Predictive models for conversion of prediabetes to diabetes.

AIM: To clarify the natural course of prediabetes and develop predictive models for conversion to diabetes. METHODS: A retrospective longitudinal study of 2105 adults with prediabetes was carried out with a mean observation period of 4.7years. Models were developed using multivariate logistic regression analysis and verified by 10-fold cross-validation. The relationship between [final BMI minus baseline BMI] (δBMI) and incident diabetes was analyzed post hoc by comparing the diabetes conversion rate for low (< -0.31kg/m2) and high δBMI (≥ -0.31kg/m2) subjects after matching the two groups for the covariates. RESULTS: Diabetes developed in 252 (2.5%/year), and positive family history, male sex, higher systolic blood pressure, plasma glucose (fasting and 1h- and 2h-values during 75g OGTT), hemoglobin A1c (HbA1c) and alanine aminotransferase were significant, independent predictors for the conversion. By using a risk score (RS) that took account of all these variables, incident diabetes was predicted with an area under the ROC curve (95% CI) of 0.80 (0.70-0.87) and a specificity of prediction of 61.8% at 80% sensitivity. On division of the participants into high- (n=248), intermediate- (n=336) and low-risk (n=1521) populations, the conversion rates were 40.1%, 18.5% and 5.9%, respectively. The conversion rate was lower in subjects with low than high δBMI (9.2% vs 14.4%, p=0.003). CONCLUSIONS: Prediabetes conversion to diabetes could be predicted with accuracy, and weight reduction during the observation was associated with lowered conversion rate.

Impact of weight gain on the evolution and regression of prediabetes: a quantitative analysis.

BACKGROUND/OBJECTIVES: The quantitative impact of weight gain on prediabetic glucose dysregulation remains unknown; only one study quantitated the impact of weight loss. We quantified the impact of weight gain on the evolution and regression of prediabetes (PDM). SUBJECTS/METHODS: In 4234 subjects without diabetes, using logistic regression analysis with a 4.8-year follow-up period, we analyzed the relationship between (1) δBMI (BMIfollow-up-basal) and the progression from normal glucose regulation (NGR) to PDM or diabetes, and (2) δBMI and the regression from PDM to NGR. RESULTS: Mean (±s.d.) δBMI was 0.17 (±1.3) kg/m2 in subjects with NGR and δBMI was positively and independently related to progression (adjusted odds ratio (ORadj) (95% CI), 1.24 (1.15-1.34), P<0.01). Mean (±s.d.) δBMI was -0.03 (±1.25) kg/m2 in those with PDM and δBMI was negatively related to the regression (ORadj, 0.72 (0.65-0.80), P<0.01). The relation of δBMI to the progression was significant in men (ORadj, 1.42 (1.28-1.59), P<0.01) but not in women (ORadj, 1.05 (0.94-1.19), P=0.36). Also, the negative impact of δBMI on the regression was significant only in men (men, ORadj, 0.65 (0.57-0.75), P<0.01; women, ORadj, 0.94 (0.77-1.14), P=0.51). CONCLUSIONS: In Japanese adults, an increase in the BMI by even 1 kg/m2 was related to 24% increase in the risk of development of PDM or diabetes in NGR subjects and was related to 28% reduction in the regression from PDM to NGR. In women, we did not note any significant impact of weight gain on the evolution or regression of PDM.

Comparison of new different assay systems for thyrotropin receptor antibodies with reference to thyroid-stimulating antibodies and thyroid stimulation-blocking antibodies in Graves' disease.

The aim of our study was to evaluate the diagnostic sensitivity of the new thyrotropin receptor antibody (TRAb) assays (Cosmic TRAb CT, ELISA and Yamasa DYNOtest TRAb). TRAb was positive in 43 of 44 (97.7%) untreated patients with Graves' disease by both TRAb CT and/or ELISA and NYNOtest TRAb. Thus the new TRAb assays were clearly more sensitive than the conventional assay (positivity: 85%). There was a strong positive correlation between the data obtained in TRAb CT and/or ELISA and those obtained in DYNOtest TRAb (r = 0.942, p < 0.0001). There was a significant correlation between the new TRAb and TSAb (r = 0.696, p < 0.0001). Although there was a significant correlation between the new TRAb and thyroid stimulation-blocking antibody (TSBAb), the correlation coefficient was low (r = 0.605, p < 0.0001). The increased sensitivity of the new TRAb assays for Graves' disease provides an advantage over conventional assay.

