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Background: We aimed to investigate the effect of chromium supplementation on glycemic control indices in patients with type 2 diabetes (T2DM)., Methods: Randomized controlled trials examining the effect of chromium supplementation on glycemic control indices and published before February 2020 were detected by searching online databases, including PubMed, Scopus, Embase, Web of sciences and The Cochrane Library, using a combination of suitable keywords. Mean change and standard deviation (SD) of the outcome measures were used to estimate the mean difference between the supplementation group and the control group at follow-up., Results: Twenty-eight studies reported fasting plasma glucose (FPG), insulin, hemoglobin A1C (HbA1C) and homeostatic model assessment for insulin resistance (HOMA-IR) as an outcome measure. Results revealed significant reduction in FPG (weighted mean difference (WMD): -19.00 mg/dl, 95% CI: -36.15, -1.85, P = 0.030; I 2 : 99.8%, p < 0.001), insulin level (WMD: -12.35 pmol/l, 95% CI: -17.86, -6.83, P < 0.001), HbA1C (WMD: -0.71 %, 95% CI: -1.19, -0.23, P = 0.004) and HOMA-IR (WMD: -1.53, 95% CI: -2.35, -0.72, P < 0.001; I 2 : 89.9%, p < 0.001) after chromium supplementation., Conclusion: The results of the current meta-analysis study might support the use of chromium supplementation for the improvement of glycemic control indices in T2DM patients., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aim: We previously reported the outcome of chromic phosphate-32( 32 P) colloid synoviorthesis in 53 haemophilic patients with an average follow-up of 31 months. The purpose of the present study was the long-term follow-up of the same cohort on both clinical and radiographic features., Materials: Nine patients failed to attend the recall appointment. The mean follow-up for the remaining 44 patients (52 procedures) was 15 years (range, 14.6-15.5). The mean age at the time of reassessment was 31 years (range, 18-43)., Results: The haemarthrosis frequency was not statistically significant at the latest follow-up years compared with 31 months (0.8 vs 0.4 per week, P = .3). There was no significant change in the clinical severity of haemophilic arthropathy (P = .5). Most of the treated joints still are in stage III of Fernandez-Palazzi and Caviglia classification. There was a trend towards the radiologic deterioration of arthritis with nearly 50% of patients at Arnold-Hilgartner Stage V. 13% of patients underwent a total knee arthroplasty (TKA). The age at which the initial radiosynovectomy was performed was significantly higher in patients who had a TKA than those who had not (22 vs 15 years, P < .002)., Conclusion: The bleeding control effect of 32P on the target joint remains over time; however, it did not appear to halt the progression of radiographic changes in haemophiliacs. It could delay the need for TKA if it performs at the right time., (© 2019 John Wiley & Sons Ltd.)

The aim of the study was to assess the combined effects of chromium(III) supplementation and iron deficiency on the copper (Cu) and zinc (Zn) status in female rats. The Cr, Fe, Cu and Zn dietary and tissular levels were measured by Atomic Absorption Spectrometry (AAS) method. The data show that chromium(III) supplementation compensated for the negative effects of Fe deficiency on the Cu content but it deepened the effect on Zn levels in the female rats. Detailed data on the status of trace elements and their interactions in healthy subjects and patients with metabolic disorders (e.g. anaemia, diabetes mellitus) are strongly required for effective nutritional and therapeutic strategies.

The sulfated rhamnose polysaccharides found in Enteromorpha prolifera belong to a class of unique polyanionic polysaccharides with high chelation capacity. In this study, a complex of sulfated rhamnose polysaccharides with chromium(III) (SRPC) was synthesized, and its effect on type 2 diabetes mellitus (T2DM) in mice fed a high-fat, high-sucrose diet was investigated. The molecular weight of SRPC is 4.57 kDa, and its chromium content is 28 μg/mg. Results indicated that mice treated by oral administration of SRPC (10 mg/kg and 30 mg/kg body mass per day) for 11 weeks showed significantly improved oral glucose tolerance, decreased body mass gain, reduced serum insulin levels, and increased tissue glycogen content relative to T2DM mice (p < 0.01). SRPC treatment improved glucose metabolism via activation of the IR/IRS-2/PI3K/PKB/GSK-3β signaling pathway (which is related to glycogen synthesis) and enhanced glucose transport through insulin signaling cascade-induced GLUT4 translocation. Because of its effectiveness and stability, SRPC could be used as a therapeutic agent for blood glucose control and a promising nutraceutical for T2DM treatment., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Psychopharmacologic treatment is playing a greater role in the management of patients with eating disorders. In this paper, we review randomized, placebo-controlled trials (RCTs) conducted in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other eating disorders over the past 3 years. Fluoxetine remains the only medication approved for an eating disorder, that being BN. RCTs of antipsychotics in AN have had mixed results; the only agent with some evidence of efficacy is olanzapine. One study suggests dronabinol may induce weight gain in AN. Preliminary studies suggest lack of efficacy of alprazolam, dehydroepiandrosterone, or physiologic estrogen replacement in AN; erythromycin in BN; and the opioid antagonist ALKS-33 in BED. In BED with obesity or overweight, bupropion may cause mild weight loss without seizures, and chromium may improve glucose regulation. Also in BED, three RCTs suggest the stimulant prodrug lisdexamfetamine may reduce binge eating episodes, and another RCT suggests intranasal naloxone may decrease time spent binge eating. There remains a disconnection between the size of eating disorders as a public health problem and the lack of pharmacotherapy research of these conditions.

