Insulin sensitivity improvement with exercise training is mediated by body weight loss in subjects with metabolic syndrome

AimTo determine whether exercise training improves insulin actions through concomitant body weight loss (BWL).MethodsSubjects (aged 55 ± 8 years) with metabolic syndrome (MetS), prediabetes (fasting blood glucose: 111 ± 2 mg·dL⁻¹, HbA1c: 5.85 ± 0.05%) and abdominal obesity (waist circumference: 104 ± 7.9 cm) were randomly allocated to either a group performing aerobic interval training (EXER; n = 76) or a sedentary group receiving lifestyle counselling (CONT; n = 20) for 16 weeks.ResultsAt baseline, insulin sensitivity (according to HOMA2 and intravenous glucose tolerance test; CS_I), body composition and VO_2max were similar between the groups. After the intervention, both groups had similar BWL (1–2%), but only the EXER group showed decreased [mean (95% CI)] trunk fat mass [from 18.2 (17.4–18.9) to 17.3 kg (16.6–17.9); P < 0.001] and HOMA2 scores [from 1.6 (1.5–1.7) to 1.4 (1.3–1.5); P = 0.001], and increased VO_2max [from 2.07 (1.92–2.21) to 2.28 (2.11–2.45) LO₂ ·min⁻¹; P < 0.001]. However, CS_I did not improve in any group. Within-group subdivision by BWL (≤ 0%, 0–3%, ≥ 3%) revealed higher CS_I in those with BWL ≥ 3% in both groups. Trunk fat mass reductions were closely associated with CS_I and HOMA-IR improvement (r = − 0.452–0.349; P < 0.001).ConclusionIn obese MetS subjects with prediabetes, 3% BWL is required for consistent improvement in insulin sensitivity. Thus, exercise-training programmes should be combined with calorie restriction to achieve BWL levels that prevent the development of diabetes.     

Evaluación multiparamétrica de la función ventricular derecha en la hipertensión arterial pulmonar asociada a cardiopatías congénitas

Introduction and objectivesOutcome in patients with congenital heart diseases and pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Two-dimensional echocardiographic parameters, such as strain imaging or RV end-systolic remodeling index (RVESRI) have emerged to quantify RV function.MethodsWe prospectively studied 30 patients aged 48 ± 12 years with pretricuspid shunt and PAH and investigated the accuracy of multiple echocardiographic parameters of RV function (tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, RV systolic-to-diastolic duration ratio, right atrial area, RV fractional area change, RV global longitudinal strain and RVESRI) to RV ejection fraction measured by cardiac magnetic resonance.ResultsRV ejection fraction < 45% was observed in 13 patients (43.3%). RV global longitudinal strain (ρ [Spearman's correlation coefficient] = −0.75; P = .001; R² = 0.58; P = .001), right atrium area (ρ = −0.74; P < .0001; R² = 0.56; P < .0001), RVESRI (ρ = −0.64; P < .0001; R² = 0.47; P < .0001), systolic-to-diastolic duration ratio (ρ = −0.62; P = .0004; R² = 0.47; P < .0001) and RV fractional area change (ρ = 0.48; P = .01; R² = 0.37; P < .0001) were correlated with RV ejection fraction. RV global longitudinal strain, RVESRI and right atrium area predicted RV ejection fraction < 45% with the greatest area under curve (0.88; 95%CI, 0.71-1.00; 0.88; 95%CI, 0.76-1.00, and 0.89; 95%CI, 0.77-1.00, respectively). RV global longitudinal strain > −16%, RVESRI ≥ 1.7 and right atrial area ≥ 22 cm² predicted RV ejection fraction < 45% with a sensitivity and specificity of 87.5% and 85.7%; 76.9% and 88.3%; 92.3% and 82.4%, respectively.ConclusionsRVESRI, right atrial area and RV global longitudinal strain are strong markers of RV dysfunction in patients with pretricuspid shunt and PAH.     

