Does seasonality of births in diabetes mellitus reflect pathogenetic differences?

OBJECTIVES

This study indicates that the seasonality of births of patients with DM1 and DM2 has occurred in their adolescence or adulthood.

BACKGROUND

Patients with Diabetes mellitus type 2 (DM2) with the maturity onset have different seasonal birth patterns from those with Diabetes mellitus type 1 (DM1) with the maturity onset, or DM1children.

METHODS

Monthly numbers of births of 81 and 236 children with DM1 and DM2, respectively, in adolescent or adult age, were adapted to different actual length of calendar months. The 12- and 6-month rhythm was tested using the cosinor regression with 95% confidence interval versus the hypothesis of null seasonality.

RESULTS

Regarding DM1 with maturity onset, annual and semiannual rhythm was significant in both genders, with the increase in birth numbers from November to January and decrease in March, April and August. In DM2, only female data displayed a significant annual rhythm, with an increase in birth from April to August and decrease from October to December.  CONCLUSION: The birth seasonality related to DM1 in adolescent or adult age appears to be reciprocal, compared to DM1 in childhood. For DM2, the seasonality of births was found only in females. The increase in female fecundity seems to be related to an increase in the risk of DM2 in female offspring. The outcomes could help in identifying environmental and endogenous factors related to seasonality cycle (Tab. 1, Fig. 1, Ref. 18).

The Derer´s biological - cosmic week and the Halberg´s circaseptan chronome

There are three common periodic intervals in the life of each human being from time immemorial: the day, the week and the year. The first one is given by the Earth´s rotation, the latter one by its revolution around the Sun. These both do have clear biomedical counterparts. The 7-day week, basically linguistically "period of change" (or a similar period, e.g.10 days in Egypt or 8 days in Etrutria) was obviously originally considered mainly as a product of a societal agreement. Two groups of Czechoslovak clinicians-scientists, however, noted in forties of the XXth century an approximately week period in human laboratory data, after similar attempts abroad a few years earlier. In fifties, L.Dérer, respecting the mathematical and biological principles in medicine and supported by the mathematician A.Huťa, demonstrated the presence of the "6-day" rhythm in blood leukocyte counts in patients with leukemia, treated by cytostatics. Posing the question "Where is it from?", he considered also cosmic influences but was unable to study this issue more deeply due to his premature decease. Two decades later, the "Dérer´s circaseptans" found wide confirmation not only in human medicine but also in biology. The pioneering role here belongs to Franz Halberg, USA, the godfather of the "circadians" (originally "Halberg´s paranoia") since the fifties. The possible geocosmic roots of circaseptans are supposed in the geomagnetic activity from interplanetary space, generating under the influence of the Sun rotation the periods around 6-7 days. This is presently documented, surprisingly, also by analysing the Dérer´s original data using more advanced, inferentially statistical method - the Halberg cosinor regression. Thus, the optimal approximation has been achieved for the period of 6.75 days - the 4th harmonics of the Bartels solar rotation cycle. Accordingly, the week can be now, after Dérer and Halberg, understood also - same as day and year - as a biological - geocosmic phenomenon, a geomagnetic week, genetically acquired in the course of billions years´ of evolution, encoded in our chronome. The personality of Ladislav Dérer should, in the history of the Czech and Slovak biomedical sciences, be permanenly standing by such giants as the well known Jan Evangelista Purkyně ("Purkinje") or as Bohumil Němec, discoverer of the mechanism of positive geotropism of plant roots (Fig. 3, Ref. 28).

Circa(ultra)dians of single extrasystoles in chronic respiratory failure versus health at lowland

BACKGROUND

The circa- and ultradians of the single extrasystoles' frequency in patients with chronic respiratory insufficiency (CRI) in lowlands (Kosice 210 m) were studied by the testing of following null hypotheses: their average frequency as well as rhythmicity is the same as at health.

