Background: No consensus exists regarding which anthropometric measurements are related to bone mineral density (BMD), and this relationship may vary according to sex and age. A large Japanese cohort was analyzed to provide an understanding of the relationship between BMD and anthropometry while adjusting for known confounding factors. Methods: Our cohort included 10,827 participants who underwent multiple medical checkups including distal forearm BMD scans. Participants were stratified into four groups according to age (≥50 years or <50 years) and sex. The BMD values were adjusted for confounding factors, after which single and partial correlation analyses were performed. The prevalence of osteopenia was plotted for each weight index (weight or body mass index [BMI]) class. Results: Cross-sectional studies revealed that weight was more favorably correlated than BMI in the older group (R=0.278 and 0.212 in men and R=0.304 and 0.220 in women, respectively), whereas weight and BMI were weakly correlated in the younger age groups. The prevalence of osteopenia exhibited a negative linear relationship with weight among older women ≥50 years of age, and an accelerated increase was observed with decreasing weight in older men weighing <50 kg and younger women weighing <60 kg. When weight was replaced with BMI, the prevalence was low in most subgroups classified by weight. Conclusions Weight, rather than BMI, was the most important indicator of osteopenia but it might not be predictive of future bone loss.

Immunoglobulin G4 (IgG4)-related disease is a chronic disease characterized by fibrotic mass and/or thickened lesions with elevated serum IgG4 concentrations, and infiltrations of IgG4 positive plasma cells. Since it has recently been reported to occur in the cardiovascular system, therapeutic strategy needs to be established. We report a case of IgG4-related thoracic aortic aneurysm (IgG4-R TAA) which was diagnosed postoperatively though suspected as aortic intramural hematoma preoperatively. A 70-year-old man who has medical histories of retroperitoneal fibrosis twice visited our hospital with chief complaints of cough and a CT scan was performed. Though there had been no episodes related to the onset of aortic dissection such as chest pain, an ascending aortic intramural hematoma of 52 mm in diameter was suspected and we planned to perform hemi-arch replacement. Intraoperative findings suggested that it was a true aneurysm and there was no sign of dissection. Histopathologically, the adventitia was obviously thickened with infiltrations of IgG4 positive plasma cells without infiltrations and dissection findings in the tunica media. In addition, serum IgG4 exceeded the normal value, thus it was diagnosed as IgG4-R TAA on the basis of the comprehensive diagnostic criteria. Great caution should be taken in IgG4-R TAA because it may show intramural hematoma on imaging and may develop aortic dissection and rupture as well.

BACKGROUND: Diabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI. MATERIALS AND METHODS: Patients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study. The routine laboratory tests including blood glucose and glycated hemoglobin (HbA1c) were done and empiric treatment with parenteral antibiotics was commenced on admission. The clinical course such as duration of fever (DOF) and length of hospital stay (LOS) were compared among groups classified by the clinical variables. RESULTS: Among the101 patients admitted for f-UTI, 15 patients with diabetes (14.9%) experienced significantly longer febrile period and hospitalization compared to those with hyperglycemia (n = 18, 17.8%) or those without diabetes and hyperglycemia (n = 68, 67.3%). Of the laboratory parameters tested on admission and several clinical factors, the presence of diabetes and risk factors for severe complicated infection (hydronephrosis, urosepsis, and disseminated intravascular coagulopathy) as well as HbA1c and albumin were identified as predictors for LOS by univariate analysis, whereas none of the variables failed to predict DOF. In the subsequent multivariate analysis, HbA1c levels and albumin levels were isolated as independent predictors of LOS. CONCLUSION: Patients with higher HbA1c and lower albumin levels required the longest period of hospitalization. Thus, an evaluation of diabetic and nutritional status on admission will be feasible to foretell the clinical course and better manage the subset of patients at risk of prolonged hospitalization.
Anti-Bacterial Agents ; Blood Glucose ; Fever ; Hemoglobin A, Glycosylated* ; Hospitalization* ; Humans ; Hyperglycemia ; Length of Stay ; Multivariate Analysis ; Nutritional Status ; Risk Factors ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: Diabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI. MATERIALS AND METHODS: Patients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study. The routine laboratory tests including blood glucose and glycated hemoglobin (HbA1c) were done and empiric treatment with parenteral antibiotics was commenced on admission. The clinical course such as duration of fever (DOF) and length of hospital stay (LOS) were compared among groups classified by the clinical variables. RESULTS: Among the101 patients admitted for f-UTI, 15 patients with diabetes (14.9%) experienced significantly longer febrile period and hospitalization compared to those with hyperglycemia (n = 18, 17.8%) or those without diabetes and hyperglycemia (n = 68, 67.3%). Of the laboratory parameters tested on admission and several clinical factors, the presence of diabetes and risk factors for severe complicated infection (hydronephrosis, urosepsis, and disseminated intravascular coagulopathy) as well as HbA1c and albumin were identified as predictors for LOS by univariate analysis, whereas none of the variables failed to predict DOF. In the subsequent multivariate analysis, HbA1c levels and albumin levels were isolated as independent predictors of LOS. CONCLUSION: Patients with higher HbA1c and lower albumin levels required the longest period of hospitalization. Thus, an evaluation of diabetic and nutritional status on admission will be feasible to foretell the clinical course and better manage the subset of patients at risk of prolonged hospitalization.
Anti-Bacterial Agents ; Blood Glucose ; Fever ; Hemoglobin A, Glycosylated* ; Hospitalization* ; Humans ; Hyperglycemia ; Length of Stay ; Multivariate Analysis ; Nutritional Status ; Risk Factors ; Urinary Tract Infections* ; Urinary Tract*

