Improvement trend for individual health guidance intervention according to Japan clinical guidelines by public health nurses for type 2 diabetes mellitus who visited for medical checkups regularly: a case-control preliminary report

We conducted a retrospective case-control study to assess the efficacy of personalized health guidance interventions on individuals with type 2 diabetes mellitus and obesity. A selection was made of individuals in regular visits to the Takagi Hospital for medical checkups between January 2017, and October 2021. Totally, 108 subjects (cases) with health guidance were divided into 2 groups: one group without pharmacotherapy for diabetes mellitus in medical institutions (n = 92) and another group with pharmacotherapy (n = 116). Cases were provided with personalized health guidance interventions by public health nurses for 30 min, in accordance with the Japanese clinical guidelines for the prevention of lifestyle-related diseases. Sex- and age-matched controls were chosen from individuals with diabetes mellitus without health guidance. The intervention without pharmacotherapy resulted in improvements in health indicators, including body weight, waist circumference, diastolic blood pressure, triglyceride levels, and γ-glutamyl trans-peptidase. These positive effects were not observed in the control group without health guidance. The therapeutic effects of health guidance were observed in cases where pharmacotherapy was administered. In conclusion, the implementation of individual health guidance interventions may prove to be effective for individuals with type 2 diabetes mellitus and obesity who regularly attend medical checkups.

Effects of starch content of calf starter on rumen properties and blood concentrations of metabolites and hormones in dairy calves under a high plane of milk feeding

The objective of this study was to investigate the effects of calf starters with different starch content on rumen and blood properties in calves fed under a high plane of nutrition program. Twenty-seven Holstein calves (14 female, 13 male) were assigned to one of three starter treatment groups in a randomized block design: high-starch (41.8%) (n = 9), H; medium-starch (31.9%) (n = 9), M; low-starch (22.0%) (n = 9), L. Milk replacer on powder basis was fed up to 1.2 kg/day as fed, gradually reduced from 6 weeks of age; calves were weaned at 8 weeks of age. Each starter (up to 3.5 kg/day as fed) and chopped hay were provided ad libitum from 5 days of age. Blood was collected from 4 to 13 weeks of age. Rumen fluid was collected at 6, 8, 10, and 13 weeks of age. Serum urea nitrogen concentration after weaning was the lowest in H. Plasma IGF-1 concentrations were higher in H than in L. Ruminal pH was not different, but the molar proportion of ruminal propionate was higher in H than in L throughout the study period. In summary, a high-starch starter may increase propionate production and microbial protein synthesis in the rumen, inducing higher plasma IGF-1 concentrations.

Analysis of Crop Consumption Using Scatological Samples from the Red-Crowned Crane Grus japonensis in Eastern Hokkaido, Japan

Total DNA extracts from the intestinal contents of 60 flying red-crowned cranes (juveniles, subadults and adults) found dead in 2006-2021, and the feces of 25 chicks collected in June and July of 2016-2018, were used for PCR reactions with primers specific for 16 crops, followed by high-throughput sequencing. The most predominant crop detected was corn in adult and subadult cranes (61.7%). Other grains (barley, wheat, soybean) (5.0-8.3%) and vegetables (tomatoes, Chinese cabbage, etc.) (1.7-6.7%) were also detected in flying cranes. Surprisingly, some of the detected crops were not grown in the Kushiro and Nemuro regions. There was no significant difference in crop intake status in winter and that in other seasons for most of the crops. Corn (28.0%), soybeans (8.0%), wheat and beet (4.0%) were detected in crane chicks in summer, though the detection rates were generally lower than those in flying cranes. Alfalfa, which is not grown in eastern Hokkaido but is used in some cattle feed, was detected in some cranes. Rice, buckwheat, adzuki beans, common beans, potatoes and carrots were not detected at any life stage, indicating the preferences of red-crowned cranes. The results suggest that red-crowned cranes in Hokkaido are dependent on dairy farmers for their feed supply.

