Correlation between serum lipid concentrations and psychological distress

This study examines the correlations between serum lipid levels and psychological distress. There were 4444 consecutive attendees of general health clinics who participated in the study. Psychological symptoms were measured by the Taiwanese version of the Symptoms Check List 90, revised (T-SCL-90-R). Levels of fasting serum lipids, including total cholesterol, total triglycerides and high-density lipoprotein cholesterol (HDL-C), were determined. Multiple linear regression analyses, with adjustment for confounders, revealed that the concentration of HDL-C had significant inverse associations with scores of depression, somatization and phobic anxiety. Women with an HDL-C level lower than 35 mg/dl scored significantly higher on depression, interpersonal sensitivity, phobia, anxiety, somatization and aggressive hostility, while subjects with a total cholesterol concentration lower than 160 mg/dl scored significantly higher on anxiety, aggressive hostility, phobia, and psychoticism. This study provides, for the first time, comprehensive data derived from the Taiwanese population on the link between lipids and psychological symptoms, revealing a reverse correlation between depression and serum concentrations of HDL-C.

X-ray absorption spectroscopy investigations on oxidized Ni/Au contacts to p-GaN

X-ray absorption spectroscopy was used to investigate the electronic structure of as-deposited and oxidized Ni/Au contacts to p-GaN and to elucidate the mechanism responsible for low impedance. X-ray absorption near edge spectra of Ni K- and L3,2-edges clearly indicate formation of NiO on the sample surface after annealing. The reason for low impedance may be attributed to increase in hole concentration and existence of p-NiO layer on the surface.

[Role of substance P in pressor response of nucleus ventromedialis to glutamate]

AIM

To analyze mechanism underlying pressor response of the nucleus ventromedialis (NVM) to glutamate.

METHODS

Effects of different drugs delivered by intra-brain or i.v. injections on blood pressure and heart rate were observed in rats.

RESULTS

(1) Excitation of the NVM by L-glutamate (Glu), injection of substance P (SP) into the nucleus dorsomedialis (NDM), nucleus paraventricularis (NPV) or rostral ventrolateral medulla (RVL), all induced pressor responses. (2) NVM pressor responses could be attenuated by preinjection of [D-Pro2, D-Phe7, D-Trp9]-SP (DPDPDT, a substance P antagonist) bilaterally into the NDM, NPV or RVL, but preinjection of atropine into the RVL had no such effect. (3) Phentolamine (i.v. ) also reduced the NVM pressor response, but propranolol or methyl atropine (i.v.) had no significant effect.

CONCLUSION

The NVM SPergic neurons can activate NDM SPergic neurons, which proceed to excite the NPV pressor area (SP receptor) and RVL (SP receptor)-sympathetic vasoconstrictor nerve system, thereby induce pressor response. The cardiac sympathetic and cardiac vagal nerves are not involved in this response.

A statistical design to evaluate the influence of manufacturing factors on the material properties and functionalities of microcrystalline cellulose

The aim of this study is to statistically evaluate the effects of manufacturing factors on the material properties and functionalities of microcrystalline cellulose (MCC) products. How the material properties of MCC products dominate their functionalities was further explored. Results demonstrate that the desired material properties and functionalities of MCC products can be obtained by manipulation of the manufacturing factors using proper polynomial equations, and the key manufacturing factor is temperature. On the other hand, the functionalities can be quantitatively predicted by material properties. Meanwhile, the key material property is molecular mass in controlling MCC functionalities. The particle morphologies may also serve as important material properties. In conclusion, the careful control of temperature during the manufacture of MCC might minimize inter-batch variation. The correlation of the material properties of MCC products with their functionalities might help the formulation designer rationally select proper MCC products. The universal harmonization of MCC products might be achieved by the regulation of their molecular mass, surface roughness, and roundness.

