Risk factors for tooth loss in community-dwelling Japanese aged 40 years and older: the Yamagata (Takahata) study

Clinical Oral Investigations - The aim of the present study was to investigate comprehensively the risk factors, including some lifestyle-associated factors, oral health habits, and socioeconomic...     

Association between renal function and cardiovascular and all-cause mortality in the community-based elderly population: results from the Specific Health Check and Guidance Program in Japan

Background

Chronic kidney disease is a significant risk factor for end-stage kidney disease, cardiovascular events, and premature death. However, the prognostic value of low estimated glomerular filtration rate (eGFR) in the elderly is debatable.

Methods

We determined eGFR using the Japanese equation in 132,160 elderly subjects (65–75 years) who attended the special health checkup (Tokutei-Kenshin) in 2008 and investigated the association between baseline eGFR and 5-year all-cause and cardiovascular mortality.

Results

The median (SD) eGFR was 70.5 ± 15.3 mL/min/1.73 m². During follow-up, we noted 2045 all-cause deaths including 408 from cardiovascular events. A J-shaped curve was obtained when all-cause and cardiovascular mortality rates were compared with decreases in eGFR, with the highest mortality observed for eGFR <45 mL/min/1.73 m². These trends were statistically significant in the Kaplan–Meier analysis (P < 0.001). In the Cox proportional hazard analysis, after adjusting for possible confounders, those with eGFR <45 mL/min/1.73 m², but not eGFR 45–59 mL/min/1.73 m² showed a higher all-cause and cardiovascular mortality than those with eGFR >90 mL/min/1.73 m² [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.06–1.91 for all-cause mortality, HR 2.28, 95% CI 1.28–4.03 for cardiovascular mortality]. Sex-based subgroup analyses showed similar results for both men and women.

Conclusions

We conclude that eGFR <45 mL/min/1.73 m² is an independent risk factor for all-cause and cardiovascular mortality in the elderly population.

     

Comparison of the predictive ability of albuminuria and dipstick proteinuria for mortality in the Japanese population: the Yamagata (Takahata) study

Background

Albuminuria and proteinuria are known risk factors for premature death. This study compared the ability of albuminuria and proteinuria to predict mortality in a community-based population.

Methods

We evaluated the urinary albumin creatinine ratio (ACR) and proteinuria by dipstick at a baseline survey and examined the association between the 7-year mortality and three categories (albuminuria [ACR ≥ 30 mg/g], trace proteinuria, and ≥[1+] proteinuria) in 3446 Japanese subjects at a local health check.

Results

Albuminuria, ≥trace proteinuria, and ≥(1+) proteinuria were identified in 514 (14.9 %), 290 (8.4 %), and 151 (4.4 %) subjects, respectively. There were 138 deaths during the follow-up period, including 41 cardiovascular deaths. A Kaplan–Meier analysis showed that all-cause mortality significantly increased along with the increase in ACR and proteinuria levels (log-rank P < 0.01). The mortality rate (deaths per 1000 person-year) was higher in subjects with albuminuria (12.8), ≥trace proteinuria (12.6), and ≥(1+) proteinuria (16.2) than in all subjects (6.9). A Cox proportional hazard model analysis showed that all three categories were significant predictors of all-cause mortality in the unadjusted model, although after adjustment for possible confounders, a significant association was observed only with albuminuria. Albuminuria, but not proteinuria, was a significant predictor of cardiovascular mortality in both the unadjusted and adjusted models.

Conclusion

Albuminuria had a high prevalence and was strongly associated with mortality, as compared with proteinuria by dipstick, suggesting that albuminuria might be a superior predictor of poor prognosis in the Japanese population.

     

Burn scar sarcoma.

Malignancies developing in burn scars have been known for a long time and are generally epidermoid carcinomas although a few sarcoma cases have been reported. A case of fibrosarcoma developing in the burn scar was presented in this report and the literature reviewed.     

A case of the benign adrenal adenoma with remarkably high concentrations of deoxycorticosterone and 11-deoxycortisol

The case was a 33-year-old woman with hypertension and hypokalemia, who presented depression of renin activity and the abnormal elevation of plasma deoxycorticosterone (DOC) and 11-deoxycortisol on laboratory tests. After admission, abdominal CT scan, 131I-adosterol scintigram and adrenal venogram revealed a tumor in the left adrenal, which histologically seemed to be benign. When the tumor was resected, blood pressure and all the biochemical data returned to normal range. DOC and 11-deoxycortisol levels in the tumor were abnormally elevated as compared with those in the normal adrenal tissue. These findings suggested that the abnormal elevation of hormone levels resulted from depression of 11 beta-hydroxylase. Though numerous adrenal tumors have been documented, we rarely encounter an apparently benign adrenal tumor that produces 2 kinds of hormones. This seemed to be the first case of benign adrenal tumor in which both DOC and 11-deoxycortisol were elevated.