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Objectives　Though having a high salt taste threshold has been associated with hypertension, its exact determinants remains unclear. This study aimed to identify the determinants of salt taste threshold in a community-based population and to determine the relationship between salt taste thresholds and the simultaneous presence of multiple determinants.Methods　Of the 1,117 participants of the baseline survey of the Kobe study, a cohort study of healthy urban residents, aged 40-74 years, with no history of cancer or cardiovascular diseases, nor undergoing treatment for hypertension, diabetes, or dyslipidemia, was conducted. Among them, 1,116 underwent the salt taste threshold test, and urine samples were collected to determine their estimated salt intake. The salt taste threshold test was carried out using SALSAVE ® , with a salt taste threshold of 0.6% defined as normal, and that of 0.8% or more defined as high. A binomial logistic regression model was used, with high salt taste threshold as the objective variable, and life and family status, education, smoking and alcohol drinking status, intake status of salt dried fish, stress indicators, and daily salt intake (estimated from the urine sample) as the explanatory variables. A binomial logistic regression analysis was conducted, through multivariate analysis using the forced entry method, with factors influencing salt taste threshold as explanatory variables, and salt taste threshold (normal/high) as the objective variable. This analysis was performed excluding the urinary sodium-to-potassium ratio to account for multicollinearity with the estimated daily salt intake.Results　The mean age was 60.9±9.0 years for men, and 58.0±8.7 years for women. The salt taste threshold was normal in 80.9% (n=903) of the participants (73.6% [n=251] men and 84.1% [n=652] women), and high in 19.1% (n=213) of the participants (26.3% [n=90] men and 15.9% [n=123] women). Multivariate analysis revealed that smoking habits were significantly associated with a higher salt taste threshold, with an odds ratio (95% confidence interval) of 2.51 (1.33-4.74) for all participants. The odds ratio for a high salt taste threshold was 1.45 (1.03-2.03) for the top 25% estimated daily salt intake group, showing a significant association with a high salt taste threshold. In the analysis by sex, smoking habits were associated with higher salt taste thresholds, while an association with estimated daily salt intake was observed only in men.Conclusion　Smoking status and estimated daily salt intake were associated with higher salt taste thresholds in healthy urban residents.

Objective　Several studies have suggested that high dietary Na/K ratio and body mass index (BMI) increase the prevalence of hypertension. However, there have been a few reports on the combination of these two factors and their relationship with hypertension. This study aimed to examine the association of the combined estimated 24-h urinary Na/K ratio (24h-u-Na/K) (high or low) and BMI (high or low) with the risk of high blood pressure.Method　We performed a cross-sectional study involving 1,112 participants (340 men and 772 women) of the Kobe Orthopedic and Biomedical Epidemiological study (KOBE study) who had no cardiovascular diseases or current anti-hypertensive medications. Sex-specific analyses were performed. The 24h-u-Na/K ratio was calculated from an estimation formula using collected spot urine. Participants were divided into four groups based on their 24h-u-Na/K ratio (low or high) and BMI (low or high), with the cutoff points being the median and 25 kg/m 2 , respectively.　Participants with systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥80 mmHg were diagnosed with high blood pressure. Odds ratios (ORs) for high blood pressure according to the combined risks of high 24h-u-Na/K and BMI were examined with a logistic regression analysis.Results　The average SBP/DBP for men and women was 122.7/77.9 and 113.3/69.1 mmHg, respectively, and prevalence of high blood pressure among men and women was 47.4% and 21.3%, respectively. The mean BMI was 22.8 kg/m 2 for men and 20.9 kg/m 2 for women. The median 24h-u-Na/K was 3.2 for men and 3.1 for women. The prevalence of high blood pressure (men, women) was the highest in the group in which both 24h-u-Na/K and BMI were high (60.0%, 62.9%; men: P=0.273; women: P<0.001). In the same group, the multivariate-adjusted ORs for high blood pressure were significantly higher for both men (2.59; 95% confidence interval [CI]: 1.15-5.86) and women (10.78; 95% CI: 4.87-23.88) compared to the reference group with both factors classified as low. Women with low BMI but high 24h-u-Na/K also demonstrated a higher risk for high blood pressure (OR: 1.62; 95% CI: 1.10-2.40).Conclusion　The risk of high blood pressure was the highest when both BMI and 24h-u-Na/K were high. The current specific healthcare guidance in Japan is focused on obese individuals. However, in order to prevent hypertension more effectively, additional focus should be placed on the Na/K diet. Increased intake of vegetables and fruits and reduced intake of salt should be strongly recommended.