Effects of starch content of calf starter on feed intake, growth performance, and fecal properties in dairy calves under a high plane of milk replacer feeding

The objective of this study was to investigate the effects of different starch contents in calf starter on the growth, feed intake, and fecal characteristics in dairy calves fed under a high plane of nutrition. Twenty-seven Holstein calves were assigned equally to one of three calf starter treatment groups in a randomized block design: high (H) starch (41.8%); medium (M) starch (31.9%); and low (L) starch (22.0%). Milk replacer was fed up to 1.2 kg/day as fed, gradually reduced from 6 weeks of age; calves were weaned at 8 weeks of age. Each starter (up to 3.5 kg/day as fed) and chopped hay were provided ad libitum from 5 days of age. Fecal samples, along with body measurements, were collected from 4 to 13 weeks of age. The average daily gain after weaning was greater in the H group than in the L group. The average starter intake for 3 days before weaning was not different among treatments but was greater after weaning in the H group than in the L group. Starter starch content did not affect the number of days with diarrhea or fecal starch concentration. The high-starch starter had no adverse effects during the weaning transition.

Sodium butyrate administration modulates the ruminal villus height, inflammation-related gene expression, and plasma hormones concentration in dry cows fed a high-fiber diet

The objectives of this study were to evaluate the effects of sodium butyrate on the ruminal villus morphology, mRNA expression associated with nutrient metabolism and inflammation in the ruminal epithelium, and plasma concentrations of metabolites and hormones in non-lactating cows fed a high-fiber diet. Four Holstein cows with a rumen cannula were assigned to two treatments in a crossover design. The treatments were ruminal administration of sodium butyrate premix or control premix before feeding to cows fed the same total mixed ration mainly composed of glass silage once a day. Sodium butyrate was provided at a butyrate dose of 0.04% per kg body weight. The control premix was made by replacing sodium-butyrate with wheat bran. The plasma β-hydroxybutyrate concentration increased 3 to 6 h after the butyrate premix administration but returned to a concentration similar to that of the control before feeding. After continuous administration, increases in the ruminal villus height and plasma concentration of glucagon-like peptide-2, and lower gene expression of TNF-α, IL-1β, and TLR-2 in the rumen epithelium were observed in cows supplied with the butyrate premix. These results showed that sodium butyrate affects rumen epithelial morphology and plasma concentrations of hormones even under a low fermentable diet.

The effect of sodium butyrate supplementation on ruminal and fecal pH and serum lipopolysaccharide-binding protein after ruminal acidosis challenge in nonlactating cows

The objective of this study was to evaluate effects of sodium-butyrate supplementation on gastrointestinal function and the inflammatory response to ruminal acidosis (RA) challenge in cows. Four nonlactating cows with a rumen cannula were assigned to two treatments in a crossover design. Treatments were ruminal administration of sodium-butyrate (BUT) or control (CON). Sodium-butyrate was provided as Gustor BP70 and administered at a butyrate dose of 0.04% per kg body weight. The CON premix was made by replacing sodium-butyrate with wheat bran. Experimental periods were 28 days long with 21-day washout period separating the treatments. On Day 25 of each period, corn starch was ruminally administered at 0.7% per kg body weight as RA challenge. After RA challenge, ruminal pH was lower, and endotoxin concentration was higher for cows provided with BUT than those with CON, but the increase in fecal starch and the decrease in fecal pH were attenuated by BUT. The effect of butyrate supplementation on serum lipopolysaccharide-binding protein after RA challenge was not found. From these findings, butyrate supplementation mitigated rectal acidosis by reducing the flux of fermentable carbohydrate into the large intestine. An anti-inflammatory effect of butyrate was not observed, possibly due to lower pH and higher endotoxin concentration in the rumen.

