Sentinel health events surveillance in diabetes. Deaths among persons under age 45 with diabetes

The pilot study for a sentinel health events surveillance system for deaths among persons under age 45 with diabetes was conducted in six states in 1984 and 1985. Two hundred and thirty-three events were identified. Information from death certificates, physicians, and families revealed that 22% died from acute complications of diabetes and 53% from chronic complications. Blood pressure measurement and urinalysis testing had been performed in the last year for almost all of the decedents, but other preventive practices were reported less frequently. Hypertension was present in 57% and of those, was not controlled in 73%. Forty-four percent were cigarette smokers at the time of death. Agreement between physicians and families was generally higher for clinical conditions than for care practices. This surveillance system appears to yield information about the health care of persons with diabetes not readily available from other sources, although modifications may be necessary before implementation.     

Neck contour deformities. The art, engineering, anatomic diagnosis, architectural planning, and aesthetics of surgical correction

The best quality long-lasting results require attention to the diagnosis of the precise anatomic problems followed by the architectural planning--the art of making beautiful highlights, shadows, and curves where indicated to produce a result that is aesthetically pleasing. Attention to the details of the surgical planning, execution of surgery, and postoperative care are essential to minimize untoward results and problems and produce a happy patient and pleased surgeon.     

Continuous 4-channel EEG monitoring: a guide to interpretation, with normal values, in preterm infants

A system is described for the rapid analysis of the extensive EEG data produced by continuous 4-channel monitoring. Using this system, the initial EEGs of 44 low-risk preterm infants between 26 and 37 weeks gestation have been analysed and quantified in order to establish standard values. This provides a basis for assessment of the acute EEG as an index of cerebral function in high-risk or abnormal preterm infants.     

Mechanism and prediction of nonspecific toxicity to fish using bioconcentration characteristics

A basic theory of nonspecific toxicity has been developed using bioconcentration as a basis and applying kinetic relationships developed in previous work. This approach has involved calculation of the critical volume fraction and critical concentration in lipid tissue of fish for a variety of organic compounds at the lethal level. Corrections to previous data sets for time period of exposure and inclusion of biodegradable compounds did not make a significant improvement in the values obtained. A new data base with compounds containing a wide range of Kow values gave results for critical volume and concentration similar to previous work. The influence of experimental procedures and methods for data development are considered. The basic theoretical derivation developed was found to provide a basis for predicting the approximate nonspecific toxicity of nondegradable lipophilic organic compounds at different exposure time periods. This requires a knowledge of the Kow value and the clearance rate constant (k2) which can be calculated from the Kow value.     

Gene expression of LDL receptor, HMG-CoA reductase, and cholesterol-7 alpha-hydroxylase in chronic renal failure

BACKGROUND: Chronic renal failure (CRF) is associated with an atherogenic lipid profile and an increased risk of ischaemic cardiovascular disease. The associated hyperlipidaemia is reportedly ameliorated by erythropoietin (Epo) therapy. According to a recent report, rats studied 3 weeks after 5/6 nephrectomy and fed a high- protein diet exhibited increased activities of hepatic HMG-CoA reductase (HMG-CoAR) and cholesterol 7 alpha-hydroxylase (Ch-7 alpha- H), despite normal corresponding mRNA values. DESIGN AND METHODS: This study was designed to examine the effects of naturally progressing CRF of longer duration as well as those of Epo therapy on gene expressions of the key factors involved in hepatic cholesterol metabolism, i.e., LDL receptor (LDLR), HMG-CoAR, and Ch-7 alpha-H. Sprague-Dawley rats were randomized to the CRF group (5/6 nephrectomy), Epo-treated CRF group (given Epo 150 U/kg/twice weekly) and sham-operated, placebo- treated normal controls. They were allowed free access to regular rat chow and studied 6 weeks after surgery. Liver mRNAs and protein mass or activities of the above factors were studied. RESULTS: Plasma cholesterol concentration was significantly increased in the CRF group (P < 0.001) and was modestly lowered (P < 0.05) by Epo therapy. However, microsomal cholesterol concentration and LDLR, HMG-CoAR, and Ch-7 alpha-H mRNA as well as HMG-CoAR activity, and Ch-7 alpha-H and LDLR protein mass measurements were virtually identical in the three groups. Thus, hepatic LDLR, HMG-CoAR, and Ch-7 alpha-H mRNA and protein measurements in rats with CRF were similar to those of the normal control group representing an inappropriate response to the associated hypercholesterolemia. Epo therapy led to partial amelioration of CRF- associated hypercholesterolaemia with no discernible effect on hepatic tissue expression of the above factors.