Diabetes, particularly type II diabetes, is a severe disease condition which affects human health worldwide, with a dramatically increasing trend in Asian countries including China. Currently, no efficient drugs other than those with observable side effects are available. Chromium complexes, with the most known representative chromium picolinate, have been listed as one of most attractive health supplements to attenuate this disease condition in western countries. Recent efforts have been made to develop new chromium complexes with novel ligands. Although fair amounts of reviews have been published to emphasize the biological activity, preclinical and clinical information of chromium picolinate, this mini-review is trying to cover the entire picture of updated research efforts on various chromium complexes highlighting the role of ligands. Chromium phenylalanine sensitizes insulin cell signaling pathway via the activation of phosphorylation of Akt (protein kinase B (PKB)) and/or AMPK (AMP-activated protein kinase). The biological activities, toxicity, pharmacological features and clinical implications, including the effect of anti-oxidative capacities, protective effect on obese-induced heart dysfunction, and efficacy and safety of chromium supplementation in diabetes are discussed as well., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aims: Chromium (Cr) is a trace element involved in glucose homeostasis. We aim to evaluate and quantify the effects of Cr supplementation on A1C and FPG in patients with T2DM., Materials and Methods: A systematic literature search of Pubmed, EMBASE and the Cochrane Library (from database inception to 11/2014) with no language restrictions sought RCTs or cohort studies evaluating Cr supplementation in T2DM vs control and reporting either change in glycated hemoglobin (A1C) or fasting plasma glucose (FPG). Meta-analysis was conducted on each subtype of Cr supplement separately, and was analyzed by random effects model to yield the weighted mean differences (WMD) and 95% confidence intervals (CIs). Heterogeneity was assessed by using the I(2) statistic., Results: A total of 14 RCTs (n=875 participants, mean age range: 30 to 83 years old, 8 to 24 weeks of follow-up) were identified (Cr chloride: n=3 study, Cr picolinate: n=5 study, brewer's yeast: n=4 study and Cr yeast: n=3 study). Compared with placebo, Cr yeast, brewer's yeast and Cr picolinate did not show statistically significant effects on A1C. Furthermore, compared to control, Cr chloride, Cr yeast and Cr picolinate showed no effect on FPG, however, brewer's yeast showed a statistically significant decrease in FPG -19.23 mg/dL (95% CI=-35.30 to -3.16, I(2)=21%, n=137)., Conclusions: Cr supplementation with brewer's yeast may provide marginal benefits in lowering FPG in patients with T2DM compared to placebo however it did not have any effect on A1C.

Background: Seasonal allergic rhinitis (SAR), also known as hay fever, is a widespread chronic respiratory disease. In treatment of SAR the use of complementary therapies is increasing, but little has been published about homeopathic complex remedies so far. Therefore, we think it is time to conduct and publish an appropriate observational study., Methods: Course of single symptoms, impairment of quality of life, general efficacy, and tolerability of a homeopathic complex remedy containing active substances on a low dilution level have been assessed and analyzed. Altogether, 123 patients with a history of allergic rhinitis of up to 45 years have been observed for about 4 weeks., Results: The majority of symptoms were shown to improve substantially and the patients' quality of life increased clearly. The overall symptom score decreased significantly from 10.3 ± 4.7 to 3.9 ± 3.1 points (p < 0.0001), and reduction of impairment of quality of life from 5.7 ± 2.3 to 1.9 ± 1.8 score points was also significant (p < 0.0001). Rating of efficacy of study medication was markedly better than efficacy rating of previous therapies (p = 0.0193). Apart from one temporary allergic reaction, the treatment was well tolerated., Conclusion: The homeopathic complex remedy (Pascallerg®) tested in this observational study offers a useful option in treatment of SAR in children and adults., (© 2015 S. Karger GmbH, Freiburg.)

In China, TianMai Xiaoke tablet (TM) is used to treat type 2 diabetes. However, the exact mechanism of TM is not clear. This study is to investigate the effect of TM on glucose metabolism in diabetic rats and to identify whether TM takes a direct action through microRNAs on islet. Rats were divided into control group, diabetic group, low dose of TM group (TML), and high dose of TM group (TMH). Pancreas samples were analyzed using microRNA array and Q-PCR. Eight-week treatment with TM significantly decreased fasting blood glucose. The blood glucose was significantly reduced in TM-treated groups before and after oral glucose administration. Fasting insulin and HOMA-IR were suppressed in TM-treated groups. miR-448, let-7b, miR-540, miR-296, miR-880, miR-200a, miR-500, miR-10b, miR-336, miR-30d, miR-208, let-7e, miR-142-5p, miR-874, miR-375, miR-879, miR-501, and miR-188 were upregulated, while miR-301b, miR-134, and miR-652 were downregulated in TMH group. Through target gene analysis and real-time PCR verification, we found that these miRNAs, especially miR-375 and miR-30d, can stimulate insulin secretion in islet. Our data suggest that TM can improve blood glucose in diabetic rats which involved increasing the expression of miR-375 and miR-30d to activate insulin synthesis in islet.

Purpose: (32)P-chromic phosphate colloid treatments of astrocytoma and craniopharyngioma cystic brain tumours in paediatric patients are conventionally based on a sphere model under the assumption of uniform uptake. The aims of this study were to determine the distribution of the absorbed dose delivered by (32)P on a patient-specific basis and to evaluate the accuracy with which this can be predicted from a pretherapy administration of (99m)Tc-Sn colloid., Methods: Three patients were treated with (32)P-chromic phosphate colloid following (99m)Tc-Sn colloid administrations. Convolution dosimetry was performed using pretherapy and posttherapy sequential SPECT imaging, and verified with EGSnrc Monte Carlo radiation transport simulations. Mean absorbed doses to the cyst wall and dose-volume histograms were also calculated and compared with those obtained by the sphere model approach., Results: Highly nonuniform uptake distributions of both the (99m)Tc and (32)P colloids were observed and characterized by dose-volume histograms to the cyst wall. Mean absorbed doses delivered to the cyst wall, obtained with the convolution method, were on average 21 % (SD 18 %) and 50 % (SD 30 %) lower than those predicted by the (99m)Tc distribution and the uniform assumption of the sphere model, respectively., Conclusion: Absorbed doses delivered to the cyst wall by (32)P are more accurately predicted from image-based patient-specific convolution dosimetry than from simple sphere models. These results indicate the necessity to perform personalized treatment planning and verification for intracavitary irradiation of cystic brain tumours treated with radiocolloids. Patient-specific dosimetry can be used to guide the frequency and levels of repeated administrations and would facilitate data collection and comparison to support the multicentre trials necessary to progress this therapy.

