Glycemic Control in Diabetic Pregnancies: Effects on Fetal and Maternal Outcome

Background: Both maternal and fetal complications are increased in diabetic pregnancies. Although hypertensive complications are increased in pregnant women with pregestational diabetes, reports on hypertensive complications in women with gestational diabetes mellitus (GDM) have been contradictory. Congenital malformations and macrosomia are the main fetal complications in Type 1 diabetic pregnancies, whereas fetal macrosomia and birth trauma but not congenital malformations are increased in GDM pregnancies. Aims: To study the frequency of hypertensive disorders in gestational diabetes mellitus. To evaluate the risk of macrosomia and brachial plexus injury (Erb’s palsy) and the ability of the 2-hour glucose tolerance test (OGTT) combined with the 24-hour glucose profile to distinguish between low and high risks of fetal macrosomia among women with GDM. To evaluate the relationship between glycemic control and the risk of fetal malformations in pregnancies complicated by Type 1 diabetes mellitus. To assess the effect of glycemic control on the occurrence of preeclampsia and pregnancy-induced hypertension in Type 1 diabetic pregnancies. Subjects: A total of 986 women with GDM and 203 women with borderline glucose intolerance (one abnormal value in the OGTT) with a singleton pregancy, 488 pregnant women with Type 1 diabetes (691 pregnancies and 709 offspring), and 1154 pregnant non-diabetic women (1181 pregnancies and 1187 offspring) were investigated. Results: In a prospective study on 81 GDM patients the combined frequency of preeclampsia and PIH was higher than in 327 non-diabetic controls (19.8% vs 6.1%, p<0.001). On the other hand, in 203 women with only one abnormal value in the OGTT, the rate of hypertensive complications did not differ from that of the controls. Both GDM women and those with only one abnormal value in the OGTT had higher pre-pregnancy weights and BMIs than the controls. In a retrospective study involving 385 insulin-treated and 520 diet-treated GDM patients, and 805 non-diabetic control pregnant women, fetal macrosomia occurred more often in the insulin-treated GDM pregnancies (18.2%, p<0.001) than in the diet-treated GDM pregnancies (4.4%), or the control pregnancies (2.2%). The rate of Erb’s palsy in vaginally delivered infants was 2.7% in the insulin-treated group of women and 2.4% in the diet-treated women compared with 0.3% in the controls (p<0.001). The cesarean section rate was more than twice as high (42.3% vs 18.6%) in the insulin-treated GDM patients as in the controls. A major fetal malformation was observed in 30 (4.2%) of the 709 newborn infants in Type 1 diabetic pregnancies and in 10 (1.4%) of the 735 controls (RR 3.1, 95% CI 1.6–6.2). Even women whose levels of HbA1c (normal values less than 5.6%) were only slightly increased in early pregnancy (between 5.6 and 6.8%) had a relative risk of fetal malformation of 3.0 (95% CI 1.2–7.5). Only diabetic patients with a normal HbA1c level (<5.6%) in early pregnancy had the same low risk of fetal malformations as the controls. Preeclampsia was diagnosed in 12.8% and PIH in 11.4% of the 616 Type 1 diabetic women without diabetic nephropathy. The corresponding frequencies among the 854 control women were 2.7% (OR 5.2; 95% CI 3.3–8.4) for preeclampsia and 5.6% (OR 2.2, 95% CI 1.5–3.1) for PIH. Multiple logistic regression analysis indicated that glycemic control, nulliparity, diabetic retinopathy and duration of diabetes were statistically significant independent predictors of preeclampsia. The adjusted odds ratios for preeclampsia were 1.6 (95% CI 1.3–2.0) for each 1%-unit increment in the HbA1c value during the first trimester and 0.6 (95% CI 0.5–0.8) for each 1%-unit decrement during the first half of pregnancy. In contrast, changes in glycemic control during the second half of pregnancy did not alter the risk of preeclampsia. Conclusions: In type 1 diabetic pregnancies it is extremely important to achieve optimal glycemic control before pregnancy and maintain it throughout pregnancy in order to decrease the complication rates both in the mother and in her offspring. The rate of fetal macrosomia and birth trauma in GDM pregnancies, especially in the group of insulin-treated women, is still relatively high. New strategies for screening, diagnosing, and treatment of GDM must be developed in order to decrease fetal and neonatal complications.

