A Fatal Case of Rapidly Progressive Glomerulonephritis With Two Anti-neutrophil Cytoplasmic Antibodies and Anti-glomerular Basement Membrane Antibody: A Description of Autopsy Findings.

A 79-year-old man presented with dyspnea upon exertion, marked renal dysfunction, proteinuria, and hematuria. He was diagnosed with rapidly progressive glomerulonephritis. Serological tests were positive for MPO-ANCA, PR3-ANCA, and anti-GBM antibodies. Since the anti-GBM antibody titer was significantly higher than the ANCA titer and the renal dysfunction was severe, we initially assumed anti-GBM disease and started treatment. Due to poor general condition, a definitive diagnosis could not be made by renal biopsy. Corticosteroid therapy, plasmapheresis, and cyclophosphamide treatment were performed. However, renal function did not improve, and hemodialysis was required. He died of sepsis during treatment. An autopsy was performed with the consent of the family. Renal pathological examination revealed fibrocellular crescent formation in the glomeruli. Immunofluorescence revealed no major deposition in the glomeruli, suggesting ANCA-associated nephritis but not anti-GBM disease. Gross pathological findings of the abdominal aorta showed that a part of the artificial blood vessel had formed a pseudoaneurysm and abscess. There is no evidence of inflammatory cell infiltration or vasculitis in the alveoli. Pathological findings in the other organs did not suggest vasculitis. The renal prognosis of this case could have been improved with appropriate treatment if early diagnosis by renal biopsy had been made. There have been case reports of triple-seropositive rapid progressive glomerulonephritis (RPGN). We report a rare autopsy case of triple-seropositive RPGN.

Early menarche and adult major depressive disorder among Japanese women: The role of childhood traumatic experience and socioeconomic conditions in young adulthood.

Aim: The aim of this study is to examine the long-term impact of early menarche with adult depression, and to assess whether this association was explained by childhood traumatic experience and socioeconomic condition in early adulthood. Methods: The data were derived from World Mental Health Survey Japan Second, a cross-sectional survey conducted among Japanese community residents between 2013 and 2015. We used the data of female respondents aged 20-75 years (N = 1171). Hazard ratio (HR) of the onset of major depression up to 40 years was calculated for an early-menarche group and a non-early-menarche group, respectively. Kaplan-Meier curve and log-rank statistics were used to examine the difference in failure. Cox proportional hazard models were administered for the association of major depression with early-menarche and early-life psychosocial factors. Results: Risk for major depressive disorders were three to four times higher in an early-menarche group, and the differences in survival functions were significant (p < 0.001). HR of early menarche was 2.79 (95% CI = 1.29-6.02), and was slightly changed when childhood traumatic experience and socioeconomic conditions in young adulthood were added in the model (HR = 2.88, 95% CI = 1.30-6.38; HR = 3.19, 95% CI = 1.41-7.21). Conclusion: Early menarche was significantly associated with increased risk for depression by the age of 40 years. Childhood trauma and socioeconomic hardship in early adulthood did not account for the association. Both physical and psychosocial risk factors in early life need to be addressed for preventing women's depression.

Association between Urban Upbringing and Compulsive Internet Use in Japan: A Cross-Sectional, Multilevel Study with Retrospective Recall.

The purpose of this study was to show the association between urban upbringing and compulsive internet use (CIU). The interview data of the sample (N = 2431) was obtained from the World Mental Health Japan Second Survey and a multilevel model was used to investigate the association. Multiple imputation was also conducted in this study. Growing up in a large city was significantly associated with higher Compulsive Internet Use Scale (CIUS) scores (γ = 1.65, Standard Error (SE) = 0.45) and Mild CIU + Severe CIU (Exp(γ) = 1.44; 95% Confidence Interval (CI) (1.04-2.00)) compared to growing up in a small municipality after adjusting for both sociodemographic characteristics and psychopathology. This study showed a possible association between urban upbringing and CIU. Future studies with longitudinal design are needed to better understand this association.

