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1.
J Atheroscler Thromb ; 2024 May 14.
Article in English | MEDLINE | ID: mdl-38749716

ABSTRACT

AIM: The present study aimed to determine whether decreased masticatory performance and tongue-lip motor function are associated with an increased incidence of adverse health events in patients with metabolic disease. METHODS: One thousand patients with metabolic diseases including diabetes, dyslipidemia, hypertension, and hyperuricemia were recruited. Masticatory performance was assessed using a gummy jelly test, wherein glucose elution from chewed gummy jelly was measured. The tongue-lip motor function was measured using repeatedly pronounced syllables per second. Their association with the incidence of adverse health events (a composite of all-cause death, cardiovascular disease, bone fracture, malignant neoplasm, pneumonia, and dementia) was investigated using the generalized propensity score (GPS) method. RESULTS: During a median follow-up period of 36.6 (interquartile range, 35.0-37.7) months, adverse health events were observed in 191 patients. The GPS adjusted dose-response function demonstrated that masticatory performance was inversely associated with the incidence of adverse health events. The 3-year incidence rate was 22.8% (95% confidence interval, 19.0-26.4%) for the lower quartile versus 13.6% (10.5-16.7%) for the upper quartile (P<0.001). Similarly, the tongue-lip motor function was inversely associated with the incidence of adverse health events, with a 3-year incidence rate of 23.6% (20.0-27.0%) for the lower quartile versus 13.2% (10.4-15.9%) for the upper quartile (P<0.001). CONCLUSIONS: Decreased masticatory performance and tongue-lip motor function were associated with an increased incidence of adverse health events in patients with metabolic disease.

2.
Fetal Diagn Ther ; 2024 May 20.
Article in English | MEDLINE | ID: mdl-38768565

ABSTRACT

INTRODUCTION: Total anomalous pulmonary venous connection (TAPVC) has a low prenatal diagnostic rate. Therefore, we investigated whether Doppler waveforms with a low pulsatility in the pulmonary veins can indicate fetal TAPVC. METHODS: This retrospective study included 16 fetuses with TAPVC, including 10 with complex congenital heart disease and 104 healthy fetuses that underwent fetal echocardiography. Pulmonary venous S and D wave flow velocities and the valley (representing the lowest velocity between the S and D waves) were measured. Valley indices I and II were then calculated as (velocity of valley/ greater of the S and D wave velocities) and (velocity of valley/lesser of the S and D wave velocities), respectively. RESULTS: Supra/infracardiac TAPVC cases exhibited significantly greater valley indices than that of the healthy group. After adjusting for gestational age at fetal echocardiography, valley index I (odds ratio [OR] 7.26, p < 0.01) and II (OR 9.23, p < 0.01) were significant predictors of supra/infracardiac TAPVC. Furthermore, valley indices I and II exhibited a high area under the curve for detecting supra/infracardiac TAPVC, regardless of the presence of pulmonary venous obstruction. CONCLUSION: The valley index may be a useful tool for the detection of fetal TAPVC.

3.
Cardiol Young ; : 1-3, 2024 Apr 22.
Article in English | MEDLINE | ID: mdl-38646890

ABSTRACT

This is a case of a 13-year-old male with frequent premature ventricular contractions with QRS configurations of the left superior axis and left bundle branch block, which originated from the posterior-superior process of the left ventricle. Premature ventricular contractions were successfully eliminated by delivering radiofrequency energy to the inferior wall of the right atrium without causing either junctional rhythm or atrioventricular block. Ventricular arrhythmias originating from this site have been sporadically reported in adults; however, this is the first report in a child.

