Peripartum management of glycemia in women with type 1 diabetes

OBJECTIVE We aimed to 1) describe the peripartum management of type 1 diabetes at an Australian teaching hospital and 2) discuss factors influencing the apparent transient insulin independence postpartum. RESEARCH DESIGN AND METHODS We conducted a retrospective review of women with type 1 diabetes delivering singleton pregnancies from 2005 to 2010. Information was collected regarding demographics, medical history, peripartum management and outcome, and breast-feeding. To detect a difference in time to first postpartum blood glucose level (BGL) >8 mmol/L between women with an early (<4 h) and late (>12 h) requirement for insulin postpartum, with a power of 80% and a type 1 error of 0.05, at least 24 patients were required. RESULTS An intravenous insulin infusion was commenced in almost 95% of women. Univariate analysis showed that increased BMI at term, lower creatinine at term, longer duration from last dose of long- or intermediate-acting insulin, and discontinuation of an insulin infusion postpartum were associated with a shorter time to first requirement of insulin postpartum (P = 0.005, 0.026, 0.026, and <0.001, respectively). There was a correlation between higher doses of insulin commenced postpartum and number of out-of-range BGLs (r[36] = 0.358, P = 0.030) and hypoglycemia (r[36] = 0.434, P = 0.007). Almost 60% had at least one BGL <3.5 mmol/L between delivery and discharge. CONCLUSIONS Changes in the pharmacodynamic profile of insulin may contribute to the transient insulin independence sometimes observed postpartum in type 1 diabetes. A dose of 50–60% of the prepregnancy insulin requirement resulted in the lowest rate of hypoglycemia and glucose excursions. These results require validation in a larger, prospective study.

Kinetic characterization of rat brain type IIA sodium channel alpha-subunit stably expressed in a somatic cell line

1. The rat brain type IIA Na+ channel alpha-subunit was stably expressed in Chinese hamster ovary (CHO) cells. Current through the expressed Na+ channels was studied using the whole-cell configuration of the patch clamp technique. The transient Na+ current was sensitive to TTX and showed a bell-shaped peak current vs. membrane potential relation. 2. Na+ current inactivation was better described by the sum of two exponentials in the potential range -30 to +40 mV, with. a dominating fast component and a small slower component. 3. The steady-state inactivation, h(infinity), was related to potential by a Boltzmann distribution, underlying thr ee states of the inactivation gate. 4. Recovery of the channels from inactivation at different potentials in the range -70 to -120 mV were characterized by al? initial delay which decreased with hyperpolarization. The time course was well fitted by the sum of two exponentials. In this case the slower exponential was the major component, and both time constants decreased with hyperpolarization. 5. For a working description of the Na+ channel inactivation in this preparation, with a minimal deviation from the Hodgkin-Huxley model, a three-state scheme of the form O reversible arrow I-1 reversible arrow I-2 was proposed, replacing the original two-state scheme of the Hodgkin-Huxley model, and the rate constants are reported. 6. The instantaneous current-voltage relationship showed marked deviation from linearity and was satisfactorily fitted by the constant-field equation. 7. The time course of activation was described by an m(x) model. However, the best-fitted value of x varied with the membrane potential and had a mean value of 2. 8. Effective gating charge was determined to be 4.7e from the slope of the activation plot, plotted on a logarithmic scale. 9. The rate constants of activation, alpha(m) and beta(m), were determined. Their functional dependence on the membrane potential was investigated.

Vitrification, relaxation and free volume in glycerol-water binary liquid mixture:Spin probe ESR studies

Glass transition and relaxation of the glycerol-water (G-W) binary mixture system have been studied over the glycerol concentration range of 5-85 mol% by using the highly sensitive technique of electron spin resonance (ESR). For the water rich mixture the glass transition,sensed by the dissolved spin probe, arises from the vitrified mesoscopic portion of the binary system. The concentration dependence of the glass transition temperature manifests a closely related molecular level cooperativity in the system. A drastic change in the mesoscopic structure of the system at the critical concentration of 40 mol is confirmed by an estimation of the spin probe effective volume in a temperature range where the tracer reorientation is strongly coupled to the system dynamics.

