Relation between the insulin lowering rate and changes in bone mineral density: Analysis among subtypes of type 1 diabetes mellitus

Aims/IntroductionThe bone mineral density in patients with type 1 diabetes mellitus is reduced due to impaired insulin secretion. However, it is unclear whether the rate of bone mineral density reduction is affected by the type 1 diabetes mellitus subtype. This study aimed to clarify the difference in bone mineral density across type 1 diabetes mellitus subtypes: slowly progressive (SP), acute‐onset (AO), and fulminant (F).MethodsThis was a retrospective, single‐center, cross‐sectional study conducted on 98 adult type 1 diabetes mellitus patients. The main outcome included the bone mineral density Z‐score (BMD‐Z) measured at the lumbar spine and femoral neck.ResultsThe lumbar spine BMD‐Z was lower in the acute‐onset than in the slowly progressive subtype (P = 0.03). No differences were observed when compared with the fulminant subtype. The femoral neck BMD‐Z tended to be higher in the slowly progressive than in the acute‐onset and fulminant subtypes. Multiple regression analyses showed that the lumbar spine BMD‐Z was associated with subtypes (AO vs SP) (P = 0.01), but not subtypes (F vs SP), adjusted for sex, duration, retinopathy, and C‐peptide immunoreactivity (CPR). When the patients were divided into disease duration tertiles, in the first and second tertiles, the CPR levels were lower in the acute‐onset or fulminant than in the slowly progressive subtype. In contrast, the lumbar spine and femoral neck BMD‐Z differed between the acute‐onset and slowly progressive only in the second tertiles (both P < 0.01), with a similar tendency between the fulminant and slowly progressive subtypes.ConclusionsAmong the type 1 diabetes mellitus subtypes, bone mineral density undergoes time‐dependent changes, which reveals that the bone mineral density decline follows the impaired insulin secretion. These results provide novel insights into the association between the low insulin exposure duration and bone mineral density.     

Long-term effects of intrasplenically transplanted adult hepatocytes and fetal liver in hyperbilirubinemic Gunn rats

We performed adult hepatocyte transplantation (HCTx) and fetal liver transplantation (FLTx) into the spleens of hyperbilirubinemic Gunn rats in congenic combination and we compared the long-term effects of these procedures for as long as 12 months. Proliferative activity of intrasplenic hepatocytes was evaluated using antiproliferating cell nuclear antigen (PCNA) immunohistochemical staining. The serum total bilirubin levels (T. Bil) significantly decreased from 7.16±0.25 mg/dl to 4.38±0.60 mg/dl 2 months after HCTx and gradually decreased thereafter until 12 months after transplantation (3.23±0.37 mg/dl, P<0.05 vs preoperative value). The T. Bil change after FLTx was similar to that of HCTx: 7.22±0.24 mg/dl before FLTx, and 4.92±0.24 and 3.06±0.47 mg/dl, 2 and 12 months after FLTx (P<0.05), respectively. Bilirubin glucuronides, which were not detectable in the bile from untreated Gunn rats, appeared in considerable amounts 4 months after HCTx and FLTx (27.5% and 36.0% of total bile, respectively). PCNA labeling indices of intrasplenic hepatocytes (4.9%±0.9% and 3.7%±0.7%, 6 months after HCTx and FLTx, respectively) were slightly higher than those of normal hepatocytes (1.0%±0.1%) in the host liver. In conclusion, both adult and fetal rat hepatocytes transplanted into the spleen in congenic combination functioned for at least a year in terms of bilirubin glucuronidation. The spleen is considered to be one of the optimal grafting sites for hepatocytes, with nearly lifelong significant function and proliferative activity.     