4.
Intern Med ; 63(1): 43-50, 2024 Jan 01.
Article in English | MEDLINE | ID: mdl-37225492

ABSTRACT

Objective This prospective observational study explored the changes in the daily glycemic profile after switching from injectable to oral semaglutide in patients with type 2 diabetes mellitus. Methods Patients with type 2 diabetes mellitus who were treated with once-weekly 0.5 mg injectable semaglutide and wished to switch to once-daily oral semaglutide participated in this study. Oral semaglutide was initiated at 3 mg and increased to 7 mg a month later, according to the package insert. Before and two months after the switch, participants wore a sensor for continuous glucose monitoring for up to 14 days. We also evaluated the questionnaire-based treatment satisfaction and the preference between the two formulations. Patients Twenty-three patients participated. Results Mean glucose levels significantly increased by 9 mg/dL on average, from 132±20 to 141±27 mg/dL (p=0.047), which was equivalent to a change of 0.2% in the estimated hemoglobin A1c (6.5±0.5% to 6.7±0.7%). The inter-individual variability assessed with standard deviation also significantly increased (p=0.004). The change in treatment satisfaction varied considerably among patients, with no specific trend in the overall population. After trying oral semaglutide, 48% of patients responded that they preferred the oral formulation, while 35% preferred the injectable formulation, and 17% had no preference. Conclusion The mean glucose levels increased by 9 mg/dL on average after switching from once-weekly 0.5 mg injectable semaglutide to once-daily 7 mg oral semaglutide, with an increased inter-individual variability. The change in treatment satisfaction considerably varied among patients.


Subject(s)
Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Glucose , Blood Glucose Self-Monitoring , Blood Glucose
5.
JMA J ; 6(4): 455-462, 2023 Oct 16.
Article in English | MEDLINE | ID: mdl-37941713

ABSTRACT

Introduction: We investigated the association between history of vaccination for coronavirus disease 2019 (COVID-19) and symptoms at its diagnosis. Methods: We retrospectively analyzed 2566 consecutive individuals suspected of having COVID-19 and visited a designated clinic between January and September 2022 (1733 were diagnosed with COVID-19, and 816 tested negative for COVID-19) in Japan. The individuals were divided by vaccination history for COVID-19. Results: In the COVID-19-free individuals, the vaccination was not significantly associated with any symptoms. Contrarily, those with COVID-19 demonstrated an inverse relationship between the vaccination and body temperature; the adjusted mean value was higher by 0.01°C, 0.04°C, 0.09°C, 0.27°C, and 0.34°C and 0.48°C in individuals vaccinated 2-4, 4-6, 6-8, 8-10, and >10 months before and those unvaccinated, respectively, than in those vaccinated within 2 months (P = 0.96, 0.41, 0.081, 0.006, 0.004, and <0.001). Furthermore, among the affected population, individuals vaccinated long before or never vaccinated more frequently complained of fatigue and headache; the adjusted odds ratios of those vaccinated >10 months before and those unvaccinated compared with those vaccinated within 2 months were 2.53 and 2.45 for fatigue and 2.53 and 2.17 for headache (all P < 0.05). Contrarily, the prevalence of rhinorrhea, sore throat, and cough was higher in recently vaccinated individuals (adjusted odds ratios of those vaccinated within 2 months versus those unvaccinated, 2.40, 2.46, and 2.46; all P < 0.05). Conclusions: Symptoms at the COVID-19 diagnosis differed with the vaccination history. Information on vaccination history would be worth using when suspecting COVID-19 based on symptoms.

6.
Clin Ophthalmol ; 17: 2149-2162, 2023.
Article in English | MEDLINE | ID: mdl-37529756

ABSTRACT

Purpose: To evaluate the efficacy of YOUSOFT soft contact lenses in correcting irregular astigmatism and prescription results of patients with keratoconus. Patients and Methods: The retrospective observational study included 55 eyes (mean age, 32.2 ± 10.6 years; 36 men and 6 women) of 42 patients with keratoconus who tried YOUSOFT for rigid gas permeable (RGP) lens intolerance. Average keratometry, corneal astigmatism, and maximum keratometry were 49.4 ± 5.2 diopters (D), 3.7 ± 2.1 D, and 57.3 ± 8.2 D, respectively. Patients were divided into YOUSOFT prescription and non-prescription cases, wherein the prescription rates were calculated. YOUSOFT visual acuity was compared with spectacle-corrected distance visual acuity (CDVA) and RGP lens-CDVA. Results: YOUSOFT was prescribed to 28 out of 42 patients (prescription rate 67%). In the YOUSOFT prescription cases, YOUSOFT-CDVA (logMAR -0.04; 95% confidence interval [CI]: -0.08 to 0.00) was significantly better than spectacle-CDVA (logMAR 0.23; 95% CI: 0.08 to 0.38; P < 0.0001), whereas YOUSOFT-CDVA (logMAR -0.03; 95% CI: -0.08 to 0.03) did not significantly differ from the RGP lens-CDVA (logMAR -0.02; 95% CI: -0.08 to 0.04; P = 0.856). Conclusion: YOUSOFT was effective in correcting irregular corneal astigmatism, suggesting that it is highly effective in patients with RGP lens intolerance.