Neurological manifestations and molecular genetics of acute intermittent porphyria in North Western Russia

Acute intermittent porphyria (AIP, MIM #176000) is an inherited metabolic disease due to a partial deficiency of the third enzyme, hydroxymethylbilane synthase (HMBS, EC: 4.3.1.8), in the haem biosynthesis. Neurological symptoms during an acute attack, which is the major manifestation of AIP, are variable and relatively rare, but may endanger a patient's life. In the present study, 12 Russian and two Finnish AIP patients with severe neurological manifestations during an acute attack were studied prospectively from 1995 to 2006. Autonomic neuropathy manifested as abdominal pain (88%), tachycardia (94%), hypertension (75%) and constipation (88%). The most common neurological sign was acute motor peripheral neuropathy (PNP, 81%) often associated with neuropathic sensory loss (54%) and CNS involvement (85%). Despite heterogeneity of the neurological manifestations in our patients with acute porphyria, the major pattern of PNP associated with abdominal pain, dysautonomia, CNS involvement and mild hepatopathy could be demonstrated. If more strict inclusion criteria for biochemical abnormalities (>10-fold increase in excretion of urinary PBG) are applied, neurological manifestations in an acute attack are probably more homogeneous than described previously, which suggests that some of the neurological patients described previously may not have acute porphyria but rather secondary porphyrinuria. Screening for acute porphyria using urinary PBG is useful in a selected group of neurological patients with acute PNP or encephalopathy and seizures associated with pain and dysautonomia. Clinical manifestations and the outcome of acute attacks were used as a basis for developing a 30-score scale of the severity of an acute attack. This scale can easily be used in clinical practice and to standardise the outcome of an attack. Degree of muscle weakness scored by MRC, prolonged mechanical ventilation, bulbar paralysis, impairment of consciousness and hyponatraemia were important signs of a poor prognosis. Arrhythmia was less important and autonomic dysfunction, severity of pain and mental symptoms did not affect the outcome. The delay in the diagnosis and repeated administrations of precipitating factors were the main cause of proceeding of an acute attack into pareses and severe CNS involvement and a fatal outcome in two patients. Nerve conduction studies and needle EMG were performed in eleven AIP patients during an acute attack and/or in remission. Nine patients had severe PNP and two patients had an acute encephalopathy but no clinically evident PNP. In addition to axonopathy, features suggestive of demyelination could be demonstrated in patients with severe PNP during an acute attack. PNP with a moderate muscle weakness was mainly pure axonal. Sensory involvement was common in acute PNP and could be subclinical. Decreased conduction velocities with normal amplitudes of evoked potentials during acute attacks with no clinically evident PNP indicated subclinical polyneuropathy. Reversible symmetrical lesions comparable with posterior reversible encephalopathy syndrome (PRES) were revealed in two patients' brain CT or MRI during an acute attack. In other five patients brain MRI during or soon after the symptoms was normal. The frequency of reversible brain oedema in AIP is probably under-estimated since it may be short-lasting and often indistinguishable on CT or MRI. In the present study, nine different mutations were identified in the HMBS gene in 11 unrelated Russian AIP patients from North Western Russia and their 32 relatives. AIP was diagnosed in nine symptom-free relatives. The majority of the mutations were family-specific and confirmed allelic heterogeneity also among Russian AIP patients. Three mutations, c.825+5G>C, c.825+3_825+6del and c.770T>C, were novel. Six mutations, c.77G>A (p.R26H), c.517C>T (p.R173W), c.583C>T (p.R195C), c.673C>T (p.R225X), c.739T>C (p.C247R) and c.748G>C (p.E250A), have previously been identified in AIP patients from Western and other Eastern European populations. The effects of novel mutations were studied by amplification and sequencing of the reverse-transcribed total RNA obtained from the patients' lymphoblastoid or fibroblast cell lines. The mutations c.825+5G>C and c.770T>C resulted in varyable amounts of abnormal transcripts, r.822_825del (p.C275fsX2) and [r.770u>c, r.652_771del, r.613_771del (p.L257P, p.G218_L257del, p.I205_L257del)]. All mutations demonstrated low residual activities (0.1-1.3 %) when expressed in COS-1 cells confirming the causality of the mutations and the enzymatic defect of the disease. The clinical outcome, prognosis and correlation between the HMBS genotype and phenotype were studied in 143 Finnish and Russian AIP patients with ten mutations (c.33G>T, c.97delA, InsAlu333, p.R149X, p.R167W, p.R173W, p.R173Q, p.R225G, p.R225X, c.1073delA) and more than six patients in each group. The patients were selected from the pool of 287 Finnish AIP patients presented in a Finnish Porphyria Register (1966-2003) and 23 Russian AIP patients (diagnosed 1995-2003). Patients with the p.R167W and p.R225G mutations showed lower penetrance (19% and 11%) and the recurrence rate (33% and 0%) in comparison to the patients with other mutations (range 36 to 67% and 0 to 66%, respectively), as well as milder biochemical abnormalities [urinary porphobilinogen 47±10 vs. 163±21 mol/L, p<0.001; uroporphyrin 130±40 vs. 942±183 nmol/L, p<0.001] suggesting a milder form of AIP in these patients. Erythrocyte HMBS activity did not correlate with the porphobilinogen excretion in remission or the clinical of the disease. In all AIP severity patients, normal PBG excretion predicted freedom from acute attacks. Urinary PBG excretion together with gender, age at the time of diagnosis and mutation type could predict the likelihood of acute attacks in AIP patients.

