Incidence of sodium-glucose cotransporter-2 inhibitor-associated perioperative ketoacidosis in surgical patients: a prospective cohort study.

PURPOSE: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are commonly prescribed anti-diabetic medications with various beneficial effects; however, they have also been associated with ketoacidosis. The aim of this study was to determine the incidence of SGLT2i-associated perioperative ketoacidosis (SAPKA) in surgical patients. METHODS: We conducted a multicenter, prospective cohort study across 16 centers in Japan, enrolling surgical patients with diabetes who were prescribed SGLT2is between January 2021 and August 2022. Patients were monitored until the third postoperative day to screen for SAPKA, defined as urine ketone positivity with a blood pH of < 7.30 and HCO3 level ≤ 18.0 mEq/L, excluding cases of respiratory acidosis. RESULTS: In total, 759 of the 762 evaluated patients were included in the final analysis. Among these, three patients (0.40%) had urine ketones with a blood pH of < 7.30; however, blood gas analysis revealed respiratory acidosis in all three, and none of them was considered to have SAPKA. The estimated incidence of SGLT2i-associated postoperative ketoacidosis was 0% (95% confidence interval, 0%-0.4%). CONCLUSIONS: The observed incidence of SAPKA in our general surgical population was lower than expected. However, given that the study was observational in nature, interpretation of study results warrants careful considerations for biases.

Failure of Limb Salvage in a Patient with Chronic Limb-Threatening Ischemia due to Persistent Sciatic Artery Stenosis: Direct Therapeutic Intervention is Important.

A 79-year-old woman presented to our hospital with a complaint of feeling a cold sensation in her right foot. After performing a contrast-enhanced computed tomography angiography, severe stenosis in the right persistent sciatic artery (PSA) was identified. However, stenting was considered inadvisable due to compression issues when sitting. Following anticoagulant therapy, the patient's symptoms improved. However, after seventeen months, she experienced recurrent severe pain in her right foot. Catheter angiography revealed occlusions in both the anterior and posterior tibial arteries. To address the issue, we conducted endovascular therapy, followed by a femoro-popliteal artery bypass and ligation of the PSA. Unfortunately, despite these efforts, a below-knee amputation was eventually performed. Limited experience with the PSA and delayed intervention may have led to the need for amputation. Therefore, it is crucial to emphasize the importance of prompt therapeutic intervention following the onset of initial symptoms.

Effects of simulated kyphosis posture on swallowing and respiratory functions.

[Purpose] To evaluate the effects of kyphosis on swallowing and respiratory functions. [Participants and Methods] In 94 healthy adult volunteers, the respiratory (vital capacity, percentage of vital capacity, and cough peak flow and swallowing (hyoid amplitude and tongue pressure) functions, were evaluated under the following conditions: vertical, moderate kyphosis, and severe kyphosis postures defined by the round-back index. [Results] The mean vital capacity and percentage of vital capacity were significantly lower in severe kyphosis than in the vertical posture. The suprahyoid muscle amplitudes, tongue pressure, and cough peak flow was significantly lower in severe kyphosis than in moderate kyphosis or the vertical positions. [Conclusion] The swallowing and breathing functions were significantly lower in volunteers with severe kyphosis than in those with moderate kyphosis or the vertical positions. Although strengthening of the suprahyoid muscles is a typical example of rehabilitation for dysphagia, but it may also be necessary to consider postural adjustment for patients with kyphosis. A comprehensive evaluation of swallowing function that takes both posture and respiratory function into consideration is necessary.

Accurate magnetic field imaging using nanodiamond quantum sensors enhanced by machine learning.

Nanodiamonds can be excellent quantum sensors for local magnetic field measurements. We demonstrate magnetic field imaging with high accuracy of 1.8 [Formula: see text]T combining nanodiamond ensemble (NDE) and machine learning without any physical models. We discover the dependence of the NDE signal on the field direction, suggesting the application of NDE for vector magnetometry and the improvement of the existing model. Our method enhances the NDE performance sufficiently to visualize nano-magnetism and mesoscopic current and expands the applicability of NDE in arbitrarily shaped materials, including living organisms. This accomplishment bridges machine learning to quantum sensing for accurate measurements.

Dexmedetomidine suppresses serum syndecan-1 elevation and improves survival in a rat hemorrhagic shock model.

