Long-term study of the association of adipokines and glucose variability with diabetic complications

BACKGROUND/AIMS: Recent studies have suggested an important role of adipokines in the development of insulin resistance and diabetes mellitus. The clinical relevance of adipokines on long-term outcomes in patients with diabetes and chronic kidney disease is uncertain. The purpose of this study was to identify a predictable factor in patients with long-term diabetic complications. METHODS: A total of 161 diabetic individuals were followed-up from 2002 to 2013. Circulating plasma levels of adiponectin, glypican-4, irisin, visfatin, and visit-to-visit glucose variability were measured in diabetic patients. Associations among adipokines and variable metabolic parameters and microvascular, and macrovascular complications were evaluated. RESULTS: Plasma adiponectin and glypican-4 levels were significantly increased in patients with renal insufficiency. These adipokines were negatively associated with estimated glomerular filtration rate and positively associated with urinary albumin excretion. The relative risk of renal progression to dialysis increased independently with increasing level of adiponectin. Glypican-4 and visfatin were not predictive of any microvascular or macrovascular complications. Glucose variability increased the risk of diabetic nephropathy and cerebrovascular complications. CONCLUSIONS: Adiponectin and glypican-4 were associated with renal function and might be able to predict renal progression. Glucose variability was a predictable factor for diabetic nephropathy and cerebrovascular complications.

Impact of inflammatory bowel disease on daily life: an online survey by the Korean Association for the Study of Intestinal Diseases

BACKGROUND/AIMS: Inflammatory bowel disease (IBD) is a chronic disabling gastrointestinal disorder that diminishes the quality of life of the affected individuals. Limited data are available regarding the impact of IBD on the daily life of Koreans. METHODS: Self-administered, computer-aided, internet-based questionnaires were distributed to members of a Korean patient organization for IBD from March to April 2013, by the Korean Association for the Study of Intestinal Diseases. RESULTS: A total of 599 patients with IBD (387 with Crohn's disease [CD] and 212 with ulcerative colitis [UC]) were enrolled. The majority of patients (81%) expressed feelings of fatigue, weakness, and being worn out in their daily lives during times of flare; this percentage was reduced to 61% during remission. Respondents were absent from work or school for an average period of 18 days because of illness, within the first 6 months; the majority of respondents (64%) felt stressed about their absence. Forty-six percent of the respondents reported having received unfair comments at work, or having suffered discrimination. Forty-seven percent of the respondents felt that IBD had negatively affected their income and earnings. Compared with patients with UC, those with CD reported a more frequent negative impact of IBD on work, or more economic burden. More than half of the respondents (61%) reported that IBD had prevented them from making or keeping friends. CONCLUSIONS: IBD significantly impacts daily life, including work, education, and social relationships. Treatment that addresses the full spectrum of life of a patient would be more effective.

Corrigendum: Effects of Toll-like receptor antagonist 4,5-dihydro-3-phenyl-5-isoxasole acetic acid on the progression of kidney disease in mice on a high-fat diet Volume 33, Issue 1, March 2014, Pages 33-44

The authors apologize for a wrong unit in the table 1.

Effects of Toll-like receptor antagonist 4,5-dihydro-3-phenyl-5-isoxasole acetic acid on the progression of kidney disease in mice on a high-fat diet

BACKGROUND: Obesity-related metabolic disorders are closely associated with inflammation induced by innate immunity. Toll-like receptors (TLRs) play a pivotal role in the innate immune system by activating proinflammatory signaling pathways. GIT27 (4,5-dihydro-3-phenyl-5-isoxasole acetic acid) is an active immunomodulatory agent that primarily targets macrophages and inhibits secretion of tumor necrosis factor alpha [as well as interleukin (IL)-1beta, IL-10, and interferon gamma]. However, the effect of TLR antagonist on kidney diseases has rarely been reported. We investigated whether the TLR antagonist GIT27 has beneficial effects on the progression of kidney disease in obese mice on a high-fat diet (HFD). METHODS: Six-week-old male C57BL/6 mice were divided into three groups: mice fed with normal chow diet (N=4); mice fed with a HFD (60% of total calories from fat, 5.5% from soybean oil, and 54.5% from lard, N=4); and GIT27-treated mice fed with a HFD (N=7). RESULTS: Glucose intolerance, oxidative stress, and lipid abnormalities in HFD mice were improved by GIT27 treatment. In addition, GIT27 treatment decreased the urinary excretion of albumin and protein in obesity-related kidney disease, urinary oxidative stress markers, and inflammatory cytokine levels. This treatment inhibited the expression of proinflammatory cytokines in the kidneys and adipose tissue, and improved extracellular matrix expansion and tubulointerstitial fibrosis in obesity-related kidney disease. CONCLUSION: TLR inhibition by administering GIT27 improved metabolic parameters. GIT27 ameliorates abnormalities of lipid metabolism and may have renoprotective effects on obesity-related kidney disease through its anti-inflammatory properties.