Methanotrophic production of extracellular polysaccharide in landfill cover soils

A bench-scale soil reactor was used to study methane oxidation and EPS production under tropical conditions. The study of pertinent environmental factors affecting EPS production was carried out by batch cultivation of methanotrophs. These factors included variations in temperature (20 degrees C to 45 degrees C), soil water content (5% to 33%), and the supply ratios of methane/oxygen. The bench-scale study revealed that excessive EPS was accumulating in an active methane oxidation zone located 5-45 cm below the soil surface of the reactor. The observed peak rates of oxidation could not be sustained over an extended period of time due to EPS accumulation. Results from the batch cultivation experiments confirmed the production of EPS in soils subject to methane oxidation. EPS production was found to correlate with methane oxidation rates which, in turn, were regulated by the variance of temperature and soil water content. A larger amount of EPS production was obtained at 30 degrees C and 17% soil water content. Oxygen is required for methane oxidation; however, at high oxygen tension it may accelerate the production of EPS by methanotrophs causing limited oxygen diffusion and declining rates of methane oxidation.

Relationships of age, menopause and central obesity on cardiovascular disease risk factors in Chinese women

OBJECTIVE

To evaluate the inter-relationships of age- and menopause- related changes of general obesity and body fat distribution and their independent effects on cardiovascular risk factors.

DESIGN

Cross-sectional study.

SUBJECTS

One-hundred and thirty-six premenopausal and 193 postmenopausal Chinese women with body mass index (BMI) < 30 kg/m2.

MEASUREMENTS

Anthropometric surrogates of general obesity (BMI, total body fat percentage) and central obesity (waist-to-hip ratio, centrality index) were measured. Blood pressure, 75 g oral glucose tolerance test, glycosylated hemoglobin A1c and lipid profiles were also measured.

RESULTS

Significant correlation coefficients between age, general obesity, central obesity and cardiovascular disease risk factors were noted. Through the menopausal transition, the BMI and total body fat percentage were increased significantly. After adjustments for age and BMI, the postmenopausal women showed higher android fat percentage, centrality index, glycosylated hemoglobin A1c, serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol and atherogenic indices than the premenopausal women. In multiple stepwise regression models, age exerted independent effects on oral glucose tolerance test 2 h plasma glucose level, systolic and diastolic blood pressure, total cholesterol level, and LDL cholesterol. Menopause was an independent variable in relation to the changes of glycosylated hemoglobin A1c, total and LDL cholesterol levels, triglyceride levels and atherogenic indices. The centrality index was the major independent variable of all the cardiovascular disease risk factors, except total and LDL cholesterol level. However, the variation of total body fat percentage had no independent effect on any cardiovascular disease risk factors.

CONCLUSION

Through the aging and menopausal effects, women will increase total body fat content, favoring the central body fat distribution. Age, menopause and central obesity were all independent and significant factors to the cardiovascular disease risk factors in Chinese women.

