Integration of DPC and clinical microbiological data in Japan reveals importance of confirming a negative follow-up blood culture in patients with MRSA bacteremia.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is one of the commonest and most life-threatening of all infectious diseases. The morbidity and mortality rates associated with MRSA bacteremia are higher than those associated with bacteremia caused by other pathogens. A common guideline in MRSA bacteremia treatment is to confirm bacteremia clearance through additional blood cultures 2-4 days after initial positive cultures and as needed thereafter. However, no study has presented statistical evidence of how and to what extent confirming a negative follow-up blood culture impacts clinical outcome. We present this evidence for the first time, by combining clinical microbiological data of blood cultures and the DPC administrative claims database; both had been systematically accumulated through routine medical care in hospitals. We used electronic medical records to investigate the clinical background and infection source in detail. By analyzing data from a university hospital, we revealed how survival curves change when a negative follow-up blood culture is confirmed. We also demonstrated confirmation of a negative culture is significantly associated with clinical outcomes: there was a more than three-fold increase in mortality risk (after adjusting for clinical background) if a negative blood culture was not confirmed within 14 days of the initial positive blood culture. Although we used data from only one university hospital, our novel approach and results will be a basis for future studies in several hospitals in Japan to provide statistical evidence of the clinical importance of confirming a negative follow-up blood culture in bacteremia patients, including those with MRSA infections.

Effect modification of green tea on the association between rice intake and the risk of diabetes mellitus: a prospective study in Japanese men and women.

BACKGROUND AND OBJECTIVES: Recent observational studies have suggested a positive association of white rice and protective associations of green tea and coffee with the risk of diabetes. However, none have examined the interaction between these dietary factors on the risk of diabetes. We prospectively investigated the effect modification of green tea and coffee on the association between rice and incident diabetes in elderly Japanese men and women. METHODS AND STUDY DESIGN: Among subjects who participated in the baseline survey (2004-2007), 11717 (91 %) subjects responded to the follow-up survey (2010-2012). By using multiple logistic regression analysis, ORs of incident diabetes were calculated according to categories of cereal food, green tea, and coffee intakes, examining also the effect modification of green tea and coffee. RESULTS: 464 new cases of diabetes were identified. Women, but not men, showed a positive association of rice intake (trend p=0.008) and an inverse association of green tea intake (trend p=0.02) with incident diabetes. Coffee showed no association with incident diabetes either in men or women. In the analysis stratified by green tea intake, the association between rice and diabetes disappeared among women with an intake of >=7 cups/d of green tea (interaction p=0.08). CONCLUSIONS: Rice intake was associated with an increased risk of diabetes only in women, and women with a higher intake of green tea had a lower risk of diabetes. A high intake of green tea may be protective against increased risk of diabetes with a higher intake of rice in women.

Mycobacterium conceptionense Bloodstream Infection in a Patient with Advanced Gastric Carcinoma.

A 65-year-old Japanese male farmer with advanced gastric adenocarcinoma and multiple hepatic metastases was admitted to our hospital. Blood culture results were positive on day 5, and Gram-positive rods were detected. According to the results of Ziehl-Neelsen staining and a cultured colony of this bacterium, we suspected a mycobacterial infection. Suspecting a rapidly growing mycobacterium (RGM), we started multidrug therapy with levofloxacin, clarithromycin, and ethambutol, and the patient recovered from the bloodstream infection. Further gene examination (16S rRNA, hsp65, and sodA) revealed an isolate of Mycobacterium conceptionense. M. conceptionense was first identified as an RGM in 2006. Among previous case reports of M. conceptionense infections, bone and soft tissue infections in hosts with a disorder of the normal structure (e.g., surgical sites) were dominant. We report the characteristics of M. conceptionense infection in this first Japanese case report and a review of the literature.

Association of symptoms of gastroesophageal reflux with metabolic syndrome parameters in patients with endocrine disease.

Background. Metabolic syndrome (MetS) and obesity are known risk factors for gastroesophageal reflux disease (GERD), which is often found in patients with endocrine disorders, such as thyroid dysfunction and hypopituitarism. To clarify the relationship of endocrine disease with GERD, we investigated the symptoms of GERD in patients with various endocrine diseases. Methods. Patients with various endocrine disorders who visited Kyushu University Hospital were included. GERD symptoms were examined using a self-administered questionnaire, the frequency scale for the symptoms of GERD (FSSG). Metabolic parameters, including body-mass index (BMI), waist circumference, blood pressure, hemoglobin A1c, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides, and values of endocrine function, including thyroid stimulating hormone, free thyroxin, cortisol, and insulin-like growth factor-1, were assessed. Results. A total of 111 consecutive patients were recruited for the study. Among these, 18 (16.2%) patients were considered to have GERD. Among the parameters, BMI (P = 0.03) and triglycerides (P = 0.001) showed a positive association and HDL-C (P = 0.0007) showed an inverse association with the FSSG score. However, none of the endocrine values were associated with the FSSG score. Conclusion. Symptoms of GERD in patients with endocrine disorders might be attributed to MetS as comorbidity.

Significant interaction between RETN -420 G/G genotype and lower BMI on decreased risk of type 2 diabetes mellitus (T2DM) in Japanese--the J-MICC Study.

