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We performed the experiment of p–$^{3}$He scattering at 65 MeV by using polarized proton beams and the newly constructed polarized $^{3}$He target. The proton analyzing power $A_{y}$, the 3He analyzing power $A^{T}_{y}$, and the spin correlation coefficient $C_{yy}$ were measured. In the conference, the experimental data were compared with the rigorous numerical calculations based on various nuclear potentials. Large discrepancies between the experimental data and the calculations were found in the $A^{T}_{y}$ and the $C_{yy}$ at the backward angles.

Objective: Adequate fruit and vegetable intake has been suggested to protect against colorectal cancer. However, several recent prospective studies have reported no association. We therefore examined the association between fruit and vegetable intakes and the risk of colorectal cancer in a prospective cohort study in Japan.Design: Between June and August 1990, 47 605 Japanese men and women completed a self-administered questionnaire, including a food-frequency questionnaire. We divided the subjects into quartiles based on their self-reported fruit and vegetable consumption. There were 165 colon cancer and 110 rectal cancer incidences identified during 7 years of follow-up, to the end of December 1997. We used Cox proportional hazards models to estimate the relative risk (RR) of developing colorectal cancer according to the level of fruit and vegetable consumption, applying adjustments for potential confounders.Results: No statistically significant association was observed between fruit and vegetable consumption and the risk of colorectal cancer. The multivariate RR of colon cancer in the highest quartile of fruit and vegetable intake compared with the lowest was 1.13 (95% confidence interval (CI) 0.73-1.75), the RR for vegetables alone was 1.24 (95% CI 0.79-1.95) and that for fruit alone was 1.45 (95% CI 0.85-2.47). The corresponding multivariate RRs for rectal cancer were 1.12 (95% CI 0.67-1.89), 1.14 (95% CI 0.67-1.93) and 1.41 (95% CI 0.73-2.73).Conclusions: We found no association between the consumption of fruit and vegetables and the risk of colorectal cancer among the Japanese population. [ABSTRACT FROM AUTHOR]

Abstract Background Although the percentage of women who initiate breast cancer screening is rising, the rate of continued adherence is poor. The purpose of this study was to examine the effectiveness and cost-effectiveness of a tailored print intervention compared with a non-tailored print intervention for increasing the breast cancer screening rate among a non-adherent population. Methods In total, 1859 participants aged 51–59 years (except those aged 55 years) were recruited from a Japanese urban community setting. Participants were randomly assigned to receive either a tailored print reminder (tailored intervention group) or non-tailored print reminder (non-tailored intervention group). The primary outcome was improvement in the breast cancer screening rate. The screening rates and cost-effectiveness were examined for each treatment group (tailored vs. non-tailored) and each intervention subgroup during a follow-up period of five months. All analyses followed the intention-to-treat principle. Results The number of women who underwent a screening mammogram following the reminder was 277 (19.9%) in the tailored reminder group and 27 (5.8%) in the non-tailored reminder group. A logistic regression model revealed that the odds of a woman who received a tailored print reminder undergoing mammography was 4.02 times those of a women who had received a non-tailored print reminder (95% confidence interval, 2.67–6.06). The cost of one mammography screening increase was 2,544 JPY or 30 USD in the tailored intervention group and 4,366 JPY or 52 USD in the non-tailored intervention group. Conclusions Providing a tailored print reminder was an effective and cost-effective strategy for improving breast cancer screening rates among non-adherent women.

The Japanese national immunization programme for Human Papillomavirus (HPV) started in 2010. Vaccination rates increased up to 70% in women in the 1996-1999 birth. However, the proactive recommendation for HPV vaccine was suspended in 2013, following repeated media reports of adverse events. Vaccination rates plumped to less than 1% in women born since 2002. In this study, incidence of abnormal cytology and histology was examined in terms of HPV vaccination among 5,924 women aged 20 to 24 years in the fiscal year (FY) 2014 and 2015. The total rate of vaccination was 16.9% (1,002/5,924). In case of FY 2015, the rates of vaccination were 59.26%, 49.68%, 11.97%, 9.08%, and 4.58% in those aged 20, 21, 22, 23, and 24 years old, respectively. The rates of high-grade squamous intraepithelial lesion (HSIL) or worse were 0.20% (2/1,002) in women with HPV vaccination and 1.14% (56/4,922) in those without HPV vaccination, indicating a significant reduction of 82.46% with vaccination (P < 0.0001). The rates of cervical intraepithelial neoplasia (CIN) 1+ were 0.80% (8/1,002) in women with vaccination and 2.28% (112/4,922) in those without vaccination. The reduction rate of CIN1+ was 64.91% (P = 0.0025). The rates of CIN2+ were 0.10% (1/1,002) with vaccination and 0.69% (34/4,922) without vaccination. The reduction rate of CIN2+ was 85.51% (P = 0.0261). Our data are the first to demonstrate a significant reduction of CIN2+ cases in an Asian population. Scientific discussion is needed to restart the proactive recommendation for HPV vaccine in Japan.

Background and Aim: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) is a variant of gastric adenocarcinoma with chief cell differentiation. GA-FG-CCP is rare and not well understood. The present study aimed to investigate the clinicopathological features of GA-FG-CCP using retrospective and prospective analyses of endoscopic findings., Methods: A total of 20 patients including nine cases treated with endoscopic submucosal dissection (ESD) were diagnosed with GA-FG-CCP. Morphological changes were analyzed by retrospectively retracing past endoscopic records and following up after definitive diagnoses, including the status of Helicobacter pylori (H. pylori) infection., Results: GA-FG-CCP were small and whitish lesions accompanied by atypical vascular growth and their macroscopic types were classified as 0-IIa (60%), 0-IIb (25%), and 0-IIc (15%), respectively. The lesions were found in the non-atrophic gastric mucosa of the upper (70%) or middle portion (30%), although gastric mucosal atrophy associated with current or past H. pylori infection was identified in 75% of cases. In the nine cases treated with ESD, submucosal invasion was identified in 80% of the resected lesions, but no lymphovenous infiltration was detected. Ki-67 labeling index of GA-FG-CCP was low at 3.2% and visible morphological changes were rarely detected during long-term endoscopic observation for 58.9 ± 13.1 months., Conclusions: These data indicate that GA-FG-CCP, even when submucosal invasion occurs easily, might be of low-grade malignancy as long as it is the chief cell predominant type without other epithelial abnormalities. In addition, GA-FG-CCP might develop despite H. pylori infection or gastric mucosal atrophy., (© 2016 Japan Gastroenterological Endoscopy Society.)

