Hypoglycemia-associated changes in the electroencephalogram in patients with type 1 diabetes and normal hypoglycemia awareness or unawareness

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Sejling, Anne-Sophie; Kjær, Troels W; Pedersen-Bjergaard, Ulrik

2015-01-01

Hypoglycemia is associated with increased activity in the low-frequency bands in the electroencephalogram (EEG). We investigated whether hypoglycemia awareness and unawareness are associated with different hypoglycemia-associated EEG changes in patients with type 1 diabetes.Twenty-four patients...... and hypoglycemia symptom scores were recorded and the counterregulatory hormonal response was measured.Quantitative EEG analysis showed that the absolute amplitude of the theta band and alpha-theta band up to doubled during hypoglycemia with no difference between the two groups. In the recovery period the theta...

Norepinephrine kinetics during insulin-induced hypoglycemia

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Hilsted, J; Christensen, N J; Larsen, S

1985-01-01

Norepinephrine (NE) kinetics (plasma appearance rate, clearance, and forearm extraction) were measured during insulin-induced hypoglycemia in six healthy subjects. NE clearance did not change during hypoglycemia, indicating that the increase in plasma NE during hypoglycemia is due to an increased...

Prevention of hypoglycemia-induced neuronal death by minocycline

Science.gov (United States)

2012-01-01

Diabetic patients who attempt strict management of blood glucose levels frequently experience hypoglycemia. Severe and prolonged hypoglycemia causes neuronal death and cognitive impairment. There is no effective tool for prevention of these unwanted clinical sequelae. Minocycline, a second-generation tetracycline derivative, has been recognized as an anti-inflammatory and neuroprotective agent in several animal models such as stroke and traumatic brain injury. In the present study, we tested whether minocycline also has protective effects on hypoglycemia-induced neuronal death and cognitive impairment. To test our hypothesis we used an animal model of insulin-induced acute hypoglycemia. Minocycline was injected intraperitoneally at 6 hours after hypoglycemia/glucose reperfusion and injected once per day for the following 1 week. Histological evaluation for neuronal death and microglial activation was performed from 1 day to 1 week after hypoglycemia. Cognitive evaluation was conducted 6 weeks after hypoglycemia. Microglial activation began to be evident in the hippocampal area at 1 day after hypoglycemia and persisted for 1 week. Minocycline injection significantly reduced hypoglycemia-induced microglial activation and myeloperoxidase (MPO) immunoreactivity. Neuronal death was significantly reduced by minocycline treatment when evaluated at 1 week after hypoglycemia. Hypoglycemia-induced cognitive impairment is also significantly prevented by the same minocycline regimen when subjects were evaluated at 6 weeks after hypoglycemia. Therefore, these results suggest that delayed treatment (6 hours post-insult) with minocycline protects against microglial activation, neuronal death and cognitive impairment caused by severe hypoglycemia. The present study suggests that minocycline has therapeutic potential to prevent hypoglycemia-induced brain injury in diabetic patients. PMID:22998689

Hypoglycemia and severe lactic acidosis in a dog following metformin exposure

OpenAIRE

Barrella, Nicole; Eisenberg, Beth; Simpson, Stephanie Nicole

2017-01-01

Key Clinical Message Hypoglycemia and lactic acidosis are rare complications with metformin use in humans. As metformin is not commonly used in veterinary medicine, severe adverse effects secondary to exposure are not known. Awareness of potentially life‐threatening complications with metformin exposure is an important addition to the veterinary literature.

Rituximab induced hypoglycemia in non-Hodgkin's lymphoma

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Lali V

2006-12-01

Full Text Available Abstract Background Hypoglycemia is a vary rare toxicity of rituximab. The exact mechanism of rituximab induced hypoglycemia is not clear. Case presentation A 50 year old female presented with a left tonsillar non Hodgkin's lymphoma and was started on R-CHOP chemotherapy. Twenty four hours after the first rituximab infusion, she developed hypoglycemia which was managed by IV glucose infusion. Conclusion Hypoglycemia following rituximab administration is rare. Possibilities of hypoglycemia should be kept in mind in patients developing symptoms like fatigue, restlessness, and sweating while on rituximab therapy.

Individual and societal consequences of hypoglycemia

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Dømgaard, Mikala; Bagger, Malene; Rhee, Nicolai Alexander

2015-01-01

BACKGROUND: Hypoglycemia and fear of hypoglycemia threaten individuals' ability to work and drive. We studied the effect of hypoglycemia on the individual and society, with a focus on possible implications of new European union legislation on patients' continued ability to drive. METHODS: A cross......-sectional survey of Danish Diabetes Association members was conducted to investigate individual and societal consequences of hypoglycemia. RESULTS: A total of 3117/9951 individuals with type 1 diabetes (T1DM) (32.2%) or type 2 diabetes (T2DM) (67.8%) completed the survey. The calculated incidence rates of self...

Diagnosis of insulinoma in a patient with hypoglycemia without obvious hyperinsulinemia.

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Coelho, Catarina; Druce, Maralyn R; Grossman, Ashley B

2009-11-01

A 41-year-old Maltese woman with a 12-month history of severe, morning episodes of confusion, blurred vision and sweating was referred to a specialist center for evaluation of fasting hypoglycemia. She was not taking medication and did not report any prior personal or familial history of endocrinopathy or other relevant pathology. Measurement of plasma glucose, insulin, C-peptide, and beta-hydroxybutyrate concentrations during a prolonged supervised fast; sulfonylurea screen; CT, MRI scan and endoscopic ultrasonography of the pancreas; calcium stimulation test; surgical exploration and intra-operative ultrasonography of the pancreas. Insulin-secreting lesion (insulinoma) in the tail of the pancreas. The tumor was resected with cure of symptoms.

Doege-Potter syndrome presenting with hypoinsulinemic hypoglycemia in a patient with a malignant extrapleural solitary fibrous tumor: a case report

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Schutt Robert C

2013-01-01

Full Text Available Abstract Introduction Doege-Potter syndrome is a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia secondary to a solitary fibrous tumor. This tumor causes hypoglycemia by the secretion of a prohormone form of insulin-like growth factor II. We describe the diagnosis and management of Doege-Potter syndrome and the use of transarterial chemoembolization in a patient with a malignant extrapleural solitary fibrous tumor. Case presentation Our patient was a 64-year-old Caucasian woman who initially presented with urinary incontinence and was found to have a 14.5×9.0×9.0cm retroperitoneal solitary fibrous tumor compressing her bladder. Her tumor was surgically resected but recurred with multiple hepatic metastatic lesions. The hepatic metastases progressed despite systemic chemotherapy and treatment with doxorubicin transarterial chemoembolization. Her course was complicated by the development of recurrent fasting hypoglycemia, most likely secondary to Doege-Potter syndrome. Her hypoglycemia was managed with corticosteroid therapy and frequent scheduled nutrient intake overnight. Conclusions The rarity of hepatic solitary fibrous tumors and consequent lack of controlled trials make this report significant in that it describes the diagnostic approach to Doege-Potter syndrome, describes our experience with the use of doxorubicin transarterial chemoembolization, and presents management options for tumor-associated hypoglycemia in the case of extensive disease not amenable to surgical resection.

Laparoscopic Adjustable Gastric Banding and Hypoglycemia

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Sigrid Bairdain

2013-01-01

Full Text Available Obesity is commonplace, and surgical treatment usually includes Roux-en-Y gastric bypasses (RYGBs. RYGBs have the most documented side effects including vitamin deficiencies, rebound weight gain, and symptomatic hypoglycemia; fewer series exist describing hypoglycemia following other bariatric operations. We reviewed all patients undergoing laparoscopic adjustable gastric banding (LAGB at our institution between 2008 and 2012. Three patients were identified to have symptomatic hypoglycemia following LAGB. Mean time from surgery was 33 months (range 14–45 months, and mean weight loss was 32.7 kg (range 15.9–43.1 kg. None of the patients had preexisting diabetes. Therefore, symptomatic hypoglycemia should be investigated irrespective of bariatric operation.

Glucose counterregulation in diabetes secondary to chronic pancreatitis

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Larsen, S; Hilsted, J; Philipsen, E K

1990-01-01

Glucose counterregulation and hormonal responses after insulin-induced hypoglycemia were investigated in six patients with diabetes mellitus secondary to chronic pancreatitis, in seven with insulin-dependent (type I) diabetes mellitus, and in seven healthy subjects. Glucose counterregulation...... was identical in type I patients and in the patients with chronic pancreatitis, whereas both groups had impaired glucose recovery compared with the healthy subjects. The patients with chronic pancreatitis had no glucagon response to hypoglycemia, whereas epinephrine increased significantly. In an additional...... experiment, glucose recovery did not occur after hypoglycemia during concomitant beta-adrenoceptor blockade in these patients. In conclusion, glucose counterregulation is preserved but slightly impaired in patients with diabetes secondary to chronic pancreatitis, and the combination of total glucagon...

Hypoglycemia, chronic kidney disease, and diabetes mellitus.

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Alsahli, Mazen; Gerich, John E

2014-11-01

Hypoglycemia is a major problem associated with substantial morbidity and mortality in patients with diabetes and is often a major barrier to achieving optimal glycemic control. Chronic kidney disease not only is an independent risk factor for hypoglycemia but also augments the risk of hypoglycemia that is already present in people with diabetes. This article summarizes our current knowledge of the epidemiology, pathogenesis, and morbidity of hypoglycemia in patients with diabetes and chronic kidney disease and reviews therapeutic considerations in this situation. PubMed and MEDLINE were searched for literature published in English from January 1989 to May 2014 for diabetes mellitus, hypoglycemia, chronic kidney disease, and chronic renal insufficiency. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia.

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Hosagasi, Nihan Hilal; Aydin, Mustafa; Zenciroglu, Aysegul; Ustun, Nuran; Beken, Serdar

2017-11-15

Hypoglycemia is low blood glucose level that may negatively affect neurological and developmental prognosis. The American Academy of Pediatrics (AAP), Committee on Fetus and Newborn defined the safe glucose concentrations in the 2011 guideline for newborns at risk for hypoglycemia. This study aimed to investigate the incidence and associated risk factors for hypoglycemia in newborn infants having risk and to assess compliance with the AAP guideline. According to 2011 AAP guideline for hypoglycemia, the newborns at risk for hypoglycemia included in this study were divided to four groups [infant of diabetic mother (IDM), large-for-gestational-age (LGA) infants, small-for-gestational-age (SGA) infants, and late preterm infants (LPI)]. Of the 207 newborn infants, there were 12 cases in IDM group (5.7%), 79 cases in LGA group (38.1%), 66 cases in SGA group (31.8%) and 50 cases in LPI group (24.1%). The incidences of hypoglycemia in these four groups were 2 (16.6%), 10 (12.7%), 8 (12.2%) and 17 (34%), respectively. Although the gender, delivery method, birth weight and 5-min Apgar score at 5-min were not found to be associated with hypoglycemia (P > 0.05), lower gestational age was determined to be associated with higher incidence of hypoglycemia (P = 0.02). Median first feeding time was 55 min and time between first nutrition and blood glucose measurement was 30 min in all cases. Highest risk for hypoglycemia in early postnatal period was present especially in LPI group. Our compliance levels with the AAP guideline was found to be satisfactory. Copyright © 2017. Published by Elsevier B.V.

Impact of Hypoglycemia on Brain Metabolism During Diabetes.

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Rehni, Ashish K; Dave, Kunjan R

2018-04-10

Diabetes is a metabolic disease afflicting millions of people worldwide. A substantial fraction of world's total healthcare expenditure is spent on treating diabetes. Hypoglycemia is a serious consequence of anti-diabetic drug therapy, because it induces metabolic alterations in the brain. Metabolic alterations are one of the central mechanisms mediating hypoglycemia-related functional changes in the brain. Acute, chronic, and/or recurrent hypoglycemia modulate multiple metabolic pathways, and exposure to hypoglycemia increases consumption of alternate respiratory substrates such as ketone bodies, glycogen, and monocarboxylates in the brain. The aim of this review is to discuss hypoglycemia-induced metabolic alterations in the brain in glucose counterregulation, uptake, utilization and metabolism, cellular respiration, amino acid and lipid metabolism, and the significance of other sources of energy. The present review summarizes information on hypoglycemia-induced metabolic changes in the brain of diabetic and non-diabetic subjects and the manner in which they may affect brain function.

Spontaneous Hypoglycemia After Islet Autotransplantation for Chronic Pancreatitis.

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Lin, Yu Kuei; Faiman, Charles; Johnston, Philip C; Walsh, R Matthew; Stevens, Tyler; Bottino, Rita; Hatipoglu, Betul A

2016-10-01

Spontaneous hypoglycemia has been reported in patients after total pancreatectomy (TP) and islet autotransplantation (IAT) with maintained insulin independence. Details surrounding these events have not been well described. The objective of the study was to determine the frequency and characteristics of spontaneous hypoglycemia in patients undergoing TP-IAT and/or to ascertain predictive or protective factors of its development. This was an observational cohort study in 40 patients who underwent TP-IAT from August 2008 to May 2014, with a median follow-up of 34 months. The study was conducted at a single institution (Cleveland Clinic). Patients included recipients of TP-IAT. The intervention included small, frequent meals in those patients who developed spontaneous hypoglycemia. Incidence of spontaneous hypoglycemia development, characteristics of the patients developing hypoglycemia, and their response to small, frequent meals were measured. Six of 12 patients, who maintained insulin independence, developed spontaneous hypoglycemia. The episodes could be fasting, postprandial, and/or exercise associated, with the frequency ranging from two to three times daily to once every 1-2 weeks. All patients experienced at least one episode that required external assistance, glucagon administration, and/or emergent medical attention. Patients who developed hypoglycemia had a lower median age and tended to have a lower median islet equivalent/kg body weight but a higher median total islet equivalent, body mass index, and homeostatic model assessment for insulin resistance score. All patients who received small, frequent meal intervention had improvement in severity and/or frequency of the hypoglycemic episodes. Spontaneous hypoglycemia is prevalent after TP-IAT. Although the underlying pathophysiology responsible for these hypoglycemia events remains to be elucidated, small, frequent meal intervention is helpful in ameliorating this condition.

Screening for Hypoglycemia in Exclusively Breastfed High-risk Neonates.

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Singh, Princy; Upadhyay, Amit; Sreenivas, Vishnubhatla; Jaiswal, Vijay; Saxena, Pranjali

2017-06-15

To determine incidence of hypoglycemia in exclusively breastfed, high-risk but healthy newborns, and risk factors for its development. This observational study enrolled 407 exclusively breastfed high-risk (low birth weight newborns (1800-2499 g), late preterms, small-for-gestation, large-for-gestation and infant of diabetic mother), who did not require admission to neonatal intensive care unit and were kept in postnatal wards with mother. Hypoglycemia was defined as blood glucose £46 mg/dL (2.6 mmol/L). Blood glucose was monitored till 48 hours of life. 27% of the screened newborns developed hypoglycemia in first 48 hours. 31 (7.6%) developed recurrent (>2) episodes, 28 (6.8%) had moderate (<37mg/dL) while 8 (1.9%) developed symptomatic hypoglycemia. With increase in birthweight, risk of hypoglycemia reduced significantly (P=0.003). Hypoglycemia was observed more frequently in first 2 hours as compared to next 48 hours (P=0.0001). Low birth- weight, preterm gestation and male gender was significantly associated with increased risk of hypoglycemia. Healthy, high-risk exclusively breastfed newborns in postnatal wards need close monitoring for hypoglycemia in first 24 hrs of life.

Hypoglycemia-associated electroencephalogram and electrocardiogram changes appear simultaneously

DEFF Research Database (Denmark)

Larsen, Anine Poulsen; Højlund, Kurt; Poulsen, Mikael Kjær

2013-01-01

Tight glycemic control in type 1 diabetes mellitus (T1DM) may be accomplished only if severe hypoglycemia can be prevented. Biosensor alarms based on the body's reactions to hypoglycemia have been suggested. In the present study, we analyzed three lead electrocardiogram (ECG) and single-channel e......Tight glycemic control in type 1 diabetes mellitus (T1DM) may be accomplished only if severe hypoglycemia can be prevented. Biosensor alarms based on the body's reactions to hypoglycemia have been suggested. In the present study, we analyzed three lead electrocardiogram (ECG) and single...

Nondiabetic Hypoglycemia

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... hypoglycemia, which may be related to a disease Glucose is the main source of energy for your body and brain. It comes from what we eat and drink. Insulin, a hormone, helps keep blood glucose at normal levels so your body can work ...

Update on neonatal hypoglycemia.

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Rozance, Paul J

2014-02-01

Neonatal hypoglycemia is one of the most common biochemical abnormalities encountered in the newborn. However, controversy remains surrounding its definition and management especially in asymptomatic patients. New information has been published that describes the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia. Furthermore, one large prospective study failed to find an association between repetitive low glucose concentrations and poor neurodevelopmental outcomes in preterm infants. But hypoglycemia due to hyperinsulinism, especially genetic causes, continued to be associated with brain injury. New advances were made in the diagnosis and management of hyperinsulinism, including acquired hyperinsulinism in small for gestational age infants and others. Continuous glucose monitoring remains an attractive strategy for future research in this area. The fundamental question of how best to manage asymptomatic newborns with low glucose concentrations remains unanswered. Balancing the risks of overtreating newborns with low glucose concentrations who are undergoing a normal transition following birth against the risks of undertreating those in whom low glucose concentrations are pathological, dangerous, and/or a harbinger of serious metabolic disease remains a challenge.

Retrospective evaluation of a national guideline to prevent neonatal hypoglycemia.

Science.gov (United States)

Rasmussen, Annett Helleskov; Wehberg, Sonja; Fenger-Groen, Jesper; Christesen, Henrik Thybo

2017-10-01

Hypoglycemia is common in neonates and may cause adverse neurological outcomes. Guidelines should aim to prevent repeated hypoglycemic episodes in risk groups, but they are not usually stratified according to the severity of hypoglycemia risk, which may lead to inappropriate and redundant interventions. We evaluated the effect of a national prevention guideline stratified according to mild, moderate, and severe risks of hypoglycemia. From national registers, a population cohort of 22,725 neonates was identified retrospectively before and after implementation of a national guideline. Of these, 1900 had World Health Organization International Classification of Diseases 10 discharge diagnoses of hypoglycemia. Diagnoses indicating hypoglycemia risk [small/large for gestational age (SGA/LGA), asphyxia, prematurity, maternal insulin-treated diabetes mellitus] were recorded. Neonatal ward files were evaluated to validate hypoglycemia diagnoses. Adjusted odds ratios (aORs) were calculated, adjusting for sex, parity, SGA, LGA, preterm birth, and asphyxia, where relevant. Primiparity and male sex were associated independently with hypoglycemia diagnosis [aORs, 1.29 (1.17-1.42) and 1.14 (1.03-1.26), respectively]. Overall incidence of hypoglycemia at discharge decreased from 9.4% to 5.5% after guideline implementation [aOR change , 0.57 (0.50-0.64)]. Overall incidence of validated hypoglycemia decreased from 2.1% to 1.2% [aOR 0.59 (0.46-0.77), phypoglycemia incidence decreased from 30.5% to 18.6% [aOR 0.52 (0.36-0.75)] among SGA neonates, from 25.8% to 16.4% [aOR 0.57 (0.42-0.76)] among preterm infants, and from 27.4% to 16.6% [aOR 0.63 (0.34-0.83)] among those with asphyxia. LGA neonates showed a decreased incidence in obstetric wards only. No significant change was observed for the diabetes group. Stratification of hypoglycemia risk in a hypoglycemia prevention guideline was followed by decreased estimated hypoglycemia incidence, but no causative conclusion could be drawn

The impact of severe hypoglycemia and impaired awareness of hypoglycemia on relatives of patients with type 1 diabetes

DEFF Research Database (Denmark)

Jørgensen, Hanne V; Pedersen-Bjergaard, Ulrik; Rasmussen, Ase K

2003-01-01

.01). CONCLUSIONS: Cohabitants of patients with type 1 diabetes recall significantly more episodes of severe hypoglycemia than the patients. The rate of severe hypoglycemia and state of hypoglycemic awareness are the principal determinants of degree of cohabitants' involvement in their partners' disease....

QT measurement and heart rate correction during hypoglycemia

DEFF Research Database (Denmark)

Christensen, Toke Folke; Randløv, Jette; Christensen, Leif Engmann

2010-01-01

induced by intravenous injection of two insulin types in a cross-over design. QT measurements were done using the slope-intersect (SI) and manual annotation (MA) methods. Heart rate correction was done using Bazett's (QTcB) and Fridericia's (QTcF) formulas. Results. The SI method showed significant......Introduction. Several studies show that hypoglycemia causes QT interval prolongation. The aim of this study was to investigate the effect of QT measurement methodology, heart rate correction, and insulin types during hypoglycemia. Methods. Ten adult subjects with type 1 diabetes had hypoglycemia...... prolongation at hypoglycemia for QTcB (42(6) ms; P measuring the QT interval has...

[Uncommon neonatal case of hypoglycemia: ACTH resistance syndrome].

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Delmas, O; Marrec, C; Caietta, E; Simonin, G; Morel, Y; Girard, N; Roucher, F; Sarles, J; Chabrol, B; Reynaud, R

2014-12-01

Monitoring of blood glucose is usually reported to reduce the risk of hypoglycemia in term newborns with high risk factors and for prematurity in neonatal intensive care unit patients. Differential diagnosis has rarely been discussed. In the eutrophic term newborn, hypoglycemia remains rare and an etiological diagnosis must be made. Intensive management of neonatal hypoglycemia is required to prevent neurodevelopmental defects. Without evident cause or if hypoglycemia persists, a systematic review of possible causes should be made. We report isolated glucocorticoid deficiency diagnosed in an infant at 10 months of age. This boy had neonatal hypoglycemia and mild jaundice that had not been investigated. During his first 9 months of life, he presented frequent infections. At 10 months of age, febrile seizures occurred associated with shock, hypoglycemia, hyponatremia, mild hyperpigmentation, and coma. He was diagnosed with hypocortisolemia and elevated ACTH levels. Brain injury was revealed by MRI after resuscitation, with hypoxic-ischemic and hypoglycemic encephalopathy. The molecular studies demonstrated the presence of p.Asp107Asn and previously unreported frameshift p.Pro281GlnfsX9 MC2R gene mutations. A substitutive hormone therapy was provided and during a follow-up of 12 months no adrenal crisis was noted. We report an unusual case of familial glucocorticoid deficiency with severe neurological injury. This case demonstrates the importance of an appropriate etiological diagnosis in neonatal hypoglycemia. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Early feeding and neonatal hypoglycemia in infants of diabetic mothers

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Leandro Cordero

2013-12-01

Full Text Available Objectives: To examine the effects of early formula feeding or breast-feeding on hypoglycemia in infants born to 303 A1-A2 and 88 Class B-RF diabetics. Methods: Infants with hypoglycemia (blood glucose < 40 mg/dL were breast-fed or formula-fed, and those with recurrences were given intravenous dextrose. Results: Of 293 infants admitted to the well-baby nursery, 87 (30% had hypoglycemia, corrected by early feeding in 75 (86%, while 12 (14% required intravenous dextrose. In all, 98 infants were admitted to the newborn intensive care unit for respiratory distress (40%, prematurity (33% or prevention of hypoglycemia (27%. Although all newborn intensive care unit patients received intravenous dextrose, 22 (22% had hypoglycemia. Of 109 hypoglycemia episodes, 89 (82% were single low occurrences. At discharge, 56% of well-baby nursery and 43% of newborn intensive care unit infants initiated breast-feeding. Conclusions: Hypoglycemia among infants of diabetic mothers can be corrected by early breast-feeding or formula feeding.

Early feeding and neonatal hypoglycemia in infants of diabetic mothers

Science.gov (United States)

Ramesh, Shilpa; Hillier, Kirsty; Giannone, Peter J; Nankervis, Craig A

2013-01-01

Objectives: To examine the effects of early formula feeding or breast-feeding on hypoglycemia in infants born to 303 A1-A2 and 88 Class B-RF diabetics. Methods: Infants with hypoglycemia (blood glucose < 40 mg/dL) were breast-fed or formula-fed, and those with recurrences were given intravenous dextrose. Results: Of 293 infants admitted to the well-baby nursery, 87 (30%) had hypoglycemia, corrected by early feeding in 75 (86%), while 12 (14%) required intravenous dextrose. In all, 98 infants were admitted to the newborn intensive care unit for respiratory distress (40%), prematurity (33%) or prevention of hypoglycemia (27%). Although all newborn intensive care unit patients received intravenous dextrose, 22 (22%) had hypoglycemia. Of 109 hypoglycemia episodes, 89 (82%) were single low occurrences. At discharge, 56% of well-baby nursery and 43% of newborn intensive care unit infants initiated breast-feeding. Conclusions: Hypoglycemia among infants of diabetic mothers can be corrected by early breast-feeding or formula feeding. PMID:26770697

Correlation between measures of hypoglycemia and glycemic improvement in sulfonylurea treated patients with type 2 diabetes in India: Results from the OBSTACLE hypoglycemia study

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S Kalra

2014-01-01

Full Text Available Background: This study aimed to assess correlation between measures of hypoglycemia and glycemic control in patients with type 2 diabetes mellitus (T2DM treated with sulfonylureas. Materials and Methods: T2DM patients being initiated on a sulfonylurea (SU on background of a failing oral antihyperglycemic regimen were followed up for 12 weeks. (HbA1c was measured at baseline and end of follow-up. Hypoglycemia was assessed using Stanford Hypoglycemia Questionnaire at week 12. Results: Of the total 1069 patients enrolled, 950 were considered evaluable. A weak negative correlation was observed between end of follow-up HbA1c values and hypoglycemia score, using both linear regression analysis (correlation coefficient -0.12; P = 0.0002 and negative binomial regression (β slope -0.09; P = 0.0010. A similar correlation was also observed between change in HbA1c from baseline and hypoglycemia score (β slope -0.07; P = 0.0048. Mean HbA1c reduction was lowest (0.65 ± 2.27% in patients not reporting any hypoglycemia and highest (1.28 ± 2.40% in patients with hypoglycemia score greater than median of 2 (P = 0.0031. There was no correlation between hypoglycemia frequency and end of follow-up HbA1c values (P = 0.4111. Conclusion: With addition of SU on a background of a failing oral anti-hyperglycemic regimen, the extent of glycemic control correlates directly with measures of patient reported hypoglycemia.

The economic impact of insulin-related hypoglycemia in Denmark

DEFF Research Database (Denmark)

Hoskins, Nicki; Tikkanen, Christian Klyver; Pedersen-Bjergaard, Ulrik

2017-01-01

AIMS: To estimate the direct cost of hypoglycemia in insulin-treated adults with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in Denmark. MATERIALS AND METHODS: The Local Impact of Hypoglycemia Tool (LIHT) was used to estimate the costs associated with insulin-related hypoglycemia. Average...

Management of Refractory Noninsulinoma Pancreatogenous Hypoglycemia Syndrome with Gastric Bypass Reversal: A Case Report and Review of the Literature

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Bhavana B. Rao

2015-01-01

Full Text Available Background. Roux-en-Y gastric bypass (RYGB is a commonly performed, effective bariatric procedure; however, rarely, complications such as postprandial hypoglycemia due to noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS may ensue. Management of refractory NIPHS is challenging. We report a case that was successfully treated with RYGB reversal. Case Report. A 58-year-old male with history of RYGB nine months earlier for morbid obesity presented for evaluation of postprandial, hypoglycemic seizures. Testing for insulin level, insulin antibodies, oral hypoglycemic agents, pituitary axis hormone levels, and cortisol stimulation was unrevealing. Computed tomography (CT scan of the abdomen was unremarkable. A 72-hour fast was completed without hypoglycemia. Mixed meal testing demonstrated endogenous hyperinsulinemic hypoglycemia (EHH and selective arterial calcium stimulation testing (SACST was positive. Strict dietary modifications, maximal medical therapy, gastrostomy tube feeding, and stomal reduction failed to alleviate symptoms. Ultimately, he underwent laparoscopic reversal of RYGB. Now, 9 months after reversal, he has markedly reduced hypoglycemia burden. Discussion. Hyperfunctioning islets secondary to exaggerated incretin response and altered intestinal nutrient delivery are hypothesized to be causative in NIPHS. For refractory cases, there is increasing skepticism about the safety and efficacy of pancreatic resection. RYGB reversal may be successful.

Recurrent antecedent hypoglycemia alters neuronal oxidative metabolism in vivo.

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Jiang, Lihong; Herzog, Raimund I; Mason, Graeme F; de Graaf, Robin A; Rothman, Douglas L; Sherwin, Robert S; Behar, Kevin L

2009-06-01

The objective of this study was to characterize the changes in brain metabolism caused by antecedent recurrent hypoglycemia under euglycemic and hypoglycemic conditions in a rat model and to test the hypothesis that recurrent hypoglycemia changes the brain's capacity to utilize different energy substrates. Rats exposed to recurrent insulin-induced hypoglycemia for 3 days (3dRH rats) and untreated controls were subject to the following protocols: [2-(13)C]acetate infusion under euglycemic conditions (n = 8), [1-(13)C]glucose and unlabeled acetate coinfusion under euglycemic conditions (n = 8), and [2-(13)C]acetate infusion during a hyperinsulinemic-hypoglycemic clamp (n = 8). In vivo nuclear magnetic resonance spectroscopy was used to monitor the rise of(13)C-labeling in brain metabolites for the calculation of brain metabolic fluxes using a neuron-astrocyte model. At euglycemia, antecedent recurrent hypoglycemia increased whole-brain glucose metabolism by 43 +/- 4% (P glucose utilization in neurons. Although acetate metabolism remained the same, control and 3dRH animals showed a distinctly different response to acute hypoglycemia: controls decreased pyruvate dehydrogenase (PDH) flux in astrocytes by 64 +/- 20% (P = 0.01), whereas it increased by 37 +/- 3% in neurons (P = 0.01). The 3dRH animals decreased PDH flux in both compartments (-75 +/- 20% in astrocytes, P neurons, P = 0.005). Thus, acute hypoglycemia reduced total brain tricarboxylic acid cycle activity in 3dRH animals (-37 +/- 4%, P = 0.001), but not in controls. Our findings suggest that after antecedent hypoglycemia, glucose utilization is increased at euglycemia and decreased after acute hypoglycemia, which was not the case in controls. These findings may help to identify better methods of preserving brain function and reducing injury during acute hypoglycemia.

Cross-cultural variation in symptom perception of hypoglycemia

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Sanjay Kalra

2013-01-01

Conclusion: Significant cross-cultural differences related to the symptomatology of hypoglycemia are noted. Indian diabetologists should be aware of the varying presentation of hypoglycemia based on language and ethnic background.

Exercise and deficient carbohydrate storage and intake as causes of hypoglycemia.

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Field, J B

1989-03-01

Exercise is associated with a marked increase in glucose uptake by muscle, which is initially supported by breakdown of hepatic glycogen and subsequently by increased gluconeogenesis. If hepatic glucose production is inadequate, hypoglycemia results. During exercise there is decreased plasma insulin and increased catecholamines, glucagon, cortisol, and growth hormone, which contribute to but are not essential for the increased hepatic output of glucose. Although insulin concentrations fall, insulin sensitivity is increased. However, the augmented glucose uptake by muscle is due to other factors. The symptoms of exhaustion during exercise are not due to hypoglycemia, and prevention of hypoglycemia may not prolong the time of exercise to exhaustion. During severe caloric restriction, hepatic glucose production decreases and free fatty acids and ketone bodies become important sources of calories. Although under these circumstances hepatic gluconeogenesis is usually sufficient to prevent hypoglycemia, with very severe caloric restriction hypoglycemia can result. With starvation, insulin concentrations fall while growth hormone and glucagon increase. Frequently the usual symptoms of hypoglycemia are absent in individuals with hypoglycemia from severe caloric restriction. Hypoglycemia from severe caloric restriction has not been totally restricted to underdeveloped areas of the world. In such patients no endocrine abnormalities have been found, and hypoglycemia has persisted despite administration of large amounts of carbohydrate. Pregnancy and lactation could predispose to hypoglycemia in the face of inadequate caloric intake.

Factors associated with hypoglycemia episodes in hospitalized type ...

African Journals Online (AJOL)

during hospital stay were those admitted due to other causes but subsequently developed hypoglycemia ..... Table 3: Association between causes and severity of hypoglycemia episodes .... An animal study in ... American Diabetes Association.

Zinc release contributes to hypoglycemia-induced neuronal death.

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Suh, Sang Won; Garnier, Philippe; Aoyama, Koji; Chen, Yongmei; Swanson, Raymond A

2004-08-01

Neurons exposed to zinc exhibit activation of poly(ADP-ribose) polymerase-1 (PARP-1), an enzyme that normally participates in DNA repair but promotes cell death when extensively activated. Endogenous, vesicular zinc in brain is released to the extracellular space under conditions causing neuronal depolarization. Here, we used a rat model of insulin-induced hypoglycemia to assess the role of zinc release in PARP-1 activation and neuronal death after severe hypoglycemia. Zinc staining with N-(6-methoxy-8-quinolyl)-para-toluenesulfonamide (TSQ) showed depletion of presynaptic vesicular zinc from hippocampal mossy fiber terminals and accumulation of weakly bound zinc in hippocampal CA1 cell bodies after severe hypoglycemia. Intracerebroventricular injection of the zinc chelator calcium ethylene-diamine tetraacetic acid (CaEDTA) blocked the zinc accumulation and significantly reduced hypoglycemia-induced neuronal death. CaEDTA also attenuated the accumulation of poly(ADP-ribose), the enzymatic product of PARP-1, in hippocampal neurons. These results suggest that zinc translocation is an intermediary step linking hypoglycemia to PARP-1 activation and neuronal death.

Cerebral glycogen in humans following acute and recurrent hypoglycemia: Implications on a role in hypoglycemia unawareness.

Science.gov (United States)

Öz, Gülin; DiNuzzo, Mauro; Kumar, Anjali; Moheet, Amir; Khowaja, Ameer; Kubisiak, Kristine; Eberly, Lynn E; Seaquist, Elizabeth R

2017-08-01

Supercompensated brain glycogen levels may contribute to the development of hypoglycemia-associated autonomic failure (HAAF) following recurrent hypoglycemia (RH) by providing energy for the brain during subsequent periods of hypoglycemia. To assess the role of glycogen supercompensation in the generation of HAAF, we estimated the level of brain glycogen following RH and acute hypoglycemia (AH). After undergoing 3 hyperinsulinemic, euglycemic and 3 hyperinsulinemic, hypoglycemic clamps (RH) on separate occasions at least 1 month apart, five healthy volunteers received [1- 13 C]glucose intravenously over 80+ h while maintaining euglycemia. 13 C-glycogen levels in the occipital lobe were measured by 13 C magnetic resonance spectroscopy at ∼8, 20, 32, 44, 56, 68 and 80 h at 4 T and glycogen levels estimated by fitting the data with a biophysical model that takes into account the tiered glycogen structure. Similarly, prior 13 C-glycogen data obtained following a single hypoglycemic episode (AH) were fitted with the same model. Glycogen levels did not significantly increase after RH relative to after euglycemia, while they increased by ∼16% after AH relative to after euglycemia. These data suggest that glycogen supercompensation may be blunted with repeated hypoglycemic episodes. A causal relationship between glycogen supercompensation and generation of HAAF remains to be established.

UV/EB curing market in Indonesia

International Nuclear Information System (INIS)

Hilmy, N.; Danu, S.

1999-01-01

The most application of UV curing of surface coating in Indonesia are on fancy plywood, furniture and wood flooring industry. Other application are on papers, printing ink/labelling, printed circuit board/PCB and dental materials. At present, application of EB curing coating is still in a pilot plant scale due to the high cost of production. Limited number of application of EB curing by using low energy electron beam machine are on wood panels, ceramics and marbles. This paper describes the market and the problem faced by the largest user of radiation curing systems such as the secondary process plywood, furniture and paper industries

No hypoglycemia after subcutaneous administration of glucagon-like peptide-1 in lean type 2 diabetic patients and in patients with diabetes secondary to chronic pancreatitis

DEFF Research Database (Denmark)

Knop, Filip K; Vilsbøll, Tina; Larsen, Steen

2003-01-01

administration of GLP-1 concomitant with intravenous glucose results in hypoglycemia in healthy subjects. Because GLP-1 is also effective in type 2 diabetic patients and is currently being evaluated as a therapeutic agent, it is important to investigate whether GLP-1 may cause hypoglycemia in such patients. We...... have previously shown that GLP-1 does not cause hypoglycemia in obese type 2 diabetic patients with insulin resistance amounting to 5.4 +/- 1.1 according to homeostasis model assessment (HOMA). In this study, we investigated diabetic patients with normal or close to normal insulin sensitivity....

Persistent hyperinsulinemic hypoglycemia of infancy: An overview of current concepts

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Prabudh Goel

2012-01-01

Full Text Available Persistent hyperinsulinemic hypoglycemia of infancy (PHHI is relatively rare but one of the most important causes of severe neonatal hypoglycemia. Recognition of this entity becomes important due to the fact that the hypoglycemia is so severe and frequent that it may lead to severe neurological damage in the infant manifesting as mental or psychomotor retardation or even a life-threatening event if not recognized and treated effectively in time. Near-total pancreatectomy may be required for patients with intractable hypoglycemia despite medical treatment; however, that may result in diabetes mellitus or recurrent postoperative hypoglycemia. This review aims to consolidate the traditional concepts and current information related to the pathogenesis and management of PHHI.

Recurrent Hypoglycemia in a Hemodialysis Patient Related to Propoxyphene Treatment

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Hui-Ting Lee

2007-07-01

Full Text Available There are various etiologies for hypoglycemia in patients with chronic renal failure, and its pathogenesis is complex. Concomitant use of medications is the most common cause. We report a rare case of an 82-year-old woman with type 2 diabetes mellitus in end-stage renal disease undergoing maintenance hemodialysis, who experienced recurrent symptomatic hypoglycemia during treatment with propoxyphene for pain relief. Hypoglycemia occurred simultaneously with elevated levels of serum immunoreactive insulin and C-peptide. After discontinuing propoxyphene, hypoglycemia mitigated and the level of insulin returned to normal range. Our case reminds us that propoxyphene-induced hypoglycemia should not be ignored, especially in hemodialysis patients with cold sweats, agitation and depressed consciousness.

What Is Hypoglycemia?

Science.gov (United States)

... symptoms of hypoglycemia are caused when not enough glucose gets to the brain; in fact, the brain is the organ that ... fatigue, and weakness. At its most severe, insufficient glucose flow to the brain can cause confusion, seizures, and loss of consciousness ( ...

Cotrimoxazole-Induced Hypoglycemia in an HIV-Infected Patient

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Christine A Hughes

2001-01-01

Full Text Available A case of cotrimoxazole-induced hypoglycemia is described in a male patient infected with HIV. Ten days after initiating high dose cotrimoxazole for suspected Pneumocystis carinii pneumonia, the patient developed neuroglycopenic symptoms and diaphoresis. Blood glucose levels were repeatedly low, with elevated insulin and C-peptide levels despite multiple intravenous bolus doses and infusions of dextrose. Hypoglycemia resolved after approximately 36 h of treatment with dextrose and discontinuation of cotrimoxazole. A review of reported cases of hypoglycemia associated with cotrimoxazole is provided, including information about onset, risk factors and possible mechanism.

Retrospective Evaluation of a National Guideline to Prevent Neonatal Hypoglycemia

DEFF Research Database (Denmark)

Rasmussen, Annett Helleskov; Wehberg, Sonja; Fenger-Groen, Jesper

2017-01-01

Background: Hypoglycemia is common in neonates and may cause adverse neurological outcomes. Guidelines should aim to prevent repeated hypoglycemic episodes in risk groups, but they are not usually stratified according to the severity of hypoglycemia risk, which may lead to inappropriate...... and redundant interventions. We evaluated the effect of a national prevention guideline stratified according to mild, moderate, and severe risks of hypoglycemia. Methods: From national registers, a population cohort of 22,725 neonates was identified retrospectively before and after implementation of a national....... Neonatal ward files were evaluated to validate hypoglycemia diagnoses. Adjusted odds ratios (aORs) were calculated, adjusting for sex, parity, SGA, LGA, preterm birth, and asphyxia, where relevant. Results: Primiparity and male sex were associated independently with hypoglycemia diagnosis [aORs, 1.29 (1...

Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits

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Lieberman Rebecca M

2008-04-01

Full Text Available Abstract Background Accurate identification of hypoglycemia cases by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM codes will help to describe epidemiology, monitor trends, and propose interventions for this important complication in patients with diabetes. Prior hypoglycemia studies utilized incomplete search strategies and may be methodologically flawed. We sought to validate a new ICD-9-CM coding algorithm for accurate identification of hypoglycemia visits. Methods This was a multicenter, retrospective cohort study using a structured medical record review at three academic emergency departments from July 1, 2005 to June 30, 2006. We prospectively derived a coding algorithm to identify hypoglycemia visits using ICD-9-CM codes (250.3, 250.8, 251.0, 251.1, 251.2, 270.3, 775.0, 775.6, and 962.3. We confirmed hypoglycemia cases by chart review identified by candidate ICD-9-CM codes during the study period. The case definition for hypoglycemia was documented blood glucose 3.9 mmol/l or emergency physician charted diagnosis of hypoglycemia. We evaluated individual components and calculated the positive predictive value. Results We reviewed 636 charts identified by the candidate ICD-9-CM codes and confirmed 436 (64% cases of hypoglycemia by chart review. Diabetes with other specified manifestations (250.8, often excluded in prior hypoglycemia analyses, identified 83% of hypoglycemia visits, and unspecified hypoglycemia (251.2 identified 13% of hypoglycemia visits. The absence of any predetermined co-diagnosis codes improved the positive predictive value of code 250.8 from 62% to 92%, while excluding only 10 (2% true hypoglycemia visits. Although prior analyses included only the first-listed ICD-9 code, more than one-quarter of identified hypoglycemia visits were outside this primary diagnosis field. Overall, the proposed algorithm had 89% positive predictive value (95% confidence interval, 86–92 for

Persistent neonatal hypoglycemia: Diagnosis and management

OpenAIRE

Marles, Sandra L; Casiro, Oscar G

1998-01-01

Maintenance of plasma glucose depends on a normal endocrine system, functional enzyme levels for glycogenolysis, gluconeogenesis and other processes, and there must be an adequate supply of endogenous fat, glycogen and substrates of gluconeogenesis. Neonatal hypoglycemia should be defined as serum glucose less than 2.2 mmol/L in the first 72 h of life and less than 2.5 mmol/L thereafter. The purpose of this paper is to review the more uncommon causes of hypoglycemia in the full term, apparent...

Cost Analysis of Treating Neonatal Hypoglycemia with Dextrose Gel.

Science.gov (United States)

Glasgow, Matthew J; Harding, Jane E; Edlin, Richard

2018-04-03

To evaluate the costs of using dextrose gel as a primary treatment for neonatal hypoglycemia in the first 48 hours after birth compared with standard care. We used a decision tree to model overall costs, including those specific to hypoglycemia monitoring and treatment and those related to the infant's length of stay in the postnatal ward or neonatal intensive care unit, comparing the use of dextrose gel for treatment of neonatal hypoglycemia with placebo, using data from the Sugar Babies randomized trial. Sensitivity analyses assessed the impact of dextrose gel cost, neonatal intensive care cost, cesarean delivery rate, and costs of glucose monitoring. In the primary analysis, treating neonatal hypoglycemia using dextrose gel had an overall cost of NZ$6863.81 and standard care (placebo) cost NZ$8178.25; a saving of NZ$1314.44 per infant treated. Sensitivity analyses showed that dextrose gel remained cost saving with wide variations in dextrose gel costs, neonatal intensive care unit costs, cesarean delivery rates, and costs of monitoring. Use of buccal dextrose gel reduces hospital costs for management of neonatal hypoglycemia. Because it is also noninvasive, well tolerated, safe, and associated with improved breastfeeding, buccal dextrose gel should be routinely used for initial treatment of neonatal hypoglycemia. Australian New Zealand Clinical Trials Registry: ACTRN12608000623392. Copyright © 2018 Elsevier Inc. All rights reserved.

Poor pregnancy outcome after octreotide treatment during pregnancy for familial hyperinsulinemic hypoglycemia

DEFF Research Database (Denmark)

Skajaa, Gitte O; Mathiesen, Elisabeth R; Iyore, Elisabeth

2014-01-01

. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate......BACKGROUND: Late familial hyperinsulinemic hypoglycemia is characterized by recurrent episodes of hypoglycemia and an inappropriate insulinemic response. Treatment with octreotide (somatostatin analogue) reduces the prevalence of clinical significant hypoglycemia and might be beneficial during...... pregnancy. To our knowledge this is the first report of a woman with late familial hyperinsulinemic hypoglycemia experiencing pregnancies with and without octreotide treatment. CASE PRESENTATION: A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well...

Effects of Hypoglycemia on Circulating Stem and Progenitor Cells in Diabetic Patients.

Science.gov (United States)

Fadini, Gian Paolo; Boscari, Federico; Cappellari, Roberta; Galasso, Silvia; Rigato, Mauro; Bonora, Benedetta Maria; D'Anna, Marianna; Bruttomesso, Daniela; Avogaro, Angelo

2018-03-01

Iatrogenic hypoglycemia is the most common acute diabetic complication, and it significantly increases morbidity. In people with diabetes, reduction in the levels of circulating stem and progenitor cells predicts adverse outcomes. To evaluate whether hypoglycemia in diabetes affects circulating stem cells and endothelial progenitor cells (EPCs). We performed an experimental hypoglycemia study (Study 1) and a case-control study (Study 2). Tertiary referral inpatient clinic. Type 1 diabetic patients (Study 1, n = 19); diabetic patients hospitalized for severe iatrogenic hypoglycemia, matched inpatient and outpatient controls (Study 2, n = 22/group). Type 1 diabetic patients underwent two in-hospital sessions of glucose monitoring during a breakfast meal with or without induction of hypoglycemia in random order. In Study 2, patients hospitalized for hypoglycemia and matched controls were compared. Circulating stem cells and EPCs were measured by flow cytometry based on the expression of CD34 and kinase insert domain receptor (KDR). In Study 1, the physiologic decline of CD34+KDR+ EPCs from 8 am to 2 pm was abolished by insulin-induced hypoglycemia in type 1 diabetic patients. In Study 2, diabetic patients hospitalized for severe iatrogenic hypoglycemia had significantly lower levels of CD34+ stem cells and CD34+KDR+ EPCs compared with diabetic inpatients or outpatient controls. In diabetic patients, a single mild hypoglycemic episode can compromise the physiologic EPC fluctuation, whereas severe hypoglycemia is associated with a marked reduction in stem cells and EPCs. These data provide a possible link between hypoglycemia and adverse outcomes of diabetes.

Hypoglycemia Secondary to Sulfonylurea Ingestion in a Patient with End Stage Renal Disease: Results from a 72-Hour Fast

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Alice Abraham

2015-01-01

Full Text Available Insulin, proinsulin, and C-peptide levels increase with sulfonylurea exposure but the acuity of increase has not been described in dialysis patients. We present a case of a dialysis patient who presented with hypoglycemia and was found to have accidental sulfonylurea ingestion. This is a 73-year-old man with ESRD on peritoneal dialysis, without history of diabetes, who presented with hypoglycemia. Past medical history includes multiple myeloma, congestive heart failure, and hypertension. At initial presentation, his blood glucose was 47 mg/dL, with concomitant elevations in the following: C-peptide 30.5 (nl: 0.8–3.5 ng/mL, insulin 76 (nl: 3–19 μIU/mL, and proinsulin 83.3 (nl: ≤8.0 pmol/L. During the 72-hour fast, which he completed without hypoglycemia, insulin declined to be within normal limits (to 12 μIU/mL; proinsulin (to 12.1 pmol/L and C-peptide (to 7.2 ng/mL levels decreased but remained elevated. The sulfonylurea screen ultimately returned positive for glipizide, clinching the diagnosis. This is the first reported case which characterizes the chronic elevation of proinsulin in a patient with ESRD, as well as its dramatic increase after a presumed solitary exposure to sulfonylurea. The 72-hour fast conducted gives insight into the clearance of insulin, proinsulin, and C-peptide after sulfonylurea ingestion in ESRD.

Prevalence and underlying etiologies of neonatal hypoglycemia.

Science.gov (United States)

Najati, N; Saboktakin, L

2010-08-01

This study aims at determining the prevalence of neonatal hypoglycemia and its underlying causes. In this prospective study 14168 newborns delivered in Tabriz Alzahra Hospital during 2 years were evaluated in regard to blood glucose level at first 24 h of life. Glucose oxidase method with 4-aminophenazone with a Greiner G-300 was the used method for determining the blood glucose level. Cases with blood glucose causes of this condition, as well as the short-term mortality rate were determined. Prevalence of neonatal hypoglycemia was 0.4% (52 newborns). Underlying causes of hypoglycemia were prematurity (61.5%), diabetic mother (13.6%), septicemia (9.6%), perinatal asphyxia (9.6%), stress (3.8%) and neonatal hyperinsulinism (1.9%). The mortality rate was 53.8%, with prematurity as the leading cause of death.

Cross-cultural variation in symptom perception of hypoglycemia

Science.gov (United States)

Kalra, Sanjay; Balhara, Yatan Pal Singh; Mithal, Ambrish

2013-01-01

Background: Cross-cultural differences in attitudes and practices related to diabetes are well-known. Similar differences in symptom reporting of endocrine conditions such as menopause are well documented. Minimal literature is available on the cross-cultural variation in reporting of hypoglycemic symptoms. Aims: This cross-sectional study aimed to assess the symptoms of hypoglycemia encountered by diabetologists who deal with patients from different language groups from various states of North and West India and Nepal. Materials and Methods: Eighty three doctors from six Indian states and Nepal, attending a continuing medical education program were requested to fill a detailed, pre-tested, Likert scale based questionnaire which assessed the frequency and symptoms with which patients presented with hypoglycemia in their clinical practice. Data were analyzed based on geographic location of the diabetologists and language spoken by their patients (Hindi vs. Gujarati). Results: Gujarati-speaking patients tended to report to their doctors, a greater inability to work under pressure and a higher frequency of intense hunger during hypoglycemia. They were less likely to report specific adrenergic (inward trembling), neuroglycopenic (feeling down over nothing), and nocturnal (crumpled bedsheets upon waking up) symptoms. Conclusion: Significant cross-cultural differences related to the symptomatology of hypoglycemia are noted. Indian diabetologists should be aware of the varying presentation of hypoglycemia based on language and ethnic background. PMID:24672191

An uncommon cause of hypoglycemia: insulin autoimmune syndrome.

Science.gov (United States)

Savas-Erdeve, Senay; Yılmaz Agladioglu, Sebahat; Onder, Asan; Peltek Kendirci, Havva Nur; Bas, Veysel Nijat; Sagsak, Elif; Cetinkaya, Semra; Aycan, Zehra

2014-01-01

Insulin autoimmune syndrome (IAS) is a condition characterized by hypoglycemia associated with the presence of autoantibodies to insulin in patients who have not been injected with insulin. A female patient (aged 16 years and 3 months) presented with the complaint of being overweight. Physical examination revealed a body weight of 78.2 kg (+2.6 SD) and a height of 167 cm (+0.73 SD). While the patient's fasting blood glucose level was found to be 40 mg/dl, blood ketone was negative and the serum insulin level was determined as 379 mIU/ml. The patient was diagnosed with hyperinsulinemic hypoglycemia. Abdominal ultrasound, pancreas MRI and endoscopic ultrasound were normal. The daily blood glucose profile revealed postprandial hyperglycemia and reactive hypoglycemia in addition to fasting hypoglycemia. The results of anti-insulin antibody measurements were as high as 41.8% (normal range 0-7%). A 1,600-calorie diet containing 40% carbohydrate and divided into 6 meals a day was given to the patient. Simple sugars were excluded from the diet. Hypoglycemic episodes were not observed, but during 2 years of observation, serum levels of insulin and anti-insulin antibodies remained elevated. In all hyperinsulinemic hypoglycemia cases, IAS should be considered in the differential diagnosis and insulin antibody measurements should be carried out. © 2014 S. Karger AG, Basel.

Prevention of acute/severe hypoglycemia-induced neuron death by lactate administration.

Science.gov (United States)

Won, Seok Joon; Jang, Bong Geom; Yoo, Byung Hoon; Sohn, Min; Lee, Min Woo; Choi, Bo Young; Kim, Jin Hee; Song, Hong Ki; Suh, Sang Won

2012-06-01

Hypoglycemia-induced cerebral neuropathy can occur in patients with diabetes who attempt tight control of blood glucose and may lead to cognitive dysfunction. Accumulating evidence from animal models suggests that hypoglycemia-induced neuronal death is not a simple result of glucose deprivation, but is instead the end result of a multifactorial process. In particular, the excessive activation of poly (ADP-ribose) polymerase-1 (PARP-1) consumes cytosolic nicotinamide adenine dinucleotide (NAD(+)), resulting in energy failure. In this study, we investigate whether lactate administration in the absence of cytosolic NAD(+) affords neuroprotection against hypoglycemia-induced neuronal death. Intraperitoneal injection of sodium L-lactate corrected arterial blood pH and blood lactate concentration after hypoglycemia. Lactate administered without glucose was not sufficient to promote electroencephalogram recovery from an isoelectric state during hypoglycemia. However, supplementation of glucose with lactate reduced neuronal death by ∼80% in the hippocampus. Hypoglycemia-induced superoxide production and microglia activation was also substantially reduced by administration of lactate. Taken together, these results suggest an intriguing possibility: that increasing brain lactate following hypoglycemia offsets the decrease in NAD(+) due to overactivation of PARP-1 by acting as an alternative energy substrate that can effectively bypass glycolysis and be fed directly to the citric acid cycle to maintain cellular ATP levels.

Severe Hypoglycemia Accompanied with Thyroid Crisis

Directory of Open Access Journals (Sweden)

Yuki Nakatani

2012-01-01

Full Text Available We report a 32-year-old Japanese women with severe hypoglycemia accompanied with thyroid crisis. She complained of dyspnea, general fatigue, and leg edema. She was diagnosed with hyperthyroidism with congestive heart failure and liver dysfunction. Soon after admission, sudden cardiopulmonary arrest occurred. She was then transferred to the intensive care unit. Her serum glucose level was 7 mg/dl. Intravenous glucose, hydrocortisone, diuretics, and continuous hemodiafiltration (CHDF saved her. We considered that hypoglycemia occurred due to heart failure and liver dysfunction due to thyroid crisis.

Brain injuries due to neonatal hypoglycemia: case report

International Nuclear Information System (INIS)

Kim, Dae Bong; Song, Chang Joon; Chang, Mae Young; Youn, Hyae Won

2003-01-01

Although hypoglycemia may be common among neonates, brain injuries resulting from isolated neonatal hypoglycemia are rare. The condition may cause neurological symptoms such as stupor, jitteriness, and seizures, though in their absence, diagnosis delayed or difficult. Hypoglycemia was diagnosed in a three-day-old neonate after he visited the emergency department with loose stool, poor oral intake, and decreased activity, first experienced two days earlier. Two days after his visity, several episodes of seizure occurred. T2 and diffusion-weighted magnetic resonance (MR) scanning, performed at 11 days of age, revealed bilateral and symmetrical high signal intensity lesions in occipital, parietal, and temporal lobes. We report the MR findings of hypoglycemic encephalopathy in a neonate

Evaluation of carbohydrate restriction as primary treatment for post-gastric bypass hypoglycemia.

Science.gov (United States)

van Meijeren, Jorick; Timmer, Ilse; Brandts, Hans; Janssen, Ignace; Boer, Hans de

2017-03-01

Up to 15% of patients who have undergone Roux-en-Y gastric bypass (RYGB) surgery may eventually develop symptoms of hypoglycemia. To evaluate the daily life efficacy of a carbohydrate (carb)-restricted dietary advice (CRD) of 6 meals per day with a 30 g carb maximum per meal in patients with documented post-RYGB hypoglycemia. Teaching hospital, the Netherlands. Frequency and severity of hypoglycemic events before and after CRD were assessed retrospectively in 41 patients with documented post-RYGB hypoglycemia, based on medical records and telephone questionnaires. Hypoglycemia was defined as a blood glucose leveltreatment of hypoglycemia, decreased from 23 to 6 (Pmeals per day with up to 30 g carbs each, is an effective treatment of post-RYGB hypoglycemia in the majority of patients. Additional medication is needed in about a third of patients. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Pyruvate administration reduces recurrent/moderate hypoglycemia-induced cortical neuron death in diabetic rats.

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Bo Young Choi

Full Text Available Recurrent/moderate (R/M hypoglycemia is common in type 1 diabetes patients. Moderate hypoglycemia is not life-threatening, but if experienced recurrently it may present several clinical complications. Activated PARP-1 consumes cytosolic NAD, and because NAD is required for glycolysis, hypoglycemia-induced PARP-1 activation may render cells unable to use glucose even when glucose availability is restored. Pyruvate, however, can be metabolized in the absence of cytosolic NAD. We therefore hypothesized that pyruvate may be able to improve the outcome in diabetic rats subjected to insulin-induced R/M hypoglycemia by terminating hypoglycemia with glucose plus pyruvate, as compared with delivering just glucose alone. In an effort to mimic juvenile type 1 diabetes the experiments were conducted in one-month-old young rats that were rendered diabetic by streptozotocin (STZ, 50mg/kg, i.p. injection. One week after STZ injection, rats were subjected to moderate hypoglycemia by insulin injection (10 U/kg, i.p. without anesthesia for five consecutive days. Pyruvate (500 mg/kg was given by intraperitoneal injection after each R/M hypoglycemia. Three hours after last R/M hypoglycemia, zinc accumulation was evaluated. Three days after R/M hypoglycemia, neuronal death, oxidative stress, microglial activation and GSH concentrations in the cerebral cortex were analyzed. Sparse neuronal death was observed in the cortex. Zinc accumulation, oxidative injury, microglial activation and GSH loss in the cortex after R/M hypoglycemia were all reduced by pyruvate injection. These findings suggest that when delivered alongside glucose, pyruvate may significantly improve the outcome after R/M hypoglycemia by circumventing a sustained impairment in neuronal glucose utilization resulting from PARP-1 activation.

Recurrent hypoglycemia increases anxiety and amygdala norepinephrine release during subsequent hypoglycemia

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Ewan eMcNay

2015-11-01

Full Text Available Recurrent hypoglycemia (RH is a common and debilitating side effect of therapy in patients with both type 1 and, increasingly, type 2 diabetes. Previous studies in rats have shown marked effects of RH on subsequent hippocampal behavioral, metabolic, and synaptic processes. In addition to impaired memory, patients experiencing RH report alterations in cognitive processes that include mood and anxiety, suggesting that RH may also affect amygdala function. We tested the impact of RH on amygdala function using an elevated plus-maze test of anxiety together with in vivo amygdala microdialysis for norepinephrine (NEp, a widely used marker of basolateral amygdala cognitive processes. In contrast to findings in the hippocampus and pre-frontal cortex, neither RH nor acute hypoglycemia alone significantly affected plus-maze performance or NEp release. However, animals tested when hypoglycemic who had previously experienced RH had elevated amygdala NEp during plus-maze testing, accompanied by increased anxiety (i.e. less time spent in the open arms of the plus-maze. The results show that RH has widespread effects on subsequent brain function, which vary by neural system.

Persistent hyperinsulinemic hypoglycemia of infancy: An overview of current concepts

OpenAIRE

Prabudh Goel; Subhasis Roy Choudhury

2012-01-01

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is relatively rare but one of the most important causes of severe neonatal hypoglycemia. Recognition of this entity becomes important due to the fact that the hypoglycemia is so severe and frequent that it may lead to severe neurological damage in the infant manifesting as mental or psychomotor retardation or even a life-threatening event if not recognized and treated effectively in time. Near-total pancreatectomy may be required for ...

Severe hypoglycemia and risks of vascular events and death.

NARCIS (Netherlands)

Zoungas, S.; Patel, A.; Chalmers, J.; Galan, B.E. de; Li, Q.; Billot, L.; Woodward, M.; Ninomiya, T.; Neal, B.; MacMahon, S; Grobbee, D.E.; Kengne, A.P.; Marre, M.; Heller, S.

2010-01-01

BACKGROUND: Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention. We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse

β-Receptor-mediated increase in cerebral blood flow during hypoglycemia

International Nuclear Information System (INIS)

Hollinger, B.R.; Bryan, R.M.

1987-01-01

The authors tested the hypothesis that β-adrenergic receptor stimulation is involved with the increase in regional cerebral blood flow (rCBF) during hypoglycemia. Rats were surgically prepared with the use of halothane-nitrous oxide anesthesia. A plaster restraining cast was placed around the hindquarters, and anesthesia was discontinued. Hypoglycemia was produced by an intravenous injection of insulin; normoglycemic control rates were given saline. Propranolol was administered to some control and some hypoglycemic rats to block the β-adrenergic receptors. Regional CBF was measured using 4-[N-methyl- 14 C]iodoantipyrine. Regional CBF increased during hypoglycemia in rats that were not treated with propranolol. The increase varied from ∼60 to 200% depending on the brain region. During hypoglycemia, propranolol abolished the increase in rCBF in the hypothalamus, cerebellum, and pyramidal tract. In other regions the increase in rCBF was only 33-65% of the increase in hypoglycemic rats that were not treated with propranolol. They conclude that β-receptor stimulation plays a major role in the increase in rCBF during hypoglycemia

Congenital Hypoglycemia Disorders: New Aspects of Etiology, Diagnosis, Treatment and Outcomes: Highlights of the Proceedings of the Congenital Hypoglycemia Disorders Symposium, Philadelphia April 2016.

