Canceling the elastic Poynting effect with geometry.

The Poynting effect is a paragon of nonlinear soft matter mechanics. It is the tendency (found in all incompressible, isotropic, hyperelastic solids) exhibited by a soft block to expand vertically when sheared horizontally. It can be observed whenever the length of the cuboid is at least four times its thickness. Here we show that the Poynting effect can be easily reversed and the cuboid can shrink vertically, simply by reducing this aspect ratio. In principle, this discovery means that for a given solid, say one used as a seismic wave absorber under a building, an optimal ratio exists where vertical displacements and vibrations can be completely eliminated. Here we first recall the classical theoretical treatment of the positive Poynting effect, and then show experimentally how it can be reversed. Using finite-element simulations, we then investigate how the effect can be suppressed. We find that cubes always provide a reverse Poynting effect, irrespective of their material properties (in the third-order theory of weakly nonlinear elasticity).

Evaluación del tratamiento intensificado con conteo de hidratos de carbono en un grupo de niños con diabetes tipo 1 / Evaluation of treatment intensified with carbohydrate counting in a group of children with diabetes type 1

Introducción. Los resultados del Diabetes Control and Complications Trial (DCCT) demostraron que con la terapéutica intensificada, se logra mejorar el control glucémico, retrasando la aparición de complicaciones crónicas de la diabetes. Objetivo. Comparar el control metabólico en un grupo de niños con diabetes tipo 1 (DM1) seguidos en el Hospital Sor María Ludovica según el esquema utilizado: Tratamiento Convencional (TC) versus Tratamiento Intensificado (TI) con educación en Conteo de Hidratos de Carbono (CHC).Materiales y método. Estudio clínico comparativo, prospectivo, descriptivo y analítico en dos grupos: TI y TC. Se evaluó la edad cronológica al debut (EC), talla (T), Índice de Masa Corporal (IMC) según curvas OMS, tiempo de evolución de la diabetes e insulinas utilizadas. Se analizaron las insulinas utilizadas en cada grupo y las modificaciones en el IMC, Hemoglobina Glicosilada (HbA1C), y la presencia de hipoglucemias severas a los 6 meses del CHC.Resultados. La media de HbA1C al inicio fue de 10.11 ± 2.51% y a los 6 meses 8.10 ± 1.77% en TI, disminuyó 2.01% (p<0.0001). En TC la HbA1C al inicio fue de 8.86 ±1.87% y a los 6 meses de 9.78 ± 2.18%, aumentó un 0.92% (p=0.0002).Discusión. Los resultados muestran que el TI en niños puede llevarse a cabo logrando una reducción de la HbA1C sin aumentar las hipoglucemias y otros efectos adversos.

Evaluación del tratamiento intensificado con conteo de hidratos de carbono en un grupo de niños con diabetes tipo 1 / Evaluation of treatment intensified with carbohydrate counting in a group of children with diabetes type 1

Introducción. Los resultados del Diabetes Control and Complications Trial (DCCT) demostraron que con la terapéutica intensificada, se logra mejorar el control glucémico, retrasando la aparición de complicaciones crónicas de la diabetes. Objetivo. Comparar el control metabólico en un grupo de niños con diabetes tipo 1 (DM1) seguidos en el Hospital Sor María Ludovica según el esquema utilizado: Tratamiento Convencional (TC) versus Tratamiento Intensificado (TI) con educación en Conteo de Hidratos de Carbono (CHC).Materiales y método. Estudio clínico comparativo, prospectivo, descriptivo y analítico en dos grupos: TI y TC. Se evaluó la edad cronológica al debut (EC), talla (T), Indice de Masa Corporal (IMC) según curvas OMS, tiempo de evolución de la diabetes e insulinas utilizadas. Se analizaron las insulinas utilizadas en cada grupo y las modificaciones en el IMC, Hemoglobina Glicosilada (HbA1C), y la presencia de hipoglucemias severas a los 6 meses del CHC.Resultados. La media de HbA1C al inicio fue de 10.11 ± 2.51% y a los 6 meses 8.10 ± 1.77% en TI, disminuyó 2.01% (p<0.0001). En TC la HbA1C al inicio fue de 8.86 ±1.87% y a los 6 meses de 9.78 ± 2.18%, aumentó un 0.92% (p=0.0002).Discusión. Los resultados muestran que el TI en niños puede llevarse a cabo logrando una reducción de la HbA1C sin aumentar las hipoglucemias y otros efectos adversos.(AU)

