bluuebunny/crossref_metadata_2025 huggingface dataset:
The Epidemiology of Lower Extremity Amputations in Diabetic Individuals
Authors: Most Randi S , Sinnock Pomeroy
Published: March 2007

The Diabetes Control Activity has established diabetes control programs in 20 states. Each has investigated the extent and nature of diabetes morbidity within its state by means of a descriptive analysis of selected health status indicators. Data from six states are included: 100% of hospital discharges from Rhode Island, South Carolina, and Maine and approximately 50% from Minnesota, Illinois, and Ohio were pooled to provide a profile of lower extremity amputations (LEA) in diabetic individuals. The purposes of this study were to identify diabetic persons at high risk of amputation for targeting preventive programs as well as to establish a baseline for monitoring trends over time. Discharge data provided by hospital abstracting services were examined for 1976–1978. Results indicate that 45% of all LEAs are performed on patients with diabetes. An age-adjusted LEA rate of 59.7/10,000 diabetic individuals was computed. Diabetes-related amputation rates increase with age and are higher in males. The overwhelming majority of LEAs are either toe or above the knee, with few performed on the foot. The relative risk of LEAs for the diabetic cqmpared with the nondiabetic population is highest in the under- 45 age group (28), although the attributable risk is highest in the older population (91.5/10,000 diabetic individuals). Overall, diabetic persons have a 15 times higher risk of LEA than nondiabetic individuals.
Rdevance of Glucose Counterregulatory Systems to Patients with Diabetes: Critical Roles of Glucagon and Epinephrine
Authors: Cryer Philip E , Gerich John E
Published: March 2007

Glucagon normally plays a primary role in promoting glucose recovery from insulin-induced hypoglycemia. Epinephrine compensates largely for deficient glucagon secretion. Glucose recovery from hypoglycemia fails to occur only in the absence of both glucagon and epinephrine. Perhaps as a relatively early feature of autonomic neuropathy, patients with insulin-dependent diabetes mellitus commonly have blunted or absent glucagon secretory responses to hypoglycemia. However, this deficient response is commonly compensated for by epinephrine and glucose recovery occurs. In some patients, progression of adrenergic neuropathy to the point of deficient epinephrine secretory responses to hypoglycemia, coupled with deficient glucagon responses, leads to frequent, severe, and prolonged hypoglycemia. Thus, these glucose counterregulatory systems are of critical importance to patients with insulindependent diabetes mellitus. The efficacy of glucose counterregulation in a given patient may determine the degree to which euglycemia can be achieved with aggressive insulin therapy in that patient.
The Effect of Fenfluramine and Caloric Restriction on Carbohydrate Homeostasis in Patients with Lipodystrophy
Authors: Wilson Thomas A , Melton Terry , Clarke William L
Published: March 2007

In an attempt to differentiate the effect of fenfluramine hydrochloride from that of caloric restriction on carbohydrate tolerance in patients with lipodystrophy, parameters of carbohydrate homeostasis were studied in patients with lipodystrophy during periods offenfluramine treatment and during periods of caloric restriction. Although carbohydrate tolerance appeared to improve initially in one patient when treated with fenfluramine, this improvement did not persist. No beneficial influence of fenfluramine on carbohydrate tolerance could be identified in the other patients studied. By contrast, all patients demonstrated an improvement in carbohydrate tolerance in response to caloric restriction. These data suggest that caloric restriction improves carbohydrate tolerance in patients with lipodystrophy whereas fenfluramine, in the absence of caloric restriction, has no long-term beneficial effect.
Scleredema Diabeticorum: A Common and Distinct Cutaneous Manifestation of Diabetes Mellitus
Authors: Cole Gary W , Headley John , Skowsky Ronald
Published: March 2007

Scleredema diabeticorum is characterized by a dramatic increase in the thickness of the skin of the posterior neck and upper back. Of the 17 scleredema patients diagnosed by us in the last 15 yr, 16 have had type II diabetes mellitus. In a prospective study of 484 diabetic outpatients we found the prevalence of scleredema to be 2.5%. Angina pectoris was the only complication that occurred significantly more frequently in scleredematous diabetic patients than in a control group of diabetic patients without scleredema. Scleredema diabeticorum is a distinct cutaneous condition peculiar to diabetic individuals and ought not to be confused with scleredema of Buschke or scleroderma.
Diabetes Mellitus and Cerebrovascular Disease: Prevalence of Carotid Artery Occlusive Disease and Associated Risk Factors in 482 Adult Diabetic Patients
Authors: Kuebler Thomas W , Bendick Phillip J , Edwin Fineberg S , Markand Omkar N , Norton James A , Frank N Vinicor , Clark Charles M
Published: March 2007

The prevalence of carotid artery occlusive disease (CAOD) in a population of adults with diabetes mellitus was determined, and factors associated with its presence were identified. By oculoplethysmography and phonoangiography, 20% of the population studied had detectable CAOD. Univariate analyses revealed that patients with CAOD had a higher prevalence of retinopathy proteinuria, a slower mean conduction velocity in two of three nerves tested, and more atherosclerosis in the leg arteries. Furthermore, increased age, higher cholesterol, lower fasting insulin, higher systolic blood pressure, and less adiposity were associated with the presence of CAOD. Sex, race, type of diabetes (type I or II), duration of diabetes, and measures of glycemia were not related to CAOD. When 10 variables were analyzed by multivariate methods, higher systolic blood pressure, higher cholesterol, and reduced adiposity were found to be the combination most significantly related to CAOD.
Tihe Glycemic Effect of Different Meals Approximately Isocaloric and Similar in Protein, Carbohydrate, and Fat Content as Calculated Using the ADA Exchange Lists
Authors: Nuttall F Q , Mooradian A P , DeMarais R , Parker S
Published: March 2007

