Increased urinary excretion of the retinol-binding protein in insulin-dependent diabetes mellitus in the absence of microalbuminuria

Urinary excretion of the retinol-binding protein (RBP) was studied in 36 insulin-dependent diabetics with serum creatinine concentrations within the normal range and no microalbuminuria. The excretion was significantly (p < 0.05) higher in the diabetics as compared to a group of apparently healthy persons. The diabetes control indices HbA₁ and serum fructosamine showed no correlation to the rate of urinary RBP excretion. The present data support the idea that tubular dysfunction may be an early symptom of diabetic nephropathy.     

Increased electronegative charge of serum low-density lipoprotein in patients with diabetes mellitus

Background: Patients with diabetes mellitus have been reported to show increased serum levels of modified low-density lipoprotein (LDL), including glycosylated, oxidized and small, dense LDL. This change has been suggested to represent an important risk factor for diabetic macroangiopathy. A common characteristic shared by these modified LDL species is the increase in electronegative charge on particle surfaces, which can be detected by agarose gel electrophoresis as “LDL charge modified frequency” (LDL-CMF) determined from the relative mobility of LDL fraction. Methods: LDL-CMF was measured in the sera from 129 outpatients with type 2 diabetes mellitus and compared with the data from 34 normal subjects. Results: The LDL fraction from diabetics migrates more closely to the anode side as compared with that from normal subjects. The LDL-CMF measured in diabetics, 5.5±8.1%, was significantly (p<0.0001) higher than 0.6±3.4% in normal subjects. Serum LDL-CMF showed significant positive correlations with triglyceride at r=0.552 (p<0.0001) and malondialdehyde modified LDL at r=0.390 (p<0.0001), as well as systolic blood pressure, body mass index, fasting plasma glucose, hemoglobin A_1c, total cholesterol, free fatty acid (FFA) and homeostasis model assessment ratio. It showed negative correlations with high-density lipoprotein and total superoxide dismutase activity. Conclusion: The results indicate that LDL-CMF reflects the degree of serum LDL modification in diabetics and can be regarded as an important risk factor for diabetic macroangiopathy.     

Catalase activity in human hepatocellular carcinoma (HCC)

Liver catalase activity, one of the free-radical scavenger enzymes, has been measured in 22 normal subjects and compared with that of 13 patients suffering from hepatocellular carcinoma. The activity was estimated both in tumor tissue and in tumor-free tissue. A significant reduction of catalase activity was noted in tumor tissue (p < 0.001) as well as in the adjacent tumor-free tissue (p < 0.02). In patients with hepatoma, the serum iron level was lower than in normal (p < 0.01) and was correlated with enzyme activity (r = 0.958). These findings suggest that in hepatocarcinoma the free radical scavenger system is impaired.     

Human platelet phenol sulphotransferase: Assay procedure, substrate and tissue correlations

Procedures for the precise assay of human platelet phenol sulphotransferase activity were determined. The coefficient of variation of the assay was 5.8% when the enzyme activity was expressed per 10⁸ platelets, and was 9.4% when it was expressed per mg soluble platelet protein. Mean platelet phenol sulphotransferase (PST) activity in samples from 102 randomly selected adults was 1.2 ± 0.4 units/10⁸ platelets (mean ± S.D.), with a range from 0.2 to 2.9. The mean activity for umbilical cord blood platelet PST was 0.93 ± 0.3 units/10⁸ platelets (mean ± S.D., N = 27). The substrate used routinely for the assay was 3-methoxy-4-hydroxyphenylglycol (MHPG). There was a significant correlation between the formation of MHPG sulfate by individual platelet preparations and the formation of sulfated product with each of the following substrates: tyramine (r = 0.92, n = 21); dopamine (r = 0.82, n = 16); 5-hydroxytryptamine (r = 0.94, n = 20); acetaminophen (r = 0.77, n = 17); and alphamethyldopa (r = 0.77, n = 17) (p < 0.001 for each). Platelet PST activity correlated significantly with human renal cortex PST activity (r = 0.54, n = 20, p < 0.02). The correlation coefficient between platelet PST activity and jejunal mucosal enzyme activity in eight patients was 0.67. These results raise the possibility that human platelet PST activity measured with MHPG as substrate might reflect the enzyme activity in other tissues and the degree of sulfate conjugation of a variety of substrates.     

