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The aim of this study was to create prediction models for two year overall survival (OS) and amputation free survival (AFS) after revascularisation in patients with chronic limb threatening ischaemia (CLTI).This was a retrospective analysis of prospectively collected multicentre registry data (JAPAN Critical Limb Ischaemia Database; JCLIMB). Data from 3 505 unique patients with CLTI who had undergone revascularisation from 2013 to 2017 were extracted from the JCLIMB for the analysis. The cohort was randomly divided into development (2 861 patients) and validation cohorts (644 patients). In the development cohort, multivariable risk models were constructed to predict two year OS and AFS using Cox proportional hazard regression analysis. These models were applied to the validation cohort and their performances were evaluated using Harrell's C index and calibration plots.Kaplan-Meier estimates of two year OS and AFS post-revascularisation in the whole cohort were 69% and 62%, respectively. Strong predictors for OS consisted of age, activity, malignant neoplasm, chronic kidney disease (CKD), congestive heart failure (CHF), geriatric nutritional risk index (GNRI), and sex. Strong predictors for AFS included age, activity, malignant neoplasm, CKD, CHF, GNRI, body temperature, white blood cells, urgent revascularisation procedure, and sex. Prediction models for two year OS and AFS showed good discrimination with Harrell's C indexes of 0.73 (95% confidence interval [CI] 0.69 - 0.77) and 0.72 (95% CI 0.68 - 0.76), respectively CONCLUSION: Prediction models for two year OS and AFS post-revascularisation in patients with CLTI were created. They can assist in determining treatment strategies and serve as risk adjustment modalities for quality benchmarking for revascularisation in patients with CLTI at each facility.

Background: The aim of the present study was to determine whether parental age has any influence on child health. Methods: Well-baby check-up data at 1 month and at 12 months of age were used. The trends of parental age in association with growth measurements, incidence of physical and developmental abnormalities, occurrence of low birthweight, and maternal history of spontaneous abortion were analyzed. Results: Associations between increasing paternal age and incidence of psychomotor developmental delay at 12 months, increasing paternal and maternal age and increasing birthweight, and increasing parental age and higher incidence of history of spontaneous abortion were found. The incidence of low-birthweight infants was significantly decreased with increasing paternal age. Conclusions: Not only increasing maternal age but also increasing paternal age have influences on child development and growth in the general population.

The main objective of this study was to develop a simulation program to determine the sample size for a clinical study to confirm a genetic-disease association observed in a retrospective exploratory study. The effect of misclassification of a binary response variable on the power is also investigated. A general expression for the magnitude of the decrease in statistical power due to misclassification is obtained based on the Pitman asymptotic relative efficiency. The simulation program presents an estimate of the exact power when misclassification exists. Running the program several times under different settings of parameters, it revealed that the effect of even low misclassification rates is serious. Response misclassification should be taken into consideration when determining the sample size. The program can be used on the Internet.

No definitive treatment strategy has been established for patients with an antenatal diagnosed congenital diaphragmatic hernia (AD-CDH). From 1997 to 2003 in this department fetal stabilization (FS) was administered using both morphine and diazepam via the placenta just before delivery of the fetus by cesarean section. In contrast, from 2004 to the present, a combination of gentle ventilation (GV) and a delayed operation was selected, which was performed when the patient’s circulatory stabilization (CS) was achieved. This study included 22 patients in the FS group and 16 patients in the GV + CS group, respectively. The outcomes in both groups were compared and the outcome in AD-CDH patients with a patch repaired operation, liver-up or lower lung-to-thorax transverse area ratio (L/T

The relationship between alcohol consumption and subclinical findings on magnetic resonance imaging (MRI) remains uncertain. We examined the relationship between light to moderate alcohol intake and silent brain infarction (SBI), white matter lesions (WMLs), and cerebral atrophy.Cranial MRI was performed on subjectsor=40 years residing in a rural community in Japan (n=385; mean age, 67.2). Alcohol intake and type was determined using a detailed questionnaire; subjects were categorized into three groups: non-drinkers, light drinkers (7 drinks per week), and moderate drinkers (or=7 drinks per week). Former drinkers were considered non-drinkers. Periventricular WMLs, deep WMLs and cerebral atrophy were measured quantitatively using a computer-assisted processing system (%PVWML, %DWML, and %Brain, respectively).Compared with non-drinkers, the prevalence odds ratios for SBI were significantly higher in light and moderate drinkers, after multivariate adjustment. After adjusting for age, sex, and other related factors, the geometric mean %PVWML volumes in light and moderate drinkers were 1.27% and 1.52%, respectively, significantly larger than those for non-drinkers (0.95%). The geometric mean %DWML volume in light drinkers was 0.10%, which was larger than the value for non-drinkers (0.06%); the value for moderate drinkers (0.13%) was significantly larger than that for non-drinkers. The geometric mean %Brain values for non-, light, and moderate drinkers were 92.1, 91.9 and 90.8%, respectively; a statistically significant difference was found between non-drinkers and moderate drinkers.The present study indicates that regular drinking, including even low levels of consumption, may be a risk factor for subclinical findings detected on MRI in community-dwelling Japanese people.

目的: 人間が一生の間にどの程度，輸血を受けるのかを知ることは，献血の際に，ボランティア·ドナーに説明するための必要なデータの一つである． 方法: 輸血回数を求めるに当たって，1．年齢別·性別人口，2．供給された献血本数，3．輸血を受けた患者の性別と年齢，を2つの県で集めた．第一は2002年の福岡県で，もう一つは2005年の神奈川県であった．各年齢の輸血回数の計算は，[Page=nage/Nage×T/t]の式で求めた．｛Page：nage：各年齢の輸血患者実数，各年齢（Nage）ごとの輸血回数，T: 一年間に供給された血液本数，t: 病院で輸注された血液本数｝ 結果: 1）福岡県の2002年の全人口は，5,034,311名であった（男性2,391,829; 女性2,642,482）．地域の赤十字血液センターは福岡県で輸血されるすべての血液をカバーしていた．2002年の血液供給本数は226,533本であった．一つの大学病院で輸血された患者数は，1,190名（男性646，女性544）であった．これらの患者に使用された血液は13,298本（男性7,210，女性6,088）であった．2）神奈川県の2005年の人口は，8,748,731名であった（男性4,420,831; 女性4,327,900）．地域の赤十字血液センターは福岡県と同様，県内使用血液のすべてをカバーしていた．2005年の供給本数は297,592本であった．5つの大学病院と1つのがん専門病院で輸血を受けた患者の総数は3,744名（男性1,673，女性2,071）であった．これらの患者に使用された血液は57,405本（男性31,760，女性25,645）であった．男性の寿命を79歳とすれば，福岡県で0.420回，神奈川県では0.297回輸血を受けていた．女性の平均寿命を87歳とすれば，福岡県では0.344回，神奈川県では0.275回輸血を受けていた． 結論: 我々のデータから，日本人は一生の間に男性は1/3，女性は1/4が輸血を受けると考えられた．さらに，輸血の可能性は80歳以上で男性，女性ともに急増していた．

