Kazuya Murata

Effects of metformin treatment on blood leptin and ghrelin levels in patients with type 2 diabetes mellitus

The aim of the present study was to conduct a meta‐analysis of randomized controlled trials (RCTs) that investigated the effects of metformin on blood leptin and ghrelin levels in patients with type 2 diabetes mellitus (T2DM).

Efficacy and safety of sitagliptin in Japanese patients with type 2 diabetes switched from glinides

The efficacy and safety of sitagliptin, a dipeptidyl peptidase (DPP)‐4 inhibitor, were compared with those of glinides in Japanese patients with type 2 diabetes.

Images of interest. Gastrointestinal: sclerosing encapsulating peritonitis.

Continuous ambulatory peritoneal dialysis (CAPD) is widely used in the treatment of renal failure. A common complication is that of bacterial peritonitis, mostly caused by contamination of the indwelling catheter with skin flora. The frequency of this complication has been estimated at 1.4 episodes per patient-year of treatment. A rare complication is that of sclerosing encapsulating peritonitis. This occurs in approximately 0.7% of patients and is usually diagnosed months or years after cessation of CAPD. The pathogenesis of this disorder may involve mesothelial damage caused by the hypertonic dialysate followed by failure to repair the mesothelial layer. Cessation of CAPD is followed by persisting inflammation, a progressive thickening of the peritoneum and by impaired bowel function. Mortality is high because of malnutrition and sepsis. The treatment of sclerosing encapsulating peritonitis is often unsatisfactory but some patients appear to improve with immunosuppressive drugs. The images shown below were from a 62-year-old man who was admitted to hospital with abdominal pain, nausea and vomiting. He had chronic renal failure caused by diabetes mellitus and had been treated with CAPD for 6 years. Sixteen months prior to admission, he had been switched from CAPD to hemodialysis because of a reduction in the efficiency of dialysis. Physical examination revealed a palpable abdominal mass and tenderness in the left abdomen. A computed tomography scan showed a thickened peritoneum (arrows), encapsulating fluid and loops of small bowel, particularly in the left abdomen (Fig. 1). He subsequently required a laparotomy because of perforation of the ileum. This revealed fibrous thickening of the peritoneum throughout the whole abdomen. Other complications included three episodes of bleeding from the small bowel that were treated with arterial embolization. He died as a result of pulmonary embolism. Histological evaluation of peritoneal specimens taken at autopsy (Fig. 2) showed diffuse thickening of the peritoneum, loss of the mesothelium (bold arrow) and thickening of the walls of arterioles (small arrow).

Gastrointestinal: Sclerosing encapsulating peritonitis

Continuous ambulatory peritoneal dialysis (CAPD) is widely used in the treatment of renal failure. A common complication is that of bacterial peritonitis, mostly caused by contamination of the indwelling catheter with skin flora. The frequency of this complication has been estimated at 1.4 episodes per patient-year of treatment. A rare complication is that of sclerosing encapsulating peritonitis. This occurs in approximately 0.7% of patients and is usually diagnosed months or years after cessation of CAPD. The pathogenesis of this disorder may involve mesothelial damage caused by the hypertonic dialysate followed by failure to repair the mesothelial layer. Cessation of CAPD is followed by persisting inflammation, a progressive thickening of the peritoneum and by impaired bowel function. Mortality is high because of malnutrition and sepsis. The treatment of sclerosing encapsulating peritonitis is often unsatisfactory but some patients appear to improve with immunosuppressive drugs. The images shown below were from a 62-year-old man who was admitted to hospital with abdominal pain, nausea and vomiting. He had chronic renal failure caused by diabetes mellitus and had been treated with CAPD for 6 years. Sixteen months prior to admission, he had been switched from CAPD to hemodialysis because of a reduction in the efficiency of dialysis. Physical examination revealed a palpable abdominal mass and tenderness in the left abdomen. A computed tomography scan showed a thickened peritoneum (arrows), encapsulating fluid and loops of small bowel, particularly in the left abdomen (Fig. 1). He subsequently required a laparotomy because of perforation of the ileum. This revealed fibrous thickening of the peritoneum throughout the whole abdomen. Other complications included three episodes of bleeding from the small bowel that were treated with arterial embolization. He died as a result of pulmonary embolism. Histological evaluation of peritoneal specimens taken at autopsy (Fig. 2) showed diffuse thickening of the peritoneum, loss of the mesothelium (bold arrow) and thickening of the walls of arterioles (small arrow).

SARC-F for Screening of Sarcopenia Among Older Adults: A Meta-analysis of Screening Test Accuracy

OBJECTIVE To examine the screening ability of SARC-F for older adults using a meta-analysis. DESIGN Meta-analysis. SETTING AND PARTICIPANTS The literature review was conducted using MEDLINE, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. Articles written on and after 1960 that included data regarding the sensitivity and specificity of SARC-Fs diagnostic criteria for sarcopenia in older adults were searched. MEASURES The bivariate random effects model was used to calculate the summary estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). The summary receiver operating characteristic curve was used to summarize the overall test performance. RESULTS Seven studies involving a total of 12,800 subjects met the eligibility criteria of our study. The pooled results of sensitivity, specificity, PLR, NLR, and DOR with the European Working Group on Sarcopenia in Older People as the reference standard were 0.21 [95% confidence interval (CI), 0.13-0.31], 0.90 (95% CI, 0.83-0.94), 2.16 (95% CI, 1.51-3.09), 0.87 (95% CI, 0.80-0.95), and 2.47 (95% CI, 1.64-3.74), respectively. Overall, we achieved similar pooled results of sensitivity and specificity for studies using the International Working Group on Sarcopenia and Asian Working Group for Sarcopenia as the reference standards. Because few studies used the Foundation National Institute of Health reference standards, a meta-analysis was not performed. CONCLUSIONS/IMPLICATIONS Although the screening sensitivity performance of SARC-F was poor, its specificity was high; thus, it is an effective tool for selecting subjects who should undergo further testing for confirming a diagnosis of sarcopenia.

