Rare inherited A2BP1 deletion in a proband with autism and developmental hemiparesis

Ataxin 2 binding protein 1 (A2BP1 aka FOX1, RBFOX1) is an RNA binding protein responsible for regulation of pre-mRNA splicing events in a number of critical developmental genes expressed in muscle, heart and neuronal cells [Shibata et al. (2000); Mamm Genome 12:595-601; Jin et al. (2003); EMBO J 22:905-912; Underwood et al. (2005); Mol Cell Biol 25:10005-10016]. Rare copy number abnormalities of A2BP1 have been previously associated with cognitive impairment, attention deficit disorder and autism [Martin et al. (2007); Am J Med Gen Part B 144B:869-876; Elia et al. (2010); Mol Psychiatry 15:637-646.]. Using a 1M Illumina SNP microarray, we identified a 1.3 kb deletion in A2BP1, which was subsequently validated by quantitative PCR. Here we present an in depth case study of an individual with autism and mild developmental hemiparesis in whom the deletion was detected. This study provides further support for the possible role of rare copy number variants in A2BP1 in the development of autism and associated motor asymmetries.

Radiation exposure from CT in early childhood: a French large-scale multicentre study

OBJECTIVES

The increasing use of CT scans in the paediatric population raises the question of a possible health impact of ionising radiation exposure associated with CT scans. The aim of this study was to describe the pattern of CT use in early childhood.

METHODS

In 14 major French paediatric radiology departments, children undergoing at least 1 CT scan before age 5, between 2000 and 2006, were included. For each examination, absorbed organ doses were calculated.

RESULTS

43% of the 27 362 children in the cohort were aged less than 1 year during their first exposure, with 9% being aged less than 1 month. The mean number of examinations per child was 1.6 (range 1-43). The examinations included: head in 63% of the cases, chest in 21%, abdomen and pelvis in 8% and others in 8%. Brain and eye lenses received the highest cumulative doses from head examinations, with mean organ dose values of 22 mGy (maximum 1107 mGy) and 26 mGy (maximum 1392 mGy), respectively. The mean cumulative effective dose was 3.2 mSv (range 0.1-189 mSv).

CONCLUSION

CT scan exposure in childhood is responsible for relatively high doses to radiosensitive organs. The rather large dose range according to the protocols used requires their optimisation. The cohort follow-up will study the risk of long-term radiation-induced cancer.

A new, pachymetry-based approach for diagnostic cutoffs for normal, suspect and keratoconic cornea

PURPOSE

To analyze whether an association exists between keratometric and pachymetric changes in the cornea, and whether it can be used to create pachymetric cutoff criteria secondary to keratometric criteria.

METHODS

In this cross-sectional study, 1000 candidates presenting to the refractive surgery services of a tertiary care hospital underwent bilateral Orbscan IIz (Bausch and Lomb) assessment along with other ophthalmic evaluation.

RESULTS

Stepwise regression analysis-based models showed that simulated keratometry (simK) astigmatism was significantly predicted by the minimum corneal thickness (MCT) and difference between central and MCT (δCT), mean SimK by the MCT and δCT, and maximum keratometry in the central 10-mm zone by the MCT and δCT (P<0.001). The mean MCT values were 542.5 ± 39.6, 539.9 ± 39.2, 524.2 ± 49.5, and 449.3 ± 73.7 μm for flatter normal (<44 D), steeper normal (≥ 44 D), keratoconus suspect and keratoconic eyes, respectively (P<0.001). The mean differences between central corneal thickness and MCT (δCT) were 12.2 ± 7.1 μm, 12.4 ± 7.4 μm, 14.4 ± 8.9 μm and 23.2 ± 10.1 μm for the flatter normal, steeper normal, keratoconus suspect, and keratoconic eyes, respectively (P<0.001). Mean and 2SD cutoff were used to suggest that a cornea having MCT< 461 μm or δCT>27 μm has only a 2.5% chance of being normal and not a keratoconus suspect or worse.