Background: The purpose of this study was to examine the effectiveness and cost-efficiency of a tailored message intervention compared with a non-tailored message intervention for increasing colorectal cancer (CRC) screening rates among a non-adherent population, in a community-based client reminder program., Methods: After a baseline survey for psychological segmentation, 2140 eligible individuals were randomly assigned either to a group with a tailored matched-message condition (N = 356), a group with a non-tailored unmatched-message condition (N = 355), or to two control groups, one using a typical message with a professional design (N = 717) and one without a professional design (N = 712). The main outcome measure was attendance rates in a community-organized CRC screening program within five months of receiving a print reminder., Results: There was a significant difference in fecal occult blood test (FOBT) attendance rates at follow-up assessments between the tailored matched-message condition (14.0 %) and the control (9.9 %; OR = 1.48, p = 0.026), while there was no significant difference between the unmatched-message condition (11.0 %) and the control (OR = 1.12, p = 0.558), and between the matched-message condition and the unmatched-message condition (OR = 1.32, p = 0.219). The cost of a one-person increase in FOBT screening was 3,740 JPY for the tailored matched-message condition, while it was 2,747 JPY for the control., Conclusions: A tailored-message intervention for segmented individuals designed to increase CRC screening rates in a community-based client reminder program was significantly effective compared to a usual reminder, but not more effective than an unmatched message in a randomized controlled trial, and was not sufficiently effective to highlight its value from a cost perspective. Therefore, the tailored intervention including target segmentation needs to be improved for future implementation in a CRC screening program for a non-adherent population., Trial Registration: UMIN Clinical Trials Registry UMIN000004384 . Date of Registration: March 2011.

Objective: To investigate the effect of the percentage of free prostate-specific antigen (%fPSA) on future prostate cancer risk., Materials and Methods: We examined serum total PSA (tPSA) and %fPSA annually in a prostate cancer-screening cohort between July 2001 and June 2011. Men with tPSA >4.0 ng/mL or tPSA of 2.0-4.0 ng/mL with %fPSA ≤12% were screened as positive and were recommended to undergo a biopsy. The study population consisted of 6368 men, aged 40-79 years, who had tPSA ≤4.0 ng/mL at initial screening and who subsequently underwent 1 or more screenings. We calculated the cumulative risk and hazard ratio of prostate cancer stratified by the initial %fPSA groups as quartiles of prostate cancer patients., Results: During a median follow-up of 36 months, 119 men were diagnosed with prostate cancer. The lowest quartile of %fPSA (<13.3%) was associated with a 21.2-fold higher risk of having prostate cancer compared with the highest quartile (>22.2%). For the subset with an initial tPSA ≤1.0 ng/mL, all men diagnosed with cancer had an initial %fPSA ≤33.3% (median). For the subset with tPSA >1.0 ng/mL, men with %fPSA ≤23.0% (median) had significantly higher risk for cancer than those with %fPSA >23.0% (P <.0001). Of the 114 men with prostate cancer in whom pathologic findings were available, 79 (69.3%) had a Gleason score ≥3 + 4 = 7., Conclusion: A low %fPSA is a strong predictor of a subsequent diagnosis of prostate cancer among men with tPSA levels ≤4.0 ng/mL. Measurement of %fPSA might enhance the detection of high-grade cancer that warrants aggressive treatment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Computer-aided detection (CAD) increases breast cancer detection, but its cost-effectiveness is unknown for breast cancer screening in Japan. We aimed to determine whether screening mammography diagnosed by one physician using CAD is cost-effective when compared with the standard double reading by two physicians., Methods: We established our model with a decision tree and Markov model concept based on feasible screening and clinical pathways, combined with prognosis of the health state transition of breast cancer. Cost-effectiveness analysis between double reading by two readers and single reading with CAD by one reader was performed from a social perspective in terms of the expected cost, life expectancy and incremental cost-effectiveness ratio (ICER). The hypothetical population comprised 50-year-old female breast cancer screening examinees. Only direct medical costs related to breast cancer screening and treatment were considered. One simulation cycle was 2 years, and the annual discount rate was 3 %. Sensitivity analysis was performed to evaluate the robustness of the model and input data., Results: Single reading with CAD increased expected costs by 2,704 yen and extended life expectancy by 0.0087 years compared with double reading. The ICER was 310,805 yen per life year gained, which is below the threshold. Sensitivity analysis showed that the sensitivity and specificity of CAD and the number of breast cancer screening examinees greatly affected the results., Conclusions: Single reading using CAD in mammography screening is more cost-effective than double reading, although the results are highly sensitive to the sensitivity and specificity of CAD and the numbers of examinees.

