Ketone Bodies in the Fetus and Newborn During Gestational Diabetes and Normal Delivery

Background: Authors successfully treated gestational diabetes by a very low carbohydrate diet without insulin and other drugs. Increased ketone bodies seemed to play an essential role in energy metabolism, and the fetus and newborn also showed hyperketosis. It is necessary to clarify how much ketone bodies were present in the placenta and umbilical cord in the fetus and newborn and the pregnant mother with or without gestational diabetes. Subjects and Methods: All cases were patients of Muneta OB/GYN Clinic in Chiba, where about 700 deliveries were done every year, 90% normal and 10% gestational diabetic. Blood of 313 mothers and babies at health check-up postpartum, 192 samples of placenta and cord blood at the delivery, and 122 cases were obtained at the time of miscarriage. Abbott's kit measured βHB, and 101 samples obtained at the post partem health check-up were biochemically analyzed for both βHB and glucose. The IBM-SPSS did the statistical analysis. Results: βHB in Mothers' and newborns' blood at four days postpartum was 0.062 and 0.244 mmole/L (median), respectively, and glucose was 4.55±0.81 mmole/L. βHB was high throughout the pregnancy; In the placenta, βHB in the first-, second-and-third trimester was 1.95±0.9 mmole/L, 2.82±0.49 mmole/L, 1.87±0,65 mM/L, respectively. In the cord blood, it was 2.3±1.13 mmole/L, 1.36±0.76 mmole/L, and 0.69±0.6 mmole/L, respectively. Placental βHB at the delivery was 1.99±0.78 mmole/L, and that of the umbilical cord was 0.75±0.36 mmole/L. In the first trimester miscarriage, βHB in spontaneous abortion was 1.84±0.85 mmole/L, while it was 2.09±0.94 mmole/L in artificial abortion. Aborted cases in the second trimester showed 1.96±0.38 mmole/L βHB and 3.74±0.75 mmole/L glucose in the cerebrospinal fluid. Discussion: Our data showed βHB and glucose concentration in the human fetus and newborn under the normal physiological condition. βHB was present in the placenta and umbilical cord blood throughout fetal life and after birth. Different concentrations between the placenta and umbilical cord blood suggested the fetus's uptake for energy and intrauterine growth. High βHB in the cerebrospinal fluid suggested the effects on neuronal development

Ketone Bodies Elevation in Placenta, Umbilical Cord, Newborn and Mother

Background: Low carbohydrate diets (LCD) have been recently prevalent in the medical and health field, especially in diabetes mellitus. We have applied LCD on thousands of patients with metabolic diseases and reported the clinical effect of LCD so far. Through our experience and research concerning LCD, the physiological role of glucose and ketone bodies during the pre- and post-partum period was investigated in this study. Subjects and methods: Subjects were 60 normal pregnant woman who had a normal delivery in full-term, without an abnormal glucose intolerance. Methods included the measurement of the value of ketone bodies in the umbilical cord blood, placental tissue fluid and maternal blood, associated with the value of blood glucose. As ketone bodies, the value of 3-hydroxybutyric acid (3-OHBA, beta-hydroxybutyric acid) was measured. 3-OHBA and glucose values were measured by the electrode method using Precision Exceed Kit (Abbott) and the conventional enzymatic cycling method, with comparison investigation of the data from two kits. Results: The average 3-OHBA levels were as follows: 2,235.0 μmol/L in the placenta, 779.2 μmol/L in the umbilical cord blood, in which the former is significantly higher than the latter (p < 0.001), 240.4μmol/L in the newborn after four days, and 366.7μmol/L after 30 days. The standard 3-OHBA level in a healthy man is less than 85 μmol/L. Glucose levels in the umbilical cord and placenta were 78.6 mg/dL vs 74.9 mg/dL, with no significant difference, and was the same as that of the pregnant woman. Accuracy management of the two kits revealed a significant correlation (r = 0.94, p < 0.001). 3-OHBA values of the maternal blood and umbilical cord blood were extremely elevated from the standard level, with a mutual significant correlation (r = 0.724, p < 0.001, n = 416). Conclusion: This clinical study concerning ketone bodies during pre- and post-partum period was investigated, and revealed that 1) a clinically rapid useful kit for ketone bodies had high reliability and validity compared with conventional kit, 2) elevated values of 3-OHBA were shown in the placental tissue fluid, umbilical cord, newborn and maternal blood, 3) 3-OHBA would be a physiologically indispensable element in nutrition metabolism for fetus and newborn at least until 30 days, with further development of investigation for ketone bodies

