Evaluation of the Association Between Sedentary Time and Low Work Engagement in the Work Environment After COVID-19 Pandemic: A Cross-Sectional Study of Japanese Workers.

Introduction The global shift toward working from home due to the COVID-19 pandemic has led to concerns about increased sedentary behavior and its potential impact on work engagement, a critical factor for employee well-being and organizational productivity. This study aims to explore the association between sedentary time and work engagement among workers in Japan in the post-pandemic work environment. Methods This cross-sectional analysis utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted from September to November 2023, after the COVID-19 pandemic period. Participants included employed individuals over 18 years, excluding those in domestic occupations. Sedentary time and work engagement were self-reported and categorized. Logistic regression analysis adjusted for confounders such as socioeconomic status, work characteristics, and mental and physical health was employed to explore this association. Results The study found a significant association between longer sedentary time and lower levels of work engagement. In particular, for desk workers, longer sedentary time was associated with lower work engagement (sedentary time, compared to the reference category "<4 hours/day", 4 to <8 h: OR 1.42, 95% CI: 1.25-1.60; 8 to <12 h: OR 1.77, 95% CI: 1.55-2.01; ≥12 h or unknown: OR 2.14, 95% CI: 1.80-2.51, respectively). Sensitivity analysis confirmed that these results are robust to different definitions of work engagement. Furthermore, analyses in subgroups of desk workers classified according to specific characteristics suggested that desk workers who are full-time workers in non-managerial positions and work from home ≥4 days per week were more strongly associated with prolonged sedentary behavior and low work engagement (in the group of full-time workers who were non-managers, sedentary time, compared to the reference category "<4 hours/day", 4 to <8 h: OR 2.14, 95% CI: 1.52-3.00; 8 to <12 h: OR 2.10, 95% CI: 1.46-3.00; ≥12 h or unknown: OR 3.32, 95% CI: 1.99-6.05; in those with work-from-home frequency of ≥4 days weekly, sedentary time, compared to the reference category "<4 hours/day", 4 to <8 h: OR 1.46, 95% CI: 0.99-2.16; 8 to <12 h: OR 1.73, 95% CI: 1.19-2.56; ≥12 h or unknown: OR 2.41, 95% CI: 1.58-3.67). Conclusions This study revealed a significant association between sedentary time and low work engagement among workers in Japan after the COVID-19 pandemic. In the future, prospective studies are needed to confirm the causal associations between the two, using more validated measures of sedentary behavior.

Dotinurad restores exacerbated kidney dysfunction in hyperuricemic patients with chronic kidney disease.

BACKGROUND: In this study, we aimed to clarify the beneficial effects of urate-lowering treatment with the novel agent dotinurad on renal function in patients with chronic kidney disease (CKD) and hyperuricemia (HUA). METHODS: Thirty-five patients with CKD (mean age 65.4 ± 14.8 years, 23 men) diagnosed with HUA were recruited. Changes in eGFR before and after dotinurad administration were assessed. Patients first underwent a 3-month observation period and then 3 months treatment with dotinurad. RESULTS: During the observation period, mean eGFR (mL/min/1.73 m2) declined significantly. The baseline eGFR was 31.8 ± 16.4 and the serum urate level (sUA, mg/dL) was 8.1 ± 1.7. During the treatment period, eGFR recovered to 36.5 ± 17.5 and sUA decreased to 6.7 ± 1.0. The increase in eGFR after dotinurad administration was correlated with a decrease in sUA (R = 0.375, p = 0.0263). CONCLUSION: Dotinurad administration to patients with CKD and HUA appears to be beneficial in restoring kidney function. Dotinurad may represent a potential medication for the prevention of kidney function decline caused by HUA.

Factors Associated with the Work Engagement of Employees Working from Home during the COVID-19 Pandemic in Japan.

