Distinct changes in serum metabolites and lipid species in the onset and progression of NAFLD in Obese Chinese

Introduction

Metabolic disturbances are major contributors to the onset and progression of non-alcoholic fatty liver disease (NAFLD), which includes a histological spectrum ranging from single steatosis (SS) to non-alcoholic steatohepatitis (NASH). This study aimed to identify serum metabolites and lipids enriched in different histological stages of NAFLD and to explore metabolites/lipids as non-invasive biomarkers in risk prediction of NAFLD and NASH in obese Chinese.

Methods

Serum samples and liver biopsies were obtained from 250 NAFLD subjects. Untargeted metabolomic and lipidomic profiling were performed using Liquid Chromatography-Mass Spectrometry. Significantly altered metabolites and lipids were identified by MaAsLin2. Pathway enrichment was conducted with MetaboAnalyst and LIPEA. WGCNA was implemented to construct the co-expression network. Logistic regression models were developed to classify different histological stages of NAFLD.

Results

A total of 263 metabolites and 550 lipid species were detected in serum samples. Differential analysis and pathway enrichment analysis revealed the progressive patterns in metabolic mechanisms during the transition from normal liver to SS and to NASH, including N-palmitoyltaurine, tridecylic acid, and branched-chain amino acid signaling pathways. The co-expression network showed a distinct correlation between different triglyceride and phosphatidylcholine species with disease severity. Multiple models classifying NAFLD versus normal liver and NASH versus SS identified important metabolic features associated with significant improvement in disease prediction compared to conventional clinical parameters.

Conclusion

Different histological stages of NAFLD are enriched with distinct sets of metabolites, lipids, and metabolic pathways. Integrated algorithms highlight the important metabolic and lipidomic features for diagnosis and staging of NAFLD in obese individuals.

Out-of-Hospital Cardiac Arrest in a Teaching Hospital in Hong Kong: Descriptive Study Using the Utstein Style

Objective

To describe, using the Utstein template, the characteristics of patients presenting with out-of-hospital cardiac arrest to a university teaching hospital in the New Territories of Hong Kong, and to evaluate survival.

Design

Prospective study.

Setting

The emergency department of a teaching hospital in the New Territories, Hong Kong.

Participants

Patients older than 12 years with non-traumatic out-of-hospital cardiac arrest who were transported to the hospital between 1 July 2002 and 31 December 2002.

Main outcome measures

Demographic data, characteristics of cardiac arrest and response time intervals of the emergency medical service presented according to the Utstein style, and also survival to hospital discharge rate.

Results

A total of 124 patients were included (49.2% male; mean age 71.9 years). The majority of cardiac arrests occurred in patients' home. The overall bystander cardiopulmonary resuscitation (CPR) rate was 15.3% (19/124). The most common electrocardiographic rhythm at scene was asystole, whilst pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) was found in 18.0%. The overall survival was 0.8% (1/124), and survival to hospital discharge was significantly higher for patients with VF or pulseless VT than those patients with other rhythms of cardiac arrest (11.1% versus 0%). The median witnessed/recognised collapse to defibrillation time was 14 minutes. The median prehospital time interval from collapse/recognition to arrival at hospital was 33 minutes.

Conclusion

The prognosis of out-of-hospital cardiac arrest in Hong Kong was poor. Major improvements in every component of the chain of survival are necessary.

Defects in ZnO nanorods prepared by a hydrothermal method

ZnO nanorod arrays were fabricated using a hydrothermal method. The nanorods were studied by scanning electron microscopy, photoluminescence (PL), time-resolved PL, X-ray photoelectron spectroscopy, and positron annihilation spectroscopy before and after annealing in different environments and at different temperatures. Annealing atmosphere and temperature had significant effects on the PL spectrum, while in all cases the positron diffusion length and PL decay times were increased. We found that, while the defect emission can be significantly reduced by annealing at 200 degrees C, the rods still have large defect concentrations as confirmed by their low positron diffusion length and short PL decay time constants.

Expression of a novel T-complex testis expressed 5 (Tctex5) in mouse testis, epididymis, and spermatozoa

Expression of T-complex testis expressed 5 (Tctex5), an orthologue of protein phosphatase-1 inhibitor-3 (PPP1R11), was enhanced in mouse testis and was also expressed in epididymis and spermatozoa. There were three transcripts of Tctex5 including one brain specific and two common transcripts dominant in mouse testis. Tctex5 protein isoforms (75, 52, 32, 25, and 14.3 kDa) were identified. Isoforms of 75 and 52 kDa were spermatogenic-specific and were found in protein fraction containing nuclei, mitochondria, and flagellum accessory, and also in protein fraction containing mainly membranes. Tctex5 was localized in nuclei of pachytene spermatocytes, round spermatocytes, cytoplasm of Sertoli cells in testis; cilia, secretion bodies and nuclei of epithelial cells and interstitium smooth muscle cells in epididymis; and head and principal piece of tail in epididymal spermatozoa. The results suggested that Tctex5 might be a specific protein phosphatase-1 inhibitor in sperm; various Tctex5 transcripts and isoforms and cellular locations imply its different roles in spermatogenesis. Nuclei-type isoforms (75 and 52 kDa) might take part in nucleus remodeling during spermatogenesis whilst membrane-type isoform (52 kDa) might be responsible for dephosphorylation of proteins during capacitation. The other isoforms might play general roles for all kinds of cell types.

By what mechanism do leeches help to salvage ischaemic tissues? A review

The therapeutic use of leeches in medicine dates back to 50 b.c. and was cited by ancient authors. The medicinal leech, Hirudo medicinalis, has been used with increasing frequency during the past few years by reconstructive surgeons to help salvage ischaemic tissues. We aim to summarise the anatomy, physiology, and pharmacological mechanisms of action of leeches to provide reconstructive surgeons with a theoretical basis for their use.

