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In secondary nasal tip plasty, it is often difficult to harvest appropriate septal extension grafts for sufficient tip projection. Therefore, studies using numerous alloplastic materials in rhinoplasty have been reported. This study aimed to evaluate the nasal tip change over time after tip plasty using a PCL mesh.We conducted a retrospective study of 86 Asian patients who received secondary tip plasty by septal extension grafting with a PCL mesh as a batten graft. Patient demographics and surgical outcomes were examined. The outcome variables were nasolabial angle, nasofrontal angle and Goode ratio. Measurements were performed with photographs obtained at short-term (postoperative 4-6 months) and long-term (more than postoperative 24 months) follow-ups. Aesthetic outcomes and safety were assessed using the Global Aesthetic Improvement Scale.Among 86 patients, 56 had a long-term follow-up. The mean age was 33.33 years, and the male-to-female ratio was 17.44:82.56. The nasolabial and nasofrontal angles did not change significantly between the short-term and long-term follow-ups. The Goode ratio, which is a useful tool to evaluate nasal projection, was decreased by 5.00%. Nevertheless, all patients were satisfied, and the long-term aesthetic outcomes were improved in 54 (96.4%) patients. There were two cases (2.33%) of complications, including one infection and one case of PCL-mesh protrusion.The present study demonstrated the usefulness and safety of PCL meshes when used in septal extension grafts as batten grafts. Although biodegradation seems to affect the nasal projection, PCL is still useful in secondary tip plasty along with other alloplastic materials.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background/Aims: The learning curve is essential in endoscopic submucosal dissection (ESD) training to improve outcomes and reduce the risk of procedure-related complications. We compared the outcomes of gastric ESD in live pigs performed by inexperienced endoscopists with or without ex vivo training.Materials and Methods: At the Olympus Medical Training and Education Center, nine endoscopists inexperienced in ESD were randomly divided into two groups (group A: ex vivo training followed by in vivo training; group B: in vivo training only), and they performed gastric ESDs.Results: A total of 18 ESDs were performed. The en bloc resection rate was 88.9% (16/18), and the complete resection rate was 94.4% (17/18). The median specimen size was 2.5 cm in group A and 2.1 cm in group B (P=0.227). There was no significant difference in the procedure time between the two groups, except for the marking time (0′58″ vs. 2′58″, P=0.027). However, group A took a shorter time in dissecting the same area than group B (109 vs. 246 sec/cm2, P=0.083). Complication rates were not significantly different between both groups.Conclusions: The procedure time during in vivo ESD training in pigs may be shortened by prior ex vivo training. However, the ex vivo model presented poor air inflation, unstable fixation, and excessive mucosal hardness for cutting. An advanced simulator or sufficient ex vivo training may be effective in training for the ESD procedure.

Introduction Endoscopically assisted malarplasty with a greenstick fracture is a method for preserving the body eminence and improving arch protrusion. However, this technique is inadequate when malar body reduction is required. To compensate for these limitations, we developed a new surgical technique using the endoscope to reduce body protrusion. Material and methods We enrolled 261 patients who visited our clinic for zygoma reduction from January 2017 to December 2018. Their mean age was 31 (range 17–63) years. After a scalp incision, an incomplete osteotomy was created from the most prominent portion of the zygoma body to the zygomaticomaxillary suture line. A complete osteotomy was performed on the arch. These osteotomies resulted in an L-shaped zygoma segment after tapping the bone with a mallet. Results Of the 261 patients who underwent our L-rotation technique, 242 also received a corticotomy. Of those patients, 15 underwent a different degree of zygoma reduction on both sides. A floating zygomatic segment occurred in four cases, although no further surgery was required. One patient's zygomatic segment dropped on one side, requiring rigid fixation through the intraoral approach. Most patients were satisfied and there were no specific complications. Conclusions Endoscopically assisted malarplasty using an L-rotation technique enables the protrusion of both the arch and body to be reduced. The zygoma reduction can be modified based on the location of the incomplete osteotomoy line and the number of corticotomies required.

Forehead reduction is gaining in popularity, as facial proportions that include shorter upper and lower thirds are currently more aesthetically pleasing. In this first large-scale study, we present an analysis of several important aspects of surgical design and postoperative complications associated with forehead reduction performed via a pretrichial skin excision. Patients who underwent surgery from 2006 to 2018 were reviewed retrospectively. Data included the amount of skin excised, postoperative complications experienced during the first three months, and forehead length measured 2 years postoperatively. Objective outcomes reported by three independent surgeons and subjective satisfaction reported by patients at three months postoperatively were evaluated on 5-point Likert scales that addressed both postoperative scarring and overall aesthetics. A total of 641 patients underwent forehead reduction surgery. The average lengths of the skin excisions were 16.64 mm, 15.36 mm, and 15.33 mm from regions at the center and at the left and right mid-pupillary lines, respectively. Long-term follow-up of 85 patients revealed forehead lengthening that exceeded the initial postoperative measurements by 2.44 mm (15.04%), 1.98 mm (11.53%), and 2.51 mm (15.8%) at the left, center, and right, respectively. Means (standard deviation [SD]) for subjective and objective measures of postoperative scarring were 1.32 (0.49) and 1.78 (0.66), respectively. The means (SD) for subjective and objective postoperative aesthetic scores were 4.38 (0.47) and 3.98 (0.39), respectively. Forehead reduction surgery via a pretrichial skin excision is a straightforward procedure that is easy to perform, has few complications, and result in high rates of patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Achieving a highly active cathode surface with extremely efficient electrocatalysts for oxygen reduction kinetics is a fundamental necessity for durable fuel cells. Developing such active materials into desirable nanostructures is crucial in the pursuit of electrocatalysis. A facile preparation of cobalt decorated nitrogen and sulfur co-doped carbon nanostructures (Co–NSC) with the added advantage of Zeolitic imidazolate frameworks (ZIF), ZIF 67@ZIF 8 is reported here. The as-prepared Co, N, S, co-doped carbon (Co–NSC) electrocatalyst comes under platinum group metal-free (PGM-free) catalysts which intends to replace the scarce and highly expensive commercial Pt catalysts. Facile preparation of the Co–NSC catalyst that is scalable, low cost and highly ORR active makes the material advantageous. Co–doping sulfur has dramatically enhanced the intrinsic catalytic activity of the catalyst, and the degree of variation in sulfurization greatly influences the overall catalytic property. Co–NSC 200 with high sulfur doping exhibit a positively shifted onset potential of 0.81 V, and a high yielding current density of 5.5 mA cm−2 at 20 mV s−1.

