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Mutsuko Kato, Michie Namba, Sachika Shimoyama, Mayumi Inoue, Chihiro Ouchi, Takehiro Shimizu Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, JapanCorrespondence: Mutsuko KatoDepartment of Ophthalmology, Japan Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ward, Okayama, 700-8607, JapanTel +81 86 222 8811Fax +81 86 222 8841Email mutsukato@okayama-med.jrc.or.jpPurpose: To report our modified simple technique for optic capture and the clinical results of intrascleral IOL fixation preserving the lens capsule, without vitrectomy, in cases of cataract with insufficient zonular support to stabilize the intraocular lens (IOL).Patients and Methods: In 37 eyes of 25 patients with phacodonesis and two or more risk factors for progressive zonular insufficiency, we inserted a CTR to support the capsule and zonules during cataract surgery and IOL fixation; an optic was inserted into the lens capsule, and a haptic was fixed in the scleral tunnel without vitrectomy. In all cases, anterior or total vitrectomy was not needed.Results: The postoperative mean (± standard deviation) tilt and decentration of the implanted IOL did not change from 6 to 12 months (6.77 ± 3.15° to 6.33 ± 3.38° and 0.60 ± 0.30 to 0.61 ± 0.35 mm, respectively). We encountered no late IOL dislocation and no retinal complications, including retinal breaks or cystoid macular oedema, postoperatively (follow-up = 21.1 ± 5.2 months).Conclusion: Our modified techniques preclude the need for vitrectomy. If the lens capsule can be preserved using a CTR, our modified technique can be used to stabilize IOL.Keywords: insufficient zonular support, phacodonesis, lens capsule, capsular tension ring, intrascleral IOL fixation

Hiroyuki Konya,1 Yuzo Yano,1 Satoshi Matsutani,1 Taku Tsunoda,2 Takashi Ikawa,2 Yoshiki Kusunoki,2 Toshihiro Matsuo,2 Masayuki Miuchi,2 Tomoyuki Katsuno,3 Tomoya Hamaguchi,4 Jun-ichiro Miyagawa,2 Mitsuyoshi Namba21Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, 2Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, 3Division of Innovative Diabetes Treatment, Hyogo College of Medicine, Nishinomiya, 4Division of Diabetes, Department of Internal Medicine, Itami City Hospital, Itami, Hyogo, JapanAbstract: Saxagliptin is a selective and potent dipeptidyl peptidase (DPP)-4 inhibitor, approved as an adjunct to diet and exercise to improve glycemic control in type 2 diabetes mellitus (T2DM) in the USA on July 2009, and had been launched globally in over 86 countries by September 2013. In patients with T2DM, once-daily administration of saxagliptin before breakfast achieves sustained inhibition of plasma DPP-4 activity and reduction of postprandial hyperglycemia, including after dinner, associated with an increase in plasma glucagon-like peptide-1 levels. This paper reviews the safety and efficacy of saxagliptin in Japanese patients with T2DM. The clinical development study in Japan supported its usefulness for the disease. Saxagliptin 1, 2.5, and 5 mg led to significant improvements in glycated hemoglobin (HbA1c), and was generally well tolerated. Treatment with saxagliptin 5 mg induced a sustained reduction in HbA1c over 52 weeks. Long-term combination therapy with saxagliptin and other oral hypoglycemic agents also provided sustained glycemic control and was well tolerated for up to 52 weeks. Saxagliptin as add-on to sulfonylureas or glinides has a tendency to increase hypoglycemia, but not with other oral antidiabetic agents, such as α-glucosidase inhibitors, metformin, or thiazolidinediones. The results of clinical trials have confirmed the long-term efficacy and safety of saxagliptin monotherapy as well as its use as add-on combination therapy, and support its usefulness as a therapeutic agent for T2DM. Saxagliptin has less concern for hypoglycemia and weight gain, which often becomes problematic in routine care of T2DM. Meta-analysis of clinical trials in the USA showed no evidence of increased risk of cardiovascular events associated with saxagliptin, suggesting the superior of saxagliptin in terms of safety. Recently, investigators in the SAVOR-TIMI (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction) 53 study suggested that DPP-4 inhibition with saxagliptin did not increase or decrease the rate of ischemic events, although the rate of hospitalization for heart failure was increased. Although saxagliptin improves glycemic control, other approaches are necessary to reduce cardiovascular risk in patients with diabetes. Saxagliptin is applicable for various pathological conditions, and is considered to be clinically significant as a new therapeutic option for Japanese patients with T2DM.Keywords: dipeptidyl peptidase-4, incretin hormones, saxagliptin, type 2 diabetes mellitus, Japan, efficacy, safety, patient acceptability

