bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self‐inflicted male urethral foreign body insertion: endoscopic management and complications
Authors: Rahman Nadeem U. , Elliott Sean P. , McAninch Jack W. 
Published: November 2004

OBJECTIVETo evaluate the cause, diagnosis, management and complications of self‐inserted urethral foreign bodies in men, reviewing a 17‐year experience.PATIENTS AND METHODSFrom November 1986 to January 2004, 17 men were treated for self‐inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications.RESULTSIn all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton‐tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body.CONCLUSIONSelf‐inflicted urethral foreign‐body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow‐up, albeit difficult in these patients, is desirable.
Ethnic differences and determinants of diabetes and central obesity among South Asians of Pakistan
Authors: Jafar T. H. , Levey A. S. , White F. M. , Gul A. , Jessani S. , Khan A. Q. , Jafary F. H. , Schmid C. H. , Chaturvedi N. 
Published: November 2004

AbstractAims  To study the within ethnic subgroup variations in diabetes and central obesity among South Asians.Methods  Data from 9442 individuals age ≥ 15 years from the National Health Survey of Pakistan (NHSP) (1990–1994) were analysed. Diabetes was defined as non‐fasting blood glucose ≥ 7.8 mmol/l, or known history of diabetes. Central obesity was measured at the waist circumference. Distinct ethnic subgroups Muhajir, Punjabi, Sindhi, Pashtun, and Baluchi were defined by mother tongue.Results  The age‐standardized prevalence of diabetes varied among ethnic subgroups (P = 0.002), being highest among the Muhajirs (men 5.7%, women 7.9%), then Punjabis (men 4.6%, women 7.2%), Sindhis (men 5.1%, women 4.8%), Pashtuns (men 3.0%, women 3.8%), and lowest among the Baluchis (men 2.9%, women 2.6%). While diabetes was more prevalent in urban vs. rural dwellers [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.24, 1.82], this difference was no longer significant after adjusting for central obesity (OR 1.15, 95% CI 0.95, 1.42). However, the ethnic differences persisted after adjusting for major sociodemographic risk factors (unadjusted OR for Pashtun vs. Punjabi 0.59, 95% CI 0.42, 0.84, adjusted OR 0.54, 95% CI 0.37, 0.78). Ethnic variation was also observed in central obesity, which varied with gender, and did not necessarily track with ethnic differences in diabetes.Conclusions  Unmeasured environmental or genetic factors account for ethnic variations in diabetes and central obesity, and deserve further study.
Elevated iron indices in patients with diabetes
Authors: Thomas M. C. , MacIsaac R. J. , Tsalamandris C. , Jerums George 
Published: November 2004

AbstractAims  Excess iron has been implicated in the pathogenesis of diabetes and its complications. This study documents the assessment of plasma iron indices and the correlation between transferrin saturation with biochemical and clinical parameters in a cross‐sectional survey of 820 patients with diabetes in long‐term follow‐up in a single clinic.Methods  Plasma iron indices, together with the biochemical and clinical profile of all patients, were recorded over a 2‐year period. Predictors of the transferrin saturation were identified using multiple and logistic regression analysis.Results  Eighty per cent of patients had Type 2 diabetes. The prevalence of elevated transferrin saturation (> 35%) was 3–4‐fold higher in patients with diabetes, compared with historical prevalence described in the general population. Independent associations with elevated transferrin saturation were male gender, low C‐reactive protein, and increased fasting plasma glucose (all P < 0.0001). Patients with Type 1 diabetes were also more likely to have an elevated transferrin saturation [odds ratio 3.9 (95% CI 1.9–8.0), P < 0.001]. Patients with an elevated transferrin saturation were younger, but had a similar duration of diabetes, possibly suggesting an earlier age of onset. There was no correlation between the presence of diabetic complications and the presence of elevated iron indices.Conclusions  Elevated iron indices are more common in patients with diabetes. Excess iron may have a role in the development of diabetes and subsequently in glycaemic control. This should be balanced by the strong association between iron indices and anaemia in patients with diabetes.
Medical management of diabetic retinopathy
Authors: Sjølie A. K. , Møller F. 
Published: November 2004