The aim of this study is to provide basic information that contributes to vaccine inoculation policy after COVID-19. We used the secondary data of the influenza vaccine inoculation behavior survey for community-dwelling adults conducted in 2011, before the COVID-19 pandemic, but after the 2009 novel influenza A (H1N1) pdm 09 pandemic. All factors such as socio-demographic characteristics, health-related behaviors, family environment, physical and social environment, and area of residence were adjusted, and factors related to vaccine inoculation behavior were analyzed. Those living with pregnant women had a significantly higher odds ratio of inoculation; this was self-evident in that those people considered infection to their family. Regarding the social environment, those aged 20-64 years with a significantly higher adjusted odds ratio of inoculation were those with "at least five people with which they interacted in the neighborhood". This result can be interpreted in two ways relating to altruism in Japan. Finally, we indicated the importance of learning from the past, including the case of 2009.

목적: 소프트 콘택트렌즈 착용 및 관리 실태를 조사하여 렌즈 종류와 연령대별 착용자 간 차이가 있는지 알아보았다. 방법: 2018년 5월부터 7월까지 소프트 콘택트렌즈를 착용중인 중·고등학교 및 대학교 여학생 153명(중학생: 52명, 고등학생: 41명, 대학생: 60명)을 대상으로 착용 및 관리 실태에 관한 설문을 시행하였다. 결과: 미용 콘택트렌즈를 착용하는 경우(62.09%)가 투명 콘택트렌즈(37.91%) 보다 2배가량 높았으며, 착용 목적으로는 미용상 착용하는 비율(51.63%)이 가장 높았다. 콘택트렌즈의 유효 착용 기간보다 오래 착용하는 경우(45.75%)와 콘택트렌즈를 착용하고 화장을 하는 경우(84.97%)가 많았으며, 보관 용기(73.72%)와 보관 용액(49.02%)의 교체주기를 잘 모르는 경우가 많았다. 보관용액의 유통기한을 정확하게 인지하지 못하고 사용하는 사람이 75.82%로 높은 수치를 보였다. 보관 용기를 올바르게 세척하지 않는 인원은 65.23%로 과반수가 적절하게 관리하지 못하고 있었다. 콘택트렌즈 구매시 교육받은 비율은 투명 렌즈와 미용 렌즈 착용자를 서로 비교했을 때 차이가 없었지만, 연령대별로 비교했을 때 중학생이 고등학생과 대학생보다 관리 방법을 안내받은 비율이 더 높았다(p＜0.05). 결론: 소프트 콘택트렌즈 착용 여학생들은 유효 착용 기간, 착용 시 화장법, 보관 용기와 용액의 관리 방법 등에 대해 정확히 숙지하지 못하고 있었다. 따라서 처음 착용하는 시기인 10대 초반뿐 만 아니라 고등학생 및 20대에서도 지속적인 교육 및 안내가 필요할 것이다.

Esophageal cancer is one of the lethal malignant tumors because it is often diagnosed in the advanced stage with lymph node or distant metastasis. The recurrence rate of esophageal cancer is known to be about 40% to 50% even in the patients who underwent curative esophageal resection. Most frequent sites of metastases are known to be the liver. Furthermore, other distant metastases also could be developed in lung, bone, brain, kidney, adrenal, abdominal cavity, and skin. However, ampulla of Vater (AoV) metastasis rarely occurs from esophageal cancer. Therefore, we report herein a case of AoV metastasis from squamous cell carcinoma of the esophagus.

Objective We aimed to investigate whether hypertensive disorders of pregnancy are associated with problematic hot flashes in Japanese women. Methods In this study, we included participants in the Japan Nurses' Health Study who were women aged 41 to 55 years at baseline, parous, and complete a 4-year follow-up questionnaire. The main outcome was self-reported problematic hot flashes. At the 4-year follow-up survey, we investigated hot flashes using the Climacteric Symptom Checklist for Japanese Women, which was developed by a subcommittee of the Japan Society of Obstetrics and Gynecology. Results At the baseline survey, of the 4,627 women included in the analysis, 610 (13.2%) reported a history of hypertensive disorders of pregnancy. At the 4-year follow-up survey, 394 women (8.5%) reported problematic hot flashes, 529 (11.4%) were diagnosed with premenopausal hypertension, and 2,389 (51.5%) were postmenopausal. Multivariable logistic regression analysis revealed a multivariable-adjusted odds ratio (95% confidence interval) of problematic hot flashes for women with a history of hypertensive disorders of pregnancy of 1.42 (1.04-1.94), compared with women without this history. Among women without premenopausal hypertension, the odds ratio increased to 1.55 (1.10-2.19) among women with hypertensive disorders of pregnancy as compared with those without these disorders. Conclusions In this prospective study, we found that women with a history of hypertensive disorders of pregnancy have a significantly increased risk of problematic hot flashes, compared with their counterparts without a history of hypertensive disorders of pregnancy.

