Incipient nephropathy in Type 1 (insulin-dependent) diabetes

Summary Patients with Type 1 (insulin-dependent) diabetes without proteinuria were studied to define those patients who will later develop persistent proteinuria (more than 0.5 g protein/24 h). Two investigations were performed; 71 patients were studied longitudinally for 6 years and another 227 patients were studied cross-sectionally. All were less than 50 years of age and had developed diabetes before the age of 40 years. At entry into the study they had no proteinuria (Albustix method), had normal blood pressure and urinary albumin excretion rates < 200 g/min (normal 20 g/min). The best predictor of persistent proteinuria or an albumin excretion rate > 200 g/min was the initial urinary albumin excretion rate. During the longitudinal study, seven patients with an urinary albumin excretion rate of more than 70 g/min at the start of the study developed persistent proteinuria or an albumin excretion rate > 200 g/min. In contrast, only three out of the remaining 64 patients with urinary albumin excretion rate 70 g/min developed urinary albumin excretion rate > 200 g/min. Patients with an urinary albumin excretion rate > 70 g/min are thus at risk of developing diabetic nephropathy. We designate this stage of renal involvement incipient nephropathy. Patients with incipient nephropathy were further characterized in the cross-sectional study. Compared with normoalbuminuric patients, patients with incipient nephropathy had increased systolic and diastolic blood pressure, but normal serum creatinine. The glomerular filtration rate was higher than normal in patients with incipient nephropathy though not different from that of normoalbuminuric patients.     

Differential diagnosis of jaundice: a pocket diagnostic chart

Based on extensive clinical and clinical chemical information (107 different items) from 1002 jaundiced patients, we developed a diagnostic algorithm which was evaluated on a test sample of another 110 jaundiced patients. A primary classification into categories of obstructive jaundice (probability of obstruction greater than or equal to 0.80), non-obstructive jaundice (probability of obstruction less than or equal to 0.20), and of doubtful causes of jaundice (probability of obstruction: 0.20-0.80) was attempted. Among 234 patients in the data base who were classified as obstructive, 220 (94%) proved to be so, as did 36 (97%) of 37 in the test sample. The corresponding figures for non-obstructive jaundice were 463 (96%) of 483 patients correctly classified in the data base and 47 (92%) of 51 patients in the test sample. Altogether 69% of the patients in the data base and 75% of those in the test sample were correctly classified, in 27% and 20% the cause of jaundice was doubtful, and only 4% and 5%, respectively, were misclassified. A slight majority of the patients in whom the algorithmic diagnoses were doubtful proved obstructive. A close correlation was found between the preliminary diagnoses made by the algorithm and by the clinicians. A secondary classification of the patients by the algorithm into benign versus malignant causes of obstructive jaundice performed equally well in the data base and the test sample.     

Identification of the mononuclear cell infiltrate in the superior cervical ganglion of athymic nude and euthymic rats after guanethidine-induced sympathectomy

Guanethidine sulphate 40 mg/kg intraperitoneally for 14 days induced chromatolysis and nerve cell death in the superior cervical ganglia of athymic nude (rnu/rnu) LEW/Mol rats and their euthymic (+/rnu) LEW/Mol heterozygous littermates. Histologically the sympathetic ganglia were dominated by an infiltration of small inflammatory cells. By means of monoclonal antibodies these cells were identified. The number of B-lymphocytes increased following guanethidine in both athymic and euthymic rats. The number of T-lymphocytes increased to a great extent in euthymic rats, but was virtually missing in athymic rats. The number of NK-cells and monocytes/macrophages increased in both athymic and euthymic rats. The conclusion is, that guanethidine exerts a direct effect on sympathetic ganglion cells followed by a thymus-independent immune response.     

