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1.
Diabetes Res Clin Pract ; 161: 108050, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035116

RESUMO

AIMS: Insulin resistance (IR) changes over time during the development of type 2 diabetes. Some reports showed that obesity was associated with progression of IR. However, no study has explored if change of IR predicts incident diabetes, and no study has investigated other factors associated with the change. METHODS: In this study, 1184 subjects without diabetes at baseline were enrolled in 2006-2016 with a median follow-up period of 4.5 years. Diabetes was diagnosed by oral glucose tolerance test and hemoglobin A1c, or if anti-diabetic agents were used. HOMA2-IR and ISI0,120 were used to estimate IR. RESULTS: The annual changes of HOMA2-IR(ΔHOMA2-IR/year) and ISI0,120(ΔISI0,120/year) were associated with BMI, waist circumference(WC), glucose, HbA1c, triglyceride and HDL-cholesterol. Subjects with pre-diabetes or metabolic syndrome were associated with a more rapid increase of IR. ΔHOMA2-IR/year and ΔISI0,120/year were correlated with annual changes of BMI and WC. The hazard ratios for ΔHOMA2-IR/year and ΔISI0,120/year to predict incident diabetes were 1.39 (95% CI 1.22-1.59, p < 0.001) and 0.13 (95% CI 0.09-0.19, p < 0.001) in adjusted models, respectively. CONCLUSIONS: Change of IR can be used as a surrogate marker of incident diabetes. The progression of IR is an important pathophysiologic link between risk factors and the incidence of diabetes.

2.
Magn Reson Med ; 82(2): 763-774, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30957300

RESUMO

PURPOSE: The purpose of this study was to investigate the feasibility of in vivo imaging of human pancreatic ductal cells by OATP1B3 reporter gene under MRI. METHODS: A human cell line (PANC-1) derived from the pancreatic ductal epithelium was used in this study. After transduction of OATP1B3, the cellular physiological functions and the ability of intracellular uptake of the MRI contrast medium (Gd-EOB-DTPA) were examined. Induced differentiation of the PANC-1 cells into hormone-secreting cells were performed to simulate pancreatic ß-like cells. The hormone-secreting cells were implanted into rats and in vivo MRI was evaluated. RESULTS: The mRNA and proteins of OATP1B3 were highly expressed. No significant change of cellular physiological functions was found after the expression. After induced differentiation, the hormone secretion capacities of the OATP1B3-expressing PANC-1 cells were confirmed. Intra-cellular uptake of Gd-EOB-DTPA was determined in vitro by inductively coupled plasma mass spectrometry and MRI. In vivo MRI of the OATP1B3-expressing xenograft revealed an increased signal intensity after contrast enhancement. CONCLUSION: OATP1B3 can be used as a safe and feasible in vivo MRI gene reporter for human pancreatic ductal cells.

3.
Int J Obes (Lond) ; 43(3): 512-522, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30022055

RESUMO

BACKGROUND/OBJECTIVES: Vascular adhesion protein-1 (VAP-1) can enhance tissue glucose uptake in cell studies and normalize hyperglycemia in animal studies. However, serum VAP-1 concentration (sVAP-1) is higher in subjects with diabetes in cross-sectional studies. In this cohort study, we test our hypothesis that sVAP-1 is increased in prediabetes to counteract hyperglycemia and is associated with incident diabetes negatively. SUBJECTS/METHODS: From 2006 to 2012, 600 subjects without diabetes from Taiwan Lifestyle Study were included and followed regularly. Diabetes was diagnosed if FPG ≥ 126 mg/dL (7 mmol/L), 2-h plasma glucose (2hPG) during an oral glucose tolerance test (OGTT) ≥ 200 mg/dL (11.1 mmol/L), or hemoglobin A1c (HbA1c) ≥ 6.5%, or if the subject received anti-diabetic medications. Abdominal fat areas were measured by abdominal computed tomography and sVAP-1 was analyzed by ELISA. RESULTS: sVAP-1 was higher in subjects with prediabetes (p < 0.05) and increased during an OGTT (p < 0.001). Fasting sVAP-1 was associated with the response of sVAP-1 during an OGTT (p < 0.001). Besides, sVAP-1 was associated negatively with body mass index (BMI, r = -0.1449, p = 0.003), waist circumference (r = -0.1425, p = 0.004), abdominal visceral (r = -0.1457, p = 0.003), and subcutaneous (r = -0.1025, p = 0.035) fat areas, and serum high-sensitivity C-reactive protein (hsCRP) concentration (r = -0.2035, p < 0.0001), and positively with plasma adiponectin concentration (r = 0.2086, p < 0.0001), adjusted for age and gender. After 4.7 ± 2.6 years, 73 subjects (12.2%) developed incident diabetes. High sVAP-1 predicted a lower incidence of diabetes, adjusted for age, gender, BMI, family history of diabetes, HbA1c, HOMA2-%B and HOMA2-IR (HR = 0.66, 95% CI = 0.50-0.88, p < 0.01). CONCLUSIONS: sVAP-1 is increased in response to hyperglycemia. It is associated with obesity and serum hsCRP concentration negatively, and plasma adiponectin concentration positively. Besides, a high sVAP-1 is associated with a lower incidence of diabetes in human.

