Insulin glargine maintains equivalent glycemic control and better lipometabolic control than NPH insulin in type 1 diabetes patients who missed a meal

Our goal was to investigate blood glucose and lipometabolism control in type 1 diabetes patients who missed breakfast and the accompanying insulin injection of NPH insulin (NPH) or insulin glargine (glargine) as part of a basal-bolus regimen. This was a multi-center, open-label, controlled study in adults (> or =18 years) with HbA (1c)< or =11.5% on insulin therapy with NPH as basal insulin. Patients were randomized to receive prandial insulin plus either bedtime glargine (n=28) or NPH (n=32). Insulin was titrated to target fasting blood glucose levels 80-130 mg/dl at 06:00-07:00. Patients had no intake of insulin or food between 22:00 and 12:00 the next day. The change in blood glucose levels (07:00-11:00) was similar (27.5 mg/dl vs. 35.4 mg/dl), but the mean blood glucose level was higher with glargine vs. NPH at 22:00 (158.2 mg/dl vs. 130.2 mg/dl). During the period without insulin or food intake, blood glucose decreased with glargine (-25.8 mg/dl) and increased with NPH (+9.1 mg/dl; p=0.0284). Nonesterified fatty acid (07:00 and 09:00-12:00) and beta-hydroxybutyrate (07:00 and 10:00-12:00) levels were lower with glargine vs. NPH (both p<0.05). For patients who miss a morning meal, glargine is associated with maintained glycemic and lipometabolic control compared with NPH insulin.

Adenosine stress protocols for nuclear cardiology imaging

The treadmill test combined with myocardial perfusion imaging (MPI) is a commonly used technique in the assessment of coronary artery disease (CAD). However, there is a group of patients who may not be able to undergo the treadmill test. Pharmacologic stress testing is increasingly utilized for stress perfusion imaging and currently accounts for nearly 40% of all nuclear stress testing [8]. The aim of this study was the introduction of adenosine stress protocols in our nuclear laboratory, and the following, recording and comparing of the frequency and severity of side-effects.

METHODS

We performed two kinds of adenosine stress protocols on 186 patients who underwent MPI with radiotracer 99mTc-sestamibi: 1st: 47 patients underwent AdenoSCAN abbreviated protocol IV. adenosin 140microg/kg/min for 3 minutes; 2nd: AdenoEX combined with low level 50W bicycle exercise in 139 patients. We followed and compared side-effects (minor and major events) between AdenoSCAN and AdenoEX protocol, and established an adequate time for imaging of both protocols.

RESULTS

Compared with AdenoSCAN, AdenoEX protocol was tolerated by all patients; it reduced all side-effects and improved image quality. Using AdenoEX protocol we found that the heart-to-liver ratio was significantly better, and we established a time of imaging of 15 minutes after stress, compared to the AdenoSCAN time of imaging which was a minimum of 45 minutes after stress.

CONCLUSION

This study gives advatages to AdenoEX protocol, because it had fewer side-effects, improved patients' tolerance, improved image quality, and enhanced efficiency and throughput given the opportunity for earlier imaging.

Absorption of ultrashort laser pulses in strongly overdense targets

Absorption measurements on solid conducting targets have been performed in s and p polarization with ultrashort, high-contrast Ti:sapphire laser pulses at intensities up to 5x10{16}W/cm{2} and pulse duration of 8 fs. The particular relevance of the reported absorption measurements lies in the fact that the extremely short laser pulse interacts with matter close to solid density during the entire pulse duration. A pronounced increase of absorption for p polarization at increasing angles is observed reaching 77% for an incidence angle of 80 degrees . Simulations performed using a 2D particle in cell code show a very good agreement with the experimental data for a plasma profile of L/lambda approximately 0.01.