This study aimed to identify factors influencing the work engagement of employees working from home during the COVID-19 pandemic in Japan. Employees' work engagement was examined using the following survey questions: "Do you feel energized when you are at work? (yes or no)" and "Do you take pride in your work? (yes or no)" After adjusting for potential confounders, Poisson regression was used to examine prevalence ratio and 95% confidence intervals for employees' work engagement. We analyzed 15,670 individuals (11,894 of whom did not work from home and 3776 of whom worked from home). Their mean age was 45.6 ± 13.8 years, and 58.3% were men. Those who worked from home were younger than those who did not (43.9 ± 13.1 vs. 46.1 ± 13.9, p < 0.001). About 44% of all employees reported high work engagement. Among the employees who worked from home, an increase in sleep hours, effective interactions with supervisors, and working hours of ≤40 h/week were associated with engagement. Sensitivity analysis showed similar results. Close communication with superiors, refraining from working long hours, and obtaining adequate sleep may boost the work engagement of employees working from home.

A Slight Decrease in the Serum Albumin Level Is Associated with the Rapid Progression of Kidney Dysfunction, Even within the Normal Range.

Objective A low-normal albumin level is associated with a high risk of cardiovascular disease and mortality in the general population. However, the relationship between the serum albumin level and the future decline in the kidney function is unclear. We evaluated the effect of the serum albumin level on the decline in the kidney function in the general population. Methods The data used were from 11,000 participants in a voluntary health checkup program conducted between 1998 and 2006 in Japan. The primary outcome for the kidney function was a difference in the estimated glomerular filtration rate (ΔeGFR) of≥3 mL/min/1.73 m2/year. The association of the risk of a decreased kidney function with the albumin level was determined using a logistic regression analysis. We fit separate multivariable logistic regressions for the serum albumin levels (g/dL) as a continuous variable and as categorical data, classified as ≤4.3 (n=2,530), 4.4-4.6 (n=5,427), and≥4.7 (n=3,043). Results Of the 11,000 participants, 346 had a ΔeGFR/year of≥3. Compared with the participants with albumin levels of≥4.7 g/dL, the risk of a decline in the kidney function was higher not only in those with albumin levels of ≤4.3 g/dL [adjusted odds ratio (OR) =2.10, 95% confidence interval (CI): 1.20-2.93] but also in those with levels of 4.4-4.6 g/dL (adjusted OR=1.53, 95% CI: 1.14-2.05). Conclusion A decreased albumin level is an independent risk factor for a rapid decline in the kidney function, even within the normal range.

Is work engagement associated with healthier dietary patterns? A cross-sectional study.

OBJECTIVES: Work engagement is defined as a positive, fulfilling feeling about one's job and is associated with higher productivity and morale. We performed a cross-sectional study to investigate whether work engagement is related to healthier dietary behaviors among Japanese workers. METHODS: The present study was part of the Japanese Study of Health, Occupation, and Psychosocial Factors Related to Equity. A validated food frequency questionnaire was used to evaluate daily nutritional intake. The following seven nutrients were considered: salt intake, dietary fat (saturated fatty acids, monounsaturated fatty acids, and polyunsaturated fatty acids), dietary fiber, folate, and isoflavone. Multivariable linear regression analysis was performed, adjusting for job stress, psychological distress, and other confounders. The baseline survey inquired about work engagement among 2,233 employees of 12 workplaces in Japan, representing a range of industries. RESULTS: The mean age of the sample was 43.4 ± 9.7 years and 89.7% of the participants were male. The mean score of work engagement was 2.9 ± 1.0. Higher work engagement was significantly positively associated with higher salt intake (ß = 0.17, SE = 0.06, P = .006), monounsaturated fatty acids (ß = 0.29, SE = 0.13, P = .03), polyunsaturated fatty acids (ß = 0.28, SE = 0.09, P = .001), dietary fiber (ß = 0.23, SE = 0.09, P = .012), and folate (ß = 10.2, SE = 2.9, P = .005) consumption, but not saturated fatty acid (ß = 0.16, SE = 0.11, P = .13) or isoflavone (ß = 0.64, SE = 0.36, P = .072). CONCLUSION: The present study suggested that higher work engagement is associated with a healthier pattern of dietary behaviors among workers. Improving work engagement may be a novel target for workplace health promotion.

