A 43-year-old woman was admitted to our hospital due to type 2 diabetes, dyslipidemia, and hypertension. Her triglyceride levels remained around 300-500 mg/dl with oral administration of pemafibrate and omega-3-acid ethyl esters granular capsules. Her diabetes and dyslipidemia had worsened since winter 2023, and at the time of her regular visit in February 2024, her triglyceride level had worsened to 4926 mg/dl. She developed epigastric pain at noon on the day after her regular outpatient visit. Although she was treated with over-the-counter medication for 1 day, there was no improvement and she was referred to our hospital. A computed tomography scan revealed swelling of the pancreatic head and fluid collection up to the right side of the perirectal space, and she was diagnosed with severe acute pancreatitis. Her triglyceride level decreased and her clinical symptoms improved with large-dose fluid replacement, meropenem injection, ulinastatin infusion, and continuous intravenous insulin and heparin infusion. In this case, acute pancreatitis was thought to be induced by worsening diabetic control, which was associated with an increase in triglycerides. Continuous intravenous injection of insulin and heparin was useful for treatment.

Objective: Blood ketone monitoring is commonly used in the management of diabetic ketoacidosis (DKA). However, bedside ketone meters have limited availability in hospitals. This study aimed to clarify the correlation between blood ketones and blood gas analysis (BGA) in the treatment of DKA and thereby identify parameters that can be used as surrogates for blood ketones.Patients and Methods: This retrospective observational study included patients with DKA admitted to the JA Toride General Medical Center between November 2021 and March 2024. Multiple regression analysis was performed using blood ketone levels as the objective variable and BGA indices as explanatory variables. Additionally, the study evaluated 1) the time course of ketone levels and BGA indices during the DKA treatment and 2) the correlation between ketone levels and the BGA indices.Results: Sixteen patients were enrolled. Multiple regression analysis showed that the corrected anion gap (cAG), defined as the anion gap minus lactate concentration, was a significant predictor of blood ketones. Among pH, HCO3−, and cAG, only cAG had significant regression coefficients (−0.061 [95% confidence interval (CI): −3.49 to 1.98], −0.233 [−0.156 to 0.0118], 0.636 [0.129 to 0.246], respectively; coefficient of determination: 0.765). The correlation coefficient between cAG and blood ketone levels was high (0.9694).Conclusion: cAG levels strongly correlate with blood ketone concentrations and may serve as a surrogate marker for blood ketones in the management of DKA. Because measurements of the anion gap and lactate concentrations are inexpensive and widely available in most medical facilities, cAG is a promising indicator for DKA management.

Risk factors for hypertension consist of lifestyle and genetic factors. Family history and twin studies have yielded heritability estimates of BP in the range of 34-67%. The most recent paper of BP GWAS has explained about 20% of the population variation of BP. An overestimation of heritability may have occurred in twin studies due to violations of shared environment assumptions, poor phenotyping practices in control cohorts, failure to account for epistasis, gene-gene and gene-environment interactions, and other non-genetic sources of phenotype modulation that are suspected to lead to underestimations of heritability in GWAS. The recommendations of hypertension guidelines in major countries consist of the following elements: weight reduction, a healthy diet, dietary sodium reduction, increasing physical activity, quitting smoking, and moderate alcohol consumption. The hypertension guidelines are mostly the same for each country or region, beyond race and culture. In this review, we summarize gene-environmental interactions associated with hypertension by describing lifestyle modifications according to the hypertension guidelines. In the era of precision medicine, clinicians who are responsible for hypertension management should consider the gene-environment interactions along with the appropriate lifestyle components toward the prevention and treatment of hypertension. We briefly reviewed the interaction of genetic and environmental factors along the constituent elements of hypertension guidelines, but a sufficient amount of evidence has not yet accumulated, and the results of genetic factors often differed in each study.
Gene-Environment Interaction ; Humans ; Hypertension ; epidemiology ; genetics ; prevention & control ; therapy ; Life Style ; Practice Guidelines as Topic ; Precision Medicine ; standards ; Risk Factors

Metabolic syndrome is a long-term complication of systemic chemotherapy for testicular germ cell tumor (TGCT). It is believed to be caused by secondary hypogonadism or toxic medicines because of orchidectomy followed by systemic chemotherapy. In this study, changes in the body composition of patients over time were quantitatively analyzed up to 24 months after chemotherapy. This study retrospectively analyzed 44 patients with TGCT who underwent chemotherapy at our institution from January 2008 to December 2016. Subcutaneous and visceral fat areas and psoas and skeletal muscle areas were measured by computed tomography before and immediately after chemotherapy as well as 3 months, 6 months, 12 months, and 24 months after chemotherapy. The subcutaneous and visceral fat indices and psoas and skeletal muscle indices were calculated as each area divided by body height squared. The total fat area had already significantly increased 3 months after the initiation of chemotherapy (P = 0.004). However, it did not return to prechemotherapeutic levels even at 24 months after chemotherapy. The skeletal muscle area was significantly decreased at the end of chemotherapy (P < 0.001); however, the value returned to baseline within 12 months. In multivariable analysis, the prechemotherapeutic skeletal muscle index and number of chemotherapy cycles were independently associated with the reduction of skeletal muscle at the end of chemotherapy (P = 0.001 and P = 0.027, respectively). In patients with TGCT, skeletal muscle mass decreased during chemotherapy and recovered within 12 months, whereas fat mass progressively increased from the initiation of chemotherapy until 24 months after chemotherapy.
Body Composition ; Body Mass Index ; Humans ; Male ; Muscle, Skeletal ; Neoplasms, Germ Cell and Embryonal ; Obesity ; Retrospective Studies ; Sarcopenia ; Testicular Neoplasms