone follow-up (TFU) improved risk factor management in hypertensive patients after stroke/TIA. Methods: we conducted a randomised controlled trial and assigned hypertensive patients within 1 month of stroke or TIA to receive usual care (n = 27) or usual care plus regular TFU (n = 29). Primary outcome was the difference in 12 h ambulatory systolic BP change from baseline to 6 months (ΔSBP) in both groups. TFU at 7 days, 1, 2 and 4 months included patientfocussed education and goal setting. Results: mean baseline BP was 145/83 mm Hg (standard deviation (SD) 21/14). There was no significant difference in ΔSBP over 6 months with TFU. Median ΔSBP was 0 mm Hg (interquartile range 19.5) in the TFU group and 3.0 mm Hg (20) fall in the usual care group (P = 0.29). Post hoc analysis showed that statin use increased from baseline to 6 months (P = 0.02) and cholesterol was significantly lower at 6 months in all patients (mean reduction 0.95 mmol/l; P < 0.001). Conclusion: our study found TFU that promoted patient-led management of risk factors did not improve BP control over 6month follow-up in primary care after stroke/TIA.

Collagen reorganization in cartilage under strain probed by polarization sensitive second harmonic generation microscopy

Abstract: Type II collagen fibril diameters in cartilage are beneath the diffraction limit of optical microscopy, which makes the assessment of collagen organization very challenging. In this work we use pol...