Fibronectin is a major surface-associated glycoprotein of cultured fibroblasts and it is also present in human plasma. Antiserum specific for human fibronectin was used to study the distribution of fibronectin in normal adult human tissues. The protein was detected (a) characteristically in various basement membranes including capillary walls: (b) around individual smooth muscle cells and in the sarcolemma of striated muscle fibers; and (c) in the stroma of lymphatic tissue and as thin fibers in loose connective tissue. The distribution of fibronectin was distinct from that of collagen and elastic fibers, but was very similar to reticulin, as demonstrated by conventional histological staining. The results indicate that fibronectin is a major component of connective tissue matrix. The distribution also indicates that most types of adherent cells abut fibronectin-containing structures. This supports the possible role of fibronectin in cell-cell and cell-matrix interactions in tissues.
Context End-stage renal disease (ESRD) is one of the most severe complications of type 1 diabetes. Yet, data on patients' risk of developing ESRD are sparse. Objectives To estimate the long-term risk of developing ESRD and to assess how age at diagnosis of diabetes, time period of diagnosis, and sex affect the risk. Design, Setting, and Patients A cohort of all patients younger than 30 years diagnosed as having type 1 diabetes in Finland in 1965-1999 (n=20 005) was identified from the Finnish Diabetes Register. The cohort was followed up from diagnosis of diabetes until development of ESRD (dialysis or kidney transplantation as identified from the Finnish Registry for Kidney Diseases), death, or end of follow-up on December 31, 2001. Main Outcome Measure Cumulative incidence of ESRD, accounting for death as a competing risk. Results The cohort was followed up for maximally 37 years, with a median of 16.7 years. During 346 851 person-years, 632 patients developed ESRD. The cumulative incidence of ESRD was 2.2% at 20 years and 7.8% at 30 years after diagnosis. The risk of developing ESRD was lowest in patients whose diagnosis occurred at younger than 5 years. The risk of ESRD was lower for patients diagnosed as having type 1 diabetes in later years. The risk did not differ significantly between sexes. Conclusions With regard to ESRD, the prognosis of type 1 diabetes has improved during the past 4 decades. Children diagnosed as having diabetes before age 5 years have the most favorable prognosis. Overall, incidence of ESRD appears to be lower than previously estimated.
Objective. To search for an association between gut infection, gut inflammation, and spondylarthropathies.Methods. Ileocolonoscopy was performed in 118 patients with various inflammatory and noninflammatory joint diseases and in 24 patients with uncomplicated acute bacterial gastroenteritis.Results. Endoscopic lesions were more frequent in patients with spondylarthropathy (44%) compared with those with other inflammatory arthritides (6%; P = 0.001). Ileal changes were observed only in patients with spondylarthropathy (20% versus 0%; P = 0.01).Inflammatory bowel disease was the endoscopic diagnosis in 19% of the arthritis patients. Possible or definite Crohn's disease was diagnosed in 26% of patients with chronic spondylarthropathy, and ulcerative colitis in 1 patient with rheumatoid arthritis and in 1 with chronic uroarthritis. Histologic evidence of inflammation differed less distinctly than endoscopy findings between patient groups. There was no association of gut lesions with the use of nonsteroidal antiinflammatory drugs or with the presence of HLA-B27.
The effects of 15 g guar gum/d on glycemic control, lipids, and insulin secretion were studied in 15 (8 male, 7 female) diet-treated subjects with non-insulin-dependent diabetes mellitus for 48 wk. Mean age (+/- SD) was 60 +/- 2 y (range 45-70 y), body mass index (in kg/m2) 28.6 +/- 0.9 (range 21.6 +/- 39.2), and duration of diabetes 6 +/- 1 y (range 2-14 y). Guar gum was preceded and followed by 8-wk placebo periods. Guar gum improved long-term glycemic control, postprandial glucose tolerance and lipid concentrations. The C-peptide response to a test meal increased by time during guar gum treatment, whereas the insulin response remained unchanged. This indicates that insulin secretion is enhanced by guar gum as reflected by increased C-peptide. A decreased molar ratio of insulin to C-peptide suggests that guar gum may increase hepatic insulin extraction. In conclusion, guar gum has favorable long-term effects on glycemic control and lipid concentrations.
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