7.
J Cardiol Cases ; 28(2): 75-78, 2023 Aug.
Article in English | MEDLINE | ID: mdl-37521575

ABSTRACT

Pheochromocytoma (PCC) can adversely affect Fontan circulation. However, there are few reports on its perioperative management before and after PCC resection in Fontan patients. A 24-year-old female patient with congenitally corrected transposition of the great arteries, ventricular septal defect, and pulmonary atresia who had undergone Fontan palliation developed heart failure caused by PCC. The patient was pre-conditioned for PCC resection with heart failure treatment, alpha-blocker titration, and careful infusion, and had a good intraoperative and postoperative course with no complications. Postoperative catheter data showed improvements in systemic vascular resistance, cardiac output, and central venous pressure compared with preoperative data. There is no established preconditioning method for PCC resection in patients with Fontan circulation. Careful perioperative management based on an understanding of the features of the Fontan circulation can lead to better outcomes. Learning objective: Pheochromocytoma (PCC) can occur in patients with Fontan circulation. Preoperative management and the PCC itself can adversely affect Fontan circulation, highlighting the importance of suspecting PCCs in Fontan patients based on symptoms such as heart failure, worsening arrhythmias, and headache, and emphasizing careful perioperative management.

8.
Circ J ; 87(12): 1828-1835, 2023 11 24.
Article in English | MEDLINE | ID: mdl-37380439

ABSTRACT

BACKGROUND: Cardiac calmodulinopathy, characterized by a life-threatening arrhythmia and sudden death in the young, is extremely rare and caused by genes encoding calmodulin, namely calmodulin 1 (CALM1), CALM2, and CALM3.Methods and Results: We screened 195 symptomatic children (age 0-12 years) who were suspected of inherited arrhythmias for 48 candidate genes, using a next-generation sequencer. Ten probands were identified as carrying variants in any of CALM1-3 (5%; median age 5 years), who were initially diagnosed with long QT syndrome (LQTS; n=5), catecholaminergic polymorphic ventricular tachycardia (CPVT; n=3), and overlap syndrome (n=2). Two probands harbored a CALM1 variant and 8 probands harbored 6 CALM2 variants. There were 4 clinical phenotypes: (1) documented lethal arrhythmic events (LAEs): 4 carriers of N98S in CALM1 or CALM2; (2) suspected LAEs: CALM2 p.D96G and D132G carriers experienced syncope and transient cardiopulmonary arrest under emotional stimulation; (3) critical cardiac complication: CALM2 p.D96V and p.E141K carriers showed severe cardiac dysfunction with QTc prolongation; and (4) neurological and developmental disorders: 2 carriers of CALM2 p.E46K showed cardiac phenotypes of CPVT. Beta-blocker therapy was effective in all cases except cardiac dysfunction, especially in combination with flecainide (CPVT-like phenotype) and mexiletine (LQTS-like). CONCLUSIONS: Calmodulinopathy patients presented severe cardiac features, and their onset of LAEs was earlier in life, requiring diagnosis and treatment at the earliest age possible.


Subject(s)
Arrhythmias, Cardiac , Calmodulin , Long QT Syndrome , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Arrhythmias, Cardiac/genetics , Calmodulin/genetics , Calmodulin/metabolism , East Asian People , Long QT Syndrome/diagnosis , Long QT Syndrome/genetics , Phenotype , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/genetics , Death, Sudden, Cardiac/etiology
9.
Clin Nephrol Case Stud ; 11: 72-78, 2023.
Article in English | MEDLINE | ID: mdl-37143613

