bluuebunny/crossref_metadata_2025 huggingface dataset:
The apolipoprotein ε2 allele and the severity of coronary artery disease in Type 2 diabetic patients
Authors: Kalix B. , Meynet M.‐C. B. , Garin M.‐C. B. , James R. W.
Published: March 2003

Aims To examine the hypothesis that apolipoprotein E2 is associated with more severe coronary disease in Type 2 diabetic patients.

Research design and methods In this retrospective cohort study, 491 patients with angiographically assessed coronary disease were recruited from those attending a university hospital cardiology department. Participants completed detailed questionnaires, from which the presence or absence of diabetes was determined. Fasting blood samples were obtained for apolipoprotein E genotype and measurement of blood lipid parameters.

Results
 
The prevalence of triple vessel disease was significantly lower in non‐diabetic, ε2 allele carriers (39.3% vs. 16.2%; odds ratio (OR) 0.30 (0.12–0.71), P < 0.03) compared with E3/3 carriers. In Type 2 diabetic patients, ε2 allele carriers had an excess of triple vessel disease compared with E3/3 genotypes (43.3 vs. 68.8%; OR 2.8 (1.07–7.30), P < 0.05). The differences were independent of other variables. The apo E4 subgroup showed no significant differences in the frequency of triple vessel disease.

Conclusions Diabetic ε2 allele carriers had more severe coronary artery disease than diabetic patients with other apo E isoforms. In non‐diabetic patients the ε2 allele appeared to protect against severe coronary disease. We hypothesize that interaction between the diabetic milieu and the ε2 allele accelerates plaque progression. It suggests that diabetic patients who are carriers of the ε2 allele, even in the heterozygous form, should be the focus of particular therapeutic attention.

Diabet. Med. 18, 445–450 (2001)
Contraindications to metformin therapy in patients with Type 2 diabetes—a population‐based study of adherence to prescribing guidelines
Authors: Emslie‐Smith A. M. , Boyle D. I. R. , Evans J. M. M. , Sullivan F. , Morris A. D. ,   for the DARTS/MEMO Collaboration
Published: March 2003

Aims  To define the number of people in Tayside, Scotland (population 349 303) with Type 2 diabetes who use metformin, the incidence of contraindications to its continued use in these people and the proportion that discontinued metformin treatment following the development of a contraindication.

Methods  Retrospective cohort study of the incidence of contraindications to metformin in all patients with Type 2 diabetes using metformin from January 1993 to June 1995. The contraindications of acute myocardial infarction, cardiac failure, renal impairment and chronic liver disease were identified by: the regional diabetes information system, biochemistry database and hospital admissions database and a database of all encashed community prescriptions.

Results  One thousand eight hundred and forty seven subjects (26.3% of those with Type 2 diabetes) redeemed prescriptions for metformin. Of these, 3.5% were admitted with an acute myocardial infarction (71 episodes); 4.2% were admitted with cardiac failure (114 episodes); 21.0% received metformin and loop diuretics for cardiac failure concurrently; 4.8% developed renal impairment; and 2.8% developed chronic liver disease. The development of contraindications rarely resulted in discontinuation of metformin, for example only 17.5% and 25% stopped metformin after admission with acute myocardial infarction and development of renal impairment, respectively. In total, 24.5% of subjects receiving metformin, 6.4% of all people with Type 2 diabetes, had contraindications to its use. There was one episode of lactic acidosis in 4600 patient years.

Conclusions  This population‐based study shows that 24.5% of patients prescribed metformin have contraindications to its use. Development of contraindications rarely results in discontinuation of metformin therapy. Despite this, lactic acidosis remains rare.

Diabet. Med. 18, 483–488 (2001)
Association of proinsulin and insulin resistance with coronary artery disease in non‐diabetic south Indian men
Authors: Snehalatha C. , Ramachandran A. , Saltyamurthy I. , Satyavani K. , Sivasankari S. , Misra J. , Viswanathan V.
Published: March 2003

Aims  To evaluate the association of plasma proinsulin and insulin resistance (IR) with coronary artery disease (CAD) in non‐diabetic subjects.

Methods  In this case control study, 41 normoglycaemic men with angiographic evidence of CAD were compared with 41 control men matched for age and glycaemia and with no history or evidence of cardiac diseases. Estimations of plasma glucose, lipids, fasting plasma specific insulin (SI) and proinsulin (PI) were performed. IR was calculated by the homeostasis model assessment (HOMA) method. Multiple logistic regression analysis was performed to test the association of the variables with the prevalence of CAD.

Results  Subjects with CAD had a higher body mass index (BMI) (25.4 ± 4.3 vs. 22.9 ± 3.2 kg/m2, P = 0.003) and waist to hip ratio (WHR) (0.95 ± 0.05 vs. 0.89 ± 0.09, P = 0.001) and a lower high‐density lipoprotein (HDL) cholesterol level (0.97 ± 0.2 vs. 1.1 ± 0.2 mmol/l, P = 0.002). They also had higher mean SI values (107.5 vs. 62.3 pmol/l, P = 0.002), PI values (19.3 vs. 5.7 pmol/l, P < 0.0001), PI/SI ratios (21.4 vs. 10.3, P < 0.0001) and HOMA IR (4.2 vs. 2.4, P = 0.004) compared with non‐CAD subjects. These variables were associated with CAD in the unadjusted multiple regression analysis. In the multiple regression with the forward entry of the variables, WHR and PI only showed independent association with CAD.