Beliefs about elderly people among social workers and the general public in Hong Kong

Social learning theory expects the social worker to hold more favorable beliefs about elderly people and scapegoat theory expects one having higher self-esteem to be so. The role of social work and self-esteem may be factors explaining ageism at the individual level. Because ageism seems to emerge in Hong Kong as well as other industrialized societies, the study surveyed the general public, social workers, students, elderly center members to (1) determine the relative extent of ageism in terms of beliefs about physical, social, and psychological dimensions of elderly people, and (2) test hypotheses deriving from social learning and scapegoat theories. Analysis of data from 902 respondents showed that people younger than 60 years were more favorable regarding the social dimension and less favorable regarding the psychological dimension of beliefs about elderly people. One with higher self-esteem tended to be more favorable in beliefs about social and psychological dimensions of elderly people but less favorable in the belief about the physical dimension. Although the gerontological social worker was more favorable in the belief regarding the social dimension of elderly people than others, this difference might be attributable to his or her higher self-esteem. Hence the role of social work did not necessarily improve one's image of elderly people in Hong Kong.

PCDD/PCDF, chlorinated pesticides and PAH in Chinese teas

Four samples of Chinese tea (two green teas, and two brick teas) were analyzed for their concentrations of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/PCDF), chlorinated pesticides and PAH. The infusions prepared from these teas were also analyzed for PCDD/PCDF. The levels of DDT and its metabolites in tea leaves were within the safety limit of 0.2 mg/kg. Rather high levels of total PAH were obtained in brick tea (1,048-1,162 mg/kg). when compared with green tea (497-517 mg/kg). In terms of PCDD/PCDF, the concentrations of green tea and brick tea differed by a factor of 16, while the concentrations of all infusions were within a factor of 2. The dioxin concentrations in green tea leaves can be explained through uptake of atmospheric PCDD/PCDF. The higher concentrations in the brick tea leaves are due the longer exposure time, and to certain extent, the use of old leaves, branches and roots when making the tea, and additional components such as soil particulates through contamination. Certain Chinese populations drinking a large amount of brick tea (>31 per day) indicated that individuals of these populations consume more tea than Europeans or North Americans result in a comparably higher intake of PCDD/PCDF. Tea consumption can attribute to up to 10% of the TDI recommended by WHO (only PCDD/PCDF considered, no PCB analyzed).

Cyberostracism: effects of being ignored over the Internet

Ostracism is such a widely used and powerful tactic that the authors tested whether people would be affected by it even under remote and artificial circumstances. In Study 1, 1,486 participants from 62 countries accessed the authors' on-line experiment on the Internet. They were asked to use mental visualization while playing a virtual tossing game with two others (who were actually computer generated and controlled). Despite the minimal nature of their experience, the more participants were ostracized, the more they reported feeling bad, having less control, and losing a sense of belonging. In Study 2, ostracized participants were more likely to conform on a subsequent task. The results are discussed in terms of supporting K. D. Williams's (1997) need threat theory of ostracism.

Cyberostracism: effects of being ignored over the Internet

Ostracism is such a widely used and powerful tactic that the authors tested whether people would be affected by it even under remote and artificial circumstances. In Study 1, 1,486 participants from 62 countries accessed the authors' on-line experiment on the Internet. They were asked to use mental visualization while playing a virtual tossing game with two others (who were actually computer generated and controlled). Despite the minimal nature of their experience, the more participants were ostracized, the more they reported feeling bad, having less control, and losing a sense of belonging. In Study 2, ostracized participants were more likely to conform on a subsequent task. The results are discussed in terms of supporting K. D. Williams's (1997) need threat theory of ostracism.

Public evaluation of an announcement of public interests communicated by an AIDS patient

Announcements of public interests (APIs) on television (TV) have been an important means of AIDS prevention. Recently in Hong Kong, the first API on TV which was communicated by a male AIDS patient, named J.J., was displayed on the screen from April to December, 1995. The objective of this study is to examine the effectiveness of this API, as compared with other APIs previously shown in Hong Kong. Collecting data from a random sample of 1,275 residential respondents in Hong Kong through a telephone survey, this study demonstrated that the public gave very favorable evaluation on J.J.'s API, when compared with other APIs. Remarkable impacts of J.J.'s API on the public included increasing concern for AIDS, condom use, and testing blood for HIV infection, and reducing the number of sex partners. The impacts tended to be more salient on male than female viewers. Some of these impacts also appeared to vary by different levels of education and family income.

Job satisfaction, work values, and sex differences in Taiwan's organizations

This study of 927 employees in Taiwan is an attempt to explain job satisfaction and sex differences with reference to work values. Initially, the results confirmed that both job satisfaction and work values consisted of 4 common dimensions pertaining to the task, team, reward, and status. Subsequent analyses showed that male employees had higher rank and higher task, team, and status satisfaction than did female employees. The sex difference was not attributable to differences in work values. Placing higher values on the task and team dimensions and a lower value on the reward dimension seemed to lead to greater job satisfaction.

Validating an American scale in Hong Kong: the Center for Epidemiological Studies Depression Scale (CES-D)

The construct validity of a Chinese-language version of the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977) was tested on a sample of 138 Hong Kong Chinese married couples. Confirmatory factor analysis identified 2 factors: (a) depressive symptom factors and (b) interpersonal problem factors. Those factors attained convergent, discriminant, and structural validity when evaluated against social desirability. The CES-D also manifested nomological validity in terms of its significant relationships with measures of life satisfaction and stressful life events.

