Objective: The risk of fracture is higher in people with than without diabetes. Because bone mineral density is not a good predictive marker of bone strength in people with diabetes, another surrogate is needed. Sclerostin is an inhibitor of bone formation and is secreted mainly by osteocytes. This study was performed to clarify how the serum sclerostin concentration reflects bone turnover in patients with type 2 diabetes.
Methods: We measured the serum sclerostin concentration and other bone turnover markers in 49 patients with type 2 diabetes (26 men and 23 postmenopausal women). The osteo-sono assessment index was measured using ultrasonography at the calcaneus.
Results: In men, the serum sclerostin concentration was significantly correlated with age, homocysteine, and pentosidine, reflecting an accumulation of advanced glycation end products in the bone. The multiple regression analysis showed that the serum pentosidine concentration was associated with the serum sclerostin concentration in men with type 2 diabetes. In contrast, sclerostin was not significantly correlated with pentosidine or other bone turnover markers in women with type 2 diabetes.
Conclusions: The serum sclerostin concentration seems to increase in accordance with the accumulation of advanced glycation end products in patients with type 2 diabetes and might reflect the bone quality in men with diabetes.
Objectives: Full-spectrum endoscopy (FUSE) provides a 330° angle of view with two side-viewing cameras in addition to a forward-viewing camera and may improve the colorectal polyp detection rate in blind spots. We evaluated whether FUSE improved colonic polyp detection in a single-center, randomized, crossover trial.
Methods: Between July 2016 and May 2017, 55 participants (40 men, 15 women) aged 23 to 82 years were enrolled for colorectal polyp screening. Participants were randomly allocated to a forward-viewing (FV)-first group or a FUSE-first group, with stratification according to participant age, sex, and endoscopist. The right colon was examined twice in succession from the cecum to the splenic flexure. Colonic polyp miss rates (PMRs) and endoscopic observation times were compared.
Results: Five participants were excluded: three because of insertion difficulty and two because of reinsertion difficulty. In the per-protocol analysis, 23 participants (46.0%) were randomly assigned to the FUSE-first group and 27 (54.0%) to the FV-first group. In the per-lesion analysis, the PMR was significantly lower with FUSE (1/29, 3.4%) than with FV (12/39, 30.7%; P=0.025). However, by per-participant analysis, polyp detection rates were not significantly different (11/23 [47.8%] with FUSE vs 9/27 [33.3%] with FV; P=0.667). All missed polyps were less than 6 mm in size. The observation time was significantly longer with FUSE than with FV in the FUSE-first group, but not in the FV-first group.
Conclusions: This study provides evidence that FUSE improves colonic polyp detection, especially in the right colon, and might improve interval colorectal cancer screening efficacy.
Objectives: Peripheral lung nodules containing ground-glass opacity (GGO), which include both pure GGN (nodules that contain only GGO) and part-solid GGN (nodules that contain both GGO and consolidation), are difficult to diagnose by conventional transbronchial biopsy (TBB) because they are not visible by fluoroscopy. Recently developed endobronchial ultrasound (EBUS)-guided TBB is useful for diagnosing these nodules. This study was performed to clarify the contribution of EBUS to the diagnostic yield of TBB for peripheral lung nodules containing GGO.
Methods: We retrospectively reviewed the medical records of 41 patients (21 male, 20 female; median age, 72 years) with peripheral lung pure GGN or part-solid GGN who underwent EBUS-guided TBB.
Results: The median diameter of the target lesions was 18.6 mm (range, 8.8–46.7 mm). There were seven pure GGN lesions and 34 part-solid GGN lesions. The total diagnostic yield was 65.9% (27/41). EBUS images could be obtained (positive) in 30 (73.1%) patients. Among the clinical factors studied, only a positive EBUS finding was significantly associated with a higher diagnostic yield (p=0.018). Diagnostic yield tended to be higher in patients with a positive CT bronchus sign (presence of a bronchus leading directly to the target lesion) and increased consolidation-to-tumor ratio.
Conclusions: EBUS-guided TBB is useful for diagnosing GGN or part-solid GGN. Obtaining positive EBUS findings is important for successful TBB for lesions containing GGO.
Objective: We previously reported that macrophages contribute to the pathogenesis of refractory nephrotic syndrome (NS). To elucidate the mechanism behind macrophage accumulation and to identify a predictive biomarker of steroid responsiveness, we compared differences in cytokine and chemokine levels in serum and urine between steroid-sensitive (SSNS) and steroid-resistant (SRNS) children with NS.
Methods: Eighteen children with NS (7.1±4.3 years; male-to-female ratio, 12:6) were divided into an SSNS group (n=10) and an SRNS group (n=8) according to their clinical course. Serum and urinary samples were collected at the time of onset and remission. Samples from age-matched healthy children were used as controls (n=15). Cytokines and chemokines were measured using a cytometric bead array kit.
Results: Clinical findings and laboratory data at sampling were comparable between the SRNS and SSNS groups. Serum cytokines and chemokines did not significantly differ at the time of onset between remission and control groups. In contrast, at onset, several urinary chemokines were significantly elevated in children with NS (IP-10, MCP-1, MIG, RANTES; all p<0.01). Urinary MCP-1 levels were significantly elevated in the SRNS group compared with the SSNS group (p<0.01).
Conclusions: Chemokines might be associated with the pathogenesis of NS. Increased urinary excretion of MCP-1 in children with SRNS is a potential predictive biomarker of steroid responsiveness in idiopathic NS. Further histological studies, including macrophage accumulation, are required to determine the mechanisms of steroid resistance in refractory NS.
Objectives: We developed standard values for the Frenchay Activities Index (FAI) for volunteers aged 10–79 years, and evaluated the lifestyles of healthy local residents by age group.
Subjects: Participants were 788 local residents (326 males, 462 females) who participated in regional events held near Nagoya City and agreed to cooperate with this survey.
Methods: We set up a survey venue during a regional event. The FAI questionnaire was administered to consenting participants by two qualified occupational therapists and five volunteer staff who were briefed regarding the FAI.
Results: Comparisons of total FAI scores by sex for each age group showed that for participants aged 30–79 years, women’s scores were significantly higher than men’s. There were no sex-based differences among participants in their teens and 20s.
Conclusions: Participants in their teens and 20s rarely engage in domestic activities, and focus on studying or academic activities. The findings also suggested that by age 30 years, men mainly focus on work and engage less in housekeeping activities. Women appear to focus on both housework and their occupations by age 30 years. The FAI reflects changes in Japanese participants’ lifestyles by age, and these scores appeared to be effective for evaluating activities parallel to daily living, regardless of age.