Conclusions  Subjects with CAD had higher levels of obesity and WHR. CAD showed an association with low HDL cholesterol, circulating PI, PI/SI ratios and IR.

Diabet. Med. 18, 706–708 (2001)
An aid to the early detection and management of diabetic nephropathy: assessment of a new point of care microalbuminuria system in the diabetic clinic
Authors: Collins A. C. G. , Vincent J. , Newall R. G. , Mitchell K. M. , Viberti G. C.
Published: March 2003

Aims  To compare the performance of the DCA2000 microalbuminuria system for albumin and creatinine concentrations and the albumin:creatinine ratio (ACR) with laboratory measurements in the hospital diabetes clinic and to assess the ease of use and applicability by standard clinic personnel.

Methods  Urine albumin and creatinine concentration and ACR were measured in 154 diabetic patient samples and in 77 normal subjects. Both albumin assays are based on immunoturbidimetry. The DCA2000 system utilizes reagent cartridges processed automatically.

Results  Control material within‐run precision (coefficient of variation (CV)) for albumin and creatinine ranged up to 7.1% and 3.3% respectively. Between‐run CVs ranged from 2.1% to 4.3%. Method comparisons yielded correlation coefficients > 0.99 for albumin, creatinine and ACR, only a small negative bias of 3.2 mg/l for albumin and 0.10 mg/mmol for ACR, no concentration‐related bias for ACR and no between‐method difference for either albumin (P = 0.195) or ACR (P = 0.341). At a laboratory albumin concentration cut‐off of 20 mg/l the sensitivity, specificity, negative and positive predictive values were 92.4% 100% 92.7% and 100%. Normal reference range mean albumin, creatinine and ACR values for the DCA2000 and the laboratory were 7.7 mg/l vs. 9.0 mg/l 13.0 mmol/l vs. 12.6 mmol/l and 0.66 mg/mmol vs. 0.81 mg/mmol respectively. Clinic personnel found that the DCA2000 system was easy to use suited the clinic environment and generated confidence in the results.

Conclusions  This point of care system safely substitutes laboratory‐based measurements. Ease of use and low cost make it suitable for screening and monitoring diabetes treatment. It facilitates the use of random urines, and may obviate the need for timed samples. This approach has a clear place in the battle to reduce the diabetic vascular disease burden.

Diabet. Med. 18, 928–932 (2001)
The effect of cigarette smoking on soluble adhesion molecules in middle‐aged patients with Type 2 diabetes mellitus
Authors: Takeuchi N. , Kawamura T. , Kanai A. , Nakamura N. , Uno T. , Hara T. , Sano T. , Sakamoto N. , Hamada Y. , Nakamura J. , Hotta N.
Published: March 2003

Aims To investigate the effect of smoking on soluble adhesion molecules in middle‐aged diabetic patients.

Methods One hundred out‐patients with Type 2 diabetes and 100 age‐ and sex‐matched non‐diabetic subjects without clinical macrovascular disease were selected. Soluble serum levels of adhesion molecules were analysed using enzyme immunoassay. Carotid atherosclerosis was assessed using an ultrasound system.

Results When compared with non‐diabetic subjects, soluble vascular cell adhesion molecule‐1 (sVCAM‐1), soluble intercellular adhesion molecule‐1 (sICAM‐1), and sE‐selectin were found at significantly high levels in diabetic patients and significantly higher levels of sICAM‐1, sE‐selectin, and sP‐selectin were observed in current smokers than never‐smokers among diabetic or non‐diabetic subjects, respectively. The combined, but not enhanced, effects of diabetes mellitus and smoking were observed in sICAM‐1 and sE‐selectin levels. Additionally, levels of sICAM‐1 (P < 0.05) and sE‐selectin (P < 0.01), but not sP‐selectin, were high in ex‐smokers when compared with never‐smokers among diabetic patients. Diabetic smokers were also found to have marked carotid atherosclerosis, which was related to increased levels of sICAM‐1.

Conclusions Our present study shows that levels of adhesion molecules were higher in diabetic smokers than diabetic non‐smokers or non‐diabetic smokers, and that cessation after chronic smoking did not restore the levels of sICAM‐1 and sE‐selectin, though sP‐selectin levels were restored. These data suggest a possible mechanism for accelerated atherosclerosis induced by smoking in patients with diabetes.
St Vincent’s Declaration 10 years on: outcomes of diabetic pregnancies
Authors: Platt M. J. , Stanisstreet M. , Casson I. F. , Howard C. V. , Walkinshaw S. , Pennycook S. , McKendrick O.
Published: March 2003

Aims To monitor pregnancies in women with pregestational Type 1 diabetes for pregnancy loss, congenital malformations and fetal growth parameters, in a geographically defined area in the north west of England.

Methods Population cohort study of 547 pregnancies in women with Type 1 diabetes from maternity clinics in 10 centres over a 5‐year period (1995–1999 inclusive). Main outcome measures were numbers and rates of miscarriages, stillbirths, neonatal and post‐neonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age.

Results Among 547 pregnancies, there were six (1.1%) pairs of liveborn twins, 439 (80.3%) liveborn singletons; 72 (13.2%) spontaneous abortions, 14 (2.6%) stillbirths and 16 (2.9%) terminations. Four of the terminations were performed because of congenital malformations. Both the stillbirth rate (30.1/1000 total births (95% confidence interval (CI) 16.6–50.0)), and prevalence of congenital malformations (84.3/1000 live births (95% CI 60.3–113.8)) were significantly higher than the local population (P < 0.001). When corrected for gestational age, mean birth weight in the sample was 1.3 sd greater than that of infants of non‐diabetic mothers (P = 0.12). Infants with congenital malformations weighed less than those without.

