Limited joint mobility in type 1 diabetic patients: associations with microangiopathy and subclinical macroangiopathy are different in men and women

OBJECTIVE

To study the relationship of limited joint mobility (LJM) in type 1 diabetic patients with microvascular complications, hypertension, and early atherosclerosis and to determine whether sex has an influence on possible associations.

RESEARCH DESIGN AND METHODS

A total of 335 consecutive unselected patients (191 women and 144 men), aged 14-40 years, were studied for LJM, retinopathy, nephropathy (stages III and IV), and hypertension. Standard laboratory tests were performed; the intima-media thickness (IMT) of the carotid arteries, which reflects the extent of early atherosclerosis, was measured by high-resolution ultrasound, and plaques were identified.

RESULTS

The frequency of LJM was 33.7% (29.8% in women and 38.9% in men). Subjects with LJM had a longer diabetes duration (P < 0.001) than those without (women 16.7 +/- 9.1 vs. 10.3 +/- 6.0 years; men 15.0 +/- 9.0 vs. 9.4 +/- 6.3 years). Age, HbA1c, lipids, and systolic/diastolic blood pressure were not different between men and women with or without LJM. Men with LJM had a higher albumin excretion rate (37.1 vs. 13.1 microg/min, P < 0.05) than those without LJM and showed a higher risk of proteinuria (odds ratio 1.8, 95% CI 1.2-2.7; P < 0.05), retinopathy (2.4, 1.7-3.5; P < 0.001), and hypertension (1.7, 1.2-2.6; P < 0.05). The occurrence of these complications was not different between women with and without LJM, but only women with LJM had a greater IMT (0.59 +/- 0.13 vs. 0.55 +/- 0.10 mm, P < 0.05) and a higher risk of plaques (odds ratio 2.1, 95% CI 1.3-3.4; P < 0.05) than women without LJM. In a multiple logistic regression analysis, adjusted for age and diabetes duration, male sex independently predicted the presence of LJM. Moreover, LJM proved to be an independent predictor of retinopathy in men only.

CONCLUSIONS

LJM is an indicator of microvascular disease in men, and LJM is associated with early macrovascular disease in women.

[Subclinical arteriosclerosis in patients with newly diagnosed type 2 diabetes mellitus. Demonstration by high-resolution ultrasound measurements of intima-media thickness of the common carotid and femoral arteries]

BACKGROUND AND OBJECTIVE

Type 2 diabetes mellitus is an important risk factor for the development of atherosclerosis. Early subclinical manifestation of atherosclerosis can be reliably recognized by measuring the thickness of the intima and media (IMT). The aim of this study was to examine vessel changes and the extent of possible risk factors in patients with newly diagnosed type 2 diabetes (interval since diagnosis < or = 1 year) and control persons without DM.

PATIENTS AND METHODS

Maximal IMT was measured by high resolution ultrasound of the common carotid (CCA) and femoral arteries (FA) in 51 type 2 diabetics and 18 controls. Various clinical and laboratory data (urinary excretion of albumin and protein, blood lipids) as well as amount of smoking, frequency of eating fruit and amount of sport activity were obtained in a standardized manner.

RESULTS

The patients' body-weight was markedly greater and blood pressure significantly higher than that of the controls. Hypertension was present in 43% of patients (control group 11%) microalbuminuria in 26%. Mean IMT of the CCA was 0.76 +/- 0.20 mm in the patients and 0.64 +/- 0.16 mm in the controls (p < 0.01). The IMT of the FA, however, was not significantly different in the two groups (patients: 0.80 + 0.30 mm, controls: 0.75 +/- 0.31 mm). The IMT of the CCA was correlated with the patients' age (r = 0.55; p < 0.001), with the level of total cholesterol (r = 0.39; p < 0.01), and with the presence of hypertension (r = 0.38; p < 0.01). Patients who daily eat fruit had a significantly lower IMT of the FA than those who did not eat fruit regularly (no such difference was found regarding the CCA). Linear multiple regression analysis indicated that these variables were factors that independently affected the IMD of the CAA and the FA.

