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Background: Breastfeeding offers significant health benefits, but its practice and success can vary. While research on induced lactation in cisgender women has been documented, there is limited research on lactation induction in transgender women. Case presentation: A 50-year-old transgender woman undergoing hormone therapy and living with a pregnant partner sought to co-feed using induced lactation. After approval by the hospital ethics committee, a regimen of estradiol, progesterone, and domperidone was initiated, accompanied by nipple stimulation. Lactation was successfully induced and maintained, with milk composition analysis indicating high levels of protein and other key nutrients. This case, the seventh reported, highlights the complexity of lactation induction in transgender women, considering factors such as age, obesity, and insulin resistance. The nutrient profile of the milk suggests its suitability for infant feeding, despite some differences from typical human milk. Conclusions: Induced lactation is feasible in transgender women, expanding the understanding of non-puerperal lactation and its potential in diverse family structures. Further research is warranted to optimize lactation induction protocols in transgender women. [ABSTRACT FROM AUTHOR]

Sugarcane (Saccharum spp. hybrids) and its processed products have supported local industries such as those in the Nansei Islands, Japan. To improve the sugarcane quality and productivity, breeders select better clones by evaluating agronomic characteristics, such as commercially recoverable sugar and cane yield. However, other constituents in sugarcane remain largely unutilized in sugarcane breeding programs. This study aims to establish a data-driven approach to analyze agronomic characteristics from breeding programs. This approach also determines a correlation between agronomic characteristics and free amino acid composition to make breeding programs more efficient. Sugarcane was sampled in clones in the later stage of breeding selection and cultivars from experimental fields on Tanegashima Island. Principal component analysis and hierarchical cluster analysis using agronomic characteristics revealed the diversity and variability of each sample, and the data-driven approach classified cultivars and clones into three groups based on yield type. A comparison of free amino acid constituents between these groups revealed significant differences in amino acids such as asparagine and glutamine. This approach dealing with a large volume of data on agronomic characteristics will be useful for assessing the characteristics of potential clones under selection and accelerating breeding programs. [ABSTRACT FROM AUTHOR]

An archaeological sample of organic residue in a noble wooden vessel excavated from the tomb of Japanese Samurai named Tsunamune Date who was buried in 1711 was analyzed using Fourier-transform infrared spectroscopy (FT-IR) and gas chromatography-mass spectrometry. The lipid extracts of plant nuts and vegetable oils were also measured as references to investigate source materials of the organic residue. The FT-IR spectrum suggests the occurrence of fatty acids in the sample, and the profile was similar to the result of IR analysis at the excavation event in 1983. This implies that the major components in the organic residue have not deteriorated, even though it has been stored at room temperature nearly 40 years. The fatty acids and their degradation products, dicarboxylic acids, were detected in the organic residue, implying that plant oil may be included in the sample. In addition, three diterpenes, pimaric acid, dehydroabietic acid, and abietic acid, and another four compounds derived from rosin were clearly identified. This result suggests that the sample analyzed here may be a mixture of lipid extracts of wax and lacquer tree nuts and rosin. Based on the ancient documents in the Edo periods (seventeenth-nineteenth centuries) in Japan, it was surmised that Tsunamune Date used the organic residues as either medical ointment or hairstyling foam in his life. [ABSTRACT FROM AUTHOR]

Purpose: Patients with a thymic epithelial tumor (TET), comprising thymoma, thymic carcinoma (TC), and thymic neuroendocrine neoplasm (TNEN), are rarely encountered. The present study was conducted to determine the recent outcomes of surgical treatment for TET in Japan and clarify the significance of prognostic factors by analyzing a nationwide database created by the Japanese Association for Research on the Thymus (JART). Methods: The JART database includes records of 2471 thymoma, 285 TC, and 56 TNEN cases surgically treated between 1991 and 2010. At the time of the final follow-up examination, 439 patients had died, with tumor the cause of death in 188. The disease-specific survival was examined using the Kaplan–Meier method, with Cox's proportional hazards model utilized to determine independent prognostic factors. Results: The 10-year survival rate according to TNM-based Stage I, II, IIIA, IIIB, IVA, and IVB classification was 98.7%, 76.8%, 85.0%, 68.9%, 66.2%, and 59.8%, respectively. The T factor, M factor, and tumor size were independent prognostic factors in both thymoma and thymic carcinoma cases, while the N factor had tendency to be a prognostic factor in thymoma but not in thymic carcinoma cases. The WHO histological type was an independent factor in thymoma cases. Conclusion: The significance of pathology and TNM classification as prognostic factors was confirmed. [ABSTRACT FROM AUTHOR]

Purpose: To clarify the impact of donor and recipient characteristics on the survival of recipients before and after lung transplantation in the Japanese population. Methods: Patients' data were collected for retrospective analysis from all authorized lung transplant centers in Japan. We included 1963 patients listed for lung transplantation by the end of December 2021, comprised of 658 deceased-donor and 270 living-donor lung transplants. Results: Primary disease had a significant impact on the mortality of patients waiting for transplantation. The indications for transplant significantly affected the post-transplant survival rate of deceased-donor lung transplant recipients. The recipient's age also significantly affected the post-transplant survival rate of the deceased-donor and living-donor lung transplant recipients. The recipients of grafts transplanted from donors aged 61 years or older showed a worse post-transplant survival rate (≧60 years old). The survival rate for the combination of a female donor to a male recipient among the deceased-donor lung transplant recipients was the worst among the four combinations. Conclusion: The donor and recipient characteristics significantly impacted the survival of recipients after lung transplantation. The underlying mechanism of the negative impact of the gender mismatch of female donor to male recipient on post-transplant survival needs to be investigated further. [ABSTRACT FROM AUTHOR]

Objective: Simulation training has focused on education and practical training. However, the adoption rate of neurointerventional simulation training in Japan is unknown. Therefore, we sent a questionnaire survey form to consulting specialists from the Japanese Society for Neuroendovascular Therapy (JSNET) to clarify the actual simulation training situation and compare the differences between university hospitals and general hospitals in Japan. Methods: The questionnaire survey was conducted in 243 neurosurgical training facilities that had JSNET consulting specialists between May 31, 2021 and July 31, 2021. The questionnaire survey forms were distributed by Google Forms. Results: A total of 162 facilities responded to the survey (response rate: 66.7%; 35.2% from university hospitals and 64.8% from general hospitals). The adoption rate for simulation training was 53.7%, and it was significantly higher in the university hospitals than in the general hospitals (64.9% vs. 47.6%, p = 0.035). On the simulation effectiveness survey, more than 80% of respondents answered that the simulation training was a useful tool for upskill training. The open-ended question on interventional simulation training showed that there are limiting factors such as financial constraints. Additionally, respondents expressed a desire for a standard neurointerventional simulation training and education program. Conclusion: The adoption rate for simulation training was 53.7% in the training facilities of JSNET, and it was higher in the university hospitals than in the general hospitals. Most of the respondents answered that simulation training is an effective tool to improve neurointerventional skills. They also requested the establishment of simulation training programs and simulation tools. [ABSTRACT FROM AUTHOR]

Purpose: Subsequent to the publication of "Guidelines for cadaver dissection in education and research of clinical medicine" in 2012, cadaver surgical training (CST) was implemented in various surgical fields across Japan. This article summarizes the recent progress made in the implementation of CST using donated cadavers, and its associated research, focusing on the field of surgery, and discusses its future direction. Methods: All reports from 2012 to 2021 registered with the CST Promotion Committee of the Japan Surgical Society were analyzed. There were 292 (24.9%) programs in the field of surgery, including acute care surgery, out of a total of 1173 programs overall. Data were classified by the purpose of implementations and fields of surgery, with subclassification by organ, costs and participation fees. Results: CST and its research were introduced in 27 (33.3%) of a total 81 universities. The total number of participants was 5564 and the major (80%) purpose of the program was to advance surgical techniques. When classified by objectives, 65, 59 and 11% were for mastering operations for malignant disease, minimally invasive surgery, and transplantation surgery, respectively. Conclusion: CST in the field of surgery is increasing progressively in Japan, but still with disproportionate dissemination. Further efforts are needed to achieve full adoption. [ABSTRACT FROM AUTHOR]

