Calorie restriction increases serum parathyroid hormone and decreases serum calcitonin levels in patients with maturity onset diabetes mellitus

Calorie restriction is important in managing patients with maturity onset diabetes mellitus (NIDDM). The effect of such restriction on calcium metabolism is not known. The objective of this study was to determine whether patients on calorie restricted diets would show any modification of parathyroid hormone (PTH) and calcitonin (CTN). The serum levels of PTH and CTN were measured by radioimmunoassays in 269 patients with NIDDM. The patients were divided into two groups depending on the intake of calorie, and PTH and CTN were monitored for 2 years. Plasma levels of vitamin D were measured by competitive protein binding assays before and after each program. The level of PTH (520.8±266.0 pg/ml) (mean±S.D.) was significantly (P<0.01) higher in 109 diabetic patients whose calorie intake was restricted for 2 years (diet (D) group) as compared with that (256.6±103.8 pg/ml) of 160 diabetic patients whose calorie intake was not restricted (non-diet (ND) group). The daily oral calcium intake of the two groups did not differ significantly. We found no significant difference in the serum PTH level in the ND groupVS. normal control subjects (248.8±98.4, N=78). The serum calcium concentration and the amount of calcium excreted in urine were slightly but significantly (P<0.01) lower in the D than in the ND group. The rate of tubular reabsorption of phosphate (% TRP) was significantly lower in the D group than that in the ND group (P<0.01). The serum CTN level was significantly (P<0.01) lower in the D group (33.9±11.3 pg/ml) than in the ND group (64.9±21.2 pg/ml) 2 years after each treatment. The plasma 1,25-(OH)₂-vitamin D level was significantly (P<0.01) lower in the D group (22.2±6.6 pg/ml) than in the ND group (50.6±4.2 pg/ml). When the restriction of calorie intake in the D group was canceled, their PTH levels decreased, which was accompanied by increase in the 1,25-(OH)₂-vitamin D levels, whereas their CTN levels were unchanged. These observations suggested that a restricted calorie intake is a risk factor for secondary hyperparathyroidism as well as for a low serum level of CTN in patients with NIDDM.     

Evidence that difference in size of fraternal twins may originate during early gestation: a case report.

We describe a woman who conceived by in vitro fertilization (IVF) and embryo transfer (ET). Transvaginal ultrasound demonstrated at least 1 week's difference in size of twin gestations from 1 month post-transfer of embryos to delivery. Differences in sac size, crown-rump length, and gestational growth are discussed, as are implications of ultrasound in early pregnancy.     

Lymphoid tissues induce NGF-dependent and NGF-independent neurite outgrowth from rat superior cervical ganglia explants in culture

Induction of neurite outgrowth from superior cervical ganglia (SCG) by rat lymphoid tissues was studied using a tissue culture model. Neonatal rat SCG were cultured with 6–12-week-old rat thymus, spleen, or mesenteric lymph node (MLN) explants in a Martrigel layer, in defined culture medium without exogenous nerve growth factor (NGF). SCG were also co-cultured with neonatal rat heart (as positive control) or spinal cord (SC; as negative control). To determine whether inflammation affects the ability of lymphoid tissues to induce neurite outgrowth, we also examined MLN at various times after infecting rats with Nippostrongylus brasiliensis (Nb-MLN). In one series of experiments, a single lymphoid tissue explant was surrounded by four SCG at a distance of 1 mm. The extent of neurite outgrowth was determinded by counting the number of neurites 0.5 mm away from each ganglion at several time points. Adult thymus and, to a lesser extent, spleen had strong stimulatory effects on neurite outgrowth from SCG after 12 hr or more in culture. For thymus tissue, this was similar to the positive control heart explants. MLN from normal rats had minimal effect on neurite outgrowth; however, Nb-MLN showed a time-dependent enhancement of the neurite outgrowth, maximal at 3 weeks after infection. The relative efficacy of neurite outgrowth induction (heart ≥ thymus ≥ Nb-MLN ≥ spleen ≥ MLN ≥ SC) was confirmed in a second series of experiments where one SCG was surrounded by three different tissue explants. We then examined the role of 2.5S NGF, a well-known trophic factor for sympathetic nerves, in the lymphoid tissue-induced neurite outgrowth. Anti-NGF treatment of co-cultures of SCG and heart almost completely blocked the neurite outgrowth. Anti-NGF also significantly inhibited thymus- and spleen-induced neurite outgrowth, but not as effectively as heart-induced neuritogenesis (93,80, and 77% inhibition at 24 hr; 86,70, and 68% inhibition at 48 hr for heart, thymus, and spleen, respectively). On the other hand, anti-NGF inhibited only 8% of neurite outgrowth induced by 3-week post-infection Nb-MLN at 24 hr, and 41% at 48 hr. These data show that several adult rat lymphoid tissues exert neurotrophic/tropic effects. The predominant growth factor in thymus and spleen is NGF, while Nb-MLN produces factor(s) which is (are) immunologically distinguishable from NGF. These neurotrophic/tropic factors are produced during the reactive lymphoid hyperplasia that forms part of the inflammatory response against the nematode, N. brasiliensis. This suggests the possibility that cytokines produced by lymphocytes or other inflammatory cells may stimulate sympathetic neurite outgrowth in vivo. © 1994 Wiley-Liss, Inc.     

