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Objective: To investigate whether conisation increases chorioamnionitis (CAM) and assess whether this risk differs between preterm and term periods. Furthermore, we estimated mediation effects of CAM between conisation and preterm birth (PTB). Design: A nationwide observational study. Setting: Japan. Population: Singleton pregnant women derived from the perinatal registry database of the Japan Society of Obstetrics and Gynaecology between 2013 and 2019. Methods: The association between a history of conisation and clinical CAM was examined using a multivariable logistic regression model with multiple imputation. We conducted mediation analysis to estimate effects of CAM on PTB following conisation. Main Outcome Measures: Clinical CAM. Results: Of 1 500 206 singleton pregnant women, 6961 (0.46%) underwent conisation and 1 493 245 (99.5%) did not. Clinical CAM occurred in 150 (2.2%) and 11 484 (0.8%) women with and without conisation, respectively. Conisation was associated with clinical CAM (odds ratio [OR] 3.09; 95% confidence interval (CI) 2.63–3.64; p < 0.001) (risk difference 1.57%; 95% CI 1.20–1.94). The association was detected among 171 440 women with PTB (OR 3.09; 95% CI 2.57–3.71), whereas it was not significant among 1 328 284 with term birth (OR 0.88; 95% CI 0.58–1.34). OR of total effect of conisation on PTB was 2.71, OR of natural indirect effect (effect explained by clinical CAM) was 1.04, and OR of natural direct effect (effect unexplained by clinical CAM) was 2.61. The proportion mediated was 5.9%. Conclusions: Conisation increased CAM occurrence. Obstetricians should be careful regarding CAM in women with conisation, especially in preterm period. Bacterial infections may be an important cause of PTB after conisation. [ABSTRACT FROM AUTHOR]

Background: In April 2020, insurance coverage for risk-reducing salpingo-oophorectomy (RRSO) for breast cancer patients with hereditary breast and ovarian cancer (HBOC) syndrome and BRCA testing were started in Japan. We investigated the impact of insurance coverage on the number of RRSO and BRCA tests performed. Methods: The subjects were 370 breast cancer patients and 23 of their relatives who received genetic counseling at our institution between April 2014 and December 2021. Finally, 349 patients and 15 relatives were analyzed. We retrospectively compared the number of BRCA tests, RRSO, insurance status, and co-payment of medical expenses before and after insurance coverage based on medical records. Results: In the 6-year pre-coverage period, 226 patients (mean: 37/year) received genetic counseling and 106 (17/year) received BRCA testing. In the 21-month post-coverage period, 161 patients (92/year) received genetic counseling and 127 (72/year) received BRCA testing. The rate of testing/counseling significantly increased in the post-coverage period (46.9% vs. 78.8%; p <.001). The number of patients who were diagnosed with HBOC were 24 (4/year) and 18 (10/year) and RRSO was performed for 7 (1/year) and 11 (6/year) patients in the pre- and post-coverage periods, respectively. The rate of RRSO/HBOC was significantly increased in the post-coverage period (29.1% vs. 61.1%; p = 0.039). RRSO patients' co-payment rates decreased from 64% to 25% pre- and post-coverage. Conclusions: Our findings suggest that decreased co-payments were the primary reason for these increases. Insurance coverage is an important factor when promoting preventive medical services such as RRSO. [ABSTRACT FROM AUTHOR]

This paper presents a rapid or real-time estimation method of the economic value of direct stock damages caused by significant earthquakes in Japan. The result will contribute to both the government and private sectors' early decision-making, particularly for provisional budget allocation. First, we developed a simple but evidence-based model for estimating stock losses explained by a representative earthquake hazard factor and an exposure factor, i.e., seismic intensity and existing stock of physical assets. The key characteristic of our estimation model is that the dependent variable is prefectural damage amount. Still, the explanatory variables come from municipal sources: we overcome this data availability problem through our estimation process. Second, we carefully checked the model's specification, estimation, and performance to be soundly applied to a real-time assessment of future earthquake events. We also explain the automated measuring of the prefectural direct loss value and its distribution to every 250 m mesh. Finally, we show two examples of the application of our model; one is the case of the 2018 Northern Osaka Earthquake, and the other is the anticipated Tokyo inland earthquake. [ABSTRACT FROM AUTHOR]

To investigate the impact of a state of emergency (i.e., voluntary lockdown) during the COVID‐19 epidemic, we conducted a retrospective cohort study using the Japanese nationwide registry. In comparison with those during 2019, the number of treatment cycles decreased in April 2020 (−9.5%) to its lowest point in May (−24.1%). The magnitude of the decline was three times larger for frozen cycles (−37.0%) than for fresh cycles (−12.4%). The decrease was significantly smaller for women aged <35 years (−31.0%) than for the older groups (−39.0% to −39.7%). Under voluntary lockdown, a considerable decrease was observed especially for frozen cycles and older women. [ABSTRACT FROM AUTHOR]

In recent years, a wide-area disaster causing enormous damage has occurred almost every year in Japan. The authors have been involved in the management of disaster volunteer centers in various places and have realized the difficulty in coordinating the actual number of activities in disaster-stricken areas and the required number of disaster volunteers. The number of disaster volunteers required varies greatly on a daily basis. The number of volunteer activities often depends on the quantity of disaster waste created from damaged houses. Accordingly, if the quantity of waste was grasped immediately on the spot, the number of disaster volunteers required in the short term could be estimated. In this study, the actual conditions in Hitoyoshi City, Kumamoto Prefecture, at the time of the Heavy Rainfall in July 2020 are considered as an example, and the method is considered to immediately grasp the quantity of waste to be disposed of and the number of people required for this task. We compared the amount of waste disposal work estimated from the in-vehicle camera image with the number of active residents and volunteers. As a result, it was estimated that 40–50% of the work was carried out by volunteers at the peak of volunteer activities. [ABSTRACT FROM AUTHOR]

