Circulating calcium levels and the risk of type 2 diabetes: a systematic review and meta-analysis.

Abnormal Ca homeostasis has been associated with impaired glucose metabolism. However, the epidemiological evidence is controversial. We aimed to assess the association between circulating Ca levels and the risk of type 2 diabetes mellitus (T2DM) or abnormal glucose homeostasis through conducting a systematic review and meta-analysis. Eligible studies were identified by searching electronic database (PubMed, Embase and Google Scholar) and related references with de novo results from primary studies up to December 2018. A random-effects meta-analysis was performed to estimate the weighted relative risks (RR) and 95 % CI for the associations. The search yielded twenty eligible publications with eight cohort studies identified for the meta-analysis, which included a total of 89 165 participants. Comparing the highest with the lowest category of albumin-adjusted serum Ca, the pooled RR was 1·14 (95 % CI 1·05, 1·24) for T2DM (n 51 489). Similarly, serum total Ca was associated with incident T2DM (RR 1·25; 95 % CI 1·10, 1·42) (n 64 502). Additionally, the adjusted RR for 1 mg/dl increments in albumin-adjusted serum Ca or serum total Ca levels was 1·16 (95 % CI 1·07, 1·27) and 1·19 (95 % CI 1·11, 1·28), respectively. The observed associations remained with the inclusion of a cohort study with ionised Ca as the exposure. However, data pooled from neither case-control (n 4) nor cross-sectional (n 8) studies manifested a significant correlation between circulating Ca and glucose homeostasis. In conclusion, accumulated data from the cohort studies suggest that higher circulating Ca levels are associated with an augmented risk of T2DM.

Increment of serum bilirubin as an independent marker predicting new-onset type 2 diabetes mellitus in a Korean population.

BACKGROUND AND AIMS: Several cross-sectional studies reported that serum bilirubin concentrations had an inverse association with type 2 diabetes mellitus (T2DM) prevalence. The aim of the current study was to investigate the relationship between percentage change in bilirubin levels (PCB) and incident risk of T2DM using a longitudinal model. METHODS AND RESULTS: 22,084 participants who received regular health check-ups between 2006 and 2012 were enrolled. Multivariable-adjusted Cox regression models were used to determine the hazard ratio (HR) of incident T2DM based on PCB. PCB was determined by subtracting baseline serum bilirubin level (BB) from the bilirubin level at the end of follow-up or a year before the last date of diagnosis, dividing by BB and multiplying by 100. Compared to non-diabetics, BB was lower in the diabetic group at the initial visit. There were 20,098 participants without T2DM at the initial visit; 1253 new cases occurred during follow-up. As PCB increased, T2DM incidence also increased (P < 0.001). After adjusting for confounders, the HR of incident T2DM in the highest PCB quartile was 2.08 (95% confidence interval [CI] 1.76-2.46). This trend remained significant when PCB was analyzed as a continuous variable (HR for 1-SD increment, 1.25; 95% CI 1.19-1.31). Additional analysis comparing the rate of PCB during the follow-up period revealed that the serum bilirubin level of the Incident T2DM group increased before T2DM development and decreased rapidly thereafter compared to others (P < 0.001). CONCLUSIONS: Bilirubin level increment over time is associated with T2DM development.

Strong correlation between glycaemic variability and total glucose exposure in type 2 diabetes is limited to subjects with satisfactory glycaemic control.

AIMS: This study investigated the relationship between markers of overall glucose exposure, postprandial glucose excursions and glycaemic variability in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 63 patients with T2DM (mean age 56 years) were enrolled. All wore a continuous glucose monitoring system (CGMS) device for 72 h to collect data on markers of overall glucose exposure, postprandial glucose excursions and glycaemic variability parameters. RESULTS: Spearman's correlation analysis revealed significant correlations between all markers of overall glucose exposure and various parameters related to glucose excursions. The percent coefficient of variation (CV) showed the strongest correlation with glycated albumin (r=0.470, P<0.01). In participants with HbA1c levels < 7.5% (n=33), almost all glycaemic markers and glycaemic variability parameters were significantly correlated with each other. Also, all postprandial glucose excursion parameters showed significant correlation with other glycaemic markers, and all markers of overall glucose exposure were significantly related to mean glucose, postprandial glucose excursions and glycaemic variability parameters (except CV). In contrast, in participants with HbA1c levels ≥ 7.5% (n=30), no parameters of postprandial glucose excursions and glycaemic variability were related to any markers of chronic glycaemia. CONCLUSION: Postprandial glucose excursions may explain glycaemic variability and total glucose exposures in well-controlled T2DM patients.

Co-transplantation of bone marrow-derived endothelial progenitor cells improves revascularization and organization in islet grafts.

