Postprandial Hyperglycemia Is Associated With White Matter Hyperintensity and Brain Atrophy in Older Patients With Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is associated with neurodegeneration and cerebrovascular disease. However, the precise mechanism underlying the effects of glucose management on brain abnormalities is not fully understood. The differential impacts of glucose alteration on brain changes in patients with and without cognitive impairment are also unclear. This cross-sectional study included 57 older type 2 diabetes patients with a diagnosis of Alzheimer’s disease (AD) or normal cognition (NC). We examined the effects of hypoglycemia, postprandial hyperglycemia and glucose fluctuations on regional white matter hyperintensity (WMH) and brain atrophy among these patients. In a multiple regression analysis, postprandial hyperglycemia was independently associated with frontal WMH in the AD patients. In addition, postprandial hyperglycemia was significantly associated with brain atrophy, regardless of the presence of cognitive decline. Altogether, our findings indicate that postprandial hyperglycemia is associated with WMH in AD patients but not NC patients, which suggests that AD patients are more susceptible to postprandial hyperglycemia associated with WMH

Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room

AIM: Cooling the pharynx and upper oesophagus would be more advantageous for rapid induction of therapeutic hypothermia since the carotid arteries run in their vicinity. The aim of this study was to determine the effects of pharyngeal cooling on brain temperature and the safety and feasibility for patients under resuscitation. METHODS: Witnessed non-traumatic cardiac arrest patients (n=108) were randomized to receive standard care with (n=53) or without pharyngeal cooling (n=55). In the emergency room, pharyngeal cooling was initiated before or shortly after return of spontaneous circulation by perfusing physiological saline (5 °C) into a pharyngeal cuff for 120 min. RESULTS: There was a significant decrease in tympanic temperature at 40 min after arrival (P=0.02) with a maximum difference between the groups at 120 min (32.9 ± 1.2°C, pharyngeal cooling group vs. 34.1 ± 1.3°C, control group; P<0.001). The return of spontaneous circulation (70% vs. 65%, P=0.63) and rearrest (38% vs. 47%, P=0.45) rates were not significantly different based on the initiation of pharyngeal cooling. No post-treatment mechanical or cold-related injury was observed on the pharyngeal epithelium by macroscopic observation. The thrombocytopaenia incidence was lower in the pharyngeal cooling group (P=0.001) during the 3-day period after arrival. The cumulative survival rate at 1 month was not significantly different between the two groups. CONCLUSIONS: Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium

Assessment of Medical Response Capacity in the time of Disaster : the Estimated Formula of Hospital Treatment Capacity (HTC), the Maximum Receivable Number of Patients in Hospital

INTRODUCTION For the assessment on medical response capacity for disaster inlocal area (such as rescue capacity, transport capacity and treatment capacity), it isnecessary to assess it in peace time, and understand how many sufferers from disasterthe hospital can respond to. Here the estimated formula of Hospital TreatmentCapacity (hereinafter shortened to HTC), the maximum receivable number of patientsin hospital (hereinafter shortened to MRN) was showed, which derived from theassessment on emergency medical response in Kobe University Hospital as an example.MATERIALS AND METHODS We treated a total of 12,032 patients transferredand admitted to Kobe University Hospital from April 2003 to January 2005. Wecalculated the required number of medical personnel, equipment and length oftreatment time in order to respond to 410 severe traumas, 35 burn injuries, and 28patients with blood purification, which were considered to be main clinical conditionsin disaster. Beside, the occupation of emergency room and the operation room per hourwere also investigated in our hospital.RESULTS HTC (MRN) for each clinical condition within H hours is expressed byfollowing formula:(1) HTC (MRN) for burn injuries= The maximum integer of(&#8804;Doctors/2∩&#8804;Respirators/1∩&#8804;outpatient beds/1∩&#8804;inpatient beds/1∩&#8804;monitors/1)x the minimum integer of (&#8805;H/1.85)(2) HTC (MRN) for patients with blood purification= The maximum integer of(&#8804;doctors/2∩&#8804; blood purification systems/1∩&#8804; outpatient beds/1∩&#8804;inpatient beds/1∩&#8804;monitors/1)x the minimum integer of (&#8805;H/2.00)(3) HTC (MRN) for severe traumas=The maximum integer of(&#8804;doctors-a/2∩&#8804;surgeons/1∩&#8804;anesthetists/1∩&#8804;radiologists/1∩&#8804;respirators/1∩&#8804;outpatient beds/1∩&#8804;inpatient beds/1∩&#8804;monitors/1∩&#8804;operation rooms/1∩&#8804;angiography rooms/1

Operative procedures of single-incision laparoscopic repair of pediatric epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle

We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result

Actual Situation Regarding Cardiac Etiology Determined by Clinical Diagnosis of and Medical Examiner's Postmortem Findings on Witnessed Out-of-hospital Cardiac Arrest Cases

Aim: To examine indicators that may assist in the diagnosis of cardiac etiology using simple tests in witnessed cardiac etiology out-of-hospital cardiac arrest cases, which is emphasized in the Utstein Style. Method: The subjects were 165 witnessed cardiac etiology out-of-hospital cardiac arrest cases, which were transported to Kobe University Hospital during the five-year period between January 1, 2005 and December 31, 2009. A comparative study was conducted into whether there were any significant differences in the initial electrocardiogram (ECG) and the various early diagnostic markers of acute myocardial infarction between the group who were finally diagnosed as being of cardiac etiology and the group who were finally diagnosed as being of non-cardiac etiology. Results: Of the 165 witnessed cardiac etiological cases, 69 cases were finally re-classified as non-cardiac etiological cases on the basis of scrutiny after admission or postmortem findings by the Medical Examiner. Ventricular fibrillation shown in the initial ECG and Qualitative cardiac troponin T test positive were significantly higher in the final diagnosis cardiac group than in the final diagnosis non-cardiac group. Ventricular fibrillation and troponin T positive can be seen as significant indicators in determining whether a case was cardiac or non-cardiac, and the model χ2 test result of p < 0.01 in the multiple logistic regression analysis was significant, and the determining predictive value was 65.4%. Conclusion: The indicators which should be noted in simple tests to improve the precision of discrimination of cardiac etiology in out-of-hospital cardiac arrests are ventricular fibrillation in the initial ECG and the qualitative test of cardiac troponin T

Laparoscopic side-to-side pancreaticojejunostomy for chronic pancreatitis in children

Surgical pancreatic duct (PD) drainage for chronic pancreatitis in children is relatively rare. It is indicated in cases of recurrent pancreatitis and PD dilatation that have not responded to medical therapy and therapeutic endoscopy. We performed laparoscopic side-to-side pancreaticojejunostomy for two paediatric patients with chronic pancreatitis. The main PD was opened easily by electrocautery after locating the dilated PD by intraoperative ultrasonography. The dilated PD was split longitudinally from the pancreatic tail to the pancreatic head by laparoscopic coagulation shears or electrocautery after pancreatography. A laparoscopic side-to-side pancreaticojejunostomy was performed by a one-layered technique using continuous 4-0 polydioxanone (PDS) sutures from the pancreatic tail to the pancreatic head. There were no intraoperative or postoperative complications or recurrences. This procedure has cosmetic advantages compared with open surgery for chronic pancreatitis. Laparoscopic side-to-side pancreaticojejunostomy in children is feasible and effective for the treatment of chronic pancreatitis