Evaluation of the Japanese Metabolic Syndrome Risk Score (JAMRISC): a newly developed questionnaire used as a screening tool for diagnosing metabolic syndrome and insulin resistance in Japan.

OBJECTIVES: To prevent the onset of lifestyle-related diseases associated with metabolic syndrome (MetS) in Japan, research into the development of a useful screening method is strongly desired. We developed a new screening questionnaire (JAMRISC) utilizing a logistic regression model and evaluated its ability to predict the development of MetS, type 2 diabetes and other lifestyle-related diseases in Japanese populace. METHODS: JAMRISC questionnaire was sent to 1,850 individuals in Rumoi, a small city in Hokkaido. We received a total of 1,054 valid responses. To maximize the target individuals accurately diagnosed with MetS, logistic regression analysis was used to generate a unique metabolic syndrome score calculation formula as taking into consideration the clinical relevance of each question item as individual coefficients. RESULTS: The results of our comparative research utilizing both JAMRISC and Finnish Diabetes Risk Score (FINDRISC) questionnaires revealed the usefulness of JAMRISC for its ability to detect risks for MetS, pre-MetS, diabetes, and pre-diabetes. Study of disease risk detection via JAMRISC questionnaire targeting the 4283 residents of Rumoi indicated a high detection rate for pre-MetS (98.8 %), MetS (94.2 %), pre-diabetes (85.1 %) and type 2 diabetes (94.9 %). In addition, JAMRISC was useful not only as a MetS risk score test, but also as a screening tool for diagnosing insulin resistance. CONCLUSIONS: JAMRISC questionnaire is a useful instrument for the detection of early risk of not only MetS and type 2 diabetes but also insulin resistance.

Visit-to-visit variability and seasonal variation in blood pressure: Combination of Antihypertensive Therapy in the Elderly, Multicenter Investigation (CAMUI) Trial subanalysis.

BACKGROUND: Combination antihypertensive therapy with an angiotensin receptor blocker (ARB) and a calcium channel blocker (CCB) or diuretics is common. This subanalysis investigated blood pressure (BP) variability in patients receiving ARB-based combination therapy. METHODS: In a prospective, randomized, open-label trial, hypertensive outpatients (≥65 years) who did not achieve their target BP with ARB monotherapy switched to losartan 50 mg/hydrochlorothiazide 12.5 mg (ARB + D) or ARB plus amlodipine 5 mg (ARB + C) for 12 months. Clinic BP and heart rate (HR), measured every 3 months, visit-to-visit variability and seasonal variation were evaluated. RESULTS: No significant between-group differences in average, maximum, or minimum systolic or diastolic BP, or HR, were found. Visit-to-visit BP variability (systolic) was significantly higher in the ARB + D group than in the ARB + C group. When each group was subdivided into two seasonal groups (summer and winter), no significant between-group differences in BP were found. Multivariate regression analyses showed a tendency toward negative correlation between outdoor temperature and urinary albumin:creatinine ratio and estimated glomerular filtration rate at 12 months in the ARB + D group. CONCLUSION: Combination therapy with an ARB plus a CCB may be preferable to that with an ARB plus diuretics for decreasing BP variability. As for seasonal variability, both treatments can be used safely regardless of season.

[A long term survivor of advanced gastric cancer treated with multi-drug combination chemotherapy].

We report a case of 70-year-old man who was admitted to our hospital due to hematemesis in June 2004. He was diagnosed by gastroscopy as having a type III moderately-poorly differentiated adenocarcinoma. A computed tomography (CT) scan revealed multiple lymph nodes swelling (#13, #16), finally he was diagnosed with gastric cancer stage IV (cT3, cN3, cM1). He was treated with S-1, but lymph nodes swelling increased in size, and then in March 2005, the treatment was changed to a second-line chemotherapy consisting of CPT-11 and CDDP. Abdominal CT scan showed a remarkable reduction of #16b1 lymph node, and the second-line chemotherapy was continued until 23 courses. But in April 2007, gastroscopy revealed the enlargement of gastric lesion. He was treated by third-line chemotherapy consisting of paclitaxel and doxifluoridine. This therapy was effective and continued until 7 courses. However, the treatment gradually became resistant and he died in May 2008, which was 4 years since the initial diagnosis.

The association between insulin resistance, metabolic syndrome, and ischemic heart disease among Rumoi residents.

Background: It has widely been proven that metabolic syndrome (MetS) increases the risk of ischemic heart disease (IHD). MetS is confirmed based upon insulin resistance (IR). Our aim of this study is to evaluate the role of MetS and IR in the prediction of IHD incidence. Methods: A total of 404 non-diabetic participants who underwent 75 g oral glucose tolerance test (75 g OGTT) were enrolled from 2001 to 2009. Risk factors for IHD were measured as well. The homeostatic index of IR (HOMA-IR) and the homeostatic model assessment beta cell function (HOMA-ß) were calculated according to the homeostasis model assessment. Cox proportional-hazard regression model was used to estimate hazard ratio (HR). All data were analyzed using SPSS 21 software (IBM, Armonk, NY, USA). Results: In our study, the average follow-up period was 6.7 years. Eighteen subjects of IHD incidence were recorded. After adjusting for age and sex, subjects with IR or hyperinsulinemia had a high risk of IHD, the hazard ratio (95% confidence intervals) for IHD were 4.58 (1.59-13.15), 4.25 (1.64-11.91), respectively. The highest hazard ratio was 7.56 (2.27-25.18) which was found among the subjects with both IR and hyperinsulinemia. In addition, the hazard ratio (95% confidence intervals) of subjects with MetS was 2.80(1.10-7.09). Conclusions: IR and hyperinsulinemia are related to the risk of IHD. IR combined with hyperinsulinemia may be superior to MetS for predicting the IHD incidence.

