Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes

AIM: To evaluate plasma cystatin C as a marker of the glomerular filtration rate in patients with type 2 diabetes and their age and sex-matched controls. MATERIALS AND METHODS: Forty-seven patients with one decade of type 2 diabetes and 51 non-diabetic control subjects were studied. Plasma cystatin C was measured by particle-enhanced turbidimetric immunoassay in a new application for the Hitachi 704 analyzer. For comparison, plasma creatinine and creatinine clearance were measured. The plasma clearance of 51Cr-EDTA by the single injection method was utilized as reference. RESULTS: In patients with type 2 diabetes the correlation coefficient between plasma cystatin C and the plasma clearance of 51Cr-EDTA was 0.774 (Spearman's coefficient) and that between plasma creatinine and the plasma clearance of 51Cr-EDTA was 0.556 (p = 0.001 for the difference). The correlation between creatinine clearance and the plasma clearance of 51Cr-EDTA was 0.411. In receiver operating characteristic (ROC) curve analysis the diagnostic accuracy of plasma cystatin C was significantly better than that of plasma creatinine (p = 0.047) or creatinine clearance (p = 0.001). The best diagnostic efficiency (98%) for cystatin C was obtained when the cut-off limit was set at 1.32 mg/l. In the control group the correlation coefficients were: between cystatin C and the plasma clearance of 51Cr-EDTA 0.627, between creatinine and the plasma clearance of 51Cr-EDTA 0.466 and between creatinine clearance and the plasma clearance of 51Cr-EDTA 0.416. The area under the ROC plot curve of cystatin C was also greatest in the control group, but the diagnostic accuracy of cystatin C was marginally better than that of either plasma creatinine (p = 0.05) or creatinine clearance (p = 0.08). Among the control subjects various non-renal causes may have interfered with cystatin C concentrations reducing the correlations. CONCLUSIONS: Cystatin C measurement is a more sensitive and specific test for GFR in patients with type 2 diabetes than plasma creatinine or its clearance, when GFR is normal or only slightly reduced. If an elevated cystatin C concentration is found, non-renal factors have to be excluded. The turbidimetric application described here can easily be applied for most clinical chemistry analyzers and is therefore useful in daily clinical practice.     

Patient education in Parkinson's disease: Formative evaluation of a standardized programme in seven European countries

OBJECTIVE: To evaluate a newly developed education programme for Parkinson's disease (PD) patients. METHODS: The programme consisted of eight sessions and aimed at improving knowledge and skills related to self-monitoring, health promotion, stress management, depression, anxiety, social competence, and social support, all with special reference to PD. The programme was formatively evaluated in seven European countries (Spain, Finland, Italy, The Netherlands, United Kingdom, Estonia, Germany) with 151 patients diagnosed with idiopathic PD. The evaluation included patients' ratings of the comprehensibility and feasibility of the programme as well as mood ratings before and after each session. Patients also completed questionnaires at the beginning and end of the programme to explore possible changes in disease-related psychosocial problems, quality of life, and depression. RESULTS: The programme was feasible to run, and patients were able to understand its elements. Patients reported mood elevations following individual sessions and reduced disease-related psychosocial problems after completing the programme. There were no substantial differences in results between cultures. CONCLUSION: Patient education appears to have potential as a useful and feasible intervention, complementing medical treatment in PD. PRACTICE IMPLICATIONS: The present programme will soon be available in seven European languages and can be tested in different health care systems.     

uPA, tPA and PAI-1 mRNA expression in periretinal membranes

PURPOSE: Formation of periretinal membranes occurs in proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR) and includes cell migration, proliferation, extracellular matrix formation and tissue contraction, processes in which plasminogen activation (PA) system is involved. METHODS: Twenty PVR, PDR or pucker membranes were examined to identify the cells with cell specific markers and to detect the expression of urokinase (uPA), tissue-type plasminogen activator (tPA) or plasminogen activator inhibitor-1 (PAI-1) by in situ hybridization and by immunohistochemistry. RESULTS: In PVR, uPA, tPA and PAI-1 were expressed by retinal pigment epithelial (RPE) cells, macrophages or retinal glial cells. In PDR, PA components were also expressed by endothelial cells. Semiquantitative analysis in in situ hybridization and immunohistochemistry results demonstrated no notable differences in uPA, tPA or PAI-1 expression between PDR and PVR membranes. CONCLUSIONS: We conclude that local proteolytic activation is involved in extracellular matrix production both in diabetic and non-diabetic membranes.     

Mistreatment of university students most common during medical studies

Background  

This study concerns the occurrence of various forms of mistreatment by staff and fellow students experienced by students in the Faculty of Medicine and the other four faculties of the University of Oulu, Finland.     

Correction to: Trends towards more active introduction of drug therapy,emphasizing methotrexate and biologic agents,for juvenile idiopathic arthritis

Clinical Rheumatology - The first and family names of the authors were interchanged and are now presented correctly. The original article has been corrected.     

Trends towards more active introduction of drug therapy,emphasizing methotrexate and biologic agents,for juvenile idiopathic arthritis

Clinical Rheumatology - To evaluate the drug treatment trends in patients with incident juvenile idiopathic arthritis (JIA) in 2006–2014. In Finland, patients are entitled to a special...     

Factors associated with intimate partner violence by a former partner by immigration status and length of residence in Canada

PurposeWe examined intimate partner violence (IPV) by a former partner among Canadian-born and immigrant women by length of residence in Canada.MethodsData from a 2009 national, population-based, telephone survey were used to determine the prevalence of and factors associated with any type of IPV (emotional, financial, physical, and/or sexual) by a former partner with whom there had been contact in the previous 5 years among immigrant women 0 to 19 years in Canada, 20 or more years or longer in Canada, and Canadian-born women (n = 1681).ResultsOf immigrant women in Canada for 0 to 19 years, 41.6% had experienced IPV by a former partner; for immigrant women in Canada for 20 or more years or longer, 60.6%, and Canadian-born women, 61.5% (P = .0423). In a logistic regression model adjusted for age and other sociodemographic characteristics, immigrant women in Canada for 0 to 19 years were less likely than Canadian-born women to experience any IPV (odds ratio, 0.266; 95% confidence interval, 0.130–0.544). There was no difference in the occurrence of any IPV between immigrant women in Canada 20 or more years or longer and Canadian-born women.ConclusionsHigh rates of any IPV by a former partner were found for both Canadian-born and immigrant women. Within immigrant communities, specific prevention campaigns should address the high risk of experiencing IPV at later stages of resettlement.