Endothelin-1-mediated miR-let-7g-5p triggers interlukin-6 and TNF-α to cause myopathy and chronic adipose inflammation in elderly patients with diabetes mellitus.

BACKGROUND: Diabetes and sarcopenia are verified as mutual relationships, which seriously affect the quality of life of the elderly. Endothelin-1 is well investigated, is elevated in patients with diabetes, and is related to muscle cellular senescence and fibrosis. However, the mechanism of ET-1 between diabetes and myopathy is still unclear. The aim of this study was to evaluate the prevalence of sarcopenia in the elderly with diabetes and to clarify its relationship with ET-1 molecular biological mechanism, progress as well as changes in muscle and fat. METHODS: We recruited 157 type 2 diabetes patients over 55 years old and investigated the prevalence of sarcopenia in diabetes patients and examined the association of ET-1 alterations with HbA1c, creatinine, or AMS/ht2. Next, sought to determine how ET-1 regulates inflammation in muscle cells by western blot and qPCR assay. Using XF Seahorse Technology, we directly quantified mitochondrial bioenergetics in 3T3-L1 cells. RESULTS: ET-1 was positively correlated with HbA1c, creatinine levels, and duration of disease, and negatively correlated with AMS/ht2. We found that ET-1 dose-dependently induces tumor necrosis factor-α (TNF-α) and interleukin (IL)-6ß expression through the PI3K/AKT, and NF-κB signaling pathways in C2C12 cells. Also identified that TNF-α, IL-6ß, and visfatin releases were found in co-cultured with conditioned medium of ET-1/C2C12 in 3T3-L1 cells. ET-1 also reduces the energy metabolism of fat and induces micro-environment inflammation which causes myopathy. ET-1 also suppresses miR-let-7g-5p expression in myocytes and adipocytes. CONCLUSION: We describe a new mechanism of ET-1 triggering chronic inflammation in patients with hyperglycemia.

Comorbidities of epilepsy in low and middle-income countries: systematic review and meta-analysis.

Epilepsy is a major public health concern in low and middle-income countries (LMICs) and comorbidities aggravate the burden associated with the disease. The epidemiology of these comorbidities has not been well described, although, identifying the main comorbidities of epilepsy, and their relative importance, is crucial for improving the quality of care. Comorbidities were defined as disorders coexisting with or preceding epilepsy, or else compounded or directly attributed to epilepsy or to its treatment. A meta-analysis of the proportion of main comorbidities by subcontinent as well as overall was also conducted. Out of the 2,300 papers identified, 109 from 39 countries were included in this systematic review. Four groups of comorbidities were identified: parasitic and infectious diseases (44% of comorbid conditions), somatic comorbidities (37%), psychosocial (11%), as well as psychiatric comorbidities (8%). Heterogeneity was statistically significant for most variables then random effect models were used. The most frequently studied comorbidities were: neurocysticercosis (comorbid proportion: 23%, 95% CI: 18-29), head trauma (comorbid proportion: 9%, 95% CI: 5-15) malnutrition (comorbid proportion: 16%, 95% CI: 28-40), stroke (comorbid proportion: 1.3%, 95% CI: 0.2-7.0), and discrimination for education (comorbid proportion: 34%, 95% CI: 28-40). Many comorbidities of epilepsy were identified in LMICs, most of them being infectious.

Comparison of various formulae for estimating low-density lipoprotein cholesterol by a combination of ages and genders in Taiwanese adults.

BACKGROUND: The accuracy and precision of the Friedewald formula for estimating low-density lipoprotein cholesterol (LDL-C) is questionable. Although other formulae have been developed, only a few studies compare them. Thus, we compared the efficiencies of various formulae, based on the age and gender of adults, to determine which ones yield more accurate estimations in terms of mean squared error, and which formulae underestimated and overestimated LDL-C performance. METHODS: This study compares various formulae in terms of mean squared error (MSE), as well as underestimation and overestimation of LDL-C concentrations, using subjects of various ages and both genders. Six groups were examined in this study based on age and gender: males 20-44 years old, 45-64, and 65 and above, and females in the same three age ranges. RESULTS: The results show that the Friedewald formula has relatively low accuracy, and while its performance among older (aged 45 and above) women with triglyceride concentrations ≤ 400 mg/dL is better than that with other groups, it is still more inaccurate than the other formulae. In terms of prediction errors and mean squared errors, Tsai's formula (TF) and a calibrated TF provide the most accurate results with regard to the LDL-C concentration. Moreover, based on a cross-validation of age and gender, these two formulae provide highly accurate results for the LDL-C concentrations of all the studied groups, except for women aged 20-44 years. CONCLUSIONS: Based on the experimental results, this study provides a set of benchmarks for the formulae used in LDL-C tests when considering the factors of age and gender. Therefore, it is a valuable method for providing formula benchmarking.

Wild bitter gourd improves metabolic syndrome: a preliminary dietary supplementation trial.