Preliminary results of power Doppler imaging in benign prostatic hyperplasia

Power Doppler imaging was performed in 77 patients with lower urinary tract symptoms to characterize Doppler blood-flow signals in benign prostatic hyperplasia (BPH). Pulsatile blood flows were detected in all patients, demonstrating a significant increase of the resistive index (RI) in BPH cases (n = 40, 0.72 ± 0.05, p < 0.0001), compared to those with a healthy prostate (n = 37, 0.64 ± 0.04). Of 40 patients with BPH, 28 (70%) had an RI of 0.70 or higher; all but 1 patient with a healthy prostate (1 of 37, 3%) had an RI lower than 0.70 (p < 0.0001). In all 10 patients with BPH, the elevated RI decreased significantly to a normal control level after surgical treatment (0.72 ± 0.02 vs. 0.64 ± 0.05, p < 0.001). In conclusion, Doppler RI might be useful as a new urodynamic parameter in BPH.     

Urinary excretion of cyclic nucleotides and principal electrolytes in healthy humans of different ages

Urinary excretion of cyclic AMP, cyclic GMP, inorganic phosphorus, calcium, sodium, potassium and creatinine was measured in 138 healthy male and 104 healthy female humans from 2 to 68 years old. The range of cyclic nucleotide excretion was as follows: cyclic AMP (μmol/day), 1.01–10.89; cyclic GMP (μmol/day), 0.13–2.00; cyclic AMP (Mmol/g creatinine), 1.52–8.93; cyclic GMP (μmol/g creatinine), 0.11–1.87. The 242 volunteers were grouped into seven classes according to age: A, 2–9 years old; B, 10–19; C, 20–29; D, 30–39; E, 40–49; F, 50–59 and G, 60–68. Average excretion (μmol/day) of cyclic AMP in class A (2.62 ± 0.29 for males and 2.30 ± 0.18 for females) was significantly smaller than that in other classes (4.59 ± 0.12 for males and 3.90 ± 0.13 for females) (p < 0.01). Such a significant difference was not observed in cyclic GMP excretion. In terms of μmol/g creatinine, however, average excretion of both cyclic AMP and cyclic GMP in class A was greater than that in other classes.

The amounts of urinary cyclic AMP and cyclic GMP (μmol/day) were correlated with age in the subjects from 2 to 16 years. A reverse correlation between the amounts of both nucleotides (μmol/g creatinine) and age was found in the young subjects. No correlation between the excretion of either urinary cyclic nucleotide and age was found in adults.

A significantly positive correlation between cyclic AMP (μmol/day) and inorganic phosphorus (g/day) was found (r = 0.50 for males and 0.56 for females) (p < 0.01). This correlation suggests that urinary cyclic AMP might reflect the activity of parathyroid hormone in normal humans. There was no significant correlation between cyclic GMP and electrolytes tested. The above results are considered to provide basic data for clinical evaluation of relevant disorders.     

Urinary proteins and red blood cell membrane negative charges in diabetes mellitus

The nature and origin of proteinuria in diabetes mellitus have been investigated by measuring the urinary excretion of seven specific proteins of low (β₂-microglobulin, retinol-binding protein) or high molecular weight (albumin, transferrin, hemopexin and IgG). Using the Alcian Blue binding test, we also measured negative charges on red blood cell (RBC) membrane which according to recent studies might mirror the glomerular polyanion charge. A group of 190 diabetics was examined, including 90 patients with type I diabetes, 23 type II diabetics treated with diet and/or hypoglycaemic agents and 77 longstanding type II diabetics requiring insulin therapy. With the exception of β₂-microglobulin all proteins measured were excreted in the urine of diabetics in significantly higher amounts than in controls. The assay of transferrin proved the most sensitive (58% positive) followed by albumin (49%), IgG (34%), hemopexin (28%) and retinol-binding protein (26%). Practically the same ranking was obtained when only type I diabetics were considered.