Parental distress and children's problems among single-parent families in China

The coercion model explains reciprocal relationships between parents' and children's adjustment problems, with the mediation of parenting behavior and social relationships. A survey of 301 single parents in Guangzhou, China, was performed to test such a model with reference to parental distress, perceived behavioral problems and anxiety of the eldest child, acceptance of the child, and experienced social pressure and social support. Structural equation modeling demonstrated a good fit of the coercion model as a theoretically based and simplified representation of the relationships, supporting the hypotheses that (a) the parent's acceptance helps prevent the child's behavioral problems, (b) the child's behavioral problems and anxiety contribute to the parent's distress, (c) the child's behavioral problems and anxiety invite social pressure on the parent, (d) social pressure on the parent aggravates and social support for the parent attenuates the parent's distress, (e) social pressure on and social support for the parent facilitate the parent's acceptance of his or her child. However, the effect of parental distress on acceptance of the child was not significant.

Toward a theoretically based measurement model of the good life

A theoretically based conceptualization of the good life should differentiate 4 dimensions-the hedonist good life, the dialectical good life, the humanist good life, and the formalist good life. These 4 dimensions incorporate previous fragmentary measures, such as life satisfaction, depression, work alienation, and marital satisfaction, to produce an integrative view. In the present study, 276 Hong Kong Chinese husbands and wives responded to a survey of 13 indicators for these 4 good life dimensions. Confirmatory hierarchical factor analysis showed that these indicators identified the 4 dimensions of the good life, which in turn converged to identify a second-order factor of the overall good life. The model demonstrates discriminant validity in that the first-order factors had high loadings on the overall good life factor despite being linked by a social desirability factor. Analysis further showed that the second-order factor model applied equally well to husbands and wives. Thus, the conceptualization appears to be theoretically and empirically adequate in incorporating previous conceptualizations of the good life.

Motor power pharmacodynamics of subarachnoid hyperbaric 5% lidocaine in the sitting position

BACKGROUND

Repetitive dynamometric measurement using a plantar flexion power device (PFPD) provides detailed data describing the onset and offset of motor block following spinal administration of lidocaine. The aim of this study was to evaluate administration of two doses of spinal lidocaine in the sitting position to determine whether our dynamometric model produces data consistent with our current understanding of the pharmacokinetics of subarachnoid, hyperbaric, 5% lidocaine.

METHODS

Twenty male patients (54 to 80 yr) undergoing cystoscopy received spinal anaesthesia with either 75 mg (n = 10) or 100 mg of hyperbaric lidocaine 5%, in the sitting position, under standardised conditions. Plantar flexion muscle power was recorded during onset and offset of anaesthesia using a load cell interfaced with a computer (PFPD).

RESULTS

Onset of paralysis following spinal block in the sitting position was rapid and complete with motor power declining exponentially to 5% of preoperative values by 8.5 min in all patients. There was no difference in decay or recovery of plantar flexion motor power data between dosage groups in the sitting position. Measurement using the PFPD shows that onset of motor paralysis is described by an exponential decay and that motor recovery occurs at a fixed rate. Extent of block to cold and pinprick was similar in both dosage groups in the sitting position (median T4).

CONCLUSION

This study shows that in the sitting position, doses less than 75 mg of 5% hyperbaric lidocaine are required to significantly improve ambulatory times.

Accuracy, precision and user-acceptability of self blood glucose monitoring machines

The performance of six self-monitoring blood glucose (SMBG) machines (Accutrend, Reflolux S, Companion 2, Glucometer GX, Glucometer IV and One Touch II) were examined using venous blood samples from 88 patients. Whole blood glucose (BG) values were measured by four machines from each brand. Machine-generated whole blood glucose (BG) values were corrected before comparison with laboratory plasma glucose values, measured by a glucose oxidase method. Based on error grid analysis, most of the corrected machine-generated BG values were clinically acceptable. Accutrend, Glucometer IV and Companion 2 showed the greatest consistency between machines of the same brand. Over 80% of corrected BG values generated by Glucometer IV fell within +/-10% of the reference values. One Touch II yielded the most reproducible results with a mean CV of 2.7% and was considered the most user friendly machine. More studies are required to examine the performance of these machines in the hands of patients.

World understanding and well-being in a Hong Kong Chinese marital context

According to social constructionist theory, an individual's understanding of the world serves to maintain social order and well-being. In this study, this assertion was tested by investigating a mediating process through the contribution of world understanding to problem-solving confidence. Causal modeling with data from 138 married couples in Hong Kong supported this mediating process: World understanding was positively related to problem-solving confidence, which in turn was positively related to well-being, defined by life satisfaction and depression. In addition, social support and exposure to information were possible determinants of one's world understanding. Social support also contributed to problem-solving confidence and well-being. The causal model was applicable to both husbands and wives.

Interference of creatinine measurement in CAPD fluid is dependent on glucose and creatinine concentrations

BACKGROUND

High glucose concentration in CAPD fluid is known to interfere with creatinine measurement, which is required for assessment of peritoneal membrane permeability and adequacy of dialysis. Correction formulae have been proposed but they may be method/analyser-dependent. We studied such interference in detail.

METHODS

CAPD fluid was diluted to prepare six specimens with glucose concentrations ranging from 9.1 to 154.4 mmol/l. To each specimen, creatinine standard was added to give five different concentrations from 50 to 800 mumol/l. The 30 specimens were assayed for creatinine with six routine clinical chemistry analysers (Hitachi 911 and 747, Technicon RAXT and SMAC3, Beckman CX7, and Kodak Ektachem 700). Creatinine interference was calculated by subtracting the apparent creatinine concentration with corresponding baseline creatinine concentration (measured at glucose = 9.1 mmol/l) in the same series.

RESULTS

At constant creatinine concentration, interference increased with increasing glucose concentration to varying extents (up to 200%) amongst the six analysers. At constant glucose concentration, interference decreased with increasing creatinine concentration in analysers using the alkaline picrate reaction but increased in the Kodak analyser using enzymatic assay.

