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Huang L, Zhong W, Liang X, Wang H, Fu SE, Luo Z. Meta-Analysis on the Association Between DPP-4 Inhibitors and Bone Mineral Density and Osteoporosis. J Clin Densitom 2024; 27:101455. [PMID: 38101289 DOI: 10.1016/j.jocd.2023.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
Background Type 2 Diabetes Mellitus (T2DM) frequently coexists with osteoporosis and reduced bone mineral density (BMD). Dipeptidyl peptidase-4 inhibitors (DPP-4i), a class of antihyperglycemic agents, are commonly employed in T2DM treatment. However, the influence of DPP-4i on bone health remains unclear and debated. This meta-analysis is conducted to explore the relationship between the use of DPP-4i and changes in BMD, as well as the prevalence of osteoporosis among T2DM patients. Methods We conducted a comprehensive search in PubMed, Embase, and Cochrane Library and Web of Science databases for relevant studies published up until June 2023. Studies included in the meta-analysis were those investigating T2DM patients under DPP-4i treatment, and examining the effects on BMD and osteoporosis. Random-effects models and fixed-effect models were utilized to compute the pooled effects. Heterogeneity among the included studies was evaluated using I² statistics. Results This meta-analysis incorporated a total of 10 studies, encompassing a combined population of 214,541 individuals. The results from this meta-analysis indicated an increase in BMD following DPP-4i usage (SMD 0.15, 95 % confidence interval 0.03-0.26). Additionally, the risk of osteoporosis was significantly reduced (OR 0.90, 95 % confidence interval 0.86-0.94) with very low heterogeneity, recorded at 0 % and 53.0 % respectively. No publication bias was detected in the funnel plot, and sensitivity analyses affirmed the stability of the study's conclusions. Conclusion Our results offer valuable insights into the positive impact of DPP-4i on bone health in T2DM patients, contributing to informed clinical decision-making. These findings may inform the development of more comprehensive T2DM management strategies that account for bone health.
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Affiliation(s)
- Lili Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China; Department of Endocrinology, The Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, Guangxi Zhuang Autonomous Region, 541001, PR China
| | - Wei Zhong
- Department of Neurosurgery, Guilin People's Hospital, The Fifth Affiliated Hospital of Guilin Medical University, Guilin 541002, PR China
| | - Xinghuan Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Huijuan Wang
- Department of General Medicine, Guilin People's Hospital, The Fifth Affiliated Hospital of Guilin Medical University, Guilin 541002, PR China
| | - Shi-En Fu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Zuojie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China.
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Fu SE, Liang XH, Tang ZP, Kuang YQ, Qiu CC, Liu XF, Yang HY, Huang ZX, Qin YF, Ma Y, Luo ZJ. Acute Thyrotoxic Myopathy Combined with Neck Pain: A Case Report. Neuro Endocrinol Lett 2023; 44:427-431. [PMID: 37874555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/04/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Acute thyrotoxic myopathy (ATM) is a rare and potentially lethal complication of thyrotoxicosis. The typical clinical symptoms of ATM are characterized by bulbar paralysis. Reports of the successful treatment of ATM are sporadic due to its low incidence. However, no English literature has reported Chinese patients with ATM and neck pain. Here, we report for the first time a Chinese patient with ATM and neck pain who recovered through large doses of systemic glucocorticoids and one intrathyroidal steroid injection. CASE REPORT A 23-year-old woman visited our hospital with a two-year history of progressive weakness of her bulbar muscles, hoarseness, cough when swallowing, dysphagia, and a one-month history of recurrent painful swelling of the thyroid gland. She was diagnosed with ATM, chronic thyrotoxic myopathy (CTM), and Graves' ophthalmopathy (GO) due to Graves' disease (GD). After she was treated with a combination of low-dose glucocorticoids, antithyroid drugs (ATDs), propranolol, and ultrasound-guided percutaneous intrathyroidal injection of glucocorticoids, her bulbar paralysis, proximal myopathy, and neck pain simultaneously improved without recurrence during follow-up. To our knowledge, this is the first case report of a patient with ATM, CTM, GD, GO and neck pain treated by administering a combination of low-dose glucocorticoids, one intrathyroidal steroid injection and antithyroid agents. CONCLUSIONS Clinicians should consider ATM and intervene with aggressive glucocorticoid therapy, and this is the key to reversing the progression of ATM when a patient has bulbar paralysis and thyrotoxic symptoms. Our case report references the clinical diagnosis and treatment of such cases.
