Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study

OBJECTIVE

Individuals with impaired glucose tolerance (IGT) have a high risk of developing NIDDM. The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM, i.e., reduce the incidence of NIDDM, and thereby reduce the overall incidence of diabetic complications, such as cardiovascular, renal, and retinal disease, and the excess mortality attributable to these complications.

RESEARCH DESIGN AND METHODS

In 1986, 110,660 men and women from 33 health care clinics in the city of Da Qing, China, were screened for IGT and NIDDM. Of these individuals, 577 were classified (using World Health Organization criteria) as having IGT. Subjects were randomized by clinic into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM. Cox's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment.

RESULTS

The cumulative incidence of diabetes at 6 years was 67.7% (95% CI, 59.8-75.2) in the control group compared with 43.8% (95% CI, 35.5-52.3) in the diet group, 41.1% (95% CI, 33.4-49.4) in the exercise group, and 46.0% (95% CI, 37.3-54.7) in the diet-plus-exercise group (P < 0.05). When analyzed by clinic, each of the active intervention groups differed significantly from the control clinics (P < 0.05). The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight (BMI < or > or = 25 kg/m2). In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31% (P < 0.03), 46% (P < 0.0005), and 42% (P < 0.005) reductions in risk of developing diabetes, respectively.

CONCLUSIONS

Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT.

[Preliminary study on pathophysiology of liver-qi deficiency syndrome]

The authors advocate a program for diagnosing Liver-Qi Deficiency Syndrome (LQDS) based on the TCM theory and clinical practice. Through investigation, LQDS was found to be widely existed as latent period or as external manifestation, which occupied 18.85% in Qi Deficiency Syndrome. The subjects were divided into four groups including normal group, Spleen-Qi Deficiency Syndrome (SQDS) group, LQDS with Liver diseases (LD) and LQDS with non-Liver diseases (NLD) group. In order to explore the essence, the simultaneous determinations were done on lactate dehydrogenase (LDH) and its isoenzyme, dopamine beta-hydroxylase (D beta H), trace element Zn and Cu, and other serological indexes such as GPT, TP, Alb, A/G, etc. The results were, the content of LDH and trace element Zn in both LQDS-NLD and SQDS were significantly lower than that of normal group. D beta H reflecting sympathetic nerve function in LQDS-NLD was significantly higher than that of both normal and SQDS group; comparing LQDS-LD and LQDS-NLD group, the content of GPT, LDH, LDH5 and trace element Cu in former was significantly higher than that of the latter, but the content of TP, Alb, A/G, D beta H and Zn in former was remarkably lower than that of the latter. In order to avoid confusion, in studying this syndrome, one should distinguish LD and NLD.

[Characterization of a fluorouracil-resistant human gastric carcinoma cell line and its morphological behavior]

A fluorouracil (FU)-resistant human carcinoma cell line (SGC-7901/R) was established in culture by progressively increasing the concentration of FU from 50 ng.ml-1 to 2.5 mg.ml-1. The cell line has been successfully subcultured for more than 150 passages during more than 2 years. Its degree of FU resistance was 139-fold vs that of FU sensitive cell line (SGC-7901/S), and the resistant phenotype was stable when cells were cultured for 23 passages in FU-free medium. The doubling time was 17.3 and 25.6 h for resistant cells and parental cells, respectively. Swiss (nu/nu) nude mice were used for the in vivo experiment, the FU-resistant cell line also exhibited resistance to FU and cross-resistance to mitomycin C. FU inhibited markedly the incorporation of [3H]UR into sensitive cells and only showed a 31.6% inhibition with FU 100 micrograms.ml-1 in resistant cells. For the incorporation of [3H]TdR into DNA, inhibitory rates were seen with different concentrations of FU in resistant cells. By morphologic observation, SGC-7901/R cells showed little secretion but without any tendency to glandular pattern. Their nuclei were allotype with enlarged perinuclear space and a few intranuclear pseudoinclusions. The mitotic phase of cells was found frequently. The phenotype of resistant cell line can be deduced more malignant than that of parental cell line.

