Evaluation of Kampo medicines used to treat rheumatoid arthritis in collagen-induced arthritic and pX transgenic mice

Abstract To evaluate the usefulness of Kampo medicines (traditional herbal medicines) used clinically for the treatment of rheumatoid arthritis (RA), we selected eight of them and examined their effects on collagen-induced arthritic and pX transgenic mice. Among these, Dai-bofu-to, Kanzo-bushi-to, and Makyo-yokkan-to significantly reduced the severity of arthritis in collagen-induced arthritis (CIA) mice. The onset of arthritis was delayed by three Kampo medicines, but only the effect of Makyo-yokkan-to was statistically significant. In addition, three Kampo medicines suppressed the arthropathy of pX transgenic mice, which had developed spontaneously. The onset of arthritis was delayed by 10.7, 8.3, and 15.4 days following treatment with Dai-bofu-to, Kanzo-bushi-to, and Makyo-yokkan-to, respectively. A study of the underlying mechanism showed that Kanzo-bushi-to decreased serum antitype II collagen antibody levels, suggesting that Kanzo-bushi-to possesses immunomodulating activity. This study shows that some Kampo medicines are effective in an induced or spontaneously developed arthritis animal model of human RA.

Salmonella ovarian abscess in a patient with rheumatoid arthritis (RA): a case report with literature review

Salmonella ovarian abscess in a patient with rheumatoid arthritis (RA) is reported here. A 33-year-old nulliparous woman with a 16-year history of RA who had been treated with corticosteroid and immunosuppressive drugs was diagnosed as having a non-typhoidal Salmonella ovarian abscess which might have been preceded by an occurrence of endometriotic cyst. Multidisciplinary therapy including surgical intervention was required to complete the eradication of infection. Although Salmonella ovarian abscess is rare, it may cause a serious complication in the ovary harboring endometriotic cyst through sustained presence of Salmonella bacteraemia.

Soil degradation and prevention in greenhouse production

Soil degradation has been a very serious problem for sustainable production, especially by a re-cropping of greenhouse-cultivated cucumber (Cucumis statirus L.). The aim of this research was to expound the actuality for soil degradation, at the same time, put forward some suggestion for preventing from soil degradation and maintain sustainable production in greenhouse basic on the two experiments conducted in a solar greenhouse during 2001-2008 suburb area of Yan'an, Shaanxi province in North China. The result shown that cucumber fruit productivity increased as the increasing of re-cropping years, but decreased after 5years continuously cropping. As increasing of re-cropping years, the population of fungus and bacteria increased, which was assumingly main factor of soil degradation. There was significant difference in cropping models on soil bio-characteristics and system productivity. The productivity were the highest in cropping model between cucumber and greengrocery, cucumber and cowpea (Vigna sinensis L), the second higher were in cropping model between cucumber and maize (Zea mays) for green manure, cucumber and kidney bean (Phaseolus vulgaris). That was the best way to reduce soil bacteria and epiphyte amount to follow lasting three or four months during summer season after cucumber harvest, the better method was planting cowpea or other leguminous crops. Basic on the experiment, the optimums approaches to preventive soil degradation were put forward.

Epidermal growth factor receptor localized to exosome membranes as a possible biomarker for lung cancer diagnosis

Detection of drug-target proteins and biomarkers that are expressed in cancer tissue has significant potential for both diagnosis and treatment of cancer. However, current immuno-histochemical and cytogenetic analyses of biopsy specimens for pre-operational diagnosis are highly invasive and often difficult to apply to lung cancer patients. The purpose of this study was to evaluate the possible utility of determining epidermal growth factor receptor (EGFR) expression on exosomal membranes using a targeted ELISA with an anti-CD81 antibody as a capture antibody for lung cancer diagnosis. While soluble EGFR (sEGFR) levels in plasma were not remarkably different between lung cancer patients and normal controls, significantly higher exosomal EGFR expression levels were observed in 5/9 cancer cases compared to normal controls. These results suggest that measurement of exosomal protein levels could be useful for in vitro diagnosis, and that exosomal EGFR is a possible biomarker for characterization of lung cancer.

