Comparison of the pattern of postprandial carbohydrate metabolism after ingestion of a glucose drink or a mixed meal

To determine whether the postprandial pattern of carbohydrate metabolism differs after ingestion of an identical amount of glucose as either a drink or as a part of a mixed meal, normal subjects were studied on two occasions. On both occasions, hepatic and extrahepatic glucose metabolism were assessed using the dual isotope and forearm catheterization techniques as well as indirect calorimetry. Plasma glucose, insulin, and C-peptide concentrations and rate of systemic entry of ingested glucose all were lower (P less than 0.05) during the first 15 min after the mixed meal than after the glucose drink. The integrated C-peptide response was greater (P less than 0.05) after the mixed meal, whereas the integrated suppression of glucagon was greater (P less than 0.05) after the glucose drink. Despite these differences in circulating hormone concentrations, after the first 15 min, the rates of systemic entry of ingested glucose, endogenous glucose release, incorporation of carbon dioxide into glucose, and glucose and lipid oxidation as well as nonoxidative glucose storage were virtually the same after the mixed meal and the glucose drink. We conclude that the pattern of postprandial carbohydrate metabolism after ingestion of a glucose meal is remarkably similar to that after ingestion of a more traditional mixed meal. These data suggest that insights regarding the pattern of postprandial carbohydrate metabolism derived from previous studies employing only a glucose drink are likely to pertain to those observed when healthy individuals ingest a meal that contains protein and fat.

Effect of the combination of alinidine and other anti-anginal drugs on heart rate and blood pressure in healthy volunteers

1. Heart rate and blood pressure changes following the administration of alinidine 30 mg alone and in combination with atenolol 25 mg, nifedipine retard 20 mg and glyceryl trinitrate 500 micrograms were investigated in three groups of six healthy male volunteers. 2. Concomitant administration of alinidine and atenolol reduced (P less than 0.05) supine, standing and exercise heart rate when compared with alinidine alone. The maximum reduction in exercise heart rate was 116 +/- 2.4 beats min-1 for the combination vs 129.0 +/- 3.1 beats min-1 for alinidine alone. 3. Supine (3, 4, 8 h) and standing (2 h) systolic BP were also reduced (P less than 0.05) with the alinidine and atenolol combination compared with alinidine alone. Little change occurred in diastolic blood pressure. 4. Alinidine and nifedipine in combination reduced (P less than 0.05) the nifedipine induced increase in heart rate in the supine (2, 4 h) and standing (4 h) position and following exercise (2, 4 h). No further decreases in systolic and diastolic blood pressure occurred with the combination. 5. Alinidine administered 2 h before a glyceryl trinitrate challenge reduced (P less than 0.05) the glyceryl trinitrate induced increase in standing heart rate at all time intervals (1 to 6 min); the maximum reduction occurred at 3 min (105.0 +/- 4.3 (glyceryl trinitrate) vs 86.8 +/- 6.7 beats min-1 (combination]. Systolic blood pressure was further reduced at all time intervals with glyceryl trinitrate taken in the presence of alinidine.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of a nursing intervention on regimen adherence and societal adjustments postmyocardial infarction

One hundred three first-time myocardial infarction (MI) patients were randomly assigned to either an experimental or a control condition. Patients completed a cardiac rehabilitation program during hospitalization and were interviewed to assess intentions to follow regimen prescriptions, attitudes toward the prescriptions, coping methods, and the perceived beliefs of others concerning their intentions. Patients were visited at home 30 days after discharge and reassessed on each of the above variables except that their behavior was substituted for intentions and societal adjustment was assessed. The experimental group was given an intervention program which included a discussion of assessment data, identification of problems, and establishment of goals. The assessment was repeated 60 days after discharge. No differences were found between experimental and control groups for either medical regimen adherence or societal adjustment. There was a significant decrease in mean scores for all variables from hospital to 30 days for both groups, but no change from 30 to 60 days. Attitudes and perceived beliefs of others were predictive of adherence, and it was concluded that these variables need to be included in any rehabilitation program.

Radiographic performance of two different total hip cemented arthroplasties. A survivorship analysis

Detailed serial radiographic analysis of the femoral and acetabular components of 367 Charnley (cobalt-chrome alloy) and 383 STH (titanium alloy) primary cemented total hip prostheses was conducted. The follow-up of the Charnley prosthesis ranged from 1 to 16 years (mean follow-up, 9 years), and for the STH from 1 to 11 years (mean follow-up, 80 months). Both single period and survivorship analyses were done to evaluate the radiographic performance. The analysis revealed that the curved STH prostheses' overall radiographic performance was less satisfactory than the Charnley prostheses. However, the STH with a straight stem had significantly better radiographic performance compared with the Charnley prostheses in all parameters except in the incidence of bone-cement radiolucent lines.

