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Changes of Noradrenergic Activity and Lipolysis in the Subcutaneous Abdominal Adipose Tissue of Hypo‐ and Hyperthyroid Patients: An In Vivo Microdialysis Study

Abstract: Thyroid function plays an important role in the regulation of overall metabolic rate and lipid metabolism. However, it is uncertain whether thyroid hormones directly affect lipolysis in adipose tissue and to what extent those changes contribute to overall metabolic phenotype. Our study was designed, using the microdialysis technique, to determine basal and isoprenaline‐stimulated local lipolysis and to determine local concentrations of lipolysis‐regulating catecholamines in abdominal subcutaneous adipose tissue in 12 patients with hypothyroidism, 6 patients with hyperthyroidism, and 12 healthy control subjects. Plasma norepinephrine (NE) concentrations in hypothyroid subjects were significantly higher than in the control and hyperthyroid groups. In contrast, systemic, adipose NE levels in hypothyroid patients were decreased relative to controls. Hyperthyroidism, on the other hand, resulted in four‐fold higher adipose NE levels. Basal lipolysis measured by glycerol concentrations in adipose tissue was significantly attenuated in hypothyroid patients and markedly increased in hyperthyroid patients in comparison with the control group. In addition to differences in basal lipolysis, hypothyroidism resulted in attenuated, and hyperthyroidism in enhanced, lipolytic response to local stimulation with β1,2‐adrenergic agonist isoprenaline. These results demonstrate that lipolysis in abdominal subcutaneous adipose tissue is strongly modulated by thyroid function. We suggest that thyroid hormones regulate lipolysis primarily by affecting local NE concentration and/or adrenergic postreceptor signaling.

Risk calculation of type 2 diabetes

The paper presents an analysis of the risk of developing Type 2 diabetes according to family history and anthropometric variables. The age of diabetes onset was analysed in 2024 diabetics. We obtained several groups according to family history. In each group taken separately, the data describing the cumulative percentage of diabetes onset was fitted by logistic curve F(x) = p1/(1 + p2*p3((x/10)-p4)). Comparing these curves we see that cumulative age-dependent risk increases from the group of randomly chosen persons through the group of first degree relatives to the children of diabetics. The highest risk of diabetes onset is determined by the curve representing the group of known diabetics. Another analysis was performed in a different group of 390 obese subjects (34 diabetics among them). Male diabetics had significantly higher body mass index (BMI) and weight than male non-diabetics. Female diabetics showed significantly higher weight, body mass index, waist to hip ratio (WHR) and age than female non-diabetics. Elimination of factors with randomization and matching showed a complicated relationship between diabetes, age and anthropometric variables. Using stepwise logistic regression we obtained the model for prediction of diabetes risk based on age, BMI, WHR: probability of diabetes = exp(u)/(1 + exp(u)), where u = -13.9 + 0.05431*age + 6.789*WHR + 0.07881*BMI for obese women, u = -11.84 + 10.01*WHR for obese men. In conclusion, genetic factors are the most important and can be exactly quantified in Type 2 diabetes. The importance of anthropometric variables for prediction of diabetes risk is also presented.

Systematic Construction of Texture Features for Hashimoto's Lymphocytic Thyroiditis Recognition from Sonographic Images

The success of discrimination between normal and inflamed parenchyma of thyroid gland by means of automatic texture analysis is largely determined by selecting descriptive yet simple and independent sonographic image features. We replace the standard non-systematic process of feature selection by systematic feature construction based on the search for the separation distances among a clique of n pixels that minimise conditional entropy of class label given all data. The procedure is fairly general and does not require any assumptions about the form of the class probability density function. We show that a network of weak Bayes classifiers using 4-cliques as features and combined by majority vote achieves diagnosis recognition accuracy of 92%, as evaluated on a set of 741 B-mode sonographic images from 39 subjects. The results suggest the possibility to use this method in clinical diagnostic process.

Dexfenfluramine in psychotic patients

Dexfenfluramine (DF) is contraindicated in severe psychiatric disorders and in depression. We used DF in 3 patients with chronic psychosis and severe overeating without changes in psychiatric pharmacotherapy. Two patients had paranoid schizophrenic psychosis with hallucinations, one patient mixed psychosis, beginning with lactation psychosis, and several attacks of hallucinations and depression later. Overeating was removed in all 3 patients without any negative effect on the psychotic state. All patients were able to maintain their body weight. Two patients with poorly controlled diabetes improved markedly their metabolic status. Doses up to 75 mg per day of DF were necessary during binge eating episodes in one patient. We conclude that DF can be used with care under close psychiatric supervision in psychotic patients with severe overeating.

