Optimizing weight control in diabetes: antidiabetic drug selection

S Kalra1, B Kalra1, AG Unnikrishnan2, N Agrawal3, S Kumar41Bharti Hospital, Karnal; 2Amrita Institute of Medical Science, Kochi; 3Medical College, Gwalior; 4Excel Life Sciences, Noida, IndiaDate of preparation: 18th August 2010Conflict of interest: SK has received speaker fees from Novo Nordisk, sanofi-aventis, MSD, Eli Lilly, BMS, and AstraZeneca.Clinical question: Which antidiabetic drugs provide optimal weight control in patients with type 2 diabetes?Results: Metformin reduces weight gain, and may cause weight loss, when given alone or in combination with other drugs. Pioglitazone and rosiglitazone use is associated with weight gain. Use of the glucagon-like peptide-1 (GLP-1) analogs, liraglutide and exenatide, is associated with weight loss. Dipeptidyl peptidase-4 (DPP-4) inhibitors are considered weight-neutral. Results with insulin therapy are conflicting. Insulin detemir provides weight control along with glycemic control.Implementation: • Weight gain is considered an inevitable part of good glycemic control using conventional modalities of treatment such as sulfonylureas.• Use of metformin, weight-sparing insulin analogs such as insulin detemir, and liraglutide, should be encouraged as monotherapy, or in combination with other drugs.Keywords: weight control, diabete

‘So people know I'm a Sikh’: Narratives of Sikh masculinities in contemporary Britain

This article examines British-born Sikh men's identification to Sikhism. In particular, it focuses on the appropriation and use of Sikh symbols amongst men who define themselves as Sikh. This article suggests that whilst there are multiple ways of ‘being’ a Sikh man in contemporary post-colonial Britain, and marking belonging to the Sikh faith, there is also a collectively understood idea of what an ‘ideal’ Sikh man should be. Drawing upon Connell and Messerschmidt's discussion of locally specific hegemonic masculinities (2005. “Hegemonic Masculinity: Rethinking the Concept.” Gender and Society 19 (6): 829–859), it is suggested that an ideal Sikh masculine identity is partly informed by a Khalsa discourse, which informs a particular performance of Sikh male identity, whilst also encouraging the surveillance of young men's activities both by themselves and by others. These Sikh masculinities are complex and multiple, rotating to reaffirm, challenge and redefine contextualised notions of hegemonic masculinity within the Sikh diaspora in post-colonial Britain. Such localised Sikh masculinities may both assert male privilege and reap patriarchal dividends (Connell, W. 1995. Masculinities. Cambridge: Polity Press), resulting in particular British Sikh hegemonic masculinities which seek to shape the performance of masculinity, yet in another context these very same performances of masculinity may also signify a more marginalised masculinity vis-à-vis other dominant hegemonic forms

Resistance to Adenovirally Induced Hyperleptinemia in Rats

Leptin regulates appetite and body weight via hypothalamic targets, but it can act directly on cultured pancreatic islets to regulate their fat metabolism. To obtain in vivo evidence that leptin may act peripherally as well as centrally, we compared the effect of adenovirally induced hyperleptinemia on food intake, body weight, and islet fat content in ventromedial hypothalamic-lesioned (VMHL) rats, shamlesioned (SL) controls, and Zucker Diabetic Fatty (ZDF) rats in which the leptin receptor is mutated. Infusion with recombinant adenovirus containing the rat leptin cDNA increased plasma leptin by z 20 ng/ml in VMHL and ZDF rats but had no effect on their food intake, body weight, or fat tissue weight. Caloric matching of hyperphagic VMHL rats to SL controls did not reduce their resistance to hyperleptinemia. Whereas prediabetic ZDF rats had a fourfold elevation in islet fat, in VMHL rats islet fat was normal and none of them became diabetic. Isolated islets from ZDF rats were completely resistant to the lipopenic action of leptin, while VMHL islets exhibited 50% of the normal response; caloric matching of VMHL rats to SL controls increased leptin responsiveness of their islets to 92% of controls. We conclude that leptin regulation of adipocyte fat requires an intact VMH but that islet fat content is regulated independently of the VMH. ( J. Clin. Invest. 1998. 102:728–733.

Resistance to Adenovirally Induced Hyperleptinemia in Rats

Leptin regulates appetite and body weight via hypothalamic targets, but it can act directly on cultured pancreatic islets to regulate their fat metabolism. To obtain in vivo evidence that leptin may act peripherally as well as centrally, we compared the effect of adenovirally induced hyperleptinemia on food intake, body weight, and islet fat content in ventromedial hypothalamic-lesioned (VMHL) rats, shamlesioned (SL) controls, and Zucker Diabetic Fatty (ZDF) rats in which the leptin receptor is mutated. Infusion with recombinant adenovirus containing the rat leptin cDNA increased plasma leptin by z 20 ng/ml in VMHL and ZDF rats but had no effect on their food intake, body weight, or fat tissue weight. Caloric matching of hyperphagic VMHL rats to SL controls did not reduce their resistance to hyperleptinemia. Whereas prediabetic ZDF rats had a fourfold elevation in islet fat, in VMHL rats islet fat was normal and none of them became diabetic. Isolated islets from ZDF rats were completely resistant to the lipopenic action of leptin, while VMHL islets exhibited 50% of the normal response; caloric matching of VMHL rats to SL controls increased leptin responsiveness of their islets to 92% of controls. We conclude that leptin regulation of adipocyte fat requires an intact VMH but that islet fat content is regulated independently of the VMH. ( J. Clin. Invest. 1998. 102:728–733.