CONCLUSION

Pachymetric diagnostic cutoffs can be used as adjuncts to the existing topographic criteria to screen keratoconus suspect and keratoconic eyes.

Giant enhancement of the second harmonic generation efficiency in poled multilayered silica glass structures

Multilayered thin-film doped silica structures are experimentally demonstrated as an effective tool to enhance the second-order nonlinear properties induced in thermally poled glass devices. A 204-fold improvement is obtained in the second harmonic generated (SHG) in a poled structure with a 3 μm-thick multilayered stack consisting of sub- 100 nm-thick alternating germanium-doped and undoped silica layers compared to poled bulk silica glass. The induced nonlinearity is localized within the layered region, indicating that the multilayered design can be used to precisely control the thickness and the location of the nonlinearity. Such artificial nonlinear structures can be used to overcome the main limitations of existing poled glass devices, therefore opening the door to practical implementations of efficient active devices in silica glass.

P1-12-12: Evaluation of Ile655Val HER2 Polymorphism Associated with Cardiac Toxicity Following the Administration of Trastuzumab in Women with Non-Metastatic Breast Cancer

Background: Trastuzumab is well tolerated without major side effects except for cardiac toxicity. Although a number of clinical parameters have been associated with trastuzumab-associated cardiac toxicity (TACT), there is some indication that genetic variation of the HER2 gene may be associated with TACT in a population of metastatic breast cancer patients. However, this finding needs confirmation and we looked at a population of non-metastatic breast cancer.

Purpose: This study aimed to evaluate the association between cardiac toxicity and HER2 [Ile655Val] polymorphism in non-metastatic breast cancer patients treated with trastuzumab.

Method: The Ile655Val HER2 polymorphism was assessed in 41 women using TaqMan technology. For this study, the genotyping was performed using DNA extracted from normal breast tissue located at more than 1 cm of any other lesions. Charts review was used to collect information on TACT which was defined as a decrease in the left ventricular ejection fraction (LVEF) of ≥15% or ≥10% with a resulting LVEF &lt; 50% or any follow-up LVEF of &lt; 45%. The Fisher exact test was used to evaluate the association between cardiac toxicity and HER2 polymorphism.

Results: No deviation from the Hardy-Weinberg equilibrium has been observed for the allele and genotype frequencies. The distribution of HER2 polymorphism was 10 Ile/Val (24%) and 31 Ile/Ile (76%). In this population, 22% (9/41) developed a cardiac toxicity. The Val655Ile genotype was associated with cardiac toxicity (0.03). In this preliminary study, 50% (5/10) of Ile/Val carriers compared to 13% (4/31) of Ile/Ile carriers showed TACT.

Conclusion: HER2 Ile655Val polymorphism may be an efficient marker of TACT considering this tendency with this small cohort of patients. Larger sample is needed to strengthen this conclusion, since this result may influence on prescribing decision for adjuvant chemotherapy and anti-HER2 therapy in HER2 positive patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-12.

Immunological markers in neurological disorders

Neurological dysfunction results from vascular, inflammatory, degenerative, neoplastic, metabolic or genetic causes. Of particular interest is a group of neurological symptoms thought to be linked to an underlying tumour, the so-called paraneoplastic syndromes. It is considered to be due to an attempt by the immune system to subjugate the growth of the tumour by triggering an antibody response against the neuronal antigens expressed by the neoplasm. The unfortunate consequence of this is an assault by the immune components on the nervous tissue, thereby rapidly precipitating a variety of neurological deficits. Every level of the nervous system is potentially vulnerable, with the disability being considered as irreversible due to the lack of regenerative capacity of the neurons. This phenomenon is rare, occurring at an approximate frequency of less than 1% of all tumours and often accompanied by the presence of specific high-titre autoantibodies in both the cerebrospinal fluid and blood. This group of antibodies are non-pathogenic markers for paraneoplastic neurological syndromes, which have expanded to almost 20 since the discovery, in 1986, of the first clinically relevant syndrome. More recently, a new generation of antineuronal antibodies against cell surface antigens, having a direct pathogenic role in causing the disease, has emerged to complement the existing repertoire. Neuronal antibodies are useful diagnostic markers of the brain disease and also, in some cases, may reveal an underlying malignancy, thus facilitating faster diagnosis and earlier treatment with consequently better prognosis.