Surrogate marker of schistocytes

Objectives : Hematopoietic stem cell transplantation (HSCT)-associated thrombotic microangiopathy (TA-TMA) is an important early post-treatment condition. This study evaluated the Revised %MICRO, a parameter obtained from the ADVIA 2120i automated blood cell counter, as a surrogate marker of the schistocyte ratio. We hypothesized that individual differences between the %MICRO value and schistocyte ratio would remain constant. Design and Methods: EDTA-2K-treated peripheral blood samples were collected from 19 patients who underwent allogeneic HSCT from April 2014 to September 2018. First, the baseline difference, X, was calculated using a sample from the first day after HSCT as X = %MICRO (first day) – schistocyte ratio (first day). Next, the Revised %MICRO for each subsequent day was calculated as Revised %MICRO = %MICRO – X. We evaluated correlations of the schistocyte ratio with the calculated %MICRO and Revised %MICRO and the RBC fragment, RBC distribution width, %MICRO and Revised %MICRO data obtained from the ADVIA 2120i. Results : The mean schistocyte percentage and Revised %MICRO were both 0.4% ± 0.6. RBC fragments correlated weakly with the %MICRO and schistocyte ratio, respectively (r = 0.162 and r = 0.771, respectively), whereas the Revised %MICRO correlated strongly with the schistocyte ratio (r = 0.893). Conclusion : The Revised %MICRO appears to be a good surrogate of the schistocyte ratio in a clinical setting

Vertebral Bone Mineral Density Measured with Dual Photon Absorptiometry Using a Gamma Camera: Clinical Application to Metabolic Bone Diseases

Dual photon absorptiometry (DPA) with a gamma camera, instead of a rectilinear scanner, has been developed for vertebral bone mineral density (BMD) measurement. The system consists of 50 mCi (1,850 MBq) 153-Gd as the emitting source, and an Anger-type gamma camera with a rectangular Nal (Tl) crystal and 22 photomultiplier tubes. The effective field of a view was enough to cover more than 3 vertebrae. With the patient sitting, data acquisition was performed. The spatial resolution and uniformity of the gamma camera were good. With the introduction of a correction equation, the error in calculated BMD due to body thickness was reduced. A data acquisition of 7.5 to 15 min led to a satisfactory C.V. value (less than 2.0%). The precision (1.63% of C.V. in vitro and 3.53% in vivo) and accuracy (r=0.999) of the BMD measurements were also good. Vertebral BMD values in 300 normal Japanese females decreased with aging. Although in involutional osteoporosis and secondary hyperparathyroidism both vertebral and radial % BMDs decreased, in steroid-induced osteoporosis and primary hyperparathyroidism, disproportionate bone loss (relatively lower in vertebral bone) was demonstrated. Thus, it was shown that a newly developed DPA system using a gamma camera provided sufficient precision and accuracy to quantificaticn of vertebral BMD, and its application should provide reliable information for clarification of the pathophysiology of metabolic bone diseases

A Clinical Study of Photodynamic Therapy for Superficial Esophageal Carcinoma by YAG-OPO Laser

A cooperative clinical study of photodynamic therapy (PDT) for superficial esophageal carcinoma was conducted at 6 medical institution. PHE (2mg/kg) with high tumor affinity was used as the oncotropic compound. The light source was a pulse wave YAG-OPO laser with high penetration into the tissue. Irradiation was performed at an energy density of 60–180 J/cm2 48–72 h after PHE administration. Eight lesions in 6 patients were treated. All were type 0-II superficial carcinomas. The depth of invasion was EP–MM for 6 lesions and SM for 2 lesions. A complete response (CR) was achieved in all patients after one session of PDT. Five adverse events, including anemia and fever, were reported by 4 patients, but all were WHO grade 2 or lower and transient. PDT using PHE and YAG-OPO laser was therefore considered effective as a curative therapy for superficial esophageal carcinoma

Cooperative Clinical Trial of Photodynamic Therapy for Early Gastric Cancer With Photofrin Injection® and YAG-OPO Laser

Background and Objective: Photodynamic therapy (PDT) treats malignant tumors using photosensitizers and light. We employed a new pulse laser as the excitation light source for PDT, i.e. an optical parametric oscillator (OPO) system pumped by a Q-switched Nd:YAG laser, because it provides extremely high peak power