Prevalence of metabolic syndrome in rural and urban Chinese population in Qingdao

AIMS

To investigate the prevalence of metabolic syndrome and its components in both rural and urban Chinese population.

SUBJECTS AND METHODS

A population-based crosssectional survey was conducted in Qingdao, China in 2006 with 6100 Chinese aged 35-74 yr invited and 5355 who attended; 3357 subjects, 1562 urban (46.5%) and 1795 rural residents (53.5%) met the inclusion criteria for the current data analysis. The metabolic syndrome definitions of National Cholesterol Education Program Adult Treatment Expert Panel III (NCEPATPIII) 2004, NCEP 2005 and International Diabetes Federation (IDF) were used.

RESULTS

The age-standardized prevalences of metabolic syndrome were 16.2%, 32.2%, and 28.3% in men and 26.8%, 37.2%, and 34.6%in women, according to the definitions of the NCEP 2004, NCEP 2005, and IDF, respectively. Urban men have more risk factors and higher prevalence of the metabolic syndrome than rural men, but the differences in women were not that striking. Elevated blood pressure (62.6%) was, among risk factors, most common in the study population, followed by central obesity (53.4%), and hyperglycemia (52.2%) defined using the NCEP 2005 criteria.

CONCLUSIONS

Metabolic disorders were common among adult Chinese in both rural and urban areas in Qingdao.

The association of gamma-glutamyltransferase and C-reactive protein with IFG/IGT in Chinese adults in Qingdao, China

BACKGROUND

Serum gamma-glutamyltransferase (GGT) and C-reactive protein(CRP) have been previously shown to be associated with impaired fasting glucose/impaired glucose tolerance (IFG/IGT), but such an association has not been well verified, and is examined in a non-diabetic Chinese population.

METHODS

A population-based cross-sectional study was conducted in 2006 in Qingdao, China. Data of 1143 men and 1689 women aged 35-74 years and free of diabetes at baseline were analyzed. Multivariable logistic regression analysis was performed to estimate the odds ratio (OR) and its 95% confidence interval (CI).

RESULTS

Compared with the lowest quartile, the ORs (95%CI) for IFG/IGT corresponding to the highest quartile were 0.89(0.61,1.28) in men and 0.87(0.64,1.18) in women for CRP and 2.12(1.40,3.38) and 1.87(1.32,2.62) for GGT, when the two were fitted simultaneously in a model adjusting for age, school years, alcohol-drinking, smoking, family history of diabetes, systolic blood pressure, waist circumference, triglycerides and high-density lipoprotein.

CONCLUSIONS

The elevated GGT, but not CRP, was independently associated with the presence of the IFG/IGT in both genders in this Chinese population.

First Report of Sweet potato chlorotic stunt virus Infecting Sweet Potato in China

Sweet potato chlorotic stunt virus (SPCSV) (genus Crinivirus, family Closteroviridae) is a whitefly-transmitted co-infectant of the sweet potato virus disease (SPVD), which can cause severe yield losses in sweet potato (Ipomoea batatas (L.) Lam.) (2,3). One isolate was obtained in Guangdong Province in August 2009 from sweet potato plants of cv. Guangshu No. 87 exhibiting symptoms typical of SPVD, including stunting, leaf distortion, vein clearing, and chlorosis. Leaf extracts from the symptomatic plants tested positive for SPCSV by nitrocellulose membrane ELISA with antisera specific for SPCSV obtained from the International Potato Center. Total RNA was extracted from young leaves of sweet potato and reverse transcription-PCR was performed by using primer pairs SPSP1 (5'-ATGRMTACTGRCAAAGTAAACGATG-3') and SPSP4 (5'-TCAACAGTGAAGACCRGYACCRGTCAA-3') corresponding to the capsid protein (CP) gene of SPCSV. Expected DNA fragments of 774 bp were obtained from symptomatic plants but not from control plants. The 774-bp fragments obtained by amplification were purified and cloned into the PMD19-T vector (TaKaRa, Dalian, China). Recombinant plasmids were then transformed into competent cells of Escherichia coli strain Jm109. Sequencing of the fragments from two individually clones plasmids yielded a nucleotide sequence (GenBank Accession No. HM773432) with 97.4 to 98.7% similarity to the CP gene of East African SPCSV isolates (1). To our knowledge, this is the first report of SPCSV in sweet potato fields from China. This virus may threaten sweet potato production in China, so cultivars and germplasm should be evaluated for resistance. References: (1) V. Aritua et al. J. Phytopathol. 156:181, 2008. (2) R. W. Njeru et al. Ann. Appl. Biol. 145:71, 2004. (3) G. A. Schaefer and E. R. Terry. Phytopathology 66:642, 1976.

Diabetes, prediabetes and cancer mortality

AIMS/HYPOTHESIS

We aimed to investigate the risk of cancer mortality in relation to the glucose tolerance status classified according to the 2 h OGTT.

METHODS

Data from 17 European population-based or occupational cohorts involved in the DECODE study comprising 26,460 men and 18,195 women aged 25-90 years were collaboratively analysed. The cohorts were recruited between 1966 and 2004 and followed for 5.9 to 36.8 years. Cox proportional hazards analysis with adjustment for cohort, age, BMI, total cholesterol, blood pressure and smoking status was used to estimate HRs for cancer mortality.

RESULTS

Compared with people in the normal glucose category, multivariable adjusted HRs (95% CI) for cancer mortality were 1.13 (1.00, 1.28), 1.27 (1.02, 1.57) and 1.71 (1.35, 2.17) in men with prediabetes, previously undiagnosed diabetes and known diabetes, respectively; in women they were 1.11 (0.94, 1.30), 1.31 (1.00, 1.70) and 1.43 (1.01, 2.02), respectively. Significant increases in deaths from cancer of the stomach, colon-rectum and liver in men with prediabetes and diabetes, and deaths from cancers of the liver and pancreas in women with diabetes were also observed. In individuals without known diabetes, the HR (95% CI) for cancer mortality corresponding to a one standard deviation increase in fasting plasma glucose was 1.06 (1.02, 1.09) and in 2 h plasma glucose was 1.07 (1.03, 1.11).

CONCLUSIONS/INTERPRETATION

Diabetes and prediabetes were associated with an increased risk of cancer death, particularly death from liver cancer. Mortality from all cancers rose linearly with increasing glucose concentrations.

Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?

BACKGROUND

Age is associated with both impaired glucose and insulin metabolism. To what extent the age-related changes in insulin resistance (IR) and beta-cell function contribute to the increase in prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is less known, and this is investigated in this study.

METHODS

This study included 6610 men and 7664 women of different ethnic groups aged 30-69 years. IR and beta-cell function were examined by the homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-B). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis adjusting for body mass index and study.

RESULTS

In Chinese men, the ORs (95% CIs) for IFG were 2.69 (1.70, 4.26), 2.51 (1.49, 4.21) and 2.89 (1.68, 4.97), respectively, in age groups of 40-49, 50-59 and 60-69 years compared with 30-39 years (p < 0.001 for trend); the corresponding figures for IGT were 1.73 (1.25, 2.38), 2.54 (1.78, 3.63) and 3.57 (2.46, 5.19) (p < 0.001 for trend). Similar trends for IGT were observed also in Chinese women and other ethnic groups, but not for IFG in Mauritius Indian and Creole men. Adjustment for HOMA-IR and HOMA-B reduced the ORs in all age groups of all ethnicities for both IFG and IGT, but the risk gradient between age groups remained particularly for the IGT.

