Plasma levels of interleukin-6 (IL-6), a cytokine known to be involved in lymphocyte activation and in inflammation, were studied in 10 normal volunteers, 21 continuous ambulatory peritoneal dialysis (CAPD) patients and 41 hemodialysis patients. Plasma IL-6 levels in hemodialysis patients were significantly higher than those in normal volunteers and CAPD patients (p < 0.05). The means of plasma IL-6 concentrations before and after hemodialysis did not change significantly. While IL-6 in peritoneal dialysate was detectable in only 3 of the 21 CAPD patients without peritonitis, it was extremely high in 2 patients with bacterial peritonitis. IL-6 levels decreased as peritonitis subsided.
on behalf of the J-STOP-MetS Study GroupThe aim of this study was to examine whether additional repeated counselling further improves the health effects of limited, highly individualized lifestyle guidance in metabolic syndrome. One hundred and nine previously untreated metabolic syndrome patients received highly standardized and individualized lifestyle guidance for weight loss. A tentative goal of 5% weight reduction over the course of 2 months was set. Patients were then randomly assigned to either the multiple guidance group who received further counselling every 2 months (n¼52) or the single guidance group who received no further guidance until the final assessment 6 months later (n¼57). Baseline data between the multiple guidance and single guidance groups were similar. Body weight and waist circumference were significantly reduced, and liver function, lipid profiles and glucose metabolism were significantly improved in both groups. After adjustment for baseline data, the multiple guidance group showed considerably higher reduction in waist circumference and fasting blood sugar concentration than the single guidance group. These data suggest that additional counselling further improved the antidiabetic effects of limited individualized lifestyle guidance in metabolic syndrome.
Patients with chronic renal failure showed the existence of phosphate retention, secondary hyperparathyroidism, and reduced production of 1,25-(OH)2D. In order to determine the effect of correction of hyperphosphatemia on secondary hyperparathyroidism and vitamin D metabolism in those patients, 7 nondiaiyzed patients with chronic renal failure were treated with large doses of Al(OH)3 (15–18 g/day) to correct their high levels of serum phosphate. After treatment with A1(OH)3, serum phosphate fell significantly (p < 0.005) from 6.3 ± 1.3 (mean ± SD) to 3.7 ± 0.5 mg/dl. Serum parathyroid hormone decreased significantly (p < 0.02) from 2.87 ± 1.64 to 1.85 ± 1.26 ngEq/ ml. Serum l,25-(OH)2D was low compared to the normal mean level before A1(OH)3 administration and decreased significantly (p > 0.02) from 19.4 ± 6.1 to 11.4 ± 4.3 pg/ml after the treatment. Aluminum levels increased significantly (p > 0.02) from 1.7 ± 1.0 to 3.6 ± 1.5 μg/dl. Serum calcium, calcitonin, and 25-(OH)D showed no significant change. Our data suggested that the suppression of secondary hyperparathyroidism by A1(OH)3 treatment results in a decrease of the 1,25-(OH)2D level in patients with chronic renal failure, even though their hyperphosphatemia has been corrected. We speculate that aluminum loading might play a role in diminishing the secretion of parathyroid hormone and the production of 1,25-(OH)2D in humans.
Prevalence of the metabolic syndrome is now a very serious health problem in Japan and a public preventive strategy is essential to reduce morbidity. A systematic interventional strategy for the metabolic syndrome remains to be established. In order to address this issue, a multi-center study; Japanese Study to Organize Proper lifestyle modifi cation for the metabolic syndrome (J-STOP-MetS), has been established by nine preventive medical centers among Rosai hospital groups. This study comprises a cross-sectional study (J-STOP-MetS 1) and a prospective randomized control study (J-STOP-MetS 2). J-STOP-MetS 1 examines the causes of the metabolic syndrome by means of a questionnaire in a large cohort of patients with the metabolic syndrome and control subjects matched for age and sex. J-STOP-MetS 2 examines the hypothesis that guidance on lifestyle modifi cations will help at risk patients to reduce abdominal fat and cardiovascular risk factors. The metabolic syndrome patients are randomly assigned either to a single visit to a guidance group or multiple visits every two months. The individualized guidance is provided by the coordination of physician, trained nurse, dietician and exercise trainer. Several parameters are measured before and six months after the fi rst guidance session, including, body weight, waist circumference, blood pressure, several blood markers and arterial stiffness. The J-STOP-MetS is the fi rst large-scale clinical study of the metabolic syndrome in Japan and should provide important evidence for the practical management of the metabolic syndrome.
Lp(a) is an LDL-like lipoprotein carrying the apoprotein(a) glycoprotein and has recently been recognized to be an independent risk factor for coronary heart disease. We studied plasma Lp(a) levels in 40 patients undergoing maintenance hemodialysis (24 male, 16 female; aged 16-83 years). Fasting plasma Lp(a) levels were measured by an enzyme-linked immunosorbent assay. The median value of plasma Lp(a) concentrations in hemodialysis patients was significantly higher than that of the normal volunteers (26.0 +/- 2.7 vs. 10.8 +/- 3.7 mg/dL, p < .05). Lp(a) levels did not correlate with age, duration of hemodialysis, total cholesterol, triglyceride, HDL cholesterol, or LDL cholesterol. The 11 patients whose plasma Lp(a) concentrations exceeded 20 mg/dL received niceritrol, a prodrug of nicotinic acid, at a dosage of 500 mg t.i.d. for 4 weeks. The plasma Lp(a) levels were significantly lower after 4 weeks of treatment (38.3 +/- 4.2 vs. 31.5 +/- 3.2 mg/dL, p < .01).
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