The study goal was to clarify the therapeutic effect and the absorbed dose of radionuclide phosphorus-32 for skin hemangiomas and the consequent risk of side effects in these patients. Phosphorus-32 is an β emitter and is used for skin hemangioma treatment. In comparison with the few Gy per minute of the linear accelerators, the dose rate of phosphorus-32 for hemangiomas is much <1 Gy/hour; so, the latter is called low-dose-rate radiation. To achieve the therapeutic dose, continuous hours or days of radiation is necessary. For strawberry hemangiomas, the phosphorus-32 applicator was tightly placed on the lesion site for several hours until reaching therapeutic dose. The absorbed dose was estimated by radiochromic films. The absorbed dose of phosphorus-32 irradiation declined exponentially with a depth from 0 to 2.5 mm. Of the 316 patients with strawberry hemangiomas, the lesion disappeared completely within 3 months after one-time treatment in 259 cases (82%). For cavernous hemangiomas, 370KBq phosphorus-32 colloid was injected into the hemangioma each square centimeter, and the absorbed radiation was estimated by theoretical calculation. Forty-two of the 58 patients with cavernous hemangiomas (72%) had lesions that completely disappeared within 3 months after receiving one to six treatments. Thus, the phosphorus-32 for strawberry hemangiomas and the chromium phosphate-32 colloid for cavernous hemangiomas were clearly efficacious.

Excessive body weight is inversely associated with insulin sensitivity in children and adults. Chromium supplementation produces modest improvement in insulin sensitivity in adults. The aim of this study was to examine the beneficial effects of chromium supplementation on insulin sensitivity and body composition in overweight children simultaneously modifying lifestyle. Twenty-five overweight children aged 9-12 years were randomized to receive either 400 μg of chromium chloride or placebo in double-blind fashion, during a 6-week lifestyle modification regimen that included nutritional education and 3×90 min of aerobic physical activity weekly. Insulin sensitivity was demonstrated using homeostasis model assessment-insulin resistance and quantitative insulin sensitivity check index (QUICKI). Changes in body mass index (BMI; kg/m(2)), BMI Z-score, waist circumference, body composition and fasting plasma glucose were measured. Although no significant benefit of chromium supplementation over placebo was evident for BMI, BMI Z-score and fasting insulin level, children who received chromium chloride demonstrated more positive changes versus the placebo group in HOMA (-1.84±1.07 vs. 0.05±0.42, P=.05), QUICKI (0.02±0.01 vs. -0.002±0.01, P=.05), lean body mass (2.43±0.68 kg vs. 1.36±1.61 kg, P=.02) and percentage body fat (-3.32±1.29% vs. 0.65±1.05%, P=.04). The desirable effects of chromium supplementation on insulin sensitivity and body composition were more apparent in pre-pubertal children. These results suggest that short-term chromium supplementation can improve insulin sensitivity and body composition in overweight children., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The synthesis, characterization, anti-hyperglycemic activity, oxidative DNA damage capacity, and acute toxicity of chromium(III) malate complex [Cr2(LMA)3] were described. [Cr2(LMA)3] was synthesized in a single-step reaction by chelating chromium(III) with L-malic acid in aqueous solution. Based on elemental analysis, thermodynamic analysis, and spectroscopy studies, the molecular formula of [Cr2(LMA)3] was inferred as Cr2(C4H4O5)3·5H2O. Daily treatment with 2.85-17.10 mg/kg body mass of [Cr2(LMA)3] in alloxan-induced diabetic rats for 2 weeks indicated that low-molecular-weight organic chromium complex [Cr2(LMA)3] had better bioavailability and more beneficial influences on the improvement of controlling blood glucose, serum lipid, and liver glycogen levels compared with CrCl3·6H2O. [Cr2(LMA)3] did not cause oxidative DNA damage under physiologically relevant conditions. Acute toxicity studies revealed no-measurable toxicity of the [Cr2(LMA)3]. Collectively, these results suggest that [Cr2(LMA)3] may represent a novel, proper chromium supplement with potential therapeutic value to control blood glucose and serum lipid in diabetes.

Background and Objective: ³²P-chromic phosphate-poly (L-lactic) acid (³²P-CP-PLLA) microparticle is a novel potent brachytherapy implant, which has good biocompatibility and biodegradability. The aim of this study is to investigate the changes of pathology and PET/CT images in VX2 rabbit tumor after treatment with intratumorol administration of ³²P-CP-PLLA microparticles, and to explore the effects and influence of tumor growth and apoptosis related proteins in VX2 lung tumor treatment with ³²P-CP-PLLA microparticles., Methods: Twenty-four tumor bearing rabbits were randomly divided into 4 groups (6 in each group). Group 1, 2 and 3 were treated groups; group 4 was the control. Under CT guidance, ³²P-CPPLLA microparticles were implanted into tumors. Low, medium and high treatment doses were 93 MBq (group 1), 185 MBq (group 2) and 370 MBq (group 3), respectively. ¹⁸F-FDG PET/CT was performed at d0, d3, d7 and d14 after intratumoral administration. In the control group, ¹⁸F-FDG PET/CT images were acquired at the same time points but without treatment. The standardized uptake value (SUV) of tumor regions were calculated. After last PET/CT imaging, the rabbits were euthanized and the tumors were removed for histological and immunohistochemical examination. The pathology and the expression of apoptosis related proteins (bcl-2, bax) were compared., Results: No significant difference of SUVmax was observed between the treatment groups and the control group at d0. At d14, the SUVmax values for group 1, 2 and 3 were 0.80±0.10, 1.1±0.19 and 2.85±0.15, respectively, and were significantly lower than that of the control group (5.61±0.50)(P < 0.05). Significant dose-response relationship was observed in SUVmax between group 1 and group 2, and the SUV values gradually decreased from d7 to d14 after treatment. In group 3, SUVmax gradually increased and reached a peak at d7 then significantly decreased. The SUVmax values of group 3 were significantly lower than those of the control at the same time point (P < 0.05). HE staining found degenerative necrosis at the site was nearby the microparticle. Necrosis became serious increasing with the radioactivity. Inflammatory cell infiltration was rarely seen in tumors treated with 93 MBq or 185 MBq ³²P-CP-PLLA microparticles. In contrast, the necrotic area was surrounded by marked inflammatory cell infiltration in group 3. IHC analysis showed that the expression of bcl-2 in treated groups were lower than those in the control group, and the expression of bax in treated group was higher than those in the control group (P < 0.05). The ratio of bcl-2/bax protein significantly decreased in the treated group (P < 0.05). Dose dependence was seen in the expression of apoptosis related proteins., Conclusions: The sustained irradiation of ³²P-CP-PLLA microparticles can direct kill the VX2 tumor cell, thus the glycolysis of which were suppressed. Although the alive tumor cells still presented faraway from the microparticle, the expression of apoptosis related proteins in which were significantly different from the control. Bcl-2 and bax gene were induced to participate in regulation for the apoptosis of VX2 tumor cell by ionizing radiation from ³²P-CP-PLLA microparticles, so that the tumor growth was inhibited.

