Relationship between Type 2 Diabetes Mellitus and Lumbar Bone Mineral Density in Postmenopausal Women.

STUDY DESIGN: Cross-sectional study using radiological measurements. PURPOSE: To analyze the relationship between type 2 diabetes mellitus (DM) and bone mineral density (BMD) in postmenopausal women and to assess risk factors of osteoporotic vertebral compression fracture (OVCF) in postmenopausal diabetic women. OVERVIEW OF LITERATURE: Type 2 DM has negative effects on the quality of bone. Patients with type 2 DM have increased risk of hip and other fractures, but their vertebral fracture risk is controversial. There is a positive correlation between body mass index (BMI) and BMD. At the same time, obesity is the most important risk factor for type 2 DM. METHODS: Consecutive patients whose BMD had been checked using dual-energy X-ray absorptiometry at Gwangmyung Sungae Hospital were recruited. Patients were divided into two groups according to the presence of type 2 DM. Risk factors of OVCF including age, BMI, current smoking status, current alcohol consumption, and presence of osteoporosis were analyzed separately in the type 2 DM group and control group. RESULTS: A total of 1,130 patients were enrolled in this study. The mean age was 63.2 years. BMI was positively correlated with lumbar BMD in the control group (r =0.284) and in the diabetic group (r =0.302). In subgroup analysis, BMI and age were significant risk factors of OVCF in the type 2 DM group. In multiple linear regression analysis, type 2 DM (ß =0.035; 95% confidence interval [CI], 0.005-0.065; p=0.024) and BMI (ß =0.015; 95% CI, 0.012-0.018; p<0.001) were positively correlated with lumbar BMD, and age was negatively correlated with BMD (ß =-0.006; 95% CI, -0.007 to -0.004; p<0.001). CONCLUSIONS: BMI was positively correlated with lumbar BMD and was higher in type 2 diabetic patients. Age was negatively correlated with lumbar BMD.

Relationship between Type 2 Diabetes Mellitus and Lumbar Bone Mineral Density in Postmenopausal Women

Methods@#Consecutive patients whose BMD had been checked using dual-energy X-ray absorptiometry at Gwangmyung Sungae Hospital were recruited. Patients were divided into two groups according to the presence of type 2 DM. Risk factors of OVCF including age, BMI, current smoking status, current alcohol consumption, and presence of osteoporosis were analyzed separately in the type 2 DM group and control group. @*Results@#A total of 1,130 patients were enrolled in this study. The mean age was 63.2 years. BMI was positively correlated with lumbar BMD in the control group (r =0.284) and in the diabetic group (r =0.302). In subgroup analysis, BMI and age were significant risk factors of OVCF in the type 2 DM group. In multiple linear regression analysis, type 2 DM (β =0.035; 95% confidence interval [CI], 0.005–0.065; p =0.024) and BMI (β =0.015; 95% CI, 0.012–0.018; p <0.001) were positively correlated with lumbar BMD, and age was negatively correlated with BMD (β =−0.006; 95% CI, −0.007 to −0.004; p <0.001). @*Conclusions@#BMI was positively correlated with lumbar BMD and was higher in type 2 diabetic patients. Age was negatively correlated with lumbar BMD.

Clinical Implication of Mid-Range Dynamic Instability in Lumbar Degenerative Spondylolisthesis.

STUDY DESIGN: Retrospective evaluation. PURPOSE: To determine the prevalence of mid-range dynamic instability in patients with degenerative spondylolisthesis (DS) and to evaluate the clinical implication of mid-range instability (MI). OVERVIEW OF LITERATURE: Instability is identified by measuring vertebral body anterior-posterior translation on static end-range flexion and extension lateral radiographs. Mid-range kinematics could evince occult dynamic instability in which motion is not appreciated at the terminal-range of motion. METHODS: In this study, 30 patients with DS with checked standing dynamic radiographs of the lumbar spine in Gwangmyeong Sungae Orthopedic Clinic were recruited. Standing lateral radiographs were evaluated in extension, 45° of flexion (mid-range) and 90° of flexion (terminal-range) of the lumbar spine. Instability was defined as sagittal translation greater than 3 mm from the extension position. Patients were divided into three groups: a control group, an MI group, and a terminal-range instability (TI) group. Radiographic outcome (stenosis grade) and clinical outcome were compared between the three groups. RESULTS: The average sagittal translation of the lumbar spine was 5.2 mm in extension, 6.6 mm in mid-range, and 7.2 mm in endrange. MI was observed in eight patients (26.2%) and TI was seen in 12 patients (40%). Of eight patients with MI, three patients did not have instability at terminal-range (occult patients) and five patients had instability at terminal-range (typical patients). Body weight and body mass index (BMI) was significantly higher in the MI group as compared to the control group. BMI was positively correlated with slippage to mid-range. There was no significant difference in stenosis grade, Visual Analog Scale, and Oswestry Disability Index. In the TI group, there was no significant difference in radiographic clinical parameters as compared to the control group. CONCLUSIONS: MI was demonstrated in 25% of DS patients. Mid-range motion was increased with BMI. Mid-range lateral radiography can reveal occult instability in patients with DS, particularly in obese patients.