Risperidone in Combination with Mood Stabilizers for Acute Mania: A Multicentre, Open Study / 신경정신의학

OBJECTIVE: The primary purpose of this study was a replication of the effectiveness and tolerability of risperidone in the treatment of patients with acute mania in very larger cohort in naturalistic treatment setting to extend the data on the effect and tolerability of risperidone in the treatment of patients with acute mania to Asian population. METHODS: A total of 909 patients with DSM-IV criteria of bipolar disorder current manic and hypomanic episode, entered this large, open, multicentre study. The Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson-Angus Rating Scale (SARS) were measured at baseline and weeks 1, 3 and 6, for the assessment of effectiveness and extrapyramidal symptom (EPS). RESULTS: This study showed statistically significant reduction of scores on the YMRS and CGI-s (mean change=-23.5+/-11.8, p<0.0001;mean change=-2.7+/-1.5, p<0.0001, respectively) from the baseline to the endpoint (week 6). Number of patients with 50% reduction or more in the YMRS and CGI-s scores was 693 (77.8%) and 630 (70.7%) at endpoint, respectively. There were no statistically significant increments of scores on SARS. Risperidone was generally well tolerated. CONCLUSION: The present larger open study demonstrates that risperidone add-on therapy is effective and tolerable in treatment of bipolar disorder, replicating results in various controlled and uncontrolled studies from Western countries.

A Very Rare Cause of Chronic Intestinal Pseudo-Obstruction: Sopradic Visceral Myopathy / 대한소화관운동학회지

Chronic intestinal pseudo-obstruction syndrome (CIPS) is a rare clinical condition in which impaired intestinal propulsion causes recurrent symptoms of bowel obstruction in the absence of mechanical obstruction. CIPS can be present as either primary or secondary although the latter is rare in children compared with adults. The primary abnormality consists of a degeneration of either the muscularis propria (visceral myopathy), or the myenteric plexus (visceral neuropathy). A 19 year old woman was recently admitted with recurrent abdominal distension and diarrhea. An abdominal plain X-ray revealed a marked dilated stomach and duodenum with some air-fluid levels. A small bowel series showed a diffusely dilated small bowel with multifocal angulation and spiculation. Computed tomograpy also revealed a dilated small bowel and distal ileal wall thickening. The patient was treated by duodenojejunostomy and ileal resection. Histologically the intestine showed thinning of the proper muscle layer with degeneration of smooth muscle cells replaced by fibrosis. Based on the specific histopathologic finding, in addition to the clinical history, physical finding and radiological evaluation, a diagnosis of sporadic visceral myopathy was rendered. The patient was treated through total parenteral nutrition with neostigmine, prokinetics, octreotide, and erythromycin postoperatively. However, she underwent ileostomy due to poor response from these therapies. After ileostomy, she improved without a recurrence of severe symptoms.

