Aim : Severe hypoglycemia remains a major complication of diabetes ; however, the background of patients with severe hypoglycemia requiring hospitalization has not been unraveled. Therefore, in this study, we examined the characteristics of patients who required hospitalization for severe hypoglycemia.
Methods : We included 330 patients with severe hypoglycemia who had type 2 diabetes and who visited the Aizawa Hospital Emergency and Critical Care Center during a 12-year period. Furthermore, we divided the patients into two groups : patients treated with insulin (INS-group) and those treated with oral hypoglycemic agents without insulin (OHA-group). We examined the time of hospital visits and the proportion of patients requiring hospitalization.
Results : The proportion of patients requiring hospitalization was significantly lower in the INS-group than in the OHA-group. The proportion of patients who visited the hospital because of severe hypoglycemia between 12 : 00 and 17 : 59 was significantly higher in the INS-group than in the OHA-group. There was no significant difference in the proportion of patients who were hospitalized and those who could return home across all periods in the INS-group. The proportion of hospitalized patients was low between 0 : 00 and 5 : 59 and high between 18 : 00 and 23 : 59 in the OHA-group.
Conclusions : In insulin-treated patients, there is a risk of severe hypoglycemia, even with poor glycemic control. However, patients treated with OHA alone were at increased risk of hospitalization for severe hypoglycemia in cases of excessively good control and the visit time between 18 : 00 and 23 : 59.These findings suggest strategies that can reduce the risk of severe hypoglycemia and hospitalization.

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Severe hypoglycemia is a serious complication of diabetes that can be directly linked to life prognosis and activities of daily living. However, sufficient knowledge regarding the trend of severe hypoglycemia has not been accumulated. In this study, 330 patients with type 2 diabetes mellitus diagnosed with severe hypoglycemia were analyzed by the month of hypoglycemia onset. The patients were enrolled from those who visited the Critical Care Center of Aizawa Hospital over a 12-year period, from January 1, 2008, to December 31, 2019. The results showed that the number of patients with hypoglycemia was the lowest in February and the highest in September. Blood pressure (both systolic and diastolic) was the lowest in September and the highest in June. Blood glucose levels were the lowest in May and the highest in July. HbA1c values were the lowest in August and the highest in October. We also examined differences in the types of drugs administered. The number of drugs administered was the lowest in October and the highest in February. In addition, the proportion of DPP4 inhibitors was the highest in February for patients with hypoglycemia. The results of this study showed a month-to-month difference in the tendency of patients to visit the emergency room for severe hypoglycemia. In particular, we considered that it was necessary to pay attention to severe hypoglycemia in patients with good glycemic control in the winter months who require treatment with multiple drugs, and in patients with inadequate control in October.

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Immune thrombocytopenia (ITP) is a hemorrhagic disease primarily caused by platelet destruction and reduced platelet production from megakaryocytes due to autoantibodies targeting platelet glycoproteins and other antigens, resulting in thrombocytopenia. While the evaluation of bone marrow megakaryocytes is important for distinguishing different causes of thrombocytopenia, recent ITP treatment guidelines state that bone marrow examination itself is not particularly useful for diagnosing ITP. However, there are only a limited number of studies focusing on ITP, particularly on megakaryocyte morphology, indicating that further research is needed.
In this study, we compared the morphology of bone marrow megakaryocytes and their platelet production patterns between ITP and control groups. Bone marrow smear specimens were analyzed to measure megakaryocyte major axis length, area, and nuclear area, as well as the number and rate of platelet attachments on megakaryocyte surfaces. The ITP group exhibited greater megakaryocyte major axis length and a larger megakaryocyte area compared to the control group. Furthermore, the number of platelet attachments on megakaryocyte surfaces was significantly lower in ITP patients.
Additionally, megakaryocytes in the pregnancy-complicated group had larger major axis length and areas than those in the non-complicated group. In refractory cases requiring thrombopoietin receptor agonists (TPORAs) for treatment, the cell major axis length, cell area, and nuclear area were all larger. The percentage and number of platelet attachments on megakaryocyte surfaces were also lower in patients with Helicobacter pylori-positive (H. pylori-positive) ITP.
The morphology of megakaryocytes in ITP exhibits characteristics related to its pathology. Therefore, focusing on the size of megakaryocytes and the appearance of platelet attachments on megakaryocyte surfaces in bone marrow smears may be useful for differentiating ITP.

