Surgical treatment of diabetes mellitus by islet cell and pancreas transplantation

Mechanism of quercetin therapeutic targets for Alzheimer disease and type 2 diabetes mellitus

Quercetin has demonstrated antioxidant, anti-inflammatory, hypoglycemic, and hypolipidemic activities, suggesting therapeutic potential against type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD). In this study, potential molecular targets of quercetin were first identified using the Swiss Target Prediction platform and pathogenic targets of T2DM and AD were identified using online Mendelian inheritance in man (OMIM), DisGeNET, TTD, DrugBank, and GeneCards databases. The 95 targets shared among quercetin, T2DM, and AD were used to establish a protein-protein interaction (PPI) network, top 25 core genes, and protein functional modules using MCODE. Metascape was then used for gene ontology and kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis. A protein functional module with best score was obtained from the PPI network using CytoHubba, and 6 high-probability quercetin targets (AKT1, JUN, MAPK, TNF, VEGFA, and EGFR) were confirmed by docking simulations. Molecular dynamics simulation was carried out according to the molecular docking results. KEGG pathway enrichment analysis suggested that the major shared mechanisms for T2DM and AD include "AGE-RAGE signaling pathway in diabetic complications," "pathways in cancer," and "MAPK signaling pathway" (the key pathway). We speculate that quercetin may have therapeutic applications in T2DM and AD by targeting MAPK signaling, providing a theoretical foundation for future clinical research.

Pancreatic Transplantation: Evaluation and Management

More than 2 million people in the United States have type 1 diabetes mellitus. Pancreatic transplantation has emerged as the single most effective means of achieving normal glucose homeostasis in this patient population. Newer immunosuppressive agents and surgical techniques continue to evolve, resulting in improved long-term graft and patient survival. Herein, an understanding of the evaluation, technical aspects, and perioperative management of pancreas transplantation is outlined.

Natural progression of diabetic peripheral neuropathy in the Zenarestat study population

OBJECTIVE

The aim of this study was to report the baseline and natural progression of diabetic peripheral neuropathy over 12 months in a large mild-to-moderate neuropathy population.

RESEARCH DESIGN AND METHODS

Patients from a multicentered trial of zenarestat, an aldose reductase inhibitor, had serial measures of neurologic function, including nerve conduction studies (NCSs), quantitative sensory testing (QST), and clinical neuropathy rating scores at baseline and at 12 months. Baseline population descriptors and changes in neurologic function in placebo-treated patients were analyzed.

RESULTS

Sural sensory velocity (P = 0.0008 [95% CI -1.04 to -0.27]), median sensory amplitude (P = 0.0021 [-1.3 to -0.29]), median distal motor latency (P = 0.002 [0.09-0.28]), cool thermal QST (P = 0.0005 [0.27-0.94]), and Michigan Neuropathy Screening Instrument results (P = 0.0087 [0.04-0.30]) declined significantly from baseline in the placebo population. NCS changes from baseline were independent of baseline HbA1c stratification.

CONCLUSIONS

The neurologic decline over 12 months is evident when measured by NCS and cool thermal QST. Other measures (vibration QST, neuropathy rating scores, monofilament examination) are insensitive to changes over 12 months in a mild-to-moderate affected population of this size.

Course of the short gastric veins and their suitability for pancreatic islet transplantation

Experience is being gained with pancreatectomy for patients with chronic pancreatitis suffering intractable pain. Transplantation of pancreatic islets isolated from the patient's own pancreas reduces the amount of injected insulin required, and research aims to develop treatments to make such patients independent of administered insulin. Claims have been made that the uppermost short gastric vein runs directly to the upper pole of the spleen in about 90% of subjects and that infusion of pancreatic islets by this route would allow them to settle in the spleen. This study investigates these claims. The findings suggest that the short gastric veins are inappropriate as a route of islet administration. Most short gastric veins, including the most superior, drain to tributaries of the splenic vein. Short gastric veins passing to the spleen itself without extra-splenic connections to the splenic vein and its tributaries are relatively rare. Only four examples in 12 specimens were found, and only two of these were the most superior short gastric vein. The short gastric veins run in the fat of the gastrosplenic ligament and are most readily visible as they leave the stomach. In our 12 dissecting room specimens, the short gastric veins ranged in number from 3-17, and in diameter from 0.5-4.5 mm (mean = 1.7 mm; SD = 0.7 mm). The four short gastric veins that drained directly to the spleen ranged in diameter from 0.5-1 mm, significantly narrower than those draining to the splenic vein or its tributaries and small for cannulation.