Effects of inhaled human insulin on airway lining fluid composition in adults with diabetes.

Inhaled human insulin (Exubera (human insulin of rDNA origin) Inhalation Powder) causes small, early and reversible changes in pulmonary function in subjects with diabetes mellitus. The present study assessed whether changes occur in cellular and soluble constituents of airway lining fluid consistent with inflammation as a possible cause for Exubera-associated lung function alterations. Two 31-week, open-label, sequential design phase 2 studies were conducted, one with 20 subjects with type 1 and one with 24 subjects with type 2 diabetes. After run-in, all subjects received subcutaneous insulin for 12 weeks, followed after 1 week by 12 weeks of Exubera. Bronchoalveolar lavage fluid cell counts and protein constituents were determined at baseline, after 12 weeks of subcutaneous insulin and after 12 weeks of Exubera. Baseline cellular and soluble constituents of lavage fluid were similar to those reported for nondiabetic adults. Exubera produced no consistent clinically or statistically significant changes in total or differential lavage fluid cell counts or protein concentrations, even though Exubera-associated changes in pulmonary function are known to be fully manifest within 12 weeks. Therefore, 12 weeks of Exubera treatment is not associated with evidence of pulmonary inflammation. The treatment effects on lung function observed in Exubera trials are not caused by lung inflammation.

Status, role, and resource explanations for age patterns in psychological distress.

Using data from the 1996 and 1998 General Social Surveys, we explore the relationships among age, age-linked personal and social qualities, and two measures of psychological distress: depression (1996) and generalized distress (1998). Our study has three aims: (1) to replicate the u-shaped age-distress relationship in two recent U.S. data sets, (2) to confirm and elaborate on the mediators of the parabolic association, and (3) to explore the possible suppressor effects. In 1996, depression decreases from young adulthood into midlife and increases among the oldest-old. Less education, lower control, and widowhood contribute to old-age upturn; however, fewer time demands and greater financial satisfaction suppress the upward curve. Conversely, greater control, less shame, and greater religious attendance contribute to the decline through midlife; however, poorer health in midlife suppress that decline. Age patterns in distress are similar in the 1998 sample. Greater satisfaction with finances and fewer religious doubts contribute to the downward slope; however, declining levels of health suppress that downturn. Less education and retired status contribute to the old-age upturn. In sum, personal and social conditions have opposing influences on the parabolic relationship between age and distress.

Looking inward: introspectiveness, physical disability, and depression across the life course.

This study investigates the interrelationships among age, physical disability, introspectiveness, and depression. Using data from a community sample of disabled and non-disabled adults (N = 1,567), this study tests: 1) if there are age variations in introspectiveness; 2) if age variations in introspectiveness differ by physical disability status; 3) if introspectiveness mediates the association between age and depression; 4) if introspectiveness and disability status have synergistic effects on depression; and if so, 5) if subjective health differences between disabled and nondisabled account for the joint impact of introspectiveness and disability status on depression. Results show that older people report less introspectiveness than younger people do--which explains part of the negative association between age and depression. Additionally, the negative association between age and introspectiveness is significantly stronger among nondisabled respondents. Adjustment for less introspectiveness among older adults accounts for about 24 percent of the negative association between age and depression. Disabled respondents experience a more positive relationship between introspectiveness and depression; however, disabled respondents' poorer global health explains most of that pattern.

[New strategy for thyroid function testing]. / Uj stratégia a pajzsmirigyfunkció diagnosztikájában.

The authors used a new protocol, based upon a supersensitive TSH assay, to examine the thyroid status of 1720 patients. Based upon the serum hormone levels, the patients were divided into different clinical groups. The biochemical relationship between the different hormone levels, and the rate of occurrence of various thyroid diseases were studied. 76.1% of the new patients hadn't received any previous treatment. 15.5% of those patients who had received treatment had hyperthyroidism, while 8.4% of those had hypothyroidism. 76% of the new patients, 38.3% of those who had hyperthyroidism, and only 29.7% of those who had hypothyroidism, were euthyroid. Undetectable TSH levels (< 0.03 mU/L) where observed in 51.8% of the new hyperthyroid patients, and in 33.8% of those who had subclinical hyperthyroidism. Similar results were obtained with those who had been previously treated for hyperthyroidism. The new protocol has the following advantages: it's more convenient to the patients, it's quick, it's economical. With this method it is possible to reduce the assays per patient by 31%. The algorithm was supplemented with results of free hormone levels. By doing this the authors were able to measure free-T4 and T3 hormone levels of 150 more patients. According to the authors, the free-T4 test is more informative than the free-T4-index, especially in the border-line cases and in treated hyperthyroidism. Primarily the free-T3 test is most necessary when examining patients treated with methimasol.

Pathogenesis of sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The organs that are involved by sarcoidosis include the lungs in which the granuloma is seen in more than 90% of patients to the pituitary, which is only rarely affected. There are many hypotheses as to the cause of sarcoidosis. Some of them rely on the similarities seen between sarcoidosis and the other granuloma-forming diseases such as tuberculosis, berylliosis, pine pollen inhalation and acute and chronic bacterial and viral infections, while others find similarities between sarcoidosis and immune reactions observed in autoimmune disorders. Still other explanations implicate a genetic predisposition or a still-unknown agent as the underlying cause of the granuloma formation.