Adropin as a potential protective factor of metabolic complications in obese pregnant women with hyperglycaemia diagnosed in early pregnancy

Adropin is a hormone which increases insulin sensitivity. It enhances the oxygenation of glucose in the muscles. The 91 obese pregnant women (BMI >30 kg/m²) with gestational diabetes mellitus (GDM) diagnosed in the first half of pregnancy has been recruited to the study group. The control group consisted of 10 age matched and homogeneous pregnant women with BMI <25 kg/m². Blood samples were collected on visit V1 - between the 28^th and 32^nd week and on visit V2 - between the 37^th and 39^th week of gestation. The ELISA test was used to measure the adropin level. The results in the study group and the control group were compared. Blood samples were collected at the same visits. The median concentration of adropin was 442.2 pg/ml on V1 and 453.1 pg/ml on V2. The increase was significant (p<0.05). Results were significantly lower in the control group's patients, i.e. 57.0 pg/ml (p<0.001) on V1 and 107.9 pg/ml on V2 (p<0.001). The higher adropin level on the V1 and V2 visits were related to patients' lower BMI and better metabolic control. The increase in the adropin level in the third trimester may have been involved in the weight gain reduction, whereas better dietary adherence might have had a compensatory effect on increasing insulin resistance. However, the small control group is a limitation of this study.

Adropin as a potential protective factor of metabolic complications in obese pregnant women with hyperglycaemia diagnosed in early pregnancy

Adropin is a hormone which increases insulin sensitivity. It enhances the oxygenation of glucose in the muscles. The 91 obese pregnant women (BMI >30 kg/m²) with gestational diabetes mellitus (GDM) diagnosed in the first half of pregnancy has been recruited to the study group. The control group consisted of 10 age matched and homogeneous pregnant women with BMI <25 kg/m². Blood samples were collected on visit V1 - between the 28^th and 32^nd week and on visit V2 - between the 37^th and 39^th week of gestation. The ELISA test was used to measure the adropin level. The results in the study group and the control group were compared. Blood samples were collected at the same visits. The median concentration of adropin was 442.2 pg/ml on V1 and 453.1 pg/ml on V2. The increase was significant (p<0.05). Results were significantly lower in the control group's patients, i.e. 57.0 pg/ml (p<0.001) on V1 and 107.9 pg/ml on V2 (p<0.001). The higher adropin level on the V1 and V2 visits were related to patients' lower BMI and better metabolic control. The increase in the adropin level in the third trimester may have been involved in the weight gain reduction, whereas better dietary adherence might have had a compensatory effect on increasing insulin resistance. However, the small control group is a limitation of this study.

Leptin and vascular endothelial growth factor A: a cross-talk in obese women with gestational diabetes and with diabetes in pregnancy - a cohort study

Vascular endothelial growth factor A (VEGF A) synthesis is intensified by leptin in: hypoxia-inducible factor 1 alpha (HIF-1A) and nuclear factor kappa-light-chain-enhancer of activated B cells (NfκB)-dependent manners. The study aimed to investigate the association between leptin and VEGF A serum levels in obese women with hyperglycaemia in the third trimester of pregnancy. Sixty obese pregnant women with hyperglycaemia were divided into groups according to body mass index (BMI): group 1: BMI 30.0-34.9 kg/m²; group 2: BMI 35.0-39.9 kg/m²; group 3: BMI ≥40 kg/m². On the enrolment visit, waist circumference, body mass and height were measured. At visit 1 (V1; gestational week (GW) 28-32) and visit 2 (V2; GW 36-38), anthropometric, blood pressure and heart rate measurements, and blood sample collection were performed. Blood levels of leptin, VEGF A, VEGF receptor 2, HIF-1A, NfκB, interleukin 1 alpha, protein delta homolog 1, nitric oxide and glycated haemoglobin were determined. To analyse the predictors of the biochemical parametres involved in leptin and VEGF A cross-talk, multivariate logistic regression was implemented. Positive correlations between serum levels of leptin and VEGF A were found. Serum level of HIF-1A at V1 was a predictor for the highest quartile of the serum levels of VEGF A at V1 and V2. Leptin serum level at V1 was a predictor for the highest quartile of HIF-1A serum concentration at V2. In group 3 HIF-1A level was higher at V2 compared to V1. We conclude that in obese women with hyperglycaemia in the third trimester of pregnancy there is a significant positive influence of serum leptin on VEGF A synthesis and serum level and HIF-1A seems to play more important role in leptin and VEGF A cross-talk than NfκB.

