Serum 25-hydroxyvitamin D and insulin resistance in people at high risk of cardiovascular disease: a euglycaemic hyperinsulinaemic clamp study.

CONTEXT: In observational studies, low serum 25-hydroxyvitamin D (25-OHD) concentration is associated with an increased risk of type 2 diabetes mellitus (DM). Increasing serum 25-OHD may have beneficial effects on insulin resistance or beta-cell function. Cross-sectional studies utilizing suboptimal methods for assessment of insulin sensitivity and serum 25-OHD concentration provide conflicting results. OBJECTIVE: This study examined the relationship between serum 25-OHD concentration and insulin resistance in healthy overweight individuals at increased risk of cardiovascular disease, using optimal assessment techniques. METHODS: A total of 92 subjects (mean age 56·0, SD 6·0 years), who were healthy but overweight (mean body mass index 30·9, SD 2·3 kg/m(2) ), underwent assessments of insulin sensitivity (two-step euglycaemic hyperinsulinaemic clamp, HOMA2-IR), beta-cell function (HOMA2%B), serum 25-OHD concentration and body composition (DEXA). RESULTS: Mean total 25-OHD concentration was 32·2, range 21·8-46·6 nmol/l. No association was demonstrated between serum 25-OHD concentration and insulin resistance. CONCLUSIONS: In this study using optimal assessment techniques to measure 25-OHD concentration, insulin sensitivity and body composition, there was no association between serum 25-OHD concentration and insulin resistance in healthy, overweight individuals at high risk of developing cardiovascular disease. This study suggests the documented inverse association between serum 25-OHD concentration and risk of type 2 DM is not mediated by a relationship between serum 25-OHD concentration and insulin resistance.

Novel characterization of capsule x-ray drive at the National Ignition Facility.

Indirect drive experiments at the National Ignition Facility are designed to achieve fusion by imploding a fuel capsule with x rays from a laser-driven hohlraum. Previous experiments have been unable to determine whether a deficit in measured ablator implosion velocity relative to simulations is due to inadequate models of the hohlraum or ablator physics. ViewFactor experiments allow for the first time a direct measure of the x-ray drive from the capsule point of view. The experiments show a 15%-25% deficit relative to simulations and thus explain nearly all of the disagreement with the velocity data. In addition, the data from this open geometry provide much greater constraints on a predictive model of laser-driven hohlraum performance than the nominal ignition target.

National Diagnostic Working Group (NDWG) for inertial confinement fusion (ICF)/high-energy density (HED) science: The whole exceeds the sum of its parts.

The National Diagnostic Working Group (NDWG) has led the effort to fully exploit the major inertial confinement fusion/high-energy density facilities in the US with the best available diagnostics. These diagnostics provide key data used to falsify early theories for ignition and suggest new theories, recently leading to an experiment that exceeds the Lawson condition required for ignition. The factors contributing to the success of the NDWG, collaboration and scope evolution, and the methods of accomplishment of the NDWG are discussed in this Review. Examples of collaborations in neutron and gamma spectroscopy, x-ray and neutron imaging, x-ray spectroscopy, and deep-ultraviolet Thomson scattering are given. An abbreviated history of the multi-decade collaborations and the present semiformal management framework is given together with the latest National Diagnostic Plan.

Demonstration of ignition radiation temperatures in indirect-drive inertial confinement fusion hohlraums.

We demonstrate the hohlraum radiation temperature and symmetry required for ignition-scale inertial confinement fusion capsule implosions. Cryogenic gas-filled hohlraums with 2.2 mm-diameter capsules are heated with unprecedented laser energies of 1.2 MJ delivered by 192 ultraviolet laser beams on the National Ignition Facility. Laser backscatter measurements show that these hohlraums absorb 87% to 91% of the incident laser power resulting in peak radiation temperatures of T(RAD)=300 eV and a symmetric implosion to a 100 µm diameter hot core.

The effect of topical phenytoin on healing in diabetic foot ulcers: a randomized controlled trial.