Conclusion In an unselected population, the infants of women with pregestational Type 1 diabetes mellitus have 6.4 times the reported risk of a congenital malformation and 5.1 times the reported risk of perinatal mortality than infants in the general population. Further improvements in the management of diabetes and pregnancy in these women are needed if the St Vincent’s Declaration target is to be met.

Diabet. Med. 19, 216–220 (2002)
Rheological determinants of red blood cell aggregation in diabetic patients in relation to their metabolic control
Authors: Elishkevitz K. , Fusman R. , Koffler M. , Shapira I. , Zeltser D. , Avitzour D. , Arber N. , Berliner S. , Rotstein R.
Published: March 2003

Aims To determine whether increased red blood cell adhesiveness/aggregation in diabetic patients is related to the extent of their metabolic control.

Methods We measured erythrocyte adhesiveness/aggregation in a group of 85 adult patients with diabetes mellitus by using citrated venous whole blood and a simple slide test. The erythrocyte adhesiveness/aggregation was determined by measuring the size of the spaces that are formed between the aggregated erythrocytes. We divided the patients into those with either low or high erythrocyte adhesiveness/aggregation values.

Results The erythrocyte adhesiveness/aggregation values of the two groups differed significantly in terms of their fibrinogen concentration, erythrocyte sedimentation rate, high sensitive C‐reactive protein (CRP), total cholesterol and triglyceride concentrations. There was no difference between the two groups regarding the concentrations of HbA1c. Logistic regression was applied to construct a model to predict the belonging of a patient in the low or high erythrocyte adhesiveness/aggregation group. A linear regression was applied to construct a model to predict the erythrocyte adhesiveness/aggregation values. Both models turned out to include gender, age, fibrinogen, triglyceride, retinopathy, coronary artery disease and age and gender interaction. Neither HbA1c nor CRP entered the models.

Conclusions The degree of erythrocyte adhesiveness/aggregation and several variables of the acute‐phase response in patients with diabetes mellitus are not directly related to the degree of metabolic control as evaluated by means of HbA1c concentration. Diabetic patients might benefit from rheological or anti‐inflammatory interventions regardless of their metabolic control.
Psychological counselling in problematic diabetes: does it help?
Authors: Snoek F. J. , Skinner T. C.
Published: March 2003

Background In past decades clinicians have increasingly recognized the importance of psychological support for people with diabetes and their families, and many have recommended integrating psychological counselling into routine diabetes care. It is therefore important to consider whether psychological interventions in diabetes are effective in improving clinical outcomes.

Methods This review was limited to the literature reporting on the treatment of five common psychological problems known to complicate diabetes management: depression, eating disorders, anxiety/stress, self‐destructive behaviour and interpersonal/family conflicts. A literature search was undertaken using MedLine and PsychInfo, including studies published in English peer‐reviewed journals between 1990 and 2001, reporting on the effects of psychological interventions in the areas mentioned. Case studies were excluded from the review.

Results In line with earlier reviews, relatively little empirical research was found to substantiate the effect of psychological counselling in complicated diabetes. Most studies are uncontrolled, and involve small samples. In total only 11 randomized controlled trials were identified. Results indicate that cognitive behaviour therapy (CBT) is effective in the treatment of depression in Type 2 diabetes patients, both in reducing depressive symptoms and HbA1c. Favourable effects have been observed in pilot studies applying CBT in the field of stress management, eating disorders and self‐destructive behaviour, but future research should substantiate these preliminary findings. Behaviour family therapy proved beneficial in terms of resolving family conflicts, but did not impact glycaemic control.

Conclusions Evidence to support the effect of psychological treatment in problematic diabetes is still scarce, due to limited research in this area. Suggestions are made to further develop psychotherapeutic research in diabetes care. We conclude that future research should gain from a behavioural medicine approach to diabetes, with close collaboration between diabetologists and psychologists.
Hypertensive disorders of pregnancy in women with Type 1 and Type 2 diabetes
Authors: Cundy T. , Slee F. , Gamble G. , Neale L.
Published: March 2003

Aims Hypertensive disorders in pregnancy are common in women with Type 1 diabetes and can be associated with adverse fetal outcomes, but little is known about hypertension in pregnancy in women with Type 2 diabetes. The aim of this study was to compare the incidence and outcomes of, and risk factors for, hypertension in pregnancy in women with Type 1 and Type 2 diabetes.

Methods One hundred consecutive singleton pregnancies in women with Type 2 and 100 in women with Type 1 diabetes were studied. Hypertension in pregnancy was classified according to Australasian Society for the Study of Hypertension in Pregnancy guidelines. Outcomes of pregnancy examined included birth weight, rates of caesarean section, premature delivery and special care unit admission, and perinatal mortality.

Results The overall incidence of hypertension in pregnancy was similar in Type 2 and Type 1 diabetes (41% vs. 45%), but the distribution of subtypes differed (P = 0.028). Women with Type 2 diabetes had more chronic hypertension (diagnosed at < 20 weeks gestation), but less preeclampsia than women with Type 1 diabetes. Hypertension in pregnancy was strongly associated with a number of adverse outcomes, but the impact of hypertension was significantly less for Type 2 diabetes than it was for Type 1 (premature delivery, P < 0.005; admission to Special Care Unit, P < 0.01; caesarean section, P = 0.05). This was, in part, because the frequency of adverse outcomes was greater in women with preeclampsia. Nulliparity, poor glycaemic control at presentation, and early pregnancy blood pressure and not smoking were risk factors for hypertension of similar magnitude in both types of diabetes. Significant effects of duration of diabetes and obesity were not seen in Type 2 subjects, but were in Type 1 (P < 0.01, P < 0.05, respectively). Early pregnancy albumin excretion rate was increased more frequently in Type 2 subjects than in Type 1 (P < 0.035), but was less strongly associated with the development of preeclampsia (P < 0.035).

