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Background: Vildagliptin/Metformin (EquMet) and imeglimin (Twymeeg) are effective oral hypoglycemic agents (OHAs) for patients with type 2 diabetes (T2D). Case Presentation: The patient was a 68-year-old male with T2D and fatty liver for several years. In November 2022, his HbA1c had increased to 8.2%, and he was started on Twymeeg, followed by EquMet. Results: Over the course of four months, the patient’s HbA1c value successfully decreased from 8.2% to 6.7%, and he did not experience any gastrointestinal adverse effects (GIAEs). Discussion and Conclusion: The combined treatment of EquMet and Twymeeg demonstrated clinical efficacy without any adverse effects. The Trials of IMeglimin for Efficacy and Safety (TIMES) provided various evidence of imeglimin’s effectiveness.

Background: Among oral hypoglycemic agents (OHAs), imeglimin (Twymeeg) would be in focus. Case Presentation: The patient in this case is a 58-year-old female with a history of obesity and previous operations for posterior longitudinal ligament ossification. In early September 2022, she developed dizziness and a general feeling of unwellness, leading to a diagnosis of Type 2 Diabetes (T2D) with an HbA1c level of 11.1%. Result: The patient was treated with a low carbohydrate diet (LCD) and Twymeeg, resulting in a significant decrease in HbA1c levels from 11.1% to 9.0%, 6.7%, and 5.9% over the course of three months. Pre-prandial and post-prandial blood glucose levels were measured with great accuracy. Discussion and Conclusion: The administration of Twymeeg was found to be effective in reducing the patient’s HbA1c levels, and the relationship between HbA1c and glucose variability could be further investigated based on these results.

Background: Recent diabetic focus includes imeglimin (Twymeeg). Case Presentation: The case was an 83-year-old female with 19 years of type 2 diabetes (T2D) associated with recent treatment for dementia. Result: HbA1c decreased from 10.0% to 6.6% for 4 months by Twymeeg 2000 mg/day. For neuropsychiatric symptoms in dementia, memantine and tiapride were provided and controlled. Furthermore, zinc acetate hydrate (Novelzin) was continued for T2D and dementia. Discussion and Conclusion: Twymeeg administration was effective as the results of Trials of IMeglimin for Efficacy and Safety (TIMES) 2 and 3. Perspectives on the efficacy of zinc were discussed including Alzheimer’s-Plus with low zinc (APLZ).

Clinical effectiveness of sedative music on sleep quality was investigated. Subjects were 14 females aged 40s to 70s, and methods included listening to music during going to sleep using by sound sleep support sound player “Lullaby reverberation (Komoriuta-no-Hibiki)”, which was evaluated by Pittsburgh Sleep Quality Index (PSQI) in 0,4,8 weeks. Thirteen cases showed decreased points of PQSI. Time to sleep and sleep duration were almost the same. The relationship figure for PSQI and time until sleeping showed general tendency of left and horizontal/lower directional arrows. These results suggest positive beneficial effect of music for sleep quality evaluated by PSQI.

As a reliable psychological test, Tokyo University Egogram (TEG) 2nd has been used widely. TEG was recently revised to TEG 3rd. Authors continued TEG research on university students for long, in which results of 2018 by TEG 2nd and results of 2019-2022 by TEG 3rd were compared. For the 3rd revision, FC dominant and AC dominant increased markedly, whereas CP dominant and NP dominant decreased. C dominant pattern showed remarkable increase, which is due to increase of AC dominant and FC dominant. This is a characteristic tendency for late teenagers. Further, mixed types of N-shaped and reverse N-shaped patterns were found.

For the latest development for anti-diabetic agents, nanoparticles (NPs) have been in focus. Permeation enhancers (PEs) are known to increase the oral absorption of various kinds of macromolecules. One of PEs would be sodium N-[8-(2-hydroxybenzoyl) amino] caprylate (SNAC), which has been used for glucagon-like peptide-1 receptor agonist (GLP-1RA) as oral semaglutide (Rybelsus). For insulin encapsulation, polyelectrolyte nanocomplex (PEC) have been the promising carriers. Furthermore, spray drying technique has been an adequate and well-known industrial method for developing pharmaceutical industries, and aqueous polymer dispersions (APDs) have been applied. Consequently, self-nanoemulsifying drug delivery systems (SNEDDS) can be expected to improve future diabetic treatment.

