A new approach to radon temporal correction factor based on active environmental monitoring devices.

The present study aims to identify novel means of increasing the accuracy of the estimated annual indoor radon concentration based on the application of temporal correction factors to short-term radon measurements. The necessity of accurate and more reliable temporal correction factors is in high demand, in the present age of speed. In this sense, radon measurements were continuously carried out, using a newly developed smart device accompanied by CR-39 detectors, for one full year, in 71 residential buildings located in 5 Romanian cities. The coefficient of variation for the temporal correction factors calculated for combinations between the start month and the duration of the measurement presented a low value (less than 10%) for measurements longer than 7 months, while a variability close to 20% can be reached by measurements of up to 4 months. Results obtained by generalized estimating equations indicate that average temporal correction factors are positively associated with CO2 ratio, as well as the interaction between this parameter and the month in which the measurement took place. The impact of the indoor-outdoor temperature differences was statistically insignificant. The obtained results could represent a reference point in the elaboration of new strategies for calculating the temporal correction factors and, consequently, the reduction of the uncertainties related to the estimation of the annual indoor radon concentration.

Chronic intermittent intravenous insulin therapy: a new frontier in diabetes therapy.

The limited success achieved in controlling diabetes and its complications with conventional insulin therapy suggests the need for reevaluation of the appropriateness of insulin administration protocols. Indeed, conventional subcutaneous insulin administration produces slowly changing blood insulin levels and suboptimal hepatocyte insulinization resulting in impaired hepatic capacity for processing incoming dietary glucose. The novel approach to insulin administration known as chronic intermittent intravenous insulin therapy (CIIIT) delivers insulin in a pulsatile fashion and achieves physiological insulin concentration in the portal vein. Done as a weekly outpatient procedure combined with daily intensive subcutaneous insulin therapy, this procedure has been shown to (1) significantly improve glycemic control while decreasing the incidence of hypoglycemic events, (2) improve hypertension control, (3) slow the progression of overt diabetic nephropathy, and (4) reverse some manifestations of diabetic autonomic neuropathy (e.g., abnormal circadian blood pressure pattern, severe postural hypotension, and hypoglycemia unawareness).

Prevalence of osteoporosis in women: variation with skeletal site of measurement of bone mineral density.

OBJECTIVE: To determine retrospectively the prevalence of osteoporosis in a referral population of female patients and to compare the sensitivity for diagnosing osteoporosis by dual-energy x-ray absorptiometry (DXA) measurements of bone mineral density (BMD) at multiple skeletal sites. METHODS: We studied the data from 625 consecutive women (mean age, 57.3 +/- 13.9 years), who had been referred to our center for lumbar spine (anteroposterior [AP] and lateral region) and hip (femoral neck [FN], Ward's triangle [WT], trochanter, intertrochanteric region, and total hip) BMD measurements with use of DXA (Hologic QDR-2000) between June 1994 and July 1998. RESULTS: Osteoporosis (based on the World Health Organization definition--T-score of -2.5 or lower for BMD) was diagnosed by DXA at the following sites: AP spine in 21.7%, lateral spine in 43.2%, FN in 33.6%, WT in 49.1%, trochanter in 26.1%, intertrochanteric region in 25.9%, and total hip in 28.4% of study patients. Significant site differences were found in the prevalence of osteoporosis between the lateral and AP spine (P < 0.001), as well as between WT and the FN, trochanter, intertrochanteric region, and total hip (P < 0.001). In a subgroup of 71 women, forearm (ultradistal radius and radius 1/3 region) BMD results indicated low sensitivity for diagnosing osteoporosis, similar to that seen at the AP spine, trochanter, and intertrochanteric region. Not surprisingly, the prevalence of osteoporosis increased with advancing age (15.5% in patients younger than 50 years, in comparison with 59.6% in those older than 69 years of age). The frequency of misclassification of patients (osteoporosis at one site and normal BMD at another) with use of the seven measurement sites was 16.6% (104 of the 625 patients). CONCLUSIONS: For diagnosis of osteoporosis, DXA BMD measurements are significantly more sensitive at the lateral spine than at the AP spine, as well as at WT than at the FN, trochanter, intertrochanteric region, and total hip sites.

Effect of intensive insulin therapy on progression of overt nephropathy in patients with type 1 diabetes mellitus.