Hemorrhagic shock causes vascular endothelial glycocalyx (EGCX) damage and systemic inflammation. Dexmedetomidine (DEX) has anti-inflammatory and EGCX-protective effects, but its effect on hemorrhagic shock has not been investigated. Therefore, we investigated whether DEX reduces inflammation and protects EGCX during hemorrhagic shock. Anesthetized Sprague-Dawley rats were randomly assigned to five groups (n=7 per group): no shock (SHAM), hemorrhagic shock (HS), hemorrhagic shock with DEX (HS+DEX), hemorrhagic shock with DEX and the α7 nicotinic type acetylcholine receptor antagonist methyllycaconitine citrate (HS+DEX/MLA), and hemorrhagic shock with MLA (HS+MLA). HS was induced by shedding blood to a mean blood pressure of 25-30 mmHg, which was maintained for 30 min, after which rats were resuscitated with Ringer's lactate solution at three times the bleeding volume. The survival rate was assessed up to 3 h after the start of fluid resuscitation. Serum tumor necrosis factor-alpha (TNF-α) and syndecan-1 concentrations, and wet-to-dry ratio of the heart were measured 90 min after the start of fluid resuscitation. The survival rate after 3 h was significantly higher in the HS+DEX group than in the HS group. Serum TNF-α and syndecan-1 concentrations, and the wet-to-dry ratio of heart were elevated by HS, but significantly decreased by DEX. These effects were antagonized by MLA. DEX suppressed the inflammatory response and serum syndecan-1 elevation, and prolonged survival in rats with HS.

Mycotic abdominal aortic aneurysm in a patient with systemic lupus erythematosus: A case of critical antinomy.

Mycotic abdominal aortic aneurysms (MAAAs) are rare but life-threatening, and no standard therapy has yet been established. Effective surgery with intensive antimicrobial therapy is crucial; however, this can be fatal in immunocompromised patients. Only a few reports of MAAA with concomitant autoimmune disease exist; therefore, we were concerned about our lack of experience and knowledge about appropriate treatment. We report a 69-year-old male with an MAAA secondary to septic shock after spinal fusion surgery. He had also been on long-term oral immunosuppressants for systemic lupus erythematosus (SLE). After preoperative cephazolin, we performed debridement of infected tissue, graft replacement with a rifampicin-bonded prosthesis, and omentopexy. On the 52nd post-operative day, he was transferred back to the previous attending hospital under oral antibiotics and prednisolone. MAAA in patients with SLE should be treated with in situ replacement using an antimicrobial prosthetic or biological graft with thorough debridement and omentopexy, followed by antimicrobials and immunosuppressants, as needed.

Near-infrared spectroscopy device selection affects intervention management for cerebral desaturation during cardiopulmonary bypass surgery.

OBJECTIVE: Currently, several near-infrared spectroscopy oximetry devices are used for detecting cerebral ischemia during cardiopulmonary bypass (CPB) surgery. We investigated whether two different models of near-infrared spectroscopy oximetry devices affect the assessment of cerebral ischemia and its management during CPB. METHODS: From January 2017 to August 2017, 70 adult cardiovascular surgery cases were randomly assigned to 1 of 2 different near-infrared spectroscopy oximetry devices. The devices were INVOS 5100C (Medtronic, Minneapolis, MN, USA) (group I; n = 35) and FORE-SIGHT ELITE (CAS Medical Systems, Branford, CT, USA) (group F; n = 35). RESULTS: There were no significant differences in patient characteristics. The rSO2 values were significantly higher for patients in group F than for patients in group I. Scalp-Cortex distance showed negative correlations with the mean rSO2 values in group I (P = 0.01). Interventions for low rSO2 during CPB for groups I and F were increase perfusion flow (13:5; P = 0.03), blood transfusion (7:1; P = 0.02), and both (6:1; P = 0.04), respectively. The Scalp-Cortex distance in group I was significantly longer in patients who required intervention than in patients who did not (17.1 ± 2.5 vs 15.1 ± 1.6 mm; P = 0.007). CONCLUSIONS: It is inappropriate to use the same intervention criteria for different near-infrared spectroscopy oximetry devices. Moreover, brain atrophy influence rSO2 values depending on device selection. It is important to note that inappropriate device selection may misguide perfusionists into performing unnecessary or excessive intervention during CPB.

