An investigation into security, self-confidence and gender differences related to undergraduate education in Endodontics.

AIM: To analyse responses from dental practitioners (DPs) on how secure they felt as a newly graduated dentist, level of confidence or self-efficacy when performing root canal treatment (RCT), and if undergraduate (UG) education in Endodontics adequately met their needs in a dental practice. METHODOLOGY: An electronic questionnaire was sent to 459 dentists who graduated from the University of Bergen, Bergen, Norway, between 2008 and 2018. The survey consisted of questions with closed-end options and Likert scale (1-5). An open-ended free text option was always provided. RESULTS: A total of 314 (68.4%) DPs answered the questionnaire. Of these, 87 (27.8%) were men and 224 (71.3%) were women. Three respondents did not disclose their gender. As a newly graduated dentist, 37.3% of the respondents felt secure when performing RCT, 30.7% felt indifferent, and 32.0% felt insecure. The majority (72.4%) of respondents were either confident or very confident when performing RCT, 21.3% were indifferent, and 6.3% had little or no confidence. A majority of DPs (84.4%) self-evaluated the quality of their root fillings as good or very good, and 15.2% were indifferent. Only one DP selected 'not good' and none selected 'bad'. There were significant gender differences where male DPs felt more secure than female DPs when performing RCT (P < 0.001). A significantly larger number of men were very confident compared to women (P < 0.001). A logistic regression analysis using confidence as a dependent variable to predict self-efficacy revealed that DPs who felt secure when performing RCT as a newly graduated dentist had about 8 times more self-efficacy (odds ratio = 8.49) than those who were insecure or indifferent. Respondents who rated their quality of root fillings as good or very good had forty times more self-efficacy (odds ratio = 40.06) when performing RCT. UG education in endodontics was considered inadequate by 71.3% of the respondents where a significantly larger number of DPs (70%) wanted more clinical training (P < 0.05). About half the DPs (47.7%) stated that there was a need for lifelong learning with majority preferring hands-on courses and continuing dental education organized by dental associations. CONCLUSIONS: The results of this study suggest that there is a need to promote self-efficacy during UG education in Endodontics. Hands-on training is the preferred form of lifelong learning for DPs.

Acousto-Optics 2017: introduction to the feature issue.

The editors of Acousto-Optics 2018 provide an overview of the featured papers in the context of the 13th School of Acousto-Optics and Applications from which the articles were drawn.

Bronchial hyper-responsiveness: a technical update.

BACKGROUND: Bronchial hyper-responsiveness (BHR) is often regarded as a 'hallmark' of asthma, and bronchoprovocation testing is frequently performed to support a diagnosis of asthma. The European Respiratory Society (ERS) and American Thoracic Society (ATS) have recently updated their technical standards and guidelines for performing methacholine challenge testing (MCT), the most commonly performed clinical test of BHR. AIMS: To review the updated guidelines and discuss the various changes and their potential impact on clinicians. METHODS: We performed a systematic review of references identified using Medline and hand searches of identified articles. RESULTS: The new ERS and ATS guidelines recommend that MCT be performed using tidal breathing, not deep inspirations with breath holding, that results be reported as the PD20 (cumulative dose causing a 20% fall in forced expiratory volume in 1 s [FEV1]), rather than PC20 (concentration causing a 20% fall in FEV1), and that manufacturers of nebulizers and other delivery systems provide performance characteristics to allow calculation of PD20 values. Our preliminary survey found that the new guidelines are only slowly being adopted. CONCLUSIONS: Clinicians should be aware that recommended BHR testing methods, particularly for MCT, have changed. As a result, they should anticipate that test outcomes will increasingly be reported in terms of PD20, which will facilitate longitudinal assessment of their patients. Compliance with the new guidelines will increase the sensitivity of MCT in mild and asymptomatic asthmatics.

A systematic review of instruments for assessment of capacity in activities of daily living in children with developmental co-ordination disorder.

