Risk prediction models for the development of diabetes in Mauritian Indians

AIMS

To develop risk prediction models of future diabetes in Mauritian Indians.

METHODS

Three thousand and ninety-four Mauritian Indians (1141 men, aged 20-65 years) without diabetes in 1987 or 1992 were followed up to 1992 or 1998. Subjects underwent repeated oral glucose tolerance tests and diabetes was diagnosed according to 2006 World Health Organization/International Diabetes Federation criteria. Cox regression models for interval censored data were performed using data from 1544 randomly selected participants. Predicted probabilities for diabetes were calculated and validated in the remaining 1550 subjects.

RESULTS

Over 11 years of follow-up, there were 511 cases of diabetes. Among variables tested, family history of diabetes, obesity (body mass index, waist circumference) and glucose were significant predictors of diabetes. Predicted probabilities derived from a simple model fitted with sex, family history of diabetes and obesity ranged from 0.05 to 0.64 in men and 0.03 to 0.49 in women. To predict the onset of diabetes, area under the receiver operating characteristic (ROC) curve (AROC) of predicted probabilities was 0.62 (95% confidence interval, 0.56-0.68) in men and 0.64 (0.59-0.69) in women. At a cut-off point of 0.12, the sensitivity and specificity were 0.72 (0.71-0.74) and 0.47 (0.45-0.49) in men and 0.77 (0.75-0.78) and 0.50 (0.48-0.52) in women, respectively. Addition of fasting plasma glucose (FPG) to the model improved the prediction slightly [AROC curve 0.70 (0.65-0.76) in men, 0.71 (0.67-0.76) in women].

CONCLUSIONS

A diabetes prediction model based on obesity and family history yielded moderate discrimination in Mauritian Indians, which was slightly inferior to the model with the FPG but may be useful in low-income countries to promote identification of people at high risk of diabetes.

Blood lipid levels in relation to glucose status in seven populations of Asian origin without a prior history of diabetes: the DECODA study

BACKGROUND

Dyslipidaemia commonly coexists with diabetes. We investigated the association of lipid profiles with glucose levels in populations of Asian origin without a prior history of diabetes.

METHODS

Cross-sectional data of 10,374 men and 12,552 women aged 30-74 years from 14 cohorts, representing seven populations of Asian origin were jointly analysed. Multivariable adjusted linear regression analyses with standardized regression coefficients (beta) were performed to estimate relationships between lipids and plasma glucose.

RESULTS

Within each glucose category, fasting plasma glucose (FPG) levels were correlated with increasing levels of triglycerides (TGs), total cholesterol (TC), TC to high-density lipoprotein (HDL) ratio and non-HDL cholesterol (non-HDL-C) (p < 0.05 in most of the ethnic groups) and inversely associated with HDL-C (p < 0.05 in some, but not all, of the populations). The association of lipids with 2-h plasma glucose (2hPG) followed a similar pattern as that for the FPG, except that an inverse relationship between HDL-C and glucose was more commonly observed for 2hPG than for FPG among different ethnic groups.

CONCLUSIONS

Hyperglycaemia is associated with adverse lipid profiles in Asians without a prior history of diabetes. The 2hPG appears to be more closely associated with lipid profiles than does FPG. When assessing the risk of cardiovascular disease, the association of the dyslipidaemia with intermediate hyperglycaemia needs to be considered.

Risk factors associated with the dramatic increase in the prevalence of diabetes in the adult Chinese population in Qingdao, China

OBJECTIVE

To investigate the major risk factors and their association with the dramatic increase in the prevalence of diabetes from 2001-2002 to 2006 in Qingdao, China.

METHODS

Population-based cross-sectional studies on diabetes were performed in 4598 men and 7026 women aged 35-74 years. The 2006 World Health Organization diagnostic criteria for diabetes were used.

RESULTS

The crude prevalence of diabetes was 11.3% in both men and women in urban areas and 5.3% and 8.9% in rural areas in 2001-2002. This increased to 19.2% and 16.1% in urban areas and 14.2% and 13.8% in rural areas in 2006 for men and women, respectively. The increase in diabetes prevalence from 2001-2002 to 2006 was paralleled by an increased body mass index in rural areas but not in urban areas. The major risk factors associated with diabetes were age, family history of diabetes, obesity, hypertension and high triglycerides. The multivariate adjusted odds ratio and 95% confidence interval for diabetes corresponding to a one standard deviation increase in waist circumference was 1.81 (1.47, 2.23) in urban men, 1.64 (1.26, 2.13) in rural men, 1.98 (1.66, 2.37) in urban women and 2.02 (1.63, 2.51) in rural women. Low socio-economic classes had a higher risk for diabetes in urban areas but a lower risk in rural areas, both associated with increased waist circumference.

CONCLUSION

Established risk factors are of great importance for the prevalence of diabetes in the urban and rural Chinese populations and changes in these factors could explain the recent dramatic increase in diabetes prevalence, particularly in rural areas. Considering the high prevalence of obesity and physical inactivity, intervention is urgently required in China.

Tissue Microarray Assessment of Selenoprotein P Expression in Gastric Adenocarcinoma

This study investigated selenoprotein P expression, using immunohistochemistry, in gastric adenocarcinoma tissue microarrays constructed from 30 gastric adenocarcinoma specimens and 30 normal gastric tissues (controls). Selenoprotein P expression scores were significantly lower in gastric adenocarcinoma (17/30, 56.7%) than in control tissues (25/30, 83.3%). Selenoprotein P was significantly more likely to be expressed in well-to-moderately differentiated cases (13/17, 76.5%) than in cases with low differentiation (4/13, 30.8%) and there was no significant difference in selenoprotein P expression between tumour node metastasis (TNM) stage I – II (11/19, 57.9%) and TNM stage III (6/11, 54.5%). In conclusion, selenoprotein P expression was low in gastric adenocarcinoma tissues compared with control tissues and was related to the degree of gastric adenocarcinoma differentiation but not to TNM stage.

Blood lipid levels in relation to glucose status in European men and women without a prior history of diabetes: the DECODE Study

OBJECTIVE

Dyslipidaemia is present not only in diabetic but also in prediabetic subjects. The purpose of this study is to investigate the relationship between lipid and glucose levels in a large European population without a prior history of diabetes.

RESEARCH DESIGN AND METHODS

Data from the population-based studies of 8960 men and 10,516 women aged 35-74 years representing 15 cohorts in 8 European countries were jointly analyzed. Multivariate adjusted linear regression analyses with standardized coefficients (beta) were performed to estimate the relationship between lipid and plasma glucose.

RESULTS

In subjects without a prior history of diabetes, positive relationships were shown between fasting plasma glucose (FPG) and total cholesterol (TC) (beta=0.06 and 0.03, respectively for men and women, p<0.01), triglycerides (TG) (beta=0.14 and 0.12, p<0.001), non-high-density lipoprotein cholesterol (non-HDL-C) (beta=0.06 and 0.03, p<0.01) and TC to HDL ratio (beta=0.06 and 0.05, p<0.001) but a negative trend between FPG and HDL-C (beta=-0.02, p>0.05 in men and beta=-0.03, p<0.05 in women). The relationship between lipid and 2-h plasma glucose (2hPG) followed a similar pattern as that for FPG, except that TC was not increased and HDL-C was reduced in both sexes in subjects with impaired glucose tolerance (IGT).

CONCLUSIONS

For cardiovascular prevention, the different lipid patterns between impaired fasting glucose (IFG) and IGT may deserve further attention to evaluate the combined risks of dyslipidaemia and elevated glucose levels below the diagnostic threshold of diabetes.

BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians

OBJECTIVE

To compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) in association with diabetes or hypertension.