CONCLUSIONS

An increase in subclinical atherosclerosis was demonstrated in type 2 diabetics already during the first year after diagnosis. The risk factors for the development of atherosclerosis in newly diagnosed diabetics exert a greater effect on the CCA than the FA. Regular eating of fruit seems to have a favourable effect on the progression of atherosclerosis of the FA.

Gene disruption of p27(Kip1) allows cell proliferation in the postnatal and adult organ of corti

Hearing loss is most often the result of hair-cell degeneration due to genetic abnormalities or ototoxic and traumatic insults. In the postembryonic and adult mammalian auditory sensory epithelium, the organ of Corti, no hair-cell regeneration has ever been observed. However, nonmammalian hair-cell epithelia are capable of regenerating sensory hair cells as a consequence of nonsensory supporting-cell proliferation. The supporting cells of the organ of Corti are highly specialized, terminally differentiated cell types that apparently are incapable of proliferation. At the molecular level terminally differentiated cells have been shown to express high levels of cell-cycle inhibitors, in particular, cyclin-dependent kinase inhibitors [Parker, S. B., et al. (1995) Science 267, 1024-1027], which are thought to be responsible for preventing these cells from reentering the cell cycle. Here we report that the cyclin-dependent kinase inhibitor p27(Kip1) is selectively expressed in the supporting-cell population of the organ of Corti. Effects of p27(Kip1)-gene disruption include ongoing cell proliferation in postnatal and adult mouse organ of Corti at time points well after mitosis normally has ceased during embryonic development. This suggests that release from p27(Kip1)-induced cell-cycle arrest is sufficient to allow supporting-cell proliferation to occur. This finding may provide an important pathway for inducing hair-cell regeneration in the mammalian hearing organ.

Determinants of carotid artery wall thickening in young patients with Type 1 diabetes mellitus

To investigate associations between early atherosclerosis and possible risk factors for it in young patients with established Type 1 diabetes mellitus (DM), we measured the combined intima-media thickness (IMT) of the common carotid arteries with high resolution ultrasound in 310 young patients (age < or = 40 years, mean 27.9 +/- 6.5) with a diabetes duration > or = 2 years, and in two control groups of similar age (control 1:40 healthy subjects, control 2: 40 Type 1 DM recently diagnosed patients). Albumin excretion rate and lipids (total cholesterol and triglycerides) were measured and retinopathy and hypertension (systolic blood pressure > 140 or diastolic blood pressure > 90 mmHg) sought in the patients. Mean maximum IMT was 0.52 +/- 0.06 mm in control group 1 and 0.50 +/- 0.05 mm in control group 2 with a mean difference of 0.02 mm (95% CI: -0.01, 0.04). The more established Type 1 DM patients had a significantly greater IMT (0.57 +/- 0.13 mm, p < 0.001) than both control groups. In a subgroup analysis, patients with microvascular diabetic complications (n = 99) had a significantly greater IMT (0.63 +/- 0.17 vs 0.55 +/- 0.10 mm, p < 0.001) than those without (n = 211). In a multiple linear regression analysis with a significance level of < or = 0.10, the carotid artery IMT of our established diabetic patients was related to age, male gender, triglycerides and nephropathy, suggesting the latter as the main diabetes-specific risk for intima-media thickening in young Type 1 DM patients.

[Determination of intima-media thickness of the carotid artery: influences of methods, proband and examination variables]

AIM

Comparison of two different methods for the measurement of the common carotid artery intima-media thickness (IMT) regarding results and reproducibility, and investigation of the influence of the subjects' characteristics on the results.

METHOD

20 healthy subjects were studied (6 men, 14 women, mean age 27.4 +/- 4.4 years). B-Mode pictures were taken of the carotid arteries on both sides (longitudinal sections from ventral and lateral) and stored for measurement either in systole or in diastole. Maximum IMT was measured conventionally by manual setting of calipers (method 1), the mean IMT over a length of 1 cm was calculated from the area of the intima plus media by means of a computer (method 2). 10 subjects were studied twice for the evaluation of intra- and interobserver variability.

