• all-cause mortality
• cancer mortality
• cardiovascular mortality
• diabetes
• serum albumin-to-globulin ratio (serum AGR)

• Humans
• Male
• Female
• Middle Aged
• Diabetes Mellitus/mortality
• Diabetes Mellitus/blood
• Nutrition Surveys
• Cause of Death
• Adult
• Prospective Studies
• Cardiovascular Diseases/mortality
• Cardiovascular Diseases/blood
• Neoplasms/mortality
• Neoplasms/blood
• Serum Globulins/analysis
• Aged
• Biomarkers/blood
• Serum Albumin/analysis
• Follow-Up Studies
• Risk Factors
• United States/epidemiology

• 81770369 National Natural Science Foundation of China

• hypomagnesemia
• primary intestinal lymphangiectasia
• tetany
• vitamin D deficiency

• cirrhosis
• malnutrition
• portal hypertension
• sarcopenia

• Humans
• Sarcopenia/complications
• Sarcopenia/therapy
• Malnutrition/complications
• Malnutrition/therapy
• Protein-Energy Malnutrition/complications
• Protein-Energy Malnutrition/therapy
• Hypertension, Portal/complications
• Hypertension, Portal/therapy
• Liver Cirrhosis/complications
• Liver Cirrhosis/therapy

Although inflammation is a known predictor for poor prognosis in patients with diabetics, few data report the synergistic association between inflammation, malnutrition, and mortality in patients with diabetics. We aim to explore whether malnutrition modifies the predictor of inflammation on prognosis.

Nutritional status and inflammation were measured in 6,682 patients with diabetics undergoing coronary angiography or percutaneous coronary intervention between January 2007 to December 2018 from Cardiorenal Improvement Registry. Malnutrition was defined as Controlling Nutritional Status (CONUT) score, which was more than 1. High-sensitivity C-reactive protein (hs-CRP) exceeding the median was assessed as a high-risk inflammation. Cox regression models were used to estimate hazard ratios (HR) for mortality across combined hs-CRP and CONUT score categories.

During a median follow-up of 5.0 years (interquartile range: 3.0–7.6 years), 759 (11.36%) patients died. The mortality of the four groups (normal nutrition and low hs-CRP level; normal nutrition and high hs-CRP level; malnutrition and low hs-CRP level; and malnutrition and high hs-CRP level) were 7.29, 7.12, 10.71, and 17.31%, respectively. Compared with normal nutrition and low hs-CRP level, an isolated condition of either malnutrition or high hs-CRP level was not associated with any significant risk for all-cause mortality. However, concomitant presence of both high hs-CRP level and malnutrition condition was associated with a significantly increased risk of all-cause mortality (HR: 1.51; 95% CI: 1.20–1.89; p < 0.001). The p-value for interaction between nutritional status and hs-CRP level on all-cause mortality was 0.03.

The interplay of inflammation and malnutrition in patients with diabetics significantly amplifies the deleterious effects of each as distinct disease entities. A prospective randomized clinical trial is needed in the future to verify the results.

• Natural Science Foundation of Fujian Province

• gastroenterology
• lymphatic system
• nutrition

• Hypoxia
• Retinal pigment epithelium
• SST
• TER
• VEGF

Primary intestinal lymphangiectasia (PIL) is a rare protein-losing enteropathy with lymphatic leakage into the small intestine. Dilated lymphatics in the small intestinal wall and mesentery are observed in this disease. Laboratory tests of PIL patients revealed hypoalbuminemia, lymphocytopenia, hypogammaglobulinemia and increased stool α-1 antitrypsin clearance. Cell-mediated immunodeficiency is also present in PIL patients because of loss of lymphocytes. As a result, the patients are vulnerable to chronic viral infection and lymphoma. However, cases of PIL with chronic viral infection, such as human papilloma virus-induced warts, are rarely reported. We report a rare case of PIL with generalized warts in a 36-year-old male patient. PIL was diagnosed by capsule endoscopy and colonoscopic biopsy with histological tissue confirmation. Generalized warts were observed on the head, chest, abdomen, back, anus, and upper and lower extremities, including the hands and feet of the patient.

