Clinical Significance of Urinary C-Peptide Excretion in Children with Insulin-Dependent Diabetes Mellitus

ABSTRACT. In order to evaluate the accuracy of urinary C-peptide determination and the clinical significance of C-peptiduria for the early course of insulin-dependent diabetes (IDDM), the rate of urinary excretion of C-peptide was determined in 32 children and adolescents with IDDM and correlated with serum C-peptide concentration, urinary excretion of albumin and β-mic-rogloublin and with the glomerular filtration rate (GFR) measured in terms of the clearance of ⁹⁹mTc-DTPA. The age of the subjects ranged from 9.1 to 17.1 years (mean 13.1) and the duration of diabetes from 0.3 to 11.9 years (mean 4.6). There was a good correlation between postprandial serum C-peptide concentration and the 24-hour urinary C-peptide excretion rate ( r =0.81; p <0.001). GFR and urinary albumin excretion were slightly elevated in the diabetic patients as compared with non-diabetic subjects ( p <0.05 and p <0.001, respectively), but C-peptide excretion was unrelated to the degree of hyperfiltration or albuminuria, neither was there any correlation between the excretion rate of β₂-microglobulin and C-peptide. Glycaemic control was poorer in the diabetic children who had only trace amounts of C-peptide in their urine (<0.05 nmol/m²/24 h) than in those with minimal (0.05–1.0 nmol/m²) or moderate 24-hour urinary C-peptide excretion (>1.0 nmol/m²). It is concluded that urinary C-peptide excretion serves very well to reflect residual β-cell function and is unrelated to the slight renal hyperfunction and albuminuria often seen in diabetic subjects. Even minimal C-peptide excretion ranging from 0.05 to 1.0 nmol/m²/24 h still seems to indicate clinically significant insulin secretion.     

Variable expression of tenascin‐C,osteopontin and fibronectin in inflammatory myofibroblastic tumour of the lung

Kaarteenaho R, Sormunen R, Pääkkö P. Variable expression of tenascin‐C, osteopontin and fibronectin in inflammatory myofibroblastic tumour of the lung. APMIS 2010; 118: 91–100. The aim of this study was to analyse the expression of tenascin‐C, osteopontin and fibronectin in inflammatory myofibroblastic tumour of the lung, which is a rare tumour of unknown aetiology. Nine patients with an inflammatory myofibroblastic tumour of lung were studied by immunohistochemistry for the presence of tenascin‐C, osteopontin, fibronectin and alpha‐smooth muscle actin, which is a common marker for myofibroblasts. The ultrastructure of myofibroblasts was confirmed by transmission electron microscopy. The expression of tenascin‐C, osteopontin, fibronectin and alpha‐smooth muscle actin was also studied by immunoelectron microscopy. All cases displayed all of the studied extracellular matrix proteins and also alpha‐smooth muscle actin‐positive spindle‐shaped fibroblastic cells that were undoubtedly myofibroblasts. The immunoelectron microscopic studies demonstrated labelling for alpha‐smooth muscle actin in intracellular filament bundles within myofibroblasts, for fibronectin in the extracellular filaments of the fibronexus and for tenascin‐C extracellularly often adjacent to myofibroblasts. Labels for osteopontin were observed within myofibroblasts and plasma cells. These results demonstrate that tenascin‐C, osteopontin and fibronectin were expressed in all three kinds of subtypes of inflammatory myofibroblastic tumours of the lung and further, variable amounts of myofibroblasts could be observed by light and transmission electron microscopy as well as by immunoelectron microscopic techniques.     