ABSTRACT

INTRODUCTION: Malignant hypertension (mHTN) damages multiple target organs, including the kidneys. mHTN has been regarded as one of the causes of secondary thrombotic microangiopathy (TMA); however, a high prevalence of complement gene abnormalities was recently reported in cohorts of mHTN. CASE REPORT: We herein describe a 47-year-old male who presented with severe hypertension, renal failure (serum creatinine (sCr): 11.6 mg/dL), heart failure, retinal hemorrhage, hemolytic anemia, and thrombocytopenia. Renal biopsy findings were consistent with acute hypertensive nephrosclerosis. The patient was diagnosed with secondary TMA associated with mHTN. However, his previous medical history of TMA of unknown origin and family history of atypical hemolytic uremic syndrome (aHUS) suggested as aHUS presenting mHTN, and genetic testing revealed a pathogenic C3 mutation (p.I1157T). The patient required plasma exchange and hemodialysis for 2 weeks and was able to withdraw from dialysis by antihypertensive therapy without eculizumab. Renal function gradually improved to a sCr level of 2.7 mg/dL under antihypertensive therapy for 2 years after the event. There was no recurrence, and renal function was preserved throughout a 3-year follow-up. DISCUSSION: mHTN is a common presentation of aHUS. In cases of mHTN, abnormalities in complement-related genes may be involved in the development of the disease.

10.
J Diabetes Investig ; 14(6): 767-773, 2023 Jun.
Article in English | MEDLINE | ID: mdl-36919944

ABSTRACT

AIMS/INTRODUCTION: Previous studies have reported that the glucagon-like peptide-1 receptor agonist (GLP-1RA) delays gastric emptying, and gastric emptying was assessed by the 13 C breath test or paracetamol absorption technique. However, neither of them is clinically familiar in real-world clinical practice. The purpose of the present study was to investigate the association between GLP-1RA treatment and gastric residue in an esophagogastroduodenoscopy. MATERIALS AND METHODS: This study was a matched pair case-control study. The study population consisted of 1,128 individuals with diabetes who had esophagogastroduodenoscopy at our clinic between July 2020 and June 2022. To account for differences in characteristics, such as age, sex, insulin treatment and glycated hemoglobin, we carried out a one-to-one nearest neighbor propensity score matching analysis between diabetes patients with and without GLP-1RA treatment. After matching, we compared the presence of gastric residue in an esophagogastroduodenoscopy by the McNemar test between patients with and without GLP-1RA treatment. RESULTS: After the propensity score matching, we selected 205 pairs. In the propensity score-matched comparison, the proportion of gastric residue was statistically significantly higher in the GLP-1RA treatment group (0.49% vs 5.4%, P = 0.004). The details of GLP-1RA prescribed for the 11 patients with gastric residue were liraglutide once daily 1.8 mg (n = 2), dulaglutide once weekly 0.75 mg (n = 5), semaglutide once weekly 0.5 mg (n = 2) and semaglutide once weekly 1.0 mg (n = 2). CONCLUSION: GLP-1RA treatment is associated with gastric residue in an esophagogastroduodenoscopy in patients with diabetes.


Subject(s)
Diabetes Mellitus, Type 2 , Hypoglycemic Agents , Humans , Hypoglycemic Agents/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Glucagon-Like Peptide-1 Receptor/agonists , Case-Control Studies , Liraglutide/therapeutic use
11.
J Hum Genet ; 68(6): 427-430, 2023 Jun.
Article in English | MEDLINE | ID: mdl-36755127

ABSTRACT

Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated disease that manifests as the triad of thrombotic microangiopathy. We identified two aHUS patients with neither anti-complement factor H (CFH) antibodies nor causative variants of seven aHUS-related genes (CFH, CFI, CFB, C3, MCP, THBD, and DGKE); however, their plasma showed increased levels of hemolysis by hemolytic assay, which strongly suggests CFH-related abnormalities. Using a copy number variation (CNV) analysis of the CFH/CFHR gene cluster, we identified CFH-CFHR1 hybrid genes in these patients. We verified the absence of aHUS-related abnormal CNVs of the CFH gene in control genomes of 2036 individuals in the general population, which suggests that pathogenicity is related to these hybrid genes. Our study emphasizes that, for patients suspected of having aHUS, it is important to perform an integrated analysis based on a clinical examination, functional analysis, and detailed genetic investigation.