Intraoperative Remifentanil Dosage in Surgery for Adolescent Idiopathic Scoliosis Does Not Increase Postoperative Opioid Consumption When Combined With Epidural Analgesia: A Retrospective Cohort Study.

Background In adults, high-dose remifentanil during surgery has been reported to increase postoperative opioid consumption, but this has not been well documented in children. Multimodal analgesia is recommended in the perioperative period for adolescent idiopathic scoliosis (AIS), but no report has examined opioid consumption under epidural analgesia, which is one of the most common types of analgesia. Aims To investigate the association between intraoperative remifentanil dosage and postoperative opioid consumption in AIS in the setting of combined epidural analgesia for postoperative multimodal analgesia. Methods In this retrospective cohort study, patients aged 10-18 years who underwent surgery for scoliosis and epidural analgesia for postoperative pain between July 2012 and April 2019 were included. The primary endpoint was the association between intraoperative cumulative weight-adjusted remifentanil dosage and logarithmic transformation of cumulative weight-adjusted fentanyl consumption in the intensive care unit (ICU). Nonopioid analgesics were investigated as secondary endpoints. An epidural catheter was inserted by the surgeon intraoperatively, and a local anesthetic was administered at the end of the surgery. Multivariate linear regression analysis with adjustment for confounders was performed for all analyses. Results In total, 142 patients were included, and the median intraoperative remifentanil dosage for all patients was 0.27 (interquartile range, 0.24-0.34) µg/kg/min. No association was observed between cumulative weight-adjusted intraoperative dosage of remifentanil and fentanyl, even after adjusting for potential confounders (slope = -1.25; 95% confidence interval [CI], -4.35 to 1.85; P = 0.43). No association was observed between nonopioid analgesic use and intraoperative remifentanil dosage. Conclusion No association was noted between remifentanil dosage during surgery for AIS and postoperative opioid consumption with epidural analgesia. However, this study has limitations due to its retrospective design; thus, further prospective studies are warranted.

Inhalation of 2% Hydrogen Improves Survival Rate and Attenuates Shedding of Vascular Endothelial Glycocalyx in Rats with Heat Stroke.

ABSTRACT: Heat stroke is characterized by excessive oxidative stress and inflammatory responses, both of which are implicated in vascular endothelial glycocalyx shedding and heat-stroke mortality. Although molecular hydrogen has antioxidation and anti-inflammatory potency, its effect on the vascular endothelial glycocalyx in heat stroke has not been examined. Therefore, the aim of this study was to investigate the influence of hydrogen inhalation on the survival and thickness of the vascular endothelial glycocalyx of rats subjected to heat stroke. Altogether, 98 Wistar rats were assigned to the experiments. A heat-controlled chamber set at 40°C temperature and 60% humidity was used to induce heat stroke. After preparation, the anesthetized rats that underwent the heating process were subjected to an hour of stabilization in which 0%, 2%, or 4% hydrogen gas was inhaled and maintained until the experiment ended. In addition to survival rate assessments, blood samples and left ventricles were collected to evaluate the thickness of the vascular endothelial glycocalyx and relevant biomarkers. The results showed that 2% hydrogen gas significantly improved survival in the heat-stroked rats and partially preserved the thickness of the endothelial glycocalyx. In addition, serum levels of endotoxin, syndecan-1, malondialdehyde, and tumor necrosis factor-α decreased, whereas superoxide dismutase levels increased, indicating that inhalation of 2% hydrogen attenuated the damage to the vascular endothelial glycocalyx through its antioxidative and anti-inflammatory effects.

Neglected roles of IgG Fc-binding protein secreted from airway mucin-producing cells in protecting against SARS-CoV-2 infection.

Both innate immunity and acquired immunity are involved in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The induction of Abs that neutralize the virus has been described, and certain Abs against endemic coronaviruses may cross-react with SARS-CoV-2. Detailed mechanisms to protect against the pandemic of SARS-CoV-2 remain unresolved. We previously reported that IgG Fc-binding protein (Fcγbp), a unique, large molecular weight, and mucin-like secretory Fc receptor protein, secreted from goblet cells of human small and large intestine, mediates the transportation of serum IgG onto the mucosal surface. In this review, we show that mucous bronchial gland cells and some goblet cells are immunoreactive for Fcγbp. Fcγbp traps the cross-reactive (both neutralizing and non-neutralizing) IgG bound to the virus and can consequently eliminate the virus from the mucosal surface to decrease viral loads. Fcγbp can also suppress immune overreaction by interfering with Fc-binding by macrophages and competing with complement fixation. Fcγbp secreted from mucin-producing cells of the airway functions as an important anti-infection mucosal defense. The Fcγbp-mediated mechanism can be a key factor in explaining why SARS-CoV-2 is less infective/lethal in children, and may also be involved in the unique Ab response, recurrent infection, and effects of serum therapy and vaccination.