Background: The effectiveness of screening mammography (MMG) has mainly been demonstrated by studies in western countries. This study was conducted to evaluate cumulative survival and the risk of breast cancer death among Japanese women aged 40-69 years with screening-detected and interval breast cancer divided into three groups: MMG with clinical breast examination (CBE), CBE alone, and self-detection., Methods: By matching a list of 126,537 women (358,242 person-screenings) who participated in the Miyagi Cancer Society Screening program between 1 April 1995 and 31 December 2002 with the Miyagi Prefectural Cancer Registry, 429 MMG with CBE, 522 CBE, and 3,047 self-detected cases were included in this study. Follow-up was performed until the date of death or 31 December 2007. Survival was estimated by the Kaplan-Meier method. The Cox proportional hazards model was used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for breast cancer death., Results: Five-year survival for women in the MMG with CBE, CBE, and self-detection groups was 96.8, 92.7, and 86.6 %, respectively. The HR (95 % CI) for breast cancer death was 2.38 (0.72-7.94) among CBE-screened and 4.44 (1.42-13.89) among self-detected cases for women aged 40-49 years, but was 3.00 (1.63-5.50) among CBE-screened and 4.51 (2.69-7.56) among self-detected cases for women aged 50-69 years relative to cases screened by use of MMG with CBE., Conclusions: In terms of the survival and risk of breast cancer death, MMG with CBE may be more effective than MMG alone or self-detection for Japanese women aged 40-69 years.

Background and Aim: We recently encountered patients with localized esophageal eosinophilia in a small area of the esophagus. However, this condition remains to be described in detail, and its clinical significance has not been established. We investigated the clinical, endoscopic and histological features of localized esophageal eosinophilia in comparison with diffuse esophageal eosinophilia., Methods: We investigated 10 patients with localized esophageal eosinophilia, and compared them with 23 who had diffuse esophageal eosinophilia. Whether esophageal eosinophilia was localized or diffuse was determined on the basis of endoscopic findings. Localized esophageal eosinophilia was defined endoscopically as a focal area of esophageal eosinophilia, whereas diffuse esophageal eosinophilia was defined as a widespread area of esophageal eosinophilia involving more than one of three locations: the upper, middle and lower esophagus. Histological esophageal eosinophilia in the mucosa showing endoscopic abnormality was confirmed by biopsy with a peak of ≥ 15 eosinophils/high-power field., Results: There were no significant differences in age, gender distribution, allergic conditions or peripheral eosinophilia between the two groups. In all cases but one, localized esophageal eosinophilia was observed in a small area above the esophagogastric junction. Esophageal symptoms such as dysphagia, heartburn or chest pain were present in 20% of the localized group and in 65% of the diffuse group, the difference being statistically significant (P<0.05). The maximum amounts of eosinophils infiltrating the esophageal mucosa did not differ between the groups., Conclusions: Esophageal eosinophilia can be localized in a small area, especially above the esophagogastric junction. Gastric acid reflux or contact may influence this condition in addition to its allergic pathogenesis., (© 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.)

Aim: To evaluate the relationship between Helicobacter pylori (H. pylori)-induced gastritis and white gastric mucosal crypt openings (COs) in the gastric corpus., Methods: A total of 175 consecutive patients (including 69 patients with gastric cancer) were enrolled in this study. We used magnifying endoscopy (ME) to observe the mucosa microsurface of the lesser and greater curvature of the gastric corpus (350 areas in all). We focused on areas with a round pit microstructure (primarily observed in non-atrophied areas) and evaluated the white openings of these gastric pits. We classified the whiteness of the COs as the "white-edged dark spot" type (consisting of a dark spot bordered by white); the "white" type (pure white with no dark spot); and the "dense white pit (DWP)" type (dense white, resembling a snowball). Gastritis was also histologically evaluated according to the updated Sydney System., Results: We detected round COs using ME in 246 of the 350 areas examined. The histological examination showed significantly more mononuclear cells and neutrophil infiltration in the "white" and "DWP" types than the "white-edged dark spot" type (P < 0.001). Furthermore, significantly high-grade inflammation and evidence of active H. pylori-induced gastritis was observed in the "DWP" type (P < 0.001). Significant differences were observed in the whiteness of COs between H. pylori-positive (n = 139) and negative (n = 36) patients (P < 0.001). The sensitivity and specificity of the "white" and "DWP" types for predicting H. pylori infection were 78.5% and 81.7%, respectively. Of the patients with gastric cancer, 22.5% (18/80) had "white-edged dark spots", 51.3% (41/80) had "white" COs, and 26.3% (21/80) had "DWP"-type COs. "DWPs" were frequently observed among patients with undifferentiated gastric cancer [45.7% (16/35)]., Conclusion: CO whiteness detected via ME was associated with histological evidence of gastritis and helps to predict the severity of inflammation and H. pylori-induced activity.

Objectives: This study aimed to develop a structural model for mammography adoption in Japanese middle-aged women by using constructs from the transtheoretical model (TTM), the theory of planned behavior (TPB), implementation intentions, and cancer worry., Methods: Questionnaires based on items including TTM, TPB, implementation intentions, cancer worry-related variables, and demographic variables were distributed to 1000 adult women aged 40 to 59 years, with 641 subjects being used in the final analysis (response rate = 64.1%)., Results: Regarding the stage of adoption, 79 participants (12.3%) were at the precontemplation stage, 30 (4.7%) were at the relapse stage, 142 (22.2%) were at the contemplation stage, 88 (13.7%) were at the action stage, and 302 (47.1%) were at the maintenance stage. Our model, derived from structural equation modeling, revealed that the stage of mammography adoption was significantly affected by goal intentions, implementation intentions, perceived barriers, history of breast cancer screening, and relative risk. A logistic regression analysis revealed that goal intentions and implementation intentions significantly predicted mammography uptake within 1 year., Conclusion: This study developed an integrated model constructed from TTM, TPB, implementation intentions, and cancer worry to account for mammography adoption in Japan, and also confirmed the predictive validity of the model., (Copyright © 2013 John Wiley & Sons, Ltd.)