METHODS AND PROCEDURES

Cross-sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged 35-74 years, of different ethnicities were included in this meta-analysis.

RESULTS

Age-adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three) adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P=0.001) in men but with WC and WSR than BMI (both P<0.05) in women. Hypertension had stronger association with BMI than WHR in men (P<0.001) and had the strongest with BMI than the others (WHR P<0.001; WSR P<0.01; and WC P<0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742) while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped.

DISCUSSION

WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly associated with hypertension in Asians.

Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women

AIMS/HYPOTHESIS

We estimated cardiovascular disease (CVD) mortality in individuals with the metabolic syndrome on the basis of different definitions.

METHODS

We collaboratively analysed data from 4,715 men and 5,554 women, who were aged 30 to 89 years, had a maximum follow-up of 7 to 16 years, and were drawn from nine European population-based cohorts. Cox regression analysis with age as time scale was performed to estimate hazard ratio (HR) for mortality, adjusting for cohort, serum total cholesterol and smoking.

RESULTS

The prevalence of the metabolic syndrome according to definitions of WHO, the National Cholesterol Education Program (NCEP), NCEP revised and the International Diabetes Federation (IDF) was 27.0%, 25.9%, 32.2% and 35.9% respectively in men and 19.7%, 23.4%, 28.5% and 34.1% respectively in women. The corresponding HRs (95% CIs) for CVD mortality were 2.09 (1.59-2.76), 1.74 (1.31-2.30), 1.72 (1.31-2.26) and 1.51 (1.15-1.99) in men, and 1.60 (1.01-2.51), 1.39 (0.89-2.18), 1.09 (0.70-1.69) and 1.53 (0.99-2.36) in women. The paired homogeneity test showed that in men the HR was higher with the WHO definition than with the IDF definition (p=0.03). In women the HR was lower with the revised NCEP definitions than with either the WHO (p=0.02) or the IDF (p=0.01) definitions. With a few exceptions, HRs for full definitions of the syndrome were not significantly different from those for their single components.

CONCLUSIONS/INTERPRETATION

Metabolic syndrome by the four definitions predicted CVD mortality in men, but the prediction was weak in women. Further research is required on the utility of definitions of the metabolic syndrome above and beyond that of its single components and in individual CVD risk stratification, particularly with regard to sex difference in the prediction.

Coffee consumption and risk of total and cardiovascular mortality among patients with type 2 diabetes

AIMS/HYPOTHESIS

Higher habitual coffee drinking has been associated with a lower risk of developing type 2 diabetes. The relation between coffee consumption and risk of cardiovascular disease (CVD) has been examined in many studies, but the issue remains controversial. This study was designed to assess the association between coffee consumption and CVD mortality among patients with type 2 diabetes.

METHODS

We prospectively followed 3,837 randomly ascertained Finnish patients with type 2 diabetes aged 25 to 74 years. Coffee consumption and other study parameters were determined at baseline. The International Classification of Diseases was used to identify CHD, CVD and stroke cases using computerised record linkage to the national Death Registry. The associations between coffee consumption at baseline and risk of total, CVD, CHD, and stroke mortality were analysed by using Cox proportional hazards models.

RESULTS

During the average follow-up of 20.8 years, 1,471 deaths were recorded, of which 909 were coded as CVD, 598 as CHD and 210 as stroke. The respective multivariate-adjusted hazard ratios in participants who drank 0-2, 3-4, 5-6, and > or =7 cups of coffee daily were 1.00, 0.77, 0.68 and 0.70 for total mortality (P<0.001 for trend), 1.00, 0.79, 0.70 and 0.71 for CVD mortality (P=0.006 for trend), 1.00, 0.78, 0.70 and 0.63 for CHD mortality (p=0.01 for trend), and 1.00, 0.77, 0.64 and 0.90 for stroke mortality (p=0.12 for trend).

CONCLUSIONS/INTERPRETATION

In this large prospective study we found that in type 2 diabetic patients coffee drinking is associated with reduced total, CVD and CHD mortality.

The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group

The category of IFG was introduced in the late 1990s to denote a state of non-diabetic hyperglycaemia defined by a fasting plasma glucose (FPG) concentration between 6.1 and 6.9 mmol/l. In 2003 the American Diabetes Association recommended that this diagnostic threshold be lowered to 5.6 mmol/l. The justification for lowering the threshold has been questioned. This simple change in cut-off value creates a pandemic of IFG, with a two- to five-fold increase in the prevalence of IFG across the world. Such a change in threshold has far-reaching public health implications. The European Diabetes Epidemiology Group (EDEG) has reviewed the evidence for this lower cut-off point for the definition of IFG and concludes that the previous definition should not be altered. EDEG further recommends that the value of all categorical definitions of non-diabetic hyperglycaemia should be reconsidered.

Advances in Polymer Flooding and Alkaline/Surfactant/Polymer Processes as Developed and Applied in the People's Republic of China

Paper includes discussion and reply published in May 2006 JPT.

Distinguished Author Series articles are general, descriptive representations that summarize the state of the art in an area of technology by describing recent developments for readers who are not specialists in the topics discussed. Written by individuals recognized as experts in the area, these articles provide key references to more definitive work and present specific details only to illustrate the technology. Purpose: to inform the general readership of recent advances in various areas of petroleum engineering.

Abstract

Polymer flooding (PF) and alkaline/surfactant/polymer (ASP) flooding have been applied throughout the world for more than 20 years. However, few large-scale successes with these processes have been reported, except in China. To date, the PF process has been applied successfully in several major Chinese oil fields such as Daqing and Shengli. PF alone contributed approximately 250,000 BOPD of production in 2004 from these two fields. Incremental oil recoveries of up to 14% of the original oil in place (OOIP) have been obtained in good-quality reservoirs.

Profile modifications by use of polymers and a crosslinker to form colloidal-dispersion gels (CDGs) also have been implemented successfully in large-scale production operations in China. Results show that the CDG process is more cost-effective than the PF process.

Several ASP floods also have been pilot tested in various Chinese oil fields. Incremental recoveries of up to 25% OOIP have been reported, although commercial-scale applications have not been implemented. Plans to implement three large-scale projects have been made for 2006 in the Daqing oil field. This paper discusses the progress made in these processes in China over the last 20 years, including field results, new concepts, and economics.

Introduction

The PF concept in the U.S. has been to use a small slug at low polymer concentrations. The amount of polymer used is measured with a combination unit calculated by multiplying the concentration in parts per million (ppm) by the slug size in pore volume (Vp). The 1976 U.S. Natl. Petroleum Council (NPC) study used 125 ppm·Vp. The amount of polymer used in the 1984 NPC study was increased to 240 ppm·Vp, but it was still much less than that used in China. NPC projected incremental recoveries were in the range of 6 to 8% OOIP in successful projects, approximately 50% of that obtained in good-quality reservoirs in the Daqing oil field.

Seven PF pilot tests were conducted in the Daqing oil field from 1972 through 1998. Continued research and field testing led to fieldwide expansion in 1996. There were 31 commercial-scale PF projects in Daqing in 2004, with 2,427 injection wells and 2,916 production wells. Currently, PF is implemented in a total area of 67,759 acres, as shown in Fig. 1. Oil production from PF has been maintained since 1999. The production reached 73.5 million bbl in 2004, approximately 23% of the total field production.

Prevalence of Type 2 diabetes in urban and rural Chinese populations in Qingdao, China

AIMS

To determine the prevalence of diabetes in the Chinese adult population in rural and urban areas of Qingdao city.

METHODS

A population-based cross-sectional study of diabetes was performed in 12 436 (5346 men) Chinese adults (20-74 years old) from 2001 to 2002. Fasting capillary whole blood glucose test (FCG) was performed in all participants and a 2-h 75-g oral glucose tolerance test in those with FCG > or = 6.1 mmol/l following initial screening. The 1999 World Health Organization diagnostic criteria for diabetes were used.

