The association between ultrafiltration rate and mortality in a co- hort of chronic hemodialysis patients with and without diabetes mellitus: a 7-year retrospective observational study.

Background: The ultrafiltration rate (UFR) is one of the important factors involved in long-term mortality in hemodialysis (HD) patients. Presence of diabetes mellitus often affects UFR due to abrupt hypotension during dialysis. In this study, we aimed to find the optimal UFR to improve the mortality in this population with and without diabetes mellitus (DM).Methods: The effect of the UFR on mortality was retrospectively evaluated in 707 patients un- dergoing regular HD from 1 June 2010 to 30 June 2017. The relationship between the UFR and mortality in patients in the non-DM group and those in the DM group was evaluated. Logistic regression analyses were used to select the determinants of mortality. Receiver operating char- acteristic (ROC) curve analyses and survival analysis were used to determine the optimal cutoff points of UFR for mortality.Results: The cutoff UFR values of the non-DM and DM groups were 12.07 ml/hr/kg and 9.66 ml/ hr/kg, respectively. A survival curve showed that in the non-DM group, the 7-year survival rate of patients with a UFR <12.07 ml/hr/kg was 72.6% and that in those with a UFR ≥12.07 ml/hr/kg was 19.6% (p<0.0001). In the DM group, the 7-year survival rate of those with a UFR <9.66 ml/ hr/kg was 66.7%, and it was 33.4% in those with a UFR ≥9.66 ml/hr/kg (p<0.0001).Conclusion: Lower UFR is essential for the long-term mortality of HD patients, and optimal UFR would be different between patients with and without DM

飢餓が雄性体線虫の生殖能力に及ぼす影響

Epigentics has recently emerged as the third contributor, the genetic and environmental factors as the first two, for development of diseases such as obesity, cardiovascular disease, stroke and diabetes in adult stage. The epigenetic modifications have been identified to be introduced into the genome during fertilization, embryogenesis and fetus development, and the quantity and quality of the modifications is known to be subjected to environmental conditions including nutrition. Thus, FOAD (Fetal Origin of Adult Diseases) theory, the molecular mechanism of which is mainly based on the epigenetic modifications, has become an attracting theory for prevention of the life-style related disease. There are not enough data, however, if the environmental conditions may affect differently between the sex of parent generation, or that of the progeny generation. To gain information, starvation was introduced to Caenorhabditis elegans male, and its effect on the fecundity was analyzed. We also analyzed if there exists difference between sex of the progeny worms, and showed that lifespan tended to extend in male progeny compared to hermaphrodite. The results indicate that different　epigenetic modifications are introduced in the progeny generations leading to the possible establishment of　sexual difference in the sensitivity toward the environmental factor

A Comparison of the Efficacy of Plastic Stent Placement Above and Across the Sphincter of Oddi for Benign Biliary Hilar Stricture

We investigated the efficacy and safety of endoscopic plastic stent (PS) placement for hilar benign biliary strictures (BBSs) and compared cases with PS placement above (inside stent, IS) and across (usual stent, US) the sphincter of Oddi. Patients who underwent initial endoscopic PS placement for hilar BBSs between August 2012 and December 2021 were retrospectively analyzed. Hilar BBSs in 88 patients were investigated. Clinical success was achieved in 81 of these cases (92.0%), including 38 patients in the IS group and 43 patients in the US group. Unexpected stent exchange (uSE) before the first scheduled PS exchange occurred in 18 cases (22.2%). The median time from first stent placement to uSE was 35 days. There was no significant difference in the rate and median time to uSE between the two groups. The rates of adverse events such as pancreatitis or cholangitis in the two groups did not significantly differ. However, the rate of difficult stent removal in the IS group (15.8%) was significantly higher than that in the US group (0%) (p=0.0019). US placement is preferable to IS placement for scheduled stent exchange, as it offers the same effectiveness and risk of adverse events with easier stent removal

Expression of Ascorbate Peroxidase Derived from Cyanidioschyzon merolae in Mammalian Cells