Objective　To explore health-related and socioeconomic factors that can predict future deterioration in Psychological Distress Scale (K6) scores.Method　We conducted a baseline (2010, 2011) self-administered questionnaire survey of the Kobe Orthopedic and Biomedical Epidemiological study (KOBE study) involving 1,117 participants who had no previous history of cancer or cardiovascular diseases and were not under treatment for hypertension, diabetes, or dyslipidemia. We used the Japanese K6 as an indicator of stress and defined K6≧5 points as a high-stress group and K6<5 points as a low-stress group. A four-year follow-up survey (2014, 2015) was conducted on 1,004 people (follow-up rate of 90%). We excluded 39 participants with missing values, and 185 people whose K6 score was higher than 5 points at baseline. A final total of 780 participants' scores were examined for: gender, age, living situation, physical activity level, average sleep time, as well as the K6 score, the Japanese Hearing Handicap Inventory for Elderly (HHIE-S), and the Japanese Oswestry Disability Index (ODI). We conducted a logistic regression analysis using K6≧5 points at the four-year follow-up survey as the dependent variable and each factor at the baseline survey as the independent variable.Results　Of the 780 subjects analyzed, 132 (16.9%) were highly stressed (K6≧5 points) at the four-year follow-up point. A logistic regression analysis found age (40s/70s) (odds ratio 3.38, 95% confidence interval 1.45-7.86), living situation (single/living together) (odds ratio 1.98, 95% confidence interval 1.07-3.68), and ODI scores (every 1%) (odds ratio 1.05, 95% confidence interval 1.01-1.09), to all be significantly associated with high stress.Conclusion　This study suggests that age, living situation, and ODI scores are related to future stress.

Interstitial pneumonia has high risk for chemotherapy-related exacerbation. Chemotherapy-related exacerbation is often fatal with respiratory failure. When we treat the cancer patient with interstitial pneumonia, it is necessary for us to regard of the efficacy of chemotherapy, and the frequency and mortality of chemotherapy-related exacerbation. All anti-cancer drugs has the possibilities of chemotherapy-related exacerbation. The incidence of chemotherapy-related exacerbation was higher in patients with target therapy agent or immune-checkpoint therapy agent, though there is not an interstitial pneumonia patient. In patients complicated with interstitial pneumonia, you should not use of these drugs, such as target therapy agent or immune-checkpoint therapy agent.

Circadian rhythm of blood pressure (BP) has recently been focused on because increase in nocturnal BP and morning BP surge have been shown to be risks for cardio-cerebrovascular diseases independent of 24-h BP level. The renin-angiotensin-aldosterone system (RAAS) is involved in BP circadian rhythm, and RAAS inhibitors therefore play an important role in the control of circadian rhythm of BP. Bedtime administration of RAAS inhibitors is more effective than morning administration for reducing nocturnal and morning BP levels in addition to converting the BP profile into a dipper pattern, which is known as chronotherapy. For reducing cardio-cerebro-vascular events, controlling abnormal circadian rhythm of BP in addition to 24-h BP using RAAS inhibitors with optimal time dosing should be considered.