METHODS

In 54 elderly males with CRI, mean numbers of supraventricular (SV) and ventricular (VE) extrasystoles were calculated for each 24 hours. The Halberg cosinor regression was used to test the presence of the 24-hour rhythm and its 2nd to 10th harmonics, i.e. ultradians with the period lengths of 12 to 2.4 hours. The resulting approximating function for either extrasystole type included its point, 95% confidence for mean and 95% tolerance for one individual. The results were compared with those obtained at health at alpha = 0.05.

RESULTS

The daily mesors in CRI were 20.9 for SV, for VE 17.6 extrasystoles per hour and subject. This was significantly (20.3 (SV) and 17.0 (VE)) higher than at health. Significant periodic harmonic components were 3 in CRI versus 6 at health for SV and 6 in CRI versus 1 at health for VE. The dominating CRI rhythm was the 8 hour ultradian for SV and circadian for VE while at health the circadian rhythm was leading for every type of extrasystoles.

CONCLUSION

The most remarkable effect of CRI versus health at lowlands is a marked increase of the frequency of every type of extrasystoles. SV extrasystoles exert more rhythmicity at health while the VE in disease (Tab. 1, Fig. 1, Ref. 20).

Time course of nontyphoid salmonellosis in Slovakia 1957-2008

AIM

To test in time salmonellosis data the hypothesis respecting the Moon gravity.

METHODS

Daily numbers of admissions at Clinic of Infectology 2005-2006 were processed on significance level alpha = 0.05, after finding out their non-Poisson distribution, by cosinor regression in relation to the cycle new moon--full moon--new moon, lasting in average 29.53 days. In yearly incidence of this disease in Slovakia 1957-2008, presence of 18.6-year periodicity, connected with nutation of Moon axis, was tested.

RESULTS

In agreement with our results 20 years ago, statistically significant 14.76-day rhythm was revealed,with pronounced swings downwards and upwards near full and new moon again. It is matching the cycling of lunar gravity. In the yearly data, statistically significant 18.6-yearly period, roughly reciprocal against the lunisolar gravitation, is apparent. It has been confirmed by cross-linear regression.

CONCLUSIONS

This study may testify to a causal relationship between the gravity and the occurrence of salmonellosis. The 18.6-years' cycling could explain the allegedly global phenomenon--steep decrease of incidence since about 2000. Nevertheless, it succeeds to an equally long and steep increase since 1990, corresponding so far to the found periodicity without proving a supposed new trend.The next years will decide whether the decrease will continue in the sense of this trend towards eradication of this disease or repeated increase will occur in the frame of continuing periodicity. Our findings are indirectly supported by the laboratory documentation of increased virulence of Salmonella in microgravity, published from NASA laboratories 10 years ago. Its practical exploitation for protecting the health of crew of cosmic flights is expected (Fig. 4, Ref. 15).

Yearly and perhaps transyearly human natality patterns near the equator and at higher latitudes

Data on the daily numbers of births in Davao, Philippines, available from 1993 to 2003 are re-analyzed herein by linear-nonlinear rhythmometry, as are data from Italy and Japan. A transyear, characterizing the solar wind and other non-photic physical environmental factors, corresponds to a spectral peak of the near-equatorial natality series. This component with a period of about 1.3 years is found to have an amplitude larger than the calendar year, the amplitude ratio being 134%. Whereas the transyear is validated nonlinearly, the 95% confidence interval for the period extending from 1.21 to 1.38 years and the 95% confidence interval for the amplitude not overlapping zero (P < 0.05), the annual variation is only demonstrable by linear least squares analysis. The results bring added evidence for an influence of non-photic environmental effects on human physiology, in this case data collected near the equatorial region, Davao being situated at 7 degrees N, 126 degrees E. They are in keeping with some degree of generality of a rule of reciprocity among mutually supporting physical and biological periodicities. They do not detract from the fact that in other longer data sets at higher latitudes, the calendar year, presumably reflecting climatic influences, dominates the spectrum.

