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

Familial Case of Type 1 Diabetes Mellitus (T1DM) with Similar Onset and HLA Analysis

Subjects: Cases are two patients with type 1 diabetes mellitus (T1DM), with the characteristic relationship and onset situation. Case 1 is 46-year-old daughter and case 2 is 69-year-old mother. They have been living apart and they rarely meet together. Twenty-two months after the onset of T1DM case 1, case 2 also developed T1DM. They did not notice clinical manifestation of upper respiratory infection, or they did not have any stressful matters before the onset of T1DM. Results: Their data in case 1 vs 2 were as follows: BMI 21.3 vs 19.8, HbA1c 10.3% vs 9.8%, anti-IA-2 antibody (IA-2 Ab) 2.1 vs 6.0 (<0.4), anti-GAD antibody (GAD Ab) 24 vs 10000 (<1.5), HLA-DR type DR9 / DR13 vs DR4/DR13. Discussion and conclusion: These 2 cases have characteristic mode for the onset of T1DM. In Japanese race, DR4 and DR9 have rather high sensitivity for T1DM, DR15 (DR2) has resistance for T1DM and DR13 has unremarkable influence. From these, HLA-DR type would be possible involved in the onset of T1DM, and further investigation would be expected

Daily improvement of glucose variability by Continuous Glucose Monitoring (CGM)

Continuous Glucose Monitoring (CGM) has been recently applied in the clinical diabetic practice. Authors have continued research of glucose variability. In this study, 51 year-old female patient with Type 1 diabetes mellitus (T1DM) was investigated. She has given multiple daily insulin injection (MDI) for long and her recent daily glucose profile was unstable. After applied with FreeStyle Libre, her blood variability was improved with the average glucose from 222 mg/dL to 135 mg/dL, which was partly from her motivation for better diabetic control. Thus, CGM may become a trigger to give beneficial influence for regular lifestyle of the patients

Significant weight reduction by super low carbohydrate diet with improved lipid profiles

The case was a 41-year-old male patient with obesity and hypertension until 2015. He became 102 kg with body mass index (BMI) of 32.5 and HbA1c value increased to 6.6% in January 2016. Then, he started a low carbohydrate diet (LCD) and continued successfully. His body weight was decreased to 77 kg within nine months with 5.7% in HbA1c. His lipid profiles were improved as follows: triglyceride 143 to 33 mg/dL, LDL-C 130 to 102 mg/dL, HDL-C 40 to 76 mg/dL. After that, he has continued LCD but has always meals with excess calories. Then, his weight became 88 kg in January 2020 with 6.4% in HbA1c. During three years, values of HbA1c and lipid profiles became gradually worse. He has been prescribed for antihypertensive drugs and not for an oral hypoglycemic agent (OHA) so far. The adequate treatment would be discussed from now

Effective Xultophy administration to stable blood glucose profile by Continuous Glucose Monitoring (CGM)

Type 2 diabetes mellitus (T2DM) need adequate diet, exercise and pharmacotherapy. Authors have continued diabetic practice and research on low carbohydrate diet (LCD), calorie restriction (CR), continuous glucose monitoring (CGM), and so on. The case is 50-year-old female patient with T2DM for 10 years. She has received insulin treatment with recent HbA1c 7.4 – 8.7%, then her glucose profile was studied on CGM by FreeStyle Libre. Treatment was changed from Glargine 15 units (until day 5) to Zultophy10-12 doses (after day 6), then her glucose variability showed remarkably improved. The average blood glucose on day 3, 5, 6, 8,10,13 was 174, 164, 125, 111, 101, 98 mg/dL, respectively. FreeStyle Libre showed estimated HbA1c as 6.2% and 44 mmol/mol

Glucose-lowering efficacy of Xultophy with low doses by FreeStyle Libre as continuous glucose monitoring (CGM)

The daily profile of blood glucose can be detected by continuous glucose monitoring (CGM) using FreeStyle Libre. The case was a 51-year-old female with type 2 diabetes mellitus (T2DM) for uncontrolled glucose variability as HbA1c 10.3%. During CGM measurement, diabetic treatment was changed from multiple daily insulin injections (MDI) to Xultophy (insulin degludec and liraglutide). Xultophy starting from 10 to 18 doses has brought the improvement of glucose variability, such as decreased pre-prandial glucose from 268 mg/dL to 101 mg/dL. Consequently, detailed data of glucose variability on Xultophy using CGM would be beneficial and become some reference for further clinical diabetic research