CONCLUSIONS

The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation

This article presents the conclusions of a WHO Expert Consultation that evaluated the utility of the 'metabolic syndrome' concept in relation to four key areas: pathophysiology, epidemiology, clinical work and public health. The metabolic syndrome is a concept that focuses attention on complex multifactorial health problems. While it may be considered useful as an educational concept, it has limited practical utility as a diagnostic or management tool. Further efforts to redefine it are inappropriate in the light of current knowledge and understanding, and there is limited utility in epidemiological studies in which different definitions of the metabolic syndrome are compared. Metabolic syndrome is a pre-morbid condition rather than a clinical diagnosis, and should thus exclude individuals with established diabetes or known cardiovascular disease (CVD). Future research should focus on: (1) further elucidation of common metabolic pathways underlying the development of diabetes and CVD, including those clustering within the metabolic syndrome; (2) early-life determinants of metabolic risk; (3) developing and evaluating context-specific strategies for identifying and reducing CVD and diabetes risk, based on available resources; and (4) developing and evaluating population-based prevention strategies.

A simple Chinese risk score for undiagnosed diabetes

AIMS

A diabetes risk score for screening undiagnosed diabetes was constructed and validated in Chinese adults.

METHODS

Two consecutive population-based diabetes surveys among Chinese adults aged 20-74 years were conducted in 2002 (n = 1986) and 2006 (n = 4336). Demographic and anthropometric measures were collected following similar procedures. Standard 2-h 75-g oral glucose tolerance tests (OGTTs) were performed to diagnose diabetes in both surveys. Fasting capillary plasma glucose (FCG) and glycated haemoglobin (HbA(1c)) were also measured together with the OGTTs on the same day of the 2006 survey. Beta coefficients estimated using logistic regression analysis derived from data of the 2002 survey were used to develop the risk assessment algorithm. The performance of the algorithm was validated in the study population of the 2006 survey.

RESULTS

Of all the variables tested, waist circumference, age and family history of diabetes were significant predictors of diabetes and were used to construct the risk assessment score. The score, ranging from 3 to 32, performed well when applied to the study population of the 2006 survey. The area under the receiver operating characteristic curve was 67.3% (95% CI, 64.9-69.7%) for the score, while it was 76.3% (73.5-79.0%) for FCG alone and 67.8% (64.9-70.8%) for HbA(1c) alone. At a cut-off point of 14, the sensitivity and specificity of the risk score were 84.2% (81.0-87.5%) and 39.8% (38.2-41.3%).

CONCLUSIONS

The risk score based on age, waist circumference and family history of diabetes is efficient as a layperson-oriented diabetes screening tool for health promotion and for population-based screening programmes.

Increasing trend in the prevalence of Type 2 diabetes and pre-diabetes in the Chinese rural and urban population in Qingdao, China

AIMS

To determine the secular trend of prevalence of Type 2 diabetes and pre-diabetes in a Chinese population from 2001 to 2006.

METHODS

Two consecutive population-based surveys for diabetes were conducted in a randomly selected population aged 35-74 years and living in Qingdao, China in 2001-2002 (n = 10854) and 2006 (n = 4416). All participants underwent standardized 2-h 75-g oral glucose tolerance tests (OGTTs), along with fasting capillary plasma glucose (FCG) tests in 2006. One urban community underwent OGTTs directly in 2002 (n = 1815), while a two-step screening strategy using FCG as a first-line screening test followed by OGTTs was used in 9039 individuals in 2001. Diabetes and pre-diabetes was defined according to the 2006 World Health Organization/International Diabetes Federation criteria.

RESULTS

Based on the results of direct OGTTs, the age-standardized prevalence of diabetes and pre-diabetes in urban areas was 12.2 and 15.4% in 2002, whereas the prevalences were 18.8 and 28.7% in urban areas and 14.1 and 20.2% in rural areas in 2006 (P < 0.001, in urban areas). Using the two-step screening strategy, the prevalence of diabetes in 2001 was 10.1% in urban and 7.7% in rural areas and 13.8% in urban and 12.2% in rural areas in 2006 (P < 0.001). Based on the data of the 2006 survey, the two-step screening strategy missed 30.2% of diabetes cases when compared with the number defined by the direct OGTT approach.

CONCLUSIONS

Qingdao has experienced a marked increase in the prevalence of diabetes and pre-diabetes in the past 5 years. Intervention to prevent a further increase in the prevalence of diabetes is urgently required.

Performance of HbA(1c) for detecting newly diagnosed diabetes and pre-diabetes in Chinese communities living in Beijing

AIM

To determine the performance of glycated haemoglobin (HbA(1c)) as a screening tool for detecting newly diagnosed diabetes (NDM) and pre-diabetes.

METHODS

A diabetes survey was conducted in Beijing among community dwellers who were willing to participate in the survey. Included in the survey were 903 individuals aged 21-79 years without previously diagnosed diabetes and in whom HbA(1c) and other required covariates had been measured. NDM and pre-diabetes (impaired glucose tolerance + impaired fasting glucose) were defined according to the World Health Organization 1999 criteria based on 75-g oral glucose tolerance test. Receiver operating characteristic curve (ROC) was plotted to determine the performance of HbA(1c).

RESULTS

The prevalence of NDM and pre-diabetes was 11.1% and 22.4%, respectively. At an optimal HbA(1c) cut-off point of > or = 6.0%, the test gave a sensitivity of 80.0% and a specificity of 89.8% for diagnosing NDM; at an optimal cut-off point of > or = 5.7%, the sensitivity was 59.4% and specificity 73.9% for diagnosing pre-diabetes. Individuals with HbA(1c)> or = 6.0% tended to be more obese than those with HbA(1c) < 6.0%, but blood pressure and lipid profiles did not differ between the two groups.

CONCLUSIONS

HbA(1c) as a single screening test is adequate to detect newly diagnosed diabetes but is not able to identify pre-diabetes in this obese Chinese population.

Risk prediction models for the development of diabetes in Mauritian Indians

AIMS

To develop risk prediction models of future diabetes in Mauritian Indians.

METHODS

Three thousand and ninety-four Mauritian Indians (1141 men, aged 20-65 years) without diabetes in 1987 or 1992 were followed up to 1992 or 1998. Subjects underwent repeated oral glucose tolerance tests and diabetes was diagnosed according to 2006 World Health Organization/International Diabetes Federation criteria. Cox regression models for interval censored data were performed using data from 1544 randomly selected participants. Predicted probabilities for diabetes were calculated and validated in the remaining 1550 subjects.

RESULTS

Over 11 years of follow-up, there were 511 cases of diabetes. Among variables tested, family history of diabetes, obesity (body mass index, waist circumference) and glucose were significant predictors of diabetes. Predicted probabilities derived from a simple model fitted with sex, family history of diabetes and obesity ranged from 0.05 to 0.64 in men and 0.03 to 0.49 in women. To predict the onset of diabetes, area under the receiver operating characteristic (ROC) curve (AROC) of predicted probabilities was 0.62 (95% confidence interval, 0.56-0.68) in men and 0.64 (0.59-0.69) in women. At a cut-off point of 0.12, the sensitivity and specificity were 0.72 (0.71-0.74) and 0.47 (0.45-0.49) in men and 0.77 (0.75-0.78) and 0.50 (0.48-0.52) in women, respectively. Addition of fasting plasma glucose (FPG) to the model improved the prediction slightly [AROC curve 0.70 (0.65-0.76) in men, 0.71 (0.67-0.76) in women].

CONCLUSIONS

A diabetes prediction model based on obesity and family history yielded moderate discrimination in Mauritian Indians, which was slightly inferior to the model with the FPG but may be useful in low-income countries to promote identification of people at high risk of diabetes.

Blood lipid levels in relation to glucose status in seven populations of Asian origin without a prior history of diabetes: the DECODA study

BACKGROUND

Dyslipidaemia commonly coexists with diabetes. We investigated the association of lipid profiles with glucose levels in populations of Asian origin without a prior history of diabetes.

