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Aim: Pancreatic reconstruction after pancreaticoduodenectomy (PD) that leaves a small remnant pancreas is often difficult. Pancreatic fistula is a major complication after PD, and fistulas are rare in patients with hard pancreas. However, the clinical impact of non‐reconstructed small remnant after PD with hard pancreas is unknown. Methods: We included all patients who underwent PD for pancreatic tumor without pancreatic reconstruction in two institutions supervised by one surgeon between January 2004 and March 2021. Their short‐ or long‐term outcome after surgery was retrospectively analyzed. Results: PD was performed in 774 patients, of whom 16 patients were without reconstruction (2.1%) with negative margins at the pancreatic stump. Pancreatic transection was performed above or to the left of the superior mesenteric artery, with a median remnant pancreas length of 3.7 cm (range, 1.3–10.0). A major complication (≥ Clavien–Dindo Grade IIIa) occurred in one patient (6%). Fistula of grade B occurred in one patient (6%). After a median follow‐up of 44 months (95%CI, 10.6–77.3), insulin administration was unnecessary in 11 patients. Conclusion: The preservation of a small pancreatic remnant without reconstruction after PD can be performed safely and may enable the keeping of pancreatic endocrine function for some selected patients with hard pancreas. [ABSTRACT FROM AUTHOR]

Objective: Given the population‐level variation in stature, a universal cut‐off for waist circumference (WC) may not be appropriate for some populations. We compared the performance of WC and waist‐to‐height ratio (WHtR) to detect the clustering of cardiovascular disease (CVD) risk factors in rural Vietnam. Methods: We obtained data from a baseline survey of the Khanh Hoa Cardiovascular Study comprising 2942 middle‐aged residents (40–60 years). We used areas under the receiver operating characteristics curve (AUROC), net reclassification index (NRI), and integrated discrimination improvement (IDI) to compare the performance of WC and WHtR in predicting CVD risk clustering (≥2 of the following risk factors: hypertension, diabetes, dyslipidemia, and elevated C‐reactive protein). Results: The optimal cut‐off values for WC were 81.8 and 80.7 cm for men and women, respectively. Regarding the clustering of CVD risk factors, the AUROC (95% CI) of WC and WHtR were 0.707 (0.676 to 0.739) and 0.719 (0.689 to 0.749) in men, and 0.682 (0.654 to 0.709) and 0.690 (0.663 to 0.717) in women, respectively. Compared with WC, WHtR had a better NRI (0.229; 0.102–0.344) and IDI (0.012; 0.004–0.020) in men and a better NRI (0.154; 0.050–0.257) in women. Conclusions: The optimal WC cut‐off for Vietnamese men was approximately 10 cm below the recommended Asian cut‐off. WHtR might perform slightly better in predicting the clustering of CVD risk factors among the rural population in Vietnam. [ABSTRACT FROM AUTHOR]

Alterations in KRAS, CDKN2A (p16), TP53, and SMAD4 genes have been major drivers of pancreatic carcinogenesis. The clinical course of patients with pancreatic cancer in relation to these driver alterations has not been fully characterised in large populations. We hypothesised that pancreatic carcinomas with different combinations of KRAS mutation and aberrant expression of CDKN2A, p53, and SMAD4 might show distinctive recurrence patterns and post‐operative survival outcomes. To test this hypothesis, we utilised a multi‐institutional cohort of 1,146 resected pancreatic carcinomas and assessed KRAS mutations by droplet digital polymerase chain reaction and CDKN2A, p53, and SMAD4 expression by immunohistochemistry. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for disease‐free survival (DFS) and overall survival (OS) were computed according to each molecular alteration and the number of altered genes using the Cox regression models. Multivariable competing risks regression analyses were conducted to assess the associations of the number of altered genes with specific patterns of recurrence. Loss of SMAD4 expression was associated with short DFS (multivariable HR, 1.24; 95% CI, 1.09–1.43) and OS times (multivariable HR, 1.27; 95% CI, 1.10–1.46). Compared to cases with 0–2 altered genes, cases with three and four altered genes had multivariable HRs for OS of 1.28 (95% CI, 1.09–1.51) and 1.47 (95% CI, 1.22–1.78), respectively (ptrend < 0.001). Patients with an increasing number of altered genes were more likely to have short DFS time (ptrend = 0.003) and to develop liver metastasis (ptrend = 0.006) rather than recurrence at local or other distant sites. In conclusion, loss of SMAD4 expression and an increasing number of altered genes were associated with unfavourable outcomes in pancreatic cancer patients. This study suggests that the accumulation of the four major driver alterations can confer a high metastatic potential to the liver, thereby impairing post‐operative survival among patients with pancreatic cancer. [ABSTRACT FROM AUTHOR]

Background: Pancreas-sparing distal duodenectomy (PSDD) is a favorable option for distal duodenal neoplasms, and its procedure, including the extent of lymphadenectomy, should be modified according to the malignancy of the tumor. However, there are no coherent reports on the details of this procedure or long-term outcomes after each resection. Methods: This study included 24 patients who underwent PSDD at our institution between January 2009 and October 2020. Patients were divided into two groups according to the tumor progression: nine with (Lv-II) and fifteen without (Lv-I) mesopancreas dissection. Postoperative outcomes were compared between the two groups. Results: Two groups had similar operation times, blood loss, hospital stay, and the rate of delayed gastric emptying (DGE): 40% versus 44%. There were no Clavien–Dindo classification ≥ III complications in the Lv-II group. The Lv-II group had a larger number of examined lymph nodes (median: 29), and three (33%) patients had lymph node metastasis. No local recurrence was observed, although two patients in the Lv-II group had liver metastasis. The 5-year overall survival rates of the Lv-I and Lv-II groups were 100% and 78%, respectively. None of the patients had an impaired nutrition status after one year of surgery, and no rehospitalization was observed in either group. Conclusion: Although PSDD with or without mesopancreas dissection entailed a high risk of DGE, this procedure showed favorable long-term outcomes and may be an alternative to pancreatoduodenectomy in patients with distal duodenal neoplasms. [ABSTRACT FROM AUTHOR]

Background: Based on the Japan Adjuvant Study Group of Pancreatic Cancer 01 study, the standard duration of adjuvant chemotherapy with S‐1 (an oral 5‐fluorouracil prodrug consisting of tegafur, gimeracil, and oteracil) in patients with resected pancreatic ductal adenocarcinoma (PDAC) was considered to be 6 months, but the impact of increasing its duration on postoperative survival was unknown. Here, the authors investigated this question by reviewing real‐world data from a large cohort of patients with PDAC. Methods: In total, 3949 patients who underwent surgery for PDAC during the study period followed by S‐1 adjuvant chemotherapy in board‐certified institutions were included. Based on the duration of S‐1 chemotherapy, two subgroups were defined: a standard‐duration group that included patients who were treated for 180 ± 30 days and a longer duration group that included patients who received treatment for >210 days. Results: The median duration of S‐1 chemotherapy was 167 days, with a mean ± standard deviation of 200 ± 193 days. After excluding patients who had a recurrence within 210 days after the initiation of adjuvant chemotherapy, postoperative recurrence‐free survival (RFS) and overall survival (OS) in the standard‐duration group (n = 1473) and the longer duration group (n = 975) were compared. RFS and OS did not differ significantly between the standard‐duration and longer duration groups (5‐year RFS: 37.8% vs. 36.2% respectively; p =.6186; 5‐year OS: 52.8% vs. 53.4%, respectively; p =.5850). The insignificant difference was verified by multivariate analysis and propensity‐score matching analysis. Conclusions: The current findings suggest that extending S‐1 adjuvant chemotherapy beyond 6 months has no significant additional effect on survival in patients with PDAC. This could be useful in determining whether to extend S‐1 chemotherapy in patients who have completed the standard 6‐month treatment. The impact of S‐1 adjuvant chemotherapy for a longer period than the standard duration (6 months) on postoperative survival was investigated in patients who had resected pancreatic ductal adenocarcinoma based on a nationwide survey that collected real‐world data. The results demonstrated that the extension of S‐1 adjuvant chemotherapy beyond 6 months had no significant additional effect on survival. [ABSTRACT FROM AUTHOR]

