Benefits of micronised Fenofibrate in type 2 diabetes mellitus subjects with good glycemic control

AIMS

To determine the effects of micronised fenofibrate on lipids and low density lipoprotein (LDL) subfraction in well-controlled diabetic subjects with mild elevations in cholesterol levels.

METHODS

Thirty-five male type 2 diabetic subjects with LDL(3) greater than 100 mg/dl and good glycemic control (mean HbA1c 6.7%) were treated with micronised fenofibrate in an open labeled study for 6 months. Anthropometric indices, blood pressure, lipids, glucose, insulin, apolipoprotein A-I and B, and LDL subfraction by density ultracentrifugation were obtained after an overnight fast of 10 h, at the beginning and end of the 6 months treatment period.

RESULTS

The blood pressure, waist to hip ratio, body mass index and glycemic control remained unchanged throughout the 6 months study period. Mean serum triglyceride fell from 2.49 to 1.72 mmol/l (33%) whilst HDL cholesterol increased from 0.88 to 0.96 mmol/l (10.8%). There were no significant changes in total or LDL cholesterol. Both LDL(1) and LDL(2) rose significantly whilst the dense LDL(3) fell from a mean of 148 to 85 mg/dl (43% reduction). Fenofibrate changed the LDL subfraction distribution from dense LDL(3) particles towards buoyant LDL(1) and LDL(2) particles in 63% of the subjects. No subjects had elevations in transaminases greater than three-fold or creatine kinase greater than ten-fold from pre-treatment levels.

CONCLUSION

Diabetic subjects with mild hypercholesterolemia and good glycemic control may benefit from therapy with micronised fenofibrate because of the reduction in serum triglyceride, elevation in HDL cholesterol and a shift in LDL subfraction towards a non-atherogenic form.

Immunocytochemical localization of neuronal and inducible nitric oxide synthase in the retina of zebrafish, Brachydanio rerio

Several previous studies have revealed the distribution of neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) in the retina of various species. However, nothing has been reported on the nNOS and iNOS expression in zebrafish retina, even though it has been used as an effective model for developmental studies. In this study on nNOS and iNOS immunoreactivity (IR) in the zebrafish retina, iNOS-IR signals were detected in the ganglion cell layer (GC), the inner plexiform layer (IP), the outer plexiform layer (OP) and the photoreceptor layer (PR). nNOS-IR signals were also intensely detected in the GC, IP, OP and PR. These signals were very similar to the iNOS-IR signals, except for some minor differences in relative intensities. This could be explained by the speculation that the synthesis of nitric oxide by iNOS may represent a compensatory mechanism in the absence of nNOS. We described for the first time the distribution of nNOS and iNOS-IR cells in zebrafish retina. This could provide the basis for further study on the nNOS and iNOS properties of zebrafish retina.

Activation of microglia in kainic acid induced rat retinal apoptosis

We applied a variety of methods to follow the course of kainic acid (KA) induced retinal apoptosis, especially with regard to the spatial and temporal aspects. At 24 h after KA injection, a massive cell increase, which showed terminal transferase-mediated dUTP nick-end-labeling technique positive signals, was observed in all of the retinal layers, with the exception of the outer nuclear and photoreceptor layers. Electron microscopy further confirmed that these cells might be apoptotic body ingesting phagocytes, whose function seemed to correlate with bcl-2 mRNA up-regulation. When histochemical studies were performed to determine the cellular identity of the phagocytes, the microglia were thought to be the one and only type of phagocytes involved in the KA-induced retinal apoptosis. In conclusion, we demonstrated that after KA injection, microglia were the only phagocytes to participate in clearing apoptotic debris from the inner retinal layers, and that their function might correlate with the change in expression of the bcl-2 gene family.