BACKGROUND: Bitter gourd (Momordica charantia L.) is a common tropical vegetable that has been used in traditional or folk medicine to treat diabetes. Wild bitter gourd (WBG) ameliorated metabolic syndrome (MetS) in animal models. We aimed to preliminarily evaluate the effect of WBG supplementation on MetS in Taiwanese adults. METHODS: A preliminary open-label uncontrolled supplementation trial was conducted in eligible fulfilled the diagnosis of MetS from May 2008 to April 2009. A total of 42 eligible (21 men and 21 women) with a mean age of 45.7 ± 11.4 years (23 to 63 years) were supplemented with 4.8 gram lyophilized WBG powder in capsules daily for three months and were checked for MetS at enrollment and follow-up monthly. After supplementation was ceased, the participants were continually checked for MetS monthly over an additional three-month period. MetS incidence rate were analyzed using repeated-measures generalized linear mixed models according to the intention-to-treat principle. RESULTS: After adjusting for sex and age, the MetS incidence rate (standard error, p value) decreased by 7.1% (3.7%, 0.920), 9.5% (4.3%, 0.451), 19.0% (5.7%, 0.021), 16.7% (5.4%, 0.047), 11.9% (4.7%, 0.229) and 11.9% (4.7%, 0.229) at visit 2, 3, 4, 5, 6, and 7 compared to that at baseline (visit 1), respectively. The decrease in incidence rate was highest at the end of the three-month supplementation period and it was significantly different from that at baseline (p = 0.021). The difference remained significant at end of the 4th month (one month after the cessation of supplementation) (p = 0.047) but the effect diminished at the 5th and 6th months after baseline. The waist circumference also significantly decreased after the supplementation (p < 0.05). The WBG supplementation was generally well-tolerated. CONCLUSION: This is the first report to show that WBG improved MetS in human which provides a firm base for further randomized controlled trials to evaluate the efficacy of WBG supplementation.

Factor analysis of modifiable cardiovascular risk factors and prevalence of metabolic syndrome in adult Taiwanese.

To assess the clustering of modifiable cardiovascular risk factors among Taiwanese adults, we evaluated 579 healthy participants who underwent health examinations between May and December 2007. Exploratory factor analysis was used to examine risk factor clustering. Smoking, alcohol intake, exercise habits, body mass index, waist circumference, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, fasting glucose, uric acid, serum hepatic enzymes, and mean arterial pressure were assessed. Separate factor analyses assessed total and low-density lipoprotein cholesterol. Principal components analysis identified five factors for a model without low-density lipoprotein cholesterol and four factors for a model without total cholesterol. Four common factors in both models explained between 51.1 and 51.8% of variance in the original 14 factors. Metabolic factors, hematological factors (white blood cells and platelets), lifestyle factors (smoking and alcohol consumption), and exercise habits and fasting blood glucose explained about 20, 11, 10, 10% of total variance, respectively. In the model without low-density lipoprotein cholesterol, total cholesterol factor explained 8.83% of variance. This study confirmed clustering of established metabolic syndrome components and revealed additional associated cardiovascular disease risk factors, including lifestyle factors, exercise and total cholesterol, which should be targeted in prevention efforts.

Factor analysis of the clustering of common somatic symptoms: a preliminary study.

BACKGROUND: Studies of outpatient department patients indicate that somatic discomforts such as headache, neck pain, chest pain, low back pain, and gastrointestinal discomfort are commonly found in patients with multiple complaints. Clustering of some symptoms has been found in common somatic symptom analyses. Because of the complexity involved in the diagnosis of patients with multiple complaints, the aim of this study is to identify and classify patterns of somatic symptoms in individuals assessed during a health examination. METHODS: A total of 683 patients (437 males, 246 females) received a one-day physical examination and completed a structured survey during the period from May 2007 to April 2008. A physical symptoms interview was conducted, and medical and demographic data was collected. RESULTS: Based on the factor analysis, 4 clusters of symptoms were identified: 1) pain symptoms, 2) cold symptoms, 3) cardiopulmonary symptoms, and 4) gastrointestinal symptoms. The distribution of symptoms differed between males and females. After varimax rotation of factor patterns, 4 extracted factors emerged. In males, the factors were 1) pain symptoms, 2) cold symptoms, 3) cardiopulmonary symptoms, and 4) gastrointestinal symptoms. In females, the factors were 1) pain symptoms, 2) cold symptoms, 3) cardiopulmonary symptoms, and 4) head and gastrointestinal symptoms. CONCLUSIONS: Four clusters of somatic symptoms emerged for both males and females; however, the predominant symptoms were different in males and females. Females displayed more head-related symptoms than males. Patients should be thoroughly interviewed about additional symptoms within the same cluster after the recognition of a single somatic complaint.

Metabolic syndrome in non-obese Taiwanese: new definition of metabolically obese, normal-weight individual.

BACKGROUND: Not only the obese, but also the non-obese adults have the high prevalence of metabolic syndrome in the upper normal weight. The aim of this study was to assess the prevalence rates of metabolic syndrome and its individual components in non-obese adult Taiwanese (body mass index (BMI)

Metabolic syndrome as a risk factor for nonalcoholic fatty liver disease.

BACKGROUND: Metabolic syndrome has been linked to nonalcoholic fatty liver disease (NAFLD). OBJECTIVES: The purpose of the current study was to evaluate metabolic syndrome as a risk factor for NAFLD in Taiwanese adults. METHODS: A cross-sectional study was conducted in which 876 subjects were enrolled. The diagnosis of NAFLD was made by abdominal ultrasonography. The Asia-Pacific modification of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines was used to establish the diagnosis of metabolic syndrome. RESULTS: NAFLD was diagnosed in 373 (42.6%) of the study population. Metabolic syndrome was diagnosed in 202 (23.1%) of the study population, and it was independently associated with NAFLD (odds ratio [OR] = 2.37; P < 0.001). Among the components of metabolic syndrome, hypertriglyceridemia (OR = 2.24; P < 0.001), hyperglycemia (OR = 2.23; P = 0.001), increased waist circumference (OR = 1.76; P = 0.013), and the diagnostic components of metabolic syndrome were independently associated with NAFLD. CONCLUSION: Metabolic syndrome and some of its diagnostic components are independent risk factors for NAFLD.