Cricket, migration and diasporic communities

Ever since different communities began processes of global migration, sport has been an integral feature in how we conceptualise and experience the notion of being part of a diaspora. Sport provides diasporic communities with a powerful means for creating transnational ties, but also shapes ideas of their ethnic and racial identities. In spite of this, theories of diaspora have been applied sparingly to sporting discourses. Due mainly to its central role in spreading dominant white racial narratives within the British Empire, and the various ways different ethnic groups have ‘played’ with the meanings and associations of the sport in the (post-)colonial period, cricket is an interesting focus for academic research. Despite W.G. Grace’s claim that cricket advances civilisation by promoting a common bond, binding together peoples of vastly different backgrounds, to this day cricket operates strict symbolic boundaries; defining those who do, and equally, do not belong. C.L.R. James’ now famous metaphor of looking ‘beyond the boundary’ captures the belief that, to fully understand the significance of cricket, and the sport’s roles in changing and shaping society, one must consider the wider social and political contexts within which the game is played. The collection of papers in this special issue does just that. Cricket acts as the point of departure in each, but the way in which ideas of power, representation and inequality are ‘played out’ is unique in each

The Association of Baseline and Longitudinal Change in Endothelial Microparticle Count with Mortality in Chronic Kidney Disease

© 2017 S. Karger AG, Basel. Background: Chronic kidney disease (CKD) is associated with a unique milieu of vascular pathology, and effective biomarkers of active vascular damage are lacking. A candidate biomarker is the quantification of circulating endothelial microparticles (EMPs). This study observed baseline and longitudinal EMP change (Î EMP) and established the association of these with all-cause mortality and cardiovascular events in CKD. Method: An observational study in adults with CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m 2). EMPs were quantified by flow cytometry of platelet poor plasma in 2 samples 12 months apart and categorised as EMP if AnnexinV+/CD31+/CD42b-EMPs were compared between primary renal diagnoses, and correlations between EMP/Î EMP and other parameters made. Adjusted hazard ratios (HRs) for time to all-cause mortality and cardiovascular events were calculated for log-transformed EMP and Î EMP using a Cox proportional hazard model. Results: There were 123 patients (age 63 ± 11 years, systolic blood pressure 135 ± 18 mm Hg, eGFR 32 ± 16 mL/min/1.73 m 2). The median baseline EMP count was 144/μL (range 10-714/μL). EMPs were numerically the highest in autosomal dominant polycystic kidney disease (253 [41-610]). An increase in urine protein:creatinine ratio was associated with an increase in EMP (co-efficient 0.21, p = 0.02). The adjusted HR for all-cause mortality for EMP was 8.20 (1.67-40.2, p = 0.01) and for Î EMP was 2.69 (0.04-165, p = 0.64). There was no association between EMP or Î EMP and cardiovascular events. Conclusion: Although EMP count was a significant marker of mortality risk, longitudinal change was not. This may reflect disease-specific EMP behaviour and the limitation of EMP as a generalised biomarker in CKD

'Who do "they" cheer for?' Cricket, diaspora, hybridity and divided loyalties amongst British Asians

This article explores the relationship between British Asians' sense of nationhood, citizenship, ethnicity and some of their manifestations in relation to sports fandom: specifically in terms of how cricket is used as a means of articulating diasporic British Asian identities. Norman Tebbit's 'cricket test' is at the forefront of this article to tease out the complexities of being British Asian in terms of supporting the English national cricket team. The first part of the article locates Tebbit's 'cricket test' within the wider discourse of multiculturalism. The analysis then moves to focus on the discourse of sports fandom and the concept of 'home team advantage' arguing that sports venues represent significant sites for nationalist and cultural expression due to their connection with national history. The article highlights how supporting 'Anyone but England', thereby rejecting ethnically exclusive notions of 'Englishness' and 'Britishness', continues to be a definer of British Asians' cultural identities. The final section situates these trends within the discourse of hybridity and argues that sporting allegiances are often separate from considerations of national identity and citizenship. Rather than placing British Asians in an either/or situation, viewing British 'Asianness' in hybrid terms enables them to celebrate their traditions and histories, whilst also being proud of their British citizenship. © The Author(s) 2011

Role of Artificial Intelligence in Radiogenomics for Cancers in the Era of Precision Medicine

Radiogenomics, a combination of “Radiomics” and “Genomics,” using Artificial Intelligence (AI) has recently emerged as the state-of-the-art science in precision medicine, especially in oncology care. Radiogenomics syndicates large-scale quantifiable data extracted from radiological medical images enveloped with personalized genomic phenotypes. It fabricates a prediction model through various AI methods to stratify the risk of patients, monitor therapeutic approaches, and assess clinical outcomes. It has recently shown tremendous achievements in prognosis, treatment planning, survival prediction, heterogeneity analysis, reoccurrence, and progression-free survival for human cancer study. Although AI has shown immense performance in oncology care in various clinical aspects, it has several challenges and limitations. The proposed review provides an overview of radiogenomics with the viewpoints on the role of AI in terms of its promises for computa-tional as well as oncological aspects and offers achievements and opportunities in the era of precision medicine. The review also presents various recommendations to diminish these obstacles