Female Baltic herring Clupea harengus allocate resources from growth to reproduction in poor feeding conditions.

The trade-off between somatic growth and reproduction in the female Baltic herring Clupea harengus was investigated from 1984 to 2002. During the study period, growth decreased, as a consequence of decreasing salinity and weakening of feeding conditions. Production of muscle and ovarian tissue decreased in repeat spawners, but investment in reproduction took an increasing amount of the total production of new tissues. This suggested that a shift in allocation to reproduction takes precedence over body growth in the reproductive strategy of C. harengus. The process also indicated one possible mechanism leading to dwarf forms in fish populations.

Health-related quality of life in colorectal cancer.

AIM: As a consequence of the improved survival of patients and of cost-effectiveness requirements for new treatments, health-related quality of life (HRQoL) issues have gained increasing attention in colorectal cancer (CRC). This cross-sectional study assesses HRQoL in several health states of CRC and explores factors influencing HRQoL. METHOD: Five hundred and eight Finnish CRC patients (aged 26-96 years; colon cancer 56%; women 47%) assessed their HRQoL using generic 15D and EQ-5D and cancer-specific EORTC QLQ-C30 questionnaires. Patients were divided into five groups: primary treatment, rehabilitation, remission, metastatic disease and palliative care. The patients' HRQoL was compared with population reference values. Multivariate modelling was used to find factors associated with HRQoL scores. RESULTS: The HRQoL of CRC patients is fairly good and comparable with that of the standardized general population except for those under palliative care. The mean 15D score of patients in the primary treatment group was 0.889 (95% CI 0.869-0.914), in rehabilitation 0.877 (0.855-0.907), in remission 0.886 (0.875-0.903), in metastatic disease 0.860 (0.844-0.878) and in palliative care 0.758 (0.716-0.808). The respective EQ-5D scores were 0.760 (0.699-0.823), 0.835 (0.777-0.881), 0.850 (0.828-0.882), 0.820 (0.783-0.858) and 0.643 (0.546-0.747). Multivariate analysis showed that fatigue, pain, age and financial difficulties had a marked negative impact on HRQoL. CONCLUSION: The mean HRQoL scores of CRC patients varied considerably depending on the HRQoL instrument used, but remained surprisingly good up to the palliative stage. In addition to age- and cancer-related symptoms, financial difficulties also had a clear negative impact on HRQoL, which needs to be taken into consideration when supporting patient HRQoL.

Effects of two histamine-N-methyltransferase inhibitors, SKF 91488 and BW 301 U, in rodent antinociception.

We have previously reported that the histaminergic system is involved in the control of pain perception, and that substances able to enhance histamine brain levels, such as the histamine-N-methyltransferase inhibitor, metoprine, induce antinociception. In the present study, in order to corroborate the idea of inducing antinociception by inhibiting histamine catabolism, the effects of a noncompetitive histamine-N-methyltransferase inhibitor. SKF 91488, were studied in rodents by means of tests inducing three different kinds of noxious stimuli: thermal (mouse hot plate), chemical (mouse abdominal constrictions) and mechanical (rat paw pressure). The ability to react to noxious stimuli was assessed by the rota-rod test. In addition, a competitive inhibitor of the histamine catabolism enzyme, BW 301 U, was studied in the hot plate test. SKF 91488 (30, 50 and 100 micrograms per animal i.c.v.) raised dose-dependently the pain threshold in all three tests. To verify whether SKF 91488-induced antinociception is due to inhibition of histamine-N-methyltransferase, (R)-alpha-methylhistamine, described to block histamine release and synthesis by stimulating the histamine H3-autoreceptor and activating the negative feed-back mechanism, was used. When administered at doses which do not alter the pain threshold per se, 0.5 microgram per rat i.c.v. or 10 mg kg-1 i.p. in mice, (R)-alpha-methylhistamine was able to antagonize significantly the antinociceptive effect induced by 30 micrograms per animal i.c.v. of SKF 91488. BW 301 U (30 and 100 mg kg-1 i.p.) showed a dose-dependent, long-lasting antinociception, which was also antagonized by pretreatment with (R)-alpha-methylhistamine. The present data show that the antinociceptive effect previously described for metoprine is not restricted to this molecule, but is also shared by other histamine-N-methyl-transferase inhibitors. This generalization provides further evidence to the importance of the histaminergic system in pain control mechanisms.

Blood pressure control in subjects with type 2 diabetes.

