Beziehungen zwischen Kalium- und Kohlenhydratstoffwechselstörungen bei Diabetes Mellitus

Zusammenfassung Bei 84 Personen mit stabilem Kohlenhydratstoffwechsel wurde die Glucosetoleranz und ihre Beziehung zum Kaliumspiegel im Serum, Plasma und in Erythrocyten untersucht. Bei 43 Fettsüchtigen wurde mehrmals oral 2 mg eines Salureticums Polythiazid-Renese, Pfizer verabreicht. Die danach auftretende Hypokaliämie verursachte eine Verminderung der Glucosetoleranz, die bei 23 Kranken mit Diabetes mellitus am ausgeprägsten war. Bei 12 Kranken mit latentem Diabetes wurde eine mittelstarke und bei 8 Fettsüchtigen ohne Kohlenhydratstoffwechselstörungen nur eine schwache Verschlechterung der Glucosetoleranz gefunden. 36 Patienten mit Hypokaliämie erhielten eine Kaliumacetatund Bromkaliummischung bis zur Erlangung der Normokaliämie. Daraufhin normalisierte sich die Glucosetoleranz. Die gleichzeitige Verabreichung von Renese und der Kaliummischung in 15 Fällen führte zu einer unbedeutenden Erniedrigung des Kaliumspiegels ohne wesentliche Glykämieveränderungen. Beim Altersdiabetes erreichte man nach Anwendung der Kaliummischung allein bei 33 von 36 Behandelten eine deutliche Verbesserung der Glucosetoleranz und gleichzeitig einen geringgradigen Anstieg des Kaliumspiegels im Serum. Bei 5 Gesunden waren die Veränderungen unwesentlich. Sämtliche Ergebnisse sind statistisch gesichert. — Schlußfolgerung: Bei Beurteilung des latenten Diabetes und Diabetes mellitus sollte der mögliche Einfluß einer Störung des Kaliumstoffwechsels mit in Betracht gezogen werden.

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Relationships between disturbances in Potassium and carbohydrate metabolism in diabetes mellitus

Summary The glucose tolerance was measured in 84 patients examined under controlled conditions, and related to the potassium concentration of serum, or plasma and that in erythrocytes. Forty-three obese patients were given 2 mg of Polythiazid-Renese [Pfizer] by mouth for 7 days to promote elimination of salt. The resulting hypokaliaemia caused a reduction in glucose tolerance. This was greatest in 23 patients with diabetes mellitus, moderate in 12 patients with latent diabetes, and least in 8 obese patients with normal carbohydrate metabolism. Thirty-six hypokaliaemic patients were given a mixture of potassium acetate and potassium bromide for several days until serum potassium was normal. This brought about a return to normal of the values obtained in the glucose tolerance test. Simultaneous administration of Renese and the potassium mixture in 15 cases caused only an insignificant fall in serum potassium without any appreciable change in blood glucose. In 33 out of 36 patients with maturity-onset diabetes, the administration of the potassium mixture alone caused a noticable improvement in the glucose tolerance test and at the same time a small rise in serum potassium. In 5 normal subjects the changes were unimportant. The results obtained were statistically significant. — Conclusion: In the assessment of latent diabetes and of diabetes mellitus the role of disturbances in potassium metabolism should not be overlooked.

Nach einer Mitteilung auf der II. Tagung der Europäischen Gesellschaft für Diabetologie in Aarhus am 6. 7. 1966.     

