AIM: To explore the association of serum insulin, insulin resistance, and β-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 ...AIM: To explore the association of serum insulin, insulin resistance, and β-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and β-cell dysfunction (HOMA β-cell). RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4th vs 1st quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4th vs 1st quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA β-cell function was significantly related to decreased risk of GSD [4th vs 1st quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA β-cell was observed among males. CONCLUSION: Serum insulin, insulin resistance, and β-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.展开更多
BACKGROUND Despite the availability of current therapies,including oral antidiabetic drugs and insulin,for controlling the symptoms caused by high blood glucose,it is difficult to cure diabetes mellitus,especially typ...BACKGROUND Despite the availability of current therapies,including oral antidiabetic drugs and insulin,for controlling the symptoms caused by high blood glucose,it is difficult to cure diabetes mellitus,especially type 1 diabetes mellitus.AIM Cell therapies using mesenchymal stem cells(MSCs)may be a promising option.However,the therapeutic mechanisms by which MSCs exert their effects,such as whether they can differentiate into insulin-producing cells (IPCs) beforetransplantation, are uncertain.METHODSIn this study, we used three types of differentiation media over 10 d to generateIPCs from human Wharton’s jelly MSCs (hWJ-MSCs). We further transplantedthe undifferentiated hWJ-MSCs and differentiated IPCs derived from them intothe portal vein of rats with streptozotocin-induced diabetes, and recorded thephysiological and pathological changes.RESULTSUsing fluorescent staining and C-peptide enzyme-linked immunoassay, we wereable to successfully induce the differentiation of hWJ-MSCs into IPCs.Transplantation of both IPCs derived from hWJ-MSCs and undifferentiated hWJMSCshad the therapeutic effect of ameliorating blood glucose levels andimproving intraperitoneal glucose tolerance tests. The transplanted IPCs homedto the pancreas and functionally survived for at least 8 wk after transplantation,whereas the undifferentiated hWJ-MSCs were able to improve the insulitis andameliorate the serum inflammatory cytokine in streptozotocin-induced diabeticrats.CONCLUSIONDifferentiated IPCs can significantly improve blood glucose levels in diabetic ratsdue to the continuous secretion of insulin by transplanted cells that survive in theislets of diabetic rats. Transplantation of undifferentiated hWJ-MSCs cansignificantly improve insulitis and re-balance the inflammatory condition indiabetic rats with only a slight improvement in blood glucose levels.展开更多
AIM:To investigate whether screening for gallstone disease was economically feasible and clinically effective.METHODS:This clinical study was initially conducted in2002 in Taipei,Taiwan.The study cohort total included...AIM:To investigate whether screening for gallstone disease was economically feasible and clinically effective.METHODS:This clinical study was initially conducted in2002 in Taipei,Taiwan.The study cohort total included2386 healthy adults who were voluntarily admitted to a regional teaching hospital for a physical check-up.Annual follow-up screening with ultrasound sonography for gallstone disease continued until December 31,2007.A decision analysis using the Markov Decision Model was constructed to compare different screening regimes for gallstone disease.The economic evaluation included estimates of both the cost-effectiveness and cost-utility of screening for gallstone disease.RESULTS:Direct costs included the cost of screening,regular clinical fees,laparoscopic cholecystectomy,and hospitalization.Indirect costs represent the loss of productivity attributable to the patient’s disease state,and were estimated using the gross domestic product for 2011 in Taiwan.Longer time intervals in screening for gallstone disease were associated with the reduced efficacy and utility of screening and with increased cost.The cost per life-year gained(average cost-effectiveness ratio)for annual screening,biennial screening,3-year screening,4-year screening,5-year screening,and no-screening was new Taiwan dollars(NTD)39076,NTD 58059,NTD 72168,NTD 104488,NTD 126941,and NTD 197473,respectively(P<0.05).The cost per quality-adjusted life-year gained by annual screening was NTD 40725;biennial screening,NTD64868;3-year screening,NTD 84532;4-year screening,NTD 110962;5-year screening,NTD 142053;and for the control group,NTD 202979(P<0.05).The threshold values indicated that the ultrasound sonography screening programs were highly sensitive to screening costs in a plausible range.CONCLUSION:Routine screening regime for gallstone disease is both medically and economically valuable.Annual screening for gallstone disease should be recommended.展开更多
Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review ...Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review the possible mechanisms, such as kokesi phenomenon or insufficient pecking motion with decreased rotational speed. We also review the potential techniques ever proposed to rescue this complica-tion percutaneously, including simple manual traction, balloon dilation to release the trap, snaring the burr as distal as possible for forceful local traction and wedging the burr with a child catheter to facilitate retrieval. Gentle pecking motion of the burr for sufficient ablation and shortening the run less than 15 s may avoid such complications. Interventional cardiologists using the rotablator should be familiar with the tips and tricks to avoid and rescue this complication.展开更多
In the presence of a large patent ductus arteriosus(PDA),aortic co-arctation(CoA)cannot be diagnosed clinically because PDA masks the clinical features.This condition impedes the identification of CoA by transthoracic...In the presence of a large patent ductus arteriosus(PDA),aortic co-arctation(CoA)cannot be diagnosed clinically because PDA masks the clinical features.This condition impedes the identification of CoA by transthoracic echcocardiography.However,the closure of PDA can result in a severe clinical condition that causes a patient with undiagnosed CoA to suffer from shock and multi-organ failure.In this article,a case of PDA was presented,in which transesophageal echocardiography provided full information that could be used as reference to identify and define CoA during PDA ligation surgery.展开更多
基金Supported by the grants from the National Science Council, Nos.NSC-91-2320-B-010-102 and NSC-92-2320-B-010-102
文摘AIM: To explore the association of serum insulin, insulin resistance, and β-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and β-cell dysfunction (HOMA β-cell). RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4th vs 1st quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4th vs 1st quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA β-cell function was significantly related to decreased risk of GSD [4th vs 1st quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA β-cell was observed among males. CONCLUSION: Serum insulin, insulin resistance, and β-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.