Association of insulin resistance,insulin and leptin levels with coronary in-stent restenosis

BackgroundIn-stent restenosis remains the major limitation of coronary stent implantation. Leptin is a hormone strongly related to insulin resistance (IR). Moreover, insulin resistance and hyperinsulinemia are common in patients with coronary heart disease (CHD), each of the previous metabolic and hormonal factors might be involved in restenosis after stent implantation.ObjectiveThis study was planned to evaluate the relationship between insulin resistance, insulin, leptin levels and coronary in-stent restenosis after coronary stent implantation in non-diabetic patients with CHD and to determine their value in prediction of restenosis.Patients and methodsThe study included 48 non-diabetic CHD patients with previous successful coronary stent implantation. They were divided into two groups according to the presence of in-stent restenosis on follow-up coronary angiography (6–9 months after stent implantation). The first group was CHD patients with in-stent restenosis which included 20 patients, the second group was CHD patients without restenosis which included 28 patients. All patients were subjected to complete clinical examination including determination of body mass index (BMI), waist to hip ratio (WHR) and laboratory investigations including fasting plasma glucose (FPG), fasting plasma insulin (FP insulin), lipid profile (total cholesterol, HDL-C, LDL-C, TG), glycoselated hemoglobin (HbA1c), plasma leptin, estimation of homeostasis model assessment of IR (HOMA-IR). All subjects were submitted to OGTT with estimation of 2-h post-prandial glucose (2-hPP glucose) and sum post-prandial insulin levels (sum PP insulin). Follow-up coronary angiography was done for all patients with the estimation of minimal luminal diameter (MLD), diameter stenosis % and late lumen loss.ResultsThere was highly significant increase in each of FP insulin, sum PP insulin, HOMA-IR, leptin, diameter stenosis % and late lumen loss (P < 0.001) and a highly significant decrease of MLD (P < 0.001) in CHD patients with in-stent restenosis when compared to CHD patients without in-stent restenosis. MLD is negatively correlated to each of FP insulin (r = −0.49, P < 0.001), sum PP insulin (r = −0.60, P < 0.001) HOMA-IR (r = −0.63, P < 0.001) and leptin (r = −0.55, P < 0.001) while late lumen loss was positively correlated to each of FP insulin (r = 0.98, P < 0.001), sum PP insulin (r = 0.70, P < 0.001), HOMA-IR (r = 0.67, P < 0.001) and leptin (r = 0.72, P < 0.001). Multiple regression analysis revealed that each of FP insulin, sum PP insulin, HOMA-IR and leptin can be considered an independent predictor of in-stent restenosis (P < 0.001).ConclusionOur study revealed that insulin resistance, fasting and post-prandial hyperinsulinemia and hyperliptinemia are considered predictors of coronary in-stent restenosis. Evaluation of HOMA-IR, insulin levels after standard OGTT and leptin levels are important tools in an attempt to recognize subjects at risk of early restenosis among non-diabetic, CHD patients undergoing percutaneous coronary revascularization and stent implantation.     

Gut microbiota of children with atopic dermatitis: Controlled study in the metropolitan region of São Paulo,Brazil

BackgroundIt is possible that imbalances in the composition of the gut microbiota or the relationship of the microbiota with the host may be implicated in the origin of allergy. Therefore, we studied the intestinal microbiota of children with atopic dermatitis (AD).MethodsCross-sectional study with 81 children aged 5–11; 23 with AD and 58 controls. Surveys were conducted to obtain demographic, socioeconomic and neonatal data. Diagnosis of AD was made based on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Eubacteria, Bacteroidetes, Firmicutes, B. fragilis, E. coli, Lactobacillus spp., S. aureus, E. faecalis, Salmonella spp., M. smithii, Bifidobacterium spp., C. difficile and C. perfringens were quantified using real-time PCR.ResultsThe analysis showed an association between presence of C. difficile (OR: 5.88; 95 % CI: 1.24; 27.98), greater abundance of bifidobacteria (OR: 11.09; 95 % CI: 2.14; 57.39) and a lower abundance of lactobacilli (OR: 0.07; 95 % CI: 0.01; 0.51) in the gut microbiota of children with AD. Counts of Eubacteria (0,05 × 10³ and 8.49 × 10³), B. fragilis (0.72 × 10⁹ and 4.5 × 10⁹), Lactobacillus spp. (0.02 × 10⁸ and 0.38 × 10⁸), E. coli (0.13 × 10⁹ and 1.52 × 10⁹) and M. smithii (0.02 × 10⁸ and 0.31 × 10⁸) were lower in children with AD (P < 0.05).ConclusionsThis study confirmed that children living in the metropolitan area of São Paulo (Brazil) with AD have a different microbiota pattern with higher prevalence of C. difficile, lower abundance of Lactobacillus and greater abundance of bifidobacteria, regardless of socioeconomic status.     

Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals

BackgroundDue to immunomodulatory properties, vitamin D status has been implicated in several diseases beyond the skeletal disorders. There is evidence that its deficiency deteriorates the gut barrier favoring translocation of endotoxins into the circulation and systemic inflammation. Few studies investigated whether the relationship between vitamin D status and metabolic disorders would be mediated by the gut microbiota composition.ObjectiveWe examined the association between vitamin D intake and circulating levels of 25(OH)D with gut microbiota composition, inflammatory markers and biochemical profile in healthy individuals.MethodsIn this cross-sectional analysis, 150 young healthy adults were stratified into tertiles of intake and concentrations of vitamin D and their clinical and inflammatory profiles were compared. The DESeq2 was used for comparisons of microbiota composition and the log2 fold changes (log2FC) represented the comparison against the reference level. The association between 25(OH)D and fecal microbiota (16S rRNA sequencing, V4 region) was tested by multiple linear regression.ResultsVitamin D intake was associated with its concentration (r = 0.220, p = 0.008). There were no significant differences in clinical and inflammatory variables across tertiles of intake. However, lipopolysaccharides increased with the reduction of 25(OH)D (p-trend < 0.05). Prevotella was more abundant (log2FC 1.67, p < 0.01), while Haemophilus and Veillonella were less abundant (log2FC − 2.92 and − 1.46, p < 0.01, respectively) in the subset with the highest vitamin D intake (reference) than that observed in the other subset (first plus second tertiles). PCR (r = − 0.170, p = 0.039), E-selectin (r = − 0.220, p = 0.007) and abundances of Coprococcus (r = − 0.215, p = 0.008) and Bifdobacterium (r = − 0.269, p = 0.001) were inversely correlated with 25(OH)D. After adjusting for age, sex, season and BMI, 25(OH)D maintained inversely associated with Coprococcus (β = − 9.414, p = 0.045) and Bifdobacterium (β = − 1.881, p = 0.051), but significance disappeared following the addition of inflammatory markers in the regression models.ConclusionThe role of vitamin D in the maintenance of immune homeostasis seems to occur in part by interacting with the gut microbiota. The attenuation of association of bacterial genera by inflammatory markers suggests that inflammation participate in part in the relationship between the gut microbiota and vitamin D concentration. Studies with appropriate design are necessary to address hypothesis raised in the current study.     

Interleukin-33 in children with asthma: A systematic review and meta-analysis

BackgroundPrevious studies have shown that serum interleukin 33 serving as an “alarmin” is increased in children with asthma. The objective of this study was to assess the validity of serum IL33 test for early diagnosis of childhood asthma.MethodsA literature search was performed in June 2016 using PubMed, Embase, the Cochrane Library and other Chinese Medical Databases to identify studies. The search terms used were “cytokine”, “interleukin-33“, “asthma” and “children”. The meta-analysis was performed using Review Manager 5.3 software. Random-effects model was used to estimate the standardized mean differences (SMDs) with 95% confidence intervals (CIs).ResultsA total of eight studies were included into this meta-analysis, involving 330 asthmatic children and 248 healthy children. The meta-analysis results revealed that the serum IL33 level was higher in asthmatic children compared to that in healthy children (SMD = 1.29, 95%CI = 0.53–2.05, P = 0.0009), with significant heterogeneity across studies (I² = 94% and P < 0.00001).ConclusionsThe meta-analysis showed that serum IL33 is a helpful biomarker for early diagnosis of childhood asthma. However, owing to lack of enough data, the increased serum concentration of IL33 cannot be an indicator for the asthma severity.     

Effects of adipose tissue distribution on maximum lipid oxidation rate during exercise in normal-weight women

AimFat mass localization affects lipid metabolism differently at rest and during exercise in overweight and normal-weight subjects. The aim of this study was to investigate the impact of a low vs high ratio of abdominal to lower-body fat mass (index of adipose tissue distribution) on the exercise intensity (Lipox_max) that elicits the maximum lipid oxidation rate in normal-weight women.MethodsTwenty-one normal-weight women (22.0 ± 0.6 years, 22.3 ± 0.1 kg.m⁻²) were separated into two groups of either a low or high abdominal to lower-body fat mass ratio [L-A/LB (n = 11) or H-A/LB (n = 10), respectively]. Lipox_max and maximum lipid oxidation rate (MLOR) were determined during a submaximum incremental exercise test. Abdominal and lower-body fat mass were determined from DXA scans.ResultsThe two groups did not differ in aerobic fitness, total fat mass, or total and localized fat-free mass. Lipox_max and MLOR were significantly lower in H-A/LB vs L-A/LB women (43 ± 3% VO_2max vs 54 ± 4% VO_2max, and 4.8 ± 0.6 mg min⁻¹ kg FFM⁻¹ vs 8.4 ± 0.9 mg min⁻¹ kg FFM⁻¹, respectively; P < 0.001). Total and abdominal fat mass measurements were negatively associated with Lipox_max (r = –0.57 and r = –0.64, respectively; P < 0.01) and MLOR [r = –0.63 (P < 0.01) and r = –0.76 (P < 0.001), respectively].ConclusionThese findings indicate that, in normal-weight women, a predominantly abdominal fat mass distribution compared with a predominantly peripheral fat mass distribution is associated with a lower capacity to maximize lipid oxidation during exercise, as evidenced by their lower Lipoxmax and MLOR.     