AbstractAlthough current treatment and prevention of diabetic retinopathy with laser photocoagulation, and tight metabolic and blood pressure control has reduced the risk of visual loss, there is still a need for additional therapies.A literature review on medical therapies for diabetic retinopathy has been performed, and the following classes of drugs are discussed: blockers of the renin–angiotensin system, protein kinase C‐β inhibitors, glitazones, somatostatin analogues, lipid‐lowering drugs and anti‐inflammatory drugs.There is experimental and clinical data suggesting beneficial effect from several classes of drugs on diabetic retinopathy, and results from large clinical trials are awaited within the next 3–4 years.
Conventional measures underestimate glycaemia in cystic fibrosis patients
Authors: Dobson L. , Sheldon C. D. , Hattersley A. T. 
Published: November 2004

AbstractAims  Diabetes mellitus is an increasingly important complication of cystic fibrosis (CF). The association with increased morbidity of cystic fibrosis‐related diabetes (CFRD) has emphasized the need for accurate monitoring of glycaemia in all CF patients. The diagnosis has relied on conventional thresholds in an oral glucose tolerance test (OGTT) derived from epidemiological studies in non‐CF subjects. However, it has not been established if these values are equivalent in CF and non‐CF populations.Methods  We compared glycaemia in 21 non‐diabetic CF subjects with 21‐age and BMI‐matched non‐CF controls using HbA1c, OGTT and a subcutaneous continuous glucose monitoring system (CGMS) that measures interstitial glucose levels.Results  All conventional measures of glycaemia were similar in the two groups: HbA1c mean CF vs. controls (5.5 vs. 5.3%P = 0.4), fasting glucose (4.8 vs. 4.7 mmol/l P = 0.7) and 2‐h glucose (5.8 vs. 5.7 mmol/l P = 0.8). However, these conventional measures did not accurately reflect glycaemia 30‐, 60‐ and 90‐min. Glucose values and area under the curve in OGTT were all higher in CF subjects than controls (P = 0.01–0.0001). Mean CGMS value [5.9 (0.8) vs. 5.1 (0.5) mmol/l, P = 0.004], and the proportion of subjects with peak CGMS values > 11.1 mmol/l (33 vs. 5%P = 0.00001) were also higher in CF subjects than controls. These results remained significantly different when only subjects with normal glucose tolerance in the two groups were studied.Conclusions  We have shown that overall glycaemia, as shown by both the response during an OGTT and CGMS, is higher in CF subjects who have similar HbA1c, fasting and 2‐h glucose values. These results question whether it is appropriate to use the diagnostic thresholds and OGTT time points derived from the non‐CF population for a diagnosis of diabetes in patients with cystic fibrosis.
Swab cultures accurately identify bacterial pathogens in diabetic foot wounds not involving bone
Authors: Slater R. A. , Lazarovitch T. , Boldur I. , Ramot Y. , Buchs A. , Weiss M. , Hindi A. , Rapoport M. J. 
Published: November 2004

AbstractAims Current clinical practice assumes swab cultures from wounds are unreliable. However, this assumption is based upon data culled only from wounds in which osteomyelitis and/or gangrene were present. This study aimed to re‐evaluate the accuracy of swab cultures vs. deep tissue cultures in diabetic wounds of varying depth and severity.Methods A total of 60 infected diabetic foot wounds were cultured. Two specimens were taken from each wound: superficial swab before debridement and deep tissue specimen towards the end of surgical debridement.Results In 37 wounds (62%), the micro‐organisms isolated from the swab specimen and those isolated from the deep tissue specimen were identical. In another 12 wounds (20%), the swab culture contained all micro‐organisms isolated from the deep tissue culture, but also contained additional micro‐organisms. Analysis according to the depth of the wound, demonstrated that swabs identified all micro‐organisms isolated from the deep tissue specimens in 36/40 wounds (90%) that did not extend to bone as opposed to 13/20 wounds (65%) that extended to bone.Conclusions Swab cultures are valuable in identifying pathogens in diabetic foot wounds when bone is not involved. When surgical debridement is contraindicated or delayed, swab cultures can be used to select appropriate antibiotic therapy.
Is human Type 2 diabetes maternally inherited? Insights from an animal model
Authors: Gill‐Randall R. J. , Adams D. , Ollerton R. L. , Alcolado J. C. 
Published: November 2004