AIM: The aim of the study was to evaluate the effect of topical phenytoin on healing in diabetic foot ulcers. A randomized, controlled, double-blind, clinical trial was conducted. METHODS: A phenytoin dressing and a control dressing were manufactured. Individuals who were ≥ 18 years of age with peripheral neuropathy, an ankle brachial pressure index > 0.5 and a diabetic foot ulcer ≥ 4 weeks' duration were independently randomized to the phenytoin group (31 participants) or the control group (34 participants). Participants with renal disease, ankle brachial pressure index < 0.5, necrosis or osteomyelitis were excluded. Subjects received standard wound care and dressing application. Primary endpoint analysis (diabetic foot ulcer closed or not at 16 weeks) was calculated by survival analysis. RESULTS: Participants (n = 65, 52 with Type 2 diabetes) were treated for a maximum of 16 weeks. Sixty per cent of the diabetic foot ulcers closed overall (18 in the phenytoin group, 20 in the control group) with no statistically significant differences in complete healing or in diabetic foot ulcer area over time between the two groups. At 24-weeks follow-up, one diabetic foot ulcer had recurred. CONCLUSIONS: There were no differences in diabetic foot ulcer closure rates or in diabetic foot ulcer area over time between the two groups. This study does not support the use of phenytoin in the treatment of diabetic foot ulcers.

Investigation of the effect of oral metformin on dipeptidylpeptidase-4 (DPP-4) activity in Type 2 diabetes.

AIMS: Glucagon-like peptide-1 (GLP-1) is an insulinotropic hormone and major component of the enteroinsular axis. Its therapeutic potential in human diabetes is limited by rapid degradation and inactivation by the enzyme dipeptidylpeptidase-4 (DPP-4). We investigated the acute effects of metformin with and without food on DPP-4 activity in Type 2 diabetes. METHODS: Ten subjects with Type 2 diabetes (6 male/4 female, age 65.8 +/- 2.6 years, body mass index 30.0 +/- 1.2 kg/m2, glycated haemoglobin (HbA(1c)) 6.3 +/- 0.2%, mean +/- SEM) received metformin 1 g orally or placebo together with a standard mixed meal (SMM) in a random crossover design. Six subjects re-attended fasting and received metformin 1 g without a SMM. RESULTS: Following SMM (n = 10), DPP-4 activity was not suppressed by metformin compared with placebo [area under curve (AUC)(0-4 h) 1574 +/- 4 vs. 1581 +/- 8 micromol/ml/min, respectively]. Plasma glucose, insulin and active GLP-1 were not different. However, DPP-4 activity was suppressed with metformin following fasting compared with a SMM (n = 6) (AUC(0-4 h) 1578 +/- 4 vs. 1494 +/- 9 micromol/min, P < 0.02). Metformin serum levels were significantly lower (P < 0.001) after SMM than fasting (AUC(0-4 h) 350 +/- 66 vs. 457 +/- 55 mg/ml/min). CONCLUSION: Metformin inhibits DPP-4 activity in Type 2 diabetic patients in the fasting state but not when taken with a standard mixed meal. Metformin serum concentrations are lower if the drug is taken with food. These findings should be taken into account in establishing how to maximize efficacy of the drug.

High-pressure physics: the 1-megabar mark on the ruby r1 static pressure scale.

Ruby crystals were subjected to a static pressure greater than 1 megabar in a diamond-windowed pressure cell. The pressure was monitored continuously by observing the spectral shift of the sharp fluorescent R(1) ruby line excited with a cadmium-helium gas-diffusion laser beam. One megabar appears to be the highest pressure ever reported for a static experiment in which an internal calibration was employed.

Observations of Hydrogen at Room Temperature (25{degrees}C) and High Pressure (to 500 Kilobars).

Hydrogen becomes a solid at 25 degrees C when subjected to a pressure of 57 kilobars. The high-pressure phase appears as a transparent crystalline mass. The refractive index of the high-pressure phase increases sharply with pressure, indicating a density increase of similar magnitude. At 360 kilobars the calculated density of the high-pressure phase is 0.6 to 0.7 grams per cubic centimeter.

Electrical conductivity and the red shift of absorption in olivine and spinel at high pressure.