This study proposed a probabilistic generic transformation model between two rock mass properties, specific fracture energy, Ev, and P-wave velocity, VP. To build the transformation model, 12 pairwise data sets of Ev and VP were collected from six different construction sites involving construction of mountain tunnels in Japan. This database is labeled as "RockMass/2/350". A probabilistic transformation model was built based on a bivariate standard normal distribution with these 350 data points. The model is generic, because it is based on a variety of sites. The performance of the constructed transformation model was evaluated through a cross-validation. It was found that 98.2% of the validation data fell within the computed 95% confidence interval of the model estimation, and this result provides a preliminary validation of the probabilistic transformation model. Unlike existing deterministic transformation models for estimating VP from Ev, the proposed model can explicitly evaluate the transformation uncertainty with a quantitative metric such as a percentile. For practical application, a 3D model of the spatial distribution for Young's modulus, E, was visualized based on the proposed transformation model. Since the proposed model is probabilistic, it can provide the spatial distribution for percentiles of E values. The constructed 3D model presented in this paper can be directly used as an input data for finite element or finite difference analysis, and probabilistic evaluation of excavation simulation is feasible based on the proposed probabilistic model. The quantitative information on such uncertainty can be useful in decision-making for tunnel constructions, such as selection of a cautious characteristic value. [ABSTRACT FROM AUTHOR]

Background: Programmed death-ligand 1 (PD-L1) inhibitor plus platinum–etoposide chemotherapy is used as a first-line treatment for extensive-stage small cell lung cancer (ES-SCLC), regardless of age. Objective: We examined the role of the Geriatric 8 (G8) screening tool for evaluating treatment outcomes in patients with ES-SCLC treated with PD-L1 inhibitor plus platinum–etoposide chemotherapy as first-line therapy. Patients and Methods: Between September 2019 and October 2021, we prospectively evaluated patients with ES-SCLC treated with immunochemotherapy at ten institutions in Japan. The G8 score was assessed before treatment initiation. Results: We evaluated 44 patients with ES-SCLC. Patients with G8 score > 11 had longer overall survival (OS) than those with G8 score ≤ 11 (not reached versus 8.3 months; log-rank test, p = 0.005). In univariate and multivariate analyses, G8 score > 11 [hazard ratio (HR) 0.34; 95% confidence interval (CI) 0.15–0.75; p = 0.008 and HR 0.34; 95% CI 0.14–0.82; p = 0.02, respectively) and performance status (PS) of 2 (HR 5.42; 95% CI 2.08–14.2; p < 0.001 and HR 6.94; 95% CI 2.25–21.4; p < 0.001, respectively) were independent prognostic factors for OS. Among patients with good PS (0 or 1), the OS in patients with G8 score > 11 was significantly longer than that in patients with G8 score ≤ 11 (not reached versus 12.3 months; log-rank test, p = 0.02). Conclusions: G8 score evaluation before treatment initiation was useful as a prognostic factor for ES-SCLC patients who received PD-L1 inhibitors and platinum–etoposide chemotherapy, even with good PS. [ABSTRACT FROM AUTHOR]

Background: The radiofrequency identification (RFID) lung marking system is a novel technique using near-field radio-communication technology. The purpose of this study was to investigate the utility and feasibility of this system in the resection of small pulmonary nodules. Methods: We retrospectively reviewed clinical records of 182 patients who underwent sublobar resection with the RFID marking system between March 2020 and November 2021 in six tertial hospitals in Japan. Target markings were bronchoscopically made within 3 days before surgery. The contribution of the procedure to the surgery and safety was evaluated. Results: Target nodule average diameter and depth from the lung surface were 10.9 ± 5.4 mm and 14.6 ± 9.9 mm, respectively. Radiologically, one third of nodules appeared as pure ground-glass nodules (GGNs) on CT. The average distance from target nodule to RFID tag was 8.9 ± 7.1 mm. All surgical procedures were completed by video-assisted thoracoscopic surgery. Planned resection was achieved in all cases without any complications. The surgeons evaluated this system as helpful in 93% (necessary: 67%, useful; 26%) of cases. Nodule radiological features (p < 0.001) and type of surgery (p = 0.0013) were associated with the degree of contribution. In most cases, identification of the RFID tag was required within 1 min despite adhesion (p = 0.27). Conclusion: The RFID lung marking system was found to be safe and effective during successful sublobar resection. Patients with pure GGNs are the best candidates for the system. [ABSTRACT FROM AUTHOR]

Simple Summary: To optimize postoperative surveillance of lung cancer patients, we investigated the hazard function of tumor recurrence in patients with completely resected lung cancer. Using the records of the 2010 Japanese Joint Committee of Lung Cancer Registry, the risk of postoperative recurrence was analyzed using a cause-specific hazard function in patients who underwent lobectomy to completely resect pathological stage I–III lung cancer. The hazard function for recurrence exhibited a peak at approximately 9 months after surgery, followed by a tapered plateau-like tail extending to 60 months. The peak risk for intrathoracic recurrence was approximately two-fold higher compared with that of extrathoracic recurrence. When considered together with the results of the subgroup analysis, the characteristics of the postoperative tumor recurrence hazard in a large cohort of lung cancer patients may be useful for improving stage-related management of postoperative surveillance. To optimize postoperative surveillance of lung cancer patients, we investigated the hazard function of tumor recurrence in patients with completely resected lung cancer. We analyzed the records of 12,897 patients in the 2010 Japanese Joint Committee of Lung Cancer Registry who underwent lobectomy to completely resect pathological stage I–III lung cancer. The risk of postoperative recurrence was determined using a cause-specific hazard function. The hazard function for recurrence exhibited a peak at approximately 9 months after surgery, followed by a tapered plateau-like tail extending to 60 months. The peak risk for intrathoracic recurrence was approximately two-fold higher compared with that of extrathoracic recurrence. Subgroup analysis showed that patients with stage IIIA adenocarcinoma had a continuously higher risk of recurrence compared with patients with earlier-stage disease. However, the risk of recurrence in patients with squamous cell carcinoma was not significantly different compared with that more than 24 months after surgery, regardless of pathological stage. In conclusion, the characteristics of postoperative tumor recurrence hazard in a large cohort of lung cancer patients may be useful for determining the time after surgery at which patients are at the highest risk of tumor recurrence. This information may improve stage-related management of postoperative surveillance. [ABSTRACT FROM AUTHOR]

Invasive non-native predators negatively affect native species; however, some native species can survive the predation pressures of invasive species by using pre-existing antipredator strategies or evolving defenses against invasive predators. The American bullfrog Lithobates catesbeianus (Anura: Ranidae) has been intentionally introduced to many countries and regions, and has impacted native animals through direct predation. Bombardier beetles (Coleoptera: Carabidae: Brachininae: Brachinini) discharge chemicals at a temperature of approximately 100 °C from the tip of the abdomen when they are attacked by predators. This "bombing" can successfully repel predators. However, adults of a native bombardier beetle Pheropsophus (Stenaptinus) occipitalis jessoensis have been reportedly found in the gut contents of the introduced bullfrog L. catesbeianus in Japan. These records suggest that the invasive bullfrog L. catesbeianus attacks the native bombardier beetle P. occipitalis jessoensis under field conditions in Japan; however, the effectiveness of the bombing defense against invasive bullfrogs is unclear. To test the effectiveness of the bombing defense against bullfrogs, we investigated the behavioral responses of L. catesbeianus juveniles to P. occipitalis jessoensis adults under laboratory conditions. Contrary to previous gut content results, almost all the bullfrogs (96.3%) rejected bombardier beetles before swallowing them; 88.9% rejected the beetles after being bombed, and 7.4% stopped attacking the beetles before being bombed. Only 3.7% successfully swallowed and digested the beetle. All of the beetles collected from non-bullfrog-invaded sites could deter bullfrogs, suggesting that the pre-existing defenses of bombardier beetles played an essential role in repelling bullfrogs. When treated beetles that were unable to discharge hot chemicals were provided, 77.8% of bullfrogs successfully swallowed and digested the treated beetles. These results indicate that bombing is important for the successful defense of P. occipitalis jessoensis against invasive bullfrogs. Although invasive bullfrogs have reportedly impacted native insect species, P. occipitalis jessoensis has an existing defense mechanism strong enough to repel the invasive predators. [ABSTRACT FROM AUTHOR]

