Masayuki Kakehashi

Combined Assessment of β- d -Glucan and Degree of Candida Colonization before Starting Empiric Therapy for Candidiasis in Surgical Patients

The purpose of the study was to investigate whether examination for plasma β-d-glucan, a cell wall constituent of fungi, is useful for selecting surgical patients with Candida colonization who would benefit from empiric antifungal therapy. We administered fluconazole to postoperative patients with Candida colonization who have risk factors for candidemia and complained of persistent fever despite prolonged antibacterial therapy. We then analyzed the clinical outcomes regarding the number of sites colonized with Candida spp. and plasma β-d-glucan. Of the 32 patients positive for β-d-glucan, 15 (46.9%) responded to the empiric therapy; only 9% of those who were negative responded (p < 0.01). In the multiple logistic regression analysis, being positive for β-d-glucan was a significant factor predicting response, with an adjusted odds ratio of 12.9 in patients with Candida colonization [95% confidence interval (CI) 2.07–80.73) (p < 0.01). In addition, the number of sites colonized with Candida spp. was a significant factor predicting response, with an estimated exposure odds ratio of 7.57 for those who were colonized at three or more sites compared with those colonized at one site (95% CI 1.20–47.70) (p = 0.031). In patients with Candida colonization, assessment of β-d-glucan was useful for deciding whether to start empiric therapy for suspected candidiasis in surgical patients.

Bacterial translocation in patients with Crohn's disease undergoing surgery.

AbstractPURPOSE: Much evidence, derived from experimental studies, suggests that bacterial translocation indeed occurs, yet its clinical significance is still a matter of controversy in humans. The aims of this study were to determine the prevalence of bacterial translocation in patients with Crohn’s disease undergoing laparotomy and to identify any association with postoperative septic complications or systemic inflammatory response syndrome. METHODS: Mesenteric lymph node and peripheral blood samples from 42 patients with Crohn’s disease undergoing laparotomy were collected for bacteriologic assessments. RESULTS: Bacterial translocation to mesenteric lymph node was identified in 20 patients (48 percent). The most common organism was Escherichia coli (27 percent). Blood cultures were positive in 2 of 20 patients in whom translocation to lymph node was identified. Bacterial translocation was associated with a greater than two-fold increase in the incidence of postoperative septic complications (35 vs.14 percent), but this difference was not significant. In the analysis of the occurrence of systemic inflammatory response syndrome, a significantly higher incidence continued until the third postoperative day in patients with vs. those without bacterial translocation. In a logistic regression analysis, bacterial translocation had a significant effect on the occurrence of systemic inflammatory response syndrome, even though septic complications were taken into account. CONCLUSIONS: Bacterial translocation to mesenteric lymph node predisposed patients with Crohn’s disease undergoing laparotomy to systemic inflammatory response syndrome.

Transmission potential of primary pneumonic plague: time inhomogeneous evaluation based on historical documents of the transmission network

Background: The transmission potential of primary pneumonic plague, caused by Yersinia pestis, is one of the key epidemiological determinants of a potential biological weapon, and requires clarification and time dependent interpretation. Method: This study estimated the reproduction number and its time dependent change through investigations of outbreaks in Mukden, China (1946), and Madagascar (1957). Reconstruction of an epidemic tree, which shows who infected whom, from the observed dates of onset was performed using the serial interval. Furthermore, a likelihood based approach was used for the time inhomogeneous evaluation of the outbreaks for which there was scarcity of cases. Results: According to the estimates, the basic reproduction number, R0, was on the order of 2.8 to 3.5, which is higher than previous estimates. The lower 95% confidence intervals of R0 exceeded unity. The effective reproduction number declined below unity after control measures were introduced in Mukden, and before the official implementation in Madagascar. Conclusion: While the time course of the latter outbreak could be explained by intrinsic factors and stochasticity in this remote and scarcely populated area, the former in Mukden suggests the possible continued chains of transmission in highly populated areas. Using the proposed methods, the who infected whom information permitted the evaluation of the time inhomogeneous transmission potential in relation to public health measures. The study also tackles the problem of statistical estimation of R0 based on similar information, which was previously performed simply by counting the number of secondary transmissions regardless of time.