Thiamine status, vitamin supplements and postoperative confusion

In a prospective, randomized, controlled study an intravenous vitamin B complex and vitamin C preparation was administered pre- and post-operatively to 28 elderly patients with a fractured proximal femur and compared with 32 nonsupplemented postoperative controls. Vitamin supplementation significantly, though only transiently, improved postoperative thiamine status (P less than 0.001), but had no influence on mental state or outcome during the postsurgical period. Therefore, the use of parenteral vitamins for postoperative confusion cannot be justified on a routine basis.

A multicase family study of rheumatoid arthritis in south west Ireland

A study of 26 families with multiple cases of RA was conducted in South West Ireland. In 149 relatives examined, 67 cases of RA were identified. An analysis of affected sibling pairs and trios revealed significant linkage between HLA and RA (p less than 0.05). A high frequency of DR4 was observed in probands (80.7 per cent) and affected members (74.6 per cent) compared with controls (18 per cent). An elevated frequency of the haplotypes A2-B44-DR4 (19.2 per cent) and A2-Bw62-DR4 (5.7 per cent) was seen in the affected sample. HLA-Bw62 was at raised frequency in probands (19.2 per cent) compared with controls (9 per cent). The haplotype frequency of A2-B44-DR4 was raised in affected females and A2-Bw62-DR4 in affected males. A low haplotype frequency of A1-B8-DR3 was found in all RA subjects. Disease severity (clinical and radiological criteria) was associated with DR4, but this did not reach statistical significance. A high incidence of extra-articular features of RA was observed, with DR4 occurring in all cases of vasculitis (75 per cent of whom were DR4 homozygous).

Life situations, health beliefs, and medical regimen adherence of patients with myocardial infarction

One hundred twelve patients with MI were followed over a 6- to 9-month period to investigate their intentions and adherence behavior to a prescribed medical regimen in four life situations. The subjects with MI had strong intentions in the hospital to follow their prescription in all four situations, with the strongest for the home situation and the weakest for work. However, the actual adherence behaviors were less than the original intentions. The findings indicate the need for a review of the content of rehabilitation programs and consideration of the stage of recovery at which instructions are presented to patients rehabilitating from a MI. The intentions and adherence behaviors of subjects with MI were closely related to their perceptions of significant others' expectations. For the health team, this emphasizes the need to include significant others in patient rehabilitation.

Interferon-induced gene expression in wild-type and interferon-resistant human lymphoblastoid (Daudi) cells

Interferon-induced gene expression was analyzed in wild-type and interferon-resistant Daudi cells. Two classes of alpha-interferon-induced mRNAs and proteins were observed: those that were similarly induced in both types of cell and those that were induced only in the wild-type cells. Furthermore, the level of c-myc mRNA decreased in the wild-type but not in the resistant cells. This differential control in the wild-type and resistant cells indicates that there must be either functionally distinct alpha-interferon receptors or more than one pathway leading to altered gene expression triggered by a single receptor.

Indicators of medical regimen adherence for myocardial infarction patients

This study investigated relationships between demographic and medical variables, attitudes, perceived beliefs of others, and intentions toward medical regimen adherence and actual posthospitalization regimen adherence. During hospitalization, attitudes, perceived beliefs of others, and intentions toward prescribed medical regimen were elicited from 112 persons recovering from a first time myocardial infarction (MI). Six to 9 months posthospitalization, attitudes, perceived beliefs of others, and adherence behaviors were assessed. Multiple regression analysis indicated that, during hospitalization, attitudes and perceived beliefs of others were strong indicators of intentions to adhere to the medical regimen, but they were not indicators of actual adherence posthospitalization. Posthospitalization, attitudes and perceived beliefs of others were strong indicators of actual regimen adherence. Findings indicate rehabilitation plans for the MI patient should be individualized for hospital and home and should include data on health belief variables.

Uveal melanoma presenting after cataract extraction with intraocular lens implantation

Four patients underwent cataract extraction with implantation of intraocular lenses. Preoperative ultrasonography did not include a comprehensive diagnostic B-scan analysis. Postoperative examination revealed uveal melanomas. The clinical presentations as well as the histopathologic findings of the two enucleated eyes are discussed. These cases emphasize the necessity for B-scan ultrasonography prior to cataract surgery when media opacity prevents adequate visualization of the fundus.

Exercise and hypertension

Hypertension is a major risk factor for atherosclerosis. In this article the authors review the use of physical activity as therapy for elevated blood pressure and explore the hemodynamic effects of exercise among patients with treated and untreated hypertension. Recommendations concerning the use of exercise in the management of hypertension are outlined.