Subject(s)
Atypical Hemolytic Uremic Syndrome , Humans , Atypical Hemolytic Uremic Syndrome/diagnosis , Atypical Hemolytic Uremic Syndrome/genetics , DNA Copy Number Variations/genetics , Complement System Proteins/genetics , Complement C3b Inactivator Proteins/genetics
12.
J Cataract Refract Surg ; 49(5): 525-530, 2023 05 01.
Article in English | MEDLINE | ID: mdl-36700937

ABSTRACT

PURPOSE: To evaluate the implantable collamer lens (ICL)-sizing method using the partial regression coefficient of the implanted ICL size to review the conventional horizontal compression coefficient and match the results of clinical observation. SETTING: Nagoya Eye Clinic, Nagoya, Japan. DESIGN: Interventional case series. METHODS: Patients who underwent ICL V4c implantation to correct myopia and myopic astigmatism were enrolled. The stepwise multiple regression analysis used achieved vault as a dependent variable and preoperative biometric parameters as explanatory variables. The partial regression coefficient of the implanted ICL size was obtained to develop the optimal ICL-sizing formula, the Nakamura-Kojima formula version 3 (NK-formula V3). 85 eyes of 45 patients were implanted with an ICL size recommended by the NK-formula V3. At 3 months postoperatively, the achieved vault was measured using anterior segment optical coherence tomography to validate the NK-formula V3. RESULTS: The study enrolled 174 patients (174 eyes). The partial regression coefficient of the implanted ICL size adopted as the compression-vault coefficient in the multiple regression equation predicting the vault was 0.729. To validate the NK-formula V3, 77 (90.6%), 7 (8.2%), and 1 (1.2%) eyes were in the moderate-vault, low-vault, and high-vault categories, respectively. The mean difference between the achieved and predicted vaults was 0.064 ± 0.190 (range: -0.264 to 0.742) mm for the NK-formula V3 and 0.176 ± 0.217 (range: -0.254 to 0.907) mm for the NK-formula V2. CONCLUSIONS: As in vivo coefficient measurement experiments are not possible, the partial regression coefficient is the best option for developing a formula to predict the optimal ICL size.


Subject(s)
Myopia , Phakic Intraocular Lenses , Humans , Visual Acuity , Lens Implantation, Intraocular/methods , Eye , Myopia/surgery , Retrospective Studies
13.
J Diabetes Investig ; 14(3): 479-485, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36695022

ABSTRACT

AIMS/INTRODUCTION: There has been an increase in research on diabetes-related stigma and its association with glycated hemoglobin (HbA1c) over the past years. However, little is known about the association of self-stigma with HbA1c in persons with type 1 diabetes. This study aims to examine the association between self-stigma and HbA1c in Japanese people with type 1 diabetes. MATERIALS AND METHODS: This cross-sectional study was conducted at a clinic in Tokyo. Questionnaires using nine items from the Japanese version of the Self-Stigma Scale was distributed to outpatients with type 1 diabetes, aged ≥18 years. We excluded outpatients with serious mental disorder, those who required urgent medical treatment or received hemodialysis. Adjusted linear regression analyses tested the association between the score of the 9-item Self-Stigma Scale and HbA1c. RESULTS: Questionnaires were distributed to 166 eligible participants. A total of 109 participants were included in the final analysis after excluding participants with incomplete answers and laboratory data. After adjusting for age, sex, employment status, body mass index, duration of diabetes and insulin secretion, there was a significant positive association between self-stigma and HbA1c (ß = 0.05, 95% confidence interval 0.01 to 0.08). CONCLUSIONS: This cross-sectional study showed a significant association between self-stigma and HbA1c in persons with type 1 diabetes. Addressing self-stigma might be as equally essential as measuring HbA1c in evaluating glycemic outcome among individuals with type 1 diabetes.