Japanese dietary pattern consistently relates to low depressive symptoms and it is modified by job strain and worksite supports

BACKGROUND This study examined the association between traditional Japanese dietary pattern and depressive symptoms in Japanese workers, employing large-scale samples, considering socioeconomic status (SES) and job stress factors. METHODS A cross-sectional study of 2266 Japanese employees aged 21-65 years from all areas of Japan was conducted as part of the Japanese Study of Health, Occupation and Psychosocial factors related Equity (J-HOPE). Habitual diet was assessed by FFQ (BDHQ). The depression degree and job stress factors (job demand, job control, and worksite support) were measured by K6 and Job Content Questionnaire. RESULTS Participants with high scores for the balanced Japanese dietary pattern were significantly less likely to show probable mood/anxiety disorders (K6≥9) with multivariate adjustment including SES and job stress factors (odds ratio=0.66 [0.51-0.86], trend P=0.002). Other dietary patterns were not associated with depressive symptoms. Even after stratification by job stress factors, the Japanese dietary pattern was consistently protective against depressive symptoms. Furthermore, a highly significant difference between the first and third tertiles of the dietary pattern was observed in participants with active strain (high demand and high control) with low worksite supports (8.5 vs. 5.2, P=0.011). LIMITATIONS Female participant sample was relatively small. CONCLUSIONS Japanese dietary pattern consistently related to low depressive symptoms in this large-scale cohort of Japanese workers, even after adjusting for SES and job stress factors. The protective impact is especially strong for workers with active strain and low support. Making better use of traditional dietary patterns may facilitate reducing social disparities in mental health.

Evolution of airborne infectious diseases according to changes in characteristics of the host population

The authors predicted evolutionary changes in airborne infectious diseases according to changes in the characteristics of the host population. The predictions were based upon a mathematical model of infectious diseases and the validity of the predictions was verified against the history of man and pathogens. The feature of this model is that it involves a density of pathogens in the environment as an additional variable which can be regarded as more suitable to airborne infectious diseases. In spite of this modification, this study reached a similar conclusion to the threshold density theory: that is, susceptible host density in the absence of the pathogen must be larger than that in the presence of the pathogen, for the pathogen to be persistent. Moreover the authors concluded that one type of pathogen cannot be replaced by another type of pathogen as long as the susceptible host density of the former type is the mininum one. The predictions were considered to be valid for a wide range of infectous diseases. Making use of these principles, the authors predicted that the variety of infectious diseases should increase as host density increases and that pathogens should evolve to be less virulent as the host life-span increases. The finalidea discussed is whether or nor the history of man and pathogen can be verified by the predictions.

Leg Swelling during Continuous Standing and Sitting Work without Restricting Leg Movement

Leg Swelling during Continuous Standing and Sitting Work without Restricting Leg Movement: Akihiko Seo, et al. Department of Public Health, Hiroshima University School of Medicine—To clarify the dynamics of leg swelling during standing and sitting work without restricting leg movement, lower leg swelling and subjective complaints were measured during work under three working conditions: Straight standing, buttock chair sitting and ordinary chair sitting. Twelve subjects (eight males and four females) were assigned jigsaw puzzles as a task for an hour. The lower leg swelling and subjective complaints were recorded every two minutes. The lower leg swelling was measured by the bioelectrical impedance method. The results were as follows: (1) The lower leg swelling increased during the work under all working conditions. The swelling was least for straight standing and greatest for ordinary chair sitting. The mean and standard deviations for leg swelling after one hours work were 5.8±3.9% for straight standing, 8.2±4.7% for buttock chair sitting and 9.7 + 7.5% for ordinary chair sitting. (2) The subjective complaints also increased during work. Complaining of lower leg dullness was least for ordinary chair sitting and greatest for straight standing. The relation to the leg swelling was reversed. Complaining of low back pain was more common for buttock chair sitting than for other working postures. It is reasonable that prolonged standing is more likely to cause leg swelling than sitting because of high hydrostatic pressure. This theory has been supported by studies on motionless standing and sitting. Our results obtained without restricting leg movement, however, showed a reversed relation. It was considered that leg swelling factors such as low muscle activity and lymph pumps, low interstitial pressure brought on by low muscle activity, and the seat pressure during prolonged sitting may be dominant in the sitting posture although the hydrostatic pressure was low compared with the standing posture.

In the Nepalese context, can a husband’s attendance during childbirth help his wife feel more in control of labour?