The pelagic shrimp Lucensosergia lucens is a commercially important species in Japan, predominantly harvested in Suruga Bay. It has been suggested that a marked decrease in the wild population over recent years is associated with an increased concentration of suspended particles. We tested the hypothesis that suspended inorganic particles (kaolinite) negatively affect the hatching ratio of fertilized eggs, and the survival, growth, and metamorphosis of nauplius and elaphocaris larvae. The relative hatching ratio of eggs decreased from 100 to 57.7% at 139 mg L−1 of kaolinite particles. Similarly, the relative survival ratio of nauplius larvae progressively decreased from 100% in filtered seawater to 73.6% after 72 h of exposure to 139 mg L−1 of kaolinite particles. Consequently, the survival ratio of elaphocaris larvae was greatly reduced at high particle concentrations. Exponential growth in the standard lengths of elaphocaris larvae occurred at particle concentrations < 6.9 mg L−1, but growth was inhibited at kaolinite concentrations > 20 mg L−1. [ABSTRACT FROM AUTHOR]

The article reports that Although better diet quality is inversely related to the risk of geriatric disorders, the association of adherence to dietary guidelines with oral health-related quality of life (OHRQoL) is unclear. We aimed to investigate this association in older Japanese adults. This cross-sectional study included 7984 Japanese participants aged ≥ 65 years from the population-based Kyoto-Kameoka study.

Background: Neuroendocrine neoplasm (NEN) is a comparatively rare tumor that has been considered indolent. Due to these characteristics, detailed epidemiological data have not been analyzed in Japan. To elucidate the present status of NEN diagnosis and treatment in Japan, we started a registry cohort study in January 2015. Methods: Patients pathologically diagnosed with NENs of the pancreas, gastrointestinal tract, lungs, bronchi, or thymus after January 2012 were enrolled in this registry after the date of ethics review committee approval in each hospital or institute. Follow-up was continued for enrolled patients. Results: During 5 years of enrollment between January 2015 and December 2019, a total of 1526 participants from 63 departments were enrolled in this registry (mean, 305.2 participants/year), covering approximately 5.8% of the annual incidence of NENs in Japan. For pancreatic NEN, 41.9% of patients had metastasis and the dominant metastatic site was the liver, at twice the rate of lymph node metastasis in the current registry. In contrast, the frequency of lymph node metastasis from gastrointestinal (GI)-NEN was similar to that of the liver. The distribution of WHO 2019-based grades varied according to the primary site. Low-to-intermediate grade (G1–G2) was dominant for duodenal, jejunal/ileal, rectal, and pancreatic NENs, whereas high grade (G3 or NEC) was dominant for esophageal, stomach, and colon NENs. For PanNENs, G3 and NEC accounted only for 1.6% and 2.9%, respectively. Conclusions: These cohort data provide crucial information for clinical research to clarify the characteristics of NENs in Japan. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to compare the outcome of lung transplantation (LT) for idiopathic pleuroparenchymal fibroelastosis (IPPFE) with that of LT for idiopathic pulmonary fibrosis (IPF). Methods: We reviewed, retrospectively, all adult patients who underwent LT for IPPFE or IPF in Japan between 1998 and 2018. Results: There were 100 patients eligible for this study (31 with IPPFE and 69 with IPF). Patients with IPPFE tended to have a significantly lower body mass index (BMI) than those with IPF (median, 16.7 vs. 22.6 kg/m2, respectively; P < 0.01). However, Kaplan–Meier survival curves showed no significant difference in overall survival between the groups. The BMI did not increase in patients with IPPFE, even 1 year after LT (pretransplant, 16.5 ± 3.2 kg/m2 vs. 1 year post-transplant, 15.6 ± 2.5 kg/m2; P = 0.08). The percent predicted forced vital capacity (%FVC) 1 year after LT was significantly lower in the IPPFE group than in the IPF group (48.4% ± 19.5% vs. 68.6% ± 15.5%, respectively; P < 0.01). Conclusions: Despite extrapulmonary problems such as a flat chest, low BMI, and associated restrictive impairment persisting in patients with IPPFE, patient survival after LT for IPPFE or IPF was equivalent. [ABSTRACT FROM AUTHOR]

Background: Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation.Methods: We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George's Respiratory Questionnaire (SGRQ).Results: Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease.Conclusions: Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients' background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality. [ABSTRACT FROM AUTHOR]

Purpose: As the number of cases of early lung cancer in Japan grows, an analysis of the present status of surgical treatments for clinical stage IA lung cancer using a nationwide database with web-based data entry is warranted. Methods: The operative and perioperative data from 47,921 patients who underwent surgery for clinical stage IA lung cancer in 2014 and 2015 were obtained from the National Clinical Database (NCD) of Japan. Clinicopathological characteristics, surgical procedure, mortality, and morbidity were analyzed, and thoracotomy and video-assisted thoracic surgery (VATS) were compared. Results: The patients comprised 27,208 men (56.8%) and 20,713 women (43.2%); mean age, 69.3 years. Lobectomy was performed in 64.8%, segmentectomy in 15.2%, and wedge resection in 19.8%. The surgical procedures were thoracotomy in 12,194 patients (25.4%) and a minimally invasive approach (MIA) in 35,727 patients (74.6%). MIA was divided into VATS + mini-thoracotomy (n = 13,422, 28.0%) and complete VATS (n = 22,305, 46.5%). The overall postoperative mortality rate was 0.4%, being significantly lower in the MIA group than in the thoracotomy group (0.3% vs 0.8%, P < 0.001). Conclusions: Our analysis of data from the NCD indicates that MIA has become the new standard treatment for clinical stage IA lung cancer. [ABSTRACT FROM AUTHOR]

Purpose: The anatomical site of resected lobes may influence postoperative cerebral infarction. The objective of the current study was to determine if left upper pulmonary lobectomy is a risk factor for postoperative cerebral infarction. Methods: This was a retrospective case–control study in patients undergoing pulmonary lobectomy from 2004 to 2013 in Japan. We retrospectively identified 610 patients from 153 institutions who had developed postoperative cerebral infarction following pulmonary lobectomy. The control group consisted of 773 patients who underwent lobectomy without cerebral infarction during a randomly selected single month in 2009 at the same institutions. Results: Factors associated with cerebral infarction were age [10-year intervals, odds ratio (OR): 1.46; 95% confidence interval (CI): 1.23–1.73; p < 0.001], male sex (OR 1.92; 95% CI 1.29–2.86; p = 0.001), presence of comorbidities (OR 1.82; 95% CI 1.35–2.44; p < 0.001), perioperative anti-platelet or anti-coagulant drug use (OR 1.71; 95% CI 1.20–2.45; p = 0.003), and lobectomy. Subgroup analyses revealed that cerebral infarction was strongly associated with left upper lobectomy. Conclusions: Our findings suggest that left upper lobectomy is associated with a higher risk of cerebral infarction than other types of lobectomy, particularly in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: Splenectomy for dissecting splenic hilar lymph nodes (#10) should be avoided for most gastric cancer, considering the high morbidity and lack of any survival benefit, but it is often selected for scirrhous gastric cancer because this type frequently invades the whole stomach and lymph nodes. Splenectomy is necessary for dissecting #10; however, the survival benefit of dissecting #10 is unclear. Methods: Patients who had scirrhous gastric cancer and underwent D2 total gastrectomy with splenectomy at National Cancer Center Hospital, Japan, between 2000 and 2011 were retrospectively analyzed. The therapeutic value index was calculated by multiplying the metastatic rate of each nodal station and the 5-year survival of patients who had metastasis to each node. Results: In total, 137 patients were eligible for the present study. The most frequent metastatic node was #3(58%), followed by #4d(46%), #1(35%), #4sb(23%), #6(22%), #7(21%), #4sa(18%), #10(15%), #2(14%), #11p(14%), #11d(13%), #9(13%), and #8a(11%). These lymph nodes had a metastatic rate of more than 10%. The node station with the highest index was #3(18.9), followed by #4d(14.1), #1(10.8), #4sa(6.11), #4sb(6.06), #10(5.09), #7(4.39), #11d(4.36), #11p(4.06), #2(2.93), #8a(2.18), and #9(1.45). The index of #10 exceeded that of #2, #7, #8a, and #9, which are the key nodes dissected in D2. Conclusion: The metastatic rate of the splenic hilar lymph nodes was relatively high, and the therapeutic index was the sixth highest among the 15 regional lymph nodes included in D2 dissection. Splenectomy for dissecting splenic hilar lymph nodes would be justified for scirrhous gastric cancer. [ABSTRACT FROM AUTHOR]

