Disparity in emergency medical services across Japan

By using a prospective, nation-wide, population-based out-of-hospital cardiac arrest (OHCA) database (All-Japan Utstein Registry, January 1, 2005 to December 31, 2012), we examined the disparity in emergency medical services across Japan and found significant disparities among prefectures. By dividing Japan into seven parts, Hasegawa et al. (2013) analysed regional variability in survival outcomes of OHCA and found a two-fold regional difference in neurologically favourable survival after OHCA. However, seven regions are constructed of North, Northeast, East, Central, Midwest, West, South, and Japan has 47 prefectures. Each prefecture grouped in the same region would be different from others in many aspects. To identify regional disparities more in prehospital care and in-hospital post-resuscitation care, we investigated survival outcomes of OHCA in prefecture levels. As the budgets of central and local governments are not unrestrained but restricted all over the world, the findings in the paper would be beneficial to consider optimal level of regional emergency medical services

Effective Single Twymeeg Administration for Elderly Patient with Type 2 Diabetes (T2D), Arthralgia and Depression as Common Medical Problems

Background: Imeglimin (Twymeeg) has been effective for patients with type 2 diabetes (T2D). Case Presentation: The patient is an 82-year-old female with T2D, arthralgia, and depression. Results: She was given duloxetine hydrochloride (Cymbalta) and Twymeeg, leading to improved symptoms of low back pain (LBP), knee osteoarthritis, osteoporosis, depression, and possible mild cognitive impairment (MCI). HbA1c decreased from 8.8% to 7.1% for 4 months with a single administration of Twymeeg 2000mg/day. Discussion: In recent clinical practice, elderly cases often tend to have simultaneously these problems, which are medical and social crucial problems. Twymeeg and Cymbalta may be indispensable agents for future practice

Localised surface plasmon resonance inducing cooperative Jahn–Teller effect for crystal phase-change in a nanocrystal

結晶中の電子の集団的な運動が原子を動かすプラズモン誘起原子変位を初めて発見 --見えない光学センサーなど新技術の実現に期待--. 京都大学プレスリリース. 2023-08-01.The Jahn–Teller effect, a phase transition phenomenon involving the spontaneous breakdown of symmetry in molecules and crystals, causes important physical and chemical changes that affect various fields of science. In this study, we discovered that localised surface plasmon resonance (LSPR) induced the cooperative Jahn–Teller effect in covellite CuS nanocrystals (NCs), causing metastable displacive ion movements. Electron diffraction measurements under photo illumination, ultrafast time-resolved electron diffraction analyses, and theoretical calculations of semiconductive plasmonic CuS NCs showed that metastable displacive ion movements due to the LSPR-induced cooperative Jahn–Teller effect delayed the relaxation of LSPR in the microsecond region. Furthermore, the displacive ion movements caused photo-switching of the conductivity in CuS NC films at room temperature (22 °C), such as in transparent variable resistance infrared sensors. This study pushes the limits of plasmonics from tentative control of collective oscillation to metastable crystal structure manipulation

Elderly Female of Type 2 Diabetes (T2D) and Dementia with Clinical Improvement by Imeglimin (Twymeeg)

Background: Recent diabetic focus includes imeglimin (Twymeeg). Case Presentation: The case was an 83-year-old female with 19 years of type 2 diabetes (T2D) associated with recent treatment for dementia. Result: HbA1c decreased from 10.0% to 6.6% for 4 months by Twymeeg 2000 mg/day. For neuropsychiatric symptoms in dementia, memantine and tiapride were provided and controlled. Furthermore, zinc acetate hydrate (Novelzin) was continued for T2D and dementia. Discussion and Conclusion: Twymeeg administration was effective as the results of Trials of IMeglimin for Efficacy and Safety (TIMES) 2 and 3. Perspectives on the efficacy of zinc were discussed including Alzheimer's-Plus with low zinc (APLZ)

Clinical Efficacy of Imeglimin (Twymeeg) for Elderly Patient with Type 2 Diabetes Mellitus (T2DM)

Background: As an oral hypoglycaemic agent (OHA), imeglimin (Twymeeg) has been recently introduced to clinical practice for patients with type 2 diabetes mellitus (T2DM) as Twymeeg. It has beneficial pharmacological mechanisms, which are improving insulin secretion, increasing insulin sensitivity, and decreasing insulin resistance. Case Presentation: The case is 84-year-old man with mild cognitive impairment (MCI) for 3 years. He visited late August, 2021 our clinic for general malaise and was pointed out to have post-prandial blood glucose 336 mg/dL and HbA1c 8.6%. He was diagnosed with T2DM. Results: He was started to be given imeglimin 1000mg twice a day, and then HbA1c value was decreased to 7.3% in 4 weeks and 5.7% in 8 weeks. During 9-12 weeks, he felt loss of appetite and reduced food intake. Biochemical examination on 12 weeks showed decreased values of TP, Alb, HbA1c, glucose, free T3, and normal values of TSH, free T4. Doses of imeglimin were 500 mg twice a day for 9-12 weeks and discontinued after 12 weeks. Discussion: Regarding appetite loss, possible causes may include MCI, previous history of gallbladder dyskinesia, adverse effect of imeglimin, and so on. Further development of research will be expected for imeglimin in the future

Analysis of prostate cancer localization toward improved diagnostic accuracy of transperineal prostate biopsy

PurposeDelineating the precise localization of prostate cancer is important in improving the diagnostic accuracy of prostate biopsy.MethodsIn Juntendo University Nerima Hospital, initial 12-core or repeat 16-core biopsies were performed using a transrectal ultrasound guided transperineal prostate biopsy method. We step-sectioned prostates from radical prostatectomy specimens at 5-mm intervals from the urethra to the urinary bladder and designated five regions: the (1) Apex, (2) Apex-Mid, (3) Mid, (4) Mid-Base, and (5) Base. We then mapped prostate cancer localization on eight zones around the urethra for each of those regions.ResultsProstate cancer was detected in 93 cases of 121 cases (76.9%) in the Apex, in 115 cases (95.0%) in the Apex-Mid, in 101 cases (83.5%) in the Mid, in 71 cases (58.7%) in the Mid-Base, and in 23 cases (19.0%) in the Base. In 99.2% of all cases, prostate cancers were detected from the Apex to Mid regions. For this reason, transperineal prostate biopsies have routinely been prioritized in the Apex, Apex-Mid, and Mid regions, while the Base region of the prostate was considered to be of lesser importance. Our analyses of prostate cancer localization revealed a higher rate of cancer in the posterior portion of the Apex, antero-medial and postero-medial portion of the Apex-Mid and antero-medial and postero-lateral portion of the Mid. The transperineal prostate biopsies in our institute performed had a sensitivity of 70.9%, a specificity of 96.6%, a positive predictive value (PPV) of 92.2% and a negative predictive value (NPV) of 85.5%.ConclusionsThe concordance of prostate cancer between prostatectomy specimens and biopsies is comparatively favorable. According to our study, the diagnostic accuracy of transperineal prostate biopsy can be improved in our institute by including the anterior portion of the Apex-Mid and Mid regions in the 12-core biopsy or 16-core biopsy, such that a 4-core biopsy of the anterior portion is included