bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Overlap of Przewalski's Gazelle, Tibetan Gazelle, and Tibetan Sheep on the Qinghai‐Tibet Plateau
Authors: LI ZHONGQIU , JIANG ZHIGANG , LI CHUNWANG
Published: April 2008

Abstract: We studied food composition and overlap among sympatric Przewalski's gazelle (Procapra przewalskii), Tibetan gazelle (P. picticaudata), and Tibetan domestic sheep (Ovis aries) in the Upper Buha River, Qinghai‐Tibet Plateau, using microscopic fecal analysis. The 2 gazelles forage mainly on plants from Leguminosae and Compositae families and domestic sheep feed mainly on Gramineae and Cyperaceae. The dietary overlap index between the 2 gazelles and Tibetan domestic sheep increased from 0.43 to 0.58 during the plant‐growing period to 0.76–0.77 during the plant‐withering period, which indicated competition for foods intensified during the food‐limited season. Although the 2 gazelle ate similar diets, they might avoid food competition by occupying different foraging areas. We suggest reducing numbers of overwintering Tibetan domestic sheep on pastures to lessen survival pressure on the endangered gazelles during winters.
siRNA-Mediated Reduction of Inhibitor of Nuclear Factor-κB Kinase Prevents Tumor Necrosis Factor-α–Induced Insulin Resistance in Human Skeletal Muscle
Authors: Austin Reginald L. , Rune Anna , Bouzakri Karim , Zierath Juleen R. , Krook Anna
Published: April 2008

OBJECTIVE—Proinflammatory cytokines contribute to systemic low-grade inflammation and insulin resistance. Tumor necrosis factor (TNF)-α impedes insulin signaling in insulin target tissues. We determined the role of inhibitor of nuclear factor-κB kinase (IKK)β in TNF-α–induced impairments in insulin signaling and glucose metabolism in skeletal muscle.

RESEARCH DESIGN AND METHODS—Small interfering RNA (siRNA) was used to silence IKKβ gene expression in primary human skeletal muscle myotubes from nondiabetic subjects. siRNA gene silencing reduced IKKβ protein expression 73% (P < 0.05). Myotubes were incubated in the absence or presence of insulin and/or TNF-α, and effects of IKKβ silencing on insulin signaling and glucose metabolism were determined.

RESULTS—Insulin increased glucose uptake 1.7-fold (P < 0.05) and glucose incorporation into glycogen 3.8-fold (P < 0.05) in myotubes from nondiabetic subjects. TNF-α exposure fully impaired insulin-mediated glucose uptake and metabolism. IKKβ siRNA protected against TNF-α–induced impairments in glucose metabolism, since insulin-induced increases in glucose uptake (1.5-fold; P < 0.05) and glycogen synthesis (3.5-fold; P < 0.05) were restored. Conversely, TNF-α–induced increases in insulin receptor substrate-1 serine phosphorylation (Ser312), Jun NH2-terminal kinase phosphorylation, and extracellular signal–related kinase-1/2 mitogen-activated protein kinase (MAPK) phosphorylation were unaltered by siRNA-mediated IKKβ reduction. siRNA-mediated IKKβ reduction prevented TNF-α–induced insulin resistance on Akt Ser473 and Thr308 phosphorylation and phosphorylation of the 160-kDa Akt substrate AS160. IKKβ silencing had no effect on cell differentiation. Finally, mRNA expression of GLUT1 or GLUT4 and protein expression of MAPK kinase kinase kinase isoform 4 (MAP4K4) was unaltered by IKKβ siRNA.

CONCLUSIONS—IKKβ silencing prevents TNF-α–induced impairments in insulin action on Akt phosphorylation and glucose uptake and metabolism in human skeletal muscle.
Heritability of Proliferative Diabetic Retinopathy
Authors: Hietala Kustaa , Forsblom Carol , Summanen Paula , Groop Per-Henrik ,   on behalf of the FinnDiane Study Group
Published: April 2008

OBJECTIVE—Diabetic nephropathy clusters in families, suggesting that genetic factors play a role in its pathogenesis. We investigated whether similar clustering exists for proliferative retinopathy in families with two or more siblings with type 1 diabetes.

RESEARCH DESIGN AND METHODS—The FinnDiane Study has characterized 20% (4,800 patients) of adults with type 1 diabetes in Finland. In 188 families, there were at least two siblings with type 1 diabetes. Ophthalmic records were obtained for 369 of 396 (93%) and fundus photographs for 251 of 369 (68%) patients. Retinopathy was graded based on photographs and/or repeated ophthalmic examinations using the Early Treatment of Diabetic Retinopathy grading scale.

RESULTS—Mean age at onset of diabetes was 14.3 ± 10.2 years, and mean duration was 25.9 ± 11.8 years. Proliferative retinopathy was found in 115 of 369 patients (31%). The familial risk of proliferative retinopathy was estimated in 168 of 188 sibships, adjusted for A1C, duration, and mean blood pressure. Proliferative retinopathy in the probands (48 of 168) was associated with an increased risk (odds ratio 2.76 [95% CI 1.25- 6.11], P = 0.01) of proliferative retinopathy in the siblings of probands (61 of 182). The heritability of proliferative retinopathy was h2 = 0.52 ± 0.31 (P < 0.05).