Background: Liver oligometastatic pancreatic cancer (PC) may have favorable outcomes. This study aims to evaluate outcomes and factors associated with overall survival (OS) of these patients. Methods: We retrospectively investigated consecutive PC patients with liver metastasis treated at our institution between 2013 and 2020. Clinical characteristics and outcomes were compared and analyzed according to the extent of liver metastasis. Cox proportional hazards model was used to identify prognostic factors for OS. Results: A total of 417 patients were included (multi‐organ metastasis/polymetastasis/oligometastasis 174/158/85). Oligometastasis showed a longer OS compared to other types of metastases (7.7 vs 8.2 vs 13.1 months). Age <70 years, performance status of 0, modified Glasgow prognostic score of 0, carbohydrate antigen 19‐9 <1000 U/mL were identified as significant prognostic factors for OS. A prognostic index consisting of these four factors successfully stratified the prognosis of these patients (prognostic index; high vs low, 19.9 vs 8.3 months). Highly selected patients who underwent surgical resection showed a median OS of 54.6 months. Conclusions: Oligometastasis presented a relatively favorable outcome. Our new prognostic index was useful in stratifying the prognosis of these patients. Multimodal treatment including surgery may have additional survival benefits for highly selected patients. [ABSTRACT FROM AUTHOR]

Background: Although surgical resection is the only potential treatment for patients with colorectal liver metastases (CLM), the actual cure is rare in patients with advanced CLM. Repeat resection (RR) is the most effective treatment in patients with recurrence; however, whether patients with initially advanced CLM achieve cure throughout RR or experience repeated recurrence even after RR remains unclear. In this study, we analyzed whether patients with advanced CLM achieve cure after RR. Methods: Consecutive patients who underwent initial hepatectomy with curative intent for CLM from January 1999 to August 2007 were included. Patients who were alive at 10 years from the initial hepatectomy without any evidence of recurrence were defined as cured. Cure rates were compared between patients with Fong's clinical risk score (CRS) of ≥ 3 and those with CRS of ≤ 2. Results: A total of 257 patients were included and followed up. Among them, 93 (36.2%) patients achieved actual cure postoperatively. The cure rate of patients with a CRS of ≥ 3 was 32.4% (33/102), which was not different from that of patients with a CRS of ≤ 2 (38.7% [60/155]; p = 0.299), although former patients had higher recurrence rate after the initial hepatectomy than latter ones (85.3% vs. 72.3%; p = 0.014). The cure rates after the initial, second, and third resections were 23.0% (59/257), 30.0% (24/80), and 22.5% (7/31), respectively. In multivariate analysis, RR was determined as an independent favorable factor of achieving cure. Conclusions: RR had a potential to cure patients with advanced CLM, and one-third of them achieved cure. [ABSTRACT FROM AUTHOR]

KRAS mutation is a major driver of pancreatic carcinogenesis and will likely be a therapeutic target. Due to lack of sensitive assays for clinical samples of pancreatic cancer with low cellularity, KRAS mutations and their prognostic association have not been fully examined in large populations. In a multi‐institutional cohort of 1162 pancreatic cancer patients with formalin‐fixed paraffin‐embedded tumor samples, we undertook droplet digital PCR (ddPCR) for KRAS codons 12/13/61. We examined detection rates of KRAS mutations by clinicopathological parameters and survival associations of KRAS mutation status. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for disease‐free survival (DFS) and overall survival (OS) were computed using the Cox regression model with adjustment for potential confounders. KRAS mutations were detected in 1139 (98%) patients. The detection rate did not differ by age of tissue blocks, tumor cellularity, or receipt of neoadjuvant chemotherapy. KRAS mutations were not associated with DFS or OS (multivariable HR comparing KRAS‐mutant to KRAS‐wild‐type tumors, 1.04 [95% CI, 0.62–1.75] and 1.05 [95% CI, 0.60–1.84], respectively). Among KRAS‐mutant tumors, KRAS variant allele frequency (VAF) was inversely associated with DFS and OS with HRs per 20% VAF increase of 1.27 (95% CI, 1.13–1.42; ptrend <0.001) and 1.31 (95% CI, 1.16–1.48; ptrend <0.001), respectively. In summary, ddPCR detected KRAS mutations in clinical specimens of pancreatic cancer with high sensitivity irrespective of parameters potentially affecting mutation detections. KRAS VAF, but not mutation positivity, was associated with survival of pancreatic cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: The secondary sex ratio (SSR, i.e., the number of male births per 100 female births) has long been proposed as a sentinel health indicator. Studies have suggested that exogenous environmental stressors reduce SSR after 3 to 6 months (via disproportionate male fetus deaths) and after 9 months (via reduced male conception). We aimed to examine whether SSR declined after the coronavirus disease 2019 (COVID‐19) pandemic in Japan. Methods: We used monthly vital statistics records collected between January 2013 and April 2021 (the ‐number of male and female live births, in particular). Using information reported before the pandemic struck Japan (i.e., January 2013 to January 2020), we predicted SSRs for the months after the pandemic (i.e., February 2020 to April 2021) and compared reported and predicted SSRs. We also stratified the analysis by including two groups of prefectures with different degrees of possible influence from the pandemic. Results: We observed a significant reduction in SSR during December 2020 of 102.81 (i.e., 9–10 months after the pandemic affected the country), which was below the lower bound of the 95% prediction intervals (103.12–106.33). This was the lowest SSR observed during the 100‐month study period. In addition, the reduction in SSR during December 2020 was more pronounced in the more seriously affected prefectures. Conclusion: In Japan, we found a significant reduction in SSR (i.e., fewer male live births) 9–10 months after COVID‐19 was declared a pandemic. This suggests the onset of the COVID‐19 pandemic was a significant population‐level stressor. [ABSTRACT FROM AUTHOR]

The structural plasticity of dendritic spines serves as the adaptive capabilities of the central nervous system to various stimuli. Among these stimuli, cerebral ischemia induces dynamic alterations in neuronal network activity. Arcadlin/Paraxial protocadherin/Protocadherin‐8 (Acad), a regulator of dendritic spine density, is strongly induced by activating stimuli to the neurons. However, the detailed distribution of Acad in normal and ischemic adult brains remains unclear. We comprehensively described Acad expression patterns in normal and ischemic adult brains by in situ hybridization histochemistry. We found that intact adult brains expressed Acad in the piriform cortex, dentate gyrus, hippocampal CA3, entorhinal cortex, amygdala, and hypothalamus. Acad expression was dramatically upregulated in the piriform cortex, olfactory area, dentate gyrus, entorhinal cortex, prefrontal cortex, insular cortex, amygdala, and septohippocampal nucleus 4 h after cerebral ischemia. Cerebral ischemia induced widespread neuronal activation, which was required for Acad upregulation. Our data suggested the involvement of Acad in the adaptive plasticity and remodeling of the neuronal network in the limbic and paralimbic systems. [ABSTRACT FROM AUTHOR]

