Masashi Goto

Background: In Japan, 5000–300 000 persons contracted measles every year until 2001. The measles/rubella‐combined (MR) vaccination at age 17–18 years (phase 4 MR vaccination: MR‐IV) was launched in 2008 in Japan as a measles–rubella catch‐up campaign. A serological assessment of this campaign has not been thoroughly performed.Methods: Titers of anti‐measles and anti‐rubella immunoglobulin G antibodies, and past medical history including measles and rubella vaccination and infection were obtained from first‐year university students in 2008 and 2009, and the immune status against measles and rubella was compared between students at the target MR‐IV age (the target age group) and those 1 year older than the target age (non‐target age group).Results: A total of 186 students were in the target age group and 146 were in the non‐target age group. The proportion of students with a history of measles and rubella infection was not significantly different between the two groups (8.8% vs. 6.3%, P = 0.41 and 11.0% vs. 9.9%, P = 0.75, respectively). A history of two or more measles and rubella vaccinations was significantly more frequent in the target age group (85.2% and 54.9%, respectively) than in the non‐target age group (20.8% and 13.2%, respectively; both P < 0.001). Prevalence of seropositivity for measles and for rubella was also higher in the target age group (98.9% and 97.8%, respectively) than in the non‐target age group (91.0% and 87.5%, respectively; both P < 0.001).Conclusions: The MR‐IV catch‐up campaign helped achieve herd immunity and will contribute to the elimination of measles and rubella.

Patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are still at a substantial risk of death after their procedures. A core group of preoperative and preprocedural risk factors and conditions contributes the majority of inherent mid- and long-term mortality risk in these patients. Therefore, we sought to develop a classification tree model as a practical and user-friendly method of predicting mid-term survival after coronary revascularization procedures. We retrospectively analyzed data from a single, large-volume institution. Specifically, we examined all-cause three-year mortality in 3387 consecutive patients with multivessel or single proximal left anterior descending coronary artery disease who underwent either PCI with stenting or CABG. Recursive partitioning indicated that the best single predictor of death within three years was a history of heart failure (HF), followed by a proximal left circumflex artery (pLCX) lesion and age greater than 65 years for patients with and without a history of HF, respectively. With these variables, patients were readily stratified into low-, intermediate-, and high-risk groups whose risks of death over three years ranged from 2.3% to 36.2%. Among patients with a history of HF, pLCX stenosis was an independent predictor of mid-term mortality after adjustment for other known risk factors (hazard ratio, 1.46; 95% CI, 1.04-2.03). The constructed risk stratification scheme stratified patients into groups at low, intermediate, and high risk of death within three years. Stenosis of the pLCX seems to be an important prognostic factor for patients with a history of HF.

Objective: To identify lifestyle and sociodemographic risk factors of overweight among male college students.Design: A retrospective cohort study.Setting: Annual health checkup in a single university in Japan.Participants: Male students who underwent two successive health checkups from their third school year between 2000 and 2007 and whose BMI at baseline of this study was 22·0 kg/m²or more (n4634).Results: During the 1-year follow-up, 598 students (12·9 %) reached the study endpoint, i.e. more than a 5 % increase in BMI. Independent risk factors for substantial BMI increase included infrequent exercise (OR = 1·33; 95 % CI 1·11, 1·60), no or infrequent alcohol drinking (OR = 1·30; 95 % CI 1·08, 1·57), frequently skipping breakfast (OR = 1·34; 95 % CI 1·12, 1·61), preference for fatty food (OR 1·36; 95 % CI 1·04, 1·78) and living alone (OR = 1·23; 95 % CI 0·99, 1·52). Students were readily stratified according to risk for substantial BMI gain by counting the number of their risk factors. OR (95 % CI) for the risk between the no risk factor group and students with two, three, four and five risk factors were 1·61 (0·96, 2·70), 2·24 (1·34, 3·75), 2·42 (1·39, 4·23) and 6·22 (2·58, 15·0), respectively.Conclusion: These data suggest that avoidance of certain risk factors in college life is associated with a decrease in incidence of overweight among male students.