CONCLUSIONS—We found a familial clustering of proliferative retinopathy in patients with type 1 diabetes. The observation cannot be accounted for by conventional risk factors, suggesting a genetic component in the pathogenesis of proliferative retinopathy in type 1 diabetes.
Activation of Peroxisome Proliferator–Activated Receptor β/δ Inhibits Lipopolysaccharide-Induced Cytokine Production in Adipocytes by Lowering Nuclear Factor-κB Activity via Extracellular Signal–Related Kinase 1/2
Authors: Rodríguez-Calvo Ricardo , Serrano Lucía , Coll Teresa , Moullan Norman , Sánchez Rosa M. , Merlos Manuel , Palomer Xavier , Laguna Juan C. , Michalik Liliane , Wahli Walter , Vázquez-Carrera Manuel
Published: April 2008

OBJECTIVE—Chronic activation of the nuclear factor-κB (NF-κB) in white adipose tissue leads to increased production of pro-inflammatory cytokines, which are involved in the development of insulin resistance. It is presently unknown whether peroxisome proliferator–activated receptor (PPAR) β/δ activation prevents inflammation in adipocytes.

RESEARCH DESIGN AND METHODS AND RESULTS—First, we examined whether the PPARβ/δ agonist GW501516 prevents lipopolysaccharide (LPS)-induced cytokine production in differentiated 3T3-L1 adipocytes. Treatment with GW501516 blocked LPS-induced IL-6 expression and secretion by adipocytes and the subsequent activation of the signal transducer and activator of transcription 3 (STAT3)–Suppressor of cytokine signaling 3 (SOCS3) pathway. This effect was associated with the capacity of GW501516 to impede LPS-induced NF-κB activation. Second, in in vivo studies, white adipose tissue from Zucker diabetic fatty (ZDF) rats, compared with that of lean rats, showed reduced PPARβ/δ expression and PPAR DNA-binding activity, which was accompanied by enhanced IL-6 expression and NF-κB DNA-binding activity. Furthermore, IL-6 expression and NF-κB DNA-binding activity was higher in white adipose tissue from PPARβ/δ-null mice than in wild-type mice. Because mitogen-activated protein kinase–extracellular signal–related kinase (ERK)1/2 (MEK1/2) is involved in LPS-induced NF-κB activation in adipocytes, we explored whether PPARβ/δ prevented NF-κB activation by inhibiting this pathway. Interestingly, GW501516 prevented ERK1/2 phosphorylation by LPS. Furthermore, white adipose tissue from animal showing constitutively increased NF-κB activity, such as ZDF rats and PPARβ/δ-null mice, also showed enhanced phospho-ERK1/2 levels.

CONCLUSIONS—These findings indicate that activation of PPARβ/δ inhibits enhanced cytokine production in adipocytes by preventing NF-κB activation via ERK1/2, an effect that may help prevent insulin resistance.
High Prevalence of Diabetes and Cardiovascular Risk Factors Associated With Urbanization in India
Authors: Ramachandran Ambady , Mary Simon , Yamuna Annasami , Murugesan Narayanasamy , Snehalatha Chamukuttan
Published: April 2008

OBJECTIVE—To compare prevalence of diabetes, impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and cardiovascular risk factors between a city, a town, and periurban villages (PUVs) in southern India and to look for temporal changes in the city and PUVs.

RESEARCH DESIGN AND METHODS—Subjects aged ≥20 years were studied in Tamilnadu, India, in Chennai (city, n = 2,192; 1,053 men and 1,138 women), Kanchipuram (town, n = 2,290; 988 men and 1,302 women), and Panruti (PUVs, n = 2,584; 1,280 men and 1,304 women) in 2006. Demographic, socioeconomic, and anthropometric details; blood pressure; physical activity; diet habits; and lipids were studied. Risk associations with diabetes were analyzed using multiple logistic regression analyses. Present and previous data in the city and the PUVs were compared.

RESULTS—Mean BMI, waist circumference, and family history of diabetes were significantly lower in the PUVs. The PUVs had a lower prevalence of diabetes (9.2 [95% CI 8.0–10.5], P < 0.0001) than the city (18.6 [16.6–20.5]) and town (16.4 [14.1–18.6]). Approximately 40% of subjects were newly diagnosed. Prevalence of impaired glucose tolerance (IGT) was higher (P < 0.0001) in the city (7.4 [6.2–8.5]) than in the town (4.3 [3.3–5.3]) and the PUVs (5.5 [4.6–6.5]). Prevalence of IFG was generally low. Age, family history, and waist circumference were significantly associated with diabetes, while physical activity was not. Overweight, elevated waist circumference, hypertension, and dyslipidemia were more prevalent in the city.

CONCLUSIONS—In the city, diabetes increased from 13.9 to 18.6% in 6 years and IGT decreased significantly. The town and city had similar prevalences; the PUVs had lower diabetes prevalence, but prevalence had increased compared with that in a previous survey. Cardiometabolic abnormalities were more prevalent in urban populations.
High Birth Weight and Early Postnatal Weight Gain Protect Obese Children and Adolescents From Truncal Adiposity and Insulin Resistance
Authors: Bouhours-Nouet Natacha , Dufresne Sylvie , de Casson Florence Boux , Mathieu Elisabeth , Douay Olivier , Gatelais Frédérique , Rouleau Stéphanie , Coutant Régis
Published: April 2008

OBJECTIVE—Low birth weight (LBW), no early catch-up weight, and subsequent fat accumulation have been associated with increased risks of insulin resistance from childhood onward and later cardiovascular disease. We sought to clarify the effects of high birth weight (HBW) and postnatal weight gain on insulin resistance.

RESEARCH DESIGN AND METHODS—A total of 117 obese children aged 10.4 ± 2.4 years were divided into three groups according to fetal growth after exclusion of maternal diabetes. They were comparable for age, sex, puberty, and percent body fat. Customized French birth weight standards, adjusted for maternal characteristics and gestation number, identified subjects with true altered fetal growth: 32 had increased fetal growth according to customized standards (HBWcust), 52 were eutrophic, and 33 had restricted fetal growth according to customized standards (LBWcust). Fat distribution by dual-energy X-ray absorptiometry, insulin sensitivity indexes from an oral glucose tolerance test (OGTT), and leptin, adiponectin, and visfatin levels were compared between groups.

