Summary
Aim To determine a new category of dysfunctional glucose homeostasis – impaired fasting glucose (IFG) – introduced by the American Diabetes Association (ADA) and the World Health Organization ...(WHO) defining those with abnormal but nondiabetic fasting glucose values and with a possible risk for developing diabetes. It is not known whether IFG is a risk factor for atherosclerosis, as is impaired glucose tolerance (IGT).
Methods In this case‐control cross‐sectional study in which the oral glucose tolerance (75‐g OGTT) and the carotid intima‐media thickness (IMT) with B mode ultrasound, as a marker of atherosclerosis, were measured, together with HbA1c, lipids, plasminogen activator (PAI), insulin and proinsulin concentrations in blood plasma. Out of 788 subjects of the risk factors in IGT for Atherosclerosis and Diabetes (RIAD) study we found 104 IFG cases that were compared to 104 controls with fasting plasma glucose (FPG) < 6.1 mmol/l, matched for age, sex and body mass index. Subjects with 2 h postprandial (pp) plasma glucose ≥ 11.1 mmol/l were excluded. The rest were subdivided into those with 2 h plasma glucose < 7.8 mmol/l (63 pairs, NGT) and those with plasma glucose > 7.8 mmol/l and < 11.1 mmol/l (41 pairs, IGT).
Results The case and control groups showed no significant differences in the major risk factors except for waist‐to‐hip ratio (WHR) which was higher in the IFG with NGT. IFG with NGT exhibited significantly higher levels of HbA1c, true insulin and proinsulin. In IFG with IGT, only HbA1c and proinsulin were significantly increased vs. controls. IMT was in the same range for cases and controls in both subgroups. However, IMT mean and IMTmax were significantly increased in IFG with IGT vs. IFG with NGT (0.95 mm vs. 0.80 mm and 1.10 mm vs. 0.90 mm). Cumulative distribution analysis of IMT illustrates that IMT in IFG with IGT is more shifted to higher artery wall thickness than in IFG with NGT.
Conclusions In our case‐control study IFG alone was not related to increased IMT. Only IFG in a combination with IGT exhibited atherosclerotic changes of the carotid arteries. IFG is not analogous to IGT as a risk factor for atherosclerosis.
Diabet. Med. 16, 212–218 (1999)
Coagulation parameters were determined in children with valproic acid mono- and valproic acid-lamotrigin combination therapy.
Monotherapy group (n = 22; mean age: 10.5 years) was compared to ...combination therapy (n = 7; 12.9 years) and a control group (n = 22; 8.7 years). The following parameters were measured: aggregation and ATP-release in whole blood (ADP: 20 μmol/l, collagen: 1 μg/ml, thrombin: 0.5 U/ml), PFA-100® closure times (CT), blood cell counts, global tests, VWF:Ag, VWF:CBA, factors VIII and XIII as well as fibrinogen. Bleeding symptoms were evaluated by using a questionnaire.
For ADP- and collagen-induced aggregation as well as for ATP release no significant differences between the groups were detected. The combined therapy group showed significantly prolonged CT. Von Willebrand disease was not detected in any of the patients. The platelet count was significantly decreased in the monotherapy group. In six children a mild bleeding tendency was observed, mostly epistaxis.
A clinically relevant influence of valproic acid on haemostasis was found only in few cases. However, before surgical procedures an extended coagulation diagnostics is recommended in patients with valproic acid therapy.
A total plasma exchange was the first extracorporeal method to treat patients with severe hypercholesterolemia. But in the long run it has several disadvantages. The newer lipoprotein apheresis (LA) ...methods claim to be more selective with respect to the removal of atherogenic lipoproteins and thus are supposed to avoid an additional protein loss.
We wanted to compare the effect of these methods on serum protein concentrations (total serum protein, albumin, proteins measured with electrophoresis, immunoglobulins, fibrinogen, transferrin, and ferritin) which were checked before and after a single LA session in 75 patients. All patients underwent active LA treatment using 6 different LA methods (HELP, TheraSorb® LDL, DALI, Lipidfiltration, Liposorber D, MONET). Post-apheresis concentrations were corrected for changes in hematocrit.
The slightest impact on total serum protein was observed with the whole-blood methods. Liposorber D showed the least reduction of albumin levels. All LA methods had a small effect on alpha1-globulins and beta-globulins, but alpha2-and gamma-globulins were reduced to a different extent. A major effect was seen on the immunoglobulins when filtration methods were applied. In the patients treated with MONET, both pre- and post-apheresis Immunoglobulin M concentrations were below the normal range. HELP and the filtration methods significantly reduced the fibrinogen concentrations. The filtration methods also decreased ferritin levels but the post-apheresis ferritin levels were still in the normal range.
All LA methods had an influence on protein concentrations. At present, these findings will not yield an individualized treatment approach for any selective LA method due to the lack of prospective comparative studies. At minimum, special attention should be paid to protein concentrations in patients suffering from protein deficit.
The Aspirin-like defect (ALD) is caused by defects in the intraplatelet arachidonic acid (AA)-metabolism. We here present the characteristics of a larger cohort in a single centre.
Based on 17 ALD ...index patients bleeding symptoms, agonist-induced platelet aggregation and closure times in the PFA-100 test were analysed in a family cohort of altogether 52 individuals from 17 families. Absent aggregation to AA (maximal aggregation <or= 10%) was the main diagnostic criterion. A mild ALD was diagnosed when aggregation was 11-40%.
In addition to 17 ALD index patients, 13 family members displayed ALD. 4 family members were diagnosed with a mild ALD. Epistaxis, easy bruising, menorrhagia and perioperative hemorrhage were the most common bleeding symptoms, whereas three quarters of ALD patients presented with >or=1 bleeding symptoms.
