North American Journal of Medicine and Science
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Analysis of Risk Factors for Normal Glucose Tolerance-Hyperinsulinemia
Get PDFThe aim of this paper is to study the prevalence of individuals with normal glucose tolerance-hyperinsulinemia in Nanshan of Shenzhen, determine the cut point values of normal glucose tolerance-hyperinsulinemia, and investigate the risk factors for it. All subjects were followed 75g oral glucose tolerance test (OGTT) and insulin releasing test. Glucose metabolic disorders were determined according to WHO definition (1999). Hyperinsulinemia was determined if fasting serum insulin and/or 2-hour serum insulin ≥ the 90th percentile, so subjects with normal glucose tolerance were divided into two groups: hyperinsulinemia and normoinsulinemia. The islet cell function and metabolic characteristics of individuals with normal glucose tolerance-hyperinsulinemia were analyzed and its related risk factors were investigated by Logistic regression analysis. The cut point values of normal glucose tolerance-hyperinsulinemia in Nanshan of Shenzhen is fasting serum insulin ≥ 13.85 mU/L and/or 2-hour serum insulin ≥ 74.97 mU/L. The prevalence of NGT- HINS in the community was 7.84%. The differences of the prevalence of high blood, HDL, LDL, TG, UA were significant between subjects with NGT-HINS and NGT-NINS (P < 0.05); and the differences are nonsignificant between subjects with NGT-HINS and IGR (P > 0.05). There were significant differences on 2hPG between subjects with NGT-HINS and IGR (P < 0.05), and no difference between individuals with NGT-HINS and NGT-NINS (P > 0.05). The differences of the smoking rates, Baecke index, BMI, WHR, TC, FPG, HbA1C, HOMA-IR, and HBCI/R were significant among these groups. There were nonsignificant differences on age, sex, drinking rate among three groups (P > 0.05). Logistic regression analysis showed that BMI (OR = 14.019, 95% CI: 4.111, 47.800; P = 0.000); TG (OR = 9.336, 95% CI: 2.697, 32.313; P = 0.000); HDL (OR = 0 .181, 95% CI: 0 .053, 0.625; P = 0.007); FPG (OR = 5.276, 95% CI: 1.588, 17.535; P = 0.007); HOMA-IR (OR = 22.727, 95% CI: 6.895, 74.915; P = 0.000); HBCI/IR (OR = 6.611, 95% CI: 2.238, 19.529; P = 0.001) were the independent predictors for NGT-HINS. Our results show that the cut point values of normal glucose tolerance-hyperinsulinemia in Nanshan of Shenzhen is fasting serum insulin ≥ 13.85 mU/L and/or 2-hour serum insulin ≥ 74.97 mU/L. Individuals with NGT-HINS suffered more metabolic risk factors and had a decreased β-cell function. NGT-HINS is a transitional state between NGT and IGR. BMI, TG, HDL, FPG, HOMA-IR, and HBCI/IR were the independent predictors for NGT-HINS. [N A J Med Sci. 2018;11(1):43-51. DOI: 10.7156/najms.2018.1101043
Primary Prostatic High-Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements: A Case Report and Literature Review
Get PDFProstatic lymphoma (mostly secondary involvement) is rare, accounting for 0.09% of all prostate tumors and 0.1% of non-Hodgkin lymphoma. Primary prostate lymphoma is extremely rare, by far only limited number of cases have been reported in English literature. Here we report a case of primary prostatic high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBCL-MBBR) in an 81 year old Caucasian male who presented with urinary outlet obstruction as sole symptom. He was diagnosed as benign prostate hyperplasia, followed with transurethral resection of prostate. Incidentally, a lymphoma was identified on H&E stains. Microscopic finding, Immunohistochemistry, and FISH study all support a diagnosis of HGBCL-MBBR. To our knowledge, this is the first case of HGBCL-MBBR reported so far.[N A J Med Sci. 2018;11(1):25-27. DOI: 10.7156/najms.2018.110125
Clinicopathologic Characteristics of EGFR Mutations in Non-Small Cell Lung Cancer (NSCLC) in Central New York
Get PDFEGFR mutation rates in NSCLC differ among ethnic groups, nations, age, sex, smoking status, and histologic differentiation. We examined the clinicopathologic characteristics of EGFR mutations in NSCLC in the Central New York (CNY) region for the first time, to further characterize the disease and facilitate management. 7.1% (33/464) NSCLCs were positive for EGFR mutations. Based on available clinical data, EGFR positive mutation status was found in 7.4% (28/380) White, 5.3% (2/38) African American, 0% (0/4) American Indian/Alaska native, 33.3% (1/3) Asian/Pacific, 0% (0/2) Hispanic, and 0% (0/1) Asian/Indian patients. Average age in EGFR positive cases was 68.3 years and 66 in negative cases (p>0.05). Prevalence of EGFR mutations was 9.2% in females and 4.4% in males (p<0.05); 37.9% in never-smokers and 4.4% in ever-smokers (p<0.05). Poorly differentiated adenocarcinoma was seen in 16.7% (4/24) of EGFR positive cases and 43.4% (105/242) of negative cases (p < 0.05). Solid pattern was seen in 9.0% (2/22) of positive cases and 33.3% (44/132) of negative cases (p < 0.05). The acinar pattern was the most common pattern seen in adenocarcinomas with exon 19 deletion, and exon 21 (L858R) mutations. Therascreen detected four additional rare mutations (1 T790M, 1 L861Q, G719X, and 1 exon 21 insertion) in 238 cases, increasing overall EGFR detection rate from 6.3% to 7.1%. EGFR mutation prevalence in NSCLC in CNY (7.1%) was lower than the global average in a recent review (13.9% [10.3-36.4]), likely due to predominantly white population in this study, accounting for 84.8% (28/33) of positive cases in CNY. Similar to previous studies, positive EGFR mutation status was more frequent in females and never-smokers, and less prevalent in adenocarcinoma with poor differentiation or solid growth.[N A J Med Sci. 2018;11(1):1-5. DOI: 10.7156/najms.2018.110101
