bluuebunny/crossref_metadata_2025 huggingface dataset:
Phyloecology of urban alien floras
Authors: Ricotta Carlo , La Sorte Frank A. , Pyšek Petr , Rapson G.L. , Celesti‐Grapow Laura , Thompson Ken
Published: July 2009

1.  Understanding the mechanisms that affect invasion success of alien species is a major issue in current ecological research. Although many studies have searched for either functional or habitat attributes that drive invasion mechanisms, few researchers have addressed the role of phylogenetic diversity of alien species.

2.  Here, using data from 21 urban floras located in Europe and eight in the USA, we show that the phylogenetic diversity of alien species is significantly lower than that of native species, both at the continental scale and at the scale of single cities.

3.  Second, we show that if archaeophytes and neophytes (non‐native species introduced into Europe before and after AD 1500, respectively) are analysed separately, archaeophytes show lower phylogenetic diversity than neophytes, while the phylogenetic structure of neophytes is indistinguishable from a random sample of species from the entire species pool.

4.  Our results suggest that urban aliens are subject to environmental filters that constrain their phylogenetic diversity, although these filters act more strongly upon archaeophytes than neophytes.

5.
 Synthesis. Despite the huge taxonomic diversity of plants imported into European and American cities, the strong environmental filters imposed by cities constrain the functional diversity of urban floras, which is reflected in their generally low phylogenetic diversity. Urban alien floras are mainly composed of phylogenetically related species that are well adapted to anthropogenic habitats, although these filters are stronger for species groups with longer residence times.
The role of the economic environment in kidney transplant outcomes
Authors: Gueye Abdou S. , Baird Bradley C. , Shihab Fuad , Koford James K. , Barenbaum Anna L. , Leviatov Alexander , Goldfarb‐Rumyantzev Alexander S.
Published: July 2009

Abstract:  The relationship between global economic indicators and kidney allograft and patient survival is unknown. To investigate possible relationships between the two, we analyzed kidney transplant recipients receiving transplants between January of 1995 and December of 2002 (n = 105 181) in the USA using Cox regression models. We found that: The Dow Jones Industrial Average had a negative association with outcome at one year post‐transplant (HR 1.03 and 1.06, p < 0.001 for graft and recipient survival, respectively) but changed to a protective effect in the late period (HR 0.77, p < 0.001, and HR 0.83, p < 0.001 for graft and recipient survival, respectively, five yr after transplantation). Unemployment rate had a protective effect at the time of transplantation (HR 0.97, p < 0.005) and at one year after transplantation (HR 0.95, p < 0.005) but changed to the opposite in the late period at the fifth post‐transplant year (HR 1.35, p < 0.001, and HR 1.20, p < 0.001, for graft and recipient survival respectively). The Consumer Price Index measured at different post‐transplant time points seems to have had a protective effect on the graft (HR 0.77, p < 0.001 at five yr) and recipient (HR 0.83, p < 0.001 at five yr) survival. Beyond three yr after transplantation, when some of the recipients lose Medicare benefits, economic downturns might have a negative association with the kidney graft and recipient survival.
Development of thyroid diseases in the treatment of chronic hepatitis C with α‐interferon may be a good prognosticator in achieving a sustained virological response: A meta‐analysis
Authors: Tran Huy Anh , Malcolm Reeves Glenn Edward , Gibson Robert , Attia John Richard
Published: July 2009

Background and Aim:  Thyroid dysfunction is the most common endocrinopathy associated with hepatitis C and its interferon‐based treatment. When undergoing treatment, interferon and ribavirin synergize to potently stimulate the immune system in order to eradicate the virus. One of the innocent bystanders in this accentuated response is the thyroid. The present study investigated whether thyroid dysfunction while undergoing combination treatment for hepatitis C is a favorable prognostic maker for a sustained virological response.

Methods:  We carried out a prospective clinical audit in 201 patients treated with combination ribavirin and α‐interferon and determined the prevalence of sustained virological response in patients in association with thyroid disease. A meta‐analysis was also carried out pooling 741 patients from four previous studies on this topic.

Results:  There was positive and significant association between thyroid disease and viral clearance. This was not supported by the meta‐analysis, however, and some plausible explanations are proffered for this inconsistency.

Conclusion:  Despite lacking supportive evidence from the meta‐analysis, it is important that this information is confirmed (or refuted) in future studies.
Comparison of temporal artery, mid‐forehead skin and axillary temperature recordings in preterm infants <1500 g of birthweight*
Authors: Duran Ridvan , Vatansever Ülfet , Acunaş Betül , Süt Necdet
Published: July 2009

Aim:  Preterm infants are prone to temperature maintenance problems due to immature thermoregulatory mechanism and relatively large body surface area. The objective of the present study was to evaluate the performance of a new non‐invasive infrared thermometer applied to the mid‐forehead and temporal artery in comparison with axillary temperature recordings by mercury‐in‐glass thermometer, and to determine the discomfort caused by these procedures in preterm infants on incubator care.

Methods:  The present comparative prospective study was composed of 34 preterm infants <1500 g of birthweight nursed in an incubator. Temperature recording from mid‐forehead, temporal artery and axilla were recorded six times a day for 7 days since the end of the first week of life. For pain assessment, the premature infant pain profile (PIPP) was used.

