A Hepatocellular Adenoma in a Diet-induced Obese Mouse

A hepatic nodule was noted in a C57BL/6J mouse with diet-induced obesity at 53 weeks of age. Macroscopically, a protruding yellowish white nodule was observed on the visceral surface of the left lateral lobe. Light microscopy demonstrated clear demarcation from the compressed adjacent parenchyma, with loss of the distinct lobular pattern. The proliferating cells of the lesion varied in shape and showed cellular atypia and prominent nucleoli along with vacuoles of various sizes. Some of the cells contained various-sized eosinophilic inclusion bodies in their cytoplasm, and electron microscopy revealed the presence of lipid droplets in the rough endoplasmic reticulum. Eosinophilic inclusions were observed as electron dense granular material in the rough endoplasmic reticulum, with one or a few low density central cores. A diagnosis of hepatocellular adenoma was made based on these findings

Impact of Polyp Regression on 2-year Outcomes of Intravitreal Aflibercept Injections: A Treat-and-Extend Regimen for Polypoidal Choroidal Vasculopathy

We conducted intravitreal aflibercept injections (IVAs) for 37 Japanese patients (28 males, 9 females, mean age 73.4 years) with polypoidal choroidal vasculopathy (PCV), with a treat-and-extend regimen (TER). We evaluated the impact of polyp regression after a loading dose (2-mg IVA 1×/month for 3 months) on the patients' 2-year treatment outcomes. Thirty-seven eyes were treated with IVA by a TER for 2 years. We divided the patients into 2 groups based on their polyp status after the loading dose: polyp regression (PR+) (n=19) and no polyp regression (PR−) (n=18). We compared the groups’ best-corrected visual acuity (BCVA), central retinal thickness (CRT), recurrence rate, total number of injections, and final treatment interval. Both the BCVA and CRT were significantly improved by the treatment in both groups, with no between-group difference in the amount of change (p=0.769). In the polyp regression (+) group, recurrence was significantly less common (p=0.03), the mean total number of injections was significantly lower (p=0.013), and the mean treatment interval was significantly longer (0.042). Regarding the 2-year outcomes for PCV, the eyes with post-loading-dose polyp regression demonstrated less frequent recurrence and required fewer numbers of injections compared to the eyes without polyp regression

Cardiogenic embolism caused hypoglycemia

The direct relationship between a hypoglycemic attack and cerebral infarction remains unknown. It has been reported that a hypoglycemic attack can result in takotsubo syndrome, leading to cerebral infarction. We report a case of a cardiogenic cerebral embolism caused by a hypoglycemic attack, with additional literature review. A 71-year-old woman was admitted to our hospital in a semi-comatose state due to a severe hypoglycemic attack ; she developed hemiplegia one day after admission. Magnetic resonance imaging revealed cerebral infarction in the area supplied by the left middle cerebral artery. Takotsubo syndrome was suspected based on echocardiography. We diagnosed cerebral embolism due to takotsubo syndrome, caused by the hypoglycemic attack

Results of a Treat-and-Extend Regimen of Intravitreal Ranibizumab Injection for Macular Edema due to Branch Retinal Vein Occlusion

To investigate the effectiveness of a treat-and-extend regimen (TAE) of intravitreal ranibizumab injections (IVR) for macular edema (ME) due to branch retinal vein occlusion (BRVO). We retrospectively examined 35 eyes of 35 patients with ME due to BRVO who underwent TAE for 1 year. Patients whose treatment interval extended to 12 weeks were switched to a pro re nata regimen (PRN; TAE to PRN group), while TAE was continued for patients whose treatment interval was less than 12 weeks (continued TAE group). Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and predictive factors for inclusion in the TAE to PRN group were analyzed. BCVA and CRT both improved significantly at 1 year compared with baseline (p<0.001). Sixteen eyes (45.7%) were included in the TAE to PRN group, while 19 eyes (54.3%) were included in the continued TAE group. BCVA in the TAE to PRN group was significantly better than that in the continued TAE group at 1 year (p=0.047). BCVA at baseline and macular BRVO were significant predictive factors for inclusion in the TAE to PRN group. TAE was effective for improving BCVA and CRT. The TAE to PRN group showed significantly better prognosis

