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Based on data from national surveys, the prevalence of hypertension rests at 40–60% in Japan, the USA, and in European countries. This suggests there has been little progress in the prevention of hypertension in even high-income countries despite their well-functioning health systems. In particular, compared with the USA and European countries, the improvement in awareness, treatment, and control of hypertension has been relatively low in Japan. For example, the rates of hypertension awareness, treatment, and control were observed, respectively, in 60–70%, 50–60%, and 20–30% of Japanese compared with 80–90%, 70–80%, and 50–60% of US citizens in the years around 2015. The lower proportions in Japan might be explained by the slower progress in lowering the accepted thresholds for diagnosis of hypertension and initiation of treatment compared with Western countries; however, the underlying reasons for the differences warrant further study. The high prevalence (>40%) of uncontrolled hypertension in even high-income countries has major implications for the prevention of cardiovascular disease. Health policy and research on early control of high blood pressure at the individual and public health levels will contribute to decreases in the prevalence of hypertension. Furthermore, proactive treatment and strict adherence to intensified antihypertensive treatment guidelines will more effectively achieve targeted blood pressure levels. In this context, it is important to continue to carefully monitor and compare trends in hypertension across countries.

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•The associations between metabolic syndrome and physical activity were compared between healthy middle-aged American men and Japanese men.•Higher total step counts/day had a protective effect on metabolic syndrome in both cohorts.•The effect of steps/day was greater than domain-specific moderate-vigorous physical activity captured by questionnaire.•Tools that capture total movement may be important to assess the effects of physical activity on metabolic syndrome.

Background/objectives:: Clinical trials of eicosapentaenoic acid (EPA) among high-risk groups in Japan in which consumption of mairne-omega-3 fatty acids (OM3) is much higher than other countries showed slower progression of coronary atherosclerosis. We aimed to determine the cross-sectional associations of coronary artery calcification (CAC) and calcium density with OM3, EPA, and docosahexaenoic acid (DHA), two principal OM3, in the general population in Japan. Subjects/methods:: The Shiga Epidemiological Study of Subclinical Atherosclerosis examined a population-based sample of 1074 men aged 40–79 in 2006–08 for computed tomography-measured CAC score (CCS), a well-established biomarker of coronary atherosclerosis, CAC density score (CDS), a potential marker of plaque stabilization, serum levels of OM3, and risk factors. Results:: Prevalence of CCS > 0, ≥ 100, and ≥ 300 was 65.8%, 25.9%, and 12.9%, respectively; the mean (SD) OM3, EPA, and DHA were 10.1% (3.2), 3.2% (1.7), and 5.9% (1.6), respectively. Odds ratios (95% CI, p-value) of CCS 0, 100, and 300 in ordinal logistic regression associated with 1 SD increase of OM3, EPA, and DHA were 0.91 (0.81–1.03, p= 0.12), 0.99 (0.88–1.11, p= 0.87) and 0.84 (0.74–0.94, p= < 0.01), respectively. The inverse association of DHA with CCS remained significant in multivariate-adjusted model: odds ratio of 0.87 (0.77–0.99, p= 0.03). Blood levels of OM3, EPA, or DHA did not have any significant associations with CDS. Conclusions:: DHA but not EPA had a significant inverse association with coronary atherosclerosis in the general population with high levels of OM3. Future trials are warranted comparing the effect of high-dose DHA and EPA on atherosclerosis and cardiovascular outcomes.