AbstractAims  Patients with Type 2 diabetes mellitus more often report a history of an affected mother than father. However, in the few studies where both parents and offspring have been directly tested, this apparent maternal excess has not been confirmed. Rodent models of diabetes have the advantage that all parents and offspring can undergo glucose tolerance testing at a specific age in adult life. The aim of this study was to gain insights into the inheritance of human Type 2 diabetes by using a rat model.Methods  Goto Kakizaki (GK) rats (a model of Type 2 diabetes) were mated with non‐diabetic Wistar rats. Offspring were produced from 20 GK female vs. Wistar male and 20 Wistar female vs. GK male crosses. Fasting blood glucose was measured at 6 weeks and 3 months of age and an intravenous glucose tolerance test (0.8 g/kg) performed at 6 months of age.Results  Wistar mothers produced litters with almost twice as many viable offspring as GK mothers (14.1 vs. 7.4, P < 0.001). Despite the larger litter size, offspring in the two groups were of comparable weight at 6 weeks and 6 months of age. At 3 months of age, male offspring of Wistar mothers were heavier than offspring of GK mothers (415.7 g vs. 379.5 g, P = 0.016) but this difference was not sustained at 6 months of age. Fasting blood glucose at all ages and average blood glucose during the glucose tolerance test were similar in both groups.Conclusions  We therefore conclude that there is no evidence for maternal transmission of diabetes in the GK rat. Mothers were able to adjust their supply of milk so that offspring attained similar weights independent of litter size. The weight of the offspring remained independent of litter size into adult life.
Nutrient intakes; biochemical and risk indices associated with Type 2 diabetes and glycosylated haemoglobin, in the British National Diet and Nutrition Survey of people aged 65 years and over
Authors: Bates C. J. , Lean M. E. J. , Mansoor M. A. , Prentice A. 
Published: November 2004

AbstractAims  To characterize nutritional differences between survey participants diagnosed with Type 2 diabetes; those without diabetes, and those with ‘undiagnosed diabetes’ based on glycosylated haemoglobin (HbA1c).Subjects and methods  The 1994/5 British National Diet and Nutrition Survey, of people aged 65 years and over (mean age 78 years), included 73 respondents with diagnosed Type 2 diabetes [mean (sd) HbA1c = 7.06 (2.05)%], and 30 with ‘undiagnosed diabetes’ (defined as HbA1c > 6.3%; mean (sd) HbA1c = 7.40 (1.66)%], among a representative sample of 1038 with anthopometry; 4‐day weighed diet; blood and urine status measurements.Results  The prevalence of Type 2 diabetes (diagnosed + undiagnosed) was 10%. In subjects without diagnosis of diabetes, those with HbA1c > 6.3% had on average a significantly higher body weight (73.6 vs. 67.9 kg), higher waist circumference (99.8 vs. 91.8 cm), higher body mass index (28.6 vs. 25.9 kg/m2) and higher white cell counts (7.64 vs. 7.09 × 109/l), than those with mean HbA1c ≤ 6.3%. Diagnosed diabetic subjects had significantly higher energy‐adjusted intakes of protein, fibre, vitamins and minerals than those not in this category (P < 0.01). In contrast, those with undiagnosed diabetes (HbA1c > 6.3%) were nutritionally ‘at risk’, having low plasma concentrations of lycopene (0.13 vs. 0.24 µmol/l) and high density lipoprotein cholesterol (0.99 vs. 1.27 µmol/l) and a trend towards low vitamin C (24 vs. 36 µmol/l) which was significant (P < 0.01) for men. HbA1c was positively correlated with white cell count, plasma fasting triglycerides, plasma alkaline phosphatase and homocysteine (all P < 0.01 overall), being particularly striking amongst men.Conclusions  Among older British citizens, those with diagnosed diabetes had healthier nutritional profiles than those undiagnosed with high HbA1c. Important health‐promoting benefits are therefore predicted following early diagnosis and nutritional advice for people with Type 2 diabetes.
The insulin receptor substrate‐1 Gly972Arg polymorphism is not associated with Type 2 diabetes mellitus in two population‐based studies
Authors: Van Dam R. M. , Hoebee B. , Seidell J. C. , Schaap M. M. , Blaak E. E. , Feskens E. J. M. 
Published: November 2004