Long-term weight loss effects on all cause mortality in overweight/obese populations

This systematic review assesses the long-term effectiveness of weight loss on all cause mortality in overweight/obese people. Medline, Embase and Cinahl were searched (1966-2005). Cohort studies and trials on participants with body mass index > or =25 kg m(-2), with weight change and mortality with > or =2-year follow-up, were included finally identifying 11 papers based on eight studies. There may be gender differences in the benefits for all cause mortality. The impact of weight loss in men on mortality was not clear with some studies indicating weight loss to be detrimental, while a recent cohort study showed benefits, if it were a personal decision. Other studies with no gender separation had similarly mixed results. However, one study indicated that overweight/obese women with obesity-related illness, who lost weight intentionally within 1 year, had significantly reduced mortality rates of 19-25%. In contrast, studies of overweight/obese diabetics irrespective of gender showed significant benefit of intentional weight loss on mortality in a meta-analysis, hazard ratios = 0.75 (0.67-0.83). There is some evidence that intentional weight loss has long-term benefits on all cause mortality for women and more so for diabetics. Long-term effects especially for men are not clear and need further investigation.

An experimental study of the biomechanical stability of ultrasound-activated pinned (SonicWeld Rx+Resorb-X) and screwed fixed (Resorb-X) resorbable materials for osteosynthesis in the treatment of simulated craniosynostosis in sheep

We compared a conventional resorbable screw osteosynthesis with a resorbable, ultrasound-activated pin osteosynthesis, and studied mechanical load capacity and operative handling. This new form of osteosynthesis aims to reduce operation times, and to avoid torque loads and screw fractures to achieve stability. A sheep craniotomy model simulated an operation for dysmorphia on an infant skull. Two rectangular craniotomies of equal size were created in 13 lamb skulls, and each refixed by different means: the first by mesh and 20 screws, and the second by mesh with 20 pins inserted with ultrasound activation. All osteosynthesis material consisted of resorbable amorphous poly-(d,l)-lactide (PDLLA) (Resorb-X, KLS Martin, Tuttlingen, Germany). The insertion time was recorded. The animals were killed at different times, and areas of the healing skull including the plates and pins or screws were removed and divided into sections, which were then tested. In total 74 pin-fixed and 77 screw-fixed samples were obtained. Bending and tensile tests were used to simulate different forms of loading. The time required for the insertion of pins was significantly shorter than for screws. The mechanical tests showed differences in the stability of the bond between the osteosynthesis plate and bone that depended on the osteosynthesis system and the length of time it was in the animal. The pin osteosynthesis gave a stable mechanical load capacity, which was significantly different from that of screw osteosynthesis. Advantages of ultrasound-assisted, resorbable, pin osteosynthesis, include optimum operative handling, reduced insertion time, avoidance of fractures of the fixation elements and higher three-dimensional load capacity.

Unique gene structure and paralogy define the 7D-cadherin family

Cadherins are Ca2+-dependent transmembrane glycoproteins crucial for cell-cell adhesion in vertebrates and invertebrates. Classification of this superfamily due to their phylogenetic relationship is currently restricted to three major subfamilies: classical, desmosomal and protocadherins. Here we report evidence for a common phylogenetic origin of the kidney-specific Ksp- (Cdh16) and the intestine-specific LI-cadherin (Cdh17). Both genes consist of 18 exons and the positions of their exon-intron boundaries as well as their intron phases are perfectly conserved. We found an extensive paralogy of more than 40 megabases in mammals as well as teleost fish species encompassing the Ksp- and LI-cadherin genes. A comparable paralogy was not detected for other cadherin gene loci. These findings suggest that the Ksp- and LI-cadherin genes originated by chromosomal duplication early during vertebrate evolution and support our assumption that both proteins are paralogues within a separate cadherin family that we have termed 7D-cadherins.