Children with developmental co-ordination disorder (DCD) face evident motor difficulties in activities of daily living (ADL). Assessment of their capacity in ADL is essential for diagnosis and intervention, in order to limit the daily consequences of the disorder. The aim of this study is to systematically review potential instruments for standardized and objective assessment of children's capacity in ADL, suited for children with DCD. As a first step, databases of MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies that described instruments with potential for assessment of capacity in ADL. Second, instruments were included for review when two independent reviewers agreed that the instruments (1) are standardized and objective; (2) assess at activity level and comprise items that reflect ADL; and (3) are applicable to school-aged children that can move independently. Out of 1507 publications, 66 publications were selected, describing 39 instruments. Seven of these instruments were found to fulfil the criteria and were included for review: the Bruininks-Oseretsky Test of Motor Performance-2 (BOT2); the Do-Eat (Do-Eat); the Movement Assessment Battery for Children-2 (MABC2); the school-Assessment of Motor and Process Skills (schoolAMPS); the Tuffts Assessment of Motor Performance (TAMP); the Test of Gross Motor Development (TGMD); and the Functional Independence Measure for Children (WeeFIM). As a third step, for the included instruments, suitability for children with DCD was discussed based on the ADL comprised, ecological validity and other psychometric properties. We concluded that current instruments do not provide comprehensive and ecologically valid assessment of capacity in ADL as required for children with DCD.

Regional differences in architecture and mineralization of developing mandibular bone.

The goal of this study was to investigate the mutual relationship between architecture and mineralization during early development of the pig mandible. These factors are considered to define the balance between the requirements for bone growth on the one hand and for load bearing on the other. Architecture and mineralization were examined using micro-CT, whereas the mineral composition was assessed spectrophotometrically in groups of fetal and newborn pigs. The development of the condyle coincided with a reorganization of bone elements without an increase in bone volume fraction, but with an increase in mineralization and a change in mineral composition. In the corpus, the bone volume fraction and mineralization increased simultaneously with a restructuring of the bone elements and a change in mineral composition. The growth of the condyle was reflected by regional differences in architecture and mineralization. The anterior and inferior regions were characterized by a more dense bone structure and a higher mineralization as compared to posterior and superior regions, respectively. In the corpus, growth was mainly indicated by differences between buccal and lingual plates as well as between anterior, middle, and posterior regions characterized by a more compact structure and higher mineralization in the lingual and middle regions. In conclusion, the architecture and mineralization in the condyle and corpus started to deviate early during development toward their destiny as trabecular and cortical bone, respectively. These results were compatible with those obtained with mineral composition analysis. Regional differences within condyle and corpus reflected known developmental growth directions.

Influence of circulating epinephrine on absorption of subcutaneously injected insulin.

Effects of epinephrine (Epi) infusion on the absorption of subcutaneously injected 125I-labeled soluble human insulin (10 U) from the thigh or the abdomen were studied in 16 healthy subjects and from the thigh in 10 insulin-dependent diabetic (IDDM) patients. Epi was infused at 0.3 (high dose) or 0.1 (low dose; healthy subjects) nmol.kg-1.min-1 i.v., resulting in arterial plasma Epi levels of approximately 6 and 2 nM, respectively. Saline was infused on a control day. Insulin absorption was measured as disappearance of radioactivity from the injection site and as appearance of plasma immunoreactive insulin (IRI). Adipose tissue blood flow was measured with the 133Xe clearance technique. First-order disappearance rate constants of 125I from the thigh depot decreased approximately 40-50% during the high dose of Epi compared with control (P less than .001). The corresponding decrease from the abdominal depot was approximately 40% (P less than .001), whereas no significant change was found during the low Epi dose. IRI fell compared with control in all groups at the high Epi dose. The Epi-induced depression of insulin absorption occurred despite unaltered or even slightly increased subcutaneous blood flow. The results indicate that circulating Epi at levels seen during moderate physical stress depresses the absorption of soluble insulin from subcutaneous injection sites to an extent that might be important for glycemic control in IDDM patients. Furthermore, dissociation is found between changes in insulin absorption and subcutaneous blood flow during Epi infusion, suggesting that factors other than blood flow may also influence the absorption of subcutaneously injected insulin.

