Hyperglycemia and the outcome of pediatric cardiac surgery patients requiring peritoneal dialysis

OBJECTIVE

To study the nature of the association between glycemia and ICU mortality in pediatric cardiac surgery patients treated with peritoneal dialysis (PD).

MATERIALS AND METHODS

Retrospective observational study in the ICU of a tertiary hospital involving forty pediatric cardiac surgery patients treated with PD. We selected patients requiring PD, extracted glucose measurements and nutritional intake data during ICU stay and calculated mean and maximum blood glucose values i) during ICU stay; ii) during dependence on PD; and iii) during independence from PD. We statistically assessed the relationship between glycemia-related variables and ICU mortality.

MEASUREMENTS AND RESULTS

Twenty-two patients treated with PD died (mortality 55%). In the PD cohort, 9725 blood glucose measurements were performed (every 3.3 hours on average). The mean glycemia during dependence on PD was significantly higher in non-survivors than survivors (p<0.0001), but not during independence from PD (p=0.49). The area under the receiver operator characteristic curve for the mean glycemia during dependence on PD was significantly greater than that obtained during independence from PD. Even after adjustment for severity of illness using multivariate logistic analysis, the mean glycemia and calorie intake during PD were significant and independent predictors of ICU mortality.

CONCLUSIONS

A higher mean blood glucose concentration during PD, but not during PD-free periods was associated with greater ICU mortality. Mean glycemia and calorie intake during PD were significant and independent predictors of ICU mortality.

[Full-thickness pleural biopsy using an Insulation-tipped Diathermic Knife in a patient with malignant pleural mesothelioma]

A 72-year-old woman was pointed out a right pleural effusion and thickening pleura on the chest computed tomography. The patient underwent semiflexible thoracoscopy under local anesthesia at the endoscopy room. The patient was placed in the lateral decubitus position, and flexible trocar was inserted with the single puncture technique. At the macroscopic findings, the parietal pleura were thickened prominently, and patchy plaques were occasionally recognized. A standard biopsy forceps hardly grasped pleura because of presence of scar, so we performed pleural biopsy using Insulation-tipped Diathermic (IT) knife. A subpleural injection of saline containing 0.5% lidokine and 0.005% epinephrine was performed for raising the affected parietal pleura with an injection needle. After a pin hole was made, the pleural lesion was incised in a circle by manipulating the IT knife, and the incised pleura were removed. Pathology revealed extensive fibrosis and epithelial mesothelioma by the specimen. This biopsy technique using IT knife through semiflexible thoracoscopy enabled to obtain a full-thickness pleura It is thought to be useful for the diagnosis of malignant pleural mesothelioma (MPM) in which standard forceps are difficult to grasp.

Increased levels of monokine induced by interferon-gamma (Mig) in the vitreous of patients with diabetic retinopathy

AIM

To determine the intravitreous concentration of monokine induced by interferon-gamma (Mig) in patients with diabetic retinopathy (DR) and the relation between Mig and vascular endothelial growth factor (VEGF).

RESEARCH DESIGN AND METHODS

Vitreous samples were obtained at the time of vitrectomy from 41 eyes of 38 DR patients (30 with active DR and 11 with inactive DR) and from 15 eyes of 15 non-diabetic patients who had macular disease (control subjects). Human Mig and VEGF were quantified using a FACS Caliber flow cytometer.

RESULTS

The vitreous concentration of Mig was increased significantly in patients with both active and inactive DR [148.0 (31.6-997.2; median range) and 82.3 (25.7-347.7) pg/ml, respectively] compared with control subjects [21.0 (5.2-74.3) pg/ml; P < 0.0001 and P < 0.001, respectively]. In DR patients, a significant (P < 0.01) correlation was observed between vitreous concentrations of Mig and VEGF.

CONCLUSION

Our results suggest that Mig may play an important role in the pathogenesis of DR and works in consort with VEGF in the progression of pathological angiogenesis in DR.

Three-dimensional optical coherence tomography of proliferative diabetic retinopathy

Fourier-domain optical coherence tomography (OCT) was used to image the three-dimensional (3D) structures of the proliferative membrane in proliferative diabetic retinopathy. The case of a 51-year-old man with retinal detachment of the macula in his left eye is reported. The proliferative membrane covered the entire macular area. In the OCT image, the 3D structure of the proliferative membrane could be clearly visualised. The OCT image showed the presence of multiple adhesions between the retina and the proliferative membrane and separation of the proliferative membrane. The patient underwent three-port vitrectomy, and the extent and locations of the adhesions corresponded well with the findings during vitrectomy. Three-dimensional OCT is an effective tool for understanding the 3D structure of the proliferative membrane in diabetic retinopathy and is useful for training and planning of the surgical procedures in vitrectomy. To view the full report and accompanying video please go to: http://bjo.bmj.com/cgi/content/full/92/5/713/DC1. All videos from the BJO video report collection are available from: http://bjo.bmj.com/video/collection.dtl.

