Purpose: To clarify the differences in the interpretation between the medical staffs and the patients / their families (hereinafter called “patients-families”) when the wording like “a yearly, monthly or weekly basis” and “the words suggesting seasons” are used on the medical sites. Method: The questionnaires were provided to both the medical staffs and the patients-families. Results: Regarding “a yearly basis”, 100% of the medical staffs use as “less than five years” and 67.1% of the patients-families interpret the same. Regarding “a monthly basis”, 100% of the medical staffs use as “less than six months” and 68.3% of the patients-families interpret the same. Regarding “a weekly basis”, 100% of the medical staffs use it as “less than eight weeks”, whereas it is 77.2% of the patients-families that interpret so. Approximately 20% of the patients-families have no ideas about the wording like “a yearly, monthly and weekly basis”. When the medical staffs mention “the cherry blossom season”, 71.4% of them are trying to indicate “the late March” or “the early April”, on the other hand, it is 58.9% of the patients-families that understand so. Regarding the expressions like “the season when the leaves turn red”, “the time when it gets warmer” or “the time when it gets colder”, there is not definite mutual understanding between the medical staffs and the patients-families. Conclusion: This awareness survey shows there is a case that the medical staffs and the patients-families may differ in the interpretation of words commonly used on medical sites.

A 64-year-old man under dialysis was referred for surgical treatment of Crawford type I thoracoabdominal aortic aneurysm. He had a history of idiopathic portal hypertension and chronic total occulusion of supra-renal abdominal aorta and appeared to have massive development of collateral arteries and veins in the abdomen. We chose endovascular repair with debranching of visceral arteries and bypass grafting to bilateral superficial femoral artery considering bleeding from collateral arteries and veins by conventional open surgery. Postoperative CT scan revealed no endoleak and all debranched and bypass grafts were patent. He was discharged with no postoperative complications including paraplegia.

Hypercholesterolemia and hypertension are among the most important risk factors for cardiovascular (CV) disease. They are also important contributors to metabolic diseases including diabetes that further increase CV risk. Updated guidelines emphasize targeted reduction of overall CV risks but do not explicitly incorporate potential adverse metabolic outcomes that also influence CV health. Hypercholesterolemia and hypertension have synergistic deleterious effects on interrelated insulin resistance and endothelial dysfunction. Dysregulation of the renin-angiotensin system is an important pathophysiological mechanism linking insulin resistance and endothelial dysfunction to atherogenesis. Statins are the reference standard treatment to prevent CV disease in patients with hypercholesterolemia. Statins work best for secondary CV prevention. Unfortunately, most statin therapies dose-dependently cause insulin resistance, increase new onset diabetes risk and exacerbate existing type 2 diabetes mellitus. Pravastatin is often too weak to achieve target low-density lipoprotein cholesterol levels despite having beneficial metabolic actions. Renin-angiotensin system inhibitors improve both endothelial dysfunction and insulin resistance in addition to controlling blood pressure. In this regard, combined statin-based and renin-angiotensin system (RAS) inhibitor therapies demonstrate additive/synergistic beneficial effects on endothelial dysfunction, insulin resistance, and other metabolic parameters in addition to lowering both cholesterol levels and blood pressure. This combined therapy simultaneously reduces CV events when compared to either drug type used as monotherapy. This is mediated by both separate and interrelated mechanisms. Therefore, statin-based therapy combined with RAS inhibitors is important for developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity. This combined therapy can help prevent or treat CV disease while minimizing adverse metabolic consequences.
Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus, Type 2 ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Hypercholesterolemia ; Hypertension ; Insulin Resistance ; Lipoproteins ; Metabolic Diseases ; Obesity ; Pravastatin ; Renin-Angiotensin System ; Risk Factors

In late August 2014, three autochthonous dengue cases were reported in Japan. Since then, as of 17 September 2014, a total of 131 autochthonous cases have been confirmed. While cases were reported from throughout Japan, the majority were linked to visiting a large park or its vicinity in Tokyo, and the serotype detected has been serotype 1. We report preliminary findings, along with the public health response activities, of the first documented autochthonous dengue outbreak in Japan in nearly 70 years.Dengue is an acute, mosquito-borne febrile illness caused by a flavivirus found widely in the Asia-Pacific region, particularly in South-East Asia. While the most competent mosquito species for dengue virus transmission is believed to be Aedes aegypti, Aedes albopictus is also a competent vector present in much of Japan during the warmer months. Infection with dengue virus may cause fever, headache, muscle pain and/or rash but may also be mild or asymptomatic. While there is no specific treatment, with early and appropriate medical care, the likelihood of infections resulting in severe forms or death is rare. In Japan, dengue has been a notifiable disease since April 1999. Physicians are required to report demographic, clinical and exposure history information of laboratory-confirmed cases to the local public health centre that are then reported to the Ministry of Health, Labour and Welfare (MHLW) and the National Institute of Infectious Diseases (NIID).