Effect of colesevelam on liver fat quantified by magnetic resonance in nonalcoholic steatohepatitis: A randomized controlled trial

Bile acid sequestrants (BAS) lower plasma low density lipoprotein levels and improve glycemic control. Colestimide, a BAS, has been claimed by computed tomography to reduce liver fat. Therefore, we examined the efficacy of colesevelam, a potent BAS, to decrease liver fat in patients with biopsy-proven nonalcoholic steatohepatitis (NASH). Liver fat was measured by a novel magnetic resonance imaging (MRI) technique, the proton-density-fat-fraction (PDFF), as well as by conventional MR spectroscopy (MRS). Fifty patients with biopsy-proven NASH were randomly assigned to either colesevelam 3.75 g/day orally or placebo for 24 weeks. The primary outcome was change in liver fat as measured by MRI-PDFF in colocalized regions of interest within each of the nine liver segments. Compared with placebo, colesevelam increased liver fat by MRI-PDFF in all nine segments of the liver with a mean difference of 5.6% (P = 0.002). We cross-validated the MRI-PDFF-determined fat content with that assessed by colocalized MRS; the latter showed a mean difference of 4.9% (P = 0.014) in liver fat between the colesevelam and the placebo arms. MRI-PDFF correlated strongly with MRS-determined hepatic fat content (r(2) = 0.96, P < 0.0001). Liver biopsy assessment of steatosis, cellular injury, and lobular inflammation did not detect any effect of treatment. Conclusion: Colesevelam increases liver fat in patients with NASH as assessed by MRI as well as MRS without significant changes seen on histology. Thus, MRI and MRS may be better than histology to detect longitudinal changes in hepatic fat in NASH. Underlying mechanisms and whether the small MR-detected increase in liver fat has clinical consequences is not known. (HEPATOLOGY 2012;56:922-932).     

Incidence rate of falls and its risk factors in patients with rheumatoid arthritis compared to controls: Four years of the TOMORROW study

Objective: Patients with rheumatoid arthritis (RA) have been recognized to experience falls frequently due to functional disabilities. The aim of this study was to prospectively investigate factors influencing falls in patients with RA compared to controls.

Methods: We compared the frequency of falls in 208 RA patients and 205 age- and sex-matched volunteers for four years and analyzed risk factors for falls in RA patients using multivariate regression analysis.

Results: No significant difference in the incidence rate of falls (/person-year) between patients with RA (median [interquartile range]: 0 [0, 0.5]) and controls (0 [0, 0.5]) was evident during four years. Logistic regression analysis identified age, sex, body mass index, history of falls, and lower limb implant at baseline as significant risk factors for falls. The highest quartile of anti-CCP antibody level (>300.6?U/ml) was the strongest predictor for multiple falls (odds ratio, 2.97; 95% confidence interval, 1.12–7.91, p?=?0.029) among RA patients.

Conclusion: During four years we could not observe the higher incidence rate of falls in RA patients compared to controls in our cohort. Subjects with a higher titer of anti-CCP antibody might be at higher risk of frequent falls among RA patients.     

Head-out immersion in hot water increases serum BDNF in healthy males

Purpose: Brain-derived neurotrophic factor (BDNF) is an important neurotrophin. The present study investigated the effects of head-out water immersion (HOI) on serum BDNF concentrations.

Methods: Eight healthy men performed 20?min head-out water immersion at 42?°C (hot-HOI) and 35?°C (neutral-HOI). These experimental trials were administered in a randomised order separated by at least 7?days. Venous blood samples were withdrawn at rest, immediately after the 20-min HOI, as well as at 15 and 30?min after the end of the HOI. Serum BDNF and S100β, plasma cortisol, platelet and monocyte counts, and core body temperature (T_cb) were measured.

Results: T_cb was higher at the end of the hot-HOI and 15?min after hot-HOI (p?T_cb was recorded during neutral-HOI. BDNF level was higher (p?Conclusions: The present findings suggested that the increase in BDNF during 20-min hot-HOI was induced by hyperthermia through enhanced production, rather than by changes in permeability of the blood–brain barrier (BBB), platelet clotting mechanisms or secretion from monocytes.     

A new device for MRI-guided surgical excision: report of a case

A 37-year-old female was indicated to have a non-mass lesion in her left breast on ultrasonography (US) and visited our outpatient clinic. Mammography showed no findings of masses or microcalcification. Dynamic magnetic resonance imaging (MRI) showed a segmental enhanced lesion consisting of nodular and ring enhancement. A US-assisted vacuumed needle biopsy was performed, and the histological findings revealed sclerosing adenosis and apocrine metaplasia. After 1 year of follow-up, the MRI findings suggested both a benign lesion and ductal carcinoma in situ, and surgical excision was performed. We used a new device to evaluate the surgical margin on MRI. The non-mass lesion was excised according to the device-guided margin under local anesthesia. The histological findings revealed the features of mastopathy. Following excision, MRI showed no residual non-mass lesions, and the shape of the patient’s left breast was maintained.