bluuebunny/crossref_metadata_2025 huggingface dataset:
MR pulsatility measurements in peripheral arteries: Preliminary results
Authors: Krug Barbara , Kugel Harald , Harnischmacher Urs , Heindel Walter , Schmidt Rainer , Krings Friedrich
Published: March 2007

Phase contrast flow velocity measurements were performed in six healthy volunteers and 30 patients with arteriosclerotic disease. The iliac arteries were investigated in 8 cases and the femoral arteries in 28 cases. In the first 24 patients, 16 evenly distributed data sets were acquired during one cardiac cycle. In the last 12 patients, a trigger pulse followed by the acquisition of 30 evenly distributed data sets was applied every second heart beat. This procedure allowed data to be acquired over a full heart cycle without any acquisition gap. The measured flow velocities were displayed as function of time. Systolic acceleration, postsystolic deceleration and pulsatility of flow velocity were calculated and compared with stenosis grades determined from DSA angiograms. Flattening of the flow velocity patterns was found to correlate with the local severity of arteriosclerotic disease.
Utilization of carbon from dietary polyunsaturates for brain cholesterol synthesis during early postnatal development in the rat: a 13c nmr study
Authors: Likhodii Sergei S. , Cunnane Stephen C.
Published: March 2007

Incorporation of 13C from a dietary precursor into cholesterol was studied in neonatal rats. Rats were given uniformly 13C‐enriched polyunsaturated fatty acids intragastrically and total lipid extracts of liver and brain were analyzed by 13C‐NMR 1,4, 8, and 15 days later. 13C‐enrichment was detected in brain but not in liver cholesterol. Maximal 13C‐labeling was observed 4 days after injection of the label. Spectra revealed that 70% of newly incorporated 13C had 13C as an adjacent neighbor, the other 30% had 12C as the neighbor. Double quantum NMR revealed the arrangement in the cholesterol skeleton of the 13C‐13C pairs transferred from precursors to cholesterol. Desmosterol, an intermediate of cholesterol synthesis, was identified in the spectra of brain lipids. Comparison of 13C‐13C unit arrangements in both cholesterol and desmosterol allowed carbons 26 and 27 of desmosterol to be unambiguously assigned.
Changes of relaxation times (T1, T2) and apparent diffusion coefficient after permanent middle cerebral artery occlusion in the rat: temporal evolution, regional extent, and comparison with histology
Authors: Hoehn‐berlar Mathias , Eis Manfred , Back Tobias , Kohno Kanehisa , Yamashita Katsuhiro
Published: March 2007

The quantitative NMR parameters T1, T2, p, and apparent diffusion coefficient (ADC) were determined during the 7 h after middle cerebral artery occlusion in rats. In the normal caudate‐putamen (CP), 869 ± 145 ms and 72 ± 2ms for T1 and for T2, respectively, were found; the corresponding values for cortex were 928 ± 117 ms and 73 ± 2 ms. The ADC showed significant dependence on gradient direction: diffusion along x resulted in 534 ± 53 μm2/s (CP) and 554 ± 62 μm2/s (cortex), and along y in 697 ± 58 μm2/s (CP) and 675 ± 53 μm2/s (cortex). In the ischemic territory, a continuous increase over time of both relaxation times was observed in the CP, leading to an increase of 29 ± 20% (T1) and 51 ± 41% (T2 above control level. ADC dropped to 63 ± 15% of control in the CP and to 74 ± 4% of control in the temporal cortex. No significant change was noted in proton density during the observation period. Strongest ADC reduction was in the center of the ischemic territory (≤ 60% of control) surrounded by a region of lesser reduction (≤ 80% of control). During the early part of the study, the area of reduced ADC was larger than that of elevated relaxation times. Toward the end of the experiment, the area of increased relaxation times approached that of decreased ADC at ≤ 80% of control. Good agreement of histological presentation of infarct with the total area of decreased ADC (≤ 80%) was demonstrated.
Contrast optimization of fluid‐attenuated inversion recovery (flair) imaging
Authors: Rydberg John N. , Riederer Stephen J. , Rydberg Charlotte H. , Jack Clifford R.
Published: March 2007

The optimization of contrast is considered for the fluid‐attenuated inversion recovery (FLAIR) MRI pulse sequence, specifically the contrast of multiple sclerosis (MS) to white matter (WM). A performance bound is identified at 1.5 Tesla as that provided using an inversion time (TI) of 2900 ms. It is shown that TR/TI times exceeding 11000/2600 ms provide about 90% of the MS‐WM contrast possible theoretically. The commonly reported TR/TI combination of 6000/2000 provides only about 60%. For TR times exceeding 8000 ms, an echo time (TE) of 140 ms is at or near optimum. Use of TR/TI times less than 9000/2400 lacks efficiency in multisection imaging. Predicted relative contrast performance of TR/TI 11000/2600 versus 6000/2000 was evaluated in seven patients with known MS lesions, and measurements closely matched theoretical predictions. It is strongly recommended that for near optimum contrast and high multisection efficiency, FLAIR should be performed with TR/TI times exceeding 10000/2500 ms.
Sleep disruption frequency in rheumatoid arthritis: Perceived stress predicts poor outcome over one year
Authors: Treharne G. J. , Lyons A. C. , Hale E. D. , Douglas K. M. J. , Goodchild C. E. , Booth D. A. , Kitas G. D.
Published: March 2007

Background: Sleep is an important daily process that can be disrupted by chronic illnesses including rheumatoid arthritis (RA).