Outdoor-Cultivated Royal Sun Medicinal Mushroom Agaricus brasiliensis KA21 (Agaricomycetes) Reduces Anticancer Medicine Side Effects.

We investigated whether outdoor-cultivated Agaricus brasiliensis (KA21) could reduce the side effects caused by the anticancer medicine 5-fluorouracil (5-FU). The adverse effects of 5-FU were analyzed in mice by orally administering the drug every day for 5 days. Leukopenia, diarrhea, body weight loss, anorexia, kidney injury, gastrointestinal tract injury, and hair loss were evaluated as side effects. We determined whether these side effects were reduced by the intake of outdoor-cultivated A. brasiliensis. The side effects were reduced in mice receiving the outdoor-cultivated A. brasiliensis but not in those receiving the indoor-cultivated A. brasiliensis. These results suggest that outdoor-cultivated A. brasiliensis is beneficial in reducing the side effects of the anticancer medicine and might, therefore, be useful in improving the quality of life of patients with cancer. Furthermore, because antioxidants have been reported to contribute to the suppression of the side effects of anticancer medicines, the antioxidant activities of different mushrooms were determined. The antioxidant activity of the outdoor-cultivated A. brasiliensis was the highest among all the tested mushrooms. These findings make it clear that the cultivation conditions of A. brasiliensis are important in suppressing the side effects of anticancer medicines. Strong antioxidant activity might be one of the mechanisms through which this pharmacological activity is mediated.

Time-averaged proteinuria during follow-up and renal prognosis in patients with biopsy-proven benign nephrosclerosis.

BACKGROUND: Heavy proteinuria at diagnostic renal biopsy has been reported as an independent risk factor for deteriorating renal function in benign nephrosclerosis (BNS). However, studies investigating the relationship between the amount of proteinuria during follow-up and long-term renal prognosis in BNS are limited. This study aimed to assess the relationship between time-averaged proteinuria (TAP) and renal prognosis in BNS. METHODS: The study participants included 98 patients with biopsy-proven BNS (average age 52 ± 13 years, estimated glomerular filtration rate (eGFR) 53 ± 25 ml/min/1.73 m2, urine protein excretion at baseline 1.34 ± 1.30 g/gCr) from the Jikei University Hospital. Multivariate analysis was used to investigate the effects of TAP and other clinicopathological findings on the risk for renal outcome in biopsy-proven BNS (a 30% decline in eGFR from baseline or end-stage renal disease). Proteinuria was measured every 6 months and the mean value was used as an indicator of TAP. RESULTS: The average observation period was 56 ± 43 months. In the unadjusted model, higher levels of TAP and urinary protein at baseline, glomerulosclerosis, and tubulointerstitial damage were associated with renal prognosis. The adjusted model demonstrated a significant association between TAP and renal outcomes (hazard ratio 5.45, 95% confidence interval 3.02-10.7), which was independent of higher baseline proteinuria, glomerulosclerosis, and tubulointerstitial damage. CONCLUSIONS: TAP is an independent risk factor for renal prognosis in patients with BNS, indicating the significance of urinary protein excretion during follow-up for the progression of BNS. Clinicians should understand the importance of follow-up evaluation for proteinuria in patients with BNS.

The Prevalence and Characteristics of Older Japanese Adults with Polypharmacy, Based on Regionally Representative Health Insurance Claims Data.