RESULTS—The HBWcust subjects had a higher adiponectin level, higher whole-body insulin sensitivity index (WBISI), and lower hepatic insulin resistance index, lower insulin and free fatty acid concentrations during OGTT, and lower trunk fat percent than eutrophic (P < 0.05) and LBWcust subjects (P < 0.05). Besides birth weight, weight gain between 0 and 2 years was a positive predictor (P < 0.05) of WBISI, whereas weight gain after 4 years was a negative predictor (P < 0.05).

CONCLUSIONS—HBW and early weight gain may program insulin sensitivity and adipose tissue metabolism and contribute to so-called metabolically healthy obesity.
Estimating Physician Effects on Glycemic Control in the Treatment of Diabetes
Authors: Tuerk Peter W. , Mueller Martina , Egede Leonard E.
Published: April 2008

OBJECTIVE—Researchers have only just begun to investigate physician-related effects on medical outcomes. Such research is necessary for developing empirically informed practice guidelines and policy. The primary goal of this study was to investigate whether glucose management in type 2 diabetes varies by randomly assigned physicians over the course of a year in treatment. A second goal of the study was to investigate whether physician-related effects vary across differential patient characteristics. A tertiary goal was to investigate potential patient-level effects on glucose management.

RESEARCH DESIGN AND METHODS—Hierarchical linear models were used to investigate A1C among 1,381 patients, nested within 42 randomly assigned primary care physicians at a Veterans Affairs medical center in the southeastern U.S. The primary outcome measure was change in A1C over the course of 1 year in treatment. On average, each study physician had 33 patients with diabetes.

RESULTS—Overall, physician-related factors were associated with statistically significant but modest variability in A1C change (2%), whereas patient-level factors accounted for the majority of variation in A1C change (98%). Physician effects varied by patient characteristics, mattering more for black patients, patients aged 65 years, and patients whose glucose management improved over the treatment year.

CONCLUSIONS—The results of this study indicate that differential physician effects have minimal impact on glycemic control. Results suggest that it is logical to support policies encouraging the development of patient-level behavioral interventions because that is the level that accounts for the majority of variance in glycemic control.
Determinants of New-Onset Diabetes Among 19,257 Hypertensive Patients Randomized in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm and the Relative Influence of Antihypertensive Medication
Authors: Gupta Ajay K. , Dahlof Bjorn , Dobson Joanna , Sever Peter S. , Wedel Hans , Poulter N.R. ,   on behalf of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Investigators
Published: April 2008

OBJECTIVE—The purpose of this study was to determine the baseline predictors of new-onset diabetes (NOD) in hypertensive patients and to develop a risk score to identify those at high risk of NOD.

RESEARCH DESIGN AND METHODS—Among 19,257 hypertensive patients in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA) who were randomly assigned to receive one of two antihypertensive regimens (atenolol ± thiazide or amlodipine ± perindopril), 14,120 were at risk of developing diabetes at baseline. Of these, 1,366 (9.7%) subsequently developed NOD during median follow-up of 5.5 years. A multivariate Cox model was developed to identify the independent predictors of NOD and individual risk scores.

RESULTS—NOD was significantly associated with an increase in baseline fasting plasma glucose (FPG), BMI, serum triglycerides, and systolic blood pressure. In contrast, amlodipine ± perindopril in comparison with atenolol ± thiazide treatment (hazard ratio 0.66 [95% CI 0.59–0.74]), high HDL cholesterol, alcohol use, and age >55 years were found to be significantly protective factors. FPG was the most powerful predictor with risk increasing by 5.8 times (95% CI 5.23–6.43) for each millimole per liter rise >5 mmol/l. The risk of NOD increased steadily with increasing quartile of risk score, with a 19-fold increase (95% CI 14.3–25.4) among those in the highest compared with those in the lowest quartile. The model showed excellent internal validity and discriminative ability.

CONCLUSIONS—Baseline FPG >5 mmol/l, BMI, and use of an atenolol ± diuretic regimen were among the major determinants of NOD in hypertensive patients. The model developed from these data allows accurate prediction of NOD among hypertensive subjects.
A1C in Children and Adolescents With Diabetes in Relation to Certain Clinical Parameters
Authors: Hanberger Lena , Samuelsson Ulf , Lindblad Bengt , Ludvigsson Johnny
Published: April 2008

OBJECTIVE—We explored the relationship between A1C and insulin regimen, duration of diabetes, age, sex, and BMI as well as the differences between clinical mean A1C levels at pediatric diabetes clinics in Sweden.

RESEARCH DESIGN AND METHODS—Data from 18,651 clinical outpatient visits (1,033 girls and 1,147 boys) at 20 pediatric clinics during 2001 and 2002 registered in the Swedish Childhood Diabetes Registry SWEDIABKIDS, a national quality registry, were analyzed.

RESULTS—A1C was <7.0% (target value ∼8% per Diabetes Control and Complications Trial/National Glycohemoglobin Standardization Program standards) at 35% of the visits. Girls had significantly higher mean A1C than boys during adolescence. High mean A1C was correlated with high mean insulin dose, long duration of diabetes, and older age. Mean A1C varied between clinics (6.8–8.2%). Differences between centers could not be explained by differences in diabetes duration, age, BMI, or insulin dose.