Formal analysis of resonance entrainment by central pattern generator

The neuronal circuit controlling the rhythmic movements in animal locomotion is called the central pattern generator (CPG). The biological control mechanism appears to exploit mechanical resonance to achieve efficient locomotion. The objective of this paper is to reveal the fundamental mechanism underlying entrainment of CPGs to resonance through sensory feedback. To uncover the essential principle, we consider the simplest setting where a pendulum is driven by the reciprocal inhibition oscillator. Existence and properties of stable oscillations are examined by the harmonic balance method, which enables approximate but insightful analysis. In particular, analytical conditions are obtained under which harmonic balance predicts existence of an oscillation at a frequency near the resonance frequency. Our result reveals that the resonance entrainment can be maintained robustly against parameter perturbations through two distinct mechanisms: negative integral feedback and positive rate feedback.

Classification of the degradability of 30 pharmaceuticals in water with ozone, UV and H2O2

Experiments were conducted to assess the degradability of 30 PPCPs, selected on the basis of consumption and environmental relevance, by O3 process, UV process and AOPs consisting of UV/ H2O2, O3/UV and O3/H2O2. A batch reactor with volume of 22L of water including the PPCPs was used. For UV process, combination of UV and H2O2 or O3 that can generate OH radicals was capable of degrading the PPCPs faster than UV radiation alone. On the other hand, O3 process and O3-based/UV-based AOPs could remove a variety of the PPCPs effectively, while some PPCPs such as 2-QCA, DEET and cyclophosphamide showed a relatively low degradability compared with the other PPCPs. However, further evaluation on formation of intermediate products resulting from the degradation of the parent PPCPs will be needed because DOC concentration was not decreased with lowered concentrations of the PPCPs.

Hepatitis C virus directly associates with insulin resistance independent of the visceral fat area in nonobese and nondiabetic patients

Insulin resistance (IR) is known to be associated with the visceral adipose tissue area. Elucidation of the relationship between hepatitis C virus (HCV) and IR is of great clinical relevance, because IR promotes liver fibrosis. In this study, we tested the hypothesis that HCV infection by itself may promote IR. We prospectively evaluated 47 patients with chronic HCV infection who underwent liver biopsy. Patients with obesity, type 2 diabetes mellitus (DM), or a history of alcohol consumption were excluded. IR was estimated by calculation of the modified homeostasis model of insulin resistance (HOMA-IR) index. Abdominal fat distribution was determined by computed tomography. Fasting blood glucose levels were within normal range in all the patients. The results of univariate analysis revealed a significant correlation between the quantity of HCV-RNA and the HOMA-IR (r = 0.368, P = 0.0291). While a significant correlation between the visceral adipose tissue area and the HOMA-IR was also observed in the 97 control, nondiabetic, non-HCV-infected patients (r = 0.398, P < 0.0001), no such significant correlation between the visceral adipose tissue area and the HOMA-IR (r = 0.124, P = 0.496) was observed in the patients with HCV infection. Multiple regression analysis with adjustment for age, gender and visceral adipose tissue area revealed a significant correlation between the HCV-RNA and the HOMA-IR (P = 0.0446). HCV is directly associated with IR in a dose-dependent manner, independent of the visceral adipose tissue area. This is the first report to demonstrate the direct involvement of HCV and IR in patients with chronic HCV infection.

[Aortic arch aneurysm with aortopulmonary fistula; report of a case]

A 77-year-old female was admitted to our hospital due to congestive heart failure. Computed tomography and angiography showed a saccular aneurysm with aortopulmonary fistula in the aortic arch. The patient underwent total arch replacement and patch closure of the pulmonary artery in an urgent operation. She was discharged after uneventful postoperative course, although staged sternal closure and 5 days of respiratory management were needed. A few cases of aortic arch aneurysm with perforation to the pulmonary artery are operated with success, which depends on severity of congestive heart failure and urgency. Therefore, it should be diagnosed exactly and rapidly. In the operation, special care should be taken to avoid right heart failure and postoperative respiratory distress.