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration

OBJECTIVES@#To determine the relationship between lumbar disc degeneration and back muscle degeneration.SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles.@*MATERIALS AND METHODS@#In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed.@*RESULTS@#The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant.@*CONCLUSIONS@#There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To determine the relationship between lumbar disc degeneration and back muscle degeneration. SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles. MATERIALS AND METHODS: In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed. RESULTS: The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant. CONCLUSIONS: There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

A 15-year-long Southern blotting analysis of FMR1 to detect female carriers and for prenatal diagnosis of fragile X syndrome in Taiwan.

Here, we review the results of Southern blotting analyses of the FMR1 gene performed in our reference laboratory in Taiwan over a 15-year period. In total, 725 high-risk women with a family history of fragile X syndrome (FXS) or idiopathic intellectual disability, 3911 low-risk pregnant women without such family history, and prenatal diagnosis data for 32 foetuses from 24 carrier mothers were included. Only 2 carriers were in the low-risk group, which indicated a prevalence of 1 of 1955 women (95% confidence interval: 1/7156-1/539). A total of 100 carriers were found to be in the high-risk group, thus revealing a significantly higher frequency than the low-risk group (100/725 vs 2/3911, P<0.0001). Eight of the 14 foetuses that inherited the maternal mutant allele were verified to have a full mutation, with the smallest maternal pre-mutation allele carrying 56 CGG repeats. The overall findings confirmed that the carrier prevalence among low-risk women in Taiwan is significantly lower than that reported in western countries. Therefore, the most important step for preventing FXS in Taiwan would be to focus on high-risk women by promoting general awareness of this disease and spreading knowledge regarding the benefits of carrier screening and prenatal testing.

Comparison of the insertion of the posterior horn of the lateral meniscus: discoid versus non-discoid.

PURPOSE: The purpose of this study was to compare the insertion sites of the posterior horn between discoid and non-discoid lateral meniscus using magnetic resonance imaging (MRI). METHODS: Two hundred and twenty-seven patients who had MRI scans before surgery and underwent arthroscopy were enroled in this study. A coronal view showing the narrowest width of the midbody of the lateral meniscus was chosen to measure the widths of the entire tibial plateau and the midbody of the lateral meniscus. Considering the ratio of the meniscal width to the tibial plateau width, the patients were divided into non-discoid, incomplete discoid, and complete discoid groups. On a coronal view accurately showing the insertion of the posterior horn of the lateral meniscus, a distance between the peak of the lateral tibial eminence and the centre of the insertion of the posterior horn, and a width of the lateral tibial plateau between the lateral edge of the tibial plateau and the peak of the lateral tibial eminence were measured. RESULTS: The insertion centre of the posterior horn was located more medially in the incomplete and complete discoid groups than in the non-discoid group (p = 0.003, 0.010, respectively). When individual differences in the knee size were corrected, the insertion centre of the posterior horn in the incomplete discoid and complete discoid groups was located more medially than in the non-discoid group (p = 0.009, 0.003, respectively). CONCLUSION: The insertion centre of the posterior horn of the lateral meniscus is located more medially to the apex of the lateral tibial eminence in the discoid group than in the non-discoid group. This finding needs to be considered for an accurate position of the posterior horn of lateral meniscus during the lateral meniscal allograft transplantation. LEVEL OF EVIDENCE: IV.