Validity and cost-effectiveness of diagnostic procedures in CS2 poisoning

To determine relatively useful diagnostic procedures of carbon disulfide (CS2) poisoning in terms of validity and cost-effectiveness, several diagnostic tests are evaluated on 1,552 people by prevalence ratio (exposed/nonexposed), dose-response relationship, sensitivity and specificity, and the cost of the tests. Several symptoms with high kappa indices are found to be useful in various combinations, showing a consistent dose-response relationship and high exposed-nonexposed ratio. In clinicopathologic tests on functions of the kidney, liver and hematopoietic systems, eight items out of 22 have been shown to have significant dose-response relationship, mostly in liver function tests. A thorough dental examination failed to identify any useful indicator peculiar to the CS2 poisoning. Unlike Western people, the prevalence of coronary heart disease among Koreans was too low to be useful in the diagnosis of CS2 poisoning. Among four elective tests, i.e., Minnesota Multiphasic Personality Inventory (MMPI), Brain magnetic resonance imaging (MRI), nerve conduction velocity (NCV), and fluorescent angiography (FAG), the NCV appeared to be a more sensitive and specific test than the others are. Combinations of the tests improved the probability of diagnosing CS2 poisoning cases when any one test out of four was positive. Addition of other valid tests increased the probability of excluding non-cases. It was concluded that diagnosis of CS2 poisoning could be made validly and inexpensively if the diagnostic tests were carefully chosen step by step.

Increase in signal intensities on T1-weighted magnetic resonance images in asymptomatic manganese-exposed workers

OBJECTIVES

To clarify the clinical significance of increased signal intensities on T1 weighted magnetic resonance imaging (MRI) we performed a large-scale epidemiological study on asymptomatic manganese (Mn)-exposed workers with its focus on MRI.

METHODS

We randomly selected 121 male workers out of a total of 750 workers including Mn-exposed, non-exposed manual, and non-exposed clerical workers in the factories. We studied environmental and biological monitoring, neurological examination, and MRI.

RESULTS

The proportion of workers with increased signal intensities among the exposed, the non-exposed manual workers, and the non-exposed clerical workers was 46.1%, 18.8%, and 0%, respectively. Especially, 73.5% of the welders showed increased signal intensities. In no subject, were clinical signs of manganism observed. The pallidal index correlated with blood Mn concentration.

CONCLUSION

Increase in signal intensities on the T1-weighted image reflect recent exposure to Mn, but not necessarily manganism. At which increase of signal intensity, the progression of manganism from Mn exposure occurs, remains to be solved.

In search of hyperglycaemia--tracing the path that leads to the new diagnostic criteria for diabetes mellitus

The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus announced the new diagnostic criteria for diabetes mellitus on 23 July 1997. The most notable change in the new criteria is a reduction in the cut-off point for fasting plasma glucose to that of 7.0 mmol/L (126 mg/dL). The present criteria have evolved through many years of intensive research and discussions. We intend to trace the path that leads to this latest recommendation so as to understand the evolution of the present criteria and its implications.

(-)-Epiafzelechin: cyclooxygenase-1 inhibitor and anti-inflammatory agent from aerial parts of Celastrus orbiculatus

An inhibitor of cyclooxygenase (COX)-1 activity of prostaglandin H2 synthase was isolated from aerial parts of Celastrus orbiculatus Thunb. (Celastraceae), an oriental folk medicine for rheumatoid arthritis by activity-guided column chromatographic methods. The COX inhibitor was identified as (-)-epiafzelechin, a member of flavan-3-ols by the structural analysis with HR-EI-mass, 1H-NMR and 13C-NMR spectral data. The compound exhibited a dose-dependent inhibition on the COX activity with an IC50 value of 15 microM. (-)-Epiafzelechin exhibited about 3-fold weaker inhibitory potency on the enzyme activity than indomethacin as a positive control. (-)-Epiafzelechin exhibited significant anti-inflammatory activity on carrageenin-induced mouse paw edema when the compound (100 mg/kg) was orally administrated at 1 h before carrageenin treatment.

