Insulin Secretion, Sensitivity, and Kidney Function in Young Individuals With Type 2 Diabetes.

OBJECTIVE: ß-Cell dysfunction and insulin resistance magnify the risk of kidney injury in type 2 diabetes. The relationship between these factors and intraglomerular hemodynamics and kidney oxygen availability in youth with type 2 diabetes remains incompletely explored. RESEARCH DESIGN AND METHODS: Fifty youth with type 2 diabetes (mean age ± SD 16 ± 2 years; diabetes duration 2.3 ± 1.8 years; 60% female; median HbA1c 6.4% [25th, 75th percentiles 5.9, 7.6%]; BMI 36.4 ± 7.4 kg/m2; urine albumin-to-creatinine ratio [UACR] 10.3 [5.9, 58.0] mg/g) 21 control participants with obesity (OCs; age 16 ± 2 years; 29% female; BMI 37.6 ± 7.4 kg/m2), and 20 control participants in the normal weight category (NWCs; age 17 ± 3 years; 70% female; BMI 22.5 ± 3.6 kg/m2) underwent iohexol and p-aminohippurate clearance to assess glomerular filtration rate (GFR) and renal plasma flow, kidney MRI for oxygenation, hyperglycemic clamp for insulin secretion (acute C-peptide response to glucose [ACPRg]) and disposition index (DI; ×103 mg/kg lean/min), and DXA for body composition. RESULTS: Youth with type 2 diabetes exhibited lower DI (0.6 [0.0, 1.6] vs. 3.8 [2.4, 4.5] × 103 mg/kg lean/min; P < 0.0001) and ACPRg (0.6 [0.3, 1.4] vs. 5.3 [4.3, 6.9] nmol/L; P < 0.001) and higher UACR (10.3 [5.9, 58.0] vs. 5.3 [3.4, 14.3] mg/g; P = 0.003) and intraglomerular pressure (77.8 ± 11.5 vs. 64.8 ± 5.0 mmHg; P < 0.001) compared with OCs. Youth with type 2 diabetes and OCs had higher GFR and kidney oxygen availability (relative hyperoxia) than NWCs. DI was associated inversely with intraglomerular pressure and kidney hyperoxia. CONCLUSIONS: Youth with type 2 diabetes demonstrated severe ß-cell dysfunction that was associated with intraglomerular hypertension and kidney hyperoxia. Similar but attenuated findings were found in OCs.

A systematic review of the association between parastomal hernia and sarcopenia.

BACKGROUND: Sarcopenia is a multifactorial loss of muscle mass that can complicate surgical outcomes and increase morbidity and mortality. Parastomal hernias can occur after any surgery requiring stoma formation and is an area of concern as a complication as it can require a second surgery or emergency surgical intervention. AIM: To assess the impact of sarcopenia on parastomal hernia formation in the postoperative period. METHOD: A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in June 2022. Data were extracted, and a narrative synthesis was undertaken. The Crowe Critical Appraisal Tool (CCAT) assessed the quality of the included studies. The systematic review included original research studies, prospective and retrospective designs, and human studies written in English. Reviews, conference papers, opinion papers, and those including participants < 18 years old were excluded. No restrictions on the date of publication and study setting were applied. RESULTS: Nine studies met the inclusion criteria, and these were conducted between 2016 and 2021; 56% (n = 5) used a retrospective study design. The mean sample size was 242.5 participants (SD = ±358.6). No consistent or standardized way of defining sarcopenia or measuring muscle mass was seen between the studies reviewed. However, 45% (n = 4) of the studies reported a significant relationship between sarcopenia and wound healing complications, including an increased incidence of parastomal and incisional hernias. The average CCAT score was 27.56 (SD = ±4.39). CONCLUSION: There is no definitive relationship between sarcopenia and hernia development; however, four studies found a significant relationship between sarcopenia and hernia formation. It must also be considered that different disease processes can cause sarcopenia either through the disease process itself, or the treatment and management. More research and consistent measurements are needed before comparable and consistent outcomes can be compiled.

Splenic Ischemia in Adolescent Sleeve Gastrectomy.

BACKGROUND: With rising childhood obesity rates, the sleeve gastrectomy (SG) is the most common bariatric surgery procedure. This surgical technique may result in ischemia to the upper pole of the spleen. While generally self-limiting, splenic ischemia may have similar postoperative symptoms to more severe complications. METHODS: We retrospectively reviewed 142 surgical videos and medical records from adolescents at our center who underwent SG from 2010 through 2018. The videos were evaluated for splenic ischemia and for the presence of separate segmental polar accessory vessels. The medical records were reviewed for postoperative symptoms of left shoulder pain, fever, leukocytosis, and tachycardia. RESULTS: We found a 31% incidence of splenic ischemia in the cases reviewed. We identified division of segmental vessels to the upper pole as increasing the relative risk of splenic ischemia by 2.3 (p = 0.0055). Immediate ischemic changes noted in the upper pole of the spleen did not correlate with any postoperative symptoms or complications. CONCLUSION: The incidence of splenic ischemia during an SG in our adolescent population was higher than in other reports. Division of separate polar vessels increased the incidence of localized splenic ischemia. Our findings suggest that splenic ischemia is incidental during an SG in adolescents and does not manifest any clinical significance.

Stimuli-responsive epoxy coatings.

The design, formulation, and characterization of new epoxy coatings with built-in chemical and threshold temperature sensors are reported. The materials were prepared by dissolving a chromogenic, fluorescent oligo(p-phenylenevinylene) dye into a cross-linked epoxy resin by reacting monomer/cross-linker/dye mixtures at 180-200 degrees C and quenching the cured polymer to below its glass transition temperature (T(g)). Subjecting these kinetically trapped, thermodynamically unstable molecularly mixed epoxy/dye blends to temperatures above T(g) leads to aggregation of the dye molecules and causes permanent and pronounced changes of their optical absorption and fluorescence properties. Exposure of the materials to selected chemical stimuli, e.g., water, acid, base, and several organic compounds, also causes plasticization of the polymer matrix and leads to irreversible aggregation of dye molecules, concomitant with the pronounced fluorescence and absorption color change. This response is well described by standard kinetic models and can be controlled via the chemical structure and cross-link density of the resin and the dye content.