RBC membrane negative charges were diminished in diabetics and negatively correlated with the urinary excretion of albumin (r = −0.61, n = 190). RBC charges were also negatively correlated with other urinary proteins of high molecular mass (r between −0.5 and −0.2) but presented no relation with urinary β₂-microglobulin or retinol-binding protein. The loss of RBC charges in diabetics most likely reflects the concomitant depletion of the glomerular polyanion responsible for the increased glomerular leakage of high molecular mass plasma proteins. The preferential increase in transform excretion together with the progressive rise in the urinary excretion of IgG lead us to postulate that the loss of glomerular polyanion in diabetes is accompanied, from the early stage, by a progressive decrease in the size-selectivity of the glomerular filter. The urinary excretion of retinol-binding protein was weakly correlated with albuminuria (r = 0.26, n = 186). Eight % of diabetics showed an elevation of urinary retinol-binding protein without evidence of microalbuminuria, which clearly demonstrates that a proximal tubular impairment can occur independently of the glomerular alterations in the course of diabetic nephropathy.     

Total plasma malondialdehyde levels in 16 Taiwanese college students determined by various thiobarbituric acid tests and an improved high-performance liquid chromatography-based method

Objectives: In determining the plasma malondialdehyde MDA levels in some Taiwanese college students, we found rather different results by using different thiobarbituric acid TBA tests, even by the high-performance liquid chromatography HPLC-based methods. Here, we re-evaluated four commonly used TBA tests and improved the HPLC-based test.

Design and Methods: We used the blood plasma of 16 college volunteers to determine plasma MDA by using four methods: a spectrophotometric measurement of thiobarbituric acid-reactive substances (TBARS) in the TCA-supernatant of plasma (Method A); a fluorescence measurement of plasma lipid peroxides (Method B); and two different HPLC-based measurements of MDA with either 532-nm measurement (Method C, HPLC/532 nm) or fluorescence measurement (Method D, HPLC/fluor.).

Results: The levels of MDA or TBA reactive substances obtained from the four methods differed substantially (0.39 ± 0.15; 2.14 ± 0.73; 0.75 ± 0.22; and 0.38 ± 0.15 μM for Methods A, B, C, and D, respectively). The results were positively correlated between Methods A and B (r = 0.740, p < 0.02) and between Methods C and D (r = 0.516, p < 0.05). However, results were negatively correlated between Methods B and D (r = −0.548, p < 0.05). Because most plasma MDA is bound to proteins, we modified the HPLC-based methods (C and D) by adding an alkaline hydrolysis step, and the plasma TBA-MDA adduct detected by HPLC/532 nm was referred to as total MDA. Results show that alkaline hydrolysis was a critical step for measurement of total MDA in plasma because this treatment led to release of MDA from plasma proteins. We also adapted the potassium iodide (KI) treatment of plasma from Method D to reduce lipid hydroperoxides. Our modified method gave a total MDA level in the 16 volunteers of 1.5 μM, which was equal to protein-bound MDA plus free MDA. This total MDA level was positively (p < 0.05) correlated with the level of TBA reactive substances obtained from Methods C (r = 0.63, p < 0.05) and D (r = 0.48, p < 0.07), but was not correlated with those from Methods A and B. The recovery (84105%), precision (within-assay coefficient of variation: 2.4%, between-assay coefficient of variation: 48%) and sensitivity of the modified procedure were comparable to other HPLC-based methods.

Conclusion: By using a validated modification of HPLC-based TBA method, the total plasma MDA in 16 Taiwanese college students was found to be 1.54 μM, which was relatively high compared to those obtained by other HPLC-based method, primarily due to the release of protein-bound MDA by alkaline hydrolysis. This level equaled the sum of protein-bound MDA and free MDA in plasma, confirming that this level represents total plasma MDA.     

Use of saliva for monitoring unbound free cortisol levels in serum

In order to verify the clinical usefulness of saliva in assessing the adrenocortical function, we measured saliva cortisol levels by a radioimmunoassay after extraction with dichloromethane, and compared the results with the levels of serum unbound cortisol determined by the method of equilibrium dialysis. Paired samples of saliva and serum were obtained from 10 healthy male volunteers.

Morning levels of saliva cortisol and serum unbound cortisol were 0.99 ± 0.42 and 1.56 ± 0.54 μg/100 ml, respectively, where serum total cortisol was 19.28 ± 3.56 μg/100 ml. A well-defined diurnal rhythm and a greater response to ACTH stimulation were observed in saliva cortisol than in serum total cortisol. Kinetic study of injected cortisol revealed almost identical values for the compartments of saliva cortisol and serum unbound cortisol. The correlation coefficient (r) between the levels of saliva cortisol and serum unbound cortisol was 0.893 (p < 0.001, n = 150).

From these results we concluded that the measurement of saliva cortisol can be used sufficiently to monitor its unbound free concentrations in serum.     