Geographic and extraterrestrial aspects of morbidity and/or mortality patterns from myocardial infarction and stroke

Two authors (M.K. and M.M.) provided insight into a manuscript submitted by them elsewhere for publication and kindly offered for meta-analysis data on the monthly incidence from January 1989 up to December 2004, of 6094 cerebral infarctions, 414 intracerebral and 277 subarachnoid hemorrhages, cases admitted at the Neurological Clinic in Nové Zamky, Slovakia. Spectral components with a period exceeding (beyond = trans) the length of the calendar year--transyears--reported originally by M.K. and M.M. are here also documented linearly on original data without and after detrending by the fit of first- or second-order polynomials. For intracerebral and subarachnoidal hemorrhage, the zero-amplitude (no-rhythm) assumption is rejected (P < 0.05, not corrected for multiple testing) for the transyear but not for a precise 1.0-year trial period. As reported earlier by M.K. and M.M., the transyear's amplitude is larger than the calendar year's amplitude for all three series of stroke incidence in Slovakia. The putative importance of the new findings stems from earlier and new analyses revealing other spectral components that are presumed signatures of magnetoperiodisms, e.g. about 50- and 7-year components in about five decades of diagnostically unqualified, pooled data on stroke in Minnesota. There is, however, the danger of relatively small numbers providing artifacts for loosely defined transyears. The original cosinor approach by M.K. and M.M., testing anticipated periods, had its strength. The observation of a quindecadal component in mortality from strokes in Minnesota supports the presence of signatures of effects from extraterrestrial space in acute human pathology such as strokes, myocardial infarctions and sudden cardiac death. Magnetoperiodic mechanisms remain to be investigated further as added strokes accumulate in Nové Zamky and greater Slovakia as well as for sudden cardiac death where transyears have been documented in the Czech Republic, in Arkansas and particularly in Minnesota, but not elsewhere (as yet?). This study is also a plea for worldwide access to morbidity, mortality and natality data that constitute a largely unexploited treasure, brought to the fore mainly for relatively short-term comparisons of the effect of interventions against the fiction of imaginary baselines.

Trends of childhood diabetes incidence in Slovakia 1985-2000: accelerated increase in the years 1990-2000

BACKGROUND

A sudden rise in the incidence of childhood diabetes (DM 1) in Central and Eastern Europe over the last decade has been reported.

AIM

To compare in Slovakia incidence trends in the 80s with those in the 90s.

SUBJECTS AND METHODS

The data from the Slovak Register of Diabetic Children diagnosed in 1985-2000 (n=1818) were divided into 6 groups according to sex and age at diagnosis (0-4, 5-9, 10-14). Trends were computed separately for 1985-1990 and 1990-2000. The 95% confidence estimates of linear regression coefficients and as percentages from the estimated starting values in 1985 and 1990, were calculated by the linear regression based on statistical inferential approach.

RESULTS

Non-significant increasing or decreasing trends were found in 6 gender/age groups 1985-1990. In the 90s, however, significantly increasing trends were present in each of 6 groups. They were significant (p<0.05) in the male groups and in the total of all cases. The overall incidence rise (+0.03 cases per 100000 children per year) was nonsignificant in the 80s but significant in the 90s (+0.63/100000/year). As a result, the incidence rate of childhood diabetes in Slovakia rose from 6.01 new cases per 100000 children per one year in 1985 to 13.53/100000/year in 2000.

CONCLUSION

The overall DM 1 incidence increaseed from the 1980s (80s) to the 1990s (90s), expressed in the number of new cases, is more than a 20-fold absolutely and almost 10-fold in relative terms. This was not due to an improvement in diagnosis in 1990s. Both the gender and age heterogeneity were present. (Tab. 2, Fig. 2, Ref. 25.).