On the growth of the Bergman kernel near an infinite-type point

We study diagonal estimates for the Bergman kernels of certain model domains in C-2 near boundary points that are of infinite type. To do so, we need a mild structural condition on the defining functions of interest that facilitates optimal upper and lower bounds. This is a mild condition; unlike earlier studies of this sort, we are able to make estimates for non-convex pseudoconvex domains as well. Thisn condition quantifies, in some sense, how flat a domain is at an infinite-type boundary point. In this scheme of quantification, the model domains considered below range-roughly speaking-from being mildly infinite-type'' to very flat at the infinite-type points.

Position preference and diffusion path of an oxygen ion in apatite-type lanthanum silicate La9.33Si6O26: A density functional study

Using density functional theory, we investigated the position preference and diffusion mechanisms of interstitial oxygen ions in lanthanum silicate La9.33Si6O26, which is an apatite-structured oxide and a promising candidate electrolyte material for solid oxide fuel cells. The reported lanthanum vacancies were explicitly taken into account by theoretically determining their arrangement with a supercell model. The most stable structures and the formation energies of oxygen interstitials were determined for each charged state. It was found that the double-negatively charged state is stable over a wide range of the Fermi level, and that the excess oxygen ions form split interstitials with the original oxygen ions, while the neutral and the single-negatively charged states preferably form molecular oxygen. These species were found near the lanthanum vacancy site. The theoretically determined migration pathway along the c-axis essentially follows an interstitialcy mechanism. The obtained migration barrier is sensitive to the charge state, and is also affected by the lanthanum vacancy. The barrier height of the double-negatively charged state was calculated to be 0.58 eV for the model structure, which is consistent with the measured activation energy.

Crystallite size effects in stacking faulted nickel hydroxide and its electrochemical behaviour

P-Nickel hydroxide comprises a long range periodic arrangement of atoms with a stacking sequence of AC AC AC-having an ideal composition Ni(OH)(2). Variation in the preparative conditions can lead to the changes in the stacking sequence (AC AC BA CB AC AC or AC AC AB AC AC) This type of variation in stacking sequence can result in the formation of stacking fault in nickel hydroxide. The stability of the stacking fault depends on the free energy content of the sample. Stacking faults in nickel hydroxide is essential for better electrochemical activity. Also there are reports correlating particle size to the better electrochemical activity. Here we present the effect of crystallite size on the stacking faulted nickel hydroxide samples. The electrochemical performance of stacking faulted nickel hydroxide with small crystallite size exchanges 0.8e/Ni, while the samples with larger crystallite size exchange 0.4e/Ni. Hence a right combination of crystallite size and stacking fault content has to be controlled for good electrochemical activity of nickel hydroxide. (C) 2008 Elsevier B.V. All rights reserved.