CONCLUSION

Interference of creatinine measurement in CAPD fluid is dependent on glucose and creatinine concentrations, and each centre should derive specific correction formulae for its analytical system.

Conservative orientation as a determinant of hopelessness

Conservative orientation is identified with reference to authoritarianism, work ethic belief, just world belief, and endorsement of individualistic causes of social problems. This over-arching orientation is hypothesized to affect hopelessness and to be affected by self-esteem with reference to ego development theory and learned helplessness theory. Causal modeling of data obtained from 1st-year college students (N = 556) in Hong Kong supports the hypotheses, showing that a student's hopelessness relates to his or her conservative orientation, even when self-esteem is controlled. This relationship can be interpreted by ego development and learned helplessness theories and cannot be explained as a spurious effect. Through the theories, hopelessness is interpreted as a result of maladaptive development and fatalistic, alienated, and helpless outlooks. This maladaptive development and the outlooks in turn result from students' conservative and individualistic orientation.

Albuminuria, insulin resistance and dyslipidaemia in Chinese patients with non-insulin-dependent diabetes (NIDDM)

In order to examine relationships between albuminuria, insulin resistance, and dyslipidaemia in non-insulin-dependent diabetes (NIDDM), we studied 164 Chinese patients (68 men, 96 women), treated with diet or oral hypoglycaemic agents, on three occasions during a 6-week period. Antihypertensive treatment, if previously prescribed, was withdrawn for at least 2 weeks before the study period. Insulin resistance was calculated from simultaneous fasting plasma glucose and insulin concentrations using the homeostasis model assessment (HOMA) method. Based on two of three 24 h urinary collections, 87 (53%) patients had normoalbuminuria, 46 (28%) microalbuminuria, and 31 (19%) macroalbuminuria. Despite similar glycaemic control, patients with abnormal albuminuria had higher mean arterial pressure, fasting plasma total cholesterol, triglyceride and serum apo B concentrations and were more insulin resistant than normoalbuminuric patients. Albuminuria correlated with mean arterial pressure (r = 0.31, p < 0.001), triglyceride (r = 0.36, p < 0.001), total cholesterol (r = 0.28, p = 0.001), apolipoprotein B (apo B) (r = 0.25, p = 0.003), and insulin resistance (r = 0.25, p < 0.002). These close associations may contribute to the increased cardiovascular risk in Chinese NIDDM patients with abnormal albuminuria.

Benign transient hyperphosphatasaemia associated with adenovirus infection

Benign transient hyperphosphatasaemia in early childhood is a harmless biochemical abnormality which is not commonly known to paediatricians. We describe a typical case in a young child and provide further evidence to support a viral aetiology.

Factors determining the blood pressure response to enalapril and nifedipine in hypertension associated with NIDDM

OBJECTIVE

To examine the factors that determine the blood pressure response to enalapril and nifedipine monotherapy in the treatment of hypertension associated with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

After a 6-week placebo baseline period, 102 hypertensive NIDDM patients were randomly assigned, double-blindly, to treatment with nifedipine retard (slow release) (n = 52) or enalapril (n = 50). The daily dosage of enalapril was increased, if required, from 10 to 20 to 40 mg and that of nifedipine from 40 to 60 to 80 mg at 4-week intervals during the 12-week titration period. Blood pressure, 24-h urinary albumin excretion (UAE), biochemical data, and serum angiotensin-converting enzyme (ACE) activity were measured at weeks -6, -4, 0, 4, 8, and 12. At week 0, venous blood was also sampled for baseline plasma atrial natriuretic peptide, renin, aldosterone, and serum insulin concentrations.

RESULTS

At week 12, the mean daily dose of enalapril was 35 +/- 11.4 mg, and 27 (57%) patients were receiving the maximum daily dose of 40 mg. In the nifedipine group, the mean daily drug dose was 50 +/- 12.9 mg, and 4 (8%) were receiving the maximum daily dose of 80 mg. Despite a dose-dependent fall in the serum ACE activity in the enalapril group, the mean arterial pressure (MAP) was reduced by only 8 mmHg throughout the 12-week titration period compared to a decline of 15, 18, and 19 mmHg at weeks 0, 4, and 12, respectively, in the nifedipine group (P = 0.01 between groups). In the enalapril group, changes in MAP between weeks 0 and 12 correlated significantly with baseline plasma glucose (r = 0.45, P = 0.001) and aldosterone concentrations (r = -0.32, P = 0.02) and UAE (r = 0.3, P = 0.04). There was no statistically significant correlation between the changes in MAP and baseline plasma renin concentration. On multivariate analysis, the baseline renal function, glycemic control, and plasma aldosterone and serum insulin concentrations were all independently related to the changes in blood pressure in the enalapril-treated patients. No such statistical associations were observed in the nifedipine group.

CONCLUSIONS

In hypertensive NIDDM patients, the activity of the renin-angiotensin-aldosterone system, the level of serum insulin, glycemic control, renal function, and proteinuria may be important determinants of the blood pressure response to ACE inhibition. Good glycemic control may optimize the antihypertensive efficacy of concomitant ACE inhibitor therapy.

Abnormal albuminuria as a predictor of mortality and renal impairment in Chinese patients with NIDDM

OBJECTIVE

Microalbuminuria predicts mortality in non-insulin-dependent diabetes mellitus (NIDDM), but its association with deterioration of renal function remains more controversial than in insulin-dependent diabetes mellitus (IDDM). Using albumin-to-creatinine ratios (ACRs) in random spot urine samples is a convenient method for evaluating albuminuria. We studied prospectively the predictive values of albuminuria in NIDDM when assessed by this urine measurement.

