Facilitating access to glucometer reagents increases blood glucose self-monitoring frequency and improves glycaemic control: a prospective study in insulin-treated diabetic patients.

AIMS: To investigate whether availability of glucometer reagents increases the frequency of self-blood glucose monitoring (SBGM) and improves glycaemic control in diabetic patients. METHODS: Sixty-two insulin-treated diabetic patients were randomized to two groups, matched for age, gender, education, income, type and duration of diabetes, years of insulin treatment, number of daily insulin injections, and haemoglobin (Hb)A1c. All patients were given a glucometer, but one group (no cost, NC) was provided glucometer test strips free of charge. The other group (control, C) had to purchase strips as they found it necessary. Both groups of patients were followed longitudinally at 2-monthly intervals for 12 months with measurement of blood glucose and HbA1c, and the frequency of SBGM was determined by downloading the glucometer memory. RESULTS: The SBGM frequency was significantly higher in the NC group vs. the C group during the first 4 months (2.0 +/- 0.2 tests/day vs. 1.4 +/- 0.1 tests/day, P<0.025). Mean HbA1c remained stable over the 12 months in the NC group, whereas an increase with time was observed in the C group. The difference in HbA1c between the two groups was significant (P<0.002) after 6 months. Random blood glucose measured at each visit and average glucose recorded by the glucometer were also lower in the NC group vs. the C group (P<0.005). There was a negative correlation between HbA1c and SBGM frequency, and HbA1c in patients testing at least twice a day was lower than in those testing less than twice a day (8.8 +/- 0.2% vs. 9.6 +/- 0.2%, P<0.001). CONCLUSIONS: In this prospective study, having easy access to glucometer strips provided free of charge to patients increased SBGM frequency. The relationship between HbA1c and SBGM frequency supports the view that SBGM is an essential tool in diabetes management.     

P-glycoprotein (P-gp) function in T cells: implications for organ transplantation

P-glycoprotein (P-gp), a member of the adenosine triphosphate (ATP)-binding cassette (ABC) family of transporter molecules, is responsible for maintaining low intracellular concentrations of a variety of extracellular compounds and xenobiotics, and for transport of various intracellular molecules. Many drugs are P-gp substrates and intracellular concentrations of these agents may be critical for drug action. Experience in oncology indicates that repeated exposure to P-gp substrate cytotoxic drugs leads to the selection of drug-resistant tumor cells that overexpress P-gp. Since immunosuppressive agents such as cyclosporine, tacrolimus, sirolimus and corticosteroids are substrates for P-gp and since T-cells also express P-gp, it is conceivable that an analogous mechanism exits for therapy-resistant graft rejection. As will be discussed in this article, P-gp may interfere with the response to immunosuppressive therapy through several distinct mechanisms, and as such may represent an attractive therapeutic target.     

Relative nocturnal hypertension in children with insulin-dependent diabetes mellitus

Twenty-four-hour blood pressure and heart rate measurements were carried out in 14 newly diagnosed diabetics and in 28 diabetics with 5–13 years' duration of the disease; 8 healthy children were used as controls. Mean arterial blood pressure increased at night in 5, decreased slightly (less than 10%) in 5 and decreased markedly (more than 10%) in 18 diabetics with longer duration of the disease. The diurnal-nocturnal differences in heart rates were significantly lower in diabetics with relative "nocturnal hypertension" compared to the control group ( p < 0.05). A significant negative correlation was found between maximal arterial blood pressure during physical exercise and the diurnal-nocturnal differences in mean arterial blood pressure in diabetics ( r =−0.58; p < 0.02). In conclusion, we found elevated nocturnal blood pressure in a subgroup of children with longer duration of diabetes and without increased albumin excretion. However, longitudinal studies of blood pressure profiles are needed to identify the candidates for diabetic vasculopathy among diabetic children.     

Effects of Carbamazepine on Murine Humoral and Cellular Immune Responses

Summary: Oral administration of carbamazepine (CBZ)(15, 10, or 5 mg/kg) to mice significantly decreased both humoral and cellular immune responses evaluated by enumeration of direct and indirect plaque-forming spleen cells (PFC) and delayed–type hypersensitivity reaction (DTH) against sheep red blood cells (SRBC) as compared with those observed in normal control animals. Moreover, spleen T cells obtained from CBZ–treated donor mice were capable of decreasing both PFC and DTH responses of normal spleen cells transferred into lethally irradiated recipient animals. The immunodepressor effect of CBZ was observed even though administration of CBZ induced augmentation of spleen cellularity.     

Comparison between a new acceleration transducer and a conventional force transducer in the evaluation of twitch responses

An acceleration transducer elicits an output voltage proportional to the deformation of the piezo crystal, in accordance with the twitch responses of the applied fingers. The reliability of such a transducer was evaluated by comparing induced twitch responses with those from a force transducer applied on the contralateral arm of an individual during neuromuscular block with vecuronium. The results obtained from twitch responses with the acceleration transducer during neuromuscular block were almost identical to those obtained with the force transducer. Also, the twitch heights due to acceleration of the examined thumb correlated extremely well with the twitch height due to twitch tension with the force transducer. It is concluded that the acceleration transducer may be a useful and reliable device for monitoring neuromuscular block, although responses during tetanic stimulation such as tetanic fade cannot be determined by the transducer.     

