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Summary Background & aims The associations between dietary magnesium intake and stroke and coronary heart disease (CHD) incidences are inconsistent and not established in Asian. We aimed to determine the association between dietary magnesium intake and the risk of stroke and CHD in a Japanese population. Subjects/Methods We studied 85,293 Japanese subjects by questionnaire at baseline (age 45–74 years, without cardiovascular disease or cancer in 1995 and 1998 for Cohorts I and II, respectively). The participants were followed until the end of 2009 and 2010 in Cohorts I and II, respectively. Dietary magnesium intake was estimated from a self-administered 138-item food-frequency questionnaire. Results After 1,305,738 person-years of follow-up, 4110 strokes and 1283 cases of CHD were documented. The multivariable-adjusted hazard ratios (HRs, 95% confidence intervals, 95%CIs) of CHD for the fourth and fifth quintiles of dietary magnesium intake were 0.70 (0.50–0.99) and 0.66 (0.44–0.97) in men (P for trend = 0.036), respectively, and third quintile of dietary magnesium intake was 0.61 (0.39–0.96) in women (P for trend = 0.241), compared with the lowest quintile in men and women. We observed no decreased risks of incident stroke in men or women with higher dietary magnesium intakes. Conclusions Higher dietary magnesium intake was associated with a reduced risk of CHD in Japanese men.

Background Few studies have assessed associations of non-enzymatic antioxidant capacity (NEAC) in the overall diet with all-cause or specific mortality, and their results have been inconsistent. Objectives The present study investigated the association between dietary NEAC and all-cause or cause-specific mortality. Methods The study was a large-scale population-based prospective cohort study in Japan consisting of 42,520 men and 50,207 women aged 44-76 y, who had no history of cancer, stroke, ischemic heart disease, or chronic liver disease. We evaluated FFQ-based dietary NEAC with use of published databases in which the NEACs of individual foods were analyzed by ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) assays. Dietary NEAC was calculated by multiplying the estimated NEAC with the consumed amount and summing up those values for all foods, and was categorized in quartiles. We identified death and cause of death with use of residential registry and death certificates. HRs and 95% Cls for death from the second survey, which was conducted from April 1995 to December 2014 were estimated with Cox proportional hazards regression analysis. Results After 1,498,308 person-years of follow-up, 12,978 total deaths occurred. The multivariable-adjusted HRs (95% Cls) for all-cause mortality for the highest compared with the lowest quartile of FRAP and ORAC were 0.85 (0.80, 0.89) and 0.84 (0.79, 0.89), respectively. Dietary NEACs were inversely associated with mortality from cardiovascular disease (CVD), but not from cancer. The multivariable-adjusted HRs (95% Cls) for CVD for the highest compared with the lowest quartile of FRAP and ORAC were 0.83 (0.75, 0.92) and 0.79 (0.70, 0.89), respectively. Conclusions Higher dietary NEACs from FRAP and ORAC were associated with lower risk of all-cause mortality and mortality from CVD in Japanese adults.

Aims Coping strategies may be significantly associated with health outcomes. This is the first study to investigate the association between baseline coping strategies and cardiovascular disease (CVD) incidence and mortality in a general population cohort. Methods and results The Japan Public Health Center-based prospective Study asked questions on coping in its third follow-up survey (2000–04). Analyses on CVD incidence and mortality included 57 017 subjects aged 50–79 without a history of CVD and who provided complete answers on approach- and avoidance-oriented coping behaviours and strategies. Cox regression models, adjusted for confounders, were used to determine hazard ratios (HRs) according to coping style. Mean follow-up time was 7.9 years for incidence and 8.0 years for mortality. The premorbid use of an approach-oriented coping strategy was inversely associated with incidence of stroke (HR = 0.85; 95% CI, 0.73–1.00) and CVD mortality (HR = 0.74; 95% CI, 0.55–0.99). Stroke subtype analyses revealed an inverse association between the approach-oriented coping strategy and incidence of ischaemic stroke (HR = 0.79; 95% CI, 0.64–0.98) and a positive association between the combined coping strategy and incidence of intra-parenchymal haemorrhage (HR = 2.03; 95% CI, 1.01–4.10). Utilizing an avoidance coping strategy was associated with increased mortality from ischaemic heart disease (IHD) only in hypertensive individuals (HR = 3.46; 95% CI, 1.07–11.18). The coping behaviours fantasizing and positive reappraisal were associated with increased risk of CVD incidence (HR = 1.24; 95% CI, 1.03–1.50) and reduced risk of IHD mortality (HR = 0.63; 95% CI, 0.40–0.99), respectively. Conclusion An approach-oriented coping strategy, i.e. proactively dealing with sources of stress, may be associated with significantly reduced stroke incidence and CVD mortality in a Japanese population-based cohort.

