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Aims/Introduction Continuous glucose monitoring (CGM) metrics, such as times in range (TIR) and time below range, have been shown to be useful as clinical targets that complement glycated hemoglobin (HbA1c) for patients with type 2 diabetes mellitus. We investigated the relationships between TIR, glycemic variability and patient characteristics in patients with type 2 diabetes mellitus. Materials and Methods We carried out continuous glucose monitoring in 281 outpatients with type 2 diabetes mellitus who participated in a multicenter cohort (Hyogo Diabetes Hypoglycemia Cognition Complications) study. Results The results are shown as the median (interquartile range). The age, disease duration and HbA1c were 68 years (62–71 years), 13 years (7–23 years) and 6.9% (6.5–7.5%), respectively. TIR and standard deviation obtained by continuous glucose monitoring worsened significantly with increasing disease duration. Multiple regression analyses showed that disease duration (standard partial regression coefficient, β = −0.160, P = 0.003), diabetic peripheral neuropathy (β = −0.106, P = 0.033) and urinary albumin excretion (β = −0.100, P = 0.043) were useful explanatory factors for TIR. In contrast, HbA1c (β = −0.398, P, In type 2 diabetes mellitus, the longer the duration of the disease, the number of patients treated with multiple medications or insulin increases and the glycemic fluctuation index measured by CGM worsens. CGM evaluations demonstrated that in elderly patients with type 2 diabetes mellitus, there is a high risk of hypoglycemia for insulin users and those with low HbA1c levels.

An 82 year-old female patient not suffering from diabetes was transported to our hospital with hyperglycemia (HbA1c 8.2%, blood glucose 584 mg/dL) and mildly increased levels of pancreatic exocrine enzymes (amylase 543 IU/L, lipase 59 U/L, elastase-1 479 ng/dL), while there were no findings indicating pancreatitis. Under a diagnosis of new-onset diabetes, she was discharged with oral hypoglycemic agents, as retention of insulin secretion function [blood glucose 117 mg/dL, serum connecting peptide immunoreactivity (CPR) 1.63 ng/mL] with normalization of the enzymes was confirmed following administration. However, at 73 days after the hospitalization, she returned with diabetic ketoacidosis (blood glucose 910 mg/dL, pH in blood gas analysis 7.15, total blood ketone bodies > 7000 µmol/L) with a transient repeated increase of the enzymes (amylase 382 IU/L, lipase 82 U/L, elastase-1 569 ng/dL) and without pancreatitis. Notably, depletion of insulin secretion (6.1 µg/day in urine, 0.36 ng/mL in serum CPR with no response in glucagon-loading test) was revealed, and serum CPR level remained low after discharge. Together with negative findings for islet-related autoantibodies, the patient was diagnosed with acute-onset type 1B diabetes (T1BD). In the present patient with acute-onset T1BD, a mild increase in pancreatic exocrine enzymes was repeatedly observed, which may mimic fulminant type and raise questions for us about the commonly accepted pathophysiology of T1D. These findings may help to clarify issues related to newly developed T1D in elderly individuals.