Blood transfusion causes deterioration in liver regeneration after partial hepatectomy in rats.

BACKGROUND: This study investigated the effects of blood transfusion on liver regeneration and function after hepatectomy in rats. METHODS: Inbred male Sprague-Dawley rats underwent a sham operation or a 70% hepatectomy (PHx) and were randomly divided into seven groups according to transfusion type: groups I and II underwent a sham operation and received saline (I) or whole blood (II). Groups III to VII underwent PHx with saline (III), whole blood (IV), irradiated/leukocyte-depleted whole blood (V), plasma (VI), or autologous blood (VII). The liver regeneration rate, proliferating cell nuclear antigen (PCNA) labeling index, serum aspartate aminotransferase, alanine aminotransferase, purine nucleoside phosphorylase (PNP) activity, hepatocyte growth factor (HGF), and activated transforming growth factor beta1 (TGF-beta(1)) were measured 6 and 24 h and 5 days after PHx. RESULTS: The liver regeneration rate and PCNA labeling index were lower in groups IV and V than in the other groups. Serum liver enzymes 6 h after PHx were worst in groups IV and V. PNP activity increased most in group IV, 6 and 24 h after PHx. The HGF values 6 h after PHx in all the transfused groups were lower than in group III. The activated TGF-beta(1) level 6 h after surgery was highest in group IV. CONCLUSION: Whole blood or irradiated/leukocyte-depleted whole blood impaired liver regeneration after PHx, probably through the production of activated TGF-beta(1) and HGF outside the liver, and plasma or autologous blood reduced the deleterious effects.

Blood transfusions impair anastomotic wound healing, reduce luminol-dependent chemiluminescence, and increase interleukin-8.

BACKGROUND/AIMS: Several studies have shown that perioperative blood transfusion increases the risk of infectious complications after surgery or trauma, however, the mechanisms behind the susceptibility to infection and impaired wound healing are not clear. This study was designed to investigate the effects of blood transfusion on anastomotic wound healing, luminol-dependent chemiluminescence, and interleukin-8. METHODOLOGY: Male Wistar rats were divided into seven groups: groups C and Tx underwent laparotomy and the other groups underwent gastrectomy and gastroduodenostomy. Groups C and G received saline; groups Tx and GT received whole blood; and groups GPT, GAT, and GRT received plasma, autologous blood, and irradiated, leukocyte-depleted whole blood, respectively. The breaking strength of the anastomosis, and plasma factor XIII, interleukin-8, and luminol-dependent chemiluminescence levels were measured. RESULTS: The plasma XIII level in group GT was significantly (P < 0.05) lower that in groups G, GPT, GAT, and GRT. The maximum breaking strength was significantly reduced in groups GT, GRT, GPT, and GAT compared to the other groups, and there was no significance between different types of transfusion. Luminol-dependent chemiluminescence levels in groups GT were severely reduced, while the and luminol-dependent chemiluminescence levels in groups GRT, GPT, and GAT were almost the same as the levels in group G. The plasma interleukin-8 levels were higher in the transfused groups, and lower in groups GRT, GPT, and GAT. CONCLUSIONS: Blood transfusions increased the incidence of anastomotic abscess and impaired anastomotic wound healing. These might be related to the reduced luminol-dependent chemiluminescence and increased interleukin-8. Autologous blood, plasma, and irradiated, leukocyte-depleted packed cells can abrogate these effects.

The role of whole-body FDG-PET in preoperative assessment of tumor staging in oral cancers.

OBJECTIVE: The aim of this study is to clarify the clinical utility of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) in determining the TNM classification in patients with oral cancer. METHODS: Twenty-five consecutive patients (14 male and 11 female; age range, 40 yr to 86 yr) with oral cancer were included in this study. The diagnostic accuracy for detecting cervical lymph nodes was investigated by comparing the results of CT and/or MRI and physical findings. For the semi-quantitative analysis, the tumor standardized uptake value (SUV) and tumor to background SUV ratio (T/B ratio) were assessed in primary tumors and cervical lymph nodes. RESULTS: All primary lesions were visualized on FDG-PET images. Even though artifacts from dental materials near the lesion hampered the delineation of primary tumors on CT/MRI, the extent of primary tumors was accurately assessed by FDG-PET. The SUV and T/B ratio in the primary tumor classified in higher T grade (T3 and T4) was significantly higher than that in lower T grade (T1 and T2) (mean +/- SD of SUV; 8.32 +/- 2.99 vs. 5.15 +/- 3.77, p < 0.01, mean +/- SD of T/B ratio; 6.96 +/- 3.23 vs. 3.61 +/- 2.76, p < 0.01). The SUV and T/B ratio of metastatic lymph nodes were also significantly higher than those of normal lymph nodes (mean +/- SD of SUV; 3.39 +/- 1.69 vs. 1.55 +/- 0.57, p < 0.001, mean +/- SD of T/B ratio; 2.46 +/- 1.08 vs. 1.03 +/- 0.22, p < 0.001). Among these three methods, FDG-PET in conjunction with CT/MRI showed the highest accuracy of 92%, but there were no significant differences in diagnostic accuracy among the three methods. For the semi-quantitative analysis, a threshold SUV of 2.0 provided 100% sensitivity, 82% specificity, and 88% accuracy. Furthermore, a threshold T/B ratio of 1.5 provided 100% sensitivity, 100% specificity, and 100% accuracy. Regarding the detection of distant metastasis, there was one positive result in FDG-PET showing distant pulmonary metastasis. CONCLUSIONS: Whole-body FDG-PET is an effective and convenient diagnostic tool for the evaluation of tumor staging in patients with oral cancer. Tumor staging by whole-body FDG-PET may, in fact, supplement the conventional staging by means of CT/MRI and physical findings.

The resection of non-hepatic intraabdominal recurrence of gastric cancer.

BACKGROUND/AIMS: Surgical resection of hepatic or pulmonary metastases from gastrointestinal cancer has been recognized as a curative modality in some patients. However, the role and outcome of the surgical management of a non-hepatic intraabdominal recurrence of gastrointestinal cancer have not been clearly delineated. METHODOLOGY: We treated 5 patients for non-hepatic intraabdominal recurrence of gastric carcinoma surgically. All the resected specimens were microscopically identified as recurrent gastric cancer. Three of 5 patients received postoperative chemotherapy. The clinicopathological findings were analyzed according to the general rules for gastric cancer study. RESULTS: The lymph nodes were dissected for lymph node metastases. Surgical resection of the tumors combined with total gastrectomy, esophagectomy, or colectomy was performed for the local and peritoneal recurrences. All of the recurrent tumors were macroscopically resected with curative states. One patient died of sepsis 54 days after surgery. Three patients died of recurrent gastric cancer: 2 within 1 year of surgery and 1 after 3 years. One patient still survives disease free 3 years and 6 months after the 2nd operation. CONCLUSIONS: Surgical resection for non-hepatic intraabdominal recurrence of gastric cancer is the treatment of choice for selected patients. Surgical resection followed by adjuvant chemotherapy may improve the outcome of these patients.

Esophageal anastomosis following gastrectomy for gastric cancer: comparison of hand-sewn and stapling technique.

