Background. Geranylgeranylacetone (GGA), which is an isoprenoid compound, has been used orally as an antiulcer drug in Japan. GGA induces antiviral gene expression by stimulating the formation of interferon-stimulated gene factor 3 in human hepatoma cells. This study verified the anti-hepatitis C virus (HCV) activity of GGA in chronic hepatitis C-infected patients. Methods. The present prospective study included 20 consecutive anti-HCV antibody-positive, HCV-genotype 1b, and chronic gastritis patients who visited Nagasaki University Hospital between January 1999 and December 1999. GGA (150 mg per day, which is the dose generally used for chronic gastritis) was taken orally for four weeks. We evaluated HCV-RNA titers and other clinical parameters at pretreatment, posttreatment, and at the endpoint of the study. Pretreatment was the beginning point of GGA treatment. Posttreatment was the termination point of GGA treatment. The endpoint was the point four weeks after the posttreatment point. Results. All patients completed four weeks of GGA treatment and four weeks of observation. HCV-RNA titers at postpoint were not significantly diminished compared to those at pretreatment. However, HCV-RNA titers were significantly diminished at endtreatment compared to pretreatment. Unfortunately, we did not observe a case with no titer of HCV-RNA. Alanine aminotransferase values and other parameters were not affected by GGA treatment. Conclusion. GGA has anti-HCV activities in chronic hepatitis C-infected patients. In the future, it will be necessary to examine the clinical effectiveness of the combination of treatment with both GGA and interferon in HCV patients.

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Protein-energy malnutrition (PEM) is frequently seen in patients with liver cirrhosis. This condition is associated with a poor prognosis and reduced survival. We investigated the protein and energy metabolic status, including serum albumin concentration, and resting energy expenditure (REE) and respiratory quotient (RQ) measured by indirect calorimetry in 23 patients with liver cirrhosis (8 men and 15 women; mean age, 60.3 years). The median value of %REE (measured REE / predicted REE) was highest in Child-Pugh grade A and lowest in grade C, and the range of RQ tended to be highest in Child-Pugh grade A and lowest in grade C, although there were not statistically significant (p=0.871 and 0.664, respectively). Serum triglyceride concentration was significantly lower in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 or more, and free fatty acid tended to be higher in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 or more. Of the 23 patients, 78.3% were in a state of protein and/or energy malnutrition and 47.8% had PEM. Our results suggest that %REE and RQ were not significantly associated with liver function, but the oxidation rate of fat was increased in advanced liver cirrhosis. A longitudinal study in a large population is needed to determine the efficacy of %REE and RQ measurements for adequate nutritional treatment and improvement of patient outcome.

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Aim Although the important role of conventional risk factors (cigarette smoking, hypertension, diabetes and dyslipidemia) in the pathogenesis of ischemic heart disease (IHD) has been established, how frequently IHD is preceded by exposure to conventional risk factors remains controversial. The present study aimed to identify the prevalence of hypertension, diabetes and dyslipidemia among patients with IHD and examine associations between each of them with IHD in a Japanese population. Methods Data were collected from health insurance claims in May 2010 for National Health Insurance beneficiaries aged 40- 79 years in Nagasaki Prefecture, Japan. One sex- and age-matched control was randomly selected for each of 42,236 patients with IHD (International Classification of Diseases, 10th Revision code: I20-25). The prevalence of hypertension, diabetes and dyslipidemia and the number of these risk factors were compared between the patients and controls. Associations between risk factors and IHD were examined using a conditional logistic regression model. Results Over 90% of patients with IHD had at least one of hypertension, diabetes or dyslipidemia. The odds of IHD were 4.5- fold (95% confidence interval [CI]: 4.3, 4.7), 4.2-fold (95% CI: 3.9, 4.6) and 5.3-fold (95% CI: 4.9, 5.7) higher for patients with hypertension, diabetes and dyslipidemia, respectively, compared with patients without any of these risk factors. Patients with several risk factors were at increased risk for IHD. Conclusion Comprehensive risk reduction strategies that encourage a healthy lifestyle and diet and promote the recognition, evaluation and management of conventional risk factors are important to prevent IHD.

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The precise distribution pattern of pediatric renal diseases has seldom been reported especially for young children. In order to clarify the incidence and distribution of renal diseases in children, 599 renal biopsy specimens obtained from 547 pediatric patients (≦15 years old) were analyzed by routine light, electron and immunofluorescence microscopy. Among the total biopsy cases, the most common renal disease identified in childhood was IgA glomerulonephritis (IgAGN; 37%). More than 80% of patients with IgAGN were discovered by urinary screening at the school, showing asymptomatic proteinuria and/or hematuria. The other major renal diseases were minor glomerular abnormality (12.2%), Henoch-Schönlein purpura nephritis (HSPN; 10.6%), and thin basement membrane disease (7.1%). One of the major causes of pediatric nephrotic syndrome were minimal change nephrotic syndrome (58%), whereas the other causes were IgAGN (11.6%), HSPN (8.9%), membranous glomerulonephritis (5.4%), membranoproliferative glomerulonephritis (3.6%). In conclusion, IgAGN was the most common renal disease also in children as in adolescence. From the age of seven years, the incidence of IgA-GN was highest among all the pediatric renal diseases during whole childhood period, and the incidence and number of the patients increased as they grow. On the other hand, there are also many cases with non-progressive clinical courses, such as minor glomerular abnormality and thin basement membrane disease in children. The renal biopsy following routine urinary screening at the school may be important for the therapeutic and prognostic guidelines of pediatric group of patients with renal diseases.

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We report a case that was successfully treated invasive pulmonary aspergillosis after living donor lobar lung transplantation and monitored patients' immune function with ImmuKnow^® assay. A 43-year-old woman underwent living donor lobar lung transplantation for pulmonary alveolar proteinosis. Two healthy her relatives donated each lower lobe. Six months after transplantation, she was diagnosed as invasive pulmonary aspergillosis (IPA). During the anti-fungal treatment, one immunosuppressant was withdrawn and the trough level of calcineurin inhibitor was reduced to the minimum. Despite of such a low immunosuppressive status, Immuknow^® assay showed that immune function was maintained in the moderate range, which encouraged us to keep this strategy for IPA. Immune evaluation by Immuknow^® is useful method for monitoring and controlling patients' immune status especially in the infected condition, which revealed moderate immune level could be maintained with only two immunosuppressant drugs in the patient after recovery from IPA.

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We report the case of a 58-year-old male presenting with an impairment of the left-sided visual acuity caused by compressive optic neuropathy, and marked bilateral proptosis. Blood test showed markedly elevated IgG4 (1830 mg/dl) and positive TSH receptor-stimulating antibodies (200%), but the thyroid function test were normal. Orbital MRI revealed abnormal soft tissue proliferation around the optic nerve and fusiform enlargement of the extraocular muscles. Systemic CT analysis detected multiple lymph node swelling, pseudotumor in the lung, retroperitoneal fibrosis, and kidney lesions. We considered that the eye manifestation was most likely caused by IgG4-related idiopathic orbital inflammation. Systemic administration of a moderate dose of prednisolone dramatically improved the compression of the optic nerve, as shown by the improvement of the visual acuity and the MRI findings. The clinical course made thyroid-associated ophthalmopathy unlikely. In conclusion, an overall consideration of the clinical picture and extensive work-up of any possible differential diagnosis including measurement of the serum levels of IgG4 was highly useful in making the diagnosis of the patient.

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