Subject(s)
Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Adult , Humans , Adolescent , Glycated Hemoglobin , Diabetes Mellitus, Type 1/therapy , Cross-Sectional Studies , Japan
14.
Ophthalmol Glaucoma ; 6(2): 198-205, 2023.
Article in English | MEDLINE | ID: mdl-36055467

ABSTRACT

PURPOSE: To perform a phase Ⅰ/Ⅱ evaluation of an H-1337 ophthalmic solution in subjects with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). DESIGN: This was a phase I/II, randomized, double-masked, vehicle-controlled, dose-response study conducted at 6 private practice sites in the United States. The study was registered with clinicaltrials.gov as NCT03452033. PARTICIPANTS: Eighty-seven subjects with bilateral POAG or OHT were enrolled. METHODS: After washout of ocular hypotensive medications as required, the subjects were randomized to receive either the H-1337 ophthalmic solution at 0.06%, 0.2%, and 0.6% or its vehicle twice daily unilaterally in the study eye for the first 3 days and then twice daily in both eyes from day 4 to 28. MAIN OUTCOME MEASURES: The primary efficacy end point was the mean change in intraocular pressure from baseline (day 0) for each group on day 28 at hour 4 compared with the vehicle. RESULTS: In the primary efficacy end point, i.e., mean change from the baseline on day 28 at hour 4, the mean change from the baseline was - 4.45 ± 3.801, - 5.16 ± 3.114, - 4.93 ± 3.110, and - 0.39 ± 2.355 in the 0.06%, 0.2%, and 0.6% H-1337 and vehicle groups, respectively. The difference between each active group and the vehicle group was statistically significant (P < 0.0001). Treatment-emergent adverse events (TEAEs) occurred in 49% of subjects who received H-1337 (range, 41% [0.2% arm]-64% [0.6% arm] across the H-1337 arms) and 18% of subjects who received the vehicle. The majority of TEAEs were mild in severity; 3 subjects who received H-1337 had a TEAE of moderate intensity (instillation site erythema, blurred vision, and muscle strain). CONCLUSIONS: The H-1337 ophthalmic solution showed clinically and statistically significant ocular hypotensive activity and was well tolerated, with a relatively low incidence of hyperemia. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.


Subject(s)
Glaucoma, Open-Angle , Glaucoma , Ocular Hypertension , Humans , Glaucoma, Open-Angle/drug therapy , Ophthalmic Solutions , Ocular Hypertension/drug therapy , Glaucoma/chemically induced , Intraocular Pressure
15.
Front Immunol ; 13: 981375, 2022.
Article in English | MEDLINE | ID: mdl-36189215

ABSTRACT

The complement system is part of the innate immune system. The crucial step in activating the complement system is the generation and regulation of C3 convertase complexes, which are needed to generate opsonins that promote phagocytosis, to generate C3a that regulates inflammation, and to initiate the lytic terminal pathway through the generation and activity of C5 convertases. A growing body of evidence has highlighted the interplay between the complement system, coagulation system, platelets, neutrophils, and endothelial cells. The kidneys are highly susceptible to complement-mediated injury in several genetic, infectious, and autoimmune diseases. Atypical hemolytic uremic syndrome (aHUS) and lupus nephritis (LN) are both characterized by thrombosis in the glomerular capillaries of the kidneys. In aHUS, congenital or acquired defects in complement regulators may trigger platelet aggregation and activation, resulting in the formation of platelet-rich thrombi in the kidneys. Because glomerular vasculopathy is usually noted with immunoglobulin and complement accumulation in LN, complement-mediated activation of tissue factors could partly explain the autoimmune mechanism of thrombosis. Thus, kidney glomerular capillary thrombosis is mediated by complement dysregulation and may also be associated with complement overactivation. Further investigation is required to clarify the interaction between these vascular components and develop specific therapeutic approaches.


Subject(s)
Atypical Hemolytic Uremic Syndrome , Thrombosis , Atypical Hemolytic Uremic Syndrome/genetics , Capillaries/metabolism , Complement C3-C5 Convertases/metabolism , Complement System Proteins/metabolism , Endothelial Cells/metabolism , Humans , Kidney/metabolism , Opsonin Proteins/metabolism , Thrombosis/metabolism
16.
J Diabetes Investig ; 13(12): 2010-2017, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36121186

