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Objectives: This study aimed to evaluate the relationship between cumulative exposure to 1,2-dichloropropane (1,2-DCP) and incidence risk of cholangiocarcinoma among workers in the offset proof-printing section of a small printing company in Osaka, Japan.Methods: We identified 95 workers of a printing company (78 men and 17 women) who had been exposed to 1,2-DCP between 1987 and 2006, and calculated the standardised incidence ratio (SIR) of cholangiocarcinoma from 1987 to 2012. We estimated cumulative exposure to 1,2-DCP and calculated SIRs in four exposure categories. We also calculated incidence rate ratios (RRs) adjusted by sex, age, calendar year and dichloromethane (DCM) exposure for three exposure categories using Poisson regression analysis.Results: Cumulative exposures to 1,2-DCP ranged from 32 to 3433 ppm-years (mean, 851 ppm-years) and the SIR was 1171 (95% CI 682 to 1875). In the analysis of the four exposure categories, SIRs increased significantly in the three highest exposure categories, but not in the lowest category. Adjusted RRs in the middle and high exposure categories were 14.9 (95% CI 4.1 to 54.3) and 17.1 (95% CI 3.8 to 76.2), respectively, in the analysis without lag time, and were 11.4 (95% CI 3.3 to 39.6) and 32.4 (95% CI 6.4 to 163.9), respectively, in the analysis with a 5-year lag. The trend analysis revealed a significant increase in RR in association with increasing cumulative exposure to 1,2-DCP. DCM exposure was not significantly associated with the development of cholangiocarcinoma.Conclusions: The present study demonstrated an exposure-response relationship between exposure to 1,2-DCP and the development of cholangiocarcinoma. [ABSTRACT FROM AUTHOR]

Objective: Recent studies have suggested that HDL cholesterol is inversely associated with the development of type 2 diabetes. However, little is known about the association between different HDL subclasses and the risk for future type 2 diabetes.Research Design and Methods: The study enrolled 406 Japanese Americans (51% male) without diabetes, aged 34-75 years. Oral glucose tolerance tests were performed to determine type 2 diabetes status at baseline, 2.5 years, 5 years, and 10 years after enrollment. HDL2, HDL3, total HDL cholesterol, and visceral adipose tissue (VAT) area by computed tomography were measured at baseline.Results: In univariate analysis, total HDL and HDL2 cholesterol were inversely associated with the incidence of type 2 diabetes, but HDL3 cholesterol was not. In multivariate analysis, total HDL cholesterol (odds ratio per 1-SD increment, 0.72 [95% CI 0.52-0.995], P = 0.047) and HDL2 cholesterol (odds ratio per 1-SD increment, 0.64 [95% CI 0.44-0.93], P = 0.018) were inversely associated with the risk for type 2 diabetes independent of age, sex, BMI, waist circumference, family history of diabetes, lifestyle factors, systolic blood pressure, lipid-lowering medication use, triglyceride level, HOMA-insulin resistance, and 2-h glucose; however, HDL3 cholesterol was not associated with diabetes risk. The association between diabetes risk and total HDL and HDL2 cholesterol became insignificant after adjustment for VAT area.Conclusions: Subjects with higher HDL2 cholesterol were at lower risk for incident type 2 diabetes, but this association was confounded by and not independent of VAT. Higher HDL3 cholesterol was not associated with diabetes risk. [ABSTRACT FROM AUTHOR]

