Biomarkers for type 2 diabetes and impaired fasting glucose using a nontargeted metabolomics approach

Using a nontargeted metabolomics approach of 447 fasting plasma metabolites, we searched for novel molecular markers that arise before and after hyperglycemia in a large population-based cohort of 2,204 females (115 type 2 diabetic [T2D] case subjects, 192 individuals with impaired fasting glucose [IFG], and 1,897 control subjects) from TwinsUK. Forty-two metabolites from three major fuel sources (carbohydrates, lipids, and proteins) were found to significantly correlate with T2D after adjusting for multiple testing; of these, 22 were previously reported as associated with T2D or insulin resistance. Fourteen metabolites were found to be associated with IFG. Among the metabolites identified, the branched-chain keto-acid metabolite 3-methyl-2-oxovalerate was the strongest predictive biomarker for IFG after glucose (odds ratio [OR] 1.65 [95% CI 1.39-1.95], P = 8.46 × 10(-9)) and was moderately heritable (h(2) = 0.20). The association was replicated in an independent population (n = 720, OR 1.68 [ 1.34-2.11], P = 6.52 × 10(-6)) and validated in 189 twins with urine metabolomics taken at the same time as plasma (OR 1.87 [1.27-2.75], P = 1 × 10(-3)). Results confirm an important role for catabolism of branched-chain amino acids in T2D and IFG. In conclusion, this T2D-IFG biomarker study has surveyed the broadest panel of nontargeted metabolites to date, revealing both novel and known associated metabolites and providing potential novel targets for clinical prediction and a deeper understanding of causal mechanisms.

Metabolomics as a key integrator for "omic" advancement of personalized medicine and future therapies

Investigation into biological complexity, whether for a better understanding of disease or drug process, is a monumental task plaguing investigators. The lure of "omic" technologies for circumventing much of these challenges has led to widespread efforts and adoption. It is becoming clearer that a single "omic" approach (e.g., genomics) is often insufficient for completely defining the complexity in these biological systems. Hence, there is an increasing awareness that a "systems" approach will serve to increase resolution and confidence and provide a strong foundation for further hypothesis-driven investigation. Although certain metabolites are already considered clinically important, the profiling of metabolites via metabolomics (the profiling of metabolites to fully characterize metabolic pathways) is the most recent to mature of these "omic" technologies and has been only recently adopted as compared to genomic or proteomic approaches in systems inquiries. Recent reports suggest that this "omic" may well be a key data stream in systems investigations for endeavors in personalized medicine and biomarker identification, as it seems most closely relevant to the phenotype.

Plasma metabolomic profile in nonalcoholic fatty liver disease

The plasma profile of subjects with nonalcoholic fatty liver disease (NAFLD), steatosis, and steatohepatitis (NASH) was examined using an untargeted global metabolomic analysis to identify specific disease-related patterns and to identify potential noninvasive biomarkers. Plasma samples were obtained after an overnight fast from histologically confirmed nondiabetic subjects with hepatic steatosis (n = 11) or NASH (n = 24) and were compared with healthy, age- and sex-matched controls (n = 25). Subjects with NAFLD were obese, were insulin resistant, and had higher plasma concentrations of homocysteine and total cysteine and lower plasma concentrations of total glutathione. Metabolomic analysis showed markedly higher levels of glycocholate, taurocholate, and glycochenodeoxycholate in subjects with NAFLD. Plasma concentrations of long-chain fatty acids were lower and concentrations of free carnitine, butyrylcarnitine, and methylbutyrylcarnitine were higher in NASH. Several glutamyl dipeptides were higher whereas cysteine-glutathione levels were lower in NASH and steatosis. Other changes included higher branched-chain amino acids, phosphocholine, carbohydrates (glucose, mannose), lactate, pyruvate, and several unknown metabolites. Random forest analysis and recursive partitioning of the metabolomic data could separate healthy subjects from NAFLD with an error rate of approximately 8% and separate NASH from healthy controls with an error rate of 4%. Hepatic steatosis and steatohepatitis could not be separated using the metabolomic profile. Plasma metabolomic analysis revealed marked changes in bile salts and in biochemicals related to glutathione in subjects with NAFLD. Statistical analysis identified a panel of biomarkers that could effectively separate healthy controls from NAFLD and healthy controls from NASH. These biomarkers can potentially be used to follow response to therapeutic interventions.

Comparison of the laser and phenol chemical peel in facial skin resurfacing

OBJECTIVE

To determine differences in postoperative outcomes, complications, and adverse effects between phenol chemical peel (CP) and the carbon dioxide laser peel, when used for facial skin resurfacing.

DESIGN

Nonrandomized prospective comparison of 2 facial skin resurfacing techniques using a split-face paradigm. In this initial study, 18 months of follow-up data are available, including the patients' subjective evaluations, the surgeons' objective assessments, and a histological analysis of 1 patient by a blinded pathologist.

SETTING

A facial plastic surgery clinic associated with a university medical center.

PATIENTS

Four female patients with actinic-damaged facial skin and facial rhytids, aged 61 to 73 years.

INTERVENTIONS

The left side of each face was treated with a phenol-based CP formula according to standard procedure. The right side was resurfaced using the Sharplan Silktouch Flashscanner carbon dioxide laser. Patients were photographed before treatment and at regular intervals postoperatively. One patient underwent rhytidectomy at 2 months posttreatment, and specimens were obtained for histological analysis.

MAIN OUTCOME MEASURES

Evaluation of observable clinical improvement in skin quality, postoperative swelling, erythema, pigmentary alterations, healing time, and complications.