Many kinds of antihypertensive drugs have been used recently. JSH2009 supported that we should prescribe one of these drugs [calcium channel blockers, angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, diuretics and beta-adrenergic blockers] for hypertensive patients at first. In this review, we provide a brief overview of the ARBs and ACE inhibitors and discuss the clinical evidence related to the use of ACE inhibitors and ARBs. In accordance with JSH2009, we summarize the clinical backgrounds which we should use ARB or ACE inhibitors for hypertensive patients with: left ventricular hypertrophy, heart failure, atrial fibrillation, old myocardial infarction, protein urea, renal disturbance, chronic cerebral stroke, diabetes mellitus, metabolic syndromes and the elderly.

A 78-year-old man presented with upper abdominal pain. He underwent an abdominal computed tomography scan which revealed irregularly shaped mass lesions in the mesentery and in the pancreatic head and body. The mass lesions were suspected to be pancreatic cancer with peritoneal dissemination and a surgical biopsy was performed. Histologic studies revealed lymphoplasmacytic sclerosing pancreatitis with significant infiltration of IgG4-positive plasma cells. His serum IgG4 level was 223 mg/dl. Findings from histologic and serum studies were compatible with IgG4-related sclerosing disorders. The mass lesions responded to steroid therapy and disappeared. The difficulty in making a definitive diagnosis is discussed.

The renin-angiotensin system (RAS) has been demonstrated to play a critical role in the initiation and progression of atherosclerosis, thereby contributing to development of cardiovascular disease. Angiotensin II(Ang II), a major substrate in RAS, stimulates atherosclerosis through various deleterious effects such as endothelial dysfunction, cellular proliferation and inflammation. Recently, local RAS in vasculature is reported to play an important role. Many of these atherogenic actions of Ang II are mediated by reactive oxygen species(ROS). Investigation of the role of ROS and inflammation induced by RAS may provide a clue to understanding the pathophysiology of atherosclerotic diseases, and may lead to a new therapeutic strategy.

Arteriosclerotic renal artery stenosis is one of the increasingly common diseases that affects many aged patients. There are various non-invasive methods to diagnose renal artery stenosis, such as contrast enhanced CT or MRI. However, these methods are not appropriate for patients with renal dysfunction. Ultrasound sonography is becoming one of the promising methods to diagnose artery stenosis because of photographic improvements. In this case, a 72-year-old woman was hospitalized 7 months after nephrectomy because of severe hypertension, heart failure and kidney dysfunction. The heart failure was quite uncontrollable in spite of massive administration of diuretics, and finally, hemodialysis was started to control her volume status. In consideration of her past history and abdominal bruit, we evaluated the renal artery stenosis by ultrasound sonography and confirmed the diagnosis by renal angiography. To improve hypertension control, we performed renal artery stenting, which resulted in an impressive improvement of her blood pressure and renal function. We recognized the importance of careful causal evaluation of renal dysfunction, even though it is difficult to apply invasive therapy to patients after nephrectomy.

IL-33 is a member of the IL-1 family and has been identified as an agonist of ST2L. IL-33 drives the production of Th2-associated cytokines and IgE, and IL-33 administration induces eosinophilia and hypertrophy of bronchial epithelial cells, as well as mucus secretion in vivo. Such changes resemble pathological findings in bronchial asthma (BA). In this study, we investigated the relationship between IL-33 and BA by evaluating serum IL-33 levels. Serum was obtained from BA patients (n = 20), emphysema patients (n = 5) and from non-smoking healthy controls (n = 8). IL-33 levels were assayed by enzyme-linked immunosorbent assay. Then, we divided BA patients according to 5 factors; (1) IgE concentration, (2) eosinophil count, (3) current treatment, (4) classification of severity, and (5) smoking status. Atopic BA patients showed significantly higher IL-33 levels than non-atopic patients. IL-33 was significantly higher in untreated patients, and in the moderate and severely affected groups. Smoking BA and emphysema patients had lower levels than nonsmoking BA patients. Eosinophil counts were not related to IL-33 levels. The present study suggests that IL-33 is closely associated with IgE levels and the exacerbation of BA. We speculated that IL-33 elevation is responsible for the maintenance of airway inflammation and hypersensitivity. It is possible that low IL-33 levels in smokers are caused by the deterioration of the airway epithelium and endothelium.