Assessment of progranulin and FAM19A5 protein blood levels in patients with metabolic syndrome

Progranulin and family with sequence similarity 19, member A5 (FAM19A5) protein are adipokines with growing importance in the context of metabolic diseases. The study aimed to determine the serum concentration of progranulin and FAM19A5 in people with metabolic syndrome (MS) compared to those without MS. The concentration of progranulin and FAM19A5 was determined in 45 people with MS (group A) and in 35 healthy people without MS (group B). Body composition analysis, blood pressure, blood oxygen saturation and anthropometric measurements were performed. There were no differences in the blood levels of progranulin and FAM19A5 between the groups. In group A, the level of progranulin was 29.25±36.92 pg/ml and in group B it was 46.00±60.12pg/ml (p=0.2693). The level of FAM19A5 was 163.16±55.11 pg/ml and 197.57±112.89 pg/ml (p=0.1341) in subjects with and without metabolic syndrome, respectively. In group A, there was a correlation between FAM19A5 and diastolic blood pressure (DBP) (R= -0.40) and high-density lipoprotein (HDL) level (R= -0.37). In group B, correlations were found between progranulin and waist circumference (R= -0.43) and progranulin and triglyceride (TG) levels (R= -0.42). Both groups together showed correlations between progranulin level and body mass index (R= -0.24), HDL (R=0.25) and TG levels (R= -0.25) and between FAM19A5 level and DBP (R= -0.34). In conclusion, patients with and without MS do not differ in the range of progranulin and FAM19A5 serum levels. In patients with MS, elevated FAM19A5 serum levels may be an indicator of dyslipidaemia development. FAM19A5 appears to be a better predictor of MS than progranulin.

Resistin is not a useful insulin resistance marker for non-obese patients

Resistin, an adipokine produced in fat tissue, may be linked to insulin resistance (IR) and type 2 diabetes. Previous data are controversial and have focused mainly on obese patients. We aimed to evaluate whether resistin plays a role in the development of IR in normal-weight individuals. The study involved 77 normal-weight participants. We defined IR using different indexes and cut-off points. Resistin, fasting insulin, glucose, and lipids concentrations and anthropometric parameters were measured. Serum resistin concentration was not associated with IR. Resistin concentration was weakly related to age in all insulin-sensitive groups and low-density lipoprotein cholesterol concentration in all IR groups. Moreover, a weak negative correlation between high-density lipoprotein cholesterol and resistin concentrations was observed in the IR group categorised by the 1.69 cut-off of the homeostasis model assessment of IR. The data suggest that resistin is not a useful marker for the prediction of IR in normal-weight individuals.

The influence of orlistat, metformin and diet on serum levels of insulin-like growth factor-1 in obeses women with and without insulin resistance

A range of studies showed confusing data about the relationship between obesity, weight reduction and circulating total insulin-like growth factor -1 (IGF-1). The aim of the study was to compare the influence of orlistat (IO), metformin (IM), or calorie-restricted diet (LC) on IGF-1, with special respect to insulin-resistance status. One hundred and fourteen obese women aged from 18 to 40 years were divided into insulin sensitive (IS) and insulin resistant (IR) groups and received a low calorie diet (LC), or an isocaloric diet and 500 mg metformin twice daily (IM), or isocaloric diet with 120 mg orlistat three times daily (IO). Before and after the intervention anthropometric parameters, serum lipid profile, serum concentrations of alanine aminotransferase, aspartate aminotransferase, insulin, glucose, IGF-1, HOMA-IR (homeostatic model assessment), and visceral adiposity index (VAI), and their changes were registered. Although the reductions in weight and body fat were comparable in IS and IR groups, only women with IR showed a significant increase in IGF-1 concentration as a result of all interventions. We found significant positive correlations of ΔIGF-1 with initial and Δ values of: HOMA-IR, triglyceride/high-density cholesterol ratio, VAI. IR premenopausal women show significant increase in IGF-1 serum concentrations regardless the method of intervention. The increase in IGF-1 was parallel to the improvement of insulin resistance parameters.