Salivary cortisol measurement--a reliable method for the diagnosis of Cushing's syndrome

The measurement of cortisol in saliva is becoming more widely accepted as a screening test for the diagnosis of hypercortisolism. Since 1986, cortisol measurement in saliva has been continuously used in our department. In this study we compared salivary cortisol profiles from proven Cushing's disease patients with profiles from healthy subjects and obese children. The purpose was to evaluate the predictive value of the method for the diagnosis of hypercortisolism and to define cut-off levels to exclude or identify hypercortisolism. Cortisol in saliva was measured in 150 Cushing's disease patients (30 children, 120 adults, ranging from age 4-70), 100 healthy subjects (55 children, 45 adults, ranging from age 6-60), and 31 children (age 7-15) with an age-related body-mass-index above the 90th percentile. Generally, five saliva samples were taken over the day at 6:00-8:00 a.m., 11:00-12:00 a.m., 4:00-6:00 p.m., 7:00-8:00 p.m., and 10:00 p.m. The samples were measured using a radioimmuno-assay (INCSTAR Corporation, Stillwater, Minnesota, USA). For healthy subjects, morning levels of cortisol in saliva between 3-19 microg/l were found. These levels dropped to levels in between <1-11 microg/l at 11:00-12:00 a.m., <1-6 microg/l at 4:00-6:00 p.m., <1-4.5 microg/l at 7:00-8:00 p.m., and <1-2.9 microg/l at 10:00 p.m. The measured values showed a correlation with age, height, and weight. In Cushing's disease patients, the circadian salivary cortisol rhythm was missing, compared to healthy subjects. There was no significant difference in salivary cortisol levels or circadian rhythm between healthy or obese children. We found a high sensitivity for the detection of hypercortisolism at the 10:00 p.m. salivary cortisol measurement. The following, age dependent cut-off levels for salivary cortisol at 10:00 p.m. were calculated for the exclusion of hypercortisolism. Age 6-10: 1.0 microg/l (specificity 100%, sensitivity 87.5%); age 11-15: 1.7 microg/l (specificity 100%, sensitivity 100%); age 16-20: 1.6 microg/l (specificity 100%, sensitivity 76.2%); age 21-60: 1.6 microg/l (specificity 100%, sensitivity 90.9%) [corrected] For the proof of Cushing's syndrome, the following age-dependent cut-off levels at 10:00 p.m. were found: age 6-10: 1.9 microg/l (specificity 100%, sensitivity 80%); age 11-15: 1.7 microg/l (specificity 100%, sensitivity 100%); age 16-20: 2.5 microg/l (specificity 100%, sensitivity 84.2%); age 21-60: 1.9 microg/l (specificity 100%, sensitivity 97.6 %) [corrected] The cortisol assessment in saliva is a sensitive and reliable method to discriminate normocortisolemic from hypercortisolemic patients. From our view, the major advantages of this method are the reliability, non-invasiveness, and use in ambulatory patients.

Study of electron-beam propagation through preionized dense foam plasmas

The transport of an intense electron-beam produced by the Vulcan petawatt laser through dense plasmas has been studied by imaging with high resolution the optical emission due to electron transit through the rear side of coated foam targets. It is observed that the MeV-electron beam undergoes strong filamentation and the filaments organize themselves in a ringlike structure. This behavior has been modeled using particle-in-cell simulations of the laser-plasma interaction as well as of the transport of the electron beam through the preionized plasma. In the simulations the filamentary structures are reproduced and attributed to the Weibel instability.

Age effects on interleukin-6 and interleukin-1beta responses to endurance exercise in patients with neuromuscular diseases

