Pub Date : 1900-01-01DOI: 10.4103/ejode.ejode_1_18
Hafez Abd-Elhafeez, El-Sayed El-Meghawry, Sabry Al-Azhary, K. Elfayoumy, T. Emran, A. Amin, Saad M. Alzokm
Introduction Hashimoto’s thyroiditis and Graves’ disease both constitute autoimmune thyroid diseases (AITD) that frequently coexist with other autoimmune disorders (AID). This study was conducted to evaluate the frequency of rheumatoid arthritis (RA) in patients diagnosed with AITD in relation to the general population. Patients and methods This was a cross-sectional case–control study, conducted on 103 patients with AITD of either Hashimoto’s thyroiditis or Graves’ disease with positive antithyroid peroxidase (TPOAb). A group 100 volunteers, matched for age and sex, with normal thyroid function and negative history of AID, were investigated for the prevalence of RA in the general population (control group). Participants in the study were tested for thyroid profile, rheumatoid factor (RF), erythrocyte sedimentation rate, and C-reactive protein. When appropriate, anticitrullinated peptide antibody was checked. Results Patients with AITD had a higher frequency of RA than the control (P=0.031). Thyroid profile showed no significant difference between patients with and without RA within the group of AITD. In that group, a positive correlation between titers of both RF and TPOAb was observed (r=0.474, P<0.001). The coexistence of RA with AITD was noticed to be associated with higher RF, C-reactive protein, and TPOAb titers as well as. the presence of type 2 diabetes mellitus, other AID and family history of RA. Conclusion RA is more prevalent in patients with AITD than the general population, and the underlying autoimmunity is likely to be the link. Our data highlight the importance of screening thyroid patients for RA especially if present with type 2 diabetes mellitus, another AID, or having a family history of RA.
{"title":"Frequency of rheumatoid arthritis in patients with autoimmune thyroid disease: a case–control study","authors":"Hafez Abd-Elhafeez, El-Sayed El-Meghawry, Sabry Al-Azhary, K. Elfayoumy, T. Emran, A. Amin, Saad M. Alzokm","doi":"10.4103/ejode.ejode_1_18","DOIUrl":"https://doi.org/10.4103/ejode.ejode_1_18","url":null,"abstract":"Introduction Hashimoto’s thyroiditis and Graves’ disease both constitute autoimmune thyroid diseases (AITD) that frequently coexist with other autoimmune disorders (AID). This study was conducted to evaluate the frequency of rheumatoid arthritis (RA) in patients diagnosed with AITD in relation to the general population. Patients and methods This was a cross-sectional case–control study, conducted on 103 patients with AITD of either Hashimoto’s thyroiditis or Graves’ disease with positive antithyroid peroxidase (TPOAb). A group 100 volunteers, matched for age and sex, with normal thyroid function and negative history of AID, were investigated for the prevalence of RA in the general population (control group). Participants in the study were tested for thyroid profile, rheumatoid factor (RF), erythrocyte sedimentation rate, and C-reactive protein. When appropriate, anticitrullinated peptide antibody was checked. Results Patients with AITD had a higher frequency of RA than the control (P=0.031). Thyroid profile showed no significant difference between patients with and without RA within the group of AITD. In that group, a positive correlation between titers of both RF and TPOAb was observed (r=0.474, P<0.001). The coexistence of RA with AITD was noticed to be associated with higher RF, C-reactive protein, and TPOAb titers as well as. the presence of type 2 diabetes mellitus, other AID and family history of RA. Conclusion RA is more prevalent in patients with AITD than the general population, and the underlying autoimmunity is likely to be the link. Our data highlight the importance of screening thyroid patients for RA especially if present with type 2 diabetes mellitus, another AID, or having a family history of RA.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132659064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/2356-8062.205209
A. Wafa, M. El-Nahas, Azza Al Biaumy, Yara Mansour
Context Diabetic neuropathy is one of the commonest long-term complications of diabetes seen in routine healthcare and considered the most common cause of peripheral neuropathy in developed world. Aim The aim of our work was to measure advanced glycation endproducts (AGEs) and their receptors (RAGEs) in diabetic peripheral neuropathy (DPN), both painful and painless DPN. Patients and methods Our study was conducted on 50 type 2 diabetes mellitus patients with peripheral neuropathy, divided into two subgroups: the first group included 25 patients with painful DPN and the second group included 25 patients with painless DPN. Moreover, a third group included 20 diabetic patients without peripheral neuropathy, and a fourth group that included 20 healthy participants. All groups were subjected to full history taking and clinical examination, anthropometric parameters, the calculation of neuropathy disability score, and nerve conduction studies (peroneal, sural, and tibial nerves). Laboratory investigations included serum AGEs and RAGEs. Results Our study demonstrated that hemoglobin A1c, AGE, and RAGE showed statistically significant difference between the studied groups. Hemoglobin A1c was significantly high in both neuropathic and diabetic groups in comparison with control. Regarding AGE, it was statistically higher in neuropathic group than in control (P<0.011). On the contrary, RAGE was significantly higher in both neuropathic and diabetic groups rather than control (P<0.02). Although the neuropathic group has higher levels of AGE and RAGE than diabetic group, the difference was statistically nonsignificant. Significant difference was found between studied groups regarding nerve conduction studies of sural and tibial nerves. Statistically significant difference was found in the parameters of nerve conduction studies between neuropathic group and both non-neuropathic diabetic and control groups. Conclusion Our study concluded that AGE and RAGE are significantly higher in diabetic patients with neuropathy versus control, with more elevation in neuropathic group than in diabetic without neuropathy.