We theoretically and empirically demonstrate the usability of the zero-crossing method for quick microtremor surveys in earthquake engineering (i.e. microtremor array surveys), namely shallow (< a few kilometres) surveys with small-scale (< 1 kilometre in radius) mobile seismic arrays with a short observation time (< a few hours). The zero-crossing method is a type of spatial autocorrelation (SPAC) method that determines phase velocities based on multiple frequencies at which the SPAC coefficient curve crosses zero. It is theoretically shown that the zero-crossing method is robust against incoherent noise and that the use of the first zero crossings (i.e. those at the lowest frequencies) is more robust against inadequate conditions of the microtremor wavefield than the use of later zero crossings (i.e. those at higher frequencies). We used microtremor array data with maximum array radii and observation durations of 400 m and 120 min on average, respectively, at 445 observation sites in the Kanto Plain, Japan, for validating the practicality of using the first zero crossings. As an illustration of the robustness against low signal-to-noise ratios (SNRs), we show that with the zero-crossing method, low-sensitivity (i.e. low-SNR) seismometers provide the same analysis results as those obtained with high-sensitivity seismometers, even when the power spectral densities for the low-sensitivity seismometers are close to the self-noise level. We then show that a reference phase velocity dispersion curve (RPVDC), created mainly based on the first zero crossings at each site, has a spatial distribution that well corresponds to the geology and topography and is consistent with that obtained in a previous study. We inverted five RPVDCs to model 1-D S -wave profiles and validated them using S -wave profiles obtained from velocity logs at nearby deep (e.g. hundreds of metres) boring wells. The accuracy of phase velocities at the later zero crossings for three-sensor/four-sensor arrays and all zero crossings for two-sensor arrays are statistically examined (maximum of 9805 data) based on a comparison with the RPVDCs. The disadvantage of the zero-crossing method is that it can only provide information on phase velocities at discrete wavelengths up to a maximum wavelength of 2.6 r (i.e. corresponding to the first zero-crossing point), where r is the radius of a seismic array. Therefore, the RPVDCs were then used to examine the upper limit of the analysable wavelength ranges for the conventional SPAC method for microtremor array surveys. Based on a few hundred three-sensor/four-sensor arrays, it was found that for arrays with radii larger than several tens of metres, three-quarters of the upper limit wavelengths (ULWs) stayed within 5 r. For arrays with radii smaller than this value, the ULWs strongly depended on the array radius; the ULWs dramatically increased with decreasing array radius. For example, for arrays with an r value of 0.6 m, half of 336 data ranged between 26 r and 54 r , and the maximum ULW reached 186 r. This strong size dependence can be explained by differences in SNR. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to explore the need for information about permanent contraception in Japanese women with repeated cesarean sections (CS). Methods: The present, cross‐sectional survey used a self‐administered questionnaire mailed to women with a second or later CS at Tokyo Metropolitan Tama Medical Center between March 2010 and December 2017. Those who were pregnant, had given birth less than 1 year before the survey or had an hysterectomy were excluded. Results: The present study analyzed 284 patients (60 with permanent contraception, 224 without permanent contraception). Forty‐eight (80%) of women with permanent contraception, and 135 (60%) of women without permanent contraception believed that information on permanent contraception was needed before CS. Among women without permanent contraception, significantly fewer women obtained adequate information of permanent contraception from their healthcare workers before a CS compared with women with permanent contraception (8% vs. 71%, p < 0.001). A higher rate of unreliable contraceptive use (41%) and unintended pregnancies (4%) after the latest CS were found among the women without permanent contraception. Conclusions: A large portion of the study cohort wished they had received information on permanent contraception before CS; however, the patients without permanent contraception had limited access to this information. Adequate information about permanent contraception should be provided to women planning a CS to enable them to make an informed decision with respect to the treatment. [ABSTRACT FROM AUTHOR]

In this paper, we develop a novel approach to estimate the compensation of employees as a portion of Japan's gross domestic income. The methodology is characterized by its extensive use of comprehensive taxation data, and all data used is publicly available. Our estimates turn out to be larger than the numbers in the official statistics, and the difference has been widening in recent years. In addition, the discrepancy of the two estimates for net lending/borrowing between non‐financial and financial transactions accounts (in theory, they should be the same) shrinks when the former is recalculated based on our estimates, both for households and for corporations. [ABSTRACT FROM AUTHOR]

The nationwide strong-motion seismograph network of K-NET and KiK-net in Japan successfully recorded the strong ground motions of the 2016 Kumamoto earthquake sequence, which show the several notable characteristics. For the first large earthquake with a JMA magnitude of 6.5 (21:26, April 14, 2016, JST), the large strong motions are concentrated near the epicenter and the strong-motion attenuations are well predicted by the empirical relation for crustal earthquakes with a moment magnitude of 6.1. For the largest earthquake of the sequence with a JMA magnitude of 7.3 (01:25, April 16, 2016, JST), the large peak ground accelerations and velocities extend from the epicentral area to the northeast direction. The attenuation feature of peak ground accelerations generally follows the empirical relation, whereas that for velocities deviates from the empirical relation for stations with the epicentral distance of greater than 200 km, which can be attributed to the large Love wave having a dominant period around 10 s. The large accelerations were observed at stations even in Oita region, more than 70 km northeast from the epicenter. They are attributed to the local induced earthquake in Oita region, whose moment magnitude is estimated to be 5.5 by matching the amplitudes of the corresponding phases with the empirical attenuation relation. The real-time strong-motion observation has a potential for contributing to the mitigation of the ongoing earthquake disasters. We test a methodology to forecast the regions to be exposed to the large shaking in real time, which has been developed based on the fact that the neighboring stations are already shaken, for the largest event of the Kumamoto earthquakes, and demonstrate that it is simple but effective to quickly make warning. We also shows that the interpolation of the strong motions in real time is feasible, which will be utilized for the real-time forecast of ground motions based on the observed shakings. [ABSTRACT FROM AUTHOR]

In this study, a method for simulating the ground motion of megathrust earthquakes at periods of approximately 2 s and longer was validated by using the characterized source model combined with multi-scale spatial heterogeneity. Source models for the M 8.3, 2003 Tokachi-oki earthquake were constructed, and ground motion simulations were conducted to test their performance. First, a characterized source model was generated based on a source model obtained from waveform inversion analysis. Then, multi-scale heterogeneity was added to the spatial distribution of several source parameters to yield a heterogeneous source model. An investigation of the Fourier spectra and 5 % damped velocity response spectra of the simulated and observed ground motions demonstrated that adding multi-scale heterogeneity to the spatial distributions of the slip, rupture velocity, and rake angle of the characterized source model is an effective method for constructing a source model that explains the ground motion at periods of 2-20 s. It was also revealed how the complexity of the parameters affects the resulting ground motion. The complexity of the rupture velocity had the largest influence among the three parameters. [ABSTRACT FROM AUTHOR]