The effect on plasma glucose concentration of four different, approximately isocaloric breakfasts designed using the American Diabetes Association food exchange lists was studied in eight type II diabetic patients. The meals were estimated to contain similar amounts of carbohydrate, protein, and fat and were given in random order. The plasma glucose responses to the different meals were similar except for one meal. This meal resulted in a greater glucose increase but the latter could be explained by the substitution of banana for orange juice in the meal. Banana contains starch as well as fructose and glucose, whereas orange juice contains glucose, fructose, and sucrose. In regard to the postmeal glucose response, these data indicate that the ADA food exchange list is useful in meal planning, at least for breakfast.
The Absorption of Subcutaneously Injected Short-Acting Soluble Insulin: Influence of Injection Technique and Concentration
Authors: Hildebrandt Per , Sestoft Leif , Nielsen Steen L
Published: March 2007

The effect of injection technique on the absorption of subcutaneously injected short-acting insulin [125I labeled Actrapid (MC), Novo, Copenhagen, Denmark] was investigated in insulin-dependent diabetic patients. In one side of the abdomen insulin was given with a fixed standard technique. In the other side of the abdomen the temperature of the injected insulin, the depth of injection, and the duration of injection were varied. Furthermore, we compared the absorption of U40 and U100 insulin by giving either 8 U of the two insulins or 0.1 ml of both insulins simultaneously to the patients in either side of the abdomen. With regard to the injection technique the only significant finding was a faster absorption rate with deep (12 mm) than with superficial (3 mm) injection. The absorption of U100 insulin was significantly slower than of U40 insulin, when given in the same amount (8 U) as well as in the same volume (0.1 ml).
Phagocytotic Activity of Monocytes from Diabetic Patients
Authors: Katz S , Klein B , Elian I , Fishman P , Djaldetti M
Published: March 2007

The phagocytotic activity of monocytes from diabetic patients and healthy controls was studied. It was found that the number of phagocytizing cells from diabetic patients was significantly reduced in comparison with that from control individuals. However, the number of bacteria phagocytized per cell was similar in both groups. Plasma from healthy controls added to diabetic monocytes did not cause any significant change in their phagocytotic capacity. Addition of insulin to the plasma of diabetic patients failed to alter the number of phagocytizing diabetic monocytes. Similarly, addition of glucose to control plasma did not affect the number of control monocytes capable of phagocytosis. Protein synthesis was increased during phagocytosis in both control and diabetic cells. The importance of monocytes in the defense mechanism of the organism is discussed.
Abnormal Blood Glucose and Coronary Heart Disease: The Puerto Rico Heart Health Program
Authors: Cruz-Vidal Mercedes , Garcia Palmieri Mario R , Costas Raul , Sorlie Paul D , Havlik Richard J
Published: March 2007

The presence of abnormal blood glucose (ABG) was determined for participants in the Puerto Rico Heart Health Program, a prospective epidemiological study of cardiovascular disease. Subjects were considered to have ABG at baseline if they were receiving treatment for diabetes (diet, oral hypoglycemics, or insulin), or if the blood glucose level was 140 mg/dl or more. Urban-rural comparisons of the prevalence of ABG were made in this cohort of 2585 rural and 6208 urban men aged 45–64 yr. The prevalence of ABG in the urban population was more than double that in the rural. This population has been followed up for coronary heart disease (CHD) over an 8¼-yr period. ABG at baseline is significantly associated with CHD death in urban men. When the relationship is controlled for smoking, systolic blood pressure, cholesterol, and relative weight, the relationship remains significant. The association with total CHD is similar. Either by adjusting for diabetes (i.e., when treated diabetes was excluded from analysis) or by entering both blood glucose and diabetes under treatment into the model, blood glucose was no longer statistically significant. This suggests that ABG, rather than blood glucose alone, is the important variable associated with CHD.
Improved Control of Non-insulin-dependent Diabetes Mellitus by Combined Halofenate and Chlorpropamide Therapy
Authors: Kohl E Alan , Magner James A , Persellin Scott T , Vaughan George M , Kudzma David J , Friedberg Samuel J
Published: March 2007

Combined halofenate-chlorpropamide was evaluated for the treatment of NIDDM. Four subjects treated with 500 mg/day chlorpropamide were given 500–1000 mg halofenate daily for 48 wk or longer. Fasting plasma glucose fell from 210 ± 16 (± SEM) (11.67 ± 0.89 mM) to 107 ± 10 mg/dl (± SEM) (5.94 ± 0.55 mM), P < 0.005. Twelve additional subjects were entered into a 16-wk double-blind study testing chlorpropamide plus either placebo or halofenate. In the halofenate group, the mean fasting glucose fell from 227 ± 27 (± SEM) (12.61 ± 1.50 mM) and reached 107 ± 19 mg/dl (± SEM) (5.94 ± 1.06 mM) during the fourth month, whereas the placebo groups showed a decrease from 242 ± 22 (± SEM) to 208 ± 29 mg/dl (± SEM) (P < 0.005). In addition, halofenate reduced the height of postprandial glycemic excursions by lowering fasting plasma glucose. When halofenate was used as the only therapy, reduction in fasting plasma glucose was small [179 ± 12 reduced to 142 ± 8 mg/dl (± SEM); 9.94 ± 0.67 mM and 7.89 ± 0.44 mM], P < 0.05.
Plasma β-Thromboglobulin, Platelet Factor 4, Fibrinopeptide A, and Other Hemostatic Functions During Improved, Short-Term Glycemic Control in Diabetes Mellitus
Authors: Rosove Michael H , Frank Harrison J L , Harwig Sylvia S L
Published: March 2007