Energetics of carbohydrate binding by a 14 kDa S-type mammalian lectin

The thermodynamics of the binding of derivatives of galactose and lactose to a 14 kDa beta-galactoside-binding lectin (L-14) from sheep spleen has been studied in 10 nM phosphate/150 mM NaCl/10 mM beta-mercaptoethanol buffer, pH 7.4, and in the temperature range 285-300 K using titration calorimetry. The single-site binding constants of various sugars for the lectin were in the following order: N-acetyl-lactosamine thiodigalactoside > 4-methylumbelliferyl lactoside > lactose > 4-methylumbelliferyl alpha-D-galactoside > methyl-alpha-galactose > methyl-beta-galactose. Reactions were essentially enthalpically driven with the binding enthalpies ranging from -53.8 kJ/mol for thiodigalactoside at 301 K to -2.2 kJ/mol for galactose at 300 K, indicating that hydrogen-bonding and van der Waals interactions provide the major stabilization for these reactions. However, the binding of 4-methylumbelliferyl-alpha-D-galactose displays relatively favourable entropic contributions, indicating the existence of a non-polar site adjacent to the galactose-binding subsite. From the increments in the enthalpies for the binding of lactose, N-acetyl-lactosamine and thiodigalactoside relative to methyl-beta-galactose, the contribution of glucose binding in the subsite adjacent to that for galactose shows that glucose makes a major contribution to the stability of L-14 disaccharide complexes. Observation of enthalpy-entropy compensation for the recognition of saccharides such as lactose by L-14 and the absence of it for monosaccharides such as galactose, together with the lack of appreciable changes in the heat capacity (delta Cp), indicate that reorganization of water plays an important role in these reactions.

Recombination and trapping in n-type cobalt-doped germanium

The role of cobalt centers in promoting the recombination and trapping processes in n-type germanium has been investigated. Data on lifetime measurements carried out by the steadystate photoconductivity and photo-magneto-electric methods in the temperature range 145 to 300°K on n-type germanium samples containing cobalt in the concentration range 1·1013 to 5.·014/cm3 are presented. The results are analysed on the basis of Sah-Shockley's multi-level formula to yield the capture cross-sections Sp= (hole capture cross-section at doubly negatively charged center) and Sn-(electron capture cross-section at singly negatively charged center) and temperature dependence. It is found that Sp= is (22 ± 6). 10-16 cm2 and Sn- is ∼ 0·1. 10-16 cm2 at 145°K. Sp= varies (n = 3·5 to 4·5) in the range 145-220°K; above 225°K the index 'n' tends to a smaller value. Sn- is practically temperature independent below 180°K and increases with increase of temperature above 180°K. The value of Sp= and its temperature variation lead one to the conclusion that during capture at attractive centers, the phonon cascade mechanism is responsible for the dissipation of the recombination energy.

Electron-hole recombination in cobalt-doped p-type germanium

The recombination properties of cobalt centers in p-type germanium containing cobalt in the concentration range 1014 to 1016 atoms/cm3 have been investigated. The measurement of lifetime has been carried out by steady-state photoconductivity and photo-magneto-electric methods in the temperature range 145 to 300°K. The cross-sections Sno (electron capture cross-section at neutral centers). Sn- (electron capture cross-section at singly negatively charged centers) and their temperature variations have been estimated by the analysis of the lifetime data on the basis of Sah-Shockley's multi-level formula. The value of Sno is (15±5).10-16 cm2 and is temperature independent. The value of Sn- is ≈4·10-16 cm2 around 225°K and it increases with increase of temperature. The possible mechanisms for capture at neutral and repulsive centers are discussed and a summary of the capture cross-sections for cobalt centers is given. A comparison of the cross-section values of cobalt and their temperature variations with those of the related impurities-manganese, iron and nickel-in germanium has been made.

Free convection heat transfer between vertical parallel plates

A new mathematical model for the solution of the problem of free convection heat transfer between vertical parallel flat isothermal plates under isothermal boundary conditions, has been presented. The set of boundary layer equations used in the model are transformed to nonlinear coupled differential equations by similarity type variables as obtained by Ostrach for vertical flat plates in an infinite fluid medium. By utilising a parameter ηw* to represent the outer boundary, the governing differential equations are solved numerically for parametric values of Pr = 0.733. 2 and 3, and ηw* = 0.1, 0.5, 1, 2, 3, 4, ... and 8.0. The velocity and temperature profiles are presented. Results indicate that ηw* can effectively classify the system into (1) thin layers where conduction predominates, (2) intermediate layers and (3) thick layers whose results can be predicted by the solutions for vertical flat plates in infinite fluid medium. Heat transfer correlations are presented for the 3 categories. Several experimental and analytical results available in the literature agree with the present correlations.

