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Aim: The aim of the present study was to assess the efficacy and safety of sitagliptin in elderly patients with type 2 diabetes mellitus. Methods: A total of 188 patients were enrolled who had type 2 diabetes mellitus with poor glycemic profiles (hemoglobin A1c [HbA1c] ≥6.2%). Patients were assigned to one of three age groups (<65, 65–74 and ≥75 years) and received 50–100 mg of sitagliptin daily for 12 months. Changes in HbA1c classified by age and body mass index (BMI) were assessed in addition to physiological parameters. Results: Mean HbA1c decreased significantly in all age groups (<65 years 8.01 ± 1.59% to 7.29 ± 1.23%; 65–74 years 7.61 ± 1.11% to 7.05 ± 0.99%; ≥75 years 7.21 ± 0.87% to 6.74 ± 0.96%). Reductions in HbA1c were not significantly different among age groups (P = 0.324). In older patients aged 65–74 years and ≥75 years, HbA1c decreased significantly in lean (BMI <25 kg/m2) patients (7.52 ± 1.10% to 6.99 ± 1.08%; P < 0.001) and in obese (BMI ≥25 kg/m2) patients (7.25% ± 0.90% to 6.86% ± 0.86%; P = 0.015); the changes in HbA1c were not significantly different between the lean and the obese groups (P = 0.943). Adverse events occurred in 12 patients (10.3%) aged ≥65 years, although there was no significant difference among the three age groups. Conclusions: Sitagliptin treatment offers elderly patients aged ≥65 years efficacious and safe reductions in HbA1c values regardless of BMI. Geriatr Gerontol Int 2018; 18: 631–639. [ABSTRACT FROM AUTHOR]

Background: Recently, incretin hormones, including glucagon-like peptide-1 (GLP-1) analogue and dipeptidyl peptidase-4 (DPP-4) inhibitor, have been found to regulate glucose metabolism. The aim of this study was to elucidate the efficacy and safety of the clinical usage of DPP-4 inhibitors in Japan. Methods: This study was designed as a prospective, open-label, multi-center trial. Patients with diabetes mellitus type 2 (T2DM) with poor glycemic profiles (HbA1c = 6.2%) in spite of receiving a medical diet, therapeutic exercise, and/or medications were eligible for this study. The participants received 50 to 100 mg of the DPP-4 inhibitor sitagliptin once daily for 12 months. Results: One hundred and eighty-eight subjects were enrolled. After 12 months of sitagliptin treatment, HbA1c levels decreased (7.65% ± 1.32% to 7.05% ± 1.10%, p < 0.001) as well as fasting plasma glucose (FPG) (145 ± 52 mg/dl to 129 ± 43 mg/dl, p = 0.005). The rate of glycemic control achieved (in accordance with the guidelines of the Japanese Diabetes Society) significantly increased. Blood pressure and serum levels of triglycerides and total cholesterol decreased significantly. Furthermore, the Pittsburgh Sleep Quality Index (PSQI) and Diabetes Symptomatic Scores improved significantly. Adverse events such as hypoglycemia and loss of consciousness occurred in twenty three subjects (11%). Conclusions: These results suggest that the actions of DPP-4 inhibitors improve not only glycemic control, but also blood pressure, lipid profiles, and quality of life (QOL). Sitagliptin is a sound agent for use in the comprehensive treatment of patients with T2DM. [ABSTRACT FROM AUTHOR]

We report a case of trigeminal neuralgia treated with microvascular decompression 10 years after We report a case of trigeminal neuralgia treated with microvascular decompression 10 years after Gamma Knife radiosurgery was performed. The patient was a 65-year-old female. The root entry zone of the trigeminal nerve received irradiation:a 4-mm shot, with a maximum dose of 80 Gy. The symptoms improved following treatment, however pain recurred five and a half years later. The pain gradually increased over time, to the point where the patient was unable to eat solid food. Carbamazepine was prescribed and the dosage increased. However, side effects such as dizziness and drowsiness manifested. Microvascular decompression was performed, revealing that the trigeminal nerve was markedly atrophied and being pressed upon by the superior cerebellar artery. The superior cerebellar artery was transpositioned with Teflon braided tape to the cerebellar tent. There were no abnormal findings such as arachnoid thickening, adhesions between vessels and nerves, or atherosclerotic plaque in the affected vessels. Pain completely abated following surgery, and side effects such as numbness of the face have not been observed at the time of writing this report.

The authors assessed the effects of switching from a conventional angiotensin II receptor blocker (ARB) to azilsartan on blood pressure (BP) and health-related quality of life (HR-QOL) in patients with uncontrolled hypertension. Key eligibility criteria were uncontrolled hypertension treated for ≥ 1 month with an ARB, excluding azilsartan, that did not reach the target BP. We recruited 147 patients (64 males and 83 females; mean ± standard deviation age 73 ± 15 years). Azilsartan reduced both systolic and diastolic BP significantly, from 151 ± 16/82 ± 12 to 134 ± 17/73 ± 12 mm Hg, 3 months after switching. Although scores on the comprehensive QOL scale, the EuroQoL 5 dimensions (EQ5D), and the simplified menopausal index (SMI) did not change, the Geriatric Depression Scale (GDS) score improved significantly, and there was a significant association between the change in the GDS score and systolic BP lowering (r = 0.2554, P = 0.030). The Pittsburgh sleep quality index (PSQI) improved significantly only in the female subgroup. Besides sufficient BP lowering activity, anti-hypertensive treatment with azilsartan may have a favorable impact on depression in geriatric patients with uncontrolled hypertension.