The effect of dietary treatment on erythrocyte lipid peroxidation, superoxide dismutase, glutathione peroxidase, and serum lipid peroxidation in patients with type 2 diabetes mellitus

Objectives: The aim of the present study was to investigate the effect of dietary treatment on serum and erythrocyte lipid peroxidation and erythrocyte antioxidative enzyme activity of patients with Type 2 diabetes.

Design and methods: A total of 30 patients with newly diagnosed as Type 2 diabetes were enrolled to the study. A total of 30 healthy subjects served as controls. Diabetic patients were given standard dietary treatment that was composed of 50% to 55% carbohydrate and 30% fat for 2 months. No diet was applied for controls. For both groups serum and erythrocyte lipid peroxidation and erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were obtained at first and at the end of 2 months.

Results: Diabetic patients had higher serum and erythrocyte lipid peroxidation than those of controls before dietary treatment(p < 0.05). However, there was no absolute differences in erythrocyte SOD and GSH-Px (p > 0.05). At the end of 2 months of dietary treatment, while diabetics had still higher glucose and erythrocyte lipid peroxidation than controls (p < 0.05), serum lipid peroxidation, erythrocyte SOD, and GSH-Px levels did not differ significantly from those of controls (p > 0.05). In diabetic patients, after 2 months of dietary treatment, whereas serum and erythrocyte lipid peroxidation decreased, erythrocyte SOD and GSH-Px activities showed significant increase (p < 0.05).

Conclusions: Our results showed significant alteration in serum and erythrocyte lipid peroxidation and erythrocyte antioxidant enzyme status of patients with Type 2 diabetes by dietary treatment. However, whether such alterations have clinical importance for diabetic patients needs further investigation.     

Serum levels of tetranectin, intercellular adhesion molecule-1 and interleukin-10 in B-chronic lymphocytic leukemia

Background and objective: The fibrinolytic regulator tetranectin (TN), in association with the circulating intercellular adhesive molecule-1 (cICAM-1) and interleukin -10 (IL-10), may be involved in the metastatic cascade of B-chronic lymphocytic leukemia (B-CLL). Our aim was to investigate the potential usefulness of these molecules as prognostic markers in B-CLL.

Design and methods: Therefore, TN, cICAM-1, and IL-10 were assessed (ELISA) in the serum of 53 B-CLL patients, classified in Binet A, B, and C stages in comparison with those in 45 healthy subjects (HS).

Results: TN was significantly lower in B-CLL patients than in HS (9.63 [8.75–11.51] mg/L, 13.75 [12.56–14.64] ng/mL, respectively, p < 10⁻⁵), being lower (p = 0.05) in B and C stage patients (subgroup B+C) than in A stage ones (subgroup A). cICAM-1 levels were significantly higher in B-CLL patients than in HS (475.86 [355.86–593.79] ng/mL vs. 225.62 [118.49–312.83] ng/mL, respectively, p < 10⁻⁵) with a tendency for higher levels in subgroup B+C than in subgroup A. A significant correlation of cICAM-1 with lactate dehydrogenase (LDH) (r_s = 0.532, p = 0.049), and a significant increase in cICAM-1 in B-CLL with diffuse bone marrow infiltration (BMI) compared to that in B-CLL with nondiffuse BMI (624.48 [557.24–726.55] ng/mL vs. 480.34 [368.96–590.34] ng/mL, respectively, p = 0.0172) were found. A significant negative correlation between TN and cICAM-1 (r_s = −0.5017, p = 0.0001) was observed. IL-10 was detected in all B-CLL patients and in no HS (7.37 [5.30–10.55] pg/mL), being higher (p = 0.0153) in C than in A stage patients. A significant correlation of IL-10 with TN and cICAM-1 in subgroup B+C (r_s = −0.659 [p = 0.014] and r_s = 0.679 [p = 0.011], respectively) was found.

Conclusions: The abovementioned findings and good performance characteristics of TN and cICAM-1 in B-CLL suggest the potential usefulness of these adhesive/recognition molecules as prognostic markers in B-CLL. The implication of these molecules along with IL-10 in the disease process deserves further study.     

Serum nitrates and vasoactive intestinal peptide in patients with gastroesophageal reflux disease

Background: The normal esophageal motility is a balance between excitatory cholinergic “muscarinic” innervations and noncholinergic nonadrenergic inhibitory innervations. The latter is mediated by nitric oxide (NO) and/or vasoactive intestinal polypeptide (VIP).