OBJECTIVE: To assess the effects of chronic (long-term) intermittent intravenous insulin therapy (CIIIT) on the progression of overt nephropathy in patients with type 1 diabetes mellitus. METHODS: We undertook a retrospective longitudinal three-center study of 31 patients with type 1 diabetes mellitus and overt nephropathy, who were receiving intensive subcutaneous insulin therapy (four insulin injections daily) and weekly CIIIT. All study patients had follow-up consultations weekly for at least 12 months (mean duration, 37.0 +/- 4.6 months). Each patient had monthly hemoglobin A(1c) (by high-performance liquid chromatography) and semiannual creatinine clearance determinations. RESULTS: The hemoglobin A(1c) levels declined significantly from 8.6 +/- 0.6% to 7.6 +/- 0.3% (P = 0.0062) during the study period. The creatinine clearance remained essentially unchanged (from 46.1 +/- 3.0 mL/min per 1.73 m 2 at baseline to 46.0 +/- 3.9 mL/min per 1.73 m 2 at the end of the observation period, with an average annualized slope increase of 3.39 +/- 1.5 mL/min per year--no significant difference). CONCLUSION: The addition of CIIIT to intensive subcutaneous insulin therapy in patients with type 1 diabetes mellitus seems to arrest or appreciably reduce the progression of overt diabetic nephropathy, as well as substantially improve their glycemic control.

[The results of using a simplified questionnaire for determining the prevalence of bronchial asthma]. / Rezultatele utilizarii unui chestionar simplificat pentru stabilirea prevalentei astmului bronsic.

UNLABELLED: The aim of the study was to assign the asthma prevalence in a Romanian region, by using a simplified questionnaire, easy to fill in by every subject without specialized help. The study included 508 subjects, 280 women (55.1%) and 238 men (44.9%). The subjects proceeded from different industrial areas (cement factory, rubber processing factory, fur and leather manufacture) and from a village (214 subjects). 203 subjects, having symptoms compatible with asthma, performed lung function tests with a Flow Screen Jaeger device, determining VC, FEV1, FEV1% VC, MEF50, MEF25, and pharmacodynamic test if needed (bronchoconstrictor or bronchodilator). RESULTS: about 40% of the subjects mentioned the wheezing, among them 18% wheezing and dyspnea. "Asthmatic bronchitis" is present at 14.8% of the subjects, including 4.5% patients with bronchial asthma diagnosed by a physician (underdiagnosis). The asthma symptoms are more frequent in the factories with exposure to inhaled allergens and air pollution. The most discriminative symptom association for asthma was: wheezing and breathlessness and a history of dyspnea in the last year. These symptoms suggest that the prevalence of asthma could be 10.43%. The positive bronchodilator or bronchoconstrictor function test associated with wheezing, present at 7.48% of the population, seems to better evaluate the prevalence of asthma, which approaches other data already published. The questionnaire we used proved that it can select with acceptable accuracy the individuals to be further investigated with lung function tests.

Effect of intensive insulin therapy on abnormal circadian blood pressure pattern in patients with type I diabetes mellitus.

OBJECTIVE: To assess the effect of tight glycemic control on the abnormal circadian BP pattern associated with IDDM. DESIGN: Retrospective, randomized control trial. SETTING: Diabetes Research Institute, ambulatory. PATIENTS: Seventy-four IDDM patients (22M/52F) on intensive subcutaneous insulin therapy (ISIT) were selected for this study. INTERVENTIONS: Group A patients (11M/25F) underwent, in addition to ISIT, weekly chronic intermittent intravenous insulin therapy (CIIIT) (TT Aoki et al, Lancet, 1993, 432:515-8). Group B patients (11M/27F) were continued on ISIT alone. All study patients were followed for 3 months on this regimen. They were seen weekly by the investigators and underwent monthly HbA1c determinations and 24-h ambulatory BP monitoring. RESULTS: Glycemic control improved significantly in group A subjects (HbA1c decreased from 7.9% to 7.2%, p = 0.0002) but changed little in the group B subjects (p = NS). The night/day systolic BP ratio decreased from 0.97 to 0.94 (-3.10%) in group A and increased from 0.95 to 0.98 (+3.16%) in group B subjects (p = 0.224). The night/day diastolic ratio decreased from 0.93 to 0.90 (-3.23%) in group A and increased from 0.91 to 0.94 (+3.29%) in group B subjects (p = 0.0037). CONCLUSIONS: CIIIT performed in IDDM patients on ISIT further improves their glycemic control and tends to reverse or at least prevent further deterioration of their abnormal circadian BP pattern.

