Establishment of a standardized protocol for postprandial lipids assessment to promote the early prevention and treatment of cardiovascular diseases / 中华内分泌代谢杂志

Dyslipidemia is closely related to the development and progression of atherosclerosis. However, current clinical practice often relies on fasting lipid levels for the assessment of dyslipidemia, with little attention given to postprandial lipid levels, thereby overlooking the cardiometabolic disease risk associated with postprandial dyslipidemia. As an indispensable component of lipid management, postprandial lipids are not routinely measured in clinical practice due to the lack of standardized protocols about test meals and blood collection program. The paper titled " Optimization of oral fat tolerance test" published in this issue proposed a standardized protocol for postprandial lipid measurement. More studies are needed to accumulate evidence about the health benefits of possible interventions and to provide a reliable scientific basis for the early identification of dyslipidemic population as well as for the prevention and treatment of cardiovascular diseases.

Optimization of oral fat tolerance test / 中华内分泌代谢杂志

Objective:To compare the effects of different test meals on postprandial triglycerides and to optimize the standard meal composition and the blood sampling protocol for the oral fat tolerance test.Methods:This study is a prospective, open-label, randomized, cross-over trial. In March 2023, 36 volunteers were recruited in Hebei General Hospital. They underwent a health examination and oral glucose tolerance test. Twenty-six healthy volunteers(11 males and 15 females) were included in this study, with an average age of(39.08±4.56) years. Each volunteer received 75 g protein meal, 75 g fat meal, 700 kcal fixed-calorie high-fat mixed meal, and a high-fat mixed meal with energy adjusted based on 10 kcal/kg body weight. A one-week washout period of regular diet was applied before each trial. Blood was collected at fasting status and 1, 2, 3, 4, 5, and 6 hours after a meal to detect serum triglycerides, total cholesterol, low density lipoprotein-cholesterol(LDL-C), high density lipoprotein-cholesterol(HDL-C), glucose, and insulin. The variations of postprandial metabolic indicators over time following the consumption of different test meals were analyzed. The disparities in postprandial metabolic responses between the two types of mixed meals were compared.Results:The protein meal, fat meal, fixed-calorie high-fat mixed meal, and adjusted-calorie high-fat mixed meal resulted in postprandial triglyceride increases of 22.45%, 115.40%, 77.14%, and 63.63%, and insulin increase of 560.43%, 85.69%, 554.18%, and 598.97%, respectively, and with reductions in total cholesterol, LDL-C, and HDL-C ranging from 5.64%-21.81%, respectively. The blood glucose changed slightly. Changes in metabolic indicators mainly occured within 4 hours. The comparison of the characteristics of postprandial triglycerides between the two high-fat mixed meals showed no statistically significant differences( P>0.05). Conclusion:A standardize protocol with a 700 kcal fixed-calorie high-fat mixed meal as test meal, and blood lipid levels measured at fasting and at 1, 2, 3, and 4 hours after consumption, can serve as an optimized approach for oral fat tolerance test.

Impact of Moringa oleifera on the post-prandial blood glucose level among adults in Rawalpindi, Pakistan

Background: Moringa oleifera (MO) has been used in the treatment of the Diabetes Mellitus (DM) all over the world. However, studies in Pakistan which show impact of MO on the blood glucose are lacking. This study was aimed to assess the impact of the MO leaf powder capsules on post-prandial blood glucose levels in diabetic and non-diabetic participants. Methods: This pilot study was conducted in a health care center, Rawalpindi, Pakistan among 14 diabetic and 14 non-diabetic participants for one year from January 2021 to December 2022. All participants were asked to fast for 12 hours on two occasions and each time their blood glucose levels were assessed via glucometer after giving bread. On first visit without MO capsules and on next visit with MO capsules. Data analysis was done by applying descriptive and paired t-test via SPSS version 25. Results: The mean values for study population of age, fasting blood glucose level, and post-prandial blood glucose level without giving MO capsules were, 51.50 with SD±5.28 year, 136.94 with SD±39.64 mg/dL, and 306.31 SD±151.35 mg/dL respectively. After 90 minutes of Intake of MO leaf powder capsule, the reduction in post-prandial blood glucose level in diabetic patients was significant (p=0.03), however, in non-diabetic healthy participants, it was statistically insignificant (p=0.08). No side-effects of MO were observed in any participant. Conclusions: In short, this study showed that Moringa oleifera ingestion decreases post-prandial blood glucose level significantly among diabetic, while not in non-diabetic. Moreover, intake of MO has no side effects.

Hypoglycemia post bariatric surgery: drugs with different mechanisms of action to treat a unique disorder

ABSTRACT Postprandial hypoglycemia (PPH) is a complex and multifactorial complication of bariatric surgery (BS). PPH may cause severe symptoms or be asymptomatic. The treatment of this condition requires dietary changes, but severe cases require drug therapy. The number of therapeutic options is limited and are often associated with adverse side effects. Different classes of drugs have been used and tested, but the resolution of PPH remains a challenge for physicians and patients. In this review, we gathered articles on PPH after BS from PubMed searches (2001 to 2022) and focused on the main drugs tested for the treatment of this condition, such as acarbose, somatostatin analogues, type 2 sodium-glucose cotransporter inhibitors, calcium channel blockers, and liraglutide. Avexitide and glucagon pump are two new therapeutic options that have been recently tested. For the search, the terms "postbariatric hypoglycemia," "bariatric surgery," and "late dumping syndrome" were used. PPH after BS is a frequent condition that should always be evaluated after BS. Treatment should be individualized and the available therapeutic options may be useful based on the condition's pathophysiology.

