Background There have been conflicting data regarding the relationship between obesity and coronary heart disease (CHD) in Japan. Obesity was reported to be a risk factor of CHD in young and middle-aged males, but not in females or older males. The age- and gender-related differences in the correlations between obesity and obesity-related metabolic risk factors might contribute to these conflicting data.
Methods Medical check-up data from 1,360 men and 821 women were divided into younger (= or < 51-year-old) and older (> 51-year-old) groups according to the median age and Spearman's correlation coefficients between waist circumference (WC) and obesity-related metabolic risk factors were calculated.
Results The correlation coefficients between WC and triglyceride and between WC and high-sensitivity C-reactive protein (hs-CRP) were significantly stronger in younger men than in older men. There was no statistically significant difference in correlation coefficients between younger and older women. The correlation coefficients between WC and triglyceride, WC and HDL cholesterol, WC and hs-CRP, WC and gamma glutamyltransferase, and WC and alanine aminotransferase (ALT) were significantly stronger in younger men than in younger women. The correlation coefficient between WC and ALT was significantly stronger in older men than in older women. And the correlations between WC and SBP, WC and DBP, and WC and GGT tended to be stronger in younger men than in older men.
Conclusion The correlations between abdominal obesity and obesity-related metabolic risk factors were stronger in younger men than in older men and women among Japanese.

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Background Early diagnosis of chronic obstructive pulmonary disease (COPD) with latent pulmonary hypertension (PH) and cor pulmonale is important because the prognosis of this condition is poor.
Objective To investigate the utility of brain natriuretic peptide (BNP) for prognostication of COPD, plasma BNP was measured in patients with COPD without symptoms or physical findings of PH or cor pulmonale.
Methods Plasma BNP was measured in 60 patients with COPD, 10 asthmatics, and 30 healthy subjects. Echocardiography, arterial blood gas analysis, and spirometry were also performed. Mortality and exacerbation were compared between COPD patients with high and low plasma BNP levels over a 3-year follow-up period.
Results Plasma BNP (mean ± SEM, pg/mL) in COPD patients (41.0±6.6) was significantly higher than in normal subjects (14.8±2.7) and asthmatics (17.4±4.5) (p<0.0001 and p<0.05, respectively). No significant correlations were observed between plasma BNP level and pulmonary function or hypoxia. There was, however, a significant correlation between plasma BNP level and % ejection fraction (r=-0.41, p=0.0197) and pulmonary artery systolic pressure (r=0.5, p=0.004). The period until initial COPD exacerbation in subjects with a high plasma BNP level was significantly shorter (p<0.05). Plasma BNP level during exacerbations (79.9±16.2) was also significantly higher than during stable disease (41.2±8.7) (p=0.004).
Conclusion We suggest that plasma BNP is a non-invasive biomarker that can be used as a screening parameter for latent PH and left ventricular dysfunction, and also as a predictor of exacerbation in stable COPD.

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Objective The concept of "lung age" is thought to be useful for understanding pulmonary function. In this study, we validated "lung age" to detect pulmonary function abnormalities in pulmonary diseases.
Methods We used both spirometry and an electronic FEV₁/FEV₆ meter (FEV₆ meter) to perform pulmonary function tests. We evaluated the sensitivity and specificity of FEV₆ and FEV₁/FEV₆, and calculated "lung age" in Japanese subjects including those with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA), and interstitial lung diseases (ILD).
Results FEV₁ (spirometer) vs. FEV₁ (FEV₆ meter), FVC (spirometer) vs. FEV₆ (FEV₆ meter), and FEV₁/FVC (spirometer) vs. FEV₁/FEV₆ (FEV₆ meter) measurements were all significantly and closely correlated. For the difference of "lung age" and "actual age", the area under the receiver operating characteristic curve (ROC-AUC) for detecting obstructive impairment was 0.807 (spirometer) and 0.772 (FEV₆ meter), respectively. The corresponding ROC-AUC for detecting restrictive impairment was 0.891 and 0.836, respectively, and that for detecting both obstructive and restrictive impairment was 0.918 and 0.853, respectively. For detection of both obstructive and restrictive impairment, the difference of the "lung age" and "actual age" cut-off value, corresponding to the greatest sum of sensitivity and specificity, was 18.3 years (spirometer) and 19.8 years (FEV₆ meter), respectively. The sensitivity was 0.783 (spirometer) and 0.801 (FEV₆ meter), and the specificity was 0.895 (spirometer) and 0.790 (FEV₆ meter), respectively.
Conclusion "Lung age" can provide an easy interpretation of the results, and can detect pulmonary function abnormalities in pulmonary diseases.