Endoscopic resection has become a major curative treatment for early colorectal carcinoma without lymph node metastasis. However, lymph node metastasis, a poor prognostic factor in colorectal carcinoma, occurs in about 10% of the patients with submucosal invasive colorectal carcinoma. Therefore, it is important to identify a high-risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma. This study was designed to identify the relationship between tumor budding with β-catenin expression and lymph node metastasis in submucosal invasive colorectal carcinoma. We investigated the immunohistochemistry of tumor budding in the 142 patients who underwent surgical resection for submucosal invasive colorectal carcinomas between 1984 and 1999 and the expression pattern of β-catenin in budding tumor cells. Accordingly, all the patients were followed up for at least 10 years or until death. Among the 142 patients, lymph node metastasis was detected in 14 patients (9.9%). Univariate analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was significantly associated with lymph node metastasis (P = 0.005). In contrast, tumor budding detected by hematoxylin and eosin staining was not associated with lymph node metastasis. Multivariate logistic regression analysis showed that tumor budding with ≥ 5 tumor cells or cell clusters with expression of β-catenin in the nucleus was a significant risk factor for lymph node metastasis (odds ratio, 7.124; 95% confidence interval, 1.407-36.062). Thus, tumor budding associated with β-catenin expression is a risk factor for lymph node metastasis in submucosal invasive colorectal carcinoma.

We examined the predictive validity of a segmentation strategy based on intention and cancer worry for mammography adoption and explored key factors for promoting mammography adoption in each segment. A questionnaire survey was completed by 641 women aged 40-59 years. Among them, 559 answered a follow-up survey after 15 months. They were categorized into five segments: maintenance group (S5), higher implementation intention group (S4), higher goal intention group (S3), higher worry group (S2), or lower worry group (S1). The odds of participants in each segment adopting mammography during the follow-up period were calculated. Logistic regression analysis was conducted to identify psychological predictors (five attitudes to mammography and perceived health competence) of transition to upper segments (S1 vs. S2, S2 vs. S3, S3 vs. S4, S4 vs. S5). Compared to S5, other segments did not undertake mammography at significant rates during the follow-up. The following were significant predictors for inclusion in upper segments: Lack of importance and perceived health competence were associated with inclusion in S2; lack of importance and barriers to screening were associated with inclusion in S3; perceived health competence was associated with inclusion in S4; and lack of importance was associated with inclusion in S5. These results confirm the predictive validity of a segmentation strategy, and indicate that there might be specific key factors for each segment in promoting mammography adoption.

Background and Aim: The distributions and grades of Helicobacter pylori induced gastritis are known to vary among H. pylori-associated diseases. The aim of this study was to investigate the differences in distributions of gastric micromucosal structures observed by magnifying narrow band imaging (NBI) endoscopy among patients with different H. pylori-associated diseases., Methods: Ninety-five patients with active duodenal ulcers (n = 24) and diffuse-type (n = 24) and intestinal-type (n = 47) early gastric cancers were enrolled. The magnified NBI findings were evaluated at the lesser and greater curvatures in the upper gastric corpus and were classified according to the modified A-B classification system. Biopsy specimens were also evaluated., Results: In a total of 190 areas observed with magnifying NBI, histological grading (inflammation, activity, atrophy and intestinal metaplasia) showed significant differences among the classified micromucosal patterns (P < 0.001). Types B-1 and B-2, with mild atrophic changes and few areas of intestinal metaplasia, were seen mostly in the duodenal ulcers group. Types B-3 and A-1, with moderate atrophic changes, were seen in the diffuse-type early gastric cancers at the lesser curvature. Types A-1 and A-2, with severe atrophic change and a high frequency of intestinal metaplasia, were seen in the intestinal-type early gastric cancers at the lesser curvature. The prevalence of micromucosal structures differed significantly among the three groups both at the lesser and greater curvatures (P < 0.001)., Conclusions: Magnifying NBI endoscopy clearly revealed detailed micromorphological differences corresponding to the histology and endoscopic findings among patients with different H. pylori-associated diseases., (© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.)

Background: Eosinophilic esophagitis (EoE) has been a rarely recognized condition in Asian populations, and its clinical manifestation is rarely documented. Our aim was to describe clinically, endoscopically, and pathologically the features of patients with esophageal eosinophilia, including EoE., Methods: Twelve patients histologically proven to have esophageal eosinophilia were investigated. The histological diagnostic cutoff value was defined as a peak of ≥15 eosinophils/high-power field (HPF) in esophageal biopsies. Symptoms, endoscopic and pathological findings, and treatment outcome were evaluated., Results: Nine of the 12 patients were male and the 12 patients had a mean age of 47.7 years. Allergic conditions were concurrent in a total of 3 patients. Mild peripheral eosinophilia was observed in only 2 patients. The predominant symptom was solid-food dysphagia, but some patients complained of heartburn, or chest, epigastric, or back pain. Three asymptomatic subjects were also incidentally diagnosed during endoscopic screening. Linear furrows, concentric rings, and white exudates in the esophagus were frequently observed. In 4 of 5 patients who were administered a proton pump inhibitor (PPI), esophageal eosinophilia was histologically decreased or disappeared with symptom relief and endoscopic improvement. In 2 patients unresponsive to PPI, topical steroid therapy, administered by the swallowing of fluticasone propionate, led to symptomatic and histological remission., Conclusions: The endoscopic recognition of linear furrows, concentric rings, and white exudates is important in the diagnosis of eosinophilic esophageal inflammation. In a subset of patients this condition improves clinicopathologically with PPI treatment, and typical EoE, as strictly defined by unresponsiveness to PPI, appears to be a rather rare condition.