Relationship Between Pelvic Tilt and Lumbar Disc Degeneration

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To determine the relationship between pelvic tilt and lumbar disc degeneration. SUMMARY OF LITERATURE REVIEW: The shape and the spatial orientation of the pelvis determine the organization of the lumbothoracic spine. The purpose of our study was to determine the relationship between pelvic tilt and lumbar disc degeneration. MATERIALS AND METHODS: Sixty patients over 50 years of age who had undergone lumbar spine magnetic resonance imaging were recruited. In individuals between 41 and 60 years of age, the normal pelvic tilt is 14°. Patients were divided into a low pelvic tilt (PT) group (<14°) and a high pelvic tilt (PT) group (≥14°). Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. We defined grades IV and V as high-grade degeneration and the others as low-grade degeneration. Radiologic parameters and lumbar disc degeneration were compared between these 2 groups. RESULTS: In the low PT group, the average degeneration grade of each lumbar segment was 2.61 in L1-L2, 2.61 in L2-L3, 3.00 in L3-L4, 3.39 in L4-L5, and 3.84 in L5-S1. The corresponding grades in the high PT group were 2.34 in L1-L2, 2.62 in L2-L3, 3.07 in L3-L4, 3.76 in L4-L5, and 3.55 in L5-S1. The grade of degeneration of the high PT group was significantly higher than that of the low PT group for L4-L5 (p=0.031). High-grade degeneration of the L4-L5 segment was significantly more common in the high PT group (odds ratio=4.65; 95% CI, 1.406-15.381; p=0.012). CONCLUSIONS: Patients with high pelvic tilt had a higher grade of lumbar disc degeneration in the L4-L5 segment regardless of age or gender.

Nafamostat Mesilate Attenuates Ischemia-Reperfusion-Induced Renal Injury.

BACKGROUND: It has been reported that nafamostat mesilate (NM) inhibits inflammatory injury via inhibition of complement activation in ischemic heart, liver, and intestine. However, it is unclear if NM also inhibits apoptosis in ischemia-reperfusion (IR)-injured kidney. We therefore investigated whether NM attenuates IR renal injury that involves inhibition of apoptosis. METHODS: HK-2 cells and male C57BL/6 mice were used for this study. C57Bl/6 mice were divided into 4 groups: sham, NM (2 mg/kg) + sham, IR injury (IR injury; reperfusion 27 minutes after clamping of both the renal artery and vein), and NM + IR injury. Kidneys were harvested 24 hours after IR injury, and functional and molecular parameters were evaluated. For in vitro studies, HK-2 cells were incubated for 6 hours with mineral paraffin oil to induce hypoxic injury, and then treated with various doses of NM to evaluate the antiapoptotic effects. RESULTS: Blood urea nitrogen, serum creatinine levels, and renal tissue injury scores in NM + IR-injured mice were significantly lower than those of control IR mice (all P < .01). NM significantly improved cell survival in hypoxic HK-2 cells (P < .01), significantly decreased renal Bax expression (P < .05), and increased renal Bcl-2 protein levels in IR kidneys and hypoxic HK-2 cells compared with those of the sham and control groups. The numbers of terminal deoxynucleotide transferase-mediated dUTP nick-end labeling- and 8-oxo-2'-deoxyguanosine-positive cells were significantly lower in NM + IR-injured kidneys compared with those in control IR-injured mice (P < .05); NM treatment decreased the expression of inducible and endothelial nitric oxide synthase in IR-injured mice (P < .05). CONCLUSIONS: NM ameliorates IR renal injury via inhibition of apoptosis by, at least in part, lowering nitric oxide overproduction, reducing Bax, and increasing Bcl-2.

Effects of training using an active video game on agility and balance.

AIM: The aim of this paper was to examine the effects of training using Xbox Kinect on agility and balance in healthy young adults. METHODS: Forty-three healthy adults (aged 20 to 30 years) were randomized to either an intervention or control group. The intervention group played Xbox Kinect 3 times per week, for an average of 20 minutes per session for 6 weeks. The control group did not play Xbox Kinect. All the participants completed assessments of agility and balance at baseline, 2, 4, and 6 weeks. RESULTS: After 6 weeks of training the intervention group showed significant improvement in agility at 2 weeks and showed continued improvement at 4 and 6 weeks (P<0.05). Dynamic balance in the medial and posterior directions also began to improve in the intervention group at 2 weeks and showed continued improvement at 4 and 6 weeks (P<0.05). There was no significant difference between the intervention and control group in static balance (P=0.538). CONCLUSION: A 6-week active video game training program appears to be effective in improving agility and dynamic balance in the medial and posterior directions in healthy young adults.