Intracavitary injections of (32)P chromic phosphate are used in the therapy of pleuropulmonary blastoma and pulmonary sarcomas in children. The lung dose, however, has never been calculated despite the potential risk of lung toxicity from treatment. In this work the dosimetry has been calculated in target tissue and lung for pediatric phantoms. Pleural cavities were modeled in the Monte Carlo code MCNP within the pediatric MIRD phantoms. Both the depth-dose curves in the pleural lining and into the lung as well as 3D dose distributions were calculated for either homogeneous or inhomogeneous (32)P activity distributions. Dose-volume histograms for the lung tissue and isodose graphs were generated. The results for the 2D depth-dose curve to the pleural lining and tumor around the pleural cavity correspond well with the point kernel model-based recommendations. With a 2 mm thick pleural lining, one-third of the lung parenchyma volume gets a dose more than 30 Gy (V(30)) for 340 MBq (32)P in a 10 year old. This is close to lung tolerance. Younger children will receive a larger dose to the lung when the lung density remains equal to the adult value; the V(30) relative lung volume for a 5 year old is 35% at an activity of 256 MBq and for a 1 year old 165 MBq yields a V(30) of 43%. At higher densities of the lung tissue V(30) stays below 32%. All activities yield a therapeutic dose of at least 225 Gy in the pleural lining. With a more normal pleural lining thickness (0.5 mm instead of 2 mm) the injected activities will have to be reduced by a factor 5 to obtain tolerable lung doses in pediatric patients. Previous dosimetry recommendations for the adult apply well down to lung surface areas of 400 cm(2). Monte Carlo dosimetry quantitates the three-dimensional dose distribution, providing a better insight into the maximum tolerable activity for this therapy.

Purpose: The effect of i.v. chromium administration on glucose control in two patients receiving enteral nutrition is described., Summary: Chromium supplementation has been hypothesized to potentiate the actions of insulin in facilitating cellular uptake of glucose. We report two cases-one involving a diabetic patient and the other a nondiabetic patient-in which chromium administration appeared to decrease insulin requirements. In case 1, a diabetic patient given a single course of chromic chloride appeared to have a probable response to the drug. Within the first day of chromic chloride administration, insulin requirements declined. When chromic chloride was discontinued, insulin requirements did not rise, suggesting efficacy and sustained effect. The patient's glucose intake and blood glucose levels remained relatively stable, while there was a significant decline in insulin requirements. Serum chromium levels were not assessed, so it is uncertain if the patient experienced chromium deficiency or if it was adequately treated with chromium supplementation, and a dose-response relationship could not be ascertained because the patient received a continuous infusion of chromium. In case 2, the insulin requirements of a nondiabetic patient appeared to decrease in response to multiple courses of chromic chloride. Upon initial discontinuation of chromic chloride, the patient's lower insulin requirements were sustained for a few days, but changes in clinical status and other medications precipitated elevated insulin requirements and the need for subsequent chromic chloride administration. Further research in more controlled settings is necessary to elucidate chromium's effect on insulin requirements., Conclusion: Infusion of chromic chloride appeared to reduce insulin requirements in one diabetic patient and one nondiabetic patient.

Objective: The purpose of our study was to retrospectively examine the efficacy of intralesional injection of 32P chromic phosphate, a beta-emitting colloidal radiopharmaceutical, in the treatment of aneurysmal bone cysts of the axial skeleton. Five patients with large aneurysmal bone cysts were managed with injection of 32P chromic phosphate into their tumors under CT guidance. With only a single minor complication, all lesions were observed to ossify on follow-up CT, with an average follow up of 2 years., Conclusion: CT-guided injection of axial aneurysmal bone cysts with 32P chromic phosphate leads to excellent local lesion control. In addition, the morbidity associated with this procedure is lower than that associated with surgical or other nonsurgical treatments.

Objective: We aimed to study the interstitial injection of (32)P-chromic phosphate colloids ((32)P-CP) during lung cancer resection to treat occult lymphatic metastasis, and to observe its medium-term and long-term effects., Methods: Seventy-three patients underwent surgery combined with injection of (32)P-CP with the dosage of 296-370 MBq/10 ml to the adipose and connective tissues neighboring pulmonary hilum, superior mediastinum, carina of trachea, and suspicious invaded pleura. Fifty-eight patients underwent only tumor resections served as control group. A monofactorial analysis by a chi test was conducted to determine the differences in positive rates of lymph nodes, the incidence of complications after the operation, the rate of supraclavicular lymph node metastasis, and the survival rate between the two groups. The survival curves were obtained using the Kaplan-Meier method and were compared by a log-rank test. The Cox's multivariate analysis was performed to identify the prognostic factors., Results: There was no significant difference between lymph node-positive rates and the incidences of major complications (P>0.05). The rate of supraclavicular lymph node metastasis in surgery plus (32)P-CP group was prominently lower than that in the control group (P<0.05). Three-year and 5-year survival rates of the two groups showed significant difference (P<0.05). A Kaplan-Meier analysis revealed prominent statistical differences between the two groups (P<0.05). The Cox's multivariate analysis showed that the injection of (32)P-CP is one of the independent predictors of survival rates., Conclusion: Interstitial mediation with (32)P-CP during the resection of lung cancer is effective in inhibiting postoperative occult lymphatic metastasis, and showed satisfactory effects in improving patients' medium-term and long-term survival rates.

Background: St John's wort is an effective antidepressant that can reduce tobacco withdrawal symptoms, but it is not known whether it assists cessation. Chromium assists weight loss and might limit post cessation weight gain., Methods: In a factorial design, we randomised smokers stopping smoking to 900 mg St John's wort (SJW) active or placebo and also randomised them to 400 microm chromium or placebo daily. Treatment started 2 weeks prior to quit day and continued for 14 weeks. Participants and researchers were blind to treatment allocation. All participants received weekly behavioural support. The primary endpoints were biochemically confirmed prolonged abstinence and mean weight gain in abstinent smokers 4 weeks after quitting., Results: 6/71 (8.5%) participants on active SJW and 9/72 (12.5%) on placebo achieved prolonged abstinence at 4 weeks, an odds ratio (OR) (95% confidence interval) of 0.65 (0.22-1.92). At 6 months, 3 (4.2%) SJW active and 6 (8.3%) SJW placebo participants were still abstinent, an OR of 0.49 (0.12-2.02). Among these participants, the mean difference in weight gain between active chromium and placebo was -0.8 1kg (-3.79 to 2.18) at 4 weeks and -3.88 kg (-12.13 to 4.38) at 6 months., Conclusions: Taking together the absolute quit rates, the small difference between active and placebo, and lack of effects on withdrawal shows that SJW is ineffective for smoking cessation. Insufficient people stopped smoking to properly test the efficacy of chromium in preventing weight gain, but the point estimate indicates a potentially worthwhile benefit.

