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Objective: The primary objective of this study is to describe cancer mortality rates and trends among Japanese adolescents and young adults aged 15–29 years for the period 1970–2006. [ABSTRACT FROM PUBLISHER]

Highlights: [•] Mouth level exposure to smoke constituents was estimated using filter analysis. [•] Calibration curves for 41 out of 47 smoke constituents were generated. [•] 780 smokers were recruited in Japan to estimate MLE to selected smoke constituents. [•] Most of measured MLE were positively correlated with ISO Tar. [•] Most of measured MLE were negatively correlated with HCI yields per mg nicotine. [Copyright &y& Elsevier]

Background: Infections and sepsis are the leading causes of death in intensive care units (ICUs). Antimicrobial agent selection is challenging because the intervention is directly related to the outcome, and the problem of antimicrobial resistance (AMR) must be considered. Therefore, in this study, we aimed to clarify the epidemiological data and examine whether the detection rate of multidrug-resistant (MDR) bacteria differed depending on the presence or absence of the risk of MDR bacterial infections to establish guidance regarding the choice of antimicrobial therapy for ICU patients., Methods: This retrospective case‒control study was performed in a single ICU in Japan. Patients admitted to the ICU who underwent blood culture (BC) analysis were considered for inclusion in this study; patients were at risk of MDR bacterial infections, and controls were not. The primary outcome measure was the detection rate of MDR bacteria in BCs collected from patients and controls. The secondary outcome measure was the selection rate of anti-Pseudomonas and anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs for patients and controls., Results: Among the 1,730 patients admitted to the ICU during the study period, BCs were obtained from 186 patients, and 173 samples were finally included in the analysis (n = 129 cases; n = 44 controls). No MDR bacteria or Pseudomonas aeruginosa were detected in the controls (14 (11%) vs. 0 (0%)) (P = 0.014) However, there was no difference in empiric antimicrobials, including anti-MRSA (30 (23%) vs. 12 (27%)) (P = 0.592) and anti-Pseudomonas aeruginosa (61 (47%) vs. 16 (36%)) (P = 0.208) drugs, that were administered to the two groups., Conclusions: Even in critically ill patients in the ICU, MDR bacteria are unlikely to be detected in patients without the risk of MDR bacterial infections. Therefore, for such patients, a strategy of starting empiric narrow-spectrum antimicrobial therapy rather than empiric broad-spectrum therapy should be considered. This strategy, in conjunction with daily updates of clinical and epidemiological data at each facility, will promote the appropriate use of antimicrobials and reduce the emergence of MDR bacteria in the ICU., Trial Registration: None., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Additional health care costs associated with ventilator-associated pneumonia (VAP) vary widely per country; none of which have been explored in Japan. Thus, we aimed to examine the economic and clinical effects of VAP in Japan., Methods: This was a retrospective matched case-control study of 22 patients with VAP who were treated in the intensive care unit of Yokohama Rosai Hospital between January 2012 and December 2018. Twenty-two matched controls were selected based on 5 variables (ie, sex, age, diagnosis and surgical procedure, underlying disease with or without advanced malignant tumor, and best motor response). The additional health care costs incurred owing to VAP were calculated from the difference between the mean costs of VAP and control cases., Results: VAP incurred an additional cost of approximately United States Dollars (USD) 34,884 per case. The length of hospitalization itself was the major factor contributing to additional medical costs, generating a difference of 9,824 USD., Discussion: VAP not only worsens patient outcomes but also generates significant additional medical costs. Patients who had developed VAP required more medical resources such as the performance of a tracheostomy., Conclusions: VAP incurs a higher mean total hospital medical cost. Thus, appropriate infection control strategies should be implemented., (Copyright © 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Aim: Frailty is a predictor of several adverse health outcomes in older adults. However, the relationship between preadmission frailty status and the incidence of dependency after discharge in hospitalized older patients remains unclear. The aim of the present study was to determine whether preadmission frailty status can predict dependency after discharge among hospitalized older patients., Methods: We analyzed the cohort data for hospitalized older patients (aged ≥65 years) with internal medical problems obtained from a prospective study. The main outcome was the incidence of dependency from admission to a month after discharge. The frailty status was assessed using the Kihon Checklist. We defined scores of ≥8 as frail, 4-7 as pre-frail and 0-3 as robust. The Cox proportional hazards regression model was used to estimate the hazard ratios and confidence intervals of the relationships between preadmission frailty status and the incidence of dependency., Results: A total of 151 participants who completed follow ups were analyzed (mean age 77.2 years [SD 6.9 years]). The prevalence of frailty, pre-frailty and robust was 22.5%, 37.8% and 39.7%, respectively. During the follow-up period, 39 participants (25.8%) had an incidence of dependency. Participants with frailty (adjusted hazard ratio 4.29, 95% confidence interval 1.72-10.69) had a significantly elevated incidence of dependency compared with that of robust participants. Participants with pre-frailty (adjusted hazard ratio 1.27, 95% confidence interval 0.51-10.69) had no significantly elevated incidence of dependency compared with robust participants., Conclusions: The preadmission frailty status using the Kihon Checklist can predict the incidence of dependency after discharge among hospitalized older patients. Geriatr Gerontol Int 2018; 18: 1609-1613., (© 2018 Japan Geriatrics Society.)

