bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of a New Visual Blood Glucose Strip
Authors: Clark Adrian J L , Cudd Rosemarie D , Newey Colette , Brooke Deirdre , Newall Ronald G , Keen Harry
Published: March 2007

A new double-tipped strip for home glucose monitoring without a meter is described. Comparison between values obtained with the new method by trained nursing staff and those obtained with a glucose-oxidase analyzer demonstrates close correlation between the two methods (r = +0.95, a = +22.2 mg/dl, b = +1.14). The mean concentration in 117 strip tests over an analyzer range of 5–775 mg/dl (0.3–43.0 mmol/L) was 52 mg/dl (2.9 mmol/L) greater than the analyzer estimate. Forty-seven percent of samples were read as the color block closest to the analyzer estimate. Samples in the lower glucose range tended to read one block high. The technique is faster to perform than most other visual blood glucose strip methods, and is a useful addition to the equipment available for home glucose monitoring. Modifications to the strip by the manufacturers appear to have overcome the low value over-reading error.
Profiling Self-Monitored Blood Glucose Results with the Personal Microcomputer
Authors: Wilson Dania E , Clarke Dana H
Published: March 2007

Personal microcomputers are becoming available to millions of individuals. Inevitably this new technology will be applied in a variety of ways to the routine management of diabetes. In this article we present the results of a pilot effort which shows that large cumbersome sets of blood glucose data, obtained by conventional self-monitoring techniques, can be stored, analyzed, and displayed conveniently with a home microcomputer. This technique has potential value for the identification of long-term trends in blood glucose regulation.
Continuous Basal Insulin Infusion: An Effective Means to Achieve Good Glycemic Control Without Premeal Boluses
Authors: Duncan John A , Malone John I
Published: March 2007

In 11 insulin-dependent diabetic subjects, aged 12–32 yr, we evaluated the efficacy of dual, basal-rate pump delivery of insulin without preprandial boluses. Mean HbA1c fell from 11.6 ± 3.1% to 7.7 ± 1.8% at 30 days (P < 0.005), and remained at 7.1 ± 1.3% at the time of this evaluation (mean duration of therapy, 6.6 mo). These data suggest that dual-rate continuous basal insulin infusion is an effective means of achieving good diabetes control. Furthermore, it is simpler than the preprandial bolus approach currently used, which may make it suitable for more patients.
Glycosylated Hemoglobins and Glycosylated Plasma Proteins in the Diagnosis of Diabetes Mellitus and Impaired Glucose Tolerance
Authors: Hall Pauline M , Cook John G , Sheldon Joanna , Rutherford Sheila M , Gould Barry J
Published: March 2007

Total and stable glycosylated hemoglobins and glycosylated plasma proteins were determined on 53 patients referred for a glucose tolerance test. Significant correlations were found with fasting blood glucose (r > 0.89), 2-h glucose (r > 0.69), and area under the glucose tolerance curve (r > 0.75), but the correlations with labile glycosylated proteins were not significant. Thirty-one of the patients were normal, five had impaired glucose tolerance (IGT), and seventeen diabetes mellitus (DM) according to the WHO criteria. Comparison of the glycosylated protein values showed that, in all cases, the values for those with IGT and DM were significantly (P < 0.001) > the values for normals. The range of values of stable glycosylated hemoglobins for those with DM (9.4–24.4%), those with IGT (8.6–10.0%), and normals (5.0–8.5%) shows that there was no overlap between overt diabetic subjects and normal subjects. This was also found for total glycosylated hemoglobins. The results for glycosylated plasma proteins, total and stable, were comparable, but one patient with overt DM and two with IGT had values within the normal range. The measurement of glycosylated hemoglobins and glycosylated plasma proteins by the simple, precise, affinity-chromatography method is potentially a quick, accurate, and simple screening test for patients with DM and IGT and deserves consideration as criteria for their diagnosis.
Pregnancy Following Renal Transplantation in a Patient with Insulin-dependent Diabetes Mellitus
Authors: Vinicor Frank , Golichowski Alan , Filo Ronald , Smith E J , Maxwell Douglas
Published: March 2007

Renal transplantation and peritoneal or hemodialysis are therapeutic options increasingly available to diabetic patients with uremia. We report a patient with insulin-dependent diabetes mellitus (IDDM) and advanced retinopathy and nephropathy who had three pregnancies. Her first pregnancy resulted in a living female with Pierre-Robin syndrome and arthrogryposis. The second pregnancy, 8 mo post-kidney transplantation, necessitated a therapeutic abortion for an anencephalic fetus. Her third pregnancy, 22 mo after kidney transplantation, was associated with intensive diabetes management and resulted in delivery by cesarean section of a healthy boy. Renal and retinal function remained stable during both her second and third pregnancies. As more patients with IDDM achieve fertility post-renal transplantation, aggressive principles of diabetes regulation need to be expanded to include consideration of the interaction of the post-kidney-transplant state and diabetes mellitus during pregnancy.
Evaluation of Three Potential Screening Tests for Diabetes Mellitus in a Biethnic Population
Authors: Haffner Steven M , Rosenthal Marc , Hazuda Helen P , Stern Michael P , Franco Laercio J
Published: March 2007

