Atherosclerotic cardiovascular diseases, including ischemic heart disease (IHD), remain the leading cause of morbidity and mortality worldwide and are typically induced by the detrimental effects of risk factors on the cardiovascular system. Although some risk factors, such as age and sex, are non-modifiable, the identification and therapeutic interventions against standard modifiable cardiovascular risk factors (SMuRFs), namely hypertension, dyslipidemia, diabetes, smoking, and obesity, contribute to improved cardiovascular outcomes. Beyond SMuRFs, non-traditional, potentially modifiable risk factors for IHD have been identified, such as inflammation, lipoprotein(a), and air pollution. This review article summarizes recent clinical evidence regarding SMuRFs and non-traditional risk factors for IHD and atherosclerotic cardiovascular diseases.

Hyperuricemia is a common comorbidity of chronic kidney disease (CKD) and contributes to kidney dysfunction through mechanisms involving glomerular, tubular, and vascular injuries. Although hyperuricemia has traditionally been classified into overproduction and underexcretion types, recent evidence highlights the importance of intrarenal urate handling, particularly tubular reabsorption, in the pathogenesis of CKD. In this review, we revisit the physiology of renal urate transport and summarize the clinical evidence that links hyperuricemia to CKD progression. We also summarize the current evidence regarding urate-lowering therapies, mainly focusing on novel selective urate reabsorption inhibitors and kidney outcomes. Based on emerging data, we propose a refined classification of hyperuricemia in CKD that stratifies patients into glomerular under-filtration and tubular over-reabsorption subtypes using a novel index that integrates both glomerular filtration and tubular reabsorption. This new classification may better guide individualized treatment strategies for CKD patients with hyperuricemia.

Objective Impaired awareness of hypoglycemia (IAH) contributes to severe hypoglycemia (SH) in adults with type 1 diabetes mellitus (T1DM). This study compared the validity of the Gold, Clarke, and Pedersen-Bjergaard methods for predicting SH in Japanese adults with T1DM.

Methods IAH was assessed at baseline using three methods, and a prospective cohort study was conducted in adults with T1DM. Multivariate Cox proportional hazards regression models adjusted for covariates were used to compare the three methods for predicting SH, and diagnostic validity was calculated.

Patients We enrolled 286 participants (mean age: 50.5±14.6 years, men: 36.7%, diabetes duration: 17.6±11.1 years, mean HbA1c level: 7.7±0.9%).

Results The prevalence of IAH identified using the Gold, Clarke, and Pedersen-Bjergaard methods was 12.2%, 19.2%, and 30.1%, respectively. The Clarke method showed the strongest association with SH [adjusted hazard ratio (aHR), 8.27; 95% confidence interval (CI), 3.43-20.0, p<0.001], whereas the Gold and Pedersen-Bjergaard methods had associations of aHR 1.90 (95% CI: 0.67-5.36, p=0.227) and aHR 2.65 (95% CI: 1.16-6.03; p=0.020), respectively. The Clarke method demonstrated 65.2% sensitivity, 84.8% specificity, a 27.3% positive predictive value, a 96.5% negative predictive value, a positive likelihood ratio of 4.29, a negative likelihood ratio of 0.41, and an overall diagnostic validity of 83.2%.

Conclusion Among the three methods, the Clarke method demonstrated the highest validity for predicting SH development. This information may assist physicians in assessing IAH in clinical practice.

Objective Recent reports have shown that patients with immunoglobulin A nephropathy (IgAN) develop gross hematuria after COVID-19 vaccination. However, the two-year prognosis remains uncertain.

Methods We conducted a retrospective review of 301 patients with IgAN at our institution to identify those who developed gross hematuria after COVID-19 vaccination. We evaluated the patients' baseline characteristics, clinical courses, and changes in the renal function, proteinuria, and hematuria for two years post-vaccination. In addition, we conducted a systematic literature review of 16 case studies, with 28 cases and 5 cohort studies.

Results Gross hematuria was observed in eight patients after vaccination. Their mean age was 42.9 years, and 87.5% were women. All patients relapsed or did not achieve clinical remission prior to vaccination. The median time to gross hematuria onset was 1.6 days, resolving within 3 days. The mean baseline estimated glomerular filtration rate (eGFR) was 69.4 mL/min/1.73 m², the urine protein-to-creatinine ratio (UPCR) was 0.23 g/gCr, and the median baseline hematuria was 10-19 red blood cells (RBCs)/high-power field (HPF). One month after vaccination, the eGFR decreased by 8.6 mL/min/1.73 m² (-12.3%), the UPCR increased by 0.64 g/gCr, and hematuria increased to 50-99 RBCs/HPF. By 6 months, the eGFR and UPCR had recovered, with median hematuria decreasing to 5-9 RBCs/HPF and stabilizing by 24 months.

Conclusion We revealed the extended prognosis of gross hematuria in patients with IgAN following COVID-19 vaccination. With appropriate follow-up, temporary renal deterioration improved within six months and remained stable for two years. These findings support the safety of the COVID-19 vaccination in this vulnerable population.

