Patients with early diabetic heart disease demonstrate a normal myocardial response to dobutamine

OBJECTIVES We sought to use quantitative markers of the regional left ventricular (LV) response to stress to infer whether diabetic cardiomyopathy is associated with ischemia. BACKGROUND Diabetic cardiomyopathy has been identified in clinical and experimental studies, but its cause remains unclear. METHODS We studied 41 diabetic patients with normal resting LV function and a normal dobutamine echo and 41 control subjects with a low probability of coronary disease. Peak myocardial systolic velocity (Sm) and early diastolic velocity (Em) in each segment were averaged, and mean Sm and Em were compared between diabetic patients and controls and among different stages of dobutamine stress. RESULTS Both Sm and Em progressively increased from rest to peak dobutamine stress. In the diabetic group, Sm was significantly lower than in control subjects at baseline (4.2 +/- 0.9 cm/s vs. 4.7 +/- 0.9 cm/s, p = 0.012). However, Sin at a low dose (6.0 +/- 1.3), before peak (8.4 +/- 1.8), and at peak stress (8.9 +/- 1.8) in diabetic patients was not significantly different from that of controls (6.3 +/- 1.4, 8.9 +/- 1.6, and 9.6 +/- 2.1 cm/s, respectively). The Em (cm/s) in the diabetic group (rest: 4.2 +/- 1.2; low dose: 5.0 +/- 1.4; pre-peak: 5.3 +/- 1.1; peak: 5.9 +/- 1.5) was significantly lower than that of controls (rest: 5.8 +/- 1.5; low dose: 6.6 +/- 1.5; pre-peak: 6.9 +/- 1.3; peak: 7.3 +/- 1.7; all p < 0.001). However, the absolute and relative increases in Sm or Em from rest to peak stress were similar in diabetic and control groups. CONCLUSIONS Subtle LV dysfunction is present in diabetic patients without overt cardiac disease. The normal response to stress suggests that ischemia due to small-vessel disease may not be important in early diabetic heart muscle disease. (C) 2003 by the American College of Cardiology Foundation.

Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function

B-type natriuretic peptide (BNP) levels increase in systolic heart failure (HF). However, the value of BNP in hypertensive patients with suspected diastolic HF (symptoms suggestive of HF but normal ejection fraction) and its relation to myocardial function in these patients is unclear. We prospectively studied 72 ambulatory hypertensive subjects (40 women, mean age 58 +/- 8 years) with exertional dyspnea and ejection fraction greater than or equal to50%. Diastolic function was evaluated with transmitral and pulmonary venous Doppler, mitral annular velocities (pulsed-wave tissue Doppler), and flow propagation velocity (color M-mode). Systolic function was assessed with strain and strain rate derived from color tissue Doppler imaging. BNP was related to myocardial function and the presence or absence of global diastolic dysfunction. By conventional Doppler criteria, 34 patients had normal left ventricular diastolic function and 38 had isolated diastolic dysfunction. BNP values were higher in patients with diastolic dysfunction (46 +/- 48 vs 20 +/- 20 pg/ml, p = 0.004) and were related independently to blood pressure, systolic strain rate, left atrial function (p < 0.01 for all), and age (p = 0.015). Patients with diastolic dysfunction and pseudonormal filling had higher BNP levels compared with impaired relaxation (89 +/- 47 vs 35 +/- 42 pg/ml, p = 0.001). However, 79% of patients with diastolic dysfunction had BNP levels within the normal range. We conclude that in ambulatory hypertensive patients with symptoms suggestive of mild HF and normal ejection fraction, BNP is related to atrial and ventricular systolic parameters, blood pressure, and age. Although elevated in the presence of diastolic dysfunction, the BNP level mostly is in the normal range and, therefore, has limited diagnostic value in stable patients with suspected diastolic HF. (C) 2003 by Excerpta Medica, Inc.