[Danaparoid Sodium Controlled Chronic Disseminated Intravascular Coagulation Associated with Chronic Aortic Dissection and Patent False Lumen for a Long Term:Report of a Case].

The management of chronic disseminated intravascular coagulation( DIC) caused by aortic dissection has not yet been established. We report the successful treatment of a case of aortic dissection with a patent false lumen using danaparoid sodium for acute exacerbation of chronic DIC. 2,000 U danaparoid sodium per day has been stabilizing the coagulative and fibrinolytic parameters and has been relieving bleeding tendencies with no side effects for a long term.

Three-body correlations in nonlinear response of correlated quantum liquid.

Behavior of quantum liquids is a fascinating topic in physics. Even in a strongly correlated case, the linear response of a given system to an external field is described by the fluctuation-dissipation relations based on the two-body correlations in the equilibrium. However, to explore nonlinear non-equilibrium behaviors of the system beyond this well-established regime, the role of higher order correlations starting from the three-body correlations must be revealed. In this work, we experimentally investigate a controllable quantum liquid realized in a Kondo-correlated quantum dot and prove the relevance of the three-body correlations in the nonlinear conductance at finite magnetic field, which validates the recent Fermi liquid theory extended to the non-equilibrium regime.

Electronic and crystal structures ofLnFeAsO1-xHx(Ln= La, Sm) studied by x-ray absorption spectroscopy, x-ray emission spectroscopy, and x-ray diffraction: II pressure dependence.

We examine electronic and crystal structures of iron-based superconductorsLnFeAsO1-xHx(Ln= La, Sm) under pressure by means of x-ray absorption spectroscopy (XAS), x-ray emission spectroscopy (XES), and x-ray diffraction. In LaFeAsO the pre-edge peak on high-resolution XAS at the Fe-Kabsorption edge gains in intensity on the application of pressure up to 5.7 GPa and it saturates in the higher pressure region. We found integrated-absolute difference values on XES forLn= La, corresponding to a spin state, decline on the application of pressure, and then it is minimized when theTcapproaches the maximum at around 5 GPa. In contrast, such the optimum value was not detected forLn= Sm. We reveal that the superconductivity is closely related to the lower spin state forLn= La unlike Sm case. We observed that As height from the Fe basal plane and As-Fe-As angle on the FeAs4tetrahedron forLn= La deviate from the optimum values of the regular tetrahedron in superconducting (SC) phase, which has been widely accepted structural guide to SC thus far. In contrast, the structural parameters were held near the optimum values up to ∼15 GPa forLn= Sm.

Electronic and crystal structures ofLnFeAsO1-xHx(Ln= La, Sm) studied by x-ray absorption spectroscopy, x-ray emission spectroscopy, and x-ray diffraction (part I: carrier-doping dependence).

A carrier doping by a hydrogen substitution in LaFeAsO1-xHxis known to cause two superconducting (SC) domes with the magnetic order at both end sides of the doping. In contrast, SmFeAsO1-xHxhas a similar phase diagram but shows single SC dome. Here, we investigated the electronic and crystal structures for iron oxynitrideLnFeAsO1-xHx(Ln= La, Sm) with the range ofx= 0-0.5 by using x-ray absorption spectroscopy, x-ray emission spectroscopy, and x-ray diffraction. For both compounds, we observed that the pre-edge peaks of x-ray absorption spectra near the Fe-Kedge were reduced in intensity on doping. The character arises from the weaker As-Fe hybridization with the longer As-Fe distance in the higher doped region. We can reproduce the spectra near the Fe-Kedge according to the Anderson impurity model with realistic valence structures using the local-density approximation (LDA) plus dynamical mean-field theory (DMFT). ForLn= Sm, the integrated-absolute difference (IAD) analysis from x-ray Fe-Kßemission spectra increases significantly. This is attributed to the enhancement of magnetic moment of Fe 3delectrons stemming from the localized picture in the higher doped region. A theoretical simulation implementing the self-consistent vertex-correction method reveals that the single dome superconducting phase forLn= Sm arises from a better nesting condition in comparison withLn= La.

