Early intervention for preservation of pancreatic β-cell function is crucial for strict glycemic control without hypoglycemia. Early intervention consists of two approaches, change of life style and drug therapy. Especially, diet therapy is important for body weight reduction. However, adherence of calorie restriction in obese patients is still low and a new approach is necessary. Improvement of life style including body weight reduction produces not only improvement of glycemic control but also prevention of incidence of diabetes. This preventive effect is recognized in patients who have many risk alleles associating with type 2 diabetes, indicating that early intervention of life style can overcome genetic risk for diabetes. Moreover, in order to maintain an appropriate life style for a long time, patients need motivation and empowerment to perform the daily management of diabetes. Therefore, we need more efficient use of Conversation Map which helps patients follow a treatment over a long period of time, or helps them change “an aspect of their lifestyle”. Finally, in addition to intervention of life style, early intervention by insulin treatment is important for the preservation of pancreatic β-cell function, however, initiation of insulin is often delayed mainly due to patients' hesitation even in insufficient glycemic control. In future, insulin treatment will need to become more popular in general physicians.
Recent medical progress in drugs has enabled appropriate control for hypertension and dyslipidemia. On the other hand, diabetes mellitus, another life style mediated disease, is difficult to be managed without improvement of the life style of the patients by themselves. In this lecture, the strategy is introduced to motivate the diabetic patients to keep appropriate glycemic control.
The Insluin Pump therapy known as “Continuous subcutaneous insulin infusion therapy” is an alternative to multiple daily injections of insulin by insulin syringe or an insulin pen. An insulin pump is a medical device used for an administration of insulin and allows intensive insulin therapy in when used in conjunction with blood glucose monitoring and carb counting. A using pump may lead better Quality of Life in Type 1 diabetes. Insulin pumps make it possible to deliver more varying type of insulin infusion to achieve tighter post meal blood glucose control. Also, Programmable basal rates allow for scheduled insulin deliveries of varying amounts at different times of the day.
The use of incretin-based therapies, such as DPP-4 inhibitors and GLP-1 receptor agonists, has increased dramatically due to their efficacy, low risk of hypoglycemia, and potential for preserving beta-cell function. Based on their effects on glycemic control and the likelihood of aiding in weight loss, GLP-1 receptor agonists provide a unique treatment option for people with type 2 diabetes. The potential benefit of incretin-based therapies in the treatment of type 2 diabetes patients and cardiovascular disease is currently an active area of research. While the potential benefits of incretin-based therapies in cardiovascular risk reduction are promising, results from ongoing outcomes-based studies will help determine the role of these agents in diabetes management.
We previously reported a negative correlation between vancomycin and linezolid susceptibility in Staphylococcus aureus (S. aureus) (Watanabe Y, et al : Antimicrob Agents Chemother, 2008; 52 : 4207-4208). In the present study, we evaluated changes in the correlations of susceptibility of vancomycin-intermediate S. aureus (VISA) to linezolid and vancomycin with the mutations of rpoB, vraSR, graRS, clpP and walRK. These mutations have been proven to contribute to the decreased vancomycin susceptibility of VISA. Of 40 VISA strains, 29 (72.5%), 9 (22.5%), 4 (10%), 3 (7.5%) and 23 (57.5%) strains carried mutation in rpoB, vraSR, graRS, clpP and walRK, respectively. Statistical analysis showed that the level of improvement in linezolid susceptibility was significant only for the rpoB mutation group. Population analysis for hVISA Mu3 and its graR - and/or rpoB -mutated mutants showed that the rpoB mutation significantly increased linezolid susceptibility, while the graR mutation significantly reduced vancomycin susceptibility. Interestingly, MIC determination with 41 rifampicin- and 46 vancomycin-selected mutants generated from 7 clinical MRSA strains showed that the MIC of linezolid was reduced by 0.45 ± 0.25 for rifampicin-selected mutants and by 0.24 ± 0.28 mg/l for vancomycin-selected mutants. For the vancomycin MIC, the rifampicin-selected mutants increased by 0.40 ± 0.37, while the vancomycin-selected mutants increased by 1.21 ± 0.74 mg/l, when compared to the parent strains. Moreover, a study with 20 rpoB -mutants developed by exposing N315Δ IP in vitro to rifampicin showed that all mutants had improved linezolid susceptibility, but this was not accompanied by a change in vancomycin susceptibility in 19 of 20 mutants. Taken together, we conclude that rpoB mutation may play a contributory role in the improvement of linezolid susceptibility in S. aureus.
