Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

[Study Design] Multicenter, prospective study. [Purpose] To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. [Overview of Literature] To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. [Methods] The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. [Results] JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. [Conclusions] Poor glycemic control might prevent postoperative functional recovery of the spinal cord

トウニョウビョウ ケア ノ リスク マネージメント

The number of diabetics has been increasing in recent years. The diabetics are under varioustreatments, including the improvement of life habit and the medication for diabetes with insulin.Our hospital set a team of diabetic care, which is composed of a diabetic specialist, certified diabeteseducators（CDEs）, nurses, dietricians and pharmacists. This team takes great care of the diabetics.For medical safety measures, the department of risk management was organized in our hospital.The department investigated the cases of Hiyari-Hatto within 1 year and 3 months, from 2005to 2006, and found that 3% of them was the diabetic case, which was caused by the nurses exceptCDEs. Therefore the department made the manual of diabetic therapy in cooperation with theCDEs. All the staffs in our hospital were educated by the seminars according to the manual. Theknowledge about the diabetic therapy proved to be mostly accurate one year after the last seminar.For the improvement of medical safety, the department of risk management helps the CDEswith holding the educational seminars by giving the informations after analyzing the cases of Hiyari-Hatto and the questionnaires following the seminars

トクシマシ イシカイ ノ トウニョウビョウ タイサク

Tokushima City Medical Association has founded the committee for the means to prevent diabetesmellitus, because the mortality rate by diabetes mellitus in Tokushima Prefecture remainedranked first for 14 years from 1993 to 2006. It has enlightened a large number of people, such asdiabetic patients and candidates for diabetes, and also healthy citizens in Tokushima for preventingdiabetes mellitus. For this aim, Tokushima City Medical Association has made the home pagenamed Tokushima City Diabetic Network to show clearly the means to prevent diabetes mellitusfor the citizens. By this Web site, the citizens can get a correct knowledge about diabetes mellitus,a useful information about the treatments including exercises, diets and medications, and an informationabout medical institutions by utilizing the search page to receive a proper diabetic treatment.Tokushima City Medical Association held several events, such as Tokushima citizens’extension courses and diabetes forums for the citizens to understand diabetes mellitus clearly.Fortunately, in 2007, Tokushima got out of the first rank of diabetic mortality rate. TokushimaCity Medical Association will continue efforts to prevent diabetes mellitus by approaching the citizensof all ages from various aspects

Preparation and characterization of chitosan–caboxymethyl-β-cyclodextrin entrapped nanozero-valent iron composite for Cu (II) and Cr (IV) removal from wastewater

The entrapment of Fe0 nanoparticles within a chitosan–carboxymethyl β-cyclodextrin complex, a nontoxic and biodegradable stabilizer, yields chitosan–Fe0 nanoparticle–carboxymethyl β-cyclodextrin beads that are 2.5 mm in diameter and contain 50% iron by weight. The complete disappearance of Cr (VI) and Cu (II) may involve both physical adsorption and reduction of Cr (VI) to Cr (III) and Cu (II) to Cu (0) while oxidizing Fe0 to Fe (III). The rate of reduction can be expressed by pseudo-second-order reaction kinetics. The rate constants increased with increasing iron loading and initial concentration at pH 6, while the adsorption of Cr (VI) and Cu (II) was found to be endothermic and exothermic, respectively. The apparent activation energies for Cr (VI) and Cu (II) were found to be 71.99 and 18.38 kJ mol−1, respectively. X-ray photoelectron spectroscopy confirmed the reduction process. The equilibrium data could be well described by both Langmuir and Temkin isotherms for describing monolayer adsorption and chemisorption processes, respectively. Both film diffusion and intraparticle diffusion were found to be the rate-limiting steps from the analysis of an intraparticle diffusion model. Thus, the synthesized chitosan–Fe0-nanoparticle–carboxymethyl β-cyclodextrin beads can be a potential material for in situ remediation of contaminated surface and ground water

River Water Pollution in Developed and Developing Countries: Judge and Assessment of Physicochemical Characteristics and Selected Dissolved Metal Concentration

To compare water quality in rivers of developed and developing countries, a study based on physicochemical parameters and dissolved metals levels was conducted. Water samples were collected from selected sites in Dhaka, Bangladesh; Hokkaido and Osaka, Japan; Erdenet, Mongolia and West Java, Indonesia. Analysis of least significant differences revealed that most water quality parameters were within comparable low levels in both developed and developing countries. The dissolved metals concentrations were found to be similar and below those of water standards except for manganese and cadmium at every sampling point, and lead in Erdenet, Mongolia. Some metals showed high enrichment factors in the rivers of Osaka, Japan and Erdenet, Mongolia, indicating accumulation possibility of metals in the river-bed sediments. High concentrations of dissolved organic carbon, Escherichia coli and dissolved metals suggested greater water pollution in some rivers of developing countries than in the rivers of Japan. Principal component analysis showed strong correlations between “dissolved organic carbon and chemical oxygen demand” and “conductivity and total dissolved solids” at each sampling point, and E. coli, nitrate (NOmath image), nitrite (NOmath image), and pH levels were found to be higher in the rivers of Dhaka and Erdenet. In addition, there were high levels of Al and Zn in West Java, Pb in Erdenet, and Mn, Fe, and Cr in the rivers of Dhaka and Japan. Based on pressures and impacts, it is evident that dissolved metal, organic, and fecal pollution in the rivers of developing countries are in somewhat dreadful condition in comparison with the rivers of developed country