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Anemia is a risk factor for frailty. Although various factors can reduce the risk of anemia, information on dietary contributions is limited. This study aimed to evaluate the association between anemia and eating patterns in Japanese elderly. Our study included 6,864 elderly individuals, aged ≥65 y, whose data were obtained from the 2010-2015 National Health and Nutritional Survey, Japan. Anemia was defined as whole blood hemoglobin concentrations

With the worldwide spread of the COVID-19 vaccine program during the COVID-19 pandemic, the numbers of reported cases with new-onset or relapsed kidney disease/vasculitis such as minimal change nephrotic syndrome, immunoglobulinA (IgA) nephropathy, and IgA vasculitis (IgAV) that developed after COVID-19 vaccination are increasing. We present the case of a 67-year-old Japanese woman who developed IgAV with purpura on her extremities and trunk in the evening of the day that she received the second dose of the Pfizer-BioNTech COVID-19 vaccine. She subsequently presented with acute kidney injury and nephrotic syndrome, and a kidney biopsy performed 14 days after the second vaccination showed diffuse mesangial and endocapillary glomerulonephritis with necrotizing crescent formation, accompanied by IgA deposition. One steroid pulse plus four administrations of a monthly intravenous cyclophosphamide injection were applied, followed by oral azathioprine during oral steroid tapering. Her response to this treatment was unsatisfactory and intractable for some time. Eventually, her renal function improved and nephrotic syndrome was resolved, while microscopic hematuria and proteinuria at ~ 1 g/gCr remained at 6 months post-vaccination. Unlike the previous milder renal-involved IgAV cases following COVID-19 vaccination, our patient's case presented severe glomerulonephritis and took a long time to recover despite intensive initial immunosuppressive treatment.

Background The Ministry of Health has reported that in Japan, the Shiga prefecture has the highest life expectancy. Subjective health perception is a predictive indicator of mortality. For this study, we examined the association between subjective health perception and multiple lifestyle factors. Methods Data were obtained from the 2015 Health and Nutrition Survey in Shiga prefecture. The analytic sample comprised 6057 adults aged 20 or older. Information on subjective health perception and lifestyle behaviors was obtained from a self-administered questionnaire. As for subjective health perception, participants were divided into 2 groups: (1) Excellent or Good and (2) Average, Poor, or Very Poor. A 1-day dietary survey was also administered. The health behaviors score (HBS) was calculated based on 5 factors: consuming a healthy diet, never smoking, low-risk alcohol drinking, regular exercise, and moderate sleep duration. HBS scores ranged from 0 to 5. Multiple logistic regression was used to calculate the sex-, age- BMI- and energy intake-adjusted odds ratios (ORs) of poor subjective health across HBS, with 0 points as the reference. Results Among all participants, 2397 (39.6%) individuals were classified into the good subjective health group. Participants with an HBS of 3 (OR 0.59, 95% CI 0.37–0.96), 4 (OR 0.40, 95% CI 0.24–0.65) or 5 (OR 0.33, 95% CI 0.19–0.59) had a lower OR of rating themselves as being average/poor health compared with those having zero. The association with a higher HBS was remarkable (p for trend: Conclusions This study showed that the higher the number of healthy lifestyle factors, the lower risk of subjective average/poor health. Combinations of healthy lifestyle factors, especially those involving exercise, suggest good subjective health for individuals living in the Shiga prefecture.

The estimated 20-year renal survival rate of immunoglobulin A (IgA) nephropathy is approx. 60%, but it is difficult to determine the 'big picture' for IgA nephropathy because a biopsy is essential for its diagnosis. Here we attempted to determine the longer and more precise renal prognosis of IgA nephropathy. We examined 310 patients with primary IgA nephropathy. Using the patients' clinical records and histological reports from our hospital and other clinics, we surveyed their renal prognoses and treatments within 1 year post-biopsy, and we sent questionnaires to the patients who had stopped visiting any hospital. We set renal death as the primary endpoint and analyzed factors related to renal death. The total patient cohort was 267: 159 males, 108 females; average age at biopsy, 37.7 years; average estimated glomerular filtration rate (eGFR), 69.7 mL/min/1.73m2; urinary protein, 1.3 g/day. The mean follow-up duration was prolonged to 13.8±8.9 years (vs. 9.2±8.5 years using only medical records). The 10- and 20-year follow-up rates were 61.7% and 27.3%. The 10-, 20-year renal survival rates were 83.6% and 72.5%. Lower eGFR, hypertension, and smoking were revealed as factors independently related to renal death. To study survival of relatively benign diseases such as IgA nephropathy, longer survival rate was affected by many censoring cases. The results regarding the long-term renal prognoses of IgA nephropathy patients (including those with a mild phenotype) obtained by our analysis of a questionnaire sent to the patients provided more precise and longer-term prognoses compared to earlier studies.