We analyzed the clinical background of 63 patients with serologically confirmed cat scratch disease (CSD), Age range of the patients was 0 to 83 years old and mean age was 35.0 years old. Seasonal patterns of cases was observed. A number of patients with CSD was increased during the summer and fall. The peak incidence of CSD occurred in October. Infection followed direct cat or dog contact. Cat contact occurred in 61 cases (96.8%) and dog contact in 2 cases (3.2%). A specific contact with kittens occurred in 39 cases (61.9%). About 49.2% of patients had a cat scratch, 3.2% had a cat bite, 3.2% had a cat flea bite, 41.2% had no history of animal bite. The papule of inoculation site were seen in 27 cases (42.9%) of CSD. The upper extremities were the most likely locations for scratches. Sixty cases (95.2%) of CSD developed lymphadenopathy, 51.7% of the involved nodes were in the axillary, 31.7% were in the inguinal, 21.7% were in the cervical, 16.7% were in the elbow. The mean incubation period of patients with CSD was 18.9 days. The mean duration of lymphadenopathy after the treatment of antibiotics was 44.2 days. The mean value of white blood cell counts was 8130/microL. The mean value of C-reactive protein level was 2.83 mg/dL.

The renin-angiotensin system (RAS) has been demonstrated to play a critical role in the initiation and progression of atherosclerosis, thereby contributing to development of cardiovascular diseases. Angiotensin II (Ang II), a major substrate in RAS, stimulates atherosclerosis through various deleterious effects such as endothelial dysfunction, cellular proliferation and inflammation. Recently, local RAS in vasculature is reported to play an important role. Many of these atherogenic actions of Ang II are mediated by reactive oxygen species (ROS). Investigation of the role of ROS and inflammation induced by RAS may provide a clue to understanding the pathophysiology of atherosclerotic diseases, and may lead to a new therapeutic strategy.

A 61-year-old woman with a past history of splenectomy was admitted to our hospital because of high fever and loss of consciousness during interferon therapy for the treatment of chronic hepatitis type C. She died of multiple organ failure, and disseminated intravascular coagulation shortly after admission. The results of blood culture and the autopsy revealed sepsis due to streptcoccus pneumonia. The neutropenia and immunosuppression by interferon therapy induced overwhelming postsplenectomy infection (OPSI), a potentially rapidly fatal septicemia. When we perform treatment with immunosuppression such as interferon therapy or anticancer drug therapy to splenectomised patients, it is necessary to carry out pnemococcus vaccination. Splenectomy is performed for patients with thrombocytopenia of chronic hepatitis type C before interferon therapy. To avoid OPSI, partial splenic arterial embolization was discussed.

A 68-year-old man was referred to our hospital because of eosinophilia in peripheral blood and pancreatic tumor on abdominal US. He was accustomed to eating the raw flesh of wild boar and keeping wild boar, and under medical treatment for Diabetes. Pancreatic tumor was diagnosed to the pancreatic ductal cancer by the imaging examination and endoscopic transpapillary brushing cytology for pancreatic duct. The diagnosis of hepatic eosinophilic granuloma was done by aspiration biopsy for hepatic multiple small nodules. Because of the strong positive finding for nematose in the assay of multi dot-ELISA for parasite, hepatic eosinophilic granuloma caused by visceral larva migrans was accidentally complicated by pancreatic cancer, and operation for the pancreatic cancer was done. To bear this disease in mind and to research his life history, is important to diagnose hepatic multiple nodules with eosinophilia.

