ABSTRACT
Previous studies have shown that chronic hyperglycemia exacerbates skeletal muscle insulin resistance and worsens β-cell function. However, the effect of sustained physiologic hyperglycemia on hepatic insulin sensitivity stays unclear. This paper is the Chinese translation of " Mild physiologic hyperglycemia induces hepatic insulin resistance in healthy normal glucose-tolerant participants" ,published on " Journal of Clinical Endocr inology&Metabolism" [Tripathy D, Merovci A, Basu R, et al. J Clin Endocrinol Metab, 2019,104( 7):2842-2850] after obtaining the copyright of the original journal. This study examined the effect of sustained physiologic hyperglycemia on endogenous glucose production ( EGP ) in 16 healthy individuals with three-step hyperinsulinemic euglycemic clamp. The results showed that sustained physiologic hyperglycemia for only 48 hours increased the rate of basal hepatic glucose production and induced hepatic insulin resistance in healthy persons with normal glucose tolerance, indicating the role of glucotoxicity in the increase of hepatic glucose production in type 2 diabetes.
ABSTRACT
BACKGROUND/AIMS: Gastroesophageal variceal hemorrhage is a common complication of portal hypertension. Endoscopic therapy is currently recommended for preventing gastroesophageal variceal rebleed. However, the rate of variceal rebleed and its associated mortality remain concerning. This study is aimed at differentiating patient response to endoscopic therapy based on endoscopic ultrasound (EUS) findings. METHODS: One-hundred seventy patients previously treated with repeat endoscopic therapy for secondary prophylaxis were enrolled and classified into two groups based on treatment response. Prior to consolidation therapy, all patients received an EUS examination to observe for extraluminal phenomena. All available follow-up endoscopic examination records were retrieved to validate study results. RESULTS: Of the 170 subjects, 106 were poor responders, while 64 were good responders. The presence of para-gastric, gastric perforating, and esophageal perforating veins was associated with poor patient response (p < 0.001). The odds ratio for para-gastric veins was 5.374. Follow-up endoscopic findings for poor responders with incomplete variceal obliteration was closely correlated with the presence of para-gastric veins (p=0.002). CONCLUSIONS: The presence of para-gastric veins is a characteristic of poor response to endoscopic therapy for treating gastroesophageal varices. Early identification of this subgroup necessitates a change in course of treatment to improve overall patient outcome.
Subject(s)
Humans , Cyanoacrylates , Endosonography , Esophageal and Gastric Varices , Follow-Up Studies , Hemorrhage , Hypertension, Portal , Mortality , Odds Ratio , Risk Assessment , Ultrasonography , Varicose Veins , VeinsABSTRACT
Objective To evaluate effects of extremely high hepatic venous pressure gradient (HVPG) on the prognosis of endoscopic therapy in secondary prophylaxis for patients with gastroesophageal varices.Methods This was a single center prospective cohort study.From April 1st,2013 to May 31st,2015,patients with gastroesophageal varices and treated for secondary prophylaxis were enrolled and divided into extremely high HVPG group (HVPG≥20 mmHg,1 mmHg=0.133 kPa) and non-extremely high HVPG group (HVPG＜ 20 mmHg).After combination of endoscopic ligation and tissue glue treatment,one-year,two-year and threeyear rebleeding rates and survival statuses were compared.Cox regression was performed for further analysis of prognosis factors related with rebleeding and survive.Results Eventually,126 patients were enrolled and divided into extremely high HVPG group (32 cases) and non-extremely high HVPG group (94 cases).The one-year rebleeding rates of extremely high HVPG group and non-extremely high HVPG group were 37.9 ℃ (11/29) and 27.6 ％ (24/87),respectively,and the difference was not statistically significant (x2 =1.105,P =0.293).The two-year rebleeding rate of extremely high HVPG group was significantly higher than non-extremely high HVPG group 51.7％ (15/29) vs 29.9％ (26/87),and the difference was statistically significant (x2 =4.539,P=0.033).And so was the three-year rebleeding rate,51.7％ (15/29) vs 29.9％ (24/87),and the difference was statistically significant (x2 =4.539,P=0.033).The one-year,two-year and three-year survival rates of extremely high HVPG group and non-extremely high HVPG group were 92.6％ (25/27) vs 94.0％ (78/83),85.2％ (23/ 27) vs 94.0 ％ (78/83),and 85.2％ (23/27) vs 94.0％ (78/83),and the differences between two groups were not statistically significant (all P＞0.05).Single factor analysis showed that portal vein thrombosis was associated with rebleeding (hazard ratio (HR)=1.883,95％ confidence interval (CI) 1.015 to 3.492,P=0.045).No prognosis factors associated with survival were found.Conclusions Medium and long term rebleeding rate of the extremely high HVPG group is higher than that of the non-extremely high HVPG group.Extremely high HVPG does not affect the one-year prognosis of endoscopic therapy in secondary prophylaxis for patients with gastroesophageal varices.