CONCLUSIONS—Adolescents with a high insulin dose and a long duration of diabetes, especially girls, need to be focused on. Differences in mean values between centers remained inexplicable and require further investigation.
Inclusion of Educational Messages in Laboratory Reports Aids to Complete the Diagnostic Workup of Hyperglycemia
Authors: Pérez-Jáuregui José , González-Cardel Ana María , Olay-Fuentes Gabriela , Reza-Albarrán Alfredo , Mehta Roopa , Aguilar-Salinas Carlos A.
Published: April 2008

OBJECTIVE—To evaluate whether educational messages regarding oral glucose tolerance test (OGTT) indications in laboratory reports increase the number of OGTTs appropriately requested.

RESEARCH DESIGN AND METHODS—The following message was printed on the lab reports of individuals with a fasting plasma glucose (FPG) concentration between 5.5 and 6.9 mmol/l: “A FPG between 5.5 and 6.9 mmol/l is considered abnormal by the American Diabetes Association (impaired fasting glucose). An OGTT is recommended if the patient does not have a diagnosis of diabetes and suffers from conditions associated with an increased risk for having type 2 diabetes (i.e., overweight, high blood pressure, abnormal plasma lipids or family history of diabetes).” The number of educational messages printed was 81,099.

RESULTS—The intervention resulted in a significant increase in the number of OGTTs requested, from 78 ± 19 to 268 ± 48 tests per month. It also resulted in a greater proportion of case subjects that had an abnormal OGTT result.

CONCLUSIONS—Educational messages in laboratory reports aid in the diagnostic workup of hyperglycemia.
Differences in Metabolites in Pain-Processing Brain Regions in Patients With Diabetes and Painful Neuropathy
Authors: Sorensen Lea , Siddall Philip J. , Trenell Michael I. , Yue Dennis K.
Published: April 2008

OBJECTIVE—Magnetic resonance spectroscopy (MRS) (specifically, 1H-MRS) has been used to show changes in the brain following peripheral nerve injury in subjects without diabetes. This study used 1H-MRS to examine the brain in subjects with or without painful diabetic neuropathy.

RESEARCH DESIGN AND METHODS—Twenty-six diabetic subjects (12 with and 14 without chronic neuropathic pain) were compared, with 18 subjects without diabetes and pain. The left thalamus, anterior cingulate cortex (ACC), and dorsolateral prefrontal cortex (DLPFC) were assessed using 1H-MRS.

RESULTS—In the DLPFC, diabetic subjects had a decrease in N-acetyl aspartate (NAA) and creatine relative to the control group. In the thalamus, there was a reduction of NAA in the diabetic group with pain compared with that in patients with diabetes and no pain.

CONCLUSION—Subjects with diabetes have metabolite differences in the brain compared with control subjects. Subjects with painful neuropathy showed reduced NAA in the thalamus, which may explain the genesis of pain in some cases.
Glucose and Insulin Measurements from the Oral Glucose Tolerance Test and Mortality Prediction
Authors: Metter E. Jeffrey , Windham B. Gwen , Maggio Marcello , Simonsick Eleanor M. , Ling Shari M. , Egan Josephine M. , Ferrucci Luigi
Published: April 2008

OBJECTIVE—To verify what information from oral glucose tolerance tests (OGTTs) independently predicts mortality.

RESEARCH DESIGN AND METHODS—A total of 1,401 initially nondiabetic participants from the Baltimore Longitudinal Study of Aging aged 17–95 years underwent one or more OGTTs (median 2, range 1–8), with insulin and glucose measurements taken every 20 min over the course of 2 h included in this study. Proportional hazards using the longitudinally collected data and Bayesian model averaging were used to examine the association of OGTT measurements individually and grouped with mortality, adjusting for covariates.

RESULTS—Participants were followed for a median 20.3 years (range 0.5–40). The first-hour OGTT glucose and insulin levels increased only modestly with age, whereas levels during the second hour increased 4% per decade. Individually, 100- and 120-min glucose measures and fasting and 100-min insulin levels were all independent predictors of mortality. When all measures were considered together, only higher 120-min glucose was a significant independent risk factor for mortality.

CONCLUSION—The steeper rise with age of the OGTT 2-h glucose values and the prognostic primacy of the 120-min glucose value for mortality is consistent with previous reports and suggests the value of using the OGTT in clinical practice.
Variation in TCF7L2 and Increased Risk of Colon Cancer
Authors: Folsom Aaron R. , Pankow James S. , Peacock James M. , Bielinski Suzette J. , Heiss Gerardo , Boerwinkle Eric
Published: April 2008

OBJECTIVE—The purpose of this study was to determine whether a variation in the transcription factor 7-like 2 (TCF7L2) gene, which influences diabetes risk, is associated with incidence of cancers.

RESEARCH DESIGN AND METHODS—We related diabetes and TCF7L2 variation with occurrence of several common cancers in a prospective cohort study of 13,117 middle-aged adults initially free of cancer in 1987–1989. We assessed five single nucleotide polymorphisms (SNPs) in TCF7L2 including the putative SNP (rs7903146) for diabetes. We identified incident cancers through 2000 via cancer registries, supplemented by hospital records.

RESULTS—Diabetes was associated marginally inversely with incidence of prostate cancer but not with incidence of colorectal, colon, lung, or breast cancer. The T allele of rs7903146 (frequency 30%) was associated with increased risk of colorectal cancer and, more specifically, colon cancer, with adjusted hazard ratios (95% CI) of 1.0 for CC, 1.25 (0.85–1.83) for CT, and 2.15 (1.27–3.64) for TT genotypes (Ptrend = 0.009). TCF7L2 variation also was associated with lung cancer incidence in whites but not blacks, but residual confounding by smoking may be present.