Aims: The aim of this work was to study the effectiveness of (32)P-chromic phosphate colloids ((32)P-CP), by stromal injection during cardiac-esophageal carcinoma resection, in the prevention and treatment of minute lymphatic metastasis., Methods: A multipointed infiltrative injection was done on 91 patients with clinically diagnosed cardiac-esophageal carcinoma to the adipose connective tissues of the corresponding bed of the resected lesion or retroperitonial wall, or tissues neighboring the left gastric artery, abdominal aorta, fenestra of aortic arch, pulmonary hilum, and superior mediastinum following the resection of a tumor. For patients with nonresectable lesions, a multipointed superficial injection of (32)P-CP-diluted solution was administered to the tumor and its surrounding invaded tissue, gastric artery, and the mediastinal adipose connective tissue. The dosage of (32)P-CP was 296 ~ 370 MBq/10 mL (8 ~ 10 mCi/10 mL). A simple operative group of 99 cases with clinically diagnosed cardiac-esophageal carcinoma, but without being given an injection of (32) P-CP, served as the control. Survival curves between the 2 groups were obtained using the Kaplan-Meier method and were compared by a log-rank test. The differences in complications following the operation, the positive rate of lymph nodes (LN), the rate of LN metastasis, and the survival rate following the operation between the 2 groups were determined by conducting a monofactorial analysis by a chi(2) test., Results: No operative deaths occurred in either group. The incidences of perioperative complications were not different statistically between the 2 groups (p > 0.05). The rate of lymph node metastasis, as well as the incidences of mediastinum, supraclavicle, and abdominal lymph node metastasis, showed that there were prominent statistical differences between the 2 groups (p < 0.05). A Kaplan-Meier analysis showed that there was a significant difference between the operative plus irradiation group, compared with the simple operative group (p = 0.0085)., Conclusions: Stromal medication with (32)P-CP during a cardiac-esophageal carcinoma resection is a simple and safe procedure for controlling postoperative lymphatic metastasis and revealed a very fair clinical effectiveness in improving both medium- and long-term survival rates in patients.

The cation [Cr(3)O(propionate)(6)(H(2)O)(3)](+) has recently been found by oral or intravenous administration to increase insulin sensitivity and improve serum lipids in healthy and type 2 diabetic model rats. Serum insulin concentrations and, hence, insulin sensitivity are in part responsible for the relationship between diet and the incidence of colorectal cancer. This strongly suggested that the synthetic cation, which in vitro is able to stimulate insulin receptor tyrosine kinase activity in a fashion similar to the oligopeptide chromodulin, could influence the incidence of colorectal cancer. Consequently, the effects of the cation on the inhibition of colon tumorigenesis induced by 1,2-dimethylhydrazine in male Sprague Dawley rats were examined. Gavage administration of aqueous solutions of the complex (1000 microg Cr/kg body mass daily for 6 months) resulted in significantly decreased colon tumor incidence (P<0.003).

Though supplementation of chromium has been found to improve deranged carbohydrate and lipid metabolism associated with suboptimal chromium intake in patients, its usefulness in the treatment of diabetes mellitus of variable etiology remains questionable. In the present investigation, the effect of 6 wk oral administration of chromium chloride (CC) on the glucose and lipid metabolism was studied in streptozotocin (STZ) diabetic and neonatal-STZ (nSTZ) diabetic rats. Further, its cellular mechanism was studied using 3T3-L1 adipocyte and C2C12 myoblast cell lines. Treatment with CC significantly improved the impaired glucose tolerance and insulin sensitivity of both STZ diabetic and nSTZ diabetic rats without any change in basal or glucose stimulated insulin response indicating insulin-sensitizing action of chromium. CC treatment also significantly improved deranged lipid metabolism. CC per se did not produce any effect in vitro, however, significantly increased insulin stimulated glucose uptake in C2C12 myoblasts and differentiation of 3T3-L1 preadipocytes into mature adipocytes supporting the in vivo insulin-sensitizing action of chromium. This study shows that CC exhibited significant anti-diabetic potential in chemically-induced diabetes in rats, the mechanism of which appears to be potentiation of insulin actions at the target tissues leading to improved peripheral insulin sensitivity.

Purpose: To conduct a prospective study of intraperitoneal radioactive chromic phosphate (32P) versus cyclophosphamide-cisplatin (CP) in women with early ovarian cancer at high risk for recurrence (International Federation of Gynecology and Obstetrics stage Ia or Ib grade 3 or Ic or stage II, no macroscopic residual disease) and to compare cumulative incidence of recurrence, overall survival, and relative toxicity., Materials and Methods: A total of 251 patients were randomly assigned to treatment with 32P or CP. Twenty-two (8.7%) were ineligible following centralized pathology review. Of the 229 patients included in the analysis, 110 received 32P, and 119 received CP., Results: The cumulative incidence of recurrence at 10 years was 35% (95% CI, 27% to 45%) for patients receiving 32P and 28% (95% CI, 21% to 38%) for those receiving CP. Patients receiving CP had a recurrence rate 29% lower than that of those receiving 32P (P =.15, two-tail test). The death rate for patients treated with CP was 17% lower than that for patients treated with 32P (difference not significant). Combining both arms, the 10-year cumulative incidence of recurrence for all stage I patients was 27% (95% CI, 20% to 34%) compared with 44% (95% CI, 32% to 56%) for stage II patients (P =.01). Both regimens were reasonably well tolerated, but problems with inadequate distribution (7%) and small-bowel perforation (3%) make the otherwise less toxic 32P less acceptable., Conclusion: Although there are no statistically significant differences in survival, the lower cumulative recurrence seen with CP and complications of 32P administration make platinum-based combinations the preferred adjuvant therapy for early ovarian cancer patients at high-risk for recurrence.

