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Miyako Kishimoto1,21Clinical Research Center, Department of Medicine, International University of Health and Welfare, Tokyo, Japan; 2Department of Internal Medicine, Sanno Hospital, Tokyo, JapanPurpose: Diabetes is a multifactorial disease, and interprofessional teamwork is essential for its treatment. For successful interprofessional teamwork, individual medical professionals need to have certain skills, experience, and mutual understanding of the role of different professions. However, there are few opportunities to educate medical professionals to meet these demands. To resolve this problem, educational seminars about diabetes were conducted by and for medical professionals, and their effects were assessed using a questionnaire survey.Participants and methods: Medical professionals, including a dietician, a physiotherapist, a pharmacist, a clinical laboratory technician, and a doctor, provided 10 lectures, approximately 50 mins each, for medical professionals about their specialized skills in diabetes care. Nurses who were certified diabetes educators in Japan planned and organized the seminars. In every seminar, participants were asked to complete a questionnaire regarding their profession, motivation to attend the seminar, general comments about the seminar, expectations regarding future seminars, and effects of the seminar on their daily work or attitude toward patients.Results: Among the 367 participants, 332 completed the questionnaire (respondents). The results revealed that by attending the seminars, some respondents strongly realized their lack of knowledge, some were inspired and encouraged to study more about diabetes, and some could understand other professions’ work in diabetes care better than before. Over 70% of respondents reported that attending the seminar had changed their daily work or attitude toward patients; the remainder, however, felt unchanged for reasons such as their own lack of experience and ability, and the few chances to aid patients with diabetes.Conclusion: Educational diabetes seminars by and for medical professionals were implemented. The survey of the effects of the seminar has provided further insights into the needs and current situation of education for medical professionals.Keywords: diabetes, educational seminar, interprofessional teamwork, questionnaire

Ryo Rokutanda, Mitsumasa Kishimoto, Masato Okada Immuno-Rheumatology Center, St Luke’s International Hospital, Tokyo, Japan Abstract: Behçet’s disease is a multi-organ disorder that is more common in countries around the Silk Road, and manifests as mucosal ulcers and skin lesions, and with ocular involvement. As a systemic disease, it can also involve gastrointestinal organs and the central nervous or cardiovascular systems. Although the etiology of Behçet's disease is not clearly identified, the pathogenesis of the disease is most commonly hypothesized as a profound inflammatory response triggered by an infectious agent in a genetically susceptible host. As there are no single specific manifestations or specific diagnostic tests, various diagnostic criteria have been proposed around the world, and, among them, the International Study Group criteria have been most commonly used. As the clinical expression of Behçet's disease is heterogeneous, the treatment should be individualized based on involved organs, severity of the disease, and patient's background. The choice of therapeutic agents is limited by lack of clinical trials and is based largely on case reports, case series, and several open-label clinical trials. Corticosteroids, colchicine, and traditional immunosuppressive agents, including azathioprine and cyclosporine, have been used for the treatment of Behçet’s disease. Recently, tumor necrosis factor (TNF) inhibitors have become available for several rheumatic diseases, and considerable published data suggest that TNF inhibitors represent an important therapeutic advance for patients with severe and resistant disease, as well as for those with contraindications or intolerance to these treatments. Keywords: Behçet’s disease, therapeutic agents, etiology, diagnosis