Science.gov (United States)

De Leon, Diva D; Stanley, Charles A

2017-02-01

Hypoglycemia continues to be an important cause of morbidity in neonates and children. Prompt diagnosis and management of the underlying hypoglycemia disorder is critical for preventing brain damage and improving outcomes. Congenital hyperinsulinism (HI) is the most common and severe cause of persistent hypoglycemia in neonates and children. Recent discoveries of the genetic causes of HI have improved our understanding of the pathophysiology, but its management is complex and requires the integration of clinical, biochemical, molecular, and imaging findings to establish the appropriate treatment according to the subtype. Here we present a summary of a recent international symposium on congenital hypoglycemia disorders with emphasis on novel molecular mechanisms resulting in HI, genetic diagnosis, overall approach to management, novel therapies under development, and current outcomes. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Neonatal hypoglycemia: prevalence and clinical manifestations in tehran children's hospital

International Nuclear Information System (INIS)

Dashti, N.; Einollahi, N.; Abbasi, S.

2007-01-01

To measure the prevalence of hypoglycemia among newborn infants in Children Hospital using a standard laboratory glucose method and to evaluate the evidence of clinical manifestations of hypoglycemia, designing appropriate strategies for prevention and treatment. The study population consisted of 673 neonates in Tehran Children's Hospital and was conducted between June 2004 and March 2005. The incidence of neonatal hypoglycemia in the present study group was 15.15% live births. The clinical features which remained significantly associated with the hypoglycemic neonates were refusal of feeding (45%), hyporeflexia (36.2%), irritability (30%), cyanosis (28.4%), tackypnea (24.5%), seizure (16.6%), weak cry (15.8%), apneic spels (9.8%), pallor (1.9%), cardiac arrest (9.1%) and sweating (1%). Hypoglycemia does occur frequently in newborn infants and requires careful monitoring and therapy of serum glucose. (author)

Prevention of Severe Hypoglycemia-Induced Brain Damage and Cognitive Impairment with Verapamil.

Science.gov (United States)

Jackson, David A; Michael, Trevin; Vieira de Abreu, Adriana; Agrawal, Rahul; Bortolato, Marco; Fisher, Simon J

2018-05-03

People with insulin-treated diabetes are uniquely at risk for severe hypoglycemia-induced brain damage. Since calcium influx may mediate brain damage, we tested the hypothesis that the calcium channel blocker, verapamil, would significantly reduce brain damage and cognitive impairment caused by severe hypoglycemia. Ten-week-old Sprague-Dawley rats were randomly assigned to one of three treatments; 1) control hyperinsulinemic (200 mU.kg -1 min -1 ) euglycemic (80-100mg/dl) clamps (n=14), 2) hyperinsulinemic hypoglycemic (10-15mg/dl) clamps (n=16), or 3) hyperinsulinemic hypoglycemic clamps followed by a single treatment with verapamil (20mg/kg) (n=11). As compared to euglycemic controls, hypoglycemia markedly increased dead/dying neurons in the hippocampus and cortex, by 16-fold and 14-fold, respectively. Verapamil treatment strikingly decreased hypoglycemia-induced hippocampal and cortical damage, by 87% and 94%, respectively. Morris Water Maze probe trial results demonstrated that hypoglycemia induced a retention, but not encoding, memory deficit (noted by both abolished target quadrant preference and reduced target quadrant time). Verapamil treatment significantly rescued spatial memory as noted by restoration of target quadrant preference and target quadrant time. In summary, a one-time treatment with verapamil following severe hypoglycemia prevented neural damage and memory impairment caused by severe hypoglycemia. For people with insulin treated diabetes, verapamil may be a useful drug to prevent hypoglycemia-induced brain damage. © 2018 by the American Diabetes Association.

Glucose turnover during insulin-induced hypoglycemia in liver-denervated rats

DEFF Research Database (Denmark)

Mikines, K J; Sonne, B; Richter, Erik

1985-01-01

The role of hepatic autonomic nerves in glucose production during hypoglycemia was studied. Selective, surgical denervation of the liver was performed in rats, which reduced hepatic norepinephrine concentrations by 96%. Hypoglycemia was induced by 250 mU of insulin intra-arterially in anesthetized...... as well as in chronically catheterized, awake rats. Half of the anesthetized denervated or sham-operated rats had previously been adrenodemedullated. Glucose turnover was measured by primed, constant intravenous infusion of [3-3H]glucose. Before as well as during hypoglycemia the arterial glucose...

Effect of Insulin Analogs on Frequency of Non-Severe Hypoglycemia in Patients with Type 1 Diabetes Prone to Severe Hypoglycemia

DEFF Research Database (Denmark)

Agesen, Rikke Mette; Kristensen, Peter Lommer; Beck-Nielsen, Henning

2018-01-01

-monitoring of blood glucose (SMBG) in patients with type 1 diabetes and recurrent severe hypoglycemia. Methods: Fifty-three patients completed a substudy of 4 × 3 days of blinded CGM. CGM traces were reviewed for hypoglycemic events lasting 15 min or longer. Results: At the threshold ≤3.9 mmol/L, the per......Background: Hypoglycemia is an increasingly important endpoint in clinical diabetes trials. The assessment of hypoglycemia should therefore be as complete as possible. Blinded continuous glucose monitoring (CGM) provides an improved opportunity to capture asymptomatic and nocturnal events. Here we...... times shorter using CGM data than SMBG data (1.4 vs. 47 weeks). Conclusions: Capturing hypoglycemic events by the conventional method of SMBG in patients with impaired awareness reveals only a limited number of events. Blinded CGM can provide more complete data, particularly in terms of asymptomatic...

Hypoglycemia evaluation and reporting in diabetes: Importance for the development of new therapies.

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Klonoff, David C; Alexander Fleming, G; Muchmore, Douglas B; Frier, Brian M

2017-07-01

Hypoglycemia complicating diabetes therapy is well recognized to be an ever-present threat to patients, their families, providers, payers, and regulators. Despite this being widely acknowledged, the regulatory stance on hypoglycemia as an endpoint in clinical trials to support new product registration has not evolved in any meaningful way since the publication of a position paper by an American Diabetes Association (ADA) Workgroup in 2005. As the impact of hypoglycemia on persons affected by diabetes is of major importance when assessing new treatments, the historical position of regulatory agencies on hypoglycemia is reviewed with respect to product approvals. The purpose of this article is to present proposals for facilitating development of therapies that reduce hypoglycemia risk through (1) development of composite measures of benefit for regulatory endpoints and (2) facilitation of the fulfillment of an unmet clinical need for reducing hypoglycemia. In view of greater comprehension of the effects of hypoglycemia, coupled with improved methodology to assess its frequency, the authors recommend: (1) a numerical cut point of <54 mg/dl (<3.0 mmol/L) as a clinically relevant level with which to define meaningful hypoglycemia for trials of diabetes therapies; (2) utilization in clinical trials of mature glucose monitoring technologies for purposes of regulatory evaluation and clinical decision-making; and (3) development of primary efficacy endpoint composites that include hypoglycemia rates and glycemic control. Copyright © 2017 John Wiley & Sons, Ltd.

Avoiding hypoglycemia: a key to success for glucose-lowering therapy in type 2 diabetes

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Ahrén B

2013-04-01

Full Text Available Bo Ahrén Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden Abstract: Type 2 diabetes carries a risk for hypoglycemia, particularly in patients on an intensive glucose control plan as a glucose-lowering strategy, where hypoglycemia may be a limitation for the therapy and also a factor underlying clinical inertia. Glucose-lowering medications that increase circulating insulin in a glucose-independent manner, such as insulin and sulfonylurea therapy, are the most common cause of hypoglycemia. However, other factors such as a delayed or missed meal, physical exercise, or drug or alcohol consumption may also contribute. Specific risk factors for development of hypoglycemia are old age, long duration of diabetes, some concomitant medication, renal dysfunction, hypoglycemia unawareness, and cognitive dysfunction. Hypoglycemia is associated with acute short-term symptoms related to either counterregulation, such as tachycardia and sweating, or to neuroglycopenia, such as irritability, confusion, and in severe cases stupor, coma, and even death. However, there are also long-term consequences of hypoglycemia such as reduced working capacity, weight gain, loss of self-confidence with reduced quality of life, and increased risk for cardiovascular diseases. For both the patients, the health care system, and the society at large, hypoglycemia carries a high cost. Strategies to mitigate the risk of hypoglycemia include awareness of the condition; education of patients, relatives, and health-care providers; and selecting appropriate glucose-lowering medication that also judges the risk for hypoglycemia to prevent this complication. This article summarizes the current knowledge of hypoglycemia and its consequences with a special emphasis on its consequences for the choice of glucose-lowering therapy. Keywords: type 2 diabetes, hypoglycemia, treatment, sulfonylurea, incretin therapy, insulin

Interdisciplinary approach to compensation of hypoglycemia in diabetic patients with chronic heart failure.

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Anfinogenova, Yana; Grakova, Elena V; Shvedova, Maria; Kopieva, Kristina V; Teplyakov, Alexander T; Popov, Sergey V

2018-05-01

Diabetes mellitus is a chronic disease requiring lifelong control with hypoglycemic agents that must demonstrate excellent efficacy and safety profiles. In patients taking glucose-lowering drugs, hypoglycemia is a common cause of death associated with arrhythmias, increased thrombus formation, and specific effects of catecholamines due to sympathoadrenal activation. Focus is now shifting from merely glycemic control to multifactorial approach. In the context of individual drugs and classes, this article reviews interdisciplinary strategies evaluating metabolic effects of drugs for treatment of chronic heart failure (CHF) which can mask characteristic hypoglycemia symptoms. Hypoglycemia unawareness and cardiac autonomic neuropathy are discussed. Data suggesting that hypoglycemia modulates immune response are reviewed. The potential role of gut microbiota in improving health of patients with diabetes and CHF is emphasized. Reports stating that nondiabetic CHF patients can have life-threatening hypoglycemia associated with imbalance of thyroid hormones are discussed. Regular glycemic control based on HbA1c measurements and adequate pharmacotherapy remain the priorities in diabetes management. New antihyperglycemic drugs with safer profiles should be preferred in vulnerable CHF patients. Multidrug interactions must be considered. Emerging therapies with reduced hypoglycemia risk, telemedicine, sensor technologies, and genetic testing predicting hypoglycemia risk may help solving the challenges of hypoglycemia in CHF patients with diabetes. Interdisciplinary work may involve cardiologists, diabetologists/endocrinologists, immunologists, gastroenterologists, microbiologists, nutritionists, imaging specialists, geneticists, telemedicine experts, and other relevant specialists. This review emphasizes that systematic knowledge on pathophysiology of hypoglycemia in diabetic patients with CHF is largely lacking and the gaps in our understanding require further discoveries.

Hypoglycemia in Older People - A Less Well Recognized Risk Factor for Frailty

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Abdelhafiz, Ahmed H; Rodríguez-Mañas, Leocadio; Morley, John E.; Sinclair, Alan J

2015-01-01

Recurrent hypoglycemia is common in older people with diabetes and is likely to be less recognized and under reported by patients and health care professionals. Hypoglycemia in this age group is associated with significant morbidities leading to both physical and cognitive dysfunction. Repeated hospital admissions due to frequent hypoglycemia are also associated with further deterioration in patients’ general health. This negative impact of hypoglycemia is likely to eventually lead to frailty, disability and poor outcomes. It appears that the relationship between hypoglycemia and frailty is bidirectional and mediated through a series of influences including under nutrition. Therefore, attention should be paid to the management of under nutrition in the general elderly population by improving energy intake and maintaining muscle mass. Increasing physical activity and having a more conservative approach to glycemic targets in frail older people with diabetes may be worthwhile. PMID:25821643

Impact of hypoglycemia on daily life of type 2 diabetes patients in Ukraine

Directory of Open Access Journals (Sweden)

Mandrik O

2013-07-01

Full Text Available Olena Mandrik,1–3 Johan L Severens,1 Olena Doroshenko,4 Vladymir Pan'kiv,5 Nonna Kravchun,6 Maryna Vlasenko,7 Mykola Hulchiy,8 Maryna Baljuk,9 Yuliia Komisarenko,10 Eugene Martsynik,11 Liubov Sokolova,12 Olga Zalis'ka,2 Boris Mankovsky131Erasmus University Rotterdam, Rotterdam, the Netherlands; 2Danylo Halytsky Lviv National Medical University, Lviv, 3MSD Ukraine, 4Ukrainian Institute for Strategic Research, 5Ukrainian Scientific Centre of Endocrine Surgery, 6Institute of Problems of Endocrine Pathology na VY Danylevskogo, Ukrainian Academy of Medical Sciences, Kyiv, 7Vinnitsa National Medical University named after MI Pyrogov, Vinnytsia, 8Kyiv City Teaching Endocrinological Center, Kyiv, 9Danilevsky Institute of Endocrine Pathology Problems, Ukrainian Academy of Medical Sciences, Kharkov, 10OO Bogomolets National Medical University, Kyiv, 11Medical Academy of Dnepropetrovsk, Dnepropetrovsk, 12Institute of Endocrinology and Metabolism after V.P. Komissarenko, National Academy of Medical Sciences of Ukraine, Kyiv, 13PL Shupik National Medical Academy of Postgraduate Education, Kyiv, UkraineAbstract: This study evaluates the impact of hypoglycemia on the lives of Ukrainian patients with type 2 diabetes mellitus. The secondary objective was to explore patient–physician relationships and the attitudes of patients towards various informational resources on diabetes management. Three focus groups with 26 patients were conducted. Qualitative information was evaluated using content analysis. The results show that patients with type 2 diabetes mellitus in Ukraine are adapting to potential attacks of hypoglycemia; however, they still experience periodic manifestations of hypoglycemia that significantly affect their psychological well-being. This result is similar to observations made in other countries. Ukrainian patients >40 years old mainly receive information on disease management from endocrinologists, and rarely use internet resources on diabetes

Hypoglycemia: Role of Hypothalamic Glucose-Inhibited (GI) Neurons in Detection and Correction.

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Zhou, Chunxue; Teegala, Suraj B; Khan, Bilal A; Gonzalez, Christina; Routh, Vanessa H

2018-01-01

Hypoglycemia is a profound threat to the brain since glucose is its primary fuel. As a result, glucose sensors are widely located in the central nervous system and periphery. In this perspective we will focus on the role of hypothalamic glucose-inhibited (GI) neurons in sensing and correcting hypoglycemia. In particular, we will discuss GI neurons in the ventromedial hypothalamus (VMH) which express neuronal nitric oxide synthase (nNOS) and in the perifornical hypothalamus (PFH) which express orexin. The ability of VMH nNOS-GI neurons to depolarize in low glucose closely parallels the hormonal response to hypoglycemia which stimulates gluconeogenesis. We have found that nitric oxide (NO) production in low glucose is dependent on oxidative status. In this perspective we will discuss the potential relevance of our work showing that enhancing the glutathione antioxidant system prevents hypoglycemia associated autonomic failure (HAAF) in non-diabetic rats whereas VMH overexpression of the thioredoxin antioxidant system restores hypoglycemia counterregulation in rats with type 1 diabetes.We will also address the potential role of the orexin-GI neurons in the arousal response needed for hypoglycemia awareness which leads to behavioral correction (e.g., food intake, glucose administration). The potential relationship between the hypothalamic sensors and the neurocircuitry in the hindbrain and portal mesenteric vein which is critical for hypoglycemia correction will then be discussed.

Hypoglycemia: Role of Hypothalamic Glucose-Inhibited (GI Neurons in Detection and Correction

Directory of Open Access Journals (Sweden)

Chunxue Zhou

2018-03-01

Full Text Available Hypoglycemia is a profound threat to the brain since glucose is its primary fuel. As a result, glucose sensors are widely located in the central nervous system and periphery. In this perspective we will focus on the role of hypothalamic glucose-inhibited (GI neurons in sensing and correcting hypoglycemia. In particular, we will discuss GI neurons in the ventromedial hypothalamus (VMH which express neuronal nitric oxide synthase (nNOS and in the perifornical hypothalamus (PFH which express orexin. The ability of VMH nNOS-GI neurons to depolarize in low glucose closely parallels the hormonal response to hypoglycemia which stimulates gluconeogenesis. We have found that nitric oxide (NO production in low glucose is dependent on oxidative status. In this perspective we will discuss the potential relevance of our work showing that enhancing the glutathione antioxidant system prevents hypoglycemia associated autonomic failure (HAAF in non-diabetic rats whereas VMH overexpression of the thioredoxin antioxidant system restores hypoglycemia counterregulation in rats with type 1 diabetes.We will also address the potential role of the orexin-GI neurons in the arousal response needed for hypoglycemia awareness which leads to behavioral correction (e.g., food intake, glucose administration. The potential relationship between the hypothalamic sensors and the neurocircuitry in the hindbrain and portal mesenteric vein which is critical for hypoglycemia correction will then be discussed.

Octreotide therapy and restricted fetal growth: pregnancy in familial hyperinsulinemic hypoglycemia

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Marianne Geilswijk

2017-02-01

Full Text Available Hypoglycemia during pregnancy can have serious health implications for both mother and fetus. Although not generally recommended in pregnancy, synthetic somatostatin analogues are used for the management of blood glucose levels in expectant hyperinsulinemic mothers. Recent reports suggest that octreotide treatment in pregnancy, as well as hypoglycemia in itself, may pose a risk of fetal growth restriction. During pregnancy, management of blood glucose levels in familial hyperinsulinemic hypoglycemia thus forms a medical dilemma. We report on pregnancy outcomes in a woman with symptomatic familial hyperinsulinemic hypoglycemia, type 3. During the patient’s first pregnancy with a viable fetus octreotide treatment was instituted in gestational age 23 weeks to prevent severe hypoglycemic incidences. Fetal growth velocity declined, and at 37 weeks of gestation, intrauterine growth retardation was evident. During the second pregnancy with a viable fetus, blood glucose levels were managed through dietary intervention alone. Thus, the patient was advised to take small but frequent meals high in fiber and low in carbohydrates. Throughout pregnancy, no incidences of severe hypoglycemia occurred and fetal growth velocity was normal. We conclude that octreotide treatment during pregnancy may pose a risk of fetal growth restriction and warrants careful consideration. In some cases of familial hyperinsulinemic hypoglycemia, blood glucose levels can be successfully managed through diet only, also during pregnancy.

[Hypoglycemia as a cause of traffic accidents].

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Metter, D

1989-05-01

Hypoglycemia is the most important subsidiary effect of insulin therapy, where traffic medicine is concerned. A study has been made of 8 motor car drivers each dependent on insulin and involved in road accidents. The evidence was issued during the trial. The questions set out to prove if there was a state of hypoglycemia and if the afflicted could have foreseen this condition. In 5 cases the driving conduct before the accidents was evident in cordinatory disturbances, which resulted in sinuous driving. The accidents all happened in every-day traffic conditions, namely counter traffic (3), front-end collision (3) and through disregard of right-of-way at cross-roads (1). A further accident was conditioned by an alcoholic state while parking in a car-park. The disturbances in consciousness conditioned by hypoglycemia occurred without warning. In 3 cases the predictability (in legal terms Actio libera in causa) had to be conceded, because the drivers had set out on their routes despite warning signals or insufficient intake of nourishment beforehand.

Glycogen Supercompensation in the Rat Brain After Acute Hypoglycemia is Independent of Glucose Levels During Recovery.

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Duarte, João M N; Morgenthaler, Florence D; Gruetter, Rolf

2017-06-01

Patients with diabetes display a progressive decay in the physiological counter-regulatory response to hypoglycemia, resulting in hypoglycemia unawareness. The mechanism through which the brain adapts to hypoglycemia may involve brain glycogen. We tested the hypothesis that brain glycogen supercompensation following hypoglycemia depends on blood glucose levels during recovery. Conscious rats were submitted to hypoglycemia of 2 mmol/L for 90 min and allowed to recover at different glycemia, controlled by means of i.v. glucose infusion. Brain glycogen concentration was elevated above control levels after 24 h of recovery in the cortex, hippocampus and striatum. This glycogen supercompensation was independent of blood glucose levels in the post-hypoglycemia period. In the absence of a preceding hypoglycemia insult, brain glycogen concentrations were unaltered after 24 h under hyperglycemia. In the hypothalamus, which controls peripheral glucose homeostasis, glycogen levels were unaltered. Overall, we conclude that post-hypoglycemia glycogen supercompensation occurs in several brain areas and its magnitude is independent of plasma glucose levels. By supporting brain metabolism during recurrent hypoglycemia periods, glycogen may have a role in the development of hypoglycemia unawareness.

Factors associated with nocturnal hypoglycemia in at-risk adolescents and young adults with type 1 diabetes.

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Wilson, Darrell M; Calhoun, Peter M; Maahs, David M; Chase, H Peter; Messer, Laurel; Buckingham, Bruce A; Aye, Tandy; Clinton, Paula K; Hramiak, Irene; Kollman, Craig; Beck, Roy W

2015-06-01

Hypoglycemia remains an impediment to good glycemic control, with nocturnal hypoglycemia being particularly dangerous. Information on major contributors to nocturnal hypoglycemia remains critical for understanding and mitigating risk. Continuous glucose monitoring (CGM) data for 855 nights were studied, generated by 45 subjects 15-45 years of age with hemoglobin A1c (HbA1c) levels of ≤8.0% who participated in a larger randomized study. Factors assessed for potential association with nocturnal hypoglycemia (CGM measurement of <60 mg/dL for ≥30 min) included bedtime blood glucose (BG), exercise intensity, bedtime snack, insulin on board, day of the week, previous daytime hypoglycemia, age, gender, HbA1c level, diabetes duration, daily basal insulin, and daily insulin dose. Hypoglycemia occurred during 221 of 885 (25%) nights and was more frequent with younger age (P<0.001), lower HbA1c levels (P=0.006), medium/high-intensity exercise during the preceding day (P=0.003), and the occurrence of antecedent daytime hypoglycemia (P=0.001). There was a trend for lower bedtime BG levels to be associated with more frequent nocturnal hypoglycemia (P=0.10). Bedtime snack, before bedtime insulin bolus, weekend versus weekday, gender, and daily basal and bolus insulin were not associated with nocturnal hypoglycemia. Awareness that HbA1c level, exercise, bedtime BG level, and daytime hypoglycemia are all modifiable factors associated with nocturnal hypoglycemia may help patients and providers decrease the risk of hypoglycemia at night. Risk for nocturnal hypoglycemia increased in a linear fashion across the range of variables, with no clear-cut thresholds to guide clinicians or patients for any particular night.

Manufacturing prepainted steel sheet by electron beam curing

International Nuclear Information System (INIS)

Oka, Joji

1987-01-01

Several advantages are offered by electron beam curing. A formidably hard and stain resistant paint film which is difficult to obtain by heat curing paint is developed. As a result, a unique new prepainted steel is produced. Four technologies are involved: development high-quality paint, selection of optimum electron beam processor, technology to control electron beam processing atmosphere and secondary X-ray shield technology. These technologies are described in detail. (A.J.)

Sleep disturbances in IDDM patients with nocturnal hypoglycemia

DEFF Research Database (Denmark)

Bendtson, I; Gade, J; Thomsen, C E

1992-01-01

Eight insulin-dependent diabetic patients were studied to evaluate sleep patterns during normoglycemia and spontaneous and insulin-induced hypoglycemia. Two channels of electroencephalogram (EEG), electromyogram and actooculogram were recorded. The signals were analyzed off-line, using...... a polygraphic sleep analysis system. The scoring was mainly based on the color density spectral array of the EEG. Blood glucose and growth hormone were measured serially. Asymptomatic, spontaneous nocturnal hypoglycemia occurred in 38% of the nights. Conventional sleep analysis showed a tendency toward...

Blood electrolyte disturbances during severe hypoglycemia in Korean patients with type 2 diabetes.

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Kang, Mi Yeon

2015-09-01

To investigate abnormalities in blood electrolyte levels during severe hypoglycemia in Korean patients with type 2 diabetes mellitus (T2DM) in a clinical setting. Blood electrolyte levels in adult T2DM patients during severe hypoglycemia were collected from January 1, 2008 to December 31, 2012. Patients who maintained normal serum creatinine and blood urea nitrogen levels were utilized in the study. Severe hypoglycemia was defined as a condition requiring medical assistance, such as administering carbohydrates when serum glucose levels less than 70 mg/dL were observed, in conjunction with other symptoms of hypoglycemia. A total of 1,068 patients who visited the emergency room with severe hypoglycemia were screened, of which 219 patients were included in this study. The incidence of abnormal levels for any electrolyte was 47%. Hypokalemia (type of electrolyte disturbance observed at 21.9%. A decrease in serum potassium levels was associated with decreases in blood glucose levels (r = 0.151, p = 0.025). During severe hypoglycemia, median blood glucose levels, incidence of tachycardia (> 100 beats per minute) and severe hypertension (≥ 180/120 mmHg) were 30 mg/dL (range, 14 to 62) and 35 mg/dL (range, 10 to 69; p = 0.04), 18.8% and 7.2% (p = 0.02), and 20.8% and 10.2% (p = 0.05) in the hypokalemia and normokalemia groups, respectively. During severe hypoglycemia, hypokalemia occurred in 21.9% of T2DM patients and was associated with tachycardia and severe hypertension. Therefore, the results suggest that severe hypoglycemia may increase cardiovascular events in T2DM.

Association of Hypoglycemia With Subsequent Dementia in Older Patients With Type 2 Diabetes Mellitus.

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Mehta, Hemalkumar B; Mehta, Vinay; Goodwin, James S

2017-08-01

Studies have found conflicting evidence regarding the association of hypoglycemia with dementia. We evaluated an association of hypoglycemia with subsequent dementia in patients with type 2 diabetes. This retrospective longitudinal cohort study used the Clinical Practice Research Datalink, an electronic medical records data from the United Kingdom, from 2003 to 2012. We included patients aged >65 years diagnosed with type 2 diabetes, with no prior diagnosis of dementia. Dementia was defined using diagnosis codes from medical records. All patients were followed from the date of initial diabetes diagnosis. To account for competing risk of death, we used Fine and Gray's competing risk model to determine the association of hypoglycemia with dementia while adjusting for potential confounders. Hypoglycemia was modeled as a time-dependent covariate. Of 53,055 patients, 5.7% (n = 3,018) had at least one hypoglycemia episodes. The overall incidence rate of dementia was 12.7 per 1,000 person-years. In the fully adjusted model that controlled for all confounders, the occurrence of at least one hypoglycemia episode was associated with 27% higher odds of subsequent dementia (hazard ratio = 1.27; 95% confidence interval = 1.06-1.51). The risk increased with the number of hypoglycemia episodes: one episode (hazard ratio = 1.26; 95% confidence interval = 1.03-1.54); two or more episodes (hazard ratio = 1.50; 95% confidence interval = 1.09-2.08). Hypoglycemia is associated with a higher risk of dementia and may be responsible in part for the higher risk of dementia in patients with diabetes. Alternatively, hypoglycemia may be a marker for undiagnosed cognitive impairment, and we cannot rule out the possibility of reverse causation between hypoglycemia and dementia. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality.

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Egi, Moritoki; Krinsley, James S; Maurer, Paula; Amin, Devendra N; Kanazawa, Tomoyuki; Ghandi, Shruti; Morita, Kiyoshi; Bailey, Michael; Bellomo, Rinaldo

2016-04-01

To study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit (ICU) patients and subsequent hospital mortality in critically ill patients. We performed a multicenter, multinational, retrospective observational study of patients with available HbA1c levels within the 3-month period preceding ICU admission. We separated patients into three cohorts according to pre-admission HbA1c levels (<6.5, 6.5-7.9, ≥8.0%, respectively). Based on published data, we defined a glucose concentration of 40-69 mg/dL (2.2-3.8 mmol/L) as moderate hypoglycemia and <40 mg/dL (<2.2 mmol/L) as severe hypoglycemia. We applied logistic regression analysis to study the impact of pre-morbid glycemic control on the relationship between acute hypoglycemia and mortality. A total of 3084 critically ill patients were enrolled in the study. Among these patients, with increasing HbA1c levels from <6.5, to 6.5-7.9, and to ≥8.0%, the incidence of both moderate (3.8, 11.1, and 16.4%, respectively; p < 0.001) and severe (0.9, 2.5, and 4.3%, respectively; p < 0.001) hypoglycemia progressively and significantly increased. The relationship between the occurrence of hypoglycemic episodes in the ICU and in-hospital mortality was independently and significantly affected by pre-morbid glucose control, as assessed by adjusted odds ratio (OR) and 95 % confidence interval (CI) for hospital mortality: (1) moderate hypoglycemia: in patients with <6.5, 6.5-7.9, and ≥8.0 % of HbA1c level-OR 0.54, 95% CI 0.25-1.16; OR 0.82, 95 % CI 0.33-2.05; OR 3.42, 95 % CI 1.29-9.06, respectively; (2) severe hypoglycemia: OR 1.50, 95% CI 0.42-5.33; OR 1.59, 95% CI 0.36-7.10; OR 23.46, 95% CI 5.13-107.28, respectively (interaction with pre-morbid glucose control, p = 0.009). We found that the higher the glucose level before admission to the ICU, the higher the mortality risk when patients experienced hypoglycemia. In critically ill patients, chronic pre

Hypoglycemia associated with refeeding syndrome in a cat.

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DeAvilla, Marisa D; Leech, Elizabeth B

2016-11-01

To describe the clinical presentation and biochemical abnormalities occurring during the successful treatment of refeeding syndrome in a cat. A 2-year-old neutered male domestic shorthair cat presented after having been missing for 12 weeks. The cat had clinical signs of severe starvation. Common complications developed during refeeding (eg, hypophosphatemia, hypokalemia, and hemolytic anemia). The cat also developed hypoglycemia, a complication common in people but not previously reported in a cat. Hypoglycemia and electrolyte deficiencies were managed with intravenous supplementation. The cat was successfully treated and was discharged alive 7 days after presentation. Hypoglycemia has not been reported previously as a complication of refeeding in a cat. Frequent monitoring of electrolyte, mineral, and blood glucose concentrations is essential to successful management of refeeding syndrome. The ideal refeeding strategy is unknown at this time. Evidence suggests that a diet low in carbohydrate decreases the likelihood of metabolic derangements commonly associated with refeeding. © Veterinary Emergency and Critical Care Society 2016.

Sustained Reduction in Severe Hypoglycemia in Adults With Type 1 Diabetes Complicated by Impaired Awareness of Hypoglycemia: 2-Year Follow-up in the HypoCOMPaSS Randomized Clinical Trial.

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Little, Stuart A; Speight, Jane; Leelarathna, Lalantha; Walkinshaw, Emma; Tan, Horng Kai; Bowes, Anita; Lubina-Solomon, Alexandra; Chadwick, Thomas J; Stocken, Deborah D; Brennand, Catherine; Marshall, Sally M; Wood, Ruth; Kerr, David; Flanagan, Daniel; Heller, Simon R; Evans, Mark L; Shaw, James A M

2018-04-16

Severe hypoglycemia is a feared complication of type 1 diabetes; yet, few trials have targeted prevention using optimized self-management (educational, therapeutic, and technological support). We aimed to investigate whether improved awareness and reduced severe hypoglycemia, achieved during an intensive randomized clinical trial (RCT), were sustained after return to routine care. Ninety-six adults with type 1 diabetes (29 ± 12 years' duration) and impaired awareness of hypoglycemia at five U.K. tertiary referral diabetes centers were recruited into a 24-week 2 × 2 factorial RCT (HypoCOMPaSS). Participants were randomized to pump (continuous subcutaneous insulin infusion [CSII]) or multiple daily injections (MDIs) and real-time continuous glucose monitoring (RT-CGM) or self-monitoring of blood glucose (SMBG), with equal education/attention to all groups. At 24 weeks, participants returned to routine care with follow-up until 24 months, including free choice of MDI/CSII; RT-CGM vs. SMBG comparison continued to 24 months. Primary outcome was mean difference (baseline to 24 months [between groups]) in hypoglycemia awareness. Improvement in hypoglycemia awareness was sustained (Gold score at baseline 5.1 ± 1.1 vs. 24 months 3.7 ± 1.9; P diabetes complicated by impaired awareness of hypoglycemia. © 2018 by the American Diabetes Association.

Nonislet Cell Tumor Hypoglycemia in a Patient with Adrenal Cortical Carcinoma

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Se Won Kim

2016-01-01

Full Text Available Nonislet cell tumor hypoglycemia (NICTH is a rare but serious paraneoplastic syndrome in which a tumor secretes incompletely processed precursors of insulin-like growth factor-II (IGF-II, causing hypoglycemia. Here, we report an exceptional case of NICTH caused by nonfunctioning adrenocortical carcinoma in a 39-year-old male with recurrent hypoglycemia. The patient’s serum IGF-II/IGF-I ratio had increased to 27.8. The serum level of the IGF-II/IGF-I ratio was normalized after removal of the tumor, and the hypoglycemic attacks no longer occurred after the operation.

[Metabolic control in the critically ill patient an update: hyperglycemia, glucose variability hypoglycemia and relative hypoglycemia].

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Pérez-Calatayud, Ángel Augusto; Guillén-Vidaña, Ariadna; Fraire-Félix, Irving Santiago; Anica-Malagón, Eduardo Daniel; Briones Garduño, Jesús Carlos; Carrillo-Esper, Raúl

Metabolic changes of glucose in critically ill patients increase morbidity and mortality. The appropriate level of blood glucose has not been established so far and should be adjusted for different populations. However concepts such as glucose variability and relative hypoglycemia of critically ill patients are concepts that are changing management methods and achieving closer monitoring. The purpose of this review is to present new data about the management and metabolic control of patients in critical areas. Currently glucose can no longer be regarded as an innocent element in critical patients; both hyperglycemia and hypoglycemia increase morbidity and mortality of patients. Protocols and better instruments for continuous measurement are necessary to achieve the metabolic control of our patients. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Fear of hypoglycemia and its clinical significance: a case-control study

Directory of Open Access Journals (Sweden)

Elena Georgievna Starostina

2013-11-01

Full Text Available Aim. To assess the prevalence of fear of hypoglycemia, its clinical features and influence on diabetes compensation. Materials and Methods. A cross-sectional study was conducted with 200 sequentially enrolled participants with type 2 diabetes mellitus (T2DM; n=139 and type 1 diabetes mellitus (T1DM; n=61. Patients were screened for psychiatric disorders with appropriate inventory and examined by a psychiatrist. Subjects identified as those with fear of hypoglycemia (n=12 formed the study group, while control group was assembled of individuals without phobic signs, matched for gender, age, type and duration of diabetes and concomitant psychiatric disorders. Results. Prevalence of fear of hypoglycemia was estimated at 6%, being consistently higher in patients with T1DM (16.1% vs. T2DM (1%; p=0.0002. Fear of hypoglycemia was associated with higher median HbA1c (9.4% [8.6 ; 9.9] vs. 8.2% [6.8 ; 9.3], p

Hypoglycemia in pregnant women with type 1 diabetes - Predictors and role of metabolic control

DEFF Research Database (Denmark)

Nielsen, L.R.; Johansen, M.; Pedersen-Bjergaard, U.

2008-01-01

OBJECTIVE- In pregnancy with type 1 diabetes, we evaluated occurrence of mild and severe hypoglycemia and analyzed the influence of strict metabolic control, nausea, Vomiting, and other potential predictors of occurrence of severe hypoglycemia. RESEARCH DESIGN AND METHODS- A prospective...... awareness or unawareness (3.2 [1.2-8.2]) as independent predictors for severe hypoglycemia. CONCLUSIONS - In pregnancy with type 1 diabetes, the incidence of mild and severe hypoglycemia was highest in early pregnancy, although metabolic control was tighter in the last part of pregnancy. Predictors...... observational study of 108 consecutive pregnant women with type 1 diabetes was conducted. At 8, 14, 21, 27, and 33 weeks of gestation, patients performed self-monitored plasma glucose (SMPG) (eight/day) for 3 days and completed a questionnaire on nausea, vomiting, hypoglycemia awareness, and history of mild...

Brain glucose metabolism during hypoglycemia in type 1 diabetes: insights from functional and metabolic neuroimaging studies.

Science.gov (United States)

Rooijackers, Hanne M M; Wiegers, Evita C; Tack, Cees J; van der Graaf, Marinette; de Galan, Bastiaan E

2016-02-01

Hypoglycemia is the most frequent complication of insulin therapy in patients with type 1 diabetes. Since the brain is reliant on circulating glucose as its main source of energy, hypoglycemia poses a threat for normal brain function. Paradoxically, although hypoglycemia commonly induces immediate decline in cognitive function, long-lasting changes in brain structure and cognitive function are uncommon in patients with type 1 diabetes. In fact, recurrent hypoglycemia initiates a process of habituation that suppresses hormonal responses to and impairs awareness of subsequent hypoglycemia, which has been attributed to adaptations in the brain. These observations sparked great scientific interest into the brain's handling of glucose during (recurrent) hypoglycemia. Various neuroimaging techniques have been employed to study brain (glucose) metabolism, including PET, fMRI, MRS and ASL. This review discusses what is currently known about cerebral metabolism during hypoglycemia, and how findings obtained by functional and metabolic neuroimaging techniques contributed to this knowledge.

Is Low Blood Glucose (Hypoglycemia) Dangerous?

Science.gov (United States)

... pills. In general, hypoglycemia is defined as a blood glucose level below 70 mg/dl. Low blood glucose is ... glucose. Always carry carbohydrate foods for treatment. Check blood glucose levels again in 15 minutes, and repeat treatment if ...

Hypoglycemic Exposure and Risk of Asymptomatic Hypoglycemia in Type 1 Diabetes assessed by Continuous Glucose Monitoring

DEFF Research Database (Denmark)

Henriksen, Marie Moth; Andersen, Henrik Ullits; Thorsteinsson, Birger

2018-01-01

: To explore the association between hypoglycemic exposure and proportion of asymptomatic hypoglycemia and relation to risk of severe hypoglycemia. Design: Prospective observational trial. Setting: Outpatient clinic. Patients: 153 unselected subjects with type 1 diabetes mellitus (T1D). Intervention: Six days...... of blinded continuous glucose monitoring (CGM) and recording of hypoglycemia symptoms. Main Outcome Measure: Proportion of asymptomatic hypoglycemic events (≤70 mg/dl). Results: Patients were grouped by the number of hypoglycemic events during the recording period (group 1: 1 event, group 2: 2-3 events...... positively associated with risk of severe hypoglycemia (incidence rate ratio (IRR) 1.3 (95% CI 1.1-1.5); p=0.003). Group 4 consisted of patients characterized by classical risk factors of severe hypoglycemia (longer duration of diabetes, lower HbA1c and more frequent impaired awareness of hypoglycemia...

Innovations and Challenges of Implementing a Glucose Gel Toolkit for Neonatal Hypoglycemia.

Science.gov (United States)

Hammer, Denise; Pohl, Carla; Jacobs, Peggy J; Kaufman, Susan; Drury, Brenda

2018-05-24

Transient neonatal hypoglycemia occurs most commonly in newborns who are small for gestational age, large for gestational age, infants of diabetic mothers, and late preterm infants. An exact blood glucose value has not been determined for neonatal hypoglycemia, and it is important to note that poor neurologic outcomes can occur if hypoglycemia is left untreated. Interventions that separate mothers and newborns, as well as use of formula to treat hypoglycemia, have the potential to disrupt exclusive breastfeeding. To determine whether implementation of a toolkit designed to support staff in the adaptation of the practice change for management of newborns at risk for hypoglycemia, that includes 40% glucose gel in an obstetric unit with a level 2 nursery will decrease admissions to the Intermediate Care Nursery, and increase exclusive breastfeeding. This descriptive study used a retrospective chart review for pre/postimplementation of the Management of Newborns at Risk for Hypoglycemia Toolkit (Toolkit) using a convenience sample of at-risk newborns in the first 2 days of life to evaluate the proposed outcomes. Following implementation of the Toolkit, at-risk newborns had a clinically but not statistically significant 6.5% increase in exclusive breastfeeding and a clinically but not statistically significant 5% decrease in admissions to the Intermediate Care Nursery. The Toolkit was designed for ease of staff use and to improve outcomes for the at-risk newborn. Future research includes replication at other level 2 and level 1 obstetric centers and investigation into the number of 40% glucose gel doses that can safely be administered.

The current status of treatment-related severe hypoglycemia in Japanese patients with diabetes mellitus: A report from the committee on a survey of severe hypoglycemia in the Japan Diabetes Society.

Science.gov (United States)

Namba, Mitsuyoshi; Iwakura, Toshio; Nishimura, Rimei; Akazawa, Kohei; Matsuhisa, Munehide; Atsumi, Yoshihito; Satoh, Jo; Yamauchi, Toshimasa

2018-03-02

Despite great strides in pharmacotherapy for diabetes, there is increasing concern over the risk of hypoglycemia in patients with diabetes receiving pharmacotherapy as they become increasingly older. This has prompted the Japan Diabetes Society (JDS) to initiate a survey on the current status of severe hypoglycemia in clinical settings. In July 2015, following approval from the JDS Scientific Survey/Research Ethics Committee, the JDS extended an invitation to executive educators, who represented a total of 631 healthcare facilities accredited by the JDS for diabetes education, to participate in the proposed survey. Of these, those who expressed their willingness to participate in the survey were sent an application form required for obtaining ethical approval at these healthcare facilities and were then asked, following approval, to enter relevant clinical data on an unlinked, anonymous basis in a web-based registry. The current survey was fully funded by the JDS Scientific Survey/Research Committee. A case registry (clinical case database) was launched after facility-specific information (healthcare facility database) was collected from all participating facilities and after informed consent was obtained from all participating patients. With severe hypoglycemia defined as the "presence of hypoglycemic symptoms requiring assistance from another person to treat and preferably venous plasma glucose levels at onset/diagnosis of disease or at presentation clearly less than 60 mg/dL (capillary whole blood glucose, less than 50 mg/dL)", the current survey was conducted between April 1, 2014 and March 31, 2015, during which facility-specific information was collected from a total of 193 facilities with a total of 798 case reports collected from 113 facilities. Of the 193 respondent facilities, 149 reported having an emergency department as well, with the median number of patients who required emergency transportation services to reach these facilities totaling 4

Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence

Directory of Open Access Journals (Sweden)

Lopez JMS

2014-05-01

Full Text Available Janice MS Lopez,1 Kathy Annunziata,2 Robert A Bailey,1 Marcia FT Rupnow,1 Donald E Morisky31Janssen Scientific Affairs, LLC, Raritan, NJ, 2Kantar Health, Princeton, NJ, 3University of California at Los Angeles Fielding School of Public Health, Los Angeles, CA, USABackground: The purpose of this study was to determine the characteristics of adults with type 2 diabetes mellitus (T2DM that correlate with greater risk of hypoglycemia and determine the impact of hypoglycemia on health-related quality of life, work productivity, and medication adherence from a patient perspective.Methods: Data from a large web-based survey were retrospectively analyzed. Adults with a diagnosis of T2DM taking antihyperglycemic agents were included in the analysis. Participants with knowledge of their hypoglycemic history were divided into three groups: those experiencing recent hypoglycemia (previous 3 months, those experiencing nonrecent hypoglycemia, and those never experiencing hypoglycemia.Results: Of the participants with T2DM taking antihyperglycemic agents who were knowledgeable of their hypoglycemia history, 55.7% had ever experienced hypoglycemia. Of those, 52.7% had recent hypoglycemia. Compared with those who never experienced hypoglycemia, those who experienced hypoglycemia tended to: be younger; be more aware of their glycated hemoglobin (HbA1c levels; have higher HbA1c levels; have a higher body mass index; have higher Charlson Comorbidity Index scores; be on insulin, sulfonylureas, and/or glucagon-like peptide-1 agonists; and be less adherent to their antihyperglycemic agents. Hypoglycemia interfered with social activities, caused more missed work (absenteeism, more impairment while at work (presenteeism, and decreased overall work productivity compared with patients who had never experienced hypoglycemia. Overall health-related quality of life, as determined by the Short Form-36 health questionnaire, was negatively impacted by hypoglycemia. Both

β1-Adrenergic receptor deficiency in ghrelin-expressing cells causes hypoglycemia in susceptible individuals

Science.gov (United States)

Mani, Bharath K.; Osborne-Lawrence, Sherri; Vijayaraghavan, Prasanna; Hepler, Chelsea; Zigman, Jeffrey M.

2016-01-01

Ghrelin is an orexigenic gastric peptide hormone secreted when caloric intake is limited. Ghrelin also regulates blood glucose, as emphasized by the hypoglycemia that is induced by caloric restriction in mouse models of deficient ghrelin signaling. Here, we hypothesized that activation of β1-adrenergic receptors (β1ARs) localized to ghrelin cells is required for caloric restriction–associated ghrelin release and the ensuing protective glucoregulatory response. In mice lacking the β1AR specifically in ghrelin-expressing cells, ghrelin secretion was markedly blunted, resulting in profound hypoglycemia and prevalent mortality upon severe caloric restriction. Replacement of ghrelin blocked the effects of caloric restriction in β1AR-deficient mice. We also determined that treating calorically restricted juvenile WT mice with beta blockers led to reduced plasma ghrelin and hypoglycemia, the latter of which is similar to the life-threatening, fasting-induced hypoglycemia observed in infants treated with beta blockers. These findings highlight the critical functions of ghrelin in preventing hypoglycemia and promoting survival during severe caloric restriction and the requirement for ghrelin cell–expressed β1ARs in these processes. Moreover, these results indicate a potential role for ghrelin in mediating beta blocker–associated hypoglycemia in susceptible individuals, such as young children. PMID:27548523

Co-Cure-Ply Resins for High Performance, Large-Scale Structures

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National Aeronautics and Space Administration — Large-scale composite structures are commonly joined by secondary bonding of molded-and-cured thermoset components. This approach may result in unpredictable joint...

Hypoglycemia induced changes in cholinergic receptor expression in the cerebellum of diabetic rats

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Anju TR

2010-02-01

Full Text Available Abstract Glucose homeostasis in humans is an important factor for the functioning of nervous system. Hypoglycemia and hyperglycemia is found to be associated with central and peripheral nerve system dysfunction. Changes in acetylcholine receptors have been implicated in the pathophysiology of many major diseases of the central nervous system (CNS. In the present study we showed the effects of insulin induced hypoglycemia and streptozotocin induced diabetes on the cerebellar cholinergic receptors, GLUT3 and muscle cholinergic activity. Results showed enhanced binding parameters and gene expression of Muscarinic M1, M3 receptor subtypes in cerebellum of diabetic (D and hypoglycemic group (D + IIH and C + IIH. α7nAchR gene expression showed a significant upregulation in diabetic group and showed further upregulated expression in both D + IIH and C + IIH group. AchE expression significantly upregulated in hypoglycemic and diabetic group. ChAT showed downregulation and GLUT3 expression showed a significant upregulation in D + IIH and C + IIH and diabetic group. AchE activity enhanced in the muscle of hypoglycemic and diabetic rats. Our studies demonstrated a functional disturbance in the neuronal glucose transporter GLUT3 in the cerebellum during insulin induced hypoglycemia in diabetic rats. Altered expression of muscarinic M1, M3 and α7nAchR and increased muscle AchE activity in hypoglycemic rats in cerebellum is suggested to cause cognitive and motor dysfunction. Hypoglycemia induced changes in ChAT and AchE gene expression is suggested to cause impaired acetycholine metabolism in the cerebellum. Cerebellar dysfunction is associated with seizure generation, motor deficits and memory impairment. The results shows that cerebellar cholinergic neurotransmission is impaired during hyperglycemia and hypoglycemia and the hypoglycemia is causing more prominent imbalance in cholinergic neurotransmission which is suggested to be a cause of cerebellar

Hyperinsulinemic hypoglycemia associated with insulin antibodies caused by exogenous insulin analog

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Chih-Ting Su

2016-11-01

Full Text Available Insulin antibodies (IA associated with exogenous insulin administration seldom caused hypoglycemia and had different characteristics from insulin autoantibodies (IAA found in insulin autoimmune syndrome (IAS, which was first described by Dr Hirata in 1970. The characteristic of IAS is the presence of insulin-binding autoantibodies and related fasting or late postprandial hypoglycemia. Here, we report a patient with type 1 diabetes mellitus under insulin glargine and insulin aspart treatment who developed recurrent spontaneous post-absorptive hyperinsulinemic hypoglycemia with the cause probably being insulin antibodies induced by exogenous injected insulin. Examinations of serial sera disclosed a high titre of insulin antibodies (33%, normal <5%, high insulin concentration (111.9 IU/mL and undetectable C-peptide when hypoglycemia occurred. An oral glucose tolerance test revealed persistent high serum levels of total insulin and undetectable C-peptide. Image studies of the pancreas were unremarkable, which excluded the diagnosis of insulinoma. The patient does not take any of the medications containing sulfhydryl compounds, which had been reported to cause IAS. After administering oral prednisolone for 3 weeks, hypoglycemic episodes markedly improved, and he was discharged smoothly.

Fasting adaptation in idiopathic ketotic hypoglycemia: a mismatch between glucose production and demand

NARCIS (Netherlands)

Huidekoper, Hidde H.; Duran, Marinus; Turkenburg, Marjolein; Ackermans, Mariëtte T.; Sauerwein, Hans P.; Wijburg, Frits A.

2008-01-01

In order to study the pathophysiology of hypoglycemia in idiopathic ketotic hypoglycemia (KH), glucose kinetics during fasting in patients with KH were determined. A fasting test was performed in 12 children with previously documented KH. Besides determination of glucoregulatory hormones, plasma

Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus

OpenAIRE

Patton, Susana R.; Dolan, Lawrence M.; Henry, Racquel; Powers, Scott W.

2008-01-01

The current study examined fear of hypoglycemia in 81 mothers and 64 fathers of young children with type 1 diabetes (T1DM) using the Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC possible range=26–130).

Impact of retrospective calibration algorithms on hypoglycemia detection in newborn infants using continuous glucose monitoring.

Science.gov (United States)

Signal, Matthew; Le Compte, Aaron; Harris, Deborah L; Weston, Philip J; Harding, Jane E; Chase, J Geoffrey

2012-10-01

Neonatal hypoglycemia is common and may cause serious brain injury. Diagnosis is by blood glucose (BG) measurements, often taken several hours apart. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing the number of BG measurements. Calibration algorithms convert sensor signals into CGM output. Thus, these algorithms directly affect measures used to quantify hypoglycemia. This study was designed to quantify the effects of recalibration and filtering of CGM data on measures of hypoglycemia (BG neonates. CGM data from 50 infants were recalibrated using an algorithm that explicitly recognized the high-accuracy BG measurements available in this study. CGM data were analyzed as (1) original CGM output, (2) recalibrated CGM output, (3) recalibrated CGM output with postcalibration median filtering, and (4) recalibrated CGM output with precalibration median filtering. Hypoglycemia was classified by number of episodes, duration, severity, and hypoglycemic index. Recalibration increased the number of hypoglycemic events (from 161 to 193), hypoglycemia duration (from 2.2% to 2.6%), and hypoglycemic index (from 4.9 to 7.1 μmol/L). Median filtering postrecalibration reduced hypoglycemic events from 193 to 131, with little change in duration (from 2.6% to 2.5%) and hypoglycemic index (from 7.1 to 6.9 μmol/L). Median filtering prerecalibration resulted in 146 hypoglycemic events, a total duration of hypoglycemia of 2.6%, and a hypoglycemic index of 6.8 μmol/L. Hypoglycemia metrics, especially counting events, are heavily dependent on CGM calibration BG error, and the calibration algorithm. CGM devices tended to read high at lower levels, so when high accuracy calibration measurements are available it may be more appropriate to recalibrate the data.

Continuous glucose monitoring in newborn infants: how do errors in calibration measurements affect detected hypoglycemia?

Science.gov (United States)

Thomas, Felicity; Signal, Mathew; Harris, Deborah L; Weston, Philip J; Harding, Jane E; Shaw, Geoffrey M; Chase, J Geoffrey

2014-05-01

Neonatal hypoglycemia is common and can cause serious brain injury. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing blood glucose (BG) measurements. Calibration algorithms use BG measurements to convert sensor signals into CGM data. Thus, inaccuracies in calibration BG measurements directly affect CGM values and any metrics calculated from them. The aim was to quantify the effect of timing delays and calibration BG measurement errors on hypoglycemia metrics in newborn infants. Data from 155 babies were used. Two timing and 3 BG meter error models (Abbott Optium Xceed, Roche Accu-Chek Inform II, Nova Statstrip) were created using empirical data. Monte-Carlo methods were employed, and each simulation was run 1000 times. Each set of patient data in each simulation had randomly selected timing and/or measurement error added to BG measurements before CGM data were calibrated. The number of hypoglycemic events, duration of hypoglycemia, and hypoglycemic index were then calculated using the CGM data and compared to baseline values. Timing error alone had little effect on hypoglycemia metrics, but measurement error caused substantial variation. Abbott results underreported the number of hypoglycemic events by up to 8 and Roche overreported by up to 4 where the original number reported was 2. Nova results were closest to baseline. Similar trends were observed in the other hypoglycemia metrics. Errors in blood glucose concentration measurements used for calibration of CGM devices can have a clinically important impact on detection of hypoglycemia. If CGM devices are going to be used for assessing hypoglycemia it is important to understand of the impact of these errors on CGM data. © 2014 Diabetes Technology Society.

The accuracy of home glucose meters in hypoglycemia.

Science.gov (United States)

Sonmez, Alper; Yilmaz, Zeynep; Uckaya, Gokhan; Kilic, Selim; Tapan, Serkan; Taslipinar, Abdullah; Aydogdu, Aydogan; Yazici, Mahmut; Yilmaz, Mahmut Ilker; Serdar, Muhittin; Erbil, M Kemal; Kutlu, Mustafa

2010-08-01

Home glucose meters (HGMs) may not be accurate enough to sense hypoglycemia. We evaluated the accuracy and the capillary and venous comparability of five different HGMs (Optium Xceed [Abbott Diabetes Care, Alameda, CA, USA], Contour TS [Bayer Diabetes Care, Basel, Switzerland], Accu-Chek Go [Roche Ltd., Basel, Switzerland], OneTouch Select [Lifescan, Milpitas, CA, USA], and EZ Smart [Tyson Bioresearch Inc., Chu-Nan, Taiwan]) in an adult population. The insulin hypoglycemia test was performed to 59 subjects (56 males; 23.6 +/- 3.2 years old). Glucose was measured from forearm venous blood and finger capillary samples both before and after regular insulin (0.1 U/kg) was injected. Venous samples were analyzed in the reference laboratory by the hexokinase method. In vitro tests for method comparison and precision analyses were also performed by spiking the glucose-depleted venous blood. All HGMs failed to sense hypoglycemia to some extend. EZ Smart was significantly inferior in critical error Zone D, and OneTouch Select was significantly inferior in the clinically unimportant error Zone B. Accu-Chek Go, Optium Xceed, and Contour TS had similar performances and were significantly better than the other two HGMs according to error grid analysis or International Organization for Standardization criteria. The in vitro tests were consistent with the above clinical data. The capillary and venous consistencies of Accu-Chek Go and OneTouch Select were better than the other HGMs. The present results show that not all the HGMs are accurate enough in low blood glucose levels. The patients and the caregivers should be aware of these restrictions of the HGMs and give more credit to the symptoms of hypoglycemia than the values obtained by the HGMs. Finally, these results indicate that there is a need for the revision of the accuracy standards of HGMs in low blood glucose levels.

Current perspectives on neonatal hypoglycemia, its management, and cerebral injury risk

Directory of Open Access Journals (Sweden)

Chandran S

2015-02-01

Full Text Available Suresh Chandran,1–4 Victor Samuel Rajadurai,1–3 Abdul Alim Abdul Haium,1–3 Khalid Hussain5,6 1Department of Neonatology, KK Women’s and Children’s Hospital, Singapore; 2Duke-NUS Graduate School of Medicine, Singapore; 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 4Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; 5Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, 6The Institute of Child Health, University College London, London, UK Abstract: Glucose is an essential substrate for mammalian cells; in particular, the brain needs glucose continuously as a primary source of energy. Hypoglycemia is the most common biochemical finding in the neonatal period. However, despite the common occurrence, there is still controversy on the definition of hypoglycemia in the newborn period. This has led to the development of guidelines designed to identify infants “at-risk” and the implementation of an “operational threshold” for physicians to consider intervention. In healthy term infants, the optimal hormonal and metabolic adaptations during the immediate neonatal period ensure an adequate energy substrate for the vital organs, whereas the abnormal glucose homeostasis observed in preterm and growth-retarded infants is multifactorial in origin. For these high-risk infants, it is important to identify, screen, and prevent significant hypoglycemia. Detailed investigations are warranted in infants with severe and persistent hypoglycemia. Neonatal hypoglycemia is a major cause of brain injury. The speculated mechanisms of cellular injury include excitatory neurotoxins active at N-methyl-D-aspartate receptors, increased mitochondrial free radical generation with initiation of apoptosis and altered cerebral energetic characteristics. This hypoglycemic brain injury predominantly affects parieto-occipital regions causing

Hypoglycemia in Patients with Diabetes and Renal Disease

OpenAIRE

Alsahli, Mazen; Gerich, John E.

2015-01-01

This article summarizes our current knowledge of the epidemiology, pathogenesis, and morbidity of hypoglycemia in patients with diabetic kidney disease and reviews therapeutic limitations in this situation.

Hypoglycemia in Patients with Diabetes and Renal Disease.

Science.gov (United States)

Alsahli, Mazen; Gerich, John E

2015-05-13

This article summarizes our current knowledge of the epidemiology, pathogenesis, and morbidity of hypoglycemia in patients with diabetic kidney disease and reviews therapeutic limitations in this situation.

Light curing through glass ceramics: effect of curing mode on micromechanical properties of dual-curing resin cements.

Science.gov (United States)

Flury, Simon; Lussi, Adrian; Hickel, Reinhard; Ilie, Nicoleta

2014-04-01

The aim of this study was to investigate micromechanical properties of five dual-curing resin cements after different curing modes including light curing through glass ceramic materials. Vickers hardness (VH) and indentation modulus (Y HU) of Panavia F2.0, RelyX Unicem 2 Automix, SpeedCEM, BisCem, and BeautiCem SA were measured after 1 week of storage (37 °C, 100 % humidity). The resin cements were tested following self-curing or light curing with the second-generation light-emitting diode (LED) curing unit Elipar FreeLight 2 in Standard Mode (1,545 mW/cm(2)) or with the third-generation LED curing unit VALO in High Power Mode (1,869 mW/cm(2)) or in XtraPower Mode (3,505 mW/cm(2)). Light curing was performed directly or through glass ceramic discs of 1.5 or 3 mm thickness of IPS Empress CAD or IPS e.max CAD. VH and Y HU were analysed with Kruskal-Wallis tests followed by pairwise Wilcoxon rank sum tests (α = 0.05). RelyX Unicem 2 Automix resulted in the highest VH and Y HU followed by BeautiCem SA, BisCem, SpeedCEM, and finally Panavia F2.0. Self-curing of RelyX Unicem 2 Automix and SpeedCEM lowered VH and Y HU compared to light curing whereas self-curing of Panavia F2.0, BisCem, and BeautiCem SA led to similar or significantly higher VH and Y HU compared to light curing. Generally, direct light curing resulted in similar or lower VH and Y HU compared to light curing through 1.5-mm-thick ceramic discs. Light curing through 3-mm-thick discs of IPS e.max CAD generally reduced VH and Y HU for all resin cements except SpeedCEM, which was the least affected by light curing through ceramic discs. The resin cements responded heterogeneously to changes in curing mode. The applied irradiances and light curing times adequately cured the resin cements even through 1.5-mm-thick ceramic discs. When light curing resin cements through thick glass ceramic restorations, clinicians should consider to prolong the light curing times even with LED curing units providing high

Incidence of Hypoglycemia in Patients With Low eGFR Treated With Insulin and Dextrose for Hyperkalemia.