Dissociation of insulin absorption and blood flow during massage of a subcutaneous injection site.

Nine healthy volunteers with normal body weights were injected subcutaneously with 125I-labeled soluble human insulin (10 U) in one thigh and 133Xe in the contralateral thigh for the measurement of subcutaneous blood flow on 2 consecutive mornings. On one of the days, standardized massage of both injection sites was performed for 30 min starting 30 min after insulin injection. Serum insulin and plasma glucose were determined intermittently before, during, and after massage, and elimination of radioactivities was monitored continuously by external detectors. During massage, the first-order elimination rate constants of 125I increased approximately sixfold compared with the rise during control (0.19 +/- 0.04 to 0.88 +/- 0.15%/min during the last 15 min of the massage vs. 0.21 +/- 0.03 to 0.32 +/- 0.03%/min during control). Serum insulin increased from 13.8 +/- 1.8 mU/L before massage to a maximal value of 56.4 +/- 8.7 mU/L 10 min after massage (vs. 15.3 +/- 3.0 and 19.7 +/- 2.2 mU/L during control). Plasma glucose fell significantly faster on the massage day, from 10 min after massage onward. No significant alteration in the subcutaneous blood flow was found during or after massage. The results suggest that the pronounced enhancement of insulin absorption induced by massage of the injection site is mainly not blood flow mediated.

Potent mental stress and insulin absorption in normal subjects.

Effects of mental stress (a 20-min modified Stroop's color-word conflict test; CWT) on the absorption of 125I-labeled soluble human insulin (10 U s.c. in the thigh 60 min before CWT) and on subcutaneous adipose tissue blood flow (ATBF; 133Xe clearance); heart rate (HR); arterial blood pressure (BP); and arterial levels of epinephrine (Epi), norepinephrine (NE), and glycerol were studied in 11 healthy subjects. Insulin absorption was measured as elimination of radioactivity (external gamma-counting) and as appearance of plasma immunoreactive insulin (IRI). The glucose-clamp technique was used to maintain normoglycemia. Identical measurements were performed during a control day without CWT. HR and mean BP increased markedly (35 +/- 5 beats/min and 30 +/- 3 mmHg) during CWT despite only minor elevations in plasma catecholamines. Thus, arterial plasma Epi rose from 0.18 +/- 0.03 to 0.82 +/- 0.17 nM (P less than .01) and NE from 0.94 +/- 0.09 to 1.69 +/- 0.18 nM (P less than .001). ATBF showed a biphasic response, with a 100% elevation during CWT followed by a decrease and a second peak of similar magnitude approximately 0.5 to 1 h after CWT. Blood glycerol was approximately doubled during CWT and remained elevated during recovery. Despite these changes, insulin absorption was unaltered during and after stress. Thus, elimination rates of 125I, plasma IRI levels, and amounts of glucose needed to maintain normoglycemia were all similar during the stress and control days. These results suggest that absorption of soluble insulin from subcutaneous injection sites in the thigh is unaltered during potent mental stress in healthy subjects despite a considerable and prolonged increase in ATBF.

Hypoglycemia risk during exercise after intramuscular injection of insulin in thigh in IDDM.