It is not fully understood how the stimulus/response curves obtained by transcranial magnetic stimulation (TMS) reflect the function of the cortico-motoneuronal (CM) and spinal motoneuronal (SM) systems in healthy subjects. To understand these response functions, we studied patients with amyotrophic lateral sclerosis (ALS) whose upper but not lower motor neurons were affected.First, we determined the effects of voluntary muscle contraction and intensity of TMS on the motor evoked potentials (MEPs) of the first dorsal interossei (FDI) muscle in ten healthy control subjects (mean age: 35.1 +/- 6.7 years) and two older female subjects (60 and 64 years old). Second, we investigated whether this relationship was altered in two ALS patients (60-year-old woman and 69-year-old man). The MEPs were recorded at different degrees of voluntary contraction by threshold stimulus intensities (TSIs) or at different levels of TMS with the muscle at rest.In the controls, the MEP amplitudes of the FDI muscle elicited by TSI increased linearly with muscle contraction (right: Y = 0.068X + 0.754; left: Y = 0.0670X + 0.807), whereas the MEP amplitudes elicited by different TMS intensities increased sigmoidally with a flexion point at 1.10-1.15 TSI: right: Amp = 2.21/[1 + exp[(S50-Stim)/K]], S50 = 10.73, K = 4.70; left: Amp = 2.90/[1 + exp[(S(50)-Stim)/K]], S50 = 13.64, K = 5.98. The latter was abnormal only on one side of each ALS patient.From these results, we suggest that the sigmoidal TMS intensity-size curves reflect mainly CM activities, while the linear contraction-size curves reflect SM activities.

Objectives: We conducted a community-based study to determine the relationship among night-time frequency, sleep disturbance and general health-related quality of life (GHQL). Methods: A total of 2271 participants, men and women, aged 41–70 and randomly selected in three Japanese towns completed a postal questionnaire survey. This questionnaire included: the International Prostate Symptom Score, the overall incontinence score of the International Consultation of Incontinence Questionnaire Short Form for lower urinary tract symptoms, the Pittsburg Sleep Quality Index for sleep problems, the Medical Outcome Study Short Form-8 for GHQL, and medical history of disease, cigarette smoking, and alcohol consumption. A multiple regression model was used for statistical analysis, and P

Objective Finite element analysis of clinical computed tomography (CT) scans provides a noninvasive means of assessing vertebral strength that is superior to dual x-ray absorptiometry (DXA)–measured areal bone mineral density. The present study was undertaken to compare strength changes, measured using this newer method, in rheumatoid arthritis (RA) patients who were treated with alendronate (ALN) versus those who were not. Methods Thirty female RA patients without radiologic signs of L3 compression fractures or a history of osteoporosis medication were enrolled in a prospective randomized clinical trial. Patients were randomly assigned to the ALN group (5 mg orally, once daily) or the control group not receiving antiresorptive treatment. All patients were evaluated by DXA and quantitative CT at baseline and reevaluated after a mean of 12.2 months. Nonlinear finite element analysis was performed on the CT scans (n = 29 available for analysis) to compute an estimate of vertebral compressive strength and to assess strength changes associated with changes in the trabecular compartment and the outer 2 mm of bone (peripheral compartment). Results On average, vertebral strength was significantly decreased from baseline in the control group (n = 15) (median change −10.6%; P = 0.008) but was maintained in the ALN group (n = 14) (median change +0.4%; P = 0.55), with a significant difference between the 2 groups (P < 0.01). Strength decreased more rapidly within the trabecular bone, and ALN treatment was much more effective in the peripheral than the trabecular compartment. Conclusion Our results indicate that patients with RA can lose a substantial amount of vertebral strength over a relatively short period of time, and this loss can be prevented by ALN, primarily via its positive effect on the outer 2 mm of vertebral bone.

The treatment outcome for infant acute lymphoblastic leukemia (ALL) with positive MLL gene rearrangements remains poor. We analyzed whether additional chromosomal abnormalities (ACA) other than 11q23 translocation could affect the disease behavior and its prognosis. Eighteen of seventy-four patients with infant acute lymphoblastic leukemia showed ACA, including three-way translocations in four, other novel translocations in four, and complex structural chromosomal changes in four. Only age less than 6 months and positive central nervous system leukemia were significant prognostic factors by multivariate analysis. However, overall survival rates were worse in patients with ACA compared to those with non-ACA. Genetic alterations induced by additional chromosomal changes may be associated with disease progression and poorer overall survival rates in infants with MLL-rearranged ALL.

Summary Purpose: To determine a psychophysiological basis for age visual sensitivity to chromatic and achromatic stimuli. Methods: We investigated the effects of achromatic and four isoluminant color combinations (blue/red, blue/green, green/red, and blue/yellow), luminance ratio changes in color combinations (blue/red; 1:1, 3:4, 4:3) and contrast changes (3 to 100%) on steady-state electroretinograms (ERGs) and visual evoked potentials (VEPs) in 32 healthy teenagers and 30 young adults. Results: We found that (1) dual peaks at 9 and 18 Hz with a dip at 12 Hz were observed in VEPs with all isoluminant color combinations, (2) VEP responses were significantly enhanced and the 12-Hz dip became unclear with luminance ratio changes between two colors with a nonantagonistic relationship (blue/red), and (3) VEP amplitudes were significantly increased when the contrast was increased. These characteristics were more evident in teenagers than young adults; however, ERGs were qualitatively similar between the two groups. Discussion: The visual cortex is differently modulated by different color-luminance combinations, and higher sensitivity to color-luminance combinations in the visual cortex in teenagers is responsible for the high prevalence of photo/chromatic sensitivity in adolescence.