228Ra/226Ra ratio and 7Be concentration in the Sea of Japan as indicators for water transport: comparison with migration pattern of Fukushima Dai-ichi NPP-derived 134Cs and 137Cs

To assess the migration patterns of radiocesium emitted from the Fukushima Dai-ichi Nuclear Power Plant (FDNPP), we analyzed (228)Ra/(226)Ra ratios and (7)Be concentrations and compared them with (134)Cs and (137)Cs concentrations in seawater samples collected within the Sea of Japan before and after the FDNPP accident (i.e., during the period 2007-2012) using low-background γ-spectrometry. The (228)Ra/(226)Ra ratios in surface waters exhibited lateral and seasonal variations, reflecting the flow patterns of surface water. This indicates the transport patterns of the FDNPP-derived radiocesium by surface water. Cosmogenic (7)Be (half-life: 53.3 d) exhibited markedly high concentrations (5-10 mBq/L) at depths shallower than 50 m, with concentrations decreasing steeply (0.2-2 mBq/L) at depths of 50-250 m. The distribution of (7)Be concentrations suggests that the downward delivery of the FDNPP-derived radiocesium to below 50 m depth was negligible for a few months prior to its removal from the Sea of Japan.

A small compound targeting TACC3 revealed its different spatiotemporal contributions for spindle assembly in cancer cells

The mitotic spindle is assembled by the coordinated action of centrosomes and kinetochore microtubules. An evolutionally conserved protein family, transforming acidic coiled-coil (TACC), has been shown to be involved in this process. In humans, TACC3 is aberrantly expressed in a variety of human cancers, but its biological significance remains to be elucidated. Here, using a novel compound targeting TACC3, spindlactone (SPL), we show that the perturbation of TACC3 selectively inhibited the nucleation of centrosome microtubules in ovarian cancer cells. In contrast to centrosome microtubules, the kinetochore microtubules were robustly assembled, forming ectopic spindle poles that resulted in multipolar spindles. Interestingly, the extensive inhibition of TACC3 partially suppressed the nucleation of kinetochore microtubules. These dose-dependent effects of SPL were consistent with the results observed by the depletion of TACC3 and its binding partner, colonic and hepatic tumor overexpressed gene protein (TOGp). Although these proteins both have roles in the assembly of centrosome and kinetochore microtubules, their contributions were spatiotemporally different. Notably, SPL did not affect spindle assembly in normal cells. Furthermore, the oral administration of SPL significantly suppressed tumor growth in vivo. The unique mechanism of action of SPL not only enables it to be used as a tool to dissect the molecular basis of spindle assembly but also to provide a rationale for the use of TACC3 as a molecular target for cancer treatment. This rationale offers an opportunity to develop new strategies for cancer chemotherapy that overcome the limitations of microtubule toxins and expand their scope and clinical efficacy.

Para-magneto- and electro-optic microcavities for blue wavelength modulation

We report on microcavities comprising para-magnetic garnet and electro-optic films (MPMEO) for modulation of the polarization rotation angle of light at near-UV wavelengths with a slight intensity change, with applying a low voltage. The MPMEO are composed of para-magnetic garnet and electro-optic films sandwiched between two Bragg mirrors. The microcavity states in MPMEO are split and yield both the large rotation angle and high optical efficiency. Significant enhancement and modulation by applied voltages are verified through a conventional matrix calculation approach. High optical efficiency (>90%) and large modulation (~90 degree) of the polarization rotation are proved.

Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy

PURPOSE

To evaluate the functional outcomes of patients with polypoidal choroidal vasculopathy (PCV) who underwent intravitreal ranibizumab (IVR) treatment, compared with photodynamic therapy (PDT), after at least 2 years.

METHODS

We retrospectively studied all the treatment-naïve patients with PCV who were scheduled to undergo IVR or PDT between August 2005 and June 2010. All the patients who had a 2-year or longer follow-up period were included in the study. The best-corrected visual acuity (BCVA) in the two groups was compared before treatment and at 3, 6, 12, 18 and 24 months after the initial treatment. The regression of the polyps was also assessed using indocyanine green angiography.

RESULTS

A total of 77 patients were included in this study. Thirty-three eyes were treated with IVR, and 44 eyes were treated with PDT. Although no significant differences between the two groups were observed at baseline or at 3, 6, and 12 months after treatment, a significantly better BCVA was seen in the IVR group, compared with the PDT group, at 18 and 24 months after treatment (P=0.035 and P=0.021, respectively). No significant difference in the rate of polyp regression was observed between the two groups (P=0.092).