Assessment of normal values of fractional anisotropy and mean diffusivity of mobile lumbar spine roots by diffuson tensor MRI: comparison between 1.5 and 3T.

PURPOSE: To assess the normal values of fractional anisotropy (FA) and mean diffusivity (MD) of L4, L5 and S1 nerve roots using diffusion tensor imaging (DTI) in healthy volunteers. MATERIALS AND METHODS: 37 subjects without previous history of lumbalgia or radiculalgia were prospectively examined: 27 at 1.5T and 10 at 3T MRI. The protocol included standard anatomical sequences and a DTI acquisition. Nerve root fibers were semi automatically extracted from DTI tractography. FA and MD values were measured at 4 key portions along each L4, L5 and S1 nerve roots. RESULTS: At 1.5T MRI, FA and MD were 0.221 ± 0.011 and 460.9 ± 35.5 mm2.s-1 respectively; at 3T MRI, FA and MD were 0.216 ± 0.01 and 480.1 ± 36.1 mm2.s-1 respectively, which may be considered as normal values for mobile lumbar spine nerve roots, independently of intersomatic space level (p = 0.06) and nerve root portion (p = 0.08) or magnetic field (p = 0.06). CONCLUSION: Normal FA and MD values can be measured along lumbar mobile spine nerve roots in healthy subjects. These values were not dependent on intersomatic space level, side or anatomical portion of the nerve root or magnetic field.

Pattern selection in growing tubular tissues.

Tubular organs display a wide variety of surface morphologies including circumferential and longitudinal folds, square and hexagonal undulations, and finger-type protrusions. Surface morphology is closely correlated to tissue function and serves as a clinical indicator for physiological and pathological conditions, but the regulators of surface morphology remain poorly understood. Here, we explore the role of geometry and elasticity on the formation of surface patterns. We establish morphological phase diagrams for patterns selection and show that increasing the thickness or stiffness ratio between the outer and inner tubular layers induces a gradual transition from circumferential to longitudinal folding. Our results suggest that physical forces act as regulators during organogenesis and give rise to the characteristic circular folds in the esophagus, the longitudinal folds in the valves of Kerckring, the surface networks in villi, and the crypts in the large intestine.

Clinical relevance of diffusion tensor imaging parameters in lumbar disco-radicular conflict.

PURPOSE: To measure the fractional anisotropy (FA) and the mean diffusivity (MD) values of L4, L5 and S1 nerve roots using diffusion tensor imaging (DTI) and to correlate them with four different clinical patterns. PATIENTS AND METHODS: Fifty-six human participants were prospectively included and divided between four groups: healthy subjects, patients with clinical symptomatic nerve root pain with and without anatomical discoradicular conflict and patients with incidental anatomical discoradicular conflict seen on magnetic resonance imaging (MRI). MRI protocol included anatomical sequences (sagittal T1- and T2-weighted, axial T2-weighted) and a 25 directions DTI sequence. FA and MD values were measured in consensus by two readers and compared between the four groups. RESULTS: Mean FA and MD values were significantly different for patients with clinically symptomatic nerve root pain (n=27) both with (n=16) (FA=0.187±0.015; MD=510±40) and without (n=11) (FA=0.193±0.011; MD=490±30.5) anatomical discoradicular conflict compared to healthy subjects (n=29) (FA=0.221±0.011; MD=460.9±35.5) including 2 subjects with incidental anatomical discoradicular conflict (FA=0.211±0.013; MD=450.8±41.2) on MRI (P=0.003). CONCLUSION: Measurement of FA and MD values of L4, L5 and S1 nerve roots using DTI could be useful in lumbar nerve root pain assessment. Further studies with different image processing methods are needed.

