Combined Treatment of Vildagliptin/Metformin (Equmet) and Imeglimin (Twymeeg) with Clinical Efficacy

Background: Vildagliptin/Metformin (EquMet) and imeglimin (Twymeeg) are effective oral hypoglycemic agents (OHAs) for patients with type 2 diabetes (T2D). Case Presentation: The patient was a 68-year-old male with T2D and fatty liver for several years. In November 2022, his HbA1c had increased to 8.2%, and he was started on Twymeeg, followed by EquMet. Results: Over the course of four months, the patient’s HbA1c value successfully decreased from 8.2% to 6.7%, and he did not experience any gastrointestinal adverse effects (GIAEs). Discussion and Conclusion: The combined treatment of EquMet and Twymeeg demonstrated clinical efficacy without any adverse effects. The Trials of IMeglimin for Efficacy and Safety (TIMES) provided various evidence of imeglimin’s effectiveness

Clinical Significance of Chest CT Scan for Previous Heavy Smoker

The patient is an 83-year-old male, who smoked 20-40 cigarettes daily during 20-75 years and quit after that. In March 2021, he revealed normal chest X-P and was explained to take chest computed tomography (CT) next year. In April 2022, chest X-P was unremarkable, but CT showed a small solid abnormal shadow in the upper left lung region nearby aortic arch and abdominal aortic aneurysm (AAA) in the upper abdomen. Almost lung cancer cases are found in current smokers or ex-smokers. Using CT, lung cancer screening shows a 20-26% decrease in cancer death. Consequently, Low-Dose CT (LDCT) for smokers would be recommended

Clinically Both Effects of Weight and Glucose Variability by Oral Semaglutide (Rybelsus) for Younger Female Patient with Type 2 Diabetes (T2D)

Background: Obesity and Type 2 Diabetes (T2D) are crucial problems worldwide. Oral semaglutide (Rybelsus) was introduced to medical practice for Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA). Case presentation: The patient is 24-year-old female with obesity (BMI 39.3 kg/m2), T2D and fatty liver. Results: She started and increased Rybelsus from 3mg, 7mg to 14mg/day each 4 weeks. She showed significant efficacy for 4 months as HbA1c 6.3% to 5.6% and weight 107kg to 103kg, without Gastrointestinal Adverse Events (GIAEs). Discussion: Rybelsus is provided just after waking up, and kept >30 min fasting period. Longer fasting time may contribute current effect

Changed Diabetic Treatment from Multiple Daily Injection (MDI), Dulaglutide to Xultophy

The patient is a 56-year old (yo) female with type 2 diabetes mellitus (T2DM). Medical histories include persisting T2DM from 35yo, renal stone at 43yo, hypertension from 45yo, photocoagulation for retinopathy on 54yo. An incidentaloma was found in the left adrenal gland, where endocrinological exams were negative for functional tumor. Her diabetic control situation became worse with HbA1c > 10%, then the treatment has been changed from multiple daily injection (MDI), Dulaglutide to Xultophy which is combined agents of degludec and liraglutide (IDegLira). It was provided 10-18 doses daily, and then glucose variability profile was improved satisfactory, suggesting the dual synergistic effects

Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet

Diabetes mellitus (DM) has wider neurological complications. They include upper gastrointestinal (GI) symptoms, impaired motility, impaired gastric emptying (GE) and diabetic gastroparesis (DG), which are usually found. The patient was a 64-year-old man with type 2 diabetes (T2D) for 22-years. The patient weighed 74 kg with body mass index (BMI) 23.6 kg/m2, hemoglobin A1C (HbA1c) 9.2%, ankle brachial index (ABI) 1.19/1.23, AST 25 U/L(7-38), ALT 23 U/L(4-44), GGT 48 U/L(<86), Chest X-P normal, and electrocardiogram (ECG) negative. When the patient was treated with low carbohydrate diet (LCD), a significant reduction in body weight and HbA1c was observed. Abdominal computerized tomography (CT) revealed multiple gall stone, dilated common bile duct and impaired GE, indicating DG. For endoscopic examination, much food residue was found in the stomach due to DG after 13 hours fasting. Treatment for DG was initiated by mosapride citrate hydrate. During clinical progress, occasional liver dysfunction was observed twice associated with elevation of AST 196 U/L, GGT 373 U/L and without symptoms, indicating cholestasis-type dysfunction. Some possible triggers may be involved in these episodes, such as gall stone, enlarged volume of stomach due to DG, overeating, overdrinking, and other factors. This impressive report will hopefully become a reference for developing diabetic practice and research

