[abstract in Japanese]
Pulmonary evaluation ; System ; Annual ; Human Development ; Health

The incredible speed at which research into the human genome has recently progressed has led to the widespread use of genomic data in clinical settings. The day will soon come when clinical practice that fails to utilize patients' genomic data will be considered outdated and will pose a high risk of legal action. In this lecture, I discuss several topics: 1.the progress of human genomic research, 2. Homo sapiens as just one of the many species on Earth; 3. the clinical applications of genomic research findings, with Kawasaki disease as an example;and 4.the current state of genomic research and its future prospects. 　　Medical researchers and doctors have long dreamed of a day when health care services based on each individual's genomic data will be a reality;this is usually referred to as “madeto-order medicine,” “tailor-made medicine,” “personalized medicine,” and most recently, “precision medicine.” Thanks to the recent rapid development of genomic analysis,such as next-generation sequencing,as well as that of statistical analysis methods, it has been said that individual genomic data were available at a cost as low as$1,000 in 2014. 　　Our planet is 4.6 billion years old, and life began 3.8 billion years ago. Since then,the Earth has witnessed the evolution of prokaryotic and eukaryotic unicellular organisms, followed by multicellular organisms, photosynthetic plants, the Cambrian explosion of marine life, and the emergence of land-dwelling creatures. Our mammalian ancestors appeared during the age of the dinosaurs, which suffered a mass extinction due to a dramatic change in climate caused by an asteroid impact. The small dinosaurs that survived evolved into today's birds while the mammals of that era evolved to successfully occupy a diverse array of ecological niches. The human family appeared about 2.5 million years ago in Africa. Archaic humans, such as Homo neanderthalensis, lived among our Homo sapiens ancestors, who appeared about 200,000 years ago. Now we know that 21%of the human genome has genes in common with prokaryotes and other eukaryotes. The difference between our genome and that of the gorilla and the chimpanzee is only 2% and 1%, respectively. Among Homo sapiens, the difference between any two individuals is only 0.2%, which manifests as differences in skin color, disease susceptibility, and other traits. 　　Kawasaki disease was identified by Dr.Tomisaku Kawasaki, who reported his findings in 1967. Since then, vigorous efforts have been made to identify the cause of the disease, but so far, nothing specific has been found. We therefore took a genome-based approach and identified several genes responsible for the development of Kawasaki disease. Because some of the identified genes are thought to participate in the Ca2+-NFAT signal transduction pathway, we hypothesized that cyclosporine A, which is known as a suppressor of this pathway, might be useful in the treatment of the disease. We performed an investigator-initiated clinical trial and confirmed our hypothesis. This was one of the first clinical applications based on human genome research. 　　Now, there are several large-scale genome-based projects, such as the UK Biobank, that are open to any researcher who would like to make use of their resources. They also contain clinical information and patient data, such as socioeconomic status, and educational background. With these kinds of resources at our disposal, we can expect great accomplishments in the not-too-distant future.

Seven years ago, we began the “Toride Project” which aimed at organized care, mainly on based a low-protein diet (LPD), for chronic renal failure patients. This project cumulatively involved 486 patients, and 219 of them have been followed up at our hospital.
In this paper, we report the 12 patients who had before shown progressive deterioration of renal function and turned out stable (less than 5% change) in creatinine clearance (Ccr) for 12-54 months after involved in the project. Their diseases were chronic glomerulonephritis (CGN; 10 cases) and nephrosclerosis (NSC; 2 cases), and the mean Ccr was 20.9±1.3 (SE) ml/min (16-32 ml/min). All of them carried out the well maintained LPD (0.62±0.02 g/kg/day), and showed relatively low urinary protein excretion (UPE; 0.4±0.2g/day). In contrast, 10 other cases (CGN; 9, NSC; 1) showed persistent deterioratiom of renal function even if they continued the LPD (0.60±0.02 g/kg/day). They significantly showed higher UPE (1.6±0.3 g/day, p<0.05) than the 12 cases mentioned above. Moreover, frequent examination revealed that the day-to-day change in their protein intake was more widely distributed (coefficient of variation; 19.5±1.3% vs 10.8±0.6%, p<0.05).

Objective: To identify the clinical and epidemiological characteristics of pernicious anemia (PA) in patients treated at Miyagami hospital on Tokunoshima Island.

Methods: We evaluated 14 patients with PA who were enrolled and treated from March 2009 to May 2014.

