Diabetes mellitus is a worldwide healthcare issue, with the number of diabetic patients continuing to increase. Strict control of plasma glucose levels is critical in order to avoid the potentially severe complications of diabetes, making tests for monitoring of glycemic control essential in the management of the disease. Glycated hemoglobin (HbA(1c)) measurement is currently the most commonly used test to monitor glycemic control in patients with diabetes. Based on the results of the Diabetes Control and Complications Trial (DCCT), an HbA(1c) level of <7% has been recommended to prevent the onset and progression of chronic diabetic complications. However, HbA(1c) may not be suitable for evaluating short-term variations in glycemic control, because of the long lifespan of erythrocytes (120 days). Glycated albumin (GA) is an indicator of diabetes that is more sensitive to change in plasma glucose than HbA(1c). Lucica(R) GA-L is a new diagnostic test for measuring GA. The test is based on an enzymatic method that uses liquid reagents requiring no preparation. Measuring the GA level should provide useful information on glycemic control when monitoring effects of therapy for patients with gestational diabetes, unstable plasma glucose levels, variant hemoglobins or diseases that shorten the lifespan of erythrocytes.

Background: Atheromatous plaques of the aortic arch that extend to the origin of its branches may cause stroke. The frequency and clinical implications of plaque at the origin of the left subclavian artery (LSCA) in patients with recent ischemic stroke were investigated. Methods: We studied 347 consecutive patients (223 men, 69 +/- 12 years) who developed symptomatic ischemic stroke and underwent transesophageal echocardiography (TEE). Results: The origin of the LSCA was identified in 303 of 347 patients (87.3%). Plaque >/=1.0 mm was detected in 108 of the 303 patients (35.6%), ranging between 1.0 and 6.1 mm (median, 2.5 mm). Patients having thicker plaque (>/=2.5 mm) were older (p = 0.012) and more commonly took antiplatelets prior to stroke (p = 0.038) than patients with no plaque and those with thinner plaque (<2.5 mm). Of the aortic arch findings detected on TEE, maximum intima-media thickness (IMT) was the highest (p < 0.001) in patients with thicker plaque, and large plaque (>/=4.0 mm)(p = 0.017), ulcerative plaques (p < 0.001), and spontaneous echo contrasts (p = 0.001) were identified most commonly in patients with thicker plaque. The frequency of infarcts involving the posterior circulation was similar among the three groups. After multivariate adjustment, maximum IMT of the aortic arch was independently related to thicker plaque at the LSCA origin (OR = 1.24, 95% CI = 1.03-1.51, p = 0.024, per 1-mm increase). Conclusions: Atheromatous plaque at the origin of the LSCA was present in approximately one third of patients with a recent ischemic stroke. High IMT at the aortic arch was independently related to the presence of thick plaque at the LSCA origin. The present study does not support the concept that plaque at the LSCA origin may be associated with posterior circulation infarction.

Objective: We have already reported that glycated hemoglobin (HbA(1C)) is elevated due to iron deficiency in late pregnancy among nondiabetic pregnant women. This report examined whether the same phenomenon is observed in pregnant women with diabetes mellitus (DM). Research design and methods: This longitudinal study was conducted in 17 pregnant women with DM (20-35 weeks of pregnancy). HbA(1C), serum glycated albumin (GA), red blood cell indices, and iron metabolism indices were measured. Results: HbA(1C) levels were significantly increased in late pregnancy, whereas serum GA showed no significant changes. GA/HbA(1C) ratio, mean corpuscular hemoglobin, serum transferrin saturation, and serum ferritin were significantly decreased in late pregnancy. Serum transferrin saturation showed a significant positive correlation with GA/HbA(1C) ratio. Conclusions: HbA(1C) levels, but not serum GA levels, are elevated in late pregnancy due to iron deficiency in diabetic women. Serum GA may offer an adequate marker for glycemic control during pregnancy.