We investigated oral glucose tolerance and tryptophan (Trp) metabolism in non-obese and non-insulin-dependent diabetic Goto-Kakizaki (GK) rats fed high-Trp diets. Five-week-old male Wistar and GK rats were fed a 20% casein diet (control diet) or the same diet supplemented with 1%, 2%, 3%, or 5% Trp for 58 d. Oral glucose tolerance tests were performed on Days 14 and 28 of the experimental period. Urine as well as livers and blood were collected on the last day of the experiment. The glucose concentration and the amount of Trp metabolites were measured. On Day 14 of the experiment, the incremental blood glucose concentrations integrated over a period of 2 h (ΔAUC0-2h) of blood glucose in rats fed the 3% and 5% Trp diets had decreased by 13% and 18%, respectively, compared with that of the control-GK rats. However, no significant differences were found in the rats fed +1% or +2% Trp diets compared with control-GK rats. On Day 28, there were no significant differences found in the ΔAUC0-2h of blood glucose levels in any group including the control-GK group. On the last day, the concentrations of plasma glucose, total cholesterol, and triglyceride did not show differences in any group. There were no specific phenomena observed in the metabolism of Trp in GK rats even when fed an excess of Trp, compared with that of Wistar rats. Oral Trp administration and its continuous use may not improve blood glucose levels in type 2 diabetic rats.

Two patients with a chronic, barking cough were diagnosed with psychogenic cough. Using an original cough counter we studied the nocturnal cough count and pattern. While the number of coughs when awake was extremely high for both patients, the number of coughs was remarkably reduced during sleep, similar to an exacerbation of asthma. Moreover, the properties of the coughs when awake were clearly different from those of coughs during sleep. In conclusion, an objective examination using a cough counter was useful for the diagnosis, treatment and management of psychogenic cough.

A 38-year-old Japanese man who had undergone clipping surgery for a ruptured aneurysm of the anterior communicating artery 2 days prior, suddenly developed refractory hypernatremia (serum sodium (Na) 156 - 162 mmol/L). Symptoms included low plasma vasopressin, fluctuating urine osmolality (120 - 710 mOsm/kg) and lack of thirst, all suggesting adipsic diabetes insipidus (ADI). Hypernatremia was corrected by scheduled water intake with desmopressin administration. During 1-year follow-up after the surgery, his serum Na level normalized despite the suspension of desmopressin, but neither thirst nor osmolality-dependent vasopressin release recovered. Meanwhile, his urine osmolality shifted to a constant high level. The present case suggests that renal compensatory adaptation, apparently independent of the circulating vasopressin level, plays a major role in water handling in longitudinal ADI. .

A cross-sectional study was conducted among 7593 adults to clarify lifestyle and psychosocial characteristics of breakfast skippers with different intention and self-efficacy toward eating breakfast. Data were obtained from Japan’s national survey in 2009. Multinomial logistic regression analyses were performed to examine the characteristics of each breakfast skipper (having intention and self-efficacy toward eating breakfast [IS], having intention but not self-efficacy [INS], and not having intention to eat breakfast [NI]) compared with breakfast eaters. IS men were less likely to demonstrate understanding of healthy eating. INS and NI men were more likely to eat alone. INS and NI women were less likely to demonstrate understanding of healthy eating. NI men and women were less likely to report weight management behavior. Current smoking and being sleep-deprived were commonly associated with breakfast skipping in both sexes. Our results suggested the need for approaches considering type of breakfast skippers (eg, different intention and self-efficacy).