{"title":"Study of advanced glycation endproducts and their receptors in Egyptian type 2 diabetic individuals with peripheral neuropathy","authors":"A. Wafa, M. El-Nahas, Azza Al Biaumy, Yara Mansour","doi":"10.4103/2356-8062.205209","DOIUrl":"https://doi.org/10.4103/2356-8062.205209","url":null,"abstract":"Context Diabetic neuropathy is one of the commonest long-term complications of diabetes seen in routine healthcare and considered the most common cause of peripheral neuropathy in developed world. Aim The aim of our work was to measure advanced glycation endproducts (AGEs) and their receptors (RAGEs) in diabetic peripheral neuropathy (DPN), both painful and painless DPN. Patients and methods Our study was conducted on 50 type 2 diabetes mellitus patients with peripheral neuropathy, divided into two subgroups: the first group included 25 patients with painful DPN and the second group included 25 patients with painless DPN. Moreover, a third group included 20 diabetic patients without peripheral neuropathy, and a fourth group that included 20 healthy participants. All groups were subjected to full history taking and clinical examination, anthropometric parameters, the calculation of neuropathy disability score, and nerve conduction studies (peroneal, sural, and tibial nerves). Laboratory investigations included serum AGEs and RAGEs. Results Our study demonstrated that hemoglobin A1c, AGE, and RAGE showed statistically significant difference between the studied groups. Hemoglobin A1c was significantly high in both neuropathic and diabetic groups in comparison with control. Regarding AGE, it was statistically higher in neuropathic group than in control (P<0.011). On the contrary, RAGE was significantly higher in both neuropathic and diabetic groups rather than control (P<0.02). Although the neuropathic group has higher levels of AGE and RAGE than diabetic group, the difference was statistically nonsignificant. Significant difference was found between studied groups regarding nerve conduction studies of sural and tibial nerves. Statistically significant difference was found in the parameters of nerve conduction studies between neuropathic group and both non-neuropathic diabetic and control groups. Conclusion Our study concluded that AGE and RAGE are significantly higher in diabetic patients with neuropathy versus control, with more elevation in neuropathic group than in diabetic without neuropathy.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121970515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/ejode.ejode_30_16
Sahar Elhini, R. Matta, M. Saad, H. Mostafa, Ahmed AbedelfadeeL
Introduction Fibroblast growth factor-21 (FGF21) regulates glucose and lipid metabolism and protects against atherosclerosis. Serum FGF21 levels were assessed in newly diagnosed, drug-naive patients with prediabetes (group 1, n=60) and diabetes mellitus type 2 (group 2, n=60), in addition to 40 healthy individuals (group 3, n=40). Results Serum FGF21 levels were significantly increased in groups 1 and 2 compared with group 3 (231.7±59.3 and 260.4±82.5 vs. 22.6±5.31 pg/dl, respectively; P<0.001 for both). Moreover, group 2 had statistically significantly higher FGF21 levels compared with group 1 (P=0.03). Receiver operating characteristic curve analysis identified FGF21 cutoff value of greater than 204 and 30 pg/ml for the diagnosis of diabetes mellitus type 2 and prediabetes, with an area under the curve 0.72 and 1, sensitivity of 82.5 and 100%, and specificity of 60 and 100%, respectively. Using univariate analysis, FGF21 was positively correlated with blood pressure, obesity (BMI and waist–hip ratio), glycemic (glucose and glycosylated hemoglobin) and insulin resistance (fasting insulin and homeostasis model assessment-insulin resistance) parameters, atherogenic lipid profile, liver enzymes, and cardiovascular disease risk score in group 1 and group 2. FGF21 correlated with albumin–creatinine ratio negatively in group 1 and positively in group 2. Independent predictors of FGF21 level were fasting glucose, insulin, and triglyceride in both patient groups. The independent predictors of FGF21 were obesity parameters in group 1 and albumin–creatinine ratio, age, and systolic blood pressure in group 2. Conclusion Among prediabetic patients, FGF21 is an excellent predictor and a novel linkage between metabolic parameters, circulatory system, and nephropathy.