U.S. laboratory and field trials of metofluthrin (SumiOne) emanators for reducing mosquito biting outdoors

Metofluthrin (SumiOne is a novel, vapor-active pyrethroid that is highly effective against mosquitoes. Laboratory and field trials were conducted in the United States to evaluate the mosquito repellent activity of metofluthrin-treated paper substrates ("emanators"). Initial studies were conducted to evaluate the field performance of 900-cm(2) paper fan emanators impregnated with 160 mg metofluthrin, where Aedes canadensis was the predominant species. Emanators reduced landing rates on human volunteers by between 85% and 100% compared to untreated controls. Subsequent tests with 4,000-cm(2) paper strip emanators impregnated with 200 mg metofluthrin were conducted in a wind tunnel as a precursor to conducting field trials using human bait and laboratory-reared Aedes aegypti. Paper strips, which were pre-aged in a fume hood to determine duration of protection, gave 89-91% reductions in landing rates compared with controls. Similar reductions in biting activity were also noted. Following these tests, field trials to assess effect on landing rates were conducted with emanators positioned 1.22 m on either side of volunteers protected from biting by Tyvek suits, with pre- and posttreatment counts being made. In Florida (predominantly Ochlerotatus spp.) 91-95% reductions were noted 10-30 min after emanators were deployed, while in Washington State (mostly Aedes vexans) 95-97% reductions were observed. These results demonstrate that metofluthrin-treated emanators are highly effective at repelling mosquitoes.

Systems approach to modeling the neuronal CPG for leech swimming

This paper proposes a mathematical model of the neuronal central pattern generator (CPG) for leech swimming. The model is developed through the "systems approach" where dynamical components and their connections are first identified through input/output data from physiological experiments and then integrated into a chain of nonlinear oscillators. Our approach leads to a model of moderate complexity when compared with existing models developed through biophysical principles. We show through numerical simulations that our model can successfully reproduce the phase coordination observed in the isolated nerve cord of the leech CPG. As a byproduct, a prediction is obtained for the intrinsic period gradient along the nerve cord.

Systems-level modeling of neuronal circuits for leech swimming

This paper describes a mathematical model of the neuronal central pattern generator (CPG) that controls the rhythmic body motion of the swimming leech. The systems approach is employed to capture the neuronal dynamics essential for generating coordinated oscillations of cell membrane potentials by a simple CPG architecture with a minimal number of parameters. Based on input/output data from physiological experiments, dynamical components (neurons and synaptic interactions) are first modeled individually and then integrated into a chain of nonlinear oscillators to form a CPG. We show through numerical simulations that the values of a few parameters can be estimated within physiologically reasonable ranges to achieve good fit of the data with respect to the phase, amplitude, and period. This parameter estimation leads to predictions regarding the synaptic coupling strength and intrinsic period gradient along the nerve cord, the latter of which agrees qualitatively with experimental observations.

Ewing's sarcoma fusion protein, EWS/Fli-1 and Fli-1 protein induce PLD2 but not PLD1 gene expression by binding to an ETS domain of 5' promoter

It was reported that short interfering RNA (siRNA) of EWS/Fli-1 downregulated phospholipase D (PLD)2 in Ewing's sarcoma (EWS) cell line, suggesting that PLD2 is the target of aberrant transcription factor, EWS/Fli-1. Here, we further investigated the regulation of PLD2 gene expression by EWS/Fli-1 and Fli-1 in another EWS cell line, and also in EWS/Fli-1- or Fli-1-transfected cell line. EWS/Fli-1- or Fli-1-overexpressed cells showed higher PLD2 but not PLD1 protein expression and enhanced cell proliferation as compared to mock transfectant. The treatment of these cells with 1-butanol or siRNA of PLD2 inhibited cell growth, suggesting the pivotal role of PLD in cell growth promotion. PLD2 but not PLD1 mRNA level was also increased in EWS/Fli-1 or Fli-1-transfectants. After determining the transcription initiation points, we cloned the 5' promoter of both PLD1 and PLD2 and analysed promoter activities. Results showed that EWS/Fli-1 and Fli-1 increase PLD2 gene expression by binding to an erythroblast transformation-specific domain (-126 to -120 bp from the transcription initiation site) of PLD2 promoter, which is the minimal and most powerful region. Electrophoresis mobility shift assay using truncated proteins showed that both DNA-binding domain and trans-activating domain were necessary for the enhanced gene expression of PLD2.