RESEARCH DESIGN AND METHODS

Between 1991 and 1992, we restudied the clinical and biochemical status of 403 Chinese NIDDM patients recruited in 1989 after a follow-up period of 26.6 +/- 3.2 months (mean +/- SD). Spot urine ACR was measured on two occasions and microalbuminuria was defined as a mean ACR between 5.6 and 38 mg/mmol.

RESULTS

From the original cohort, 29 patients had died mostly because of cardiovascular events with or without renal failure. The overall relative risk of death in patients with abnormal albuminuria was 7.1 (P < 0.001) (microalbuminuria: 3.7, P = 0.04; macroalbuminuria: 11, P < 0.001). On multivariate analysis, the independent predictive factors for mortality were plasma creatinine (wald = 12.1, P < 0.001) and glucose concentrations (wald = 10.4, P < 0.001) in the normo- and microalbuminuric patients (n = 11) and age (wald = 4.4, P = 0.03) and plasma creatinine (wald = 8.2, P < 0.01) in the macroalbuminuric group (n = 18). In the survivors (n = 374), baseline spot urine ACR was independently associated with 2-year spot urine ACR in the normo- (P < 0.001), micro- (P < 0.01), and macroalbuminuric groups (P = 0.01). In addition, baseline spot urine ACR was independently related to 2-year plasma creatinine (P = 0.01) in the macroalbuminuric group. The rates of change of the reciprocal of plasma creatinine ( delta [Cr]-1) were -27.3 +/- 62.5, -43.4 +/- 68.6, and -108.8 +/- 98.81.mumol01.month-1 in the normo-, micro-, and macroalbuminuric groups, respectively (P < 0.001). The delta [Cr]-1 was independently and inversely related to the baseline spot urine ACR (P < 0.001) and 2-year systolic blood pressure (P < 0.001).

CONCLUSIONS

Abnormal albuminuria as indicated by a random spot urine ACR > 5.6 mg/mmol predicts increased mortality and is associated with the progression of albuminuria and deterioration of renal function in Chinese NIDDM patients.

Immunoassay of a tartrate-resistant acid phosphatase in serum

A tartrate-resistant acid phosphatase (TRACP) was purified from cord plasma by use of cation-exchange chromatography (carboxymethyl Sepharose), gel-filtration chromatography (Sephacryl S-200), and preparative isoelectric focusing. After raising polyclonal antibodies to the purified TRACP in rabbit, we used the antiserum to develop an ELISA. The antiserum cross-reacted with an extract of bone, but not with extracts of spleen, erythrocytes, platelets, or osteoblasts or with prostatic acid phosphatase. With this ELISA we determined the concentration of serum TRACP in healthy men to be 197 (61-301) micrograms/L (median and range). Serum TRACP concentrations were significantly higher in children and postmenopausal women and in patients with chronic renal failure, hyperparathyroidism, or hyperthyroidism. Estrogen replacement therapy of postmenopausal women for 3-6.5 months decreased their serum TRACP concentration by 70%.

Immunoassay of a tartrate-resistant acid phosphatase in serum

A tartrate-resistant acid phosphatase (TRACP) was purified from cord plasma by use of cation-exchange chromatography (carboxymethyl Sepharose), gel-filtration chromatography (Sephacryl S-200), and preparative isoelectric focusing. After raising polyclonal antibodies to the purified TRACP in rabbit, we used the antiserum to develop an ELISA. The antiserum cross-reacted with an extract of bone, but not with extracts of spleen, erythrocytes, platelets, or osteoblasts or with prostatic acid phosphatase. With this ELISA we determined the concentration of serum TRACP in healthy men to be 197 (61-301) micrograms/L (median and range). Serum TRACP concentrations were significantly higher in children and postmenopausal women and in patients with chronic renal failure, hyperparathyroidism, or hyperthyroidism. Estrogen replacement therapy of postmenopausal women for 3-6.5 months decreased their serum TRACP concentration by 70%.

Increased bone resorption and decreased bone formation in Chinese patients with hip fracture

Biochemical markers of bone formation (bone-specific alkaline phosphatase and osteocalcin) and bone resorption (hydroxyproline excretion and bone isoenzyme of acid phosphatase) were measured in 30 patients (15 M and 15 F) with hip fracture and 30 healthy subjects matched for age and sex. Bone isoenzyme of tartrate-resistant acid phosphatase (TRACP) was measured by a recently developed specific immunoassay. Serum osteocalcin concentration and bone-specific alkaline phosphatase activity were significantly lower and serum TRACP concentration and urinary hydroxyproline excretion were elevated in patients compared with healthy subjects. We suggest that there is reduced bone formation and increased bone resorption in patients with hip fracture.

Atrial natriuretic peptide and renin-angiotensin-aldosterone system in non-insulin-dependent diabetes mellitus

A total of 78 Chinese patients with clinically uncomplicated non-insulin-dependent diabetes (NIDDM) who had plasma creatinine concentrations of < 150 mumol/l were studied. Antihypertensive treatment was discontinued for at least six weeks prior to measurements of routine biochemistry, proteinuria, plasma atrial natriuretic peptide (ANP) concentrations and components of the renin-angiotensin-aldosterone system (RAAS). BP was measured on three occasions during the six weeks period prior to these measurements. At the end of the six week period, a total of 33 patients had definite hypertension (supine BP > or = 160/95 mmHg). The hypertensive patients had significantly higher plasma sodium (mean +/- SD): 140.3 +/- 1.9 vs. 138.5 +/- 2.0 mmol/l, P < 0.001) and lower plasma potassium (3.8 +/- 0.5 vs. 4.2 +/- 0.5 mmol/l, P < 0.01) concentrations. These were associated with reduced plasma aldosterone (median (range): 297 (98-1145) vs. 448.5 (93-1330) pmol/l, P < 0.01) and renin concentrations (16.8 (7.4-71.8) vs. 23.5 (7.4-83.7) ng/l, P = 0.06). The hypertensive patients also had significantly higher plasma ANP concentrations (36.5 (20.5-125.1) vs. 23.2 (11.7-63.0) pg/ml, P < 0.001), serum angiotensin converting enzyme (ACE) activity (65 (26-140.9) vs. 47 (22-106) units/l, P < 0.001) and urinary albumin excretion (UAE) (35.4 (1.6-4800) vs. 7.8 (1.8-310.4) mg/day, P < 0.001). Glycaemic control and renal function were similar between the two groups. Mean arterial pressure (MAP) correlated positively with plasma ANP concentration (r = 0.53, P < 0.001) and serum ACE activity (r = 0.37, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Obesity, albuminuria and hypertension among Hong Kong Chinese with non-insulin-dependent diabetes mellitus (NIDDM)