Morpho-elasticity of intestinal villi.

Villi are ubiquitous structures in the intestine of all vertebrates, originating from the embryonic development of the epithelial mucosa. Their morphogenesis has similar stages in living organisms but different forming mechanisms. In this work, we model the emergence of the bi-dimensional undulated patterns in the intestinal mucosa from which villi start to elongate. The embryonic mucosa is modelled as a growing thick-walled cylinder, and its mechanical behaviour is described using an hyperelastic constitutive model, which also accounts for the anisotropic characteristics of the reinforcing fibres at the microstructural level. The occurrence of surface undulations is investigated using a linear stability analysis based on the theory of incremental deformations superimposed on a finite deformation. The Stroh formulation of the incremental boundary value problem is derived, and a numerical solution procedure is implemented for calculating the growth thresholds of instability. The numerical results are finally discussed with respect to different growth and materials properties. In conclusion, we demonstrate that the emergence of intestinal villi in embryos is triggered by a differential growth between the mucosa and the mesenchymal tissues. The proposed model quantifies how both the geometrical and the mechanical properties of the mucosa drive the formation of previllous structures in embryos.

Imaging of the nerves of the knee region.

Peripheral neuropathies are a frequent, but often underdiagnosed, cause of pain and functional impairment. The clinical symptoms can be subtle, and other neurologic or non neurologic clinical entities are often evoked. MRI and ultrasonography are the imaging modalities of choice for depicting nerves and assessing neuropathies. Common neuropathies in the knee area involve the saphenous, the tibial, the common peroneal and the sural nerves. The most frequent mechanisms of nerve injury in this area are nerve entrapment and nerve stretching. A perfect knowledge of the normal imaging anatomy is essential for accurate assessment of neuropathies. In this article, we will review the anatomy of the nerves around the knee, and their normal and pathological appearance.

Radiographic anatomy of the intervertebral cervical and lumbar foramina (vessels and variants).

The intervertebral foramen is an orifice located between any two adjacent vertebrae that allows communication between the spinal (or vertebral) canal and the extraspinal region. Although the intervertebral foramina serve as the path traveled by spinal nerve roots, vascular structures, including some that play a role in vascularization of the spinal cord, take the same path. Knowledge of this vascularization and of the origin of the arteries feeding it is essential to all radiologists performing interventional procedures. The objective of this review is to survey the anatomy of the intervertebral foramina in the cervical and lumbar spines and of spinal cord vascularization.

Tractography of peripheral nerves and skeletal muscles.

The assessment of human peripheral nerves and skeletal muscles by means of diffusion tensor imaging and tractograpy has been a recent area of research. These techniques have been successfully applied in both volunteers and patients, providing non-invasively, quantitative microstructural parameters (mainly mean fractional anisotropy and apparent diffusion coefficient) and offering a three-dimensional visualization tool of nerves and muscles fibers. DTI and tractography may reveal abnormalities that are beyond the resolution of conventional MR techniques and hence open the way to potential clinical applications. In this article, we will first summarize the current state of DTI and tractography in the evaluation of peripheral nerves and skeletal muscles as well as their potential future clinical applications. Then, we will address important technical considerations, which understanding is necessary to appropriately apply DTI and tractograhy, and in order to understand the current limitations of these innovative and promising techniques.

Glucose tolerance and insulin action in healthy centenarians.

