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Myositis ossificans (MO) is a benign soft-tissue lesion characterized by the heterotopic formation of the bone in skeletal muscles, usually due to trauma. MO is occasionally difficult to diagnose because of its clinical and radiological similarities with malignancy. We report a case of traumatic MO (TMO) in the masseter and brachial muscles of a 37-year-old man who presented with painless swelling in the left cheek and severe trismus. Due to the absence of a traumatic history at the first consultation and identification of a tumorous lesion in the left masseter muscle by magnetic resonance imaging (MRI), the lesion was suspected to be a malignant tumor. Subsequently, 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) showed multiple regions of high FDG uptake across the whole body, suggestive of multiple metastases or other systemic diseases. However, intramuscular calcifications were also observed in the left masseter and brachial muscles, overlapping the areas with high FDG uptake. Moreover, multiple fractures were seen in the rib and lumbar spine, also overlapping the areas with high FDG uptake. Based on these imaging findings, along with a history of jet-ski trauma, TMO was suspected. The left cheek mass was surgically excised and histologically diagnosed as TMO. In this case report, FDG-PET/CT could detect multiple TMOs across the whole body. To the best of our knowledge, cases of multiple TMOs located far apart in different muscles are rare, and this may be the first report.

Patient: Male, 46 Final Diagnosis: Eosinophilic granulomatosis with polyangiitis Symptoms: Chest pain Medication: — Clinical Procedure: Skin biopsy Specialty: Cardiology Objective: Rare co-existance of disease or pathology Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis of unknown cause accompanied by prominent eosinophilia. Intracardiac thrombosis is one of the major cardiac complications in EGPA that may cause thromboembolism. Case Report: A 46-year-old male presenting with intermittent chest pain and numbness of the lower extremities was admitted to our center. His case was complicated by multiple brain infarcts and endocardial thrombosis in the left ventricle. A condition of restrictive cardiomyopathy was also found. After a thorough workup, he was diagnosed with antineutrophil cytoplasmic antibody (ANCA) positive EGPA. Interestingly, the thrombus was accompanied by a pressure gradient producing mid-ventricular obstruction. The patient improved reasonably with immunosuppression and anticoagulation treatment, in addition to heart failure treatment, and had a concomitant regression of the thrombus and reduction of the pressure gradient. Conclusions: For an EGPA patient complicated by intraventricular obstruction caused by endocardial thrombosis, which could accelerate the release of the thrombus into the systemic circulation resulting in a life-threating condition, timely and aggressive measures against cardioembolic complications should be considered.

Background: Circulating soluble urokinase-type plasminogen activator receptor (suPAR), which can reflect immune activation and low-grade inflammation, may be a novel biomarker of cardiovascular disease. Methods: We investigated the potential association between suPAR and the prevalence of atrial fibrillation (AF) by analyzing patients with either sinus rhythm, paroxysmal atrial fibrillation (PAF), or non-paroxysmal atrial fibrillation (NPAF), which indicates either permanent or persistent AF. Results: Among 426 patients enrolled (mean age 71.4±9.2 years; 110 (25.8%) female), 310, 62, and 54 were diagnosed with sinus rhythm, PAF, and NPAF, respectively. NPAF was >10-fold more prevalent in the highest suPAR quartile (>3534 pg/mL; 32 (30.2%) of 106 patients) than in the lowest suPAR quartile (

BackgroundInfluenza virus infection (IVI) was reported to be associated with minor cardiac changes, mostly those detected on electrocardiogram with and without elevated blood markers of myocardial injury; however, the characteristics of myocardial involvement in association with IVI are poorly understood. This study used echocardiographic tissue imaging (tissue Doppler, strain, and strain rate) to evaluate changes in left atrial (LA) and left ventricular (LV) myocardial function after IVI.Methods and resultsWe examined 20 adult individuals (mean age, 43 years) at 2 and 4 weeks after diagnosis of IVI. For myocardial functional variables, we obtained LV global longitudinal strain (GLS), LV early diastolic strain rate (e'sr), LA strain, and LA stiffness (E/e'/LA strain), in addition to data on tissue Doppler (s', e', and a') and myocardial performance index. Blood markers of myocardial injury were also examined. During follow-up, there were no significant changes in global chamber function such as LV ejection fraction, E/e', and LA volume. However, significant changes in myocardial function were observed, namely, in s' (8.0 ± 1.6 cm/s to 9.3 ± 1.5 cm/s; p = 0.01), e' (10.2 ± 2.8 cm/s to 11.4 ± 3.0 cm/s; p < 0.001), e'sr (1.43 ± 0.44 1/s to 1.59 ± 0.43 1/s; p = 0.005), and LA strain (35 ± 8% to 40 ± 12%; p = 0.025), and the myocardial performance index (0.52 ± 0.20 to 0.38 ± 0.09; p = 0.009), but not in a', LA stiffness, or GLS. Cardiac troponin T and creatinine kinase isoenzyme MB were not elevated significantly at any examination.ConclusionsMyocardial dysfunction during IVI recovery appeared to be transient particularly in the absence of myocardial injury. Echocardiographic tissue imaging may be useful to detect subclinical cardiac changes in association with IVI.

