Gender difference in the impact of coexisting diabetes mellitus on long-term clinical outcome in people with heart failure: a report from the Korean Heart Failure Registry.

AIM: Few data are available on the gender-related differences in the prognostic impact of diabetes in people with heart failure. This study was performed to investigate whether there is a gender difference in the association between diabetes and long-term clinical outcomes in people hospitalized for heart failure. METHODS: A total of 3162 people hospitalized with heart failure (aged 67.4 ± 14.1 years, 50.4% females) from the data set of the nationwide registry were analysed. The primary endpoint was a composite of all-cause mortality and heart failure readmission. RESULTS: People with diabetes (30.5% for males vs. 31.1% for females, P = 0.740) were older and had more unfavourable risk factors and laboratory findings than those without diabetes in both genders. During a median follow-up period of 549 days, there were 1418 cases of composite events (44.8%). In univariable analysis, the coexistence of diabetes was significantly associated with a higher incidence of composite events in both genders (P < 0.05 each for males and females). In multivariable analysis, the prognostic impact of diabetes on the development of composite events remained significant in females even after controlling for potential confounders (hazard ratio 1.43, 95% confidence intervals 1.12-1.84; P = 0.004). However, an independent association between diabetes and composite events was not seen in males in the same multivariable analysis (P > 0.05). CONCLUSIONS: In people with heart failure, the impact of diabetes on long-term mortality and heart failure readmission seems to be stronger in females than in males. More careful and intensive management is needed especially in females with heart failure and diabetes.

Sequential subtrochanteric femoral fracture after atypical diaphyseal fracture in a long-term bisphosphonate user: a case report.

Recent reports have found a relationship between long-term bisphosphonate therapy and the occurrence of low-energy subtrochanteric or diaphyseal atypical femoral fractures. These fractures usually occur at only one site in the same bone. We report a rare case of a patient with sequential atypical femoral fractures (first, a diaphyseal fracture, and second, an ipsilateral subtrochanteric fracture) after low-energy trauma. We present the clinical and operative findings and discuss how to prevent subsequent atypical femoral fractures. This case indicates that an atypical subtrochanteric femoral fracture can occur after an atypical diaphyseal fracture in a long-term bisphosphonate user. Doctors should be aware of the possibility of a second fracture and explain the risk to the patient. Key words: bisphosphonate, atypical femoral fracture, low-energy trauma, subtrochanteric and diaphyseal femoral fractures.

Simultaneous pancreas-kidney transplantation from living donor using hand-assisted laparoscopic donor surgery: single-center experience.

BACKGROUND: Simultaneous pancreas-kidney (SPK) transplantation has been the fundamental treatment and has shown significant results in selected patients diagnosed with type 1 diabetes with renal insufficiency. Most pancreas transplantations are dependent on deceased donors, yet the waiting time for SPK transplantation from deceased donors is significantly long in Asian countries. METHODS: In 3 cases, living-donor SPK transplantation was performed with the use of hand-assisted laparoscopic donor surgery (HALS). Three cases of patients who underwent SPK transplantation from living donors (LDSPK) with the use of HALS at Korea University Anam Hospital from 2012 to 2013 were retrospectively reviewed regarding patient characteristics and clinical outcomes of donors and recipients. For the donors, the pancreas and renal function had been well preserved postoperatively. RESULTS: One donor had a pancreatic fistula, which was controlled with conservative management. Of the 3 cases of recipient operation, 1 case was performed by ABO incompatibility donor. The levels of creatinine, serum insulin, and C-peptide of recipients were normalized and remained stable at the last follow-up. CONCLUSIONS: LDSPK can be an efficient alternative in cases in which the deceased donor is not present at the proper time, depending on the degree of completion in the operator's skill.

Rationale for Using Social Media to Collect Patient-Reported Outcomes in Patients with Celiac Disease.

Patients with celiac disease (CD) are increasingly interconnected through social media, exchanging patient experiences and health-tracking information between individuals through various web-based platforms. Social media represents potentially unique communication interface between gastroenterologists and active social media users - especially young adults and adolescents with celiac disease-regarding adherence to the strict gluten-free diet, gastrointestinal symptoms, and meaningful discussion about disease management. Yet, various social media platforms may be underutilized for research purposes to collect patient-reported outcomes data. In this commentary, we summarize the scientific rationale and potential for future growth of social media in patient-reported outcomes research, focusing on college freshmen with celiac disease as a case study and provide overview of the methodological approach. Finally, we discuss how social media may impact patient care in the future through increasing mobile technology use.

Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting.

Background. Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD). Aim. To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US). Methods. We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn's disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures. Results. Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N = 238), $7,827 (N = 95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N = 276, 372, p < 0.05). Publicly insured patients incurred the highest costs ($18,067) over privately insured ($8,014, p < 0.05) or uninsured patients ($5,129, p < 0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p < 0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI [1.08-4.19]) or no insurance (OR 4.94, CI [1.26-19.47]), with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI [0.15-0.95]) and office-based care (OR 0.21, CI [0.07-0.62]). Conclusions. In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.

Experiences on conversion to once-daily Advagraf and sirolimus combination in stable kidney recipients.

In transplant recipients, nephrotoxicity due to long-term use of calcineurin inhibitor (CNI) is a serious problem that cannot be overlooked. Medication compliance can cause graft failure in transplant recipients who are bound to long-term medication. In this study, 36 patients who underwent conversion to once-daily Advagraft and sirolimus combination at Korea University Anam Hospital from September 2011 to March 2013 were retrospectively reviewed at 3 and 6 months for laboratory findings, mean arterial pressure (MAP), and so on. After conversion, serum creatinine level and glomerular filtration rate (GFR) decreased significantly at 3 months (P = .024 and P < .001, respectively). Fasting serum glucose level and proteinuria increased significantly at 6 months (P = .016 and P = .030, respectively). The impact of time after conversion at 3 months was significantly related to the increase in postoperative estimated glomerular filtration rate (eGFR). Graft rejection, morbidity, and mortality did not occur within the study period. A once-daily Advagraf and sirolimus regimen can be a novel standard regimen in stable kidney recipients due to its effects in improving renal function and convenience for patients.

Aluminum in pediatric parenteral nutrition products: measured versus labeled content.

OBJECTIVE: Aluminum is a contaminant in all parenteral nutrition solutions. Manufacturers currently label these products with the maximum aluminum content at the time of expiry, but there are no published data to establish the actual measured concentration of aluminum in parenteral nutrition solution products prior to being compounded in the clinical setting. This investigation assessed quantitative aluminum content of products commonly used in the formulation of parenteral nutrition solutions. The objective of this study is to determine the best products to be used when compounding parenteral nutrition solutions (i.e., those with the least amount of aluminum contamination). METHODS: All products available in the United States from all manufacturers used in the production of parenteral nutrition solutions were identified and collected. Three lots were collected for each identified product. Samples were quantitatively analyzed by Mayo Laboratories. These measured concentrations were then compared to the manufacturers' labeled concentration. RESULTS: Large lot-to-lot and manufacturer-to-manufacturer differences were noted for all products. Measured aluminum concentrations were less than manufacturer-labeled values for all products. CONCLUSIONS: The actual aluminum concentrations of all the parenteral nutrition solutions were significantly less than the aluminum content based on manufacturers' labels. These findings indicate that 1) the manufacturers should label their products with actual aluminum content at the time of product release rather than at the time of expiry, 2) that there are manufacturers whose products provide significantly less aluminum contamination than others, and 3) pharmacists can select products with the lowest amounts of aluminum contamination and reduce the aluminum exposure in their patients.

Growth effects of botulinum toxin type A injected into masseter muscle on a developing rat mandible.

OBJECTIVES: Botulinum toxin type A (BTX-A) reduces the muscular contractions by temporarily inhibiting the release of acetylcholine at the neuromuscular junction. The purpose of this study was to investigate the effects of the BTX-A injected into the masseter muscle of a developing rat mandible. MATERIALS AND METHODS: Four-week-old male (no. 80) Sprague-Dawley rats were divided into four groups: control group, saline group, BTX-A group and baseline control group. Rats of baseline group were sacrificed at 0 day to provide baseline values of the mandibular measurements. The masseter muscle of rats in the saline and the BTX-A group were administered with saline and BTX-A solutions respectively. Experimental animals were sacrificed after 4 weeks. RESULTS: The BTX-A group demonstrated smaller mandibular dimension compared with the other groups (P < 0.05). Their condylar cartilages showed increased apoptosis at the proliferation stage of the reserve zone and masseter muscle fibers demonstrated atrophic changes. CONCLUSIONS: The result demonstrated BTX-A influence on inhibitory action of the developing mandible because of apoptosis at the proliferation stage of the reserve zone of the condylar cartilage in developing rat mandible.