[A case of elderly myxedema coma patient with end-stage renal failure]

CASE

84-year-old woman had been diagnosed hypothyroidism before, but she did not take tablets of thyroid hormone prescribed. Anorexia and decreased consciousness level were discovered by workers of the facility. Her family doctor found thyroid function abnormality as a cause, and she was introduced to our hospital to treat because the whole body condition was bad. Her physical examination was observed that JCS was 3-10. Laboratory examination showed that TSH 562.81 μIU/mL, fT4 0.40 ng/mL, pH 7.33, and Na 124 mEq/L. It was not a contradictory finding with the diagnostic criteria of mucus edema coma. Blood and peritoneal dialysis is denied, although her data indicated eGFR 8-10 ml/min/1.73 m2. Her hospitalization was long-term, but exhibited finally good clinical course. After three months of hospitalization, she was discharged from the hospital. The problems were as follows. The clear guideline of myxedema coma with end-stage renal failure state and many complications was not found. She and her family did not hope dialysis under this condition.We treated a case of myxedema coma in a case of an elderly person with terminal renal failure who did not hope dialysis. In addition to myxedema coma as a rare disease, there are many basic diseases in the elderly. Although it was a difficult case, it is important to repeatedly confirm the explanation and the intention of the person and the family with regard to the selection of the treatment policy.

Effect of yeast cell wall supplementation on production performances and blood biochemical indices of dairy cows in different lactation periods

Aim:

This experiment was conducted to determine the effect of yeast cell wall (YCW) supplementation on production performances and blood biochemical indices such as liver enzyme activities, energy metabolites, and electrolyte concentrations of dairy cows in different lactation periods (LP).

Materials and Methods:

Thirty-two lactating Holstein cows were assigned into 2×2 factorial arrangement, in which the factors were the treatment (TM) (control [n=16] vs. YCW [n=16]) and the LP (early lactation [n=14] vs. mid-lactation [n=18]). The cows with day in milk (DIM) <120 (81±7 DIM) were defined as early lactating cows, whereas the cows with DIM >120 (179±5 DIM) were assumed as mid-lactating cows. The YCW (SafMannan; Phileo, Lesaffre Animal Care, France) was used as the dietary supplement (10 g/cow/day) in this experiment. The statistical analysis of the data was performed by the two-way analysis of variance using the general linear model procedure to determine the main effects (TM and LP) and their interaction (TM×LP) on production performances and blood biochemical parameters of experimental cows.

Results:

No significant effects (p>0.05) of YCW supplementation on production performances and blood biochemical indices of cows in TM groups (control vs. YCW) were observed; however, some obvious effects were detected in LP (early- and mid-lactation). Milk and milk component yield of cows in early lactation were significantly higher (p<0.05) than in mid-lactation, whereas somatic cell count and milk urea nitrogen were not different (p>0.05) with the YCW supplementation. The higher level (p<0.05) of serum albumin was found in mid-lactating cows after YCW supplementation. Before the experiment, the higher (p<0.05) non-esterified fatty acid (NEFA) and NEFA/total cholesterol (T-Cho) ratio, and the lower (p<0.05) calcium (Ca) concentration were observed in early lactating cows comparison with mid-lactating cows; however, there were not different after YCW supplementation.

Conclusion:

The positive effects of YCW supplementation on milk and milk component yields, energy metabolite, especially NEFA and NEFA/T-Cho ratio and Ca concentration were observed in early lactating cows rather than mid-lactating cows.

A case of spontaneous coronary artery dissection complicated with pseudoaneurysm healed by medical treatment: Follow-up by multidetector computed tomography

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial ischemia. Identification of intimal flap, true and false lumens in coronary angiogram (CAG) is the standard method to diagnose SCAD. In cases of obscure intimal flap, intravascular ultrasound (IVUS) is a useful method to diagnose, although crossing the wire and IVUS in the dissected lesion is invasive. Multidetector computed tomography (MDCT) provides valuable information in any clinical setting less invasively. We report here a rare case of spontaneous dissecting coronary artery pseudoaneurysm diagnosed by CAG and MDCT, healed by medical treatment, and followed up by MDCT over a 2-year period. <Learning objective: Spontaneous coronary artery dissection (SCAD) is usually diagnosed by the findings of intimal flap, true and false lumens in coronary angiogram (CAG). In case intimal flap is not obvious in CAG, intravascular ultrasound (IVUS) is a useful method to diagnose, although crossing the wire and IVUS in the dissected lesion is invasive. Multidetector computed tomography is an alternative useful method to obtain valuable information to diagnose SCAD less invasively.>.