A 38-year-old woman had developed an abdominal distention, lower extremity edema, and dyspnea. Imaging examination revealed a large mass in the right atrium which was connected to lesions within the inferior vena cava. Although complete resection of the mass was not possible, partial surgical tumor resection was performed to avoid pulmonary embolization and circulatory collapse. Leiomyosarcoma was diagnosed histologically, and chemotherapy (doxorubicin) followed by radiotherapy was started. By reviewing papers published in the past 10 years that included 322 patients, we also discuss the clinical presentations and prognosis of leiomyosarcoma in the inferior vena cava.

Neurofibromatosis?Noonan syndrome (NFNS) is an uncommon chromosomal disorder showing features of both neurofibromatosis (NF-1) and Noonan syndrome (NS). We encountered a case of NFNS with keratocystic odontogenic tumor and dentigerous cysts. A 19-year-old Japanese girl was referred to our hospital with a chief complaint of swelling in the left side of the mandible. The patient showed symptoms of both NF-1, in the form of cafe-au-lait spots and neurofibromatosis, and NS, in the form of short stature, intellectual disturbance, webbed neck, and hypertelorism. Panoramic radiography showed three cystic lesions, one on each side of the mandible and one on the left side of the maxilla. All cysts were removed surgically under general anesthesia. Histopathological examination revealed that both mandibular cysts were dentigerous cysts, while the maxillary cyst was a keratocystic odontogenic tumor. No recurrence has been seen as of 5 years postoperatively. Multiple jaw cysts might be added as a potential finding in NFNS., Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 28(1), pp.51-54; 2016

The aim of the present study was to elucidate the associations between the expression of the vascular endothelial growth factor-C (VEGF-C)/VEGF receptor-3 (VEGFR-3) axis and lymphangiogenesis, regional lymph node metastasis and clinicopathological factors in oral tongue squamous cell carcinoma (OTSCC) using immunohistochemistry. The expression of VEGF-C, VEGFR-3 and podoplanin was immunohistochemically evaluated in specimens obtained from 65 patients with OTSCC (T1-2, N0) who had undergone radical surgery alone. The associations between the expression of VEGF-C, VEGFR-3 and podoplanin, and lymphangiogenesis, regional lymph node metastasis and clinocopathological factors were determined by immunohistochemical analysis. VEGF-C, VEGFR-3 and combined VEGF-C/VEGFR-3 expression was significantly higher in cases with regional recurrence compared with those without lymph node involvement (P, Oncology Letters, 10(4), pp.2027-2034; 2015

Tumor perfusion can be evaluated by analyzing the time-signal intensity curve (TIC) after dynamic contrast-enhanced (DCE) MR imaging. Accordingly, TIC profiles are characteristic of some benign and malignant salivary gland tumors. A carcinoma ex pleomorphic adenoma (CXPA) arises from a long-standing pleomorphic adenoma (PA) and has a distinctive prognostic risk depending on the tumor growth potential such as invasion beyond the preexisting capsule. Differentiating CXPA from PA can be very challenging. In this study, we have attempted to discriminate CXPA from PA based on a two-dimensional TIC mapping algorithm. TIC mapping analysis was performed on 8 patients with CXPA and 20 patients with PA after dynamic contrast-enhanced (DCE) MR imaging using a 1.5-T MR system. The TIC profiles obtained were automatically categorized into 5 types based on the enhancement ratio, maximum time, and washout ratio (Type 1 TIC with flat profile, Type 2 TIC with slow uptake, Type 3 TIC with rapid uptake and a low washout ratio, Type 4 TIC with rapid uptake and a high washout ratio, and Type 5 TIC not otherwise specific). The percentage tumor areas with each of the 5 TIC types were compared between CXPAs and PAs. Stepwise differentiation and cluster analysis using multiple TIC cut-off thresholds distinguished CXPAs from PAs with 75% sensitivity, 95% specificity, 86% accuracy, and 86% positive and 90% negative predictive values, when tumors with ≤1.1% Type 1 and ≥15% Type 4, or those with ≤1.1% Type 1, ≥78.1% Type 2, ≥16.1% Type 3, and 1.1% Type 1, ≥78.1% Type 2, and ≥16.1% Type 3 areas were diagnosed as CXPAs. The overall TIC profiles predicted some aggressive CXPA growth patterns. These results suggest that stepwise differentiation based on TIC mapping is helpful in differentiating CXPAs from PAs.

