Comparison of coronary heart disease risk among four diagnostic definitions of metabolic syndrome

PURPOSE

Metabolic syndrome (MetS) is now well known as one of the major risk factors for coronary heart disease (CHD). Currently, there are several methods used to define MetS. The aim of this study was to determine to what extent current MetS definition reflects CHD risk using the probability of CHD in 10 years based on Framingham risk score algorithms.

METHODS

A total of 7575 adults, aged 16-93 years (2532 men and 5043 women), were recruited. We conducted a cross-sectional health survey in China using MetS criteria from four different definitions: modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF), Chinese and Japanese.

RESULTS

Differences in the prevalence of MetS by each definition were small in males (22.9-25.9 %), whereas in females, MetS was three times more prevalent using the IDF definition (29.1 %) versus the Japanese definition (9.7 %). Framingham risk scores in participants with MetS were significantly higher than in those without MetS by all definition criteria (p < 0.001). The CHD risk scores for participants with MetS by each definition showed similar values in males (range 11.5-12.1 %) with no significant differences among definitions. Conversely, in females with MetS the risk score for CHD was low (range 3.5-4.3 %) by each MetS definition.

CONCLUSIONS

These findings suggest that further studies are required to establish appropriate criteria of MetS in females.

Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery

Background

Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperatively, and compared these measurements between the two different incision types. Further we explored the risk factors of the postoperative MRD1 reduction.

Methods

The study population included patients who underwent cataract surgery on both eyes at Aichi Medical University between October 2013 and September 2015. In each patient, one eye was operated using an upper 2.4-mm transconjunctival sclerocorneal incision, and the other with a temporal incision. We prespecified that an MRD1 difference of ≥0.5 mm between the pre- and post-surgical measurements indicated postoperative ptosis, which was a strict criterion. MRD1 was measured using digital photography, and we calculated the difference between the preoperative and postoperative MRD1 values. This change in MRD1 was compared between the groups with different incision locations. The change in MRD1 was analyzed by using the multivariate regression model including incision position (temporal or upper), preoperative MRD1, and preoperative distance between medial and lateral canthi.

Results

We assessed data from a total of 34 patients. The mean change in MRD1 from pre-operation to post-operation measurements was −0.26 ± 0.93 with the temporal incision and −0.24 ± 0.86 with the upper incision. The mean difference in the change in MRD1 between the different two incision types was −0.02, with a 95 % CI of −0.24 to 0.20, establishing equivalence between these incision types. The multivariate regression analysis showed that the preoperative MRD1 was significantly associated with the reduction of MRD1 after surgery (p = 0.034).

Conclusions

Cataract surgery using upper and temporal 2.4-mm transconjunctival sclerocorneal incisions are clinically equivalent with regards to change in MRD1, and neither incision type caused critical postoperative ptosis. The longer preoperative MRD1 was significantly associated with the reduction of MRD1 after surgery.

Trial registration

Current Controlled Trials UMIN000022310. Retrospectively registered 14 May 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-016-0286-1) contains supplementary material, which is available to authorized users.

Early resolution of subretinal fluid without high-dose corticosteroids in a pregnant patient with Vogt-Koyanagi-Harada disease: a case report

BACKGROUND

At present, there is no standard of treatment using systemic high-dose corticosteroids in cases of pregnant women with Vogt-Koyanagi-Harada (VKH) disease. Although high-dose systemic corticosteroid treatment is often used for VKH disease during pregnancy, it also poses a risk to the fetus.

FINDINGS

A 29-year-old woman in the 34th week of pregnancy experienced bilateral metamorphopsia. She had been receiving 5 mg of prednisolone daily for the past 8 years as treatment for rheumatoid arthritis. In order to prevent progression of bilateral serous retinal detachment caused by VKH disease, we recommended the use of high-dose systemic corticosteroids but the patient refused. Thus, we administered only topical ophthalmic betamethasone for mild anterior uveitis. Surprisingly, however, the bilateral bullous retinal detachment healed in just 19 days after the onset of symptoms. A healthy baby was born 1 month later, and sunset glow fundus was subsequently observed without any recurrence of uveitis.

