トクシマ コウエン トクシマ チュウオウ コウエン ノ ゾウエン セッケイ ニツイテ : ヒビヤ コウエン オヨビ ザイファースドルフジョウ トノ ヒカク

Tokushima Park (originally named Tokushima Central Park) is the Japan’s second western-style park that was opened in 1906. We investigated landscape architecture of Tokushima Park based on a blueprint made in 1905 to understand its purpose and function of the park, and compared with Hibiya Park that is the Japan’s first western-style park. Tokushima Park consisted of five areas. The central area included Mt. Shiroyama (Castle Mountain), and primeval forest was protected without allowing to make a big building within the area. A commercial museum, an athletic field, and a botanical garden and a library were placed in the southern, western and eastern areas respectively, so that each area was designed to exhibit each function. Tokushima Park and Hibiya Park were designed by the same two persons Seiroku Honda and Takanori Hongo. The two parks were equipped with a wide road, an athletic field, a botanical garden and so on, and these facilities were adopted to the park made since them. Because Seiroku Honda adopted three design drawings of German parks from the book Gärtnerisches Planzeichnen into a blueprint of Hibiya Park, we investigated the book to ascertain whether any design drawing was also used in Tokushima Park. We found that Seifersdorf Castle, the castle of count Brühl that was built at Seifersdorf in Germany in 13th century, is similar to the southern area of Tokushima Park

Prevention of hypoglycemia by intermittent-scanning continuous glucose monitoring device combined with structured education in patients with type 1 diabetes mellitus : A randomized, crossover trial

Aims: We conducted a randomized, crossover trial to compare intermittent-scanning continuous glucose monitoring (isCGM) device with structured education (Intervention) to self-monitoring of blood glucose (SMBG) (Control) in the reduction of time below range. Methods: This crossover trial involved 104 adults with type 1 diabetes mellitus (T1DM) using multiple daily injections. Participants were randomly allocated to either sequence Intervention/Control or sequence Control/Intervention. During the Intervention period which lasted 84 days, participants used the first-generation FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) and received structured education on how to prevent hypoglycemia based on the trend arrow and by frequent sensor scanning (≥10 times a day). Confirmatory SMBG was conducted before dosing insulin. The Control period lasted 84 days. The primary endpoint was the decrease in the time below range (TBR; <70 mg/dL). Results: The time below range was significantly reduced in the Intervention arm compared to the Control arm (2.42 ± 1.68 h/day [10.1 %±7.0 %] vs 3.10 ± 2.28 h/day [12.9 %±9.5 %], P = 0.012). The ratio of high-risk participants with low blood glucose index >5 was significantly reduced (8.6 % vs 23.7 %, P < 0.001). Conclusions: The use of isCGM combined with structured education significantly reduced the time below range in patients with T1DM

Protective and risk factors of impaired awareness of hypoglycemia in patients with type 1 diabetes: a cross-sectional analysis of baseline data from the PR-IAH study

Abstract Background Hypoglycemia in type 1 diabetes (T1D) is associated with mortality and morbidity, especially when awareness of hypoglycemia is impaired. This study aimed to investigate the protective and risk factors for impaired awareness of hypoglycemia (IAH) in adults with T1D. Methods This cross-sectional study enrolled 288 adults with T1D (mean age, 50.4 ± 14.6 years; male, 36.5%; diabetes duration, 17.6 ± 11.2 years; mean HbA1c level, 7.7 ± 0.9%), who were divided into IAH and non-IAH (control) groups. A survey was conducted to assess hypoglycemia awareness using the Clarke questionnaire. Diabetes histories, complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem-solving abilities, and treatment data were collected. Results The prevalence of IAH was 19.1%. Diabetic peripheral neuropathy was associated with an increased risk of IAH (odds ratio [OR] 2.63; 95% confidence interval [CI] 1.13–5.91; P = 0.014), while treatment with continuous subcutaneous insulin infusion and hypoglycemia problem-solving perception scores were associated with a decreased risk of IAH (OR, 0.48; 95% CI, 0.22–0.96; P = 0.030; and OR, 0.54; 95% CI, 0.37–0.78; P = 0.001, respectively). There was no difference in continuous glucose monitoring use between the groups. Conclusion We identified protective factors in addition to risk factors for IAH in adults with T1D. This information may help manage problematic hypoglycemia. Trial registration University hospital Medical Information Network (UMIN) Center: UMIN000039475). Approval date 13 February 2020

未知のR112X変異を伴ったPROP1遺伝子異常症で，成長ホルモン補充療法を開始した日本人男性の一例

Congenital combined pituitary hormone deficiency (CPHD) is associated with deficiencies of anterior pituitary hormones. PROP1 gene mutations are often responsible for CPHD, but few such cases have been reported in Japan. This study describes a 37-year-old Japanese man with CPHD, treated with hydrocortisone, testosterone, and L-thyroxine, who was evaluated for adult growth hormone deficiency (GHD). Gene analysis revealed a previously unknown PROP1 mutation (R112X). After 10 months of recombinant human growth hormone (rhGH) administration, cortisol and urinary free cortisol levels were significantly lower than before therapy. This case underscores the importance of reassessing hypothalamic-pituitary-adrenal axis function in GHD patients, especially those with a PROP1 mutation, during rhGH therapy.先天性下垂体ホルモン複合欠損症は，下垂体前葉ホルモンが先天性にいろいろな欠損を伴う疾患である．PROP1 遺伝子異常症はしばしば先天性下垂体ホルモン複合欠損症の原因となりうるが，日本人患者の報告は非常に少ない．本症例は37 歳日本人男性のPROP1 遺伝子異常症であり，ハイドロコートン，テストステロンおよびチラージンS の補充療法を以前から受けている．今回精査の結果，重症成人成長ホルモン分泌不全症が判明し成長ホルモンの補充を開始した症例である．遺伝子解析にてR112X（Arg 112 Ter）と今までに報告のない変異を伴ったPROP1 遺伝子異常症であることが判明した．ところで成長ホルモン補充開始後10 カ月において，血中コルチゾール，尿中コルチゾールが補充前と比較して有意な低下を認めた．成長ホルモンの補充を開始したPROP1遺伝子異常症において，視床下部―下垂体―副腎系の厳重な経過観察が重要であることが示唆された

Mannose-specific lectin from the mushroom Hygrophorus russula

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