Purpose: The objectives of this prospective randomized study of consolidation therapy were to evaluate recurrence-free survival (RFS), overall survival (OS), and the morbidity of intraperitoneal (IP) chromic phosphate suspension (32P) therapy in patients with stage III epithelial ovarian carcinoma who have no detectable evidence of disease at the second-look laparotomy (SLL) procedure after primary chemotherapy., Patients and Methods: In a multi-institution clinical cooperative trial, 202 eligible patients with a negative SLL were randomly selected to receive either 15 mCi IP 32P (n = 104) or no further therapy (NFT; n = 98)., Results: With a median follow-up of 63 months in living patients, 68 patients in the IP 32P group (65%) and 63 patients in the NFT group (64%) have developed tumor recurrence. The relative risk of recurrence is 0.90 (IP 32P to NFT) (90% confidence interval [CI], 0.68 to 1.19). The 5-year RFS rate is 42% and 36% for the IP 32P and NFT groups, respectively; the difference is not statistically significant (log-rank test, P =.27). There was no statistically significant difference in OS (P =.19). The relative risk of death is 0.85 (IP 32P to NFT) (90% CI, 0.62 to 1.16). Sixteen patients (8%) experienced grade 3 or 4 adverse effects, with eight in each respective group., Conclusion: Intraperitoneal chromic phosphate did not decrease the risk of relapse or improve survival for patients with stage III epithelial ovarian cancer after a negative SLL. Despite complete pathologic remission at SLL after initial surgery and platinum-based chemotherapy, 61% of stage III ovarian cancer patients had tumor recurrence within 5 years of negative SLL. This indicates a need for more effective initial therapy and further studies of consolidation therapy.

During the last decade, intraperitoneal injection of phosphorus-32 chromic phosphate (P-32 CP) has been used principally for its initial intended purpose, the palliative management of malignant ascites. The authors describe a patient with a stage IIIB well-differentiated extraovarian peritoneal serous papillary adenocarcinoma. As a palliative treatment for malignant ascites, P-32 CP was instilled intraabdominally eight times. Adverse effects were limited to the third instillation, when abdominal pain occurred as a result of leakage of the P-32 CP in the subcutaneous tissue. The P-32 CP instillations reduced the frequency of paracentesis for almost 1 year, until disease progression prevented palliation. Considering the few palliative options, there could be more widespread use of P-32 CP as a palliative treatment for patients with malignant ascites caused by ovarian cancer or extraovarian peritoneal adenocarcinoma. However, intraperitoneal P-32 CP is not without potential intestinal complications, which must be considered before it is recommended.

Radiosynovectomy offers a potentially effective, minimally invasive option for patients with chronic hemarthrosis and synovitis. The long-term outcome of patients with hemophilia who were treated with phosphate-32 chromic phosphate radiosynovectomy was evaluated. One hundred twenty-five procedures in 81 patients were done. Two- to 10-year followup by age and joint included joint bleeding and quality-of-life assessment. In addition, a relative cost comparison, scintigraphic imaging, and evaluation of biodistribution of the radionuclide were done. Of 125 procedures, 54% resulted in complete cessation of bleeding into the treated joint after the procedure, and 73% of patients reported improved mobility of the treated joint. Of patients 18 years old and younger, 79% had a greater than 75% reduction in bleeding incidence, and of patients older than 40 years, only 56% had a similar reduction. Seventy-nine percent of patients surveyed had a significant improvement in quality of life attributable to the treated joint. No evidence of significant leakage was observed. Billing records analysis indicated that radiosynovectomy costs less than 5% of surgical synovectomy. Phosphate-32 chromic phosphate radiosynovectomy is a clinically useful, safe, and cost-effective outpatient procedure in the treatment of patients with chronic hemarthrosis and synovitis.

The principal medical consequence of haemophilia is the development of arthropathy, initiated by a haemarthrosis giving rise to chronic synovitis. Traditional methods of synovectomy include open excision and arthroscopy each of which require substantial amounts of clotting factor concentrate for several weeks, and in the case of open synovectomy, is often associated with loss of range of motion and arthrofibrosis. Radiosynovectomy, the intra-articular injection of low penetration radiocolloids, has been utilized outside the United States for over 20 years. Since 1988, our centre has performed 170 radiosynovectomies utilizing 32P chromic phosphate (32P). This study reports results of 130 32P radiosyovectomies with an average follow-up of 36.5 months (6-140 months). For primary procedures, excellent and good results (haemarthrosis reduction from 75 to 100%) were obtained in 79.2% of cases at 6 months to 8 years. For repeat procedures a combination of excellent and good results were obtained in 62.4% of cases at 6 months to 3 years. Regression analysis showed no correlation between results and age or degree of arthropathy. Radiation was well contained within the joint. There were no observed or identified complications. The procedure is highly cost effective in comparison to open surgical or arthroscopic synovectomy.

Objective: To review the drug treatments and some of the popular, nontraditional remedies now available for type 2 diabetes mellitus, as well as selected investigational agents; to describe each medication's place in the overall approach to treatment., Data Sources: English-language journals, abstracts, review articles, and newspaper accounts., Data Synthesis: In the past five years, there has been tremendous progress in the pharmacotherapy of diabetes, particularly type 2 diabetes. Several new agents have entered the clinical arena, and many more are in the late stages of investigation leading to approval. Sulfonylureas stimulate the production and release of insulin; these drugs must be used in patients with an intact pancreas. The meglitinides are nonsulfonylurea agents that are also insulin secretagogues. Unlike the sulfonylureas, repaglinide appears to require the presence of glucose to close the adenosine triphosphate-sensitive potassium channels and induce calcium influx. Metformin reduces hepatic glucose production in some patients and increases peripheral glucose utilization, but its use is hampered by a high percentage of adverse reactions. Disaccharidase inhibitors effectively compensate for the defective early-phase insulin release by slowing the production of sugars from carbohydrates. Thiazolidinediones appear to activate peroxisome proliferator-activated receptor gamma, which is involved in the metabolism of lipids. Short-acting insulin and the role of weight-loss agents are also discussed., Conclusions: The availability of new options for diabetes therapy provides a chance for successful therapy in a larger number of patients. However, it is important to consider how much true benefit these new forms of treatment will have on the diabetic community. The best choice for a patient remains controversial.