Epidemiologic study of type 2 diabetes in Taiwan

Diabetes mellitus (DM) in adults is a global health problem, although its prevalence varies widely between different populations and the rate has generally increased worldwide. In Taiwan, the mortality rate from DM has almost doubled over the past 10 years. The prevalence of DM in Taiwan was established between 1985 and 1996 and the rates were between 4.9 and 9.2%. The prevalence of impaired glucose tolerance (IGT) was 15.5% (men 15% and women 15.9%). The prevalence of DM and IGT increased significantly with age for both genders. The significant factors associated with newly diagnosed DM were age, BMI, family history of DM, systolic blood pressure (hypertension), physical activity and serum triglyceride levels. The prevalence of large vessel disease (LVD) in DM and non-diabetic subjects were 20.0 and 12.9%, respectively. Among diabetics, 15.8% had ischemic heart disease (IHD), 1.7% leg vessel disease (leg VD), and 2.5% stroke. In non-diabetics, the prevalence of the aforementioned macroangiopathies were 11.5, 0.2 and 1.2%, respectively. The diabetics had a significantly higher prevalence of macrovascular disease than non-diabetic subjects. The most significantly associated with the LVD was serum cholesterol levels. Serum cholesterol and HbA1(c) were significantly associated with the development of IHD. Cigarette smoking and female gender were significantly associated with the leg VD. The prevalence of diabetic retinopathy (DR) was 35.0%. (background DR 30%, preproliferative DR 2.8% and proliferative DR 2.2%, respectively.) The prevalence of DR for previously and newly diagnosed diabetics were 45.2 and 28.3% (men 42.8 vs. 33.3% and women 47.5 vs. 24.8%), respectively. From multiple logistic regression analysis, duration of DM was the most important risk factor related to DR. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control. The prevalence of nephropathy and neuropathy were 12.9 and 23.5%, respectively. For those patients with and those without nephropathy and neuropathy, the duration of DM, percentage of insulin treatment, percentage of hypertension, and fasting plasma glucose were significantly different. Diabetic duration, hypertension, insulin treatment and glycemic control consistently correlated with nephropathy and neuropathy. In conclusion, the prevalence of DM in Taiwan was between 4.9 and 9.2%, and the prevalence of IGT was 15.5%. The possible risk factors of newly diagnosed diabetes were age, family history of DM, BMI, SBP (hypertension), physical activity and triglyceride levels. Diabetes in Chinese subjects share many characteristics similar to other Asian populations. The burden imposed by the chronic complications of diabetes is massive. In Taiwan, the mortality rates from DM have increased greatly over the past 10 years. Reduction of the modificable risk factors such as BMI, hypertenion and dyslipidemia, and increase of physical activity and good glycemic control through public health efforts may help to reduce the risk of DM and its chronic complications.

Nasopharyngeal carcinoma: the role of the dentist in assessment, early diagnosis and care before and after cancer therapy

Nasopharyngeal carcinoma (NPC) may present first to the dental profession as facial pain, neck masses, difficulty in speech and swallowing, ear, nose and throat symptoms, or as symptoms of temporomandibular disorders (TMD). Recognition of the signs and symptoms are essential in order to lead to the correct diagnosis, and to avoid inappropriate intervention that may further delay diagnosis and initiation of treatment of the cancer. Differentiation between NPC and TMD may be facilitated by specific questioning of other symptoms that are not frequently associated with TMD such as neck masses, nasal obstruction, recent unilateral hearing deficit and epistaxis. The general dentist can become involved at three stages of a patient's experience with NPC: Stage 1, recognition of signs and symptoms; Stage 2, pre-treatment dental assessment; and Stage 3, post-treatment support. This paper is intended to: (1) alert the general dentist of the signs and symptoms associated with NPC, such that timely and appropriate treatment may ensue; (2) provide a basic outline for assessment, preparation, palliation and continuing care of a patient diagnosed with NPC; and (3) underline the significant role of the general dentist in achieving an optimal quality of life for these patients

Development of a laparoscopic approach to neurolytic celiac plexus block in a porcine model

BACKGROUND

Neurolytic celiac plexus block (NCPB) is an effective method of palliative pain control in cases of inoperable pancreatic cancer. This study was undertaken to evaluate the feasibility of a laparoscopic approach to NCPB in an experimental animal model.

METHODS

The laparoscopic technique for NCPB was developed in an acute study of six domestic swine followed by a chronic study of nine domestic swine that were monitored 3-21 days after surgery for adverse neurologic, gastrointestinal, or other sequelae. Using a four-port laparoscopic technique, the esophageal hiatus was dissected to expose the aorta at the level of the diaphragmatic crura. Under combined endoscopic and laparoscopic ultrasound (LUS) guidance, 5 ml of sclerosant dye (95% ethanol mixed with India ink) was injected into either side of the para-aortic soft tissue via a percutaneously placed 18-gauge spinal needle. After the animals were killed, the aorta and periaortic tissue were harvested from each animal for gross and histologic analysis.