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Affiliation(s)
- Shi-En Fu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xing-Huan Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhi-Ping Tang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ya-Qi Kuang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng-Cheng Qiu
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Fan Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai-Yan Yang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhen-Xing Huang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ying-Fen Qin
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Ma
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zuo-Jie Luo
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Chang FY, Lu CL, Chen CY, Lee SD, Tsai DS, Fu SE. Applied potential tomography in liquid gastric emptying measurement: design, assembling, calibration, and clinical application. Dig Dis Sci 2001; 46:1839-45. [PMID: 11575434 DOI: 10.1023/a:1010614526685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The present study aimed to validate the accuracy of a homemade applied potential tomography (APT) apparatus for liquid gastric emptying (GE). Twelve electrodes were placed in a circular array around the subjects. Ten electrodes in a rotated order recorded electrical current delivered from a driving pair of electrodes. Based on tomography, averaged signals of changed resistivity were constructed to display area changes. Six beakers were respectively placed into a saline-filled Perspex tank to measure their cross-sections. True beaker cross-sections are 2.01, 15.9, 18.8, 30.19, 38.48, and 63.61 cm2, respectively, whereas APT generated cross-sections were 7.9 +/- 2.9, 16.7 +/- 3.3, 22.4 +/- 4.9, 28 +/- 4.8, 48.7 +/- 7.6, 67 +/- 6.1 cm2, respectively (r = 0.98, P < 0.001). Twenty-four healthy males ingested 500-ml test solution to assess GE using both APT and scintigraphy. Only 20 (83.3%) subjects had a successful measurement. The APT half emptying time was 15.6 +/- 4.8 min, whereas scintigraphy was 21.9 +/- 6.3 min (r = 0.67, P < 0.01). In conclusion, our APT apparatus is a simple, noninvasive, and inexpensive way to assess liquid GE. Its clinical usefulness is confirmed using both phantom and human models.
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Affiliation(s)
- F Y Chang
- Division of Gastroenterology, Taipei Veterans General Hospital, Taiwan, Republic of China
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Chang FY, Lu CI, Chen CY, Lee SD, Tsai DS, Fu SE. The pharmacological effect of omeprazole on water gastric emptying: A study based on an impedance measure. Pharmacology 2001; 63:50-7. [PMID: 11408832 DOI: 10.1159/000056112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The present study was performed to validate the accuracy of a self-designed applied-potential tomograph (APT) in measuring the cross area of a studied object and to assess the effect of omeprazole premedication on water gastric emptying (GE), based on APT. Twelve electrodes were evenly placed in a circular array around the studied subjects. Ten electrodes in a rotated order recorded the electrical current injected into paired electrodes. Based on tomography, averaged signals of changed resistivity were constructed to display the area of interest and GE curve. Six beakers of various diameters were respectively placed into a cylindrical perspex tank which was filled with saline to measure their cross areas via computer-generated diagrams of APT. One hour after either omeprazole (20 mg) or placebo premedication, 15 healthy males were ordered to consume 500 ml of test water to assess emptying for 40 min. Within 3 days, a similar procedure was repeated using the counterpart premedication. The true cross areas of the 6 beakers are 2.01, 15.9, 18.8, 30.19, 38.48 and 63.61 cm(2), whereas those obtained by APT were 7.9 +/- 2.9, 16.7 +/- 3.3, 22.4 +/- 4.9, 28 +/- 4.8, 48.7 +/- 7.6 and 67 +/- 6.1 cm(2), respectively (r = 0.98, p < 0.001). Valid emptying data were obtained in 73.3 and 86.6% of subjects, following placebo and omeprazole, respectively (not significant). The half emptying times were 12.7 +/- 5.1 min for the placebo-treated group and 10.5 +/- 3.6 min for the omeprazole-treated group, respectively (p < 0.05). The areas under the emptying curve were 1,611.5 +/- 357.6 and 1,317.3 +/- 316.7 arbitrary units, respectively (p < 0.01). In conclusion, our APT system is accurate for large-area measurements; acid inhibition before APT measurement does not increase the success rate but enhances water emptying. The interpretation of impedance-obtained GE should consider the acid-inhibitory effect.
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Affiliation(s)
- F Y Chang
- Division of Gastroenterology, Taipei Veterans General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China.
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Chang FY, Lu CL, Chen CY, Lee SD, Jang HC, Fu SE. Factors responsible for computed electrogastrographic parameters in humans. Am J Gastroenterol 1997; 92:2090-3. [PMID: 9362199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Clinical knowledge about myoelectrical frequency is well known, but the factors responsible for recorded myoelectrical amplitude remain less clear. METHODS We assembled an electrogastrographic system that could automatically compute the dominant myoelectrical frequency and power and power ratio. We enrolled 50 healthy volunteers (25 men and 25 women) to study their myoelectrical characteristics. Three surface electrodes were placed in the fundic, stomach body, and antral positions for two 30-min recordings in the fasting and postprandial states. RESULTS The three different electrodes recorded similar dominant frequencies of about 3 cpm before and after a meal. The fasting dominant powers from these electrodes were 52.9 +/- 14.7, 44.6 +/- 11.5, and 50.1 +/- 15.1 dB, respectively (p < 0.01), whereas the postprandial dominant powers were 61.6 +/- 28.8, 54.3 +/- 26.6, and 61.9 +/- 27.8 dB, respectively (p < 0.01). Meal ingestion did increase the power (p < 0.05). Women had a lower dominant power than men (p < 0.001). Moreover, the dominant powers of each electrode were significantly correlated with body mass index (r = 0.3-0.36, p < 0.05) regardless of meal ingestion. The postprandial power ratio was not influenced by electrode position, gender, or body mass index. CONCLUSIONS Myoelectrical dominant frequencies and power ratios are similar throughout the whole stomach area, whereas a lower power area exists on the stomach body. Gender-related variation in dominant power seems to be an effect of body size. The power ratio is the only reliable parameter for expressing myoelectrical amplitude.