Association of response rate and prevalence estimates of common mental disorders across 129 areas in a nationally representative survey of adults in Japan.

OBJECTIVE: To investigate the association of area response rate with prevalence estimates of mental disorders in the 2nd World Mental Health Survey (WMHJ2). METHODS: The sample of the WMHJ2 was selected from community residents in 129 areas from three regions of Japan. The surveys were conducted between 2013 and 2015, and 2450 (43.4%) responded. Mental disorders as well as three disorder classes (mood, anxiety, and substance use disorders) were identified using the WHO CIDI/DSM-IV. Response rates and 12-month and lifetime prevalences were calculated for each area. A generalized linear mixed model analysis was conducted to associate area response rate with the prevalence of mental disorders, controlling for sex, age, urbanity, and geographical region. RESULTS: Area response rates ranged from 0.05 to 0.80 across the 129 areas. Area response rate was not significantly associated with 12-month or lifetime prevalence of mental disorder. Lifetime prevalences of substance use disorder were significantly lower in a survey with a higher response rate than a survey of the same area with a lower response rate. CONCLUSION: Response rate may not strongly affect the prevalence estimates of mental disorders in a community-based survey of the prevalence of common mental disorders during a particular time frame. However, a lower response rate could be associated with overestimation of lifetime prevalence of substance use disorder. This needs further elucidation.

Psychological distress with and without a history of depression: Results from the World Mental Health Japan 2nd Survey (WMHJ2).

BACKGROUND: Psychological distress is prevalent and heterogenous. Checking a history of depression may contribute to identifying those who need intensive preventive support, but few studies have examined how different the dysfunction of people with and without a history of depression among those with psychological distress are. The study aimed to compare the two groups in physical health problems, level of social and familial support. METHODS: The World Mental Health Japan 2nd Survey (WMHJ2), a cross-sectional, nationally representative face-to-face survey of residents aged 20-75 years old, was conducted from 2013 to 2015. We defined psychological distress as a K6 score of 5 or more. A history of major depressive disorder (MDD) was assessed by the WHO Composite International Diagnostic Interview version 3.0. Multinomial logistic regression analysis was used to examine the associations of sociodemographic characteristics, physical health problems, social support and mental health service use among those with no psychological distress, with psychological distress having no history of MDD, and with psychological distress having a history of MDD, adjusted for sociodemographic characteristics. RESULTS: Unemployment, physical health problems, and lack of social support were much more common among those with psychological distress without a history of MDD than those with no psychological distress, and were largely comparable with those with psychological distress having a history of MDD. LIMITATIONS: The relatively low response rate might limit generalizability. CONCLUSIONS: The dysfunction in psychological distress without a history of MDD was largely equivalent to that seen in distress with a history of MDD.

Psychotic Experiences and Hikikomori in a Nationally Representative Sample of Adult Community Residents in Japan: A Cross-Sectional Study.

Psychotic experiences (PEs) may be associated with hikikomori. In the present study, we analyzed interview data from a community-based representative sample (N = 1,616) in Japan to know the association of PEs over a life time, as well as the two components, hallucinatory experiences (HEs) and delusional experiences (DEs), with lifetime experience of hikikomori (severe social withdrawal). Logistic regression analysis was used to estimate the association between any PE, any HE, and any DE; and hikikomori, adjusting for socio-demographics and other psychopathologies (mental disorder in the past 12 months or having autistic spectrum disorder trait). Any PE was significantly associated with hikikomori [odds ratio (OR) =3.44, 95% CI = 1.14-10.33] after adjustment for sociodemographic factors, although the association attenuated after adjusting for other psychopathologies. Any DE remained significantly associated with hikikomori, even after adjustment for all the covariates (OR = 10.50, 95% CI = 1.57-70.29). Any HE was not significantly associated with hikikomori. DEs may be associated with hikikomori. However, because the study sample was small and the temporal association between DEs and hikikomori was unclear, a future study is needed to examine a causal relationship between DEs and hikikomori.