Aims: We tested whether demographic, medical and psychological factors act as predictors of change in frequency of sleep disruption associated with RA.

Methods: A cohort of 129 White British people with RA (mean duration of RA 7.19 years; mean age 55.40 years; 75% women) was followed for one year. Self‐report questionnaires were employed to record demographic information and assess participants' sleep disruption (on a 4‐point frequency scale), morning stiffness (duration), pain and fatigue (visual analogue scales), impact of disability, anxiety, depression, stress, coping, illness perceptions and self‐efficacy. Hospital notes were reviewed for duration of RA, antidepressant use and comorbidity.

Results:  Participants were split into those with sleep disruption that was consistently infrequent or decreasing in frequency (n = 56; 43%) and those with sleep disruption that was consistently frequent or increasing in frequency (n = 73; 57%). Results of a logistic regression demonstrated that greater perceived stress at baseline predicted sleep disruption that was consistently frequent or increasing in frequency over the year. Change in sleep disruption frequency was not predicted by any other assessed variable. Perceived stress at the end of the year was not predicted by change in frequency of sleep disruption.

Conclusions: Self‐reported frequency of sleep disruption among people with RA relates to perceived stress. Psychoeducational programmes that help people with RA manage their stress may be a non‐pharmacological method of improving sleep quality and therefore merits testing in specific interventional studies. Copyright: © 2007 John Wiley & Sons, Ltd.
Rendez‐vous search on a rectangular lattice
Authors: Ruckle William H.
Published: March 2007

In a rendez‐vous search two or more teams called seekers try to minimize the time needed to find each other. In this paper, we consider s seekers in a rectangular lattice of locations where each knows the configuration of the lattice, the distribution of the seekers at time 0, and its own location, but not the location of any other. We measure time discretely, in turns. A meeting takes place when the two seekers reach the same point or adjacent points. The main result is that for any dimension of lattice, any initial distribution of seekers there are optimal strategies for the seekers that converge (in a way we shall make clear) to a center. © 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2007
A modified operator splitting (OS) method for collaborative structural analysis (CSA)
Authors: Tada Motohide , Pan Peng
Published: March 2007

The collaborative structural analysis (CSA) system is capable of performing highly sophisticated structural analyses utilizing the beneficial features of existing individual structural analysis programmes. It requires a time consuming static condensation procedure if adopting an implicit integration scheme. The operator splitting (OS) method, which does not require the tangential stiffness, can be used to improve the system efficiency. Furthermore, the conventional OS method is not able to provide enough numerical stability, particularly for the analyses considering geometrical non‐linearity. Thus, improvement is needed. To this end, a modified OS method is proposed, which treats unbalanced forces in the current step as pseudo‐external forces in the immediate following step. In this paper, first, the conventional OS method is reformulated in an incremental form, and a CSA scheme based on it is proposed. Second, a modified OS method is developed to improve the numerical stability. Third, a fixed‐base steel column with a lumped mass assigned at its top is analysed using the CSA system as a numerical example. It is found that the OS methods are effective for CSA, and the modified OS method exhibits better numerical stability than the conventional one for the analysis considering geometrical non‐linearity. Copyright © 2007 John Wiley & Sons, Ltd.
Oscillotonometry: A simple non‐invasive method of differentiating proximal arterial obstruction from distal microangiopathy in the vascular assessment of diabetics
Authors: Tovey F I , Karanjia N , Plant G R , Rees M
Published: March 2007

In diabetic patients with ischaemic feet a frequent clinical problem is the differentiation between those with distal microangiopathy alone and those with proximal arterial inflow obstruction.

Doppler pressure measurement is of assistance but there is a significant subgroup who have proximal obstruction despite the findings of a high ankle systolic pressure. These patients have stiff arterial walls and the Doppler cuff does not compress them normally.

If oscillotonometry is performed, a low range of swing suggests an inflow obstruction whereas a high range suggests a good inflow. This differentiation enables suitable patients to be selected for angiography and possible angioplasty or bypass surgery.
Diabetes education and schools
Authors: Burden Mary L , Burden A C , Butterworth S
Published: March 2007

A questionnaire was sent to schools, prisons and industries in the Trent region using addresses supplied by diabetes health visitors or specialist nurses to discover the level of diabetes education and whether it was thought to be adequate. Forty four (59%) of the 75 responded. Twenty four schools had received literature and all found it useful or adequate. However only 50% felt there was a need for educational facilities for children with diabetes within their school, but 56% thought there was a need for educational facilities for staff who deal with children with diabetes.
A combination of once daily insulin and glibenclamide therapy in patients with type 2 diabetes and secondary drug failure
Authors: Fonseca V A , D'Souza V. , Bell J L , Dandona P
Published: March 2007

Twenty eight patients with non‐insulin‐dependent diabetes mellitus (NIDDM) who were not adequately controlled with maximum doses of sulphonylureas and metformin (Group I; n=13) or with insulin injections (Group II; n=15) were treated with a combination of insulin injections in the morning and glibenclamide, a sulphonylurea, in the evening. Patients in Group I had significantly lower glycosylated haemoglobin (HbA1) and post‐breakfast blood glucose concentrations after treatment with the combination. Similarly, HbA1 and post‐breakfast blood glucose concentrations improved in Group II patients. Nocturnal hypoglycaemia resolved. The removal of glibenclamide from treatment in both groups resulted in a significant increase in glycosuria and abnormal fasting blood glucose concentrations.