We tested the ability of three potential screening tests for diabetes (fasting plasma glucose value ≥140 mg/dl, 1-h postglucose (PG) load value ≥200 mg/dl, and 2-h PG value ≥200 mg/dl) to detect non-insulin-dependent diabetes in 130 diabetic Mexican Americans (MAs) and 50 diabetic Anglo Americans (AA) usingthe National Diabetes Data Group criteria as the standard. The sensitivity of the fastingplasma glucose (FPG) cutpoint in detecting diabetes was low in both AAs (36.0%) and MAs (59.3%) and was related to the age-adjusted prevalence rates of diabetes in the two ethnic groups (AAs, 4.9% MAs, 10.9%). The 2-h PG load cutpoint had good sensitivity (> 93%) and specificity (> 99%) in both ethnic groups. The ethnic difference in the sensitivity of the FPG cutpoint appeared to be related to the greater hyperglycemia of diabetic MAs compared with diabetic AAs. Nearly 30% of diabetic MAs had FPG values ≥ 200 mg/dl as contrasted with only 10% of diabetic AAs. The difference in severity of hyperglycemia between the ethnic groups appears to be unrelated to ethnic differences in adiposity, pharmacologic treatment, or delay in diagnosis, although longer disease duration in MAs may explain part of the difference.
The Urine Anion Gap: The Critical Clue to Resolve a Diagnostic Dilemma in a Patient with Ketoacidosis
Authors: Hilton Jack G , Vandenbroucke Arthur C , Josse Robert G , Buckley Gloria C , Halperin Mitchell L
Published: March 2007

Usually, ketoacidosis presents few if any diagnostic or therapeutic problems; in this article, we report a case where ketoacidosis was clinically occult and biochemically obscure. The patient presented with acute pancreatitis associated with a modest antecedent alcohol intake. Metabolic acidosis with a normal anion gap (10 meq/L) was observed together with moderate hyperglycemia and a 2 + (but not 4 +) test for serum ketones. None of the usual causes of metabolic acidosis with a normal anion gap was identified nor was there an obvious explanation for a reduction in unmeasured anion gap (e.g., hypoalbuminemia, dysproteinemia, or the presence of abnormal halides). Despite the initial normal anion gap, ketoacidosis was suspected clinically and this was confirmed by the elevated serum B-hydroxybutyrate of 8 mmol/L. We deduced that the serum unmeasured anions, which should have been increased by at least 8 meq/L, were being underestimated because of the effect of hypertriglyceridemia on the serum chloride determination. When the serum chloride was reestimated by a method not influenced by hyperlipidemia, the value was 102 mmol/L not 112 mmol/L and, when reevaluated, the anion gap was indeed appropriately elevated. In addition, the urine anion gap (Na + K − Cl) was 103 meq/L in the absence of renal disease. This indicated that the expected large quantity of urinary ammonium must have been masked by an even greater quantity of unmeasured anion; in this case proven by direct measurement to be B-hydroxybutyrate. Finally, metabolism of the alcohol ingested, which yields hepatic NADH, could explain, in part, the modest hyperglycemia and the absence of a 4 + test for serum ketones. With this information, appropriate treatment for ketoacidosis was instituted and within 36− 48 h the bicarbonate (23 mmol/L) and the anion gap (11 meq/L) returned to normal. Thus, knowledge of how the determination of the serum chloride can be influenced by hypertriglyceridemia and, at the same time, our utilization of the urine anion gap permitted us to make the diagnosis and effect the treatment of an obscure case of metabolic acidosis due to ketoacidosis.
The Course of Peripheral Vascular Disease in Non-insulin-dependent Diabetes
Authors: Kreines Kenneth , Johnson Eugene , Albrink Margaret , Knatterud Genell L , Levin Marvin E , Lewitan Alexander , Newberry William , Rose Frederick A
Published: March 2007

The present report is an analysis of the course of peripheral vascular disease (PVD) in 619 patients with non-insulin-dependent diabetes (NIDDM) recruited within 1 yr of diagnosis and followed quarterly for up to 14 yr (X = 10.5 yr). At 13 yr duration, the actuarially determined cumulative risks for intermittent claudication (IC), nonpalpable dorsalis pedis pulse (NPUL), and arterial calcification (CALC) were, respectively, 37.9%, 34.5%, and 60.9% for men and 24.3%, 37.6%, and 32.2% for women. Major amputations (AMP) occurred in only 1.3% of the patients, equivalent to approximately one case per 1000 patients per year. The corresponding incidences of IC, NPUL, and CALC were, respectively, 29, 27, and 47 per 1000 men and 19, 27, and 25 per 1000 women per year. CALC and NPUL were strongly related to mortality. Baseline risk factors with probability levels that suggest a relationship to PVD were, in women, age versus CALC (P < 0.01), age versus NPUL (P < 0.05), weight versus NPUL (P < 0.05), systolic BP versus CALC (P < 0.01), summed glucose tolerance test versus CALC (P < 0.01), and triglyceride level versus CALC (P < 0.05). In men, the only significant risk factors were diminished vibration perception, which was related to NPUL (P < 0.05), and the serum triglyceride level, which was related to IC (P < 0.05). In patients who are carefully followed prospectively, IC is far more common, but AMP is far less common than has been generally appreciated. Further studies are needed to clarify the roles of the diverse risk factors that are possibly related.
The Effects of Sucrose, Fructose, and High-Fructose Corn Syrup Meals on Plasma Glucose and Insulin in Non-insulin-dependent Diabetic Subjects
Authors: Akgün Suat , Ertel Norman H
Published: March 2007