The influence of bicycle exercise (60% of W170 [working capacity at a pulse rate of 170 beats/min]; 40 min) on the absorption of 125I-labeled fast-acting insulin (10 U; Actrapid human insulin) after intramuscular compared with subcutaneous injection in the thigh was studied on 2 consecutive days in 10 insulin-dependent diabetes mellitus (IDDM) patients. Insulin absorption was measured as disappearance of radioactivity (1st-order elimination rate constants) by continuous external monitoring and as appearance of plasma free immunoreactive insulin (IRI). Subcutaneous adipose tissue blood flow (ATBF) and skeletal muscle blood flow (MF) were measured concomitantly in the contralateral thigh with the 133Xe wash-out technique. Plasma glucose was determined intermittently. The rate constant for 125I-insulin increased during exercise from 0.46 +/- 0.08 to 1.17 +/- 0.14%/min after intramuscular injection (P less than 0.001) and from 0.31 +/- 0.05 to 0.45 +/- 0.09%/min (NS) after subcutaneous injection. The rate constant of 125I-insulin from muscle remained elevated during the 80-min recovery period. The peak plasma free-IRI value was 39 mU/L higher, the area under the IRI curve was approximately 80% greater, and the decrease in plasma glucose was approximately 2 mM greater after intramuscular injection. Whereas MF increased fivefold, ATBF did not rise significantly during exercise. The results demonstrate that intramuscular compared with subcutaneous thigh injection of insulin followed by bicycle exercise induces a marked increase in insulin absorption and a substantial fall in plasma glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption of rapid-acting insulin in obese and nonobese NIDDM patients.

OBJECTIVE: To study the absorption rate of rapid-acting insulin from subcutaneous injection sites in nonobese and obese non-insulin-dependent diabetes mellitus (NIDDM) patients. RESEARCH DESIGN AND METHODS: Ten nonobese and 10 obese NIDDM patients (body mass indexes 24.1 +/- 0.4 and 31.4 +/- 0.8 kg/m2, respectively) received four subcutaneous injections of 125I-labeled rapid-acting insulin (Actrapid Human, 5 U): three in the abdominal wall above, lateral to, and below the umbilicus; and one in the thigh. The depth of the subcutaneous fat layer was measured using ultrasound techniques. The residual radioactivity was monitored externally for 270 min. RESULTS: The disappearance half-life of 125I-insulin was between 4 and 6 h from all injection sites, with the exception of the upper abdominal area in the nonobese subjects, where it measured approximately 3 h. The residual radioactivity did not differ between nonobese and obese patients measured from any of the sites. In the nonobese group, the most rapid absorption of 125I-insulin was found from the upper abdominal area and the slowest from the thigh. In the obese group, the absorption rates did not differ between sites. No correlation was found between the depth of the fat layer and the residual radioactivity when measured at any site. CONCLUSIONS: Our results indicate that the absorption of rapid-acting insulin is markedly slow in both obese and nonobese NIDDM patients compared with IDDM patients and healthy subjects studied previously. In the nonobese group, the most rapid absorption of 125I-insulin is obtained after injection into the upper abdominal area. Inter- and intraregional differences are small in the obese patients. Consequently the choice of injection site is of little importance in this group.

Insulin absorption, glucose homeostasis, and lipolysis in IDDM during mental stress.

OBJECTIVE: To study the effects of mental stress on the absorption kinetics of insulin and on glucose homeostasis and lipolysis in insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: Nine IDDM patients were exposed to the Stroop color word conflict test (CWT) during 40 min after injection of 125I-labeled soluble human insulin (10 U) into the abdomen. Adipose tissue blood flow (133Xe-clearance) was determined concomitantly to elucidate the importance of blood flow for insulin absorption during CWT. The effect of the CWT was followed by measurement of arterial levels of catecholamines and as blood pressure and heart-rate responses. Lipolysis was measured as arterial glycerol levels, and ketone body levels were monitored by determination by beta-hydroxybutyrate. RESULTS: Although insulin absorption (residual 125I-radioactivity and plasma free insulin levels) and the arterial levels of glucose and beta-hydroxybutyrate were not significantly changed by the CWT, arterial glycerol and norepinephrine levels and adipose tissue blood flow were approximately doubled, and epinephrine levels increased fourfold. Heart rate increased approximately 35 beats/min and mean blood pressure approximately 25 mmHg. CONCLUSIONS: The results suggest that intense mental stress of 40 min duration does not alter the absorption of subcutaneously injected insulin, glucose homeostasis, or ketone body levels in patients with IDDM, despite a considerable increase in blood flow and lipolysis.

