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Drawing lines in the sand: The growing threat of obesity in type 1 diabetes

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World Journal of Diabetes 2024年第5期15卷 823-827页

作者： Theocharis Koufakis Dimitrios Patoulias Ioanna Zografou Nikolaos Papanas Djordje S Popovic Second Propedeutic Department of internal medicine Aristotle University of ThessalonikiThessaloniki 54642Greece Diabetes Centre Second Department of Internal MedicineDemocritus University of ThraceAlexandroupolis 68100Greece Clinic for Endocrinology Diabetes and Metabolic DisordersClinical Center of VojvodinaMedical FacultyUniversity of Novi SadNovi Sad 21000Serbia

In this editorial,we comment on the article by Zeng et al published in the recent issue of the World Journal of Diabetes in *** focus on the epidemiological,pathophysiological,and clinical interplay between obesity and type 1 diabetes mellitus(T1DM).Overweight and obesity represent a growing threat for modern societies and people with T1DM could not be an exception to this *** exogenous insulin administration,genetic and epigenetic factors,and psy-chosocial and behavioral parameters,along with the modern way of life that incorporates unhealthy eating patterns and physical inactivity,set the stage for the increasing obesity rates in *** our knowledge of the underlying mechanisms that lead to the development of obesity and hyperglycemia expands,it becomes clear that there are overlap zones in the pathophysiology of the two main types of *** regarding strict dividing lines between“autoimmune”and“metabolic”phenotypes increase the risk of trapping physicians into ineffective therapeutic approaches,instead of individualized diabetes *** this context,the use of adjuncts to insulin therapy that have the potential to alleviate cardiorenal risk and decrease body weight can reduce the burden of obesity in patients with T1DM.

关键词： Obesity Overweight Type 1 diabetes metabolic syndrome

Alanine aminotransferase predicts incident steatotic liver disease of metabolic etiology: Long life to the old biomarker!

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World Journal of Gastroenterology 2024年第24期30卷 3016-3021页

作者： Amedeo Lonardo Department of internal medicine Azienda Ospedaliero-Universitaria of Modena(2023)Modena 41126Italy

Alanine aminotransferase(ALT)serum levels increase because of hepatocellular *** dysfunction-associated fatty liver disease(MAFLD),which identifies steatotic liver disease(SLD)associated with≥2 metabolic abnormalities,has prominent sexual *** metabolic Syndrome defines a cluster comprising abdominal obesity,altered glucose metabolism,dyslipidemia,and *** sex,body mass index,glucose,lipids,ferritin,hypertension,and age independently predict ALT levels among blood *** the last few decades,the reference range of ALT levels has been animatedly debated owing to attempts to update sex-specific reference *** this backset,Chen et al have recently published a study which has two main ***,>80%of indi-viduals with MAFLD had normal ALT ***,there was a linear increa-sing trend in the association between cumulative excess high-normal ALT levels and the rate of incident *** study has biologically credible ***,it inaccurately considered sex differences in the MAFLD ***,future studies on SLD owing to metabolic dysfunction should adopt locally determined and prospectively validated reference ranges of ALT and carefully consider sex differences in liver enzymes and MAFLD pathobiology.

关键词： Alanine aminotransferase Biomarker History of medicine metabolic dysfunction-associated fatty liver disease Metabolism Nonalcoholic fatty liver disease Reference range Sex differences Steatotic liver disease

metabolic dysfunction-associated steatotic liver disease:Navigating terminological evolution,diagnostic frontiers and therapeutic horizon-an editorial exploration

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World Journal of Gastroenterology 2024年第18期30卷 2387-2390页

作者： Aleksandra Boldys Lukasz Buldak Department of internal medicine and Clinical Pharmacology School of Medicine in KatowiceMedical University of SilesiaKatowice 40-752Poland

metabolic dysfunction-associated steatotic liver disease(MASLD),once known as non-alcoholic fatty liver disease(NAFLD),represents a spectrum of liver disorders characterized by lipid accumulation within *** redefinition of NAFLD in 2023 marked a significant reposition in terminology,emphasizing a broader understanding of liver steatosis and its associated *** is now recognized as a major risk factor for liver cirrhosis,hepatocellular carcinoma,and systemic complications such as cardiovascular diseases or systemic *** challenges arise,particularly in identifying MASLD in lean individuals,necessitating updated diagnostic protocols and investing in non-invasive diagnostic ***,there is an urgent need for effective treatments targeting MASLD,with emerging pharmacological options focusing on,among others,carbohydrate and lipid ***,understanding the roles of bile acid metabolism,the microbiome,and dietary interventions in MASLD pathogenesis and management holds promise for innovative therapeutic *** is a strong need to emphasize the importance of collaborative efforts in understanding,diagnosing,and managing MASLD to improve physicians’approaches and patient outcomes.

