Clinical Aspects of Physical Exercise for Diabetic Patients: Theory and Practice

In recent years, the Westernization of dietary habits and increasingly sedentary lifestyles have contributed to a marked increase in the number of patients with lifestyle-related diseases, including type 2 diabetes (T2D), worldwide. Epidemiological studies of physical exercise, such as the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study, have shown that lifestyle intervention programs involving diet and/or exercise reduce the progression of impaired glucose tolerance to T2D. In Japan, a nationwide survey regarding exercise therapy for diabetic patients revealed that relatively few physicians provide patients with exercise guidance because of time constraints, that the physicians do not receive additional consultation fees, and there is a lack of specialized physical exercise educators. It has been demonstrated in well-controlled diabetic patients that physical exercise promotes the utilization of blood glucose and free fatty acids in the muscles and lowers blood glucose levels. Furthermore, long-term, mild, regular jogging increases the action of insulin without affecting body mass index or maximum oxygen uptake. It is suggested that people with T2D undertake at least 150 min/week of moderate-to-vigorous aerobic exercise spread out over at least 3 days/week, with no more than 2 consecutive days between bouts of aerobic activity. Mild-intensity resistance training using light dumb-bells and stretch cords is recommended for elderly individuals who have decreased muscle strength and mass (sarcopenia). An active lifestyle is essential for the management of diabetes, a typical lifestyle-related disease

短期入所施設利用者の栄養状態に関する研究

Introduction:The short-term admission facilities can be used for up to 30days in a row per month,and short-stay users with a maximum of 30days were more likely than expected,and they learned that re-hospitalization would be a reset or a waiting place for the next facility. In addition,in the case of 40 bedsor less,there is no placement standard of a dietitian and a registered dietitian,in a environment where nutritional management by the profession can not be managed, the elderly are prone to low nutrition due to a decrease in physical function,etc.,during the use of up to30 days,This study was conducted to clarify the importance of nutrition status and nutritional management of users, thinking that the possibility of users, thinking that the possibility of falling into low nutrition increased.Method: The target is 25 cases of elderly people who agreed to this study using the short stay of the nursing care complex between November 1, 2017 and April 30, 2018, and 17 cases of women.Survey items: age, height, weight, weight loss, upper arm perimeter (AC), triceps subcutaneous fat thickness (TSF), lower leg circumference (CC: calf) was measured, The amount of basal metabolism and the required amount of nutrition was used by Harris Benedict\u27s formula. Measuring instruments: Using Abbott\u27s Addipometer (Caliper), Insert tape, MNA®CC measure. Usage scale: ADL:Barthel Index. Evaluation of nutritional status: Mini Nutritional Assessment-Short Form was used for evaluation. In order to assess the risk of low nutrition among the elderly in the incoming, we investigated daily life independence, cognitive independence, meal intake during admission, presence of appetite loss, presence or absence of eating and swallowing disorders, presence of pressure ulcers, dementia, and the degree of need for care.Results:The total number of data collected was 25, eight men and 17 females. All have been judged to be elderly people with dementia. Mean age 84.9 years old(68-94 years old), average weight 47.1 kg, average BMIwas 20.7. The average amount of nutrients required was about 1300 to 1400kcal, but the least small was 1012kcal, and the most common was 1857kcal, and it was found that there was variation. The daily amount of food provided by the facility was about 1600kcal, and it was found that some people were short of nutritional supplementation even if they ingested the entire amount. Although the intake of the meal during the admission was maintained as imagined, the correlation with BMI and the amount of basic metabolism was low, and it was suggested that it was necessary to consider whether the meal provided by the related facilities was appropriate. It is suggested that it is difficult for the elderly to show up to the weight even if the whole amount of the meal is taken, and it is suggested that it is appropriate to use the weight (BMI22 is good, how much is good if BMI is good), and how many kcal is put on the weight? It is also necessary to consider which factor is appropriate.Conclusion:In the elderly, muscle mass decreased with age, and as a result, the basal metabolism showed a significant downward trend, and it was found that the individual difference increased. In order to avoid low nutrition, we need to better understand the characteristics of the elderly, and work with nurses, physical therapists, occupational therapists, etc., to provide detailed nutritional care and management to suit the characteristics of the individual. the importance of carrying out the in addition, it was suggested that the elderly who used short stays needed to implement nutritional management that took into consideration the amount of basic metabolism and the amount of nutrition required

Gastroenteropancreatic neuroendocrine tumor of the accessory papilla of the duodenum: a case report