CONCLUSIONS—Subjects who were initially cancer-free and carrying certain genetic variants of TCF7L2, most notably the T allele of rs7903146, have an increased risk of colon cancer. This association appears to be an independent gene effect not explained by diabetes. Because the T allele of rs7903146 is common, if a causal link is established, this variant could account for a sizable proportion (∼17% here) of cases of colon cancer in the general population.
Plasma Adiponectin as a Marker of Insulin Receptor Dysfunction
Authors: Semple Robert K. , Cochran Elaine K. , Soos Maria A. , Burling Keith A. , Savage David B. , Gorden Phillip , O'Rahilly Stephen
Published: April 2008

OBJECTIVE—Severe insulin resistance is associated with high morbidity. Identification of severely insulin-resistant patients who have genetic or acquired insulin receptor dysfunction may aid therapeutic decision making; however, onerous diagnostic tests allied to a low frequency of insulin receptor dysfunction often preclude formal diagnosis. Our previous observation of paradoxical hyperadiponectinemia in insulin receptoropathy provides a possible basis for a simpler and cheaper screening test.

RESEARCH DESIGN AND METHODS—Receiver operating characteristics analysis was used to determine diagnostic thresholds for insulin receptoropathy in severe insulin resistance for adiponectin and for the insulin-regulated hepatic proteins sex hormone–binding globulin (SHBG) and IGF binding protein-1 (IGFBP-1).

RESULTS—Adiponectin >7 mg/l in severe insulin resistance had a 97% positive predictive value for insulin receptoropathy and <5 mg/l a 97% negative predictive value. IGFBP-1 and SHBG had lesser, though still significant, utility.

CONCLUSIONS—Use of these markers is likely to have significant value in accelerating the diagnosis of insulin receptoropathies.
Effect of Race/Ethnicity and Persistent Recognition of Depression on Mortality in Elderly Men With Type 2 Diabetes and Depression
Authors: Richardson Lisa K. , Egede Leonard E. , Mueller Martina
Published: April 2008

OBJECTIVE—To determine whether mortality risk from depression among elderly men with type 2 diabetes differs by ethnicity and persistent recognition of depression.

RESEARCH DESIGN AND METHODS—Data on a cohort of 14,500 male veterans with type 2 diabetes were analyzed. Diagnoses of depression and diabetes were based on ICD-9 codes. Persistent recognition was defined as an ICD-9 code for depression documented in at least the second or third visit after the initial diagnosis of depression. Hazards of death were compared using Cox proportional hazards regression models adjusting for relevant covariates.

RESULTS—Over 10 years, 2,305 deaths were documented. Mortality risk was higher for depressed than nondepressed veterans with diabetes (hazard ratio [HR] 1.6 [95% CI 1.3–1.8]). Among those with depression, mortality risk was lower with persistent recognition (0–2 visits vs. ≥3 visits after initial diagnosis, HR 0.58 [0.40–0.89]) but higher for whites than blacks (1.60 [1.11–2.31]).

CONCLUSIONS—Increased mortality from depression differs by ethnicity and persistent recognition.
Age, BMI, and Race Are Less Important Than Random Plasma Glucose in Identifying Risk of Glucose Intolerance
Authors: Ziemer David C. , Kolm Paul , Weintraub William S. , Vaccarino Viola , Rhee Mary K. , Caudle Jane M. , Irving Jade M. , Koch David D. , Narayan K.M. Venkat , Phillips Lawrence S.
Published: April 2008

OBJECTIVE—Age, BMI, and race/ethnicity are used in National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and American Diabetes Association (ADA) guidelines to prompt screening for pre-diabetes and diabetes, but cutoffs have not been evaluated rigorously.

RESEARCH DESIGN AND METHODS—Random plasma glucose (RPG) was measured and 75-g oral glucose tolerance tests were performed in 1,139 individuals without known diabetes. Screening performance was assessed by logistic regression and area under the receiver operating characteristic curve (AROC).

RESULTS—NIDDK/ADA indicators age >45 years and BMI >25 kg/m2 provided significant detection of both diabetes and dysglycemia (both AROCs 0.63), but screening was better with continuous-variable models of age, BMI, and race and better still with models of age, BMI, race, sex, and family history (AROC 0.78 and 0.72). However, screening was even better with RPG alone (AROCs 0.81 and 0.72). RPG >125 mg/dl could be used to prompt further evaluation with an OGTT.

CONCLUSIONS—Use of age, BMI, and race/ethnicity in guidelines for screening to detect diabetes and pre-diabetes may be less important than evaluation of RPG. RPG should be investigated further as a convenient, inexpensive screen with good predictive utility.
Custom Therapeutic Insoles Based on Both Foot Shape and Plantar Pressure Measurement Provide Enhanced Pressure Relief
Authors: Owings Tammy M. , Woerner Julie L. , Frampton Jason D. , Cavanagh Peter R. , Botek Georgeanne
Published: April 2008

OBJECTIVE—The purpose of this study was to determine whether custom insoles tailored to contours of the barefoot pressure distribution and shape of a patient's foot can reduce plantar pressures in the metatarsal head (MTH) region to a greater extent than conventional custom insoles.

RESEARCH DESIGN AND METHODS—Seventy regions of elevated barefoot pressures (mean peak 834 kPa under MTHs) were identified in 20 subjects with diabetes. Foam box impressions of their feet were sent to three different orthotic supply companies for fabrication of custom insoles. One company was also given plantar pressure data, which were incorporated into the insole design. Measurements of in-shoe plantar pressures were recorded during gait for the three custom insoles in a flexible and a rocker-bottom shoe. Peak pressure and force-time integral were extracted for analysis.

RESULTS—In 64 of 70 regions, the shape-plus-pressure–based insole in the flexible shoe achieved superior unloading compared with the two shape-based insoles. On average, peak pressure was reduced by 32 and 21% (both P ≤ 0.0001) and force-time integral by 40 and 34% (both P < 0.0001) compared with the shape-based insoles. At the midfoot, force-time integral was increased by 51 and 33% (both P < 0.01). Similar trends were found using the rocker-bottom shoe.