BACKGROUND: In gastrectomized subjects, oral glucose tolerance test often shows marked hyperglycaemia (oxyhyperglycaemia) after glucose loading. Because serum glycated albumin (GA) has been shown to better reflect postprandial and maximum plasma glucose levels, we investigated whether or not the clinical significance of serum GA and glycated haemoglobin (HbA(1C)) in non-diabetic gastrectomized subjects differs. METHODS: During health examinations, 62 non-diabetic subjects with a history of gastrectomy and 87 non-diabetic control subjects were selected in the present study. Body mass index (BMI) in the gastrectomy group was significantly lower than in the control group. RESULTS: Fasting plasma glucose levels were significantly lower in the gastrectomized subjects than in the control subjects. Although both HbA(1C) and serum GA were significantly higher in the gastrectomized subjects, there was a significant difference in GA/HbA(1C) ratio between the gastrectomized subjects and the control subjects. BMI-adjusted serum GA, based on our previous finding of inverse influence of BMI on serum GA, was also significantly higher in the gastrectomized subjects than in the controls. CONCLUSIONS: Serum GA is higher relative to HbA(1C) in gastrectomized subjects. This suggests that serum GA may be a better marker than HbA(1C) for glycaemic excursion in these subjects.

Aims To determine the predictors of efficacy, including magnetic resonance imaging information, for low-dose intravenous alteplase therapy for stroke patients. Methods Seventy-eight patients were prospectively enrolled in a single Stroke Unit (SU) receiving alteplase at a dose of 0.6 mg/kg during the initial 27 months after its approval in Japan. Ischaemic changes and vascular lesions were identified using computed tomography, diffusion-weighted magnetic resonance imaging, and magnetic resonance angiography. Early ischaemic signs were assessed using the Alberta Stroke Program Early CT Score. Results The median baseline National Institutes of Health Stroke Scale score of 78 patients was 12. In 19 patients (24%), the National Institutes of Health Stroke Scale score improved by >/=8 points at 24 h. After multivariate adjustment, occlusion at the internal carotid artery (odds ratio 11.82, 95% confidence interval 1.73-142.74), Alberta Stroke Program Early CT Score on diffusion-weighted imaging </=6 (15.23, 1.88-351.50), and a lower National Institutes of Health Stroke Scale score (1.24, 1.08-1.47, per 1-point decrease) were inversely correlated with early improvement. Four patients (5%) had symptomatic intracranial haemorrhage. At 3 months, 76 patients (98%) survived, and 36 of 78 patients (46%) overall, but only two of 19 patients (11%) with internal carotid artery occlusion, had a favourable functional outcome, corresponding to a modified Rankin scale score </=1. After multivariate adjustment, internal carotid artery occlusion (odds ratio 15.84, 95% confidence interval 3.12-128.69) and Alberta Stroke Program Early CT Score on diffusion-weighted imaging </=6 (15.62, 1.78-410.12) were independent predictors of poor outcome. Conclusions Intravenous alteplase therapy at a dose of 0.6 mg/kg resulted in a relatively good overall outcome when compared with outcomes reported by western studies using an alteplase dose of 0.9 mg/kg. However, patients with occlusion at the internal carotid artery did not respond to this low-dose alteplase therapy.

Measurements of glycated albumin (GA) as well as glycated haemoglobin (HbA(1C)) have been applied in order to monitor chronic glycemic control in diabetic patients. Since the levels of both glycated proteins are influenced by various factors other than glycemia, cautions are necessary to evaluate such measures in some specific conditions. In this study, we examined the effects of serum uric acid (UA) levels on these glycemic markers. One hundred and ninety-three men with normal glucose tolerance were enrolled in this study. Association of serum UA with BMI, plasma glucose (PG), high sensitivity CRP (hs-CRP), serum GA and HbA(1C) was analysed. Serum UA showed a significant positive correlation with BMI (R = 0.329, P < 0.0001) and hs-CRP (R = 0.306, P < 0.0001). Multivariate analysis revealed serum UA to be a significant positive explanatory variable for hs-CRP. There was a significant positive correlation of serum UA with the 2-h PG after 75 g OGTT but not fasting PG. Although there was no correlation of serum UA with HbA(1C), serum UA showed a significant inverse correlation with both serum GA (R =-0.402, P < 0.0001) as well as BMI-adjusted serum GA (R =-0.327, P < 0.0001). By multivariate analysis, serum UA was an explanatory variable for serum GA. Serum GA, but not HbA(1C), is set lower in relation to plasma glucose levels in hyperglycemic men. This may be caused by microinflammation associated with hyperuricemic state.