Background/Aims: The association between alcohol consumption and the risk of chronic kidney disease (CKD) has been reported. What is not known is whether drinking pattern combined with the weekly frequency of alcohol consumption and the quantity per drinking day is associated with the risk of CKD. Methods: We enrolled 9,112 Japanese nondiabetic men aged 40 to 55 years with absence of proteinuria, an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m2 or higher, and not on antihypertensive medications at baseline. CKD was defined if eGFR was <60 ml/min/1.73 m2. The weekly frequency classification was nondrinkers, 1-3 drinking days/week, or 4-7 drinking days/week. The quantity consumed per drinking day was classified as 0.1-23.0 g ethanol/drinking day, 23.1-46.0 g ethanol/drinking day, 46.1-69.0 g ethanol/drinking day, and ≥69.1 g ethanol/drinking day. Results: During the 79,099 person-years, 1,253 subjects developed CKD. Compared to nondrinkers, those who consumed 23.1-46.0 or 46.1-69.0 g ethanol/drinking day on 4-7 drinking days/week had a decreased risk of CKD (multiple-adjusted hazard ratio (HR) 0.62 (0.52-0.74) and 0.76 (0.59-0.97), respectively). The association between the quantity per drinking day and the incidence of CKD was U-shaped among each category of the weekly frequency. HRs within similar categories of quantity per drinking day were lower in the 4-7 drinking days/week group than in the 1-3 drinking days/week group. Conclusion: Among middle-aged Japanese men, the people who drank middle-range quantity, specifically who drank 4-7 days/week, had lower risk of CKD than nondrinkers. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background Moderate alcohol consumption is associated with a decreased risk of type 2 diabetes. However, the relationship between drinking patterns, such as the weekly frequency of alcohol consumption and the quantity per drinking day, and the incidence of type 2 diabetes has not been sufficiently addressed. Methods Study participants included 10 631 Japanese men aged 40e55 years without type 2 diabetes at entry. Type 2 diabetes was diagnosed if a fasting plasma glucose level was $7.0 mmol/l or if participants were taking diabetes medications. Data on alcohol consumption were obtained from questionnaires. Results During the 37 172 person-years of follow-up, we confirmed 878 cases of type 2 diabetes. Frequent alcohol consumption was associated with a low risk of type 2 diabetes. Compared to non-drinkers, the multiple-adjusted HR for those who drank 4e7 days weekly was 0.76 (95% CI, 0.63 to 0.92). To assess the association between drinking pattern and type 2 diabetes, we examined the joint association of the weekly frequency and the quantity per drinking day with type 2 diabetes. Men who consumed 0.1e2.0 or 2.1e4.0 US standard drinks per drinking day on 4e7 days weekly had a lower risk of type 2 diabetes (HR 0.74, 95% CI 0.58 to 0.95; HR 0.74, 95% CI 0.60 to 0.91, respectively) compared to non-drinkers. Conclusions More frequent alcohol consumption lowered the risk of type 2 diabetes. Light to moderate alcohol consumption per drinking day on 4e7 days weekly lowered the risk of type 2 diabetes compared to non-drinkers. [ABSTRACT FROM AUTHOR]

: BackgroundAlthough it was reported that the pulsatility of ascending aortic pressure is closely related to restenosis after percutaneous transluminal coronary angioplasty (PTCA), it is not known whether the reflection period of ascending aortic pressure can predict restenosis after PTCA. The purpose of this study was to evaluate whether reflection in the arterial system can be used to predict restenosis after PTCA.: MethodsWe used the inflection point as the reflection period index and measured the coronary artery diameter, aortic pressure, and inflection time before PTCA. We defined the inflection time as the time interval from the initiation of systolic pressure waveform to the inflection point. We prospectively investigated the effect of inflection time in relation to the subsequent risk of restenosis after PTCA in patients with coronary artery disease.: ResultsCrude cumulative incidence rates of restenosis were 74.1% for the lowest, 33.3% for the middle, and 26.1% for the highest tertile of inflection point levels. After adjustments for age, gender, smoking habits, hypertension, type 2 diabetes, hypercholesterolemia, old myocardial infarction, vessel location, post-minimal lumen diameter, heart rate, and ejection fraction, the odds ratio of restenosis was 6.99 (95% confidence interval, 1.54 to 31.7) for the lowest tertile of the inflection time level compared with the highest tertile level.: ConclusionsInflection time is a powerful predictor of restenosis after PTCA. [Copyright &y& Elsevier]