Background: Several reports have described the usefulness of magnifying endoscopy in observing the surface structure in gastric neoplasia. The aim of the present study was to evaluate the characteristics of the surface structure of non-cancerous mucosa surrounding gastric cancer., Methods: Sixty Japanese patients with early gastric cancer were enrolled in this study. We observed the non-cancerous gastric mucosa surrounding gastric carcinoma by magnifying endoscopy and classified the magnified view into four patterns: (A) dotted; (B) short-linear; (C) striped; and (D) granular, according to Sakaki's classification., Results: All patients were diagnosed as having Helicobacter pylori infection, and histological evaluation revealed 46 types of differentiated and 14 types of undifferentiated-type gastric carcinomas. There were significant differences in the gender, age and endoscopic-atrophic-border scale between patients with these two types. In all, the surface structure at 240 points (4 points each in 60 patients) of non-cancerous mucosa was observed by magnifying endoscopy. The prevalences of the surface patterns of the mucosa surrounding differentiated carcinoma were: A, 1.1%; B, 8.1%; C, 28.3%; D, 62.5%, and those of the mucosa surrounding undifferentiated carcinoma were: A, 8.9%; B, 73.2%; C, 14.3%; D, 3.6%. There were significant differences in the surface structure of the non-cancerous mucosa surrounding differentiated and undifferentiated gastric carcinoma., Conclusion: The microsurface structure of the gastric mucosa surrounding gastric cancer lesions differed between patients with differentiated and undifferentiated gastric cancer. These findings are expected to be useful for the early detection of gastric carcinoma lesions or for the determination of extensions of carcinoma lesions., (© 2010 The Authors. Digestive Endoscopy © 2010 Japan Gastroenterological Endoscopy Society.)

Background/aims: Little is known about the correlation between clinical symptoms in daily life and the endoscopic features of gastroesophageal reflux disease (GERD). The study aim is to evaluate the correlation between clinical symptoms in daily life and endoscopic findings in reflux esophagitis (RE), and endoscopically suspected esophageal metaplasia (ESEM) in a large number of Japanese non-clinical cases., Methodology: A total of 6504 subjects who underwent an endoscopy for their annual medical check-up at Miyagi cancer society were enrolled in this study. If esophagitis was present, it was graded according to the Los Angeles classification. ESEM describes endoscopic findings consistent with BE that await histological evaluation. It was also investigated the symptom of heartburn as a "typical symptom" of GERD, and dysphagia as an "atypical symptom" of GERD., Results: The prevalence of heartburn and dysphagia significantly increased concomitantly with endoscopic the esophagitis grading. The prevalence of heartburn was significantly higher in subjects with long segment ESEM than those without it., Conclusion: The prevalence of heartburn and dysphagia were closely associated with RE grading. Long segment ESEM is strongly associated with the reflux symptom and RE. The more frequent the GERD symptoms, the greater the risk for the development of severe RE, and ESEM.

Electrocorticography of the primary motor cortex (M1) is a promising tool for controlling a brain-computer interface (BCI). Electrocorticograms (ECoG) of the human M1 within the central sulcus (intrasulcal ECoG) have been rarely examined. In order to evaluate the usefulness of intrasulcal ECoG for BCI, we examined patients with subdural electrodes placed temporarily inside the central sulcus and over the sensorimotor cortex (gyral ECoG). Five patients were asked to perform or imagine two or three classes of simple upper limb movements. Univariate statistical analysis of the results revealed that the intrasulcal ECoG on M1 showed significant variability across movement classes. A support vector machine was used for classification of single-trial ECoG signals to infer movement class (neural decoding). The movement classes were predicted with 80-90% accuracy (chance level: 33% or 50%). To reveal the relative importance of anatomical areas for neural decoding, the decoding performance was compared between gyral and intrasulcal ECoGs. The intrasulcal ECoG on the motor bank showed higher performance than the equally-sized gyral ECoG or the intrasulcal ECoG on the sensory bank. Analysis using a short time window revealed that movement class could be decoded even before movement onset. These results suggest the usefulness of intrasulcal ECoG on M1 to infer upper limb movements and present a promising application for a practical BCI system.

The age-specific sensitivity of a screening program was investigated using a population-based cancer registry as a source of false-negative cancer cases. A population-based screening program for breast cancer was run using either clinical breast examinations (CBE) alone or mammography combined with CBE in the Miyagi Prefecture from 1997 to 2002. Interval cancers were newly identified by linking the screening records to the population-based cancer registry to estimate the number of false-negative cases of screening program. Among 112 071 women screened by mammography combined with CBE, the number of detected cancers, false-negative cases and the sensitivity were 289, 22 and 92.9%, respectively, based on the reports from participating municipalities. The number of newly found false-negative cases and corrected sensitivity when using the registry were 34 and 83.8%, respectively. In detected cancers, the sensitivity of screening by mammography combined with CBE in women ranging from 40 to 49 years of age based on a population-based cancer registry was much lower than that in women 50-59 and 60-69 years of age (40-49: 18, 71.4%, 50-59: 19, 85.8%, 60-69: 19, 87.2%). These data suggest that the accurate outcome of an evaluation of breast cancer screening must include the use of a population-based cancer registry for detecting false-negative cases. Screening by mammography combined with CBE may therefore not be sufficiently sensitive for women ranging from 40 to 49 years of age.

Aim: To test this hypothesis of barrett esophagus (BE) classified into two types and to further determine if there was any correlation between the shape of endoscopically suspected esophageal metaplasia (ESEM), prevalence of reflux esophagitis (RE) and heartburn., Methods: A total of 6504 Japanese who underwent endoscopy for their annual stomach check-up were enrolled in this study. BE was detected without histological confirmation that is ESEM. We originally classified cases of ESEM into 3 types based on its shape: Tongue-like (T type), Dome-like (D type) and Wave-like (W type) ESEM. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a one-month period., Results: ESEM was observed in 10.3% of 6504 subjects (ESEM < 1 cm, 9.4%; 1 cm < or = ESEM < 3 cm, 1.7%; ESEM > or = 3 cm, 0.5%). The frequency of ESEM was significantly higher in males compared with female subjects. Statistical analysis showed that the prevalence of heartburn and RE were significantly higher in the T type ESEM than in the W type ESEM (P < 0.05)., Conclusion: The T type ESEM was strongly asso-ciated with reflux symptoms and RE whereas the W type ESEM was not associated with GERD.