Objective: The effects of continuation of chemotherapy on the quality of life (QOL) of elderly patients with lung cancer have not yet been clearly demonstrated. The aim of this study was to clarify the QOL profiles in elderly patients during chemotherapy in comparison with younger patients.
Patients: Forty-nine patients aged 65 and older (group A) who were undergoing chemotherapy for lung cancer and 36 patients younger than 65 (group B) in similar therapy were retrospectively analyzed.
Methods: QOL and performance status (PS) were evaluated using the QOL-anticancer drugs (ACD) scale and Karnofsky performance status (KPS) scale at the beginning of each course of chemotherapy, respectively. The total score of each QOL domain and KPS at each course were compared between the groups.
Results: No differences were observed in gender, histology, stage, KPS, applied chemotherapeutic regimen, response rate, or median survival between the groups. With regard to the hematological toxicity, greater than grade 3 or equal leukopenia and neutropenia were more frequently observed in group A. The total score of the functional domain was significantly deteriorated during chemotherapy in group A, while that in group B was not altered (p = 0.014 by repeated ANOVA). Interestingly, a moderate correlation between KPS and the total score of the functional QOL domain was observed (r = 0.454).
Conclusions: Continuation of chemotherapy for elderly patients with lung cancer led to a marked deterioration in the functional QOL. The KPS can be useful for estimating the functional QOL in cases where QOL data is missing.
Objective : We used audiometry and follow-up examinations in male university students to investigate whether kendo (Japanese fencing with bamboo swords) has an effect on hearing in kendo practitioners.
Materials and methods : We conducted audiometry for 237 male university students (117 kendo practitioners and 120 non-practitioners), and followed up for two years with audiometry and a distortion-product otoacoustic emission (DPOAE) test for 13 kendo practitioners.
Results : Only four out of 120 non-practitioner male students had hearing deficits, but 32 out of 117 male kendo practitioners showed deficits. The hearing deficits of the practitioners showed a wide range from 0.5 to 8 kHz, and many of the audiograms indicated frequency-hearing deficits at 2 or more frequencies. Testing showed a significant deficit in kendo practitioners at 0.5, 1 and 2 kHz, according to the follow-up DPOAE testing. In addition, according to audiograms and DPOAE test results, hearing decreased significantly in practitioners at 3, 4, 5 and 6 kHz.
Conclusions : Our audiometry results suggested that kendo practice has a negative influence on hearing. Long-term kendo practice showed a stronger effect in the frequency range from 1 kHz to 4 kHz. However, we found that the negative impacts could possibly be reduced with consideration of the spatial and environmental conditions of the practice room. Moreover, our findings suggested that the DPOAE test may be useful as an index for evaluation in the early stages of hearing change.
We report a case of triple cancers : male breast cancer, colon cancer, and lung cancer. A 75-year-old male presented with a lump in his breast in 2003. Fine needle aspiration revealed adenocarcinoma, and he underwent mastectomy, chemotherapy, radiotherapy and hormonal therapy. In 2004, he presented with a fecal occult blood, and colonoscopy revealed a tumor. Endoscopic resection was performed and the tumor was found to be well-differentiated adenocarcinoma. He was followed-up in our hospital from 2007, and presented with a cough in 2009. Computed tomography revealed a lung carcinoma, and underwent upper lobe resection with a pathological diagnosis of squamous cell carcinoma. The patient has been well since the latest resection without recurrence of any carcinomas. We utilized cooperative approaches in this case both in Juntendo University Hospital and our hospital.
Three cities in Chiba Prefecture, Japan (Matsudo, Kashiwa, and Nagareyama) have been operating a nighttime and weekend emergency treatment system called the GIB (for gastrointestinal bleeding) Network in order to provide emergency medical services including endoscopic hemostatic treatment for acute hematemesis or melena patients since March 2010. This is a report on our hospital's activities related to the network from March 2010 through February 2012. Our experience has shown that smooth communication among hospitals on GIB duty, hospitals designated as secondary emergency service institutions, and ambulance squads is vitally important in order to maintain efficient network operations.