Evaluation of interleukin-33 & sST2 levels in type-2 diabetic mellitus patients with or without metabolic syndrome

Background & objectives: Diabetes mellitus (DM) is characterized by increase in blood glucose levels due to defective insulin secretion or insulin sensitivity. Interleukins (ILs) are known to play an important role in the pathogenesis of DM. The aim of this study was to investigate the serum concentration of IL-33 and its receptor soluble ST2 (sST2) in patients with diabetes and draw a correlation between their serum levels and different standard glycaemic indices of patients affected with type-2 diabetes with or without metabolic syndrome. Methods: Thirty type-2 diabetic individuals and 30 healthy controls were recruited for this study. Serum and plasma were separated by centrifugation of blood for quantitative measurement of IL-33, sST2 and other biochemical parameters. Results: It was observed that serum IL-33 levels were significantly less and sST2 levels were significantly high in type-2 diabetic individuals as compared to healthy controls. A significant correlation between the serum IL-33 concentration and fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels were also found. Additionally, data also elucidated that serum levels of high-density lipoprotein, low-density lipoprotein or triglyceride in type-2 diabetics did not influence the serum levels of IL-33 and sST2, thereby excluding these factors as the major drivers of changes in serum IL-33 and sST2 concentration. Interpretation & conclusions: This study demonstrated alteration in serum levels of IL-33 and sST2 in type-2 diabetic individuals. Further mechanistic studies, focusing on the progression of type-2 diabetes could elucidate the involvement of IL-33 in the cellular acquisition of insulin resistance as observed in type-2 diabetics

Efficacy and safety of ultra rapid lispro in the treatment of type 2 diabetes mellitus: a randomized controlled clinical trial / 中华内科杂志

Objective:To evaluate and compare the efficacy and safety of ultra-rapid lispro insulin (URLi) and humalog lispro (HL) in the treatment of type 2 diabetes mellitus.Methods:This was an international multicenter, double-blind, randomized controlled study. From May 2019 to January 2021, a total of 481 patients with type 2 diabetes mellitus, who had been using insulin for at least 90 days and had poor glycemic control, were included. These patients were recruited from 34 research centers in China, including Shanghai Jiao Tong University School of Medicine Affiliated Sixth People′s Hospital. They were assigned to either the URLi group (319 patients) or the HL group (162 patients) using stratified blocked randomization. The primary endpoint was the change in hemoglobin A 1c (HbA 1c) relative to baseline after 26 weeks of treatment. Secondary endpoints included the proportion of patients who achieved HbA 1c<7.0% and ≤6.5% after 26 weeks of treatment, 1-h postprandial glucose (1hPG) or 2-h postprandial glucose (2hPG) excursions during a mixed meal tolerance test at week 26, as well as safety parameters. Continuous variables were compared using mixed model repeated measures or analysis of covariance, and categorical variables were compared using logistic regression or Fisher′s exact test. Results:Data based on the Chinese subgroup showed that there were no statistically significant differences between the URLi and HL groups in terms of male percentage [56.1% (179/319) vs. 56.2% (91/162); P=0.990], age [(59.5±8.4) vs. (59.6±9.3) years; P=0.839] and other baseline characteristics. Regarding the change in HbA 1c relative to baseline, the URLi group was non-inferior to the HL group (-0.59%±0.05% vs. -0.66%±0.06%; P=0.312). There were no statistically significant differences between the URLi and HL groups in proportion of patients who achieved HbA 1c<7.0% [47.3% (138/292) vs. 45.2% (70/155); P=0.907] and≤6.5% [27.7% (81/292) vs. 27.7% (43/155); P=0.816]. The excursions in 1hPG [(6.20±0.21) vs. (6.90±0.25) mmol/L; P=0.001] and 2hPG [(8.10±0.27) vs. (9.30±0.31) mmol/L; P<0.001] were lower in the URLi group than the HL group, with statistically significant differences. In terms of safety, there were no statistically significant differences in the percentage of subjects who reported treatment-emergent adverse events between the URLi and HL groups [49.8% (159/319) vs. 50.0% (81/162); P=1.000]. The event rate of nocturnal hypoglycemia was lower in the URLi group than the HL group, with statistically significant differences [(0.53±0.10) vs. (0.89±0.16) events per patient -year; P=0.040]. Conclusions:With good glycemic control, URLi showed non-inferiority for HbA 1c improvement versus HL and was superior to HL for postprandial glucose excursion control. Meanwhile the rate and incidence of nocturnal hypoglycemia were lower in the URLi group than the HL group.