SUPERFICIAL BRANCH OF THE RADIAL NERVE PIERCING THE BRACHIORADIALIS TENDON TO BECOME SUBCUTANEOUS: AN ANATOMICAL VARIATION WITH CLINICAL RELEVANCE

We dissected 20 preserved Caucasian cadaveric upper limbs looking at the relation of the superficial branch of the radial nerve (SBRN) to the brachioradialis tendon. SBRN emerged from deep to superficial position by piercing the brachioradialis tendon near its dorsal border in four limbs. The resulting dorsal tendinous band compressed the nerve and prevented longitudinal gliding movement during ulnar flexion. This is likely to increase the risk of chronic compression neuropathy (Wartenberg's syndrome). In two of these four limbs, there was a communication between the SBRN and lateral cutaneous nerve of the forearm. No such communication was found in the remaining 16 forearms. This communication could contribute to the minimal area of sensory loss observed in Wartenberg's syndrome. We recommend that this anatomical anomaly is looked for and if present dealt with during surgical treatment of Wartenberg's syndrome, as it is likely to predispose to chronic compression neuropathy.

Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation

PURPOSE

To evaluate the visual acuity and quality-related satisfaction of patients implanted with a refractive design multifocal intraocular lens (IOL), and evaluate the factors predicting it including angle kappa.

SETTING

Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai.

METHODS

In this prospective trial, 50 eyes of 44 consecutive patients were included. All patients underwent phacoemulsification with multifocal IOL implantation (Rezoom IOL, Abbott Medical Optics). The preoperative and postoperative assessment included slit lamp biomicroscopy, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and kappa angle assessment. At 1 year, 37 patients (43 eyes), who finished follow-up, were asked to rate their symptoms on a graded questionnaire (0-5 for five queries).

RESULTS

The decimal scores for UCVA and BCVA were 0.38±0.21 and 0.47±0.17 (preoperative), and 0.75±0.22 and 0.99±0.11 (postoperative), respectively. Symptom scores were haloes 0.98±1.7, glare 0.69±1.48, blurred distance 1.0±1.7, intermediate 1.34±1.6, near 1.06±1.8. On regression analysis haloes depended on angle kappa and distance UCVA (R (2)=0.26, P=0.029), and glare on angle kappa (R (2)=0.26, P=0.033). Poor satisfactions with distance, intermediate, and near vision were linked with distance UCVA (R (2)=0.17, P=2.3 × 10(-4)), distance UCVA (R (2)=0.1, P=0.04), and near UCVA (R (2)=0.12, P=0.03), respectively. The strongest predictor, however, for overall visual discomfort was distance UCVA (R (2)=0.1, P=0.04).

CONCLUSIONS

Our study suggests that there may be a role of misalignment between the visual and pupillary axis (angle kappa) in the occurrence of photic phenomenon after refractive multifocal IOL implantation.

Outcomes following a limited approach to radiotherapy in rectal cancer

BACKGROUND

Variation in the use of neoadjuvant and adjuvant radiotherapy for rectal cancer suggests an opportunity to avoid it in all but patients at highest risk of local recurrence.

METHODS

Between 1 July 1999 and 1 February 2006, patients with primary rectal cancer were treated by a single surgeon operating at McMaster University, Hamilton, Ontario, Canada. Digital rectal examination and pelvic computed tomography were used to determine whether the mesorectal margin was threatened by tumour and thus whether preoperative radiotherapy would be needed. The study outcome was local tumour recurrence.