Methods: The study included 50 patients with gastro-esophageal reflux disease (GERD), and 10 healthy controls of matched age and sex. Patients were divided into five groups according to the degree of lower end esophagitis (Savary-Miller classification). Serum VIP was measured using enzyme immunoassay after peptide purification. Serum nitrate as an index of nitric oxide generation was determined biochemically.

Results: Serum nitrate and VIP levels were significantly higher in GERD patients than the control group (p < 0.001). Grade 0 serum nitrates was significantly higher than the control group (p < 0.05) with some overlap between the individual values of the two groups. Serum VIP was significantly higher in grade 0 group compared to control group (p < 0.001) with no overlap in the individual values. There was a significant positive correlation between the grade of lower end esophagitis and each of serum nitrate and VIP (p < 0.001), as well as between serum nitrate and each of serum VIP, cigarette smoking index (CSI) and BMI (p < 0.001).

Conclusion: Abnormally high levels of serum VIP and NO may have a role in the pathogenesis of GERD. Exposure of esophageal mucosa to noxious effect of acid refluxed due to the relaxant effect of VIP on lower esophageal sphincter may cause increased NO levels. BMI and CSI are risk factors for GERD progression.     

US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules

The aim of the study was to define the effectiveness and safety of ultrasound-guided percutaneous radiofrequency (RF) thermal ablation in the treatment of compressive solid benign thyroid nodules. Thirty-one patients not eligible for surgery or radioiodine (¹³¹I) treatment underwent RF ablation for benign nodules; a total of 33 nodules were treated (2 patients had 2 nodules treated in the same session): 10 cold nodules and 23 hyperfunctioning. Fourteen patients complained of compressive symptoms. Nodule volume, thyroid function and compressive symptoms were evaluated before treatment and at 1, 3 and 6 mo. Ultrasound-guided RF ablation was performed using a Starbust RITA^® needle, with nine expandable prongs; total exposure time was 6 to 10 min at 95° C in one area or more of the nodule. Baseline volume (measured at the time of RF ablation) was 27.7 ± 21.5 mL (mean ± SD), but significantly decreased during follow-up: 19.2 ± 16.2 at 1 mo (–32.7%; p < 0.001), 15.9 ± 14.1 mL at 3 mo (–46.4 %; p < 0.001) and 14.6 ± 12.6 mL at 6 mo (–50.7%; p < 0.001). After treatment, all patients with cold nodules remained euthyroid: five patients with hot nodules normalized thyroid function, and the remaining sixteen showed a partial remission of hyperthyroidism. Besides a sensation of heat and mild swelling of the neck, no major complications were observed. Improvement in compressive symptoms was reported by 13 patients, with a reduction on severity scale from 6.1 ± 1.4 to 2.2 ± 1.9 (p < 0.0001). Radiofrequency was effective and safe in reducing volume by about 50% and compressive symptoms in large benign nodules. Hyperfunction was fully controlled in 24% of patients and partially reduced in the others. (E-mail: mdeandrea@libero.it)     

Chemiluminescence in inflammatory bowel disease patients: a parameter of inflammatory activity

Background: Reactive oxygen species (ROS) are produced in excess in the inflamed mucosa and peripheral blood of patients with inflammatory bowel disease. These species have emerged as a common pathway of tissue injury in a wide variety of inflammatory and other disease processes. The present study was conducted to assess ROS production and to correlate this with parameters of inflammatory activity. Methods: In 25 patients with Crohn's disease (CD), 20 patients with ulcerative colitis (UC) and 65 age- and sex-matched healthy volunteers ROS production was measured using the whole blood luminol enhanced chemiluminescence assay (LECA). Disease activity was assessed using the Crohn's disease activity index and the Ulcerative Colitis Symptoms Score (UCSS) for CD and UC, respectively. Furthermore, the effect of various scavengers, enzymes and enzyme inhibitors on LECA was studied to assess the contribution of different ROS. Results: LECA was significantly higher in CD and UC patients compared with healthy controls (7.1±4.7 and 9.8±6 vs. 5.2±2.8×10³ counts per minute (cpm), p<0.05 and <0.001). In CD, relative LECA (patient/control) was correlated with the Crohn's disease activity index and C-reactive protein (CRP) (r=0.54, p=0.001 and r=0.51, p=0.01). In UC, CRP but not LECA was correlated with the Ulcerative Colitis Symptoms Score (C-reactive protein: r=0.42, p=0.01). Addition of azide, superoxide dismutase, deferoxamine and dimethylthiourea resulted in a decrease of LECA values. Conclusion: Whole blood LECA is increased in patients with CD and UC. This parameter is correlated with disease activity in CD. The observed chemiluminescence is probably due to generation of superoxide and the hydroxyl radical.     

