Postprandial Hypotension due to a Lack of Sympathetic Compensation in Patients with Diabetes Mellitus.

Postprandial hypotension is an important hemodynamic abnormality in diabetes mellitus, but few reports are available on the relationship between autonomic dysfunction and postprandial hypotension. Ten diabetic patients and 10 healthy volunteers were recruited for this study. Postural blood pressure and heart rate changes were measured before lunch, and then the hemodynamic responses to a standardized meal were investigated. Holter electrocardiogram (ECG) monitoring was conducted for assessing spectral powers and time-domain parameters of RR variations. Postural changes from the supine to the upright position decreased the systolic blood pressure of the diabetics from 133(+-)16 to 107(+-)20 mmHg (p<0.01), but did not decrease the systolic blood pressure of the controls. The heart rate remained constant in the diabetics but was increased in the controls. Food ingestion decreased systolic blood pressure in the diabetics, with a maximum reduction of 25(+-)5 mmHg. This decrease was not associated with any changes in the ratio of low frequency to high frequency, and yet the heart rate remained almost constant. Indexes involving parasympathetic tone were not affected. Food ingestion did not affect blood pressure in the control group. These findings suggest that lack of compensatory sympathetic activation is a factor contributing to postprandial hypotension in diabetics, and that parasympathetic drive does not make a significant contribution to this condition

Blood flow velocity in the anterior humeral circumflex artery and tear size can predict synovitis severity in patients with rotator cuff tears

Background Rotator cuff tears are often associated with synovitis, but the ability of noninvasive ultrasonography to predict the severity of synovitis remains unclear. We investigated whether ultrasound parameters, namely peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, reflect synovitis severity. Methods A total of 54 patients undergoing arthroscopic rotator cuff repair were selected. Doppler ultrasound was used to measure peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, and these values were compared with the intraoperative synovitis score in univariate and multivariate analyses. Results Univariate analyses revealed that tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the glenohumeral joint were associated with synovitis in the glenohumeral joint (P=0.02, P<0.001, P=0.02, respectively). In the subacromial space, tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the subacromial space were associated with synovitis severity (P=0.02, P<0.001, P=0.02, respectively). Multivariate analyses indicated that tear size and peak systolic velocity in the anterior humeral circumflex artery were independently associated with synovitis scores in both the glenohumeral joint and the subacromial space (all P<0.05). Conclusions These findings demonstrate that tear size and peak systolic velocity in the anterior humeral circumflex artery, which can both be measured noninvasively, are useful indicators of synovitis severity. Level of evidenceIV

Correlation and Finite Interaction-Range Effects in High-Energy Electron Inclusive Scattering

We calculate cross sections of high energy electron inclusive scattering off nuclear matter in a new and consistent formulation based on the Green's function method with the Glauber approximation, which is an extension of our previous work on the nuclear transparency in (e, e'p) reaction. The comparison with other approaches is discussed. In this framework, we study the finite-range effect of the nucleon-nucleon interaction in the final-state interactions, and the effect of the nuclear short-range correlation. We propose a zero-range approximation, which works well when correlation and finite interaction-range effects are included. It greatly reduces the numerical work, while maintaining a reasonable accuracy.Comment: 28 pages, latex, 12 figures. Nuclear Physics A in pres