The symposium "New criteria of resectability for pancreatic cancer" was held during the 33nd meeting of the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery (JSHBPS) in 2021 to discuss the potential modifications that could be made in the current resectability classification. The meeting focused on setting the foundation for developing a new prognosis‐based resectability classification that is based on the tumor biology and the response to neoadjuvant treatment (NAT). The symposium included selected experts from Western and Eastern high‐volume centers who have discussed their concept of resectability status through published literature. During the symposium, presenters reported new resectability classifications from their respective institutions based on tumor biology, conditional status, pathology, and genetics, in addition to anatomical tumor involvement. Interestingly, experts from all the centers reached the agreement that anatomy alone is insufficient to define resectability in the current era of effective NAT. On behalf of the JSHBPS, we would like to summarize the content of the conference in this position paper. We also invite global experts as internal reviewers of this paper for intercontinental cooperation in creating an up‐to‐date, prognosis‐based resectability classification that reflects the trends of contemporary clinical practice. [ABSTRACT FROM AUTHOR]

Summary: Background: Few studies have focused on the role of adverse childhood experiences (ACEs) in relation to genetic susceptibility to obesity. Objective: We aimed to examine the interaction between the presence of ACEs (i.e., physical, psychological and sexual abuse) before the age of 18 and BMI polygenic score. Methods: Data came from the National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave IV (2007/2008) where saliva samples were collected for DNA genotyping and information on BMI and ACEs were obtained from 5854 European American (EA), 2073 African American (AA) and 1448 Hispanic American (HA) participants aged 24 to 32 years old. Polygenic scores were calculated as the sum of the number of risk alleles of BMI‐related SNPs which were weighted by effect size. A race/ethnicity‐stratified mixed‐effects linear regression model was used to test for differential association between BMI polygenic score and BMI by the presence of ACEs. Results: We did not find any evidence of significant interaction between ACEs and polygenic score in relation to BMI among EA (p = 0.289), AA (p = 0.618) or HA (p = 0.870). In main effects models, polygenic score was positively associated with BMI in all race/ethnic groups, yet the presence of ACEs was associated with increased BMI only among EA. Conclusion: We did not find any evidence that ACEs exacerbate genetic predisposition to increased BMI in early adulthood. [ABSTRACT FROM AUTHOR]

Background: For pancreatic ductal adenocarcinoma (PDAC) surgery, extended dissection of the nerve plexus (pl) around the superior mesenteric artery (SMA) or celiac artery (CA) is sometimes necessary. This consequently results in postoperative refractory diarrhea. This study aimed to evaluate the clinical impact of extended nerve plexus dissection around major arteries on postoperative diarrhea. Methods: Patients who underwent pancreatoduodenectomy (PD) for PDAC between January 2013 and December 2016 were included. The frequency of diarrhea (defined as a condition requiring opioid antidiarrheal drug for at least 6 months after surgery) and its short- and long-term outcomes were reviewed. Results: Of 200 consecutive patients who underwent PD, 78 (39.0%) developed postoperative refractory diarrhea (diarrhea group), and 73 of them (93.6%) underwent hemi-circumferential or more nerve dissection for SMA or CA; both plSMA and plCA dissection were associated with diarrhea. Borderline resectable artery (BR-A) PDAC was included more in the diarrhea group (32.0% vs. 13.1%, P = 0.001); however, the local recurrence rate in the diarrhea group was significantly lower than that in the non-diarrhea group (14.1% vs. 26.2%, P = 0.036). The completion of adjuvant chemotherapy and overall survival were comparable between the two groups. The pre-albumin level improved in 2 years, and 61.3% of patients with diarrhea could stop opioid antidiarrheal drugs within 3 years of surgery. Conclusions: Although the frequency of diarrhea increased following nerve plexus dissection around arteries, diarrhea was controllable and resulted in a reduced local recurrence rate. Aggressive dissection of the nerve plexus may be justified for local disease control in BR-A PDAC. [ABSTRACT FROM AUTHOR]

Aim: While accumulating evidence suggests a protective role of healthy diet against depression, evidence on this issue is limited among healthcare workers combating COVID‐19 pandemic. The aim of this study was to determine the cross‐sectional association between frequency of balanced meal consumption and depressive symptoms among Japanese hospital workers during the COVID‐19 pandemic. Methods: Participants were 2,457 workers of the National Center for Global Health and Medicine who responded to a questionnaire survey in October or December 2020. Depressive symptoms were assessed using the patient health questionnaire‐9 (PHQ‐9). The number of days per week of eating two or more balanced meals was categorized into four from ≤1 day/week to daily. The association between frequency of balanced meal consumption and depressive symptoms was assessed using logistic regression analysis, with adjustment for lifestyle and COVID‐19‐related factors. Results: The prevalence of depressive symptoms was 14.8%. The odds of depressive symptoms increased with decreasing frequency of balanced meal consumption. The multivariable‐adjusted odds ratios (95% confidence intervals) of depressive symptoms were 1.00 (reference), 1.09 (0.75‐1.58), 1.62 (1.17‐2.24), and 2.21 (1.54‐3.17) for balanced meal consumption categories of daily, 4‐5 days/week, 2‐3 days/week, and ≤1 day/week, respectively (P for trend<0.001). Conclusions: Our results suggest that infrequent consumption of well‐balanced meal is associated with increased depressive symptoms among hospital workers during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: A modified Fong clinical score (m-Fong CS) that includes the RAS mutation status has recently been proposed and offered an improved survival stratification of patients who undergo surgery and systemic chemotherapy for colorectal liver metastases (CLM). The aim of this study is to assess whether a CS that includes RAS status is influenced by whether patients receive perioperative chemotherapy. Methods: We created a new CS using multivariate analysis of data of patients who underwent hepatectomy for CLM for the first time between 2010 and 2016 at a single hospital (n = 341, 79% received perioperative chemotherapy). The resulting CS and m-Fong CS were then validated in the patient cohort at three other hospitals (n = 309). Furthermore, the applicability of the two CS in the total cohort (n = 650) was tested according to whether the patients received perioperative chemotherapy. Results: The new CS comprised mutant RAS status, ≥4 CLMs, and a CA19-9 level ≥100 U/mL (1 point per factor). Both the new CS and m-Fong CS failed to stratify the survival of the 309 patients in the validation cohort, including those who did not receive perioperative chemotherapy (29%). Both of the CS accurately stratified the survival of patients who underwent perioperative chemotherapy but not of those who underwent surgery alone. Conclusion: A CS that includes the RAS mutation status can stratify the survival of patients who undergo hepatectomy combined with perioperative chemotherapy, but it has limited value for patients who undergo surgery alone. [ABSTRACT FROM AUTHOR]