Aim: To examine the prevalence of gastroesophageal reflux disease (GERD) symptoms in a large unselected general population in Japan., Methods: In Japan, mature adults are offered regular check-ups for the prevention of gastric cancer. A notice was sent by mail to all inhabitants aged>40 years. A total of 160983 Japanese (60774 male, 100209 female; mean age 61.9 years) who underwent a stomach check up were enrolled in this study. In addition, from these 160983 subjects, we randomly selected a total of 82894 (34275 male, 48619 female; mean age 62.4 years) to evaluate the prevalence of abdominal pain. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a 1 mo period., Results: The respective prevalences of the symptoms in males and females were: heartburn, 15.8% vs 20.7%; dysphagia, 5.4% vs 7.8%; and abdominal pain, 6.6% vs 9.6%. Among these symptoms, heartburn was significantly high compared with the other symptoms, and the prevalence of heartburn was significantly more frequent in females than in males in the 60-89-year age group. Dysphagia was also significantly more frequent in female patients., Conclusion: The prevalence of typical GERD symptoms (heartburn) was high, at about 20% of the Japan population, and the frequency was especially high in females in the 60-89 year age group.

Higher levels of physical activity have been consistently associated with a lower risk of colon cancer in earlier epidemiological studies. The specific benefits of walking, however, remain relatively unexplored. In 1990, 20 519 men and 21 469 women in Japan completed a self-administered questionnaire including a question on time spent walking per day. During 7 years of follow-up, 260 cases of colorectal cancer were documented in 305 790 person-years. We used the Cox proportional hazards regression model to estimate the relative risk of incident cancer (colorectal, colon, and rectal) according to three levels of walking. Time spent walking was inversely associated with risk of colorectal cancer incidence in men. Compared with men who walked 0.5 h or less per day, the multivariate relative risks were 1.06 (95% confidence interval 0.72-1.57) for men who walked between 0.5 and 1 h per day, and 0.57 (95% confidence interval 0.38-0.83) for men who walked 1 h or more per day (P for trend=0.003). Time spent walking per day was associated with a lower risk of colon cancer in Japanese men but not in women, and there was no association between time spent walking and the risk of rectal cancer.

Objective: This study aimed to investigate the association between gastric cancer screening and mortality from gastric cancer., Methods: In 1990, 47,605 Japanese subjects were recruited and completed a questionnaire about participation in gastric cancer screening and life-style. We followed up their vital status through December 2001. In this cohort, 41,394 subjects without a history of cancer were allocated to the screened group or the unscreened group according to their response to the question about gastric cancer screening. We estimated the relative risk (RR) of death from gastric cancer, death from any cause except gastric cancer, and incidence of gastric cancer with adjustment for potential confounding variables., Results: The risk of death from gastric cancer among the screened group was significantly lower than that among the unscreened group. The multivariate RR of death from gastric cancer for screened individuals compared with those not screened was 0.54 (95% confidence interval [CI]: 0.38, 0.77). The RR of death from any cause except gastric cancer was 0.83 (95% CI: 0.77, 0.90), and the RR of incidence of gastric cancer was 0.94 (95% CI: 0.79, 1.13)., Conclusion: Our data suggest that gastric cancer screening or factors associated with it may be associated with lower mortality from gastric cancer.

Although case-control studies suggested that coffee consumption is associated with a decreased risk of liver cancer, no prospective cohort study has been carried out. To examine the association between coffee consumption and the risk of liver cancer, we conducted a pooled analysis of data available from 2 cohort studies in Japan. A self-administered questionnaire about the frequency of coffee consumption and other health habits was distributed to 22,404 subjects (10,588 men and 11,816 women) in Cohort 1 and 38,703 subjects (18,869 men and 19,834 women) in Cohort 2, aged 40 years or more, with no previous history of cancer. We identified 70 and 47 cases of liver cancer among the subjects in Cohort 1 (9 years of follow-up with 170,640 person-years) and Cohort 2 (7 years of follow-up with 284,948 person-years), respectively. We used Cox proportional hazards regression analysis to estimate the relative risk (RR) and 95% confidence interval (CI) of liver cancer incidence. After adjustment for potential confounders, the pooled RR (95% CI) of drinking coffee never, occasionally and 1 or more cups/day were 1.00 (Reference), 0.71 (0.46-1.09) and 0.58 (0.36-0.96), respectively (p for trend = 0.024). In the subgroup of subjects with a history of liver disease, we found a significant inverse association between coffee consumption and the risk of liver cancer. Our findings support the hypothesis that coffee consumption decreases the risk of liver cancer. Further studies to investigate the role of coffee in prevention of liver cancer among the high-risk population are needed., ((c) 2005 Wiley-Liss, Inc.)

Background: Although laboratory experiments suggest protective effects of green tea against colorectal cancer, few prospective cohort studies have been conducted., Methods: We conducted a pooled analysis of two prospective cohort studies among residents in Miyagi Prefecture in rural northern Japan. The first study started in 1984 and included 26,311 subjects. The second study started in 1990 and included 39,604 subjects. The subjects responded to a self-administered questionnaire including an item on green tea consumption. With 7 to 9 years of follow-up, 305 colon and 211 rectal cancers were identified in the two cohorts through record linkage to a regional cancer registry. We used Cox regression to estimate the hazard ratio (HR) of colorectal cancer according to the consumption of green tea with adjustment for potential confounders, and pooled the estimates obtained from each cohort by general variance-based method., Results: Multivariate pooled HRs for colon cancer associated with drinking 1-2, 3-4, and 5 or more cups of green tea per day, as compared with less than 1 cup per day, were 1.06 (95% confidence interval [CI]=0.74-1.52), 1.10 (0.78-1.55), 0.97 (0.70-1.35), respectively (trend p=0.81). Corresponding HRs for rectal cancer were 0.85 (95% CI=0.56-1.29), 0.70 (0.45-1.08), 0.85 (0.58-1.23), respectively (trend p=0.31)., Conclusions: Consumption of green tea was not associated with lower risk of colorectal cancer.

