ObjectiveFever of unknown origin (FUO) can be caused by many diseases, and varies depending on region and time period. Research on FUO in Japan has been limited to single medical institution or region, and no nationwide study has been conducted. We identified diseases that should be considered and useful diagnostic testing in patients with FUO.DesignA nationwide retrospective study.Setting17 hospitals affiliated with the Japanese Society of Hospital General Medicine.ParticipantsThis study included patients ≥18 years diagnosed with ‘classical fever of unknown origin’ (axillary temperature ≥38°C at least twice over a ≥3-week period without elucidation of a cause at three outpatient visits or during 3 days of hospitalisation) between January and December 2011.ResultsA total of 121 patients with FUO were enrolled. The median age was 59 years (range 19–94 years). Causative diseases were infectious disease in 28 patients (23.1%), non-infectious inflammatory disease in 37 (30.6%), malignancy in 13 (10.7%), other in 15 (12.4%) and unknown in 28 (23.1%). The median interval from fever onset to evaluation at each hospital was 28 days. The longest time required for diagnosis involved a case of familial Mediterranean fever. Tests performed included blood cultures in 86.8%, serum procalcitonin in 43.8% and positron emission tomography in 29.8% of patients.ConclusionsWith the widespread use of CT, FUO due to deep-seated abscess or solid tumour is decreasing markedly. Owing to the influence of the ageing population, polymyalgia rheumatica was the most frequent cause (9 patients). Four patients had FUO associated with HIV/AIDS, an important cause of FUO in Japan. In a relatively small number of cases, cause remained unclear. This may have been due to bias inherent in a retrospective study. This study identified diseases that should be considered in the differential diagnosis of FUO.

The purpose of the present study was to elucidate the cardiac structure and function in patients who have metabolic syndrome but no history of cardiovascular disease by analyzing echocardiographic findings.

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A miniature x-ray tube is described. The tube is made of Kovar, inside which a grounded target is located close to a field-electron emitter consisting of aligned carbon nanofibers, which continues to work for around 100 h in the 10 Ϫ6 Pa region unless arcing is induced between the electrodes. The resolution of the contact x-ray images provided by the tube would be impossible using the existing techniques of conventional x-ray radiography, whether the sample is biological or nonbiological.

A transmission x-ray tube super-miniature in size is described. The x-ray tube is 5mm in diameter, and comprised of a built-in electron-emitter assembly and a grounded planar target. The key component of the emitter assembly is a Kovar pipe 2mm in diameter, inside which carbon nanofibers aligned on an electro-polished molybdenum tip are loaded to serve as the electron emitter. This type of electron emitter is highly robust in non-ultrahigh vacuum, continuing to field emit electrons for 100h or longer at pressures in the 10−5Pa region. This x-ray tube provides clear x-ray images.

These findings suggest that polaprezinc exerts an anti-inflammatory effect on the liver in patients with HCV-related CLD by reducing iron overload.

Although visit-to-visit variability in systolic blood pressure (SBP) has recently been demonstrated to be a strong predictor of stroke, there are no data about relationships between SBP variability and cardiac damage in hypertensive patients. We compared relationships between visit-to-visit variability in SBP and left ventricular (LV) diastolic dysfunction with the relationships between the mean SBP value and cardiac parameters in treated patients. Forty treated hypertensive patients (69±9 years of age) had their blood pressure measured at outpatient clinics every 1 or 2 months over a 1-year period. The standard deviation (s.d.) of SBP and the difference between the maximum and minimum SBPs during this year were calculated to assess visit-to-visit variability. The mean SBP during the year was also calculated. LV diastolic function was assessed by the ratio (E/A) of early (E) and late (A) diastolic transmitral flows, early diastolic mitral annular velocity (e¢) and the ratio (E/e¢) of E to e¢ using Doppler echocardiography. E/A only correlated with the s.d. of SBP (r¼À0.327, P¼0.040), whereas e¢ correlated with s.d. of SBP (r¼À0.496, P¼0.001) and maximum-minimum SBP difference (r¼À0.490, P¼0.001). E/e¢ correlated with s.d. of SBP (r¼0.384, P¼0.014), maximum-minimum SBP difference (r¼0.410, P¼0.009), and the mean value of SBP (r¼0.349, P¼0.028). Multiple regression analysis demonstrated only the maximum-minimum SBP difference independently associated with E/e¢ (b¼0.410, P¼0.009). Thus, the visit-to-visit variability of SBP showed better correlation with LV diastolic dysfunction than mean values of SBP. High visit-to-visit variability of SBP was associated with LV diastolic dysfunction and may constitute a high risk for diastolic heart failure in hypertensive patients.

The diameter of the inferior vena cava (IVC) measured with echocardiography is clinically used as a parameter to estimate right atrial pressure, which reflects dehydration or overhydration. Because elderly patients fall easily into dehydration, normal values for IVC diameters in elderly patients may be helpful for geriatric medicine. However, normal values of IVC diameter in relation to age have not been investigated. The purpose of this study was to elucidate age-related changes in IVC diameter using echocardiography. Enrolled in the study were 200 patients (67 ± 15 yrs: range 17-94 yrs) with cardiovascular risk factors but no overt cardiac diseases. IVC diameters throughout the respiratory cycle were measured as maximum and minimum IVC diameters (IVC max , IVC min ) using M-mode echocardiography. To assess IVC collapsibility, the respirophasic variation of IVC diameter was calculated as (IVC max -IVC min )/(IVC max ) × 100. Maximum IVC diameter was decreased with advancing age (r = -0.221, p = 0.002). The respirophasic variation of the IVC diameter was increased with advancing age (r = 0.244, p = 0.001). Stepwise multiple regression analysis showed that age was an independent determinant for both maximum IVC diameter (ß coefficient = -0.249, p < 0.001) and respirophasic variation of the IVC diameter (ß coefficient = 0.268, p < 0.001).Age-related decrease in maximum IVC diameter and increase in the respirophasic IVC collapsibility may indicate the decrease in right atrial pressure in some elderly patients. Therefore, elderly patients with decreased maximum IVC and increased respirophasic IVC collapsibility may need prevention for dehydration.