Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m²). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m². Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.
Adult ; Asia* ; Asian Continental Ancestry Group ; Bariatric Surgery* ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Global Health ; Humans ; Incidence ; Obesity ; Patient Selection

Background: and purpose: The anti-aging standard forest healing program (ASFHP), which uses forest therapy, was reported to be effective in improving psychological, physical, and cognitive functions. However, there are several challenges to directly visiting the forest. This study aimed to investigate the impact of multi-session ASFHP with forest visit on the mental and physical health of the older people with visits to forest facilities and compared them with those of the same program conducted indoors. Methods: Individuals aged over 70 years with concerns about cognitive decline were recruited at dementia relief centers and divided into control and experimental groups. A total of 33 people were administered ASFHP under the supervision of a forest therapy instructor. The control group stayed indoors, while the experimental group visited a forest healing center and repeated the program 20 weeks. Results: The multiple-session ASFHP positively affected cognitive impairment screening test (CIST) total scores (p=0.002), memory (p=0.014), Korean version of the Repeatable Battery for the Assessment of Neuropsychological Status total scores (p<0.001), immediate recall (p=0.001), visuospatial/construction (p<0.001), language (p<0.001), forest healing standard questionnaire total scores (p=0.002), and cognitive function (p=0.019), regardless of location. The forest visits during the ASFHP showed positive effects on orientation (p=0.035), delayed recall (p=0.042), emotional stability (p=0.032), physical activity (p=0.005), and health (p=0.022). The CIST scores of the memory domain were the strongest indicator of the multiple-session ASFHP effects. Conclusions The 20-week multi-session ASFHP with forest visit showed effects on cognitive improvement and physical and emotional stability compared to indoor education.

Overactive bladder (OAB) is defined as urgency, usually with frequency and nocturia, and with or without urge incontinence. Duloxetine, an antidepressant that inhibits reuptake of serotonin and norepinephrine, is indicated for the treatment of stress urinary incontinence in Europe. In this paper, we present a case of a 17-year-old female patient with OAB and depressive symptoms who was successfully treated with duloxetine. This case suggests duloxetine can be an option for patient with OAB, and it also highlights the need for further studies of duloxetine's use in the treatment of OAB.
Adolescent* ; Depression ; Europe ; Female* ; Humans ; Nocturia ; Norepinephrine ; Serotonin ; Urinary Bladder, Overactive* ; Urinary Incontinence ; Urinary Incontinence, Urge ; Duloxetine Hydrochloride

OBJECTIVE: This study was designed to investigate the mechanism of the primary afferent input to spread of contralateral hyperalgesia in the persistent muscle pain model in the rat. METHOD: Muscle pain was induced by twice repeated intramuscular injections of pH 6.0 buffered saline into the unilateral gastrocnemius muscle of the rats. Change of mechanical withdrawal threshold to von-Frey filament was measured after ipsilateral laser irradiation, anesthetic blockade with lidocaine and dorsal rhizotomy (L2~L6) to reduce primary afferent input from the tissue injury. RESULTS: Bilateral persistent mechanical hyperalgesia in the hind paw was evoked after second injection. Ipsilateral laser irradiation, lidocaine injection and dorsal rhizotomy had no effect on the contralateral spread of mechanical hyperalgesia. CONCLUSION: These results suggest that contralateral hyperalgesia was produced by, but didn't need to be maintained by inputs from an injury. Therefore, central nervous systems are responsible for the contralateral spread of hyperalgesia.
Animals ; Central Nervous System ; Hydrogen-Ion Concentration ; Hyperalgesia* ; Injections, Intramuscular ; Lidocaine ; Models, Animal* ; Muscle, Skeletal ; Myalgia* ; Rats* ; Rhizotomy