An exploration of the role of the nurses'' uniform through a period of non-uniform wear on an acute medical ward

The nursing staff on an acute medical hospital ward elected to wear their own clothes to work for a period of 2 months. The trial was evaluated using a variety of research methods and it raised a number of issues about the role of uniform, about patients' perceptions of nurses and nurses' perceptions of their role. The study has led to questions being raised about the assumptions that are made if uniform is worn and the appropriateness of a uniform dress.     

起搏器更换时原起搏电极导线参数及更换指标分析

目的:分析74例更换起搏器时电极导线的各项参数的变化并探讨导线更换指标。方法:本组年龄12~87(62.8±18.4)岁,其中病窦综合征45例,房室传导阻滞29例,均为单腔VVI起搏。结果:至测量时原心室起搏电极导线的埋置时间60~148(97.4±22.8)月,首次埋置时起搏阈值为(0.48±0.24)V,更换时为(1.29±0.64)V(P(0.01),增加0.81V,增幅为168%,首次植入时R波幅为(7.8±3.6)mV,更换时为(5.9±3.4)mV(P(0.05)。植入时电极导线阻抗为(664±122)Ω,更换时阻抗为(726±148)Ω,增幅9.3%(P(0.05)。7例因起搏阈值大于2.0 V或阻抗大于1 250Ω而重新植入电极导线。原电极导线使用率为90.5%。结论:埋置起搏电极导线8~9年后,90.5%原电极导线仍在可使用的范围内,能否支持到再次更换需进一步随访。     

Use of long catheters for multipatient anesthetic monitoring at high respiratory frequencies

Anesthetic gases from several patients can be monitored simultaneously with a centrally located mass spectrometer. Such monitoring requires catheters from patient to spectrometer that are several meters long. Scamman (J Clin Monit 1988;4:227–229) found that when the respiratory frequency is high, as with infants, the CO₂ signal from the patient is unacceptably distorted during passage down the catheter. This is due to Taylor dispersion of the input signal. An outline of the theory of Taylor dispersion is given. The equations describe the interaction between the velocity distribution (which, in laminar flow, is parabolic) and the radial diffusion of CO₂. This interaction keeps a tracer signal together in a pulse, as it moves down the tube with themean velocity, spreading somewhat as it proceeds. How much does an initially sharp signal become blurred? The spread of such a signal when it reaches the detector, measured in time, can be expressed in various ways. Measurement is complicated, however, by the fact that the gas pressure may fall by as much as a factor of 10 along the line. The resultant expansion and acceleration of the gas cannot be ignored. A full treatment of this complication is given elsewhere, but the following simple equation is described: {ie237-1} Typically, the spread time is up to a quarter of a second for catheters of 50 m, such as used by Scamman. This is comparable with the period of CO₂ rise and fall for infants and explains the serious distortion in wave form that Scamman found. Some distortion can be eliminated by reducing R to 0.1 or less, but the extent of this improvement is small. Ideally, for fast-breathing patients, the catheter length should be reduced to 20 m or less, if possible.     

Chemotherapy-induced nausea

The rubric complementary medicine covers a variety of approaches that may seem alike only in their being outside conventional care and training. We have asked experienced practitioners to present their own pieces of this jigsaw, realising that these clinical fragments, when seen together, create excitement but also confusion. Of course, this forum is not intended to be a comprehensive review of relevant complementary treatments, and often the individual apporaches to clinical problems will appear totally unrelated, while their apparent effectiveness stretches the biomedical model and conventional research methodology beyond their capacity. With this in mind, we intend that forthcoming articles and reviews will expand on the therapies themselves, and discuss the evidence supporting them.     

尿液有形成分镜检与自动化检测方法学利弊和互补分析

结合当前国内外尿液分析的发展现状和目前国内常规检验工作忽视尿有形成分检查的错误倾向,笔者参考国家(际)标准、文献及本人的临床实践、科研成果,阐述了尿液有形成分检查的临床价值、标准检验流程,评论了应用各种仪器进行镜检筛选的优点与不足,并对如何加强我国尿液分析的质最管理提出了见解.