Information about an association between animal food intakes and risk of anemia is still limited. This study aimed to investigate the association between fish and meat intake and anemia risk in the Japanese elderly.A nationally representative sample of 6,469 aged 65 years and over was obtained from pooled data of annual National Health and Nutritional Survey in Japan during 2002-2011. Anemia was defined as hemoglobin concentrations13.0 g/dL in males and12.0 g/dL in females. Logistic regression analysis, with the lowest intake tertile as the reference, was applied to estimate anemia risk for each nutrient and food group.After adjustment for putative confounding factors, males in the highest tertile of animal protein intake had significantly lower risk of anemia than those in the lowest tertile (odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63, 0.95; p for trend=0.017). These associations were not seen in females (OR: 0.72, 95% CI: 0.49, 1.06; p for trend=0.100). Multivariate analyses revealed that anemia risk (OR: 0.80; 95% CI: 0.65, 0.97; p for trend =0.002) was lower for males in the highest tertile of fish intake than in the lowest tertile; this effect was also observed for females (OR: 0.64; 95% CI: 0.45, 0.92; p for trend =0.014). In both sexes, the highest tertile of meat intake was not associated with lower anemia risk in the multivariate-adjusted models.The current cross-sectional study in Japanese elderly males suggests that higher animal protein, specifically the high protein content of fish may be associated with a lower prevalence of anemia.

Background: To decrease mortality, the benefit of combined healthy lifestyles has been suggested but is still unclear, especially for cause-specific mortality. We examined the relationship between combined lifestyle factors and all-cause and cause-specific mortality in Shiga prefecture, Japan. Methods: This was an ecological study of 19 municipalities, using the data from the 2008&ndash, 2012 standard mortality ratio (SMR) reported by the Ministry of Health and Welfare and the 2015 Health and Nutrition Survey in Shiga prefecture. The health behaviors score was calculated based on five factors (ranging from 0 to 5): diet quality (assessed adherence to dietary reference intake for Japanese), smoking, alcohol drinking, regular exercise, and sleep duration. In the multiple linear regression, the relationships between the health behaviors score and SMR of all-cause, cancer, heart diseases, and cerebrovascular diseases were estimated by sex. Results: The health behaviors score was negatively associated with the cancer SMR in women (&beta, = &minus, 0.968, p = 0.011). For other causes, no significant association was found for either sex. A greater proportion of those who never smoked (&beta, 0.780, p = 0.016) and those who had a higher quality diet (&beta, 0.703, p = 0.048) were associated with lower cancer SMR in women. Women&rsquo, s intake of some micronutrients, particularly fruits, was higher than men. This study suggests that a combination of health behaviors, especially never smoking and high-quality diet intake are associated with lower cancer SMR in women and could be helpful in prolonging life expectancy.

Background Anaemia is a common complication of patients with antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis. Nevertheless, the cause and degree of such cases of anaemia have not been elucidated in detail. We aimed to investigate the prevalence, cause, pathogenesis of anaemia and the impact of anaemia on prognosis in patients with ANCA-associated renal vasculitis. Methods We identified 45 patients with ANCA-associated renal vasculitis that were clinically and/or histologically diagnosed and treated from 2003 to 2014 at University of Tsukuba Hospital. The relationships between anaemia and various clinicopathological findings were evaluated. Results At the time of diagnosis of ANCA-associated renal vasculitis, all patients showed anaemia, with a mean haemoglobin level of 7.5 ± 1.3 g/dL. Renal anaemia was diagnosed in 92% of patients, anaemia of chronic disease (ACD) in 56%, and anaemia due to hemorrhage in 20%. Next, the patients were divided into two groups according to anaemia severity: minimum haemoglobin (min Hb)

A cross-sectional study was conducted among 7593 adults to clarify lifestyle and psychosocial characteristics of breakfast skippers with different intention and self-efficacy toward eating breakfast. Data were obtained from Japan's national survey in 2009. Multinomial logistic regression analyses were performed to examine the characteristics of each breakfast skipper (having intention and self-efficacy toward eating breakfast [IS], having intention but not self-efficacy [INS], and not having intention to eat breakfast [NI]) compared with breakfast eaters. IS men were less likely to demonstrate understanding of healthy eating. INS and NI men were more likely to eat alone. INS and NI women were less likely to demonstrate understanding of healthy eating. NI men and women were less likely to report weight management behavior. Current smoking and being sleep-deprived were commonly associated with breakfast skipping in both sexes. Our results suggested the need for approaches considering type of breakfast skippers (eg, different intention and self-efficacy).