Normal sonographic values of maternal spleen size throughout pregnancy

This study aims to establish normal range of sonographically measured maternal spleen size throughout pregnancy. Currently, 288 healthy pregnant women between 6 and 42 weeks’ gestation underwent ultrasonographic measurements of spleen length and width. The relationships between ultrasound measurements with prepregnancy body mass index (BMI) and gestational age were assessed using the Pearson correlation coefficient. A linear regression model was applied to construct the appropriate equation for measuring the spleen area relative to BMI and gestational age. A significant correlation (R) was found between gestational age and spleen dimensions length (R = 0.486; p < 0.001), width (R = 0.455; p < 0.001) and area (R = 0.522; p < 0.001)) as well as between prepregnancy BMI and spleen length [(R = 0.314; p < 0.001), width (R = 0.380; p < 0.001) and area (R = 0.413; p < 0.001)]. We divided the spleen area by the BMI, thus enabling to perform a linear regression analysis with gestational age (weeks) as an independent continuous variable. A high multiple correlation (R) between spleen area and this variable was found (R² = 0.47; p < 0.001). The equation [spleen area/BMI = 1.598 + 0.032 × gestational age in weeks] was performed for calculating the spleen area throughout pregnancy. A significant overall growth pattern of spleen area in pregnancy with increasing gestational age was found. Normograms from these data can be used to evaluate splenomegaly throughout pregnancy. (E-mail: intposgr@post.tau.ac.il)     

Relationship between myocardial tissue density measured by microgravimetry and sound speed measured by acoustic microscopy

If myocardial tissue can be assumed to be fluid-like, myocardial tissue elasticity can be estimated by the sound speed of tissue based on the equation K=ρc², where K is the elastic bulk modulus, ρ is density, and c is the sound speed of tissue. However, little data exist regarding the relationship between the sound speed of tissue and tissue density. The purpose of the present study was to evaluate the relationship between the sound speed of tissue and tissue density of various diseased myocardia. Myocardial tissue specimens at autopsy were obtained from 10 control patients without cardiovascular disease, 8 patients with pressure overload left ventricular hypertrophy (POLVH), and 8 patients with cardiac amyloidosis (AMD). Myocardial tissue sound speed was measured using a scanning acoustic microscope operating in the frequency of 450 MHz, and tissue density was measured by microgravimetry. The sound speed in POLVH (1639 ± 17 m/s) was higher and that in AMD (1565 ± 11 m/s) was lower than that in control patients (1615 ± 15 m/s) (p < 0.001) at the temperature of 20–22°C. The density in POLVH (1.087 ± 0.004 g/cm³) was higher and that in AMD (1.072 ± 0.003 g/cm³) was lower than that in control patients (1.082 ± 0.003 g/cm³) (p < 0.001). Tissue density correlated with sound speed in all three groups (r = 0.96, p < 0.001). Therefore, myocardial tissue sound speed data obtained by acoustic microscopy enabled us to evaluate tissue elasticity without measuring tissue density directly.     

Increased peak blood velocity in association with elevated blood pressure

To test the hypothesis that peak blood velocity in the common carotid artery is increased in association with elevated blood pressure, the authors measured peak common carotid blood velocity in 458 subjects by color Doppler ultrasonography. Blood pressure was measured at the time of ultrasound examination by automated sphygmomanometer. Peak blood velocity was increased in subjects with elevated blood pressure (right common carotid: 72.5 ± 2.0 cm/s vs. 62.7 ± 2.5 cm/s, left common carotid: 72.0 ± 1.8 cm/s vs. 63.9 ± 2.0 cm/s, p < 0.001). Peak blood velocity was significantly correlated with systolic blood pressures between 135 and 160 mmHg (r = 0.47 in right common carotid, 0.45 in left common carotid, n = 123, p < 0.001). No correlation was found between peak blood velocity and blood pressures less than 135 mmHg or greater than 160 mmHg. By increasing erythrocyte momentum, increased peak blood velocity may play a role in the pathogenesis of arterial diseases associated with hypertension.     