Daily birth numbers in Passo Fundo, South Brazil, 1997-1999: trends and periodicities

Between October 6, 1997 and April 30, 1999, 5011 births (mean: 8.76 per day) were registered in the city of Passo Fundo, South Brazil. The sequence of 572 daily birth numbers was not random (iteration test). Neyman distribution (m = yen ) showed the best fit. Clusters of days with higher birth numbers alternated with days with low numbers of births. Periodogram analysis revealed a significant periodicity of 6.98 days. The cosinor regression, testing 10 a priori supposed period lengths, found significant seasonality peaking in August-September and significantly highest birth numbers on Thursdays. Among the lunar and solar rotation cycles, the tropic lunar cycle and its 4th harmonic were most pronounced, in agreement with results concerning natality in Germany obtained by Svante Arrhenius in the 19th century. These findings confirm Derer-Halberg's concept of multiseptans. In addition to cycling, a significantly increasing linear trend with a daily increase of 0.0045 births was encountered. This documents a growth of the population in agreement with national statistical data.

Onset of spontaneous pneumothorax and the synodic lunar cycle

The relation between spontaneous pneumothorax events and synodic lunar cycle was studied in a retrospective analysis of patients with a first or recurrent spontaneous pneumothorax. The study included a total of 244 patients, 203 males and 41 females. The data were arranged along the first (new moon) to 28th day (one day before another new moon) of the synodic lunar cycle. Periodogram analysis revealed a 14-day rhythm, significant for the male and pooled sample. Cosinor analysis found the whole synodic lunar cycle and its 2nd, 4th and 5th harmonics as significant. Maximal accumulation of cases happened 1 week before and 1 week after the new moon. Mechanisms of a putative moon influence are not clear.

Risk factors for glucose intolerance in active acromegaly

In the present retrospective study we determined the frequency of glucose intolerance in active untreated acromegaly, and searched for risk factors possibly supporting the emergence of the diabetic condition. Among 43 patients, 8 (19%; 95% CI: 8-33%) had diabetes mellitus and 2 (5%; 1-16%) impaired glucose tolerance. No impaired fasting glycemia was demonstrable. The frequency of diabetes was on average 4.5 times higher than in the general Slovak population. Ten factors suspected to support progression to glucose intolerance were studied by comparing the frequency of glucose intolerance between patients with present and absent risk factors. A family history of diabetes and arterial hypertension proved to have a significant promoting effect (P<0.05, chi-square test). A significant association with female gender was demonstrated only after pooling our data with literature data. Concomitant prolactin hypersecretion had a nonsignificant promoting effect. In conclusion, the association of active untreated acromegaly with each of the three categories of glucose intolerance (including impaired fasting glycemia, not yet studied in this connection) was defined as a confidence interval, thus permitting a sound comparison with the findings of future studies. Besides a family history of diabetes, female gender and arterial hypertension were defined as additional, not yet described risk factors.

Alterations in lymphocyte subpopulations in peripheral blood at manifestation of type 1 diabetes mellitus in childhood

BACKGROUND

Alterations in cellular immunity at manifestation of type 1 diabetes mellitus, as described in publications so far, are equivocal. Moreover, the age of children was usually not taken into account.

OBJECTIVES

Exact inferentially statistical measures were used to arrive at reliable information.

METHODS

Thirty four diabetic children and 48 normals were taken randomly according to the established criteria, and scrutinized. Lymphocyte subpopulations counts were measured by flow cytometry using three-color-labelled monoclonal antibodies against cell surface markers. The resulting absolute cell counts as well as percentages from the total lymphocyte count were expressed in terms of univariate and bivariate 95% confidence intervals. They render an illustrative way for defining statistically significant (alpha = 5%) differences between health and disease.

RESULTS

The CD8, CD16 absolute counts in younger diabetics were significantly decreased in average to 96-58% of the normal subgroup. For older children, CD4, CD8, CD16 and CD19 absolute counts were significantly lowered to 75-61% of the norm. Relative changes in Ly subpopulations were less pronounced. The immunoregulatory index increased significantly to 125-128% of the norm in either age group. The proportion of CD4 memory cells from the total of naive and memory cells was significantly increased to 122-133% of the norm in diabetic children of either age group.