Differences in lung function, growth parameters and frequency of hospital admissions between adolescents with cystic fibrosis-related diabetes and controls

As survival of patients with CF increases,glucose intolerance and cystic fibrosisrelated diabetes (CFRD),ar e increasingly recognised common complications. CFRD may be preceded by a pre-diabetic state. Using markers identified as being associated with CFRD may improve targeted screening. Aim: To identify features consistently predicting CFRD in paediatric patients. Patients diagnosed with CFRD between January 1997–January 2002 were compared with age and sex matched controls. Clinical,micr obiological, and hospitalisation data was collected at time of CFRD diagnosis,and at six monthly intervals for 3 yr prior to diagnosis. Eight patients with CFRD were identified,mean age 13.7 yr (S.D. 3.49) at time of diagnosis. Control patients underwent OGTT to ensure normal glucose tolerance. Patients with CFRD had a lower FEV1 up to 12 months prior to diagnosis however, this was only significant at diagnosis. There was no difference in weight and height z scores between the 2 groups; however,the decrease in weight and height z scores in the CFRD group over 3 yr prior to diagnosis was significant. Mean number of days in hospital and admissions per patient significantly increased in the CFRD group,6 months prior to diagnosis. No other significant differences were observed between the 2 groups. Conclusions: This study has shown a difference in lung function,gr owth parameters and frequency of hospital admissions between patients with CFRD and controls. These differences may be utilised as tools for targeted screening in the paediatricyadolescent population. Further larger scale studies are required to improve guidelines for targeted screening in this population.

Use of confocal microscopy to follow the development of penetrative hyphae during growth of Rhizopus oligosporus in an artificial solid-state fermentation system

Two methods were compared for determining the concentration of penetrative biomass during growth of Rhizopus oligosporus on an artificial solid substrate consisting of an inert gel and starch as the sole source of carbon and energy. The first method was based on the use of a hand microtome to make sections of approximately 0.2- to 0.4-mm thickness parallel to the substrate surface and the determination of the glucosamine content in each slice. Use of glucosamine measurements to estimate biomass concentrations was shown to be problematic due to the large variations in glucosamine content with mycelial age. The second method was a novel method based on the use of confocal scanning laser microscopy to estimate the fractional volume occupied by the biomass. Although it is not simple to translate fractional volumes into dry weights of hyphae due to the lack of experimentally determined conversion factors, measurement of the fractional volumes in themselves is useful for characterizing fungal penetration into the substrate. Growth of penetrative biomass in the artificial model substrate showed two forms of growth with an indistinct mass in the region close to the substrate surface and a few hyphae penetrating perpendicularly to the surface in regions further away from the substrate surface. The biomass profiles against depth obtained from the confocal microscopy showed two linear regions on log-linear plots, which are possibly related to different oxygen availability at different depths within the substrate. Confocal microscopy has the potential to be a powerful tool in the investigation of fungal growth mechanisms in solid-state fermentation. (C) 2003 Wiley Periodicals, Inc.

Opening windows into the mind: mothers' preferences for mental state explanations and children's theory of mind

A new questionnaire, the Maternal Mental State Input Inventory (MMSII) was created to measure mothers' preferences for introducing and elaborating on mental states in conversation with their young children. In two studies, the questionnaire was given to mothers of young children, and the children's theory of mind (ToM) development was assessed with standard tasks. In both studies, the questionnaire exhibited good internal reliability, and significant correlations emerged between mothers' self-reported preferences for elaborated, explanatory talk about the mental states and children's theory of mind performance. Further, mothers' conversational preferences, as measured by the MMSII, were the best predictors of children's theory of mind development when relevant control variables were included in the analyses. These results converge with naturalistic observational research that has demonstrated links between mothers' conversational styles and their children's theory of mind. They go further in suggesting that mothers' tendencies toward elaborated, explanatory talk about a range of mental states is particularly beneficial to children's theory of mind development. (C) 2003 Elsevier Inc. All rights reserved.