Background/Purpose: We evaluated efficacy of neoadjuvant therapy with gemcitabine and nab‐paclitaxel (GNP‐NAT) in borderline resectable pancreatic cancer (BR‐PC) patients compared to conventional upfront surgery (UPS). Methods: This single‐center retrospective study assessed 151 consecutive patients: 96 diagnosed in 2008‐2014 underwent UPS (UPS group) and 55 diagnosed in 2015‐2017 underwent GNP‐NAT (GN group). Patient background, surgical, pathological, and survival outcomes were compared between groups. Results: Age, sex, and pretreatment carbohydrate antigen 19‐9 were similar between groups. After four courses of NAT‐GNP, 46 GN patients (84%) underwent surgery while all UPS patients underwent surgery. Only three GN patients (5%) underwent non‐therapeutic procedures, compared to 23 (24%) in the UPS group (P =.004). In the whole cohort, R0‐resection was achieved in 40 GN patients (73%) vs 46 UPS patients (48%; P =.004) and the 3‐year overall survival was significantly higher in the GN group (median survival time, 31.9 vs 18.1 months, P =.014). In the resection cohort, the R0‐resection rate was 93% (GN) vs 63% (UPS; P =.0007). There was no 90‐day mortalities in either group. Conclusions: Intention‐to‐treat‐based analysis indicated considerable benefits of GNP‐NAT in BR‐PCs for long‐term survival, contributing to improved tumor suppression and patient selection. [ABSTRACT FROM AUTHOR]

Objective: Chronic stress is a risk factor for hypertension in adults. However, there is conflicting evidence for older adults. We hypothesized that age‐related arterial stiffening, which leads to a lower blood pressure (especially diastolic blood pressure [DBP]), is more pronounced among older adults with high vs low stress. The objectives of this study were (a) to investigate age‐related trends in systolic and DBPs among adults in rural Fujian, China, and (b) to examine differences in age‐related blood pressure trends according to levels of stress by using Epstein‐Barr virus (EBV) antibody titer as a marker of chronic stress status. Methods: We collected cross‐sectional data from 764 rural community‐dwelling adults in rural Fujian, China (mean age = 59.4). Participants were categorized into high and low stress groups by median split of EBV antibody titer. A least‐squares regression analysis was used to investigate the association between age and blood pressures. Results: We observed an inverted U‐shaped association between age and DBP, while there was a linear association between age and systolic blood pressure in the overall sample. When stratified by stress, the inverted U‐shaped associations with age (both systolic and DBPs) were seen only among those with high stress; DBP peaked at the age of ~68 years, and the declining trend later in life was more clearly observed among those with high chronic stress. Discussion Decrease of DBP was more pronounced among older adults with high vs low chronic stress in rural China. [ABSTRACT FROM AUTHOR]

Objectives: While several experimental studies in animals and humans have suggested the protective effect of nightly fasting duration (NFD) against cardiometabolic risk factors, few population‐based studies have been conducted. This study aimed to investigate the association between NFD and metabolic syndrome (MetS) among Japanese non‐shift workers. Methods: A subset of 1054 non‐shift workers from the Furukawa Nutrition and Health Study were included in this analysis. Participants completed dietary and lifestyle surveys during a periodic checkup. NFD was defined as the time between dinner and breakfast and was categorized into four groups (ie, ≥12 hours, 11 hours, 10 hours, and ≤9 hours). MetS was defined as ≥3 of the following components: high waist circumference (≥90 cm [men] and ≥80 cm [women]), high triglycerides (≥150 mg/dL), low high‐density lipoprotein cholesterol (<40 mg/dL [men] and <50 mg/dL [women]), hypertension (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg), and high fasting glucose (fasting plasma glucose ≥100 mg/dL or hemoglobin A1c ≥5.6%). A multivariable logistic regression model was used to examine the association between NFD and MetS. Results: The odds ratios (95% confidence intervals) of MetS for the highest (≥12 hours) through lowest (≤9 hours) NFD categories were 1.00 (reference), 0.83 (0.51‐1.35), 0.83 (0.48‐1.43), and 0.80 (0.43‐1.48) (P for trend = 0.50) after adjusting for covariates. Further analyses on the relationship between NFD and each MetS component found no significant associations. Conclusions: We did not find any evidence of a significant association between NFD and MetS among non‐shift workers in Japan. [ABSTRACT FROM AUTHOR]

Background: Among grade B/C postoperative pancreatic fistula (POPF), the clinical burden of patients treated with persistent drainage alone was reported to be less. As the clinical difference might depend on drain management, we evaluated their clinical burden under conservative drain management. Methods: We included 292 patients who underwent pancreaticoduodenectomy or distal pancreatectomy between 2013 and 2015. Patients with grade B POPF were categorized into those receiving persistent drainage alone (B‐drain) and those receiving other treatments (B‐other). The clinical burden of these groups and patients with biochemical leakage (BL) was compared. Results: BL, grade B POPF, and grade C POPF occurred in 42 (14%), 93 (32%), and 4 (1.4%) patients, respectively. The B‐drain group comprised 61% of grade B POPF. The overall major morbidity (Clavien–Dindo grade ≥ 3) in the B‐drain group was significantly lower than in the B‐other group (18% vs 50%, P =.001) but was comparable to that of the BL group (19%, P =.848). The POPF‐related major morbidity in the B‐drain and B‐other group were 0% and 25%, respectively (P <.001). Conclusions: Under conservative drain management, patients with grade B POPF frequently experienced persistent drainage alone and the clinical burden of B‐drain group and BL group was comparable. [ABSTRACT FROM AUTHOR]

Background: The TNM (Tumor, Node, Metastasis) classification of the 8th Union for International Cancer Control and the 6th Japanese classification of biliary tract cancer were made on the premise that the prognostic effect of each regional lymph node station is similar. However, some studies have reported different effects of lymph node metastasis location on post‐resection prognosis. This study aimed to investigate outcome following radical resection of ampullary carcinoma according to station of lymph node metastasis. Methods: Patients who underwent surgical resection for ampullary carcinoma between January 2007 and December 2017 at two separate Japanese institutions were included. Regional lymph nodes were subclassified as follows: Pancreatoduodenal lymph nodes (PD) and others (OT). Results: Of the 101 patients analyzed, 34 had regional lymph node metastasis. OT metastasis was found in eight patients. Significant differences were found in relapse‐free survival (RFS) and overall survival (OS) between the three study groups (no nodal metastasis, only PD metastasis and OT metastasis; P <.001 for both). OT metastasis was an independent prognostic factor in the multivariate analysis for RFS (hazard ratio [HR] 17.14; 95% confidence interval [CI], 6.33‐43.93) and OS (HR 11.06; 95% CI, 3.7‐32.99). Conclusion: The poor prognosis of ampullary carcinoma patients with OT metastasis suggests that regional lymph nodes should not be categorized equally into one group. [ABSTRACT FROM AUTHOR]

Aim: Weight and height are usually self‐reported in population‐based epidemiological surveys. While the accuracy of self‐reports has been extensively studied in younger populations, less is known in older populations. We investigated the accuracy of self‐reported weight, height and body mass (BMI) in an older cohort in Japan, where overweight/obesity and underweight coexist. Methods: We used data from older Japanese adults (≥65 years) participating in the Japan Gerontological Evaluation Study in 2016 to 2017 (7357 men and 9271 women). Self‐report data were linked to objective data obtained from clinical examinations. Results: The mean ± standard deviation (SD) age was 74.5 ± 5.8 years, mean ± SD weight, height and BMI were 55.7 ± 10.1 kg, 156.0 ± 8.9 cm and 22.8 ± 3.1, respectively. Results showed high intraclass correlation coefficients for self‐reported and measured values (0.97 for weight; 0.96 for height). While weight/height were overestimated among men (weight by 0.096 kg; height by 0.27 cm) and women (weight by 0.18 kg; height by 0.27 cm), BMI tended to be slightly underestimated (−0.034 kg/m2 for men; −0.037 kg/m2 for women). However, the absolute differences between self‐reported and measured values were not negligible; people had a higher risk for both under‐ and overestimation of their BMI category with increasing age. Lower education predicted BMI overestimation, whereas lower income predicted BMI underestimation. Conclusions: Overall accuracy of self‐reported body habitus was higher in this cohort of older Japanese compared with previous reports. Nevertheless, misclassification of BMI due to the misreporting of their weight/height was more common among the oldest‐old, as well as those with lower education and income. Geriatr Gerontol Int 2020; 20: 803–810. [ABSTRACT FROM AUTHOR]

