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Nishi-Tokyo-shi, Japan

Nishijima T.,Clinical Center | Nishijima T.,Kumamoto University | Shimbo T.,Center for Clinical science | Komatsu H.,Saku Central Hospital | And 5 more authors.
Journal of Acquired Immune Deficiency Syndromes

Background: The epidemiology of hepatitis C virus (HCV) infection among HIV-infected men who have sex with men (MSM) who do not inject drugs in Asia remains unknown. Method: The incidence and risk factors for incident HCV infection among HIV-infected MSM at a large HIV clinic in Tokyo were elucidated. Poisson regression compared the incidence of HCV seroconversion at different observation periods. Results: Of 753 HIV-1 infected MSM patients negative for HCV antibody (HCVAb) at baseline and available follow-up HCVAb test, 21 patients (2.8%) seroconverted to HCVAb positive over 2246 person-years (PY), for an incidence of 9.35 per 1000 PY. The incidence increased over time from 0 per 1000 PY in 2005-2006, 3.0 per 1000 PY in 2007-2008, 7.7 per 1000 PY in 2009-2010, to 24.9 per 1000 PY in 2011-2012 (P = 0.012). Of 21 incident cases, only 4 (19%) were injection drug users, and sensitivity analysis that excluded injection drug users yielded similar findings. Multivariate analysis identified illicit drug use to be an independent risk for HCV infection (hazard ratio = 3.006; 95% confidence interval: 1.092 to 8.275; P = 0.033). Conclusions: Incident HCV infection is increasing among HIV-1- infected MSM noninjection drug users at resource-rich setting in Asia. Illicit drug use is an independent risk factor for incident HCV infection in this population. Copyright © 2013 by Lippincott Williams and Wilkins. Source

Nishijima T.,Clinical Center | Nishijima T.,Kumamoto University | Shimbo T.,Center for Clinical science | Komatsu H.,Saku Central Hospital | And 6 more authors.
Journal of Antimicrobial Chemotherapy

Objectives: This study aimed to examine the effect of long-term treatment with ritonavir-boosted atazanavir (atazanavir/ritonavir) on cholelithiasis. Methods: A single-centre, cross-sectional study was conducted to elucidate the prevalence of cholelithiasis in patients with HIV-1 infection who underwent abdominal ultrasonography between January 2004 and March 2013. Univariate and multivariate logistic regression analyses were applied to estimate the effects of >2 years of atazanavir/ritonavir exposure on cholelithiasis as the primary exposure. Results: Of the 890 study patients, 84 (9.4%) had >2 years of atazanavir/ritonavir exposure. Cholelithiasis was twice as frequent in those treated for >2 years with atazanavir/ritonavir [15 (18%) of 84 patients] compared with those treated for <2 years [72 (8.9%) of 806 patients] (P1/40.018). Univariate analysis showed a significant association between >2 years of atazanavir/ritonavir exposure and cholelithiasis (OR=2.216; 95% CI=1.206-4.073; P=0.010) and the association almost persisted in multivariate analysis (adjusted OR=1.806; 95% CI=0.922- 3.537; P=0.085). Long-term treatment (>2 years) with other commonly used protease inhibitors, such as ritonavir- boosted lopinavir and ritonavir-boosted darunavir, was not associated with cholelithiasis in univariate and multivariate analysis. Additional analysis showed that >1 year of exposure to atazanavir/ritonavir was significantly associated with cholelithiasis (OR=1.857; 95% CI=1.073-3.214; P=0.027), whereas >1 year of exposure to ritonavir-boosted lopinavir and ritonavir-boosted darunavir was not. Conclusions: Long-term treatment of patients with HIV-1 infection for >2 years with atazanavir/ritonavir was associated with an increased risk of cholelithiasis compared with patients with shorter exposure. Long-term exposure to atazanavir/ritonavir appears to increase the risk of cholelithiasis in patients with HIV-1 infection.©The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Source

Asada T.,University of Tokyo | Aoki Y.,University of Tokyo | Aoki Y.,New York University | Sugiyama T.,Center for Clinical science | And 7 more authors.
Critical Care Medicine