Objectives: To determine the association between protein intake and risk of higher-level functional decline in older community-dwelling adults. Design: Prospective. Setting: Ohasama Town, Japan. Participants: Residents (N = 1,007; mean age 67.4 ± 5.5) free of functional decline at baseline; follow-up was conducted for 7 years. Measurements: Nutrient and food intakes were determined using a validated 141-item food frequency questionnaire. Participants were divided into quartiles according to intake levels of total, animal, and plant protein. Subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence subscales were used to assess higher-level functional decline. Logistic regression analysis was used to examine the future risk of higher-level functional decline in relation to protein intake, with lowest protein intake as reference. Results: During the study period, 24.4% of eligible participants reported declines in higher-level functional capacity. After adjustment for putative confounding factors, men in the highest quartile of animal protein intake had significantly lower risk of higher-level functional decline than those in the lowest quartile (odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.20�0.83; P for trend .01). These associations were not seen in women (OR = 0.76, 95% CI = 0.41�1.34; P for trend .37). No consistent association was observed between plant protein intake and future higher-level functional decline in either sex. Conclusion: Higher protein, particularly animal protein, was associated with lower risk of decline in higher-level functional capacity in older men. Animal protein intake may be a modifiable indicator for early detection and prevention of higher-level functional decline in elderly adults.

Summary Limited T cell availability and proliferative exhaustion present major barriers to successful T cell-based immunotherapies and may potentially be overcome through the use of “rejuvenated” induced pluripotent stem cells derived from antigen-specific T cells (T-iPSCs). However, strict antigen specificity is essential for safe and efficient T cell immunotherapy. Here, we report that CD8αβ T cells from human T-iPSCs lose their antigen specificity through additional rearrangement of the T cell receptor (TCR) α chain gene during the CD4/CD8 double positive stage of in vitro differentiation. CRISPR knockout of a recombinase gene in the T-iPSCs prevented this additional TCR rearrangement. Moreover, when CD8αβ T cells were differentiated from monocyte-derived iPSCs that were transduced with an antigen-specific TCR, they showed monoclonal expression of the transduced TCR. TCR-stabilized, regenerated CD8αβ T cells effectively inhibit tumor growth in xenograft cancer models. These approaches could contribute to safe and effective regenerative T cell immunotherapies.

The Japanese population routinely consumes iodine-rich seaweed, thereby probably making Japan the nation with the highest iodine intake worldwide. The present study aimed to estimate the duration of dietary records (DRs) needed to calculate the usual iodine intake and to ascertain the frequency of iodine intakes above the tolerable upper intake level (UL) in the Dietary Reference Intakes for Japanese. Four 3-d DRs for the 4 seasons within a year were collected for 55 men and 58 women. On the basis of analysis of variance, the total variance in iodine intake was classified into inter-individual and intra-individual components. The frequency of appearance for high iodine intakes was estimated. The most commonly consumed types of iodine-containing food items were seaweed, milk and milk products, fish and shellfish, and tofu. The percentage contribution of intra-individual variance was markedly greater than that of inter-individual variance, and the excessive iodine intake was intermittent rather than continuous. The duration for which dietary records were required to assess the usual intake of iodine within 10% of their true mean was 6,276 d for men and 4,953 d for women. The period that transpired until a value was exceeded once was 6.3 d/occurrence for values above UL (2,200 μg), 8.5 d/occurrence for values above 3,000 μg, 9.8 d/occurrence for values above 4,000 μg, 11.2 d/occurrence for values above 5,000 μg, and 16.7 d/occurrence for values above 10,000 μg. To avoid errors in interpretation, it is inappropriate to assess the habitual nutrient intake of a nutrient that is intermittently consumed at maximal levels. It is important to assess the iodine intake in consideration of the range of the nutrient intake and of the time period in which the upper limit is exceeded.