RESULTS

Mean IMT was between 0.48 +/- 0.07 mm (method 1/observer 1) and 0.55 +/- 0.07 mm (method 2/observer 2). IMT values resulting from method 2 had a better correlation in repeated measurements (coefficient 0.84/0.93 for inter-/intraobserver comparison) than those resulting from method 1 (0.79/0.67). Age and height were significantly correlated with IMT (coefficients 0.53 and 0.52 for method 2), no correlation was found for body weight, BMI, sex or years of smoking. There was a significant inverse correlation between blood pressure and IMT (-0.21 to -0.32).

CONCLUSION

In younger healthy subjects, the results of IMT measurement are influenced by age, height and actual blood pressure. The values resulting from both methods are comparable, whereas method 2 has a better reproducibility.

Evaluation of the insertion/deletion ACE gene polymorphism as a risk factor for carotid artery intima-media thickening and hypertension in young type 1 diabetic patients

OBJECTIVE

To study the distribution of the insertion/deletion polymorphism of the ACE gene in young type 1 diabetic patients and to evaluate possible associations between the ACE genotype, arterial hypertension, and intima-media thickness (IMT) of the common carotid artery.

RESEARCH DESIGN AND METHODS

Study participants were 148 type 1 diabetic patients (56 men and 92 women), aged 14-44 years, with a diabetes duration of > or = 2 years. HbA1c, albuminuria, and lipid status were assessed by standard laboratory techniques; the ACE genotypes were assessed by polymerase chain reaction. The patients were categorized according to the presence or absence of hypertension, nephropathy, and retinopathy. The IMT, which can be used to estimate early stages of atherosclerosis, was measured by high-resolution ultrasonography.

RESULTS

The ACE genotypes were distributed as follows: 21% II, 37% ID, 42% DD. The IMT values did not differ among patients with various ACE genotypes (0.63 +/- 0.15 mm), but the prevalence of hypertension was significantly higher in patients with DD (odds ratio, 4.26 versus II + ID; 95% CI, 1.64-11.06). Multiple linear regression analysis showed that only age, hypertension, and sex were determinants for the IMT.

CONCLUSIONS

Our results suggest a relationship between the prevalence of hypertension and the deletion polymorphism of the ACE gene in young type 1 diabetic patients, but we could not find an association between carotid artery IMT and ACE genotype in this population.

Lack of association between the insertion/deletion polymorphism of the angiotensin-converting-enzyme gene and diabetic nephropathy in IDDM patients

The insertion/deletion (I/D) polymorphism of the angiotensin-converting-enzyme (ACE) gene has been reported to be associated with diabetic nephropathy in IDDM. We studied the relationship between this polymorphism and diabetic nephropathy in 210 IDDM patients. Their DNA was analyzed by polymerase chain reaction to type for the presence (I) or absence (D) of the 287 bp fragment in intron 16 of the ACE gene. The relative frequency of the different genotypes was 33.8% (DD), 43.8% (ID), and 22.4% (II). There were no significant differences between the genotypes in age, body-mass-index, blood pressure, plasma total cholesterol and triglycerides. The prevalence of microalbuminuria or nephropathy was 23.9% in the DD, 16.3% in the ID, and 17% in the II genotypes. The higher percentage of microalbuminuria or nephropathy in the DD genotypes was due to an increasing frequency of DD genotypes in the IDDM patients with long diabetes duration. After matching for diabetic retinopathy, gender, and diabetes duration, there was no association between the ACEI/D polymorphism and diabetic nephropathy. In conclusion, these results suggest that the ACE DD genotype cannot be regarded as a risk factor for diabetic nephropathy, but may even be associated with diabetes duration and thus longevity in IDDM patients.