Results:  The mean mid‐forehead, temporal artery and axillary temperatures were 36.72 ± 0.08, 36.81 ± 0.09 and 36.71 ± 0.07°C, respectively. No statistically significant difference was noted between the means of mid‐forehead and axillary temperatures. The mean temporal artery temperature was statistically higher than the means of the mid‐forehead and axillary temperatures. The PIPP scores of the mid‐forehead, temporal artery and axillary temperature measurements were 5.07 ± 0.36°C, 5.18 ± 0.43°C and 7.59 ± 0.84°C, respectively. The mean PIPP score of axillary temperature measurements was statistically higher than the means of mid‐forehead and temporal artery measurements.

Conclusions:  The infrared skin thermometer applied to the mid‐forehead is a useful and valid device for easy and less painful measurement of skin temperature in preterm infants <1500 g of birthweight.
Combined enzyme replacement and haematopoietic stem cell transplantation in Hurler syndrome
Authors: Bijarnia Sunita , Shaw Peter , Vimpani Anne , Smith Robert , Pacey Verity , O'Grady Helen , Christodoulou John , Sillence David
Published: July 2009

We report the long‐term follow‐up of successful treatment of mucopolysaccharidosis type I H (MPS IH, Hurler syndrome) with combined enzyme replacement therapy and haematopoietic progenitor stem cell transplant.
Management of children with otitis media: A survey of Australian Aboriginal Medical Service practitioners
Authors: Gunasekera Hasantha , Morris Peter S , Daniels John , Couzos Sophie , Craig Jonathan C
Published: July 2009

Aim:  To determine whether Australian Aboriginal Medical Service (AMS) practitioners treat otitis media (OM) more aggressively in Aboriginal than non‐Aboriginal children and the factors influencing their management decisions.

Methods:  A case vignette questionnaire was sent to all AMS practitioners working in December 2006. We compared responses based on the child's Aboriginal status using χ2 analysis.

Results:  Questionnaires were returned from 63/87 (72%) of the AMSs by 131/238 (55%) eligible practitioners. Few practitioners (13%) reported using tympanometry or pneumatic otoscopy (9%) when examining children's ears. Practitioners were more likely to treat acute OM with antibiotics (92% vs. 49%, P < 0.01) and to treat with courses longer than 7 days (25% vs. 14%, P= 0.03) in Aboriginal than non‐Aboriginal children. Most practitioners (60%) used oral antibiotics to treat chronic suppurative OM and OM with effusion in Aboriginal children (58%). Factors increasing the likelihood of antibiotic use included: the child being Aboriginal (67%), wet perforations (62%) and bulging eardrums (59%). No AMS or practitioner characteristics were significant predictors. Most practitioners (99%) were aware of Therapeutic Guidelines (Antibiotic). Only half (54%) were aware of the Australian Government guidelines for managing OM in Aboriginal and Torres Strait Islander populations and only 22% used them ‘often’ or ‘always’.

Conclusions:  Australian AMS practitioners treat OM more aggressively in Aboriginal children, consistent with the Australian Government guidelines, despite half being unaware of them. Opportunities to improve management include increased use of pneumatic otoscopy and tympanometry, and decreased antibiotic usage for OM with effusion and chronic suppurative OM.
Fourth Joint Meeting of the American Urological Association and the Japanese Urological Association Specialty Society Program at the 104th Annual Meeting of the American Urological Association at Chicago 2009
Authors: Cooperberg Matthew R , Hinotsu Shiro , Chancellor Michael B , Homma Yukio , Nelson Peter S , Matsuyama Hideyasu , Menon Mani , Kucuk Omer , Hara Isao , Egawa Shin , Uzzo Robert G , Kanayama Hiro‐omi , Okuyama Akihiko , Akaza Hideyuki
Published: July 2009

Preface:  We are heartily grateful for the warm support of all of the people concerned, including the moderators and panelists of both societies for giving us the opportunity to hold the 4th American Urological Association/Japanese Urological Association (AUA/JUA) Joint Meeting, held once again at the 104th Annual Meeting of the American Urological Association (25–30 April 2009, Chicago, Illinois, USA).

2009 is a memorable year, being the start of new collaborations between AUA and JUA. The JUA in collaboration with AUA is promoting an academic exchange program whereby outstanding and promising Japanese and American junior faculty members will be given the opportunity to work in the USA and Japan for one month. The program not only allows the sharing of knowledge and experience, but is designed to foster a closer alliance between the AUA and JUA, and assists in identifying future leaders within both organizations.

The JUA will have an exhibit booth at the AUA annual meeting, promoting our new joint activities. The Journal of Urology and International Journal of Urology will share reviewers. The JUA will participate in developing AUA guidelines. With all of these activities, the JUA hopes it will provide greater opportunities to young Japanese urologists to participate in educational projects in the US.

We would like to thank Professor Robert C. Flanigan, the Secretary General of AUA, Professor Glenn M. Preminger, the Chairman of the AUA Office of Education and the staff of AUA and JUA for supporting our program. We hope to keep holding the joint meeting and have plenty of ideas on themes and forums. We believe that this international program helps to establish a closer relationship between JUA and AUA in the scientific field.

Akihiko Okuyama md, President of JUA

Hideyuki Akaza md, Chairman of the International Committee of JUA
Surveillance following orchiectomy for stage I testicular seminoma: Long‐term outcome
Authors: Yoshida Takahiro , Kakimoto Ken‐ichi , Takezawa Kentaro , Arai Yasuyuki , Ono Yutaka , Meguro Norio , Kinouchi Toshiaki , Nishimura Kazuo , Usami Michiyuki
Published: July 2009

Objectives:  To report the long‐term outcome of surveillance for stage I seminoma at a single institution in Japan.