Prevalencia de dispepsia funcional en adolescentes cubanos / Prevalence of Functional Dyspepsia in Cuban Adolescents

Resumen Introducción: los trastornos digestivos funcionales son frecuentes en niños; sin embargo, hay escasos datos sobre la dispepsia funcional (DF) en adolescentes cubanos. Objetivo: determinar la prevalencia de DF en adolescentes cubanos y sus posibles asociaciones. Metodología: se usó el cuestionario para síntomas digestivos pediátricos de Roma IV en español para identificar la presencia de DF en adolescentes de 3 centros escolares de La Habana, Cuba. Se tuvieron en cuenta variables sociodemográficas, personales, familiares, clínicas y epidemiológicas. Resultados: de los 318 adolescentes que participaron en el estudio, 11 adolescentes (3,5 %) de 11,4 ± 1,2 años de edad, 81,8 % de sexo femenino, presentaron DF. La DF fue más frecuente en el sexo femenino (odds ratio [OR]: 5,33; intervalo de confianza [IC] 95 %: 1,06-51,45; p = 0,019). El síndrome de dificultad posprandial (SDP) fue mayor que el síndrome de dolor epigástrico (SDE) en una proporción 1,8:1. En el 63,6 % se presentó superposición entre DF y estreñimiento funcional. Hubo predominio de DF en los niños con padres separados/divorciados (OR: 4,74; IC 95 %: 1,09-28,31; p = 0,014). Conclusión: la DF es más común en adolescentes femeninas, el SDP es el subtipo más frecuente y su presencia está asociada con padres separados/divorciados.

Abstract Introduction: functional gastrointestinal disorders (FGID) are common in children. However, data on functional dyspepsia (FD) in Cuban adolescents is scarce. Objective: to determine the prevalence of FD in Cuban adolescents and their possible associations. Methodology: the questionnaire for pediatric digestive symptoms of Rome IV was used in Spanish to identify the presence of DF in adolescents from 3 schools in La Havana, Cuba. Sociodemographic, personal, family, clinical, and epidemiological variables were considered. Results: of the 318 adolescents who participated in the study, 11 (3.5%) aged 11.4 ± 1.2 years, 81.8% female, presented FD. Functional dyspepsia was more frequent in females (odds ratio [OR]: 5.33; 95% confidence interval [CI]: 1.06-51.45; p = 0.019). The postprandial distress syndrome (PDS) was higher than the epigastric pain syndrome (SDE) by a 1.8:1 ratio. There was an overlap between DF and functional constipation in 63.6% of the patients. There was an FD predominance in children with separated or divorced parents (OR: 4.74; 95% CI: 1.09-28.31; p = 0.014). Conclusion: functional dyspepsia is most common in female adolescents, PSD is the most frequent subtype, and its presence is associated with separated or divorced parents.

Impaired glucose tolerance in dengue fever: A case-control study

Background: Studies on dengue fever demonstrated that the dengue viral infection of pancreas is often associated with disease morbidity and complication. Aims and Objectives: The pancreas-pathogen interactions in dengue-infected persons were evaluated using endocrine deregulation as an investigation marker of complication. Materials and Methods: A prospective observational study was conducted in a tertiary care medical college and hospital of West Bengal, over 1 year and 4 months. Blood samples from 286 cases and 258 controls were collected on day 2. After plasma glucose determination, 44 cases and 39 controls were excluded as frank cases of diabetes mellitus. On day 6, fasting and 2 h postprandial plasma glucose estimation were done in 73 cases and 61 controls by glucose oxidase-peroxidase method using autoanalyzer. Data were analyzed using the Statistical Package for the Social Sciences version 20.0. Results: The prevalence of impaired glucose tolerance was higher in cases on day 2 than on follow-up on day 6 (12.3% vs. 8%). There existed no statistical difference in terms of fasting plasma glucose between cases and control on day 2 and day 6 and postprandial (PP) plasma glucose on day 2. However, the PP values on day 6 in cases were significantly higher in cases in comparison to controls (P = 0.006). Among cases, day 6 values were higher than day 2 values (0.016). Conclusion: Dengue viral infection correlates with the involvement of the pancreas in terms of impaired tolerance to glucose which has implications for understanding disease pathogenesis in terms of developing chronic complications.

A study on the association of postprandial hypotension with insulin and neurotensin in very old adults / 中华老年医学杂志