Advancing age has been found to be associated with a decline in insulin action. Nevertheless, no study has been conducted in healthy centenarians. Our study investigates glucose tolerance and insulin action in centenarians. Fifty-two subjects were enrolled. The subjects were divided in three groups as follows: 1) adults (< 50 yr; n = 20);2) aged subjects (> 75 yr; n = 22); and 3) centenarians (> 100 yr; n = 14). Body composition was studied by bioimpedance analysis. In all subjects, an oral glucose tolerance test and euglycemic glucose clamp were performed. Centenarians have a lower fat-free mass (FFM) than aged subjects and adults, whereas fasting plasma glucose, triglycerides, free fatty acids, urea, and creatinine were not different in the groups studies. Centenarians had a 2-h plasma glucose concentration (6.0 +/- 0.2 mmol/l) that was lower than that in aged subjects (6.6 +/- 0.5 mmol/l, P < 0.05) but not different from adults [6.4 +/- 0.4 mmol/l, P = not significant (NS)]. During the clamp, plasma glucose and insulin concentrations were similar in the three groups. In these conditions, centenarians had a whole body glucose disposal (34.1 +/- 0.6 mumol.kg FFM-1.min 1) that was greater than that in aged subjects (23.3 +/- 0.5 mumol.kg FFM-1.min-1 P < 0.01) but not different from adults (34.6 +/- 0.5 mumol/kg x min, P = NS). In conclusion, our study demonstrates that centenarians compared with aged subjects had a preserved glucose tolerance and insulin action.

The therapy of aged diabetic hypertensives.

The great prevalence and incidence of non-insulin dependent diabetes mellitus (NIDDM) and hypertension in the elderly represent several therapeutic problems. Due to aged-related changes in glucose handling and cardiovascular functions which occur with advancing age, it is necessary to treat aged diabetic hypertensive patients with drugs lowering arterial blood pressure but without side effects on glucose metabolism. Non-pharmacological and pharmacological protocols can be taken into account. With regard to the non-pharmacological therapy, a decline in body fatness, an increase in body fitness and an appropriate dietary assumption of sodium, potassium, calcium and magnesium are the most important approach. As far as the therapeutic approach, calcium channel blockers and angiotensin converting enzyme (ACE)-inhibitors seem to be particularly useful in the treatment of aged diabetic hypertensive patients. Calcium channel blockers have no effects on glucose tolerance while they are very effective on heart beating and arterial blood pressure. ACE-inhibitors lowers arterial blood pressure, delay the progression of diabetic nephropathy to the renal failure and, have null or beneficial effects on glucose handling. In conclusion, in aged diabetic hypertensive patients non-pharmacological therapy should be combined to administration of calcium channel blockers and ACE-inhibitors.

The oncological therapy in the elderly.

The rising incidence of cancer in old subjects yields great scientific interest. Cancer itself has different features in the elderly. Thus the choice of therapy must follow a wide investigation on the "performance status" through acknowledgements on psychological and social factors, too. The therapeutic strategy is not usually different from the one used in other sections of life, but it is important to remember that an aged patient with cancer has to be submitted to a multidimensional evaluation using specific tools, that consider not only the neoplastic pathology but also the functional consequences. Always respecting quality of life and the eventual side effects, the choice of less aggressive strategies is especially important in those patients presenting a reduced expectancy of life. The improvement of surgery and anesthesiological techniques, the use of high-energy radiotherapy, the use of hemopoietic growing factors, antiemetics of last generation and a suitable support therapy give the medical specialist the chance to choose the adequate therapeutic strategy. This is a short review of the main guide-lines to be taken into consideration in the assessment and management of elderly patients with cancer.

Body composition, body fat distribution, and resting metabolic rate in healthy centenarians.