RESULTS

Forty-six (48 per cent) of 96 patients received preoperative radiation therapy. The median follow-up was 4·2 years. Tumours were fixed or tethered in 31 (67 per cent) of the 46 irradiated patients. In contrast, no tumour was fixed in unirradiated patients and only ten (20 per cent) of the 50 tumours were tethered. The proportion of patients with stage I or II tumours based on final pathology was similar: 61 per cent (28 of 46) and 56 per cent (28 of 50) in irradiated and unirradiated groups respectively (P = 0·287). There were four (9 per cent) and two (4 per cent) local recurrences among irradiated and unirradiated patients respectively (P = 0·422).

CONCLUSION

Limiting preoperative radiotherapy in rectal cancer to patients with a threatened circumferential margin does not compromise patient outcome.

Monitoring of water quality from roof runoff: Interpretation using multivariate analysis

The quality of harvested rainwater used for toilet flushing in a private house in the south-west of France was assessed over a one-year period. Temperature, pH, conductivity, colour, turbidity, anions, cations, alkalinity, total hardness and total organic carbon were screened using standard analytical techniques. Total flora at 22 °C and 36 °C, total coliforms, Escherichia coli and enterococci were analysed. Overall, the collected rainwater had good physicochemical quality but did not meet the requirements for drinking water. The stored rainwater is characterised by low conductivity, hardness and alkalinity compared to mains water. Three widely used bacterial indicators - total coliforms, E. coli and enterococci - were detected in the majority of samples, indicating microbiological contamination of the water. To elucidate factors affecting the rainwater composition, principal component analysis and cluster analysis were applied to the complete data set of 50 observations. Chemical and microbiological parameters fluctuated during the course of the study, with the highest levels of microbiological contamination observed in roof runoffs collected during the summer. E. coli and enterococci occurred simultaneously, and their presence was linked to precipitation. Runoff quality is also unpredictable because it is sensitive to the weather. Cluster analysis differentiated three clusters: ionic composition, parameters linked with the microbiological load and indicators of faecal contamination. In future surveys, parameters from these three groups will be simultaneously monitored to more accurately characterise roof-collected rainwater.

Inorganic-Organic Hybrid Polymers as Photo-Patternable Dielectrics for Multilayer Microwave Circuits

Inorganic-organic hybrid polymers (ORMOCE®s) combine very good optical and dielectricproperties in the frequency range up to 1 MHz (εr = 3.1 and tanδ = 0.004, both at 1 MHz). Thisis particularly promising for electro-optical (e/o) applications. Multi-layer microwave circuits forhigh frequency applications up to 100 GHz demand extraordinary material properties such as alow permittivity εr < 3 and a dielectric loss tanδ of about 10-3. For low-cost processing, direct UVpatterning would be particularly advantageous. Additionally, the material should be thermallystable at least up to temperatures around 300°C.

We have developed a series of novel ORMOCE® materials for high frequency applications.Using these ORMOCE®s, thick film coatings (up to 150 m) can be produced and directlypatterned by UV lithography with sufficiently high resolution. The synthesis has been carried outusing styrene-substituted organosilanes and silanediols as precursors reacted by simplified solgel-processing in combination with organic cross-linking of polymerizable organic functions.The materials have been characterized at high frequencies up to 40 GHz, exhibiting verypromising dielectric properties of εr = 2.5 and tanδ = 0.0035.

Abstract P3-11-11: A Comparison of Breast Cancer Treatment Rates in British Columbia, Scotland, and Western Australia, and a Comparison with Models of “Optimal” Therapy

Background: Evidence-based optimal utilization models provide estimates of optimal radiotherapy, chemotherapy and hormonal therapy utilization by stage and other clinically relevant patient sub-groups. We therefore compared predicted utilization with actual utilization of radiotherapy, hormone therapy and chemotherapy in 3 jurisdictions with population-based stage and treatment data: British Columbia, Canada; Dundee, Scotland; and Perth, Western Australia.