Methods:  A retrospective review of medical records of 64 patients who underwent orchiectomy between January 1982 and December 2005 was carried out. All of them were managed by surveillance for stage I seminoma.

Results:  Median follow‐up time was 123.8 months. Of the 64 patients, seven developed relapse. Four relapses occurred within the first year after orchiectomy, but three occurred over 4 years after orchiectomy. The actuarial relapse‐free rates at 5, 10, and 15 years were 92.1%, 90.0%, and 86.0%, respectively. All patients received salvage chemotherapy at relapse. Four of these seven patients were alive without evidence of disease. One patient died of seminoma and one was alive with this disease. The remaining one patient died of leukemia without secondary relapse of seminoma. T classification was a statistically significant (P = 0.028) risk factor for relapse on univariate analysis. In T1 patients, relapse‐free rates at 5, 10, and 15 years were all 97.1%, whereas in T2/T3 patients the corresponding relapse‐free rates were 86.4%, 82.1%, and 71.8%, respectively.

Conclusions:  The relapse‐free rate in the present study was similar to previous reports. Late relapse should be considered during surveillance.
Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis
Authors: Chandrasekaran Sivashankar , Ariaretnam Siva Kumar , Tsung Jason , Dickison David
Published: July 2009

Both chemical and mechanical methods of prophylaxis have reduced the incidence of thromboembolic complications following total knee replacement (TKR). Only a few studies have shown that mobilization on the first post‐operative day further reduces the incidence of thromboembolic phenomena. We conducted a prospective study to verify not only if early mobilization but also whether the distance mobilized on the first post‐operative day after TKR reduced the incidence of thromboembolic complications.

The incidence of deep venous thrombosis and pulmonary embolism were compared in 50 consecutive patients who underwent TKR from July 2006 following a change in the mobilization protocol with 50 consecutive patients who underwent TKR before the protocol was instigated. The mobilization protocol changed from strict bed rest the first post‐operative day to mobilization on the first post‐operative day. Mobilization was defined as sitting out of bed or walking for at least 15–30 min twice a day. The distance mobilized was accurately recorded by the physiotherapists. All patients underwent duplex scans of both lower limbs on the fourth post‐operative day.

There was a significant reduction in the incidence of thromboembolic complications in the mobilization group (seven in total) compared with the control group (16 in total) (P= 0.03). Furthermore, in the mobilization group the odds of developing a thromboemobloic complication was significantly reduced the greater the distance the patient mobilized (Chi‐squared linear trend = 8.009, P= 0.0047).

Early mobilization in the first 24 h after TKR is a cheap and effective way to reduce the incidence of post‐operative deep venous thrombosis.
Emphysema on imaging is associated with quality of life in elderly patients with chronic obstructive pulmonary disease
Authors: Motohashi Norihisa , Kimura Kazuyoshi , Ishii Takeo , Wakabayashi Ritsuko , Kurosaki Hiroko , Motegi Takashi , Yamada Kouichi , Jones Rupert CM , Gemma Akihiko , Kida Kozui
Published: July 2009

Background:  Limited data are available on the association between the severity of emphysema or airway narrowing, and health‐related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD), which has been seen to be more prevalent among elderly subjects. The aim of this study was to examine the association between HRQOL, physical parameters and structural alterations in lung of COPD patients.

Methods:  Stable COPD patients (n = 125; mean age 71.0) were studied. Both the severity of emphysema, which was expressed as the extent of the low‐attenuation area (LAA%), and percentage of the large airway wall area (WA%) on high‐resolution computed tomography (HRCT) were compared with various parameters of the generic and HRQOL, respectively, together with pulmonary function tests and exercise capacity.

Results:  The predicted value of forced expiratory volume in 1 s was significantly associated with both LAA% and WA%, but the diffusion capacity was strongly correlated with LAA% alone. Parameters of the generic and HRQOL, and almost all other parameters appeared to be significantly associated with LAA% alone, whereas no association was observed between WA% and QOL.

Conclusion:  We concluded that the severity of emphysema, but not that of large airway narrowing on HRCT, is associated with both generic and health‐related QOL and reduced diffusion capacity. This notion might provide useful information in practice among elderly subjects who are unable to perform a spirometry.
Understanding the oldest old in northern Japan: An overview of the functional ability and characteristics of centenarians
Authors: Freeman Shannon , Kurosawa Hajime , Ebihara Satoru , Kohzuki Masahiro
Published: July 2009

Aim:  To increase knowledge of the functional ability of centenarians by examining the situation of Japanese centenarians residing in an urban region in northern Japan.

Methods:  Questionnaires focused on functional ability, demographics, housing and care needs were received from 56 centenarians and 104 control subjects: 56 aged 80–89 and 48 aged 90–99.

Results:  Centenarian physical capabilities, care needs and health history were diversified. Centenarians most commonly resided with family in the community and were likely to utilize informal and insurance care services. Gender differences in functional ability by age groups known as gender cross‐over were observed in control subjects but reduced in centenarians. A few who reported physical limitations were not entitled to receive nationally subsidized care services suggesting inaccuracies may have occurred during certification determination.

