Evaluation of high-resolution X-ray absorption and emission spectroscopy for the chemical speciation of binary titanium compounds.

For the chemical speciation of binary compounds of tri- and tetravalent titanium, high-resolution X-ray absorption and emission spectra were recorded in different energy regimes in order to evaluate and to qualify both near-edge X-ray absorption fine structure (NEXAFS or XANES) spectroscopy and wavelength-dispersive X-ray emission spectroscopy (WDXES) as spectroscopic methods for this analytical task. A high resolving power in the excitation channel was ensured by use of monochromatic synchrotron radiation provided by BESSY II, where the soft X-ray emission spectra were recorded as well. In the hard X-ray range, emission measurements were performed at SPring-8. For a comparison of the information gained from the various methods, the titanium compounds were classified according to the bonded titanium's oxidation state. Thus, it was possible to distinguish between inner atomic effects due to different oxidation states and external effects related to the respective ligand and the surrounding structure. It becomes evident, that certain compounds, while hardly distinguishable in their Ti-K XANES spectra, still show significant differences in their emission characteristics. On the other hand, some compounds with little difference in their emission spectra are easily distinguished by their NEXAFS structures. Only the combined use of the complementary methods both in the soft and the hard X-ray range allows for a reliable speciation of tri- and tetravalent titanium compounds.

Air pollution and type 1 diabetes in children.

BACKGROUND: Over the past decade, there has been a worldwide largely unexplained increase in the incidence of type 1 diabetes in young children. This study explores the quantitative role of exposure to specific air pollutants in the development of type 1 diabetes in children. METHODS: A total of 402 children were retrospectively studied. Zip code-related, time-specific birth-to-diagnosis exposure to five ambient air pollutants was obtained for 102 children with type 1 diabetes and 300 healthy children receiving care at a single hospital. Pollution exposure levels were created by summing up zip code-specific pollution data and dividing by months of exposure from birth to diagnosis. Analysis employed chi2, two-tailed independent sample t-test and unconditional logistic regression. RESULTS: Odds ratio (OR) was significantly high for cumulative exposure to ambient ozone (O3) and sulfate (SO4) in cases compared with controls, OR = 2.89 [95% confidence interval (CI) = 1.80-4.62] and OR = 1.65 (CI = 1.20-2.28), respectively, even after adjustment for several potential confounders. Passive smoking was more frequent in children with diabetes (30 vs. 10%, p = 0.001). Attending day care and breast feeding in infancy were less frequent in children with diabetes (14 vs. 23%, p = 0.025; 59 vs. 78%, p = 0.001). Family history of diabetes, autoimmune disease and drug abuse was more frequent in cases (p < 0.01). CONCLUSION: Cumulative exposure to ozone and sulfate in ambient air may predispose to the development of type 1 diabetes in children. Early infant formula feeding and passive smoking in the household may precipitate or accelerate the onset of type 1 diabetes.

Familial juvenile autoimmune hypothyroidism, pituitary enlargement, obesity, and insulin resistance.

The proband, a 9-year-old Hispanic female, presented with hair loss, strabismus, and weight gain. On magnetic resonance imaging (MRI) she was found to have severe primary hypothyroidism and a large pituitary mass. In addition, acanthosis nigricans, obesity, and hyperinsulinism were observed. Findings were similar in three of four siblings. Thyroid peroxidase antibodies were detected in the father and three of four siblings. Although all family members were obese, and hyperinsulinemia with high proinsulin and C-peptide was found in all except one sibling, only the mother and one child had overt type 2 diabetes mellitus. Because of the unusual association of autoimmune thyroid disease, insulin resistance and obesity rather than insulin deficiency, we searched for possible genetic abnormalities. The HLA haplotypes did not cosegregate with autoimmune thyroid disease or insulin resistance. Mutational analysis of known obesity genes was done. Leptin was not deficient, and sequencing of the proband's DNA showed no mutations in the perixisome proliferator activated receptor (PPAR)-gamma, PPAR-gamma(2), PPAR-alpha or melanocortin 4 receptor genes. Maternally inherited diabetes and deafness was ruled out since no mutations were found in mitochondria DNA. Insulin receptor antibodies were not detected. In conclusion, the remarkably high incidence of childhood autoimmune hypothyroidism, pituitary enlargement, insulin resistance and obesity in this family is not linked to known HLA types or known gene defects.