We conclude that in patients with non‐insulin‐dependent diabetes and drug failure, the institution of treatment with a combination of insulin in the morning and sulphonylurea in the evening produces adequate control of diabetes, and that the removal of the evening dose of sulphonylurea results in marked hyperglycaemia in the fasting state.
The clinical impact of a fast fructosamine service
Authors: Clark J D A , Hartog M , Morgan J , Stansbie D , Tarleton D
Published: March 2007

This study was undertaken to determine whether serum fructosamine results could be made available during routine diabetic out‐patient attendance and to assess the clinical impact of such a service. A blood sample was taken for serum fructosamine from 180 consecutive diabetic patients attending the out‐patient clinic. Results became available to the clinician within a median of 50 mins (range 30‐80 mins) of the patient's arrival. This identified 43/180 (24%) patients in whom glycaemic control was worse than initially appreciated, and it allowed immediate discussion of ways to try and improve treatment.
A survey of the use of special food products by diabetics
Authors: Fairchild R M , Daniels C E , Ellis P R
Published: March 2007

A questionnaire concerning food consumption and artificial sweeteners has been used in Cardiff to assess the frequency with which special dietary products specifically promoted for diabetes are used. A total of 106 adults and 36 children attending clinics at the University Hospital Wales, Cardiff, completed the questionnaire. Seventy‐four per cent of people with diabetes indicated regular usage of special food products and 51% used them daily. Preserves, sweeteners, squash, sweets and chocolate were the most popular products: artificial sweeteners accounted for 45% of total usage.

Age had a significant effect on the consumption of these products with greatest popularity being amongst the under 18 age group. A significantly high proportion of insulin‐dependent diabetics used special food products compared with non‐insulin‐dependent (NIDDM) patients, whilst 26% of patients never used them at all.

The commonest reason for non‐use cited was: dietetic advice, high cost, poor palatability, lack of availability and unsuitability for use by other members of the family. Only NIDDM patients quoted dietetic advice as a reason not to use special products, whilst others disliked them because they were not sufficiently low in calories. Duration of diabetes and gender of patients did not significantly affect the use of the products or the type of product consumed.
Amputation: Is diabetes an underdiagnosed cause?
Authors: Rose C A H , McIntosh C S
Published: March 2007

Patients attending the Roehampton limb fitting centre were assessed to determine the cause of amputation.

Government statistics for 1986 state that diabetes was the cause of amputation in 20% of people who were attended to by the Department of Health and Social Services Artificial Limb Service. Results of this London study, however, support the higher figures of 45‐70% amputations resulting from diabetes, as indicated by American studies.

This discrepancy may be attributed to the DHSS form AP11 which is used to collect statistical data regarding the aetiology of amputations but allows only one entry under aetiology of the amputation.
A screening programme for diabetic retinopathy
Authors: Heaven C J , Cansfield J , Shaw K M
Published: March 2007

Retinal photography using a non‐mydriatic fundus camera has been proposed as a means of screening for diabetic retinopathy. We describe a screening programme which uses this technique and is run by liaison between a Diabetic Day Unit and Ophthalmology Department within a District General Hospital. A 10‐month period of screening is reported during which time 639 patients were photographed. Of these, 110 patients (17.2%) were referred for clinical eye examination of which 100 attended (15.6%), 27 patients (4.2%) subsequently underwent laser retinal photocoagulation. Of these, 22 received focal treatment and five required panretinal photocoagulation, nine cases (1.4%) were submitted to fundus fluorescein angiography. In 12 patients (1.9%), non‐diabetic ocular disease was detected.
An introductory diet kit
Authors: Pirie E , Colagiuri R , Colagiuri S , Taylor L
Published: March 2007

A diet kit was developed to enable non‐dietitian health professionals to provide standardised introductory diet advice to people with NIDDM who were awaiting consultation with a dietitian and was trialled by medical practitioners and diabetes educators. Both groups responded favourably to the kit. Average time to apply the kit was 20 minutes for the medical practitioners and 24 minutes for educators. The effect of providing initial diet advice with the kit was assessed in 53 kit‐instructed patients. The majority felt that they had been given sufficient preliminary diet advice and were able to make several changes to their diet by the time of the visit to the dietitian.
Long‐term glycaemic control achieved in young insulin‐dependent diabetics
Authors: McLaren E H , Lakhdar A A , McLellan I
Published: March 2007