Conclusion:  Centenarians in northern Japan represent a heterogeneous cohort suggesting multiple paths to the attainment of advanced old age. This is the first study designed to provide a solid knowledge base of actual circumstances experienced by centenarians specifically in northern Japan.
Evolutionary rescue can prevent extinction following environmental change
Authors: Bell Graham , Gonzalez Andrew
Published: July 2009

The ubiquity of global change and its impacts on biodiversity poses a clear and urgent challenge for evolutionary biologists. In many cases, environmental change is so widespread and rapid that individuals can neither accommodate to them physiologically nor migrate to a more favourable site. Extinction will ensue unless the population adapts fast enough to counter the rate of decline. According to theory, whether populations can be rescued by evolution depends upon several crucial variables: population size, the supply of genetic variation, and the degree of maladaptation to the new environment. Using techniques in experimental evolution we tested the conditions for evolutionary rescue (ER). Hundreds of yeast populations were exposed to normally lethal concentrations of salt in conditions, where the frequency of rescue mutations was estimated and population size was manipulated. In a striking match with theory, we show that ER is possible, and that the recovery of the population may occur within 25 generations. We observed a clear threshold in population size for ER whereby the ancestral population size must be sufficiently large to counter stochastic extinction and contain resistant individuals. These results demonstrate that rapid evolution is an important component of the response of small populations to environmental change.
Microalbuminuria Predicts Mortality in Noninsulin‐dependent Diabetes
Authors: Jarrett R. J. , Viberti G. C. , Argyropoulos A. , Hill R. D. , Mahmud U. , Murrells T. J.
Published: July 2009

Forty‐four non‐insulin‐dependent diabetics (NIDD), all with urine negative to Albustix, were studied in 1966/67. By the end of 1980, 17 had died, all but two from cardiovascular causes. All causes of mortality and time to death were significantly related in univariate analyses to age and to the overnight urinary albumin excretion rate (AER), but not to systolic and diastolic blood pressure levels or to duration of diabetes when the latter was corrected for age. Age and duration were highly correlated with each other. In multivariate analyses age and AER were independent predictors of both mortality and time to death, with AER having the greater degree of significance.

Thus subclinically elevated albumin excretion rates (‘microalbuminuria’) indicate a substantially increased mortality risk in non‐insulin‐dependent diabetes.
Prostaglandin E1Accelerates Subcutaneous Insulin Absorption in Insulin‐dependent Diabetic Patients
Authors: Williams G. , Pickup J. C. , Collins Andrea C. G. , Keen H.
Published: July 2009

The powerful vasodilator, prostaglandin E1(PGE1), was added to Actrapid insulin to try to accelerate the early phase of subcutaneous insulin absorption through increasing injection site blood flow. Actrapid insulin alone (6U) and insulin containing PGE1(7.5times10‐6M) were injected on different days into 13 fasting insulin‐dependent diabetics. With the insulin/PGE1mixture, increases in both free and total plasma insulin concentrations were greater at all times up to 120 minutes after injection than with insulin alone, with signficant differences in the first 40 minutes. With insulin/PGE1the area under the total plasma insulin curve increased significantly more rapidly between 80 and 120 minutes. Plasma glucose concentrations fell consistently more rapidly with insulin/PGE1than with insulin alone although the differences were small (mean fall ±S.E.M. at 120 minutes: 4.9 ±0.5 mmol/l vs 4.0 ±0.6; p ‐ 0.02). Addition of local hyperaemic agents to short‐acting insulin preparations could be therapeutically useful in hastening insulin entry to the circulation at mealtimes.
Diabetes and Insurance: A Survey of Patient Experience
Authors: Frier B. M. , Sullivan F. M. , Stewart Elizabeth J. C.
Published: July 2009

A survey of 186 diabetic patients examined their collective experience of life and motor insurance. Some form of life insurance policy had been obtained by 150 patients, with a combined total of 204 policies, 107 of which had been agreed before the diagnosis of diabetes. Most patients had declared diabetes to the insurer but 12 patients had been refused acceptance. Only 15 patients sought alternative quotations. The premium had been loaded by 10–40% for 36 patients because of diabetes, and 48 required a medical report.

Of 147 diabetic drivers, 95 (65%) had declared diabetes either to the Licensing authority, or to the motor insurer, but only 62 (42%) had informed both. Fourteen patients had been refused motor insurance cover by individual companies, and 36 patients were aware of having had their premium increased, but only 16 patients had sought alternative quotations.

Major differences in attitude with regard to diabetes as a risk factor for insurance are evident, and patients should be advised to approach several companies when seeking insurance cover.
Medical Staff in Training to Become Consultant Physicians with an Interest in Diabetes
Authors: Turner R. C. , Smith A.
Published: July 2009

A census in 1982 of 44 registrars and 66 senior registrars each of whom intends to become a ‘consultant with an interest in diabetes’ revealed that the training posts are geared to produce the 11 consultants appointments per year which currently become available. However, on top of this ‘ladder’ are 26 senior registrars who are already due for a consultant post. This backlog would appear to be a permanent feature unless extra new consultant posts become available. A newly appointed senior registrar can anticipate an average of 6 years before a consultant appointment. The majority of junior staff approved the current regulations and training programmes, although 87% felt that they received insufficient guidance.
Seven Years Experience of Home Management in Pregnancy in Women with Insulin‐dependent Diabetes
Authors: Heller S. R. , Lowe J. M. , Johnson I. R. , O'Brien P. M. S. , Clarke P. , Symonds E. M. , Tattersall R. B.
Published: July 2009

Fifty‐eight of a consecutive series of 75 pregnancies in women with insulin‐dependent diabetes went into the third trimester. Diabetes was managed by home blood glucose monitoring and women were not routinely admitted at any stage before delivery. The mean number of in‐patient days before delivery was 15 for the whole series but has been reduced to 9 during the past four years. Each woman performed an average of 171 blood glucose measurements during her pregnancy. Mean blood glucose (including post‐prandial levels) fell significantly from 7.9 mmol/l in the first trimester to 7.3 in the second and 6.4 in the third. Mean percentage of haemoglobin A1 was within the normal range in the second and third trimesters. The caesarian section rate was high at 66% but there were no perinatal deaths. Three infants had congential abnormalities.