Objective: We sought to examine whether the effect of treatment modality and drugs for cerebral vasospasm on clinical outcomes differs between elderly and non-elderly subarachnoid hemorrhage (SAH) patients in Japan. Methods: We analyzed the J-ASPECT Study Diagnosis Procedure Combination database (n = 17,343) that underwent clipping or coiling between 2010 and 2014 in 579 hospitals. We stratified patients into two groups according to their age (elderly [≥75 years old], n = 3,885; non-elderly, n = 13,458). We analyzed the effect of treatment modality and anti-vasospasm agents (fasudil hydrochloride, ozagrel sodium, cilostazol, statin, eicosapentaenoic acid [EPA], and edaravone) on in-hospital poor outcomes (mRS 3–6 at discharge) and mortality using multivariable analysis. Results: The elderly patients were more likely to be female, have impaired levels of consciousness and comorbidity, and less likely to be treated with clipping and anti-vasospasm agents, except for ozagrel sodium and statin. In-hospital mortality and poor outcomes were higher in the elderly (15.8% vs. 8.5%, 71.7% vs. 36.5%). Coiling was associated with higher mortality (odds ratio 1.43, 95% confidence interval 1.2–1.7) despite a lower proportion of poor outcomes (0.84, 0.75–0.94) in the non-elderly, in contrast to no effect on clinical outcomes in the elderly. A comparable effect of anti-vasospasm agents on mortality was observed between non-elderly and elderly for fasudil hydrochloride (non-elderly: 0.20, 0.17–0.24), statin (0.63, 0.50–0.79), ozagrel sodium (0.72, 0.60–0.86), and cilostazol (0.63, 0.51–0.77). Poor outcomes were inversely associated with fasudil hydrochloride (0.59, 0.51–0.68), statin (0.84, 0.75–0.94), and EPA (0.83, 0.72–0.94) use in the non-elderly. No effect of these agents on poor outcomes was observed in the elderly. Conclusions: In contrast to the non-elderly, no effect of treatment modality on clinical outcomes were observed in the elderly. A comparable effect of anti-vasospasm agents was observed on mortality, but not on functional outcomes, between the non-elderly and elderly. [ABSTRACT FROM AUTHOR]

In recent years, long work hours and overtime work have become a social problem in Japan. Therefore, attention is focused on improving the work style in Japan. In particular, there is a demand for improving the efficiency of desk work. In this paper, we aim to clarify the relationship between work and concentration, and the influence of interruptions on the concentration state and the number of working hours (work time) to realize appropriate time allocation in desk work. In the experiment, staff members of the Toyama prefectural office were recruited as subjects to obtain data on the work times and concentration state. We use a device called Spire to determine the concentration state. Spire can acquire respiration information. As a result, it was found to be necessary to continue work for 10 min or more in order to achieve high concentration and work efficiency. However, it was found that if concentration was not attained within 10 min from the start of work, it was necessary to interrupt the work. It was also found that interruption did not affect the work time or concentration state. [ABSTRACT FROM AUTHOR]

Background: Pulmonary arterial hypertension (PAH) is a severe lung disease with only few effective treatments available. Familial cases of PAH are usually recognized as an autosomal dominant disease, but incomplete penetrance of the disease makes it difficult to identify pathogenic variants in accordance with a Mendelian pattern of inheritance.Methods: To elucidate the complex genetic basis of PAH, we obtained whole exome- or genome-sequencing data of 17 subjects from 9 families with heritable PAH and applied gene-based association analysis with 9 index patients and 300 PAH-free controls.Results: A burden of rare variants in BMPR2 significantly contributed to the risk of the disease (p = 6.0 × 10-8). Eight of nine families carried four previously reported single nucleotide variants and four novel insertion/deletion variants in the gene. One of the novel variants was a large 6.5 kilobase-deletion. In the remaining one family, the patient carried a pathogenic variant in a member of potassium channels, KCNK3, which was the first replicative finding of channelopathy in an Asian population.Conclusions: The variety of rare pathogenic variants suggests that gene-based association analysis using genome-wide sequencing data from increased number of samples is essential to tracing the genetic heterogeneity and developing an appropriate panel for genetic testing. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Owing to the severe donor shortage in Japan, living-donor lobar lung transplantation (LDLLT) remains a valuable option. As only lobes are implanted in LDLLT, grafts may be too small, especially for adult recipients. To overcome this obstacle, we developed right-to-left inverted LDLLT. In this procedure, the right lower lobe, which is 25% bigger than the left lower lobe, is used as the left-side graft instead of the left lower lobe. This study aimed to investigate the characteristics and intermediate outcomes of right-to-left inverted LDLLT. METHODS Since the first right-to-left inverted LDLLT performed in 2014, 48 LDLLTs have been performed in our institution, of which 15 were right-to-left inverted LDLLTs. We reviewed their characteristics and intermediate outcomes. RESULTS The reasons for choosing an inverted procedure instead of the standard LDLLT were small-for-size graft in 11 cases and anatomical variation of donor vessels in 4 cases. The first patient underwent left single LDLLT using a right lower lobe graft, and the following 14 patients underwent bilateral LDLLT using 2 right lower lobe grafts. A native upper lobe-sparing procedure was additionally applied in 2 patients. No complications occurred in the bronchial and vascular anastomoses. No operative mortality occurred, and all the patients were discharged home after LDLLT. The 3-year survival was 92.3%, with a median follow-up time of 40 months. The donor postoperative course was uneventful, and all the donors returned to their regular routine postoperatively. CONCLUSION Right-to-left inverted LDLLT is a safe and useful option with encouraging intermediate outcome. [ABSTRACT FROM AUTHOR]

Background: The Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and 3 (JR-NET3) were nationwide surveys that evaluated clinical outcomes after neuroendovascular therapy in Japan. The aim of this study was to compare the prevalence and risk factors of complications of intracranial tumor embolization between JR-NET2 and JR-NET3. Methods: A total of 1018 and 1545 consecutive patients with intracranial tumors treated with embolization were enrolled in JR-NET2 and JR-NET3, respectively. The prevalence of complications in intracranial tumor embolization and related risk factors were compared between JR-NET2 and JR-NET3. Results: The prevalence of complications in JR-NET3 (3.69%) was significantly higher than that in JR-NET2 (1.48%) (p = 0.002). The multivariate analysis in JR-NET2 showed that embolization for tumors other than meningioma was the only significant risk factor for complication (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.13–12.10; p = 0.032), and that in JR-NET3 revealed that embolization for feeders other than external carotid artery (ECA) (OR, 3.56; 95% CI, 2.03–6.25; p < 0.001) and use of liquid materials (OR, 2.65; 95% CI, 1.50–4.68; p < 0.001) were significant risks for complications. The frequency of embolization for feeders other than ECA in JR-NET3 (15.3%) was significantly higher than that in JR-NET2 (9.2%) (p < 0.001). Also, there was a significant difference in the frequency of use of liquid materials between JR-NET2 (21.2%) and JR-NET3 (41.2%) (p < 0.001). Conclusions: Embolization for feeders other than ECA and use of liquid materials could increase the complication rate in intracranial tumor embolization. [ABSTRACT FROM AUTHOR]