Conclusions The incidence of hypertension in pregnancy is similar in Type 2 and Type 1 diabetes, but the different population characteristics are reflected in a significantly different pattern of types of hypertension. Hypertension has less impact on adverse outcomes in Type 2 diabetes. Some risk factors for hypertension also differ between Type 2 and Type 1 diabetes.
Diabetic ketosis activates lymphomonocyte‐inducible nitric oxide synthase
Authors: Iori E. , Calò L. , Valbusa D. , Ceolotto G. , Milani M. , Pengo V. , De Kreutzenberg S. V. , Tiengo A. , Avogaro A.
Published: March 2003

Aims Inappropriate production of nitric oxide (NO) may be responsible for the haemodynamic disturbances of diabetic ketoacidosis. We investigated whether this metabolic condition is associated with increased plasma nitrate (the stable oxidation product of NO) levels and NO synthase gene expression in lymphomonocytes.

Research design and methods Plasma nitrate concentrations, lymphomonocyte‐inducible nitric oxide synthase (iNOS) gene expression, tumour necrosis factor‐alpha (TNF‐α) and soluble thrombomodulin were measured in 11 Type 1 diabetic patients at baseline, during mild ketosis and after euglycaemia was re‐established.

Results During diabetic ketosis plasma nitrate concentrations were higher (18 (16–21) vs. 9 (7–11) µmol/l; (95% lower‐upper confidence interval) P < 0.05) than at baseline. At baseline lymphomonocyte iNOS mRNA expression and iNOS protein levels were undetectable, but in ketosis both were increased (both at P < 0.0001). After recovery from ketosis, NO3 concentration, iNOS mRNA, and iNOS expression (270 ± 36%, mean ± sd) decreased but not significantly. No significant changes were observed in either TNF‐α or soluble thrombomodulin levels between the three conditions.

Conclusions Diabetic ketosis is associated with increased nitrate levels and the activation of iNOS expression in circulating lymphomonocytes, but it does not affect either the proinflammatory cytokine TNF‐α or a marker of endothelial dysfunction such as thrombomodulin. Our data support the hypothesis that, during diabetic ketosis, alterations in NO homeostasis are present in circulating lymphomonocytes.
Basal‐bolus insulin therapy in Type 1 diabetes: comparative study of pre‐meal administration of a fixed mixture of insulin lispro (50%) and neutral protamine lispro (50%) with human soluble insulin
Authors: Herz M. , Arora V. , Sun B. , Ferguson S. C. , Bolli G. B. , Frier B. M.
Published: March 2003

Aims To ascertain whether pre‐meal administration of 50% insulin lispro and 50% neutral protamine lispro (NPL), given as a fixed mixture (Humalog® Mix50™, Eli Lilly) (Mix50), provides satisfactory glycaemic control throughout the day compared with pre‐meal human soluble (regular) insulin as a basal‐bolus regimen in people with Type 1 diabetes. Both regimens included bedtime human isophane (NPH) insulin.

Methods This was a multinational, multicentre, randomized, open‐label, two‐period crossover comparison of two insulin treatments for two 12‐week periods in 109 patients with Type 1 diabetes. The protocol provided preliminary evaluations of dose requirements and recommendations for insulin dose adjustment when switching regimens on the basis of blood glucose (BG) values. Eight‐point BG profiles, frequency of hypoglycaemia, HbA1c, insulin dose, time of injection, and frequency of snacking were assessed during each treatment.

Results Total daily insulin dose was similar for both treatments, but the total pre‐meal doses were higher (P < 0.001) and the bedtime dose of isophane was lower (P < 0.001) with Mix50. The pre‐meal dose before breakfast and lunch, although statistically different (P = 0.006 and P < 0.001, respectively), was of similar magnitude, but the pre‐evening meal dose was higher with Mix50 (P < 0.001). Median (interquartile range) time of insulin injection before meals was: Mix50 4.2 (25th percentile = 1.0; 75th percentile = 6.3) min, human soluble insulin 24.6 (25th percentile = 16.6; 75th percentile = 30.0) min. Pre‐meal and bedtime BG concentrations did not differ between treatments. The BG 2 h after the evening meal was lower with Mix50 (8.40 ± 2.95 mmol/l vs. 9.60 ± 3.47 mmol/l) (P = 0.049). BG after breakfast and lunch, mean HbA1c, frequency of hypoglycaemia, frequency of snacks, and body weight were not different.

Conclusion The use of Mix50 in a basal‐bolus regimen achieved similar control of pre‐meal BG to human soluble insulin, and overall glycaemic control and hypoglycaemia risk were equivalent. This suggests that Mix50 can provide an adequate supply of insulin to control BG between meals while providing the convenience of injecting immediately before meals.

Diabet. Med. 19, 917–923 (2002)
Improvements in insulin sensitivity and β‐cell function (HOMA) with weight loss in the severely obese
Authors: Dixon J. B. , Dixon A. F. , O'Brien P. E.
Published: March 2003

Aims  To examine the effect of weight loss on insulin sensitivity and β‐cell function in severely obese subjects of varying glycaemic control.

