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Monte Carlo simulations of the solubility and structure of water in polyethylene in thermodynamic equilibrium with liquid water were performed in external fields ranging from 2 x 10(5) to 4 x 10(9) V/m. For a given equilibrium temperature and pressure, the water solubility decreases at higher fields. This occurs since it is energetically favorable for water molecules to be in the pure water phase than in the polyethylene matrix at high field strengths, and results in an increased density in the water phase. However, fields relevant to high voltage conduction (in the absence of defects that can lead to large local field strengths) do not change the solubility. In addition, at large fields the number of water clusters decreases for all cluster sizes. The rate of decrease is highest for large clusters, and a larger fraction of water molecules exist as monomers in the polyethylene matrix at high fields. Large fields also cause alignment of the water molecules, which leads to more clusters with linear topologies and hence an increase in the cluster radius of gyration.

Gibbs ensemble Monte Carlo methods based on a force field that combines the simple point charge [Berendsen et al., in Intermolecular Forces, edited by Pullman (Reidel, Dordrecht, 1981), p. 331] and transferable potentials for phase equilibria [Martin and Siepmann, J. Phys. Chem. B 102, 2659 (1998)] models were used to study the equilibrium properties of binary systems consisting of water and n-alkanes with chain lengths from hexane to hexadecane. In addition, systems where extended linear alkane chains (up to 300 carbon units long) were used to represent amorphous polyethylene were simulated in the presence of water using a connectivity altering osmotic Gibbs ensemble. In these simulations the equilibrium between a liquid water phase and a polymer phase into which water was inserted was studied. The predicted solubilities, which were determined between 350 and 550 K, are in good agreement with experiment, where experimental results are available, and the density of water molecules in the hydrocarbons is approximately 63% as high as in saturated water vapor under the same conditions. At the lower temperatures most of the water exists as monomers; increasing the temperature leads to an increase in the density of water in the alkane phase and hence in the fraction of molecules that participate in clusters. Dimers are the most prevalent clusters in all hydrocarbons and at all temperatures studied, and the fraction of clusters of given size decrease with increasing cluster size. A large fraction of trimers, tetramers, and pentamers, which are the cluster sizes for which topologies have been studied, are cyclic at low temperatures, but at higher temperatures linear structures predominate. The same properties are observed for pure water vapor clusters in equilibrium with the liquid phase, showing that the cluster topologies are not significantly affected by the surrounding hydrocarbon.

Configurational-bias Monte Carlo simulations were carried out in the Gibbs ensemble to generate phase equilibrium data for several carboxylic acids. Pure component coexistence densities and saturated vapor pressures were determined for acetic acid, propanoic acid, 2-methylpropanoic acid, and pentanoic acid, and binary vapor-liquid equilibrium (VLE) data for the propanoic acid + pentanoic acid and 2-methylpropanoic acid + pentanoic acid systems. The TraPPE-UA force field was used, as it has recently been extended to include parameters for carboxylic acids. To simulate the branched compound 2-methylpropanoic acid, certain minor assumptions were necessary regarding angle and torsion terms involving the -CH- pseudo-atom, since parameters for these terms do not exist in the TraPPE-UA force field. The pure component data showed good agreement with the available experimental data, particularly with regard to the saturated liquid densities (mean absolute errors were less than 1.1%). On average, the predicted critical temperature and density were within 1% of the experimental values. All of the binary simulations showed good agreement with the experimental x-y data. However, the TraPPE-UA force field predicts saturated vapor pressures of pure components that are larger than the experimental values, and consequently the P-x-y and T-x-y data of the binary systems also deviate from the measured data.

We review the advances made in understanding the mechanism of catalyzed carbon nanotube growth, with the main focus on direct dynamics and molecular dynamics studies of single-walled carbon nanotube (SWNT) growth. These studies have deepened our understanding of the catalytic SWNT nucleation and growth mechanisms, but more accurate and efficient methods are required for a complete investigation at experimental growth conditions.

A new model is proposed for the encapsulation of catalyst metal particles by graphite layers that are obtained, for example, in low-temperature chemical vapor deposition production of carbon nanotubes (CNTs). In this model graphite layers are primarily formed from the dissolved carbon atoms in the metal-carbide particle when the particle cools. This mechanism is in good agreement with molecular dynamics simulations (which show that precipitated carbon atoms preferentially form graphite sheets instead of CNTs at low temperatures) and experimental results (e.g., encapsulated metal particles are found in low-temperature zones and CNTs in high-temperature regions of production apparatus, very small catalyst particles are generally not encapsulated, and the ratio of the number of graphitic layers to the diameter of the catalyst particle is typically 0.25 nm(-1)).