Background: As complete prevention of postoperative pancreatic fistula (POPF) after pancreatic surgery remains difficult, many risk factors for clinically relevant POPF (CR-POPF) have been reported. However, their clinical impact could be limited because all previous reports included patients without biochemical leakage (BL) that rarely developed to CR-POPF. Therefore, a new strategy for identifying high-risk patients who develop delayed complications from patients with confirmed BL and for implementing interventions for such patients in the early postoperative period is required. This study aimed to examine the role of fistulography in predicting CR-POPF from confirmed BL. Methods: Consecutive patients diagnosed with BL on postoperative day 3 after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) from January 2013 to June 2015 in our institution were included. Fistulography was performed 1 week after the operation, and the associations between findings on fistulography and delayed complications associated with POPF were evaluated. Results: Eighty-four (37%) of 227 patients who underwent PD and 45 (48%) of 94 patients who underwent DP were included and divided to two groups according to fistulographic findings (simple type, n = 107, 83%; cavity type, n = 22, 17%). The latter finding was associated with a greater morbidity rate (Clavien–Dindo grade ≥ 2: 36% vs 59%, p = 0.018) and a worse final POPF grade (B/C 64% vs 95%, p = 0.003). In the multivariate analysis, cavity type on fistulography was a significant predictive factor for grade B/C POPF. Conclusions: Fistulography is a useful examination for identifying patients with a high risk of developing delayed complications associated with POPF. [ABSTRACT FROM AUTHOR]

Objectives: In contrast to the health of migrants, which has been extensively studied, little attention has been paid to the health of adults left behind by family members who out‐migrated to other locations. This study was performed to investigate the association between being left behind and the Epstein‐Barr virus (EBV) antibody titer, which is an indicator of cellular immune functioning previously shown to be associated with psychological stress. Methods: A cross‐sectional survey was conducted in rural communities in Fujian, China, in 2015. Questionnaire data and dried blood spot samples were collected from 748 adults. A mixed effect regression analysis was conducted to investigate the association. Results: Results indicated that the EBV antibody titers were higher among people who had been left behind compared with those who had not. Conclusions: Our findings suggest that, in rural Fujian, China, family separation following the out‐migration of family members is an important determinant of psychological stress. [ABSTRACT FROM AUTHOR]

Objective: In contrast to the association between excess weight and sickness absence (SA), the association in relation to underweight has been under-researched. This study aimed to examine the effects of BMI at both extremes of its distribution on SA.Methods: Data came from the Japan Epidemiology Collaboration on Occupational Health study of 77,760 workers aged 20 to 59 years (66,166 males, 11,594 females). Information was collected on medically certified long-term SA (LTSA) (i.e., SA lasting ≥ 30 consecutive days) from April 2012 to March 2017. A sex-specific Cox proportional hazards model was used to investigate the associations.Results: Among males, both obesity (hazard ratio [HR] = 1.81, 95% CI: 1.50-2.17) and underweight (HR = 1.56, 95% CI: 1.23-1.96) were significantly associated with LTSA compared with normal weight. This U-shaped association between BMI categories and LTSA was observed both for mental and physical disorders. Among females, an elevated risk was observed among those with overweight (HR = 1.54, 95% CI: 1.16-2.05).Conclusions: In a cohort of the Japanese working-age population, both obesity and underweight were associated with a greater risk of LTSA in males. Future research should not overlook the excess risk of LTSA associated with underweight. [ABSTRACT FROM AUTHOR]

Background: Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. Methods: Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. Results: Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90‐day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. Conclusion: LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy. [ABSTRACT FROM AUTHOR]

Background: It is unclear how early liver recurrence negatively affects survival in patients undergoing surgery for colorectal liver metastases (CLM) and whether to perform re-hepatectomy for early recurrence is still controversial. We aimed to evaluate the prognostic value of re-hepatectomy for early recurrence of CLM. Methods: We reviewed 634 patients undergoing initial hepatectomy for CLM between 2004 and 2015. In 131 patients (20.7%), liver recurrence occurred within 6 months after surgery (early recurrence group [ER]). Recurrence pattern and survivals of ER were compared with those of 150 patients (23.7%) who had liver recurrence more than 6 months after surgery (late recurrence group [LR]). Re-hepatectomy was indicated for resectable disease regardless of the timing of recurrence without using preoperative chemotherapy. Results: The 5-year overall survival (OS) rates after initial hepatectomy in ER (24.0%) were worse than those in LR (57.7%, p < 0.01). Although the incidence of concomitant extrahepatic recurrence was not different between ER and LR, the rate of re-hepatectomy for recurrence confined to the liver in ER (72.5% [58/80]) was lower than that in LR (88.9% [96/108], p < 0.01). In ER, re-hepatectomy was found to independently improve survival (HR: 6.479, p < 0.01), offering the 5-year OS rate after re-hepatectomy of 45.2%. The sites and timing of re-recurrence after re-hepatectomy were not different between ER and LR. Conclusions: Impaired survival of early liver recurrence is attributed to extensive liver recurrence. However, re-hepatectomy indicated based on resectability is associated with improved survival in patients with early recurrence, tempering the re-recurrence mode. [ABSTRACT FROM AUTHOR]

This study investigated the role of childhood parental deprivation in the association between quality of life (QOL) and the Epstein–Barr virus (EBV) antibody titer, a marker of cellular immune functioning, using data from 734 adults living in seven communities in rural Fujian, China. Parental deprivation was defined if either of their parents had died, divorced, or left them for migratory work for more than 1 year before they turned (a) 16 years of age (childhood and adolescence), or (b) 3 years of age (early childhood). A mixed‐effects regression analysis with a random effects model revealed that parental deprivation during early childhood was positively associated with the EBV antibody titer (coefficient = 0.33, p = 0.007), whereas parental deprivation during the first 16 years was not. Further analysis incorporating an interaction term between QOL and parental deprivation revealed a significant interaction between QOL and parental deprivation during early childhood; a significant association between QOL and the EBV antibody titer was found only among those who reported parental deprivation during early childhood. This study suggests that parental deprivation during the period of immune system development may be linked with physiological responses to stressors later in life. [ABSTRACT FROM AUTHOR]

