Objectives Glaucomas that do not exhibit any symptoms, such as primary open-angle glaucoma (POAG), are one target of a general medical check (MC). Normal intraocular pressure (IOP) is seen in 92% with POAG. Since glaucoma leads to the visual field loss, we added a visual field test to the examinations performed during a MCs starting in 2001. The purpose of the current study was to investigate potential benefits of visual field tests over standard non-contact IOP measurements commonly used in MCs to detect glaucoma. Methods and Subjects Between April 2010 and March 2011, we screened 6,453 individuals who underwent annual MCs. Results 34 subjects (0.5%) found to have an IOP of 22 mmHg and higher. Among them, 7 subjects (0.1%) had already been previously found to have glaucoma, while another 2 subjects (0.03%) were newly diagnosed with glaucoma. Among the 683 subjects (10.6%) that exhibited visual field test abnormalities, 309 (4.8%) had already been diagnosed with glaucoma. The remaining 374 subjects (5.8%) without any glaucoma diagnosis were followed until March 2012. During the follow-up, 66 subjects (1.0% of the total MC subjects) were newly diagnosed with glaucoma, while 63 subjects (1.0%) had other eye diseases. 48 subjects (27% of the subjects who visited an ophthalmologist) exhibited no abnormalities during follow-up, there is no information from197 subjects who did not visiting an ophthalmologist or undergo any further comprehensive examination. Conclusions This study showed there was a significantly higher percentage of newly diagnosed glaucoma cases when using the visual field test method (1.0%) compared to the non-contact IOP test (0.03%). Our results demonstrate the importance of adding a visual field test to the standard eye examinations used in MCs.
Objective To investigate the relationship between visceral fat area (VFA) with the anthropometric and biochemical clinical parameters of lifestyle-related diseases, adipocytokines, inflammation and atherosclerosis in Japanese men and women. Subjects and methods The correlation between VFA and the following parameters was evaluated in 94 healthy volunteers (48 men and 46 women): body weight, BMI, waist circumference, body composition, blood pressure, glucose homeostasis, insulin resistance, lipids, uric acid, liver enzymes, leptin, adiponectin, high sensitivity C-reactive protein (hsCRP) and the degree of atherosclerosis (mean intima-media thickness by carotid ultrasonography). Results The mean age was 40.1 ± 9.6 years (42.0 ± 10.2 for men and 38.1 ± 8.6 for women) and the mean VFA was 47.4 ± 40.9 cm2 (70.5 ± 41.4 for men and 23.3 ± 22.3 for women). VFA was positively correlated with blood pressure, fasting glucose, HbA1c, insulin resistance, LDL-C, triglycerides, ALT, γGT and uric acid. A negative correlation was observed in HDL-C and adiponectin. Furthermore, hsCRP and carotid intima-media thickness showed a positive association with VFA. Conclusion The present study shows that those with subclinical visceral fat accumulation have potential atherosclerotic risk even though they show no apparent clinical abnormalities.
Background We have previously reported that early exposure to tobacco smoke significantly increases the prevalence of chronic obstructive pulmonary disease (COPD). As a follow-up, we hypothesized that COPD arising from early exposure to tobacco smoke may increase intima media thickness (IMT), which correlates with an increased prevalence of smoke-related vascular comorbidities such as cardiovascular and cerebrovascular diseases. Methods This prospective, observational study of a consecutive cohort of COPD patients was carried out between 2009 and 2013. Potential subjects were identified from the Erimo town clinic and were divided into three groups: Group (1) had a history of COPD and early exposure to tobacco smoke; Group (2) had a history of COPD and non-early exposure to tobacco smoke; and Group (3) included subjects without COPD. The IMT of members of all 3 groups was measured by ultrasonography using the longitudinal axis of the common carotid arteries. Early smoke exposure was defined as habitual smoking starting before age 20. Results A total of 152 subjects (mean age 72 ± 10 years) were enrolled in the study after providing their informed consent. Groups 1, 2, and 3 consisted of 41 subjects (mean age 68 ± 9), 80 subjects (mean age 71 ± 11), and 31 subjects (mean age 69 ± 10), respectively. The maximum IMT value in Groups 1, 2, and 3 was 1.62 ± 0.35 mm, 1.46 ± 0.43 mm, and 1.32 ± 0.26 mm, respectively. Groups with a history of COPD tended to have higher maximum IMT values that the group without COPD. Furthermore, Group 1 had the highest IMT value. Conclusion In subjects with COPD, early smoke exposure promoted atherosclerotic changes, which may have increased the likelihood of smoke-related vascular comorbidities such as cardiovascular and cerebrovascular diseases. Further studies are needed to elucidate the precise magnitude of the increased risk of these comorbidities associated with COPD and early smoke exposure.
