Although regular aerobic physical activity increases exercise capacity and plays a role in both primary and secondary prevention of a variety of chronic disorders, competitive physical exercise is associated with a significant increase of risk of sudden death in athletes, especially adolescents and young adults. Several pathogenetic mechanisms have been speculated, including silent cardiovascular conditions, mostly cardiomyopathy, premature coronary artery disease and congenital coronary anomalies. Uneventful events, especially commotio cordis, and abuse of unfair and dangerous performance-enhancing drugs, are also claimed as potential causes. Although identification of athletes at major risk and prevention of adverse events seems the more pervasive strategy, guidelines for screening athletes differ widely on international basis and even among the different Sport federations. The aim of this review was to compile the current knowledge on the prevalence and the most common causes of sudden death in sportsmen, providing an overview of the guidelines for pre-participation screening.

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Background Atherosclerotic vascular diseases such as cerebrovascular and cardiovascular diseases are major causes for fatality of hemodialysis (HD) patients. Since adipocytokines are key players for arteriosclerosis in the concept of metabolic syndrome (MetS), we aimed to determine whether circulating levels of major three adipocytokines, adiponectin, TNF-α, and leptin, could be associated with various parameters and clinical events in HD patients who are diagnosed as MetS using a new criteria designed for the Japanese population.
Patients and Methods We enrolled 53 very stable patients under maintenance HD at Minami-Senju Hospital. Basically, clinical and laboratory data were taken just before HD therapy. HD sessions were performed regularly and all the participants took oral administration and injection as usual. A cross-sectional study was performed to evaluate clinical and laboratory data related to three major adipocytokines, adiponectin, TNF-α and leptin.
Results We observed no significant differences of three adipocytokines when the participants were divided in accordance with existence of MetS or past cerebrocascular/cardiovascular diseases. Only the serum adiponectin levels were significantly different in two groups categorized by existence of diabetes mellitus. Serum triglycerides (TG) were significantly correlated with two circulating adipocytokines, adiponectin (r=-0.328, p<0.016) and leptin (r=0.397, p<0.003), when we analyzed all 53 patients together.
Conclusion Plasma adiponectin and leptin are expected as contributors related to dyslipidemia, suggesting these may be targets of prevention of vascular diseases in maintenance HD patients.

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Objective The transforming growth factor beta-1 gene (TGFB1) is one of the most promising candidate genes for chronic obstructive pulmonary disease (COPD). Several case-control studies have been performed and generated inconsistent results. The possible reasons for these discrepancies include the diversity of ethnic populations and the heterogeneity of COPD, including emphysema and airway disease. We designed this study to investigate the association of single nucleotide polymorphisms (SNPs) of TGFB1 with the emphysema phenotype in the Japanese population.
Methods Eight SNPs in TGFB1 (rs2241712, rs1982072, and rs1800469 in the promoter region; rs1982073 in exon 1; rs2241716 and rs4803455 in intron 2; rs6957 and rs2241718 in the 3' region) were genotyped by allelic discrimination assays in 70 COPD patients with emphysema phenotype and 99 healthy smokers. The emphysema phenotype was identified by high-resolution computed tomography imaging using Goddard's method.
Results The frequency of one significant haplotype structured by the eight SNPs was significantly higher in the emphysema group (10%) than in the healthy smokers (4%, p=0.02). In the emphysema group, the predicted value of forced expiratory volume in 1 second after bronchodilator administration was significantly associated with the minor alleles of the two SNPs (rs1800469 and rs1982073, p=0.007 and 0.032, respectively), however, the low attenuation area and carbon monoxide diffusing capacity were not associated with the SNPs. In addition, the rs1800469T and rs1982073C alleles were significantly more prevalent in patients with severe and very severe airflow limitation than in those with mild and moderate airflow limitation (p=0.007 and 0.041, respectively).
Conclusions One significant haplotype of TGFB1 is associated with the emphysema phenotype in the Japanese population. Two TGFB1 SNPs (rs1800469 and rs1982073) are associated with the severity of COPD in patients with emphysema phenotype.

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Objective Diabetic Neuropathy Symptom (DNS) scoring and medial plantar NCS are useful methods for diagnosis of diabetic polyneuropathy (DPN). We evaluated the correlation between DNS score and medial plantar NCS in diabetic patients with a normal routine NCS.
Method Nineteen healthy subjects were included as a control group. Fifty patients with diabetes mellitus who were referred for the evaluation of DPN were recruited (35 asymptomatic and 15 symptomatic). Control subjects and diabetic patients over the age of 70 were excluded from this study.
Results Medial plantar nerve action potential (NAP) was recordable in all 19 control subjects and was not obtainable in 7 out of 15 symptomatic patients and in 5 out of 35 asymptomatic patients. The amplitudes of sural (Spearman r=-0.293, p=0.003) and medial plantar NAP (Spearman r=-0.215, p=0.03) correlated with DNS score.
Conclusion An abnormality finding in the medial plantar sensory nerve conduction study is a more sensitive indicator than sural nerve conduction study in the diagnosis of DPN and the medial plantar sensory nerve should be included in the evaluation of DPN in patients showing normal routine NCS.