The Adequate Intake (AI) values in the Dietary Reference Intakes for Japanese (DRIs-J) 2010 were mainly determined based on the median intakes from 2 y of pooled data (2005-2006) from the National Health and Nutrition Survey-Japan (NHNS-J). However, it remains unclear whether 2 y of pooled data from the NHNS-J are appropriate for evaluating the intake of the population. To clarify the differences in nutrient intakes determined from 2 and 7 y of pooled data, we analyzed selected nutrient intake levels by sex and age groups using NHNS-J data. Intake data were obtained from 64,624 individuals (age: ≥1 y; 47.4% men) who completed a semi-weighed 1-d household dietary record that was part of the NHNS-J conducted annually in Japan from 2003 to 2009. There were no large differences between the median intakes calculated from 2 or 7 y of pooled data for n-6 or n-3 polyunsaturated fatty acids (PUFAs), vitamin D, pantothenic acid, potassium, or phosphorus. When the AI values and median intakes were compared, there was no large difference in the values for n-6 or n-3 PUFAs, pantothenic acid, or phosphorus. Conversely, the AI values for vitamin D and potassium differed from the median intakes of these nutrients for specific sex and age groups, because values were not based on NHNS-J data. Our results indicate that 2 y of pooled data from the NHNS-J adequately reflect the population's intake, and that the current system for determination of AI values will be applicable for future revisions.

The definition of DKI is a new onset of kidney injury or the worsening of an existing kidney injury due to drug administration. DKI can be classified based on the mechanism of pathogenesis, as well as on the damaged segment of the kidney. The classification based on the mechanism of pathogenesis is as follows: (1) toxic kidney injury (direct toxicity); (2) acute interstitial nephritis (AIN) due to allergic mechanism (hypersensitivity and direct toxicity); (3) indirect toxicity, such as electrolyte abnormalities and decrease of renal blood flow; and (4) obstruction of urinary tract. The classification based on the damaged segment of kidney is as follows: (1) glomerular injury; (2) tubular injury; (3) interstitial injury; and (4) vascular injury. The criteria for diagnosis are as follows: (1) new onset of kidney injury after the start of the administration of the candidate agent and (2) improvement or stoppage of the progression of the kidney injury after the cessation of the candidate agent, and all other causes can be ruled out. The cornerstone of treatment is the identification and cessation of the candidate agent as soon as possible.

Survey items of the Japan National Nutrition Survey (J-NNS) have changed over time. Several papers on dietary surveys have been published; however, to date, there are no in-depth papers regarding physical examinations. Therefore, we investigated changes in the survey items in the physical examinations performed in the J-NNS and the National Health and Nutrition Survey (NHNS), with the aim of incorporating useful data for future policy decisions.We summarized the description of physical examinations and marshalled the changes of survey items from the J-NNS and NHNS from 1946 to 2012. The physical examination is roughly classified into the following six components: some are relevant to anthropometric measurements, clinical measurements, physical symptoms, blood tests, lifestyle and medication by interview, and others.Items related to nutritional deficiency, such as anaemia and tendon reflex disappearance, and body weight measurements were collected during the early period, according to the instructions of the General Headquarters. From 1989, blood tests and measurement of physical activity were added, and serum total protein, total cholesterol, triglycerides, HDL-cholesterol, blood glucose, red blood corpuscles and haemoglobin measurements have been performed continuously for more than 20 years.This is the first report on the items of physical examination in the J-NNS and NHNS. Our research results provide basic information for the utilization of the J-NNS and NHNS, to researchers, clinicians or policy makers. Monitoring the current state correctly is essential for national health promotion, and also for improvement of the investigation methods to apply country-by-country comparisons.背景和目的：日本国民营养普查(J-NNS)项目随时间变化。关于饮食调查的几 篇论文已经发表，但是，到目前为止，还没有关于体检的进一步论文发表。因 此，我们研究了J-NNS 和国民健康和营养普查（NHNS）中体检项目的变化， 为进一步的政策制定提供有用的数据。方法与研究设计：我们总结了从1946 年J-NNS 到2012 年NHNS 体检项目的变化。体检大致分为以下六个部分：人 体测量相关参数、临床测量、身体症状、血液检测、生活方式和药物治疗及其 它。结果：根据总部的建议，早期就已经收集与营养缺乏有关内容，如贫血、 肌腱反射消失和体重测量。从1989 年开始，增加了血液检测和身体活动的测 量，血清总蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、血糖、红细胞 和血红蛋白，已连续检测20 多年。结论：这是J-NNS 更名为NHNS 后的第一 份关于体检的报告。我们的研究结果为研究人员、临床医生和政策决策者使用 J-NNS 和NHNS 提供了基本信息。正确监测当前状态是国民健康促进的必要手 段；也可改善普查方法，从而适用于国与国之间的相互比较。.