Beneficial dose-independent influence of Camellia sinensis supplementation on lipid profile, glycemia, and insulin resistance in an NaCl-induced hypertensive rat model

Green tea extract exerts favorable influence on the lipid profile and insulin resistance in the high-sodium intake arterial hypertension. A high-sodium diet (HSD) was introduced to thirty Wistar rats to create a model of hypertension. Rats were randomized into three groups, 10 animals each. The SK group consumed HSD. The SH2 group consumed HSD with 2 g of green tea extract in kg of diet. The SH4 group was fed HSD with 4 g of green tea extract in kg of diet. After six-week trial blood samples were collected. The serum concentrations of glucose, insulin and lipids were estimated, and insulin sensitivity was calculated using homeostatic model assessment (HOMA). Neither the high-sodium diet nor supplementation with green tea extract had any significant influence on the body mass of the animals in either group. Total cholesterol (TCH) and low-density lipoproteins (LDL) cholesterol serum concentrations were significantly smaller in both supplemented groups than in the SK group. The insulin level in the SH2 rats and HOMA in SH2 and SH4 groups were found to be significantly smaller than in the SK group. There were no differences in glucose concentrations between groups. Within the whole population, statistically significant positive correlations between HOMA and LDL, TCH were found. We conclude that in NaCl-induced hypertensive Wistar rats, supplementation with green tea extract produced a dose-independent beneficial and parallel effect on the lipid profile and insulin resistance.

Gender-related effect of cold water swimming on the seasonal changes in lipid profile, ApoB/ApoA-I ratio, and homocysteine concentration in cold water swimmers

It has been proposed that regular cold swimming is associated with health benefits. However, the effect of cold adaptation on particular cardiovascular risk factors, within a single swimming season, remains unknown. Our aim was to evaluate the impact of cold water swimming on the seasonal changes in lipid profile and on apolipoprotein and homocysteine concentration in 34 cold water swimmers (CWS) aged 48 - 68 years. Blood samples were collected at the beginning (October), the middle (January), and the end (April) of the swimming season. Body mass (BM), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), ApoB/ApoA-I ratio, and homocysteine concentrations were evaluated. In October, female CWS showed lower BM (P = 0.01), TG concentrations (P = 0.03), and ApoB/ApoA-I ratios (P = 0.008), and higher HDL (P = 0.01) than in men. Similar trends in BM (P = 0.002), HDL (P = 0.0006), and ApoB/ApoA-I ratio (P = 0.01) were seen in January, and for BM (P = 0.002), TG (P = 0.005), HDL (P = 0.003), and ApoB/ApoA-I (P = 0.01) in April. A decrease in TG concentration between January and April (P = 0.05), lower homocysteine concentration between October and January (P = 0.01), and between October and April (P = 0.001) were documented in CWS. A strong drop in homocysteine concentration was observed in female versus male CWS (P = 0.001 versus P = 0.032), particularly between October and April in women (P = 0.001) and October and January in men (P = 0.05). The ApoB/ApoA-I ratio in female CWS decreased over the season (P = 0.02), particularly between October and January (P = 0.05), and a trend toward the TG concentration to reduce over the swimming season was also observed in female CWS. No beneficial changes were noticed in the control group over the season. Our results suggest that the favorable effect of cold swimming on the cardiovascular risk factors may be gender-dependent; further studies are thus needed to draw a precise conclusion.

Late-onset Pompe disease in a 54 year-old sportsman with an episode of syncope: a case report

Pompe disease is an extra-rare metabolic storage disease with deficiency of acid-alpha-glucosidase (GAA) enzyme activity, which leads to the pathologic accumulation of glycogen in target tissues (skeletal muscles, heart, brain). Clinical features and severity vary by the age of onset, rate of extent of organ involvement. In the late-onset Pompe disease (LOPD) form, essential cardiomyopathy seems to be uncommon. Muscles weakness and respiratory failure are the main symptoms of adult patient with Pompe disease. In presented case LOPD coupled with patient's regular sporting activity and healthy diet, which may explain the low intensity of the symptoms and the slow progress of the disease, lack of skeletal muscles weakness and lack of brain manifestation. Myocardial storage deposits are the only abnormalities found.