Background: The Dietary Inflammatory Index (DII) is a comprehensive, literature-derived index for assessing the effect of dietary constituents on inflammatory biomarkers. Several studies have shown an association between DII score and mortality, but there are limited prospective studies in Asian populations.Objectives: The aim of this study was to investigate the association between DII score and risk of all-cause, total cardiovascular disease (CVD), stroke, coronary heart disease (CHD), total cancer, digestive cancer, and noncancer/non-CVD mortality in the Japanese population.Methods: A total of 58,782 Japanese participants aged 40-79 y who were enrolled in the Japan Collaborative Cohort Study during 1988-1990 were included in the analysis. DII scores were calculated based on a food-frequency questionnaire. HRs and 95% CIs for mortality according to DII quintiles were estimated using Cox proportional hazards models.Results: During the median follow-up period of 19.3 y, a total of 11,693 participants died. The multivariable HR for all-cause mortality for the highest compared with the lowest DII quintiles was 1.13 (95% CI: 1.05, 1.21). For CVD mortality, the highest multivariable HRs were 1.30 (95% CI: 1.13, 1.49), 1.29 (95% CI: 1.05, 1.59), and 1.30 (95% CI: 0.96, 1.76) for total CVD, stroke, and CHD, respectively. No significant associations were observed between DII and risk of total cancer, digestive cancer, and noncancer/non-CVD mortality.Conclusion: Our findings suggest that a higher DII was associated with an increased risk of all-cause and CVD mortality among Japanese adults. [ABSTRACT FROM AUTHOR]

Occurrence of sulfur spherules near subaerial fumaroles is relatively uncommon and their mineralogical characteristics and formation mechanisms are still incompletely understood. Yellow to greenish-gray solid sulfur spherules were observed near a fumarole that was formed in the fumarolic area (Owakudani) during the 2015 eruption of Hakone volcano, Japan. The yellow sulfur spherules (up to 1 mm in diameter) are composed entirely of α-sulfur, and the greenish-gray spherules (up to 2 mm in diameter) consist mainly of matrix-forming α-sulfur with lesser amounts of pyrite, amorphous silica, pyrophyllite, and rare marcasite. Based on the results of the field observations and the micro-analyses of the samples, these sulfur spherules were formed by rapid cooling of molten sulfur blobs ejected from a low-viscosity molten sulfur pool (124.7-128.7 °C) in the bottom of the fumarole during vigorous fumarolic activity. Color difference between yellow and greenish-gray sulfur spherules is explained by the presence of xenolithic altered mineral fragments in the greenish-gray sulfur spherules. Our observations indicate significant fluctuations of the level of the molten sulfur forming inside the fumarolic vent, and these fluctuations may imply the existence of other molten sulfur reservoirs beneath the fumarolic area. Presence of solid sulfur spherules in the fumarolic area may be an indicator of a molten sulfur pool within fumaroles or volcanic vents that are often difficult to directly observe. [ABSTRACT FROM AUTHOR]

Primary ciliary dyskinesia (PCD) is a relatively rare genetic disorder that affects approximately 1 in 20,000 people. Approximately 50 genes are currently known to cause PCD. In light of differences in causative genes and the medical system in Japan compared with other countries, a practical guide was needed for the diagnosis and management of Japanese PCD patients. An ad hoc academic committee was organized under the Japanese Rhinologic Society to produce a practical guide, with participation by committee members from several academic societies in Japan. The practical guide including diagnostic criteria for PCD was approved by the Japanese Rhinologic Society, Japanese Society of Otolaryngology–Head and Neck Surgery, Japanese Respiratory Society, and Japanese Society of Pediatric Pulmonology. The diagnostic criteria for PCD consist of six clinical features, six laboratory findings, differential diagnosis, and genetic testing. The diagnosis of PCD is categorized as definite, probable, or possible PCD based on a combination of the four items above. Diagnosis of definite PCD requires exclusion of cystic fibrosis and primary immunodeficiency, at least one of the six clinical features, and a positive result for at least one of the following: (1) Class 1 defect on electron microscopy of cilia, (2) pathogenic or likely pathogenic variants in a PCD-related gene, or (3) impairment of ciliary motility that can be repaired by correcting the causative gene variants in iPS cells established from the patient's peripheral blood cells. This practical guide provides clinicians with useful information for the diagnosis and management of PCD in Japan. [ABSTRACT FROM AUTHOR]

Few studies have reported the association between the Japanese diet as food score and mortality. This study aimed to investigate adherence to the Japanese food score associated with all-cause, CVD and cancer mortality. A total of 58 767 (23 162 men and 34 232 women) Japanese participants aged 40–79 years, who enrolled in the Japan Collaborative Cohort Study between 1988 and 1990, were included. The Japanese food score was derived from the components of seven food groups (beans and bean products, fresh fishes, vegetables, Japanese pickles, fungi, seaweeds and fruits) based on the FFQ. The total score ranged from 0 to 7, and participants were divided into five categories based on scores (0–2, 3, 4, 5 and 6–7). Hazard ratios (HR) and 95 % CI for all-cause, CVD and cancer mortality based on sex were estimated using Cox proportional models. During the follow-up period until 2009, 11 692 participants with all-cause, 3408 with CVD and 4247 with cancer died. The multivariable HR in the 6–7 and 0–2 Japanese food score groups were 0·93 (95 % CI 0·86, 1·01) in men and 0·82 (95 % CI 0·75, 0·90) in women for all-cause mortality and 0·89 (95 % CI 0·76, 1·04) in men and 0·66 (95 % CI 0·56, 0·77) in women for CVD mortality. Our findings suggest that adherence to the Japanese food score consisting of food combinations characterised by a Japanese diet may help in preventing all-cause and CVD mortality, especially in women. [ABSTRACT FROM AUTHOR]

In the northern part of Japan, close cooperation is essential in preparing for any possible emergency response to radiation accidents because several facilities, such as the Low-Level Radioactive Waste Disposal Facility, the MOX Fuel Fabrication Plant and the Vitrified Waste Storage Center, exist in Rokkasho Village (Aomori Prefecture). After the accident at Fukushima Daiichi Nuclear Power Plant in 2011, special attention should be given to the relationship between radiation and human health, as well as establishing a system for managing with a radiation emergency. In the area of Hokkaido and Aomori prefectures in Japan, since 2008 an exchange meeting between Hokkaido University and Hirosaki University has been held every year to have opportunities to discuss radiation effects on human health and to collect the latest news on monitoring environmental radiation. This meeting was elevated to an international meeting in 2014 titled 'Educational Symposium on Radiation and Health (ESRAH) by Young Scientists'. The 3rd ESRAH meeting took place in 2016, with the theme 'Investigating Radiation Impact on the Environmental and Health'. Here we report the meeting findings on the continuing educational efforts after the Fukushima incident, what was accomplished in terms of building a community educational approaches, and future goals. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking technique using virtual images. The purpose of this study was to evaluate the safety, efficacy and reproducibility of VAL-MAP among multiple centres. METHODS: Selection criteria included patients with pulmonary lesions anticipated to be difficult to identify at thoracoscopy and/or those undergoing sub-lobar lung resections requiring careful determination of resection margins. Data were collected prospectively and, if needed, compared between the centre that originally developed VAL-MAP and 16 other centres. RESULTS: Five hundred patients underwent VAL-MAP with 1781 markings (3.6 ± 1.2 marks/patient). Complications associated with VAL-MAP necessitating additional management occurred in four patients (0.8%) including pneumonia, fever and temporary exacerbation of pre-existing cerebral ischaemia. Minor complications included pneumothorax (3.6%), pneumomediastinum (1.2%) and alveolar haemorrhage (1.2%), with similar incidences between the original centre and other centres. Marks were identifiable during operation in approximately 90%, whereas the successful resection rate was approximately 99% in both groups, partly due to the mutually complementary marks. The contribution of VAL-MAP to surgical success was highly rated by surgeons resecting pure ground glass nodules (P < 0.0001), tumours <5mm (P = 0.0016), and performing complex segmentectomy and wedge resection (P = 0.0072). CONCLUSIONS: VAL-MAP was found to be safe and reproducible among multiple centres with variable settings. Patients with pure ground glass nodules, small tumours and resections beyond conventional anatomical boundaries are considered the best candidates for VAL-MAP. [ABSTRACT FROM AUTHOR]