OBJECTIVE: The purposes of this study were the development and assessment of an animal model of persistent muscle pain induced by repeated intramuscular injections of low pH buffered saline. METHOD: Buffered saline at pH 4, 6 or 7.2 were injected twice, 3 days apart, into the gastrocnemius muscles of thirty Sprague-Dawley rats. To quantify hyperalgesia, paw withdrawal response to von Frey filament (mechanical hyperalgesia) and acetone (cold hyperalgesia) were measured for the 4 weeks after injection. Also the locomotor performance with inclined plane board and treadmill, and electrophysiologic study were evaluated. RESULTS: Mechanical hyperalgesia that was produced by the single injection of saline lasted less than 24 hours. The repeated injection of acidic saline produced mechanical hyperalgesia for more than 4 weeks at injected side and 3 weeks at contralateral side. Cold hyperalgesia lasted for 1 week after injection bilaterally. The locomotor performance and nerve conduction studies were not changed after injection. CONCLUSION: We have developed and characterized a model of muscular pain that was long lasting and widespread. This might prove useful for studying pain of muscular origin that may be similar to the chronic pain syndromes observed clinically.
Acetone ; Animals* ; Chronic Pain ; Hydrogen-Ion Concentration ; Hyperalgesia ; Injections, Intramuscular ; Models, Animal* ; Muscles ; Myalgia* ; Neural Conduction ; Rats, Sprague-Dawley

OBJECTIVE: To investigate the effects of botulinum toxin on the mechanical hyperalgesia, electrophysiology and motor functions in the persistent muscle pain rat model. METHOD: A secondary mechanical hyperalgesia in the bilateral hindpaws of Sprague-Dawley rats was produced by the repeated injections of acidic saline into gastrocnemius. Botulinum toxin A (BTX-A(4): 4 U/kg, BTX-A(7): 7 U/kg) was administrated into same muscle 24 hours after a second injection of saline. The mechanical hyperalgesia was measured with withdrawal threshold to von Frey filament. The grade of muscle paralysis was evaluated with electrophysiology and the locomotor performance using inclined plane board. RESULTS: The mechanical hyperalgesia was significantly decreased from 5 days to 2 weeks in BTX-A(7) group in the injected side. The dose-dependent decreased amplitude of compound muscle action potential and reduced prevalence of endplate noise from the first day of botulinum toxin injection lasted for 4 weeks in both gastrocnemius. The maximum angle maintained at initial position on the inclined plane board did not change. CONCLUSION: Local muscular injection of botulinum toxin A reduced ipsilateral hyperalgesia dose-dependently in persistent muscle pain rat model without motor deficit. The antinociceptive mechanism of botulinum toxin might act at a local or peripheral rather than a systemic or central effect due to ineffectiveness of contralateral hyperalgesia. Clinically, botulinum toxin A might be useful for the treatment of local and referred pain of muscle origins.
Action Potentials ; Animals ; Botulinum Toxins ; Electrophysiology ; Hyperalgesia ; Muscles ; Noise ; Pain, Referred ; Paralysis ; Prevalence ; Rats ; Rats, Sprague-Dawley

We tried to review and update clinical and preclinical studies evaluating vilazodone's role as an antidepressant for patients with major depressive disorder (MDD). In terms of its mechanism of actions, we sought to elaborate them mainly through preclinical animal studies. A data search was conducted in November 1, 2013, using the key terms "vilazodone" or "Viibryd," in PubMed and Medline databases. All published and unpublished studies are included and citations from publications were also reviewed for additional references. Five unpublished, phase-II and two pivotal published phase-III clinical trials with nearly identical design (8-week, double-blind, randomized, and placebo-controlled) investigated efficacy of vilazodone, were found for the treatment of patients with MDD. Two post-hoc studies and one long-term open study were also included. Data were thoroughly reviewed to incorporate the pharmacology, action mechanism, efficacy and safety for the vilazodone in the treatment of major depressive disorder. Vilazodone is an antidepressant with novel mechanism of action because its chemical structure is unrelated to conventional antidepressant, and it has a selective serotonin (5-HT) reuptake inhibitor and 5-HT1A receptor partial agonist profile. Vilazodone is an effective and safe treatment option with its novel action mechanisms for patients with depression. Its putative benefits compared with other antidepressants must be thoroughly studied in adequately-powered and well-designed future clinical trials.
Animals ; Antidepressive Agents ; Depression ; Depressive Disorder, Major* ; Humans ; Pharmacology ; Receptor, Serotonin, 5-HT1A ; Serotonin ; Vilazodone Hydrochloride