Ameloblastic fibrodentinoma (AFD) is a rare benign mixed odontogenic tumor that occurs predominantly in children and young adults. AFD is usually associated with delayed eruption of the tooth and shows painless swelling. We present a case of AFD affecting an 8-year-old Japanese girl with a complaint of delayed eruption of her left mandibular second premolar tooth. Intraoral examination did not reveal any sign of pain or swelling in the left mandible. Panoramic radiography revealed a radiolucent and well-circumscribed lesion, which contained radiopaque material at the premolar lesion of the left mandible. The second deciduous molar tooth was unerupted and the second premolar tooth was congenitally lacking. Our provisional diagnoses were odontogenic tumor. The biopsy confirmed AFD. The treatment included total excision of the tumor and the second premolar tooth. No recurrence has been noted during the 2 years of follow-up., Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 117(2), pp.e88-e91; 2014

Locoregional recurrence of oral tongue squamous cell carcinoma (OTSCC) has been considered a poor prognostic entity in terms of survival rate. The purpose of this study was to evaluate the incidence of locoregional recurrence and to identify significant risk factors for locoregional recurrence in early-stage OTSCC. We retrospectively reviewed the records of 58 patients who underwent radical surgery for T1-2N0 OTSCC. The local recurrence and regional recurrence rates were 10.3 % (6/58 patients) and 15.5 % (9/58 patients) in this study, respectively. The survival rate of patients with local recurrence was 66.7 %, which was significantly lower than that (96.2 %) of patients without local recurrence, whereas the survival rates of patients with or without regional recurrence were not significantly difference. Pattern of invasion (POI), neoadjuvant chemotherapy (NAC) and the status of the surgical margin were identified as factors influencing local recurrence. In particular, the status of the deep surgical margin was a high potential independent risk factor. The deep surgical margin was resected closely in many NAC-treated cases, suggesting that NAC may lead to local recurrence and a poor outcome. No efficacy of NAC was observed, suggesting that the standard treatment for early OTSCC is surgery alone., Pathology & Oncology Research, 19(4), pp.795-803; 2013

Carcinoma ex pleomorphic adenoma (CEPA) is defined as a pleomorphic adenoma from which an epithelial malignancy is derived. Most cases of CEPA occur in parotid glands, and CEPA arising in minor salivary glands is rare. We report an extremely rare case of CEPA arising in the minor salivary glands of the anterior tongue in a 64-year-old man. The mass of the left anterior surface of tongue was a 30 mm × 20 mm × 20 mm, relatively well-defined, elastic, hard, and tender. Biopsy was performed and the histological diagnosis was adenocarcinoma, not otherwise specified (NOS). Benign PA was not included in the biopsy specimen. A wide local excision of the tongue, with left upper neck dissection, and local flap repair were performed. The removed tumor was composed of adenocarcinoma, NOS accompanied with small foci of pre-existing chondroid areas of PA. A diagnosis of CEPA was finally made. There were no signs of recurrence and metastasis 22 months after the surgery., Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 25(2), pp.197-200; 2013