Objective:To investigate the association of postprandial hypotension(PPH)with insulin and neurotensin(NT)in very old adults.Methods:In this retrospective study, 22 people with PPH and 21 without non-PPH, aged ≥80, were enrolled from patients hospitalized at the First Division of the Health Department of China-Japan Friendship Hospital between September 2015 and October 2021.The levels of blood pressure, blood glucose, insulin and NT at fasting and 30, 60, 90 and 120 minutes after a meal were monitored.Changes in values of each parameter before and after a meal were compared between the two groups, and the correlation of the maximum decrease in postprandial blood pressure with the maximum increase in blood glucose, insulin and neurotensin was analyzed.Results:The maximum decrease in postprandial systolic blood pressure(SBP)in the PPH group was significantly higher than that in the non-PPH group[(35.5±13.2)mmHg(1 mmHg=0.133 kPa) vs.(16.0±8.6)mmHg, t=4.135, P<0.01)]. The maximum increase in postprandial insulin was significantly higher than that in the non-PPH group[(20.9±4.2)mU/L vs.(12.1±4.1)mU/L, t=3.949, P<0.01)]. There was no statistically significant difference between the PPH and non-PPH groups in the maximum increase in postprandial blood glucose[(3.6±1.8)mmol/L vs.(2.5±0.5)mmol/L, t=1.912, P>0.05)]or NT[65.7(22.0, 110.1)ng/L vs.112.2(47.2, 270.2)ng/L, Z=1.817, P>0.05)]. There was a significant positive correlation between the maximum decrease in postprandial systolic blood pressure and the maximum increase in insulin( r=0.907, P<0.05). There was no correlation between the maximum decrease in postprandial systolic blood pressure and the maximum increase in blood glucose( r=0.016, P>0.05). There was no correlation between the maximum decrease in postprandial systolic blood pressure and the maximum increase in NT( r=0.396, P>0.05). Conclusions:The PPH is related to abnormal increases in postprandial insulin secretion.

A dietary intervention study on the effects of different dietary structures on postprandial drowsiness / 上海预防医学

ObjectiveTo find the type of dietary structure that can effectively prevent or improve postprandial sleepiness in the Chinese population， and provide scientific basis and solutions for improving or avoiding postprandial sleepiness. MethodsIn this study， a six-day dietary intervention trial was conducted for 20 volunteers on four different diets （normal diet， high-fat diet， high-carbohydrate diet and healthy diet）. ResultsThe results showed that sleepiness increased after all four types of meals， but decreased after 30 minutes in the healthy balanced diet group； meanwhile， it increased for 60 minutes before it declined in the high-carbohydrate， high-fat， and normal diet （control） group. At 60 minutes after meal， the drowsiness of the healthy balanced diet group was the weakest， and that of the high carbohydrate diet groups was the strongest， while that of the normal diet group and the high fat diet group was intermediate （P<0.000 1）. Postprandial sleepiness was positively correlated with intake of carbohydrate and manganese， and negatively correlated with intake of protein， some mineral elements and vitamins. ConclusionThese results suggest that controlling carbohydrate and fat intake and appropriately increasing the intake of mineral elements and vitamins in a healthy and balanced diet can significantly improve and prevent postprandial sleepiness.

A Preliminary Study for the Suppressive Effect of Mulberry Leaf Powder-containing Foods on the Postprandial Blood Glucose Level / 日本補完代替医療学会誌

A crossover study was conducted to evaluate suppressive effect of a commercially available green juice (Katuna-Aojiru;Egao Co., Ltd.) containing mulberry leaf powder as the main ingredient on postprandial hyperglycemia. The blood glucose and iAUC (0-120min) values after loading cooked white rice were significantly lower with the consumption of Katuna-Aojiru than with the consumption of water. Katuna-Aojiru is effective in controlling postprandial blood glucose.

Study on postprandial bioequivalence of Diacerein capsules in healthy volunteers / 中国药房

OBJECTIVE To evaluate the postprandial bioequivalence of two kinds of Diacerein capsules in healthy volunteers with oral administration . METHODS A total of 24 adult healthy subjects were included and randomly divided into two groups ， with 12 subjects in each group . A randomized ，open，double-cycle cross -over trial design was adopted . Both groups took 50 mg of the test preparation （domestic Diacerein capsules ）or the reference preparation （Ambridine®）respectively at 30 min after eating the standard meal in the morning of the first day of each cycle of the trial . The cleaning period was one week . Blood samples were collected at different time points before and after taking the medicine and the protein was precipitated with methanol for sample pretreatment. The concentration of active metabolite rhein was determined by LC -MS/MS using emodin as internal standard . The pharmacokinetic parameters were calculated with DAS 3.2.9 software，and the bioequivalence of test and reference preparation were evaluated. RESULTS After the subjects took the test preparation and the reference preparation after meal ， the main pharmacokinetic parameters of rhein were as follows ：cmax were（3 517±1 121）and（3 225±755）ng/mL；AUC0－24h were （25 764±6 134）and（24 316±5 856）ng·h/mL；AUC0－∞ were（26 679±6 409）and（25 170±6 415）ng·h/mL；tmaxwere 3.50 （0.67，12.00）and 4.00（1.50，7.00）h；t1/2 were（4.26±1.12）and（4.19±1.05）h，respectively. The 90% confidence intervals of the geometric mean ratios of cmax，AUC0－24h and AUC 0－∞ were 100.8%-113.9%，103.1%-109.4% and 103.2%-109.9%，respectively. CONCLUSIONS The test preparation and reference preparation are bioequivalent in the postprandial state of healthy subjects .