We report the nonoperative treatment of a recurrent, multilevel spinal aneurysmal bone cyst by injection of 32P chromic phosphate colloid into the cyst. The patient was then followed up with serial CT examinations, which showed stabilization and progressive ossification within the lesion. The rationale, alternatives, and possible contraindications to radionuclide ablation of spinal aneurysmal bone cysts are discussed.

Malignant pericardial effusion is usually treated only when signs of cardiac tamponade develop. Several methods of treatment have been reported with an overall response rate of approximately 75%. Since our initial study using intrapericardial 32P-colloid instillation as a treatment modality for pericardial effusion demonstrated a significant higher response rate, this study was conducted to further evaluate the efficacy of intrapericardial 32P-colloid in terms of response rates and duration of remissions. Intrapericardial instillation of 185-370 MBq (5-10 mCi) 32P-colloid in 36 patients with malignant pericardial effusion resulted in a complete remission rate of 94.5% (34 patients) whereas two patients did not respond to treatment due to a foudroyant formation of pericardial fluid. The median duration time was 8 months. No side-effects were observed. These results suggest that intrapericardial instillation of 32P-colloid is a simple, reliable and safe treatment strategy for patients with malignant pericardial effusions. Therefore, since further evidence is provided that 32P-colloid is significantly more effective than external radiation or non-radioactive sclerosing agents, this treatment modality should be considered for the management of malignant pericardial effusion.

The purported performance-enhancing effects of supplemental Cr, as elaborated in studies focusing on beef and dairy cattle models of agricultural stress, affect both immune and endocrine pathways. Furthermore, interactions between the immune and endocrine systems, associated with the actions of insulin and cortisol, may be coordinated through the production of regulatory cytokines. Unlocking the mechanism of action of Cr as a useful farm animal management tool may provide further understanding of the health and performance ramifications of immune-endocrine interactions in agricultural species.

Background: The prognosis of unresectable pancreatic adenocarcinoma is poor. Therefore, the treatment potential of an intratumoral infusional brachytherapy using macroaggregated human albumin in combination with radioactive chromic phosphate [32P] was investigated in this group of patients., Methods: Seventeen patients with unresectable tumors received intratumoral infusional brachytherapy. Treatment and assessment of response was performed with the aid of ultrasonography., Results: Four patients had complete response with a duration ranging from 2-57 weeks and 5 patients had partial response with a duration ranging from 4-21 weeks, corresponding to an objective response of 53% (9 of 17 patients). Six of these patients were alive 33-57 weeks after treatment. Radiation necrosis was observed in 1 patient after a 19,000-gray cumulative radiation dose and a slight decrease in blood counts was observed in 2 patients., Conclusions: Intratumoral infusional brachytherapy using radioactive colloidal chromic phosphate has the potential to reduce inoperable pancreatic tumors with few side effects.

Trends in CA-125 levels after completion of therapy in ovarian cancer patients who received intraperitoneal radioactive chromic phosphate therapy (32P) after primary surgical resection or second-look surgery were evaluated. Ninety patients who underwent surgical exploration and 32P were reviewed. Twenty-nine patients were excluded due to insufficient number of CA-125 levels or recurrence within 12 months, with 61 patients with serial CA-125 levels and no evidence of disease for 12 months available for analysis. 32P followed initial resection in 24 patients (16 Stage I, 3 Stage II, 5 Stage III). 32P followed chemotherapy and second-look procedures in 37 patients (4 Stage I, 3 Stage II, 27 Stage III, 3 Stage IV). Elevated CA-125 levels were present in 25 (41%) patients within 12 months of 32P (46% after primary exploration, 38% after second-look). The degree of CA-125 elevation (U/ml) was 30-100 (23%), 100-200 (11%), and >200 (7%). Of the 25 patients with an elevated CA-125, the elevation persisted more than 4 months in 11 (44%). All but two patients had normal CA-125 levels by 12 months. An abnormal elevation in CA-125 was seen in 33% of patients 4 months after receiving 32P and abdominal surgery, with values ranging as high as 500 U/ml. Although elevations in CA-125 are reported following surgery alone, the duration of elevation appears to be longer with 32P. Therefore, persistent elevations of CA-125 following 32P between 4 and 12 months should be judged with caution as they may not reflect recurrent disease.

A patient with postoperative Stage I ovarian carcinoma received 15 mCi of 32P-chromic phosphate suspension in normal saline intraperitoneally as part of her therapy. The following day, a portion of the infused radiopharmaceutical and normal saline had passed transdiaphragmatically into the patient's right pleural cavity. Thoracentesis removed as much fluid as possible and this fluid contained radioactive material. In the ensuing 4 yr, the patient has not manifested any detectable pleural or pulmonary abnormalities attributable to the radioactivity. Retrospective review of 100 consecutive patients receiving 32P-chromic phosphate intraperitoneal therapy resulted in 43 patients in whom the hemithoraces could be evaluated scintigraphically. Three of the 43 patients (7%) had right pleural fluid radioactivity. This is similar to the percentages reported in patients with cirrhosis with ascites in whom hepatic hydrothorax is identified.

With the purpose of studying the effectivity of an intratumoral single dose of chromic [32P] phosphate with great particles for the treatment of solid tumors, studies of bioelimination, biodistribution and therapeutic action were carried out. Only for comparative purposes, similar studies were undertaken using a solution of sodium -32P- orthophosphate-gelatine. The results show that when sodium [32P] orthophosphate-gelatine is used, the percentage of total elimination is (85.90 +/- 8.70)% with a higher percentage in urine (64.50 +/- 13.70)% than in faeces (21.40 +/- 4.50)%. In biodistribution studies, the greater percentage is found in bone (15.54 +/- 2.21)% while only a (2.51 +/- 0.39)% remains in the tumor. When great particles chromic [32P]phosphate was intratumorally injected, we determined that the total elimination is equal (36.28 +/- 6.27)%, finding a higher amount in faeces (29.44 +/- 5.26)% than in urine (6.84 +/- 2.21)%. Biodistribution studies demonstrated that (49.82 +/- 5.41)% remains in the tumor and (9.63 +/- 4.89)% of the injected activity is found in the liver. On the other hand, when therapeutic action was evaluated, we observed that the percentage of tumor regression (P.T.R.) is 52.0% for the tumors injected with chromic [32P]phosphate and 0.0% for those injected with sodium [32P]orthophosphate-gelatine. These results show that the great particles colloid of chromic [32P]phosphate is not safe enough for the treatment of solid tumors, since it is mobilized from the injection point, delivering a high dose to the whole organism.