We have previously shown that fructose and sorbitol given with a standard meal cause less increment in plasma glucose than sucrose and high fructose corn syrup (HFCS) in patients with NIDDM. However, there was no direct comparison of sucrose with HFCS. Sixteen men and one woman aged 54–67) with NIDDM were given either 35 g sucrose, 35 g fructose, or 43.75 g HFCS containing 35 g carbohydrate as part of a 400-calorie test meal. Blood samples were obtained at frequent intervals up to 3 h and were analyzed for glucose and insulin. As compared with a fructose meal, the mean increment in plasma glucose (ΔPG) after a sucrose meal was significantly higher at 45 min and after an HFCS meal it was significantly higher at 30 and 45 min, but sucrose and HFCS meals did not differ. When delta PGs were compared in nine patients with basal PG > 140 mg/dl and in eight patients with basal PG < 140 mg/dl, differences in ΔPG after sucrose and HFCS versus fructose meals became more significant but still did not differ from each other. The integrated total areas under the ΔPG curves after sucrose, HFCS, and fructose meals were not statistically different. However, the areas under the curves up to 90 min after sucrose and HFCS meals, which did not differ, were greater than the fructose meal. The mean delta IRI after sucrose meals was markedly elevated at 45, 60, and 75 min (P < 0.05) and after HFCS meals at 45 min as compared with fructose meals. There was no significant difference in the mean AIRI between sucrose and HFCS meals. This study shows that sucrose and HFCS cause greater increments of PG than fructose in patients with NIDDM, but do not differ from each other. Thus, even though HFCS is less expensive than fructose, its effect on plasma glucose and insulin is not different from that of sucrose, and we cannot confirm on a scientific basis a useful function for HFCS in diets for persons with diabetes. Also, diabetic patients with higher basal PG (i.e., > 140 mg/dl) show similar increase in PG whether they are given sucrose, HFCS, or fructose meals. Therefore, fructose has potential value only in patients with mild diabetes mellitus.
Quantification of Early Subclinical Limited Joint Mobility in Diabetes Mellitus
Authors: Slama G , Letanoux M , Thibult N , Goldgewicht C , Eschwege E , Tchobroutsky G
Published: March 2007

Limited joint mobility (LJM) has been described in juvenile diabetic patients by Rosenbloom et al.; similar abnormalities are also present in adult diabetes. This modification may be associated with a high risk of microvascular complications. We tested the use of a goniometer in measuring subclinical joint limitation in 50 adult diabetic patients without overt, i.e., clinically evident, LJM as described by these authors. This diabetic population was compared with 118 nondiabetic adult controls. We found significant changes in hand mobility between the two groups for wrist flexion and extension of the 3rd and 5th fingers (P < 0.001). Age was correlated to wrist flexion, wrist extension, and proximal interphalangeal flexion of the little finger. Wrist extension correlated with duration of diabetes (r = − 0.37, P < 0.01). Heavy manual activities significantly limited all motions except wrist and 5th finger metacarpophalangeal flexion. Early systematic examination by goniometry may prove to be a sensitive, quantitative, and inexpensive way of detecting joint stiffness at an early stage.
Compliance to Self-Monitoring of Blood Glucose: A Marked-Item Technique Compared with Self-Report
Authors: Wing Rena R , Epstein Leonard H , Patricia Nowalk Mary , Scott Nancyxs , Koeske Randi
Published: March 2007

This study compared subjects' self-reported rates of compliance to self-monitoring of blood glucose (SMBG) with an objective measure based on a “marked-item” technique. We followed 25 obese patients with type II diabetes who were participating in a behavorial weight control program and monitoring their blood glucose with Chemstrips bG (Bio-Dynamics, Inc., Indianapolis, Indiana). Subjects' self-report significantly overestimated actual compliance as assessed by the marked-item technique. Moreover, the self-report measure failed to identify 35–45% of the noncompliant patients. Compliance decreased steadily over the course of the 37-wk program. Accuracy of SMBG was less problematic than compliance; 85% of patients were able to read Chemstrips bG within 20% of actual blood sugar, and the average blood sugar reading obtained from 2 mo of SMBG correlated highly (r = 0.78, P < 0.01) with HbA1. Our data suggest that objective measures such as the marked-item technique described in this article should be used to assess compliance to SMBG and behavioral strategies to improve compliance should be developed.
Veterans Administration Cooperative Study on Antiplatelet Agents in Diabetic Patients After Amputation for Gangrene: II. Effects of Aspirin and Dipyridamole on Atherosclerotic Vascular Disease Rates
Authors: Colwell John A , Bingham Stephen F , Abraira Carlos , Anderson James W , Comstock John P , Kwaan Hau C , Nuttall Frank ,   The Cooperative Study Group
Published: March 2007

We report the results of a randomized multicenter clinical trial on the effects of aspirin plus dipyridamole versus placebo on major vascular end points in 231 non-insulin-dependent diabetic men with either a recent amputation for gangrene or active gangrene. Primary end points were death from atherosclerotic vascular disease plus amputation of the opposite extremity for gangrene. There were 24 atherosclerotic deaths in the drug treatment group (21.8%) and 23 in the placebo group (19.0%). There were 22 patients in the drug treatment group (20.0%) and 29 patients in the placebo group (24.0%) with opposite-side amputations. Survival curve analyses revealed little difference between these groups for major vascular end points, total mortality, all amputations, or myocardial infarctions. The most noteworthy group difference was observed for cerebrovascular end points (strokes and transient ischemic attacks), with an incidence of 8.2% (9 patients) in the drug treatment group and 19.0% (23 patients) in the placebo group. We conclude from this study that antiplatelet agents have no effect on the primary vascular end points, vascular deaths and/or amputation of the opposite extremity, in this population. Similarly, no effects were seen on secondary vascular end points, except for a suggestion of protection versus strokes and transient ischemic attacks. However, this finding must be interpreted with caution, since it is a secondary end point and was found only after multiple analyses of the data.
Role of Obesity and Fat Distribution in Non-insulin-dependent Diabetes Mellitus in Mexican Americans and Non-Hispanic Whites
Authors: Haffner Steven M , Stern Michael P , Hazuda Helen P , Rosenthal Marc , Knapp J Ava , Malina Robert M
Published: March 2007

