High HbA1c is a risk factor for complications after hepatectomy and influences for hepatocellular carcinoma without HBV and HCV infection

BackgroundCurrently, the population with type 2 diabetes mellitus (DM) is increasing worldwide. However, the influence of DM or hyperglycemia on the outcome of resected hepatocellular carcinoma (HCC) is unclear.MethodsWe analyzed 756 patients with HCC who underwent hepatectomy. These patients were assigned to an HbA1c ≥7.0% (H-A1c; n=100) or HbA1c <7.0% (L-A1c; n=656) group depending on their HbA1c level at admission. We investigated prognoses, clinicopathological characteristics and surgical outcomes including morbidities of HCC patients with high HbA1c, prognoses according to the treatment for DM were also investigated.ResultsAmong all patients and those with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, overall survival (OS) and relapse-free survival (RFS) did not differ significantly between the H-A1c and L-A1c groups. In contrast, the 5-year OS rate of the H-A1c group was 55% and that of the L-A1c group 71% among patients without HBV and HCV (NBNC patients) (P=0.03). Among NBNC patients, the median RFS of the H-A1c group was 13 months, and that of the L-A1c group was 26 months (P=0.02). In addition, metformin use was an independent favorable factor for both OS and RFS. The H-A1c group had significantly higher rates of hyperbilirubinemia, wound infection, and pneumonia.ConclusionsHCC patients with high HbA1c might have poor prognoses for both survival and recurrence in NBNC-HCC. High HbA1c may also be a risk factor for morbidities after hepatectomy. Metformin use may constitute a good option for NBNC patients with HCC.     

Ultrasonic irrigation of a maxillary lateral incisor with perforation of the apical third of the root

We describe the successful use of a combination of nonsurgical root canal treatment and ultrasonic irrigation for collaborative management of a maxillary left lateral incisor with perforation of the apical third of the root. During the endodontic treatment procedure, the ultrasonically activated tip was used for intracanal irrigation. The area of perforation in the apical third of the root and the main root canal space were obturated with gutta-percha and root canal sealer, using a lateral condensation method. A follow-up clinical and radiographic examination at 5 years after treatment showed an asymptomatic tooth with excellent osseous healing.     

Management strategies for infants with total intestinal aganglionosis

Purpose

This study investigated appropriate management strategies for infants with total intestinal aganglionosis(TIA), focusing on surgical and medical managements.

Methods

Six infants with TIA or near TIA treated in our institution between 1980 and 2007 were reviewed retrospectively. Surgery was performed as a simple jejunostomy, 65 to 70 cm below the ligament of Treitz (LOT) in 2 infants, and 30 cm below LOT in 1 without extended myectomy-myotomy(EMM). Jejunostomy with EMM 30 to 35 cm below LOT were performed in 3.

Results

Two infants with jejunostomy 65 cm or 70 cm distal from LOT died of sepsis at 7 months and 8 months of age, respectively. One infant with jejunostomy 30 cm from LOT without EMM died of cholestatic liver failure at the age of 1 year and 8 months. To date, the remaining 3 infants with jejunostomy 30 cm or 35 cm distal from LOT in addition to EMM have survived 10 years, 3 years and 10 months, and 2 years of age, respectively. Nutritional managements such as parenteral nutrition with 80 to 100 kcal/kg/day and oral feeding with elemental diet(ED) were preferable to reduce the occurrence of enteritis, sepsis, and cholestatic liver dysfunction.

Conclusion

A good combination of cyclic parenteral nutrition and oral intake with elemental diet after short proximal jejunostomy with EMM may be a key for the survival of infants with TIA. In addition, in infants whose absorptive function was not ameliorated by EMM, medical management such as GH administration might be worth trying.     

Natural killer cells of Parkinson's disease patients are set up for activation: a possible role for innate immunity in the pathogenesis of this disease

Neuroinflammation in Parkinson's disease (PD) involves activation of microglia, participation of several inflammatory cytokines, prostaglandins, complement and systemic activation of natural killer (NK) cells, suggesting that innate immunity has a role in the pathogenesis of this disease. In this study, we examined NK activity and the expression of its regulatory molecules in peripheral lymphocytes of PD patients and compared the results with those of healthy controls. Expression of the inhibitory NKG2A receptors was significantly lower in PD, causing PD patients to be susceptible in a condition for NK activation after NK cells bind to target cells via these receptors.