To examine the association between cigarette smoking and the risk of gastric cancer, we conducted a pooled analysis of 2 population-based prospective cohort studies in rural northern Japan. Cohort 1 included 9,980 men (>or=40 years old) and Cohort 2 included 19,412 men (40-64 years old). The subjects completed a self-administered questionnaire on cigarette smoking and other health habits. We identified 228 cases of gastric cancer among Cohort 1 subjects (9 years of follow-up with 74,073 person-years) and 223 among Cohort 2 subjects (7 years of follow-up with 141,675 person-years). From each cohort, we computed the relative risk (RR) and 95% confidence interval (CI) of gastric cancer associated with smoking using a Cox regression analysis and pooled these estimates to obtain summary measures. The pooled multivariate RRs (95% CIs) for current smokers and past smokers compared to subjects who had never smoked were 1.84 (1.39-2.43) and 1.77 (1.29-2.43), respectively. The higher number of cigarettes smoked per day among current smokers was associated with a linear increase in risk (trend p < 0.05). The significant increase in risk for past smokers remained for up to 14 years after cessation. An increased risk was noted for cancer of the antrum but not for cardia or body lesions. The risk was increased for both differentiated and nondifferentiated histologic subtypes. Our findings support the hypothesis that cigarette smoking is a risk factor for gastric cancer., ((c) 2004 Wiley-Liss, Inc.)

During recent decades, breast cancer incidence has been increasing in Japan. According to the latest reports from several cancer registries in Japan, the breast has become the leading cancer site in female cancer incidence. To analyze the trend of breast cancer incidence in detail, we summarized female breast cancer incidence in Miyagi Prefecture, Japan during 1959-1997, and evaluated the period and cohort effect on breast cancer incidence using the age-period-cohort model. Age-specific and age-standardized rates have increased over successive calendar periods. Around 1980, an accelerated increase in these incidence rates took place. A full model including age, period and cohort was best fitted to the trend of incidence. In the model, the effects of period and cohort were statistically significant. The nonlinear effect for cohort indicates an increasing trend, beginning with the cohort in 1888-1897, and the nonlinear effect for period showed a clear increase in risk with calendar period. Furthermore, the full model including a linear component showed a steadily upward trend in the cohort effect. Based on our own epidemiologic studies previously conducted in Miyagi Prefecture, and other published reports, the cohort effect is likely to be related to the change in prevalence of women with risk factors such as low parity and insufficient breastfeeding. We believe that the emergence of the cohort effect is an important finding, although the period effect may also persist. The significant cohort effect may give a caution for continuous increase of breast cancer incidence in Japan., (Copyright 2003 Wiley-Liss, Inc.)

Background: We examined the association between alcohol consumption and all-cause mortality in Japanese men and women., Methods: From June through August 1990, a total of 39,076 subjects (20,660 men and 18,416 women) in 14 municipalities of Miyagi Prefecture in rural northern Japan (40-64 years of age) completed a self-administered questionnaire that included information about alcohol consumption and various health habits. During 11 years of follow-up, we identified 1,879 deaths (1,335 men and 544 women). We used Cox proportional-hazards regression to estimate relative risk (RR) of all-cause mortality according to categories of alcohol consumption and to adjust for age, education, marital status, past histories of chronic diseases, body mass index, smoking, walking and dietary variables., Results: Among men, the risk for all-cause mortality was significantly higher in past drinkers than never-drinkers (multivariate RR, 1.86; 95% confidence interval [CI], 1.50-2.29). There was a dose-response association between alcohol consumption and the risk of all-cause mortality among current drinking men: multivariate RRs in reference to never-drinkers (95% CI) were 1.10 (0.90-1.33), 1.17 (0.96-1.42), 1.16 (0.96-1.40), and 1.62 (1.32-1.99) in current drinkers who consumed less than 22.8 g, 22.8-45.5 g, 45.6-68.3 g, and 68.4 g or more alcohol per day, respectively (P for trend<0.001). Similar association was observed among women (P for trend=0.005)., Conclusions: The results indicated that alcohol consumption tended to be associated with linear increase in risk of all-cause mortality among Japanese men and women, and the association was remarkable for younger men.

Background: There were few prospective cohort studies in Japan using cancer incidence as an endpoint., Methods: We conducted a baseline survey with two self-administered questionnaires regarding lifestyle and personality on the residents aged 40 to 64 years in 14 municipalities of Miyagi Prefecture, Japan, during June through August, 1990. Out of the eligible 51,921 residents, 47,605 (91.7%) responded to the lifestyle questionnaire and formed the cohort under study. We collated the list of subjects in the cohort with the Miyagi Prefectural Cancer Registry data through December 31, 1997. To identify the same person between two data, we used four personal characteristics (sex, name, birthday, and municipality of dwelling)., Results: We ascertained 1,718 cases of incident cancer. In men, gastric cancer was the leading site of cancer (27.7%), followed by lung cancer and colon cancer. In women, breast cancer was the most common (19.6%), followed by gastric cancer and colon cancer., Conclusions: By record linkage with regional cancer registry data, it becomes possible for us to investigate the effect of various life-styles on cancer incidence in the Miyagi Cohort Study. We expect this data to contribute to the progress of research on cancer etiology and cancer prevention.