Background and aims Higher intake of fish or n-3 polyunsaturated fatty acids (PUFAs) has been associated with reduced risk of coronary heart disease (CHD). However, it is unclear whether increased blood levels of n-3 PUFAs are associated with reduced risk of CHD in the Japanese population. Methods The relationship between circulating levels of n-3 PUFAs (eicosapentaenoic acid + docosapentaenoic acid + docosahexaenoic acid) and risk of CHD was examined in a nested case-control study among participants in the Japan Public Health Center (JPHC)-based Study Cohort. Plasma n-3 PUFA phospholipid levels were measured at baseline by gas chromatography in 209 cases with CHD and 418 controls matched for sex, age, date of blood draw, time elapsed since last meal before blood collection, and study location. The CHD cases (n = 209) comprised 168 cases of myocardial infarction and 41 of sudden cardiac death, otherwise classified as 157 non-fatal and 52 fatal coronary events, respectively. Mean duration of follow-up was 13.5 years. Results Multivariate conditional logistic analysis showed no significant association between n-3 PUFAs and risk of total CHD. The odds ratio (OR) for the highest versus lowest quartiles of plasma n-3 PUFAs was 0.79 (95% confidence interval [95% CI]: 0.41–1.51, p for trend = 0.51). Subtype analysis of CHD revealed that the multivariate ORs for the highest versus lowest quartiles for n-3 PUFAs were 0.91 (95% CI: 0.43–1.89, p for trend = 0.90) for myocardial infarction, 0.08 (95% CI: 0.01–0.88, p for trend = 0.04) for sudden cardiac death, 0.89 (95% CI: 0.42–1.89, p for trend = 0.97) for nonfatal coronary events, and 0.12 (95% CI: 0.02–0.75, p for trend = 0.03) for fatal coronary events. Conclusions Plasma n-3 PUFA levels were not associated with risk of total CHD but were inversely associated with risks of sudden cardiac death and fatal coronary events among middle-aged Japanese individuals.

Seafood/fish intake has been regarded as a protective factor for coronary heart disease (CHD), while smoking is a strong risk factor. To examine whether associations between smoking and risk of CHD are modified by seafood/fish intake, we studied 72,012 Japanese men and women aged 45-74 years who completed 2 food frequency questionnaires, 5 years apart, during the period 1995-2009. After 878,163 person-years of follow-up, 584 incident cases of CHD (101 fatal and 483 nonfatal), including 516 myocardial infarctions, were documented. There was a clear dose-response association between smoking and CHD risk among subjects with a low seafood/fish intake (

Segmented-in-series-type solid oxide fuel cells (SIS-SOFCs) have been developed for residential applications. The average stack voltage of the SIS-SOFC with a fuel consisting of CH4 (steam/carbon = 2.5) was 0.75 V and 0.24 A/cm2 at fuel utilisation = 70.1%, yielding a direct current lower heating value (LHV) energy conversion efficiency of 50.6%. The degradation ratio, the ratio for thermal cycling, and the ratio for redox cycling were 0.62%/1000 h, 0.11% per cycle, and 0.04% per cycle, respectively. A micro combined heat and power (m-CHP) SOFC system was fabricated and successfully demonstrated for over 4000 h. The degradation ratio of 0.75%/1000 h was almost the same as that of the stack in a furnace. An LHV alternating current electrical efficiency of over 40% and LHV heat recovery efficiency of over 35% was achieved. Thus, SIS-SOFCs are suitable for m-CHP SOFC systems.