Science.gov (United States)

Pierce, Dwayne A; Russell, Greg; Pirkle, James L

2015-12-01

Hyperkalemia is a potentially life-threatening condition that is common in kidney disease patients. Insulin is used to treat hyperkalemia, but may cause hypoglycemia, especially in kidney disease when insulin may be metabolized more slowly. We compared the rates of hypoglycemia in patients with low estimated glomerular filtration rate (eGFR) using high versus low doses of insulin for hyperkalemia to determine if lower doses of insulin would decrease the incidence of hypoglycemia. This was a retrospective study of hospitalized patients receiving intravenous insulin for hyperkalemia during a 6-month period. Patients with low eGFR were analyzed based on how much insulin they received: high dose (10 units, n = 78) versus low dose (5 units, n = 71). Postdose nadir blood glucose values were examined for up to 8 hours after the dose. The percentage of hypoglycemia (blood glucose ≤70 mg/dl) and a subset of severe hypoglycemia (blood glucose <50 mg/dl) were then reported for each dose group. A total of 149 doses were identified in patients with low eGFR. The rates of hypoglycemia were 16.7% and 19.7% (P = 0.79), respectively, among high-dose (n = 78) and low-dose (n = 71) groups. Rates of severe hypoglycemia were 8.9% and 7.0%, respectively (P = 0.90). More than 28% of hypoglycemic episodes with high doses occurred after 4 hours (median = 2.5 hours) compared with 14.3% with low doses (median = 2.38 hours). There was no difference in the rate of hypoglycemia or severe hypoglycemia between high or low doses of insulin in patients with low eGFR. We recommend monitoring up to 6 hours after insulin use in hyperkalemia. © The Author(s) 2015.

Symptomatic hypoglycemia causing brain injury in a term breast fed newborn following early discharge.

Science.gov (United States)

Marwah, Ashish; Gathwala, Geeta

2011-12-01

Cerebral metabolism and functioning depends upon an adequate blood glucose supply which provides for majority of the brain's energy requirement. Studies from the past have shown that neonatal hypoglycemia is associated with acute and long term neurological sequelae. Early discharge without adequately established breast feeding may lead to feeding problems, post discharge hypoglycemia and its associated neurological complications. The authors describe one such case of an exclusively breast fed term newborn who presented on day 3 with symptomatic hypoglycemia and associated neurological injury.

Gcg-XTEN: an improved glucagon capable of preventing hypoglycemia without increasing baseline blood glucose.

Directory of Open Access Journals (Sweden)

Nathan C Geething

2010-04-01

Full Text Available While the majority of current diabetes treatments focus on reducing blood glucose levels, hypoglycemia represents a significant risk associated with insulin treatment. Glucagon plays a major regulatory role in controlling hypoglycemia in vivo, but its short half-life and hyperglycemic effects prevent its therapeutic use for non-acute applications. The goal of this study was to identify a modified form of glucagon suitable for prophylactic treatment of hypoglycemia without increasing baseline blood glucose levels.Through application of the XTEN technology, we report the construction of a glucagon fusion protein with an extended exposure profile (Gcg-XTEN. The in vivo half-life of the construct was tuned to support nightly dosing through design and testing in cynomolgus monkeys. Efficacy of the construct was assessed in beagle dogs using an insulin challenge to induce hypoglycemia. Dose ranging of Gcg-XTEN in fasted beagle dogs demonstrated that the compound was biologically active with a pharmacodynamic profile consistent with the designed half-life. Prophylactic administration of 0.6 nmol/kg Gcg-XTEN to dogs conferred resistance to a hypoglycemic challenge at 6 hours post-dose without affecting baseline blood glucose levels. Consistent with the designed pharmacokinetic profile, hypoglycemia resistance was not observed at 12 hours post-dose. Importantly, the solubility and stability of the glucagon peptide were also significantly improved by fusion to XTEN.The data show that Gcg-XTEN is effective in preventing hypoglycemia without the associated hyperglycemia expected for unmodified glucagon. While the plasma clearance of this Gcg-XTEN has been optimized for overnight dosing, specifically for the treatment of nocturnal hypoglycemia, constructs with significantly longer exposure profiles are feasible. Such constructs may have multiple applications such as allowing for more aggressive insulin treatment regimens, treating hypoglycemia due to insulin

Long-Term Prediction of Severe Hypoglycemia in Type 1 Diabetes

DEFF Research Database (Denmark)

Henriksen, Marie Moth; Færch, Louise; Thorsteinsson, Birger

2016-01-01

BACKGROUND: Prediction of risk of severe hypoglycemia (SH) in patients with type 1 diabetes is important to prevent future episodes, but it is unknown if it is possible to predict the long-term risk of SH. The aim of the study is to assess if long-term prediction of SH is possible in type 1...... diabetes. METHODS: A follow-up study was performed with 98 patients with type 1 diabetes. At baseline and at follow-up, the patients filled in a questionnaire about diabetes history and complications, number of SH in the preceding year and state of awareness, and HbA1c and C-peptide levels were measured......-up. CONCLUSIONS: Long-term prediction of severe hypoglycemia in type 1 diabetes was not possible, although baseline hypoglycemia unawareness tended to remain a predictor for risk of SH at follow-up. Therefore, it is important repeatedly to assess the different risk factors of SH to determine the actual risk....

Prevention of acute/severe hypoglycemia-induced neuron death by lactate administration

OpenAIRE

Won, Seok Joon; Jang, Bong Geom; Yoo, Byung Hoon; Sohn, Min; Lee, Min Woo; Choi, Bo Young; Kim, Jin Hee; Song, Hong Ki; Suh, Sang Won

2012-01-01

Hypoglycemia-induced cerebral neuropathy can occur in patients with diabetes who attempt tight control of blood glucose and may lead to cognitive dysfunction. Accumulating evidence from animal models suggests that hypoglycemia-induced neuronal death is not a simple result of glucose deprivation, but is instead the end result of a multifactorial process. In particular, the excessive activation of poly (ADP-ribose) polymerase-1 (PARP-1) consumes cytosolic nicotinamide adenine dinucleotide (NAD+...

Continuous glucose monitoring in newborn infants: how do errors in calibration measurements affect detected hypoglycemia?

OpenAIRE

Thomas, Felicity Louise; Signal, Mathew; Harris, Deborah L.; Weston, Philip J.; Harding, Jane E.; Shaw, Geoffrey M.; Chase, J. Geoffrey

2014-01-01

Neonatal hypoglycemia is common and can cause serious brain injury. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing blood glucose (BG) measurements. Calibration algorithms use BG measurements to convert sensor signals into CGM data. Thus, inaccuracies in calibration BG measurements directly affect CGM values and any metrics calculated from them. The aim was to quantify the effect of timing delays and calibration BG measurement errors on hypoglycemia me...

Hypoglycemia in Patients with Diabetes and Renal Disease

Directory of Open Access Journals (Sweden)

Mazen Alsahli

2015-05-01

Full Text Available This article summarizes our current knowledge of the epidemiology, pathogenesis, and morbidity of hypoglycemia in patients with diabetic kidney disease and reviews therapeutic limitations in this situation.

Fear of Hypoglycemia in Children and Adolescents and Their Parents with Type 1 Diabetes.

Science.gov (United States)

Driscoll, Kimberly A; Raymond, Jennifer; Naranjo, Diana; Patton, Susana R

2016-08-01

Hypoglycemia is a frequent occurrence in children and adolescents with type 1 diabetes. A variety of efforts have been made to standardize the definition of hypoglycemia and to define one of its most significant psychosocial consequences-fear of hypoglycemia (FOH). In addition to documenting the experience of FOH in children and adolescents type 1 diabetes and their parents, studies have investigated the relations between FOH and glycemic control and diabetes technology use. This review provides a summary of the recent FOH literature as it applies to pediatric type 1 diabetes.

A Novel Algorithm in the Management of Hypoglycemia in Newborns

Directory of Open Access Journals (Sweden)

Swapna Naveen

2014-01-01

Full Text Available Study Objective. To evaluate the safety of a new protocol in comparison to the standard protocol for managing hypoglycemia in neonates. Methods. Open label RCT-pilot study. Neonates admitted to NICU with hypoglycemia and requiring intravenous fluids were included. Fifty-seven eligible neonates were randomly allocated to either intervention group (starting fluids with 10% dextrose and increments of 1.5% or standard protocol group (GIR of 6 mg/kg/min with increments of 2 mg/kg/min till control of hypoglycemia. Primary outcome of the study was to know proportion of infants with subsequent hypoglycemia and hyperglycemia after enrolment. Results. The initial GIR (6 ± 0 mg/kg/min versus 4.8 ± 1.4 mg/kg/min, P < 0.001, the mean maximum GIR (6.7 ± 1.6 mg/kg/min versus 5.6 ± 2 mg/kg/min, P = 0.03, the maximum concentration of glucose infused (13.8 ± 2.9% versus 10.9 ± 1.9%, P < 0.001, and the total amount of glucose infused were significantly lower in the intervention group. The mean maximum blood sugar was significantly higher (129 ± 57 mg/dL versus 87 ± 30 mg/dL, P = 0.001 and there was a trend towards high proportion of infants with Hyperglycemia in the standard protocol group (n = 10, 39% versus n = 5, 16%, P = 0.07. The median difference between the highest and the lowest recorded sugar for any infant was significantly higher in the standard protocol group (median 93 mg/dL, IQR 52 to 147 mg/dL versus median 50 mg/dL, IQR 38 to 62.5 mg/dL, P = 0.03. Conclusion. A new and novel algorithm in the management of hypoglycemia in neonates is as safe as the standard protocol and requires further testing before routine implementation.

Hypoglycemia: a review of definitions used in clinical trials evaluating antihyperglycemic drugs for diabetes

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Balijepalli C

2017-05-01

Full Text Available Chakrapani Balijepalli,1,2 Eric Druyts,2 Gaye Siliman,2 Michel Joffres,1 Kristian Thorlund,2,3 Edward J Mills3 1Faculty of Health Sciences, Simon Fraser University, Burnaby, 2Precision Health Economics, Vancouver, BC, 3Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada Objective: To understand the severity and potential impact of heterogeneity in definitions of hypoglycemia used in diabetes research, we aimed to review the hypoglycemia definitions adopted in randomized controlled trials (RCTs.Methods: We reviewed 109 RCTs included in the Canadian Agency for Drugs and Technologies in Health reports for the second- and third-line therapy for the patients with type 2 diabetes (T2D.Results: Nearly 60% (n=66 of the studies reviewed presented the definitions for overall hypoglycemia, and another 20% (n=22 of the studies reported the results for hypoglycemia but did not report a definition. Among these 66 studies, only 9 (14% followed the American Diabetes Association/European Medicines Agency specified guidelines to define hypoglycemia, with an exact threshold of plasma glucose ≤3.9 mmol/L. Fifty-two of the 66 studies (79% used a threshold considerably lower than the recommended ≤3.9 mmol/L, and 16 studies used a threshold between 3.8 and 4.0 mmol/L. The proportion of the trials that used a cutoff value of <3.1 mmol/L appeared to be slightly similar among the more commonly used non-insulin treatments, GLP-1s (7 of 18 [39%], thiazolidinediones (TZDs; 6 of 11 [55%], DPP-4s (12 of 19 [64%], and sulfonylureas (11 of 20 [55%]. Among trials with intermediate-long-acting insulins (neutral protamine Hagedorn insulin, detemir, glargine, 7 of 26 trials (27% used a cutoff of <3.1 mmol/L. The definition of severe hypoglycemia was also subject to substantial heterogeneity, in both the utilized threshold and accompanying soft definitions.Conclusion: This review demonstrates

Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia.

Science.gov (United States)

Bateman, Brian T; Patorno, Elisabetta; Desai, Rishi J; Seely, Ellen W; Mogun, Helen; Maeda, Ayumi; Fischer, Michael A; Hernandez-Diaz, Sonia; Huybrechts, Krista F

2016-09-01

β blockers are widely used in the treatment of hypertensive disorders during pregnancy. These medications cross the placenta and may cause physiologic changes in neonates exposed in utero. We sought to define the risks of neonatal hypoglycemia and bradycardia associated with maternal exposure to β blockers at the time of delivery in a large, nationwide cohort of Medicaid beneficiaries. We used a cohort of 2 292 116 completed pregnancies linked to liveborn infants of Medicaid-enrolled women from 2003 to 2007. We examined the risks of neonatal hypoglycemia and neonatal bradycardia associated with maternal exposure to β blockers at the time of delivery. Propensity score matching was used to control for potential confounders including maternal demographics, obstetric and medical conditions, and exposure to other medications. There were 10 585 (0.5%) pregnancies exposed to β blockers at the time of delivery. The risk of neonatal hypoglycemia was 4.3% in the β blocker-exposed neonates versus 1.2% in the unexposed; the risk of neonatal bradycardia was 1.6% in the exposed versus 0.5% in the unexposed. After controlling for confounders, risk remained elevated for both neonatal hypoglycemia and bradycardia among exposed pregnancies versus unexposed (adjusted odds ratio, 1.68, 95% confidence interval, 1.50-1.89 and adjusted odds ratio, 1.29, 95% confidence interval, 1.07-1.55, respectively). Our findings suggest that neonates born to mothers exposed to β blockers in late pregnancy, including labetalol, are at elevated risk for neonatal hypoglycemia and bradycardia. Copyright © 2016 by the American Academy of Pediatrics.

CURING EFFICIENCY OF DUAL-CURE RESIN CEMENT UNDER ZIRCONIA WITH TWO DIFFERENT LIGHT CURING UNITS

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Pınar GÜLTEKİN

2015-04-01

Full Text Available Purpose: Adequate polymerization is a crucial factor in obtaining optimal physical properties and a satisfying clinical performance from composite resin materials. The aim of this study was to evaluate the polymerization efficiency of dual-cure resin cement cured with two different light curing units under zirconia structures having differing thicknesses. Materials and Methods: 4 zirconia discs framework in 4 mm diameter and in 0.5 mm, 1 mm and 1.5 mm thickness were prepared using computer-aided design system. One of the 0.5 mm-thick substructures was left as mono-layered whereas others were layered with feldspathic porcelain of same thickness and ceramic samples with 4 different thicknesses (0.5, 1, 1.5 and 2.0 mm were prepared. For each group (n=12 resin cement was light cured in polytetrafluoroethylene molds using Light Emitting Diode (LED or Quartz-Tungsten Halogen (QHT light curing units under each of 4 zirconia based discs (n=96. The values of depth of cure (in mm and the Vickers Hardness Number values (VHN were evaluated for each specimen. Results: The use of LED curing unit produced a greater depth of cure compared to QTH under ceramic discs with 0.5 and 1 mm thickness (p<0.05.At 100μm and 300 μm depth, the LED unit produced significantly greater VHN values compared to the QTH unit (p<0.05. At 500 μm depth, the difference between the VHN values of LED and QTH groups were not statistically significant. Conclusion: Light curing may not result in adequate resin cement polymerization under thick zirconia structures. LED light sources should be preferred over QTH for curing dual-cure resin cements, especially for those under thicker zirconia restorations.

Autoimmune Hypoglycemia in a Patient with Characterization of Insulin Receptor Autoantibodies

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Suk Chon

2011-02-01

Full Text Available BackgroundType B insulin resistance syndrome is a manifestation of autoantibodies to the insulin receptor that results in severe hyperglycemia and acanthosis nigricans. However, the mechanisms by which these autoantibodies induce hypoglycemia are largely unknown. In this paper, we report the case of patient with type B insulin resistance syndrome who presented with frequent severe fasting hypoglycemia and acanthosis nigricans.MethodsTo evaluate the mechanism of hypoglycemia, we measured the inhibition of insulin binding to erythrocytes and IM9 lymphocytes in a sample of the patient's dialyzed serum before and after immunosuppressive therapy.ResultsIn the patient's pre-treatment serum IgG, the binding of 125I-insulin to erythrocytes was markedly inhibited in a dose-dependent manner until the cold insulin level reached 10-9 mol/L. We also observed dose-dependent inhibition of insulin binding to IM9 lymphocytes, which reached approximately 82% inhibition and persisted even when diluted 1:20. After treatment with glucocorticoids, insulin-erythrocyte binding activity returned to between 70% and 80% of normal, while the inhibition of insulin-lymphocyte binding was reduced by 17%.ConclusionWe treated a patient with type B insulin resistance syndrome showing recurrent fasting hypoglycemia with steroids and azathioprine. We characterized the patient's insulin receptor antibodies by measuring the inhibition of insulin binding.

Post-Gastric Bypass Hyperinsulinemic Hypoglycemia: Fructose is a Carbohydrate Which Can Be Safely Consumed.

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Bantle, Anne E; Wang, Qi; Bantle, John P

2015-08-01

Postprandial hypoglycemia after gastric bypass surgery is a serious problem. Available treatments are often ineffective. The objective was to test the hypotheses that injection of rapid-acting insulin before a high-carbohydrate meal or replacement of other carbohydrates with fructose in the meal would prevent hypoglycemia. This was a randomized, crossover trial comparing a high-carbohydrate meal with premeal saline injection (control), a high-carbohydrate meal with premeal insulin injection, and a high-fructose meal with total carbohydrate content similar to the control meal. The setting was an academic medical center. Ten patients with post-gastric bypass hyperinsulinemic hypoglycemia participated. Interventions included lispro insulin injected before test meals and replacement of other carbohydrates with fructose in test meals. The main outcome measure was plasma glucose meals. After the control meal, mean peak glucose and insulin were 173 ± 47 mg/dL and 134 ± 55 mU/L, respectively; mean glucose nadir was 44 ± 15 mg/dL; and eight of 10 subjects demonstrated glucose meal, mean peak postprandial glucose and insulin were 117 ± 20 mg/dL and 45 ± 31 mU/L, respectively (both P meal sweetened with fructose with little risk of hypoglycemia. Treatment with rapid-acting insulin before a carbohydrate-containing meal did not prevent hypoglycemia.

Fear of hypoglycemia and its clinical significance: a case-control study

OpenAIRE

Elena Georgievna Starostina; Elena Nikolaevna Moshnyaga

2013-01-01

Aim. To assess the prevalence of fear of hypoglycemia, its clinical features and influence on diabetes compensation.Materials and Methods. A cross-sectional study was conducted with 200 sequentially enrolled participants with type 2 diabetes mellitus (T2DM; n=139) and type 1 diabetes mellitus (T1DM; n=61). Patients were screened for psychiatric disorders with appropriate inventory and examined by a psychiatrist. Subjects identified as those with fear of hypoglycemia (n=12) formed the study gr...

Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus.

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Bernd Schultes

2007-02-01

Full Text Available BACKGROUND: Nocturnal hypoglycemia frequently occurs in patients with type 1 diabetes mellitus (T1DM. It can be fatal and is believed to promote the development of the hypoglycemia-unawareness syndrome. Whether hypoglycemia normally provokes awakening from sleep in individuals who do not have diabetes, and whether this awakening response is impaired in T1DM patients, is unknown. METHODS AND FINDINGS: We tested two groups of 16 T1DM patients and 16 healthy control participants, respectively, with comparable distributions of gender, age, and body mass index. In one night, a linear fall in plasma glucose to nadir levels of 2.2 mmol/l was induced by infusing insulin over a 1-h period starting as soon as polysomnographic recordings indicated that stage 2 sleep had been reached. In another night (control, euglycemia was maintained. Only one of the 16 T1DM patients, as compared to ten healthy control participants, awakened upon hypoglycemia (p = 0.001. In the control nights, none of the study participants in either of the two groups awakened during the corresponding time. Awakening during hypoglycemia was associated with increased hormonal counterregulation. In all the study participants (from both groups who woke up, and in five of the study participants who did not awaken (three T1DM patients and two healthy control participants, plasma epinephrine concentration increased with hypoglycemia by at least 100% (p < 0.001. A temporal pattern was revealed such that increases in epinephrine in all participants who awakened started always before polysomnographic signs of wakefulness (mean +/- standard error of the mean: 7.5 +/- 1.6 min. CONCLUSIONS: A fall in plasma glucose to 2.2 mmol/l provokes an awakening response in most healthy control participants, but this response is impaired in T1DM patients. The counterregulatory increase in plasma epinephrine that we observed to precede awakening suggests that awakening forms part of a central nervous system

Assessing fear of hypoglycemia in a population-based study among parents of children with type 1 diabetes - psychometric properties of the hypoglycemia fear survey - parent version.

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Haugstvedt, Anne; Wentzel-Larsen, Tore; Aarflot, Morten; Rokne, Berit; Graue, Marit

2015-01-19

In the treatment of childhood type 1 diabetes, being aware of the parents' fear of hypoglycemia is important, since the parents' fear may influence the management of treatment and the children's blood glucose regulation. The availability of proper instruments to assess the parents' fear of hypoglycemia is essential. Thus, the aim of this study was to examine the psychometric properties of the Hypoglycemia Fear Survey - Parent version (HFS-P). In a Norwegian population-based sample, 176 parents representing 102 children with type 1 diabetes (6-15 years old) completed the HFS-P, comprising a 15-item worry subscale and a 10-item behavior subscale. We performed exploratory and confirmatory factor analysis and further analysis of the scales' construct validity, content validity and reliability. The Norwegian version of the HFS-P had an acceptable factor structure and internal consistency for the worry subscale, whereas the structure and internal consistency of the behavior subscale was more questionable. The HFS-P subscales were significantly correlated (from moderately to weakly) with symptoms of emotional distress, as measured by the Hopkins Symptom Checklist - 25 items. The mothers scored higher than fathers on both HFS-P subscales, but the difference was not statistically significant for the worry subscale. The HFS-P worry subscale seems to be a valid scale for measuring anxiety-provoking aspects of hypoglycemia, and the validity of the HFS-P behavior subscale needs to be investigated further.

Influence of Hypoglycemia During The 100-G Oral Glucose Tolerance Test on Obstetrics Outcomes

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İlknur İnegöl Gümüş

2008-08-01

CONCLUSIONS: Women who experience hypoglycemia during the OGTT have a significantly higher incidence of gestational weight gain and higher neonatal birth weights as well. As a result if a pregnant has hypoglycemia during OGTT we should monitorize her and the fetus as well carefully.

Tramadol use and the risk of hospitalization for hypoglycemia in patients with noncancer pain.

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Fournier, Jean-Pascal; Azoulay, Laurent; Yin, Hui; Montastruc, Jean-Louis; Suissa, Samy

2015-02-01

Tramadol is a weak opioid analgesic whose use has increased rapidly, and it has been associated with adverse events of hypoglycemia. To assess whether tramadol use, when compared with codeine use, is associated with an increased risk of hospitalization for hypoglycemia. A nested case-control analysis was conducted within the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database of all patients newly treated with tramadol or codeine for noncancer pain between 1998 and 2012. Cohort and case-crossover analyses were also conducted to assess consistency of the results. Cases of hospitalization for hypoglycemia were matched with up to 10 controls on age, sex, and duration of follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated comparing use of tramadol with codeine. A cohort analysis, with high-dimensional propensity score-adjusted hazard ratios (HRs) and 95% CIs, was performed comparing tramadol with codeine in the first 30 days after treatment initiation. Finally, a case-crossover analysis was also performed, in which exposure to tramadol in a 30-day risk period immediately before the hospitalization for hypoglycemia was compared with 11 consecutive 30-day control periods. Odds ratios and 95% CIs were estimated using conditional logistic regression analysis. The cohort included 334,034 patients, of whom 1105 were hospitalized for hypoglycemia during follow-up (incidence, 0.7 per 1000 per year) and matched to 11,019 controls. Compared with codeine, tramadol use was associated with an increased risk of hospitalization for hypoglycemia (OR, 1.52 [95% CI, 1.09-2.10]), particularly elevated in the first 30 days of use (OR, 2.61 [95% CI, 1.61-4.23]). This 30-day increased risk was confirmed in the cohort (HR, 3.60 [95% CI, 1.56-8.34]) and case-crossover analyses (OR, 3.80 [95% CI, 2.64-5.47]). The initiation of tramadol therapy is associated with an increased risk of hypoglycemia requiring

Stepwise Approach to Problematic Hypoglycemia in Korea: Educational, Technological, and Transplant Interventions

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Sang-Man Jin

2017-06-01

Full Text Available Impaired awareness of hypoglycemia has been found to be prevalent in 20% to 40% of people with type 1 diabetes. If a similar prevalence exists in Koreans with type 1 diabetes, at a minimum, thousands of people with type 1 diabetes suffer at least one unpredicted episode of severe hypoglycemia per year in Korea. For patients with problematic hypoglycemia, an evidence-based stepwise approach was suggested in 2015. The first step is structured education regarding multiple daily injections of an insulin analog, and the second step is adding a technological intervention, such as continuous subcutaneous insulin infusion or real-time continuous glucose monitoring. The next step is a sensor-augmented pump, preferably with a low glucose suspension feature or very frequent contact, and the final step is islet or pancreas transplantation. In Korea, however, none of these treatments are reimbursed by the National Health Insurance, and thus have not been widely implemented. The low prevalence of type 1 diabetes means that Korean physicians are relatively unfamiliar with the new technologies in this field. Therefore, the roles of new technologies and pancreas or islet transplantation in the treatment of problematic hypoglycemia need to be defined in the current clinical setting of Korea.

Acute Hypoglycemia Induces Painful Neuropathy and the Treatment of Coenzyme Q10

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Yan Ping Zhang

2016-01-01

Full Text Available Diabetic neuropathic pain is reduced with tight glycemic control. However, strict control increases the risk of hypoglycemic episodes, which are themselves linked to painful neuropathy. This study explored the effects of hypoglycemia-related painful neuropathy. Pretreatment with coenzyme Q10 (CoQ10 was performed to explore the preventive effect of CoQ10 on hypoglycemia-related acute neuropathic pain. Two strains of mice were used and 1 unit/kg of insulin was given to induce hypoglycemia. Mechanical sensitivity of hindpaw withdrawal thresholds was measured using von Frey filaments. Blood glucose levels were clamped at normal levels by joint insulin and glucose injection to test whether insulin itself induced hypersensitivity. Results suggest that the increased mechanical sensitivity after insulin injection is related to decreased blood glucose levels. When blood glucose levels remained at a normal level by the linked administration of insulin and glucose, mice demonstrated no significant change in mechanical sensitivity. Pretreatment with CoQ10 prevented neuropathic pain and the expression of the stress factor c-Fos. These results support the concept that pain in the diabetic scenario can be the result of hypoglycemia and not insulin itself. Additionally, pretreatment with CoQ10 may be a potent preventive method for the development of neuropathic pain.

Effects of hypoglycemia on human brain activation measured with fMRI.

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Anderson, Adam W; Heptulla, Rubina A; Driesen, Naomi; Flanagan, Daniel; Goldberg, Philip A; Jones, Timothy W; Rife, Fran; Sarofin, Hedy; Tamborlane, William; Sherwin, Robert; Gore, John C

2006-07-01

Functional magnetic resonance imaging (fMRI) was used to measure the effects of acute hypoglycemia caused by passive sensory stimulation on brain activation. Visual stimulation was used to generate blood-oxygen-level-dependent (BOLD) contrast, which was monitored during hyperinsulinemic hypoglycemic and euglycemic clamp studies. Hypoglycemia (50 +/- 1 mg glucose/dl) decreased the fMRI signal relative to euglycemia in 10 healthy human subjects: the fractional signal change was reduced by 28 +/- 12% (P variations in blood glucose levels may modulate BOLD signals in the healthy brain.

Genetic variation and activity of the renin-angiotensin system and severe hypoglycemia in type 1 diabetes

DEFF Research Database (Denmark)

Pedersen-Bjergaard, U.; Dhamrait, S.S.; Sethi, A.A.

2008-01-01

BACKGROUND: The deletion-allele of the angiotensin-converting enzyme (ACE) gene and elevated ACE activity are associated with increased risk of severe hypoglycemia in type 1 diabetes. We explored whether genetic and phenotypic variations in other components of the renin-angiotensin system...... are similarly associated. METHODS: Episodes of severe hypoglycemia were recorded in 171 consecutive type 1 diabetic outpatients during a 1-year follow-up. Participants were characterized at baseline by gene polymorphisms in angiotensinogen, ACE, angiotensin-II receptor types 1 (AT1R) and 2 (AT2R), and by plasma...... associate with high risk of severe hypoglycemia in type 1 diabetes. A potential preventive effect of renin-angiotensin system blocking drugs in patients with recurrent severe hypoglycemia merits further investigation Udgivelsesdato: 2008/3...

Descriptions of health states associated with increasing severity and frequency of hypoglycemia: a patient-level perspective

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Harris SB

2013-09-01

Full Text Available Stewart B Harris,1 Kamlesh Khunti,2 Mona Landin-Olsson,3 Claus B Galbo-Jørgensen,4 Mette Bøgelund,4 Barrie Chubb,5 Jens Gundgaard,6 Marc Evans71Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; 2Diabetes Research Unit, University of Leicester, Leicester, UK; 3Department of Medicine, Helsingborg Hospital, Lund University, Lund, Sweden; 4Incentive, Holte Stationsvej, Holte, Denmark; 5EU Health Economics and Outcomes Research, Novo Nordisk Ltd, Crawley, UK; 6Health Economics and HTA, Novo Nordisk A/S, Søborg, Denmark; 7Department of Diabetes, University Hospital Llandough, Cardiff, UKAims: We sought to develop descriptions of health states associated with daytime and nocturnal hypoglycemia in a structured fashion from the patient's perspective under different combinations of severity and frequency of hypoglycemic events.Methods: An expert meeting followed by two patient focus groups was used to develop comprehensive descriptions of acute consequences of severe and non-severe, daytime and nocturnal hypoglycemia. Patients with diabetes (type 1 = 85, type 2 = 162 from a survey panel then validated these descriptions and assessed how often they worried and took different actions to prevent hypoglycemia. Severity and frequency of hypoglycemia were compared with respect to how often people worried and took actions to prevent an event. The effect of hypoglycemia on 35 different life activities was quantitatively compared for patients who had and had not experienced a severe hypoglycemic event.Results: At least 95% of respondents agreed that the detailed patient-level descriptions of health states accurately reflected their experience of severe and non-severe, daytime and nocturnal hypoglycemia, thereby validating these descriptions. Respondents who had experienced a severe hypoglycemic event were generally more adversely affected in their worries and actions and life events than those who experienced only non

Pre-cure freezing affects proteolysis in dry-cured hams.

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Bañón, S; Cayuela, J M; Granados, M V; Garrido, M D

1999-01-01

Several parameters (sodium chloride, moisture, intramuscular fat, total nitrogen, non-protein nitrogen, white precipitates, free tyrosine, L* a* b* values and acceptability) related with proteolysis during the curing were compared in dry-cured hams manufactured from refrigerated and frozen/thawed raw material. Pre-cure freezing increased the proteolysis levels significantly (pcured meat, although it does not significantly affect the sensory quality of the dry-cured ham.

Persistent hyperinsulinemic hypoglycemia of infancy: long-term ...

African Journals Online (AJOL)

Aim The aim of this study was to investigate the long-term outcome of six children with persistent hyperinsulinemic hypoglycemia of infancy (PHHI) after pancreatectomy who have been followed since 1990 at the Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia. Patients and methods Data from six patients were ...

An evidence-based approach to breastfeeding neonates at risk for hypoglycemia.

Science.gov (United States)

Csont, Georgia Lowmaster; Groth, Susan; Hopkins, Patrick; Guillet, Ronnie

2014-01-01

The revised standard of care for breastfeeding infants at risk of developing hypoglycemia during transitioning to extrauterine life was developed using the American Academy of Pediatrics (AAP) 2011 hypoglycemia guidelines, the Academy of Breastfeeding Medicine protocol, and staff input. A pre/postimplementation chart audit indicated support of infant safety by glucose stabilization, breastfeeding within the first hour of life, and breastfeeding frequency without an increase in blood sampling, formula use, or admissions to the special care nursery. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Cure of skin cancer. Surgical cure of skin cancer

International Nuclear Information System (INIS)

Zikiryakhodjaev, D.Z.; Sanginov, D.R.

2001-01-01

In this chapter authors studied the cure of skin cancer in particular the surgical cure of skin cancer. They noted that surgical cure of skin cancer is remain one of the primary and most important methods in treatment of skin cancer

Overnight Glucose Control with Dual- and Single-Hormone Artificial Pancreas in Type 1 Diabetes with Hypoglycemia Unawareness: A Randomized Controlled Trial.

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Abitbol, Alexander; Rabasa-Lhoret, Remi; Messier, Virginie; Legault, Laurent; Smaoui, Mohamad; Cohen, Nathan; Haidar, Ahmad

2018-03-01

The dual-hormone (insulin and glucagon) artificial pancreas may be justifiable in some, but not all, patients. We sought to compare dual- and single-hormone artificial pancreas systems in patients with hypoglycemia unawareness and documented nocturnal hypoglycemia. We conducted a randomized crossover trial comparing the efficacy of dual- and single-hormone artificial pancreas systems in controlling plasma glucose levels over the course of one night's sleep. We recruited 18 adult participants with hypoglycemia unawareness and 17 participants with hypoglycemia awareness, all of whom had documented nocturnal hypoglycemia during 2 weeks of screening. Outcomes were calculated using plasma glucose. In participants with hypoglycemia unawareness, the median (interquartile range [IQR]) percentage of time that plasma glucose was below 4.0 mmol/L was 0% (0-0) on dual-hormone artificial pancreas nights and 0% (0-10) on single-hormone artificial pancreas nights (P = 0.20). Additionally, participants with hypoglycemia unawareness experienced two hypoglycemic events (dual-hormone artificial pancreas nights and three hypoglycemic events on single-hormone artificial pancreas nights. In participants with hypoglycemia awareness, the median (IQR) percentage of time that plasma glucose was below 4.0 mmol/L was 0% (0-0) on both dual- and single-hormone artificial pancreas nights. Hypoglycemia awareness participants experienced zero hypoglycemic events on dual-hormone artificial pancreas nights and one event on single-hormone artificial pancreas nights. In this study, dual-hormone and single-hormone systems performed equally well in preventing nocturnal hypoglycemia in participants with hypoglycemia unawareness. Longer studies over the course of multiple days and nights may be needed to explore possible specific benefits in this population. ClinicalTrials.gov No. NCT02282254.

Cure Cycle Optimization of Rapidly Cured Out-Of-Autoclave Composites

Science.gov (United States)

Dong, Anqi; Zhao, Yan; Zhao, Xinqing; Yu, Qiyong

2018-01-01

Out-of-autoclave prepreg typically needs a long cure cycle to guarantee good properties as the result of low processing pressure applied. It is essential to reduce the manufacturing time, achieve real cost reduction, and take full advantage of out-of-autoclave process. The focus of this paper is to reduce the cure cycle time and production cost while maintaining high laminate quality. A rapidly cured out-of-autoclave resin and relative prepreg were independently developed. To determine a suitable rapid cure procedure for the developed prepreg, the effect of heating rate, initial cure temperature, dwelling time, and post-cure time on the final laminate quality were evaluated and the factors were then optimized. As a result, a rapid cure procedure was determined. The results showed that the resin infiltration could be completed at the end of the initial cure stage and no obvious void could be seen in the laminate at this time. The laminate could achieve good internal quality using the optimized cure procedure. The mechanical test results showed that the laminates had a fiber volume fraction of 59–60% with a final glass transition temperature of 205 °C and excellent mechanical strength especially the flexural properties. PMID:29534048

Self-curing concrete with different self-curing agents

Science.gov (United States)

Gopala krishna sastry, K. V. S.; manoj kumar, Putturu

2018-03-01

Concrete is recognised as a versatile construction material globally. Properties of concrete depend upon, to a greater extent, the hydration of cement and microstructure of hydrated cement. Congenial atmosphere would aid the hydration of cement and hence curing of concrete becomes essential, till a major portion of the hydration process is completed. But in areas of water inadequacy and concreting works at considerable heights, curing is problematic. Self-Curing or Internal Curing technique overcomes these problems. It supplies redundant moisture, for more than sufficient hydration of cement and diminish self-desiccation. Self-Curing agents substantially help in the conservation of water in concrete, by bringing down the evaporation during the hydration of Concrete. The present study focuses on the impact of self-curing agents such as Poly Ethylene Glycol (PEG), Poly Vinyl Alcohol (PVA) and Super Absorbent Polymer (SAP) on the concrete mix of M25 grade (reference mix). The effect of these agents on strength properties of Concrete such as compressive strength, split tensile strength and flexural strength was observed on a comparative basis which revealed that PEG 4000 was the most effective among all the agents.

Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review

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Malabu UH

2014-08-01

Full Text Available Usman H Malabu,1 Venkat N Vangaveti,1 Richard Lee Kennedy2 1School of Medicine and Dentistry, James Cook University, QLD, Australia; 2Department of Medicine, Deakin University, VIC, Australia Abstract: A hypoglycemia-induced fall is common in older persons with diabetes. The etiology of falls in this population is usually multifactorial, and includes microvascular and macrovascular complications and age-related comorbidities, with hypoglycemia being one of the major precipitating causes. In this review, we systematically searched the literature that was available up to March 31, 2014 from MEDLINE/PubMed, Embase, and Google Scholar using the following terms: hypoglycemia; insulin; diabetic complications; and falls in elderly. Hypoglycemia, defined as blood glucose <4.0 mmol/L (70 mg/dL requiring external assistance, occurs in one-third of elderly diabetics on glucose-lowering therapies. It represents a major barrier to the treatment of diabetes, particularly in the elderly population. Patients who experience hypoglycemia are at a high risk for adverse outcomes, including falls leading to bone fracture, seizures, cognitive dysfunction, and prolonged hospital stays. An increase in mortality has been observed in patients who experience any one of these events. Paradoxically, rational insulin therapy, dosed according to a patient's clinical status and the results of home blood glucose monitoring, so as to achieve and maintain recommended glycemic goals, can be an effective method for the prevention of hypoglycemia and falls in the elderly. Contingencies, such as clinician-directed hypoglycemia treatment protocols that guide the immediate treatment of hypoglycemia, help to limit both the duration and severity of the event. Older diabetic patients with or without underlying renal insufficiency or other severe illnesses represent groups that are at high risk for hypoglycemia-induced falls and, therefore, require lower insulin dosages. In this review

Doege–Potter Syndrome, cause of nonislet cell tumor hypoglycemia: the first case report from Nepal

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Pant V

2017-08-01

Full Text Available Vivek Pant,1 Suman Baral,2 Gita Sayami,3 Prakash Sayami4 1Department of Biochemistry, 2Endocrinology Unit, Department of Medicine, 3Department of Pathology, 4Manmohan Cardiothoracic vascular and transplant Center, Institute of Medicine (IOM, Tribhuvan University Teaching Hospital (TUTH, Kathmandu, Nepal Abstract: Doege–Potter syndrome (DPS, a paraneoplastic syndrome, presents as a hypoinsulinemic hypoglycemia from the ectopic secretion of insulin-like growth factor II from a solitary fibrous tumor which may be intrapleural or extrapleural in origin. We report a case of severe hypoglycemia in a 70-year old female initially admitted for resection of left sided solitary fibrous tumor of pleura. Investigation revealed true hypoglycemia, and DPS was diagnosed. The tumor was completely resected, after which no further hypoglycemic episodes were seen in 2 years follow-up. This is the first case of solitary fibrous tumor of pleura with DPS reported from Nepal. Keywords: insulin-like growth factor II, IGF-II, solitary fibrous tumor, hypoglycemia

Vascular endothelial growth factor during hypoglycemia in patients with type 1 diabetes mellitus: relation to cognitive function and renin-angiotensin system activity

DEFF Research Database (Denmark)

Kristensen, Peter Lommer; Høi-Hansen, Thomas; Boomsma, Frans

2009-01-01

hypoglycemia. High activity in the renin-angiotensin system (RAS) is associated with an increased risk of severe hypoglycemia in patients with type 1 diabetes mellitus. Renin-angiotensin system possibly exerts its mechanism in hypoglycemia via VEGF. We studied the impact of mild hypoglycemia on plasma VEGF...... in patients with type 1 diabetes mellitus and high or low RAS activity and analyzed associations between VEGF levels and cognitive function during hypoglycemia. Eighteen patients with type 1 diabetes mellitus-9 with high and 9 with low RAS activity-underwent a single-blinded, placebo-controlled, crossover...... study with either mild hypoglycemia or stable glycemia. Cognitive function was assessed by the California Cognitive Assessment Package and the Alzheimer Quick Test. Nadir plasma glucose was 2.2 (0.3) mmol/L. During the control study, plasma VEGF did not change. During hypoglycemia, plasma VEGF increased...

Factors associated with an inadequate hypoglycemia in the insulin tolerance test in Japanese patients with suspected or proven hypopituitarism.

Science.gov (United States)

Takahashi, Kiyohiko; Nakamura, Akinobu; Miyoshi, Hideaki; Nomoto, Hiroshi; Kameda, Hiraku; Cho, Kyu Yong; Nagai, So; Shimizu, Chikara; Taguri, Masataka; Terauchi, Yasuo; Atsumi, Tatsuya

2017-04-29

We attempted to identify the predictors of an inadequate hypoglycemia in insulin tolerance test (ITT), defined as a blood glucose level higher than 2.8 mmol/L after insulin injection, in Japanese patients with suspected or proven hypopituitarism. A total of 78 patients who had undergone ITT were divided into adequate and inadequate hypoglycemia groups. The relationships between the subjects' clinical parameters and inadequate hypoglycemia in ITT were analyzed. Stepwise logistic regression analysis identified high systolic blood pressure (SBP) and high homeostasis model assessment of insulin resistance (HOMA-IR) as being independent factors associated with inadequate hypoglycemia in ITT. Receiver operating characteristic (ROC) curve analysis revealed the cutoff value for inadequate hypoglycemia was 109 mmHg for SBP and 1.4 for HOMA-IR. The areas under ROC curve for SBP and HOMA-IR were 0.72 and 0.86, respectively. We confirmed that high values of SBP and HOMA-IR were associated with inadequate hypoglycemia in ITT, regardless of the degree of reduction of pituitary hormone levels. Furthermore, the strongest predictor of inadequate hypoglycemia was obtained by using the cutoff value of HOMA-IR. Our results suggest that HOMA-IR is a useful pre-screening tool for ITT in these populations.

Radish juice and corn oil as adjuvants that decrease the destructive alterations in hypoglycemia rats subjected to gamma irradiation

International Nuclear Information System (INIS)

Hanafy, N.

2007-01-01

This study was performed to investigate the decrease in different biochemical and histopathological alterations that may occur following the oral administration of aqueous extract of radish at the dose level (50 mg/100 g body weight) and the addition of 10% corn oil to the diet of hypoglycemia rats and /or exposed to 6 Gy of gamma radiation. The experiment included normal male albino rats and hypoglycemia ones.The hypoglycemia rats divided into tow groups; the first group was treated with radish juice or radish juice with diet containing corn oil and the other group was hypoglycemia rats exposed to 6 Gy of gamma radiation then treated also with radish juice or radish juice with diet containing 10% corn oil. Biochemical analysis included levels of blood sugar, total lipids, cholesterol, total protein and albumin, in addition to the activity of AST and ALT were evaluated. The level of TBARs and the histopathological changes in liver and kidney were also investigated. Treatment of irradiated hypoglycemia rats with radish juice either alone or combined with a diet containing 10% corn oil reverse the serum fasting glucose level nearly to the control level. Amelioration in lipid profile was recorded after the treatment of the hypoglycemia rats or those hypoglycemia irradiated then treated with radish juice and fed on a diet containing 10% corn oil. Also, significant amelioration was occurred in liver transaminases, total proteins, albumin and creatinine levels as compared to those of hypoglycemia group. TBARs levels showed remarkable decrease in liver and kidney tissues in comparison with control and hypoglycemia rats and/or gamma irradiated levels when it is treated with radish juice and diet containing corn oil. Also, the histopathological changes of the same tissues revealed the same trend. From the different observations , it is possible to conclude that treatment of rats with radish juice in addition to feeding on diet containing 10% corn oil could reduce the

The role of hypoglycemia in the burden of living with diabetes among adults with diabetes and family members

DEFF Research Database (Denmark)

Nefs, Giesje; Pouwer, François

2018-01-01

-severe hypoglycemia in the past year (OR = 2.45, 1.25-4.83), self-reported severe hypoglycemia in the past year (OR = 1.91, 1.02-3.58), and being very worried about hypoglycemia at least occasionally (OR = 3.64, 2.18-6.10). For family members, the odds of experiencing living with diabetes as a burden was increased......, 412 Dutch adults with type 1 or type 2 diabetes and 86 family members completed questions about the burden of living with diabetes, the frequency of hypoglycemia, worries about these events, and several demographic and clinical factors. Analyses included hierarchical logistic regression. RESULTS...

Prevalence of nocturnal hypoglycemia in first trimester of pregnancy in patients with insulin treated diabetes mellitus

DEFF Research Database (Denmark)

Hellmuth, Ellinor Adelheid; Damm, P; Mølsted-Pedersen, L

2000-01-01

BACKGROUND: Excellent metabolic control before conception and during diabetic pregnancies is the aim in order to avoid malformations and perinatal morbidity. Since an inverse correlation between median blood glucose concentration (BG) and hypoglycemia as well as a high prevalence of nocturnal...... the night, caused by either discomfort or cannula problems. Of the remaining 43 patients, 16 (37%) had at least one blood glucose ... of pregnancy in insulin treated patients. Only one patient registered the hypoglycemia. Nocturnal hypoglycemia could be predicted in the majority of patients by measurements of BG before bedtime....

Hypoglycemia in small for gestational age neonates based on gestational age, gender, birth weight and mode of delivery

International Nuclear Information System (INIS)

Ramzan, M.; Razzaq, A.; Kiyani, A.N.

2017-01-01

To determine the frequency of hypoglycemia in small for gestational age neonates based on gestational age, gender, birth weight and mode of delivery. Study Design: Cross sectional study. Place and Duration of Study: Neonatal Intensive Care Unit (NICU), Military Hospital Rawalpindi, from Dec 2011 to Jul 2012. Material and Methods: We included 383 small for gestational age (SGA) neonates admitted in NICU. Blood glucose levels were checked in all neonates. Variables included in study were gestational age, gender, birth weight and mode of delivery. Results: Out of 383 SGA neonates enrolled by non-probability consecutive sampling, 191 (49.87%) were males and 192 (50.13%) were females. Out of these 203 (53%) were preterm, 165 (43.08%) were delivered at term and 15 (3.92%) were post-term SGA neonates with mean gestational age of 34 weeks 5 days. Out of the total 383 SGA neonates 208 (54.31%) developed hypoglycemia during stay in NICU and 175 (45.69%) remained euglycemic. Extremely low birth weight (ELBW) neonates were at highest risk to develop hypoglycemia (82.35%). It was seen that SGA neonates delivered by instrumental vaginal delivery had highest risk of developing hypoglycemia i.e. 20 (76.92) out of 26 neonates. Out of 103 vaginal deliveries 41 (39.81%) had hypoglycemia and out of 254 Caesarean section 147 (57.87%) had hypoglycemia. Conclusion: Low birth weight neonates delivered by instrumental vaginal delivery were found to be at a higher risk of developing hypoglycemia. (author)

Factors associated with hypoglycemia episodes in hospitalized type ...

African Journals Online (AJOL)

Purpose: To determine the factors associated with severity of hypoglycemia in hospitalized type 2 diabetes mellitus patients in a tertiary health facility in Malaysia. Methods: This retrospective study involved 207 hospitalised T2DM patients with hypoglycaemia episodes from January 2008 to December 2012 and was ...

Review of insulin-associated hypoglycemia and its impact on the management of diabetes in Southeast Asian countries.

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Goh, Su-Yen; Hussein, Zanariah; Rudijanto, Achmad

2017-09-01

Although the incidence of diabetes is rising in Southeast Asia, there is limited information regarding the incidence and manifestation of insulin-associated hypoglycemia. The aim of the present review was to discuss what is currently known regarding insulin-associated hypoglycemia in Southeast Asia, including its known incidence and impact in the region, and how the Southeast Asian population with diabetes differs from other populations. We found a paucity of data regarding the incidence of hypoglycemia in Southeast Asia, which has contributed to the adoption of Western guidelines. This might not be appropriate, as Southeast Asians have a range of etiological, educational and cultural differences from Western populations with diabetes that might place them at greater risk of hypoglycemia if not managed optimally. For example, Southeast Asians with type 2 diabetes tend to be younger, with lower body mass indexes than their Western counterparts, and the management of type 2 diabetes with premixed insulin preparations is more common in Southeast Asia. Both of these factors might result in higher rates of hypoglycemia. In addition, Southeast Asians are often poorly educated about hypoglycemia and its management, including during Ramadan fasting. We conclude there is a need for more information about Southeast Asian populations with diabetes to assist with the construction of more appropriate national and regional guidelines for the management of hypoglycemia, more closely aligned to patient demographics, behaviors and treatment practices. Such bespoke guidelines might result in a greater degree of implementation and adherence within clinical practice in Southeast Asian nations. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Hypoglycemia, S-ACE and ACE genotypes in a Danish nationwide population of children and adolescents with type 1 diabetes

DEFF Research Database (Denmark)

Johannesen, Jesper; Svensson, Jannet; Bergholdt, Regine

2011-01-01

OBJECTIVE: High S-ACE levels have been shown to predispose to increased risk of hypoglycemia, however; some inconsistency relates to the risk of the ACE genotype. We investigated the association between S-ACE level at diagnosis and ACE genotype to long-term risk of severe hypoglycemia in more than...... to increased risk of hypoglycemia generated from a negative binominal model were long diabetes duration (p high S-ACE level (p = 0.0497) when adjusted for ACE genotype. In the stratified analysis, S-ACE and insulin dosage were associated with hypoglycemia in girls (p = 0.026 and 0...

What Happens to Blood Glucose Concentrations After Oral Treatment for Neonatal Hypoglycemia?

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Harris, Deborah L; Gamble, Greg D; Weston, Philip J; Harding, Jane E

2017-11-01

To determine the change in blood glucose concentration after oral treatment of infants with hypoglycemia in the first 48 hours after birth. We analyzed data from 227 infants with hypoglycemia (blood glucose dextrose or placebo gel plus feeding with formula, expressed breast milk, or breast feeding. The overall mean increase in blood glucose concentration was 11.7 mg/dL (95% CI 10.4-12.8). The increase was greater after buccal dextrose gel than after placebo gel (+3.0 mg/dL; 95% CI 0.7-5.3; P = .01) and greater after infant formula than after other feedings (+3.8 mg/dL; 95% CI 0.8-6.7; P = .01). The increase in blood glucose concentration was not affected by breast feeding (+2.0 mg/dL; 95% CI -0.3 to 44.2; P = .09) or expressed breast milk (-1.4 mg/dL; 95% CI -3.7 to 0.9; P = .25). However, breast feeding was associated with reduced requirement for repeat gel treatment (OR = 0.52; 95% CI 0.28-0.94; P = .03). Treatment of infants with hypoglycemia with dextrose gel or formula is associated with increased blood glucose concentration and breast feeding with reduced need for further treatment. Dextrose gel and breast feeding should be considered for first-line oral treatment of infants with hypoglycemia. Copyright © 2017 Elsevier Inc. All rights reserved.

Successful use of long acting octreotide in two cases with Beckwith-Wiedemann syndrome and severe hypoglycemia.

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Al-Zubeidi, Hiba; Gottschalk, Michael E; Newfield, Ron S

2014-01-01

Hyperinsulinism associated with Beckwith-Wiedemann syndrome (BWS) can occur in about 50% of cases, causing hypoglycemia of variable severity. Parenteral use of octreotide may be indicated if unresponsive to diazoxide. There is limited data on use of octreotide in BWS. Chart review describing 2 cases with BWS and hypoglycemia treated with long acting Octreotide as a monthly injection. We describe two unrelated females born large for gestational age found to have clinical features consistent with BWS, who developed severe hypoglycemia. Genetic diagnosis of BWS was confirmed. The first patient was born at 37 weeks and developed hypoglycemia shortly after birth. She was initially started on diazoxide but developed pulmonary congestion and was therefore switched to depot octreotide (LAR). She maintained euglycemia with LAR. In the second patient (born at 26-4/7 weeks), onset of hypoglycemia was delayed till 11 weeks of age due to hydrocortisone (indicated hemodynamically) and continuous feeding, and was partially responsive to diazoxide. She was switched to octreotide 4 times daily, treated till at age 18 months. Despite frequent feeds, she required treatment again between ages 4-6.5 years, initially with diazoxide but due to severe hypertrichosis she was switched to LAR with an excellent response. Both patients treated with LAR for over two years achieved euglycemia above 70 mg/dl and had normal height gain, without side effects. Successful treatment of hypoglycemia can be achieved and maintained with LAR in infants and children with BWS who are either resistant or cannot tolerate diazoxide.

ACUTE HYPOGLYCEMIA RESULTS IN REDUCED CORTICAL NEURONAL INJURY IN THE DEVELOPING IUGR RAT

OpenAIRE

Maliszewski-Hall, Anne M.; Stein, Ariel B.; Alexander, Michelle; Ennis, Kathleen; Rao, Raghavendra

2015-01-01

Background Hypoglycemia (HG) is common in IUGR neonates. In normally grown (NG) neonatal rats, acute HG causes neuronal injury in the brain, cerebral cortex more vulnerable than the hippocampus (HPC). We hypothesized that the IUGR brain is less vulnerable to hypoglycemia-induced injury while preserving the regional variation in vulnerability. Methods We induced IUGR via bilateral uterine artery ligation on gestational day 19 (term 22d) rats. On postnatal day 14, insulin-induced HG of equivale...

Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections.

Science.gov (United States)

Holmes-Walker, Deborah Jane; Gunton, Jenny E; Hawthorne, Wayne; Payk, Marlene; Anderson, Patricia; Donath, Susan; Loudovaris, Tom; Ward, Glenn M; Kay, Thomas Wh; OʼConnell, Philip J

2017-06-01

The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia. This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4). After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0). In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence.

Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study.

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Giorda, Carlo B; Ozzello, Alessandro; Gentile, Sandro; Aglialoro, Alberto; Chiambretti, Anna; Baccetti, Fabio; Gentile, Francesco M; Lucisano, Giuseppe; Nicolucci, Antonio; Rossi, Maria Chiara

2015-10-01

Hypoglycemia is common in type 1 diabetes mellitus (T1DM). We aimed to update the incidence of severe and symptomatic hypoglycemia and investigate several correlated factors. In this multicenter, observational retrospective study, the data of 206 T1DM patients from a sample of 2,229 consecutive patients seen at 18 diabetes clinics were analyzed. Sociodemographic and clinical characteristics, severe hypoglycemia in the past 12 months, and symptomatic hypoglycemia in the past 4 weeks were recorded with a self-report questionnaire and a clinical form during a routine visit. Poisson multivariate models were applied. A minority of patients accounted for the majority of both severe and symptomatic episodes. The incidence rate (IR) of severe hypoglycemia was 0.49 (0.40-0.60) events/person-years. The incidence rate ratio (IRR) was higher in patients with previous severe hypoglycemia (3.71; 2.28-6.04), neuropathy (4.16; 2.14-8.05), long duration (>20 years, 2.96; 1.60-5.45), and on polypharmacy (1.24; 1.13-1.36), but it was lower when a complication was present. The IR of symptomatic hypoglycemia was 53.3 events/person-years, with an IRR significantly higher among women or patients with better education, or shorter duration or on pumps. The IRR was lower in patients with higher BMI or neuropathy or aged more than 50 years. Fewer than 20 % of T1DM patients are free from hypoglycemia, with one in six having experienced at least one severe episode in the last year. The distribution is uneven, with a tendency of episodes to cluster in some patients. Severe and symptomatic episodes have different correlates and reflect different conditions.

Profound neonatal hypoglycemia and lactic acidosis caused by pyridoxine-dependent epilepsy.

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Mercimek-Mahmutoglu, Saadet; Horvath, Gabriella A; Coulter-Mackie, Marion; Nelson, Tanya; Waters, Paula J; Sargent, Michael; Struys, Eduard; Jakobs, Cornelis; Stockler-Ipsiroglu, Sylvia; Connolly, Mary B

2012-05-01

Pyridoxine-dependent epilepsy (PDE) was first described in 1954. The ALDH7A1 gene mutations resulting in α-aminoadipic semialdehyde dehydrogenase deficiency as a cause of PDE was identified only in 2005. Neonatal epileptic encephalopathy is the presenting feature in >50% of patients with classic PDE. We report the case of a 13-month-old girl with profound neonatal hypoglycemia (0.6 mmol/L; reference range >2.4), lactic acidosis (11 mmol/L; reference range A (p.Val278Val), and a novel putative pathogenic missense mutation c.1192G>C (p.Gly398Arg) in the ALDH7A1 gene. She has been seizure-free since 1.5 months of age on treatment with pyridoxine alone. She has motor delay and central hypotonia but normal language and social development at the age of 13 months. This case is the first description of a patient with PDE due to mutations in the ALDH7A1 gene who presented with profound neonatal hypoglycemia and lactic acidosis masquerading as a neonatal-onset gluconeogenesis defect. PDE should be included in the differential diagnosis of hypoglycemia and lactic acidosis in addition to medically refractory neonatal seizures.

Prophylactic Dextrose Gel Does Not Prevent Neonatal Hypoglycemia: A Quasi-Experimental Pilot Study.

Science.gov (United States)

Coors, Sarah M; Cousin, Joshua J; Hagan, Joseph L; Kaiser, Jeffrey R

2018-03-28

To test the hypothesis that prophylactic dextrose gel administered to newborn infants at risk for hypoglycemia will increase the initial blood glucose concentration after the first feeding and decrease neonatal intensive care unit (NICU) admissions for treatment of asymptomatic neonatal hypoglycemia compared with feedings alone. This quasi-experimental study allocated asymptomatic at-risk newborn infants (late preterm, birth weight 4000 g, and infants of mothers with diabetes) to receive prophylactic dextrose gel (Insta-Glucose; Valeant Pharmaceuticals North America LLC, Bridgewater, New Jersey); other at-risk infants formed the control group. After the initial feeding, the prophylactic group received dextrose gel (0.5 mL/kg) rubbed into the buccal mucosa. The blood glucose concentration was checked 30 minutes later. Initial glucose concentrations and rate of NICU admissions were compared between the prophylactic group and controls using bivariate analyses. A multivariable linear regression compared first glucose concentrations between groups, adjusting for at-risk categories and age at first glucose concentration. There were 236 subjects (72 prophylactic, 164 controls). The first glucose concentration was not different between the prophylactic and control groups in bivariate analysis (52.1 ± 17.1 vs 50.5 ± 15.3 mg/dL, P = .69) and after adjusting for covariates (P  = .18). Rates of NICU admission for treatment of transient neonatal hypoglycemia were 9.7% and 14.6%, respectively (P = .40). Prophylactic dextrose gel did not reduce transient neonatal hypoglycemia or NICU admissions for hypoglycemia. The carbohydrate concentration of Insta-Glucose (77%) may have caused a hyperinsulinemic response, or alternatively, exogenous enteral dextrose influences glucose homeostasis minimally during the first few hours when counter-regulatory mechanisms are especially active. ClinicalTrials.gov: NCT02523222. Copyright © 2018 Elsevier Inc. All

Hypoglycemia and Medical Expenses in Patients with Type 2 Diabetes Mellitus: An Analysis Based on the Korea National Diabetes Program Cohort.

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Sang Youl Rhee

Full Text Available Hypoglycemia is one of the most important adverse events in individuals with type 2 diabetes mellitus (T2DM. However, hypoglycemia-related events are usually overlooked and have been documented less in clinical practice.We evaluated the incidence, clinical characteristics, and medical expenses of hypoglycemia related events in T2DM patients based on the Korea National Diabetes Program (KNDP, which is the largest multi-center, prospective cohort in Korea (n = 4,350. For accurate outcomes, the KNDP data were merged with claims data from the Health Insurance Review and Assessment Service (HIRA of Korea.During a median follow-up period of 3.23 years (95% CI: 3.14, 3.19, 88 subjects (2.02% were newly diagnosed with hypoglycemia, and the incidence of hypoglycemia was 6.44 cases per 1,000 person-years (PY. Individuals with hypoglycemia were significantly older (59.7±10.7 vs. 53.3±10.4 years, p < 0.001, had more hospital visits (121.94±126.88 days/PY, p < 0.001, had a longer hospital stays (16.13±29.21 days/PY, p < 0.001, and incurred greater medical costs ($2,447.56±4,056.38 vs. $1,336.37±3,403.39 /PY, p < 0.001 than subjects without hypoglycemia.Hypoglycemia-related events were infrequently identified among the medical records of T2DM subjects. However, they were associated significantly with poor clinical outcomes, and thus, hypoglycemia could have a substantial burden on the Korean national healthcare system.

Roux en Y gastric bypass hypoglycemia resolves with gastric feeding or reversal: Confirming a non-pancreatic etiology

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Dawn Belt Davis

2018-03-01

Full Text Available Objective: Postprandial hypoglycemia is an infrequent but disabling complication of Roux-en-Y gastric bypass (RYGB surgery. Controversy still exists as to whether the postprandial hyperinsulinemia observed is due to inherent changes in pancreatic β-cell mass or function or to reversible alterations caused by RYGB anatomy. We aimed to determine if gastric feeding or reversal of RYGB would normalize postprandial glucose and hormone excursions in patients with symptomatic hypoglycemia. Methods: We completed a prospective study of six patients with severe symptomatic RYGB hypoglycemia who underwent RYGB reversal. An additional subject without hypoglycemia who underwent RYGB reversal was also studied prospectively. Mixed meal tolerance testing (MTT was done orally (RYGB anatomy, via gastrostomy tube in the excluded stomach in the setting of RYGB, and several months after RYGB reversal. Results: All subjects reported symptomatic improvement of hypoglycemia after reversal of RYGB. Weight gain after reversal was moderate and variable. Postprandial glucose, insulin, and GLP-1 excursions were significantly diminished with gastric feeding and after reversal. Insulin secretion changed proportional to glucose levels and insulin clearance increased after reversal. Glucagon/insulin ratios were similar throughout study. We further compared the impact of modified sleeve gastrectomy reversal surgery to those with restoration of complete stomach and found no significant differences in weight regain or in postprandial glucose or hormone levels. Conclusions: Reversal of RYGB is an effective treatment option for severe postprandial hypoglycemia. The pathophysiology of this disorder is primarily due to RYGB anatomy resulting in altered glucose, gut, and pancreatic hormone levels and decreased insulin clearance, rather than inherent β-cell hyperplasia or hyperfunction. Keywords: Hypoglycemia, Insulin, Glucagon-like peptide 1, Roux en Y gastric bypass, Gastric bypass

Nocturnal hypoglycemia identified by a continuous glucose monitoring system in patients with primary adrenal insufficiency (Addison's Disease).