The Relationship Between Neutrophil Lymphocyte Ratio With Urinary Protein Albumin Excretion in Newly Diagnosed Patients With Type 2 Diabetes

BackgroundRecent evidence suggests that neutrophil/ lymphocyte (N/L) ratio play a role in the development and progression of cardiovascular complications. Increased urinary albumin and protein excretion has been shown to be a risk factor for cardiovascular disease. Thus, this study aimed to investigate the relationship between circulating total and differential leukocyte counts including N/L ratio with urinary protein and albumin excretion in patients with newly diagnosed type 2 diabetes.MethodsAll patients underwent history taking, physical examination, blood pressure measurement, 12-lead electrocardiographic evaluation, routine urine analysis, biochemical analysis, 24-hour urine collection to measure protein and albumin excretion and creatinine clearance. Peripheral total and differential leukocyte analyses were performed using an automated cell counter.ResultsIn total, 80 patients were included. spearman correlation analysis revealed that 24-hour urinary protein excretion was correlated with neutrophil count (ρ = 0.280, P = 0.012), lymphocyte count (ρ = − 0.365, P = 0.001) and N/L ratio (ρ = 0.474, P < 0.0001). Spearman correlation analysis revealed that 24-hour urinary albumin excretion was correlated with neutrophil count (ρ = 0.261, P = 0.019), lymphocyte count (ρ = − 0.278, P = 0.013) and N/L ratio (ρ = 0.415, P < 0.0001). In stepwise linear regression analysis, 24-hour urinary protein excretion was independently associated with high-density lipoprotein cholesterol (P = 0.01), blood urea (P = 0.014) and N/L ratio (P = 0.041). On the other hand, 24-hour urinary albumin excretion was independently associated with creatinine clearance (P = 0.004), albumin (P < 0.0001) and N/L ratio (P = 0.011).ConclusionsThis study demonstrated that increased N/L ratio was independently related with both 24-hour urinary protein and urinary albumin excretion in newly diagnosed patients with type 2 diabetes.     

Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes

ObjectiveThe objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes.Research design and methods615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care.ResultsBased on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r = 0.28, p < 0.001) and access to healthy foods (r = −0.16, p = 0.003) were significantly associated with self-care behaviors, while neighborhood violence (r = −0.06, p < 0.001) and esthetics (r = −0.07, p = 0.278) were not χ² (180, N = 611) = 192, p = 0.26, RMSEA = 0.01, CFI = 0.999). In the final trimmed model, social support (r = 0.31, p < 0.001) and access to healthy foods (r = −0.20, p < 0.001) remained significantly associated with self-care behaviors χ² (76, N = 611) = 60, p = 0.91, RMSEA = 0.00, CFI = 1.0).ConclusionThis study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.     

Accumulation of plasma 3-deoxyglucosone impaired glucose regulation in Chinese seniors: Implication for senile diabetes?

AimsTo investigate the impact of increasing accumulation of 3-deoxyglucosone (3-DG) on glucose regulation in non-diabeteic seniors.MethodsThis research is a 2-year prospective follow-up study. We conducted a HPLC assay to determine the plasma 3-DG concentrations of 132 non-diabetic retirees of Suzhou. An oral glucose tolerance test was carried out 2 years after baseline in 16 subjects with continual high plasma 3-DG and 16 control subjects randomly sampled in those with normal plasma 3-DG.ResultsThe median plasma 3-DG level of 132 subjects was 43.52 ng/ml (7.89–736.09 ng/ml), of which 47 subjects (36.6%) were beyond 70 ng/ml. A correlation between age and 3-DG was found among people between 50 and 66 years old (r = 0.408, P < 0.001). The 60–69 years group had a higher 3-DG level than 50–59 years group (P < 0.001). Compared with control group, the continual high plasma 3-DG subjects had a higher level of FINs (P < 0.05), FBG (P < 0.01), HOMA-IR (P < 0.001), and a lower level of ISI (P < 0.001) and ΔI₆₀/ΔG₆₀ (P < 0.05), as well as a higher incidence of impaired glucose regulation (χ² = 7.814, P < 0.05).ConclusionsThere was abnormal elevation of plasma 3-DG in non-diabetic seniors, and the increasing accumulation of plasma 3-DG, which mainly resulted from aging, eventually lead to the impaired glucose regulation, indicating an association of 3-DG with senile diabetes.     

Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging

ObjectiveA major concern with carotid artery stenting (CAS) is the potential for cerebral embolism. The purpose of this study was to determine whether integrated backscatter (IBS) ultrasound and black-blood magnetic resonance imaging (BB-MRI) can predict the risk of a silent ischemic lesion after CAS.MethodsWe performed quantitative analysis of plaque characteristics in carotid arteries using IBS ultrasound and BB-MRI before CAS in 50 patients. We measured IBS values and the signal intensity ratio (SIR) from T1 weighted images of all plaques. We also performed diffusion-weighted (DWI) MRI of the brain before and after CAS.ResultsIn the patient group that was positive (n = 19) for newly appearing ipsilateral silent ischemic lesions (NISIL), relative unstable component area (%UCA) evaluated by IBS analysis (60.2 ± 23.4% and 35.3 ± 19.2%, p < 0.001) and SIR (1.40 ± 0.19 and 1.18 ± 0.25, p < 0.01) in most stenotic lesions were higher than in the NISIL-negative group (n = 31). From the analysis of receiver operating characteristic curves, 50% of the %UCA measured by IBS and an SIR of 1.25 measured by BB-MRI were the most reliable cutoff values for predicting NISIL. In multivariate logistic regression analysis, the independent predictors of NISIL were SIR (p = 0.030), the CRP level (p = 0.041) and the %UCA measured by IBS (p = 0.049).ConclusionsQuantitative tissue characterization of carotid plaques using IBS ultrasound and BB-MRI was useful to predict NISIL after CAS. The plaque components in carotid arteries should be evaluated by BB-MRI or IBS ultrasound before CAS to improve the clinical outcome of this procedure.     

Fecal microbiota transplantation as therapy for inflammatory bowel disease: A systematic review and meta-analysis

Background and aimsFecal microbiota transplantation (FMT) has gained interest as a novel treatment option for inflammatory bowel diseases (IBD). While publications describing FMT as therapy for IBD have more than doubled since 2012, research that investigates FMT treatment efficacy has been scarce. We conducted a systematic review and meta-analysis to evaluate the efficacy of FMT as treatment for patients with IBD.MethodsA systematic literature search was performed through May 2014. Inclusion criteria required FMT as the primary therapeutic agent. Clinical remission (CR) and/or mucosal healing were defined as primary outcomes. Studies were excluded if they did not report clinical outcomes or included patients with infections.ResultsEighteen studies (9 cohort studies, 8 case studies and 1 randomized controlled trial) were included. 122 patients were described (79 ulcerative colitis (UC); 39 Crohn's disease (CD); 4 IBD unclassified). Overall, 45% (54/119) of patients achieved CR during follow-up. Among the cohort studies, the pooled proportion of patients that achieved CR was 36.2% (95% CI 17.4%–60.4%), with a moderate risk of heterogeneity (Cochran's Q, P = 0.011; I² = 37%). Subgroup analyses demonstrated a pooled estimate of clinical remission of 22% (95% CI 10.4%–40.8%) for UC (P = 0.37; I² = 0%) and 60.5% (95% CI 28.4%–85.6%) for CD (P = 0.05; I² = 37%). Six studies performed microbiota analysis.ConclusionsThis analysis suggests that FMT is a safe, but variably efficacious treatment for IBD. More randomized controlled trials are needed and should investigate frequency of FMT administration, donor selection and standardization of microbiome analysis.     