RESULTS

All 4 patients experienced transient initial discomfort on the CP side that subsided within 24 hours after treatment. The laser side was noted to have slightly more prolonged stinging, erythema, and edema. Erythema was noted to be more uniform in the laser-treated areas. Final clinical improvement in rhytids was evaluated by 4 surgeons who reviewed color slide presentations of each patient 1 year or more postoperatively. Uniform wrinkle improvement was noted around the eyelid and lateral cheek areas on both the CP and laser-treated sides. A moderate advantage in the degree of wrinkle improvement was noted on the laser-treated sides of the upper lip and forehead. Thick-skinned, glandular skin areas, such as the nasolabial fold and chin, were found to be substantially smoother in the laser-treated areas. Histological studies indicate that the CP side was noted to have a deeper injury, extending into the reticular dermis. The skin treated with the laser was injured more superficially, down to the papillary dermis.

CONCLUSIONS

Phenol CP is as effective as the laser in diminishing rhytids in the thin-skinned areas of the face. The laser produces improved results in the thick, glandular areas of the face, but also produces more intense hypopigmentation, longer periods of patient discomfort, and longer periods of postoperative erythema. Both phenol CP and laser resurfacing remain useful clinical tools.

Taking practice forward in paediatric oncology: the impact of a newly developed education programme for nurses working in shared-care hospitals

Fundamental to any change or development in health care is the quality of the service received by patients and their families. Practitioner-led initiatives that are designed to improve the quality of care are more likely to succeed if they are underpinned with appropriate educational input. A structured programme in paediatric oncology nursing was developed to meet the needs of nurses working in District General Hospitals. Nurses' perceptions of the consequences of undertaking the programme were explored using a focus group approach. Findings have shown that there have been significant changes to nurses' roles and this in turn has had an impact on the individual and the organization. It was perceived that there are positive outcomes for both the service and quality of care for children with cancer and their families. The shared-care nurses believe that this has been the result of improved knowledge, skill and expertise, better communication between care providers, and the collaborative frameworks which have evolved.

Strial dysfunction in the MRL-Fas mouse

The MRL-Fas(lpr) mouse, a model of multisystemic autoimmune disease, has been proposed as a potential model of autoimmune inner ear disease. Cochlear pathology, consisting of hydropic degeneration of the stria vascularis, has been documented to occur coincident with the establishment of systemic disease in this animal. Because the cochlear pathology is restricted to the stria, this study was designed to evaluate whether the endocochlear potential (EP) would be diminished in these animals because of a loss in strial Na, K-ATPase. Experimental (MRL-Fas(lpr)) mice, with established systemic disease, had auditory brain stem response thresholds and EPs recorded. MRL-+/+ mice served as controls. Animals were then euthanized, and their cochleas were processed for immunohistologic assay for the alpha1 and beta2 subunits of Na,K-ATPase. Density of staining was evaluated by use of quantitative means with densitometry image analysis of digitized images. MRL-Fas(lpr) mice revealed significant elevations in auditory brain stem response thresholds and reductions in EPs but no reductions in Na,K-ATPase levels, as evidenced by immunohistochemical assay. The reduction of EP likely occurs as a result of cellular degeneration within the stria vascularis and likely results from an abrogation of the strial perilymph/endolymph barrier and not from a reduction in strial Na, K-ATPase levels.

Unusual neck masses secondary to jugular venous abnormalities: case report and discussion

Thrombosis of the lateral sinus/proximal jugular vein and jugular venous ectasia are infrequent but not uncommon neck masses. Lateral sinus thrombosis was well described in the preantibiotic era, but modern-day surgeons may not be familiar with this entity. Failure to diagnose a neck mass due to jugular vein thrombosis may have deadly consequences. Jugular vein ectasia, which is innocuous, has been mistaken for laryngocele, cystic hygroma, as well as other vascular lesions. However, the management of jugular vein ectasia, which is thought to be caused by incompetence of the bicuspid jugular venous valve, is conservative. We present a case illustrating a neck mass arising from the internal jugular vein with a discussion of jugular venous pathology.

Nursing care that patients value

The delivery of nursing care should be based on meeting patients' individual needs. This article presents the findings of a small-scale study which explored the feelings that people express regarding the care they would like and receive from nurses.

Compensation for elected hospital medical staff leadership

As physicians' practices become more complex and their practice incomes more difficult to maintain, hospitals concurrently require more physician input into organizational, utilization, and strategic planning matters. Physicians and hospitals across the country are discussing the question of financial compensation to physicians for the time they spend performing these hospital administrative tasks. It is already common practice for hospitals to pay a salary for medical direction of hospital departments such as intensive care units or pulmonary laboratories. The question has become whether this practice should be extended to elected medical staff leadership.

Correlates of first trimester care in a public health prenatal clinic

Early access to prenatal care is a major issue in the prevention of low birth weight. Therefore, the authors studied 107 indigent women seen consecutively for their initial visits at a public health department's prenatal clinic to ascertain factors associated with first trimester care. The questionnaire included items on individual health behaviors, attitudes toward medical care, perceived social support, depression, and demographics. Data were collected over 12 weeks by a clinic nurse, and all patients agreed to participate. Using logit estimated odds ratios (OR), none of the independent variables examined were associated with first trimester care for married women. For unmarried women first trimester care was related to finding the clinic by word of mouth (OR = 5.5, 95% CI, 1.2-22.9) and maternal depression (OR = 4.0, 95% CI, 1.1-15.3). Finding the prenatal clinic by word of mouth and maternal depression were still associated with first trimester care after controlling for maternal education and health attitudes. These data suggest that subsequent explanatory research should explore the association between informal social support of unmarried women and first trimester prenatal care.