AbstractAims  The insulin receptor substrate‐1 (IRS‐1) gene is among the most frequently studied candidate genes for Type 2 diabetes, but findings have been inconsistent. This may have been due to generally small study sizes, or to interaction with body fatness as suggested by studies of insulin sensitivity. The aim of this study was to test the hypothesis that the IRS‐1 Gly972Arg variant increases risk of Type 2 diabetes.Methods  We conducted two large population‐based studies including a total of 725 cases and 742 control subjects, who were Caucasian Dutch men and women aged 40–70 years. We calculated odds ratios adjusted for body mass index, study centre, sex and age.Results  Carriers of the Arg allele did not have a higher prevalence of newly detected (OR 0.49, 95% CI 0.24–1.01) or treated (OR 0.71, 0.37–1.35) Type 2 diabetes in the first study, or a higher prevalence of glucose intolerance (OR 1.07, 0.71–1.59) in the second study. The summary odds ratio was 0.86 (0.62–1.17) for carrying the Arg allele as compared with the Gly/Gly genotype. Associations did not differ appreciably by degree of obesity. Also, the Arg variant was not associated with detrimental values for body mass index, waist circumference, plasma HDL‐and total cholesterol or hypertension.Conclusions  Our findings indicate that the IRS‐1 Gly972Arg variant does not substantially increase risk of common Type 2 diabetes, or Type 2 diabetes in obese persons.
Angiopoietic factors and retinopathy in pregnancies complicated with Type 1 diabetes
Authors: Loukovaara S. , Immonen I. , Koistinen R. , Rudge J. , Teramo K.A. , Laatikainen L. , Hiilesmaa V. , Kaaja R.J. 
Published: November 2004

AbstractAims  To evaluate the role of systemic angiopoietic factors in the progression of diabetic retinopathy during pregnancy.Methods  In a prospective study of 26 pregnant women with diabetes and eight non‐diabetic pregnant women, retinopathy was graded from fundus photographs. Plasma levels of angiopoietin‐1, angiopoietin‐2, human vascular endothelial growth factor A (hVEGF‐A), and total soluble receptor of vascular endothelial growth factor (sVEGF) receptor‐1 were measured during the first and third trimester and 3 months postpartum.Results  In diabetic women, levels of angiopoietin‐2 were 26.5 ng/ml (12.1–47.7) (median and range) during the first trimester, 2.9 ng/ml (0.6–3.5) during the third trimester, and 0.5 ng/ml (0.3–0.7) 3 months postpartum, compared with 44.3 (38.3–61.9), 5.7 (3.1–8.4) and 0.9 (0.6–4.9) ng/ml, respectively, in non‐diabetic women (P = 0.002 between groups). Levels of angiopoietin‐1 and sVEGF receptor‐1 did not differ between the groups. Postpartum hVEGF‐A levels were lowest in women with progression of retinopathy. In logistic regression analyses, progression of retinopathy during pregnancy was not explained by the levels of the angiopoietic factors.Conclusions  The circulating levels of angiopoietic factors in pregnant diabetic women were either lower than (Ang‐2) or similar to (Ang‐1, hVEGF‐A, VEGFR‐1) those levels observed in non‐diabetic pregnant women. The levels of angiopoietic factors measured here appear not to be connected with the progression of retinopathy during pregnancy.
Vascular dysfunction and autonomic neuropathy in Type 2 diabetes
Authors: Meyer C. , Milat F. , McGrath B. P. , Cameron J. , Kotsopoulos D. , Teede H. J. 
Published: November 2004

AbstractAims  To test the hypothesis that arterial dysfunction in Type 2 diabetes is related to autonomic neuropathy.Methods  Arterial function and autonomic neuropathy were assessed over two consecutive days in 45 Type 2 diabetic and control subjects. Systemic arterial compliance (SAC), arterial stiffness (pulse‐wave velocity, PWV) and carotid intima thickness (IMT) were assessed; these markers reflect early vascular disease and predict clinical vascular events. Autonomic neuropathy was assessed using heart rate variability with continuous ECG recording during various breathing and postural manoeuvres and an overall autonomic score was generated. Fasting metabolic parameters including glucose, insulin, HbA1c and lipid profile were measured.Results  Autonomic neuropathy tests were all repeatable in diabetic subjects. Compared with controls, diabetic subjects had arterial dysfunction with increased PWV (P = 0.009), IMT (P < 0.001) and reduced SAC (P = 0.053). After adjustment for age, central PWV correlated with fasting insulin (r2 = 0.45, P < 0.05) and autonomic score (r2 = 0.44, P < 0.05), peripheral PWV correlated with autonomic score (r2 = 0.51, P < 0.005) and IMT correlated with fasting insulin (r2 = 0.5, P < 0.005). The presence of autonomic neuropathy correlated with fasting insulin (P = 0.015), but not age, duration diabetes, lipids or blood pressure.Conclusion  Using repeatable measures of autonomic neuropathy and vascular function in Type 2 diabetic subjects, we have demonstrated associations between autonomic neuropathy, vascular dysfunction and hyperinsulinaemia. This may help to explain the excess cardiovascular mortality seen in diabetic subjects with autonomic neuropathy.
Hypoglycaemia with insulin aspart: a double‐blind, randomised, crossover trial in subjects with Type 1 diabetes
Authors: Heller S. R. , Colagiuri S. , Vaaler S. , Wolffenbuttel B. H. R. , Koelendorf K. , Friberg H. H. , Windfeld K. , Lindholm A. 
Published: November 2004

