Advanced Glycation End Products and Their Effect on Vascular Complications in Type 2 Diabetes Mellitus.

Diabetes is well established as a chronic disease with a high health burden due to mortality or morbidity from the final outcomes of vascular complications. An increased duration of hyperglycemia is associated with abnormal metabolism. Advanced glycation end products (AGEs) are nonenzymatic glycated forms of free amino acids that lead to abnormal crosslinking of extra-cellular and intracellular proteins by disrupting the normal structure. Furthermore, the interaction of AGEs and their receptors induces several pathways by promoting oxidative stress and inflammation. In this review, we discuss the role of AGEs in diabetic vascular complications, especially type 2 DM, based on recent clinical studies.

Not only a small liver - The pathologist's perspective in the pediatric liver transplant setting.

Pediatric liver transplantation represents a safe and long-lasting treatment option for various disease types, requiring the pathologist's input. Indeed, an accurate and timely diagnosis is crucial in reporting and grading native liver diseases, evaluating donor liver eligibility and identifying signs of organ injury in the post-transplant follow-up. However, as the procedure is more frequently and widely performed, deceptive and unexplored histopathologic features have emerged with relevant consequences on patient management, particularly when dealing with long-term treatment and weaning of immunosuppression.In this complex and challenging scenario, this review aims to depict the most relevant histopathologic conditions which could be encountered in pediatric liver transplantation. We will tackle the conditions representing the main indications for transplantation in childhood as well as the complications burdening the post-transplant phases, either immunologically (i.e., rejection) or non-immunologically mediated. Lastly, we hope to provide concise, yet significant, suggestions related to innovative pathology techniques in pediatric liver transplantation.

The Relationship of Hyperferritinemia to Metabolism and Chronic Complications in Type 2 Diabetes.

AIM: Elevated serum ferritin has been found to be closely related to type 2 diabetes mellitus. This study aimed to explore the relationship of high serum ferritin to metabolism and chronic complications in type 2 diabetes. METHODS: This was a cross-sectional study. A total of 330 type 2 diabetes patients who visited an endocrine clinic were included for the analysis. Serum ferritin and metabolic parameters were recorded. The prevalence of chronic diabetic complications was evaluated. Based on serum ferritin, participants were divided into hyperferritinemia and normal-ferritin groups. Metabolic parameters and prevalence of chronic diabetic complications were compared. The relationship between hyperferritinemia and chronic diabetic complications was explored with multivariate logistic regression models. Data were statistically analyzed by sex. RESULTS: Compared with the normal-ferritin group, the hyperferritinemia group showed higher levels of the serum inflammatory marker CRP and higher prevalence of diabetic retinopathy (DR) and coronary heart disease (CHD), regardless of sex (p<0.05). Moreover, male patients with hyperferritinemia had increased serum triglyceride, alanine transferase, γ-glutamyltranspeptidase, urea nitrogen, creatinine, and uric acid and higher prevalence of microalbuminuria (p<0.01). After controlling for demographics and metabolic profiles, hyperferritinemia remained an independent risk factor of DR (male OR 3.957, 95% CI 1.559-10.041, p=0.004; female OR 2.474, 95% CI 1.127-5.430, p=0.024) and CHD (male OR 2.607, 95% CI 1.087-6.257, p=0.032; female OR 2.293, 95% CI 1.031-5.096, p=0.042). CONCLUSION: This study found that hyperferritinemia was associated with increased CRP and higher prevalence of DR and CHD in type 2 diabetes. In men, high serum ferritin was also associated with dyslipidemia, hepatic dysfunction, and microalbuminuria.

[Management of the adult with sickle cell disease]. / Prise en charge de l'adulte drépanocytaire.

Sickle cell disease is a chronic disease with multisystemic complications. Follow-up requires specialised and multidisciplinary care. The consultation allows for the screening of complications.

Which factors determine exocrine pancreatic dysfunction in diabetes mellitus?

The exocrine structure is significantly affected by diabetes because of endocrine structure-function disorder within the pancreas. Exocrine pancreatic dysfunction (EPD) is the general name of the malabsorption process resulting from inadequate production, release, decreased activation, and/or insufficient degradation of enzymes required for digestion from pancreatic acinar cells. It is important to diagnose patients early and correctly, since there may be both macro- and micro-nutrient deficiency in EPD. In this paper, EPD, the diabetes-EPD relationship, and the predictive, effective factors affecting the emergence of EPD are briefly explained and summarized with contemporary literature and our experienced based on clinical, lab, and radiological findings.

[Profil course of SC sickle-cell patients in Dakar: a case-control study with SS sickle cell form]. / Profil evolutif de la drepanocytose SC A Dakar: étude cas-témoin avec la forme SS.

AIMS: The study aim to describe the epidemiological, clinico-biological and evolutionary aspects of SC sickle cell patients compared to SS sickle cell disease. PATIENTS AND METHODS: We realized a case-control study of 12 months duration including 98 major sickle cell patients (49 SC and 49 SS sickle cell patients). SS sickle cell patients were randomly selected according to age and sex. Socio-demographic, clinico-biological and evolutionary data were noted for each patient. RESULTS: Mean age was 24.7 years (5 - 53). Sex ratio was 0.8. Mean number of transfusions was 0.06 of SC patients and 0.34 for SS patients (p=0.0008). Mean number of vaso-occlusive crisis per year was 2.24 of SC patients and 2.37 of SS patients (p=0.3). Mean basic hemoglobin level was 10.8 of SC patients and 7.8 of SS patients (p=0.0000). Priapism was found in 2.04% of SC patients and 4.04% of SS patients (p=0.3) and acute anemia in 2.04% of SC and 24.48% of SS patients (p=0.003); 26.53% of SC patients had a chronic complication compared to 18.36% of SS patients (p=0.0001). CONCLUSION: This study shows that SC sickle cell patients are less symptomatology compared to SS patients, however they would develop more chronic complications from where the utility for regular follow-up.