Science.gov (United States)

Meyer, Gesine; Hackemann, Annika; Reusch, Juergen; Badenhoop, Klaus

2012-05-01

Hypoglycemia can be a symptom in patients with Addison's disease. The common regimen of replacement therapy with oral glucocorticoids results in unphysiological low cortisol levels in the early morning, the time of highest insulin sensitivity. Therefore patients with Addison's disease are at risk for unrecognized and potentially severe nocturnal hypoglycemia also because of a disturbed counterregulatory function. Use of a continuous glucose monitoring system (CGMS) could help to adjust hydrocortisone treatment and to avoid nocturnal hypoglycemia in these patients. Thirteen patients with Addison's disease were screened for hypoglycemia wearing a CGMS for 3-5 days. In one patient we identified a hypoglycemic episode at 3:45 a.m. with a blood glucose level of 46 mg/dL, clearly beneath the 95% tolerance interval of minimal glucose levels between 2 and 4 a.m. (53.84 mg/dL). After the hydrocortisone replacement scheme was changed, the minimum blood glucose level between 2 and 4 a.m. normalized to 87 mg/dL. Continuous glucose monitoring can detect nocturnal hypoglycemia in patients with primary adrenal insufficiency and hence prevent in these patients an impaired quality of life and even serious adverse effects.

Hypoglycemia perception: Cross-cultural differences in Punjabi and Hindi speaking postmenopausal women.

Science.gov (United States)

Bhutani, Jaikrit; Kalra, Sanjay; Bhutani, Sukriti; Kalra, Bharti

2013-10-01

The cross cultural differences in perception of menopausal symptoms are well known and these differences in perception of hypoglycemic symptoms in Russian-speaking and Caucasian postmenopausal women have been reported. This study assessed cross - linguistic and cross - cultural differences in symptomatology of self reported hypoglycemia, between Punjabi and Hindi speaking diabetic post menopausal women. Thirty Punjabi speaking and 20 Hindi speaking diabetic postmenopausal women aged over 50 years, were recruited for this study. Each subject was asked, what happens to you when you have low sugar? in the language of her choice, and spontaneous answers were recorded verbatim. The data so obtained was analyzed by paper and pen method to obtain an understanding of the frequency of self reporting of various symptoms and then analyzed using Statistical Package for Social Science ver.19.0. Symptoms of hollowness, cold sweats and headache correlated significantly (P Punjabi speaking cohort were bilingual. Some symptoms of hypoglycemia may have been missed or over-reported by participants. Diabetes care professionals should be aware that persons with diabetes from varying linguistic backgrounds may report symptoms of hypoglycemia differently.

[Spontaneous hypoglycemia].

Science.gov (United States)

Ellorhaoui, M; Schultze, W

1977-01-15

On the basis of a survey is attempted to describe mode of development, symptomatology, individual forms and the different possibilities of therapy of the spontaneous hypoglycaemias. A particularly broad range was devoted to the cerebral sequelae, since in these cases--according to our experience--on account of simulation of neurologico-psychiatric symptoms at the soonest wrong diagnoses are to be expected. Furthermore, it is attempted to classify the hypoglycemias according to their development, in which cases their incompleteness was evident from the very beginning. The individual forms of appearance are treated according their to significance. Out of the inducible hypoglycaemias a particular attention is devoted to the forms caused by insulin and oral antidiabetics, since these most frequently participate in the development. Finally the author inquires into diagnostic measures for recognition of special forms of hypoglycaemia. In this place the diagnostics of hyperinsulinism conditioned by adenomatosis or tumours of other kinds is of particular importance. Finally conservative and operative possibilities of the therapy of these tumours are discussed,whereby the only recently tested treatment with streptotocin is mentioned.

EVALUATION OF DIELECTRIC CURING MONITORING INVESTIGATING LIGHT-CURING DENTAL FILLING COMPOSITES

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Johannes Steinhaus

2011-05-01

Full Text Available The aim of this study is the evaluation of a dielectric analysis (DEA method monitoring the curing behaviour of a light curing dental filling material in real-time. The evaluation is to extract the influence of light intensity on the photo-curing process of dental composite filling materials. The intensity change is obtained by measuring the curing process at different sample depth. It could be shown that increasing sample thickness, and therefore exponentially decreasing light intensity, causes a proportional decrease in the initial curing rate. Nevertheless, the results give rise to the assumption that lower illumination intensities over a long period cause higher overall conversion, and thus better mechanical properties. This would allow for predictions of the impact of different curing-rates on the final mechanical properties.

A social media intervention to improve hypoglycemia management at a multicenter hospital: a quality improvement pilot for clinical nurses.

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De Sousa, Filomena; Jackson, Jennifer; Knight, Ruth; Cloutier, Edith; Basa, Rosemary; Fourney, Anne; Devecseri, Kathleen

2018-02-01

Hypoglycemia poses significant risk to inpatients. Nursing management of hypoglycemia is a challenge, despite established best practice guidelines. Social media is an effective tool for sharing information and could overcome barriers to clinical education at a multicenter hospital. The purpose of this quality improvement intervention was to create and disseminate social media posts about best practices in hypoglycemia management. An unmatched pre-and post-survey assessed nursing knowledge of hypoglycemia management. Social media posts were created to visually outline the steps for hypoglycemia management over 2 weeks, across a nursing social media platform. We assessed the reach of the posts via Facebook and a survey. The posts reached 2962 users during the first week, and 1491 users the second week. A social media intervention can have a substantial reach and distribute information across a multicenter hospital. Additional study is needed to determine what factors could support an increase in nursing knowledge through a social media campaign.

The unexpected truth about dates and hypoglycemia

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Mohammed I Yasawy

2016-01-01

Full Text Available Background: Dates are a concentrated source of essential nutrients, vitamins, minerals, and carbohydrates (CHOs, which are necessary for the maintenance of optimum health. Most of the CHOs in dates come from sugars including glucose and fructose. Dates are commonly consumed in Saudi Arabia, particularly at the time of breaking the fast to provide instant energy and maintain blood sugar level. However, dates may cause hypoglycemia in a rare condition named as heredity fructose intolerance (HFI, and a few families have been to see us with a history of that nature. This is to report the preliminary results of an on-going study of a group of patients who get symptoms of hypoglycemia following the ingestion of dates and have suffered for years without an accurate diagnosis. Methodology: This report is based on three patients, from the same family, living in a date growing region of the Kingdom of Saudi Arabia (KSA. The patients had been to several medical centers without getting any definite answers or diagnosis until they were referred to the Gastroenterology Clinic of King Fahd Hospital of the University, Al-Khobar, KSA. The data were obtained by careful history and laboratory investigations, and a final diagnosis of HFI made on fructose intolerance test (FIT. Results: The patients reported that they had avoided eating dates because of various symptoms, such as bloating, nausea, and even hypoglycemia when larger amounts were consumed. Their other symptoms included sleepiness, sweating, and shivering. After full examinations and necessary laboratory tests based on the above symptoms, FIT was performed and the patients were diagnosed with HFI. They were referred to a dietitian who advised a fructose-free diet. They felt well and were free of symptoms. Conclusion: HFI may remain undiagnosed until adulthood and may lead to disastrous complications and even death. The diagnosis can only be suspected after a careful dietary history is taken supported by

HEART FAILURE, DIABETES, BETA-BLOCKERS AND RISK OF HYPOGLYCEMIA

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A. A. Aleksandrov

2008-01-01

Full Text Available Aim. To evaluate an influence of carvedilol on risk of hypoglycemia in patients with diabetes type 2 (D2 and chronic heart failure (CHF treated with angiotensin converting enzyme (ACE inhibitors.Material and methods. 13 patients (10 men, 3 women; aged 59,8±6,7 y.o. with D2 and CHF caused by ischemic heart disease were included in the study. Before inclusion all patients were treated with ACE inhibitors and various beta-blockers (atenolol, metoprolol, bisoprolol. These beta-blockers were changed for carvedilol. Heart ultrasonography, blood pressure control, glycemia monitoring, HbA1c level determination were performed before, during and after carvedilol therapy.Results. Carvedilol reduces frequency and duration of hypoglycaemia episodes. There were not episodes of severe hypoglycaemia during carvedilol therapy.Conclusion. Carvedilol reduces risk of hypoglycemia when it is used in combination with ACE inhiditors in diabetic patients with CHF.

Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India.

Science.gov (United States)

Shriraam, Vanishree; Mahadevan, Shriraam; Anitharani, M; Jagadeesh, Nalini Sirala; Kurup, Sreelekha Bhaskara; Vidya, T A; Seshadri, Krishna G

2015-01-01

Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD) of a medical college hospital. Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire. The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9%) and 126 (34.4%) patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%), weakness (73.8%), and drowsiness (72.1%). Overall, 242 (66.1%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure). Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia. Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.

Light-Cured Self-Etch Adhesives Undergo Hydroxyapatite-Triggered Self-Cure

Science.gov (United States)

Liu, Y.; Bai, X.; Liu, Y.W.; Wang, Y.

2015-01-01

Light cure is a popular mode of curing for dental adhesives. However, it suffers from inadequate light delivery when the restoration site is less accessible, in which case a self-cure mechanism is desirable to salvage any compromised polymerization. We previously reported a novel self-cure system mediated by ethyl 4-(dimethylamino)-benzoate (4E) and hydroxyapatite (HAp). The present work aims to investigate if such self-cure phenomenon takes place in adhesives that underwent prior inadequate light cure and to elucidate if HAp released from the dental etching process is sufficient to trigger it. Model self-etch adhesives were formulated with various components, including bis[2-methacryloyloxy)ethyl]-phosphate (2MP) as acidic monomer and trimethylbenzoyl-diphenylphosphine oxide (TPO) as photoinitiator. In vitro evolution of degree of conversion (DC) of HAp-incorporated adhesives was monitored by infrared spectroscopy during light irradiation and dark storage. Selected adhesives were allowed to etch and extract HAp from enamel, light-cured in situ, and stored in the dark, after which Raman line mapping was used to obtain spatially resolved DC across the enamel-resin interface. Results showed that TPO+4E adhesives reached DC similar to TPO-only counterparts upon completion of light irradiation but underwent another round of initiation that boosted DC to ~100% regardless of HAp level or prior light exposure. When applied to enamel, TPO-only adhesives had ~80% DC in resin, which gradually descended to ~50% in enamel, whereas TPO+4E adhesives consistently scored ~80% DC across the enamel-resin interface. These observations suggest that polymerization of adhesives that underwent insufficient light cure is salvaged by the novel self-cure mechanism, and such salvaging effect can be triggered by HAp released from dental substrate during the etching process. PMID:26635279

Light-Cured Self-Etch Adhesives Undergo Hydroxyapatite-Triggered Self-Cure.

Science.gov (United States)

Liu, Y; Bai, X; Liu, Y W; Wang, Y

2016-03-01

Light cure is a popular mode of curing for dental adhesives. However, it suffers from inadequate light delivery when the restoration site is less accessible, in which case a self-cure mechanism is desirable to salvage any compromised polymerization. We previously reported a novel self-cure system mediated by ethyl 4-(dimethylamino)-benzoate (4E) and hydroxyapatite (HAp). The present work aims to investigate if such self-cure phenomenon takes place in adhesives that underwent prior inadequate light cure and to elucidate if HAp released from the dental etching process is sufficient to trigger it. Model self-etch adhesives were formulated with various components, including bis[2-methacryloyloxy)ethyl]-phosphate (2MP) as acidic monomer and trimethylbenzoyl-diphenylphosphine oxide (TPO) as photoinitiator. In vitro evolution of degree of conversion (DC) of HAp-incorporated adhesives was monitored by infrared spectroscopy during light irradiation and dark storage. Selected adhesives were allowed to etch and extract HAp from enamel, light-cured in situ, and stored in the dark, after which Raman line mapping was used to obtain spatially resolved DC across the enamel-resin interface. Results showed that TPO+4E adhesives reached DC similar to TPO-only counterparts upon completion of light irradiation but underwent another round of initiation that boosted DC to ~100% regardless of HAp level or prior light exposure. When applied to enamel, TPO-only adhesives had ~80% DC in resin, which gradually descended to ~50% in enamel, whereas TPO+4E adhesives consistently scored ~80% DC across the enamel-resin interface. These observations suggest that polymerization of adhesives that underwent insufficient light cure is salvaged by the novel self-cure mechanism, and such salvaging effect can be triggered by HAp released from dental substrate during the etching process. © International & American Associations for Dental Research 2015.

SureCure{sup (R)}-A new material to reduces curing time and improve curing reproducibility of lead-acid batteries

Energy Technology Data Exchange (ETDEWEB)

Boden, David P.; Loosemore, Daniel V.; Botts, G. Dean [Hammond Lead Products Division, Hammond Group Inc., 2323 165th Street, Hammond, IN 46320 (United States)

2006-08-25

This paper introduces a technology that considerably reduces the time to cure the positive plates of lead-acid batteries. In each of several full-scale trials at automotive and industrial battery manufacturers, the simple replacement of 1wt.% of leady oxide with finely-divided tetrabasic lead sulfate (SureCure(TM) by Hammond Group Inc.) is shown to accelerate significantly the conversion of tribasic lead sulfate (3BS) to tetrabasic lead sulfate (4BS) in the curing process while improving crystal structure and reproducibility. Shorter curing times result in reduced labour and energy costs, as well as reduced fixed (curing chambers and plant footprint) and working (plate inventory) capital investment. (author)

Postprandial hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass

DEFF Research Database (Denmark)

Øhrstrøm, Caroline Christfort; Worm, Dorte; Hansen, Dorte Lindqvist

2017-01-01

of developing hypoglycemia. Known risk factors are female sex, longer time since surgery, and lack of prior diabetes. Management of the hypoglycemic episodes is difficult, and only dietary modifications consisting of frequent and less carbohydrate-rich meals seem to be efficient. Medical treatments and surgical...

Effects of Sleep Deprivation on Hypoglycemia-Induced Cognitive Impairment and Recovery in Adults With Type 1 Diabetes.

Science.gov (United States)

Inkster, Berit E; Zammitt, Nicola N; Ritchie, Stuart J; Deary, Ian J; Morrison, Ian; Frier, Brian M

2016-05-01

To ascertain whether hypoglycemia in association with sleep deprivation causes greater cognitive dysfunction than hypoglycemia alone and protracts cognitive recovery after normoglycemia is restored. Fourteen adults with type 1 diabetes underwent a hyperinsulinemic, hypoglycemic clamp on two separate occasions. Before one glucose clamp, the participants stayed awake overnight to induce sleep deprivation. Participants were randomized and counterbalanced to the experimental condition. Cognitive function tests were performed before and during hypoglycemia and for 90 min after restoration of normoglycemia. Cognitive impairment during hypoglycemia did not differ significantly between the sleep-deprived and non-sleep-deprived conditions. However, in the sleep-deprived state, digit symbol substitution scores and choice reaction times were significantly poorer during recovery (P sleep deprivation, such as tiredness, were removed. Hypoglycemia per se produced a significant decrement in cognitive function; coexisting sleep deprivation did not have an additive effect. However, after restoration of normoglycemia, preceding sleep deprivation was associated with persistence of hypoglycemic symptoms and greater and more prolonged cognitive dysfunction during the recovery period. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

A randomized trial of a home system to reduce nocturnal hypoglycemia in type 1 diabetes.

Science.gov (United States)

Maahs, David M; Calhoun, Peter; Buckingham, Bruce A; Chase, H Peter; Hramiak, Irene; Lum, John; Cameron, Fraser; Bequette, B Wayne; Aye, Tandy; Paul, Terri; Slover, Robert; Wadwa, R Paul; Wilson, Darrell M; Kollman, Craig; Beck, Roy W

2014-07-01

Overnight hypoglycemia occurs frequently in individuals with type 1 diabetes and can result in loss of consciousness, seizure, or even death. We conducted an in-home randomized trial to determine whether nocturnal hypoglycemia could be safely reduced by temporarily suspending pump insulin delivery when hypoglycemia was predicted by an algorithm based on continuous glucose monitoring (CGM) glucose levels. Following an initial run-in phase, a 42-night trial was conducted in 45 individuals aged 15-45 years with type 1 diabetes in which each night was assigned randomly to either having the predictive low-glucose suspend system active (intervention night) or inactive (control night). The primary outcome was the proportion of nights in which ≥1 CGM glucose values ≤60 mg/dL occurred. Overnight hypoglycemia with at least one CGM value ≤60 mg/dL occurred on 196 of 942 (21%) intervention nights versus 322 of 970 (33%) control nights (odds ratio 0.52 [95% CI 0.43-0.64]; P 2 h was reduced by 74%. Overnight sensor glucose was >180 mg/dL during 57% of control nights and 59% of intervention nights (P = 0.17), while morning blood glucose was >180 mg/dL following 21% and 27% of nights, respectively (P 250 mg/dL following 6% and 6%, respectively. Morning ketosis was present <1% of the time in each arm. Use of a nocturnal low-glucose suspend system can substantially reduce overnight hypoglycemia without an increase in morning ketosis. © 2014 by the American Diabetes Association.

Grafting and curing

International Nuclear Information System (INIS)

Garnett, J.L.; Loo-Teck Ng; Visay Viengkhou

1998-01-01

Progress in radiation grafting and curing is briefly reviewed. The two processes are shown to be mechanistically related. The parameters influencing yields are examined particularly for grafting. For ionising radiation grafting systems (EB and gamma ray) these include solvents, substrate and monomer structure, dose and dose-rate, temperature and more recently role of additives. In addition, for UV grafting, the significance of photoinitiators is discussed. Current applications of radiation grafting and curing are outlined. The recent development of photoinitiator free grafting and curing is examined as well as the potential for the new excimer laser sources. The future application of both grafting and curing is considered, especially the significance of the occurrence of concurrent grafting during cure and its relevance in environmental considerations

Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India

Directory of Open Access Journals (Sweden)

Vanishree Shriraam

2015-01-01

Full Text Available Introduction: Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD of a medical college hospital. Materials and Methods: Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire. Results: The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9% and 126 (34.4% patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%, weakness (73.8%, and drowsiness (72.1%. Overall, 242 (66.1% diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure. Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia. Conclusion: Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.

Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society.

Science.gov (United States)

Seaquist, Elizabeth R; Anderson, John; Childs, Belinda; Cryer, Philip; Dagogo-Jack, Samuel; Fish, Lisa; Heller, Simon R; Rodriguez, Henry; Rosenzweig, James; Vigersky, Robert

2013-05-01

To review the evidence about the impact of hypoglycemia on patients with diabetes that has become available since the past reviews of this subject by the American Diabetes Association and The Endocrine Society and to provide guidance about how this new information should be incorporated into clinical practice. Five members of the American Diabetes Association and five members of The Endocrine Society with expertise in different aspects of hypoglycemia were invited by the Chair, who is a member of both, to participate in a planning conference call and a 2-day meeting that was also attended by staff from both organizations. Subsequent communications took place via e-mail and phone calls. The writing group consisted of those invitees who participated in the writing of the manuscript. The workgroup meeting was supported by educational grants to the American Diabetes Association from Lilly USA, LLC and Novo Nordisk and sponsorship to the American Diabetes Association from Sanofi. The sponsors had no input into the development of or content of the report. The writing group considered data from recent clinical trials and other studies to update the prior workgroup report. Unpublished data were not used. Expert opinion was used to develop some conclusions. Consensus was achieved by group discussion during conference calls and face-to-face meetings, as well as by iterative revisions of the written document. The document was reviewed and approved by the American Diabetes Association's Professional Practice Committee in October 2012 and approved by the Executive Committee of the Board of Directors in November 2012 and was reviewed and approved by The Endocrine Society's Clinical Affairs Core Committee in October 2012 and by Council in November 2012. The workgroup reconfirmed the previous definitions of hypoglycemia in diabetes, reviewed the implications of hypoglycemia on both short- and long-term outcomes, considered the implications of hypoglycemia on treatment outcomes

Neonatal episodic hypoglycemia: a finding of valproic acid withdrawal.

Science.gov (United States)

Çoban, Dilek; Kurtoğlu, Selim; Akın, Mustafa Ali; Akçakuş, Mustafa; Güneş, Tamer

2010-01-01

The treatment of epilepsy during pregnancy is a worldwide problem. Drugs need to be used to control seizures in the mothers. In utero, exposure to valproic acid (VPA) and phenytoin (PH) may cause congenital malformations and also withdrawal symptoms such as irritability, jitteriness and symptoms of hypoglycemia. We present here a newborn with episodic hypoglycemia due to in utero exposure to VPA and PH. The mother was diagnosed as having complex partial epilepsy and was treated with PH (200 mg/day) and VPA (600 mg/day). The offspring developed jitteriness on the second day of life. The infant was hypoglycemic (32 mg/dl). These findings were accepted as withdrawal symptoms, since serum levels of VPA and PH were 37.8 μg/ml (50-100 μg/ml) and 6.37 μg/dl (10-20 μg/ml), respectively. Measurement of blood glucose is important and should be carefully monitored in infants exposed to antiepileptics in utero.

Hypoglycemia-Induced Decrease of EEG Coherence in Patients with Type 1 Diabetes

DEFF Research Database (Denmark)

Rubega, Maria; Sparacino, Giovanni; Sejling, A. S.

2016-01-01

investigated. The aim of the present work is to use a coherence approach to quantitatively assess how hypoglycemia affects mutual connectivity of different brain areas. MATERIALS AND METHODS: EEG multichannel data were obtained from 19 patients with T1D (58% males; mean age, 55 ± 2.4 years; diabetes duration......: In passing from eu- to hypoglycemia, absolute values of the iPDC function tend to decrease in both bands in all combinations of the considered channels. In particular, the scalar indicator [Formula: see text], which summarizes iPDC information, significantly decreased (P ...-A1A2 to C3-A1A2 from O1-A1A2 to C4-A1A2 and from O2-A1A2 to Cz-A1A2 in the theta band and from O1-A1A2 to T4-A1A2 and from O1-A1A2 to C4-A1A2 in the alpha band. CONCLUSIONS: The coherence decrease measured by iPDC in passing from eu- to hypoglycemia is likely related to the progressive loss...

Effect of cure cycle on curing process and hardness for epoxy resin

Directory of Open Access Journals (Sweden)

2009-09-01

Full Text Available A 3-dimensional finite element model is developed to simulate and analyze the temperature and degree of cure field of epoxy casting part during cure process. The present model based on general finite element software ABAQUS is verified by literature example and experimental data. The numerical results show good agreement with literature example and measured data, and are even more accurate than the simulation of literature. After modeling successfully, the influence of temperature cure cycle ramps have on the temperature and degree of cure gradient is investigated. Moreover, the effect of non-uniform temperature and degree of cure field within epoxy casting part on hardness is demonstrated. The present model provides an accurate and novel method that allows further insight into the process of cure for epoxy resin.

Rat liver responsiveness to gluconeogenic substrates during insulin-induced hypoglycemia

Directory of Open Access Journals (Sweden)

H.M. de Souza

2001-06-01

Full Text Available Hepatic responsiveness to gluconeogenic substrates during insulin-induced hypoglycemia was investigated. For this purpose, livers were perfused with a saturating concentration of 2 mM glycerol, 5 mM L-alanine or 5 mM L-glutamine as gluconeogenic substrates. All experiments were performed 1 h after an ip injection of saline (CN group or 1 IU/kg of insulin (IN group. The IN group showed higher (P<0.05 hepatic glucose production from glycerol, L-alanine and L-glutamine and higher (P<0.05 production of L-lactate, pyruvate and urea from L-alanine and L-glutamine. In addition, ip injection of 100 mg/kg glycerol, L-alanine and L-glutamine promoted glucose recovery. The results indicate that the hepatic capacity to produce glucose from gluconeogenic precursors was increased during insulin-induced hypoglycemia.

Nocturnal Hypoglycemia in Type 2 Diabetes

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Clus Simona

2018-03-01

Full Text Available Background and aims: It is known that the majority of critical unacknowledged hypoglycemia has an increased incidence in patients with type 1 diabetes (T1DM with a long evolution. The aim of this research is to evaluate the variability of glucose level and hypoglycemic events in patients with type 2 diabetes (T2DM having pharmacological interventions with hypoglycemic risk. These events are sometimes asymptomatic also in T2DM: frequently in elderly, patients with autonomic neuropathy, or having a long evolution of disease.

Theophylline enhances glucose recovery after hypoglycemia in healthy man and in type I diabetic patients

DEFF Research Database (Denmark)

Hvidberg, A; Rasmussen, M H; Christensen, N J

1994-01-01

followed by IV infusion of 1 mg/kg/h) was administered from 1 hour before induction of hypoglycemia until the end of the study period. On the other day, NaCl was administered. Plasma glucose before induction of hypoglycemia was equal on the 2 study days. The plasma glucose area under the curve (AUC......). The incremental AUC for cAMP was larger with theophylline for diabetic patients (P = .01). For healthy subjects, cAMP was greater with theophylline 30 minutes after insulin (P = .03). In conclusion, glucose recovery after hypoglycemia is significantly increased when theophylline is administered in an asthma......The principal mediators of glucose counterregulation (glucagon and epinephrine) use intracellular cyclic adenosine monophosphate (cAMP) to mediate glucose release. Since theophylline increases cAMP (by inhibiting its decomposition), we investigated the effect of theophylline on glucose recovery...

INCIDENCE & CAUSES OF NEONATAL HYPOGLYCEMIA AFTER CESAREAN SECTION IN A RURAL SETUP OF WEST BENGAL

OpenAIRE

Rudradev; Anirban; Abhijit; Maitreyi; Banani; Srimanta; Loknath; Bhaskar

2014-01-01

Neonatal hypoglycaemia a major cause of morbidity and mortality may lead to permanent brain damage. This is more common in babies delivered by Caesar ean Section. AIMS: A clinico - statistical study was performed among newborns delivered by Caesarean Section for a period of 1 year to find out: 1. The incidence of neonatal hypoglycemia at 48 hrs of birth. 2. Risk factors of neonatal hypoglycemia in case of cesarean section. 3. Incidence of neonat...

Steam Cured Self-Consolidating Concrete and the Effects of Limestone Filler

Science.gov (United States)

Aqel, Mohammad A.

The purpose of this thesis is to determine the effect and the mechanisms associated with replacing 15% of the cement by limestone filler on the mechanical properties and durability performance of self-consolidating concrete designed and cured for precast/prestressed applications. This study investigates the role of limestone filler on the hydration kinetics, mechanical properties (12 hours to 300 days), microstructural and durability performance (rapid chloride permeability, linear shrinkage, sulfate resistance, freeze-thaw resistance and salt scaling resistance) of various self-consolidating concrete mix designs containing 5% silica fume and steam cured at a maximum holding temperature of 55°C. This research also examines the resistance to delayed ettringite formation when the concrete is steam cured at 70°C and 82°C and its secondary consequences on the freeze-thaw resistance. The effect of several experimental variables related to the concrete mix design and also the curing conditions are examined, namely: limestone filler fineness, limestone filler content, cement type, steam curing duration and steam curing temperature. In general, the results reveal that self-consolidating concrete containing 15% limestone filler, steam cured at 55°C, 70°C and 82°C, exhibited similar or superior mechanical and transport properties as well as long term durability performance compared to similar concrete without limestone filler. When the concrete is steam cured at 55°C, the chemical reactivity of limestone filler has an important role in enhancing the mechanical properties at 16 hours (compared to the concrete without limestone filler) and compensating for the dilution effect at 28 days. Although, at 300 days, the expansion of all concrete mixes are below 0.05%, the corresponding freeze-thaw durability factors vary widely and are controlled by the steam curing temperature and the chemical composition of the cement. Overall, the material properties indicate that the use

Hypoglycemia-related electroencephalogram changes are independent of gender, age, duration of diabetes, and awareness status in type 1 diabetes

DEFF Research Database (Denmark)

Remvig, Line Sofie; Elsborg, Rasmus; Sejling, Anne-Sophie

2012-01-01

Introduction: Neuroglycopenia in type 1 diabetes mellitus (T1DM) results in reduced cognition, unconsciousness, seizures, and possible death. Characteristic changes in the electroencephalogram (EEG) can be detected even in the initial stages. This may constitute a basis for a hypoglycemia alarm...... device. The aim of the present study was to explore the characteristics of the EEG differentiating normoglycemia and hypoglycemia and to elucidate potential group differences. Methods: We pooled data from experiments in T1DM where EEG was available during both normoglycemia and hypo-glycemia for each...

Spanish translation, adaptation and validation of the Hypoglycemia Fear Survey in adults with type 1 diabetes in the Community of Madrid.

Science.gov (United States)

Tasende, Clara; Rubio, José Antonio; Álvarez, Julia

2018-05-01

The negative impact of hypoglycemia on patients with type 1 diabetes mellitus (T1DM) may lead to development of fear of hypoglycemia. In this study, the original Hypoglycemia Fear Survey (HFS) questionnaire was translated into Spanish, adapted and validated, and variables associated to fear of hypoglycemia in T1DM were analyzed. The HFS was translated and adapted to Spanish using the forward-backward translation method. The resulting questionnaire, EsHFS, was administrated to a population with T1DM. The following parameters of the questionnaire were analyzed: feasibility, reliability (Cronbach's alpha), content validity (correlating EsHFS and EsDQOL [Diabetes Quality of Life] questionnaire), and stability (by means of test-retest correlation). The EsHFS questionnaire consists of 24 items and three subscales including: subscale 1 on worry; subscale 2 on hypoglycemia-avoidant behavior, and subscale 3 on hyperglycemia-influenced behavior. 163 subjects, with a mean aged (SD) of 36 (10.5) years, 24% on continuous subcutaneous insulin infusion. Of these, 99.8% completed the EsHFS questionnaire in less than 10minutes. Cronbach's alpha for global EsHFS was 0.92. EsHFS and its subscales correlated with EsDQOL. Test-retest correlation (Pearson) was r=0.92. Age, female sex, lower educational level, living alone, frequency of daily self-monitoring and non-severe hypoglycemia, and history of severe and/or asymptomatic hypoglycemia were independently associated to the result of EsHFS. The Spanish version of the HFS, EsHFS, has good psychometric properties and may be a useful tool to assess fear of hypoglycemia in Spanish-speaking patients with T1DM. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Symptomatic Hypoglycemia Related to Inappropriately High IGF-II Serum Levels in a Patient with Desmoplastic Small Round Cell Tumor

Directory of Open Access Journals (Sweden)

Williams Fernandes Barra

2010-01-01

Full Text Available A 45-year old man was diagnosed with desmoplastic small round cell tumor (DSRCT with involvement of the peritoneum and pelvis. Disease progression was observed despite systemic chemotherapy. Six months after diagnosis, he developed severe hypoglycemia presented with seizures. He received intravenous glucose infusion and hydrocortisone with poor glycemic control, but with seizures resolution. The investigation excluded insulinoma, adrenal, liver and GH deficiencies. Laboratory showed slight rise of IGF-II and significant increase of the ratio IGF-II : IGF-I, which is pathognomonic of non-islet cell tumor hypoglycemia (NICTH. He received the diagnoses of NICTH related to IGF-II inappropriate production by DSRCT. Despite the attempt to control tumor mass and hypoglycemia, the patient died 9 months after diagnosis. NICTH related to inappropriate IGF-II secretion should be investigated in all cancer patients with refractory hypoglycemia whom insulinoma and other metabolic abnormalities were excluded from.

Blocking of beta-2 adrenergic receptors hastens recovery from hypoglycemia-associated social withdrawal.

Science.gov (United States)

Park, Min Jung; Guest, Christopher B; Barnes, Meredith B; Martin, Jonathan; Ahmad, Uzma; York, Jason M; Freund, Gregory G

2008-11-01

Hypoglycemia is associated with a variety of adverse behaviors including fatigue, confusion and social withdrawal. While these clinical symptoms are well characterized, the mechanism of their cause is not understood. Here we investigated how insulin-induced hypoglycemia causes social withdrawal. Male 8-12-week-old C57BL/6J mice were injected intraperitoneally (IP) with or without and/or insulin, norepinephrine (NE) and epinephrine (Epi), terbutaline and butoxamine with subsequent measurement of blood glucose, social withdrawal and plasma catecholamines. Insulin generated (0.75h post-injection) significant hypoglycemia with blood glucose nadirs of 64+/-4 and 48+/-5mg/dl for 0.8 and 1.2units/kg of insulin, respectively. Insulin (0.8 or 1.2units/kg) caused near total social withdrawal at 0.75h with full recovery not occurring until 4h (0.8units/kg) or 8h (1.2units/kg) post-insulin injection. Insulin also caused a marked elevation in plasma catecholamines. Basal 12h fasting NE and Epi were 287+/-38 and 350+/-47pg/ml, respectively. Insulin at 0.8units/kg increased plasma NE and Epi to 994+/-73 and 1842+/-473pg/ml, respectively. Administration of exogenous NE or Epi caused social withdrawal similar in magnitude to insulin. Importantly, administration of the beta-2 adrenergic receptor agonist terbutaline also caused social withdrawal while administration of the beta-2 adrenergic receptor antagonist butoxamine blocked NE-induced social withdrawal. Finally, butoxamine blocked insulin-induced social withdrawal. These data demonstrate that hypoglycemia-associated social withdrawal is dependent on catecholamines via a beta-2 receptor-mediated pathway.

Radiation curing - a personal perspective

International Nuclear Information System (INIS)

Pappas, S.P.

1992-01-01

This chapter briefly introduces radiation curing from the personal perspective of the author. Topics covered in this chapter include characteristic features of radiation curing, photoinitiated polymerization -- ultraviolet (UV) curing, and general principles of electron beam (EB) curing. 57 refs., 2 tabs

Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification.

Science.gov (United States)

Aucoin, Monique; Bhardwaj, Sukriti

2016-01-01

Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of protein, fat, and fiber to her diet resulted in a substantial decrease in anxiety symptoms as well as a decrease in the frequency and severity of hypoglycemia symptoms. A brief return to her previous diet caused a return of her anxiety symptoms, followed by improvement when she restarted the prescribed diet. This case strengthens the hypothesis that dietary glycemic index may play a role in the pathogenesis or progression of mental illnesses such as generalized anxiety disorder and subsequently that dietary modification as a therapeutic intervention in the treatment of mental illness warrants further study.

Whole genome expression profiling associates activation of unfolded protein response with impaired production and release of epinephrine after recurrent hypoglycemia.

Directory of Open Access Journals (Sweden)

Juhye Lena Kim

Full Text Available Recurrent hypoglycemia can occur as a major complication of insulin replacement therapy, limiting the long-term health benefits of intense glycemic control in type 1 and advanced type 2 diabetic patients. It impairs the normal counter-regulatory hormonal and behavioral responses to glucose deprivation, a phenomenon known as hypoglycemia associated autonomic failure (HAAF. The molecular mechanisms leading to defective counter-regulation are not completely understood. We hypothesized that both neuronal (excessive cholinergic signaling between the splanchnic nerve fibers and the adrenal medulla and humoral factors contribute to the impaired epinephrine production and release in HAAF. To gain further insight into the molecular mechanism(s mediating the blunted epinephrine responses following recurrent hypoglycemia, we utilized a global gene expression profiling approach. We characterized the transcriptomes during recurrent (defective counter-regulation model and acute hypoglycemia (normal counter-regulation group in the adrenal medulla of normal Sprague-Dawley rats. Based on comparison analysis of differentially expressed genes, a set of unique genes that are activated only at specific time points after recurrent hypoglycemia were revealed. A complementary bioinformatics analysis of the functional category, pathway, and integrated network indicated activation of the unfolded protein response. Furthermore, at least three additional pathways/interaction networks altered in the adrenal medulla following recurrent hypoglycemia were identified, which may contribute to the impaired epinephrine secretion in HAAF: greatly increased neuropeptide signaling (proenkephalin, neuropeptide Y, galanin; altered ion homeostasis (Na+, K+, Ca2+ and downregulation of genes involved in Ca2+-dependent exocytosis of secretory vesicles. Given the pleiotropic effects of the unfolded protein response in different organs, involved in maintaining glucose homeostasis, these

Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: an open label randomized clinical trial.

Science.gov (United States)

Kutamba, E; Lubega, S; Mugalu, J; Ouma, J; Mupere, E

2014-09-01

Hypoglycemia is a major cause of morbidity and mortality among preterm infants and its management remains a challenge in resource limited settings. Use of dextrose infusion by the recommended infusion pumps is not feasible in our environment due to their high costs and yet the current use of mini dextrose boluses with syringes as adapted at Mulago national referral and tertiary teaching hospital has unknown efficacy in prevention of hypoglycemia. We determined the efficacy of dextrose infusions by burettes versus two hourly dextrose boluses in prevention of hypoglycemia among preterms admitted in the first 72 hours at Special Care Unit, Mulago Hospital. One hundred and forty preterms aged 0 to 24 hours of life were randomized to receive 10% IV dextrose either as mini boluses or by infusion using burettes in an open label clinical trial. Blood glucose was measured at 0, two hourly for next 6 hours, 6 hourly for next 12 hours and thereafter 12 hourly until end of 72 hours following admission. Primary end point was incidence of hypoglycemia (random blood sugar (RBS) dextrose infusion was computed using 1-RR. From February 2012 to April 2012, 68 preterms in the bolus arm and 72 in the infusion arm were studied. Hypoglycemia was detected in 34% (48/140). The incidence of hypoglycemia in the bolus arm was 59% (40/68) compared to 11% (8/72) in the infusion arm (RR; 0.19, 95% CI; 0.09-0.37). Efficacy (1-RR) of infusion by burettes versus boluses in prevention of hypoglycemia among preterms was 0.81 (95% CI; 0.63-0.90). Continuous 10% dextrose infusion by burettes reduced the incidence of hypoglycemia by 81% in the first 72 hours of admission compared to two hourly 10% mini dextrose boluses among preterms admitted at Special Care Unit, Mulago Hospital. (ClinicalTrials.gov Identifier: NCT01688674).

Evaluation of the Counter-regulatory Responses to Hypoglycemia in Patients with Type 1 Diabetes during Opiate Receptor Blockade with Naltrexone

DEFF Research Database (Denmark)

Naik, Sarita; Belfort-DeAguiar, Renata; Sejling, Anne-Sophie

2017-01-01

AIMS: Hypoglycemia is the major limiting factor in achieving optimal glycemic control in people with type 1 diabetes (T1DM), especially intensively treated patients with impaired glucose counterregulation during hypoglycemia. Naloxone, an opiate receptor blocker, has been reported to enhance...... with a high risk for hypoglycemia. MATERIALS AND METHODS: We performed a randomized, placebo-controlled, double-blinded, cross-over study in which 9 intensively treated subjects with T1DM underwent a 2-step euglycemic-hypoglycemic-hyperinsulinemic clamp on two separate occasions. Twelve hours and 1 hour...

Influence of erythropoietin on cognitive performance during experimental hypoglycemia in patients with type 1 diabetes mellitus: a randomized cross-over trial.

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Peter Lommer Kristensen

Full Text Available The incidence of severe hypoglycemia in type 1 diabetes has not decreased over the past decades. New treatment modalities minimizing the risk of hypoglycemic episodes and attenuating hypoglycemic cognitive dysfunction are needed. We studied if treatment with the neuroprotective hormone erythropoietin (EPO enhances cognitive function during hypoglycemia.Eleven patients with type 1 diabetes, hypoglycemia unawareness and recurrent severe hypoglycemia completed the study. In a double-blind, randomized, balanced, cross-over study using clamped hypoglycemia they were treated with 40,000 IU of EPO or placebo administered intravenously six days before the two experiments. Cognitive function (primary endpoint, hypoglycemic symptoms, and counter-regulatory hormonal response were recorded.Compared with placebo, EPO treatment was associated with a significant reduction in errors in the most complex reaction time task (-4.7 (-8.1 to -1.3, p = 0.01 and a less reaction time prolongation (-66 (-117 to -16 msec, p = 0.02. EPO treatment did not change performance in other measures of cognition. Hypoglycemic symptoms, EEG-changes, and counter-regulatory hormone concentrations did not differ between EPO and placebo treatment.In patients with type 1 diabetes and hypoglycemia unawareness, treatment with EPO is associated with a beneficial effect on cognitive function in a complex reaction time task assessing sustained attention/working memory. Hypoglycemic symptoms and hormonal responses were not changed by EPO treatment.ClinicalTrials.gov NCT00615368.

Radiation curing of polymers

International Nuclear Information System (INIS)

Randell, D.R.

1987-01-01

The contents of this book are: Areas of Application of UV Curing; Areas of Application of EB Curing; Laser Curing of Acrylic Coatings; A User's View of the Application of Radiation Curable Materials; Radiation Curable Offset Inks: A Technical and Marketing Overview; and UV Curable Screen Printing Inks

Is testing for postprandial hyperinsulinemic hypoglycemia after gastric bypass necessary?

Science.gov (United States)

Gasser, Michèle; Meier, Claudia; Herren, Sylvia; Aubry, Emilie; Steffen, Rudolf; Stanga, Zeno

2017-11-23

Postprandial hyperinsulinemic hypoglycemia (pHH) is an increasingly reported complication after Roux-en-Y gastric bypass (RYGB). As pHH can cause life-threatening emergencies if occurring without warning symptoms, challenge testing may detect patients at risk. The study objective was to determine the frequency of occurrence of pHH with or without symptoms of hypoglycemia after RYGB. We undertook an observational cohort study of consecutive, unselected patients approximately one year after uncomplicated RYGB. To simulate normal habits, all patients received a standardized carbohydrate-rich solid mixed meal. Plasma glucose and insulin were measured at 30, 60, 90, 120, and 150 min thereafter. Symptoms were classified as autonomous or neuroglycopenic. Patients with hypoglycemia (plasma glucose meal. 113 patients were included. Total weight loss at the first follow-up check (14 ± 0.4 months) was 33.97 ± 9.3%. After the carbohydrate-rich meal, glucose dropped to meal. The pHH occurred in 11.5% (n = 13) of patients. Asymptomatic patients (5.3%, n = 6) carried an increased risk (p = 0.008) for pHH. One patient needed emergency treatment after sudden loss of consciousness after the carbohydrate-rich meal. The occurrence of pHH was quite high in our study population with 11.5% thereof 5.3% asymptomatic. We therefore suggest that detection of these patients warrants a screening of patients after RYGB. At-risk patients should than be adequately advised to avoid carbohydrate-rich meals in order to optimize risk management. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Severe paraneoplastic hypoglycemia in a patient with a gastrointestinal stromal tumor with an exon 9 mutation: a case report

International Nuclear Information System (INIS)

Escobar, Guillermo A; Robinson, William A; Nydam, Trevor L; Heiple, Drew C; Weiss, Glen J; Buckley, Linda; Gonzalez, Rene; McCarter, Martin D

2007-01-01

Non-islet cell tumor induced hypoglycemia (NICTH) is a very rare phenomenon, but even more so in gastrointestinal stromal tumors. It tends to present in large or metastatic tumors, and can appear at any time in the progression of the disease. We present herein a case of NICTH in a GIST tumor and report an exon 9 mutation associated to it. A thirty nine year-old man with a recurrent, metastatic gastrointestinal stromal tumor presented to the hospital with nausea, dizziness, loss of consciousness, and profound hypoglycemia (20 mg/dL). There was no evidence of factitious hypoglycemia. He was stabilized with a continuous glucose infusion and following selective vascular embolization, the patient underwent debulking of a multicentric 40 cm × 25 cm × 10 cm gastrointestinal stromal tumor. After resection, the patient became euglycemic and returned to his normal activities. Tumor analysis confirmed excessive production of insulin-like growth factor II m-RNA and the precursor protein, 'big' insulin-like growth factor II. Mutational analysis also identified a rare, 6 bp tandem repeat insert (gcctat) at position 1530 in exon 9 of KIT. Optimal management of gastrointestinal stromal tumor-induced hypoglycemia requires a multidisciplinary approach, and surgical debulking is the treatment of choice to obtain immediate symptom relief. Imatinib or combinations of glucocorticoids and growth hormone are alternative palliative strategies for symptomatic hypoglycemia. In addition, mutations in exon 9 of the tyrosine kinase receptor KIT occur in 11–20% of GIST and are often associated with poor patient outcomes. The association of this KIT mutation with non-islet cell tumor induced hypoglycemia has yet to be established

Dipyrone in association with atropine inhibits the effect on gastric emptying induced by hypoglycemia in rats

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E.F. Collares

2017-08-01

Full Text Available Atropine (AT and dipyrone (Dp induce a delay of gastric emptying (GE of liquids in rats by inhibiting muscarinic receptors and activating β2-adrenergic receptors, respectively. The objective of the present study was to determine the effects of pretreatment with AT and Dp, given alone or in combination, on the effect of hypoglycemia in the liquid GE in rats. Male Wistar adult rats (280-310 g were pretreated intravenously with AT, Dp, AT plus Dp or their vehicle and then treated 30 min later with iv insulin or its vehicle (n=8-10 animals/group. Thirty min after treatment, GE was evaluated by determining, in awake rats, the percent gastric retention (%GR of a saline meal labeled with phenol red administered by gavage. The results indicated that insulin induced hypoglycemia in a dose-dependent manner resulting in a significant reduction in %GR of liquid only at the highest dose tested (1 U/kg. Pretreatment with AT significantly increased %GR in the rats treated with 1 U/kg insulin. Surprisingly, after pretreatment with AT, the group treated with the lowest dose of insulin (0.25 U/kg displayed significantly lower %GR compared to its control (vehicle-treated group, which was not seen in the non-pretreated animals. Pretreatment with Dp alone at the dose of 40 mg/kg induced an increase in %GR in both vehicle and 0.25 U/kg-treated rats. A higher dose of Dp alone (80 mg/kg significantly reduced the effect of a marked hypoglycemia induced by 1 U/kg of insulin on GE while in combination with AT the effect was completely abolished. The results with AT suggest that moderate hypoglycemia may render the inhibitory mechanisms of GE ineffective while Dp alone and in combination with AT significantly overcame the effect of hypoglycemia on GE.

Glucose-Dependent Insulinotropic Polypeptide Augments Glucagon Responses to Hypoglycemia in Type 1 Diabetes

DEFF Research Database (Denmark)

Christensen, Mikkel; Calanna, Salvatore; Sparre-Ulrich, Alexander H

2015-01-01

constituted a "recovery phase." During the recovery phase, GIP infusions elicited larger glucagon responses (164 ± 50 [GIP] vs. 23 ± 25 [GLP-1] vs. 17 ± 46 [saline] min ⋅ pmol/L, P endogenous glucose production was higher with GIP and lower with GLP-1 compared with saline (P ... days, significantly less exogenous glucose was needed to keep plasma glucose above 2 mmol/L (155 ± 36 [GIP] vs. 232 ± 40 [GLP-1] vs. 212 ± 56 [saline] mg ⋅ kg(-1), P ... similar on all days. Our results suggest that during hypoglycemia in patients with T1DM, exogenous GIP increases glucagon responses during the recovery phase after hypoglycemia and reduces the need for glucose administration....

Hypoglycemia-Associated EEG Changes in Prepubertal Children With Type 1 Diabetes

DEFF Research Database (Denmark)

Hansen, Grith Lærkholm; Foli-Andersen, Pia; Fredheim, Siri

2016-01-01

were calculated. A within-patient analysis was conducted comparing hypoglycemia versus euglycemia changes in the qEEG. The nonparametric Wilcoxon signed rank test was performed. A real-time analyzing algorithm developed for adults was applied. RESULTS: The qEEG showed significant differences...

Radiation curing in the eighties

International Nuclear Information System (INIS)

Vrancken, A.

1984-01-01

The subject is discussed under the headings: introduction; what is radiation curing; history; radiation curable resins (with properties of products); ultraviolet and electron beam curing; photoinitiation and the ultraviolet light curing process; electron beam curing (initiation; electron beam accelerators); end uses (graphic arts; wood finishing; paper upgrading; adhesives; metal finishing; electronic chemical; floor coatings). (U.K.)

Profound hypoglycemia-ınduced by vaccinium corymbosum juice and laurocerasus fruit.

Science.gov (United States)

Aktan, Ahmet Hamdi; Ozcelik, Abdullah; Cure, Erkan; Cure, Medine Cumhur; Yuce, Suleyman

2014-01-01

An emergency intervention was performed in a 75-year-old male patient with hypoglycemic attack and blackout. Although he was diagnosed with prediabetes before 2 years, he did not take any anti-diabetic drug or follow dietary advice. He drank Vaccinium corymbosum L (VC) juice daily with a belief that it increases sexual potency. Before the development of hypoglycemia, the patient had consumed about 500 ml VC juice in addition to eating 200-300 gram of Laurocerasus officinalis (LO) fruit. The measured plasma glucose (PG) level during loss of consciousness was 30 mg/dl. The profound hypoglycemia may be an unexpected side effect of an interaction between the chemical compositions of the two plants, occurred as a result of LO fruit intake that may have a strong PG-lowering effect or related to excessive intake of VC juice. Both plants may be considered in the alternative treatment of diabetes.

Monogenic hyperinsulinemic hypoglycemia: current insights into the pathogenesis and management

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Lord Katherine

2013-02-01

Full Text Available Abstract Hyperinsulinism (HI is the leading cause of persistent hypoglycemia in children, which if unrecognized may lead to development delays and permanent neurologic damage. Prompt recognition and appropriate treatment of HI are essential to avoid these sequelae. Major advances have been made over the past two decades in understanding the molecular basis of hyperinsulinism and mutations in nine genes are currently known to cause HI. Inactivating KATP channel mutations cause the most common and severe type of HI, which occurs in both a focal and a diffuse form. Activating mutations of glutamate dehydrogenase (GDH lead to hyperinsulinism/hyperammonemia syndrome, while activating mutations of glucokinase (GK, the “glucose sensor” of the beta cell, causes hyperinsulinism with a variable clinical phenotype. More recently identified genetic causes include mutations in the genes encoding short-chain 3-hydroxyacyl-CoA (SCHAD, uncoupling protein 2 (UCP2, hepatocyte nuclear factor 4-alpha (HNF-4α, hepatocyte nuclear factor 1-alpha (HNF-1α, and monocarboyxlate transporter 1 (MCT-1, which results in a very rare form of HI triggered by exercise. For a timely diagnosis, a critical sample and a glucagon stimulation test should be done when plasma glucose is ATP channel agonist, suggests a KATP defect, which frequently requires pancreatectomy. Surgery is palliative for children with diffuse KATPHI, but children with focal KATPHI are cured with a limited pancreatectomy. Therefore, distinguishing between diffuse and focal disease and localizing the focal lesion in the pancreas are crucial aspects of HI management. Since 2003, 18 F-DOPA PET scans have been used to differentiate diffuse and focal disease and localize focal lesions with higher sensitivity and specificity than more invasive interventional radiology techniques. Hyperinsulinism remains a challenging disorder, but recent advances in the understanding of its genetic basis and breakthroughs in

Impact of screening and monitoring of capillary blood glucose in the detection of hyperglycemia and hypoglycemia in non-critical inpatients

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Rogerio Silicani Ribeiro

2011-03-01

Full Text Available Objective: To evaluate the impact of screening hyper and hypoglycemia measured by capillary glycemia and standard monitorization of  hyperglycemic patients hospitalized in regular care units of Hospital Israelita Albert Einstein. Methods: The capillary glycemia was  measured by the Precision PCx (Abbott glucosimeter, using the PrecisionWeb (Abbott software. The detection of hyper and hypoglycemia during the months of May/June were compared to those of March/April in 2009 and to the frequency of the diagnosis of diabetes in 2007. Rresults: There was an increase in the glycemia screening from 27.7 to 77.5% of hospitalized patients (p < 0.001, of hyperglycemia detection (from 9.3 to 12.2%; p < 0.001 and of hypoglycemia (from 1.5 to 3.3%; p < 0.001 during  the months of May/June  2009. According to this action 14 patients for each additional case of hyperglycemia and 26 cases for each case of hypoglycemia were identified. The detection of hyperglycemia was significantly higher (p < 0.001 than the frequency of registered diagnosis related do diabetes in the year of 2007. Cconclusions: the adoption of an institutional program of glycemia monitorization improves the detection of hyper and hypoglycemia and glycemia control in hospitalized patients in regular care units.

Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes.

Science.gov (United States)

Karges, Beate; Schwandt, Anke; Heidtmann, Bettina; Kordonouri, Olga; Binder, Elisabeth; Schierloh, Ulrike; Boettcher, Claudia; Kapellen, Thomas; Rosenbauer, Joachim; Holl, Reinhard W

2017-10-10

Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. To determine whether rates of severe hypoglycemia and diabetic ketoacidosis are lower with insulin pump therapy compared with insulin injection therapy in children, adolescents, and young adults with type 1 diabetes. Population-based cohort study conducted between January 2011 and December 2015 in 446 diabetes centers participating in the Diabetes Prospective Follow-up Initiative in Germany, Austria, and Luxembourg. Patients with type 1 diabetes younger than 20 years and diabetes duration of more than 1 year were identified. Propensity score matching and inverse probability of treatment weighting analyses with age, sex, diabetes duration, migration background (defined as place of birth outside of Germany or Austria), body mass index, and glycated hemoglobin as covariates were used to account for relevant confounders. Type 1 diabetes treated with insulin pump therapy or with multiple (≥4) daily insulin injections. Primary outcomes were rates of severe hypoglycemia and diabetic ketoacidosis during the most recent treatment year. Secondary outcomes included glycated hemoglobin levels, insulin dose, and body mass index. Of 30 579 patients (mean age, 14.1 years [SD, 4.0]; 53% male), 14 119 used pump therapy (median duration, 3.7 years) and 16 460 used insulin injections (median duration, 3.6 years). Patients using pump therapy (n = 9814) were matched with 9814 patients using injection therapy. Pump therapy, compared with injection therapy, was associated with lower rates of severe hypoglycemia (9.55 vs 13.97 per 100 patient-years; difference, -4.42 [95% CI, -6.15 to -2.69]; P young patients with type 1 diabetes, insulin pump therapy, compared with insulin injection therapy, was associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and with better glycemic control during the

A flexible cure rate model with dependent censoring and a known cure threshold.

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Bernhardt, Paul W

2016-11-10

We propose a flexible cure rate model that accommodates different censoring distributions for the cured and uncured groups and also allows for some individuals to be observed as cured when their survival time exceeds a known threshold. We model the survival times for the uncured group using an accelerated failure time model with errors distributed according to the seminonparametric distribution, potentially truncated at a known threshold. We suggest a straightforward extension of the usual expectation-maximization algorithm approach for obtaining estimates in cure rate models to accommodate the cure threshold and dependent censoring. We additionally suggest a likelihood ratio test for testing for the presence of dependent censoring in the proposed cure rate model. We show through numerical studies that our model has desirable properties and leads to approximately unbiased parameter estimates in a variety of scenarios. To demonstrate how our method performs in practice, we analyze data from a bone marrow transplantation study and a liver transplant study. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Development and validation of a prediction model for insulin-associated hypoglycemia in non-critically ill hospitalized adults.

Science.gov (United States)

Mathioudakis, Nestoras Nicolas; Everett, Estelle; Routh, Shuvodra; Pronovost, Peter J; Yeh, Hsin-Chieh; Golden, Sherita Hill; Saria, Suchi

2018-01-01

To develop and validate a multivariable prediction model for insulin-associated hypoglycemia in non-critically ill hospitalized adults. We collected pharmacologic, demographic, laboratory, and diagnostic data from 128 657 inpatient days in which at least 1 unit of subcutaneous insulin was administered in the absence of intravenous insulin, total parenteral nutrition, or insulin pump use (index days). These data were used to develop multivariable prediction models for biochemical and clinically significant hypoglycemia (blood glucose (BG) of ≤70 mg/dL and model development and validation, respectively. Using predictors of age, weight, admitting service, insulin doses, mean BG, nadir BG, BG coefficient of variation (CV BG ), diet status, type 1 diabetes, type 2 diabetes, acute kidney injury, chronic kidney disease (CKD), liver disease, and digestive disease, our model achieved a c-statistic of 0.77 (95% CI 0.75 to 0.78), positive likelihood ratio (+LR) of 3.5 (95% CI 3.4 to 3.6) and negative likelihood ratio (-LR) of 0.32 (95% CI 0.30 to 0.35) for prediction of biochemical hypoglycemia. Using predictors of sex, weight, insulin doses, mean BG, nadir BG, CV BG , diet status, type 1 diabetes, type 2 diabetes, CKD stage, and steroid use, our model achieved a c-statistic of 0.80 (95% CI 0.78 to 0.82), +LR of 3.8 (95% CI 3.7 to 4.0) and -LR of 0.2 (95% CI 0.2 to 0.3) for prediction of clinically significant hypoglycemia. Hospitalized patients at risk of insulin-associated hypoglycemia can be identified using validated prediction models, which may support the development of real-time preventive interventions.

Relaxed Poisson cure rate models.

Science.gov (United States)

Rodrigues, Josemar; Cordeiro, Gauss M; Cancho, Vicente G; Balakrishnan, N

2016-03-01

The purpose of this article is to make the standard promotion cure rate model (Yakovlev and Tsodikov, ) more flexible by assuming that the number of lesions or altered cells after a treatment follows a fractional Poisson distribution (Laskin, ). It is proved that the well-known Mittag-Leffler relaxation function (Berberan-Santos, ) is a simple way to obtain a new cure rate model that is a compromise between the promotion and geometric cure rate models allowing for superdispersion. So, the relaxed cure rate model developed here can be considered as a natural and less restrictive extension of the popular Poisson cure rate model at the cost of an additional parameter, but a competitor to negative-binomial cure rate models (Rodrigues et al., ). Some mathematical properties of a proper relaxed Poisson density are explored. A simulation study and an illustration of the proposed cure rate model from the Bayesian point of view are finally presented. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Prevalence and possible mechanisms of reactive hypoglycemia in polycystic ovary syndrome

DEFF Research Database (Denmark)

Mumm, Hanne; Altinok, Magda Lambaa; Henriksen, Jan Erik

2016-01-01

STUDY QUESTION: What is the prevalence of reactive hypoglycemia (RH) in polycystic ovary syndrome (PCOS) versus age- and body mass index (BMI)-matched healthy controls. SUMMARY ANSWER: The prevalence of RH was increased in PCOS versus controls. WHAT IS KNOWN ALREADY: Previous studies suggested...

Hepatopathy in an adult, secondary to congenital untreated panhypopituitarism and ectopic posterior pituitary gland

Directory of Open Access Journals (Sweden)

Miguel A Valle-Murillo

2012-01-01

Full Text Available We report a rare case of an adult with advanced liver failure in the setting of an untreated congenital panhypopituitarism. A 32-years-old man presented with a newly onset seizure episode secondary to hypoglycemia. In the initial exploration, we found eunuchoid habitus, absence of secondary sexual characteristics, ascites, and hepatic encephalopathy. Hormonal evaluation confirmed the absence of anterior hypophyseal hormones and the liver function tests showed derangement of liver function. Magnetic Resonance Imaging (MRI showed hypoplastic adenohypophysis and ectopic posterior pituitary gland. In the approach to liver disease, no cause was identified, besides the untreated panhypopituitarism.

Hepatopathy in an adult, secondary to congenital untreated panhypopituitarism and ectopic posterior pituitary gland.

Science.gov (United States)

Valle-Murillo, Miguel A; Perez-Diaz, Ivan

2012-09-01

We report a rare case of an adult with advanced liver failure in the setting of an untreated congenital panhypopituitarism. A 32-years-old man presented with a newly onset seizure episode secondary to hypoglycemia. In the initial exploration, we found eunuchoid habitus, absence of secondary sexual characteristics, ascites, and hepatic encephalopathy. Hormonal evaluation confirmed the absence of anterior hypophyseal hormones and the liver function tests showed derangement of liver function. Magnetic Resonance Imaging (MRI) showed hypoplastic adenohypophysis and ectopic posterior pituitary gland. In the approach to liver disease, no cause was identified, besides the untreated panhypopituitarism.

Curing agent for polyepoxides and epoxy resins and composites cured therewith. [preventing carbon fiber release

Science.gov (United States)

Serafini, T. T.; Delvigs, P.; Vannucci, R. D. (Inventor)

1981-01-01

A curing for a polyepoxide is described which contains a divalent aryl radical such as phenylene a tetravalent aryl radical such as a tetravalent benzene radical. An epoxide is cured by admixture with the curing agent. The cured epoxy product retains the usual properties of cured epoxides and, in addition, has a higher char residue after burning, on the order of 45% by weight. The higher char residue is of value in preventing release to the atmosphere of carbon fibers from carbon fiber-epoxy resin composites in the event of burning of the composite.