Background The association between glucose variability and the progression of atherosclerosis is not completely understood. We aimed to evaluate the associations of glucose variability with the progression of atherosclerosis in the early stages. Methods We conducted a cross-sectional analysis to investigate the associations of glucose variability, assessed by continuous glucose monitoring, with intima-media thickness (IMT) and gray-scale median (GSM) of the carotid arteries, which are different indicators for the progression of atherosclerosis. We used baseline data from a hospital-based multicenter prospective observational cohort study among Japanese patients with type 2 diabetes without a history of cardiovascular diseases aged between 30 and 80 years. Continuous glucose monitoring was performed by Freestyle Libre Pro, and glucose levels obtained every 15 min for a maximum of eight days were used to calculate the metrics of glucose variability. IMT and GSM were evaluated by ultrasonography, and the former indicates thickening of intima-media complex in the carotid artery wall, while the latter indicates tissue characteristics. Results Among 600 study participants (age: 64.9 ± 9.2 (mean ± SD) years; 63.2%: men; HbA1c: 7.0 ± 0.8%), participants with a larger intra- and inter-day glucose variability had a lower GSM and most of these associations were statistically significant. No trend based on glucose variability was shown regarding IMT. Standard deviation of glucose (regression coefficient, β = − 5.822; 95% CI − 8.875 to − 2.768, P P = 0.002), mean amplitude of glycemic excursion (β = − 1.689; − 2.567 to − 0.811, P P P = 0.002) had a statistically significant association with mean-GSM after adjustment for conventional cardiovascular risk factors, including HbA1c. No metrics of glucose variability had a statistically significant association with IMT. Conclusions Continuous glucose monitoring-assessed glucose variability was associated with the tissue characteristics of the carotid artery wall in type 2 diabetes patients without cardiovascular diseases.

Although white esophagus is an extremely rare disease, careful diagnosis and intensive treatment are required because of a relationship with black esophagus. Further case accumulation including duodenal and jejunum lesion is needed.

Acute focal bacterial nephritis (AFBN) is a bacterial infection of the renal parenchyma without abscess formation and is classified as a subtype of acute renal pyelitis. There are many reports of AFBN in pediatrics; however, urinary tract infection, cystitis, or pyelitis developed into AFBN in few adult cases. AFBN symptoms include fever, shivering, back pain, and/or costovertebral angle tenderness. Here, we report two adult cases of AFBN in which its diagnosis using contrast-enhanced computed tomography was helpful. World J Nephrol Urol. 2016;5(3):63-66 doi: http://dx.doi.org/10.14740/wjnu280w

Background Although obesity-related type 2 diabetes mellitus (T2DM) and sarcopenia in the elderly have been increasing worldwide, the associations among visceral fat accumulation, skeletal muscle indices (mass, strength, and quality) and cardiovascular diseases in T2DM remain poorly investigated. Methods We enrolled 183 Japanese T2DM inpatients (126 men, 57 women; mean age 64.7 ± 12.6 years, ± SD). The estimated-visceral fat area (eVFA) and skeletal muscle mass were measured by each device using bioelectrical impedance analysis method. We also measured grip strength by dynamometer and motor nerve conduction velocity (MCV). We analyzed the difference in skeletal muscle indices between T2DM patients with and without visceral fat accumulation, and examined the impact of skeletal muscle indices on cardiovascular diseases in patients with visceral fat accumulation. Results The prevalence of sarcopenia defined by the Consensus of Asian Working Group for Sarcopenia and low skeletal muscle mass were both lower in the visceral fat accumulation (+) group than in (−) group. However, the prevalence of weak hand grip strength was similar in the visceral fat accumulation (−) and (+) groups, indicating that considerable patients with visceral fat accumulation had weak grip strength in spite of fair skeletal muscle mass. Muscle quality [grip strength (kg)/arm muscle mass (kg)] was significantly lower in patients with visceral fat accumulation. Multiple regression analysis identified eVFA, MCV and sex as significant and independent determinants of muscle quality. In visceral fat accumulation (+) group, the patients with low muscle quality had longer duration of diabetes, lower eGFR, higher serum adiponectin, lower MCV and higher prevalence of cardiovascular diseases, compared to the patients with high muscle quality. Finally, sex- and age-adjusted models showed significant association between low muscle quality and cardiovascular diseases in all subjects (odds ratio 2.28, p = 0.012), especially in patients with visceral fat accumulation (odds ratio 2.72, p = 0.018). Conclusions T2DM patients with visceral fat accumulation had low muscle quality, and patients with low muscle quality were more affected with cardiovascular diseases. Electronic supplementary material The online version of this article (10.1186/s12933-018-0755-3) contains supplementary material, which is available to authorized users.