Above 100 kilobars the apparent absorption edges (approximately 3 electron volts) of single-crystal and polycrystalline samples of the metastable olivine and stable spinel forms of Fe(2)SiO(4) shift rapidly with pressure from the near-ultraviolet into the lower-energy infrared region. Simultaneously, an exponential increase in electrical conductivity occurs. These effects are reversible as pressure is reduced or reapplied and are not accompanied by a first-order phase change in olivine or spinel. These observations relate to fundamental concepts of electrical conductivity and photon absorption in complex transition-metal silicates in that they cannot be readily interpreted in terms of an intrinsic band-gap model. The intensity and energy changes are too great and the effect occurs at too low a pressure to be explained by processes such as spin-pairing and other crystal-field effects. The results suggest that a new mechanism of conduction, perhaps symbiotic and employing an efficient charge-transfer process, is induced at high pressure.

Ultrahigh pressure: beyond 2 megabars and the ruby fluorescence scale.

A new design of the diamond-window, high-pressure cell has permitted static pressure of 2.8 megabars to be generated for the first time. The design is unusually stable mechanically, and thus it should be possible to use the new cell to study most materials, including hydrogen, in the unexplored pressure region above 1 megabar.

High-pressure ruby and diamond fluorescence: observations at 0.21 to 0.55 terapascal.

A diamond-anvil, high-pressure apparatus was used to extend the upper pressure limit of static laboratory experiments. Shifts of the R(1) strong fluorescent line of ruby were observed that correspond to static pressures of 0.21 to 0.55 terapascal (2.1 to 5.5 megabars) at 25 degrees C. Sensitive spectroscopic techniques in the pressure range 0.15 to 0.28 terapascal were used to observe ruby and diamond fluorescence separately; these two fluorescent emissions overlap strongly at high pressures. At pressures greater than approximately 0.28 terapascal, the diamond fluorescence diminished and the ruby fluorescence reappeared strongly. Pressure was determined by extrapolation of the calibrated shift of the ruby R(1) line.

Laser techniques in high-pressure geophysics.

Laser techniques in conjunction with the diamond-anvil cell can be used to study high-pressure properties of materials important to a wide range of problems in earth and planetary science. Spontaneous Raman scattering of crystalline and amorphous solids at high pressure demonstrates that dramatic changes in structure and bonding occur on compression. High-pressure Brillouin scattering is sensitive to the pressure variations of single-crystal elastic moduli and acoustic velocities. Laser heating techniques with the diamond-anvil cell can be used to study phase transitions, including melting, under deep-earth conditions. Finally, laser-induced ruby fluorescence has been essential for the development of techniques for generating the maximum pressures now possible with the diamond-anvil cell, and currently provides a calibrated in situ measure of pressure well above 100 gigapascals.

B1-b2 transition in calcium oxide from shock-wave and diamond-cell experiments.

Volume and structural data obtained by shock-wave and diamond-cell techniques demonstrate that calcium oxide transforms from the B1 (sodium chloride type) to the B2 (cesium chloride type) structure at 60 to 70 gigapascals (0.6 to 0.7 megabar) with a volume decrease of 11 percent. The agreement between the shockwave and diamond-cell results independently confirms the ruby-fluorescence pressure scale to about 65 gigapascals. The shock-wave data agree closely with ultrasonic measurements on the B1 phase and also agree satisfactorily with equations of state derived from ab initio calculations. The discovery of this B1-B2 transition is significant in that it allows considerable enrichment of calcium components in the earth's lower mantle, which is consistent with inhomogeneous accretion theories.

Iron-titanium oxides and olivine from 10020 and 10071.

A new mineral (approximately Fe(0.5)Mg(0.5)Ti(2)O(5)) related to the pseudobrookite series has been discovered in section 10071,28. Electron-probe analyses for this mineral, a coexisting ilmenite, and a chromian ulvöspinel-ilmenite assemblage in section 10020,40 indicate crystallization under highly reducing conditions. Analytical and optical absorption studies of the olivine in 10020 show it to contain unusually high Cr (1400 parts per million) probably as Cr(2+).

