Bronchial asthma and chronic obstructive pulmonary disease (COPD) are obstructive pulmonary diseases with airway inflammation. Both diseases have similar pathologies such as airflow limitation, inflammation and airway hyperresponsiveness. These findings provide molecular levels molecular support for both points of view in the British/Dutch hypothesis controversy regarding the relationship between bronchial asthma and COPD. Both diseases are often complicated, and a new concept such as Asthma COPD Overlap Syndrome (ACOS) is proposed.

Today, ultrasound devices (US) for medical and healthcare uses are undergoing a revolutionary transition from conventional cart-based US to pocket-sized hand-held US (phUS) in terms of size, performance, cost, and portability. Each type has its best area of application. For example, while cart-based US is essential for elaborate and precise diagnoses in laboratories, phUS is ideal for quick point-of-care applications and data-sharing via a network inside and outside medical institutions because it is handy, portable, and networking. The remarkable progress in electronics technologies has indeed made these devices ever smaller, smarter, and more affordable, leading to their growing proliferation in Japan. As we believe this irreversible trend will quickly spread into other parts of the world, we feel a pressing need to establish an education system, rules, and guidelines for governing US (especially phUS), first domestically and then globally.

Objective: To analyze the effects of respiratory rehabilitation on the activities of daily living (ADL) and quality of life (QOL) in community-dwelling frail elderly.

Design: Pilot intervention study after a one-year period of observation.

Setting: Day care facility in a rehabilitation hospital.

Subjects: Thirty community-dwelling frail elderly using rehabilitation services

Intervention: After a one-year observation period of usual rehabilitation, 30 participants were given 12 rehabilitation sessions that included respiratory rehabilitation (three sessions a week for four weeks).

Main Measures: The measurement was performed approximately one year before the 12 rehabilitation sessions (initial evaluation), prior to training (pre-training evaluation), and after the sessions (post-training evaluation). Primary outcome measures included: respiratory function, swallowing function, ADL, and QOL. Secondary outcome measures included: depressive score, exercise tolerance, 6-minute walk distance, thorax flexibility, and muscle strength (knee extension, grip, and abdominal). QOL were estimated using questionnaires.

Results: Swallowing function, ADL, QOL (SF8 physical and mental summary score), respiratory function, and physical function were significantly reduced during usual rehabilitation (between the initial evaluation and pre-training evaluation), whereas swallowing function, ADL, QOL (SF8 physical component summary score [PCS]), respiratory function, exercise tolerance, 6-minute walk distance, thorax flexibility, and muscle strength (knee extension) were significantly improved during respiratory rehabilitation (between the pre-training evaluation and post-training evaluation).

Conclusions: Our results suggest that a usual rehabilitation program without respiratory training is not sufficient for the frail elderly to maintain their ADL and QOL, and furthermore that respiratory rehabilitation can help improve their ADL and QOL as well as their swallowing and respiratory function.

Background: The skills of individuals to find and apply adequate information needed to make health decisions have been conceptualized as health literacy (HL). However, limited studies have examined the association between HL and healthy lifestyle characteristics among patients with lifestyle related disorders.

Methods: This cross-sectional study examined associations between HL and healthy lifestyle characteristics among Japanese outpatients with lifestyle related disorders. Participants were 207 men and 254 women who visited Tokorozawa Medical Clinic in Tokorozawa City, Japan, from April to May 2015. Information on five items for functional HL, five items for communicative HL, and four items for critical HL, and healthy lifestyle characteristics was collected by self-administered questionnaires.

Results: Mean age was 68.1 years among men, and 70.3 years among women. In multivariate logistic analysis, a higher HL was significantly associated with having 6–7 healthy lifestyle characteristics among men [Odds ratio (OR) = 2.19, 95% Confidence interval (CI) = 1.09–4.41]. Moreover, functional, communicative, and critical HLs were significantly associated with having 6–7 healthy lifestyle characteristics among men [(OR = 2.34, 95% CI = 1.09–5.02), (OR = 2.37, 95% CI = 1.15–4.88), (OR = 2.78, 95% CI = 1.36–5.70)]. No association was observed between total HL score and healthy lifestyle characteristics among women.