Background: Endometrial cytology by direct intrauterine sampling is the most common test for an initial evaluation of the endometrium in Japan. However, its diagnostic value for endometrial cancer remains unknown. Here, we assess the correlation between cytopathology and histopathology to evaluate the diagnostic value of cytology for endometrial cancer. Methods: Patients with histologically confirmed endometrial cancer and controls with a normal endometrium confirmed by hysterectomy had all undergone preoperative endometrial cytology between 2001 and 2010 at our eight institutions and were retrospectively analyzed. The cytological results were compared by clinical stage, histological type, differentiation, and sampling instrument. Results: We analyzed 1,441 endometrial cancer and 1,361 control cases. Endometrial cytology detected cancer in 1,279 (916 positive and 363 suspicious) cases with a sensitivity (positive plus suspicious cases) of 88.8% and a specificity of 98.5%. The positive rate was high in advanced-stage, nonendometrioid, and undifferentiated cases, but there was no significant difference in sensitivity between these clinical conditions. Conclusion: Endometrial cytology shows a relatively high sensitivity and specificity for endometrial cancer, and neither statistical measure is significantly affected by clinical stage, histological type, differentiation, sample numbers, or sampling instrument. These findings form a superior dataset for evaluating the efficacy of endometrial cytology. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: While radiation therapy is administered as a palliative treatment for recurrent ovarian cancer, it remains unclear whether it improves the prognosis. Methods: The effects and adverse events of radiation therapy for patients with recurrent epithelial ovarian cancer were investigated using medical records. Results: Herein, 46 subjects comprising 33 patients whose recurrent lesions were contained within the irradiation field (therapeutic radiation group; TRG) and 13 patients with some recurrent lesions outside the irradiation field (palliative radiation group; PRG) were included. The TRG achieved a response rate (RR) of 66%, a disease control rate (DCR) of 100%, a progression-free survival (PFS) of 10 months, and an overall survival (OS) of 20 months. The PFS after radiation therapy was significantly longer than that following chemotherapy received just before radiation therapy. The PFS of patients with recurrent intrapelvic lesions was longer than that of patients with some extrapelvic recurrence. There was no significant association between PFS after radiation therapy and the duration from the previous chemotherapy or histological type. The RR, DCR, PFS, and OS of the PRG were 30 and 90% and 2 and 6 months, respectively. Serious adverse events were rare. Conclusions: Radiation therapy is a potential option for chemotherapy-resistant, localized recurrent ovarian cancer. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aim: The optimal chemotherapy regimen for patients with endometrial cancer has not been established. We assessed the feasibility of paclitaxel plus carboplatin (TC) for postoperative chemotherapy in patients with endometrial cancer. Material and Methods: Patients with newly diagnosed endometrial cancer received TC (paclitaxel 180 mg/m2, carboplatin AUC6 mg/mL/min) every three weeks. Treatment was continued until disease progression or completion of six cycles. Toxicities were evaluated every cycle according to NCI-CTCAE version 3.0. Results: Sixty patients were registered from December 2005 through November 2006. Forty-four of 60 (73.3%) cases completed all of the planned six cycles. Grades 3 and 4 hematologic toxicities were observed as follows: leukopenia (61.7%), neutropenia (95.0%), anemia (21.7%), and thrombocytopenia (5.0%). There were six patients who dropped out from the protocol by neutropenia. Grade 3 non-hematologic toxicities were observed as follows: nausea (3.3%), vomiting (1.7%), neuropathy (5.0%), myalgia (6.7%) and constipation (1.7%). No grade 4 non-hematologic toxicity was observed. Conclusion: This TC regimen is feasible for endometrial cancer patients. [ABSTRACT FROM AUTHOR]

The strong ground motion prediction method 'Recipe' was published by the Headquarters for Earthquake Research Promotion (HERP) of Japan. HERP has applied this method to prepare shaking maps for scenario earthquakes in specific active faults. Recently, Recipe was updated following its verification by simulations of strong ground motions associated with the Mw = 6.6 off-shore earthquake west of Fukuoka prefecture in 2005, which occurred in the northwest part of the Kego fault zone located in northern Kyushu, Japan. One of the prominent changes in the upgraded version of Recipe is the inclusion of a procedure to evaluate seismic intensities on the ground surface from waveforms of S-wave velocity of 400 m/s on the engineering bedrock. By applying the upgraded version of Recipe, we have made shaking-maps for earthquakes in the southeast part of the Kego fault zone, which is located directly below the mega-city of Fukuoka. We assume four source models for scenario earthquakes; the locations of the asperities and the hypocenters vary between the models. The results show that in all cases, disastrous seismic intensities can strike a wide area of Fukuoka city. Differences in the distributions of seismic intensities among the four cases can be clearly observed in the area located on the extension of the source fault. Furthermore, we construct a velocity-layer structure model on the engineering bedrock for the central area of Fukuoka city. We assess not only the distribution of seismic intensities but also waveforms on the ground by using an equivalent linear method for the central area of Fukuoka city. [ABSTRACT FROM AUTHOR]

Following the 1995 Hyogo-ken Nanbu Kobe. Earthquake, the Japanese government, in an effort to prevent future earthquake disasters, installed networks consisting of a large number of strong-motion observation stations. Further, national seismic hazard maps were made available to the public on an Internet website in March 2005 by the Headquarters for Earthquake Research Promotion. However, these maps indicate only the local seismic intensity for Japan, as empirically convened from predicted peak velocity in consolidated soils. For various applications, other strong-motion indexes such as the response spectral acceleration are required. In this study, a database of whole Japanese strong ground motion records between 1963 and 2003 is established in order to identify a new standard attenuation relation for Japan, for response acceleration as well as peak value. It is usually very difficult to determine a suitable model form due to the large variability of strong-motion data and correlation among the model variables, because the strong coupling of variables in an attenuation model, and the statistical power of the data is often not large enough to determine the necessity of these parameters. Therefore, in this study, our model has only three variables: earthquake magnitude, shortest distance to the seismic fault plane, and focal depth. To improve predictions given by the model, site correction terms are adopted and additional terms for correcting regional anomalous seismic intensity with respect to the base model are determined. The good fit between the model and observed strong-motion records suggests that the new model is reasonably robust. [ABSTRACT FROM AUTHOR]

Cervical cancer screening has been shifting from primary cytology to primary HPV testing worldwide as primary HPV testing is more sensitive than primary cytology. To the best of our knowledge, the current study is the first in Japan to examine the feasibility of primary HPV testing. One of the disadvantages of this shift is that hrHPV-/≥LSIL/CIN2+ (high-risk HPV negative cancers or pre-cancerous lesions with abnormal cytology results) can be missed. The objectives of the present study are to clarify in detail CIN2+ missed by this shift and to evaluate the feasibility of primary HPV testing in Japan. Data from 115,273 women who underwent co-testing with cytology and HPV testing in cancer screening were used in the current study. The cases with hrHPV-/≥LSIL ('hrHPV-/≥L-SIL' include CIN2-, in contrast, 'hrHPV-/≥L-SIL/CIN2+' doesn't include CIN2-) were analysed in detail. Women with hrHPV-/≥LSIL comprised 0.3% of the total. The prevalence of CIN2, CIN3, SCC or cervical adenocarcinomas in the lesions with HPV-/≥LSIL was 0.03% in the cancer screening group. Only one case of 14 cervical adenocarcinomas in ≥LSIL was hrHPV-. The prevalence of cancer missed by the shift in patients >50 years of age was significantly higher compared with patients younger than 49 years. In conclusion, the prevalence of CIN2+, which might be missed by the shift from primary cytology to primary HPV testing, was remarkably low in this Japanese cancer screening. The data indicated that primary HPV testing, which was more sensitive for CIN2+ than primary cytology, was a feasible method that can be used in Japan. In particular, primary HPV testing should be introduced for women <50 years old. [ABSTRACT FROM AUTHOR]