Purpose: A prospective, randomized, controlled trial was done to evaluate whether oral administration of a preparation of the probiotic agent Lactobacillus casei (Yakult Honsha, Tokyo, Japan) could enhance the prevention of recurrence by intravesical instillation of epirubicin after transurethral resection for superficial bladder cancer.Materials and Methods: Between August 1999 and December 2002, 207 patients clinically diagnosed with superficial bladder cancer were included as study candidates and underwent transurethral resection, followed by intravesical instillation of 30 mg epirubicin/30 ml saline twice during 1 week. After histological confirmation of superficial bladder cancer they were again included as study participants with 102 randomized to receive treatment with 6 additional intravesical instillations of epirubicin during the 3-month period after transurethral resection (epirubicin group) and 100 randomized to intravesical chemotherapy on the same schedule as the epirubicin group plus oral a...

Objective: To investigate which features of eating disorders are associated with retinopathy and nephropathy in Type 1 diabetic females with clinical eating disorders. Method: Participants were 109 Type 1 diabetic females with clinical eating disorders diagnosed by the structured clinical interview for DSM-IV (bulimia nervosa [n = 70], binge-eating disorder [n = 28], anorexia nervosa [n = 7], and eating disorder not otherwise specified [n = 4]). Retinopathy and nephropathy were screened and demographic, medical, and eating disorder related factors were investigated. To identify the factors associated with each complication, logistic regression analysis was done. Results: Duration of severe insulin omission and duration of Type 1 diabetes were significantly associated with retinopathy (odds ratios = 1.35 and 1.23, respectively) and nephropathy (odds ratio = 1.35 and 1.21, respectively) in multivariate regression analyses. Conclusion: Of the various problematic behavioral factors related to eating disorders, the duration of severe insulin omission was the factor most closely associated with the retinopathy and nephropathy of Type 1 diabetic females with clinical eating disorders by multivariate analysis. This finding may help patients who deliberately omit insulin become aware of medical risk of insulin omission. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord, 2008

Introduction Protein S (PS) activity has been shown to decrease during normal pregnancy. The aim of this study was to determine any correlation between decreased maternal PS activity and fetal growth restriction (FGR). Methods We carried out a retrospective study of maternal PS activity and complement 4b-binding protein (C4BP) concentration in 102 patients with FGR and 58 patients with fetuses that had normal growth. Among pregnancies affected by FGR, 14 diagnoses were made in the second trimester and 88 in the third trimester. Patients whose fetuses had normal growth were matched with FGR subjects for maternal age and gestational age at sampling (29 cases each in the second and third trimester). Results Mean PS activity of the control group in the third trimester was significantly lower than in the second trimester (56.5 ± 16.5% vs 35.8 ± 13.8%). PS activity in women with FGR was significantly decreased in both the second trimester (36.6 ± 13.2%) and third trimester (30.2 ± 12.2%) compared with control group levels. Plasma concentrations of C4BP for the control group were significantly higher in the third trimester than in the second trimester (90.5 ± 17.5% vs 81.1 ± 13.6%). However, in women with FGR, plasma C4BP concentrations in both the second trimester (84.0 ± 14.8%) and the third trimester (86.0 ± 17.7%) were comparable with concentrations of the control group. Conclusions Maternal PS activity decreased as normal pregnancies progressed but decreased over time in cases with FGR. Excessive decreases in PS activity during pregnancy could contribute to development of FGR.

アトピー性皮膚炎(以下:AD)にとってかゆみはきわめて重要な臨床症状であり，掻破による皮疹の増悪が問題となる。そこで今回，精製ツバキ油100％のツバキ油スプレー(アトピコ®スキンヘルスケアオイル)を用いて，AD患者のかゆみに対する即時的な軽減効果，及びその保湿効果を副次的に検討した。AD患者39例を対象にツバキ油スプレー(以下:ツバキ油)または対照製剤として精製水スプレー(以下:精製水)を各々2週間使用させ，二重盲検·クロスオーバー比較試験を実施した。その結果，ツバキ油使用群は精製水使用群と比較して有意にかゆみを軽減する効果が認められた(p

In order to investigate the contribution of genetic variation in the human dopamine receptor D4 gene (DRD4) to the risk of developing schizophrenia, we carried out a genetic analysis of 27 polymorphisms in 216 schizophrenic patients and 243 healthy controls from the Kyushu region of Japan. Twenty-two single nucleotide polymorphisms (SNPs) and five insertion/deletion polymorphisms were analyzed in this study, including four novel SNPs and a novel mononucleotide repeat. Linkage disequilibrium (LD) and haplotype analyses reveal weak LD across the DRD4 gene. In univariate analysis female individuals with allele -521C had a higher risk for schizophrenia. However, this finding was not significant after correction for multiple hypothesis testing. No other polymorphisms or haplotypes differed between schizophrenic patients and controls. Likewise, multivariate analyses did not reveal any statistically significant associations.

This study aimed to investigate whether accumulation of subcutaneous abdominal fat has a beneficial correlation with lipid metabolism in premenopausal and/or postmenopausal Japanese women. The study enrolled 146 premenopausal women, ranging in age from 19 to 54 years, and 82 postmeno-pausal women, ranging in age from 47 to 66 years. Fat distribution, including abdominal visceral fat area (VFA) and abdominal subcutaneous fat area (SFA), were measured in an outpatient clinic by magnetic resonance imaging. Homogeneity of the regression slopes for SFA to total cholesterol ( P = 0.030), low-density lipoprotein cholesterol ( P = 0.020), apolipoprotein B (apoB) ( P = 0.001), and the ratio of apoB to apolipoprotein A-I (apoA-I) ( P = 0.003) were not found between premenopausal and postmenopausal women, even after adjustment for both VFA and age. However, the regression slopes for VFA to all measured lipid parameters, as well as apolipoproteins, were homogeneous between the premenopausal and postmeno-pausal groups. Abdominal SFA in postmenopausal women correlated negatively with total cholesterol ( P = 0.007), low-density lipoprotein cholesterol ( P = 0.002), apoB ( P < 0.001), and the ratio of apoB to apoA-I ( P = 0.001), after adjustment for age and VFA, but this was not the case in premenopausal women. The mechanisms involved in the beneficial effects of subcutaneous fat accumulation in postmenopausal women remain obscure, but upregulated aromatase expression, derived from adipose tissue, may possibly improve lipid and apolipoprotein metabolism.