Background Many women experience various symptoms during the period of menopausal transition, including complaints of reduced cognitive functioning. However, these complaints are not necessarily recognized as core menopausal symptoms. In this study, we sought to characterize subjective complaints of reduced cognitive functioning by analyzing cross-sectional data from the Japan Nurses’ Health Study (JNHS). Methods The JNHS 4-year follow-up questionnaire containing a 21-item climacteric symptom checklist, which included a question about “poor memory or forgetfulness”, was mailed between 2005 and 2011 to all JNHS participants, regardless of their age at the time of the survey. We estimated the prevalence of slight and severe complaints in 5-year age-groups. We used principal component analysis to explore the underlying factors among the 21 symptoms during the menopausal transition period in women aged 45–54 years at the time of the survey. We also examined risk factors for complaints using multivariable modified Poisson regression analysis. Results In total, 12,507 women responded to the 4-year survey. The mean age at the time of the 4-year survey was 46.5 years (range 27–82). “Poor memory or forgetfulness” showed a peak prevalence of 81.7% (severe 27.9%; slight 53.8%) at 50–54 years, and gradually decreased after 55 years. Principal component analysis indicated that “poor memory or forgetfulness” belonged to somatic symptoms and was close to psychological symptoms in women aged 45–54 years. In women aged 45–54 years, the complaint was also significantly associated with hot flashes and sweats. Multivariable modified Poisson regression analysis showed that menopausal status (uncertain and postmenopausal), less sleep (sleep of Conclusions We found that prevalence of “poor memory or forgetfulness” was highest during the menopausal transition period and among perimenopausal women. This subjective complaint was associated with somatic, psychological complaints and VMS. It may be useful for women with cognitive problems in the transition period to consider management of comorbid menopausal symptoms.

Background Various questionnaires have been developed to assess physical activity, but only a few simple questionnaires are suitable for self-administration in large groups of midlife working women. This study examined the usefulness of the Japan Nurses’ Health Study (JNHS) questionnaire for self-administered physical activity surveys. Methods The JNHS physical activity questionnaire consisted of items covering seven degrees of intensity. The metabolic equivalents (METs) for the physical activity intensity of the questionnaire were estimated from energy expenditure as measured by a uniaxial accelerometer with the Markov Chain Monte Carlo (MCMC) simulation. The estimated METs were then assigned to the JNHS baseline survey data, and the total energy expenditure (TEE) and the time spent performing ≥3 METs hour of physical activity, called moderate to vigorous intensity physical activity (MVPA), were calculated. Results For working situations, application of the MCMC simulation resulted in estimated reference values of 1.2 METs for “sitting work”, 1.6 METs for “standing work”, 1.8 METs for “walking work”, and 4.5 METs for “heavy work”. For non-working situations, the estimated values were 1.1 METs for sedentary time, 2.4 METs for “moderate physical activity”, 4.4 METs for “vigorous physical activity”, and 9.4 METs for “very vigorous physical activity”. When these estimated METs were used, the mean TEE/day was 1808 kcal. This corresponded to − 3.0% of the TEE/day generated by the accelerometer. These estimated MET values showed similar results as a previous study measuring activity using the doubly-labeled water method. The number of hours per week of MVPA significantly decreased with age, which is also consistent with previous findings. Conclusions Estimated reference MET values in this study were similar to those in previous studies of Japanese women. The JNHS questionnaire is therefore useful for epidemiological surveys of midlife working women because it assigns estimated MET values as physical activity intensities.

The endoscopic features between herpes simplex virus (HSV) and cytomegalovirus (CMV) esophagitis overlap significantly, and hence the differential diagnosis between HSV and CMV esophagitis is sometimes difficult. Therefore, we developed a machine-learning-based classifier to discriminate between CMV and HSV esophagitis. We analyzed 87 patients with HSV esophagitis and 63 patients with CMV esophagitis and developed a machine-learning-based artificial intelligence (AI) system using a total of 666 endoscopic images with HSV esophagitis and 416 endoscopic images with CMV esophagitis. In the five repeated five-fold cross-validations based on the hue–saturation–brightness color model, logistic regression with a least absolute shrinkage and selection operation showed the best performance (sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve: 100%, 100%, 100%, 100%, 100%, and 1.0, respectively). Previous history of transplantation was included in classifiers as a clinical factor; the lower the performance of these classifiers, the greater the effect of including this clinical factor. Our machine-learning-based AI system for differential diagnosis between HSV and CMV esophagitis showed high accuracy, which could help clinicians with diagnoses.

Background Endoscopic surveillance after total gastrectomy (TG) for gastric cancer is routinely performed to detect tumor recurrence and postoperative adverse events. However, the reports on the clinical benefits of endoscopic surveillance are ambiguous. We investigated the clinical benefit of endoscopic surveillance after TG for gastric cancer. Methods We analyzed 848 patients who underwent TG with R0 resection for gastric cancer between 2011 and 2012 (380 early gastric cancer and 468 advanced gastric cancer) and underwent regular postoperative surveillance with endoscopy and abdominopelvic computed tomography (CT) with contrast. Results Median follow-up periods were 58 months for both endoscopy (range, 3–96) and abdominopelvic CT (range, 1–96). Tumor recurrence occurred in 167 patients (19.7%), of whom seven (4.2%) were locoregional recurrences in the peri-anastomotic area (n = 5) or regional gastric lymph nodes (n = 2). Whereas the peri-anastomotic recurrences were detected by both endoscopy and abdominopelvic CT, regional lymph node recurrences were only detected by abdominopelvic CT. Out of the 23 events of postoperative adverse events, the majority (87%) were detected by radiologic examinations; three events of benign strictures in the anastomotic site were detected only by endoscopy. Conclusion Endoscopic surveillance did not have a significant role in detecting locoregional tumor recurrence and postoperative adverse events after TG with R0 resection for gastric cancer. Routine endoscopic surveillance after TG may be considered optional and performed according to the capacities of each clinical setting., Graphical Abstract

