Short-term efficacy of high intensity group and individual education in patients with type 2 diabetes: a randomized single-center trial.

PURPOSE: The aim of this randomized study was to examine the efficacy of two high intensity educational programs: the conversation maps-based (CM™) education and the individual education (IE), compared to usual care (UC) in a cohort of type 2 diabetic (T2DM) patients. METHODS: Ninety T2DM outpatients (30 per group) were randomized and 79 finished the study and were analyzed. The CM™ and IE groups received four educational sessions at 0, 4, 8 and 12 weeks, while the UC group received two brief individual sessions at 0 and 12 weeks. We evaluated glycemic control (HbA1c), diabetes treatment, body mass index (BMI) and carried out a questionnaire survey at three time points (before intervention, at 12 and at 32 weeks) to assess patients' satisfaction, attitudes toward diabetes and dietary knowledge. RESULTS: All the three groups showed a significant and comparable reduction of both HbA1c and BMI. Diabetes therapy needed to be reinforced in a higher percentage of cases (39.3%) among UC patients compared to the IE (14.8%; p = 0.04) and the CM™ (8.3%; p = 0.01) groups. At 32 weeks Diabetes Treatment Satisfaction (DTSQ Q1 + Q4-8) significantly improved in the CM™ group (25.8 ± 4.5 vs. 22.4 ± 6.0; p < 0.01) and attitudes toward diabetes (ATT19) significantly improved in the IE group (58.0 ± 4.7 vs. 55.3 ± 5.1; p = 0.02). CONCLUSIONS: Our trial provides preliminary data regarding the efficacy of structured group and individual education on achieving better glyco-metabolic control without drug therapy reinforcement and with positive effects on patients' attitude and treatment satisfaction.

Dentigerous cysts associated with impacted third molars in adults after decompression: a prospective survey of reduction in volume using computerised analysis of cone-beam computed tomographic images.

We prospectively investigated in adults the decompression of dentigerous cysts associated with impacted third molars at high risk of iatrogenic damage during extraction. The computerised calculated volumetric postoperative reductions measured by cone-beam computed tomography at four and eight months were correlated with the duration of treatment, initial volume, and patient's age. We prospectively monitored 14 adult patients with 14 dentigerous cysts that were associated with impacted third molars, for eight months after decompression. The mean (SD) reduction in volume during the first eight months was 71 (14) % (51% after the first four months and 20% after the second four months), with a monthly reduction rate of 9%. Both the total decrease in volume (a) and the monthly rate of reduction (b) were significantly associated (p<0.01) and linearly correlated with the duration of decompression [r (a)=-0.89, r (b)=-0.61] and initial volume [r (a)=r (b)=0.92], but not with the patient's age (p=0.49) [r (a)=r (b)=0.04]. The trend towards reduction in volume within a period of eight months of treatment allowed us to better understand the duration of decompression required.

Healing of chronic necrobiosis lipoidica lesions in a type 1 diabetic patient after pancreas-kidney transplantation: a case report.

Necrobiosis lipoidica (NL) is a degenerative disease of dermal connective tissue of unknown etiology characterized by erythematous plaques preferentially localized to distal extremities. Skin lesions show a chronic relapsing nature. NL is often associated with diabetes mellitus and satisfactory treatment options are lacking. We describe the spontaneous healing of NL lesions after pancreas and kidney transplantation in a Type 1 diabetic patient with chronic NL recalcitrant to a variety of standard treatments. The 31-yr-old male patient had experienced NL lesions for more than 15 yr; despite various systemic and topical treatments, the skin lesions had pregressively enlarged. Because of end-stage renal disease, a simultaneous pancreas and kidney transplantation was performed and immunosuppressive therapy with tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisone was started. Pancreatic transplantation maintained satisfactory metabolic control with no need of exogenous insulin. After transplantation, skin lesions slowly healed without any specific treatment, leaving residual areas of fibrotic scars. A skin biopsy confirmed the absence of typical NL lymphocytic and histiocytic inflammatory response. Clinical remission of NL lesions may probably be explained by the concomitant effect of multiple-drug regimen for immunosuppression (TAC, MMF, and prednisone) and improved skin microcirculation secondary to the good metabolic control provided by pancreas transplantation.

Diabetic mastopathy: a case report.