METHODS

Cross-sectional data of 10,374 men and 12,552 women aged 30-74 years from 14 cohorts, representing seven populations of Asian origin were jointly analysed. Multivariable adjusted linear regression analyses with standardized regression coefficients (beta) were performed to estimate relationships between lipids and plasma glucose.

RESULTS

Within each glucose category, fasting plasma glucose (FPG) levels were correlated with increasing levels of triglycerides (TGs), total cholesterol (TC), TC to high-density lipoprotein (HDL) ratio and non-HDL cholesterol (non-HDL-C) (p < 0.05 in most of the ethnic groups) and inversely associated with HDL-C (p < 0.05 in some, but not all, of the populations). The association of lipids with 2-h plasma glucose (2hPG) followed a similar pattern as that for the FPG, except that an inverse relationship between HDL-C and glucose was more commonly observed for 2hPG than for FPG among different ethnic groups.

CONCLUSIONS

Hyperglycaemia is associated with adverse lipid profiles in Asians without a prior history of diabetes. The 2hPG appears to be more closely associated with lipid profiles than does FPG. When assessing the risk of cardiovascular disease, the association of the dyslipidaemia with intermediate hyperglycaemia needs to be considered.

Risk factors associated with the dramatic increase in the prevalence of diabetes in the adult Chinese population in Qingdao, China

OBJECTIVE

To investigate the major risk factors and their association with the dramatic increase in the prevalence of diabetes from 2001-2002 to 2006 in Qingdao, China.

METHODS

Population-based cross-sectional studies on diabetes were performed in 4598 men and 7026 women aged 35-74 years. The 2006 World Health Organization diagnostic criteria for diabetes were used.

RESULTS

The crude prevalence of diabetes was 11.3% in both men and women in urban areas and 5.3% and 8.9% in rural areas in 2001-2002. This increased to 19.2% and 16.1% in urban areas and 14.2% and 13.8% in rural areas in 2006 for men and women, respectively. The increase in diabetes prevalence from 2001-2002 to 2006 was paralleled by an increased body mass index in rural areas but not in urban areas. The major risk factors associated with diabetes were age, family history of diabetes, obesity, hypertension and high triglycerides. The multivariate adjusted odds ratio and 95% confidence interval for diabetes corresponding to a one standard deviation increase in waist circumference was 1.81 (1.47, 2.23) in urban men, 1.64 (1.26, 2.13) in rural men, 1.98 (1.66, 2.37) in urban women and 2.02 (1.63, 2.51) in rural women. Low socio-economic classes had a higher risk for diabetes in urban areas but a lower risk in rural areas, both associated with increased waist circumference.

CONCLUSION

Established risk factors are of great importance for the prevalence of diabetes in the urban and rural Chinese populations and changes in these factors could explain the recent dramatic increase in diabetes prevalence, particularly in rural areas. Considering the high prevalence of obesity and physical inactivity, intervention is urgently required in China.

Tissue Microarray Assessment of Selenoprotein P Expression in Gastric Adenocarcinoma

This study investigated selenoprotein P expression, using immunohistochemistry, in gastric adenocarcinoma tissue microarrays constructed from 30 gastric adenocarcinoma specimens and 30 normal gastric tissues (controls). Selenoprotein P expression scores were significantly lower in gastric adenocarcinoma (17/30, 56.7%) than in control tissues (25/30, 83.3%). Selenoprotein P was significantly more likely to be expressed in well-to-moderately differentiated cases (13/17, 76.5%) than in cases with low differentiation (4/13, 30.8%) and there was no significant difference in selenoprotein P expression between tumour node metastasis (TNM) stage I – II (11/19, 57.9%) and TNM stage III (6/11, 54.5%). In conclusion, selenoprotein P expression was low in gastric adenocarcinoma tissues compared with control tissues and was related to the degree of gastric adenocarcinoma differentiation but not to TNM stage.

Blood lipid levels in relation to glucose status in European men and women without a prior history of diabetes: the DECODE Study

OBJECTIVE

Dyslipidaemia is present not only in diabetic but also in prediabetic subjects. The purpose of this study is to investigate the relationship between lipid and glucose levels in a large European population without a prior history of diabetes.

RESEARCH DESIGN AND METHODS

Data from the population-based studies of 8960 men and 10,516 women aged 35-74 years representing 15 cohorts in 8 European countries were jointly analyzed. Multivariate adjusted linear regression analyses with standardized coefficients (beta) were performed to estimate the relationship between lipid and plasma glucose.

RESULTS

In subjects without a prior history of diabetes, positive relationships were shown between fasting plasma glucose (FPG) and total cholesterol (TC) (beta=0.06 and 0.03, respectively for men and women, p<0.01), triglycerides (TG) (beta=0.14 and 0.12, p<0.001), non-high-density lipoprotein cholesterol (non-HDL-C) (beta=0.06 and 0.03, p<0.01) and TC to HDL ratio (beta=0.06 and 0.05, p<0.001) but a negative trend between FPG and HDL-C (beta=-0.02, p>0.05 in men and beta=-0.03, p<0.05 in women). The relationship between lipid and 2-h plasma glucose (2hPG) followed a similar pattern as that for FPG, except that TC was not increased and HDL-C was reduced in both sexes in subjects with impaired glucose tolerance (IGT).

CONCLUSIONS

For cardiovascular prevention, the different lipid patterns between impaired fasting glucose (IFG) and IGT may deserve further attention to evaluate the combined risks of dyslipidaemia and elevated glucose levels below the diagnostic threshold of diabetes.

BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians

OBJECTIVE

To compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) in association with diabetes or hypertension.

METHODS AND PROCEDURES

Cross-sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged 35-74 years, of different ethnicities were included in this meta-analysis.

RESULTS

Age-adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three) adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P=0.001) in men but with WC and WSR than BMI (both P<0.05) in women. Hypertension had stronger association with BMI than WHR in men (P<0.001) and had the strongest with BMI than the others (WHR P<0.001; WSR P<0.01; and WC P<0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742) while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped.

DISCUSSION

WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly associated with hypertension in Asians.

Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women

AIMS/HYPOTHESIS

We estimated cardiovascular disease (CVD) mortality in individuals with the metabolic syndrome on the basis of different definitions.

METHODS

We collaboratively analysed data from 4,715 men and 5,554 women, who were aged 30 to 89 years, had a maximum follow-up of 7 to 16 years, and were drawn from nine European population-based cohorts. Cox regression analysis with age as time scale was performed to estimate hazard ratio (HR) for mortality, adjusting for cohort, serum total cholesterol and smoking.

RESULTS

The prevalence of the metabolic syndrome according to definitions of WHO, the National Cholesterol Education Program (NCEP), NCEP revised and the International Diabetes Federation (IDF) was 27.0%, 25.9%, 32.2% and 35.9% respectively in men and 19.7%, 23.4%, 28.5% and 34.1% respectively in women. The corresponding HRs (95% CIs) for CVD mortality were 2.09 (1.59-2.76), 1.74 (1.31-2.30), 1.72 (1.31-2.26) and 1.51 (1.15-1.99) in men, and 1.60 (1.01-2.51), 1.39 (0.89-2.18), 1.09 (0.70-1.69) and 1.53 (0.99-2.36) in women. The paired homogeneity test showed that in men the HR was higher with the WHO definition than with the IDF definition (p=0.03). In women the HR was lower with the revised NCEP definitions than with either the WHO (p=0.02) or the IDF (p=0.01) definitions. With a few exceptions, HRs for full definitions of the syndrome were not significantly different from those for their single components.