日本人の糖尿病と微量元素に関する栄養学的研究

糖尿病外来患者87名を村象として,罹病期間・合併症発症の危険因子となる肥満・禁煙・飲酒,主な3大合併症である腎症・神経症・網膜症の分類による臨床検査所見の変動を比較した。(1)罹病期間が長くなるに従って,血糖コントロールは悪化し,マグネシウムも同様に減少がみられた。(2)肥満になるにつれ,血糖コントロールは不良となり,HDLコレステロールやマグネシウムも減少傾向を示した。(3)喫煙者に血糖コントロール不良が多くみられ,マグネシウムは非喫煙者よりも低値であった。(4)FBSでは毎日飲酒する群が最も高く1.5AGも同様に悪い結果を示し,HbA_は飲酒による変動はみられなかった。(5)腎症,単純網膜症,増殖性網膜症,神経症を併発した群はFBS,HbA_は,もたない群に対して高値であるため,コントロールが良好でないことが示された。さらに,血中マグネシウムは低値を示した。(6)骨減少症とうつ病を合併している群においても血中マグネシウム量の減少が見られた。(7)マグネシウム摂取量を計算した。最初に穀類中のマグネシウム摂取量の年次推移を計算した。これは穀類中に含まれるマグネシウムの量が圧倒的に多く,これの計算のみでマグネシウム摂取量の年次推移の傾向を知ることができるからである。その結果年を経るとともに,徐々に急速に減少している。最近では日本人の栄養推奨量300mgに不足してきたことが分かる。これらは主に,日本人が穀物を徐々に摂取しなくなったためである。糖尿病の有病者数と死亡者数も年々増加してきている。糖尿病とMgとの関係は大きく,そのため食事によるマグネシウムの摂取は極めて重要なことである。このことからマグネシウムの摂取について国民はもっと注意を払うべきだと考えられた。Diabetes mellitus is a disorder of carbohydrate metabolism characterized by hyperglycemia and glycosuria, and associated with a disturbance of the normal insulin mechanism. Moreover, diabetes mellitus occurs more often in patients with cardiovascular disease, arteriosclerosis, diabetic nephrosis, diabetic retinopathy, necrosis of lower limbs and at least the patients died from these complications. In Japan, a prevalence rate of diabetes was very low in 1920\u27s. But recently, its patients are increasing with satiation and unbalance of food intakes. The purpose of this research is to clarify the relationship between increasing diabetes mellitus and their food habits. For this reason, we examined the physical and nutritional status of about 100 diabetic patients and analyzed the relationship between their clinical findings and food habits. Eighty-seven of diabetic outpatients were examined clinically in relation to duration of disease and complications. The control of blood sugar in diabetic patients with complications were dull, and their blood magnesium levels were also deteriorated. The levels of HbA_, and 1.5AG in patients with diabetic nephropathy were high, and the blood magnesium level was low. In Japan, the consumption of rice as a staple food has declined sharply, from 358g/day in 1960 to only 216g/day in 1985, resulting in a low intake of magnesium. On the contrary, the intakes of animal foods such as milk and dairy products, egg and meat, are markedly increased. Changes of magnesium contents from cereals are decreased about half of 40 years ago. Changes in morbidity and mortality rates from diabetes mellitus were compared with changes of magnesium intake. The mortality rates increased about 10 times in past 40 years, and magnesium intake also decreased about half in past 40 years. This result suggests that increased magnesium intakes play an important role in prevention of diabetes mellitus

Two-year Results of Intravitreal Ranibizumab Injections Using a Treat-and-extend Regimen for Macular Edema due to Branch Retinal Vein Occlusion

We investigated the effectiveness of a treat-and-extend regimen (TAE) of intravitreal ranibizumab injections for macular edema (ME) due to branch retinal vein occlusion (BRVO). We retrospectively examined 2-year results of 32 eyes of 32 patients who underwent TAE to treat ME due to BRVO. The patients whose treatment interval extended to ≥ 12 weeks were switched to a pro re nata regimen (PRN). For the patients whose treatment interval was <12 weeks, TAE was continued. At 2 years, 10 eyes had required no additional injections after the initial treatment period [recurrence(−) group], whereas the other 22 eyes required additional treatment [recurrence(+) group]. Among the recurrence(+) patients, 11 eyes (34.4% of total) were eventually switched from TAE to PRN; the other 11 eyes (34.4%) continued TAE for 2 years. Visual acuity and central retinal thickness were significantly improved in both the recurrence(+) and (−) groups, and there was no significant betweengroup difference in visual acuity at 2 years. Univariate analyses revealed significant differences in visual acuity (p=0.004), age (p=0.014), and vessel occlusion site (p=0.018) between these groups. Our results suggest that TAE may be effective for BRVO patients with lower visual acuity, older age, and occlusion of a major vein

Increased secretion of salivary glands produced by facial vibrotactile stimulation

Patients with low-back pain can be evaluated immediately by means of an electrical tool that produces bony vibration to the lumbar spinal processes (Yrjama M, Vanharanta H. Bony vibrotactile stimulation: A new, non-invasive method for examining intradiscal pain. European Spine Journal 1994;3:233–235). In the rehabilitation of masticatory disturbance and dysphagia, an electric toothbrush is commonly used as an oral motor exercise tool for the facilitation of blood flow and metabolism in the orofacial region in Japanese hospitals. However, subjects receiving vibration in the facial regions reported increased salivary secretion. We attempted to develop an oral motor exercise apparatus modified by a headphone headset that was fixed and could be used for extended periods. The vibration apparatus of the heating conductor is protected by the polyethyle methacrylate (dental mucosa protective material), and electric motors for vibration control of the PWM circuit. We examined the amount of salivation during vibration stimuli on the bilateral masseter muscle belly, using a cotton roll positioned at the opening of the secretory duct for 3 min. Although the quantity of salivation in each subject showed various and large fluctuations in the right and left sides of the parotid and submandibular and sublingual glands, one or more of the salivary glands were effectively stimulated by 89 Hz vibration. The reported apparatus will be useful as an additional method in orofacial rehabilitation