BACKGROUND Generative adversarial networks(GAN) in medicine is a valuable technique for augmenting unbalanced data, anomaly detection, learning representation, and avoiding patient privacy issues. However, there were limitations in generating highly realistic endoscopic images with various characteristics, such as peristalsis, viewpoints, light sources, artifacts, and mucous patterns. OBJECTIVE The purpose of this study is to evaluate the ability to generate gastrointestinal images using a progressive growing GAN(PGGAN) within the distribution of a normal dataset and to investigate obstacles of PGGAN in compositing high-quality endoscopic images. METHODS We trained the PGGAN with 107,060 normal gastroscopy images obtained from 4,165 normal patients 5122 pixels images. For the evaluation, visual Turing tests were conducted by endoscopists on 200 images(randomly selected 100 real and 100 synthetics) to distinguish the authenticity of the images. Nineteen endoscopists were divided into three groups to determine differences in discernment based on clinical experience.(Twelve endoscopists with 0-5 yrs experience[Group I], three endoscopists with 5-10 yrs experience[Group II], four endoscopists more than 10 yrs experience[Group III]). In addition, subgroup analysis by anatomical structures was performed to analyze 100 generated images. RESULTS The overall accuracy, sensitivity, and specificity of the nineteen endoscopists were 61.3, 70.3, and 52.4%, respectively. The mean accuracy of the three endoscopist groups was 62.4[Group I], 59.8[Group II], and 59.1 %[Group III], which was not shown a meaningful difference(P=.73). There were no statistical differences in the locations and forward/retroflexion view of the stomach. However, in sensitivity to anatomical landmarks, the sensitivity to the pylorus was higher than in other locations(P=.002). The discontinuous gastric folds in the stomach were the main reason for endoscopists to detect the generated image as a fake image. CONCLUSIONS The images generated by PGGAN showed highly realistic depictions that were difficult to distinguish for 5122 pixels images. However, it has limitations in generating gastric folds in high-resolution images. CLINICALTRIAL

Importance: Early menarche and early menopause are associated with increased risk of cardiovascular disease (CVD) in midlife, but little is known about the association between reproductive life span and the risk of CVD. Objective: To investigate the association between the length of reproductive life span and risk of incident CVD events, while also considering the timing of menarche and menopause. Design, Setting, and Participants: Individual-level data were pooled from 12 studies participating in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events consortium. Women provided complete information on the timing of menarche and menopause, nonfatal CVD events, and covariates. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs, adjusted for covariates. The association between reproductive life span and CVD was adjusted for age at menarche and age at menopause separately. Analysis began March 2018 and ended December 2019. Exposures: Reproductive life span was calculated by subtracting age at menarche from age at menopause and categorized as younger than 30, 30 to 32, 33 to 35, 36 to 38 (reference group), 39 to 41, 42 to 44, and 45 years or older. Main Outcomes and Measures: First nonfatal CVD event, including coronary heart disease and stroke events. Results: A total of 307 855 women were included. Overall, the mean (SD) ages at menarche, menopause, and reproductive life span were 13.0 (1.5) years, 50.2 (4.4) years, and 37.2 (4.6) years, respectively. Pooled analyses showed that women with a very short reproductive life span (

Eosinophilic cholangiopathy is an uncommon etiology of biliary stenosis, which is characterized by eosinophilic infiltration. Clinically, it is difficult to distinguish eosinophilic cholangiopathy from other causes of obstructive cholangiopathy before pathologic confirmation. We report a case of eosinophilic cholangiopathy. A 30-year-old male patient complained of right upper quadrant abdominal pain. Magnetic resonance cholangiopancreatography showed distended gallbladder and multifocal bile duct strictures with diffuse wall thickening. His bilirubin level increased continuously even after endoscopic retrograde cholangiopancreatography. He underwent laparoscopic cholecystectomy for cholecystitis and pathology of resected gallbladder revealed marked eosinophilic infiltration with no malignant component. His pain improved after cholecystectomy and multifocal bile duct strictures with wall thickening were rapidly improved after steroid therapy.

Early menopause is associated with an increased risk of subsequent cardiovascular disease (CVD). Few studies have investigated the converse. We examined whether premenopausal CVD events are associated with early age at menopause. We pooled the individual data of 177,131 women from nine studies. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRR) and 95% confidence intervals (CI) for the associations between age at onset of premenopausal CVD events—including coronary heart disease (CHD) and stroke—and age at natural menopause. Altogether 1561 (0.9%) premenopausal participants reported CVD events (including 1130 CHD and 469 stroke) at a mean age of 41.3 years. Compared with women without any premenopausal CVD events, women who experienced a first CVD event before age 35 years had a twofold risk of menopause before age 45 years (early menopause); adjusted RRR (95% CI) of 1.92 (1.17, 3.14) for any CVD, 1.86 (1.01, 3.43) for CHD and 2.17 (1.43, 3.30) for stroke. Women who experienced a first premenopausal CVD event after age 40 years underwent a natural menopause at the expected age (around 51 years). These associations were robust to adjustment for smoking status, BMI, educational level, race/ethnicity, age at menarche, parity, hypertension and family history of CVD. For premenopausal women, a first CVD event before age 35 years is associated with a doubling of the risk of an early menopause, while a first CVD event occurred after 35 years indicates a normal menopause at around 51 years. Shared genetic and environmental factors (such as smoking), as well as compromised vasculature following CVD events, may contribute to this outcome.