Background: From 1983 to 1990, 271 consecutive patients with stage I ovarian cancer entered two randomised trials, aimed at assessing the role of adjuvant chemotherapy after radical surgery in early stages of ovarian cancer. Trial I compared cisplatin (50 mg/m2 with repeated courses every 28 days for 6 cycles) to no further therapy in F.I.G.O. stage Ia & b Grade II-III patients; trial II compared cisplatin (same dose and schedule) to 32P in Iaii & bii and Ic patients., Methods: Both studies were multicentric and centrally randomized. Treatment was allocated by phone and stratified by center. All patients satisfying major eligibility criteria (histological and grade, no previous neoplasms) were analysed according to treatment allocated by randomisation., Results: With a median observation time of 76 months, cisplatin significantly reduced the relapse rate by 65% (HR = 0.35; 95% CI = 0.14-0.89, p = 0.028; Cox Model) in trial I and 61% (HR = 0.39; 95% CI = 0.19-0.77, p = 0.007; Cox Model) in trial II. Survival was not significantly different (trial I - Kaplan-Meier overall 5-year survival: cisplatin = 88%, control = 82%, HR = 1.15; 95% CI = 0.44-2.98; p = 0.773; Cox Model); trial II - overall 5-year survival: cisplatin = 81%, 32P = 79%, HR = 0.72; 95% CI = 0.37-1.43; p = 0.354; Cox model). In both studies the risk of dying after relapse increased for patients originally randomized to the cisplatin arms: in trial I, 6 of 7 patients in the cisplatin relapsed arm and died of tumor compared with 8 of 14 patients in the control arm. In trial II 11 of 12 patients on cisplatin, and 18 of 26 on 32P succumbed to tumor recurrence., Conclusion: Adjuvant cisplatin treatment in early ovarian cancer significantly prevents relapse in comparison to 32P in stage IC patients or to no immediate treatment in earlier stage women. The impact of cisplatin adjuvant treatment on survival remains, however, unclear.

Although the cause of ovarian cancer is unknown, the risk of developing the disease increases with age. Postmenopausal uterine bleeding is assumed to be caused by endometrial cancer until proven otherwise by adequate cytologic or histologic sampling of the endometrium. Older women need to be educated as to the benefits of regular pelvic examinations and Papanicolaou smears.

Unlabelled: For many years, 32P-chromic phosphate (32P-CP) intraperitoneal instillations and platinum analogue chemotherapy have been used to treat disseminated ovarian cancer. To investigate possible enhancement of 32P-CP irradiation due to the concomitant administration of chemotherapy, in vitro studies were undertaken. Based on those laboratory investigations, a clinical regimen of combined 32P-CP and platinum analogue chemotherapy was developed., Methods: In vitro enhancement of 32P-CP cytotoxicity by cisplatin was studied in cultured human ovarian adenocarcinoma (CHOA) cell lines and in a fibroblast cell strain. In addition, ovarian cancer cells obtained from the malignant abdominal ascites and pleural effusions of 10 individual patients were also studied ex vivo. As part of routine clinical care, 30 patients with disseminated ovarian adenocarcinoma underwent up to eight monthly cycles of platinum analogue chemotherapy with concomitant intraperitoneal instillation of 5 mCi of 32P-CP at each monthly chemotherapy cycle., Results: There was an enhanced and possibly supra-additive effect of cisplatin on the cytotoxicity from 32P-CP irradiation. For the 30 patients, the survival rate at 3 yr was 63%., Conclusion: Phosphorus-32 CP low-dose intraperitoneal treatments in conjunction with platinum analogue chemotherapy is a promising approach for the treatment of disseminated intraperitoneal ovarian cancer.

Background: Adjuvant therapy with intraperitoneal (IP) chromic phosphate (P-32) instillation in both early and advanced carcinoma of the ovary requires adequate intra-abdominal distribution for maximum therapeutic benefit. Abdominal-pelvic computed tomographic (CT) scanning with water-soluble IP contrast to establish the absence of intra-abdominal adhesions prior to P-32 instillation has not been previously reported., Study Design: Sixteen patients with carcinoma of the ovary who were offered IP P-32 therapy between January 1988 and December 1992 were retrospectively reviewed. Computed tomographic scans on 13 patients were reevaluated using a modification of Muggia and associates' distribution scoring system., Results: Of the 16 patients, one had a negative second look operation for stage IIIc carcinoma of the ovary. The remaining 15 with stage I and II disease underwent at least a staging laparotomy, bilateral salpingo-oophorectomy, and omentectomy. The mean time from operation to IP P-32 attempt was 28 days with a range of 17 to 90 days. Adequate distribution was considered present in two of the three cases evaluated by technetium scanning and in four of the 13 cases studied by CT scanning. On review, 12 of 13 cases studied by CT scans revealed some areas of IP contrast exclusion and loculation., Conclusions: We suspect that uneven postoperative IP P-32 distribution is common and may be missed by two-dimensional imaging techniques such as technetium scanning or fluoroscopy.

Women diagnosed with early stage ovarian cancer may be considered for adjuvant therapy. Intraperitoneal chromic phosphate (P-32) is commonly used in these patients with few complications. A woman found to have early stage ovarian cancer was given intraperitoneal P-32 in the presence of a lingering pelvic infection, which is usually not mentioned as a contraindication to its use. Radiation damage to the small bowel and cecum developed as did damage to the ureter and bladder, which then required surgery.

This study addressed the technique of intraperitoneal distribution imaging (IDI). A literature search (MEDLINE database) revealed wide variations in IDI techniques without a basis for comparison. From April 1990 to September 1992, the authors studied 8 patients (age 43-65 years) with ovarian cancer. A total of 1000 ml of normal saline and 1 mCi of Tc-99m SC was infused intraperitoneally for IDI. In one patient loculation was observed, but only 250 ml of normal saline was infused with Tc-99m SC. A repeat study using our standard technique rendered free intraperitoneal distribution in this patient, as well as in the other seven cases. Some investigators recommend low volumes, but in our experience this produced the finding of pseudoloculation, which could change treatment inappropriately. Although the number of patients studied at our institution was small, administration of 1 liter intraperitoneally provided consistent IDI results.