A total of 412 Hong Kong Chinese diabetic patients were studied on at least two occasions 8-16 weeks apart. Although 28% were insulin-treated, only 3.6% had insulin-dependent diabetes (IDDM). In the remaining 397 patients with non-insulin-dependent diabetes (NIDDM), the mean (s.d.) body mass index (BMI) was 24.4 +/- 3.2 kg/m2 in females and 24.2 +/- 3.2 kg/m2 in males. Obesity was present in 17% of males (BMI > 27 kg/m2) and 40% of females (BMI > 25 kg/m2). Established hypertension was present in 49%. Abnormal albuminuria, defined as a mean urinary albumin/creatinine (UA/Cr) ratio greater than 5.4 mg/mmol based on two random spot urine samples, was present in 47%. On stepwise multiple regression analysis, UA/Cr ratio (R2 = 0.34, F = 65.4, P < 0.001) showed significant associations with systolic blood pressure (standardized regression coefficient beta = 0.40, P < 0.001), plasma creatinine concentration (beta = 0.27, P < 0.001) and glycosylated haemoglobin (beta = 0.20, P < 0.001). While the prevalence of hypertension increased with increasing severity of proteinuria, 40% of normoalbuminuric patients had hypertension. Among patients diagnosed before the age of 35 (n = 67), 52% were insulin-treated although only 10% were insulin-dependent. Among these NIDDM patients of young onset (n = 59), obesity was present in 25% of males and 56% of females. Overall, 18% of these patients had a blood pressure greater than 140/90 mmHg and 27% had abnormal albuminuria. In Hong Kong Chinese, diabetes mellitus is predominantly non-insulin-dependent even in the young. Obesity is more prevalent among females. Abnormal albuminuria is relatively common and is closely associated with hypertension and glycaemic control. In the light of increasing prevalence of diabetes among overseas Chinese, our findings may have important implications in the management of Chinese diabetic patients.

Protein excretion after prolonged exercise

Random urine samples were obtained from 16 healthy subjects (nine men and seven women) before and after a 100 Km hill walk for the estimation of total protein, albumin, N-acetyl-beta-glucosaminidase (NAG), retinol binding protein (RBP) and creatinine. The excretion of total protein, albumin and NAG (expressed in relation to creatinine excretion) increased significantly after the walk. The relative clearance of protein and albumin also increased. In four subjects serial measurements were made for 4 days and the excretion of albumin and NAG on the fourth day were similar to the pre-walk values. We conclude that proteinuria of prolonged exercise is at least partly due to reduced tubular reabsorption.

Comparison of enalapril and nifedipine in treating non-insulin dependent diabetes associated with hypertension: one year analysis

OBJECTIVES

To compare the efficacy, safety, and tolerance of enalapril and nifedipine in hypertensive patients with non-insulin dependent diabetes.

DESIGN

One year double blind follow up of patients randomly allocated to either enalapril or nifedipine with matching placebos for the alternative drug.

SETTING

Metabolic Investigation Unit, Hong Kong.

SUBJECTS

102 patients were randomised: 52 to nifedipine and 50 to enalapril. At baseline 44 patients had normoalbuminuria, 36 microalbuminuria, and 22 macroalbuminuria.

MAIN OUTCOME MEASURES

Blood pressure, albuminuria, and parameters of renal function and glycaemic control.

RESULTS

In patients who completed one year's treatment the median dose required by the nifedipine group (n = 49) was 60 mg/day; seven (14%) required additional diuretics. Of 41 patients given enalapril, 37 required the maximum dose (40 mg/day) and 27 (76%) required diuretics. At one year mean arterial blood pressures were similar in both groups. Albuminuria fell by 54% in the enalapril group and 11% in the nifedipine group (p = 0.006). Fractional albumin clearance ratio fell by 47% in the enalapril group and increased by 3% in the nifedipine group (p = 0.009). Creatinine clearance fell similarly in both groups but plasma creatinine concentration was increased by 20% in the enalapril group versus 8% in the nifedipine group (p = 0.001).

CONCLUSION

Patients taking enalapril often required diuretics to control blood pressure. Enalapril reduced proteinuria significantly more than nifedipine in the microalbuminuric and macroalbuminuric patients but increased plasma creatinine concentrations. Longer follow up is required to clarify the importance of enalapril's antiproteinuric effect.

