Comparison between basal insulin glargine and NPH insulin in patients with diabetes type 1 on conventional intensive insulin therapy

BACKGROUND/AIM: Insulin glargine is a long-acting insulin analog that mimics normal basal insulin secretion without pronounced peaks. The aim of this study was to compare insulin glargine with isophane insulin (NPH insulin) for basal insulin supply in patients with type 1 diabetes. METHODS: A total of 48 type 1 diabetics on long term conventional intensive insulin therapy (IT) were randomized to three different regimens of basal insulin substitution: 1. continuation of NPH insulin once daily at bedtime with more intensive selfmonitoring (n = 15); 2. NPH insulin twice daily (n = 15); 3. insulin glargine once daily (n = 18). Meal time insulin aspart was continued in all groups. RESULTS: Fasting blood glucose (FBG) was lower in the glargine group (7.30+/-0.98 mmol/1) than in the twice daily NPH group (7.47+/-1.06 mmol/1), but without significant difference. FBG was significantly higher in the once daily NPH group (8.44+/-0.85 mmol/l; p < 0.05). HbAlc after 3 months did not change in the once daily NPH group, but decreased in the glargine group (from 7.72+/-0.86% to 6.87+/-0.50%), as well as in the twice daily NPH group (from 7.80+/-0.83% to 7.01+/-0.63%). Total daily insulin doses were similar in all groups but only in the glargine group there was an increase of basal and decrease of meal related insulin doses. The frequency of mild hypoglycemia was significantly lower in the glargine group (6.56+/-2.09) than in both NPH groups (9.0+/-1.65 in twice daily NPH group and 8.13+/-1.30 in other NPH group) (episodes/patients-month, p < 0.05). CONCLUSION: Basal insulin supplementation in type 1 diabetes mellitus with either twice daily NPH insulin or glargine can result in similar glycemic control when combined with meal time insulin aspart. However, with glargine regimen FBG, HbAlc and frequency of hypoglycemic event are lower. These facts contribute to better patients satisfaction with insulin glargine versus NPH insulin in IIT in type 1 diabetics.     

Age-related changes of the human fetal kidney size

Early prenatal diagnostics and the importance of genetic counseling are of great interest for echosonographic evaluation of normal fetus anatomy. Development of the human fetal kidney runs through a series of continual and mutually dependent changes during which the kidney obtains its morphological and functional maturity. This study was created to estimate the changes in kidney size during gestation in fetuses from the 4th to the 10th lunar month, to evaluate the dynamics of their growth, as well as to establish the validity of the volume calculated from these dimensions. Serial measurements of kidney dimensions (length, width, thickness) were performed in 110 fetuses. Photomicrographs of kidneys from the 4th, 6th, 8th and 10th lunar months are also presented. On the basis of the results obtained by our examination, we concluded that the period from the 14th to 16th week of intrauterine life is the fastest period of kidney growth during fetal development. Using the ellipsoid formula for calculating the fetal renal volume offers an underestimation of about 32-33% on average. The importance of this study lies in determining the average fetal kidney dimensions, which could be used as standard values in obstetrics.     

Tuberculosis in a developing country — how much patients know about disease

Introduction  

Knowledge of tuberculosis among patients with the disease is crucial for early disease recognition, patients’ full cooperation during the treatment, and prevention of future relapses. Our major aim was to evaluate knowledge about tuberculosis among patients and its correlation to their socioeconomic status (education level, employment status, monthly income, living conditions).     