RESULTS

The age-standardized prevalence of diabetes was 6.1% (4.1% for undiagnosed and 2.1% for previously known diabetes) in adults aged 20-74 years. Diabetes prevalence increased with age up to the oldest age group (70-74); in subjects over 50 years of age, the prevalence reached 10%. Men tended to have a higher prevalence of known diabetes than women, whereas the prevalence of undiagnosed diabetes was lower in men than in women (4.6% vs. 3.3%, d.f. = 1, P = 0.001). Diabetes was more prevalent in the urban than in the rural population (6.9% vs. 5.6%, d.f. = 1, P < 0.001). However, the proportion of undiagnosed diabetes was higher in the rural than in the urban areas (70.5% vs. 58.0%, d.f. = 1, P < 0.001).

CONCLUSIONS

The prevalence of Type 2 diabetes in Qingdao city is moderately high, but much higher than reported in 1996. The large proportion of undiagnosed cases of diabetes indicates the lack of public awareness of diabetes and shortage of medical facilities. In view of the huge population in China, the results of this study emphasize the need to improve the early detection and prevention of diabetes in China to prevent the emerging diabetes epidemic.

Effects of smoking, obesity and physical activity on the risk of type 2 diabetes in middle-aged Finnish men and women

OBJECTIVE

To examine the association of cigarette smoking with the risk of type 2 diabetes and to find out whether the association is modified by obesity and physical activity.

DESIGN AND SUBJECTS

A prospective study comprising 41,372 men and women aged 25--64 years without a history of diabetes, coronary heart disease or stroke at baseline. Data on incident cases of diabetes were ascertained through the nationwide Drug Register and the Hospital Discharge Register. During the mean follow-up of 21 years 2770 subjects were diagnosed with type 2 diabetes. The Cox proportional hazards model was used to estimate the effect of smoking and other factors on the risk of type 2 diabetes.

RESULTS

Smoking had a graded association with the risk type 2 diabetes, and it remained significant after controlling for age and major risk factors. The multifactorial-adjusted (age, study year, education, body mass index (BMI), systolic blood pressure, physical activity and coffee and alcohol drinking) hazard ratio was 1.22 [95% confidence interval (CI) 1.04--1.43] amongst men smoking less than 20 cigarettes per day and 1.57 (95% CI 1.34--1.84) amongst men smoking 20 cigarettes per day or more. In women the corresponding hazard ratios were 1.46 (95% CI 1.21--1.76) and 1.87 (95% CI 1.36--2.59) respectively. Smoking increased the risk of type 2 diabetes at all levels of BMI and physical activity.

CONCLUSION

Smoking is a risk factor for type 2 diabetes independently of BMI and physical activity. Prevention of smoking should be encouraged as a part of efforts to reduce the risk of type 2 diabetes, and it will result in other health benefits, too.

Sex differences in cardiovascular and total mortality among diabetic and non-diabetic individuals with or without history of myocardial infarction

AIMS/HYPOTHESIS

We investigated the associations of type 2 diabetes and a history of myocardial infarction (MI) with coronary heart disease, stroke, cardiovascular and total mortality, and whether these effects are different in men and women.

METHODS

Study cohorts included 51,735 Finnish men and women aged 25-74 years. Smoking status and the history of MI and type 2 diabetes were recorded, and height, weight, blood pressure and serum cholesterol levels were measured at baseline. Additional data on the occurrence of diabetes and MI prior to baseline survey were obtained from national hospital discharge and drug registers through computerised register linkage. Mortality data were obtained from the national mortality register.

RESULTS

During a mean follow-up period of 17.2 years, 9,201 deaths were recorded. Hazard ratios (HRs) for coronary mortality were 2.1, 4.0 and 6.4 among men with diabetes alone, men with MI alone, and men with diabetes and MI, respectively, compared with men with neither diabetes nor a history of MI. The corresponding HRs among women were 4.9, 2.5 and 9.4, respectively. The equivalent HRs for cardiovascular and total mortality were 2.2, 3.3 and 6.0, and 1.8, 2.3 and 3.7 in men, and 4.4, 2.4 and 6.5, and 3.2, 1.7 and 4.4 in women, respectively. Diabetic men and women had similar total mortality rates, whereas total mortality rates were markedly higher among men in the other three diabetes-MI categories.

CONCLUSIONS/INTERPRETATION

Diabetes and MI markedly increase cardiovascular and all-cause mortality. In women, the association between diabetes and mortality was stronger than that between MI and mortality, whereas the converse was true among men.

Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE Study

AIMS/HYPOTHESIS

Risk scores have been developed to predict cardiovascular or coronary risk, and while most have included diabetes as a risk factor, none have included lower glucose concentrations, either at fasting or following a 2-h oral glucose tolerance test. This article develops 5- and 10-year risk scores for cardiovascular mortality that include glucose concentrations as well as known diabetes status.

METHODS

Data is from the DECODE cohort: 16,506 men and 8,907 women from 14 European studies. The risk factors studied were as follows: age, fasting and 2-h glucose (including cases of known diabetes), fasting glucose alone (including cases of known diabetes), cholesterol, smoking status, systolic blood pressure and BMI. For an absolute risk score the 1995 country- and sex-specific cardiovascular death rates were used.

RESULTS

In men, for both 5- and 10-year cardiovascular mortality, after adjusting for age and study centre, all studied risk factors, except BMI, were significantly associated with cardiovascular mortality (p<0.05). These results were unchanged in multivariate models with all factors included. In women, after adjusting for age and centre, glucose categories, systolic blood pressure and BMI were predictive of 5-year cardiovascular mortality. With all factors in the model, only age and glucose categories were predictive. In terms of 10-year cardiovascular mortality, smoking status and blood pressures were also predictive in the women. For men and women, the same scores were used for the risk factors, except for age and glucose categories where the hazard ratios differed significantly.

CONCLUSIONS/INTERPRETATION

Including glucose concentrations as well as diabetic status provides quantitative information on cardiovascular risk prediction.

Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemia

AIMS

To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance.

METHODS

Men (1223) and women (1370) aged 45-64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register.

RESULTS

During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72-0.82) than for fasting glucose (0.65, 0.58-0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4-6.2) than for isolated IFG (2.3, 0.9-5.7) as compared with subjects with neither IFG nor IGT.

CONCLUSION

Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention.

Age, body mass index and Type 2 diabetes-associations modified by ethnicity

AIMS/HYPOTHESIS

The aim of this study was to assess the effect of ethnicity on the association between age and body mass index as well as the prevalence of diabetes.

METHODS

We selected population-based studies carried out after 1980 in the DECODE/A studies representing different ethnic groups: 11 European, 1 Maltese, 3 Indian, 2 Chinese and 3 Japanese surveys. The total numbers of subjects were 14,240 men and 15,129 women who were 30 to 89 years of age. Diabetes was diagnosed according to the 1999 World Health Organization criteria based on a standard 75 g OGTT. Sex-specific prevalence of diabetes by age and BMI was stratified by ethnic group, in particular the interaction of ethnicity on the associations between age/BMI and the prevalence of diabetes.

RESULTS

The prevalence of diabetes was higher in studies from India and Malta compared to Japan, China, and the rest of Europe. The association between BMI and diabetes, adjusted for age, showed noticeable differences between the ethnic groups with an increase in prevalence starting at a BMI between 15 and 20 kg/m(2) in the Maltese and Indian populations compared to 25 kg/m(2 )in Europeans.