RESULTS

Under LUS guidance, sclerosant was injected successfully into the para-aortic soft tissue in all animals. There were no intraoperative complications in the acute animal group. Placement of sclerosant injection was successful in all nine chronic cases. Two pigs in the chronic study group died in the immediate postoperative period secondary to pneumothorax. No adverse neurologic, gastrointestinal, or other sequelae were observed in the remaining seven animals at 3-21 days postoperatively. After the animals were killed, we found no injuries to the aorta or esophagus, and histologic analysis demonstrated good placement of dye-labeled sclerosant with no compromise of aortic structural integrity.

CONCLUSION

A laparoscopic approach to the aortic hiatus and NCPB is feasible. Further studies are warranted to evaluate this approach in patients who undergo staging laparoscopy for pancreatic cancer and are found to have unresectable disease.

Consumer health information websites in Taiwan

Developers of consumer health information (CHI) websites and pages in Taiwan have included: 1) individuals; 2) general hospitals; 3) disease-oriented associations; 4) government health administrative agencies; and 5) commercial corporations. General hospitals have developed the largest number of sites, but the quality of these sites differs widely. The unprecedented impact of health-oriented websites on medical care and the health of the public in general necessitates the establishment of credible instruments for the evaluation and rating of the quality of such websites and pages. In this paper, we describe the current status of CHI websites and pages in Taiwan. Suggestions for improving the content of CHI websites and pages are also proposed.

Hypertension in elderly persons: its prevalence and associated cardiovascular risk factors in Tainan City, southern Taiwan

BACKGROUND

Hypertension was the eighth leading cause of death in Taiwan in 1996, and the prevalence of hypertension has increased recently. The purpose of the study was to assess the prevalence of hypertension and its associated cardiovascular risk factors in elderly persons in Tainan City, southern Taiwan.

METHODS

The study was a cross-sectional, population-based study. We used the stratified cluster sampling method to enroll subjects aged 65 years and above, 1435 persons in total, into our study. Questionnaire interview, body weight, body height, and blood pressure measurement were completed for 876 participants (response rate of 70.2%) at each subject's home by home visit.

RESULTS

Hypertension was defined according to the criteria of the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The crude prevalence of hypertension was 60.4% (men 59.1%, women 61.9%); previously diagnosed hypertension was 31.1% (men 29.4%, women 33.1%); and newly diagnosed hypertension was 29.3% (men 29.7%, women 28.8%). The hypertensive group had a higher body mass index (BMI) than the normotensive group. There were no lifestyle differences such as smoking, drinking, eating a vegetarian diet, reading health information, and undergoing a health examination in the past year between the hypertensive and normotensive groups. However, the hypertensive group had a higher prevalence of regular exercise than did the normal blood pressure group on univariate analysis. Only BMI and family history of hypertension had a significantly positive association with hypertension on multiple logistic regression analysis.

CONCLUSIONS

The crude prevalence of hypertension was 60.4% in elderly persons in Tainan City. Subjects who had family history of hypertension and higher BMI had a higher risk of hypertension, so they should be screened for high blood pressure regularly.

Linkage of a gene for familial hypobetalipoproteinemia to chromosome 3p21.1-22

Familial hypobetalipoproteinemia (FHBL) is an apparently autosomal dominant disorder of lipid metabolism characterized by less than fifth percentile age- and sex-specific levels of apolipoprotein beta (apobeta) and low-density lipoprotein-cholesterol. In a minority of cases, FHBL is due to truncation-producing mutations in the apobeta gene on chromosome 2p23-24. Previously, we reported on a four-generation FHBL kindred in which we had ruled out linkage of the trait to the apobeta gene. To locate other loci containing genes for low apobeta levels in the kindred, a genomewide search was conducted. Regions on 3p21.1-22 with two-point LOD scores >1.5 were identified. Additional markers were typed in the region of these signals. Two-point LOD scores in the region of D3S2407 increased to 3.35 at O = 0. GENEHUNTER confirmed this finding with an nonparametric multipoint LOD score of 7.5 (P=.0004). Additional model-free analyses were conducted with the square root of the apobeta level as the phenotype. Results from the Loki and SOLAR programs further confirmed linkage of FHBL to 3p21.1-22. Weaker linkage to a region near D19S916 was also indicated by Loki and SOLAR. Thus, a heretofore unidentified genetic susceptibility locus for FHBL may reside on chromosome 3.