The time factor in mortality: weather associations in a subtropical environment

Mortality rates for a decade in Brisbane are analysed for dependence upon atmospheric factors. Time filters are applied to both the dependent and independent variables, and several models are developed to enable prediction, especially for weekly intervals. Statistically, deaths are observed to increase with colder and less humid weather with winds from a westerly, direction. Overall, taking account of both synoptic and seasonal influences, > 90% of cumulative deviations from mean death rates are explained. Some differences are also noted in the association of death with the weather between sexes, age groups and causes of death.

Partial purification of (1,3)-beta-glucan synthase from Candida albicans

(1,3)-beta-Glucan synthase from Candida albicans was solubilized from microsomal membranes using the detergent 3-[(3-cholamidopropyl) dimethylammonio]-1-propane sulfonate (Chaps). Effective solubilization was dependent upon the strain and the method used to detect enzyme activity. The solubilized enzyme was purified over 765-fold using a modified product entrapment technique. Bovine serum albumin, an activator of glucan synthase, precipitated proteins during product entrapment and was replaced with BSA immobilized on agarose beads. SDS-PAGE analysis revealed a prominent 187-kDa band present in the product entrapped pellet as well as several additional polypeptides at 227, and 187, 182 and 39 kDa which were not prevalent in crude preparations.

Advances in the molecular genetic analysis of the flax-flax rust interaction

The L6 and M rust-resistance genes, representing two of the five rust-resistance gene loci in flax (Linum usitatissimum), have been cloned. The molecular data are fully consistent with earlier genetic data: the L locus is a single gene with multiple alleles expressing different rust resistance specificities, and the M locus is complex, containing an array of about 15 similar genes. Thus, while L6 and M resistance genes have 86% nucleotide identity, their locus structure is very different. These genes encode products belonging to the nucleotide binding site-leucine-rich repeat class of disease-resistance proteins. Analysis of alleles from the L locus and chimeric genes is providing evidence suggesting that important specificity determinants occur in the C-terminal half of the proteins, the region containing the leucine-rich repeats. The isolation and characterization of the rust (Melampsora lini) avirulence genes that correspond to the cloned rust-resistance genes is one of the major challenges remaining to the understanding of this system.

Immunogenicity and efficacy against lethal aerosol staphylococcal enterotoxin B challenge in monkeys by intramuscular and respiratory delivery of proteosome-toxoid vaccines

Staphylococcal enterotoxin B (SEB), a primary cause of food poisoning, is also a superantigen that can cause toxic shock after traumatic or surgical staphylococcal wound [correction of would] infections or viral influenza-associated staphylococcal superinfections or when aerosolized for use as a potential biologic warfare threat agent. Intranasal or intramuscular (i.m.) immunization with formalinized SEB toxoid formulated with meningococcal outer membrane protein proteosomes has previously been shown to be immunogenic and protective against lethal respiratory or parenteral SEB challenge in murine models of SEB intoxication. Here, it is demonstrated that immunization of nonhuman primates with the proteosome-SEB toxoid vaccine is safe, immunogenic, and protective against lethal aerosol challenge with 15 50% lethal doses of SEB. Monkeys (10 per group) were primed i.m. and given booster injections by either the i.m. or intratracheal route without adverse side effects. Anamnestic anti-SEB serum immunoglobulin G (IgG) responses were elicited in all monkeys, but strong IgA responses in sera and bronchial secretions were elicited both pre- and post-SEB challenge only in monkeys given booster injections intratracheally. The proteosome-SEB toxoid vaccine was efficacious by both routes in protecting 100% of monkeys against severe symptomatology and death from aerosolized-SEB intoxication. These data confirm the safety, immunogenicity, and efficacy in monkeys of parenteral and respiratory vaccination with the proteosome-SEB toxoid, thereby supporting clinical trials of this vaccine in humans. The safety and enhancement of both bronchial and systemic IgA and IgG responses by the proteosome vaccine delivered by a respiratory route are also encouraging for the development of mucosally delivered proteosome vaccines to protect against SEB and other toxic or infectious respiratory pathogens.