Administración crónica de cafeína evita la alteración de la glucosa postprandial en ratas / Chronic caffeine administration prevents postprandial glucose disturbance in rats

La administración crónica de cafeína evita la alteración de la glucosa postprandial en ratas. El aumento en el consumo de la cafeína alrededor del mundo no es discutible, es así como su investigación se ha vuelto extensa en sus diferentes campos. Objetivo. Analizar los efectos de la administración crónica de cafeína en ratas alimentadas con dieta de cafetería, a través de evaluar índices de consumo, antropométricos y bioquímicos. Materiales y métodos. La dieta de cafetería es un modelo dietético equivalente a las características de la dieta occidental típica que origina síndrome metabólico en humanos. En esta investigación se realizó la administración crónica vía intraperitoneal de cafeína por ocho semanas a ratas adultas macho Wistar alimentadas con dieta de cafetería. Dada la poca evidencia acerca de los efectos biológicos y comportamentales de la administración crónica de dicha sustancia frente a un modelo de dieta de cafetería se evaluaron parámetros de consumo, antropométricos y bioquímicos. Resultados. La dieta de cafetería ocasionó anomalías asociadas al síndrome metabólico; no obstante, la administración de cafeína en las ratas alimentadas con esa dieta resultó ser un factor protector en la glucosa postprandial, más no en la alteración de la tolerancia a la glucosa o perfil lipídico. Conclusiones. La cafeína permitió proteger los niveles de glucosa postprandial al término del experimento y un descenso en el peso corporal y consumo de alimento solo en la primera semana. Sin embargo, no se observaron mejoras significativas en el perfil de lípidos, adiposidad, tolerancia a la glucosa y glucosa plasmática(AU)

Chronic caffeine administration prevents postprandial glucose disturbance in rats. The increase in caffeine consumption is not debatable, this is how his research has become extensive in his different fields. Objective. To analyze the effects of chronic administration of caffeine in rats fed a cafeteria diet, by evaluating consumption, anthropometric and biochemical indices. Previous studies refer to administering caffeine in diets high in carbohydrates and / or in fat that induce obesity or symptoms of metabolic syndrome. Material and methods. The cafeteria diet is a dietary model equivalent to the characteristics of the typical western diet that causes metabolic syndrome in humans. In this research, chronic intraperitoneal administration of caffeine was performed for 8 weeks to adult male Wistar rats fed a cafeteria diet. Given the little evidence about the biological and behavioral effects of the chronic administration of this substance against a cafeteria diet model, consumption, anthropometric and biochemical parameters were evaluated. Results. After eight weeks it was found that the cafeteria diet given to the controls caused abnormalities associated with the metabolic syndrome; regarding the administration of caffeine in the rats fed this diet, the treatment turned out to be a protective factor in postprandial glucose, but not in the alteration of glucose tolerance or lipid profile. Conclusions. Caffeine allowed to protect postprandial glucose levels at the end of the experiment and a decrease in body weight and food consumption only in the first week. However, no significant improvements were seen in lipid profile, adiposity, glucose tolerance, and plasma glucose(AU)

Páncreas ectópico, una posible y rara causa de hipoglucemia postprandial / Ectopic pancreas, a possible rare cause of postprandial hypoglycemia

Introducción: El páncreas ectópico es la segunda anomalía congénita pancreática más frecuente después del páncreas divisum. Fue descrito por primera vez en 1729 por Schultz y se define como la presencia de tejido pancreático que carece de comunicación anatómica o vascular con el cuerpo principal del páncreas. La localización más frecuente es en el estómago (25 - 38 por ciento), seguido de duodeno, yeyuno e íleon. El 40 por ciento de los casos son sintomáticos y es más frecuente su presentación en varones en torno a la 5ª y 6ª década de la vida. Objetivo: Presentar un caso de páncreas ectópico diagnosticado a través de un estudio histológico tras realizada la cirugía. Presentación de caso: Presentamos el caso de una paciente compatible con hipoglucemia y cuyo estudio definitivo mostró la presencia de tejido pancreático ectópico en estómago, con resolución completa de los síntomas tras tratamiento quirúrgico. La anatomía patológica mostró una lesión nodular tumoral benigna (2,5 cm), constituida por tejido pancreático heterotópico, con presencia de páncreas exocrino con acinos. Páncreas endocrino con presencia de islotes de Langerhans y componente epitelial con ductos. Afectación desde la submucosa hasta la subserosa, con una pared muscular propia con hiperplasia muscular en relación a la heterotopía pancreática. La mucosa gástrica mostraba inflamación crónica leve con escasos folículos linfoides. Conclusiones: La presencia de páncreas ectópico es una entidad poco frecuente, pero a tener en cuenta en pacientes con clínica de hipoglucemia, una vez descartadas otras causas. No existe consenso con respecto a indicaciones en el manejo de lesiones pequeñas y asintomáticas, por lo que se recomienda individualizar cada caso teniendo en cuenta el tamaño, la localización y el tipo histológico(AU)