Use of non-steroidal anti-inflammatory drugs and risk of chronic kidney disease in people with Type 2 diabetes mellitus, a nationwide longitudinal cohort study.

AIMS: To investigate the temporal relationship between non-steroidal anti-inflammatory drug use and the development of chronic kidney disease in people with Type 2 diabetes mellitus. METHODS: We conducted a retrospective cohort study and followed up a population with Type 2 diabetes who were chronic kidney disease-free (n = 48,715) using national health insurance claims data in Taiwan. Exposure status to non-steroidal anti-inflammatory drugs in 2007 was measured. A total of 6406 subjects with incident chronic kidney disease were identified from the period 2008 to 2011. Multivariable proportional hazards models were applied to determine the temporal relationship between non-steroidal anti-inflammatory drug use and the development of chronic kidney disease. RESULTS: We observed a significant temporal relationship between non-steroidal anti-inflammatory drug use and the development of chronic kidney disease in people with Type 2 diabetes. Compared with people not taking any non-steroidal anti-inflammatory drug in 2007, those who were taking such drugs for at least 90 days in 2007 had a higher risk of chronic kidney disease development (adjusted hazard ratio 1.37, 95% CI 1.26-1.49). In subgroup analyses, those people (irrespective of age, sex, various comorbidities and use of anti-hypertensive drugs, aspirin or acetaminophen) who were taking non-steroidal anti-inflammatory drugs for at least 90 days were more likely to develop chronic kidney disease than people who were not taking any non-steroidal anti-inflammatory drug. CONCLUSIONS: The results suggest that there is a positive temporal relationship between non-steroidal anti-inflammatory drug use and increased risk of chronic kidney disease in people with Type 2 diabetes. The use of non-steroidal anti-inflammatory drugs should be based on clinical evaluations of benefits and risks, and should be prescribed with caution for people with Type 2 diabetes.

Decreased parathyroid Klotho expression is associated with persistent hyperparathyroidism after kidney transplantation.

Although successful kidney transplantation usually corrects hyperparathyroidism, the condition persists in some patients. The present study was designed to determine whether Klotho or fibroblast growth factor 23, the key regulator of parathyroid hormone, is involved in persistent hyperparathyroidism in kidney transplant recipients (KTRs). Nineteen hyperplastic parathyroid glands were obtained from end-stage renal disease (ESRD) patients and KTRs; 6 normal parathyroid glands were used as controls. We compared the expression of Klotho, fibroblast growth factor receptor 1 (FGFR1) and calcium-sensing receptor (CaSR) in the KTRs and ESRD patients. Expressions of Klotho, FGFR1, CaSR and vitamin D receptor, as evaluated by immunohistochemistry, were quantified as the number of positive cells per unit area. The Klotho, FGFR1 and CaSR expressions in parathyroid glands of the post-kidney transplantation (PSKT) and the ESRD groups were significantly decreased compared with normal controls. In the ESRD group, Klotho expression and number of proliferating cell nuclear antigen-positive cells in the parathyroid gland were significantly decreased in parathyroid adenomas as compared with parathyroid hyperplasia. The expression of FGFR1 and CaSR in the parathyroid glands was significantly increased in the PSKT compared with the ESRD group. There was no significant difference in Klotho expression between the PSKT and ESRD groups. Incomplete recovery of Klotho levels in the parathyroid gland may play a role in the pathogenesis of tertiary hyperparathyroidism after kidney transplantation.

Intracervical misoprostol and prostaglandin E2 for labor induction.