CONCLUSION

More significant changes of lymphocyte subpopulations than those given in literature were revealed at manifestation of childhood type 1 diabetes. They testify to the autoimmune pathogenesis of the type 1 diabetes mellitus. (Tab. 3, Fig. 4, Ref. 18.)

Diabetes mellitus in primary aldosteronism

BACKGROUND

Information concerning diabetes mellitus associated with primary aldosteronism is scarce.

OBJECTIVES

To determine the prevalence of diabetes mellitus in its two main pathogenetic forms of primary aldosteronism and to evaluate its association with several clinical variables.

PATIENTS

Fifty in-patients (31 female and 19 male, aged 16-66), diagnosed during the years 1980-1998 as aldosterone producing adenoma (n = 26) or as idiopathic hyperaldosteronism (n = 24).

METHODS

Morning fasting plasma glucose was measured by glucoso oxidase method in all patients. In the presence of higher values, confirmatory measurements were performed on the next day. The results were evaluated retrospectively by the diagnostic criteria of American Diabetes Association, 1997. Statistical significance of the association between diabetes mellitus and clinical variables was evaluated by chi-square test.

RESULTS

Diabetes mellitus was ascertained in 6 patients out of 50 (12%; interval of 95% confidence 5-24%). Diabetes was accompanied significantly more often with idiopathic hyperaldosteronism (10-47%) than with aldosterone producing adenoma (0-13%). Patients with the family history of diabetes suffered more often (9-76%) from this disease than those without the history (1-19%). Obesity, longer (> 5 years) duration of hypertension and hypokalaemia did not affect the occurrence of diabetes.

CONCLUSIONS

The occurrence of diabetes in primary aldosteronism was connected significantly with its idiopathic subtype and positive family history of diabetes. (Tab. 2, Ref. 11.)

Daily blood pressure profile in Cushing's syndrome before and after surgery

No significant difference has been demonstrated in the altered circadian blood pressure pattern between the pituitary-dependent and adrenal forms of Cushing's syndrome before surgery. The effect of therapy, however, proved to be different. The mesor was normalized in the pituitary-dependent Cushing's syndrome more conspicuously for systolic than for diastolic blood pressure. In Cushing's syndrome due to adrenal adenoma, systolic and diastolic blood pressure mesors have been even significantly "overnormalized" after treatment, being 11 to 27 and 2 to 13 mmHg (95% confidence) lower than corresponding mesors in controls. There was no difference between forms in the effect of treatment on blood pressure amplitudes, which remained significantly lower than in controls. Finally, acrophase patterns were partly normalized after treatment of the pituitary-dependent form only for diastolic blood pressure, while both systolic and diastolic blood pressure acrophases were normalized in the treated adrenal form. In conclusion, complete normalization of the pattern of daily blood pressure profile has not been achieved in either form of the syndrome. This may be one of the reasons for the reduced long-term survival after surgical cure of hypercortisolism, than expected.

Worker honeybee hemolymph lipid composition and synodic lunar cycle periodicities

The aim of the present investigation was to extend a previous study, showing a correlation of the variations of hemolymph carbohydrates with synodic lunar-like cycle and its circaseptan harmonics to worker honeybee hemolymph lipids. Hemolymph lipid concentrations of emerging worker imagos were analyzed in terms of one ideal synodic lunar cycle and processed by the cosinor method testing the null hypothesis versus the presence of 29.5-, 14.8- or 7.4-day periods in the data. A rhythmicity statistically compatible with a 29.5-day rhythm was observed for triacylglycerols and steroids as well as for body weight. A circadiseptan rhythm was determined for 1,3 diacylglycerols, while fatty acids and phospholipids exhibited a circaseptan rhythm. An agreement of peaks for triacylglycerols, steroids and body weight at the new moon, but not at the full moon, was noted with respect to trehalose and glucose circadiseptan rhythms. The latter moon-phase timing of peaks and nadirs, compared with that previously determined for trehalose and glucose, appeared to be identical to the circadiseptan rhythm and reciprocal for the circaseptan rhythms of 1,3 diacylglycerols. Reciprocal tendencies in circaseptans of trehalose and glucose on the one hand, and fatty acids and phospholipids on the other are indicated. The underlying causal nexus of these relationships is unknown.