Objectives: To determine in a population of children who underwent a medical examination after alleged sexual assault the proportion who had unmet medical or psychiatric needs., Design: Retrospective medical record review., Setting: A referral center for alleged child victims of sexual assault in Houston, Tex, from December 1, 2003, through April 30, 2004., Participants: Four hundred seventy-three children (81% girls). Nine children refused all or part of the medical evaluation., Main Outcome Measure: Diagnoses that warranted intervention at the time of the medical evaluation., Results: A medical or psychological diagnosis that required intervention as judged by the examiner was made in 123 children (26%) (95% confidence interval, 22%-30%). In 39 children (8% of the total study population) (95% confidence interval, 6%-11%), the diagnosis had the potential to result in significant patient morbidity if not immediately addressed. In contrast, 44 children (9%) (95% confidence interval, 7%-12%) had probable or definite physical or laboratory evidence that supported the allegation of sexual assault., Conclusion: Among children undergoing a medical evaluation after an alleged sexual assault, important unmet health care needs are at least as common as forensic findings.

To identify genes involved in the central regulation of energy balance, we compared hypothalamic mRNA from lean and obese Psammomys obesus, a polygenic model of obesity, using differential display PCR. One mRNA transcript was observed to be elevated in obese, and obese diabetic, P. obesus compared with lean animals and was subsequently found to be increased 4-fold in the hypothalamus of lethal yellow agouti (A(y)/a) mice, a murine model of obesity and diabetes. Intracerebroventricular infusion of antisense oligonucleotide targeted to this transcript selectively suppressed its hypothalamic mRNA levels and resulted in loss of body weight in both P. obesus and Sprague Dawley rats. Reductions in body weight were mediated by profoundly reduced food intake without a concomitant reduction in metabolic rate. Yeast two-hybrid screening, and confirmation in mammalian cells by bioluminescence resonance energy transfer analysis, demonstrated that the protein it encodes interacts with endophilins, mediators of synaptic vesicle recycling and receptor endocytosis in the brain. We therefore named this transcript Src homology 3-domain growth factor receptor-bound 2-like (endophilin) interacting protein 1 (SGIP1). SGIP1 encodes a large proline-rich protein that is expressed predominantly in the brain and is highly conserved between species. Together these data suggest that SGIP1 is an important and novel member of the group of neuronal molecules required for the regulation of energy homeostasis.

The Gibbs-ensemble Monte Carlo methods based on the extended single point charge [H. J. C. Berendsen, J. R. Grigera, and T. P. Straatsma, J. Phys. Chem. 91, 6269 (1987)] potential-energy surface have been used to study the clustering of vapor phase water under vapor-liquid equilibrium conditions between 300 and 600 K. It is seen that the number of clusters, as well as the cluster size, increase with temperature. This is primarily due to the increase in vapor density that accompanies the temperature increase at equilibrium. In addition, due to entropic effects, the percentage of clusters that have linear (or open) topologies increases with temperature and dominates over the minimum-energy cyclic topologies at the temperatures studied here. These results are insensitive to the number of molecules used in the simulations and the criterion used to define a water cluster.

We report the observation of unusually strong and systematic changes in the electron transport in metallic single-walled carbon nanotubes that are undergoing collisions with inert gas atoms or small molecules. At fixed gas temperature and pressure, changes in the resistance and thermopower of thin films are observed that scale as roughly M(1/3), where M is the mass of the colliding gas species (He, Ar, Ne, Kr, Xe, CH4, and N2). Results of molecular dynamics simulations are also presented that show that the maximum deformation of the tube wall upon collision and the total energy transfer between the colliding atom and the nanotube also exhibit a roughly M(1/3) dependence. It appears that the transient deformation (or dent) in the tube wall may provide a previously unknown scattering mechanism needed to explain the atom collision-induced changes in the electrical transport.