Background: Ascorbate peroxidase (APX) derived from Cyanidioschyzon merolae, a primitive red alga living in high temperature and acidic environments, has a greater anti-oxidative capacity than similar peroxidases occurring in other plants. In the present study, we examined the ability of Cyanidioschyzon merolae-derived APX (cAPX) to increase anti-oxidative capacity when expressed in mammalian cells. Materials and Methods: The cAPX gene was introduced into the mouse fibroblast-like cell line C3H10T1/2. Production of reactive oxygen species (ROS) and/or cell viability was assessed after heat, H2O2 and acid stimulation. Results: Heat and H2O2 stimulation caused ROS production. cAPX-expressing cells were more tolerant to oxidative stress induced by heat, H2O2 and acid stimulations than control cells lacking cAPX. Conclusion: Introduction of cAPX increases anti-oxidative capacity in mammalian cells

Effective and convenient treatment of Xultophy with lower doses for elderly diabetic patient

The case is an 82-year-old female patient with Type 2 Diabetes Mellitus (T2DM) for 22 years. She developed right empyema in early January, 2021 and was treated by antibiotics and CT-guided drainage. After improving the status, she was transferred to Hayashi hospital, Tokushima, Japan. Treatment for T2DM was initially multiple daily insulin injection (MDI), but it could not continue because of injection several times a day by the family. Then, Xultophy was started once a day, which brought satisfactory glucose variability with lower doses. Consequently, Xultophy would be effective and useful agent from bio-psycho-social points of view

The neural tides of sleep and consciousness revealed by single-pulse electrical brain stimulation

Wakefulness and sleep arise from global changes in brain physiology that may also govern the flow of neural activity between cortical regions responsible for perceptual processing vs planning and action. To test whether and how the sleep/wake cycle affects the overall propagation of neural activity in large-scale brain networks, we applied single-pulse electrical stimulation (SPES) in patients implanted with intracranial EEG electrodes for epilepsy surgery. SPES elicited cortico-cortical spectral responses at high-gamma frequencies (CCSRHG, 80-150 Hz), which indexes changes in neuronal population firing rates. Using event-related causality analysis (ERC), we found that the overall patterns of neural propagation among sites with CCSRHG were different during wakefulness and different sleep stages. For example, stimulation of frontal lobe elicited greater propagation toward parietal lobe during slow wave sleep than during wakefulness. During REM sleep, we observed a decrease in propagation within frontal lobe, and an increase in propagation within parietal lobe, elicited by frontal and parietal stimulation, respectively. These biases in the directionality of large-scale cortical network dynamics during REM sleep could potentially account for some of the unique experiential aspects of this sleep stage. Together these findings suggest that the regulation of conscious awareness and sleep is associated with differences in the balance of neural propagation across large-scale frontal-parietal networks

High Serum Advanced Glycation End Products Are Associated with Decreased Insulin Secretion in Patients with Type 2 Diabetes: A Brief Report

Advanced glycation end products (AGEs) are important in the pathophysiology of type 2 diabetes mellitus (T2DM). They directly cause insulin secretory defects in animal and cell culture models and may promote insulin resistance in nondiabetic subjects. We have developed a highly sensitive liquid chromatography-tandem mass spectrometry method for measuring AGEs in human serum. Here, we use this method to investigate the relationship between AGEs and insulin secretion and resistance in patients with T2DM. Methods. Our study involved 15 participants with T2DM not on medication and 20 nondiabetic healthy participants. We measured the AGE carboxyethyllysine (CEL), carboxymethyllysine (CML), and methyl-glyoxal-hydro-imidazolone (MG-H1). Plasma glucose and insulin were measured in these participants during a meal tolerance test, and the glucose disposal rate was measured during a euglycemic-hyperinsulinemic clamp. Results. CML and CEL levels were significantly higher in T2DM than non-DM participants. CML showed a significant negative correlation with insulin secretion, HOMA-%B, and a significant positive correlation with the insulin sensitivity index in T2DM participants. There was no correlation between any of the AGEs measured and glucose disposal rate. Conclusions. These results suggest that AGE might play a role in the development or prediction of insulin secretory defects in type 2 diabetes