Lunar influence on atrial fibrillation?

The most popular periodicities in biology and medicine-the circadians and circannuals-stem undoubtedly from the Earth's rotation and its revolution around the sun. The problem is how to explain the existence of circaseptan, i.e. 5-9-day, and other infradian rhythms. They may correspond to the lunar cycles and their 2nd to 6th harmonics. To test such hypothesis, the calendar dates of 127 attacks of atrial fibrillation in one male subject (M.M.) between 1980 and 1994 were transformed into the days numbered 0-29 for the synodic, and 0-26 for tropic lunar cycle. The daily frequencies obtained in this way were smoothed by moving averages of three successive days each. Considerable fluctuations of frequencies of attacks during both cycles were visible by inspection of the corresponding graphs, called lunar plexograms. Thus, a conspicuous nadir is found under the full moon in the synodic cycle, and a marked peak shortly after the extreme southern position of the moon in the tropic cycle. Halberg's cosinor analysis testing the presence of the 1st to 6th harmonic of either lunar cycle rejected the null hypothesis at the alpha = 0.05 level for all harmonics. Accordingly, the occurrence of attacks was cycling with the period lengths of synodic and tropic lunar cycles, and with those of their 1/2-1/6 period lengths, i.e. with a cluster of approximately circa(di)-septan rhythms. This conclusion is supported by similar findings obtained earlier for various medical and biological events.

Lunisolar tidal waves, geomagnetic activity and epilepsy in the light of multivariate coherence

The computed daily values of lunisolar tidal waves, the observed daily values of Ap index, a measure of the planetary geomagnetic activity, and the daily numbers of patients with epileptic attacks for a group of 28 neurology patients between 1987 and 1992 were analyzed by common, multiple and partial cross-spectral analysis to search for relationships between periodicities in these time series. Significant common and multiple coherence between them was found for rhythms with a period length over 3-4 months, in agreement with seasonal variations of all three variables. If, however, the coherence between tides and epilepsy was studied excluding the influence of geomagnetism, two joint infradian periodicities with period lengths of 8.5 and 10.7 days became significant. On the other hand, there were no joint rhythms for geomagnetism and epilepsy when the influence of tidal waves was excluded. The result suggests a more primary role of gravitation, compared with geomagnetism, in the multivariate process studied.

Somatostatin and large bowel polyps

BACKGROUND/AIMS

Somatostatin, a polypeptide hormone, inhibits cellular proliferation of the mucosa. As this cellular proliferation has been observed in large bowel polyps and cancer, the exact pattern of secretion may be of importance to the understanding of such diseases.

MATERIALS AND METHODS

The circadian (24 hours rhythmicity) of plasma somatostatin was studied and established in patients suffering from large bowel polyps. Blood was drawn from the study subjects at regular intervals and the plasma somatostatin levels were determined by radioimmunoassay.

RESULTS

In both groups, a circadian rhythm of somatostatin was confirmed. In patients with P higher mesor (p < 0.05), higher 24 hour amplitude (p < 0.05) and longer acrophase (p < 0.05) were found.

CONCLUSION

These findings may indicate the defense antiproliferative role of somatostatin in malignant and premalignant states. Somatostatin may prove beneficial as one of the treatment possibilities for large bowel polyps.

Additivity test for composition of binomial effects in chromosome aberrations after radiation injury

Additivity of clastogenic effects of two doses of radiation to human peripheral blood lymphocytes is considered. We compare the effects of combined tritium and gamma irradiation with the sum of the effects of either irradiation administered separately. Our solution is based on combination of de Moivre and Cramèr-Slucky theorems. The results for 14 subjects where the deletion types of chromosome aberrations were counted indicate a Normal distribution of the sample additivity index, oscillating non-significantly around zero, with one outlier towards adaptivity and another towards synergism of the effect of the two doses absorbed by the cells.