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Background : Hydralazine (HYD) is a vasodilator widely used for the management of hypertension and related conditions, including heart failure and eclampsia. While previous studies have shown that HYD mitigates hepatic steatofibrosis induced by a high-fat, high-cholesterol diet in spontaneously hypertensive rats (SHRs), its precise effects on lipid metabolism remain unclear. This study investigated the impact of HYD on serum and hepatic lipid profiles and explored potential underlying mechanisms.
Methods : Male SHRs received HYD via drinking water (60mg/L) for either four or ten weeks, followed by analyses of clinical parameters and hepatic gene expression.
Results : HYD significantly reduced serum triglyceride (TG) levels at both time points. In the liver, HYD markedly upregulated small heterodimer partner, a target gene of the farnesoid X receptor (FXR), as well as adipose triglyceride lipase (ATGL). After ten weeks of HYD treatment, the expression of peroxisome proliferatoractivated receptor α was also significantly elevated, coinciding with reduced serum TG levels.
Conclusion : These findings suggest that HYD lowers lipid levels primarily by activating the FXR signaling pathway and enhancing ATGL expression, highlighting a novel pharmacological role of HYD in lipid metabolism.

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Objective : Neurodevelopmental disorders (NDD) affect a significant percentage of children, with 4.4％ diagnosed and an additional 12.3％ suspected in Japan. Inclusive education is essential to support these children, yet current teaching methods in Japan often fail to accommodate their unique needs. To address the educational and parental support needs of pre-school to early primary school children with and without NDD, we aimed to develop a mobile application.
Methods : Unstructured interviews with stakeholders, including preschool teachers, childcare workers, child psychiatrists, and parents, were conducted to understand the challenges faced by children with developmental concerns. A digital prototype was created based on initial feedback and further refined through additional interviews. The final application was evaluated through a post-release questionnaire.
Results : Stakeholder interviews revealed isolation among parents of “problematic” children, reluctance to accept NDD diagnoses, and communication challenges between teachers and parents. Parents expressed a need for reliable, relevant child-rearing information and concise advice. The developed mobile application, “Nobi-nobi TOIRO,” addresses these needs through Q&A services, information sharing, and note-taking functionalities. As of May 2024, it has been downloaded approximately 36,000 times, with 92.2％ user satisfaction and 99.4％ of users recommending it.
Conclusion : The “Nobi-nobi TOIRO” application demonstrates the potential of mobile technology to provide inclusive support for children with developmental concerns. The user-centric development approach ensured its relevance and usability, making it a valuable tool for parents, preschool teachers, and childcare workers in promoting inclusive education.

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Primary hyperparathyroidism (PHPT) is rare in children. The endocrinological management after parathyroidectomy in children is not well established. The patient reported here was an 11-year-old boy who underwent parathyroidectomy for PHPT. He started taking calcium lactate hydrate and alfacalcidol 6 days after surgery to prevent postoperative hypocalcemia. His intact parathyroid hormone (PTH) level subsequently increased over the 2 months after surgery, while his serum calcium levels were stable. Although we were concerned about recurrence, his intact PTH level subsequently decreased, and his bone mineral density (BMD) improved postoperatively. Three years after parathyroidectomy, his intact PTH level and BMD are normal, and he is growing normally. It was thought that his transient intact PTH elevation had been caused secondarily by insufficient calcium supplementation after surgery, as suggested by low urine calcium levels at that time. Fortunately, in our case, growth and BMD were not affected postoperatively. Nevertheless, in pediatric cases of PHPT, following up the postoperative endocrinological course is thought to be necessary to obtain healthy growth in terms of stature and bone.

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