Plasma IL-6 before and 20 min after prolonged muscular exercise for 20 min at the individual aerobic/anaerobic threshold was analyzed in patients with neuromuscular diseases and in controls. Patients were assigned to the following diagnostic categories: Controls (n=18); amyotrophic lateral sclerosis (n=7); peripheral neuropathy (n=6); muscular dystrophy (n=13); mitochondriopathy (n=3); myopathy (others) (n=3); inflammatory myopathy (n=6); mononeuropathy (n=4). The concentrations of IL-6 before exercise were 5.55+/-0.94 pg/ml, and 6.52+/-0.97 pg/ml after exercise (P=0.0001). We introduced the independent variables age, sex and diagnostic category into a stepwise multiple linear regression model. Age emerged as a significant predictor of the IL-6 ratio (IL-6 post exercise/lL-6 before exercise). The regression equation was: IL-6 ratio=0.87+0.009xage (years), R=0.33, P<0.01, simple linear regression model. All IL-1beta concentrations were below the sensitivity of the assay (5 pg/ml). Concerning patients with neuromuscular diseases, the age associated increased IL-6 release after exercise could mean additional muscle damage.

[The prevalence of pain and deformities in the feet of adolescents. Results of a cross-sectional study]

AIM

The purpose of the study was to evaluate the prevalence of foot pain and foot deformities in adolescents. It was aimed to obtain information on the association between foot pain and foot deformities.

METHOD

A total of 2 368 adolescents (age 14.5 +/- 0.7 years) were evaluated. The frequency of foot pain was probed by using a self-reporting questionnaire. The foot deformities were evaluated during clinical examinations by school doctors.

RESULTS

The prevalence of foot pain was 14.0 % and the prevalence of foot deformities was 13.7 %. The prevalence of pain was significantly higher in adolescents with foot deformity (17.8 %) than in persons without deformity (13.4 %), p < 0.05. The prevalence of a flexible flat foot was 6.2 % and the prevalence of a rigid flat foot was 0.5 %. Other deformities registered were splay foot (2.3 %) and flexible splay-flat foot (2.0). The prevalence of hallux-valgus deformity was 3.5 %. A total of 3.5 % patients were suffering from a plantar hyperkeratosis. This was significantly correlated to a high pain prevalence (the hyperkeratosis was significantly associated with a high prevalence of pain). Significant factors which were significantly associated with foot pain were foot deformity (1.4 fold) and hyperkeratosis (75 fold). Foot pain was 1.4 fold higher in children with foot deformity and 75 fold higher in feet with hyperkeratosis.

CONCLUSION

The prevalence of foot pain and foot deformity in adolescent is high. Mild deformities (flexible flat foot and splay foot) are physiological variations without any association to foot pain. Pathological conditions that are associated with foot pain are the rigid flat foot, the hallux valgus and the cavus deformity. Plantar hyperkeratosis is an indicator of foot pathology.

Pharmacokinetics of perfluorooctanoate in cynomolgus monkeys

The pharmacokinetics of perfluorooctanoate (PFOA) in cynomolgus monkeys were studied in a six-month oral capsule dosing study of ammonium perfluorooctanoate (APFO) and in a single-dose iv study. In the oral study, samples of serum, urine, and feces were collected every two weeks from monkeys given daily doses of either 0, 3, 10, or 20 mg APFO/kg. Steady-state was reached within four weeks in serum, urine, and feces. Serum PFOA followed first-order elimination kinetics after the last dose, with a half-life of approximately 20 days. Urine was the primary elimination route. Mean serum PFOA concentrations at steady state in the 3, 10, and 20 mg/kg-day dose groups, respectively, were 81, 99, and 156 microg/ml in serum; 53, 166, and 181 microg/ml in urine; and, 7, 28, and 50 microg/g in feces. Mean liver concentrations reached 16, 14, and 50 microg/g in the 3, 10, and 20 mg/kg groups, respectively. In the iv study, three monkeys per sex were given a single dose of 10 mg/kg potassium PFOA. Samples were collected through 123 days. The terminal half-life of PFOA in serum was 13.6, 13.7, and 35.3 days in the three male monkeys and 26.8, 29.3, and 41.7 days in the three females. Volume of distribution at steady state was 181 +/- 12 and 198 +/- 69 ml/kg for males and females, respectively. Based on the result of both the oral and iv studies, the elimination half-life is approximately 14-42 days, and urine is the primary route of excretion.

