Journal of Investigative Medicine

Both chronic obstructive pulmonary disease (COPD) and asthma are important causes of morbidity and mortality worldwide. They primarily affect the lungs, but they have various extrapulmonary manifestations. The aim of our study was to evaluate the hemodynamic changes in orbital vessels of the patients with COPD and asthma using color Doppler ultrasonography and compare the results with healthy control subjects.

Thirty-seven patients with COPD, 37 patients with asthma, and 41 healthy control subjects were included in this study. All patients with COPD were in moderate to severe group according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), and similarly, all patients with asthma were in moderate to severe persistent group according to GINA (Global Initiative for Asthma) 2006 guidelines. End-tidal carbon dioxide, peripheral oxygen saturation, pulse rate, and respiratory rate were measured by using pulse oximeter in all patients. Measurements were performed in only 1 randomly selected eye of each participant. The peak systolic velocity, end diastolic velocity, and resistance index were measured in the central retinal artery, temporal posterior ciliary artery, and nasal posterior ciliary artery using the color Doppler ultrasonography technique.

The peak systolic velocity, end diastolic velocity, and resistance index values of temporal posterior ciliary artery and nasal posterior ciliary artery were significantly higher in COPD and asthma than in the control subjects. There was no difference between asthma and COPD.

We concluded that retrobulbar hemodynamics change in COPD and asthma is showing 1 of the systemic effects in these diseases.

Clostridium difficile infection (CDI) has recently markedly increased, incurring greater health care–associated costs and hospitalizations especially in vitamin D deficient patients. Accordingly, the aim of this study was to evaluate the relationship between low vitamin D levels and the severity and recurrence of CDI.

A retrospective case-control study evaluated patients hospitalized between 2007 and 2013 with CDI and a positive C. difficile toxin assay. Severe complicated CDI was defined based on (1) laboratory or radiological criteria correlated clinically and (2) sepsis requiring intensive care unit admission. Recurrent CDI (RCDI) was defined as a new episode of diarrhea occurring within 90 days of resolution of the initial episode for at least 10 days after discontinuing therapy and confirmed by positive stool C. difficile toxin assay or polymerase chain reaction. Patients were divided into 4 groups based on vitamin D level (ng/mL): severely deficient (<10), insufficient (10-19.9), predeficient (20-29.9), and control group (≥30).

Two hundred seventy-one patients were diagnosed with CDI, of which 48 had RCDI distributed as 5 (12.5%), 15 (16.1%), 10 (15.6%), and 13 (17.5%) patients in each of the aforementioned groups, respectively (P= 0.55). Severe complicated CDI was identified in 7 (17.5%), 17 (18.2%), 9 (14%), and 3 (4%) patients, respectively (P = 0.04). Thirty-day mortality was 1 of 40, 1 of 93, 2 of 64, and 2 of 74 patients, respectively (P = 0.43).

Normal vitamin D level has a protective effect against severe CDI, and low vitamin D is associated with greater severity of CDI but not with an increased risk of RCDI or 30-day mortality.

The effect of eating speed at a meal on appetite gut hormone responses and future food consumption is not clear. This study examined the effect of eating speed at breakfast on postprandial gut hormone responses, subjective appetite, and daily food consumption.

Twenty-five participants [68% men; age, 25.9 (8.1) years; body mass index, 25.0 (3.2) kg/m²] were recruited. Each participant consumed the same breakfast at a slow (30 minutes) and fast (10 minutes) speed, on 2 separate days, in a randomized crossover design. Blood samples were collected in the fasting state and 3 hours postprandially during each eating condition. Appetite was assessed over the same period using visual analog scales. Blood concentrations of orexigenic hormone, ghrelin, and anorexigenic hormones, glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), were determined. Daily food intake was measured, by food recall, after the slow and fast breakfast.