Miyako Kishimoto,1,2 Mitsuhiko Noda2,3 1Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; 2Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; 3Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan Background: Diabetes is a multifactorial disease and its nature means that interprofessional teamwork is essential for its treatment. However, in general, interprofessional teamwork has certain problems that impede its function. To clarify these problems in relation to diabetes care, a questionnaire survey was conducted. Methods: The participants who were involved in diabetes-related educational seminars, and medical personnel who were engaged in diabetes care from the National Center for Global Health and Medicine, were asked to complete the questionnaire about perceptions of, and satisfaction with, interprofessional teamwork across multiple health care providers, who were actually involved in diabetes care. Results: From 456 people who were asked to take the questionnaire, 275 people answered. The percentages of the respondents according to profession who considered multidisciplinary teamwork sufficient were as follows: physicians, 20.5%; nurses, 12.7%; registered dietitians, 29.6%; pharmacists, 21.9%; physiotherapists, 18.2%; and clinical laboratory technicians 15.4%. Insufficient interprofessional communication and inconsistency in motivation levels among staff were frequently cited as causes of insufficient teamwork. All professions considered interprofessional meetings or conferences necessary and essential for teamwork. Conclusion: The survey revealed that interprofessional teamwork in diabetes care is currently insufficient. Continuous efforts to change each profession's perceptions about interprofessional teamwork and efforts to improve the quality of interprofessional meetings are necessary. Keywords: diabetes, interprofessional, questionnaire survey, communication

Taro Shimizu,1 Yusuke Tsugawa,2,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Mitsumasa Kishimoto,7 Toshiaki Shiojiri,8 Yasuharu Tokuda9 1Hospitalist Division, Department of Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan; 2Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 3Center for Clinical Epidemiology, St Luke's Life Science Institute, 4Department of Vascular and Oncological Surgery, Hospital of Tokyo University, 5Department of General Internal Medicine, Kanto Rousai Hospital, 6Department of Cardiology, Juntendo University School of Medicine, 7Division of Rheumatology, St Luke's International Hospital, Tokyo, Japan; 8Asahi Chuo Hospital, Chiba, Japan; 9Department of Medicine, Tsukuba University Mito Kyodo General Hospital, Mito City, Ibaraki, Japan Background: It is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven. Objective: We aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals. Methods: To assess the knowledge base of medicine, we conducted the General Medicine In-Training Examination (GM-ITE) for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM) score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score. Results: Twenty-one teaching hospitals participated in the study and a total of 206 residents (67 women) participated and completed the exam. There were no residents who declined to participate in the exam. The mean GM-ITE score was 58 (standard deviation 8.4). The mixed-effects linear regression analysis showed that a higher PHEEM score was associated with a higher GM-ITE score (P = 0.02). Having a department of general medicine, and hospital location in a provincial community (versus an urban setting), were also shown to have a significant relationship with the higher score (P = 0.03, and P = 0.02, respectively). Conclusion: We found that the performance of the medical knowledge base of resident physicians was significantly associated with the educational environment of their hospitals. Improvement of the educational environment in teaching hospitals might be crucial for enhancing the performance of resident physicians in Japan. Keywords: outcome-based education, postgraduate medical education, educational environment, general medicine, provincial hospital

Miyako KishimotoDepartment of Diabetes and Metabolic Medicine, Center Hospital, Tokyo, Japan; Diabetes and Metabolism Information Center, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, JapanAbstract: Dipeptidyl peptidase-4 (DPP-4) inhibitors have recently emerged as a new class of antidiabetic that show favorable results in improving glycemic control with a minimal risk of hypoglycemia and weight gain. Teneligliptin, a novel DPP-4 inhibitor, exhibits a unique structure characterized by five consecutive rings, which produce a potent and long-lasting effect. Teneligliptin is currently used in cases showing insufficient improvement in glycemic control even after diet control and exercise or a combination of diet control, exercise, and sulfonylurea- or thiazolidine-class drugs. In adults, teneligliptin is orally administered at a dosage of 20 mg once daily, which can be increased up to 40 mg per day. Because the metabolites of this drug are eliminated via renal and hepatic excretion, no dose adjustment is necessary in patients with renal impairment. The safety profile of teneligliptin is similar to those of other available DPP-4 inhibitors. However, caution needs to be exercised when administering teneligliptin to patients who are prone to QT prolongation. One study has reported that the postprandial blood glucose-lowering effects of teneligliptin administered prior to breakfast were sustained throughout the day, and the effects observed after dinner were similar to those observed after breakfast or lunch. Thus, although clinical data for this new drug are limited, this drug shows promise in stabilizing glycemic fluctuations throughout the day and consequently suppressing the progression of diabetic complications. However, continued evaluation in long-term studies and clinical trials is required to evaluate the efficacy and safety of the drug as well as to identify additional indications for its clinical use.Keywords: teneligliptin, DPP-4 inhibitor, diabetes