SummaryCapsular polysaccharide from Actinobacillus actinomycetemcomitans Y4 (Y4 CP) induces bone resorption in a mouse organ culture system and osteoclast formation in mouse bone marrow cultures, as reported in previous studies. We also found that Y4 CP inhibits the release of interleukin (IL)-6 and IL-8 from human gingival fibroblast (HGF). Thus Y4 CP induces various responses in localized tissue and leads to the secretion of several cytokines. However, the effects of Y4 CP on human monocytes/macrophages are still unclear. In this study, THP-1 cells, which are a human monocytic cell line, were stimulated with Y4 CP, and we measured gene expression in inflammatory cytokine and signal transduction pathways. IL-1β and tumour necrosis factor (TNF)-α mRNA were induced from Y4 CP-treated THP-1 cells. IL-1β mRNA expression was increased according to the dose of Y4 CP, and in a time-dependent manner. IL-1β mRNA expression induced by Y4 CP (100 µg/ml) was approximately 7- to 10-fold greater than that in the control by real-time PCR analysis. Furthermore, neither PD98059, a specific inhibitor of extracellular signal-regulated kinase nor SB203580, a specific inhibitor of p38 kinase prevented the IL-1β expression induced by Y4 CP. However, JNK Inhibitor II, a specific inhibitor of c-Jun N-terminal kinase (JNK) prevented the IL-1β mRNA expression induced by Y4 CP in a concentration-dependent manner. These results indicate that Y4 CP-mediated JNK pathways play an important role in the regulation of IL-1β mRNA. Therefore, Y4 CP-transduced signals for IL-1β induction in the antibacterial action of macrophages may provide a therapeutic strategy for periodontitis.

Recent changes in the histology of lung cancer, namely a relative increase of adenocarcinoma compared to squamous cell carcinoma, might be due to a temporal shift from nonfilter to filter cigarettes. To investigate the association between type of cigarette and lung cancer by histological type, we conducted a case-control study in Japan, comprising 356 histologically confirmed lung cancer cases and 162 controls of male current smokers, who provided complete smoking histories. Overall, logistic regression analysis after controlling for age and prefecture revealed decreased risk, as shown by adjusted odds ratios, for both squamous cell carcinoma and adenocarcinoma among lifelong filter-exclusive smokers as compared to nonfilter or mixed smokers. This decrease was greater for squamous cell carcinoma than for adenocarcinoma. Among men under 54 years, filter-exclusive smokers displayed increased risk of adenocarcinoma, but decreased risk of squamous cell carcinoma. The recent shift in histology from squamous cell carcinoma to adenocarcinoma, particularly among younger smokers, might be due to changes in cigarette type. However, among subjects aged 65 years or more, no differences in histological type appeared related to type of cigarette smoked, implying that other factors are associated with increases in adenocarcinoma among older Japanese population.

We examined the association between green tea consumption and mortality due to all causes, cancer, heart disease, cerebrovascular disease, respiratory disease, injuries, and other causes of death in a large-scale population-based cohort study in Japan.We studied 90,914 Japanese (aged between 40 and 69 years) recruited between 1990 and 1994. After 18.7 years of follow-up, 12,874 deaths were reported. The association between green tea consumption and risk of all causes and major causes of mortality was assessed using the Cox proportional hazards regression model with adjustment for potential confounders.Hazard ratios for all-cause mortality among men who consumed green tea compared with those who drank less than 1 cup/day were 0.96 (0.89-1.03) for 1-2 cups/day, 0.88 (0.82-0.95) for 3-4 cups/day, and 0.87 (0.81-0.94) for more than 5 cups/day (P for trend.001). Corresponding hazard ratios for women were 0.90 (0.81-1.00), 0.87 (0.79-0.96), and 0.83 (0.75-0.91; P for trend.001). Green tea was inversely associated with mortality from heart disease in both men and women and mortality from cerebrovascular disease and respiratory disease in men. No association was found between green tea and total cancer mortality.This prospective study suggests that the consumption of green tea may reduce the risk of all-cause mortality and the three leading causes of death in Japan.