In the current changing society, the elderly need the zest for living. For acquiring satisfactory health care and management, an adequate degree of health literacy would be required. From the research of Health Literacy Questionnaire (HLQ) and Short Test of Functional Health Literacy Assessment (S-TOFHLA), significant differences were found in living in urban areas, regular exercise, medical service-seeking behavior, occupation, self-care ability and others. For higher health literacy, the significance of cultural and recreational activities would be advocated, such as sports and music. This continuation would bring appropriate long-term care services and support (LTSS), leading to well-being, satisfaction and happiness.

Background: Seasonal variation of HbA1c has been in focus. Patients and Methods: The protocol included type 2 diabetes (T2D) patients (n=26, 71.4±10.2 years) on vildagliptin and metformin (EquMet) and HbA1c changes in 4 seasons for 6 years. Results: HbA1c values ranged 6.9-7.5%, and tend to show highest in winter, and rather lower in autumn. Discussion & Conclusion: Rather elderly T2D cases can tolerate EquMet with fair control. Previous reports showed a similar tendency. Some factors may be involved in the variation, such as temperature, climate, carbohydrate intake, Ramadan, and others. Furthermore, blood pressure and cardiovascular disease (CVD) can also influence them.

Authors and collaborators have investigated the subjective health and life satisfaction of elderly male Masters’ athletes. Subjects were 97 cases with 63.9 years in average, who participated in Masters track and field competition event, and they are asked to answer the questionnaire concerning healthy lifestyle habits. It had the inquiries about subjective health, satisfaction of daily life, spending leisure time and others. Two groups were categorized as non-elderly and elderly people (n=46/51), and compared for the detail such as frailty. As a result, no significant difference was found between two age groups for several aspects including daily lifestyle situation.

Sodium–glucose cotransporter 2 inhibitor (SGLT2i) has been attracting attention for novel agent for patients with diabetes and also heart failure (HF), in which the left ventricular ejection fraction (LVEF) has decreased. For standard cardiovascular treatment, 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure is recently presented. Some important perspectives were found, which are HF with mildly reduced EF (HFmrEF), HF with improved EF (HFimpEF) and HF with preserved EF (HFpEF). For patients with HFmrEF, SGLT2i can contribute reducing HF hospitalizations and cardiovascular death. From now, the guideline-directed medical therapy (GDMT) will contribute the standard and beneficial therapy.

Background: Recent pharmacological studies reveal imeglimin (Twymeeg) including dual mechanisms for stimulating insulin secretion and reducing insulin resistance. Case Presentation: The case is a 62-year-old male with type 2 diabetes (T2D). He showed HbA1c 6.4% and started imeglimin. After 5 weeks, a 75g oral glucose tolerance test (75gOGTT) was conducted, and the biomarkers were compared with that of 6 months ago. Insulinogenic index (IGI) 0-30min was stable, but insulin secretion was increased during 30-60min and 60-120min. Discussion: Previous studies of imeglimin revealed improved insulin secretion for GTT. Clinical progress will be followed up with detailed investigation of glucose and insulin variability.

Background: Oral semaglutide (Rybelsus) has been in focus for type 2 diabetes (T2D). Case Presentation: The patient is a 73-year-old male with T2D treated with metformin, Ipragliflozin, and rosuvastatin. He was diagnosed with depression by the Geriatric depression scale (GDS) with a stable condition by mirtazapine. His diabetic control was exacerbated to HbA1c 8.8% and weight 63.5kg in Feb 2022. Results: He started to take Rybelsus, and then clinical improvement was found as HbA1c 6.9% and weight 57.5kg for 4 months. Discussion: Remarkable effect of HbA1c and weight may be from longer fasting time after post-med, and regular lifestyle from the stable psychosomatic situation.

The discussion of chronic kidney disease (CKD), kidney replacement therapy (KRT), and end-stage kidney disease (ESKD) has been important. Recently, a useful predictive model of CKD progression to renal failure was reported by the German CKD study group. They include a novel 6-variable risk score (Z6), composed of creatinine, albumin, cystatin C, urea, hemoglobin, and urinary alb/cre ratio (UACR). CKD patients were studied in 3 groups based on educational attainment. Hazard ratios compared to low vs high groups showed mortality of 1.48, MACE 1.37, and renal failure 1.54, respectively. For the prediction of CKD progression, UACR and estimated glomerular filtration rate (eGFR) are useful.

