α‑Glucosidase inhibitor miglitol attenuates glucose fluctuation, heart rate variability and sympathetic activity in patients with type 2 diabetes and acute coronary syndrome : a multicenter randomized controlled (MACS) study

Background: Little is known about clinical associations between glucose fluctuations including hypoglycemia, heart rate variability (HRV), and the activity of the sympathetic nervous system (SNS) in patients with acute phase of acute coronary syndrome (ACS). This pilot study aimed to evaluate the short-term effects of glucose fluctuations on HRV and SNS activity in type 2 diabetes mellitus (T2DM) patients with recent ACS. We also examined the effect of suppressing glucose fluctuations with miglitol on these variables. Methods: This prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group comparative study included 39 T2DM patients with recent ACS, who were randomly assigned to either a miglitol group (n = 19) or a control group (n = 20). After initial 24-h Holter electrocardiogram (ECG) (Day 1), miglitol was commenced and another 24-h Holter ECG (Day 2) was recorded. In addition, continuous glucose monitoring (CGM) was performed throughout the Holter ECG. Results: Although frequent episodes of subclinical hypoglycemia (≤4.44 mmo/L) during CGM were observed on Day 1 in the both groups (35% of patients in the control group and 31% in the miglitol group), glucose fluctuations were decreased and the minimum glucose level was increased with substantial reduction in the episodes of subclinical hypoglycemia to 7.7% in the miglitol group on Day 2. Holter ECG showed that the mean and maximum heart rate and mean LF/HF were increased on Day 2 in the control group, and these increases were attenuated by miglitol. When divided 24-h time periods into day-time (0700–1800 h), night-time (1800–0000 h), and bed-time (0000–0700 h), we found increased SNS activity during day-time, increased maximum heart rate during night-time, and glucose fluctuations during bed-time, which were attenuated by miglitol treatment. Conclusions: In T2DM patients with recent ACS, glucose fluctuations with subclinical hypoglycemia were associated with alterations of HRV and SNS activity, which were mitigated by miglitol, suggesting that these pathological relationships may be a residual therapeutic target in such patients

プロテインC カッセイ テイカ オ ハイケイ トシ オートマチックシャ エノ ヘンコウ オ ケイキ ニ ハイケッセン ソクセンショウ オ ハッショウ シタ タクシー ウンテンシュ ノ イチレイ

A ６２-year-old man, who was a taxi-driver, presented to our hospital for further examination and treatment of deep venous thrombosis（DVT）suspected in another clinic. Before ３ months of consultation, he had changed his taxi from manual transmission car to automatic transmission car. Around the same time, he had complained progressively worsening left pedal edema and pain. When he consulted our hospital, blood examination showed elevated D-dimer and deficiency of protein C. A venous ultrasound showed an occlusive DVT in left lower extremity through an external iliac vein. A contrast-enhanced computed tomography showed bilateral pulmonary embolism（PE） and extensive thrombus in the left lower extremity. Following hospitalization, an inferior vena cava （IVC）filter was placed in an infrarenal IVC position, and anticoagulant therapy was initiated with heparin and warfarin. His DVT and PE were managed successfully with anticoagulant therapy, and pedal edema was improved. Besides some risk factors of thrombogenicity such as age and deficiency of protein C, sitting position for long hours and decreased motion of left leg might have triggered off the thrombus formation in the left lower extremity. This report demonstrates the importance of careful follow-ups to long-distance drivers with risk factors of thrombus formation, especially about clutch operation

