Association between BMI and risk of severe hypoglycaemia in type 2 diabetes

Aim

This study aimed to assess the association between body mass index (BMI) and the development of severe hypoglycaemia in patients with type 2 diabetes (T2D), using nationwide data for the entire South Korean population.

Leptin receptors are down-regulated in uterine implantation sites compared to interimplantation sites

Leptin is a circulating hormone that plays an important role in the regulation of metabolism, obesity, and reproduction. Leptin binds to its receptors on the cell membrane and is involved in the activation of STAT3. Recently, endometrium was suggested to be a novel target for leptin recently. We, therefore, examined the expression of leptin, leptin receptors, and STAT3 in the mouse uterus (implantation and interimplantation sites) to investigate the role of the leptin system during the early implantation period. Leptin mRNA was not detected in mouse uterine tissues or blastocysts, although adipose tissue, the positive control, showed a strong signal. Both of the receptor splice variants were expressed in the uterus and blastocysts, but the mRNA level was much lower in implantation sites compared to interimplantation sites. The mRNA expression of leptin receptors was determined to be higher in stromal cells than in the luminal epithelium using laser capture microdissection (LCM) analysis. Using immunohistochemistry, leptin was detected as a strong signal in the luminal epithelium and embryo, whereas the receptor was detected in subepithelial stromal cells rather than the luminal epithelium. As leptin itself was not detected by RT-PCR, the immunohistologically detected leptin may originate elsewhere, such as in adipose tissue. The differential expression of leptin receptors in implantation sites compared to interimplantation sites suggests that the leptin/leptin receptor system may be a delicate regulator of the implantation process.     

The role of interferon in virus-induced diabetes

The repeated administration of interferon (IFN) or an IFN inducer reduced the development of diabetes in mice infected with the D variant of encephalomyocarditis (EMC) virus. Mice treated with the IFN inducer had less infectious virus, fewer pathologic changes, and higher concentrations of immunoreactive insulin in the islets of Langerhans in comparison with untreated mice. Antibody to mouse IFN (MuIFN) suppressed circulating IFN in mice infected with the B variant of EMC virus. Mice treated with antibody to MuIFN had four times more infected islet cells and 10 times more infectious virus in the pancreas compared with untreated mice. Of the surviving animals treated with antibody to MuIFN, approximately 40% developed mild diabetes whereas none of the mice developed diabetes when infected with the B variant of EMC virus alone. The IFN system is an important determinant of the outcome in EMC virus-induced diabetes in mice.     

Diagnosis of tricuspid regurgitation. Current status

The most accepted diagnostic methods of tricuspid regurgitation (TR) are the physical examinations and the evaluation of right atrial pressure. However, these methods are not consistently diagnostic, and a "silent" form of TR has been recognized. The current status of noninvasive and invasive diagnostic techniques is reviewed.     

Determination of the need for tricuspid valve replacement: value of preoperative right ventricular angiocardiography

Of 530 patients undergoing tricuspid valve surgery from January 1, 1961 through December 31, 1987, those 362 patients having had preoperative right ventricular angiocardiography were studied. Mean age was 58.5 years. There were 71 males and 291 females. Tricuspid valve replacement (TVR) was performed in 126 (34.8%), and 236 underwent tricuspid valve repair (65.2%). The predominant pathology was combined tricuspid insufficiency and stenosis in 18 patients (4.9%), and isolated tricuspid insufficiency in 344 (95.1%). There were no complications related to the right ventriculogram. Preoperative angiographic severity of tricuspid valve incompetence was grade 1 in 23 patients (6.4%), grade 2 in 65 (17.9%), grade 3 in 109 (30.1%), and grade 4 in 165 (45.6%). Intraoperative assessment of the severity of tricuspid valve incompetence correlated 72% of the time with the preoperative angiographic assessment, in those patients with more severe degrees of incompetence (grade 3+ or 4+), p (X 2) less than 0.001. Increasing severity of preoperative angiographic triscuspid valve incompetence was associated with the requirement for TVR (vs. repair), p (X 2) = 0.0002. In conclusion, preoperative right ventricular angiography is a useful method for assessing tricuspid valve function and may predict the requirement for TVR in patients undergoing tricuspid valve surgery.     

Changes in autoimmune thyroid disease following allogeneic bone marrow transplantation

Autoimmune diseases can be transmitted and eliminated by bone marrow transplantation (BMT). There have been several cases of autoimmune thyroid disease (AITD) occurring after BMT, but AITD remission has been rarely reported. We present four cases in which the remission or transfer of AITD occurred after an allogeneic BMT. Two patients with severe aplastic anemia (SAA) showed evidence of remission of Hashimoto's thyroiditis which they had before allogeneic BMT. One patient with SAA, which developed during treatment with propylthiouracil for Graves' disease, underwent allogeneic BMT and showed evidence of Graves' disease remission following BMT. In one patient, new AITD occurred after an allogeneic BMT from an HLA-matched sibling who already had AITD. These cases support the evidence that the immune system is newly reconstituted after BMT, and severe autoimmune disease can be an indication for BMT. To fully understand the real changes in autoimmune status after BMT, long-term prospective studies are necessary.     