First-Line afatinib versus chemotherapy in patients with non–small cell lung cancer and common epidermal growth factor receptor gene mutations and brain metastases

Introduction Metastatic spread to the brain is common in patients with non–small cell lung cancer (NSCLC), but these patients are generally excluded from prospective clinical trials. The studies, phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations (LUX-Lung 3) and a randomized, open-label, phase III study of BIBW 2992 versus chemotherapy as first-line treatment for patients with stage IIIB or IV adenocarcinoma of the lung harbouring an EGFR activating mutation (LUX-Lung 6) investigated first-line afatinib versus platinum-based chemotherapy in epidermal growth factor receptor gene (EGFR) mutation-positive patients with NSCLC and included patients with brain metastases; prespecified subgroup analyses are assessed in this article. Methods For both LUX-Lung 3 and LUX-Lung 6, prespecified subgroup analyses of progression-free survival (PFS), overall survival, and objective response rate were undertaken in patients with asymptomatic brain metastases at baseline (n = 35 and n = 46, respectively). Post hoc analyses of clinical outcomes was undertaken in the combined data set (n = 81). Results In both studies, there was a trend toward improved PFS with afatinib versus chemotherapy in patients with brain metastases (LUX-Lung 3: 11.1 versus 5.4 months, hazard ratio [HR] = 0.54, p = 0.1378; LUX-Lung 6: 8.2 versus 4.7 months, HR = 0.47, p = 0.1060). The magnitude of PFS improvement with afatinib was similar to that observed in patients without brain metastases. In combined analysis, PFS was significantly improved with afatinib versus with chemotherapy in patients with brain metastases (8.2 versus 5.4 months; HR, 0.50; p = 0.0297). Afatinib significantly improved the objective response rate versus chemotherapy in patients with brain metastases. Safety findings were consistent with previous reports. Conclusions These findings lend support to the clinical activity of afatinib in EGFR mutation–positive patients with NSCLC and asymptomatic brain metastases.

Search for new color-octet vector particle decaying to t tbar in p pbar collisions at sqrt{s} = 1.96 TeV

We present the result of a search for a massive color-octet vector particle, (e.g. a massive gluon) decaying to a pair of top quarks in proton-antiproton collisions with a center-of-mass energy of 1.96 TeV. This search is based on 1.9 fb$^{-1}$ of data collected using the CDF detector during Run II of the Tevatron at Fermilab. We study $t\bar{t}$ events in the lepton+jets channel with at least one $b$-tagged jet. A massive gluon is characterized by its mass, decay width, and the strength of its coupling to quarks. These parameters are determined according to the observed invariant mass distribution of top quark pairs. We set limits on the massive gluon coupling strength for masses between 400 and 800 GeV$/c^2$ and width-to-mass ratios between 0.05 and 0.50. The coupling strength of the hypothetical massive gluon to quarks is consistent with zero within the explored parameter space.

Purification and properties of β-glucosidase from a thermophilic fungus Humicola lanuginosa (Griffon and Maublanc) Bunce

An extracellular β-glucosidase (EC 3.2.1.21) has been purified to homogeneity from the culture filtrate of a thermophilic fungus, Humicola lanuginosa (Griffon and Maublanc) Bunce, using duplicating paper as the carbon source. The enzyme was purified 82-fold with a 43% yield by ion-exchange chromatography and gel filtration. The molecular weight of the protein was estimated to be 135,000 by gel filtration and 110,000 by electrophoresis. The sedimentation coefficient was 10.5 S. It was an acidic protein containing high amounts of acidic amino acid residues. It was poor in sulphur-containing amino acids. It also contained 9% carbohydrate. The enzyme activity was optimum at pH 4.5 and at 60°C. The enzyme was stable in the pH range 6–9 for 24 h at 25°C. The enzyme had similar affinities towards cellobiose and p-nitrophenyl-β-d-glucoside with Km values of 0.44 mM and 0.50 mM, respectively. The enzyme was capable of hydrolysing larchwood xylan, xylobiose and p-nitrophenyl-β-d-xyloside, though to a lesser extent. The enzyme was specific for the β-configuration and glucose moiety in the substrate.