Spirulina maxima improves insulin sensitivity, lipid profile, and total antioxidant status in obese patients with well-treated hypertension: a randomized double-blind placebo-controlled study

OBJECTIVE

Spirulina maxima consumption is known to be associated with enhanced cardiovascular and metabolic health. Human studies on this topic have recently been described in a few papers; however, potential protective cardiovascular properties of Spirulina in obese patients receiving standard pharmacological antihypertensive treatment remain to be elucidated. Putative beneficial cardiovascular effects of Spirulina supplementation in well treated, obesity-related hypertension were studied in a double-blind placebo-controlled trial.

PATIENTS AND METHODS

Total 50 obese subjects with treated hypertension, each randomized to receive 2 g of Spirulina or a placebo daily, for three months. At baseline and after treatment anthropometric parameters, plasma lipid levels, inflammation, and oxidative stress biomarkers along with insulin sensitivity estimated by euglycemic clamp were assessed.

RESULTS

After three months of Spirulina supplementation significant decrease in body mass (p < 0.001), body mass index (BMI; p < 0.001) and waist circumference (WC; p = 0.002) were observed in Spirulina group. Spirulina had also significant, lowering effect on low-density lipoprotein cholesterol (LDL-C; p < 0.001) and interleukin-6 (IL-6) concentration (p = 0.002) in supplemented patients compared to placebo group. Spirulina supplementation considerably improved total antioxidant status (TAS; p = 0.001) and insulin sensitivity ratio (M; p < 0.001) in Spirulina group compared to placebo-treated individuals.

CONCLUSIONS

The favorable influence of Spirulina supplementation on insulin sensitivity, plasma lipid levels along with inflammation and oxidative stress biomarkers reported in this study creates the promise for new therapeutic approaches in obese patients with well-treated hypertension.

Relationship between deficiency of vitamin D and exponents of metabolic syndrome

OBJECTIVE

Widespread hypovitaminosis D and an increased incidence of metabolic syndrome (MetS) represent significant problems of contemporary medicine but link between them remain unresolved. We aimed to define relationship between vitamin D serum concentration and exponents of MetS.

PATIENTS AND METHODS

The studies were conducted on 70 individuals (51 with and 19 without MetS). Concentrations of 25(OH)D (25-hydroxyergocalciferol and 25-hydroxycholecalciferol), calcium, cholesterol, HDL, cholesterol LDL, triglycerides, fasting glucose, blood pressure and anthropometric parameters were measured.

RESULTS

Median concentration of vitamin D in the research population amounted to 41.46 nmol/L. Concentration of 25(OH)D in MetS group was lower than in remainder participants (38.45 nmol/L vs. 58.50 nmol/L, p = 0.0104). An inverse correlation was demonstrated between 25(OH)D level on one hand and body weight, waist and hips circumference, adipose body weight, Body Mass Index, Waist to Height Ratio (WHtR), glycaemia and number of MetS components on the other in persons free of MetS. No such relationships could be documented in MetS group. In the entire population values of Waist to Hip Ratio (WHpR) and WHtR indices manifested correlation with hyperglycaemia, hypertriglyceridaemia, low HDL concentrations.

CONCLUSIONS

In persons without MetS a relationship was detected between vitamin D concentration and exponents of metabolic syndrome, although further studies on this problem are required.

Prognostic usefulness of IL-6 and VEGF for the occurrence of changes in coronary arteries of patients with stable angina and implanted stents

AIM

The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) in patients with chronic coronary artery disease treated who underwent percutaneous coronary intervention with stent implantation, for assessing the risk of restenosis and the occurrence of de novo lesions.

PATIENTS AND METHODS

498 patients with stable angina were examined during 18 months. 50 patients with significant (> 70%) stenosis of one coronary artery, eligible for the implantation of one stent, were enrolled to the study. Il-6 and VEGF level was measured using ELISA immunoassays during the initial coronary angiography with simultaneous angioplasty and stent implantation and 4 weeks after stent implantation. Coronary angiography was carried out 8-12 months after stent implantation.

