Urban-Rural Differences Explain the Association between Serum 25-Hydroxyvitamin D Level and Insulin Resistance in Korea

An increasing number of studies report associations between low serum 25-hydroxyvitamin D [25(OH)D] level and insulin resistance; however, whether low vitamin D levels directly contribute to increased insulin resistance is unclear. We investigated the impact of residential area on the association between 25(OH)D and insulin resistance in elderly Koreans. Using data from the Korean Urban Rural Elderly study, we conducted cross-sectional analyses in 1628 participants (505 men and 1123 women). Serum 25(OH)D was analyzed as both continuous and categorized variables. Homeostasis model assessment for insulin resistance (HOMA-IR) was calculated using fasting blood glucose and insulin levels. In men, 25(OH)D level was inversely associated with HOMA-IR (standardized β = −0.133, p < 0.001) after adjustment for age, body mass index, waist circumference, smoking, alcohol intake, exercise, and study year. However, we noted significant urban-rural differences in 25(OH)D level (43.4 versus 65.6 nmol/L; p < 0.001) and HOMA-IR (1.2 versus 0.8 mmol·pmol/L²; p < 0.001). When we additionally adjusted for residential area, the association between 25(OH)D and HOMA-IR was attenuated (standardized β = −0.063, p = 0.115). In women, the association between 25(OH)D and HOMA-IR was not significant before or after adjustment for residential area. Environmental or lifestyle differences in urban and rural areas may largely explain the inverse association between serum 25(OH)D and insulin resistance.     

Antidiabetic and enzymatic antioxidant properties from methanol extract of Ficus talboti bark on diabetic rats induced by streptozotocin

ObjectiveTo explore scientifically, the type–I anti-diabetic potential of Ficus talboti bark (FTB).MethodsThe HPLC analysis was carried out to identify the phenolic compounds. Effect of two doses of methanol extract of FTB (100 mg/kg and 200 mg/kg body wt.) was orally administered to STZ (Streptozotocin) induced diabetic rats for 21 days. The various parameters were studied including body weight, fasting blood glucose levels, plasma insulin, lipid profile, glycogen content, total protein, serum enzymes levels, and antioxidant activities in normal, treated and diabetic rats. Histochemical analysis of liver and pancreas were also carried out in normal, treated and diabetic rats.ResultsThe HPLC analysis showed the presence of antidiabetic responsible compounds of Rutin, Quercetin and Kaemfeorl. The treatment group with the extract at two dose levels showed a significant increase in the liver, muscle glycogen and serum insulin level and a significant decrease in fasting blood glucose and serum marker enzyme levels. The total cholesterol and serum triglycerides levels were also significantly reduced and the high density lipoprotein and plasma enzymes level was significantly increased upon treatment with the FTB methanol extract. Histochemical study of pancreas also confirmed the biochemical findings. Acute toxicity studies revealed the non-toxic nature of the FTB methanol extract.ConclusionThe results of the experiments presented here suggest that methanol extract of FTB exerts significant antidiabetic and antioxidant effect in STZ induced diabetic rats.     

Protein kinase C isoforms in atherosclerosis: Pro- or anti-inflammatory?

Atherosclerosis is a pathologic condition caused by chronic inflammation in response to lipid deposition in the arterial wall. There are many known contributing factors such as long-term abnormal glucose levels, smoking, hypertension, and hyperlipidemia. Under the influence of such factors, immune and non-immune effectors cells are activated and participate during the progression of atherosclerosis. Protein kinase C (PKC) family isoforms are key players in the signal transduction pathways of cellular activation and have been associated with several aspects of the atherosclerotic vascular disease. This review article summarizes the current knowledge of PKC isoforms functions during atherogenesis, and addresses differential roles and disputable observations of PKC isoforms. Among PKC isoforms, both PKCβ and PKCδ are the most attractive and potential therapeutic targets. This commentary discusses in detail the outcomes and current status of clinical trials on PKCβ and PKCδ inhibitors in atherosclerosis-associated disorders like diabetes and myocardial infarction. The risk and benefit of these inhibitors for clinical purposes will be also discussed. This review summarizes what is already being done and what else needs to be done in further targeting PKC isoforms, especially PKCβ and PKCδ, for therapy of atherosclerosis and atherosclerosis-associated vasculopathies in the future.     