[Effects of sex hormones on plasma lipoproteins in middle older age non-diabetes, diabetes and coronary heart disease]

We has observed the effects of sex hormones on plasma lipoproteins by analysing 165 patients of non-diabetes mellitus (NDM), diabetes mellitus (DM) and coronary heart disease (CHD) in the elder than 45 years. Of these subjects, NDM were 54, DM 47, CHD 48 and DM with CHD 16. The result statistically showed that is a significant difference in high density lipoprotein cholesterol (HDL-C) and Apolipoprotein A1 (Apo-A1) between male and female subjects in NDM group and general population (P = 0.0001, 0.003 and P = 0.009, 0.002 respectively), but this statistically significant difference could not be observed between male and female patients in groups of DM, CHD and DM with CHD. After adjusting multiple factors of age, body mass index (BMI), estradiol (E2), fasting plasma insulin (FINS), fasting blood glucose (FBS) by the stepwise procedure analysis, the levels of HDL-C and Apo-A1 have significantly negative association with the level of testosterone (T) (P = 0.0012 and 0.0040), however, have no association with E2. Total cholesterol (TC) and triglyceride (TG) have no association with T and E2. The result suggests that T should be an independent risk factor which reduces HDL-C level.

Right gastroepiploic artery: an alternative arterial conduit for coronary artery bypass

From September 1990 to February 1991, 15 cases of myocardial revascularization with the right gastroepiploic artery (RGEA) combined with arterial or venous grafts were performed at VGH-Taipei. All were males, ranging in age from 49 to 64 years (mean age 61.2 +/- 4.6 years). The mean number of distal anastmoses including vein grafts was 3.6 +/- 0.7 and the mean number of graft was 3.1 +/- 0.3 per patient. The mean aortic clamp time was 123.6 +/- 24.0 minutes and the mean cardiopulmonary bypass time was 176 +/- 35 minutes. There was one mortality (6.7%). The other 14 patients are alive without angina. Studied within 3 postoperative months, graft early patency was 100% (6/6) in GEA graft. GEA graft should be a third available arterial conduit for coronary artery bypass.

Pseudoaneurysm of the profundus femoris artery resulting from chronic injury of internal fixation screw

We present an unusual case of pseudoaneurysm of profundus femoris artery which formed after injury from internal fixation screw for intertrochanteric fracture 8 years before. The main clinical manifestation was progressively enlarged pulsating mass and mild intermittent claudication. We resected the pseudoaneurysm after ligating the vessel proximal and distal to the pseudoaneurysm and cut off the excessive tip of the screw. After operation, the recovery was uneventful and no problem of the limb viability was noted.

[Antitumor activities of 4 derivatives of artemisic acid and artemisinin B in vitro]

The cytotoxicities of 2 derivatives of artemisinin B and 2 derivatives of artemisic acid (designated as Compound A, B, C, and D) were investigated, using trypan blue dye exclusion test and colony-forming units assay. At the concentration of 5 micrograms.ml-1, the inhibition rates of these 4 compounds against murine leukemia cell line P388 were > 85%. When tested against human hepatoma cell line SMMC-7721 at 25 micrograms.ml-1, the inhibition rates of Compound A, B, C, and D were found to be 92.3%, 96.9%, 84%, and 82.1%, respectively, and 27%, 8%, 37.8%, 1.7% against normal human embryonic lung cell line WI-38, respectively. These 4 compounds all showed an inhibition rate of 100% against human gastric cancer cell line SGC-7901 at 50 micrograms.ml-1.