Our study investigated body composition and body fat distribution in healthy centenarians. Body composition, body fat distribution, and resting metabolic rate (RMR) were studied in 40 adult subjects aged < 50 y, 35 aged subjects > 75 y, and 15 healthy centenarians aged > 100 y. Body composition was determined by bioimpedance analysis, body fat distribution was calculated as waist-hip ratio (WHR), and RMR was calculated by using the Arciero-Poehlman formula. Healthy centenarians had a cognitive impairment and degree of disability greater than aged subjects. Despite such differences, fat-free mass (FFM) and RMR were not different in centenarians compared with aged subjects but were lower than in adult subjects. In contrast, healthy centenarians had a WHR lower than that of aged subjects but not different from that of the adult subjects. After the level of physical activity and degree of disability were adjusted for, FFM (44 +/- 2.7 and 40 +/- 1.1 kg; P < 0.05) and RMR (6757 +/- 761 and 5891 +/- 723 kJ/24 h; P < 0.05) were significantly higher in healthy centenarians than in aged subjects, respectively. Independent of age, sex, body weight, degree of disability, level of physical activity, and fasting plasma triiodothyronine, there was a strong correlation between RMR and FFM (r = 0.50, P < 0.05) in healthy centenarians. In conclusion, healthy centenarians had a lower FFM and higher body fat content than aged subjects. Level of physical activity and degree of disability seem to be the major determinants for explaining such differences.

Metabolic benefits deriving from chronic vitamin C supplementation in aged non-insulin dependent diabetics.

OBJECTIVE: Our study investigated the metabolic benefits deriving from chronic pharmacological vitamin C administration in aged non-insulin dependent (Type II) diabetic patients. METHODS: Forty type II diabetic patients (age: 72 +/- 0.5 years) underwent placebo and vitamin C (0.5 g twice daily) administration in double-blind, randomized, cross-over fashion. All patients were treated by oral hypoglycaemic agents which continued throughout the study. After baseline observations, treatment periods lasted 4 months and were separated by a 30-day wash-out period. RESULTS: Patients' antropometric data were unchanged throughout the study. Chronic vitamin C administration vs placebo was associated with a significant decline in fasting plasma free radicals (0.26 +/- 0.06 vs 0.49 +/- 0.07 p < 0.03) and insulin (90 +/- 4 vs 73 +/- 6 pmol/L p < 0.04), total- (7.3 +/- 0.5 vs 5.8 +/- 0.4 mmol/L p < 0.03), LDL-cholesterol (5.6 +/- 0.6 vs 4.1 +/- 0.3 mmol/L p < 0.05) and triglycerides (2.58 +/- 0.07 vs 2.08 +/- 0.04 mmol/L p < 0.04) levels. In 20 patients, chronic vitamin C administration improved whole body glucose disposal and nonoxidative glucose metabolism. Percent increase in plasma vitamin C levels correlated with the percent decline in plasma LDL-cholesterol (r = 0.44; p < 0.007) and insulin levels (r = 0.42; p < 0.006). Finally percent increase in plasma vitamin C levels was correlated with the percent decline in plasma free radicals and increase in GSH levels. CONCLUSIONS: Chronic vitamin C administration has beneficial effects upon glucose and lipid metabolism in aged non-insulin dependent (type II) diabetic patients.

Lisinopril administration improves insulin action in aged patients with hypertension.

Thirty elderly, mildly hypertensive patients were enrolled for a single-blind, randomised cross-over placebo controlled trial in which placebo and lisinopril (20 mg/day before breakfast) were given for 4 and 8 weeks, respectively. A wash-out period of 3 weeks between placebo and lisinopril was observed. In each patient a euglycaemic glucose clamp with simultaneous indirect calorimetry allowed us to determine whole body glucose disposal and substrate oxidation. Changes in morning SBP and DBP were also determined. Lisinopril vs. placebo significantly improved whole body glucose disposal (40.4 +/- 0.4 vs. 30.3 +/- 0.4 mumol/kg LBM x min; P < 0.01), non-oxidative glucose metabolism (18.1 +/- 0.7 vs. 10.9 +/- 0.6 mumol/kg LBM x min; P < 0.01) and fasting plasma potassium levels (4.8 +/- 3 vs. 4.4 +/- 0.4 mmol/l; P < 0.05). SBP (175 +/- 3.3 vs. 160 +/- 3.0 mm Hg; P < 0.001) and DBP (106 +/- 2.3 vs. 95 +/- 2.0 mm Hg; P < 0.001) were significantly reduced by lisinopril administration. After ACE inhibition, fasting plasma potassium levels correlated with the decline in mean arterial BP (r = -0.71; P < 0.006). In conclusion, lisinopril administration reduces arterial BP and improves insulin sensitivity in elderly hypertensive patients.