ABSTRACT

AIMS/INTRODUCTION: Aging of society is accelerating in many countries. The purpose of this study was to describe the clinical features and sulfonylurea usage among diabetes outpatients aged ≥90 years (nonagenarians). MATERIALS AND METHODS: This study was a retrospective observational study. The study population consisted of 69 nonagenarian diabetes outpatients and 857 diabetes outpatients aged <90 years. Patients were classified into four groups: group 1, <65 years; group 2, 65-74 years; group 3, 75-89 years; and group 4, ≥90 years. The presence of hypoglycemic episodes was defined as having self-reported symptoms, or self-monitored or clinically measured blood glucose level <70 mg/dL. RESULTS: The median glycated hemoglobin (HbA1c) in group 1 and group 4 was 7.0% and 7.2%, respectively (P = 0.506). The proportion of sulfonylurea treatment in group 4 was 45.5%, which is significantly higher compared with the other three groups (20.0-27.8%, P < 0.001). In group 4, there was no difference between patients with or without sulfonylurea in age, sex, body mass index, HbA1c and number of antihyperglycemic agents. Five out of 25 nonagenarian sulfonylurea-treated patients had hypoglycemic episodes within the last 2 years, their HbA1c were all 7.0 ≤ HbA1c < 8.0, and sulfonylurea or insulin was tapered in all cases after confirming hypoglycemia. Tapering dosage was attempted in all 25 sulfonylurea-treated nonagenarian patients, but 15 needed to continue sulfonylurea for glycemic control, and 10 continued sulfonylurea with unknown reasons from their medical records. CONCLUSIONS: Although tapering the dosage of sulfonylurea was attempted in nonagenarian patients, sulfonylurea was widely continued for glycemic control. Reverse clinical inertia may exist in some sulfonylurea-treated nonagenarian patients.


Subject(s)
Diabetes Mellitus, Type 2 , Hypoglycemia , Aged, 80 and over , Humans , Glycated Hemoglobin/analysis , Outpatients , Tokyo , Blood Glucose , Diabetes Mellitus, Type 2/drug therapy , Sulfonylurea Compounds , Hypoglycemic Agents/adverse effects , Hypoglycemia/chemically induced , Hypoglycemia/epidemiology
18.
Echocardiography ; 39(8): 1142-1145, 2022 08.
Article in English | MEDLINE | ID: mdl-35871719

ABSTRACT

INTRODUCTION: Agenesis of the venous duct is rare, with an incidence rate of .04%-.6%. Abnormal drainage of the umbilical vein (UV) to superior vena cava (SVC) is seen in .5% of agenesis of the venous duct cases. We present a case of agenesis of the venous duct with drainage of the UV into the SVC accompanied by tetralogy of Fallot. CASE PRESENTATION: The fetus was diagnosed with agenesis of the venous duct and tetralogy of Fallot at 29 gestational weeks. The UV directly returned to the SVC. Cardiomegaly and pericardial effusion were observed but did not deteriorate. The female infant was born at 40 gestational weeks. Contrast-enhanced computed tomography showed that the UV was occluded at its proximal aspect. No abnormality of the portal system was noted. The infant underwent intracardiac repair and was doing well at 16 months of age. DISCUSSION/CONCLUSION: Although the extrahepatic drainage type of agenesis of the venous duct is occasionally associated with heart failure and hydrops, severe hydrops was absent in this case. It was speculated that vascular resistance in the long pathway to the SVC restricted direct inflow from the UV. Portosystemic shunts and agenesis of the portal system are reported complications of agenesis of the venous duct. Prenatal agenesis of the venous duct diagnosis may be crucial for early postnatal diagnosis of these conditions.


Subject(s)
Tetralogy of Fallot , Vena Cava, Superior , Edema , Female , Humans , Pregnancy , Ultrasonography, Prenatal , Umbilical Veins
19.
BMC Endocr Disord ; 22(1): 150, 2022 Jun 04.
Article in English | MEDLINE | ID: mdl-35658859