Background: We examined the association between smoking and all-cause mortality among Japanese men and women., Methods: In 1990, 18,945 men and 17,107 women in Miyagi Prefecture in rural northern Japan (40-64 year of age) completed a self-administered questionnaire including items on smoking. Cox regression was used to estimate relative risk (RR) of mortality according to smoking categories, with adjustment for age, education, marital status, past history of diseases, drinking, body mass index, walking, and dietary variables. During 11 years of follow-up, 1,209 men and 499 women had died., Results: Multivariate RRs of all-cause mortality for current smokers as compared with never smokers were 1.71 (95% confidence interval, 1.44-2.03) for men and 1.44 (95% confidence interval, 1.06-1.94) for women. Among men, risk in past smokers who had quit smoking for 15 years or longer was not different from the risk in never smokers (RR, 0.97; 95% confidence interval, 0.68-1.39). Of all deaths, 34% in men and 4% in women were attributable to current or past smoking., Conclusions: This study indicates that smoking increases the risk of premature death among middle-aged Japanese men and women and that substantial proportion of death, especially for men, is attributable to smoking.

Background: Findings from a large-scale population-based prospective cohort would lead us to better understanding of the relationship between lifestyle and health, thus better provision of strategies for disease prevention and health promotion., Methods: We conducted a baseline survey with two self-administered questionnaires regarding lifestyle and personality on the residents aged 40 to 64 years in 14 municipalities of Miyagi Prefecture, Japan, during June through August, 1990. Out of the eligible 51,925 residents, 47,605 (91.7%) responded to the lifestyle questionnaire and formed the cohort under study. We then have been following up the subjects for mortality, migration, and incidence of cancer., Results: During the follow-up from June 1990 through March 2001, 2,536 subjects (5.3%) died and 2,166 subjects (4.5%) emigrated. The distribution of the causes of death among the study subjects was quite consistent with the national average., Conclusions: In this cohort study, both the participation rate and the follow-up rate are satisfactorily high. We expect this Miyagi Cohort Study to provide the society with evidence for health promotion and disease prevention.

Background: The role of personality in the causation of cancer has been controversial. We examined this question in a large, prospective study., Methods: From June through August 1990, 30 277 residents of Miyagi Prefecture in northern Japan completed a Japanese version of the short form of the Eysenck Personality Questionnaire-Revised and a questionnaire on various health habits. There were 671 prevalent cases of cancer at baseline, and 986 incident cases of cancer were identified during 7 years of follow-up, through December 1997. We used Cox proportional hazards regression to estimate the relative risk (RR) of incident cancer (total, stomach, colorectal, breast, and lung) according to four levels of each of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for sex, age, education, smoking, alcohol use, body mass index, and family history of cancer. Statistical tests were two-sided., Results: Multivariable RRs of total cancer for individuals in the highest level of each personality subscale as compared with those in the lowest were 0.9 for extraversion (95% confidence interval [CI] = 0.7 to 1.1; P(trend) =.32), 1.1 for psychoticism (95% CI = 0.9 to 1.3; P(trend) =.96), 0.9 for lie (95% CI = 0.7 to 1.0; P(trend) =.19), and 1.2 for neuroticism (95% CI = 1.0 to 1.4; P(trend) =.06). There were no associations between any personality subscale and risk of specific cancers. Neuroticism showed statistically significant positive, linear associations with prevalent cancer at baseline (P(trend)<.001) and with the 320 incident cancer cases diagnosed within the first 3 years of follow-up (P(trend) =.03); however, it showed no association with the 666 cases diagnosed during the fourth through the seventh years of follow-up (P(trend) =.43)., Conclusion: Our data do not support the hypothesis that personality is a risk factor for cancer incidence. The association between neuroticism and prevalent cancer may be a consequence, rather than a cause, of cancer diagnosis or symptoms.

Gastric adenocarcinoma is one of the most common gastrointestinal (GI) malignancies, especially among Japanese adults, but represents only 0.05% of all malignant pediatric GI tumors. We report a case of gastric adenocarcinoma arising at the esophageal gastric junction of an 11-year-old girl. The tumor was polypoid, measuring 3.0 x 3.0 x 1.2 cm and was light gray and partially red in color with a stalk. Light microscopic examination of the lesion demonstrated adenocarcinoma of variable degrees of both architectural and nuclear atypia with invasion into the submucosa. Immunohistochemical findings of cytokeratin subtypes revealed positive immunoreactivity for cytokeratin subtypes 8, 19 and 20 and negative for 5/6/18, 7, 13 and 14, which is consistent with those of gastric adenocarcinoma. The patient was alive and well 12 months postoperatively.

A 68-year-old male was referred to our hospital for the precise examination of a giant hepatic tumor detected in a mass survey. The lesion occupied most of the right hepatic lobe, further advancing to the medial segment of the left lobe. However, hepatic functions were well preserved (ICG K = 0.141). Considering the characteristic images of the lesion with positive anti-HCV and high titer of PIVKA II (0.860 AU/ml), the diagnosis was hepatocellular carcinoma. First arterial administration of SMANCS was performed on May in 1994, followed by 6 successive procedures with an interval of about 2 months (total dosage 36 mg), resulting in remarkable tumor shrinkage and tumor marker normalization. On January in 1995, a metastatic lesion to the right rib was controlled by 2 mg of SMANCS administered to the intercostal artery combined with radiation therapy (60 Gray). Frequent administrations of SMANCS caused no serious complications, and tumor feeders were well preserved. Therefore, arterial administration of SMANCS is thought to be one choice for the therapy of giant HCC with good functional reserve.

A 78-year-old man presented with an esophageal polyp that was confirmed by immunohistochemistry and electron microscopy to be malignant fibrous histiocytoma. The tumor was comprised of a proliferation of spindle-shaped cells admixed with bizarre giant cells. These tumor cells were immunoreactive for smooth muscle actin, vimentin, alpha-1-anti-chymotrypsin and CD68. Electron microscopic examination revealed the myofibroblastic and histiocytic features of the tumor cells. No elements of epithelial or myogenic differentiation were found in the tumor. Malignant fibrous histiocytoma of the esophagus is extremely rare, with 10 cases being documented so far in the literature. The differential diagnosis of pleomorphic tumors of the esophagus is discussed.