The long‐term glycaemic control, assessed by the mean of three successive levels of glycosylated haemoglobin (HbA1c) achieved in a special clinic for insulindependent diabetics aged 12–40, was audited in 1984 and 1987. Clinic policy involved a twice‐daily insulin regimen with infrequent blood glucose monitoring and little emphasis on dietary compliance or formal education. Overall levels of diabetic control were identical in 1984 and 1987; 34% of patients had HbA levels within three standard deviations of the mean and 60% within five standard deviations. There was no correlation between control and age or duration of diabetes. Diabetic control deteriorated in 24% of patients and improved in 20% between 1984 and 1987. There was no significant difference in the overall levels of control compared with other centres. It is concluded that frequent blood glucose monitoring, strict dietary compliance and formal education are not important factors in glycaemic control in insulin‐dependent diabetes.
Injection giving in children with insulin‐dependent diabetes mellitus: Responsibility and performance
Authors: Moyer A , Tomalin D A
Published: March 2007

Insulin is the keystone of diabetes management yet there is little empirical data on children's injection technique as they assume responsibility for their own care. Interviews with 171 children 10‐16 years old with Insulin‐Dependent Diabetes Mellitus (IDDM) and their parents provided information on responsibility for insulin injections. The Johnson Test of Diabetes Knowledge and a skills check list were used to generate data on knowledge and technical skill. All families had access to specialist nurses. Most children prepared and gave their own injections but only 20% routinely prepared and checked the dose with a parent; 21% children drew up an inaccurate dose. Technical skill was lower when diabetes was of a longer duration but knowledge increased with age (p<0.01, Kendall's tau‐b) hence older children were not necessarily more skilful. Parents' accounts of recent stressful incidents suggest that they continue to monitor injection practice even though they may not be directly involved. Periodic review and strategies to increase technical proficiency are recommended.
Do patients with insulin‐treated diabetes use alcohol safely
Authors: Gregory R , Inglesfield J , Molloy O , Yateman N
Published: March 2007

A questionnaire was administered at interview to 65 consecutive diabetic out‐patients (39 male, 26 female; ages 18‐75 years) to ascertain drinking habits of diabetic patients, knowledge about alcohol and health in general, and the effects of alcohol on diabetes in particular. Nine (14%: 2 male) drank no alcohol. Six (9%: 5 male) regularly drank more than the safe limit recommended by the Health Education Council in 1986. Only 2 (3%) knew the accepted maximum safe limits for alcohol consumption for men and women. Patients tended to understimate the alcohol content of beers and overestimate that of wines and spirits. Thirty‐two (49%) did not know that alcohol made hypoglycaemia more likely (95% confidence interval: 37‐61%). We conclude that there is a need for education about safe drinking in our clinic population, particularly on how to avoid alcohol‐induced hypoglycaemia.
Home blood glucose monitoring: How often?
Authors: Willey K A , Twigg S M , Constantino M I , Yue D K , Turtle J R
Published: March 2007

Multiple daily home blood glucose monitoring (HBGM) on a long‐term basis places a heavy burden on people with diabetes. This study questions whether multiple daily testing is superior to once‐daily testing for the purposes of clinical decision‐making once a patient is established on insulin therapy. The HBGM data of 12 IDDM patients treated with three or more insulin injections daily were studied to determine whether once‐daily HBGM at a variable time each day (Var1/day) gave adequate information for clinical use. How the type of patient and the different prescribing habits of health professionals affected the outcome were also examined.

We found that there was no significant difference in the estimate of mean blood glucose levels derived from Var 1/day and four times daily (4/day) HBGM data. Comparison of insulin dosage adjustments made by six health professionals (based on pairs of glycaemic profiles derived from these two frequencies of monitoring) showed some discrepancies. However, the discrepancies were not greater than those found when the same health professionals adjusted insulin dosage on two different occasions using the same glycaemic profile. By contrast, insulin adjustment was more dependent on whether the patient was suitable for tight glycaemic control (p < 0.05) and on the prescribing habits of health professionals (p < 0.05). Once‐daily HBGM at a variable time of the day gave adequate information for clinical intervention and has the advantage of reducing the heavy demand on people with diabetes.
Ambulance personnel can successfully treat severe hypoglycaemia
Authors: Yaxley L , Aldridge V , Almond J , Greenwood R H , Heyburn P J , Harradence F , Paramedic P Henry
Published: March 2007

With the current emphasis on stricter control of blood glucose levels in insulin‐treated diabetics, instances of severe hypoglycaemia seem to be increasing. In order to reduce the known risks of prolonged untreated hypoglycaemia ambulance paramedics have been trained to administer glucagon to hypoglycaemic patients in their homes. During an 18 month period glucagon was administered on 28 occasions to 17 patients, and in 25 instances hospital admission was avoided. This study has shown that the administration of glucagon by ambulance personnel is a safe and effective way of treating severely hypoglycaemic patients at home. Widespread adoption of this policy would reduce the risk of hypoglycaemic brain damage as well as saving NHS resources.
Assessment of retinopathy in diabetics newly referred to the diabetic clinic
Authors: Moriarty A P , Shilling J S , Williams C D , Smith S A , Lowy C
Published: March 2007

