kusuhara yasuhiro

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is a common debilitating condition in many industrialized countries that increases the risk of cardiovascular disease. The aim of this study was to derive a simple and accurate screening tool for the prediction of NAFLD in the Japanese population. METHODS: A total of 945 participants, 279 men and 666 women living in Hokkaido, Japan, were enrolled among residents who attended a health check-up program from 2010 to 2014. Participants with an alcohol consumption > 20 g/day and/or a chronic liver disease, such as chronic hepatitis B, chronic hepatitis C or autoimmune hepatitis, were excluded from this study. Clinical and laboratory data were examined to identify predictive markers of NAFLD. RESULTS: A new predictive index for NAFLD, the NAFLD index, was constructed for men and for women. The NAFLD index for men = -15.5693+0.3264 [BMI] +0.0134 [triglycerides (mg/dl)], and for women = -31.4686+0.3683 [BMI] +2.5699 [albumin (g/dl)] +4.6740[ALT/AST] -0.0379 [HDL cholesterol (mg/dl)]. The AUROC of the NAFLD index for men and for women was 0.87(95% CI 0.88-1.60) and 0.90 (95% CI 0.66-1.02), respectively. The cut-off point of -5.28 for men predicted NAFLD with an accuracy of 82.8%. For women, the cut-off point of -7.65 predicted NAFLD with an accuracy of 87.7%. CONCLUSION: A new index for the non-invasive prediction of NAFLD, the NAFLD index, was constructed using available clinical and laboratory data. This index is a simple screening tool to predict the presence of NAFLD.

A 35-year-old woman visited our hospital on January 16th, 2000, because she had felt pain on her right temporal scalp during trip in Australia, and noticed eruption at the site when she came back to Japan. Since a tick clung the scalp, we resected it together with surrounding normal skin, and made a diagnosis of tick bite. The tick was identified as Ixodes holocyclus which lives only in Australia and has strong neurotoxin in the salivary gland. Two days after the resection, edema and erythema around the tick bite lesion expanded to the right upper face, and the right facial palsy became apparent. We diagnosed it as tick paralysis. Since paralysis commonly worsens between 24 and 48hours after tick removal. it must be carefully observed for this period. We treated her with antibiotics by way of precaution for Lyme disease that is also caused by a tick bite. She completely recovered from her facial palsy in one month.