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Uzawa M, Koda K, Kimura H, Kimura R, Ito Y, Saito A, Motomura N, Kitamura T. Time course changes in insulin sensitivity during cardiac surgery: A retrospective study on intraoperative glycemic management using an artificial pancreas. Perfusion 2024; 39:593-602. [PMID: 36757374 DOI: 10.1177/02676591231156366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Glycemic control is essential for improving the prognosis of cardiac surgery, although precise recommendations have not yet been established. Under a constant blood glucose level, the insulin infusion rate correlates with insulin resistance during glycemic control using an artificial pancreas (AP). We conducted this retrospective study to elucidate changes in intraoperative insulin sensitivity as a first step to creating glycemic control guidelines. METHODS Fifty-five cardiac surgery patients at our hospital who underwent intraoperative glycemic control using an AP were enrolled. Twenty-three patients undergoing surgical procedures requiring cardiac arrest under hypothermic cardiopulmonary bypass (CPB) with minimum rectal temperatures lower than 32°C, 13 patients undergoing surgical procedures requiring cardiac arrest under hypothermic CPB with minimum rectal temperatures of 32°C, eight patients undergoing on-pump beating coronary artery bypass grafting and 11 patients undergoing off-pump coronary artery bypass were assigned to groups A, B, C and D, respectively. We analyzed the time course of changes in the data derived from glycemic control using the AP. RESULTS Significant time course changes were observed in groups A and B, but not in groups C and D. Insulin resistance was induced after the start of hypothermic CPB in groups A and B, and the induced change was not resolved by the rewarming procedure, remaining sustained until the end of surgery. CONCLUSIONS Hypothermia is the predominant factor of the induced insulin resistance during cardiac surgery. Thus, careful glycemic management during hypothermic CPB is important. Prospective clinical studies are required to confirm the findings of this study.
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Affiliation(s)
- Masashi Uzawa
- Department of Anesthesiology, Toho University Sakura Medical Center, Chiba, Japan
| | - Kenichiro Koda
- Department of Anesthesiology, Toho University Sakura Medical Center, Chiba, Japan
| | - Haruka Kimura
- Department of Anesthesiology, Toho University Sakura Medical Center, Chiba, Japan
| | - Rie Kimura
- Department of Anesthesiology, Toho University Sakura Medical Center, Chiba, Japan
| | - Yuya Ito
- Department of Cardiovascular Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Aya Saito
- Department of Cardiovascular Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Takayuki Kitamura
- Department of Anesthesiology, Toho University Sakura Medical Center, Chiba, Japan
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Yu X, Pan Z, Chu H, Pan H, Zhao S, Li D. Diode-pumped efficient high-power cascade Tm:GdVO 4 laser simultaneously operating at ∼2 μm and ∼2.3 μm. OPTICS EXPRESS 2023; 31:26368-26377. [PMID: 37710499 DOI: 10.1364/oe.497230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 09/16/2023]
Abstract
The laser diode (LD)-pumped efficient high-power cascade Tm:GdVO4 laser simultaneously operating on the 3F4 → 3H6 (at ∼2 μm) and 3H4 → 3H5 (at ∼2.3 μm) Tm3+ transition was first reported in this paper. The cascade Tm:GdVO4 laser generated a maximum total continuous-wave (CW) laser output power of 8.42 W with a slope efficiency of 40%, out of which the maximum ∼2.3 μm CW laser output power was 2.88 W with a slope efficiency of 14%. To our knowledge, 2.88 W is the highest CW laser output power amongst the LD-CW-pumped ∼2.3 μm Tm3+-doped lasers reported so far.
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Yu X, Pan Z, Chu H, Zha F, Pan H, Ma L, Loiko P, Camy P, Li D. Cascade lasing at ∼2 μm and ∼2.3 μm in a diode-pumped Tm:YVO 4 laser. OPTICS EXPRESS 2023; 31:13576-13584. [PMID: 37157242 DOI: 10.1364/oe.484647] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We report on the cascade continuous-wave operation of a diode-pumped Tm:YVO4 laser on the 3F4 → 3H6 (at ∼2 μm) and 3H4 → 3H5 (at ∼2.3 μm) Tm3+ transitions. Pumped with a fiber-coupled spatially multimode 794 nm AlGaAs laser diode, the 1.5 at.% Tm:YVO4 laser yielded a maximum total output power of 6.09 W with a slope efficiency of 35.7% out of which the 3H4 → 3H5 laser emission corresponded to 1.15 W at 2291-2295 and 2362-2371 nm with a slope efficiency of 7.9% and a laser threshold of 6.25 W.
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Hanazaki K, Tanioka N, Munekage M, Uemura S, Maeda H. Closed-loop artificial endocrine pancreas from Japan. Artif Organs 2021; 45:958-967. [PMID: 34105784 DOI: 10.1111/aor.14008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022]
Abstract
The development of a closed-loop artificial pancreas (AP) in the Western countries and Japan is different. In Western countries, wearable AP with a closed-loop glycemic control system has been developed as a treatment for patients with type 1 and type 2 diabetes. On the contrary, in Japan, bedside closed-loop AP explored by a Japanese company (Nikkiso, Tokyo, Japan) has developed as perioperative glycemic control device in surgical patients and acute care patients with emergency. In this article, we reviewed the scientific evidence in the past and present and future prospects of perioperative glycemic control using bedside AP with a closed-loop system in Japan. Conventional perioperative strict glycemic controls have three major problems: hyperglycemia, hypoglycemia, and variability in blood glucose concentrations. In Japan, perioperative strict glycemic control using the current bedside AP STG-55 (Nikkiso, Tokyo, Japan) has been developed since 2010. This novel glycemic control method achieved not only stable glycemic control without hyperglycemia, hypoglycemia, and less variability of blood glucose concentrations but also reduced postoperative infectious complications in patients undergoing major surgeries. Among the rapidly increasing number of surgical or emergency patients with diabetes, frailty, and sarcopenia of intrinsic glucose intolerance, more sophisticated and smaller AP available easily in operating rooms and intensive care units will be warranted to promote improved therapeutic outcomes in such critically ill patients.