Ectopic Hamartomatous Thymoma: A Case Report and Literature Review
Get PDFEctopic hamartomatous thymoma is a rare benign tumor located at supraclavicular/suprasternal area and is speculated with a branchial anlage origin. There are usually 3 components in the tumor: spindle cells, epithelial cells, and adipose tissue, although proportion of each varies from case to case. The tumor cells present with a unique immunophenotype, with strong positivity for AE1/AE3, CD34, CD10, and variable staining for Bcl-2 and SMA. Here we report such a case in a 61 year old male, with a compatible morphology and immunopattern for this entity.[N A J Med Sci. 2018;11(1):11-14. DOI: 10.7156/najms.2018.110111
Merkel Cell Carcinoma: A Comparison of Different Immunohistochemical Markers Useful in Diagnosis
Get PDFMerkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma associated with a high mortality rate. A polyomavirus integrated into the genome of most tumors is thought to be pathogenic. MCCs may be difficult to distinguish from other small cell carcinomas, melanoma, lymphoma, and others. Immunohistochemical marker studies are essential for accurate and efficient diagnosis. Although the paranuclear dot-like pattern seen with staining for cytokeratin 20 is considered characteristic, antibodies directed at other cytokeratins such as cytokeratin 8 (CAM 5.2), pancytokeratins (AE1/AE3), and other clones that recognize low molecular weight cytokeratins are also useful for diagnosis. We set out to evaluate which stains are helpful in diagnosing the cases of MCC encountered in our patient population. A retrospective study of 59 cases of MCC from our files was performed. Each MCC was stained with a panel of IHC markers and evaluated for the staining pattern and intensity in an effort to identify the most efficient IHC stains useful in establishing a diagnosis of MCC. [N A J Med Sci. 2018;11(1):34-38. DOI: 10.7156/najms.2018.1101034
Food Environment, Policy and Sugar-Sweetened Beverages Consumption in U.S. Adolescents
Get PDFIncreased consumption of sugar-sweetened beverages (SSBs) is a critical nutrition problem in the U.S. and has been identified as a key contributor to the current epidemic of obesity among adolescents. Up to date, little is known on how this high level of SSBs consumption can be reduced. Recently, environmental and policy interventions have been advocated as powerful strategies to address the epidemic. While there is a growing consensus that food environments and policies play important roles in influencing individuals’ food choice, reviews of studies linking the food environment (i.e. fast food restaurants density, conventional stores density, school cafeteria and vending machines) and policies (i.e. food price and tax) with the SSBs consumption in adolescents indicate the research is equivocal and data for policy making is lacking. In addition, little research has been done to compare the relative importance of the various aspects of food environment in influencing SSBs intake in youth. Part of the research barriers could be lack of database that includes validated measures of multiple environmental and policy factors. In this review, we summarized the environments and policy determinants of SSB consumptions in U.S. adolescents and the challenges in measuring environmental contexture factors. We also proposed the future research directions and believed findings from research in these areas will inform policy and guide future environmental and policy interventions on reducing the SSBs consumption and lower the obesity rate in U.S. adolescents.[N A J Med Sci. 2017;10(2):73-77. DOI: 10.7156/najms.2017.1002073
Adverse Effects and Safety of SGLT2 Inhibitor Use among Patients with Type 2 Diabetes: Findings from RCT Evidence
Get PDFSodium-glucose cotransporter 2 (SGTL2) inhibitors, a novel class of glucose-lowering agents, act in an insulin-independent manner by increasing urinary glucose excretion. In addition to reduce hyperglycemia, SGTL2 inhibitor exerts beneficial effects on cardiovascular risk factors (e.g., lower blood pressure and enhance weigh loss), which may confer additional health benefits for type 2 diabetes patients. The EMPA-REG OUTCOME trial showed that empagliflozin not only reduced the risk of major adverse cardiovascular events but also slowed down the progression of kidney disease compared with placebo. However, some evidence indicated an increased risk of composite renal events among patients using dapagliflozin. The beneficial cardiovascular and renal effects of EMPA-REG OUTCOME trial representing a class effect or a specific drug effect warrants to be further investigated. SGLT2 inhibitors were associated with increased risks of genital mycotic infections and urinary tract infections. Some mechanisms indicated that SGLT2 inhibitor might lead to diabetic ketoacidosis and bone fracture. These risks remain uncertain, though some evidence from the meta-analyses did not find any significantly increased risks of diabetic ketoacidosis and bone fracture. The findings of ongoing trials will provide more definitive evidence on safety of SGLT2 inhibitors. [N A J Med Sci. 2017;10(2):78-82. DOI: 10.7156/najms.2017.1002078