Idiopathic parkinsonism with superimposed manganese exposure: utility of positron emission tomography

It is difficult to distinguish manganism from idiopathic parkinsonism by clinical signs only. Case history and examination: A 48-year-old welder for over 10 years complained of masked face, right side (arm and leg) resting tremor, and bradykinesia for over one year. Magnetic resonance imaging (MRI) findings showed symmetrical high signal intensities in the globus pallidus on T1 weighted image. These intensities disappeared almost completely six months after cessation of exposure. 18F-6-fluorodopa (18F-dopa) positron emission tomography (PET) findings showed reduced 18F-dopa uptake in the left putamen, findings which appear in idiopathic parkinsonism. A PET study is necessary to distinguish manganism from idiopathic parkinsonism, especially in a working environment with elevated Mn concentrations, such as welding.

Are substance P neurons of the paraventricular nucleus related to the osmotic regulation in the Mongolian gerbil?

In recent years, the gerbil has been used as an experimental animal for study osmotic regulation, because of its inherent high degree of water re-uptake in kidney. Many evidences to explain this characteristic accumulated on the kidney level, it do not, however, manifest what concerns on hypothalmo-hypophyseal level. In this study, we have focused on the difference between the colchicine treated gerbil and rat in distributions of substance P (SP), which is known to have antidiuretic property. Unlike rat, in which a few SP+ neuron is present, SP+ neurons were abundantly observed in the paraventricular nucleus (PVN) of the gerbil. Furthermore SP+ cells in PVN were manifested in dehydrated gerbils, in spite of non-colchicine treatment. Therefore, we suggest that the abundant SP+ neurons in PVN may be a clue to address the neuroendocrinal mechanism concerning the high degree of osmotic regulation in this animal.

A case report of a patient with bronchial carcinoid tumour and late presentation of Cushing's syndrome

Bronchial carcinoid tumour with ectopic adrenocorticotrophin (ACTH) production is an uncommon cause of Cushing's syndrome. In most instances, the patient presents with clinical hyperglucocorticolism and a search for its underlying pathology leads to the discovery of an inconspicuous bronchial carcinoid tumour, if at all. Often the tumour is not immediately detectable. We report a patient who presented in the reverse order--she initially had a large asymptomatic bronchial carcinoid tumour that subsequently manifested as clinical Cushing's syndrome after remaining quiescent for four years.

Aldosterone to renin ratios in the evaluation of primary aldosteronism

Primary aldosteronism, though an uncommon cause of hypertension, causes significant morbidity, making it important to diagnose and treat this condition. Its evaluation requires complex and time consuming investigative procedures in order to confirm the diagnosis and to differentiate between the subtypes of aldosterone producing adenoma and idiopathic hyperaldosteronism. Often, the values of renin and aldosterone are equivocal, and the diagnosis of primary aldosteronism is in doubt. In this study, we examine the use of aldosterone to renin ratios in confirming the diagnosis of primary aldosteronism when the usual criteria of suppressed renin and elevated aldosterone are not met. We have found that an aldosterone to renin ratio of 50 has a 100% specificity and 92% sensitivity for detecting primary aldosteronism. Also, an aldosterone to renin ratio of > 2000 is suggestive of an aldosterone producing adenoma.

Maximal airway narrowing on the dose-response curve to methacholine is increased after exercise-induced bronchoconstriction

The changes in airway responsiveness between before and after exercise in asthma are not well defined. We investigated the effect of exercise on PC20 (bronchial sensitivity) and maximal airway narrowing (MAN) on the dose-response curve to methacholine in 56 mildly asthmatic children. High-dose methacholine inhalation tests were performed before and 7 hr after exercise challenge. Methacholine PC20 was not changed by exercise, irrespective of exercise-induced bronchoconstriction (EIB). However, the subjects with (+)EIB displayed increased MAN after exercise, whereas those with (+/-)EIB or (-)EIB did not. The results showed that EIB may be followed by increased MAN but not by the change of bronchial sensitivity.

Association of exposure to polycyclic aromatic hydrocarbons (estimated from job category) with concentration of 1-hydroxypyrene glucuronide in urine from workers at a steel plant

OBJECTIVES

Increased risk of lung cancer has been associated with employment in the steel industry. This association is thought to be due in part to increased concentrations of polycyclic aromatic hydrocarbons (PAHs) in air found in this work environment. Measurement of PAH metabolites in human urine provides a means of assessing individual internal dose of PAHs. This study examined the relative contribution of occupation and smoking to urinary concentration of 1-hydroxypyrene glucuronide (1-OHPG) among a group of workers at a steel plant.