Cholestasis and hypercalcemia secondary to panhypopituitarism in a newborn.

Science.gov (United States)

Dursun, Fatma; Gerenli, Nelgin; Kırmızıbekmez, Heves

2017-01-01

Dursun F, Gerenli N, Kırmızıbekmez H. Cholestasis and hypercalcemia secondary to panhypopituitarism in a newborn. Turk J Pediatr 2017; 59: 100-103. Cholestatic hepatitis and hypercalcemia are rare features of hypopituitarism in newborns. So diagnosis of hypopituitarism is frequently delayed. The most frequent symptoms of congenital hypopituitarism are hypoglycemia, prolonged jaundince and micropenis. A patient with congenital hypopituitarism associated with cholestasis and hypercalcemia is reported here. Newborns with hypercalcemia and cholestasis should alert pediatricians to the possibility of congenital hypopituitarism and prompt endocrinological investigation.

Malignant phyllodes tumor of the breast presenting with hypoglycemia: a case report and literature review

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Pacioles T

2014-12-01

Full Text Available Toni Pacioles,1 Rahul Seth,2,3 Cesar Orellana,3 Ivy John,4 Veera Panuganty,3 Ruban Dhaliwal3,5 1Department of Hematology and Oncology, Edwards Comprehensive Cancer Center, Marshall University, Huntington, WV, USA; 2Division of Hematology and Oncology, 3Department of Medicine, 4Department of Pathology, 5Division of Endocrinology, SUNY Upstate Medical University, Syracuse, NY, USA Abstract: Phyllodes tumors are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors and are typically found in middle-aged women. Phyllodes tumors that present with hypoglycemia are even rarer. No one morphologic finding is reliable in predicting the clinical behavior of this tumor. Surgery has been the primary mode of treatment to date. However, the extent of resection and the role of adjuvant radiotherapy or chemotherapy are still controversial. Here, we present a challenging case of malignant phyllodes tumor of the breast associated with hypoglycemia, and review the literature regarding clinical findings, pathologic risk factors for recurrence, and treatment recommendations. Keywords: breast cancer, fibroepithelial neoplasm, neuroendocrine tumor, adjuvant treatment, non-islet cell tumor-induced hypoglycemia

Kinetic studies of chemical shrinkage and residual stress formation in thermoset epoxy adhesives under confined curing conditions

Science.gov (United States)

Schumann, M.; Geiß, P. L.

2015-05-01

Faultless processing of thermoset polymers in demanding applications requires a profound mastering of the curing kinetics considering both the physico-chemical changes in the transition from the liquid to the solid state and the consolidation of the polymers network in the diffusion controlled curing regime past the gel point. Especially in adhesive joints shrinkage stress occurring at an early state of the curing process under confined conditions is likely to cause defects due to local debonding and thus reduce their strength and durability1. Rheometry is considered the method of choice to investigate the change of elastic and viscous properties in the progress of curing. Drawbacks however relate to experimental challenges in accessing the full range of kinetic parameters of thermoset resins with low initial viscosity from the very beginning of the curing reaction to the post-cure consolidation of the polymer due to the formation of secondary chemical bonds. Therefore the scope of this study was to interrelate rheological data with results from in-situ measurements of the shrinkage stress formation in adhesive joints and with the change of refractive index in the progress of curing. This combination of different methods has shown to be valuable in gaining advanced insight into the kinetics of the curing reaction. The experimental results are based on a multi component thermoset epoxy-amine adhesive.

Critical parameters for electron beam curing of cationic epoxies and property comparison of electron beam cured cationic epoxies versus thermal cured resins and composites

International Nuclear Information System (INIS)

Janke, C.J.; Norris, R.E.; Yarborough, K.; Lopata, V.J.

1997-01-01

Electron beam curing of composites is a nonthermal, nonautoclave curing process offering the following advantages compared to conventional thermal curing: substantially reduced manufacturing costs and curing times; improvements in part quality and performance; reduced environmental and health concerns; and improvements in material handling. In 1994 a Cooperative Research and Development Agreement (CRADA), sponsored by the Department of Energy Defense Programs and 10 industrial partners, was established to advance electron beam curing of composites. The CRADA has successfully developed hundreds of new toughened and untoughened resins, offering unlimited formulation and processing flexibility. Several patent applications have been filed for this work. Composites made from these easily processable, low shrinkage material match the performance of thermal cured composites and exhibit: low void contents comparable to autoclave cured composites (less than 1%); superb low water absorption values in the same range as cyanate esters (less than 1%); glass transition temperatures rivaling those of polyimides (greater than 390 C); mechanical properties comparable to high performance, autoclave cured composites; and excellent property retention after cryogenic and thermal cycling. These materials have been used to manufacture many composite parts using various fabrication processes including hand lay-up, tow placement, filament winding, resin transfer molding and vacuum assisted resin transfer molding

Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification

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Monique Aucoin

2016-01-01

Full Text Available Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of protein, fat, and fiber to her diet resulted in a substantial decrease in anxiety symptoms as well as a decrease in the frequency and severity of hypoglycemia symptoms. A brief return to her previous diet caused a return of her anxiety symptoms, followed by improvement when she restarted the prescribed diet. This case strengthens the hypothesis that dietary glycemic index may play a role in the pathogenesis or progression of mental illnesses such as generalized anxiety disorder and subsequently that dietary modification as a therapeutic intervention in the treatment of mental illness warrants further study.

Handling and Curing Characteristics of Cut-Strip Tobacco. Part 2: Effect of Yellowing Time and Drying Potential

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Johnson WH

2014-12-01

Full Text Available This paper presents Part 2 of a study on comparative handling and curing characteristics of cut-strip vs. whole leaf tobacco. Part 1 considered the effect of leaf size (cut-strip size vs. whole leaf, packing density and mode of leaf orientation on cured leaf chemistry and leaf quality; whereas, the present study considers further the effect of leaf form, two yellowing times and two drying potentials during yellowing. Results showed that leaf chemistry and quality were quite similar for cut-strip (15.2 × 22.9 cm and whole leaf. Insignificant differences were noted for cured leaf starch and sugars, although slightly lower levels of alkaloids (significant at the 0.01 level were observed for cut strip. Curing treatments significantly affected leaf chemistry. Increased yellowing time resulted in lower levels of starch and higher levels of sugar. Sugars were also higher for tobacco yellowed under the higher drying potential. The two forms of leaf responded similarly to different curing schedules (i.e. no interaction of leaf form with schedule. Also, government grade and price data were essentially unaffected by leaf form or curing schedule over the range of variables tested. Cured leaf starch was abnormally high on the average for both leaf forms. Interestingly, starch levels were lower when intact tobacco was bulk-cured in racks rather than box cured (6.35% vs. 9.02%. Since curing schedules were similar, air velocity in the two curing methods might be a factor. Also the cured leaf starch content was about 56% lower for tobacco produced at the Oxford Tobacco Research Station (in a secondary study than at the Central Crops Research Station. It is postulated that carbohydrate and nitrogen metabolism during growth and maturation might be affected by excess rainfall events and/or nitrogen availability, with subsequent effects on starch-to-sugar conversion during curing.

Curing kinetics of visible light curing dental resin composites investigated by dielectric analysis (DEA).

Science.gov (United States)

Steinhaus, Johannes; Hausnerova, Berenika; Haenel, Thomas; Großgarten, Mandy; Möginger, Bernhard

2014-03-01

During the curing process of light curing dental composites the mobility of molecules and molecule segments is reduced leading to a significant increase of the viscosity as well as the ion viscosity. Thus, the kinetics of the curing behavior of 6 different composites was derived from dielectric analysis (DEA) using especially redesigned flat sensors with interdigit comb electrodes allowing for irradiation at the top side and measuring the ion viscosity at the bottom side. As the ion viscosities of dental composites change 1-3 orders of magnitude during the curing process, DEA provides a sensitive approach to evaluate their curing behavior, especially in the phase of undisturbed chain growth. In order to determine quantitative kinetic parameters a kinetic model is presented and examined for the evaluation of the ion viscosity curves. From the obtained results it is seen that DEA might be employed in the investigation of the primary curing process, the quality assurance of ingredients as well as the control of processing stability of the light curing dental composites. Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Residual Stress Developed During the Cure of Thermosetting Polymers: Optimizing Cure Schedule to Minimize Stress.

Energy Technology Data Exchange (ETDEWEB)

Kropka, Jamie Michael; Stavig, Mark E.; Jaramillo, Rex

2016-06-01

When thermosetting polymers are used to bond or encapsulate electrical, mechanical or optical assemblies, residual stress, which often affects the performance and/or reliability of these devices, develops within the structure. The Thin-Disk-on-Cylinder structural response test is demonstrated as a powerful tool to design epoxy encapsulant cure schedules to reduce residual stress, even when all the details of the material evolution during cure are not explicitly known. The test's ability to (1) distinguish between cohesive and adhesive failure modes and (2) demonstrate methodologies to eliminate failure and reduce residual stress, make choices of cure schedules that optimize stress in the encapsulant unambiguous. For the 828/DEA/GMB material in the Thin-Disk-on-Cylinder geometry, the stress associated with cure is significant and outweighs that associated with cool down from the final cure temperature to room temperature (for measured lid strain, Scure I > I I e+h erma * II) * The difference between the final cure temperature and 1 1 -- the temperature at which the material gels, Tf-T ge i, was demonstrated to be a primary factor in determining the residual stress associated with cure. Increasing T f -T ge i leads to a reduction in cure stress that is described as being associated with balancing some of the 828/DEA/GMB cure shrinkage with thermal expansion. The ability to tune residual stress associated with cure by controlling T f -T ge i would be anticipated to translate to other thermosetting encapsulation materials, but the times and temperatures appropriate for a given material may vary widely.

Neonatal hypoglycemia: A wide range of electroclinical manifestations and seizure outcomes.

Science.gov (United States)

Arhan, Ebru; Öztürk, Zeynep; Serdaroğlu, Ayşe; Aydın, Kürşad; Hirfanoğlu, Tuğba; Akbaş, Yılmaz

2017-09-01

We examined the various types of epilepsy in children with neonatal hypoglycemia in order to define electroclinical and prognostic features of these patients. We retrospectively reviewed the medical records of patients with a history of symptomatic neonatal hypoglycaemia who have been followed at Gazi University Hospital Pediatric Neurology Department between 2006 and 2015. Patients with perinatal asphyxia were excluded. Details of each patient's perinatal history, neurological outcome, epilepsy details, seizure outcome and EEG and brain MRI findings were reviewed. Fourty five patients (range 6 mo-15 y) with a history of symptomatic neonatal hypoglycaemia were included the study. Epilepsy developed in 36 patients and 23 of them had intractable epilepsy. All patients had occipital brain injury. We observed that most of the patients, either manifesting focal or generalized seizures, further develop intractable epilepsy. This finding establishes neonatal hypoglycemia as a possible cause to be considered in any case of intractable epilepsy. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Effect of curing mode on the hardness of dual-cured composite resin core build-up materials

Directory of Open Access Journals (Sweden)

César Augusto Galvão Arrais

2010-06-01

Full Text Available This study evaluated the Knoop Hardness (KHN values of two dual-cured composite resin core build-up materials and one resin cement exposed to different curing conditions. Two dual-cured core build-up composite resins (LuxaCore®-Dual, DMG; and FluoroCore®2, Dentsply Caulk, and one dual-cured resin cement (Rely X ARC, 3M ESPE were used in the present study. The composite materials were placed into a cylindrical matrix (2 mm in height and 3 mm in diameter, and the specimens thus produced were either light-activated for 40 s (Optilux 501, Demetron Kerr or were allowed to self-cure for 10 min in the dark (n = 5. All specimens were then stored in humidity at 37°C for 24 h in the dark and were subjected to KHN analysis. The results were submitted to 2-way ANOVA and Tukey's post-hoc test at a pre-set alpha of 5%. All the light-activated groups exhibited higher KHN values than the self-cured ones (p = 0.00001, regardless of product. Among the self-cured groups, both composite resin core build-up materials showed higher KHN values than the dual-cured resin cement (p = 0.00001. LuxaCore®-Dual exhibited higher KHN values than FluoroCore®2 (p = 0.00001 when they were allowed to self-cure, while no significant differences in KHN values were observed among the light-activated products. The results suggest that dual-cured composite resin core build-up materials may be more reliable than dual-cured resin cements when curing light is not available.

Enhanced 911/global position system wizard: a telemedicine application for the prevention of severe hypoglycemia--monitor, alert, and locate.

Science.gov (United States)

Dassau, Eyal; Jovanovic, Lois; Doyle, Francis J; Zisser, Howard C

2009-11-01

Intensive insulin therapy has an inherent risk of hypoglycemia that can lead to loss of consciousness, cardiac arrhythmia, seizure, and death ("dead-in-bed syndrome"). This risk of hypoglycemia is a major concern for patients, families, and physicians. The need for an automated system that can alert in the event of severe hypoglycemia is evident. In engineering systems, where there is a risk of malfunction of the primary control system, alert and safety mechanisms are implemented in layers of protection. This concept has been adopted in the proposed system that integrates a hypoglycemia prediction algorithm with a global position system (GPS) locator and short message service such that the current glucose value with the rate of change (ROC) and the location of the subject can be communicated to a predefined list. Furthermore, if the system is linked to the insulin pump, it can suspend the pump or decrease the basal insulin infusion rate to prevent the pending event. The system was evaluated on clinical datasets of glucose tracings from the DexCom Seven system. Glucose tracings were analyzed for hypoglycemia events and then a text message was broadcast to a predefined list of people who were notified with the glucose value, ROC, GPS coordinates, and a Google map of the location. In addition to providing a safety layer to a future artificial pancreas, this system also can be easily implemented in current continuous glucose monitors to help provide information and alerts to people with diabetes.

Accelerated dry curing of hams.

Science.gov (United States)

Marriott, N G; Kelly, R F; Shaffer, C K; Graham, P P; Boling, J W

1985-01-01

Uncured pork legs from the right side of 18 carcasses were treated with a Ross Tenderizer and the left side were controls. All 36 samples were dry-cured for 40, 56 or 70 days and evaluated for appearance traits, cure penetration characteristics, microbial load, Kramer Shear force and taste attributes. The tenderization treatment had no effect (P > 0·05) on visual color or cure penetration rate, weight loss before curing, percentage moisture, nitrate level, nitrite level, total plate count, anaerobic counts, psychrotrophic counts, objective and subjective tenderness measurements or juiciness. However, the higher values of salt suggested a possible acceleration of the dry cure penetration process among the tenderized samples. Cure time had no effect (P > 0·05) on percentage moisture, percentage salt, nitrate content, nitrite content, shear force and juiciness. Results suggest a limited effect of the mechanical tenderization process on certain traits related to dry curing and that total process time should be at least 70 days if color stability during cooking is desired. Copyright © 1985. Published by Elsevier Ltd.

The lactate receptor HCAR1 promotes neuronal development and protects axons and myelin during hypoglycemia

DEFF Research Database (Denmark)

Kennedy, L. H.; Andersson, K. A.; Haugen, O. P.

2017-01-01

Lactate plays a significant role as an energy supply for neurons and has a neuroprotective effect in hypoglycemia and ischemia (1±5). Further, oligodendrocytes can use lactate for myelination when glucose levels are low. New studies suggest that lactate is not only a metabolic fuel but also...... in the development and survival of neurons and oligodendrocytes in normal conditions and hypoglycemia. We show that young HCAR1 KO mice have a reduced number of neural progenitor cells in the hippocampus and the cerebral cortex, and the average size of cortical axons is smaller in KO compared with WT mice...

Change of the structure and the digestibility of myofibrillar proteins in Nanjing dry-cured duck during processing.

Science.gov (United States)

Du, Xiaojing; Sun, Yangying; Pan, Daodong; Wang, Ying; Ou, Changrong; Cao, Jinxuan

2018-06-01

To investigate the change of bioavailability and structure of myofibrillar proteins during Nanjing dry-cured duck processing, carbonyl content, sulfhydryl (SH) group, disulfide (SS) group, sodium dodecyl sulfate polyacrylamide gel electrophoresis, surface hydrophobicity, secondary structures and in vitro digestibility were determined. During processing, carbonyl content and surface hydrophobicity increased; SH turned into SS group; α-helix turned into β-sheet and random coil fractions. Protein degradation occurred during dry-curing and drying-ripening stages. The in vitro digestibility of pepsin and pancreatic proteases increased during the salt curing stage and decreased during the drying-ripening stage. The increase of digestibility could be attributed to the mild oxidation, degradation and unfolding of proteins while the decrease of digestibility was related to the intensive oxidation and aggregation of proteins. Protein degradation was not a main factor of digestibility during the drying-ripening stage. Results demonstrated that the bioavailability loss of myofibrillar proteins in Nanjing dry-cured duck occurred during the stage of drying-ripening instead of curing. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Development situation of radiation curing materials

International Nuclear Information System (INIS)

He Songhua; Luo Junyi; Liu Zhen

2010-01-01

Due to fitting the '4E' principle, radiation curing technology, known as green technology, have shown its own superiority in many applications. It has been rapid developed in China and abroad in recent years, especially ultraviolet/electron beam (UV/EB) radiation curing technology. In order to let the researchers have a general understanding on the radiation curing materials and their development, in this paper a briefly introducing on the related radiation sources, chemical systems, curing mechanism, and the application, the common and difference of ultraviolet curing and electron beam curing has been made. A brief account of development of radiation-curable material in China and the outlook of the development of materials can be found in this paper. At last, we have proposed that the development of radiation curing technology will promote the development of the radiation curing material and benefit in the humanity. (authors)

Curing behavior and thermal properties of trifunctional epoxy resin cured by 4, 4’-diaminodiphenyl sulfone

Directory of Open Access Journals (Sweden)

2009-08-01

Full Text Available A novel trifunctional epoxy resin 4-(3, 3-dihydro-7-hydroxy-2, 4, 4-trimethyl-2H-1-benzopyran-2-yl-1, 3-benzenediol glycidyl (shorted as TMBPBTH-EPOXY was synthesized in our lab to improve thermal performance. Its curing behavior and performance were studied by using 4, 4′-diaminodiphenyl sulfone (DDS as hardener with the mass ratio of 100:41 of TMBPBTH-EPOXY and DDS. The curing activation energy was investigated by differential scanning calorimetry (DSC to be 64.0 kJ/mol estimated by Kissinger’s method and 68.7 kJ/mol estimated by Flynn-Wall-Ozawa method respectively. Thermogravimetric analyzer (TGA was used to investigate the thermal decomposition of cured compounds. It was found that when curing temperature was lower than 180°C, the thermal decomposition temperature increased with the rise of curing temperature and curing time. On the other hand, when the curing temperature was higher than 180°C, the thermal decomposition temperature went down instead with the increase of curing time that might be the over-crosslinking of TMBPBTH-EPOXY and DDS hardener. The glass transition temperature (Tg of cured TMBPBTH-EPOXY/DDS compound determined by dynamic mechanical thermal analysis (DMTA is 290.1°C.

Degree of conversion and surface hardness of resin cement cured with different curing units.

Science.gov (United States)

Ozturk, Nilgun; Usumez, Aslihan; Usumez, Serdar; Ozturk, Bora

2005-01-01

The aim of this study was to evaluate the degree of conversion and Vickers surface hardness of resin cement under a simulated ceramic restoration with 3 different curing units: a conventional halogen unit, a high-intensity halogen unit, and a light-emitting diode system. A conventional halogen curing unit (Hilux 550) (40 s), a high-intensity halogen curing unit used in conventional and ramp mode (Optilux 501) (10 s and 20 s, respectively), and a light-emitting diode system (Elipar FreeLight) (20 s, 40 s) were used in this study. The dual-curing resin cement (Variolink II) was cured under a simulated ceramic restoration (diameter 5 mm, height 2 mm), and the degree of conversion and Vickers surface hardness were measured. For degree of conversion measurement, 10 specimens were prepared for each group. The absorbance peaks were recorded using the diffuse-reflection mode of Fourier transformation infrared spectroscopy. For Vickers surface hardness measurement, 10 specimens were prepared for each group. A load of 200 N was applied for 15 seconds, and 3 evaluations of each of the samples were performed. Degree of conversion achieved with Optilux 501 (20 s) was significantly higher than those of Hilux, Optilux 501 (10 s), Elipar FreeLight (20 s), and Elipar FreeLight (40 s). For Vickers surface hardness measurement, Optilux 501 (20 s) produced the highest surface hardness value. No significant differences were found among the Hilux, Optilux 501 (10 s), Elipar FreeLight (20 s), and Elipar FreeLight (40 s). The high-intensity halogen curing unit used in ramp mode (20 s) produced harder resin cement surfaces than did the conventional halogen curing unit, high-intensity halogen curing unit used in conventional mode (10 s) and light-emitting diode system (20 s, 40 s), when cured through a simulated ceramic restoration.

A Comparative Study of Blood Glucose Measurements Using Glucometer Readings and the Standard Method in the Diagnosis of Neonatal Hypoglycemia

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Mohammad Torkaman

2016-03-01

Full Text Available Background: Hypoglycemia is one of the most common neonatal disorders, associated with severe complications. There has been a great deal of controversy regarding the definition and screening of hypoglycemia. Therefore, in this study, we aimed to determine a cut-off value for blood glucose level in glucometer readings. Methods: This cross-sectional study was conducted on 238 newborns at risk of hypoglycemia, admitted to Baqiyatallah Hospital of Tehran, Iran in 2012; the subjects were selected via simple sampling. After obtaining informed consents from the newborns’ parents, 1 cc blood samples were sent to the laboratory for measuring the blood glucose level. Moreover, venous blood samples, as well as heel-stick blood samples, were obtained for glucometer measurements. Blood glucose measurements were used to determine the cut-off value by the receiver operating characteristic (ROC curve and make comparisons with the diagnostic criteria for hypoglycemia in the literature. Results: A total of 238 infants with the mean weight of 2869±821.9 g were enrolled in this study. The mean (±SD blood glucose levels were 65.1±22.9, 82.9±24.7, and 84.4±24.8 mg/dl, based on the standard laboratory method, glucometer reading of venous blood samples, and glucometer reading of heel-stick capillary blood samples, respectively. The optimal cut-off point for hypoglycemia was determined as 65 mg/dl, using glucometer-based assessment of heel-stick blood samples. Conclusion: The significant difference in blood glucose levels measured by the laboratory method and outpatient glucometer readings highlights the importance of a cut-off value for rapid assessment and control of blood glucose and timely detection of hypoglycemia. In fact, the cut-off value introduced in the present study could facilitate such measurements.

Inborn Errors of Metabolism with Hypoglycemia Glycogen Storage Diseases and Inherited Disorders of Gluconeogenesis : Glycogen Storage Diseases and Inherited Disorders of Gluconeogenesis

NARCIS (Netherlands)

Weinstein, David A.; Steuerwald, Ulrike; De Souza, Carolina F. M.; Derks, Terry G. J.

Although hyperinsulinism is the predominant inherited cause of hypoglycemia in the newborn period, inborn errors of metabolism are the primary etiologies after 1 month of age. Disorders of carbohydrate metabolism often present with hypoglycemia when fasting occurs. The presentation, diagnosis, and

Excimer UV curing in printing

International Nuclear Information System (INIS)

Mehnert, R.

1999-01-01

It is the aim of this study to investigate the potential of 308 run excimer UV curing in web and sheet fed offset printing and to discuss its present status. Using real-time FTIR-ATR and stationary or pulsed monochromatic (313 nm) irradiation chemical and physical factors affecting the curing speed of printing inks such as nature and concentration of photo-initiators, reactivity of the ink binding system, ink thickness and pigmentation, irradiance in the curing plane, oxygen concentration and nitrogen inerting, multiple pulse exposure, the photochemical dark reaction and temperature dependence were studied. The results were used to select optimum conditions for excimer UV curing in respect to ink reactivity, nitrogen inerting and UV exposure and to build an excimer UV curing unit consisting of two 50 W/cm 308 run excimer lamps, power supply, cooling and inerting unit. The excimer UV curing devices were tested under realistic conditions on a web offset press zirkon supra forte and a sheet fed press Heidelberg GTO 52. Maximum curing speeds of 300 m/min in web offset and 8000 sheets per hour in sheet fed offset were obtained

Electron curing of surface coatings

International Nuclear Information System (INIS)

Nablo, S.V.

1974-01-01

The technical development of electron curing of surface coatings has received great impetus since 1970 from dramatic changes in the economics of the conventional thermal process. The most important of these changes are reviewed, including: the Clear Air Act, increasing cost and restrictive allocation of energy, decreased availability and increased costs of solvents, competitive pressure for higher line productivity. The principles of free-radical initiated curing as they pertain to industrial coatings are reviewed. Although such electron initiated processes have been under active development for at least two decades, high volume production applications on an industrial scale have only recently appeared. These installations are surveyed with emphasis on the developments in machinery and coatings which have made this possible. The most significant economic advantages of electron curing are presented. In particular, the ability of electron curing to eliminate substrate damage and to eliminate the curing station (oven) as the pacing element for most industrial surface coating curing applications is discussed. Examples of several new processes of particular interest in the textile industry are reviewed, including the curing of transfer cast urethane films, flock adhesives, and graftable surface finishes

Composite cements benefit from light-curing.

Science.gov (United States)

Lührs, Anne-Katrin; De Munck, Jan; Geurtsen, Werner; Van Meerbeek, Bart

2014-03-01

To investigate the effect of curing of composite cements and a new ceramic silanization pre-treatment on the micro-tensile bond strength (μTBS). Feldspathic ceramic blocks were luted onto dentin using either Optibond XTR/Nexus 3 (XTR/NX3; Kerr), the silane-incorporated 'universal' adhesive Scotchbond Universal/RelyX Ultimate (SBU/RXU; 3M ESPE), or ED Primer II/Panavia F2.0 (ED/PAF; Kuraray Noritake). Besides 'composite cement', experimental variables were 'curing mode' ('AA': complete auto-cure at 21°C; 'AA*': complete auto-cure at 37°C; 'LA': light-curing of adhesive and auto-cure of cement; 'LL': complete light-curing) and 'ceramic surface pre-treatment' ('HF/S/HB': hydrofluoric acid ('HF': IPS Ceramic Etching Gel, Ivoclar-Vivadent), silanization ('S': Monobond Plus, Ivoclar-Vivadent) and application of an adhesive resin ('HB': Heliobond, Ivoclar-Vivadent); 'HF/SBU': 'HF' and application of the 'universal' adhesive Scotchbond Universal ('SBU'; 3M ESPE, only for SBU/RXU)). After water storage (7 days at 37°C), ceramic-dentin sticks were subjected to μTBS testing. Regarding the 'composite cement', the significantly lowest μTBSs were measured for ED/PAF. Regarding 'curing mode', the significantly highest μTBS was recorded when at least the adhesive was light-cured ('LA' and 'LL'). Complete auto-cure ('AA') revealed the significantly lowest μTBS. The higher auto-curing temperature ('AA*') increased the μTBS only for ED/PAF. Regarding 'ceramic surface pre-treatment', only for 'LA' the μTBS was significantly higher for 'HF/S/HB' than for 'HF/SBU'. Complete auto-cure led to inferior μTBS than when either the adhesive (on dentin) or both adhesive and composite cement were light-cured. The use of a silane-incorporated adhesive did not decrease luting effectiveness when also the composite cement was light-cured. Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Curing efficiency of three light emitting diode units at different curing profiles

Directory of Open Access Journals (Sweden)

Priyanka Verma

2016-01-01

Conclusions: Reduction of exposure time to 6 s with high-intensity curing light seemed to be clinically acceptable and should be recommended. Curing of metal brackets with single exposure from buccal side showed lower shear bond strength values.

Hypoglycemia in noncritically ill patients receiving total parenteral nutrition: a multicenter study. (Study group on the problem of hyperglycemia in parenteral nutrition; Nutrition area of the Spanish Society of Endocrinology and Nutrition).

Science.gov (United States)

Olveira, Gabriel; Tapia, María José; Ocón, Julia; Cabrejas-Gómez, Carmen; Ballesteros-Pomar, María D; Vidal-Casariego, Alfonso; Arraiza-Irigoyen, Carmen; Olivares, Josefina; Conde-García, Maria Carmen; García-Manzanares, Álvaro; Botella-Romero, Francisco; Quílez-Toboso, Rosa P; Matía, Pilar; Rubio, Miguel Ángel; Chicharro, Luisa; Burgos, Rosa; Pujante, Pedro; Ferrer, Mercedes; Zugasti, Ana; Petrina, Estrella; Manjón, Laura; Diéguez, Marta; Carrera, Ma José; Vila-Bundo, Anna; Urgelés, Juan Ramón; Aragón-Valera, Carmen; Sánchez-Vilar, Olga; Bretón, Irene; García-Peris, Pilar; Muñoz-Garach, Araceli; Márquez, Efren; Del Olmo, Dolores; Pereira, José Luis; Tous, María C

2015-01-01

Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose parenteral nutrition (TPN). This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage. The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose <70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia. The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia. Copyright © 2015 Elsevier Inc. All rights reserved.

Severe Hypoglycemia due to Isolated ACTH Deficiency in Children: A New Case Report and Review of the Literature

OpenAIRE

Torchinsky, Michael Y.; Wineman, Robert; Moll, George W.

2011-01-01

Isolated ACTH deficiency causes life-threatening severe hypoglycemia. A 7-year-old girl with hypoglycemia due to this rare disorder is described. Our patient had undetectable plasma ACTH repeatedly and cortisol 0 mcg/dl before and after ACTH 1-24 stimulation. There was no evidence of other pituitary hormone deficiency. Glucocorticoid replacement therapy resulted in resolution of all symptoms and normalization of blood glucose. Previously published data on isolated ACTH deficiency in children ...

Self-monitoring of blood glucose is associated with problem-solving skills in hyperglycemia and hypoglycemia.

Science.gov (United States)

Wang, Jing; Zgibor, Janice; Matthews, Judith T; Charron-Prochownik, Denise; Sereika, Susan M; Siminerio, Linda

2012-01-01

The purpose of this study was to examine the association between self-monitoring of blood glucose (SMBG) and problem-solving skills in response to detected hyperglycemia and hypoglycemia among patients with type 2 diabetes. Data were obtained from the American Association of Diabetes Educators Outcome System, implemented in 8 diabetes self-management education programs in western Pennsylvania. SMBG was measured by asking patients how often they checked, missed checking, or checked blood glucose later than planned. Problem-solving skill was measured by asking how often they modified their behaviors after detecting high or low blood glucose. Most patients checked their blood glucose at least once per day. However, when blood glucose was high or low, many of them reported doing nothing, and only some of them resolved the problem. There were significant associations between self-monitoring of blood glucose and problem-solving skills for hyperglycemia and hypoglycemia, after controlling for age, gender, ethnicity, education, and time since diagnosis. Patients reported poor problem-solving skills when detecting hyperglycemia and hypoglycemia via SMBG. Patients need to learn problem-solving skills along with SMBG training to achieve glycemic control.

Recurrent Hypoglycemia in a Patient with Hodgkin’s Lymphoma: A Case Report with Review of Literature

Directory of Open Access Journals (Sweden)

Rawal Gautam

2016-09-01

Full Text Available A rare complication associated with the Hodgkin’s lymphoma is the occurrence of persistent or recurrent hypoglycemia. Although few cases have been reported in the literature, describing its pathophysiology to be multifactorial, it is difficult to determine the exact cause. We present the case of a 26 year old patient diagnosed with Hodgkin’s lymphoma who developed recurrent episodes of hypoglycemia and also discuss the various causes for its pathogenesis. In this case the serum insulin and C-peptide levels were found to be low, suggesting the presence of insulin like growth factors (IGF secreted by the cancer cells. Also, we performed a18F-2-fluoro-2-deoxy-d-glucose positron emission tomography that showed a massive tumor load. The published reports in literature have similary suggested the presence of IGF or auto-antibodies secreted by the tumor cells and also the Warburg effect in patients with high tumor load. Further research is required to clearly diagnose and define the exact etiopathogenesis of the hypoglycemia occurring in a patient with Hodgkin’s lymphoma.

Effect of oral amino acids on counterregulatory responses and cognitive function during insulin-induced hypoglycemia in nondiabetic and type 1 diabetic people.

Science.gov (United States)

Rossetti, Paolo; Porcellati, Francesca; Busciantella Ricci, Natalia; Candeloro, Paola; Cioli, Patrizia; Nair, K Sreekumaran; Santeusanio, Fausto; Bolli, Geremia B; Fanelli, Carmine G

2008-07-01

Amino acids stimulate glucagon responses to hypoglycemia and may be utilized by the brain. The aim of this study was to assess the responses to hypoglycemia in nondiabetic and type 1 diabetic subjects after ingestion of an amino acid mixture. Ten nondiabetic and 10 diabetic type 1 subjects were studied on three different occasions during intravenous insulin (2 mU . kg(-1) . min(-1)) plus variable glucose for 160 min. In two studies, clamped hypoglycemia (47 mg/dl plasma glucose for 40 min) was induced and either oral placebo or an amino acid mixture (42 g) was given at 30 min. In the third study, amino acids were given, but euglycemia was maintained. Plasma glucose and insulin were no different in the hypoglycemia studies with both placebo and amino acids (P > 0.2). After the amino acid mixture, plasma amino acid concentrations increased to levels observed after a mixed meal (2.4 +/- 0.13 vs. placebo study 1.7 +/- 0.1 mmol/l, P = 0.02). During clamped euglycemia, ingestion of amino acids resulted in transient increases in glucagon concentrations, which returned to basal by the end of the study. During clamped hypoglycemia, glucagon response was sustained and increased more in amino acid studies versus placebo in nondiabetic and diabetic subjects (P colored words, and verbal memory tests for nondiabetic subjects; and Trail-Making part B, digit span backward, and Stroop color tests for diabetic subjects. Oral amino acids improve cognitive function in response to hypoglycemia and enhance the response of glucagon in nondiabetic and diabetic subjects.

Post-cure depth of cure of bulk fill dental resin-composites.

Science.gov (United States)

Alrahlah, A; Silikas, N; Watts, D C

2014-02-01

To determine the post-cure depth of cure of bulk fill resin composites through using Vickers hardness profiles (VHN). Five bulk fill composite materials were examined: Tetric EvoCeram(®) Bulk Fill, X-tra base, Venus(®) Bulk Fill, Filtek™ Bulk Fill, SonicFill™. Three specimens of each material type were prepared in stainless steel molds which contained a slot of dimensions (15 mm × 4 mm × 2 mm), and a top plate. The molds were irradiated from one end. All specimens were stored at 37°C for 24h, before measurement. The Vickers hardness was measured as a function of depth of material, at 0.3mm intervals. Data were analysed by one-way ANOVA using Tukey post hoc tests (α=0.05). The maximum VHN ranged from 37.8 to 77.4, whilst the VHN at 80% of max.VHN ranged from 30.4 to 61.9. The depth corresponding to 80% of max.VHN, ranged from 4.14 to 5.03 mm. One-way ANOVA showed statistically significant differences between materials for all parameters tested. SonicFill exhibited the highest VHN (pFill the lowest (p≤0.001). SonicFill and Tetric EvoCeram Bulk Fill had the greatest depth of cure (5.03 and 4.47 mm, respectively) and was significant's different from X-tra base, Venus Bulk Fill and Filtek Bulk Fill (p≤0.016). Linear regression confirmed a positive regression between max.VHN and filler loading (r(2)=0.94). Bulk fill resin composites can be cured to an acceptable post-cure depth, according to the manufacturers' claims. SonicFill and Tetric EvoCeram Bulk Fill had the greatest depth of cure among the composites examined. Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Cure Schedule for Stycast 2651/Catalyst 11.

Energy Technology Data Exchange (ETDEWEB)

Kropka, Jamie Michael [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); McCoy, John D. [New Mexico Inst. of Mining and Technology, Socorro, NM (United States)

2017-11-01

The Henkel technical data sheet (TDS) for Stycast 2651/Catalyst 11 lists three alternate cure schedules for the material, each of which would result in a different state of reaction and different material properties. Here, a cure schedule that attains full reaction of the material is defined. The use of this cure schedule will eliminate variance in material properties due to changes in the cure state of the material, and the cure schedule will serve as the method to make material prior to characterizing properties. The following recommendation was motivated by (1) a desire to cure at a single temperature for ease of manufacture and (2) a desire to keep the cure temperature low (to minimize residual stress build-up associated with the cooldown from the cure temperature to room temperature) without excessively limiting the cure reaction due to vitrification (i.e., material glass transition temperature, T_g, exceeding cure temperature).

Properties of radiation cured coatings

International Nuclear Information System (INIS)

Larson, E.G.; Spencer, D.S.; Boettcher, T.E.; Melbauer, M.A.; Skarjune, R.P.

1987-01-01

Coatings were prepared from acrylate or methacrylate functionalized resins to study the effect of end group functionality on the physical properties of u.v. and electron beam cured coatings. Cure response was measured by solid state NMR and gel extraction, as expected, methacrylate resins cured much slower. Thermal Gravimetric Analysis (TGA) revealed acrylate coatings have greater thermal stability. Properties such as tensile strength and hardness showed little effect of end group functionality or curing method. The O 2 and H 2 O permeabilities of the coating were correlated with the processing conditions. (author)

The situation of radiation curing

International Nuclear Information System (INIS)

Chen Weixiu

1988-01-01

Radiation curing is a branch of radiation processing. It has developed significantly and its annual growth rate exceeds 10% in the nineteen eighties. Several products were manufactured by radiation curing, such as magnetic media, release coating, floor tile, printing flates, optical fiber, electronics, lithography and pressure sensitive adhesives etc. The chemistry of radiation curing is often considered ahead. The safe handling of UV/EB curable material, the regulation of industial and the patent protection for development in radiation curing were introduced. The equipment and processes of this field have got progress recently

ASPIRE In-Home: rationale, design, and methods of a study to evaluate the safety and efficacy of automatic insulin suspension for nocturnal hypoglycemia.

Science.gov (United States)

Klonoff, David C; Bergenstal, Richard M; Garg, Satish K; Bode, Bruce W; Meredith, Melissa; Slover, Robert H; Ahmann, Andrew; Welsh, John B; Lee, Scott W

2013-07-01

Nocturnal hypoglycemia is a barrier to therapy intensification efforts in diabetes. The Paradigm® Veo™ system may mitigate nocturnal hypoglycemia by automatically suspending insulin when a prespecified sensor glucose threshold is reached. ASPIRE (Automation to Simulate Pancreatic Insulin REsponse) In-Home (NCT01497938) was a multicenter, randomized, parallel, adaptive study of subjects with type 1 diabetes. The control arm used sensor-augmented pump therapy. The treatment arm used sensor-augmented pump therapy with threshold suspend, which automatically suspends the insulin pump in response to a sensor glucose value at or below a prespecified threshold. To be randomized, subjects had to have demonstrated ≥2 episodes of nocturnal hypoglycemia, defined as >20 consecutive minutes of sensor glucose values ≤65 mg/dl starting between 10:00 PM and 8:00 AM in the 2-week run-in phase. The 3-month study phase evaluated safety by comparing changes in glycated hemoglobin (A1C) values and evaluated efficacy by comparing the mean area under the glucose concentration time curves for nocturnal hypoglycemia events in the two groups. Other outcomes included the rate of nocturnal hypoglycemia events and the distribution of sensor glucose values. Data from the ASPIRE In-Home study should provide evidence on the safety of the threshold suspend feature with respect to A1C and its efficacy with respect to severity and duration of nocturnal hypoglycemia when used at home over a 3-month period. © 2013 Diabetes Technology Society.

Electron beam curing of coatings

International Nuclear Information System (INIS)

Schmidt, J.; Mai, H.

1986-01-01

Modern low-energy electron beam processors offer the possibility for high-speed curing of coatings on paper, plastics, wood and metal. Today the electron beam curing gets more importance due to the increasing environmental problems and the rising cost of energy. For an effective curing process low-energy electron beam processors as well as very reactive binders are necessary. Generally such binders consist of acrylic-modified unsaturated polyester resins, polyacrylates, urethane acrylates or epoxy acrylates and vinyl monomers, mostly multifunctional acrylates. First results on the production of EBC binders on the base of polyester resins and vinyl monomers are presented. The aim of our investigations is to obtain binders with curing doses ≤ 50 kGy. In order to reduce the curing dose we studied mixtures of resins and acrylates. (author)

Impact of genetic polymorphism in the β₂-receptor gene on risk of severe hypoglycemia in patients with type 1 diabetes

DEFF Research Database (Denmark)

Rokamp, Kim Zillo; Olsen, Niels Vidiendal; Færch, Louise

2018-01-01

characterized by diabetes history, state of hypoglycemia awareness (Clarke, Gold, and Hillerød methods), C-peptide status, hemoglobin A1c (HbA1c), and ADRB2 genotype. Results: The ADRB2 Gly16Arg genotype distribution was in Hardy-Weinberg equilibrium. There was a difference in rate of severe hypoglycemia...

Thermal Aging Behaviors of Rubber Vulcanizates Cured with Single and Binary Cure Systems

Energy Technology Data Exchange (ETDEWEB)

Choi, Sung Seen; Ha, Sung Ho [Sejong University, Seoul (Korea, Republic of); Woo, Chang Su [Korea Institute of Machinery and Materials, Daejeon (Korea, Republic of)

2006-03-15

In general, an accelerated sulfur cure system consists of elemental sulfur, one or two cure accelerators, and cure activators. Crosslink density of a rubber vulcanizate determines the physical properties. By increasing the crosslink density, the modulus, hardness, resilience, and abrasion resistance increase, whereas the elongation at break, heat build-up, and stress relaxation decrease. Sulfur linkages are composed of monosulfide, disulfide, and polysulfides. Sulfur linkages, especially polysulfides, are dissociated by heating and this brings about decrease of the crosslink density.

Noninsulinoma pancreatogenous hypoglycemia syndrome in a Saudi male

International Nuclear Information System (INIS)

Karawagh, Abullah M.; Gasim, Abdelhamid M.; Abdelaziz, Muntasir M.; Abdullah, Layla S.

2008-01-01

Nesidioblastosis is focal or diffuse islet hyperplasia leading tohyperinsulinism with subsequent hypoglycemia in the absence of insulinoma,usually described in neonates and infancy. We described the first adult caseof nesidioblastosis in Saudi Arabia and the Gulf region. The diagnosis andtreatment of the condition can be very difficult and challenging. Despite thefact that our patient responded initially to surgical treatment, hishypoglycemic symptoms occasionally recurred and needed adjunctive medicaltreatment. Although initially thought to affect only infants and children,cases of nesidioblastosis can effect adults and pose a diagnostic andtherapeutic challenge to the clinicians. (author)

MRI findings of brain damage due to neonatal hypoglycemia

International Nuclear Information System (INIS)

Wang Lu; Fan Guoguang; Ji Xu; Sun Baohai; Guo Qiyong

2009-01-01

Objective: To report the MRI findings of brain damage observed in neonatal patients who suffered from isolated hypoglycemia and to explore the value of diffusion-weighted imaging(DWI) in early detection of neonatal hypoglycemic brain injury. Methods: Twelve neonates with isolated hypoglycemia (10 of the 12 were diagnosed to suffer from hypoglycemic encephalopathy) were enrolled in this study. They were first scanned at age from 3 days to 10 days with T 1 WI, T 2 WI and DWI(b is 0 s/mm 2 , 1000 s/mm 2 ), and 4 of them were then scanned from 7 days to 10 days following the initial scan. All acquired MR images were retrospectively analysed. Results: First series of DWI images showed distinct hyperintense signal in 11 cases in several areas including bilateral occipital cortex (2 cases), right occipital cortex (1 case), left occipital cortex and subcortical white matter(1 case), bilateral occipital cortex and subcortical white matter (2 cases), bilateral parieto-occipital cortex (2 cases), bilateral parieto-occipital cortex and subcortical white matter(2 cases), the splenium of corpus callosum (4 cases), bilateral corona radiata( 2 cases), left caudate nucleus and globus pallidus (1 case), bilateral thalamus (1 case), bilaterally posterior limb of internal capsule (1 case). In the initial T 1 WI and T 2 WI images, there were subtle hypointensity in the damaged cortical areas (3 cases), hyperintensity in the bilaterally affected occipital cortex( 1 case) on T 1 weighted images, and hyperintensity in the affected cortex and subcortical white matter with poor differentiation on T 2 weighted images. The followed-up MRI of 4 cases showed regional encephalomalacia in the affected occipital lobes(4 cases), slightly hyperintensity on T 2 weighted images in the damaged occipital cortex (2 cases), extensive demyelination (1 case), disappearance of hyperintensity of the splenium of corpus callosum (1 case), and persistent hyperintensity in the splenium of corpus callosum (1 case

Hypoglycemia, S-ACE and ACE genotypes in a Danish nationwide population of children and adolescents with type 1 diabetes

DEFF Research Database (Denmark)

Johannesen, Jesper; Svensson, Jannet; Bergholdt, Regine

2011-01-01

High S-ACE levels have been shown to predispose to increased risk of hypoglycemia, however; some inconsistency relates to the risk of the ACE genotype. We investigated the association between S-ACE level at diagnosis and ACE genotype to long-term risk of severe hypoglycemia in more than 1000 chil...... children and adolescents with type 1 diabetes being part of the Danish Registry of Childhood diabetes over a 10-yr period....

Strength of Geopolymer Cement Curing at Ambient Temperature by Non-Oven Curing Approaches: An Overview

Science.gov (United States)

Wattanachai, Pitiwat; Suwan, Teewara

2017-06-01

At the present day, a concept of environmentally friendly construction materials has been intensively studying to reduce the amount of releasing greenhouse gases. Geopolymer is one of the cementitious binders which can be produced by utilising pozzolanic wastes (e.g. fly ash or furnace slag) and also receiving much more attention as a low-CO2 emission material. However, to achieve excellent mechanical properties, heat curing process is needed to apply to geopolymer cement in a range of temperature around 40 to 90°C. To consume less oven-curing energy and be more convenience in practical work, the study on geopolymer curing at ambient temperature (around 20 to 25°C) is therefore widely investigated. In this paper, a core review of factors and approaches for non-oven curing geopolymer has been summarised. The performance, in term of strength, of each non-oven curing method, is also presented and analysed. The main aim of this review paper is to gather the latest study of ambient temperature curing geopolymer and to enlarge a feasibility of non-oven curing geopolymer development. Also, to extend the directions of research work, some approaches or techniques can be combined or applied to the specific properties for in-field applications and embankment stabilization by using soil-cement column.

Accuracy evaluation of a new real-time continuous glucose monitoring algorithm in hypoglycemia

DEFF Research Database (Denmark)

Mahmoudi, Zeinab; Jensen, Morten Hasselstrøm; Johansen, Mette Dencker

2014-01-01

UNLABELLED: Abstract Background: The purpose of this study was to evaluate the performance of a new continuous glucose monitoring (CGM) calibration algorithm and to compare it with the Guardian(®) REAL-Time (RT) (Medtronic Diabetes, Northridge, CA) calibration algorithm in hypoglycemia. SUBJECTS...... AND METHODS: CGM data were obtained from 10 type 1 diabetes patients undergoing insulin-induced hypoglycemia. Data were obtained in two separate sessions using the Guardian RT CGM device. Data from the same CGM sensor were calibrated by two different algorithms: the Guardian RT algorithm and a new calibration...... algorithm. The accuracy of the two algorithms was compared using four performance metrics. RESULTS: The median (mean) of absolute relative deviation in the whole range of plasma glucose was 20.2% (32.1%) for the Guardian RT calibration and 17.4% (25.9%) for the new calibration algorithm. The mean (SD...

A comparative evaluation of effect of modern-curing lights and curing modes on conventional and novel-resin monomers

Science.gov (United States)

Roy, Konda Karthik; Kumar, Kanumuru Pavan; John, Gijo; Sooraparaju, Sujatha Gopal; Nujella, Surya Kumari; Sowmya, Kyatham

2018-01-01

Aim: The aim of this study is to compare and to evaluate effect of curing light and curing modes on the nanohybrid composite resins with conventional Bis-GMA and novel tricyclodecane (TCD) monomers. Methodology: Two nanohybrid composites, IPS empress direct and charisma diamond were used in this study. Light-emitting diode (LED)-curing unit and quartz-tungsten-halogen (QTH)-curing unit which were operated into two different modes: continuous and soft start. Based on the composite resin, curing lights, and mode of curing used, the samples were divided into 8 groups. After polymerization, the samples were stored for 48 h in complete darkness at 37°C and 100% humidity. The Vickers hardness (VK) of the surface was determined with Vickers indenter by the application of 200 g for 15 s. Three VK readings were recorded for each sample surface both on top and bottom surfaces. For all the specimens, the three hardness values for each surface were averaged and reported as a single value. The mean VK and hardness ratio were calculated. The depth of cure was assessed based on the hardness ratio. Results: Comparison of mean hardness values and hardness ratios was done using ANOVA with post hoc Tukey's test. Conclusion: Both QTH- and LED-curing units had shown the adequate depth of cure. Soft-start-curing mode in both QTH- and LED-curing lights had effectively increased microhardness than the continuous mode of curing. TCD monomer had shown higher hardness values compared with conventional Bis-GMA-containing resin. PMID:29628651

Brain glucose transport and phosphorylation under acute insulin-induced hypoglycemia in mice: an 18F-FDG PET study.

Science.gov (United States)

Alf, Malte F; Duarte, João M N; Schibli, Roger; Gruetter, Rolf; Krämer, Stefanie D

2013-12-01

We addressed the questions of how cerebral glucose transport and phosphorylation change under acute hypoglycemia and what the underlying mechanisms of adaptation are. Quantitative (18)F-FDG PET combined with the acquisition of real-time arterial input function was performed on mice. Hypoglycemia was induced and maintained by insulin infusion. PET data were analyzed with the 2-tissue-compartment model for (18)F-FDG, and the results were evaluated with Michaelis-Menten saturation kinetics. Glucose clearance from plasma to brain (K1,glc) and the phosphorylation rate constant increased with decreasing plasma glucose (Gp), in particular at a Gp of less than 2.5 mmol/L. Estimated cerebral glucose extraction ratios taking into account an increased cerebral blood flow (CBF) at a Gp of less than 2 mmol/L were between 0.14 and 0.79. CBF-normalized K1,glc values were in agreement with saturation kinetics. Phosphorylation rate constants indicated intracellular glucose depletion at a Gp of less than 2-3 mmol/L. When brain regions were compared, glucose transport under hypoglycemia was lowest in the hypothalamus. Alterations in glucose transport and phosphorylation, as well as intracellular glucose depletion, under acute hypoglycemia can be modeled by saturation kinetics taking into account an increase in CBF. Distinct transport kinetics in the hypothalamus may be involved in its glucose-sensing function.

Presentations for hypoglycemia associated with diabetes mellitus to emergency departments in a Canadian province: A database and epidemiological analysis.

Science.gov (United States)

Alexiu, Chris J; Chuck, Anderson; Jelinski, Susan E; Rowe, Brian H

2017-08-01

The prevalence of diabetes mellitus was reportedly 9% in 2014, making it one of the most common global chronic conditions. Hypoglycemia is an important complication of diabetes treatment. The objective of this study was to quantify and characterize hypoglycemia presentations associated with type 1 or 2 diabetes made to emergency departments (EDs) by adults in a Canadian province. A retrospective cohort study was conducted using reliable administrative data from Alberta for a five-year period (2010/11-2014/15). Records of interest were those with an ICD-10-CA diagnosis of diabetes-associated hypoglycemia (e.g., E10.63). A descriptive analysis was conducted. Data extraction yielded 7835 presentations by 5884 patients. The majority (56.2%) of presentations were made by males, median patient age was 62, and 60.5% had type 2 diabetes. These episodes constituted 0.08% of presentations to Alberta EDs. The annual rate of presentations decreased by 11.8% during the five-year period. Most presentations (63.4%) involved transportation to ED via ambulance. Median length-of-stay was four hours. For 27.5% of presentations, an X-ray was obtained. Most hypoglycemic episodes (65.2%) were considered to be moderate, while 34.3% were considered to be severe. Diabetes-associated hypoglycemia presentations to Alberta EDs are more commonly made by patients with type 2 diabetes, who are more likely to be transported via ambulance and also admitted. Each year, approximately one percent of Albertans with diabetes presented with a hypoglycemia episode; however, knowledge of the variation across regions can guide a strategy for improved care. Copyright © 2017 Elsevier B.V. All rights reserved.

Non-severe Hypoglycemia Risk Difference between Sulfonylurea and Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2-I) as an Add-On to Metformin in Randomized Controlled Trials.

Science.gov (United States)

Farahani, Pendar

2017-05-23

Non-severe hypoglycemia reduces well-being, lowers quality of life, reduces productivity and increases treatment costs. The non-severe hypoglycemia rate, attributable to sulfonylurea (SU) utilization compared with newer classes such as SGLT2-I, could be of clinical significance. To explore the non-severe hypoglycemia risk difference (RD) for SU use compared with SGLT2-I in randomized controlled trials (RCTs) as an add on to metformin. A search was conducted for RCTs of SGLT2-I. PubMed database were utilized for this search. The search was limited to RCTs reported in English language for canagliflozin, dapagliflozin, and empagliflozin. SU dose comparison was utilized to convert the dose of SUs to glimepiride equivalent doses. Totally, 118 RCTs were reviewed; 6 articles had an arm for a SU as add on to metformin. Six articles belong to 3 RCTs, which reported results for 52 weeks and 104 weeks. Average non-severe hypoglycemia rate for SU arm was 30% (5.5%) [Mean (SD)] for 52 weeks and 35.6% (6.1%) for 104 weeks. RD for non-severe hypoglycemia events for SU compared to SGLT2-I was 26.7% (4.9%) for 52 weeks (p-value less than 0.001) and 30.6% (5.5%) for 104 weeks (p-value less than 0.001). There was a significant correlation between dose of SU and hypoglycemia rate (Pearson correlation 0.995; R-square 99%). This study illustrated that a large proportion of patients who had exposure to SU in RCTs of SGLT2-I experienced non-severe hypoglycemia compared to SGLT2-I. There was a close relation between SU dose and increased probability of non-severe hypoglycemia events. © 2017 Journal of Population Therapeutics and Clinical Pharmacology. All rights reserved.

Characterization of the concurrent metabolic changes in brain and plasma during insulin-induced moderate hypoglycemia using 1H NMR spectroscopy in juvenile rats.

Science.gov (United States)

Ennis, Kathleen; Lusczek, Elizabeth; Rao, Raghavendra

2017-07-13

Treatment of hypoglycemia in children is currently based on plasma glucose measurements. This approach may not ensure neuroprotection since plasma glucose does not reflect the dynamic state of cerebral energy metabolism. To determine whether cerebral metabolic changes during hypoglycemia could be better characterized using plasma metabolomic analysis, insulin-induced acute hypoglycemia was induced in 4-week-old rats. Brain tissue and concurrent plasma samples were collected from hypoglycemic (N=7) and control (N=7) rats after focused microwave fixation to prevent post-mortem metabolic changes. The concentration of 29 metabolites in brain and 34 metabolites in plasma were determined using 1 H NMR spectroscopy at 700MHz and examined using partial least squares-discriminant analysis. The sensitivity of plasma glucose for detecting cerebral energy failure was assessed by determining its relationship to brain phosphocreatine. The brain and plasma metabolite profiles of the hypoglycemia group were distinct from the control group (brain: R 2 =0.92, Q 2 =0.31; plasma: R 2 =0.95, Q 2 =0.74). Concentration differences in glucose, ketone bodies and amino acids were responsible for the intergroup separation. There was 45% concordance between the brain and plasma metabolite profiles. Brain phosphocreatine correlated with brain glucose (control group: R 2 =0.86; hypoglycemia group: R 2 =0.59; pplasma glucose. The results confirm that plasma glucose is an insensitive biomarker of cerebral energy changes during hypoglycemia and suggest that a plasma metabolite profile is superior for monitoring cerebral metabolism. Copyright © 2017 Elsevier B.V. All rights reserved.

Gut microbiome response to short-term dietary interventions in reactive hypoglycemia subjects.

Science.gov (United States)

Quercia, Sara; Turroni, Silvia; Fiori, Jessica; Soverini, Matteo; Rampelli, Simone; Biagi, Elena; Castagnetti, Andrea; Consolandi, Clarissa; Severgnini, Marco; Pianesi, Mario; Fallucca, Francesco; Pozzilli, Paolo; Brigidi, Patrizia; Candela, Marco

2017-11-01

Reactive hypoglycemia is a metabolic disorder that provokes severe hypoglycemic episodes after meals. Over recent years, the gut microbiota has been recognized as potential target for the control of metabolic diseases, and the possibility to correct gut microbiota dysbioses through diet, favouring the recovery of metabolic homeostasis, has been considered. We investigate the impact of 2 short-term (3-day) nutritional interventions, based on the macrobiotic Ma-Pi 2 diet and a control Mediterranean diet, on the structure and functionality of the gut microbiota in 12 patients affected by reactive hypoglycemia. The gut microbiota composition was characterized by next-generation sequencing of the V3 to V4 region of the 16S rRNA gene, and the ecosystem functionality was addressed by measuring the faecal concentration of short-chain fatty acids (SCFAs). In order to measure the short-term physiological gut microbiota fluctuation, the microbiomes of 7 healthy people were characterized before and after 3 days of constant diet. While no convergence of the gut microbiota compositional profiles was observed, a significant increase in SCFA faecal levels was induced only in the Ma-Pi 2 diet group, suggesting the potential of this diet to support a short-term functional convergence of the gut microbiota, regardless of the individual compositional layout. The Ma-Pi 2 diet, with its high fibre load, was effective in increasing the production of SCFAs by the gut microbiota. Because these metabolites are known for their ability to counterbalance the metabolic deregulation in persons with glucose impairment disorders, their increased bioavailability could be of some relevance in reactive hypoglycemia. Copyright © 2017 John Wiley & Sons, Ltd.

Lipolysis, lipid peroxidation, and color characteristics of Serrano Hams from Duroc and large white pigs during dry-curing.

Science.gov (United States)

del Olmo, Ana; Calzada, Javier; Nuñez, Manuel

2013-11-01

Lipolysis, lipid peroxidation, and colorimetric characteristics of Serrano hams from Duroc and Large White pigs along a 15-mo curing period were investigated. Physicochemical parameters of both types of hams evolved similarly during curing. Twelve of 13 free fatty acids (FFAs) increased during curing, eicosatrienoic acid being the only exception. Linoleic, stearic, and arachidonic acids and the minor heptadecanoic acid reached lower concentrations, and the rest of minor FFAs higher concentrations, in Duroc hams than in Large White hams. The index measuring the early stage of lipid peroxidation declined from month 5 onwards, indicating that the phenomenon had been completed by month 5, while the index of the secondary stage of lipid peroxidation increased with curing time. Higher values were found for the 1st index in Duroc hams. Curing affected color parameters. Lightness decreased and redness increased in both types of hams, while yellowness decreased only in Duroc hams. Lower redness values were found for Duroc hams. Major differences in color parameters were found between muscles. Principal components analysis of FFAs yielded 2 main principal components. The 1st factor, correlated with all FFAs excepting eicosatrienoic acid, allowed discrimination between curing times. The 2nd factor, correlated with eicosatrienoic acid, permitted discrimination between breeds. © 2013 Institute of Food Technologists®

Clopidogrel-Induced Insulin Autoimmune Syndrome: A Newly Recognized Cause of Hypoglycemia in a Patient Without Diabetes.

Science.gov (United States)

Rajpal, Aman; Kassem, Laure Sayyed; Moscoso-Cordero, Maria; Arafah, Baha M

2017-09-01

Insulin autoimmune syndrome (IAS), defined as hyperinsulinemic hypoglycemia with high titers of anti-insulin antibodies, is frequently reported in Japanese patients but rarely observed in whites. We report in this study on a 79-year-old white male without diabetes who developed IAS following exposure to clopidogrel, a drug not previously known to cause hypoglycemia. The patient presented with recurrent symptomatic hypoglycemia. During one episode, serum glucose was 45 mg/dL, whereas insulin and C-peptide levels were 40,000 mIU/mL and 40 ng/mL, respectively. Additional studies revealed no intake of insulin or its secretagogues, whereas anti-insulin antibody titer was high (59.3 nmol/L). Although total insulin levels were consistently high, free insulin concentrations (polyethylene glycol precipitation) were appropriate for ambient glycemia. The patient was found to have HLA-DRB1*0404, a feature often reported in Japanese patients with IAS. Three weeks prior to symptom onset, he was started on clopidogrel, a drug that does not have a sulfhydryl group, but its active metabolite does. Clopidogrel was switched to a nonsulfhydryl antiplatelet agent, and glucocorticoid therapy was initiated. Shortly thereafter, the frequency of hypoglycemic episodes decreased, and glucocorticoids were tapered over the ensuing 3 months. No hypoglycemic episodes were noted during 6 months of observation after discontinuing glucocorticoids, whereas the total insulin and anti-insulin antibody levels normalized. The data indicate that IAS should be considered in the differential diagnosis of hyperinsulinemic hypoglycemia in seemingly well individuals, even when no drugs known to cause IAS were used. Clinical suspicion of IAS can avoid expensive imaging and unnecessary surgery in affected patients.