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Affiliation(s)
- Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
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Inoue H, Harada K, Narimatsu E, Uemura S, Aisaka W, Bunya N, Nomura K, Katayama Y. Pathophysiologic Mechanisms of Hypothermia-Induced Pancreatic Injury in a Rat Model of Body Surface Cooling. Pancreas 2021; 50:235-242. [PMID: 33565801 DOI: 10.1097/mpa.0000000000001738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The mechanisms underlying hypothermia-induced pancreatic injury are unclear. Thus, we investigated the pathophysiology of hypothermia-induced pancreatic injury. METHODS We created a normal circulatory model with body surface cooling in rats. We divided the rats into control (36°C-38°C), mild hypothermia (33°C-35°C), moderate hypothermia (30°C-32°C), and severe hypothermia (27°C-29°C) (n = 5 per group) groups. Then, we induced circulatory failure with a cooling model using high-dose inhalation anesthesia and divided the rats into control (36°C-38°C) and severe hypothermia (27°C-29°C) (n = 5 per group) groups. Serum samples were collected before the introduction of hypothermia. Serum and pancreatic tissue were collected after maintaining the target body temperature for 1 hour. RESULTS Hematoxylin and eosin staining of the pancreas revealed vacuoles and edema in the hypothermia group. Serum amylase (P = 0.056), lactic acid (P < 0.05), interleukin 1β (P < 0.05), interleukin 6 (P < 0.05), and tumor necrosis factor α (P = 0.13) levels were suppressed by hypothermia. The circulatory failure model exhibited pancreatic injury. CONCLUSIONS Hypothermia induced bilateral effects on the pancreas. Morphologically, hypothermia induced pancreatic injury based on characteristic pathology typified by vacuoles. Serologically, hypothermia induced protective effects on the pancreas by suppressing amylase and inflammatory cytokine levels.
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Affiliation(s)
| | | | | | | | - Wakiko Aisaka
- Intensive Care Medicine, Sapporo Medical University, Sapporo, Japan
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Utility of bedside artificial pancreas for postoperative glycemic control in cardiac surgery. J Artif Organs 2020; 24:225-233. [DOI: 10.1007/s10047-020-01223-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/21/2020] [Indexed: 01/23/2023]
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Aizawa K, Muraoka A, Kurumisawa S, Akutsu H, Sugaya A, Uesugi S, Kawahito K. Artificial endocrine pancreas with a closed-loop system effectively suppresses the accelerated hyperglycemic status after reperfusion during aortic surgery. Gen Thorac Cardiovasc Surg 2020; 69:14-18. [PMID: 32845449 DOI: 10.1007/s11748-020-01415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To control intraoperative hyperglycemia in patients who underwent aortic surgery using STG-55® artificial endocrine pancreas and clarify the effectiveness of this device. METHODS Blood glucose control using the STG-55® was performed in 18 patients (15 men and 3 women; age, 66 ± 10 years) who required hypothermic circulatory arrest (STG-55® group). Seventeen patients (10 men and 7 women; age, 71 ± 8 years) whose blood glucose was controlled using the conventional method were included in the control group. Glucose concentration was controlled with the aim of maintaining it at 150 mg/dl. RESULTS In both groups, the blood glucose concentrations did not significantly change during the interruption of systemic perfusion; however, a sharp increase was noted immediately after reperfusion. Although the hyperglycemic status persisted after reperfusion in the control group, it was effectively suppressed in the STG-55® group (STG® vs. control group at 50 min after reperfusion: 180 ± 35 vs. 212 ± 47 mg/dl, p = 0.026) and blood glucose concentration reached the target value of 150 mg/dl at 100 min after reperfusion (STG® vs. control group: 153 ± 29 vs. 215 ± 43 mg/dl, p = 0.0008). The total administered insulin dose was 175 ± 81 U and 5 ± 3 U in the STG® and control groups, respectively (p < 0.0001). CONCLUSIONS To treat the accelerated hyperglycemic status in aortic surgery requiring circulatory arrest, strict glycemic control using an artificial endocrine pancreas might be beneficial.
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Affiliation(s)
- Kei Aizawa
- Department of Cardiovascular Surgery, Jichi Medical School, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Arata Muraoka
- Department of Cardiovascular Surgery, Jichi Medical School, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Soki Kurumisawa
- Department of Cardiovascular Surgery, Jichi Medical School, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hirohiko Akutsu
- Department of Cardiovascular Surgery, Jichi Medical School, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Akira Sugaya
- Department of Cardiovascular Surgery, Jichi Medical School, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Satoshi Uesugi
- Department of Cardiovascular Surgery, Jichi Medical School, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Koji Kawahito
- Department of Cardiovascular Surgery, Jichi Medical School, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
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