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Background and Aim:To determine whether a mild decrease in renal function is an indicator of early detection of silent cerebrovascular disease, we conducted a cross-sectional study in 735 community-dwelling Japanese men.Methods:The prevalence of silent cerebrovascular disease was defined as intracranial artery stenosis (ICAS), lacunar infarctions (LIs), cerebral microbleeds (CMBs), periventricular hyperintensities (PVHs: grade ≥2), and deep and subcortical white matter hyperintensities (DSWMHs: grade ≥3), using brain magnetic resonance imaging independently evaluated by two specialists. In addition, a total cerebral small vessel disease (TCSVD) score was used, summing LIs, CMBs, PVHs, and DSWMHs. We calculated the estimated glomerular filtration rate calculated with creatinine or cystatin C (eGFRcr or eGFRcys) using the CKD-EPI formula for Japanese and the equations by the Japanese Society of Nephrology, respectively. The urinary albumin/creatinine ratio (UACR) was dichotomized at 30 mg/gCre, and the low group was further divided into tertiles. eGFRcr and eGFRcys were also dichotomized at 60 ml/min/1.73 m2, and the high group was further divided into tertiles. The odds ratios (ORs) and 95% confidence intervals (95%CIs) for the prevalence of silent cerebrovascular disease by renal function were calculated using binary or ordinal multivariable adjusted logistic regression models.Results:The prevalence of ICAS, LIs, CMBs, and white matter lesions (WMLs: the prevalence of PVHs or DSWMHs) was 30% (220/735), 21% (155/735), 14% (102/735), and 32% (237/735), respectively. The multivariable adjusted ORs (95%CI) of the prevalence of CMBs and TCSVD score were higher in the high UACR (>30mg/gCre) group (3.83 (1.90-7.73) and 1.75 (1.12-2.74), respectively) than in the low UACR (≤4.7 mg/gCre) group; the linear trend was significant (p <0.001 and p=0.025, respectively). The multivariable adjusted ORs (95%CI) of TCSVD score was higher in the decreased (<60 ml/min/1.73 m2) eGFRcr or eGFRcys group (1.70 (0.998-2.91) and 1.85 (1.10-3.10), respectively) than in the high eGFRcr group (≥75.9 ml/min/1.73 m2) or the high eGFRcys group (≥83.3 ml/min/1.73 m2); the linear trend was shown (p=0.036 and p=0.072, respectively). The multivariable adjusted ORs (95%CI) of the prevalence of WML was higher in the decreased (<60 ml/min/1.73 m2) and mildly decreased (60-69.9 ml/min/1.73 m2) eGFRcr groups (2.41 (1.31-4.43) and 1.78 (1.05-3.02), respectively) than in the high eGFRcr group (≥75.9 ml/min/1.73 m2); the linear trend was significant (p<0.001). eGFRcys and the prevalence of WML also showed similar associations.Conclusion:Decreased renal function was associated with the presence of silent cerebrovascular disease. Our results suggest that even a mild decline in renal function may be an indicator of early detection of silent cerebrovascular disease.

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In Western populations, blood pressure (BP) measured at baseline has been reported to predict long-term (over 20 years) risk of mortality from cardiovascular diseases (CVDs). However, corresponding evidence is scarce in Asia where stroke is dominant. We investigated the association between baseline BP and 24-year mortality risk due to CVD, in a representative Japanese general population.

Abstract: The metastasis suppressor gene nm23 located on chromosome 17 might be one of the targets in deletions of chromosome 17. In this study, we analyzed the expression of nm23 and chromsome 17 aberrations in gastric cancer and assessed their clinicopathological and prognostic significance. In 103 gastric cancer patients, we examined nm23 expression by immunohistochemistry and detected chromosome 17 aberrations by fluorescence in situ hybridization. There was a significant difference in the expression of nm23 among differentiated histologic types (well>moderately>poorly) (p<0.01). Negative expression of nm23 correlated with depth of invasion (p<0.01), lymph node metastasis (p<0.05), lymphatic invasion (p<0.05), venous invasion (p<0.05), poor prognosis (p<0.05), and chromosome 17 loss (p<0.05). Chromosome 17 aberrations broadly correlated with clinicopathological variables and were associated with poor prognosis (p<0.05). Univariate analyses identified nm23 (p<0.05), chromosome 17 aberrations (p<0.05), tumor size (p<0.01), depth of invasion (p<0.0001), lymph node metastasis (P<0.001), hepatic metastasis (p<0.01), peritoneal dissemination (p<0.01), and lymphatic invasion (p<0.01) as significant prognostic factors. Multivariate analysis showed that expression of nm23 and chromosome 17 aberrations were not independent prognostic indicators. Our results indicate that negative expression of nm23 and chromosome 17 numerical aberrations correlate with tumor progression and poor prognosis but are not independent prognostic indicators.

