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In individuals with Type 2 diabetes on hypoglycaemic medications, fasting of any type increased the rate of hypoglycaemia. With education and medication reduction, fewer than expected hypoglycaemic events occurred. Although it was not possible to determine whether fasting on consecutive days increased the risk of hypoglycaemia, an acceptable rate was observed in both arms.

From November 1984 through May 1985 a study was made of the density and distribution of the lowland gorilla (Gorilla gorilla gorilla (Savage and Wyman)), the forest elephant (Loxodonta africana cyclotis) and associated fauna in the dense forest of Southwestern Central African Republic (CAR). The goal of the study was to gather preliminary information on habitat use by gorillas and to determine potential areas for conservation of these species and their habitat. The study area consisted of approximately 3 500 km 2 in the Sangha-Economique Prefecture, CAR.The method for determining gorilla density was based on nest counts from line transects which allowed calculation of population density of all individuals except suckling infants. 12 habitats were identified and related to 4 logging status types. 1 420 gorilla nests and 100 chimpanzee nests were recorded in 783 km of transects in 7 100 km 2 sample blocks. Relative densities in the various habitat/logging status combinations were estimated and the mean gorilla density ranged between 0.89 and 1.45 gorillas/km 2 . These figures are high in comparison to those calculated for other areas in Africa, possibly due to large areas of regrowth of herbaceous vegetation, especially plants of the genus Aframomum, in logged areas. Although gorillas favored secondary forest habitats they used all forest habitats for feeding and/or nesting. Light gaps in primary forest, herbaceous inundated forest, depleted forest, and areas of high elephant activity exhibited high relative densities of gorillas. Their primary food and nest material consisted of Aframomum spp., and its presence and abundance played an important role in the distribution of gorillas.Résumé. -De novembre 1984 à mai 1985 une étude de la densité et de la répartition du gorille de plaine, de l'éléphant de forêt et de la faune associée, a été effectuée dans la forêt dense du sud-ouest de la R.C.A. Le but de cette étude était de rassembler des informations préliminaires sur l'utilisation de leur habitat par les gorilles et de déterminer des zones potentielles de conservation de cette espèce et de son habitat. La surface étudiée couvre environ 3 500 km 2 dans la préfecture de la Sangha-Economique.La méthode utilisée pour déterminer la densité des gorilles est basée sur le dénombre-ment des nids sur des itinéraires-échantillons, ce qui permet le calcul de la densité de peuplement de tous les individus, à l'exception des jeunes en lactation. Douze habitats Mammaha, t. 52. n° 3, 1988.Brought to you by | University of Arizona Authenticated Download Date | 5/27/15 12:36 PM 310 MAMMALIA ont été identifiés et rapportés à quatre stades d'exploitation forestière. Sur 783 km de transects dans 7 100 km 2 de blocs-échantillons, 1 420 nids de gorilles et 100 nids de chimpanzés ont été identifiés. Des densités relatives en des combinaisons d'habitats -stade d'exploitation forestière, ont été estimées : la densité moyenne des gorilles est de 0,89 à 1,45 gorilles au knr. Ces chiffres sont élevés en comparaison de ceux qui ont été obtenus ...

There is no consensus on optimal follow-up for completely resected gastroenteropancreatic neuroendocrine tumors. Published guidelines for follow-up are complex and emphasize closer surveillance in the first 3 years after resection. Neuroendocrine tumors have a different pattern and timescale of recurrence, and thus require more practical and tailored follow-up. The Commonwealth Neuroendocrine Tumour Collaboration convened an international multidisciplinary expert panel, in collaboration with the North American Neuroendocrine Tumor Society, to create patient-centered follow-up recommendations for completely resected gastroenteropancreatic neuroendocrine tumors. This panel used the RAND/UCLA (University of California, Los Angeles) Appropriateness Method to generate recommendations. A large international survey was conducted outlining current the surveillance practice of neuroendocrine tumor practitioners and shortcomings of the current guidelines. A systematic review of available data to date was supplemented by recurrence data from 2 large patient series. The resultant guidelines suggest follow-up for at least 10 years for fully resected small-bowel and pancreatic neuroendocrine tumors and also identify clinical situations in which no follow-up is required. These recommendations stratify follow-up strategies based on evidence-based prognostic factors that allow for a more individualized patient-centered approach to this complex and heterogeneous malignant neoplasm.