We evaluated the efficacy of a treatment strategy in which infants with acute lymphoblastic leukemia (ALL) were stratified by their MLL gene status and then assigned to different risk-based therapies. A total of 102 patients were registered on two consecutive multicenter trials, designated MLL96 and MLL98, between 1995 and 2001. Those with a rearranged MLL gene (MLL-R, n=80) were assigned to receive intensive chemotherapy followed by hematopoietic stem cell transplantation (HSCT), while those with germline MLL (MLL-G, n=22) were treated with chemotherapy alone. The 5-year event-free survival (EFS) rate for all 102 infants was 50.9% (95% confidence interval, 41.0-60.8%). The most prominent late effect was growth impairment, observed in 58.9% of all evaluable patients in the MLL-R group. This plan of risk-based therapy appears to have improved the overall prognosis for infants with ALL, compared with previously reported results. However, over half the events in patients with MLL rearrangement occurred before the instigation of HSCT, and that HSCT-related toxic events comprised 36.3% (8/22) of post-transplantation events, suggesting that further stratification within the MLL-R group and the development of more effective early-phase intensification chemotherapy will be needed before the full potential of this strategy is realized.

Hemophagocytic lymphohistiocytosis (HLH), a disorder of the mononuclear phagocyte system, can be classified into two distinct forms: primary HLH (FHL) and secondary HLH. To clarify the epidemiology and clinical outcome for each HLH subtype, we conducted a nationwide survey of HLH in Japan. Since 799 patients were diagnosed in 292 institutions of Japan between 2001 and 2005, the annual incidence of HLH was estimated as 1 in 800,000 per year. Among them, 567 cases were actually analyzed in this study. The most frequent subtype was Epstein-Barr virus (EBV)-associated HLH, followed by other infection- or lymphoma-associated HLH. Age distribution showed a peak of autoimmune disease- and infection-associated HLH in children, while FHL and lymphoma-associated HLH occurred almost exclusively in infants and the elderly, respectively. The 5-year overall survival rate exceeded 80% for patients with EBV- or other infection-associated HLH, was intermediate for those with FHL or B-cell lymphoma-associated HLH, and poor for those with T/NK cell lymphoma-associated HLH (

Objective: Patients with acute myelogenous leukaemia (AML) show co-existing frequently internal tandem duplications of FLT3 (FLT3-ITD) and mutations of nucleophosmin (NPM1-Mt). We investigated the biological and clinical significance of FLT3-ITD and/or NPM1-Mt in this context. Methods: We analysed 89 AML patients according to whether NPM1 and FLT3-ITD were single mutants, double mutants, or wild type for both. Results: FLT3-ITD was detected in 19 of 89 patients (21.3%), while NPM1-Mt was detected in 19 of 89 patients (21.3%); eight of 89 patients (9.0%) carried both FLT3-ITD and NPM1-Mt. By multivariate analysis, white blood cell count and peripheral blood blast cell count at diagnosis were significantly higher in patients with FLT3-ITD but not in those with only NPM1-Mt. NPM1-Mt was significantly related to female gender, normal karyotype, and M4 or M5 disease according to French–American–British criteria. In addition, leukaemic blast cells with NPM1-Mt, FLT3-ITD, or both expressed CD34 less frequently than wild-type blasts (P

Aim: Glutathione-S-transferase P1 (GSTP1) detoxifies a wide range of endogenous and exogenous carcinogens and anticancer agents such as cisplatin and doxorubicin. The aim of this study was to examine the association between GSTP1 polymorphism and both urothelial cancer susceptibility and adverse events of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) chemotherapy in Japanese urothelial cancer patients. Methods: This cohort consisted of 179 urothelial cancer patients and 225 healthy controls matched for age and sex. GSTP1 Ile105Val polymorphism was identified by direct sequencing methods. Furthermore, the association of GSTP1 polymorphism and adverse events of M-VAC chemotherapy was investigated. Results: A similar frequency of GSTP1 Ile105Val allele was observed in the urothelial cancer patients and in the control group. However, when the 46 patients who underwent systemic M-VAC chemotherapy were investigated, significantly more severe toxicity in leukocytopenia (P = 0.044, odds ratio +∞, 95% confidence interval 0.9203– +∞) and a prolonged duration of G-CSF administration (P = 0.013, odds ratio 8.625, 95% confidence interval 1.390–89.98) were observed in patients with the Val allele in comparison to those with the Ile allele. Conclusions: The GSTP1 Ile105Val polymorphism was not found to be significantly associated with urothelial cancer susceptibility but it may be associated with myelosuppressive adverse events in M-VAC chemotherapy. The 105Val might therefore be a useful marker for predicting myelosuppression in M-VAC chemotherapy.

The objective was to investigate the relationship between fetal aortic distension waveforms and fetal hypoxemia and/or acidosis. Aortic distension waveforms were recorded using an echo-tracking system in nine late-gestation catheterized fetal lambs. Under hypoxic conditions induced by inhalation of gas mixture, fetal blood pressure and aortic distension waveforms were recorded. Four parameters, namely peak systolic and end diastolic diameter, amplitude (DeltaD) and ratio of DeltaD to end diastolic diameter (%DeltaD), were obtained, and correlations between these parameters and partial arterial oxygen tension (PaO(2)) and pH of fetal blood gas were analyzed. These four parameters were compared between the control, hypoxemic and asphyxic groups. The DeltaD and %DeltaD were significantly correlated with PaO(2) and pH using linear regression analysis. Both the DeltaD and %DeltaD decreased significantly, in a stepwise fashion, in the hypoxemic and asphyxiated groups compared with controls using repeated measured analysis of variance. It was concluded that fetal aortic distension waveforms proved to be a useful tool to detect the deterioration in the fetal circulation secondary to intrauterine hypoxemia/asphyxia.