To determine the effect of improved, short-term glycemic control on various functions of hemostasis in insulin-dependent diabetes, we measured changes in plasma fibrinogen, fibrinopeptide A (FPA), functional antithrombin III (AT-III), factor VIII:ristocetin cofactor (VIIIRCoF), beta-thromboglobulin (BTG), platelet factor 4 (PF4), and platelet aggregation responses to ADP and collagen in 12 patients with low or undetectable stimulated (postprandial) serum C-peptide levels during 4–8 wk (median, 6 wk) of treatment with constant subcutaneous insulin infusion. Mean plasma fibrinogen, FPA, AT-III, VIIIRCoF , and BTG at baseline were elevated compared with normal. Three patients had heightened platelet responses to ADP that did not correlate to other indicators of a hypercoagulable state; the affected patients, in fact, had significantly lower plasma BTG (25.5 ± 5.3 [SEM] versus 44.6 ± 4.6 ng/ml, P < 0.05) and FPA (1.1 ± 0.1 versus 2.5 ± 0.5 ng/ml, P < 0.05) than the remaining patients. Patients with clinically evident vascular disease had higher baseline plasma BTG and FPA than those without vascular disease (44.6 ± 5.4 versus 30.2 ± 4.6, and 2.6 ± 0.6 versus 1.3 ± 0.2 ng/ml, P < 0.05, respectively). During treatment, all patients had declining blood glucose (200 ± 18 to 102 ± 5 mg/dl, P < 0.001) and HbA1 (11.8 ± 0.6 to 10.2 ± 0.4%, P < 0.005). No statistically significant changes in hemostaticfunctions were noted. During treatment, one patient had an acute myocardial infarction. It appears that short-term glycemic control alone in insulin-dependent diabetes does not exert a remarkable ameliorative effect on some aspects of hemostatic hyperfunction as defined by currently available, sensitive laboratory tests. It remains to be determined whether excellent long-range control, taking into consideration the extent of pre-existing vascular disease, might be more successful.
Cognitive Processes in Insulin-dependent Diabetes
Authors: Franceschi Massimo , Cecchetto Roberta , Minicucci Fabio , Smizne Salvatore , Baio Giuseppina , Canal Nicola
Published: March 2007

Cognitive processes in a group of neurologically asymptomatic patients with relativelysevere but uncomplicated insulin-dependent diabetes mellitus (IDDM) were studied. In comparison with a homogeneous group of normoglycemic controls, the diabetic group performed significantly worse in global memory, abstract reasoning, and eye-hand coordination tests. The two groups scored similarly in intelligence, concentration and attention, spatial, visual, and psychomotor tests. The neuropsychological deficits did not correlate with the duration or the severity of the disease. Whether these mild neuropsychological deficits are transient or stable or whether they are caused by central nervous system vascular or metabolic dysfunctions or by the emotional influence of the chronic illness on the intellectual and educational development of patients remains unclear. Our findings need to be cautiously interpreted and perhaps could not be extended to diabetic patients with better metabolic control.
Rapid Deterioration of Diabetic Retinopathy During Treatment with Continuous Subcutaneous Insulin Infusion
Authors: Ballegooie Evert van , Hooymans Johanna M M , Timmerman Zwaan , Reitsma Wepco D , Sluiter William J , Schweitzer Nico M J , Doorenbos Hieronymus
Published: March 2007

The effect of continuous subcutaneous insulin infusion (CSII) on diabetic retinopathy was studied in 19 patients with insulin-dependent diabetes mellitus (IDDM). All had diabetes before age 30. Three patients had no retinal abnormalities at the start of the study, 12 had minimal or mild background retinopathy, and 4 had a preproliferative retinopathy. The follow-up period was 12–14 mo. Fundus photography and fluorescein angiography was performed every 2–6 mo. Despite marked improvement of metabolic control, none of the patients with retinopathy showed reversal of the fundal abnormalities. In seven patients with background retinopathy the abnormalities remained unchanged; in five patients a slight worsening was noted. Four patients with moderate-to-severe background retinopathy showed a rapid and severe progression of the fundal abnormalities into a florid proliferative diabetic retinopathy 3–6 mo after initiation of CSII. A higher incidence of hypoglycemic episodes could not be demonstrated in this group. Two of these patients showed a marked reduction in glomerular filtration rate (GFR), 34% and 38%, respectively, during the course of their follow-up. This is compared with a decrease in GFR by only 5.6% for the group as a whole. The four patients with rapidly progressive retinopathy all had long-standing poorly controlled diabetes with preproliferative retinal changes, diabetic neuropathy, and, with the exception of one patient, signs of nephropathy at the start of CSII. The incidence of these features was nil or very low in the remaining 15 patients. This study and similar ones raise the question of whether rapid improvement in glycemic control, after long periods of poor control, could result in rapid deterioration of retinopathy, especially in those with diabetes of long duration or with preproliferative changes.
Effect of Digestible Carbohydrates on Glucose Control in Insulin-dependent Diabetic Patients
Authors: Perrotti Nicola , Santoro Donatella , Genovese Salvatore , Giacco Angela , Rivellese Angela , Riccardi Gabriele
Published: March 2007

