Search

Abstract Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been reported to have effects beyond lowering blood glucose levels, with certain SGLT2i expanding their indications to chronic kidney disease and chronic heart failure. We focused on the hepatoprotective and renoprotective effects of six SGLT2i and assessed whether the effects were unique to each drug or common class effects, in addition to whether the renal and hepatoprotective effects vary based on renal and hepatic status. Methods Patients with diabetes (ipragliflozin: 837, empagliflozin: 850, canagliflozin: 922, dapagliflozin: 590, tofogliflozin: 288, and luseogliflozin: 193) who initiated SGLT2i treatment and were monitored for one year were included. The propensity score (PS) was calculated using patient backgrounds (age, sex, height, weight, body mass index [BMI], disease duration, concomitant diabetes medications, underlying conditions, glycated hemoglobin [HbA1c], estimated glomerular filtration rate [eGFR], aspartate aminotransferase [AST], alanine aminotransferase [ALT], high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglyceride [TG] levels) as covariates. Additionally, the inverse probability of treatment weighting (IPTW) approach was used to compare liver and renal function test values. Results Pre- and 12-month post-treatment comparisons demonstrated a significant reduction in hepatic function (AST and ALT) and an increase in renal function (eCcr and eGFR) for all SGLT2i. Comparison of differences between pre- and 12-month post-treatment using the IPTW approach demonstrated no significant differences in AST, ALT, and eGFR levels between SGLT2i. At 12 months post-treatment, 67 patients were classified as having a more severe CKD than those at pre-treatment, representing only 1.8% of all patients (67/3,680). Similarly, 107 patients with AST and 147 patients with ALT were classified as having progressed to a more severe grade than at pre-treatment, representing only 2.9 and 4.0%, respectively. Conclusions Renoprotective and hepatoprotective effects are class effects of SGLT2i, and their effects are thought to be independent of kidney or liver status.

Abstract Background Sarcopenia is an important factor in the postoperative outcome of gastrointestinal cancer patients. However, little research has been carried out on potential biomarkers of sarcopenia. Carnitine is an amino acid derivative that is stored in skeletal muscle and is essential for muscle energy metabolism. The primary purpose of this study was to investigate whether serum carnitine level is a biomarker of sarcopenia in preoperative patients with gastrointestinal cancer. The secondary purposes were (i) to examine the associations between carnitine, nutritional status, and albumin level, and (ii) to determine whether carnitine is a prognostic factor for postoperative complications. Methods One hundred fourteen patients scheduled to undergo gastroenterological surgery between August 2016 and January 2017 were enrolled. Their mean age was 68.4 ± 10.5, and 64.9% were male. Serum carnitine fractions [total carnitine (TC), free l‐carnitine (FC), and acylcarnitine (AC)] were measured prior to surgery. The correlation between carnitine level and a variety of clinical features was analysed, including skeletal muscle index (SMI), sarcopenia, prognostic nutritional index (PNI), and postoperative complications. Results Tumour locations included the oesophagus (n = 17), stomach (n = 16), pancreas (n = 20), bile duct (n = 9), liver [n = 33; primary liver cancer (n = 18), liver metastasis (n = 15)], and colorectal region (n = 19). TC and FC levels varied significantly by tumour location. TC and FC showed significant positive correlations with SMI [TC (r = 0.295, P = 0.0014), FC (r = 0.286, P = 0.0020)] and PNI [TC (P = 0.0178, r = 0.222), FC (P = 0.0067, r = 0.2526)]. These levels were significantly lower in the sarcopenia group (TC, P = 0.0124; FC, P = 0.0243). In addition, TC and FC showed significant positive correlations with ALB level [TC (P = 0.038 r = 0.19), FC (P = 0.016 r = 0.23)]. When patients were divided into high ALB (≥3.5 g/dL, 96 patients) and low ALB (

Abstract Background Continuous-flow left ventricular assist devices (LVADs), called “second generation LVADs,” have significantly improved the survival and quality of life outcomes. Accordingly, non-cardiac surgery in a patient with LVADs has required for conditions not directly related to their LVADs. And the management of bleeding in non-cardiac site remains one of long-term critical topics. Laparoscopic approach is useful in a patient with LVADs; however, there have been only few clinical reports. This report describes the first case of laparoscopic cholecystectomy (LC) for intraabdominal hemorrhage from the gallbladder serosa in a patient with LVADs. Case presentation A 56-year-old man with an LVAD had undergone LVAD (Jarvik 2000™; Jarvik Heart, Inc., New York, NY, USA) implantation at 53 years of age. He was in shock, and contrast-enhanced computed tomography revealed abdominal hemorrhage from the gallbladder serosa. Emergency laparoscopic cholecystectomy was performed. We could avoid injury of the LVADs driveline, which was located across the upper abdominal midline, near the right hypochondriac region, by laparoscopic approach. LVADs (Jarvik 2000) did not disturb the operating field because of its smaller size. There were no intra- and postoperative complications. Conclusions Laparoscopic approach is useful and safe in a patient with LVADs for abdominal surgery. We could perform LC for intraabdominal hemorrhage from gallbladder serosa safety.

