Management of Diabetes Mellitus With Glucagonlike Peptide-1 Agonist Liraglutide in Renal Transplant Recipients: A Retrospective Study.

BACKGROUND: Diabetes mellitus (DM) is the major cause of end-stage renal disease (ESRD) in Taiwan. Despite the use of steroids and/or calcineurin inhibitors (CNIs) in renal transplantation (RTx), additional challenges occur when a patient displays persisting metabolic disease, carries on an unhealthy lifestyle, or experiences genetic effects. Although RTx recipients could get better glycemic control by oral anti-diabetic drugs (OADs) or several insulin agents, they still need more than two kinds of medication. Liraglutide, a GLP-1 receptor agonist, stimulates insulin secretion and inhibits glucagon secretion and hepatic glucose production in a glucose-dependent manner. In addition, it delays gastric emptying and suppresses appetite through the central pathways. Herein we report on the long-term benefits of liraglutide in the management of DM in RTx recipients. METHODS: We retrospectively retrieved 7 RTx patients in August 2015, who had been prescribed liraglutide due to their poor glycemic control; however, 2 of them discontinued their scheduled doses within 1 month. The mean follow-up period was 19.4 ± 7.6 (range 10.5-27.6) months. RESULTS: Glycemic control improved fasting blood sugar (FBS) from an initial 228.6 ± 39.1 mg/dL to a final FBS of 166.0 ± 26.6 mg/dL (P = .103), with a significant improvement in nadir glucose control (136.4 ± 5.8 mg/dL, P = .017) and with glycated hemoglobin (HbA1c) from an initial 10.0 ± 1.6% to a final 8.1 ± 0.8% (P = .043). The average body weight was from an initial of 78.0 ± 7.8 kg to a nadir of 75.1 ± 9.1 kg (P = .032). Graft renal function of the estimated glomerular filtration rate (eGFR) significantly improved from an initial 67.7 ± 18.7 to a nadir of eGFR 76.5 ± 18.7 mg/dL (P = .024). There was no significant change in urinary protein:creatinine ratio. CONCLUSION: Liraglutide may be safe and effective for RTx recipients with poor diabetic glycemic control, although there have been incidences of intolerance in some patients, and potential concern regarding absorption of oral medications due to a delay of gastric emptying. Evidence of liraglutide in diabetic RTx recipients is limited, so additional prospective clinical studies should be undertaken in the future.

Polarity-variable birefringence on hyperlens structure.

A variable birefringence effect has been observed with 1D PMMA surface gratings on a gold film substrate. By changing the operation wavelength on the Au film, the birefringence value Δn(eff) changes from positive to negative. The result verified that this uniaxial crystal-like plasmonic surface gratings showed good superlensing effect at 515 nm when PMMA width:Air width=1:1 where the absolute value of Δn(eff) is relatively large.

Mediastinal cavernous haemangioma in a patient with Klippel-Trenaunay syndrome.

The Klippel-Trenaunay syndrome (KTS) is a rare syndrome characterised by the triad of varicose veins, bony and soft tissue hypertrophy, and cutaneous haemangioma. A 30 year old man with KTS with a right mediastinal mass which progressively enlarged over 5 years is described. Computed tomography, magnetic resonance imaging, and bronchial angiography revealed a vascular lesion in the azygous area. After complete excision of the mass, histological examination revealed cavernous haemangioma. To our knowledge, this is the first report of intrathoracic haemangioma in KTS.

Serotonin 6 receptor polymorphism in schizophrenia: frequency, age at onset and cognitive function.

The relative abundance of serotonin 6 receptor (5HT6) in some limbic regions and the high affinity of some antipsychotics for 5HT6 suggest that the 5HT6 gene might play a role in the pathogenesis of schizophrenic disorders. A recent study reported an association between a C267T polymorphism of the 5HT6 gene and schizophrenia. In order to test whether the 5HT6 gene plays a role in the pathogenesis of schizophrenic disorders, patients (n = 148) and control subjects (n = 160) were genotyped for 5HT6. We also investigated the relationship between genotypes and patients' age at onset and cognitive function in schizophrenic patients. Cognitive function in the patients was evaluated by the Mini-Mental State Examination (MMSE). The results demonstrated no significant differences in genotype or allele frequencies between controls and patients. In the patient group, age at onset and MMSE score did not differ significantly among the three 5HT6 genotpyes. The results of this study suggest that the 5HT6 C267T polymorphism plays no major role in susceptibility to the development of schizophrenia and is not related to cognitive impairment or age at onset in schizophrenic patients. Further studies of the relation between 5HT6 polymorphism and the symptoms and the therapeutic response in schizophrenic patients may help to elucidate the role of 5HT6 in the pathogenesis of schizophrenia.

Recognition and pose estimation of unoccluded three-dimensional objects from a two-dimensional perspective view by banks of neural networks.

This paper describes a neural network (NN) based system for recognition and pose estimation of an unoccluded three-dimensional (3-D) object from any single two-dimensional (2-D) perspective view. The approach is invariant to translation, orientation, and scale. First, the binary silhouette of the object is obtained and normalized for translation and scale. Then, the object is represented by a set of rotation invariant features derived from the complex orthogonal pseudo-Zernike moments of the image. The recognition scheme combines the decisions of a bank of multilayer perceptron NN classifiers operating in parallel on the same data. These classifiers have different topologies and internal parameters, but are trained on the same set of exemplar perspective views of the objects. Next, two pose parameters, elevation and aspect angles, are obtained by a novel two-stage NN system consisting of a quadrant classifier followed by NN angle estimators. Performance is tested on clean and noisy data bases of military ground vehicles. Comparative studies with three other classifiers (a single NN, the weighted nearest-neighbor classifier, and a binary decision tree) are carried out.