Effect of chronic intermittent intravenous insulin therapy on antihypertensive medication requirements in IDDM subjects with hypertension and nephropathy.

OBJECTIVE: The prevalence of systemic hypertension is increased in patients with diabetes. In this prospective, randomized, crossover clinical trial, we assessed antihypertensive effects of chronic intermittent intravenous insulin therapy (CIIIT) on insulin-dependent diabetes mellitus (IDDM) subjects with hypertension and nephropathy by monitoring the amount of antihypertensive medication (AHM) required to maintain blood pressure (BP) < or = 140/90 mmHg. RESEARCH DESIGN AND METHODS: After a stabilization period, 26 hypertensive IDDM subjects were randomly assigned to a control or treatment phase for 3 months and then crossed over into the opposite phase for another 3 months. Addition of CIIIT during the treatment phase was the only procedural difference between the control and treatment phases. RESULTS: The AHM dosage requirements for maintenance of the baseline BP levels decreased significantly (46%; P < 0.0001) and linearly over time (P < 0.0058) during the treatment phase, while remaining essentially unchanged during the control phase. CONCLUSIONS: Our data suggest that CIIIT markedly improves BP control, as evidenced by the significantly reduced AHM dosage requirements in subjects with IDDM and hypertension, possibly through an improvement in vascular reactivity.

Effects of medroxyprogesterone acetate on some parameters of calcium metabolism in patients with glucocorticoid-induced osteoporosis.

Long-acting medroxyprogesterone acetate (MPA) effect on some important parameters of calcium metabolism in patients with glucocorticoid-induced osteoporosis (GCO) was evaluated. Twelve steroid-dependent asthmatic male patients with GCO were administered 200 mg of MPA (Depo-Provera) intramuscularly, and had fasting serum samples obtained at baseline and at weekly intervals for 5 consecutive weeks. Baseline serum samples were also obtained from 12 control healthy male subjects matched for age. The following measurements were made from each serum sample: osteocalcin (OC), skeletal (SAP) and total alkaline phosphatase (TAP), calcitonin (C), insulin-like growth factor I (IGF1), 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D. Significantly lower baseline serum levels of OC and C were found in the patients with GCO than in controls (P less than 0.001). Following MPA administration in GCO patients statistically significant and sustained increases in OC, SAP and C were noticed during the next 5 weeks. No significant differences in baseline levels for TAP, IGF1, 1,25(OH)2D and 25(OH)D between GCO patients and controls were found, and no significant changes following MPA administration in GCO patients were obtained for these parameters. In conclusion, when administered to patients with GCO, MPA seems to stimulate the osteoblastic activity as suggested by sustained increases in OC and SAP serum levels, and also enhances the C production by the C-cells of the thyroid.

Effective therapy of glucocorticoid-induced osteoporosis with medroxyprogesterone acetate.

The effect of long-acting medroxyprogesterone acetate (MPA) on the trabecular bone density in patients with glucocorticoid-induced osteoporosis (GCO) was evaluated. Thirteen steroid-dependent asthmatic male patients with GCO were administered 200 mg MPA intramuscularly at 6-week intervals and 1 g of elemental calcium daily for a period of 1 year. Ten additional matched steroid-dependent asthmatic male patients received 1 g of elemental calcium daily (controls). All 23 patients involved in the study had vertebral trabecular bone densitometry (TBD) by quantitative computed tomography (QCT) at baseline and at 6 and 12 months into the study. A 17% increase in TBD was found in the MPA-treated patients at 1 year (from 68.5 +/- 5 to 80.2 +/- 4 mg K2HPO4/cc) in contrast to the control group who experienced a 21% decrease in TBD during the same period of time (from 80.5 +/- 7 to 63.7 +/- 8 mg K2HPO4/cc) (T = 6.90, P = 0.0001 df = 21). There were no significant changes in other parameters followed during the study in the MPA-treated group (serum calcium, phosphorus, magnesium, PTH, alkaline phosphatase, triglycerides, total and HDL cholesterol, urinary excretion of calcium, phosphate, creatinine) except for a decrease in the serum luteinizing hormone (LH) and testosterone (P less than 0.01) as well as of the hydroxyproline-creatinine ratio (P less than 0.01). The results lend support to the hypothesis of a progesterone-glucocorticoid competitive antagonism at the bone level, though other possibilities can be entertained, and suggest MPA as an effective therapy for glucocorticoid-induced osteoporosis in men.