We examined the association of the RETN (resistin) -420 C>G polymorphism (rs1862513) with risk of diabetes mellitus (DM), considering lifestyle factors, in Japanese. Subjects were participants of J-MICC Study, where 2,651 participants aged 35-69 years provided their blood for genotyping and lifestyle data after informed consent. Odds ratio (OR) of DM for RETN-420 G/G genotype was estimated using unconditional logistic regression model. Statistically significant interaction on risk of DM was observed between RETN-420 G/G genotype and BMI<25 (OR for interaction = 0.12; P = 0.046), and when subjects with RETN-420 C/C+C/G and BMI ≥ 25 (n = 69 for DM and 544 for non-DM) were defined as the reference, the adjusted ORs for subjects with RETN-420 G/G genotype and BMI>25 (n = 10 for DM and 111 for non-DM), RETN-420 C/C+C/G and BMI<25 (n = 81 for DM and 1,605 for non-DM), and RETN-420 G/G and BMI<25 (n = 1 for DM and 230 for non-DM) were demonstrated to be 0.72 (95% confidence interval: 0.36-1.46), 0.40 (0.28-0.56) and 0.03 (0.005-0.25), respectively. The present study revealed the significant interaction of RETN-420 G/G genotype with lower BMI on the decreased risk of DM, but the direction was opposite to the reported ones in Japanese. We should be careful in interpretation of the present study results because of the limited sample sizes. Further investigation of this association as well as of the actual biological roles of RETN in the genesis of human metabolic disorders including DM will be required.

[A case with Abiotrophia defectiva isolated from postoperative blood culture of a patient with diffuse peritonitis].

We have recently detected Abiotrophia defectiva (A. defectiva) from postoperative blood culture of a patient with diffuse peritonitis. Pleomorphic Gram positive rod appearance and no growth on a standard sheep blood agar led us to suspect aerotolerant anaerobe. From the test results of simplified identification kit for anaerobes, we tentatively reported Clostridium tertium (C. tertium) to the clinician. However, the analysis of 16SrRNA sequence proved it to be A. defectiva. When Gram positive coccus or pleomorphic Gram positive rod are observed on blood culture, it is recommended to incubate Brucella HK (RS) blood agar plates for 24 hours at 35 degrees C both aerobically and anaerobically. The growth both aerobically and anaerobically suggests A. defectiva and Satellitism test and Rapid ID 32 STREP(SYSMEX) testing should be performed to identify the responsible bacteria. A. defectiva is Gram positive streptococcus and requires pyridoxal hydrochloride or L-cysteine to grow. It could be unidentified or misidentified and its particularity often leads incomplete report to the clinician. Our study shows that more careful examination will increase the detection of A. defectiva.

Neuroticism and extraversion personality traits, health behaviours, and subjective well-being: the Fukuoka Study (Japan).

PURPOSE: We evaluated personality dimensions captured by an abbreviated 8-item questionnaire and examined associations of the personality traits with health behaviours and subjective well-being (SWB) measures. METHODS: The subjects were 11,554 participants in the Kyushu University Fukuoka Cohort Study who completed a self-administered questionnaire inquiring health behaviours, morbidity, personality, and SWB. Personality was assessed by using a questionnaire appeared to capture neuroticism and extraversion traits, and SWB-related variables were assessed with 3 single-item questions. RESULTS: Neuroticism was negatively and extraversion was positively associated with BMI. Extraversion, but not neuroticism, was positively associated with smoking and alcohol drinking. After multivariate adjustment, neuroticism was strongly associated with each of 3 SWB measures. The multivariate-adjusted odds ratios for the highest versus lowest quintile of neuroticism were 6.09 (95% confidence interval [CI], 5.05-7.33) for perceived stress; 0.21 (95% CI, 0.18-0.25) for good health condition; and 0.26 (95% CI, 0.22-0.31) for life satisfaction. Extraversion showed no clear association with the SWB measures. CONCLUSIONS: The neuroticism and extraversion scales were associated with health behaviours and BMI differently. The neuroticism scale, but not the extraversion scale, was strongly associated with higher perception of stress, poorer perceived health, and lower satisfaction with life in a Japanese population.

Constipation and colorectal cancer risk: the Fukuoka Colorectal Cancer Study.

Constipation has been suspected to be linked to colorectal cancer risk, but epidemiological evidence is inconclusive. We described the prevalence of constipation and related lifestyle factors in a community and examined the relation of constipation and other bowel habits to colorectal cancer risk. The prevalence study was based on 833 community controls in the Fukuoka Colorectal Cancer Study, and 212 cases of Dukes' stage A were used in a study on bowel habits and colorectal cancer risk. Bowel habits were assessed by in-person interview. Odds ratio (OR) and 95% confidence interval (CI) of colorectal cancer were estimated with adjustment for dietary and nondietary factors. Constipation was reported by 10.3% of men and 27.7% of women. Individuals with less frequent bowel movements had a lower intake of total energy and were physically less active. The multivariate-adjusted OR (95% CI) of colorectal cancer were 1.51 (1.02-2.25) for self-reported constipation, 1.60 (1.05-2.44) for functional constipation, and 1.24 (0.81-1.90) for infrequent bowel movements (<1 stool/day). Self-reported constipation was fairly common in Japanese adults. Constipation was associated with a moderately increased risk of colorectal cancer.