Objectives: As interactions of each organ system have been conceptually known to play an important role during life-threatening conditions, we quantitatively evaluated the organ system interactions in critically ill patients and examined the difference in the organ system network structure between the survivors and the nonsurvivors. Design: Prospective observational study. Settings: An ICU of a university hospital. Patients: Two hundred and eighty-two patients who were admitted to the ICU. Interventions: Blood samples were obtained at ICU admission. Measurements and Main Results: We analyzed the associations among nine representative laboratory variables of each organ system using network analysis. We compared the network structure of the variables in the 40 nonsurvivors with that in the 40 survivors. Their baseline characteristics, including the degree of organ dysfunction, were matched using propensity score matching method. Network structure was quantitatively evaluated using edge (significant correlation among variables evaluated by the p value), weight (connective strength of edge evaluated by coefficient), and cluster (group with tight connection evaluated by edge betweenness). The number of edges among the nine variables was significantly fewer for the nonsurvivors than for the severity-matched survivors (3 vs 12; p = 0.035). The mean weight of edges was significantly smaller for the nonsurvivors (0.055 vs 0.119; p = 0.007). The nine laboratory variables for the nonsurvivors were divided into a significantly larger number of clusters (7 vs 2; p = 0.001). Statistical conclusions were preserved with Bonferroni multiple comparison procedure. These findings were consistently observed in comparison of the 40 nonsurvivors with all the survivors. Conclusions: This study, as a preliminary proof-of-concept, quantitatively demonstrated a more disrupted network structure of organ systems in the nonsurvivors compared with that in the survivors. These observations suggest the necessity of assessment for organ system interactions to evaluate critically ill patients. Copyright © 2015 by the Society of Criti. Source

Nawa T.,Hitachi General Hospital | Nakagawa T.,Hitachi General Hospital | Mizoue T.,Hitachi Health Care Center | Endo K.,Center for Clinical science
Journal of Thoracic Imaging

Lung cancer is a leading cause of cancer death in both male and female individuals in Japan. The effect of screening using chest radiography is assumed to be limited. In Japan, screening using low-dose computed tomography (CT) was initiated in 1993, and its dissemination has progressed with studies evaluating its efficacy, although it is not officially recommended. In addition to the academic activities of the Japanese Society of CT Screening, certification of physicians and radiologic technologists by the Japan Accreditation Council for CT Screening has been progressing. Currently, several hundred thousand low-dose CT screenings are performed annually in Japan. In Hitachi City, Ibaraki Prefecture, low-dose CT screening among employees and in communities started in 2001, and it was estimated that 40% of 50-to 69-year-old citizens had undergone screening at least once by March 2009. The lung cancer mortality rate in citizens in this age group decreased by 24% in 2005 to 2009 compared with the national statistics. Low-dose CT screening targeting the general population may be effective, but it is necessary to consider the target and interval of screening separately from those for the highrisk group. Observational study may play a role in evaluating the efficacy of screening in Japan. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Kurotani K.,Center for Clinical science | Nanri A.,Center for Clinical science | Goto A.,National Center for Global Health and Medicine | Mizoue T.,Center for Clinical science | And 4 more authors.
British Journal of Nutrition

Limited and inconsistent associations between cholesterol and egg consumption and type 2 diabetes risk have been observed in Western countries. In the present study, the association of dietary cholesterol and egg intakes with type 2 diabetes risk was examined prospectively. The study subjects comprised 27 248 men and 36 218 women aged 45-75 years who participated in the second survey of the Japan Public Health Center-based Prospective Study and had no histories of type 2 diabetes or other serious diseases. Dietary cholesterol and egg intakes were estimated using a validated 147-item FFQ. The OR of self-reported, physician-diagnosed type 2 diabetes over 5 years were estimated using multiple logistic regression. A total of 1165 newly diagnosed cases of type 2 diabetes were self-reported. Although dietary cholesterol intake was not associated with type 2 diabetes risk in men, it was found to be associated with a 23 % lower odds of type 2 diabetes risk in women in the highest quartile of intake, albeit not statistically significant, compared with those in the lowest quartile (P trend= 0·08). Such risk reduction was somewhat greater among postmenopausal women; the multivariable-adjusted OR for the highest quartile of cholesterol intake compared with the lowest quartile was 0·68 (95 % CI 0·49, 0·94; P trend= 0·04). No association between egg intake and type 2 diabetes risk was found in either men or women. In conclusion, higher intake of cholesterol or eggs may not be associated with an increased risk of type 2 diabetes in Japanese populations. The observed association between decreased type 2 diabetes risk and higher dietary cholesterol intake in postmenopausal women warrants further investigation. Copyright © The Authors 2014. Source

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