METHODS

Concentrations of 1-OHPG in urine from 44 workers with jobs associated with increased air concentrations of PAHs and 40 workers with jobs with low or no exposure to PAHs were measured. 20 workers in each group were not current smokers. Urinary 1-OHPG was measured by synchronous fluorescence spectroscopy after immunoaffinity chromatography specific for PAH metabolites.

RESULTS

Mean (SEM) urinary 1-OHPG concentration was 2.16 (0.42) pmol/ml urine among the 44 occupationally exposed workers compared with 0.38 (0.05) among the 40 workers with no or low exposure (P < 0.0001). Mean urinary 1-OHPG concentration was 1.82 (0.41) pmol/ml urine among the 44 current smokers compared with 0.75 (0.20) among the 40 non-smokers (P < 0.005). Mean 1-OHPG concentrations in non-smokers were 0.26 (n = 20), 0.70 (n = 15), and 2.84 pmol/ml urine (n = 5) for strata of exposure to PAHs (no or low, mid, and high) based on job category; the corresponding values in smokers were 0.55 (n = 20), 0.94 (n = 12), and 4.91 pmol/ml (n = 12), respectively. Multiple linear regression showed significant differences between subjects in different PAH exposure with increased concentrations of 1-OHPG in urine. Amounts of foods containing PAHs ingested by this group of workers were relatively low and did not contribute significantly to urinary 1-OHPG concentrations.

CONCLUSIONS

These results indicate that 1-OHPG is a common urinary metabolite in people with recent occupational exposure to PAHs and is associated with both job category and estimated stratum of PAH exposure.

In vitro metabolism of testosterone by gonads of the grouper (Epinephelus tauvina) before and after sex inversion with 17 alpha-methyltestosterone

The steroidogenic potential of gonadal tissues of the protogynous grouper (Epinephelus tauvina) was examined before and after sex inversion with 17 alpha-methyltestosterone. Incubations of gonadal tissues of the fish with [3H]testosterone resulted in the biosynthesis of 5 beta-androstane-3 beta, 17 beta-diol and 5 beta-dihydrotestosterone as the only metabolites in the female phase. Although the production of these 5 beta-reduced androgens persisted in the male phase, there was a shift toward the production of 11 beta-hydroxytestosterone and 11-ketotestosterone as major metabolites.

Reading-related wavelength and spatial frequency effects in visual spatial location

Specific deficits in the processing of transient visual stimuli have been identified in reading-disabled children, and it has been shown that the filtering out of some medium to high spatial frequencies and some visible wavelengths impacts on their performance in a number of visual tasks. To assess further how these light diffusing and colour filtering manipulations might mediate visual processing, this study compared the letter-naming accuracy and visual spatial location judgements of eighteen poor readers with those made by eighteen good readers of the same age. Naming and spatial discrepancy measures were recorded for briefly displayed target letters at varying eccentricities, for each child, under a normal (NI) condition and wearing blue (Be), yellow (Yw), diffusion (Dn), blue with diffusion (BeDn), and yellow with diffusion (YwDn) optical framed lenses. A preliminary analysis of the data detected larger spatial discrepancies for the poor readers, and this finding was consistent with the presence of a deficit in transient (or magnocellular) activity in these children. Both the naming accuracy data and the spatial location data showed filter-dependent differences in reading ability. The letter-naming data showed that the addition of the blue filter to the diffusion lens significantly depressed performance only for the good readers, and that the addition of the yellow filter to the diffusion lens significantly improved performance only for the poor readers. Comparison of the spatial discrepancies showed that the rate at which location accuracy declined with increasing target eccentricity was smaller for the blue and yellow lenses than for normal viewing in the case of the good readers but not in the case of the poor readers.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway responsiveness to allergen is increased 24 hours after exercise challenge

