小佐見 光樹

IMPORTANCE: The COVID-19 pandemic may serve as a natural experiment, with pandemic-associated changes in the epidemiology of Kawasaki disease (KD) potentially informing understanding of KD pathogenesis. OBJECTIVES: To assess long-term KD incidence across 50 years and to examine pandemic-associated changes in KD epidemiology across age groups. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a descriptive epidemiologic analysis of data from the Japanese Nationwide Survey of Kawasaki Disease conducted from 2023 to 2024, along with 50 years of historical data. Data were included from patients with KD in the current 2023-2024 survey (n = 29 841) and historical and current survey data from 1975 through 2024 (n = 467 456) for trend analysis. MAIN OUTCOMES AND MEASURES: Annual KD incidence overall and stratified by 3 age groups: infants (<1 year), 1 to 4 years, and 5 to 9 years. RESULTS: The current survey registered 15 032 and 14 809 patients with KD in 2023 and 2024, respectively (overall, 57.3% male; median [IQR] age, 2 [1-4] years). Across the 50-year study period, despite the population under 5 years of age declining in Japan by 61.6%, KD incidence rates increased 16.1-fold. Across the COVID-19 pandemic period, patient numbers reached a nadir of 10 333 in 2022, then rebounded to 15 032 cases (45.5% increase) in 2023. Notably, decline and rebound patterns differed by age. Indexed incidence rates (using 2017 as a baseline of 100) demonstrated that patients 5 to 9 years of age had the largest decline (nadir of 54.2 in 2021, 45.8% below baseline) and the largest rebound (134.8 in 2024, 34.8% above baseline). In contrast, patients younger than 1 year showed the smallest decline (nadir of 73) and incidence rates did not return to baseline levels. When comparing the magnitude of rebound in KD incidence, a distinct age-dependent dose-response pattern was observed: 26.1% for infants, 38.9% for patients aged 1 year, 42.7% for patients aged 2 years, 85.8% for patients aged 3 years, 105.3% for patients aged 4 years, and 166.7% for patients aged 5 to 9 years. CONCLUSIONS AND RELEVANCE: In this nationwide cohort study of KD in Japan, KD incidence rebounded after the relaxation of COVID-19 pandemic-related restrictions, with age-dependent patterns. Nonpharmaceutical interventions (eg, mask-wearing) during the pandemic may explain the greater rebound pattern observed in older children; however, the minimal changes in infants suggest different exposure pathways to potential KD triggers. These findings support an age-stratified approach to KD pathogenesis research, distinguishing infants from older children.

The frequency of heart failure and hyperuricemia is increasing worldwide. Hyperuricemia as a complication of heart failure is known to be an indicator of poor prognosis. However, no consensus exists on whether treating hyperuricemia as a complication of heart failure would alleviate symptoms or improve prognosis in patients with heart failure. There is insufficient evidence regarding whether treatment with uric acid-lowering agents can alleviate symptoms and improve prognosis in patients with heart failure. However, considering the prevention of gout, hypertension, and chronic kidney disease caused by hyperuricemia, if the serum uric acid level does not fall below 8 mg/dL with improvement in lifestyle habits, uric acid-lowering agents can be a treatment option. In an US cohort study comprising approximately 100,000 participants using Medicare data, less aggravation of heart failure was observed in patients who were administered febuxostat compared to allopurinol. Recent evidence further suggests that serum uric acid may reflect not only a biomarker of disease severity but also underlying xanthine oxidase activity and oxidative stress, which may be therapeutically targetable in selected subgroups of heart failure patients. Moreover, differential effects among uric acid-lowering agents raise the possibility that drug-specific properties, rather than uric acid reduction per se, may influence cardiovascular outcomes. In this review, we discuss clinical trials on hyperuricemia with heart failure and its treatment. Further large-scale, high-quality, prospective intervention studies on the efficacy of treating hyperuricemia as a complication of heart failure are required.

ABSTRACT Background Case reports are an important academic output for general medicine physicians; however, publication rates in Japan remain low, and barriers to preparing case reports have not been fully clarified. Thus, we aimed to identify barriers perceived by Japanese general medicine physicians when writing case reports. Methods A web‐based questionnaire survey was administered to physician members of JPCA between November and December 2021. Sixteen potential barriers identified in previous studies were assessed using an 11‐point Likert scale (0–10). Participants were categorized into two groups based on their experience writing case reports. Group comparisons were performed using the Mann–Whitney test and chi‐squared test. Logistic regression analyses, adjusted for age and sex, were conducted to estimate adjusted odds ratios (aORs) for each barrier. Results Overall, 315 physicians responded to the survey (response rate: 10.2%). Of these, 159 (50.4%) had experience in writing case reports. Fifteen of the 16 barrier items scored significantly higher among inexperienced physicians. The aORs were significantly elevated for 13 items, excluding financial factors. The major barriers included lack of sufficient medical documentation to write a report (aOR: 7.99), unfamiliarity with writing case reports (aOR: 6.44), not recognizing suitable cases (aOR: 4.79), and difficulty identifying the main case points and clinical messages (aOR: 3.80). Experienced physicians not “having adequate time to write” remained the main obstacle (69.8%). Conclusions Barriers to writing case reports vary markedly by experience. Systematic education, strengthened mentorship, and organizational support for protected academic time are essential to promoting case report writing among general medicine physicians.

BACKGROUND: We investigated the association between the development of sarcoidosis and personal or family medical history, with a focus on immune-mediated inflammatory diseases (IMIDs), in a Japanese population. METHODS: In this exploratory case-control study, self-administered questionnaires were completed by 164 patients with newly diagnosed sarcoidosis (64 men, 100 women) who visited public health centres in 7 prefectures between 2018 and 2020 to apply for medical expense subsidies (cases) and by 1779 community-dwelling controls (641 men, 1138 women) undergoing municipal health checkups (controls). The questionnaire collected information on personal and family medical histories, including IMIDs. Logistic regression analyses adjusted for age and sex were used to identify risk factors associated with onset of sarcoidosis. RESULTS: A history of IMIDs was associated with a greater likelihood of sarcoidosis (adjusted odds ratio [aOR] 3.05, 95 % confidence interval [CI] 1.79-5.21). Increased risk was observed for rheumatoid arthritis (aOR 2.63, 95 % CI 1.06-6.53), Sjögren's syndrome (aOR 14.39, 95 % CI 4.30-48.10), and hypothyroidism (aOR 4.91, 95 % CI 2.20-10.97). Some conditions, such as asthma, lymphoma, and insulin use, showed possible associations, with wide CIs including 1.0. Additionally, a family history of sarcoidosis was strongly associated with disease occurrence (aOR 21.30, 95 % CI 3.86-117.68), supporting a potential genetic predisposition consistent with previous epidemiological findings. CONCLUSIONS: This study suggests that sarcoidosis may be associated with IMIDs in the Japanese population. However, its findings should be interpreted with caution, given its exploratory design and limited statistical power.