Clinical Characteristics Associated with the Development of Diabetic Ketoacidosis in Patients with Type 2 Diabetes

Objective This study analyzed the clinical and laboratory parameters that might influence the clinical outcomes of patients with type 2 diabetes who develop diabetic ketoacidosis (DKA), which has not been well investigated. Methods We reviewed the clinical and laboratory data of 158 patients who were hospitalized due to DKA between January 2006 and June 2019 and compared the data of patients stratified by the type of diabetes. In addition, the patients with type 2 diabetes were subdivided according to age, and their clinical and laboratory findings were evaluated. Results Patients with type 2 diabetes had a longer symptom duration associated with DKA, higher body mass index (BMI), and higher C-peptide levels than those with type 1 diabetes (p＜0.05). Among patients with type 2 diabetes, elderly patients (≥65 years old) had a longer duration of diabetes, higher frequency of DKA onset under diabetes treatment, higher effective osmolarity, lower BMI, and lower urinary C-peptide levels than nonelderly patients (＜65 years old) (p＜0.05). A correlation analysis showed that age was significantly negatively correlated with the index of insulin secretory capacity. Conclusion Patients with DKA and type 2 diabetes had a higher BMI and insulin secretion capacity than those with type 1 diabetes. However, elderly patients with type 2 diabetes, unlike younger patients, were characterized by a lean body, impaired insulin secretion, and more frequent DKA development while undergoing treatment for diabetes.     

Genotoxicity studies of glycidol fatty acid ester (glycidol linoleate) and glycidol

Glycidol fatty acid esters (GEs) are found in refined edible oils. Safety concerns have been alleged due to the possible release of glycidol (G), an animal carcinogen.     

Treatment of bone and soft tissue sarcomas of the hand and wrist

We studied 13 consecutive patients with bone and soft tissue sarcomas of the hand and wrist. Chondrosarcoma, Ewing's sarcoma, synovial sarcoma and epithelioid sarcoma were the most frequent histological diagnoses. Limb-sparing surgery was performed in ten patients but eventually three patients required an amputation. Surgical margins were wide in nine patients and marginal in four. Adjuvant therapy for nine patients consisted of chemotherapy in five and chemotherapy with radiation in four. Local recurrence occurred in two patients with epithelioid sarcoma. There was no significant relationship between surgical margin and local recurrence. Distant metastasis occurred in four patients. The 5-year survival rate was 66%. The mean functional score was 87%. Our study indicates that treatment consisting of resection of these tumours with either a wide margin or a marginal margin followed by adjuvant radiation appeared to be safe and resulted in an acceptable degree of limb function except in the patients with epithelioid sarcoma.     

Remifentanil is useful for cardiovascular stability during cesarean delivery in a parturient with Marfan's syndrome

A 25-year-old parturient with Marfan's syndrome was scheduled for cesarean delivery. She suffered with severe scoliosis and asymptomatic aortic root dilatation. To establish a cardiovascular stability and prevent aortic dissection perioperatively, we selected the use of remifentanil, an ultra-short acting opioid analgesic with general anesthesia. General anesthesia was induced with remifentanil (0.2 microg x kg(-1) x min(-1)), propofol (100 mg), and vecuronium bromide (10 mg). Anesthesia was maintained with 100% O2, sevoflurane (1-1.5%), and remifentanil (0.2-0.25 microg x kg(-1) x min(-1)). She remained hemodynamically stable during surgery. A lively infant was delivered and Apgar scores were 8 and 9 at 1 and 5 min, respectively. Their post-delivery courses were uneventful. Remifentanil was useful for anesthetic management in a pregnant patient with Marfan's syndrome undergoing cesarean delivery, although attention to infant's respiratory condition should be paid because remifentanil can cross the placenta.     

Recovery from rocuronium by sugammadex does not affect motor evoked potentials

Motor evoked potential (MEP) monitoring has been employed to detect the spinal cord injury during spinal, neurosurgical and cardiovascular operations. Muscle relaxants diminish the amplitude of MEP because MEP is the picture of electromyogram. In 5 cases undergoing MEP monitoring, we examined the effect of rocuronium followed by the administration of sugammadex on MEP Anesthesia was induced with propofol (target controlled infusion 3.0-3.5 microg x ml(-1)) and remifentanil 0.15-0.3 microg x kg(-1) x min(-1), and the trachea was intubated with the use of rocuronium 0.6 mg x kg(-1) without any muscle rigidity, bucking and laryngospasm. General anesthesia was maintained by total intravenous anesthesia using propofol and remifentanil with no muscle relaxants. Immediately after the tracheal intubation, sugammadex 4 mg x kg(-1) was intravenously given. The amplitude of MEP was measured just before the administration of rocuronium, immediately after the tracheal intubation, and 1, 2, 3, 5 min following the administration of sugammadex. Sugammadex restored the MEP amplitude, deteriorated by rocuronium, in 3 to 5 min to the level of non-paralytic muscles. In one case, it took 8 min to restore the MEP of hemiparetic leg. Taking these findings into consideration, it is likely that rocuronium might not affect the MEP when reversed by sugammadex, and should be safe for smooth tracheal intubation in patients who need MEP monitoring.     

Nilotinib attenuates renal injury and prolongs survival in chronic kidney disease

The tyrosine kinase inhibitor imatinib is beneficial in experimental renal diseases, but the effect of the new tyrosine kinase inhibitor nilotinib on the progression of renal failure is unknown. We administered either nilotinib or vehicle to Sprague-Dawley rats beginning 2 weeks after 5/6 nephrectomy (Nx) or laparotomy and continuing for 8 weeks. Serum creatinine levels were significantly lower in the nilotinib group after 6 and 8 weeks of treatment. Furthermore, nilotinib-treated rats had less proteinuria, attenuated glomerulosclerosis and tubulointerstitial damage, and reduced macrophage infiltration into the tubulointerstitium. Treatment with nilotinib also significantly decreased renal cortical expression of profibrogenic genes, such as IL-1β and monocyte chemotactic protein-1, which correlated closely with the tubulointerstitial damage score and ED1-positive macrophages score. In addition, nilotinib treatment significantly prolonged survival. Taken together, these results suggest that nilotinib may limit the progression of chronic kidney disease.     

Effect of divided supplementation of remifentanil on seizure duration and hemodynamic responses during electroconvulsive therapy under propofol anesthesia

Purpose

Although a reduced dose of propofol combined with remifentanil is often used in anesthesia for electroconvulsive therapy (ECT), there have been few studies in which the optimal technique for injection of remifentanil was examined in detail. The aim of this study was to evaluate the effects of single and divided injection of remifentanil combined with propofol on seizure duration and hemodynamic responses during ECT.

Methods

Twenty-six ASA I?CII patients were enrolled in this study and received a total of 78 ECTs. Each patient received propofol 1.2?mg/kg (group P), remifentanil 1???g/kg followed by propofol 0.5?mg/kg (group R1), and remifentanil 1???g/kg followed by propofol 0.5?mg/kg and thereafter remifentanil 2???g/kg (group R2). Succinylcholine 1?mg/kg was used for muscle paralysis after loss of consciousness.

Results

Although mean motor seizure durations were significantly longer in groups R1 and R2 than in group P (P?P?P?Conclusions Divided use of remifentanil at 1 and 2???g/kg combined with propofol 0.5?mg/kg produces an acceptable outcome in both seizure duration and hemodynamic stability during ECT compared with the standard hypnotic doses of propofol alone or remifentanil 1???g/kg followed by propofol 0.5?mg/kg.