Kymmenen koirarodun perinnöllinen monimuotoisuus

Tämän tutkimuksen tavoitteena oli selvittää koirarotujen sisäistä ja välistä perinnöllistä muuntelua ja populaatioiden rakenteita. Tutkimuksessa käytettiin Finnzymes Oy:ltä saatua koirien mikrosatelliittimerkkeihin perustuvaa genotyypitysaineistoa. Lopullisessa aineistossa oli 395 koiraa kymmenestä keskenään varsin erilaisesta rodusta. Koirien määrä rotua kohti vaihteli 31:stä 53:een. Tutkimuksessa käytettiin 18 mikrosatelliittilokusta. Alleelirikkaus vaihteli mikrosatelliittilokuksissa välillä 2,0 – 9,9. Kaikkein muuntelevin lokus oli AHT137 ja vähiten muunteleva AHTk211. Jackrussellinterrierin alleelirikkaus oli yli kaikkien lokusten tarkasteltuna suurinta ja cavalier kingcharlesinspanielin pienintä. Eniten Hardy-Weinbergin tasapainosta poikkeavia mikrosatelliittilokuksia oli schipperke- rodulla. Coton de tulearin, saksanpaimenkoiran ja suomenlapinkoiran kaikki mikrosatelliittilokukset olivat Hardy-Weinbergin tasapainossa. Cavalier kingcharlesinspanielin havaittu heterotsygotia-aste oli matalin kaikkien lokusten yli tarkasteltuna (0,50) ja suomenlapinkoiran korkein (0,73). Ainoat tilastollisesti merkitsevät FIS-arvot olivat schipperken lokuksessa INU030 (0,39) ja kaikkien lokusten yli tarkasteltuna (0,11). Eniten populaatioiden välisiin eroihin perustuvaa muuntelua oli cavalier kingcharlesinspanielin ja pitkäkarvaisen collien välillä (FST = 0,34) ja vähiten chihuahuan ja coton de tulearin välillä (FST = 0,07). Koko aineistossa noin 17,7 % populaatioiden välisestä geneettisestä muuntelusta johtui populaatioiden välisistä eroista. Rodut ovat tulosten perusteella selvästi erillisiä populaatioita. Coton de tulearin alleeliparit olivat selvästi eniten kytkentäepätasapainossa keskenään (94) ja tiibetinspanielin vähiten (15). Pitkäkarvaisen collien tehollinen populaatiokoko oli pienin (35) ja chihuahuan suurin (86). U seiden populaatiogeneettisten tunnuslukujen perusteella nousivat esiin cavalier kingcharlesinspanieli, pitkäkarvainen collie ja schipperke perinnöllisen muuntelun vähäisyyden perusteella ja chihuahua, jackrussellinterrieri ja suomenlapinkoira keskimääräistä suuremman perinnöllisen muuntelun perusteella. Selityksiä geneettisen monimuotoisuuden vaihteluun näillä roduilla löytyy rotujen historiasta.

Photochemical, photophysical, and theoretical studies on cyclobutanethiones..alpha.-Cleavage reactions

Photophysics and photochemistry of cyclobutanethiones 1-5 have been studied with the view to generalize the a-cleavage reactions of cyclobutanethiones. The above cyclobutanethiones possess a unit intersystem crossing efficiency from S1 to T1, a high self-quenching rate (-4 X lo9 M-' s-'), and a short triplet lifetime (<0.50 ws). Photolysis of 1-5 yields in benzene a product resulting from 1,3-transposition and in methanol two cyclic thioacetals.The origin of these products is traced to the triplet excited state. A mechanistic scheme involving a-cleavage as the primary photoprocess and diradicals and thiacarbenes as intermediates has been formulated to rationalize the formation of thioacetals and rearranged products. The proposed mechanistic scheme is supported by UHF MIND013 calculations performed on four model systems, cyclobutanethiones and 1,3-cyclobutanedithiones 18-21. These calculations indicate that formation of diradical is favored thermodynamically and kinetically for systems analogous to 19 and 21, while rearrangement to thiacarbene is likely only for those similar to 21.