Recent data have suggested that central obesity is related positively to the prevalence of non-insulindependent diabetes mellitus (NIDDM). We examined whether central obesity (measured by the ratio of subscapular to triceps skinfold) was predictive of NIDDM prevalence independently of overall obesity (measured by body mass index, BMI) in 1231 Mexican Americans and 939 non-Hispanic whites who participated in the San Antonio Heart Study, a population-based survey of diabetes and cardiovascular risk factors. Mexican Americans are characterized by higher rates of NIDDM, greater overall obesity, and more central body fat distribution than age-matched non-Hispanic whites. Using multiple logistic regression with age, ethnicity, BMI, and central obesity as covariates, overall obesity was positively associated with NIDDM prevalence in both sexes (P < 0.001) but central obesity was related to NIDDM prevalence only in women. Our data suggest that the effect of centrality decreases at higher levels of centrality. While both BMI and centrality narrow the ethnic difference in NIDDM prevalence, Mexican Americans still have an increased risk of NIDDM (odds ratio = 2.33 in men and 1.80 in women), suggesting that other factors, possibly genetic, may also be important determinants of the ethnic differences in NIDDM prevalence.
Prevalence of Insulin Deficiency Among Initially Non-Insulin-Dependent Middle-Aged Diabetic Individuals
Authors: Laakso Markku , Sarlund Helena , Pyörälä Kalevi
Published: March 2007

The endogenous insulin secretion capacity of 171 insulin-treated middle-aged persons with diabetes (81 men, 90 women) of the Kuopio University Central Hospital district (population 250,000), East Finland, was measured by the C-peptide response to glucagori. The prevalence of insulin deficiency among initially non-insulin-dependent diabetic (NIDDM) individuals was calculated on the basis of those who were initially treated with diet or oral drugs and 3 yr or more after diagnosis had been treated with insulin and were insulin deficient in this study. The prevalence of complete insulin deficiency (postglucagon C-peptide undetectable) was among initially NIDDM individuals of the same region, 0.7% in menand 1.2% in women. Using the postglucagon C-peptide level of 0.20 nmol/L as a cut-offpoint, the prevalence of insulin deficiency was 2.0% in men and 1.9% in women and, on thebasis of C-peptide level of 0.60 nmol/L, the prevalence of insulin deficiency was 3.5% in men and 2.7% in women. Our data suggest that the deterioration of insulin secretion capacity in NIDDM to the level that leads to insulin dependency occurs less often than has been previously suggested.
Cost Efficacy of Routine Screening for Diabetes in Pregnancy: 1-h Versus 2-h Specimen
Authors: Weiner Carl P , Fraser Mary M , Burns Julie M , Schnoor Debra , Herrig James , Whitaker Linda A
Published: March 2007

Undetected gestational diabetes mellitus (GDM) is associated with a two-to fivefold increase in perinatal morbidity and mortality. Widespread screening of the obstetric population (resulting in identification and treatment) should reduce these rates. Seven hundred ninety-eight women were examined during a 13-mo period of universal glucose challenge testing (GCT). A total of 2.8% of the population had an abnormal oral glucose tolerance test (OGTT). Thirty percent of those with an abnormal OGTT were <25 yr old. The specificity of a 1-h GCT (50-g carbohydrate load) using a threshold of either 140 or 150 mg/dl was compared with that of a 2-h specimen using a threshold of 118 mg/dl to determine whether the cost of screening could be reduced. One- and 2-h specimens were obtained i3347 of these women. A 34% reduction in the number of follow-up OGTTs required would have been achieved if a 2-h specimen had been used as the index instead of a 1-h specimen (P < .05). As a result, the (direct and indirect) cost per patient identified with GDM would have declined 23.5%—from $866 to $662. No comment concerning the actual false-negative rate of either the 1- or 2-h GCT can be made because only select women underwent an OGTT. To assess the validity of the 2-h threshold, an OGTT was performed in an additional 190 women if either the 1- or 2-h screen was abnormal. The results were confirmatory: the 2-h screen would have reduced the cost per case identified by 32% in this small group. Screening on the basis of past medical history clearly lacked sensitivity and cost efficacy in comparison with the GCT and should be abandoned as a practice.
Comparison of Metabolic Effects of White Beans Processed Into Two Different Physical Forms
Authors: Golay Alain , Coulston Ann M , Hollenbeck Clarie B , Kaiser Lucia L , Würsch Pierre , Reaven Gerald M
Published: March 2007