Aims To determine the distributions of bothersome and non-bothersome nocturnal voiding and the differences between them using a community-based study. Subjects and Methods A total of 2,205 men and women aged 41–70 years from three Japanese towns responded to our postal questionnaire survey. The questionnaire included the International Prostate Symptom Score, Pittsburgh Sleep Quality Index (PSQI), Medical Outcome Study Short Form-8, medical history of several diseases, and history of cigarette smoking and alcohol consumption. We chose subjects who had one or two episodes of nocturnal voiding per night and divided them into two subgroups based on the answer to a question on trouble sleeping due to nocturnal voiding in the PSQI. We compared data regarding lower urinary tract symptoms (LUTS), sleep, and general health-related quality of life (GHQL) among these subgroups. Results Of the subjects: 314 (14.2%), 693 (31.4%), 149 (6.8%), and 168 (7.6%) had once-bothersome, once-non-bothersome, twice-bothersome, and twice-non-bothersome nocturnal voiding per night, respectively. Regarding LUTS, the twice-bothersome nocturnal voiding group had the worst and the once-non-bothersome group had the best scores while the once-bothersome and twice-non-bothersome nocturnal voiding groups had equivalent scores. Regarding sleep and GHQL, trouble sleeping but not the frequency of nocturnal voiding per se affected the scores. The twice-non-bothersome nocturnal voiding group generally had better scores than the once-bothersome group, while the former had more frequent nocturnal voiding. Conclusions Sleep and GHQL of subjects with mild (once or twice) night-time frequency are considerably impacted by sleeping troubles. Neurourol. Urodynam. 26:1014–1019, 2007. © 2007 Wiley-Liss, Inc.

OBJECTIVE To evaluate the clinical outcome of radical prostatectomy (RP) in Japan, by retrospectively analysing the clinicopathological data in patients with clinical T1-T2 prostate cancer treated by RP, as there can be prostate-specific antigen (PSA) recurrence after RP in substantially many patients, and its character can differ according to ethnic group and/or country. PATIENTS AND METHODS We reviewed 1192 patients who had a RP from 1993 to 2002 with no neoadjuvant/adjuvant therapy and whose PSA level after RP decreased at least once to undetectable levels (

OBJECTIVE To evaluate the expression of thymidylate synthase and dihydropyrimidine dehydrogenase in prostate tissue. MATERIALS AND METHODS Tissue from 79 patients with localized prostate cancer was used. Thymidylate synthase and dihydropyrimidine dehydrogenase expression were determined semiquantitatively by immunohistochemistry. RESULTS Thymidylate synthase and dihydropyrimidine dehydrogenase immunostaining grades of benign tissue were significantly higher than those of cancer tissue (both P

Aim: To investigate which part of the fetal aortic distension waveform is mainly influenced by changes in fetal cardiac contractility and aortic blood pressure. Methods: In acute preparation, aortic distension waveforms were recorded using an echo-tracking system, and aortic and left ventricular pressure waveforms were obtained from six late-gestation catheterized fetal lambs. Dobutamine and angiotensin II were separately infused and the correlations between the maximum value in the first derivative of left ventricle pressure waveforms (Max dP/dt) and fetal blood pressure, and the parameters obtained from aortic distension waveforms were analyzed using linear regression analysis. Results: With a change in cardiac contractility, the maximum value of first derivative of the systolic rising slope in the aortic distension waveform had a positive correlation with Max dP/dt (r = 0.93, P

Antibody responses to two doses of influenza hemagglutinin (HA) vaccine were evaluated in 45 previously unimmunized preterm infants aged 6–11 months before the 2003/2004 influenza season. Twenty-three (51.1%), 21 (46.6%) and 2 (4.4%) of the subjects acquired protective (≥1:40) hemagglutination inhibition (HI) antibody titers after vaccination for A/New Caledonia (H1N1), A/Panama (H3N2) and B/Shandong, respectively. Antibody responses to A (H1N1), A (H3N2) appeared to be comparable to those reported on full-term infants of similar ages vaccinated with the identical vaccine. Serum IgG levels at vaccination had no positive association with antibody responses on univariate or multivariate analysis, indicating that prolonged hypogammaglobulinemia after 6 months of age in preterm infants was not a factor to affect antibody responses to influenza HA vaccine.

Objective To record mismatch negativity (MMN) to a visual stimulus fulfilling similar criteria to those of auditory MMN (A-MMN). Methods Twelve normal adults were instructed to simultaneously listen to a story and to pay attention to a visual target. Three windmill patterns that differed in the number of vanes (standard, deviant, or target) were used as visual stimuli, and were randomly presented. To ensure endogeneity, standard and deviant stimuli were alternated. To vary differences between frequent (standard) and infrequent (deviant) stimuli, deviants were changed by modulating the number of vanes. To examine effects of physical features of the target stimulus on changes in detection, two target conditions were used. The deviant-related component (DRC) was obtained by subtracting event-related potentials (ERPs) to the deviant stimulus from those to the standard stimulus. Results Seven subjects completed all phases of the experiment. Behavioral performances indicated that subjects' attention was directed by auditory context and identification of the target stimulus. Visual DRC appeared 150–300 ms after stimulus onset, and consisted of an early (DRN1) and a late (DRN2) component. Magnitude of deviancy from standard stimulus significantly influenced latency of DRN2 but not its magnitude, while changes in target stimulus affected latencies of both DRN1 and DRN2. Conclusions Our DRCs satisfied criteria for A-MMN. In contrast to A-MMN, only latency of the DRC was associated with visual sensory discrimination and attentional reorienting. Significance It is possible to record valid MMN to a visual stimulus, which allows the study of preattentive visual information processing.

Objectives To evaluate multiple known prognostic markers in localized prostate cancer using tissue microarrays in Japanese patients. Molecular studies have suggested that ethnicity influences prostate tumor biology. Methods Specimens were studied from 52 patients who underwent radical surgery at our institution between 1997 and 2001 without neoadjuvant hormonal therapy and with three or more available and complete cancer spots. Ki67, p53, and androgen receptor antigen expression were examined. Immunohistochemical scores were compared with outcomes of chemical relapse as monitored using prostate-specific antigen. Results Pathologic tumor classification ( P = 0.047), World Health Organization score ( P = 0.026), World Health Organization histologic grade ( P = 0.026), and surgical margin status ( P = 0.018) were significant conventional clinicopathologic variables for predicting biochemical failure. The tissue microarray Gleason sum ( P = 0.038), tissue microarray primary Gleason grade ( P = 0.013), Ki67 labeling index ( P P = 0.0097), and androgen receptor ( P = 0.0113) antigen expression also were significant. Moreover, surgical margin status and Ki67 labeling index were independently associated with treatment failure. Conclusions Especially together, the Ki67 labeling index and p53 and androgen receptor expression in localized prostate cancer often predicted postoperative progression in Japanese patients.