Transient ischemic dilation ratio (TID) correlates with HbA1c in patients with diabetes type 2 with proven myocardial ischemia according to exercise myocardial SPECT

ObjectiveAbnormal values of the transient ischemic dilation ratio (TID) according to an exercise myocardial SPECT are linked to severe coronary artery disease. The authors investigated the relationship between TID and the levels of VCAM, ICAM, E-selectin, microalbuminuria, intima-media thickness and HbA1c of diabetic subjects.MethodsWe observed 38 subjects with diabetes type 2 (10 women, 28 men), of average age 56.08 ± 8.24 years, with no past history of cardiovascular disease. All subjects were examined using an exercise myocardial SPECT. Transient ischemic dilation, summed stress score (SSS), summed rest score (SRS) and stress total severity score (STSS) were determined to quantify myocardial ischemia.ResultsThe average IMT value was 1.05 ± 0.31 mm. The TID value was 1.02 ± 0.154, VCAM 795.24 ± 163.25 mg/l, ICAM 516.55 ± 164.07, E-selectin 63.82 ± 38.89, HbA1c 7.09 ± 1.68%, microalbuminuria 68.01 ± 55.21 mg/l. When ascertaining the relation of TID to the other factors we used Pearson’s correlation at the level of significance p < 0.05. We proved a statistically significant correlation between the value of TID and glycosylated hemoglobin HbA1c (p = 0.035); the other factors did not show any significant correlation.ConclusionDiabetes and its long term unsatisfactory compensation can be one of the factors which affect left ventricular transient ischemic dilation.

Glucose Control in the ICU Is There a Time for More Ambitious Targets Again

During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.

Automatic Internal Medicine Diagnostics Using Statistical Imaging Methods

To develop a computer-aided diagnostic system for diagnosing different internal medicine diseases based on imaging methods. We focus on focal liver lesions in CT images. The diagnosing process follows the learning phase from known images. For image description, 22 first-order and 108 second-order texture features are used. They are used as input for network of Bayes classifiers. The best value of 100% success of classification between hepatocellular carcinoma and non-parasitic solitary liver cysts was achieved. The method allows discriminating between different liver diseases based on computer imaging. The method may be very useful in cases where any internal images of patients already diagnosed are available

Clinical Evaluation of Subcutaneous Lactate Measurement in Patients after Major Cardiac Surgery

Minimally invasive techniques to access subcutaneous adipose tissue for glucose monitoring are successfully applied in type1 diabetic and critically ill patients. During critical illness, the addition of a lactate sensor might enhance prognosis and early intervention. Our objective was to evaluate SAT as a site for lactate measurement in critically ill patients. In 40 patients after major cardiac surgery, arterial blood and SAT microdialysis samples were taken in hourly intervals. Lactate concentrations from SAT were prospectively calibrated to arterial blood. Analysis was based on comparison of absolute lactate concentrations (arterial blood vs. SAT) and on a 6-hour lactate trend analysis, to test whether changes of arterial lactate can be described by SAT lactate. Correlation between lactate readings from arterial blood vs. SAT was highly significant (r2 = 0.71, P < .001). Nevertheless, 42% of SAT lactate readings and 35% of the SAT lactate trends were not comparable to arterial blood. When a 6-hour stabilization period after catheter insertion was introduced, 5.5% of SAT readings and 41.6% of the SAT lactate trends remained incomparable to arterial blood. In conclusion, replacement of arterial blood lactate measurements by readings from SAT is associated with a substantial shortcoming in clinical predictability in patients after major cardiac surgery.

TIME-VARIANT INSULIN SENSITIVITY IN CRITICALLY ILL SUBJECTS

Abstract Critically ill subjects display high temporal variations in insulin sensitivity, which complicate efficient glucose control by glucose controllers. In the present study, we combined a simple, discrete-time model of glucoregulation with the regularisation method to obtain a time-variant marker of insulin sensitivity from hourly plasma glucose measurements and information about intravenous insulin infusion and parenteral intake in six critically ill subjects studied over 24 to 48h. The focus of the study was to determine “basal insulin requirements„ representing insulin appearance, which maintains normoglycaemia. We observed up to five-fold variations in the basal insulin requirements over a period of 8-10h in a half of the studied subjects. The remaining subjects had virtually unchanged basal insulin requirements. We conclude that considerable heterogeneity exist in the temporal variation of insulin resistance in critically ill subjects.

Modelling of metabolic syndrome components adherence

Abstract Metabolic (Reavens) syndrome is a set of metabolic abnonnalities including common diseases e.g. diabetes, hypertension. According to unknown pathogenesis quantitative approaches are used to analyse the adherence of the syndrome components. We have described quantitative changes in components adherence in obese patients during quantified weight loss. The number of factors describing the components of the disease is decreasing. Using an other approach (odds ratio calculation) we have described the adherence of colon cancer to diabetes. Statistical modelling was successfully used to quantify the adherence of disease components.