We aimed to clarify the prevalence of polypharmacy among elderly individuals in Japan. We used the data obtained from a large-scale population-based representative database of health insurance claims in a single prefecture in Japan. We examined all of the outpatient and pharmaceutical health insurance claims for National Health Insurance and those for Late-stage Elderly Health Insurance in Nagasaki Prefecture, Japan between April and June 2016. When two or more claim forms were issued for a patient in a single month, we combined the data and identified the number of prescribed drugs for each person. The definition of polypharmacy is a the prescription of six or more drugs per month. We investigated the prevalence of polypharmacy among the beneficiaries of the two insurance systems. Of the 605,406 beneficiaries of the 2 insurance systems, 121,033 (20.0%) patients with polypharmacy were identified. The prevalence of polypharmacy increased with age, especially among the beneficiaries aged > 85 years, with about half of the beneficiaries having polypharmacy status. About half of the people aged > 85 years in the database had polypharmacy status. When a drug is prescribed to an elderly individual, it is necessary to consider the possibility of polypharmacy-related problems.

Is Higher Work Engagement Associated With Healthy Behaviors? A Longitudinal Study.

OBJECTIVES: We conducted a longitudinal study to examine whether work engagement promotes healthy employee behaviors (smoking cessation, drinking moderation, and regular exercise) among Japanese workers. METHODS: The study was part of the Japanese Study of Health, Occupation, and Psychosocial Factors Related to Equity (J-HOPE). The survey measured work engagement of 8050 employees from 12 workplaces. A multivariable logistic analysis was used to examine the odds ratio and 95% confidence intervals after adjusting for job stress, psychological distress, and other confounders. RESULTS: The mean age of the sample was 40.6 years and 77.4% of the participants were men. The mean work engagement score was 2.9. Higher work engagement was significantly positively associated with drinking moderation and weekly exercise behavior, but not smoking cessation. CONCLUSIONS: Higher work engagement was associated with healthier employee behaviors after 1 year.

Coding and prescription rates of osteoporosis are low among distal radius fracture patients in Japan.

INTRODUCTION: This study aimed to clarify the coding and prescription rates for osteoporosis in distal radius fracture patients and to investigate the associated factors to help prevent subsequent osteoporotic fracture. MATERIALS AND METHODS: Between 2014-2015, among 294,374 eligible individuals (42% female) aged 50-75 years in a health insurance claims database, we identified 192 individuals (mean age: 59.8 years, 74% female), counted the coding of distal radius fracture (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code: S525, S526), and determined if the patient had been assigned the code for osteoporosis and been prescribed osteoporosis medications. Logistic regression was performed to identify factors related to each rate. RESULTS: The osteoporosis coding rate and osteoporosis medication prescription rate were 17.2% (n = 33) and 10.9% (n = 21), respectively. Most codes were assigned ≤ 3 months after injury (88%) at the distal radius fracture treatment facilities (84.8%). Patients who were assigned the code for osteoporosis or treated with osteoporosis medications were older (p = 0.08, p = 0.02, respectively), female (p = 0.05, p = 0.06, respectively) and having comorbidity (p = 0.02, p = 0.07, respectively). After adjustment, being female and having comorbidity remained the independent factors for the assignment of the code for osteoporosis (OR: 3.30, 95%, CI: 1.08-10.07, OR: 2.77, 95% CI: 1.24-6.12, respectively). No factor remained significant for the osteoporosis prescription. Active vitamin D analogues were most frequently prescribed medication (67%) followed by bisphosphonates (48%). CONCLUSION: The overall coding and prescription rates for osteoporosis after distal radius fracture were low, which suggested that physician adherence to the osteoporosis guideline was low.

Prediction of presepsin concentrations through commensurate decline in kidney function in the elderly.