Hyponatremia and hyperkalemia in relation to hyperglycemia in insulin-treated diabetic out-patients

Interrelations between glucose and electrolyte homeostasis were evaluated in 193 insulin-treated diabetic out-patiens. All had normal serum creatinine and were studied during their everyday metabolic control. Although the patients were selected to be without proteinuria and ketonuria, they exhibited wide ranges of blood glucose values (2.5–29.5 mmol/1) and urine glucose excretions (0–301 mmol/mmol creatinine). Patients with blood glucose values within 2.5–10 mmol/1 (n = 80) had entirely normal levels of serum sodium (140.6 ± 2.7 (SD) versus 141.0 ± 2.6 mmol/1) and potassium (4.35 ± 0.38 versus 4.40 ± 0.38 mmol/1) as compared with normals (n = 371). In contrast, diabetics with higher blood glucose concentrations (n = 113) showed hyponatremia (137.7 ± 2.6 mmol/1, p < 0.001) and a moderate increase of serum potassium (4.60 ± 0.39 mmol/1, p < 0.001). On stratification into classes of blood glucose, serum sodium declined from 142 to 135 mmol/1 (r = ?0.61, p < 0.001), whereas serum potassium rose from 4.33 to 4.87 mmol/1 (r = 0.37, p < 0.001). Despite these reciprocal changes the urinary excretion rates relative to creatinine of sodium, potassium and water rose with rising degrees of glycosuria (r = 0.24, p < 0.001; r = 0.28, p < 0.001; and r = 0.63,p < 0.001, respectively).The decline in serum sodium represents a well-known osmoregulatory response to hyperglycemia. However, the rising level of serum potassium in virtual absence of renal failure and ketonuria suggests an abnormality in potassium homeostasis. Diabetic dysregulation, or rather relative insulin deficiency may be its cause.     

Comparison of 5-hydroxyindole-acetic acid and para-mamino hippurate clearances in newborn rabbits

Recent study indicates that endogenous 5-hydroxyindole-acetic acid (5-HIAA) clearance can be used as an alternative procedure to para-amino hippurate (PAH) clearance for the estimation of renal plasma flow in human patients. In view of the limitations of PAH clearance measurements in newborn infants we made an attempt to validate the technique of measuring renal blood flow with 5-HIAA quantitatively against PAH clearance. Thirty-four simultaneous determinations of PAH and 5-HIAA clearances were performed in 14 newborn rabbits. 5-HIAA concentrations in plasma and urine were measured by using HPLC coupled with electrochemical detection (Beckman). Renal blood flow was found to range between 0.60 and 6.90 ml/min/kg (mean: 3.39 ml/min/kg) for 5-HIAA and from 0.93 to 6.61 ml/min/kg (mean: 3.68 ml/min/kg) for PAH clearances. There was a significant positive correlation between the values obtained by the two techniques (r = 0.84, P < 0.001). When 5-HIAA clearance was analyzed as a function of plasma 5-HIAA level only a weak, but statistically significant correlation could be detected (r = 0.33, P < 0.05). Plasma 5-HIAA measurement alone, therefore, does not reflect renal blood flow in newborn rabbits. It is concluded that endogenous 5-HIAA clearance might serve as a reliable estimate of renal blood flow in the neonate under different physiologic and pathologic conditions.     

The impact of a stage-matched intervention to promote exercise behavior in participants with type 2 diabetes

This study was designed to develop and evaluate a stage-matched intervention (SMI) in Korean participants with type 2 Diabetes. The SMI was based on main constructs derived from the Transtheoretical Model match to the individual’s stages of readiness for exercise behavior. The SMI was developed according to the results of the content validity tested by an expert group (n=9). A control group pre- and post-test design was used for evaluating the impact of the SMI: the intervention group (n=22) participated in the SMI for 3 months, while the control group (n=23) received usual educational advice. The intervention group, compared to the control group, showed significant improvements in stages of change for exercise behavior (p < 0.001), physical activity levels (p < 0.001), and reductions in FBS (p < 0.05) and HbA₁c (p < 0.05). This study yielded evidence for the beneficial impact of the SMI in participants with type 2 Diabetes.