4.
Conf Proc IEEE Eng Med Biol Soc ; 2019: 1035-1038, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31946070

RESUMO

Inspired by the outstanding performance of deep convolutional neural networks (CNNs), nowadays modern computer-aided detection (CAD) systems for CT lung nodules generally delve into 2D or 3D CNNs directly without considering traditional image preprocessing techniques. However, detection of large pulmonary nodules and masses are computationally challenging, especially for 3D CNNs. In this paper, we examine the possibility of using volume visualized CT thin-slab images with 2D CNNs to reduce computation complexity and improve CAD performance. We tested 4 types of images: original 2D CT, 2D projection of thin slabs, mixture by arranging original and projection in different color channels, and mixture by the pixelwise maximum intensity of original CT and projection. We evaluated these images on a dataset of 30 CT scans with 30 different-sized nodules and masses on GoogLeNet via a transfer learning and cross validation paradigm. We found that projection visualization alone had a better or equal area-under curve score for all the different-sized nodules and masses. However, mixture by the maximum of CT and projection demonstrated a preferred performance with a true positive rate of 0.8 and a false positive rate of 0.046 in detecting large nodules and masses.

5.
Clin Neurophysiol ; 129(9): 1899-1906, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30005217

RESUMO

OBJECTIVE: This study aimed to investigate the association between mismatch negativity (MMN) and volumes of several brain regions measured using a semi-automated method in patients with schizophrenia and healthy controls. METHODS: MMN in response to duration deviants and magnetic resonance imaging were acquired from 36 schizophrenia patients and 14 healthy controls. FreeSurfer was used for volumetric analysis. MMN amplitudes, brain volumes and their association were compared between schizophrenia and controls. Correlation analysis and multiple linear regression analysis were used to examine the correlated variables of MMN. RESULTS: MMN amplitude was significantly lower in the schizophrenia group. In schizophrenia, MMN was positively correlated with age and negatively correlated with left hippocampal and right pars opercularis volumes. The association between left hippocampal volume and MMN in schizophrenia remained significant after controlling for potential confounders. CONCLUSIONS: Smaller hippocampal volume may play a role in the abnormal manifestation of MMN in schizophrenia. SIGNIFICANCE: The significant association between MMN and left hippocampal volume may suggest unique neurobiological contribution of hippocampus in auditory processing in schizophrenia.


Assuntos
Encéfalo/fisiopatologia , Potenciais Evocados/fisiologia , Esquizofrenia/fisiopatologia , Estimulação Acústica , Adulto , Encéfalo/diagnóstico por imagem , Eletroencefalografia , Potenciais Evocados Auditivos/fisiologia , Feminino , Hipocampo/diagnóstico por imagem , Hipocampo/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Esquizofrenia/diagnóstico por imagem , Adulto Jovem
6.
Sci Rep ; 8(1): 9249, 2018 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-29915377

RESUMO

Inflammation, oxidative stress, and the formation of advanced glycated end-products (AGEs) are important components of atherosclerosis. Vascular adhesion protein-1 (VAP-1) participates in inflammation. Its enzymatic activity, semicarbazide-sensitive amine oxidase (SSAO), can catalyze oxidative deamination reactions to produce hydrogen peroxide and aldehydes, leading to the subsequent generation of AGEs. This study aimed to investigate the effect of VAP-1/SSAO inhibition on atherosclerosis. In our study, immunohistochemical staining showed that atherosclerotic plaques displayed higher VAP-1 expression than normal arterial walls in apolipoprotein E-deficient mice, cholesterol-fed New Zealand White rabbits and humans. In cholesterol-fed rabbits, VAP-1 was expressed on endothelial cells and smooth muscle cells in the thickened intima of the aorta. Treatment with PXS-4728A, a selective VAP-1/SSAO inhibitor, in cholesterol-fed rabbits significantly decreased SSAO-specific hydrogen peroxide generation in the aorta and reduced atherosclerotic plaques. VAP-1/SSAO inhibition also lowered blood low-density lipoprotein cholesterol, reduced the expression of adhesion molecules and inflammatory cytokines, suppressed recruitment and activation of macrophages, and decreased migration and proliferation of SMC. In conclusion, VAP-1/SSAO inhibition reduces atherosclerosis and may act through suppression of several important mechanisms for atherosclerosis.