Sleep disorders and depression due to menopausal symptoms in middle-aged Korean females

[Purpose] The purpose of this study was to identify the differences in the incidence of sleep disorders and depression in postmenopausal middle-aged females in South Korea. [Participants and Methods] This study was a cross-sectional study. A total of 87 middle-aged females between the ages of 40 and 60 years were selected through convenience sampling. The data were collected with a self-reported questionnaire from May 1 to May 29, 2017. [Results] The mean menopause score of the study was 5.37. The menopause symptoms indicated significant differences in sexual life. The association between the incidence of menopausal symptoms and sleep disorders and depression scores based on a scale of 1 to 10 was analyzed. Menopausal symptoms strongly affected sleep and depression in middle-aged females. [Conclusion] The findings of this study may be useful in understanding depression and sleep disorders in middle-aged females and for developing more specific programs for depression and sleep disorders. Management strategies are also needed.     

Free-Breathing Motion-Corrected Single-Shot Phase-Sensitive Inversion Recovery Late-Gadolinium-Enhancement Imaging: A Prospective Study of Image Quality in Patients with Hypertrophic Cardiomyopathy

ObjectiveMotion-corrected averaging with a single-shot technique was introduced for faster acquisition of late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging while free-breathing. We aimed to evaluate the image quality (IQ) of free-breathing motion-corrected single-shot LGE (moco-ss-LGE) in patients with hypertrophic cardiomyopathy (HCM).Materials and MethodsBetween April and December 2019, 30 patients (23 men; median age, 48.5; interquartile range [IQR], 36.5–61.3) with HCM were prospectively enrolled. Breath-held single-shot LGE (bh-ss-LGE) and free-breathing moco-ss-LGE images were acquired in random order on a 3T MR system. Semi-quantitative IQ scores, contrast-to-noise ratios (CNRs), and quantitative size of myocardial scar were assessed on pairs of bh-ss-LGE and moco-ss-LGE. The mean ± standard deviation of the parameters was obtained. The results were compared using the Wilcoxon signed-rank test.ResultsThe moco-ss-LGE images had better IQ scores than the bh-ss-LGE images (4.55 ± 0.55 vs. 3.68 ± 0.45, p < 0.001). The CNR of the scar to the remote myocardium (34.46 ± 11.85 vs. 26.13 ± 10.04, p < 0.001), scar to left ventricle (LV) cavity (13.09 ± 7.95 vs. 9.84 ± 6.65, p = 0.030), and LV cavity to remote myocardium (33.12 ± 15.53 vs. 22.69 ± 11.27, p < 0.001) were consistently greater for moco-ss-LGE images than for bh-ss-LGE images. Measurements of scar size did not differ significantly between LGE pairs using the following three different quantification methods: 1) full width at half-maximum method; 23.84 ± 12.88% vs. 24.05 ± 12.81% (p = 0.820), 2) 6-standard deviation method, 15.14 ± 10.78% vs. 15.99 ± 10.99% (p = 0.186), and 3) 3-standard deviation method; 36.51 ± 17.60% vs. 37.50 ± 17.90% (p = 0.785).ConclusionMotion-corrected averaging may allow for superior IQ and CNRs with free-breathing in single-shot LGE imaging, with a herald of free-breathing moco-ss-LGE as the scar imaging technique of choice for clinical practice.     

Feasibility of Sorafenib Combined with Local Radiotherapy in Advanced Hepatocellular Carcinoma

Purpose

Sorafenib is an effective systemic agent for advanced hepatocellular carcinoma. To increase its efficacy, we evaluated the feasibility and benefit of sorafenib combined with radiotherapy.

Materials and Methods

From July 2007 to July 2011, 31 patients were treated with a daily dose of 800 mg of sorafenib and radiotherapy. Among them, 13 patients who received radiotherapy on the bone metastasis were excluded. Thirteen patients received 30-54 Gy of radiotherapy on the primary tumor (primary group) and 5 patients received 30-58.4 Gy on the measurable metastatic lesions (measurable metastasis group). Tumor responses at 1 month after the completion of radiotherapy and overall survival were evaluated.

Results

The in-field response rate was 100% in the primary group and 60% in the measurable metastasis group. A decrease of more than 80% in the tumor marker α-fetoprotein was observed in 7 patients in the primary group (54%). Toxicities of grades 3-4 were hand-foot syndrome in 3 (17%) patients, duodenal bleeding in 1 (6%) patient, thrombocytopenia in 3 (17%) patients and elevation of aspartate transaminase in 1 (6%) patient. The median overall survival was 7.8 months (95% confidence interval, 3.0-12.6).

Conclusion

The combined treatment of sorafenib and radiotherapy was feasible and induced substantial tumor responses in the target lesions. The results of this study emphasize the importance of individualized approach in the management of advanced hepatocellular carcinoma and encourage the initiation of a controlled clinical trial.