Inter-relationships between the severity of metabolic syndrome, insulin and adiponectin and their relationship to future type 2 diabetes and cardiovascular disease.

BACKGROUND: The severity of the metabolic syndrome (MetS) is related to future incidence of type 2 diabetes (T2DM) and cardiovascular disease (CVD). However, the relationship between MetS severity and levels of fasting insulin and adiponectin-markers of insulin resistance-is unclear. METHODS: We used linear and logistic regression to analyze data from 711 participants of the Princeton Lipid Research Cohort with information regarding levels of insulin, adiponectin and MetS severity during 1998-2003 (mean age 39.5 years); 595 participants had MetS severity data from childhood (1973-1976, mean age 12.9 years) and 417 had updated disease status from 2010 to 2014 (mean age 50.9 years). RESULTS: Childhood MetS Z-scores were positively associated with adult insulin levels (P<0.001) and negatively associated with adiponectin levels (P=0.01). In individual analyses, higher insulin levels and MetS Z-score as adults were related to higher odds of incident diabetes and CVD over the next 11.2 years (all P<0.001), whereas lower adiponectin levels were only related to odds of future T2DM (P<0.0001). In a model including insulin, adiponectin and MetS Z-score, adiponectin was not linked to future disease; both insulin (P=0.027) and MetS Z-score (P=0.002) were related to risk of future T2DM, while only MetS Z-score was related to future CVD (P<0.001). CONCLUSIONS: The severity of MetS exhibits long-term links to levels of insulin and adiponectin, suggesting potential genetic and environmental influences on insulin resistance over time. As a long-term predictor of T2DM and CVD, the severity of MetS exhibited consistent independent correlations. This supports clinical utility in evaluating MetS severity as a predictor of risk for future disease.

Standardization of amniotic fluid leptin levels and utility in maternal overweight and fetal undergrowth.

OBJECTIVE: Leptin is an adipokine that regulates energy homeostasis. The objective of this study was to establish a gestational age-specific standard for amniotic fluid leptin (AFL) levels and examine the relationship between AFL, maternal overweight and fetal growth restriction. STUDY DESIGN: Amniotic fluid was obtained at mid-gestation from singleton gravidas, and leptin was quantified using enzyme-linked immunosorbent assay. Amniotic fluid samples from 321 term pregnancies were analyzed. Clinical data, including fetal ultrasound measurements and maternal and infant characteristics, were available for a subset of patients (n=45). RESULTS: The median interquartile range AFL level was significantly higher at 14 weeks' gestation (2133 pg ml(-1) (1703 to 4347)) than after 33 weeks' gestation (519 pg ml(-1) (380 to 761), P trend<0.0001), an average difference of 102 pg ml(-1) per week. AFL levels were positively correlated with maternal pre-pregnancy body mass index (BMI) (r=0.36, P=0.03) adjusting for gestational age at measurement, but were not associated with fetal growth. CONCLUSIONS: AFL levels are higher at mid-gestation than at late gestation, and are associated with maternal pre-pregnancy BMI.

Auxiliary partial orthotopic liver transplantation in the treatment of acute liver failure: a case report.

A successful experience with auxiliary partial orthotopic liver transplantation (APOLT) for acute liver failure is reported in a 29-year-old woman who experienced jaundice, generalized erythema for 7 days, and decreased mentation for 3 days. Two months prior, she suffered pulmonary tuberculosis, being currently treated with antituberculous medications, which caused the fulminant hepatic failure. We decided to perform APOLT based on two facts. The first was the possibility that the diseased native liver may recover sufficiently to withdraw the immunosuppressants. Second, the pulmonary tuberculosis may have been worsened by immunosuppression. We removed the extended lateral section of the recipient for the graft. The left hepatic vein of the extended left lateral graft was anastomosed to the left hepatic vein of the recipient. The left portal vein of the graft was anastomosed to the left portal vein of the recipient. The right portal vein of the recipient was left without any manipulation. A duct-to-duct anastomosis was performed. On postoperative day 3, antituberculous medications were started. On the postoperative day 37, she was discharged without any problems. On the postoperative day 120, she showed no event of rejection, and her pulmonary symptoms improved. We performed the operation without transection of the portal branch to the native liver, but no functional competition has been discovered.