Delay in referral of patients with significant diabetic retinopathy by the diabetic physician to the ophthalmologist may compromise visual outcome. We prospectively audited the ophthalmic assessment of 37 newly referred diabetic patients to the diabetic clinic. Unbeknown to the diabetologist, patients underwent retinal photography with review of photographs by a consultant ophthalmologist and finally another examination with slit‐lamp biomicroscopy by an independent ophthalmologist as “gold standard”. Maculopathy present in 12 of 74 eyes was missed on seven occasions by the diabetic physician and on one occasion by photography (p<0.03 McNemar's test; confidence intervals −15.2% −72.3% physicians, 61.5 −99.8% photography). Inaccuracies in visual acuity measurement and inconsistencies in pupil dilation were noted. Retinal photography may provide a superior means for detection of maculopathy in the newly referred diabetic than assessment by the diabetic physician.
Spontaneous regression of pre‐proliferative diabetic retinopathy
Authors: Murdoch J R , Bibby K , Barrie T , Hammer H M , Maccuish A
Published: March 2007

It has been suggested that the presence of two or more features of preproliferative diabetic retinopathy normally points to development of overt proliferative retinopathy within two years. In a retrospective review of 78 patients with two or more pre‐proliferative features, followed up for a mean period of 4.2 years, proliferative retinopathy developed in only 29.5%. In 24.3% the preyproliferative features persisted, and in 46.2% spontancous regression to background retinopathy occurred. Regression of pre‐proliferative retinopathy tended to occur in eyes with fewer preyproliferative features on fundoscopy and, in patients with Type I diabetes, in those who developed diabetes at an older age. In Type 2 diabetes, apart from fundus appearance, there was no significant difference between patients whose retinopathy regressed or progressed. Cottonywool spots were found more frequently in eyes which underwent regression of retinopathy, suggesting that this is the least sinister pre‐proliferative feature.

Pre‐proliferative retinopathy always requires careful follow up but its apperance does not necessarily lead to the development of sight‐threatcning retinopathy.
The gentle art of giving information to people with type 2 diabetes. Part I: An alternative to checklists
Authors: Walker Rosemary
Published: March 2007

In the first of two articles, Rosemary Walker discusses some issues relating to how information is communicated to those with Type 2 diabetes and suggests how this could be improved.
Screening strategies in the detection of microalbuminuria in insulin‐dependent diabetic patients
Authors: Adamson C. L. , Kumar Sudesh , Sutcliffe H , France M W , Boulton A J M
Published: March 2007

A dipstick immunochemical method (Micral‐Test®) and albumin:creatinine ratios were compared with Urinary Albumin Excretion Rates (UAER) measured in an overnight urine specimen in the early detection of microalbuminuria in IDDM patients. One hundred and nine patients (59 men and 50 women) who had IDDM for at least five years, tested negative for proteinuria and had no history of hypertension were asked to provide early morning (EMU), random and overnight urine samples, Micral‐Test®, urine albumin:creatinine rations, and albumin excretion rates were assessed. All Micral‐Test® results were read by a single observer. In the detection of subjects with UAER>20μg/min, Micral‐Test® in an EMU sample had a sensitivity of 87.5% and specificity of 95.1%. Albumin:creatinine ratio (predictive value>3.6mg/mmol) in an EMU sample has a sensitivity of 87.5% and specificity of 92.1%; in random urine sample values of 84.6% and 80.7% were obtained respectively. Both Micral‐Test® and albumin: creatinine ratios in EMU samples have high negative predictive values (97.5% and 97.2% respectively). Micral‐Test® and albumin:creatinine ratio in an early morning urine sample may be acceptable alternative methods for screening for microalbuminuria.
Annual review of diabetes: Patients' views
Authors: Malik W , Hollowood A D , Nattrass M , Smith J M , Wright A D
Published: March 2007

A questionnaire survey of 625 consecutive patients attending for their second annual review diabetes clinic in a hospital setting was conducted in order to ascertain patients' views. Seventy‐eight per cent were satisfied with the annual review clinic though 25% considered the time interval between hospital visits was too long. The questionnaire revealed that the biochemistry investigation results obtained during the annual review visit had not been explained adequately and that the use of co‐operation cards was far from complete. Modifications to the annual review clinic have been made as a result of the questionnaire.
Measurement of HbA1 using patient‐collected finger‐prick specimens
Authors: Patel V , McNally P , Chambers K , Swift P , Mitchell Ve
Published: March 2007

Despite accepting finger‐prick blood glucose monitoring most children with diabetes retain an intense dislike of venepunctures. We have developed and evaluated a simple method for children to collect finger‐prick samples of blood, and if necessary post them to the laboratory for HbA1 measurement. Comparison of capillary and venous samples in a group of 50 adult diabetic subjects shows close correlation. This allows children to be relieved of the fear of clinic venepuncture.
Home glucose monitoring in patients aged over 40 years with diabetes mellitus
Authors: Leese Gp , Jung Rt , Newton Rw
Published: March 2007