CONCLUSION/INTERPRETATION

The effect of BMI on the age-adjusted prevalence of Type 2 diabetes was modified by ethnicity with considerably lower thresholds in Indian and Maltese subjects compared to those from the rest of Europe. This difference should be reflected in national and international recommendations regarding "optimal" BMI.

Post-challenge hyperglycaemia is associated with premature death and macrovascular complications

Unravelling the precise association between cardiovascular disease and Type II (non-insulin-dependent) diabetes mellitus has proved problematic, largely as a result of the confusing variety of diagnostic criteria and methodologies used in previous studies of disease-associated risk. More recently, improved standardization and continuing refinements to risk analyses have begun to clarify the relative importance of individual risk factors for macrovascular complications and progression to cardiovascular disease. The evidence accumulated from several large-scale epidemiological and intervention studies strongly indicates that hyperglycaemia and specifically the post-load hyperglycaemia resulting from postprandial glucose excursions is the main factor associated with increasing the risks of morbidity and mortality in Type II diabetes. The DECODE study has de-emphasized the importance of fasting glucose, in contrast to post-load hyperglycaemia, as the principal measurable determinant of exposure to the risk of cardiovascular disease in Type II diabetes. Similarly, the Diabetes Intervention Study identified mealtime hyperglycaemia as an independent risk factor for myocardial infarction and all-cause mortality, while several other studies have also shown that such mortality is better predicted from post-challenge measurement criteria rather than from fasting-glucose criteria. It is likely that postprandial hyperglycaemia is an independent risk factor for atherosclerosis and is also exerting an atherogenic effect indirectly through the clustering of a number of risk factors for atherosclerosis. Whether the relation between post-load hyperglycaemia and the risk of cardiovascular events is causal is still not known.

Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women

AIM/HYPOTHESIS

Leisure-time physical activity can reduce the risk of Type 2 diabetes, but the potential effect of different types of physical activity is still uncertain. This study is to examine the relationship of occupational, commuting and leisure-time physical activity with the incidence of Type 2 diabetes.

METHODS

We prospectively followed 6898 Finnish men and 7392 women of 35 to 64 years of age without a history of stroke, coronary heart disease, or diabetes at baseline. Hazards ratios of incidence of Type 2 diabetes were estimated by levels of occupational, commuting, and leisure-time physical activity.

RESULTS

During a mean follow-up of 12 years, there were 373 incident cases of Type 2 diabetes. In both men and women combined, the hazards ratios of diabetes associated with light, moderate and active work were 1.00, 0.70 and 0.74 (p=0.020 for trend) after adjustment for confounding factors (age, study year, sex, systolic blood pressure, smoking, education, the two other types of physical activity and BMI). The multivariate-adjusted hazards ratios of diabetes with none, 1 to 29, and more than 30 min of walking or cycling to and from work were 1.00, 0.96, and 0.64 (p=0.048 for trend). The multivariate-adjusted hazards ratios of diabetes for low, moderate, high levels of leisure-time physical activity were 1.00, 0.67, and 0.61 (p=0.001 for trend); after additional adjustment for BMI, the hazards ratio was no longer significant.

CONCLUSIONS/INTERPRETATION

Moderate and high occupational, commuting or leisure-time physical activity independently and significantly reduces risk of Type 2 diabetes among the middle-aged general population.

Advanced wound care materials: developing an alginate fibre containing branan ferulate

OBJECTIVE

This laboratory-based study set out to establish whether branan ferulate--a polysaccharide compound available in gels such as as Sterigel (SSL International, UK)--could be successfully added to the fibre of an alginate dressing to provide a superior wound-care dressing.

METHOD

A wet extruder (Howden Engineering Services, UK) was used to produce the fibres. Researchers examined the effect of spinning-bath calcium chloride concentration (used as the coagulant in the fibre-spinning process) on the tensile and absorption properties of alginate fibres containing 25% w/w branan ferulate. Sodium alginate and branan ferulate were separately dissolved in de-ionised water and then stirred together to make up a 5% dope solution. The dope was then forced through a spinneret and into the calcium chloride bath, where fibres were precipitated and then carried over the first set of rollers. The fibres were washed in the next bath and drawn at different rates to enhance their tensile properties. At the 'winding-up' stage the filaments were either passed over a contact heater and into a furnace (dry pick-up) or transferred into acetone baths of increasing concentrations of 50, 80 and 100% aqueous acetate to remove the water (wet pick-up). The moisture content of standard alginate fibres and those with branan ferulate were measured and compared. Breaking load, tenacity and breaking extension, and the quantity of branan ferulate in the fibres were also measured. The process was repeated four times, using different strengths of calcium chloride. Using various draw ratios, the effects of liquid uptake were measured using water, saline and a solution called A (to mimic human blood and exudate-type fluids).

RESULTS

Out of the four calcium chloride concentrations used, 1% concentration appeared to give the highest and most conclusive results for fibre-breaking load, tenacity and breaking extension.

CONCLUSION

A 1% w/v concentration of calcium chloride provides the optimum conditions for achieving suitably strong fibres with adequate absorption capacity, while allowing the least branan ferulate loss during wash and post-production treatments. In a laboratory setting the product showed promise. Research is now needed in a clinical setting and for comparison with existing wound-care products.

Two-hour glucose is a better risk predictor for incident coronary heart disease and cardiovascular mortality than fasting glucose

AIMS

To assess the predictive value of fasting and 2-h glucose after a 75 g glucose load, with regard to incidence of coronary heart disease and cardiovascular mortality.

METHODS AND RESULTS

6766 subjects from five Finnish cohorts aged 30-89 years were followed up for 7-10 years. Hazards ratios associated with increasing glucose concentrations were homogeneous over studies. Multivariate Cox regression analyses showed that the hazards ratio for one standard deviation increase in 2-h glucose after logarithmic transformation was 1.17 (95% CI 1.05-1.30) for coronary heart disease incidence and 1.22 (1.09-1.37) for cardiovascular mortality. For fasting glucose, they were 1.05 (0.94-1.17) and 1.13 (1.01-1.25), respectively. Inclusion of 2-h glucose in the model based on fasting glucose significantly improved the prediction (P<0.005 for coronary heart disease incidence and P<0.025 for cardiovascular mortality), whereas fasting glucose did not add significant information to the model initially based on 2-h glucose (P>0.10 for both events).

CONCLUSION

In subjects without a prior history of diabetes the association of 2-h glucose with coronary heart disease incidence and cardiovascular morality is graded and independent. The results of our study indicate that 2-h glucose is superior to fasting glucose in assessing the risk of future cardiovascular disease events.

High serum insulin-like growth factor binding protein-1 is associated with increased cardiovascular mortality in elderly men

Insulin-like growth factor binding protein-1 (IGFBP-1) has been implicated in the development of cardiovascular disease, but it is not known whether IGFBP-1 is related to cardiovascular mortality. We examined the relation of circulating IGFBP-1 to death from coronary heart disease, cardiovascular disease, and all causes in a cohort study consisting of 622 men aged 65 - 84 years, at baseline in 1984. Fasting serum IGFBP-1 and other risk factors were measured in 1984 and 1989. Cardiovascular events for those who died between 1984 and 1995 were analyzed, and cardiovascular diagnoses were coded centrally according to standardized procedures. Of the 622 men, 358 died between 1984 and 1995; 160 deaths were due to cardiovascular causes, 113 of which were coronary deaths. High fasting serum IGFBP-1 concentration (> 75 percentile) in 1984 was associated with increased five-year total mortality (OR 2.05, 95 % CI 1.41 - 2.99; p < 0.0002), cardiovascular mortality (OR 2.20, 95 % CI 1.37 - 3.50; p < 0.0009) and coronary heart disease mortality (OR 2.29, 95 % CI 1.35 - 3.88; p < 0.002). After adjustment for age, high serum IGFBP-1 concentrations still carried an increased risk of total mortality due to (OR 1.73, 95 % CI 1.16 - 2.59; p < 0.007), cardiovascular (OR 1.91 95 % CI 1.18 - 3.09; p < 0.008) and coronary heart disease (OR 2.02. 95 % CI 1.18 - 3.47; p < 0.01). In conclusion, high fasting serum IGFBP-1 is related to increased five-year total and cardiovascular mortality in elderly men.