Effects of accidental intramuscular injection on insulin absorption in IDDM.

Recent studies have shown that with the injection technique presently recommended to diabetic patients, accidental intramuscular injection of insulin is liable to occur quite frequently. In this study, the simultaneous absorption of 125I-labeled soluble human insulin (5 U) from subcutaneous and intramuscular injection sites in the thigh and abdomen was measured for 3 h in 10 insulin-dependent diabetic subjects to evaluate the importance of accidental intramuscular injection for insulin absorption in the resting state. Injection sites were located with computed tomography of the thigh and abdomen. From a superficial part of the thigh musculature, the absorption rate was at least 50% higher than from the adjacent subcutaneous tissue, the time until 50% of the initial activity remained (t1/2) being 123 +/- 14 and greater than 180 min, respectively (P less than .001). No difference in absorption rates was found between the two tissues in the abdomen (t1/2 84 +/- 6 vs. 93 +/- 7 min, NS). The results suggest that in the thigh, accidental intramuscular injections will considerably increase the variability of insulin absorption and may impair glycemic control in insulin-dependent diabetic patients. Furthermore, the influence of accidental intramuscular injection on insulin absorption seems to vary among injection regions.

Subcutaneous injection of the incretin hormone glucagon-like peptide 1 abolishes postprandial glycemia in NIDDM.

OBJECTIVE: To investigate the effect of subcutaneously injected glucagon-like peptide 1 (GLP-1) (7-36)amide on postprandial plasma glucose, insulin, and C-peptide levels in patients with non-insulin-dependent diabetes mellitus (NIDDM) and a secondary failure to sulfonylureas. RESEARCH DESIGN AND METHODS: GLP-1 (25 nmol) was injected subcutaneously into either the abdominal wall or the gluteal region at a standardized depth and speed. The injection device was guided by the ultrasound determination of the depth of the fat layer. The peptide was given 5 min before a standard meal. Plasma concentrations of glucose, C-peptide, insulin, glucagon, and GLP-1 were followed during 240 min after the injection. RESULTS: In control experiments, a significant hyperglycemia was attained after the meal. GLP-1 given into the abdominal wall not only virtually abolished the post-prandial blood glucose rise but significantly decreased glucose concentrations, with a nadir at approximately 25 min after the injection. A rapid rise of C-peptide and insulin levels was observed 10-15 min after the injection of GLP-1. The stimulatory effect of GLP-1 was transient, and, at 45 min after the meal, both insulin and C-peptide levels were almost identical in GLP-1 and control experiments. Significantly lower glucagon concentrations were observed 35-65 min after the peptide injection. GLP-1 concentration in plasma increased from 10 pM to a peak concentration (Cmax) of 70 pM at Tmax 30 min after injection. Then GLP-1 levels rapidly decreased to 25 pM at 95 min and returned to basal at 215 min. The gluteal injection of GLP-1 had similar effects compared with the abdominal administration on plasma levels of glucose, insulin, C-peptide, and glucagon. CONCLUSIONS: GLP-1 is promptly absorbed from the subcutaneous tissue. It exerts a significant blood glucose lowering effect when administered before meals in overweight patients with NIDDM.

Genome sizes of 227 accessions of Gagea (Liliaceae) discriminate between the species from the Netherlands and reveal new ploidies in Gagea.