ABSTRACT BACKGROUND AND PURPOSE The use of 3-dimensional computed tomography angiography (3D-CTA) for clipped aneurysms is limited. Usefulness of 3D-CTA with elimination of bone and clips was evaluated in patients with clipped cerebral aneurysms. METHODS Forty-three clipped cerebral aneurysms were included. As review of digital subtraction angiography after surgery is the current gold standard, the presence or absence of remnant necks on 3D-CTA with elimination of bone and clips was compared with that on conventional CTA, using receiver operating characteristic analysis (5, definitely absent; 1, definitely present). RESULTS In the ROC analysis, the Az (.949) in CTA with clip elimination significantly (P <.05) differed from that (.751) of conventional 3D-CTA. If a score of 1 or 2 is considered to represent positive detection of remnant necks, then the sensitivity of 3D-CTA with clip elimination and of conventional 3D-CTA is 73% and 36%, respectively. If a score of 5 or 4 is considered to represent negative detection of remnant necks, then the specificity of 3D-CTA with clip elimination and of conventional 3D-CTA is 88% and 78%, respectively. CONCLUSIONS 3D-CTA with elimination of bone and clips can improve the accuracy of detection of remnant necks after clipping surgery for cerebral aneurysms. J Neuroimaging 2009;XX:1-6.

The purpose of this study was to evaluate the effect of an autogenous free fat graft (FFG) on hemilaminectomy defects. Hemilaminectomy was performed at three levels in three beagles, and each defect was designated as a control site or a site treated with one of two different sizes of FFG. Subsequently, longitudinal computed tomography scanning and histopathological examination were performed. As a result, no postoperative dural adhesion was recognized at the sites where FFGs were placed regardless of the size of the FFG. Moreover, there was no compression of the spinal cord by the FFG. Therefore, it appears that postoperative dural adhesion was controlled by the FFG and that the possibility of FFG migration into the spinal canal is low in hemilaminectomy. In conclusion, placement of an FFG over the defect was considered useful for preventing complications in hemilaminectomy.

Objective: Glycated albumin (GA) relative to glycated hemoglobin (HbA(1C)) is a useful marker of short-term glycemic control. We investigated whether endogenous insulin secretion in type 2 diabetes mellitus (T2DM) has different effects on GA and HbA(1C) levels. Research Design and Methods: HbA(1C), GA and GA/HbA(1C) ratio were compared in 202 T2DM patients by type of treatment. Effect of beta-cell function determined by homeostasis model assessment (HOMA-%beta) on GA/HbA(1C) ratio was examined. In addition, GA/HbA(1C) ratio was compared between T2DM patients and 16 patients with type 1 diabetes mellitus (T1DM). Results: In T2DM patients, GA/HbA(1C) ratio was significantly higher in those treated with insulin than in those treated with diet or oral hypoglycemic agents. HOMA-%beta showed a significant inverse correlation with GA/HbA(1C) ratio. This ratio was higher in T1DM patients than in T2DM patients. Conclusions: In diabetic patients with decreased insulin secretion, serum GA levels are higher relative to HbA(1C).

In order to examine whether FcepsilonRI-dependent degranulation of intestinal mast cells is required for expulsion of intestinal nematode Strongyloides ratti, CD45 exon6-deficient (CD45-/-) mice were inoculated with S. ratti. In CD45-/- mice, egg excretion in feces persisted for more than 30 days following S. ratti larvae inoculation, whereas in wild-type (CD45+/+) mice, the eggs completely disappeared by day 20 post-infection. The number of intestinal mucosal mast cells, which are known effector cells for the expulsion of S. ratti, was 75% lower in CD45-/- mice compared with that in CD45+/+ mice. Adoptive transfer of wild-type T cells from CD45+/+ mice into CD45-/- mice reduced the duration of S. ratti infection to comparable levels observed in CD45+/+ mice, with concomitant increases in intestinal mucosal mast cells. These results showed that CD45 is not involved in the effector function of intestinal mucosal mast cells against S. ratti infection. Since FcepsilonRI-dependent degranulation of mast cells is completely impaired in these CD45 knockout mice, we conclude that FcepsilonRI-dependent degranulation is not required in the protective function of intestinal mucosal mast cells against primary infection of S. ratti.