Ketoacidosis,Hypertriglyceridemia and Acute Pancreatitis Induced by Soft Drink Polydipsia in a Patient with Occult Central Diabetes Insipidus

A 21-year-old Japanese man without known diabetes mellitus had abdominal pain. The diagnosis was ketoacidosis and hypertriglyceridemia-induced acute pancreatitis. He had polydipsia and polyuria and had habitually drunk several soft drinks every day for two years. After hospitalization, despite adequate liquid intake, dehydration remained with hypotonic polyuria. Further examinations revealed the coexistence of central diabetes insipidus (CDI), possibly caused by lymphocytic infundibulo-neurohypophysitis, based on anti-rabphilin-3A antibody positivity. Although CDI had been undiagnosed for two years, over-consumption of sugar-rich soft drinks to ease thirst caused ketoacidosis, hypertriglyceridemia, and acute pancreatitis. There are no previous reports of this three-part combination of symptoms caused by CDI.     

Analysis of sodium generation by sodium oxide decomposition on corrosion resistance materials: a new approach towards sodium redox water-splitting cycle

In this study, the investigation of materials with corrosion resistance was carried out to prevent side reactions caused by sodium oxide (Na₂O) in the Na-redox thermochemical water splitting cycle, and essential operational conditions for sodium (Na) generation from Na₂O were also investigated. Thermal desorption spectroscopy and X-ray diffraction techniques at altered conditions were mainly used for the experimental investigation. Numerous types of materials were tested to find materials with high resistance towards corrosion and to understand essential thermal decomposition processes of Na₂O. In addition, under different temperatures and pressure conditions, the thermodynamic calculation of Gibbs free energy was performed to obtain experimental results. As a result, a Ti alloy showed significant resistance towards the corrosive reaction by Na₂O. The obtained experimental and simulated results support the direct decomposition of Na₂O to form Na and O₂ below 600 °C under low partial pressure conditions. The optimized conditions for Na generation with the Ti alloy sample can be used for low temperature water splitting.

In this study, investigation of materials with corrosion resistance was carried out to prevent side reactions by sodium oxide (Na₂O) in the Na-redox cycle, and essential operational conditions for Na generation from Na₂O were investigated.     

Appropriate definition of diabetes using an administrative database: A cross‐sectional cohort validation study

Aims/IntroductionThe purpose of the present study was to quantify errors in the diagnosis of diabetes for use in the national database, using a sufficient population size.Materials and methodsA claims database constructed by the JMDC (Tokyo, Japan), using standardized disease classifications and anonymous record linkage, was used in this validation study. We included patients with health insurance claims data from April 2005 to March 2019 in the JMDC claims database. We excluded patients without a record of specific health checkups in Japan. Sample size calculation was based on a 5% prevalence of diabetes and 0.4% absolute accuracy (i.e., 1,250,000 individuals), to calculate the sensitivity, specificity, positive predictive value and negative predictive value.ResultsIn total, 2,999,152 patients were included in this study, of which 165,515 were classified as having diabetes based on specific health checkups (validation cohort prevalence of 5.5%). The newly devised algorithm had three elements – the diagnosis‐related codes for diabetes without suspected flag, the medication codes for diabetes and then these two codes on the same record – and yielded a sensitivity of 74.6%, positive predictive value of 88.4% and Kappa Index of 0.80 (the highest values).ConclusionsIn future claims database studies, our validated algorithms will be useful as diagnostic criteria for diabetes.     

Muscular Metastasis of Hepatocellular Carcinoma: Case Report and Literature Review

There are few case reports of hepatocellular carcinoma (HCC) metastasis to the skeletal muscle. A 78-year-old man developed a mass in the right shoulder. Washout of contrast medium during contrast-enhanced ultrasonography (CEUS) in both the primary HCC and the metastatic site was detected. Several nodules were scattered throughout the liver on an autopsy. In addition, the moderately differentiated HCC had metastasized to the right teres major muscle. Rare muscular metastasis should be considered if a hepatic tumor is moderately or poorly differentiated HCC. Early washout during CEUS is consistent with a pathological diagnosis of moderately or poorly differentiated HCC.     

Psoas muscle size,possible sarcopenia and frailty,and long-term survival in elderly patients after isolated surgical aortic valve replacement for aortic stenosis

PurposeThis study investigated the use of psoas muscle area index (PAI) as an indicator of mortality risk in relation to survival in elderly patients after isolated surgical aortic valve replacement (SAVR) for aortic valve stenosis (AS).MethodsBetween January 2005 and March 2015, 140 patients with AS, aged ≥ 70 years, and with preoperative abdominal computed tomography scans, underwent elective, primary, isolated SAVR. PAI showed the ratio of the psoas muscle cross-sectional area at the fourth lumbar vertebral level to body surface area, and PAI less than the gender-specific lowest 20th percentile we called “low PAI” for the purposes of this study. Patients were classified as low PAI (n = 29) or normal PAI (n = 111).ResultsThe mean age in the low-PAI group was significantly older than in the normal-PAI group (81.0 vs. 77.3 years; p = 0.001). The mean follow-up was 4.25 years. The low-PAI group had a lower survival rate than the normal-PAI group at 1 year (89.7 ± 5.7% vs. 96.3 ± 1.8%), at 3 years (71.6 ± 9.3% vs. 91.5 ± 2.7%), and overall (53.0 ± 13.4% vs. 76.0 ± 5.6%; p = 0.039). The prognostic factors of mortality included low PAI (hazard ratio 2.95; 95% confidence interval 1.084–8.079; p = 0.034).ConclusionsPAI was associated with reduced overall survival after isolated SAVR in elderly people. PAI measurement may help to predict patient risks.