Personal characteristics associated with individual degree of family function in residents of Rumoi City, Hokkaido.

Background: We assessed the association of personal factors with Family APGAR not only among the subjects in nonsingle households, but also in single households. Methods: We randomly chose 1 000 persons aged from 50 to 89 years in Rumoi City of the west area of Hokkaido as study candidates, and 493 subjects responded to the survey. We compared the group of high Family APGAR (FA) score of more than or equal to seven with the group of low FA score of less than or equal to 6 with regard to health-related QOL (HRQOL), measured with SF-8, Index of Social interaction (ISI), and other personal characteristics. Being in the low FA group indicates living with a status of poor family function. Results: As a result of the multivariate logistic regression model, living in single households, currently smoking, a low score of mental component summary (MCS) in HRQOL, and a low score of lSI were all significantly associated with being in the low FA group. A low score of MCS was significantly associated with being in the low FA group both in the stratum of nonsingle households, and in the stratum of single households. Conclusions: There were three risk factors of low FA. The first is a single household, second is currently smoking in a nonsingle household, and the third is low ISI. Worse mental status is found to be associated with low FA among the subjects not only in nonsingle households, but also in single households.

Gastric Invasive Micropapillary Carcinoma with Intestinal Phenotypes Harboring a TP53 R175H Mutation.

We report a case of gastric invasive micropapillary carcinoma (IMPC) in an 86-year-old female patient. She was admitted to our hospital with a chief complaint of bloody emesis. Upper gastrointestinal endoscopy found a gastric adenocarcinoma at the antrum. The biopsy specimens showed moderately differentiated adenocarcinoma with invasive small tumor nests. Distal gastrectomy with systematic lymph node dissection demonstrated that the tumor had IMPC through a pathological examination. Despite the depth of tumor invasion (the submucosa), extensive lymph node metastases were observed. Anti-D2-40 immunostaining revealed numerous infiltrating tumor cell nests in the lymphatic vessels, which could explain subsequent multiple lymph node metastases. The adenocarcinoma showed intestinal phenotypes by several immunohistochemical studies. One of these antibodies (CD10) clearly demonstrated the inverted apical-basal (inside-out) pattern of IMPC, whereas it showed an ordinary pattern in intestinal metaplasia adjacent to the tumor. Furthermore, genetic analysis by direct sequencing revealed a point mutation in the exon 5 of TP53 in the tumor. The mutation presumably harbors a missense mutation from Arg to His at the codon 175 (R175H). R175H has been previously described as a 'gain-of-function' mutation with a high invasive or metastatic potential in several types of cancers. In summary, this is one of the first reported cases of gastric IMPC with intestinal phenotypes harboring a TP53 R175H mutation in the literature.

Combination of antihypertensive therapy in the elderly, multicenter investigation (CAMUI) trial: results after 1 year.

OBJECTIVE: Combination therapy with angiotensin receptor blockers (ARBs) and calcium channel blockers or diuretics is common for hypertensive patients. This study aimed to determine which combination is better for elderly hypertensive patients. METHODS: In this prospective, randomized, open-label trial, hypertensive outpatients aged at least 65 years who had not achieved their target blood pressure (BP) with standard ARB dosages were randomly assigned to receive either a fixed-dose combination of losartan (50 mg) and hydrochlorothiazide (12.5 mg) (ARB+D; n = 72) or a combination of amlodipine (5 mg) and the typical dosage of ARBs (ARB+C; n = 68) to evaluate the change in the BP, laboratory values and cognitive function. RESULTS: At 3 months, the SBP/DBP was found to have significantly decreased from 156/83 ±â€Š15/11 mmHg to 139/76 ±â€Š14/10 mmHg in the ARB+D group and 155/83 ±â€Š11/10 mmHg to 132/72 ±â€Š14/10 mmHg in the ARB+C group. The BP reduction efficacy was greater in the ARB+C group than in the ARB+D group. At 6 months, the SBP/DBP reached the same level in both groups. At 12 months, the urine albumin/creatinine ratio was significantly decreased from the geometric mean of 17.1 to 9.6 mg/g in the ARB+D group, whereas it was increased from 19.8 to 23.7 mg/g in the ARB+C group. Conversely, the estimated glomerular filtration rate tended to show a decrease in the ARB+D group. There was no significant difference in mini-mental state examination after 1 year. CONCLUSION: ARB+amlodipine (5 mg) yielded a greater BP reduction, whereas ARB+HCTZ (12.5 mg) resulted in a greater reduction in the albuminuria, suggesting that each combination therapy is advantageous in a different manner for elderly hypertensive patients.

The chilblain-like eruption as a diagnostic clue to the blast crisis of chronic myelocytic leukemia.

A 70-year-old Japanese man visited our clinic with the chief complaint of chilblain-like eruptions on the toes of both feet. His toes were bluish, erythematous, and swollen. Neither oral administration of vitamin E for 2 weeks nor wearing insulated socks improved the clinical manifestations. Peripheral blood examination revealed the presence of a large number of monocytic atypical cells and myeloblasts, anemia, and thrombocytopenia. In the bone marrow, monocytic cells were elevated, and myelocytic atypical cells were observed. Chromosomal analysis demonstrated Philadelphia chromosome. We diagnosed him as having a blast crisis of chronic myelocytic leukemia (CML). A biopsy specimen of the skin from the chilblain-like eruption showed infiltration of large, atypical, mononuclear cells; most of them were positive for CD68, and some of them were positive for CD14. Therefore, we concluded that the chilblain-like eruptions on his toes were specific skin lesions of a blast crisis in CML.