Mediastinitis resulting from a perforated esophageal diverticulum is a potentially fatal complication and the surgical treatment of persistent esophagomediastinal fistula may be difficult. In this report, we describe the successful application of an omental pedicle flap in the delayed repair of a perforated esophageal diverticulum. A 53-year-old man presented with chest and back pain and a diagnosis of perforated esophageal diverticulum was subsequently confirmed. After receiving conservative treatment, he was referred to our department and underwent surgical repair 6 months following the onset of the perforation. Through a right thoracotomy, the mucosal layer of the esophagus around the diverticulum was sutured, and an omental pedicle flap was used to cover the suture line and obliterate the fistulous tract. His postoperative course was uneventful and the suture line healed well. The successful treatment of this patient reinforces our belief that wider application of the omental pedicle flap can be expected in the field of thoracic surgery.

Problematic internet use (PIU) has been suggested in relation to psychological symptoms among schoolteachers, but the relationship with physical symptoms remains unclear. We examined whether PIU or longer Internet usage time is associated with neck pain in schoolteachers. We conducted a cross‐sectional study among 2582 teachers aged 20 years or older (35.6% women) in Shimane and Tottori, Japan in 2018. Neck pain was defined as ≥5 points on the Neck Disability Index. The Compulsive Internet Use Scale (CIUS) was used to assess PIU. Internet usage time on weekdays and weekends was divided into five groups: 0, 1–29, 30–59, 60–119, and ≥120 min/day. Logistic regression analysis was conducted to examine the association of the CIUS score and Internet usage time on weekdays or weekends with neck pain, adjusting for sex, age, position at school, insomnia, and psychological distress. We observed 800 (31.0%) teachers with neck pain. The median (interquartile range) of their CIUS scores was 7 (2, 14). A higher CIUS score was independently associated with a higher prevalence of neck pain (odds ratio of 4th vs. 1st quartiles, 1.41; 95% confidence interval, 1.06–1.87; trend P= .006). Compared with non‐Internet users, Internet users on weekdays had almost double the odds of neck pain although the difference did not reach the customary level for designating statistical significance. In conclusion, teachers with higher scores in CIUS were associated with a higher prevalence of neck pain in Japan, suggesting adults with PIU being at risk of physical disorders.

Introduction:Drinking alcohol before sleeping (Ne-Zake) or in the morning (Mukae-Zake) is occasionally seen in Japan although it is well known that drinking alcohol have some negative effects on sleep. There have been studies which indicated that alcohol worsen sleep quality and quantity however few which investigated how alcohol before sleeping and no which noticed on how alcohol in the morning affects. The purpose of this study is to verify the relationship between Ne-Zake and/or Mukae-Zake and insomnia adjusting the influence of quality and frequency of drinking on the relationship.Hypothesis:We assessed the hypothesis that there is a significant association between Ne-Zake and/or Mukae-Zake and sleeplessness but this association can be confounded by quality and frequency of drinking.Method:Seven hundred and forty-six farmers who underwent annual medical checkups were analyzed. Ne-Zake was defined as “drinking as a sleeping aid” and Mukae-Zake was defined as “drinking in order to get calm down or to fix hungover”. Athene Insomnia Scale (AIS) was used to evaluate objective sleeplessness. AIS consists of 8 questions, which were evaluated from 0 (no sleeplessness) to 3 points (severe sleeplessness), asking the sleeping status in the previous 2 weeks. Insomnia was defined by AIS point more than 6. We conducted the multivariable logistic analysis, setting the presence of insomnia as a dependent variable and the presence of Ne-Zake and Mukae-Zake, quantity of alcohol at one time, frequency of drinking, sleeping related diseases (sleep apnea syndrome, restless leg syndrome, narcolepsy, limb movement disorder, depression), gender, and age as independent variables.Results:Among a total of 746 farmers (mean age 59.5 years; 74.1% men), insomnia, Ne-Zake, and Mukae-Zake were observed in 151 (20.2%), 140 (18.8%) and 37 (5.0%), respectively. Adjusted odds ratios (95% Confidence Intervals) of Ne-Zake and Mukae-Zake were 1.75 (1.07-2.88) and 3.01 (1.41-6.42). The association of Ne-Zake was consistent between men and women but that of Mukae-Zake was stronger in men than in women. (P-values for interaction = 0.98 and 0.03, respectively).Conclusion:Both Ne-Zake and Mukae-Zake had statistically positive significant association with insomnia independent of quantity and frequency of drinking. It may indicate that the timing of drinking alcohol has a stronger relationship with insomnia than quantity and frequency of drinking does. The feature of farmers’ lives in which they can decide their life style might give more opportunities to have Ne-Zake and/or Mukae-Zake than groups with well-scheduled working environment. This result can be utilized to improve farmers’ further physical and psychological health related to alcohol by encouraging to pay attention to not only the quantity or frequency of alcohol drinking but also the timing in a day.