CONCLUSIONS—Compared with insoles based only on shape, the use of foot shape with barefoot plantar pressure measurements in designing custom insoles results in enhanced offloading of high-pressure areas under the forefoot. This offloading was achieved by a greater transfer of load to the midfoot without additional loading of other forefoot structures.
Inverse Correlation Between Heart Rate Recovery and Metabolic Risks in Healthy Children and Adolescents
Authors: Lin Lian-Yu , Kuo Hsu-Ko , Lai Ling-Ping , Lin Jiunn-Lee , Tseng Chuen-Den , Hwang Juey-Jen
Published: April 2008

OBJECTIVE—Heart rate recovery (HRR) is a marker for survival. Little is known about the association between HRR and metabolic risks in healthy children or adolescents.

RESEARCH DESIGN AND METHODS—We examined 993 healthy children and adolescents aged 12–19 years with reliable measures of cardiovascular fitness from the National Health and Nutrition Examination Survey 1999–2002. HRR parameters 1–3 min after exercise were calculated from exercise test results. Anthropometric and metabolic risk factors as well as metabolic Z score were obtained.

RESULTS—The HRR parameters were inversely correlated with most of the metabolic risks, including waist circumference, systolic blood pressure (SBP), serum triglycerides, and serum C-reactive protein (CRP) levels, and were positively correlated with serum HDL levels. In multiple linear regression analysis, among the metabolic risks, waist circumference was the only parameter associated with HRR parameters (P = 0.038, 0.001, and 0.001 for 1-, 2-, and 3-min HRR, respectively) in boys. In girls, waist circumference (P = 0.001 and <0.001 for 2- and 3-min HRR, respectively), SBP (P = 0.029 for 1-min HRR), serum glucose (P = 0.021 for 2-min HRR), and serum CRP (P = 0.007 for 2-min HRR) levels were the most important determinants of HRR parameters. The adjusted 1-min HRR did not change across four quartiles of metabolic Z score, while the adjusted 3-min HRR decreased significantly with four quartiles of metabolic Z score.

CONCLUSIONS—Metabolic risks are inversely associated with HRR in healthy children and adolescents. Our finding suggests that there is a link between metabolic risks and autonomic nervous system functions in healthy young ages.
Trends in the Prevalence of Preexisting Diabetes and Gestational Diabetes Mellitus Among a Racially/Ethnically Diverse Population of Pregnant Women, 1999–2005
Authors: Lawrence Jean M. , Contreras Richard , Chen Wansu , Sacks David A.
Published: April 2008

OBJECTIVE—The purpose of this study was to assess changes in the prevalence of preexisting diabetes (diabetes antedating pregnancy) and gestational diabetes mellitus (GDM) from 1999 through 2005.

RESEARCH DESIGN AND METHODS—In this retrospective study of 175,249 women aged 13–58 years with 209,287 singleton deliveries of ≥20 weeks’ gestation from 1999 through 2005 in all Kaiser Permanente hospitals in southern California, information from clinical databases and birth certificates was used to estimate the prevalence of preexisting diabetes and GDM.

RESULTS—Preexisting diabetes was identified in 2,784 (1.3%) of all pregnancies, rising from an age- and race/ethnicity-adjusted prevalence of 0.81 per 100 in 1999 to 1.82 per 100 in 2005 (Ptrend < 0.001). Significant increases were observed in all age-groups and all racial/ethnic groups. After women with preexisting diabetes were excluded, GDM was identified in 15,121 (7.6%) of 199,298 screened pregnancies. The age- and race/ethnicity-adjusted GDM prevalence remained constant at 7.5 per 100 in 1999 to 7.4 per 100 in 2005 (Ptrend = 0.07). Among all deliveries to women with either form of diabetes, 10% were due to preexisting diabetes in 1999, rising to 21% in 2005, with GDM accounting for the remainder.

CONCLUSIONS—The stable prevalence of GDM and increase in the prevalence of preexisting diabetes were independent of changes in the age and race/ethnicity of the population. The increase in preexisting diabetes, particularly among younger women early in their reproductive years, is of concern.
Use of the SINBAD Classification System and Score in Comparing Outcome of Foot Ulcer Management on Three Continents
Authors: Ince Paul , Abbas Zulfiqarali G. , Lutale Janet K. , Basit Abdul , Ali Syed Mansoor , Chohan Farooq , Morbach Stephan , Möllenberg Jörg , Game Fran L. , Jeffcoate William J.
Published: April 2008

OBJECTIVE—To compare populations with and outcomes of diabetic foot ulcers managed in the U.K., Germany, Tanzania, and Pakistan and to explore the use of a new score of ulcer type in comparing outcomes among different countries.

RESEARCH DESIGN AND METHODS—Data from a series of 449 patients with diabetic foot ulcers managed in the U.K. were used to evaluate the new simplified system of classification and to derive an aggregate score. The use of the score was then explored using data from series managed in Germany (n = 239), Tanzania (n = 479), and Pakistan (n = 173).

RESULTS—A highly significant difference was found in time to healing between ulcers of increasing score in the U.K. series (Kruskal-Wallis test; P = 0). When data from all centers were examined, a step-up in days to healing was noted for those with scores of ≥3 (out of 6). Examination of baseline variables contributing to outcome revealed the following differences among centers: ischemia, ulcer area, and depth contributing to outcome in the U.K.; ischemia, area, depth, and infection in Germany; depth, infection, and neuropathy in Tanzania; and depth alone in Pakistan.