Observations are presented primarily from two study sites located in the extreme southwestern tip of the Central African Republic. The use of flexible stalks and rigid sticks to extract termites from mounds and pounding, prying, and digging tools to penetrate melipone, honey bee, and ground-dwelling bee hives by Pan t. troglodytes are documented or inferred from circumstantial evidence. Functionally, termite extraction tools were similar to other locations in west and central Africa, but the plant species used were considerably different. Extraction of bees using large pieces of wood as pounding tools has not been recorded elsewhere in wild chimpanzees. No environmental factor that differs between the east and west of the range of P. t. troglodytes that would cause the difference in tool use was identified. o

We studied the western lowland gorilla diet as a possible model for human nutrient requirements with implications for colonic function. Gorillas in the Central African Republic were identified as consuming over 200 species and varieties of plants and 100 species and varieties of fruit. Thirty-one of the most commonly consumed foods were collected and dried locally before shipping for macronutrient and fiber analysis. The mean macronutrient concentrations were (mean +/- SD, g/100 g dry basis) fat 0.5 +/- 0.4, protein 11.8 +/- 8.2, available carbohydrate 7.7 +/- 6.3 and dietary fiber 74.0 +/- 12.9. Assuming that the macronutrient profile of these foods was reflective of the whole gorilla diet and that dietary fiber contributed 6.28 kJ/g (1.5 kcal/g), then the gorilla diet would provide 810 kJ (194 kcal) metabolizable energy per 100 g dry weight. The macronutrient profile of this diet would be as follows: 2.5% energy as fat, 24.3% protein, 15.8% available carbohydrate, with potentially 57.3% of metabolizable energy from short-chain fatty acids (SCFA) derived from colonic fermentation of fiber. Gorillas would therefore obtain considerable energy through fiber fermentation. We suggest that humans also evolved consuming similar high foliage, high fiber diets, which were low in fat and dietary cholesterol. The macronutrient and fiber profile of the gorilla diet is one in which the colon is likely to play a major role in overall nutrition. Both the nutrient and fiber components of such a diet and the functional capacity of the hominoid colon may have important dietary implications for contemporary human health.

Pancreatic neuroendocrine tumors (pNETs) are uncommon cancers arising from pancreatic islet cells. Here we report the analysis of gene mutation, copy number, and RNA expression of 57 sporadic well-differentiated pNETs. pNET genomes are dominated by aneuploidy, leading to concordant changes in RNA expression at the level of whole chromosomes and chromosome segments. We observed two distinct patterns of somatic pNET aneuploidy that are associated with tumor pathology and patient prognosis. Approximately 26% of the patients in this series had pNETs with genomes characterized by recurrent loss of heterozygosity (LoH) of 10 specific chromosomes, accompanied by bi-allelic MEN1 inactivation and generally poor clinical outcome. Another ~40% of patients had pNETs that lacked this recurrent LoH pattern but had chromosome 11 LoH, bi-allelic MEN1 inactivation, and universally good clinical outcome. The somatic aneuploidy allowed pathogenic germline variants (e.g., ATM) to be expressed unopposed, with RNA expression patterns showing inactivation of downstream tumor suppressor pathways. No prognostic associations were found with tumor morphology, single gene mutation, or expression of RNAs reflecting the activity of immune, differentiation, proliferative or tumor suppressor pathways. In pNETs, single gene mutations appear to be less important than aneuploidy, with MEN1 the only statistically significant recurrently mutated driver gene. In addition, only one pNET in the series had clearly actionable single nucleotide variants (SNVs) (in PTEN and FLCN) confirmed by corroborating RNA expression changes. The two clinically relevant patterns of LoH described here define a novel oncogenic mechanism and a plausible route to genomic precision oncology for this tumor type.

Hypercalcaemia is commonly seen in the context of parathyroid dysfunction and malignancy and, when severe, can precipitate life-threatening sequelae. The differential of hypercalcaemia is broad and can be categorized based on parathyroid hormone (PTH) levels. The acute management of severe hypercalcaemia is discussed along with a brief review of therapeutic advances in the field.