We conclude that home blood glucose monitoring is a safe and effective way of managing pregnant diabetic women as out‐patients. The cost of meters and sticks is repaid many times over in the saving of hospital costs. In addition, home blood glucose monitoring is popular with the patients and many choose to continue it after delivery.
Development of Scales to Measure Perceived Control of Diabetes Mellitus and Diabetes‐related Health Beliefs
Authors: Bradley Clare , Brewin Chris R. , Gamsu Deborah S. , Moses Jennifer L.
Published: July 2009

A series of scales was designed to measure perceived control of diabetes and diabetes‐related health beliefs with a view to predicting treatment preferences and individual differences in response to the treatments. Scale development is described and the psychometric properties examined with responses from 286 insulin requiring adult diabetic patients. Patients were significantly more likely (p < 0.001) to attribute responsibility for their diabetes control to themselves rather than to their medical advisors or to other factors.

For most of the patients the benefits of treatment were perceived substantially to outweigh any barriers (p < 0.001). Compared with their perceptions of vulnerability to disorders unrelated to diabetes, patients thought that they were more vulnerable to such diabetes related complications as eye, kidney and foot problems (p < 0.001) but not to heart disease.
A Feasibility Study of the Use of Continuous Subcutaneous Insulin Infusion in a Diabetic Clinic: Patients' Choice of Treatment
Authors: Knight G. , Boulton A. J. M. , Drury J. , Gamsu D. S. , Moses J. L. , Bradley C. , Ward J. D.
Published: July 2009

Insulin‐treated diabetic patients attending a busy diabetic clinic were approached to determine their interest in using continuous subcutaneous insulin infusion (CSII) via a portable pump. Three hundred and eighty‐two patients were offered the choice of CSII, intensified conventional therapy (ICT) or continuation of less intensified treatment. One hundred and sixteen patients (30.4%) chose CSII, 169 (44.2%) chose ICT, 97 (25.4%) chose the less intensive regimen. Those choosing CSII represented a broad cross section of the clinic population, though older patients with a longer duration of diabetes tended to continue with less intensified therapy. There were no differences between groups in the level of blood glucose control or the prevalence of complications at the outset of the study. Of 104 patients not previously using CSII, 86 have so far commenced the therapy. Twenty‐seven (32.6%) of these discontinued within one year, 23 doing so in the first three months of treatment. Metabolic control, assessed by glycosylated haemoglobin, was significantly improved in the CSII group after three months and in the other treatment groups by six months. Glycosylated haemoglobin levels achieved with CSII were significantly lower at three and six months when compared with the other treatments.
Insulin Action and Pharmacokinetics in Insulin Treated Diabetics during the Third Trimester of Pregnancy
Authors: Gray R. S. , Cowan P. , Steel J. M. , Johnstone F. D. , Clarke B. F. , Duncan L. J. P.
Published: July 2009

Insulin action and pharmacokinetics were compared, using the euglycaemic insulin clamp technique, in seven insulin‐treated diabetics during the third trimester of pregnancy and one to three weeks post‐partum. At an insulin infusion rate of 1 mU/kg/min, insulin mediated glucose disposal was significantly greater (p<0.02) following delivery (1.194±0.138 mmol/m2/min) than in pregnancy (0.761±0.072 mmol/m2/min) and the rate of decline in insulin mediated glucose disposal, at the end of the insulin infusion, was significantly greater (p<0.02) following delivery (24.78±4.22 μmol/m2/min2) than in pregnancy (15.17±2.00 μmol/m2/min2). The metabolic clearance rate, distribution space and pharmacological half‐life of insulin were not significantly altered by pregnancy. These findings show that the third trimester of pregnancy is associated with steady state insulin resistance accompanied by a reduced rate of insulin deactivation, but normal insulin pharmacokinetics.
Plasma C‐peptide Levels Identify Insulin‐treated Diabetic Patients Suitable for Oral Hypoglycaemic Therapy
Authors: Grant P. J. , Barlow E. , Miles D. W.
Published: July 2009

Plasma C‐peptide levels were measured fasting and 2 h after an oral glucose load in 37 insulin‐treated diabetic patients to assess their clinical value in identifying any non‐insulin‐dependent diabetic patients. All subjects were changed from insulin to oral hypoglycaemic therapy and followed for 3 months. Twenty patients (group A) completed the trial without requiring insulin and 17 (group B) required restabilization on insulin due to deteriorating metabolic control. Fasting and 2 h C‐peptide levels were significantly higher in group A (0.11±0.09 and 0.17±0.12 nmol/l; mean±S.D.) compared with group B (0.02±0.03 and 0.02±0.03 nmol/l) (p<0.002 and p<0.002). The fasting C‐peptide levels at 3 months (0.28±0.14 nmol/l) were also significantly higher than the fasting levels at the beginning of the study (p<0.002).

