Nephropathy of type II diabetes: evidence for hereditary factors?

Family studies point to an important genetic element in the genesis of diabetic nephropathy, but it is not known whether renal abnormalities are present prior to the onset of diabetes. To address this issue we examined all consecutive patients suffering from type II diabetes with a duration of more than 10 years who attended a diabetes outpatient clinic. Ninety-four patients had nephropathy, 307 did not. All offspring who were phenotypically normal (no hypertension, normal oral glucose tolerance, non-smoking) and agreed to participate were examined, 26 from nephropathic and 30 from non-nephropathic diabetic parents. They were compared with 30 offspring matched for age, gender and BMI from non-diabetic parents as controls. We measured urinary albumin excretion under baseline conditions and at several time points after ingestion of 300 g cooked beef and submaximal treadmill exercise, respectively. In addition, casual blood pressure, ambulatory blood pressure, urinary albumin and urinary alpha-1-microglobulin were measured. Primary renal disease was excluded by clinical examination. Under baseline conditions, median urinary albumin excretion rate (AER; microgram/min) was significantly (P < 0.005) higher in offspring of nephropathic type II diabetic patients (7.8; range 1.04 to 19.5) than in the offspring of non-nephropathic type II diabetic patients (4.8; 0.36 to 17.5) and controls (4.4; 0.16 to 18.4). Submaximal treadmill exercise caused a greater proportional increase of AER in offspring of nephropathic type II diabetics (median 16-fold) than in offspring of non-nephropathic diabetic patients (6.3-fold) or controls (4.8-fold). In offspring of nephropathic diabetic patients casual and particularly ambulatory systolic blood pressures were significantly higher, but AER was not correlated with blood pressure. In summary, higher values, albeit within the normal range, for baseline and postexercise albuminuria were noted in phenotypically normal offspring of parents with type II diabetes and nephropathy. The observation suggests that changes in transglomerular albumin traffic are demonstrable prior to the onset of diabetes and diabetic nephropathy in subjects with a potential genetic predisposition to these conditions.     

Relationship of seizure duration to antidepressant efficacy in electroconvulsive therapy

BACKGROUND: Aprotinin and epsilon-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery. The marked difference in average wholesale cost between these two drug therapies (aprotinin, $1,080 vs. epsilon-aminocaproic acid, $11) has generated significant controversy regarding their relative efficacies and costs. METHODS: In a multicenter, randomized, prospective, blinded trial, patients having repeated cardiac surgery received either a high-dose regimen of aprotinin (total dose, 6 x 10(6) kallikrein inactivator units) or epsilon-aminocaproic acid (total dose, 270 mg/kg). RESULTS: Two hundred four patients were studied. Overall (data are median [25th-75th percentiles]), aprotinin-treated patients had less postoperative thoracic drainage (511 ml [383-805 ml] vs. 655 ml [464-1,045 ml]; P = 0.016) and received fewer platelet transfusions (0 [range, 0-1] vs. 1 [range, 0-2]; P = 0.036). The surgical field was more likely to be considered free of bleeding in aprotinin-treated patients (44% vs. 26%; P = 0.012). No differences, however, were seen in allogeneic erythrocyte transfusions or in the time required for chest closure. Overall, direct and indirect bleeding-related costs were greater in aprotinin- than in epsilon-aminocaproic acid-treated patients ($1,813 [$1,476-2,605] vs. $1,088 [range, $511-2,057]; P = 0.0001). This difference in cost per case varied in magnitude among sites but not in direction. CONCLUSIONS: Aprotinin was more effective than epsilon-aminocaproic acid at decreasing bleeding and platelet transfusions. Epsilon-aminocaproic acid, however, was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery. A cost-benefit analysis using the lower cost of half-dose aprotinin ($540) still resulted in a significant cost advantage using epsilon-aminocaproic therapy (P = 0.022).     

Space-domain method of moments solution for a strip on a dielectricslab

This paper presents a space-domain method of moments (MoM) solution to the problem of a strip dipole on a dielectric slab. The solution involves the use of a special junction basis function which models the nearly singular polarization currents in the vicinity of the strip/dielectric junction     

High ratios of free to total insulin-like growth factor-I in early infancy

A case of huge desmoid tumor successfully treated by hyperthermoradiotherapy is described. A 23-year-old man with familial adenomatous polyposis was operated upon for a desmoid tumor in the mesenterium involving the right kidney and small intestine in 1988. In 1990, the tumor recurred and could not be resected because of the involvement of the vena cava. The tumor grew larger and larger, and occupied two-thirds of the right lower quadrant. Several therapies using sulindac, tamoxifen, prednisolone, indomethacin, luteinizing hormone-releasing hormone analogue, and ascorbate were all ineffective. Finally, the combination of radiation and hyperthermia was used over a 6-month period. At the end of the hyperthermoradiotherapy, the tumor in the abdominal wall was markedly reduced in size, and the protruded abdominal wall became flat. To our best knowledge, this is the first report of the successful treatment of a huge desmoid tumor by hyperthermoradiotherapy.     

