Objectives: The dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin is indicated for type 2 diabetes mellitus (T2DM). However, the long-term safety, effectiveness, and clinical relationship with cardiovascular events of vildagliptin have not been evaluated in Japan. Methods: The authors conducted post-marketing surveillance (PMS) to evaluate the safety and effectiveness of vildagliptin in more than 3000 Japanese T2DM patients for up to 3 years. Main assessments included demographics, major adverse cardiovascular events (MACE), adverse events (AEs), adverse drug reactions (ADRs), and glycated hemoglobin (HbA1c). Results: In this PMS, 3831 patients (775 sites) were registered in April 2010 − April 2012. The safety analysis population comprised 3769 patients; 2085 patients were aged ≥65 years, and 240, 411, and 114 had renal impairment, hepatic impairment, and heart failure, respectively. The median treatment duration was 2.7 years. The incidence of MACE was 6.04 cases/1000 person-years, mostly attributable to cerebrovascular events (4.27 cases/1000 person-years). The AE and ADR incidences were 26.0% and 5.3%, respectively. The incidence of hypoglycemia was 0.6%. No significant changes in body weight occurred and mean change in HbA1c from baseline at final assessment was −0.74 ± 1.41% (p < 0.0001). Conclusions: In real-world clinical settings, vildagliptin was well tolerated, with similar profiles as previously reported.

We investigated whether non-digestible saccharide fermentation-derived hydrogen molecules (H2) in rat colon could improve the in vivo reduction–oxidation (redox) balance via regeneration of α-tocopherol, by assessing their effect on hydroxyl radicals, the α-tocopherol concentration and the redox balance. In Expt 1, a Fenton reaction with phenylalanine (0 or 1·37 mmol/l of H2) was conducted. In Expt 2, rats received intraperitoneally maize oil containing phorone (400 mg/kg) 7 d after drinking ad libitum water containing 0 or 4 % fructo-oligosaccharides (FOS) (groups CP and FP, respectively). In Expt 3, rats unable to synthesise ascorbic acid drank ad libitum for 14 d water with 240 mg ascorbic acid/l (group AC), 20 mg of ascorbic acid/l (group DC) or 20 mg of ascorbic acid/l and 4 % FOS (group DCF). In the Fenton reaction, H2 reduced tyrosine produced from phenylalanine to 72 % when platinum was added and to 92 % when platinum was excluded. In Expt 2, liver glutathione was depleted by administration of phorone to rats. However, compared with CP, no change in the m-tyrosine concentration in the liver of FP was detected. In Expt 3, net H2 excretion was higher in DCF than in the other rats after 3 d of the experiment. Furthermore, the concentrations of H2 and α-tocopherol and the redox glutathione ratio in perirenal adipose tissue of rats were significantly higher in DCF than in DC. To summarise, in rat colon, fermentation-derived H2 further shifted the redox balance towards a more reducing status in perirenal adipose tissue through increased regeneration of α-tocopherol.

We describe a case of cardiac compression caused by an esophageal hiatal hernia that resulted in circulatory failure and cardiac arrest. Computed tomography revealed gastric herniation into the mediastinum, with marked cardiac compression. Cardiopulmonary resuscitation was performed, and a nasogastric tube was inserted for gastric decompression, which resulted in the return of spontaneous circulation and subsequent hemodynamic stabilization.

Case 1 involved a 74-year-old man with a several-day history of appetite loss presented to the Critical Care Center in our hospital because of the abrupt onset of abdominal pain. A contrast-enhanced abdominal CT scan showed a tumor in the transverse colon at the splenic flexure and its direct invasion into the stomach. Colonoscopy revealed a tumor of the transverse colon completely encircled the colon. Upper gastrointestinal series revealed infiltrating findings of an extramurally growing tumor in the middle portion of the gastric body. A biopsy of the colon showed poorly differentiated adenocarcinoma. Cancer of the transverse colon with a resultantly caused gastrocolic fistula was diagnosed. Left hemicolectomy and segmental resection of the stomach were performed. Case 2 involved an 87-year-old man with a 2-week history of appetite loss and right upper quadrant pain. He visited a neighboring hospital and was referred to our hospital with a suspicion of an intraabdominal tumor. A contrast-enhanced abdominal CT scan showed a tumor in the transverse colon at the hepatic flexure. Upper gastrointestinal series showed infiltrating findings of an extramurally growing tumor at the pyloric antrum. A biopsy of the colon revealed poorly differentiated adenocarcinoma. Cancer of the transverse colon with a resultantly caused gastrocolic fistula was diagnosed. Right hemicolectomy and distal gastrectomy were performed. We present these two cases of cancer of the transverse colon causing a gastrocolic fistula. Key words：gastrocolic fistula，carcinoma of the transverse colon，acute abdomen

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