The inter-relationships between albuminuria, plasma albumin concentration and indices of glycaemic control in non-insulin-dependent diabetes mellitus

We studied the relationship between albuminuria (measured as albumin/creatinine ratio (alb/Cr) in a random urine sample) and measures of glycaemic control (fructosamine, HbA1 and glucose) in 470 patients with non-insulin-dependent diabetes mellitus (NIDDM). Albumin excretion was in the microalbuminuric range (alb/Cr ratio > 5.4-40.3) in 112 (23.8%) and in the macroalbuminuric range (alb/Cr ratio > 40.3 mg/mmol) in 89 patients (18.9%). Fourteen percent (n = 67) of patients had a normal plasma HbA1 (< or = 8.5%) while 27% (n = 127) had a normal plasma fructosamine concentration (< or = 2.2 mmol/l). Using stepwise multiple regression analysis, plasma fructosamine concentration was found to be independently and negatively associated with urine albumin/creatinine ratio (B = 0.24, P < 0.006) in the macroalbuminuric group. Further analysis of the relationship between plasma albumin concentration and indices of glycaemic control showed that plasma albumin concentration correlated negatively with random plasma glucose concentration in the normoalbuminuric patients (r = -0.16, P = 0.008) but not in microalbuminuric or macroalbuminuric groups. HbA1 was not correlated with plasma albumin concentration. Our results indicate that albuminuria has an effect on the plasma fructosamine concentration which is independent of plasma albumin concentration.

Urinary excretion of albumin and enzymes in non-insulin-dependent Chinese diabetics

Urine albumin (Alb), total protein (TP) and creatinine (Cr) concentrations and the activities of N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase (AAP) and gamma-glutamyl transpeptidase (GGT) were measured in untimed random urine samples from 157 non-insulin-dependent (NIDDM) diabetic subjects and 54 healthy subjects. In NIDDM subjects the excretions of TP, Alb, NAG, AAP, GGT (expressed in relation to creatinine) were significantly higher and were abnormal in 59.9%, 68.8%, 47.2%, 41.4% and 13.4% of the subjects, respectively. However, 24.5%, 22.4% and 6.1% of NIDDM subjects with normal Alb/Cr ratio had abnormal excretion of NAG, AAP and GGT, respectively. Alb/Cr ratio was greater than 26.8 mg/mmol (considered to be equivalent to albumin excretion of 250 mg/24 h) in 14.6% and between 2.5-26.8 mg/mmol (equivalent to albumin excretion rates of 20-250 mg/24 h) in 54.1% of subjects. In those diabetic subjects with clinical retinopathy only Alb/Cr ratio was higher. Arterial blood pressure was significantly correlated with Alb/Cr (r = 0.365) and NAG/Cr (r = 0.204). We conclude that prevalence of abnormal Alb/Cr is relatively common among Chinese NIDDM subjects.

A case control study of some hematological and biochemical variables in acute stroke and their prognostic value

Hematocrit, total white cell and platelet counts, plasma urea and creatinine concentrations were estimated in 291 patients (mean age 70 +/- 12 years) admitted consecutively over a 6-month period to a district general hospital with acute stroke. Urinary albumin/creatinine ratio was also determined in a subgroup of patients during a follow-up visit 3 months after ictus. Results were compared with those from age- and sex-matched community controls. Total white cell count was elevated in all types of stroke compared with values from control subjects. Platelet count, plasma urea and creatinine concentrations were higher and the plasma albumin/globulin ratio was lower among patients with ischemic stroke. Elevated total white cell count, urea and creatinine, which were of prognostic significance, were found to be associated with the severity of stroke as indicated by the Glasgow coma score, and did not have any independent prognostic value. Elevated hematocrit was not shown to be a risk factor and did not have any prognostic significance. A low plasma albumin/globulin ratio, an index of plasma viscosity, was a possible risk factor for ischemic strokes. Urinary albumin/creatinine ratios in the highest quintile increased the risk of stroke 13-fold.

Urinary levels of proteins and metabolites in workers exposed to toluene. A cross-sectional study

We measured urinary excretion of albumin and retinol-binding proteins to investigate the occurrence of early renal dysfunction in 45 paint workers exposed principally to toluene, and in the same number of unexposed control subjects matched individually for sex and age. Two biological indicators of personal toluene absorption, namely urine hippuric acid and o-cresol, were also measured in the exposed subjects. A significantly higher level and increased prevalence of elevated retinol-binding protein in the urine of exposed workers was found, whereas no significant difference in urinary albumin concentration was seen between the two groups. Urinary concentrations of retinol-binding protein was correlated (r = 0.399, P less than 0.006) with that of o-cresol, but not with hippuric acid or employment duration. The results suggest a dose-dependent early tubular effect due to toluene exposure that might be useful for monitoring individuals exposed to toluene at work.

Automated immunoturbidimetric methods for the determination of retinol binding protein, prealbumin and transferrin in urine

We describe the development of rapid and simple automated methods for the estimation of retinol binding protein (RBP), prealbumin (PA) and transferrin (TRF) in urine. These methods measure the turbidity formed as a result of reaction between the protein and a specific antibody in a phosphate buffer containing 70 g/L polyethyleneglycol as accelerator for the antigen antibody reaction. The method for retinol binding protein (RBP) correlated well when compared with a method based on enzyme-linked immunosorbent assay (ELISA) (r = 0.978). The recoveries were 93-104%, 84-95% and 84-100% for RBP, PA and TRF respectively. The between-batch coefficients of variation were 2.6-10.6, 2.8-12.6 and 4.2-8.7% respectively. The analytical range of the method was 0.0625 to 40 mg/L for RBP, 0.28 to 45 mg/L for PA and 0.14 to 70 mg/L for TRF. The methods can be performed manually using a simple spectrophotometer or can be easily automated.