National Research Institute for Earth Science and Disaster Resilience (NIED) integrated the land observation networks established since the 1995 Kobe earthquake with the seafloor observation networks established since the 2011 Tohoku earthquake and tsunami as MOWLAS (Monitoring of Waves on Land and Seafloor) in November 2017. The purpose of MOWLAS is to provide comprehensive, accurate, and rapid observation and monitoring of earthquake, tsunami, and volcano events throughout Japan and its offshore areas. MOWLAS data are widely utilized for long-term earthquake forecasting, the monitoring of current seismic activity, seismic and tsunami hazard assessments, earthquake early warning, tsunami warning, and earthquake engineering, as well as earthquake science. Ocean bottom observations provide an extension of observations to areas where no people are living and have the advantage of increasing lead time of earthquake early warning and tsunami warning. The application of recent technology advancements to real-time observations as well as the processing of MOWLAS data has contributed to the direct disaster mitigation of ongoing earthquakes. These observations are fundamental for both science and disaster resilience, and thus it is necessary to continue ceaseless operation and maintenance. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effect of various community-based interventions in support of HPV vaccination implemented by cities and towns within Tochigi prefecture, Japan with a view to identifying useful indicators which might guide future interventions to improve HPV vaccination coverage in the prefecture. A postal questionnaire survey of all 27 local governments in Tochigi Prefecture was conducted in December 2010. All 27 responded, and 22 provided the exact numbers of the targeted and vaccinated populations of 13- to 15-year-old girls from April to December 2010. The local governments also answered questions on the type of interventions implemented including public subsidies, school-based programs, direct mail, free tickets and recalls. Local governments that conducted a school-based vaccination program reported 96.8% coverage for the 1st dose, 96.2% for the 2nd dose, and 91.2% for the 3rd dose. Those that provided subsidies without school-based programs reported a wide range of vaccination rates: 45.7%–95.0% for the 1st dose, 41.1%–93.7% for the 2nd dose and 3.1%–90.1% for the 3rd dose. Among this group, the combination of a free ticket, direct mail and recall was most effective, with 95.0% coverage for the 1st dose, 93.7% for the 2nd dose, and 90.1% for the 3rd dose. The governments that did not offer a subsidy had the lowest vaccination coverage, with 0.8%–1.4% for the 1st dose, 0.0%–0.8% for the 2nd dose, and 0.1%–0.1% for the 3rd dose. The results of this survey indicate that school-based vaccinations and public subsidies are the most effective method to improve HPV vaccination coverage; however, the combination of a free ticket, direct mail, and recalls with public subsidies are also important measures in increasing the vaccination rate. These data may afford important indicators for the successful implementation of future HPV vaccination programs. [ABSTRACT FROM AUTHOR]

In earthquake hazard assessment studies, the focus is usually on horizontal ground motion. However, records from the 14 June 2008 Iwate-Miyagi earthquake in Japan, a crustal event with a moment magnitude of 6.9, revealed an unprecedented vertical surface acceleration of nearly four times gravity, more than twice its horizontal counterpart. The vertical acceleration was distinctly asymmetric; the waveform envelope was about 1.6 times as large in the upward direction us in the downward direction, which is not explained by existing models of the soil response. We present a simple model of a mass bounding on a trampoline to account for this asymmetry and the large vertical amplitude. The finding of a hitherto-unknown mode of strong ground motion may prompt major progress in near-source shaking assessments. [ABSTRACT FROM AUTHOR]

Ground motions of earthquakes cause fatal damages on buildings and infrastructures. Accurate knowledge on ground motions of prospective earthquakes is indispensable for seismic hazard and engineering applications. Physics-based numerical simulations have been developed to generate precise ground motions and building responses, but it is limited only to long periods, e.g., down to 1 sec due to heavy computational costs, and the lack of detailed knowledge of the source rupture process the subsurface structure. A hybrid approach was proposed to combine numerical simulations for long periods with stochastic approaches for short periods to generate broadband motions. But it still has drawbacks that generated short period motions do not reflect source and path effects, and resulting building responses can be inconsistent over the joint periods between the long and short periods.In Japan, a large amount of observation data have been collected by K-NET over the past 20 years. Then machine learning approaches would be effective to estimate broadband ground motions from simulated long period motions. From this perspective, we propose a ground-motion synthesis method based on the state-of-the-art machine learning techniques, i.e., embeddings and neural networks, and apply it to an M7.0 earthquake in Japan to evaluate its performance.In our method, the time property (envelope of accelerogram) and frequency property (Fourier amplitude spectrum) of broadband motions are separately estimated. The time property is estimated using embeddings. A common embedded space representing both long and broadband period motions is built by an extended version of t-SNE, so that neighbor identities of envelopes are preserved. Then, unknown broadband envelopes for test data can be interpolated in this space. The similarity of envelopes is measured by the Wasserstein distance of the optimal transport theory, which captures the time dependence of waveforms. We discuss the seismological implications of the embedded space.The frequency property is estimated using deep neural networks. The Fourier spectrum of the short period motion are estimated from that of the long period motion. In order to increase the number of training data and while keeping the properties of observation site, we train the network in the following two steps. We first train the network with large data from all sites to model a general frequency property, and then retrain it with small data from a specific site to model a site-specific frequency property. We found that this approach could avoid overfitting and improve the accuracy.Finally, the estimated time and frequency properties are combined to synthesize broadband ground motions. We show that the resulting broadband ground motions could match the ground-truth observations well, and examine the consistency of waveforms in terms of building response properties. [ABSTRACT FROM AUTHOR]

Objective: Over the past decade, liquid-based cytology has replaced conventional cytology for cervical cancer screening in many countries, including Japan. We aimed to evaluate the efficacy of liquid-based cytology using a large database and compare two major liquid-based cytology platforms, SurePath and ThinPrep, to conventional cytology., Methods: Cervical cancer screening data were collected from the Japan Cancer Society between 2015 and 2019. The efficacy of liquid-based and conventional cytology in detecting cervical intraepithelial neoplasia (CIN) was evaluated. Detection rates and positive predictive values were compared using a Poisson regression model., Results: We collected data of 3,918,149 participants, including 2,248,202 conventional cytology, 874,807 SurePath and 795,140 ThinPrep smears. The detection rate of CIN2 or more was 1.14 times higher using SurePath than that using conventional cytology (95% confidence interval [CI], 1.09-1.20; p < 0.001). Contrastingly, the detection rate of CIN2 or more was 0.91 times lower using ThinPrep (95% CI, 0.86-0.96; p < 0.001). The detection rates of CIN3 or more did not differ significantly between SurePath and conventional cytology (detection rate ratio, 1.04; 95% CI, 0.97-1.12; p = 0.224). The positive predictive value ratios of CIN2 or more were 0.80 using SurePath (95% CI, 0.76-0.84; p < 0.001) and 0.83 using ThinPrep (95% CI, 0.79-0.87; p < 0.001) compared with conventional cytology., Conclusions: Liquid-based cytology, particularly SurePath, was useful for detecting CIN2 or higher in population-based cervical cancer screening. Further widespread use of liquid-based cytology methods would lead to efficient detection of cervical precancerous lesions., (© 2024 The Author(s). Cytopathology published by John Wiley & Sons Ltd.)

Objectives: To investigate the association between adenomyosis and placenta accreta spectrum (PAS) and to evaluate the effect of assisted reproductive technology (ART) in mediating this association., Methods: We retrieved data for singleton women from the Japanese nationwide perinatal registry between 2013 and 2019, excluding women with a history of adenomyomectomy. To investigate the association between adenomyosis and PAS among women, we used a multivariable logistic regression model with multiple imputation for missing data. We evaluated mediation effect of ART including in vitro fertilization and intracytoplasmic sperm injection on the association between adenomyosis and PAS using causal mediation analysis based on the counterfactual approach., Results: Of 1 500 173 pregnant women, 1539 (0.10%) had adenomyosis. The number receiving ART was 489/1539 (31.8%) and 117 482/1 498 634 (7.8%) in women with and without adenomyosis, respectively. The proportion of women who developed PAS was 21/1539 (1.4%) in women with adenomyosis and 7530/1 498 634 (0.5%) in women without adenomyosis. Adenomyosis was significantly associated with PAS (odds ratio [OR] 1.95; 95% confidence interval [CI] 1.26-3.00; P = 0.002). Mediation analysis showed that OR of the total effect of adenomyosis on PAS was 1.98 (95% CI 1.13-3.04), OR of natural indirect effect (effect explained by ART) was 1.15 (95% CI 1.01-1.41), and OR of natural direct effect (effect unexplained by ART) was 1.72 (95% CI 0.86-2.82). The proportion mediated (natural indirect effect/total effect) was 26.5%. Adenomyosis was also significantly associated with PAS without previa (OR 1.96; 95% CI 1.23-3.13, P = 0.005)., Conclusion: Adenomyosis was significantly associated with PAS. ART mediated 26.5% of the association between adenomyosis and PAS., (© 2024 International Federation of Gynecology and Obstetrics.)

Objective: The study aimed to investigate treatment options for older women with pelvic organ prolapse (POP) and postoperative outcomes based on their long-term care (LTC) status., Methods: We used the medical and LTC insurance claims databases of Tochigi Prefecture in Japan, covering 2014 to 2019. We included women 65 years and older with POP and evaluated their care status and treatment, excluding women with an observation period <6 months. Among women with a postsurgical interval ≥6 months, we compared care level changes and deaths within 6 months and complications within 1 month postoperatively between those with and without LTC using Fisher exact test., Results: We identified 3406 eligible women. Of the 447 women with LTC and 2959 women without LTC, 16 (3.6%) and 415 (14.0%), respectively, underwent surgery. Among 393 women with a postsurgical interval ≥6 months, 19 (4.8%) required LTC at surgery. Two of the 19 women with LTC (10.5%) and eight of 374 women without LTC (2.1%) experienced worsening care-needs level. No deaths were recorded. Urinary tract infection (UTI) was significantly more frequent in women with LTC than in women without LTC (36.8% vs 8.6%). Other complications were rare in both groups., Conclusion: The proportion of patients who underwent surgery for POP was lower in women with LTC than in women without LTC. Postoperative UTI was common and 11% had a worsening care-needs level postoperatively, whereas other complications were infrequent. Further detailed studies would contribute to providing optimal treatment to enhance patients' quality of life., (© 2024 International Federation of Gynecology and Obstetrics.)

Objective: This study aimed to show the results of radical radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) for vulvar cancer (VC) based on data from a Japanese nationwide survey., Materials and Methods: We collected data from 108 institutions on cases of VC diagnosed between January 2001 and December 2010. Patients with histologically proven squamous cell carcinoma and adenocarcinoma with curative intent were selected, and 172 patients with VC were included in this study. The collected data were analyzed for overall survival (OS) using the Kaplan-Meier method. Univariate and multivariate analyses were performed to examine the prognostic factors for patients with VC., Results: The median follow-up period was 16.8 (range; 3.2-154.8) months. Fifty-five patients received CCRT, and 117 patients received RT alone. The 2-year OS rates (95% confidence interval [CI]) for stages I, II, III, and IV were 77.9% (55.8-100.0), 71.9% (53.8-89.9), 55.4% (42.5-68.3), and 41.5% (27.3-55.7) respectively. Univariate analyses showed that the FIGO stage (p = 0.001), tumor diameter (p = 0.005), and lymph node (LN) status (p = 0.001) were associated with OS. The concurrent use of chemotherapy resulted in a significantly longer OS in Stage III (p = 0.013). Multivariate analysis showed that the hazard ratios (95% CI) for tumor diameter, positivity for LN metastasis, and RT alone (no concurrent chemotherapy) were 1.502 (1.116-2.021), 1.801 (1.287-2.521), and 1.936 (1.187-3.159), respectively., Conclusions: Our analysis revealed that CCRT should be recommended, especially for Stage III VC patients. Further studies are warranted to determine who benefits from CCRT, considering primary tumor size and LN status. The study was registered at the University Hospital Medical Information Network (protocol number: UMIN000017080) on April 8th, 2015., (© 2024. The Author(s).)

Objective: In Japan, perioperative prophylaxis of pulmonary embolism (PE) in gynecologic cancer patients with preoperative asymptomatic venous thromboembolism (VTE) has not been well established yet. The GOTIC-VTE trial was a prospective, multi-center, single-arm clinical trial to investigate the prevention of postoperative symptomatic PE onset by seamless anticoagulant therapy from the preoperative period to 4 weeks after surgery instead of using intermittent pneumatic compression., Methods: Anticoagulant therapy was started immediately after asymptomatic VTE diagnosis and stopped preoperatively according to the rules of each institution. Unfractionated heparin administration was resumed within 12 hours postoperatively, and this was followed by the switch to low-molecular-weight heparin and subsequently, edoxaban; this cycle was continued for 28 days. Primary outcome was the occurrence of symptomatic PE in 28 days postoperatively. Secondary outcomes were the incidence of VTE-related events in 28 days and 6 months postoperatively and protocol-related adverse events., Results: Between February 2018 and September 2020, 99 patients were enrolled; of these, 82 patients were assessed as the full analysis set, including 58 for ovarian cancer, fallopian tube, or peritoneal cancer; 21 for endometrial cancer; and 3 for cervical cancer. No symptomatic PE was observed within 28 days postoperatively; two patients had bleeding events (major bleeding and clinically relevant nonmajor bleeding) and three had grade 3 adverse events (increased alanine transaminase, aspartate aminotransferase, or gamma-glutamyl transferase)., Conclusion: The multifaceted perioperative management for gynecologic malignancies with asymptomatic VTE effectively prevented postoperative symptomatic PE., Trial Registration: JRCT Identifier: jRCTs031180124., Competing Interests: YT, TS, and HF received honoraria from Daiichi Sankyo. KY received a research grant from Daiichi Sankyo. KH received honoraria and a research grant from Daiichi Sankyo. KF received honoraria from Daiichi Sankyo for consultation., (© 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.)

Objective: To investigate whether conisation increases chorioamnionitis (CAM) and assess whether this risk differs between preterm and term periods. Furthermore, we estimated mediation effects of CAM between conisation and preterm birth (PTB)., Design: A nationwide observational study., Setting: Japan., Population: Singleton pregnant women derived from the perinatal registry database of the Japan Society of Obstetrics and Gynaecology between 2013 and 2019., Methods: The association between a history of conisation and clinical CAM was examined using a multivariable logistic regression model with multiple imputation. We conducted mediation analysis to estimate effects of CAM on PTB following conisation., Main Outcome Measures: Clinical CAM., Results: Of 1 500 206 singleton pregnant women, 6961 (0.46%) underwent conisation and 1 493 245 (99.5%) did not. Clinical CAM occurred in 150 (2.2%) and 11 484 (0.8%) women with and without conisation, respectively. Conisation was associated with clinical CAM (odds ratio [OR] 3.09; 95% confidence interval (CI) 2.63-3.64; p < 0.001) (risk difference 1.57%; 95% CI 1.20-1.94). The association was detected among 171 440 women with PTB (OR 3.09; 95% CI 2.57-3.71), whereas it was not significant among 1 328 284 with term birth (OR 0.88; 95% CI 0.58-1.34). OR of total effect of conisation on PTB was 2.71, OR of natural indirect effect (effect explained by clinical CAM) was 1.04, and OR of natural direct effect (effect unexplained by clinical CAM) was 2.61. The proportion mediated was 5.9%., Conclusions: Conisation increased CAM occurrence. Obstetricians should be careful regarding CAM in women with conisation, especially in preterm period. Bacterial infections may be an important cause of PTB after conisation., (© 2023 John Wiley & Sons Ltd.)