Stereochemical control factors in the Hantzsch thiazole synthesis: a Hammett substitution correlation analysis

[reaction--see text] It is possible to correlate the distribution of stereochemical products produced during a Hantzsch thiazole synthesis according to the Hammett free-energy equation. This analysis confirms the presumed control of the rate of epimerization during thiazole formation due to stabilization of a cationic transition state intermediate during dehydration of the thiazoline ring system. In the chemical system under study, the stereochemical outcome of the reaction also appears to occur according to a kinetically controlled protonation of a thiazoline tautomer.

[Magnetic stimulation: theory and advance]

Magnetic stimulation is a noninvasive diagnostic and therapeutic technique. The basic theory of magnetic stimulation is presented briefly. Its advances are elaborated in three aspects of mechanism, instrumentation and applications. The problems in focality, location, safety and its trend are discussed.

[Study on effect of spleen invigorating, qi benefiting and dampness removing Chinese drugs and Western medicine on serum epidermal growth factor in chronic atrophic gastritis patients]

OBJECTIVE

To investigate the effect of various combinations of Spleen invigorating and Dampness removing recipes and western medicine on level of serum epidermal growth factor (sEGF) in patients of chronic atrophic gastritis (CAG).

METHODS

By means of Syndrome Differentiation three groups were divided as (1) Spleen invigorating I group (SI-I); (2) Spleen invigorating II group (SI-II); (3) Dampness removing group (DR); (4) western medicine group (WM); (5) healthy volunteers served as normal control group. The changes of symptoms and sEGF level were determined and compared between groups as well as before and after treatment.

RESULTS

The sEGF in various groups of CAG were higher than that in the normal control (P < 0.01). In patients of SI-I and II groups, symptoms and pathological manifestations were improved significantly (P < 0.01), and sEGF dropped markedly after treatment (P < 0.01 and P < 0.05). The level of sEGF in DR raised after treatment (P < 0.05), but the level of sEGF in WM group lowered insignificantly.

CONCLUSION

Inflammation of gastric mucosa could cause responsive elevation of sEGF in CAG patients. After treated with Spleen invigorating and Dampness removing Chinese drugs, the symptoms of CAG improved, simultaneously with the restoration of sEGF. sEGF could be taken as a sensitive index of the prognosis of CAG.

Reduced membranous and ectopic cytoplasmic expression of beta -catenin correlate with cyclin D1 overexpression and poor prognosis in pancreatic cancer

Beta-catenin is a component of the E-cadherin-catenin cell adhesion complex. It plays also a role in intracellular signaling and can function as an oncogene when it binds to the T-cell factor 4 (Tcf4)-binding site in the promoter region of cyclin D1 and transactivates genes after translocation to the nucleus. We evaluated the immunohistochemical expression pattern of beta-catenin in relationship with cyclin D1 overexpression, tumor grade, clinicopathologic parameters and patients' survival in 43 ductal adenocarcinomas of the pancreas and 5 normal pancreatic tissues. We were able to show that, both reduced membranous beta-catenin expression (25 of 43, 58.1%) and accumulation of beta-catenin in the cytoplasm (28 of 43, 65.1%) correlated significantly with cyclin D1 overexpression (both p < 0.0005). Furthermore, we could show a clear correlation between reduced membranous expression and ectopic cytoplasmic expression of beta-catenin (p < 0.0005). Among patients with carcinomas showing no cytoplasmic expression, the 1-year survival was 86.6% whereas among patients with carcinomas showing cytoplasmic expression only 35.7% survived 1 year (p < 0.01). Co-precipitation experiments revealed reduced beta-catenin bound to the E-cadherin-catenin complex in pancreatic tumor tissues compared with normal pancreatic tissues. These results suggest that beta-catenin may be involved in the tumorigenesis of pancreatic cancer and exhibited its effects mainly by the transactivation of cyclin D1.

Reduced membranous and ectopic cytoplasmic expression of beta -catenin correlate with cyclin D1 overexpression and poor prognosis in pancreatic cancer

Beta-catenin is a component of the E-cadherin-catenin cell adhesion complex. It plays also a role in intracellular signaling and can function as an oncogene when it binds to the T-cell factor 4 (Tcf4)-binding site in the promoter region of cyclin D1 and transactivates genes after translocation to the nucleus. We evaluated the immunohistochemical expression pattern of beta-catenin in relationship with cyclin D1 overexpression, tumor grade, clinicopathologic parameters and patients' survival in 43 ductal adenocarcinomas of the pancreas and 5 normal pancreatic tissues. We were able to show that, both reduced membranous beta-catenin expression (25 of 43, 58.1%) and accumulation of beta-catenin in the cytoplasm (28 of 43, 65.1%) correlated significantly with cyclin D1 overexpression (both p < 0.0005). Furthermore, we could show a clear correlation between reduced membranous expression and ectopic cytoplasmic expression of beta-catenin (p < 0.0005). Among patients with carcinomas showing no cytoplasmic expression, the 1-year survival was 86.6% whereas among patients with carcinomas showing cytoplasmic expression only 35.7% survived 1 year (p < 0.01). Co-precipitation experiments revealed reduced beta-catenin bound to the E-cadherin-catenin complex in pancreatic tumor tissues compared with normal pancreatic tissues. These results suggest that beta-catenin may be involved in the tumorigenesis of pancreatic cancer and exhibited its effects mainly by the transactivation of cyclin D1.

Diagnostic criteria of glucose intolerance and mortality

In 1997 American Diabetes Association (ADA) Expert Committee approved changing the diagnostic criteria for diabetes. The major change is to lower fasting plasma glucose from 7.8 mmol/l to 7.0 mmol/l for diabetes and did not recommend the use of 2-hour 75 g oral glucose tolerance test (OGTT). The decision by the ADA not to recommend the OGTT has been criticised based on the findings of several recent studies, in particularly those from the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) and in Asia (DECODA) Studies. These studies have reported that only 29% of all newly screened diabetic subjects qualified for diabetes on both the fasting and the 2-hour glucose criteria in European and 37% in Asian populations. It has now been clearly shown that elderly and less obese patients are more likely to have diagnostic 2-hour values, whereas fasting hyperglycaemia is more common among obese subjects. Analysis of the prospective DECODE data showed that elevated 2-hour glucose was a better predictor of mortality from all-cause and from cardiovascular and non-cardiovascular diseases than elevated fasting glucose alone. The largest absolute number of excess deaths was observed in subjects with impaired glucose tolerance (IGT), especially in those whose fasting glucose was normal.

[Preliminary study of closing cleft of soft palate at an early age for complete cleft palate]

OBJECTIVE

The aim is to introduce the method closing the soft palate at an early age in order to produce better speech and lessen interruption to the development of maxilla.

METHODS

Clinical data of 37 cases with treated cleft were preliminarily analyzed. Some dental casts were measured.

RESULTS

1. No complications of anaesthesia and surgery. Except 2 cases whose soft palates were split after surgery were observed as they were coughing. 2. A reduction in the width of the hard palate cleft was noticed.

CONCLUSION

Closing the soft palate at an early age is possible and safe. It shows that the Langebeck method could be used to close the hard palate of patients at an early age.