BACKGROUND: Presepsin is a useful biomarker to diagnose sepsis. However, the correlation between plasma presepsin concentrations and kidney function in the elderly with chronic kidney disease (CKD) remains to be elucidated. We determined whether plasma presepsin concentrations were influenced by kidney function decline in the elderly. METHODS: One hundred seventy outpatients with CKD aged ≥65 y were enrolled. Plasma presepsin concentrations were measured using immunoassay analysis. The relationship between plasma presepsin concentration and kidney function was assessed. RESULTS: The median age of patients of this cohort was 778 (72-85) y and the mean estimated glomerular filtration rate was 51.8 ±â€¯28.1 ml/min/1.73 m2. Plasma presepsin concentrations in those with CKD G4-G5 (362 pg/ml [273-553]) were significantly higher than in those with CKD G1-G2 (111 pg/ml [91-113]) and CKD G3 (145 pg/ml [124-205]) (p < 0.001, p < 0.001, respectively). A high correlation between plasma presepsin concentrations and kidney function was observed (R2 = 0.733, p < 0.001). Even after adjusting for confounders, plasma presepsin concentrations were independently associated with kidney function. CONCLUSIONS: Increases in plasma presepsin concentrations were exponentially correlated to kidney function decline in the elderly with CKD.

Spot urine protein/creatinine ratio as a reliable estimate of 24-hour proteinuria in patients with immunoglobulin A nephropathy, but not membranous nephropathy.

BACKGROUND: Proteinuria is known to be associated with both kidney function deterioration and cardiovascular diseases. While proteinuria estimation from 24-h urine samples has traditionally been considered as the standard method for assessment of the degree of urinary protein excretion, sample collection is associated with several technical problems such as inaccurate collection and the potential spread of drug-resistant pathogens. Therefore, the spot urine protein/creatinine ratio (PCR) assessment is currently recommended as an alternative. While the utility of PCR has been validated, studies on the association between spot urine PCR and 24-h proteinuria (24HP) in patients with chronic glomerular nephritis (CGN) and nephrotic syndrome (NS) are limited. This study aimed to evaluate whether an estimated result from a spot urine PCR could sufficiently approximate the daily urine protein excretion amount from a 24-h urine sample in patients with immunoglobulin A nephropathy (IgAN), minimal change disease (MCD), and membranous nephropathy- nephrotic syndrome (MN-NS). METHODS: The study participants included 161 patients with IgAN, MCD, or MGN-NS at the Jikei University Kashiwa Hospital and Kanagawa Prefecture Shiomidai Hospital. The correlation between spot urine PCR and a 24-h urine protein was investigated using linear regression analysis with Spearman's correlation (r) coefficient and intraclass correlation coefficient (ICC). RESULTS: While high correlation coefficients (r = 0.86, P < 0.001) and substantial agreement (ICC: 0.806, P < 0.001) were observed in patients with IgAN, similar correlations were not observed in patients with MCD or MN-NS. In the patients with MCD, r was 0.53 (P < 0.001), which signified a slight correlation, and in the patients with MN-NS, r was 0.289 (P = 0.17), which was not statistically significant. CONCLUSIONS: This study revealed that spot urine PCR is a reliable estimate of 24HP value in patients with IgAN. In contrast, there is a considerable difference between the daily urine protein excretion amount based on a 24-h urine sample and that which is calculated from spot urine PCR in patients with NS.

Adiponectin levels among individuals with varied employment status in Japan: a cross-sectional analysis of the J-SHINE study.

The purpose of this study was to examine the association between employment status and adiponectin levels. This cross-sectional study was a part of the Japanese Stratification, Health, Income, and Neighborhood study, a population-based survey in metropolitan Japan. The analysis included data from 848 individuals. A one-way analysis of variance was used to assess differences in log-transformed adiponectin levels among individuals according to their employment status. Multiple linear regression analysis was used to assess these differences after adjusting for other cardiovascular disease risk factors. The main outcome was log-transformed adiponectin. Of the participants, 6.2% of the men and 15.1% of the women were precarious workers. Mean adiponectin values differed significantly by employment status in men, but not in women. In men, multiple regression analysis showed that precarious workers had significantly lower adiponectin levels than permanent workers (ß = -0.16, P = 0.02). However, in women, adiponectin levels were significantly lower only in precarious workers with low household incomes (ß = -0.35, P = 0.02). Male precarious workers and their female counterparts with low annual household incomes had significantly lower levels of adiponectin. These results might help us to understand mechanisms underlying the relationship between employment status and cardiovascular disease.