In the present study eight control subjects and eight patients with non-insulin-dependent diabetes mellitus (NIDDM) consumed single portions of processed beans equivalent to 50 g of carbohydrate. The beans were processed by different methods into two physical forms; one maintained the integrity of the bean cells (undamaged bean cells, UC) and the other ruptured the bean cells (damaged bean cells, DC). Incremental glucose response areas after ingestion of either UC or DC were not significantly different in control subjects, while incremental insulin response areas (49 ± 7 vs. 26 ± 4 μU · ml−1 · h−1 P < .05) were significantly lower after eating UC-processed beans. In patients with NIDDM both incremental glucose (150 ± 14 vs. 73 ± 25 mg · dl−1 · h - 1 ,P < .001) and insulin (67 ± 16 vs. 46 ± 11 μU · ml−1 · h−1 P < .05) response areas were significantly lower after UC administration. To test the effectiveness of the UC-processed bean when incorporated into mixed meals, nine patients with NIDDM consumed mixed meals containing either DC or UC on two separate mornings. The test meals represented a typical Mexican American use of pureed beans wrapped in a flour tortilla topped with melted cheese. Incremental glucose responses were significantly lower after the UC meal (171 ± 42 mg · dl−1 · h−1 P < .05) when compared with the DC meal (212 ± 34 mg · dl−1 · h−1). Incremental insulin areas were also lower after the UC (91 ± 19 μU · ml−1 · h−1) when compared with the DC meal (120 ± 22 μU · ml−1 · h−1). Our study demonstrates that consumption of white beans prepared in a manner that maintains the integrity of the cells profoundly modified the ensuing plasma glucose and insulin response in patients with NIDDM as compared with white beans milled in a more conventional fashion. Moreover, the lower glucose and insulin response to UC beans occurred when the beans were consumed alone or in a mixed meal and suggests that the practice of processing carbohydrate-rich foods in a manner that leaves the food form intact may be of significant clinical importance.
Decreased Numbers of Platelet α-Adrenergic Binding Sites in Diabetes Mellitus
Authors: Spalding Richard M , Ward W Kenneth , Malpass Thomas W , Stratton John R , Halter Jeffery B , Porte Daniel , Pfeifer Michael A
Published: March 2007

Eleven men with diabetes mellitus were compared with 45 male controls for platelet a-adrenergic binding sites by using [3H]dihydroergocryptine (DHE) as the radioligand antagonist. There was no difference between the two for binding affinity, but the number of sites was 430 ± 30 (x ± SEM) for diabetic subjects and 574 ± 29 for controls (P = .005). Decreased sites were related to increased glycosylated hemoglobin levels (P = .002). There was no relationship between the decreased sites and catecholamine levels, duration of disease, body weight, or fasting blood sugar. Hence, binding sites were inversely related to control, but further studies are needed to define the pathophysiologic significance of this.
Diet-Induced Essential Fatty Acid Deficiency in Ambulatory Patient With Type I Diabetes Mellitus
Authors: Piper Cheryl M , Carroll Patricia B , Dunn Fredrick L
Published: March 2007

We report a case of symptomatic essential fatty acid deficiency (EFAD) occurring in afree-living individual with type I diabetes mellitus who was voluntarily following a high-carbohydrate, fat-restricted diet. The patient was 43 yr old with type I diabetes for 18yr and no chronic complications. His self-imposed diet excluded all red meats, fats, and oils. After several months of this diet, the patient developed lethargy and a pruritic, diffuse, scaly, and erythematous rash. Biochemical studies revealed a mildly elevated SGOTand abnormally low levels of linoleic, linolenic, and arachidonic fatty acids. Treatment with linoleic acid supplementation in his diet improved the rash, normalized SGOT, and corrected the fatty acid profile. We conclude that EFAD may occur in a free-living individual after consuming a very low-fat diet.
Insulin-Dependent Diabetes Mellitus and Child Abuse: Is There a Relationship?
Authors: Horan Patricia F , Gwynn Carol , Renzi Debbie
Published: March 2007

Many of the family psychosocial variables significantly related to child abuse are also significantly related to insulin-dependent diabetes mellitus (IDDM) control. These variables are reviewed, and an increased child abuse risk factor for children with IDDM is discussed. Behavioral indicators of families experiencing difficulty in coping with IDDM are provided. These indicators are associated with both diabetes control and child abuse and should be recognized by diabetes health-care professionals.
Low Frequency of 5'-Flanking Insertion of Human Insulin Gene in Japanese Non-Insulin-Dependent Diabetic Subjects
Authors: Aoyama N , Nakamura T , Doi K , Baba S , Takahashi R , Sugiyama T
Published: March 2007

Polymorphism in the 5'-flanking region of the human insulin gene in 149 unrelated Japanese subjects [77 with non-insulin-dependent diabetes mellitus (NIDDM), 17 with insulin-dependent diabetes mellitus (IDDM), and 55 controls] was analyzed with Southern blot hybridization. We used the size of the hybridized fragments to classify the locus into three groups according to Bell's method (a short, class 1 allele averaging 570 base pairs; an intermediate-size, class 2 allele averaging 1320 base pairs, and a long, class 3 allele averaging 2470 base pairs in size). The allelic frequency of classes 2 and 3 in 298 alleles was 5.0% and in the 146 alleles of NIDDM, 7.8%. The value is lower than in Caucasians, American Blacks, and Pima Indians, and the results suggest that the 5'-flanking insertion is not a genetic marker in most NIDDM patients who are Japanese. However, the frequency of the 5'-flanking insertion in those who were not obese and had a family history of diabetes was higher than that of other NIDDM patients (P = .013), and the frequency in NIDDM patients with onset of diabetes at age ≤39 yr was lower than those whose onset was at age ≥40 yr (P = .053). As NIDDM is a heterogeneous disorder, further analysis is needed. These results suggest that we cannot completely exclude the meaning of the insertion in NIDDM. On the other hand, the frequency in IDDM was 0%, lower than in NIDDM (P = .094). Because the number of subjects studied was small, this result is speculative.
comparison of Plasma Lipoproteins and Apoproteins in Chinese and American Non-Insulin-Dependent Diabetic Subjects and Controls
Authors: Pan X-R , Walden C E , Warnick G R , Hu S-X , Albers J J , Cheung M , Bierman E L
Published: March 2007

