The antidiabetic effects of lactic acid bacteria were investigated using mice. In Experiment 1, normal ICR mice were loaded with sucrose or starch with or without viable Lactobacillus rhamnosus GG cells. GG significantly inhibited postprandial blood glucose levels when administered with sucrose or starch. In Experiment 2, KK-Ay mice, a model of genetic type 2 diabetes, were given a basal diet containing viable GG cells or viable Lactobacillus delbrueckii subsp. bulgaricus cells for 6 weeks. Viable GG cells significantly inhibited fasting blood glucose, postprandial blood glucose in a glucose tolerance test and HbA1c. Such effects were not shown by viable L. bulgaricus cells. In Experiment 3, the KK-Ay mice were given a basal diet containing viable GG cells or heat-treated GG cells for 3 weeks. The viable GG cells significantly suppressed fasting blood glucose and impaired glucose tolerance, but the heat-treated GG showed no effects. These results demonstrated that GG decreased the postprandial blood glucose in ICR mice, and that the antidiabetic activity of lactic acid bacteria on the KK-Ay mice differed depending on the bacterial strain and whether the bacterium is viable when it arrives in the intestine. In the present study, we conclude that the antidiabetic activity may result from continuous inhibition of the postprandial blood glucose through suppression of glucose absorption from the intestine. These findings indicate that specific strains of lactic acid bacterium can be expected to be beneficial for the management of type 2 diabetes.
We found that the addition of fentanyl 1 mug kg(-1) to ropivacaine 0.2% for caudal analgesia provides no further analgesic advantages over ropivacaine 0.2% alone.
Pulmonary atresia with intact ventricular septum (PAIVS) is sometimes associated with coronary artery anomalies, including right ventricle (RV)-to-coronary artery fistulas (sinusoidal communications), coronary artery stenoses, and coronary artery occlusions. In some cases, the coronary circulation depends entirely or partly on the desaturated systemic venous blood supply from the RV. Under these circumstances, decompression of the RV can result in fatal myocardial ischemia. A 6-month-old boy, diagnosed with PAIVS associated with sinusoidal communications, underwent a bidirectional cavopulmonary shunt procedure under venoarterial cardiopulmonary bypass (CPB). During CPB, to prevent RV decompression, we maintained right atrial pressure above 5 mmHg and used a pump perfusion rate of 30%-40% of the calculated value based on body surface area. Although electrocardiography showed slight ST depression and bradycardia, myocardial contractility after weaning from CPB was adequate to maintain the circulation with the administration of dobutamine and atrial pacing. In patients with PAIVS and RV-dependent coronary circulation, it is important to maintain coronary artery perfusion throughout the period of anesthesia.
Dementia, gait disturbance and urinary incontinence were noted in two elderly patients, and diagnosed as idiopathic normal pressure hydrocephalus (iNPH). Case 1 was a 79-year-old man in whom dementia symptoms appeared 2 years ago. Gait disturbance and urge incontinence of urine developed later, and the patient visited our hospital. Walking was widebased and frozen gait was noted at the time of visiting our hospital. The mini-mental state examination (MMSE) score was 11. A head MRI detected expansion of the cerebral ventricles and sylvian fissures, and narrowing of the cerebral fissures and the subarachnoid space in the higher convexity region. The diagnosis of iNPH was made based on the clinical symptoms and imaging findings, and a shunt operation (cerebrospinal fluid shunt) was performed in the neurosurgery department. Gait disturbance and cognitive function slightly improved after the operation. Case 2 was an 81-year-old woman who had had brachybasia for 1 year, and swayed from side to side while walking. Since disorientation and urge incontinence transiently occurred, the patient visited our hospital. The MMSE score was 24. Head MRI findings were similar to those in case 1. The cerebrospinal tap test was performed, and walking improved in the 1-week course observation. iNPH is not very well recognized, compared to secondary NPH, and is likely to be overlooked because differentiation from Alzheimer's disease and vascular dementia based on symptoms and imaging is difficult in elderly patients. As iNPH is treatable by accurate diagnosis and therapy, the accumulation of cases indicated for shunt operation may be necessary.
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