The effects of rosiglitazone and metformin on inflammation and endothelial dysfunction in patients with type 2 diabetes mellitus.

Diabetic patients have a markedly increased risk of cardiovascular disease compared with non-diabetics. Two drug groups today target insulin resistance; biguanides and thiazolidinediones. In addition, these may have other effects on cardiovascular risk factors. The aim of this study was to evaluate the effects of metformin and rosiglitazone on non-traditional cardiovascular risk factors. Forty type 2 diabetic patients were randomized into metformin and rosiglitazone groups. After receiving the optimal doses, the patients were monitored for 12 weeks. Biochemical parameters, lipid parameters, CRP, insulin, c-peptide, and HbA1c levels were analyzed. VWF, PAI-1, ICAM-1, TNF-α, IL-6, E-selectin, and fibrinogen levels were measured in order to assess coagulation status and endothelial dysfunction. In the metformin group, body mass index, PPG, HbA1c, IL-6, ICAM-1, and TNF-α levels were significantly decreased after 12 weeks compared with the basal levels. IL-6 levels decreased from 75 pg/ml ± 20 to 42 pg/ml ± 9 (P 0.023) and TNF- α levels from 61 pg/ml ± 31 to 39 pg/ml ± 10 (P 0.018). In the rosiglitazone group, FPG, PPG, HbA1c, insulin, HOMA-IR, IL-6, and TNF-α levels decreased significantly after 12 weeks compared with the basal levels. IL-6 levels decreased from 78 pg/ml ± 21 to 41 pg/ml ± 9 (P 0.028) and TNF-α levels from 62 pg/ml ± 19 to 37 pg/ml ± 10 (P 0.012). At the end of the study, no significant differences were determined between groups. Insulin resistance and type 2 diabetes are strongly associated with low grade inflammation. Both metformin and rosiglitazone were effective in controlling inflammatory markers in addition to metabolic parameters.

Comparison of the effect of propofol and N-acetyl cysteine in preventing ischaemia-reperfusion injury.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the effects of propofol and N-acetyl cysteine (NAC) on tourniquet-induced ischaemia-reperfusion injury by determining malonyldialdehyde, ischaemia-modified albumin, lactate, blood gas and haemodynamic levels in arthroscopic knee surgery. METHODS: Sixty ASA I or II patients were randomized into three groups. Intrathecal anaesthesia was administered using 0.5% heavy bupivacaine in all patients. In group P, propofol was administered in a 0.2 mg kg(-1) bolus, followed by infusion at a rate of 2 mg kg(-1) h(-1); in group NAC, NAC was administered as an infusion at a rate of 5 mg kg(-1) h(-1), and, in group C (the control group), an equal volume of isotonic saline was administered to patients until 30 min after reperfusion. Blood samplings were obtained immediately before intrathecal anaesthesia (t1), 1 min before tourniquet release (t2), 5 min after tourniquet release (t3) and 30 min after tourniquet release (t4). RESULTS: Plasma malonyldialdehyde, ischaemia-modified albumin and lactate levels increased significantly in group C at t3 and t4 compared with the baseline values. Plasma concentrations of malonyldialdehyde, ischaemia-modified albumin and lactate in groups P and NAC were significantly lower than those in group C at t3 and t4. In blood gas analyses, pH, HCO3 and base excess were found to be significantly lower at t3 and t4 compared with t1 and t2 in group C. Comparisons between groups P and NAC revealed no significant differences. CONCLUSION: Small-dose infusions of both propofol and NAC appear to provide similar protection against ischaemia-reperfusion injury in arthroscopic knee surgery.

The effects of increased intraabdominal pressure on testicular blood flow, oxidative stress markers, and morphology.

BACKGROUND: This study was carried out to evaluate the effects of increased intraabdominal pressure (IAP) on testicular blood flow (TBF), oxidative stress markers, and morphology. METHODS: Twenty-four Sprague-Dawley rats weighing 300 to 350 g were allocated randomly into 3 groups consisting of 8 animals each: A, gasless (control); B, 10 mm Hg IAP with CO(2) pneumoperitoneum for 60 minutes; and C, 20 mm Hg IAP with CO(2) pneumoperitoneum for 60 minutes. Testicular blood flow was studied using the Doppler technique. In the 10 and 20 mm Hg IAP groups, time points of TBF measurements were defined as follows: TBF(baseline), 10 minutes before insufflation; TBF(10min), 10 minutes after pneumoperitoneum; TBF(50min), 50 minutes after pneumoperitoneum; and TBF(reperfusion), 10 minutes after pneumoperitoneum deflation. To evaluate the changes in oxidative stress, we assayed the malondialdehyde (MDA) levels of testicular tissues. A 4-level grading scale was used to quantify histologic injury. RESULTS: For both testes of each rat, TBF(10min), TBF(50min), and TBF(reperfusion) values of each group were separately evaluated according to their TBF(baseline) value percentages. The results revealed no significant differences for each time point of TBF measurements between the right and left testes in any group. Pneumoperitoneum caused a significant decrease in TBF at the 10th and 50th minutes of pneumoperitoneum, both in the 10 and 20 mm Hg IAP groups, compared with their baseline values. TBF(reperfusion) values in both groups were also lower than their baseline values. We determined that mean TBF(10min) and TBF(50min) values decreased significantly in the 20 mm Hg IAP group compared with the 10 mm Hg IAP group, despite there being no significant difference in their mean TBF(reperfusion) values. Mean MDA levels were significantly increased in both the 10 and 20 mm Hg IAP groups compared with those of the control group for the right and left testes. However, there was no significant difference between the mean MDA levels in these first 2 groups. The histologic injury score was significantly increased in both the 10 and 20 mm Hg IAP groups compared with the control group; however, there was no difference in the scores between these first 2 groups. CONCLUSIONS: We demonstrated in an animal model that abdominal deflation after IAP of 10 and 20 mm Hg for 60 minutes causes testicular hypoperfusion, free radical production, and subsequent testicular damage.

Screening for gestational diabetes mellitus in northeastern Turkey (Trabzon City).

OBJECTIVE: The purposes of this study were to determine the prevalence of gestational diabetes mellitus (GDM) in Trabzon city of Turkey and to identify appropriate risk factors for gestational diabetes in pregnant mothers. RESEARCH DESIGN AND METHODS: Eight hundred and seven adult pregnant women were screened for GDM with a 1-hour, 50 g oral glucose challenge test (GCT). Three-hour, 100 g oral glucose tolerance tests (GTTs) were performed on screen-positive women. RESULTS: Of the 807 pregnancies screened, 59 (7.3%) had an initial oral GCT result of > or = 140 mg/dl. Diagnostic testing with the oral GTT was performed on the 59 screen-positive gravid women. Of those tested, 10 were diagnosed with GDM on the basis of greater > or = 2 criteria over 3 hours, for a prevalence of 1.23%. Significant associations were found between age, body mass index (BMI) and GDM positivity (p < 0.01 and p < 0.05; respectively). The prevalence of GDM was associated with diastolic blood pressure (DBP) and weeks' gestation (p < 0.05). There was no significant association between increased BMI, systolic blood pressure, number of pregnancies and GDM positivity. In addition, the birth weights of the babies born to mothers with GDM were significantly higher than those of the non-diabetic healthy mothers' babies (p < 0.001). CONCLUSIONS: The prevalence of GDM in a Turkish population was low. The prevalence of GDM showed an increase with the ages of pregnant women, gestational age and DBP. This study demonstrates that the universal screening for GDM is not mandatory in our pregnant population. The cost of universal screening may be prohibitive in our population. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adult pregnancies.