CONCLUSION

IVR was well tolerated and maintained or improved the vision of patients with PCV, compared with PDT, as evaluated at 2-year follow-up examinations. PDT for the treatment of PCV might result in unfavorable outcomes, with no superiority to achieving the involution of polyps.

Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma

This study retrospectively analyzed the clinical outcomes of endoscopic resection of 26 sporadic (i. e., not associated with polyposis syndrome) nonampullary duodenal lesions representing high-grade dysplasia or intramucosal carcinoma (duodenal HGD/IMC) in 23 patients. No severe complications such as perforation were observed, but three cases of delayed bleeding were seen. The use of endoscopic clips significantly decreased the delayed bleeding rate (0/19, 0%) compared with cases in which clips were not used (3/7, 42.9%; P = 0.013, χ2 test). Eighteen lesions (69.2%) were removed by en bloc resection. The follow-up period after resection was 25.5 ± 23.3 months. Two lesions (7.7%) that recurred locally were detected at the first surveillance endoscopy 3 months after resection. These lesions were 22 and 15 mm in size respectively and were resected piecemeal. Endoscopic resection is an effective and safe procedure for treating duodenal HGD/IMC. En bloc resection and prophylactic clip usage are encouraged.

Ultraviolet B irradiation of the mouse eye induces pigmentation of the skin more strongly than does stress loading, by increasing the levels of prohormone convertase 2 and α-melanocyte-stimulating hormone

BACKGROUND

In previous studies, we made the unexpected finding that in mice, ultraviolet (UV)B irradiation of the eye increased the concentration of α-melanocyte-stimulating hormone (α-MSH) in plasma, and systemically stimulated epidermal melanocytes.

AIMS

To compare the extent of the pigmentation induced by social and restraint stress (which activate the hippocampus-pituitary system) with that induced by UVB irradiation.

METHODS

DBA/2 and sham-operated or hypophysectomized DBA/2 mice were subjected to local UVB exposure using a sunlamp directed at the eye, and two types of stress (social and restraint) were imposed.

RESULTS

UVB irradiation of the eye or exposure to stress loading both increased the number of Dopa-positive melanocytes in the epidermis, and hypophysectomy strongly inhibited the UVB-induced and stress-induced stimulation of melanocytes. Irradiation of the eye caused a much greater increase in dopamine than did the stress load. Both UVB eye irradiation and stress increased the blood levels of α-MSH and adrenocorticotropic hormone (ACTH). In addition, the increase in plasma α-MSH was greater in animals subjected to UVB eye irradiation than in those subjected to stress loading, whereas the reverse occurred for plasma ACTH. UVB irradiation to the eye and stress loading increased the expression of prohormone convertase (PC)1/3 and PC2 in the pituitary gland. The increase in expression of pituitary PC2 was greater in animals subjected to UVB eye irradiation than to stress, whereas no difference was seen between the two groups for the increase in PC1/3.

CONCLUSIONS

UVB eye irradiation exerts a stronger effect on pigmentation than stress loading, and is related to increased levels of α-MSH and PC2.

Prediction of contralateral inguinal hernias in children: a prospective study of 357 unilateral inguinal hernias

Purpose

Previously, we established a pre-operative risk scoring system to predict contralateral inguinal hernia in children with unilateral inguinal hernias. The current study aimed to verify the usefulness of our pre-operative scoring system.

Methods

This was a prospective study of patients undergoing unilateral inguinal hernia repair from 2006 to 2009 at a single institution. Gender, age at initial operation, birth weight, initial operation side, and the pre-operative risk score were recorded. We analyzed the incidence of contralateral inguinal hernia, risk factors, and the usefulness of our pre-operative risk scoring system. The follow-up period was 36 months. We used forward multiple logistic regression analysis to predict contralateral hernia.

Results

Of the 372 patients who underwent unilateral hernia repair, 357 (96.0 %) were completely followed-up for 36 months, and 23 patients (6.4 %) developed a contralateral hernia. Left-sided hernia (OR = 5.5, 95 %, CI = 1.3–24.3, p = 0.023) was associated with an increased risk of contralateral hernia. The following covariates were not associated with contralateral hernia development: gender (p = 0.702), age (p = 0.215), and birth weight (p = 0.301). The pre-operative risk score (cut-off point = 4.5) of the patients with a contralateral hernia was significantly higher, compared with the patients without a contralateral hernia using the area under the receiver operating characteristic curve (p = 0.024).