Chronic intake of pharmacological doses of vitamin E might be useful in the therapy of elderly patients with coronary heart disease.

Thirty elderly (mean +/- SEM: 73.8 +/- 2.1 y) nondiabetic, moderately obese (body mass index = 28.3 +/- 0.6 kg/m2) patients with stable effort angina underwent an oral-glucose-tolerance test and a euglycemic hyperinsulinemic glucose clamp before and after vitamin E supplementation (900 mg/d for 4 mo). The study was of a randomized, placebo-controlled, double-blind, and crossover design. Anthropometric indexes were stable throughout the study. Despite similar fasting and 2-h plasma glucose concentrations, vitamin E administration (compared with placebo) lowered fasting (88 +/- 14 and 68 +/- 9 pmol/L, P < 0.02) and 2-h (348 +/- 43 and 263 +/- 28 pmol/L, P < 0.05) plasma insulin concentrations, plasma triglyceride concentrations (1.34 +/- 0.06 and 1.07 +/- 0.03 mmol/L, P < 0.05), and the ratio of plasma LDL to HDL cholesterol (7.64 +/- 0.31 and 5.52 +/- 0.38, P < 0.02). Vitamin E administration was associated with higher nonoxidative glucose metabolism (18.1 +/- 0.5 and 10.6 +/- 0.7 mumol.kg lean body mass-1.min-1, P < 0.03) than was placebo administration during the euglycemic glucose clamp. We conclude that chronic intake of pharmacological doses of vitamin E might be useful in the therapy of elderly insulin-resistant patients with coronary heart disease.

Evidence for a relationship between oxidative stress and insulin action in non-insulin-dependent (type II) diabetic patients.

Ten healthy subjects and 30 non-insulin-dependent (type II) diabetic patients matched for age, gender ratio, body mass index, lean body mass (LBM), waist to hip ratio, and arterial blood pressure volunteered for the study. In all subjects, fasting plasma free radical (O2-) levels and basal membrane lipid fluidity (MLF) and protein mobility (MPM) were determined. The whole group of subjects underwent a euglycemic hyperinsulinemic glucose clamp with simultaneous indirect calorimetry for substrate oxidation determination. Diabetic patients versus controls displayed higher fasting plasma glucose (8.3 +/- 0.4 v 5.1 +/- 0.4 mmol/L, P +/- .001), O2- (0.48 +/- 0.02 v 0.16 +/- 0.02 mumol/L x min), and hemoglobin A1c ([HbA1C] 7.9% +/- 0.4% v 5.7% +/- 0.3%, P < .03) levels and a stronger reduction in basal MLF (0.243 +/- 0.006 v 0.318 +/- 0.009, P < .003) and basal MPM (0.348 +/- 0.003 v 0.518 +/- 0.010, P < .002). Whole-body glucose disposal (WBGD) and oxidative and nonoxidative glucose metabolism were also significantly lower in diabetics than in controls. In diabetic patients (n = 30), plasma O2- levels correlated with basal MLF (r = -.59, P < .005), basal MPM (r = -.84, P < .001), fasting plasma insulin level (r = .51, P < .004), WBGD (r = -.53, P < .002), and nonoxidative (r = -.45, P < .01) glucose metabolism. In conclusion, our results demonstrate that a relationship between plasma O2- levels and insulin action occurs in non-insulin-dependent diabetics.