Mixed-model repeated-measures analysis showed no eating condition or eating condition by time interaction effect on ghrelin, GLP-1, PYY, hunger, or fullness. Significant eating speed by time interaction effect on desire to eat was found (P = 0.007). Desire to eat was lower at 60 minutes (P = 0.007) after breakfast began during the slow versus fast eating condition. Eating speed at breakfast did not affect daily energy and macronutrient intake.

Eating speed at breakfast did not affect postprandial ghrelin, GLP-1, PYY, hunger, and fullness values or daily energy and macronutrient intake. Desire to eat was lower at 60 minutes in the slow versus fast eating condition, but this result could not be explained by the changes in meal-related hormones measured in the study.

Physical activity improves body composition and inflammatory markers in obese individuals, but little is known about the nonobese population.

The aim of this study was to investigate associations between exercise and inflammatory cytokines in lean male adolescents in Taiwan.

This interventional study enrolled a total of 79 normal body weight male adolescents [mean age, 16.8 (1.0) years] from the Army Academy of Taiwan. Body composition and inflammatory markers were measured at baseline and upon completion of a 12-week exercise intervention program.

Subjects’ postintervention anthropometric measures, including waist circumference [74.6 (5.2) → 72.6 (5.2) cm], hip circumference [92.3 (4.1) → 89.9 (5.0) cm], body fat mass [10.2 (3.2) → 8.2 (3.2) kg], and body fat percentage [15.8% (4.2) → 12.6 (4.5)%] declined significantly compared to preintervention (all P < 0.001), as did systolic blood pressure (P = 0.002) and mean blood pressure (P = 0.020). Postintervention body height and free fat mass increased significantly (both P < 0.001). Subjects’ postintervention lipids including total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides increased significantly (all P < 0.001). Inflammatory markers including adiponectin [14.32 (6.68) → 31.31 (30.53) μg/mL, P < 0.001], interleukin 6 [2.15 (4.81) → 2.86 (6.37) pg/mL, P = 0.005], and C-reactive protein [1.00 (2.57) → 2.30 (4.17) μg/mL, P < 0.001] increased significantly postintervention, but not leptin.

Exercise training significantly improves body composition and anti-inflammatory adiponectin levels in lean male adolescents.

(1) Assess individual oral hydrocortisone pharmacokinetics; (2) relate the observed cortisol exposure in each subject to the observed exposures of 17-hydroxyprogesterone and androstenedione; (3) determine potential individualized treatment regimens based on each subject's pharmacokinetic and pharmacodynamic parameters.

Thirty-four patients (18 boys, 16 girls, aged 1.4 to 18.1 years) with CAH underwent 6-hour pharmacokinetic studies. Results were analyzed by noncompartmental methods to obtain the area under the curve (AUC) for cortisol, 17-hydroxyprogesterone, and androstenedione; maximum concentration and time-to-maximum concentration for cortisol; and minimum and time-to-minimum concentration for 17-hydroxyprogesterone and androstenedione.

Mean (SD) cortisol half-life and C_max were 1.01 (0.20) hours and 24.4 (5.4) μg/dL, respectively. The AUCs for cortisol, 17-hydroxyprogesterone and androstenedione were 40.8 (14.5) μg hour/dL, 29,490 (23,539) ng hour/dL, and 680 (795) ng hour/dL, respectively. No significant relationships existed between cortisol AUCs and the AUCs of either 17-hydroxyprogesterone (P = 0.32) or androstenedione (P = 0.99); nor were there differences between the change-from-baseline concentrations for cortisol with either 17-hydroxyprogesterone (P = 0.80) or androstenedione (P = 0.40). Cortisol simulations indicated that although four daily doses decreased 24-hour hypercortisolemia and hypocortisolemia, substantial periods of each remained.

Concentration profiles of cortisol, 17-hydroxyprogesterone, and androstenedione are highly variable in children with CAH, and knowledge of them can assist in personalizing the therapy of CAH patients. Hydrocortisone's rapid half-life and the lack of a sustained-released product make it difficult to closely approximate normal circadian profiles.