Urbanization and Internet addiction in a nationally representative sample of adult community residents in Japan: A cross-sectional, multilevel study.

This study examines the relationship between urbanization and Internet addiction (IA) and association with other psychopathology and social support, in a nationally representative sample in Japan. Data from the World Mental Health Japan Second Survey were used. There were 2450 survey respondents, with an average response rate of 43.4%. Respondents' living areas were divided into three groups on the basis of urbanization (operationalized as city size). IA was measured using the Compulsive Internet Use Scale (CIUS). Three variables - psychological distress, past-12-month mental disorder, and social support - were measured using established instruments. A multilevel model was conducted to clarify the association between urbanization and IA (continuous scores and prevalence), before and after adjusting for possible individual-level and area-level variables and demographic variables. CIUS scores were significantly higher in large cities than in small municipalities before adjusting for psychological distress, social support, and past-12-month mental disorder. After adjustment, these associations attenuated substantially: urbanization was no longer significantly associated with odds of mild/severe IA, while the relationship held for continuous CIUS scores. Thus, residence in large cities is associated with higher odds of IA in Japan; psychological distress, social support, and past-12-month mental disorder partly explain this association.

Prevalence of mental disorders and mental health service use in Japan.

A high disease burden of mental disorders has been noted worldwide, including Japan. It is important to monitor mental disorder prevalence trends and the use of mental health services over time using epidemiological data and to plan appropriate policies and measures that consider mental health in each country. This review outlines the prevalence trends of common mental disorders (CMD) and the use of mental health services in Japan from the 2000s to the 2010s and compares them with those in other countries. This review clarifies that the prevalence of CMD in Japan has been relatively stable in the past decade. The 12-month prevalence of mental health service use has increased about 1.2 times to 1.6 times in the past 10-15 years. Thus, it is very likely that the rise in mental health service use contributes to increased patient numbers. Regarding cross-national comparison, the prevalence rate of CMD in Japan is much lower compared to rates in the USA and Europe. The 12-month prevalence of mental health service use was also lower in Japan compared to prevalence rates in other high-income countries. Mental health epidemiology has clarified that the prevalence of CMD worldwide has remained unchanged, even though mental health service use has increased in high-income countries. Thus, the gap in treatment quality and prevention should be addressed in the future.

Comorbidity and sociodemographic characteristics of adult autism spectrum disorder and attention deficit hyperactivity disorder: epidemiological investigation in the World Mental Health Japan 2nd Survey.

Objectives: The present study aims to examine sociodemographic correlates and comorbid mental disorders among adult with autism spectrum disorders (ASD) and attention deficit hyperactivity disorders (ADHD) using the national representative data of Japan. Methods: Analysis was conducted on the cross-sectional data derived from the World Mental Health Japan Survey 2, whose participants were community residents aged 20-75 years old. Multiple logistic regression was conducted on the data of those who were assessed for adult ASD (N = 2227) and ADHD (N = 2297). The association of adult ASD/ADHD with sociodemographics, mood disorders, anxiety disorders, substance use disorders, suicide ideation, hikikomori (social withdrawal), and internet addiction was examined, adjusting for sex and age. Gender difference in the association was also assessed based on the interaction terms of sex. Results: None of the sociodemographics characteristics were significantly associated with adult ASD/ADHD. ADHD had increased risks for a variety of mental disorders, having the highest odds ratios for social phobia. However, a significant positive association was limited to social phobia and to drug abuse and dependence among those with adult ASD. Hikikomori and internet addiction were positively associated with ASD/ADHD, while suicide ideation was only associated with ADHD. Women with ADHD were more likely to have any one of mental disorders, as well as alcohol abuse and dependence, compared to men with ADHD. Conclusions: Adults with ASD/ADHD in Japan had increased mental health needs. The specific needs of women with ADHD should be also considered in future clinical work and research.

Prevalence, treatment, and the correlates of common mental disorders in the mid 2010's in Japan: The results of the world mental health Japan 2nd survey.