CONCLUSIONS

We report a case in which bilateral subretinal fluid caused by VKH disease in a young woman during late pregnancy resolved without high-dose corticosteroid treatment. Pregnancy may have had a beneficial effect on uveitis activity caused by VKH disease. To our knowledge, this report describes the shortest healing period for bilateral bullous retinal detachment in a pregnant woman with VKH disease.

Use of Robotic Pets in Providing Stimulation for Nursing Home Residents with Dementia

Trial experiments utilized robotic pets to facilitate self-reliance in nursing home residents. A remote-control robot modeled clear and meaningful behaviors to elderly residents. Special attention was paid to its effects on mental and social domains. Employing the robot as a gaze target and center of attention created a cue to initiate a communication channel between residents who normally show no interest in each other. The Sony AIBO robot in this study uses commercially available wireless equipment, and all its components are easily accessible to any medical or welfare institution interested in additional practice of these activities.

Biphasic modulation by mGlu5 receptors of TRPV1-mediated intracellular calcium elevation in sensory neurons contributes to heat sensitivity

BACKGROUND AND PURPOSE

Elevation of glutamate, an excitatory amino acid, during inflammation and injury plays a crucial role in the reception and transmission of sensory information via ionotropic and metabotropic receptors. This study aimed to investigate the mechanisms underlying the biphasic effects of metabotropic glutamate mGlu5 receptor activation on responses to noxious heat.

EXPERIMENTAL APPROACH

We assessed the effects of intraplantar quisqualate, a non-selective glutamate receptor agonist, on heat and mechanical pain behaviours in mice. In addition, the effects of quisqualate on the intracellular calcium response and on membrane currents mediated by TRPV1 channels, were examined in cultured dorsal root ganglion neurons from mice.

KEY RESULTS

Activation of mGlu5 receptors in hind paw transiently increased, then decreased, the response to noxious heat. In sensory neurons, activation of mGlu5 receptors potentiated TRPV1-mediated intracellular calcium elevation, while terminating activation of mGlu5 receptors depressed it. TRPV1-induced currents were potentiated by activation of mGlu5 receptors under voltage clamp conditions and these disappeared after washout. However, voltage-gated calcium currents were inhibited by the mGlu5 receptor agonist, even after washout.

CONCLUSIONS AND IMPLICATIONS

These results suggest that, in sensory neurons, mGlu5 receptors biphasically modulate TRPV1-mediated intracellular calcium response via transient potentiation of TRPV1 channel-induced currents and persistent inhibition of voltage-gated calcium currents, contributing to heat hyper- and hypoalgesia.

Simultaneous modified Camitz opponensplasty using a pulley at the radial side of the flexor retinaculum in severe carpal tunnel syndrome

Camitz opponensplasty using the palmaris longus has been used in patients undergoing open carpal tunnel release. It is considered to have several advantages over other opponensplasty techniques, but it provides weak flexion and pronation, which are prerequisites for opposition. To address this shortcoming, we have used a modified Camitz procedure with a pulley at the radial side of the dissected flexor retinaculum and have assessed the results in comparison with the conventional Camitz procedure. Both procedures provided significant improvements in palmar abduction and Disabilities of the Arm, Shoulder, and Hand and Kapandji scores at 3 months post-operatively, but patients who underwent the modified Camitz procedure showed better improvement in pulp pinch, palmar abduction, and thumb pronation.

166 MATURATION OF BOVINE OOCYTES IN POLY(DIMETHYLSILOXANE) MICROWELLS AND THEIR SUBSEQUENT DEVELOPMENT FOLLOWING IN VITRO FERTILIZATION