Liquified Natural Gas Pump With Hydrostatic Journal Bearings

Lecturepg. 39In view of the inflammability of LNG (liquefied natural gas), submerged type pumps are normally used to protect against leaks. The overhaul interval of an LNG pump, therefore, is subject to the life of its ball bearings, because LNG is an extremely low temperature, low viscosity and low boiling point liquid. The use of LNG to fulfill the extremely demanding functions of lubrication and cooling of ball bearings results in substantial reduction in the bearings’ maximum load tolerance. The limits inherent in the ball bearings, consequently, will make it difficult to extend the life of the bearings beyond that currently achieved, if the bearing system itself depends on the use of conventional ball bearings. Since the service life of a ball bearing is not necessarily constant, there is a possibility of sudden break-down. Thus, new LNG pumps were developed using a form of bearing for which service lifetime is not primary importance, though it nevertheless has a long service life and high reliability, and is small and light. Details are given later. Two types of the static bearings were developed: a hydrostatic slide bearing and a hydrostatic guide bearing, incorporating a hydrostatic journal bearing surrounding the ball bearing. The hydrostatic slide bearing supports the shaft by virtue of the film pressure of the LNG discharged from the pump itself. Therefore, the shaft with ball bearings in the usual way, the buffer effect of LNG in the hydrostatic guide section substantially reduces the radial load of the ball bearings. A hydrostatic journal bearing does not bear any of the thrust load. A structure has, therefore, been developed in which a disk-piston-type thrust balancing system can be used to enable self-balancing of the shaft thrust load, thereby reducing the thrust load to zero. The downstream side of the disk piston is designed to allow a variable clearance whereby, when it is at its maximum, the total flow area upward thrust force exceeds the downward thrust force. In this way, the two thrust forces always balance each other automatically. A high lift impeller was designed, the number of operational stages was reduced, and, radial diffusers were used to enable the use of shorter shafts. For the stage housing, a piston ring type sealing is used, a single layer cylinder casing method was developed that enables a multistep seal provided by the piston rings at each stage. This allowed the pump diameter to be reduced. The use of hydrostatic slide bearings (hydrostatic guide bearings), a thrust balancing mechanism, and the reduction of shaft length has enabled substantial extension to be made to the overhaul interval of pump. Pumps with hydrostatic slide bearings:100,000 hours or more. Pumps with hydrostatic guide bearings:50,000 hours or more. The use of hydrostatic slide bearings results in some reduction in the shaft bearing performance, due to wear of the face of the bearing. Measurement of the amount of wear, however, enables the remaining life of the bearing to be predicted, and this in turn facilitates cost reductions in terms of the failure diagnosis system employed. Furthermore, since there is little likelihood of sudden failure, maintenance schedules can be organized in a systematic way. The use of high lift impeller and single wall cylindrical radial diffuser has enabled the production of a compact, lighter pump unit, which is easy to disassemble and reassemble. This technology is applicable to pumps for other liquefied gas, for example, LPG, LEG (liquefied ethylene gas), etc

Retroperitoneal Endometriotic Cyst Infiltrated in the Iliopsoas Incidentally Found in a Patient with Acute Back Pain

We describe a rare case of retroperitoneal endometriotic cyst infiltrated in the iliopsoas incidentally found in a patient with acute back pain. Endometriosis at the pelvic peritoneum, including the Douglas pouch, has been reported often; there are few reports of cystic endometriosis in the retroperitoneal cavity. Today there are various theories regarding how endometriosis occurs. By pathological findings and lesion sites of the present case, we concluded that the endometrial tissues in the menstrual blood might metastasize lymphatically and implant and form the retroperitoneal cyst

Gastrointestinal Stromal Tumor of the Stomach with an Abscess Excised by Laparoscopic Surgery

Gastrointestinal stromal tumors (GISTs) of the stomach presenting as an intra-abdominal abscess are extremely rare. We herein report a case that underwent successful laparoscopic resection of gastric GIST presenting with an intra-abdominal abscess. A 70-year-old man presented with a 3-day history of acute upper abdominal pain with a fever. Laboratory data showed an elevated white blood cell count and C-reactive protein level. A CT scan revealed a mass of mixed solid and fluid components, measuring 5.5 cm, in the adjacent lesser curvature of the stomach. He was diagnosed as having an intra-abdominal abscess, and antibiotic therapy was administered. Consequently, his symptoms were relieved and a CT scan on the 7th day showed that the mass reduced and became homogenous. According to the results of a fine-needle aspiration biopsy, the tumor was suspected to be a GIST. Laparoscopic surgery with the 5-port approach was performed. The tumor existed in the lesser curvature of the stomach, and was excised en bloc with the omentum and gastric wall by wedge resection. The tumor measured 3.0 cm in diameter and originated from the serosal layer of the stomach. Histological findings showed spindle cells with a stromal growth pattern that was positive for c-kit (CD 117) and CD 34. The postoperative course was uneventful, and no recurrence has been noted in the 2 years since the operation. This is the first report of a case with gastric GIST with an intra-abdominal abscess that was successfully treated by laparoscopic surgery

Increasing Venous Return Blood Flow to the Right Atrium Using the Party Balloon Inflation Maneuver

The party balloon inflation maneuver increases intrathoracic pressure, decreases venous return, and after release enhances venous return to the right atrium more effectively than does the conventional Valsalva maneuver. Therefore, it shows potential for more effective detection of right-to-left shunts in patients with a patent foramen ovale. (Level of Difficulty: Intermediate.