Objective：To assess the risk for hyperkalemia caused by treatment with angiotensin Ⅱ Type 1 receptor blockers （ARB） in clinical practice with Japanese medical database.Design：A cohort study in patients treated with ARB alone and those treated with calcium channel blockers （CCB） alone as control.Methods：The Diagnosis Procedure Combination （DPC） database provided by Medical Data Vision Co., Ltd. was used to identify patients who received a diagnosis of hypertension (ICD-10 codes, I10 to I15) and were treated with ARB or CCB from April 2008 to June 2017. A logistic regression model was applied to estimate adjusted odds ratios （OR） and their 95％ confidence intervals （CI） in these patients. The outcome in the logistic model was hyperkalemia （serum potassium≧5.5 mEq/L） and the covariates were sex, age, renal insufficiency, hepatic insufficiency, and baseline serum potassium levels. And, subgroup analysis was also performed in patients with and without renal insufficiency.Results：The incidence of hyperkalemia （per 1000 person-years） with ARB was 39.4 and that with CCB was 32.6. And, median periods from the index date to the date of occurrence of hyperkalemia for both exposure and control groups were 36 days （Min-Max：12-85） and 51.5 days（Min-Max：8-88）respectively. However, treatment with ARB was not associated with occurrence of hyperkalemia （OR 1.26, 95％CI： 0.58-2.75). The risk for hyperkalemia among those with renal insufficiency was higher （OR 3.31, 95％CI： 1.39-7.88）and as baseline serum potassium increased, the risk increased as well （OR 9.20, 95％CI： 3.52-24.10). And, the subgroup analysis also showed that rare occurrence of hyperkalemia by ARB and elevation risk for hyperkalemia by baseline serum potassium.Conclusion：The clinical data showed rare occurrence of hyperkalemia caused by ARB, indicating that renal insufficiency and baseline serum potassium levels affected the onset of the disease in clinical practice. Previous studies also reported the effects of renal insufficiency and other factors on the onset of hyperkalemia. ARB should be prescribed carefully in patients with these factors, as is conventionally done.

Objectives: To investigate the correlation between imbalance of muscle mass to body weight and lifestyle-related diseases using bioelectrical impedance analysis (BIA) among Japanese population. Methods: This was a retrospective, cross-sectional study conducted at Juntendo University Hospital in Tokyo, Japan, from May 2015 to November 2017. Their muscle-to-weight ratio were stratified into “muscle-to-weight ratio” quartiles as follows: men, Q1 (0.79), Q2 (0.75 to <0.79), Q3 (0.72 to <0.75), and Q4 (<0.72); women, Q1 (0.73), Q2 (0.68 to <0.73), Q3 (0.63 to <0.68), and Q4 (<0.63). The primary outcome was prevalence of 2 lifestyle-related diseases, including hypertension, dyslipidemia, type 2 diabetes mellitus, and hyperuricemia. Results: Data from 2009 individuals (men, 55%; mean age, 62 years) were analyzed. Compared to the lowest quartile, risk for the presence of 2 lifestyle-related diseases, in a multivariable regression model for men was as follows: Q2 (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.31e2.87), Q3 (OR, 2.85; 95% CI, 1.89e4.29), and Q4 (OR, 6.00; 95% CI, 4.07e8.84). For women, an increased risk was seen in Q2 (OR, 2.31; 95% CI, 1.20e4.46), Q3 (OR, 4.45; 95% CI, 2.40e8.26), and Q4 (OR, 12.6; 95% CI, 6.80e23.5). Cutoff values of muscle-to-weight ratio correlated with lifestyle-related diseases (2) were 0.76 for men and 0.68 for women. Conclusions Our results showed that an imbalance of muscle mass to body weight confers an independent and stepwise increased risk for lifestyle-related diseases.

Objectives: To investigate the correlation between imbalance of muscle mass to body weight and lifestyle-related diseases using bioelectrical impedance analysis (BIA) among Japanese population. Methods: This was a retrospective, cross-sectional study conducted at Juntendo University Hospital in Tokyo, Japan, from May 2015 to November 2017. Their muscle-to-weight ratio were stratified into “muscle-to-weight ratio” quartiles as follows: men, Q1 (0.79), Q2 (0.75 to <0.79), Q3 (0.72 to <0.75), and Q4 (<0.72); women, Q1 (0.73), Q2 (0.68 to <0.73), Q3 (0.63 to <0.68), and Q4 (<0.63). The primary outcome was prevalence of 2 lifestyle-related diseases, including hypertension, dyslipidemia, type 2 diabetes mellitus, and hyperuricemia. Results: Data from 2009 individuals (men, 55%; mean age, 62 years) were analyzed. Compared to the lowest quartile, risk for the presence of 2 lifestyle-related diseases, in a multivariable regression model for men was as follows: Q2 (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.31e2.87), Q3 (OR, 2.85; 95% CI, 1.89e4.29), and Q4 (OR, 6.00; 95% CI, 4.07e8.84). For women, an increased risk was seen in Q2 (OR, 2.31; 95% CI, 1.20e4.46), Q3 (OR, 4.45; 95% CI, 2.40e8.26), and Q4 (OR, 12.6; 95% CI, 6.80e23.5). Cutoff values of muscle-to-weight ratio correlated with lifestyle-related diseases (2) were 0.76 for men and 0.68 for women. Conclusions Our results showed that an imbalance of muscle mass to body weight confers an independent and stepwise increased risk for lifestyle-related diseases.

BACKGROUND: We describe a 40-year-old Thai woman living in Japan who was transferred to Juntendo University Hospital after lung cancer was suspected. Chest X-ray showed a nodular lesion and pleural effusion in the left lung. Laboratory data showed eosinophilia. She denied having consumed raw or undercooked food at the initial interview. Microplate enzyme-linked immunosorbent assay (ELISA) for Paragonimus westermani specific immunoglobulin (Ig) G antibody was positive at a high titer, confirming the diagnosis of P. westermani infection. She was successfully treated with oral praziquantel. All primary practitioners should be aware that paragonimiasis is an important pulmonary disease that can cause nodular lesions on chest X-ray.

We recently encountered a case of fatal pneumococcal infection in a previously healthy 19-year-old female. She had no history of splenectomy, but on autopsy she was found to have hyposplenism. It has been widely reported that life-threatening pneumococcal infection can occur after splenectomy, though cases of hyposplenic or asplenic adults, without a history of splenectomy, are very rare. We report this case and review the literature dealing with 6 similar cases.

ABSTRACT: A case of infectious mononucleosis (IM) in a previously healthy 43-year-old male is presented. The patient complained of fever and a sore throat of 3 weeks' duration. Although blood tests showed a marked increase in atypical lymphocytes, tests for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were negative. Human immunodeficiency virus type 1 (HIV-1) antibody was positive on enzymelinked immunosorbent assay (ELISA), and the HIV-1 viral load was 6.4×10⁴copies/mL. Western blot (WB) analysis did not initially confirm HIV-1 infection ; however, HIV-1 infection was confirmed one month after presentation. Although several pathogens can cause infections presenting as IM, in Japan there have been few reports of acute retroviral syndrome presenting as IM. This case is being reported to stress the importance of the early diagnosis of acute retroviral syndrome.