Disordered glycemic control in women with type 2 diabetes is associated with increased TNF receptor-2 levels

BackgroundEvidence implicates tumor necrosis factor (TNF) in the pathophysiology of Type 2 Diabetes (T2D) through unclear mechanisms. We hypothesized that disordered glycemic control leads to TNF activation and increases in soluble-TNF (sTNF) and its receptors-1 (sTNFR1) and -2 (sTNFR2).MethodsWe characterized 265 T2D and non-diabetic Latin American subjects and assessed the relationship between the TNF system and fasting plasma glucose (FPG), hemoglobin-A1C (A1C), insulin (FPI), C-peptide and HOMA-Beta.ResultssTNF and sTNFR2 but not sTNFR1 levels were higher in T2D than non-diabetics (P < 0.0001). In T2D, sTNFR2 was associated with A1C and C-peptide (R² = 0.354, b = 0.504, P < 0.0001; b = 0.167, P = 0.049). Also, T2D patients with disordered glycemic control had increased sTNFR2 levels that correlated with FPG (Rho:0.393, P < 0.001), A1C (Rho:0.451, P < 0.001) and HOMA-Beta (Rho:-0.308, P = 0.005); events not observed in T2D patients with adequate glycemic control. Furthermore, sex-based comparative analyses of T2D patients showed that women compared to men had higher sTNFR2 levels (P = 0.017) that correlated with FPG, A1C, FPI and HOMA-Beta.ConclusionsDisordered glycemic control is associated with sTNF and sTNFR2. sTNFR2 levels were higher in T2D women than men. Thus, increased sTNFR2 levels may be an important biomarker for disordered glucose and inflammatory complications in T2D patients and women in particular.     

Depression and resilience mediates the effect of family function on quality of life of the elderly

BackgroundFamily function, which improves individual resilience and strongly link to quality of life (QOL) among the elderly, increases the risk of depression. Because of these demonstrated relationships, it can be hypothesized that both depression and resilience are mediators of the association between family function and QOL.MethodsTo test this hypothesis, the structural equation model (SEM) constructed by Amos 21.0 was employed to assess the indirect effect of depression (Geriatric Depression Scale, GDS) and resilience (Connor-Davidson Resilience Scale, CD-RISC) on the relationship between family function (Family APGAR Score, APGAR) and QOL (12-item Short Form health survey, SF-12) in 474 elderly adults from three communities in Guangzhou, China.ResultsCorrelation matrix showed that depression is significantly negatively correlated with family functioning (r = −0.54, P < 0.01), resilience (r = −0.46, P < 0.01) and QOL (r = −0.63, P < 0.01), while resilience is significantly positively correlated with family functioning (r = 0.35, P < 0.01) and QOL (r = 0.40, P < 0.01). SEM indicated that Family functioning appeared to have significant indirect effects through resilience (β = 0.089) and depression (β = 0.307; combined β = 0.056) on QOL (R² = 0.55). The model fit indices showed a good fit of the model of the data (χ²/df = 1.362, P > 0.05, SRMR = 0.023, RMSEA = 0.028, GFI = 0.985, NFI = 0.987, TLI = 0.993, CFI = 0.996).ConclusionsThe finding supports the assumption that depression and resilience are consistent intermediary factors of the relationship between family function and QOL among the elderly.     

Eating disorders in patients with irritable bowel syndrome

IntroductionEating disorders (ED) constitute an important group of conditions that commonly occur in adolescents. Gastrointestinal complaints are frequently reported in ED patients. Few studies assessed the association of irritable bowel syndrome (IBS) with ED. The aim of the current study is to determine the prevalence of ED in a group of IBS patients and compare it with a healthy control group and assess the relationship of IBS sub-types, it's duration and severity with ED.Patients and methods100 IBS patients diagnosed according to the Rome-IV criteria and a control group consisting of 100 healthy adults, between 18 and 65 years old, were enrolled in this study. Sub-type, duration and severity of IBS were determined. All participants were requested to fill questionnaires to screen for ED.Results200 subjects participated in the study. 118(59%) were female and 92(41%) were male. The Eating Attitudes Test (EAT) score was significantly higher in the IBS group (Odds ratio: 5.3 CI 95%:4.3–9.3; p < 0.001). The number of subjects with EAT score >30 was significantly higher in the IBS group (p < 0.001). EAT scores were significantly higher in female IBS patients and in younger patients (p = 0.013 and p = 0.043; respectively). No significant association between the IBS sub-type and EAT score was found (p > 0.05). However, IBS severity and duration positively correlated with EAT scores.DiscussionED should be considered in the management of IBS patients. Since many psychological factors can exacerbate IBS symptoms a multidisciplinary approach consisting of medical and behavioral therapeutic modalities should be employed for a better management of these patients.     