Patients and methods  Subjects were 254 (F:M 209:45) patients having adjustable gastric banding for severe obesity, with paired biochemical data from before operation and at 1‐year follow up. The homeostatic model assessment method was used to calculate insulin sensitivity (HOMA%S) and β‐cell function (HOMA%B). Subjects were grouped by diabetic status and by pre‐weight loss HbA1c.

Results  Initial mean (sd) weight and body mass index were 128 (26) kg and 46.2 (7.7) kg/m2, respectively, and at 1‐year were 101 (22) kg and 36.4 (6.7) kg/m2. The percentage of excess weight lost (%EWL) was 44.3 (14)%. HOMA%S improved from 37.5 (16)% presurgery to 62 (25)% (P < 0.001). %EWL was the only predictor of HOMA%S improvement (r = 0.28, P < 0.001). Subjects with normal fasting glucose, impaired fasting glucose and Type 2 diabetes had a fall, no change and increase in HOMA%B, respectively. The improvement in HOMA%B in subjects with diabetes (n = 39) was inversely related to the time with diabetes (r = −0.36, P = 0.02). In non‐diabetic subjects the HOMA%S–HOMA%B relationship was favourably altered with weight loss, so that for any given HOMA%S there was an increase in HOMA%B (f = 11.8, P = 0.001). This improvement in HOMA%B was positively related to %EWL (r = 0.25, P = 0.019).

Discussion  There are beneficial changes in both insulin sensitivity and β‐cell function with weight loss. Modern laparoscopic obesity surgery may have an important early role in the management of Type 2 diabetes in obese subjects.
Body size and latitudinal gradients in regional diversity of New World birds
Authors: Cardillo Marcel
Published: March 2003

Are latitudinal gradients in regional diversity random or biased with respect to body size? Using data for the New World avifauna, I show that the slope of the increase in regional species richness from the Arctic to the equator is not independent of body size. The increase is steepest among small and medium‐sized species, and shallowest among the largest species. This is reflected in latitudinal variation in the shape of frequency distributions of body sizes in regional subsets of the New World avifauna. Because species are added disproportionately in small and medium size classes towards low latitudes, distributions become less widely spread along the body size axis than expected from the number of species. These patterns suggest an interaction between the effects of latitude and body size on species richness, implying that mechanisms which vary with both latitude and body size may be important determinants of high tropical diversity in New World birds.
Are there fine‐scale spatial patterns in community similarity among temporary freshwater pools?
Authors: Spencer Matthew , Schwartz Steven S. , Blaustein Leon
Published: March 2003

One expects greater similarity between communities that are close together in space than between communities that are widely separated. This may be due to similarity in environmental conditions, short‐range dispersal, or both processes together. We examined whether these mechanisms were important in determining the invertebrate communities in a set of temporary freshwater rockpools within an area of 800 m2. Adjacent pools tended to share similar environmental characteristics (conductivity, pH, presence of predatorySalamandra salamandraL. larvae and amount of shade). Community dissimilarity was not strongly related to interpool distance. Environmental variables did not explain a significant amount of variation in community dissimilarity, although differences in pH and depth were the best predictors of community dissimilarity. We conclude that dispersal is not limiting in our study system.
Design and test of a generic cohort model of soil organic matter decomposition: the SOMKO model
Authors: Gignoux Jacques , House Joanna , Hall David , Masse Dominique , Nacro Hassan B. , Abbadie Luc
Published: March 2003

SOMKO is a new simulation model of soil organic matter (SOM) dynamics aimed at predicting long‐term and short‐term SOM dynamics based on a mechanistic approach focusing on microbes as the key agents of decomposition.

 SOM is partitioned into cohorts and chemical quality pools (classified by age and chemical composition), the microbial community processes are explicitly represented, and the C : N stoichiometric constraints are accounted for through a new mechanism of offer and demand.

 The analysis of model equations shows that: (1) SOM C : N cannot decrease below microbial C : N; and (2) the nitrogen limitation of decomposition depends on SOM C : N, microbial biomass and soil mineral nitrogen. First tests of the model show good qualitative behaviour for simulating the dynamics of short‐term litter‐bag type decomposition, long‐term SOM increase, pulsed mineral nitrogen production, the priming effect due to easily decomposable carbon addition, and the effects of vegetation clearance and climate change on SOM. Simulations are in good agreement with long‐term experimental data.

 SOMKO is an integrated component of the coupled soil–vegetation models within the ETEMA (European Terrestrial Ecosystem Modelling Activity) framework. Future extensions of this work include: (1) estimating microbial parameters from specific experiments; (2) spatial distribution of SOMKO in multistrata models; and (3) implementing nitrification/denitrification processes, phosphorus limitation and microfaunal activity.
Patterns of ant species richness along elevational gradients in an arid ecosystem
Authors: Sanders Nathan J. , Moss Jarrod , Wagner Diane
Published: March 2003

Aim In this study, we examine patterns of local and regional ant species richness along three elevational gradients in an arid ecosystem. In addition, we test the hypothesis that changes in ant species richness with elevation are related to elevation‐dependent changes in climate and available area.

Location Spring Mountains, Nevada, U.S.A.

Methods We used pitfall traps placed at each 100‐m elevational band in three canyons in the Spring Mountains. We compiled climate data from 68 nearby weather stations. We used multiple regression analysis to examine the effects of annual precipitation, average July precipitation, and maximum and minimum July temperature on ant species richness at each elevational band.