Results: The majority of patients were older than 50 years of age and primarily consisted of elderly women. Routine medical examinations revealed macrocytic anemia in 6 of the 14 patients (43%), although they were clinically asymptomatic and subsequently diagnosed with PA. The average number of patients per year was reported to be 3 (95% confidence interval [CI]: 1.25-3.42).

Conclusions: The annual incidence of PA per 100,000 individuals on Tokunoshima Island is possibly much higher than that previously reported in Japan. An increase in the elderly population, a negligence of the disease, and an ethnic and regional diversity may explain this discrepancy. As the annual incidence of PA may be higher than that previously reported, anemia must be carefully evaluated in the differential diagnosis of PA.

Infectious abdominal aortic aneurysm is a relatively rare disease, and there is no consensus regarding its surgical treatment. Medical infectious control should be concerned comparison with surgical treatment if there is sepsis, however we sometimes have no other choice but emergency operation for uncontrollable cases. In many reports, cryopreserved homografts were used as in-situ alternative grafts for infectious aortic aneurysms because they had some merits such as anti-infectious effects, suitability and so on. However the number of in-situ cryopreserved homograft replacement cases are few, and the long term result is unclear. We encountered a ruptured cropreserved homograft case 7 months after urgent in-situ cryopreserved homograft replacement. We report the case and refer to the relevans literature.

Objective: Early life events connected with the risk of later disease can occur not only in utero, but also in infancy. In study of the developmental origins of health and disease, the relationship between infantile growth patterns and adolescent body mass index and blood pressure is one of the most important issues to verify.
Materials and Methods: We analyzed the correlation of current body mass index and systolic blood pressure of 168 female college students with their growth patterns in utero and in infancy.
Results: Body mass index and systolic blood pressure in adolescence showed positive correlations with changes in weight-for-age z scores between 1 and 18 months but not with those between 18 and 36 months. Stepwise multiple regression analysis showed that both change in weight-for-age z scores from 1 to 18 months and body mass index at 1 month were significantly and independently associated with systolic blood pressure in adolescence. Body mass index at 36 months was positively correlated with body mass index in adolescence, while body mass index at birth was negatively correlated with body mass index in adolescence.
Conclusion: Our findings shows that restricted growth in utero and accelerated weight gain in early infancy are associated with the cardiovascular risk factors of high systolic blood pressure and high body mass index in adolescence. In Japan, an increasing proportion of low birth weight infants and accelerated catch-up growth after birth have been observed in recent decades. This might be an alarming harbinger of an increase in diseases related to the developmental origins of health and disease in Japan.

　　As part of the special study project of the Japanese Association of Rural Medicine (JARM), a questionnaire survey was conducted to probe into the attitude of rural people toward their eating habits and health. Most of the people surveyed had received health checkups carried out by medical facilities affiliated with the JARM.　　Questionnaires were distributed to a total of 5,397 people (2,588 men; 2,809 women) living in and around provincial cities. Mean age was 53.4 for men and 53.8 for women. More than half of those questioned were farmers or had experienced in farming. The people aged 80 and older accounted for 3.2% of the total.　　Eighty percent of the total said they felt happy, and those who felt short of exercise also represented 80%, but with advancing age, the ratio decreased. Those over the age of 70 who said they had a habit of taking exercise made up as high as 60%.　　Many said they were satisfied with food in terms of quantity, but not a few people expressed uneasiness about food safety, dietary life and supply of food. Regarding favorite foodstuffs, many gave rice, vegetables and dairy products. There was a tendency for older people to eat meat less. It was found that, with increasing age, people took to eat dairy products, soybeans, vegetables, fruits and fish were ranked among the most popular foodstuffs.　　A study of factors related to local production for local consumption and commitment to agriculture found that a significantly large number of people were interested in social participation, eating breakfast, securing food supply and purchasing foodstuffs at outlet stores run by local agricultural cooperatives.　　From these findings, it was suggested that many residents in and around provincial cities oriented themselves to healthy eating habits and lifestyle, and were very interested in social participation, local economy, agricultural production and consumption of local farm produce.

The Japanese adult cardiovascular database (JACVSD) contains details of all adult cardiovascular surgeries performed in Japan. This database has the potential to make data from all of Japan available to the world in the future. However, it is time consuming to enter several items from an individual terminal for all cases ; adding further pressure to already busy routine work. In our facilities, an original system using Filemaker Pro has been developed and used since 2004. This system has various functions integrated into it, and currently, the input system of JACVSD has been added. As a result, it becomes possible to automatically enter more than half the data of JACVSD, and excellent results can be reported. Intellectual property rights have been owed by Nihon University since 2007.