The molecular dynamics method, based on an empirical potential energy surface, was used to study the effect of catalyst particle size on the growth mechanism and structure of single-walled carbon nanotubes (SWNTs). The temperature for nanotube nucleation (800-1100 K), which occurs on the surface of the cluster, is similar to that used in catalyst chemical vapor deposition experiments, and the growth mechanism, which is described within the vapor-liquid-solid model, is the same for all cluster sizes studied here (iron clusters containing between 10 and 200 atoms were simulated). Large catalyst particles, which contain at least 20 iron atoms, nucleate SWNTs that have a far better tubular structure than SWNTs nucleated from smaller clusters. In addition, the SWNTs that grow from the larger clusters have diameters that are similar to the cluster diameter, whereas the smaller clusters, which have diameters less than 0.5 nm, nucleate nanotubes that are approximately 0.6-0.7 nm in diameter. This is in agreement with the experimental observations that SWNT diameters are similar to the catalyst particle diameter, and that the narrowest free-standing SWNT is 0.6-0.7 nm.

The growth of single wall carbon nanotubes (SWNTs) mediated by metal nanoparticles is considered within (i) the surface diffusion growth kinetics model coupled with (ii) a thermal model taking into account heat release of carbon adsorption-desorption on nanotube surface and carbon incorporation into the nanotube wall and (iii) carbon nanotube-inert gas collisional heat exchange. Numerical simulations performed together with analytical estimates reveal various temperature regimes occurring during SWNT growth. During the initial stage, which is characterized by SWNT lengths that are shorter than the surface diffusion length of carbon atoms adsorbed on the SWNT wall, the SWNT temperature remains constant and is significantly higher than that of the ambient gas. After this stage the SWNT temperature decreases towards that of gas and becomes nonuniformly distributed over the length of the SWNT. The rate of SWNT cooling depends on the SWNT-gas collisional energy transfer that, from molecular dynamics simulations, is seen to be efficient only in the SWNT radial direction. The decreasing SWNT temperature may lead to solidification of the catalytic metal nanoparticle terminating SWNT growth or triggering nucleation of a new carbon layer and growth of multiwall carbon nanotubes., ((c) 2004 American Institute of Physics.)

Semiempirical and density functional electronic structure theory methods were used to study SWNT-X--R bond strengths, where the single-walled carbon nanotube (SWNT) had an armchair or zigzag structure, the link heteroatom X was O, N(H), or S and the hydrocarbon chain R was CH(2)CH(3), CH(OH)CH(3), CHCH(2), or CH(CF(3))CH(3). In all systems the hydrocarbon was bonded to the end of the nanotube. The SWNT-X--R bond (that is, the bond joining the link atom to the hydrocarbon) is more than 0.4 eV stronger for armchair than for zigzag nanotubes with the same diameters, irrespective of whether O, N, or S are used as link atoms or whether OH, C==C, or CF(3) groups are present in the hydrocarbon chain. This raises the possibility for selective manipulation of armchair/zigzag nanotubes using a variety of link atoms and hydrocarbon structures. The SWNT-O--CH(CF(3))CH(3) bond is weaker than the SWNT-O--CH(2)CH(3) bond (for both armchair and zigzag nanotubes), while inclusion of a double bond in the ethyl chain increases the bond strengths. Also, SWNT-S--CH(2)CH(3) and SWNT-N(H)--CH(2)CH(3) bonds are stronger than SWNT-O--CH(2)CH(3) bonds.

SelS is a newly identified selenoprotein and its gene expression is up-regulated in the liver of Psammomys obesus after fasting. We have examined whether SelS is regulated by glucose deprivation and endoplasmic reticulum (ER) stress in HepG2 cells. Glucose deprivation and the ER stress inducers tunicamycin and thapsigargin increased SelS gene expression and protein content several-fold in parallel with glucose-regulated protein 78. The overexpression of SelS increased Min6 cell resistance to oxidative stress-induced toxicity. These results indicate that SelS is a novel member of the glucose-regulated protein family and its function is related to the regulation of cellular redox balance.