Assuntos
Amina Oxidase (contendo Cobre)/antagonistas & inibidores , Aterosclerose/tratamento farmacológico , Inibidores Enzimáticos/uso terapêutico , Comportamento Alimentar , Alilamina/análogos & derivados , Alilamina/farmacologia , Alilamina/uso terapêutico , Amina Oxidase (contendo Cobre)/metabolismo , Animais , Aorta/metabolismo , Apolipoproteínas E/deficiência , Aterosclerose/sangue , Aterosclerose/patologia , Benzamidas/farmacologia , Benzamidas/uso terapêutico , Peso Corporal , Moléculas de Adesão Celular/metabolismo , Colesterol , Citocinas/metabolismo , Inibidores Enzimáticos/farmacologia , Jejum/sangue , Humanos , Peróxido de Hidrogênio/metabolismo , Mediadores da Inflamação/metabolismo , Ativação de Macrófagos , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Camundongos , Miócitos de Músculo Liso/metabolismo , Placa Aterosclerótica/patologia , Antígeno Nuclear de Célula em Proliferação/metabolismo , Coelhos
7.
Med Oncol ; 34(8): 143, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28726044

RESUMO

Although current staging workups could differentiate most patients with operable from inoperable advanced gastric cancers, there are still some patients with low-volume peritoneal carcinomatosis, defined as only metastasis with multiple subcentimeter lesions in peritoneum, receiving unnecessary open-close procedures. The computed tomography (CT) of the patients with unresectable advanced gastric cancer harboring low-volume peritoneal carcinomatosis was retrospectively identified and then thoroughly reviewed by two independent radiologists unaware of the peritoneal carcinomatosis status. Of the 798 patients with newly diagnosed gastric cancer between January 2007 and December 2010, 52 patients harboring advanced gastric cancer with low-volume peritoneal carcinomatosis receiving surgery with curative intent were identified. Descriptive statistic was used for the radiologic characteristics. The most common radiologic characteristic of CT was omental fat stranding (57.7%), followed by omental clustered subcentimeter nodules (53.8%), distant enlarged lymph node (40.4%), distant grouping of small lymph nodes (36.5%), peritoneal nodules or thickening (34.6%), minimal loculated ascites (21.2%), intestinal wall thickening or irregularity (9.6%), and hydronephrosis or hydroureter without stone or urothelial lesion (5.8%). Comprehensively reviewing the radiologic characteristics of CT may identify the patients harboring advanced gastric cancer with low-volume peritoneal carcinomatosis.


Assuntos
Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
8.
Asian J Surg ; 40(1): 61-65, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23978432

RESUMO

Extracranial and meningeal seeding of glioblastoma multiforme is rare. We report herein a case of glioblastoma in a 41-year-old man who underwent surgical resection, concomitant chemoradiotherapy (CCRT) and seven courses of adjuvant chemotherapy with temozolomide. The patient then complained of intermittent severe lower back pain and gait disturbance. Imaging studies demonstrated that although the intracranial residual tumors were well-controlled by the treatment, meningeal seeding involving the brainstem and spinal cord was present. The patient died 2 months after the diagnosis of spinal seeding. This case illustrates the need for consideration of extracranial metastasis if a patient is symptomatic, even if the intracranial tumor appears responsive to treatment. We suggested that the prophylactic craniospinal irradiation may be considered in patients at high risk of meningeal seeding immediately after surgery.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/patologia , Quimiorradioterapia Adjuvante , Dacarbazina/análogos & derivados , Glioblastoma/secundário , Neoplasias Meníngeas/secundário , Inoculação de Neoplasia , Adulto , Neoplasias Encefálicas/terapia , Dacarbazina/uso terapêutico , Evolução Fatal , Glioblastoma/terapia , Humanos , Masculino , Temozolomida
9.
J Physiol ; 595(2): 505-521, 2017 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-27121603