Introduction: Ectopic pancreas is the second most frequent congenital anomaly after pancreas divisum. It was described for the first time in 1729 by Schultz and it is defined as the presence of pancreatic tissue with no anatomical or vascular communication with the main body of pancreas. The most common location is in the stomach (25-38 percent), followed by the duodenum, jejunum and ileum ones. 40 percent of the cases are symptomatic and is more frequent their presentation in males in the fifth or sixth decade of life. Objective: To present a case of ectopic pancreas diagnosed through a histological study after surgery. Case presentation: Case of a patient with clinical features compatible with hypoglycemia that after being studied showed the presence of ectopic pancreatic tissue in the stomach, with a complete solution of the symptoms after surgical treatment. The pathological anatomy showed a benign tumor nodular lesion (2.5 cm), made up of heterotopic pancreatic tissue, with the presence of exocrine pancreas with acini. Endocrine pancreas with the presence of islets of Langerhans and epithelial component with ducts. Involvement from the submucosa to the subserosa, with a proper muscular wall with muscular hyperplasia in relation to pancreatic heterotopia. The gastric mucosa showed mild chronic inflammation with few lymphoid follicles. Conclusions: The presence of ectopic pancreas is a rare condition, but it should be taken into account in patients with clinical features of hypoglycemia once ruled out other causes. There is no consensus in regards to the indications for the management of small and asymptomatic lesions, so, it is recommended to individualize each case taking into account the size, location and histological type(AU)

El agregado de aceite de Sacha inchi disminuye la relación granulocitos/linfocitos postprandial producida por una comida rica en grasas, en adultos saludables

RESUMEN La etapa postprandial se ha relacionado con cambios en marcadores inflamatorios, bioquímicos y celulares. El objetivo de este estudio fue evaluar los efectos postprandiales del agregado de aceite de Sacha inchi sobre la concentración y tamaño de leucocitos, eritrocitos y plaquetas, y en marcadores de inflamación, después de la ingesta de una comida rica en grasas. Una muestra de 42 individuos aparentemente sanos de sexo masculino consumió dos desayunos, uno de ellos adicionado con 15 mL de aceite rico en ácidos grasos poliinsaturados extraído de semillas de Sacha Inchi. Se tomaron muestras de sangre en ayunas y a las 4 horas postprandiales para determinar variables hematológicas (número y tamaño de leucocitos y plaquetas y distribución porcentual de leucocitos) y bioquímicas como interleukina 6 (IL6) y proteína C reactiva de alta sensibilidad (PCR-as). Con ambos desayunos aumentaron la concentración de PCR y los recuentos de leucocitos y plaquetas. El agregado de aceite de Sacha inchi aumentó el porcentaje de linfocitos (p= 0,005) y disminuyó el de granulocitos (p= 0,012), revirtiendo el aumento de la relación evidenciada luego de la ingesta grasa y las concentraciones de IL6. Los resultados permiten concluir que el agregado de 15 mL de aceite de Sacha inchi a un desayuno rico en grasas afecta la relación entre las diferentes poblaciones leucocitarias, lo que podría atenuar los efectos inflamatorios postprandiales y el riesgo cardiovascular. Registro: NCT02886169.

ABSTRACT The postprandial stage is related to an increase in biochemical and cellular inflammatory markers. The objective of this study was to evaluate the postprandial effects of the addition of Sacha inchi oil on the concentration and size of leukocytes, erythrocytes and platelets, and on inflammation markers, after the ingestion of a high-fat meal. A sample of 42 seemingly healthy male individuals consumed two high-fat breakfast meals, one with the addition of 15mL of oil rich in polyunsaturated fatty acids (omega 3 and 6 series), extracted from Sacha Inchi seeds. Fasting blood samples were taken at 4 hours postprandial to determine hematological variables (number and size of leukocytes and platelets and percentage distribution of leukocytes) and biochemical variables such as interleukin 6 (IL6) and high-sensitivity C-Reactive protein (hs-CRP). The concentration of CRP and leukocyte and platelet counts increased following ingestion of both types of breakfast. The addition of Sacha inchi oil increased the percentage of lymphocytes (p= 0.005) and decreased that of granulocytes (p= 0.012), reversing the increase in the granulocytes / lymphocytes ratio evidenced after fat intake. The percentage of intermediate-sized cells and postprandial concentrations of IL6 also decreased. In conclusion, the addition of 15.0 mL of Sacha inchi oil to a high-fat breakfast modulates the relationship between different leukocyte populations, which could mitigate postprandial inflammatory effects and cardiovascular risk. Registration: NCT02886169.

Optimization and implementation of clinical trial of acupuncture: reflection on the successful case of acupuncture for postprandial distress syndrome / 中国针灸

Taking the clinical trial of acupuncture in treatment of postprandial distress syndrome as an example, this paper proposes that the acupuncture clinical trial protocol should be optimized in view of acupuncture prescription, acupuncture frequency and outcomes. Besides, the data quality of acupuncture clinical trial should be improved in consideration of data sharing and electronic data capture so as to provide a reference for the majority of researchers to optimize and implement acupuncture clinical trial.