Hospital ambulatory pediatric surgery

Since 1990, we have been conducting ambulatory pediatric surgery in an unit established solely for this purpose, supported by a team of kindergarten teachers, pediatric nurses, anesthesiologists and pediatric surgeons. This prospective investigation includes all ambulatory pediatric operations performed in our department from 1990 to 1995. In this time 3665 infants and children between the ages of 6 weeks and 18 years underwent an ambulatory operation. The ratio male to female was 4.1 to 1. The series consists of 1400 inguinal hernias, 722 inguinal testes, 191 hydroceles/funiculoceles, 75 umbilical hernias, 667 phimoses, 70 meatotomies, 59 hemangiomas, 217 endoscopies and 264 other surgical procedures. Postoperative complications defined as secondary hemorrhage, fever, obvious vomiting, urine retention and laryngospasm upon terminating anesthesia accompanied by subsequent vomiting occurred in 59 (1.6%) of all infants and children. Wound infections were seen in 0.48% (17/3517) of all patients. The recurrence rate for inguinal hernias were 0.79% and 1.12% for inguinal testes. Our experience enables us to summarize that a variety of pediatric operations can be performed today as ambulatory procedures. Nevertheless one must be prepared for the occurrence of complications and always have capacities free for inpatient care where adequate observation and treatment are available. Further improvement is necessary in quality management. In the last 20 years only a few data have been published about recurrence rates after pediatric ambulatory operations for inguinal hernias and inguinal testes. Therefore we started a prospective long- term study.     

Why are experts not better in judging the danger of filmed traffic conflicts?

Earlier studies on the subject of subjective judgment of traffic conflicts showed that untrained subjects can reliably judge the dangerousness of filmed traffic conflicts. It was concluded that these judgements were based on a concept of dangerousness. In line with these findings two experiments were conducted. Experiment 1 tested the hypothesis that traffic experts (traffic engineers trained to evaluate and improve traffic safety) and lay people use the same concept of dangerousness when judging filmed conflicts. Experiment 2 investigated which aspects of the conflicts are considered by experts when making these judgements. The results show that (i) experts and lay people are equally reliable in judging traffic conflicts, (ii) experts base their judgement on the same concept of dangerousness, (iii) experts do not base their judgement on aspects that they themselves regard as important for the conflict, (iv) a weak relation is found between violations of traffic regulations and judgements of dangerousness.     

Forming mental models in learning operating procedures for terminalequipment

People faced with an unfamiliar product or service tend to fall back on mental models based on analogical relationships with familiar products or services. Two experiments on the analogical relationships or metaphors that people might use when operating a communications terminal are described. In the first experiment, the role previously acquired operating knowledge has in determining the mental models people use when directory dialing with novel equipment is examined. In a second experiment, it is shown that an explicit appeal to an analogy between conventional mail and electronic mail can help users learn to use an electronic mail system, and make it easier for them to remember how to use the system as long as 90 days after initial exposure. It is concluded that the mental model is constructed only from the user's operating knowledge acquired as a result of past experiences, and the metaphor method is effective when the instructions are metaphorically taught     

List-mode likelihood: EM algorithm and image quality estimationdemonstrated on 2-D PET

Using a theory of list-mode maximum-likelihood (ML) source reconstruction presented recently by Barrett et al. (1997), this paper formulates a corresponding expectation-maximization (EM) algorithm, as well as a method for estimating noise properties at the ML estimate. List-mode ML is of interest in cases where the dimensionality of the measurement space impedes a binning of the measurement data. It can be advantageous in cases where a better forward model can be obtained by including more measurement coordinates provided by a given detector. Different figures of merit for the detector performance can be computed from the Fisher information matrix (FIM). This paper uses the observed FIM, which requires a single data set, thus, avoiding costly ensemble statistics. The proposed techniques are demonstrated for an idealized two-dimensional (2-D) positron emission tomography (PET) [2-D PET] detector. The authors compute from simulation data the improved image quality obtained by including the time of flight of the coincident quanta     

From genome to proteome: protein map of Haemophilus influenzae

High-resolution two-dimensional (2-D) polyacrylamide gel electrophoresis allows the separation of complex biological mixtures (i.e., several hundred proteins from a bacterial cell lysate) in a single experiment. In this report proteins from Haemophilus influenzae were separated by 2-D gels and analyzed by peptide mass fingerprinting and/or amino acid analysis. By comparing the peptide mass profiles and the amino acid composition with the Haemophilus influenzae database, 119 protein spots were identified. The combination of amino acid analysis and peptide mass fingerprinting is a powerful tool for a rapid and economical identification of a large number of proteins resolved by 2-D gels. Studies on gene regulation and changes of protein expression upon drug treatment require quick and serial analysis techniques to efficiently identify potential new drug targets.