BackgroundContrary to the increasing incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), GEP-NETs of the accessory papilla of the duodenum are extremely rare. Furthermore, there have been no recommendations regarding the treatment strategy for GEP-NETs of the accessory papilla of the duodenum. We present a case of GEP-NET of the accessory papilla of the duodenum successfully treated with robotic pancreatoduodenectomy.Case presentationA case of a 70-year-old complaining of no symptoms was diagnosed with GEP-NET of the accessory papilla of the duodenum. A 8-mm tumor was located at the submucosal layer with a biopsy demonstrating a neuroendocrine tumor grade 1. The patient underwent robotic pancreatoduodenectomy as curative resection for the tumor. The total operative time was 406 min with an estimated blood loss of 150 mL. The histological examination revealed a well-differentiated neuroendocrine tumor with low Ki-67 index (<1%). In the posterior areas of the pancreas, the lymph node metastases were detected. The patient was followed up for 6 months with no recurrence postoperatively.ConclusionsConsidering the potential risks of the lymph node metastases, the standard treatment strategy for GEP-NETs of the accessory papilla of the duodenum should be radical resection with pancreatoduodenectomy. Minimally invasive approach can be the alternative to the conventional open surgery

Imprinting spatial helicity structure of vector vortex beam on spin texture in semiconductors

We present the transfer of the spatially variant polarization of topologically structured light to the spatial spin texture in a semiconductor quantum well. The electron spin texture, which is a circular pattern with repeating spin-up and spin-down states whose repetition rate is determined by the topological charge, is directly excited by a vector vortex beam with a spatial helicity structure. The generated spin texture efficiently evolves into a helical spin wave pattern owing to the spin-orbit effective magnetic fields in the persistent spin helix state by controlling the spatial wave number of the excited spin mode. By tuning the repetition length and azimuthal angle, we simultaneously generate helical spin waves with opposite phases by a single beam.Comment: 6 pages, 4 figure

Living Donor Liver Transplantation to a Survivor of LiverResection for Hepatocellular Carcinoma with Major Portal Vein Invasion

We present a case of living donor liver transplantation to a 3-year disease-free survivor of liver resection for hepatocellular carcinoma (HCC) with major portal vein invasion. A 48-year-old man had HCC in the right lobe with a portal venous tumor thrombus extending into the left portal vein. An extended right lobectomy with thrombectomy was performed to remove the thrombus. Three years after liver resection, the patient experienced liver failure, with massive ascites and jaundice due to the formation of a thrombus in the main and left portal veins. During the 3 years after liver resection, no metastasis or recurrence of HCC had been detected, and tumor markers had been within normal ranges. The portal venous thrombus did not show any arterial enhancement under contrast-enhanced computed tomography, suggesting that the co-existence of any HCC component in the portal venous thrombus may have been negative. Based on these findings, living donor liver transplantation was performed using a right lobe graft from the patientʼs son. The patient is alive at 87 months after the transplantation, with no evidence of HCC recurrence

Metabolic Characterization of Antifolate Responsiveness and Non-responsiveness in Malignant Pleural Mesothelioma Cells

Antifolates are a class of drugs effective for treating malignant pleural mesothelioma (MPM). The majority of antifolates inhibit enzymes involved in purine and pyrimidine synthesis such as dihydrofolate reductase (DHFR), thymidylate synthase (TYMS), and glycinamide ribonucleotide formyltransferase (GART). In order to select the most suitable patients for effective therapy with drugs targeting specific metabolic pathways, there is a need for better predictive metabolic biomarkers. Antifolates can alter global metabolic pathways in MPM cells, yet the metabolic profile of treated cells has not yet been clearly elucidated. Here we found that MPM cell lines could be categorized into two groups according to their sensitivity or resistance to pemetrexed treatment. We show that pemetrexed susceptibility could be reversed and DNA synthesis rescued in drug-treated cells by the exogenous addition of the nucleotide precursors hypoxanthine and thymidine (HT). We observed that the expression of pemetrexed-targeted enzymes in resistant MPM cells was quantitatively lower than that seen in pemetrexed-sensitive cells. Metabolomic analysis revealed that glycine and choline, which are involved in one-carbon metabolism, were altered after drug treatment in pemetrexed-sensitive but not resistant MPM cells. The addition of HT upregulated the concentration of inosine monophosphate (IMP) in pemetrexed-sensitive MPM cells, indicating that the nucleic acid biosynthesis pathway is important for predicting the efficacy of pemetrexed in MPM cells. Our data provide evidence that may link therapeutic response to the regulation of metabolism, and points to potential biomarkers for informing clinical decisions regarding the most effective therapies for patients with MPM

Thermal dependency of shell growth, microstructure, and stable isotopes in laboratory‐reared Scapharca broughtonii (Mollusca: Bivalvia)