Central adiposity is generally considered to play a key role in the metabolic syndrome. The purpose of this study is whether abdominal fat depots directly measured by computed tomography (CT) and their changes during a follow-up period are associated with future levels of HDL cholesterol, triglycerides, and non-HDL cholesterol. In addition, we investigated whether these associations differed between men and women. We followed 376 Japanese Americans over 10-11 years who were not taking oral hypoglycemic medication or insulin at entry and not taking lipid lowering medications both at entry and at 10-11 year follow-up. Intra-abdominal fat area (IAFA) and abdomen subcutaneous fat area (ASFA) were measured at the umbilicus by CT. In men greater baseline IAFA was significantly associated with decreased future HDL cholesterol (standardized regression coefficient =-0.260 (p=0.007)) and increased future triglycerides (0.293 (p=0.003), but was not related to non-HDL cholesterol (0.088 (p=0.392)) in a regression model that included both baseline and change in IAFA, ASFA and its change, age, fasting plasma glucose, fasting plasma insulin, daily alcohol consumption, weekly energy expenditure, and smoking habit. Change over time in IAFA was significantly and positively correlated with higher future triglycerides (0.239 (p=0.002)) but not related to either future HDL cholesterol (-0.091 (p=0.222)) or non-HDL cholesterol (0.155 (p=0.057)). Neither ASFA nor its change were correlated with any future lipid level. In women both baseline and change in IAFA were correlated with decreased future HDL cholesterol (-0.610 (p<0.001), -0.396 (p<0.001) respectively), increased future triglycerides (0.315 (p=0.009), 0.434 (p<0.001) respectively), and non-HDL cholesterol (0.258 (p=0.045), 0.244 (p=0.007)) in a regression model that included the same variables as above. Greater ASFA at baseline was significantly correlated with higher future HDL cholesterol (0.248 (p=0.005) but was unrelated to triglycerides (-0.086 (p=0.379) or non-HDL cholesterol (-0.007 (p=0.948). In conclusion, greater IAFA and its change are independently associated with unfavorable future lipids levels. In women only, greater ASFA is independently associated with higher future HDL cholesterol. [ABSTRACT FROM AUTHOR]

Cigarette smoking is a risk factor for type 2 diabetes and cardiovascular disease. Not known is whether smoking habit is associated with the risk of developing the metabolic syndrome among men. Study subjects consisted of 7355 Japanese men aged 40 to 55 years without the metabolic syndrome. The metabolic syndrome was defined using modified Adult Treatment Panel III criteria using body mass index in place of waist circumference. Data on smoking habit was obtained from questionnaires. During the 4-year follow-up period, we confirmed 806 cases of the metabolic syndrome. After adjustment for age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, HDL cholesterol, fasting plasma glucose, alcohol daily consumption, and physical activity, the odds ratio (OR) of the metabolic syndrome among current smokers was 1.30 (95% confidence interval (CI) 1.04-1.61) in comparison to never smokers. Men who smoked more than 30 cigarettes a day had a higher risk compared with never smokers (OR 1.61, 95% CI 1.16-2.24) (Table 1). To evaluate the chronic effect of cigarettes smoking for the risk of the incidence of the metabolic syndrome, we assessed the relationship between pack-years and the risk of the metabolic syndrome. The value of pack-years is also associated with the increased risk of the metabolic syndrome in a dose-dependent manner. The multiple-adjusted OR for those whose pack-years value is more than 40 is 1.49 (95% CI 1.12-1.98). Furthermore, we assessed the association between cigarettes smoking and the incidence of the components of the metabolic syndrome. Cigarette smoking was associated with the risk of the incidence of hyperglycemia, high triglycerides, and low HDL cholesterol but not high blood pressure or high body mass index. In conclusion, cigarette smoking habit is an independent risk factor for the development of the metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Glomerular hyperfiltration has been reported to be associated with adverse renal outcomes in the general population. It is not known whether drinking pattern is associated with the risk of glomerular hyperfiltration in healthy individuals., Methods: We prospectively followed middle-aged 8,640 Japanese men with normal renal function, no proteinuria, no diabetes, and no use of antihypertensive medications at entry. Data on alcohol consumption were gathered by questionnaire. Glomerular hyperfiltration was defined as estimated glomerular filtration rate (eGFR) ≥117 mL/min/1.73 m 2 , which was the upper 2.5th percentile value of eGFR in the entire cohort., Results: During 46,186 person-years of follow-up, 330 men developed glomerular hyperfiltration. In a multivariate model, for men who consumed alcohol on 1-3 days per week, alcohol consumption of ≥69.1 g ethanol/drinking day was significantly associated with the risk of glomerular hyperfiltration (hazard ratio [HR] 2.37; 95% confidence interval [CI], 1.18-4.74) compared with non-drinkers. For those who consumed alcohol on 4-7 days per week, higher alcohol consumption per drinking day was associated with a higher risk of glomerular hyperfiltration: the HRs for alcohol consumption of 46.1-69.0, and ≥69.1 g ethanol/drinking day were 1.55 (95% CI, 1.01-2.38), and 1.78 (95% CI, 1.02-3.12), respectively., Conclusion: For high drinking frequency per week, more alcohol intake per drinking day was associated with an increased risk of glomerular hyperfiltration, while for low drinking frequency per week, only very high alcohol intake per drinking day was associated with an increased risk of glomerular hyperfiltration in middle-aged Japanese men.