Reversal of Atrial Remodeling after Cardioversion of Persistent Atrial Fibrillation Measured with Magnetocardiography

Background : Atrial fibrillation (AF) causes electrical, functional, and structural changes in the atria. We examined electrophysiologic remodeling caused by AF and its reversal noninvasively by applying a new atrial signal analysis based on magnetocardiography (MCG).
Methods : In 26 patients with persistent AF, MCG, signal-averaged electrocardiography (SAECG), and echocardiography were performed immediately after electrical cardioversion (CV), and repeated after 1 month in 15 patients who remained in sinus rhythm (SR). Twenty-four matched subjects without history of AF served as controls. P-wave duration (Pd) and dispersion (standard deviation of Pd values in individual channels) and root mean square amplitudes of the P wave over the last 40 ms portions (RMS40) were determined.
Results : In MCG Pd was longer (122.8 ± 18.2 ms vs 101.5 ± 14.6 ms, P < 0.01) and RMS40 was higher (60.4 ± 28.2 vs 46.9 ± 19.1 fT) in AF patients immediately after CV as compared to the controls. In SAECG Pd dispersion was increased in AF patients. Mitral A-wave velocity and left atrial (LA) contraction were decreased and LA diameter was increased (all P < 0.01). After 1 month, Pd in MCG still remained longer and LA diameter greater (both P < 0.05), while RMS40 in MCG, Pd dispersion in SAECG, mitral A-wave velocity, and LA contraction were recovered.
Conclusions : Magnetocardiographically detected atrial electrophysiologic alterations in persistent AF diminish rapidly although incompletely during maintained SR after CV. This might be related to the known early high and late lower, but still existent tendency to AF relapses.     

Irradiation of human dental tissues with CO2-, Nd:YAG-, and CO2-Nd:YAG combination laser

Abstract— Extracted third molars were used to study the effect of Nd:YAG laser irradiation combined with CO₂ laser beam on dental hard tissues. The specimens were studied with SEM after lasing and the size of the impact areas and beam penetration into enamel and dentin were planimetrically analyzed. High-energy CO₂ laser (e.g. 10 s irradiation with 10 W output energy) penetrated all enamel and dentin. The simultaneous addition of Nd:YAG irradiation to the CO₂ beam was found to increase the effect of CO₂ laser, while Nd:YAG irradiation alone, used with equivalent energy densities, did not cause any effect on enamel surface. Thus, Nd:YAG laser was found to potentiate statistically significantly the effect of CO₂ irradiation, but the morphologic alterations on dental hard tissues, such as crater formation at the beam focus site, appeared to be due to CO₂ irradiation alone.     

Experimental sports drinks with minimal dental erosion effect

Abstract – The effects of new experimental sports drinks on dental enamel were studied in vitro using bovine tooth specimens. Profilometric analysis was used to measure the loss of tooth material after immersion of the specimens in the drinks. Thereafter the specimens' surface hardness was measured and scanning electron microphotographs were taken. In addition, 13 commercial sports drinks and experimental drinks containing either citric acid or malic acid were tested for their capacity to dissolve hydroxyapatite in vitro. The erosive effect increased markedly with decreasing pH. The citric acid containing drinks were more erosive than malic acid containing drinks. No erosion was observed with the malic acid containing drink (pH 5.90) but the drink of similar composition containing citric acid caused an erosion 1.3± 1.1μm deep and a commercial citric acid containing drink caused a lesion 12.3± 4.5μm deep after 120 min immersion. Softening of enamel was greater in specimens immersed in citric acid than in those immersed in malic acid containing drink. The in vitro hydroxyapatite dissolving effect of the commercial sports drink samples studied (all having a pH under 4.22) was markedly greater (0.48–4.38 mmol/l) than that of the malic acid containing experimental drink (pH 5.50, Ca⁺⁺ concentration in the supernatant 0.19 mmol/l) and of the similar citric acid containing drink (0.35 mmol/l). The hydroxyapatite dissolving effect of both drinks started to be marked at a pH level of about 5.0 but increased thereafter exponentially with decreasing pH. At pH levels above 4.0 the hydroxyapatite dissolving effect of citric acid containing drinks was greater than that of malic acid containing drinks.     