Pharmacological effects of epibatidine optical enantiomers

The pharmacology of synthetic - and -epibatidine, an alkaloid originally characterized from frog skin, were studied in different behavioral tests in mice and rats. The two enantiomers have potent antinociceptive activity in mice using the tail-flick test, with an ED₅₀ of 6.1 and 6.6 μg/kg for - and -epibatidine respectively. Epibatidine enantiomers were 200 × more potent than -nicotine as an antinociceptive agent in mice after s.c. administration. Their analgesic effect was blocked by mecamylamine but not naloxone, an opiate antagonist. Both - and -epibatidine have high affinity (K_i 54.7 and 55.0 pM, respectively) for [³H]nicotine binding site in rat brain. In addition, they reduced mice locomotor activity and body temperature in a dose-dependent manner. In rats trained with nicotine (0.4 mg/kg), epibatidine enantiomers engendered nicotine-like responding in a dose-related manner with an ED₅₀ of 1.00 and 0.93 μg/kg for and , respectively. The discriminative effect of - and -epibatidine in rats was blocked by mecamylamine but not by hexamethonium. As in binding results, there was no significant enantioselectivity for these effects in our study.     

战伤绿脓杆菌感染源及防治研究

本文对云南老山前、后方医院环境及战伤感染标本中绿脓杆菌(简称PA)进行调查,对所分离的333株PA进行血清学分型及药物敏感性测定。结果可看出除炸伤时创口易被泥土中PA污染外,前、后方医院环境也是感染源之一。提示各级医疗单位在战伤救治中对PA的监控十分重要。本文结果直接有益于前、后方医院对战创伤PA的防治。     

Anticonvulsant Activities of 4–Bromobenzaldehyde Semicarbazone

Summary: Some of the properties of 4–bromobenzalde-hyde semicarbazone (compound IV), a prototype molecule of a new class of anticonvulsants, aryl semicarbazones, are described. Compound IV demonstrated activity in the maximal electroshock (MES) and subcutaneous pentylenetetrazol (scPTZ) tests in mice, with low neurotoxicity. When given orally to rats, it displayed high potency in the MES test and very low neurotoxicity, resulting in a high protective index (PI). Compound IV displayed no proconvulsant properties, and development of rapid tolerance was not noted. When administered intraperitoneally (i.p.) at doses of 100, 300, or 600 mg/kg to rats, compound IV had no effect on levels of γ-aminobu-tyric acid (GABA) or on GABA-T activity in whole brain. When tested in vitro, compound IV had no effect on rat brain GABA-T at a drug concentration of 100 μM. Although the activities of certain drug-metabolizing enzymes were increased after oral administration of compound IV to rats, these effects were less prominent than those of phenytoin (PHT) and carbamazepine (CBZ). The principal mode of action of compound IV does not appear to be an interaction with the GABA_A receptor complex, and other mechanisms, involving excitatory amino acid neurotransmission, will have to be considered in future investigations of the anticonvulsant activity of this compound.     

Early diagnosis of n-hexane–caused neuropathy

n-Hexane neuropathy was studied in 20 workers exposed for prolonged periods to this solvent, and with urinary 2, 5-hexanedione concentrations exceeding the biological exposure index recommended by the American Conference of Governmental Industrial Hygienists (5 mg/L) with a mean of 11.02 mg/L (range 5.3—24.2 mg/L). Although neurological examination did not detect significant anomalies in any of the patients, and the conduction velocity and F waves of all the nerves tested were normal, neurographic studies revealed significant differences in the amplitude of sensory nerve action potentials (SNAP) recorded from the sural (mean 14.0 μV), median (mean 17.3 μV), and ulnar (mean 7.9 μV) nerves when compared with normal values from healthy adults of the same age range, examined under identical conditions. The amplitude of the SNAP in sural and median nerves correlated significantly with the number of years worked. The notable decrease in mean amplitude of the SNAP appeared to reflect the primary neurotoxic effects of 2,5-hexanedione. © 1994 John Wiley & Sons, Inc.     

The acceleration transducer – an assessment of its precision in comparison with a force displacement transducer

A new and simple acceleration transducer (ACT)–based system of neuromuscular monitoring has recently been introduced. The precision of this transducer has been evaluated as compared to a conventional force displacement transducer (FDT) in the present study. Ten progressions of spontaneous recovery from atracurium–induced block with simultaneous measurements using the ACT on one hand and the FDT on the other were studied. Five individuals undergoing elective surgery in modified neurolept anaesthesia and one ICU–patient requiring prolonged neuromuscular blockade, sedated with pentobarbital, were included. Measurements were carried out on the latter patient on 5 consecutive days. Train–of–four (TOF) stimulation was used, readings were given in twitch heights (TH) (Tl/control value), and when four responses were obtained in TOF–ratios (T4/T1). Linearity was achieved after logit–transformation and the values regressed on time for each progression of recovery. Analysis of variance was applied to the regressions for the TH and TOF–ratio readings of each transducer. No significant differences were found, either between variation due to differences between slopes or variation due to technical error between the two transducers. The study indicates that the ACT is equal to the FDT with regard to precision in clinical recordings on atracuriumrelaxed individuals.