RESUMO

KEY POINTS: Intestinal ischaemia causes epithelial death and crypt dysfunction, leading to barrier defects and gut bacteria-derived septic complications. Enteral glucose protects against ischaemic injury; however, the roles played by glucose metabolites such as pyruvate and ATP on epithelial death and crypt dysfunction remain elusive. A novel form of necrotic death that involves the assembly and phosphorylation of receptor interacting protein kinase 1/3 complex was found in ischaemic enterocytes. Pyruvate suppressed epithelial cell death in an ATP-independent manner and failed to maintain crypt function. Conversely, replenishment of ATP partly restored crypt proliferation but had no effect on epithelial necroptosis in ischaemic gut. Our data argue against the traditional view of ATP as the main cytoprotective factor by glucose metabolism, and indicate a novel anti-necroptotic role of glycolytic pyruvate under ischaemic stress. ABSTRACT: Mesenteric ischaemia/reperfusion induces epithelial death in both forms of apoptosis and necrosis, leading to villus denudation and gut barrier damage. It remains unclear whether programmed cell necrosis [i.e. receptor-interacting protein kinase (RIP)-dependent necroptosis] is involved in ischaemic injury. Previous studies have demonstrated that enteral glucose uptake by sodium-glucose transporter 1 ameliorated ischaemia/reperfusion-induced epithelial injury, partly via anti-apoptotic signalling and maintenance of crypt proliferation. Glucose metabolism is generally assumed to be cytoprotective; however, the roles played by glucose metabolites (e.g. pyruvate and ATP) on epithelial cell death and crypt dysfunction remain elusive. The present study aimed to investigate the cytoprotective effects exerted by distinct glycolytic metabolites in ischaemic gut. Wistar rats subjected to mesenteric ischaemia were enterally instilled glucose, pyruvate or liposomal ATP. The results showed that intestinal ischaemia caused RIP1-dependent epithelial necroptosis and villus destruction accompanied by a reduction in crypt proliferation. Enteral glucose uptake decreased epithelial cell death and increased crypt proliferation, and ameliorated mucosal histological damage. Instillation of cell-permeable pyruvate suppressed epithelial cell death in an ATP-independent manner and improved the villus morphology but failed to maintain crypt function. Conversely, the administration of liposomal ATP partly restored crypt proliferation but did not reduce epithelial necroptosis and histopathological injury. Lastly, glucose and pyruvate attenuated mucosal-to-serosal macromolecular flux and prevented enteric bacterial translocation upon blood reperfusion. In conclusion, glucose metabolites protect against ischaemic injury through distinct modes and sites, including inhibition of epithelial necroptosis by pyruvate and the promotion of crypt proliferation by ATP.


Assuntos
Trifosfato de Adenosina/metabolismo , Enterócitos/metabolismo , Enterócitos/patologia , Glucose/metabolismo , Ácido Pirúvico/metabolismo , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Animais , Apoptose , Enterócitos/ultraestrutura , Jejuno/metabolismo , Jejuno/patologia , Jejuno/ultraestrutura , Fígado/microbiologia , Masculino , Microscopia Eletrônica de Transmissão , Necrose , Proteínas Serina-Treonina Quinases/metabolismo , Ratos Wistar , Proteína Serina-Treonina Quinases de Interação com Receptores/metabolismo , Baço/microbiologia
10.
PLoS One ; 11(1): e0146913, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26812647

RESUMO

PURPOSE: To assess the inter session reproducibility of automatic segmented MRI-derived measures by FreeSurfer in a group of subjects with normal-appearing MR images. MATERIALS AND METHODS: After retrospectively reviewing a brain MRI database from our institute consisting of 14,758 adults, those subjects who had repeat scans and had no history of neurodegenerative disorders were selected for morphometry analysis using FreeSurfer. A total of 34 subjects were grouped by MRI scanner model. After automatic segmentation using FreeSurfer, label-wise comparison (involving area, thickness, and volume) was performed on all segmented results. An intraclass correlation coefficient was used to estimate the agreement between sessions. Wilcoxon signed rank test was used to assess the population mean rank differences across sessions. Mean-difference analysis was used to evaluate the difference intervals across scanners. Absolute percent difference was used to estimate the reproducibility errors across the MRI models. Kruskal-Wallis test was used to determine the across-scanner effect. RESULTS: The agreement in segmentation results for area, volume, and thickness measurements of all segmented anatomical labels was generally higher in Signa Excite and Verio models when compared with Sonata and TrioTim models. There were significant rank differences found across sessions in some labels of different measures. Smaller difference intervals in global volume measurements were noted on images acquired by Signa Excite and Verio models. For some brain regions, significant MRI model effects were observed on certain segmentation results. CONCLUSIONS: Short-term scan-rescan reliability of automatic brain MRI morphometry is feasible in the clinical setting. However, since repeatability of software performance is contingent on the reproducibility of the scanner performance, the scanner performance must be calibrated before conducting such studies or before using such software for retrospective reviewing.