Étude de la corrélation entre la sensibilité à l’insuline et les paramètres anthropométriques et métaboliques dans le diabète de type 2

AimThe aim of the study was to evaluate correlations between insulin sensitivity and insulinosecretion with anthropometric and metabolic parameters in type 2 diabetics.Materials and methodsWe conducted a cross-sectional study among patients with type 2 diabetes mellitus treated with oral antidiabetic medications. The evaluation of insulin resistance and insulinosecretion was based on the calculation of the HOMA-IR and HOMA-β indices.ResultsThe mean age for the 100 diabetes recruited was 56.4 ± 8.4 years. The mean body mass index (BMI) and waist circumference (WC) were 30.5 ± 5.7 kg/m² and 101.2 ± 11.9 cm respectively. The HOMA-IR and HOMA β indices were respectively 3.5 ± 2.8 and 48.9 ± 45.5. We have found a significantly positive correlation between HOMA-IR index and weight (r = 0.406, p < 10⁻³), BMI (r = 0.432, p < 10⁻³) and WC (r  =  0.412, p < 10⁻³). We noticed a significant negative correlation between HOMA β index and fasting glucose (r = −0.457, p < 10⁻³) and A1 C (r = −0.399, p < 10⁻³). A positive statistically significant correlation was noted between HOMA-IR and HOMA-β (r = 0.400, p < 10⁻³).ConclusionInsulin resistance is very related to overweight, especially the android distribution of fat hence the need for adequate management of this android obesity. It would also be interesting to evaluate the effects of weight loss on insulin resistance parameters.     

Effects of pioglitazone on beta-cell function in metabolic syndrome patients with impaired glucose tolerance

ObjectiveTo determine the potential effects of pioglitazone on beta-cell function in metabolic syndrome patients with impaired glucose tolerance and probe into the possible mechanisms.Research design and methodsTwenty-two subjects were treated with pioglitazone 30 mg/day for 4 months. At baseline and after treatment, each subject underwent an IVGTT. The acute insulin response (AIRg), the glucose disappearance rates (coefficients K) and the ratio of Δinsulin/Δglucose (ΔI/ΔG) were calculated according to IVGTT results. Hyperglycemic clamp study was conducted to determine the second-phase insulin response, insulin sensitivity index (ISI) and glucose infusion rate (GIR). Euglycemic–hyperinsulinemic clamp study was made to measure the glucose disposal rate (GDR). Plasma glucose, free fatty acids (FFAs), serum insulin and proinsulin levels were measured.ResultsAIRg unchanged (P = 0.25) after treatment, whereas the values of coefficients K (P < 0.01) and ΔI/ΔG increased (P < 0.05). The second-phase insulin response and GIR were both demonstrated marked increments (P < 0.01 and P < 0.01, respectively). Pioglitazone therapy also resulted in improvement of ISI value (P < 0.05). And the increment of GDR during the euglycemic–hyperinsulinemic clamp was also significant (P < 0.01). Furthermore, a decrease in fasting proinsulin level was observed (P < 0.001). And plasma glucose, FFAs and serum insulin levels all declined. The increase of ΔI₁/ΔG₁ was positively correlated with the improvement of GDR (r = 0.536, P = 0.089). And a positive relationship was observed between the change in the second-phase insulin response and change in K value (r = 0.682, P = 0.021).ConclusionsShort-term pioglitazone therapy improved beta-cell dysfunction, the mechanism might involve the attenuation of insulin resistance.     

Efficacy and Safety of Oral Conivaptan,a Vasopressin-Receptor Antagonist,Evaluated in a Randomized,Controlled Trial in Patients With Euvolemic or Hypervolemic Hyponatremia

BackgroundIn most cases of hyponatremia, arginine vasopressin secretion is inappropriately high. This placebo-controlled, randomized, double-blind multicenter study evaluated the efficacy and safety of oral conivaptan, a V_1A/V₂-receptor antagonist, in patients with euvolemic or hypervolemic hyponatremia.MethodsEighty-three patients with serum [Na⁺] less than 130 mEq/L were stratified by volume status and randomly assigned to placebo or conivaptan 40 or 80 mg/d for 5 days.ResultsConivaptan increased the baseline-adjusted area under the serum [Na⁺]-time curve significantly more than placebo (P = 0.0001). Patients given either dose of conivaptan demonstrated a serum [Na⁺] of 4 mEq/L or greater above baseline significantly faster than those given placebo (P < 0.001) and maintained that increase for a greater total time (P = 0.0001). The least squares mean change in serum [Na⁺] from baseline to end of treatment was also significantly greater with conivaptan 40 and 80 mg/d (6.8 and 8.8 mEq/L, respectively) (P = 0.0001) than that with placebo (1.2 mEq/L). The percentage of patients who obtained an increase from baseline in serum [Na⁺] of 6 mEq/L or greater or normal serum [Na⁺] was significantly higher among patients given conivaptan 40 and 80 mg/d (67% and 88%, respectively) than among those given placebo (20%; P < 0.001). Conivaptan was well tolerated; the most frequent adverse events were urinary tract infection, anemia, pyrexia, cardiac failure, hypotension, and hypokalemia.ConclusionOral conivaptan was effective in increasing serum [Na⁺] in patients with euvolemic or hypervolemic hyponatremia and had a favorable safety profile.     