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Objective Familial Mediterranean fever (FMF) is characterized by recurrent episodes of peritonitis. Abdominal FMF attacks can be indistinguishable from those of an acute abdominal emergency, and patients may undergo one or more laparotomies before the true nature of their disease is documented. The objectives of this study were to investigate the frequency and reasons for abdominal surgeries performed on patients with FMF.
Methods We retrospectively reviewed the files of 254 patients with FMF (127 males, 127 females, mean age 27.2±6.3 years). We also included 182 healthy individuals for this study (89 males, 93 females, mean age 27.6±5 years; range 11-43) to make a comparison between FMF and healthy controls (HC) with respect to frequency of abdominal operations.
Results The number of patients with abdominal surgery in FMF group was 74 (29.1%). The number of surgeries performed in 74 patients with FMF was 92. The first abdominal surgery before the diagnosis of FMF was appendectomy in 68 patients (26.6%). In HC group, the number of abdominal operations was found to be 16 (8.7%). Of these abdominal operations, 9 (4.9%) were due to appendectomy. The rate of total abdominal operations and appendectomy were significantly higher in FMF group than in HC group (p=0.0001).
Conclusion Abdominal attacks of FMF patients may cause an unnecessary laparotomy prior to the diagnosis of FMF. FMF patients can present with abdominal emergency while they are receiving colchicine. Therefore, each abdominal pain should be carefully determined according to clinical findings. The purpose of this study was to emphasize the misdiagnosis of appendicitis.

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Background and Objective The growing problem of drug resistance among respiratory pathogens in community-acquired pneumonia (CAP), particularly Streptococcus pneumoniae, (S. pneumoniae) has complicated initial empiric therapy of CAP. This study was undertaken to evaluate the efficacy and tolerability of a 3-day course of azithromycin in adults with mild to moderately severe CAP, and to determine whether in vitro macrolide resistance among strains of S. pneumoniae is related to clinical efficacy/failure.
Methods An open-label, non-comparative study was undertaken at 3 university-affiliated hospitals in Japan. Patients were eligible if they were 18 years or older and had mild or moderately severe CAP. All patients received azithromycin 500 mg/day for three days, and clinical and microbiological responses were evaluated 1 and 2 weeks after initiating therapy.
Results A total of 78 patients received the study medication, 59 of whom had sufficient data available for efficacy analysis. Overall, a good clinical response with azithromycin was achieved in 49 patients (83.1%) and a microbiological response was achieved in 78.3%. Azithromycin resistance, based on CLSI criteria, was demonstrated in 85.7% (12/14) of S. pneumoniae isolates, and the presence of ermB genes was found in 50.0% (7/14). However, among patients in whom S. pneumoniae was isolated (n=17), a good clinical response was achieved in 76.5% (13/17), and the microbiological response rate was 64.3% (9/14). Furthermore, 6 of 7 patients in whom high-level resistance was documented (MICs >256 μg/mL and carrying ermB genes) exhibited good clinical responses. Azithromycin was well tolerated; adverse events, mainly of a gastrointestinal nature, were recorded in 6 patients (7.7%).
Conclusion Most patients responed well to azithromycin, indicating that azithromycin might be clinically effective for the treatment of CAP with macrolide-resistant S. pneumoniae. However, a larger study is necessary to prove the efficacy against macrolide-resistant S. pneumoniae.

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Objective To derive and validate a clinical prediction model with high sensitivity for differentiating aseptic meningitis (AM) patients from bacterial meningitis (BM) patients.
Methods We developed the model using the derivation cohort in a community rural hospital in Okinawa and assessed its performance using the validation cohort in a metropolitan urban hospital in Tokyo. There were 66 (39.5%) and 5 (17.9%) adult patients with BM among the derivation (n=167) and the validation cohort (n=28), respectively. Recursive partitioning analysis was used to determine the important classification variables and to develop a sensitive model to safely exclude BM.
Results The model produced high- and low-risk groups based on the following: 1) Gram stain, 2) CSF neutrophil percent ≤15%, 3) CSF neutrophil count ≤150 cells/mm³, and, 4) mental status change. Among the derivation cohort, there were 65 patients with BM in the high-risk group (n=76), while only one patient with BM was noted (sensitivity, 99%) in the low-risk group (n=91). Among the validation cohort, there were 5 patients with BM in the high-risk group (n=7), while no patient was classified with BM (sensitivity, 100%) in the low-risk group (n=21).
Conclusion This simple and sensitive model might be useful to safely identify low-risk patients for BM who would not require antibiotic treatment.

