Comparison of vildagliptin twice daily vs. sitagliptin once daily using continuous glucose monitoring (CGM): Crossover pilot study (J-VICTORIA study)

BACKGROUND: No previous studies have compared the DPP-4 inhibitors vildagliptin and sitagliptin in terms of blood glucose levels using continuous glucose monitoring (CGM) and cardiovascular parameters. METHODS: Twenty patients with type 2 diabetes mellitus were randomly allocated to groups who received vildagliptin then sitagliptin, or vice versa. Patients were hospitalized at 1 month after starting each drug, and CGM was used to determine: 1) mean (± standard deviation) 24-hour blood glucose level, 2) mean amplitude of glycemic excursions (MAGE), 3) fasting blood glucose level, 4) highest postprandial blood glucose level and time, 5) increase in blood glucose level after each meal, 6) area under the curve (AUC) for blood glucose level ≥180 mg/dL within 3 hours after each meal, and 7) area over the curve (AOC) for daily blood glucose level <70 mg/dL. Plasma glycosylated hemoglobin (HbA1c), glycoalbumin (GA), 1,5-anhydroglucitol (1,5AG), immunoreactive insulin (IRI), C-peptide immunoreactivity (CPR), brain natriuretic peptide (BNP), and plasminogen activator inhibitor-1 (PAI-1) levels, and urinary CPR levels, were measured. RESULTS: The mean 24-hour blood glucose level was significantly lower in patients taking vildagliptin than sitagliptin (142.1 ± 35.5 vs. 153.2 ± 37.0 mg/dL; p = 0.012). In patients taking vildagliptin, MAGE was significantly lower (110.5 ± 33.5 vs. 129.4 ± 45.1 mg/dL; p = 0.040), the highest blood glucose level after supper was significantly lower (206.1 ± 40.2 vs. 223.2 ± 43.5 mg/dL; p = 0.015), the AUC (≥180 mg/dL) within 3 h was significantly lower after breakfast (484.3 vs. 897.9 mg/min/dL; p = 0.025), and urinary CPR level was significantly higher (97.0 ± 41.6 vs. 85.2 ± 39.9 μg/day; p = 0.008) than in patients taking sitagliptin. There were no significant differences in plasma HbA1c, GA, 1,5AG, IRI, CPR, BNP, or PAI-1 levels between patients taking vildagliptin and sitagliptin. CONCLUSIONS: CGM showed that mean 24-h blood glucose, MAGE, highest blood glucose level after supper, and hyperglycemia after breakfast were significantly lower in patients with type 2 diabetes mellitus taking vildagliptin than those taking sitagliptin. There were no significant differences in BNP and PAI-1 levels between patients taking vildagliptin and sitagliptin. TRIAL REGISTRATION: UMIN00000768

メイジキ ニ オケル カンゴ ノ モンダイ ギョウガ ノ イシ コンドウ ツネジロウ オ メグッテ

The nursing system in Japan was begun during the Boshin War (between the Tokugawa Shogunate and Meiji Government) at the time of the Meiji Restoration in 1868. In 1877,Tsunetami Sano established Hakuai-sha (a philanthropic organisation) which became the original Japanese Red Cross. In 1878, a report on The Need for Training of Nurses was published in the Tokyo Iji Shinpo (Tokyo Medical Journal). In 1879/1880, a naval medical officer, Kanehiro Takagi started to train nurses. In 1885, the Yushi Kyoritsu Tokyo Hospital (literally Sympathy Co-operative Tokyo Hospital) which later became the Tokyo Jikeidai Hospital, initiated a training school for nurses, based on Florence Nightingale\u27s ideas of modern training. In 1886, Japan signed the Red Cross Convention, which brought Japanese nursing and training closer to international practice. In 1879, the Examination for Medical Practitioners Regulations were enacted, and in 1883, the Medical License Regulations and Medical Practicing Regulations were enacted. The legalisation of nursing standards, however, occurred later than for physicians. The Nurses Regulations were enacted in 1915. After the Second World War, General MacArthur\u27s main focus was to demilitarise and democratise Japan. During and after the American occupation, the nursing system was also improved. Three model nursing schools were set up, two in Tokyo and one in Osaka. In 1948, the Health Nurses, Midwives and Sick Nurses Act was enacted, and the new nursing system began to be adopted. In 1949, the Japanese Council of Nurses rejoined the International Council of Nurses, although it had left ICN during World War II. During the early development, Tsunejiro Kondo, a bed-ridden doctor in the Meiji era, had already sounded the alarm about the problems of nurses and the nursing system. Some of the points he raised are still relevant today. This paper introduces Kondo who strove for the nursing department to become independent from the medical department in hospitals. He also researched the psychological needs of patients that can be met through the nursing skills he proposed, in the light of the new external cultural influences experienced in Meiji Japan

