Advantage of Insulin Glulisine Over Regular Insulin in Patients With Type 2 Diabetes and Severe Renal Insufficiency

ObjectivesTo compare the efficacy and safety of insulin glulisine over regular insulin in patients with type 2 diabetes and severe renal insufficiency.SubjectsOur study included 18 patients with type 2 diabetes and a mean (range) estimated glomerular filtration rate of 13.2 mL/minute/1.73 m2 (5.8-27.6), which corresponds to stage 4-5 chronic kidney disease.DesignAfter titration of doses, regular insulin was administered thrice daily on Day 1, along with continuous glucose monitoring for 24 h starting at 7 am. Exactly equal doses of insulin glulisine were administered on Day 2. Area under the curve (AUC) for blood glucose level variation after breakfast (AUC-B 0-4), lunch (AUC-L 0-6), and dinner (AUC-D 0-6) were evaluated.ResultsAUC-B 0-4 and AUC-D 0-6 were significantly lower with insulin glulisine than with regular insulin (AUC-B 0-4: 3.3 ± 4.7 vs. 6.2 ± 5.4 × 102 mmol/L·minute, respectively, P = .028; AUC-D 0-6: 1.8 ± 7.3 vs. 6.5 ± 6.2 × 102 mmol/L·minute, respectively, P = .023). In contrast, AUC-L 0-6 was higher with insulin glulisine than with regular insulin (AUC-L 0-6: 7.6 ± 6.4 vs. 4.2 ± 8.7 × 102 mmol/L·minute, respectively, P = .099), suggesting a prolonged hypoglycemic action of regular insulin after lunch.ConclusionsInsulin glulisine effectively suppressed postprandial hyperglycemia, whereas regular insulin caused a prolonged hypoglycemic action. These findings support the effectiveness and safety of insulin glulisine in patients with type 2 diabetes and severe renal insufficiency

Latent adrenal Ewing sarcoma family of tumors: A case report

Ewing sarcoma family of tumors (ESFT) is derived from the neural crest, which originates from basal embryo cells in the primitive neural tube. ESFT often arises at the bone, chest wall, and soft tissues of the thoracic region. However, ESFT that arises from the adrenal gland is much rarer and it is usually revealed by clinical symptoms. We report an autopsy case of suicidal hanging, in which adrenal ESFT was incidentally revealed. To our knowledge, this is the first case of latent ESFT arising from the adrenal gland. Autopsy can sometimes reveal latent disease. Some of these latent diseases are very rare and we would not be able to detect them without a complete autopsy. As forensic pathologists, we should attempt to perform a complete autopsy and report new discoveries for the development of medicine

Carnitine palmitoyltransferase 2 gene polymorphism is a genetic risk factor for sudden unexpected death in infancy

Rationale: Carnitine palmitoyltransferase (CPT) II is one of a pivotal enzyme in mitochondrial fatty acid oxidation, which is essential for energy production during simultaneous glucose sparing and a requirement for major energy supply, such as prolonged fasting or exercise. When infants require more energy than provided by the glycolytic system, they rely on the mitochondrial fatty acid oxidation pathway. Mutations of the CPT2 gene have been reported to cause sudden unexpected death in infancy (SUDI). A thermolabile phenotype of a CPT2 polymorphism (F352C) has been recently reported to reduce CPT II enzyme activity. The F352C variant results in energy crisis at high temperature and is suspected as a risk factor for acute encephalopathy. However, a relationship between CPT2 gene polymorphism and SUDI has not been described. Methods: Single nucleotide polymorphisms of the CPT2 gene were investigated among 54 SUDI cases and 200 healthy volunteers. Results: The frequency of the C allele was significantly higher in the SUDI group than in the control group [25.0% vs 16.0%, odds ratio (OR). = 1.75, 95% confidence interval (CI). = 1.05-2.92, p= 0.030). The frequency of the F352C homozygote was significantly higher in the SUDI group than in control group (11.1% vs 3.5%, OR. = 3.45, 95% CI. = 1.11-10.73, p= 0.036). Conclusion: The F352C CPT2 variant might be a genetic risk factor for SUDI

眼球毒性の観察された農薬についての文献的考察

Pesticides evaluated previously by the Food Safety Commission of the Cabinet Office, Japan were in vestigated retrospectively for induction of ocular toxicity. A total of 339 assessment reports representing 345 compounds were investigated. Ocular toxicity was observed in 56 compounds. Target sites were pupils for 21 compounds, retinas for 21 compounds, lenses for 16 compounds, corneas for 15 compounds, conjunctiva for 3 compounds and whole eyeballs for 2 compounds. These ocular toxicities were not related to local irritation, but were due to systemic exposure after oral absorption. For many of these compounds, the mechanism (s) of ocular toxicities are unknown. Ocular toxicities were only induced at considerably higher doses of exposure compared to the acceptable daily intake (ADI) with sufficient safety margins for ocular toxicity. Although it is unlikely that ocular toxicities induced by these chemicals will occur in humans, it is though that future studies anticipating actual human exposure conditions and associated pharmacokinetic information will be important

Two Cases of Painful Ophthalmoplegia

Even though painful ophthalmoplegia may be attributable to serious diseases, sometimes it is difficult to make a diagnosis. We present two cases of painful ophthalmoplegia

保育士・幼稚園教諭に求められる保育及び子育て支援現場におけるソーシャルワーク機能についての一考察 : フィンランドのネウボラの視察から [The Function of Social Work as Part of Child Support by Nursery and Kindergarten Teachers : an Observation Study of Finnish Neuvola System]

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フィンランドのネウボラの視察から見えたわが国の利用者支援事業の課題 －ケースの視察及び利用者インタビューから－ [Issues Related to Japan's User Support Project for Children and Childcare Support System Discovered by Visiting Neuvola in Finland]

The aim of this article is to introduce Neuvola, a childrearing support service in Finland, and to discuss issues related to Japanʼs User Support Project for Children and Childcare Support System. The authors visited and sat in on Neuvola sessions for three clients, and they conducted interviews with a client between October 4 and 8, 2015. Clients and Neuvola nurses were relaxed, and clients initiated the topics discussed during the visit. There was rapport between clients and Neuvola nurses, and clients seemed to be at ease in receiving the service. During the interviews, the client mentioned that she was able to talk about sensitive issues because the nurses would help the family to move in the right direction. Moreover, an information sharing system through ICT had been created between related facilities so that clients did not need to repeat their stories whenever they were referred to other facilities. On the other hand, it became clear that, like Japan, there were budgetary issues limiting Neuvola office hours in some communities. Findings made by visiting Neuvola suggest that it is important for the User Support Project to establish a system and an environment that enable clients and workers to develop mutual trust.nonPeerReviewe

Transient Visual Hallucinations with Eye Closure After Gamma Knife Radiosurgery

Visual hallucination with eye closure is rare and we report the case after Gamma Knife radiosurgery