Tissue inhibitor metalloproteinases 1 (TIMP-1) and 2 have been reported to inhibit bone resorption. However, here, we report the direct action of both TIMP-1 and TIMP-2 on isolated rabbit mature osteoclasts to stimulate their bone-resorbing activity at significantly lower concentrations (approximately ng/ml) than those (approximately microg/ml) required for the inhibition of bone resorption. The cell population used in this study consisted of a mature osteoclast population with95% purity. TIMP-1 (approximately 50 ng/ml) and TIMP-2 (approximately 8-10 ng/ml) increased the pit area excavated by the isolated mature osteoclasts. The stimulatory effects of TIMPs were abolished by simultaneous addition of anti-TIMP antibodies. At higher concentrations, the stimulation of bone resorption decreased reversely to the control level. The magnitude of the stimulatory effect of TIMP-2 was more than that of TIMP-1. Metalloproteinase inhibitors such as BE16627B and R94138 could not replace TIMPs with respect to the bone-resorbing activity, suggesting that the osteoclast-stimulating activity of TIMPs was independent of the inhibitory activity on matrix metalloproteinases (MMPs). TIMPs stimulated tyrosine phosphorylation of cellular proteins in the isolated mature osteoclasts. Both herbimycin A, an inhibitor of tyrosine kinases, and PD98059 and U0126, inhibitors of mitogen-activated protein kinase (MAPK), completely blocked the TIMP-induced stimulation of osteoclastic bone-resorbing activity. On the plasma membrane of osteoclasts, some TIMP-2-binding proteins were detected by a cross-linking experiment. These findings show that TIMPs directly stimulate the bone-resorbing activity of isolated mature osteoclasts at their physiological concentrations and that the stimulatory action of TIMPs is likely to be independent of their activities as inhibitors of MMPs.

SOFCs have a potential of showing extraordinarily high electric conversion efficiency. Thus they are considered as promising candidates for future distributed generators. However operations of SOFCs are not simple compared with the other generators such as gas engines or gas turbine since SOFCs have to be operated at a high temperature. It is difficult to start up SOFCs rapidly and thus they are not suitable for situations where there is a large fluctuation of demand. This limits the application of SOFCs and the introduction is restricted within a narrow market. In order to promote the introduction of SOFCs to a market, how to make use of SOFCs is a very significant factor. Techniques to operate and control SOFCs are key factors to draw the potential of SOFCs. Therefore information technologies are expected as a powerful tool to improve the total performance of SOFCs.

In recent years, in the industry, real-time decision making integrating plant field and business systems information has become indispensable. In addition, with the arrival of the ubiquitous information society, the use of sensors in the field and information utilized for business are increasing. In this environment, handling field information in real time and connecting it with business is a crucial challenge. With condition-based management, the facilities are monitored and are kept in good condition depending on their state rather than according to a prescribed schedule. However, in the event of a facilities error, demand for access to the same data centers increases, degrading response performance. A method is described for delivering information data to operating applications as triggered by a control event. In the event of a facilities error, access to information data is integrated, and the information data is duplicated and delivered to operating applications. Then, concentrated demand for access to information data can be avoided, and the response performance of operating applications can be ensured. Since the method has not been tested, it is now necessary to perform a feasibility study including performance verification.

In a pooled analysis of two prospective studies with 88 658 Japanese men and women, fruit and vegetable consumptions, were not associated with a lower risk of colorectal cancer (705 cases); multivariate relative risk (95% confidence interval) for the highest vs the lowest quartile of intake being 0.92 (0.70–1.19) and 1.00 (0.79–1.27), respectively.

To evaluate colorectal cancer screening with faecal occult blood testing (FOBT) in terms of prevention of advanced cancers, we conducted a case-control study in the areas where an annual screening programme with immunochemical FOBT has been offered to all inhabitants aged 40 years or over. Cases were 357 consecutive patients in the study areas clinically diagnosed as having advanced colorectal cancer or a tumour invading the muscularis propriae or deeper, that is, T(2)-T(4) in TNM classification. Three controls were selected for each case matched by gender, age, residential area and exposure status to screening within 1 year before case diagnosis. The odds ratios (ORs) of developing advanced cancer were calculated using conditional logistic regression analyses. The OR for those screened within 3 years before the diagnosis vs those not screened was 0.54 (95% confidence interval (CI) 0.29-0.99). The ORs were lower for rectum than for colon (0.32-0.73 and 0.84-1.18 for rectum and colon, respectively). For those screened within the past 3 years, OR of developing advanced cancer in the rectum was 0.32 ( 95%CI: 0.12-0.84). A screening programme with immunochemical FOBT can be effective for prevention of advanced colorectal cancer. Risk reduction appears to be larger for rectal than for colon cancer. British Journal of Cancer (2003) 89, 23-28. doi:10.1038/sj.bjc.6601002 www.bjcancer.com

We propose an extraction method of the structural motion information for compact image representation. The advanced motion analysis needs segmentation and motion velocity information. Conventional segmentation methods by using edge detection with high-pass filtering tend to fall into over-segmentation. The morphological filter is used to obtain edge information avoiding the selection of small oscillation. In the filtering process, various sizes of structural element (SE) makes possible gradual segmentation with respect to the object size. Then in each divided region, the simultaneous equations of motion velocity are solved to get the affine parameter (AP) which can describe the object's movement of translation, rotation, expansion and reduction. If the intensity error in a region is larger than the threshold, a smaller structural element is used to segment the region. This enables one to get affine motion parameters without the waste of over-segmentation.

