PubMed · 4589936
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R S Lawson. 1973. Amputations through the ages.. https://doi.org/10.1111/j.1445-2197.1973.tb06784.x
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BACKGROUND: Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. METHODS: The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. RESULTS: The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79). CONCLUSIONS: A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent.
Lobsters have a self-renewing olfactory system and, like many animals, continuously replace old or dying olfactory receptor neurons. In addition, lobsters are able to regenerate the peripheral olfactory system even after complete loss. The olfactory sensors in lobsters are located distally on a pair of antennules. These antennules are often damaged, but this has little impact on the lobster's sense of smell because damaged olfactory tissue is rapidly replaced. In this study, we investigated damage-induced regeneration of the olfactory system by measuring cell proliferation following controlled amputation. We show that amputation-induced regeneration occurs as a result of up-regulating the normal development of olfactory sensors. A unique feature of up-regulated development is the formation of patches of proliferating cells within the antennular epithelium. Epithelial patches were typically formed between 3 and 10 days postamputation on the amputated side. They were characterized by their: proximal position with respect to developing clusters of olfactory receptor neurons (ORNs); tendency to form two discrete patches within the borders of each existing annulus; cell size, which was approximately twice that of mature ORNs; and location within the ventral epithelium. The development of epithelial patches was immediately followed by proliferation of clusters of ORNs and associated glial cells, and the level of this proliferation increased significantly during the premolt stage of the lobster's molt cycle. These epithelial patches may represent populations of precursor cells, because they develop in response to amputation and immediately precede development of cell clusters composed of ORNs and glia. Possible regulatory signals controlling epithelial patch development are discussed.