Optimum loading for maximizing muscle power output: the effect of training history

Although the effect of external load on the mechanical output of individual muscle has been well documented, the literature still provides conflicting evidence regarding whether the optimum loading (L_opt) for exerting the maximum muscle power output (MPO) could be different for individuals with different levels of strength and power. The aim of this study was to explore the effect of training history on L_opt that maximizes MPO during the 6-s maximal cycling sprint test. Forty healthy young males (strength-and speed-trained athletes, and physically active and sedentary non-athletes) were tested on maximum strength, and on peak MPO when loaded 5–12% of body weight (BW). As expected, the strength trained and sedentary participants, respectively, revealed the highest and lowest strengths and MPO (p < 0.001). However, the main finding was a significant across-group difference in L_opt (p < 0.001) revealing the values 9.7% (for strength trained), 9.2% (speed trained), 8.7% (active), and 8.0% of BW (sedentary individuals). This suggests that the effects of external loading on maximum MPO in complex functional movements could be training history dependent. In addition to revealing a sensitivity of the 6-s maximal cycling sprint tests (and, perhaps, other maximum cycling tests), the results suggest that the external loading in routine MPO tests should not be solely adjusted to a fixed percentage of subject’s BW (as routinely done in standard tests), but also to their training history. The same phenomenon remains to be evaluated in a number of other routine tests of MPO and other maximum performance tasks.     

Urine release of systemically administered bone morphogenetic protein hybrid molecule

BACKGROUND: Although it is well known that TGF-beta circulates, the presence and activity of endogenous bone morphogenetic proteins (BMPs) in biological fluids has not been studied. Here we investigated the urine secretion of a systemically administered BMP hybrid molecule. METHODS: A dimeric recombinant human BMP molecule consisting of the BMP-7 prodomain and the BMP-6 mature domain was constructed and injected into Sprague Dawley rats. The blood was collected from the rats' orbital plexus, and 24-hour urine samples were pooled and purified using a heparin sepharose column. Protein identity was confirmed by Western blot and by liquid chromatography-mass spectrometry (LC-MS) of the resulting peptides. Urine-derived protein from the 35-kDa band was bound to inactive demineralized bone matrix and implanted subcutaneously into rats. RESULTS: Western blot analysis of sera demonstrated that BMP-7/6 remained intact in the rat plasma and could still be visualized 30 minutes after its systemic administration. Two protein bands at 35 and 39 kDa were detected with anti-BMP antibodies in the urine of rats, corresponding to the mature active BMP-6 dimer and the prodomain of BMP-7, respectively. LC-MS analysis detected only peptides derived from the BMP-7/6 molecule. Histological analysis of implanted pellets revealed formation of a new endochondral bone 14 days following implantation. CONCLUSIONS: These results show for the first time that systemically administered BMP-7/6 hybrid molecule is secreted into the urine and that its biological activity is preserved, suggesting that analysis of BMP in urine might reflect its presence in serum.     

Dosimetric properties of improved GafChromic films for seven different digitizers

Two recently introduced GafChromic film models, HS and XR-T, have been developed as more sensitive and uniform alternatives to GafChromic MD-55-2 film. The HS model has been specifically designed for measurement of absorbed dose in high-energy photon beams (above 1 MeV), while the XR-T model has been introduced for dose measurements of low energy (0.1 MeV) photons. The goal of this study is to compare the sensitometric curves and estimated dosimetric uncertainties associated with seven different GafChromic film dosimetry systems for the two new film models. The densitometers tested are: LKB Pharmacia UltroScan XL, Molecular Dynamics Personal Densitometer, Nuclear Associates Radiochromic Densitometer Model 37-443, Photoelectron Corporation CMR-604, Laser Pro 16, Vidar VXR-16, and AGFA Arcus II document scanner. Pieces of film were exposed to different doses in a dose range from 0.5 to 50 Gy using 6 MV photon beam. Functional forms for dose vs net optical density have been determined for each of the GafChromic film-dosimetry systems used in this comparison. Two sources of uncertainties in dose measurements, governed by the experimental measurement and calibration curve fit procedure, have been compared for the densitometers used. Among the densitometers tested, it is found that for the HS film type the uncertainty caused by the experimental measurement varies from 1% to 3% while the calibration fit uncertainty ranges from 2% to 4% for doses above 5 Gy. Corresponding uncertainties for XR-T film model are somewhat higher and range from 1% to 5% for experimental and from 2% to 7% for the fit uncertainty estimates. Notwithstanding the significant variations in sensitivity, the studied densitometers exhibit very similar precision for GafChromic film based dose measurements above 5 Gy.