Recent studies have demonstrated that high-carbohydrate—high-fiber diets may improve the metabolic control in diabetes. To evaluate the influence of dietary carbohydrates separate from dietary fiber on blood glucose control, six insulin-dependent diabetic patients (IDD) were assigned in random order to two weight-maintaining diets for consecutive periods of 10 days. The diets differed in carbohydrate (41% in diet A and 60% in diet B) and fat content (41% and 20%, respectively) but were identical in calories, proteins, simple sugars, and fiber. After each dietary period blood glucose was continuously monitored for 24 h (Biostator GCIIS, Life Science Instruments, Miles Laboratories, Elkhart, Indiana). The M value was 48 ± 20 after diet A and 96 ± 27 after diet B (t = 3.83, P < 0.025); the mean daily blood glucose was 152 ± 5 mg/dl after diet A and 206 ± 11 mg/dl after diet B (t = 7.50, P < 0.001). Similarly, the blood glucose level for the 3-h period after each of the three main meals was lower after diet A than after diet B (analysis of variance: F = 5.2, P < 0.05). No significant difference in fasting serum cholesterol, triglycerides, or serum lipoprotein composition was observed between the two diets. In order to separate the influence of dietary carbohydrate and fat on postprandial blood glucose concentration, an additional test meal experiment was performed in eight insulin-dependent diabetic patients. In random order on consecutive days they were given two standard meals that were identical in carbohydrate and protein content and differed only in the amount of olive oil added to the meals (12 g versus 36 g) The average blood glucose increments calculated for the 3h after the meal were almost identical after the high-fat and the low-fat test meal. It is concluded that increasing the amount of dietary carbohydrate leads to the deteriorationof blood glucose control in ID
Recurrent Ketoacidosis in Acquired, Total Lipodystrophy (Lipoatrophic Diabetes)
Authors: Robbins David C , Sims Ethan A
Published: March 2007

The absence of ketoacidosis is thought to be characteristic of generalized lipoatrophic diabetes. It is widely believed that lipoatrophic diabetic patients are able to tolerate starvation and therapeutic insulin withdrawal, due to absence of subcutaneous body fat,the substrate essential for ketogenesis. In this article, we document nine episodes of acidosis and accelerated ketone body formation in a 24-yr-old woman whose deterioration followed episodes of dietary excesses without evidence of intercurrent infection or other identifiable forms of metabolic stress. Serum C-peptide measurements demonstrated that an absolute insulin deficiency did not exist. During short-term, experimental, dietary manipulations, excess dietary calories worsened the hyperglycemia and hyperlipidemia but did not reproduce the ketoacidotic state. Excess fat added to the diet was the most poorly tolerated of the food groups, causing ketonuria, hypertriglyceridemia, and abdominal pain. Our experience with this patient suggests that increased food consumption, insufficient insulin relative to an insulin-resistant state, and increased amounts of insulin counterregulatory hormones (stress), acted in concert to cause acidosis and increased ketone body formation.
Improvement in Metabolic Control in Diabetic Adolescents by the Use of Increased Insulin Dose
Authors: Mann Nicholas P , Johnston Derek I
Published: March 2007

Ten diabetic adolescents who had poor blood glucose control during the preceding year were recruited into a crossover insulin dosage study. Diabetic control was assessed on two insulin dosage regimens; either 1.0 U/kg/day (“limited dosage”) or 1.4 U/kg/day (“increased dosage”). The study had a 1-mo run-in period followed by two treatment periods each of 3-mo duration. Improvement in control occurred during “increased” insulin dosage with reduction of glycosylated hemoglobin levels (P < 0.001), self-monitored blood glucose levels (P < 0.001), and 24-h urine glucose excretion (P < 0.01). Overnight studies did not reveal hypoglycemia (blood glucose < 2 mmol/L) in either group, but improved overnight glucose profiles were demonstrated on the “increased” dosage and were associated with higher free insulin levels. The study supports the case for a higher maximal insulin dosage than commonly recommended during adolescence.
The Role of Undernutrition in the Pathogenesis of Diabetes Mellitus
Authors: Rao R Harsha
Published: March 2007

Recent epidemiologic studies show that diabetes mellitus is almost as prevalent in undernourished populations as it is in well-nourished ones, despite the virtual absence of obesity as an etiologic determinant in the former. Undernutrition itself may be the risk factor that replaces obesity in predisposing such populations to diabetes. The glucose intolerance of protein-energy malnutrition is known to be associated with structural changes in the beta cell, and in a significant proportion of undernourished subjects it is irreversible despite prolonged and vigorous nutritional rehabilitation. Chronic undernutrition over a lifetime may, therefore, be an important determinant of diabetes in an individual, either by progressively impairing beta cell function or by increasing the susceptibility of the individual to other genetic and environmental diabetogenic influences.
Visual Function After Pan-Retinal Photocoagulation: A Survey
Authors: Russell Phillip W , Sekuler Robert , Fetkenhour Carl
Published: March 2007

