An epidemiologically rare case of Vibrio vulnificus infection that occurred in October in an inland city of Japan

　A 68-year-old man with alcohol addiction, who lived in the suburbs of Tsuyama, an inland city located in northeast Okayama prefecture, was transported to the emergency unit of the Tsuyama Central Hospital in a state of cardiopulmonary arrest (CPA). Despite rigorous systemic investigation and treatment, the patient died 2 hours after arrival. After his death, Vibrio vulnificus was isolated from his blood culture. 　Vibrio vulnificus causes fatal infection in humans, usually only in areas located close to the sea where appropriate temperature and suitable salt concentration for its growth are available. Therefore, its occurrence is epidemiologically restricted ; in Japan, the western coastal areas, especially in summers, are reported to be the high-risk regions. This is a rare case because it occurred in a city approximately 50 kilometers from both the Sea of Japan and the Pacific coast of Okayama, and at the end of October in 2011. Economic development and distribution systems have made it possible to transport various food products from coastal areas or abroad to any place in a short time, such that these infections can potentially develop in areas other than expected. We should be aware of the increasing risk of Vibrio vulnificus infection during any season and at any place, especially in patients with abnormal liver function

2ガタ トウニョウビョウ カンジャ ニオケル ケットウ シヒョウ ト ゲンエン ガ モタラス ケツアツ テイカ トノ レンカン

Background : The majority of patients with type２diabetes mellitus（T２DM）have hypertension, leading to serious cardiovascular events, including acute myocardial infarction, heart failure and stroke. Therefore, blood pressure（BP）control is a critical issue in patients with T２DM. Although sodium restriction is known to reduce BP, it is unclear what factors are associated with sodium restriction-induced BP reduction in T２DM patients. Subjects and Methods : A retrospective analysis was performed in hospitalized patients with T２DM（６６males and６１females, mean age :５８．１±１４．２years, mean HbA１c :９．５±２．０％）. They received diet therapy including sodium restriction as NaCl of５to８g/day during admission. The relationship between changes in systolic BP（SBP）during admission and clinical parameters at the time of admission was statistically analyzed. Results : Mean SBP in the sodium-restricted patients was significantly reduced during admission（ from １３０．２±１６．１ to １２２．７±１３．９ mmHg, p＜０．０１）. Multiple regression analysis showed that serum creatinine levels and presence of hypertension were inversely associated with and that initial SBP value was positively associated with the change in SBP. On the other hand, no glycemic parameters, including fasting plasma glucose levels, HbA１c, M values calculated from daily blood glucose profile, duration of T２DM and duration of hospitalization, were associated with the change in SBP. Conclusion : Sodium restriction-induced BP reduction in T２DM patients was associated with presence of hypertension, serum creatinine levels and initial SBP values. Sodium restriction is a useful treatment for T２DM patients regardless of their glycemic condition

Treatment algorithm of ACTH deficiency

Objective : To examine diagnostic performance of corticotropin-releasing hormone (CRH) test combined with baseline dehydroepiandrosterone sulfate (DHEA-S) in patients with a suspect of central adrenal insufficiency. Methods : Patients (n=215) requiring daily or intermittent hydrocortisone replacement, or no replacement were retrospectively checked with their peak cortisol after CRH test and baseline DHEA-S. Results : None of 106 patients with the peak cortisol ≥ 17.5 μg / dL after CRH test required replacement, and all 64 patients with the peak cortisol < 10.0 μg / dL required daily replacement. Among 8 patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL and baseline DHEA-S below the reference range, 6 patients required daily replacement and 1 patient was under intermittent replacement. Among 37 patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL and baseline DHEA-S within the reference range, 10 and 6 patients were under intermittent and daily replacement, respectively. Conclusions : No patients with the peak cortisol ≥ 17.5 μg / dL required hydrocortisone replacement, and all patients with the peak cortisol below 10.0 μg / dL required daily replacement. Careful clinical evaluation was required to determine requirement for replacement in patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL even in combination with baseline DHEA-S

The Estrogenic Effect of Bisphenol A Disrupts Pancreatic β-Cell Function and Induces Insulin Resistance-1

<p><b>Copyright information:</b></p><p>Taken from "The Estrogenic Effect of Bisphenol A Disrupts Pancreatic β-Cell Function and Induces Insulin Resistance"</p><p>Environmental Health Perspectives 2005;114(1):106-112.</p><p>Published online 20 Sep 2005</p><p>PMCID:PMC1332664.</p><p>This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI.</p