We distributed a questionnaire to 209 patients who visited the Digestive Disease Center of Kurume University for liver disease treatment from October 2006 to April 2007 to determine whether patients with hepatitis C virus (HCV) or hepatitis B virus (HBV) disclosed their disease status to dental clinics personnel. We found that 59.8% (125/209) always did so, 12.0% (25/209) sometimes did so, and 28.2% (59/209) never did so. The main reason (71.2%) for nondisclosure was failure of dental healthcare workers to ask whether patients had systemic disease. Other reasons included fear of negative reactions from healthcare workers (11.9%) and not wanting dentists or staff to know their specific liver ailment (10.2%). Men were less likely than women to disclose status for these reasons. It thus cannot be over emphasized that liver disease patients be advised by medical specialists to make known their HCV or HBV status when undergoing dental care. Above all, it is important for dental workers to take standard precautions with all patients to ensure medical safety and to prevent infection in dental practice. The government should take appropriate measures to encourage and support dentists who use precautions to prevent nosocomial infection.

A 57-year old woman received interferon alfa-2b and ribavirin combination treatment for chronic hepatitis C. High fever and lower abdominal pain developed 10 months after the start of treatment. Antibiotic drugs were not effective. After two weeks, colonoscopic findings revealed a periappendiceal abscess. After colonoscopy study, fever decreased. We have to suspect abscess formation too as appearing a high fever during interferon and ribavirin combination treatment.

A 64-year-old man was admitted for further examinations of a liver tumor. The patient was diagnosed as chronic hepatitis C complicated with advanced hepatocelluar carcinoma (HCC) with left portal vein tumor thrombosis. As he refused surgical treatment, hepatic arterial infusion chemotherapy (HAIC) using cisplatin and 5-fluorouracil was performed initially. Administration of ursodesoxycholic acid (UDCA) was also started. Following HAIC, microwave coagulation therapy for residual tumor was added. Consequently, viable lesions of HCC disappeared completely. At present, after more than 8 years, neither signs of tumor recurrence, nor elevation of hepatic enzymes has been observed. Although the precise reason for long survival of this patient is not known, we speculate that suppression of levels of hepatic enzymes, as well as HAIC for subclinical intrahepatic metastasis, contributed to the good outcome. Therapeutic strategy for hepatic inflammation seems to be important for long-term prevention of hepatocarcinogenesis.

Although various therapies have been tried to improve advanced nonresectable pancreatic cancer, a sufficient consensus has not yet been obtained about the treatment. We have performed arterial infusion chemotherapy for pancreatic cancer in order to maintain QOL. The response rate was 17.3%, the mean survival time 282.1+/-204.7 days, median survival time 243.0+/-84.7 days, and many patients were continuously treated on an outpatient basis. It is thus expected that survival time and maintenance of QOL can be extended by self-sustaining arterial infusion chemotherapy.

The patient was a 58-year-old female. Though she had been in good health, increased hepatobiliary enzymes were detected in a health examination. She visited our hospital for close examination. The serum IgG4 level was normal, but ERCP and MRCP showed band-like stricture and beaded appearance of the bile ducts. A diagnosis of primary sclerosing cholangitis (PSC) was made. Since hyperlipidemia was also observed, oral administration of bezafibrate (400mg/day) alone was performed as the initial treatment, and transaminase, ALP, and GGT rapidly decreased. These results suggested that the initial administration of bezafibrate alone is effective against PSC.

A 80-year old man was referred to our hospital because of an elevation of serum amylase level. Diffuse enlargement of the pancreas was detected by abdominal computed tomography, and also diffuse narrowing of the main pancreatic duct was revealed using endoscopic retrograde cholangiopancreatography. The serum level of IgG was elevated to 3450mg/dl. Besides, on the 10th hospital day, petechia developed and the platelet level decreased to 1.5 x 10(4)/microl. The platelet-associated IgG, antiplatelet antibody and antinuclear antibody in serum were positive. The levels of serum complements were low. From all these findings the patient was diagnosed as autoimmune pancreatitis complicated with immune thrombocytopenia. The treatment with prednisolone was started, which was effective on each disease. The medication was suspended a year ago, and so far there is no data suggesting the recurrence of autoimmune pancreatitis or immune thrombocytopenia.