CONCLUSIONS/INTERPRETATION

Metabolic syndrome by the four definitions predicted CVD mortality in men, but the prediction was weak in women. Further research is required on the utility of definitions of the metabolic syndrome above and beyond that of its single components and in individual CVD risk stratification, particularly with regard to sex difference in the prediction.

Coffee consumption and risk of total and cardiovascular mortality among patients with type 2 diabetes

AIMS/HYPOTHESIS

Higher habitual coffee drinking has been associated with a lower risk of developing type 2 diabetes. The relation between coffee consumption and risk of cardiovascular disease (CVD) has been examined in many studies, but the issue remains controversial. This study was designed to assess the association between coffee consumption and CVD mortality among patients with type 2 diabetes.

METHODS

We prospectively followed 3,837 randomly ascertained Finnish patients with type 2 diabetes aged 25 to 74 years. Coffee consumption and other study parameters were determined at baseline. The International Classification of Diseases was used to identify CHD, CVD and stroke cases using computerised record linkage to the national Death Registry. The associations between coffee consumption at baseline and risk of total, CVD, CHD, and stroke mortality were analysed by using Cox proportional hazards models.

RESULTS

During the average follow-up of 20.8 years, 1,471 deaths were recorded, of which 909 were coded as CVD, 598 as CHD and 210 as stroke. The respective multivariate-adjusted hazard ratios in participants who drank 0-2, 3-4, 5-6, and > or =7 cups of coffee daily were 1.00, 0.77, 0.68 and 0.70 for total mortality (P<0.001 for trend), 1.00, 0.79, 0.70 and 0.71 for CVD mortality (P=0.006 for trend), 1.00, 0.78, 0.70 and 0.63 for CHD mortality (p=0.01 for trend), and 1.00, 0.77, 0.64 and 0.90 for stroke mortality (p=0.12 for trend).

CONCLUSIONS/INTERPRETATION

In this large prospective study we found that in type 2 diabetic patients coffee drinking is associated with reduced total, CVD and CHD mortality.

The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group

The category of IFG was introduced in the late 1990s to denote a state of non-diabetic hyperglycaemia defined by a fasting plasma glucose (FPG) concentration between 6.1 and 6.9 mmol/l. In 2003 the American Diabetes Association recommended that this diagnostic threshold be lowered to 5.6 mmol/l. The justification for lowering the threshold has been questioned. This simple change in cut-off value creates a pandemic of IFG, with a two- to five-fold increase in the prevalence of IFG across the world. Such a change in threshold has far-reaching public health implications. The European Diabetes Epidemiology Group (EDEG) has reviewed the evidence for this lower cut-off point for the definition of IFG and concludes that the previous definition should not be altered. EDEG further recommends that the value of all categorical definitions of non-diabetic hyperglycaemia should be reconsidered.

Advances in Polymer Flooding and Alkaline/Surfactant/Polymer Processes as Developed and Applied in the People's Republic of China

Paper includes discussion and reply published in May 2006 JPT.

Distinguished Author Series articles are general, descriptive representations that summarize the state of the art in an area of technology by describing recent developments for readers who are not specialists in the topics discussed. Written by individuals recognized as experts in the area, these articles provide key references to more definitive work and present specific details only to illustrate the technology. Purpose: to inform the general readership of recent advances in various areas of petroleum engineering.

Abstract

Polymer flooding (PF) and alkaline/surfactant/polymer (ASP) flooding have been applied throughout the world for more than 20 years. However, few large-scale successes with these processes have been reported, except in China. To date, the PF process has been applied successfully in several major Chinese oil fields such as Daqing and Shengli. PF alone contributed approximately 250,000 BOPD of production in 2004 from these two fields. Incremental oil recoveries of up to 14% of the original oil in place (OOIP) have been obtained in good-quality reservoirs.

Profile modifications by use of polymers and a crosslinker to form colloidal-dispersion gels (CDGs) also have been implemented successfully in large-scale production operations in China. Results show that the CDG process is more cost-effective than the PF process.

Several ASP floods also have been pilot tested in various Chinese oil fields. Incremental recoveries of up to 25% OOIP have been reported, although commercial-scale applications have not been implemented. Plans to implement three large-scale projects have been made for 2006 in the Daqing oil field. This paper discusses the progress made in these processes in China over the last 20 years, including field results, new concepts, and economics.

Introduction

The PF concept in the U.S. has been to use a small slug at low polymer concentrations. The amount of polymer used is measured with a combination unit calculated by multiplying the concentration in parts per million (ppm) by the slug size in pore volume (Vp). The 1976 U.S. Natl. Petroleum Council (NPC) study used 125 ppm·Vp. The amount of polymer used in the 1984 NPC study was increased to 240 ppm·Vp, but it was still much less than that used in China. NPC projected incremental recoveries were in the range of 6 to 8% OOIP in successful projects, approximately 50% of that obtained in good-quality reservoirs in the Daqing oil field.

Seven PF pilot tests were conducted in the Daqing oil field from 1972 through 1998. Continued research and field testing led to fieldwide expansion in 1996. There were 31 commercial-scale PF projects in Daqing in 2004, with 2,427 injection wells and 2,916 production wells. Currently, PF is implemented in a total area of 67,759 acres, as shown in Fig. 1. Oil production from PF has been maintained since 1999. The production reached 73.5 million bbl in 2004, approximately 23% of the total field production.

Prevalence of Type 2 diabetes in urban and rural Chinese populations in Qingdao, China

AIMS

To determine the prevalence of diabetes in the Chinese adult population in rural and urban areas of Qingdao city.

METHODS

A population-based cross-sectional study of diabetes was performed in 12 436 (5346 men) Chinese adults (20-74 years old) from 2001 to 2002. Fasting capillary whole blood glucose test (FCG) was performed in all participants and a 2-h 75-g oral glucose tolerance test in those with FCG > or = 6.1 mmol/l following initial screening. The 1999 World Health Organization diagnostic criteria for diabetes were used.

RESULTS

The age-standardized prevalence of diabetes was 6.1% (4.1% for undiagnosed and 2.1% for previously known diabetes) in adults aged 20-74 years. Diabetes prevalence increased with age up to the oldest age group (70-74); in subjects over 50 years of age, the prevalence reached 10%. Men tended to have a higher prevalence of known diabetes than women, whereas the prevalence of undiagnosed diabetes was lower in men than in women (4.6% vs. 3.3%, d.f. = 1, P = 0.001). Diabetes was more prevalent in the urban than in the rural population (6.9% vs. 5.6%, d.f. = 1, P < 0.001). However, the proportion of undiagnosed diabetes was higher in the rural than in the urban areas (70.5% vs. 58.0%, d.f. = 1, P < 0.001).

CONCLUSIONS

The prevalence of Type 2 diabetes in Qingdao city is moderately high, but much higher than reported in 1996. The large proportion of undiagnosed cases of diabetes indicates the lack of public awareness of diabetes and shortage of medical facilities. In view of the huge population in China, the results of this study emphasize the need to improve the early detection and prevention of diabetes in China to prevent the emerging diabetes epidemic.

Effects of smoking, obesity and physical activity on the risk of type 2 diabetes in middle-aged Finnish men and women

OBJECTIVE

To examine the association of cigarette smoking with the risk of type 2 diabetes and to find out whether the association is modified by obesity and physical activity.

DESIGN AND SUBJECTS

A prospective study comprising 41,372 men and women aged 25--64 years without a history of diabetes, coronary heart disease or stroke at baseline. Data on incident cases of diabetes were ascertained through the nationwide Drug Register and the Hospital Discharge Register. During the mean follow-up of 21 years 2770 subjects were diagnosed with type 2 diabetes. The Cox proportional hazards model was used to estimate the effect of smoking and other factors on the risk of type 2 diabetes.