Background: In recent decades, there have been enthusiastic discussions of, and active proposals for, new approaches to dissection around the superior mesenteric artery during pancreaticoduodenectomy (PD). In contrast, dissection along the celiac axis (CA) and hepatic artery (HA) and in the hepatoduodenal ligament has rarely been systematically discussed. In this report, we propose and describe a three-level classification of dissection along the CA-HA system which is applicable to a variety of diseases for which PD is indicated.Methods: The extent of dissection is classified into three levels. With the first level (LV-1), neither LN nor plexus dissection is required. The second level (LV-2) includes en bloc resection of LNs along the CA, HA, and in the hepatoduodenal ligament, preserving the nerve plexus around the artery. The third level (LV-3) includes en bloc dissection of LNs and the nerve plexus close to cancer invasion, for example, being accompanied by half circumferential dissection of the nerve plexus around the CA or circumferential dissection of that of HA. LV-1 dissection is indicated for benign lesions, low grade malignancy, pancreatic metastasis, or intraductal papillary mucinous neoplasm. LV-2 is indicated for periampullary malignancies requiring dissection of regional LNs, including ampullary, distal bile duct, duodenal cancers, and pancreatic cancers without evidence of invasion around the CA-HA system. LV-3 is indicated for malignancies with evidence of perineural invasion in the CA-HA system, such as pancreatic cancer at the pancreatic neck or advanced bile duct cancer.Conclusions: In combination with classified superior mesenteric artery dissection, a variety of PD procedures would be systematically classified, understood, and reproduced regardless of nature of disease, surgeon, or approach. [ABSTRACT FROM AUTHOR]

Aim: We aimed to examine the association between attention‐deficit/hyperactivity disorder (ADHD) symptoms and suicidal behavior in psychiatric outpatients and whether this association differs among patients with different psychiatric disorders. Methods: Cross‐sectional data came from the Japan Prevalence Study of Adult ADHD at Psychiatric Outpatient Care, which included psychiatric outpatients aged 18–65 years recruited from one university hospital and three general psychiatric outpatient clinics in Kitakyushu City, Fukuoka, Japan from April 2014 to January 2015 (N = 864). The Adult ADHD Self‐Report Scale (ASRS) Screener was used to collect information on ADHD symptoms. Reports of current and lifetime suicidal behavior were also obtained. A multivariable Poisson regression analysis was used to examine the association between ADHD symptoms and suicidal behavior. Results: After adjusting for covariates there was a strong association between possible ADHD (ASRS ≥14) and suicidal behavior with prevalence ratios ranging from 1.17 (lifetime suicidal ideation) to 1.59 (lifetime suicide attempt) and 2.36 (current suicidal ideation). When ASRS strata were used, there was a dose–response association between increasing ADHD symptoms and suicidal ideation and suicide attempts. Analyses of individual ICD‐10 psychiatric disorders showed that associations varied across disorders and that for anxiety disorder, ADHD symptoms were significantly linked to all forms of suicidal behavior. Conclusion: ADHD symptom severity is associated with an increased risk for suicidal behavior in general psychiatric outpatients. As ADHD symptoms are common among adult psychiatric outpatients, detecting and treating ADHD in this population may be important for preventing suicidal behavior. [ABSTRACT FROM AUTHOR]

Aim: While previous studies have examined the association between health‐related behaviors and hypertension, comparatively little attention has been paid to the role of social participation (i.e. participating in community organizations). The aim of the present study was to investigate the longitudinal association between social participation and hypertension among the middle‐aged and older population (aged ≥45 years) in China where the prevalence of hypertension has been increasing rapidly in the past few decades. Methods: Data came from the China Health and Retirement Longitudinal Study waves 2011 and 2013. Information was obtained from 5483 participants on blood pressure, social participation and covariates. A sex‐stratified Poisson regression model with a robust variance estimator was used to examine the associations. Results: During the period between 2011 and 2013, 20.6% of men and 17.2% of women developed hypertension. A Poisson regression model showed that participating in community organizations once a week or more frequently was inversely associated with the onset of hypertension in women (incidence rate ratio 0.80, 95% confidence interval 0.67–0.95, P = 0.012). Among men, no such association was found. Conclusion: The present study suggests that promoting social participation might help mitigate the disease burden associated with hypertension in China, particularly among women. Geriatr Gerontol Int 2018; 18: 1093–1099. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: There has been little research on the association between social capital and psychological stress measured by a biomarker, particularly in developing countries. Our objective was to investigate the association between Epstein‐Barr virus (EBV) antibody titer, an indicator of cellular immune function previously shown to be associated with psychological stress, and social capital among rural community dwellers in Fujian Province, China. Methods: We conducted a cross‐sectional survey in seven rural communities in Fujian in 2015. We used questionnaire data and dried blood spot samples for the measurement of biomarkers collected from 734 local residents for the analysis. We conducted a mixed effects regression analysis to investigate the association between EBV antibody titer and four social capital variables, which included cognitive and structural social capital assessed both at individual and community levels. Results: Community‐level structural social capital was inversely associated with psychological stress (coefficient = −0.96, 95% confidence interval [CI] = −1.91, −0.01) while individual‐level structural social capital was positively associated with it (coefficient = 0.21, 95% CI = 0.07, 0.36). Neither individual‐ nor community‐level cognitive social capital was associated with psychological stress status. Conclusions: In rural Fujian, China, social capital seemed to be an important determinant of psychological health. While living in a community with active social interaction may benefit the residents psychologically, social interaction in the form of strongly bonded relationships may be a source of psychological stress at the individual level due to the potential demands and obligations that may be associated with such connections. [ABSTRACT FROM AUTHOR]

Background Dabigatran is a direct thrombin inhibitor used to decrease the risk of ischemic stroke in patients with non-valvular atrial fibrillation (NVAF). Its prodrug, dabigatran etexilate (DE) is often co-administrated with a proton pump inhibitor (PPI) because of its adverse effects on the gastrointestinal tract. Drug-drug interactions between DE and PPIs in daily clinical practice have not been fully elucidated. Methods Changes in blood dabigatran concentration (DC) were investigated using the dilute thrombin time test in a randomized, open-label, two-period crossover study including 34 Japanese patients with NVAF receiving dabigatran therapy with or without PPI. Results The average trough DC was significantly higher without PPI than with PPI (83 ± 42.3 vs. 55.5 ± 24.6 ng/mL, respectively; P < 0.001). Similarly, the average peak DC was significantly higher without PPI than with PPI (184.1 ± 107.7 vs. 124 ± 59.2 ng/mL, respectively; P = 0.0029). The average ratio of DC change at the trough and peak levels did not differ significantly among the three PPI types. Conclusions PPI administration significantly decreased the trough and peak DCs in patients with NVAF. Therefore, when prescribing PPIs for patients with NVAF in a clinical setting, the possibility that the bioavailability of dabigatran may decrease should be considered. [ABSTRACT FROM AUTHOR]

Background: A distal pancreatectomy with en bloc celiac axis resection (DP-CAR) is indicated for left-sided locally advanced pancreatic ductal adenocarcinoma. However, ischemic complication resulting from the sacrifice of the common hepatic artery and left gastric artery (LGA) remain problematic. The aim of this study was to analyze the feasibility of DP-CAR with preservation or reconstruction of the left gastric artery. Method: Between April 2011 and December 2014, we treated 17 cases using DP-CAR with preservation or reconstruction of the LGA. If the tumor had involved the LGA, the LGA was dissected and reconstructed using the middle colic artery. We retrospectively analyzed the feasibility of this procedure. Results: Among 17 consecutive patients who underwent DP-CAR, the LGA was preserved in 13 patients and reconstructed in four patients. Major postoperative complications were observed in seven cases (41 %). A pancreatic fistula (grade B/C) or delayed gastric emptying (grade B/C) occurred in 7 (41 %) and 2 (12 %) cases, respectively. The overall R0 resection rate was 94 % (16/17). Eleven cases developed recurrences (liver, n = 4; lymph nodes, n = 2; peritoneal dissemination, n = 2; lung, n = 2; local recurrence, n = 1). The overall 1- and 3-year postoperative survival rates were 74 and 45 %, respectively. Conclusions: Our preliminary data showed that DP-CAR with preservation or reconstruction of the LGA is a safe and feasible approach, and that this procedure may reduce the risk of ischemic complications. [ABSTRACT FROM AUTHOR]