Many methods for understanding document images have been investigated to extract/classify meaningful information from paper-based documents. These methods focused on the same types/classes of documents whose layout structures can be represented by single specification. However, widely used documents are not always simple, but composed of different types/classes of simple ones: these documents cannot be represented by a simple document model. In this paper, we address the layout analysis of complex documents. In particular, the knowledge representation of layout structure is discussed. Although the representation means are divided into structure description and operator-specification, our representation means is based on operator-specification.

Dietary habit is closely associated with development of cancer and cardiovascular diseases, however little prospective evidence has been published for Japanese, whose dietary habit is substantially different from Western countries. Therefore, frequencies of food consumption, food preference, cooking method and acceptance of dietary advice were investigated at the baseline by two kinds of self-administered food frequency questionnaires. Dietary habits between urban and rural (Tokyo and Osaka vs. others), or between Okinawa and non-Okinawa revealed recognizable differences. The so-called westernized foods such as bread, beef and coffee were more consumed in the urban areas such as Tokyo and Osaka and also in Okinawa. The frequencies of salted food intake such as pickled vegetables and salted seafoods were remarkably low in Okinawa. Cooking methods for meats, seafoods and vegetables were also unique in Okinawa. No distinct geographical difference was shown in food preference and modification of dietary habit by dietary advice.

The data collection from cohort subjects at baseline is the core work for prospective study as well as follow-up. We set up 140,420 cohort subjects (68,722 men and 71,698 women) (61,595 in 1990 as Cohort I and 78,825 in 1993 as Cohort II) based on resident registry of 29 districts under 11 Public Health Center areas and baseline survey were submitted for them. The survey consisted of the following three components: (1) self-administered questionnaire survey, (2) collection of blood samples (plasma and buffy coat) for deep-freezed storage and (3) collection of health check-up data. All survey were completed during the first five year of each study. Among all cohort subjects, 113,461 (81%) (53,375 men and 60,086 women, 50,245 in Cohort I and 63,216 in Cohort II) returned the questionnaire and 49,011 (35%) (18,159 men and 30,852 women, 24,637 in Cohort I and 24,374 in Cohort II) provide their blood. The health check-up data were collected from 47,910 (34%) (17,276 men and 30,664 women, 23,311 in Cohort I and 24,599 in Cohort II). These data and blood samples serve as basis for the Japan Public Health Center-based prospective Study on cancer and cardiovascular diseases (JPHC Study).

Smoking and drinking habits at baseline survey among 110,896 male and female residents aged 40-69 are reported as part of an ongoing prospective population-based cohort in 11 geographically diverse health centers in Japan. The age-adjusted proportion of current and former smokers was 54.8% and 21.8% in males and 8.3% and 2.1% in females, respectively. Mean age at initiation of smoking in males and females was 20.6 and 27.8 years of age, respectively. In males, the age-adjusted proportion of those who drink almost daily was 49.1% and that of those who drink almost never was 19.7%, while in females, it was 5.9% and 71.6%, respectively. When compared by health center, the proportion of male current smokers was lower in Miyako and Ishikawa, both located in Okinawa Prefecture, while in females the proportion was higher in urban areas, such as Katsushika and Suita. The proportion of those who drink almost daily in males was higher in Yokote, Kashiwazaki, Katsushika and Suita, and lower in Ishikawa and Miyako, but in Ishikawa and Miyako, the proportion of those who drink at social events was higher. In females, the proportion of those who drink almost daily was higher in urban areas. There was substantial variation in the types of alcohol beverages consumed by males. In contrast, alcohol consumption in females comprised mainly beer.

The Japan Public Health Center-based Prospective Study on Cancer and Cardiovascular Diseases (JPHC Study; formerly called "Koseisho Multipurpose Prospective Cohort Study") began in 1990 (Cohort I) and 1993 (Cohort II). The JPHC Study covers 11 public health center areas throughout Japan and includes a total of 140,420 residents. The study's design includes a baseline survey with a self-administered questionnaire on lifestyle and collection of blood and health checkup data; a follow-up system for mortality, migration, and incidence of cancer and cardiovascular diseases; an additional follow-up survey after 5 and 10 years; and distribution of a newsletter. The JPHC study is expected to provide evidence for the prevention and control of cancer and cardiovascular diseases in the 21st century.