We experimentally examined the growth, microstructure, and chemistry of shells of the bloody clam, Scapharca broughtonii (Mollusca: Bivalvia), reared at five temperatures (13, 17, 21, 25, and 29°C) with a constant pCO2 condition (∼450 μatm). In this species, the exterior side of the shell is characterized by a composite prismatic structure; on the interior side, it has a crossed lamellar structure on the interior surface. We previously found a negative correlation between temperature and the relative thickness of the composite prismatic structure in field‐collected specimens. In the reared specimens, the relationship curve between temperature and the growth increment of the composite prismatic structure was humped shaped, with a maximum at 17°C, which was compatible with the results obtained in the field‐collected specimens. In contrast, the thickness of the crossed lamellar structure was constant over the temperature range tested. These results suggest that the composite prismatic structure principally accounts for the thermal dependency of shell growth, and this inference was supported by the finding that shell growth rates were significantly correlated with the thickness of the composite prismatic structure. We also found a negative relationship between the rearing temperature and δ18O of the shell margin, in close quantitative agreement with previous reports. The findings presented here will contribute to the improved age determination of fossil and recent clams based on seasonal microstructural records

臨地実習参加前後における職業意識の変化について

Students enrolled in a registered dietitian training course were the subjects of this study. The changes in the occupational perception of (registered) dietitians before and after the on-site practical training were investigated, and the level of competency attainment before and after was evaluated. Moreover, the level of understanding of the content of the practical training subjects experienced was surveyed using a questionnaire, and the responses were examined and analyzed. In the survey conducted after the practical training, most students responded that the on-site practical training was useful. The most often cited reason was being “able to learn about the specific methods.” This response was most likely because the subjects could acquire hands-on and professional content in this training that cannot be experienced in classroom lectures at the university. These results suggest that, through the on-site practical training, students enrolled in the (registered) dietitian training course experienced the content they learned in lectures and practical training in real-life situations. Consequently, this training improved their occupational perception and enhanced their understanding and learning level of the training content. Regarding on-site practical training and lectures and practical training in the university, education with content more professional than current ones is needed

Favorable control of hepatocellular carcinoma with peritoneal dissemination by surgical resection using indocyanine green fluorescence imaging: a case report and review of the literature

Background The optimal management for peritoneal dissemination in patients with hepatocellular carcinoma remains unclear. Although several reports have described the usefulness of surgical resection, the indications should be carefully considered. Herein, we report the case of a patient with hepatocellular carcinoma with peritoneal recurrence who underwent surgical resection using an indocyanine green fluorescence navigation system and achieved favorable disease control. Case presentation A 45-year-old Asian woman underwent left hemihepatectomy for a ruptured hepatocellular carcinoma. Seventeen months after the initial surgery, a single nodule near the cut surface of the liver was detected on computed tomography, along with elevation of tumor markers. The patient was diagnosed with peritoneal metastasis and underwent a surgical resection. Twelve months later, a single nodule on the dorsal side of the right hepatic lobe was detected on computed tomography, and we performed surgical resection. Indocyanine green (0.5 mg/kg) was intravenously administered 3 days before surgery, and the indocyanine green fluorescence imaging system revealed clear green fluorescence in the tumor, which helped us perform complete resection. Indocyanine green fluorescence enabled the detection of additional lesions that could not be identified by preoperative imaging, especially in the second metastasectomy. There was no further recurrence at 3 months postoperatively. Conclusion When considering surgical intervention for peritoneal recurrence in patients with hepatocellular carcinoma, complete resection is mandatory. Given that disseminated nodules are sometimes too small to be detected by preoperative imaging studies, intraoperative indocyanine green fluorescence may be an essential tool for determining the indications for surgical resection

Adenomatoid mesothelioma arising from the diaphragm: a case report and review of the literature

Background Adenomatoid mesothelioma is a rare subtype of malignant mesothelioma that can be confused with adenomatoid tumors, which are classified as benign. The clinical features and optimal management of adenomatoid mesothelioma have not been elucidated in the literature. In this report, we present an extremely rare case of adenomatoid mesothelioma that developed on the peritoneal surface of the diaphragm as well as a literature review of adenomatoid mesothelioma in the abdominal cavity. Case presentation The patient was a 61-year-old Japanese woman who had undergone resection of a malignant peripheral nerve sheath tumor of the hand 18 years prior. She was diagnosed with clinical stage I lung adenocarcinoma on follow-up chest radiography. Simultaneously, a 20-mm enhancing nodule with slow growth on the right diaphragm was detected on contrast-enhanced computed tomography. She presented no specific clinical symptoms. At this point, the lesion was suspected to be a hypervascular tumor of borderline malignancy, such as a solitary fibrous tumor. After a left upper lobectomy for lung adenocarcinoma, she was referred to our department, and laparoscopic tumor resection was performed. Adenomatoid tumors were also considered based on the histopathological and immunohistochemical analyses, but we made the final diagnosis of adenomatoid mesothelioma using the results of the genetic profile. The patient remains alive, with no recurrence noted 6 months after surgery. Conclusion We encountered a valuable case of adenomatoid mesothelioma of peritoneal origin. There are some previously reported cases of adenomatoid mesothelioma and adenomatoid tumors that may need to be recategorized according to the current classification. It is important to accumulate and share new findings to clarify the clinicopathological characteristics and genetic status of adenomatoid mesothelioma