Accuracy of a cow-side test for the diagnosis of hyperketonemia and hypoglycemia in lactating dairy cows.

Science.gov (United States)

Macmillan, K; López Helguera, I; Behrouzi, A; Gobikrushanth, M; Hoff, B; Colazo, M G

2017-12-01

The objective of this study was to evaluate the use of a cow-side device (FreeStyle Precision Neo™) to diagnose ketosis and hypoglycemia based on measures of blood β-hydroxybutyrate (BHBA) and glucose. Eleven commercial dairy farms were visited and blood samples were taken from Holstein cows between 2 and 14days in milk, yielding 441 samples for BHBA analysis and 308 samples for glucose analysis. Concentrations of BHBA and glucose were measured in two ways, 1) using the cow-side device with whole blood immediately after sampling and 2) serum samples analyzed with a standard laboratory assay (Animal Health Laboratory, University of Guelph, Canada). The accuracy of the device was determined by comparing the results to the laboratory method as well as the ability to diagnose ketosis (BHBA ≥1.2mmol/L) and hypoglycemia (glucose cow-side device is accurate for rapid measurement of blood BHBA and diagnosis of ketosis on farms but is not accurate for measurement of blood glucose concentrations and diagnosis of hypoglycemia. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

The software package for solving problems of mathematical modeling of isothermal curing process

Directory of Open Access Journals (Sweden)

S. G. Tikhomirov

2016-01-01

Full Text Available Summary. On the basis of the general laws of sulfur vulcanization diene rubbers the principles of the effective cross-linking using a multi-component agents was discussed. It is noted that the description of the mechanism of action of the complex cross-linking systems are complicated by the diversity of interactions of components and the influence of each of them on the curing kinetics, leading to a variety technological complications of real technology and affects on the quality and technical and economic indicators of the production of rubber goods. Based on the known theoretical approaches the system analysis of isothermal curing process was performed. It included the integration of different techniques and methods into a single set of. During the analysis of the kinetics of vulcanization it was found that the formation of the spatial grid parameters vulcanizates depend on many factors, to assess which requires special mathematical and algorithmic support. As a result of the stratification of the object were identified the following major subsystems. A software package for solving direct and inverse kinetic problems isothermal curing process was developed. Information support “Isothermal vulcanization” is a set of applications of mathematical modeling of isothermal curing. It is intended for direct and inverse kinetic problems. When solving the problem of clarifying the general scheme of chemical transformations used universal mechanism including secondary chemical reactions. Functional minimization algorithm with constraints on the unknown parameters was used for solving the inverse kinetic problem. Shows a flowchart of the program. An example of solving the inverse kinetic problem with the program was introduced. Dataware was implemented in the programming language C ++. Universal dependence to determine the initial concentration of the curing agent was applied . It allowing the use of a model with different properties of multicomponent

Dielectric Cure Monitoring of Thermosetting Matrix Composites

Energy Technology Data Exchange (ETDEWEB)

Kim, Hyoung Geun [Agency for Defense Development, Daejeon (Korea, Republic of); Lee, Dae Gil [KAIST, Daejeon (Korea, Republic of)

2003-10-15

Cure monitoring can be used to improve the quality and productivity of thermosetting resin matrix composite products during their manufacturing process. In this work, the sensitivity of dielectrometry was improved by adequate separation the efforts of sensor and externals on the measured signal. A new algorithm to obtain the degree of cure during dielectric cure monitoring of glass/polyester and glass/epoxy composites was developed by employing a function of both temperature and dissipation factor, in which five cure monitoring parameters were used to calculate the degree of cure. The decreasing pattern of dissipation factor was compared with the relationships between the degree of cure and the resin viscosity. The developed algorithm might be employed for the in situ cure monitoring of thermosetting resin composites

Dielectric Cure Monitoring of Thermosetting Matrix Composites

International Nuclear Information System (INIS)

Kim, Hyoung Geun; Lee, Dae Gil

2003-01-01

Cure monitoring can be used to improve the quality and productivity of thermosetting resin matrix composite products during their manufacturing process. In this work, the sensitivity of dielectrometry was improved by adequate separation the efforts of sensor and externals on the measured signal. A new algorithm to obtain the degree of cure during dielectric cure monitoring of glass/polyester and glass/epoxy composites was developed by employing a function of both temperature and dissipation factor, in which five cure monitoring parameters were used to calculate the degree of cure. The decreasing pattern of dissipation factor was compared with the relationships between the degree of cure and the resin viscosity. The developed algorithm might be employed for the in situ cure monitoring of thermosetting resin composites

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

Science.gov (United States)

Algarra, Nelson N; Lele, Abhijit V; Prathep, Sumidtra; Souter, Michael J; Vavilala, Monica S; Qiu, Qian; Sharma, Deepak

2017-07-01

Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score Secondary insults examined were: systemic hypotension (systolic blood pressurehypertension (ICP>20 mm Hg), cerebral hypotension (cerebral perfusion pressure40 mm Hg), hypocarbia (end-tidal CO2hypertension), hyperglycemia (glucose>200 mg/dL), hypoglycemia (glucose38°C). A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (Psecondary insults were common during orthopedic surgery in patients with TBI and were associated with postoperative escalation of care. Strategies to minimize intraoperative secondary insults are needed.

The Impact of Nocturnal Hypoglycemia on Sleep in Subjects With Type 2 Diabetes

DEFF Research Database (Denmark)

Jennum, Poul; Stender-Petersen, Kirstine; Rabøl, Rasmus

2015-01-01

night visits (one normoglycemic and one hypoglycemic) in randomized order. Plasma glucose (PG) levels were controlled by hyperinsulinemic glucose clamping. On the hypoglycemic night, hypoglycemia was induced after reaching sleep stage N2 by turning off glucose infusion until the PG target of 2......OBJECTIVE: The aim of this trial was to investigate the impact of nocturnal hypoglycemia on sleep patterns (assessed by polysomnography) and counterregulatory hormones. RESEARCH DESIGN AND METHODS: In this single-blinded, crossover trial, 26 subjects with type 2 diabetes attended two experimental.......7-2.8 mmol/L was reached and maintained for 15 min. Thereafter, subjects were brought back to normoglycemia for the rest of the night. On the normoglycemic night, PG was maintained at 5.0-7.0 mmol/L throughout the night. RESULTS: During the first 4 h of sleep (0-4 h; after reaching sleep stage N2...

Frequency and risk factors of severe hypoglycemia in insulin-treated type 2 diabetes

DEFF Research Database (Denmark)

Akram, Kamran; Pedersen-Bjergaard, Ulrik; Borch-Johnsen, Knut

2006-01-01

Intensive treatment regimens including early initiation of insulin treatment are important to prevent late complications in type 2 diabetes. The assumed risk of severe hypoglycemia (SH) is a major barrier to initiation of insulin treatment. To assess the relevance of this risk we evaluated...... the frequency of SH as reported in the literature. Using Medline and Embase search we identified 11 studies (5 retrospective and 6 prospective) including at least 50 patients with insulin-treated type 2 diabetes followed for at least 6 months in which frequency of SH was reported. The incidence of SH....... Only few studies looked into the impact of risk factors on the rate of SH. Impaired hypoglycemia awareness, high age, long duration of diabetes and insulin therapy increased the risk, while no association was found with HbA1c and insulin dose. The present knowledge of SH in insulin-treated type 2...

The Influence of New European Union Driver’s License Legislation on Reporting of Severe Hypoglycemia by Patients With Type 1 Diabetes

DEFF Research Database (Denmark)

Pedersen-Bjergaard, Ulrik; Færch, Louise; Allingbjerg, Marie-Louise

2015-01-01

OBJECTIVE: We test the hypotheses that the implementation in Denmark of new, stricter European Union (EU) legislation on driver's licensing, with the purpose to improve traffic safety in January 2012, has reduced the self-reported rate of severe hypoglycemia in a routine clinical setting...... of concealed severe hypoglycemia may impair the safety of affected patients and unintentionally paradoxically reduce the general traffic safety....

Neonatal hyperinsulinemic hypoglycemia in a patient with 9p deletion syndrome

DEFF Research Database (Denmark)

Bayat, Allan; Kirchhoff, Maria; Madsen, Camilla Gøbel

2018-01-01

We report the clinical and neuroradiological findings in a young boy harboring the 9p deletion syndrome including the novel findings of thalamic infarction and germinal matrix haemorrhage and neonatal hyperinsulinemic hypoglycemia. Both the hypoglycemic events and the ventriculomegaly found...... in this patient have previously only been reported in two patients, while the thalamic infarction and germinal matrix haemorrhage are novel features....

Testicular regulation of neuronal glucose and monocarboxylate transporter gene expression profiles in CNS metabolic sensing sites during acute and recurrent insulin-induced hypoglycemia.

Science.gov (United States)

Vavaiya, Kamlesh V; Paranjape, Sachin A; Briski, Karen P

2007-01-01

Recurrent insulin-induced hypoglycemia (RIIH) impairs glucose counter-regulatory function in male humans and rodents and, in the latter, diminishes neuronal activation in CNS structures that monitor metabolic homeostasis, including the lateral hypothalamic area (LHA) and dorsal vagal complex (DVC). We investigated whether habituated neuronal reactivity in CNS sensing sites to hypoglycemia is correlated with modified monocarboxylate and/or glucose uptake by using quantitative real-time RT-PCR to analyze neuronal monocarboxylate transporter (MCT2) and glucose transporter variant (GLUT and GLUT4) gene expression profiles in the microdissected LHA, ventromedial nucleus hypothalamus (VMH), and DVC after one or multiple insulin injections. Because orchidectomy (ORDX) maintains uniform glycemic responses to RIIH in male rats, we also examined whether regional gene response patterns are testes dependent. In the intact male rat DVC, MCT2, GLUT3, and GLUT4 gene expression was not altered by acute hypoglycemia but was enhanced by RIIH. MCT2 and GLUT3 mRNA levels in the ORDX rat DVC did not differ among groups, but GLUT4 transcripts were progressively increased by acute and recurrent hypoglycemia. Precedent hypoglycemia decreased or increased basal MCT2 and GLUT4 gene expression, respectively, in the intact rat LHA; LHA GLUT3 transcription was augmented by RIIH in intact rats only. Acute hypoglycemia suppressed MCT2, GLUT3, and GLUT4 gene expression in the intact rat VMH, a response that was abolished by RIIH. In ORDX rats, VMH gene transcript levels were unchanged in response to one dose of insulin but were selectively diminished during RIIH. These data demonstrate site-specific, testes-dependent effects of acute and recurrent hypoglycemia on neuronal metabolic substrate transporter gene expression in characterized rat brain metabolic sensing loci and emphasize the need to assess the impact of potential alterations in glucose and lactate uptake during RIIH on general and

Severe Hypoglycemia Is a Serious Complication and Becoming an Economic Burden in Diabetes

Directory of Open Access Journals (Sweden)

Won Chul Ha

2012-08-01

Full Text Available BackgroundThe prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER of Uijeongbu St. Mary's Hospital.MethodsThe study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009.ResultsMost hypoglycemic patients (87.5%, 280/320 were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR was 48.0±33.6 mL/min/1.73 m2. In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes.ConclusionSevere hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.

EB/UV curing market in Malaysia

Energy Technology Data Exchange (ETDEWEB)

Dahlan, Khairul Zaman; Nik Salleh, Nik Ghazali; Mahmood, Mohd Hilmi [Malaysian Inst. for Nuclear Technology Res. (MINT), Bangi (Malaysia)

1999-07-01

Radiation curing of coatings of wood based products is expanding and being used for curing of coatings of table tops, parquet, wood panel, furniture, curtain railing, etc. UV curing of over print varnish is still the main application of UV curing in printing industry. However, curing ofprinting ink has also been extended in the printing of CD and VCD in addition to other printing such as paper, magazine, label on bottles, metal-can, etc. In the electronic industry, the manufacturer of printed circuit board is still the main consumer of UV curable resins. On the other hand, low energy electron beam machine is used mainly for cross-linking of heat shrink films.

EB/UV curing market in Malaysia

International Nuclear Information System (INIS)

Khairul Zaman Dahlan; Nik Ghazali Nik Salleh; Mohd Hilmi Mahmood

1999-01-01

Radiation curing of coatings of wood based products is expanding and being used for curing of coatings of table tops, parquet, wood panel, furniture, curtain railing, etc. UV curing of over print varnish is still the main application of UV curing in printing industry. However, curing of printing ink has also been extended in the printing of CD and VCD in addition to other printing such as paper, magazine, label on bottles, metal-can, etc. In the electronic industry, the manufacturer of printed circuit board is still the main consumer of UV curable resins. On the other hand, low energy electron beam machine is used mainly for cross-linking of heat shrink films

Prevalence and predictors of severe hypoglycemia in Danish children and adolescents with diabetes

DEFF Research Database (Denmark)

Johansen, Anders; Kanijo, B; Fredheim, S

2015-01-01

OBJECTIVE: To investigate the prevalence of severe hypoglycemia in Danish children and adolescents with type 1 diabetes and to pinpoint predictors of this acute complication in children on modern treatment modalities. RESEARCH DESIGN AND METHODS: The study is based on data from DanDiabKids...

Changes of cognition and regional cerebral activity during acute hypoglycemia in normal subjects

DEFF Research Database (Denmark)

Bie-Olsen, Lise G; Kjaer, Troels W; Pedersen-Bjergaard, Ulrik

2009-01-01

cerebral blood flow (rCBF) as a marker of cerebral activity. Hypoglycemia was induced by intravenous insulin infusion in 19 healthy men performing two different cognitive tasks of varying complexity. The hypoglycemic stimulus [plasma glucose 2.2 mmol/liter (0.4)] produced a significant hormonal...

Hypoglycemia in type 2 diabetes patients treated with insulin: the advantages of continuous glucose monitoring

Directory of Open Access Journals (Sweden)

Vadim Valer'evich Klimontov

2014-03-01

Full Text Available Aims.  To determine the incidence and risk factors for hypoglycemia in elderly insulin-treated type 2 diabetes mellitus (T2DM patients by means of continuous glucose monitoring (CGM. Materials and Methods.  We observed seventy-six hospitalized patients with T2DM, aged 65 to 79 years. Treatment with basal insulin (n=36, premixed insulin (n=12 or basal-bolus insulin regimen (n=28 was followed by metformin (n=44, glimepiride (n=14 and dipeptidyl peptidase-4 inhibitors (n=14. 2-days CGM with retrospective data analysis was performed in all patients. During CGM, three fasting and three 2-h postprandial finger-prick glucose values were obtained daily with portable glucose meter. Results.  Hypoglycemia (identified as blood glucose

Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification

OpenAIRE

Aucoin, Monique; Bhardwaj, Sukriti

2016-01-01

Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of ...

Insulinoma: A rare cause of hypoglycemia in a young female

Directory of Open Access Journals (Sweden)

Fnu Kelash

2014-09-01

Full Text Available Insulinoma is an exceedingly uncommon pancreatic islet cell neuroendocrine tumor. The estimated incidence is approximately four cases per million individuals per year and accounts for 60% of islets cell tumors. It causes glycopenic symptoms which includes headache, feeling irritable, confused, seizure or coma and leads to catecholamine excess which includes rapid heartbeat, sweating, palpitations and feelings of hunger. Early detection of the tumor prevents recurrent episodes of lethal hypoglycemia.

Cure Behavior and Thermal Properties of Diepoxidized Cardanol Resin Cured by Electron Beam Process

International Nuclear Information System (INIS)

Cho, Donghwan; Cheon, Jinsil

2013-01-01

Thermal curing of epoxy resin requires high temperature, time-consuming process and the volatilization of hardener. It has known that electron beam curing of epoxy resin is a fast process and occurs at low or room temperature that help reduce residual mechanical stresses in thermosetting polymers. Diepoxidized cardanol (DEC) can be synthesized by an enzymatic method from cashew nut shell liquid (CNSL), that constitutes nearly one-third of the total nut weight. A large amount of CNSL can be formed as a byproduct of the mechanical processes used to render the cashew kerneledible and its total production approaches one million tons annually, which can be bio-degradable and replace the industrial thermosetting plastics. It is expected that DEC may be cured as in an epoxy resin, which was constituted on two epoxide group and long alkyl chain, and two-types of onium salts (cationic initiator) were used as a photo-initiator. The experimental variables of this study are type and concentration of photo-initiators and electron beam dosage. In this study, the effects of initiator type and concentration on the cure behavior and the thermal properties of DEC resin processed by using electron beam technology were studied using FT-IR, TGA, TMA, DSC, and DMA. Figure 1 is the FT-IR results, showing the change of chemical structure of pure DEC and electron beam cured DEC. The characteristic absorption peak of epoxide group appeared at 850cm -1 . The shape and the height were reduced when the sample was irradiated with electron beam. From this result, the epoxide groups is DEC were opened by electron beam and cured. After then, electron beam cured DEC was investigated the effect of forming 3-dimensional network

Cure Behavior and Thermal Properties of Diepoxidized Cardanol Resin Cured by Electron Beam Process

Energy Technology Data Exchange (ETDEWEB)

Cho, Donghwan; Cheon, Jinsil [Kumoh National Institute of Technology, Gumi (Korea, Republic of)

2013-07-01

Thermal curing of epoxy resin requires high temperature, time-consuming process and the volatilization of hardener. It has known that electron beam curing of epoxy resin is a fast process and occurs at low or room temperature that help reduce residual mechanical stresses in thermosetting polymers. Diepoxidized cardanol (DEC) can be synthesized by an enzymatic method from cashew nut shell liquid (CNSL), that constitutes nearly one-third of the total nut weight. A large amount of CNSL can be formed as a byproduct of the mechanical processes used to render the cashew kerneledible and its total production approaches one million tons annually, which can be bio-degradable and replace the industrial thermosetting plastics. It is expected that DEC may be cured as in an epoxy resin, which was constituted on two epoxide group and long alkyl chain, and two-types of onium salts (cationic initiator) were used as a photo-initiator. The experimental variables of this study are type and concentration of photo-initiators and electron beam dosage. In this study, the effects of initiator type and concentration on the cure behavior and the thermal properties of DEC resin processed by using electron beam technology were studied using FT-IR, TGA, TMA, DSC, and DMA. Figure 1 is the FT-IR results, showing the change of chemical structure of pure DEC and electron beam cured DEC. The characteristic absorption peak of epoxide group appeared at 850cm{sup -1}. The shape and the height were reduced when the sample was irradiated with electron beam. From this result, the epoxide groups is DEC were opened by electron beam and cured. After then, electron beam cured DEC was investigated the effect of forming 3-dimensional network.

Hypoglycemia is associated with increased risk for brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy.

Science.gov (United States)

Tam, Emily W Y; Haeusslein, Laurel A; Bonifacio, Sonia L; Glass, Hannah C; Rogers, Elizabeth E; Jeremy, Rita J; Barkovich, A James; Ferriero, Donna M

2012-07-01

To investigate the contribution of hypoglycemia in the first 24 hours after birth to brain injury in term newborns at risk for neonatal encephalopathy. A prospective cohort of 94 term neonates born between 1994 and 2010 with early postnatal brain magnetic resonance imaging studies were analyzed for regions of brain injury. Neurodevelopmental outcome was assessed at 1 year of age. Hypoglycemia (glucose encephalopathy with increased corticospinal tract injury and adverse motor and cognitive outcomes. Copyright © 2012 Mosby, Inc. All rights reserved.

PEPCK-C reexpression in the liver counters neonatal hypoglycemia in Pck1 del/del mice, unmasking role in non-gluconeogenic tissues.

Science.gov (United States)

Semakova, Jana; Hyroššová, Petra; Méndez-Lucas, Andrés; Cutz, Ernest; Bermudez, Jordi; Burgess, Shawn; Alcántara, Soledad; Perales, José C

2017-02-01

Whole body cytosolic phosphoenolpyruvate carboxykinase knockout (PEPCK-C KO) mice die early after birth with profound hypoglycemia therefore masking the role of PEPCK-C in adult, non-gluconeogenic tissues where it is expressed. To investigate whether PEPCK-C deletion in the liver was critically responsible for the hypoglycemic phenotype, we reexpress this enzyme in the liver of PEPCK-C KO pups by early postnatal administration of PEPCK-C-expressing adenovirus. This maneuver was sufficient to partially rescue hypoglycemia and allow the pups to survive and identifies the liver as a critical organ, and hypoglycemia as the critical pathomechanism, leading to early postnatal death in the whole-body PEPCK-C knockout mice. Pathology assessment of survivors also suggest a possible role for PEPCK-C in lung maturation and muscle metabolism.

7 CFR 30.12 - Fire-cure.

Science.gov (United States)

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Fire-cure. 30.12 Section 30.12 Agriculture Regulations... AND STANDARDS Classification of Leaf Tobacco Covering Classes, Types and Groups of Grades § 30.12 Fire-cure. To cure tobacco under artificial atmospheric conditions by the use of open fires, the smoke and...

Radiation curing

International Nuclear Information System (INIS)

Wendrinsky, J.

1987-04-01

In the beginning of the seventies the two types of radiation sources applied in industrial processes, electron radiation and UV, had been given rather optimistic forecasts. While UV could succeed in the field of panel and film coating, electron radiation curing seems to gain success in quite new fields of manufacturing. The listing of the suggested applications of radiation curing and a comparison of both advantages and disadvantages of this technology are followed by a number of case studies emphasizing the features of these processes and giving some examplary calculations. The data used for the calculations should provide an easy calculation of individual manufacturing costs if special production parameters, investment or energy costs are employed. (Author)

Glycemic Control, Self-Efficacy and Fear of Hypoglycemia Among Iranian Children with Type 1 Diabetes.

Science.gov (United States)

Amiri, Fatemehsadat; Vafa, Mohammadreza; Gonder-Frederick, Linda

2015-08-01

This study was designed to test the reliability of a Persian version of 2 questionnaires to assess the level of fear of hypoglycemia (FoH) and self-efficacy in diabetes management and their association with glycated hemoglobin (A1C) and parents' demographic characteristics in a sample of children with type 1 diabetes. We assessed 61 children with type 1 diabetes (35 boys and girls, 6.0 to 12.7 years of age) using the Hypoglycemia Fear Survey-Child version (HFS-C) and Self-Efficacy for Diabetes Scale-Child version (SED-C). Their glycemic control was evaluated by A1C levels. The internal consistency of the Persian version of HFS-C and SED-C were very good. Our results showed that children older than 10 years of age report lower levels of FoH, which are related to higher levels of self-efficacy (r=-.30, p=0.025 and r=-.30, p=0.02, respectively). Of the children, 42.3% of girls and 31.4% of boys reported that low blood sugar is a big problem for them. These findings suggest that FoH is a significant concern for this target group. Only 19.7% of children had controlled diabetes based on A1C levels. There was no significant association between higher A1C levels and other variables, including HFS-C, SED-C and parents' demographic characteristics. The Persian version of HFS-C and SED-C are reliable and valid measures of the fear of hypoglycemia and of self-efficacy in children with type 1 diabetes, and these questionnaires could be used in our country for identifying those children who may need diabetes education and other supports. The association between greater self-efficacy and lower fear of hypoglycemia suggests that addressing self-efficacy in diabetes education courses may be effective in helping to overcome FoH. Copyright © 2015 Canadian Diabetes Association. All rights reserved.

Ruling out secondary causes of hypertension.

Science.gov (United States)

Ott, Christian; Schneider, Markus P; Schmieder, Roland E

2013-05-01

In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of patients with secondary hypertension a specific underlying cause is responsible for the elevated blood pressure. The prevalence of secondary hypertension is higher in patients with resistant hypertension than in the general hypertensive population and increases with age. The list of secondary forms of hypertension is long and prevalence of the individual causes of secondary hypertension varies. Hence, this review divides them into two categories: common causes and rare causes. If appropriately diagnosed and treated, patients with a secondary form of hypertension might be cured, or at least show an improvement in their blood pressure control. Consequently, screening for secondary causes of hypertension plays an essential part in the care of patients with arterial hypertension. If the basal work-up raises the suspicion of a secondary cause of hypertension, specific diagnostic procedures become necessary, some of which can be performed by primary care physicians, while others require specialist input.

Accounting for Cured Patients in Cost-Effectiveness Analysis.

Science.gov (United States)

Othus, Megan; Bansal, Aasthaa; Koepl, Lisel; Wagner, Samuel; Ramsey, Scott

2017-04-01

Economic evaluations often measure an intervention effect with mean overall survival (OS). Emerging types of cancer treatments offer the possibility of being "cured" in that patients can become long-term survivors whose risk of death is the same as that of a disease-free person. Describing cured and noncured patients with one shared mean value may provide a biased assessment of a therapy with a cured proportion. The purpose of this article is to explain how to incorporate the heterogeneity from cured patients into health economic evaluation. We analyzed clinical trial data from patients with advanced melanoma treated with ipilimumab (Ipi; n = 137) versus glycoprotein 100 (gp100; n = 136) with statistical methodology for mixture cure models. Both cured and noncured patients were subject to background mortality not related to cancer. When ignoring cured proportions, we found that patients treated with Ipi had an estimated mean OS that was 8 months longer than that of patients treated with gp100. Cure model analysis showed that the cured proportion drove this difference, with 21% cured on Ipi versus 6% cured on gp100. The mean OS among the noncured cohort patients was 10 and 9 months with Ipi and gp100, respectively. The mean OS among cured patients was 26 years on both arms. When ignoring cured proportions, we found that the incremental cost-effectiveness ratio (ICER) when comparing Ipi with gp100 was $324,000/quality-adjusted life-year (QALY) (95% confidence interval $254,000-$600,000). With a mixture cure model, the ICER when comparing Ipi with gp100 was $113,000/QALY (95% confidence interval $101,000-$154,000). This analysis supports using cure modeling in health economic evaluation in advanced melanoma. When a proportion of patients may be long-term survivors, using cure models may reduce bias in OS estimates and provide more accurate estimates of health economic measures, including QALYs and ICERs. Copyright © 2017 International Society for Pharmacoeconomics

Reactive hypoglycemia in lean young women with PCOS and correlations with insulin sensitivity and with beta cell function.

Science.gov (United States)

Altuntas, Yuksel; Bilir, Muammer; Ucak, Sema; Gundogdu, Sadi

2005-04-01

Reactive hypoglycemia (RH), which is a postprandial hypoglycemic state, occurs within 2-5 h after food intake. It is classified as idiopathic, alimentary, or diabetic reactive hypoglycemia. We studied the incidence of reactive hypoglycemia and looked for any correlations between it and the presence of insulin sensitivity and/or beta cell function in young lean polycystic ovary syndrome (PCOS) patients. This study was designed as a cross-sectional study in 64 lean young women with PCOS (BMI lean young women with PCOS. DHEA-S and PRL levels were found to be lower in subjects with RH (P 0.05, respectively). Beta cell function indices such as the insulinogenic index (at 120 min), CIR (at 120 min) and HOMA beta cell index were found to be insignificantly higher in the RH group than the nonreactive hypoglycemia (NRH) group. The 4 h glucose level, but not the 3 h glucose level, was significantly correlated with insulin resistance indices, such as fasting insulin level, HOMA-IR, Quicky index, and FIRI in the RH group. Significantly decreased DHEA-S levels were an interesting finding. In conclusion, there is an urgent need to investigate RH in lean young women with PCOS. Our results indicate that more definite insulin resistance occurs in subjects with RH in the fourth hour of the OGTT than those with RH in the third hour. In addition, RH in the fourth hour together with a low DHEA-S level may be predictive of future diabetes in young women with PCOS even when they are not obese.

Histopathological nerve and skeletal muscle changes in rats subjected to persistent insulin-induced hypoglycemia

DEFF Research Database (Denmark)

Jensen, Vivi Flou Hjorth; Mølck, Anne-Marie; Heydenreich, Annette

2016-01-01

femoris muscle tissue, as little is known about the response to persistent hypoglycemia in these tissues. Histopathologic changes in insulin-infused animals included axonal degeneration and myofibre degeneration. To our knowledge, this is the first study to show that persistent IIH provokes peripheral...

Novel techniques for concrete curing

DEFF Research Database (Denmark)

Kovler, Konstantin; Jensen, Ole Mejlhede

2005-01-01

It is known that some high-strength/high-performance concretes (HSC/HPC) are prone to cracking at an early age unless special precautions are taken. The paper deals with the methods of curing as one of the main strategies to ensure good performance of concrete. Curing by both external (conventional......) and internal methods is reviewed and analyzed, among other methods of mitigating shrinkage and cracking of concrete. The focus is on the mitigation of autogenous shrinkage of low water to binder ratio (w/b) concrete by means of internal curing. The concepts of internal curing are based on using lightweight...... aggregate, superabsorbent polymers or water-soluble chemicals, which reduce water evaporation (so called "internal sealing"). These concepts have been intensively researched in the 90s, but still are not widespread among contractors and concrete suppliers. The differences between conventional methods...

Examination of a Standardized Test for Evaluating the Degree of Cure of EVA Encapsulation (Presentation)

Energy Technology Data Exchange (ETDEWEB)

Miller, D.; Wohlgemuth, J.; Gu, X.; Haldeman, S.; Hidalgo, M.; Malguth, E.; Reid, C.; Shioda, T.; Schulze, S.; Wang, Z.

2013-11-01

The curing of cross-linkable encapsulation is a critical consideration for photovoltaic (PV) modules manufactured using a lamination process. Concerns related to ethylene-co-vinyl acetate (EVA) include the quality (e.g., expiration and uniformity) of the films or completion (duration) of the cross-linking of the EVA within a laminator. Because these issues are important to both EVA and module manufacturers, an international standard has recently been proposed by the Encapsulation Task-Group within the Working Group 2 (WG2) of the International Electrotechnical Commission (IEC) Technical Committee 82 (TC82) for the quantification of the degree of cure for EVA encapsulation. The present draft of the standard calls for the use of differential scanning calorimetry (DSC) as the rapid, enabling secondary (test) method. Both the residual enthalpy- and melt/freeze-DSC methods are identified. The DSC methods are calibrated against the gel content test, the primary (reference) method. Aspects of other established methods, including indentation and rotor cure metering, were considered by the group. Key details of the test procedure will be described.

Examination of a Standardized Test for Evaluating the Degree of Cure of EVA Encapsulation: Preprint

Energy Technology Data Exchange (ETDEWEB)

Miller, D. C.; Gu, X.; Haldenman, S.; Hidalgo, M.; Malguth, E.; Reid, C. G.; Shioda, T.; Schulze, S. H.; Wang, Z. Y.; Wohlgemuth, J. H.

2013-11-01

The curing of cross-linkable encapsulation is a critical consideration for photovoltaic (PV) modules manufactured using a lamination process. Concerns related to ethylene-co-vinyl acetate (EVA) include the quality (e.g., expiration and uniformity) of the films or completion (duration) of the cross-linking of the EVA within a laminator. Because these issues are important to both EVA and module manufacturers, an international standard has recently been proposed by the Encapsulation Task-Group within the Working Group 2 (WG2) of the International Electrotechnical Commission (IEC) Technical Committee 82 (TC82) for the quantification of the degree of cure for EVA encapsulation. The present draft of the standard calls for the use of differential scanning calorimetry (DSC) as the rapid, enabling secondary (test) method. Both the residual enthalpy- and melt/freeze-DSC methods are identified. The DSC methods are calibrated against the gel content test, the primary (reference) method. Aspects of other established methods, including indentation and rotor cure metering, were considered by the group. Key details of the test procedure will be described.

C-CURE

Data.gov (United States)

US Agency for International Development — C-CURE system manages certain aspects of the access control system, including collecting employee and contractor names and photographs. The Office of Security uses...

The GOAT-ghrelin system is not essential for hypoglycemia prevention during prolonged calorie restriction.

Directory of Open Access Journals (Sweden)

Chun-Xia Yi

Full Text Available Ghrelin acylation by ghrelin O-acyltransferase (GOAT has recently been reported to be essential for the prevention of hypoglycemia during prolonged negative energy balance. Using a unique set of four different genetic loss-of-function models for the GOAT/ghrelin/growth hormone secretagogue receptor (GHSR system, we thoroughly tested the hypothesis that lack-of-ghrelin activation or signaling would lead to hypoglycemia during caloric deprivation.Male and female knockout (KO mice for GOAT, ghrelin, GHSR, or both ghrelin and GHSR (dKO were subjected to prolonged calorie restriction (40% of ad libitum chow intake. Body weight, fat mass, and glucose levels were recorded daily and compared to wildtype (WT controls. Forty-eight hour blood glucose profiles were generated for each individual mouse when 2% or less body fat mass was reached. Blood samples were obtained for analysis of circulating levels of acyl- and desacyl-ghrelin, IGF-1, and insulin.Chronic calorie restriction progressively decreased body weight and body fat mass in all mice regardless of genotype. When fat mass was depleted to 2% or less of body weight for 2 consecutive days, random hypoglycemic events occurred in some mice across all genotypes. There was no increase in the incidence of hypoglycemia in any of the four loss-of-function models for ghrelin signaling including GOAT KO mice. Furthermore, no differences in insulin or IGF-1 levels were observed between genotypes.The endogenous GOAT-ghrelin-GHSR system is not essential for the maintenance of euglycemia during prolonged calorie restriction.

Gamma and electron beam curing of polymers and composites

International Nuclear Information System (INIS)

Saunders, C.B.; Dickson, L.W.; Singh, A.

1987-01-01

Radiation polymerization has helped us understand polymer chemistry, and is also playing an increasing role in the field of practical applications. Radiation curing has a present market share of about 5% of the total market for curing of polymers and composites and the annual growth rate of the radiation curing market is ≥20% per year. Advantages of radiation curing over thermal or chemical curing methods include: improved control of the curing rate, reduced curing times, curing at ambient temperatures, curing without the need for chemical initiators, and complete (100%) curing with minimal toxic chemical emissions. Radiation treatment may also be used to effect crosslinking and grafting of polymer and composite materials. The major advantage in these cases is the ability to process products in their final shape. Cable insulation, automotive and aircraft components, and improved construction materials are some of the current and near-future industrial applications of radiation curing and crosslinking. 19 refs

Diabetic emergencies including hypoglycemia during Ramadan

Directory of Open Access Journals (Sweden)

Jamal Ahmad

2012-01-01

Full Text Available Majority of physicians are of the opinion that Ramadan fasting is acceptable for well-balanced type 2 patients conscious of their disease and compliant with their diet and drug intake. Fasting during Ramadan for patients with diabetes carries a risk of an assortment of complications. Islamic rules allow patients not to fast. However, if patient with diabetes wish to fast, it is necessary to advice them to undertake regular monitoring of blood glucose levels several times a day, to reduce the risk of hypoglycemia during day time fasting or hyperglycemia during the night. Patient with type 1 diabetes who fast during Ramadan may be better managed with fast-acting insulin. They should have basic knowledge of carbohydrate metabolism, the standard principles of diabetes care, and pharmacology of various antidiabetic drugs. This Consensus Statement describes the management of the various diabetic emergencies that may occur during Ramadan.

Diabetic emergencies including hypoglycemia during Ramadan

Science.gov (United States)

Ahmad, Jamal; Pathan, Md Faruque; Jaleel, Mohammed Abdul; Fathima, Farah Naaz; Raza, Syed Abbas; Khan, A. K. Azad; Ishtiaq, Osama; Sheikh, Aisha

2012-01-01

Majority of physicians are of the opinion that Ramadan fasting is acceptable for well-balanced type 2 patients conscious of their disease and compliant with their diet and drug intake. Fasting during Ramadan for patients with diabetes carries a risk of an assortment of complications. Islamic rules allow patients not to fast. However, if patient with diabetes wish to fast, it is necessary to advice them to undertake regular monitoring of blood glucose levels several times a day, to reduce the risk of hypoglycemia during day time fasting or hyperglycemia during the night. Patient with type 1 diabetes who fast during Ramadan may be better managed with fast-acting insulin. They should have basic knowledge of carbohydrate metabolism, the standard principles of diabetes care, and pharmacology of various antidiabetic drugs. This Consensus Statement describes the management of the various diabetic emergencies that may occur during Ramadan. PMID:22837906

Cure Schedule for Stycast 2651/Catalyst 9.

Energy Technology Data Exchange (ETDEWEB)

Kropka, Jamie Michael [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); McCoy, John D. [New Mexico Inst. of Mining and Technology, Socorro, NM (United States)

2017-11-01

The Emerson & Cuming technical data sheet (TDS) for Stycast 2651/Catalyst 9 lists three alternate cure schedules for the material, each of which would result in a different state of reaction and different material properties. Here, a cure schedule that attains full reaction of the material is defined. The use of this cure schedule will eliminate variance in material properties due to changes in the cure state of the material, and the cure schedule will serve as the method to make material prior to characterizing properties. The following recommendation uses one of the schedules within the TDS and adds a “post cure” to obtain full reaction.

Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes

Directory of Open Access Journals (Sweden)

Yun-Mi Yong

2015-04-01

Full Text Available BackgroundWe investigated whether an intensive individualized reinforcement education program could influence the prevention of hypoglycemic events in patients with type 2 diabetes.MethodsFrom March 2013 to September 2013, patients aged 35 to 75 years with type 2 diabetes who had not previously participated in diabetes education, and treated with insulin or a sulfonylurea-containing regimen were included in the study. After structured group education, the patients assigned to the intensive individualized education group (IT were requested to visit for reinforcement. All subjects in the IT were encouraged to self-manage dose adjustments. Participants in both groups (control group [CG, group education only; n=22] and IT [n=24] attended follow-up visits at 2, 8, 12, and 24 weeks. At each visit, all patients were asked whether they had experienced hypoglycemia.ResultsThe total study population consisted of 20 men (43.5%; mean age and diabetic duration of 55.9±11.0 and 5.1±7.3 years, respectively. At 24 weeks, there were no significant differences in hemoglobin A1c values between the CG and IT. The total number of hypoglycemic events per patient was 5.26±6.5 in the CG and 2.58±2.3 times in the IT (P=0.004. Adherence to lifestyle modification including frequency of exercise, self-monitoring of blood glucose, or dietary habit was not significantly different between the groups. However, adherence to hypoglycemia management, especially the dose adjustment of medication, was significantly higher in the IT compared with the CG.ConclusionCompared with the structured group education, additional IT resulted in additional benefits in terms of avoidance of hypoglycemia and treating hypoglycemia in patients with type 2 diabetes.

Intensive individualized reinforcement education is important for the prevention of hypoglycemia in patients with type 2 diabetes.

Science.gov (United States)

Yong, Yun-Mi; Shin, Kyung-Mi; Lee, Kang-Min; Cho, Jae-Young; Ko, Sun-Hye; Yoon, Min-Hyang; Kim, Tae-Won; Jeong, Jong-Hyun; Park, Yong-Moon; Ko, Seung-Hyun; Ahn, Yu-Bae

2015-04-01

We investigated whether an intensive individualized reinforcement education program could influence the prevention of hypoglycemic events in patients with type 2 diabetes. From March 2013 to September 2013, patients aged 35 to 75 years with type 2 diabetes who had not previously participated in diabetes education, and treated with insulin or a sulfonylurea-containing regimen were included in the study. After structured group education, the patients assigned to the intensive individualized education group (IT) were requested to visit for reinforcement. All subjects in the IT were encouraged to self-manage dose adjustments. Participants in both groups (control group [CG, group education only; n=22] and IT [n=24]) attended follow-up visits at 2, 8, 12, and 24 weeks. At each visit, all patients were asked whether they had experienced hypoglycemia. The total study population consisted of 20 men (43.5%; mean age and diabetic duration of 55.9±11.0 and 5.1±7.3 years, respectively). At 24 weeks, there were no significant differences in hemoglobin A1c values between the CG and IT. The total number of hypoglycemic events per patient was 5.26±6.5 in the CG and 2.58±2.3 times in the IT (P=0.004). Adherence to lifestyle modification including frequency of exercise, self-monitoring of blood glucose, or dietary habit was not significantly different between the groups. However, adherence to hypoglycemia management, especially the dose adjustment of medication, was significantly higher in the IT compared with the CG. Compared with the structured group education, additional IT resulted in additional benefits in terms of avoidance of hypoglycemia and treating hypoglycemia in patients with type 2 diabetes.

Radiation curing of polymers II

International Nuclear Information System (INIS)

Randell, D.R.

1991-01-01

During the last decade radiation cured polymers have continued to grow in importance not only by expansion within existing coatings applications but also by extension into new fields of application such as ceramics, ink-jet inks and fibres. To provide a further update on the rapidly growing science and technology of radiation curing the Third International Symposium was held. Apart from providing an update on the application, chemistry and control aspects of the radiation curing the aim of the meeting was also to provide the newcomer with a basic insight into radiation curing applications. Accordingly the proceedings contained in this special publication which follow closely the format of the meeting, has five sections covering the background/trends, applications, initiator chemistry, substrate chemistry and analytical, physical chemical and health and safety aspects. There are twenty-five papers all told, three of which are indexed separately. (Author)

Effect of fasting ramadan in diabetes control status - application of extensive diabetes education, serum creatinine with HbA1c statistical ANOVA and regression models to prevent hypoglycemia.

Science.gov (United States)

Aziz, Kamran M A

2013-09-01

Ramadan fasting is an obligatory duty for Muslims. Unique physiologic and metabolic changes occur during fasting which requires adjustments of diabetes medications. Although challenging, successful fasting can be accomplished if pre-Ramadan extensive education is provided to the patients. Current research was conducted to study effective Ramadan fasting with different OHAs/insulins without significant risk of hypoglycemia in terms of HbA1c reductions after Ramadan. ANOVA model was used to assess HbA1c levels among different education statuses. Serum creatinine was used to measure renal functions. Pre-Ramadan diabetes education with alteration of therapy and dosage adjustments for OHAs/insulin was done. Regression models for HbA1c before Ramadan with FBS before sunset were also synthesized as a tool to prevent hypoglycemia and successful Ramadan fasting in future. Out of 1046 patients, 998 patients fasted successfully without any episodes of hypoglycemia. 48 patients (4.58%) experienced hypoglycemia. Χ(2) Test for CRD/CKD with hypoglycemia was also significant (p-value Ramadan diabetes management. Some relevant patents are also outlined in this paper.

Curing reaction of bisphenol-A based benzoxazine with cyanate ester resin and the properties of the cured thermosetting resin

Directory of Open Access Journals (Sweden)

H. Kimura

2011-12-01

Full Text Available Curing reaction of bisphenol-A based benzoxazine with cyanate ester resin and the properties of the cured thermosetting resin were investigated. The cure behavior of benzoxazine with cyanate ester resin was monitored by model reaction using nuclear magnetic resonance (NMR. As a result of the model reaction, the ring opening reaction of benzoxazine ring and thermal self-cyclotrimerization of cyanate ester group occurred, and then the phenolic hydoroxyl group generated by the ring opening reaction of benzoxazine ring co-reacted with cyanate ester group. The properties of the cured thermosetting resin were estimated by mechanical properties, electrical resistivity, water resistance and heat resistance. The cured thermosetting resin from benzoxazine and cyanate ester resin showed good heat resistance, high electrical resistivity and high water resistance, compared with the cured thermosetting resin from benzoxazine and epoxy resin.

Effects of Chemical Curing Temperature and Time on the Properties of Liquefied Wood based As-cured Precursors and Carbon Fibers

Directory of Open Access Journals (Sweden)

Junbo Shang

2015-09-01

Full Text Available Liquefied wood based as-cured precursors and carbon fibers prepared by different chemical curing processes were carried out to investigate the effects of curing temperature and time on the thermostability and microstructure of liquefied wood based precursors, the tensile strength of carbon fibers as well. The primary fibers can be converted into precursors with high performance by directly heating at target curing temperature. With the temperature and duration increasing, the numbers of methylene bonds in precursors increased, resulting in the enhancement of cross-linkages among molecular chains and then the improvement of thermostability of precursors. Carbon fibers prepared from as-cured precursors (curing temperature 95 oC, curing time 3h had the minimum value of the average interlayer spacing (d002, it also showed the highest tensile strength, almost 800 MPa, which can be classified as fibers of general grade.

Influence of curing profile and fibre architecture on the fatigue resistance of composite materials for wind turbine blades

DEFF Research Database (Denmark)

Mikkelsen, Lars Pilgaard

been investigated during a variety of curing profiles of the used epoxy material system. Thereby, it is possible to observe that even though the overall chemical shrinkage of the epoxy material system is independent on the chosen curing profile, the location of the gel-point and thereby the amount......The fatigue performance of unidirectional glass fibre reinforced epoxy is found to be highly dependent on the manufacturing conditions, where a low manufacturing temperature, for the investigated wind turbine relevant composite material system, is found to improve the tension/tension fatigue life....... It is a failure mechanism which is judge to be highly influenced by the magnitude of the residual stresses exhibit in the matrix material and therefore also in the secondary oriented backing bundles. Using fibre Bragg grated optical fibres2; the build-up of the cure-induced strains in the fibre-reinforcement has...

The irradiation curing of coatings

International Nuclear Information System (INIS)

Autio, T.

1974-01-01

The electron beam irradiation curing of coatings has been technically feasible for over a decade. A brief description of the process is presented. The progress in this field has been astonishingly slow in comparison with the use of UV lamps as radiation source. The primary reason for this has been the great advantage in terms of capital cost of the UV curing lines and their ready adaptability to low or high production rates. A literature survey is given concerning basic and applied research in the electron curing area, patents, economics and existing installations around the world. (author)

The impact of eating behavior on psychological symptoms typical of reactive hypoglycemia. A pilot study comparing women with polycystic ovary syndrome to controls.

Science.gov (United States)

Barry, John A; Bouloux, Pierre; Hardiman, Paul J

2011-08-01

The idea that diet can affect mood and behavior in women with polycystic ovary syndrome (PCOS) by altering blood glucose levels has become popular in recent years. This paper describes an online survey (N=462) of 24 women with PCOS, 299 healthy control women, 47 women who possibly had undiagnosed PCOS, and 92 men. The groups were compared for symptoms of mood and behavioral symptoms typical of reactive (postprandial) hypoglycemia. The outcome measures were two questionnaires that measure states associated with hypoglycemia: the Hypoglycemia Symptom Checklist-7 (HSC-7), which measures behavioral symptoms and the Mood Adjective Checklist (MACL), which measures emotional states. Controlling for age and body mass index (BMI) using between-groups analysis of covariance (ANCOVA), the women with PCOS scored significantly higher than the other three groups (pPCOS compared to twelve healthy control women closely matched for age, BMI, and eating behavior. The findings are suggestive of hypoglycemia-related mood and behavioral problems in PCOS. Future research should test whether blood glucose levels correlate with these symptoms in PCOS, and whether a low glycemic index ('low-GI') diet improves the symptoms. Copyright © 2011 Elsevier Ltd. All rights reserved.

Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.

Science.gov (United States)

Lipska, Kasia J; Yao, Xiaoxi; Herrin, Jeph; McCoy, Rozalina G; Ross, Joseph S; Steinman, Michael A; Inzucchi, Silvio E; Gill, Thomas M; Krumholz, Harlan M; Shah, Nilay D

2017-04-01

To examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM). Using claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1 ) age- and sex-standardized proportion of patients who filled each class of agents; 2 ) age-, sex-, race-, and region-standardized proportion with hemoglobin A 1c (HbA 1c ) use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged. © 2017 by the American Diabetes Association.

Study on the heat-resistant EB curing composites

International Nuclear Information System (INIS)

Bao Jianwen; Li Yang; Li Fengmei

2000-01-01

There are many advantages in the EB-curing process of composites. Heat-resistant EB-curing composites could substitute for polyimide composites used in aeronautical engine. The effects of catalyst and dose on the cured resin were investigated. The heat-resistance of the resin cured by EB was evaluated by dynamic mechanical thermal analysis (DMTA). The experiment result shows that the mechanical property of the composites cured by EB could meet the needs of the aeronautical engine in 250degC. (author)

An emerging alternative to thermal curing: Electron curing of fiber-reinforced composites

International Nuclear Information System (INIS)

Singh, A.; Saunders, C.B.; Lopata, V.J.; Kremers, W.; Chung, M.

1995-01-01

Electron curing of fiber-reinforced composites to produce materials with good mechanical properties has been demonstrated by the authors' work, and by Aerospatiale. The attractions of this technology are the technical and processing advantages offered over thermal curing, and the projected cost benefits. Though the work so far has focused on the higher value composites for the aircraft and aerospace industries, the technology can also be used to produce composites for the higher volume industries, such as transportation and automotive

Radiation cured acrylonitrile--butadiene elastomers

International Nuclear Information System (INIS)

Eldred, R.J.

1976-01-01

In accordance with a preferred embodiment of this invention, the ultimate elongation of an electron beam radiation cured acrylonitrile-butadiene elastomer is significantly increased by the incorporation of a preferred noncrosslinking monomer, glycidyl methacrylate, in combination with the conventional crosslinking monomer, trimethylolpropanetrimethacrylate, prior to the radiation curing process

Techniques for internal water curing of concrete

DEFF Research Database (Denmark)

Jensen, Ole Mejlhede; Pietro, Lura

2003-01-01

This paper gives an overview of different techniques for incorporation of internal curing water in concrete. Internal curing can be used to mitigate self-desiccation and self-desiccation shrinkage. Some concretes may need 50 kg/m3 of internal curing water for this purpose. The price of the internal...

A cure for HIV: is it in sight?

Science.gov (United States)

Pace, Matthew; Frater, John

2014-07-01

HIV is a devastating disease affecting millions of people worldwide despite the advent of successful antiretroviral therapy (ART). However, ART does not result in a cure and has to be taken for life. Accordingly, researchers are turning towards cure efforts, particularly in the light of two patients whose HIV has been seemingly eradicated. Numerous approaches and strategies have been considered for curing HIV, but no scalable and safe solution has yet been reached. With newly discovered difficulties in measuring the HIV reservoir, the main barrier to a cure, the only true test of cure is to stop ART and see whether the virus becomes detectable. However, it is possible that this treatment interruption may be associated with certain risks for patients. Here, we compare the current major approaches and recent advances for curing HIV, as well as discuss ways of evaluating HIV cure and the safety concerns involved.

Hematocrit correction does not improve glucose monitor accuracy in the assessment of neonatal hypoglycemia.

Science.gov (United States)

Wang, Li; Sievenpiper, John L; de Souza, Russell J; Thomaz, Michele; Blatz, Susan; Grey, Vijaylaxmi; Fusch, Christoph; Balion, Cynthia

2013-08-01

The lack of accuracy of point of care (POC) glucose monitors has limited their use in the diagnosis of neonatal hypoglycemia. Hematocrit plays an important role in explaining discordant results. The objective of this study was to to assess the effect of hematocrit on the diagnostic performance of Abbott Precision Xceed Pro (PXP) and Nova StatStrip (StatStrip) monitors in neonates. All blood samples ordered for laboratory glucose measurement were analyzed using the PXP and StatStrip and compared with the laboratory analyzer (ABL 800 Blood Gas analyzer [ABL]). Acceptable error targets were ±15% for glucose monitoring and ±5% for diagnosis. A total of 307 samples from 176 neonates were analyzed. Overall, 90% of StatStrip and 75% of PXP values met the 15% error limit and 45% of StatStrip and 32% of PXP values met the 5% error limit. At glucose concentrations ≤4 mmol/L, 83% of StatStrip and 79% of PXP values met the 15% error limit, while 37% of StatStrip and 38% of PXP values met the 5% error limit. Hematocrit explained 7.4% of the difference between the PXP and ABL whereas it accounted for only 0.09% of the difference between the StatStrip and ABL. The ROC analysis showed the screening cut point with the best performance for identifying neonatal hypoglycemia was 3.2 mmol/L for StatStrip and 3.3 mmol/L for PXP. Despite a negligible hematocrit effect for the StatStrip, it did not achieve recommended error limits. The StatStrip and PXP glucose monitors remain suitable only for neonatal hypoglycemia screening with confirmation required from a laboratory analyzer.

Effect of various infection-control methods for light-cure units on the cure of composite resins.

Science.gov (United States)

Chong, S L; Lam, Y K; Lee, F K; Ramalingam, L; Yeo, A C; Lim, C C

1998-01-01

This study (1) compared the curing-light intensity with various barrier infection-control methods used to prevent cross contamination, (2) compared the Knoop hardness value of cured composite resin when various barrier control methods were used, and (3) correlated the hardness of the composite resin with the light-intensity output when different infection-control methods were used. The light-cure unit tips were covered with barriers, such as cellophane wrap, plastic gloves, Steri-shields, and finger cots. The control group had no barrier. Composite resins were then cured for each of the five groups, and their Knoop hardness values recorded. The results showed that there was significant statistical difference in the light-intensity output among the five groups. However, there was no significant statistical difference in the Knoop hardness values among any of the groups. There was also no correlation between the Knoop hardness value of the composite resin with the light-intensity output and the different infection-control methods. Therefore, any of the five infection-control methods could be used as barriers for preventing cross-contamination of the light-cure unit tip, for the light-intensity output for all five groups exceeded the recommended value of 300 W/m2. However, to allow a greater margin of error in clinical situations, the authors recommend that the plastic glove or the cellophane wrap be used to wrap the light-cure tip, since these barriers allowed the highest light-intensity output.

Congenital hyperinsulinism: current trends in diagnosis and therapy

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Bellanné-Chantelot Christine

2011-10-01

Full Text Available Abstract Congenital hyperinsulinism (HI is an inappropriate insulin secretion by the pancreatic β-cells secondary to various genetic disorders. The incidence is estimated at 1/50, 000 live births, but it may be as high as 1/2, 500 in countries with substantial consanguinity. Recurrent episodes of hyperinsulinemic hypoglycemia may expose to high risk of brain damage. Hypoglycemias are diagnosed because of seizures, a faint, or any other neurological symptom, in the neonatal period or later, usually within the first two years of life. After the neonatal period, the patient can present the typical clinical features of a hypoglycemia: pallor, sweat and tachycardia. HI is a heterogeneous disorder with two main clinically indistinguishable histopathological lesions: diffuse and focal. Atypical lesions are under characterization. Recessive ABCC8 mutations (encoding SUR1, subunit of a potassium channel and, more rarely, recessive KCNJ11 (encoding Kir6.2, subunit of the same potassium channel mutations, are responsible for most severe diazoxide-unresponsive HI. Focal HI, also diazoxide-unresponsive, is due to the combination of a paternally-inherited ABCC8 or KCNJ11 mutation and a paternal isodisomy of the 11p15 region, which is specific to the islets cells within the focal lesion. Genetics and 18F-fluoro-L-DOPA positron emission tomography (PET help to diagnose diffuse or focal forms of HI. Hypoglycemias must be rapidly and intensively treated to prevent severe and irreversible brain damage. This includes a glucose load and/or a glucagon injection, at the time of hypoglycemia, to correct it. Then a treatment to prevent the recurrence of hypoglycemia must be set, which may include frequent and glucose-enriched feeding, diazoxide and octreotide. When medical and dietary therapies are ineffective, or when a focal HI is suspected, surgical treatment is required. Focal HI may be definitively cured when the partial pancreatectomy removes the whole lesion. By

Mechanical properties of self-curing concrete (SCUC

Directory of Open Access Journals (Sweden)

Magda I. Mousa

2015-12-01

Full Text Available The mechanical properties of concrete containing self-curing agents are investigated in this paper. In this study, two materials were selected as self-curing agents with different amounts, and the addition of silica fume was studied. The self-curing agents were, pre-soaked lightweight aggregate (Leca; 0.0%, 10%, 15%, and 20% of volume of sand; or polyethylene-glycol (Ch.; 1%, 2%, and 3% by weight of cement. To carry out this study the cement content of 300, 400, 500 kg/m3, water/cement ratio of 0.5, 0.4, 0.3 and 0.0%, 15% silica fume of weight of cement as an additive were used in concrete mixes. The mechanical properties were evaluated while the concrete specimens were subjected to air curing regime (in the laboratory environment with 25 °C, 65% R.H. during the experiment. The results show that, the use of self-curing agents in concrete effectively improved the mechanical properties. The concrete used polyethylene-glycol as self-curing agent, attained higher values of mechanical properties than concrete with saturated Leca. In all cases, either 2% Ch. or 15% Leca was the optimum ratio compared with the other ratios. Higher cement content and/or lower water/cement ratio lead(s to more efficient performance of self-curing agents in concrete. Incorporation of silica fume into self-curing concrete mixture enhanced all mechanical properties, not only due to its pozzolanic reaction, but also due to its ability to retain water inside concrete.

Effects of Alcohol on Plasma Glucose and Prevention of Alcohol-induced Hypoglycemia in Type 1 Diabetes - A Systematic Review with GRADE

DEFF Research Database (Denmark)

Tetzschner, R; Nørgaard, K; Ranjan, A

2018-01-01

systematically reviewed the literature for ethanol effects on plasma glucose and for prevention strategies on ethanol-induced hypoglycemia. METHODS: Electronic searches on PubMed and Google were conducted in February 2017. Randomized clinical trials and observational studies were included. Studies involved...... patients with T1D with no history of ethanol abuse. The primary aims were changes in plasma glucose after ethanol intake and prevention strategies for ethanol-induced hypoglycemia. Quality of the studies was assessed by GRADE. Additionally, we searched for guidelines from diabetes associations...

Severe Hypoglycemia due to Isolated ACTH Deficiency in Children: A New Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Michael Y. Torchinsky

2011-01-01

Full Text Available Isolated ACTH deficiency causes life-threatening severe hypoglycemia. A 7-year-old girl with hypoglycemia due to this rare disorder is described. Our patient had undetectable plasma ACTH repeatedly and cortisol 0 mcg/dl before and after ACTH 1-24 stimulation. There was no evidence of other pituitary hormone deficiency. Glucocorticoid replacement therapy resulted in resolution of all symptoms and normalization of blood glucose. Previously published data on isolated ACTH deficiency in children is summarized. Review of the literature showed that the prevalence of this condition could be underestimated in the neonatal period and in Prader-Willi syndrome. Isolated ACTH deficiency occurs in older children as well as in neonates.

Familial hyperinsulinemic hypoglycemia caused by a defect in the SCHAD enzyme of mitochondrial fatty acid oxidation

NARCIS (Netherlands)

Molven, Anders; Matre, Guri E.; Duran, Marinus; Wanders, Ronald J.; Rishaug, Unni; Njølstad, Pål R.; Jellum, Egil; Søvik, Oddmund

2004-01-01

Inappropriately elevated insulin secretion is the hallmark of persistent hyperinsulinemic hypoglycemia of infancy (PHHI), also denoted congenital hyperinsulinism. Causal mutations have been uncovered in genes coding for the beta-cell's ATP-sensitive potassium channel and the metabolic enzymes

Radiation curing - twenty five years on

International Nuclear Information System (INIS)

Garnett, J.L.

1995-01-01

Progress in UV/EB curing during the past twenty five years is briefly reviewed. During this time developments in unique polymer chemistry, novel equipment design and the introduction of relevant educational programmes has enabled radiation curing to become an established technology with specific strengths in certain industries. Possible reasons for the emergence of the technology in these niche markets are discussed. Despite the worldwide recession, radiation curing is shown to be expanding at 5% per annum with the prospect of higher growth with improving economic conditions. (Author)

Silicone rubber curing by high intensity infrared radiation

International Nuclear Information System (INIS)

Huang, T.; Tsai, J.; Cherng, C.; Chen, J.

1994-01-01

A high-intensity (12 kW) and compact (80 cm) infrared heating oven for fast curing (12 seconds) of tube-like silicone rubber curing studies is reported. Quality inspection by DSC and DMA and results from pilot-scale curing oven all suggest that infrared heating provides a better way of vulcanization regarding to curing time, quality, cost, and spacing over conventional hot air heating. copyright 1995 American Institute of Physics

Usefulness of continuous glucose monitoring for the diagnosis of hypoglycemia after a gastric bypass in a patient previously treated for type 2 diabetes.

Science.gov (United States)

Hanaire, Hélène; Dubet, Audrey; Chauveau, Marie-Emilie; Anduze, Yves; Fernandes, Martine; Melki, Vincent; Ritz, Patrick

2010-01-01

Hypoglycemia is rare after a gastric bypass and can be taken for a dumping syndrome. There is no report in the literature of the contribution of continuous glucose monitoring to the diagnosis of hypoglycemia in these circumstances. The present case report shows that continuous glucose monitoring can be a useful tool for the diagnosis and the management of such episodes. Continuous glucose monitoring revealed hypoglycemic episodes in free living circumstances that were not present during 72-h fasting. These episodes followed wide hyperglycemic swings. No such episode resumed over 8 months after specific dietary advices and treatment by 50 mg TID of acarbose. Because hypoglycemia can be difficult to diagnose from dumping syndrome, continuous glucose monitoring is a very useful tool revealing the episodes in free living circumstances and can be used to monitor the treatment success.

Effect of curing modes of dual-curing core systems on microtensile bond strength to dentin and formation of an acid-base resistant zone.