In case of a bleeding tendency diagnostic procedures should rule out primary haemostatic defects. Hereditary platelet function defects including ALD are an important differential diagnosis. Family studies are reasonable.
To evaluate the role of inherited thrombophilia in the development of central venous line (CVL)-related thrombosis, the following parameters were determined in 77 pediatric-oncologic patients with ...CVL: activated protein C (APC)-ratio, factor V (FV) G1691A and prothrombin G20210A mutation, protein C, protein S, antithrombin, coagulation factor XII, lipoprotein (a) and homocysteine. An inherited prothrombotic risk factor was found in 17 patients (23%). Four out of 14 patients with a single detect (hyperlipoproteinemia, heterozygous FV G1691A and prothrombin G20210A mutation, protein C deficiency type I) and all three patients with combined defects (heterozygous FV G1691A mutation combined with heterozygous prothrombin G20210A variant, protein S deficiency or hyperlipoproteinemia) suffered from CVL-related thrombosis. In 11 out of 77 patients (14%) a CVL-related thrombosis was detected. In 2 children thrombosis occurred a few days after asparaginase therapy and in another three thrombosis was associated with CVL-related septicemia caused by Staphylococcus epidermidis. After removal of CVL, thrombosis was detected in 5 children, in 2 without clinical symptoms but in the presence of inherited prothrombotic risk factors.
The present study demonstrates the clinical importance of CVL in combination with inherited thrombophilia in the development of thrombosis in pediatric-oncologic patients. Before or shortly after insertion of CVL, patients should be tested for the presence of factor V G1691A mutation, prothrombin G20210A variant and increased lipoprotein (a) values.
Platelet hyperaggregability contributes to thromboembolic events of obesity in adulthood. In obese children hyperaggregability was described in platelet rich plasma. We investigated platelet ...aggregation in children with obesity and lipometabolic disorders in whole blood.
Specimens from patients with overweight (n = 35), hypercholesterolaemia and normal weight (n = 5), overweight plus combined lipometabolic disorder (n = 5) and healthy controls (n = 20) were investigated. Aggregation and ATP release were induced by ADP (20 μmol/l), collagen (1 μg/ml) and thrombin (0.5 U/ml) using a lumiaggregometer.
Overweight children and normal weight patients with hypercholesterolaemia exhibited no significant differences in platelet aggregation compared to controls. Contrastingly, in patients with obesity plus lipometabolic disorder the aggregation rate was significantly higher (p < 0.05) suggesting a hyperaggregable state.
Obviously in obese children a hypercoagulable state exists and the slight hyperaggregability observed in whole blood in this cohort might contribute to that. Any effort should be undertaken to avoid obesity in children especially in those countries where the prevalence of obesity in childhood is continuously increasing.
The domain wall formulation of lattice fermions is expected to support accurate chiral symmetry, even at finite lattice spacing. Here we attempt to use this new fermion formulation to simulate ...two-flavor, finite temperature QCD near the chiral phase transition. In this initial study, a variety of quark masses, domain wall heights and domain wall separations are explored using an 8{sup 3}{times}4 lattice. Both the expectation value of the Wilson line and the chiral condensate show the temperature dependence expected for the QCD phase transition. Further, the desired chiral properties are seen for the chiral condensate, suggesting that the domain wall fermion formulation may be an effective approach for the numerical study of QCD at finite temperature.
The European Commission supports the development of a European Virtual Coastal and Marine Data Warehouse called CoastBase that aims to improve data and information search and exchange. This paper ...discusses a study of user requirements and defines relevant and obtainable data and information within the CoastBase project. Thematic as well as technical considerations were taken into account in the study. CoastBase aims to satisfy a variety of users. Potential users interested in data and information on various aggregation levels are represented within the CoastBase consortium. They described their requirements, initially unguided but later guided by a few broad questions about their present work and about the potential role of CoastBase in facilitating it. The results were grouped and summarised. Institutional user groups were formed based on the focus of the organisations on European, regional, national, and local issues, respectively. Individual users were grouped according to their function as Decision & policy maker, Policy advisor & project manager, Researcher, or Database administrator & programmer, respectively. The study has shown that the individual user groups in particular differed in their preferences for aggregation level of the data and information to be extracted from CoastBase. Implications, in the form of envisioned dissimilar use of the CoastBase system are discussed. Both institutional and individual users had different preferences for topic and geographical area to be covered in the CoastBase prototype. However, the study provided a useful synthesis for discussion in plenary, and led to identification of two thematic scenarios for development of the prototype, which are Eutrophication in the North Sea, and Planning in the North Sea and Mediterranean coastal zone. In addition, a comprehensive list of requirements and recommendations for the technical development and evaluation of the system had been compiled from the user requirements. This list, which was approved by the consortium, is included in the paper.
Thrombin-activable fibrinolysis inhibitor (TAFI) is a recently described inhibitor of fibrinolysis. The aim of this study was to estimate the risk of deep venous thrombosis (DVT) caused by the ...polymorphisms in the TAFI gene in relation to polymorphisms of the other fibrinolytic variables such as PAI-844A>G and t-PA-7,351C>T. This study includes 130 patients with DVT and 130 age- and sex-matched healthy controls. Our results showed no association of the investigated "TAFI-increasing" alleles TAFI 505A (Thr147) and TAFI+1542C with the risk of venous thrombosis. However the adjustment for age, sex, factor V Leiden, PAI-844A allele and t-PA-7,351T allele indicates a tendency to a moderately increased thrombotic risk of TAFI+1542GG carriers (low TAFI level).
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