分子遺伝学的手法を用いたわが国メロン品種の多様性と分類

For the breeding of Japanese netted melon, various types of foreign cultivars have been utilized for improving adaptability, disease and pest resistance, fruit quality and so on. However, little is known about their genetic diversity and relationships, since most cultivars derived from crosses between various horticultural groups. To figure out the genetic structure of Japanese melon, in this study, 57 melon accessions from three horticultural groups were examined using 55 RAPD markers produced by 24 RAPD primers. Genetic diversity of the Japanese netted melon was as high as those of cultivar groups of Groups Cantalupensis and Inodorus, while it was low in Group Conomon irrespective of large variations in fruit traits. Cluster analysis and PCO analysis based on genetic distance showed that Group Conomon was distantly related to other melon accessions. Among the latter, European cantaloupe (nonnetted) and American open-field type (netted) proved to be genetically close, while England glasshouse melon (netted) including ‘Earl’s Favourite’ is distantly related to these two groups and closely related with Group Inodorus. It was therefore suggested that England glasshouse type was established from hybrids between European cantaloupe and Group Inodorus. Japanese netted melon was most closely related with England glasshouse type, irrespective of the fact that various kinds of melon accessions have been crossed to improve adaptability, disease resistance and so on. In contrast, pure line cultivars of the Japanese netted melon bred by pure line selection from ‘Earl's Favourite’ or by crossing ‘Earl’s Favourite’ with ‘British Queen’ were confirmed to be mostly homogenous, and it was difficult to establish RAPD markers to discriminate each cultivar. Group Conomon var. makuwa and var. conomon, which have been cultivated and utilized as different crops, proved to be genetically indistinguishable and were considered to share the same gene pool

Clearer Image of Computed Tomography by Reconstruction Analysis Method

Computed tomography (CT) has been widely used for long. In recently years, the useful application of CT would be the method of the reconstruction images. Historically speaking, reconstruction images were conducted so far by algebraic reconstruction technique (ART), filtered back projection (FBP), iterative reconstruction (IR) algorithms and so on. There are various effects of reconstruction image of CT in clinical practice. Two cases with such beneficial experiences were reported. Case 1 is 74-year-man with hypertension. He was diagnosed to have abdominal aortic aneurysm (AAA). By reconstruction images, the general shape and details were clearly observed including regulating background data. Case 2 is 48-year-female without history of low back pain. When she received abdominal CT, she was pointed out to have lumbar disc herniation between L4 and L5. The diagnosis was done from the lateral tomography of lumbar vertebrae. By reconstruction images with colored modification, the detail status of herniation was clearly observed. Consequently, reconstruction image method of CT would be useful and effective. Further evolution of CT apparatus and development of computer analysis would be expected for better clinical practice and research in the future

GDP/GTP exchange reaction-stimulating activity of Rabphilin-3A for Rab3A small GTP-binding protein

AbstractRabphilin-3A is a putative target protein for Rab3A, a small GTP-binding protein particularly implicated in neurotransmitter release. Rabphilin-3A interacts more preferentially with GTP-Rab3A than with GDP-Rab3A. Moreover, Rabphilin-3A shows a weak activity to stimulate the GTPase activity of Rab3A and a strong activity to inhibit the Rab3A GTPase-activating protein (GAP)-stimulated GTPase activity of Rab3A. Here, we show that Rabphilin-3A has another activity to stimulate the GDP/GTP exchange reaction of Rab3A. Rabphifin-3A may keep Rab3A continuously in the GTP-bound form by converting again GDP-Rab3A, which may be converted from GTP-Rab3A by Rab3A GAP, to GTP-Rab3A, until the function of Rab3A is accomplished

The novel latex agglutination turbidimetric immunoassay system for simultaneous measurements of calprotectin and hemoglobin in feces

Background/Aims Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system. Methods Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification. Results The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P Conclusions The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC