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To elucidate the relevance of genetic alterations, we analysed 17 genes known to be involved in haematological neoplasms in patients with chronic leucocytosis and patients with persistent thrombocytosis. Mutations of the JAK2, SETBP1 and ASXL1 genes were found in 1/13, 1/13, and 2/13 patients with leucocytosis, respectively. Mutations of the JAK2, CALR, SETBP1 and ASXL1 genes were found in 1/5, 1/5, 1/5 and 2/5 patients with thrombocytosis, respectively. One leucocytosis patient with a JAK2 V617F mutation developed polycythaemia vera. Another leucocytosis patient developed Philadelphia chromosome-negative chronic myeloid leukaemia (Ph(−) CML) accompanied by t(9;12)(q34.1;p13.?3) (Mori et al. 2016). Another leucocytosis patient with mutations of the SETBP1 and ASXL1 genes progressed to blast crisis of Ph(−) CML accompanied by i(17)(q10). Chronic leucocytosis patients who had genetic alterations tended to develop haematological neoplasms, while thrombocytosis unexpectedly resolved in two persistent thrombocytosis patients with genetic alterations. [ABSTRACT FROM AUTHOR]

Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates renal phosphate reabsorption and vitamin D synthesis in renal proximal tubules. High circulating FGF23 levels are associated with increased mortality in patients with chronic kidney disease and those on dialysis. Current data also suggest higher circulating levels of FGF23 are associated with cardiovascular mortality, vascular calcification, and left ventricular hypertrophy; however, evidence on the role of FGF23 in patients on dialysis is incomplete, and some of the data, especially those on cardiovascular disease (CVD), are controversial. This study aimed to evaluate factors associated with FGF23 in hemodialysis patients with or without CVD. Randomly selected 76 patients on maintenance hemodialysis at a single hemodialysis center were enrolled. After the exclusion of eight patients with extremely outlying FGF23 levels, 68 patients, including 48 males and 46 patients with a CVD history, were included in the study. The mean age was 64.4 ± 12.1 years, and the mean dialysis duration was 12.7 ± 7.1 years. Dialysis duration, time-averaged concentration of urea (TAC-urea), ultrafiltration rate (UFR), blood pressure during hemodialysis session, laboratory data, and echocardiographic parameters including interventricular septum thickness (IVST), left ventricular mass indices (LVMI), and ejection fraction were included in univariate and multivariate analyses. The median lgFGF23 levels in the overall cohort and in those with and without CVD were 2.14 (interquartile range, IQR − 0.43 to − 4.23), 2.01 (− 0.52 to 4.12), and 2.59 (0.07 to 4.32), respectively, and there was no difference between the patients with and without CVD (p = 0.14). The univariate analysis revealed that FGF23 was significantly associated with age (r = − 0.12, p < 0.01), duration of hemodialysis (r = − 0.11, p < 0.01), TAC-urea (r = 0.29, p = 0.01), UFR (r = 0.26, p = 0.04), alkaline phosphatase (ALP; r = − 0.27, p = 0.03), corrected serum calcium (cCa; r = 0.32, p < 0.01), serum phosphate (iP, r = 0.57, p < 0.01), intact parathyroid hormone (iPTH; r = 0.38, p < 0.01), IVST (r = 0.30, p = 0.01), and LVMI (r = 0.26, p = 0.04). In multivariate regression analysis, FGF23 was significantly associated with cCa (F = 25.6, p < 0.01), iP (F = 22.5, p < 0.01), iPTH (F = 19.2, p < 0.01), ALP (F = 5.34, p = 0.03), and UFR (F = 3.94, p = 0.05). In addition, the univariate analysis after the categorization of patients according to CVD indicated that FGF23 was significantly associated with cCa (r = 0.34, p = 0.02), iP (r = 0.41, p < 0.01), iPTH (r = 0.39, p = 0.01), and TAC-urea (r = 0.45, p < 0.01) in patients with CVD, whereas only IVST (r = 0.53, p = 0.04) was associated with FGF23 in those without CVD. FGF23 levels in hemodialysis patients were extremely high and associated not only with mineral bone disease-related factors but also with UFR. Additionally, dialysis efficacy might be associated with lower FGF23 levels in patients with CVD. [ABSTRACT FROM AUTHOR]