AbstractAims  To compare the effects of the rapid‐acting insulin analogue insulin aspart and soluble human insulin on hypoglycaemia and glycaemic control in patients with Type 1 diabetes when injected immediately before meals as part of intensive insulin therapy.Methods  In this multinational, double‐blind, randomised, crossover trial, 155 patients with Type 1 diabetes (HbA1c < 8.0%) were symmetrically randomised to two 16‐week treatment periods on either type of insulin, both injected 0–5 min before meals. NPH insulin was given as basal insulin once or twice daily as needed, and insulin dosages were regularly adjusted using pre‐defined algorithms to maintain tight glycaemic control. Treatment periods were separated by a 4‐week washout.Results  The rate of major nocturnal (24.00–06.00 h) hypoglycaemic episodes was 72% lower with insulin aspart than with human insulin (0.067 vs. 0.225 events/month; P = 0.001). Total rate of major hypoglycaemia did not differ significantly between treatments (insulin aspart/human insulin relative risk 0.72; 95% CI 0.47–1.09, P = 0.12). The rate of minor events was significantly reduced by 7% with insulin aspart (P = 0.048). Reductions in rate of hypoglycaemia were achieved with maintained overall glycaemic control: Mean HbA1c remained constant, slightly below 7.7% on both treatments.Conclusions  The use of insulin aspart in an intensive insulin regimen in patients with tightly controlled Type 1 diabetes led to clinically significant reductions in major nocturnal hypoglycaemia with no deterioration in glycaemic control. Major nocturnal hypoglycaemia appears to be a strong clinical indication for the use of rapid‐acting insulin analogues during intensive insulin therapy.
Monetary and Fiscal Policy Rules in the EMU
Authors: Aarle Bas van , Huart Florence , Garretsen Harry 
Published: November 2004

AbstractThis paper studies the design and effects of monetary and fiscal policy in the euro area. To do so, a stylized two-region model of monetary and fiscal policy rules in the EMU is built. We analyse how monetary and fiscal rules affect the adjustment dynamics in the model. Both the effects on the individual countries and on the EMU aggregate economy are studied. Three aspects play an important role in the analysis: (i) the consequences of alternative monetary and fiscal policy rules, (ii) the consequences of asymmetries between EMU countries (asymmetries in macroeconomic shocks and macroeconomic structures), and (iii) the role of alternative degrees of backward- and forward-looking behaviour in consumer decisions and inflation expectations.
Spillover Dynamics of Central Bank Interventions
Authors: Westerhoff Frank H. , Wieland Cristian 
Published: November 2004

Abstract
Central banks frequently intervene in foreign exchange markets to reduce volatility or to correct misalignments. Such operations may be successful if they drive away destabilizing speculators. However, the speculators do not simply vanish but may reappear on other foreign exchange markets. Using a model in which traders are able to switch between foreign exchange markets, we demonstrate that while a central bank indeed has several means at hand to stabilize a specific market, the variability of the other markets depends on how the interventions are implemented.
Norm-Based Trade Union Membership: Evidence for Germany
Authors: Goerke Laszlo , Pannenberg Markus 
Published: November 2004

AbstractIn the absence of closed shops and discriminatory wage policies, union membership can be explained by the existence of social norms.We describe a model, incorporating institutional features of the German labour market, which explicitly allows for social custom effects in the determination of union membership. Using panel data for Germany, we find evidence for according effects which restrict freeriding. The impact of social norms tends to increase with net union density. Hence, observed reductions in the demand for union membership can weaken the impact of a norm and accentuate the free-rider problem.