The effectiveness of home glucose monltoring (HGM) was assessed In patients over the age of 40 years with dlabetes. Results were obtalned from 158 patients who were seen consecutlvely in the clinic. Of Insulin‐treated patients, 78.0% performed self‐monitorlng of blood glucose (SMBG), whlist 76.3% of non‐insulin‐treated patients performed urlne testing alone at home. Only 5.6% of patients failed to undertake any HGM and these were all non‐insulin‐treated patients. Insulin‐treated patients performing SMBG did not have an improved HbA1 compared with those doing urine tests alone (SMBG 10.3±1.8%, Urine 9.9±1.8%). only 26.6% of patients performing SMBG felt confident to change their own insulin regimens. Patients performing urine tests seemed generally more satisfied with their HGM (91. 5%) than those performing urine blood tests (63.0% p<6;0.01). In summary, virtually all patients performed some form of HGM, the majority being those on insulin who were attempting SMBG. With SMBG there was no improvement in glycaemic control, few patients changed their own insulin and many patlents would have preferred urine testing alone. Patients should be carefulty selected for use of SMBG.
Free provision of blood glucose sensors improves diabetic control in a children's diabetes clinic
Authors: Page MD , Moran M , Holland P , Bodansky HJ
Published: March 2007

We wished to examine the effect of free provision of miniaturised glucose sensors on glycaemic control in our children's diabetes clinic. Thirty‐six children were studied over six months. Those already using meters formed a control group (n=11). The remainder were randomised according to birthdate either to receive a glucose sensor (n=15) or to continue visually reading blood glucose strips (n=10) Views on the sensors were sought by questionnaire after the study period. HbA1c measurements (equating to glycaemic control) did not change in the two control groups but fell in the intervention group from 9.7% (6.3−12.6), median (range) at entry to 9.1% (5.8−12.5) at six months (p=0.035), indicating improved control. Children and parents liked the sensor and reported testing frequency increased. If this improvement of control is maintained the reduction in subsequent morbidity will justify the free provision of sensors to diabetic children.
Retinal photography in diabetes in general practice: How worthwhile?
Authors: O'Neill JP , Hungin APS , Carr D
Published: March 2007

Although retinal photography is established in hospital diabetes clinics there has been little evaluation of it in general practice. This study examines the outcome of non‐mydriatic retinal photography (NMRP) performed on‐site within general practice in NE England. The three participating practices already had a structured diabetes care system and the results from the NMRP were compared with previously recorded information. From the 200 photographs assessed there was a 22% reporting failure rate because of technical problems. No statistically significant difference was found in the numbers of abnormalities noted by NMRP and conventional screening, although two eyes with proliferative retinopathy were discovered. Patient attendance for NMRP was 75% but the operational efforts and costs apart from equipment, technical operation and consultant reporting had to be borne by the practices. The study does not establish the value of NMRP for screening in general practices where structured diabetes care already exists, but this may be more valuable where structured care does not already exist.
An effective insulin regimen for long distance air travel
Authors: Jones H , Platts J , Harvey JN , Child DF
Published: March 2007

Long distance air travel which involves crossing time zones can cause problems with insulin dosage and timing. During the summer of 1993, 16 insulin‐treated patients who sought advice about crossing time zones were advised to change to a pre‐meal short‐acting insulin regimen during their flight. Patients taking twice‐daily insulin were individually advised and took between 15% and 20% of their total daily dose as short‐acting insulin with each main meal. No intermediate‐or long‐acting insulin was given. They were encouraged to monitor blood glucose levels frequently, to make minor adjustments where necessary and to return to their usual regimen when their daily routine had returned to normal. Patients found this system easy to apply and were satisfied with it. No significant problems were encountered.
Potential manipulation of glycaemic control by patients with diabetes: Unreliability of random blood glucose measurements
Authors: Gold AE , Charlton J , Allwinkle J , Frier BM
Published: March 2007

Glycaemic control is often assessed using a random blood glucose measurement in patlents attending for diabetes review in specialist clinics. This measurement is susceptible to manipulation by patients and the aim of this study was to determine the extent to which patients modify their behaviour to influence their random blood glucose measured at the review clinic. Four hundred and ninety eight patients attending the Diabetes Review Clinic of the Royal Infirmary were asked to complete a questionnaire about any self‐imposed dietary changes or alteration of medication which they observed prior to attending for review. One third of all patients admitted to either eating less for a few days before attending the clinic, reducing caloric intake on the day of the review or altering the doses of their hypoglycaemic agents. Random blood glucose monitoring in the setting of an outpatient review clinic may therefore be of limited value in assessing glycaemic control.
Recurrent brittle diabetes after years of good glycaemic control
Authors: Jamieson K , Thompson CJ , Newton RW
Published: March 2007

Brittle diabetes is characterised by recurrent episodes of hypo or hyperglycaemia which constantly interrupt normal life patterns. Most studies have shown that brittle behaviour resolves with time, but may persist against a background of poor glycaemic control. We report the case of a young woman who suffered six years of recurrent ketoacidosis which resolved in 1985 with pregnancy. Since then she has maintained good glycaemic control, but developed recurrent ketoacidosis in 1988/89 and again in 1992 in response to stressful life events; the brittle behaviour stopped with resolution of the life events. This unusual pattern of brittle behaviour indicates that those patients regarded as having ‘recovered’ from brittle diabetes may relapse in response to stressful stimuli.
Screening for diabetic retinopathy in general practice using 35mm colour transparency fundal photographs
Authors: Gibbins RL , Kinsella F , Young S , Saunders J , Owens DR
Published: March 2007

The objective of the study was to determine whether a general practitioner could effectively interpret fundal photographs obtained from clinics organised in a primary care setting ‐ in this case, a rural group general practice in Mid Wales. All patients registered with the practice and indentified as having diabetes were included into the study. The study was designed as a population‐based study and the GP diabetes register used to arrange photographic clinics in general practice. Comparison was made between the GP's and the ophthalmologist's (reference standard) interpretation of fundal photographs. Observers were unaware of the identity of the subjects and of each others results.