Quantification of the total Na,K-ATPase concentration in atria and ventricles from mammalian species by measuring3H-ouabain binding to intact myocardial samples. Stability to short term ischemia reperfusion

Summary Na,K-ATPase concentration was measured by vanadata facilitated³H-ouabain binding to intact samples taken from various parts of porcine and canine myocardium. In porcine and canine heart³H-ouabain binding site concentration in ventricles was 1.4–2.5 times larger than in atria. Evaluation of³H-ouabain binding kinetics revealed no major difference between atria and ventricles: Equilibrium was obtained after the same incubation time in right atrium (RA) as in left ventricle (LV), both in porcine and canine heart. Unspecific uptake and retention of³H-ouabain was for porcine heart RA and LV 1.5 and 1.4, respectively, and for canine heart RA and LV, both 1.2% filling (i.c., volume (ml) of incubation medium³H-radioactivity taken up per mass unit (g wet wt.) of tissue multiplied by 100). The apparent dissociation constant (K _d ) was 1.4×10^–8 and 1.9×10^–8 in porcine RA and LV and 2.6×10^–8 and 6.1×10^–8 mol/l in canine RA and LV. Loss of specifically bound³H-ouabain during the washout procedure occurred with a half-life time (T_1/2) of 16.7 in RA and LV of porcine heart and 91.2 and 151.6h in RA and LV of canine heart. Duly corrected for these errors of the method-factor 1.16 and 1.13, respectively, for porcine RA and LV, and factor 1.11 and 1.13 for canine RA and LV, total³H-ouabain binding site concentration was found to be 553±74 and 1037±45 pmol/g wet wt. (means±SEM, n=5) in porcine RA and LV, and 569±37 and 1410±40 pmol/g wet wt. (means ±SEM, n=5) in the canine RA and LV. These values were confirmed by measurements of³H-digoxin binding to the porcine heart. The present quantification of myocardial Na, K-ATPase gives values up to 154 times higher than measurements based upon Na,K-ATPase activities in membrane fractions where the recovery of Na,KK-ATPase may be less than 1% due to loss during purification. A higher Na,K-ATPase concentration is found in small animals than in large animals. A relationship between higher concentration of Na, K-ATPase and larger pressure work in ventricles compared to atria is suggested. Myocardial³H-ouabain binding sites were found to be stable for 20 min of ischemia, followed by 1h of reperfusion, supporting the concept that myocyte injury induced by short term ischemia may be reversible and that reperfusion may result in normalization.     

Access to contraceptive services among unmarried young people in the north-east of China

Objective The concerns about the potential threats of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have increased, since, in China, there is a lack of sexual education and condom use is rare. A community-based survey was conducted in September 2001 in Changchun city among 1227 unmarried young people aged 15-24 years (619 males and 608 females) to assess risky sexual practices and the obstacles to accessing appropriate contraceptive and other services. Method The study comprised a survey employing self-administered questionnaires, as well as key informant interviews, focus group discussions and in-depth interviews. This paper investigates the factors associated with young people's access to contraceptive services. Results Results showed that 16% of young people had experienced premarital sexual intercourse and, among them, only 48.2% used contraceptive methods during the first sexual intercourse; 29.9% used a condom. Drug stores were the main source of contraceptives. Conclusions While data are sparse, findings suggest that the hostile and judgmental attitudes of providers, as well as the lack of counseling and privacy, were the key obstacles that unmarried youth encountered in their search for contraceptive services. Findings suggest the need for a reorientation of the contraceptive services to focus on unmarried youth, and generally to make contraceptive services more accessible to young people.     

Sarcoidosis‐associated pulmonary hypertension: acute vasoresponsiveness to inhaled nitric oxide and the relation to long‐term effect of sildenafil