Assuntos
Encéfalo/anatomia & histologia , Imagem por Ressonância Magnética/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
PLoS One ; 9(11): e112355, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25401949

RESUMO

OBJECTIVE: Whether retroperitoneal fat should be included in the measurement of visceral fat remains controversial. We compared the relationships of fat areas in peritoneal, retroperitoneal, and subcutaneous compartments to metabolic syndrome, adipokines, and incident hypertension and diabetes. METHODS: We enrolled 432 adult participants (153 men and 279 women) in a community-based cohort study. Computed tomography at the umbilicus level was used to measure the fat areas. RESULTS: Retroperitoneal fat correlated significantly with metabolic syndrome (adjusted odds ratio (OR), 5.651, p<0.05) and the number of metabolic abnormalities (p<0.05). Retroperitoneal fat area was significantly associated with blood pressure, plasma glycemic indices, lipid profile, C-reactive protein, adiponectin (r =  -0.244, P<0.05), and leptin (r = 0.323, p<0.05), but not plasma renin or aldosterone concentrations. During the 2.94 ± 0.84 years of follow-up, 32 participants developed incident hypertension. Retroperitoneal fat area (hazard ration (HR) 1.62, p = 0.003) and peritoneal fat area (HR 1.62, p = 0.009), but not subcutaneous fat area (p = 0.14) were associated with incident hypertension. Neither retroperitoneal fat area, peritoneal fat area, nor subcutaneous fat areas was associated with incident diabetes after adjustment. CONCLUSIONS: Retroperitoneal fat is similar to peritoneal fat, but differs from subcutaneous fat, in terms of its relationship with metabolic syndrome and incident hypertension. Retroperitoneal fat area should be included in the measurement of visceral fat for cardio-metabolic studies in human.


Assuntos
Gordura Abdominal/anatomia & histologia , Pesos e Medidas Corporais , Gordura Abdominal/metabolismo , Gordura Abdominal/patologia , Adipocinas/metabolismo , Adulto , Idoso , Comorbidade , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Tamanho do Órgão , Vigilância em Saúde Pública , Fatores de Risco , Tomografia Computadorizada por Raios X
12.
PLoS One ; 8(11): e76212, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24223698

RESUMO

BACKGROUND: Computer-aided diagnosis (CADx) software that provides a second opinion has been widely used to assist physicians with various tasks. In dermatology, however, CADx has been mostly limited to melanoma or melanocytic skin cancer diagnosis. The frequency of non-melanocytic skin cancers and the accessibility of regular digital macrographs have raised interest in developing CADx for broader applications. OBJECTIVES: To investigate the feasibility of using CADx to diagnose both melanocytic and non-melanocytic skin lesions based on conventional digital photographic images. METHODS: This study was approved by an institutional review board, and the requirement to obtain informed consent was waived. In total, 769 conventional photographs of melanocytic and non-melanocytic skin lesions were retrospectively reviewed and used to develop a CADx system. Conventional and new color-related image features were developed to classify the lesions as benign or malignant using support vector machines (SVMs). The performance of CADx was compared with that of dermatologists. RESULTS: The clinicians' overall sensitivity, specificity, and accuracy were 83.33%, 85.88%, and 85.31%, respectively. New color correlation and principal component analysis (PCA) features improved the classification ability of the baseline CADx (p = 0.001). The estimated area under the receiver operating characteristic (ROC) curve (Az) of the proposed CADx system was 0.949, with a sensitivity and specificity of 85.63% and 87.65%, respectively, and a maximum accuracy of 90.64%. CONCLUSIONS: We have developed an effective CADx system to classify both melanocytic and non-melanocytic skin lesions using conventional digital macrographs. The system's performance was similar to that of dermatologists at our institute. Through improved feature extraction and SVM analysis, we found that conventional digital macrographs were feasible for providing useful information for CADx applications. The new color-related features significantly improved CADx applications for skin cancer.


Assuntos
Interpretação de Imagem Assistida por Computador , Neoplasias Cutâneas/diagnóstico , Software , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Análise de Componente Principal , Curva ROC , Reprodutibilidade dos Testes , Máquina de Vetores de Suporte
13.
Cardiovasc Diabetol ; 12: 127, 2013 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-24001037

RESUMO

BACKGROUND: Symptoms of heart failure with preserved left ventricular systolic function are common among patients undergoing peritoneal dialysis (PD). Epicardial fat (EpF) is an ectopic fat depot with possible paracrine or mechanical effects on myocardial function. The aim of our current study is to assess the association between EpF and Left ventricular diastolic dysfunction (LVDD) in patients undergoing PD and to clarify the relationships among EpF, inflammation, and LVDD in this population. METHODS: This was a cross-sectional study of 149 patients with preserved left ventricular systolic function who were undergoing PD. LVDD was diagnosed (according to the European Society of Cardiology guidelines) and EpF thickness measured by echocardiography. The patients without LVDD were used as controls. The serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) was measured. The location and amount of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra. RESULTS: Subjects with LVDD had higher levels of hsCRP, more visceral and peritoneal fat, and thicker EpF (all p < 0.001) than controls. Visceral adipose tissue, hsCRP, and EpF all correlated significantly (p < 0.05) with LVDD. Multivariate regression analysis rendered the relationship between visceral adipose tissue and LVDD insignificant, whereas EpF was the most powerful determinant of LVDD (odds ratio = 2.41, 95% confidence interval = 1.43-4.08, p < 0.01). EpF thickness also correlated significantly with the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e'; r = 0.27, p < 0.01). CONCLUSION: EpF thickness is significantly independently associated with LVDD in patients undergoing PD and may be involved in its pathogenesis.