Something old,something new and something very old: drugs for treating type 2 diabetes

Diabetes mellitus belongs to the most rapidly increasing diseases worldwide. Approximately 90–95% of these patients suffer from type 2 diabetes mellitus, which is characterized by peripheral insulin resistance and the progressive loss of beta-cell function and mass. Considering the complications of this chronic disease, a reliable anti-diabetic treatment is indispensable. An ideal oral anti-diabetic drug should not only correct glucose homeostasis but also preserve or even augment beta-cell function and mass, ameliorate the subclinical inflammation present under insulin-resistant conditions and prevent the macro- and microvascular consequences of diabetes in order to reduce the mortality. Despite the many anti-diabetic drugs already in use, there is an ongoing research for additional drugs, guided by different concepts of the pathogenesis of type 2 diabetes. This review will briefly summarize current oral anti-diabetic drugs. In addition, emerging strategies for the treatment of diabetes will be described, among them the inhibition of glucagon action and anti-inflammatory drugs. Their suitability as ‘ideal anti-diabetic drugs’ will be discussed.     

Insulin therapy and the risk of colorectal cancer in patients with type 2 diabetes: a meta-analysis of observational studies

Aims

Several epidemiological studies have reported inconsistent associations between insulin therapy and the risk of colorectal cancer (CRC) in patients with type 2 diabetes mellitus. We performed this meta-analysis of observational studies to evaluate the effect of insulin therapy on the risk of CRC.

Methods

We carried out a systematic search of PubMed, Embase and the Cochrane Library Central database between January 1966 and August 2013. Fixed-effects and random-effects models were used to estimate the pooled relative risk (RR) and corresponding 95% confidence interval (CI).

Results

A total of 12 epidemiological studies were included in the present meta-analysis, involving a total of 7947 CRC cases and 491 384 participants. There was significant heterogeneity among the studies, but no publication bias. Insulin therapy significantly increased the risk of CRC [RR = 1.69, 95% CI (1.25, 2.27)]. When the various studies were stratified by study design, we found that insulin use was associated with a statistically significant 115% higher risk of CRC among case–control studies [RR = 2.15, 95% CI (1.41, 3.26)], but not among cohort studies [RR = 1.25, 95% CI (0.95, 1.65)]. Furthermore, a significant association was noted among studies conducted in USA [RR = 1.73, 95% CI (1.15, 2.60)] and Asia [RR = 2.55, 95% CI (2.14, 3.04)], but not in Europe [RR = 1.20, 95% CI (0.92, 1.57)].

Conclusions

The present meta-analysis suggests that insulin therapy may increase the risk of CRC. More prospective cohort studies with longer follow-up durations are warranted to confirm this association. Furthermore, future studies should report results stratified by gender and race and should adjust the results by more confounders.     

某“三甲”医院2010-2012年H2受体拮抗药和质子泵抑制剂应用分析

目的:评价某"三甲"医院抑酸药的应用情况。方法:对2010-2012年该院H2受体拮抗药和质子泵抑制剂这两类抑酸药的销售金额、用量、用药频度(DDDs)等进行统计、分析。结果:2010-2012年,该院质子泵抑制剂的销售金额始终占抑酸药的99%以上,且金额逐年上升;H2受体拮抗药的销售金额只占1%以下,且构成比逐年降低。泮托拉唑胶囊和奥美拉唑胶囊的用量3年来一直居第1、2位,两者的排序比均大于3;注射用泮托拉唑在静脉用药中的用量最大,排序比为0.33。结论:质子泵抑制剂在该院抑酸药的应用中占绝对主导地位,使用数量及金额逐年增加,但仍存在一些不合理的用药现象。     

