Masked obesity is the presence of obesity based on percent body fat (%BF) when the body mass index (BMI) shows an absence of obesity. To examine the relationship between masked obesity and arteriosclerosis risk factors, we compared both serum lipid levels and the prevalence of hyperlipidemia in male and female high school freshmen with and without masked obesity. Subjects consisted of 403 male and 326 female high school students aged 15∼16 years. Of these, 34(8.4%) males and 36(11.0%) females had masked obesity, defined as 17≤BMI<23.60 and %BF≥25% in males, and 17≤BMI<24.17 and %BF≥30% in females, while the remaining 300 males and 246 females were not obese, having 17≤BMI<23.60 and %BF<25% and 17≤BMI<24.17 and %BF<30%, respectively. For both sexes, serum total-cholesterol (TC), low-density lipoprotein cholesterol (LDLC), triglycerides and the arteriosclerotic index (AI) were significantly higher (p<0.05∼0.01) in those with masked obesity. And many of the subjects with masked obesity had abnormal levels of TC, LDLC and AI, compared with those who were not obese (p<0.05∼0.01). Additionally, we compared both serum lipid levels and the prevalence of hyperlipidemia between subjects with masked obesity and control groups with the same BMI values. As a result, subjects with masked obesity had high serum lipid levels and a prevalence of hyperlipidemia. These results support the existence of masked obesity and suggest that masked obesity is associated with increased serum lipid levels, and thus could be a risk factor for arteriosclerosis in male and female high school freshmen.

Infected aortic aneurysm is very difficult to treat and is associated with a high mortality rate. A 78-year-old man had been scheduled to undergo selective endovascular repair for distal aortic arch aneurysm. While standby, however, he was admitted to our emergency room because of hemoptysis. Rapid dilatation of the aneurysm shown on serial CT and elevated of inflammatory reactions yielded a diagnosis of infected aortic aneurysm. Because the aneurysm had ruptured into the left lung, emergency surgery was performed. Six days after the first operation, critical bleeding due to anastomotic disruption of the distal aorta caused by infection and subsequent cardiac arrest occurred. We immediately started open chest massage and controlled the bleeding manually in the ICU, while an operating room was prepared. In the redo operation, anastomotic disruption was repaired using the visceral pleura under deep hypothermic circulatory arrest. Anastomotic bleeding is a potentially life-threatening condition, therefore extremely prompt measures are vital. Appropriate management based on the assumption of anastomotic bleeding was very important in the postoperative course of this case of infectious aortic aneurysm.

BACKGROUNDIn an earlier study, we identified a locus for Moyamoya disease (MMD) on 17q25.3.

METHODSLinkage analysis and fine mapping were conducted for two new families in additional to the previously studied 15 families. Three genes, CARD14, Raptor, and AATK, were selected based on key words, namely, "inflammation", "apoptosis", "proliferation", and "vascular system", for further sequencing. A segregation analysis of 34 pedigrees was performed, followed by a case-control study in Japanese (90 cases vs. 384 controls), Korean (41 cases vs. 223 controls), Chinese (23 cases and 100 controls), and Caucasian (25 cases and 164 controls) populations.

RESULTSLinkage analysis increased the LOD score from 8.07 to 9.67 on 17q25.3. Fine mapping narrowed the linkage signal to a 2.1-Mb region. Sequencing revealed that only one newly identified polymorphism, ss161110142, which was located at position -1480 from the transcription site of the Raptor gene, was common to all four unrelated sequenced familial affected individuals. ss161110142 was then shown to segregate in the 34 pedigrees studied, resulting in a two-point LOD score of 14.2 (P = 3.89 × 10(-8)). Its penetrance was estimated to be 74.0%. Among the Asian populations tested (Japanese, Korean, and Chinese), the rare allele was much more frequent in cases (26, 33, and 4%, respectively) than in controls (1, 1, and 0%, respectively) and was associated with an increased odds ratio of 52.2 (95% confidence interval 27.2-100.2) (P = 2.5 × 10(-49)). This allele was, however, not detected in the Caucasian samples. Its population attributable risk was estimated to be 49% in the Japanese population, 66% in the Korean population, and 9% in the Chinese population.

CONCLUSIONss161110142 may confer susceptibility to MMD among East Asian populations.

ELECTRONIC SUPPLEMENTARY MATERIALThe online version of this article (doi:10.1007/s12199-009-0116-7) contains supplementary material, which is available to authorized users.