Change of Oral to Topical Corticosteroid Therapy Exacerbated Glucose Tolerance in a Patient with Plaque Psoriasis

BACKGROUND Psoriasis is known as the most frequent disease treated by long-term topical steroids. It is also known that patients with thick, chronic plaques require the highest potency topical steroids. However, the treatment is limited to up to four weeks due to risk of systemic absorption. CASE REPORT An 80-year-old man was diagnosed with type 2 diabetes 16 years before, and was being administered insulin combined with alpha glucosidase inhibitor. He was diagnosed with plaque psoriasis and his oral steroid treatment was switched to topical steroid treatment due to lack of improvement and poorly controlled blood glucose level. The hypoglycemic events improved after the psoriatic lesions improved. CONCLUSIONS Control of blood glucose level is difficult at the very beginning of topical steroid treatment for psoriasis especially if a patient is receiving insulin treatment. Intense monitoring of blood glucose level during initiation of topical steroid treatment is necessary to prevent unfavorable complications.

TYK2 Promoter Variant and Diabetes Mellitus in the Japanese

BACKGROUND

Recently, natural mutation of Tyrosine kinase 2 (Tyk2) gene has been shown to determine susceptibility to murine virus-induced diabetes. In addition, a previous human genome-wide study suggested the type 1 diabetes (T1D) susceptibility region to be 19p13, where the human TYK2 gene is located (19p13.2).

METHODS

Polymorphisms of TYK2 gene at the promoter region and exons were studied among 331 healthy controls, and 302 patients with T1D and 314 with type 2 diabetes (T2D) in the Japanese.

FINDINGS

A TYK2 promoter haplotype with multiple genetic polymorphisms, which are in complete linkage disequilibrium, named TYK2 promoter variant, presenting decreased promoter activity, is associated with an increased risk of not only T1D (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.2 to 4.6; P = 0.01), but also T2D (OR, 2.1; 95% CI, 1.1 to 4.1; P = 0.03). The risk is high in patients with T1D associated with flu-like syndrome at diabetes onset and also those without anti-glutamic acid decarboxylase autoantibody.

INTERPRETATION

The TYK2 promoter variant is associated with an overall risk for diabetes, serving a good candidate as a virus-induced diabetes susceptibility gene in humans.

FUNDING

Ministry of Education, Culture, Sports, Science and Technology and of Health, Labor and Welfare of Japan.

Reduced Tyk2 gene expression in β-cells due to natural mutation determines susceptibility to virus-induced diabetes

Accumulating evidence suggests that viruses play an important role in the development of diabetes. Although the diabetogenic encephalomyocarditis strain D virus induces diabetes in restricted lines of inbred mice, the susceptibility genes to virus-induced diabetes have not been identified. We report here that novel Tyrosine kinase 2 (Tyk2) gene mutations are present in virus-induced diabetes-sensitive SJL and SWR mice. Mice carrying the mutant Tyk2 gene on the virus-resistant C57BL/6 background are highly sensitive to virus-induced diabetes. Tyk2 gene expression is strongly reduced in Tyk2-mutant mice, associated with low Tyk2 promoter activity, and leads to decreased expression of interferon-inducible genes, resulting in significantly compromised antiviral response. Tyk2-mutant pancreatic β-cells are unresponsive even to high dose of Type I interferon. Reversal of virus-induced diabetes could be achieved by β-cell-specific Tyk2 gene expression. Thus, reduced Tyk2 gene expression in pancreatic β-cells due to natural mutation is responsible for susceptibility to virus-induced diabetes.

Diabetes can be caused by viral infections in humans and some inbred mice, suggesting genetic predisposition. Here the authors show that mutations in Tyk2 gene underlie susceptibility to virus-induced diabetes in mice, due to Tyk2 requirement for antiviral response in insulin-producing cells.