Clinical and radiographic study of pulpectomy and root canal therapy

abstract — A clinical and radiographic reexamination of 2,459 roots 2–7 years after initial pulpectomy or root canal therapy is presented. The overall success rate, which was 53%, was not affected by the sex or age of the patient, or by the jaw in which the tooth was situated. The tooth group, however, had a significant influence on the success rate, the worst results being obtained for incisors and especially the mandibular central and maxillary lateral incisors. The prognosis was clearly better for the pulpectomies than for the root canal therapy. Mortal pulpectomy was found to succeed more often than vital. The presence of a primary periapical rarefaction worsened the success rate. The success rate was lower for the teeth in which a posttreatment prosthetic crown had been fitted. Fillings which went beyond the apex had a significantly lower success rate than those which nearly or exactly reached the apex.     

SERUM FSH, LH AND PROLACTIN IN NORMAL MALES AND PATIENTS WITH PROSTATIC DISEASES

Serum FSH, LH and prolactin were measured in fifty-eight normal males between 30 and 80 years of age. At the same time, similar estimations were performed on samples taken from 232 patients with benign prostatic hypertrophy (BPH) and twenty-six patients with prostatic carcinoma. The three groups were compared with respect to age, and it was observed that significant rises related to age occurred in the serum levels of FSH, LH and prolactin in normal men after the sixth decade. The patient groups did not differ significantly from each other, or from the normal age-matched population in respect to prolactin and FSH levels. Serum LH in both the carcinoma and BPH patient groups, however, differed significantly from the controls, and remained at the level associated with younger normal males. It is suggested that testosterone metabolites from the prostate exert a negative feedback on pituitary LH secretion.     

ELEVATED ERYTHROCYTE ADENOSINE DEAMINASE ACTIVITY IN DOWN'S SYNDROME

Abstract. Puukka, R., Puukka, M., Linna, S-L., Joensuu, T. and Kouvalainen, K. (Departments of Clinical Chemistry and Paediatrics, University of Oulu, Oulu, Finland). Elevated erythrocyte adenosine deaminase activity in Down's syndrome. Acta Paediatr Scand, 70:739,.–Erythrocyte ADA activity was measured in 29 cases of Down's syndrome and in 29 age- and sex-matched control subjects. The mean activity (± S.D.) of ADA in Down's syndrome was 1 883±463 mU/g Hb (37°C) and 1 361 ±294 mll/g Hb in the controls. The difference was statistically significant ( p <0.001). The purine metabolism of Down's syndrome patients is discussed.     

Improved metabolic control in patients with non-insulin-dependent diabetes mellitus is associated with a slower accumulation of glycation products in collagen*

Abstract. Twenty-one patients with non-insulin-dependent diabetes in poor metabolic control were subjected to intensified therapy, in most cases with insulin, to investigate whether it is possible to slow down the accumulation of advanced glycosylation end products of collagen by improving glycaemic control. Fasting and mean daily blood glucose, serum fructo-samine and glycohaemoglobin levels, as well as glycation of collagen were measured before and after 1.5 years of intensified therapy. All these parameters except for fructosamine correlated significantly with fasting blood glucose and glycohaemoglobin when measured before the insulin therapy was started, when the patients had had poor but stable metabolic control for a long period of time. After 1.5 years of intensified therapy the level of glycation of collagen did not significantly correlate with the fasting blood glucose or glycohaemoglobin levels, suggesting that the non-enzymatic glycosylation of collagen reflects a longer period of metabolic control of diabetes than the glycohaemoglobin level. Intensified treatment improved previously poor metabolic control in patients with non-insulin-dependent diabetes, and this improvement was reflected in a decrease in fasting and mean daily blood glucose levels, serum fructosamine and glycohaemoglobin concentrations, and in the level of early products of glycation of collagen. The average content of advanced glycosylation end products of collagen, assayed in terms of collagen-linked fluorescence did not decrease. However, they accumulated more slowly in the patient tercile with the greatest decrease in the level of fasting blood glucose than in the tercile with the smallest decrease, and even a decrease in fluorescence was observed in the patients with the greatest improvement in the metabolic control. Our findings suggest that the improvement of metabolic control in non-insulin-dependent diabetes is reflected in a slower accumulation of advanced glycosylation end products in collagen. If the slower accumulation of advanced glycosylation end products in collagen is translated into a slower development of the long-term complications of diabetes remains to be studied.