Background: Recently, incretin hormones, including glucagon-like peptide-1 (GLP-1) analogue and dipeptidyl peptidase-4 (DPP-4) inhibitor, have been found to regulate glucose metabolism. The aim of this study was to elucidate the efficacy and safety of the clinical usage of DPP-4 inhibitors in Japan., Methods: This study was designed as a prospective, open-label, multi-center trial. Patients with diabetes mellitus type 2 (T2DM) with poor glycemic profiles (HbA1c ≥ 6.2%) in spite of receiving a medical diet, therapeutic exercise, and/or medications were eligible for this study. The participants received 50 to 100 mg of the DPP-4 inhibitor sitagliptin once daily for 12 months., Results: One hundred and eighty-eight subjects were enrolled. After 12 months of sitagliptin treatment, HbA1c levels decreased (7.65% ± 1.32% to 7.05% ± 1.10%, p < 0.001) as well as fasting plasma glucose (FPG) (145 ± 52 mg/dl to 129 ± 43 mg/dl, p = 0.005). The rate of glycemic control achieved (in accordance with the guidelines of the Japanese Diabetes Society) significantly increased. Blood pressure and serum levels of triglycerides and total cholesterol decreased significantly. Furthermore, the Pittsburgh Sleep Quality Index (PSQI) and Diabetes Symptomatic Scores improved significantly. Adverse events such as hypoglycemia and loss of consciousness occurred in twenty three subjects (11%)., Conclusions: These results suggest that the actions of DPP-4 inhibitors improve not only glycemic control, but also blood pressure, lipid profiles, and quality of life (QOL). Sitagliptin is a sound agent for use in the comprehensive treatment of patients with T2DM.

In recent years, the advancements in MR technology combined with the development of the multi-channel coil have resulted in substantially shortened inspection times. In addition, rapid improvement in functional performance in the workstation has produced a more simplified imaging-making process. Consequently, graphical images of intra-cranial lesions can be easily created. For example, the use of three-dimensional spoiled gradient echo (3D-SPGR) volume rendering (VR) after injection of a contrast medium is applied clinically as a preoperative reference image. Recently, improvements in 3D-SPGR VR high-resolution have enabled accurate surface images of the brain to be obtained. We used stereo-imaging created by weighted maximum intensity projection (Weighted MIP) to determine the skin incision line. Furthermore, the stereo imaging technique utilizing 3D-SPGR VR was actually used in cases presented here. The techniques we report here seemed to be very useful in the pre-operative simulation of neurosurgical craniotomy.

A 59-year-old diabetic male presented with transient motor aphasia and monoparesis of the right upper limb. Brain CT scan showed a low density area in the left subdural space with a mild midline shift. Magnetic resonance (MR) T2-weighted and fluid-attenuated inversion recovery (FLAIR) imagings revealed homogenous hyperintensity with a hypointense web-like structure in the subdural hematoma. Cervical MR angiography showed no abnormal lesion at the bifurcation of the bilateral common carotid arteries. Conventional cerebral angiography showed an avascular, crescent, space-occupying mass over the left hemisphere without an etiologic lesion of cerebral ischemia. CT perfusion imagings indicated reduced cerebral blood flow (CBF) and prolonged mean transit time (MTT) in the left middle cerebral artery territory underneath the subdural hematoma. No epileptic discharge was found in electroencephalogram. Operative findings indicated that the hematoma was encapsulated with thickened outer and inner membranes including paste-like materials, and the brain surface was intact. Postoperative CT perfusion imagings revealed normal CBF and MTT. The pathophysiological mechanism which the chronic subdural hematoma produces the transient neurological deficit is still uncertain. The mechanical pressure of the hematoma on the neighboring cerebral vessels may cause impairment of blood flow leading to cerebral ischemia and paralysis of function. Our case indicated the transient neurological deficits attributed to a decreased CBF around the subdural hematoma and a change in pressure exerted by the hematoma during changes of head position and increased blood viscosity.

Gamma knife radiosurgery was carried out for spontaneous CCF (carotid-cavernous sinus fistula) in 8 patients (1 male and 7 females), and its results were reported. The ages ranged from 48 to 74 years with a mean of 60.6 years. As initial treatment before radiosurgery, embolization was carried out except in one patient, and radiotherapy was used in two patients. Six patients were in the category of Barrow's type D, and two patients were in the category of Barrow's type B. As it contained the fistula, the lateral wall of the cavernous sinus was irradiated with 8-14.5 Gy (mean 10.8 Gy). As a result, complete obliteration of CCF was confirmed by DSA in seven of the eight patients between 6 and 18 months after radiosurgery. There were no side effects observed during a follow-up period of 8 to 116 months. Although the main treatment for spontaneous CCF is intravascular surgery at present, gamma knife radiosurgery is a useful adjuvant treatment for the residual CCF after embolization.