Volume Ratio of Glomerular Tufts to Bowman Capsules and Renal Outcomes in Nephrosclerosis.

BACKGROUND: The concomitant appearance of glomerular collapse and enlargement is characteristic of the histological findings in nephrosclerosis. However, no previous study quantitatively examined the clinicopathological significance of this feature in patients with biopsy-proven nephrosclerosis. METHODS: Renal biopsy specimens and follow-up data from nephrosclerosis patients with estimated glomerular filtration rates >30 ml/min/1.73 m2 at diagnosis were retrospectively reviewed. Mean volumes for glomerular tufts (GV) and Bowman capsules (BV) were separately calculated, based on the measurement of all areas of glomerular tufts and Bowman capsules in a cross-section of biopsy specimens. The G/B ratio was defined as the ratio of GV to BV. The doubling of serum creatinine levels (DSC) and the initiation of renal replacement therapies (end-stage renal disease (ESRD)) were examined as renal outcome indices. RESULTS: A total of 67 patients with biopsy-proven nephrosclerosis were included. Clinicopathological findings at biopsy, other than GV, were comparable among all patients, irrespective of G/B ratio. Overall, 25 patients (37%) developed DSC and 9 (13%) developed ESRD during the median observation periods of 7.8 and 8.5 years, respectively. Renal survival curve analyses indicated a significantly worse prognosis for patients with a low G/B ratio, as compared with those with a high G/B ratio. Cox hazard analyses for DSC identified low G/B ratio as a significant predictor, but not low GV or BV. CONCLUSIONS: These results suggest that the quantitative evaluation of G/B ratio may detect subtle abnormalities in the glomerulus, indicating the subsequent renal outcomes of nephrosclerosis patients.

Distribution of nephrologists and regional variation in the clinical severity of IgA nephropathy at biopsy diagnosis in Japan: a cross-sectional study.

OBJECTIVES: The clinical severity of IgA nephropathy (IgAN) at the time of biopsy diagnosis differs significantly among cases. One possible determinant of any such difference is the time taken for referral from the primary care physician to a nephrologist, but the definitive cause remains unclear. This study examined the contribution of the number of nephrologists per regional population as a potential social factor influencing the clinical severity at diagnosis among patients with IgAN in Japan, which has an ethnically homogeneous population. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: Patients were registered in the Japan Renal Biopsy Registry (J-RBR), a nationwide multicentre registry, and 6426 patients diagnosed with IgAN were analysed. The facilities registered to the J-RBR were divided into 10 regions and the clinical features of IgAN at biopsy diagnosis, including renal function and level of proteinuria, were examined. MAIN OUTCOME MEASURES: Renal prognosis risk at the time of biopsy diagnosis defined by Kidney Disease Improving Global Outcomes guideline 2012. RESULTS: Among the regions, there were significant differences in the estimated glomerular filtration rate (67.5-91.4 mL/min/1.73 m2), urinary protein excretion rate (0.93-1.93 g/day) and renal prognosis risk group distribution at diagnosis. The severity of all clinical parameters was inversely correlated with the number of nephrologists per regional population, which showed an up to 2.7-fold difference among regions. A generalised linear mixed model revealed that a low number of nephrologists per regional population were significantly associated with fulfilment of clinical criteria indicating a very-high-risk renal prognosis (ß=-0.484, 95% CI -0.959 to -0.010). CONCLUSIONS: Among Japanese patients with IgAN, significant regional differences were detected in clinical severity at the time of diagnosis. Social factors, such as an uneven distribution of nephrologists across regions, may influence the timing of biopsy and determine such differences.

Measurement of daily sodium excretion in patients with chronic kidney disease; special reference to the difference between the amount measured from 24 h collected urine sample and the estimated amount from a spot urine.

