Hiroshi Yoshida

Background: The cholesterol efflux capacity (CEC) of high-density lipoprotein (HDL) (HDL-CEC) is inversely associated with atherosclerotic cardiovascular disease. Type 2 diabetes mellitus (T2DM) is frequently complicated by chronic kidney disease (CKD), usually associated with increased homocysteine (Hcy), and these conditions are likely to be involved in HDL dysfunction. However, the relationship between HDL-CEC and CKD, as well as Hcy levels in patients with T2DM remains unclear.Methods and Results: This cross-sectional study involved 138 patients with T2DM. CEC was measured using a stable-isotope method with J774 macrophage-like cells and apolipoprotein B-depleted serum. Multiple regression analysis showed that sex (β=0.278; P=0.005), estimated glomerular filtration rate (eGFR; β=0.232; P=0.038), and HDL cholesterol (HDL-C; β=0.197; P=0.030) were independently associated with CEC.Conclusions: Sex, eGFR, and HDL-C were independently associated with HDL-CEC in patients with T2DM. These findings suggest that impaired renal function may be related to impaired HDL function in this population, although causal relationships cannot be inferred from this cross-sectional analysis.

Purpose: The present study aimed to investigate the proportion of myofascial pain syndrome (MPS) among patients with definitively diagnosed or suspected fibromyalgia (FM), and to compare patients ultimately diagnosed with MPS and those diagnosed with FM, as well as to describe the clinical characteristics of the MPS group. Patients and Methods: This retrospective cross-sectional study was conducted at a university hospital. Clinical data were retrospectively extracted from electronic medical records of patients referred with suspected or diagnosed FM between January 2018 and December 2022. Available clinical information was limited to routinely documented data in referral documents and medical records. Patients included those definitively diagnosed with FM, as well as those suspected of FM based on established criteria or on the opinion of a rheumatologist or an FM expert. Final diagnoses were reassessed by one of the authors, who reviewed the original documentation to assess reclassification as MPS, based on regional pain, myofascial trigger points, and taut bands of muscle fibers. Results: A total of 29 patients were identified as potentially eligible, and 28 were included in the final analysis (mean age, 48.8 years; 28.6% male). Of the 29 patients, 25 (86.2%) were ultimately diagnosed with MPS. Compared with the FM group, the MPS group was older, responded better to local treatments, and reported less fatigue. A substantial proportion of patients with MPS had upper back pain and chronic widespread pain. Conclusion: In this retrospective record-based study, most patients with diagnosed or suspected FM were ultimately diagnosed with MPS. Although several clinical features distinguished MPS from FM, patients in the MPS group in this referral-based cohort frequently exhibited upper back pain and chronic widespread pain, features typically associated with FM, which may contribute to diagnostic confusion. Careful physical examination and assessment of response to local treatments may improve diagnostic accuracy.

Background: Thiamine responsive disorder (TRD), a clinical condition which improves with the administration of vitamin B1, has been proposed in pediatrics to detect the atypical and diverse symptoms of vitamin B1 deficiency which has been widely overlooked. Previous studies were not conducted in internal medicine and in developed countries. Therefore, the aim of this study was to determine the characteristics of Japanese TRD patients in internal medicine. Methods: This case-control study was conducted at Department of General Medicine in the Jikei University Kashiwa Hospital from January 2018 to December 2022. Participants were tested for whole blood total vitamin B1, serum albumin levels, and total lymphocyte count; started newly on a vitamin B1 preparation for treating patients’ signs and symptoms; and re-visited the hospital to evaluate drug effectiveness. Signs and symptoms were chosen whether they had been suspected to be a vitamin B1 deficiency by the treating physicians. All enrolled patients were assessed recovery status by the clinician at that time, and one of the authors assigned them to a TRD or not using a two-point scale (getting better vs. no change or getting worse) based on all the information available from electronic medical records. Results: A total of 35 patients were enrolled (median age 48 years; 31.4% male). A univariate logistic regression analysis showed that sex was associated with TRDs (female: unadjusted odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.0043 - 0.55, P = 0.007), which was the same as the result of a multivariate logistic regression analysis with forced entry method (female: adjusted OR = 0.03, 95% CI: 0.0009 - 0.32, P = 0.002). In addition, there was an atypical symptom of vitamin B1 deficiency such as orthostatic dysregulation (OD): lightheadedness and syncope in the TRDs albeit being nonsignificant. Conclusions: Japanese TRD patients in internal medicine were associated with sex, and had a symptom of OD. Further well-designed, large-scale studies are needed to explore the features of TRDs in internal medicine.