BUTS: Le but de notre étude était de décrire les aspects épidémiologiques, clinico-biologiques et évolutifs des patients SC comparés aux patients SS. PATIENTS ET MÉTHODES: Il s'agissait d'une étude cas témoins d'une durée de 12 mois portant sur 98 patients (49 SC et 49 SS8). Les témoins SS étaient choisis de façon aléatoire après appariement selon l'âge et le sexe. Pour chaque patient nous avons noté les aspects sociodémographiques, clinicobiologiques et évolutifs. RÉSULTATS: L'âge moyen était de 24,7 ans (5 - 53). Le sex ratio était de 0,8. Le nombre moyen de transfusions était de 0,06 chez les SC et 0,34 chez les SS (p=0,0008). Le nombre moyen de CVO/an était de 2,24 chez les SC et 2,37 chez les SS (p=0,3). Le taux moyen d'hémoglobine de base était de 10,8 chez les SC et 7,8 chez les SS (p=0,0000). Le priapisme était trouvé chez 2,04% des SC et 4,04% des SS (p=0,3) et l'anémie aigue chez 2,04% des SC et 24,48% des SS (p=0,003); 26,53% des SC souffraient d'une complication chronique contre 18,36% des SS (p=0,0001). CONCLUSION: Cette étude montre que les drépanocytaires SC ont une symptomatologie moindre par rapport aux patients SS, cependant ils développeraient plus de complications chroniques d'où l'utilité d'un suivi régulier.

The emerging role of nuclear factor erythroid 2-related factor 2 signaling pathway in diabetic chronic complications / 中华内分泌代谢杂志

Oxidative stress played an important role in the development of diabetes and its complications. Nuclear factor erythroid 2-related factor 2 (NRF2) pathway is one of the most vital endogenous antioxidant pathways. Accumulated evidences indicated that the relationship between diabetes and NRF2 pathway attracted more and more attention in recent years. Our group has devoted ourselves to the researches concerning the chronic complications of diabetes and NRF2 pathways. This review highlighted our recent progresses in the underlying mechanism of the protective role of NRF2 in diabetic nephropathy, diabetic ulcers and diabetic amyotrophy. Finally, the possibility of NRF2 agonists applied to clinical therapy for diabetic chronic complications was explored.

Dose-volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy.

The purpose of this study is to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in patients with cervical cancer who have undergone postoperative concurrent chemotherapy and whole-pelvic radiation therapy (WPRT). The subjects were 135 patients who had undergone postoperative WPRT with concurrent nedaplatin-based chemotherapy between 2000 and 2014. Associations between selected DVH parameters and the incidence of chronic GI complications of G3 or higher were evaluated. Chronic GI complications of severity G3 occurred in 18 (13%) patients. Patients with GI complications had significantly greater V5-V45, mean dose and the generalized equivalent uniform dose (gEUD) of the small bowel loops, compared with those without GI complications. V30-V45, mean dose and gEUD of the bowel bag also showed significant differences between patients with and without GI complications. In contrast, no parameter for the large bowel loop was correlated with GI complications. Receiver operating characteristics curve analysis indicated that V30-V45 of the small bowel loops were better predictors than these respective parameters for the bowel bag. Next, patients were divided into four groups based on the median V15 and V40 of the small bowel loops. The group with both a high V15 and a high V40 showed a significantly higher probability of chronic GI complications. In conclusion, the small bowel loops are better predictors of chronic GI complications compared with the bowel bag, and a relatively high-dose volume (e.g. V40) of the small bowel loops is a useful predictor of chronic GI complications.

A case of toxic epidermal necrolysis (ten) with severe chronic ocular complications in a healthy 46-year-old woman.

Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a severe drug reaction characterized by extensive destruction of the epidermis and mucosal epithelia. The eyes are typically involved in TEN. The precise pathomechanisms involved remain unknown. We present a case of toxic epidermal necrolysis in a healthy 46-yr-old female patient who had inhaled glycophosphate (herbicide) and was treated with paracetamol, aspirin, and chlorpheniramine. Thirty-five per cent of the skin area was affected by the syndrome, with involvement of conjunctival, gastrointestinal, and respiratory mucous membranes. Topical treatment was performed every day and the patient did not undergo surgery. Complete wound healing was achieved in 47 days. There were acute complications, consisting of infection of the skin areas ( Candida), gastrointestinal bleeding, pleural effusion, and severe ocular mucous membrane damage. The most serious chronic complication was the presence of significant opacity of the corneal epithelium, causing almost complete loss of vision. According to the data in the literature, ocular complications in TEN are frequent and are present in the majority of the patients studied, but are not often severe. Risk factors for the development of ocular complications are not known. Ocular sequelae may appear after the acute period and they can be extremely disabling, even causing almost complete loss of vision. Treatment includes corticosteroids and topical antibiotic therapy in the acute phase and if necessary corneal transplantation in the event of chronic damage to the corneal epithelium.