Comparison of effects of combined ACE inhibitor and low-dose thiazide diuretic with ACE inhibitor alone on insulin action in patients with hypertension and Type 2 diabetes: a double-blind crossover study.

AIMS: To establish the safety in terms of insulin sensitivity of a low dose thiazide/ACE inhibitor combination. METHODS: We examined the effects on insulin sensitivity of captopril either alone or in combination with low-dose bendroflumethiazide (1.25 mg) in 15 hypertensive Type 2 diabetic patients. Insulin action was assessed using an isoglycaemic hyperinsulinaemic clamp in a double-blind, randomised, crossover study after a 6-week placebo run-in and following two 12-week treatment periods with captopril (C) (100 mg) alone or in combination with bendroflumethiazide (CB) (1.25 mg). RESULTS: Blood pressure was lower following CB compare to C (138/83 vs. 144/85 mmHg; P < 0.05) and both were lower than baseline (153/92 mmHg; P < 0.01). CB resulted in a significant increase in fasting plasma glucose compared to C (9.6 +/- 2.6 vs. 8.5 +/- 1.6 mmol/l; P < 0.05). Exogenous glucose infusion rates required to maintain isoglycaemia during hyperinsulinaemia were lower after CB compared to C (25.1 +/- 13.3 vs. 34.2 +/- 16.8 micromol/kg/min; P < 0.01) as were isotopically determined glucose utilisation rates (29.0 +/- 12.4 vs. 36.6 +/- 17.3 micromol/kg/min; P < 0.05). There was no significant difference in fasting endogenous glucose production between treatments (CB 9.3 +/- 3.3 vs. C 8.6 +/- 1.6 micromol/kg/min), nor between suppression following insulin (CB 4.0 +/- 2.1 vs. C 4.3 +/- 3.1 micromol/kg/min). CONCLUSIONS: Combination of low-dose bendroflumethiazide with captopril lowered blood pressure but resulted in deleterious effects on insulin action compared to captopril alone.

Time resolved detection of two-plasmon decay using three-halves harmonic emission on the National Ignition Facility.

Supra-thermal (>100 keV) electrons generated by laser plasma interactions can be detrimental to the performance of ignition experiments conducted on the National Ignition Facility (NIF). On a NIF shot, the amount of electrons is estimated by measuring the hard X-rays passing through the hohlraum wall. The primary sources of hot electrons in a hohlraum are Stimulated Raman Scattering (SRS) and two plasmon decay (TPD). While SRS is well diagnosed on the NIF, there has been no diagnosis of TPD. We have designed and implemented a new diagnostic to characterize the time history of TPD on the NIF. The instrument provides a time resolved measurement of the 3/2 ω harmonic emission which is indicative of the presence of TPD. We describe the diagnostic setup, calibration, and the preliminary results obtained on NIF hohlraum experiments. We find evidence of a correlation between measured hard X-rays generated from the hot electron bremsstrahlung and the TPD emission.

The dilation aided single-line-of-sight x-ray camera for the National Ignition Facility: Characterization and fielding.

Crystal x-ray imaging is frequently used in inertial confinement fusion and laser-plasma interaction applications as it has advantages compared to pinhole imaging, such as higher signal throughput, better achievable spatial resolution, and chromatic selection. However, currently used x-ray detectors are only able to obtain a single time resolved image per crystal. The dilation aided single-line-of-sight x-ray camera described here was designed for the National Ignition Facility (NIF) and combines two recent diagnostic developments, the pulse dilation principle used in the dilation x-ray imager and a ns-scale multi-frame camera that uses a hold and readout circuit for each pixel. This enables multiple images to be taken from a single-line-of-sight with high spatial and temporal resolution. At the moment, the instrument can record two single-line-of-sight images with spatial and temporal resolution of 35 µm and down to 35 ps, respectively, with a planned upgrade doubling the number of images to four. Here we present the dilation aided single-line-of-sight camera for the NIF, including the x-ray characterization measurements obtained at the COMET laser, as well as the results from the initial timing shot on the NIF.