Purpose: Lung transplant recipients are known to be at risk of a postoperative malignancy. In Western countries, skin cancer and post-transplant lymphoproliferative disorder (PTLD) are the most common malignancies in this cohort. We conducted this study to evaluate the characteristics of postoperative malignancies in Japanese patients following living-donor lobar lung transplantation (LDLLT) or cadaveric lung transplantation (CLT). Methods: We reviewed the medical records of 120 Japanese patients who underwent either LDLLT ( n = 62) or CLT ( n = 58) between April 2002 and July 2015. Results: Postoperative malignancy developed in 11 patients (9.2 %), as PTLD in 7, breast cancer in 1, gastric cancer in 1, glioblastoma in 1, and adenocarcinoma of unknown primary in 1. Twenty-six (21.7 %) of the 120 transplant patients had a history of malignancy pre-transplant; however, the postoperative malignancies were all de novo without any recurrence of the original disease. The malignancies developed after LDLLT in six patients (9.7 %) and after CLT in 5 patients (8.6 %). Three of the four patients with solid organ malignancies had distant metastasis at diagnosis. Three patients died of PTLD and one patient died of gastric cancer. Conclusions: PTLD occurred after both LDLLT and CLT. There was no case of skin cancer in this series of Japanese patients, suggesting ethnic differences. Solid organ malignancies in lung transplant recipients tended to progress rapidly. [ABSTRACT FROM AUTHOR]

In the 1960s, the basic structure of linked religious organisations and political parties was formed, as can be seen from the rise of Kōmeitō, a political party founded by Sōka Gakkai, and the creation of the Shintō Political Association (spa). In the 1970s, when Japan was undergoing high economic growth, the social status of Sōka Gakkai members was elevated, although the expansion of the group came to a halt. After Kōmeitō formed a coalition government with the Liberal Democratic Party (ldp) in the 1990s, the supporters for each party came to play complementary roles. Seeing the active involvement of these religious organisations in politics--though with a varying degree of media exposure--it is possible to say that public religion has reappeared in Japanese society. However, I would like to argue that this is not a sign of post-secular "religious revival." It is rather the "depoliticisation" among Japanese people that makes the presence of religious organisations seem more conspicuous. This paper aims to redraw the configuration of religion and politics in postwar Japan chiefly by examining the relationship between the spa and the ldp, and that between Sōka Gakkai and Kōmeitō. [ABSTRACT FROM AUTHOR]

Background: Lung transplantation has been established as the definitive treatment option for patients with advanced lymphangioleiomyomatosis (LAM). However, the prognosis after registration and the circumstances of lung transplantation with sirolimus therapy have never been reported. Methods: In this national survey, we analyzed data from 98 LAM patients registered for lung transplantation in the Japan Organ Transplantation Network. Results: Transplantation was performed in 57 patients as of March 2014. Survival rate was 86.7% at 1 year, 82.5% at 3 years, 73.7% at 5 years, and 73.7% at 10 years. Of the 98 patients, 21 had an inactive status and received sirolimus more frequently than those with an active history (67% vs. 5%, p<0.001). Nine of twelve patients who remained inactive as of March 2014 initiated sirolimus before or while on a waiting list, and remained on sirolimus thereafter. Although the statistical analysis showed no statistically significant difference, the survival rate after registration tended to be better for lung transplant recipients than for those who awaited transplantation (p = 0.053). Conclusions: Lung transplantation is a satisfactory therapeutic option for advanced LAM, but the circumstances for pre-transplantation LAM patients are likely to alter with the use of sirolimus. [ABSTRACT FROM AUTHOR]

Although habitual seaweed consumption in Japan would suggest that iodine intake in Japanese is exceptionally high, intake data from diet records are limited. In the present study, we developed a composition database of iodine and estimated the habitual intake of iodine among Japanese adults. Missing values for iodine content in the existing composition table were imputed based on established criteria. 16 d diet records (4 d over four seasons) from adults (120 women aged 30–69 years and 120 men aged 30–76 years) living in Japan were collected, and iodine intake was estimated. Habitual intake was estimated with the Best-power method. Totally, 995 food items were imputed. The distribution of iodine intake in 24 h was highly skewed, and approximately 55 % of 24 h values were < 300 μg/d. The median iodine intake in 24 h was 229 μg/d for women and 273 μg/d for men. All subjects consumed iodine-rich foods (kelp or soup stock) on one or more days of the sixteen survey days. The mean (median) habitual iodine intake was 1414 (857) μg/d for women and 1572 (1031) μg/d for men. Older participants had higher intake than younger participants. The major contributors to iodine intake were kelp (60 %) and soup stock (30 %). Habitual iodine intake among Japanese was sufficient or higher than the tolerable upper intake level, particularly in older generations. The association between high iodine intake as that observed in the present study and thyroid disease requires further study. [ABSTRACT FROM PUBLISHER]

The majority of neural tube defects were believed to be folic acid (FA)-preventable in the 1990s. The Japanese government recommended women planning pregnancy to take FA supplements of 400 mg/d in 2000, but the incidence of spina bifida has not decreased. We aimed to evaluate the OR of having an infant with spina bifida for women who periconceptionally took FA supplements and the association between an increase in supplement use and possible promoters for the increase. This is a case-control study which used 360 case women who gave birth to newborns afflicted with spina bifida, and 2333 control women who gave birth to healthy newborns during the first 12 years of this century. They were divided into two 6-year periods; from 2001 to 2006 and from 2007 to 2012. Logistic regression analyses were conducted to compute OR between cases and controls. The adjusted OR of having an infant with spina bifida for supplement users was 0·48 in the first period, and 0·53 in the second period. The proportion of women who periconceptionally consumed supplements significantly increased from 10% in the first period to 30% in the second period. Awareness of the preventive role of FA was a promoter for an increase in supplement use, and thus an FA campaign in high school seems rational and effective. The failure of the current public health policy is responsible for an epidemic of spina bifida. Mandatory food fortification with FA is urgent and long overdue in Japan. [ABSTRACT FROM AUTHOR]

Background We examined the effect of seasonality on the validity (ability to estimate the mean intake of a group and ranking ability) of nutrient intakes estimated with a comprehensive self- administered diet history questionnaire (DHQ) developed for the assessment of Japanese diets during the preceding one month, using semi-weighed dietary records (DRs) as a reference method. Methods This study was conducted in three areas in Japan (Osaka, Nagano, and Tottori). The study population included 92 Japanese men aged 32-76 years and 92 Japanese women aged 31-69 years (30 from Osaka, 31 from Nagano, and 31 from Tottori for each sex). A DHQ and a four-day DR were completed four times at 3-month intervals, once per season. The effect of seasonality was examined by the level of agreement among seasons using mean nutrient intake and correlation coefficients. Results Significant differences in estimated energy-adjusted intakes of 42 selected nutrients between the average of DRs administered 16 times throughout a year and that of the DHQ administered four times in each season (fall, winter, spring, and summer) were observed for 30, 29, 30, and 31 nutrients for men and 21, 28, 30, and 31 nutrients for women, respectively. Pearson correlation coefficients between the DRs and the DHQs for energy-adjusted intakes of the 42 nutrients showed significant inter-season differences in 11 nutrients for men and 13 nutrients for women. Particularly, correlation coefficients of fat, monounsaturated fat, polyunsaturated fat, n-6 polyunsaturated fat, a-linolenic acid, and cholesterol in spring and cryptoxanthin in summer for men, and fat, saturated fat, and monounsaturated fat in spring and summer and thiamin and iron in summer for women were markedly altered by seasonality. Conclusions Mean nutrient intake estimated by the DHQ varied by season, indicating that any consideration of nutrient intake estimated by the DHQ as a yearly average intake may be problematic. In contrast, the effect of seasonality on the ranking ability of the DHQ was relatively small, and thus the use of a DHQ to rank individuals by nutrient intake is acceptable for epidemiological studies, regardless of season. [ABSTRACT FROM AUTHOR]