CONCLUSIONS—Any system of classification designed for general implementation must encompass all the variables that contribute to outcome in different communities. Adoption of a simple score based on these variables, the Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) score, may prove useful in predicting ulcer outcome and enabling comparison among different centers.
Synthesis and monolayer film of a series of new twin-tailed gemini cationic surfactants at the air/water interface
Authors: Chen Zhi , Feng Yujun , Zhou Dongliang , Zhu Puxin , Wu Dacheng
Published: April 2008

A series of new dimeric surfactants, twin-tailed gemini surfactants, 2(12)-s-2(12), were successfully prepared and characterized, and their monolayer films investigated by the measurement of surface pressure-area (π-A) and surface pressure-time (π-t) isotherms at the air/water interface by a Langmuir film balance. Compared to their monomeric counterparts, their collapse pressure (γcollapse) is smaller, whilst all the molecular area parameters are larger. The limited area (Alimited) and the initial area (Ainitial) of these twin-tailed gemini surfactants change with increasing spacer length s, and the surface pressure decreases with increasing time. It was also found that the higher the initial surface pressure, the larger the attenuation.
Minifragment Screw Fixation of the Scarf Osteotomy
Authors: Gupta Sanjay , Ali Fazal Mohammad , Williams Lloyd
Published: April 2008

Background

Various techniques have been used for internal fixation of Scarf osteotomies. Stability of fixation plays an important role in determining the outcome. We prospectively studied 23 consecutive cases of hallux valgus treated with a scarf osteotomy, which were internally fixed with AO mini fragment screws. The aim of our study was to evaluate the clinical efficacy of the AO mini fragment screw used as fixation device in Scarf osteotomy.

Materials and Methods

Twenty-three feet (1 male, 16 female) were evaluated. Bilateral procedures were performed on six patients. Mean age was 46 years. The mean followup was 18 months. One surgeon performed all the procedures.

Results

43.5% of the patients were very satisfied, 52.2% were satisfied and 4.34% were not satisfied. All osteotomies united without any hardware complications. The mean global AOFAS score improved significantly from a preoperative score of 55 points to 91.95 ( p < 0.001). The intermetatarsal, hallux valgus angle, and DMMA improved from the mean preoperative values of 15.9 degrees, 31.2 degrees, and 14.1 degrees to 9.1 degrees, 15.2 degrees, and 8.4 degrees, respectively ( p < 0.001 for all). One patient developed a superficial wound infection, which responded to antibiotics and one patient developed a painful spur at first MTPJ.

Conclusion

We conclude that this is a safe and simple technique of fixing a Scarf osteotomy. It is cost effective, provides stable fixation and maintains correction until the osteotomy unites.
Subtalar Release in Clubfeet: A Retrospective Study of 10-Year Outcomes
Authors: Henn R. Frank , Crawford Dennis C. , Eberson Craig P. , Ehrlich Michael G.
Published: April 2008

Background

Optimal management of congenital talipes equinovarus continues to be controversial. There is a dramatically renewed emphasis on non-operative management partly because there has been a high recurrence rate among operated feet. Our hypothesis is that early, extensive subtalar ligament release as the cornerstone of aggressive hindfoot realignment prevents recurrence and retains mobility.

Materials and Methods

Twenty-two congenital clubfeet (14 patients) corrected by one surgeon were evaluated using two validated patient-based outcome instruments, dynamic pedobarographic analysis, hindfoot mobility, and weightbearing radiographs. Pedobarographic analysis consisted of quantifying peak plantar forces and pressures during the gait cycle in 22 corrected feet and 24 control feet using the FSCAN in-shoe device.

Results

The mean age at surgery was 8 months and mean followup was 10 years. No patients experienced recurrence of deformity. Reported foot function and satisfaction were very high for all patients and were comparable to reported normal population values. AP and lateral talocalcaneal angles for each foot were within normal limits for age. Hindfoot range of motion, including dorsiflexion, was preserved in all feet. Peak regional forces throughout the gait cycle and plantar pressures at foot flat were mildly, but statistically significantly, higher in the midfoot of corrected feet suggesting slight flattening of the arch. One patient had tendon transfers for bilateral calcaneal deformity and one patient had surgical correction of a bilateral valgus deformity.

Conclusion

Aggressive hindfoot realignment provides definitive treatment of an equinovarus deformity, but care must be taken to avoid overcorrection.
Correlation of Compensatory Alignment of the Subtalar Joint to the Progression of Primary Osteoarthritis of the Ankle
Authors: Hayashi Koji , Tanaka Yasuhito , Kumai Tsukasa , Sugimoto Kazuya , Takakura Yoshinori
Published: April 2008

Background

The etiology of primary osteoarthritis of the ankle is not well understood. The varus deformity of the ankle and the compensatory function of the subtalar joint are expected to be important factors in the progression of osteoarthritis. The purpose of this study was to document joint inclination at the various stages and to try to deduce the mechanism of primary, varus osteoarthritis of the ankle.

Materials and Methods

Weightbearing ankle anteroposterior (AP) views, lateral views and subtalar views were taken for 133 ankles in 80 patients (OA group) and 62 ankles in 50 subjects (control group). The OA group was divided into 5 radiographic stages. The inclination of the articular surface of the tibial plafond, the talar dome and the posterior facet of the calcaneus were measured from the radiographs. The inclination of the subtalar joint against the ankle was also calculated. At each stage, each value of the OA group was compared with the control group.

Results

The varus inclination of the articular surface of the tibial plafond progressed by stages; however, anterior opening was not significant at all stages. The valgus inclination of the subtalar joint progressed until the intermediate stage and converted to varus position at the later stage.