Backgrounds: Multidisciplinary therapy has increased the risk of subsequent late effects, but detailed analyses on secondary cancers in childhood cancer survivors (CCSs) are limited in Asian countries., Methods: This was a retrospective cohort study comprising 10,069 CCSs who were diagnosed between 1980 and 2009 across 15 Japanese hospitals. We conducted secondary analyses to estimate the incidence of secondary cancer according to each primary malignancy and to elucidate the association between primary and secondary cancers. We also explored the risk factors for the development of secondary cancer in each independent primary malignancy., Results: The cumulative incidence of secondary cancer at 20 years varied among primary cancers: hematological malignancy, 3.1% (95% CI 2.2-4.3); retinoblastoma, 6.6% (95% CI 1.5-16.8); pediatric solid tumor, 2.5% (95% CI 1.3-4.2); brain tumors, 5.2% (95% CI 1.7-11.8) bone/soft tissue sarcoma, 5.2% (95% CI 2.3-10.1); and others, 3.3% (95% CI 1.6-6.0) (p = 0.015). The cumulative incidence of secondary cancers is highest in those with osteosarcoma (13.1%) followed by those with hepatoblastoma (8.4%) and retinoblastoma (6.6%). Close association between the primary and secondary cancer diagnoses was found. The risk factors for secondary cancer development depended on the primary cancer, but autologous/allogeneic stem cell transplantation was a relatively common risk factor., Conclusion: The cumulative incidence of secondary cancer varied among primary cancers. The primary cancer was closely associated with the secondary cancer but stem cell transplantation was a common risk factor for secondary cancers among CCSs.

Background: Data of pancreatoduodenectomy (PD) cases from the National Clinical Database (NCD) were analyzed in order to validate the board certification system established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS)., Methods: Board-certified A training institutions and board-certified B training institutions were required to perform at least 50 and 30 high-level hepato-biliary-pancreatic (HBP) surgeries per year, respectively. Records of 17,563 patients who had undergone PD during 2011 and 2012 were retrospectively analyzed according to the category of the board-certified institution and with or without participation of board-certified instructors or expert surgeons., Results: Operative mortality rates after PDs performed at certified A institutions, certified B institutions, and non-certified institutions were 1.5%, 3.0%, and 3.9%, respectively (P < 0.001). The operative mortality rates after PDs performed with participation of certified instructors or expert surgeons were better than those without (2.2% vs. 3.8%, P < 0.001). A multiple logistic regression model showed that cutoffs of high-level HBP surgeries performed per year at hospitals that predicted 30-day mortality after PDs were 10 and 50, and that those that predicted operative mortality were 10 and 70., Conclusions: The requirements for board-certified institutions, instructors, and expert surgeons to perform PD were appropriate. The requirements for board-certified A institutions were close to the identified cutoffs. Further analyses are necessary to elucidate the implications of the board certification system., (© 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