We systematically reviewed case reports of posterior reversible encephalopathy syndrome (PRES), and investigated the characteristics of PRES in pregnant Japanese women and the clinical relevance of reversible cerebral vasoconstriction syndrome (RCVS) in pregnant women with PRES. Articles were collected using the PubMed/Medline and Ichushi-Web databases. This review was ultimately conducted on 121 articles (162 patients). The clinical characteristics of PRES, individual sites of PRES lesions, edema types, and clinical characteristics of RCVS in PRES cases were examined. The most common individual site of PRES lesion was the occipital lobe (83.3%), followed by the basal ganglia, parietal lobe, frontal lobe, brain stem, cerebellum, temporal lobe, thalamus, and splenium corpus callosum (47.5, 42.6, 24.7, 16.1, 9.3, 5.6, 4.3, and 0.0%, respectively). Edema types in 79 cases with PRES were mainly the vasogenic edema type (91.1%), with very few cases of the cytotoxic edema type (3.8%) and mixed type (5.1%). Among 25 PRES cases with RCVS, RCVS was not strongly suspected in 17 (68.0%) before magnetic resonance angiography. RCVS was observed at the same time as PRES in 13 cases (approximately 50%), and between days 1 and 14 after the onset of PRES in the other 12. These results suggest that the basal ganglia is a frequent site of PRES lesions in pregnant women. RCVS may occur at or after the onset of PRES, even if there are no symptoms to suggest RCVS., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Background: Intraperitoneal adhesion is a common complication of cesarean section, and adhesion barriers are often used to prevent postoperative adhesion. However, the association between the use of adhesion barriers and infections after cesarean section remains unknown. This study aimed to evaluate the association., Methods: Using the administrative claims database of a single prefecture in Japan, we identified all patients who underwent cesarean section from June 2014 to February 2019. A multivariable logistic regression model fitted with a generalized estimating equation was used to compare the postoperative outcomes between patients who received intraperitoneal adhesion barriers during cesarean section and those who did not. The primary outcome was intraperitoneal or uterine infections within 3 months after cesarean section, including intraperitoneal abscess, pelvic inflammatory disease, peritonitis, uterine wound infection, endometritis, and adnexitis., Results: A total of 1,392 patients with 1,498 cesarean section cases were reviewed. Adhesion barriers were used in 1,153/1,498 (77.0%) cases. One hundred and fourteen (9.9%) intraperitoneal or uterine infections occurred in the group with and 15 (4.3%) in the group without adhesion barriers. The proportion of intraperitoneal or uterine infections was significantly higher in the group with than in the group without adhesion barriers (9.9% and 4.3%, respectively; adjusted odds ratio = 2.59; 95% confidence interval, 1.40-4.77; P = .002)., Conclusion: The use of adhesion barriers was associated with an increase in intraperitoneal or uterine infections after cesarean section., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: In Japan, no region has introduced primary HPV testing for cervical cancer screening. We assessed the diagnostic value and possible harm of HPV testing in Japan., Methods: This cross-sectional study with historical controls used cytology-based screening and co-testing data in Japan. As surrogate indicators of possible harm, colposcopy referral rate and cervical intraepithelial neoplasm (CIN) 1 detection rates were calculated. As surrogate indicators with diagnostic values, the detection rates of CIN2 or greater (CIN2+) and CIN3+ were calculated., Results: The data of 297 970 women (182 697 for cytology-based, 115 273 for co-testing) were examined. The detection rates of CIN1, CIN2+, and CIN3+ were significantly higher in the co-testing group than in the cytology-based group (P < 0.001, P < 0.0001, P < 0.01, respectively). Between ages 25-49, CIN2+ detection rates were significantly higher in the co-testing group than in the cytology-based group (P < 0.05 for each 5-year age group). Between ages 30-49, CIN3+ detection rates were significantly higher in the co-testing group than in the cytology-based group (P < 0.05 for each 5-year age group)., Conclusion: Limiting the target age group may minimize the possible harm of screening. Cytology/HPV co-testing may be useful in Japanese populations if balance is maintained between benefit and harm., (© 2021 International Federation of Gynecology and Obstetrics.)

Objective: The addition of maintenance olaparib to bevacizumab demonstrated a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the PAOLA-1/ENGOT-ov25 trial (NCT02477644). We evaluated maintenance olaparib plus bevacizumab in the Japan subset of PAOLA-1., Methods: PAOLA-1 was a randomized, double-blind, phase III trial. Patients received maintenance olaparib tablets 300 mg twice daily or placebo twice daily for up to 24 months, plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total. This prespecified subgroup analysis evaluated investigator-assessed PFS (primary endpoint)., Results: Of 24 randomized Japanese patients, 15 were assigned to olaparib and 9 to placebo. After a median follow-up for PFS of 27.7 months for olaparib plus bevacizumab and 24.0 months for placebo plus bevacizumab, median PFS was 27.4 versus 19.4 months, respectively (hazard ratio [HR]=0.34; 95% confidence interval [CI]=0.11-1.00). In patients with tumors positive for homologous recombination deficiency, the HR for PFS was 0.57 (95% CI=0.16-2.09). Adverse events in the Japan subset were generally consistent with those of the PAOLA-1 overall population and with the established safety and tolerability profiles of olaparib and bevacizumab., Conclusion: Results in the Japan subset of PAOLA-1 support the overall conclusion of the PAOLA-1 trial demonstrating that the addition of maintenance olaparib to bevacizumab provides a PFS benefit in patients with newly diagnosed, advanced ovarian cancer., Trial Registration: ClinicalTrials.gov Identifier: NCT02477644., Competing Interests: Professor Keiichi Fujiwara reports receiving consulting fees and grant support from Pfizer, Eisai, Merck Sharp & Dohme, Taiho, Zeria, Chugai Pharmaceutical, Genmab, and Takeda Pharmaceutical Company, receiving grant support from Immunogen, Oncotherapy, and Regeneron, and receiving consulting fees from Novartis, Kyowa Hakko Kirin, Daiichi Sankyo, Mochida Pharmaceutical, and NanoCarrier; Dr Toyomi Satoh reports receiving consulting fees from AstraZeneca, Chugai Pharmaceutical, Daiichi Sankyo, Kyowa Kirin, Eisai, Tsumura, Nippon Kayaku, Mochida Pharmaceutical, Bayer Yakuhin, ASKA Pharmaceutical, Bristol-Myers Squibb, Taiho Pharmaceutical, Takeda Pharmaceutical Company, Kaken Pharmaceutical, Nobelpharma, and Ono Pharmaceutical; Dr Kan Yonemori reports receiving lecture fees and advisory fees from Takeda Pharmaceutical Company and Esai, receiving lecture fees from AstraZeneca, Pfizer, and Daiichi Sankyo, and advisory fees from Chugai Pharmaceutical, Ono Pharmaceutical, and Novartis; Dr Shogi Nagao reports receiving consulting fees and grant support from Takeda Pharmaceutical Company, consulting fees from Chugai Pharmaceutical, AstraZeneca, Asahi Kasei Medical, and Mochida Pharmaceutical, and grant support from AbbVie, Clovis Oncology, Pfizer, Toray, Tosoh, and Preferred Networks; Dr Philipp Harter reports receiving consulting fees and grant support AstraZeneca, Roche, Tesaro, and GlaxoSmithKline, consulting fees from Sotio, Zai Lab, Merck Sharp & Dohme, Clovis Oncology, and Immunogen, and grant support from Boehringer Ingelheim, Medac, Genmab, the European Union, Deutsche Krebshilfe, and Deutsche Forschungsgemeinschaft; Dr Isabel Palacio Vazquez reports receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Novartis, GlaxoSmithKline, and Bristol-Myers Squibb, travel fees from Novartis, GlaxoSmithKline, and Roche, and advisory board fees from AstraZeneca, Bristol, GSK, and Clovis Oncology; Tomoko Fujita reports being employed by AstraZeneca and being a shareholder of AstraZeneca; Philip Rowe reports being employed by AstraZeneca; Professor Eric Pujade-Lauraine reports receiving consulting and other non-financial support from AstraZeneca, Roche, and Tesaro, consulting fees from Clovis Oncology, Incyte, and Pfizer, and holds the role as chairperson in ARCAGY Research; Professor Isabelle Ray-Coquard reports receiving consulting fees, grant and travel support from AstraZeneca and Roche, consulting fees and travel support from GlaxoSmithKline, consulting fees from Clovis Oncology, PharmaMar, Mersana Therapeutics, Deciphera Pharmaceutical, Amgen, and Chugai Pharmaceutical, grant support from Bristol Myers Squibb, and consulting fees and grant support from Merck Sharp & Dohme; Dr Hiroyuki Fujiwara, Dr Hiroyuki Yoshida, Dr Takashi Matsumoto, Dr Hiroaki Kobayashi, Dr Hugues Bourgeois, Dr Anna Maria Mosconi, and Dr Alexander Reinthaller report no potential conflict of interest relevant to this article., (Copyright © 2021. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.)

