Observation of polarization-maintaining light propagation in depoled compositionally disordered ferroelectrics.

We investigate the evolution of the state of polarization of light propagating through bulk depoled composite ferroelectrics below the Curie temperature. In contrast to standard depoled ferroelectrics, where random birefringence causes depolarization and scattering, light is observed to suffer varying degrees of depolarization and remains fully polarized when linearly polarized along the crystal principal axes. The effect is found to be supported by the formation of polarized speckles organized into a spatial lattice and occurs as the ferroelectric settles into a spontaneous super-crystal, a three-dimensional coherent mosaic of ferroelectric clusters. The polarization lattices gradually disappear as the ferroelectric state reduces to a disordered distribution of polar nanoregions above the critical point.

Continuous Solitons in a Lattice Nonlinearity.

We study theoretically and experimentally the propagation of optical solitons in a lattice nonlinearity, a periodic pattern that both affects and is strongly affected by the wave. Observations are carried out using spatial photorefractive solitons in a volume microstructured crystal with a built-in oscillating low-frequency dielectric constant. The pattern causes an oscillating electro-optic response that induces a periodic optical nonlinearity. On-axis results in potassium-lithium-tantalate-niobate indicate the appearance of effective continuous saturated-Kerr solitons, where all spatial traces of the lattice vanish, independently of the ratio between beam width and lattice constant. Decoupling the lattice nonlinearity allows the detection of discrete delocalized and localized light distributions, demonstrating that the continuous solitons form out of the combined compensation of diffraction and of the underlying periodic volume pattern.

Effect of long-term near-normoglycemia on the progression of diabetic nephropathy.

The effect of prolonged restoration of near-normoglycemia on the progression of diabetic nephropathy was evaluated in a controlled study in which 10 insulin-dependent (type 1) diabetic patients with clinical proteinuria were randomized to continue with conventional insulin treatment (CIT) or to undertake more intensive diabetic therapy using continuous subcutaneous insulin infusion (CSII). The patients, mean age 33 +/- 8 yr, mean duration of diabetes 15 +/- 4 yr, were studied before and during 12 months of either CIT or CSII therapy. Glycemic control was assessed by means of mean blood glucose (MBG) +/- Standard deviation (SD), urinary glucose excretion and glycosylated hemoglobin, while renal function was assessed by albumin, IgG and beta-2-microglobulin urinary excretion rates, serum creatinine and creatinine clearance. Blood glucose level, urinary glucose excretion and glycosylated hemoglobin fell significantly in the CSII group, while no differences were found in the CIT group after the 12 months observation period. Both groups showed a deterioration in all indices of renal function, as illustrated by an increase of protein excretion rates and of serum creatinine, and by a decline in creatinine clearance. Comparison of the rate of increase of urinary albumin and IgG excretion and of serum creatinine and of the rate of fall in creatinine clearance between CIT and CSII groups demonstrated that the rate of progression of diabetic nephropathy may be slowed by correction of hyperglycemia. Our study, with due reservations because of the small number of examined patients and differences in kidney function at the beginning of the trial shows that intensive diabetic care may play a role in the proteinuric stage of diabetes in slowing further destruction of residual glomerular structure and in delaying end stage renal failure.

Diabetes as pro-infective risk factor in total hip replacement.

It is widely accepted that diabetic patients, above all poorly controlled ones, are more susceptible to infection. To verify whether diabetes might be considered a pro-infective risk factor in total hip replacement, 1,042 patients, who from 1969 to 1979 underwent an operation for arthropros thesis of the hip, were studied. The patients were subdivided into two groups according to whether they were diabetic or not. The diabetic patients, though well controlled by diet or by diet plus oral hypoglycemic agents, received insulin for at least two days before surgery. In the early post-operative phase they showed transient worsening of glycemic control rapidly corrected by increased insulin dosage. The patients of both groups were operated in low air exchange operating theaters, by the same staff and using standardized surgical techniques, and all received antibiotic coverage as preventive treatment against infections for a week after surgery. Infection and suppuration occurred in 11% of diabetic patients and only in 2% of non-diabetic patients (p less than 0.001); in these cases the prostheses were removed after unsuccessful antimicrobial treatment. Our study indicates that diabetes mellitus must be considered a proinfective risk factor in patients who undergo an operation for total hip replacement and suggests that a conservative approach is required in diabetic patients.