シロリムス ヨウシュツ ステント リュウチ 7ネンゴ ニ ハジメテ ゾウエイザイ ステント シュウイ シミダシゾウ オ ミトメタ イチレイ

A 74-year-old man who had a history of percutaneous coronary intervention ［left anterior descending coronary artery ＃6‐7, sirolimus eluting stent （SES） （Cypher stent,3.0×18mm）, left circumflex coronary artery ＃13, SES （Cypher stent, 2.5×23mm）］ for angina pectoris experienced chest pain on effort after seven years from the coronary intervention. He was introduced to our hospital and coronary angiography revealed late acquired peri-stent contrast staining （PSS）, which is defined as an angiographical finding of contrast medium stain outside the stent being ＞20％ of the stent diameter, in the SES of the left anterior descending artery. Drug-eluting stent （DES） significantly inhibits neointimal proliferation, thereby significantly reducing in-stent restenosis. However, the risk of very late stent thrombosis has become a major problem after the DES implantation against the bare-metal stent implantation. PSS has been reported that PSS after SES implantation could predict late stent thrombosis and incomplete stent apposition of the lesion with PSS. In this case, PSS was pointed out for the first time in seven years after SES implantation nevertheless it did not be pointed out in three years. The mechanism and prognosis of PSS is unclear. But, we found the increase in local coagulation at the coronary artery in this case and the degree of prothrombin fragment F1＋2, one of the coagulation marker, was greater in seven years after SES implantation than in three years. We thought these findings might reflect that PSS after SES implantation was associated with very late stent thrombosis. So we started the dual antiplatelet therapy for the prevention of stent thrombosis. Careful long-term observation might be recommended in patients with late acquired PSS and elevated local coagulation response following SES implantation

シン サルコイドーシス シンダン ノ テビキ ニオケル カクシュ シンダン モダリティー ノ ケントウ

Background : Sarcoidosis is a multiple organ granulomatous disease of undefined cause. Although cardiac involvement often leads to adverse outcomes in patients with sarcoidosis, diagnosis of cardiac sarcoidosis（CS）remains difficult due to the lack of sensitive diagnostic tests. Purpose : To determine an appropriate combination of diagnostic tests for detecting CS. Method and Results : Thirteen patients were diagnosed with CS from December ２００６ to November２０１０by the use of２００６revised guidelines for diagnosing CS of the Japanese Society of Sarcoidosis and Other Granulomatous Disorders. Positive rate of each major or minor criterion in the guidelines was examined. We also evaluated positive rate of each diagnostic test. In the major criteria, basal thinning of the ventricular septum showed a high positive rate of７１．４％, although the others were less than５０％. In the minor criteria, positive rates of abnormal electrocardiogram findings and abnormal echocardiogram were７６．９％ and８４．６％, respectively. Late gadolinium enhancement （LGE）of the myocardium on cardiac MRI scanning（CMR）showed a positive rate of１００％ ; however, CMR was not performed in four patients due to life-threatening arrhythmia. All１３patients showed abnormal findings at least in either echocardiogram or LGE on CMR. Conclusion : Echocardiography is a convenient diagnostic test for detecting CS. The combination of cardiac MRI and echocardiography may improve diagnostic sensitivity

シシツ テイカ リョウホウ ニヨル ケイドウミャク プラーク アンテイカ ノ ヒョウカ : チョウオンパ integrated backscatter オ モチイタ カラー マッピング システム ノ カイハツ ト リンショウ オウヨウ

Background : The carotid plaque vulnerability is related to myocardial and cerebral infarction. We intended to develop an imaging system which enables to visualize tissue characteristics in the carotid plaques based on ultrasound integrated backscatter（IB）. And to test its clinical efficacy, effect of the statin therapy on the plaques was evaluated with our software. Methods and Results : Carotid ultrasound examination was performed and ultrasonographic RAW data of the plaques were obtained from８patients undergoing carotid artery endarterectomy. Tissue characteristics in the plaques of resected examples were compared with preoperative ultrasonic images and the tissue IB values corresponding to the specimens were determined for developing our imaging system. Using this system, Color-coded maps of plaques in the three patients were constructed before and after lipid lowing therapy. We could demonstrate that lipid fraction in each plaque decreased and fibrous or calcification fraction increased in the follow-up study. Conclusions : Changes in histology of carotid plaques by statin could visualized with our imaging system. This technique may become a useful tool for the management of atherosclerosis

MOESM2 of Îą-Glucosidase inhibitor miglitol attenuates glucose fluctuation, heart rate variability and sympathetic activity in patients with type 2 diabetes and acute coronary syndrome: a multicenter randomized controlled (MACS) study

Additional file 2. Correlations of standard deviation (SD Glucose) in 24-hour glucose levels with heart rate variability parameters