Assuntos
Adiposidade , Diástole , Gordura Intra-Abdominal/fisiopatologia , Pericárdio/fisiopatologia , Diálise Peritoneal/efeitos adversos , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Adulto , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia Doppler , Feminino , Humanos , Mediadores da Inflamação/sangue , Gordura Intra-Abdominal/diagnóstico por imagem , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Pericárdio/diagnóstico por imagem , Valor Preditivo dos Testes , Fatores de Risco , Volume Sistólico , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia
14.
PLoS One ; 8(8): e71636, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23977097

RESUMO

BACKGROUND: Peritoneal calcification (PC) is a specific finding in patients undergoing peritoneal dialysis (PD), but its prevalence, risk factors, and impacts in PD patients remain unclear. The present study investigated these issues and provided information useful for the management of PC. METHODS: The study included 183 PD patients. The severity of PC was determined using abdominal computed tomography (CT), and we summed up all scores from slices obtained from the diaphragm to the pelvic floor normalized to body surface area. We analyzed the associations between PC and demographic and clinical characteristics, and between PC and levels of biomarkers, including C-reactive protein (CRP), osteoprotegrin and fetuin-A. The determinants of PC were examined using multiple regression analysis. RESULTS: Patients were categorized into group 1 (without PC, n = 133) and group 2 (with PC, n = 50). Group 2 patients showed different degrees of PC with a mean of 160±769 mm(2)/m(2). Group 1 patients had higher fetuin-A levels than group 2 patients (861±309 vs. 760±210 µg/mL; p = 0.021). The independent risk factors for the presence of PC included male gender, previous peritonitis, and PD adequacy (KT/V). Further analysis performed in group 2 patients showed that the dosage of vitamin D, serum levels of CRP, and dialysate calcium load were the independent determinants of PC. However, the presence of PC did not affect patients' technique survival, peritonitis incidence, or mortality in the mean follow up period of 28±12 months. CONCLUSIONS: The presence and severity of PC were associated with inflammation, peritoneal KT/V, and mineral metabolism. The impact of PC on the outcomes of PD patients requires further study with a longer follow-up.


Assuntos
Calcinose/complicações , Calcinose/patologia , Peritônio/patologia , Peritonite/complicações , Peritonite/patologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal , Peritônio/diagnóstico por imagem , Peritonite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Cardiovasc Diabetol ; 12: 86, 2013 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-23758640

RESUMO

BACKGROUND: In the general population, metabolic syndrome (MetS) is correlated with visceral fat and a risk factor for cardiovascular disease (CVD); however, little is known about the significance of abdominal fat and its association with inflammation and medication use in peritoneal dialysis (PD) patients. We investigated the relationship of visceral fat area (VFA) with C-reactive protein (CRP) levels and medication use in PD patients and followed their clinical outcomes. METHODS: In a prospective study from February 2009 to February 2012, we assessed diabetes mellitus (DM) status, clinical and PD-associated characteristics, medication use, CRP levels, components of MetS, and VFA in 183 PD patients. These patients were categorized into 3 groups based on MetS and DM status: non-MetS (group 1, n = 73), MetS (group 2, n = 65), and DM (group 3, n = 45). VFA was evaluated by computed tomography (CT) and corrected for body mass index (BMI). RESULTS: Patients in group 1 had smaller VFAs than patients in groups 2 and 3 (3.2 ± 1.8, 4.6 ± 1.9, and 4.9 ± 2.0 cm2/[kg/m2], respectively, P < 0.05) and lower CRP levels (0.97 ± 2.31, 1.27 ± 2.57, and 1.11 ± 1.35 mg/dL, respectively, P < 0.05). VFA increased with the number of criteria met for MetS. After adjusting for age, body weight, and sex, CRP and albumin levels functioned as independent positive predictors of VFA; on other hand, the use of renin-angiotensin system blockers was inversely correlated with VFA in PD patients without DM. In the survival analysis, DM patients (group 3) had the poorest survival among the 3 groups, but no significant differences were found between groups 1 and 2. CONCLUSION: This study showed that VFA and MetS are associated with CRP levels but cannot predict survival in PD patients without DM. The complex relationship of nutritional parameters to VFA and MetS may explain these results. The type of antihypertensive medication used was also associated with the VFA. The mechanisms behind these findings warrant further investigation.