Methods: Previously published optimal radiotherapy, chemotherapy, and endocrine therapy treatment utilization trees for an Australian population were modified to incorporate epidemiological data from British Columbia, Dundee, and Perth, such that the optimal trees for each region reflected the casemix for each region. Frequency data on patient, tumour, and surgical factors were used to calculate optimal treatment rates for each region. Optimal rates were then compared with actual rates of surgery, radiotherapy, chemotherapy, and endocrine therapy use obtained from 2 population-based and 1 institution-based cancer registries for patients diagnosed with breast cancer between 2000 to 2004. Information on region-specific treatment guidelines was also collected.

Results: Region-specific optimal treatment utilization rates at diagnosis varied between 80% and 81% for radiotherapy (62 to 64% when patient preference is taken into account), 53% to 56% for chemotherapy, and 49% to 54% for endocrine therapy. The predicted ranges were due to local variations in demographics, and tumour stage. Actual radiotherapy utilization was 57%, 49%, and 52%; chemotherapy utilization was 32%, 24%, and 29%; and endocrine therapy utilization was 56%, 64%, and 52% for British Columbia, Dundee, and Perth, respectively. Conclusion: There are significant differences in actual treatment utilisation rates between the study populations. It is unlikely that all of this variation is due to differences in tumour characteristics alone. Actual utilization rates were lower than the calculated optimal rates for radiotherapy and chemotherapy, and higher for endocrine therapy. Differences between actual regional rates of treatment utilization were seen, and were associated with differences in mastectomy rates, and guideline recommendations for treatment use in that region. This methodology allows comparison of the treatment that occurs in a jurisdiction against what would be considered optimal based on evidence.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-11-11.

Cardiac resynchronization therapy: current trends and future directions

Despite the clear cut indications for cardiac resynchronization therapy (CRT) laid down by guideline forming bodies, there are numerous unresolved issues. This review article primarily focuses on the current trends in CRT and the challenges encountered in patient selection, procedure related and postimplantation patient management issues. The high rate of non-response to CRT warrants a critical appraisal of the patient selection criteria, with the role of QRS duration and use of imaging to quantify ventricular dyssynchrony being the major points of discussion. Likewise the role of CRT in relatively asymptomatic heart failure patients, those with atrial fibrillation and the benefits of providing an implantable cardioverter defibrillator backup to all CRT devices has yet to be clearly defined. The development of effective and minimally invasive surgical techniques, dependable and reproducible means for optimal pacing site localization and comparative trials on superior mode of lead positioning, pacing sites and optimized CRT programming encompassing diverse patient populations would further advance current standards of CRT. Innovative approaches to resolve these controversies and future goal directed research is needed. Development of novel, comprehensive prediction tools to identify responders to CRT and the possibility of 'leadless' pacing would be interesting futuristic prospects.

Distal radial and ulnar landmarks used in percutaneous pin fixation: anatomical relationship to the superficial radial and ulnar nerves

BACKGROUND

The radial and ulnar styloids as well as Lister's tubercle are important surgical landmarks in the surgical treatment of distal forearm fractures. There have been limited studies assessing their relative safety in terms of their distance from superficial nerves which are in danger during surgical procedures. The aim of this cadaveric study was to assess and compare the distance of superficial nerves to these important surgical landmarks.

METHODS

Twenty embalmed cadaveric upper limbs were dissected exposing the nerves and tendons around the wrist. The radial styloid, Lister's tubercle, ulnar styloid and nerve branches were marked with pins. The distance of the nearest nerve branch to each landmark was measured with a digital calliper. Statistical analysis of the data was performed using SPSS for Windows 11.5 (SPSS Inc., Chicago, IL) using Friedman Tests and Wilcoxon Signed Ranks tests.

