Patient and professional partnership in diabetic nephropathy.

Diabetes mellitus (DM) is a complex multifaceted metabolic disorder characterised by chronic disease processes of hyperglycaemia and changes in the metabolism of carbohydrates, fats and proteins. It holds no boundaries with age, gender, culture or social strata. It is a life long disease process, which belongs to the individual, impacting on physical, social, psychosocial and spiritual life experiences. Diabetes is a worldwide burden to healthcare providers. In the United Kingdom (UK) 1.4 million people are affected with a suspected million people undiagnosed. A significant subgroup of patients with DM are predisposed to developing diabetic nephropathy, and it is now the single commonest cause of end-stage renal failure, accounting for 16% of new patients taken on to renal replacement therapy each year. It is in this subgroup that other diabetes related complications such as retinopathy, neuropathy and peripheral vascular disease are also concentrated. Microalbuminuria is an early indicator of renal disease in diabetes, and also predictive of total mortality, cardiovascular mortality and cardiovascular morbidity. These associated macro and microvascular complications can result in high personal, social and financial costs of managing complications associated with diabetic nephropathy and end-stage renal disease (ESRD). Some ethnic groups are particularly vulnerable--in the UK, the incidence of ESRD in South Asians and African Caribbean's is three times higher than in White Caucasians, in part due to the high prevalence of diabetic nephropathy.

Characterization and mRNA expression in an unusual odontogenic lesion in a patient with tricho-dento-osseous syndrome.

UNLABELLED: Odontogenic lesions are rare, but can be associated with significant morbidity. While their molecular determinants are unknown, they likely express many genes common to normal odontogenesis. This study evaluated the histology and mRNA expression of an unusual odontogenic lesion in a patient with a confirmed history of tricho-dento-osseous syndrome. METHODS: Decalcified, frozen 8 micro m sections of the lesion were cut and mounted on glass slides and stained with hematoxylin/eosin for analysis. The expression of multiple genes associated with normal odontogenesis and related pathologies were evaluated by RT-PCR, where possible in samples of the hard and soft tissue components of the lesion. RESULTS: Histological examination showed the lesion had large areas of irregular, dentine-like material, enamel matrix, areas of woven immature bone and multiple fully mineralised tooth crowns. Although most of the gene transcripts were amplified from both samples, some, including DLX3/7 and Collagen I demonstrated differential expression. CONCLUSIONS: This study shows the gene expression profile of aberrant odontogenesis with associated odontoma formation is similar to that of normal tooth and the genes expressed in other odontogenic lesions. While the role of altered gene expression in the development of such lesions has previously been postulated from transgenic models, this is the only report of an odontogenic lesion in a patient with TDO, and begins to elucidate possible gene interactions key to its development.

European Gene Mapping Project (EUROGEM): breakpoint panels for human chromosomes based on the CEPH reference families. Centre d'Etude du Polymorphisme Humain.

Meiotic breakpoint panels for human chromosomes 2, 3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 17, 18, 20 and X were constructed from genotypes from the CEPH reference families. Each recombinant chromosome included has a breakpoint well-supported with reference to defined quantitative criteria. The panels were constructed at both a low-resolution, useful for a first-pass localization, and high-resolution, for a more precise placement. The availability of such panels will reduce the number of genotyping experiments necessary to order new polymorphisms with respect to existing genetic markers. This paper shows only a representative sample of the breakpoints detected. The complete data are available on the World Wide Web (URL http:/(/)www.icnet.uk/axp/hgr/eurogem++ +/HTML/data.html) or by anonymous ftp (ftp.gene.ucl.ac.uk in/pub/eurogem/maps/breakpoints).

Osteoporosis and genetic influence: a three-generation study.

We have studied 27 triads of mother, daughter and grandmother for possible genetic influence on distal and proximal forearm bone density, measured by single photon absorptiometry. We found a significant correlation of bone density at the proximal forearm between the mothers and grandmothers (r = 0.499, P < 0.01). There was also a weak correlation between proximal forearm bone densities of mothers and daughters (r = 0.327, P < 0.1). Significant correlations were found between the three generations for grip strength, pedometry, height and triceps skinfold thickness. There was also significant correlation between mother and grandmother for alcohol intake. There was no correlation for contraceptive pill use, smoking, dietary calcium intake, body weight or body mass index. The study concludes that, although there are similarities in bone mineral content between the three generations, genetic factors cannot be conclusively proven to be the major determinant of bone density. Lifestyle and environmental factors may have a bearing on achieving the peak bone mass and subsequent development of osteoporosis.

Climacteric symptoms in healthy middle-aged women.

The incidence of climacteric symptoms was determined in 247 healthy premenopausal women in a community setting. These volunteers had been recruited to a longitudinal study of bone density. Of these subjects, 46 ceased to menstruate during the study, and in this subgroup symptoms were compared before and after cessation of menstruation. Only hot flushes increased after cessation of menstruation in the longitudinal study and showed age correlation in the cross-sectional study. Hot flushes thus emerged as a true menopausal symptom. Although evidence for this is weaker, cold sweats and suffocation seem likely to be genuinely menopausal. Breast discomfort and the four mood symptoms of irritability, excitability, depression and poor concentration improved after cessation of menstruation, and this study gives no support for their being part of the menopausal syndrome; it suggests that these symptoms are more likely to be related to menstruation than to the menopause.