Plasma vitamin C affects glucose homeostasis in healthy subjects and in non-insulin-dependent diabetics.

In aged healthy (n = 10) and non-insulin-dependent (type II) diabetic (n = 10) subjects matched for age [67.3 +/- 0.5 vs. 68.0 +/- 0.4 yr, P = not significant (NS)], body mass index (25.7 +/- 0.7 vs. 26.0 +/- 0.2 kg/m2, P = NS), gender ratio [6 males (M)/4 females (F) vs. 5 M/5 F], and mean arterial blood pressure (104 +/- 6 vs. 105 +/- 9 mmHg, P = NS), we determined the changes in insulin secretion and action after vitamin C infusion and the relative increase in plasma vitamin C levels. At the highest vitamin C infusion rate (0.9 mmol/min) the increase in plasma vitamin C levels did not affect B cell response to glucose, but it improved Conard's K values and whole body glucose disposal in healthy subjects and in diabetic patients. In both groups of subjects vitamin C-mediated increase in insulin action was mainly due to an improvement in nonoxidative glucose metabolism. After fasting, plasma vitamin C levels correlated with basal whole body glucose disposal (r = -0.44, P < 0.05; n = 20). After vitamin C infusion, percent change in plasma vitamin C level correlated with the percent decline in membrane microviscosity (r = 0.53, P < 0.01; n = 20) and increase in whole body glucose disposal (r = 0.63, P < 0.003; n = 20). In conclusion, plasma vitamin C levels seem to play a role in the modulation of insulin action in aged healthy and diabetic subjects.

Metabolic features of patients with and without coronary heart disease but with a superimposable cluster of cardiovascular risk factors.

BACKGROUND: Many studies have shown a significant association between the magnitude of insulin resistance and the plasma insulin levels in non-diabetic patients. It has also been shown that all major cardiovascular risk factors are associated with the presence of hyperinsulinemia or insulin resistance. However, studies have not addressed the possible metabolic differences in insulin action that can occur in patients with and without coronary heart disease (CHD) but with a superimposable cluster of risk factors. METHODS: Three groups of patients matched for age, sex, and lean body mass, but different in their absence of risk factors (group A; n = 8), presence of risk factors but no clinical and electrocardiographic signs of CHD (group B; n = 12), and the presence of risk factors, family history of CHD, and clinical and electrocardiographic signs of CHD (group C; n = 14) volunteered for the study. Patients in groups B and C were also matched for main risk factors. All patients were submitted to a euglycemic hyperinsulinemic glucose clamp during which a an infusion of 3H-glucose and indirect calorimetry facilitated the determination of glucose turnover parameters and substrate oxidation. RESULTS: Patients with CHD (group C) had the highest fasting plasma insulin levels (98 +/- 13 pmol/l) compared with patients in group B (86 +/- 4 pmol/l; P < 0.05) and in group A (63 +/- 4 pmol/l; P < 0.05) and the lowest insulin-mediated stimulation in non-oxidative glucose metabolism. Fasting lipid oxidation was similar in the three groups, but a stronger insulin-mediated inhibition in the control patients (group A) was found. Multiple regression analysis of the pooled data from the patients in groups B and C (n = 26) demonstrated that all risk factors considered correlated (t = 1.58, P < 0.04) with total body glucose disposal (TBGD) and accounted for 77% of the variability in TBGD. Furthermore, a separate analysis for groups B and C demonstrated a different contribution of all risk factors (89% and 65% for groups B and C, respectively) to the variability in TBGD. In group C patients, a multiple logistic regression analysis encompassing all risk factors studied, but also the family history of CHD, explained 92% of the variability in TBGD. CONCLUSION: In patients with and without CHD but with similar risk factors, a significant reduction in non-oxidative glucose metabolism occurs; nevertheless, such impaired glucose handling seems to be worsened in the presence of CHD. Further studies will be needed to determine the cause of such differences.