Neural networks in clinical medicine

Neural networks are parallel, distributed, adaptive information-processing systems that develop their functionality in response to exposure to information. This paper is a tutorial for researchers intending to use neural nets for medical decision-making applications. It includes detailed discussion of the issues particularly relevant to medical data as well as wider issues relevant to any neural net application. The article is restricted to back-propagation learning in multilayer perceptrons, as this is the neural net model most widely used in medical applications.

The transfer of knowledge in occupational therapy: the case of work ability assessment

Kunskapsöverföringen inom arbetsterapi diskuteras i marknadsföringstermer. Dessa exemplifieras med strategier som författarna föreslår för att lärare, kliniskt verksamma arbetsterapeuter och annan rehabiliteringspersonal skulle kunna förbättra sina kunskaper om arbetsförmågebedömningar och om arbetsrelsterade rehabiliteringsprogram.

(1,3) beta-Glucan synthase activity of Neurospora crassa: identification of a substrate-binding protein

(1,3)beta-Glucan synthase activity from the filamentous Ascomycete Neurospora crassa was purified 1300-fold to a specific activity of 14,000 nmol glucose incorporated/min per mg protein. Hyphae were disrupted and crude membrane fractions obtained by high-speed centrifugation. Membrane fractions were extracted with Tergitol NP-40 and a second high-speed particulate fraction was obtained. Enzyme activity was solubilized with (3-((3-cholamidopropyl)dimethylammonio)-1-propanesulfonate and octyl-beta-D-glucoside from Tergitol-extracted membrane preparations. Solubilized enzyme activity was purified by product entrapment and recovered by low-speed centrifugation through a layer of sucrose. SDS-PAGE analysis revealed 2 proteins of 165 and 100 kDa as likely candidates for subunits of the (1,3)beta-glucan synthase enzyme complex. 5-Azido-[32P]UDP-glucose was photo-crosslinked to UDP-glucose-binding proteins in each fraction of the purification procedure. Autoradiograms of SDS-PAGE gels revealed a single protein of 165 kDa enriching with enzyme activity and labeling with the substrate analog. Photoincorporation of 5-azido-[32P]UDP-glucose by the 165 kDa protein was competed by 0.25 mM UDP-glucose (80%) and TDP-glucose (65%) while ADP-glucose (27%), CDP-glucose (36%), and GDP-glucose (8%) where less effective. These results were similar to in vitro inhibition of enzyme activity by the same compounds. These data strongly suggest that the 165 kDa protein is a substrate-binding subunit of (1,3)beta-glucan synthase.

[Carotid artery wall changes in young type-1 diabetics. The ultrasonic diagnosis of early arteriosclerosis]

In a prospective study high-resolution ultrasonography was used to document any early carotid-artery wall changes (intima-media thickening; plaques), in 165 type I diabetics up to the age of 40 years (66 males, 99 females; mean age 27.5 +/- 6 years; duration of diabetes > 1 year). In two control groups (group 1: 40 with type I diabetes of up to one year's duration; group 2: 20 healthy subjects) the mean intima-media thickness was 0.50 +/- 0.05 and 0.51 +/- 0.06 mm, respectively (maximal value 0.6 mm). In the patients with a longer duration of diabetes it was significantly higher at 0.56 +/- 0.11 mm (P < 0.001). Of the 165 patients with a diabetes duration of more than 1 year, 134 had normal intima-media wall thickness (< 0.6 mm, mean 0.52 +/- 0.07 [group A]), in 15 (group B) it was 0.75 +/- 0.06 mm, and in 16 (group C) there were plaques with a wall thickness of 0.67 +/- 0.15 mm. The incidence of nephropathy and hypertension or hypercholesterolaemia (only in group C) was significantly higher in groups B and C than A (P < 0.01). It is thus clear that these consequential or associated diseases go together, in young type I diabetics, with an increased risk of early arteriosclerosis.