Background Several experimental studies have demonstrated that fibroblast growth factor 23 (FGF23) may induce myocardial hypertrophy via pathways independent of α-Klotho, its co-factor in the induction of phosphaturia. On the other hand, few studies have clearly demonstrated the relationship between FGF23 level and left ventricular hypertrophy among subjects without chronic kidney disease (CKD; i.e., CKD stage G1 or G2). Purpose To investigate the data from 903 patients admitted to the cardiology department with various degrees of renal function, including 234 patients with CKD stage G1/G2. Methods and Results Serum levels of full-length FGF23 and α-Klotho were determined by enzyme immunoassay. After adjustment for sex, age, and estimated glomerular filtration rate (eGFR), the highest FGF23 tertile was significantly associated with left ventricular hypertrophy among patients with CKD stage G1/G2 and those with CKD stage G3a/G3b/G4 as compared with the lowest FGF23 tertile, and the association retained significance after further adjustment for serum levels of corrected calcium, inorganic phosphate, and C-reactive protein, as well as diuretic use, history of hypertension, and systolic blood pressure. FGF23 was also associated with low left ventricular ejection fraction among patients with CKD stage G1/G2 and those with CKD stage G3a/G3b/G4 after adjusting for age, sex, eGFR, corrected calcium, and inorganic phosphate. On the other hand, compared with the highest α-Klotho tertile, the lowest α-Klotho tertile was associated with left ventricular hypertrophy and systolic dysfunction only among patients with CKD stage G3b and stage G3a, respectively. Conclusions An association between FGF23 and cardiac hypertrophy and systolic dysfunction was observed among patients without CKD as well as those with CKD after multivariate adjustment. However, the association between α-Klotho and cardiac hypertrophy and systolic dysfunction was significant only among patients with CKD G3b and G3a, respectively.

Intramuscular lipoma (IML) is an uncommon tumor in the oral cavity, and characterized by infiltrating adipose tissue and muscle atrophy. Although oral IMLs are almost always solitary, we reported a rare case of IML of the tongue complicated with diffuse lipomatosis of the forearm. A 58-year-old woman was referred to our department with a painless swelling of the left tongue that had been present for 6 months. Clinical examination revealed a 35mm×30mm×20mm well-defined, elastic soft mass in the anterior left region of the tongue border. The lesion was removed under general anesthesia via the left margin of the tongue. No signs of recurrence have been observed 15 months after surgery., Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 24(4), pp.237-240; 2012

Although neurofibroma frequently occurs as a local manifestation of von Recklinghausen's disease, solitary lesions in the oral and maxillofacial region are rare. Here, we describe an extremely rare solitary neurofibroma that arose in the maxillary sinus of a 41-year-old man. Panoramic radiography and a CT scan showed a slightly swollen maxillary sinus mucosa and a well-circumscribed cystic lesion suggesting a radicular cyst associated with a maxillary molar. The lesions were removed by radical sinusotomy under genera anesthesia. A histopathological examination revealed that the nodular lesion of the sinus mucosa was not encapsulated and that it was composed of somewhat increased numbers of spindle cells accompanied by delicate hyperplastic fibers. These cells had flexed, wavy and linear spindle nuclei. Immunohistochemistry revealed that these tumor cells were positive for S-100 and neuron-specific enolase (NSE). A few spindle cells that were positive for α-SMA within the tumor were thought to be fibroblastic cells (myofibroblasts) derived from the endoneurium or surrounding connective tissue. These findings overall were compatible with the characteristics of neurofibroma. The cystic lesion was diagnosed as a radicular cyst. The patient remained free of tumor recurrence at 26 months of follow-up., Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 24(3), pp.171-174; 2012

Soft tissue chondroma of the palate is a rare lesion. We report a rare case of soft tissue chondroma of the hard palate with a review of the literature. A 59-year-old man was referred to our department because of a symptomatic mass on the median anterior margin of the hard palate of 4 year's duration. The lesion was approximately 15 mm × 10 mm × 8 mm in size and pedunculated. The lesion was excised under local anesthesia, and the pathological diagnosis was soft tissue chondroma. The histopathological findings suggested that the heterotopic formation of cartilage was caused by the metaplastic change of mesenchymal cells into chondrocytes. Postoperative wound healing has been uneventful, with no sign of recurrence during 2 years after surgery., Asian Journal of Oral and Maxillofacial Surgery, 23(2), pp.92-95; 2011