Although exercise is one of the most ubiquitous triggers of acute bouts of asthma, the changes in airway responsiveness before and after exercise are not well defined. Specifically, the effect of the changes in airway responsiveness induced by exercise has not been studied on subsequent allergen exposure. To test whether the reactivity to allergen is altered by preceding exercise and to define possible factors determining it, we subjected 24 children with atopic asthma to the relevant allergen challenge on two occasions: one as a control without a preceding procedure and the other 24 hours after exercise challenge. Mean postallergen maximal percent falls in forced expiratory volume in 1 second from baseline (delta FEV1) of the whole group were higher after the exercise challenge compared with those of control in both early (< 1 hour) and late (3 to 10 hours) phases. The changes of postallergen maximal delta FEV1 between the control and post-exercise allergen challenges were not related to the early bronchial response to the preceding exercise challenge. Late asthmatic responses to exercise developed in six children, and the changes in both early and late phases were significantly higher in these children, compared with those without late asthmatic responses. Furthermore, the changes were well correlated with the magnitude of the late-phase response to preceding exercise in the group as a whole. It is concluded that an increased airway responsiveness to allergen occurs 24 hours after exercise in some patients with asthma. As the changes are related to a late bronchial response to exercise, late asthmatic response to exercise, when it occurs, may be associated with increased asthmatic symptoms for as long as 24 hours after exercise.

Airways of allergic rhinitics are 'primed' to repeated allergen inhalation challenge

The hypothesis that repeated exposure to a specific allergen will further increase bronchial responsiveness to that allergen is supported by indirect evidence. However, it has not been tested as intensely in the laboratory setting, and in some cases, conflicting results are presented. In order to test the hypothesis in the atopic subjects, allergen inhalation challenge tests were performed in 29 house dust mite (Dermatophagoides pteronyssinus) sensitive subjects with allergic rhinitis. Nine subjects displayed early asthmatic responses (EARs) to the first challenge (Group I). Twenty subjects with no significant airway response were submitted to the second challenge 24 h later. Thirteen subjects showed EARs (Group II) and two of these showed late asthmatic responses (LARs) as well. In Group II, there were significant changes between the first and second challenge in post-allergen early phase FEV1 (88.1 +/- 4.2 vs 71.7 +/- 4.2% baseline, P < 0.05) and in post-allergen late phase FEV1 (93.1 +/- 3.4 vs 86.6 +/- 7.8, P < 0.05). After the second challenge, PD20 (provocative dose of methacholine required to produce a 20% fall in FEV1) decreased significantly from the baseline values. When challenged separately with twofold dose of allergen, only three and one of the Group II showed EAR and LAR respectively. PD20 did not change significantly after this challenge. These results indicated that two repeated exposure to allergen dose, which is not enough to cause significant airway responses at a time, may provoke asthmatic airway responses in the subjects with allergic rhinitis and that this effect of priming is not attributed to the cumulative dose but to the consequent effect of repeated allergen exposure.

Spatial distribution of mammalian cells grown on macroporous microcarriers with improved attachment kinetics

Vero and HepG2 cells were cultivated on macroporous gelatin microcarriers prepared by the calcium carbonate inclusion method. Cell attachment to these microcarriers was slow. For HepG2 cells the subsequent growth was poor. Modification of the microcarriers by incorporation of (diethylamino)ethyl-HCl improved HepG2 attachment and subsequent growth. Optical sectioning with confocal microscopy allowed visualization of the distribution of cells within microcarriers. In most microcarriers, cells were found to preferentially populate regions close to the external surface and some cavities in the interior. Despite the incomplete occupancy of the interior of the microcarriers, high cell concentrations were achieved.

Lactobacillus casei subspecies casei endocarditis--a case report

Lactobacillus sp., generally considered to be a harmless indigenous bacteria of the mucous membrane, occasionally causes serious infections. Lactobacillus endocarditis is a very rare disease, and no case has been reported in Korea. Gram-positive bacilli were isolated from blood cultures of a 41-year-old man with clinically suspected subacute bacterial endocarditis. The patient had a dental procedure 3 months prior to the infection. The isolate was identified as L. casei subsp. casei based on the cultural characteristics and gas liquid chromatography of metabolic products. The patient was treated with ampicillin and improved. When Lactobacillus is isolated from the blood of an endocarditis patient, the significance should be seriously considered.

