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Although the economic burden of multimorbidity is a growing global challenge, the contribution of multimorbidity in patients with high medical expenses remains unclear. We aimed to clarify multimorbidity patterns that have a large impact on medical costs in the Japanese population. We conducted a cross-sectional study using health insurance claims data provided by the Japan Health Insurance Association. Latent class analysis (LCA) was used to identify multimorbidity patterns in 1,698,902 patients who had the top 10% of total medical costs in 2015. The present parameters of the LCA model included 68 disease labels that were frequent among this population. Moreover, subgroup analysis was performed using a generalized linear model (GLM) to assess the factors influencing annual medical cost and 5-year mortality. As a result of obtaining 30 latent classes, the kidney disease class required the most expensive cost per capita, while the highest portion (28.6%) of the total medical cost was spent on metabolic syndrome (MetS) classes, which were characterized by hypertension, dyslipidemia, and type 2 diabetes. GLM applied to patients with MetS classes showed that cardiovascular diseases or complex conditions, including malignancies, were powerful determinants of medical cost and mortality. MetS was classified into 7 classes based on real-world data and accounts for a large portion of the total medical costs. MetS classes with cardiovascular diseases or complex conditions, including malignancies, have a significant impact on medical costs and mortality., Competing Interests: Fuminori Katsukawa received funding from the Japan Health Insurance Association. Yuki Nishida was paid from funding from the Japan Health Insurance Association for 1 year from April 2021 to March 2022. The other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Nishida et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Regional disparity is an imperative component of health disparity. In particular, providing emergency care that is equally available in rural areas is an essential part of reducing the urban-rural disparity. The objective of this study was to examine the worsening admission rate among Cambodian emergency patients in a rural area and determine their background characteristics that cause this decline., Methods: To investigate the disparity among patients who visited Sunrise Japan Hospital (SJH), a major general private hospital in the capital, patient data from November 2016 to September 2019 were obtained from the electronic reception patient database. The primary outcome was defined as the proportion of admission patients as an indicator of illness severity. The patients' addresses were classified into 4 areas based on distance from the capital., Results: A total of 6167 patients who visited the emergency department at SJH between January 2017 and September 2019 were included in the analysis. The proportion of patients who needed to be hospitalized or transferred increased with the distance from the capital. The proportion of patients who finished consultation decreased with the distance from the capital ( P <.01: Chi-square test). The results of the logistic regression analysis showed that the admission rate in rural areas was significantly higher only among males as compared to that of the capital in multivariate analyses adjusted for age, time, and season., Conclusion: The admission rate of emergency patients who visited a private general hospital in Cambodia's capital city increased with distance from the capital city. To improve regional disparity among emergency patients, further research is necessary to identify the issues among emergency patients, especially those who are vulnerable., (© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Mineralocorticoid receptor (MR) and its ligand aldosterone play a central role in controlling blood pressure by promoting sodium reabsorption in the kidney. Coregulators are recruited to regulate the activation of steroid hormone receptors. In our previous study, we identified several new candidates for MR coregulators through liquid chromatography-tandem mass spectrometry analysis using a biochemical approach. Lysine-specific demethylase 1 (LSD1) was identified as a candidate. The relationship between LSD1 and salt-sensitive hypertension has been reported; however, the role of MR in this condition is largely unknown. Here, we investigated the functions of LSD1 as a coregulator of MR. First, a coimmunoprecipitation assay using HEK293F cells showed specific interactions between MR and LSD1. A chromatin immunoprecipitation study demonstrated LSD1 recruitment to the gene promoter of epithelial Na + channel (ENaC), a target gene of MR. Reduced LSD1 expression by treatment with shRNA potentiated the hormonal activation of ENaC and serum/glucocorticoid-regulated kinase 1, another target gene of MR, indicating that LSD1 is a corepressor of MR. In an animal study, mice with kidney-specific LSD1 knockout (LSD1 flox/flox KSP-Cre mice) developed hypertension after a high-salt diet without elevation of aldosterone levels, which was counteracted by cotreatment with spironolactone, an MR antagonist. In conclusion, our in vitro and in vivo studies demonstrated that LSD1 is a newly identified corepressor of MR., (© 2022. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

In this study, we prepared a polyhedral oligomeric silsesquioxane (POSS)-linking polyamide (POSS polyamide) by a polycondensation of ammonium-functionalized POSS (POSS-A) and carboxyl-functionalized POSS (POSS-C) in dehydrated dimethyl sulfoxide (DMSO) using 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride (EDC) and N -hydroxysuccinimide (NHS) as condensing agents. The obtained POSS polyamide was soluble in various highly polar solvents, and it could form a self-standing film. FT-IR, 1 H NMR, and 29 Si NMR analyses showed that POSS polyamide is a polymer in which POSS-A and POSS-C are linked almost linearly by amide bonds. Furthermore, the cast film obtained by heat-treating the polymer at 150 °C for 30 min exhibited excellent transparency and hard-coating (pencil scratch test: 5H) and antifogging properties (evaluation by water vapor exposure).