BackgroundWe compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar.MethodsNational register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35–64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference.ResultsClear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6–2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers.ConclusionPatterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.

The Rutgeerts score is used to predict postoperative recurrence in CD patients after ileocolic resection and is primarily based on endoscopic findings at the neoterminal ileum. However, the optimal assessment of anastomotic ulcers (AUs) remains subject to debate. We aimed to investigate the association between anastomotic ulcers (AUs) and endoscopic recurrence in postoperative Crohn’s disease (CD) patients. This single-center retrospective study, conducted between 2000 and 2016, evaluated postoperative CD patients with endoscopic remission at the first ileocolonoscopy within 1 year after ileocolic resection and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs in predicting endoscopic recurrence. Among 116 patients who were in endoscopic remission defined as the RS of i0 to i1 at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the median 30.0 months (interquartile range, 21.3–53.3) of follow-up after the first ileocolonoscopy, 56.1% (55/98) of patients showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs, defined as either an ulcer occupying ≥ 1/4 of the circumference, ≥ 3 ulcers confined to anastomotic ring, or any ulcers extending to the ileocolonic mucosa, showed endoscopic recurrence. On multivariable analysis, AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87–10.0; P

Aims/Introduction To examine the association between adult‐onset diabetes and life‐course bodyweight changes. Materials and Methods In a cross‐sectional study, 17,398 Japanese female nurses aged ≥30 years completed a self‐administered questionnaire in 2001–2007. Bodyweight indices were calculated for three life stages: birthweight (adjusted for gestational age), body mass index (BMI) at age 18 years and current BMI. Odds ratios for being diagnosed with adult‐onset diabetes were calculated according to the combined bodyweight categories of two life stages: at birth and age 18 years; and at age 18 years and the survey (current). Path analysis was carried out to decompose the effect of each bodyweight index into direct and mediating effects. Results After adjustment for age at survey and parental diabetes history, “low” birthweight (

We performed a scrutiny survey of self-reported uterine leiomyomata (UL) to investigate the associations of parental history with hypertension and personal history of hypertension in the UL cases in Japanese women. Questionnaires that included items on the sites of UL determined by imaging techniques and surgical procedure were mailed to 2015 women with a self-reported UL at a baseline survey of the Japan Nurses' Health Study (n = 15,019). We found that women with a past history and a maternal history of hypertension had an increase in their risk of UL. A maternal history of hypertension was significantly associated with an increase in the risk of UL in women without a past history of hypertension but not in the women with a past history of hypertension. A past history and a parental history of diabetes mellitus were not associated with an increase in the risk of UL. Women of reproductive age with a maternal history of hypertension may be at a higher risk for hypertension and UL. Impact Statement What is already known on this subject? A positive association of uterine leiomyomata (UL) with a past history of hypertension has been found but the association of a parental history of hypertension with UL has not yet been clarified. What do the results of this study add? Maternal hypertension, as well as a personal history of hypertension, was associated with an increased risk of UL and a past history and a parental history of diabetes mellitus were not associated with an increase in the risk of UL. What are the implications of these findings for clinical practice and/or further research? Women of a reproductive age with a maternal history of hypertension may be at a higher risk for hypertension and UL.

Background As atrial fibrillation (AF) increases with the aging of the population, it is urgently required to clarify modifiable factors to prevent AF. However, evidence regarding the independent influence of abdominal-obesity and habitual behaviors on incident AF is limited among Japanese. Methods and Results Those aged 40–79 years undergoing periodic health checkups during 2008–2014 were followed-up in 2015 (n = 96,841) and the independent risk of incident AF was estimated using multivariate Cox proportional hazards regression models after adjustment for potential covariates. Participants were classified into four groups according to the baseline body mass index (BMI: kg/m2) (normal-BMI or overweight: Conclusions Abdominal-obesity could be a crucial risk factor in prediction of AF in Japanese, and an aggregation of four behavioral factors increased the risk of AF almost three times. To prevent incident AF, practicing healthy habitual behaviors is recommended.

Background Although several studies have shown that blood type O is associated with increased risk of peptic ulcer, few studies have investigated these associations in Japan. We sought to investigate the association between the ABO blood group and risk of gastroduodenal ulcers (GDU) using combined analysis of both retrospective and prospective data from a large cohort study of Japanese women, the Japan Nurses' Health Study (JNHS; n = 15,019). Methods The impact of the ABO blood group on GDU risk was examined using Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CI), with adjustment for potential confounders. Results Compared with women with non-O blood types (A, B, and AB), women with blood type O had a significantly increased risk of GDU from birth (multivariable-adjusted HR 1.18; 95% CI, 1.04-1.34). Moreover, the highest cumulative incidence of GDU was observed in women born pre-1956 with blood type O. In a subgroup analysis stratified by birth year (pre-1956 or post-1955), the multivariable-adjusted HR of women with blood type O was 1.22 (95% CI, 1.00-1.49) and 1.15 (95% CI, 0.98-1.35) in the pre-1956 and post-1955 groups, respectively. Conclusion In this large, combined, ambispective cohort study of Japanese women, older women with blood type O had a higher risk of developing GDU than those with other blood types.

Background Although birth weight is considered as a fetal determinant of the development of adult-onset diabetes mellitus (DM), its public health importance relative to adult body mass index (BMI) remains unclear. We aimed to examine the association between adult-onset DM and birth weight in relation to adult BMI. Methods We conducted a self-administered questionnaire as a baseline survey of the Japanese Nurses' Health Study cohort between 2001 and 2007. Exclusion criteria were applied to the volunteer sample of 49,927 female nurses (age, Highlights • Association of birth weight and adult-onset DM was analyzed using JNHS study data. • Odds ratio for developing DM per 100 g increase in birth weight was 0.93. • The link was also observed when birth weight percentile for gestational age was used. • Low birth weight was associated with adult-onset DM, even with normal current BMI.