Conclusions

Using multivariate analysis, we confirmed usefulness of our pre-operative scoring system and initial side of the inguinal hernia, together, for the prediction of contralateral inguinal hernia in children.

Medical emergency education using a robot patient in a dental setting

INTRODUCTION

In an ageing society, the frequency of medical emergencies in a dental setting appears to be increasing because of a growing number of medically compromised patients. However, we currently have no dental-specific simulation environment with advanced reproducibility for medical emergencies. Therefore, we used the robot patient in objective structured clinical examinations (OSCEs) for testing student competence in emergency management. This study aimed to evaluate student responses to medical emergencies in the dental setting.

MATERIAL AND METHODS

We used 98 fifth-grade dental students at Showa University as subjects and implemented the OSCE task entitled 'Management of medical emergency using a robot patient'. Candidates were asked to manage an emergency situation immediately after local anaesthesia, with one robot patient configured to develop vasovagal syncope and the other to experience adrenaline hypersensitivity. A questionnaire on the educational value of the robot patient was completed after the examination.

RESULTS

Thirty-two per cent of students could not accurately count her pulse because of an inappropriate method. Moreover, 78% could not correctly attach either the tonometer or pulse oximetry to the patient. Accurate diagnoses were given by only 22% of students, with vasovagal syncope diagnosed by 33% and adrenaline hypersensitivity by 8%. From a questionnaire, 78% of students recognised the usefulness of the robot patient in medical emergency training.

CONCLUSION

We found that student responses to the emergency situation were poor. The robot patient is useful in dental education for medical emergency training and assessment not only for situation management but also for differential diagnosis.

Efficacy of porcine placental extract on shoulder stiffness in climacteric women

OBJECTIVES

Some of the most common climacteric symptoms are somatic symptoms, such as muscle and joint pain, which cause limitations in performing daily tasks. This study aimed to assess whether oral porcine placental extract (PPE) affects patients with shoulder stiffness, one of the most common types of muscle-tendon stiffness, in climacteric women and postmenopausal women with hormone therapy (HT).

METHODS

Sixty-six climacteric women (33 each in the control and study groups) with shoulder stiffness and 54 postmenopausal women (27 each in the control and study groups) with HT-resistant shoulder stiffness were enrolled into this open-label, randomized, controlled study. The control subjects received Toki-shakuyaku-san (TJ23; 7.5 g/day, daily per os), an oral herbal remedy used to alleviate climacteric symptoms, and study subjects received PPE orally for 24 weeks in climacteric women and for 12 weeks in postmenopausal women with HT. Changes in the degree of shoulder stiffness were evaluated by the Visual Analog Scale (VAS).

RESULTS

Treatment with PPE was significantly effective in reducing the VAS score for shoulder stiffness during the study period compared with the control group in both climacteric and postmenopausal women with HT. The VAS score at the end of treatment was significantly reduced (p < 0.01 vs. baseline) by 76.4% for climacteric women and 64.8% for postmenopausal women with HT compared with baseline.

CONCLUSIONS

PPE is useful as an oral supplement for shoulder stiffness in climacteric women without HT or in postmenopausal women with HT-resistant, long-term shoulder stiffness.

[Pulmonary mucosa-associated lymphoid tissue lymphoma coexisting with intratumoral tuberculosis]

A mass in the right upper lobe of the lung was observed in a chest X-ray examination of a 66-year-old woman. Pathological examination of the lung biopsy revealed a mucosa- associated lymphoid tissue (MALT) lymphoma within the lesion. A systemic survey demonstrated no other lesions, and the patient was diagnosed as having a solitary pulmonary MALT lymphoma (Stage IE). After 9 months of careful monitoring, progressive enlargement of the lung tumor and involvement of right hilar lymph nodes were observed using positron emission tomography-computed tomography. Therefore, surgical resection of the right upper lobe and right hilar lymph nodes was performed, and coexistence of MALT lymphoma with tuberculosis was identified by pathological investigations. The association of chronic inflammation with the development of MALT lymphomas has been widely accepted. In the present case, pulmonary tuberculosis may have played a role in the pathogenesis of pulmonary MALT lymphoma.

Dietary patterns and type 2 diabetes in Japanese men and women: the Japan Public Health Center-based Prospective Study

BACKGROUND/OBJECTIVE

Dietary patterns in Western populations have been linked to type 2 diabetes, but the association of distinctive dietary patterns of Japanese population remains unclear. We prospectively investigated the association between dietary patterns and risk of developing type 2 diabetes among Japanese adults.