Carnitine for Body Composition in Hemodialysis Patients

Background: Authors and colleagues have continued clinical research for hemodialysis patients. Currently, a pilot study presents intervention of carnitine for changes of the body composition. Subjects and Methods: Subjects were six patients on hemodialysis with intervention of carnitine (group 1). Average data were 74.3 years, 65.4 kg, 22.6 in BMI. As levocarnitine, L-Cartin FF injection 1000 mg was administered three times a week for six months. Group 2 has six control patients for age-, sex-, body weight, BMI-matched (group 2). Body composition of muscle and fat tissues were measured by InBody 770 on 0 and 6 months. Results: In group 1, muscle volume and skeletal muscle showed increasing tendency without statistical significance. In contrast, there were significant decreases of body fat volume (22.3 kg vs 20.5 kg, 39.0% vs 35.8%) (p<0.05). No significant differences were found in hemoglobin, total protein, albumin and Cardio-Thoracic Ratio (CTR) of chest X-ray. Group 2 showed no significant changes. Discussion and Conclusion: Hemodialysis patients often have muscular reduction. Previous reports showed improved lean body mass by carnitine administration, which may support our result. These results from current pilot study would be expected to become useful reference data in the pathophysiological investigation in patients on hemodialysis

Variability Of Glucose And Lifestyle In Continuous Glucose Monitoring (CGM)

Background: Investigation of glucose variability is crucial for patient with Type 1 Diabetes mellitus (T1DM) on insulin treatment. For Continuous Glucose Monitoring (CGM), FreeStyle Libre (Abbott) has been introduced to clinical practice with useful and beneficial efficacy. Case and Results: The patient was 55 year-old T1DM female with body mass index (BMI) 21 kg/m2, HbA1c 8.0 %. She was on CGM for 14 days, with obtained glucose data in every 15 minutes. Treatment included multiple daily insulin injection (MDI) of Insulin Aspart 3 times and Insulin Glargin once a day. She showed unstable blood glucose variability with hyperglycemia and hypoglycemia, besides 2 hours delay shift in daily lifestyle rhythm. There was a discrepancy of HbA1c between actual value 8.0% and presumed value 6.9% by FreeStyle Libre. Discussion and Conclusion: Obtained glucose data from FreeStyle Libre have been satisfactory. One reason for lower HbA1c value would be from the characteristic tendency in lower glucose region. Larger distribution of glucose variability would be due to delayed shift of lifestyle, sleep situation and irregular meal. These results would become the basal data for CGM, the reference to better modification of MDI and clinical diabetic practice in future research

Daily improvement of blood glucose profile by continuous glucose monitoring (CGM)

Background: The problem of glucose variability has been in focus for type 1 diabetes mellitus (T1DM) on insulin treatment. Daily profile of blood glucose was studied on Continuous Glucose Monitoring (CGM) using Free Style Libre. Case presentation and results: Patient is 54 year-old T1DM female, with HbA1c 7.8%. The blood glucose variability was measured by Free Style Libre. Insulin therapy included multiple daily insulin injection (MDI) of Insulin Glargin and Aspart. The result revealed unstable blood glucose profile in day 1 and 2. After that, the level and fluctuation of blood glucose gradually decreased from day 3 to 14. Average blood glucose in a day was 174mg/dL, 159mg/dL, 138mg/dL, 125mg/dL and 110mg/dL, in day 2, 4, 7, 9, 11, respectively. There was a discrepancy of HbA1c between 7.8% by laboratory measurement and 6.3% presumed value by Free Style Libre. Discussion and Conclusion: Free Style Libre showed satisfactory results as CGM. There was lower HbA1c value by presumed calculation, which would be possibly due to every 15minutes measurement and difficulty in checking abrupt glucose surges. CGM application would probably bring diabetic subjects behavioral change of life style, leading to better diabetic control. These results would become reference data in CGM study for future research

Glycemic control may be influenced by climate changes in type 2 diabetes mellitus (T2DM)

Authors have continued clinical research on type 2 diabetes mellitus (T2DM). The trigger of this research was to make notice of elevated HbA1c of younger male diabetics for hot climate in the summer 2018. Enrolled subjects were 89 male patients with T2DM. Methods include the classification of 6 groups by the age, which are 21-40, 41-50, 51-60, 61-70, 71-80 and 81-90. HbA1c values in median were calculated for five seasons of 15 months. Basal HbA1c in 6 groups was 7.0%, 7.1%, 7.2%, 7.2%, 6.9% and 7.0%, respectively. Seasonal changes in HbA1c values are as follows: i) groups 21-50 showed highest in the summer, ii) groups 51-70 showed gradually decrease from winter to summer, iii) groups 71-90 showed gradually decrease from winter to autumn, and increase for winter. For seasonal HbA1c changes, influence of hot climate during from spring to summer may be involved for 21-50 years. More activity in spring to summer may be related for 51-70 years. Less exercise and more eating may be observed for 71-90 years. There are not enough analyze for related factors, then further study concerning various biomarkers would be expected