Ionic conductivity and dielectric measurements in single crystal β---AgI

Ionic conductivity measurements have been made on pure, copper-doped and cadmium-doped single crystals. Dielectric measurements in the frequency range 30Hz–100Hz showed that there was no anomalously to be (0.64 ± 0.02) eV and migration energies for silver ion intersitials and vacancies in the c direction to be (0.41 ± 0.02) eV and (0.50 ± 0.02) eV respectively. ESR measurements have shown that copper exists as Cu+ in these crystals. Dielectric measurements in the frequency range (OHz–100KHz showed that there was no anomalously high value for ε as reported earlier.

Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.

Metastable extension of the fluorite phase field in Y2O3---ZrO2 and its effect on grain growth

Pure Y2O3 and Y2O3-ZrO2 solid solutions have been prepared by melt atomization and by pyrolysis of nitrate solutions. Extended solubility is readily achieved in both techniques for the entire composition range investigated: melts with 0-30% ZrO2 and precursors with 0-50% ZrO2. However, solidification of under cooled droplets yields almost exclusively single phase powders with the structure of cubic yttria (D5(3)). In contrast, the pyrolysis route leads to a sequence of metastable microstructures beginning with a nanocrystalline disordered fluorite-based (C1) solid solution. Further heating leads to the evolution of much larger (micron size) flake crystals with a {001} texture, concurrent with partial ordering of the oxygen ions to the sites occupied in the D5(3) structure. The driving force for ordering and the rate of grain growth decrease with increasing ZrO2 addition. Abrupt heating to high temperatures or electron irradiation can induce ordering without substantial grain growth. There is no significant reduction in porosity during the recrystallization, which with the other observations suggests that grain growth is driven by the free energy available for the ordering transformation from fluorite to the yttria structure. This route offers opportunities for single crystal thin film development at relatively low processing temperatures.

Synthesis and thermal expansion hysteresis of Ca1-xSrxZr4P6O24

The low thermal expansion ceramic system, Ca1-xSrxZr4P6O24, for the compositions with x = 0, 0.25, 0.50, 0.75 and 1 was synthesized by solid-state reaction. The sintering characteristics were ascertained by bulk density measurements. The fracture surface microstructure examined by scanning electron microscopy showed the average grain size of 2.47 mum for all the compositions. The thermal expansion data for these ceramic systems over the temperature range 25-800degreesC is reported. The sinterability of various solid solutions and the hysteresis in dilatometric behaviour are shown to be related to the crystallographic thermal expansion anisotropy. A steady increase in the amount of porosity and critical grain size with increase in x is suggested to explain the observed decrease in the hysteresis.

Electron beam surface melting of model 1200 Al alloys

Electron beam surface melting has been used to characterise the phase content formed in a number of model 1200 series Al alloys with increasing solidification velocity in the range 2–50 mm s−1, typical of that experienced during continuous strip casting. Phases were extracted from the Al matrix and analysed by X-ray diffraction. A qualitative solidification microstructure selection map has been produced, showing that, for a given Fe content of 0.55 wt.%: with increasing solidification velocity the metastable aluminides FeAl6 and FeAlm displace equilibrium Fe4Al13 at Si contents milar0.15 wt.%, and that α-AlFeSi displaces these Fe aluminides at Si contents >0.15 wt.%, and that α-AlFeSi is an equilibrium phase at a Si content ≥0.50 wt.%.