Background: It may be useful to examine associations of fat intakes with total mortality as a basis for dietary recommendations. We aimed to elucidate associations between dietary fat and total mortality among Japanese populations with low fat intake. Methods: We conducted a prospective study consisting of 58,672 men and women aged 40 to 79 years. Fat intakes were estimated using a food frequency questionnaire. Multivariate-adjusted hazard ratios (HRs) for mortality by sex were computed according to quintiles of energyadjusted fat intakes. Results: During the follow-up period (median duration, 19.3 years), 11,656 deaths were recorded. In men, we found no clear association between total fat and total mortality. HRs across quintiles of total fat intake were 1.00, 1.03 (95% confidence interval [CI], 0.95-1.12), 1.02 (0.94- 1.10), 0.98 (0.90-1.07), and 1.07 (0.98-1.17). No significant association was detected in regard to types of fat. In women, HR was lowest in the fourth quintile of total fat intake followed by the top quintile; HRs across quintiles were 1.00, 1.03 (0.94-1.11), 1.00 (0.92- 1.09), 0.88 (0.81-0.96), and 0.94 (0.86-1.03). Regarding types of fat in women, total mortality was inversely associated with intakes of saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA); the lowest HR was in the top quintile of intake for SFA, MUFA, and PUFA: 0.91 (95% CI, 0.83-1.00), 0.91 (0.83-0.99) and 0.88 (0.80 - 0.97), respectively (trend P across quintiles, 0.020, 0.012, and 0.029, respectively). Causes of death other than cancer and cardiovascular disease contributed most to decreases in HRs for total and types of fat. In women, analysis with finer categories revealed that the lowest risk for total mortality appeared at total fat intake of 28% of energy. Conclusions: Our findings from a large cohort study among populations with relatively low fat intake provide evidence regarding optimal levels of fat intakes. [ABSTRACT FROM AUTHOR]

Introduction: Embolization of intracranial tumor is widely performed in Japan, mainly before neurosurgical resection. A retrospective, multicenter, observational study in Japan was conducted to clarify the nature, frequency, and risk factors of complications in intracranial tumor embolization. Methods: Patients were derived from the Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2). A total of 20,854 patients were enrolled in JR-NET2, of which 1,018 patients (4.88 %) with intracranial tumors underwent embolization. The primary end point was the proportion of patients with a modified Rankin scale (mRS) score of 0-2 (independency) at 30 days. The secondary end point was the occurrence of complications related to the procedures. The risk factors of the occurrence of complications were studied. Results: The proportion of patients with mRS scores ≤2 at 30 days after procedure was 91.3 %. Complications occurred in 15 of the 1,012 patients (1.48 %). Multivariate analysis showed that embolization for tumors other than meningioma (OR, 4.626; 95 % CI, 1.347-14.59; p = 0.0105) was significantly associated with the development of complications. Conclusion: The frequency of complications after intracranial tumor embolization was relatively low in this large Japanese cohort. Embolization for tumors other than meningioma was the only significant risk factor for the occurrence of complications. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Current treatments for Japanese patients with active Crohn''s disease have not proved optimal, and new treatment options are required. The present study therefore evaluated the efficacy and tolerability of oral budesonide in Japanese patients with mild-to-moderate active Crohn''s disease. Methods: In this multicentre, double-blind, randomized, parallel-group, Phase II study, patients (18–65years) with baseline Crohn''s Disease Activity Index (CDAI) score≥200 were randomized to once-daily (od) oral budesonide 9mg or 15mg, or matching placebo, for 8weeks. Concomitant therapy with sulfasalazine or 5-aminosalicylic acid, and nutritional therapy, was allowed. The rate of remission (defined as CDAI score≤150) after 8weeks'' treatment (primary variable), health-related quality of life (assessed using the Inflammatory Bowel Disease Questionnaire [IBDQ]), and tolerability were assessed. Results: 77 patients were randomized and 63 completed the study. The proportion of budesonide-treated patients with remission after 8weeks'' treatment was higher compared with placebo (23.1%, 28.0%, and 11.5% for budesonide 9mg, 15mg, and placebo, respectively; no significant difference). The mean change from baseline to week 8 in CDAI total score (−48.0, −58.2, and −27.2, respectively) and IBDQ total score (10.8, 23.2, and 6.5, respectively) was greater for budesonide-treated patients than placebo recipients. While budesonide 9mg and 15mg demonstrated similar efficacy, budesonide 9mg caused fewer drug- and glucocorticosteroid-related adverse events and less adrenal suppression. Conclusions: Oral budesonide 9mg od (for up to 8weeks) may offer a new treatment option for Japanese patients with mild-to-moderate active Crohn''s disease. [Copyright &y& Elsevier]

Individual mathematics teachers may value different aspects of teaching and learning mathematics, but at the same time their value systems are under the influence of socially shared values. This paper describes such values in Japanese mathematics education from a historical and normative perspective. After the introduction of Western mathematics into the modern school system in the Meiji period (1868-1912), the people of Japan struggled to adapt and absorb it onto the foundation of Japanese tradition. In the subsequent development of Japanese mathematics education, the integration of both practical and theoretical aspects have been issues, alongside changes in educational focus and in society at large, which are symbolically represented by the enrolment rates at all of elementary, secondary, and tertiary education levels. Mathematics education in Japan has also been subject to international influences, such as the reform movement and the modernization movement, at critical junctures in its development. Key concepts such as mathematical ideas, mathematical thinking, and mathematical activities are traces of such historical efforts by the Japanese mathematics education community, and represent their socially shared values. [ABSTRACT FROM AUTHOR]