Results We found that patterns of local ant species richness differed among the three gradients we sampled. Ant species richness increased linearly with elevation along two transects and peaked at mid‐elevation along a third transect. This suggests that patterns of species richness based on data from single transects may not generalize to larger spatial scales. Cluster analysis of community similarity revealed a high‐elevation species assemblage largely distinct from that of lower elevations. Major changes in the identity of ant species present along elevational gradients tended to coincide with changes in the dominant vegetation. Regional species richness, defined here as the total number of unique species within an elevational band in all three gradients combined, tended to increase with increasing elevation. Available area decreased with increasing elevation. Area was therefore correlated negatively with ant species richness and did not explain elevational patterns of ant species richness in the Spring Mountains. Mean July maximum and minimum temperature, July precipitation and annual precipitation combined to explain 80% of the variation in ant species richness.

Main conclusions Our results suggest that in arid ecosystems, species richness for some taxa may be highest at high elevations, where lower temperatures and higher precipitation may support higher levels of primary production and cause lower levels of physiological stress.
Models of predation and fishing mortality in aquatic ecosystems
Authors: Whipple Stuart J , Link Jason S , Garrison Lance P , Fogarty Michael J
Published: March 2003

The dynamics of fish stocks are greatly influenced by predatory and fishery removals. We describe the strengths and weaknesses of a suite of approaches that assess the scope and magnitude of fishery and predatory mortality in aquatic ecosystems. We examine: (i) empirical models for pattern detection, process exploration, and model parameterization (e.g. multispecies time series and multiple regression); (ii) qualitative process‐based models of species interactions (e.g. food web analyses and loop analyses); and quantitative process‐based multispecies models that include: (iii) static flow models (e.g. Ecopath); (iv) dynamic models of either numerical abundance (e.g. Lotka–Volterra) or biomass (e.g.
Ecosim and multispecies biomass dynamics); and (v) spatially explicit versions of the above. Decisions concerning a specific modelling approach should be evaluated in the context of the goals of the model and empirical database. Important considerations include model use, desired output, and management context. Four important factors to consider in model selection are the spatial and temporal extent and resolution, conservation of mass or numbers, mathematical representation of predator–prey interactions, and mathematical representation of technical interactions. We conclude that the most effective modelling exercise to achieve a given set of goals should incorporate the evaluation of multiple model configurations.
Myths and moderation in marine ‘metapopulations’?
Authors: Smedbol R Kent , McPherson Arran , Hansen Michael M , Kenchington Ellen
Published: March 2003

The metapopulation concept is appearing with increasing frequency in the marine population dynamics and genetics literature, though its applicability to marine systems remains an open question. Moreover, in recent years, the meaning of the term ‘metapopulation’ has become blurred, concomitant with its increasing use. In this paper, we summarize the concept of metapopulation dynamics and the associated theoretical assumptions. We call for a stricter definition and use of the term ‘metapopulation’, critically evaluate the applicability of metapopulation theory to marine population dynamics and its use in the related literature, and consider two published case‐studies that investigate metapopulation structuring in specific marine populations. Finally, we urge scientists to carefully articulate what is meant by the term ‘metapopulation’ and to use appropriate citations in the primary literature to circumvent the potential for nebulous (and possibly damaging) conclusions in the future.
Spinocerebellar ataxia type 6: CAG trinucleotide expansion, clinical characteristics and sperm analysis
Authors: Shizuka M. , Watanabe M. , Ikeda Y. , Mizushima K. , Kanai M. , Tsuda T. , Abe K. , Okamoto K. , Shoji M.
Published: March 2003

Spinocerebellar ataxia type 6 (SCA6) is an autosomal dominant spinocerebellar degeneration caused by CAG repeat expansions in the human α1A voltage‐dependent calcium channel subunit gene. We analyzed 16 SCA6 patients in 14 unrelated Japanese families, and documented the clinical and molecular properties correlating with the CAG repeat expansion. Three of them were sporadic. The CAG repeat number of the expanded and normal alleles was 22.7 ± 2.0 (mean ± SD, n = 15) and 13.8 ± 2.0 (n = 15), respectively, and the repeat size of the expanded alleles correlated inversely with age at onset. The patients presented here were clinically characterized by a slowly progressive cerebellar ataxia and nystagmus. In leukocytes, the strict pattern of the peak in the expanded allele on polyacrylamide gel electrophoresis did not show the presence of cell mosaicism in SCA6, in contrast to other trinucleotide disorders. Moreover, in each patient, the number of CAG repeats in sperm was the same as in leukocytes, and the expanded alleles in sperm indicated uniform peaks as well. In our geographic area, the frequency of SCA6 was as high as MJD, in contrast to the low frequency of other autosomal dominant cerebellar ataxias. Thus, a geographic difference in the frequency of autosomal dominant spinocerebellar ataxias may be present in Japan.
Pharmacokinetic behaviour of carbamazepine and its main metabolite‐10, 11 epoxide of carbamazepine in monotherapy or in combination with other anti‐epileptic drugs
Authors: Divanoglou D. , Orologas A. , Iliadis S. , Nathanael V. , Constantinidis T.C. , Milonas I.
Published: March 2003