SUBJECTS/METHODS

Participants were 27, 816 men and 36,889 women aged 45-74 years who participated in the second survey of the Japan Public Health Center-based prospective study and had no history of diabetes. Dietary patterns were derived by using principal component analysis of the consumption of 134 food and beverage items ascertained by a food frequency questionnaire. Odds ratios of self-reported physician-diagnosed type 2 diabetes over 5 year were estimated using logistic regression analysis.

RESULTS

A total of 1194 new cases (692 men and 502 women) of type 2 diabetes were self-reported. We identified three dietary patterns: prudent, westernized and traditional Japanese patterns. Any dietary pattern was not significantly associated with type 2 diabetes risk after adjustment for covariates in both men and women. The multivariate-adjusted odds ratios (95% confidence interval) for type 2 diabetes for the highest versus lowest quartile of each dietary pattern score in men and women, respectively, were 0.93 (0.74-1.16) and 0.90 (0.69-1.16) for the prudent pattern, 1.15 (0.90-1.46) and 0.81 (0.61-1.08) for the westernized pattern, and 0.97 (0.74-1.27) and 0.87 (0.66-1.15) for the traditional pattern.

CONCLUSIONS

Although a small protective effect of the prudent dietary pattern cannot be excluded, dietary patterns may not be appreciably associated with type 2 diabetes risk in Japanese.

P53 expression in esophageal dysplasia - a possible biomarker for carcinogenesis of esophageal squamous-cell carcinoma

The tumor suppressor gene product p53 has been detected in a high percentage of esophageal squamous cell carcinoma. To evaluate the role of this protein in carcinogenesis, we examined the p53 overexpression both in esophageal dysplasia and in esophageal squamous cell carcinoma in the same patients. Using anti-p53 antibodies pAb1801 and CM-1, we analyzed immunohistochemically 36 dysplastic lesions from 36 patients with esophageal cancer. Nuclear p53 was detected in 14 of 36 dysplasias (39%). From mild to moderate to severe dysplasia, p53 positivity showed tendency to increase in number. Seventeen of the 36 squamous cell carcinomas showed p53 expression (47%). There was a significant concurrent p53 expression in esophageal dysplasia and its related squamous cell carcinoma (p=0.00345). These results indicate that p53 mutation is closely associated with the initiation of this cancer.

Intra-articular injection of mesenchymal stem cells expressing coagulation factor ameliorates hemophilic arthropathy in factor VIII-deficient mice

BACKGROUND

Transplantation of cells overexpressing a target protein represents a viable gene therapeutic approach for treating hemophilia. Here, we focused on the use of autologous mesenchymal stem cells (MSCs) expressing coagulation factor for the treatment of coagulation factor VIII (FVIII) deficiency in mice.

METHODS AND RESULTS

Analysis of luciferase gene constructs driven by different promoters revealed that the plasminogen activator inhibitor-1 (PAI-1) gene promoter coupled with the cytomegalovirus promoter enhancer region was one of the most effective promoters for producing the target protein. MSCs transduced with the simian immunodeficiency virus (SIV) vector containing the FVIII gene driven by the PAI-1 promoter expressed FVIII for several months, and this expression was maintained after multiple mesenchymal lineage differentiation. Although intravenous injection of cell supernatant derived from MSCs transduced with an SIV vector containing the FVIII gene driven by the PAI-1 promoter significantly increased plasma FVIII levels, subcutaneous implantation of the MSCs resulted in a transient and weak increase in plasma FVIII levels in FVIII-deficient mice. Interestingly, intra-articular injection of the transduced MSCs significantly ameliorated the hemarthrosis and hemophilic arthropathy induced by knee joint needle puncture in FVIII-deficient mice. The therapeutic effects of a single intra-articular injection of transduced MSCs to inhibit joint bleeding persisted for at least 8 weeks after administration.

CONCLUSIONS

MSCs provide a promising autologous cell source for the production of coagulation factor. Intra-articular injection of MSCs expressing coagulation factor may offer an attractive treatment approach for hemophilic arthropathy.

