Search

Monoclonal immunoglobulin deposition diseases (MIDDs), including light and heavy chain deposition disease (LHCDD), are rare and heterogeneous disorders associated with underlying B-cell clonal disorders. Adrenal involvement is a potential extrarenal manifestation of MIDDs; however, limited data are available regarding its prevalence and clinical presentation. Herein, the present report describes, for the first time, a case of primary adrenal insufficiency that developed twenty-two years after a diagnosis of LHCDD had been made. A 69 year-old woman with a 10 year history of hemodialysis suddenly became bedridden after falling down stairs in the absence of focal neurological deficits. Subsequently, she experienced appetite loss, nausea, vomiting, a fever of unknown origin, and unexplained hypotension. Several months later, primary adrenal insufficiency and normal pressure hydrocephalus were diagnosed and successfully managed. The long-term clinical prognosis of MIDDs has not been fully elucidated despite recent advances in the management of the disorders. This report may contribute to improving our understanding of the disease course., (© 2024. The Author(s), under exclusive licence to Japanese Society of Nephrology.)

Cardiovascular diseases (CVDs), such as heart disease and stroke, have a significant impact on life expectancy, healthy life expectancy, and medical costs in Japan. Each prefecture is currently promoting measures in accordance with the Japanese National Plan for Promotion of Measures Against Cerebrovascular and Cardiovascular Disease, which was established by the government. In recent years, the crude mortality rate of heart disease in Japan has been increasing year by year with the aging population. Meanwhile, the age-adjusted mortality rate has leveled off or shown a downward trend. In addition, the proportion of acute myocardial infarction has decreased, whereas the proportion of heart failure has increased. By contrast, both the crude and age-adjusted mortality rates of stroke have a declining trend. Nevertheless, considering the potential variations in death certificates issued for patients with myocardial infarction across different prefectures, it is crucial to determine the incidence of CVD in each prefecture for the accurate assessment of CVD trends. However, as for the incidence of CVD, not many prefectures have yet implemented registration programs. The age-adjusted incidence rate of acute myocardial infarction has been increasing in some areas and decreasing in others since 1990. The age-adjusted incidence rate of stroke has consistently declined since the 1960s. Nevertheless, the possible increase in the incidence rate of cerebral embolism and thrombotic cerebral infarction among patients with different stroke subtypes is a cause of concern. The impact of heart failure on the incidence of heart disease has increased. Therefore, relevant academic societies and prefectures must collaborate in registering the incidence of heart failure as well as myocardial infarction and implementing countermeasures., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Melanoma metastases to the CNS rank third in frequency, just after lung and breast metastases. There is controversy regarding the factors predisposing to developing CNS metastases in patients with cutaneous melanoma and their survival with conventional treatments., Methods: We carried out a retrospective analysis in a third-level hospital in Mexico to determine epidemiological aspects of melanoma metastases to the central nervous system, factors related to its appearance, clinical presentation, and survival in three treatment groups: surgery, radiotherapy, and conservative management., Results: We found that the nodular variant has the most significant association with CNS metastases. In addition, the superficial spreading variant has the highest risk of presenting a more substantial number of lesions, up to seven for each case and predominantly in the infratentorial space. On the other hand, we found more remarkable survival in patients treated only with surgery than those treated with radiotherapy or conservatively., Conclusions: This study lays the foundations for future prospective survival analysis of the different current treatment modalities for metastatic melanoma in the brain and spine. It also highlights the clinical risk factors for metastatic brain and spine tumors of melanoma., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The 2011 Great East Japan Earthquake has resulted in a nuclear accident, forcing residents of the surrounding areas to evacuate. To determine any association between excessive drinking and hypertension in the setting of disaster, we assessed whether the proportion of excessive drinkers increased and if post-disaster excessive drinking was a risk factor for hypertension., Methods: This retrospective study assessed data from the Japanese National Database. Cumulative population data for Fukushima Prefecture (3,497,576 people) were analyzed by categorizing residents into four areas-evacuation, coastal, central, and mountainous-to calculate the proportion of excessive, heavy (equivalent to binge drinking), and at-risk drinkers for 2008-2017. The hazard ratios (HRs) for the incidence of hypertension for 2012-2017 were examined in association with changes in drinking status pre- and post-disaster, which included 136,404 people who received specific health checkups pre-disaster (2008-2010) and post-disaster (2011-2012)., Results: The proportion of excessive drinkers among women increased after the disaster in all areas examined. The association between excessive drinking and the incidence of hypertension was determined among men and women in all areas; it was stronger among women in the evacuation areas, with the sex- and age-adjusted HRs for the incidence of hypertension of 1.41 for pre-disaster excessive drinking, 2.34 for post-disaster excessive drinking, and 3.98 for pre- and post-disaster excessive drinking, compared with not excessive drinking pre- and post-disaster., Conclusion: Excessive drinking post-disaster may be associated with an increased risk of hypertension among men and women, especially among women in the evacuation areas.