Effect of therapy with insulin glargine (lantus) on glycemic control in toddlers, children, and adolescents with diabetes.

To determine the effect of insulin glargine on glycemic control in pediatric type 1 and 2 diabetes, a retrospective repeated-measure analysis of variance was performed of hemoglobin A1C (HbA1C), frequency of hypoglycemia and hyperglycemia, mean blood glucose, body mass index (BMI), and daily weight-adjusted insulin dosage before and after institution of glargine therapy in 72 children and adolescents with diabetes. At glargine start, age range was 1.2-19.6 years, mean age was 12.5 +/- 4.6 years, BMI was 22.48 +/- 6.3 kg/m(2), and mean HbA1C was 9.7 +/- 1.9%. Mean duration of diabetes was 3.58 years, and mean baseline insulin dose was 0.93 U/kg/day. Gender breakdown was 60% female, and the majority (83%) had type 1 diabetes. Average HbA1C decreased from 9.5% pre-glargine to 8.6% post-glargine (p < 0.001). HbA1C decrease was significant in both types of diabetes without a concomitant increase in frequency of hypoglycemia, BMI, or weight-adjusted insulin dose. Hypoglycemia decreased significantly in type 1 diabetes. Thus, glargine therapy may decrease HbA1C and frequency of hypoglycemia in toddlers, children, and adolescents with diabetes, without an increase in BMI or insulin requirements.

Glycemic, auxologic, and seasonal aspects of continuous subcutaneous insulin infusion therapy in children and young adults with type 1 diabetes.

Use of continuous subcutaneous insulin infusion (CSII) therapy has increased among patients with type 1 diabetes. This study was performed: (1) to evaluate the effect of CSII on diabetes control in children and young adults, (2) to detect effects of CSII on weight, body mass index (BMI), and insulin requirements, (3) to investigate seasonal variation in diabetes control during CSII therapy, and (4) to investigate the effect of season of initiation of CSII on glycemic control. Thirty-nine patients, ranging in age from 10.1 to 20.5 years, with type 1 diabetes were studied. Quarterly data over 12 months preceding and following CSII initiation were obtained retrospectively. Variables were compared over similar time periods. SAS was used for descriptive and paired t test analysis. (1) Mean blood glucose level was significantly lower at 3 months but not different from baseline at 6, 9, and 12 months post-CSII. (2) Glycosylated hemoglobin (HbA1c) was significantly lower at 3 and 6 months but not at 9 and 12 months post-CSII. (3) There was no significant difference in the frequency of hypoglycemia or hyperglycemia at any of the time periods studied. (4) There was an initial but unsustained decrease in daily weight-adjusted insulin requirements after CSII. (5) There was a rapid, sustained increase in weight and BMI following CSII in females. (6) Frequency of ketoacidosis decreased in two patients. (7) There was no seasonal variation in weight change, HbA1c, or frequency of measured hypoglycemic episodes with CSII. (8) There was some effect of the season of initiation of CSII therapy on glycemic control. Thus, (1) CSII glycemic benefits may not be sustained, (2) weight gain is a significant effect of CSII in adolescent females, and (3) CSII may be a means of decreasing ketoacidosis episodes, and eliminating seasonal variability in diabetes control.

Pediatric post-transplant diabetes: data from a large cohort of pediatric heart-transplant recipients.