Date Y, Yokoyama Y, Kondo H, Kuroda S, Ohya K, Ota MS, Iseki S, Kasugai S. Restricted expression of chromatin remodeling associated factor Chd3 during tooth root development. J Periodont Res 2012; 47: 180-187. © 2011 John Wiley & Sons A/S Background and Objective: The tooth root is one of the critical parts to maintain tooth function; however, the molecular mechanisms of root development remain unknown. We aimed to identify specific factors for root morphogenesis using a newly developed experimental system. Material and Methods: Tentative cementoblasts and periodontal ligament cells from mouse mandibular molars were isolated using laser capture microdissection. More than 500 cementoblasts and periodontal ligament cells were separately captured. After RNA extraction and amplification, mRNA expression in isolated cementoblasts was compared with that of periodontal ligament cells by cDNA microarray analysis. Then, putative cementoblast-specific genes were subjected to in situ hybridization analysis to confirm the results in mouse mandible. Results: Approximately 2000 genes were differentially expressed between these tissues. Among those genes, zinc finger helicase (ZFH), also termed chromodomain-helicase-DNA-binding protein 3 (Chd3), was one of the highly expressed transcripts in tentative cementoblasts. In situ hybridization revealed that ZFH/Chd3 was strongly expressed in Hertwig's epithelial root sheath rather than in cementum. Moreover, its expression disappeared when root formation was advanced in the first molar. In contrast, Chd3 was continuously expressed in dental epithelial cells of the cervical loop, in which root extension is never terminated. Conclusion: These results suggest that ZFH/Chd3 might play an important role in tooth root development and subsequent cementogenesis. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective: Genetic background is thought to be one of the risk factors for development of COPD. Recently, it has been proposed that the innate immune system is involved in the pathophysiology of COPD. We hypothesized that polymorphisms in the nucleotide-binding and oligomerization domain (NOD)1 and NOD2 genes would be associated with the pathogenesis of COPD. In addition, the associations between these single nucleotide polymorphisms (SNPs) and phenotypes of COPD were analysed. Methods: Japanese COPD patients ( n = 228) and non-COPD smokers ( n = 101) were recruited from the outpatient clinic at Kyoto University Hospital, Kyoto, Japan. At entry into the study, a blood sample was taken and a pulmonary function test was performed. Genotyping was performed for 6 selected tag SNPs of NOD1 and 5 tag SNPs of NOD2. Further investigations were performed for SNP that were associated with COPD, including baseline gene expression, the relative proportions of splicing variants in whole blood, responses to ligand and enhancement of gene expression in peripheral blood neutrophils stimulated with pro-inflammatory cytokines. Results: The distribution of NOD2 rs1077861 genotypes differed between Japanese COPD patients and non-COPD smokers ( P = 0.036). This SNP was also associated with a lower FEV1 % predicted (57.2 ± 1.8 for TT vs 50.8 ± 2.3 for TA/AA, P = 0.03) and DLCO/VA (2.89 ± 0.1 in TT vs 2.53 ± 0.14 in TA/AA, P = 0.036) in COPD patients. NOD2 gene expression after stimulation with 10 ng/mL of tumour necrosis factor-α for 4 h, was increased to a greater extent in TA/AA genotype than in TT genotype peripheral blood neutrophils ( P = 0.015). Conclusions: The NOD2 rs1077861 SNP may influence the development and progression of COPD in Japanese subjects. [ABSTRACT FROM AUTHOR]

Purpose: Erlotinib is the first epidermal growth factor receptor-tyrosine kinase inhibitor shown to provide a survival benefit for advanced non-small-cell lung cancer (NSCLC) patients. Adverse drug reactions of erlotinib in Japanese, which may be very different from those in Caucasians because of differences in genetic background, have not been fully reported. Therefore, we aimed to clarify the safety profile of erlotinib. Methods: Forty-eight patients with pretreated NSCLC were treated with erlotinib between March 2008 and January 2009 in this historical cohort study at Kyoto University Hospital Outpatients Oncology Unit. Erlotinib 150 mg/day was administered until progressive disease or discontinuation due to adverse events. The primary endpoint was frequency and degree of adverse events, and secondary endpoints were clinical efficacy including response rate, disease control rate, progression-free survival and overall survival. Results: Of 48 patients, 3 patients experienced erlotinib-induced interstitial pneumonitis, which appeared on day 15 and 70 in 2 patients who recovered and on day 8 in 1 patient who died. The incidences of pruritus, dry skin, diarrhea and stomatitis rapidly increased within 14 days after the start of medication with erlotinib. However, these adverse events were well controllable in outpatients treated with erlotinib. Overall response rate was 10% and disease control rate was 68%. The median progression-free survival was 58 days (95% confidence interval 30-118) and the median overall survival was 229 days (95% confidence interval 135-not available). Conclusions: Outpatients with NSCLC can be treated with initial administration of erlotinib by careful management. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare the relative validity of food group intakes derived from a comprehensive self-administered diet history questionnaire (DHQ) and a brief-type DHQ (BDHQ) developed for the assessment of Japanese diets during the previous month using semi-weighed dietary records (DR) as a reference method.DesignBetween November 2002 and September 2003, a 4 d DR (covering four non-consecutive days), a DHQ (150-item semi-quantitative questionnaire) and a BDHQ (fifty-eight-item fixed-portion-type questionnaire) were completed four times (once per season) at 3-month intervals.SettingThree areas in Japan: Osaka, Nagano and Tottori.SubjectsNinety-two Japanese women aged 31–69 years and ninety-two Japanese men aged 32–76 years.ResultsMedian food group intakes were estimated well for approximately half of the food groups. No statistically significant differences were noted between a 16 d DR and the first DHQ (DHQ1) or between the DR and the first BDHQ (BDHQ1) in fifteen (44 %) and fifteen (52 %) food items for women and in fourteen (41 %) and sixteen (55 %) food items for men, respectively, indicating that both questionnaires estimated median values reasonably well. Median Spearman's correlation coefficients with the DR were 0·43 (range: −0·09 to 0·77) for DHQ1 and 0·44 (range: 0·14 to 0·82) for BDHQ1 in women, with respective values of 0·44 (range: 0·08 to 0·87) and 0·48 (range: 0·22 to 0·83) in men, indicating reasonable ranking ability. Similar results were observed for mean values of the four DHQ and BDHQ.ConclusionsIn terms of food intake estimates, both the DHQ and the BDHQ showed reasonable validity. [ABSTRACT FROM AUTHOR]

Rice is a staple food in Japan and provides 43% of carbohydrate and 29% of energy intake in the Japanese population. In a prospective study encompassing 83,752 Japanese men and women aged 40-79 y, rice intake was determined by self- administered FF0. Median follow-up time was 14.1 y from 1988-1990 to the end of 2003, and HR and 95% Cl of mortality were calculated according to quintiles of energy-adjusted rice intake. A total of 3514 cardiovascular deaths 11640 strokes, 707 coronary heart disease ICHDI, and 560 heart failure] were documented. There was a gender difference on the effect of rice intake on the risk of cardiovascular disease (CVD). Overall, rice intake wasinversely associated with CHD, heart failure, and total CVD in men but not in women. Rice intake was not associated with risk of stroke in either gender. The multivariable HR (95% CII for the extreme quintiles of rice intake in men were 0.70 [(0.49-0.991; P-trend = 0.02] for CHD, 0.70 [10.46-1.051; P-trend = 0.051 for heart failure, and 0.82 1(0.70-0.97); P-trend = 0.006] for total CVD For women, rice was not associated with reduced risk of mortality from CVD after adjusting for lifestyle and dietary variables. In conclusion, the consumption of steamed rice was associated with reduced risk of mortality from CVD in Japanese men but not women. This finding necessitates further investigations on the mechanisms leading to this gender difference. [ABSTRACT FROM AUTHOR]

Background The effects of coffee and green, black and oolong teas and caffeine intake on cardiovascular disease (CVD) mortality have not been well defined in Asian countries. Methods To examine the relationship between the consumption of these beverages and risk of mortality from CVD, 76 979 individuals aged 40-79 years free of stroke, coronary heart disease (CHD) and cancer at entry were prospectively followed. The daily consumption of beverages was assessed by questionnaires. Results 1362 deaths were documented from strokes and 650 deaths from CHD after 1 010 787 person-years of follow-up. Compared with non-drinkers of coffee, the multivariable HR and 95% CI for those drinking 1-6 cups/week, 1-2 cups/day and ≥3 cups/day were 0.78 (0.50 to 1.20), 0.67 (0.47 to 0.96) and 0.45 (0.17 to 0.87) for strokes among men (p=0.009 for trend). Compared with non-drinkers of green tea, the multivariable HR for those drinking 1-6 cups/week, 1-2 cups/day, 3-5 cups/day and ≥6 cups/day were 0.34 (0.06-1.75), 0.28 (0.07-1.11), 0.39 (0.18-0.85) and 0.42 (0.17-0.88) for CHD among women (p=0.038 for trend). As for oolong tea, the multivariable HR of those drinking 1-6 cups/week and ≥1 cups/day were 1.00 (0.65-1.55) and 0.39 (0.17-0.88) for total CVD among men (p=0.049 for trend). Risk reduction for total CVD across categories of caffeine intake was most prominently observed in the second highest quintile, with a 38% lower risk among men and 22% among women. Conclusions Consumption of coffee, green tea and oolong tea and total caffeine intake was associated with a reduced risk of mortality from CVD. [ABSTRACT FROM AUTHOR]