Science.gov (United States)

Li, Na; Takagaki, Tomohiro; Sadr, Alireza; Waidyasekera, Kanchana; Ikeda, Masaomi; Chen, Jihua; Nikaido, Toru; Tagami, Junji

2011-12-01

To evaluate the microtensile bond strength (μTBS) and acid-base resistant zone (ABRZ) of two dualcuring core systems to dentin using four curing modes. Sixty-four caries-free human molars were randomly divided into two groups according to two dual-curing resin core systems: (1) Clearfil DC Core Automix; (2) Estelite Core Quick. For each core system, four different curing modes were applied to the adhesive and core resin: (1) dual-cured and dual-cured (DD); (2) chemically cured and dual-cured (CD); (3) dual-cured and chemically cured (DC); (4) chemically cured and chemically cured (CC). The specimens were sectioned into sticks (n = 20 for each group) for the microtensile bond test. μTBS data were analyzed using two-way ANOVA and the Dunnett T3 test. Failure patterns were examined with scanning electron microscopy (SEM) to determine the proportion of each mode. Dentin sandwiches were produced and subjected to an acid-base challenge. After argon-ion etching, the ultrastructure of ABRZ was observed using SEM. For Clearfil DC Core Automix, the μTBS values in MPa were as follows: DD: 29.1 ± 5.4, CD: 21.6 ± 5.6, DC: 17.9 ± 2.8, CC: 11.5 ± 3.2. For Estelite Core Quick, they were: DD: 48.9 ±5.7, CD: 20.5 ± 4.7, DC: 41.4 ± 8.3, CC: 19.1 ± 6.0. The bond strength was affected by both material and curing mode, and the interaction of the two factors was significant (p < 0.001). Within both systems, there were significant differences among groups, and the DD group showed the highest μTBS (p < 0.05). ABRZ morphology was not affected by curing mode, but it was highly adhesive-material dependent. The curing mode of dual-curing core systems affects bond strength to dentin, but has no significant effect on the formation of ABRZ.

Experimental Study on the Curing Effect of Dredged Sediments with Three Types of Curing Agents

Directory of Open Access Journals (Sweden)

Yan Lei-Ming

2016-01-01

Full Text Available Sediment solidification technology is widely used to dispose dredged sediment, three types of curing agents were used in this study to solidified the dredged sediment from shallows in Nantong with three types of curing agents: JY, ZL and FJ. The results showed that the optimal additive amounts of these three curing agents were 140g JY, 16g ZL, 2.0g FJ per 1000g of the dredged sediment respectively, their 28d USC were up to 2.48 MPa, 2.96 MPa and 3.00 MPa. JY has obvious early strength effect, which of FJ is not that obvious, but the later-stage strength of sediment solidified by FJ are relatively higher.

Effect of curing methods, packaging and gamma irradiation on the weight loss and dry matter percent of garlic during curing and storage

International Nuclear Information System (INIS)

Mahmoud, A.A.; El-Oksh, I.I.; Farag, S.E.A.

1988-01-01

The Egyptian garlic plants, showed higher percent of weight loss at 17 or 27 days from curing compared to those of Chinese plants. The curing period of 17 days seemed satisfactory for the Egyptian cultivar, whereas, 27 days seemed to be enough for the Chinese garlic. No significant differences were observed between common and shaded curing methods in weight loss per cent. The Chinese garlic contained higher dry matter percentage than those of the Egyptian cultivar. Shaded cured plants of the two cultivars contained higher dry matter percent than those subjected to the common curing methods. Irradiation of garlic bulbs, shaded curing method and sack packaging decreased, in general the weight loss during storage in comparison with other treatments

Proceedings of workshop on surface finishing by radiation curing technology: radiation curing for better finishing

International Nuclear Information System (INIS)

1993-01-01

This book compiled the paper presented at this workshop. The papers discussed are 1. Introduction to radiation curing, 2. Radiation sources -ultraviolet and electron beams, 3. UV/EB curing of surface coating - wood and nonwood substrates, 4. Development of EPOLA (epoxidised palm oil products acrylate) and its application, 5. Development of radiation-curable resin based natural rubber

Proceedings of workshop on surface finishing by radiation curing technology: radiation curing for better finishing

Energy Technology Data Exchange (ETDEWEB)

NONE

1994-12-31

This book compiled the paper presented at this workshop. The papers discussed are 1. Introduction to radiation curing, 2. Radiation sources -ultraviolet and electron beams, 3. UV/EB curing of surface coating - wood and nonwood substrates, 4. Development of EPOLA (epoxidised palm oil products acrylate) and its application, 5. Development of radiation-curable resin based natural rubber.

Impact of symptomatic hypoglycemia on medication adherence, patient satisfaction with treatment, and glycemic control in patients with type 2 diabetes

Directory of Open Access Journals (Sweden)

Walz L

2014-04-01

Full Text Available Lotta Walz,1,3 Billie Pettersson,2,3 Ulf Rosenqvist,4 Anna Deleskog,3,5 Gunilla Journath,6 Per Wändell7 1Department of Oncology-Pathology, Karolinska Institutet, Stockholm, 2Center for Medical Technology Assessment, Linköping University, Linköping, 3Merck Sharp and Dohme (Sweden AB, Sollentuna, 4Department of Internal Medicine, Motala Hospital, Motala, 5Department of Molecular Medicine and Surgery, 6Department of Medicine, Karolinska Institutet, Stockholm, 7Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden Background: The purpose of this study was to evaluate the impact of symptomatic hypoglycemia on medication adherence, satisfaction with treatment, and glycemic control in patients with type 2 diabetes based on the treatment goals stated in the Swedish national guidelines. Methods: This cross-sectional, multicenter study was carried out between January and August 2009 in 430 consecutive primary health care patients on stable doses of metformin and sulfonylureas for at least 6 months. The patients completed questionnaires covering their experiences of low blood glucose and adherence, as well as barriers to and satisfaction with drug treatment (using the Treatment Satisfaction Questionnaire for Medication. Physicians collected the data from medical records. Results: Patients who experienced moderate or worse symptoms of hypoglycemia reported poorer adherence to medication (46% versus 67%; P<0.01 and were more likely to perceive barriers such as “bothered by medication side effects” (36% versus 14%; P<0.001 compared with patients with no or mild symptoms. Patients with moderate or worse symptoms of hypoglycemia were less satisfied with their treatment than those with no or mild symptoms as determined by the Treatment Satisfaction Questionnaire for Medication-Global satisfaction (67.0 versus 71.2; P<0.05. Overall, achievement of target glycated hemoglobin

The incidence and risk factors associated with developing symptoms of hypoglycemia after bariatric surgery.

Science.gov (United States)

Lee, Clare J; Brown, Todd T; Schweitzer, Michael; Magnuson, Thomas; Clark, Jeanne M

2018-01-31

Hypoglycemia after bariatric surgery is an increasingly recognized metabolic complication associated with exaggerated secretion of insulin and gut hormones. We sought to determine the incidence of hypoglycemic symptoms (hypo-sx) after bariatric surgery and characteristics of those affected compared with those unaffected. University hospital. We collected retrospective survey data from the patients who underwent bariatric surgery at a single center. Based on number and severity of postprandial hypo-sx in Edinburgh hypoglycemia questionnaire postoperatively, patients without preoperative hypo-sx were grouped into high versus low suspicion for hypoglycemia. We used multivariable logistic regression to examine potential baseline and operative risk factors for the development of hypo-sx after surgery. Among the 1119 patients who had undergone bariatric surgery who received the questionnaire, 464 (40.6%) responded. Among the 341 respondents without preexisting hypo-sx, 29% (n = 99) had new-onset hypo-sx, and most were severe cases (n = 92) with neuroglycopenic symptoms. Compared with the low suspicion group, the high suspicion group consisted of more female patients, younger patients, patients without diabetes, and those who underwent Roux-en-Y gastric bypass with a longer time since surgery and more weight loss. In multivariate analysis, factors independently associated with incidence of hypo-sx after bariatric surgery were female sex (P = .003), Roux-en-Y gastric bypass (P = .001), and absence of preexisting diabetes (P = .011). New onset postprandial hypoglycemic symptoms after bariatric surgery are common, affecting up to a third of those who underwent bariatric surgery. Many affected individuals reported neuroglycopenic symptoms and were more likely to be female and nondiabetic and to have undergone Roux-en-Y gastric bypass. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Physical properties of self-curing concrete (SCUC

Directory of Open Access Journals (Sweden)

Magda I. Mousa

2015-08-01

The results show that the use of self-curing agent (Ch. in concrete effectively improves the physical properties compared with conventional concrete. On the other hand, up to 15% saturated leca was effective while 20% saturated leca was effective for permeability and mass loss but adversely affects the sorptivity and volumetric water absorption. Self-curing agent Ch. was more effective than self-curing agent leca. In all cases, both 2% Ch. and 15% leca were the optimum values. Higher cement content and/or lower water–cement ratio leads to more effective results of self-curing agents in concrete. Incorporation of silica fume into concrete mixtures enhances all physical properties.

Influence of erythropoietin on cognitive performance during experimental hypoglycemia in patients with type 1 diabetes mellitus

DEFF Research Database (Denmark)

Kristensen, Peter Lommer; Pedersen-Bjergaard, Ulrik; Kjær, Troels Wesenberg

2013-01-01

The incidence of severe hypoglycemia in type 1 diabetes has not decreased over the past decades. New treatment modalities minimizing the risk of hypoglycemic episodes and attenuating hypoglycemic cognitive dysfunction are needed. We studied if treatment with the neuroprotective hormone...

Comparing depth-dependent curing radiant exposure and time of curing of regular and flow bulk-fill composites

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Jose Augusto RODRIGUES

2017-08-01

Full Text Available Abstract The effect of restoration depth on the curing time of a conventional and two bulk-fill composite resins by measuring microhardness and the respective radiosity of the bottom surface of the specimen was investigated. 1-, 3- and 5-mm thick washers were filled with Surefil SDR Flow–U (SDR, Tetric EvoCeram Bulk Fill-IVA (TEC or Esthet-X HD–B1 (EHD, and cured with Bluephase® G2 for 40s. Additional 1-mm washers were filled with SDR, TEC or EHD, placed above the light sensor of MARC®, stacked with pre-cured 1-, 3- or 5-mm washer of respective material, and cured for 2.5~60s to mimic 2-, 4- and 6-mm thick composite curing. The sensor measured the radiosity (EB at the bottom of specimen stacks. Vickers hardness (VH was measured immediately at 5 locations with triplicate specimens. Nonlinear regression of VH vs EB by VH=α[1-exp(-EB/β] with all thickness shows that the values of α, maximum hardness, are 21.6±1.0 kg/mm2 for SDR, 38.3±0.6 kg/mm2 for TEC and 45.3±2.6 kg/mm2 for EHD, and the values of β, rate parameter, are 0.40±0.06 J/cm2 for SDR, 0.77±0.04 J/cm2 for TEC and 0.58±0.09 J/cm2 for EHD. The radiosity of the bottom surface was calculated when the bottom surface of each material attained 80% of α of each material. The curing times for each material are in agreement with manufacturer recommendation for thickness. It is possible to estimate time needed to cure composite resin of known depth adequately by the radiosity and microhardness of the bottom surface.

Comparing depth-dependent curing radiant exposure and time of curing of regular and flow bulk-fill composites.

Science.gov (United States)

Rodrigues, Jose Augusto; Tenorio, Ilana Pais; Mello, Ginger Baranhuk Rabello de; Reis, André Figueiredo; Shen, Chiayi; Roulet, Jean-François

2017-08-21

The effect of restoration depth on the curing time of a conventional and two bulk-fill composite resins by measuring microhardness and the respective radiosity of the bottom surface of the specimen was investigated. 1-, 3- and 5-mm thick washers were filled with Surefil SDR Flow-U (SDR), Tetric EvoCeram Bulk Fill-IVA (TEC) or Esthet-X HD-B1 (EHD), and cured with Bluephase® G2 for 40s. Additional 1-mm washers were filled with SDR, TEC or EHD, placed above the light sensor of MARC®, stacked with pre-cured 1-, 3- or 5-mm washer of respective material, and cured for 2.5~60s to mimic 2-, 4- and 6-mm thick composite curing. The sensor measured the radiosity (EB) at the bottom of specimen stacks. Vickers hardness (VH) was measured immediately at 5 locations with triplicate specimens. Nonlinear regression of VH vs EB by VH=α[1-exp(-EB/β)] with all thickness shows that the values of α, maximum hardness, are 21.6±1.0 kg/mm2 for SDR, 38.3±0.6 kg/mm2 for TEC and 45.3±2.6 kg/mm2 for EHD, and the values of β, rate parameter, are 0.40±0.06 J/cm2 for SDR, 0.77±0.04 J/cm2 for TEC and 0.58±0.09 J/cm2 for EHD. The radiosity of the bottom surface was calculated when the bottom surface of each material attained 80% of α of each material. The curing times for each material are in agreement with manufacturer recommendation for thickness. It is possible to estimate time needed to cure composite resin of known depth adequately by the radiosity and microhardness of the bottom surface.

Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia.

Science.gov (United States)

Rawat, Munmun; Chandrasekharan, Praveen; Turkovich, Stephen; Barclay, Nancy; Perry, Katherine; Schroeder, Eileen; Testa, Lisa; Lakshminrusimha, Satyan

2016-01-01

Newborn infants with risk factors may require intravenous (IV) dextrose for asymptomatic hypoglycemia. Administration of IV dextrose and transfer to the neonatal intensive care unit (NICU) may interfere with parent-infant bonding. To study the effect of implementing dextrose gel supplement with feeds in late preterm/term infants affected by asymptomatic hypoglycemia on reducing IV dextrose therapy. A retrospective study was conducted before and after dextrose gel use: 05/01/2014 to 10/31/2014 and 11/01/2014 to 04/30/2015, respectively. Asymptomatic hypoglycemic (blood glucose level dextrose gel (200 mg/kg of 40% dextrose) along with feeds. Transfer to the NICU for IV dextrose was considered treatment failure. Dextrose gel with feeds increased the blood glucose level in 184/250 (74%) of asymptomatic hypoglycemic infants compared to 144/248 (58%) with feeds only (p dextrose decreased from 35/1,000 to 25/1,000 live births (p dextrose gel with feeds reduced the need for IV fluids, avoided separation from the mother and promoted breastfeeding. Neonates who failed dextrose gel therapy were more likely to be large for gestational age, delivered by cesarean section and had lower baseline blood glucose levels.

Individuals with Type 1 and Type 2 Diabetes Mellitus Trade Increased Hyperglycemia for Decreased Hypoglycemia When Glycemic Variability is not Improved.

Science.gov (United States)

Jangam, Sujit R; Hayter, Gary; Dunn, Timothy C

2018-02-01

Glycemic variability refers to oscillations in blood glucose within a day and differences in blood glucose at the same time on different days. Glycemic variability is linked to hypoglycemia and hyperglycemia. The relationship among these three important metrics is examined here, specifically to show how reduction in both hypo- and hyperglycemia risk is dependent on changes in variability. To understand the importance of glycemic variability in the simultaneous reduction of hypoglycemia and hyperglycemia risk, we introduce the glycemic risk plot-estimated HbA1c % (eA1c) vs. minutes below 70 mg/dl (MB70) with constant variability contours for predicting post-intervention risks in the absence of a change in glycemic variability. The glycemic risk plot illustrates that individuals who do not reduce glycemic variability improve one of the two metrics (hypoglycemia risk or hyperglycemia risk) at the cost of the other. It is important to reduce variability to improve both risks. These results were confirmed by data collected in a randomized controlled trial consisting of individuals with type 1 and type 2 diabetes on insulin therapy. For type 1, a total of 28 individuals out of 35 (80%) showed improvement in at least one of the risks (hypo and/or hyper) during the 100-day course of the study. Seven individuals (20%) showed improvement in both. Similar data were observed for type 2 where a total of 36 individuals out of 43 (84%) showed improvement in at least one risk and 8 individuals (19%) showed improvement in both. All individuals in the study who showed improvement in both hypoglycemia and hyperglycemia risk also showed a reduction in variability. Therapy changes intended to improve an individual's hypoglycemia or hyperglycemia risk often result in the reduction of one risk at the expense of another. It is important to improve glucose variability to reduce both risks or at least maintain one risk while reducing the other. Abbott Diabetes Care.

Electron beam curing of coating

International Nuclear Information System (INIS)

Fujioka, S.; Fujikawa, Z.

1974-01-01

Electron beam curing (EBC) method, by which hardened coating film is obtained by polymerizing and cross-linking paint with electron beam, has finally reached industrialized stage. While about seven items such as short curing time, high efficiency of energy consumption, and homogeneous curing are enumerated as the advantages of EBC method, it has limitations of the isolation requirement from air needing the injection of inert gas, and considerable amount of initial investment. In the electron accelerators employed in EBC method, the accelerating voltage is 250 to 750 kV, and the tube current is several tens of mA to 200 mA. As an example of EBC applications, EBC ''Erio'' steel sheet was developed by the cooperative research of Nippon Steel Corp., Dai-Nippon Printing Co. and Toray Industries, Inc. It is a high-class pre-coated metal product made from galvanized steel sheets, and the flat sheets with cured coating are sold, and final products are fabricated by being worked in various shapes in users. It seems necessary to develop the paint which enables to raise added value by adopting the EBC method. (Wakatsuki, Y.)

Accelerated production of dry cured hams.

Science.gov (United States)

Marriott, N G; Graham, P P; Shaffer, C K; Phelps, S K

1987-01-01

Ten uncured legs from the right side of the sampled pork carcasses (Study A) were vacuum tumbled with the cure adjuncts for 30 min (T) and 10 counterparts from the left side were tumbled 30 min, rested 30 min and tumbled an additional 30 min (TRT). Evaluations were conducted at 40 and 70 days after cure application for color, taste attributes, percentage moisture, percentage salt and NO(3)(-) and NO(2)(-) content. Study B was the same except that 18 legs were boned, tumbled and cured for 40, 56 and 70 days. The TRT samples (Study A) at 40 days sustained less color fading (P 0.05) existed among the uncooked hams. Increased cure time enhanced moisture loss and salt content (Study A) and color retention during cookery (Study B). The TRT samples had increased moisture loss and salt content (Study A). Copyright © 1987. Published by Elsevier Ltd.

Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study.

Science.gov (United States)

Karateke, Ates; Haliloglu, Berna; Cam, Cetin; Sakalli, Mustafa

2009-02-01

Recently, mid-urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI). To investigate tension-free vaginal tape (TVT) and tension-free obturator tape (TVT-O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints). One-hundred and sixty-four patients were included in the study (n = 81 for TVT, n = 83 for TVT-O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q-tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures. The cure rates were similar in TVT and TVT-O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT-O group (P = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility (P = 0.001). The TVT and TVT-O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid-urethral slings.

Rubber curing chemistry governing the orientation of layered silicate

Directory of Open Access Journals (Sweden)

2007-11-01

Full Text Available The effect of curing systems on the orientation and the dispersion of the layered silicates in acrylonitrile butadiene rubber nanocomposite is reported. Significant differences in X-ray diffraction pattern between peroxide curing and sulfur curing was observed. Intense X-ray scattering values in the XRD experiments from peroxide cured vulcanizates indicate an orientation of the layers in a preferred direction as evinced by transmission electron micrographs. However, sulfur cured vulcanizates show no preferential orientation of the silicate particles. Nevertheless, a closer inspection of transmission electron microscopy (TEM images of peroxide and sulfur cured samples shows exfoliated silicate layers in the acrylonitrile butadiene rubber (NBR matrix. It was revealed in the prevailing study that the use of an excess amount of stearic acid in the formulation of the sulfur curing package leads to almost exfoliated type X-ray scattering pattern.

Curing kinetics of alkyd/melamine resin mixtures

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Jovičić Mirjana C.

2009-01-01

Full Text Available Alkyd resins are the most popular and useful synthetic resins applied as the binder in protective coatings. Frequently they are not used alone but are modified with other synthetic resins in the manufacture of the coatings. An alkyd/melamine resin mixture is the usual composition for the preparation of coating called 'baking enamel' and it is cured through functional groups of resins at high temperatures. In this paper, curing kinetics of alkyd resins based on castor oil and dehydrated castor oil with melamine resin, has been studied by DSC method with programmed heating and in isothermal mode. The results determined from dynamic DSC curves were mathematically transformed using the Ozawa isoconversional method for obtaining the isothermal data. These results, degree of curing versus time, are in good agreement with those determined by the isothermal DSC experiments. By applying the Ozawa method it is possible to calculate the isothermal kinetic parameters for the alkyd/melamine resin mixtures curing using only calorimetric data obtained by dynamic DSC runs. Depending on the alkyd resin type and ratio in mixtures the values of activation energies of curing process of resin mixtures are from 51.3 to 114 kJ mol-1. The rate constant of curing increases with increasing the content of melamine resin in the mixture and with curing temperature. The reaction order varies from 1.12 to 1.37 for alkyd based on dehydrated castor oil/melamine resin mixtures and from 1.74 to 2.03 for mixtures with alkyd based on castor oil. Based on the results obtained, we propose that dehydrated castor oil alkyd/melamine resin mixtures can be used in practice (curing temperatures from 120 to 160°C.

Short-term cost-effectiveness of insulin detemir and insulin aspart in people with type 1 diabetes who are prone to recurrent severe hypoglycemia

DEFF Research Database (Denmark)

Pedersen-Bjergaard, Ulrik; Kristensen, Peter Lommer; Nørgaard, Kirsten

2016-01-01

to a lower event rate. QALYs were higher with insulin analogues vs. human insulin (difference 0.0672). The resulting ICER was 27,685 DKK (2674 GBP) per QALY gained, which is well below the generally accepted cost–effectiveness threshold. Conclusions: The analysis shows that treating people with type 1......Objective: Based on the data of the HypoAna trial (ClinicalTrials.gov NCT00346996), a short-term cost–effectiveness analysis was conducted comparing an all insulin analogue regimen with an all human insulin regimen in people with type 1 diabetes who are prone to recurrent severe hypoglycemia....... Methods: Clinical data from the HypoAna trial and Danish cost data related to the treatment of severe hypoglycemia were used to populate a 1-year cost–effectiveness analysis. Hypoglycemia quality-of-life data were based on previously published utility values, used to calculate the quality-adjusted life...

Monitoring Prepregs As They Cure

Science.gov (United States)

Young, P. R.; Gleason, J. R.; Chang, A. C.

1986-01-01

Quality IR spectra obtained in dynamic heating environment. New technique obtains quality infrared spectra on graphite-fiber-reinforced, polymeric-matrix-resin prepregs as they cure. Technique resulted from modification of diffuse reflectance/Fourier transform infrared (DR/FTIR) technique previously used to analyze environmentally exposed cured graphite composites. Technique contribute to better understanding of prepreg chemistry/temperature relationships and development of more efficient processing cycles for advanced materials.

Catalyzed Synthesis and Characterization of a Novel Lignin-Based Curing Agent for the Curing of High-Performance Epoxy Resin

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Saeid Nikafshar

2017-07-01

Full Text Available In this study, lignin, an aromatic compound from the forestry industry, was used as a renewable material to synthesize a new aromatic amine curing agent for epoxy resin. Firstly, lignin was separated from black liquor and hydroxyl groups were converted to tosyl groups as leaving groups. Then, primary amination was conducted using an ammonia solution at high pressure and temperature, in the presence of a nano-alumina-based catalyst. The structure of the nanocatalyst was confirmed by FT-IR, ICP, SEM, and XPS analyses. According to the FT-IR spectra, a demethylation reaction, the substitution of hydroxyl groups with tosyl groups, and then an amination reaction were successfully performed on lignin, which was further confirmed by the 13C NMR and CHNS analyses. The active hydrogen equivalent of aminated lignin was determined and three samples with 9.9 wt %, 12.9 wt %, and 15.9 wt % of aminated lignin, as curing agents, were prepared for curing the diglycidyl ether of bisphenol A (DGEBA. The thermal characteristics of the curing process of these epoxy samples were determined by DSC and TGA analyses. Moreover, the mechanical performance of the cured epoxy systems, e.g., the tensile strength and Izod impact strength, were measured, showing that in the presence of 12.9 wt % aminated lignin, the mechanical properties of the aminated lignin-epoxy system exhibited the best performance, which was competitive, compared to the epoxy systems cured by commercial aromatic curing agents.

Translating Genomic Discoveries to Cure Ultrahypermutant ...

International Development Research Centre (IDRC) Digital Library (Canada)

Translating Genomic Discoveries to Cure Ultrahypermutant Mismatch Repair Deficient Brain Tumours. Malignant brain tumours are the most common cause of death among children with cancer, but there is no known cure. This project will advance research in this important field. Inherited mutations and childhood cancer.

Influence of curing time, overlay material and thickness on three light-curing composites used for luting indirect composite restorations.

Science.gov (United States)

D'Arcangelo, Camillo; De Angelis, Francesco; Vadini, Mirco; Carluccio, Fabio; Vitalone, Laura Merla; D'Amario, Maurizio

2012-08-01

To assess the microhardness of three resin composites employed in the adhesive luting of indirect composite restorations and examine the influence of the overlay material and thickness as well as the curing time on polymerization rate. Three commercially available resin composites were selected: Enamel Plus HRI (Micerium) (ENA), Saremco ELS (Saremco Dental) (SAR), Esthet-X HD (Dentsply/DeTrey) (EST-X). Post-polymerized cylinders of 6 different thicknesses were produced and used as overlays: 2 mm, 3 mm, 3.5 mm, 4 mm, 5 mm, and 6 mm. Two-mm-thick disks were produced and employed as underlays. A standardized amount of composite paste was placed between the underlay and the overlay surfaces which were maintained at a fixed distance of 0.5 mm. Light curing of the luting composite layer was performed through the overlays for 40, 80, or 120 s. For each specimen, the composite to be cured, the cured overlay, and the underlay were made out of the same batch of resin composite. All specimens were assigned to three experimental groups on the basis of the resin composite used, and to subgroups on the basis of the overlay thickness and the curing time, resulting in 54 experimental subgroups (n = 5). Forty-five additional specimens, 15 for each material under investigation, were produced and subjected to 40, 80, or 120 s of light curing using a microscope glass as an overlay; they were assigned to 9 control subgroups (n = 5). Three Vicker's hardness (VH) indentations were performed on each specimen. Means and standard deviations were calculated. Data were statistically analyzed using 3-way ANOVA. Within the same material, VH values lower than 55% of control were not considered acceptable. The used material, the overlay thickness, and the curing time significantly influenced VH values. In the ENA group, acceptable hardness values were achieved with 3.5-mm or thinner overlays after 120 or 80 s curing time (VH 41.75 and 39.32, respectively), and with 2-mm overlays after 40 s (VH 54

Radiation cured coating containing glitter particles and process therefor

International Nuclear Information System (INIS)

Sachs, P.R.; Sears, J.W.

1992-01-01

Radiation curable coatings for use on a variety of substrates and curable by exposure to ionizing irradiation of ultraviolet light are well known. The use of urethane type coatings cured with ultraviolet light to provide protective wear layers for wall or floor tile is for instance described in U.S. Pat. No. 4,180,615. U.S. Pat. No. 3,918,393 describes a method for obtaining a non-glossy coating on various substrates by curing radiation sensitive material with ionizing irradiation or ultraviolet light in two stages. In this process the coating is partially cured in an oxygen-containing atmosphere and the curing is completed in an inert atmosphere. U.S. Pat. No. 4,122,225 discloses a method and apparatus for coating tile which involves the application of one coat of radiation curable material to an entire substrate followed by partial curing and the subsequent application and curing of a second coat or radiation curable material only on high areas of the substrate which are subject to greater than average wear. Use of pigment in radiation cured coatings on products such as floor covering which are subject to wear during use has presented substantial difficulties. Incorporation of pigment, especially enough pigment to make the coating opaque, makes the coating hard to cure and substantially reduces the thicknesses of coating which can be cured relative to a clear coating cured under the same conditions

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

Science.gov (United States)

Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara

2016-01-01

The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

Accelerated Cure Project for Multiple Sclerosis

Science.gov (United States)

... questions and enable an era of optimized MS treatment. Read more... The Accelerated Cure Project for MS is a non-profit, 501(c)(3) tax-exempt organization whose mission is to accelerate efforts toward a cure for multiple sclerosis by rapidly advancing research that determines its causes ...

7 CFR 29.3002 - Air-cured.

Science.gov (United States)

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Air-cured. 29.3002 Section 29.3002 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing...-cured tobacco should not carry the odor of smoke or fumes resulting from the application of artificial...

Microwave and thermal curing of an epoxy resin for microelectronic applications

Energy Technology Data Exchange (ETDEWEB)

Johnston, K. [Institute of Chemical Sciences, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Pavuluri, S.K.; Leonard, M.T.; Desmulliez, M.P.Y. [MIcroSystems Engineering Centre (MISEC), Institute of Signals, Sensors and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Arrighi, V., E-mail: v.arrighi@hw.ac.uk [Institute of Chemical Sciences, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom)

2015-09-20

Graphical abstract: - Highlights: • Thermal and microwave curing of a commercial epoxy resin EO1080 are compared. • Microwave curing increases cure rate and does not adversely affect properties. • The curing of EO1080 is generally autocatalytic but deviates at high conversion. • Microwave radiation has a more complex effect on curing kinetics. - Abstract: Microwave curing of thermosetting polymers has a number of advantages to natural or thermal oven curing and is considered a cost-effective alternative. Here we present a detailed study of a commercially available epoxy resin, EO1080. Samples that are thermally cured are compared to curing using a recently developed modular microwave processing system. For commercial purposes it is crucial to demonstrate that microwave curing does not adversely affect the thermal and chemical properties of the material. Therefore, the kinetics of cure and various post cure properties of the resin are investigated. Attenuated Total Reflectance Fourier-Transform Infrared (ATR-FTIR) analysis shows no significant difference between the conventionally and microwave cured samples. Differential scanning calorimetry (DSC) is used to monitor the kinetics of the curing reaction, as well as determine the thermal and ageing properties of the material. As expected, the rate of curing is higher when using microwave energy and we attempt to quantify differences compared to conventional thermal curing. No change in glass transition temperature (T{sub g}) is observed. For the first time, enthalpy relaxation measurements performed on conventional and microwave cured samples are reported and these indicate similar ageing properties at any given temperature under T{sub g}.

Microwave and thermal curing of an epoxy resin for microelectronic applications

International Nuclear Information System (INIS)

Johnston, K.; Pavuluri, S.K.; Leonard, M.T.; Desmulliez, M.P.Y.; Arrighi, V.

2015-01-01

Graphical abstract: - Highlights: • Thermal and microwave curing of a commercial epoxy resin EO1080 are compared. • Microwave curing increases cure rate and does not adversely affect properties. • The curing of EO1080 is generally autocatalytic but deviates at high conversion. • Microwave radiation has a more complex effect on curing kinetics. - Abstract: Microwave curing of thermosetting polymers has a number of advantages to natural or thermal oven curing and is considered a cost-effective alternative. Here we present a detailed study of a commercially available epoxy resin, EO1080. Samples that are thermally cured are compared to curing using a recently developed modular microwave processing system. For commercial purposes it is crucial to demonstrate that microwave curing does not adversely affect the thermal and chemical properties of the material. Therefore, the kinetics of cure and various post cure properties of the resin are investigated. Attenuated Total Reflectance Fourier-Transform Infrared (ATR-FTIR) analysis shows no significant difference between the conventionally and microwave cured samples. Differential scanning calorimetry (DSC) is used to monitor the kinetics of the curing reaction, as well as determine the thermal and ageing properties of the material. As expected, the rate of curing is higher when using microwave energy and we attempt to quantify differences compared to conventional thermal curing. No change in glass transition temperature (T g ) is observed. For the first time, enthalpy relaxation measurements performed on conventional and microwave cured samples are reported and these indicate similar ageing properties at any given temperature under T g

Financing cures in the United States.

Science.gov (United States)

Basu, Anirban

2015-02-01

True cures in health care are rare but likely not for long. The high price tag that accompanies a cure along with its rapid uptake create challenges in the financing of cures by public and private payers. In the US, the disaggregated nature of health insurance system adds to this challenge as patients frequently churn across multiple health plans. This creates a 'free-rider' problem, where no one health plan has the incentive to invest in cure since the returns will be scattered over many health plans. Here, a new health currency is proposed as a generalized version of a social impact bond that has the potential to solve this free-rider problem, as it can be traded not only between public and private payers but also within the private sector. An ensuing debate as to whether and how to develop such a currency can serve the US health care system well.

Glucose and amino acid metabolism in rat brain during sustained hypoglycemia

International Nuclear Information System (INIS)

Wong, K.L.; Tyce, G.M.

1983-01-01

The metabolism of glucose in brains during sustained hypoglycemia was studied. [U- 14 C]Glucose (20 microCi) was injected into control rats, and into rats at 2.5 hr after a bolus injection of 2 units of insulin followed by a continuous infusion of 0.2 units/100 g rat/hr. This regimen of insulin injection was found to result in steady-state plasma glucose levels between 2.5 and 3.5 mumol per ml. In the brains of control rats carbon was transferred rapidly from glucose to glutamate, glutamine, gamma-aminobutyric acid and aspartate and this carbon was retained in the amino acids for at least 60 min. In the brains of hypoglycemic rats, the conversion of carbon from glucose to amino acids was increased in the first 15 min after injection. After 15 min, the specific activity of the amino acids decreased in insulin-treated rats but not in the controls. The concentrations of alanine, glutamate, and gamma-amino-butyric acid decreased, and the concentration of aspartate increased, in the brains of the hypoglycemic rats. The concentration of pyridoxal-5'-phosphate, a cofactor in many of the reactions whereby these amino acids are formed from tricarboxylic acid cycle intermediates, was less in the insulin-treated rats than in the controls. These data provide evidence that glutamate, glutamine, aspartate, and GABA can serve as energy sources in brain during insulin-induced hypoglycemia

Photoacoustic monitoring of inhomogeneous curing processes in polystyrene emulsions

International Nuclear Information System (INIS)

Vargas-Luna, M.; Gutierrez-Juarez, G.; Rodriguez-Vizcaino, J.M.; Varela-Nsjera, J.B.; Rodriguez-Palencia, J.M.; Bernal-Alvarado, J.; Sosa, M.; Alvarado-Gil, J.J.

2002-01-01

The time evolution of the inhomogeneous curing process of polystyrene emulsions is studied using a variant of the conventional photoacoustic (PA) technique. The thermal effusivity, as a function of time, is determined in order to monitor the sintering process of a styrene emulsion in different steps of the manufacturing procedure. PA measurements of thermal effusivity show a sigmoidal growth as a function of time during the curing process. The parameterization of these curves permits the determination of the characteristic curing time and velocity of the process. A decreasing of the curing time and an increasing curing velocity for the final steps of the manufacturing process are observed. The feasibility of our approach and its potentiality for the characterization of other curing process are discussed. (author)

7 CFR 29.1019 - Flue-cured.

Science.gov (United States)

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Flue-cured. 29.1019 Section 29.1019 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... tobacco; or tobacco cured by some other process which accomplishes the same results. [42 FR 21092, Apr. 25...

CURING OF POLYMERIC COMPOSITES USING MICROWAVE RESIN TRANSFER MOULDING (RTM

Directory of Open Access Journals (Sweden)

R. YUSOFF

2007-08-01

Full Text Available The main objective of this work is to compare the difference between microwave heating and conventional thermal heating in fabricating carbon/epoxy composites. Two types of epoxy resin systems were used as matrices, LY5052-HY5052 and DGEBA-HY917-DY073. All composite samples were fabricated using resin transfer moulding (RTM technique. The curing of the LY5052-HY5052-carbon and the DGEBA-HY917-DY073-carbon composite systems, were carried out at 100 °C and 120 °C, respectively. Microwave heating showed better temperature control than conventional heating, however, the heating rate of the microwave cured samples were slower than the conventionally cured samples. This was attributed to the lower power (250 W used when heating with microwaves compared to 2000 W used in conventional heating. Study of thermal characteristics as curing progressed showed that the polymerisation reaction occurred at a faster rate during microwave curing than in conventional curing for both the DGEBA and the LY/HY5052 carbon composite systems. The actual cure cycle was reduced from 60 minutes to 40 minutes when using microwaves for curing DGEBA-carbon composites. As for LY/HY5052-carbon composites, the actual cure cycle was reduced from 3 hours to 40 minutes. Both conventional and microwave heating yielded similar glass transition temperatures (120 °C for DGEBA systems and 130 °C for LY/HY5052 systems. Microwave cured composites had higher void contents than conventionally cured composites (2.2-2.8% and 1.8-2.4% for DGEBA and LY/HY5052 microwave cured composites, respectively, compared to 0.2-0.4% for both DGEBA and LY/HY5052 thermally cured composites. C-scan traces showed that all composites, regardless of methods of curing, had minimal defects.

Determinant of flexible Parametric Estimation of Mixture Cure ...

African Journals Online (AJOL)

AIC, mean time to cure), variance and cure fraction (c) were used to determine the flexible Parametric Cure Fraction Model among the considered models. Gastric Cancer data from 76 patients received adjuvant CRT and 125 receiving resection (surgery) alone were used to confirm the suitability of the models. The data was ...

Curing of Thick Thermoset Composite Laminates: Multiphysics Modeling and Experiments

Science.gov (United States)

Anandan, S.; Dhaliwal, G. S.; Huo, Z.; Chandrashekhara, K.; Apetre, N.; Iyyer, N.

2017-11-01

Fiber reinforced polymer composites are used in high-performance aerospace applications as they are resistant to fatigue, corrosion free and possess high specific strength. The mechanical properties of these composite components depend on the degree of cure and residual stresses developed during the curing process. While these parameters are difficult to determine experimentally in large and complex parts, they can be simulated using numerical models in a cost-effective manner. These simulations can be used to develop cure cycles and change processing parameters to obtain high-quality parts. In the current work, a numerical model was built in Comsol MultiPhysics to simulate the cure behavior of a carbon/epoxy prepreg system (IM7/Cycom 5320-1). A thermal spike was observed in thick laminates when the recommended cure cycle was used. The cure cycle was modified to reduce the thermal spike and maintain the degree of cure at the laminate center. A parametric study was performed to evaluate the effect of air flow in the oven, post cure cycles and cure temperatures on the thermal spike and the resultant degree of cure in the laminate.

Radiation curing--new technology of green industries facing 21st century

International Nuclear Information System (INIS)

Wang Jianguo; Teng Renrui

2000-01-01

The development of radiation curing was simply reviewed and the mechanism of UV curing and EB curing, the equipment and materials used in the radiation curing were also introduced. Compared with ordinary curing, the radiation curing has advantages of energy saving, high effectiveness and little pollution. It is a new technology of green industries facing the 21st century

Overview of UV and EB curing

International Nuclear Information System (INIS)

Garnett, J.L.

2000-01-01

Full text: UV and EB are complementary techniques in radiation curing. In the proposed paper, a brief review of both fields will be given. This will include principles of the process, the chemistry of the systems including monomers/oligomers/polymers used, additives required where necessary such as photoinitiators for UV, flow aids, adhesion promoters and the like. The types of equipment used in such processes will also be discussed including low energy electron beam utilisation and excimer curing. The advantages and disadvantages of both techniques will be examined. Mechanistic aspects of both curing systems will be discussed. Applications of the technology including developments in the banknote printing field will be summarised

A Comparison of Curing Process-Induced Residual Stresses and Cure Shrinkage in Micro-Scale Composite Structures with Different Constitutive Laws

Science.gov (United States)

Li, Dongna; Li, Xudong; Dai, Jianfeng; Xi, Shangbin

2018-02-01

In this paper, three kinds of constitutive laws, elastic, "cure hardening instantaneously linear elastic (CHILE)" and viscoelastic law, are used to predict curing process-induced residual stress for the thermoset polymer composites. A multi-physics coupling finite element analysis (FEA) model implementing the proposed three approaches is established in COMSOL Multiphysics-Version 4.3b. The evolution of thermo-physical properties with temperature and degree of cure (DOC), which improved the accuracy of numerical simulations, and cure shrinkage are taken into account for the three models. Subsequently, these three proposed constitutive models are implemented respectively in a 3D micro-scale composite laminate structure. Compared the differences between these three numerical results, it indicates that big error in residual stress and cure shrinkage generates by elastic model, but the results calculated by the modified CHILE model are in excellent agreement with those estimated by the viscoelastic model.

High Power UV LED Industrial Curing Systems

Energy Technology Data Exchange (ETDEWEB)

Karlicek, Robert, F., Jr; Sargent, Robert

2012-05-14

UV curing is a green technology that is largely underutilized because UV radiation sources like Hg Lamps are unreliable and difficult to use. High Power UV LEDs are now efficient enough to replace Hg Lamps, and offer significantly improved performance relative to Hg Lamps. In this study, a modular, scalable high power UV LED curing system was designed and tested, performing well in industrial coating evaluations. In order to achieve mechanical form factors similar to commercial Hg Lamp systems, a new patent pending design was employed enabling high irradiance at long working distances. While high power UV LEDs are currently only available at longer UVA wavelengths, rapid progress on UVC LEDs and the development of new formulations designed specifically for use with UV LED sources will converge to drive more rapid adoption of UV curing technology. An assessment of the environmental impact of replacing Hg Lamp systems with UV LED systems was performed. Since UV curing is used in only a small portion of the industrial printing, painting and coating markets, the ease of use of UV LED systems should increase the use of UV curing technology. Even a small penetration of the significant number of industrial applications still using oven curing and drying will lead to significant reductions in energy consumption and reductions in the emission of green house gases and solvent emissions.

Could Continuous Glucose Monitoring Facilitate Identifying Diabetes Patients with a Higher Risk of Hypoglycemia during Driving?

Czech Academy of Sciences Publication Activity Database

Brož, J.; Doničová, V.; Brabec, Marek; Janíčková Žďárská, D.; Polák, J.

2013-01-01

Roč. 7, č. 6 (2013), s. 1644-1645 ISSN 1932-2968 Institutional support: RVO:67985807 Keywords : continuous glucose monitoring * driving * hypoglycemia * insulin pump * prevention * type 1 diabetes mellitus Subject RIV: BB - Applied Statistics, Operational Research http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876343/

Production of secondary metabolites by some terverticillate penicillia on carbohydrate-rich and meat substrates.

Science.gov (United States)

Núñez, Félix; Westphal, Carmen D; Bermúdez, Elena; Asensio, Miguel A

2007-12-01

Most terverticillate penicillia isolated from dry-cured meat products are toxigenic, but their ability to produce hazardous metabolites on meat-based substrates is not well known. The production of extrolites by selected terverticillate penicillia isolated from dry-cured ham has been studied on carbohydrate-rich media (malt extract agar, Czapek yeast autolysate agar, rice extract agar, and rice), meat extract triolein salt agar, and ham slices. Chloroform extracts from the selected strains grown on malt extract agar were toxic for the brine shrimp (Artemia salina) larvae and VERO cells at a concentration of 2 mg/ml, but 0.02 mg/ml produced no toxic effect. Analysis by high-pressure liquid chromatography (HPLC) coupled with photodiode array detection (DAD) or with mass spectrometry (MS) and an atmospheric pressure chemical ionization (APCI) source revealed different biologically active metabolites: cyclopiazonic acid and rugulovasine A from Penicillium commune; verrucosidin, anacine, puberuline, verrucofortine, and viridicatols from Penicillium polonicum; arisugacin and viridicatols from Penicillium echinulatum; and compactin and viridicatols from Penicillium solitum. Most of these metabolites, including the amino acid-derived compounds, were produced in the media containing high levels of carbohydrates. High concentrations of nitrogen compounds in the medium does not imply a greater production of the metabolites studied, not even those derived from the amino acids. However, molds growing on dry-cured ham are able to synthesize limited amounts of some secondary metabolites, a fact not previously reported. The combination of HPLC coupled with DAD and MS-APCI was useful for identification of closely related terverticillate Penicillium species from dry-cured ham. These techniques could be used to characterize the risk associated with the potential production of secondary metabolites in cured meats.

Create Your Plate

Medline Plus

Full Text Available ... Diabetes Program In It Together We Can Help Center for Information Legal Assistance Success Stories Complications Hypoglycemia ... help us get closer to curing diabetes and better treatments for those living with diabetes. Other Ways ...

Facts about Type 2

Medline Plus

Full Text Available ... Diabetes Program In It Together We Can Help Center for Information Legal Assistance Success Stories Complications Hypoglycemia ... help us get closer to curing diabetes and better treatments for those living with diabetes. Other Ways ...

Curing mechanism of flexible aqueous polymeric coatings.

Science.gov (United States)

Irfan, Muhammad; Ahmed, Abid Riaz; Kolter, Karl; Bodmeier, Roland; Dashevskiy, Andriy

2017-06-01

The objective of this study was to explain curing phenomena for pellets coated with a flexible polymeric coating based on poly(vinyl acetate) (Kollicoat® SR 30D) with regard to the effect of starter cores, thickness of drug layer, adhesion of coating to drug-layered-cores as well as coating properties. In addition, appropriate approaches to eliminate the curing effect were identified. Sugar or MCC cores were layered with the model drugs carbamazepine, theophylline, propranolol HCl, tramadol HCl and metoprolol HCl using HPMC (5 or 25% w/w, based on drug) as a binder. Drug-layered pellets were coated with Kollicoat® SR 30D in a fluidized bed coater using TEC (10% w/w) as plasticizer and talc (35-100% w/w) as anti-tacking agent. Drug release, pellet properties (morphology, water uptake-weight loss and osmolality) and adhesion of the coating to the drug layer were investigated as a function of curing at 60°C or 60°C/75% RH for 24h. The film formation of the aqueous dispersion of Kollicoat® SR 30D was complete, and therefore, a strong curing effect (decrease in drug release) at elevated temperature and humidity (60°C/75% RH) could not be explained by the well-known hydroplasticization and the further gradual coalescence of the colloidal polymer particles. According to the provided mechanistic explanation, the observed curing effect was associated with (1) high flexibility of coating, (2) adhesion between coating and drug layer, (3) water retaining properties of the drug layer, and (4) osmotically active cores. Unwanted curing effects could be minimized/eliminated by the addition of talc or/and pore-forming water soluble polymers in the coating, increasing binder amount or applying an intermediate coating, by increasing the thickness of drug layer or using non-osmotic cores. A new insight into curing phenomena mainly associated with the adhesion between drug layer and coating was provided. Appropriate approaches to avoid unwanted curing effect were identified

Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries.

Science.gov (United States)

Geelhoed-Duijvestijn, Petronella H; Pedersen-Bjergaard, Ulrik; Weitgasser, Raimund; Lahtela, Jorma; Jensen, Marie Markert; Östenson, Claes-Göran

2013-12-01

Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing. Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics, NSHE occurrence in the last 7 days, hypoglycemia-related resource use, and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance. Three thousand, nine hundred and fifty-nine respondents completed at least one wave of the survey, with 57% completing all four questionnaires; 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable, and having negative feelings following hypoglycemia. Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies, and methods of data collection. NSHE were associated with use of extra healthcare resources and work-time loss in all

Proceedings of national executive management seminar on surface finishing by radiation curing technology: radiation curing for better finishing

Energy Technology Data Exchange (ETDEWEB)

NONE

1994-12-31

This book compiled the paper presented at this seminar. The papers discussed are 1. Incentives for investment in the manufacturing sector (in Malaysia) 2.Trends and prospect of surface finishing by radiation curing technology in Malaysia 3. Industrial application of radiation curing.

Proceedings of national executive management seminar on surface finishing by radiation curing technology: radiation curing for better finishing

International Nuclear Information System (INIS)

1993-01-01

This book compiled the paper presented at this seminar. The papers discussed are 1. Incentives for investment in the manufacturing sector (in Malaysia) 2.Trends and prospect of surface finishing by radiation curing technology in Malaysia 3. Industrial application of radiation curing

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

Directory of Open Access Journals (Sweden)

Mathieu Boulin

Full Text Available The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.An economic (decision-tree analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services and Canadian public health payer perspectives were adopted.Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

A 7-year randomized prospective study of a one-step self-etching adhesive in non-carious cervical lesions. The effect of curing modes and restorative material

DEFF Research Database (Denmark)

van Dijken, Jan W V; Pallesen, Ulla

2012-01-01

Objective: The aim of this study was to evaluate the clinical retention of a one-step self-etching adhesive system (Xeno III) in Class V non-carious cervical lesions and the effect of restorative material and curing techniques on longevity of the restorations. Material and methods: A total of 139...... be evaluated. No post-operative sensitivity was reported by the participants. Overall relative cumulative loss rate frequencies for the adhesive system at 6, 18 and 7 years, independent of curing technique and restorative material, were 0.8%, 6.9% and 23.0%, respectively. The self-etching adhesive fulfilled...... secondary caries was observed. Significance: The single-step self-etching adhesive showed acceptable clinical long-time retention rates to dentin surfaces independent of restorative material and curing technique used....

Maintenance of high-energy brain phosphorous compounds during insulin-induced hypoglycemia in men. 31P nuclear magnetic resonance spectroscopy study

DEFF Research Database (Denmark)

Hilsted, Jannik; Jensen, K E; Thomsen, C

1988-01-01

31P nuclear magnetic resonance (NMR) spectroscopy allows noninvasive studies of cerebral energy-rich phosphorous compounds in humans. In an attempt to characterize the relationship between peripheral blood glucose concentrations and whole-brain phosphate metabolism during insulin......-induced hypoglycemia, 31P NMR spectra were obtained before and after intravenous injection of insulin (0.15 IU/kg body wt) in six men. Compared with prehypoglycemic measurements, no significant changes were found in brain content of Pi, sugar phosphates, phosphocreatine, phosphodiesters, and ATP, and brain pH remained...... constant during the experiment. These results show that the integrated brain profile of energy-rich phosphorous compounds is unaffected by experimental insulin-induced hypoglycemia in humans....

Additive effects in radiation grafting and curing

International Nuclear Information System (INIS)

Viengkhou, V.; Ng, L.

1996-01-01

Full text: Detailed studies on the accelerative effect of novel additives in radiation grafting and curing using acrylated monomer/oligomer systems have been performed in the presence of ionising radiation and UV as sources. Methyl methacrylate (MMA) is used as typical monomer for these grafting studies in the presence of the additives with model backbone polymers, cellulose and propropylene. Additives which have been found to accelerate these grafting processes are: mineral acid, occlusion compounds like urea, thermal initiators and photoinitiators as well as multifunctional monomers such as multifunctional acrylates. The results from irradiation with gamma rays have also been compared with irradiation from a 90W UV lamp. The role of the above additives in accelerating the analogous process of radiation curing has been investigated. Acrylated urethanes, epoxies and polyesters are used as oligomers together with acrylated monomers in this work with uv lamps of 300 watts/inch as radiation source. In the UV curing process bonding between film and substrate is usually due to physical forces. In the present work the presence of additives are shown to influence the occurrence of concurrent grafting during cure thus affecting the nature of the bonding of the cured film. The conditions under which concurrent grafting with UV can occur will be examined. A mechanism for accelerative effect of these additives in both grafting and curing processes has been proposed involving radiation effects and partitioning phenomena

Radiation sources EB and UV curing machines

Energy Technology Data Exchange (ETDEWEB)

Sasaki, Takashi [Japan Atomic Energy Research Inst., Takasaki, Gunma (Japan). Takasaki Radiation Chemistry Research Establishment

1994-12-31

This paper describes electron beam processors and related technologies for curing applications to facilitate those industrial personals who are trying to understand and evaluate the applicability and benefits of radiation curing to their products. 4 tabs., 10 figs.

Radiation sources EB and UV curing machines

International Nuclear Information System (INIS)

Takashi Sasaki

1993-01-01

This paper describes electron beam processors and related technologies for curing applications to facilitate those industrial personals who are trying to understand and evaluate the applicability and benefits of radiation curing to their products. 4 tabs., 10 figs

What is radiation curing

International Nuclear Information System (INIS)

Kinstle, J.F.

1975-01-01

Radiation curing is a highly interdisciplinary and sophisticated field. Successful interplay between chemists and engineers of various disciplines is required. Throughout the research-development-applications cycle, two disciplines for which hybridization is extremely important are radiation chemistry and polymer chemistry. The molecular level effects caused by absorbed radiation depend strongly on the type and intensity of the radiation. Efficient utilization of the radiation to effect desired transformations in a monomer and/or polymer system, and maximization of final properties, depend on well-planned polymer synthesis and system formulation. The elementary basis of these two disciplines and the manner in which they necessarily coalesce in the field of radiation curing are reviewed

Modeling the curing process of thermosetting resin matrix composites

Science.gov (United States)

Loos, A. C.

1986-01-01

A model is presented for simulating the curing process of a thermosetting resin matrix composite. The model relates the cure temperature, the cure pressure, and the properties of the prepreg to the thermal, chemical, and rheological processes occurring in the composite during cure. The results calculated with the computer code developed on the basis of the model were compared with the experimental data obtained from autoclave-curved composite laminates. Good agreement between the two sets of results was obtained.

Excimer Laser Curing Of Polymer Coatings

Science.gov (United States)

Klick, David; Akerman, M. Alfred; Paul, George L.; Supurovic, Darko; Tsuda, Haruki

1988-12-01

The use of the excimer laser as a source of energy for photo-assisted curing of industrial polymeric coatings was investigated. Presently, UV lamps are sometimes used to excite a photoinitiating molecule mixed with the starting monomers and oligomers of a coating. The resulting polymeric chain reaction multiplies the effect of the initial photons, making economical use of the light source. The high cost of laser photons may thus be justifiable if lasers provide advantages over lamps. A series of visibly transparent 7 μm coatings (a typical thickness for 'slick' magazine coatings) with various photoinitiators, monomers, and oligomers was illuminated with excimer laser light of various wavelengths, fluences, and pulse repetition rates. For the optimum parameters, it was found that the laser had large advantages in curing speed over existing UV lamp processes, due to its monochromaticity. Pigmented coatings (20 μm TiO2 mixtures typical of appliance or automotive finishes) are not easily cured with UV lamps due to the inability of light to penetrate the absorbing and scattering pigmented layer. However, economically-viable cure rates were achieved with certain photoinitiators using a tunable excimer-pumped dye laser. A prototype of such a laser suitable for factory use was built and used to cure these coatings. Results are scaled to a factory situation, and costs are calculated to show the advantages of the laser method over currently used processes.

Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial.

Science.gov (United States)

Harris, Deborah L; Alsweiler, Jane M; Ansell, Judith M; Gamble, Gregory D; Thompson, Benjamin; Wouldes, Trecia A; Yu, Tzu-Ying; Harding, Jane E

2016-03-01

To determine neurodevelopmental outcome at 2 years' corrected age in children randomized to treatment with dextrose gel or placebo for hypoglycemia soon after birth (The Sugar Babies Study). This was a follow-up study of 184 children with hypoglycemia (dextrose (90/118, 76%) or placebo gel (94/119, 79%). Assessments were performed at Kahikatea House, Hamilton, New Zealand, and included neurologic function and general health (pediatrician assessed), cognitive, language, behavior, and motor skills (Bayley Scales of Infant and Toddler Development, Third Edition), executive function (clinical assessment and Behaviour Rating Inventory of Executive Function-Preschool Edition), and vision (clinical examination and global motion perception). Coprimary outcomes were neurosensory impairment (cognitive, language or motor score below -1 SD or cerebral palsy or blind or deaf) and processing difficulty (executive function or global motion perception worse than 1.5 SD from the mean). Statistical tests were two sided with 5% significance level. Mean (± SD) birth weight was 3093 ± 803 g and mean gestation was 37.7 ± 1.6 weeks. Sixty-six children (36%) had neurosensory impairment (1 severe, 6 moderate, 59 mild) with similar rates in both groups (dextrose 38% vs placebo 34%, relative risk 1.11, 95% CI 0.75-1.63). Processing difficulty also was similar between groups (dextrose 10% vs placebo 18%, relative risk 0.52, 95% CI 0.23-1.15). Dextrose gel is safe for the treatment of neonatal hypoglycemia, but neurosensory impairment is common among these children. Australian New Zealand Clinical Trials Registry: ACTRN 12608000623392. Copyright © 2016 Elsevier Inc. All rights reserved.

Bulk-Fill Composites: Effectiveness of Cure With Poly- and Monowave Curing Lights and Modes.

Science.gov (United States)

Gan, J K; Yap, A U; Cheong, J W; Arista, N; Tan, Cbk

This study compared the effectiveness of cure of bulk-fill composites using polywave light-emitting diode (LED; with various curing modes), monowave LED, and conventional halogen curing lights. The bulk-fill composites evaluated were Tetric N-Ceram bulk-fill (TNC), which contained a novel germanium photoinitiator (Ivocerin), and Smart Dentin Replacement (SDR). The composites were placed into black polyvinyl molds with cylindrical recesses of 4-mm height and 3-mm diameter and photopolymerized as follows: Bluephase N Polywave High (NH), 1200 mW/cm 2 (10 seconds); Bluephase N Polywave Low (NL), 650 mW/cm 2 (18.5 seconds); Bluephase N Polywave soft-start (NS), 0-650 mW/cm 2 (5 seconds) → 1200 mW/cm 2 (10 seconds); Bluephase N Monowave (NM), 800 mW/cm 2 (15 seconds); QHL75 (QH), 550 mW/cm 2 (21.8 seconds). Total energy output was fixed at 12,000 mJ/cm 2 for all lights/modes, with the exception of NS. The cured specimens were stored in a light-proof container at 37°C for 24 hours, and hardness (Knoop Hardness Number) of the top and bottom surfaces of the specimens was determined using a Knoop microhardness tester (n=6). Hardness data and bottom-to-top hardness ratios were subjected to statistical analysis using one-way analysis of variance/Scheffe's post hoc test at a significance level of 0.05. Hardness ratios ranged from 38.43% ± 5.19% to 49.25% ± 6.38% for TNC and 50.67% ± 1.54% to 67.62% ± 6.96% for SDR. For both bulk-fill composites, the highest hardness ratios were obtained with NM and lowest hardness ratios with NL. While no significant difference in hardness ratios was observed between curing lights/modes for TNC, the hardness ratio obtained with NM was significantly higher than the hardness ratio obtained for NL for SDR.

A Fourier transform Raman spectroscopy analysis of the degree of conversion of a universal hybrid resin composite cured with light-emitting diode curing units.

Science.gov (United States)

Lindberg, Anders; Emami, Nazanin; van Dijken, Jan W V

2005-01-01

The degree of conversion (DC), of a universal hybrid resin composite cured with LED curing units with low and high power densities and a 510 mW/cm2 quartz tungsten halogen unit, was investigated with Fourier Transform Raman spectroscopy. Three curing depths (0, 2, 4mm) and 0 and 7 mm light guide tip - resin composite (LT - RC) distances were tested. The DC of the LED units varied between 52.3% - 59.8% at the top surface and 46.4% - 57.0% at 4 mm depth. The DC of specimen cured with a 0 mm LT- RC distance at 4 mm depth varied between 50.8% - 57.0% and with 7 mm distance between 46.4% - 55.4%. The low power density LED unit showed a significantly lower DC for both distances at all depth levels compared to the other curing units (p units were only found at the 4 mm depth level cured from 7 mm distance (p units. It can be concluded that the improved LED curing units could cure the studied resin composite to the same DC as the control unit.

NT-pro-BNP during hypoglycemia and hypoxemia in normal subjects: impact of renin-angiotensin system activity

DEFF Research Database (Denmark)

Due-Andersen, R; Pedersen-Bjergaard, U; Høi-Hansen, T

2008-01-01

subjects with high-RAS activity and 10 subjects with low-RAS activity (age 26 +/- 1 yr; mean +/- SE) were studied in a single-blinded, randomized, counterbalanced, crossover study on three occasions separated by at least 3 wk: 1) hypoglycemia (mean nadir plasma glucose 2.7 +/- 0.5 mmol/l), 2) hypoxemia...

Reexamining the Hypoglycemia Fear Survey for Parents of Young Children in a Sample of Children Using Insulin Pumps.

Science.gov (United States)

Patton, Susana R; Noser, Amy E; Clements, Mark A; Dolan, Lawrence M; Powers, Scott W

2017-02-01

We update the psychometric properties of the Hypoglycemia Fear Survey-Parents of Young Children (HFS-PYC), a 26-item measure of parents' hypoglycemia fear for young children using an insulin pump. We combined three similar datasets for the analyses. The data analyzed included parents' responses to the HFS-PYC and a demographic form. For a subset of children (n = 91), we also analyzed self-monitoring of blood glucose data. We used confirmatory factor analysis (CFA) to confirm the measure's original factor structure. Additional analyses examined reliability and validity of a revised HFS-PYC for parents of young children using pumps. We analyzed data from 116 parents (93% mothers). Mean child age and HbA1c were 5.2 ± 1.3 years and 8.2% ± 1.1%, respectively. CFA identified a 22-item two-factor solution (χ 2 (208, n = 116) = 368.688, P 0.65). Correlations revealed significant negative associations between current HFS-PYC worry scores and children's mean daily blood glucose and percent of very high glucose levels per day, suggesting less fear among parents of young children with elevated glycemic levels. In addition, there was a positive association with the percent of glucose levels in target, suggesting greater hypoglycemia fear among parents of children who have better control. Results provide preliminary evidence for the reliability and validity of a reduced 22-item HFS-PYC for parents of children using insulin pumps.