Antihypertensive drugs as predictors of type 2 diabetes among subjects with impaired glucose tolerance

AIMS

to examine the incidence rate of progression to Type 2 diabetes and baseline prognostic risk factors, focusing on hypertension and antihypertensive medication, in a cohort (n=207) with impaired glucose tolerance (IGT).

METHODS

after 2 and 4.6 (1. 9-6.4) years new cases of diabetes were diagnosed by the oral glucose tolerance test (OGTT). Hypertension (BP 160/95 or antihypertensive medication) was included in multiple regression analyses to assess the effect of risk factors on the development of diabetes.

RESULTS

diabetes developed in 32 subjects (19%), an incidence of 41/1000 (95% CI 28-57/1000) person-years. In univariate analyses, progression to diabetes was associated with a high (>9.0 mmol/l) 2-h OGTT value (P=0.008), a high fasting insulin (>12.0 mU/l) level (P=0.000), a high triglyceride (>/=1.3 mmol/l) level (P=0.028), a high BMI (>/=28.0 kg/m(2)) (P=0.013) and hypertension (P=0.003). The risk for the development of diabetes was not increased in hypertensive subjects without antihypertensive medication compared with normotensive subjects (OR 0.8, 95% CI 0.3-2. 6). However, it was increased in subjects with on medication, especially diuretics alone or in combination with other drugs. Hypertensive subjects on diuretics had higher levels of fasting insulin and triglycerides and higher BMIs at baseline than normotensive subjects. After adjustment for 2-h OGTT, fasting insulin, triglycerides and BMI, the OR for diabetes was 7.7 (95% CI 2.1-28.2) in hypertensive subjects using diuretics alone or in combination with other drugs and 2.6 (95% CI 1.0-6.7) in those using other drugs compared with normotensive subjects. The OR of diabetes corresponding to a one-unit increase in the 2-h OGTT concentration was 2.5 (95% CI 1.6-4.0) in the whole cohort.

CONCLUSIONS

the rate of progression from IGT to Type 2 diabetes in this population was similar to that seen in other studies among Caucasian populations. The use of antihypertensive medication, especially diuretics, and a high 2-h OGTT level were significant predictors of subsequent deterioration to diabetes.

Comparison of the fasting and the 2-h glucose criteria for diabetes in different Asian cohorts

AIMS/HYPOTHESIS

The American Diabetes Association recommended that only a single fasting plasma glucose of greater than or equal to 7.0 mmol/l should be used for diagnosing diabetes in epidemiological studies and did not recommend using a 2-h oral glucose tolerance test. We evaluated the effect of diagnostic changes on the prevalence of diabetes and on the choice of subjects diagnosed with diabetes.

METHODS

Existing epidemiological data collected from Asian people between 30 and 89 years of age, was re-analysed separately in 11 population-based studies (n = 17,666), 6 pre-selected hyperglycaemic cohorts (n = 12,221) and one suspected diabetic cohort (n = 8382).

RESULTS

Among the 11 population-based studies, the new fasting glucose criteria resulted in an overall reduction of 1.8% in the prevalence of diabetes, which ranged from a reduction of 4.8% to an increase of 1.7% in the different studies. Of 1215 subjects diagnosed with diabetes by either criteria, only 449 met both criteria, a concordance of 37%. More than half of the diabetic subjects had isolated post-challenge hyperglycaemia and three quarters of the subjects with impaired glucose tolerance, according to the 2-h glucose criteria, were normal according to the fasting glucose criteria. Subjects diagnosed as diabetic based only on the 2-h glucose criteria were, on average, older than those with diabetes according to the fasting criteria.

CONCLUSION/INTERPRETATION

The fasting and the 2-h glucose criteria diagnose different groups of subjects. It would therefore be inappropriate to use the fasting glucose criteria alone for screening diabetes in Asian populations.

[Clinical analysis of 40 patients who were re-operated after prosthetic augmentation mammaplasty]

OBJECTIVE

To summarize the reasons of complications after prosthetic augmentation mammaplasty and explore the optimal preventive measures and therapy.

METHOD

The reasons for 40 patients who were re-operated on after prosthetic augmentation mammaplasty were analyzed in as many aspects as possible, such as the location of the incision, the type of the prosthesis, etc. Preventive measures and therapy of the complications were also summarized.

RESULTS

Capsular contracture was the most common reason for reoperation. The second was prosthetic rupture and translocation. The main reasons resulting in complications included impertinent indications, poor quality of the prosthesis and an incompetent surgeon.

CONCLUSIONS

The key to reduce the complications is proper selection of good prosthesis, strict indications, better comprehension of the knowledge about prosthetic augmentation mammaplasty and a qualified plastic and aesthetic surgeon for the operation. The inareolar incision is the best choice to remedy the complications.

Mortality from all causes and from coronary heart disease related to smoking and changes in smoking during a 35-year follow-up of middle-aged Finnish men

AIMS

The risk of early and late death in relation to smoking and ex-smoking were studied.

METHODS AND RESULTS

A cohort of 1711 Finnish men born between 1900 and 1919 were recruited in 1959 and followed up for 35 years. Information on smoking status was collected at each of six examinations made from 1959 to 1989 using a standardized questionnaire. Vital status at the end of 1994 was collected for every man. The effect of smoking on mortality was assessed using Cox proportional hazards model. Adjusted ratios for 35-year all-cause mortality were 1.62 (95% CI 1.40-1.88) in current smokers and 1.13 (CI 0.93-1.36) in former smokers compared with non-smokers. The hazards ratios for 35-year coronary heart disease mortality were 1. 63 (CI 1.24-2.13) and 1.39 (CI 1.00-1.94), respectively. The risk for 10 year mortality was stronger than for 35 year mortality among both former and current smokers, given the same amount of cigarettes consumed. Men smoking persistently were most at risk, while those who persisted in quitting had no increased risk of death compared with non-smokers.

CONCLUSION

Smoking increases the risk of premature death in middle-aged men and giving up smoking earlier in life can prevent smoking attributable premature death.

Short stature and coronary heart disease: a 35-year follow-up of the Finnish cohorts of The Seven Countries Study

OBJECTIVES

To examine whether short stature is associated with an increased risk of coronary heart disease.

DESIGN

Follow-up study.

SETTING

Two geographically defined areas in eastern and western Finland.

SUBJECTS

A total of 1441 men who were free of coronary heart disease at the start of the follow-up.

MAIN OUTCOME MEASURES

Hazard ratios for fatal and non-fatal coronary heart disease

RESULTS

Height was inversely related to fatal coronary heart disease and incident non-fatal coronary heart disease during the follow-up. These relationships persisted after adjusting for other major cardiovascular risk factors. Comparing the high-risk area in eastern Finland with the low-risk area in south-western Finland, no difference in fatal coronary heart disease and cumulative incidence of non-fatal coronary heart disease was seen in tall men. The increase in risk of coronary heart disease death was 19% for a 10 cm decrease in height (OR = 0.81, 95% CI = 0.68-0.95).

CONCLUSIONS

Our results show that short stature is an independent risk factor for coronary heart disease. Differences in stature partly explain the Finnish east-west difference in the incidence of coronary heart disease.

A general approach to cyathin diterpenes. Total synthesis of allocyathin B(3)

[reaction: see text] The synthesis of allocyathin B(3) from an advanced intermediate possessing the ring system and relative stereochemistry but lacking the isopropyl and hydroxymethyl groups is reported. The isopropyl group was introduced by radical cyclization of a methyl propargyl acetal of an alpha-bromo ketone, and the hydroxymethyl group was generated by Pd-catalyzed carbonylation of a vinyl triflate. The route provides functionalized intermediates that could allow access to more complex members of the cyathin family of diterpenes.