Efficacy and safety of the combination of agomelatine and low-dose olanzapine in 184 cases of postprandial distress syndrome with depression, anxiety and sleep disorders / 中华消化杂志

Objective:To observe the efficacy and safety of the combination of agomelatine and low-dose olanzapine (AO) in the treatment of postprandial distress syndrome (PDS) with depression, anxiety and sleep disorders.Methods:From April 2019 to September 2020, PDS patients with depression, anxiety and sleep disorders in Tianjin Medical University General Hospital were selected and divided into AO group and flupentixol-melitracen (FM) group. Patients of the AO group were given oral agomelatine 25 mg and AO 1.70 mg (both once per day), and the patients of FM group were given oral FM 10.5 mg (once per day), and all patients took itopride 50 mg (three times per day) at the same time. The total treatment course was eight weeks. Nepean dyspepsia index-symptom (NDIS), patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Pittsburgh sleep quality index (PSQI) were used to evaluate the gastrointestinal symptoms, depression, anxiety and sleep disorders before treatment and two, four and eight weeks after treatment, respectively. The efficacy was evaluated according to the changes of scores of gastrointestinal symptoms before and after treatment. The adverse effects after medication were recorded. Independent sample t test and chi-square test were used for statistical analysis. Results:A total of 184 PDS patients with depression, anxiety and sleep disorders were enrolled, including 98 patients in AO group and 86 patients in FM group. At two, four and eight weeks after treatment, NDIS, PHQ-9, GAD-7 and PSQI scores of AO group and FM group were all lower than those of each group before treatment (AO group: 13.73±0.53, 10.13±0.44 and 7.87±0.31 vs. 27.08±0.84; 6.04±0.35, 4.70±0.31 and 3.81±0.22 vs. 10.04±0.50; 6.36±0.30, 5.29±0.28 and 4.21±0.19 vs. 10.71±0.51; 6.64±0.37, 5.27±0.35 and 4.09±0.30 vs. 11.14±0.42; FM group: 15.33±0.58, 11.58±0.50 and 9.80±0.35 vs. 25.10±0.79; 6.79±0.35, 5.71±0.32 and 4.86±0.30 vs. 9.11±0.46; 7.27±0.31, 6.51±0.32 and 5.21±0.27 vs. 9.79±0.44; 8.01±0.33, 6.76±0.32 and 5.78±0.32 vs. 10.44±0.32), and the differences were statistically significant (AO group: tNDIS=13.470, 17.930 and 21.530, tPHQ-9=6.488, 8.991 and 11.300, tGAD-7=7.361, 9.315 and 11.031, tPSQI=7.088, 9.736 and 12.550. FM group: tNDIS=9.921, 14.400 and 17.640, tPHQ-9=4.032, 6.106 and 7.781, tGAD-7=4.638, 5.993 and 8.840, tPSQI=5.289, 8.199 and 10.310, all P<0.05). At two, four and eight weeks after treatment, NDIS, GAD-7 and PSQI scores of AO group were all lower than those of the FM group during the same period (NDIS: 13.73±0.53 vs. 15.33±0.58, 10.13±0.44 vs. 11.58±0.50, 7.87±0.31 vs. 9.80±0.35; GAD-7: 6.36±0.30 vs. 7.27±0.31, 5.29±0.28 vs. 6.51±0.32, 4.21±0.19 vs. 5.21±0.27; PSQI: 6.64±0.37 vs. 8.01±0.33, 5.27±0.35 vs. 6.76±0.32, 4.09±0.30 vs. 5.78±0.32), and the differences were statistically significant ( tNDIS=2.018, 2.225 and 4.156, tGAD-7=2.097, 2.869 and 2.536, tPSQI=1.951, 2.359 and 3.099, all P<0.05). At eight weeks after treatment, the total effective rate of the AO group was higher than that of the FM group (94.9%, 93/98 vs. 84.9%, 73/86), and the difference was statistically significant ( χ2=5.205, P=0.026). The incidence of adverse reactions of constipation and somnolence of the AO group were both lower than those of the FM group (2.0%, 2/98 vs. 9.3%, 8/86 and 1.0%, 1/98 vs. 8.1%, 7/86, respectively), and the differences were statistically significant ( χ2=4.699 and 5.582, P=0.047 and 0.027). Conclusion:AO may be a treatment option for PDS with depression, anxiety and sleep disorders.

Improvement in dyspepsia related symptoms treated with acupuncture in 278 patients with postprandial distress syndrome: a secondary analysis of a multi-center randomized controlled trial / 中国针灸

OBJECTIVE@#To evaluate the clinical effect of acupuncture for the improvements in various dyspeptic symptoms of postprandial distress syndrome.@*METHODS@#The secondary analysis on the data of a multi-center randomized controlled trial (RCT) was conducted. 278 patients with postprandial distress syndrome were randomized into an acupuncture group (138 cases) and a sham-acupuncture group (140 cases). In the acupuncture group, acupuncture was applied to Baihui (GV 20), Danzhong (CV 17), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), Zusanli (ST 36), etc. In the sham-acupuncture group, 6 sites, neither located on meridians nor belonged to meridian acupoints, were selected and punctured shallowly. The duration of treatment was 20 min each time, 3 times a week, for 4 weeks totally in the two groups. The follow-up visit lasted for 12 weeks. The scores of dyspeptic symptoms were compared between the two groups before treatment, during treatment (in week 1, 2, 3 and 4) and during follow-up (in week 8, 12 and 16) separately.@*RESULTS@#Besides the scores of early satiety and vomiting in the sham-acupuncture group in week 1, the scores of the other dyspepsia symptoms during treatment and follow-up were all reduced in the two groups as compared with those before treatment (@*CONCLUSION@#Acupuncture remarkably relieves postprandial fullness, early satiety, upper abdominal bloating and belching in patients with postprandial distress syndrome.