Objectives The objectives of this study are firstly to clarify how the Doppler isovolumetric contraction time (ICT) is influenced by arterial oxygen pressure (PaO2) or pH, and secondly to confirm the relationship between the Doppler ICT and myocardial contractility during hypoxemia and/or acidemia in the fetal lamb. Material and methods In 12 pregnant ewes, fetal hypoxemia and acidemia were induced by giving ewes a variable mixture of gases for 120 min. The chronological change of fetal PaO2, pH, Doppler ICT and maximum first derivative of the left ventricular pressure waveform (Max dp/dt) was recorded every 30 min. Results Doppler ICT and PaO2 had no significant regression. On the other hand, Doppler ICT and pH demonstrated a significant negative regression. Moreover, one critical given pH point was indicated with statistical significance at 7.20 and the prolongation of the Doppler ICT was found more markedly in the range below the pH of 7.20 compared with the range above 7.20. A significant negative linear regression was found between the Doppler ICT and the Max dp/dt. Conclusion The measurement of Doppler ICT enables us to predict severe acidosis and a decrease of myocardial contractility in the fetus.

Summary Laminin-5 (LN-5) and cyclooxygenase 2 (COX-2) play important roles in many kinds of cancers. Recently, it has been reported that epidermal growth factor (EGFR) and/or human epidermal growth factor 2 (HER2) expressions are associated with LN-5 and/or COX-2 expressions in a few carcinoma cell lines and human tumor tissue. LN-5, COX-2, EGFR, and HER2 expressions were examined immunohistochemically in 67 patients with urothelial carcinomas (UCs), and associations among these 4 biomarkers and clinicopathologic characteristics were investigated. Patients were classified into transurethral resection group and cystectomy group based on clinical end points, and prognostic significances of increased expressions were evaluated. Overexpression of LN-5, COX-2, EGFR, and HER2 was observed in 16 (23.9%), 34 (50.7%), 42 (62.7%), and 15 (22.4%) of 67 patients, respectively. LN-5 overexpression was associated high-grade ( P = .002), invasive (pTa+1 versus pT2-4, P = .011), and nonpapillary ( P = .027) UCs. Concerning EGFR and HER2, high-grade (EGFR, P = .0009; HER2, P = .003) and nonpapillary (EGFR, P = .016; HER2, P = .0002) UCs had a significantly higher overexpression rate. UCs penetrating basal membrane (pT1-4) showed significantly higher overexpression rates than pTa UCs on all biomarkers. In transurethral resection group, LN-5 overexpression could be proved as an independent prognostic parameter for intravesical recurrence ( P = .007), whereas in cystectomy group, nodal involvement was an independent prognostic parameter for cause-specific survival ( P = .025). The current study showed that the 4 biomarkers were associated with aggressive behaviors of UCs. Above all, LN-5 overexpression was considered to play an important role in intravesical recurrence of superficial UCs.

There have been many studies of the prevalence of atopic dermatitis (AD), but few population-based epidemiologic studies measure the prevalence in Japan among children aged 5 years and younger. We examined the prevalence of AD, serum total IgE levels and specific IgE antibodies to 10 common allergens among children in Ishigaki Island, Okinawa, Japan in 2001. We also obtained information on the predictability of the U.K. Working Party diagnostic questionnaire criteria for AD in this population. Five hundred and sixty five children aged 5 years and younger were enrolled in this study with informed consent from their parents. The questionnaire of the U.K. Working Party diagnostic criteria for AD was translated into Japanese, and the parents completed the questionnaire sheet. Physical examination and blood sampling were done for all children. Thirty-nine out of the 565 (6.9%) children were diagnosed with AD by physical examination. The total and specific IgE levels were significantly higher in the children with AD than in those without AD. High levels of total IgE were found in 33.3% of the children with AD. A specific IgE to one or more allergens was detected in 64.1% of children with AD. However, a substantial population of children without AD also had high levels of total IgE (12.7%) and a specific IgE to one or more allergens (30.2%), and the increment of total and specific IgE levels was significantly associated with age. The percentage of positive answers to the questionnaire of the U.K. Working Party diagnostic criteria for AD was significantly higher in children with AD (59.0%) than in children without AD (5.3%) (P

Objective To study the effects of volcanic ash on the ocular symptoms of schoolchildren ages 6 to 15 residing near Mt. Sakurajima, an active volcano. Design Retrospective, cross-sectional study. Participants A total of 10 380 children ages 6 to 15, 1175 in a high-exposure area and 9205 in a low-exposure area, were studied. Methods High- and low-exposure areas for volcanic ash were selected. All subjects in both areas were examined annually each September in the decade from 1994 to 2003. Main outcome measures The frequency of positive ocular symptoms in years with and without active volcanic eruptions was compared. The association of ocular symptoms with volcanic ash dispersal was assessed with the Mantel–Haenszel test or chi-square test. Results Subjects in the high-exposure area showed ocular symptoms more often than those in the low-exposure area ( P 2 /year or more) were closely related to years with a high frequency of ocular symptoms in subjects in the high-exposure area ( P P Conclusions Ocular symptoms in subjects were strongly influenced by volcanic eruptions in the Mt. Sakurajima area, but direct influence was limited to those living in areas very near the volcano (i.e., 4 km from the volcano's crater).

Colorectal cancer patients with lymph node metastasis constitute a heterogeneous population with variable prognoses. In this study, my colleagues and I propose a simpler lymph node (LN) staging system for colorectal cancer.Four-hundred and twenty-three consecutive colorectal cancer patients were studied. Of these, 36 were excluded because another carcinoma was present. The remaining 387 patients entered the TNM staging analysis. In the survival analysis, 76 patients with distant metastasis were excluded and the remaining 311 patients (LN(-) = 204 and LN(+) = 107) were studied. The diameter of the largest metastatic LN (MLN) was measured on histopathological slides. After examination of various cutpoints and survival outcomes, patients with MLNs were classified into n1 (or = 9 mm) and n2 (or = 10 mm) groups, according to size of MLNs (n-stage).Using disease-free survival (DFS) and overall survival (OS) as outcomes, patients were separated into significant prognostic groups by MLN size (univariate, p0.0001) (5-year survival, DFS: n0 = 91.5%, n1 = 62.2%, and n2 = 34.4%; OS: n0 = 85.1%, n1 = 63.5%, and n2 = 42.5%) and International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) (N-stage) (univariate, p0.0001) (5-year survival, DFS: N0 = 91.5%, N1 = 60.5%, and N2 = 36.8%; OS: N0 = 85.1%, N1 = 65.3%, and N2 = 38.0%). But in patients with fewer than 15 LNs examined (n = 31), only the new nodal stage stratified patients into significant groups (OS: p = 0.003 and DFS: p = 0.001). Only the UICC/AJCC N-stage subcategories were further split into significant prognostic groups by MLN size (UICC/AJCC N1: DFS, p = 0.048 and OS, p = 0.11; N2: DFS, p = 0.04 and OS, p = 0.04). n-stage was an independent important factor both in the DFS and OS in multivariable analysis.MLN size is a strong prognostic variable in colorectal carcinoma. This new metric may help clinicians treating colorectal cancer patients, but additional studies are required before clinical application.