Pediatric trauma: special patients/special needs.

Traumatic injuries are the primary cause of death in children. Nursing care that the critically injured child receives during the acute phases of resuscitation and stabilization and critical care have direct impact on potential for good long-term outcome. The nurse works in concert with other members of the trauma team to provide comprehensive assessment and interventions during both the primary and secondary surveys. Knowledge of mechanisms of injury in the pediatric population, patterns of injury unique to children, physiologic differences between adults and children and their impact on care, and developmental needs of children and families guide the trauma nurse in providing expert clinical care and caring psychosocial support to traumatized patients and families.

Determinants of forearm bone density in premenopausal women: a study in one general practice.

Predictors of distal and proximal forearm bone density, measured by photon absorbtiometry, were investigated in 248 premenopausal women aged 39-56 years. Only one strong predictor of lower bone density was found--history of previous fracture at any site (P less than 0.001). Two other factors showed a weaker association with density, but only at the distal site--history of diuretic use showed a positive association (P less than 0.02) whereas alkaline phosphatase level was inversely correlated with density (P less than 0.01). Other factors were not significant predictors: these included age, calcium intake, level of exercise, anthropometric measures of obesity, serum calcium level, parity, lactation history, a menopausal symptom history, use of the contraceptive pill, smoking and alcohol intake. These results contrast with the far stronger predictors found for postmenopausal women and suggest that genetic endowment rather than lifestyle may be the major determinant of bone density before the menopause.

Loss of production of myoepithelial cells and basement membrane proteins but retention of response to certain growth factors and hormones by a new malignant human breast cancer cell strain.

Digestion of primary breast cancers and their metastases with collagenase yields cell clusters which can be selectively isolated from stromal cells and from the less malignant-looking epithelium of the primary tumors by their failure to attach as rapidly to collagen gel. Continued passage in culture of one preparation of cell clusters has yielded a continuously growing cell strain, termed Ca2-83. This strain continues to grow mainly as cell clusters with doubling times of 10 to 14 days, although some clusters eventually adhere to plastic substrata. Two morphological extremes of cell were observed, smaller polygonal or cuboidal cells and larger, often-multinucleated cells which contain fat droplets. Cell clusters grew in a gland-like pattern similar to those of the original carcinoma and formed small nodules in 50% of recipient nu/nu mice. Both morphological forms of Ca2-83 in culture or in tumor nodules stained immunocytochemically with epithelial cell-specific antisera to epithelial membrane antigens and to human keratins but not to laminin or actin. Cultures of Ca2-83 failed to synthesize laminin under conditions where its synthesis was observed in a rat myoepithelial cell line. Ultrastructural analysis of the cell clusters has identified microvilli coated with epithelial membrane antigens and junctional complexes typical of secretory epithelia in both morphological forms, but no characteristics of myoepithelial cells or basement membranes were observed. The DNA content of the cultures increased in response to serum, a bovine pituitary fraction, and insulin. Numbers of cell clusters were also increased in the presence of culture medium exposed to preadipocytes, myoepithelial- or mesothelial-like cells/stromal cells, or to prostaglandin E2.

Energy expenditure after spinal cord injury: an evaluation of stable rehabilitating patients.

Caloric requirements for spinal cord patients are not well understood. Energy expenditure was measured by indirect calorimetry and compared with predicted expenditure by manipulations of the Harris-Benedict (Long and Rutten), Quebbeman, and Spanier and Shizgal equations, using actual and ideal body weight: 45 measurements were made on 22 spinally injured patients, who were medically stable in their early rehabilitation phase of treatment, and included quadriplegics, paraplegics, and patients with Brown-Sequard syndrome. Other nutritional parameters were also followed. Equations based on normal patients consistently overestimated energy requirements of spinally injured patients. From the time of injury, spinally injured patients appear to have a reduction in their energy needs proportional to the amount of muscle which has been denervated. This decrease in caloric requirements continues throughout the rehabilitation and plateau phases. We have demonstrated that stable, rehabilitating spinally injured patients require 23.4 kcal/kg/day. As a group, quadriplegics required 22.7 kcal/kg/day, and paraplegics 27.9 kcal/kg/day. This represents only 45 to 90% of the recommended calories for maintenance as calculated by any of these recognized formulae, based on normal heights, weights, age, and sex, when using either current weight or ideal body weight. Spinally injured patients as a group are subjected to fluctuations in weight during treatment. Our own patients tended to become obese approximately 12 months after spinal cord injury on uncontrolled diets. All patients underwent an initial weight loss which was greater in the quadriplegics as a group, compared with paraplegics. On uncontrolled diets, our patients gained an average of 1.7 kg/wk and this was also greater in the quadriplegic group.