Effect of exogenous insulin on glucose kinetics in rats with noninsulin-dependent diabetes

Noninsulin-dependent diabetes (NIDD) was induced in adult female rats by neonatal administration of streptozotocin. Despite elevated basal plasma glucose values in the postabsorptive state (196 +/- 16 mg/100 mL as compared to 118 +/- 7 in the controls), the glucose disappearance rate measured after the intravenous glucose load was not significantly lower in the diabetic than in control rats. In contrast, in vivo glucose-induced insulin release was drastically reduced, thus suggesting that endogenous insulin was more effective on the target tissues of the diabetic rats. Glucose kinetics (glucose production, utilization, and clearance) in response to intravenous insulin injection were studied in anesthetized postabsorptive diabetic and control female rats using [6-3H] glucose. With a maximal dose of insulin (0.5 U/kg body weight) no difference in blood glucose-lowering effect of insulin was found between the 2 groups. With 2 submaximal insulin doses (0.15 and 0.3 U/kg body weight), glucose production was inhibited more rapidly and more efficiently in diabetic rats than in control rats: 2 minutes after the 0.15 U/kg insulin injection, endogenous glucose production fell by 79 +/- 5% in the diabetics while being unchanged in the controls and the maximal decrease of glucose production after the same insulin injection was significantly greater in the diabetic rats (79 +/- 5% at 2 minutes) compared to the controls (33 +/- 4% at 6 min). The rise of glucose clearance in response to insulin was not significantly different in the 2 groups. These findings are discussed in view of the increased insulin clearance rate in these diabetic females.(ABSTRACT TRUNCATED AT 250 WORDS)     

Achieving the optimal epinephrine effect in wide awake hand surgery using local anesthesia without a tourniquet

Background

In our experience, for all surgeries in the hand, the optimal epinephrine effect from local anesthesia—producing maximal vasoconstriction and visualization—is achieved by waiting significantly longer than the traditionally quoted 7 min from the time of injection.

Methods

In this prospective comparative study, healthy patients undergoing unilateral carpal tunnel surgery waited either 7 min or roughly 30 min, between the time of injection of 1 % lidocaine with 1:100,000 epinephrine and the time of incision. A standardized incision was made through dermis and into the subcutaneous tissue followed by exactly 60 s of measuring the quantity of blood loss using sterile micropipettes.

Results

There was a statistically significant reduction in the mean quantity of bleeding in the group that waited roughly 30 min after injection and before incision compared to the group that waited only 7 min (95 % confidence intervals of 0.06 + −0.03 ml/cm of incision, compared to 0.17 + −0.08 ml/cm, respectively) (P = 0.03).

Conclusions

Waiting roughly 30 min after injection of local anesthesia with epinephrine as oppose to the traditionally taught 7 min, achieves an optimal epinephrine effect and vasoconstriction. In the hand, this will result in roughly a threefold reduction in bleeding—making wide awake local anesthesia without tourniquet (WALANT) possible. This knowledge has allowed our team to expand the hand procedures that we can offer using WALANT. The benefits of WALANT hand surgery include reduced cost and waste, improved patient safety, and the ability to perform active intraoperative movement examinations.     

急性ST段抬高型心肌梗死合并射血分数保留的心力衰竭患者急诊经皮冠状动脉介入治疗术中无复流的影响因素分析

目的 探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)合并射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者行急诊经皮冠状动脉介入术(primary percutaneous coronary intervention,PPCI),术中发生无复流的影响因素.方法 连续选取2017年1月至2019年1月就诊于首都医科大学附属北京安贞医院急诊科并行急诊PCI治疗的STEMI合并HFpEF患者326例,按照急诊PCI术中血流情况,分为正常复流组(255例)和无复流组(71例).比较两组的临床资料,分析无复流发生的影响因素.结果 合并HFpEF的STEMI患者,PPCI术后无复流发生率为21.8%(71/326),两组之间急诊收缩压(SBP)[(113.75±23.27)mm Hg比(127.84±34.58)mm Hg,P=0.046]、即刻血糖水平[(14.32±6.75)mmol/L比(9.17±7.50)mmol/L,P=0.038]、发病到再灌注时间[(118.07±41.35)min比(9.74±39.23)min,P=0.037]、球囊扩张次数(12.5%比10.1%,P=0.042)差异均有统计学意义(P<0.05);经多因素Logistic回归分析显示,急诊SBP(OR=1.089,95%CI 0.746~18.247,P=0.031)、球囊扩张次数(OR=1.980,95%CI 0.883~1.087,P=0.039)、发病至再灌注时间(OR=2.985,95%CI 0.064~0.982,P=0.048)是急诊PCI术中无复流发生的危险因素.结论 合并EFpHF合并STEMI患者行PPCI后无复流发生与入院收缩压、球囊扩张次数、发病至再灌注时间具有相关性.     