Ascertainment rate for diabetes was 2.2% (166 patients). Photographs were obtained in 143 (86%); quality was sufficient for analysis in 137 (82.5%). Twenty‐three patients were identified by ophthalmologists as having retinopathy, eight (6% of whole sample) with sight‐threatening lesions. The GP's sensitivity for the presence of retinopathy was 87% (95% CI 66%‐97%), and specificity 77% (95% CI 70%‐85%). No sight‐threatening lesions were missed by the GP. Of 18 false positives with good picture quality, 10 (56%) had drusen; eight other false positives had photographic artefacts or poor picture quality.

It was concluded that, given adequate training, GPs could act as first screeners for diabetic retinopathy by utilising fundal photographs taken in general practice. Analysis of the effectiveness of screening methods for diabetes should take into account ascertainment rate of diabetes in the study population.
Cutaneous allergy (urticaria) to insulin preparations
Authors: Brooks AP , Roseveare CD
Published: March 2007

Five patients are described who experienced generalised cutaneous reactions, urticarla and itching, after Injecting varlous modern human insulln preparations. This allergy was not due to the Insulin, but to some of the non‐Insulin components of Insulin solutions. Prick‐skin testing Identified the specific allergen in each patient; In three cases, protamine. Change to another human insulin preparation without the allergen in its constltuents resolved the symptoms in each patient.
Relationship between insulin dose, body weight and glycaemic control in insulin‐dependent diabetes
Authors: Gill G , Hardy K , Lorains J
Published: March 2007

The relationships between daily insulin dose, body weight, age, sex and glycosylated haemoglobin (HbA1) were explored in a group of 198 insulin‐dependent (IDDM) diabetics of at least five years' duration. Insulin dose was positively correlated with body weight (p<0.001), and negatiely related to age (p<0.005). Doses in units/kg were also higher in males when compared with females (0.76 ± 0.25 v 0.61 ± 0.20 ± u/kg, p<0.001). There was no correlation between insulin dose and HbA1.

Higher insulin requirements in males, a positive relationship with body weight, together with declining requirements with age, suggests a possible dependence of insulin dose on lean body mass. The lack of relationship between insulin dose and HbA1 is perhaps disappointing, but may reflect the many factors affecting insulin absorption and action, as well as perhaps the destabilising effects of ‘over‐insulinisation’.
Use of computer simulator training in the education of diabetic teenagers
Authors: Hedbrant J , Ludvigsson J
Published: March 2007

Diabetic patients learning to manage diabetes are often at the mercy of trial and error. To speed up and improve the learning process a computerised diabetes simulator may be used for experiments with food, insulin and exercise without risk of inconvenience.

When measuring the impact of computer training, only 11 out of 58 diabetic teenagers wanted to participate in the study. These diabetic teenagers were educated in four computer lessons and evaluated with respect to metabolic control, emotional adjustment, locus of control, self‐esteem and ability to discuss treatment problems. It was not possible to recruit a control group.

In a few individuals there were significant improvements in locus‐of‐control, self‐esteem, knowledge and diabetes related stress. Side‐effects were an increased level of guilt and an alienation from medical professionals.

The computer training was considered to be enjoyable and of great value. Consistent with our hope, the participants regarded the computer simulator as a source of inspiration rather than as an instrument for calculating the optimal insulin regimen.

We conclude that although young people get more and more used to computers, still only a minority are attracted by this type of education. On a group basis limited computer training has no significant influence, but for certain individuals computer simulation may be a good educational tool.
An efficient and cost‐effective method of running diabetes clinics
Authors: Preston FM , Young PM
Published: March 2007

The traditional diabetes clinic at Bradford Royal Infirmary involves a consultant diabetologist, a junior doctor and a clinical assistant. Patients usually remain on the same doctor's list. A clinical audit revealed significant differences between the numbers of complication reviews performed by junior doctors and the consultant diabetologist, with the consultant performing significantly more tests than the junior doctors. The clinical assistant performed even fewer tests, which probably reflected his lack of time to review the tests. As junior doctors rotate jobs every six months and patients often attend clinic six monthly there was no real continuity of care for the patient.

Our project aimed to substitute diabetes specialist nurses (DSN) for the junior doctors and to audit the result. We found that the number of complication reviews performed was significantly increased and that the DSN could effectively replace the junior doctors and clinical assistant in the diabetes clinic, with medical support when required.
Diabetic peripheral neuropathy, acupuncture and moxibustion
Authors: Clark MH , Jowett NI
Published: March 2007

Symptomatic peripheral neuropathy in diabetes can cause great distress to the patient. Acupuncture may be sought as an alternative therapy. Acupuncture associated with moxibustion (a form of heat stimulation) can be dangerous to the patient because of the lack of pain sensation. In this case, the patient sustained a large partial thickness burn.
Discussing diabetic retinopathy with NIDDM patients. An evaluation of varying the content of information given to patients and its impact on anxiety
Authors: McGill MJ , Molyneaux LM , O'Dea J A , Yue DK
Published: March 2007

There are no clear guidelines to assist health professionals in discussing diabetic complications with patients. This study was designed to evaluate the impact of anxiety‐provoking detailed content of complications information on NIDDM patients' levels of anxiety.