Plasma lipoproteins and apoproteins were compared among Chinese and American controls and noninsulin-dependent diabetic (NIDDM) subjects in the same laboratory. Apoprotein AI concentrations in Chinese subjects, both NIDDM subjects and controls (men, 147 and 158 mg/dl, respectively), were significantly higher than those in American subjects (men, 104 and 124 mg/dl, respectively). Apoprotein All concentrations, however, were comparable between Chinese and American subjects. Chinese NIDDM subjects had lower high-density lipoprotein cholesterol (HDLC), higher low-density lipoprotein cholesterol (LDLC), and higher apoprotein B levels than Chinese controls. Chinese subjects with NIDDM had HDLC and LDLC levels similar to those of American controls but trends of higher HDLC and lower LDLC compared with American subjects with NIDDM. These differences may in part explain the relatively higher incidence of atherosclerotic vascular disease in Americans.
Glycemic Response to Pasta: Effect of Surface Area, Degree of Cooking, and Protein Enrichment
Authors: Wolever T M S , Jenkins D J A , Kalmusky J , Giordano C , Giudici S , Jenkins A L , Thompson L U , Wong G S , Josse R G
Published: March 2007

To see whether food form, the degree of cooking, or protein enrichment affected the glycemic response to pasta, we gave test-meal breakfasts to 13 diabetic patients. Macaroni had a significantly greater glycemic index (GI) (68 ± 8) than spaghetti (45 ± 6, P < .01); the GI of star pastina was intermediate (54 ± 6). The GI of spaghetti was not significantly affected by cooking for 5 or 15 min (45 ± 6 and 46 ± 5, respectively), or by protein enrichment (38 ± 4). The GI of spaghetti was similar in 11 noninsulin-dependent and 6 insulin-dependent diabetic patients (49 ± 7 compared with 57 ± 8). We conclude that different types of pasta may produce different glycemic responses but that these are not necessarily related to differences in cooking or surface area.
Current Therapeutic Concepts in Diabetic Hypertension
Authors: Peiris A N , Gustafson A B
Published: March 2007

Diabetes mellitus and hypertension are both prevalent in the adult population. The development of hypertension in the diabetic patient is likely to increase the morbidity and mortality in a subgroup already at high risk for atherosclerosis and deserves special consideration. Several studies have confirmed the beneficial effects of antihypertensive therapy on complications such as diabetic nephropathy. This emphasizes the importance of normalizing blood pressure in the diabetic population. It has been suggested that the threshold for initiating antihypertensive therapy should be lower in diabetic patients. All antihypertensive agents have potential disadvantages in patients with diabetes. The commonly encountered effects include deterioration of diabetic control, sexual dysfunction, electrolyte imbalance, and lipid disorders. The adverse effects of these agents on serum lipids have been implicated in the lessthan-expected reduction in coronary heart disease noted in some studies. The recent Lipid Research Council study has emphasized the importance of elevated lipid levels and increased cardiovascular mortality. Antihypertensive therapy has advanced rapidly in the last 5 yr. The special problems in the treatment of hypertension within the diabetic population are now receiving greater attention. Undesirable biochemical side effects of drugs used to treat hypertension have become publicized, and the long-term consequences of these abnormalities are under critical scrutiny. The new antihypertensive medications offer exciting alternative approaches to the more traditional agents with less chance of significant metabolic side effects.
Early Diabetic Nephropathy: Assessment and Potential Therapeutic Interventions
Authors: Rosenstock Julio , Raskin Philip
Published: March 2007

End-stage renal failure secondary to diabetes has increasingly become a health and socioeconomic issue. Diabetic nephropathy is the major cause of death in type I insulin-dependent diabetic patients and accounts for ∼25% of all patients beginning hemodialysis in the United States. Once diabetic nephropathy is well established, attempts to modify the relentless downward progression of the disease have been essentially unsuccessful. We focus on the early structural and functional changes that occur as a consequence of diabetic renal disease and examine the evidence for microalbuminuria as an early marker and predictor for future overt diabetic nephropathy. The rationale for different therapeutic interventions to alter the course of early diabetic nephropathy are discussed.
Immunological Markers in the Diagnosis and Prediction of Autoimmune Type 1a Diabetes
Authors: Winter William E. , Harris Neil , Schatz Desmond
Published: March 2007

In Brief

Several autoantibodies are associated with autoimmune type 1 diabetes. Measurements of islet autoantibodies can assist in the diagnosis of autoimmune diabetes, and the detection of islet autoantibodies in nondiabetic individuals indicates a significantly increased risk for the subsequent development of type 1 diabetes. When preventive therapies for type 1 diabetes become available, islet autoantibody screening of the general pediatric population should be considered to identify at-risk individuals.
An Overview of Obesity and Weight Loss Surgery
Authors: O'Connell Thomas L.
Published: March 2007

IN BRIEF

Obesity has become an epidemic in the United States, with more than 60% of the population now either overweight or obese. Lifestyle modifications and weight loss medications have failed to provide significant, lasting weight loss in the majority of people who are overweight. Weight loss surgery has proven to be a safe and effective means of losing significant and lasting weight and should be considered in those who are morbidly obese.
Oral Agents for Type 2 Diabetes: An Update
Authors: Kimmel Bonnie , Inzucchi Silvio E.
Published: March 2007