Objectives: Assessment of the efficacy of a prevention of mother-to-child transmission (PMTCT) programme in a routine service setting in comparison to a research environment., Design: Descriptive study over a 13-month period utilising retrospective data obtained from hospital records complemented by prospective data on a sample of patients enrolled in a study to determine an affordable HIV diagnostic protocol for infants., Setting: Routine PMTCT service at Coronation Women and Children's Hospital (CWCH) situated in Johannesburg and affiliated to the University of the Witwatersrand., Subjects: Pregnant women known to be HIV infected who delivered at CWCH from 1 October 2001 to 31 October 2002., Outcome Measures: The HIV transmission rate to infants, which reflects nevirapine (NVP) delivery and infant feeding practices, and follow-up rates of perinatally exposed children., Results: Of the 8,221 deliveries, 1,234 (15%) occurred in women known to be HIV infected. HIV transmission rates of 8.7% at 6 weeks and 8.9% at 3 months of age in the study population verifies the high rate of NVP administration and the ability of women to formula-feed their babies and abstain from breast-feeding. More than one-third of infants never return for follow-up and more than 70% are lost to follow-up by 4 months of age., Conclusions: The low HIV transmission rate confirms the efficacy of this routine service PMTCT programme. HIV-infected children are not being identified for medical management as part of PMTCT follow-up. It is imperative that record keeping is improved to facilitate ongoing monitoring.

The incidence of cardiovascular disease (CVD) is very high in patients with chronic kidney (CKD) disease and in kidney transplant recipients. Indeed, available evidence for these patients suggests that the 10-year cumulative risk of coronary heart disease is at least 20%, or roughly equivalent to the risk seen in patients with previous CVD. Recently, the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K/DOQI) published guidelines for the diagnosis and treatment of dyslipidemias in patients with CKD, including transplant patients. It was the conclusion of this Work Group that the National Cholesterol Education Program Guidelines are generally applicable to patients with CKD, but that there are significant differences in the approach and treatment of dyslipidemias in patients with CKD compared with the general population. In the present document we present the guidelines generated by this workgroup as they apply to kidney transplant recipients. Evidence from the general population indicates that treatment of dyslipidemias reduces CVD, and evidence in kidney transplant patients suggests that judicious treatment can be safe and effective in improving dyslipidemias. Dyslipidemias are very common in CKD and in transplant patients. However, until recently there have been no adequately powered, randomized, controlled trials examining the effects of dyslipidemia treatment on CVD in patients with CKD. Since completion of the K/DOQI guidelines on dyslipidemia in CKD, the results of the Assessment of Lescol in Renal Transplantation (ALERT) Study have been presented and published. Based on information from randomized trials conducted in the general population and the single study conducted in kidney transplant patients, these guidelines, which are a modified version of the K/DOQI dyslipidemia guidelines, were developed to aid clinicians in the management of dyslipidemias in kidney transplant patients. These guidelines are divided into four sections. The first section (Introduction) provides the rationale for the guidelines, and describes the target population, scope, intended users, and methods. The second section presents guidelines on the assessment of dyslipidemias (guidelines 1-3), while the third section offers guidelines for the treatment of dyslipidemias (guidelines 4-5). The key guideline statements are supported mainly by data from studies in the general population, but there is an urgent need for additional studies in CKD and in transplant patients. Therefore, the last section outlines recommendations for research.

Ionization of hydrochloric acid (HCl) on stratospheric ice particles is believed to be a key step in the depletion of stratospheric ozone. Ab initio calculations based on a model HCl-water cluster show that HCl ionization on ice surfaces is a barrierless process. Since this mechanism is rapid and produces chloride anions that are exposed to ambient stratospheric chlorine reservoir molecules, it is likely to be important for stratospheric chemistry. It complements a previously suggested mechanism where HCl forms part of the ice lattice before ionizing. The mechanism proposed here is also consistent with experimentally observed ionization of HCl on ice at low temperatures and under vacuum, where the HCl is not expected to be encapsulated in the ice lattice.

The validity of a steady-state mass balance model (Arp et al., 1996; referred to as ARP) was tested using physicochemical soil data from the Monitoring Acid Rain Youth Program (MARYP). Four ARP sites were matched with ten MARYP sites according to proximity, bedrock type and subsoil pH to test the validity of the ARP model for critical load exceedances. Soil solution pH, base concentration and A1 concentration from MARYP sites, which were well matched to ARP sites, validated the modelled critical load exceedances. Higher exceedance areas were associated with more acidic pH and lower base and higher A1 concentrations from matched MARYP sites and vice versa. One ARP site was inappropriately matched with MARYP sites and could not be validated using base and A1 concentrations. This study also confirmed the southern limit of the zero critical load exceedance isopleth from the model. However, variability of the other exceedance isopleths was noted due to the limited number of sites used in the model. The validation of these sites in the ARP model and the zero critical load exceedance isopleth nonetheless allows greater confidence in using this model as a management tool for acidic deposition.