Free-to-bound and bound exciton transitions at isoelectronic impurities: GaP(Zn,O)

We show, for sufficiently high temperatures and sufficiently weak majority-carrier binding energies, that the dominant radiative transition at an isoelectronic acceptor (donor) in p-type (n-type) material consists of the recombination of singly trapped minority carriers (bound by central-cell forces) with free majority carriers attracted by a Coulomb interaction. There are two reasons why the radiative recombination rate of the free-to-bound process is greater than the bound exciton process, which dominates at lower temperatures: (i) The population of free majority-carrier states greatly exceeds that of exciton states at higher temperatures, and (ii) the oscillator strength of the free-to-bound transition is greatly enhanced by the Coulomb attraction between the free carrier and the charged isoelectronic impurity. This enhancement is important for isoelectronic centers and is easily calculable from existing exciton models. We show that the free carrier attracted by a Coulomb interaction can be viewed as a continuum excited state of the bound exciton. When we apply the results of our calculations to the GaP(Zn, O) system, we find that the major part of the room-temperature luminescence from nearest-neighbor isoelectronic Zn-O complexes results from free-to-bound recombination and not exciton recombination as has been thought previously. Recent experiments on impulse excitation of luminescence in GaP(Zn, O) are reevaluated in the light of our calculations and are shown to be consistent with a strong free-to-bound transition. For deep isoelectronic centers with weakly bound majority carriers, we predict an overwhelming dominance of the free-to-bound process at 300°K.

Free convection heat transfer from vertical cylinders part I: Power law surface temperature variation

This paper reports on the investigations of laminar free convection heat transfer from vertical cylinders and wires whose surface temperature varies along the height according to the relation TW - T∞ = Nxn. The set of boundary layer partial differential equations and the boundary conditions are transformed to a more amenable form and solved by the process of successive substitution. Numerical solutions of the first approximated equations (two-point nonlinear boundary value type of ordinary differential equations) bring about the major contribution to the problem (about 95%), as seen from the solutions of higher approximations. The results reduce to those for the isothermal case when n=0. Criteria for classifying the cylinders into three broad categories, viz., short cylinders, long cylinders and wires, have been developed. For all values of n the same criteria hold. Heat transfer correlations obtained for short cylinders (which coincide with those of flat plates) are checked with those available in the literature. Heat transfer and fluid flow correlations are developed for all the regimes.

Genetic characterization of Indian type O FMD virus 3A region in context with host cell preference

The 3A region of foot-and-mouth disease virus has been implicated in host range and virulence. For example, amino acid deletions in the porcinophilic strain (O/TAW/97) at 93-102 aa of the 153 codons long 3A protein have been recognized as the determinant of species specificity. In the present study, 18 type 0 FMDV isolates from India were adapted in different cell culture systems and the 3A sequence was analyzed. These isolates had complete 3A coding sequence (153 aa) and did not exhibit growth restriction in cells based on species of origin. The 3A region was found to be highly conserved at N-terminal half (1-75 aa) but exhibited variability or substitutions towards C-terminal region (80-153). Moreover the amino acid substitutions were more frequent in recent Indian buffalo isolates but none of the Indian isolates showed deletion in 3A protein, which may be the reason for the absence of host specificity in vitro. Further inclusive analysis of 3A region will reveal interesting facts about the variability of FMD virus 3A region in an endemic environment. (C) 2010 Elsevier B.V. All rights reserved.

Thermodynamics of GdMnO3 and GdMn2O5 phases determined by the EMF method

Using solid oxide galvanic cells of the type: MnO + Gd2O3 + GdMnO3/O-2/Ni + NiO and Mn3O4 + GdMnO3 + GdMn2O5/O-2/air the equilibrium oxygen pressure for the following reactions :MnO + 1/2Gd(2)O(3) + 1/4O(2) = GdMnO3 1/3Mn(3)O(4) + GdMnO3 + 1/3O(2) = GdMn2O5 was determined in the temperature range from 1073 to 1450 K. From the determined equilibrium oxygen partial pressure the corresponding G i b b s free energy change for these reactions was derived: Delta G(f,GdMnO3)(0) (+/- 425J) 132721(+/ - 2240) +51.91(+/ - 0.81)T Delta G(f,GdMn2O5)(0)(+/- 670J) 121858(+/ - 6176) + 79.52(+/ - 4.83)T From these data, standard G i b b s energies, enthalpies and entropies of formation of GdMnO3 and GdMn2O5 from component oxides and from the elements are derived. Thermodynamic data tables for the two ternary phases are compiled from 298.15 to 1400 K.