Urinary excretion of some proteins and enzymes during normal pregnancy

Total protein (TP), albumin (Alb), transferrin (TRF), retinol-binding protein (RPB), N-acetyl-beta-glucosaminidase (NAG), alanine aminopeptidase (AAP), gamma-glutamyltransferase (GGT), and creatinine (Cr) were measured in random (untimed) urine samples from 29 nonpregnant women and from pregnant subjects (11 in the first trimester, 34 in the second, and 37 in the third). The excretion of TP, Alb, TRF, NAG, and AAP (relative to creatinine) and the RBP concentration were all higher (P less than or equal to 0.05) in the second and third trimesters compared with values for the nonpregnant controls. The GGT/Cr ratio was significantly higher only in the third trimester. The increase in low-molecular-mass proteins and tubular enzymes suggests that at least part of the increase in Alb, TRF, and TP results from decreased tubular reabsorption. We conclude that excretion of both high- and low-molecular-mass proteins is increased during pregnancy.

Urinary excretion of some proteins and enzymes during normal pregnancy

Total protein (TP), albumin (Alb), transferrin (TRF), retinol-binding protein (RPB), N-acetyl-beta-glucosaminidase (NAG), alanine aminopeptidase (AAP), gamma-glutamyltransferase (GGT), and creatinine (Cr) were measured in random (untimed) urine samples from 29 nonpregnant women and from pregnant subjects (11 in the first trimester, 34 in the second, and 37 in the third). The excretion of TP, Alb, TRF, NAG, and AAP (relative to creatinine) and the RBP concentration were all higher (P less than or equal to 0.05) in the second and third trimesters compared with values for the nonpregnant controls. The GGT/Cr ratio was significantly higher only in the third trimester. The increase in low-molecular-mass proteins and tubular enzymes suggests that at least part of the increase in Alb, TRF, and TP results from decreased tubular reabsorption. We conclude that excretion of both high- and low-molecular-mass proteins is increased during pregnancy.

Urinary excretion of transferrin by non-insulin-dependent diabetics: a marker for early complications?

We measured concentrations of transferrin (TRF, in micrograms), and creatinine (Cr, in millimoles) in samples of untimed urine from 53 healthy subjects and 157 non-insulin-dependent diabetic (NIDD) subjects. The urinary TRF/Cr ratio was significantly higher in the NIDD group (P less than 0.001). If NIDD subjects are grouped according to their Alb/Cr ratio into normal albuminuria (Group A, Alb/Cr less than 2.5 mg/mmol), microalbuminuria (Group B, Alb/Cr 2.5-26.8 mg/mmol), and macroalbuminuria (Group C, Alb/Cr greater than 26.8 mg/mmol), the TRF/Cr ratios in all three groups exceeded those for healthy controls. Moreover, this ratio was higher in Group B than in Group A and higher in Group C than in Group B. The value for TRF/Cr was clearly abnormal (i.e., exceeded the 95th percentile value found in healthy subjects) in 61%, 95%, and 100% of Group A, B, and C subjects, respectively. The TRF/Cr ratio was significantly higher in those NIDD subjects with clinical retinopathy, and it correlated with arterial pressure. Evidently, TRF/Cr may be increased early in NIDD subjects, and it may be a sensitive marker for detecting development of complications of diabetes.

Urinary excretion of transferrin by non-insulin-dependent diabetics: a marker for early complications?

We measured concentrations of transferrin (TRF, in micrograms), and creatinine (Cr, in millimoles) in samples of untimed urine from 53 healthy subjects and 157 non-insulin-dependent diabetic (NIDD) subjects. The urinary TRF/Cr ratio was significantly higher in the NIDD group (P less than 0.001). If NIDD subjects are grouped according to their Alb/Cr ratio into normal albuminuria (Group A, Alb/Cr less than 2.5 mg/mmol), microalbuminuria (Group B, Alb/Cr 2.5-26.8 mg/mmol), and macroalbuminuria (Group C, Alb/Cr greater than 26.8 mg/mmol), the TRF/Cr ratios in all three groups exceeded those for healthy controls. Moreover, this ratio was higher in Group B than in Group A and higher in Group C than in Group B. The value for TRF/Cr was clearly abnormal (i.e., exceeded the 95th percentile value found in healthy subjects) in 61%, 95%, and 100% of Group A, B, and C subjects, respectively. The TRF/Cr ratio was significantly higher in those NIDD subjects with clinical retinopathy, and it correlated with arterial pressure. Evidently, TRF/Cr may be increased early in NIDD subjects, and it may be a sensitive marker for detecting development of complications of diabetes.

Protein nutritional status in elderly Chinese in Hong Kong

Daily intakes of protein and energy were estimated in a group of 417 apparently healthy elderly Chinese subjects aged 60 years and over, living independently in the community. The mean protein intake was 1.2 g/kg body weight, well above the WHO/FAO/UNU recommendation of 0.8 g/kg, and comparable to intakes of elderly Americans and Britons. Plasma total protein, albumin, prealbumin, retinol binding protein and transferrin concentrations were also measured. No age- or sex-related differences were found and the values were comparable to published values for elderly Caucasians. Plasma prealbumin and retinol binding protein concentrations correlated with protein intake and with arm muscle area. Protein nutritional status appears adequate for elderly Chinese living in the community.

Massive hydrothorax in continuous ambulatory peritoneal dialysis: diagnosis, management and review of the literature

Recurrent massive hydrothorax is an uncommon but serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). Accurate confirmative diagnostic procedures of the pleuroperitoneal communication is lacking and the management remains difficult. We reported three patients who developed massive hydrothorax at different periods after commencement of CAPD treatment (1.5-9 months). These patients underwent different investigatory procedures for demonstrating the pleuroperitoneal communication. We conclude that both technetium 99m-tagged macroaggregated albumin intraperitoneal radionuclide scan and stereoisomeric analysis of lactate in the peritoneal and pleural fluid are safe and reliable procedures to demonstrate the pleuroperitoneal communication. The massive hydrothorax was successfully treated in two patients by pleurodesis induced by intrapleural administration of oxytetracycline combined with 10-days small volume intermittent peritoneal dialysis. The clinical findings of 18 other cases previously reported in the literature are also reviewed.