A retrospective analysis of 381 pediatric heart-transplant recipients was performed to determine the frequency, characteristics, and risk factors for post-transplant diabetes. The rate of post-transplant diabetes was 1.8% with antithymocyte globulin, cyclosporine and azathioprine as primary immunosuppressive therapy. Time from transplant to diabetes was 0.25-13 years. Diabetes was characterized by reversibility, and lack of insulinopenia and autoimmunity. The post-transplant diabetes rate in tacrolimus-converted children (n = 45) was 8.8%. In tacrolimus-converted children, age at transplant, mean and maximum tacrolimus blood levels, and first-year rejection episodes were higher in the post-transplant diabetes group, which also consistently had DR-mismatched transplants and HLA DR3/DR4 haplotypes. Body mass index was not different between diabetic and control tacrolimus-converted children. In conclusion, pediatric post-transplant diabetes may be related to reversible insulin resistance. Tacrolimus levels, HLA DR mismatch, and older age at transplant may predispose to post-transplant diabetes.

Clinical, autoimmune, and HLA characteristics of children diagnosed with type 1 diabetes before 5 years of age.

BACKGROUND: Little is known about auxologic, autoimmune, and HLA characteristics specific to children with early-onset diabetes (EOD). HLA subtypes have been shown to play an important part in the determination of islet-cell autoimmunity and in the pace and intensity of the beta-cell destructive process. OBJECTIVES: Our goals were to: 1) outline auxologic, autoimmune, and HLA class II characteristics of children diagnosed with type 1 diabetes before 5 years of age (EOD); 2) evaluate differences between EOD and later-onset or non-age-stratified type 1 diabetes; and 3) investigate the relation between type 1 diabetes-related HLA subtypes and markers of diabetic autoimmunity in EOD. METHODS: Forty children with EOD were studied. Auxologic and antibody radioimmunoassay data were obtained by retrospective analysis of records. HLA diabetes-related class II alleles were typed by polymerase chain reaction using sequence-specific primers. RESULTS: At diagnosis, the average age of the EOD study patients was 2.6 years, body mass index was 16.9 kg/m2, and weight was 106% of average weight for height. When compared with a matched subgroup of children with later-onset type 1 diabetes, preschoolers did not significantly differ in terms of birth weight or body mass index. The frequency of positive islet cell antibodies 512 and glutamic acid decarboxylase 65 antibodies was significantly less in EOD (28.6% and 31.6%, respectively). There were significant differences in the frequencies of some diabetes-related HLA alleles and haplotypes between the early-onset group and a large non-age-stratified type 1 diabetes group. None of the patients with EOD had either of the protective DRB1*1501 or DQB1*0602 alleles. There was a negative correlation between glutamic acid decarboxylase and the predisposing haplotype DR3/DQ2. CONCLUSIONS: Children diagnosed with type 1 diabetes before 5 years of age may have different diabetes-related autoimmune and genetic characteristics from those diagnosed at a later age.

Role of exposure to air pollutants in the development of type 1 diabetes before and after 5 yr of age.

OBJECTIVE: To assess the role of ambient air pollutants in type 1 diabetes in children. DESIGN AND METHODS: Prediagnosis exposure to five air pollutants was studied in two subgroups with onset of type 1 diabetes before and after 5 yr of age, and two matched subgroups of healthy children. Zip codes and dates of residence from birth to diagnosis were used to obtain geographic- and time-specific air concentrations of SO(2), NO(2), ozone (O(3)), SO(4), and particulate matter < 10 micro m in diameter (PM(10)). Prediagnosis time-adjusted pollutant exposure levels were created by summing up zip code-specific pollution data and dividing by months of exposure from birth to diagnosis. Two-tailed t-test and logistic regression were used to evaluate relative effects and test data between cases and controls. RESULTS: Prediagnosis average O(3) exposure was significantly higher in children with type 1 diabetes than in healthy controls. Prediagnosis PM(10) exposure was significantly higher in children diagnosed before 5 yr of age, when compared with healthy controls. SO(2) exposure was significantly higher in children with later-onset diabetes compared with those with early-onset diabetes (EOD). NO(2), SO(2) and SO(4) exposure was significantly lower in children diagnosed after 5 yr of age, when compared with healthy controls. O(3), NO(2), SO(4) and PM(10) levels did not significantly differ between the two diabetic subgroups. CONCLUSION: Increased ozone exposure may be a contributory factor to the increased incidence of type 1 diabetes. PM(10) may be a specific contributory factor to the development of type 1 diabetes before 5 yr of age.