Lipid abnormalities in insulin-dependent diabetic patients with albuminuria.

The relationship between serum lipid, lipoprotein, and apolipoprotein levels and abnormalities of renal function has been investigated in 112 insulin-dependent (type I) diabetic patients. They were subdivided into three matched groups according to the amount of albuminuria: group A (albuminuria less than 20 micrograms/min), group B (albuminuria between 20 and 150 micrograms/min; Albustix negative), and group C (albuminuria greater than 150 micrograms/min; Albustix positive). Twenty-one nondiabetic subjects with albuminuria above 150 micrograms/min but without nephrotic syndrome and/or renal failure and 77 healthy subjects were also studied. Mean total and LDL cholesterol, triglycerides, and apo B were higher, while HDL cholesterol and HDL/LDL cholesterol ratio were lower in group C than in groups A and B; the apo A/apo B ratio was lower in group C than in group A. Differences in apo B and in apo A/apo B ratio were found between groups A and B. No correlation between lipid parameters and amount of albuminuria was observed. Significant differences in lipid concentrations were also found in diabetic patients when compared with nondiabetic subjects with albuminuria and with healthy subjects. The present study confirmed previous reports of lipid disorders in insulin-dependent (type I) diabetes; however, the most important observation was the finding of albuminuria-related differences in lipid parameters in diabetic patients without renal failure. We think that the greater lipid abnormalities observed in diabetic patients with larger amounts of albuminuria might be the consequence both of impairment of glomerular permeability and of the diabetic state.

Kidney function after improved metabolic control in newly diagnosed diabetes and in diabetic patients with nephropathy.

To evaluate the effect of improved metabolic control on kidney function, urinary excretion rate of beta-2-microglobulin, lysozyme, and gamma-glutamyltransferase were evaluated in nine poorly controlled, newly diagnosed diabetic patients before and during treatment. In six poorly controlled insulin-dependent nephropathic diabetic patients, besides the parameters cited above, urinary albumin excretion rate and IgG/transferrin clearance ratio were further investigated to estimate the permeability and the selectivity of glomerular barrier during conventional treatment and after improvement of the metabolic control by a glucose-controlled insulin infusion system (GCIIS). The improved glycemic control resulted in a significant reduction of urinary beta-2-microglobulin and lysozyme excretion in all diabetic patients. Significant decreases of urinary albumin excretion and of IgG/transferrin clearance ratio (indicating a more selective proteinuria) during strict metabolic control were also observed in nephropathic diabetic patients. The reduction of urinary beta-2-microglobulin and lysozyme excretion indicates that a tubular reabsorptive dysfunction, reversible with the amelioration of glycemic control, can be observed in poorly controlled, newly diagnosed and in insulin-dependent nephropathic diabetic patients during conventional treatment. In the latter patients, the permeability and the selectivity properties of glomerular barrier also improved during GCIIS.

The molar ratio of C-peptide to insulin after two consecutive stimulations with glucagon in obesity.

The same dose (1 mg) of intravenous glucagon, administered in two consecutive pulses, demonstrates that insulin and C-peptide secretory responses in obese patients exceed those of normal weight subjects. The analysis of the molar ratio of serum immunoreactive C-peptide (IRCP) to serum immunoreactive insulin (IRI) which revealed significant differences between obese and control groups suggests that higher plasma insulin levels in obesity may result not only from a greater response to glucagon loads and from an impaired sensitivity to endogenous insulin by target tissues, but also from a decreased hepatic removal and destruction of the hormone. Perhaps an anomaly in the hepatic handling of insulin exists in obese subjects and thus a greater amount of the hormone reaches the periphery contributing to hyperinsulinemia, as observed in hyperglycemic and hyperinsulinemic obese (ob/ ob) mice.