RESULTS

The median distance of the nearest nerve branch to the radial styloid was 5.42 mm, to the Lister's tubercle was 16.68 mm and to the ulnar styloid was 13.56 mm. There was unequal safety for these three surgical landmarks regarding proximity to nerve branches (p < 0.00001). Paired comparison using Wilcoxon Signed Ranks Test showed that the Lister's tubercle was safer than the radial styloid (p < 0.0001) and ulnar styloid (p = 0.04). In addition, the ulnar styloid was safer than the radial styloid (p < 0.001).

CONCLUSIONS

There is a higher risk of injury to superficial nerves when operating near the radial styloid as it is significantly closer to nerve branches as compared to Lister's tubercle and ulnar styloid.

Effects of in vitro antagonism of endocannabinoid-1 receptors on the glucose transport system in normal and insulin-resistant rat skeletal muscle

OBJECTIVE

We determined the direct effects of modulating the endocannabinoid-1 (CB1) receptor on the glucose transport system in isolated skeletal muscle from insulin-sensitive lean Zucker and insulin-resistant obese Zucker rats.

METHODS

Soleus strips were incubated in the absence or presence of insulin, without or with various concentrations of the CB1 receptor antagonist SR141716 or with the CB1 receptor agonist arachidonyl-2-chloroethylamide (ACEA).

RESULTS

CB1 receptor protein expression in visceral adipose (57%), soleus (40%) and myocardial (36%) tissue was significantly (p < 0.05) decreased in obese compared to lean animals, with a trend for a reduction (17%, p = 0.079) in the liver. In isolated soleus muscle from both lean and obese Zucker rats, CB1 receptor antagonism directly improved glucose transport activity in a dose-dependent manner. Basal glucose transport activity was maximally enhanced between 100 and 200 nM SR141716 in lean (26-28%) and obese (22-31%) soleus. The maximal increase in insulin-stimulated glucose transport for lean muscle ( approximately 30%) was achieved at 50 nM SR141716 and for obese muscle ( approximately 30%) at 100 nM SR141716. In contrast, CB1 receptor antagonism did not alter hypoxia-stimulated glucose transport activity. CB1 receptor agonism (1 mM ACEA) significantly decreased both basal (15%) and insulin-stimulated (22%) glucose transport activity in isolated lean soleus. This effect was reversed by 200 nM SR141716. In both lean and obese muscle, the functionality of key signalling proteins (insulin receptor beta-subunit, Akt, glycogen synthase kinase-3beta (GSK-3beta), AMP-dependent protein kinase (AMPK), p38 mitogen-activated protein kinase (p38 MAPK)) was not altered by either CB1 receptor agonism or antagonism.

CONCLUSION

These results indicate that the engagement of CB1 receptor can negatively modulate both basal and insulin-dependent glucose transport activity in lean and obese skeletal muscles, and that these effects are not mediated by the engagement of elements of the canonical pathways regulating this process in mammalian skeletal muscle.

Preparation and evaluation of microencapsulated fast melt tablets of ambroxol hydrochloride

Natural resources in general and plant materials in particular are receiving more attention due to their safety as pharmaceutical excipients. Present work assessed the potential of a natural polysaccharide, pectin to mask the bitter taste of ambroxol hydrochloride, by microencapsulation technique, and its possibility to formulate as a fast disintegrating dosage form. Taste masking is an important developmental challenge in fast dissolving drug delivery system since it dissolves or disintegrates in the patient's mouth in close proximity to the taste buds. The prepared microspheres by emulsion solvent evaporation technique possessed good sphericity, smooth surface morphology, uniform and narrow size distribution (10-90 μm), when analyzed by scanning electron microscopy, laser diffraction and optical microscopy. Method of preparation has influenced the particle size and drug loading efficiency. Drug-polymer compatibility was confirmed by Fourier transform infrared spectroscopy and thin layer chromatography. DSC and X-ray diffraction studies revealed that the drug was dispersed inside the microspheres in the form of an insoluble matrix. The formation of microspheres was affected by glass transition temperature of the polymer, surfactant, type of plasticizers, volume of internal phase, stirrer speed etc. Fast dissolving tablets were prepared by the modification of melt granulation technique. The resulting granules were found to melt fast at body temperature, have smooth mouth feel and good physical stability. This study demonstrated that pectin could be a right choice in developing patient favored formulations for bitter drugs and can be utilized in fast disintegrating dosage forms as well.