Background: Early menopause is linked to an increased risk of cardiovascular disease mortality; however, the association between early menopause and incidence and timing of cardiovascular disease is unclear. We aimed to assess the associations between age at natural menopause and incidence and timing of cardiovascular disease. Methods: We harmonised and pooled individual-level data from 15 observational studies done across five countries and regions (Australia, Scandinavia, the USA, Japan, and the UK) between 1946 and 2013. Women who had reported their menopause status, age at natural menopause (if postmenopausal), and cardiovascular disease status (including coronary heart disease and stroke) were included. We excluded women who had hysterectomy or oophorectomy and women who did not report their age at menopause. The primary endpoint of this study was the occurrence of first non-fatal cardiovascular disease, defined as a composite outcome of incident coronary heart disease (including heart attack and angina) or stroke (including ischaemic stroke or haemorrhagic stroke). We used Cox proportional hazards models to estimate multivariate hazard ratios (HRs) and 95% CIs for the associations between age at menopause and incident cardiovascular disease event. We also adjusted the model to account for smoking status, menopausal hormone therapy status, body-mass index, and education levels. Age at natural menopause was categorised as premenopausal or perimenopausal, younger than 40 years (premature menopause), 40–44 years (early menopause), 45–49 years (relatively early), 50–51 years (reference category), 52–54 years (relatively late), and 55 years or older (late menopause). Findings: Overall, 301 438 women were included in our analysis. Of these 301 438 women, 12 962 (4·3%) had a first non-fatal cardiovascular disease event after menopause, of whom 9369 (3·1%) had coronary heart disease and 4338 (1·4%) had strokes. Compared with women who had menopause at age 50–51 years, the risk of cardiovascular disease was higher in women who had premature menopause (age

Introduction Walking activity shows differences by season or neighborhood walkability (NW). Elucidation of interactions between season and NW may contribute to the identification of high-risk populations. We examined the interaction effect of objectively measured NW and season on step counts in a large population. Methods We analyzed consecutively measured pedometer data collected from 47,233 adults aged 40–79 years who participated in the Yokohama Walking Point Program. Step counts in May 2018 (spring) and August (summer) as well as October (autumn) and January 2019 (winter) were compared. Neighborhoods (postal code areas) were classified into quartiles for each of the three NW variables (i.e., distance to the nearest railway station, population density, and street intersection density). The interaction effect of each of the NW variables and season on step count was examined using mixed-effects linear regression analyses. Results The average daily step counts were fewer in summer and winter and higher in areas near the railway stations and areas with higher population density. We found a significant interaction effect of NW and season on step counts in summer. Participants residing in areas farther from the nearest railway station (P Conclusions NW and season showed interaction effect on adults’ step counts, indicating that in low walkable areas where residents generally walk less, their step counts decrease more in summer when compared with those in other areas; however, this was not the case in winter. Promoting walking in the less walkable neighborhoods, specifically during summer, is required.

Although the Congo-red agar method has been widely used to detect slime-producing or biofilm forming Staphylococcus sp. in numerous previous studies, their results were contradictory and did not show high correlation with other biofilm characteristics of bacteria such as ica gene profiles, biofilm formation, and so on. Therefore, this study was conducted to evaluate various Congo-red agar methods and to develop the accurate detection method for slime-producing Staphylococcus sp. using Congo-red dye. Total 47 Staphylococcus sp. (36 Staphylococcus aureus and 11 other strains) were tested for the ica gene profiles and phenotypes on various Congo-red agars or broths based on TSB, BHI, or BAB with sucrose or glucose. The icaA/icaD genes were found in 32 S. aureus and 5 other strains and these results was perfectly correlated with results on Congo-red broth based on TSB supplemented with sucrose. Relatively high positive-predictive values (84–93%) were observed when Congo-red agars were tested while negative-predictive values were low (26–44%). From these results, phenotypes on Congo-red agar or broth methods could be different depending on types or chemical composition of tested media and Congo-red broth method based on TSB supplemented with sucrose designed in this study were very accurate to detect slime-producing Staphylococcus sp.

We present proton-induced single event effects (SEEs) and γ-ray-induced total ionizing dose (TID) data for 1 Gbit lowpower double data rate synchronous dynamic random access memory (LPDDR SDRAM) fabricated on a 5 μm epitaxial layer (54 nm complementary metal-oxide-semiconductor (CMOS) technology). We compare our radiation tolerance data for LPDDR SDRAM with those of general DDR SDRAM. The data confirms that our devices under test (DUTs) are potential candidates for space flight applications.

A one-step immunoassay for influenza A virus detection was developed using two different microbeads and a filter-inserted bottle. Two bead types with diameters of 15 (capture bead) and 3 (detection bead) μm were prepared to specifically detect influenza A virus. Anti-influenza A virus antibodies were coated on both bead types, whereas urease was immobilized only on the detection bead. An influenza A-positive sample could form a sandwich complex with the capture and detection beads; this complex would not pass through the filter, which had a controlled pore size. As the detection bead was used at a limiting concentration, it would be prevented from crossing the filter; thus, it would further react with the substrate urea and consequently increase the pH. An influenza A-negative sample would fail to form the sandwich complex in the presence of the capture and detection beads. Accordingly, the detection bead would pass through the filter into the urea buffer and increase the pH. The pH change in the urease reaction could be quantitatively measured by an indicator such as phenol red or using ion-selective field-effect transistor (ISFET). This one-step immunoassay was used for the detection of influenza A virus in real samples. The receiver operating characteristic (ROC) plot analysis showed an area under the curve (AUC) value of 0.931; the sensitivity and specificity of the assay was 80% and 90%, respectively, at a cutoff value of 0.9986. These results demonstrate that the one-step immunoassay could increase the sensitivity of influenza A virus detection in real samples.