Diabetic mastopathy, although reported since 1984, is a poorly recognized diabetes complication. It more frequently affects pre-menopausal women with Type 1 diabetes mellitus and microvascular complications. The pathogenesis of this condition is believed to involve mammary tissue autoimmune reaction to the accumulation of abnormal matrix proteins, caused by hyperglycemia. The lesion often simulates breast cancer; its recognition, therefore, is important to avoid unnecessary diagnostic procedures and surgical treatments. We now report a case of diabetic mastopathy which clinically simulated breast cancer in a young pre-menopausal diabetic woman who, after sonography and mammography, was suggested surgery under suspicion of breast cancer. Histopathological examination by core-biopsy ruled out malignancy.

A ten-year (1989-1998) perspective study of the incidence of Type 1 diabetes in the district of Catania (Sicily) in a 0-14 year age group.

The aim of this report was to evaluate the incidence of Type 1 diabetes mellitus (T1DM) in the district of Catania (eastern Sicily) in children under 15 yr of age over a ten-yr period (01/01/1989 - 31/12/1998) in relation to age, sex, monthly-seasonal variability, calendar yr and spatial clustering. The estimated completeness of our register was 99.2%. The overall incidence rate was 12.38 per 100,000 during the period of the study. Twenty-four percent of cases were 0-4 yr at diagnosis, 42% were 5-9 yr and 34% were 10-14 yr. More males (no. 148) than females (no. 125) were newly diagnosed with a male/female ratio similar to the base population ratio in the range 0-14 yr and within age groups. The study revealed a non-random spatial distribution of T1DM incidence in children not accounted for by known demographic factors. A significant seasonal pattern and temporal trend of incidence were also detected.

Regulation of norepinephrine in the medial preoptic area of Siberian hamsters by gonadal steroids.

Photoperiod has profound effects upon the neuroendocrine axis underlying reproductive physiology in seasonally breeding mammals. For long-day (LD) breeders, such as the Siberian hamster, exposure to a short-day (SD) photoperiod results in declines in circulating levels of gonadal steroids, luteinizing hormone (LH), and prolactin (PRL). The current study sought to investigate the effects of photoperiod and steroid levels on norepinephrine (NE), one of the major neurochemical regulators of gonadotropin-releasing hormone (GnRH) function. Since NE release within the medial preoptic area (mPOA) has been shown to stimulate the activity of GnRH cells, it was hypothesized that exposure to a short photoperiod would decrease NE levels. Furthermore, since gonadal steroids show negative feedback on GnRH function, it was hypothesized that gonadectomy would result in increased levels of NE. Adult male and female Siberian hamsters were gonadectomized and implanted with silastic capsules containing either cholesterol (C) or a mixture of estradiol (E) or testosterone (T). Microdialysis sampling within the mPOA was conducted after 8 weeks of exposure to either an LD or an SD photoperiod. Blood samples were analyzed for LH and PRL, while dialysis samples were analyzed for NE and its major metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG). The results revealed significant suppression of LH and PRL by exposure to the SD photoperiod in both males and females. For LH, the steroid implants suppressed circulating hormone levels under both photoperiods, whereas for PRL, steroid treatment facilitated circulating levels. In contrast, there were no significant effects of photoperiod on NE or MHPG release for either males or females, but there was a significant decrease in extracellular levels of these neurochemicals in steroid-treated animals. These data suggest that photoperiodic modulation of GnRH neuronal function by NE is achieved largely through the indirect effects of photoperiod on circulating gonadal steroids.

Genotypic diversity and typing of cyanobacterial strains of the genus Arthrospira by very sensitive total DNA restriction profile analysis.

Arthrospira maxima and A. platensis are two species of cyanobacteria cultivated and sold as health food, animal feed and source of food additives and fine chemicals. The genotypic diversity of several strains attributed to these two species on the basis of morphological criteria was investigated using very sensitive total DNA restriction profile analysis. The restriction profiles were obtained after sodium dodecyl sulphate polyacrylamide gel electrophoresis and silver staining. The unweighted pair-group method using arithmetic averages applied to the matrix of Dice similarity coefficient values clustered the electropherograms of the strains in two well-separated genotypic groups. These clusters corresponded to those obtained with morphological criteria. The molecular approach used was also able to type the examined strains.

Phototrophic biodeteriogens on lithoid surfaces: An ecological study.