Bone marrow-derived early endothelial progenitor cells (BM-EPCs) are a clinical tool for enhancing revascularization. However, the therapeutic efficacy of co-transplantation of BM-EPC with islets has not been investigated. In this study, marginal mass islets were co-transplanted with or without BM-EPCs under the kidney capsules of syngeneic streptozotocin-induced diabetic mice. Using green fluorescent protein transgenic (GFP-Tg) mice as BM-EPC and islet donors or recipients, the role of EPCs in revascularization was assessed for graft morphology, vascular density and fate of EPCs by immunohistochemistry. Islet-EPC co-transplantation improved the outcome of islet transplantation as measured by glucose tolerance, serum insulin level and diabetes reversal rate, compared with transplantation of islets alone. Between groups, the morphology of islet grafts showed significant differences in size and composition of grafted endocrine tissues. Significantly more vessel density derived from donors and recipients was detected with islet-EPC co-transplantation. Abundant GFP-Tg mice-derived BM-EPCs (GFP-EPCs) were observed in or around islet grafts and incorporated into CD31-positive capillaries. Remaining GFP-EPCs expressed VEGF. In conclusion, co-transplantation of islets with BM-EPCs could improve the outcome of marginal mass islet transplantation by promoting revascularization and preserving islet morphology.

The role of serum adipocyte fatty acid-binding protein on the development of metabolic syndrome is independent of pro-inflammatory cytokines.

BACKGROUND AND AIM: Adipocyte fatty acid-binding protein (FABP4) is abundantly expressed in adipocytes and plays a role in glucose homeostasis. We analysed the relationship between serum FABP4 levels and the progression of metabolic syndrome in healthy adults. METHODS AND RESULTS: A total of 465 subjects were selected from participants in a medical check-up programme at a Health Promotion Center. Baseline serum FABP4 levels were measured, and the subjects were evaluated for the presence of metabolic syndrome (MetS) according to the recommendations of the American Heart Association/National Heart, Lung, and Blood Institute. The subjects were re-evaluated 4 years later. Baseline FABP4 concentrations were significantly higher in subjects with MetS than in those without MetS (P<0.001). At the 4-year follow-up, subjects in the highest FABP4 tertile at baseline exhibited higher values for body mass index, fat mass and percent body fat, as well as blood pressure, fasting glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, insulin, homeostasis model assessment of insulin resistance, monocyte chemoattractant protein-1 and tumor necrosis factor-α levels (all P<0.05). The subjects with higher FABP4 levels had lower HDL-cholesterol concentrations (P<0.05). After adjustment for age, sex, change in percent body fat and baseline values for other metabolic and inflammatory parameters, FABP4 levels at baseline were shown to be strongly associated with the development of MetS by year 4 (odds ratio (OR), 5.75; 95% confidence interval (CI), 2.71-12.23 for highest tertile vs. lowest tertile, P<0.001) CONCLUSION: Baseline serum FABP4 levels appear to be a significant predictor for the future development of MetS, independent of pro-inflammatory cytokines.

The alteration of corticotropin-releasing factor (CRF) receptor immunoreactivity in the gerbil hippocampus and neocortex following ischemic insults.

Recently, we suggested that the ectopic expression of corticotropin-releasing factor (CRF) is associated with processes linked to neuronal injury and/or degeneration in response to an ischemic insult. However, little experimental data currently links the CRF receptor directly to neuronal death induced by ischemia. Therefore, in the present study, we investigated the temporal and spatial changes in CRF receptor immunoreactivity in the hippocampus and the neocortex after transient ischemia. CRF receptor immunoreactivity in the hippocampus was reduced up to 24h after ischemia insult, as compared to the sham. Interestingly, CRF receptor immunoreactivity disappeared in the CA1 region of the hippocampus at 4 days in the post-ischemic group. The other regions of hippocampus maintained their immunoreactivities at this time point. On the other hand, in the neocortex, 3h after transient ischemia, the CRF receptor immunoreactivity was elevated in regions vulnerable to ischemia. At 12h post-ischemia, its immunoreactivity had decreased versus the sham operated animals. These results suggest that the selectively ectopic expression of CRF following ischemia, which we reported previously, may regulate inflammatory responses. In addition, these findings also suggest that the mechanisms of neuronal death as mediated by CRF receptor differ in the hippocampus and the neocortex.

Analysis of particle laden flow and heat transfer in cascade and rocket nozzle.

This paper presents results for the calculation of particle trajectories in a cascade and a rocket nozzle using a Lagrangian method. When the floating particles collide to the components, the component surface is damaged severely. The surface erosion rate is strongly dependent on a particle size, a particle impact angle and a surface material. For a compressor cascade, the particle impact rate increases proportionally with the flow inlet angle and the erosion rate on the pressure side surface of blade are related to the surface or coating materials. For a solid rocket nozzle, the particle free zone in the nozzle divergent section increases quickly with increasing particle size and the maximum heat transfer density occurs at the starting region of nozzle convergent section. The Al2O3 droplet breaks up around the nozzle throat due to the high velocity difference between the droplet and gas stream, resulting in the big change of particle free zone.

Cerebral sparganosis with intracerebral hemorrhage: a case report.

We describe the clinical case and radiologic findings in a woman with cerebral sparganosis in which intracerebral hemorrhage was the presenting feature with hemiparesis and dysarthria. CT demonstrated high-density lesions in the right frontoparietal area, suggesting a hematoma. With conservative management, hemiparesis improved and follow-up CT revealed what looked like a resolving hematoma. Two weeks later, she complained once again of aggravated left hemiparesis and facial weakness. Diagnosis of sparganosis was made on the basis of brain MRI and ELISA. Stereotactic surgery was performed, and a live larva of sparganum was successfully removed.