Daily variation of serum cortisol, 17-hydroxyprogesterone and five androgens in healthy women

Serum cortisol, 17-hydroxyprogesterone and five androgens (androstenedione, 11-hydroxyandrostenedione, dehydroepiandrosterone and its sulphate, and testosterone) were measured by radioimmunoassay at 8:00, 16:00, 20:00 and 24:00 h and again at 8:00 h on the next day in eight healthy female subjects aged 16-40 years in the midfollicular phase of the menstrual cycle. Regression analysis revealed a significant (alpha = 0.05) circadian periodicity, with estimated peaks between 8:00 a.m. (testosterone) and 2:00 p.m. (dehydroepiandrosterone sulphate), and with estimated amplitudes between 76% (11-hydroxyandrostenedione) and 33% (17-hydroxyprogesterone, testosterone and dehydroepiandrosterone sulphate) of the rhythm adjusted mean. The inferential statistical approach illustrated here should contribute significantly to the diagnostic elucidation of adrenocortical disorders.

Plasma somatostatin levels in ulcerative colitis

The circadian (24 hour) rhythmicity of somatostatin in healthy subjects and patients with ulcerative colitis (UC) was studied and established. UC patients were found to have a higher 24-hour amplitude, a higher average level and a longer peak level phase of plasma somatostatin. This finding may indicate a defensive role of somatostatin in inflammatory bowel disease.

Urinary excretion of retinol-binding protein in type 1 (insulin-dependent) diabetic patients with microalbuminuria and clinical diabetic nephropathy

The urinary excretion of retinol-binding protein (RBP) was studied in 101 insulin-dependent diabetic patients allocated to three groups according to 24-h urinary albumin excretion rate (UAE) (median of three urine collections): group 1 (n = 45), normal UAE less than 30 mg/24 h; group 2 (n = 27), microalbuminuria (UAE 30-300 mg/24 h); and group 3 (n = 29), clinical diabetic nephropathy (UAE greater than 300 mg/24 h). We used 23 healthy subjects as controls. Fractional clearance of RBP (FC-RBP) and its 24-h urinary excretion rate (URBP) were higher in each diabetic group than in healthy subjects, the highest values being found in group 3. Groups 1 and 2 did not differ in URBP and FC-RBP. There was a correlation between FC-RBP and haemoglobin A1c in both the total diabetic cohort (P less than 0.001) and in diabetic patients in groups 1 and 2 with a glomerular filtration rate of more than 90 ml/min (P less than 0.05). No correlation was found between FC-RBP and UAE and/or duration of diabetes in any of the diabetic groups. We conclude that the increased urinary excretion of RBP, indicating proximal tubular dysfunction, is already present in normoalbuminuric insulin-dependent diabetic patients and correlates with metabolic control. Further deterioration in proximal tubular function was not observed in microalbuminuric patients, but is a late event in clinical diabetic nephropathy.

Circadian pattern of serum androgens in women with Cushing's syndrome

Circadian profiles of the serum levels of cortisol and five androgens were studied in 20 females including 8 controls, 7 patients with ACTH-dependent Cushing's syndrome and 5 with hypercortisolism due to adrenal adenoma. A significant 24-h periodicity was found for each steroid in all groups. Besides hypercortisolaemia, a significant increase of 11-hydroxyandrostenedione was shown in both forms of Cushing's syndrome. The most conspicuous finding was a decreased dehydroepiandrosterone and its sulphate in adrenal adenoma. The peaks for the studied steroids were shifted from the morning hours towards the noon in ACTH-dependent Cushing's syndrome and towards the evening (for cortisol) and night hours (for androgens) in adrenal adenoma.