Early menopause is associated with an increased risk of subsequent cardiovascular disease (CVD). Few studies have investigated the converse. We examined whether premenopausal CVD events are associated with early age at menopause. We pooled the individual data of 177,131 women from nine studies. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRR) and 95% confidence intervals (CI) for the associations between age at onset of premenopausal CVD events-including coronary heart disease (CHD) and stroke-and age at natural menopause. Altogether 1561 (0.9%) premenopausal participants reported CVD events (including 1130 CHD and 469 stroke) at a mean age of 41.3 years. Compared with women without any premenopausal CVD events, women who experienced a first CVD event before age 35 years had a twofold risk of menopause before age 45 years (early menopause); adjusted RRR (95% CI) of 1.92 (1.17, 3.14) for any CVD, 1.86 (1.01, 3.43) for CHD and 2.17 (1.43, 3.30) for stroke. Women who experienced a first premenopausal CVD event after age 40 years underwent a natural menopause at the expected age (around 51 years). These associations were robust to adjustment for smoking status, BMI, educational level, race/ethnicity, age at menarche, parity, hypertension and family history of CVD. For premenopausal women, a first CVD event before age 35 years is associated with a doubling of the risk of an early menopause, while a first CVD event occurred after 35 years indicates a normal menopause at around 51 years. Shared genetic and environmental factors (such as smoking), as well as compromised vasculature following CVD events, may contribute to this outcome.

Results of studies on the associations of soy food intake with urinary estrogen levels in premenopausal women and in postmenopausal women have been inconsistent. We examined the associations of urinary isoflavone levels as well as soy food intake with estrone (E1) and estradiol (E2) in pre- and postmenopausal women. In addition, we compared the levels of isoflavones, E1 and E2 across current hormone users such as those receiving hormone replacement therapy and those using oral contraceptives and non-users among both pre- and postmenopausal women. Urinary levels of isoflavones, E1 and E2 in 498 women (36 hormone users and 462 non-users) were analyzed. Premenopausal women with a higher frequency of soy food intake had higher urinary isoflavone levels, but there were no significant associations between E1 and E2 levels and urinary isoflavone levels. Levels of E1 and E2 in hormone users were significantly lower than those in hormone non-users among premenopausal women, but levels of E1 and E2 in hormone users were significantly higher than those in hormone non-users among postmenopausal women. Postmenopausal women with a higher frequency of soy food intake had higher urinary isoflavone levels, and postmenopausal women with high urinary isoflavone levels had significantly higher E1 and E2 levels. In conclusion, the associations of urinary isoflavone levels with urinary estrogen levels differed with menopausal status. Urinary levels of E1 and E2 were high in postmenopausal women with high urinary isoflavone levels but not in premenopausal women with high urinary isoflavone levels.

Background: Smartphones have been integrated into our society and are expected to serve as tools to improve health outcomes. In the summer of 2016, Pokemon GO, a location-based augmented reality game for smartphones was released; it attracted attention from the perspective of health, especially with its potential to increase physical activity (PA). A few studies have compared objectively measured step counts before and after the release of the game; however, they were conducted over a short study period and evaluated only young people. Objective: The objective of this study was to confirm whether there was a difference in step counts between middle-aged and elderly players and nonplayers before and after the release of Pokemon GO. Methods: A total of 46 players and 184 nonplayers aged ≥40 years were matched for sex, age group, and PA level; they were respondents to a questionnaire randomly sent to citizens who were given free pedometers by Yokohama city. Their play status was identified through the questionnaire. To investigate the change in step counts before and after the release of Pokemon GO according to play status, a 2-way repeated-measures analysis of variance was performed. Step counts 1 month before the release of the game were compared with those 8 months after the release. In addition, subgroup analyses according to sex, age group, PA level, and subjective health status were performed. Results: The mean ages of players and nonplayers were 56.5 (SD 9.9) years and 57.3 (SD 9.6) years, respectively, and the mean baseline step counts of players and nonplayers were 7641.8 (SD 2754.5) and 7903.3 (SD 2674.7), respectively. There was no significant difference in the age and baseline step counts according to a t test (2-tailed). In the analysis of all samples, the interaction between play status and time effect was significant for 3 of 8 months after release. In the subgroup analyses, the interaction was significant for 3 months in men, 7 months in the 55-64-year-old group, 2 months in workers, 4 months in the active group in PA level, and 2 months in participants with subjectively good health. The interaction was significant for only 1 month, at most, in other subgroups. Conclusions: The present study confirmed a difference in step counts between players and nonplayers before and after the release of Pokemon GO. According to our analysis, step counts were higher until 7 months after the release. The player group maintained their step counts in winter, despite the decrease in step counts of nonplayers. In subgroup analyses, players were more likely to be men, aged