{"title":"Fibroblast growth factor-21 is a novel linkage between metabolic parameters, cardiovascular risk, and nephropathy in prediabetes","authors":"Sahar Elhini, R. Matta, M. Saad, H. Mostafa, Ahmed AbedelfadeeL","doi":"10.4103/ejode.ejode_30_16","DOIUrl":"https://doi.org/10.4103/ejode.ejode_30_16","url":null,"abstract":"Introduction Fibroblast growth factor-21 (FGF21) regulates glucose and lipid metabolism and protects against atherosclerosis. Serum FGF21 levels were assessed in newly diagnosed, drug-naive patients with prediabetes (group 1, n=60) and diabetes mellitus type 2 (group 2, n=60), in addition to 40 healthy individuals (group 3, n=40). Results Serum FGF21 levels were significantly increased in groups 1 and 2 compared with group 3 (231.7±59.3 and 260.4±82.5 vs. 22.6±5.31 pg/dl, respectively; P<0.001 for both). Moreover, group 2 had statistically significantly higher FGF21 levels compared with group 1 (P=0.03). Receiver operating characteristic curve analysis identified FGF21 cutoff value of greater than 204 and 30 pg/ml for the diagnosis of diabetes mellitus type 2 and prediabetes, with an area under the curve 0.72 and 1, sensitivity of 82.5 and 100%, and specificity of 60 and 100%, respectively. Using univariate analysis, FGF21 was positively correlated with blood pressure, obesity (BMI and waist–hip ratio), glycemic (glucose and glycosylated hemoglobin) and insulin resistance (fasting insulin and homeostasis model assessment-insulin resistance) parameters, atherogenic lipid profile, liver enzymes, and cardiovascular disease risk score in group 1 and group 2. FGF21 correlated with albumin–creatinine ratio negatively in group 1 and positively in group 2. Independent predictors of FGF21 level were fasting glucose, insulin, and triglyceride in both patient groups. The independent predictors of FGF21 were obesity parameters in group 1 and albumin–creatinine ratio, age, and systolic blood pressure in group 2. Conclusion Among prediabetic patients, FGF21 is an excellent predictor and a novel linkage between metabolic parameters, circulatory system, and nephropathy.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"58 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120823886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/2356-8062.159989
M. A. Abdel Khalek, Amal El-Barbary, A. Elsherbeny, Emad Abdel Abdel Hadi, Mona Balata, M. Hussein, R. Gaber, S. El-Gaaly
Introduction Type 2 diabetes mellitus (T2DM) is a group of pandemic debilitating metabolic diseases featuring chronic hyperglycemia that results from defective insulin secretion and/or insulin actions. Dame and Sutor reported that diabetic patients are prone to thrombocytosis through a complex interplay of mechanisms. Therefore, the aim of our work is to evaluate serum sclerostin levels in patients with T2DM and to analyze the relationships among sclerostin, bone mineral density (BMD), bone metabolism, and thrombocytosis. Objective This study aimed to evaluate serum sclerostin in T2DM and its correlations with bone metabolism and thrombocytosis. Patients and methods Fifty male T2DM patients were enrolled; they were divided into two groups according to existing thrombocytosis. Forty age-matched men were included as controls. Clinical tests of physical mobility, fasting blood glucose, glycated hemoglobin, calcium, creatinine, parathormone (PTH), 25-hydroxyvitamin D, bone-specific alkaline phosphatase (BALP), serum carboxy-terminal cross-linked telopeptide of type I collagen (sCTX-I), serum sclerostin, and BMD were performed. Results There were insignificant increases in BMD in diabetic patients versus controls. There were significantly lower levels of PTH, BALP, and sCTX-I in the diabetes mellitus (DM) patient groups compared with the controls (P < 0.001). Serum sclerostin levels were significantly higher in DM patients than the controls, with insignificantly higher sclerostin levels in group II. Serum sclerostin was correlated positively with disease duration and correlated negatively with PTH, BALP, and sCTX-I (P < 0.001). Conclusion Sclerostin plays a role in the pathogenesis of bone changes in T2DM. The interplay between vitamin D, PTH, and blood glucose highlights the possibility of an existing endocrine axis. Finally, the role of osteocytes in regulating hematopoiesis and association with DM and osteoporosis should be investigated further.
{"title":"Serum sclerostin levels in type 2 diabetes mellitus patients: possible correlations with bone metabolism parameters and thrombocytosis","authors":"M. A. Abdel Khalek, Amal El-Barbary, A. Elsherbeny, Emad Abdel Abdel Hadi, Mona Balata, M. Hussein, R. Gaber, S. El-Gaaly","doi":"10.4103/2356-8062.159989","DOIUrl":"https://doi.org/10.4103/2356-8062.159989","url":null,"abstract":"Introduction Type 2 diabetes mellitus (T2DM) is a group of pandemic debilitating metabolic diseases featuring chronic hyperglycemia that results from defective insulin secretion and/or insulin actions. Dame and Sutor reported that diabetic patients are prone to thrombocytosis through a complex interplay of mechanisms. Therefore, the aim of our work is to evaluate serum sclerostin levels in patients with T2DM and to analyze the relationships among sclerostin, bone mineral density (BMD), bone metabolism, and thrombocytosis. Objective This study aimed to evaluate serum sclerostin in T2DM and its correlations with bone metabolism and thrombocytosis. Patients and methods Fifty male T2DM patients were enrolled; they were divided into two groups according to existing thrombocytosis. Forty age-matched men were included as controls. Clinical tests of physical mobility, fasting blood glucose, glycated hemoglobin, calcium, creatinine, parathormone (PTH), 25-hydroxyvitamin D, bone-specific alkaline phosphatase (BALP), serum carboxy-terminal cross-linked telopeptide of type I collagen (sCTX-I), serum sclerostin, and BMD were performed. Results There were insignificant increases in BMD in diabetic patients versus controls. There were significantly lower levels of PTH, BALP, and sCTX-I in the diabetes mellitus (DM) patient groups compared with the controls (P < 0.001). Serum sclerostin levels were significantly higher in DM patients than the controls, with insignificantly higher sclerostin levels in group II. Serum sclerostin was correlated positively with disease duration and correlated negatively with PTH, BALP, and sCTX-I (P < 0.001). Conclusion Sclerostin plays a role in the pathogenesis of bone changes in T2DM. The interplay between vitamin D, PTH, and blood glucose highlights the possibility of an existing endocrine axis. Finally, the role of osteocytes in regulating hematopoiesis and association with DM and osteoporosis should be investigated further.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123411600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/ejode.ejode_29_17
L. E. El Toony, W. Khalifa, Osama Ghazaly
Objective The aim was to evaluate the effectiveness of an individualized educational program in improving patient’s awareness, knowledge, and attitude and to assess its role in reducing the burden of gestational diabetes mellitus (GDM). Patients and methods A prospective study was conducted on women diagnosed to have GDM at 24–28 weeks of gestation according to The Diabetes In Pregnancy Study group India criteria 2015 (2 h blood glucose ≥140 mg/dl) between December 2015 and December 2016 who were enrolled into an individualized GDM educational program. A modified and shortened version of a validated questionnaire developed by Carolan and colleagues was tested before and after education to evaluate the feedback of education. Follow-up was every 2 weeks till labor to assess awareness together with both maternal and fetal outcomes. Results A total of 60 pregnant women diagnosed to have GDM were included. The questions that were answered correctly in the post-test by more than 50% of the participants fell into these categories: definition of GDM (100%), associated risk factors (75%), way of diagnosis (83.3%), management of GDM (71.7%), and postpartum follow-up (56.7%). As regards fetal and maternal outcome it was observed that both weight gain and glycemic control were better in the well-educated group versus other groups (P=0.02, 0.01, respectively). Conclusion Health education plays an important role in increasing patients awareness regarding the GDM risk and its proper management in order to reduce its complications both for the mother and the fetus.