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Background: Numerous epidemiological studies have shown that hypertriglyceridemia is a significant risk factor for cardiovascular diseases (CVD). However, large clinical studies on triglyceride‐lowering therapy have yielded inconsistent results. In the current review, we reassess the importance of triglyceride‐lowering therapy in preventing CVD based on previous literature and the recently published findings of the PROMINENT trial.Methods: This narrative review is based on literature and public documents published up to November 2023.Results: Meta‐analyses of trials on peroxisome proliferator‐activated receptor α agonists and triglyceride‐lowering therapy, including the PROMINENT trial, have indicated that triglyceride‐lowering therapy can reduce CVD events. Mendelian randomization studies have also indicated that triglyceride is indeed a true risk factor for coronary artery disease, leaving no doubt about its relationship to CVD. Meanwhile, the negative results from the PROMINENT trial were likely due to the insufficient triglyceride‐lowering effect, slight increases in low‐density lipoprotein cholesterol and apolipoprotein B, and the inclusion of mostly high‐intensity statin users as target patients. It is unlikely that adverse events counteracted the effectiveness of pemafibrate on outcomes. Additionally, pemafibrate has shown positive effects on non‐alcoholic fatty liver disease and peripheral artery disease.Conclusion: Although the PROMINENT trial did not demonstrate the significance of pemafibrate as a triglyceride‐lowering therapy in a specific population, it does not necessarily negate the potential benefits of treating hypertriglyceridemia in reducing CVD events. It is necessary to explore appropriate populations that could benefit from this therapy, utilize data from the PROMINENT trial and other databases, and validate findings in real‐world settings.

A 62-year-old female patient under long-term corticosteroid therapy for systemic lupus erythematosus consulted our hospital for generalized malaise and was subsequently admitted to the hospital with the diagnosis of prerenal renal failure. During hospitalization, right lateral abdominal erythema and an elevated serum C-reactive protein level were observed. Chest computed tomography showed multiple nodular shadows in the right upper lung lobe. Thereafter, Cryptococcus neoformans was isolated from the blood and skin biopsy samples obtained from the erythematous region in the right lateral abdomen. Based on the findings, we established the diagnosis of disseminated cryptococcosis. Although the patient was immediately initiated on antifungal treatments, she developed cerebral infarction and pancreatitis, which were possibly attributed to the disseminated cryptococcosis. Subsequently, she rapidly developed evidence of disseminated intravascular coagulation syndrome and multiple organ failure, resulting in death. Herein, we report a case of disseminated cryptococcosis, in which detailed microbiological and pathological analysis was conducted.

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide. The risk of developing CVD is associated with an unhealthy lifestyle. A high level of low-density lipoprotein (LDL) cholesterol (LDL-C) is a primary risk factor for ASCVD. However, even if the LDL-C management target has been achieved, hypertriglyceridemia and a high level of total cholesterol minus high-density lipoprotein (HDL) cholesterol (non-HDL-C), which contains cholesterol concentrations of triglyceride-rich lipoproteins, are considered a significant residual risk factor for ASCVD and consequently the management of these conditions is important for controlling the residual risk for ASCVD.

Comprehensive management of a variety of risk factors including dyslipidemia is important for the prevention of atherosclerotic cardiovascular diseases. For the treatment of dyslipidemia as one such representative risk factor, diet therapy is fundamental ahead of drug therapy, and functional foods are also expected to have favorable effects. In the quantitative evaluation of serum lipids, including LDL cholesterol, HDL cholesterol, and triglyceride, a high level of LDL cholesterol is defined as a primary risk factor for atherosclerosis, but many unresolved questions remain as to whether hypertriglyceridemia and a low level of HDL cholesterol can be regarded as residual risk factors beyond the increased LDL cholesterol. For the establishment of better comprehensive management of atherosclerosis risk factors, we have consistently strived to investigate issues related to metabolism and nutrition science, including the improvement of lipid metabolism-related biomarkers using antioxidant substances (vitamin E and carotenoids) and sophisticated methods for quantitative and qualitative measurement of serum lipids. We believe that these efforts and achievements will help to extend healthy longevity in the general population.

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