Fasting and 2‐h glucose levels were lower in group A (11.0±3.7 and 17.6±5.2 mmol/l) than in group B (14.4±6.2 and 23.1±5.9 mmol/l; p<0.05 and 0.02, respectively). The differences in glycosylated haemoglobin and fasting glucose levels at the start of the study and after 3 months of oral therapy were not statistically significant.

Although C‐peptide values overlapped in groups A and B, they were of greater value in identifying patients suitable for oral therapy than any single clinical criterion, and thus may help in identifying insulin‐treated diabetic patients who may be treated with oral therapy without deterioration in metabolic control.
Urinary Insulin Excretion Rate: An Index of Free Insulinaemia in Insulin‐dependent Diabetics
Authors: Pickup J. C. , Collins A. C. G. , Keen H.
Published: July 2009

In 25 insulin‐dependent diabetics, 14 managed by conventional insulin injection treatment (CIT) and 11 treated by continuous subcutaneous insulin infusion (CSII), there was a highly significant correlation between urinary insulin excretion rate (IER) per 1.73 m2 and mean serum free insulin concentration (r = 0.73, p<0.001), measured over a 24 h period. Urinary IER and mean daily serum free insulin levels were significantly higher in diabetics than in non‐diabetics. CSII‐treated patients had significantly lower mean 24 h plasma glucose levels than CIT‐treated patients despite similar values of urinary IER and mean daily serum free insulin in the two groups. Urinary IER may be a useful indicator of average insulinaemia in large scale studies, avoiding the problems of multiple blood sampling and immunoassay in the presence of anti‐insulin antibodies.
Short‐term Inhibition of Prostaglandin Synthesis has no Effect on the Elevated Glomerular Filtration Rate of Early Insulin‐dependent Diabetes
Authors: Christiansen J. Sandahl , Feldt‐Rasmussen B. , Parving H.‐H.
Published: July 2009

Glomerular filtration rate and renal plasma flow (constant infusion technique using 125I‐iothalamate and 131I‐hippuran) were measured twice within a 1‐week interval in nine young males with insulin‐dependent diabetes of short duration (2–5 years). The study was performed in a randomized double‐blind design, with the patients receiving either indomethacin (150 mg/day) or placebo for 3 days before the study. Measures of metabolic control did not change. No differences were found in glomerular filtration rate (144 ± 9 versus 144 ± 9 ml/min × 1.73 m2, mean ± S.E.M.) or renal plasma flow (579 ± 43 versus 560 ± 52 ml/min × 1.73 m2), when measured during placebo or indomethacin treatment, respectively. It is concluded that the steady‐state enhancement of glomerular filtration rate and renal plasma flow found in early insulin‐dependent diabetes is not due to an excessive activity of the prostaglandin system.
Loss of Diabetic Control and Increased Protein Glycosylation Following Minor Intercurrent Infections
Authors: Haitas B. , Barnes A. J. , Moore J. C. , Turner R. C.
Published: July 2009

To investigate the effect of intercurrent infections, 30 insulin‐dependent diabetics and 12 normal subjects were followed prospectively during one winter, with short‐term periods of control being assessed by the degree of glycosylation of plasma proteins. Eight diabetics and 7 normal subjects developed an intercurrent infection. During stable control, the diabetics had a mean ± 1 S.D. glycosylation of 0.90 ± 0.06 nmol HMF/mg protein/2 hour incubation, compared with the normal subjects of 0.63 ± 0.04 nmol HMF/mg protein/2 hour. Following infection, there was no increase in glycosylated plasma protein in the normal subjects, but the diabetics increased at 3 and 6 days to 1.07 ± 0.17 and 1.12 ± 0.17 nmol HMF/mg protein/2 hour respectively (p<0.05 and p<0.01). This was similar to levels (1.09 ± 0.20 nmol HMF/mg protein/2 hour) found in 12 diabetic subjects admitted to hospital because of marked loss of control with ketonuria. The marked protein glycosylation effect of temporary loss of glucose control following ‘minor’ intercurrent infections suggests that more attention should be paid to diabetic control during brief illnesses.
Effect of Sulphonylurea Administration on Insulin Secretion and Amino Acid Metabolism in Non‐insulin‐dependent Diabetic Patients
Authors: Paterson K. R. , Gyi K. M. , McBride D. , Cohen H. N. , Shenkin A. , Manderson W. G. , MacCuish A. C.
Published: July 2009

Sulphonylureas lower blood glucose but other metabolic effects have been little studied. In an assessment of carbohydrate and amino acid metabolism in 9 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) before and after 3 months' therapy with gliclazide, glycaemic control was improved (mean ± S.D. glycosylated haemoglobin 13.8 ± 1.9% before therapy, 10.2 ± 2.1% after therapy (p<0.01)), but fasting amino acid levels were not altered. In contrast, postprandial levels of branched chain amino acids (BCAA) were significantly reduced: total BCAA (valine, leucine, and isoleucine) 120 mins following a standard test meal fell from 717 ± 71 μmol/l before therapy to 600 ± 90 μmol/l after 3 months' therapy (p<0.01). This finding implies an increased action of endogenous insulin on skeletal muscle to promote uptake of BCAA postprandially and, in accord with this, peripheral insulin levels were significantly increased following drug treatment (peak insulin level 55.6 ± 20.2 mU/l before therapy, 91.3 ± 17.9 mU/l after therapy (p<0.01)). Sulphonylurea drugs therefore do not simply have a hypoglycaemic action but also affect amino acid metabolism in NIDDM patients.
Experience with Long‐term Peritoneal Insulin Infusion from External Pumps
Authors: Selam J. L. , Slingeneyer A. , Saeidi S. , Mirouze J. , Richard J‐L. , Rodier M. , Daynes B. , Lapinski H.
Published: July 2009

