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Treatment of Diabetic Kidney Disease: Current and Future
Tomotaka Yamazaki,Imari Mimura,Tetsuhiro Tanaka,Masaomi Nangaku 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.1
Diabetic kidney disease (DKD) is the major cause of end-stage kidney disease. However, only renin-angiotensin system inhibitor with multidisciplinary treatments is effective for DKD. In 2019, sodium-glucose cotransporter 2 (SGLT2) inhibitor showed efficacy against DKD in Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial, adding a new treatment option. However, the progression of DKD has not been completely controlled. The patients with transient exposure to hyperglycemia develop diabetic complications, including DKD, even after normalization of their blood glucose. Temporary hyperglycemia causes advanced glycation end product (AGE) accumulations and epigenetic changes as metabolic memory. The drugs that improve metabolic memory are awaited, and AGE inhibitors and histone modification inhibitors are the focus of clinical and basic research. In addition, incretin-related drugs showed a renoprotective ability in many clinical trials, and these trials with renal outcome as their primary endpoint are currently ongoing. Hypoxia-inducible factor prolyl hydroxylase inhibitors recently approved for renal anemia may be renoprotective since they improve tubulointerstitial hypoxia. Furthermore, NF-E2-related factor 2 activators improved the glomerular filtration rate of DKD patients in Bardoxolone Methyl Treatment: Renal Function in chronic kidney disease/Type 2 Diabetes (BEAM) trial and Phase II Study of Bardoxolone Methyl in Patients with Chronic Kidney Disease and Type 2 Diabetes (TSUBAKI) trial. Thus, following SGLT2 inhibitor, numerous novel drugs could be utilized in treating DKD. Future studies are expected to provide new insights.
Microscale Surface Patterning of Zirconia by Femtosecond Pulsed Laser Irradiation
Yuka Yamamuro,Tomotaka Shimoyama,Jiwang Yan 한국정밀공학회 2022 International Journal of Precision Engineering and Vol.9 No.2
Irradiation of yttria-stabilized zirconia (YSZ) was performed by a femtosecond pulsed laser to investigate the feasibility of V-shaped groove microstructure fabrication. Firstly, fundamental characteristics of microgroove fabrication was investigated by varying scanning speed of laser and number of scans. Higher scanning speed resulted in a smooth surface without any debris adhesion. By increasing number of scans, the cross-sectional profile of the microgroove became a well-defined V shape, and the taper angle of the V-shaped groove can be precisely controlled by laser scanning speed. Moreover, the laserinduced phase transformation of YSZ was characterized, and it was found that the monoclinic ratio after irradiation decreased in comparison with original YSZ surface, indicating improved strength and toughness. TEM cross-sectional observation of the microgrooves was performed and tetragonal phase was detected independent of locations. Finally, micro pyramid structures were created on the YSZ surface by perpendicularly crossing the laser scan directions. The resulting surface showed a drastic change in surface wettability. These findings demonstrated the possibility of generating precise complex microstructures on YSZ surface with high functionality and low subsurface damage, presenting great potential of wide applications in industry.
Total Cholesterol Level for Assessing Pancreatic Insufficiency Due to Chronic Pancreatitis
( Kenji Hirano ),( Tomotaka Saito ),( Suguru Mizuno ),( Minoru Tada ),( Naoki Sasahira ),( Hiroyuki Isayama ),( Miho Matsukawa ),( Gyotane Umefune ),( Dai Akiyama ),( Kei Saito ),( Shuhei Kawahata ),( 대한소화기학회 2014 Gut and Liver Vol.8 No.5
Background/Aims: To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice. Methods: A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups. Results: The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052). Conclusions: Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis. (Gut Liver 2014;8:563-568)
( Masako Amano ),( Tomotaka Nishizawa ),( Tomohiro Ohba ),( Kojirou Honda ),( Ryo Okuda ),( Hidekazu Matsushima ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Generally, organizing pneumonia (OP) responds well to steroid therapy with good prognosis. However, relapses sometimes occur, thus a treatment policy based on the cause and background of each case should be carefully considered. Methods: The medical records of 46 patients with biopsy-proved OP were retrospectively reviewed. Their clinical presentations, radiographic studies, bronchoalveolar lavage (BAL) fi ndings, treatment, and outcomes were analyzed. Cases where the fi nal diagnosis was eosinophilic pneumonia were excluded from this study. Results: The mean age at presentation was 64±13.9 years. Nineteen patients were diagnosed with Cryptogenic organizing pneumonia (COP), 6 patients had drug induced OP, 6 patients were associated with collagen disease, 7 patients had post pneumonia, 4 were post-radiation therapy patients, 3 patients were fi nally diagnosed with nonspecifi c interstitial pneumonia (NSIP) and 1 patient was associated with radiofrequency ablation (RFA) for hepatocellular carcinoma. Twenty nine patients were treated with systemic steroid therapy. The mean duration of steroid therapy was 7.2 months. The relapse rate was 10% for COP and 75% for post-radiation therapy patients. The steroid- refractory cases were patients with NSIP who needed immunosuppressant drugs for treatment. Conclusions: The relapse rate was high among radiation therapy patients. Although patients were given more than 6 months to taper off of steroid therapy, relapse still occurred. If the patient is refractory to steroid therapy, then we need to consider that the diagnosis could be NSIP, instead of OP.