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Objective Metabolic syndrome (MetS) is a major public health problem. However, few studies have examined the significance of MetS as a risk factor for the development of chronic kidney disease (CKD) in the general Japanese population.
Methods Study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina, or renal failure (1,158 men, aged 61±15 years and 1,606 women, aged 63±12 years) were recruited from a single community. We examined the cross-sectional relationship between MetS and renal function as evaluated by estimated glomerular filtration rate (eGFR).
Results The presence of MetS was consistently associated with reduced eGFR, with the level of reduction proportional to the number of MetS components present. Multiple linear regression analysis using eGFR as an objective variable showed that BMI, DBP, antihypertensive drug use, high-density lipoprotein cholesterol, antilipidemic drug use and fasting blood glucose, which were components of MetS, were significantly and independently associated with eGFR, in addition to age and low-density lipoprotein cholesterol. Individuals with MetS showed a multivariate-adjusted odds ratio of 1.53 (95% confidence interval, 1.10-2.13) for CKD compared to those without MetS.
Conclusions MetS was significantly associated with decreased eGFR in the general population.

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Radiation therapy can be used to treat Helicobacter pylori-negative or eradication-refractory extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of the stomach. We report a case of gastric perforation which occurred more than 1 year after the completion of radiotherapy for H. pylori eradication-refractory gastric MALT lymphoma, and then recurred shortly afterwards. This was considered to be a late complication of radiation toxicity. Although gastric perforation due to radiotherapy has been reported very rarely in the past, even in advanced disease, this case shows that perforation can develop in patients with superficial disease and can relapse.

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Chronic expanding hematoma in the chest is identified as a specific type of chronic empyema. We encountered a case of chest chronic expanding hematoma presenting as a huge mass, which compressed the heart, trachea and esophagus. The disease was recognized as a cause of aspiration pneumonia and was successfully treated by surgical resection. Computed tomography revealed a large area of calcifications at the periphery of the mass. Magnetic resonance T2-weighted imaging indicated the mosaic patterns of various signal intensities as specific features of chronic expanding hematoma. Imaging diagnosis showed good correlation with pathology of the disease.

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Timely diagnosis of pulmonary embolism (PE) is crucial because prompt appropriate management can decrease mortality and morbidity. However, the diagnosis of PE is often a challenge because of aspecific clinical presentation and the lack of a single non-invasive diagnostic test sufficiently sensitive for the diagnosis in all suspected cases. The present report describes a 37-year-old woman in whom diagnosis of recurrent subsegmental PE was achieved through subtle integration of imaging techniques including thoracic ultrasound (TUS) that was demonstrated to be of valuable usefulness. We think that TUS may represent an adjunctive technique for diagnosing PE.

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We herein report an 80-year-old man with prostatic carcinoma who developed eosinophilic pneumonia and intrathoracic metastases. He presented with shortness of breath, cough, and fever as a chief complaint. Chest X-ray and computed tomography showed bilateral pulmonary nodules, intrathoracic lymphadenopathy, and right-sided consolidation. Positron emission tomography (PET) using ¹⁸F-fluorodeoxyglucose (FDG) showed poor uptake in these nodules and lymph nodes. The patient subsequently received a pelvic computed tomography scan, which revealed a massively enlarged prostate. The serum prostate specific antigen level was elevated to 4,181.2 ng/mL, and a transrectal biopsy revealed prostatic adenocarcinoma. Based on the morphological and immunohistochemical findings, the nodules in the lung and the lymph nodes were diagnosed as secondary neoplasm from the prostate. As for right-sided consolidation, remarkable bronchoalvelar lavage fluid eosinophilia was detected, that was compatible with eosinophilic pneumonia. Eosinophilic pneumonia in this case disappeared and has not recurred by treatment of prostatic carcinoma and steroid therapy for a week, and was regarded to be tumor-associated. Although prostatic carcinoma with an initial manifestation of intrathoracic metastases and eosinophilic pneumonia is uncommon, physicians should suspect the condition. In addition, we should also keep in mind that prostatic carcinoma sometimes shows poor uptake in FDG-PET.
PET: Positron emission tomography, FDG: ¹⁸F-flouorodeoxyglucose

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We report four diabetic patients with a central pontine lesion on magnetic resonance imaging (MRI). All patients also had hypertension, diabetic neuropathy and nephropathy, and three had chronic hepatitis C. Their neurological symptoms were disproportionately mild compared with the MRI features, which were of high intensity on T2-weighted images, but were less prominent on T1- and diffusion-weighted images. A subclinical pontine lesion was found in two patients who had undergone MRI previously. We consider that diabetes mellitus is an important factor for developing a pontine lesion with or without symptoms, probably in association with hepato-renal problems and hypertension.

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A 66-year-old right-handed woman with type 2 diabetes mellitus was admitted to our hospital with progressive dysarthria and gait disturbance preceded by difficulty in knitting. Brain magnetic resonance imaging (MRI) showed a lesion involving the entire corpus callosum. Although tumor was considered in the differential diagnosis because of the atypical imaging findings, she was diagnosed with infarction based on clinical improvement after admission and sequential changes in MRI. We suggest that difficulty in knitting may be an important early manifestation of a callosal disconnection syndrome and that follow-up clinical and imaging examinations would contribute to confirmation of the diagnosis.

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A 58-year-old man was admitted to our hospital with fever. The vegetation was confirmed by echocardiography on the tricuspid valve and Erysipelothrix rhusiopathiae was isolated by blood culture. The patient died due to heart failure, and tricuspid valve vegetation was confirmed on autopsy and the sample of Gram's staining showed Gram-positive microcolonies. Although about 60 cases of E. rhusiopathiae endocarditis have been reported, Japanese cases are extremely rare.

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