The Fourth Edition of the Guidelines for Treatment of Uterine Body Neoplasm was published in 2018. These guidelines include 9 chapters: 1. Overview of the guidelines, 2. Initial treatment for endometrial cancer, 3. Postoperative adjuvant therapy for endometrial cancer, 4. Post-treatment surveillance for endometrial cancer, 5. Treatment for advanced or recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment of uterine carcinosarcoma and uterine sarcoma, 8. Treatment of trophoblastic disease, 9. Document collection; and nine algorithms: 1-3. Initial treatment of endometrial cancer, 4. Postoperative adjuvant treatment for endometrial cancer, 5. Treatment of recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment for uterine carcinosarcoma, 8. Treatment for uterine sarcoma, 9. Treatment for choriocarcinoma. Each chapter includes overviews and clinical questions, and recommendations, objectives, explanation, and references are provided for each clinical question. This revision has no major changes compared to the 3rd edition, but does have some differences: 1) an explanation of the recommendation decision process and conflict of interest considerations have been added in the overview, 2) nurses, pharmacists and patients participated in creation of the guidelines, in addition to physicians, 3) the approach to evidence collection is listed at the end of the guidelines, and 4) for clinical questions that lack evidence or clinical validation, the opinion of the Guidelines Committee is given as a "Recommendations for tomorrow"., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2020. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.)

Objective: We conducted a prospective, multicentre study to compare the clinical performance of liquid-based endometrial cytology (LBEC) using SurePath™ with that of suction endometrial tissue biopsy (SETB). This study is officially advocated and reported by the Japan Association of Obstetricians and Gynecologists. By publishing our midterm data, we intend to disseminate the benefits of LBEC system, using the descriptive reporting format and algorithmic interpretational approach., Methods: From April 2014 to December 2015, we consecutively assessed 1116 LBEC specimens and 1044 SETB specimens in our five outpatient clinics., Results: The sensitivity of suction tissue biopsies was 85.2%, whereas the sensitivity of LBEC was 92.2%. The specificity of suction tissue biopsies was 98.9% and that of LBEC was 98.5%. The negative predictive value of LBEC (99.1%) was higher than that of SETB (98.1%), although the difference between these values was not significant., Conclusions: The clinical performance of LBEC for detecting endometrial malignancies was almost identical to the performance of SETB. This indicates that LBEC was not inferior to SETB for the detection of endometrial cancer. The LBEC is appropriate for various clinical situations as the first-step detecting tool. In addition, it could be used for cancer surveillance for women with signs highly suggestive of endometrial malignancies and in Lynch syndrome patients, on a larger scale., (© 2018 John Wiley & Sons Ltd.)

Background: One of the features of cervical cancer screening using the combination of cytology and human papillomavirus (HPV) testing is the triage for atypical squamous cells of undetermined significance (ASC-US). The effectiveness of the triage has been recognized widely. However, there are few reports evaluating this triage process in Japan. Material and Methods: We retrospectively examined the results of cytology and HPV co-testing for cervical cancer screening in the Oyama area of Tochigi Prefecture between 2012 and 2014. Women who were ASC-US/HPV positive and had cytologic abnormalities [low-grade squamous intraepithelial lesions (LSIL) or worse] were examined by colposcopy. The results of the colposcopy testing were evaluated. In addition, we also examined the results of those who underwent co-testing a year after a ASC-US/HPV-negative result. Results: A total of 21,342 women received their first screening test during the study period, with 542 (2.5%) found to have ASC-US. Of the ASC-US-positive women, 289 (53.3%) were also HPV positive. The prevalence of CIN+ (cervical intraepithelial neoplasia or higher) in the ASC-US/HPV-positive group was 63.2%, with 81.8%, 16.4% and 4.8%. showing CIN 1, CIN 2 and CIN 3+, respectively. The prevalence of CIN+ in the LSIL group was 66.8%, with the majority having a low risk CIN 1 (76.6%) compared to CIN 2 (18.6%), and CIN 3+ (4.8%). No significant difference was observed between the LSIL and ASC-US/ HPV-positive groups. The prevalence of women diagnosed with CIN in the ASC-US/HPV-negative group, following co-testing a year after colposcopy was low (3%). Conclusions: The ASC-US/HPV-positive group was comparable to the LSIL group in terms of prevalence of CIN+ lesions. Furthermore, low CIN prevalence after one year in the ASCUS/ HPV-negative group provides confirmation that the screening interval could be extended. The application of HPV triage (which is routine in other countries) to identify these groups would be of benefit in Japan., (Creative Commons Attribution License)