BACKGROUND/AIMS: During the past 4 years, we have experienced a marked reduction in the incidence of esophageal anastomotic leakage and/or stricture coinciding with the use of a mechanical circular stapler for gastric cancer patients. METHODOLOGY: We reviewed medical records of gastric cancer patients who underwent a total or proximal gastrectomy, and compared the leakage or stricture of stapled anastomosis with the hand-sewn anastomosis technique. A total of 390 esophageal anastomosis were performed between January 1978 and August 1997. Two types of mechanical circular staplers were used (EEA and CDH). RESULTS: Anastomotic leakage occurred in 13 (3.3%) of 390 cases; three (4.5%) of 66 cases with hand-sewn anastomosis, and 10 (3.1%) of 324 cases with stapled anastomosis (EEA: 4.5%, CDH: 0%). The anastomotic leakage rate was significantly lower in the CDH stapler group than in the EEA stapler group. Anastomotic stricture occurred in one (1.5%) of 66 cases of hand-sewn anastomosis, and 16 (4.9%) of 324 cases of stapled anastomosis (EEA: 5.9%, CDH: 2.9%). There were no significant differences in the stricture rate between the hand-sewn group and the stapler group. CONCLUSIONS: Stapling anastomosis using a CDH stapler led to a reduction in the incidence of anastomotic leakage. Surgeons must, however, continue to be aware of anastomotic stricture.

Surgical treatment of spontaneous dissection of the superior mesenteric artery: a case report.

A case of a 46-year-old man with spontaneous dissection of the superior mesenteric artery (SMA) demonstrated by ultrasonography is presented. He was successfully treated by emergency aorto-SMA bypass surgery, but complicated with bilateral internal iliac aneurysm. The patient has remained asymptomatic with full employment.

Effects of transfusion on gastrointestinal anastomotic wound healing and leukocyte function in rats.

BACKGROUND: This study was done to investigate the effects of blood transfusion on gastrointestinal anastomotic wound healing and leukocyte function. METHODS: Closed-colony male Wistar rats were divided into five groups in a group-mixed fashion and underwent laparotomy (the CONT and WB groups) or gastrectomy and gastroduodenostomy (the GAST, GAST/WB and GAST/LDRWB groups). Immediately, they received 3 ml of saline (the CONT and GAST groups) or blood from Wistar donors (the WB and GAST/WB groups, whole blood; the GAST/LDRWB group, a transfusion of irradiated and leukocyte-depleted whole blood). The animals were killed 7 days after surgery. RESULTS: The GAST/WB group had a higher incidence of anastomotic abscess, a lower level of factor XIII and a lower maximum breaking strength than the GAST group. Gastrectomy decreased L-DCL (luminol-dependent chemiluminescence) more than whole-blood transfusion. In the GAST/WB group, L-DCL was severely reduced, while in the GAST/LDRWB group it was roughly equivalent to the level in the GAST group. CONCLUSIONS: Whole-blood transfusion increased the incidence of anastomotic abscess and impaired anastomotic wound healing, and these might relate to the reduction of L-DCL. Irradiated and leukocyte-depleted transfusion can improve these effects.

Arginine-supplemented diets inhibit endotoxin-induced bacterial translocation in mice.

We studied the effects of supplemental dietary arginine (ARG) on endotoxin-induced bacterial translocation. Mice were fed a 20%-casein diet (control) or a 20%-casein diet supplemented with 2% or 4% ARG and then injected with lipopolysaccharide (1 mg/500 microliters). The incidence of bacterial translocation was noted by the recovery of viable organisms from the mesenteric lymph node (MLN) and spleen. The mortality rates of the mice were 40%, 10%, and 20% in the control group and 2%- and 4%-ARG groups, respectively. Of the surviving mice, bacterial translocation occurred in 100% of the control group, in 56% (MLN) and 56% (spleen) in the 2%-ARG group, and in 36% (MLN) and 25% (spleen) in the 4%-ARG group. Quantitative colony counts and median numbers of viable bacteria were lower (p < 0.05) in the 2%-ARG group and slightly lower in the 4%-ARG group compared with the control group. MLN and spleen weights expressed as a percentage of body weight were heavier (p < 0.05) only in the 2%-ARG group. These results support the concept that bacteria may translocate from the gut to other organs and be a potential source of lethal infection after injury, and that supplementation with 2% or 4% ARG could improve outcome.

A mixture of nucleosides and nucleotides increases bone marrow cell and peripheral neutrophil number in mice infected with methicillin-resistant Staphylococcus aureus.