Thirty-five diabetic patients who had undergone pan-retinal photocoaguiation were surveyed to determine the frequency and severity of visual difficulties they experience. Among the most frequent problems were difficulty adjusting to dim lighting, difficulty adjusting to bright lighting, and trouble in sorting dark colors. Judging distances, negotiating stairways, and avoiding obstacles were identified as having become more difficult since the laser treatment. According to a correlation analysis, the difficulties encountered in some important tasks, such as driving in the daytime, were highly related to visual acuity. However, many of the problems reported most frequently, and many of the problems whose frequency had increased the most since the laser therapy, were not related to acuity. Despite their many visual complaints, the patients expressed very positive attitudes toward the photocoagulation treatment.
Clinical Experience with a New Device that Will Simplify Insulin Injections
Authors: Berger Allan S , Saurbrey Nina , Kühl Claus , Villumsen John
Published: March 2007

In order to test clinically a newly developed, simple, and convenient device for giving multiple injections of short-acting insulin (Actrapid HM, Novo, Bagsværd, Denmark), 16 type I diabetic patients previously stabilized on intensified conventional therapy regimens participated in a randomized crossover study for a period of 6 wk. The patients used conventional syringes for injections of short-acting insulin during one period and the new device during the other. Conventional syringes were used for injections of basal insulin during both periods. Metabolic control was assessed by twice-weekly blood glucose profiles, HbA1c, and the frequency of hypoglycemic reactions; no significant differences were found during the two treatment periods. No infections at the injection sites were seen. Patients' evaluation of the new device was very positive.
Hepatitis B Virus Markers in Diabetes Mellitus
Authors: Khuri Khalil G , Shamma'a Munir H , Abourizk Nicolas
Published: March 2007

Serum markers for hepatitis B virus (HBV) were studied in 395 healthy control subjects and in 100 diabetic patients. Of the patients, 28 had type I diabetes, 31 had type II diabetes requiring insulin, and 41 had type II diabetes treated with oral agents or diet alone. None gave history of previous icterus or other signs of hepatitis, had received blood transfusions, or had been on hemodialysis. There was a significant difference in the prevalence of HBV markers (mainly HB surface antibody) between the diabetic group and the controls (51% versus 25%, P < 0.001). The control subjects included hospital personnel and, hence, their risk of HBV exposure was already relatively high. The increased occurrence of HBV markers did not seem to be related to diabetes duration, patient age, intake of insulin injections, or presence of microvascular complications. This study reveals a high degree of exposure to HBV in a moderately controlled diabetic group and possibly a high degree of proneness to subclinical hepatitis B.
Prospective Evaluation of HDL Cholesterol Changes After Diet and Physical Conditioning Programs for Patients with Type II Diabetes Mellitus
Authors: Kaplan Robert M , Wilson Dawn K , Hartwell Sherry L , Merino Katherine L , Wallace Janet P
Published: March 2007

High-density lipoprotein (HDL) cholesterol is known to be low in patients with diabetes mellitus. Low HDL levels are correlated with premature cardiovascular mortality in several major epidemiologic studies and many investigators believe increases in HDL cholesterol may reduce the risk of coronary heart disease. We evaluated dietary and exercise interventions in relation to HDL cholesterol in patients with type II diabetes mellitus. Sixty-five volunteers were randomly assigned to one of four experimental conditions: diet, exercise, diet plus exercise, or education control. Three months after entering the program, those exposed to the dietary intervention had significant increases in HDL cholesterol. HDL increases for the other two treatment groups did not differ significantly from the education control.
Asymptomatic Myocardial Ischemia in Diabetes and Its Relationship to Diabetic Neuropathy: An Exercise Electrocardiography Study in Middle-Aged Diabetic Men
Authors: Hume L , Oakley G P , Boulton A J M , Hardisty C , Ward J D
Published: March 2007

The incidence of painless ischemic heart disease is increased in diabetic patients, and it has been suggested that this may be partly due to diabetic neuropathy involving cardiac afferent nerves. We have performed exercise electrocardiography in middle-aged diabetic men without cardiac symptoms to see if silent myocardial ischemia is more common in patients with neuropathy. Thirty patients had diabetic neuropathy (group 1), and 30 did not (group 2). The groups were matched for age and duration of diabetes. The exercise test was abnormal in 14 patients. A positive test was no more common in patients with diabetic neuropathy.

During a mean follow-up period of 50 mo, five patients developed clinical heart disease, four of whom had a positive exercise test. An abnormal exercise ECG is common in diabetic men without cardiac symptoms, but our study does not suggest that the high incidence of silent myocardial ischemia in diabetic patients is related to the presence of diabetic neuropathy. In patients with diabetes a positive exercise test is associated with a high risk of developing clinical heart disease in subsequent years.
Focal Infarction of Muscle in Diabetics
Authors: Chester C S , Banker B Q
Published: March 2007

Diabetic patients may develop a painful mass in the leg as a manifestation of spontaneous infarction of muscle. Experience with six patients with focal infarction of muscle without peripheral gangrene has demonstrated a stereotyped clinical presentation. The use of an open muscle biopsy to confirm the diagnosis has been associated with increased signs and symptoms. Clinical exacerbations occur during vigorous physical therapy. We delineate the characteristic clinical and pathologic findings and the course of the illness with emphasis on the importance of recognition of the syndrome so that biopsy and overzealous therapy are avoided.
Is There a Need for a Better Basal Insulin?
Authors: Guthrie Richard
Published: March 2007