The renin-angiotensin system(RAS) has been demonstrated to play a critical role in initiation and progression of atherosclerosis, thereby contributing to development cardiovascular diseases. Angiotensin II(Ang II), major substrate in RAS, stimulates atherosclerosis through various processes such as endothelial dysfunction, cellular proliferation and inflammation. Recently, local RAS in vasculature is reported to play an important role. Many of these atherogenic effects of Ang II are mediated by reactive oxygen species(ROS). Investigation of the role of ROS and inflammation induced by RAS may provide a clue to understanding the pathophysiology of atherosclerotic diseases, and may lead to a new therapeutic strategy.

Atherosclerosis is responsible for more than half of all deaths in western countries. Numerous studies have reported that exuberant accumulation of smooth muscle cells plays a principal role in the pathogenesis of vascular diseases. It has been assumed that smooth muscle cells derived from the adjacent medial layer migrate, proliferate and synthesize extracellular matrix. Although much effort has been devoted, targeting migration and proliferation of medial smooth muscle cells, no effective therapy to prevent occlusive vascular remodeling has been established. Recently, we reported that bone marrow cells substantially contribute to the pathogenesis of vascular diseases, in models of post-angioplasty restenosis, graft vasculopathy and hyperlipidemia-induced atherosclerosis. It was suggested that bone marrow cells may have the potential to give rise to vascular progenitor cells that home in the damaged vessels and differentiate into smooth muscle cells or endothelial cells, thereby contributing to vascular repair, remodeling, and lesion formation. This article overviews recent findings on circulating vascular precursors and describes potential therapeutic strategies for vascular diseases, targeting mobilization, homing, differentiation and proliferation of circulating progenitor cells.

At present, in Japan, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection by blood transfusion rarely happens. However, according to the national survey, outbreak of sporadic acute hepatitis B and C is reported every year and viral hepatitis induced by iatrogenic infection is also reported. We think that education and enlightenmen for measures of infection control for hepatitis virus in dentisal medical care are important. Therefore, we carried out a questionnaire survey about measures of an infection control including hepatitis B and C for 352 students of a certain faculty of dentistry and a dental hygienist school. 35.5% of the total students thought the defense of oneself against infection was more important than defense of cross infection. Furthermore, the prevalence of the student who thought to permit recycle of a disposer glove and a disposer cartridge of a local anesthesia was 13.1% (46/352), 14.8% (52/352), respectively. The prevalence of students who recognized that HCV and HBV were detected from not only blood but also body fluid such as saliva remained in 65.3%. Consequently, the reality that knowledge of hepatitis virus and understanding about sterilization and disinfection of instruments were low became clear. In conclusion, immediate making of the guideline that aimed at standardization of prevention of hospital infection in domestic dental treatment and education to introduce the curriculum with a high regard for risk management of infection for students of dentistry will be required. In addition, it is an important problem to spread thoughts of standard precautions for dentistry.

A 68-year-old man was diagnosed as having bronchial asthma in November 1996. He presented with leukocytosis in June 2002. The WBC count was 29,900/microliter with 82% mature neutrophils showing toxic granules. The neutrophil alkaline phosphatase score and serum level of vitamin B12 were elevated. Bone marrow demonstrated myeloid hyperplasia and plasmacytosis. Cytogenetic and molecular analyses were negative for Philadelphia chromosome and BCR/ABL fusion gene. Lambda-type Bence-Jones protein was detected on the serum and urinary immunoelectrophoresis. The coexistence of chronic neutrophilic leukemia and myeloma was suspected based on the clinical features. The serum level of granulocyte-colony stimulating factor (G-CSF) was elevated. Immunohistochemically, atypical plasma cells were positive for anti G-CSF antibody. Finally, we diagnosed this patient as having a G-CSF-producing myeloma. Treatment with melphalan and prednisolone was initiated without beneficial response. He was then admitted to our hospital for ROAD therapy (ranimustine, vincristine, melphalan, and dexamethasone). The neutrophil count decreased in parallel with the serum G-CSF level. These observations indicated that the neutrophilia in this case was probably caused by a reactive response to G-CSF secreted from the myeloma cells.