{"title":"Assessing the effectiveness of an educational program for patients with gestational diabetes in Assiut University","authors":"L. E. El Toony, W. Khalifa, Osama Ghazaly","doi":"10.4103/ejode.ejode_29_17","DOIUrl":"https://doi.org/10.4103/ejode.ejode_29_17","url":null,"abstract":"Objective The aim was to evaluate the effectiveness of an individualized educational program in improving patient’s awareness, knowledge, and attitude and to assess its role in reducing the burden of gestational diabetes mellitus (GDM). Patients and methods A prospective study was conducted on women diagnosed to have GDM at 24–28 weeks of gestation according to The Diabetes In Pregnancy Study group India criteria 2015 (2 h blood glucose ≥140 mg/dl) between December 2015 and December 2016 who were enrolled into an individualized GDM educational program. A modified and shortened version of a validated questionnaire developed by Carolan and colleagues was tested before and after education to evaluate the feedback of education. Follow-up was every 2 weeks till labor to assess awareness together with both maternal and fetal outcomes. Results A total of 60 pregnant women diagnosed to have GDM were included. The questions that were answered correctly in the post-test by more than 50% of the participants fell into these categories: definition of GDM (100%), associated risk factors (75%), way of diagnosis (83.3%), management of GDM (71.7%), and postpartum follow-up (56.7%). As regards fetal and maternal outcome it was observed that both weight gain and glycemic control were better in the well-educated group versus other groups (P=0.02, 0.01, respectively). Conclusion Health education plays an important role in increasing patients awareness regarding the GDM risk and its proper management in order to reduce its complications both for the mother and the fetus.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114207685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/2356-8062.184396
M. Abdelkader, A. Mansour, Heba S Elshaer, Amr K. Hussien
Background Acute kidney injury (AKI) is a major complication of sepsis in ICU patients. The overall incidence of AKI in ICU patients ranges from 20 to 50% with lower incidence seen in elective surgical patients and higher incidence in sepsis patients. AKI represents a significant risk factor for mortality and can be associated with mortality greater than 50%. The aim of this study was to investigate the role of angiopoietin-2 as a biomarker in sepsis induced AKI. Patients and methods The study was conducted on 60 participants (20 patients with septic AKI, 20 patients with sepsis only without AKI and 20 healthy volunteers as the control group). Serum angiopoietin-2 levels were assessed by the ELISA technique. Clinical, biochemical, and therapeutic data were collected. Results High levels of serum angiopoietin-2 were detected in patients with septic AKI. These levels were significantly higher in relation to septic patients with no AKI and the control group. There was a statistically significant positive correlation between serum angiopoietin-2 level in the septic AKI group and serum creatinine, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and there was a statistically significant negative correlation between serum angiopoietin-2 level in the septic AKI group and the estimated glomerular filtration rate. Conclusion Serum angiopoietin-2 levels were significantly positive in patients with septic AKI. Serum angiopoietin-2 may be used as a biomarker in sepsis induced AKI.