RhoC is essential for TGF-beta1-induced invasive capacity of rat ascites hepatoma cells

Transforming growth factor-beta1 (TGF-beta1) is a multifunctional growth factor that plays a role in cell proliferation, differentiation, extracellular matrix production, apoptosis, and cell motility. We show here that TGF-beta1 increased the invasiveness of MM1 cells, which are a highly invasive clone of rat ascites hepatoma cells. Both mRNA and protein levels of RhoC but not RhoA in TGF-beta1-treated MM1 cells increased. In parallel with this increase in expression, RhoC activity was induced by TGF-beta1 treatment. When RhoC was overexpressed in MM1 cells, the invasive capacity increased. The RhoC-overexpressing cells formed more nodules than did mock cells when injected into rat peritoneum. Furthermore, when RhoC expression was reduced by transfection with shRNA/RhoC, the invasiveness of MM1 cells decreased with concomitant suppression of RhoC expression. Thus, the induced expression of RhoC by TGF-beta1 in MM1 cells plays a critical role in TGF-beta1-induced cell migration.

Sensory feedback mechanism underlying entrainment of central pattern generator to mechanical resonance

Rhythmic body motions observed in animal locomotion are known to be controlled by neuronal circuits called central pattern generators (CPGs). It appears that CPGs are energy efficient controllers that cooperate with biomechanical and environmental constraints through sensory feedback. In particular, the CPGs tend to induce rhythmic motion of the body at a natural frequency, i.e., the CPGs are entrained to a mechanical resonance by sensory feedback. The objective of this paper is to uncover the mechanism of entrainment resulting from the dynamic interaction of the CPG and mechanical system. We first develop multiple CPG models for the reciprocal inhibition oscillator (RIO) and examine through numerical experiments whether they can be entrained to a simple pendulum. This comparative study identifies the neuronal properties essential for the entrainment. We then analyze the simplest model that captures the essential dynamics via the method of harmonic balance. It is shown that robust entrainment results from a strong, positive-feedback coupling of a lightly damped mechanical system and the RIO consisting of neurons with the complete adaptation property.

Comparison Between Intraperitoneal CO2 Insufflation and Abdominal Wall Lift on QT Dispersion and Rate-corrected QT Dispersion During Laparoscopic Cholecystectomy

This study compared the effect of intraperitoneal CO2 insufflation with abdominal wall lift on RR interval, QT interval, the rate-corrected QT (QTc) interval, QT dispersion (QTD), and the rate-corrected QTD (QTcD) using computerized measurement during laparoscopic cholecystectomy. Thirty patients scheduled for laparoscopic cholecystectomy were randomly assigned to 2 groups: intraperitoneal CO2 insufflation (CO2 group) or abdominal wall lift (lift group). A 12-lead electrocardiogram was monitored to measure parameters. The RR interval, QT interval, and QTc interval did not change significantly during the study in both groups. The QTD and QTcD in the CO2 group increased significantly during CO2 insufflation, and were significantly higher than those of the lift group. Statistically significant increases of QTD and QTcD, which are associated with an increased risk of arrhythmias and cardiac events, occur during CO2 insufflation, and QTD and QTcD in the CO2 group were significantly higher than those of the lift group.

Interdigital involvement in a case of primary cutaneous canine histoplasmosis in Japan

A 5-year-old male Siberian husky bred outdoor in Tokyo had a swollen paw with interdigital granulomatous lesions in the left hindlimb. The dog had no apparent pulmonary or gastrointestinal involvement. Histopathological analysis of the skin lesions demonstrated yeast-like organisms predominantly within macrophages. Sequence analysis of fungal ribosome RNA gene isolated from a paraffin sample revealed a 100% homology with the teleomorph of Histoplasma capsulatum. The present case may support the concept of primary cutaneous canine histoplasmosis as an endemic phenotype recognized in Japan.

Long-term results of rotational acetabular osteotomy for dysplasia of the hip in adult ambulatory patients with cerebral palsy

We performed rotational acetabular osteotomy in order to treat dysplasia of the hip in five ambulatory adults with cerebral palsy. There was one man and four women, with a mean age of 21 years (16 to 27) who were followed up for a mean of 12 years and two months. The mean Sharp angle improved from 52 degrees to 43 degrees , the mean acetabular index from 30.2 degrees to 2.8 degrees , the mean centre-edge angle from -5.6 degrees to 29.2 degrees , and the mean acetabular head index from 49.2 to 88.2. There was no progression of joint degeneration and relief from pain was maintained. Our results suggest that rotational acetabular osteotomy is a valuable option for the treatment of acetabular dysplasia in adults with cerebral palsy who have incapacitating pain in the hip.