Assuntos
Gordura Abdominal/fisiopatologia , Inflamação/imunologia , Síndrome Metabólica/imunologia , Síndrome Metabólica/fisiopatologia , Obesidade Abdominal/fisiopatologia , Diálise Peritoneal/efeitos adversos , Gordura Abdominal/diagnóstico por imagem , Adiposidade , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Inflamação/sangue , Inflamação/diagnóstico , Mediadores da Inflamação/sangue , Estimativa de Kaplan-Meier , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/mortalidade , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estado Nutricional , Obesidade Abdominal/diagnóstico , Obesidade Abdominal/mortalidade , Diálise Peritoneal/mortalidade , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
PLoS One ; 8(5): e62722, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23675418

RESUMO

OBJECTIVE: Patients with symptoms of heart failure and preserved left ventricular (LV) systolic function are commonly encountered in clinical practice especially in peritoneal dialysis (PD) patients. We hypothesized that adiposity might influence LV diastolic function through systemic inflammation in this specific group. METHODS: We designed a cross-sectional study in 173 prevalent PD patients. LV diastolic dysfunction was diagnosed by echocardiography. PD patient without LV diastolic dysfunction served as the control group. Serum inflammatory biomarkers were examined including tissue necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). The location and amount of adipose tissue were assessed by computerized tomography (CT) at the level of the fourth lumbar vertebra. RESULTS: Subjects with LV diastolic dysfunction had higher levels of the pro-inflammation cytokines and more visceral and peritoneal fat (all P<0.001) than control subjects. A significant correlation was found between visceral adipose tissue and pro-inflammatory cytokines (r = 0.70; P<0.001). Multivariable regression analysis found that the relationship between visceral adipose tissue and LV diastolic dysfunction became insignificant when either TNF-α or IL-6 were introduced into the model, although TNF-α and IL-6 were both significantly associated with LV diastolic dysfunction even after adjusting for visceral fat (OR = 1.51; 95% CI = 1.09-2.02; P = 0.033 and OR = 1.62; 95% CI = 1.09-1.82; P = 0.031, respectively). CONCLUSIONS: Larger amounts of adipose tissue were associated with higher serum pro-inflammatory levels in PD patients, which might be related to the development of LV diastolic dysfunction. Modulating inflammatory reactions in PD patients can be a useful therapeutic approach for managing LV diastolic dysfunction.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Gordura Intra-Abdominal/fisiopatologia , Diálise Peritoneal , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Biomarcadores/sangue , Estudos Transversais , Ecocardiografia , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Inflamação , Interleucina-6/sangue , Gordura Intra-Abdominal/patologia , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/sangue , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/complicações
17.
Neuroradiology ; 55(4): 475-81, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23388889

RESUMO

INTRODUCTION: This study aims to report the treatment and outcome of sequential bilateral acute carotid artery blowout syndrome. METHODS: From 2004 to 2010, we treated seven male patients with sequential bilateral blowout syndrome long after irradiation treatment for head and neck cancer. After first common carotid artery (CCA)-internal carotid artery (ICA) rupture, six were treated with CCA-ICA occlusion and one with graft stenting. The contralateral ICAs were normal or stenotic on angiography in all patients. After the contralateral CCA-ICA rupture, five patients received CCA-ICA occlusion, one received graft stent treatment, and one received no treatment. RESULTS: Five of the seven patients died soon after the final treatment. Two patients developed cerebral infarctions (one treated with bilateral stenting, one treated with occlusion), one died from extensive local infection, one died soon after a third treatment, one died of progression of the disease, and one refused a second treatment and died soon after the diagnostic angiography. Two patients survived with follow-up periods of 1 and 5 years. In all seven patients, the contralateral CCA-ICA blowout occurred within 3 months after the first ICA occlusion. CONCLUSION: Bilateral ICA occlusion is an alternative management for sequential carotid artery blowout, but the mortality is high and outcome is poor. A normal angiogram cannot exclude the possibility of rapid development of a contralateral carotid artery blowout shortly after a first episode in patients who have received radiotherapy for head and neck cancer.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Doença Aguda , Adulto , Idoso , Doenças das Artérias Carótidas/cirurgia , Evolução Fatal , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento
18.
Diabetes Care ; 36(6): 1660-6, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23275359