{"title":"The role of serum angiopoietin-2 as a biomarker in sepsis induced acute kidney injury","authors":"M. Abdelkader, A. Mansour, Heba S Elshaer, Amr K. Hussien","doi":"10.4103/2356-8062.184396","DOIUrl":"https://doi.org/10.4103/2356-8062.184396","url":null,"abstract":"Background Acute kidney injury (AKI) is a major complication of sepsis in ICU patients. The overall incidence of AKI in ICU patients ranges from 20 to 50% with lower incidence seen in elective surgical patients and higher incidence in sepsis patients. AKI represents a significant risk factor for mortality and can be associated with mortality greater than 50%. The aim of this study was to investigate the role of angiopoietin-2 as a biomarker in sepsis induced AKI. Patients and methods The study was conducted on 60 participants (20 patients with septic AKI, 20 patients with sepsis only without AKI and 20 healthy volunteers as the control group). Serum angiopoietin-2 levels were assessed by the ELISA technique. Clinical, biochemical, and therapeutic data were collected. Results High levels of serum angiopoietin-2 were detected in patients with septic AKI. These levels were significantly higher in relation to septic patients with no AKI and the control group. There was a statistically significant positive correlation between serum angiopoietin-2 level in the septic AKI group and serum creatinine, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and there was a statistically significant negative correlation between serum angiopoietin-2 level in the septic AKI group and the estimated glomerular filtration rate. Conclusion Serum angiopoietin-2 levels were significantly positive in patients with septic AKI. Serum angiopoietin-2 may be used as a biomarker in sepsis induced AKI.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122627415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/2356-8062.178331
F. Bukhary, Yehia Z. Mahmoud, Ragaa Abdel-Shahid, H. Keryakos, L. Mohsen, Tamer T. Ismail, L. Hamdy
Introduction Several studies have shown high prevalence of osteoporosis and weight loss in patients with chronic obstructive pulmonary disease (COPD). Leptin regulates bone metabolism, body weight, and pulmonary artery pressure. The association of bone density and serum leptin with BODE score in moderate COPD patients is still unclear. Aim of the study The aim of the study was to explore the association of serum leptin with average bone attenuation assessed by routine chest MDCT, and their correlation with clinical and echocardiographic parameters. Patients and methods The study included 54 male patients with low BMI and moderate COPD severity. Patients were divided into two groups: those with COPD exacerbations (24 patients; group I) and those with stable COPD (30 patients, group II). Twenty male volunteers of matched age and BMI were included as controls (group III). Calculation of BMI and BODE score was done. Spirometry and echocardiography were performed in all participants. Average bone attenuation of the thoracic spine was estimated by MDCT. Serum leptin was estimated. Results Group I and group II had significantly lower bone attenuation and higher BODE index, pulmonary artery systolic pressure (PASP), and right ventricle diameter (RVD) as compared with healthy controls (P < 0.001). Serum leptin level and leptin/BMI ratio were significantly increased in group I than in other groups (P < 0.001). Group II had significantly lower serum leptin than did controls. Serum leptin correlated positively with age, BMI, COPD severity, and bone attenuation and showed significant negative correlation with BODE score and serum calcium in group II. Meanwhile; it showed significant positive correlation with BMI and PASP in group I. In the stable COPD group, PASP, RVD, BMI, and bone attenuation were independent predictors of serum leptin, whereas BODE score, FEV 1 , FEV 1 /FVC, PASP, RVD, BMI, and serum leptin were independent predictors of bone attenuation. Conclusion COPD patients with moderate severity and low BMI had increased circulating leptin and low calcium level during exacerbation. Serum leptin level correlated with bone attenuation in stable but not in exacerbation states.
{"title":"Serum leptin and multi-detector computed tomography (MDCT)-measured bone attenuation among low BMI male patients with moderate-severity chronic obstructive pulmonary disease in exacerbation and stable states","authors":"F. Bukhary, Yehia Z. Mahmoud, Ragaa Abdel-Shahid, H. Keryakos, L. Mohsen, Tamer T. Ismail, L. Hamdy","doi":"10.4103/2356-8062.178331","DOIUrl":"https://doi.org/10.4103/2356-8062.178331","url":null,"abstract":"Introduction Several studies have shown high prevalence of osteoporosis and weight loss in patients with chronic obstructive pulmonary disease (COPD). Leptin regulates bone metabolism, body weight, and pulmonary artery pressure. The association of bone density and serum leptin with BODE score in moderate COPD patients is still unclear. Aim of the study The aim of the study was to explore the association of serum leptin with average bone attenuation assessed by routine chest MDCT, and their correlation with clinical and echocardiographic parameters. Patients and methods The study included 54 male patients with low BMI and moderate COPD severity. Patients were divided into two groups: those with COPD exacerbations (24 patients; group I) and those with stable COPD (30 patients, group II). Twenty male volunteers of matched age and BMI were included as controls (group III). Calculation of BMI and BODE score was done. Spirometry and echocardiography were performed in all participants. Average bone attenuation of the thoracic spine was estimated by MDCT. Serum leptin was estimated. Results Group I and group II had significantly lower bone attenuation and higher BODE index, pulmonary artery systolic pressure (PASP), and right ventricle diameter (RVD) as compared with healthy controls (P < 0.001). Serum leptin level and leptin/BMI ratio were significantly increased in group I than in other groups (P < 0.001). Group II had significantly lower serum leptin than did controls. Serum leptin correlated positively with age, BMI, COPD severity, and bone attenuation and showed significant negative correlation with BODE score and serum calcium in group II. Meanwhile; it showed significant positive correlation with BMI and PASP in group I. In the stable COPD group, PASP, RVD, BMI, and bone attenuation were independent predictors of serum leptin, whereas BODE score, FEV 1 , FEV 1 /FVC, PASP, RVD, BMI, and serum leptin were independent predictors of bone attenuation. Conclusion COPD patients with moderate severity and low BMI had increased circulating leptin and low calcium level during exacerbation. Serum leptin level correlated with bone attenuation in stable but not in exacerbation states.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116515633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/2356-8062.197589
M. Zeid, A. Deghady, Hesham Elsaygh, H. El Shaer, Rasha Gawish
Introduction Fibroblast growth factor 23 (FGF23) plays an important role in regulating phosphate and vitamin D homeostasis. Elevated levels of FGF23 are independently associated with mortality in patients with chronic kidney disease and End stage renal disease (ESRD). Whether FGF23 levels are elevated and associated with adverse outcomes in patients with acute kidney injury (AKI) has not been studied so far. Objective The aim of this study was to determine the relationship between FGF23 levels in patients with AKI and morbidity, mortality, and/or the need for renal replacement therapy. Patients and methods The study included two groups: group 1, which included 30 AKI patients from the general medical ward and ICUs [identified in accordance with the criteria established by Acute Kidney Injury Network (AKIN) grading of AKI]; and group 2, which included 30 healthy controls matched with the patients as regards age and sex. Plasma levels of C-terminal FGF23, 1,25-dihydroxy vitamin D [1,25(OH)2D], and intact parathyroid hormone (iPTH) were measured within 24 h of AKI onset and 5 days later. The composite end point was death or need for renal replacement therapy. Results FGF23 levels on day 1 were significantly higher among participants with AKI than among controls (mean level: 278.20 ± 220.58 vs. 14.60 ± 9 pg/ml). There was a statistically significant negative correlation between FGF23 and vitamin D on day 1, with a P-value of less than 0.023, whereas there was no statistically significant negative correlation between FGF23 and vitamin D on day 5, with a P-value of 0.102. There was a statistically significant positive correlation between FGF23 on day 1 and both Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores, with a P-value of less than 0.001. FGF23 proved to be a good predictor of mortality (sensitivity: 100%, specificity: 85%) at a cutoff value of 280 pg/ml. Conclusion FGF23 levels are elevated in AKI patients and are associated with increased mortality. AKI is also associated with significant reduction in the level of 1,25(OH)2D and with significant elevation of PTH.