Efecto de un desayuno alto en ácidos grasos saturados vs insaturados, sobre las cifras postprandiales de glucosa y lípidos en pacientes diabéticos tipo 2 / Effect of a breakfast high in saturated vs unsaturated fatty acids on postprandial glucose and lipid values in type 2 diabetic patients

Introducción: la diabetes tipo 2 es una enfermedad cuya prevalencia se incrementa rápidamente en los países de ingresos medianos y bajos. Siendo los carbohidratos el principal determinante de la glucemia posprandial, se ha evidenciado que existe también influencia de los ácidos grasos sobre las cifras postprandiales de glucosa y lípidos. El objetivo del presente estudio es determinar si los niveles postprandiales de glucosa y lípidos difieren entre un desayuno con ácidos grasos saturados vs ácidos grasos insaturados en pacientes con diabetes mellitus tipo 2 (DMT2). Métodos: Es un estudio de tipo cuasi experimental con diseño cruzado, en el cual se realizó eva-luación antropométrica (peso, talla, IMC, circunferencia de cintura, porcentaje de grasa y músculo) y evaluación bioquímica preprandial y postprandial (glucosa, colesterol total, colesterol HLD, colesterol LDL, triglicéridos) en 30 pacientes adultos con diabetes tipo 2, a los cuales se les administró dos tipos de desayunos isocalóricos, el uno con aporte de ácidos grasos saturados 99,3 Kcal y el otro de ácidos grasos insaturados 113,4 Kcal. Resultados: la ingesta de ácidos grasos saturados produce una mayor elevación de las cifras postpran-diales de glucosa (p=0,01) y no de los lípidos postprandiales. Los ácidos grasos insaturados, permitieron llegar al objetivo de glucosa postprandial recomendada (<140mg/dL), en un mayor porcentaje de pacientes (p=0,02). Conclusiones: el consumo de un desayuno alto en ácidos grasos insaturados permitió un mejor control de las cifras postprandiales de glucosa en comparación con el consumo de un desayuno alto en ácidos grasos saturados. No existió diferencia en las cifras de lípidos posprandiales en los dos tipos de desayuno

Background and objective: type 2 diabetes mellitus is a disease that has been increasing rapidly in low- and middle-income countries, affecting a large population group. Being the carbohydrates, the main determinant of the postprandial glucose elevation, it has been evidenced that there is also an influence of the fatty acids on the postprandial values of glucose and lipids. The aim of the present study is to compare the postprandial levels of glucose and lipids between a breakfast high in saturated fatty acids vs unsaturated fatty acids in patients with T2DM. Materials and methods: it is an cuasi experimental crossover study. We did an anthropometric evaluation (weight, height, BMI, waist circumference, percentage of fat and muscle) and preprandial and postprandial biochemical evaluation (glucose, total cholesterol, HLD cholesterol, LDL cholesterol, Triglycerides) in 30 adults patients with type 2 diabetes, to determine the influence of fatty acids in two different breakfasts with the same caloric load, but each with a different contribution of saturated 99.3 Kcal or unsaturated fatty acids 113.4 Kcal. Results: the intake of a breakfast high in saturated fatty acids produced a higher increase in postprandial glucose values (p = 0.01) and not in postprandial lipids. Unsaturated fatty acids permit attain the goal of postprandial glucose (<140mg /dL) (p = 0.02) in most patients. Conclusions: The intake of high unsaturated fatty acids breakfast allowed a better postprandial glucose control, in comparison to the consumption of a breakfast high in saturated fatty acids. We did not find any difference in postprandial lipids with both types of breakfast.

Ambulatory glucose profile in managing post-prandial hyperglycaemia in patients with type 2 diabetes mellitus: a case report

The case report describes the potential role of real-time Ambulatory Glucose Profile (AGP) in identifying and managing a patient with hyperglycemia. This 55-years-old male patient with type 2 Diabetes Mellitus (T2DM) was presented to the clinic with weakness, increased urinary frequency, with constipation for the past 3 months. The patient was a known case of T2DM for 10 years, along with dyslipidemia, hypertension, and obesity. The profile obtained from AGP revealed glucose fluctuations with post-prandial excursions. Consequently, the patient抯 treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with voglibose 0.2 mg bid with two meals, metformin 100 mg + dapagliflozin 10 mg combination with morning meals, and metformin 1000 mg with evening meals. The treatment for hypertension and dyslipidemia was continued. This case study indicates that CGM can help improve our understanding of glycemic patterns and can have a beneficial effect on glycemic control.