A 53-year-old woman with an atrioventricular septal defect who had undergone 3 valvuloplasties by 7 years old underwent a kidney biopsy because of lower extremity edema and proteinuria. The glomeruli were intact; however, the proximal tubules showed marked hemosiderin deposition, which was assumed to be related to a fissure in the calcified cardiac patch. The fissure acts as a collateral blood channel from the left ventricle to the left atrium, and the resulting mitral regurgitation and backflow of blood cause turbulent flow phenomena and chronic hemolysis. After hospitalization and dietary guidance on salt reduction, the edema improved, and the proteinuria disappeared.

A 68-year-old woman presented with a history of hemoptysis. She had been receiving hormone therapy and chemotherapy for recurrent breast cancer. She was diagnosed with diffuse alveolar hemorrhage caused by metastatic breast cancer, as evidenced by increasingly bloody bronchoalveolar lavage fluid and malignant cells in multiple lung lobes. This condition was associated with tumor emboli in the pulmonary vasculature and transformation into a hormone receptor-negative state. Serial changes in chest computed tomography findings, from diffuse patchy ground-glass opacities to multiple nodules, are notable. This rare mode of metastasis may be associated with a poor prognosis.

A 78-year-old man presented to our hospital with left-sided pleural effusion. A diagnosis could not be established based on blood or pleural fluid analyses. A re-evaluation of his medical history revealed that he had begun taking hachimijiogan five months prior to presentation. Pleural effusion resolved after discontinuation of hachimijiogan, resulting in a diagnosis of drug-induced pleuritis. Subsequently, an accidental rechallenge was performed to confirm the diagnosis. Drug-induced pleuritis due to Kampo medicines is uncommon, with no prior reports of hachimijiogan being associated with this condition. Obtaining a detailed medication history is essential for diagnosing pleural effusions of unknown etiology.

Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening condition for organ transplantations. There are no established treatments for PTLD, and it is associated with a poor prognosis. Patients with PTLD treated with Pola-R-CHP have rarely been reported, and long-term remission results are unknown. This is the first report of previously untreated PTLD treated with a Pola-R-CHP regimen that achieved long-term remission. Pola-R-CHP may be a promising treatment option for patients with PTLD, especially monomorphic diffuse large B-cell lymphoma, and those with an increased International Prognostic Index score.

Immune checkpoint inhibitors (ICIs) are effective against many types of cancers. However, these drugs can trigger unintended immune attacks on normal tissues, leading to a range of side effects known as immune-related adverse events (irAEs). Involvement of the hematopoietic system in irAEs is rare, and a standard treatment has not yet been established. We herein report a 72-year-old man with non-small-cell lung cancer who developed aplastic anemia (AA) after ICI treatment. Eltrombopag improved the long-term blood count without causing severe infection. This case suggests that eltrombopag may be a viable treatment option for ICI-induced AA.

Pure red cell aplasia (PRCA) is a rare disorder characterized by a significant reduction in red blood cell production. A 65-year-old man with myelodysplastic syndrome and monoclonal gammopathy of undetermined significance developed acquired PRCA (aPRCA) 2 weeks after receiving the BNT162b2 mRNA coronavirus disease 2019 vaccine, with Epstein-Barr virus DNA detected at the onset. The patient did not respond to immunosuppressive therapy and required red blood cell transfusion every one to two weeks. Although the causal relationship between vaccination and aPRCA remains unclear, adequate attention should be paid to post-vaccination aPRCA in patients with hematological disorders.

We herein report a 60-year-old man with transient lupus anticoagulant positivity in the acute phase of cerebral infarction due to left vertebral artery dissection who experienced repeated occlusion of the affected artery despite mechanical thrombectomy and stent placement. The addition of anticoagulants prevented further cerebral infarctions. In this case, it was believed that vascular injury caused by vertebral artery dissection, combined with the presence of antiphospholipid antibodies, accelerated repeated thrombosis. Interestingly, anti-cardiolipin antibodies were detected eight months later, although all antiphospholipid antibodies were negative at the time of the first follow-up.

We herein report an 82-year-old man with post-stroke epilepsy (PSE) who presented with persistent complex visual hallucinations (CVH) involving past episodic scenes. Electroencephalography revealed epileptic discharges in the right posterior temporal and parietal regions. The symptoms resolved with levetiracetam and were maintained with zonisamide. A literature review suggested that CVH may occur when epileptic activity spreads to non-dominant temporal or parietal regions. In conclusion, CVH may reflect visual memory and retention and can be accompanied by psychiatric symptoms. Improved recognition of CVH as a manifestation of PSE may help avoid misdiagnoses and lead to appropriate treatment.