Synthesis, Structure, Negative Thermal Expansion, and Photocatalytic Property of Mo Doped ZrV(2)O(7)

A new series of compounds identified in the phase diagram of ZrO(2)-V(2)O(8)-MoO(3) have been synthesized via the solution combustion method. Single crystals of one of the compounds in the series, ZrV(1.50)Mo(0.50)O(7.25), were grown by the melt-cool technique from the starting materials with double the MoO(3) quantity. The room temperature average crystal structure of the grown crystals was solved using the single crystal X-ray diffraction technique. The crystals belong to the cubic crystal system, space group Pa (3) over bar (No. 205) with a = 8.8969 (4) angstrom, V = 704.24 (6) angstrom(3), and Z = 4. The final R(1) value of 0.0213 was achieved for 288 independent reflections during the structure refinement. The Zr(4+) occupies the special position (4a) whereas V(5+) and Mo(6+) occupy two unique (8c) Wyckoff positions. Two fully occupied O atoms, (24d) and (4b), one partially occupied 0 atom (8c) have been identified for this molybdovanadate, which is a unique feature for these crystals. The structure is related to both ZrV(2)O(7) and cubic ZrMo(2)O(8). The temperature dependent single crystal studies show negative thermal expansion above 370 K. The compounds have been characterized by powder X-ray diffraction, solid-state UV-vis diffuse reflectance spectra, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). The photocatalytic activity of these compounds has been investigated for the degradation of various dyes, and these compounds show specificity toward the degradation of non-azoic dyes.

Ba(3)(P(1-x)Mn(x)O(4))(2): Blue/green inorganic materials based on tetrahedral Mn(V)

We describe a blue/green inorganic material, Ba(3)(P(1-x)-Mn(x)O(4))(2) (I) based on tetrahedral MnO(4)(3-):3d(2) chromophore. The solid solutions (I) which are sky-blue and turquoise-blue for x <= 0.25 and dark green for x >= 0-50, are readily synthesized in air from commonly available starting materials, stabilizing the MnO(4)(3-) chromophore in an isostructural phosphate host. We suggest that the covalency/ionicity of P-O/Mn-O bonds in the solid solutions tunes the crystal field strength around Mn(V) such that a blue colour results for materials with small values of x. The material could serve as a nontoxic blue/green inorganic pigment.

Structural and dielectric characteristics of Bi2O3-TiO2-SrB4O7 glasses

Glasses of the composition 0.20 Bi2O3 - 0.30 TiO2 - 0.50 SrB4O7 and 0.30 Bi2O3 - 0.45 TiO2 - 0.25 SrB4O7 have been fabricated by conventional glass processing technique. These glasses have been characterized using X-ray powder diffraction (XRD), differential thermal analysis (DTA) and high resolution transmission electron microscopy (HRTEM). The frequency response of the dielectric constant and the loss tangent of these glasses has been studied. The formation of the crystalline bismuth titanate, Bi4Ti3O12 (BiT) phase in the heat treated samples has been confirmed by XRD and HRTEM studies. The measured ET Of the glass-ceramics are found to be in good agreement with those predicted by the logarithmic mixture rule. Optical second harmonic generation (SHG) at 1064 nm has been observed in the heat treated samples and is attributed to the formation of crystalline Bi4Ti3O12 (BiT) phase in the SrB4O7 (SBO) matrix.

Defluoridation of Drinking Water and Rainwater Harvesting Using a Solar Still

When people drink water having a fluoride (F-) concentration >1-1.5 mg/L for a long period of time, various ailments that are collectively referred to as fluorosis occur. Based on the design of Thomas (http://www.planetkerala.org), an inclined basin-type solar still containing sand and water has been used at Bangalore for defluoridation. For water samples having a fluoride concentration in the range 5-20 mg/L, the fluoride concentration in the distillate was usually <1.5 mg/L. During the periods October 2006 May 2007 and October 2007 May 2008, the volume of distillate showed a significant diurnal variation, ranging from 0.3 to 4.0 L/m(2).day. Based on the figures for 2006, the cost of the still was about Rs. 850 (US$16) for collector areas in the range 0.50-0.57 m(2). The occurrence of F- in the distillate merits further investigation. Overall, the still effectively removes F-, but a large area of the collector, in the range 2.5-25 m(2), is needed to produce about 10 L of distilled water for cooking and drinking. Rainwater falling on the upper surface of the still was collected, and its fluoride concentration was found to be below the desirable limit of 1 mg/L. Hence it can also be used for cooking and drinking.