This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15-101) years and duration of diabetes was 8.8 (+/-1.5 SD) years. Patients were categorised into 'low' (64%), 'moderate' (23%) or 'high' (13%) risk of developing foot ulcers by trained staff using five clinical criteria during routine patient care. During follow-up (1.7 years), 166 (4.7%) patients developed an ulcer. Foot ulceration was 83 times more common in high risk and six times more in moderate risk, compared with low-risk patients. The negative predictive value of a 'low-risk score' was 99.6% (99.5-99.7%; 95% confidence interval). This clinical tool accurately predicted foot ulceration in routine practice and could be used direct scarce podiatry resources towards those at greatest need.

In this double-blind crossover study, the effects of bolus infusions of 0.9% saline (NaCl) and Hartmann's solution on serum albumin, haematocrit and serum and urinary biochemistry were compared in healthy subjects. Nine young adult male volunteers received 2-litre intravenous infusions of 0.9% saline and Hartmann's solution on separate occasions, in random order, each over 1 h. Body weight, haematocrit and serum biochemistry were measured pre-infusion and at 1 h intervals for 6 h. Biochemical analysis was performed on pooled post-infusion urine. Blood and plasma volume expansion, estimated by dilutional effects on haematocrit and serum albumin, were greater and more sustained after saline than after Hartmann's solution (P <0.01). At 6 h, body weight measurements suggested that 56% of the infused saline was retained, in contrast with only 30% of the Hartmann's solution. Subjects voided more urine (median: 1,000 compared with 450 ml) of higher sodium content (median: 122 compared with 73 mmol) after Hartmann's than after saline (both P =0.049), despite the greater sodium content of the latter. The time to first micturition was less after Hartmann's than after saline (median: 70 compared with 185 min; P =0.008). There were no significant differences between the effects of the two solutions on serum sodium, potassium, urea or osmolality. After saline, all subjects developed hyperchloraemia (>105 mmol/l), which was sustained for >6 h, while serum chloride concentrations remained normal after Hartmann's (P <0.001 for difference between infusions). Serum bicarbonate concentration was significantly lower after saline than after Hartmann's (P =0.008). Thus excretion of both water and sodium is slower after a 2-litre intravenous bolus of 0.9% saline than after Hartmann's solution, due possibly to the more physiological [Na(+)]/[Cl(-)] ratio in Hartmann's solution (1.18:1) than in saline (1:1) and to the hyperchloraemia caused by saline.

In this double-blind crossover study, the effects of bolus infusions of 0.9% saline (NaCl) and Hartmann's solution on serum albumin, haematocrit and serum and urinary biochemistry were compared in healthy subjects. Nine young adult male volunteers received 2-litre intravenous infusions of 0.9% saline and Hartmann's solution on separate occasions, in random order, each over 1 h. Body weight, haematocrit and serum biochemistry were measured pre-infusion and at 1 h intervals for 6 h. Biochemical analysis was performed on pooled post-infusion urine. Blood and plasma volume expansion, estimated by dilutional effects on haematocrit and serum albumin, were greater and more sustained after saline than after Hartmann's solution (P <0.01). At 6 h, body weight measurements suggested that 56% of the infused saline was retained, in contrast with only 30% of the Hartmann's solution. Subjects voided more urine (median: 1,000 compared with 450 ml) of higher sodium content (median: 122 compared with 73 mmol) after Hartmann's than after saline (both P =0.049), despite the greater sodium content of the latter. The time to first micturition was less after Hartmann's than after saline (median: 70 compared with 185 min; P =0.008). There were no significant differences between the effects of the two solutions on serum sodium, potassium, urea or osmolality. After saline, all subjects developed hyperchloraemia (>105 mmol/l), which was sustained for >6 h, while serum chloride concentrations remained normal after Hartmann's (P <0.001 for difference between infusions). Serum bicarbonate concentration was significantly lower after saline than after Hartmann's (P =0.008). Thus excretion of both water and sodium is slower after a 2-litre intravenous bolus of 0.9% saline than after Hartmann's solution, due possibly to the more physiological [Na(+)]/[Cl(-)] ratio in Hartmann's solution (1.18:1) than in saline (1:1) and to the hyperchloraemia caused by saline.