Background:Blood pressure (BP) indexes (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], mean arterial pressure [MAP]) shows association with subclinical cerebrovascular diseases (SCVDs). Although various studies reported this association, there are still controversy in the effect size of long period versus short period of these indexes to SCVDs.Aim:Identifying the effect size of four BP indexes measured at two visits on SCVDs assessed by magnetic resonance imaging (MRI) in general Japanese men.Methods:Four office BP indexes were measured at two visits 4.5 years apart in general Japanese men aged 40-79 years. Participants without myocardial infarction or stroke history were analyzed (N=629). MRI obtained at 3rdvisit were investigated for prevalent of five SCVDs diagnosed as follows; lacunar infarction (LI)= any presence, periventricular hyperintensity (PVH)= Fazekas grade ≥2, deep subcortical white matter hyperintensity (DSWMH)= Fazekas grade ≥3, microbleeds= any presence, and intracranial arterial stenosis (ICAS)= ≥1% stenosis. Using multivariable logistic regression, we computed and compared odds ratio OR (95% CI) of each prevalent SCVD for 1 standard deviation higher of each of 4 BP indexes after adjusting for SCVDs’ conventional risk factors.Results:Participants’ mean age at Visit 1 was 63.9 years. Our results show all office BP indexes, except PP, similar association with MRI outcomes at both Visit 1 and Visit 2. SBP, DBP and MAP were associated with LI, PVH, DSWMH, microbleed and ICAS, while PP was associated with LI and ICAS only.Conclusion:In general Japanese men, BP indexes SBP, DBP and MAP measured at two distinct visits show similar association to all future MRI assessed SCVD, while PP shows association to LI and ICAS only.