• Protein-losing enteropathy
• Lymphocytopenia
• Cell-mediated immunodeficiency
• Primary intestinal lymphangiectasia
• Warts

• Adult
• Biopsy
• Capsule Endoscopy
• Chronic Disease
• Colonoscopy
• Diet, Fat-Restricted
• Dietary Proteins/administration & dosage
• Humans
• Immunocompromised Host
• Immunohistochemistry
• Lymphangiectasis, Intestinal/complications
• Lymphangiectasis, Intestinal/diagnosis
• Lymphangiectasis, Intestinal/diet therapy
• Lymphangiectasis, Intestinal/immunology
• Lymphedema/complications
• Lymphedema/diagnosis
• Lymphedema/diet therapy
• Lymphedema/immunology
• Male
• Opportunistic Infections/diagnosis
• Opportunistic Infections/immunology
• Opportunistic Infections/virology
• Papillomavirus Infections/diagnosis
• Papillomavirus Infections/immunology
• Papillomavirus Infections/virology
• Tomography, X-Ray Computed
• Treatment Outcome
• Triglycerides/administration & dosage
• Warts/diagnosis
• Warts/immunology
• Warts/virology

We report a case of a 42-year-old man with a rare disorder known as primary intestinal lymphangiectasia, which is characterized by dilated intestinal lymphatics that lead to the development of protein-losing enteropathy. The patient presented with a grand mal seizure caused by malabsorption-derived electrolytes and a protein disorder. Signs of the disease, including chronic diarrhea and peripheral edema, manifested 10 years ago, but a diagnosis was never made. The diagnosis was suspected because of the clinical manifestations, laboratory tests, imaging and endoscopic findings. Hyperemic and edematous mucosa of the small intestine corresponded to scattered white spots with dilated intestinal lymphatics and whitish villi in the histological specimen of the biopsied jejunal mucosa. Although numerous therapeutic strategies are available, only octreotide therapy proved to be an effective means of therapeutic resolution in this patient. Although the patient had a partial remission following the use of a slow release formula of octreotide, his prognosis, clinical course, and future treatment challenges are yet to be determined.

• Primary intestinal lymphangiectasia
• Malabsorption
• Seizure
• Treatment
• Diet
• Octreotide

• Adult
• Biopsy
• Double-Balloon Enteroscopy
• Epilepsy, Tonic-Clonic/etiology
• Gastrointestinal Agents/therapeutic use
• Humans
• Intestines/diagnostic imaging
• Intestines/drug effects
• Intestines/pathology
• Lymphangiectasis, Intestinal/complications
• Lymphangiectasis, Intestinal/diagnosis
• Lymphangiectasis, Intestinal/drug therapy
• Lymphedema/complications
• Lymphedema/diagnosis
• Lymphedema/drug therapy
• Male
• Octreotide/therapeutic use
• Predictive Value of Tests
• Radionuclide Imaging
• Radiopharmaceuticals
• Technetium Tc 99m Aggregated Albumin
• Treatment Outcome

A number of disorders have been described to cause protein losing enteropathy (PLE) in children. Primary intestinal lymphangiectasia (PIL) is one mechanism leading to PLE. Few syndromes are associated with PIL; Hennekam syndrome (HS) is one of them. The principal treatment for PIL is a high protein, low fat diet with medium chain triglycerides supplementation. Supportive therapy includes albumin infusion. Few publications have supported the use of octreotide to diminish protein loss and minimize hypoalbuminemia seen in PIL. There are no publications on the treatment of PIL with octreotide in patients with HS. We report two children with HS and PLE in which we used octreotide to decrease intestinal protein loss. In one patient, octreotide increased serum albumin to an acceptable level without further need for albumin infusions. The other patient responded more dramatically with near normal serum albumin levels and cessation of albumin infusions. In achieving a good response to octreotide in both patients, we add to the publications supporting the use of octreotide in PIL and suggest that octreotide should be tried in patients with PIL secondary to HS. To the best of our knowledge, this is the first case report on the use of octreotide in HS-associated PIL.

