Liudmyla G. Savchenko, Nataliia I. Digtiar, Liudmyla G. Selikhova, Elvira I. Kaidasheva, Oksana A. Shlykova, Liudmyla E. Vesnina and Igor P. Kaidashev
Introduction. Liraglutide (L) is the analogue of human glucagon-like peptide 1 which stimulates glucose-dependent insulin secretion and can modify the level of inflammatory biomarkers.
L can influence NF-kB inflammatory cascade, but the mechanisms of anti-inflammatory activities of L remain to be determined. In animal models L influenced an activity of Sirtuin 1(SIRT1). Moreover, recent evidences strongly suggest that SIRT1 up-regulation may serve as a potent therapeutic approach against development and progression of diabetic complications. The aim of this study was to investigate L effects directed on the pro-inflammatory NF-kB pathway and expression of SIRT1 in obese patients with type 2 diabetes mellitus (DM).
Materials and Methods. 15 obese patients with type 2 diabetes were studied, all using metformin (1-2 g/day) and sulfonylurea (glimiperide). All patients received L 1.2 mg daily add-on to stable therapy for 6 weeks. Blood samples were collected before, 6 weeks after start of treatment and after an overnight fast 6 weeks after stopping L, mononuclear cells (MNC) were isolated. The mRNA expressions of TNF-α, TLR2, TLR4, NOD1, IL-2 and SIRT1 were measured in MNC by RT-PCR. Ceruloplasmin concentration was measured in plasma by photometric method.
Results. In this add-on pilot clinical investigation we received new data that L can inhibit proinflammatory NF-kB pathway by increased SIRT1 expression in obese patients with type 2 DM improving metabolic profile. The mRNA expression in MNC of TNF-α, IkB, TLR2, TLR4, and plasma ceruloplasmin fell after 6 weeks of L. Expressions of IL-2 and NOD-1 were stable. There was a significant increase of SIRT1 mRNA expression. The mRNA expression in MNC of TNF-α, IkB, TLR2, TLR4, NOD1, SIRT1 and ceruloplasmin concentrations did not reverse to baseline levels after 6 weeks stopping of L treatment. IL-2 expression decreased in comparison with basic level.
Conclusions. L has a potent anti-inflammatory effect as do GLP-1 agonists due to inhibition of NF-kB pathways and up-regulate SIRT1 expression, down-regulating pro-inflammatory factors including cytokines (TNF-α), extra- and intracellular receptors (TLR2, TLR4), and inflammation markers such as ceruloplasmin. Long lasting effects of L can be mediated by epigenetic regulation of NF-kB pathway by SIRT-1.
Alana Murphy, Seth Teplitsky, Akhil K. Das, Joon Yau Leong, Andrew Margules and Costas D. Lallas
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Larisa Pinte, Daniel Vasile Balaban, Cristian Băicuş and Mariana Jinga
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establish the current state of the use of MSUS and the members’ view on the future development of MSUS training and services in Hong Kong.
A three-page English language anonymous questionnaire was sent either in electronic format or hardcopy to 79 members (70 full members and 9 ordinary members) of the Hong Kong Society of Rheumatology. The survey ran from March until May 2015. The aim is to inquire about the use of MSUS by rheumatologists and their views on the future development of MSUS training and service in Hong Kong. After
Ramona Moldovan, Mădălina Radu, Adriana Băban and D.L. Dumitraşcu
The so-called “Psychosomatic symptoms” represent a real challenge for internists. These have often been described as non-specific, non-organic, functional, dysfunctional or idiopathic. These “diagnostic puzzles” are obviously difficult to treat. Psychosomatic symptoms have been categorized as hysteria, psychogenic, psychosomatic, conversion, somatization and somatoform disorder. It is only when modern classificatory systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) were developed that research was stimulated and new clinical developments became much stronger than any other time. The current paper is aimed at briefly presenting the evolution of psychosomatic symptoms in DSM while pointing out the major milestones as well as the benefits and challenges along the way. We discuss the perspectives open with the advent of the 5th edition the DSM-V.
Manju Ceylony, Jahan Porhomayon, Leili Pourafkari and Nader D. Nader
Introduction. Internal Medicine residents must develop competency as Primary Care Providers, but a gap exists in their curriculum and training with regard to women’s reproductive health. With increasing need in VA due to new influx of women veterans it poses problems in recruitment of competent physicians trained in Women’s health. Methods. An intensive, one-month women’s reproductive health curriculum with hands on experience for Internal Medicine residents was provided. Curriculum was taught to the residents who rotated at the Women’s Health Clinic for one month. Pre-test and post-test exams were administered. Increase in knowledge of residents in providing gender specific evaluations and management was objectively assessed by changes in post-test scores. Data were analyzed for statistically significant improvement in written tests scores. Results. Total of 47 Internal Medicine residents rotated through Women’s Health Center during the evaluation period. All residents completed both pre-test and post-test exams. The average time to complete the pre-test was 20.5 ± 5.4 min and 19.5 ± 4.8 min for post-test. There was no correlation between the time to complete the pre-test exam and the post-test exam. The total score was significantly improved from 8.5 ± 1.6 to 13.2 ± 1.8 (p < 0.0001). Conclusion. This study shows how to equip physicians in training with information on women’s health that enables them to provide safe and gender appropriate care in primary care settings. This practice will reduce the need for frequent referrals for specialized care and thus provide cost saving for patient and health care on the whole.
Alireza Sepehri Shamloo, Nikolaos Dagres, Arash Arya and Gerhard Hindricks
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Evelyn Nathalia, Madelaine Skolastika Theardy, Sharleen Elvira, Graciella Rosellinny, Andrew Steven Liyanto, Michael Putra Utama and Anton Sumarpo
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Ipilimumab, a CTLA-4 inhibitor, was first approved by the Food and Drug Administration in 2011 for the treatmentof late-stage melanoma. Since then, the development of immunotherapy has been thriving and became part of the standard oncology care. The indications of anti-cytotoxic T-lymphocyte-associated antigen 4 (anti-CTLA-4), anti-programmed cell death protein (anti-PD1), and anti-programmed cell death protein ligand (anti-PDL1) now extend from melanoma to non
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