トリプトファン (Trp) の異化代謝にはビタミンB1, B2, B6が関わっている。そこで, 低用量, 中用量, 十分量のビタミン混合を含む飼料を投与した時にTrp異化代謝がどのように変動するのかを, 健常ラットと糖尿病ラットを用いて比較した。健常ラットにおいても, 糖尿病ラットにおいても, 飼料中のビタミン混合含量の差異はTrp異化代謝には全く影響をおよぼさなかった。糖尿病ラットにおけるTrp-ニコチンアミド (Nam) 転換率は健常ラットの1/3程度にまで低下していた。N1-メチルニコチンアミドが体内に蓄積しやすい代謝状態にあった。この現象は体内の遊離状態のNam濃度の上昇を引き起こす可能性がある。遊離型のNamは, poly (ADP-ribose) 合成酵素やヒストンデアセチラーゼなど種々の酵素の阻害剤である。したがって, 糖尿病時にはNam代謝変動による影響が表れる可能性があり, さらなる研究が必要である。

Aims/Introduction: To estimate nutritional risk factors for osteoporosis in patients with type 2 diabetes, bone mineral density, homocysteine level, and intakes and levels of Hcy-related vitamins including folate, vitamin B6 and vitamin B12 were analyzed in a cross-sectional study. Materials and Methods: Lumbar spine and femoral neck bone mineral density, serum concentrations of vitamin B6, vitamin B12, and folate and plasma homocysteine levels were measured in 125 Japanese patients with type 2 diabetes. Nutrient intake values were evaluated using a food frequency questionnaire. Results: Homocysteine was inversely correlated with bone mineral density, and with both dietary intake and serum concentration of folate. Intake of green vegetables was correlated with intake and level of folate and homocysteine levels. When the population was analyzed across the quartiles, bone mineral density, serum folate concentration, folate intake and intake of green vegetables were lowest in the highest homocysteine group. Conclusions: In patients with type 2 diabetes, the nutritional status of folate might affect the homocysteine level, a putative risk factor for osteoporosis. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00088.x, 2011)

In mammals, the small Arf GTPase-activating protein (SMAP) subfamily of Arf GTPase-activating proteins consists of closely related members, SMAP1 and SMAP2. These factors reportedly exert distinct functions in membrane trafficking, as manifested by different phenotypes seen in single knockout mice. The present study investigated whether SMAP proteins interact genetically. We report for the first time that simultaneous loss of SMAP1 and SMAP2 promotes apoptosis in the distal region of E7.5 mouse embryos, likely resulting in embryonic lethality. Thus, at least one SMAP gene, either SMAP1 or SMAP2, is required for proper embryogenesis.

Weaning rats were fed a niacin-free 20% casein diet. Twenty-four-h-urine samples were collected, and nicotinamide and its catabolites were measured. A correlation was found between the urinary excretory ratio of nicotinamide catabolites (N(1)-methyl-2-pyridone-5-carboxamide + N(1)-methyl-4-pyridone-3-carboxamide)/N(1)-methylnicotinamide and the tryptophan-nicotinamide conversion ratio during growing period of the rats. This indicates the possibility that the conversion ratio can be deduced from the excretory ratio.

Quinine is used for the treatment of malarial infection, though not in common use. It is especially valuable for the parenteral treatment of severe illness owing to drug-resistant strains of Plasmodium falciparum. Quinine is also known to occasionally cause acute renal failure (ARF). Although quinine is listed in some reviews as a cause of acute interstitial nephritis, most cases of quinine-associated acute renal failure have been attributed to the hemolytic-uremic syndrome (HUS). Only two cases of acute renal failure due to acute interstitial nephritis associated with quinine have been reported [1, 2]. To our knowledge, there have been 6 reported cases of quinine-induced hepatic granuloma [3–8]. We report a case of quinine-induced acute interstitial nephritis (AIN) along with granulomatous hepatitis, both of which were confirmed on biopsy. A 50-year-old Nigerian man was admitted to the hospital with complaints of fever and general fatigue. He had been prescribed quinine as an antimalarial drug in a Nigerian hospital. The patient was febrile and showed nonoliguric ARF and liver dysfunction. In this case, liver injury showed gradual and spontaneous resolution after discontinuing quinine, and ARF resolved after treatment with oral prednisolone.

