Diabetes, pre-diabetes and insulin resistance screening in Native American children and youth.

OBJECTIVES: Early identification of pre-diabetes and insulin resistance (IR) provides an important window of opportunity for diabetes prevention. Little is known about the prevalence of pre-diabetes and IR in Native American (NA) youth. We designed a cross-sectional, community-based study of NA children to estimate the prevalence of diabetes, pre-diabetes and IR and their association with other diabetes risk factors. STUDY DESIGN: NA children (5-18 years) were screened with body mass index (BMI), blood pressure, oral glucose tolerance test (OGTT), lipids, insulin and highly sensitive C-reactive protein (hsCRP), and calculated homeostatic model assessment of IR (HOMA-IR). RESULTS: Mean age of the cohort (n=201) was 10.8 ± 3.8 years (± s.d.; 94/107 M/F). BMI percentile for age and sex (BMI%) was elevated (≥ 85 th percentile) in 58.6% of 5-11 years and 51.1% of 12-18 years, and positively correlated with HOMA-IR, blood pressure, triglycerides and hsCRP (P<0.05). The prevalence rate for pre-diabetes and diabetes were 6.5% (3.5-10.8%) and 1.0% (0.1-3.6%), respectively. Mean HOMA-IR was greater in the older than younger age group while prevalence of pre-diabetes was the same. Those with pre-diabetes and diabetes had a greater HOMA-IR, abdominal circumference and BMI% than normal youth. CONCLUSION: In the first prospective, community-based screening for pre-diabetes, IR and diabetes in United States NA youth using OGTT, while the number of diabetes cases was low, pre-diabetes was found in a significant number of youth, particularly in those with BMI ≥ 95 th%. As proportions of pre-diabetes were similar in 5-11 and 12-18 year olds, diabetes risk begins early in NA youth.

Anemia.

OBJECTIVES: To provide an overview of the disorders that cause anemia and to review clinical and laboratory assessment and medical and nursing management of the anemic patient. DATA SOURCES: Published articles and book chapters that pertain to red blood cell physiology and the major causes and types of anemia. CONCLUSIONS: Advances in molecular and genetic aspects of anemia are leading to new developments in the diagnosis and management of all types of anemia. Symptomatic relief to maintain quality of life is essential for all anemic patients. IMPLICATIONS FOR NURSING PRACTICE: Nurses can play a major role in the supportive care of patients with anemia through interventions related to pharmacological therapy, blood transfusions, nutritional counseling, and symptom management.

Assembly of the Photosystem II oxygen-evolving complex is inhibited in psbA site-directed mutants of Chlamydomonas reinhardtii. Aspartate 170 of the D1 polypeptide.

Photosystem II catalyzes the photooxidation of water to molecular oxygen, providing electrons to the photosynthetic electron transfer chain. The D1 and D2 chloroplast-encoded reaction center polypeptides bind cofactors essential for Photosystem II function. Transformation of the chloroplast genome of the eukaryotic green alga Chlamydomonas reinhardtii has allowed us to engineer site-directed mutants in which aspartate residue 170 of D1 is replaced by histidine (D170H), asparagine (D170N), threonine (D170T), or proline (D170P). Mutants D170T and D170P are completely deficient in oxygen evolution, but retain normal (D170T) or 50% (D170P) levels of Photosystem II reaction centers. D170H and D170N accumulate wild-type levels of PSII centers, yet evolve oxygen at rates approximately 45% and 15% those of control cells, respectively. Kinetic analysis of chlorophyll fluorescence in the mutants reveals a specific defect in electron donation to the reaction center. Measurements of oxygen flash yields in D170H show, however, that those reaction centers capable of evolving oxygen function normally. We conclude that aspartate residue 170 of the D1 polypeptide plays a critical role in the initial binding of manganese as the functional chloroplast oxygen-evolving complex is assembled.

Update on Hodgkin's disease.

Hodgkin's disease is a rare lymphoma usually diagnosed in adults presenting with painless lymphadenopathy. Treatment includes radiation therapy for early stages of the disease and chemotherapy for advanced stages. While the majority with Hodgkin's disease will be cured of their disease, patients must complete a period of therapy with risks of significant acute side effects and serious long-term complications. This article provides an overview of the natural history, diagnosis, and staging of Hodgkin's disease as well as a discussion about treatment modalities and associated complications.

Molecular and biophysical analysis of herbicide-resistant mutants of Chlamydomonas reinhardtii: structure-function relationship of the photosystem II D1 polypeptide.

Plants and green algae can develop resistance to herbicides that block photosynthesis by competing with quinones in binding to the chloroplast photosystem II (PSII) D1 polypeptide. Because numerous herbicide-resistant mutants of Chlamydomonas reinhardtii with different patterns of resistance to such herbicides are readily isolated, this system provides a powerful tool for examining the interactions of herbicides and endogenous quinones with the photosynthetic membrane, and for studying the structure-function relationship of the D1 protein with respect to PSII electron transfer. Here we report the results of DNA sequence analysis of the D1 gene from four mutants not previously characterized at the molecular level, the correlation of changes in specific amino acid residues of the D1 protein with levels of resistance to the herbicides atrizine, diuron, and bromacil, and the kinetics of fluorescence decay for each mutant, which show that changes at two different amino acid residues dramatically slow PSII electron transfer. Our analyses, which identify a region of 57 amino acids of the D1 polypeptide involved in herbicide binding and which define a D1 binding niche for the second quinone acceptor, QB of PSII, provide a strong basis of support for structural and functional models of the PSII reaction center.

Chromosome assignment of the owl monkey MOS and MYC gene loci.

Southern blot hybridizations of rodent x owl monkey hybrid DNAs with human cDNA probes allowed the mapping of the MOS and MYC gene loci to owl monkey chromosome 16 of karyotype VI (2n = 49 male/50 female) and to the homologous chromosome 15 of karyotype V (2n = 46). Synteny of MOS and MYC gene loci in both man and owl monkey suggests this chromosome segment's conservation in primates, contrasting with its disruption in the mouse.

Permissible limits of flexor digitorum profundus tendon advancement--an anatomic study.

Lacerations of the profundus tendon distal to the superficialis insertion can be treated by advancement of the proximal cut end of the tendon to its insertion. In the English-language literature, limits cited for the distance a profundus tendon can be safely advanced vary from 0.75 to 2.5 cm and appear to be based on clinical impressions. Our cadaver model suggested the degree of tendon advancement tolerable was 1 cm. A delicate balance exists in the profundus tendon system, and this should be considered when surgical advancement is contemplated.