OBJECTIVES: To compare the safety and efficacy of misoprostol with PGE(2) for induction of labor by intracervical administration. METHODS: Eighty-six women with indications for labor induction at term were randomly assigned to two groups. Each woman received either 50 microg of misoprostol or 0.5 mg of prostaglandin E(2) intracervically. If labor was not initiated after 4 h, the same dose was repeated every 4 h to a maximum of 200 microg of misoprostol or 1.5 mg of PGE(2) until adequate labor was achieved. RESULTS: Forty-three women were allocated to the misoprostol group and 43 to the prostaglandin E(2) group. Misoprostol was more effective than PGE(2) in producing cervical changes (P<0.025). Delivery within 12 h after the first administration occurred more often in the misoprostol group than in the PGE(2) one (85% vs. 56%, P<0.05). Less patients in the misoprostol group required oxytocin augmentation than in the PGE(2) one (16.3% vs. 39.5%, P<0.05). Uterine tachysystole and hyperstimulation occurred more frequently in the misoprostol group (44.1%) than in the PGE(2) group (18.7%) (P<0.05). Nevertheless, no statistically significant differences were noted between the two groups including mode of delivery and neonatal or maternal adverse outcome. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (480+/-172 min vs. 657+/-436 min, P<0.01). CONCLUSIONS: Compared with prostaglandin E(2), intracervical misoprostol is more effective in cervical ripening and labor induction at term. The higher frequency of uterine hypercontractility associated with the use of misoprostol did not increase the risk of adverse intrapartum and neonatal outcomes.

Correlation of redox potential with state variables in cultures under controlled dissolved oxygen concentration and pH

In batch cultures for L-ornithine production in which dissolved oxygen concentration and pH were closely controlled, time changes of redox potential were observed in connection with the profiles of cell, glucose, and ornithine concentrations. It was found that the redox potential profile had four different phases reflecting the physiological state of the culture and that it was closely related to cell concentration change. Effects of glucose and ornithine on the redox potential were identified in a separate series of experiments. On the basis of the experimental results, a correlation of redox potential to glucose, cell, and ornithine concentrations has been proposed. The proposed correlation can be used for on-line estimation of ornithine concentration from on-line data of redox potential, glucose concentration, and cell concentration.

Desulfurization of dibenzothiophene and diesel oils by a newly isolated gordona strain, CYKS1

A dibenzothiophene (DBT)-desulfurizing bacterial strain was isolated and identified as Gordona strain CYKS1. Strain CYKS1 was found to transform DBT to 2-hydroxybiphenyl via the 4S pathway and to be able to also use organic sulfur compounds other than DBT as a sole sulfur source. Its desulfurization activity was susceptible to sulfate repression. Active resting cells for desulfurization could be prepared only in the early growth phase. When two types of diesel oils, middle distillate unit feed (MDUF) and light gas oil (LGO) containing various organic sulfur compounds including DBT, were treated with resting cells of strain CYKS1 for 12 h, the total sulfur content significantly decreased, from 0.15% (wt/wt) to 0.06% (wt/wt) for MDUF and from 0.3% (wt/wt) to 0.25% (wt/wt) for LGO. The newly isolated strain CYKS1 is considered to have good potential for application in the biodesulfurization of fossil fuels.

Advantages of Total Laparoscopic Hysterectomy

We compared 112 total laparoscopic hysterectomies (TLH) with 72 laparoscopic hysterectomies (LH) performed from January 1, 1995, to September 30, 1995. Patient characteristics (age, weight, parity) and indications for surgery were similar between the groups. All surgeries were performed with electrosurgery or suture ligature, or both. Average uterine weight was slightly lower with TLH (193.1 ± 96.2 g) versus LH (237.4 ± 84.5 g). Thirty-three women (29.46%) undergoing TLH had had previous pelvic surgery, versus 12 having LH (16.67%). Operating time was significantly shorter for TLH (117.6 ± 38.2 min) than LH (134.9 ± 37.4 min). Less bleeding, as indicated by decreased postoperative hemoglobin, was noted with TLH (1.3 ± 0.7 g/ml) versus LH (1.7 ± 1.1 g/ml). Fewer cases of serious complications, such as genitourinary tract damage, and less formation of granulation tissues on the vaginal cuff associated with persistent leukorrhea and postcoital bleeding occurred with TLH, probably because more precise surgery can be done under direct vision. We believe TLH can be performed more safely and quickly than LH by an experienced surgeon. A potential advantage of TLH is less postoperative infection due to less vaginal manipulation. Other advantages are the lengthening of the vagina, less postoperative prolapse of the vagina, and less enterocele development because of more precise anatomic restoration of the pelvic structures under direct visualization. Since detailed pelvic structures can be visualized, excised, and restored, TLH has all the possible benefits of subtotal hysterectomy, if any, due to the maximum preservation of supporting structures (cardinal, uterosacral ligaments) and nerve plexus, thus making subtotal hysterectomy obsolete. Further studies and long-term follow-up are required.