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Here we report a patient with a pancreaticobiliary fistula that was possibly associated with pancreatolithiasis. He was admitted due to mild pancreatitis. Pancreatolithiasis was revealed in the parenchyma of the head region and in the main pancreatic duct of the pancreas body with distal dilatation. Extracorporeal shock wave lithotripsy (ESWL) effectively eliminated the pancreatic stones; however, an apparent internal fistula from the middle portion of the common bile duct (CBD) to the main pancreatic duct was revealed where the parenchymal stones had been located. The patient was considered to be in the same condition as pancreato-biliary malunion without CBD dilatation, and was treated with laparoscopic cholecystectomy.

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Although germ cell tumors are the most common malignancy in young men, extragonadal germ cell tumors are rare. Gastric metastasis presenting initially as upper gastrointestinal hemorrhage is also exceedingly rare. A 27-year-old man presented at our hospital with tarry stool. Gastric fiberscopy images revealed a bleeding gastric polypoid lesion in the anterior wall of the gastric body, from which a biopsy specimen was obtained. Histopathological analysis of the biopsy showed syncytiotrophoblast-like cells with multiple, large nuclei, consistent with choriocarcinoma. Based on these results, our diagnosis was extragonadal retroperitoneal germ cell tumor with gastric metastasis.

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We report three cases of thoracic aortic aneurysm and dissection in a Japanese family. Marfan-related genes were analyzed; FBN1 and TGFBR2 gene mutations were observed in this family.

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A 49-year-old HIV-positive Japanese man was referred to our hospital for multiple skin nodules. Many plasmablastic atypical lymphocytes were observed in the peripheral blood. He was diagnosed with diffuse large B cell lymphoma (DLBCL) by a biopsy of the inguinal lymph node. IgH/MYC translocation was detected by in situ hybridization of the lymph node and chromosomal analysis of bone marrow cells showed 46, XY, t(8 ; 14)(q24 ; q32)add(14)(q32), der(21)t(1 ; 21)(q12 ; p11). He showed a transient response to multi-agent chemotherapy, and during the course of salvage chemotherapy, he died of urinary infection. This case has unique clinical features compared with previously reported DLBCLs with plasmablastic differentiation.

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We present a 23-year-old man with chronic neutrophilic leukemia (CNL). Physical examination revealed hepatosplenomegaly. Leukocytosis was evident with predominance of mature neutrophils with basophilic granules. Bone marrow aspiration revealed mature myeloid hyperplasia. Congenital Robertsonian translocation [45,XY,der(13;22)(q10;q10), in all of analyzed 20 cells] was detected; however, cytogenetic and molecular studies for 9:22 translocation were negative. He was diagnosed with CNL and hydroxyurea was started to control his symptoms and white blood cell count. He was then successfully treated with allogeneic bone marrow transplantation (BMT). Although the prognosis of CNL was not determined, curative therapy including allogeneic hematopoietic stem cell transplantation should be attempted in young patients with CNL.

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Polyethylene glycol-interferon α (PEG-IFNα) has been used as the standard treatment for hepatitis C virus (HCV) infection. There have been no previous reports of polyradiculoneuropathy with anti-ganglioside antibodies induced by PEG-IFNα-2b. We report a 59-year-old man who developed polyradiculoneuropathy during treatment with PEG-IFN α-2b for chronic HCV infection. Serum levels of anti-asialo-GM1 (GA1) and anti-GM1 antibodies were elevated. Cessation of therapy with double filtration plasmapheresis resulted in marked improvement in his symptoms accompanied by a reduction in the antibody level. PEG-IFN α-2b may induce peripheral neuropathy mediated by anti-GA1 and anti-GM1 antibodies.

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The number "24/69" in Table 6 (column; IGT with high-Glucose _{(0 or 60)} classified by each item, row; Not classified) should be "34/69".

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