No abstract

Valerian did not improve sleep in this sample of older women with insomnia. Findings from this study add to the scientific evidence that does not support use of valerian in the clinical management of insomnia.

Although weight loss in older subjects has been shown to improve insulin sensitivity, it is unclear what effect this lifestyle intervention has on beta-cell function. To determine whether diet-induced weight loss can improve beta-cell function in older subjects, we studied 19 healthy male subjects (age, 65.4 +/- 0.9 yr; body mass index, 30.9 +/- 0.6 kg/m2; mean +/- SEM) before and after a 3-month 1200-kcal/d diet. The insulin sensitivity index (SI) was quantified using Bergman's minimal model. The acute insulin response to glucose (AIRg) and the maximal glucose-potentiated insulin response (AIRmax) were determined and then adjusted for SI (SI x AIRg and SI x AIRmax), thus providing measures of beta-cell function. Subjects demonstrated significant weight loss (95.6 +/- 2.4 to 86.1 +/- 2.5 kg; P < 0.001). Both fasting plasma glucose [97.3 +/- 1.6 to 95.1 +/- 1.3 mg/dl (5.4 +/- 0.09 to 5.3 +/- 0.07 mM); P = 0.05] and insulin [18.5 +/- 1.3 to 12.2 +/- 1.0 microU/ml (110.9 +/- 7.7 to 73.5 +/- 5.9 pM); P < 0.001] levels decreased. With weight loss, SI increased [1.59 +/- 0.24 to 2.49 +/- 0.32 x 10(-4) min(-1)/(microU/ml) (2.65 +/- 0.4 to 4.15 +/- 0.5 x 10(-5) min(-1)/pM); P < 0.001], whereas both AIRg [63.4 +/- 13.4 to 51.0 +/- 10.7 microU/ml (380 +/- 80 to 306 +/- 64 pM); P < 0.05] and AIRmax [314 +/- 31.4 to 259.9 +/- 33.4 microU/ml (1886 +/- 188 to 1560 +/- 200 pM); P < 0.05] decreased. Overall beta-cell function improved (SI x AIRg, 9.63 +/- 2.28 to 12.78 +/- 2.58 x 10(-3) min(-1), P < 0.05; and SI x AIRmax, 51.01 +/- 9.2 to 72.69 +/- 13.4 x 10(-3) min(-1), P < 0.05). Thus, the weight loss-associated improvements in both insulin sensitivity and beta-cell function may explain the beneficial effects of a lifestyle intervention on delaying the development of diabetes in older subjects.

No abstract

No abstract

Insomnia is a commonly reported clinical problem with as many as 50% of older adults reporting difficulty in falling and/or remaining asleep. Valerian (Valeriana officinalis) is a commonly used herb that has been advocated for promoting sleep. Valerenic acid is used as a marker for quantitative analysis of valerian products with evidence of pharmacological activity relevant to the hypnotic effects of valerian. The objective of this study was to determine the pharmacokinetics of valerenic acid in a group of elderly women after receiving a single nightly valerian dose and after 2 weeks of valerian dosing. There was not a statistically significant difference in the average peak concentration (C(max)), time to maximum concentration (T(max)) area under the time curve (AUC), elimination half-life (T(1/2)) and oral clearance after a single dose compared with multiple dosing. There was considerable inter- and intra-subject variability in the pharmacokinetic parameters. C(max) and AUC deceased and T(1/2) increased with increased body weight. The variability between the capsules was extremely low: 2.2%, 1.4% and 1.4%, for hydroxyvalerenic acid, acetoxyvalerenic acid and valerenic acid, respectively. In conclusion, large variability in the pharmacokinetics of valerenic acid may contribute to the inconsistencies in the effect of valerian as a sleep aid.

No abstract

Primary hyperparathyroidism is the commonest causes of hypercalcemia in the outpatient setting with a prevalence of ~0.1-0.2%. In most patients calcium elevation is fortuitously detected during routine blood chemistry analysis. Most (≥80%) of these patients have a solitary adenoma, with the reminder having multi-glandular hyperplasia. Surgical removal of the abnormal gland (s) is the treatment of choice for permanent cure. The traditional surgical approach involves full cervical exploration with identification of all four glands. Localized or minimally invasive surgery relies on localization techniques such as Technetium 99 Sestamibi. We performed high resolution ultrasound (US, 10 Mhz) as the primary modality of localization along with fine needle aspiration biopsy or as a complementary test to Sestamibi scans. The operator was blinded to the result of prior localization if any had been performed. 17 patients were subjected to US examination of the neck, 7 of whom also underwent Sestamibi scans. Average age was 54 years (10 females and 7 males), serum calcium 10.9Ϯ0.08 mg /dl, and serum PTH 123Ϯ12.9 pg/ml. A possible parathyroid adenoma was found by US in all of the subjects, with a calculated volume of 1.037Ϯ0.3cm 3 . Fine needle biopsy syringe washings on these adenomas had a PTH level of 19,959Ϯ7948pg/ml. We also analyzed PTH syringe washings of thyroid nodules that co-existed in patients (n=12) and the average was 11.25Ϯ2.5pg/ml, significantly different (p≤0.0001) from the parathyroid washings. A solitary adenoma was found on US examination in 15/17 subjects, and in all cases the localization was confirmed in the course of minimally invasive surgery. Successful removal was confirmed by a ≥50% fall in the intra-operative PTH level after removal of the identified gland. All patients remain normocalcemic several months after surgery. Two subjects had multiglandular hyperplasia detected by lack of intra-operative PTH fall, these patients underwent four gland explorations. Of the 7 subjects who had also had Sestamibi scans, four of the scans had been negative and one was a false positive as judged by the surgical results. There was no relationship of the level of elevation of PTH in the syringe washing specimen to the volume of the parathyroid gland, serum PTH level, serum calcium level or age of patients. We conclude that cervical US localization of parathyroid adenomas, confirmed by PTH estimation in fine needle aspirates of the adenoma, is an accurate localization technique that is far superior to Sestamibi scanning and allows minimally invasive surgery in most subjects with primary hyperparathyroidism.