Human epididymis protein 4 (HE4) levels and the Risk of Ovarian Malignancy Algorithm (ROMA) have recently been shown to improve the sensitivity and specificity of epithelial ovarian cancer (EOC) diagnosis. We evaluated HE4 levels and ROMA as diagnostic tools of type I and type II EOC in Japanese women. Women who had a pelvic mass on imaging and were scheduled to undergo surgery were enrolled as ovarian mass patients. Serum levels of carbohydrate antigen 125 (CA125) and HE4 were tested in 319 women (131 benign, 19 borderline, 75 malignant, and 94 healthy controls). CA125, HE4, and ROMA were evaluated for sensitivity and by receiver operating characteristics (ROC) in type I and type II EOC. The results showed that, at 75% specificity, the sensitivity of CA125 and HE4 for type II was 92.1% for both markers and for type I was 51.5% and 78.8%, respectively. The sensitivities of ROMA (type I, 84.8% and type II, 97.4%) were better than those of CA125 and HE4. CA125, HE4, and ROMA were all highly accurate markers for type II. For type I, HE4 and ROMA showed better sensitivity than CA125. ROMA displayed the best diagnostic power for type I and type II including for the early stage of type I. In conclusion, HE4, CA125, and ROMA are valuable markers for type II EOC diagnosis. HE4 and ROMA analyses may improve differentiation between type I EOC and a benign mass. Measurement of combined HE4 and CA125 levels provides a more accurate method for EOC diagnosis.

Background: The aim of this study was to investigate the impact of the histological findings on the treatment of malignant ovarian tumors in pregnant women., Methods: This is a retrospective study of 41 patients diagnosed and treated for ovarian malignancy during pregnancy between 1985 and 2010., Results: The median age of the study group was 30 years old, ranging from 20 to 41. Thirty-eight (92 %) patients were diagnosed with stage I, and one (2 %) with each of stages II, III, and IV. Twenty-five (61 %) patients had borderline malignancy, 8 (20 %) were diagnosed with epithelial ovarian cancer, 7 (17 %) with germ cell tumor, and one with sex cord stromal tumor. All patients received primary surgery; 7 (17 %) patients had cystectomy, 32 (78 %) had unilateral salpingo-oophorectomy, and 3 (7 %) underwent hysterectomy with bilateral salpingo-oophorectomy. Thirty-one (76 %) patients delivered live newborns; 21 had borderline tumor (84 %), 2 had ovarian cancers (25 %), and 8 had non-epithelial tumor (100 %). Six cases were terminated in order to perform the standard treatment for ovarian malignancy and 2 cases aborted spontaneously., Conclusion: In pregnant women, ovarian cancer is exceptionally less frequent compared with non-pregnant women, i.e. age-matched, statistically-corrected controls based on the Japanese annual report [8/33 (24 %) vs. control (60 %); ovarian cancer/(ovarian cancer + borderline tumor), P = 0.001]. The pregnant women with ovarian cancer chose to prioritize treatment of ovarian cancer at the sacrifice of their babies while those with borderline tumor or non-epithelial tumor were able to successfully deliver live newborns.

Pathologic slides from 150 patients with clear cell adenocarcinoma from the collaborating institutions were reviewed independently by 2 pathologists, and each tumor was graded histologically using the Shimizu-Silverberg and International Federation of Gynecology and Obstetrics (FIGO) grading systems. For the Shimizu-Silverberg grading system, 3 parameters-architectural pattern, nuclear pleomorphism, and mitotic activity-were assessed and scored as 1 to 3. When the summed scores of these parameters were 3 to 5, 6 to 7, and 8 to 9, grades 1, 2, and 3 were assigned, respectively. The FIGO grade was based on the ratio of glandular/papillary growth versus solid growth: grade 1, less than 5% solid tumor; grade 2, 5% to 50% solid tumor; grade 3, greater than 50% solid tumor. Interobserver agreement levels for assignment of both gradings were fair (κ=0.32 and 0.24, respectively). After consensus had been acquired, 82 (55%), 56 (37%), and 12 (8%) tumors were classified as grades 1, 2, and 3 by the Shimizu-Silverberg grading system, and 88 (59%), 38 (25%), and 24 (16%) were classified as grades 1, 2, and 3 by the FIGO grading system, respectively. Survival analyses indicated that patients with grade 3 tumors, as defined by both the grading systems, tended to have a poor outcome, but any differences between them were not statistically significant. Multivariate analysis showed that only the presence of residual tumor after initial surgery was an independent prognostic factor for overall survival. These results suggest that the 2 tested grading systems have limited value for the prognostication of patients with clear cell adenocarcinoma, and that a more effective grading system for this tumor may be required.

Background: Advanced-stage ovarian cancer patients are generally treated with platinum/taxane-based chemotherapy after primary debulking surgery. However, there is a wide range of outcomes for individual patients. Therefore, the clinicopathological factors alone are insufficient for predicting prognosis. Our aim is to identify a progression-free survival (PFS)-related molecular profile for predicting survival of patients with advanced-stage serous ovarian cancer., Methodology/principal Findings: Advanced-stage serous ovarian cancer tissues from 110 Japanese patients who underwent primary surgery and platinum/taxane-based chemotherapy were profiled using oligonucleotide microarrays. We selected 88 PFS-related genes by a univariate Cox model (p<0.01) and generated the prognostic index based on 88 PFS-related genes after adjustment of regression coefficients of the respective genes by ridge regression Cox model using 10-fold cross-validation. The prognostic index was independently associated with PFS time compared to other clinical factors in multivariate analysis [hazard ratio (HR), 3.72; 95% confidence interval (CI), 2.66-5.43; p<0.0001]. In an external dataset, multivariate analysis revealed that this prognostic index was significantly correlated with PFS time (HR, 1.54; 95% CI, 1.20-1.98; p = 0.0008). Furthermore, the correlation between the prognostic index and overall survival time was confirmed in the two independent external datasets (log rank test, p = 0.0010 and 0.0008)., Conclusions/significance: The prognostic ability of our index based on the 88-gene expression profile in ridge regression Cox hazard model was shown to be independent of other clinical factors in predicting cancer prognosis across two distinct datasets. Further study will be necessary to improve predictive accuracy of the prognostic index toward clinical application for evaluation of the risk of recurrence in patients with advanced-stage serous ovarian cancer.

Study Objective: To investigate the feasibility and clinical usefulness of transvaginal salpingoscopy (TS) during transvaginal hydrolaparoscopy (THL) in infertile women., Design: Retrospective study (Canadian Task Force classification II-3)., Setting: Jichi Medical School, Tochigi, Japan., Patients: One hundred thirty infertile women, aged 22 to 43 years, who underwent THL., Interventions: Transvaginal salpingoscopy findings in comparison with THL findings., Measurements and Main Results: Transvaginal salpingoscopy could be performed in 41.0% of the attempted tubes. In comparing rates of successful TS in relation to tubal patency, tubal morphology, and past Chlamydia trachomatis infection, patent tubes and normal-appearing tubes classified with normal morphology had a significantly higher TS success rate. However, past C. trachomatis infection did not affect the success of TS. There was a significant correlation between salpingoscopic and laparoscopic findings; however, there were no significant correlations between salpingoscopic findings and C. trachomatis antibody titers., Conclusions: These findings suggest that TS can be performed simultaneously in some infertile women undergoing THL especially those with patent tubes or with normal-appearing tubes. Further studies are required to show the usefulness of intratubal exploration in assessing tubal infertility.