134Cs and 137Cs activities in coastal seawater along Northern Sanriku and Tsugaru Strait, northeastern Japan, after Fukushima Dai-ichi Nuclear Power Plant accident

A total of 37 seawater samples were collected at 10 sites along the coastline of the Northern Sanriku and Tsugaru Strait, 250-450 km north of the Fukushima Dai-ichi Nuclear Power Plant in April-December 2009 and May-June 2011, and analyzed for (134)Cs and (137)Cs activities using low-background γ-spectrometry. The (134)Cs and (137)Cs activities measured in these samples in May 2011 were found to be 2-3 mBq/L and 2.5-4 mBq/L, respectively. By June, these values had decreased by 25-45%/month and 5-30%/month, respectively. These results can be plausibly explained by surface infusion of these isotopes into the sea by atmospheric transport from Fukushima and their subsequent reduction by water migration to off-shore and deeper regions.

Efficacy of porcine placental extract on climacteric symptoms in peri- and postmenopausal women

OBJECTIVES

Injections of human placental extract have long been used to treat menopausal symptoms. Recently, porcine placental extract (PPE), an oral supplement, has been developed for this purpose. The aim of this study was to assess whether PPE has an impact on climacteric symptoms in perimenopausal and postmenopausal women.

METHODS

Seventy-six women with climacteric symptoms were enrolled into this open-label, randomized, controlled study. The control group (n = 38) underwent 24 weeks of open treatment with Toki-shakuyaku-san (TJ23), an oral herbal remedy used to alleviate climacteric symptoms. The PPE group (n = 38) received three capsules of PPE/day orally for the initial 12 weeks and six capsules/day for the next 12 weeks. Climacteric symptoms were evaluated in both groups using the Simplified Menopausal Index (SMI) score, Zung's Self-Rating Depression Scale (ZSDS) and the Spielberger State-Trait Anxiety Inventory (STAI) before commencing treatment, after 12 weeks of treatment and on completion of treatment.

RESULTS

Treatment with PPE was significantly (p < 0.01) more effective in reducing the SMI, ZSDS and STAI measures at 12 and 24 weeks than TJ23 treatment alone. Treatment with PPE was also significantly effective (p < 0.01) in reducing the subscale scores of the SMI for items such as hot flushes, insomnia, irritability, depression, fatigue and joint pain. PPE treatment had no significant adverse effects.

CONCLUSION

Oral PPE treatment is another possible option for treating perimenopausal and postmenopausal women with climacteric symptoms.

Persistent fasting hyperglycaemia is more predictive of type 2 diabetes than transient fasting hyperglycaemia

AIMS

We investigated the value of persistent fasting hyperglycaemia as assessed by repeated elevated fasting plasma glucose in predicting the progression to diabetes.

METHODS

A retrospective cohort study was conducted from 1998 to 2006 inclusive among 7929 persons (37,742 person-years), with a mean age of 53.0 years at baseline. The cumulative incidence of diabetes was measured. A baseline and follow-up fasting plasma glucose were categorized as normal fasting glucose (< 5.56 mmol/l), or impaired fasting glucose (5.56-6.94 mmol/l).

RESULTS

The cumulative incidence and incidence density of diabetes were 3.5% (275 cases) and 7.3 per 1000 person-years over a mean follow-up period of 4.8 years. The cumulative incidence of diabetes among subjects with impaired fasting glucose at both previous examinations (persistent impaired fasting glucose) was 30.4% (222/1518) compared with 0.6% (15/5063) of those with normal fasting glucose at both baseline and initial follow-up. The hazard ratios to develop diabetes, adjusted for possible confounders, was 37.10 (95% CI, 21.6-63.7) for persistent impaired fasting glucose versus persistent normal fasting glucose. Persistent impaired fasting glucose predicted diabetes at 80.7% (222/275) sensitivity and 83.1% (6358/7654) specificity, whereas first baseline impaired fasting glucose only predicted diabetes at 86.9% (239/275) sensitivity and 74.9% (5730/7654) specificity. The model using both previous fasting plasma glucose levels had a greater AUROC (area under receiver operating characteristic) than that using first baseline fasting plasma glucose only (0.92 vs. 0.88; P < 0.001).

CONCLUSIONS

Repeated measurements of fasting plasma glucose better predicts incidence of diabetes than a single test. In particular, persistent fasting hyperglycaemia adds more substantial precision to the prediction of future diabetes than transient impaired fasting glucose. This combination is cost efficient and may be practical for early detection of high-risk individuals.