Application of hemodilution in microsurgical free flap transplantation

The intra-operative hemodilution and blood auto-transfusion is a blood-saving technique that can be performed when major blood loss is expected. The effects of this technique were studied in 30 microsurgical free flap transplantation patients. Between 400-600 ml blood was collected from the patients before surgery. The patients received dextran, a balanced salt solution, and glucose with the ratio of 3:1 to the collected blood volume, bleeding, and urine before the blood auto-transfusion. There were no significant changes in RBC, HCT, MCV, blood pressure, or heart rate. Of the 30 free flaps, 28 were successful with a 93.3% survival rate. The safety of intra-operative hemodilution and autologous blood transfusion in microsurgery as well as the effect of hemodilution on transplanted flap survival are discussed in this study.

[Relation of venous drainage and inadequate circulation in the rat pedicled TRAM flap model]

OBJECTIVE

To evaluate the circulatory characteristics of the TRAM flap because the vascular supply to lateral portion of the conventional TRAM (zone 4) occasionally may become compromised resulting in necrosis of fat tissue or requiring segmental excision of the poor perfused tissue.

METHODS

In this study, we designed a rat pedicled TRAM flap model with either inadequate arterial or venous circulation. The skin paddle was photographed and the survival areas were measured on the tenth postoperative day.

RESULTS

The results showed that the group with poor arterial inflow of the flap, which resulted from ligation of the superior deep epigastric artery, exhibited skin necrosis in zone 1 and 2. Venous stasis due to selective ligation of the venous pedicle resulted in necroses of a major area in the lateral part of the flap, especially in zone 4. However, venous stasis may be alleviated by an additional cutaneous venous return system.

CONCLUSIONS

Our results demonstrated that conventional rat TRAM flap with poor arterial inflow differs from that with venous stasis in terms of manifestations and extent of inadequate circulation. Necrosis of the lateral portion of human TRAM flaps may therefore be attributed to problems of venous stasis. Such problems might then be ameliorated by creating an additional cutaneous venous return system.

Smoking and the risk of diabetes in elderly Finnish men. Retrospective analysis of data from a 30-year follow-up study

OBJECTIVE

To assess the association of smoking with the risk of glucose intolerance (diabetes plus impaired glucose tolerance).

RESEARCH DESIGN AND METHODS

A cohort consisting of 1,711 Finnish men born in 1900-1919 were followed up from 1959 to 1994. Smoking status was assessed in a similar way at each of the six surveys from 1959 to 1989, and subjects were classified as never, former, or current smokers. Diagnosis of diabetes and impaired glucose tolerance was made according to the oral glucose tolerance tests made in 1984 and 1989, and the 1985 World Health Organization criteria was applied.

RESULTS

Association between smoking and glucose intolerance was estimated separately for 420 participants and 243 nonparticipants in 1989. Multiple logistic regression analyses show that odds ratios of glucose intolerance in 1984 for current smokers in 1984 were 0.36 (0.19-0.70) and 1.20 (0.52-2.78), respectively, in the participants and the nonparticipants in 1989. Among the nonparticipants in 1989, the odds ratio for current smokers in 1969 was 2.23 (1.00-4.96). A reduced risk of glucose intolerance in 1989 associated with smoking in the participants in 1989 was found to be significant from the beginning of the follow-up. The participants in 1989 were generally healthier and had a longer life expectancy than the nonparticipants in 1989.

CONCLUSIONS

In a retrospective study of men, an increased risk of diabetes and impaired glucose tolerance in smokers was found among the nonparticipants, but a reduced risk was found among the participants in 1989. The difference observed might be attributed to the fact that the participants were constitutionally different from the nonparticipants.

109 cases of blepharoptosis treated by forked frontalis muscle aponeurosis procedure with long term follow-up

109 cases of severe or recurrent blepharoptosis have been treated with the forked frontalis muscle aponeurosis (FFMA) technique since 1989. In comparison with other frontalis muscle flap (FMF) protocols, this technique has three advantages: (i) no skin incision in the lower rim of the eyebrow; (ii) no incision in the frontalis muscle; and (iii) no dissection under the frontalis muscle. The FFMA is formed at the junction of the frontalis and orbicularis muscles. The 9-year follow-up shows that this is a highly effective procedure. The postoperative function of the frontalis muscle is good and the lack of damage has been confirmed by EMG. There are a few complications such as the sluggishness of the upper eyelid on downward gaze and the possibility of asymmetrical brow height in unilateral blepharoptosis. However, this technique may serve as the best choice in the treatment of severe or recurrent blepharoptosis.

Patterns of flap loss related to arterial and venous insufficiency in the rat pedicled TRAM flap

Vascular supply to the contralateral portion of the conventional transverse rectus abdominis musculocutaneous (TRAM) flap (zone IV) may become compromised, resulting in partial flap loss and requiring segmental excision. The etiology of this necrosis is not clear. This study determines skin necrosis patterns on a superiorly pedicled caudal TRAM flap during conditions of venous and arterial insufficiency, and determines whether cutaneous venous outflow can sustain a flap with venous insufficiency. Twenty-eight adult male Sprague-Dawley rats underwent superior pedicled TRAM flap elevation, and the zones were marked on the skin paddle. The animals were divided into four groups: control (group A, N = 6), arterial ligation (group B, N = 6), venous ligation (group C, N = 8), and venous ligation with cutaneous venous outflow (group D, N = 8). After 10 days, the skin paddle was photographed and the areas of necrotic skin were measured. Results showed that group B (selective arterial ligation) had 51.7 +/- 2.8% and 40.0 +/- 2.0% skin necrosis in zones I and II respectively. Zone I necrosis was significantly greater in group B compared with the control (p < 0.05). Group C (selective venous ligation) resulted in 73.8 +/- 16.4% and 93.8 +/- 33.4% skin necrosis in zones III and IV respectively. This necrosis was significantly greater compared with the control (p < 0.001). Group D rats' lateral skin necrosis compared significantly less with group C (p < 0.001). These results demonstrate that the patterns of flap necrosis in rat TRAM flaps with poor arterial inflow differ from those with venous stasis. Necrosis of the contralateral portion (zone IV) of human TRAM flaps may be related to problems with venous stasis; thus, a cutaneous venous outflow may prevent this problem.

Prevalence of retinopathy in people with diabetes, impaired glucose tolerance, and normal glucose tolerance

OBJECTIVE

Recently, an international expert committee published new revised criteria for diagnosing diabetes. According to the new criteria, the 2-h glucose level for diabetes in the oral glucose tolerance test (OGTT) is the same as in the previous World Health Organization criteria, but the cut point for the fasting blood glucose level has been lowered to be equivalent to the 2-h OGTT level. Measurement of the fasting blood glucose level is preferred to the 2-h OGTT glucose level. The ability of the new cut point for fasting blood glucose to discriminate between those at a high and a low risk for retinopathy was tested in a population-based study

RESEARCH DESIGN AND METHODS

The population consisted of all the 1,008 subjects (456 men) born in 1935 and living in a Finnish city A screening for type 2 diabetes was carried out in the first phase. All participants who were not on antidiabetic medication were invited for an OGTT in the second phase. A fasting blood glucose value was measured from the diabetic subjects on antidiabetic medication. In addition, measurements of serum cholesterol, HDL cholesterol, and triglycerides were made, and fundus photographs were taken. Altogether, 831 subjects (368 men) (82%) participated and constitute the eligible study population for the present analyses. Fundus photographs were available for 790 subjects (347 men) (95%).