This report is a comprehensive review of the basic and clinical science relating to the morphology and function of the intervertebral disc of the lumbar spine. The purpose is to review the anatomy, physiology, and biomechanics of the intervertebral disc of the lumbar spine in health, with aging, and in pathologic conditions. The complex morphology and ultrastructure of the intervertebral disc of the lumbar spine in the human provide the critical elements that permit normal mobility and transmission of force through the vertebral column. Alterations in this structure are manifest in a variety of clinical conditions routinely encountered in orthopaedic physical therapy practice. These structural and biomechanical changes are related to degenerative changes that occur in association with aging and trauma. Knowledge of the gross morphology and ultrastructure of the intervertebral disc and pathobiologic processes underlying associated conditions is essential to orthopaedic practice.

Objective: To determine if the use of the whistle watch (WW), a simple device to monitor peak flow rate, affects the use of bronchodilators at home., Study Design: Prospective, randomised, crossover design., Setting: The asthma outpatients' clinic at Coronation Hospital, a tertiary care centre in Johannesburg., Patients and Methods: Children between 6 and 18 years of age with moderate or severe asthma for more than a year were enrolled. They were randomised into two groups, with bronchodilator use determined either by the WW or solely by the patient's perceived symptomatology. The patients acted as their own controls, switching over to the other group after 30 days. Eighty patients were enrolled into the study., Results: Forty-three patients completed the study (54%). There were no significant differences between these patients and those who did not complete the study in terms of sex, age and treatment characteristics. There was a significant reduction in the mean monthly number of bronchodilator doses used by the WW group (5.5 doses v. 16.81 doses, paired t-test, t = 3.64, P < 0.001, 95% confidence interval (CI) 6.1-16.55). The change in individual participants varied between 13 extra bronchodilator doses and 71 fewer doses per month with the use of the WW device., Conclusion: The WW device is a cheap, easy-to-use and effective tool that reduces the number of bronchodilator doses used by asthmatic children at home.

Objectives: To examine changes in survival rates among low-birth-weight (LBW) infants between the years 1950 and 1996., Methods: Survival figures were analysed for LBW infants managed at Baragwanath Hospital, a tertiary care centre in Soweto, Johannesburg, over four periods spanning five decades., Results: The overall mortality rates of LBW infants decreased markedly between the early 1950s and the period 1995/96. By the mid-1990's approximately four times the number of infants with birth weight less than 1,500 g were surviving compared with the early 1950s. The reduction in mortality rates occurred in all LBW groups during the first three decades. However, since 1981 infants who weighed less than 1,500 g at birth were the major contributors to the overall reduction in mortality. Between the years 1981/82 and 1995/96, survival increased significantly from 64% to 79% for infants with birth weight 1,000-1,499 g, and from 14% to 32% for those with birth weight less than 1,000 g. Since infants in the latter group were seldom offered mechanical ventilation or artificial surfactant, a large part of these increases in survival can be attributed to improvement in the general level of care., Conclusion: There have been dramatic improvements in the survival of LBW infants over this time period at Baragwanath Hospital. Although newer interventions such as mechanical ventilation and artificial surfactant have played a significant role, improvement in care at primary and secondary levels has been of major importance.

About 1% of Staphylococcus aureus cells survived the production of gelatin sheets containing nutrient broth. Those cells which survived showed no evidence of injury. Growth occurred in rubbery state gelatin with a(w) values of 0.98 and 0.93 ; viability decreased during storage at a(w) values of 0.89, 0.62 and 0.36 but there was little loss of viability in gelatin at an aw of 0.25 over 27 d storage at 26 degrees C. Assays for enterotoxin A detected no synthesis of new toxin but no loss in pre-formed toxin. The results suggest that high levels of Staph. aureus and its toxins should be excluded from glassy and rubbery state food products in order to prevent illness.

Salmonella senftenberg and Salmonella typhimurium survived the production of gelatin sheets containing nutrient broth although there was some evidence of cell damage. Both strains survived but did not grow in glassy states with an a(w) of 0.45-0.28 and rubbery states with an a(w) of 0.93-0.96 for at least 28 d. Survival was less in intermediate states with an a(w) between 0.55 and 0.74. The results suggest that salmonellas should be excluded from glassy state products in order to prevent salmonellosis.