We studied the effects of a mixture of nucleosides and nucleotides on the peripheral neutrophil number and the proliferation of bone marrow cells in mice challenged with methicillin-resistant Staphylococcus aureus. BALB/c mice were fed a nucleotide-free 20% casein diet (control) or this diet supplemented with nucleosides and nucleotides orally (Expt. 1) or intraperitoneally (Expt. 2 and 3). On d 10, the mice were challenged intravenously with methicillin-resistant S. aureus (6.7 x 10(12) colony forming units/L). In Expt. 1 and 2, numbers of total and differential counts of blood leucocytes were counted on d 0 (before), 1, 3 and 5 after the infection. In Expt. 3, 30 min before killing, bromodeoxyuridine (20 mg/kg), an analogue of thymidine, was administered intraperitoneally and its incorporation in the DNA synthetic phase of bone marrow cells was determined at 0 h (before), 3, 6 and 24 h after the infection. Mice fed the supplemented diet had higher (P < 0.05) leucocyte and neutrophil numbers on d 0 compared with the control group. The neutrophil numbers tended to be greater in the supplemented group at 1, 3 and 5 d after the infection. Intraperitoneal administration of nucleosides and nucleotides increased (P < 0.05) neutrophil numbers before and after the infection. Twenty-four h after the infection, incorporation of bromodeoxyuridine into the DNA synthetic phase of bone marrow cells in the group administered nucleosides and nucleotides was higher (P < 0.05) than in the control group. We conclude that, following methicillin-resistant S. aureus injection, intraperitoneal administration of a nucleoside-nucleotide mixture may stimulate bone marrow cell proliferation and increase the peripheral blood neutrophil numbers. Oral administration may elicit weaker effects.

Intraperitoneal administration of nucleoside-nucleotide mixture inhibits endotoxin-induced bacterial translocation in protein-deficient mice.

Nucleosides and nucleotides as a precursor for nucleic acid synthesis may be essential for rapidly growing cells, since intestinal epithelial cells have limited capacity for the de novo purine and pyrimidine synthesis. The present study was undertaken to determine the effect of intraperitoneal administration of nucleoside-nucleotide mixture (NNM) or saline on endotoxin-induced bacterial translocation, ileal histology, and cecal population levels in protein-deficient mice. Intraperitoneal administration of NNM for 14 days was associated with reduced translocation of gram-negative enterics to the mesenteric lymph node and spleen in comparison to saline. Histologically, the extent of the damage to the gut mucosa was greater in the saline group. This was confirmed by the profound diminution of the villous height, crypt depth, and the intestinal wall in the saline treated group as compared to the NNM treated group, suggestive of the efficacy of NNM in improving the gut and epithelial mucosal cells. However, the cecal population levels in both groups were not different. Additionally, the mice in the saline group were more susceptible to the lethal effects of endotoxin as compared to the NNM group suggesting that NNM may be essential for the enhancement of the host defense system. These results suggest that NNM may be used to an advantage to inhibit or reduce the incidence of endotoxin-induced bacterial translocation and improved survival in protein-deficient mice.

Extracapsular spread of squamous cell carcinoma in neck lymph nodes: prognostic factor of laryngeal cancer.

Fifty-two patients with laryngeal cancer who underwent radical neck dissections were studied to provide further information on the prognosis of various clinical and histopathological parameters. Extracapsular spread (ECS) was found in 31% of patients with N1 nodes, and in 60% of patients with histopathologically positive nodes. The 5-year survival rate of histopathological findings was as follows: patients with no pathological evidence of neck metastasis (81%), patients with neck metastasis confined to the lymph node (no ECS) (76%), and patients with ECS (17%). The difference in survival rate between patients with no ECS and patients with ECS was statistically significant (P = .001). Staging classification, T-stage classification, the number of malignant nodes, the diameter of malignant nodes, and combined therapy had no prognostic importance. The most significant factor was the presence of extracapsular spread.

Drug-susceptibility and isolation of a plasmid in Haemophilus (Actinobacillus) pleuropneumoniae.

