Prevalence of diabetes mellitus in individuals with airflow obstruction in a Japanese general population: The Yamagata-Takahata Study

Background

Diabetes has been reported as a comorbidity of chronic obstructive pulmonary disease (COPD) in Western countries, but it has not been demonstrated in epidemiological reports in Japan. The purpose of this study was to clarify whether the relationship between airflow obstruction and diabetes can be confirmed in a Japanese general population.

Impact of bulky phenylalkyl substituents on the air-stable n-channel transistors of birhodanine analogues

By introducing bulky 2-phenylethyl groups into sulfur-rich electron acceptors, 5,5′-bithiazolidinylidene-2,2′-dione-4,4′-dithione and 5,5′-bithiazolidinylidene-2,4,2′,4′-tetrathione, electron transport with the mobility of 0.27 cm² V⁻¹ s⁻¹ with ambient and long-term stability is achieved in thin-film transistors. Bulky groups destroy the intermolecular S–S network, but the long-term transistor stability is maintained. Here, benzyl groups realize one-dimensional stacking structures, whereas 2-phenylethyl groups lead to herringbone structures.

Performance and long-term air stability of birhodanine-based n-channel transistors are improved by introducing phenylethyl moieties.     

Indication for resection and possibility of observation for intraductal papillary mucinous neoplasm with high-risk stigmata

Background/ObjectivesAccording to the revised international intraductal papillary mucinous neoplasm (IPMN) guidelines (2017), the indication for surgery is based on risk classification. However, some IPMNs with high-risk stigmata (HRS) can be observed for long periods without resection. Hence, we need to reconsider the risk stratification, and this study aimed to propose a novel risk stratification for HRS-IPMNs.MethodsWe enrolled 328 patients diagnosed with IPMN using endoscopic ultrasound between 2012 and 2019. We compared clinicopathological features between HRS and worrisome features (WF) and evaluated outcomes of HRS-IPMN.ResultsFifty-three patients (HRS 38, WF 15) underwent resection at initial diagnosis and 275 patients were observed. Following observation for 30 months, 22 patients (17 HRS, 5 WF) underwent resection. Analysis of resected IPMNs (n = 75) revealed that HRS had dominantly pancreatobiliary mucin subtype. Pancreatobiliary-type IPMN had larger nodule sizes and lymphatic invasion and high recurrence with poor prognosis. Seventy-four patients were diagnosed with HRS, 55 underwent resection, and 19 continue to be observed. The resected group had larger nodule sizes (median 8 mm vs. 5 mm; P = 0.060), whereas the observed group had more main pancreatic duct (MPD) dilation (median 10 mm vs. 5 mm; P = 0.005). In the resected HRS group, only patients with MPD dilation ≥10 mm (n = 10) had no recurrence but had a favorable prognosis compared with those nodule size ≥5 mm (n = 45).ConclusionsLarge nodule size may be associated with pancreatobiliary subtype and poor prognosis; however, patients with MPD dilation ≥10 mm with nodule size <5 mm did not require resection.     

Second Hepatic Resection for Recurrent Hepatocellular Carcinoma in Patients with Chronic Hepatitis C

Background Although a second hepatic resection (SHR) for recurrent hepatocellular carcinoma (HCC) is widely accepted, the indications for SHR have not been established. The risk factors for HCC recurrence after SHR were evaluated to investigate the indications for SHR. Methods Subjects included 51 patients who underwent a second hepatic resection for recurrence of HCV-related HCC. Sixteen patients received interferon therapy before or after the first operation. Six patients attained a sustained viral response (SVR) that was defined as return of the alanine aminotransferase (ALT) activity to within the reference range and no detectable serum HCV RNA for at least 1 year after interferon therapy. A biochemical response (BR), defined as a normalized ALT activity for at least 1 year after interferon therapy with or without the transient disappearance of serum HCV RNA, was attained in three patients. The other seven patients were defined as the nonresponse (NR) group. Results By univariate analysis, NR and lack of interferon therapy, high indocyanine green retention rate at 15 min (ICGR15), high aspartate aminotransferase activity, high ALT activity, large tumor, and multiple tumors were risk factors for HCC recurrence after SHR. By multivariate analysis, NR and lack of interferon therapy, high ICGR15, large tumor, and multiple tumors were independent risk factors. Conclusions Patients in whom active hepatitis has been controlled by interferon therapy are the best candidates for SHR. Interferon therapy should be recommended in patients undergoing resection of an HCV-related HCC because SHR can prolong life in SVR and BR patients.     

Enhancement by yohimbine of nicotine- and dimethylphenylpiperadinium-induced release of norepinephrine from cardiac sympathetic nerves of the dog: interaction of presynaptic alpha and nicotinic receptors

The effect of yohimbine on nicotine- and dimethylphenylpiperadinium (DMPP)-induced release of norepinephrine (NE) from sympathetic cardiac nerves of the dog was examined in order to elucidate the interaction of presynaptic alpha and nicotinic receptors. Intracoronary infusion of nicotine (300 or 500 micrograms/min) or DMPP (100 or 300 micrograms/min) into the left circumflex artery increased coronary sinus output of NE (NE output), left ventricular dp/dt maximum (LV dp/dt max) and coronary sinus blood flow. The nicotine-induced increases in NE output, LV dp/dt max and coronary sinus blood flow were enhanced by simultaneous yohimbine infusion in doses of 10 and 30 micrograms/min into the same artery, and were attenuated by the drug in a dose of 100 micrograms/min. The DMPP-induced increases were enhanced by 10 micrograms/min of yohimbine infusion, but the enhancement was decreased by 30 and 100 micrograms/min. Yohimbine did not modify increases in NE output, LV dp/dt max and coronary sinus blood flow induced by intracoronary infusion of tyramine (100 micrograms/min). We have reported previously that yohimbine in the dose range used enhanced cardiac sympathetic nerve stimulation-induced increases in these parameters in a dose-dependent manner in the same preparation. The enhancement by yohimbine of nicotinic receptor-mediated NE release would be due to the blockade of presynaptic alpha-2 adrenoceptors. Therefore, it is suggested that presynaptic alpha-2 adrenoceptor-mediated feedback control operates on the process of NE release induced by nicotinic receptor activation as well as nerve stimulation. Although the mechanism of loss of the enhancement of the nicotinic effect by the large dose of yohimbine is not known, the possible mechanisms are discussed.     

Risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis

BACKGROUND/AIMS: Liver resection for hepatocellular carcinoma in patients with cirrhosis carries risk of major hemorrhage and sometimes requires blood transfusion. We investigated risk factors for massive blood loss during liver resection and indications for storing blood for autologous intraoperative transfusion. METHODOLOGY: We analyzed clinical records of 100 patients with cirrhosis who underwent liver resection for hepatocellular carcinoma. Autologous blood was stored preoperatively for 19 patients. RESULTS: Intraoperative blood loss ranged from 5 to 3000 mL (mean, 640). Liver resection was performed without transfusion in 67 patients and with autologous blood storage in 17 patients not receiving homologous blood. In the other 16 patients, homologous blood was transfused. Univariate analysis identified youth, large tumors (> 4cm), major hepatectomy, portal tumor involvement, hepatic vein involvement, and prolonged operation time as risk factors for massive blood loss; multivariate analysis identified portal involvement and hepatic vein involvement as independent risk factors. Blood loss exceeded 1000 mL in the 4 transfused group B patients and 3 of the 4 patients had hepatic vein involvement. CONCLUSIONS: Portal involvement and hepatic vein involvement were risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis. Autologous blood storage is indicated in patients with such risk factors.