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Metabolic syndrome (MetS) and its components are well established as risk factors for cardiovascular disease (CVD). On the other hand, it has also been reported that social isolation is associated with an increased risk of CVD. However, the relationship between social isolation and MetS and its components is not clear. Thus, the purpose of this study is to investigate the association between social isolation and the number of MetS components in Japanese adults. Participants were 28,917 individuals (male/female = 10,226/18,691, age = 59.9±11.6 years) from the Iwate area of the Tohoku Medical Megabank Organization Community-based cohort study (TMM CommCohort study). They had no history of coronary heart disease or stroke. Social isolation was assessed using the Lubben Social Network Scale-6 (LSNS-6). The participants were classified into two groups, the social isolation group and the non-isolation group, based on a cutoff point of 11/12 on the LSNS-6. An assessment of MetS used the criteria defined by the Japanese societies’ committee. The multivariate-adjusted odds ratios (95% confidence intervals) [AORs (95% CIs)] of the social isolation group versus the non-isolation group were calculated using ordered logistic analyses and compared to the number of MetS components. We used gender, age, education, current smoker, current alcohol drinker, total physical activity, current job status, and depression as covariates. AORs (95% CIs) of social isolation against non-isolation were 1.02 (0.95-1.09) for one component of MetS, 1.09 (1.01-1.19) for two components of MetS, and 1.16 (1.06-1.28) for three or more components of MetS, when compared to 0 component of MetS. In conclusion, Japanese adults who experience social isolation might have a greater number of MetS components.

Introduction: Recently, the balance between sodium and potassium intake, i.e. sodium-to-potassium (Na/K) ratio, has received significant attention for prevention of hypertension. Previous studies reported the positive association between urinary Na/K (uNa/K) ratio and hypertension. However, even the same uNa/K ratio value, there might be high Na/ high K ratio or low Na/ low K ratio. Hypothesis: We assessed the hypothesis that blood pressure (BP) is higher in high Na/ high K group than that in low Na/ low K group even at the same uNa/K ratio in general population in cross-sectional study. Methods: The subjects were 20 to 74 years old who participated in The Tohoku Medical Megabank Project Community-based Cohort Study. Of these participants, we targeted 54,011 subjects (men: 20,505 women: 33,506 mean age: 59.9 years) who had information of BP, urinary Na and K. We estimated 24-h urinary excretion of Na and K using Tanaka formula. Urinary Na and K were each classified into quartiles (Na; Q1~Q4, K; Q1~Q4), and set all 16 groups of uNa/K ratio by combining Na and K respectively. To assess the relationship between casual uNa/K ratio and BP, we performed an analysis of covariance to calculate the adjusted mean systolic BP (SBP). We included covariate factors as age, sex, BMI and alcohol intake. We also assessed the relationship between uNa/K ratio and SBP using multiple regression analyses adjusted for covariate factors. We stratified the participants into two groups: ‘under treatment for hypertension’ (n=17,091) and ‘without treatment for hypertension (n=36,920)’. Results: The mean of uNa/K ratio for each group of Na (Q1)/K(Q1), Na (Q2)/K(Q2), Na (Q3)/K(Q3) and Na (Q4)/K(Q4) was all 4.0. As previous report showed, higher uNa/K ratio group showed higher SBP and lower uNa/K group showed lower BP. When we compared adjusted mean SBP of Na (Q1)/K(Q1) and Na (Q4)/K(Q4) the value were comparable, but the value were significantly higher in Na (Q4)/K(Q4) group (The adjusted mean SBP of Na (Q1)/K(Q1), Na (Q2)/K(Q2), Na (Q3)/K(Q3) and Na (Q4)/K(Q4) was 123.6, 124.9, 124.7 and 125.5 mmHg, respectively). The uNa/K was significantly positively associated with SBP independently of age, sex, BMI, and alcohol intake. The finding was unchanged the results in under treatment group. Conclusions: BP was significantly higher in high Na/ high K group than in low Na/ low K group even at the same uNa/K ratio. We suggested that not only increasing K intake but also reducing salt is important for preventing hypertension.

Although radical surgery is recommended for patients not meeting the curative criteria for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) because of the potential risk of lymph node metastasis (LNM), this recommendation may be overestimated and excessive. We aimed to establish a simple scoring system for decision making after ESD.This multicenter retrospective study consisted of two stages. First, the risk-scoring system for LNM was developed using multivariate logistic regression analysis in 1,101 patients who underwent radical surgery after having failed to meet the curative criteria for ESD of EGC. Next, the system was internally validated by survival analysis in another 905 patients who also did not meet the criteria and did not receive additional treatment after ESD.In the development stage, based on accordant regression coefficients, five risk factors for LNM were weighted with point values: three points for lymphatic invasion and 1 point each for tumor size30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 μm. Then, the patients were categorized into three LNM risk groups: low (0-1 point: 2.5% risk), intermediate (2-4 points: 6.7%), and high (5-7 points: 22.7%). In the validation stage, cancer-specific survival differed significantly among these groups (99.6, 96.0, and 90.1%, respectively, at 5 years; P0.001). The C statistic of the system for cancer-specific mortality was 0.78.This scoring system predicted cancer-specific survival in patients who did not meet the curative criteria after ESD for EGC. ESD without additional treatment may be an acceptable option for patients at low risk.