Studies have demonstrated a relationship between clinical outcomes after curative resection for colorectal cancer (CRC) and gene mutations of the EGFR pathway; however, no studies have examined metastatic CRC (mCRC) patients with metastasectomy. The aim of this study was to evaluate the relationship between gene mutations of EGFR pathway and clinical outcomes after metastasectomy in mCRC patients. A total of 1,053 patients histopathologically confirmed CRC received a genotyping test for the EGFR pathway from February 2012 to October 2013. Detailed information was obtained through review of medical records. Gene mutations of EGFR pathway were analyzed by Luminex assay. Overall survival (OS) and recurrence free survival were estimated by the Kaplan-Meier method and the log-rank test was used to compare the survival outcomes by gene mutation status. A total of 132 patients received metastasectomy. The frequencies of KRAS exon 2, KRAS exon 3.4, NRAS, BRAF, and PIK3CA mutations were 38.6% (51/132), 3.6% (5/132), 5.1% (7/132), 5.1% (7/132), and 8.7% (12/132), respectively. With a median follow-up of 84.1 months (57.2-NA) for a survivor, the 4-year OS rate was 65.6% for mCRC with RAS mutation, and 81.3% for mCRC with wild-type RAS ( p < 0.05). We observed a statistically significant correlation for only the RAS mutation and OS. In multivariate analysis, RAS mutation and liver metastasis were independent factors for shorter OS. There were no significant differences between gene mutations of EGFR pathway and recurrence free survival. RAS mutation in mCRC metastasectomy patients was associated with shorter overall survival. [ABSTRACT FROM AUTHOR]

Background: The clinical course of hepatectomy in patients with preexisting bilioenteric anastomosis (BEA) is poorly understood. The aim of this study was to evaluate the potential influence of preexisting BEA on organ/space surgical site infection (SSI) after hepatectomy. Methods: We analyzed consecutive hepatectomies performed between March 2005 and January 2015. Patients' background, operative results, and complications were compared between hepatectomies with and without preexisting BEA. Results: Twenty-two hepatectomies with preexisting BEA were identified among 1745 hepatectomies. The rate of organ/space SSI was much higher in hepatectomies with preexisting BEA than in those without preexisting BEA (40.9 vs. 6.4 %, P < 0.001). Multivariate analyses identified four variables as independent factors associated with organ/space SSI: liver-directed chemotherapy [odds ratio 5.06 (95 % confidence interval 2.29-10.54), P < 0.001], operative time ≥ 300 min [2.40 (1.30-4.54), P = 0.006], estimated blood loss ≥ 500 ml [2.34 (1.26-4.31), P < 0.001], and preexisting BEA [12.08 (4.54-31.32), P < 0.001]. A higher rate of organisms from intestinal flora was detected in organ/space SSI after hepatectomies with preexisting BEA (77.8 vs. 21.3 % without BEA, P = 0.002). Analysis of hepatectomies with preexisting BEA identified selection of antibiotics for prophylaxis as the sole risk factor for organ/space SSI ( P = 0.049 for cefazolin versus other antibiotics targeting intestinal flora). Conclusions: Preexisting BEA is an independent risk factor for the development of organ/space SSI after hepatectomy. Antibiotics targeting intestinal flora are strongly recommended for prophylaxis of infectious complications. [ABSTRACT FROM AUTHOR]

Objective Earlier fieldwork in rural areas of Hainan Island, China, demonstrated that during the course of economic development increasing differences had emerged in lifestyles within communities. It is possible that these variations might have stratified residents into subpopulations with different health attributes. This study examined the association between C-reactive protein (CRP) concentration, a biomarker of future cardiovascular events, and personal lifestyle parameters and the degree of community-level economic development among rural communities. Methods A cross-sectional field survey was undertaken in 19 rural communities in Hainan. Convenience sampling was used to recruit 1,744 participants. Dried blood spot samples were collected to measure high-sensitivity CRP concentration. Sex-stratified multilevel regression analyses were conducted to identify factors associated with CRP concentration among the participants. Results While CRP concentration was negatively associated with being married and (more) education among men, for women CRP concentration was associated with the frequency of poultry consumption ( P = 0.014) and the experience of migratory work in the previous year ( P = 0.009). In addition, for females, living in communities with a greater degree of inequality, as indexed by the Gini coefficient, was also associated with increased CRP concentration ( P = 0.003). Conclusion Given that CRP concentration is a marker of future CVD risk, this study suggests that within these previously homogenous rural communities, economic development might have stratified people into population subgroups with a different CVD risk. Am. J. Hum. Biol. 28:186-196, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing ('combination skin care') may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo-ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4-week clinical trial with 29 post-adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non-hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be 'useful' or 'slightly useful'. Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post-adolescent Japanese women with sensitive skin. [ABSTRACT FROM AUTHOR]