ABSTRACT

BACKGROUND: The current study aimed to reveal the correlation of beta-cell function and insulin sensitivity with glycemic control and weight control before and after medical nutrition therapy (MNT) in patients with newly-diagnosed type 2 diabetes mellitus. METHODS: We retrospectively analyzed consecutive 68 patients with newly-diagnosed type 2 diabetes mellitus who started MNT without antihyperglycemic medications and underwent a 75-g oral glucose tolerance test (OGTT) before and after the therapy. Beta-cell function was evaluated by the OGTT-derived disposition index, whereas insulin sensitivity was evaluated by Matsuda's insulin sensitivity index. RESULTS: After 4.0 ± 1.5 months of MNT, mean HbA1c and body mass index significantly decreased from 9.6 ± 1.8% to 7.2 ± 1.0% and from 26.9 ± 4.1 to 25.4 ± 3.7 kg/m2 (both P < 0.001), while the median disposition index and Matsuda's index significantly increased from 0.34 (0.20-0.68) to 0.88 (0.53-1.52) (P < 0.001) and from 4.70 (2.95-5.93) to 5.17 (3.48-6.89) (P = 0.003), respectively. The disposition index was significantly correlated with HbA1c levels both before and after MNT (r = -0.61 and -0.68; both P < 0.001). The magnitude of the correlation after MNT was not different from that before MNT (P = 0.42). Matsuda's index was correlated not with HbA1c levels but with body mass index, both before (r = 0.07 [P = 0.57] and r = -0.58 [P < 0.001]) and after MNT (r = -0.01 [P = 0.95] and r = -0.52 [P < 0.001]). CONCLUSIONS: Beta-cell function was improved in conjunction with glycemic control after MNT in patients with newly-diagnosed type 2 diabetes mellitus. Insulin sensitivity was linked with weight control rather than glycemic control.


Subject(s)
Diabetes Mellitus, Type 2 , Insulin Resistance , Nutrition Therapy , Blood Glucose/physiology , Diabetes Mellitus, Type 2/drug therapy , Glycated Hemoglobin/analysis , Glycemic Control , Humans , Insulin/therapeutic use , Retrospective Studies
20.
Clin Ophthalmol ; 16: 1909-1923, 2022.
Article in English | MEDLINE | ID: mdl-35711971

ABSTRACT

Purpose: This study aimed to investigate the relationship between changes in corneal biomechanical properties and changes in anterior segment optical coherence tomography (AS-OCT) parameters preoperatively and following customized corneal cross-linking (C-CXL) in eyes with progressive keratoconus. Patients and Methods: This study included 44 eyes of 44 patients (33 men, 11 women; average age 22.8 ± 6.4 years) who underwent C-CXL for progressive keratoconus. Scheimpflug-based tonometer (SBT) and AS-OCT findings were evaluated preoperatively and 3 months following CXL. Parameters related to changes in SBT parameters were examined by multiple regression analysis using the stepwise method. Results: Regarding SBT parameters, significant changes were observed in the integrated area under the curve of the inverse concave radius (pre, 12.19 ± 1.95/mm; post, 11.26 ± 1.89/mm; p < 0.0001), maximum inverse radius (pre, 0.24 ± 0.04/mm; post, 0.23 ± 0.04/mm; p = 0.0053), deformation amplitude ratio max 2 mm (pre, 5.53 ± 0.81; post, 5.29 ± 0.71; p = 0.0048), and stress-strain index (pre, 0.74 ± 0.16; post, 0.84 ± 0.20; p < 0.0001), pre and post C-CXL. Regarding AS-OCT parameters, significant changes were observed in average keratometry (pre, 47.87 ± 3.61 D; post, 47.56 ± 3.29 D, p = 0.0104), steep keratometry (pre, 49.61 ± 4.01 D; post, 49.25 ± 3.59 D; p = 0.0115), maximum keratometry (pre, 55.44 ± 6.22 D; post, 54.68 ± 5.56 D; p = 0.0061), and thinnest corneal thickness (pre, 450.43 ± 41.74 µm; post, 444.00 ± 39.35 µm; p < 0.0001), pre and post C-CXL. Multiple regression analysis demonstrated that when the change in the deformation amplitude (DA) ratio max (2 mm) was the dependent variable, age, change in average keratometry, and change in the thinnest corneal thickness were selected as explanatory variables. When changes in the stiffness parameter at applanation 1 and stress-strain index were the dependent variables, change in the intraocular pressure (IOP) was selected as the explanatory variable. Conclusion: Change in the SBT parameters following C-CXL could be related to the age, change in the IOP value, change in average keratometry, and thinnest corneal thickness.

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