RESULTS

Smoking had a graded association with the risk type 2 diabetes, and it remained significant after controlling for age and major risk factors. The multifactorial-adjusted (age, study year, education, body mass index (BMI), systolic blood pressure, physical activity and coffee and alcohol drinking) hazard ratio was 1.22 [95% confidence interval (CI) 1.04--1.43] amongst men smoking less than 20 cigarettes per day and 1.57 (95% CI 1.34--1.84) amongst men smoking 20 cigarettes per day or more. In women the corresponding hazard ratios were 1.46 (95% CI 1.21--1.76) and 1.87 (95% CI 1.36--2.59) respectively. Smoking increased the risk of type 2 diabetes at all levels of BMI and physical activity.

CONCLUSION

Smoking is a risk factor for type 2 diabetes independently of BMI and physical activity. Prevention of smoking should be encouraged as a part of efforts to reduce the risk of type 2 diabetes, and it will result in other health benefits, too.

Sex differences in cardiovascular and total mortality among diabetic and non-diabetic individuals with or without history of myocardial infarction

AIMS/HYPOTHESIS

We investigated the associations of type 2 diabetes and a history of myocardial infarction (MI) with coronary heart disease, stroke, cardiovascular and total mortality, and whether these effects are different in men and women.

METHODS

Study cohorts included 51,735 Finnish men and women aged 25-74 years. Smoking status and the history of MI and type 2 diabetes were recorded, and height, weight, blood pressure and serum cholesterol levels were measured at baseline. Additional data on the occurrence of diabetes and MI prior to baseline survey were obtained from national hospital discharge and drug registers through computerised register linkage. Mortality data were obtained from the national mortality register.

RESULTS

During a mean follow-up period of 17.2 years, 9,201 deaths were recorded. Hazard ratios (HRs) for coronary mortality were 2.1, 4.0 and 6.4 among men with diabetes alone, men with MI alone, and men with diabetes and MI, respectively, compared with men with neither diabetes nor a history of MI. The corresponding HRs among women were 4.9, 2.5 and 9.4, respectively. The equivalent HRs for cardiovascular and total mortality were 2.2, 3.3 and 6.0, and 1.8, 2.3 and 3.7 in men, and 4.4, 2.4 and 6.5, and 3.2, 1.7 and 4.4 in women, respectively. Diabetic men and women had similar total mortality rates, whereas total mortality rates were markedly higher among men in the other three diabetes-MI categories.

CONCLUSIONS/INTERPRETATION

Diabetes and MI markedly increase cardiovascular and all-cause mortality. In women, the association between diabetes and mortality was stronger than that between MI and mortality, whereas the converse was true among men.

Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE Study

AIMS/HYPOTHESIS

Risk scores have been developed to predict cardiovascular or coronary risk, and while most have included diabetes as a risk factor, none have included lower glucose concentrations, either at fasting or following a 2-h oral glucose tolerance test. This article develops 5- and 10-year risk scores for cardiovascular mortality that include glucose concentrations as well as known diabetes status.

METHODS

Data is from the DECODE cohort: 16,506 men and 8,907 women from 14 European studies. The risk factors studied were as follows: age, fasting and 2-h glucose (including cases of known diabetes), fasting glucose alone (including cases of known diabetes), cholesterol, smoking status, systolic blood pressure and BMI. For an absolute risk score the 1995 country- and sex-specific cardiovascular death rates were used.

RESULTS

In men, for both 5- and 10-year cardiovascular mortality, after adjusting for age and study centre, all studied risk factors, except BMI, were significantly associated with cardiovascular mortality (p<0.05). These results were unchanged in multivariate models with all factors included. In women, after adjusting for age and centre, glucose categories, systolic blood pressure and BMI were predictive of 5-year cardiovascular mortality. With all factors in the model, only age and glucose categories were predictive. In terms of 10-year cardiovascular mortality, smoking status and blood pressures were also predictive in the women. For men and women, the same scores were used for the risk factors, except for age and glucose categories where the hazard ratios differed significantly.

CONCLUSIONS/INTERPRETATION

Including glucose concentrations as well as diabetic status provides quantitative information on cardiovascular risk prediction.

Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemia

AIMS

To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance.

METHODS

Men (1223) and women (1370) aged 45-64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register.

RESULTS

During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72-0.82) than for fasting glucose (0.65, 0.58-0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4-6.2) than for isolated IFG (2.3, 0.9-5.7) as compared with subjects with neither IFG nor IGT.

CONCLUSION

Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention.

Age, body mass index and Type 2 diabetes-associations modified by ethnicity

AIMS/HYPOTHESIS

The aim of this study was to assess the effect of ethnicity on the association between age and body mass index as well as the prevalence of diabetes.

METHODS

We selected population-based studies carried out after 1980 in the DECODE/A studies representing different ethnic groups: 11 European, 1 Maltese, 3 Indian, 2 Chinese and 3 Japanese surveys. The total numbers of subjects were 14,240 men and 15,129 women who were 30 to 89 years of age. Diabetes was diagnosed according to the 1999 World Health Organization criteria based on a standard 75 g OGTT. Sex-specific prevalence of diabetes by age and BMI was stratified by ethnic group, in particular the interaction of ethnicity on the associations between age/BMI and the prevalence of diabetes.

RESULTS

The prevalence of diabetes was higher in studies from India and Malta compared to Japan, China, and the rest of Europe. The association between BMI and diabetes, adjusted for age, showed noticeable differences between the ethnic groups with an increase in prevalence starting at a BMI between 15 and 20 kg/m(2) in the Maltese and Indian populations compared to 25 kg/m(2 )in Europeans.

CONCLUSION/INTERPRETATION

The effect of BMI on the age-adjusted prevalence of Type 2 diabetes was modified by ethnicity with considerably lower thresholds in Indian and Maltese subjects compared to those from the rest of Europe. This difference should be reflected in national and international recommendations regarding "optimal" BMI.

Post-challenge hyperglycaemia is associated with premature death and macrovascular complications

Unravelling the precise association between cardiovascular disease and Type II (non-insulin-dependent) diabetes mellitus has proved problematic, largely as a result of the confusing variety of diagnostic criteria and methodologies used in previous studies of disease-associated risk. More recently, improved standardization and continuing refinements to risk analyses have begun to clarify the relative importance of individual risk factors for macrovascular complications and progression to cardiovascular disease. The evidence accumulated from several large-scale epidemiological and intervention studies strongly indicates that hyperglycaemia and specifically the post-load hyperglycaemia resulting from postprandial glucose excursions is the main factor associated with increasing the risks of morbidity and mortality in Type II diabetes. The DECODE study has de-emphasized the importance of fasting glucose, in contrast to post-load hyperglycaemia, as the principal measurable determinant of exposure to the risk of cardiovascular disease in Type II diabetes. Similarly, the Diabetes Intervention Study identified mealtime hyperglycaemia as an independent risk factor for myocardial infarction and all-cause mortality, while several other studies have also shown that such mortality is better predicted from post-challenge measurement criteria rather than from fasting-glucose criteria. It is likely that postprandial hyperglycaemia is an independent risk factor for atherosclerosis and is also exerting an atherogenic effect indirectly through the clustering of a number of risk factors for atherosclerosis. Whether the relation between post-load hyperglycaemia and the risk of cardiovascular events is causal is still not known.

Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women

AIM/HYPOTHESIS

Leisure-time physical activity can reduce the risk of Type 2 diabetes, but the potential effect of different types of physical activity is still uncertain. This study is to examine the relationship of occupational, commuting and leisure-time physical activity with the incidence of Type 2 diabetes.