Cryogenic GaAs high-electron-mobility-transistor amplifier for current noise measurements.

We show that a cryogenic amplifier composed of a homemade GaAs high-electron-mobility transistor (HEMT) is suitable for current-noise measurements in a mesoscopic device at dilution-refrigerator temperatures. The lower noise characteristics of our homemade HEMT lead to a lower noise floor in the experimental setup and enable more efficient current-noise measurement than is available with a commercial HEMT. We present the dc transport properties of the HEMT and the gain and noise characteristics of the amplifier. With the amplifier employed for current-noise measurements in a quantum point contact, we demonstrate the high resolution of the measurement setup by comparing it with that of the conventional one using a commercial HEMT.

Etching process of narrow wire and application to tunable-barrier electron pump.

Single electron sources have been studied as a device to establish an electric current standard for 30 years and recently as an on-demand coherent source for fermion quantum optics. In order to construct the single electron source on a GaAs/AlGaAs two-dimensional electron gas (2DEG), it is often necessary to fabricate a sub-micrometer wire by etching. We have established techniques to fabricate the wire made of the fragile 2DEG by combining photolithography and electron beam lithography with one-step photoresist coating, which enables us to etch fine and coarse structures simultaneously. It has been demonstrated that the fabricated single electron source pumps a fixed number of electrons per cycle with radio frequency. The fabrication technique improves the lithography process with lower risk of damage to the 2DEG.

Negative resistance state in superconducting NbSe2 induced by surface acoustic waves.

We report a negative resistance, namely, a voltage drop along the opposite direction of a current flow, in the superconducting gap of NbSe2 thin films under the irradiation of surface acoustic waves (SAWs). The amplitude of the negative resistance becomes larger by increasing the SAW power and decreasing temperature. As one possible scenario, we propose that soliton-antisoliton pairs in the charge density wave of NbSe2 modulated by the SAW serve as a time-dependent capacitance in the superconducting state, leading to the dc negative resistance. The present experimental result would provide a previously unexplored way to examine nonequilibrium manipulation of the superconductivity.

Hot spring frogs (Buergeria japonica) prefer cooler water to hot water.

"Hot spring frog" is an informal name used for the Japanese stream tree frog (Buergeria japonica), which is widely distributed in Taiwan and the Ryukyu Archipelago in Japan. Some populations of the species are known to inhabit hot springs. However, water temperature can be extremely high around the sources of hot springs. Thus, it is questionable whether B. japonica selectively inhabits such dangerous environments. To address this question, we conducted a series of observations of water temperature preferences of a hot spring population of B. japonica in Kuchinoshima Island in Japan: (a) a field observation of tadpole density in water pools of different temperatures, (b) a field observation of water temperatures where adult males appear for breeding, and (c) an indoor observation of water temperatures selected by adult females for oviposition. As a result, tadpoles showed a higher density in cooler water. Adult males avoided water pools hotter than 37°C, and adult females selected cooler pools for oviposition. Camera records also showed that adult individuals tend to appear around cooler pools. Thus, we did not find any support for the hypothesis that hot spring frogs prefer hot water. Conversely, they apparently tended to prefer cooler water if it was available. Water temperatures around the sources of the hot spring exceed thermal tolerances of the species and could be a strong selective pressure on the population. Thus, the ability to sense and avoid lethal temperatures may be a key ecological and physiological characteristic for the species that inhabit hot springs.

[Thoracic Aortic Rupture of Stanford Type B Acute Aortic Dissection in a Patient with Polycystic Kidney Disease;Report of a Case].

We report a case of a 48-year-old man with polycystic kidney disease (PKD), who was emergently transported to our institution by ambulance because of thoracic aortic rupture of Stanford type B acute aortic dissection. PKD is a congenital disease associated with hypertension( 60%) and cerebrovascular disease (20%). Few reports have described sudden death due to the rupture of an abdominal aortic aneurysm and acute aortic dissection. In this case, emergency hemi-arch replacement was performed successfully. His postoperative course was uneventful, and he was discharged on the 15th postoperative day.