Nuclear genome size, as measured by flow cytometry with propidium iodide, was used to investigate the relationships within the genus Gagea (Liliaceae), mainly from the Netherlands. The basic chromosome number for Gagea is x = 12. The inferred ploidy in the Dutch and German accessions varies from diploid to decaploid. Consequently there is a large range of genome sizes (DNA 2C-values) from 14.9 to 75.1 pg. Genome sizes are evaluated here in combination with the results of morphological observations. Five species and the hybrid G. × megapolitana are reported. Apart from 14 diploid G. villosa, six plants of G. villosa with an inferred tetraploidy were found. For the 186 Dutch accessions investigated 85 turned out to be the largely sterile G. pratensis (inferred to be pentaploid). Inferred tetraploid and hexaploid G. pratensis were found in 30 and 20 localities, respectively. In one locality an inferred decaploid (10×) plant was found that could represent a doubled pentaploid G. pratensis. An inferred decaploid G. pratensis was never reported before. The genome size of Gagea × megapolitana from Germany fitted with its origin as a cross between the two hexaploids G. pratensis and G. lutea. Gagea spathacea from the Netherlands was inferred to be nonaploid as was recorded from plants across Europe. The aim of the study was to use flow cytometry as a tool to elucidate the taxonomic position of the Dutch Gagea.

Influence of hyper- and hypothyroidism on subcutaneous adipose tissue blood flow in man.

Subcutaneous adipose tissue (AT) blood flow (BF) in the abdomen, thigh, and arm was determined by measuring the local clearance of [133]Xe in patients with untreated hyper- or hypothyroidism (n = 10, n = 7); six patients in each group were reexamined after treatment when they were euthyroid. Abdominal ATBF before treatment was 5.5 +/- 0.8 (SE) ml/min X 100 g AT in the hyperthyroid patients and 1.3 +/- 0.3 ml/min X 100 g AT in those who were hypothyroid. After therapy abdominal ATBF was 60% lower (P less than 0.05) in the hyperthyroid group and 80% higher (P less than 0.05) in the hypothyroid group. Similarly, ATBF in the thigh and arm was significantly reduced and increased, respectively, after treatment in the two groups. The blood glycerol level in the hyperthyroid group was 128 +/- 24 mumol/liter initially and was 50% lower (P less than 0.05) after therapy, whereas in the hypothyroid group blood glycerol levels were similar before (46 +/- 4 mumol/liter) and after therapy. Body fat, expressed as a percentage of body weight, was similar in the two groups before and after treatment. There was a positive correlation (P less than 0.001) between ATBF and serum T3 and T4 levels and an inverse correlation (P less than 0.01) between ATBF and plasma norepinephrine levels. Mean arterial blood pressure was similar in the two groups indicating that the alterations in ATBF were due to changes in vascular resistance. The results of this study suggest that thyroid hormones regulate sc ATBF in man.

Insulin absorption and subcutaneous blood flow in normal subjects during insulin-induced hypoglycemia.

We studied the effects of insulin-induced hypoglycemia on the absorption of 10 U 125I-labeled soluble human insulin injected sc in the thigh in 10 normal subjects. The disappearance of 125I from the injection site was followed by external gamma-counting. Subcutaneous blood flow (ATBF) was measured concomitantly with the 133Xe washout technique. The plasma glucose nadir [mean, 2.0 +/- 0.1 (+/- SE) mmol/L] occurred at 33 +/- 3 min and resulted in maximal arterial plasma epinephrine concentrations of approximately 6 nmol/L. From 30 min before to 60 min after the glucose nadir the [125I]insulin absorption rate was depressed compared to that during normoglycemia. The first order disappearance rate constants were reduced by approximately 50% (P less than 0.01) during the first 30-min interval after the glucose nadir. During the same period ATBF increased by 100% (P less than 0.05). The results suggest that in normal subjects the absorption of soluble insulin from a sc depot is depressed in connection with hypoglycemia, despite considerably elevated ATBF.

Maternal hemodynamics and impaired fetal growth in pregnancy-induced hypertension.