The Antiarrhythmic Drug BRL‐32872

BRL‐32872 is a new antiarrhythmic drug with balanced class‐III and class‐IV actions as categorized by the Vaughan‐Williams classification. BRL‐32872 blocks the rapid component of the cardiac delayed rectifier potassium channel IK_r (IC₅₀= 28 nM) and its molecular correlate HERG (“Human‐ether‐a‐go‐go related gene,” IC₅₀ of 19.8 nM in cell lines) at low concentrations. It also inhibits the L‐type calcium current (ICa) at higher concentrations (IC₅₀= 2.8 μM). This dual concentration‐dependent profile of action at higher concentrations may possibly prevent “torsades de pointes” ventricular arrhythmias, which is a dangerous side effect of many other class‐III antiarrhythmic drugs. With BRL‐32872, an excessive prolongation of the action potential duration and consecutive QTc prolongation is prevented by a concentration‐dependent increase of calcium channel block, resulting in the so‐called “bell‐shaped” profile of antiarrhythmic drug action. BRL‐32872 is very effective in the treatment of ventricular arrhythmias in animal models of cardiac ischemia. In the ischemic hearts of animals the drug significantly reduced early afterdepolarization and ventricular tachycardia. The antiarrhythmic effect of BRL‐32872 has not yet been demonstrated in humans.     

Cellular magnesium acquisition: an anomaly in embryonic cation homeostasis

The intracellular dominance of magnesium ion makes clinical assessment difficult despite the critical role of Mg(++) in many key functions of cells and enzymes. There is general consensus that serum Mg(++) levels are not representative of the growing number of conditions for which magnesium is known to be important. There is no consensus method or sample source for testing for clinical purposes. High intracellular Mg(++) in vertebrate embryos results in part from interactions of cations which influence cell membrane transport systems. These are functionally competent from the earliest stages, at least transiently held over from the unfertilized ovum. Kinetic studies with radiotracer cations, osmolar variations, media lacking one or more of the four biological cations, Na(+), Mg(++), K(+), and Ca(++), and metabolic poison 0.05 mEq/L NaF, demonstrated that: (1) all four cations influence the behavior of the others, and (2) energy is required for uptake and efflux on different time scales, some against gradient. Na(+) uptake is energy dependent against an efflux gradient. The rate of K(+) loss is equal with or without fluoride, suggesting a lack of an energy requirement at these stages. Ca(++) efflux took twice as long in the presence of fluoride, likely due in part to intracellular binding. Mg(++) is anomalous in that early teleost vertebrate embryos have an intracellular content exceeding the surrounding sea water, an isolated unaffected yolk compartment, and a clear requirement for energy for both uptake and efflux. The physiological, pathological, and therapeutic roles of magnesium are poorly understood. This will change: (1) when (28)Mg is once again generally available at a reasonable cost for both basic research and clinical assessment, and (2) when serum or plasma levels are determined simultaneously with intracellular values, preferably as part of complete four cation profiles. Atomic absorption spectrophotometry, energy-dispersive x-ray analysis, and inductively coupled plasma emission spectroscopy on sublingual mucosal and peripheral blood samples are potential methods of value for coordinated assessments.     

消癌平片联合SOX方案治疗胃癌的临床研究

目的探讨消癌平片联合SOX方案治疗胃癌的临床疗效。方法选取2013年1月—2017年5月洛阳市第六人民医院收治的胃癌术后化疗患者300例为研究对象,根据随机数字表法将所有患者随机分为对照组和治疗组,每组各150例。对照组采用SOX方案辅助化疗,即第1天静脉滴注注射用奥沙利铂,130 mg/m2加入到5%葡萄糖注射液500 m L中,滴注2 h以上,1次/3周;并口服替吉奥胶囊,2～3粒/次,2次/d,连续治疗14 d,停药7 d,3周为1个周期。治疗组在对照组治疗的基础上口服消癌平片,6～8片/次,3次/d,连续治疗14 d,停药7 d,3周为1个周期。两组患者均连续治疗4个周期。观察两组的临床疗效,比较两组的视觉模拟评分法(VAS)评分、生命质量测定量表(QLQ-C30)评分、T细胞亚群和不良反应。结果治疗后,对照组和治疗组的总有效率、疾病控制率分别为44.00%、56.67%,74.67%、88.67%,两组比较差异有统计学意义(P0.05)。治疗后,两组VAS评分显著降低,QLQ-C30评分显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些指标明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组CD3+、CD4+、CD4+/CD8+均显著升高,CD8+水平显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组T细胞亚群指标明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组Ⅲ度和Ⅳ度骨髓抑制、恶心呕吐、便秘腹泻、肝肾功能损害发生率显著低于对照组,两组比较差异有统计学意义(P0.05)。结论消癌平片联合SOX方案治疗胃癌具有较好的临床疗效,能减轻疼痛,提高免疫功能,改善生活质量,安全性高,具有一定的临床推广应用价值。     