ヒト ノ セイショク ホジョ イリョウ ト ホウセイド

わが国における非配偶者間人工授精児の初めての誕生は1949年のことで、既に半世紀が過ぎた。この間生殖補助医療はめざましい進歩を示したが、法制面においては、日本産科婦人科学会の自主規制ともいうべき会告はあるものの、法律としての整備はなんらなされてこなかった。学会、科学技術庁、文部省などによる幾度かの討論はきわだった進展を示すものとはならなかった。厚生省は1997年に「厚生科学審議会先端医療技術評価部会」を、翌年10月にはそのワーキング・グループの一つに「生殖補助医療技術専門委員会」を発足させ、法的、社会的、倫理的の各角度から問題の所在とその対応の策定を行った。 2000年12月には報告書が出され、現在法制化が検討されているところである。本報告はわが国における生殖補助医療の現況を伝えると共に近い将来における法制化への道すじを求めるものである

アンラクシ ト トウツウ カンワ イリョウ : オランダ ヨウセイ ニヨル セイメイ ノ シュウケツ オヨビ ジサツ ホウジョ シンサ テツヅキ ホウ シコウ オ キ ニ カンガエル

オランダでは、2002年4月1日に、「要請による生命の終結および自殺幇助(審査手続き)法」が施行された。本法は国家の法としては世界初の安楽死法となるものである。オランダは自立して生活するための社会福祉も充実しており、弱者を切り捨てない平等主義が行き渡っている。その社会背景の中で、判例の積み重ねによって安楽死を許容するための基準が形成された。1993年には遺体埋葬法の一部が改正され、安楽死への厳格なガイドラインとなっていたが、本法はさらに刑法と遺体埋葬法を改正し、その要件を満たした安楽死を実施した医師を刑事訴追しないこととした。他方、1994年の英国の「医療の倫理特別委員会報告書」は、オランダの疼痛緩和医療が英国ほど進んでいないこと、また厳格な要件のもとであるにせよ安楽死許容の方向をとっていたことが、疼痛緩和医療を更に進めるための部分的障壁となっていることを指摘している。本論文はオランダの安楽死について疼痛緩和医療との関連のもとで考察するものである。On 1 April 2002, the following act came into force in the Netherlands: Review procedures for the termination of life on request and assisted suicide and amendment of the Criminal Code and the Burial and Cremation Act. This legislation allows patients experiencing unbearable suffering to request euthanasia, and the doctors who carry it out to be free from prosecution, provided they follow strict procedures. The legislation was passed in a society where individual independence and social welfare are well developed. However, the British Select Committee on Medical Ethics, which reported on the state of palliative care in Holland, together with some Dutch doctors, have expressed the view that palliative care is not as advanced in Holland as it is in Britain. One view is that legalization of euthanasia can become an obstacle to improving palliative care. Given this relationship between palliative care and euthanasia, it is impossible to consider one without looking at both. In this paper, I examine this relationship with reference to the effects of the new legislation in the Netherlands

Ghrelin

This work was supported by grants from the NIH (DP2DK105570-01 and 2P30DK046200 to MLA, DK21397 to HJG, K01DK098319 to KMH, K01MH091222 to LH, DK093848 to RJS, R01DK082590 to LS, R01DK097550 to JT, RO1 DK 076037 to MOT, R01DA024680 and R01MH085298 to JMZ, R01AG019230 and R01AG029740 to RGS) The Wellcome Trust (MK), Science Foundation Ireland (12/YI/B2480 to CWL), the Alexander von Humboldt Foundation (MHT), the Deutsches Zentrum für Diabetesforschung (MHT), the Helmholtz Alliance ICEMED e Imaging and Curing Environmental Metabolic Diseases, through the Initiative and Networking Fund of the Helmholtz Association (MHT), and the Helmholtz cross-program topic “Metabolic Dysfunction” (MHT). Allan Geliebter was sponsored by NIH grants R01DK80153; R01DK074046; R03DK068603; P30DK26687