Background Genetic polymorphisms may affect the development of prostate cancer (Pca). HER-2 is a proto-oncogene that has an important role in many human cancers, including Pca. To determine the association of the HER-2 gene with Japanese sporadic Pca, we analyzed the frequency of codon 655 (A/G, isoleucine, or valine) in case and control group. Methods We genotyped Ile 655 Val in Pca patients (n = 285) and in matched controls (n = 233). Statistical analyses were performed by Fisher's exact test and logistic regression analysis. Results We observed a significantly lower frequency of the Val655 allele in the Pca patients (14.7%) compared to the control group (26.2%) (P = 0.0025, odds ratio (OR) = 0.476, 95% CI = 0.306-0.740). This SNP was not found to be correlated with clinical stage, PSA level, Gleason score of biopsies or age at diagnosis. Conclusions Our results indicate that the frequency of Val655 in HER-2 was significantly lower in Japanese Pca patients, however, it was recently reported that Val655 was significant higher in breast cancer patients. This contradictory observation in prostate and breast cancer patients is interesting considering the opposite hormonal sensitivity of these two cancers.

Long-term survival of transfused patients was studied at a single institution. This study, to our knowledge the first such report in Japan, compared long-term survival before (Group 1: 1986-1987, 1, 781 patients) and after implementation (Group 2:1992-1993 1, 326 patients) of HCV antibody screening. Unexpectedly, post-transfusion survival rate by Kaplan-Meier analysis showed no significant difference between the two groups. Female-s had a greater survival rate than male-s in both group 1 (1-year survival; male 74.1%, female 79.9%; p

We analyzed the genetic polymorphisms of vascular endothelial growth factor (VEGF) and its receptors [Fms-related tyrosine kinase-1, kinase insert domain receptor (KDR)] in Japanese patients with Kawasaki disease (KD) and normal control subjects to examine whether these genes would contribute to the KD occurrence and/or the development of coronary artery lesion (CAL) in KD. We found that the frequency of G allele of VEGF g.-634 G>C single-nucleotide polymorphism in the promoter region was significantly higher in KD patients with CAL than in those without CAL (p = 0.012) or control subjects (p = 0.021) because of a significantly higher frequency of the GG genotype in KD patients with CAL. In addition, the frequency of the A1 allele with 11 AC repeats of KDR g.+4422(AC)11-14 dinucleotide repeat polymorphism in intron 2 was significantly higher in KD patients with CAL than in those without CAL (p = 0.013) or control subjects (p = 0.040) as a result of a significantly higher frequency of the A1A1 genotype in KD with CAL patients. The multivariate analysis of clinical features and genotypes of the two polymorphisms showed that the A1A1 genotype of KDR g.+4422(AC)11-14 polymorphism was an independent risk factor for the development of CAL with the highest odds ratio among several clinical parameters (odds ratio 6.76; 95% confidence interval 1.05-43.48). Dual luciferase assay demonstrated that the A1 allele with KDR g.+4422(AC)11 repeats showed a weaker silencer function than the A2 allele with 12 AC repeats. These findings suggested that VEGF and its receptor, KDR, genes contributed to the development of CAL in KD patients.

Objective: To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. Methods: A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. Results: Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (

Since 1999, combination therapy with tacrolimus and topical steroids has been widely used for the treatment of adolescent/adult-type atopic dermatitis. In order to determine the clinical doses of topical tacrolimus and steroids for daily treatment of atopic dermatitis and to elucidate their beneficial and adverse effects, we analyzed the clinical data from 215 patients with atopic dermatitis who were more than 16 years old. Less than 70 g of tacrolimus and less than 15 g of steroids were applied to 90% of the patients on the face and neck, and less than 75.8 g of tacrolimus and less than 322 g of steroids were applied to 90% of the patients on the trunk and extremities during the six-month treatment period. Topical tacrolimus is much more frequently used on face and neck lesions (99.1%); in only 39.5% of cases was it used on the trunk and extremities. The majority of patients improved after six months of the combination topical therapy; however, atopic dermatitis was not controlled in 6% of the patients. The combination therapy did not seem to increase the risk of cutaneous infections; however, the incidence of herpes simplex infection on the face and neck was 2.8% at pre-treatment and slightly increased to 4.7% during the therapy. The incidence of all steroid-induced adverse effects was reduced both in frequency and intensity with a decrease in the dose of topical steroids through simultaneous tacrolimus application. Combination therapy with topical tacrolimus and steroids is useful for treating atopic dermatitis, but a small percentage of the patients still cannot be satisfactorily treated. For such patients, adjustments of the dose and rank of topical steroids and tacrolimus and other therapeutic adjuncts are necessary.

Background Patients with gastric cancer that has metastasized to the lymph nodes are a heterogeneous population with a variable prognosis. Stratification of these patients into prognostic groups is necessary for optimal adjuvant therapy. Methods The study comprised 715 patients who had undergone curative resection of a gastric neoplasm. Lymph nodes were sectioned, stained with haematoxylin and eosin, and the diameter of the largest metastatic lymph node (MLN) was measured. Patients with metastatic nodes were divided into groups n1 and n2 according to the size of the MLN. The cut-off level was set at 7 mm by a two-sample log rank test; patients in group n1 had a MLN size of 7 mm or less and those in group n2 had a MLN of 8 mm or more. Results Patients were stratified into significant prognostic groups by both the Union International Contra la Cancrum (UICC) node (N) stage and MLN size (n group). The UICC N-stage subcategories were further divided into prognostic groups according to MLN size (n group). On multivariate analysis the MLN size remained independently significant in terms of overall and disease-free survival rates, and the UICC N stage was not significant, independently of the n group. Node-positive patients with fewer than 15 lymph nodes removed at operation could also be stratified into prognostic groups by the n group. Stratification according to the TNM stage and by MLN size was superior to existing UICC TNM staging. Conclusion This new method may help clinicians to design a more appropriate treatment strategy for patients with gastric cancer.