Conclusion

The compensatory function of the subtalar joint was most pronounced at the intermediate ankle arthritis stage.
Classification Systems for Hallux Rigidus: A Review of the Literature
Authors: Beeson Paul , Phillips Carol , Corr Susan , Ribbans William
Published: April 2008

Background

Hallux rigidus (HR) is one of the most common causes of forefoot pain. A number of classification systems have been developed to evaluate HR. These systems are based on either radiological parameters alone or a combination of radiological and clinical features. The purpose of this paper is to critically evaluate HR classification systems by undertaking a detailed review using English language medical and paramedical databases.

Materials and Methods

The authors identified 18 formal HR classification systems described in the literature, some of which are variations on a theme.

Results

No clear consensus on the construction of HR classification systems appears to exist. Different criteria and methods are used which make comparison difficult. Furthermore, it appears that, no serious consideration has been given to their reliability and validity. Criteria used to justify inclusion of these parameters have been based mainly on clinical experience rather than formal research.

Conclusion

For such a common condition, there is a need for a properly constructed, prospective study to develop a suitable classification system. It should include scientifically validated parameters to help stratify different stages of the disease and aid clinical and scientific communication.
The Use of Fibular Autograft and Ankle Arthrodesis for Aggressive Giant Cell Tumor in the Distal Tibia: A Case Report
Authors: Saglik Yener , Yildiz Yusuf , Atalar Hakan , Gunay Cuneyd
Published: April 2008

The case describes successful distal tibial resection, fibular autograft, and ankle arthrodesis in two patients who had giant cell tumor in the distal tibia. At long-term followup, the patients had no pain and no limitation in daily or low-impact recreational activities. In conclusion, due to the large resection that is often necessary for aggressive tumors, fibular autograft and ankle arthrodesis may be a useful method in the distal tibia.
Local genetic structure in a North American epiphytic lichen, Ramalina menziesii (Ramalinaceae)
Authors: Werth Silke , Sork Victoria L.
Published: April 2008

Epiphytic lichens possess unique life history traits that can have conflicting effects on genetic structure: symbiotic mutualism between a fungus with its algal or cyanobacterial photobiont, association with a host plant, and ability to reproduce sexually and asexually. Our study species, Ramalina menziesii, has small ascospores that can facilitate long‐distance gene movement, and it is capable of clonal reproduction. The goals of this study are to test whether different haplotypes were differentially distributed across host plant species, to look for evidence of asexual vs. sexual reproduction, and to assess the local genetic structure of the population. We sampled individuals from multiple trees of three oak species in four lichen subpopulations within a savanna ecosystem. Using DNA sequence data from four fungal nuclear loci, we found no tendency for host specialization. Alleles were randomly distributed across subpopulations. The frequency of multilocus genotypes was consistent with a randomly mating population. Sexual reproduction involving relichenization appeared to be the predominant mode of reproduction of R. menziesii at this study site. We found no significant local genetic structure suggesting widespread gene flow at the local scale. The genetic structure of this lichen is comparable to that of widely distributed epiphytic plants.
Bryophyte diaspore bank: a genetic memory? Genetic structure and genetic diversity of surface populations and diaspore bank in the liverwort Mannia fragrans (Aytoniaceae)
Authors: Hock Zsófia , Szövényi Péter , Schneller Jakob J. , Tóth Zoltán , Urmi Edwin
Published: April 2008

Propagule banks are assumed to be able to store considerable genetic variability. Bryophyte populations are expected to rely more heavily on stored propagules than those of seed plants due to the vulnerability of the haploid gametophyte. This reliance has important implications for the genetic structure and evolutionary potential of surface populations. A liverwort, Mannia fragrans, was used to test whether the bryophyte diaspore bank functions as a “genetic memory.” If a diaspore bank is capable of conserving genetic variability over generations, the levels of genetic diversity in the soil are expected to be similar or higher than at the surface. Surface and diaspore bank constituents of two populations of M. fragrans were investigated. Genetic structure and diversity measured as unbiased heterozygosity were analyzed using three ISSR markers. Similar genetic diversities were found in the soil (Hs = 0.067) and at the surface (Hs= 0.082). However, more haplotypes and specific haplotype lineages were present in soil samples. The results suggest that the bryophyte diaspore bank has an important role in accumulating genetic variability over generations and seasons. It is postulated that the role of the diaspore bank as a “genetic memory” is especially important in species of temporarily available habitats that have long‐lived spores and genetically variable populations.
Genetic structure and diversity in Ramonda myconi (Gesneriaceae): effects of historical climate change on a preglacial relict species
Authors: Dubreuil Marta , Riba Miquel , Mayol Maria
Published: April 2008

The importance of the Mediterranean Basin as a long‐term reservoir of biological diversity has been widely recognized, although much less effort has been devoted to understanding processes that allow species to persist in this area. Ramonda myconi (Gesneriaceae) is a Tertiary relict plant species restricted to the NE Iberian Peninsula. We used RAPD and chloroplast markers to assess the patterns of genetic structure in eight mountain regions covering almost the full species range, to identify the main historical processes that have shaped its current distribution and to infer the number and location of putative glacial refugia. While no cpDNA variation was detected, the species had relatively high levels of RAPD variation. Maximum levels of diversity were found within populations (71%), but there was also a significant differentiation between geographical regions (20%) and among populations within regions (9%). A spatial AMOVA identified three main groups of populations, corresponding to previously recognized centers of endemism and species richness. In addition, we found a marked geographical pattern of decreasing genetic diversity and increasing population differentiation from west to east. Our results support a complex phylogeographic scenario in the Iberian Peninsula of “refugia‐within‐refugia” and suggest that the higher diversity observed in western regions might be associated with prolonged and more stable climatic conditions in this area during the Quaternary.