Objective: As a subanalysis of the Januvia Multicenter Prospective Trial in Type 2 Diabetes (JAMP study), we examined factors that decreased blood glucose control effect of sitagliptin after 3 months and patients requiring an addition or increase of diabetes treatment.Methods: We selected patients in whom glycated hemoglobin (HbA1c) levels decreased by month 3 after initiation of sitagliptin treatment and conducted two analyses: (1) in patients who did not change drugs until month 12, we compared changes in HbA1c levels between concomitant drugs and examined factors that decreased blood glucose control effect of sitagliptin; (2) compared changes in HbA1c levels and backgrounds between patients who did and did not require an addition to or increased dose of the antidiabetic agent.Results: Four hundred and ninety-eight patients were chosen. In 369 patients without drug change until month 12, changes in HbA1c levels during months 3-12 were not significantly different among concomitant drugs; factors causing rebound HbA1c were smoking and weight gain. Patient characteristics were compared between those who did and did not require an additional drug or a dose increase (n = 114) (n = 384). Drug changes were associated with longer disease duration, younger age, higher rate of smoking, and higher degree of insulin resistance but not with concomitantly administered drugs.Conclusion: Smoking and weight gain were factors that decreased the effect of sitagliptin on reducing blood glucose levels. Differences in concomitant drugs did not affect sitagliptin’s effects on glycemic control. A dose increase or the addition of the antidiabetic drug was not associated with concomitant drugs. [ABSTRACT FROM AUTHOR]

Purpose: To determine the efficacy and safety of sitagliptin when used with some therapeutic drugs to treat elderly patients.Methods: Sitagliptin (50 mg/day) was added to the pre-existing therapy for type 2 diabetes. Changes in the glycated hemoglobin (HbA1c) level after 3 months of treatment were compared with the baseline, and exploratory analysis was performed. These analyses were conducted as subanalyses of the JAMP study, which was an open-label observational study.Results: For patients who were ≥65 years of age, the change in HbA1c level from baseline ranged from −0.50 to −0.87% at 3 months after starting treatment. There was no significant difference in the change in HbA1c level between the patients treated with different concomitant drugs. No significant difference in HbA1c variations at 3 and 12 months from baseline was noted among the three age groups (≥75, 65-74, and <65 years). Multiple regression analysis was performed, and it revealed that patients with higher HbA1c levels at baseline were likely to show decreased HbA1c levels, while those with higher triglyceride (TG) levels were unlikely to show decreased HbA1c levels.Conclusion: Sitagliptin has the potential to both improve glycemic control and prevent hypoglycemia, and can be considered a potent alternative drug. [ABSTRACT FROM AUTHOR]

Antihistamines are widely used to treat pruritus in patients receiving hemodialysis. In a previous cross-sectional study, we reported an association between antihistamine use and the absence of eccentric cardiac hypertrophy in patients receiving hemodialysis. Therefore, in this study, we sought to evaluate the efficacy of antihistamines on all-cause and cardiovascular mortality in patients receiving hemodialysis according to our outpatient dialysis database. We used a propensity score matching method. Among the 389 patients receiving hemodialysis according to our database, we extracted those taking antihistamines and matched them with patients not taking antihistamines using propensity scores based on 38 variables. All-cause mortality and cardiovascular mortality were estimated by the Kaplan-Meier method, and a log-rank test was used to examine the differences between the survival curves. We included 154 patients, or 77 matched pairs, from the entire cohort (c-statistic = 0.78, p < 0.0001). There were no differences in any background factor between the antihistamine and non-antihistamine group. During the mean observational period of 5.4 years, 50 patients died, and the all-cause mortality rate was 27.3% (21 patients) in the antihistamine group and 37.3% (29 patients) in the non-antihistamine group ( p = 0.0314). The cardiovascular mortality rate was 16.9% (13 patients) in the antihistamine group and 25.9% (20 patients) in the non-antihistamine group ( p = 0.0417). The results of this study suggest that all-cause and cardiovascular mortality improved with antihistamine use in patients receiving hemodialysis. However, the clinical efficacy of antihistamines needs to be confirmed in a prospective randomized study in the future. [ABSTRACT FROM AUTHOR]

Aims and introduction: It is helpful for both diabetologists and obstetricians to identify patients with gestational diabetes who require insulin therapy for glycemic control during pregnancy. The aim of the present study was to assess potential predictors of insulin requirement in patients with gestational diabetes. Materials and methods: One hundred thirteen patients with gestational diabetes [mean age 34.2 ± 4.5 years; pre-gestational body mass index (BMI), 23.6 ± 6.0 kg/m] were included in this study. The associations between insulin requirement and the following factors were analyzed: clinical maternal characteristics, number of abnormal oral glucose tolerance test (OGTT) values, gestational age at diagnosis, plasma glucose levels measured during the OGTT, glycated hemoglobin (HbA1c) and glycated albumin levels, and serum C-peptide level before breakfast and 1 and 2 h after breakfast. Results: Thirty-six patients (32 %) required insulin during pregnancy ('insulin group'); the remaining patients were treated with nutrition therapy ('nutrition group'). The insulin group had a higher pre-gestational BMI, higher fasting glucose level, higher area under the curve (AUC) for serum C-peptide level, higher HbA1c level, and a younger gestational age at diagnosis than the nutrition group ( p < 0.05, all). Logistic regression analysis showed that the pre-gestational BMI, AUC for serum C-peptide level, and the HbA1c level were independent predictors for the insulin group ( p < 0.05, all). Conclusions: The results suggest that a high insulin resistance and HbA1c level may be associated with insulin requirement in patients with gestational diabetes. [ABSTRACT FROM AUTHOR]