{"title":"Association of fibroblast growth factor 23, parathyroid hormone, and vitamin D with acute kidney injury","authors":"M. Zeid, A. Deghady, Hesham Elsaygh, H. El Shaer, Rasha Gawish","doi":"10.4103/2356-8062.197589","DOIUrl":"https://doi.org/10.4103/2356-8062.197589","url":null,"abstract":"Introduction Fibroblast growth factor 23 (FGF23) plays an important role in regulating phosphate and vitamin D homeostasis. Elevated levels of FGF23 are independently associated with mortality in patients with chronic kidney disease and End stage renal disease (ESRD). Whether FGF23 levels are elevated and associated with adverse outcomes in patients with acute kidney injury (AKI) has not been studied so far. Objective The aim of this study was to determine the relationship between FGF23 levels in patients with AKI and morbidity, mortality, and/or the need for renal replacement therapy. Patients and methods The study included two groups: group 1, which included 30 AKI patients from the general medical ward and ICUs [identified in accordance with the criteria established by Acute Kidney Injury Network (AKIN) grading of AKI]; and group 2, which included 30 healthy controls matched with the patients as regards age and sex. Plasma levels of C-terminal FGF23, 1,25-dihydroxy vitamin D [1,25(OH)2D], and intact parathyroid hormone (iPTH) were measured within 24 h of AKI onset and 5 days later. The composite end point was death or need for renal replacement therapy. Results FGF23 levels on day 1 were significantly higher among participants with AKI than among controls (mean level: 278.20 ± 220.58 vs. 14.60 ± 9 pg/ml). There was a statistically significant negative correlation between FGF23 and vitamin D on day 1, with a P-value of less than 0.023, whereas there was no statistically significant negative correlation between FGF23 and vitamin D on day 5, with a P-value of 0.102. There was a statistically significant positive correlation between FGF23 on day 1 and both Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores, with a P-value of less than 0.001. FGF23 proved to be a good predictor of mortality (sensitivity: 100%, specificity: 85%) at a cutoff value of 280 pg/ml. Conclusion FGF23 levels are elevated in AKI patients and are associated with increased mortality. AKI is also associated with significant reduction in the level of 1,25(OH)2D and with significant elevation of PTH.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129593967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/2356-8062.159986
A. Kaseb, Lianchun Xiao, R. Naguib, Wafaa El-Shikh, Manal M. Hassan, H. Hassabo, Jeong‐Hoon Lee, Jung‐Hwan Yoon, Hyo‐suk Lee, Y. Chae, J. Abbruzzese, Jeffrey S. Morris
Background The Child-Turcotte-Pugh (CTP) score inaccurately predicts survival in patients with chronic liver disease, including hepatocellular carcinoma (HCC), yet remains the standard tool for assessing hepatic reserve and guiding therapeutic decisions. CTP scoring relies on objective laboratory values for albumin, bilirubin, and prothrombin time and subjective clinical grading of hepatic encephalopathy and ascites. As liver production of insulin-like growth factor-1 (IGF-1) is significantly reduced in patients with cirrhosis, we hypothesized that IGF-1 could be a valid surrogate for hepatic reserve to replace the subjective parameters in CTP scores. Materials and methods We prospectively enrolled patients and collected data and retrospectively tested plasma IGF-1 levels in four independent cohorts: two HCC cohorts from the USA [n = 310 (training set) and n = 99 (validation set 1)]; one HCC cohort from Korea [n = 188 (validation set 2)]; and one cirrhosis cohort from Egypt [n = 71 (validation set 3)]. Recursive partitioning identified within the training set three optimal IGF-1 ranges that correlated with survival: >50 ng/ml = 1 point; 26-50 ng/ml = 2 points; and <26 ng/ml = 3 points. We modified the CTP score by replacing ascites and encephalopathy grading with IGF-1 values, subjected both the resulting IGF score and the CTP score to log-rank analysis, and quantified the prognostic values with C-statistics to compare the scores′ performance in all cohorts. Results The IGF score was significantly more accurate in predicting survival and improved the stratification of all CTP classes in the training and validation cohorts. Conclusion The new IGF score is simple and blood-based, and validated well on multiple independent HCC cohorts. It could identify a subpopulation of patients who may benefit from active therapy because of their preserved hepatic reserve, as distinct from patients for whom therapy can be deferred or avoided.
