Hirohide Yokokawa

Overlap of primary biliary cirrhosis and autoimmune hepatitis: Characteristics, therapy, and long term outcomes

Background:  Coexistence of primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH) is referred to as PBC‐AIH overlap. Pathogenesis of PBC‐AIH is not well understood and its diagnosis is challenging. We previously reported the clinical characteristics of 10 patients diagnosed with PBC‐AIH overlap.

Prevalence of A-to-G mutation at nucleotide 3243 of the mitochondrial tRNA Leu(UUR) gene in Japanese patients with diabetes mellitus and end stage renal disease

AbstractThe A-to-G mutation at nucleotide 3243 of the mitochondrial tRNALeu(UUR) gene (mt.3243A>G) is associated with both diabetes mellitus and myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Recently, this mutation was found in three diabetic subjects with progressive kidney disease, suggesting that it may be a contributing factor in the development of kidney disease in patients with diabetes. The aim of this study was to evaluate the contribution of this mutation to the development of end stage renal disease (ESRD) in patients with diabetes. The study group consisted of 135 patients with diabetes and ESRD. The control group consisted of 92 non-diabetic subjects with ESRD who were receiving hemodialysis. The mt.3243A>G mutation was detected by polymerase chain reaction-restriction frag-ment length polymorphism (PCR-RFLP). We found the mt.3243A>G mutation in eight patients (8/135; 5.9%), all of whom were initially diagnosed with type II diabetes. Five of the eight patients were subsequently also diagnosed with MELAS. We did not find the mutation in any of the 92 non-diabetic subjects with ESRD. The prevalence of this mutation was 6.5-fold higher in patients with diabetes and ESRD than in those with diabetes alone (8/135 vs 5/550, respectively; χ2 = 13.704; P = 0.0002). The mt.3243A>G mutation may be a contributing genetic factor in the development of ESRD in Japanese patients with diabetes.

Evaluation of a Simple Protein Extraction Method for Species Identification of Clinically Relevant Staphylococci by Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry

ABSTRACT In clinical microbiology, bacterial identification is labor-intensive and time-consuming. A solution for this problem is the use of matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). In this study, we evaluated a modified protein extraction method of identification performed on target plates (on-plate extraction method) with MALDI-TOF (Bruker Microflex LT with Biotyper version 3.0) and compared it to 2 previously described methods: the direct colony method and a standard protein extraction method (standard extraction method). We evaluated the species of 273 clinical strains and 14 reference strains of staphylococci. All isolates were characterized using the superoxide dismutase A sequence as a reference. For the species identification, the on-plate, standard extraction, and direct colony methods identified 257 isolates (89.5%), 232 isolates (80.8%), and 173 isolates (60.2%), respectively, with statistically significant differences among the three methods (P < 0.05). In conclusion, the on-plate extraction method is at least as good as standard extraction in identification rate and has the advantage of a shorter processing time.

Risk factors associated with relapse of type 1 autoimmune hepatitis in Japan.

Aim:  Patients receiving corticosteroid therapy on a tapered schedule occasionally suffer autoimmune hepatitis (AIH) relapses. The aim of this study was to assess the frequency and features of relapses, explore risk factors associated with relapses, and evaluate the effectiveness of azathioprine (AZP) therapy against relapses in Japanese patients with type 1 AIH.

Prevalence of metabolic syndrome and serum marker levels in patients with four subtypes of cerebral infarction in Japan

In this hospital-based cross-sectional study we investigated differences in the levels of serum atherosclerotic and fibrinolytic markers and the prevalence of metabolic syndrome (MS) among patients with four subtypes of cerebral infarctions. Blood samples were taken from 171 cerebral infarction inpatients to determine the levels of high-sensitivity C-reactive protein, serum total homocysteine, serum plasminogen activator inhibitor 1 and lipoprotein a. Subjects were also screened for MS. Atherothrombotic infarction was most prevalent, followed by lacunar and embolic infarction. The median length of hospital stay was longest for embolic infarcts. There were no statistically significant differences in serum marker concentrations. The proportion of MS varied significantly among the subtypes, and was highest among patients with embolic infarctions with the lowest high density cholesterol levels. MS was most prevalent among patients having undergone embolic events that are reported to have the worst prognoses. Further epidemiologic studies are needed to better understand the characteristics and differences in the etiology of cerebral infarction subtypes.

Evaluation of atherosclerosis‐associated factors and pulse wave velocity for predicting cerebral infarction: a hospital‐based, case–control study in Japan

Background: The mortality rate for cerebrovascular diseases is much higher in Japan than in North American and West European countries. The primary aim of this study was to elucidate from an epidemiological perspective, the associations between cerebral infarction and demographic factors, medical history and other clinical measurements including pulse wave velocity, a newly introduced non‐invasive measurement procedure used to assess aortic stiffness.

Gaps between hypertension treatment guidelines and clinical practice in Japan: Baseline survey results from Fukushima Research of Hypertension (FRESH).

This observational study assessed the achievement of treatment goals, as defined by the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004). These goals are: <140/80 mm Hg in elderly patients (65 years and older), <130/80 mm Hg in patients with diabetes or kidney disease, and <130/85 mm Hg in younger patients (younger than 65). From July 2006 to May 2007, 72 physician members of the Fukushima Hypertension Conference enrolled a total of 3320 patients from Fukushima Prefecture, Japan. The median age of the patients was 71 years and 46% were male. The success rate was 27% among patients with diabetes mellitus or renal disease, 30% among those younger than 65 years, and 66% among the elderly without the diseases. Factors significantly associated with an increased risk of failure to achieve goals were obesity, dyslipidemia, family histories of diabetes mellitus or hypertension, and number of antihypertensive drugs used. The presence of atherosclerotic complications decreased the risk. This study revealed low achievement rates, identified the importance of weight control and family histories, and indicated a need for better management to prevent complications.

Longitudinal Community‐Based Assessment of Blood Pressure Control Among Japanese Hypertensive Patients: Fukushima Research of Hypertension (FRESH)

J Clin Hypertens (Greenwich). 2010;12:166–173. ©2010 Wiley Periodicals, Inc.

Lifestyle characteristics and 3-year total mortality of Japanese with self-reported diabetes.

Despite the significant adverse health consequences of diabetes, data on lifestyle characteristics and mortality among the Japanese with diabetes are limited. Our objective was to investigate the lifestyles of Japanese community residents with self-reported diabetes and their 3-year total mortality. Our cohort was 7178 randomly selected residents aged 30-79 years in Nihonmatsu City, Fukushima Prefecture, Japan; 5187 responded to the survey (72% response rate) and were followed for 3 years. Baseline data were collected using questionnaires in December 2002, and deaths were monitored monthly. Only 19% of women and 4% of men followed six to seven of Breslows seven health practices. The percentage of people with self-reported diabetes was 4.2%[95% confidence interval (CI), 3.4-5.1%] for women and 7.9% (95% CI, 6.8-9.1%) for men, and the 3-year total mortality was 1.4% (95% CI, 1.0-1.9%) for women and 3.1% (95% CI, 2.4-3.8%) for men. Factors associated with 3-year mortality were fair or poor subjective health [odds ratio (OR) = 3.1, 95% CI 1.7-5.5] and self-reported diabetes (OR = 2.3, 95% CI 1.1-4.9) in a logistic regression controlling for age and gender. In stratified analyses, 3-year mortality of those with diabetes was significantly higher than those without the disease among men and those aged under 65. Those with diabetes were more likely to have self-reported comorbidities, high blood pressure and report poor subjective health regardless of age and gender, and healthier lifestyles among the women and those aged under 65. Our results support the need for community-based primary prevention measures to improve the lifestyles of residents, along with secondary prevention approaches to monitor those with diabetes for complications and to give them lifestyle instructions.

Factors influencing the diagnostic accuracy of the rapid influenza antigen detection test (RIADT): a cross-sectional study

Objective To evaluate the diagnostic accuracy of the rapid influenza antigen detection test (RIADT) and determine which symptoms are relevant to results. Design Single-centre, cross-sectional study. Setting Primary care centre, Tokyo, Japan. Participants 82 consecutive outpatients presenting with upper respiratory symptoms and fever ≥37°C at any time from symptom onset, between December 2010 and April 2011. Main outcome measures Results of history and physical examination including age, sex, temperature, time of test from symptom onset, vaccination record and current symptoms (sore throat, arthralgia and/or myalgia, headache, chills, cough and/or throat phlegm, nasal discharge) were recorded. The RIADT and a fully automated respiratory virus nucleic acid test (Verigene Respiratory Virus Plus; VRV), the latter being the gold standard, were performed. Patients were divided into four groups: false negative (FN), RIADT− and VRV+; true positive (TP), RIADT+ and VRV+; true negative (TN), RIADT− and VRV−; and false positive, RIADT+ and VRV−. Groups were compared regarding age, sex, temperature, time of test from symptom onset, vaccination record and symptoms. Results RIADT sensitivity, specificity, positive predictive value and negative predictive value were 72.9% (95% CI 61.5% to 84.2%), 91.3% (79.7% to 102.8%), 95.6% (89.5% to 101.6%) and 56.8% (40.8% to 72.7%), respectively. Time from symptom onset to test was shorter for the FN group than the TP group (p=0.009). No significant differences were detected for the other factors assessed. Results revealed higher temperatures for FN than TN patients (p=0.043), and more FN than TN patients had chills (p=0.058). Conclusions The RIADT sensitivity was low, due to early administration of the test. In the epidemic season, the RIADT should not be used for suspected influenza until 12 h after symptom onset. A positive RIADT firmly supports the influenza diagnosis; a negative result does not confirm its absence. High fever and chills might indicate influenza, but additional tests are sometimes necessary.