RESULTS

Statistically significant increase in IL-6 (from 4.02 ± 4.40 to 10.90 ± 8.23) and VEGF (from 310.13 ± 50.90 to 392.32 ± 106.84) level was observed 4 weeks after stent implantation in the group with restenosis.

CONCLUSIONS

Increased levels of IL-6 and VEGF in the peripheral blood of patients with chronic stable angina pectoris, measured 4 weeks after coronary angioplasty with stent implantation, may indicate an increased risk of angiographic restenosis and de novo coronary artery lesions.

The influence of antihypertensive drugs on mineral status in hypertensive patients

OBJECTIVES

Long-term therapy of hypertension may influence mineral status in patients. However, drug-micronutrient interactions are largely unexplored in practice. This study intended to evaluate the effect of hypotensive monotherapy on iron, zinc, and copper levels, as well as on selected biochemical parameters, in newly diagnosed patients with hypertension, and to assess the influence of diet with optimal mineral levels on the mineral balance in these subjects.

PATIENTS AND METHODS

Forty-five patients, aged 18-65 years with diagnosed essential hypertension, beginning monotherapy treatment with diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and β-blockers, were employed. Over three months, the patients underwent monotherapy (stage II). Next, patients were randomly divided into a diet group (of 27 subjects) and a control group (of 18 subjects). In this stage, which lasted one month, patients were given the same drug but also followed an optimal mineral-content diet (for the diet group), or else continued drug use without any change in diet (for control group) (stage III). Lipids, glucose, ceruloplasmin, and ferritin--along with superoxide dismutase and catalase activities--were assayed in serum. Iron, zinc, and copper concentrations in serum, erythrocytes, and urine were determined using flame atomic absorption spectrometry. Blood pressure was measured. Diet intake was monitored at each stage.

RESULTS

It was found that the zinc level in serum significantly decreased following treatment, and that the use of the optimal-mineral diet during antihypertensive treatment markedly increased zinc serum concentration. After treatment, a significant increase in zinc excretion in the urine was observed. Glucose levels in the serum of patients in stage II were significantly higher than in the baseline. In patients in the diet group, glucose levels markedly decreased. Moreover, a negative correlation was found between serum glucose and zinc levels in patients.

CONCLUSIONS

Antihypertensive treatments should include monitoring of mineral status. It seems that the zinc balance of patients on long-term therapy with hypotensive drugs may benefit from an optimal-mineral diet.

The effect of L-arginine supplementation on serum resistin concentration in insulin resistance in animal models

BACKGROUND

Understanding the mechanism of development of the insulin resistance associated with obesity is crucial in identifying new therapeutic options for obese patients.

AIM

The aim of this study was to examine the effects of L-arginine on the secretion of resistin in the context of insulin resistance in animal models.

MATERIALS AND METHODS

30 male and female Wistar rats were assigned to three equal groups: the standard diet group, the high-fat diet group, and the high-fat diet supplemented with L-arg group. After 6 weeks, the weight of the rats was measured. The animals were euthanized. The relative weight of the perirenal fat was determined and blood samples were taken for serum glucose, insulin, NO, and resistin. Insulin resistance was estimated using homeostasis model assessment (HOMA).

RESULTS

It was found that the absolute and relative masses of the perirenal fat were significantly higher in rats fed the high-fat diet than in the control group. In rats on the high-fat diet supplemented with L-arginine, a tendency for perirenal fat to decrease was observed. The high-fat diet resulted in significant increases in glucose and insulin concentrations, and L-arginine supplementation significantly ameliorated the increase in both glucose and insulin. Moreover, significant decreases in NO concentration were seen in rats fed the high-fat diet. L-arginine supplementation protected significantly against increased NO concentration. Increases in HOMA-IR level and in resistin concentrations were observed in rats fed the high-fat diet. L-arginine supplementation partially restored HOMA-IR levels to those of the control group and did not influence resistin concentration.

CONCLUSIONS

L-arginine supplementation improves insulin sensitivity in rats fed a high-fat diet, independently of resistin activity.

