Our findings suggest that elevated serum tHcy levels are a significant risk factor for the development of CKD in the general population.

An 86-year-old woman with a 13-year history of hypertension was admitted because of consciousness disturbance, hypotension, tachycardia, and cyanosis at her extremities. Enhanced computed tomography showed a thrombus in the truncus pulmonalis and right pulmonary artery, and also showed a left renal mass and a right renal cyst. Under a diagnosis of pulmonary embolism we started anticoagulant therapy, but the patient died five days after admission. At autopsy, a saddle-like thrombus was found in the truncus pulmonalis and bilateral trunks of pulmonary arteries. Microscopic examination showed smooth muscle cells in the thrombus. We could not find any other thrombus in the inferior vena cava, intrapelvic veins, nor in veins of lower extremities by milking. We also found tumors in both kidneys. Microscopically all tumors were diagnosed as angiomyolipoma. There were many fibrin thrombi in the sinuses of the tumors but there was no evidence of malignancy. We finally diagnosed pulmonary embolism due to renal angiomyolipoma because there was no other thrombus origin and microscopically the same smooth muscle cells were found both in the renal tumor and the pulmonary thrombus. There is only one case report concerning pulmonary embolism due to renal angiomyolipoma which happened during operative treatment. The treatment method of renal angiomyolipoma is determined by tumor size and symptoms, and usually intensive treatment is not performed in cases without symptoms. Our patient had no symptoms until the onset of severe complication of pulmonary embolism, suggesting that radical treatment is necessary for renal angiomyolipoma with a thrombus even when there are no symptoms.

The aim of this review is to introduce the adverse health effects of indium compounds. This review consists of 2 parts: (1) a study of the toxic effects in indium compounds in humans, and (2) a study of the toxic effects of indium tin oxide (ITO) and copper indium gallium diselenide (CIGS) in animals.To date, 4 epidemiological surveys have been conducted of indium-handling workers in Japan, and all who were studied showed that exposure to indium compounds caused pulmonary interstitial and emphysematous changes. There were clear dose-response and dose-effect relationships between the serum indium levels and the levels of Krebs von den Lungen-6 (KL-6), which is a serological indicator of interstitial pneumonia up until 2011, 8 cases of interstitial pneumonia in Japanese indium-exposed workers, 2 cases of pulmonary alveolar proteinosis (PAP) in US indium-exposed workers, and 1 case of PAP in a Chinese indium-exposed worker have been reported.In animals studies, it has been clearly demonstrated that ITO and CIGS particles cause pulmonary toxicity and that the dissolution of ITO and CIGS particles in the lungs is considerably slow when repeated intratracheal instillations were given to experimental animals.Thus, more studies are needed on the effects of human exposure to indium compounds.

Objective Elevated blood pressure (BP) response to the cold pressor test (CPT) is associated with increased risk of hypertension and cardiovascular diseases. However, it is still unclear whether BP response to CPT is a stable and reproducible trait over time. Design and methodsWe repeated the CPT among 568 Han Chinese 4.5 years after the initial study. The same CPT protocol was applied in the initial and repeated studies. BP was measured prior to and at 0, 1, 2, and 4 minutes after the participants immersed their hand in ice water (3 °C to 5 °C) for 1 minute using a standard mercury sphygmomanometer. ResultsAbsolute BP levels and BP responses during the CPT in the initial and repeated studies were highly correlated. For example, the correlation coeffi cients were 0.67, 0.73, 0.71, and 0.72 for absolute systolic BP (SBP) levels at 0, 1, 2, and 4 minutes after ice water immersion (all P Ͻ 0.0001). The correlation coeffi cients for SBP responses were 0.41 at 0 minute, 0.37 at 1 minute, 0.42 for maximum responses, and 0.39 for the area-under-the-curve during CPT (all P Ͻ 0.0001). ConclusionsThese data indicate that BP response to CPT is a long-term reproducible and stable characteristic in general population.Objective We examined the relationship between brachial-ankle pulse wave velocity and the development of cardiovascular disease in prospective study of a general Japanese population. Design and MethodsA total of 2,916 community-dwelling Japanese individuals without history of cardiovascular disease aged Ն 40 years were followed up for an average of 7.1 years, and the relationship between brachial-ankle pulse wave velocity and the development of cardiovascular disease was estimated using the Cox proportional hazards model. To compare the accuracy of the risk assessment for future cardiovascular events between the models adjusted for known cardiovascular risk factors with and without brachial-ankle pulse wave velocity, receiver operating characteristic curves for the model were plotted. ResultsDuring the follow-up period, 126 subjects experienced cardiovascular events. Age-and sex-adjusted cumulative incidence rates of cardiovascular disease increased linearly with elevating brachial-ankle pulse wave velocity levels (p for trend Ͻ 0.001). After adjusting for potential confounding factors, every 20% increment in brachial-ankle pulse wave velocity was associated with a 1.30-fold (95% confi dential interval, 1.10-1.53) greater cardiovascular risk. The area under the receiver operating characteristic curve was signifi cantly increased when brachial-ankle pulse wave velocity was incorporated into a model with known cardiovascular risk factors (0.776 vs. 0.761, p ϭ 0.01). ConclusionsOur fi ndings suggest that brachial-ankle pulse wave velocity is a signifi cant predictive factor for cardiovascular disease in the general Japanese population and that information on brachial-ankle pulse wave velocity substantially improves cardiovascular risk assessment beyond a model based on potential risk factors in general practice.

SummaryTo elucidate the risk factors for initiating glucose intolerance, the relevant factors were explored in a cross-sectional survey conducted in a sample population aged 40-79 years old selected from a Japanese community, Hisayama, Japan in 1988. A 75-g oral glucose tolerance test was used to classify 1,073 men (72.5 % of the entire population in the same age range) and 1,407 women (80.5 %) into normal, impaired glucose tolerance and diabetes mellitus groups. In all age and sex groups with normal glucose tolerance, the sum of fasting and 2-h post-load insulin values varied widely and demonstrated significant positive correlations with triglycerides, body mass index, waist-hip ratio, systolic and diastolic blood pressure, while it negatively correlated to HDL cholesterol (p < 0.05). Insulin resistance was presumed to develop in normal glucose tolerance subj ects with hyperinsulinaemia. The sum of the insulin concentrations, triglycerides, body mass index, waist-hip ratio and blood pressure levels was significantly associated with impaired glucose tolerance in all age and sex groups after adjustment for age (p < 0.05) and was also related to diabetes in either all or some age and sex groups, respectively (p < 0.05). It was shown that glucose intolerance in the general population was associated with the factors related to insulin resistance. These cross-sectional data, therefore, support the hypothesis that insulin resistance is the primary defect in the development of glucose intolerance in the Japanese general population. However, a further prospective study is still needed in order to confirm this hypothesis. [Diabetologia (1994) 37: 897-904]