We isolated 56 Haemophilus (Actinobacillus) pleuropneumoniae strains from the pneumonic porcine lung tissues and tested them for antimicrobial susceptibility. Two drug-resistant strains were obtained. One, named KH-265, was resistant to streptomycin (SM) and sulfonamide (SA), and the other, named KH-195, was resistant to tetracycline (TC). The minimum inhibitory concentrations (MICs) of drugs for resistant strains were 100 micrograms/mliters for SM, 3200 micrograms/mliters for SA, and 12.5 micrograms/mliters for TC. KH-265 possessed a 8.3Kb nonconjugative plasmid, pMS260, encoding SM and SA resistance, which was transformable to E. coli strains. pMS260 belonged to none of 14 incompatibility groups including Inc. P and Inc. Q, so far tested. It was mobilizable to various causative strains for respiratory infections, Pseudomonas aeruginosa, Bordetella bronchiseptica, Pasteurella multocida and Haemophilus pleuropneumoniae, by RP4 (Inc. P) plasmid.

Laryngeal epithelial changes on effects of smoking and drinking.

The human larynx is essential not only for speech, but also for swallowing and respiration. Its tissues are affected by the presence of alcohol and cigarette smoke. In this report we present our findings on the effects of smoking and drinking on histological changes in laryngeal tissue. The larynges studied were those of autopsy patients: cases with damaged tissue were excluded. We studied the larynges of 84 men (non-smoker and non-drinker, 22 cases; smoker and drinker, 62 cases) and 48 women (non-smoker and non-drinker, 40 cases; smoker and drinker, 8 cases) between the ages of 12 and 88. The squamous metaplasia of laryngeal epithelium was examined using the gross staining method (Pyronin Y) of STELL et al. (J. Laryngeal. Otol. 86: 589-594, 1972). The squamous epithelium is unstained, whereas the respiratory epithelium is a brilliant red. The area of metaplasia in the supraglottic region increased with aging, tobacco and alcohol consumption. Microscopic changes of the laryngeal epithelium were investigated using the hematoxylin-eosin staining method. The thickness of epithelium of the supraglottic region and vocal cord increased with age. There is a significant difference in the thickness of the epithelium of the supraglottic region and vocal cords of smoking and drinking patients, when compared with the same tissues of non-smokers and non-drinkers. Furthermore, there is a significant difference in those tissues of the supraglottic region of heavy smokers, when compared with light smokers, but no significant difference when compared with drinkers. However, there is no significant difference in the thickness of vocal cord tissues when comparing light smokers and drinkers on the one hand, and heavy smokers and drinkers on the other.

[Evaluation of systolic motion of the pulmonic valve with special reference to pulmonary arterial pressure and flow velocity (author's transl)].

To predict pulmonary arterial pressure non-invasively, systolic motion of the pulmonic valve was evaluated in relation to flow velocity at the pulmonic valve measured by the electromagnetic catheter-tip flow velocity probe or by linear contrast echo. Seventy-five cases including 45 cases with pulmonary hypertension (PH) of mean pulmonary arterial pressure (PAP) above 25 mmHg were studied. On the basis of the presence and velocity of mid-systolic semi-closure, the reopening and fluttering of the PV, the systolic motion of the pulmonic valve was classified into the following 5 types: 1) rapid semi-closure followed by reopening, 2) rapid semi-closure without reopening, 3) slow semi-closure followed by slow reopening, 4) rough fluttering during whole systole, and 5) rapid opening without semi-closure. Results were as follows: (1) In all cases in which mean PAP was normal, PV motion could be classified as type 5, (2) In 45 PH cases, mean PAP was 50.2 +/- 8.3 mmHg in type 1, 38.4 +/- 5.5 mmHg type 5, mean PAP was 16.3 +/- 11.7 mmHg when 30 normal cases were added. Flow velocity at the PV orifice was maximum in type I and decreased in type 2, 3 and 4 in this order. In type 4, cardiac indices were minimum in all groups of pulmonary hypertension. In conclusion, 1) systolic pulmonic valve motion is of value to predict PAP, and 2) it was suggested that mid-systolic semi-closure of the PV is related to increase in flow velocity at the PV orifice.