{"title":"Development and validation of an IGF-1-modified Child-Pugh score to risk-stratify hepatocellular carcinoma patients","authors":"A. Kaseb, Lianchun Xiao, R. Naguib, Wafaa El-Shikh, Manal M. Hassan, H. Hassabo, Jeong‐Hoon Lee, Jung‐Hwan Yoon, Hyo‐suk Lee, Y. Chae, J. Abbruzzese, Jeffrey S. Morris","doi":"10.4103/2356-8062.159986","DOIUrl":"https://doi.org/10.4103/2356-8062.159986","url":null,"abstract":"Background The Child-Turcotte-Pugh (CTP) score inaccurately predicts survival in patients with chronic liver disease, including hepatocellular carcinoma (HCC), yet remains the standard tool for assessing hepatic reserve and guiding therapeutic decisions. CTP scoring relies on objective laboratory values for albumin, bilirubin, and prothrombin time and subjective clinical grading of hepatic encephalopathy and ascites. As liver production of insulin-like growth factor-1 (IGF-1) is significantly reduced in patients with cirrhosis, we hypothesized that IGF-1 could be a valid surrogate for hepatic reserve to replace the subjective parameters in CTP scores. Materials and methods We prospectively enrolled patients and collected data and retrospectively tested plasma IGF-1 levels in four independent cohorts: two HCC cohorts from the USA [n = 310 (training set) and n = 99 (validation set 1)]; one HCC cohort from Korea [n = 188 (validation set 2)]; and one cirrhosis cohort from Egypt [n = 71 (validation set 3)]. Recursive partitioning identified within the training set three optimal IGF-1 ranges that correlated with survival: >50 ng/ml = 1 point; 26-50 ng/ml = 2 points; and <26 ng/ml = 3 points. We modified the CTP score by replacing ascites and encephalopathy grading with IGF-1 values, subjected both the resulting IGF score and the CTP score to log-rank analysis, and quantified the prognostic values with C-statistics to compare the scores′ performance in all cohorts. Results The IGF score was significantly more accurate in predicting survival and improved the stratification of all CTP classes in the training and validation cohorts. Conclusion The new IGF score is simple and blood-based, and validated well on multiple independent HCC cohorts. It could identify a subpopulation of patients who may benefit from active therapy because of their preserved hepatic reserve, as distinct from patients for whom therapy can be deferred or avoided.","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131701511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/2356-8062.184398
S. Zaki, Osama Hassan Shehata, Akram A Deghedi, Shehab Mohamed Sami, Rehab Hussien Mohamed Mersal
Introduction Cardiovascular disease is the leading cause of mortality in patients with end-stage renal disease (ESRD) and is attributed to a combination of traditional and nontraditional risk factors. In recent years, there has been an increasing recognition of a very high prevalence of cardiovascular calcification in the ESRD population, including patients receiving hemodialysis (HD) and peritoneal dialysis. The mechanism is multifactorial, including structural and functional abnormalities in the large vessels, disorders in calcium (Ca2+) and phosphate (P) metabolism, vascular smooth muscle cells changes, and regulatory markers such as fetuin-A and osteoprotegerin (OPG). Aim of the work The aim of the present study was to determine the utility of multislice computed tomography (MSCT) for the assessment of coronary artery calcifications (CACs) and to identify the potential risks for CAC, including calcification regulating proteins such as fetuin-A and OPG, among patients with ESRD on maintenance dialysis (HD and peritoneal dialysis). Patients and methods This study included 70 patients who were divided into four groups: 20 patients on continuous ambulatory peritoneal dialysis (CAPD), 10 patients with ESRD stage 4 and 5, 30 patients on HD (subdivided into three subgroups according to the duration of HD: for 1–5 years, for 5–10 years, and for more than 10 years), and 10 healthy controls. They were subjected to complete history-taking, thorough clinical examination, investigations including serum level of fetuin-A, serum level of OPG by using the enzyme-linked immunosorbent assay technique, as well as MSCT imaging using 128-detector scanners for the quantification of CAC (calcium scoring) by using the Agatston method. Results There was a significant decrease in the serum level of fetuin-A in patients on HD compared with patients on CAPD, as well as in healthy controls. Moreover, there was a significant increase in the serum level of OPG in patients on HD compared with its level in CAPD patients as well as in healthy controls. The calcium scoring was significantly high in the HD group of patients (group IIa) (P = 0.032), with a low calcium score in CAPD patients group (group I) (P = 0.036) compared with healthy controls in group IV. CAC scoring was correlated positively and significantly with serum level of OPG in the total samples (r = 0.345* and P = 0.0270). On the other hand, it was negatively and significantly correlated with the serum level of fetuin-A in the total samples (r = −0.411FNx01 and P = 0.002). Conclusion Fetuin-A and OPG can be early and important markers of vascular calcifications in patients on dialysis; in addition, calcium scoring using MSCT provides a noninvasive method of assessment of the vascular calcification in these patients. Vascular calcification is more evident in patients on HD than in patients treated using CAPD; this can help in the selection of the modality of treatment of patients with ESRD, as well as early detect