Cardiac and pulmonary vagal neurons receive excitatory chemoreceptor input

The effects of hypercapnia and hypocapnia on the activities of the cardiac and pulmonary vagal single fibers were examined in the decerebrated, unanesthetized, paralyzed, and vagotomized cats. The animals breathed 100% O2. Fractional end tidal CO2 concentration was raised to 9% by adding CO2 into the O2 inlet. Average discharge rate of efferent cardiac vagal units (n=10) increased from 1.0+/-0.3 to 2.2+/-0.3 Hz. Hypocapnia apnea was produced by hyperventilation. Activities of cardiac vagal units tested (n = 4) showed dramatic decrease (0.1+/-0.0 Hz). Mean arterial blood pressure did not change significantly under these conditions. In contrast, only instantaneous firing rate during inspiration was significantly increased for efferent pulmonary vagal units (n = 11) during hypercapnia. The activities of the 3 pulmonary vagal units tested with hypocapnia decreased significantly. We concluded that cardiac and pulmonary vagal neurons were excited by chemoreceptor input.

Chlamydia pneumoniae infection in community-acquired pneumonia in Taiwan

Chlamydia pneumoniae is a common cause of pneumonia worldwide. This study examined the role of C. pneumoniae in 229 patients with community-acquired pneumonia. The ages of the patients ranged from 2 to 95 years. Sera were assayed for IgM and IgG antibodies with microimmunofluorescence (MIF). An IgM titer equal to or greater than 1:20 and IgG titer equal to or greater than 1:64 were considered positive. The prevalence of positive IgG among all of the patients was 75.1% (172/229). The seroprevalence was 81.8% (9/11) for patients in the 11- to 20-year-old group, 63.6% (14/22) in the 31- to 40-year-old group and 88.1% (52/59) in the 71- to 80-year-old group. All patients had a negative result for IgM antibody. Twenty-five of the patients had an IgG titer equal to or greater than 1:512, indicating the presence of current infection or reinfection. Age older than 60 years (vs. < or = 60 years) was a risk factor for C. pneumoniae seropositivity in patients with community-acquired pneumonia (p < 0.001). Males had a significantly higher seroprevalence of C. pneumoniae infection (p = 0.1010). Patients older than 60 years were more likely to have C. pneumoniae infection (p = 0.1107). In this series, C. pneumoniae infection accounted for 10.9% (25/229) of community-acquired pneumonia. The most common clinical manifestations included fever (92%), productive cough (52%), white blood cell more than 10,000/mm3 (56%), and bilateral pulmonary infiltrate (60%).

Community-acquired methicillin-resistant Staphylococcus aureus endocarditis with septic embolism of popliteal artery: a case report

A 20-year-old man presented with a 14-day course of fever. Physical examination showed petechiae of the conjunctivae, Janeway lesions on both hands, a grade III/VI systolic murmur over the apex, pulseless dorsal pedal artery and posterior tibial artery of the right leg, and a pale right foot. Femoral arteriogram of the right leg revealed total occlusion of the popliteal artery with collateral circulation of the posterior tibial artery. Transthoracic echocardiogram showed trace mitral regurgitation. Embolectomy of the right popliteal artery was done, and penicillin and gentamicin treatment was administered. However, postoperative fever developed intermittently. Transesophageal echocardiogram disclosed vegetation over the anterior leaflet of the mitral valve. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from all three cultures of blood drawn at admission and from the septic embolus during operation. He had neither evidence of underlying heart disease, nor history of intravenous drug abuse or hospitalization. Exploratory cardiotomy with removal of vegetation on the mitral valve was performed followed by a 4-week treatment with intravenous vancomycin. After discharge, he was well at 2-year follow-up.