The evaluation of selected serum mineral concentrations and their association with insulin resistance in obese adolescents

BACKGROUND

In obesity, elevated insulin resistance is observed, which may be associated with disturbances in mineral status in the body. The few studies concerning the status of minerals and their relationships with insulin resistance and body composition in adolescent populations have brought inconclusive results.

AIM

of this study is, thus, to assess serum mineral concentration in obese adolescents, and to evaluate their potential association with insulin resistance.

SUBJECTS AND METHODS

Seventy-eight obese adolescents and 20 healthy volunteers aged 12-18 years were recruited for the study. Selected anthropometrical measurements and levels of iron, zinc, copper, calcium, and magnesium were assessed in serum. Insulin resistance in the participants was evaluated according to the homeostatic model of assessment for insulin resistance (HOMA-IR) protocol. Levels of iron, zinc, copper, calcium, and magnesium were assessed in serum.

RESULTS

Obese subjects had significantly higher HOMA-IR indices than the control group. Compared to healthy subjects, the serum concentration of zinc, calcium, and magnesium was significantly lower in obese subjects. A significant inverse relation was found between HOMA-IR and zinc levels in serum.

CONCLUSIONS

Obese adolescents have a poorer mineral status (especially zinc) than adolescents of normal weight, which can contribute to insulin resistance.

Supplementation with L-arginine favorably influences plasminogen activator inhibitor type 1 concentration in obese patients. A randomized, double blind trial

BACKGROUND

Elevated plasminogen activator inhibitor type 1 (PAI 1) plays an important role in the pathogenesis of excess blood coagulability in obese patients. L-arginine supplementation has shown to be associated with enhanced cardiovascular and metabolic health. The aim of the study was to assess the effect of L-arginine supplementation on PAI 1 concentration and to evaluate the relation to changes in nitric oxide (NO) plasma level, insulin sensitivity (M value), and total antioxidant status (TAS) in obese patients.

MATERIAL/SUBJECTS AND METHODS

A randomized, double-blind, placebo-controlled study was conducted from March 2010 to June 2011. Eightyeight obese patients were randomly assigned to receive either 9 g of L-arginine or placebo daily for 6 months. At baseline and after 6 months, selected anthropometrical measurements and blood biochemical analyses were performed, and PAI 1, NO, TAS levels were assessed. Insulin sensitivity was evaluated using the hyperinsulinemic euglycemic clamp technique.

RESULTS

We found that 6-month L-arginine supplementation resulted in significant decrease of PAI 1. Significant increase of NO, TAS, and insulin sensitivity level were noticed. In a group of patients treated with L-arginine, negative correlation between a change of insulin sensitivity value and a change of PAI 1 concentration was found.

CONCLUSIONS

The present findings demonstrate favorable influence of L-arginine supplementation on PAI 1 concentration in obese patients. Beneficial influence is related to insulin sensitivity improvement. The potential therapeutic role of L-arginine administration in patients with obesity needs further investigation.

Effect of 3-month L-arginine supplementation on insulin resistance and tumor necrosis factor activity in patients with visceral obesity

BACKGROUND

The role of tumor necrosis factor alpha (TNF-alpha), one of the adipose tissue products, in the pathogenesis of insulin resistance is well-documented. Many recent studies have shown beneficial influence of L-arginine supplementation on cardiovascular system. However, molecular mechanisms of its positive actions are not fully elucidated.

AIM

The aim of the study was to evaluate the influence of L-arginine supplementation on tumor necrosis factor alpha, insulin resistance and selected anthropometric and biochemical parameters in patients with visceral obesity.

PATIENTS AND METHODS

60 patients with visceral obesity were randomly assigned to either receive 9 g of L-arginine or placebo for 3 months. 20 healthy lean subjects were used as control. Selected anthropometrical measurements and blood biochemical analyses were performed at baseline and after 3-months. TNF-alpha and its soluble receptor 2 (sTNFR2) were assessed in both treated groups. Insulin resistance in the participants was evaluated according to the homeostasis model assessment-insulin resistance (HOMA-IR) protocol.

RESULTS

The concentration of insulin, TNF-a and sTNFR2 and HOMA-IR level in both obese groups significantly exceeded these observed in the control. Basal TNF-alpha and sTNFR2 concentrations were positively correlated with basal body mass index (BMI), waist circumference, percent of body fat and HOMA-IR. We found that 3-month L-arginine supplementation resulted in significant decrease of HOMA-IR and insulin concentration. Only insignificant tendency to decrease of TNF-alpha and sTNFR2 was observed.