ABSTRACT Life history theory predicts a trade-off between immunostimulation and growth. Using a cross-sectional study design, this study aims to test the hypothesis that C-reactive protein (CRP) is negatively associated with height-for-age z-scores (HAZ scores) and BMI-for-age z-scores (BAZ scores) among 6- to 19-year olds ( N = 426) residing in five Nepalese communities. Dried blood spot (DBS) samples were collected and assayed for CRP using an in-house enzyme immunoassay (EIA). Sex- and age-group-specific CRP quartiles were used to examine its association with growth in linear mixed-effects (LME) models. A significant difference was found in the proportion of elevated CRP (>2 mg/L, equivalent to ∼3.2 mg/L serum CRP) between 13- and 19-year-old boys (12%) and girls (4%). Concentrations of CRP were positively associated with HAZ score among adolescent (13-19 years) boys, which may indicate that individuals with greater energy resources have better growth and a better response to infections, thus eliminating the expected trade-off between body maintenance (immunostimulation) and growth. Adolescent boys with low BAZ and HAZ scores had low CRP values, suggesting that those who do not have enough energy for growth cannot increase their CRP level even when infected with pathogens. Among adolescent girls a positive association was observed between CRP and BAZ scores suggesting the possible effects of chronic low-grade inflammation due to body fat rather than infection. The association between CRP and growth was less evident among children (6-12 years) compared with adolescents, indicating that the elevated energy requirement needed for the adolescent growth spurt and puberty may play some role. Am J Phys Anthropol 154:42-51, 2014. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective Epstein-Barr virus (EBV) antibody titer has recently been used as a biomarker of psychological stress. This is the first study to investigate the association between EBV antibody titer and perceived quality of life (QOL) in Hainan Island, China. Methods Participants from two regions of Hainan Island, recruited into a larger study investigating the health impact of rapid economic development among rural residents, were stratified by age, sex, and region; 15 people were randomly selected from each of the 16 subgroups, to give a total sample size of 240. EBV antibody titer in dried blood spot samples was measured by enzyme-linked immunosorbent assay. The abbreviated version of the World Health Organization's Quality of Life questionnaire was used to gather information on six categories of QOL. Multiple linear regression analysis was used to examine the relationship between EBV antibody titer and QOL. Results After adjusting for the effects of age, sex, region and C-reactive protein concentration, EBV antibody titer was negatively associated with the physical ( P = 0.044) and psychological QOL domains ( P = 0.039). Conclusion This study suggests that among individuals living in an environment in the initial stages of economic development EBV antibody titer, a biomarker of psychological stress, is not only associated with the psychological aspects of QOL but is also linked to physical problems. Am. J. Hum. Biol. 26:51-55, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective Little is known about inter-individual variation in psychological stress in modernizing rural populations in developing countries. The objective of this study was to investigate the association between Epstein-Barr virus (EBV) antibody titer, a biomarker of psychological stress, and lifestyle parameters in rural communities in Hainan Island, China. Methods EBV antibody titer was measured in dried blood spot (DBS) samples collected from 240 adults living in rural communities in Hainan Island. Measures of two major lifestyle changes in rural areas of Hainan Island, i.e., diet and commercial goods possession, were examined by using information on the weekly frequency of pork consumption and monthly mobile phone fees. Both parameters were standardized to create two composite scores: a total affluence index (TAI-the sum of these scores), and an investment tendency index (ITI-the difference between them). Least-squares regression analysis was used to investigate the association between EBV antibody titer and these lifestyle parameters. Results A positive association was found between the frequency f pork consumption and EBV antibody titer ( P = 0.040), whereas a negative association was found between mobile phone fees and EBV antibody titer ( P = 0.028). A negative association was also observed between ITI and EBV antibody titer ( P = 0.002) after adjusting for the effect of TAI. Conclusion Psychological stress among local residents was linked to the type of lifestyle changes they had experienced, where the adoption of a more market-oriented lifestyle, irrespective of current affluence, was associated with less psychological stress. Am. J. Hum. Biol. 26:36-42, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Association between living with others and depressive symptoms in Japanese hospital workers during the COVID-19 pandemic While accumulating evidence suggests that living alone exacerbates depressive symptoms,6 research on this issue among health-care workers during the COVID-19 pandemic is scarce. This Letter presents the findings of a cross-sectional study on the association between living with others and depressive symptoms among 1228 workers, aged 21-73 years, from a large hospital and its affiliated institute in Tokyo, 66.8% of whom had engaged in some sort of COVID-19-related work. [Extracted from the article]

Background: Although portal vein embolization (PVE) has been applied for surgical resection of colorectal liver metastases (CLM), the clinical usefulness of liver surgery following PVE for CLM remains unknown. Methods: A total of 115 patients were evaluated retrospectively. Among them, 49 underwent one-stage hepatectomy following PVE (PVE group). The remaining 66 patients underwent at least hemihepatectomy without PVE (non-PVE group). This analysis compared the short- and long-term outcomes between the PVE and non-PVE groups. Results: There were no deaths in either group. Using the Clavien-Dindo classification, the rates of postoperative morbidity ≥ grade 1 were 34.7 % in the PVE group and 25.0 % in the non-PVE group ( p = 0.26). The 3-year overall survival rates were 54.6 and 64.5 % in the PVE and non-PVE groups, respectively ( p = 0.89). The multivariate analysis the variable performance/nonperformance of PVE was not detected as an independent predictor of poor survival. Conclusions: Our one-stage hepatectomy policy of using PVE provides acceptable morbidity and favorable long-term outcomes. [ABSTRACT FROM AUTHOR]

The effects of Sox21 gene deletion on hair lipids have been studied. For the cuticle-specific bound lipid 18-methyl eicosanoic acid (18- MEA), which was found to predominantly exist as the free form in Sox21−/− hair, total levels and distribution were unexpectedly unchanged. This indicates that while the biosynthesis of 18- MEA is unaffected, its covalent attachment to the cuticle surface is disrupted by loss of keratin-associated protein binding partners. Although the class compositions differed, the total ceramide ( CER) levels were found to be comparable between Sox21+/+ and Sox21−/− hairs. Deletion of the gene was also found to increase cholesterol sulphate ( CS) levels. The biosynthesis process might be associated with cuticle keratinocyte maturation, because both CS and CERs are known bioactives in keratinocyte differentiation. [ABSTRACT FROM AUTHOR]

In the original article, the captions for Figs. 2 and 3 were erroneously interchanged. The original article has been corrected. [ABSTRACT FROM AUTHOR]

Objectives: While adverse childhood experiences (ACEs) have been shown to be associated with adulthood obesity, less is known about their association with underweight. We examined the associations between parental absence (i.e., a major component of ACEs) and both underweight and excess weight among middle-aged rural community dwellers in Vietnam, where experiences of parental absence was not uncommon during and after the Vietnam War (1955-1975)., Methods: Data came from 3000 middle-aged adults who participated in the baseline survey of Khánh Hòa Cardiovascular Study. Parental absence was defined as parental absence due to death, divorce, or out-migration. Using information on the timing of such events, we categorized participants into those who experienced parental absence before the age of 3, between the ages of 3 and 15, and those without such experiences. BMI was calculated based on measured height and weight (kg/m 2 ) and categorized into three groups: underweight <18.5; normal 18.5-24.9; excess weight ≥ 25. Multinomial logistic regression was then used to investigate the association between parental absence and adult weight status., Results: Parental absence that occurred before the age of 3 was marginally significantly associated with underweight (relative risk ratio [RRR] = 1.44, 95% confidence interval [CI] 0.95, 2.20) but not with overweight/obesity. Parental divorce was associated with overweight/obesity (RRR = 2.48, 95% CI 1.28, 4.81), but not parental absence due to migratory work., Conclusions: While previous studies in Western settings focused almost exclusively on the risk of obesity in relation to exposure to ACEs, our findings point to the potential importance of considering the risk of underweight in low- and middle-income countries., (© 2022 Wiley Periodicals LLC.)

Aim: To evaluate the surgical outcomes and midterm results of patients under 50 years old with acute type A aortic dissection (AAAD)., Methods: The study population included 51 patients who underwent AAAD repair between 2003 and 2016. Of these 51 patients, 46 (90.1%) were males and 14 (27.5%) had connective tissue disorders. Twenty-five patients (49.0%) had a body mass index >25.0 kg/m 2 and two patients were pregnant. Total arch replacement was performed in 39 patients (76.5%) and hemiarch replacement in 12 patients (23.5%). Twenty patients (39.2%) underwent concomitant surgeries, including root replacement, lower limb bypass, or coronary artery bypass grafting., Results: There was one in-hospital death (2.0%). Median follow-up was 55 months and overall survival rates were 87.7% at 5 years and 81.9% at 10 years. Rates of freedom from reoperation were 60.2% at 5 years and 50.2% at 10 years. Eighteen patients (35.3%) required reoperation, due to progressive aortic dilatation, new dissection in the aortic root, infection, and hemolysis. A patent false lumen represented a significant risk factor for reoperation (P < 0.001). Four patients (7.8%) underwent reoperation within 3 months after the initial repair., Conclusions: Surgical outcomes after AAAD repair for young patients were satisfactory. A patent false lumen significantly increased the need for reoperation (P = 0.002), but did not affect long-term survival. Close follow-up is mandatory after the initial repair in young patients following AAAD., (© 2018 Wiley Periodicals, Inc.)