A patient underwent an electrophysiological study (EPS) and catheter ablation (CA) for ventricular tachycardia (VT) that developed 11 years after myocardial infarction. Entrainment mapping (EM) of the left ventricle did not identify the origin of the VT during induction. Electro-anatomical mapping revealed a low voltage area from the anterior to the inferior left ventricular wall. Another EPS was performed for right ventricular mapping. A basket catheter was placed in the right ventricle to evaluate impulse propagation and we attempted to identify the VT circuit with EM during the same VT (complete left bundle branch block configuration, inferior axis) as the previous EPS. Eight different VT appeared, three of which were sustained during CA. The reentry circuit exit was identified on the tricuspid annulus (TA) at the 9:00 site and radiofrequency (RF) ablation was performed, but the axis transformed from the inferior to the superior and another VT appeared. Despite RF ablation to the VT circuit exit at the 5:00 site, another sustained VT appeared. Finally, it was terminated by ablation to a critical slow conduction zone (SCZ) located near the 7:00 site one year later. Electro-anatomical voltage mapping detected a critical isthmus between TA and right ventricle infarct scar. Here, we describe a rare SCZ proximal to the TA in a patient with VT late after myocardial infarction.

Introduction: In a case of pacemaker and/or implantable cardioverter defibrillator (ICD) implantations, there is the possibility of infections related to the device. In such case, the removal of the total system is desirable, however, the lead extraction can sometimes be difficult. Methods: Among 756 subjects who underwent a device implantation procedure, we experienced 19 cases with a device infection or skin problems requiring a surgical procedure such as thinning or inflammation of the skin over the pocket or lead. We divided these 19 cases into three groups as cases with neither systemic nor local infections (N group), cases with regional but systemic infections (R group), and cases with systemic infections (S group). And the prognoses of these cases were investigated. Results: Out of the 19 cases, 12 cases were classified into N group, 5 cases were classified into R group, and the remaining 2 cases were classified into S group. The lead extractions were performed in one case each in the N, R and S groups. None of the cases in the N group developed a systemic infection over an average observation period of 31 months. Four cases in the R group remain been free from systemic infection over an average observation period of 39.5 months. Conclusion: Lead extractions are the ideal treatment in cases with device implantation site complications, but are not necessary if the extraction is difficult.

The article presents the synthesis, STM detection and the efficient energy hopping (EEH) in near-infrared region of cyclic and hexagonal prismatic porphyrin arrays. Two-dimensional cyclic arrays are found to be excellent for EEH processes for artificial biomimic light harvesting apparatus.

Scanning surface probes delivered from atomic force microscopy (AFM) are expected to investigate local electrostatic properties on insulating surfaces by forces. Electrostatic force spectroscopy is especially suitable to clarify the capacitive interaction. In order to perform it at a well-defined tip-surface separation, we developed a dynamic mode, in which the tip-surface separation is regulated by maintaining the cantilever oscillation amplitude with an active feedback, while the electrostatic force gradient is simultaneously detected with a variable resonant frequency shift. Using the method, it turns out that the quadratic dependence of the electrostatic force gradient on an applied bias observed on an insulating Al2O3(0001) is comparable to those on a metallic Au(111). It results from the potential difference between the tip and the insulator surface being only one order smaller than that between the tip and the metal surface despite the spacing between electrodes for the insulator being 106 times larger than for the metal, because the capacitive interaction is modified primarily between the sharp AFM tip and the surface. [ABSTRACT FROM AUTHOR]

We present electrostatic force microscopy images of double-stranded DNA and transcription complex on an insulating mica substrate obtained with molecular resolution using a frequency-mode noncontact atomic force microscope. The electrostatic potential images show that both DNA and transcription complexes are polarized with an upward dipole moment. Potential differences of these molecules from the mica substrate enabled us to estimate dipole moments of isolated DNA and transcription complex in zero external field to be 0.027 D/base and 0.16 D/molecule, respectively. Scanning capacitance microscopy demonstrates characteristic contrast inversion between DNA and transcription complex images, indicating the difference in electric polarizability of these molecules. These findings indicate that the electrostatic properties of individual biological molecules can be imaged on an insulator substrate while retaining complex formation. [ABSTRACT FROM AUTHOR]