Background: The objective of this study was to validate the board certification system of the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) using the data of hepatectomy cases from the National Clinical Database (NCD) of Japan., Methods: Minimal required annual numbers of high-level hepato-biliary-pancreatic (HBP) surgeries were 50 for a board-certified A training institution and 30 for a board-certified B training institution. Records of 14,970 patients who had undergone hepatectomy of more than one segment (MOS), excluding lateral segmentectomy, during 2011 and 2012 were analyzed according to the category of board-certified institution and with or without participation of board-certified instructors or expert surgeons., Results: Thirty-day mortality and operative mortality of 14,970 patients after MOS hepatectomy were 1.9% and 3.8%, respectively. Operative mortality rates after MOS hepatectomies performed at certified A institutions, certified B institutions, and non-certified institutions were 3.1%, 3.8%, and 4.5%, respectively (P < 0.001). The operative mortality rates after MOS hepatectomies performed with participation of certified instructors or expert surgeons were better than those without (3.5% vs. 4.3%, P = 0.012). A multiple logistic regression model showed that the cutoffs of high-level HBP surgeries performed per year at hospitals that predicted operative mortality after MOS hepatectomies were 10 and 50., Conclusions: Competences and requirements for board-certified institutions, instructors, and expert surgeons to perform hepatectomy were found to be appropriate., (© 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

Background: This study aimed to provide an updated analysis of childhood cancer mortality rates and long-term trends to 2013 to describe the current level of deaths and identify changes in recent decades., Methods: Data on number of deaths from cancer in children aged under 15 years were derived from Vital Statistics in Japan and the World Health Organization (WHO) mortality database for comparison countries. Trends in mortality were examined by fitting a joinpoint regression model., Results: For all cancers combined, the mortality rate during 2010-2013 was 19.9 per 1,000,000 population for boys and 17.5 for girls in Japan. Mortality from all cancers combined decreased significantly from 1980 to 2003 for boys and from 1980 to 2001 for girls. Afterwards, the rates remained stable for both sexes. Mortality from leukemia declined over the entire study period by 4.6% per year (p<0.05) in boys and 4.3% per year (p<0.05) in girls. For central nervous system (CNS) tumors, a slight increase in mortality was observed for both sexes, with a statistically significant annual percent change (APC) of 0.5% (p<0.05) for boys and 0.6% (p<0.05) for girls., Conclusions: We provided updated information on recent trends of childhood cancer death. The establishment of a nationwide, childhood cancer registry is required in Japan. Moreover, trends in cancer mortality should be monitored continuously.

Background: Previous Japanese studies of childhood B-cell non-Hodgkin lymphoma (B-NHL) have shown a favorable outcome, though the study size was too small to effectively assess the efficacy and safety of treatment for childhood B-NHL., Procedure: We performed a nation-wide prospective B-NHL03 study to assess the efficacy and safety of short-pulse intensive chemotherapy for children with B-NHL. They were stratified into four treatment groups according to disease stage, tumor resectability and bone marrow/CNS involvement: Group 1 with all resected stage I/II, Group 2 with non-resected stage I/II, Group 3 with stage III & CNS-negative stage IV, and Group 4 with CNS-positive stage IV & Burkitt leukemia. Treatment duration was 2 courses for Group 1, 4 courses for Group 2, and 6 courses for Groups 3 and 4, respectively. CNS irradiation was omitted in all patients., Results: The follow-up time ranged from 0.8 to 88 months, with a median of being 45 months. For 321 patients analyzed in this study, overall survival and event-free survival (EFS) at 4 years was 92.7% and 87.4%, respectively. The 4-year EFS according to treatment group were 94% for Group 1 (n = 17), 98% for Group 2 (n = 103), 84% for Group 3 (n = 111), and 78% for Group 4 (n = 90). There was no significant difference in outcome by histology. Therapy-related death occurred in three patients in remission., Conclusions: Our nationwide large-scale study resulted in a cure rate above 90% with <1% toxic death in childhood B-NHL., (© 2014 Wiley Periodicals, Inc.)

The composition of the human gut microbiota is related to host health, and it is thought that dietary habits may play a role in shaping this composition. Here, we examined the population size and prevalence of six predominant bacterial genera and the species compositions of genus Bifidobacterium (g-Bifid) and Bacteroides fragilis group (g-Bfra) in 42 healthy Belgian adults by quantitative PCR (qPCR) over a period of one month. The population sizes and prevalence of these bacteria were basically stable throughout the study period. The predominant g-Bifid species were Bifidobacterium adolescentis and Bifidobacterium longum ss. longum, and the predominant g-Bfra species were Bacteroides vulgatus, Bacteroides uniformis, and Bacteroides ovatus. The Belgian gut microbiota data were then compared with gut microbiota data from 46 Japanese subjects collected according to the same protocol (Matsuki et al., Appl. Environ. Microbiol. 70, 167-173, 2004). The population size and prevalence of Bifidobacterium catenulatum group were significantly lower in the Belgian gut microbiota than in the Japanese gut microbiota (P < 0.001); however, the population size and prevalence of g-Bifid did not differ. This species-level qPCR analysis will be helpful for investigating the diversity of gut microbiota among ethnic groups., (Copyright © 2013 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.)