Diffuse esophageal spasm (DES) is a typical esophageal dysfunction, but its cause is unknown. DES has been classified into reflux-associated esophageal spasm (RDES), caused by acid exposure, and idiopathic esophageal spasm (IDES), of unknown causes. The differences in esophageal motility pattern between the RDES and IDES are clues to elucidating the pathogenesis of DES. Although 24-hr ambulatory esophageal motility and pH monitoring is considered a feasible method for evaluating gastroesophageal reflux and esophageal function, most researchers previously defined the RDES as DES accompanied by esophagitis and heartburn using standard manometry over a short time frame. To clarify the pathogenesis of RDES, we did this research using 24-hr ambulatory esophageal motility and pH monitoring. The investigation included 25 normal controls and 116 patients with upper digestive symptoms. Among the 116 patients, 45 had DES (11 RDES, 30 IDES, and DES-GERD coexistence). Patients with RDES showed a significantly higher frequency of simultaneous contractions than did patients with IDES. Heartburn has been said to be peculiar to RDES, but also occurred in 12.5% of IDES. No significant differences in the mean pH of the esophagus during acid reflux were found between the RDES and IDES patients. Based on the results, we have proposed a refined definition of RDES.

We elucidate the learning curve, efficacy and safety of holmium laser enucleation of prostatic adenomas.We retrospectively reviewed data on 70 patients who had undergone holmium laser enucleation for prostatic adenoma. All patients were assessed preoperatively and at an interval of 6 months postoperatively based on the International Prostate Symptom Score, quality of life index, peak urinary flow rate and post-void residual urine measurement. All complications were noted. The relationship between the number of procedures performed and treatment efficacy was analyzed. The learning curve with regard to efficiency for tissue enucleation and morcellation was assessed.Holmium laser enucleation of the prostate resulted in a significant improvement in subjective symptoms and urodynamic parameters. The ratio of improvement in the preoperative-to-postoperative peak urinary flow rate, post-void residual urine, International Prostate Symptom Score and quality of life index did not change significantly as experience increased. However, the efficiency of enucleation increased significantly as experience increased. Complications included short-term stress urinary incontinence in 8 cases and postoperative urethral stricture in 5. Bladder injury during morcellation was observed in 2 cases.Holmium laser enucleation of the prostate is an effective treatment option for benign prostatic adenoma, providing good treatment efficacy and minimal bleeding even if the surgeon has minimal experience. It requires more time to perform than traditional surgery but there is a learning curve for the enucleation technique as experience increases. Technical improvement in tissue morcellation may be necessary if the prevalence of this treatment is to increase dramatically.

We investigated effects of variations in the cellular composition of G-CSF-mobilized peripheral blood progenitor cell (G-PBPC) allografts on clinical outcomes of allogeneic PBPC transplantation. We retrospectively analyzed transplanted doses of various immunocompetent cells from 27 HLA-identical sibling donors in relation to engraftment, incidence of graft-versus-host disease (GVHD), and survival. Significant variability was documented in both absolute numbers and relative proportions of CD34+, CD2+, CD3+, CD4(high)+, CD4+25+, CD8(high)+, CD19+, CD56+, and CD56+16+ cells contained in these allografts. Stepwise Cox regression analysis revealed that the CD56+ cell dose was significantly inversely correlated with the incidence of GVHD. Thus, there was a significantly higher incidence of grade II acute GVHD in patients receiving a lower CD56+16+ cell dose (hazard ratio (HR) 0.0090; 95% confidence interval (CI)

Summary. Hyper-IgE syndrome (HIES) is a primary immunodeficiency disease characterized by recurrent infections and marked immunoglobulin (Ig)E elevation. To assess the proper T-cell defects of HIES, the cytokine profile of naturally activated T cells was compared between HIES, atopic dermatitis and chronic granulomatous disease (CGD). Intracellular flow cytometric analysis after in vitro stimulation showed no difference in the proportion of interferon (IFN)γ- or interleukin 4 (IL-4)-producing T cells among these diseases. Quantitative polymerase chain reaction (PCR) for the cytokine genes was performed using circulating highly fractionated HLA-DR+ and HLA-DR– T cells. The IFNγ/IL-4 or IFNγ/IL-10 ratios were lower in HLA-DR+ T cells of HIES than in CGD (P = 0·0106, 0·0445), but did not differ between HIES and atopy. The transforming growth factor-β (TGFβ)/IL-4 ratio in HLA-DR+ T cells of HIES was lower than that of atopy (0·0106) or CGD (0·0062). The TGFβ/IL-4 ratio in HLA-DR– T cells of HIES was also lower than that of atopy (0·0285). Stepwise logistic regression analysis identified TGFβ/IL-4 ratios in HLA-DR+ (0·0001) or HLA-DR– (0·0086) T cells as the most powerful parameters to distinguish HIES from atopy and/or CGD. Serum IgE levels negatively correlated with IFNγ/IL-4 (0·0108), IFNγ/IL-10 (0·0254), or TGFβ/IL-4 (0·0163) ratios in HLA-DR+, but not HLA-DR–, T cells. These results suggested that the in vivo activated T cells of HIES did not sufficiently express the IFNγ and TGFβ genes, which could affect IL-4-dependent IgE production. The reduced TGFβ expression may involve the indigenous T-cell defects of HIES.

Background Topical steroids are used as the first-line therapy for atopic dermatitis. Objectives To determine the clinical doses of topical steroids for the daily treatment of atopic dermatitis in clinics and to elucidate their adverse effects. Patients and methods A multicentre retrospective analysis of a series of 1271 patients (210 infants, 546 children, and 515 adolescents and adults) with atopic dermatitis. Results Less than 89.5 g, 135 g and 304 g of topical steroid were applied in 90% of the patients in the infant, childhood, and adolescent and adult AD groups, respectively, on the entire body during the 6-month treatment period. The majority of patients were controlled well; however, 7% of infant, 10% of childhood and 19% of adolescent and adult patients remained in a very severe or severe state or experienced exacerbation even though they applied larger amounts of topical steroids. With regard to adverse effects, the incidence of telangiectasia on cheeks tended to increase in patients who had a longer duration of disease and who applied more than 20 g to the face during the 6-month treatment period. The steroid-induced atrophy of the antecubital and popliteal fossae was more frequently observed in males than in females. Conclusions Topical steroids are useful for treating atopic dermatitis, but a substantial percentage of patients cannot be satisfactorily treated with topical steroids. For such patients, adjustments of dose and rank of topical steroids and other therapeutic adjuncts are necessary.