IN BRIEF

The paradigms for oral pharmacological therapy in type 2 diabetes are shifting as we attain new insights into the optimal metabolic control in our patients. Each drug category has unique advantages and disadvantages, and their proper use necessitates a full understanding of their mechanisms of action, glycemic and nonglycemic effects, and prescribing indications. This article reviews published clinical trial data and places them into the context of contemporary, rational therapeutic strategies for this increasingly common condition.
A nonlinear tracking control for sensorless induction motors with uncertain load torque
Authors: Marino R. , Tomei P. , Verrelli C. M.
Published: March 2007

We propose a novel nonlinear tracking control algorithm for induction motors with uncertain load torque in which only stator currents are used for feedback: rotor speed and flux sensors are not required; no open‐loop integration of flux dynamics is used. For a class of reference signals, for sufficiently small computable time‐varying load torque uncertainty and for any initial condition belonging to an explicitly computed region, closed‐loop boundedness is guaranteed while, under persistency of excitation, local exponential rotor speed and flux modulus tracking are achieved in the case of constant load torque. Copyright © 2007 John Wiley & Sons, Ltd.
Cross‐sectional study of electrocardiographic pattern in healthy children resident at high altitude
Authors: Huicho Luis , Niermeyer Susan
Published: March 2007

Electrocardiographic studies have reported persistent right ventricle predominance in high altitude children as an adaptive response. No information was provided on ethnicity and environmental factors in those studies. We assessed the electrocardiographic characteristics in healthy high altitude children with mixed ancestry and relatively high mobility to lower altitudes. A cross‐sectional study of 321 children aged 2 months through 19 years old and living at high altitude (Tintaya, Peru, 4,100 m) was conducted. Standard 12‐lead electrocardiography was performed. Information was obtained on ethnicity, medical history, place and altitude of pregnancy and birth, mobility of children and their parents and grandparents to lower altitudes, and housing conditions. A medical examination, echocardiography, hemoglobin, oxygen saturation, and anthropometric measurements were performed. Means between sexes were compared through Mann–Whitney test for independent samples not normally distributed. Potentially influential variables on electrocardiographic values were controlled through a general linear model. Electrocardiographic parameters including QRS axis, RV1, RSV1, RV1SV5, RSV5, RSV6, and SV1RV5 did not show a right predominance pattern at any age. Values were within sea level norms. None of the genetic or environmental factors controlled showed a consistent influence on the electrocardiographic variables. Our study showed an electrocardiographic pattern similar to that of sea level in high altitude children with some degree of high‐altitude ancestry, comparatively well‐nourished and with relatively high mobility to low altitudes. Am J Phys Anthropol, 2007. © 2007 Wiley‐Liss, Inc.
Synthesis of compatibilizers and characterization of the compatibilized and noncompatibilized blends of PP/Rodrun LC3000
Authors: Cidade M. T. , Filipe S. , Duarte A. P. , Bordado J. C. M.
Published: March 2007

The addition of a liquid crystalline polymer (LCP) to a matrix of a flexible thermoplastic (TP) has been used in the last two decades as an in situ reinforcement of the matrix. Owing to the immiscibility of the two phases and the high degree of orientation typical of LCPs, the dispersed phase is, after processing, essentially constituted by fibrillar structures, which are responsible for the reinforcement of the matrix and the decrease of viscosity with respect to the matrix. The low degree of adhesion typical of LCP/TP blends often requires the use of compatibilizers, which will act reducing the interfacial tension between the two components. In this work, we present the synthesis of three different compatibilizers, as well as the mechanical characterization of the corresponding compatibilized blends. Some scanning electron microphotographs will be also presented to better explain the mechanical results. The mechanical properties of these blends were compared with the noncompatibilized blend, as well as with the ones presented by blends obtained with two commercial compatibilizers, leading to the conclusion that, considering our compatibilizer C, the one that leads to the higher enhancement of the Young's modulus, when compared with the noncompatibilized blend, we obtain a Young's modulus 27% higher than the one presented by the noncompatibilized blend. Comparing this result with those presented by the blends compatibilized with the two commercial compatibilizers, D and E, we conclude that this enhancement is higher than those presented by those blends (increase in Young's modulus of 16% for both compatibilizers). © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007
Preparation of HDPE/SEBS‐g‐MAH and its effect on mechanical properties of HDPE/wood flour composites
Authors: Shi Hengchong , Li Bin , Chen Cheng , Jia Yonglin
Published: March 2007

In this article, high density polyethylene/styrene‐ethylene‐butylene‐styrene block copolymer blends (HDPE/SEBS) grafted by maleic anhydride (HDPE/SEBS‐g‐MAH), which is an effective compatibilizer for HDPE/wood flour composites was prepared by means of torque rheometer with different contents of maleic anhydride (MAH). The experimental results indicated that MAH indeed grafted on HDPE/SEBS by FTIR analysis and the torque increased with increasing the content of maleic anhydride and dicumyl peroxide (DCP). Styrene may increase the graft reaction rate of MAH and HDPE/SEBS. When HDPE/SEBS MAH was added to HDPE/wood flour composites, tensile strength and flexural strength of composites can reach 25.9 and 34.8 MPa in comparison of 16.5 and 23.8 MPa (without HDPE/SEBS‐g‐MAH), increasing by 157 and 146%, respectively. Due to incorporation of thermoplastic elastomer in HDPE/SEBS‐g‐MAH, the Notched Izod impact strength reached 5.08 kJ m−2, increasing by 145% in comparison of system without compatibilizer. That HDPE/SEBS‐g‐MAH improved the compatibility was also conformed by dynamic mechanical measurement. Scanning electron micrographs provided evidence for strong adhesion between wood flour and HDPE matrix with addition of HDPE/SEBS‐g‐MAH. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 2007
High‐performance liquid chromatography analysis of curcumin in rat plasma: application to pharmacokinetics of polymeric micellar formulation of curcumin
Authors: Ma Zengshuan , Shayeganpour Anooshirvan , Brocks Dion R. , Lavasanifar Afsaneh , Samuel John
Published: March 2007