• Hennekam syndrome
• Lymphangiectasia
• Octreotide
• Protein losing enteropathy

Opportunistic infections usually occur in patients with an immunocompromised state, and can be severe. Cryptoccocal meningitis is a fatal condition if left untreated, and is usually found in such patients. We report the case of an adult patient with cryptoccocal meningitis secondary to intestinal lymphangiectasia. A 30 year old female was admitted to our hospital for meningitis. Biochemical and radiological investigations were performed. A cerebrospinal fluid latex agglutination test showed positive cryptoccocal antigen. In addition, there were features of humoral and cell mediated immunity deficiency (lymphopenia, hypoalbuminemia, hypogammaglobulinemia), with a negative human immunodeficiency virus (HIV) test by enzyme linked immunosorbent assay and polymerase chain reaction. An upper gastroduodenoscopy was performed, which showed multiple lymphangiectasias, and a biopsy confirmed the diagnosis of primary intestinal lymphangiectasia (PIL). The patient was treated with intravenous amphotericin B and oral flucytosine, and the meningitis resolved. PIL should be suspected in patients with cryptoccocal meningitis, combined with humoral and cell mediated immunity with a negative HIV test. The management issues, in addition to antifungal therapy, include nutritional supplements for the protein losing enteropathy.

• Cryptoccocal meningitis
• cellular and humoral immunity
• intestinal lymphangiectasia

• Procto-colectomy
• Protein-losing enteropathy
• Ulcerative colitis

The objective of this article is to report improvement of nutritional status by protein supplements in the patient with protein-losing enteropathy. The patient was a female whose age was 25 and underwent medical treatment of Crohn's disease, an inflammatory bowl disease, after diagnosis of cryptogenic multifocal ulcerous enteritis. The weight was 33.3 kg (68% of IBW) in the severe underweight and suffered from ascites and subcutaneous edema with hypoalbuminemia (1.3 g/dL) at the time of hospitalization. The patient consumed food restrictively due to abdominal discomfort. Despite various attempts of oral feeding, the levels of calorie and protein intake fell into 40-50% of the required amount, which was 800-900 kcal/d (24-27 kcal/kg/d) for calorie and 34 g/d (1 g/kg/d) for protein. It was planned to supplement the patient with caloric supplementation (40-50 kcal/kg) and protein supplementation (2.5 g/kg) to increase body weight and improve hypoproteinemia. It was also planned to increase the level of protein intake slowly to target 55 g/d in about 2 weeks starting from 10 g/d and monitored kidney load with high protein supplementation. The weight loss was 1.0 kg when the patient was discharged from the hospital (hospitalization periods of 4 weeks), however, serum albumin was improved from 1.3 g/dL to 2.5 g/dL and there was no abdominal discomfort. She kept supplement of protein at 55 g/d for 5 months after the discharge from the hospital and kept it at 35 g/d for about 2 months and then 25 g/d. The body weight increased gradually from 32.3 kg (65% of IBW) to 44.0 kg (89% of IBW) by 36% for the period of F/u and serum albumin was kept above 2.8 g/dL without intravenous injection of albumin. The performance status was improved from 4 points of 'very tired' to 2 points of 'a little tired' out of 5-point scale measurement and the use of diuretic stopped from the time of 4th month after the discharge from the hospital owing to improvement in edema and ascites. During this period, the results of blood test such as BUN, Cr, and electrolytes were within the normal range. In conclusion, hypoproteinemia and weight loss were improved by increasing protein intake through utilization of protein supplements in protein-losing enteropathy.

• Diagnosis, Differential
• Female
• Humans
• Infant, Newborn
• Infant, Premature
• Infant, Premature, Diseases/diagnosis
• Infant, Premature, Diseases/nursing
• Intensive Care Units, Neonatal
• Lymphangiectasis, Intestinal/diagnosis
• Lymphangiectasis, Intestinal/nursing
• Neonatal Nursing/methods

Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography (CT) are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.

• Intestinal lymphangiectasia
• Capsule endoscopy
• Hypoproteinemia
• Lymphocytopenia
• Edema
• Surgery

• Capsule Endoscopy/methods
• Female
• Humans
• Lymphangiectasis, Intestinal/complications
• Lymphangiectasis, Intestinal/diagnosis
• Lymphangiectasis, Intestinal/surgery
• Middle Aged
• Protein-Losing Enteropathies/diagnosis
• Protein-Losing Enteropathies/etiology

• Diabetes Mellitus, Type 2/complications
• Diabetic Retinopathy/physiopathology
• Diabetic Retinopathy/surgery
• Humans
• Macular Degeneration/physiopathology
• Macular Degeneration/surgery
• Somatostatin/deficiency
• Somatostatin-28/blood
• Somatostatin-28/deficiency
• Vitrectomy
• Vitreous Body/chemistry

• Adolescent
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/diagnosis
• Diagnosis, Differential
• Diarrhea/etiology
• Fatal Outcome
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Liver Neoplasms/complications
• Liver Neoplasms/diagnosis
• Male