METHODS

We prospectively followed 6898 Finnish men and 7392 women of 35 to 64 years of age without a history of stroke, coronary heart disease, or diabetes at baseline. Hazards ratios of incidence of Type 2 diabetes were estimated by levels of occupational, commuting, and leisure-time physical activity.

RESULTS

During a mean follow-up of 12 years, there were 373 incident cases of Type 2 diabetes. In both men and women combined, the hazards ratios of diabetes associated with light, moderate and active work were 1.00, 0.70 and 0.74 (p=0.020 for trend) after adjustment for confounding factors (age, study year, sex, systolic blood pressure, smoking, education, the two other types of physical activity and BMI). The multivariate-adjusted hazards ratios of diabetes with none, 1 to 29, and more than 30 min of walking or cycling to and from work were 1.00, 0.96, and 0.64 (p=0.048 for trend). The multivariate-adjusted hazards ratios of diabetes for low, moderate, high levels of leisure-time physical activity were 1.00, 0.67, and 0.61 (p=0.001 for trend); after additional adjustment for BMI, the hazards ratio was no longer significant.

CONCLUSIONS/INTERPRETATION

Moderate and high occupational, commuting or leisure-time physical activity independently and significantly reduces risk of Type 2 diabetes among the middle-aged general population.

Advanced wound care materials: developing an alginate fibre containing branan ferulate

OBJECTIVE

This laboratory-based study set out to establish whether branan ferulate--a polysaccharide compound available in gels such as as Sterigel (SSL International, UK)--could be successfully added to the fibre of an alginate dressing to provide a superior wound-care dressing.

METHOD

A wet extruder (Howden Engineering Services, UK) was used to produce the fibres. Researchers examined the effect of spinning-bath calcium chloride concentration (used as the coagulant in the fibre-spinning process) on the tensile and absorption properties of alginate fibres containing 25% w/w branan ferulate. Sodium alginate and branan ferulate were separately dissolved in de-ionised water and then stirred together to make up a 5% dope solution. The dope was then forced through a spinneret and into the calcium chloride bath, where fibres were precipitated and then carried over the first set of rollers. The fibres were washed in the next bath and drawn at different rates to enhance their tensile properties. At the 'winding-up' stage the filaments were either passed over a contact heater and into a furnace (dry pick-up) or transferred into acetone baths of increasing concentrations of 50, 80 and 100% aqueous acetate to remove the water (wet pick-up). The moisture content of standard alginate fibres and those with branan ferulate were measured and compared. Breaking load, tenacity and breaking extension, and the quantity of branan ferulate in the fibres were also measured. The process was repeated four times, using different strengths of calcium chloride. Using various draw ratios, the effects of liquid uptake were measured using water, saline and a solution called A (to mimic human blood and exudate-type fluids).

RESULTS

Out of the four calcium chloride concentrations used, 1% concentration appeared to give the highest and most conclusive results for fibre-breaking load, tenacity and breaking extension.

CONCLUSION

A 1% w/v concentration of calcium chloride provides the optimum conditions for achieving suitably strong fibres with adequate absorption capacity, while allowing the least branan ferulate loss during wash and post-production treatments. In a laboratory setting the product showed promise. Research is now needed in a clinical setting and for comparison with existing wound-care products.

Two-hour glucose is a better risk predictor for incident coronary heart disease and cardiovascular mortality than fasting glucose

AIMS

To assess the predictive value of fasting and 2-h glucose after a 75 g glucose load, with regard to incidence of coronary heart disease and cardiovascular mortality.

METHODS AND RESULTS

6766 subjects from five Finnish cohorts aged 30-89 years were followed up for 7-10 years. Hazards ratios associated with increasing glucose concentrations were homogeneous over studies. Multivariate Cox regression analyses showed that the hazards ratio for one standard deviation increase in 2-h glucose after logarithmic transformation was 1.17 (95% CI 1.05-1.30) for coronary heart disease incidence and 1.22 (1.09-1.37) for cardiovascular mortality. For fasting glucose, they were 1.05 (0.94-1.17) and 1.13 (1.01-1.25), respectively. Inclusion of 2-h glucose in the model based on fasting glucose significantly improved the prediction (P<0.005 for coronary heart disease incidence and P<0.025 for cardiovascular mortality), whereas fasting glucose did not add significant information to the model initially based on 2-h glucose (P>0.10 for both events).

CONCLUSION

In subjects without a prior history of diabetes the association of 2-h glucose with coronary heart disease incidence and cardiovascular morality is graded and independent. The results of our study indicate that 2-h glucose is superior to fasting glucose in assessing the risk of future cardiovascular disease events.

High serum insulin-like growth factor binding protein-1 is associated with increased cardiovascular mortality in elderly men

Insulin-like growth factor binding protein-1 (IGFBP-1) has been implicated in the development of cardiovascular disease, but it is not known whether IGFBP-1 is related to cardiovascular mortality. We examined the relation of circulating IGFBP-1 to death from coronary heart disease, cardiovascular disease, and all causes in a cohort study consisting of 622 men aged 65 - 84 years, at baseline in 1984. Fasting serum IGFBP-1 and other risk factors were measured in 1984 and 1989. Cardiovascular events for those who died between 1984 and 1995 were analyzed, and cardiovascular diagnoses were coded centrally according to standardized procedures. Of the 622 men, 358 died between 1984 and 1995; 160 deaths were due to cardiovascular causes, 113 of which were coronary deaths. High fasting serum IGFBP-1 concentration (> 75 percentile) in 1984 was associated with increased five-year total mortality (OR 2.05, 95 % CI 1.41 - 2.99; p < 0.0002), cardiovascular mortality (OR 2.20, 95 % CI 1.37 - 3.50; p < 0.0009) and coronary heart disease mortality (OR 2.29, 95 % CI 1.35 - 3.88; p < 0.002). After adjustment for age, high serum IGFBP-1 concentrations still carried an increased risk of total mortality due to (OR 1.73, 95 % CI 1.16 - 2.59; p < 0.007), cardiovascular (OR 1.91 95 % CI 1.18 - 3.09; p < 0.008) and coronary heart disease (OR 2.02. 95 % CI 1.18 - 3.47; p < 0.01). In conclusion, high fasting serum IGFBP-1 is related to increased five-year total and cardiovascular mortality in elderly men.

Stereochemical control factors in the Hantzsch thiazole synthesis: a Hammett substitution correlation analysis

[reaction--see text] It is possible to correlate the distribution of stereochemical products produced during a Hantzsch thiazole synthesis according to the Hammett free-energy equation. This analysis confirms the presumed control of the rate of epimerization during thiazole formation due to stabilization of a cationic transition state intermediate during dehydration of the thiazoline ring system. In the chemical system under study, the stereochemical outcome of the reaction also appears to occur according to a kinetically controlled protonation of a thiazoline tautomer.

[Magnetic stimulation: theory and advance]

Magnetic stimulation is a noninvasive diagnostic and therapeutic technique. The basic theory of magnetic stimulation is presented briefly. Its advances are elaborated in three aspects of mechanism, instrumentation and applications. The problems in focality, location, safety and its trend are discussed.

[Study on effect of spleen invigorating, qi benefiting and dampness removing Chinese drugs and Western medicine on serum epidermal growth factor in chronic atrophic gastritis patients]

OBJECTIVE

To investigate the effect of various combinations of Spleen invigorating and Dampness removing recipes and western medicine on level of serum epidermal growth factor (sEGF) in patients of chronic atrophic gastritis (CAG).

METHODS

By means of Syndrome Differentiation three groups were divided as (1) Spleen invigorating I group (SI-I); (2) Spleen invigorating II group (SI-II); (3) Dampness removing group (DR); (4) western medicine group (WM); (5) healthy volunteers served as normal control group. The changes of symptoms and sEGF level were determined and compared between groups as well as before and after treatment.