A Very Rare Cause of Chronic Intestinal Pseudo-Obstruction: Sopradic Visceral Myopathy / 대한소화관운동학회지

Chronic intestinal pseudo-obstruction syndrome (CIPS) is a rare clinical condition in which impaired intestinal propulsion causes recurrent symptoms of bowel obstruction in the absence of mechanical obstruction. CIPS can be present as either primary or secondary although the latter is rare in children compared with adults. The primary abnormality consists of a degeneration of either the muscularis propria (visceral myopathy), or the myenteric plexus (visceral neuropathy). A 19 year old woman was recently admitted with recurrent abdominal distension and diarrhea. An abdominal plain X-ray revealed a marked dilated stomach and duodenum with some air-fluid levels. A small bowel series showed a diffusely dilated small bowel with multifocal angulation and spiculation. Computed tomograpy also revealed a dilated small bowel and distal ileal wall thickening. The patient was treated by duodenojejunostomy and ileal resection. Histologically the intestine showed thinning of the proper muscle layer with degeneration of smooth muscle cells replaced by fibrosis. Based on the specific histopathologic finding, in addition to the clinical history, physical finding and radiological evaluation, a diagnosis of sporadic visceral myopathy was rendered. The patient was treated through total parenteral nutrition with neostigmine, prokinetics, octreotide, and erythromycin postoperatively. However, she underwent ileostomy due to poor response from these therapies. After ileostomy, she improved without a recurrence of severe symptoms.

A Case of Zollinger-Ellison Syndrome Caused by Gastrinoma Found in a Pyloric Region / 대한소화기내시경학회지

Zollinger-Ellison syndrome (ZES) is characterized by severe peptic ulcer disease that results from gastrin-secreting tumors (gastrinoma) of the gastrointestinal tract. About 25% of patients have multiple endocrine neoplasia type 1 (MEN- 1). More than 80% of the tumors were noted in an area described as gastrinoma triangle. All manifestations of ZES including peptic ulcer, reflux esophagitis and watery diarrhea may result from the function of gastrin. A 54-year-old man was admitted due to abdominal pain and watery diarrhea for 18 months. Esophagogastroduodenoscopy revealed severe reflux esophagitis and multiple bulbar and postbulbar ulcers with evidence of recent bleeding. Also he suffered from recurrent small bowel perforation. He was diagnosed as ZES based on markedly elevated fasting serum gastrin level (1,189 pg/mL), typical clinical features, peripancreatic mass on CT scan and octreotide scintigraphy. Pathologic findings after Whipple's operation revealed malignant gastrinoma located in a subpyloric area.

Choledochal cyst associated the with anomalous union of pancreaticobiliary duct (AUPBD) has a more grave clinical course than choledochal cyst alone

OBJECTIVE: Since choledochal cyst is frequently associated with the anomalous union of pancreaticobiliary duct (AUPBD), AUPBD has been regarded to be the etiologic factor of choledochal cyst. However, the clinical significance of AUPBD an patients with choledochal cyst has not been clearly defined. Therefore, to clarify the significance of AUPBD in choledochal cyst patients, we compared the clinical features of patients with choledochal cyst according to the presence or absence of AUPBD. METHODS: Among 52 cases which were diagnosed as choledochal cyst out of 5,037 ERCP referrals between August 1990 and December 1996, we selected 44 cases, in which the pancreaticobiliary junction was clearly visualized on cholangio-pancreaticography. These cases were divided into AUPBD-present group (n = 28) and AUPBD-absent group (n = 16). Clinical features were compared between the two groups. Furthermore, in AUPBD-present group, clinical data were also analyzed according to Kimura's classification of AUPBD. RESULTS: In our study, AUPBD was associated with choledochal cyst in 28 (64%) cases. AUPBD was found only in type I and IV according to Todani's classification of choledochal cyst. There were no significant differences between the AUPBD-present group and the AUPBD-absent group in the incidence of gallstone disease, while the incidence of acute inflammation was 93% (26/28) in the AUPBD-absent group (p < 0.01). Carcinoma developed only in the AUOBD-present group (9/28, 32%) (p < 0.05). Pancreatic disorders (i.e. pancreatic stone, pancreatitis or pancreatic cancer) occurred in 12 of 28 cases in the AUPBD-present group (43%), while only in 1 of 16 cases in the AUPBD-absent group (6%) (p < 0.05). CONCLUSION: AUPBD associated with choledochal cyst may have implications not only as a possible etiologic factor but also as an important factor that may affect the clinical course, surgical planning and prognosis. In cases with choledochal cyst, we should make an effort to evaluate the presence of AUPBD.