Epimeric separation of L-ascorbic acid and D-isoascorbic acid by capillary zone electrophoresis

Capillary zone electrophoresis (CZE) was used for separation of L-ascorbic acid (L-AA) and D-isoascorbic acid (D-IAA) in a model system. The effects of borate buffer concentration (0.05-0.25 M) and pH (pH 7.5-9.0) on migration time, resolution (Rs), and theoretical plates (N) were investigated. The migration times of L-AA and D-IAA increased with the increasing pH of carrier electrolyte (0.2 borate buffer), and the resolutions (Rs) of L-AA and D-IAA were calculated to be 12.98 at pH 9.0. Concentrations of borate buffer (pH 9.0) increased the Rs values of L-AA and D-IAA, and buffer concentrations >0.1 M were found to be effective for separation of L-AA and D-IAA. Methanol in the carrier electrolyte was also influential in improving the separation of L-AA and D-IAA, which increased with the increasing concentrations (0-10%) of methanol. The optimal separation conditions for L-AA and D-IAA were as follows: carrier electrolyte, 0.2 M borate buffer (pH 9.0); applied voltage, 25 kV, with an uncoated fused silica capillary, 75 microm (i.d.) x 57 cm.

The mitotic centromeric protein MEI-S332 and its role in sister-chromatid cohesion

Faithful segregation of sister chromatids during cell division requires properly regulated cohesion between the sister centromeres. The sister chromatids are attached along their lengths, but particularly tightly in the centromeric regions. Therefore specific cohesion proteins may be needed at the centromere. Here we show that Drosophila MEI-S332 protein localizes to mitotic metaphase centromeres. Both overexpression and mutation of MEI-S332 increase the number of apoptotic cells. In mei-S332 mutants the ratio of metaphase to anaphase figures is lower than wild type, but it is higher if MEI-S332 is overexpressed. In chromosomal squashes centromeric attachments appear weaker in mei-S332 mutants than wild type and tighter when MEI-S332 is overexpressed. These results are consistent with MEI-S332 contributing to centromeric sister-chromatid cohesion in a dose-dependent manner. MEI-S332 is the first member identified of a predicted class of centromeric proteins that maintain centromeric cohesion.

Discriminating glucose tolerance status by regions of interest of dual-energy X-ray absorptiometry. Clinical implications of body fat distribution

OBJECTIVE

To determine whether measuring body fat distribution by dual-energy X-ray absorptiometry (DEXA) can be used to discriminate glucose tolerance status.

RESEARCH DESIGN AND METHODS

Using a 75-g oral glucose tolerance test, a total of 1,015 Chinese subjects (559 men and 456 women) were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes. Blood pressure and lipid profiles of these subjects were measured. Waist-to-hip ratio (WHR) and DEXA were used to evaluate the varying patterns of body fat distribution among the groups.

RESULTS

Body fat distribution, as reflected by WHR and the centrality index, showed significant partial correlation coefficients with glycosylated hemoglobin, blood pressure, and lipid profiles in all subjects. After adjusting for age and BMI, there were significant differences among the three glycemic groups for all the cardiovascular risk factors except for total cholesterol level. The diabetic group had a significantly higher WHR and centrality index, but lower femoral fat percentage than the NGT and IGT groups. The diabetic group also showed higher abdominal fat percentage than the NGT group. Moreover, the IGT group had a higher centrality index than the NGT group. However, no significant differences were found in the percentage of lean tissue mass among the three groups. Using multiple stepwise logistic regression models, the centrality index remained a significant factor for discriminating different glucose tolerance status independent of the percentage total body fat.

CONCLUSIONS

Central obesity has shown significant correlation with cardiovascular risk factors among the three different glycemic groups. Centrality index measured by DEXA appears to be the better predictor of glucose intolerance, compared with WHR, abdominal fat, and general obesity (reflected by percentage total body fat or BMI) in a large cohort of the Chinese population.