To clarify the cause of deaths associated with pandemic (H1N1) 2009 among children in Japan, we retrospectively studied 41 patients <20 years of age who had died of pandemic (H1N1) 2009 through March 31, 2010. Data were collected through interviews with attending physicians and chart reviews. Median age of patients was 59 months; one third had a preexisting condition. Cause of death was categorized as unexpected cardiopulmonary arrest for 15 patients, encephalopathy for 15, and respiratory failure for 6. Preexisting respiratory or neurologic disorders were more frequent in patients with respiratory failure and less frequent in patients with unexpected cardiopulmonary arrest. The leading causes of death among children with pandemic (H1N1) 2009 in Japan were encephalopathy and unexpected cardiopulmonary arrest. Deaths associated with respiratory failure were infrequent and occurred primarily among children with preexisting conditions. Vaccine use and public education are necessary for reducing influenza-associated illness and death.

Lung cancer, COPD and cardiovascular diseases are highlighted as some of the most common disease that cause mortality, and for that reason are the most active areas for drug development. This perspective paper overviews the urgent need to develop a health care system for a rapidly growing patient population in Japan, including forthcoming demands on clinical care, expecting outcomes, and economics. There is an increasing requirement to build on the strengths of the current health care system, thereby delivering urgent solutions for the future. There is also a declaration from the Ministry of Health, Labour and Welfare (MHLW), to develop new biomarker diagnostics, which is intended for patient stratification, aiding in diagnostic phenotype selection for responders to drug treatment of Japanese patients. This perspective was written by the panel in order to introduce novel technologies and diagnostic capabilities with successful implementation. The next generation of personalized drugs for targeted and stratified patient treatment will soon be available in major disease areas such as, lifestyle-related cancers, especially lung cancers with the highest mortality including a predisposing disorder chronic obstructive pulmonary disease, cardiovascular disease, and other diseases. Mass spectrometric technologies can provide the "phenotypic fingerprint" required for the concept of Personalized Medicine. Mass spectrometry-driven target biomarker diagnoses in combination with high resolution computed tomography can provide a critical pathway initiative facilitated by a fully integrated e-Health infrastructure system. We strongly recommend integrating validated biomarkers based on clinical proteomics, medical imaging with clinical care supported by e-Health model to support personalized treatment paradigms to reduce mortality and healthcare costs of chronic and co-morbid diseases in the elderly population of Japan., (Copyright © 2011. Published by Elsevier B.V.)

Objective: The primary objective of this study is to describe cancer mortality rates and trends among Japanese elderly aged 65-84 years for the period 1970-2007., Materials and Methods: Age-standardized mortality rates were calculated by the direct method using age-specific mortality rates at 5-year age intervals and weights based on the age distribution of the standard world population. The joinpoint regression model was used to describe changes in trends., Results: For all cancers combined, the mortality rate at age 65-84 years during 2000-2007 was 1145.13 (per 100,000 population) for men and 461.93 (per 100,000) for women. Mortality rates have declined in the past 10 years in both sexes. These favorable trends were driven largely by decreases in mortality for three leading cancers in the elderly men [lung, stomach and colorectal cancer (CRC)] and for two of the three most common cancers in the elderly women (stomach and CRC), combined with a leveling off of death rate from lung cancer in women., Conclusion: The population-based data in the current study underscore the importance of cancer research and prevention for the older segment in Japan to reduce the additional cancer burden among the growing number of elderly persons.