Reduced Akkermansia muciniphila and Faecalibacterium prausnitzii levels in the gut microbiota of children with allergic asthma

Introduction and objectivesThe amounts of Akkermansia muciniphila and Faecalibacterium prausnitzii in gut microbiota are reduced in patients with allergic diseases compared to healthy controls. We aimed to quantify levels of A. muciniphila and F. prausnitzii amounts using real-time quantitative PCR (qPCR) in the gut microbiota of children with allergic asthma and in healthy controls.Materials and methodsIn total, 92 children between the ages of three and eight who were diagnosed with asthma and 88 healthy children were included in the study and bacterial DNA was isolated from the stool samples using the stool DNA isolation Kit. qPCR assays were studied with the microbial DNA qPCR Kit for A. muciniphila and microbial DNA qPCR Kit for F. prausnitzii.ResultsBoth bacterial species showed a reduction in the patient group compared to healthy controls. A. muciniphila and F. prausnitzii were found to be 5.45 ± 0.004, 6.74 ± 0.01 and 5.71 ± 0.002, 7.28 ± 0.009 in the stool samples of the asthma and healthy control groups, respectively.ConclusionsF. prausnitzii and A. muciniphila may have induced anti-inflammatory cytokine IL-10 and prevented the secretion of pro-inflammatory cytokines like IL-12. These findings suggest that A. muciniphila and F. prausnitzii may suppress inflammation through its secreted metabolites.     

Relationship between circulating endothelial progenitor cells and insulin resistance in non-diabetic patients with ischemic chronic heart failure

AimThe objective of this study was to assess a relationship between insulin resistance (IR) and counts of CD45⁻CD34⁺, CD14⁺CD309⁺, and CD14⁺CD309⁺Tie2⁺ phenotyped circulating endothelial progenitor cells (EPCs) in patients with ischemic chronic heart failure (CHF).MethodsThe study involved 300 CHF patients (186 males) aged 48–62 years with angiografically proven coronary artery disease and/or previously defined myocardial infarction. Insulin resistance was assessed by the homeostasis model assessment for insulin resistance (HOMA-IR). EPC populations were phenotyped by flow cytofluorimetry.ResultsCirculating EPCs counts were statistically significantly lower in CHF patients with IR than in patients without IR. We found that the most valuable multivariable predictors of the depletion of the CD45⁺CD34⁺ EPCs were NT-pro-brain natriuretic peptide (BNP) (1.32; 95% CI = 1.19–2.77; P = 0.001), left ventricular ejection fraction (OR = 1.30; 95% CI = 1.09–1.60; P = 0.002), NYHA class (OR = 1.12; 95% CI = 1.02–1.19; P = 0.001). NT-pro-BNP (OR = 1.45; 95% CI = 1.15–2.90; P = 0.003), left ventricular ejection fraction (OR = 1.32; 95% CI = 1.11–1.65; P = 0.001) were found as powerful predictors for depletion in CD45⁻CD34⁺ EPCs. We also identified six independent variables with high predictive value for depletion of CD14⁺CD309⁺ EPCs: NT-pro-BNP (OR = 1.41; 95% CI = 1.15–2.90; P = 0.003), left ventricular ejection fraction (OR = 1.18; 95% CI = 1.10–1.76; P = 0.036), NYHA class (OR = 1.15; 95% CI = 1.07–1.22; P = 0.001), hs-C reactive protein (OR = 1.02; 95% CI = 1.01–1.05; P = 0.012). As independent multivariable predictors for depletion in CD14⁺CD309⁺Tie2⁺ EPCs were selected five variables: NT-pro-BNP (OR = 1.65; 95% CI = 1.44–4.70; P = 0.006), left ventricular ejection fraction (OR = 1.07; 95% CI = 1.02–1.12; P = 0.018), NYHA class (OR = 1.13; 95% CI = 1.06–1.21; P = 0.001), hs-C-reactive protein (OR = 1.08; 95% CI = 1.03–1.16; P = 0.002).ConclusionIR may be an additional factor contributing decreased circulating level of proangiogenic EPCs in non-diabetic CHF patients.