Objective:Passive smoking was reported to impair endothelial vascular function in an acute phase. However, studies regarding the vascular effect of passive smoking status among general population are still scarce. We investigated the association of passive smoking status to endothelial vascular function among general Japanese women.Methods:Study participants were 243 Japanese women who had never smoked, and aged 69 to 85 years randomly selected from Kusatsu City, Japan. Using self-administered questionnaire, passive smoking status and passive smoking hour per week at recent 1 year and those of 20 years ago were obtained. They were classified into 4 groups (never, past, current; <2 hours/week, ≥2 hours/week). Endothelial vascular function was assessed with reactive hyperemia index (RHI) using Endo-PAT2000 (itamar-medical). RHI ≤1.67 were defined as low RHI. Age adjusted means of RHI according to passive smoking status was estimated. Simple liner regression analysis tested the association between RHI and traditional atherosclerotic risk factors such as age, body mass index (BMI), systolic and diastolic blood pressure, heart rate, lipids, fasting blood glucose and hemoglobin A1c. Age and multivariable adjusted odd’s ratios and 95% confidence intervals (OR, 95%CI) of passive smoking status for low RHI were estimated using logistic regression. Variables which showed statistical significant association to RHI in simple liner regression were adjusted.Results:Distribution of passive smoking status was; never 42.4%, past 42.0%, current <2 hours/week 6.5%, ≥2 hours/week 9.1%. Low RHI was confirmed in 41.2% of study participants. Age adjusted means of RHI did not differ significantly by smoking status (Age adjusted mean ± SD of RHI; never 1.94 ± 0.06, past 1.88 ± 0.06, current <2 hours/week 1.85 ± 0.15, ≥2 hours/week 2.15 ± 0.13, p=0.270). In simple liner regression analysis, BMI, diastolic blood pressure, heart rate and fasting glucose showed statistical significant association to RHI, and these variables were adjusted in multivariable adjusted logistic regression model. In logistic regression analyses, significant association of passive smoking status to low RHI was not confirmed [Age adjusted OR (95%CI); never (reference), past 1.00 (0.57-1.75), current <2 hours/week 1.45 (0.50-4.23), ≥2 hours/week 0.66 (0.25-1.76), multivariable adjusted OR (95%CI); never (reference), past 1.02 (0.57-1.82), current <2 hours/week 1.72 (0.57-5.21), ≥2 hours/week 0.61 (0.22-1.73)].Conclusion:Passive smoking status was not associated to endothelial vascular function assessed with RHI among general Japanese women. Further investigation is still required.

Background and Purpose:Intracranial subclinical vessel diseases are considered important indicators of cognitive impairment. However, comprehensive assessment on various types of vessel disease is lacking. We aim to compare various types of intracranial vessel disease in association with cognitive function among a community-based male population.Method:The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited and examined participants from Shiga, Japan in 2006-08 at baseline. Among 824 male participants in the follow-up exam (2010-12), we restricted our analyses to those who underwent the Cognitive Abilities Screening Instrument (CASI), cranial magnetic resonance imaging/angiogram (MRI/MRA, 1.5-Tesla), and free of stroke or neurodegenerative disease. Using MRI/MRA, we assessed intracranial arterial stenosis and four types of small vessel diseases: lacunar infarction and microbleed, periventricular hyperintensity (PVH), deep and subcortical white matter hyperintensity (DSWMH). We graded each vessel disease into 3 grades by severity. Cerebral artery stenosis was graded according to the presence of most stenotic lesions in the major 11 vessels: no stenosis (grade 1), 1-50% stenosis at least 1 vessel (grade 2), ≥ 50% stenosis at least 1 vessel (grade 3). Lacunar infarct was graded according to number of infarct: 0 (grade 1), 1-2 (grade 2), >2 (grade 3). Microbleed was graded according to number of microbleed: 0 (grade 1), 1 (grade 2), ≥2 (grade 3). PVH and DSWMH were graded according to Shinohara’s scale (a modified Fazekas scale): scale 0 to 1 (grade 1), scale 2 (grade 2), scale ≥3 (grade 3). Using linear regression, CASI score (ranging from 0 to 100 with a higher score indicating better cognition) was calculated according to the grade of each vessel disease adjusted for age and education year attained.Results:We analyzed 693 men. Mean (standard deviation) age and CASI score was 67.9 (8.1) years, and 91.2 (5.4), respectively. Significant inverse trends were observed between disease grade and CASI score for DSWMH and PVH: adjusted CASI scores of grade 1, 2, and 3 were 91.7, 91.2, and 90.4 (Ptrend0.015) for DSWMH, and 91.5, 90.4, and 89.8 (Ptrend0.007) for PVH. No clear trend across the grade was observed in other vessel diseases.Conclusion:Among various types of intracranial subclinical vessel diseases assessed with MRA/MRI, white matter hyperintensity (PVH, and DSWMH) had significant dose-response relationships to cognitive function in a community-based male sample that has a relatively well-preserved cognition level. Our finding suggests that white matter hyperintensity is an important early predictor of cognitive functions among subclinical vessel diseases.

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