Music has beneficial power physically and psychologically. Among Integrative Medicine (IM), music therapy (MT) has been useful, and authors have continued research for IM, MT, and piano-playing. Most pianists do not consider the movement of their fingers, because the memorized process is transformed into automatic action. The function may involve the neural signals from the superior parietal lobule to the primary motor area and dorsal premotor cortex, which is called the sensory-motor transformations. The supplementary motor area (SMA) in the frontal lobe seems to be involved in the function of beat-based timing, expression, and activity of musical behavior.

As recommended pharmacological agents for type 2 diabetes mellitus (T2DM), Glucagon-Like Peptide 1 receptor agonist (GLP-1Ra) is highly evaluated for its various beneficial effects. Among them, semaglutide (Rybelsus) has been in focus for useful oral formation with useful oral hypoglycemic agent (OHA). Administration per os is possible due to the developed technique of absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate. Clinical efficacy was shown by a series of Peptide Innovation for Early Diabetes Treatment (PIONEER) with enough weight reduction and decreased HbA1c. From the results of several PIONEER programs, oral semaglutide 14 mg/day had reduced HbA1c values by approximately 1.0-1.4%.

Background: As an oral hypoglycaemic agent (OHA), imeglimin (Twymeeg) has been recently introduced to clinical practice for patients with type 2 diabetes mellitus (T2DM) as Twymeeg. It has beneficial pharmacological mechanisms, which are improving insulin secretion, increasing insulin sensitivity, and decreasing insulin resistance. Case Presentation: The case is 84-year-old man with mild cognitive impairment (MCI) for 3 years. He visited late August, 2021 our clinic for general malaise and was pointed out to have post-prandial blood glucose 336 mg/dL and HbA1c 8.6%. He was diagnosed with T2DM. Results: He was started to be given imeglimin 1000mg twice a day, and then HbA1c value was decreased to 7.3% in 4 weeks and 5.7% in 8 weeks. During 9-12 weeks, he felt loss of appetite and reduced food intake. Biochemical examination on 12 weeks showed decreased values of TP, Alb, HbA1c, glucose, free T3, and normal values of TSH, free T4. Doses of imeglimin were 500 mg twice a day for 9-12 weeks and discontinued after 12 weeks. Discussion: Regarding appetite loss, possible causes may include MCI, previous history of gallbladder dyskinesia, adverse effect of imeglimin, and so on. Further development of research will be expected for imeglimin in the future.

The authors and collaborators have continued practice of hospital art in the university and community hospitals and various research with experts. The material for hospital art is masking tape which is easily made and attached for everyone. Formerly, we have conducted artwork in front of the wall, which took a long time. Currently, we have tried to take the most advantage of the thin-film sheet. Our staff can prepare artwork with a size of 20 cm square in advance. Many square parts with double-sided attachment tape can be gathered together, which is completed and useful in a short time.

From Integrative Medicine point of view, people tend to exercise less, leading to decreased physical, nutritional and cognitive function. Authors have been involved in rehabilitation and workshop for various subjects with masters’ athletes. Previous walking methods have some problems, such as stretching the chest, large movement of arm swing, heel touchdown with extended knees and push backward with thumb-ball. In contrast, our recommended methods include walking with the concept of centered position, using the gravity center and reflection power by flat grounding, adjusting speed and striding with forward leaning angle and creating some effective image in the mind.

Background: Transactional Analysis (TA) and egogram have been in focus for medical and educational fields. There has been a reliable personality battery, Tokyo University Egogram (TEG). Recent topic includes TEG new version 3 for clinical introduction. Using TEG ver.3, university students were investigated for their egogram pattern. Subjects & Methods: Subjects were 99 late teenagers. They were given lectures of TEG and their data was analyzed three months after the admission of the university. Results: TEG ver3 presents 33 egogram types which are related to the personality of Japanese people. Among them, there were four higher prevalence of egogram types, which were Free Child (FC) dominant, Adapted Child (AC) dominant, Critical Parent (CP) inferior and Child (C) Dominant. The percentage datum of current study vs previous standard value in each type was 10 vs 6.8%, 26 vs 6.1%, 8 vs 2.1% 9 vs 1.1%, respectively. Discussion & Conclusion: These four types are estimated as free-spirit, dependent, loose and selfishness. Elevated FC and AC would be probably due to the influence of educational and social environment in Japan. Among them, high school students must study hard for entrance exams without meaningful social experiences. Further investigation will be required for TEG.