Normal values for pelvic organ descent in health nulligravid young caucasian women

Translabial ultrasound is increasingly being used for the assessment of women presenting with pelvic floor dysfunction and incontinence (1,2). However, there is little information on normal values for bladder neck descent, with the two available studies disagreeing widely (3,4). No data has so far been published on mobility of the central and posterior compartment which can now also be assessed by ultrasound (5). This study presents normal values for urethral, bladder, cervical and rectal mobility in a cohort of young, stress continent, nulliparous nonpregnant women. Methods 118 nonpregnant nulliparous Caucasian women between 18 and 23 years of age were recruited for an ongoing twin study of pelvic floor function. Translabial ultrasound assessment of pelvic organ mobility was undertaken supine and after bladder emptying (6,7). The best of at least three effective Valsalva manoeuvres was used for evaluation, with no attempts at standardization of Valsalva pressure. Parameters of anterior compartment mobility were obtained by the use of on-screen calipers; cervical and rectal descent were evaluated on printouts. All examinations were carried out under direct supervision of the first author or by personnel trained by him for at least 100 consecutive assessments. Results The median age of participants in this study was 20 (range 18- 23). Mean body mass index was 23 (range 16.9- 36.7). Of 118 women, 2 were completely unable to perform a Valsalva manoeuvre despite repeated efforts at teaching and were excluded from analysis, as were ten women who complained of urinary stress incontinence, leaving 106 datasets. Average measurements for the parameters ‘retrovesical angle at rest’ (RVA-R) and on Valsalva (RVA-S), urethral rotation, bladder neck mobility, cysto-cele descent, cervical descent and descent of the rectal ampulla are given in Table 1.

Low-temperature single-crystal Raman and neutron-diffraction study of the hydrogenous ammonium copper(II) tutton salt and the deuterated analogue in the metastable state

Low-temperature (15 K) single-crystal neutron-diffraction structures and Raman spectra of the salts (NX4)(2)[CU(OX2)(6)](SO4)(2), where X = H or D, are reported. This study is concerned with the origin of the structural phase change that is known to occur upon deuteration. Data for the deuterated salt were measured in the metastable state, achieved by application of 500 bar of hydrostatic pressure at similar to303 K followed by cooling to 281 K and the subsequent release of pressure. This allows for the direct comparison between the hydrogenous and deuterated salts, in the same modification, at ambient pressure and low temperature. The Raman spectra provide no intimation of any significant change in the intermolecular bonding. Furthermore, structural differences are few, the largest being for the long Cu-O bond, which is 2.2834(5) and 2.2802(4) Angstrom for the hydrogenous and the deuterated salts, respectively. Calorimetric data for the deuterated salt are also presented, providing an estimate of 0.17(2) kJ/mol for the enthalpy difference between the two structural forms at 295.8(5) K. The structural data suggest that substitution of hydrogen for deuterium gives rise to changes in the hydrogen-bonding interactions that result in a slightly reduced force field about the copper(II) center. The small structural differences suggest different relative stabilities for the hydrogenous and deuterated salts, which may be sufficient to stabilize the hydrogenous salt in the anomalous structural form.

An Australian PR state?

In their 1994 study Taxation and Representation, Deacon and Golding point to the extensive use of press and public relations professionals by governments to promote policy, and to outmanouvre their opponents. With the UK specifically in mind, they warn: 'we cannot ignore the massive expansion of the public relations state.' (p.6). What distinguishes their approach from the more usual preoccupation with the use of 'spin' to 'package' political leaders is a focus on the institutionalisation of public relations within government. In this paper, I explore the utililty of the concept, and consider what the broad features of an Australian 'PR State' might be.

Seasonality of Monomachus Klug (Hymenoptera, Monomachidae) in the Biological Reserve of Duas Bocas, Espírito Santo State, Brazil

A survey of Monomachidae species was carried out in anarea of Atlantic rain forest of the Biological Reserve of Duas Bocas, Espírito Santo State, Brazil between September, 1996 and August, 1997. Two species of Mollomachus Klug, 1841, M. fuscator Perty, 1833 and M. eurycephalus Schletterer, 1890 were collected from May to September. Both species are typical of winter time and showed the same parttern of seasonality.