BackgroundA husband’s support during childbirth is vital to a parturient woman’s emotional well-being. Evidence suggests that this type of support enables a woman to feel more in control during labour by reducing maternal anxiety during childbirth. However, in Nepal, where childbearing is considered an essential element of a marital relationship, the husband’s role in this process has not been explored. Therefore, we examined whether a woman in Nepal feels more in control during labour when her husband is present, compared to when another woman accompanies her or when she has no support person.MethodsThe study participants were low risk primigravida women in the following categories: women who gave birth with their husband present (n = 97), with a female friend present (n = 96), with mixed support (n = 11), and finally, a control group (n = 105). The study was conducted in the public maternity hospital in Kathmandu in 2011. The Labour Agentry Scale (LAS) was used to measure the extent to which women felt in control during labour. The study outcome was compared using an F-test from a one-way analysis of variance, and multiple regression analyses.ResultsThe women who gave birth with their husband’s support reported higher mean LAS scores (47.92 ± 6.95) than the women who gave birth with a female friend’s support (39.91 ± 8.27) and the women in the control group (36.68 ± 8.31). The extent to which the women felt in control during labour was found to be positively associated with having their husband’s company during childbirth (β = 0.54; p < 0.001) even after adjusting for background variables. In addition, having a female friend’s company during childbirth was related to the women’s feeling of being in control during labour (β = 0.19; p < 0.001) but the effect size was smaller than for a husband’s company.ConclusionThe results show that when a woman’s husband is present at the birth, she feels more in control during labour. This finding has strong implications for maternity practices in Nepal, where maternity wards rarely encourage a woman to bring her husband to a pregnancy appointment and to be present during childbirth.

Bacterial Translocation: Not a Clinically Relevant Phenomenon in Colorectal Cancer

The aim of this study was to identify the risk factors for bacterial translocation and to determine the clinical significance of bacterial translocation in patients with colorectal cancer. Mesenteric lymph node sampling was performed to identify the presence of bacterial translocation in 75 patients with colorectal cancer undergoing laparotomy. Bacterial translocation was identified in 29 patients (39%), with the most common organism being Escherichia coli (31%). Three factors for bacterial translocation were identified, including a preoperative low peripheral lymphocyte count, metastasis to lymph nodes, and invasion depth (= T3). Stepwise regression analysis, however, selected only = T3 [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.2-13.5]. Altogether, 35% of patients with bacterial translocation developed septic complications, compared with 20% in patients without bacterial translocation. In the multivariate analysis, bacterial translocation was not an independent risk factor for infection, with an OR of 1.8 (95% CI 0.56-5.96). Systemic inflammatory response syndrome developed on the first day in 62% of patients with bacterial translocation, compared with 50% of patients without bacterial translocation. Adjusting for the other factors, bacterial translocation was not a significant risk factor in the occurrence of systemic inflammatory response syndrome after surgery (OR 1.1, 95% CI 0.37-3.29). We concluded that n patients with colorectal cancers bacterial translocation does occur and is increased in patients with deep invasion. However, it appears to be of no clinical significance.

Prevalence of painful bladder syndrome (PBS) symptoms in adult women in the general population in Japan

The aim of this study was to clarify the prevalence of painful bladder syndrome (PBS) symptoms in adult women in the general population in Japan.

Determinants of the daily rhythm of blood fluidity

Background Numerous processes in the living body exhibit daily rhythmicity. In this study, we characterized a daily rhythm of blood fluidity and identified its determinants. Methods The subjects were nine young males. We measured the physiological parameters and performed hematological and biochemical analyses. We repeated the measurements six times during the day at 7:30 (just after getting up and before breakfast), 10:00, 13:30 (after lunch), 16:30, 19:30 (after dinner), and 21:30. The subjects performed sedentary work all day, and the contents and time of the meals were uniform. Investigation of blood rheology was based on Kikuchis microchannel method. Results Blood passage time varied significantly with time of day. Stepwise regression analysis was used to determine the significant factors affecting blood passage time. Body temperature, heartbeat, hematocrit, white blood cell and total cholesterol were significant determinants of blood passage time. Conclusion We confirmed that blood fluidity has a daily rhythm. In addition, we found that the determinants of blood fluidity included physiological parameters such as body temperature and heartbeat, hematological parameters such as hematocrit, and white blood cell and total cholesterol.