Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease

BACKGROUND: Although some laboratory findings are known to be indicators of the risk of giant coronary aneurysm formation among Kawasaki disease patients, an appropriate cut-off point to predict aneurysm formation is not clear. METHODS: One hundred and five patients with giant coronary aneurysms were selected from the 15th and 16th nationwide surveys of Kawasaki disease in Japan. A total of 2936 patients without Kawasaki disease were recruited from a single hospital as a control group. Odds ratios were calculated for six laboratory data with specific values as cut-off points. Receiver operating characteristic (ROC) curves were observed to determine the most appropriate laboratory tests and cut-off points. RESULTS: Hematocrit, leukocyte count, neutrophil proportion, and hemoglobin had one or more peaks of odds ratio for specific cut-off points, but they did not have a clear cut-off point for the predictor according to the receiver operating characteristic curves. Alanine aminotransferase (ALT) increased the risk of giant coronary aneurysms continuously so no clearly appropriate cut-off point was identified. Serum sodium concentration of 135 mEq/L had a peak of odds ratio, and those with <135 mEq/L had the highest odds ratio (4.78). This value seemed appropriate with a sensitivity of 78% and specificity of 57%, although the predictive positive value was as small as 5%. CONCLUSION: The author's propose that a serum sodium concentration of <135 mEq/L at the patient's first visit to hospital may be a predictor of giant coronary aneurysms due to Kawasaki disease.     

Analyses of fatal cases of Kawasaki disease in Japan using vital statistical data over 27 years

BACKGROUND: Chronological changes in mortality and case fatality rates from Kawasaki disease covering an extended period in Japan are still unknown. METHODS: We analyzed 679 deaths of patients in Japan whose underlying cause was Kawasaki disease, by using the data of vital statistics between 1972 and 1998. RESULTS: The male-to-female ratio of the number of deaths was 2.07 and the mean age at death in males was higher. Two unusual increases in the epidemic years, 1982 and 1986, were observed in the chronological changes of the number of deaths. The mortality rate of males was higher than that of females, with a few exceptional years, and the annual mortality rates were high in three epidemic years. The age-specific mortality rate was highest in infants under one year of age. Prefectures with high mortality rate clustered in some regions. The case fatality rate decreased annually, declining to as low as 0.2% among those who were born in 1986 and thereafter; and unusual increases in the case fatality rate affected by these three epidemic years were not repeated. CONCLUSIONS: The case fatality rate from Kawasaki disease in Japan decreased during the 27 years of observation: improvements in treatment might account for this.     

Effectiveness of Comprehensive Health Education Combining Lifestyle Education and Hot Spa Bathing for Male White-Collar Employees: A Randomized Controlled Trial with 1-Year Follow-Up

Background

Physical activity is known to prevent obesity and metabolic syndrome in middle-aged and elderly people; however, the effectiveness of a comprehensive health education program for male white-collar employees is uncertain.

Methods

Forty-three men volunteered to participate in this study and were randomly assigned into 2 groups. The intervention group participated in a 2-hour program comprising comprehensive health education and hot spa bathing, offered once every 2 weeks, in addition to individualized programs once a week, for 24 weeks. The control group received only general health guidance. We compared their lifestyle characteristics and physical and mental health criteria at baseline, immediately after the intervention, and 1 year after the end of the intervention.

Results

Rates of adherence to individualized programs were 60.0 ± 27.2% and 30.5 ± 29.6% at the end of the intervention and at 1 year after the end of the intervention, respectively. Significant (P < 0.05) interaction of criteria was observed for cluster of differentiation 4+ (CD4+) cells and the ratio of cluster of differentiation 4+ to 8+ (CD4/8) cells, which were used to represent the participants'' immunological function. We divided the intervention group into 2 subgroups on the basis of their attendance. Among the resulting 3 groups, significant interaction of criteria was observed for CD4+ and CD4/8 cells. In addition, the high attendance group had the highest CD4+ count and CD4/8 ratio.

Conclusions

Participants who attended classes and/or performed the supplementary individualized programs tended to maintain their immunological function and to experience a decrease in body fat percentage. However, few effects were noted in participants with poor adherence, even in the intervention group.Key words: male, white-collar-employees, randomized controlled trial, lifestyle education, hot spa, and exercise     

Consumption of dairy products and cancer risks

BACKGROUND: Relationships between consumption of dairy products and death from various types of cancer are largely unknown. METHODS: Between April 1992 and July 1995, a baseline survey was conducted for 11,349 residents in 12 communities in Japan, which included collection of demographic data and a self-administered food-frequency questionnaire inquiring about three dairy products: milk, butter and yogurt. The subjects were followed prospectively until 2002. Causes of death were identified using death certificates. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for each dairy product were calculated using Cox's proportional hazard models. RESULTS: Among eight common cancers, only deaths from hematopoietic neoplasm (n=14) were significantly associated with consumption of butter (HR=5.11, 95% CI: 1.40-18.62), though they exhibited a nearly-significant association with milk consumption (HR=3.17, 95% CI: 0.99-10.17), independent of age and sex. Consumption of milk and butter was significantly associated with non-lymphoma deaths (n=9) when adjusted for age and sex (HR=9.86, 95% CI: 1.23-79.19 for milk; and HR=10.04, 95% CI: 2.39-42.18 for butter). CONCLUSION: The frequencies of butter consumption, and probably that of milk, were correlated with death from hematopoietic neoplasm, particularly from non-lymphomas.     

Comparison of C-reactive protein levels between serum and plasma samples on long-term frozen storage after a 13.8 year interval: the JMS Cohort Study

BACKGROUND: C-reactive protein (CRP) is an acute phase reactant, and has been reported as a predictor of cardiovascular diseases. Measurements of high sensitive CRP in thawed samples are possible and the values are thought to remain stable even after frozen storage. However, the long-term stability of CRP values has not been documented. We measured the values of CRP before and after long-term storage, and examined the difference in determined values. METHODS: High sensitive CRP was measured before and after long-term storage of samples from 99 men and women among the JMS Cohort Study subjects. We selected subjects who underwent measurement of high sensitive CRP at the baseline by stratified sampling methods using baseline CRP values. CRP was measured in serum samples at the baseline and in thawed plasma samples after an average storage period of 13.8 years. RESULTS: Geometric means of CRP were 0.25 mg/L and 0.59 mg/L before and after storage, respectively. The CRP values were significantly higher after long-term frozen storage than at the baseline (p<0.0001). The both values of logarithm CRP were significantly correlated using Pearson's correlation (r = 0.920, 95% confidence interval: 0.883-0.945). CONCLUSION: CRP values increased after long-term frozen storage. The CRP values showed a high correlation between before and after long-term storage.     

Ophthalmic surgery in prion diseases

Eleven (1.8%) of 597 patients underwent ophthalmic surgery within 1 month before the onset of prion disease or after the onset. All ophthalmologists reused surgical instruments that had been incompletely sterilized to eliminate infectious prion protein. Ophthalmologists should be aware of prion diseases as a possible cause of visual symptoms and use disposable instruments whenever possible.