Mitochondrial DNA (mtDNA) and non-recombining Y chromosome (NRY) are inherited uni-parentally from mother to daughter or from father to son respectively. Their polymorphism has initially been studied throughout populations of the world to demonstrate the "Out of Africa" hypothesis. Here, to correlate the distribution of nasopharyngeal carcinoma (NPC) in different populations of insular Asia, we analyze the mtDNA information (lineages) obtained from genotyping of the hyper variable region (HVS I & II) among 1400 individuals from island Southeast Asia (ISEA), Taiwan and Fujian and supplemented with the analysis of relevant coding region polymorphisms. Lineages that best represented a clade (a branch of the genetic tree) in the phylogeny were further analyzed using complete genomic mtDNA sequencing. Finally, these complete mtDNA sequences were used to construct a most parsimonious tree which now constitutes the most up-to-date mtDNA dataset available on ISEA and Taiwan. This analysis has exposed new insights of the evolutionary history of insular Asia and has strong implications in assessing possible correlations with linguistic, archaeology, demography and the NPC distribution in populations within these regions. To obtain a more objective and balanced genetic point of view, slowly evolving biallelic Y single nucleotide polymorphism (Y-SNP) was also analyzed. As in the first step above, the technique was first applied to determine affinities (macro analysis) between populations of insular Asia. Secondly, sixteen Y short tandem repeats (Y-STR) were used as they allow deeper insight (micro analysis) into the relationship between individuals of a same region. Together, mtDNA and NRY allowed a better definition of the relational, demographic, cultural and genetic components that constitute the make up of the present day peoples of ISEA. Outstanding findings were obtained on the routes of migration that occurred along with the spread of NPC during the settlement of insular Asia. The results of this analysis will be discussed using a conceptual approach.
Asia, Southeastern ; epidemiology ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Chromosomes, Human, Y ; genetics ; DNA, Mitochondrial ; genetics ; Emigration and Immigration ; Genetics, Population ; Haplotypes ; genetics ; Humans ; Melanesia ; epidemiology ; Microsatellite Repeats ; Nasopharyngeal Neoplasms ; epidemiology ; genetics ; Oceanic Ancestry Group ; genetics ; Phylogeny ; Polymorphism, Single Nucleotide ; Taiwan ; epidemiology

The Acknowledgement was published incorrectly.

OBJECTIVE: The present study aimed to observe potential benefit of aripiprazole augmentation in the treatment of major depressive disorder with mixed specifier (MDDM) in naturalistic treatment setting. METHODS: Data were collected from MDDM patients using a retrospective chart review for 8 weeks (week –8 and week 0) in routine practice. All patients were on current antidepressants upon starting of aripiprazole. Patients were treated without restriction of doses of aripiprazole. The primary endpoint was the mean change of Montgomery–Åsberg Depression Rating Scale (MADRS) total scores along with various secondary endpoint measures. RESULTS: In total 38 patients were analyzed. The changes of MADRS, Clinical Global Impression (CGI)-severity, Young Mania Rating Scale, Sheehan Disability Scale, and CGI-clinical benefit total scores from baseline to the endpoint were −7.1, −0.8, −4.9, −4.1, and −3.6, respectively (all p < 0.0001). At the endpoint, the responder and remitter rates by MADRS score criteria were approximately 32% and 21%, respectively. CONCLUSION: The present findings have clearly shown the effectiveness and tolerability of aripiprazole augmentation for MDDM patients in routine practice. The present study warrants subsequent, adequately-powered, well-controlled studies for generalizability near future.
Antidepressive Agents ; Aripiprazole ; Bipolar Disorder ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Humans ; Retrospective Studies