基金Taipei Veterans General Hospital,No.V106B-024Yen Tjing Ling Medical Foundation,No.CI-106-20+1 种基金Cheng Hsin General Hospital,No.CY10716Taiwan Ministry of Science and Technology,No.MOST 105-2314-B-010-010-MY3 and No.MOST 106-2314-B-010-009
文摘BACKGROUND Despite the availability of current therapies,including oral antidiabetic drugs and insulin,for controlling the symptoms caused by high blood glucose,it is difficult to cure diabetes mellitus,especially type 1 diabetes mellitus.AIM Cell therapies using mesenchymal stem cells(MSCs)may be a promising option.However,the therapeutic mechanisms by which MSCs exert their effects,such as whether they can differentiate into insulin-producing cells (IPCs) beforetransplantation, are uncertain.METHODSIn this study, we used three types of differentiation media over 10 d to generateIPCs from human Wharton’s jelly MSCs (hWJ-MSCs). We further transplantedthe undifferentiated hWJ-MSCs and differentiated IPCs derived from them intothe portal vein of rats with streptozotocin-induced diabetes, and recorded thephysiological and pathological changes.RESULTSUsing fluorescent staining and C-peptide enzyme-linked immunoassay, we wereable to successfully induce the differentiation of hWJ-MSCs into IPCs.Transplantation of both IPCs derived from hWJ-MSCs and undifferentiated hWJMSCshad the therapeutic effect of ameliorating blood glucose levels andimproving intraperitoneal glucose tolerance tests. The transplanted IPCs homedto the pancreas and functionally survived for at least 8 wk after transplantation,whereas the undifferentiated hWJ-MSCs were able to improve the insulitis andameliorate the serum inflammatory cytokine in streptozotocin-induced diabeticrats.CONCLUSIONDifferentiated IPCs can significantly improve blood glucose levels in diabetic ratsdue to the continuous secretion of insulin by transplanted cells that survive in theislets of diabetic rats. Transplantation of undifferentiated hWJ-MSCs cansignificantly improve insulitis and re-balance the inflammatory condition indiabetic rats with only a slight improvement in blood glucose levels.
基金Supported by Grant from the National Science Council,No.NSC-98-2314-B-350-002-MY3(in part)
文摘AIM:To investigate whether screening for gallstone disease was economically feasible and clinically effective.METHODS:This clinical study was initially conducted in2002 in Taipei,Taiwan.The study cohort total included2386 healthy adults who were voluntarily admitted to a regional teaching hospital for a physical check-up.Annual follow-up screening with ultrasound sonography for gallstone disease continued until December 31,2007.A decision analysis using the Markov Decision Model was constructed to compare different screening regimes for gallstone disease.The economic evaluation included estimates of both the cost-effectiveness and cost-utility of screening for gallstone disease.RESULTS:Direct costs included the cost of screening,regular clinical fees,laparoscopic cholecystectomy,and hospitalization.Indirect costs represent the loss of productivity attributable to the patient’s disease state,and were estimated using the gross domestic product for 2011 in Taiwan.Longer time intervals in screening for gallstone disease were associated with the reduced efficacy and utility of screening and with increased cost.The cost per life-year gained(average cost-effectiveness ratio)for annual screening,biennial screening,3-year screening,4-year screening,5-year screening,and no-screening was new Taiwan dollars(NTD)39076,NTD 58059,NTD 72168,NTD 104488,NTD 126941,and NTD 197473,respectively(P<0.05).The cost per quality-adjusted life-year gained by annual screening was NTD 40725;biennial screening,NTD64868;3-year screening,NTD 84532;4-year screening,NTD 110962;5-year screening,NTD 142053;and for the control group,NTD 202979(P<0.05).The threshold values indicated that the ultrasound sonography screening programs were highly sensitive to screening costs in a plausible range.CONCLUSION:Routine screening regime for gallstone disease is both medically and economically valuable.Annual screening for gallstone disease should be recommended.
文摘Entrapment of the burr within calcified lesion is an uncommon, but serious complication during rotational atherectomy and usually needs surgical retrieval. We report a case series of this complication and also review the possible mechanisms, such as kokesi phenomenon or insufficient pecking motion with decreased rotational speed. We also review the potential techniques ever proposed to rescue this complica-tion percutaneously, including simple manual traction, balloon dilation to release the trap, snaring the burr as distal as possible for forceful local traction and wedging the burr with a child catheter to facilitate retrieval. Gentle pecking motion of the burr for sufficient ablation and shortening the run less than 15 s may avoid such complications. Interventional cardiologists using the rotablator should be familiar with the tips and tricks to avoid and rescue this complication.
文摘In the presence of a large patent ductus arteriosus(PDA),aortic co-arctation(CoA)cannot be diagnosed clinically because PDA masks the clinical features.This condition impedes the identification of CoA by transthoracic echcocardiography.However,the closure of PDA can result in a severe clinical condition that causes a patient with undiagnosed CoA to suffer from shock and multi-organ failure.In this article,a case of PDA was presented,in which transesophageal echocardiography provided full information that could be used as reference to identify and define CoA during PDA ligation surgery.