Background Cardiovascular events are important comorbidities and complications of chronic obstructive pulmonary disease (COPD). We analyzed data on the maximum intima media thickness (max-IMT), the ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA), and the Ankle Brachial Pressure Index (ABI) to determine whether there are any correlations among these parameters. Methods A total of 149 subjects (84 men, 65 women) were enrolled in the study between May, 2007 and January, 2014 at the Erimo town clinic in Hokkaido after providing their informed consent. Potential subjects were divided into two groups: Group 1 (G1) had a history of COPD and moderate to severe exposure to tobacco smoke, and a Brinkman Index>400; Group 2 (G2) had a history of other diseases without COPD, such as diabetes, hypertension, and hyperlipidemia. Results G1 included 73 subjects (47 men, 26 women) and G2 included 76 subjects (37 men, 39 women). The max-IMT was1.49±0.83 mm for G1 and 1.36±0.68 mm for G2, the ABI values were 0.81±0.48 and 0.91±0.21, and the EPA/AA values 0.41±0.13 and 0.47±0.16, respectively. The Max-IMT of G1 was thus significantly larger than that of G2, and the ABI of G1 was significantly lower than that of G2. There was no significant difference in EPA/AA between G1 and G2. Conclusion In COPD patients with moderate to severe exposure to smoke, a significant increase in max-IMT and decrease in ABI were observed. The results of the present study suggest that COPD patients are at increased risk of smoke-related cardiovascular diseases such as acute myocardial infarction and stroke. However, the EPA/AA ratio might not be a good biomarker for assessing cardiovascular risks in COPD.
There are two major guidelines in the field of diabetes created under the supervision of the Japan Diabetes Society: “Treatment Guide for Diabetes” and “Evidence-based Practice Guideline for the Treatment of Diabetes in Japan”. Both are commonly used in various clinical settings related to diabetes in the country. Since the revision of diagnostic criteria of diabetes in 2010 and the global standardization of HbA1c in 2012, the aggressive use of glycated hemoglobin (HbA1c) is recommended in the diagnostic screening of diabetes in Japan, because much clinical and epidemiological data showed that the early identification and treatment of diabetes is beneficial in preventing diabetic complications and mortality. In particular, the guideline recommends the simultaneous measurement of glucose as well as HbA1c, to avoid delays or misclassifying people. Moreover, a patient-centered approach is strongly recommended. The guidelines do not include a specific regime of medications, but recommend the individualized selection of medicine based on pathophysiology and living conditions such as age, hypoglycemia, and comorbidity. Based on these considerations, three levels of HbA1c (<6, 7, and 8%) are adopted and HbA1c <7% is now widely known as a new treatment target with respect to diabetic complications. As introduced, the treatment guidelines have been updated repeatedly according to the progress of diagnosis and treatment of diabetes. However, the objectives of treatment for diabetes are consistent, which are to maintain a quality of life similar to that of healthy people, and to ensure a normal life expectancy in people living with diabetes.
Viral hepatic disorders and viral hepatitis refer to hepatic disorders caused by hepatitis virus such as HAV, HBV, HCV, HDV, or HEV. In general, HBs antigen and HCV antibody are using as screening items in health check-ups and medical tests. These two viruses are transmitted from person to person and, in most cases, they follow an asymptomatic course from carrier to chronic hepatitis and cirrhosis, ultimately resulting in liver cancer. Recently, there are numerous guidelines to standardize diagnoses and therapeutic strategies with regard to various diseases, to ensure consistency from one physician to another. While many of these guidelines are revised every several years, those pertaining to HBV and HCV infections are revised every year due to the development of so many new diagnostic and therapeutic methods for liver diseases that only a specialist could possibly keep up. The present article provides a general overview of viral hepatic disorders, and then focused on the latest diagnostic and therapeutic methods for hepatitis B and C, as well as the government-funded subsidy system currently in use in Japan.
Background Although statin-related myopathy is a common adverse event, diagnostic criteria and standard treatments have not yet been established. Furthermore, statin-related myopathy is a major concern because of intolerance and discontinuation of statin agents. Objective To elucidate the clinical characteristics of statin-related myopathy, we retrospectively studied 20 patients with hyperlipidemia who had been receiving statin agents. Results Five of 20 patients developed creatine kinase (CK) elevation, and 2 of these 5 patients developed statin-related myopathy. Statistical analysis of the differences between the CK-high and CK-normal groups revealed that a relatively younger age and hepatic dysfunction were risk factors for statin-related myopathy. Among the 20 patients administered statin agents, patients taking atorvastatin (cytochrome P450 inhibitor) had a high tendency for CK elevation (3/7 patients). The 2 patients with statin-related myopathy were discontinued atorvastatin for four weeks. Statin-related myopathy had gradually resolved. Subsequently, we administered pitavstatin (non-cytochrome P450 inhibitor) for 2 cases. This treatment led to the inhibition and resolution of statin-related myopathy. In the 3 patients with CK elevation without myopathy, we did not change the statin agent. However, these patients did not develop statin-related myopathy. Conclusion We present the detailed clinical characteristics of 5 patients with CK elevation and address our experiences with the control of side effect. This case-oriented study should be helpful to the physicians who directly care for statin-related myopathy patients, and may provide a future direction for performing a more efficient control.