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zaterdag 17 februari 2018

The Lancet: [Seminar] Primary sclerosing cholangitis

[Seminar] Primary sclerosing cholangitis
Primary sclerosing cholangitis is a rare, chronic cholestatic liver disease characterised by intrahepatic or extrahepatic stricturing, or both, with bile duct fibrosis. Inflammation and fibrosis of bile ducts and the liver are followed by impaired bile formation or flow and progressive liver dysfunction. Patients might be asymptomatic at presentation or might have pruritus, fatigue, right upper quadrant pain, recurrent cholangitis, or sequelae of portal hypertension. The key diagnostic elements are cholestatic liver biochemistry and bile duct stricturing on cholangiography.
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[Department of Error] Department of Error
Agusti A. Filling the gaps in COPD: the TRIBUTE study. Lancet 2018; published online Feb 8. https://doi.org/10.1016/S0140-6736(18)30252-6—In this Comment, the first sentence of the fourth paragraph has been corrected to read "First, the incidence of COPD exacerbations was low in both groups of the study." This correction has been made to the online version as of Feb 14, 2018, and will be made to the printed Comment.
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[Comment] Continuous glucose monitoring: transforming diabetes management step by step
The introduction and evolution of continuous glucose monitoring (CGM) has transformed how glucose control is defined and approached. Glycated haemoglobin (HbA1c) remains the key surrogate for the risk of microvascular complications and a good comparator of average glycaemic control in different populations. But use of HbA1c alone to guide diabetes management can be misleading.1 With the high clinical burden and cost associated with substantial hypoglycaemia,2 a better approach to optimal glycaemic management might be HbA1c combined with a measure of hypoglycaemia.
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[Articles] Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial
Usage of rtCGM reduced the number of hypoglycaemic events in individuals with type 1 diabetes treated by MDI and with impaired hypoglycaemia awareness or severe hypoglycaemia.
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[Comment] Time for use of mesh repair for all umbilical hernias?
The indication for open umbilical hernia repair is based predominantly on a surgeon's preference rather than solid evidence, and whether to suture or reinforce the repair with mesh has been heavily debated.1–3 Annually, millions of patients undergo repair for an umbilical hernia,4 and despite 90% of these defects being less than 2 cm in diameter, 5–10% of patients are reoperated for recurrence, and many more have a clinically detectable recurrence and therefore risk chronic pain.5,6
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