Thirty six Gram-positive, rod-shaped, non-spore-forming, non-motile bacterial strains were isolated from the non-salted pickle solution used in producing sunki products, a traditional Japanese pickle. The novel strains were discriminated and separated into four groups by amplified fragment length polymorphism profiling, and by analysis based on recA gene sequences. The strains were classified into four species groups belonging to the Lactobacillus buchneri species group, which consists of L. buchneri, Lactobacillus diolivorans, Lactobacillus hilgardii, Lactobacillus kefiri, Lactobacillus parabuchneri and Lactobacillus parakefiri. The phenotypic and genotypic features of the four groups demonstrated that they represented four novel species, for which the names Lactobacillus kisonensis sp. nov. (type strain YIT 11168(T)=NRIC 0741(T)=JCM 15041(T)=DSM 19906(T)), Lactobacillus otakiensis sp. nov. (type strain YIT 11163(T)=NRIC 0742(T)=JCM 15040(T)=DSM 19908(T)), Lactobacillus rapi sp. nov. (type strain YIT 11204(T)=NRIC 0743(T)=JCM 15042(T)=DSM 19907(T)) and Lactobacillus sunkii sp. nov. (type strain YIT 11161(T)=NRIC 0744(T)=JCM 15039(T)=DSM 19904(T)) are proposed.

Background: The treatment outcome of multifocal childhood Langerhans cell histiocytosis (LCH) has not been satisfactory and has resulted in poor therapeutic responses with high mortality and a high incidence of reactivation with late sequelae. To overcome these issues, the Japan LCH Study Group-96 (JLSG-96) protocol was conducted prospectively from 1996 to 2001 in Japan., Methods: Newly diagnosed children with multifocal LCH were classified into 2 groups: a single-system multisite (SS-m) group and a multisystem (MS) group. All patients initially were treated on Protocol A, which consisted of 6 weeks of induction therapy with combined cytosine arabinoside, vincristine (VCR), and prednisolone (PSL) followed by 6 months of maintenance therapy. Patients who had a poor response to the induction of Protocol A were switched to a salvage regimen (Protocol B), which consisted of an intensive combination of doxorubicin, cyclophosphamide, VCR, and PSL., Results: In total, 91 patients were treated, including 32 patients in the SS-m group and 59 patients in the MS group. At the median 5-year follow-up, 96.9% of patients in the SS-m group and 78.0% of patients in the MS group had good response status. Diabetes insipidus developed in 3.1% of patients in the SS-m group and in 8.9% of patients in the MS group. The overall survival rate at 5 years for the SS-m and MS groups was 100% and 94.4% +/- 3.2%, respectively., Conclusions: The JLSG-96 protocol attained very low mortality for pediatric patients with multifocal LCH., (Copyright 2006 American Cancer Society.)

A silent mutation in B-domain of the estrogen receptor-alpha (ER B) change codon 87 (from GCG to GCC) is clinically correlated with frequent spontaneous abortion and familial history of breast cancer among Caucasian patients. However, none of the 167 Japanese female patients and 46 Japanese female healthy volunteers showed ER B variant. Therefore, this DNA polymorphism might involve a genetic racial difference, and appears not to be correlated with frequent spontaneous abortion or familial history of breast cancer at least among Japanese women.

The number of reported cases of leukemia developing in growth hormone (GH) users worldwide has reached 31. Twelve Japanese cases are briefly reviewed; five each of AML and ALL, and one each of CML and malignant histiocytosis. The underlying diseases of these patients consisted of 8 idiopathic disease, 3 tumors and one Fanconi's anemia. Leukemia occurred during GH treatment in 9 cases and after cessation of GH in 3. The longest interval from the cessation of GH therapy was 10 years. GH administration from a younger age tended to be linked to myeloid type. Risk factors and possible mechanisms of leukemogenesis by growth hormone are discussed, and proposals for the future have been made by the Foundation for Growth Science in Japan.

During the period from May to August, 1978, an epidemic of hand, foot and mouth disease (HFMD) occurred in Gifu prefecture. Epidemiological, virological and serological investigations were performed. Cases involved ranged from 0 to 31 years of age, and 80.2% of them were under 5 years of age. The incidence of HFMD with neurological complication (3.7%) was lower than that in 1973. Enterovirus 71 (EV71) was isolated from 83 of 108 cases (75.9%) and a significant rise in the neutralization antibody titer against the isolate was found in 14 of 25 cases (56%). Thus, it was confirmed that the causative agent of the epidemic of HFMD in Gifu prefecture in 1978 was enterovirus 71.