Aims/Introduction: To estimate nutritional risk factors for osteoporosis in patients with type 2 diabetes, bone mineral density, homocysteine level, and intakes and levels of Hcy‐related vitamins including folate, vitamin B6 and vitamin B12 were analyzed in a cross‐sectional study. Materials and Methods: Lumbar spine and femoral neck bone mineral density, serum concentrations of vitamin B6, vitamin B12, and folate and plasma homocysteine levels were measured in 125 Japanese patients with type 2 diabetes. Nutrient intake values were evaluated using a food frequency questionnaire. Results: Homocysteine was inversely correlated with bone mineral density, and with both dietary intake and serum concentration of folate. Intake of green vegetables was correlated with intake and level of folate and homocysteine levels. When the population was analyzed across the quartiles, bone mineral density, serum folate concentration, folate intake and intake of green vegetables were lowest in the highest homocysteine group. Conclusions: In patients with type 2 diabetes, the nutritional status of folate might affect the homocysteine level, a putative risk factor for osteoporosis. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00088.x, 2011)

Previous research has reported that mirtazapine, a 5-HT3 antagonist, is effective for alleviation of digestive symptoms.To elucidate the effect of low-dose mirtazapine on digestive symptoms.Mirtazapine was administered to 50 cancer patients with digestive symptoms in palliative care, and the data were retrospectively examined. The initial doses ranged from 1.875 to 7.5 mg, and were increased to a maintenance dose according to its effects and the degree of somnolence.The cases were divided into 2 groups based on the cause of the digestive symptoms, including unknown causes(27 cases)and chemotherapy and/or opioid treatment(23 cases). At the initial dose, the efficacy rate was 74.4%, and the effectiveness was significantly higher in patients whose symptoms were due to chemotherapy and/ or opioid use than in those with symptoms of unknown cause(p=0.008). The rate of somnolence was 29.5%. Discontinuation of treatment within 1 week occurred in 10 cases. In 40 cases that continued administration of the maintenance dose, the efficacy rate was 82.5%, and the increased doses provided relief in the patient group with digestive symptoms of unknown cause.Low-dose mirtazapine showed different effects depending on the cause of digestive symptoms; therefore, the dose should be increased in patients whose symptoms are of unknown cause. Somnolence often appeared even at a low-dose, and this should be taken into consideration in the palliative care setting.

This study was performed to: (1) assess the prevalence of dietary supplement and fortified food use, (2) examine the differences in vitamin E intake with and without dietary supplementation and/or fortified food use, and (3) determine whether some individuals consume vitamin E above the tolerable upper intake level (UL). Data were obtained from 64,624 individuals (age, ≥1 y; 47.4% males) who completed a 1-d household dietary assessment that was part of the National Health and Nutrition Survey conducted in Japan, 2003-2009. The survey also obtained information on the brand or generic name of each dietary supplement or fortified food reported, including their ingredients, through dietary assessment. The prevalence of a potential risk of excess was estimated by the proportion of persons above the age-/sex-specific ULs provided by the Dietary Reference Intakes for Japanese 2010. Supplement use was reported by 5.8% of men and 7.7% of women, whereas fortified food consumption was reported by only 2.9% of men and 3.6% of women. Use of dietary supplements was most common among older women, whereas use of fortified foods was most common among younger women. Both dietary supplement and fortified food use accounted for maximum vitamin E intake; however, the use of dietary supplements and fortified foods had little effect on the median and 95th percentile intake values. None of the subjects consumed nutrients above the UL. The collected data confirm that the use of both dietary supplements and fortified foods contributes a small amount to nutrient intake in Japanese subjects.

A 40-year-old Japanese man who had a medical history of hypokalemic periodic paralysis 4 months prior was hospitalized to undergo a cholecystectomy. Hypokalemia, nephrocalcinosis and alkaluria suggesting distal renal tubular acidosis (dRTA) were detected, but metabolic acidosis was not evident. An ammonium chloride/furosemide-fludrocortisone/bicarbonate loading test demonstrated a remarkable disability in urinary H(+) excretion. A novel heterozygous mutation in the ATP6V0A4 gene encoding the vacuolar H(+)-ATPase (V-ATPase) a4 subunit p.S544L was detected. Among cases of V-ATPase a4 mutations, this is the first case in which a heterozygous mutation developed to an incomplete or latent form of dRTA.