Blood pressure (BP) control of type 2 diabetic subjects aged under 65 years was assessed in a primary care setting. In addition, the usefulness of 24-h ambulatory BP measurement (ABPM) in the treatment of hypertension was assessed in subjects with diastolic BP (DBP) > or = 90 mm Hg. Of the total 381 diabetic subjects, 260 (68%) participated in the first phase, and 48 of the 110 subjects with DBP > or = 90 mm Hg were equipped with a Meditech ABPM-02 monitor in the second phase. The mean BP of the 260 participants was 156/91 (s.d. 22/11) mm Hg. According to the WHO criteria, 58% had hypertension, and 42% had a diagnosis of hypertension. Albuminuria > or = 20 micrograms/min was detected in 32% of the subjects. Ten percent of the subjects with diagnosed hypertension had a mean BP < 140/90 mm Hg and 50% had a mean BP > or = 160/95 mm Hg, as many as 38% of those not having a diagnosis of hypertension. Only long-term poor BP control in casual measurements was associated with albuminuria (42% vs 27%, P = 0.018). It is concluded that BP control was unsatisfactory and diagnosis of hypertension was delayed in most subjects with type 2 diabetes. Occurrence of microalbuminuria was associated with poor BP control and urinary albumin excretion rate may be useful in assessing the BP control. Further studies are needed to assess the position of 24-h ABPM in the treatment of hypertension of subjects with type 2 diabetes.

Good continuity of care may improve quality of life in Type 2 diabetes.

Some features of diabetes care and diabetes treatment regimen which may have an impact on health-related quality of life (HRQOL) in people with diabetes were studied cross-sectionally using the SF-20 questionnaire. Of the 381 subjects with Type 2 diabetes aged under 65 years, 260 (68%) participated in the study. On univariate analysis, HRQOL was associated with regular clinical review (check-up at least twice a year) and continuity of care (the same GP for at least 2 years), education by a diabetes nurse, and satisfaction with diabetes education. No associations were found between the HRQOL dimensions and home glucose monitoring, participation in educational courses, or satisfaction with care. On logistic regression analysis only good continuity of care was significantly associated with the better well-being dimensions of the SF 20 (ORs 2.5-6.0). However, good continuity of care was also associated with less satisfactory glucose control (HbA(1c) 8.9 +/- 2.0 (+/- SD) vs 8.3 +/- 2.0%, P=0.04). It is concluded that a permanent physician-patient relationship may improve HRQOL in subjects with Type 2 diabetes, but further prospective studies are needed to confirm this finding.

Quality of life in NIDDM patients assessed with the SF-20 questionnaire.

The health-related quality of life (HRQOL) was studied in non-insulin-dependent diabetic (NIDDM) patients aged under 65 years, compared with age- and gender-matched controls, with the Medical Outcomes Study short-form (SF-20) general measure. Of 260 NIDDM patients and their 260 controls, 254 (98%) and 177 (68%), respectively, completed the SF-20. Among NIDDM patients, mean age was 56.3 (SD 6.9) years, BMI 30.4 (SD 5.5) kg/m2 and HbA1c 8.6% (SD 2.0%). The mean scores of six SF-20 dimensions were 11-27% lower in the NIDDM patients than in the controls (P < 0.01). Obesity, longer duration of diabetes, insulin treatment and impaired visual acuity were associated with poor HRQOL. In logistic regression analysis with the entire study population, existence of diabetes, coronary heart disease (CHD) and other macrovascular diseases were associated with impaired physical (OR 3.8-7.4), role (OR 2.2-2.8) and social (OR 2.2-2.8) functioning and health perception (OR 2.4-3.7). Diabetes was also associated with impaired mental health (OR 2.8). No associations were found between HRQOL and gender, age or marital status. NIDDM patients had significant and major impairments in HRQOL compared with non-diabetic controls, which were mainly due to macrovascular diseases.

Albuminuria and other risk factors for mortality in patients with non-insulin-dependent diabetes mellitus aged under 65 years: a population-based prospective 5-year study.

The overall 5-year mortality of non-insulin-dependent diabetes mellitus (NIDDM) patients aged under 65 years and associated risk factors were examined with a population-based study in a primary care setting. At the baseline, diabetic patients were asked of existing coronary heart disease (CHD) and hypertension, and checked for body mass index (BMI), glycemic control, lipid values and overnight albuminuria. Of 381 identified NIDDM patients, 252 (66%) participated in the study. The median age was 58 (range 36-64) years, BMI 30.5 (S.D. 5.5) kg/m2 and glycosylated hemoglobin A1c 8.7 (S.D. 2.0)%. Overall 5-year mortality was 8.3%. Factors associated with mortality were male gender, low high-density lipoprotein cholesterol, initial CHD and albuminuria > or = 20 microg/min. In Cox regression analysis, combination of CHD and albuminuria had the highest relative risk for mortality (RR = 3.43, 95% CI 1.63-7.19, P = 0.001), adjusted for gender and age. Albuminuria was associated with CHD only in male NIDDM patients. In primary health care, physicians should be aware that combination of CHD and (micro)albuminuria is a major predictor of mortality in NIDDM patients.

Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study.

AIMS/HYPOTHESIS: In type 2 diabetic patients we compared 9 months of combination therapy with insulin glargine and metformin with 9 months of NPH insulin combined with metformin. The primary focus was changes in HbA(1c); secondary focus was diurnal glucose profiles and symptomatic hypoglycaemia. METHODS: In this investigator-initiated open, parallel-group clinical trial involving seven centres, 110 insulin-naive type 2 diabetic patients with poor glycaemic control (HbA(1c) >or=8.0%) on oral hypoglycaemic agents (90% using sulfonylurea plus metformin) were randomised to receive bedtime insulin glargine with metformin (G+MET) or bedtime NPH with metformin (NPH+MET) for 36 weeks. The patients were taught how to self-adjust their insulin dose and use a modem to send the results of home glucose monitoring to treatment centres. The goal was to achieve a fasting plasma glucose (FPG) of 4.0 to 5.5 mmol/l in both groups. RESULTS: During the last 12 weeks, FPGs averaged 5.75+/-0.02 and 5.96+/-0.03 mmol/l (p<0.001) and insulin doses were 68+/-5 and 70+/-6 IU/day (0.69+/-0.05 and 0.66+/-0.04 IU kg(-1) day(-1), NS) in the G+MET and NPH+MET groups, respectively. At 36 weeks, mean HbA(1c) was 7.14+/-0.12 and 7.16+/-0.14%, respectively (NS). Symptomatic, but not confirmed symptomatic, hypoglycaemia was significantly lower during the first 12 weeks in the G+MET group (4.1+/-0.8 episodes/patient-year) than in the NPH+MET group (9.0+/-2.3 episodes/patient-year, p<0.05), but not significantly different thereafter. Glucose levels before dinner were higher in the NPH+MET group (10.1+/-0.3 mmol/l) than in the G+MET group (8.6+/-0.3 mmol/l, p=0.002) throughout the 36-week study. With regard to baseline characteristics such as initial glycaemia or C-peptide, there was no difference between patients who achieved good glycaemic control (HbA(1c) <7.0%) and those who did not. Differences were seen in the following: between study centres, weight gain during the run-in period and insulin therapy, and FPG during the last 12 weeks (5.7+/-0.2 vs 6.7+/-0.3 mmol/l for patients reaching vs those not reaching target, p<0.01). CONCLUSIONS/INTERPRETATION: Good glycaemic control can be achieved with both G+MET and NPH+MET. Use of G+MET reduces symptomatic hypoglycaemia during the first 12 weeks and dinner time hyperglycaemia compared with NPH+MET.

Population-based audit of non-insulin-dependent diabetic patients aged under 65 years in primary health care.

OBJECTIVE: To audit treatment of non-insulin-dependent diabetes mellitus (NIDDM). DESIGN: Cross-sectional, descriptive, population-based study. SETTING: Primary health care. SUBJECTS: NIDDM patients aged under 65 years in Mikkeli District, in eastern Finland. RESULTS: Of 381 (220 men) eligible NIDDM patients, 260 (141 men) participated (68%). Of subjects with at least two fasting blood glucose values > or = 6.7 mmol/l, diabetes diagnosis had been set to 63%. Eighty seven per cent had been annually checked up, and 36% had a satisfactory (< 7.5%) glycosylated haemoglobin A1c. Retinopathy, neuropathy and occasional microalbuminuria were detected in 13, 59 and 32% of patients, respectively. Patient education had been given to 85% of patients by the diabetes nurse. Of the patients, 79% were satisfied with the quality of diabetes education and care. MAIN OUTCOME MEASURES: Diagnostics of hyperglycaemia, regularity and continuity of care, metabolic control, complications, patient education and satisfaction. CONCLUSIONS: The metabolic control was poor among NIDDM patients in the study area. The diagnostics, regularity of care and the treatment of hyperglycaemia should be improved. Nevertheless, most patients were satisfied with both diabetes care and patient education.

Neptune's partial rings: action of galatea on self-gravitating arc particles

Numerical simulations of Neptune's arcs show that self-gravity between macroscopic arc particles can prevent interparticle impacts and thereby stabilize their resonant confinement by Galatea, a satellite of Neptune. Stable subkilometer arc particles provide a source for replenishing the observed dust and explain the clumpy substructure seen in arcs. A few confining kilometer-sized particles between the major arc components can account for the observed arc widths spanning several resonance sites. The modeled distribution of dust is consistent with observations and helps to explain how embedded satellites may affect the structure and evolution of planetary ring systems.