Abnormalities in thyroid function tests in patients admitted to medical service.

Serum thyroid hormone, thyrotropin (TSH) and thyroxine-binding globulin (TBG) concentrations, free thyroxine index values, and free thyroxine concentrations were measured at the time of admission in all 77 patients hospitalized on a medical service on four separate days. Serum thyroxine (T4) concentrations and serum free T4 index values were decreased in 19.5% and 11.7%, respectively, and increased in 3.9% and 11.7%, respectively; serum free T4 concentrations were decreased in 6.8% and increased in 5.4%. Six patients (7.8%) had increased serum TSH concentrations. Serum triiodothyronine (T3) concentrations were decreased in 26.0% and reverse triiodothyronine (rT3) concentrations were increased in 29.9%. None had manifestations of thyroid disease. These results indicate that available thyroid function tests may give misleading results in patients with nonthyroid illness and suggest that caution be exercised in diagnosing thyroid disease in hospitalized patients.

Exercise in insulin-dependent diabetes mellitus: the effect of continuous insulin infusion using the subcutaneous, intravenous, and intraperitoneal sites.

The metabolic response to exercise in insulin-dependent diabetic (IDD) man was assessed during continuous insulin infusion using the subcutaneous (CSII), intravenous (CIVII), and intraperitoneal (CIPII) routes. During the basal period, plasma glucose levels were higher with CIPII (153 +/- 17 mg/dl) than with CSII (117 +/- 13 mg/dl) or CIVII (118 +/- 17 mg/dl). Basal free insulin concentrations were similar for CSII (12.3 +/- 10 microU/ml) and CIVII (12.4 +/- 1.4 MicroU/ml) but lower in CIPII (8.5 +/- 1.0 microU/ml, P less than 0.05). Exercise on a stationary bicycle at 75 W for 60 min produced a decline of plasma glucose in each protocol that was significantly only during CIVII (55 +/- 11 mg/dl, P less than 0.01). Insulin levels remained unchanged throughout the study period in all protocols. In normals, insulin values decreased during exercise and remained below basal levels through the recovery period (P less than 0.05), while plasma glucose remained unchanged. Plasma glucagon and epinephrine levels were similar in all protocols and remained unchanged with exercise, while plasma norepinephrine tended to be higher than normal in all diabetic subjects. Significant differences between normal and diabetic subjects (P less than 0.05) were observed for blood ketone bodies, while blood lactate, glycerol, and plasma FFA were similar. Normalization of intermediary metabolites occurred only with CIVII. Continuous insulin infusion provides near-normal glycemic and metabolic control before, during and following exercise in IDD man. However, to produce normal blood concentrations of intermediary metabolites during exercise, the insulin infusion rate may be excessive in terms of its hypoglycemic effect. CSII appears to be a safe, accessible, and adequate method for treating diabetic man during exercise.

Effects of dietary lecithin on hormonal and neurobehavioral profiles in normal subjects.

Four normal subjects received lecithin supplements sufficient to elevate serum choline levels 3-fold. Despite persistent hypercholinemia over 48 hours of close observation, no increase was observed in serum ACTH, cortisol, and insulin concentrations, or in free urinary catecholamine excretion. Screening of a large group of other pituitary and gonadal hormones also failed to reveal any influence of lecithin supplements. EEG patterns and results of psychometric tests were also unaltered.

Determination of glucose concentrations in an aqueous matrix from NIR spectra using optimal time-domain filtering and partial least-squares regression.

We have investigated the use of a time-domain optimal filtering method to simultaneously minimize both the baseline variation and high-frequency noise in near-infrared (NIR) spectrophotometric absorption data of glucose dissolved in a simple aqueous (deionized water) matrix. By coupling a third-order (six-pole) digital Butterworth bandpass filter with partial least-squares (PLS) regression modeling, glucose concentrations were determined for a set of test data with a standard error of prediction (SEP) of 10.53 mg/dl (mean percent error: 4.24%) using seven PLS factors. Compared to the unfiltered test data for six PLS factors and a SEP = 17.00 (mean percent error: 7.38%) this results shows more than a 38% decrease in the error. The glucose concentrations ranged from 51 mg/dl to 493 mg/dl, and the NIR spectral region between 2088 nm and 2354 nm (4789 cm-1 and 4248 cm-1) was used to develop the optimal PLS model. The optimal PLS model was determined from a sequence of three-dimensional performance response maps for different numbers of PLS factors (2-10). A total of 99 NIR spectra were generated for glucose dissolved in deionized water using a NIRsystems 5000 dispersive spectrophotometer. Nine of these spectra were generated for only water, which were averaged and subtracted from the remaining 90 spectra to generate the training and test data sets, thereby, removing the intrinsic high background absorption due to the water. The training set consisted of 57 spectra and associated glucose concentration target values, and the test set was comprised of the remaining 33 spectra and target values. Performance results were compared for three different digital Butterworth bandpass filters (four-poles, six-poles, and eight-poles), and a digital Gaussian filter design approach (i.e., Fourier filtering).

Multivariate determination of glucose concentrations from optimally filtered frequency-warped NIR spectra of human blood serum.

Glucose concentrations over the 39-160 mg dl-1 range have been determined from 357 NIR (near-infrared) spectra of human blood serum in the spectral region from 6766 cm-1 to 4003 cm-1. A frequency-warping procedure was applied to the NIR data to compress 511 spectral components into 102 in the 6766-4003 cm-1 spectral region. Before the data compression process was carried out, the NIR spectrum of deionized water was subtracted from each of the blood serum spectra to remove the intrinsic high background absorption due to the water. PLS (partial least-squares) regression was coupled with time-domain digital Butterworth bandpass filtering in an optimization procedure. The optimization procedure was carried out over a range of centre frequencies and bandwidths for first- (two-pole), second- (four-pole) and third- (six-pole) order bandpass filters, and over a range of PLS factors. The optimal PLS model and filter parameters were determined from a sequence of three-dimensional performance response maps for different numbers of PLS factors and filter orders. As a basis for comparison, the same optimization process was carried out for a Gaussian filter design approach (i.e., Fourier filtering). Using the optimally filtered frequency-warped NIR spectral data, an SEP (standard error of prediction) of 13.2 mg dl-1 was achieved fro the test (monitoring) data using 14 PLS factors and a simple first-order (two-pole) digital Butterworth bandpass filter.

Near normalization of metabolism of IDDM: comparison of continuous subcutaneous (CSII) versus intraperitoneal (CIPII) insulin delivery.

The effects of continuous insulin infusion given subcutaneously (CSII) and intraperitoneally (CIPII) on 24 h "metabolic" profile of four insulin dependent diabetic volunteers were assessed. When the insulin dose delivered is adjusted to achieve a near match of the peripheral plasma glucose profile, the 24 h profiles of free fatty acids, glycerol, lactate and beta-hydroxybutyrate and the hormones, insulin, glucagon, cortisol and catecholamines were identical. These results suggest that CIPII has no advantage over CSII in normalizing of the metabolism of the insulin dependent diabetic.