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Affiliation(s)
- F Y Chang
- Division of Gastroenterology, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Abstract
We have assembled an electrogastrographic device based on the main components of amplifiers, a band-pass filter, an analogue/digital converter, low band-pass digital filters and a personal computer. The analysis software uses autoregressive moving average modelling to compute the frequency of slow waves and uses fast Fourier transformation for power spectral computation. Twenty healthy young male volunteers were enrolled in the study to test meal-elicited responses of the slow wave. Subjects underwent a 15 min recording while fasting and then a standard breakfast, which included 250 mL milk and a cake with a total of 1.45 kj, was ingested within 5 min. The post-prandial 15 min recording was immediately resumed after the meal. A slight but significant increase in the frequency of slow waves was seen in post-prandial measurement (mean +/- s.d., 0.0506 +/- 0.0005 vs 0.0497 +/- 0.0005 Hz; P < 0.0001). Moreover, a significant enhancement of the power of slow waves was elicited following the meal (36.0 +/- 3.1 vs 27.6 +/- 3.1 dB; P < 0.0001). We conclude that this assembled electrogastrographic device is a reliable means of monitoring gastric myoelectrical activity because the phenomenon of post-prandial responses of slow waves in either frequency or power is well demonstrated.
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Affiliation(s)
- F Y Chang
- Division of Gastroenterology, Veterans General Hospital-Taipei, Taiwan, ROC
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Abstract
Palpation of pulses is an ancient clinical technique. In modern medical terms, arterial pulse analysis permits the evaluation of vascular characteristics, the important parameters for study of the properties of vessels. However, the various parameters used to describe the vascular characteristics have been conventionally deriving from expensive, invasive, and complicated methods and involving complex computations. The authors designed, therefore, a simple, noninvasive system to evaluate vascular characteristics. The system consisted of two units of pressure transducer for simultaneous recording of two peripheral arterial pulses, an analog signal processor, an A/D converter, and a personal computer. The vascular characteristics were analyzed by use of the Windkessel model and cross-correlation function. The analysis program was designed by members of this team. Through this system, systemic arterial compliance and pulse wave velocity can be obtained. Thirty-five children (11 normal children and 24 children with various stable, mild congenital heart diseases) were enrolled for data analysis. For these 35 children without hypertension or other clinically apparent arterial disease, the pulse wave velocity in the upper limb as between 3.7 and 16.8 m x sec-1, with a mean +/- standard deviation of 9.3 +/- 3.3 m x sec-1. The arterial compliance among the 11 normal children was between 0.72 and 1.72 mL x mmHg-1 x m-2 with a mean of 1.15 mL x mmHg-1 x m-2; both were consistent with the previously reported values obtained from complex methods. This system provides data comparable with those obtained from invasive methods. In the past, the arterial characteristics could not be extensively studied owing to the invasive nature of the conventional methods. This new, simple, convenient noninvasive system will thus provide a convenient method for clinical use in evaluating the vascular characteristics of patients, especially of children.
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Affiliation(s)
- K S Hsieh
- Department of Pediatrics, Veterans General Hospital-Kaohsiung, Taiwan
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Jiang CC, Liu YJ, Yip KM, Fu SE, Su JL. Vibration arthrometry of the knee with torn meniscus: a preliminary report. J Formos Med Assoc 1994; 93:622-5. [PMID: 7866062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Although projects using vibration signals generated by the joint to detect joint disorders are still experimental, vibration arthrometry has been shown to be useful in assessing meniscal pathology. A prospective study using vibration arthrometry to diagnose meniscal tears was carried out in 25 consecutive patients with knee injuries. They comprised 20 males and five females with an average age of 34 years. An arthroscopic examination of the injured knee was given to every patient. Six cases of medial meniscal tear, 12 lateral meniscal tear, and two torn discoid menisci were found. The remaining five cases had normal menisci. By correlating the vibration arthrography of the patients to their corresponding arthroscopic findings, 15 were found to be true-positive, five true-negative and five false-negative. There were no false-positive readings. The accuracy, sensitivity and specificity of the vibration arthrometry in diagnosing meniscal tear was 80%, 75% and 100%, respectively. Vibration arthrometry was shown to be a reliable, non-invasive diagnostic tool in diagnosing meniscal tear of the knee.
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Affiliation(s)
- C C Jiang
- Department of Orthopedic Surgery, National Taiwan University, Taipei, R.O.C
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