For two strains, the green alga Pleurococcus CVB4 and the cyanobacterium Lyngbya CCB2, isolated from the pioneering algal biocoenosis present on a marble statue, we determined the optimum range of growth in selective cultural media in relation to pH, light intensity, and temperature, together with the ability of these organisms to colonize stone surfaces that differed either in the structure-texture or in the physico-chemical composition of the various lithotypes. The results showed a higher capacity of the green alga to withstand environmental factor changes. For both organisms the preferential colonization of the stone surface was correlated primarily, together with the environmental factors (pH, temperature, irradiance), to the physical characteristics (roughness and porosity) and secondarily to the chemical composition of the assayed lithotypes.

Incidence of type I diabetes in the district of Catania, Sicily.

The incidence of type I (insulin-dependent) diabetes was determined in the district of Catania (eastern Sicily) in children under 15 years of age over a 3-year period (1 January 1989 to 31 December 1991). Two independent sources of information were used. The primary source was contact with all medical services in the province, and the secondary source was the personal identification cards issued to all diabetic patients by the National Health System necessary for obtaining free medical care. The information obtained was 99.6% complete. The overall incidence was 10.2/10(5) per year. This study provides the first standardized data on the incidence of type I diabetes in Sicily and is consistent with the possibility of regional deviations from the proposed north to south gradient.

Survival of diazotrophic cyanobacteria in soil.

The survival under drough conditions for one year of 12 heterocystous cyanobacterial strains inoculated in three different soil types (silt clay, calcareous clay and silt loam) gave the highest survival (50%) forScytonema 208L.Fischerella 288L andNostoc OP25 also showed significant survival. Moreover, the soils inoculated withFischerella 288L andScytonema 208L had a higher total N content than non-inoculated soils.

Evaluation of albumin excretion rate in overnight versus 24-h urine.

This study was performed to assess whether the albumin excretion rate (AER) measured in overnight urine (N-AER) and 24-h urine (24-h AER) gives comparable results. For this reason we evaluated N-AER and 24-h AER on the same day from 35 control subjects, 57 patients with insulin-dependent diabetes mellitus (IDDM), and 63 patients with non-insulin-dependent diabetes mellitus (NIDDM). AER values obtained from the two urine collection procedures were significantly different (P less than .01), with 24-h AER approximately 30% higher than N-AER. Moreover, when the same cutoff value (20 micrograms/min) was used to define the normal range, 21% of IDDM patients and 6.3% of NIDDM patients had on the same day normal N-AER and abnormal (greater than 20 micrograms/min) 24-h AER. Although N-AER values were significantly correlated to 24-h AER values (r = 0.67, P less than .001), it was not possible to assess an N-AER value able to predict a 24-h AER value greater than 20 micrograms/min. In conclusion, N-AER and 24-h AER cannot be used as an equivalent method to establish AER.

Serum thyroglobulin levels are elevated in newborns from iodine-deficient areas.

Newborn infants have elevated serum thyroglobulin (Tg) levels and reduced iodination of Tg. To determine whether a relationship exists between serum Tg levels and the degree of Tg iodination, 699 newborn infants were studied in 3 areas of Sicily: a normal iodine-sufficient (control) area and 2 iodine-deficient areas. In the iodine-sufficient area, the mean cord serum Tg level was 25.8 ng/ml (median, 18.0; n = 183). In the iodine-deficient areas, the serum Tg levels in newborns were significantly higher, with mean levels of 43.4 ng/ml (median, 29.7; n = 304; P less than 0.01) and 60.1 ng/ml (median, 48.0; n = 212; P less than 0.005), respectively. The higher serum Tg level at birth was not entirely due to increased cord serum TSH levels, since newborns from the iodine-deficient areas with serum TSH levels at birth similar to those in infants from the control area had higher serum Tg levels. Serum Tg levels correlated with the serum T3 to T4 ratio, but not with serum TSH, T4, or T3 levels. These data suggest that iodine availability, which affects the degree of thyroid Tg iodination, partially determines serum Tg levels at birth.

Recent legal decisions and the implications for governance.

What major legal precedents were considered in the past year that affect hospital governance? The assistant general counsel of the American Hospital Association examines three particular areas of concern: the composition of hospital boards, trustee liability for federal taxes, and antitrust analysis of exclusive contracts.