A 77-year-old male patient on maintenance hemodialysis therapy who underwent unilateral adrenonephrectomy 9 years ago was transferred to our hospital after 4 months of acute treatment for skull base osteomyelitis. He presented with unexplained hypotension during dialysis sessions. Further evaluation led to a diagnosis of primary adrenal insufficiency, followed by the start of oral hydrocortisone. Six months after admission, the patient was found to have a positive COVID-19 result on a rapid antigen test and mild symptoms. The patient complained of fatigue after the disappearance of the symptoms. Subsequently, the systolic blood pressure gradually declined despite the additional administration of fludrocortisone and caused difficulties in undergoing hemodialysis. The patient's lasting fatigue raised a suspicion of post-COVID-19 syndrome, requiring larger dosages of corticosteroids by stress dosing. Hypotension was interpreted as a symptom associated with adrenal insufficiency. The dosages of corticosteroids were increased beyond the upper recommended limits. The effect eventually stabilized the patient's hemodynamics. Hydrocortisone was increased as follows: 35 mg/day for nondialysis days and 55 mg/day for dialysis days, divided into three or four doses per day (20 mg in the morning, 20 mg before dialysis, 10 mg in the afternoon, and 5 mg in the evening). The dosage of fludrocortisone was increased up to 0.5 mg/day. In conclusion, the requirement for corticosteroids significantly increased in association with post-COVID-19 syndrome. The management of patients with adrenal insufficiency in the context of concomitant post-COVID-19 syndrome needs further investigation., (© 2023. The Author(s) under exclusive licence to The Japan Society of Nephrology.)

Competing Interests: Dr. Ikeda reports grants from JSPS KAKENHI received during the study period. Dr. Saito reports grants received from the 8020 Promotion Foundation during the study period. Dr. Tanigawa reports grants received from JSPS KAKENHI during the study period. The remaining authors have nothing to disclose.

Background: Laughter has been reported to have various health benefits. However, data on the long-term effects of laughter interventions on diabetes are limited. This study aimed to investigate whether laughter yoga can improve glycemic control among individuals with type 2 diabetes., Methods: In a single-center, randomized controlled trial, 42 participants with type 2 diabetes were randomly assigned to either the intervention or the control group. The intervention consisted of a 12-week laughter yoga program. Hemoglobin A1c (HbA1c), body weight, waist circumference, psychological factors, and sleep duration were evaluated at baseline and week 12., Results: Intention-to-treat analysis showed that participants in the laughter yoga group experienced significant improvements in HbA1c levels (between-group difference: -0.31%; 95% CI -0.54, -0.09) and positive affect scores (between-group difference: 0.62 points; 95% CI 0.003, 1.23). Sleep duration tended to increase in the laughter yoga group with a between-group difference of 0.4 hours (95% CI -0.05, 0.86; P = 0.080). The mean attendance rate for laughter yoga program was high (92.9%)., Conclusions: A 12-week laughter yoga program is feasible for individuals with type 2 diabetes and improves glycemic control. These findings suggest that having fun could be a self-care intervention. Further studies with larger numbers of participants are warranted to better evaluate the effects of laughter yoga., Clinical Trial Registration: http://www.chinadrugtrials.org.cn, identifier UMIN000047164., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hirosaki, Ohira, Wu, Eguchi, Shirai, Imano, Funakubo, Nishizawa, Katakami, Shimomura and Iso.)

Since the Great East Japan Earthquake in March 2011, an increase in lifestyle-related diseases due to changes in living environment following the nuclear power plant accident has been reported in Fukushima Prefecture, especially among evacuees. However, no long-term studies covering the entire Fukushima Prefecture have been conducted. The study aim was to investigate the effects of post-disaster evacuation life on the prevalence of dyslipidemia in Fukushima Prefecture using a national database. The data from 3,866,674 people who underwent specific health checkups between fiscal year (FY) 2008 and FY2017 were analyzed. Fukushima Prefecture was divided into four areas, and the prevalence of dyslipidemia and related parameters were compared. The prevalence of dyslipidemia increased overall, with a particularly sharp increase after FY2011 in the evacuation area. The sex- and age-adjusted odds ratio (95% confidence intervals) of having dyslipidemia in the evacuation area compared with that in the control area was 0.951 (0.929-0.973) in FY2008-2010, which increased to 1.130 (1.105-1.155) in FY2012-2014 and 1.117 (1.092-1.143) in FY2015-2017. Since the prevalence of dyslipidemia has increased and remained high after the earthquake in Fukushima Prefecture, especially in the evacuation area, continued measures to prevent cardiovascular diseases among the residents are needed.