During bovine oocyte maturation, a lower density of cumulus cells surrounding oocytes reduces the developmental competence of the oocytes after IVF. Adding more cumulus cells (Hashimoto et al. 1998) rescues the developmental competence of the corona-enclosed oocytes. In this study, we examined the effects of poly(dimethylsiloxane) (PDMS) microwells (MW) for bovine oocyte maturation on the developmental competence of the oocytes following IVF. In experiment 1, MW were produced by making holes on 0.5-mm-thick PDMS plates using a 0.5-mm-diameter biopsy punch. The punched plates were placed on the bottoms of culture dishes. Bovine cumulus oocytes complexes (COC) were collected from slaughterhouse ovaries. Cumulus layers were removed from COC to prepare corona-enclosed oocytes (CEO) and denuded oocytes (DO). Then, COC, CEO, or DO were individually matured in single MW for 24 h at 39°C under 5% CO2 in air with high humidity. Ten oocytes of each group were matured in 50-μL droplets of maturation medium (group culture, GC) as controls. Maturation medium was TCM-199 supplemented with 10% FCS, 0.02 AU mL–1 FSH, and 1 μg mL–1 E2. The matured oocytes were fertilized with frozen–thawed spermatozoa. The embryos were cultured in CR1aa medium for 168 h under 5% CO2, 5% O2 and 90% N2 with high humidity. In experiment 2, effects of depth of MW for maturation on subsequent development following IVF were examined. Microwells were produced by making 0.5-mm-diameter holes on 0.5- or 1.5-mm-thick PDMS plates. Then, COC or CEO were individually matured in the MW for 24 h. Matured oocytes were fertilized in vitro and cultured for 168 h. Oocytes that were matured by GC were used as controls. In experiment 1(N = 4), rates of maturation (76–100%, n = 26 to 38), normal fertilization (53–70%, n = 44 to 49), and cleavage (61–77%, n = 114 to 117) were not different among all groups (P > 0.05; Fisher's PLSD test following ANOVA). Blastocyst rates were the same (P > 0.05) for COC matured in MW (50%) and by GC (43%). The rate for CEO that matured in MW (46%) tended to be higher (P = 0.061) than the rate for CEO that matured by GC (31%), and was comparable to the rate for COC matured by GC (43%). The blastocyst rates for DO that matured in MW and by GC were low (6%). In experiment 2 (N = 3), rates of maturation (86–100%, n = 13 to 28), normal fertilization (60–78%, n = 22 to 40), and cleavage (67–73%, n = 85 to 90) were not different among all groups (P > 0.05). However, the blastocyst rate for COC that matured in 1.5-mm-deep MW (53%) was significantly higher than the rates for COC that matured in 0.5-mm-deep MW (38%) and by GC (31%; P < 0.05). The results indicate that the developmental competence of oocytes that matured individually in PDMS MW was greater than that of oocytes that matured by GC. The deeper (1.5 mm) MW were found to be more effective for oocyte maturation than shallow (0.5 mm) MW and GC. The MW might increase density of cumulus cells surrounding oocytes, and the high cell-density enhanced the developmental competence of the oocytes.

The burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka

AIMS

To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka.

METHODS

A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data.

RESULTS

Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes.

CONCLUSIONS

Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes.

A Comparison between Revised NCEP ATP III and IDF Definitions in Diagnosing Metabolic Syndrome in an Urban Sri Lankan Population: The Ragama Health Study

Background. The prevalence of metabolic syndrome (MetS) within individual cohorts varies with the definition used. The aim of this study was to compare the prevalence of MetS between IDF and revised NCEP ATP III criteria in an urban Sri Lankan population and to investigate the characteristics of discrepant cases. Methods. 2985 individuals, aged 35-65 years, were recruited to the study. Anthropometric and blood pressure measurements and laboratory investigations were carried out following standard protocols. Results. Age and sex-adjusted prevalences of MetS were 46.1% and 38.9% by revised NCEP and IDF definitions, respectively. IDF criteria failed to identify 21% of men and 7% of women identified by the revised NCEP criteria. The discrepant group had more adverse metabolic profiles despite having a lower waist circumference than those diagnosed by both criteria. Conclusion. MetS is common in this urban Sri Lankan cohort regardless of the definition used. The revised NCEP definition was more appropriate in identifying the metabolically abnormal but nonobese individuals, especially among the males predisposed to type 2 diabetes or cardiovascular disease. Further research is needed to determine the suitability of the currently accepted Asian-specific cut-offs for waist circumference in Sri Lankan adults.