A comparison of the associations of dynapenia and sarcopenia with fear of falling in elderly diabetic patients

AIM To comparatively investigate whether dynapenia and sarcopenia, as defined by the Asian Working Group for Sarcopenia (AWGS), are associated with fear of falling in elderly patients with diabetes. METHODS The subjects were outpatients with diabetes who were at least 65 years of age when they visited our hospital. Sarcopenia was evaluated based on the AWGS definition. The cutoff values for the appendicular skeletal mass index (multi-frequency bioelectrical impedance method), grip strength, and walking speed were, respectively, 7.0 kg/m2 for men and 5.7 kg/m2 for women, 26 kg for men and 18 kg for women, and ≤0.8 m/s for both men and women. Those with grip strength of less than or equal to the cutoff value were considered to have dynapenia. Fear of falling was assessed by a self-administered questionnaire survey with the Fall Efficacy Scale (FES) Japanese version. A multiple regression analysis was conducted using the FES score as a dependent variable and dynapenia or sarcopenia and moderators as explanatory variables. RESULTS A total of 202 patients (male, n=127; female, n=75) were analyzed in this study. The FES scores of the patients with and without sarcopenia did not differ to a statistically significant extent in either male or female patients. The multiple regression analysis revealed a statistically significant association between dynapenia and the FES score in men (P=0.028). CONCLUSIONS In elderly outpatients with diabetes, no association was found between sarcopenia and the fear of falling in either men or women. In contrast, a statistically significant association was found between dynapenia and fear of falling in men. This suggests the importance paying attention to the fear of falling when examining elderly male diabetes patients with dynapenia.

Hepatobiliary and pancreatic: Cholangiocarcinoma with chylous ascites

Chylous ascites is ascitic fluid with a milky appearance that is rich in triglycerides. The disorder is rare, with a reported frequency of 1 in 20 000 hospital admissions. The most common cause is an intra-abdominal malignancy, usually advanced gastric or pancreatic cancer. The typical mechanism involves obstruction or malignant infiltration of lymphatic channels with the subsequent development of a lymphatic fistula that communicates with the peritoneal cavity. Non-malignant causes of chylous ascites include cirrhosis, tuberculosis, filariasis, abdominal trauma, abdominal surgery and abdominal irradiation. In cirrhosis, the mechanism for chylous ascites might involve increases in lymphatic flow leading to increases in pressure and the rupture of small lymphatic channels. The investigations illustrated below were from a 60-year-old woman who presented with epigastric pain, abdominal fullness and weight loss. She had hepatitis C and had previously had a cholecystectomy. A computed tomography scan showed ascites and a mass near the hilum of the liver consistent with cholangiocarcinoma. An ascitic tap revealed milky fluid with a triglyceride level of 285 mg/dL (3.2 mmol/L). Ascitic fluid cytology was positive for malignant cells. Her serum triglyceride level was 60 mg/dL (0.7 mmol/L) and she had an elevated serum concentration of the tumor marker, Ca19.9. An upper gastrointestinal endoscopy showed multiple white dots in the second part of the duodenum (Fig. 1). Histological evaluation of duodenal biopsies revealed mild inflammation and dilated submucosal lymphatics. A lymphangiogram was performed by injecting 99mTc-labeled human serum albumin into both feet. At 10 min, the label was detected in the mid-abdomen (anterior and posterior views) and, at 4 h, there was partial obstruction of abdominal lymphatic channels (Fig. 2). Some of the label leaked into the peritoneal cavity and was subsequently absorbed into the general circulation. An autopsy at 5 months after the initial presentation confirmed the presence of widespread cholangiocarcinoma.

Validity of Japanese version of SARC-F questionnaire in patients with chronic liver disease: Japanese version of SARC-F questionnaire

We aimed to examine the validity of the Japanese version of SARC‐F questionnaire (SARC‐F‐J) that employs the diagnostic criteria for sarcopenia established by the Japan Society of Hepatology in patients with chronic liver disease.

Effects of sulfonylurea treatment on blood plasminogen activator inhibitor-1 levels in patients with type 2 diabetes mellitus: A network meta-analysis

Abstract Background: To compare the effects ofthree types of sulfonylureas (glibenclamide, gliclazide, and glimepiride) on blood plasminogen activator inhibitor-1 levels in patients with type2 diabetes mellitus, a

Effects of pioglitazone treatment on blood leptin levels in patients with type 2 diabetes

The aim of the present study was to carry out a meta‐analysis of randomized controlled trials (RCTs) that investigated the effects of pioglitazone on blood leptin levels in patients with type 2 diabetes.