Assessment of Medical Expenditures for Sepsis:Differentiating between Cases with and without Ruled-out Diagnoses

Setting public health priorities requires precise estimation of the burden of disease, including disease-specific medical expenditure. Information on multiple and ruled-out diagnoses on health insurance claims (HICs) has been ignored in traditional analyses of disease-specific medical expenditures in Japan. This study reviewed 448 inpatients with at least one diagnosis of sepsis on their HICs, who were insured by corporate health insurance organizations making claims on services provided from April 2006 to March 2007 in Japan. Subjects in whom sepsis-related diagnoses were specified as “ruled-out” were compared with subjects in whom sepsis-related diagnoses were classified as “not-ruled-out” (i.e., subjects in whom sepsis was considered possibly or likely present). Direct medical expenditure, length of stay (LOS), cost per day, cost of antibiotics, and proportion of administered cephalosporin and carbapenems were significantly higher in subjects classified as not-rule-out. When using health insurance claims in Japan, the statistics of medical expenditures and LOS are influenced by procedures performed to rule out a diagnosis, as well as those performed to treat a confirmed diagnosis of sepsis

Inverse Correlation between Adiponectin and the Risk of Metabolic Syndrome in Middle-aged Japanese Male Workers

Despite a close association between adiponectin and both hypertension and type 2 diabetes, the relationship between adiponectin and metabolic syndrome has not yet been well-investigated. To examine and evaluate the association between serum adiponectin levels and metabolic syndrome based on Japanese diagnostic criteria, we analyzed adiponectin and anthropometric parameters in 869 male employees aged 40-59 who belonged to a health insurance society in Fukuoka Prefecture and who underwent annual health check-ups from August 2006 to July 2007. Two hundred and thirty-two of the 869 subjects (26.7%) were diagnosed with metabolic syndrome. The serum adiponectin levels were significantly higher in the non-metabolic syndrome group. In a multiple logistic regression analysis, the subjects in the top quartile of serum adiponectin (adjusted odds ratio:0.36;95% confidence interval:0.21-0.63) and the second (adjusted odds ratio:0.51;95% confidence interval:0.31-0.84) quartile had a significantly decreased risk for metabolic syndrome in comparison to the bottom quartile. The dose-response relationship between serum adiponectin levels and metabolic syndrome was significant (p for trend 0.0001) after adjusting for age, body mass index, smoking status, and drinking status. The current findings suggest that hypoadiponectinemia is inversely correlated with the risk of metabolic syndrome in middle-aged Japanese male workers.</p

Hyperleptinemia is associated with hypertension in Japanese males

Leptin is a hormone which is predominantly secreted by adipose tissue. Recent studies have shown that leptin increases arterial blood pressure. Although data from available animal studies clearly indicate an association between leptin and hypertension, results of human studies have been less definitive. We conducted a case-control study to examine the association between serum leptin levels and hypertension in 111 hypertensive subjects and 222 male controls, using conditional logistic regression analyses. Mean serum leptin levels were found to be marginally higher in the case subjects than in the control subjects (3.3 ng/ml versus 3.0 ng/ml), however, conditional logistic regression analysis revealed that subjects in the highest quartile had a significantly increased risk of hypertension compared with those in the lowest quartile, even after adjusting for drinking status and diabetes mellitus (adjusted OR, 2.11;95% CI, 1.01-4.39). Our findings suggest that leptin plays an important role in the development of hypertension.</p

High abundance ratio of 13^{13}CO to C18^{18}O toward photon-dominated regions in the Orion-A giant molecular cloud