PURPOSE: To investigate whether seasonal changes occurred in lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). METHODS: Patients aged 50 years and older with BPH treated with α1-blockers were enrolled. The International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum and average flow rate, voided volume, and postvoid residual volume were measured in summer and winter. RESULTS: A total of 164 patients were enrolled. The total IPSS and QoL index did not show a significant difference between the 2 seasons. When the IPSS was divided into storage symptoms and voiding symptoms, storage symptoms in winter were substantially but nonsignificantly higher than those in summer (P=0.056). Of the 7 individual symptoms in the IPSS, a significant seasonal difference was observed only for nocturia, with a higher score in winter. Moreover, none of the uroflowmetric parameters showed a seasonal change. Voided volume had significant correlations with each symptom (urgency and nocturia) and overall subjective scores (storage, total IPSS, and QoL) exclusively in summer, while this correlation remained only for nocturia in winter. CONCLUSIONS: As it has generally been assumed that LUTS deteriorate in winter, the present study corroborated that the severity of storage symptoms was higher in winter than in summer, even in patients treated with α₁-blockers. In contrast, a seasonal difference was not observed in the uroflowmetric parameters, which may be partly due to the loss of the correlation between subjective and objective measurements of storage symptoms in winter.
Adrenergic alpha-Antagonists ; Asian Continental Ancestry Group* ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Nocturia ; Prostate ; Prostatic Hyperplasia* ; Quality of Life ; Residual Volume ; Seasons* ; Urodynamics

A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.
Shock ; Respiratory Distress Syndrome, Adult ; Pneumonia ; Kidney Failure, Acute ; Complicated

  A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.

Westernization of lifestyles among Japanese, in particular among young generations, is a matter of concern for future increase in coronary heart disease. We surveyed a total of 349 male university students to examine changes in lifestyles and coronary risk factors in campus life. We compared dietary habits and serum fatty acid compositions as well as other coronary risk characteristics between freshmen (n=171) and fourth-year (senior) students (n=178). Serum fatty acid compositions and dietary intakes of selected foods as well as serum lipids, blood pressures and physical characteristics were examined at the 1996 and 1997 annual health examinations. Compared to freshmen, senior students had a lower frequency of fish, vegetable, milk and egg intake, and a higher frequency of oil and fat intake. The proportions of serum saturated and monounsaturated fatty acids were significantly higher among senior students than among freshmen, whereas the proportion of serum polyunsaturated fatty acids was significantly lower among senior students than among freshmen. Senior students also had higher systolic and diastolic blood pressures, percent body fat, smoking rate and alcohol usage than freshmen. Mean body weight and mean body mass index were not different between the two groups. Senior students generally showed Westernized dietary habits and higher coronary risk profiles than freshmen as indicated by the change of serum fatty acid compositions. Modification of these dietary habits and lifestyles may be important for the prevention of future CHD among Japanese young adults.
Serum ; Fatty Acids ; seconds ; Cardio- ; Risk