Biological activation of bone grafts using injectable platelet-rich fibrin

Platelet-rich fibrin (PRF) is gaining acceptance as a bioactive surgical additive in regenerative dentistry. However, PRF has only been available in gel or membrane form and is not suitable for injection. Recently, however, a liquid, injectable PRF has been introduced. This paper introduces the concept of injectable PRF and discusses its applications for biologic activation of bone grafts.     

Localization and characterization of val‐opsin isoform‐expressing cells in the brain of adult zebrafish

In addition to vision, light information is used to regulate a range of animal physiology. Such nonimage‐forming functions of light are mediated by nonvisual photoreceptors expressed in distinct neurons in the retina and the brain in most vertebrates. A nonvisual photoreceptor vertebrate ancient long opsin (VAL‐opsin) possesses two functional isoforms in the zebrafish, encoded by valopa and valopb, which has received little attention. To delineate the neurochemical identities of valop cells and to test for colocalization of the valop isoforms, we used in situ hybridization to characterize the expression of the valop genes along with that of neurotransmitters and a neuropeptide known to be present at the sites of valop expression. Double labeling showed that the thalamic valop population coexpresses valopa and valopb. All the thalamic valop cells overlapped with a GABAergic cell mass that continues from the anterior nucleus to the intercalated thalamic nucleus. A novel valopa cell population found in the superior raphe was serotonergic in nature. A valopb cell population in the Edinger‐Westphal nucleus was identified as containing thyrotropin‐releasing hormone. Valopb cells localized in the hindbrain intermediate reticular formation were noncholinergic in nature (nonmotorneurons). Thus, the presence of valop cell populations in different brain regions with coexpression of neurotransmitters and neuropeptides and the colocalization of valop isoforms in the thalamic cell population indicate regulatory and functional complexity of VAL‐opsin in the brain of the zebrafish. J. Comp. Neurol. 522:3847–3860, 2014. © 2014 Wiley Periodicals, Inc.     

Our experience of coronary angiography with and without heparin

AimCoronary angiography is usually done with heparin. Our aim is to see whether it can be done without heparin through femoral route and its effect on local complications.MethodWe have studied 3780 patients from 2006 to 2010 using standard dose Heparin (5000 units), low dose heparin (2000 units) and no heparin. We have compared safety and complications in these three groups.ResultsLocal complications were lowest in no heparin group. Blood transfusion requirements and surgical interventions were lowest in no heparin group. Thrombosis rate did not increase in no heparin group.ConclusionCoronary angiography can be done safely without heparin through femoral route.     

Language Learning From Positive Evidence,Reconsidered: A Simplicity‐Based Approach

Children learn their native language by exposure to their linguistic and communicative environment, but apparently without requiring that their mistakes be corrected. Such learning from “positive evidence” has been viewed as raising “logical” problems for language acquisition. In particular, without correction, how is the child to recover from conjecturing an over‐general grammar, which will be consistent with any sentence that the child hears? There have been many proposals concerning how this “logical problem” can be dissolved. In this study, we review recent formal results showing that the learner has sufficient data to learn successfully from positive evidence, if it favors the simplest encoding of the linguistic input. Results include the learnability of linguistic prediction, grammaticality judgments, language production, and form‐meaning mappings. The simplicity approach can also be “scaled down” to analyze the learnability of specific linguistic constructions, and it is amenable to empirical testing as a framework for describing human language acquisition.