Use of the GlucoWatch biographer in children and adolescents with diabetes.

OBJECTIVE: This study was done to evaluate the accuracy and safety of measuring glucose with the GlucoWatch biographer in children and adolescents with diabetes. METHODS: Accuracy was assessed by comparing biographer glucose measurements with hourly blood glucose measurements using the HemoCue (Aktiebolaget Leo, Helsingborg, Sweden) Photometer for up to 12 h of monitoring. Safety was evaluated by examining the biographer application sites immediately upon removal of the devices, and then at regular intervals. RESULTS: Sixty-six subjects each wore three biographers at sites including the forearm, upper arm, leg, and torso. For forearm biographers, the mean absolute relative difference between biographer readings and blood glucose was 21%. Ninety-five per cent of biographer readings fell into the A or B regions of the Clarke error grid, and 97.3% into the A or B regions of the consensus error grid. Data from biographers worn at the alternative sites were similar to data from the forearm biographers. Two strong reactions to the adhesive pad of the biographer AutoSensor were observed. Most skin reactions were mild. CONCLUSIONS: The GlucoWatch biographer is well tolerated by children and adolescents with diabetes. Performance is similar when the device is worn at different anatomical sites, and is similar to the performance on the forearm, previously reported in adults.

Trace chemical characterization using monochromatic X-ray undulator radiation

An efficient Johansson-type X-ray fluorescence spectrometer has been developed for advanced X-ray spectroscopic analysis with third-generation synchrotron radiation. Kalpha and Kbeta X-ray fluorescence spectra for trace metals have been collected by a Ge(220) analyzing crystal with a Rowland radius of 150 mm, under monochromatic X-ray excitation at the undulator beamline at the SPring-8. The energy resolution is approximately 10 eV for most of the K lines for 3d transition metals. In light of the greatly improved efficiency, as well as the excellent signal-to-background ratio, the relative and absolute detection limits achieved are 1 ppm and 1.2 ng of copper in a carbon matrix, respectively. The energy resolution of the present spectrometer permits the observation of some chemical effects in Kbeta spectra. It has been demonstrated that the changes in Kbeta5 and Kbeta'' intensity for iron and cobalt compounds can be used for the analysis of chemical states. Resonant X-ray fluorescent spectra are another important application of monochromatic excitation. In view of trace chemical characterization, the present spectrometer can be a good alternative to a conventional Si(Li) detector system when combined with highly brilliant X-rays.

Magnesium and fluoride distribution in human cementum with age.

Sixty-two human teeth, obtained from subjects aged 11 to 80 years, were used to determine the magnesium and fluoride concentration and distribution with age in human cementum. Transverse sections were prepared from the root region of teeth. Samples, each 30 microm thick, were abraded in sequence from the cementum surface and the cemento-dentine junction by an abrasive micro-sampling technique. Magnesium concentrations were lower in the cementum surface, and increased towards the cemento-dentine junction (CDJ), while fluoride concentrations were higher in cementum surfaces and tended to decrease towards CDJ. Fluoride distribution patterns were similar to that reported earlier while average fluoride concentration increased with age, however, either no change or decreasing tendencies were observed with magnesium.

[Clinical study of cefotetan in complicated urinary tract infections].

Clinical effectiveness and safety of Cefotetan were evaluated in 28 patients with complicated urinary tract infections. The results were excellent in 12 patients (42.9%), moderate in 10 patients (35.7%) and poor in 6 patients (21.6%), and the effectiveness rate was 78.6%. Bacteriologically, 24 (75%) out of 32 strains were eradicated. Subjective side effects, nausea and abdominal discomfort, were observed in one patient. Abnormal laboratory findings were observed in 6 patients, eosinophilia in 3 patients and slight elevation of transaminase in 3 patients.

