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

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

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

Protocol for a multicentre, prospective, cohort study to investigate patient satisfaction and quality of life after immediate breast reconstruction in Japan: the SAQLA study

Introduction The aim of breast reconstruction (BR) is to improve patients' health-related quality of life (HRQOL). Therefore, measuring patient-reported outcomes (PROs) would clarify the value and impact of BR on a patient's life and thus would provide evidence-based information to help decision-making. The Satisfaction and Quality of Life After Immediate Breast Reconstruction study aimed to investigate satisfaction and HRQOL in Japanese patients with breast cancer who undergo immediate breast reconstruction (IBR). Methods and analysis This ongoing prospective, observational multicentre study will assess 406 patients who had unilateral breast cancer and underwent mastectomy and IBR, and were recruited from April 2018 to July 2019. All participants were recruited from seven hospitals: Okayama University Hospital, Iwate Medical University Hospital, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Showa University Hospital, University of Tsukuba Hospital, Osaka University Hospital and Yokohama City University Medical Center. The patients will be followed up for 36 months postoperatively. The primary endpoint of this study will be the time-dependent changes in BREAST-Q satisfaction with breast subscale scores for 12 months after reconstructive surgery, which will be collected via an electronic PRO system. Ethics and dissemination This study will be performed in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects published by Japan's Ministry of Education, Science and Technology and the Ministry of Health, Labour and Welfare, the modified Act on the Protection of Personal Information and the Declaration of Helsinki. This study protocol was approved by the institutional ethics committee at the Okayama University Graduate School of Medicine, Dentistry, on 2 February 2018 (1801-039) and all other participating sites. The findings of this trial will be submitted to an international peer-reviewed journal

総合科学科におけるキャリア教育を軸としたグローバル人材育成の試み : SGH3年目における1年次生の学年経営実践報告

学年経営は日々の指導の積み重ねによって成される。これさえ行えば何もかもうまく行くというような秘策はない。担任副担任でチームを組み、生徒集団を複数の目で見守りながら、授業や行事を展開していく。本年次は本校総合科学科20年余りの歴史が築きあげたキャリア教育を大切にしながら、スーパーグローバルハイスクール(SGH) の目標であるグローバル人材の育成に向けて取り組んできた。本稿ではその1年間の取り組みについて報告する

Aeroacoustic Prediction for Vertical Axis Wind Turbines

This thesis investigates the aerodynamic and aeroacoustic prediction of vertical axis wind turbines, using computational fluid dynamics simulations. Noise pollution from wind turbines is one of the disadvantages of wind energy, calling for strategies to reduce noise levels. Yet for vertical axis wind turbines in particular, there is insufficient knowledge of how to identify sound sources and mitigate the sound level. The aim of this study is to predict aerodynamic noise, using large eddy simulation and acoustic analogy, so as to better understand the mechanism of sound generation for vertical axis wind turbines. First, the prediction method is validated for a static single blade in stall. This model is able to capture the dominant frequency, but it does not well reproduce the broadband characteristics. Next, the aerodynamic behavior of the 12 kW H-rotor vertical axis wind turbine is studied, whereby the focus is on the importance of properly modeling the strut influence for an accurate prediction of the blade forces. To achieve this, the flow field is solved for three different tip speed ratios. The results show that the struts significantly affect on the force distribution along the blade. The reduction of the blade force is observed to occur not only at the attachment points of the struts, but also over a large area of the blade section in the downwind side where the blade interacts with the wake created in the upwind. Finally, the noise radiated from the vertical axis wind turbine operating at high tip speed ratio is predicted. Measurements are conducted to validate the prediction, with the experimental data representing the broadband noise characteristics dominant at around 800 Hz. The prediction reproduces the sound pressure level observed at a radial distance of 1.4 rotor diameter, with a few decibels difference. However, these discrepancies become more pronounced at double distance, which can be considered to arise due to the effect of the ground reflection being ignored. The simulation furthermore indicates, that the main sound sources are emitted when the blade rotates in the downwind. It is suggested that future work should properly consider the atmospheric turbulence for more accurate predictions