We present new Very Large Telescope Interferometer (VLTI)/GRAVITY near-infrared interferometric measurements of the angular size of the innermost hot dust continuum for 14 type 1 active galactic nuclei (AGNs). The angular sizes are resolved on scales of ∼0.7 mas and the inferred ring radii range from 0.028 to 1.33 pc, comparable to those reported previously and a factor of 10−20 smaller than the mid-infrared sizes in the literature. Combining our new data with previously published values, we compiled a sample of 25 AGNs with bolometric luminosity ranging from 1042 to 1047 erg s−1, with which we studied the radius-luminosity (R − L) relation for the hot dust structure. Our interferometric measurements of radius are offset by a factor of 2 from the equivalent relation derived through reverberation mapping. Using a simple model to explore the dust structure's geometry, we conclude that this offset can be explained if the 2 μm emitting surface has a concave shape. Our data show that the slope of the relation is in line with the canonical R ∝ L0.5 when using an appropriately non-linear correction for bolometric luminosity. In contrast, using optical luminosity or applying a constant bolometric correction to it results in a significant deviation in the slope, suggesting a potential luminosity dependence on the spectral energy distribution. Over four orders of magnitude in luminosity, the intrinsic scatter around the R − L relation is 0.2 dex, suggesting a tight correlation between the innermost hot dust structure size and the AGN luminosity. [ABSTRACT FROM AUTHOR]

We present the ionized gas outflow morphology in the Circinus galaxy using the narrow-field mode (NFM) of the Multi Unit Spectroscopic Explorer (MUSE) instrument onboard the Very Large Telescope (VLT). The NFM observations provide a spatial resolution of ∼0.1 arcsec, corresponding to a physical scale of ∼2 pc, one of the highest spatial resolution achievable using ground-based adaptive optics-assisted observations in the optical wavelengths. The MUSE observations reveal a collimated clumpy outflow profile originating near the active galactic nucleus (AGN) location and extending up to 1.5 arcsec (∼30 pc) in the north-west direction. The collimated structure then fragments into two filaments, giving the entire outflowing gas a 'tuning-fork' morphology. These structures remain undetected in the lower spatial resolution MUSE wide-field mode data. We explain the origin of this tuning-fork structure to the interaction of the outflow with a dense clump in the interstellar medium (ISM) as the outflow propagates outwards. The origin of the collimated structure itself could be from jet–ISM interactions on small scales. These observations also provide evidence to the origin of the ionized gas filaments previously observed in the Circinus galaxy out to kiloparsec scales. We find instantaneous and time-averaged mass outflow rates of 10−2 and 10−4 M⊙ yr−1, respectively. Based on the star formation rate in the Circinus galaxy reported in the literature, the observed ionized outflows are not expected to regulate star formation within the ∼100 pc scales probed by the NFM data. [ABSTRACT FROM AUTHOR]

We have fabricated ferromagnetic Fe-oxide nanoparticles as a candidate of hysteresis-loss heating materials used for hyperthermia and thermoablation and examined heating abilities. The coercivities were controlled in a range between 50 Oe and 240 Oe. The temperature-rising characteristics were examined for randomly oriented solid nanoparticles by applying a 17-kHz ac magnetic field with an amplitude up to 550 Oe. A temperature rising rate [DELTA]/[DELTA]t was proportional to the square of the peak magnetic field Ho in the lower Ho region; however, the relation dose not hold at higher [H.sub.o]. The maximum loss power was obtained to be 4 W/g, which is smaller than the value expected from the minor loop experiment (13.7 W/g). The reason for small heating capability is discussed. Index Terms--Hyperthermia, hysteresis loss, iron oxide, magnetite, nanoparticle, thermoablation.