Prävalenz funktioneller Beschwerden des Rückens und der Hüft- und Kniegelenke bei Adoleszenten

OBJECTIVE

To determine the prevalence of functional back, hip and knee pain in adolescents. Risk factors which are associated with these complaints also should be detected.

METHODS

A total of 2368 adolescents were included (1137 male, 1231 female, age 14.5 +/- 0.7 years). The persons were interviewed in a self-reported questionnaire about episodes of back, hip and knee pain, furthermore sociodemographic information, activity in sports and consumption of legal drugs (tobacco and alcoholic beverages). All adolescents were examined by school doctors to determine back, hip and knee pathologies.

RESULTS

A total of 62.4 % of the adolescents were suffering from musculo-skeletal pain (back 45.4 %, hip 6.4 % and knee 33.6 %). The prevalence of pathological findings was: back 18.0 %, hip 2.7 % and knee 28.5 %. Summarized the prevalence of functional pain was 34.5 % for back pain, 5.7 % for hip pain and 28.5 % for knee pain. There were significantly with functional pain associated factors. Male sex was significantly associated with functional back and hip pain. Knee pain was associated with sports activity. Adolescents who were visiting a high school and adolescents who were smoker had a significant higher prevalence of functional pain.

CONCLUSION

The majority of functional back, hip and knee pain in adolescents must be classified as functional complaints. There is a significant association with female sex, visiting a high school and the consumption of legal drugs.

Surveillance of multi-drug resistant Pseudomonas aeruginosa in an urban tertiary-care teaching hospital

Antimicrobial resistance in Pseudomonas aeruginosa is a serious clinical problem. To determine the incidence of multi-drug resistant P. aeruginosa, resistance rates of P. aeruginosa clinical isolates against commonly used antibiotics were evaluated for the period 1998 to 2002. Multi-drug resistance was defined as resistance to at least three of the four drugs, ceftazidime, imipenem, ciprofloxacin, and tobramycin. Resistance to most anti-pseudomonal agents has increased by >20% over the five-year period, with dramatic increases observed with fluoroquinolones, tobramycin, and imipenem (resistance increased by 34-37%). In 1998, 78% of isolates were susceptible to all four anti-pseudomonal agents and no isolate was considered multi-drug resistant. However, in 2002, only 27% of isolates were sensitive to all four of the drugs and 32% were considered multi-drug resistant. Multi-drug resistance in individual institutions may be significantly higher than rates reported in nationwide surveillance studies and may more accurately reflect the true magnitude of local resistance problems. On-going surveillance within individual institutions is critical for the selection of appropriate empiric antimicrobial therapy.

Use of exogenous erythropoietin in critically ill patients

OBJECTIVE

Review the literature regarding the use of recombinant human erythropoietin (rHuEPO) to prevent red blood cell (RBC) transfusion in critically ill patients.

DATA SOURCES

A computerized search of MEDLINE and EMBASE from 1966 through June 2003 was conducted using the terms erythropoietin, anemia, hemoglobin, critical care, intensive care, surgery, trauma, burn, and transfusion. References of selected articles were reviewed. A manual search of critical care, surgery, trauma, burn, hematology, and pharmacy journals was conducted to identify relevant abstracts.

RESULTS

Six randomized studies have evaluated exogenous administration of erythropoietin to prevent RBC transfusions in critically ill patients. Studies vary with respect to rHuEPO dosage regimens, dose of concurrently administered iron, patient characteristics, and transfusion thresholds. Administration of rHuEPO rapidly produces erythropoiesis to reduce the need for RBC transfusions. The largest study conducted to date used weekly rHuEPO administration and found a modest decrease in transfusion requirements although the time to first transfusion was delayed. Reduced intensive care unit (ICU) length of stay (LOS) was shown in only one study of surgical/trauma patients. Reduced LOS after ICU discharge was found in another study of severely ill patients (APACHE II score >22). Other clinical outcomes were not altered by rHuEPO use. No adverse events were associated with rHuEPO use although studies were not designed to evaluate safety.