RESULTS

The sEGF in various groups of CAG were higher than that in the normal control (P < 0.01). In patients of SI-I and II groups, symptoms and pathological manifestations were improved significantly (P < 0.01), and sEGF dropped markedly after treatment (P < 0.01 and P < 0.05). The level of sEGF in DR raised after treatment (P < 0.05), but the level of sEGF in WM group lowered insignificantly.

CONCLUSION

Inflammation of gastric mucosa could cause responsive elevation of sEGF in CAG patients. After treated with Spleen invigorating and Dampness removing Chinese drugs, the symptoms of CAG improved, simultaneously with the restoration of sEGF. sEGF could be taken as a sensitive index of the prognosis of CAG.

Reduced membranous and ectopic cytoplasmic expression of beta -catenin correlate with cyclin D1 overexpression and poor prognosis in pancreatic cancer

Beta-catenin is a component of the E-cadherin-catenin cell adhesion complex. It plays also a role in intracellular signaling and can function as an oncogene when it binds to the T-cell factor 4 (Tcf4)-binding site in the promoter region of cyclin D1 and transactivates genes after translocation to the nucleus. We evaluated the immunohistochemical expression pattern of beta-catenin in relationship with cyclin D1 overexpression, tumor grade, clinicopathologic parameters and patients' survival in 43 ductal adenocarcinomas of the pancreas and 5 normal pancreatic tissues. We were able to show that, both reduced membranous beta-catenin expression (25 of 43, 58.1%) and accumulation of beta-catenin in the cytoplasm (28 of 43, 65.1%) correlated significantly with cyclin D1 overexpression (both p < 0.0005). Furthermore, we could show a clear correlation between reduced membranous expression and ectopic cytoplasmic expression of beta-catenin (p < 0.0005). Among patients with carcinomas showing no cytoplasmic expression, the 1-year survival was 86.6% whereas among patients with carcinomas showing cytoplasmic expression only 35.7% survived 1 year (p < 0.01). Co-precipitation experiments revealed reduced beta-catenin bound to the E-cadherin-catenin complex in pancreatic tumor tissues compared with normal pancreatic tissues. These results suggest that beta-catenin may be involved in the tumorigenesis of pancreatic cancer and exhibited its effects mainly by the transactivation of cyclin D1.

Reduced membranous and ectopic cytoplasmic expression of beta -catenin correlate with cyclin D1 overexpression and poor prognosis in pancreatic cancer

Beta-catenin is a component of the E-cadherin-catenin cell adhesion complex. It plays also a role in intracellular signaling and can function as an oncogene when it binds to the T-cell factor 4 (Tcf4)-binding site in the promoter region of cyclin D1 and transactivates genes after translocation to the nucleus. We evaluated the immunohistochemical expression pattern of beta-catenin in relationship with cyclin D1 overexpression, tumor grade, clinicopathologic parameters and patients' survival in 43 ductal adenocarcinomas of the pancreas and 5 normal pancreatic tissues. We were able to show that, both reduced membranous beta-catenin expression (25 of 43, 58.1%) and accumulation of beta-catenin in the cytoplasm (28 of 43, 65.1%) correlated significantly with cyclin D1 overexpression (both p < 0.0005). Furthermore, we could show a clear correlation between reduced membranous expression and ectopic cytoplasmic expression of beta-catenin (p < 0.0005). Among patients with carcinomas showing no cytoplasmic expression, the 1-year survival was 86.6% whereas among patients with carcinomas showing cytoplasmic expression only 35.7% survived 1 year (p < 0.01). Co-precipitation experiments revealed reduced beta-catenin bound to the E-cadherin-catenin complex in pancreatic tumor tissues compared with normal pancreatic tissues. These results suggest that beta-catenin may be involved in the tumorigenesis of pancreatic cancer and exhibited its effects mainly by the transactivation of cyclin D1.

Diagnostic criteria of glucose intolerance and mortality

In 1997 American Diabetes Association (ADA) Expert Committee approved changing the diagnostic criteria for diabetes. The major change is to lower fasting plasma glucose from 7.8 mmol/l to 7.0 mmol/l for diabetes and did not recommend the use of 2-hour 75 g oral glucose tolerance test (OGTT). The decision by the ADA not to recommend the OGTT has been criticised based on the findings of several recent studies, in particularly those from the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) and in Asia (DECODA) Studies. These studies have reported that only 29% of all newly screened diabetic subjects qualified for diabetes on both the fasting and the 2-hour glucose criteria in European and 37% in Asian populations. It has now been clearly shown that elderly and less obese patients are more likely to have diagnostic 2-hour values, whereas fasting hyperglycaemia is more common among obese subjects. Analysis of the prospective DECODE data showed that elevated 2-hour glucose was a better predictor of mortality from all-cause and from cardiovascular and non-cardiovascular diseases than elevated fasting glucose alone. The largest absolute number of excess deaths was observed in subjects with impaired glucose tolerance (IGT), especially in those whose fasting glucose was normal.

[Preliminary study of closing cleft of soft palate at an early age for complete cleft palate]

OBJECTIVE

The aim is to introduce the method closing the soft palate at an early age in order to produce better speech and lessen interruption to the development of maxilla.

METHODS

Clinical data of 37 cases with treated cleft were preliminarily analyzed. Some dental casts were measured.

RESULTS

1. No complications of anaesthesia and surgery. Except 2 cases whose soft palates were split after surgery were observed as they were coughing. 2. A reduction in the width of the hard palate cleft was noticed.

CONCLUSION

Closing the soft palate at an early age is possible and safe. It shows that the Langebeck method could be used to close the hard palate of patients at an early age.

Antihypertensive drugs as predictors of type 2 diabetes among subjects with impaired glucose tolerance

AIMS

to examine the incidence rate of progression to Type 2 diabetes and baseline prognostic risk factors, focusing on hypertension and antihypertensive medication, in a cohort (n=207) with impaired glucose tolerance (IGT).

METHODS

after 2 and 4.6 (1. 9-6.4) years new cases of diabetes were diagnosed by the oral glucose tolerance test (OGTT). Hypertension (BP 160/95 or antihypertensive medication) was included in multiple regression analyses to assess the effect of risk factors on the development of diabetes.

RESULTS

diabetes developed in 32 subjects (19%), an incidence of 41/1000 (95% CI 28-57/1000) person-years. In univariate analyses, progression to diabetes was associated with a high (>9.0 mmol/l) 2-h OGTT value (P=0.008), a high fasting insulin (>12.0 mU/l) level (P=0.000), a high triglyceride (>/=1.3 mmol/l) level (P=0.028), a high BMI (>/=28.0 kg/m(2)) (P=0.013) and hypertension (P=0.003). The risk for the development of diabetes was not increased in hypertensive subjects without antihypertensive medication compared with normotensive subjects (OR 0.8, 95% CI 0.3-2. 6). However, it was increased in subjects with on medication, especially diuretics alone or in combination with other drugs. Hypertensive subjects on diuretics had higher levels of fasting insulin and triglycerides and higher BMIs at baseline than normotensive subjects. After adjustment for 2-h OGTT, fasting insulin, triglycerides and BMI, the OR for diabetes was 7.7 (95% CI 2.1-28.2) in hypertensive subjects using diuretics alone or in combination with other drugs and 2.6 (95% CI 1.0-6.7) in those using other drugs compared with normotensive subjects. The OR of diabetes corresponding to a one-unit increase in the 2-h OGTT concentration was 2.5 (95% CI 1.6-4.0) in the whole cohort.