Less Segregated Processing of Visual Information in V2 than in V1 of the Monkey Visual Cortex

To test the possibility of cross-talk between parallel pathways dealing with different aspects of visual information, such as orientation, direction of motion and colour in cortical area V2, we quantitatively analysed visual responses of 121 V2 cells recorded from anaesthetized and paralysed macaques and compared them with those of 147 V1 cells. A selectivity index of visual responses was calculated for each neuron, which was then classified as selective or not to a particular attribute of visual stimuli. Twenty-one percent of the V2 neurons had dual selectivity to both colour and direction of stimulus motion (C&D cells). In V1, only 5% of the cells were C&D cells. Thus, the proportion of C&D cells significantly increased from V1 to V2. We also carried out cross-correlation analysis of spike trains recorded simultaneously from pairs of V2 neurons or pairs of V1 neurons. In V2, correlated firings could be observed between cells with completely different optimal orientation, such as orthogonal, while it was never observed in V1. The cross-correlation analysis further indicated that functional interactions in V2 were more widespread than those in V1. These results suggest that neurons which have different functional properties become less segregated, and that functional interactions become more widespread in V2 than in V1.     

Computerized image analysis of clustered microcalcifications on mammography: Morphometric comparison between mammography and pathology

The clusters of microcalcifications under 2 cm in greatest dimension were analyzed in terms of size and shape by an image processor with a computer after being magnified 33 times. The mean diameter of mammographic microcalcifications was 188 μm in benign cases, 226 μm in cribriform or papillary type cancer cases, 213 μm in intermediate type cancer cases, and 324 μm in comedo type cancer cases, showing significant differences among the groups. The size distribution of mammographic microcalcifications in the comedo type was characteristic, showing a second peak in distribution between 500 and 700 μm. The radiodensity of microcalcifications compared to the breast parenchyma, the caliber of breast ducts containing the malignant calcifications, and the unit volume of calcium deposits within the ductal lumens were greater in cancer cases.     

Quality of life in adult patients after stem cell transplantation

Many articles pertaining to quality of life (QOL) following stem cell transplantation have been published in the US and western Europe. However, since the actions of health insurance systems and overall cultural aspects are strongly associated with QOL, investigations into QOL should be carried out within all countries. Therefore, we have investigated the QOL of adult patients following stem cell transplantation at 31 hospitals in Japan. The survivors, who were surveyed by mail questionnaire, were 20 years or older at the time of this study. The underlying diseases were acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, non-Hodgkin's lymphoma, Hodgkin's disease, myelodysplastic syndrome, and multiple myeloma. Median age at the time of the study was 36 years, and median interval after transplantation was 35.3 months. Of 383 patients surveyed, 282 (73.6%) responded to the questionnaire. One hundred and ninety-two patients were treated with an allogeneic-related transplantation, 52 with allogeneic-unrelated, and 38 with an autologous transplantation. Our data revealed that the length of time since transplantation and the diagnosis of chronic GVHD were associated with QOL. When unrelated and related transplantation recipients were compared, ratings on relief from pain, stability in weight, and confidence in dealing with daily life were lower among unrelated transplantation patients.     

Impact of Type and Duration of Application of Commercially Available Oral Moisturizers on Their Antifungal Effects

Purpose

To examine the impact of oral moisturizer type and application time on antifungal effects.

Materials and Methods

Seventeen oral moisturizers (7 liquids, 10 gels) and amphotericin B (AMPH‐B) were tested. Antifungal effects were evaluated with newly opened moisturizer samples (0 hour) and with samples incubated for 8 hours to simulate contact during sleep. Candida albicans samples (10⁸ cells/ml) were placed into cylindrical holes in 50% trypticase soy agar plates. Antifungal effects were evaluated based on growth‐inhibitory zones after 24 hours. Equal quantities of moisturizers showing growth‐inhibitory zones were mixed as additional samples. The effects of moisturizer type and application time on growth‐inhibitory zones were evaluated with ANOVA. Growth‐inhibitory zone sizes were compared with multiple comparisons.

Results

Growth‐inhibitory zones were found with two liquids, one gel, moisturizer mixtures, and AMPH‐B. Significant differences in antifungal effects were found among different moisturizer types and between the 0‐ and 8‐hour groups. The growth‐inhibitory zones of the 8‐hour group were significantly smaller than those of the 0‐hour group. In both the 0‐ and 8‐hour groups, the growth‐inhibitory zones of the liquid‐gel mixtures were significantly larger than those of other moisturizer types, and were the same size as those of AMPH‐B at two concentrations (1.25 and 2.5 μg/ml). Growth‐inhibitory zones of individual moisturizers and liquid‐liquid mixtures were the same size as those of lower AMPH‐B concentrations (0.16, 0.31, and 0.63 μg/ml).