The long‐term acceptability and feasibility of continuous peritoneal insulin infusion (CPII) from external pumps was evaluated in 40 insulin‐dependent diabetic patients continuously treated for 1–27 months (mean 12 months). Blood glucose control was satisfactory and did not deteriorate with time (glycosylated haemoglobin 8.1 ± 1.1%, mean ± S.D., normal range 5.5–7.5%). Major problems included 1 episode of local peritonitis, 12 hypoglycaemic comas, 7 severe hyperglycaemic episodes, all cured without sequelae. Minor problems were frequent, mostly pump and catheter‐related. Pump and catheter survival rates were 46% and 70% at one year, respectively. No peritoneal reaction was noted apart from occasional tissue growth around the catheter. This method of insulin treatment was judged satisfactory and acceptable by most of the subjects. Only one patient dropped out, after 1.5 years. These results were achieved through stringent selection of patients, intensive education with strict instructions, careful medical care, and possibly through the inherent physiological advantages of intraperitoneal insulin infusion.
Is it a Hypo? Knowledge of the Symptoms of Hypoglycaemia in Elderly Diabetic Patients
Authors: Mutch W. J. , Dingwall‐Fordycet I.
Published: July 2009

Knowledge of the symptoms of hypoglycaemia was assessed in 161 elderly diabetic patients using insulin or a sulphonylurea. Nine percent knew no symptoms. Patients on insulin and those with poorer control had significantly greater knowledge (p<0.01). Those reporting episodes of hypoglycaemia had significantly greater knowledge of some symptoms. Knowledge decreased with age, but was not related to sex, duration of diabetes or living alone. Patients and relatives had similar knowledge and education of both needs to be improved.
Diabetic Control and the Effect of Changing a Diabetic Clinic to Modern Management
Authors: Barnett A. H.
Published: July 2009

The feasibility and effects of changeover from traditional to modern methods of diabetic management in insulin‐dependent diabetics (IDDs) are described. Patients were asked to switch from urine testing to home blood glucose monitoring, from carbohydrate restricted to high carbohydrate‐high fibre diets and from one to two injections of insulin per day with the help of a diabetic education sister. Most patients (81%) changed immediately to blood glucose monitoring and after 6 months none wanted to go back to urine tests and 58% changed to a high fibre diet. Subjects in the ‘monitoring’ group had a significant improvement in HbA1 (mean ± S.E.M. 14.1 ± 0.4% to 11.4 ± 0.5% and 11.8 ± 0.5% at 4 and 8 months, respectively, p<0.01), without any increase in frequency of hypoglycaemia, whereas the rest showed no change. No subject was hospitalized for hyperglycaemia. In conclusion, these newer management techniques can be successful in the majority of IDDs. They are easy to apply, highly acceptable and effective.
Glycosylated Haemoglobin and Glycosylated Albumin in Non‐diabetic and Diabetic Mothers, and their Babies
Authors: John W. G. , Webb A. M. C. , Jones A. E.
Published: July 2009

Glycosylated haemoglobin (GHb), glycosylated albumin (GAlb), and blood glucose were measured from 283 non‐diabetic, 7 insulin‐dependent diabetic, and 5 gestational diabetic mothers, and in the cord blood of their babies. Significant correlation was found between mother and baby for GHb (r = 0.31) and GAlb (r = 0.42). However, GHb, GAlb and glucose concentration were significantly higher in maternal blood compared to cord blood (p<0.001). Only GAlb showed any difference between a pregnant and a non‐pregnant population (p<0.001). All three parameters were significantly higher in the diabetic mothers compared to the non‐diabetic mothers (p<0.001). No difference was found between the levels of GHb and GAlb in babies from these two groups. There was no difference in the level of GHb between gestational and insulin‐dependent mothers although the latter showed a significantly higher blood glucose (p<0.05).
Measurement of Platelet Aggregation in Diabetics using the New Electronic Platelet Aggregometer
Authors: Jones R. J. , Delamothe A. P. , Curtis L. D. , Machin S. J. , Betteridge D. J.
Published: July 2009

Platelet function has been studied in diabetic subjects using a new electronic platelet aggregometer which enables platelet aggregation to be studied in whole blood. This may be a more physiological approach to the assessment of platelet behaviour as centrifugation is avoided and platelets are studied in the presence of other blood elements which may be important modulators of platelet functionin vivo.

Twenty insulin‐dependent diabetic subjects were studied along with 20 age and sex‐matched controls. Platelet aggregation to collagen (1 μg/ml) and arachidonic acid (1 mM) was significantly increased in the diabetic group. In addition the sensitivity of diabetic platelets to the antiaggregatory effects of prostacyclin was significantly reduced. A significant inverse correlation was found between platelet sensitivity to prostacyclin and glycosylated haemoglobin concentration in the diabetic group. It is unlikely that the platelet abnormalities in this diabetic group are due to underlying vascular disease as none of the patients had evidence of diabetic complications. These findings may have important implications for the development of vascular disease in diabetics.
Abnormal Insulin Secretion in Carcinoma of the Pancreas: Response to Glucagon Stimulation
Authors: Fox J. N. , Frier B. M. , Armitage Mary , Ashby J. P.
Published: July 2009