IN BRIEF

Basal insulin therapy is an integral part of intensive management of type 1 diabetes and is often used in conjunction with oral agent therapy for type 2 diabetes. Currently available insulins do not always provide adequate background coverage. Insulin glargine, a new product that will soon be available for commercial use, addresses this need by providing 24-h coverage without peaks or valleys.
Cardiovascular Safety of Oral Antidiabetic Agents: The Insulin Secretagogues
Authors: Caulfield Michael T. , O’Brien Kevin D.
Published: March 2007

In Brief

This article reviews and dispels concerns about the potential cardiotoxicity of insulin and oral diabetes drugs, specifically the insulin secretagogues, in patients with type 2 diabetes. The authors focus on insulin and the sulfonylurea drugs but also briefly discuss meglitinide analogs.
Glucagon-Like Peptide 1-Based Therapies for Type 2 Diabetes: A Focus on Exenatide
Authors: Dungan Kathleen , Buse John B.
Published: March 2007

IN BRIEF

Therapies based on the incretin hormone glucagon-like peptide 1 are novel treatment options for type 2 diabetes that act through a variety of complementary mechanisms. Exenatide, which will likely become the first application to reach the market, has shown promise in phase III trials in reducing hemoglobin A1c without causing significant hypoglycemia or weight gain.
Dynamic‐mechanical and thermal characterization of polypropylene/ethylene–octene copolymer blend
Authors: Mohanty Smita , Nayak Sanjay K.
Published: March 2007

Polypropylene/Ethylene–Octene copolymer (PP/EOC) blends were prepared by melt blending technique followed by compression molding. The effect of addition of EOC on the mechanical behavior of the PP matrix was investigated. Tensile and flexural strengths decreased with the incorporation of EOC. However, the impact strength of the matrix polymer increased in all the blend systems. The blends prepared at 30% EOC content showed an increase in the impact strength to the tune of 380% as compared with polypropylene (PP) matrix. The morphology of the fractured surfaces was investigated employing Scanning Electron Microscopy. SEM micrographs depicted the formation of biphase structure, wherein the EOC phases were homogeneously dispersed as small droplets within the PP matrix. WAXD patterns revealed that the α monoclinic form of isotactic PP does not show any significant change with the incorporation of EOC up to 70 wt %. DSC thermograms revealed a decrease in the melting temperature of the virgin matrix with the addition of EOC. The blend system at 50% EOC exhibited a broad crystallization exotherm at 75°C thus indicating multiple crystallization behavior primarily attributed to the difference in the nucleation process. Further DMA analysis showed presence of two different relaxation peaks corresponding to the Tg of EOC and PP matrix respectively, confirming the formation of a biphase structure. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007
Ermüdungssicherheit für Stahlbeton unter Temperaturzwang: Einsichten für Praktiker
Authors: Meek Jethro W.
Published: March 2007

Für Stahlbetonbrücken erweist sich der Nachweis der Ermüdungssicherheit manchmal als entwurfsbestimmend. Die Wichtigkeit von Temperaturzwang in statisch unbestimmten Tragwerken wird überschätzt, wenn die effektive Steifigkeit gerissener Querschnitte unnötig groß angesetzt wird und die daraus resultierenden Spannungsschwankungen in voller Höhe als ermüdungswirksam angesehen werden. Einfache aber grundsätzliche Überlegungen decken die physikalischen Zusammenhänge auf und ermöglichen eine realistische Erfassung der Auswirkung von Temperaturzwang auf die Ermüdungssicherheit.
Density Matrices in NMR Spectroscopy: Part I
Authors: Farrar Thomas C.
Published: March 2007

For many of the modern NMR experiments such as INEPT, DEPT, COSY and others, simple vector diagrams are not adequate for explaining or predicting the time evolution, the selective cross‐polarization or the multiple quantum processes which take place in the spin system. Density matrix theory is a powerful, elegant and relatively simple formalism for describing in detail the time evolution of spin systems. The fundamentals of matrix theory are presented in this paper along with some simple examples for a single spin of 1/2 and for a system of two spins of 1/2.
Introduction to magnetic resonance imaging
Authors: Talagala S. Lalith , Lowe Irving J.
Published: March 2007

Cross‐sectional magnetic resonance imaging using the spin‐warp technique is described in detail. NMR signals originating from different positions in a three‐dimensional object are discriminated via slice‐selection, phase‐encoding, and frequency‐encoding procedures. During slice selection, magnetization corresponding to a narrow slice of the object is excited by a frequency selective rf pulse applied in the presence of a magnetic field gradient perpendicular to the slice. The spatial information along one of the dimensions in the imaged plane is encoded into the phase of the ensuing signal by incrementing, in successive experiments, the magnitude of a field gradient applied before signal detection (phase‐encoding). The spatial information along the other dimension defining the imaged plane is incorporated into the frequency of the signal by imposing a gradient during signal detection. Cross‐sectional images are obtained by two‐dimensional Fourier transformation of a series of appropriately phase‐ and frequency‐encoded echoes. Extension of the method to multi‐slice imaging is also discussed.
The effects of pay and job satisfaction on the labour supply of hospital consultants
Authors: Ikenwilo Divine , Scott Anthony
Published: March 2007

There is little evidence about the responsiveness of doctors' labour supply to changes in pay. Given substantial increases in NHS expenditure, new national contracts for hospital doctors and general practitioners that involve increases in pay, and the gradual imposition of a ceiling on hours worked through the European Working Time Directive, knowledge of the size of labour supply elasticities is crucial in examining the effects of these major changes. This paper estimates a modified labour supply model for hospital consultants, using data from a survey of consultants in Scotland. Rigidities in wage setting within the NHS mean that the usual specification of the labour supply model is extended by the inclusion of job quality (job satisfaction) in the equation explaining the optimal number of hours worked.