关键词： metabolic dysfunction-associated steatotic liver disease Diagnostics Pathophysiology of metabolic dysfunction-associated steatotic liver disease Therapy of metabolic dysfunction-associated steatotic liver disease Therapeutic innovations

Deferred revascularization in diabetic patient according to combined invasive functional and intravascular imaging data:A case report

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World Journal of Clinical Cases 2024年第13期12卷 2269-2274页

作者： Arif Al Nooryani Wael Aboushokka Branko Beleslin Biljana Nedeljkovic-Beleslin Department of Cardiology Al Qassimi HospitalSharjah 1234United Arab Emirates Department of Cardiology Medical FacultyUniversity of BelgradeBelgrade 11000Serbia Institute of Endocrinology Diabetes and Metabolic DisordersUniveristy Clinical Center of SerbiaBelgrade 11000Serbia Department of internal medicine/Endocrinology Medical facultyUniversity of BelgradeBelgrade 11000Serbia

BACKGROUND Invasive functional evaluation by fractional flow reserve(FFR)is considered as a gold standard for the evaluation of intermediate coronary ***,in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional *** SUMMARY We present a case of 55-year-old male diabetic patient who was admitted for chest *** coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted *** undergone invasive functional testing of intermediate lesion with preserved FFR(0.88),low coronary flow reserve(1.2)and very high index of microvascular resistance(84).Due to discrepancy in invasive functional parameters,intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup *** of the preserved FFR and no signs of vulnerable plaque,the interventional procedure was deferred and the patient continued with optimal *** Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.

关键词： Fractional flow reserve Coronary flow reserve Index of microvascular resistance Optical coherence tomography Intermediate coronary stenosis Case report

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 1097-1108页

作者： Hassam Ali Faisal Inayat Vishali Moond Ahtshamullah Chaudhry Arslan Afzal Zauraiz Anjum Hamza Tahir Muhammad Sajeel Anwar Dushyant Singh Dahiya Muhammad Sohaib Afzal Gul Nawaz Amir H Sohail Muhammad Aziz Department of Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of internal medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of internal medicine Saint Peter's University Hospital and Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of internal medicine St.Dominic's HospitalJacksonMS 39216United States Department of internal medicine Rochester General HospitalRochesterNY 14621United States Department of internal medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of internal medicine UHS Wilson Medical CenterJohnsonNY 13790United States Division of Gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansasKS 66160United States Department of internal medicine Louisiana State University HealthShreveportLA 71103United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Department of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III *** aids in significant weight loss and improves obesity-related medical *** its effectiveness,postoperative care still has *** evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after ***,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB *** To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing *** Using the 2016–2021 metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of *** resultant risk scores were derived from the coefficients of statistically significant *** performance of the model was evaluated using receiver operating curves through 5-fold *** Of the 26 initial variables,six predictors were *** included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk *** risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of *** training,the same model performed satisfactorily

关键词： Roux-en-Y gastric bypass Venous thromboembolism Machine learning Bariatric surgery Predictive modeling

The Role of Adipose Tissue-derived Exosomes in Chronic metabolic Disorders

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Current Medical Science 2024年第3期44卷 463-474页

作者： Rui HE Yong CHEN Division of Endocrinology Department of Internal MedicineTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China Laboratory of Endocrinology & Metabolism Key Laboratory of Vascular Aging of the Ministry of EducationTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China Branch of National Clinical Research Center for metabolic Diseases Wuhan430030China

Excessive fat deposition in obese subjects promotes the occurrence of metabolic diseases,such as type 2 diabetes mellitus(T2DM),cardiovascular diseases,and non-alcoholic fatty liver disease(NAFLD).Adipose tissue is not only the main form of energy storage but also an endocrine organ that not only secretes adipocytokines but also releases many extracellular vesicles(EVs)that play a role in the regulation of whole-body *** are a subtype of EVs,and accumulating evidence indicates that adipose tissue exosomes(AT Exos)mediate crosstalk between adipose tissue and multiple organs by being transferred to targeted cells or tissues through paracrine or endocrine ***,the roles of AT Exos in crosstalk with metabolic organs remain to be fully *** this review,we summarize the latest research progress on the role of AT Exos in the regulation of metabolic ***,we discuss the potential role of AT Exos as biomarkers in metabolic diseases and their clinical application.

关键词： exosome adipose tissue obesity diabetes chronic metabolic disorder miRNA

Glucagon-like peptide 1 agonists are potentially useful drugs for treating metabolic dysfunction-associated steatotic liver disease

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World Journal of Gastroenterology 2024年第30期30卷 3541-3547页

作者： Maurizio Soresi Lydia Giannitrapani Department of Health Promotion Sciences Maternal and Infant CareInternal Medicine and Medical Specialties(PROMISE)University of PalermoPalermo 90127Italy