Induction of human mRNAs by interferon

We have cloned a set of seven cDNAs corresponding to mRNAs induced by type I interferon in human cells, and are using these probes to characterize the response to interferon in detail. We have studied the kinetics of induction of each mRNA in three different human cell lines, the sensitivity of induction to cycloheximide, the effect of withdrawing interferon and the response of a receptor-positive interferon-resistant cell line.

Transcriptional and posttranscriptional regulation of interferon-induced gene expression in human cells

Eighteen cDNAs, cloned from interferon-treated T98G neuroblastoma cells, correspond to seven different mRNAs induced up to 40-fold by interferon. One codes for metallothionein II and another for a class I HLA. The others do not code for proteins of known sequence. In the continued presence of interferon, accumulation of the mRNAs continues for about 1 day but ceases whenever interferon is removed. Once induced, the mRNAs are stable. Synthesis of new proteins is not required for induction. The rate of transcription of one of the genes doubles 5 min after treatment with interferon and reaches a maximum by 60 min. This rate begins to fall after 4-6 hr, reaching the uninduced level by 8-12 hr. Since the mRNA continues to accumulate after 8-12 hr, posttranscriptional events must also play a role in increasing its level.

Quinidine-induced lupus erythematosus

A 60-year-old white man presented with a syndrome of fever, polyarthritis, pleurisy, and lymphopenia, and had a positive antinuclear antibody test (after 5 months of quinidine therapy). Quinidine-induced antinuclear autoantibodies were of the IgM and IgG classes and were directed mainly to nuclear histones, predominantly histones H1 and H2B. Antibodies to native DNA and nonhistone nuclear antigens were not seen during the patient's clinical course. Upon withdrawal of quinidine therapy, the patient had prompt improvement of clinical symptoms followed by a gradual resolution of serologic abnormalities.

Neurofibroma of the infratemporal fossa: case report and technical note

The authors present a case of benign neurofibroma arising from the infratemporal fossa, which they removed successfully through a transoral transmaxillary approach. The anatomy of the infratemporal region is discussed. The transoral transmaxillary approach and the parotid approach to the infratemporal fossa are contrasted.

Hyperthermia and the heat-shock proteins of HeLa cells

When HeLa cells are subject to hyperthermia, the synthesis of specific heat-shock proteins (HSP) is induced under a variety of thermal conditions. HSP synthesis does not occur at temperatures above 43 degrees C but requires return to a culture temperature of 37 degrees C. Maximal induction appears to be achieved if a brief hyperthermia treatment (10 min, 45 degrees -46 degrees C) is followed by 2 h "development" at 37 degrees C. The induction process requires transcription but not DNA replication, and general cell metabolism is probably also required, as induction does not occur if the heat-treated cells are returned to 4 degrees (rather than 37 degrees C) for development. A small proportion of the HSPs of 72-74 Kd are found in nuclei, but do not appear to bind to DNA. The bulk of these proteins, as well as those at 100 Kd, are cytoplasmic, but none are preferentially associated with mitochondria. Increased synthesis of the 100Kd and 72-74 Kd HSPs was also triggered by pretreatment of the cells with 5 x 10(-5) M sodium arsenite.

Development of a health attitude scale

A tool was developed to assess attitudes of patients with cardiac disease toward performing prescribed behaviors of their medical regimen. Two groups of subjects with heart disease were used to examine validity and reliability of the Miller Attitude Scale. One group included 480 members of Mended Hearts, Inc., and the second group consisted of 35 patients diagnosed with a first myocardial infarction. The second group repeated the attitude scale six months post-hospitalization. Performance of the medical regimen by this group was verified at the six-month follow-up period. Using Spearman Rank Correlation, there was a significant relationship between attitudes and adherence behaviors for three of the five subscales. Alpha reliabilities revealed a high degree of internal consistency of scale items for all five subscales when testing both groups. A factor analysis resulted in eight factors accounting for the majority of the variance. Each of the five behaviors of the medical regimen clearly defined a factor supporting used of the Miller Attitude Scale for assessing attitudes of heart patients toward behaviors of their medical regimen.

A new anorexigen assay: stress-induced hyperphagia in rats

Humans often respond to stress by overeating. A rat model of hyperphagia induced by a stressful tail-pinch has been described. Consumption of sweetened condensed milk by vaive rats was measured durin the stress. This milk drinking was prevented by pretreatment with d-amphetamine, chlorphentermine, diethylpropion, fenfluramine, methamphetamine, morphine, chlorpromazine and haloperidol. The benzodiazepines chlordiazepoxide and diazepam increased the hyperphagia. The relevance of dopaminergic agonistic and antagonist activities to anorexigenic activity are questioned.