Early third trimester maternal response to glucose challenge and pregnancy outcome in Chinese women-relationship between upper distribution level and recommended diagnostic criteria.

BACKGROUND/OBJECTIVES: The objective of this study was to examine the relationship between upper distribution levels of glucose values in the 75-g oral glucose tolerance test (OGTT) and recommended diagnostic criteria for gestational diabetes mellitus (GDM) and adverse pregnancy outcomes. SUBJECTS/METHODS: The distribution of the OGTT 2-h values of 13,501 pregnant women, which were below the World Health Organization (WHO) threshold for overt diabetes mellitus (DM), and managed in one teaching hospital in China, was reviewed and related to maternal characteristics and pregnancy outcomes. RESULTS: For the entire group, the 90th and 95th percentile values of the OGTT 2-h glucose level, respectively, were close to the diagnostic cutoff values of the WHO and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. For adverse maternal outcomes, glucose level above the 90th percentile value was associated with increased hypertensive disorders, whereas no difference was seen with cutoff using the 95th percentile value. For perinatal outcomes, the 90th percentile was associated with increased neonatal intensive care unit admission and hypoglycemia, whereas the 95th percentile showed in addition association with phototherapy for jaundice and 5th-minute Apgar score <7. Although no differences in the incidence of adverse pregnancy outcomes were found using the different cutoffs, the >95th percentile cutoff value would have missed out 33.3-56.7% of the cases of adverse outcomes that would otherwise have been attributed to GDM. CONCLUSIONS: Further studies are warranted to clarify which diagnostic criterion is most appropriate universally to identify adverse pregnancy outcomes attributed to GDM, and which could be mitigated with treatment specific for GDM.

Sequential changes to clinical parameters and adhesion molecules following intravenous pulse cyclophosphamide and methylprednisolone treatment of refractory juvenile idiopathic arthritis.

It is believed that the systemic subtype and the positive rheumatoid factor, polyarticular subtype of juvenile idiopathic arthritis (JIA) show the least favorable outcomes for therapy; patients with systemic JIA are often resistant to recommended therapeutic modalities. We report the sequential changes to clinical and laboratory findings from pulse therapy with monthly intravenous cyclophosphamide (0.5 g/m2 body surface area) administration combined with methylprednisolone (30 mg/kg; 1 gm maximum) for 6 months, following which the medication interval was elongated to 3 months for a total of from 7 to 12 courses. Among 4 children suffering from refractory systemic JIA, 3 demonstrated clinical improvement, 2 of whom achieved clinical remission. Furthermore, we also adminstered this therapy to a girl suffering from refractory polyarticular JIA, following which she revealed clinical remission subsequent to 9 courses of such therapy. From our experience, we suggest that patients afflicted with JIA that is unresponsive to traditional medication may experience benefit from this type of pulse therapy.

Trace elements in hair of Blackfoot disease.

Blackfoot disease is a peripheral vascular disease resulting in gangrene of the lower extremities. Though extensive epidemiological study has implicated that high arsenic content in artesian well water of the endemic area bears some important connection with the disease, the etiology of the disease is still unknown. In this study, attention is paid to multielement determination in order to find out whether the trace elements in hair of Blackfoot disease patients are different from those of the controls. Experimental results indicate that the concentrations of As and Se in hair of patients are significantly higher than those of the controls, but Ca and Zn are significantly lower than those of the controls. The possible connection of these elements with the etiology of the disease is discussed.

[Heavy metals in traditional Chinese medicine: ba-pao-neu-hwang-san].

Heavy metal intoxication of newborn infants fed with "Ba-Pao-Neu-Hwang-San" has been reported every year by many hospitals in Taiwan. About nine years ago, the National Laboratories of Foods and Drugs of the Department of Health, Executive Yuan, received one case report of a five month old female infant who died as a result of long term feeding with "Ba-Pao-Neu-Hwang-San". The drug was found to have contained lead 44,000 ppm. Although this unfortunate incident was propagated by most newspapers, the prescription of this ancient Chinese medicinal preparation is still widely accepted by ordinary people. Herbal medicine doctors prefer complex mineral drugs as did their ancestors thousands of years ago. In the last two years, we have collected 5 samples of "Ba-Pao-Neu-Hwang-San" from different manufacturers and measured the concentration of 16 heavy metals (including Cadmium, Mercury, Arsenic, Lead, Chromium, Manganese, Selenium, Germanium, Nickel, Calcium, Magnesium, Aluminum, Iron, Copper, Zinc, and Vanadium) in these drugs with Inductively-Coupled Plasma Atomic Emission Spectrometry and Graphite Furnace Atomic Absorption Spectrometry. The result of our survey revealed that the first sample (from Tainan) contained mercury 52,800 ppm, the fourth (from Ping-tung) contained mercury 34,500 ppm, and the fifth (from Sin-chu) contained mercury 65,700 ppm. The mercurial contents of these samples were apparently too high to be a safe drug.

[Survey of heavy metals in traditional Chinese medicinal preparations].

Traditional Chinese medicinal preparations are still widely used by natives in Taiwan. Some traditional Chinese medicine prepared with ancient formulas have been found to contain some heavy metals. There has been an occasional pediatric case admitted with heavy metal intoxication. In the last two years, we collected 11 ancient formula drug samples from the families of the patients. We detected the heavy metals with an inductively-coupled plasma atomic emission spectrometry and a graphite furnace atomic absorption spectrometry. The final result of our report reveals the problem of heavy metals in traditional Chinese medicinal preparations as being very serious.

Effect of wet decomposition methods on the determination of cobalt, copper, selenium, and zinc in biological samples using electrophoresis.

A method combining radiotracer techniques with paper electrophoresis to investigate the optimal decomposition conditions for cobalt, copper, selenium, and zinc in rat liver samples is described. After oral and intraperitoneal administration of the respective nuclides of 60Co, 64Cu, 75Se, and 65Zn solutions, the livers of the tested rats are removed and decomposed with a nitric and sulfuric acid mixture. The completeness of decomposition is investigated by measuring the respective radionuclide-containing species in the decomposed samples by electrophoretic analysis. The results indicate that the Co- and Se-containing liver samples are more easily decomposed than those containing Cu and Zn under the specific conditions. The same decomposition effects are observed for ingested radioisotopes as for intraperitoneally injected ones. The possible connection of decomposition with the analytical error is discussed.

Arsenic, selenium, and zinc in patients with Blackfoot disease.

Blackfoot disease is a peripheral vascular disease resulting in gangrene of the lower extremities. Extensive epidemiological study implicates that high arsenic content in artesian well water is the responsible causal factor of the disease. In the present study the concentrations of arsenic, selenium, and zinc in the body fluids and hair of patients with Blackfoot disease, in comparison to age- and sex-matched normal controls, are investigated. Two analytical techniques that include atomic absorption spectrometry and neutron activation analysis were used for the analysis of urine, serum, hair, and whole blood. The analytical results indicate that hair arsenic of the patients is significantly higher than that of the controls, but still below the critical value of 1 microgram/g. In addition, the patients showed significantly lower concentrations of Se and Zn in the urine and blood than the normal controls. The possible connection of these elements with the etiology of the disease is discussed.