A standardized glucose-insulin-potassium infusion protocol in surgical patients: Use of real clinical data from a clinical data warehouse

AIMS

We evaluated the clinical usefulness of a new unified glucose-insulin-potassium (GIK) regimen in a general surgical department.

METHODS

Surgical patients treated under the previous diverse GIK regimens (September 2016 to August 2017) and the new unified GIK regimen (September 2017 to August 2018) were identified in records of the Clinical Data Warehouse of Seoul National University Bundang Hospital. Serial and area under the curve (AUC) glucose levels, and percentages of time within the target glucose levels were compared in propensity score matched patients in the diverse GIK regimen and in the unified GIK regimen (n = 227 in each group).

RESULTS

The AUC of glucose at 6 h and 12 h was lower under the unified GIK regimen than the diverse GIK regimen. The percentage of target glucose levels was higher in the unified GIK regimen compared to the diverse GIK regimen (81.5% vs. 75.0%, P = 0.026), but the occurrence of hypoglycaemia did not differ significantly between groups.

CONCLUSIONS

The unified GIK regimen was more effective than the diverse GIK regimen for glycaemic control and did not increase the number of patients developing hypoglycaemia. This validated written GIK regimen can be safely used in a general surgical department.

Increased expression of bitter taste receptors in human allergic nasal mucosa and their contribution to the shrinkage of human nasal mucosa

OBJECTIVE

Bitter taste receptors (TAS2Rs) are expressed in the extraoral tissues, where they possess various physiological functions. This study is to characterize TAS2Rs expression in normal and allergic nasal mucosa and analyse nasal symptom after challenge with bitter tastes to evaluate their pathophysiological function in normal and allergic nasal mucosa.

METHODS

The expression levels of TAS2Rs (TAS2R4, 5, 7, 10, 14, 39, and 43) in nasal mucosa were investigated by real-time PCR, Western blot, and immunohistochemistry. The expression levels of TAS2Rs and Ca(2+) imaging in cultured epithelial cells were measured after stimulation with type 2 cytokines (IL-4, IL-5, and IL-13) or bitter tastes. Nasal symptoms in control subjects and allergic rhinitis patients using visual analogue score and acoustic rhinometry were evaluated before and after stimulation with bitter tastes. Vascular diameter of rat nasal septum was measured before and after treatment with bitter tastes.

RESULTS

TAS2Rs tested here were expressed in nasal mucosa where they were commonly distributed in superficial epithelium, submucosal glands, and endothelium. Their expression levels are increased in allergic nasal mucosa and up-regulated in cultured epithelial cells simulated with type 2 cytokines. After treatment with bitter tastes, intracellular Ca(2+) signalling was increased in cultured epithelial cells, and vascular constriction was found in rat nasal septum. Increased nasal patency was observed in human nasal mucosa without pain or sneezing.

CONCLUSION AND CLINICAL RELEVANCE

TAS2Rs are constitutively expressed in human nasal mucosa and their expression levels are increased in allergic nasal mucosa, where they could potentially contribute to shrinkage of normal and allergic nasal mucosa.

Proportion of proliferative cells in the tadpole retina is increased after embryonic lesion

Little is known about the cellular mechanisms that cause some cells to stop dividing while leaving neighboring cells free to continue dividing. Such events occur during development of the Xenopus retina; all cells of the embryonic eyebud are mitotic, but by stage 37 (St 37), only cells at the ciliary margin continue to proliferate as neighboring cells become post-mitotic. The mechanisms that control these different proliferative fates remain unknown. One possibility is that total cell number regulates the initial number of proliferative cells at the ciliary margin. To test this hypothesis, we reduced the cell number by surgically removing a portion of the embryonic eyebud, including part of the prospective proliferative zone. Cell counts confirmed that the numbers of both the mitotic, undifferentiated cells and the post-mitotic, differentiated cells were reduced following the partial ablation. A regression analysis suggested that the initial number of undifferentiated cells was a fixed proportion of the total number, but that this proportion was increased by the partial ablation. This increase occurred for all stages that the partial ablation was performed, from early optic vesicle to mid optic cup stages. The proportion of undifferentiated cells was normal in sham-operated retinas, indicating that the increase in partially ablated retinas was induced by tissue removal and not by wound healing. Analyses of clones derived from single precursors, labeled with a fluorescent lineage tracer, indicated that the rate of proliferation was the same in partially ablated and sham-operated retinas. Measurements of bromodeoxyuridine incorporation directly confirmed that at the ciliary margin cell division time was unchanged after partial ablation. Our observations are most consistent with the hypothesis that the proportion of undifferentiated cells was increased because cells that would have become post-mitotic remained proliferative after the partial ablation. Furthermore, cell-cell interactions most likely play a major role in controlling the initial number of proliferative cells in the tadpole retina.