OBJECTIVE: Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma, occurring mostly in oral mucosa. To clarify the role of human papillomavirus (HPV) in VC tumorigenesis, we investigated localization and genotypes of HPV and p53 expression in oral VC. METHODS: We studied paraffin-embedded specimens of 23 VCs and 10 control non-neoplastic lesions in oral mucosa. To investigate HPV infection, HPV genotypes and p53 expression, we respectively employed in situ hybridization (ISH), sequence analysis following short PCR fragment-PCR assay and immunohistochemistry. RESULTS: Of the 23 VC specimens, 11 (48%) had HPV-DNA (detectable by PCR), and 6 (26%) had intranuclear HPV in the upper portion of the squamous epithelium (detectable by ISH). Nine of the 11 PCR-positive specimens showed multiple infections with low- and high-risk HPVs. No HPV-16 infection was detected. Although HPV-6 and HPV-18 were frequently detected by PCR, no HPV could be found in control specimens by ISH. p53 expression was inversely correlated with HPV infection. CONCLUSION: Thus, multiple infections with low- and high-risk HPVs and their rapid replication during hyperkeratinization may participate in the histogenesis of oral VC. Oral VC tumorigenesis may involve the inactivation of p53, which is associated with HPV infection., Pathobiology, 75(4), pp.257-264; 2008

Midkine (MK; a low molecular weight heparin-binding growth factor) is a multifunctional cytokine. MK plays a role in morphogenesis of many organs including teeth through epithelial-mesenchymal interactions. We immunohistochemically examined MK expression in various human odontogenic tumors. There was no difference in positive rate and intensity of MK between benign odontogenic tumors and their malignant counterparts. Ameloblastoma showed MK localization in the peripheral columnar cells in budding processes from the parenchyma, which frequently expressed proliferating cell nuclear antigen. MK was also preferentially expressed in keratinized cells in acanthomatous ameloblastoma and keratocystic odontogenic tumor. In odontogenic mixed tumors except for odontoma, intense immunoreactivity to MK was found in epithelial follicles, the surrounding odontogenic ectomesenchymal tissue, and the basement membrane between them. Intensity in the odontogenic ectomesenchyme decreased in relation to distance from the epithelial follicles. No expression was found in tumor cells associated with production of dental hard tissues in odontogenic mixed tumors including odontoma. These findings suggested that MK is involved in the reciprocal interaction between odontogenic epithelium and odontogenic ectomesenchymal tissue in areas without dental hard tissue formation in odontogenic mixed tumors. Coexpression of MK and proliferating cell nuclear antigen was also observed in epithelial follicles and highly cellular nodules in the ectomesenchyme of odontogenic mixed tumors. MK is considered to mediate growth activity of odontogenic tumors and cell differentiation of odontogenic mixed tumors through molecular mechanisms similar to those involved in morphogenesis of the tooth., Human Pathology, 39(5), pp.694-700; 2008

Background Several studies have shown that serum uric acid (UA) is associated with left ventricular (LV) hypertrophy. Serum levels of parathyroid hormone (PTH), which has bbe shown to be correlated with UA, is also known to be associated with cardiac hypertrophy; however, whether the association between UA and cardiac hypertrophy is independent of PTH remains unknown. Purpose We investigated whether the relationship between serum uric acid (UA) and LV hypertrophy is independent of intact PTH and other calcium-phosphate metabolism-related factors in cardiac patients. Methods and Results In a retrospective study, the association between UA and left ventricular mass index was assessed among 116 male cardiac patients (mean age 65±12 years) who were not taking UA lowering drugs. The median UA value was 5.9 mg/dL. Neither age nor body mass index differed significantly among the UA quartile groups. Patients with higher UA levels were more likely to be taking loop diuretics. UA showed a significant correlation with intact PTH (R = 0.34, P

A case of Hodgkin's disease, mixed cellularity type, similarly to the histological findings of anaplastic large cell lymphoma(ALCL)is presented.A 64-year-old man with a painless mobile swelling of left submandibular lymph nodes was referred to Nagasaki University Dental Hospital.CT, MRI and ultrasonic examination identified three enlarged lymph nodes adjacent to the submandibular gland.Histologically, proliferation of lymphoid cells with clusters of epithelioid cells, plasma cells and a few eosinophils were observed.Giant cells with one or more bizarre nuclei including distinct nucleoli were scattered or cohesively arranged in the lymph nodes.The giant cells were regarded as Hodgkin or Reed-Sternberg cells.However, cohesive arrangement and immunopositivity for EMA of the giant cells resemble the findings of ALCL.In order to discriminate between Hodgkin's disease and ALCL, immunohistochemical examination using other antibodies was performed.Finally, the lesion was diagnosed as Hodgkin's disease because of immunoreactivity for CD 15, CD 30 and EBV-LMP 1, and strong reactivity for fascin, in addition to the presence of classical Reed-Sternberg cells., Oral medicine & pathology. 2000, 5(2), p.99-103