Conclusion: Our study revealed a positive association between HL and healthy lifestyle characteristics among male outpatients with lifestyle related disorders, suggesting that men, but not women, are likely to engage in health-promoting behaviors based on several aspects of HL. Further studies will be needed to confirm this gender discrepancy.

Hereditary spherocytosis is a familial hemolytic anemia. In this report, we describe a rare case of hereditary spherocytosis complicated by IgA nephropathy which was successfully treated with an angiotensin converting enzyme inhibitor. This is the first time that such a case in an adult has been documented. We describe a 72-year-old Japanese male who presented with hereditary spherocytosis, accompanied by Immunoglobulin A nephropathy. The patient had renal dysfunction, proteinuria, and hematuria. The patient was treated with an angiotensin converting enzyme inhibitor, resulting in clinical improvement. Clinicians should recognize that hereditary spherocytosis with IgA nephropathy can occur in the post-splenectomy patients.

It is important to discriminate between deep vein thrombosis (DVT) and conditions that mimic it. Here we report on three patients, who had unilateral leg swelling mimicking DVT. The following diagnoses were found: cellulitis and metastatic abscesses by Staphylococcus aureus bacteremia, inter-muscular hematoma through femoral muscle injury, venous insufficiency caused by ureteral cancer. The cases of these various disease states serve to remind us that physicians should pay careful attention to unilateral leg swelling, when DVT has been excluded.

A 74-year-old man was admitted to our hospital due to low-grade fever and severe epigastric pain. Abdominal computed tomography revealed a linear structure surrounded by a small amount of air that had pierced the angular region of the gastric wall. Esophagogastroduodenoscopy showed that the structure was a fish bone. Gastric perforation due to fish bone ingestion is rare and almost all of the cases need surgical procedures. In this case, we endoscopically removed the foreign body with forceps and clipped the hole. Antimicrobial therapy was performed for one week, and the symptoms were completely improved.

Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) on the splenium of the corpus callosum (SCC) present with relatively mild central nervous system disturbances. A 41-year-old man was admitted with fever and headache and, his main symptoms were mild headache and fatigue. There were no neurological focal signs. Brain magnetic resonance imaging (MRI) showed abnormal signals in SCC. We report, for the first time, a MERS patient, detected on MRI, who did not present with central nervous system disturbances. Our experience suggests MERS should be considered as a differential diagnosis in patients with fever of unknown origin.

“Red eye” is the most common ocular manifestation seen by primary care physicians. Most cases are connected with benign diseases, yet some may require emergent ophthalmologic intervention or herald a life-threatening systemic disorder. Scleritis usually manifests as severe and painful red eye and is frequently associated with systemic vasculitis. Herein, we report the case of an 81-year-old man with microscopic polyarteritis presenting with rapidly progressive glomerulonephritis, diffuse alveolar hemorrhage, and bilateral painless scleritis. Our experience may remind clinicians of the importance of “red eye” as a clue in the early diagnosis of systemic vasculitis, even in the absence of pain.

A 62-year-old man was referred to our hospital due to acute-onset severe left lumbar pain. Computed tomography of the abdomen revealed a nonenhancing area in the left kidney with renal artery occlusion. Hyperhomocysteinemia, which is known as a risk factor of cardiovascular and thrombotic diseases, was also diagnosed. We performed percutaneous transluminal renal intervention using an aspiration catheter, and started the replacement therapy for folic acid and vitamin B deficiencies in addition to anticoagulant therapy. With improvement of blood perfusion in the left kidney, the patient was discharged after 15 days. In this patient with renal infarction, hyperhomocysteinemia may have been responsible.

Background: It is important to assess cause of death in patients with acute coronary syndrome (ACS) to improve the accuracy of prognosis.

Methods: We investigated the cause of death in 221 patients with a first diagnosis of ACS.

Results: In the short-term outcome, the major cause of death was cardiovascular disease (35/50, 70.0%). In the long-term outcome, non-cardiovascular death was the major cause of death (97/171, 56.7%). The major preventable causes of death were pneumonia (13/171, 7.6%) and heart failure (19/171, 11.1%).

Conclusions: The major preventable causes of death in patients with ACS are pneumonia and heart failure in the long-term outcome.