RESULTS

There were 28 subjects (3.5%) who had mild retinopathic changes in the fundus photographs. Retinopathic changes were associated with higher fasting blood glucose levels, but not with any of the other background factors. The prevalence of retinopathy was 10.2% (95% CI 4.8-18.5) in subjects with a fasting blood glucose of > or =6.1 mmol/l, while it was 2.6% (1.5-4.0) in those with a lower fasting blood glucose level. In the former group, a majority (seven of nine) of the subjects with retinopathy were previously diagnosed diabetic patients. Some cases of retinopathy were found regardless the level of glycemia, and measurement of the 2-h OGTT glucose levels did not increase information.

CONCLUSIONS

The results of this population study give support to the use of fasting blood glucose levels in diagnosing type 2 diabetes. The lower limit of the highest decile of the fasting glucose level was 6.1 mmol/l, and it discriminated subjects at a high risk for retinopathy from those at a low risk. Because of the limited number of subjects with retinopathy in this study, the level of hyperglycemia associated with retinopathy cannot be estimated accurately.

Ultrasonographic manifestations of carotid atherosclerosis and glucose intolerance in elderly eastern Finnish men

OBJECTIVE

To study the association of ultrasonographic manifestations of common carotid atherosclerosis with glucose intolerance in survivors of the cohort of men born in 1900-1919 in eastern Finland.

RESEARCH DESIGN AND METHODS

Carotid ultrasonography was carried out for 182 men in 1989. Glucose tolerance status classified based on an oral glucose tolerance test in 1984 and 1989 surveys was used in both prospective and cross-sectional analyses.

RESULTS

Carotid atherosclerosis was common in men aged 70-89 years. There was no significant difference in the maximal carotid intimal-medial thickness between diabetic and nondiabetic men and over different age-groups; it was 1.28, 1.33, and 1.36 mm in subjects with diabetes, impaired glucose tolerance, and normal glucose tolerance, respectively (P = 0.69). No association between the presence of a nonmineralized or a mineralized atherosclerotic lesion with diabetes was found. Fasting plasma insulin did not relate to ultrasonographically detectable atherosclerotic lesions.

CONCLUSIONS

Hyperglycemia and hyperinsulinemia may not be main contributors to atherosclerosis in elderly men, partly because smoking is less common and total and LDL cholesterol concentrations are lower in diabetic men than in men with normal glucose tolerance.

Clinical experience with orbicularis oculi myocutaneous flaps in the temporal area

There are many methods to repair facial skin defects in clinical practice. The desired outcome for the surgeon and the patient is the restoration of facial appearance and function. The temporal region is one of the ideal donor sites for the repair of a facial skin defect, because this area is relatively inconspicuous and the skin quality is similar to that of the face. In the past, the temporal region was always used as the donor site of the local flap for repairing the facial skin defect. Because the blood supply of the skin comes from the subjacent tissue mainly rather than from the contiguous tissue, the pedicles of the local flaps are short, limiting the use of this area as a donor site. From 1993 to 1996, the anatomy of the orbicularis oculi myocutaneous flap in five cadavers was studied; what was learned allowed for the use of this flap to repair skin defects of the face in 13 patients. In this paper, the clinical experiences using the orbicularis oculi myocutaneous flaps to repair skin defects of the face and the surgical anatomy of this myocutaneous flap are discussed.

[The pathological action of surrounding connective tissues of alar cartilage in the cleft lip nose]

OBJECTIVE

This study was to explore the pathological action of the adjacent connective tissues of alar cartilage in unilateral cleft lip nose.

METHODS

Anatomic-histological and pathoanatomical study was carried on 40 normal cadavers and 30 patients with secondary deformities of unilateral cleft lip during their operations.

RESULTS

Six kinds of connective tissues with different histological features were found between the alar cartilage and adjacent skin, cartilage or bone. There was no histological difference in each connective tissue between the normal and the cleft lip nose. In the cleft lip nose, due to histological differences among the six connective tissues, there existed various changes of pathological dislocations between the alar cartilage and adjacent skin, cartilage or bone.

CONCLUSION

The authors suggest that the surrounding connective tissues of the alar cartilage play an important role and be the intrinsic basis to produce the characteristic deformities of the cleft lip nose. The result is helpful in understanding the anatomical and histological features of the connective tissues around the alar cartilage and the deformities of the unilateral cleft lip nose so as to select a reasonable operation method.

Hypertension, hyperinsulinaemia and obesity in middle-aged Finns with impaired glucose tolerance

The aim of the study was to analyse the data obtained from a 2-year follow-up study of middle-aged Finnish subjects (n = 183) with a previous history of impaired glucose tolerance (IGT) in order to elucidate the longitudinal relationships between hypertension, fasting hyperinsulinaemia and obesity. Hypertension was defined as either a systolic blood pressure (BP) of > or =160 mm Hg or a diastolic BP of > or =95 mm Hg or being on anti-hypertensive medication regardless of the BP value. Multiple logistic regression analysis adjusted for glucose tolerance status, serum lipids, exercise behaviour and alcohol consumption shows that the odds ratios of one unit (mU/l) increase in the baseline fasting insulin concentration were 1.13 (95% confidence interval 1.00-1.28) for the 2-year incidence of hypertension in subjects with IGT at baseline. Baseline body mass index (BMI) also predicted the 2-year incidence of hypertension, with an odds ratio of 1.20 (95% CI 1.02-1.42). BMI correlated positively with fasting insulin level (r = 0.54, P < 0.001). It is concluded that an elevated fasting insulin concentration as well as an increased BMI preceded the onset of hypertension in subjects with IGT. It may suggest a causal relationship between hypertension and hyperinsulinaemia.

[Clinical and experimental study of improving left ventricular diastolic function by total saponins of panax notoginseng]

OBJECTIVE

To investigate the effect of total saponins of Panax Notoginseng (TSPNS) on left ventricular diastolic function in patients with essential hypertension (EH) and possible mechanism.

METHODS

Left ventricular diastolic function (peak E, peak A, E/A, A area fraction, E area fraction), left ventricular muscle mass index (LV-MI), intraerythrocytic calcium and calcium pump activity on erythrocytes membrance of 30 patients with EH before and after the combined treatment of captopril and TSPNS were measured. Captopril was used singly on 30 patients above mentioned that were also studied as self-control. Observation of TSPNS and normal saline was used on a matched control in treating SHR rats. WKY rats of similar age were also studied as normal control.

RESULTS

Left ventricular diastolic function were improved markedly by TSPNS. The activity of calcium pump on membrance of sarcoplasmic reticulum were increased and the myocardial intracellular calcium were decreased and the left ventricular muscle mass were reduced after treatment of TSPNS. The calcium and calcium pump of erythrocyte showed marked simple correlation with myocardial cell.

CONCLUSIONS

The TSPNS could improve myocardial relaxation function due to enhancing calcium pump activity and inhibiting intracellular calcium overload and lightening left ventricular muscle mass.

[Diagnosis and treatment of congenital choledochal cysts in adults]

We report the experience with 97 adult patients with bile duct cysts in the past 30 years (1965-1995). The median age at time of initial therapy in our department was 37 years (range, 16 to 78 years). Clinical symptoms in most cases were non-specific, resulting in delayed diagnosis. 74 patients (76%) had coexistent pancreaticohepatobiliary disease. Carcinoma of the biliary duct occurred in 16 patients (17%). Abnormal pancreatobiliary duct junction (APBDJ) was found in 28 patients. 94 patients underwent a total of 169 biliarytract procedures. Cyst excision with Roux-en-y hepaticojejunostomy and internal drainage were the main procedures. The result of long-term follow-up shows that internal drainage frequently resulted in recurrent cholangitis and cyst malignancy which need reoperation. In contrast, cyst excision was associated with a significantly lower incidence of recurred cholangitis and lower occurrence of malignancy. Thus, cyst excision with Roux-en-y hepaticojejunostomy is recommended as the treatment of choice for adult patient.