[Mecobalamin improved pernicious anemia in an elderly individual with Hashimoto's disease and diabetes mellitus]

A 73-year-old Japanese man with Hashimoto's disease and diabetes mellitus received regular medical checkups for type 2 diabetes care. Blood tests indicated macrocytic anemia (red blood cell count, 279×104 /μL; hemoglobin, 12.2 g/dL; hematocrit, 34.0%; mean corpuscular volume, 121.9 fL). The laboratory data demonstrated a normal folic acid level with a low vitamin B12 level. An endoscopic examination indicated no signs of gastric or intestinal bleeding. Positive results for anti-intrinsic factor antibodies were strongly suggestive of pernicious anemia. The patient refused cobalamin injections to treat the anemia. However, the oral administration of mecobalamin for the treatment of diabetic neuropathy was simultaneously initiated. Subsequently, the anemia gradually improved. Oral mecobalamin was presumably effective for pernicious anemia management. Anemia is frequently observed in elderly patients, and the incidence of pernicious anemia increases with age. Anemia is conventionally treated with cobalamin injections. Currently, the oral administration of mecobalamin is not the typical treatment for anemia. However, as in our case, a few reports have documented positive results following oral mecobalamin treatment. Moreover, oral mecobalamin is a fairly recent, novel, noninvasive mode of treatment, making it ideal for elderly patients, who are generally frail. This case suggests the efficacy of mecobalamin for the treatment of pernicious anemia.

The significance of tyrosine kinase 2 gene in encephalomyocarditis-D virus-induced diabetes as studied in Tyk2 gene knockout mice (P6334)

Type 1 diabetes mellitus results form progressive loss of pancreatic β cells. The virus, as one of environmental factors, has been long considered to play a role in the development of type 1 diabetes. The D variant of encephalomyocarditis (EMC-D) virus induced susceptible strain of mice to become type 1 diabetes. We have already reported that innate immunity may play an important role in protection against EMC-D virus-induced diabetes (Arch Virol, 2008). In the present study, we analyzed the role of Tyk2 gene in the pathogenic mechanism of EMC-D virus-induced diabetes by using Tyk2 gene knockout (KO) mice. Tyk2 gene KO C57BL/6J mice, mouse strain resistant to EMC-D virus-induced diabetes, developed diabetes. In order to examine whether Tyk2 gene expression was important in parenchymal or immune cells to protect against EMC-D virus-induced diabetes, we developed splenic chimera mice. Tyk2 gene expression was important in parenchymal cells, but not in spleen cells, to resist against EMC-D virus-induced diabetes. Consistently, mice specifically expressed Tyk2 gene only in pancreatic β cells prevented EMC-D virus-induced diabetes. These observations suggest that Tyk2 gene expressed in pancreatic β cells plays a significant role in preventing EMC-D virus-induced diabetes in mice.

Post-challenge hyperglycemia is a significant risk factor for the development of hepatocellular carcinoma in patients with chronic hepatitis C

BACKGROUND

Several epidemiological studies have reported that diabetes mellitus is a risk factor for hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-positive patients. However, it is unclear whether or not post-challenge hyperglycemia is a risk factor. The purpose of this study was to determine the association between post-challenge hyperglycemia and hepatocarcinogenesis in HCV-positive patients.

METHODS

A total of 203 HCV-RNA-positive subjects (108 males, mean age 54.3 ± 10.8 years; 95 females, mean age 56.6 ± 10.3 years; genotype 1b/2a/2b/3a: 152/38/12/1) who underwent liver biopsy and a 75-g oral glucose tolerance test, and who were treated with interferon (IFN) were enrolled in this study. None of the subjects had been treated with antidiabetic drugs. The subjects underwent ultrasonography and/or computed tomography every 6 months after the end of the IFN therapy.

RESULTS

Thirteen patients, including one patient who achieved a sustained viral response (SVR) with IFN, developed HCC. On multivariate analysis, male sex, age >65 years, excessive alcohol consumption, non-SVR, liver steatosis area >5% in liver specimens, and 120-min post-challenge hyperglycemia were risk factors for the development of HCC. After matching subjects for sex, age, alcohol intake, and response to the IFN therapy, advanced fibrosis stages [hazard ratio (HR) 2.8], liver steatosis (HR 5.4), and 120-min post-challenge hyperglycemia (HR 4.9) were significant risk factors for the development of HCC. Furthermore, after matching for the fibrosis stage, liver steatosis (HR 5.7) and 120-min post-challenge hyperglycemia (HR 6.9) remained as significant factors for HCC development.

