Computational assessment of insulin secretion and insulin sensitivity from 2-h oral glucose tolerance tests for clinical use for type 2 diabetes

In type 2 diabetes mellitus, glucose homeostasis is tightly maintained through insulin secretion and insulin sensitivity. Therefore, finding an accurate method to assess insulin secretion and sensitivity using clinically available data would enhance the quality of diabetic medical care. In an effort to find such a method, we developed a computational approach to derive indices of these factors using a 2-h oral glucose tolerance test (OGTT). To evaluate our method, clinical data from subjects who received an OGTT and a glucose clamp test were examined. Our insulin secretion index was significantly correlated with an analogous index obtained from a hyperglycemic clamp test (r = 0.90, n = 46, p < 0.001). Our insulin sensitivity index sensitivity was also significantly correlated with an analogous index obtained from a hyperinsulinemic-euglycemic clamp test (r = 0.56, n = 79, p < 0.001). These results suggest that our method can potentially provide an accurate and convenient tool toward improving the management of diabetes in clinical practice by assessing insulin secretion and insulin sensitivity

A method for simultaneous detection and identification of Brazilian dog- and vampire bat-related rabies virus by reverse transcription loop-mediated isothermal amplification assay

At present, the sporadic occurrence of human rabies in Brazil can be attributed primarily to dog- and vampire bat-related rabies viruses. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) was employed as a simultaneous detection method for both rabies field variants within 60 min. Vampire bat-related rabies viruses could be distinguished from dog variants by digesting amplicons of the RT-LAMP reaction using the restriction enzyme Alwl. Amplification and digestion could both be completed within 120 min after RNA extraction. In addition, the RI-LAMP assay also detected rabies virus in isolates from Brazilian frugivorous bats and Ugandan dog, bovine and goat samples. In contrast, there were false negative results from several Brazilian insectivorous bats and all of Chinese dog, pig, and bovine samples using the RI-LAMP assay. This study showed that the RT-LAMP assay is effective for the rapid detection of rabies virus isolates from the primary reservoir in Brazil. Further improvements are necessary so that the RT-LAMP assay can be employed for the universal detection of genetic variants of rabies virus in the field. (C) 2010 Elsevier B.V. All rights reserved.Kurozumi Medical FoundationMinistry of Education, Culture, Sports, Science and Technology (MEXT) of Japa

開腹手術既往症例における後腹膜到達法によるロボット支援腎部分切除術の経験

2016年4月より小径腎腫瘍に対しロボット支援腎部分切除術（RAPN）が保険適応となり，当院でも同年5月よりRAPN を導入した．初期導入28症例まで経腹膜到達法で行ってきたが，今回開腹手術の既往症例に対して後腹膜到達法で行った．症例は70歳代，男性．右腎下極腫瘍，腫瘍径24mm，腎背側に位置した．臨床病期cT1aN0M0 stage Ⅰ，術前 eGFR 68.8ml╱min，大腸癌術後，胆石症術後であり体表に腹部正中創，人工肛門を認めた．手術は全身麻酔，左側臥位，ジャックナイフ位で開始した．腎動脈の確保まで腹腔鏡鉗子操作で行った．手術時間3時間8分，コンソール時間49分，温阻血時間23分，出血少量であった．病理検体は7g，Renal cell carcinoma，pT1a，断端陰性であった．術後6日目に退院し術後eGFR 50.4ml╱min，4ヵ月後eGFR 62.1ml╱min と腎機能は術前と同様の水準まで改善した．後腹膜到達法により腹腔内癒着の影響を受けることなくRAPN を安全に施行することが可能であった