Corticotropin releasing factor and substance P mediate the nucleus amygdaloideus centralis-nucleus ventromedialis-nucleus dorsomedialis pressor system

Prolonged emotional stress is an important factor in the development of neurogenic hypertension, but its mechanism is still unclear. The purpose of the present study is to analyze the possible neural basis of hypertension induced by prolonged emotional stress. In the brain many nuclei are involved in emotional reaction, stress or defense response; among them the nucleus amygdaloideus centralis (AC) is the most important one which widely connects with other nuclei controlling emotion and stress, such as nucleus ventromedialis (NVM), nucleus dorsomedialis (NDM), nucleus paraventricularis (NPV) etc. These nuclei contain corticotropin releasing factor (CRF)- and substance P (SP)-immunoreactive cell bodies, nerve terminals and corresponding receptors. Our previous and present studies showed that microinjection of CRF or SP into these nuclei induced pressor responses. These data imply that excitation of the AC can activate many nuclei controlling emotion and stress via CRF and SP, and excessive activities of these nuclei may be the neural basis of hypertension induced by prolonged emotional stress. The present study revealed that (1) the AC pressor response to glutamate (Glu) could be reduced by preinjection of CRF antagonist (alpha-Helical CRF[9-41] or SP antagonist ([D-Pro(2), D-Phe(7), D-Trp(9)]-substance P) into bilateral NVM, (2) the NVM pressor response to Glu were decreased by pretreatment of the NDM with CRF- or SP-antagonist, (3) the AC-, NVM- or NDM-pressor responses were all attenuated by preinjection of CRF- or SP-antagonist into bilateral NPV or rostral ventrolateral medulla (RVL). The results indicate that excitation of the AC can indirectly activate the NPV and RVL to evoke pressor response via the NVM-NDM, CRF and SP are transmitters in each connection of this pathway; this is one component of the mechanism underlying the AC pressor response. Taken together with the findings of our previous studies, it provides neurophysiological basis for the above-mentioned implications.

Postural hypotension and postural dizziness in patients with non-insulin-dependent diabetes

BACKGROUND

Postural hypotension with a decline of 20 mm Hg or more in systolic blood pressure on standing is considered a potentially dangerous hypotensive response. Postural dizziness is often strongly associated with postural hypotension. However, there is conflicting evidence, and previous studies have been confined to the elderly, not specifically to patients with diabetes. Thus, we evaluated the association between postural hypotension and postural dizziness, and determined the factors most likely related to postural hypotension in patients with diabetes.

METHODS

The subjects were 204 consecutive noninsulin-dependent patients with diabetes and 408 age- and sex-matched control subjects. Postural hypotension was defined as a decline of 20 mm Hg or more in systolic blood pressure 1 minute after standing. Postural dizziness was any feelings of dizziness, lightheadedness, or faintness that occurred while standing during the examination.

RESULTS

The prevalence of postural hypotension and postural dizziness in patients with diabetes was higher than in control subjects. Those patients with both diabetes and postural hypotension were older and had higher supine systolic blood pressures and higher plasma glycosylated hemoglobin and fasting glucose levels. They had higher prevalence of postural dizziness, hypertension, and cerebrovascular disease, and lower standing systolic blood pressures than those without postural hypotension. They also were more often being treated with antihypertensive agents. Only 32.8% of patients with diabetes with postural hypotension suffered from postural dizziness. Postural dizziness, hypertension, cerebrovascular disease, and plasma glycosylated hemoglobin levels were independently associated with postural hypotension in patients with diabetes.

CONCLUSIONS

Postural dizziness, glycemic control, hypertension, and cerebrovascular disease were important determinants of postural hypotension in patients with diabetes. Postural hypotension was associated with postural dizziness, but it cannot be determined clinically just from the presence of postural dizziness because the sensitivity for diagnosis of postural hypotension is low.