Generalised Method of Moments estimation is used to account for the endogeneity of both earnings and job quality. Our results confirm the importance of pay and non‐pay factors on the supply of labour by consultants. The results are sensitive to the exclusion of job quality and show a slight underestimation of the uncompensated earnings elasticity (of 0.09) without controlling for the effect of job quality, and 0.12 when we controlled for job quality. Pay increases in the new contract for consultants will only result in small increases in hours worked. Small and non‐significant elasticity estimates at higher quantiles in the distribution of hours suggest that any increases in hours worked are more likely for consultants who work part time. Those currently working above the median number of hours are much less responsive to changes in earnings. Copyright © 2007 John Wiley & Sons, Ltd.
Annexin 1: Differential expression in tumor and mast cells in human larynx cancer
Authors: Silistino‐Souza Rosana , Rodrigues‐Lisoni Flávia C. , Cury Patricia M. , Maniglia José V. , Raposo Luis S. , Tajara Eloiza H. , Christian Helen C. , Oliani Sonia M.
Published: March 2007

Annexin 1 protein (ANXA1) expression was evaluated in tumor and mast cells in human larynx cancer and control epithelium. The effect of the exogenous ANXA1 (peptide Ac 2‐26) was also examined during the cellular growth of the Hep‐2 human larynx epidermoid carcinoma cell line. This peptide inhibited the proliferation of the Hep‐2 cells within 144 hr. In surgical tissue specimens from 20 patients with larynx cancer, ultrastructural immunocytochemistry analysis showed in vivo down‐regulation of ANXA1 expression in the tumor and increased in mast cells and Hep‐2 cells treated with peptide Ac2‐26. Combined in vivo and in vitro analysis demonstrated that ANXA1 plays a regulatory role in laryngeal cancer cell growth. We believe that a better understanding of the regulatory mechanisms of ANXA1 in tumor and mast cells may lead to future biological targets for the therapeutic intervention of human larynx cancer. © 2007 Wiley‐Liss, Inc.
Microwave tomography: From theory to practical imaging systems
Authors: Bolomey Jean‐Charles , Pichot Christian
Published: March 2007

This paper deals with numerical processing techniques and practical applications of active microwave imaging. Different wavefront processing are presented, from an immediate use of measured projections to more complex procedures. Both spectral approaches to diffraction tomography and spatial iterative methods for generalized imaging are considered using multi‐incidence of multifrequency techniques for 3D and/or 2D objects. The technology of the so‐called microwave camera is presented for the fast recording of the scattered field with arrays of probes involving one‐ or two‐dimensional sensors at a single frequency or in a broad‐frequency band. Three different systems are depicted: a single‐frequency linear sensor devoted to industrial applications (on‐line transverse control of conveyed products), a single‐frequency planar microwave camera for biomedical applications and research, and a broad‐frequency linear microwave camera for civil engineering applications (detection of the rebars in reinforced concrete strctures). Microwave images obtained experimentally with the three systems are presented on configurations of practical interest for each field of application.
Object synthesis in remote sensing imagery understanding
Authors: Denisov D. A. , Plaksin M. V.
Published: March 2007

Matching as a general decision‐making paradigm in computer vision and image understanding is considered. The object‐growing technique as an “analysis by synthesis” idea elaboration is developed. The technique applied to “geological objects” extraction and identification is described. Computer implementation on the base of production model utilization is suggested. The results of experiments of remote sensing image processing aimed at geological deciphering are presented.
Polarimetric synthetic aperture radar imaging
Authors: Novak L. M. , Netishen C. M.
Published: March 2007

MIT Lincoln Laboratory in investigating the detection and identification of stationary ground targets in high resolution, fully polarimetric, synthetic aperture radar (SAR) imagery. This article (1) provides a brief description of the Lincoln Laboratory SAR, (2) describes an optimum polarimetric processing technique used to construct minimum‐speckle SAR intensity imagery, and (3) presents examples of polarimetrically processed imagery.©1993 John Wiley & Sons Inc
Development of experimental ionospheric tomography
Authors: Kersley L. , Pryse S. E.
Published: March 2007

This article describes the development of experimental work on ionospheric tomography carried out in Europe. It starts with early two‐station observations and discusses the recent complex coordinated campaigns that have involved ionosondes to determine the bottomside profile and incoherent scatter radar to verify the image.©1994 John Wiley & Sons Inc
Edge‐preserving tomographic reconstruction from gaussian data using a gibbs prior and a generalized expectation‐maximization algorithm
Authors: Bedini Luigi , Salerno Emanuele , Tonazzini Anna
Published: March 2007