A simple, rapid and reliable high‐performance liquid chromatographic (HPLC) method was developed and validated for the determination of curcumin in rat plasma. Plasma was precipitated with acetonitrile after addition of the internal standard (IS), 4‐hydroxybenzophenone. Separation was achieved on a Waters µBondapak™ C18 column (3.9 × 300 mm, 5 µm) using acetonitrile (55%) and citric buffer, pH 3.0 (45%) as the mobile phase (flow rate = 1.0 mL/min). The UV detection wavelength was 300 and 428 nm for IS and curcumin, respectively. The extraction efficiencies were 97.08, 95.69 and 94.90% for 50, 200 and 1000 ng/mL of curcumin in rat plasma, respectively. The calibration curve was linear over the range 0.02–1 µg/mL with a correlation coefficient of r2 > 0.999. The intra‐ and inter‐day coefficients of variation were less than 13%, and mean intra‐ and inter‐day errors were less than ±6% at 50, 200 and 1000 ng/mL of curcumin. This assay was successfully applied to the pharmacokinetic studies of both solubilized curcumin and its polymeric micellar formulation in rats. It was found that polymeric micelles increased the half‐life of curcumin 162‐fold that of solubilized curcumin and increased the volume of distribution (Vdss) by 70‐fold. Copyright © 2007 John Wiley & Sons, Ltd.
Novel Synthesis of Barbiturates
Authors: Ashnagar Alamdar , Gharib naseri Nahid , Sheeri Behrang
Published: March 2007

Knovenagel reaction of barbituric acid with different aldehydes were used to synthesize new barbiturates.This is a novel method which can be used to synthsis various types of new generation of barbiturates which are different from the previously reported.
Fundamental Concepts of NMR in Paramagnetic Systems Part I: The Isotropic Shift
Authors: Satterlee James D.
Published: March 2007

A simple model is presented as the basis for explaining the equations that describe the isotropic shift for paramagnetic molecules in solution. The simplest case is that of an axially symmetric molecule for which the Curie Law is valid and for which zero field splitting and second‐order Zeeman effects are small. It is used as a point of departure for considering the many underlying factors that affect observation of NMR resonances in paramagnetic molecules.
Echoes—how to generate, recognize, use or avoid them in MR‐imaging sequences. Part I: Fundamental and not so fundamental properties of spin echoes
Authors: Hennig Jürgen
Published: March 2007

Spin echoes have been known since 1950. Although their formal description by use of the Bloch equations is straightforward, it does not lead to an intuitive understanding of their behavior except for the special cases of 180° or 90° pulses, especially when many pulses are applied before the magnetization has returned into thermal equilibrium. The extended‐phasegraph algorithm, which takes into account that the total magnetization in spin‐echo sequences is a superposition of many isochromats, allows the recognition of all possible echo signals in arbitrary pulse sequences. Its application to multi‐echo sequences leads to a number of surprising results. It can be demonstrated that refocusing pulses with flip angles much lower than 180° generate an unexpectedly high signal intensity after a few echo periods. Apart from leading to a simple algorithm for the exact calculation of echo intensities in arbitrary multi‐pulse sequences, the phase‐graph algorithm leads to a simple understanding of the contrast behavior of different gradient echo sequences and gives a rational means for the design of MR‐imaging sequences that are free from spurious echoes.
Relaxation. Can T2, be longer than T1?
Authors: Traficante Daniel D.
Published: March 2007

The basic equations describing the decay of the magnetization vector in the transverse plane and its growth along the longitudinal axis, after a pulse, are briefly examined for very simple systems that obey the extreme narrowing condition, and relax in the absence of radiation damping. It is shown that in these cases, the vector does not simply tip backwards with a constant magnitude, retracing the path it followed during the pulse. It is mathematically proven that if T2 is equal to or less than twice T1, then immediately after a pulse, the vector first shrinks and then grows back to its initial magnitude while it tips back toward the longitudinal axis, instead of simply retracing its path. It is also shown that if T2 is greater than this threshold value, then at some point during the relaxation, the magnitude of the resultant will exceed its starting value, a situation apparently not consistent with our present understanding of the laws of physics.
Statistically based image reconstruction for emission tomography
Authors: Liacer Jorge , Veklerov Eugene , Nunez Jorge
Published: March 2007

This paper presents the motivation, development, algorithms, and performance tests of some fundamental statistically based reconstruction algorithms in emission tomography (ET). The motivation is based on an analysis of the filtered backprojection method (FBP) of reconstruction as a statistical process in which it is shown that it corresponds to the wrong statistical distribution for the ET problem. The development of the target functions and algorithms for the maximum likelihood estimator method (MLE) and for a Bayesian method with entropy prior is shown in a manner consistent with the FBP analysis. The concept of a “feasible” image is discussed as a necessary condition for a reconstruction to be acceptable and the choice of a uniform image field as the initial guess for the iterative methods is justified in terms of the lack of prior information on the image to be reconstructed. Finally, a number of image and profile comparisons are presented in which the feasible images obtained by the above methods, and by the method of sieves, appear superior to FBP images. Real data from the ECAT‐III tomography are used for all the reconstruction.