Purposes: This study aimed to determine the association of the long-term refractive outcomes of cataract surgery with self-reported visual function obtained using Catquest-9SF. Methods: Patients recruited from the cataract outpatient clinic of VER MAIS Oftalmologia underwent a complete ophthalmologic examination. Patients who were diagnosed with cataract with indications for phacoemulsification and intraocular lens implantation received the Catquest-9SF questionnaire before and after surgery at 30 days and 1 year. Results: A total of 133 patients were recruited, but 32 patients were lost to follow-up; finally, data from 101 patients (48 men, 53 women) were analyzed. The crude variance explained by the data was 69.9%, and the unexplained variance in the first contrast was 2.39 eigenvalues (>2); thus, these results are different from those expected from random data. The people separation index was 2.95 (>2), and the people trust value was 0.9 (>0.8). These indices were evaluated in the assessment of skill levels. Visual acuity was the main variable that correlated with the Catquest score. Conclusions: The Catquest-9SF translated into Portuguese proved to be a one-dimensional and psychometrically valid tool to assess visual dysfunction in patients with cataract, and it is successful in objectively quantifying improvements after surgery. The results of this tool could be predictive and concordant of visual acuity improvement.

In recent rehabilitation, treatments include electrical stimulation and magnetic stimulation. They are transcranial magnetic stimulation (TMS), repetitive peripheral magnetic stimulation (rPMS), transcutaneous electrical nerve stimulation (TENS), and others. rPMS has been effective technique for non-invasive neuromodulation. Clinical effects of rPMS have been reported such as generalized sarcopenia and dysphagia, measurement of rectus femoris muscle (RF), strength of suprahyoid muscles and association of hand splint materials. TENS also shows clinical efficacy for decreasing peripheral and central neuropathic pain (PNP, CNP). Beneficial efficacy is found in diabetes and herpes zoster for PNP, and in stroke and spinal cord injury for CNP.

Frailty, sarcopenia, geriatric syndrome and diabetes have been in focus. Several types of frailty are present from medical, psychological, and social points of view. The risk of developing diabetic frailty is 1.48 times for meta-analysis. By a systematic review of 15 studies, type 2 diabetes (T2D) patients showed higher sarcopenia risk with odd ratio (OR) 1.55. Concerning the relationship of senile frailty and body composition, male body fat mass correlated with frailty associated with cut off value of 27.6%. Protein intake amount per weight per day was divided into quartile groups. Hazard ratio of mortality for lowest/highest quartile was 2.26. In conclusion, geriatric syndrome may bring generalized various influence to each subject. For patient-centered practice of medicine, personalized medical practice would be required and recommended from now on.

Integrative Medicine (IM) and Complementary and Alternative Medicine (CAM) have been gradually prevalent. Authors are involved in IM, CAM, music therapy and piano-playing. Perspectives of the brain mechanism for piano playing are described. Responsible of area in the brain include primary motor cortex (M1), dorsal pre-motor cortex (dPMC), ventral pre-motor cortex (vPMC), primary somatosensory cortex (S1), superior parietal lobule (SPL), inferior parietal lobule (IPL). Various integrated images and music are created and preserved, and then data will be changed into motion and playing the piano by the mechanism of sensory-motor transformations. Further research development concerning these will be expected.

Recently, chronic kidney disease (CKD), diabetic kidney disease (DKD), glomerular filtration rate (GFR) and related matters have been in focus. Estimated GFR (eGFR) has been usually calculated by serum creatinine and age corrected by body surface area (BSA). In contrast, Cockcroft-Gault formula is another way that is not corrected by BSA. When the patient's physique is significantly larger or smaller, BSA correction may remarkably change the value of eGFR. Based on the data of Japan Multi-institutional Collaborative Cohort (J-MICC) study, various factors influencing renal function were investigated. As a result, problem solving degree in men revealed inverse relationship with eGFR.