In 34 patients suspected of having pancreatic cancer glucose homeostasis and insulin secretion in response to intravenous glucagon (1 mg) were studied prospectively. Twelve patients had pancreatic cancer at laparotomy and the remainder were designated a control group. Responses were also measured in 12 healthy volunteers. There was no significant difference in the rise of blood glucose between the groups after glucagon. The mean plasma insulin concentrations rose rapidly in both groups after glucagon but were significantly lower in the pancreatic cancer group. In patients with obstructive jaundice the plasma insulin response was a better discriminator of pancreatic cancer. Abnormal pancreatic beta‐cell function is detectable in patients with pancreatic carcinoma before any change in glucose homeostasis, particularly in patients with obstructive jaundice. The glucagon stimulation test may be useful in the earlier diagnosis of pancreatic carcinoma before the development of clinically overt diabetes mellitus.
The Effect of Vitamin C Supplementation on Diabetic Hyperlipidaemia: a Double Blind, Crossover Study
Authors: Bishop N. , Schorah C. J. , Wales J. K.
Published: July 2009

Fifty diabetic patients took part in a four‐month, double‐blind crossover study comparing 500 mg of vitamin C daily with placebo. No significant difference was observed between vitamin C and placebo therapy in fasting whole blood glucose, serum cholesterol, triglycerides, and glycosylated haemoglobin levels.
How Inaccurate is Insulin Mixing? Patient Variability and Syringe Dead Space Effect
Authors: Corcoran J. S. , Yudkin J. S.
Published: July 2009

One hundred diabetics were investigated for the accuracy and reproducibility with which they delivered a mixture of insulins. In contrast with previous reports, 80 patients delivered their total dose with a bias < 5% from the prescribed dose and 87 with a CV < 5%. There was little deterioration with age. The proportions of short‐ and intermediate‐acting insulin prescribed were also delivered with commendable skill. In a separate study, syringe dead space was shown to incur a potential financial loss through insulin wastage, as well as affecting the proportions of short‐ and intermediate‐acting insulins delivered.
Effect of Storage in Light and Dark on Accuracy of Blood Glucose Test Strips
Authors: Anderson John
Published: July 2009

Two‐hundred and twenty‐five BM 20–800 blood glucose test strips were developed from a series of blood samples spanning their glucose range. Groups of 75 strips were stored under three differing sets of conditions. The change with time of the mean indicated blood glucose concentration of the strips during storage in light or dark conditions was recorded. Strips stored on a ward chart in the light faded slowly with time. Storing with a Sellotape covering accelerated the fading process. In contrast developed strips were found to be stable when stored in a sealed tin in the dark. Three rules of thumb have been derived to allow retrospective estimation of the initial indicated blood glucose concentration of strips stored for up to 10 days on a bedside chart in the light without a Sellotape covering. Sealed tin storage would allow clinic based quality control of home blood glucose monitoring.
A Microbiological Study of Diabetic Foot Lesions
Authors: Jones Emyr W. , Edwards Richard , Finch Roger , Jeffcoate William J.
Published: July 2009

The bacterial nature of infected foot lesions presenting to a diabetic unit during the course of twelve months was studied. Fifty‐six swabs were obtained from 25 patients. Swabs were processed within ten minutes of being collected. An average of 3.3 organisms per swab were isolated, Staphylococcus aureus was the most common bacterial species isolated, while anaerobic bacteria comprised 10% of the isolates. Sensitivity testing of the isolates against commonly used antibiotics showed that the antimicrobial regimen that we have previously used empirically on such patients may not always be optimal.
The Effect of Glibenclamide Administration on Insulin Sensitivity and Insulin Binding to Monocytes in Normal Subjects
Authors: Olczak S. A. , Greenwood R. H. , Hales C. N.
Published: July 2009

Insulin sensitivity and insulin binding to monocytes were determined in seven normal subjects before and after one week's treatment with glibenclamide 2 mg three times daily. Glibenclamide administration produced a 60% increase in maximal specific insulin binding to monocytes. There was no effect on the blood glucose response to an intravenous bolus of insulin but fasting blood glucose was significantly elevated following glibenclamide treatment. Statistically significant changes in the fasting levels of plasma C‐peptide and serum proinsulin were not detected.
The Subcutaneous Absorption of Human and Bovine Ultralente Insulin Formulations
Authors: Hildebrandt P. , Berger A. , Vølund Aa. , Kühl C.
Published: July 2009

The subcutaneous absorption of125l‐labelled semisynthetic human ultralente insulin was compared with that of125l‐labelled beef ultralente in eight insulin‐dependent diabetic patients using a balanced cross‐over design. In randomized order, 6 U of human ultralente was given in the thigh and in the abdominal wall while 24 U was given in the contralateral thigh and 6 U of bovine ultralente in the abdominal wall. On a second occasion the injection sites of human and bovine ultralente were reversed. Human ultralente was absorbed significantly faster than bovine ultralente. Thus, the 50% disappearance time of the radioactivity in the thigh was 15 ± 3 h versus 44 ± 9 h for the high dose, and 13 ± 2 h versus 21 ± 5 h for the small dose for human and bovine ultralente, respectively. Correspondingly, values for the abdomen (6U) were 9 ± 1 h and 16 ± 2 h. The difference between the absorption rates for 6 U and 24 U was statistically significant for bovine ultralente only. Human ultralente, but not bovine ultralente showed faster absorption from the abdomen than from the thigh. The absorption rate of human ultralente insulin, though faster than bovine ultralente insulin, makes it suitable as the basal insulin preparation for multiple insulin injection regimens.