注射用丙帕他莫单药及与β-内酰胺类药、质子泵抑制剂的配伍稳定性考察

目的:考察注射用丙帕他莫与β-内酰胺类药、质子泵抑制剂(PPI)的配伍稳定性。方法:采用高效液相色谱(HPLC)法测定丙帕他莫48 h内的含量变化,考察其p H值变化,并观察与β-内酰胺类药及PPI配伍后各溶液的外观变化。结果:丙帕他莫的水溶液不稳定,药物含量在7 h内可降解至90%以下,p H值在3 h内从5.37降至3.52,48 h后p H值降至1.87。丙帕他莫与β-内酰胺类药配伍3 h时肉眼可观察到液体乳光,配伍12 h时可观察到白色沉淀;与PPI配伍立即发生颜色的变化并逐渐形成深色沉淀。结论:丙帕他莫的水溶液稳定性差,与β-内酰胺类药物及PPI存在配伍禁忌。丙帕他莫临床上应现配现用,尽量在配伍1 h内用完且不与其他药物进行配伍,输液前后应冲管。     

泮托拉唑联合生长抑素治疗不明原因消化道出血的疗效

目的观察单用泮托拉唑（PPI）及联用生长抑素治疗不明原因消化道出血的疗效。方法将92例不明原因消化道出血患者,均分为单用PPI组和联合用药组。PPI组予泮托拉唑40mg加0.9%Na Cl溶液100ml静滴,2次/d;联合组在使用PPI基础上加用生长抑素250μg首剂缓慢静推,然后3mg加36ml 0.9%Na Cl溶液微泵静脉持续泵入,250μg/h。两组均观察48h。观察期间所有患者均不使用其他止血药物。分别对两组患者治疗24h及48h后止血率进行比较,同时对比72h内仍有间断或持续性出血,进一步行介入或手术治疗的患者例数。结果联合组24h及48h止血率分别为89.1%和95.7%,单药组24h及48h止血率分别为71.7%和82.6%,两组比较差异有统计学意义（P〈0.05）。单药组最终需要接受急诊介入及手术例数比例为17.4%,联合组最终需要接受急诊介入及手术例数比例为4.3%,两组比较差异有统计学意义（P〈0.05）。结论使用PPI联合生长抑素与单独用PPI相比,在治疗不明原因消化道出血中更有效。     

谷胱甘肽对胰岛素淀粉样纤维化的抑制作用

目的探索谷胱甘肽抑制胰岛素淀粉样纤维化及纤维细胞毒性的分子机制。方法在pH 2.0、37℃及90r·min-1震荡的条件下孵育胰岛素,采用硫黄素(ThT)荧光检测胰岛素形成淀粉样纤维的动力学曲线,8-苯胺-1-萘磺酸(ANS)荧光检测胰岛素分子聚集体表面疏水性的变化,透射电镜观察纤维形态,以淀粉样纤维诱导人红细胞的聚集为指标,评估谷胱甘肽对胰岛素纤维细胞毒性的抑制作用。结果胰岛素在本文的实验条件下孵育可形成淀粉样纤维,谷胱甘肽能够抑制胰岛素的淀粉样纤维化和降低形成的纤维聚集体的表面疏水性,并降低胰岛素纤维对细胞的损害作用。谷胱甘肽的这种作用与分子中的巯基相关。结论谷胱甘肽能够抑制胰岛素的淀粉样纤维化,改变胰岛素聚集体的表面特性,从而使聚集体的细胞毒性降低。     

甘精胰岛素联合二甲双胍治疗糖尿病合并高脂血症40例临床观察

目的:观察甘精胰岛素联合二甲双胍治疗糖尿病合并高脂血症的临床疗效。方法:将符合诊断标准的40例患者按随机数字表法分为治疗组和对照组,每组各20例,对照组单用甘精胰岛素治疗,治疗组在甘精胰岛素治疗基础上加服二甲双胍片,共治疗12周后检测各项指标。结果:经治疗后2组患者HbA1c均有改善,但对血脂水平的影响各有不同。治疗组血清TG及LDL-C降低明显,而对照组与治疗前相比变化不明显。结论:甘精胰岛素联合二甲双胍治疗糖尿病合并高脂血症效果优于单纯胰岛素治疗,值得临床推广。