BACKGROUND Smartphones have been integrated into our society and are expected to serve as tools to improve health outcomes. In the summer of 2016, Pokémon GO, a location-based augmented reality game for smartphones was released; it attracted attention from the perspective of health, especially with its potential to increase physical activity (PA). A few studies have compared objectively measured step counts before and after the release of the game; however, they were conducted over a short study period and evaluated only young people. OBJECTIVE The objective of this study was to confirm whether there was a difference in step counts between middle-aged and elderly players and nonplayers before and after the release of Pokémon GO. METHODS A total of 46 players and 184 nonplayers aged ≥40 years were matched for sex, age group, and PA level; they were respondents to a questionnaire randomly sent to citizens who were given free pedometers by Yokohama city. Their play status was identified through the questionnaire. To investigate the change in step counts before and after the release of Pokémon GO according to play status, a 2-way repeated-measures analysis of variance was performed. Step counts 1 month before the release of the game were compared with those 8 months after the release. In addition, subgroup analyses according to sex, age group, PA level, and subjective health status were performed. RESULTS The mean ages of players and nonplayers were 56.5 (SD 9.9) years and 57.3 (SD 9.6) years, respectively, and the mean baseline step counts of players and nonplayers were 7641.8 (SD 2754.5) and 7903.3 (SD 2674.7), respectively. There was no significant difference in the age and baseline step counts according to a t test (2-tailed). In the analysis of all samples, the interaction between play status and time effect was significant for 3 of 8 months after release. In the subgroup analyses, the interaction was significant for 3 months in men, 7 months in the 55-64-year-old group, 2 months in workers, 4 months in the active group in PA level, and 2 months in participants with subjectively good health. The interaction was significant for only 1 month, at most, in other subgroups. CONCLUSIONS The present study confirmed a difference in step counts between players and nonplayers before and after the release of Pokémon GO. According to our analysis, step counts were higher until 7 months after the release. The player group maintained their step counts in winter, despite the decrease in step counts of nonplayers. In subgroup analyses, players were more likely to be men, aged

Recently, marine accidents such as the sinking accident Mongol freighter ship and the sinking accident of Sewol ferry in Jindo continuously happen. In order to decrease the number of these marine accidents, Korean ships are obliged to follow the AIS(Automatic Identification System) system. The AIS protocol includes all information for sailing ships. However, the standard AIS protocol does not provide any security function, In addition, it is possible to hijack the standard AIS protocol in case of using a satellite communication device called FUNcuve Dongle Pro+. Therefore, this paper analyzes weak points of the security in the standard AIS protocol. Furthermore, this paper ensures reliability by marking the MAC Address of sender and receiver for secure communication and suggests the protocol that can securely send data, using the VPN Tunnelling method. Therefore, the suggested AIS protocol provides the secure communication to the AIS protocol and protect the messages in the AIS protocol, which can serve safe voyages by decreasing the marine accidents.

Study design A retrospective observational and case control study. Purpose To identify appropriate treatment options according to the types of surgical site infections (SSI) in instrumented posterior lumbar interbody fusion (PLIF). Overview of literature There has been no agreement or consensus with regard to this matter. Methods Thirty-two consecutive SSIs were included and followed for more than one year. The elapsed time to diagnosis (ETD) according to the type of SSI was analyzed. The treatment options for each type and consequent clinical results were reviewed. The risk factors of removing the implants were analyzed. Results There were 6/32 (19%) superficial incisional, 6/32 (19%) deep incisional, and 20/32 (62%) organ/space infection cases (SII, DII, and O/SI, respectively) (p=0.002). ETD was 8.5±2.3 days in SII, 8.7±2.3 days in DII, and 164.5±131.1 days in O/SI (p=0.013). All cases of SII and DII retained implants and were treated by repeated irrigation and secondary closure. Among O/SIs, 10/20 were treated conservatively. Nine out of ten underwent posterior one stage simultaneous revision (POSSR) and in one case, the cage was removed anteriorly. Those who had ETDs longer than 3 months showed a significant risk of implant removal (p=0.008, odds ratio [OR]=40.3). The Oswestry disability index (ODI) improved from 47.3% to 33.8% in SII, from 55.0% to 32.3% in DII, and from 53.4% to 42.1% in O/SI (p=0.002). There was no difference among the three groups (p=0.106); however, there was a partial correlation between ETD and final ODI (r=0.382, p=0.034). Conclusions Latent O/SI was the most common type of SSI in PLIF. In cases of SII and DII, early aggressive wound management and secondary closure was effective and implant removal was not necessary. In some cases of O/SI, implant removal was unavoidable. However, implant removal could be averted by an earlier diagnosis. POSSR was feasible and safe. Functional outcomes were improved; however, disability increased as ETD increased.

UNLABELLED This study investigated the effect of material types (polystyrene, polypropylene, glass, and stainless steel) and glucose addition on Staphylococcus aureus biofilm formation, and the relationship between biofilm formation measured by crystal violet (CV) staining and the number of biofilm cells determined by cell counts was studied. We also evaluated the efficacy of chlorine sanitizer on inhibiting various different types of S. aureus biofilms on the surface of stainless steel. Levels of biofilm formation of S. aureus were higher on hydrophilic surfaces (glass and stainless steel) than on hydrophobic surfaces (polypropylene and polystyrene). With the exception of biofilm formed on glass, the addition of glucose in broth significantly increased the biofilm formation of S. aureus on all surfaces and for all tested strains (P ≤ 0.05). The number of biofilm cells was not correlated with the biomass of the biofilms determined using the CV staining method. The efficacy of chlorine sanitizer against biofilm of S. aureus was not significantly different depending on types of biofilm (P > 0.05). Therefore, further studies are needed in order to determine an accurate method quantifying levels of bacterial biofilm and to evaluate the resistance of bacterial biofilm on the material surface. PRACTICAL APPLICATION Biofilm formation of Staphylococcus aureus on the surface was different depending on the surface characteristics and S. aureus strains. There was low correlation between crystal violet staining method and viable counts technique for measuring levels of biofilm formation of S. aureus on the surfaces. These results could provide helpful information for finding and understanding the quantification method and resistance of bacterial biofilm on the surface.