A novel healthy diet index for dietary quality can be used to assess food intake. After the Great East Japan Earthquake in 2011, the Fukushima Health Management Survey collected dietary data using a short-form food frequency questionnaire (FFQ). The current study included eligible participants ( n = 64,909) aged 16-84 years who answered the FFQ in 2011. The year- and sex-specific dietary patterns were determined via principal component analysis. Based on the typical Japanese, juice/dairy, and meat patterns, healthy diet index (HDI) scores were assigned for food items, resulting in Spearman's correlation coefficients of 0.730, -0.227, and -0.257, respectively. The mean (standard deviation) of the HDI scores (range: 1-18) were 9.89 (2.68) in men and 9.96 (2.58) in women. Older individuals, women, nonsmokers, those in good health and with regular physical exercise, and those who did not transfer residences had a high HDI score. In the confirmatory analysis, the adjusted odds ratio (95% confidence interval) of the highest vs. the lowest quartiles of HDI scores was 0.87 (0.80, 0.94) for overweight, 0.89 (0.81, 0.97) for large waist circumference, and 0.73 (0.66, 0.80) for dyslipidemia. The HDI score obtained using the FFQ can be applied to evaluate dietary profiles.

Objective: To examine the association between positive psychological factors and the risk of pneumonia-associated mortality in a large prospective Japanese cohort., Methods: The Japan Collaborative Cohort Study assessed 64,231 participants (26,293 men and 37,938 women), aged 40-79 years, without a history of stroke, myocardial infarction, cancer or tubercules at baseline (1988-1990). We used self-administered questionnaires about lifestyle, medical history, and mental states, including three positive psychological factors, and followed-up for mortality outcomes until the end of 2009. The Cox proportional hazard model was used to calculate the multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) of pneumonia-associated mortality after adjustment for potential confounding factors, mutually positive psychological factors, and consideration for the competing risk., Results: Having Ikigai (in Japanese) was inversely associated with the risk of pneumonia-associated mortality in both men and women; the multivariable HRs (95% CIs) for high versus low levels were 0.68 (0.48-0.97), P trend =0.090 and 0.66 (0.43-1.00), P trend =0.146, respectively. Such inverse associations were more pronounced in working men and non-working women; the multivariable HRs (95% CIs) for high versus low levels were 0.52 (0.32-0.85), P trend =0.010 and 0.59 (0.37-0.94), P trend =0.079, respectively. Being relied upon by others and Enjoyment of life was not associated with the risk in both genders., Conclusion: Having Ikigai was associated with a lower risk of pneumonia-associated mortality in both genders, especially in working men and non-working women., (Copyright © 2022 Elsevier Inc. All rights reserved.)

There has been an increase in lifestyle-related diseases in Fukushima Prefecture since the Great East Japan Earthquake. However, the overall long-term trends of lifestyle-related diseases in the Fukushima Prefecture according to the evacuation and other area are not reported. Therefore, we examined the long-term trends in the prevalence of metabolic syndrome before and after the Great East Japan Earthquake in Fukushima Prefecture according to these areas using a national database. The target population was approximately 330,000-440,000 per year; Fukushima Prefecture residents aged 40-74 years who underwent specific health check-ups during 2008-2017 participated in the study. Fukushima was divided into mountainous, central, coastal and evacuation areas. Using the Poisson regression model, the prevalence of metabolic syndrome in each fiscal year was determined by gender and age group for each location and compared before and after the disaster as well as between areas. Prevalence increased significantly throughout the observation period, particularly in the evacuation area. Age- and gender-adjusted prevalence rates significantly increased from 16.2% in 2010 to 19.5% in 2012 (prevalence ratios = 1.21) and 20.4% in 2017 in the evacuation area. Among other areas, coastal areas showed the highest increase with 17.9% (2017), followed by central areas with 16.5% (2017) and mountainous areas with 18.3% (2016). These increases were particularly high among men and the elderly. The prevalence of metabolic syndrome increased rapidly after the disaster, especially in evacuation area, and continued for subsequent 6-7 year. Long-term monitoring and measures to prevent lifestyle-related diseases are needed after major disasters, especially in evacuation areas, among men and the elderly.