The problem of edge‐preserving tomographic reconstruction from Gaussian data is considered. The problem is formulated within a Bayesian framework, where the image is modeled as a pair of Markov Random Fields: a continuous‐valued intensity process and a binary line process. The a priori information considered here enforces constraints both on the local regularity of the image and on the line configurations. The solution, defined as the maximizer of the posterior probability, is obtained using a Generalized Expectation‐Maximization (GEM) algorithm, in which both the intensity and the line processes are iteratively updated. The simulation results show that introducing suitable priors on the line configurations improves the quality of the reconstructed images, and is particularly useful when the data record is small. The relationships with other approaches for managing discontinuities are outlined. A comparison between the GEM algorithm and an algorithm based on mixed‐annealing is made on the basis of computer simulations.©1994 John Wiley & Sons Inc
High‐temporal‐resolution studies of the human primary visual cortex at 4 T: Teasing out the oxygenation contribution in FMRI
Authors: Menon Ravi S. , Ogawa Seiji , Uǧurbil Kâmil
Published: March 2007

We examined the EPI time course in functional MR imaging at 4 T from cortical gray matter, local draining veins, and venous sinuses. We found a small temporal shift between the initial hyperoxygenation blood oxygen level‐dependent (BOLD) response in tissue and the larger draining veins. However, the fluctuations in the tissue time course showed strong similarity with the fluctuations in the local veins when shifted by the appropriate lag, suggesting that a large amount of this apparent “noise” is hemodynamic in nature and not related to motion. The tissue BOLD time course was observed to display a biphasic time dependence (first negative, then positive) in response to photic stimulation when substantial intersubject averaging was performed. Other areas, including those where draining veins are visible, showed only a monophasic (positive) signal change, reaching a maximum of about 6% after the onset of the visual stimulus. These time constants are in very good agreement with published data obtained with intrinsic optical mapping techniques, in which a deoxygenation phase has been shown to occur in functionally specific cortical columns, followed by an increase in blood volume which is more distributed in nature. We can use the time lag between oxygen demand and flow increase to estimate stimulus induced local tissue oxygen extraction increases of about 11%.
Using light to probe the brain: Intrinsic signal optical imaging
Authors: Frostig Ron D. , Masino Susan A. , Kwon Mike C. , Chen Cynthia H.
Published: March 2007

The theory and application of intrinsic signal optical imaging is described. This in vivo imaging method is based on capturing small activity‐related reflectance changes from the illuminated brain with sensitive cameras. Intrinsic signal imaging excels in the spatial domain (∼50 μ m) and thus enables the visualization of the small, repeated functional domains that are the basis of the functional organization of the cortex in mammals. Recent developments are described, and the advantages and limitations of this imaging method and its relevance of fMRI are discussed.
Some practical aspects of image restoration
Authors: King Ivan R.
Published: March 2007

Restoration procedures can greatly sharpen and beautify the details of an image, but they also have some drawbacks. Some of these adversely affect the photometry of stars in an astronomical image. One trouble is nonlinearity; another is that the restored pixels are no longer statistically independent. A more subtle problem is that the comparison of images in different wavelength bands poses an unusual requirement of identical restoration of two images that have different values of signal‐to‐noise ratio.
Astrometry with reconstructed hubble space telescope planetary camera (WF/PC 1) images
Authors: Girard Terrence M. , Li Yu , Van Altena William F. , Núñez Jorge , Prades Albert
Published: March 2007

The effect of image reconstruction on the astrometric precision of the Hubble Space Telescope Planetary Camera (WF/PC 1) has been investigated. Depending on the crowded nature and exposure of the stellar images, the reconstruction process may provide benefits for the image centering, especially in terms of the number of stars which can be detected. Unfortunately, there is also evidence that the positions derived from reconstructed images are biased toward the center of individual pixels, an astrometrically unacceptable condition.
Determination of five protein analytes using the beckman array™ and the behring nephelometer system
Authors: Schotters Susan B. , McBride James H. , Rodgerson Denis O. , Higgins Sharon , Pisa Marilyn
Published: March 2007

The Beckman Array and the Behring Nephelometer offer the clinical laboratory completely automated discrete protein analysis. To select one of these systems, we compared five protein analytes: IgG, IgA, IgM, transferrin, and prealbumin. In addition to automation, we wanted to achieve better precision than our present method and have available a wider range of test selection. The Beckman Array gave 2‐week stability of calibration, analyzed lipemic samples without significant problems, and had direct manufacturer's service available. The Behring Nephelo meter offered a choice of single or multipoint calibration, retrieval of raw data, ease of operation, more flexibility in test parameters, and choice of calibrator. Interference from lipemia frequently caused variable results requiring pretreatment of the sample. Both instruments demonstrated excellent precision, linearity, and correlated adequately with the Hyland Laser Nephelometer PDQ. The Array demonstrated slightly better slope values than those of the Behring Nephelometer with the exception of prealbumin analysis.
Development and applications of sensitive enzyme immunoassay for antibodies: A review
Authors: Ishikawa Eiji , Kohno Takeyuki
Published: March 2007

The sensitivity of the conventional enzyme immunoassay methods is seriously limited by the presence of nonspecific immunoglobulins at high concentrations in test serum. In order to overcome this difficulty, various methods have been developed, and the detection limit of serum antibodies has been lowered to 50–100 ng/l, which is 300,000‐fold lower than that by the conventional enzyme immunoassay method using antigen‐coated solid phases and anti‐immunoglobulin antibody‐enzyme conjugates. As a result, anti‐insulin antibodies have been demonstrated in most of patients treated with insulin for 0.5–10 months, and anti‐thyroglobulin IgG has been demonstrated not only in all patients with Graves' disease and chronic thyroiditis, but also in a large proportion of healthy subjects.