Four videotapes with differing levels of anxiety‐provoking content and detail within the content were used. After becoming familiar with each patient, educators selected a videotape they considered suitable for the individual patient. Patients were then randomised to: (i) viewing a videotape of the educator's choice (n=55); (ii) viewing a videotape of their own choice (n=45). Using a 10cm LASA scale, patient anxiety was measured before and after viewing.

Patient anxiety rose significantly after viewing videotapes with anxietyprovoking or detailed content, by 0.6 and 1.0 respectively. This increase was mainly due to the selection of one videotape which contained both anxiety‐provoking and detailed content, particularly when it was chosen by the educators. Factors which determined patient anxiety were, (A) before viewing of videotapes: (i) knowing others with complications; (ii) age; and (B) after viewing: (i) which videotape was viewed; (ii) age. Awareness of the term ‘retinopathy’ and previous consultation with an ophthalmologist were the best predictors for reduction in anxiety. Patients with NIDDM were prepared to learn about retinopathy, including the use of anxiety‐provoking materials. Less anxiety was generated when selection of information was made by the patients themselves rather than by the educators.
An assessment of perceived wellbeing in a diabetic population
Authors: Sturrock NDC , Moriarty KT
Published: March 2007

Perceived wellbeing in a diabetes mellitus population was assessed using the Nottingham Health Profile (NHP) in a group of diabetic patients aged 30–40 years (n=300) and age‐matched healthy controls (n=143). The NHP grades wellbeing into six categories: emotional reaction (ER), social isolation (SI), energy (E), pain (P), sleep (S) and physical mobility (PM). The Kruskal‐Wallis H test was used to compare patients with the control scores for each category. In all categories, the scores of patients were significant greater than controls, indicating reduced perception of wellbeing: ER 13.3 versus 10.5*, SI 8.5 v 6.1*; E 21.2 v 12.4*; P 7.9 v 2.7*; S12.2 v 9.3*; PM 3.6 v 1.5*; (patients v controls; *p<0.05).

Analysis of patient characteristics in relation to whether they scored positively or not on the NHP revealed a female preponderance, but no association with diabetes control, duration of diabetes, age at onset of diabetes or complications, except the presence of nephropathy.
A proteome study of the proliferation of cultured Medicago truncatula protoplasts
Authors: de Jong Femke , Mathesius Ulrike , Imin Nijat , Rolfe Barry G.
Published: March 2007

A proteome study of the first five days of Medicago truncatula protoplast cultures was done to investigate molecular changes taking place during protoplast proliferation. A total of 1556 protein spots were analysed, of which 886 protein spots showed significant (p<0.005) changes in abundance at some time during the first five days of protoplast culture. Of the 886 significantly changing protein spots, 89 proteins were identified by MALDI‐TOF MS. The majority of the identified proteins were part of four main cellular processes that may be involved in protoplast proliferation: energy metabolism, defence or stress response, secondary metabolism and protein synthesis and folding. The accumulation pattern of these proteins indicates extensive changes in the energy metabolism of the cells, accompanied by the activation of stress response pathways and modifications of the cell wall. In addition, seven PR10‐like (pathogenesis related) proteins were identified. The accumulation pattern of these seven PR10‐like proteins suggests that they could have a developmental role during protoplast proliferation.
Proteomic analysis of dimorphic transition in the phytopathogenic fungus Ustilago maydis
Authors: Böhmer Maik , Colby Thomas , Böhmer Christian , Bräutigam Anne , Schmidt Jürgen , Bölker Michael
Published: March 2007

In the corn smut fungus Ustilago maydis, the dimorphic transition from budding to filamentous growth is intrinsically associated with the switch from a saprophytic to a pathogenic lifestyle. Both pathogenicity and filament formation are triggered by a heterodimeric homeodomain transcription factor encoded by the b mating type locus. Here, we present a reference map of the proteome of this dimorphic phytopathogenic fungus. Using 2‐DE in combination with MALDI‐TOF‐MS and ESI‐MS/MS, we were able to identify 250 distinct proteins obtained from soluble protein samples. In addition, we determined the abundance of cytosolic proteins in filamentous U. maydis cells and compared it with that of budding cells. Filamentous growth was induced by two independent regimes, either by overexpression of the bW2/bE1‐heterodimer or by overexpression of the small GTP binding protein Rac1. By comparison of expression profiles, we have identified 13 protein spots that were significantly enhanced during filamentous growth induced by bW2/bE1. Rac1 only up‐regulates a subset of four of these protein spots. None of these proteins have previously been associated with filamentous growth. Comparison of Rac1‐ and b‐regulated protein sets supports the hypothesis that filament formation during pathogenic development occurs via stimulation of a Rac1‐containing signalling module.