Hiroyuki Konya,1 Tomoyuki Katsuno,2 Taku Tsunoda,1 Yuzo Yano,1 Mai Kamitani,1 Masayuki Miuchi,2 Tomoya Hamaguchi,3 Jun-Ichiro Miyagawa,2 Mitsuyoshi Namba2 1Department of Internal Medicine, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan; 2Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; 3Division of Innovative Diabetes Treatment, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan Abstract: Patients with diabetes mellitus are at increased risk from cardiovascular-related morbidity and mortality as compared with healthy individuals. An association between the postprandial metabolic state and atherogenesis has been observed in patients with diabetes mellitus. In the Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM), treatment with an α-glucosidase inhibitor (α-GI) in patients with impaired glucose tolerance not only reduced the rate of conversion from impaired glucose tolerance to type 2 diabetes mellitus (T2DM), but was also associated with a reduction in the risk of cardiovascular events. These results suggested the importance of treating postprandial hyperglycemia in the early stages of T2DM. Glinides are rapid and short-acting insulin secretagogues that bind to the sulfonylurea receptors on pancreatic β-cells to facilitate rapid insulin secretion, restore postprandial early insulin secretion, and reduce the postprandial glucose spike. Moreover, α-GIs reduce postprandial hyperglycemia and insulin secretion by delaying the digestion of carbohydrates and polysaccharides in the small intestine. Then, both glinides and α-GI have beneficial effects for treating patients with T2DM and impaired glucose tolerance. Considering the ameliorating effects of these drugs on postprandial metabolic disorders, combinations of glinides and α-GI might constitute a promising therapeutic strategy for managing patients with T2DM, and also appear to be suitable for Japanese people, who consume more carbohydrates, such as polished rice, than Caucasians. It has recently been reported that combined use of mitiglinide and voglibose reduces postprandial insulin secretion and blunts diurnal glycemic changes in T2DM patients. This therapy can thus be regarded as being suitable for achieving strict postprandial glycemic control. In this report, we outline the effects of this combination therapy on postprandial plasma glucose and assess its safety. Keywords: mitiglinide, voglibose, combination therapy, type 2 diabetes mellitus, postprandial hyperglycemia

The effect of c-axis correlated pinning on the critical current density at low temperatures under high magnetic fields was investigated on the basis of the transport critical current density and irreversibility field properties of an ErBa2 Cu3 Oy film with inclined columnar defects. We found that the contribution of correlated pinning on Jc decreased drastically with decreasing temperature under high magnetic fields above the matching field, but still retained more than a 60% enhancement at 13 K. These effects of correlated pinning can be described using a cooperative model based on a combination of correlated and random pinning. At low temperatures, the presence of a matching field limited the flux pinning force for correlated pinning in comparison with that of random pinning, while the ratio of the maximum pinning force of the correlated pinning to the random one was proportional to the inverse of the irreversibility field. This suggests that the low efficiency of correlated pinning at low temperatures under a strong magnetic field is a result of a high irreversibility field and a low matching field. In order to improve the critical current properties at low temperatures under high magnetic fields, an increase in the matching field and/or the introduction of strong random pinning are effective. [ABSTRACT FROM AUTHOR]