Patisiran is a disease-modifying RNA interference agent for ATTRv amyloidosis caused by transthyretin gene mutations. We herein report a case of hypothyroidism in a 70-year-old man with ATTRv amyloidosis after treatment with patisiran. Although his neurological function score did not deteriorate, non-pitting edema and weight gain appeared approximately 13 months after treatment, and blood tests revealed hypothyroidism. The symptoms and thyroid function improved after treatment with levothyroxine. This is the only case of hypothyroidism among 317 patients reported in a nationwide post-marketing surveillance study of patisiran. In ATTRv amyloidosis, long-term changes in thyroid function should be monitored regardless of the response to patisiran.

Anti-N-methyl-d-aspartate receptor encephalitis is an autoimmune disorder typically associated with normal or intraparenchymal brain magnetic resonance imaging (MRI) findings. We herein report a patient who initially presented with extraparenchymal brain lesions and later developed primary leptomeningeal lymphoma (PLML), an uncommon sequence that may inform clinical vigilance and diagnostic refinement.

A 49-year-old woman presented with a headache and dysarthria. MRI revealed hyperintensity along the right central sulcus and fluid accumulation in the right frontal epidural space. Anti-NMDAR antibodies were detected in the cerebrospinal fluid, confirming the diagnosis of anti-NMDAR encephalitis. She was treated with steroids, intravenous immunoglobulin, plasma exchange, and cyclophosphamide, which resulted in a full recovery. Two years later, she presented with cerebellar symptoms and was diagnosed with PLML via a brain biopsy.

Atypical extraparenchymal brain lesions were present at disease onset. Despite successful initial treatment, the patient later developed PLML, suggesting a potential paraneoplastic relationship or immunological continuum between the two diseases.

his case illustrates the diagnostic challenges posed by atypical neuroimaging findings in anti-NMDAR encephalitis and the need for a longitudinal follow-up. Clinicians should consider neoplastic etiologies when imaging or the clinical course deviates from the norm, even if anti-NMDAR antibodies are positive.

A 48-year-old man presented with impaired consciousness and aphasia. Magnetic resonance imaging (MRI) of the head revealed acute cerebral infarction in the left temporal and parietal lobes. Carotid ultrasonography revealed a mobile structure at the origin of the left internal carotid artery. Cervical MRI using fat-saturation T1 imaging showed an isointense structure at the origin, with a high-signal structure extending toward the head. Digital subtraction angiography revealed contrast stagnation, suggesting the presence of a carotid web (CaW). The mobile structure was released, indicating thrombus resolution. Carotid artery stenting eliminated contrast stagnation and was well-tolerated. This case highlights the diagnostic challenges associated with a CaW-related stroke.

Opsoclonus-myoclonus syndrome (OMS) is a rare paraneoplastic neurological disorder that is usually associated with breast cancer or small-cell lung carcinoma. We report the case of a 71-year-old woman with anti-Ri antibody-positive OMS, in whom no malignancy was initially identified. Thirty months later, carcinoma of an unknown primary tumor with supraclavicular and liver metastases was diagnosed. Neurological symptoms remained stable with immunosuppressive therapy, but the overall outcome was poor owing to progressive malignancy. This case underscores the fact that neurological stability does not necessarily equate to a favorable prognosis, and highlights the need for long-term surveillance in cases involving paraneoplastic syndromes.

Anti-synthetase syndrome is an autoimmune disorder associated with anti-aminoacyl-tRNA synthetase antibodies, including anti-Jo-1. However, antibody positivity alone is insufficient for the diagnosis because overlapping features with other diseases may lead to a misdiagnosis. We herein report a 69-year-old woman initially suspected of having anti-synthetase syndrome due to anti-Jo-1 antibody positivity and muscle weakness. Additional findings, including mononeuritis multiplex, purpura, crescentic glomerulonephritis, and strongly positive myeloperoxidase-antineutrophil cytoplasmic antibodies, led to a diagnosis of microscopic polyangiitis. Although anti-Jo-1 antibodies are highly specific, false-positive results can occur. This case highlights the need for a comprehensive evaluation beyond antibody testing to avoid diagnostic errors.

We herein report a patient with immunoglobulin (Ig) G4-related hypertrophic pachymeningitis (HP) with myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) positivity without renal dysfunction at the time of the diagnosis who subsequently developed nephritis after an unplanned interruption of maintenance glucocorticoid therapy. A renal biopsy specimen obtained at the time of the development of renal dysfunction revealed the possibility of both ANCA-associated nephritis and IgG4-related tubulointerstitial nephritis, with no HP relapse. The present case highlights the need to monitor other organ complications, including renal damage, in patients with IgG4-related HP with MPO-ANCA positivity, even after achieving remission.

We herein report a case of disseminated strongyloidiasis in a 64-year-old man with human T-lymphotropic virus type 1 infection who developed the condition after undergoing chemoradiotherapy for lung cancer. Treatment included daily ivermectin, which eradicated Strongyloides stercoralis after 7 days but was interrupted after 14 days due to the development of skin rashes. After excluding ivermectin as the cause of the drug eruption, intermittent ivermectin was continued monthly for six months, with no recurrence of strongyloidiasis or bacteremia. This case highlights the importance of obtaining a comprehensive patient history and making an early diagnosis to improve the outcomes of disseminated strongyloidiasis.