Some immunological findings in adult periodontitis

There is little doubt that immunological mechanisms play an important role in chronic inflammatory periodontal disease. At the same time, it is recognized that patient susceptibility is ultimately responsible for the clinical manifestation of the disease. In this context, the present study was undertaken to examine a range of systemic immunological parameters in patients with adult periodontitis (AP), so as to test the hypothesis that a specific pattern would identify diseased--possibly 'at risk'--patients. These parameters included serum IgA, IgG, IgM, IgD, C3, transferrin, the presence of circulating immune complexes, and the number of circulating T (E-rosette forming) cells. One hundred and forty AP patients and 70 healthy controls were examined. Following a complex statistical analysis only the levels of IgG, IgM and IgD were significantly increased in adult periodontitis (p less than 0.05) while an increase in circulatory immune complexes was significant only for separate statistical tests. Although statistically different, the levels seen in AP patients were still within the normal range hence the clinical significance of the findings is such that it is unlikely that these systemic immunological parameters per se do define an 'at risk' population.

Effect of initial treatment of chronic inflammatory periodontal disease in adults on spontaneous peripheral blood lymphocyte proliferation

The spontaneous proliferative response (SPR) of peripheral blood lymphocytes, as a measure of the autologous mixed lymphocyte reaction (AMLR), has been found to be depressed in adults with chronic inflammatory periodontal disease (CIPD). The aim of the present study was to test the hypothesis that initial treatment of CIPD in adults restores the SPR to normal levels. 10 periodontal disease subjects (mean probing attachment loss of 4.2 mm and a mean bleeding index of 0.65) and 10 age- and sex-matched healthy control subjects were studied. The SPR for each patient was evaluated on days 3, 5, 7, 9 and 11 in culture, before and after initial treatment for CIPD. The peak SPR, which occurred at day 5, was depressed in the untreated periodontal disease subjects compared to the healthy control subjects (p less than 0.01). In addition, the kinetics of the SPR were found to be significantly different in 4 of the 10 parameters compared with the untreated periodontal disease patients and the healthy control subjects. After treatment, there was a significant reduction in probing attachment loss and bleeding indexes (p less than 0.001). In addition, the magnitude of the peak SPR was not significantly different from that of the healthy control subjects. Nevertheless, a difference in 1 of the 10 kinetic parameters persisted, which suggested that complete restoration of the SPR to normal had not occurred so soon after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Catecholamine clearance is not enhanced by increasing levels within the physiological range

If rising plasma catecholamine levels enhance their own clearance, such a mechanism could be protective, and its absence predispose to hypertension. In normal subjects and in mild essential hypertensives serial increases in plasma noradrenaline (NA) and adrenaline (ADR) generated by intravenous infusion were used to test the effect of rising plasma levels on clearance. Plasma NA and ADR were measured radio-enzymatically, venous clearance of NA by isotopic infusion and clearance of ADR by increment in arterial plasma levels. Serial increases in NA and ADR through the physiological range did not lead to increased plasma clearance: in fact, NA and NA clearance were significantly negatively correlated. For ADR, a circulating hormone, any effect on clearance may be biologically important. Chronic increases in circulating ADR due to mental stress have been suggested as an etiological factor in essential hypertension, working through enhanced noradrenergic transmission. The significance of these findings for NA, a local neurotransmitter rather than a circulating hormone, depends on the extent to which changes in plasma clearance reflect changes in tissue clearance.

A biometrical view on normal values of CD4 and CD8 lymphocyte counts in peripheral blood

Statistical methods have been used to determine an optimal approach to the definition of the reference range for CD4 ("helper") and CD8 ("suppressor/cytotoxic") T cell numbers and the CD4/CD8 ratio in the peripheral blood. A graphical presentation of the absolute values for CD4 and CD8 for 85 healthy blood donors showed that a reference ellipse defined by fitting a gaussian distribution to logarithmically transformed data for absolute counts of CD4 and CD8 cells was superior to the fitting of an ellipse to untransformed data. Further analysis for another 147 subjects showed that the 95% tolerance prediction for the CD4/CD8 ratio in health could be stated with 95% confidence as 0.6 to 5.0. This approach allows clear definition of reference ranges for T cell tests in health and would also be applicable to results for patients with a disease such as HIV 1 infection in which a reference range for "well" patients exists and a change in the T cell ratio is of prognostic significance.