心血管疾病是终末期肾病(ESRD)患者死亡的主要原因，并归因于传统和非传统危险因素的结合。近年来，越来越多的人认识到ESRD人群中心血管钙化的患病率非常高，包括接受血液透析(HD)和腹膜透析的患者。其机制是多因素的，包括大血管的结构和功能异常，钙(Ca2+)和磷酸盐(P)代谢紊乱，血管平滑肌细胞的变化以及调节标志物，如胎蛋白a和骨保护素(OPG)。本研究的目的是确定多层计算机断层扫描(MSCT)用于评估冠状动脉钙化(CACs)的效用，并确定CAC的潜在风险，包括钙化调节蛋白，如胎蛋白a和OPG，在维持透析(HD和腹膜透析)的ESRD患者中。患者和方法本研究纳入70例患者，分为4组:20例持续动态腹膜透析(CAPD)患者，10例ESRD 4期和5期患者，30例HD患者(根据HD持续时间分为3个亚组:1-5年，5 - 10年和10年以上)，10例健康对照。他们接受了完整的病史记录，彻底的临床检查，包括使用酶联免疫吸附测定技术进行血清胎儿素a水平、血清OPG水平的调查，以及使用Agatston法使用128检测器扫描仪进行MSCT成像以定量CAC(钙评分)。结果与CAPD患者及健康对照组相比，HD患者血清中胎儿素a水平明显降低。此外，与CAPD患者和健康对照组相比，HD患者的血清OPG水平显著升高。HD组(IIa组)患者钙评分显著高于健康对照组(P = 0.032)， CAPD组(I组)患者钙评分显著低于健康对照组(P = 0.036)。CAC评分与总样本血清OPG水平呈显著正相关(r = 0.345*， P = 0.0270)。另一方面，与总样本血清中胎儿素a水平呈显著负相关(r = - 0.411FNx01, P = 0.002)。结论胎儿素a和OPG是透析患者血管钙化的早期重要指标;此外，使用MSCT进行钙评分提供了一种评估这些患者血管钙化的无创方法。血管钙化在HD患者中比使用CAPD治疗的患者更明显;这有助于选择ESRD患者的治疗方式，以及早期发现和预防接受透析(HD或CAPD)治疗的ESRD患者的心血管(CVS)疾病。
{"title":"Evaluation of coronary artery calcification using multislice computed tomography in patients on dialysis: association with fetuin-A and osteoprotegerin","authors":"S. Zaki, Osama Hassan Shehata, Akram A Deghedi, Shehab Mohamed Sami, Rehab Hussien Mohamed Mersal","doi":"10.4103/2356-8062.184398","DOIUrl":"https://doi.org/10.4103/2356-8062.184398","url":null,"abstract":"Introduction Cardiovascular disease is the leading cause of mortality in patients with end-stage renal disease (ESRD) and is attributed to a combination of traditional and nontraditional risk factors. In recent years, there has been an increasing recognition of a very high prevalence of cardiovascular calcification in the ESRD population, including patients receiving hemodialysis (HD) and peritoneal dialysis. The mechanism is multifactorial, including structural and functional abnormalities in the large vessels, disorders in calcium (Ca2+) and phosphate (P) metabolism, vascular smooth muscle cells changes, and regulatory markers such as fetuin-A and osteoprotegerin (OPG). Aim of the work The aim of the present study was to determine the utility of multislice computed tomography (MSCT) for the assessment of coronary artery calcifications (CACs) and to identify the potential risks for CAC, including calcification regulating proteins such as fetuin-A and OPG, among patients with ESRD on maintenance dialysis (HD and peritoneal dialysis). Patients and methods This study included 70 patients who were divided into four groups: 20 patients on continuous ambulatory peritoneal dialysis (CAPD), 10 patients with ESRD stage 4 and 5, 30 patients on HD (subdivided into three subgroups according to the duration of HD: for 1–5 years, for 5–10 years, and for more than 10 years), and 10 healthy controls. They were subjected to complete history-taking, thorough clinical examination, investigations including serum level of fetuin-A, serum level of OPG by using the enzyme-linked immunosorbent assay technique, as well as MSCT imaging using 128-detector scanners for the quantification of CAC (calcium scoring) by using the Agatston method. Results There was a significant decrease in the serum level of fetuin-A in patients on HD compared with patients on CAPD, as well as in healthy controls. Moreover, there was a significant increase in the serum level of OPG in patients on HD compared with its level in CAPD patients as well as in healthy controls. The calcium scoring was significantly high in the HD group of patients (group IIa) (P = 0.032), with a low calcium score in CAPD patients group (group I) (P = 0.036) compared with healthy controls in group IV. CAC scoring was correlated positively and significantly with serum level of OPG in the total samples (r = 0.345* and P = 0.0270). On the other hand, it was negatively and significantly correlated with the serum level of fetuin-A in the total samples (r = −0.411FNx01 and P = 0.002). Conclusion Fetuin-A and OPG can be early and important markers of vascular calcifications in patients on dialysis; in addition, calcium scoring using MSCT provides a noninvasive method of assessment of the vascular calcification in these patients. Vascular calcification is more evident in patients on HD than in patients treated using CAPD; this can help in the selection of the modality of treatment of patients with ESRD, as well as early detect","PeriodicalId":260758,"journal":{"name":"Egyptian Journal of Obesity, Diabetes and Endocrinology","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133881369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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