CONCLUSIONS

Our results confirm TNF-alpha role in the complex pathogenesis of insulin resistance in patients with visceral obesity. 3-months L-arginine supplementation in a dose of 9 g improves insulin sensitivity in patients with visceral obesity with no impact on tumor necrosis factor alpha concentration.

Continuous quality improvement: at the grassroots

As a philosophy and a belief system, continuous quality improvement (CQI) provides the basis for organizational commitment to strategic leadership, customer focus, an empowered workforce, and reliance on evidence to improve processes and outcomes. This paper describes the process engaged in by the hemodialysis unit at St. Joseph's Health Care, London to formalize our CQI processes. The paper emphasizes: the selection of outcome measures, the strategies to link outcomes to improvement opportunities, and the resulting improvement projects. The formal commitment to CQI has affected both patient care and staff morale in many positive ways.

Genetic markers among three population groups of Hungary

Three ethnic groups from Hungary, the general population of Hungary, the Matyo and the Gypsies, were examined with respect to the genetic markers PGP, GLO1, GPT, ACP1, ESD, PGD, ADA, AK1, PGM1 subtypes, C3, BF, HP, GC subtypes, PI, TF subtypes and AMY2. Significant variations were noted for the gene frequencies of GPT and PGD between the Hungarian and Matyo sample. The Gypsies deviate in the systems of GLO1, ACP1, ADA, C3, BF and HP from the Hungarians.

Polymorphisms of Pi, Hp, ADA and AK in Mongolian, Korean and Zhuang populations of China

Three minority ethnic groups from China, Mongolian, Koreans, and Zhuangs were studied for the genetic markers AK, ADA, Hp, and Pi. AK was monomorphic in Koreans and Zhuangs. Significant differences were observed in the Hp system between Mongolians and Zhuangs.

Genetic studies in Atacameño Indians: serum protein and red cell-enzyme polymorphisms

Phenotype and gene frequencies among Atacameño Indians are presented for nine serum protein polymorphisms (Hp, Gc with subtypes, Tf with subtypes, Amy, C3, Bf, PLG) and nine red-cell-enzyme polymorphisms (AcP, PGM1 with subtypes, AK, ADA, 6-PGD, GPT, EsD, GLO). Four systems--Tf, Amy, AK, ADA were found to be monomorphic. In the PGM1 subtypes an extremely high frequency of PGM1a3 could be observed. In two samples a new Gc mutant was identified and classified as Gc1A26. In the EsD system an unusual phenotype was detected in one sample.

Ecogenetic studies in Atacameño Indians

Aldehyde dehydrogenase deficiency, N-acetyltransferase variation and the polymorphisms of alpha 1-antitrypsin, serum cholinesterase, paraoxonase, and delta-aminolevulinic acid dehydratase were investigated in 180 Atacameño Indians from the North of Chile. The genetic predisposition of these individuals for possible atypical reactions against environmental agents and drugs, as well as general implications of these findings, are discussed.

Population genetic studies in three Chinese minorities

Three minority ethnic groups from China (Mongolians, Koreans, Zhuang) were examined with respect to the genetic markers GLO, GPT, ACP, ESD, 6-PGD, PGM1 subtypes, C3, and TF. Significant variations were noted for the gene frequencies of GLO, GPT, ESD, sub PGM1 between Zhuang and Mongolians; for GPT, ACP, ESD, sub PGM1 between Zhuang and Koreans; and for GLO between Mongolians and Koreans.

Aldehyde dehydrogenase isozyme deficiency and alcohol sensitivity in four different Chinese populations

Four different populations of China were studied regarding aldehyde dehydrogenase isozyme variation and incidence of alcohol sensitivity. While Korean and Mongolian minorities in the north showed an isozyme I deficiency with a frequency of about 25 and 30%, 45-50% of Zhuang and Han were deficient, respectively. Adverse reactions after alcohol drinking were mainly reported by those subjects who showed the lack of aldehyde dehydrogenase isozyme I.