A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.

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Harmonizing the Metabolic Syndrome A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity

DNA microarrays can be used to identify gene expression changes characteristic of human disease. This is challenging, however, when relevant differences are subtle at the level of individual genes. We introduce an analytical strategy, Gene Set Enrichment Analysis, designed to detect modest but coordinate changes in the expression of groups of functionally related genes. Using this approach, we identify a set of genes involved in oxidative phosphorylation whose expression is coordinately decreased in human diabetic muscle. Expression of these genes is high at sites of insulin-mediated glucose disposal, activated by PGC-1α and correlated with total-body aerobic capacity. Our results associate this gene set with clinically important variation in human metabolism and illustrate the value of pathway relationships in the analysis of genomic profiling experiments.

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PGC-1alpha-responsive genes involved in oxidative phosphorylation are coordinately downregulated in human diabetes

The metabolic syndrome

Adipose tissue is a complex, essential, and highly active metabolic and endocrine organ. Besides adipocytes, adipose tissue contains connective tissue matrix, nerve tissue, stromovascular cells, and immune cells. Together these components function as an integrated unit. Adipose tissue not only responds to afferent signals from traditional hormone systems and the central nervous system but also expresses and secretes factors with important endocrine functions. These factors include leptin, other cytokines, adiponectin, complement components, plasminogen activator inhibitor-1, proteins of the renin-angiotensin system, and resistin. Adipose tissue is also a major site for metabolism of sex steroids and glucocorticoids. The important endocrine function of adipose tissue is emphasized by the adverse metabolic consequences of both adipose tissue excess and deficiency. A better understanding of the endocrine function of adipose tissue will likely lead to more rational therapy for these increasingly prevalent disorders. This review presents an overview of the endocrine functions of adipose tissue.

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Adipose Tissue as an Endocrine Organ

The epidemic of type 2 diabetes and impaired glucose tolerance is one of the main causes of morbidity and mortality worldwide. In both disorders, tissues such as muscle, fat and liver become less responsive or resistant to insulin. This state is also linked to other common health problems, such as obesity, polycystic ovarian disease, hyperlipidaemia, hypertension and atherosclerosis. The pathophysiology of insulin resistance involves a complex network of signalling pathways, activated by the insulin receptor, which regulates intermediary metabolism and its organization in cells. But recent studies have shown that numerous other hormones and signalling events attenuate insulin action, and are important in type 2 diabetes.

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Insulin signalling and the regulation of glucose and lipid metabolism

PURPOSE:To provide an antireflection effect to light incident at 45 deg. angle from a medium side by forming the antireflection film in such a manner that the even layers of multilayered films have the refractive index higher than the refractive index of a substrate, the refractive index of the even layers is lower than the refractive index of the substrate and the optical film thicknesses of the respective layers satisfy specific conditions. CONSTITUTION:The multilayered films of the antireflection film 7 consist of 7-layered films of the 1st to the 7th layers successively from the medium side toward the substrate 1 side. The refractive index of the even layers is higher than the refractive index of the substrate 1 and is in a 1.40 to 1.48 range. The optical film thicknesses of the respective layers are so set as to satisfy the conditions of equation I where the refractive index of the i-th layer is designated as ni, the optical film thicknesses of the i-th layer are designated as nind and i is 1 to 7 integer. In the equation, lambda0 denotes a designed main wavelength; nd is the refractive index of the optical glass substrate to d rays in a 1.50 to 1.54 range. The decrease in transmitted light 5 by the reflection loss on the surface of the optical parts to be used at 45 deg. angle with the incident light 3 is prevented in this way.

Antireflection film of optical parts

To evaluate and compare the clinical outcomes between percutaneous gallbladder drainage (PGBD) and percutaneous gallbladder aspiration (PGBA) for acute cholecystitis after biliary stenting for malignant biliary obstruction. Twenty-six and 14 patients underwent PGBD and PGBA, respectively, for acute cholecystitis after biliary stenting for malignant obstruction. The technical success rate, clinical effectiveness, and safety were compared between the 2 groups. Technical success was achieved in all patients. Clinical effectiveness rate was significantly higher in the PGBD group than in the PGBA group [100% (26/26) vs. 57% (8/14), p < 0.01]. In the PGBA group, clinical effectiveness rate was significantly lower in patients with tumor involvement of the cystic duct [13% (1/8) with involvement vs. 83% (5/6) without involvement, p = 0.03]. There were no deaths related to the procedure or acute cholecystitis aggravation. Pleural effusion and biliary peritonitis occurred in 1 patient each after PGBD and intra-abdominal bleeding occurred in 1 patient after PGBA as complications requiring treatment. Although PGBD was a more effective treatment for acute cholecystitis after biliary stenting for malignant obstruction, PGBA may be a less invasive option for high-risk patients without tumor involvement of the cystic duct.