It is important to grasp a patient's daily sodium intake in the management of chronic kidney disease, as sodium intake is widely recommended at 6 g/day or less. There are multiple equations widely known for estimating the daily sodium excretion from a spot urine sample, but these are aimed at healthy people. There are few reports that validate equations in patients with chronic kidney disease. The purpose of this study is to evaluate whether the amount of measured daily sodium excretion from a sample collected for 24-h urine (24HU) is equal to that of using an equation from a spot urine sample (SU) in patients with chronic kidney disease. One hundred sixty-two patients with chronic kidney disease from Kanagawa Prefecture Shiomidai Hospital, Japan and the Jikei University Kashiwa Hospital, Japan participated in the study. Daily sodium excretion was measured from 24HU and compared with it from SU by using the formula according to Tanaka et al. Sodium excretion by 24HU was 2744 mg/day and estimating daily sodium excretion from SU was 3315 mg/day. The coefficient of determination was 0.17 (p < .001) in multivariate regression analysis. The coefficient of determination was extremely low. Thus, there is a considerable difference between the amount of sodium excretion calculated from a 24HU and that from a SU in patients with chronic kidney disease.

Interleukin-6 Level among Shift and Night Workers in Japan: Cross-Sectional Analysis of the J-HOPE Study.

AIM: Shift workers have a high risk of cardiovascular disease (CVD). Systemic inflammation measured has been associated with the risk of CVD onset, in addition to classical risk factors. However, the association between work schedule and inflammatory cytokine levels remains unclear. The purpose of this study was to examine the association between work schedule and interleukin-6 (IL-6)/high-sensitivity C-reactive protein (hs-CRP) levels among Japanese workers. METHODS: The present cross-sectional study was a part of the Japanese Study of Health, Occupation and Psychosocial Factors Related Equity (J-HOPE). A total of 5259 persons who measured inflammatory cytokine were analyzed in this study. One-way analysis of variance was used to test log-transformed IL-6/hs-CRP differences by work schedule. Multiple regression analysis was used to examine the difference adjusted for other possible CVD risk factors. RESULTS: There were 3660 participants who had a regular work schedule; the remaining schedules were shift work without night work for 181 participants, shift work with night work for 1276 participants, and only night work for 142 participants. The unadjusted model showed that only night workers were significantly related to high levels of IL-6 compared with regular workers. Even in the multiple regression analysis, the higher level of IL-6 among only night workers remained significant (ß=0.058, P=0.01). On the contrary, hs-CRP was not. CONCLUSION: The present study revealed that only night shift work is significantly associated with high levels of IL-6 in Japanese workers. These observations help us understand the mechanism for the association between work schedule and CVD onset.

Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification.

BACKGROUND: In patients with IgA nephropathy (IgAN), recurrence after steroid pulse therapy is associated with reduced renal survival. However, the predictors of recurrence have not yet been clarified. METHODS: All patients who received 6-month steroid pulse therapy from 2004 to 2010 in our four affiliated hospitals and achieved a reduction of proteinuria to <0.4 g/day 1 year after treatment were retrospectively evaluated. The primary outcome was proteinuria ≥1.0 g/day during follow-up or additional antiproteinuric therapy. Two histological classifications were evaluated, the Oxford Classification with a split system and Japanese histological grades (HGs) with a lumped system. RESULTS: During a median follow-up of 3.4 years, 27 (26.7 %) of the 101 patients showed recurrence. Multivariate analysis showed that HG was the only significant predictor of recurrence, with HG 2+3+4 vs HG 1 having a hazard ratio of 7.38 (95 % confidence interval 1.52-133). Furthermore, in patients with mesangial hypercellularity according to the Oxford Classification, cumulative rate of recurrence-free survival was greater in patients with steroid therapy plus tonsillectomy compared with those who received steroid therapy alone (Log-rank test, P = 0.022). However, this association was not observed in patients without mesangial hypercellularity. CONCLUSIONS: HG is a novel predictor of recurrence after steroid pulse therapy in patients with IgAN. Moreover, the combination of steroid pulse therapy plus tonsillectomy may indicate a lower risk of recurrence in patients with mesangial hypercellularity, as defined by the Oxford Classification.