碘化钾制备的碘涂层钛板的抗菌性能研究

目的探讨利用碘化钾制备碘涂层钛板的可行性,并验证其抗菌性能。方法以碘化钾作为电解液,使用电泳沉积法将碘负载到钛板表面,制备出碘涂层钛板。通过扫描电镜与能谱分析,观察碘涂层钛板的表面征象和成分结构。实验分组:对照组是经过预处理但未行载碘的钛板,共10块;实验组是经过预处理后再行载碘的碘涂层钛板,根据电解液浓度的不同分为3组:1000 mg/L、2000 mg/L、4000 mg/L组,每组各10块。使用1×106 CFU/mL的金黄色葡萄球菌(ATCC25923)进行体外抗菌实验,并对其抗菌性能进行研究。结果碘涂层钛板外观呈灰色,表面可均匀覆盖一层平整、无塌陷的涂层,电镜下见其表面可形成碘涂层,局部散在分布大小不等的不规则陷凹。对照组、1000 mg/L组、2000 mg/L组、4000 mg/L组的钛板碘含量分别为0、5.10、10.32、15.05 mass%;其体外抗菌菌落计数分别为56.00±5.09、21.40±2.76、9.10±2.51和2.00±1.88,4组之间菌落计数比较差异均有统计学意义(P<0.05)。结论碘化钾作为电解液,使用电泳沉积法可成功制备出碘含量稳定、涂层分布均匀的碘涂层钛板。体外抗菌实验证明碘涂层钛板的抗菌性能强于未载碘钛板。     

Re-visiting pH-adjusted potassium to avoid hypokalemic crisis during management of diabetic ketoacidosis: A conceptual framework

Background and aimsDiabetic ketoacidosis (DKA) treatment guidelines recommend to initiate potassium-replacement when serum potassium (S_K) drops within normal range, and to withhold insulin if S_K is below normal. Despite strict recommendations, hypokalemia is frequently observed in DKA.MethodsScientific literature was thoroughly searched to find 1) DKA treatment guidelines, 2) studies reporting hypokalemia in DKA, 3) and literature elaborating mechanisms involved in hypokalemia.ResultsAcidosis affects S_K and its regulators including insulin, catecholamines and aldosterone. Current conceptual framework is an argument to gauge the degree of hypokalemia before it strikes DKA patients utilizing S_K level after adjusting it with pH. Suggested approach will reduce hypokalemia risk and its associated complications. The nomogram calculates pH-adjusted potassium and expected potassium loss. It also ranks hypokalemia associated risk, and proposes the potassium-replacement rate over given time period. The differences between current DKA treatment guidelines and proposed strategy are also discussed. Moreover, reasons and risk of hyperkalemia due to early initiation of potassium replacement and remedial actions are debated.ConclusionIn light of proposed strategy, utilizing the nomogram ensures reduced incidence of hypokalemia in DKA resulting in improved clinical and patient outcomes. Pharmacoeconomic benefits can also be expected when avoiding hypokalemia ensures early discharge.     

Genome sequencing in a genetically elusive multigenerational long QT syndrome pedigree identifies a novel LQT2-causative deeply intronic KCNH2 variant

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Prediction of return of spontaneous circulation in out-of-hospital cardiac arrest with non-shockable initial rhythm using point-of-care testing: a retrospective observational study

BACKGROUND:Out-of-hospital cardiac arrest(OHCA) is a public health concern, and many studies have been conducted on return of spontaneous circulation(ROSC) and its prognostic factors.Rotational thromboelastometry(ROTEM^?), a point-of-care testing(POCT) method, has been useful for predicting ROSC in patients with OHCA, but very few studies have focused on patients with non-shockable rhythm. We examined whether the parameters of POCT could predict ROSC in patients with OHCA and accompany...