Survey of the Hymenoptera parasitoids in Eucalyptus grandis and in a native vegetation area in Ipaba, State of Minas Gerais, Brazil

Foi feito um levantamento da fauna de Hymenoptera parasitóides em um transecto eucalipto/vegetação nativa/eucalipto, em Ipaba, Minas Gerais, no período de março de 1997 a março de 1998, com armadilhas Malaise. Foram coletados indivíduos de nove superfamílias (Ceraphronoidea, Chalcidoidea, Chrysidoidea, Cynipoidea, Evanioidea, Ichneumonoidea, Proctotrupoidea, Platygastroidea e Vespoidea), distribuídos em 26 famílias.

Non-volant tetrapods from Reserva Biológica de Duas Bocas, State of Espírito Santo, Southeastern Brazil

A Reserva Biológica de Duas Bocas (2.190 ha) é um dos maiores remanescentes de Mata Atlântica do Estado do Espírito Santo, Sudeste do Brasil. Nós amostramos tetrápodes não voadores nessa área entre maio de 2007 e abril de 2008, utilizando armadilhas de queda, armadilhas de isca, armadilhas fotográficas e buscas oportunísticas diurnas e noturnas. Além disso, nós compilamos registros de vertebrados não voadores ocorrentes nesta área disponíveis na literatura e através de espécimes em museus. Nós documentamos 52 espécies de anfíbios, 24 espécies de répteis não voadores e 39 espécies de mamíferos não voadores. Do total de 115 espécies, 47 configuram novos registros para a área e seis outras espécies tiveram sua distribuição geográfica ampliada com os resultados do presente estudo. Além disso, apresentamos o registro de predação da perereca Hypsiboas faber pela serpente Chironius bicarinatus. Cinco das espécies registradas são listadas como ameaçadas no Estado do Espírito Santo e muitas outras possuem estado de conservação incerto. A Reserva Biológica de Duas Bocas é um importante refúgio de vida selvagem, principalmente quando consideramos a expansão de áreas urbanas no seu entorno.

Processos de exclusão da/na escola no período da Primeira República (1889-1930) no Estado do Espírito Santo

O objetivo desta tese é analisar que práticas de tradução educacional foram feitas em relação às crianças e jovens excluídos da/na escola da Primeira República (1889-1930) no Estado do Espírito Santo. Período este em que a cultura ocidental, mais especificamente a europeia, exercia forte influência nas políticas de regulação e de emancipação do Brasil. Assim constando, na área educacional, muitas das experiências e teorias defendidas e socializadas na Europa foram traduzidas para o Brasil, e por extensão, para o Espírito Santo. Para compreender as traduções na área educacional, situada no contexto da modernidade é que se reportou a Boaventura de Sousa Santos, à luz das ferramentas disponíveis pela Sociologia das Ausências, pela Sociologia das Emergências, bem como o Trabalho de Tradução. A proposta de pesquisa está ancorada numa perspectiva qualitativa de base hermenêutica e, para construir a investigação, foram utilizadas fontes históricas bibliográficas e documentais. As fontes de investigação permitiram explicar parte das possíveis razões para as exclusões da escola ou defesas de segregação (exclusão na escola). Estas exclusões se concentram em torno de cinco tempos: 1909, 1917, 1923, 1924 e 1929. Nos anos de 1909 e 1924, disserta-se pela via educacional, sobre as práticas da área jurídica em relação aos órfãos. A Escola Normal do Espírito Santo, por sua vez, reproduzia a ideia de ordem ao atrelar a Pedagogia à educação cívica. Em 1917, a partir do episódio relativo a uma jovem, associada a um possível caso de loucura/alienação mental, é abordada a influência da área médica na área educacional, no Estado do Espírito Santo. Quanto à década de 20, existiu todo um discurso sobre o estudo da criança, na formação de educadores, como tentativa de apreender a totalidade do ser humano. Algumas práticas de tradução construtivas na área educacional foram evidenciadas, como por exemplo, quando o professor Elpídio Pimentel sugere que os educadores trabalhem com o que o aluno sabe ou poderá aprender. Ao final do trabalho, percebe-se que, muitas exclusões poderiam ter sido evitadas, mas para isso, a sociedade, os educadores teriam que ter adotado uma outra postura em relação às práticas de tradução: talvez uma menos idealizada e que valorizasse o que emergia de potencial nas realidades locais.