DipeptiDyl peptiDase-4 (DPP-4) inhibitor is a new class of anti-diabetic drug which enhances circulating levels of a gut incretin hormone, glucagon-like peptide-1 (GLP-1), by inhibiting the degradation of GLP-1 [1]. GLP-1 stimulates insulin secretion from pancreatic β-cells in a blood glucose-dependent manner and suppresses glucagon release from pancreatic abstract. Dipeptidyl peptidase-4 (DPP-4) inhibitor is a new class of anti-diabetic drug which exerts its glucose-lowering action by suppressing the degradation of a gut incretin hormone glucagon-like peptide-1 (GLP-1). To elucidate whether treatment with stronger DPP-4 inhibitor on top of angiotensin II type 1 receptor blocker (ARB) provides greater renal protective effects, we performed a crossover study with two DPP-4 inhibitors, sitagliptin and alogliptin, in twelve type 2 diabetic patients with incipient nephropathy taking ARBs. This study consisted of three treatment periods: sitagliptin 50 mg/day for 4 weeks (first period), alogliptin 25 mg/day for 4 weeks (second period), and sitagliptin 50 mg/day for 4 weeks (third period). Significant changes in body mass index, blood pressure, serum lipids, serum creatinine, estimated glomerular filtration rate, and HbA1c were not observed among the three treatment periods. Reduced urinary levels of albumin and an oxidative stress marker 8-hydroxy-2'-deoxyguanosine (8-OHdG), increased urinary cAMP levels, and elevated plasma levels of stromal cell-derived factor-1α (SDF-1α) which is a physiological substrate of DPP-4 were observed after the switch from sitagliptin to a stronger DPP-4 inhibitor alogliptin. Given a large body of evidence indicating anti-oxidative action of cAMP and up-regulation of cellular cAMP production by SDF-1α, the present results suggest that more powerful DPP-4 inhibition on top of angiotensin II type 1 receptor blockade would offer additional protection against early-stage diabetic nephropathy beyond that attributed to glycemic control, via reduction of renal oxidative stress by SDF-1α-cAMP pathway activation.

Objects Ultrashort‐segment Barrett’s esophagus (USSBE; length of <1 cm) is very frequently diagnosed in Japan, but the cancer risk of USSBE is unknown. In this study, by retrieving endoscopic images, we retrospectively investigated the incidence of esophageal adenocarcinoma (EAC) by the grade of Barrett’s esophagus (BE) and compared the findings with those of gastric cancer by the degree of endoscopic gastric atrophy in the same population. Methods Among consecutive participants who had undergone endoscopy for an annual health checkup in 2014, the 9121 who had received at least one follow‐up endoscopy by December 2020 were enrolled in this study. Using the retrieved endoscopic images, we retrospectively evaluated BE and gastric atrophy. Information on the subsequent occurrence of EAC and gastric cancer as of December 2020 was also collected. The incidence of cancer by the extent of BE and gastric atrophy was calculated and expressed as the percentage per year. Results On reviewing the endoscopic image in 2014, 4190 (45.9%) were found to have been diagnosed with BE, of whom 3318 (36.4%) were judged to have USSBE. During an observation period of 54.1 (17.9) months, 89 gastric cancers and only two EACs were identified. The incidence of EAC in USSBE was 0.0068%/year, which was nearly as low as the incidence of gastric cancer in atrophy‐free patients (0.0068% vs. 0.0059%/year). Conclusions Although the prevalence of USSBE is quite high (36.4%), the incidence of EAC in USSBE is very low (0.0068%/year). Accordingly, USSBE can be excluded from targets for endoscopic surveillance in Japan.

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This paper proposes a two-step topology optimization method based on the normalized Gaussian functions. The proposed method is shown effective for design of a claw-pole alternator. In this method, the global search using the micro-genetic algorithm is followed by the local search using the sensitivity analysis based on the adjoint variable method. The three dimensional structure of the rotor is optimized using the proposed method under low and high speed conditions.

This paper presents a new pole‐changing method with multiple three‐phase inverters. Since the number of controllable current phases is much larger than that in conventional methods, a higher winding factor can be obtained in both high‐ and low‐pole driving modes. To evaluate the magnetic characteristics of the proposed method, magnetomotive force analysis is conducted based on Fourier series expansion and finite element method (FEM). Moreover, mutual inductance is compared between high‐ and low‐pole drives using FEM. To validate the effectiveness, an efficiency map is evaluated by using a prototype induction motor. © 2019 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.