Assessment of insulin action in insulin-dependent diabetes mellitus using [6(14)C]glucose, [3(3)H]glucose, and [2(3)H]glucose. Differences in the apparent pattern of insulin resistance depending on the isotope used.

To determine whether [2(3)H], [3(3)H], and [6(14)C]glucose provide an equivalent assessment of glucose turnover in insulin-dependent diabetes mellitus (IDDM) and nondiabetic man, glucose utilization rates were measured using a simultaneous infusion of these isotopes before and during hyperinsulinemic euglycemic clamps. In the nondiabetic subjects, glucose turnover rates determined with [6(14)C]glucose during insulin infusion were lower (P less than 0.02) than those determined with [2(3)H]glucose and higher (P less than 0.01) than those determined with [3(3)H]glucose. In IDDM, glucose turnover rates measured with [6(14)C]glucose during insulin infusion were lower (P less than 0.05) than those determined with [2(3)H]glucose, but were not different from those determined with [3(3)H]glucose. All three isotopes indicated the presence of insulin resistance. However, using [3(3)H]glucose led to the erroneous conclusion that glucose utilization was not significantly decreased at high insulin concentrations in the diabetic patients. [6(14)C] and [3(3)H]glucose but not [2(3)H]glucose indicated impairment in insulin-induced suppression of glucose production. These results indicate that tritiated isotopes do not necessarily equally reflect the pattern of glucose metabolism in diabetic and nondiabetic man.

Postprandial hyperglycemia in patients with noninsulin-dependent diabetes mellitus. Role of hepatic and extrahepatic tissues.

Patients with noninsulin-dependent diabetes mellitus (NIDDM) have both preprandial and postprandial hyperglycemia. To determine the mechanism responsible for the postprandial hyperglycemia, insulin secretion, insulin action, and the pattern of carbohydrate metabolism after glucose ingestion were assessed in patients with NIDDM and in matched nondiabetic subjects using the dual isotope and forearm catheterization techniques. Prior to meal ingestion, hepatic glucose release was increased (P less than 0.001) in the diabetic patients measured using [2-3H] or [3-3H] glucose. After meal ingestion, patients with NIDDM had excessive rates of systemic glucose entry (1,316 +/- 56 vs. 1,018 +/- 65 mg/kg X 7 h, P less than 0.01), primarily owing to a failure to suppress adequately endogenous glucose release (680 +/- 50 vs. 470 +/- 32 mg/kg X 7 h, P less than 0.01) from its high preprandial level. Despite impaired suppression of endogenous glucose production during a hyperinsulinemic glucose clamp (P less than 0.001) and decreased postprandial C-peptide response (P less than 0.05) in NIDDM, percent suppression of hepatic glucose release after oral glucose was comparable in the diabetic and nondiabetic subjects (45 +/- 3 vs. 39 +/- 2%). Although new glucose formation from meal-derived three-carbon precursors (53 +/- 3 vs. 40 +/- 7 mg/kg X 7 h, P less than 0.05) was greater in the diabetic patients, it accounted for only a minor part of this excessive postprandial hepatic glucose release. Postprandial hyperglycemia was exacerbated by the lack of an appropriate increase in glucose uptake whether measured isotopically or by forearm glucose uptake. Thus as has been proposed for fasting hyperglycemia, excessive hepatic glucose release and impaired glucose uptake are involved in the pathogenesis of postprandial hyperglycemia in patients with NIDDM.

Structured photocathodes for improved high-energy x-ray efficiency in streak cameras.

We have designed and fabricated a structured streak camera photocathode to provide enhanced efficiency for high energy X-rays (1-12 keV). This gold coated photocathode was tested in a streak camera and compared side by side against a conventional flat thin film photocathode. Results show that the measured electron yield enhancement at energies ranging from 1 to 10 keV scales well with predictions, and that the total enhancement can be more than 3×. The spatial resolution of the streak camera does not show degradation in the structured region. We predict that the temporal resolution of the detector will also not be affected as it is currently dominated by the slit width. This demonstration with Au motivates exploration of comparable enhancements with CsI and may revolutionize X-ray streak camera photocathode design.