Twenty-one subjects with pregnancy-induced hypertension were investigated with regard to the relationship between maternal hemodynamics and fetal growth. Five of the infants were small for gestational age (SGA) (less than tenth percentile) and 16 were appropriate for gestational age (AGA) (greater than tenth percentile). Mean arterial blood pressure, cardiac output, and stroke volume were significantly lower in the group of mothers with SGA infants than in the group with AGA infants (102 +/- 3 versus 115 +/- 3 mmHg, 5.8 +/- 0.2 versus 8.2 +/- 0.3 L/minute, and 76 +/- 7 versus 100 +/- 5 mL, respectively). The results of this investigation suggest that the hemodynamic background to the blood pressure increase in pregnancy-induced hypertension ranges from a low cardiac output, high vascular resistance condition to a high-output, low-normal resistance variant. The former subtype is often associated with the birth of an SGA infant.

Cardiovascular responses to isometric handgrip exercise: an invasive study in pregnancy-induced hypertension.

Nine patients with pregnancy-induced hypertension and nine healthy pregnant controls were compared in the last trimester with regard to cardiovascular and sympathoadrenal reactivity during a standardized isometric handgrip exercise test. At rest, the blood pressure elevation with pregnancy-induced hypertension resulted from increased systemic vascular resistance. The test increased the blood pressure, heart rate, cardiac output, stroke volume, and epinephrine and norepinephrine concentrations in arterial plasma, but did not change the calf or systemic vascular resistance. The responses of the two groups did not differ significantly with regard to any of the above variables. Thus, pregnancy-induced hypertension does not seem to be associated with exaggerated cardiovascular or sympathoadrenal reactivity to isometric exercise when compared with normal pregnancy. The mechanism underlying the blood pressure response appears to be similar in the two groups, ie, an increase in cardiac output.

Sympathoadrenal and cardiovascular responses to mental stress in pregnancy-induced hypertension.

Nine patients with pregnancy-induced hypertension and nine healthy pregnant controls with similar gestational lengths were compared with regard to cardiovascular and sympathoadrenal reactivity during a standardized mental stress procedure (Stroop color word conflict test). The test induced increases in blood pressure, heart rate, cardiac output, arterial plasma epinephrine and norepinephrine concentrations, and a decrease in calf vascular resistance, but no changes in stroke volume or systemic vascular resistance. The responses of the two groups did not differ significantly with regard to any of the mentioned variables. Pregnancy-induced hypertension does not seem to be associated with an exaggerated cardiovascular or sympathoadrenal reactivity to mental stress when compared to normal pregnancy.

Clinically important differences in insulin absorption from abdomen in IDDM.

The absorption of radiolabeled soluble insulin ([125I]Actrapid Human; 10 U) from subcutaneous injection sites above (120 mm) and below (40 mm) the umbilicus was studied on 2 consecutive days in nine IDDM patients during 180 min. Insulin absorption was measured as disappearance of radioactivity by continuous external monitoring and as appearance of plasma immunoreactive free insulin (IRI). Adipose tissue blood flow (ATBF) was measured concomitantly by the 133Xe-washout technique. Plasma glucose was determined. Prior to the injections the depth of the subcutaneous fat tissue was determined using ultrasound. Significantly less radioactivity remained at the upper site, 42 +/- 5 vs. 60 +/- 6% after 180 min (P < 0.001). In accordance with this, injection into the site above vs. below the umbilicus resulted in a greater area under curve for plasma insulin, 3306 +/- 493 vs. 2357 +/- 466 mU/l per min (0-180 min; P < 0.01), and a more pronounced plasma glucose-lowering effect (P < 0.05). However, ATBF did not differ significantly between the two sites. These data suggest that there are clinically relevant differences in insulin absorption within the abdomen. Thus, insulin injection into the epigastric area causes more rapid insulin absorption resulting in an enhanced plasma glucose-lowering effect than injection into the more conventional site close beneath the umbilicus.