Lack of von Willebrand factor, factor VIII related antigen and factor VIII coagulant response to human growth hormone infusion in type 2 diabetes mellitus.

Excessive growth hormone (GH) secretion and platelet hyperaggregation have been considered to be involved in the development of the vascular complications of diabetes mellitus (DM). Trying to find a common link between GH and platelet hyperaggregation, we measured von Willebrand or ristocetin cofactor activity (VIII R:Rcof), factor VIII-related antigen (VIII R:Ag) and factor VIII coagulant activity (VIII:C) in ten type 2 DM (NIDDM) and seven normal control (C) human subjects. These three parameters were measured before (time 0), and after a one-hour intravenous infusion of 0.1 U/kg bw of GH, (times 1, 4, 6, and 24 hours). The NIDDM subjects were nonobese and without clinical evidence of diabetic vascular complications. Despite remarkably high levels of GH reached during the infusion (average 280 ng/ml), there were no significant changes in the measured parameters in either NIDDM or C group. The baseline levels of factors VIII R:Rcof, VIII R:Ag and VIII:C were also not significantly different in the two groups. Changes in GH serum levels seem to have no effect on the factors VIII:C, VIII R:Ag or VIII R:Rcof levels in normals (C) or in NIDDM subjects without evidence of vascular complications. These results do not preclude the possibility that there may be a different response to GH in DM patients with advanced vascular complications and probable endothelial cell abnormalities.

Exaggerated somatomedin-C response to human growth hormone infusion in patients with type II diabetes mellitus.

The suggestion of a role for the abnormally regulated growth hormone (GH) in the pathogenesis of diabetes mellitus (DM), implicates also the somatomedins, as mediators of some of GH actions. The present study was aimed at assessing the somatomedin response to exogenous GH administration in diabetes type II (NIDDM) subjects as well as its possible relationship with the degree of control of diabetes. Twenty-two subjects (seven controls and 15 NIDDM patients), matched for sex and age, underwent human GH infusion (0.1 U/kg b.w.) over a one-hour period (time 0 to 1 hour). Total somatomedins (SMs) were measured by human placental membrane radioreceptor assay (in which all SMs crossreact) and Somatomedin-C (SM-C) was determined by a specific RIA. Values were obtained from plasma samples at times 0, 1, 4, 6, and 24 hours. Glycosylated hemoglobin (HbA1a-c) measurements were done from blood samples obtained at time 0. The increase in SMs following GH infusion in NIDDM group was not significantly different from that of the controls. In contrast, the SM-C increase at time 6 and 24 hours were significantly higher than in controls (p less than 0.05 and p less than 0.01, respectively). No significant difference was found between SMs or SM-C response to GH infusion in patients with HbA1a-c greater than 10% vs. less than 10%. These results indicate an exaggerated and prolonged increase in SM-C synthesis following exogenous GH infusion in NIDDM subjects, apparently unrelated to the degree of control of diabetes.

Paradoxical release of growth hormone during oral glucose tolerance test in patients with abnormal glucose tolerance.

Oral glucose tolerance tests were performed on 24 patients characterized as having abnormal glucose tolerance (AGT) and on 27 control subjects. Serums for glucose, growth hormone and insulin determinations were serially obtained for 4 hr after glucose administration. As serum glucose declined 2 hr or more after glucose ingestion a rise in growth hormone, as has been previously described, was observed in 40% of control subjects and 12% of AGT patients. However, of interest was a paradoxical early increase in growth hormone levels noted in 44% of lean AGT subjects occurring during the first 2 hr of the test with glucose levels rising. This response was seen in only one of 8 obese patients with AGT and in none of the control subjects. An abnormality in the hypothalamic glucose receptors in the ventromedial nucleus is a possible explanation for the changes observed. It is possible that this early inappropriate increase in growth hormone release may in some nonobese subjects with AGT contribute to the abnormal oral glucose tolerance tests observed.

Modifications of dermatoglyphics in thyreopathy.

Examination of the digito-palmar and plantar dermatoglyphics of 50 thyreopathic women revealed no statistically significant variations depending on the clinical form of thyreopathy, for the quantitative aspects of digito-palmar and plantar dermatoglyphics. Qualitative determatoglyphic differences were found (reoccurrence of the patterns on areas of the palm and plant) according to the clinical form of thyreopathy. These differences are more obvious in Graves's disease patients which may support the idea of a hereditary factor implied in the disease.