Introduction: Poor sleep efficiency is a risk for prevalent hypertension, and also overweight is one of the major risk factors for hypertension. Generally, overweight participants have poor sleep efficiency, and thus, overweight may modify the association between poor sleep efficiency and hypertension. However, there are no previous reports to examine the impact of overweight on the association between poor sleep efficiency and hypertension. Hypothesis: Poor sleep efficiency is associated with increased with prevalent hypertension, particularly in individuals with non-overweight. Methods: We conducted a cross-sectional study of 779 participants aged 20 years or older who lived in Miyagi prefecture, Japan. All the participants were recruited from June 2017 to March 2018. Sleep efficiency was measured by HSL-101 sleep sensor, and then we classified all the participants into four groups according to their sleep efficiency (good; ≥90%/poor; 2 or higher based on the Western Pacific Region of WHO criteria for Japanese. Hypertension was defined as morning home blood pressure ≥135/85 mmHg or receiving treatment for hypertension. Multivariable logistic regression models were used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to assess the combined associations of poor sleep efficiency and overweight with prevalent hypertension. Models were adjusted for sex, age, alcohol drinking status, smoking status, average daily steps, urinary sodium/potassium ratio, and sleep duration. Results: Of the 779 participants (68.3% women, mean age 61.0 years), 252 (32.3%) had poor sleep efficiency, 331 (42.5%) had overweight, and 303 (38.9%) had hypertension. The prevalence of poor sleep efficiency was higher in men (41.7% in men vs. 28.0% in women), and the individuals with poor sleep efficiency had a higher proportion of overweight (52.8 % in participants with poor sleep efficiency vs. 37.6 % in those with good sleep efficiency) and shorter sleep duration. In a multivariable analysis, compared with individuals with good sleep efficiency and non-overweight for hypertension, the adjusted ORs (95% CIs) of those with poor sleep efficiency and non-overweight, good sleep efficiency and overweight, and poor sleep efficiency and overweight for hypertension were 1.79 (1.08 to 2.98), 2.99 (1.99 to 4.49), and 4.15 (2.56 to 6.71), respectively. Conclusions: Poor sleep efficiency was associated with increased prevalence of hypertension even in individuals with non-overweight, and additionally the risk of poor sleep efficiency for prevalent hypertension in individuals with overweight was relatively higher than that in individuals with non-overweight.

Introduction: Recently, the balance between sodium and potassium intake, i.e. sodium-to-potassium (Na/K) ratio, has received a lot of attention for prevention of hypertension. Previous studies reported that the positive association between 24-hour urinary Na/K (uNa/K) ratio and hypertension. However, no studies have evaluated the relationship between uNa/K ratio measured by casual urine measurement and home hypertension in large populations. We aimed to clarify whether casual uNa/K ratio using the self-monitoring device was associated with home hypertension in general population. In addition, we assessed whether multiple days measurement of uNa/K ratio by casual urine increase the accuracy of the prediction of home hypertension compared with casual urine collected in a single day. Hypothesis: We assessed the hypothesis that multiple measurement of uNa/K ratio was positively associated with home hypertension, and increase the prediction of home hypertension compared with a single measurement. Methods: The subjects were over 20 years old who participated in The Tohoku Medical Megabank Project Cohort Study. Of these participants, we targeted 2,551 subjects who borrowed home blood pressure monitors (HEM-7080IC) and uNa/K ratio monitors (HEU-001F) for continuous 10 days. To assess the relationship between casual uNa/K ratio and home hypertension, we performed multiple logistic regression analyses and calculated aOR with 95% CI. We included covariate factors as age, sex, BMI and drinking status. In addition, to compare the prediction of home hypertension in multiple measurement with that in a single measurement, we calculated area under the ROC curve (AUROC) of uNa/K ratio. Home hypertension was defined as a SBP ≥ 135 mmHg and/or a DBP ≥ 85 mmHg. Results: Among 849 subjects had home hypertension (33.3%). Although uNa/K ratio was even positively associated with home hypertension by a single day (P for trend Conclusions: In conclusion, even single measurement of uNa/K ratio was positively associated with hypertension, the multiple measurement of uNa/K ratio strongly related with home hypertension. We suggested that multiple measurement of uNa/K ratio is desirable for assessing home hypertension because long term measurement of uNa/K ratio might reflect participants’ dietary balance of Na/K ratio.

Acute aortic dissection (AAD) is associated with an inflammatory reaction, as evidenced by elevated inflammatory markers, including C-reactive protein (CRP). The association between the peak CRP level and long-term outcomes in type B AAD has not been systematically investigated. The purpose of this study was to investigate whether the peak CRP level during admission predicts long-term outcomes in type B AAD. We conducted a clinical follow-up study of type B AAD. We divided the study population into 4 groups according to the tertiles of peak CRP levels (T1: 0.60 to 9.37 mg/dL; T2: 9.61 to 14.87 mg/dL; T3: 14.90 to 32.60 mg/dL; and unavailable peak CRP group). Multivariate Cox regression analysis was applied to investigate whether the tertiles of peak CRP predict adverse events even after adjusting for other variables. A total of 232 type B AAD patients were included in this analysis. The median follow-up period was 50 months. CRP reached its peak on day 4.5±1.7. Mean peak CRP values in T1, T2, and T3 were 6.4±2.4, 12.0±1.5, and 19.5±4.0 mg/dL, respectively. There were 65 events (39 deaths and 26 aortic events) during the follow-up. T3 and T2 (versus T1) were strong predictors of adverse events (T3: hazard ratio: 6.02 [95% CI: 2.44 to 14.87], P =0.0001; T2: hazard ratio: 3.25 [95% CI: 1.37 to 7.71], P =0.01) after controlling for all of the confounding factors. In conclusion, peak CRP is a strong predictor for adverse long-term events in patients with type B AAD.