In this editorial,we comment on Yin et al’s recently published Letter to the *** particular,we focus on the potential use of glucagon-like peptide 1 receptor agonists(GLP-1RAs)alone,but even more so in combination therapy,as one of the most promising therapies in metabolic dysfunction-associated steatotic liver disease(MASLD),the new definition of an old condition,non-alcoholic fatty liver disease,which aims to better define the spectrum of steatotic *** is well known that GLP-1RAs,having shown outstanding performance in fat loss,weight loss,and improvement of insulin resistance,could play a role in protecting the liver from progressive *** clinical trials have shown that,among GLP-1RAs,semaglutide is a safe,well-studied therapeutic choice for MASLD patients;however,most studies demonstrate that,while semaglutide can reduce steatosis,including steatohepatitis histological signs(in terms of inflammatory cell infiltration and hepatocyte ballooning),it does not improve *** of therapies with different but complementary mechanisms of action are considered the best way to improve efficiency and slow disease progression due to the complex pathophysiology of the *** particular,GLP-1RAs associated with antifibrotic drug therapy,dual glucose-dependent insulinotropic polypeptide(GIP)/GLP-1RA or GLP-1 and glucagon RAs have promoted greater improvement in hepatic steatosis,liver biochemistry,and non-invasive fibrosis tests than ***,although to date there are no definitive indications from international drug agencies,there is the hope that soon the therapeutic lines in the most advanced phase of study will be able to provide a therapy for MASLD,one that will certainly include the use of GLP-1RAs as combination therapy.

关键词： Non-alcoholic fatty liver disease Glucagon-like peptide 1 Semaglutide Liver fibrosis Therapy

Mesenchymal stem cells: A promising therapeutic avenue for nonalcoholic fatty liver disease

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World Journal of Stem Cells 2024年第8期16卷 780-783页

作者： Chun-Han Cheng Wen-Rui Hao Tzu-Hurng Cheng Department of Medical Education Linkou Chang Gung Memorial HospitalTaoyuan 33305Taiwan Division of Cardiology Department of Internal MedicineShuang Ho HospitalMinistry of Health and WelfareTaipei Medical UniversityNew Taipei 23561Taiwan Division of Cardiology Department of Internal MedicineSchool of MedicineCollege of MedicineTaipei Medical UniversityTaipei 11002Taiwan Department of Biochemistry School of MedicineCollege of MedicineChina Medical UniversityTaichung 404328Taiwan

Non-alcoholic fatty liver disease(NAFLD)is a pressing global health concern that is associated with metabolic syndrome and *** the basis of the insights provided by Jiang et al,this editorial presents an exploration of the potential of mesenchymal stem cells(MSCs)for NAFLD *** have numerous desirable characteristics,including immunomodulation,anti-inflammatory pro-perties,and tissue regeneration promotion,rendering them attractive candidates for NAFLD *** preclinical and early clinical studies have high-lighted the efficacy of MSCs in improving liver function and reducing disease severity in NAFLD ***,MSC heterogeneity,long-term safety concerns,and unoptimized therapeutic protocols remain substantial *** these challenges through standardized protocols and rigorous clinical trials is essential to the safe and successful application of MSCs in NAFLD *** research into MSC mechanisms and therapeutic optimization is required to improve treatments for NAFLD and related liver diseases.

关键词： Mesenchymal stem cells Non-alcoholic fatty liver disease Therapeutic potential Liver fibrosis Regenerative medicine Stem cell therapy Inflammation Clinical trials

metabolic Syndrome in the internal medicine Department of Chu Point G

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Open Journal of internal medicine 2023年第3期13卷 139-143页

作者： Djenebou Traoré Sy Djibril Nongoba Sawadogo Djeneba Sylla Sow Massama Konaté Nounga Romuald Nyanke Ayayi Edem D’Almeida Kaly Keita Sekou Landouré Nouhoum Koné Moussa Sangaré Mamadou Mallé Ibrahima Amadou Dembélé Mamadou Cissoko Yacouba Koné Aoua Diarra Assetou Kaya Soukho Department of internal medicine University Hospital Center of Point G Bamako Mali Faculty of medicine and Odontostomatology Bamako Mali Departement of internal medicine Kaya Regional Hospital Kaya Burkina Faso Department of Medical University Hospital Center from the Hospital in Mali Bamako Mali

Introduction: The metabolic syndrome according to the IDF (International Diabetes Federation) is at the origin of the double global epidemic of type 2 diabetes and cardiovascular diseases. This work aims to study the metabolic syndrome in the internal medicine department of CHU Point G. Methodology: This was a descriptive study of patients who presented a metabolic syndrome according to the definition of the IDF definition, hospitalized in the internal medicine department of the CHU du point G for the period from January 1 2010 to December 31, 2019. Results: During the study period, 4189 patients were hospitalized, including 60 with metabolic syndrome, representing a hospital frequency of 1.43%. The sex ratio was 0.36. The age group of 50 and 60 years accounted for 28.3%. Forty-six point six percent (46.6%) of our patients were diabetic, 45% obese, 60% hypertensive, 70% sedentary and 10% smokers. Our patients had in 53.3% of cases a blood pressure figure ≥ 130/85 mmHg, abdominal obesity in 100%, hypertriglyceridemia in 33.3%, HDL-C less than 0.40 g/l in 62.5% of men and less than 0.50 g/l in 77.27% of men, blood sugar ≥ 1 g/l in 88.3%. Conclusion: The metabolic syndrome, in view of the entities that compose it, is a real cardiovascular risk factor and therefore a major public health issue.

关键词： metabolic Syndrome CHU Point G internal medicine