Background: Severe pulmonary sarcoidosis is often complicated by pulmonary hypertension (PH) caused by different pathophysiological mechanisms. Objectives: To assess the acute vasoresponsiveness in patients with sarcoidosis and PH and the relation to the therapeutic effect of sildenafil. Methods: A retrospective chart review of 25 patients with recalcitrant pulmonary sarcoidosis being evaluated for lung transplantation at our centre. Haemodynamics were evaluated by right heart catheterisation in 24 patients of whom 19 had PH. Eight of the 19 patients received vasodilator challenge with inhaled nitric oxide (iNO). Results: The study group of eight patients (seven men) had a median age of 51 years (range 38 years–58 years). During iNO we observed a reduction in all patients’ mean pulmonary arterial pressure (MPAP) of median 9 mmHg (range 1 mmHg–20 mmHg) (P = 0.01) and in all patients’ pulmonary vascular resistance of median 2.0 Wood Units (0.7 Wood Units–5.8 Wood Units) (P = 0.01). Acute vasoresponsiveness defined as reduction in MPAP of ≥10 mmHg to a MPAP of ≤40 mmHg without reduction in cardiac output was achieved in two of eight patients. Seven patients were subsequently started on sildenafil and had haemodynamics measured during treatment. There was no relationship between the acute vasoresponsiveness and the response to treatment. One patient had similar responses, but in six patients, the responses were reversed. Conclusions: Approximately a quarter of the tested patients with end‐stage pulmonary sarcoidosis and PH displayed acute vasoresponsiveness to iNO. However, the degree of vasoresponsiveness appears to be a poor predictor of the response to treatment of PH with sildenafil. Please cite this paper as: Milman N, Svendsen CB, Iversen M, Videbæk R and Carlsen J. Sarcoidosis‐associated pulmonary hypertension: acute vasoresponsiveness to inhaled nitric oxide and the relation to long‐term effect of sildenafil. The Clinical Respiratory Journal 2009; 3: 207–213.     

Sexual habits before multiple sclerosis: a national case-control study

The trigging off agent for multiple sclerosis (MS) is despite intensive epidemiological and biomedical research still unknown. The disease is typically diagnosed in reproductive age and recent findings have suggested that MS could be a sexually transmitted disease. AIM: To assess the influence of different sexual practices in young age on the risk of developing MS, and specifically to explore the possible impact of oral sex and oral sperm exposure on this risk. DESIGN: National case-control study. METHODS: Inclusion: Danish women with a first time MS discharge diagnosis from a neurological department at most 40 years old during the period 1998-2005, and an age and geographically matched control group. The response rate to our postal questionnaires was 75% for cases and 61% for controls. A total of 604/619 completed case/control questionnaires were included in the analysis. Data underwent logistic regression analysis. RESULTS: We found no difference between women with and without MS for years of schooling, oral herpes infections, genital herpes, blood transfusions, age at sexual debut, age at coital debut, number of sexual partners before and after age 20 years, anal sex, condyloma attack or chlamydia infections. Family disposition with an affected father, mother or sibling, increased the risk of MS 9.1, 6.9 and 4.1 times, respectively. A total of 68% of cases and of 72% of controls had oral sex sometimes or often before their 20th year. Among women entertaining oral sex, 53%, respectively, 54% had experienced oral sperm exposure. Also oral sex after 20 years was similar in women with and without MS. CONCLUSION: Neither oral sex in early reproductive age, oral sperm exposure, oral sex after 20 years, sexual debut, nor number of sexual partners had any association to the risk of later developing MS. This study does not support the hypothesis that MS is a sexually transmitted or acquired disease.     

Variability in childhood allergy and asthma across ethnicity, language, and residency duration in El Paso, Texas: a cross-sectional study

Background  

We evaluated the impact of migration to the USA-Mexico border city of El Paso, Texas (USA), parental language preference, and Hispanic ethnicity on childhood asthma to differentiate between its social and environmental determinants.     

肺癌CT普查--疾病分期与肿瘤大小的关系

目的：肺癌分期与肿瘤直径的关系已被证实是一个预后指标,因此被纳入1986年肺癌分类的国际系统。近年来由于CT飞速发展,人们可以诊断出更小的肺癌,于是有人提倡对肺癌Ⅰ期进一步分期,即根据肿瘤直径小于还是大于30mm,将无确切远处淋巴结转移的病例（Ⅰ期病例）细分为Ⅰa和Ⅰb期。在诊断无症状（即潜伏）的肺癌时,CT普查的开展使人们考虑肿瘤大小的预后价值。在此我们对CT普查诊断的无症状潜伏型肺癌作了分期与大小关系的报道。