Domperidone has difficulty passing the blood–brain barrier, thus rarely causes tardive dyskinesia. Furthermore, its symptoms in adults are generally mild. Although both alcohol and diabetes are thought to increase the risk of development of tardive dyskinesia, their impact remains controversial, especially diabetes, and factors related to worsened tardive dyskinesia have not been clearly elucidated. A 59-year-old man with type 2 diabetes and history of alcohol misuse, who had been chronically prescribed domperidone at 15 mg/day, showed severe tardive dyskinesia, which was remitted within several days by stopping the drug. In our case, albuminocytological dissociation and white matter hyperintensity on MRI were confirmed, which were thought to be related to blood–brain barrier dysfunction. This present findings indicate that alcohol misuse and type 2 diabetes, as well as albuminocytological dissociation and white matter hyperintensity may result in severe tardive dyskinesia, even in individuals receiving domperidone.

Here, we report a case of fulminant amebic colitis diagnosed after colonic resection in a 66-year-old male who visited our hospital complaining of prolonged fever and consistent pain in the right abdomen. The patient had neither watery nor bloody stool. Laboratory data revealed increased white blood cell counts (15,900 cells/μl) and high levels of C-reactive protein (10.3 mg/dl). Contrast enhanced computed tomography revealed remarkably hypertrophic and edematous lesions in the right-sided colon. Stool culture revealed no pathogens. The patient was suspected to have infectious colitis; thereafter, the antibiotic flomoxef sodium (3 g/day) was administered. Colonoscopy revealed a circumferential white coat and stripped mucosal lesions in the right-sided colon; thereafter, ischemic colitis or enterohemorrhagic Escherichia coli colitis was the differential diagnosis. When the general condition of the patient and their inflammatory response deteriorated, surgical treatment was adopted. Surgical findings revealed a rightsided necrotizing colon and yellowish ascites, which was later found to contain Enterococcus faecalis and grampositive bacillus. Pathological findings revealed the presence of trophozoites of Entamoeba histolytica. Consequently, fulminant amebic colitis was diagnosed. The postoperative course was uneventful, and the patient was discharged on postoperative day 18.

An 82-year-old female presented to our institution with mild dyspnea. Her medical history included effort angina pectoris, which was treated with stent placement in the coronary artery at the age of 78, and congestive heart failure, which was improved by oxygen inhalation and administration of diuretic agents. Chest radiography revealed evidence of swollen lymph nodes at the level of the left pulmonary hilar lesion. Contrast-enhanced chest computed tomography revealed a mass at the pulmonary hilar lesion site extending into the left pulmonary artery and left lower pulmonary vein, swollen lymph nodes proximal to the left pulmonary hilar lesion and bilateral mediastinum, and pleural dissemination. Bronchoscopy revealed almost total occlusion of the left upper bronchial trunk. Biopsied specimen confirmed the diagnosis of small-cell lung carcinoma (SCLC). Although the standard chemotherapy regimen for extended SCLC is a combination therapy of cisplatin (CDDP) and etoposide (ETP), that regimen was considered intolerable for the patient because of chronic heart and renal failure. Therefore, the regimen of amrubicin hydrochloride (AMR) monotherapy was decided. After the first cycle of chemotherapy, the tumor was remarkably reduced. Despite mild digestive symptoms, including nausea and loss of appetite, and mild myelosuppression, the patient was well tolerated with AMR monotherapy. The patient has been kept partial response during the fifth cycle of chemotherapy until the patient developed pneumonia.