Psychiatric complications with chronic hemodialysis--importance of psychological and social care.

Because of a desire to provide the most suitable treatment for hemodialysis patients, psychological, physical and social problems influencing psychiatric conditions of the patients were studied. One hundred hemodialysis inpatients were compared in each group divided by their characteristics, i.e. age, presence of family problems, occupation, physical complications and their character traits. Psychiatric conditions were most favorable between 3 and 12 months after the introduction of hemodialysis, whereas in other hemodialysis terms depression was noticed in more than half of the subjects. In most of the patients, irritation and anger, and loss of brightness and sympathy were observed during the first 3 months or later than 12 months after the introduction of therapy, respectively. Some of the patients required explanations about the necessity of hemodialysis repeatedly and/or through consecutive psychotherapeutic interviews. This study suggested that a poor outcome of psychological conditions after the introduction of hemodialysis was indicated by the presence of family problems, symptoms of physical origin, the absence of full-time work, having a young child or children, age in the 20-40 year group, B and E type character traits classified by the Yatabe and Gilford test and a long duration of therapy.

[Corticoids secretion in primary aldosteronism. I. Diurnal variation and the effect of dexamethasone (author's transl)].

For the purpose of studying the metabolism of adrenocortical steroids in primary aldosteronism, diurnal variation and the effect of dexamethasone were examined in four patients. The circadian rhythm of cortisol was observed in plasma aldosterone and corticosterone in all cases in the preoperative state. With regards to plasma progesterone, 17 alpha-hydroxyprogesterone and dehydroepiandrosterone-sulfate, however, no demonstrable change was noted. Dexamethasone was administered to two subjects for 10 days before the operation. As a result, the urinary aldosterone of one subject decreased on the 5th day after the administration but was restored to its original value on the 10th day, while the urinary aldosterone of the other subject did not decrease at all. On the first day after the operation, the value of plasma cortisol was elevated, losing its circadian rhythm. On the 7th day after the operation, the normal circadian rhythm was observed again in plasma cortisol. Plasma aldosterone was reduced to the normal range without any demonstrable changes on the first and 7th days after the operation. On the 30th day after the operation, a slight cortisol-like circadian rhythm was observed. Plasma levels of progesterone, corticosterone, 17 alpha-hydroxyprogesterone and dehydroepiandrosterone-sulfate were almost within the normal range throughout the pre- and post-operative periods. Although plasma progesterone was within the normal range, it tended to be lower in the postoperative state than in the preoperative state.

[Corticoid secretion in primary aldosteronism. II. The renin releasing test and the angiotensin II analog infusion test (author's transl)].

To study the secretion of adrenocortical steroids, the renin releasing test and the angiotensin II analog (1-Sar, 8-Ala-Angiotensin II) infusion test was performed on four subjects with primary aldosteronism. The plasma renin activities of these subjects in the preoperative state were rather low, without any response to the renin releasing test. Plasma aldosterone was, however, significantly high and showed a tendency to declineits value when the subject was in an upright position. In the preoperative state, all the subjects lacked any alterations in plasma renin activity throughout the angiotensin II analog infusion test. Though slight elevations were observed in the blood pressure of three subjects, there was no demonstrable change in plasma aldosterone. In the other subject, though blood pressure did not change, plasma aldosterone exhibited a remarkable rise as did progesterone, 11-deoxycorticosterone and corticosterone. From these data, it was suggested that in the latter subject the aldosterone secretion was sensitive to angiotensin in comparison with ACTH. Three weeks after the operation, it was observed that plasma aldosterone response decreased, while the response of plasma renin activity to the renin releasing test was normal. This is considered to be due to the diminished sensitivity of the glomerulosa of the nonadenomatous adrenal gland to angiotensin. The levels of 17 alpha-hydroxyprogesterone, 11-deoxycorticosterone and corticosterone were almost within the normal range in the pre- and postoperative state. The levels of plasma progesterone and 11-deoxycorticosterone, however, tended to be lower in the postoperative state compared with the preoperative state.