A combination of anti‐epileptic drugs is used for the necessary control of seizures. This results in a modulation of the metabolism in the epileptic patient and a concentration of the drugs and their metabolites in serum and in the brain, the target organ. Carbamazepine‐10,11 epoxide (CBZE) is the main active metabolite of carbamazepine (CBZ). We have studied their interrelationship in concentrations in the plasma of 68 patients receiving CBZ, either as monotherapy or in combination with phenytoin (PHT) and phenobarbital (PB). The rate of CBZ metabolism was modulated in drug co‐administration, which, depending on the grade of the induction of cytochrome p‐450, decreases or increases the concentration of CBZE. A graph plotting the relationship between CBZ and CBZE concentrations in patients stabilized on a regime of CBZ alone is linear. The ratio of concentrations of CBZE/CBZ in serum is 0.12 when CBZ is administered as monotherapy, rising to 0.14 (CBZ + PB), 0.18 (CBZ + PHT) and 0.25 (CBZ + PHT + PB) when administered with the other drugs mentioned. From this it can be hypothesized that the additive of induction activities of PHT and PB operates on the mixed function oxidase system.
Quality of life measurements in patients with Parkinson's disease: A community‐based study
Authors: Karlsen Karen H. , Larsen Jan P. , Tandberg Elise , Mæland John G.
Published: March 2003

The objective of this paper is to evaluate the health‐related quality of life in a community‐based population of patients with Parkinson's disease (PD). The PD population consisted of 233 patients and was derived from a wider prevalence study in the county of Rogaland, Norway. The quality of life was measured by the Nottingham Health Profile (NHP) and four general health and well‐being questions. The results were compared with quality of life measurements in 100 patients with diabetes mellitus (DM) and 100 healthy elderly people. The control groups had the same age and sex distribution as the patients with PD. This study showed that PD has a substantial impact on the health‐related quality of life. Patients with PD had higher distress scores in all measured dimensions of the NHP than the two control groups. The negative impact of PD was highest for physical mobility, emotional reactions, social isolation and energy. Correlation analysis of the quality of life showed that age, duration of levodopa therapy, higher levodopa doses, depression, cognitive impairment and more advanced disease correlated with higher distress scores in patients with PD. The results of this study showed that PD had a broad impact on well‐being, more so than DM. The distress related to the severity of the disease, as well as to depressive symptoms and cognitive impairment. An important finding was the underestimated distress related to lack of energy.
Risk factors of stroke after percutaneous transluminal coronary angioplasty
Authors: Cubo Esther , Estefania Carlos Martin , Monaco Mary , Monaco Elizabeth , Gonzalez Miguel , Egido Jose Antonio , Gonzalez Jose Luis , Macaya Carlos
Published: March 2003

Objective: to determine possible risk factors of a stroke after percutaneous transluminal coronary angioplasty (PTCA). Design: this is a retrospective evaluation of a consecutive group of 4088 patients undergoing PTCA between 1988 and 1995. We have studied the incidence, clinical characteristics, risk factors, and outcome. Results: seven patients, six males and one female (0.17%) developed a stroke after this procedure. In comparison with the control group, the stroke group did not differ regarding age or gender. The existence of a stroke (six located in the brain, and one in the brain, and one in the spinal cord), represented 1.24% of all complications (P < 0.001), and 5% of all deaths (P < 0.01) of PTCA. Three patients developed TIA, two patients developed hemorrhagic strokes (in which they received previous thrombolytic therapy), and the other two patients suffered from an ischemic stroke. The statistically significant risk factors of a stroke after PTCA included: intracoronary thrombolytic therapy (P < 0.01), hypercholesterolemia (P < 0.001) and a prior PTCA (P < 0.05). Conclusions: although these procedural complications are infrequent, they are usually serious and important risk factors which could be identified prior to the procedure. These risk factors would allow identification of patients who are prone to a stroke after PTCA. Intracranial hemorrhage occurred only after thrombolytic therapy, and the factors related to hemorrhagic strokes were probably different from those predisposed to ischemic strokes and TIA.
Motor fluctuations in Parkinson's disease: pathophysiology and treatment
Authors: Colosimo Carlo , Michele Manuela De
Published: March 2003

At the initial stages of Parkinson's disease (PD), levodopa (LD) is able to reduce most motor symptoms and to significantly improve the patient's quality of life. However, in the vast majority of patients with prolonged LD usage, some decline in efficacy occurs and motor complications eventually begin to appear. These complications consist not only of daily fluctuations in the voluntary motor performance often accompanied by involuntary movements, but also of fluctuations in cognitive, autonomic, and sensory functions. Several recent studies on LD complications in PD have led to a better understanding of their pathophysiology and of the possible therapeutic interventions, and a summary of these findings is presented in this review. Different observations now suggest that postsynaptic pharmacodynamic factors play a major role in determining fluctuations in PD. Two explanations are given: chronic intermittent dopaminergic therapy may lead to postsynaptic receptor downregulation in PD; or, receptor changes in the striatum may occur independently of treatment as a result of structural adaptation of the postsynaptic dopaminergic system to the progressive decline of the nigrostriatal pathway. The hypothesis of reversible postsynaptic changes as the main mechanism underlying a fluctuating response to LD lends itself to a possible pharmacological manipulation of the dopaminergic response to reverse, or even avoid, motor fluctuations (initial monotherapy with dopamine agonists and early combination LD/dopamine agonists). The role of peripheral pharmacokinetics factors is also critical and the use of controlled release LD formulations, of monoamine oxidase (MAO)‐B and of catechol‐O‐methyltransferase (COMT) inhibitors may all, to a different degree, improve such phenomena. In the last decade, there has been a resurgence in surgical therapies in advanced PD, due to higher levels of accuracy and safety provided by the new surgical devices, and to a more precise localization of the target areas allowed by the neurophysiological mapping techniques. The surgical procedures currently used in advanced PD are stereotactic brain lesions (internal globus pallidus and subthalamic nucleus), chronic brain stimulation (of the same nuclei) and striatal grafting of dopamine‐producing cells. All these procedures have already shown their efficacy in the management of severe fluctuations in PD, but their indications, and relative advantages and disadvantages, are still the subject of considerable debate and controversy.
Direct costs during the first year after intracerebral hemorrhage
Authors: Porsdal Vibeke , Boysen Gudrun
Published: March 2003