CONCLUSIONS

the rate of progression from IGT to Type 2 diabetes in this population was similar to that seen in other studies among Caucasian populations. The use of antihypertensive medication, especially diuretics, and a high 2-h OGTT level were significant predictors of subsequent deterioration to diabetes.

Comparison of the fasting and the 2-h glucose criteria for diabetes in different Asian cohorts

AIMS/HYPOTHESIS

The American Diabetes Association recommended that only a single fasting plasma glucose of greater than or equal to 7.0 mmol/l should be used for diagnosing diabetes in epidemiological studies and did not recommend using a 2-h oral glucose tolerance test. We evaluated the effect of diagnostic changes on the prevalence of diabetes and on the choice of subjects diagnosed with diabetes.

METHODS

Existing epidemiological data collected from Asian people between 30 and 89 years of age, was re-analysed separately in 11 population-based studies (n = 17,666), 6 pre-selected hyperglycaemic cohorts (n = 12,221) and one suspected diabetic cohort (n = 8382).

RESULTS

Among the 11 population-based studies, the new fasting glucose criteria resulted in an overall reduction of 1.8% in the prevalence of diabetes, which ranged from a reduction of 4.8% to an increase of 1.7% in the different studies. Of 1215 subjects diagnosed with diabetes by either criteria, only 449 met both criteria, a concordance of 37%. More than half of the diabetic subjects had isolated post-challenge hyperglycaemia and three quarters of the subjects with impaired glucose tolerance, according to the 2-h glucose criteria, were normal according to the fasting glucose criteria. Subjects diagnosed as diabetic based only on the 2-h glucose criteria were, on average, older than those with diabetes according to the fasting criteria.

CONCLUSION/INTERPRETATION

The fasting and the 2-h glucose criteria diagnose different groups of subjects. It would therefore be inappropriate to use the fasting glucose criteria alone for screening diabetes in Asian populations.

[Clinical analysis of 40 patients who were re-operated after prosthetic augmentation mammaplasty]

OBJECTIVE

To summarize the reasons of complications after prosthetic augmentation mammaplasty and explore the optimal preventive measures and therapy.

METHOD

The reasons for 40 patients who were re-operated on after prosthetic augmentation mammaplasty were analyzed in as many aspects as possible, such as the location of the incision, the type of the prosthesis, etc. Preventive measures and therapy of the complications were also summarized.

RESULTS

Capsular contracture was the most common reason for reoperation. The second was prosthetic rupture and translocation. The main reasons resulting in complications included impertinent indications, poor quality of the prosthesis and an incompetent surgeon.

CONCLUSIONS

The key to reduce the complications is proper selection of good prosthesis, strict indications, better comprehension of the knowledge about prosthetic augmentation mammaplasty and a qualified plastic and aesthetic surgeon for the operation. The inareolar incision is the best choice to remedy the complications.

Mortality from all causes and from coronary heart disease related to smoking and changes in smoking during a 35-year follow-up of middle-aged Finnish men

AIMS

The risk of early and late death in relation to smoking and ex-smoking were studied.

METHODS AND RESULTS

A cohort of 1711 Finnish men born between 1900 and 1919 were recruited in 1959 and followed up for 35 years. Information on smoking status was collected at each of six examinations made from 1959 to 1989 using a standardized questionnaire. Vital status at the end of 1994 was collected for every man. The effect of smoking on mortality was assessed using Cox proportional hazards model. Adjusted ratios for 35-year all-cause mortality were 1.62 (95% CI 1.40-1.88) in current smokers and 1.13 (CI 0.93-1.36) in former smokers compared with non-smokers. The hazards ratios for 35-year coronary heart disease mortality were 1. 63 (CI 1.24-2.13) and 1.39 (CI 1.00-1.94), respectively. The risk for 10 year mortality was stronger than for 35 year mortality among both former and current smokers, given the same amount of cigarettes consumed. Men smoking persistently were most at risk, while those who persisted in quitting had no increased risk of death compared with non-smokers.

CONCLUSION

Smoking increases the risk of premature death in middle-aged men and giving up smoking earlier in life can prevent smoking attributable premature death.

Short stature and coronary heart disease: a 35-year follow-up of the Finnish cohorts of The Seven Countries Study

OBJECTIVES

To examine whether short stature is associated with an increased risk of coronary heart disease.

DESIGN

Follow-up study.

SETTING

Two geographically defined areas in eastern and western Finland.

SUBJECTS

A total of 1441 men who were free of coronary heart disease at the start of the follow-up.

MAIN OUTCOME MEASURES

Hazard ratios for fatal and non-fatal coronary heart disease

RESULTS

Height was inversely related to fatal coronary heart disease and incident non-fatal coronary heart disease during the follow-up. These relationships persisted after adjusting for other major cardiovascular risk factors. Comparing the high-risk area in eastern Finland with the low-risk area in south-western Finland, no difference in fatal coronary heart disease and cumulative incidence of non-fatal coronary heart disease was seen in tall men. The increase in risk of coronary heart disease death was 19% for a 10 cm decrease in height (OR = 0.81, 95% CI = 0.68-0.95).

CONCLUSIONS

Our results show that short stature is an independent risk factor for coronary heart disease. Differences in stature partly explain the Finnish east-west difference in the incidence of coronary heart disease.

A general approach to cyathin diterpenes. Total synthesis of allocyathin B(3)

[reaction: see text] The synthesis of allocyathin B(3) from an advanced intermediate possessing the ring system and relative stereochemistry but lacking the isopropyl and hydroxymethyl groups is reported. The isopropyl group was introduced by radical cyclization of a methyl propargyl acetal of an alpha-bromo ketone, and the hydroxymethyl group was generated by Pd-catalyzed carbonylation of a vinyl triflate. The route provides functionalized intermediates that could allow access to more complex members of the cyathin family of diterpenes.

Application of hemodilution in microsurgical free flap transplantation

The intra-operative hemodilution and blood auto-transfusion is a blood-saving technique that can be performed when major blood loss is expected. The effects of this technique were studied in 30 microsurgical free flap transplantation patients. Between 400-600 ml blood was collected from the patients before surgery. The patients received dextran, a balanced salt solution, and glucose with the ratio of 3:1 to the collected blood volume, bleeding, and urine before the blood auto-transfusion. There were no significant changes in RBC, HCT, MCV, blood pressure, or heart rate. Of the 30 free flaps, 28 were successful with a 93.3% survival rate. The safety of intra-operative hemodilution and autologous blood transfusion in microsurgery as well as the effect of hemodilution on transplanted flap survival are discussed in this study.

[Relation of venous drainage and inadequate circulation in the rat pedicled TRAM flap model]

OBJECTIVE

To evaluate the circulatory characteristics of the TRAM flap because the vascular supply to lateral portion of the conventional TRAM (zone 4) occasionally may become compromised resulting in necrosis of fat tissue or requiring segmental excision of the poor perfused tissue.

METHODS

In this study, we designed a rat pedicled TRAM flap model with either inadequate arterial or venous circulation. The skin paddle was photographed and the survival areas were measured on the tenth postoperative day.

RESULTS

The results showed that the group with poor arterial inflow of the flap, which resulted from ligation of the superior deep epigastric artery, exhibited skin necrosis in zone 1 and 2. Venous stasis due to selective ligation of the venous pedicle resulted in necroses of a major area in the lateral part of the flap, especially in zone 4. However, venous stasis may be alleviated by an additional cutaneous venous return system.

CONCLUSIONS

Our results demonstrated that conventional rat TRAM flap with poor arterial inflow differs from that with venous stasis in terms of manifestations and extent of inadequate circulation. Necrosis of the lateral portion of human TRAM flaps may therefore be attributed to problems of venous stasis. Such problems might then be ameliorated by creating an additional cutaneous venous return system.