Objectives: An outbreak of neurological health disorder caused by drinking well water occurred in 2003 at one apartment building in Kamisu, Ibaraki, Japan. This was the first case of mass poisoning due to well water contaminated with diphenylarsinic acid (DPAA). Subsequently, other residents in Kamisu were confirmed to have drunk well water containing lower concentrations of DPAA. The present study aimed to investigate neurological and other subjective symptoms and miscarriage occurrences after DPAA exposure., Methods: Subjects were residents of Kamisu aged 10-65 years in 2004. Twenty residents (high-level exposure group) had lived in the apartment building and drunk well water containing DPAA at arsenic concentrations of 2,262 μg/L. The moderate/low-level exposure group (67 residents) had drunk other well water containing DPAA at arsenic concentrations of 2-230 μg/L (mean: 85 μg/L) and DPAA was detected in their hair or nails. A control group (134 residents), matched to the latter group by sex and age, had only drunk tap water. Public health nurses completed a questionnaire on symptoms, pregnancy, and miscarriage through interviews., Results: Dizziness, unsteadiness, dysesthesia, writing disturbance, diplopia, insomnia, melancholy, headache, itchiness, weight change, diarrhea, cough, and dyspnea were significantly higher in the moderate/low-level exposure group than in the control group. A similar tendency was found in the high-level exposure group. From 1999 through 2003, no miscarriages occurred among 15 pregnancies in the control group, while three miscarriages occurred among five pregnancies in the moderate/low-level group., Conclusion: DPAA exposure via well water caused miscarriage, in addition to neurological and other subjective symptoms.

Aim: To clarify the risk factors for bleeding after endoscopic mucosal resection (EMR)., Methods: A total of 297 consecutive patients who underwent EMR were enrolled. Some of the patients had multiple lesions. Bleeding requiring endoscopic treatment was defined as bleeding after EMR. Odds ratios (OR) with 95% confidence intervals (CI), calculated by logistic regression with multivariate adjustments for covariates, were the measures of association., Results: Of the 297 patients, 57 (19.2%) patients with bleeding after EMR were confirmed. With multivariate adjustment, the cutting method of EMR, diameter, and endoscopic pattern of the tumor were associated with the risk of bleeding after EMR. The multivariate-adjusted OR for bleeding after EMR using endoscopic aspiration mucosectomy was 3.07 (95%CI, 1.59-5.92) compared with strip biopsy. The multiple-adjusted OR for bleeding after EMR for the highest quartile (16-50 mm) of tumor diameter was 5.63 (95%CI, 1.84-17.23) compared with that for the lowest (4-7 mm). The multiple-adjusted OR for bleeding after EMR for depressed type of tumor was 4.21 (95%CI, 1.75-10.10) compared with elevated type., Conclusion: It is important to take tumor characteristics (tumor size and endoscopic pattern) and cutting method of EMR into consideration in predicting bleeding after EMR.

Background: Because nicorandil, a potassium channel opener, has a cardioprotective effect and attenuates reperfusion injury in patients with acute myocardial infarction (AMI), intravenous nicorandil should reduce arrhythmic mortality and QT dispersion in patients with AMI., Objectives: The purpose of this study was to evaluate whether intravenous nicorandil reduces the occurrence of ventricular fibrillation and QT dispersion in patients with successful coronary angioplasty in AMI., Methods: A historical cohort study on the effect of nicorandil on ventricular fibrillation and QT dispersion was conducted. Eighty-three patients with AMI who underwent successful percutaneous transluminal coronary angioplasty (PTCA) were enrolled. The patients were divided into two groups: nicorandil (n=46) and control group (n=37). Nicorandil was injected at 4 mg/h continuously from admission to 48 h after PTCA in the nicorandil group. QT dispersion was measured before, immediately after, 24 h after and 48 h after PTCA., Results: Ventricular fibrillation was observed in three patients in the control group, but none was observed in the nicorandil group. QT dispersion in the nicorandil group was shorter than that in the control group 48 h after PTCA (QT dispersion was 23.2+/-16.1 ms and 33.4+/-24.0 ms, respectively, P<0.05). There was a significant difference between the two groups in time course after the onset of AMI (P<0.05)., Conclusions: Because intravenous nicorandil reduces the occurrence of ventricular fibrillation and QT dispersion in patients with successful coronary angioplasty in AMI, it would prevent the occurrence of cardiac events after successful PTCA for AMI.