CONCLUSION

Post-challenge hyperglycemia is an independent risk factor for HCC in HCV-positive patients.

Effects of feeding ratio of beet pulp to alfalfa hay or grass hay on ruminal mat characteristics and chewing activity in Holstein dry cows

The influence of the feeding ratio of a non-forage fiber source and hay on ruminal mat characteristics and chewing activity was evaluated in dairy dry cows. Cows were fed four different diets: the ratios of alfalfa hay (AH) to beet pulp (BP) were 8:2 (dry matter basis, A8B2) and 2:8 (A2B8), and those of grass hay (GH) to BP were 8:2 (G8B2) and 2:8 (G2B8). Total eating time was decreased with increasing BP content (P < 0.01). Total rumination time for AH was shorter than that for GH (P < 0.01), and it decreased with increasing BP content (P < 0.01). The ruminal mat was detected by using a penetration resistance test of the rumen digesta. Penetration resistance value (PRV) of ruminal mat was highest with the G8B2 diet and PRV decreased with increasing BP content (P < 0.05) and feeding AH (P < 0.05). Thickness of the ruminal mat was greater for increasing BP content (P < 0.05). Simple linear regression of ruminal mat PRV on total rumination time resulted in a high positive correlation (r = 0.744; P < 0.001; n = 16). The results demonstrated that increasing the PRV of the ruminal mat stimulated rumination activity and a ruminal mat could be formed, although it was soft even when cows were offered a large quantity of BP.

A pilot study suggests that the G/G genotype of resistin single nucleotide polymorphism at -420 may be an independent predictor of a reduction in fasting plasma glucose and insulin resistance by pioglitazone in type 2 diabetes

The aim of this study was to determine the relation between the G/G genotype of a resistin gene promoter single nucleotide polymorphism (SNP) at -420 (rs1862513) and glycemic control by pioglitazone in type 2 diabetes. In Study 1, 121 type 2 diabetic patients were treated with pioglitazone (15 or 30 mg/day) for 12 weeks, in addition to previous medication. In Study 2, 63 patients who had been treated with pioglitazone for 12 weeks were examined retrospectively. In Study 1, multiple regression analysis revealed that the G/G but not C/G genotype was correlated with a reduction in fasting plasma glucose (FPG) and homeostasis model assessment of insulin resistance (HOMA-IR) compared to C/C. When adjusted for age, gender, and BMI, the G/G genotype was an independent factor for the reduction of FPG (P=0.020) and HOMA-IR (P =0.012). When studies 1 and 2 were combined by adjusting the studies, age, gender, and BMI, the reduction of HbA1c was correlated with the G/G genotype (beta=-0.511, P=0.044). Therefore, this pilot study suggests that the G/G genotype of resistin SNP -420 may be an independent predictor of the reduction of fasting plasma glucose and HOMA-IR by pioglitazone.

A case of atypical thyroid storm with hypoglycemia and lactic acidosis

We describe herein a case of thyroid storm with hypoglycemia and lactic acidosis-a rare complication of thyroid storm. The patient was a 50-year-old Japanese woman who suffered cardiopulmonary arrest an hour after hospitalization. Analysis of a blood sample obtained before her cardiopulmonary arrest yielded surprising results: Her plasma glucose level was 14 mg/dL and her lactic acid concentration had increased to 6.238 mM. Thus, if atypical thyroid storm presents with normothermic hypoglycemia, and lactic acidosis, we believe it is necessary to consider a diagnosis of thyroid storm earlier, because this condition requires emergency treatment. Moreover, it is very important to apply standard principles in the treatment of atypical cases of thyroid storm.