Conclusion

Our findings suggest that mixing liquid and gel moisturizers improves their antifungal efficiency.     

A case of misinsertion of the PEG tube into the abdominal cavity recovered on a referral to the outpatient by using simple endoscopy techniques

We report a case of a 53-year-old man, who had been bed-ridden due to the progression of spinocerebellar degeneration and had been relying on percutaneous endoscopic gastrostomy (PEG) feeding for long-term nutritional support at home. The patient was referred to our clinic from his local GP because of suspected misinsertion of the PEG tube into the abdominal cavity on regular exchange of the tube. We performed emergent gastric endoscopy. First we induced the biopsy forceps through an endoscopic fiber, and pulled the forceps out through the injured fistula to the surface. Then the loop wire used for PEG placement was inserted through the fistula to the stomach using the forceps. The PEG tube was then inserted per oral and replacement was completed according to the usual pull-method. This procedure enabled the replaced PEG tube to cover the perforated site as well as to reduce intragastric pressure, thereby prevented the occurrence of panperitonitis, a common severe complication expected in case of perforated fistula, caused by the leakage of intragastric contents. The patient showed no signs of complications, and could continue to receive in-home care without being admitted to the hospital for acute care.     

Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease

Thrombotic microangiopathy after bone marrow transplantation (post-BMT TMA) is a serious transplant-related complication. We identified 16 patients with TMA after allogeneic BMT who showed histopathological evidence of intestinal TMA in their gut specimens (six autopsies, 10 biopsies). In all, 14 patients had grade II-IV acute graft-versus-host disease (GVHD). The first seven patients were retrospectively diagnosed with TMA. Since six of them were diagnosed with progressive GVHD at that time because there was no awareness of the existence of intestinal TMA, they received more intensive treatment for GVHD, but all died between days +49 and +253. In contrast, the remaining nine patients were recently diagnosed with intestinal TMA on the basis of colonoscopic biopsies. For eight of these patients, the immunosuppressants were reduced, and the patients' intestinal symptoms improved gradually. Six of the nine patients were still alive 12 months after the diagnosis of TMA. Our findings suggest that the gut may be a site involved in post-BMT TMA, presenting as ischemic enterocolitis. Differentiating intestinal TMA from acute GVHD is important in patients suffering from severe and refractory diarrhea after BMT.     

Novel Nasogastric Tube-Related Criteria for Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Bleeding

Background

Patients with active upper gastrointestinal bleeding (UGIB) require urgent endoscopy, but appropriate criteria for urgent endoscopy in these patients have not yet been established.

Aims

The goal of this study is to establish a simple system for the selection of UGIB patients who may benefit from urgent endoscopy.

Methods

Of the 335 patients who required emergency hospitalization for UGIB from May 2010 to March 2012 at Nagoya Daini Red Cross Hospital, 166 patients who underwent placement of a nasogastric tube (NGT) were retrospectively identified. Active bleeding on the endoscopic image was used as an endpoint that reflected the need for urgent endoscopy.

Results

The ratio of the heart rate to the systolic blood pressure (HR/SBP ratio) and aspiration of fresh or dark red fluid from the NGT [NGT(+)] were significant predictors of active bleeding in the univariate analysis [HR/SBP ratio, P = 0.016; NGT(+), P < 0.001]. The HR/SBP ratio [odds ratio (OR) 8.118; 95 % confidence intervals (CI) 1.696–38.850; P = 0.009] and NGT(+) (OR 4.630; 95 % CI 2.092–10.204; P < 0.001) were also significantly associated with active bleeding in the multivariate analysis. Moreover, receiver operating characteristic analysis revealed a setting with HR/SBP ratio >1.4 or NGT(+) to be optimal criteria to predict active bleeding. These criteria were associated with a sensitivity of 64.9 % (24/37) and a specificity of 76.7 % (99/129) for the prediction of active bleeding; consequently, they are superior to the sensitivity and specificity of previously proposed criteria.

Conclusions

A novel and simple criteria system using NGT(+) and HR/SBP is a good predictor of the need for urgent endoscopy in patients with nonvariceal UGIB.