Proliferating cell nuclear antigen (PCNA) is a nuclear protein synthesized in the late G1 and S phase of the cell cycle, and immunohistochemical detection of the protein represents a useful marker for the proliferating fraction of cells in tissue specimens. PCNA expression was studied in odontogenic keratocysts (n= 15) and ameloblastomas (n= 46) using an avidin–biotin–peroxidase complex method on routinely processed paraffin sections. The percentage of PCNA-positive cells determined by point counting was significantly lower in the ameloblastomas (mean 9.4%, standard deviation (SD) 11.0) than in odontogenic keratocysts (mean 29.9%, SD 24.0). In ameloblastomas, the mean percentage of PCNA-positive cells was lowest in the acanthomatous pattern and highest in plexiform pattern. The mean percentage of PCNA-positive cells in plexiform pattern was non-significantly higher than that in follicular pattern. The mean percentage of PCNA-positive cells in plexiform and follicular patterns was significantly higher than that in cyctic and acanthomatous patterns. The frequency of PCNA-positive cells was significantly higher in the peripheral cells of follicular and plexiform patterns than in the central cells of both patterns (p< 0.01). Therefore, peripheral cells were regarded as reserve cell of central cells. The mean percentage of PCNA-positive cells in the epithelial lining of odontogenic keratocyst was not significantly different from those in the peripheral cells of follicular and plexiform patterns of ameloblastoma. In contrast, the odontogenic keratocyst exhibited a mean percentage of PCNA-positive cells which was statistically higher than that in other histological elements of ameloblastomas. The present study suggests that odontogenic keratocyst is regarded as benign odontogenic tumour.

Amelanotic melanoma of the oral mucosa is extremely rare. We describe herein our experience of amelanotic melanoma arising in the mandibular mucosa. An 85-year-old woman was referred to our clinic with swelling of the left lower gingival mucosa. The histopathological diagnosis was amelanotic melanoma, as determined by immunohistochemical examination. The tumor cells were positive for S-100, Melan-A, HMB-45, and vimentin. The patient declined surgical treatment, so she received irradiation therapy. At a total dose of 10. Gy, the patient exhibited lassitude, so we terminated radiotherapy. Bleeding from the tumor persisted, and the patient developed anemia and hypouresis. She also contracted pneumonia. The patient's general condition worsened, and she died., Oral Science International, 8(2), pp.60-63; 2011

Summary Spindle cell lipoma is a benign tumour composed of mature fat cells, spindle cells, and a myxoid matrix separated by thick bands of birefringent collagen. Oral spindle cell lipoma is a very rare lesion. We report a case of spindle cell lipoma of the cheek. A 42-year-old woman was referred to our department because of a painless swelling on the left cheek. Clinical examination revealed a mobile, well-demarcated mass of the cheek. The tumour was removed surgically under general anaesthesia. A histopathological specimen revealed a spindle cell lipoma. Following surgery, no evidence of recurrence has been observed.

Background Expression and/or excretion of fibroblast growth factor-23 (FGF23) and its co-receptor Klotho are altered in patients with end-stage renal disease. The possibility that the FGF23/α-Klotho system mediates the aggravated cardiovascular outcome among patients with chronic kidney disease (CKD) has been suggested. We determined whether FGF23 and α-Klotho concentrations are altered among patients with reduced renal function and proteinuria. Methods Serum FGF23 and α-Klotho were measured in cardiology patients who were not undergoing chronic hemodialysis. Estimated glomerular filtration rate (eGFR) was correlated negatively with FGF23 and positively with α-Klotho. Results The correlation between FGF23 and the renal tubular maximum reabsorption rate of phosphate to the GFR (TmP/GFR) was not significant, but that between FGF23 and serum calcium or inorganic phosphate was significant among patients with an estimated GFR of less than 60 mL/min/m2. By stepwise multivariate regression analysis, eGFR was selected as significant predictor for FGF23 or α-Klotho among patients with an estimated GFR of less than 60 mL/min/m2; however, urine albumin/creatinine ratio was not selected as a predictor for FGF23 or α-Klotho irrespective of the eGFR levels. In patients with eGFR of