Background: Anastomotic leak is a common complication after colorectal surgery, associated with increased morbidity and mortality, and poorer long-term survival after oncological resections. Early diagnosis improves short-term outcomes, and may translate into reduced cancer recurrence. Multiple studies have attempted to identify biomarkers to enable earlier diagnosis of anastomotic leak. One study demonstrated that the trajectory of C-reactive protein (CRP) levels was highly predictive of anastomotic leak requiring intervention, with an area under the curve of 0⋅961. The aim of the present study was to validate this finding externally. Methods: This was a prospective international multicentre observational study of adults undergoing elective colorectal resection with an anastomosis. CRP levels were measured before operation and for 5 days afterwards, or until day of discharge if earlier than this. The primary outcome was anastomotic leak requiring operative or radiological intervention. Results: Between March 2017 and July 2018, 933 patients were recruited from 20 hospitals across Australia, New Zealand, England and Scotland. Some 833 patients had complete CRP data and were included in the primary analysis, of whom 41 (4⋅9 per cent) developed an anastomotic leak. A change in CRP level exceeding 50 mg/l between any two postoperative days had a sensitivity of 0⋅85 for detecting a leak, and a high negative predictive value of 0⋅99 for ruling it out. A change in CRP concentration of more than 50 mg/l between either days 3 and 4 or days 4 and 5 after surgery had a high specificity of 0⋅96-0⋅97, with positive likelihood ratios of 4⋅99-6⋅44 for a leak requiring intervention. Conclusion: This study confirmed the value of CRP trajectory in accurately ruling out an anastomotic leak after colorectal resection.

Conclusion-This study adds further evidence to the concept that SPP IOLs can be a significant risk factor in the development of postoperative endophthamitis. (Br J Ophthalmol 1998;82:1312-1315 Postoperative endophthalmitis remains a serious sight threatening complication of cataract surgery. Despite improved antiseptic and antimicrobial prophylaxis the incidence of endophthalmitis following cataract surgery is quoted as 0.08%-0.12%. [1][2][3][4][5] In many cases the organisms involved are thought to originate from periocular flora.6 These organisms may gain entry to the eye by means of surgical instruments, the irrigation fluid, 7 or by contamination of the intraocular lens implant itself.8 Adherence of bacteria to IOLs results from electrostatic charges and is enhanced by the formation of polysaccharide biofilms. The propensity of bacteria to adhere to IOLs may vary according to the lens material. A previous report has suggested an association between the use of an intraocular lens with haptics made of polypropylene and an increased risk of postoperative endophthalmitis. 9This study compared the incidence of postoperative endophthalmitis in eyes with siliconepolypropylene (SPP) and single piece polymethylmethacrylate (PMMA) intraocular lens implants (IOLs). Materials and methodsA retrospective study was conducted to identify the incidence of endophthalmitis following cataract surgery at our unit during a 3 year period by means of a systematic review of operating theatre records and patient case notes. Data on age, sex, type of procedure (conventional extracapsular cataract extraction or phacoemulsification), and IOL type were collected for all patients undergoing cataract surgery during the study period. The diagnosis of endophthalmitis was made clinically, on the basis of symptoms of pain and redness associated with hypopyon and cellular infiltrate of the vitreous, and was confirmed by positive microbiological cultures following aqueous tap or vitreous biopsy. The relative risk of postoperative endophthalmitis associated with the use of a SPP IOL compared with a PMMA IOL was calculated. Fisher's exact test (EPI-INFO Version 6, USD Inc, Stone Mountain, GA, USA) was used to establish the significance of the findings. ResultsA total of 772 patients underwent cataract surgery by phacoemulsification with intraocular lens implant during the study period. There were 470 (61%) females and 302 (39%) males with an age range of 12-101 years and a mean age of 73.4 years (females 75, males 71). There was no significant diVerence in mean age (p=0.74) or male:female ratio (p=0.31) between the PMMA and SPP IOL groups. Seven cases of postoperative endophthalmitis were identified (Table 1) with an overall incidence of 0.91%. In five cases the diagnosis was confirmed by microbiological cultures. In the two culture negative cases the diagnoses were made clinically on the basis of symptoms of pain and redness associated with hypopyon and cellular infiltrate of the vitreous.Before surgery, one patient had a history of mild dry eye ...