Objectives: Knowledge of resource use and associated costs of treatment, care and rehabilitation at hospitals and in the health care and social service sectors is limited. This study presents data on the total resource use during the first year after spontaneous intracerebral hemorrhage. Methods: All patients hospitalized because of stroke at a university hospital in Copenhagen, Denmark, during a 1‐year period 1994–1995 were included in a database. The patients were followed until 1 year after the stroke, and data on resource use during and after the hospital stay were collected prospectively. This study investigates a subgroup comprising 90 patients with intracerebral hemorrhage. Resource use is described and costs are calculated. Results: The cost of the hospital stay including acute care and rehabilitation had a mean of 90 200 DKK (US$16 100). The total cost of health care and social services during the first year had a mean of 123 200 DKK (US$22 000). Costs decreased significantly with age, but when differences of 30 days case fatality between age groups were considered, the association between costs and age disappeared. Conclusions: The mean cost of treatment, care and rehabilitation during the first year after intracerebral hemorrhage was 123 200 DKK, of which the primary hospital stay constituted 73%.
Glucocorticoid receptor concentrations in muscle biopsies from patients with neuromuscular diseases
Authors: Stuerenburg Hans Joerg , Kunze Klaus
Published: March 2003

Increases in circulating glucocorticoids promote catabolism, particularly in skeletal muscle. The sensitivity of the muscle to glucocorticoids can be altered by a change in the number of glucocorticoid receptors in the muscle, or by a change in the proportions of activated receptors (between binders IB and II). We have investigated the concentration of glucocorticoid receptors, and the proportions of types IB and II, in healthy and diseased muscle. We found significantly reduced concentrations of glucocorticoid receptors in the group of inflammatory myopathies (51% reduction; P<0.05, Wilcoxon signed rank test). No significant changes in the relative proportions of binders IB and II were found in pathological muscle, although the proportion of binder IB tended towards elevated values (especially in the diabetic neuropathies, with a 17% increase). We conclude that the sensitivity of muscle to glucocorticoids can be reduced in neuromuscular diseases, especially in myositis, by a reduction in the number of glucocorticoid receptors in the tissue, but that no relevant shift in the relation between activated receptor types is present. This could be important in relation to the risk of a secondary steroid myopathy and catabolism of skeletal muscle in the treatment of inflammatory myopathies with glucocorticoids.
Multimodal event‐related potential P3 after transient global amnesia
Authors: Trinka E. , Pfisterer G. , Unterrainer J. , Staffen W. , Wranek U. , Löscher N. W. , Ladurner G.
Published: March 2003

The putative generators of the event‐related P3 component are still a matter of debate. There is reasonable evidence that the mesial temporal lobe structures are crucial in the generation of event‐related potentials. Transient global amnesia (TGA) is characterized by anterograde and retrograde amnesia without neurological deficits in which a temporal hypoperfusion is the most likely pathomechanism.

The aim of this study is to evaluate a possible delay in the P3 latency in a cohort of patients with TGA (n = 18). We used classic oddball paradigms with visual and auditory stimuli . The P3 latencies were compared to 18 age‐matched patients with transient ischaemic attacks (TIAs) in the carotid artery territory and 23 age‐matched controls.

The mean age of the patients was 60.1 years (SD 14.1), in the TIA group 64.7 (SD 12.1) and 57.7 (SD 10.1) in the controls; the mean time interval between onset of TGA symptoms and performance of P3 investigations was 4.3 days (range 1–7 days); and the mean latencies measured at the vertex (Cz electrode) were 422.9 ms (SD 44.6) for the TGA patients, 436.4 ms (SD 62.1) for the TIA group, and 409.3 ms (SD 48.5) for the controls in the visual paradigm and 371.7 ms (SD 41.7), 399.7 ms (SD 51.2) and 385.3 ms (SD 46.5) in the auditory paradigm for the TGA, the TIA and the control groups. The P‐values were not significant.

These results suggest different neuronal networks in the generation of scalp P3 from those responsible for the disturbance of episodic memory in TGA .
Progressive response to Botulinum A toxin in cerebral palsy
Authors: García Ruiz P. J. , Pascual Pascual I. , Sánchez Bernardos V.
Published: March 2003

Botulinum A toxin (BT) has been successfully used for the management of spasticity in cerebral palsy (CP). However, the long‐term results of BT have not yet been determined. We have studied the evolution of a homogeneous group of patients with CP treated with BT. All these patients had an equinus gait resulting from calf muscle spasticity without other muscle group involvement. All of these patients were treated with the same total dose (4 µg/kg) at the same time interval (three months). The mean follow‐up time was 33 months. Gait evaluation was made blind on videotape recordings by two independent physicians according to five point scale. All our patients exhibited a progressive improvement in their gait pattern. None of our patients developed fixed contractures nor did any of them need surgical correction. No significant side‐effects were seen. The response observed in our study could be due to a progressive symptomatic effect of BT, but it might be also explained by a change in the natural history of the spasticity related to CP, at least in this selected group of patients.