Serum insulin, insulin resistance, p-cell dysfunction, and gallstone disease among type 2 diabetics in Chinese population: A community-based study in Kinmen, Taiwan

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.

Clinical correlation of gallstone disease in a Chinese population in Taiwan:Experience at Cheng Hsin General Hospital

AIM： TO explore the prevalence of gallstone disease （GSD） in Taiwan and condition-associated factors related to it. METHODS： We studied a total of 2386 healthy adults （1235 males and 1151 females） voluntarily admitted to Cheng Hsin General Hospital for a paid physical check-up between January 2002 and December 2002. Blood samples and ultrasound sonography results were collected. RESULTS： The overall prevalence of GSD among this study-population was 5.3%, including 1.7% （n=40） having a single stone, 2.3% （n = 55） having multiple stones, and 1.3% （n = 31） having cholecystectomy. The prevalence revealed a statistically significant increase with increasing age （P〈 0.0001）. Females exhibited a greater prevalence of multiple stones than did males （3.0% vs 1.7%, P= 0.04）. Using multiple logistic regression analysis, the following appeared to be significantly related to the prevalence of GSD： older age （40-49 years vs 〈40 years, OR= 1.63 [95% CI： 0.76-3.48], 50-59 years vs 〈40 years, OR=4.93 [95% CI： 2.43-9.99], 60-69 years vs 〈40 years, OR = 6.82 [95% CI： 3.19-14.60], ≥70 years vs 〈40 years, OR= 10.65 [95% CI： 4.78-23.73]）, higher BMI （≥27 kg/m^2 vs 〈24 kg/m^2, adjusted OR= 1.74 [95% CI： 1.04-2.88]）, and higher FPG （≥ 126 mg/dL vs 〈110 mg/dL, OR= 1.71, 95% CI： 1.01-2.96）. CONCLUSION： Older age （≥50 years）, obesity （BMI ≥ 27 kg/m^2）, and type 2 diabetes （FPG ≥126 mg/dL） are associated with the prevalence of GSD.

A population-based follow-up study on gallstone disease among type 2 diabetics in Kinmen,Taiwan

AIM： To assess the incidence of and risk factors for gallstone disease （GSD） among type 2 diabetics in Kinmen, Taiwan. METHODS： A screening program for GSD was performed by two specialists who employed real-time abdominal ultrasound to examine the abdominal region after patients had fasted for at least eight hours. Screening, which was conducted in 2001, involved 848 patients diagnosed with type 2 diabetes. After exclusion of 63 subjects with prevalent GSD, 377 participants without GSD were invited in 2002 for a second round of screening. A total of 281 （74.5%） subjects were re-examined. RESULTS： Among the 281 type 2 diabetics who had no GSD at the first screening, 10 had developed GSD by 2002. The incidence was 3.56% per year （95%CI： 1.78% per year-6.24% per year）. Using a Cox regression model, age （RR = 1.07, 95% CI： 1.00-1.14）, waist circumference （RR = 1.12, 95% CI： 1.01-1.29）, and ALT （RR = 1.13, 95%CI： 1.01-1.26） appeared to be significantly correlated with development of GSD. CONCLUSION： Older age is a known risk factor for the development of GSD. Our study shows that greater waist circumference and elevated ALT levels are also associated with the development of GSD among type 2 diabetics in Kinmen.

Associations between walking parameters and subsequent sleep difficulty in older adults: A 2-year follow-up study

Purpose: This 2-year follow-up study aimed to examine the associations between total volume, frequency, duration, and speed of walking with subsequent sleep difficulty in older adults.Methods: A total of 800 older adults aged 65 years and over participated in the first survey in 2012 and 511 of them were followed 2 years later.The 5-item Athens Insomnia Scale(AIS-5) was used to measure sleep difficulty. Frequency, duration, and speed of outdoor walking were self-reported. Walking speed was assigned a metabolic equivalent value(MET) from 2.5 to 4.5. Total walking volume in MET-h/week was calculated as frequency × duration × speed. Negative binomial regressions were performed to examine the associations between volume and components of walking with subsequent sleep difficulty with covariates of age, sex, education, marital status, living arrangement, smoking, alcohol consumption, mental health, Charlson Index, exercise(excluding walking), and sleep difficulty at baseline.Results: Participants with low walking volume had a higher level of sleep difficulty 2 years later compared with those with high walking volume(incident rate ratios = 1.61, p = 0.004). When speed, frequency, and duration of walking were simultaneously entered into 1 model, only walking speed was significantly associated with subsequent sleep difficulty(after the model was adjusted for covariates and baseline sleep difficulty).Sensitivity analyses showed that walking duration emerged as a significant predictor among 3 walking parameters, with 2-year changes of sleep scores as dependent variable.Conclusion: Total amount of walking(especially faster walking and lasting for more than 20 min) is associated with less subsequent sleep difficulty after 2 years among older adults.

Prevention of Malpractice in the Field of Health, as the Other Type of Prevention

Background: So far, five types of prevention including: primordial, primary, secondary, tertiary and quaternary prevention levels have been defined in literatures. Aim: In this study, we have proposed “prevention of malpractice” as the other level of prevention. Methods: Qualitative comparison of the data, obtained from the review of conducted studies by using of scientific literatures, registered in PubMed, Google Scholar and Scopus sites. Results: Bringing dozens of examples of “malpractice” in the five areas of prevention. Conclusion: We concluded that, “malpractice” may be occurred at all levels of prevention and preventing it can be considered as the other level of prevention.

Aryl hydrocarbon receptor signaling promotes ORMDL3- dependent generation of sphingosine-1-phosphate by inhibiting sphingosine-1-phosphate lyase

Aryl hydrocarbon receptor(AhR),a cellular chemical sensor,controls cellular homeostasis,and sphingosine-1-phosphate(S1P),a bioactive intermediate of sphingolipid metabolism,is believed to have a role in immunity and inflammation,but their potential crosstalk is currently unknown.We aimed to determine whether there is a functional linkage between AhR signaling and sphingolipid metabolism.We showed that AhR ligands,including an environmental polycyclic aromatic hydrocarbon(PAH),induced S1P generation,and inhibited S1P lyase(S1PL)activity in resting cells,antigen/IgE-activated mast cells,and mouse lungs exposed to the AhR ligand alone or in combination with antigen challenge.The reduction of S1PL activity was due to AhR-mediated oxidation of S1PL at residue 317,which was reversible by the addition of an antioxidant or in cells with knockdown of the ORMDL3 gene encoding an ER transmembrane protein,whereas C317A S1PL mutant-transfected cells were resistant to the AhR-mediated effect.Furthermore,analysis of AhR ligand-treated cells showed a time-dependent increase of the ORMDL3–S1PL complex,which was confirmed by FRET analysis.This change increased the S1P levels,which in turn,induced mast cell degranulation via S1PR2 signaling.In addition,elevated levels of plasma S1P were found in children with asthma compared to non-asthmatic subjects.These results suggest a new regulatory pathway whereby the AhR–ligand axis induces ORMDL3-dependent S1P generation by inhibiting S1PL,which may contribute to the expression of allergic diseases.