Magnetic Resonance Imaging Signal Intensities of the Temporomandibular Joint Articular Disc and Cortical Bone: Are These Measurements Valid for the Diagnosis of Temporomandibular Joint Disease?

The purpose of this study was to clarify the validity of measuring the signal intensities of cortical bone (CB) and temporomandibular joint (TMJ) discs on magnetic resonance (MR) images for the diagnosis of TMJ disease. Two investigations were performed. In the first investigation, MR images of 13 TMJs of volunteers were obtained using a multi spin-echo sequence. Echo time (TE) was increased from 10msec to 200msec in steps of 10msec. The signal intensities of the CB of the condylar head, and the anterior (AD) and posterior (PD) bands of the TMJ disc were measured, and their attenuation patterns were compared. In the second investigation, clinical MR images of 30 TMJs from patients with suspected TMJ disorders were selected. Proton density-weighted images (PDWIs) and T2-weighted images (T2WIs) were obtained at TEs of 14 and 85msec, respectively, using a double-echo fast spin-echo sequence. The signal intensities of CB, AD, and PD were measured and compared with that of the external auditory meatus (air) using a Bonferroni test. AD and PD showed nearly identical signal intensity attenuation patterns. The signal intensities of AD and PD were lower than CB at TEs longer than 20msec although they were higher at TEs shorter than 20msec. Clinical PDWIs and T2WIs showed similar results. The signal intensities of CB, AD, and PD were significantly higher than the external auditory meatus (air) in both PDWIs and T2WIs. CB and TMJ discs show characteristic signal intensities, suggesting that the signal intensity measurement of these structures is valid

Long-term safety and efficacy of alogliptin, a DPP-4 inhibitor, in patients with type 2 diabetes: a 3-year prospective, controlled, observational study (J-BRAND Registry)

Introduction Given an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methods We registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.Results Of the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (>90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.Conclusions Alogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting