Efficacy of intensive lipid-lowering therapy with statins stratified by blood pressure levels in patients with type 2 diabetes mellitus and retinopathy: Insight from the EMPATHY study

Intensive lipid-lowering therapy is recommended in individuals exhibiting type 2 diabetes mellitus (T2DM) with microvascular complications (as high-risk patients), even without known cardiovascular disease (CVD). However, evidence is insufficient to stratify the patients who would benefit from intensive therapy among them. Hypertension is a major risk factor, and uncontrolled blood pressure (BP) is associated with increased CVD risk. We evaluated the efficacy of intensive vs. standard statin therapy for primary CVD prevention among T2DM patients with retinopathy stratified by BP levels. We used the dataset from the EMPATHY study, which compared intensive statin therapy targeting low-density lipoprotein cholesterol (LDL-C) levels of <70 mg/dL and standard therapy targeting LDL-C levels ranging from ≥100 to <120 mg/dL in T2DM patients with retinopathy without known CVD. A total of 4980 patients were divided into BP ≥ 130/80 mmHg (systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg, n = 3335) and BP < 130/80 mmHg (n = 1645) subgroups by baseline BP levels. During the median follow-up of 36.8 months, 281 CVD events were observed. Consistent with previous studies, CVD events occurred more frequently in the BP ≥ 130/80 mmHg subgroup than in the BP < 130/80 mmHg subgroup (P < 0.001). In the BP ≥ 130/80 mmHg subgroup, intensive statin therapy was associated with lower CVD risk (HR 0.70, P = 0.015) than standard therapy after adjustment. No such association was observed in the BP < 130/80 mmHg subgroup. The interaction between BP subgroup and statin therapy was significant. In conclusion, intensive statin therapy targeting LDL-C < 70 mg/dL provided benefits in primary CVD prevention when compared with standard therapy among T2DM patients with retinopathy and BP ≥ 130/80 mmHg.

Evaluation of a web-based educational programme for pharmacists during the COVID-19 pandemic in Japan

WHAT IS KNOWN AND OBJECTIVE

Continuing education is essential for pharmacists to acquire and maintain the knowledge, skills, and ethical attitudes necessary for clinical practice. However, with the emergence of COVID-19, the social circumstances and face-to-face learning environments have changed. The objectives of this study were to determine Japanese pharmacists' perception of a web-based educational programme in oncology, and assess changes in their understanding of pharmaceutical care in oncology before and after their participation in the webinar.

METHODS

Questionnaire-based surveys were conducted for the participants of the web-based educational programme to determine their perspectives on the webinar, and their degree of comprehension of the five cancer types covered before and after watching the webinar.

RESULTS AND DISCUSSION

Of the 1936 pharmacists taking the programme, all participated in the pre-webinar survey, and 1861 (96.1%) in the post-webinar survey. Compared with previous seminars that were held in the offline mode before the COVID-19 pandemic, 76.8% of respondents were significantly satisfied with the web-based educational programme. The median post-webinar comprehension scores in all modules were significantly higher than the median pre-webinar scores (p < 0.0001). A majority of the participants agreed that a web-based educational programme was satisfactory in acquiring knowledge.

WHAT IS NEW AND CONCLUSION

This web-based educational programme was effective for Japanese pharmacists for postgraduate education in pharmaceutical care in oncology. To the best of our knowledge, our study is the first to report the effectiveness of a web-based educational programme for oncology pharmacists using a large population.

Undiagnosed Cardiac Sarcoidosis Causing Refractory Heart Failure After Acute Myocardial Infarction due to Thromboembolism

A 61-year-old woman suffered chest pain and was admitted to a nearby hospital emergency department. She was diagnosed with acute myocardial infarction probably due to thromboembolism in the left anterior descending coronary artery and aspiration thrombectomy was performed. Afterwards, she developed refractory heart failure with severe global left ventricular dysfunction and was transferred to our hospital. An ¹⁸F-FDG-PET/CT scan revealed abnormal ¹⁸F-FDG uptake in non-infarcted regions of the left ventricle. Non-caseating granulomas were detected by biopsy from a skin eruption. She was diagnosed with cardiac sarcoidosis. In cases of refractory heart failure which cannot be explained only by myocardial infarction, evaluation of other undiagnosed cardiomyopathies is important for optimal management.

Inactivation of the ventral hippocampus facilitates the attenuation of odor neophobia in rats

Food neophobia is a behavior observed in rodents involving reduced consumption of a novel food or drink. In the absence of negative post-ingestive consequences, consumption increases with exposure (attenuation of neophobia), which is seen as an associative safe memory. Olfaction and gustation are sensory modalities essential for the development of a food preference. However, little is known about the neural mechanisms underlying neophobia to a food-related odor stimulus. In the present study, we examined the effect of pharmacological inactivation of the ventral hippocampus (vHPC) on neophobia to orally consumed solutions in rats using muscimol, a gamma aminobutyric acid type A receptor agonist. Two different types of solutions, almond odor (benzaldehyde) and sweet taste (saccharin), were prepared. In the results, microinjections of muscimol into the bilateral vHPC before the first odor and taste exposures did not alter the neophobic reactions of the rats to each stimulus. However, in the second odor, but not taste, exposure, the muscimol-injected rats showed higher consumption in comparison to that observed in the control rats, suggesting that the vHPC inactivation facilitates the attenuation of odor neophobia. On the other hand, intra-vHPC muscimol microinjections after the first odor and taste exposures did not facilitate consumption at the second exposures. These results indicate that neural activations within vHPC during orally consuming a novel odor, but not taste, solution play an inhibitory role in the subsequent attenuation of neophobia.

Conceptual design of a collimator for the neutron emission profile monitor in JT-60SA using Monte Carlo simulations

Materials and structures of a collimator for a new neutron emission profile monitor in JT-60SA are examined through Monte Carlo simulations using the Monte Carlo N-Particle transport code. First, the shielding properties of various material combinations are compared in order to determine a combination with high shielding performances against both neutrons and gamma-rays. It is found that a collimator consisting of borated polyethylene and lead has a high shielding performance against neutrons. Moreover, a high shielding performance against gamma-rays is obtained when a lead pipe with a radial thickness of 0.01 m is inserted into a collimation tube. Second, we demonstrate that it is possible to improve the spatial resolution to a desired level by installing a thin tubular extension structure that fits into the limited space available between the main collimator block and the tokamak device. Finally, the collimator structures that meet both the targeted spatial resolutions (<10% of the plasma minor radius) and the targeted counting rate (10⁵ cps order) are discussed.

Abstract P199: Effectiveness Of Intensive Lipid-lowering Therapy With Statins In Type 2 Diabetes Mellitus Patients With Poorly Controlled Blood Pressure

Introduction: Control of blood pressure (BP) is associated with decreased risk of cardiovascular (CV) events in patients with type 2 diabetes mellitus (T2DM). Lowering the level of low-density lipoprotein cholesterol (LDL-C) by statins is also effective to reduce CV events in T2DM patients with hyperlipidemia. In this study, we examined whether the effectiveness of statin lipid-lowering therapy was affected by baseline BP level in T2DM patients in a primary prevention setting.

Methods: The EMPATHY study was a randomized controlled trial investigating the effects of statin intensive therapy targeting LDL-C <70 mg/dL compared to standard therapy targeting LDL-C ≥100 to <120 mg/dL in T2DM patients with diabetic retinopathy and hyperlipidemia without known CV diseases. In this post-hoc subgroup analysis, a total of 4980 patients were divided into two groups based on baseline BP: high BP (systolic BP ≥130 mmHg and/or diastolic BP ≥80 mmHg) and non-high BP (systolic BP <130 mmHg and diastolic BP <80 mmHg) groups. CV events were defined as composite of cardiac, cerebral, renal, and vascular events.

Results: At baseline, mean systolic and diastolic BP values were 141.7 and 78.3 mmHg in high BP group (n=3335) and 120.2 and 67.9 mmHg in non-high BP group (n=1645). Compared to non-high BP group, the proportion of patients with diabetic nephropathy (55.5 % vs 46.6 %), body mass index (26.1 kg/m 2 vs 24.8 kg/m 2 ), HbA1c (7.82 % vs 7.67 %), and LDL-C (131.3 mg/dL vs 129.6 mg/dL) were significantly higher in high BP group. During a median follow-up of 36.8 months, 281 CV events were observed. In high BP group, statin intensive therapy was associated with low risk of CV events (HR 0.70, 95% CI 0.54-0.92, p=0.011) compared to standard therapy after adjustment. In non-high BP group, no such association was observed. Interaction between BP group and statin therapy was significant in CV events (p=0.036).

Conclusion: Compared to statin standard therapy, statin intensive therapy targeting LDL-C <70 mg/dL significantly reduced CV events in the primary prevention setting among T2DM patients with BP ≥130/80 mmHg, but not among those with BP <130/80 mmHg.

DPP (Dipeptidyl Peptidase)-4 Inhibitor Attenuates Ang II (Angiotensin II)-Induced Cardiac Hypertrophy via GLP (Glucagon-Like Peptide)-1-Dependent Suppression of Nox (Nicotinamide Adenine Dinucleotide Phosphate Oxidase) 4-HDAC (Histone Deacetylase) 4 Pathway

Nox4 (NADPH [Nicotinamide adenine dinucleotide phosphate] oxidase 4) is a major source of oxidative stress and is intimately involved in cardiac hypertrophy. DPP (Dipeptidyl peptidase)-4 inhibitor has been reported to regulate Nox4 expression in adipose tissues. However, its effects on Nox4 in cardiac hypertrophy are still unclear. We investigated whether DPP-4 inhibitor could ameliorate cardiac hypertrophy by regulating Nox4 and its downstream targets. Ang II (Angiotensin II; 1.44 mg/kg per day) or saline was continuously infused into C57BL/6J mice with or without teneligliptin (a DPP-4 inhibitor, 30 mg/kg per day) in the drinking water for 1 week. Teneligliptin significantly suppressed plasma DPP-4 activity without any significant changing aortic blood pressure or metabolic parameters such as blood glucose and insulin levels. It attenuated Ang II-induced increases in left ventricular wall thickness and the ratio of heart weight to body weight. It also significantly suppressed Ang II-induced increases in Nox4 mRNA, 4-hydroxy-2-nonenal, and phosphorylation of HDAC4 (histone deacetylase 4), a downstream target of Nox4 and a crucial suppressor of cardiac hypertrophy, in the heart. Exendin-3 (150 pmol/kg per minute), a GLP-1 (glucagon-like peptide 1) receptor antagonist, abrogated these inhibitory effects of teneligliptin on Nox4, 4-hydroxy-2-nonenal, phosphorylation of HDAC4, and cardiac hypertrophy. In cultured neonatal cardiomyocytes, exendin-4 (100 nmol/L, 24 hours), a GLP-1 receptor agonist, ameliorated Ang II-induced cardiomyocyte hypertrophy and decreased in Nox4, 4-hydroxy-2-nonenal, and phosphorylation of HDAC4. Furthermore, exendin-4 prevented Ang II-induced decrease in nuclear HDAC4 in cardiomyocytes. In conclusion, GLP-1 receptor stimulation by DPP-4 inhibitor can attenuate Ang II-induced cardiac hypertrophy by suppressing of the Nox4-HDAC4 axis in cardiomyocytes.

Quantitative analysis of mammalian chromosome by scanning transmission soft X-ray microscopy

Soft X-ray spectromicroscopy was applied to study the quantitative distribution of DNA and protein in a mammalian chromosome at the spatial resolution of 100 nm. The quantities of DNA and protein were evaluated using 1s-π* transition in the NEXAFS spectra at the nitrogen K absorption edge. DNA was not uniformly distributed in the chromosome and DNA/protein ratio was less than 0.497. The present analysis revealed the clues to identify other molecules that contribute to the absorption spectrum of the sample. The results suggested that accumulation of the absorption spectra of relevant molecules would support the refinement of the analysis.