Aims. We derive physical properties such as the optical depths and the column densities of $^{13}$CO and C$^{18}$O to investigate the relationship between the far ultraviolet (FUV) radiation and the abundance ratios between $^{13}$CO and C$^{18}$O. Method. We have carried out wide-field (0.4 deg$^2$) observations with an angular resolution of 25.8 arcsec ($\sim$ 0.05 pc) in $^{13}$CO ($J$=1--0) and C$^{18}$O ($J$=1--0) toward the Orion-A giant molecular cloud using the Nobeyama 45 m telescope in the on-the-fly mode. Results. Overall distributions and velocity structures of the $^{13}$CO and C$^{18}$O emissions are similar to those of the $^{12}$CO ($J$=1--0) emission. The optical depths of the $^{13}$CO and C18O emission lines are estimated to be 0.05 $<$ $\tau_{\rm ^{13}CO}$ $<$ 1.54 and 0.01 $<$ $\tau_{\rm C^{18}O}$ $<$ 0.18, respectively. The column densities of the $^{13}$CO and C$^{18}$O emission lines are estimated to be 0.2 $\times$ 10$^{16}$ $<$ $N_{\rm ^{13}CO}$ $<$ 3.7 $\times$ 10$^{17}$ cm$^{-2}$ and 0.4 $\times$ 10$^{15}$ $<$ $N_{\rm C^{18}O}$ $<$ 3.5 $\times$ 10$^{16}$ cm$^{-2}$, respectively. The abundance ratios between $^{13}$CO and C$^{18}$O, $X_{\rm ^{13}CO}$/$X_{\rm C^{18}O}$, are found to be 5.7 - 33.0. The mean value of $X_{\rm ^{13}CO}$/$X_{\rm C^{18}O}$ in the nearly edge-on photon-dominated regions is found to be 16.47 $\pm$ 0.10, which is a third larger than that the solar system value of 5.5. The mean value of $X_{\rm ^{13}CO}$/$X_{\rm C^{18}O}$ in the other regions is found to be 12.29 $\pm$ 0.02. The difference of the abundance ratio is most likely due to the selective FUV photodissociation of C$^{18}$O.Comment: 11 pages, 9 figures, Accepted to A&

Idiopathic Plasmacytic Lymphadenopathy Forms an Independent Subtype of Idiopathic Multicentric Castleman Disease

Idiopathic multicentric Castleman disease (iMCD) is a type of Castleman disease that is not related to KSHV/HHV8 infection. Currently, iMCD is classified into iMCD-TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) and iMCD-NOS (not otherwise specified). The former has been established as a relatively homogeneous disease unit that has been recently re-defined, while the latter is considered to be a heterogeneous disease that could be further divided into several subtypes. In 1980, Mori et al. proposed the concept of idiopathic plasmacytic lymphadenopathy (IPL), a disease presenting with polyclonal hypergammaglobulinemia and a sheet-like proliferation of mature plasma cells in the lymph nodes. Some researchers consider IPL to be a part of iMCD-NOS, although it has not been clearly defined to date. This is the first paper to analyze iMCD-NOS clinicopathologically, to examine whether IPL forms a uniform disease unit in iMCD. Histologically, the IPL group showed prominent plasmacytosis and the hyperplasia of germinal centers, while the non-IPL group showed prominent vascularity. Clinically, the IPL group showed significant thrombocytosis and elevated serum IgG levels compared to the non-IPL group (p = 0.007, p < 0.001, respectively). Pleural effusion and ascites were less common in the IPL group (p < 0.001). The IPL group was more likely to have an indolent clinical course and a good response to the anti-IL-6 receptor antibody, while the non-IPL counterpart frequently required more aggressive medical interventions. Thus, the IPL group is a clinicopathologically uniform entity that forms an independent subtype of iMCD

Idiopathic multicentric Castleman disease with positive antiphospholipid antibody: atypical and undiagnosed autoimmune disease?

Idiopathic multicentric Castleman disease (iMCD) is a systemic disorder characterized by systemic inflammation and organ dysfunction associated with an increase in pro-inflammatory cytokines. Some patients with iMCD are positive for autoantibodies, although their significance and relationship with specific associated autoimmune diseases are unclear. This study retrospectively analyzed the clinicopathological features of iMCD patients focusing on autoantibodies. Among 63 iMCD patients in our database, 19 were positive for at least one autoantibody. Among the 19, we identified five with plasma cell type (PC)-iMCD lymph node histopathology and positive anti-phospholipid antibodies. These patients were likely to have thrombocytopenia, anasarca, fever, reticulin fibrosis or renal insufficiency, organomegaly (TAFRO) symptoms, and thrombotic events. The present study suggests that patients with undiagnosed or atypical autoimmune diseases, including anti-phospholipid syndrome (APS), were treated for iMCD. APS may present with thrombocytopenia or even multi-organ failure, which overlap with clinical presentations of iMCD. Due to differences in the treatment regimen and follow-up, recognition of the undiagnosed autoimmune disease process in those suspected of iMCD is essential. Our study highlights the importance of complete exclusion of differential diagnoses in patients with iMCD in their diagnostic workup