Background. Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis, and a substantial number of patients succumb to end-stage renal disease (ESRD). However, prediction of the renal outcome in individual patients remains difficult. We have already published a scoring system using the data in a prospective cohort of IgAN patients followed up from 1995 to 2002. Methods. The cohort was further followed up until 2005 in 97 clinical units in Japan. The data from 2283 patients were analysed by Cox regression to determine the predictors of ESRD in IgAN, and their β-coefficients were converted into scores to estimate ESRD risk within 10 years. Results. During the follow-up (median, 87 months), 252 patients developed ESRD. Male sex, age less than 30 years, family histories of chronic renal failure and chronic glomerulonephritis, hypertension, proteinuria, mild haematuria, hypoalbuminaemia, low glomerular filtration rate and a high histological grade at initial renal biopsy were associated with the risk of ESRD in the multivariable analysis. A scoring system was framed to estimate the 10-year ESRD risk using eight variables significant in both univariable and multivariable models. This prognostic score accurately classified patients by risk: patients with estimates of 0–4.9, 5.0–19.9, 20.0–49.9 and 50.0–100% had an observed incidence of 1.7, 8.3, 36.7 and 85.5%, respectively. The corresponding area under the receiver-operating characteristic curve was 0.942 (95% confidence interval, 0.925–0.958). Conclusion. This validated scoring system to quantitatively estimate ESRD risk during the 10-year follow-up of IgAN patients will serve as a useful prognostic tool in clinical practice.

Background. Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis, and many patients are at risk of at least slow progression. However, prediction of the renal outcome in individual patients remains difficult. Methods. To develop a practical and user-friendly scheme for risk stratification of IgAN patients, data were extracted from a prospective cohort study conducted in 97 clinical units in Japan from 1995. Specifically, we examined deterioration in renal function, defined as doubling of serum creatinine, within 10 years of follow-up in 790 adult IgAN patients without substantial renal dysfunction at baseline using a decision tree induction algorithm. Results. Recursive partitioning indicated that the best single predictor of renal deterioration was severe proteinuria on urine dipstick testing, followed by hypoalbuminaemia and the presence of mild haematuria for patients with and without severe proteinuria, respectively. Serum total protein levels, diastolic blood pressure and histological grade were placed in the third tier of the decision tree model. With these six variables, patients can be readily stratified into seven risk groups whose incidence of renal deterioration within 10-year follow-up ranges from 1.0% to 51.4%. Logistic regression also identified severe proteinuria, hypoalbuminaemia and mild haematuria as significant predictors of deterioration. Areas under the receiver-operating characteristic curve for the prediction were comparable between the decision tree model and the logistic regression model [0.830 (95% confidence interval, 0.777–0.883) versus 0.808 (95% confidence interval, 0.754–0.861)]. Conclusion. Risk of substantial renal deterioration in IgAN patients can be validly estimated using six predictors obtained from clinical routine.

Objective: To describe characteristics and outcomes for patients hospitalized with fever, not only patients with fever of unknown origin (FUO). Methods: Medical records were reviewed for 226 consecutive patients hospitalized in a Japanese referral hospital with fever as one of the clinical problems. Results: Although the majority of illnesses involved some sort of infection (54%), noninfectious inflammatory diseases, particularly adult Stills disease (n=6) and primary vasculitis syndromes (n=5) including 3 cases of Behçets disease, represented the leading cause in patients who met the definition of FUO [16/51(31%)]. Tuberculosis (n=6) and psychological disorders (n=6) were associated with late diagnosis. However, there was only one patient meeting the definition of FUO among those with a psychological disorder. Among the patients with prolonged fever who did not strictly meet the definition of FUO, there was a considerable number of patients with critical illnesses, such as intra-abdominal abscess, polymyalgia rheumatica, sarcoidosis, ulcerative colitis, Castlemans disease, hematological and solid malignancies, and panhypopituitarism. Drug-induced fever, systemic viral infection and unspecified vasculitis were difficult to definitively diagnose, although these pathologies were suspected as causes of fever. Follow-up of patients without definitive diagnosis at discharge confirmed that the fever subsided spontaneously or the cause of fever was properly treated after diagnosis in every patient and that none died of the underlying febrile illness. Conclusions: The present findings, from all patients displaying fever at hospitalization, are in agreement with findings from prior FUO series. Strict use of the definition of FUO is thus unwarranted when managing patients with prolonged fever.