RESUMO

OBJECTIVE: Waist circumference (WC) is used to define central obesity. This study aimed to compare the performance of two recommended locations of WC measurement. RESEARCH DESIGN AND METHODS: A cohort of 1,898 subjects who were without diabetes from 2006 to 2012 were followed for a median of 31 months (Taiwan Lifestyle Study). The WC-IC, recommended by the National Cholesterol Education Program Third Adult Treatment Panel, was measured at the superior border of the iliac crest, and the WC-mid, recommended by World Health Organization and International Diabetes Federation, was measured midway between the lowest ribs and the iliac crest. The abdominal subcutaneous fat area (SFA) and visceral fat area (VFA) were assessed by computed tomography. RESULTS: There was greater difference between WC-IC and WC-mid measurements in women than in men (P < 0.001). Both WC-IC and WC-mid correlated significantly with BMI, VFA, and SFA (all P < 0.001). WC-mid was better correlated to VFA than WC-IC, particularly in women, and it correlated more strongly to blood pressure, plasma glucose, hemoglobin A1c, triglyceride levels, HDL cholesterol, and C-reactive protein (all P < 0.05). The association of WC-mid with hypertension, diabetes, and metabolic syndrome was slightly better than that of WC-IC (area under the receiver operator curve 0.7 vs. 0.69, 0.71 vs. 0.68, and 0.75 vs. 0.7, respectively; all age-adjusted P < 0.05). With 90 cm (male)/80 cm (female) as criteria for central obesity, WC-mid, but not WC-IC, predicted the incidence of diabetes development (age-adjusted P = 0.003). CONCLUSIONS: WC-mid is a better measurement to define central obesity than WC-IC, particularly in women.


Assuntos
Obesidade Abdominal/diagnóstico , Circunferência da Cintura/fisiologia , Adulto , Idoso , Antropometria , Feminino , Humanos , Gordura Intra-Abdominal/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/metabolismo , Gordura Subcutânea/metabolismo
20.
Lab Invest ; 92(5): 783-96, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22370946

RESUMO

Intestinal ischemia/reperfusion (I/R) induces mucosal barrier dysfunction and bacterial translocation (BT). Neutrophil-derived oxidative free radicals have been incriminated in the pathogenesis of ischemic injury in various organs, but their role in the bacteria-containing intestinal tract is debatable. Primed neutrophils are characterized by a faster and higher respiratory burst activity associated with more robust bactericidal effects on exposure to a second stimulus. Hypoxic preconditioning (HPC) attenuates ischemic injury in brain, heart, lung and kidney; no reports were found in the gut. Our aim is to investigate whether neutrophil priming by HPC protects against intestinal I/R-induced barrier damage and bacterial influx. Rats were raised in normoxia (NM) or kept in a hypobaric hypoxic chamber (380 Torr) 17 h/day for 3 weeks for HPC, followed by sham operation or intestinal I/R. Gut permeability was determined by using an ex vivo macromolecular flux assay and an in vivo magnetic resonance imaging-based method. Liver and spleen homogenates were plated for bacterial culturing. Rats raised in HPC showed diminished levels of BT, and partially improved mucosal histopathology and epithelial barrier function compared with the NM groups after intestinal I/R. Augmented cytokine-induced neutrophil chemoattractant (CINC)-1 and -3 levels and myeloperoxidase activity correlated with enhanced infiltration of neutrophils in intestines of HPC-I/R compared with NM-I/R rats. HPC alone caused blood neutrophil priming, as shown by elevated production of superoxide and hydrogen peroxide on stimulation, increased membrane translocation of cytosolic p47(phox) and p67(phox), as well as augmented bacterial-killing and phagocytotic activities. Neutrophil depletion reversed the mucosal protection by HPC, and aggravated intestinal leakiness and BT following I/R. In conclusion, neutrophil priming by HPC protects against I/R-induced BT via direct antimicrobial activity by oxidative respiratory bursts and through promotion of epithelial barrier integrity for luminal confinement of enteric bacteria.


Assuntos
Translocação Bacteriana/fisiologia , Hipóxia/metabolismo , Mucosa Intestinal/metabolismo , Intestinos/microbiologia , Neutrófilos/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Traumatismo por Reperfusão/microbiologia , Animais , Membrana Celular/metabolismo , Células Cultivadas , Quimiocina CXCL1/análise , Quimiocina CXCL1/metabolismo , Quimiocina CXCL2/análise , Quimiocina CXCL2/metabolismo , Mucosa Intestinal/microbiologia , Mucosa Intestinal/fisiopatologia , Intestinos/fisiopatologia , Fígado/citologia , Fígado/metabolismo , Masculino , Permeabilidade , Peroxidase/análise , Peroxidase/metabolismo , Ratos , Ratos Wistar , Traumatismo por Reperfusão/imunologia , Traumatismo por Reperfusão/fisiopatologia , Baço/citologia , Baço/metabolismo
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