CONCLUSIONS

rHuEPO reduces the need for transfusions. A cost-effectiveness analysis of rHuEPO for this indication is needed. Defining an optimal dosage regimen, identifying patients most likely to respond to rHuEPO, and determining risk factors for ICU associated anaemia would provide information for appropriate rHuEPO utilization.

Phylogenetic origin of LI-cadherin revealed by protein and gene structure analysis

The intestine specific LI-cadherin differs in its overall structure from classical and desmosomal cadherins by the presence of seven instead of five cadherin repeats and a short cytoplasmic domain. Despite the low sequence similarity, a comparative protein structure analysis revealed that LI-cadherin may have originated from a five-repeat predecessor cadherin by a duplication of the first two aminoterminal repeats. To test this hypothesis, we cloned the murine LI-cadherin gene and compared its structure to that of other cadherins. The intron-exon organization, including the intron positions and phases, is perfectly conserved between repeats 3-7 of LI-cadherin and 1-5 of classical cadherins. Moreover, the genomic structure of the repeats 1-2 and 3-4 is identical for LI-cadherin and highly similar to that of the repeats 1-2 of classical cadherins. These findings strengthen our assumption that LI-cadherin originated from an ancestral cadherin with five domains by a partial gene duplication event.

Ksp-cadherin is a functional cell–cell adhesion molecule related to LI-cadherin

Ksp- and LI-cadherin are structurally homologous proteins coexpressed with E-cadherin in renal and intestinal epithelia, respectively. Whereas LI-cadherin has been shown to mediate Ca2+-dependent homotypic cell-cell adhesion independent of stable interactions with the cytoskeleton, little is known about the physiological role of Ksp-cadherin. To analyze its potential adhesive and morphoregulatory functions, we expressed murine Ksp-cadherin in CHO cells. In this report, we show that Ksp-cadherin induces homotypic and Ca2+-dependent cell-cell adhesion that can be specifically blocked with antibodies raised against the cadherin repeats EC1 and EC2. Ksp-cadherin mediates about the same quantitative adhesive effect (aggregation index) as LI- and E-cadherin. However, the cellular phenotype induced by Ksp-cadherin resembles more closely that of LI- than E-cadherin. This could reflect our observation, that Ksp-cadherin, as well as LI-cadherin, does not directly interact with beta-catenin. In conclusion, both cadherins are thus not only structurally but also functionally related and may share other functions within their respective epithelia.

Weight loss in obese diabetic and non-diabetic individuals and long-term diabetes outcomes--a systematic review

The aim was to review the evidence for the long-term effects of weight loss on diabetes outcomes in obese people or for those at risk of developing type 2 diabetes. Current evidence is mostly based on short-term studies. This is a systematic review of long-term outcomes of weight loss in studies published between 1966 and 2001. Eleven long-term studies with a follow up of more than 2 years were included. Results show that those with diabetes who lost weight intentionally significantly reduced their mortality risks by 25%. Additionally, weight loss of 9-13 kg was most protective. Patients with the risk of developing diabetes due to either family history of diabetes or impaired glucose tolerance, saw a reduction in this risk. Those with large weight losses achievable with surgical interventions reduced their risk by at least 63%. Metabolic handling of glucose improved in 80% of those already with type 2 diabetes who lost weight. Based on one large study, intentional weight loss in obese patients appears to have a beneficial effect on mortality risk for those with type 2 diabetes. Clearly, further studies are needed to endorse this. The risk of developing diabetes being reduced by weight loss was shown in seven studies. However, the results were from studies with different analytical adjustments and outcome indices, making it difficult to make direct comparisons and should be viewed with caution. More long-term prospective studies need to be conducted with commitment to improving the methodological quality and standardization, in order to accurately assess the long-term effects of weight loss for obese diabetic and non-diabetic individuals.