Diabetic ketoacidosis with cytomegalovirus-associated colitis

Cytomegalovirus-associated colitis (CMV colitis) typically occurs in patients in the immunosuppressed state. A diabetic ketoacidosis state further deteriorates immunological functions. However, diabetic patients in a hyperglycemic state developing CMV colitis have been rarely observed. During the course of this study, we came across a case of diabetic ketoacidosis (DKA) with CMV colitis, which is reported herein.

[An elderly case of hyperglycemic hyperosmolar syndrome with hyperketonemia]

A 72-year-old man had been treated for type 2 diabetes mellitus and gastric cancer. He had been receiving insulin and chemotherapy because of diabetes mellitus and terminal gastric cancer. The dose of insulin was decreased due to the appetite loss, but his general condition deteriorated with disturbed consciousness (JCS I-3), so he was admitted to our hospital in November 2006. On admission, he showed abnormal laboratory data such as WBC 11,070/microl, Hb 10.2 g/dl, serum BUN 64.1 mg/dl, serum Cr 2.23 mg/dl, serum CRP 16.78 mg/dl, plasma glucose 830 mg/dl, serum osmolarity 360 mOsm/l, and serum total keton body 5,490 micromol/l. However, serum Na (142 mEq/l), serum K (4.5 mEq/l), arterial blood pH (7.368), and the anion gap (15 mEq/l) were within the normal range. He was given a diagnosis of hyperglycemic hyperosmolar syndrome with hyperketonemia. Immediately treatment was started with physiologic saline and regular insulin infusion. After treatment, glucose level and serum osmolarity ameliorated. Though elderly cases with hyperglycemic hyperosmolar syndrome and hyperketonemia are rarely reported, it is important to be aware that elderly patients often have very atypical signs and symptoms. We report this case to show diverse nature of elderly patients.

The significance of T cells, B cells, antibodies and macrophages against encephalomyocarditis (EMC)-D virus-induced diabetes in mice

In order to clarify the significance of protective mechanisms against encephalomyocarditis (EMC) virus-induced diabetes in mice, we studied the relative importance of T cells, B cells, antibodies and macrophages in the prevention of virus-induced diabetes. Neither T cell-deficient athymic nude mice nor B cell-deficient microMT/microMT mice showed an enhanced clinical course of EMC-D virus-induced diabetes, indicating that neither T cells nor B cells played a major role in the protection against EMC-D-virus-induced diabetes. Transfer of a large amount of antiserum to EMC-D-virus-infected mice protected the development of diabetes only when transferred within 36 h of infection, the timing of which was earlier than that for the production of natural neutralizing antibodied. Since pretreatment of mice with the macrophage-activating immunopotentiator Corynebacterium parvum (CP) completely prevented the development of diabetes, we studied the clinical outcome of EMC-D-virus-infected mice pretreated with CP. Mice treated with CP showed reduced proliferation of EMC-D virus in the affected organs, including the pancreas, while the levels of development of neutralizing antibody and serum interferon were not enhanced compared with the controls. Finally, we studied the macrophages derived from mice pretreated with CP and found that they inhibited the growth of EMC-D virus in vitro more than those derived from non-treated and thioglycolate-treated mice. Taken together, it can be suggested that neither T cells nor B cells, which have to do with adaptive immunity, play a significant role in the pathogenesis of EMC-D-virus-induced diabetes, while innate immunity, which is dependent on activated macrophages, contributes to in vivo resistance against EMC-D-virus-induced diabetes.

[Case of multiple vertebral osteomyelitis due to Streptococcus pneumoniae]

We report a rare case of multiple vertebral osteomyelitis due to Streptococcus pneumoniae. A 73-year-old man admitted for back pain and a low-grade fever was found in laboratory studies to have severe leukocytosis and increased C-reactive protein, but neither computed tomography (CT) nor vertebral magnetic resonance imaging (MRI) clarified the cause of infection in the painful hip lesion, and paralysis developed. in the left leg MRI eventually indicated a vertebral abscess involving multiple lesions at C4-7 and L4-5. We had started antibiotics before blood culture clarified Streptocccus pneumonaie, and antibiotics acted more effectively thereafter. The clinical course was good, little paralysis remained.