Brain energy metabolism during hypoglycaemia in healthy and Type 1 diabetic subjects

Aims/hypothesis This study aimed to examine brain energy metabolism during moderate insulin-induced hypoglycaemia in Type 1 diabetic patients and healthy volunteers.Methods Type 1 diabetic patients (mean diabetes duration 13±2.5 years; HbA₁c 6.8±0.3%) and matched controls were studied before, during (0–120 min) and after (120–240 min) hypoglycaemic (~3.0 mmol/l) hyperinsulinaemic (1.5 mU·kg^–1·min^–1) clamp tests. Brain energy metabolism was assessed by in vivo ³¹P nuclear magnetic resonance spectroscopy of the occipital lobe (3 Tesla, 10-cm surface coil).Results During hypoglycaemia, the diabetic patients showed blunted endocrine counter-regulation. Throughout the study, the phosphocreatine:-ATP ratios were lower in the diabetic patients (baseline: controls 3.08±0.29 vs diabetic patients 2.65±0.43, p<0.01; hypoglycaemia: 2.97±0.38 vs 2.60±0.35, p<0.05; recovery: 3.01±0.28 vs 2.60±0.35, p<0.01). Intracellular pH increased in both groups, being higher in diabetic patients (7.096±0.010 vs. 7.107±0.015, p<0.04), whereas intracellular magnesium concentrations decreased in both groups (controls: 377±33 vs 321±39; diabetic patients: 388±47 vs 336±68 µmol/l; p<0.05).Conclusions/interpretation Despite a lower cerebral phosphocreatine:-ATP ratio in Type 1 diabetic patients at baseline, this ratio does not change in control or diabetic patients during modest hypoglycaemia. However, both groups exhibit subtle changes in intracellular pH and intracellular magnesium concentrations.Abbreviations [Mg²⁺]_i intracellular magnesium - NMR nuclear magnetic resonance - PCr phosphocreatine - pH_i intracellular pH - P_i intracellular inorganic phosphate     

磁共振弥散加权成像在淋巴结病变中的应用

在临床中,准确评价淋巴结的情况对肿瘤患者治疗方案的选择及预后的判断具有重要的意义。影像学判断良、恶性淋巴结常以淋巴结的大小、形态、有无中心坏死以及有无包膜外侵袭等来作为参考标准,但这些指标的敏感性和可靠性均较低,转移性淋巴结直径可以很小,而且并不是所有直径较大的淋巴结都是恶性。近年来,磁共振弥散加权成像在鉴别良、恶性病变成为研究的热点,本文对弥散加权成像在淋巴结的应用及研究现状予以综述。     

Water content of hearts perfused with crystalloid and nutrient solutions

One hundred and twenty excised rabbits hearts were subjected to 1 h of continuous pulsatile coronary perfusion with acellular fluids in a Lindbergh-Rockefeller Institution organ perfusion apparatus. Perfusions were carried out at 26°C and 15°C. At the end of 1 h of perfusion, samples of the left ventricular myocardium were packed into nuclear magnetic resonance (NMR) tubes and the water peak area and linewidth of the water signal were determined by the steady-state NMR spectroscopy. Seventeen different perfusates were employed. Four hearts were perfused and one control heart was processed in an identical way, with each set of experiments. Results were expressed as the mean percentage increase in total myocardial water in perfused hearts, as compared to unperfused hearts. At 26°C these ranged from 9.31 (s.e. 0.66) to 35.89 (s.e. 4.09). At 15°C the range was from 13.26 (s.e. 1.03) to 39.14 (s.e. 2.06). At 26°C, the mean linewidth (Hz) in control myocardiums was 11.60 (s.e. 0.40), in perfused hearts 7.34 (s.e. 0.33); at 15°C it was 12.15 (s.e. 0.29) in control hearts, and 7.84 (s.e. 0.37) in perfused ones. Hearts perfused with lactated Ringer's solution showed the greatest interstitial water accumulation. Linewidth narrowing indicated an accumulation of “unstructured” presumably extracellular water. In edematous hearts, interstitial spaces were widely dilated. The described technique can serve as a rapid screening method for assessing myocardial edema produced by perfusion.     

Pathogenesis, diagnosis and treatment of cerebral fat embolism

In this study, we analyzed two cases of pure cerebral fat embolism and reviewed related literatures to explore the pathogenesis, clinical manifestations, diagnosis and treatment of cerebral fat embolism, improve the treatment efficiency and reduce the misdiagnosis rate. In our cases, patients fully returned to consciousness at the different times with good prognosis, normal vital signs and without obvious sequelae. For patients with the limb fractures, who developed coma without chest distress, dyspnea or other pulmonary symptoms 12 or 24 h post injury, cerebral fat embolism should be highly suspected, except for those with intracranial lesions, such as delayed traumatic intracerebral hemorrhage, etc. The early diagnosis and comprehensive treatment can improve prognosis.     

Rectal puncture complicating caudal blockade in a child with severe rectal distension

We describe a case of unrecognized rectal puncture following unsuccessful caudal blockade in a patient later found to have marked rectal distension on MRI. This may have contributed to the rectal injury.     

Wireless micro current stimulation – an innovative electrical stimulation method for the treatment of patients with leg and diabetic foot ulcers

Clinical experience with a new electrical stimulation (ES) technique, the wireless micro current stimulation (WMCS), for the treatment of chronic wounds is described. WMCS transfers the current to any surface wound from a distance, by using oxygen's and nitrogen's ability to exchange electrons. We studied 47 patients with hard‐to‐heal wounds. Patients with venous, arterial and mixed leg ulcers were predominant; other aetiologies such as diabetic foot lesions, pressure ulcers, vasculitis and pyoderma were also included. WMCS treatment protocol specified treatment twice or thrice per week, for 45–60 minutes per session, with 1·5 μA current intensity. Standard wound care was applied to all patients, including compression bandages, if necessary. Clear progress of wound healing, even after 2 weeks, was observed in all cases. The mean reduction of the wound surface after WMCS treatment was 95% in 8 weeks. Complete healing was achieved within 3 months for the majority of the cases. No clinical side effects were observed. WMCS technology significantly accelerated wound healing for patients with hard‐to‐heal wounds of different aetiologies. This new therapy offers multiple advantages compared with the previous methods of ES, as it is contactless, free of pain and very easy to use.