BACKGROUND: Despite numerous changes in the mental health care system in Japan in 2000's, little is known about changes in the prevalence or treatment rates of mental disorders. METHODS: The World Mental Health Japan (WMHJ) 2nd Survey was a nationally representative face-to-face household survey of residents aged 20-75 years old conducted between 2013 and 2015. We compared the findings with those of an earlier study, the first WMHJ (WMHJ1) survey, conducted in 2002-2006. RESULTS: Overall, 2450 residents completed the interview. Lifetime prevalence of any common mental disorder was 22%, with high prevalence of alcohol abuse (15.1%). Twelve-month prevalence rates of any common mental disorder and major depressive disorder were 5.2% and 2.7%, respectively. Severe cases comprised 24% of 12-month disorders. Lifetime prevalence of any common mental disorder was greater for males. The persistence of any common mental disorder was greater for females. Proportion of those with 12-month disorders who sought treatment was 34%. Mental health care use was the most prevalent among 12-month cases. Twelve-month prevalence of any common mental disorder was similar to that of the WMHJ1 while the proportion of seeking treatment increased for disorders with moderate severity. LIMITATIONS: Institutionalized people were not included. The lower response rate might also limit the interpretation of the findings. CONCLUSIONS: The study found lower prevalence of mental disorders in Japan than in Western countries in the mid 2010's, suggesting that the prevalence of mental disorders remained stable in the last decade in Japan. Treatment rate increased for those with moderate disorders, which might reflect the government's attempt to raise people's awareness of mental health.

Differences in cancer stage, treatment and in-hospital mortality between patients with and without schizophrenia: retrospective matched-pair cohort study.

BACKGROUND: Healthcare access and outcomes in cancer patients with schizophrenia remain unclear. AIMS: To investigate the likelihood of early diagnosis and treatment in patients with schizophrenia who have cancer and their prognosis. METHOD: A retrospective matched-pair cohort of gastrointestinal cancer patients was identified using a national in-patient database in Japan. Multivariable ordinal/binary logistic regressions was modelled to compare cancer stage at admission, invasive treatments and 30-day in-hospital mortality between patients with schizophrenia (n = 2495) and those without psychiatric disorders (n = 9980). RESULTS: The case group had a higher proportion of stage IV cancer (33.9% v. 18.1%), a lower proportion of invasive treatment (56.5% v. 70.2%, odds ratio (OR) = 0.77, 95% CI 0.69-0.85) and higher in-hospital mortality (4.2% v. 1.8%, OR = 1.35, 95% CI 1.04-1.75). CONCLUSIONS: Patients with schizophrenia who had gastrointestinal cancer had more advanced cancer, a lower likelihood of invasive treatment and higher in-hospital mortality than those without psychiatric disorders.

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels.

Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a four-channel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multi-detector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.

Proteome analysis of an aerobic hyperthermophilic crenarchaeon, Aeropyrum pernix K1.

We analyzed the proteome of a crenararchaeon, Aeropyrum pernix K1, by using the following four methods: (i) two-dimensional PAGE followed by MALDI-TOF MS, (ii) one-dimensional SDS-PAGE in combination with two-dimensional LC-MS/MS, (iii) multidimensional LC-MS/MS, and (iv) two-dimensional PAGE followed by amino-terminal amino acid sequencing. These methods were found to be complementary to each other, and biases in the data obtained in one method could largely be compensated by the data obtained in the other methods. Consequently a total of 704 proteins were successfully identified, 134 of which were unique to A. pernix K1, and 19 were not described previously in the genomic annotation. We found that the original annotation of the genomic data of this archaeon was not adequate in particular with respect to proteins of 10-20 kDa in size, many of which were described as hypothetical. Furthermore the amino-terminal amino acid sequence analysis indicated that surprisingly the translation of 52% of their genes starts with TTG in contrast to ATG (28%) and GTG (20%). Thus, A. pernix K1 is the first example of an organism in which TTG is the most predominant translational initiation codon.