[A survey on the epidemiological factors of clonorchiasis in the Pohang industrial belt along the Hyungsan river, Kyongsangbuk-do]

The employees at the Pohang industrial area, where Clonorchis sinensis has been known to be endemic along the Hyungsan River, were examined parasitologically for clonorchiasis and a part of the infected cases were surveyed with a questionnaire to outline the recent infection status of C. sinensis and epidemiological parameters in the area. Total of 3,180 cases were tested by intradermal inoculation of C. sinensis antigen (Green Cross Co., Korea), and 834 (26.2%) were found positive. Out of the positive cases, 598 were subjected to fecal examination for helminth ova. The examination revealed 129 (21.6%) ova positive cases of C. sinensis, and Trichuris trichiura 1.7%, Ascaris lumbricoides 0.3%, and Metagonimus yokogawai 0.2%. The questionnaire analysis showed some significant differences between the infected and non-infected (control) groups. The infected cases were less educated than the control, and they lived at the closer area to the river, and most of them lived there over 20 years. Also they preferred eating raw fresh water fish. Most of the detected cases were treated with praziquantel and found negative for the eggs in 85.3% of them 1 year after the treatment. The present data reveal markedly decreased endemicity of clonorchiasis compared with previous prevalence rates but still clonorchiasis is endemic in the Hyungsan river basin. A comprehensive measure including case detection, treatment and education for parasite control should be applied to control clonorchiasis in such endemic areas.

Manifestations and outcome of treatment of thyrotoxicosis: a clinical study

We studied a series of 89 consecutive patients who presented with thyrotoxicosis at a medical unit. Clinical parameters and laboratory abnormalities were recorded. Treatment was initiated and response in terms of side-effects, clinical and laboratory remissions were monitored. The frequency of the various clinical manifestations, cardiovascular and neurological complications were documented. Laboratory data on electrolytes, haematological changes and thyroid antibodies were noted. The treatment outcome revealed a relapse of 37.7% in patients with 6 months of treatment (90% occurred within the first year). We also noted that 6.7% of patients developed skin reaction. A treatment default rate of 30% was noted.

Hypopituitarism following head injury--a case report

A 16 year-old boy sustained fracture of the floor of the right orbital fossa in a road traffic accident with resultant diplopia and right enophthalmos. Symptoms of hypocortisolism subsequently developed. About two years after the trauma, pubertal changes which had occurred at 13-14 years had completely regressed. Endocrine testings confirmed clinical anterior hypopituitarism. Post-traumatic hypopituitarism may follow injury to the hypothalamus, the pituitary stalk or the pituitary itself. The normal thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH) in this patient is in favour of a hypothalamic lesion. The patient has responded to replacement hormonal therapy.

Effects of low dose guar in non-insulin dependent diabetic patients

Thirteen non-obese, non-insulin-dependent diabetic patients were given guar granulate in an average dose of 7.1 grams daily for 8 weeks. The mean fructosamine fell from 3.3 +/- 0.69 mmol/L (p less than 0.01). Mean glycosylated haemoglobin (HbA1c) fell from 8.17 +/- 2.2% preguar to 7.67 +/- 1.81% (1 = ns) and to 7.39 +/- 1.23% (p = ns) at 8 weeks and 12 weeks postguar respectively. Eight weeks after the discontinuation of guar fructosamine rose to 3.61 +/- 0.95 mmol/L (p less than 0.05) while HbA1c rose to 8.23 +/- 2.08% (p = 0.05). There were no significant changes in fasting blood glucose, lipids, and body weight. Mild gastrointestinal side-effects occurred in 11 patients during the treatment with guar. It is concluded that daily ingestion of low dose guar modestly improves glycaemic control, such improvement dissipating by 8 weeks following cessation of its use.