The prevalence of periventricular-intraventricular haemorrhage (PV-IVH) among very-low-birth-weight infants at Baragwanath Hospital has not been well documented. In this prospective study, a total of 282 live-born infants with birth weights of 1,000-1,749 g were studied over a 4 1/2-month period. Every infant had at least one cranial ultrasound examination at 7-10 days of age, while one-third of non-ventilated and all ventilated infants had ultrasound examinations on days 3, 7 and 14. Where possible, all infants had a follow-up ultrasound scan at 40 weeks' post-conceptional age. The overall prevalence of PV-IVH was 53% for infants weighing less than 1,500 g at birth and 52% for infants born at less than 35 weeks' gestation, but only 12% had either grade III or grade IV haemorrhages. The prevalence and severity of PV-IVH increased with both decreasing birth weight and decreasing gestational age and was also predicted by the need for active resuscitation at birth, mechanical ventilation and the development of pneumothorax. A total of 93% of infants without PV-IVH survived, but survival decreased with increasing grade of PV-IVH. Germinal matrix cysts were noted on follow-up in 55% of surviving infants with grade I PV-IVH. Very-low-birth-weight infants at Baragwanath Hospital therefore seem to have a higher prevalence of PV-IVH when compared with reported figures, but this is due mainly to an increase in smaller haemorrhages.

Family physicians frequently perform outpatient vasectomies. A new approach to exposing the vas deferens, called the no-scalpel vasectomy, results in fewer complications and, the authors believe, improved patient acceptance. This technique, which calls for two specialized instruments, is described, along with patient selection and education issues, vasal occlusion techniques and post-vasectomy follow-up.

A congenital pericardial effusion without a clinically obvious cause is rare. The presentation, diagnostic studies, and anatomic findings in three such cases are described. It is postulated that the fluid within the pericardial sac, was a transudate produced by a partially strangulated portion of the liver, trapped in an intrapericardial hernia with sac, which was present in each case. Encroachment with compression by the enlarged pericardium on the developing lung bud structures is the reason given for the pulmonary hypoplasia, associated with this form of diaphragmatic hernia. Severe pulmonary insufficiency was the presenting feature, while cardiac tamponade is noted for its absence, in these cases.

A combined clinic for pregnant diabetic women was established at Baragwanath Hospital to assess the effects of intensive monitoring of mother and fetus and of good glycaemic control on perinatal outcome. Home blood glucose monitoring was introduced as a method for assessing glycaemic control. Standard methods of maternal and fetal monitoring were used. Sixty-two diabetic pregnancies were evaluated prospectively. Twenty women had diabetes diagnosed for the first time in the current pregnancy and the remaining 42 had established diabetes. All patients followed a diabetic diet, and 95% were treated with insulin. The technique and accurate recording of blood glucose were managed by all patients, and a mean capillary blood glucose of 6.5 mmol/l for the group was achieved. Caesarean section was performed in 52% of cases with a mean period of gestation at the time of delivery for the total study population of 37 weeks. The mean neonatal weight was 3,130 g. The perinatal mortality rate of 64/1,000 was accounted for by 3 stillbirths and 1 early neonatal death. No major congenital anomalies occurred.

The timing of umbilical cord clamping in 38 women with preterm labour was randomly assigned. Ultrasonographic evidence of periventricular/intraventricular haemorrhage (PVH/IVH), assessed blindly, was found in 77% of the group clamped early compared with 35% of those in whom clamping of the cord was delayed for 1 minute. A hypothesis to explain the possible contribution of the haemodynamic events which accompany cord clamping to the development of PVH/IVH is presented.

1. Levels of serum UDP-galactose:glycoprotein galactosyltransferase in 117 unselected diabetics were compared with those in 60 non-diabetic healthy controls. 2. Enzyme activity (mean +/- 2 S.D.) of control sera was found to be 90.2 +/- 21.5 etamoles/ml/hr at 37 degrees. In 30 of the 117 diabetic sera (26%) enzyme activity was elevated (greater than mean + 2 S.D. of the controls). Sixteen of 19 (84%) patients with retinopathy, 16 of 26 (62%) patients with peripheral vasculopathy and 13 of 26 (50%) patients with neuropathy had higher levels of serum enzyme. When serum enzyme levels of groups of diabetics with retinopathy, peripheral vasculopathy and neuropathy were compared with the enzyme level in all diabetics, there was a significant difference with p values of 0.001, 0.05 and 0.05 respectively.