Management of acute cholecystitis after biliary stenting for malignant obstruction: comparison of percutaneous gallbladder drainage and aspiration

We describe a 54-year old woman with oxaliplatin-induced autoimmune hemolytic anemia and review the clinical features of similar published cases. The present patient had metastatic colon cancer and was admitted to our hospital with a floating sensation and general malaise on day 4 after undergoing the last of 4 cycles of a 7th round of chemotherapy with XELOX. Laboratory data revealed 4.6g/dl hemoglobin and 8.77 mg/dl creatinine. Direct and indirect Coombs tests of a blood sample for blood transfusion were both positive. We diagnosed immune hemolysis with acute renal failure based on the clinical course and blood samples showing haptoglobin <10mg/dl. We treated her with hemodialysis, plasmapheresis and immune suppression with prednisolone, which improved the anemia and renal failure.

Recurrent autoimmune hemolytic anemia induced by XELOX chemotherapy for colon cancer

ABSTRACT Helicobacter pylori infection is a significant risk factor for gastric cancer. The infection is acquired mainly in early childhood and is influenced by environmental factors, including socioeconomic status and sibling number. However, the impact of socioeconomic status and sibling number on Helicobacter pylori infection has not been well studied in Japan. We conducted a cross-sectional study to evaluate the impact of socioeconomic status, represented by education level, and sibling number on the prevalence of Helicobacter pylori infection among 3,423 non-cancer subjects who visited Aichi Cancer Center between 2005 and 2013. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using a logistic regression model adjusted for potential confounding variables. Of the 3,423 subjects, 1,459 (42.6%) were Helicobacter pylori-positive. The prevalence of Helicobacter pylori infection linearly decreased with increasing socioeconomic status [ORs (95% CIs) of moderate and high socioeconomic status relative to low socioeconomic status of 0.67 (0.53–0.84) and 0.43 (0.34–0.54), respectively; P trend=9.7×10–17]. In contrast, the prevalence of Helicobacter pylori infection linearly increased with increasing sibling number [ORs (95% CIs) of SN 3–4 and ≥5 relative to sibling number ≤2 of 1.74 (1.47–2.06) and 2.54 (2.12–3.04), respectively; P trend=1.2×10–24]. This study showed that socioeconomic status and sibling number were significantly associated with the prevalence of Helicobacter pylori infection.

Impact of socioeconomic status and sibling number on the prevalence of Helicobacter pylori infection: a cross-sectional study in a Japanese population

PURPOSE:To reduce a weight and obtain uniform polarized light separating performance by forming a triangular prism consecutive body formed by arraying triangular prisms so that the surfaces forming vertical angles are parallel and the bottom surfaces form the same plane adjacently. CONSTITUTION:The incidence side prisms 1-7 are formed on plane glass 15 and a dielectric multilayered film is formed as a polarized light separating film 16 on the opposite side surface of the plane glass 15. The output side prisms 8-14 are formed on the other plane glass 18 and the surface of the polarized light separating film 16 on the plane glass 15 and the reverse side of the plane glass 18 are joined together across an adhesive layer 17 to form the polarization beam splitter which has many prism surfaces. Namely, the triangular prisms 1-14 are arrayed into the triangular prism consecutive body so that the surfaces forming the vertical angles are parallel and the bottom surfaces form the same plane adjacently.

Kazuo Hara

Papers

Antireflection film of optical parts

Management of acute cholecystitis after biliary stenting for malignant obstruction: comparison of percutaneous gallbladder drainage and aspiration

Recurrent autoimmune hemolytic anemia induced by XELOX chemotherapy for colon cancer

Impact of socioeconomic status and sibling number on the prevalence of Helicobacter pylori infection: a cross-sectional study in a Japanese population

Polarization beam splitter