A new autoperfusion technique for aortic reconstruction of suprarenal aortic aneurysm

Visceral ischemia is a serious factor in the postoperative morbidity and mortality of suprarenal aortic reconstruction. We reported two patients of suprarenal aortic aneurysm involving visceral arteries, who received successful Dacron graft replacement by using Pruitt-Inahara balloon catheters as an autoperfusion for preservation of the visceral organs. No visceral organ ischemia occurred postoperatively except in patient 2 who had preoperative chronic renal failure and persistent renal failure after the operation. The renal function recovered gradually during the follow-up period. Both patients are doing well at the present time. The new autoperfusion technique can directly deliver normothermic blood from the arterial cannula at proximal aorta to the individual visceral arteries by using the balloon perfusion catheters. It is simple, safe, easily instituted and the used products are readily obtainable. It allows the surgeon to provide an effective protection of visceral organs for the suprarenal aortic reconstruction.

Cytotoxic activity of trewiasine in 4 human cancer cell lines and 5 murine tumors

Trewiasine (TWS) is a mytansinoid compound. It possessed a significant cytotoxic activity against various human cancer cell lines in vitro. U937 cells, which were more sensitive to the TWS, required TWS 1 microgram.ml-1 to inhibit cell growth over 90% (P less than 0.01). TWS also showed activities against murine tumors in vivo, such as the ascitic tumors S180, hepatoma, U14, and solid tumor Lewis lung carcinoma. Depression of leukocytes was not seen when mice were given ip TWS 10 or 50 micrograms.kg-1.d-1 x 7 d. TWS 0.1-1 micrograms.ml-1 caused no sister chromatid exchange induction in Chinese hamster cell line V79.

[Delayed gastric emptying in diabetes mellitus]

Function of gastric motility was studied in thirty one diabetes mellitus patients by testing gastric emptying time (GET). The test was performed by giving patients food labelled with 99mTc. The results showed that GET in patients with diabetes mellitus was significantly delayed as compared with that in the controls (P less than 0.001). 15 among the 31 diabetic patients had delayed GET, accounting for 48.4%. There was no difference in age, duration of the disease, treatment regimen and microvascular complications between patients with delayed GET and those with normal GET. The only difference was the obviously increased incidence of autonomic nerve dysfunction in the former group of patients (P less than 0.05). We concluded that the incidence of delayed gastric emptying time was higher in diabetic patients with autonomic neuropathy.

Large mass-like pulmonary cryptococcosis: report of 2 cases

Pulmonary cryptococcosis, a less common fungal infection, frequently reveals nodular lesions (single or multiple) and patchy infiltrations (alveolar or interstitial) on chest X rays. A large mass-like pattern is less common. Here we report 2 cases of pulmonary cryptococcosis with negative bronchoscopic findings. One patient received a right lower lobectomy under the impression of malignancy; the other received a transthoracic needle aspiration, and numerous cryptococci were found by India ink preparation. Thus, pulmonary cryptococcosis should be included in the differential diagnosis of a mass lesion. A brief review of the literature is also included about diagnostic approach and management of pulmonary cryptococcosis.

Experimental tissue molding for soft-tissue reconstruction: a preliminary report

Molding of pig omentum to create external structures, such as the ear or penis, was performed using silicone rubber molds. The omentum was mobilized on its gastroepiploic pedicle and brought out through a fascial defect. The molds containing the omentum were placed beneath the skin and panniculus carnosus for 4 weeks. Split-thickness skin grafts were placed on both surfaces of the mold, and a series of synthetic materials was placed within the omentum to provide structural support. When an appropriate amount of tissue had been placed within the device, omentum took on the contour of the mold. Excessive pressure associated with swelling resulted in necrosis, while an inadequate amount of tissue gave poor contour. Omentum molded without any support material rapidly lost its contour once removed from the mold. Omentum molded in combination with a synthetic material maintained its shape up to 1 month after mold removal in a limited number of animals. This model was designed to create structures with the fine detail of a prosthesis using autologous tissue. This "prosthesis" made from living tissue could then be transferred secondarily to its recipient area by microvascular technique.