AIM The aim of the current study was to investigate circulating adiponectin levels and their associated factors in young lean healthy Japanese women. METHODS We recruited 82 healthy Japanese women in their twenties and thirties with their body mass index

A 80-year-old female was referred to our hospital for hematomesis. An abdominal CT revealed a heterogeneous giant tumor of about 11 cm, rich in vascularity, extending from the gastric fundus, beyond the upper side of the spleen, to the left thoracic diaphragm. Gastroscopy showed a 5 cm submucosal tumor with a visible vessel at the gastric fundus. After biopsy was performed, she was diagnosed with a c-kit-positive gastrointestinal stromal tumor (GIST)of the stomach. Following endoscopic hemostasis for gastric bleeding, imatinib mesilate was administered. The tumor reduced markedly, and vascularity in the tumor was diminished, the visible vessels of the tumor disappeared. For curative resection, total gastrectomy with a distal pancreato -splenectomy and a left diaphgram resection is necessary, but surgery was high-risk for this patient because she was advanced in age. She is now achieving a good partial response without surgery.

To study the role of interferon-gamma (IFN gamma), which is released from activated lymphocytes in the development of lymphocytic thyroiditis, we investigated the effects of IFN gamma on the morphology of mouse thyrocytes, using scanning electron microscopy. Thyrocytes were cultured in monolayers for 5-7 days and incubated with TSH (10 mU/ml) for 1 h before fixation. IFN gamma (200 U/ml) was added to the culture medium for 1 h to 5 days before TSH stimulation. Coculture of thyrocytes with IFN gamma for more than 24 h inhibited TSH-induced morphological changes in the thyrocytes; IFN gamma inhibited the increase in the number of and elongation of microvilli and the appearance of pseudopods. IFN gamma also reduced the number of actin filaments in thyrocytes, as confirmed by immunofluorescence photometry. These results suggest that IFN gamma inhibits the morphological response of thyrocytes to TSH stimulation by the reduction of actin filaments.

症例は80歳,男性.多発性脳梗塞の既往があり真性多血症で通院中,呼吸困難にて入院.著明な低酸素血症があり,心エコーで右心系の高度拡大を認め,肺動脈圧95/42 (59) mmHgと著明な肺高血圧を呈した.治療に抵抗し,右心不全から両心不全となり第12病日に死亡.剖検では肺動脈幹部に著明な粥状硬化を認めた.真性多血症による血液粘稠度の亢進に起因する,末梢動脈の内膜障害・微小血栓形成が肺高血圧症の原因と考えられた.

The effects of interferon-gamma (IFN gamma) on the morphology of thyroid follicles and the expression of major histocompatibility complex (MHC) class II antigens were examined. The thyroid follicles were suspended in RPMI-1640 containing 10% fetal calf serum with or without IFN gamma (200 U/ml). After culture for 5 days, follicles were incubated in the presence of TSH (10 mU/ml) for 1 h and fixed for electron microscopic and immunohistochemical examination. Regardless of the presence of IFN gamma, suspended follicles became inverted within 5 days. However, MHC class II antigens were expressed only in inverted follicles cultured with IFN gamma. In inverted follicles cultured without IFN gamma, TSH stimulation induced remarkable morphological changes, such as elongation of microvilli and an appearance of pseudopods. On the other hand, the follicles cultured with IFN gamma showed poor response to TSH. Thus, IFN gamma induced the expression of MHC class II antigens of cultured thyroid follicles and inhibited TSH-induced morphological changes in the cells.

After a 3-month leukopenic phase, a patient developed hematologic pictures of acute promyelocytic leukemia (APL). Treatment with chemotherapy and radiotherapy had been given 10 months previously for a non-Hodgkin's lymphoma (NHL) of diffuse large cell type arising in the Waldeyer's ring. A computed tomographic scan demonstrated a high density mass in the left frontal cerebrum, which was enhanced uniformly by the contrast material. Cytocentrifuge examination of cerebrospinal fluid also showed an excess of promyelocytes. From these observations, the mass was considered to be an infiltration of leukemic cells. The intracerebral mass and meningeal involvement were resolved concomitantly with a hematologic remission of APL after intrathecal injection of cytosine arabinoside and systemic combination chemotherapy. This is a particular case of APL previously undescribed, representing an unusual presentation with intracerebral APL mass as well as a rare posttherapeutic APL following NHL. Cancer 59:94–98, 1987.