Cure kinetics and chemorheology of EPDM/graphene oxide nanocomposites

Energy Technology Data Exchange (ETDEWEB)

Allahbakhsh, Ahmad [Department of Polymer Engineering, Islamic Azad University, South Tehran Branch, 17776-13651 Tehran (Iran, Islamic Republic of); Mazinani, Saeedeh, E-mail: s.mazinani@aut.ac.ir [Amirkabir Nanotechnology Research Institute (ANTRI), Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Kalaee, Mohammad Reza [Department of Polymer Engineering, Islamic Azad University, South Tehran Branch, 17776-13651 Tehran (Iran, Islamic Republic of); Sharif, Farhad [Department of Polymer Engineering and Color Technology, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of)

2013-07-10

Graphical abstract: - Highlights: • Graphene oxide content and dispersion as effective parameters on cure kinetics. • Graphene oxide as an effective controlling factor of crosslink density. • Interaction of graphene oxide with curing system (ZnO) during curing process. - Abstract: In this study, the effect of graphene oxide on cure behavior of ethylene–propylene–diene rubber (EPDM) nanocomposite is studied. In this regard, the cure kinetics of nanocomposite is studied employing different empirical methods. The required activation energy of nth-order cure process shows about 160 kJ/mol increments upon 5 phr graphene oxide loading compared to 1 phr graphene oxide loading. However, the required activation energy is significantly reduced followed by incorporation of graphene oxide in nanocomposites compared to neat EPDM sample. Furthermore, the effect of graphene oxide on structural properties of nanocomposites during the cure process is studied using X-ray diffraction, scanning electron microscopy and Fourier transform infrared spectrometry techniques. As the results show, graphene oxide interestingly affects the structure of zinc oxide during the vulcanization process. This behavior could be probably related to high tendency of zinc oxide to react with oxidized surface of graphene oxide.

UV curing of a liquid based bismaleimide-containing polymer system

Directory of Open Access Journals (Sweden)

2007-06-01

Full Text Available A new liquid formulation of commercial bismaleimide and n-acryloylmorpholine was prepared that could be UV cured as an alternative to traditional thermal cure methods presently used for BMI in the industry. UV curing was shown to be an efficient method which promoted the reaction rate significantly and was able to achieve this at low temperatures (30–50°C. A free radical polymerization approach has been used to explain the cure mechanism and cure kinetics, using data elucidated from the DPC and FTIR. The cured thin film was shown to achieve very high thermal stability (~400°C, with the BMI shown to retard the thermal degradation temperature and rate.

Radiation curing: Science and technology

International Nuclear Information System (INIS)

Pappas, S.P.

1992-01-01

The science and technology of radiation curing have progressed substantially within the last 20 years. Nevertheless, radiation-curable compositions typically command relatively small shares in many of their competitive markets. This situation signifies that potential advantages of radiation curing are not generally perceived to overcome their limitations. An important objective of this book is to address this issue, within the scope of the subjects offered, by providing the present state of knowledge and by identifying the directions and challenges for future studies. The first chapter introduces radiation curing. Chapter 2 offers the first systematic presentation of inorganic and organometallic photoinitiators. Chapters 3 and 4 present the analytical techniques of photocalorimetry and real-time infrared spectroscopy, respectively. Recent advances in resin technology are offered in Chapters 5 and 6, which constitute the first comprehensive accounts of (meth)acrylated silicones and vinyl ethers, respectively. Radiation-curable coatings, printing inks, and adhesives are discussed in Chapters 7-9, respectively. Chapter 10 offers a discussion on photopolymer imaging systems

Techniques and materials for internal water curing of concrete

DEFF Research Database (Denmark)

Jensen, Ole Mejlhede; Lura, Pietro

2006-01-01

This paper gives an overview of different techniques for incorporation of internal curing water in concrete. Internal water curing can be used to mitigate self-desiccation and selfdesiccation shrinkage. Some concretes may need 50 kg/m3 of internal curing water for this purpose. The price...

Factors affecting dry-cured ham consumer acceptability.

Science.gov (United States)

Morales, R; Guerrero, L; Aguiar, A P S; Guàrdia, M D; Gou, P

2013-11-01

The objectives of the present study were (1) to compare the relative importance of price, processing time, texture and intramuscular fat in purchase intention of dry-cured ham through conjoint analysis, (2) to evaluate the effect of dry-cured ham appearance on consumer expectations, and (3) to describe the consumer sensory preferences of dry-cured ham using external preference mapping. Texture and processing time influenced the consumer preferences in conjoint analysis. Red colour intensity, colour uniformity, external fat and white film presence/absence influenced consumer expectations. The consumer disliked hams with bitter and metallic flavour and with excessive saltiness and piquantness. Differences between expected and experienced acceptability were found, which indicates that the visual preference of consumers does not allow them to select a dry-cured ham that satisfies their sensory preferences of flavour and texture. Copyright © 2013 Elsevier Ltd. All rights reserved.

Steam-cured stabilised soil blocks for masonry construction

Energy Technology Data Exchange (ETDEWEB)

Venkatarama Reddy, B.V. [Indian Inst. of Science, Bangalore (India). Dept. of Civil Engineering; Lokras, S.S. [Indian Inst. of Science, Bangalore (India). ASTRA

1998-12-01

Energy-efficient, economical and durable building materials are essential for sustainable construction practices. The paper deals with production and properties of energy-efficient steam-cured stabilised soil blocks used for masonry construction. Problems of mixing expansive soil and lime, and production of blocks using soil-lime mixtures have been discussed briefly. Details of steam curing of stabilised soil blocks and properties of such blocks are given. A comparison of energy content of steam-cured soil blocks and burnt bricks is presented. It has been shown that energy-efficient steam cured soil blocks (consuming 35% less thermal energy compared to burnt clay bricks) having high compressive strength can be easily produced in a decentralised manner. (orig.)

UV/EB curing in Australia

International Nuclear Information System (INIS)

Woods, R.; Garnett, J.; Loo Teck Ng

1999-01-01

Progress in LTV/EB curing is reviewed in Australia. Generally the technology is used by those industries where curing is well developed in Europe and North America, however the scale is an order of magnitude lower due to the smaller market size. The Asian economic crisis does not appear to have affected expansion of the technology in Australia. EB continues to be successfully used in the packaging and foam fields whilst in UV, security devices, particularly banknotes are steadily expanding especially in export markets have been studied

Muscle individual phospholipid classes throughout the processing of dry-cured ham: influence of pre-cure freezing.

Science.gov (United States)

Pérez-Palacios, Trinidad; Ruiz, Jorge; Dewettinck, Koen; Le, Thien Trung; Antequera, Teresa

2010-03-01

This paper aims to study the profile of phospholipid (PL) classes of Iberian ham throughout its processing and the changes it underwent due to the influence of the pre-cure freezing treatment. The general profile of each PL class did not vary during the ripening stage. Phosphatidylcholine (PC) showed the highest proportion, followed by phosphatidyletanolamine (PE) and phosphatidylserine (PS) and phosphatidylinositol (PI) being the minor PL. The four PL classes were highly hydrolysed during the salting stage and their degradation continued during the rest of the processing. Pre-cure freezing of Iberian ham influenced the levels of the four PL classes at the initial stage, all of them being higher in refrigerated (R) than in pre-cure frozen (F) hams. Moreover, the pattern of hydrolysis was not the same in these two groups. Copyright 2009 Elsevier Ltd. All rights reserved.

Curing the queue

NARCIS (Netherlands)

Zonderland, Maartje Elisabeth

2012-01-01

In this dissertation we study several problems related to the management of healthcare and the cure of disease. In each chapter a hospital capacity distribution problem is analyzed using techniques from operations research, also known as mathematical decision theory. The problems considered are

Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy

DEFF Research Database (Denmark)

Mathiesen, Elisabeth R; Kinsley, Brendan; Amiel, Stephanie A

2007-01-01

OBJECTIVE: To assess the safety and efficacy of insulin aspart (IAsp) versus regular human insulin (HI) in basal-bolus therapy with NPH insulin in pregnant women with type 1 diabetes. RESEARCH DESIGN AND METHODS: Subjects (n = 322) who were pregnant or planning pregnancy were randomized to IAsp...... in basal-bolus therapy with NPH insulin in pregnant women with type 1 diabetes and may potentially offer some benefits in terms of postprandial glucose control and preventing severe hypoglycemia....... or HI as meal-time insulin in an open-label, parallel-group, multicenter study. Subjects had A1C pregnancy. Insulin doses were titrated toward predefined glucose targets and A1C 1C, plasma glucose...

Effects of feeding high protein or conventional canola meal on dry cured and conventionally cured bacon.

Science.gov (United States)

Little, K L; Bohrer, B M; Stein, H H; Boler, D D

2015-05-01

Objectives were to compare belly, bacon processing, bacon slice, and sensory characteristics from pigs fed high protein canola meal (CM-HP) or conventional canola meal (CM-CV). Soybean meal was replaced with 0 (control), 33, 66, or 100% of both types of canola meal. Left side bellies from 70 carcasses were randomly assigned to conventional or dry cure treatment and matching right side bellies were assigned the opposite treatment. Secondary objectives were to test the existence of bilateral symmetry on fresh belly characteristics and fatty acid profiles of right and left side bellies originating from the same carcass. Bellies from pigs fed CM-HP were slightly lighter and thinner than bellies from pigs fed CM-CV, yet bacon processing, bacon slice, and sensory characteristics were unaffected by dietary treatment and did not differ from the control. Furthermore, testing the existence of bilateral symmetry on fresh belly characteristics revealed that bellies originating from the right side of the carcasses were slightly (P≤0.05) wider, thicker, heavier and firmer than bellies from the left side of the carcass. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of curing time on microstructure and mechanical strength ...

Indian Academy of Sciences (India)

The aim of this paper is to study the influence of curing time on the microstructure and mechanical strength development of alkali activated binders based on vitreous calcium aluminosilicate (VCAS). Mechanical strength of alkali activated mortars cured at 65 °C was assessed for different curing times (4–168 h) using 10 ...

Curing potential of experimental resin composites with systematically varying amount of bioactive glass: Degree of conversion, light transmittance and depth of cure.

Science.gov (United States)

Par, Matej; Spanovic, Nika; Bjelovucic, Ruza; Skenderovic, Hrvoje; Gamulin, Ozren; Tarle, Zrinka

2018-06-17

The aim of this work was to investigate the curing potential of an experimental resin composite series with the systematically varying amount of bioactive glass 45S5 by evaluating the degree of conversion, light transmittance and depth of cure. Resin composites based on a Bis-GMA/TEGDMA resin with a total filler load of 70 wt% and a variable amount of bioactive glass (0-40 wt%) were prepared. The photoinitiator system was camphorquinone and ethyl-4-(dimethylamino) benzoate. The degree of conversion and light transmittance were measured by Raman spectroscopy and UV-vis spectroscopy, respectively. The depth of cure was evaluated according to the classical ISO 4049 test. The initial introduction of bioactive glass into the experimental series diminished the light transmittance while the further increase in the bioactive glass amount up to 40 wt% caused minor variations with no clear trend. The curing potential of the experimental composites was similar to or better than that of commercial resin composites. However, unsilanized bioactive glass fillers demonstrated the tendency to diminish both the maximum attainable conversion and the curing efficiency at depth. Experimental composite materials containing bioactive glass showed a clinically acceptable degree of conversion and depth of cure. The degree of conversion and depth of cure were diminished by bioactive glass fillers in a dose-dependent manner, although light transmittance was similar among all of the experimental composites containing 5-40 wt% of bioactive glass. Reduced curing potential caused by the bioactive glass has possible consequences on mechanical properties and biocompatibility. Copyright © 2018 Elsevier Ltd. All rights reserved.

Low-Carbohydrate Diet Impairs the Effect of Glucagon in the Treatment of Insulin-Induced Mild Hypoglycemia

DEFF Research Database (Denmark)

Ranjan, Ajenthen; Schmidt, Signe; Damm-Frydenberg, Camilla

2017-01-01

OBJECTIVE: This study compared the ability of glucagon to restore plasma glucose (PG) after mild hypoglycemia in patients with type 1 diabetes on an isocaloric high-carbohydrate diet (HCD) versus a low-carbohydrate diet (LCD). RESEARCH DESIGN AND METHODS: Ten patients with insulin pump-treated type...... 1 diabetes randomly completed 1 week of the HCD (≥250 g/day) and 1 week of the LCD (≤50 g/day). After each week, mild hypoglycemia was induced by a subcutaneous insulin bolus in the fasting state. When PG reached 3.9 mmol/L, 100 µg glucagon was given subcutaneously, followed by 500 µg glucagon 2 h...... later. RESULTS: Compared with the HCD, the LCD resulted in lower incremental rises in PG after the first (mean ± SEM: 1.3 ± 0.3 vs. 2.7 ± 0.4 mmol/L, P = 0.002) and second glucagon bolus (4.1 ± 0.2 vs. 5.6 ± 0.5 mmol/L, P = 0.002). No differences were observed between the diets regarding concentrations...

Effect of oral contraceptives and/or metformin on GLP-1 secretion and reactive hypoglycemia in PCOS

DEFF Research Database (Denmark)

Glintborg, Dorte; Mumm, Hanne; Holst, Jens Juul

2017-01-01

CONTEXT: Insulin resistance in polycystic ovary syndrome (PCOS) may increase the risk of reactive hypoglycaemia (RH) and decrease glucagon-like peptide-1 (GLP-1) secretion. The possible effects of treatment with oral contraceptives (OCP) and/or metformin on GLP-1 secretion and risk of RH in PCOS ...... significantly lower in obese vs. lean patients and were inversely associated with BMI. CONCLUSIONS: AUC GLP-1 levels were unchanged during treatment. Increased risk of hypoglycemia during metformin +OCP could be associated with increased insulin secretion.......CONTEXT: Insulin resistance in polycystic ovary syndrome (PCOS) may increase the risk of reactive hypoglycaemia (RH) and decrease glucagon-like peptide-1 (GLP-1) secretion. The possible effects of treatment with oral contraceptives (OCP) and/or metformin on GLP-1 secretion and risk of RH in PCOS......, glucose, insulin, and C-peptide during 5 h OGTT. RESULTS: Fasting GLP-1 levels increased during metformin+OCP vs. OCP treatment, whereas AUC GLP-1 levels were unchanged during medical treatment. The prevalence of reactive hypoglycemia increased from 9/65 to 14/65 after intervention (P

Hard facts for radiation curing of elastomers

International Nuclear Information System (INIS)

Lyall, D.J.

1984-01-01

The subject is covered under the headings: introduction; outline of chemistry (differences between conventional and radiation curing); compounding; green strength; response of rubbers to electron beam treatment; electron beam cured applications:(a) wire and cable applications;(b) rubber tyre components;(c) heat shrinkable materials;(d) roofing materials. (U.K.)

Cure modeling in real-time prediction: How much does it help?

Science.gov (United States)

Ying, Gui-Shuang; Zhang, Qiang; Lan, Yu; Li, Yimei; Heitjan, Daniel F

2017-08-01

Various parametric and nonparametric modeling approaches exist for real-time prediction in time-to-event clinical trials. Recently, Chen (2016 BMC Biomedical Research Methodology 16) proposed a prediction method based on parametric cure-mixture modeling, intending to cover those situations where it appears that a non-negligible fraction of subjects is cured. In this article we apply a Weibull cure-mixture model to create predictions, demonstrating the approach in RTOG 0129, a randomized trial in head-and-neck cancer. We compare the ultimate realized data in RTOG 0129 to interim predictions from a Weibull cure-mixture model, a standard Weibull model without a cure component, and a nonparametric model based on the Bayesian bootstrap. The standard Weibull model predicted that events would occur earlier than the Weibull cure-mixture model, but the difference was unremarkable until late in the trial when evidence for a cure became clear. Nonparametric predictions often gave undefined predictions or infinite prediction intervals, particularly at early stages of the trial. Simulations suggest that cure modeling can yield better-calibrated prediction intervals when there is a cured component, or the appearance of a cured component, but at a substantial cost in the average width of the intervals. Copyright © 2017 Elsevier Inc. All rights reserved.

Electron Beam Curing of Polymer Matrix Composites - CRADA Final Report

Energy Technology Data Exchange (ETDEWEB)

Janke, C. J. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Howell, Dave [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Norris, Robert E. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

1997-05-01

The major cost driver in manufacturing polymer matrix composite (PMC) parts and structures, and one of the elements having the greatest effect on their quality and performance, is the standard thermal cure process. Thermal curing of PMCs requires long cure times and high energy consumption, creates residual thermal stresses in the part, produces volatile toxic by-products, and requires expensive tooling that is tolerant of the high cure temperatures.

UV curing by radical, cationic and concurrent radicalcationic polymerization

International Nuclear Information System (INIS)

Pappas, S.P.

1984-01-01

UV and EB curing represent complementary technologies with respective advantages and disadvantages. This paper deals with the design and evaluation of UV curable coatings to optimize cure rate and film properties. Topics included are state-of-the-art photoinitiator systems, light intensity effects, retardation of air-inhibition, adhesion, and amplification of photons for enhanced speed of cure

A single bout of high-intensity interval training reduces awareness of subsequent hypoglycemia in patients with type 1 diabetes

NARCIS (Netherlands)

Rooijackers, H.M.M.; Wiegers, E.C.; Graaf, M. van der; Thijssen, D.H.J.; Kessels, R.P.C.; Tack, C.J.J.; Galan, B.E. de

2017-01-01

High-intensity interval training (HIIT) gains increasing popularity in patients with diabetes. HIIT acutely increases plasma lactate levels. This may be important, since administration of lactate during hypoglycemia suppresses symptoms and counterregulation, whilst preserving cognitive function. We

Study of oxygen inhibition effect on radiation curing

International Nuclear Information System (INIS)

Xiao Bin; Yang Xuemei; Zhao Pengji; Zeng Shuqing; Jiang Bo; Zhou Yong; Huang Wei; Zhou Youyi

1995-01-01

Michacl addition reaction product was used in the research of oxygen inhibition effect of radiation curing. The experimental results was measured by the content of gel and percentage of double bonds. It was proved that 9% of Michacl addition product could speed up 1.2 times of the radiation curing rate at 30 kGy of EB irradiation. This kind of formulation can withstand oxygen inhibition effect obviously, so it was the foundation of application for radiation curing in atmospheric condition

Curing and caring competences in the skills training of physiotherapy students.

Science.gov (United States)

Dahl-Michelsen, Tone

2015-01-01

This article explores the significance of curing and caring competences in physiotherapy education, as well as how curing and caring competences intersect within the professional training of physiotherapy students. The empirical data include participant observations and interviews with students attending skills training in the first year of a bachelor's degree program in Norway. Curing and caring are conceptualized as gender-coded competences. That is, curing and caring are viewed as historical and cultural constructions of masculinities and femininities within the physiotherapy profession, as well as performative actions. The findings illuminate the complexity of curing and caring competences in the skills training of physiotherapy students. Curing and caring are both binary and intertwined competences; however, whereas binary competences are mostly concerned with contextual frames, intertwined competences are mostly concerned with performative aspects. The findings also point to how female and male students attend to curing and caring competences in similar ways; thus, the possibilities of transcending traditional gender norms turn out to be significant in this context. The findings suggest that, although curing somehow remains hegemonic to caring, the future generation of physiotherapists seemingly will be able to use their skills for both caring and curing.

effect of curing methods on the compressive strength of concrete

African Journals Online (AJOL)

High curing temperature (up to 212◦F or. 100◦C) ... are affected by curing and application of the ... for concrete production, it is important to ... Concrete properties and durability are signif- ... Curing compounds are merely temporary coatings on.

7 CFR 30.36 - Class 1; flue-cured types and groups.

Science.gov (United States)

2010-01-01

...-cured, produced principally in the Piedmont sections of Virginia and North Carolina. (b) Type 11b. That... lying between the Piedmont and coastal plains regions of Virginia and North Carolina. (c) Type 12. That type of flue-cured tobacco commonly known as Eastern Flue-cured or Eastern Carolina Flue-cured...

A novel syndrome of autosomal-dominant hyperinsulinemic hypoglycemia linked to a mutation in the human insulin receptor gene

DEFF Research Database (Denmark)

Højlund, Kurt; Hansen, Torben; Lajer, Maria

2004-01-01

a missense mutation (Arg1174Gln) in the tyrosine kinase domain of the insulin receptor gene that cosegregated with the disease phenotype (logarithm of odds [LOD] score 3.21). In conclusion, we report a novel syndrome of autosomal-dominant hyperinsulinemic hypoglycemia. The findings demonstrate...

Determinant of flexible Parametric Estimation of Mixture Cure ...

African Journals Online (AJOL)

PROF. OLIVER OSUAGWA

2015-12-01

Dec 1, 2015 ... Suitability of four parametric mixture cure models were considered namely; Log .... regression analysis which relies on the ... The parameter of mixture cure fraction model was ..... Stochastic Models of Tumor Latency and Their.

Year of progress for radiation curing

International Nuclear Information System (INIS)

Mesrobian, R.B.

1975-01-01

New developments in ultraviolet and electron beam curing of inks and coatings are reviewed. Current installations of radiation systems are noted. An assessment is presented on raw and intermediate materials availability. Current outlook on such problems as toxicity (FDA and OSHA), residual volatiles, materials cost, adhesion and flow-out of coatings is discussed. The future potential for radiation curing systems is contrasted with that of other systems, in view of EPA requirements

Thermal analysis of bulk filled composite resin polymerization using various light curing modes according to the curing depth and approximation to the cavity wall

Directory of Open Access Journals (Sweden)

Hoon-Sang Chang

2013-07-01

Full Text Available OBJECTIVE: The purpose of this study was to investigate the polymerization temperature of a bulk filled composite resin light-activated with various light curing modes using infrared thermography according to the curing depth and approximation to the cavity wall. MATERIAL AND METHODS: Composite resin (AeliteFlo, Bisco, Schaumburg, IL, USA was inserted into a Class II cavity prepared in the Teflon blocks and was cured with a LED light curing unit (Dr's Light, GoodDoctors Co., Seoul, Korea using various light curing modes for 20 s. Polymerization temperature was measured with an infrared thermographic camera (Thermovision 900 SW/TE, Agema Infra-red Systems AB, Danderyd, Sweden for 40 s at measurement spots adjacent to the cavity wall and in the middle of the cavity from the surface to a 4 mm depth. Data were analyzed according to the light curing modes with one-way ANOVA, and according to curing depth and approximation to the cavity wall with two-way ANOVA. RESULTS: The peak polymerization temperature of the composite resin was not affected by the light curing modes. According to the curing depth, the peak polymerization temperature at the depth of 1 mm to 3 mm was significantly higher than that at the depth of 4 mm, and on the surface. The peak polymerization temperature of the spots in the middle of the cavity was higher than that measured in spots adjacent to the cavity wall. CONCLUSION: In the photopolymerization of the composite resin, the temperature was higher in the middle of the cavity compared to the outer surface or at the internal walls of the prepared cavity.

Monitoring cure of composite resins using frequency dependent electromagnetic sensing techniques

Science.gov (United States)

Kranbuehl, D. E.; Hoff, M. S.; Loos, A. C.; Freeman, W. T., Jr.; Eichinger, D. A.

1988-01-01

A nondestructive in situ measurement technique has been developed for monitoring and measuring the cure processing properties of composite resins. Frequency dependent electromagnetic sensors (FDEMS) were used to directly measure resin viscosity during cure. The effects of the cure cycle and resin aging on the viscosity during cure were investigated using the sensor. Viscosity measurements obtained using the sensor are compared with the viscosities calculated by the Loos-Springer cure process model. Good overall agreement was obtained except for the aged resin samples.

Mixture proportioning for internal curing

DEFF Research Database (Denmark)

Bentz, Dale P.; Pietro, Lura; Roberts, John W.

2005-01-01

of additional internal water that is not part of the mixing water.” The additional internal water is typically supplied by using relatively small amounts of saturated, lightweight, fine aggregates (LWA) or superabsorbent polymer (SAP) particles in the concrete. Benefits of internal curing include increased...... less than that of bulk water, a hydrating cement paste will imbibe water (about 0.07 g water/g cement) from an available source. While in higher w/c concretes, this water can be, and often is, supplied by external (surface) curing, in low w/c concretes, the permeability of the concrete quickly becomes...

Simulation of curing of a slab of rubber

International Nuclear Information System (INIS)

Abhilash, P.M.; Kannan, K.; Varkey, Bijo

2010-01-01

The objective of the present work is to predict the degree of curing for a rectangular slab of rubber, which was subjected to non-uniform thermal history. As the thermal conductivity of rubber is very low, the temperature gradient across a slab is quite large, which leads to non-uniform vulcanization, and hence non-uniform mechanical properties-an inhomogeneous material. Since curing is an exothermic reaction, heat transfer and chemical reactions are solved in a coupled manner. The effect of heat generation on curing is also discussed.

Experimental observation of internal water curing of concrete

DEFF Research Database (Denmark)

Lura, Pietro; Jensen, Ole Mejlhede

2007-01-01

Internal water curing has a significant effect on concrete. In addition to affecting hydration and moisture distribution, it influences most concrete properties, such as strength, shrinkage, cracking, and durability. The following paper is an overview of experimental methods to study internal water...... curing of concrete and its consequences. The special techniques needed to study internal water curing are dealt with along with the consequences of this process. Examples of applications are given and new measuring techniques that may potentially be applied to this field are addressed....

Simulation of curing of a slab of rubber

Energy Technology Data Exchange (ETDEWEB)

Abhilash, P.M. [Department of Mechanical Engineering, IIT Madras, Chennai 600036 (India); Kannan, K., E-mail: krishnakannan@iitm.ac.i [Department of Mechanical Engineering, IIT Madras, Chennai 600036 (India); Varkey, Bijo [Advanced Design Department, MRF Ltd., Chennai 600019 (India)

2010-04-15

The objective of the present work is to predict the degree of curing for a rectangular slab of rubber, which was subjected to non-uniform thermal history. As the thermal conductivity of rubber is very low, the temperature gradient across a slab is quite large, which leads to non-uniform vulcanization, and hence non-uniform mechanical properties-an inhomogeneous material. Since curing is an exothermic reaction, heat transfer and chemical reactions are solved in a coupled manner. The effect of heat generation on curing is also discussed.

Effect of light-curing units on the thermal expansion of resin nanocomposites.

Science.gov (United States)

Park, Jeong-Kil; Hur, Bock; Ko, Ching-Chang; García-Godoy, Franklin; Kim, Hyung-Il; Kwon, Yong Hoon

2010-12-01

To examine the thermal expansion of resin nanocomposites after light-curing using different light-curing units. Four different resin nanocomposites and four different light-curing units [quartz-tungsten-halogen (QTH), light emitting diode (LED), laser, and plasma arc] were chosen. Metal dies were filled with resin to make specimens and light-cured. The light intensity and light-curing time of the QTH and LED light-curing units were 1000 mW/cm2 and 40 seconds, 700 mW/cm2 and 40 seconds for the laser, and 1600 mW/cm2 and 3 seconds for the plasma arc. The coefficient of thermal expansion (CTE) was evaluated using a thermomechanical analyzer (TMA) at temperatures ranging from 30-80 degrees C. The CTE of the resin nanocomposites tested ranged from 28.5 to 65.8 (x 10(-6)/ degrees C), depending on the product and type of light-curing unit used. Among the specimens, Grandio showed the lowest CTE. The specimens cured using the plasma arc unit (Apollo 95E) showed the highest CTE. There was a linear correlation between the CTE and filler content (vol%) (R: -0.94-0.99 depending on the light-curing unit). The results may suggest a careful selection of the light-curing unit because there was more expansion in the specimens cured using the plasma arc unit than those cured by the other units.

UV-cured polymer optics

Science.gov (United States)

Piñón, Victor; Santiago, Freddie; Vogelsberg, Ashten; Davenport, Amelia; Cramer, Neil

2017-10-01

Although many optical-quality glass materials are available for use in optical systems, the range of polymeric materials is limited. Polymeric materials have some advantages over glass when it comes to large-scale manufacturing and production. In smaller scale systems, they offer a reduction in weight when compared to glass counterparts. This is especially important when designing optical systems meant to be carried by hand. We aimed to expand the availability of polymeric materials by exploring both crown-like and flint-like polymers. In addition, rapid and facile production was also a goal. By using UV-cured thiolene-based polymers, we were able to produce optical materials within seconds. This enabled the rapid screening of a variety of polymers from which we down-selected to produce optical flats and lenses. We will discuss problems with production and mitigation strategies in using UV-cured polymers for optical components. Using UV-cured polymers present a different set of problems than traditional injection-molded polymers, and these issues are discussed in detail. Using these produced optics, we integrated them into a modified direct view optical system, with the end goal being the development of drop-in replacements for glass components. This optical production strategy shows promise for use in lab-scale systems, where low-cost methods and flexibility are of paramount importance.

Weak interfaces for UV cure nanoimprint lithography

Science.gov (United States)

Houle, Frances; Fornof, Ann; Simonyi, Eva; Miller, Dolores; Truong, Hoa

2008-03-01

Nanoimprint lithography using a photocurable organic resist provides a means of patterning substrates with a spatial resolution in the few nm range. The usefulness of the technique is limited by defect generation during template removal, which involves fracture at the interface between the template and the newly cured polymer. Although it is critical to have the lowest possible interfacial fracture toughness (Gc less than 0.1 Jm-2) to avoid cohesive failure in the polymer, there is little understanding on how to achieve this using reacting low viscosity resist fluids. Studies of debonding of a series of free-radical cured polyhedral silsesquioxane crosslinker formulations containing selected reactive diluents from fluorosilane-coated quartz template materials will be described. At constant diluent fraction the storage modulus of cured resists follows trends in initial reaction rate, not diluent Tg. Adhesion is uncorrelated with both Tg and storage modulus. XPS studies of near-interface compositions indicate that component segregation within the resist fluid on contact with the template, prior to cure, plays a significant role in controlling the fracture process.

Cure monitoring of epoxy resin by using fiber bragg grating sensor

Energy Technology Data Exchange (ETDEWEB)

Lee, Jin Hyuk [KEPCO, Naju (Korea, Republic of); Kim, Dae Hyun [Dept. of Mechanical and Automotive Engineering, Seoul National University of Science and Technology, Seoul (Korea, Republic of)

2016-06-15

In several industrial fields, epoxy resin is widely used as an adhesive for co-curing and manufacturing various structures. Controlling the manufacturing process is required for ensuring robust bonding performance and the stability of the structures. A fiber optic sensor is suitable for the cure monitoring of epoxy resin owing to the thready shape of the sensor. In this paper, a fiber Bragg grating (FBG) sensor was applied for the cure monitoring of epoxy resin. Based on the experimental results, it was demonstrated that the FBG sensor can monitor the status of epoxy resin curing by measuring the strain caused by volume shrinkage and considering the compensation of temperature. In addition, two types of epoxy resin were used for the cure-monitoring; moreover, when compared to each other, it was found that the two types of epoxy had different cure-processes in terms of the change of strain during the curing. Therefore, the study proved that the FBG sensor is very profitable for the cure-monitoring of epoxy resin.

Investigation of the cure behaviour of an epoxy polyester powder coating

International Nuclear Information System (INIS)

Ishrat, S.; Nadeem, M.

1993-01-01

The epoxy polyester based thermo sets make attractive matrix materials for many industrial and commercial applications because of their excellent performance properties. These properties for example, dimensional stability, adhesion, chemical resistance, and thermal stability arise primarily from the formation of crosslinks during cure. While many factors, such as the reactivity and stoichiometry of the reactants can influence the course of the crosslinking reaction, the cure temperature and cure time ultimately govern the end use performance of the thermosetting systems of powder coatings. The interrelationship between the network formation process and performance properties makes cure process studies critically important in product development. A products end use performance properties can be correlated with the processing conditions by monitoring specific polymeric properties such as gel points, glass transition temperature (TgS,) and the kinetics of the crosslinking reaction. By plotting the change in these properties against cure time and or cure temperature, a 'profile' or degree of cure (DOC) curve can be formed. These profiles illustrate the progress of the crosslinking reaction and can be used to optimize thermo set handling, processing and cure process. (author)

Status of radiation curing in South America

International Nuclear Information System (INIS)

Machado, L.D.B.; Rotta, A.C.; Petrie, I.

2007-01-01

In August 2006, an agreement between the Rad tech International North America and the ATBCR, the Brazillian Technical Association for Radiation cure, turns ATCBR into RadTech South America. This new institution starts with already 10 years of history and pioneering technical experience and achievements in UV and EB radiation cure. Both RadTech institutions have asserted a whole cooperation and information exchange to continue with the initial ATBCR compromise in promoting UV and EB curing technology and to make it available to professionals, enterprise and other organizations. The RadTech South America has it's headquarter at the Energy and Nuclear Research Institute, IPEN, in Sao Paulo, Brazil, from whom also gets sponsorship. (Author)

Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study.

Science.gov (United States)

Giorda, C B; Rossi, M C; Ozzello, O; Gentile, S; Aglialoro, A; Chiambretti, A; Baccetti, F; Gentile, F M; Romeo, F; Lucisano, G; Nicolucci, A

2017-03-01

To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year. Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Anisotropic Dielectric Properties of Carbon Fiber Reinforced Polymer Composites during Microwave Curing

Science.gov (United States)

Zhang, Linglin; Li, Yingguang; Zhou, Jing

2018-01-01

Microwave cuing technology is a promising alternative to conventional autoclave curing technology in high efficient and energy saving processing of polymer composites. Dielectric properties of composites are key parameters related to the energy conversion efficiency during the microwave curing process. However, existing methods of dielectric measurement cannot be applied to the microwave curing process. This paper presented an offline test method to solve this problem. Firstly, a kinetics model of the polymer composites under microwave curing was established based on differential scanning calorimetry to describe the whole curing process. Then several specially designed samples of different feature cure degrees were prepared and used to reflect the dielectric properties of the composite during microwave curing. It was demonstrated to be a feasible plan for both test accuracy and efficiency through extensive experimental research. Based on this method, the anisotropic complex permittivity of a carbon fiber/epoxy composite during microwave curing was accurately determined. Statistical results indicated that both the dielectric constant and dielectric loss of the composite increased at the initial curing stage, peaked at the maximum reaction rate point and decreased finally during the microwave curing process. Corresponding mechanism has also been systematically investigated in this work.

Comparison of the heat generation of light curing units.

Science.gov (United States)

Bagis, Bora; Bagis, Yildirim; Ertas, Ertan; Ustaomer, Seda

2008-02-01

The aim of this study was to evaluate the heat generation of three different types of light curing units. Temperature increases were recorded from a distance of 1 mm from a thermocouple to the tip of three different types of light curing units including one quartz-tungsten halogen (QTH), one plasma arc (PAC), and one light emitting diode (LED) unit. An experimental model was designed to fix the 1 mm distance between the tip of the light curing units and the thermocouple wire. Temperature changes were recorded in 10 second intervals up to 40 seconds. (10, 20, 30, and 40 seconds). Temperature measurements were repeated three times for every light curing unit after a one hour standby period. Statistical analysis of the results was performed using the analysis of variance (ANOVA) and the Bonferroni Test. The highest temperature rises (54.4+/-1.65 degrees C) occurred during activation of a PAC light curing unit for every test period (pdamage to the pulp.

Influence of curing protocol on selected properties of light-curing polymers

DEFF Research Database (Denmark)

Dewaele, Magali; Asmussen, Erik; Peutzfeldt, Anne

2009-01-01

The purpose of this study was to investigate the effect of light-curing protocol on degree of conversion (DC), volume contraction (C), elastic modulus (E), and glass transition temperature (T(g)) as measured on a model polymer. It was a further aim to correlate the measured values with each other....

Effect of In-Situ Curing on Compressive Strength of Reactive Powder Concrete

Directory of Open Access Journals (Sweden)

Bali Ika

2016-01-01

Full Text Available A development of Reactive Powder Concrete (RPC currently is the use of quartz powder as a stabilizing agent with the content to cement ratio of 30% and steam curing method in an autoclave temperature of 250ºC which produced a high compressive strength of 180 MPa. That RPC can be generated due to one reason for using the technique of steam curing in an autoclave in the laboratory. This study proposes in-situ curing method in order the curing can be applied in the field and with a reasonable compressive strength results of RPC. As the benchmarks in this study are the curing methods in laboratory that are steam curing of 90°C for 8 hours (C1, and water curing for 28 days (C2. For the in-situ curing methods that are covering with tarpaulins and flowed steam of 3 hours per day for 7 days (C3, covering with wet sacks for 28 days (C4, and covering with wet sacks for 28 days for specimen with unwashed sand as fine aggregate (C5. The comparison of compressive strength of the specimens in this study showed compressive strength of RPC with in-situ steam curing (101.64 MPa close to the compressive strength of RPC with steam curing in the laboratory with 8.2% of different. While in-situ wet curing compared with the water curing in laboratory has the different of 3.4%. These results indicated that the proposed in-situ curing methods are reasonable good in term of the compressive strength that can be achieved.

Temperature rise produced by different light-curing units through dentin.

Science.gov (United States)

Yazici, A Rüya; Müftü, Ali; Kugel, Gerard

2007-11-01

This study investigated the temperature rise caused by different light curing units and the temperature increase in dentin of different thicknesses. Dentin discs of 1.0 and 2.0 mm thicknesses were prepared from extracted human mandibular molars. Temperatures were recorded directly at the surface of the light guide tip, under dentin discs with different thicknesses, and through a sandwich composed of 2 mm thick cured composite and dentin using a K-type thermocouple. The curing units used were two quartz-tungsten-halogen lights (Spectrum and Elipar Trilight-ET) and a light-emitting diode (LED). The highest temperature rise was observed under a Mylar strip using ET standard mode. Under 1 and 2 mm thick dentin barriers, the lowest temperature rise was measured for the LED curing light. Significant differences in temperature rise existed among all curing units except between the Spectrum and ET exponential modes under a 1 mm thick dentin barrier with cured composite. Temperature rises were insignificant between the Spectrum and ET exponential modes and between two modes of Trilight when the same experimental setup was used under a 2 mm thick dentin barrier. For all curing units, temperature elevation through 2 mm of dentin was less than for 1 mm of dentin thickness. The ET standard mode produced the highest and the LED produced the lowest temperature rise for all tested conditions. The thickness of dentin and light-curing unit might affect temperature transmission.

Fear of Hypoglycemia, Parenting Stress, and Metabolic Control for Children with Type 1 Diabetes and Their Parents.

Science.gov (United States)

Viaene, Ann-Sofie; Van Daele, Tom; Bleys, Dries; Faust, Kelly; Massa, Guy G

2017-03-01

This study sets out to extend current knowledge of parenting stress and fear of hypoglycemia (FoH) in parents of children with type 1 diabetes mellitus (T1DM). We examined if the relationship between parental and children's FoH and metabolic control, as reflected by HbA1c, is mediated by parenting stress. A total of 63 parents and children with T1DM were recruited during their routine physician's appointment. Parents completed questionnaires on parenting stress and FoH. Children eight years and older also completed a questionnaire on FoH. HbA1c values were obtained from all children. Mediation analysis revealed an indirect association between parental FoH and HbA1c values through parenting stress (Sobel's z = 2.42, p = .02), but no indirect association between children's FoH and HbA1c. We concluded that parental FOH has an indirect association with the child's metabolic control that is mediated by parenting stress. More simply, fear of hypoglycemia predicts parent stress, which in turn, predicts metabolic control.

Monitoring the Cure State of Thermosetting Resins by Ultrasound.

Science.gov (United States)

Lionetto, Francesca; Maffezzoli, Alfonso

2013-09-05

The propagation of low intensity ultrasound in a curing resin, acting as a high frequency oscillatory excitation, has been recently proposed as an ultrasonic dynamic mechanical analysis (UDMA) for cure monitoring. The technique measures sound velocity and attenuation, which are very sensitive to changes in the viscoelastic characteristics of the curing resin, since the velocity is related to the resin storage modulus and density, while the attenuation is related to the energy dissipation and scattering in the curing resin. The paper reviews the results obtained by the authors' research group in the last decade by means of in-house made ultrasonic set-ups for both contact and air-coupled ultrasonic experiments. The basics of the ultrasonic wave propagation in polymers and examples of measurements of the time-evolution of ultrasonic longitudinal modulus and chemical conversion of different thermosetting resins are presented. The effect of temperature on the cure kinetics, the comparison with rheological, low frequency dynamic mechanical and calorimetric results, and the correlation between ultrasonic modulus and crosslinking density will be also discussed. The paper highlights the reliability of ultrasonic wave propagation for monitoring the physical changes taking place during curing and the potential for online monitoring during polymer and polymer matrix composite processing.

Monitoring the Cure State of Thermosetting Resins by Ultrasound

Directory of Open Access Journals (Sweden)

Alfonso Maffezzoli

2013-09-01

Full Text Available The propagation of low intensity ultrasound in a curing resin, acting as a high frequency oscillatory excitation, has been recently proposed as an ultrasonic dynamic mechanical analysis (UDMA for cure monitoring. The technique measures sound velocity and attenuation, which are very sensitive to changes in the viscoelastic characteristics of the curing resin, since the velocity is related to the resin storage modulus and density, while the attenuation is related to the energy dissipation and scattering in the curing resin. The paper reviews the results obtained by the authors’ research group in the last decade by means of in-house made ultrasonic set-ups for both contact and air-coupled ultrasonic experiments. The basics of the ultrasonic wave propagation in polymers and examples of measurements of the time-evolution of ultrasonic longitudinal modulus and chemical conversion of different thermosetting resins are presented. The effect of temperature on the cure kinetics, the comparison with rheological, low frequency dynamic mechanical and calorimetric results, and the correlation between ultrasonic modulus and crosslinking density will be also discussed. The paper highlights the reliability of ultrasonic wave propagation for monitoring the physical changes taking place during curing and the potential for online monitoring during polymer and polymer matrix composite processing.

Solid-state /sup 13/C NMR study of cured resorcinol-formaldehyde resins

Energy Technology Data Exchange (ETDEWEB)

Lippmaa, H.; Samoson, A.

1988-08-01

The curing process generally follows the pattern observed in the stage of prepolymer formation. Catalysts (NaOH, hexa, Mg(OCOCH/sub 3/)/sub 2/) that have no substantial influence on the isomeric composition of the resorcinol-formaldehyde prepolymers, do not affect the isomeric composition of the cured resins to any significant extent either. Isomeric composition of the cured resins depends mostly on the presence of water during the curing process, necessary for depolymerisation of the added paraformaldehyde. Curing in the melt leads to enhanced 2-substitution in the 1,3-dihydroxybenzene rings. In the /sup 13/C NMR spectra of cured powdered samples, the tendency of 5-methylresorcinol to form oligomers with a higher degree of 2-substitution than resorcinol is clearly apparent. Polycondensation process continues in the powdered resins after initial curing until complete consumption of all formaldehyde. Curing of phenol-formaldehyde resols proceeds through intermediate dimethylene ether formation.

Efficiency of light curing units in a government dental school.

Science.gov (United States)

Nassar, Hani M; Ajaj, Reem; Hasanain, Fatin

2018-01-01

The light intensity of a light-curing unit is a crucial factor that affects the clinical longevity of resin composites. This study aimed to investigate the efficiency of light-curing units in use at a local governmental dental school for curing conventional and bulk-fill resin materials. A total of 166 light-curing units at three locations were examined, and the brand, type, clinic location, diameter of curing tip, tip cleanliness (using a visual score), and the output (in mW/cm 2 using a digital radiometer) were recorded. Only 23.5% of the units examined had clean tips, with the graduate student clinical area containing the highest percentage of clean tips. Further, tips with poor cleanliness score values were associated with significantly lower output intensities. A small percentage (9.4%) of units was capable of producing intensities higher than 1,200 mW/cm 2 and lower than 600 mW/cm 2 (7.6%). The majority of the low intensity units were located in the undergraduate student area, which also contained the highest number of units with intensities between 900 and 1,200 mW/cm 2 . The output of all the units in service was satisfactory for curing conventional resin composites, and most units were capable of curing bulk-fill resin materials.

Pulp chamber temperature rise during curing of resin-based composites with different light-curing units.

Science.gov (United States)

Durey, Kathryn; Santini, Ario; Miletic, Vesna

2008-01-01

The purpose of the present study was to measure the intrapulpal temperature rise occurring during polymerisation of different shades of resin-based composites (RBCs), and two light-emitting diode (LED) units. Seventy non-carious permanent molars, that had been extracted for orthodontic purposes and stored in 2% thymol for not more than four months, were selected. Patient age range was 11-18 years. Standard cavity preparation with standardised remaining dentine thickness and placement of thermocouples (TCs) was prepared using a novel split-tooth technique. Cavities were filled with one of two shades of RBC (A2 and C4, Filtek Z250, 3M ESPE, Seefeld, Germany), and cured with two LED high-intensity units (Elipar Freelight2, 3M ESPE, Seefeld, Germany; Bluephase, Ivoclar Vivadent, Schaan, Liechtenstein) and a conventional halogen light-curing unit (LCU) (Prismetics Lite 2, Dentsply, Weybridge, Surrey, UK) as a control. Pulp temperature rises during bonding [A2 results: H;2.67/0.48:E;5.24/1.32;B;5.99/1.61] were always greater than during RBC curing [A2 results: 2.44/0.63;E3.34/0.70;B3.38/0.60], and these were significant for both LED lights but not for the halogen control, irrespective of shade (Mann-Whitney test: 95% confidence limits). Temperature rises were at times in excess of the values normally quoted as causing irreversible pulp damage. Pulp temperature rises during bonding were higher with the LED lights than with the halogen control. There was no significant difference in temperature rise between the two LED lights when bonding but there was a significant difference between the two LED lights and the halogen control LCUs (Kruskal-Wallis Test: 95% confidence limits). The results support the view that there is a potential risk for heat-induced pulpal injury when light-curing RBCs. The risk is greater during bonding and with high energy, as compared to low-energy output systems. As the extent of tolerable thermal trauma by the pulp tissues is unknown, care and

Detection of hypoglycemia with continuous interstitial and traditional blood glucose monitoring using the FreeStyle Navigator Continuous Glucose Monitoring System.

Science.gov (United States)

McGarraugh, Geoffrey; Bergenstal, Richard

2009-03-01

The objective of the analysis was to compare detection of hypoglycemic episodes (glucose 15 min) with the FreeStyle Navigator Continuous Glucose Monitoring System (FSN-CGM) (Abbott Diabetes Care, Alameda, CA) alarms to detection with traditional finger stick testing at an average frequency of eight tests per day. The performance of FSN-CGM alarms was evaluated in a clinic setting using 58 subjects with type 1 diabetes mellitus (T1DM) monitoring interstitial glucose concentration over a 5-day period compared to reference YSI measurements (instrument manufactured by YSI, Yellow Springs, OH) at 15-min intervals. Finger stick glucose testing was evaluated in the home environment with 91 subjects with TIDM monitoring with the blood glucose meter integrated into the FreeStyle Navigator (FSN-BG) over a 20-day period. The reference was FSN-CGM with results masked from the subjects. Blood glucose values glucose was <= 85 mg/dL 77.2% of the time. In the home environment, the average FSN-BG testing frequency was 7.9 tests per day. Hypoglycemia was verified within +/- 30 min by FSN-BG measurements <= 85 mg/dL at a rate of 27.5%. Even with a high rate of FSN-BG testing, hypoglycemia detected by FSN-CGM was verified by patients with T1DM very infrequently. A high rate of hypoglycemia detection with a moderate rate of unnecessary alarms can be attained using FSN-CGM.

Performance during a strenuous swimming session is associated with high blood lactate: pyruvate ratio and hypoglycemia in fasted rats.

Science.gov (United States)

Travassos, P B; Godoy, G; De Souza, H M; Curi, R; Bazotte, R B

2018-03-26

The aim of this study was to investigate the effect of lactatemia elevation and glycemia reduction on strenuous swimming performance in fasted rats. Three rats were placed in a swimming tank at the same time. The first rat was removed immediately (control group) and the remaining ones were submitted to a strenuous swimming session. After the second rat was exhausted (Exh group), the third one was immediately removed from the water (Exe group). According to the period of time required for exhaustion, the rats were divided into four groups: low performance (3-7 min), low-intermediary performance (8-12 min), high-intermediary performance (13-17 min), and high performance (18-22 min). All rats were removed from the swimming tanks and immediately killed by decapitation for blood collection or anesthetized for liver perfusion experiments. Blood glucose, lactate, and pyruvate concentrations, blood lactate/pyruvate ratio, and liver lactate uptake and its conversion to glucose were evaluated. Exhaustion in low and low-intermediary performance were better associated with higher lactate/pyruvate ratio. On the other hand, exhaustion in high-intermediary and high performance was better associated with hypoglycemia. Lactate uptake and glucose production from lactate in livers from the Exe and Exh groups were maintained. We concluded that there is a time sequence in the participation of lactate/pyruvate ratio and hypoglycemia in performance during an acute strenuous swimming section in fasted rats. The liver had an important participation in preventing hyperlactatemia and hypoglycemia during swimming through lactate uptake and its conversion to glucose.

Polyglandular autoimmune syndrome iii with hypoglycemia and association with empty sella and hypopituitarism

Directory of Open Access Journals (Sweden)

Samia Abdulla Bokhari

2017-01-01

Full Text Available A 25-year-old Saudi female with a known case of autoimmune thyroiditis presented to the Emergency Room in stuporous condition. A blood test revealed a blood sugar level of 1.7 mmols/l (30.6 mg/dl. The patient was resuscitated with intravenous glucose. Further evaluations of the patient revealed celiac disease and idiopathic thrombocytopenia with preexisting autoimmune thyroiditis (polyglandular autoimmune syndrome III [PAS III]. The severe hypoglycemia, coupled with 6 years of infertility evaluation, revealed a rare association of empty sella syndrome with hypopituitarism {PAS II}.

Electron beam-cured coating

International Nuclear Information System (INIS)

Kishi, Naoyuki

1976-01-01

The method for hardening coatings by the irradiation with electron beams is reviewed. The report is divided into seven parts, namely 1) general description and characteristics of electron beam-cured coating, 2) radiation sources of curing, 3) hardening conditions and reaction behaviour, 4) uses and advantages, 5) latest trends of the industry, 6) practice in the field of construction materials, and 7) economy. The primary characteristics of the electron beam hardening is that graft reaction takes place between base resin and coating to produce strong adhesive coating without any pretreatment. A variety of base resins are developed. High class esters of acrylic acid monomers and methacrylic acid monomers are mainly used as dilutants recently. At present, scanning type accelerators are used, but the practical application of the system producing electron beam of curtain type is expected. The dose rate dependence, the repetitive irradiation and the irradiation atmosphere are briefly described. The filed patent applications on the electron beam hardening were analyzed by the officer of Japan Patent Agency. The production lines for coatings by the electron beam hardening in the world are listed. In the electron beam-cured coating, fifty percent of given energy is consumed effectively for the electron beam hardening, and the solvents discharged from ovens and polluting atmosphere are not used, because the paints of high solid type is used. The running costs of the electron beam process are one sixth of the thermal oven process. (Iwakiri, K.)

Degree of conversion of resin-based materials cured with dual-peak or single-peak LED light-curing units.

Science.gov (United States)

Lucey, Siobhan M; Santini, Ario; Roebuck, Elizabeth M

2015-03-01

There is a lack of data on polymerization of resin-based materials (RBMs) used in paediatric dentistry, using dual-peak light-emitting diode (LED) light-curing units (LCUs). To evaluate the degree of conversion (DC) of RBMs cured with dual-peak or single-peak LED LCUs. Samples of Vit-l-escence (Ultradent) and Herculite XRV Ultra (Kerr) and fissure sealants Delton Clear and Delton Opaque (Dentsply) were prepared (n = 3 per group) and cured with either one of two dual-peak LCUs (bluephase(®) G2; Ivoclar Vivadent or Valo; Ultradent) or a single-peak (bluephase(®) ; Ivoclar Vivadent). High-performance liquid chromatography and nuclear magnetic resonance spectroscopy were used to confirm the presence or absence of initiators other than camphorquinone. The DC was determined using micro-Raman spectroscopy. Data were analysed using general linear model anova; α = 0.05. With Herculite XRV Ultra, the single-peak LCU gave higher DC values than either of the two dual-peak LCUs (P < 0.05). Both fissure sealants showed higher DC compared with the two RBMs (P < 0.05); the DC at the bottom of the clear sealant was greater than the opaque sealant, (P < 0.05). 2,4,6-trimethylbenzoyldiphenylphosphine oxide (Lucirin(®) TPO) was found only in Vit-l-escence. Dual-peak LED LCUs may not be best suited for curing non-Lucirin(®) TPO-containing materials. A clear sealant showed a better cure throughout the material and may be more appropriate than opaque versions in deep fissures. © 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Consumer satisfaction with dry-cured ham in five European countries.

Science.gov (United States)

Resano, H; Pérez-Cueto, F J A; Sanjuán, A I; de Barcellos, M D; Grunert, K G; Verbeke, W

2011-04-01

The objective is to investigate consumer satisfaction with dry-cured ham in five European countries. A logistic regression model has been fitted using data collected through a cross-sectional web-based survey carried out in Belgium, Germany, Denmark, Poland and Greece during January 2008 (n=2437 of which 2156 were dry-cured ham consumers). Satisfaction was evaluated as overall satisfaction, as well as specific satisfaction with healthfulness, price, convenience and taste. The findings show that the main determinant of overall satisfaction is taste satisfaction, hence, producers are recommended to focus on matching sensory acceptability of dry-cured ham. No significant between-country differences were found, reflecting the wide availability of this product in all countries. Consumer characteristics influenced their level of satisfaction. Men, older (age > 52 years) and frequent consumers of dry-cured ham consumption were more likely to be satisfied with dry-cured ham. Consumers trust the butcher's advice and they preferred purchasing dry-cured ham at a butcher shop rather than in a supermarket. © 2010 The American Meat Science Association. Published by Elsevier Ltd. All rights reserved.

Optimal cure cycle design of a resin-fiber composite laminate

Science.gov (United States)

Hou, Jean W.; Sheen, Jeenson

1987-01-01

A unified computed aided design method was studied for the cure cycle design that incorporates an optimal design technique with the analytical model of a composite cure process. The preliminary results of using this proposed method for optimal cure cycle design are reported and discussed. The cure process of interest is the compression molding of a polyester which is described by a diffusion reaction system. The finite element method is employed to convert the initial boundary value problem into a set of first order differential equations which are solved simultaneously by the DE program. The equations for thermal design sensitivities are derived by using the direct differentiation method and are solved by the DE program. A recursive quadratic programming algorithm with an active set strategy called a linearization method is used to optimally design the cure cycle, subjected to the given design performance requirements. The difficulty of casting the cure cycle design process into a proper mathematical form is recognized. Various optimal design problems are formulated to address theses aspects. The optimal solutions of these formulations are compared and discussed.

Evaluation of shear bond strength of orthodontic brackets using trans-illumination technique with different curing profiles of LED light-curing unit in posterior teeth.

Science.gov (United States)

Heravi, Farzin; Moazzami, Saied Mostafa; Ghaffari, Negin; Jalayer, Javad; Bozorgnia, Yasaman

2013-11-21

Although using light-cured composites for bonding orthodontic brackets has become increasingly popular, curing light cannot penetrate the metallic bulk of brackets and polymerization of composites is limited to the edges. Limited access and poor direct sight may be a problem in the posterior teeth. Meanwhile, effectiveness of the trans-illumination technique is questionable due to increased bucco-lingual thickness of the posterior teeth. Light-emitting diode (LED) light-curing units cause less temperature rise and lower risk to the pulpal tissue. The purpose of this study was to evaluate the clinical effectiveness of trans-illumination technique in bonding metallic brackets to premolars, using different light intensities and curing times of an LED light-curing unit. Sixty premolars were randomly divided into six groups. Bonding of brackets was done with 40- and 80-s light curing from the buccal or lingual aspect with different intensities. Shear bond strengths of brackets were measured using a universal testing machine. Data were analyzed by one-way analysis of variance test and Duncan's post hoc test. The highest shear bond belonged to group 2 (high intensity, 40 s, buccal) and the lowest belonged to group 3 (low intensity, 40 s, lingual). Bond strength means in control groups were significantly higher than those in experimental groups. In all experimental groups except group 6 (80 s, high intensity, lingual), shear bond strength was below the clinically accepted values. In clinical limitations where light curing from the same side of the bracket is not possible, doubling the curing time and increasing the light intensity during trans-illumination are recommended for achieving acceptable bond strengths.

Assessment of Salmonella survival in dry-cured Italian salami.

Science.gov (United States)

Bonardi, S; Bruini, I; Bolzoni, L; Cozzolino, P; Pierantoni, M; Brindani, F; Bellotti, P; Renzi, M; Pongolini, S

2017-12-04

The inactivation of Salmonella during curing of Italian traditional pork salami was investigated. A total of 150 batches of ground raw meat (GRM) used for salami manufacturing by four producers were tested for Salmonella by real-time PCR followed by ISO 6579 cultural confirmation and MPN enumeration. Salami produced with Salmonella positive GRMs were re-tested at the end of their curing period. Aw, pH and NaCl content were also measured. Detection of Salmonella was performed testing both 25 and 50g of the samples. By Real-Time PCR 37% of the GRMs resulted positive, but cultural detection of Salmonella was obtained in 14% of the samples only. Salmonella enumeration ranged from 31 MPN/g to Salmonella in 100% of all positive samples, vs. 62% of ISO-25g. Salami made of the contaminated GRMs were 29% Salmonella-positive, as most batches of salami produced with Salmonella-positive GRMs resulted negative after regular curing (20-48days). Overall, 13% of salami produced with Salmonella-contaminated GRMs were positive. They belonged to six batches, which turned out negative after prolonged curing ranging between 49 and 86days. Salmonella enumeration in salami ranged from 8.7 MPN/g to Salmonella in cured salami (p value: >0.05). The most common Salmonella serovars in GRMs were Derby (52%), Typhimurium monophasic variant 4, (Barbuti et al., 1993), 12:i:- (19%) and Stanley (10%). Salmonella Derby (56%), London, Branderup, Panama (13%, respectively) and Goldcoast (6%) were most frequent in cured salami. The study showed negative correlation between real-time CT values and cultural confirmation of Salmonella, as well as the importance of sample size for Salmonella detection. Among considered factors with possible effect on the occurrence of Salmonella in salami, statistical analysis revealed a role for aw in salami and for Salmonella load in GRMs, while pH and NaCl content did not significantly affect the probability of finding Salmonella in dry-cured salami in the context of

Process Formulations And Curing Conditions That Affect Saltstone Properties

Energy Technology Data Exchange (ETDEWEB)

Reigel, M. M.; Pickenheim, B. R.; Daniel, W. E.

2012-09-28

The first objective of this study was to analyze saltstone fresh properties to determine the feasibility of reducing the formulation water to premix (w/p) ratio while varying the amount of extra water and admixtures used during processing at the Saltstone Production Facility (SPF). The second part of this study was to provide information for understanding the impact of curing conditions (cure temperature, relative humidity (RH)) and processing formulation on the performance properties of cured saltstone.

Position statement: hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

Science.gov (United States)

Mezquita-Raya, Pedro; Reyes-García, Rebeca; Moreno-Pérez, Óscar; Muñoz-Torres, Manuel; Merino-Torres, Juan Francisco; Gorgojo-Martínez, Juan José; Jódar-Gimeno, Esteban; Escalada San Martín, Javier; Gargallo-Fernández, Manuel; Soto-Gonzalez, Alfonso; González Pérez de Villar, Noemí; Becerra Fernández, Antonio; Bellido Guerrero, Diego; Botella-Serrano, Marta; Gómez-Peralta, Fernando; López de la Torre Casares, Martín

2013-11-01

To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Radiation curing technology progress and its industrial applications in Japan

International Nuclear Information System (INIS)

Ukachi, Takashi

2003-01-01

Optics, electronics and display industries are now the driving forces for the Japanese radiation curing technology. The purpose of this paper is to overview the newly developed radiation curing technology in Japan, in particular, its industrial applications, and to present the market figures in radiation curing applications, which were surveyed by RadTech Japan in 2002 afresh. (author)

Electron beam curing - taking good ideas to the manufacturing floor

International Nuclear Information System (INIS)

Saunders, C.; Lopata, V.; Barnard, J.; Stepanik, T.

2000-01-01

Acsion is exploiting several emerging electron beam EB applications ranging from composite curing and repair to viscose manufacturing. EB curing of composite structures offers several advantages: significantly reduced curing times; improvements in part quality and performance; reduced environmental and health concerns; improvements in material handling; and reduced overall manufacturing costs compared to thermal curing. The aerospace industry is developing EB technology in all of their market sectors, including military aviation and space products. Some specific products include cryogenic fuel tanks, improved canopy frames for jet aircraft, and the all-composite military aircraft. This paper discusses each of these opportunities. (author)

Variable selection for mixture and promotion time cure rate models.

Science.gov (United States)

Masud, Abdullah; Tu, Wanzhu; Yu, Zhangsheng

2016-11-16

Failure-time data with cured patients are common in clinical studies. Data from these studies are typically analyzed with cure rate models. Variable selection methods have not been well developed for cure rate models. In this research, we propose two least absolute shrinkage and selection operators based methods, for variable selection in mixture and promotion time cure models with parametric or nonparametric baseline hazards. We conduct an extensive simulation study to assess the operating characteristics of the proposed methods. We illustrate the use of the methods using data from a study of childhood wheezing. © The Author(s) 2016.