Suicide rates are higher at high altitudes, and some hypothesize that hypoxia is the cause. There may be a significant correlation between rates of depression and altitude, but little data exist outside the United States. The purpose of the present study is to conduct a survey of depression among the elderly highlanders in Asia. We enrolled 114 persons aged 60 years or older (mean, 69.2 ± 6.7 years; women, 58.8%) in Domkhar (altitude, 3800 m), Ladakh, India and 173 ethnic Tibetans (mean, 66.5 ± 6.1 years; women, 61.3%) in Yushu (altitude, 3700 m), Qinghai Province, China. The two-item Patient Health Questionnaire (PHQ-2) and the geriatric depression scale were administered. A psychiatrist interviewed the subjects who had a positive score on the PHQ-2. The results of the interview with the residents conducted by the specialist showed that two cases (1.8%) from Domkhar and four (2.3%) from Qinghai had depression. Despite the high altitude, the probability of depression was low in elderly highlander in Ladakh and Qinghai. Our finding seems to indicate that cultural factors such as religious outlook and social/family relationship inhibit the development of depression. [ABSTRACT FROM AUTHOR]

Clinical cardiac applications of single-source dual-energy computed tomography (DECT) have recently been introduced. This study aimed to analyze the components of coronary arterial calcification (CAC) in vivo by material decomposition achieved with DECT. We reconstructed computed tomography (CT) angiography images for 51 consecutive patients with CACs who had undergone electrocardiography-gated coronary CT angiography by single-source DECT with fast tube voltage switching. We placed regions of interest (ROIs) within the CAC with margins of at least 0.5 mm to minimize partial volume averaging. We compared histograms for the effective atomic number (EAN) and the median, mean, and maximum EANs for each CAC with the theoretical EANs for possible CAC components, including hydroxyapatite (HA), calcium oxalate monohydrate (COM), and dicalcium phosphate dehydrate. We also investigated the in vivo EAN for COM and in vitro EAN for HA by our phantom experiment. Analysis of the CAC components was feasible in 177 ROIs from 28 patients. The median EAN was 13.8 ± 0.8 (95 % confidence interval 13.7-13.9), which is similar to the theoretical EAN for COM (13.8). The EAN for HA in vitro was 16.5 ± 0.1, which was slightly higher than the theoretical EAN value for HA (16.1). Notably, the median EAN in 144 ROIs (81.4 %) was between 11.2 and 14.4, which is the reported range of the in vivo EAN for COM. Our results suggest that COM might be a more frequent CAC component than previously reported. [ABSTRACT FROM AUTHOR]

A 29-year-old woman with diabetes mellitus was admitted to our hospital for severe congestive heart failure. She was suspected of having Prader-Willi syndrome (PWS) or Angelman syndrome. On admission, a chest X-ray showed pneumonia and cardiomegaly with massive pleural and pericardial effusion. Obstructive and central sleep apnea syndrome was suggested, because of severe obesity and episodes of apnea without breathing and movement of the rib cage. The causes of central sleep apnea syndrome include pneumonia, hypoxia, and high metabolic production of an anticonvulsant drug because of epileptic seizure, and she had an abnormal electroencephalogram. She went on to mechanical ventilation (for example BiPAP, CPAP, and SIMV) and treatment with antibiotics. She continued to receive pressure support ventilation and antiepileptic drug treatment, and her systemic condition improved markedly after transfer to another hospital. She was finally diagnosed as PWS by genetic testing. Unfortunately, she died suddenly after choking on a sputum clog 5 months after discharge from the hospital. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify clinical factors that were associated with insulin sensitivity and secretion by multiple linear regression analysis in Japanese subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT). Materials and methods: A total of 2,983 subjects were classified into two groups, NGT and IGT, according to the oral glucose tolerance test criteria. To assess insulin sensitivity, homeostasis model assessment (HOMA)-S and the Matsuda index were used. To determine insulin secretion, HOMA-β, the insulinogenic index (IGI), basal disposition index (DI), and early phase DI were calculated. Stepwise multiple regression analyses were performed to examine the relationships between these indices and certain clinical factors, such as body mass index (BMI), HbA1c, age, sex, and family history. Results: BMI was the only significant factor associated with HOMA-S. For the Matsuda index, the most important factor was BMI, followed by age and sex. BMI, HbA1c, age, sex, and family history were significantly associated with HOMA-β, IGI, basal DI, and early phase DI. The standardized partial regression coefficients of HOMA-β and IGI were highest for BMI. For basal DI and early phase DI, the highest standardized partial regression coefficient was found to be HbA1c, followed by age and BMI. Basal DI and early phase DI were more useful than HOMA-β and IGI to assess insulin secretion. Conclusions: The most important factors associated with insulin sensitivity and secretion are BMI and HbA1c, respectively. Age is more associated with insulin secretion than with insulin sensitivity. [ABSTRACT FROM AUTHOR]

Erratum to: Diabetol Int DOI 10.1007/s13340-017-0330-2. [ABSTRACT FROM AUTHOR]