A Contralateral Complication of Extra-peritoneal Laparoscopic Inguinal Hernia Repair

A 63 year old female underwent an uncomplicated total extraperitoneal repair of a right direct inguinal hernia. One week later she presented with a strangulated left femoral hernia. We believe the dissection of the extraperitoneal space caused bleeding which tracked down through the femoral canal resulting in a femoral hernia. To date there are no reports of such a complication following total extraperitoneal inguinal hernia repair in the literature.

Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes

PURPOSE

To evaluate the post-operative outcome of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation in eyes with deficient capsular support after 1 year.

METHODS

Eyes operated with fibrin glue-assisted posterior chamber IOL implantation from December 2007 to May 2008 were included. The post-operative best spectacle-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure (IOP), central macular thickness, and specular count were evaluated. IOL position and centration at 1 year was determined. The 1-year post-operative complications were analysed.

RESULTS

A total of 53 eyes of 53 patients were analysed. There was significant improvement in UCVA (P=0.000) and BCVA (P=0.000). There was no significant change (P=0.447) in IOP from the pre-operative value. The early post-operative complication was decentration (5.6%). The late complication was pigment dispersion (3.7%) and healed macular oedema (7.5%). No vision threatening complications such as retinal break, retinal detachment, or endophthalmitis were seen. The percentage (%) loss of endothelial cells was 5.23+/-3.4% at 1-year follow-up. No pseudophakodonesis was seen in the follow-up visits.

CONCLUSION

Results obtained at 1 year after fibrin glue-assisted posterior chamber IOL implantation showed a good visual outcome with minimal complications in eyes with deficient capsular support.

Improvement of insulin-stimulated glucose-disposal in type 2 diabetes after repeated parenteral administration of thioctic acid

Insulin resistance of skeletal muscle glucose uptake is a prominent feature of Type II diabetes (NIDDM); therefore, pharmacological intervention should aim to improve insulin sensitivity. Thioctic acid (TA), a naturally occurring compound, was shown to enhance glucose utilization in various experimental models after acute and chronic administration. It also increased insulin-stimulated glucose disposal in patients with NIDDM after acute administration. This pilot study was initiated to see whether this compound also augments glucose disposal in humans after repeated treatment. Twenty patients with NIDDM received TA (500 mg/ 500 ml NaCl, 0.9%) as daily infusions over a period of ten days. A hyperinsulinaemic, isoglycaemic glucose-clamp was done on day 0 and day 11. Parenteral administration of TA resulted in a significant increase of insulin-stimulated glucose-disposal by about 30% (metabolic clearance rate for glucose, 2.5 +/- 0.3 vs. 3.2 +/- 0.4 ml/kg/min and insulin-sensitivity-index: 3.5 +/- 0.5 vs. 4.7 +/- 0.4 mg/kg/microU/ml; p < 0.05, Wilcoxon-Rank-Sum-Test). There were no changes in fasting plasma levels for glucose or insulin; this can be explained, however, by the short period of treatment and observation. This is the first clinical study to show that a ten day administration of TA is able to improve resistance of insulin-stimulated glucose disposal in NIDDM. Experimental data suggest several mechanisms in the mode of action. As the present investigation was an uncontrolled pilot trial, the encouraging results call for controlled studies to further elucidate the clinical relevance of the findings and the mode of action of this compound.