A new inductively coupled plasma (ICP) torch with an air-cooling system has been designed and developed for both argon and helium plasma. The same torch and impedance-matching network could be used to generate stable Ar- and He-ICP. The torch consists of three concentric quartz tubes. The carrier gas, plasma gas, and cooling gas flow through the intervals between each tube. In an experiment, it was found that Ar-ICP could form a stable plasma under the following conditions: RF power of 1 kW, plasma gas flow rate of 11 L min(-1), and cooling gas flow rate of 20 L min(-1). For He-ICP, an input RF power of 2 kW, which is two-times higher than that of a conventional He-ICP, could be constantly applied to the plasma with plasma gas and cooling gas flow rates of 15 and 20 L min(-1), respectively. Using this torch, it is possible to realize lower plasma gas consumption for Ar- and He-ICP and a high-power drive for He-ICP. It has been found that the air-cooling gas stabilizes the shape of the plasma due to the pressure difference between the cooling gas and the plasma gas.

Metabolites of collagen metabolism were analyzed in patients with Menkes' disease. The urinary deoxypyridinoline level was significantly low in the patients with Menkes' disease, indicating that it is a good marker of lysyl oxidase activity, which is related to the connective tissue abnormalities.

Epithelioid hemangioendothelioma of the liver is a rare vascular neoplasm with intermediate malignant potential. The prognosis is highly unpredictable. We report the case of a 59-year-old woman who had the tumor radically resected, but multiple metastases of the liver developed associated with thrombocytopenia and consumption coagulopathy, as observed in Kasabach-Merritt syndrome. The patient did not respond to any treatment and the behavior of the tumor was very aggressive. The patient died 15 months after radical resection of the tumor.

A 54-year-old man underwent right transfemoral angiography because of left renal hematuria. During angiography, dissection of abdominal aorta and thoracic aorta was encountered. It was initiated by intramural catheter passage at the bifurcation of the internal and external iliac artery. Transaxillary aortography about one month after the first angiography showed occlusion of the dissecting space in the thoracic aorta and existence of dissecting space in the abdominal aorta. Communicating orifices between the true space and the false space existed not only at the bifurcation of internal iliac artery and external iliac artery, but also at the abdominal aorta near the left renal artery. CT 1.5 months after the first angiography did not demonstrate more improvement. Surgery was performed. It was impossible to sew up and close the orifices of the space because of the fragility of the intima. Surrounding abdominal aorta and common iliac artery were wrapped near orifices with a dacron graft. A follow-up CT obtained 3 months postoperatively showed that the dissecting space in the abdominal aorta had disappeared. Wrapping was very useful to promote organization of the dissecting space.

Six cases of pulmonary embolism were reported. As pulmonary embolism often becomes critical condition, early diagnosis and medical treatment is need. Perfusion lung scan for pulmonary embolism may be useful for a diagnosis and evaluation of the degree of its disease and therapeutic value.

A case of renovascular hypertension in a patient with a congenitally solitary kidney associated with retrocaval ureter is reported. Aortorenal bypass with autogenous saphenous vein graft and concomitant mobilization of the ureter by division and reanastomosis of the inferior vena cava were performed. Pathogenesis of the stenotic lesion of the renal artery was fibromuscular dysplasia. Postoperative improvement of hypertension was not so good as expected. Soon after administration of nifedipine (20mg/day) was started, blood pressure decreased down to 130/80mmHg and had been well controlled. Problems regarding renovascular hypertension with a solitary kidney and surgical treatment of retrocaval ureter are discussed.

An isolated iliac aneurysm is an uncommon entity with a relative incidence to abdominal aortic aneurysm of 0.9 to 1.9 percent. Analysis of 16 cases with 20 isolated iliac aneurysms experienced at our vascular service makes the basis of this report. Seventeen aneurysms involved the common iliac artery, two the internal iliac artery and one the external iliac artery. As we experienced 341 abdominal aortic aneurysms during the same period, relative incidence of isolated iliac aneurysm to abdominal aortic aneurysm was 4.7 percent. Fifteen of the 16 cases were male; isolated iliac aneurysms had significantly higher preponderance for the male. Six of the cases were presented with ruptured aneurysms, giving a rupture rate of 37.5 percent. This rupture rate was significantly higher than that of abdominal aortic aneurysms of 11.1 percent. Operation was performed on 15 patients; the remaining one died before surgery. Although there was no operative death among the elective cases, three patients in the ruptured group died postoperatively giving a mortality rate of 60 percent. The least diameter of the ruptured aneurysms was 3.5 centimeter. Among the 16 patients 5 presented with a ruptured aneurysm and 3 had no symptoms related to the aneurysm. Five patients complained of a pulsatile abdominal mass. Two of the ruptured aneurysms were associated with an iliac arteriovenous fistula. Both of them involved the common iliac artery. Although emergency operation was performed on one of them, he died of acute renal failure due to preoperative dehydration and hypovolemia. The another one was operated on electively after intensive medical treatment for heart failure and the patient survived.(ABSTRACT TRUNCATED AT 250 WORDS)

A 76 year-old woman visited our university hospital with a complaints of dysphagia of 3 months duration and was discovered to have a right internal carotid aneurysm protruding to the right side of the larynx. A day prior to admission, dysarthria and left hemiparesis occurred with sudden onset. These ischemic attacks spontaneously remitted within 48 hours. A carotid arteriogram showed a saccular aneurysm located high in the right internal carotid artery. Four days after admission, aneurysmectomy with end-to-end anastomosis was carried out with the temporary internal shunt under the induced hypertension. There was no sign of ischemic brain damage after the operation. But she suffered from dysphagia due to the NO. 9, 10, and 12 cerebral nerve palsies, which took 5 months to recover completely. Despite several difficulties in the operation for a highly located internal carotid aneurysm, we emphasize in this report the necessity of aneurysmectomy and the establishment of vascular continuity with the aid of internal shunt to prevent the ischemic brain damage.