OBJECTIVE— To examine whether hyperglycemia at the time of presentation was associated with outcomes in patients admitted to non–intensive care settings with community-acquired pneumonia (CAP). RESEARCH DESIGN AND METHODS— Prospective cohort study of consecutive patients admitted to six hospitals between 15 November 2000 and 14 November 2002. RESULTS— Of the 2,471 patients in this study (median age 75 years), 279 (11%) had serum glucose at presentation >11 mmol/l: 178 of the 401 patients (44%) with a prior diagnosis of diabetes and 101 of the 2,070 patients (5%) without a history of diabetes. Of patients hospitalized with CAP, 9% died and 23% suffered an in-hospital complication. Compared with those with values ≤11 mmol/l, patients with an admission glucose >11 mmol/l had an increased risk of death (13 vs. 9%, P = 0.03) and in-hospital complications (29 vs. 22%, P = 0.01). Compared with those patients with admission glucose ≤6.1 mmol/l, the mortality risk was 73% higher (95% CI 12–168%) and the in-hospital complication risk was 52% higher (12–108%) in patients with admission glucose >11 mmol/l. Even after adjustment for factors in the Pneumonia Severity Index, hyperglycemia on admission remained significantly associated with subsequent adverse outcomes: for each 1-mmol/l increase, risk of in-hospital complications increased 3% (0.2–6%). CONCLUSIONS— Hyperglycemia on admission is independently associated with adverse outcomes in patients with CAP, with the increased risks evident at lower glucose levels than previously reported.
OBJECTIVE -To determine whether arterial compliance of patients with type 1 diabetes is reduced before the development of clinically apparent diabetes complications.RESEARCH DESIGN AND METHODS -Pulse-wave analysis was used to compare vascular compliance between patients with type 1 diabetes and nondiabetic control subjects. Analysis of covariance was used to determine differences between the two groups with adjustment for age if needed.RESULTS -A total of 59 patients with type 1 diabetes were studied; age ranged from 17-61 years. Of the 59 patients, 32 had no evidence of diabetes complications and 27 had microvascular complications. The control group consisted of 57 healthy subjects ranging in age from 23-79 years. In the control group, large artery compliance (C1) and small artery compliance (C2) were inversely proportional to age (r ϭ Ϫ0.55 for C1 and Ϫ0.50 for C2; P Ͻ 0.01). When the control subjects were compared with type 1 diabetic patients without microvascular complications, C1 was 1.51 Ϯ 0.04 (SEM) for the control group and 1.33 Ϯ 0.06 (SE) ml/mmHg for the diabetic group, whereas C2 was 0.080 Ϯ 0.005 (SE) and 0.065 Ϯ 0.005 (SE) ml/mmHg for the control and diabetic subjects, respectively, when adjusted for age (P ϭ 0.03 for both C1 and C2).CONCLUSIONS -Vascular compliance of both the large and small arteries is reduced in type 1 diabetic patients before any clinical complications from the diabetes are evident. This study serves to emphasize that vascular changes occur at an early point in the disease and may increase risk of cardiovascular events in patients with diabetes. Larger prospective studies are required to confirm this finding and to investigate the efficacy of medical intervention. Diabetes Care 24:2102-2106, 2001H ypertension, hypercholesterolemia, and diabetes are well-recognized cardiovascular risk factors (1). Emerging evidence suggests that decreased vascular elasticity and storage capacity of the vessels, also known as vascular compliance, is associated with each of these conditions and may predispose patients to cardiovascular events (2,3). A reduction in arterial compliance is a marker for vascular disease and should prompt a more aggressive approach in managing cardiovascular risk factors (3-6). Several studies have demonstrated diminished arterial compliance in patients with type 1 or type 2 diabetes, which may contribute, in part, to the excess cardiovascular morbidity and mortality associated with these conditions (7-11).Noninvasive technology has enabled the measurement of pulse wave velocity and arterial pulse contour to assess vascular compliance (12,13). Doppler ultrasound has been used to measure pulsewave velocity and aortic compliance, but this method is operator-dependent and more prone to error (12). In addition, Doppler techniques only assess large arteries because measurements are taken from the aorta or the aorta-iliac junction (12). Pulse-wave contour analysis is a reproducible and objective method for determining compliance of both the large and small arteries by using...
The induction of rat hepatic mRNA S11 by L-T3 (T3) is a useful model for studying the mechanisms of thyroid hormone action. Although numerous reports have examined the response of mRNA S11 to various physiological and hormonal manipulations, the role of S11 protein in cellular metabolism remains unknown. In this study we show that mRNA S11 is abundantly expressed and regulated by T3 only in liver and small intestine. High levels of the mRNA are present at birth, but drop sharply between 30-60 days of age. These and other features of the S11 gene product were similar to those of rat apolipoprotein-A1 (Apo-A1). The sequence of S11 cDNA was identical to a portion of the Apo-A1 mRNA, thus confirming identity of the S11 mRNA. To examine whether DNA sequences immediately adjacent to the transcription start site mediate the effects of thyroid hormone, we measured the activity of an Apo-A1 gene fragment, U-1 (-474 to -7) using a transient transfection assay. The activity of the full-length U-1 DNA in HuH-7 hepatoma cells was 2- to 2.5-fold higher in the presence of thyroid hormone. This finding closely matched previous results using the in vitro nuclear run-on assay. Internal deletion of a motif that resembles a thyroid hormone response element from U-1 DNA not only abolished the induction by T3, but suppressed promoter activity by 3- to 4-fold in response to the hormone.(ABSTRACT TRUNCATED AT 250 WORDS)
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