In Asia, the concept of dietary reference values is shifting from recommended dietary allowances (RDAs) to dietary reference intakes (DRIs). To assist Asian countries that are planning to develop or revise their own DRIs, this study summarizes the scientific literature used in the development of the latest DRIs for the Japanese (DRIs-J 2010): it aims to clarify critical issues on- and discuss future prospects for DRIs in Asia. The criteria and studies used to determine reference values in DRIs-J 2010 in adults were extracted from the DRIs-J 2010 report, systematically classified, and summarized for each nutrient in tables according to the type of DRIs. The classification categories were as follows: criteria, subject ethnicity, year of publication, type of study and study design, number of subjects, and study content. In all, 184 studies were extracted and some issues in DRIs-J 2010 were clarified: 1) some nutrients were lacking in studies based on native populations; 2) only a few and relatively old studies determined tolerable upper intake levels for some nutrients; 3) with the same DRIs, there were inconsistencies among the nutrients in the study criteria. These were considered common issues when determining DRIs in other Asian countries. When establishing DRIs, these issues should be considered, in addition to population health status and country-specific needs.在亞洲，對膳食參考值的概念正從建議攝取量(RDAs)轉變成膳食營養素參考攝 取量(DRIs)。為了協助正計畫發展或修改己國DRIs 之亞洲國家，本篇研究綜整 所有用來發展日本最新DRIs(DRIs-J 2010)之科學性文獻，目的是釐清當前重要 議題並剖析亞洲DRIs 之未來展望。DRIs-J 2010 中訂定成人參考值的標準與研究 主要摘錄自DRIs-J 2010 報告，並根據DRIs 中的類型，將每一營養素予以系統 性分類並匯整於表中。分類項目如下：量測標準、對象種族、出版年份、研究 型態與設計、樣本數及研究內容。在所有文獻中，共挑出184 篇，並將DRIs-J 2010 中的部分議題分成以下幾點說明：1) 部份營養素缺乏以當地族群為主之研 究；2) 部分營養素僅賴少數或早期幾篇研究來決定其上限容許攝取量；3)制定 相同DRIs，營養素之量測標準卻不一致。以上這些常見議題亦是其他亞洲國家 訂定DRIs 時會遭遇到。建立DRIs 時，除了族群之健康狀態和國家特定之需求 外，這些議題也需納入考慮。

It is thought that the contents of water-soluble vitamins in the body are generally low in diabetic patients because large amounts of vitamins are excreted into urine. However, this hypothesis has not been confirmed. To investigate this hypothesis, diabetes was induced in male Wistar rats (6 wk old) by streptozotocin treatment, and they were then given diets containing low, medium or sufficient vitamins for 70 d. The contents of 6 kinds of B-group vitamins, namely vitamin B₁, vitamin B₂, vitamin B₆, vitamin B₁₂, folate and biotin, were determined in the urine, blood and liver. No basic differences among the dietary vitamin contents were observed. The urinary excretion of vitamins was higher in diabetic rats than in control rats. The blood concentrations of vitamin B₁₂ and folate were lowered by diabetes, while, those of vitamin B₁, vitamin B₂, vitamin B₆, and biotin were not. All liver concentrations of vitamins were increased in diabetic rats above those in control rats. These results showed that streptozotocin-induced diabetes increased urinary excretion of water-soluble vitamins, though their blood and liver concentrations were essentially maintained in the rats.

This paper presents a man in his 80's with pancreatic cancer(cStage IV). He suffered from nausea duringS -1 therapy, and therefore, prochlorperazine maleate at a daily dose of 15 mgwas administered. However, refractory nausea was diagnosed because it did not improve, and mirtazapine at a daily dose of 7. 5 mgbefore bedtime was started. Nausea was improved in the next morning, and the patient ate almost all of his breakfast. After that, no nausea appeared, and his food intake was robust. Mirtazapine is a new antidepressant called noradrenergic and specific serotonergic antidepressant(NaSSA)and blocks 5-HT3 receptors to improve nausea. Mirtazapine is usually started at a daily dose of 15 mg, but this dose induces somnolence. Therefore, mirtazapine was administered at a low daily dose of 7. 5 mgin the present case. No somnolence or disturbance of daily life was seen, and administration was safely continued. We conclude that low-dose mirtazapine is one effective option for refractory nausea duringS -1 therapy.