The number of lung cancer deaths in Japan has been continuously increasing for decades, mainly because of the growing size of the elderly population. In contrast, age-specific lung cancer death rates for those aged under 79 years plateaued recently, reflecting the decreasing smoking rates since 1966. However, the smoking rate for males (54% in 1999) is still extraordinarily high in Japan compared to other developed countries, so it is necessary to further promote anti-smoking activities. It is reported that the relative risk for lung cancer due to cigarette smoking increases 4-5 fold (current smokers versus non-smokers) for males and 2-3 fold for females, and that the population attributable risk is 70% for males and 15-25% for females in Japan, which indicates that cigarette smoking is the most influential risk factor for lung cancer. However, the magnitude of the relative risk and population attributable risk is not as high as those observed in other developed countries. In order to clarify the reasons for this, it is necessary to further accumulate findings from actual epidemiological studies in Japan. In addition to cigarette smoking, occupational exposures, dietary habits (low intake of vegetables and fruits), atmospheric air pollution, environmental tobacco smoke, cooking and heating fuels, indoor radon and previous lung diseases are reported to increase the risk of lung cancer.

Lung cancer screening using chest X-ray examination and sputum cytology was introduced by the Japanese government in 1987. However, there was no direct evidence of the benefit from lung cancer screening in terms of reduction of mortality at that time.A case-control study was conducted using the data from 50 areas in which population-based lung cancer screening programs had been conducted for several years. Case series consisted of 273 deceased lung cancer cases, and 1269 control patients were collected from those who were alive at the time of diagnosis of the corresponding case: These were matched by gender, age, smoking status, and type of health insurance. Screening histories, which were obtained from the list of screenees, were compared between cases and matched controls for the identical calendar period before the time of diagnosis of the case.The odds ratio for dying from lung cancer for those who were screened within 12 months compared with those who were not screened was 0.72 (95% confidence interval, 0.50-1.03). When divided by gender, the odds ratio was significantly decreased in females.The authors interpreted these data to indicate that there is a small positive effect of lung cancer screening in terms of reducing mortality due to lung cancer. However, this small effect cannot be evaluated adequately by observational studies, such as case- control studies, because of the self-selection bias. Discussion is needed to determine the resources that should be allocated to this issue for developing an effective strategy for lung cancer control.

The 150 male patients exposed to Thorotrast who were confirmed by a 1975-1978 national survey with diagnostic X rays of 50,860 war-wounded soldiers were followed up between 1979 and 1998 (Aichi series or second series). Age-adjusted rate ratios of deaths from all causes were 3.0 times higher in Thorotrast patients compared to controls; this was statistically significant. Rate ratios for liver cancer, liver cirrhosis and leukemia were 35.0, 7.5 and 18.2, respectively.

Updated data from two series in a cancer mortality study for a total of 412 Japanese Thorotrast patients were combined. The rate ratio for all deaths of Thorotrast patients, compared to controls, started to increase after a latent period of 20 years after injection of Thorotrast. Rate ratios for liver cancer, liver cirrhosis, leukemia and lung cancer were 35.9, 6.9, 12.5 and 2.0 times higher, respectively, than those for controls.

We identified 12 new cases of hypertrophic cardiomyopathy (HCM) and 3 new cases of dilated cardiomyopathy (DCM with echocardiography) in 72980 (aged 18-85 years, 43.1 +/- 14.1) industrial workers during an annual health check from April to October in 1996. Two of 3 patients with DCM were males, 21 and 25 years of age. No patients had symptoms. ST-T abnormalities by electrocardiography were found in 87% (13/15) of patients with cardiomyopathy and left ventricular hypertrophy (LVH) in 53% (8/15). Our findings suggest that echocardiography is important in mass screening for early detection of asymptomatic cardiomyopathy in middle-aged as well as young patients with ST-T abnormalities.

Patients with small-cell lung cancer who survive more than 2 years have a significantly increased risk (relative risk of 3.6) of developing a second primary tumour. The cessation of cigarette smoking after successful therapy is associated with a significantly decreased risk of a second primary tumour.

We investigated the effect of mild exercise on global and regional diastolic function in patients with hypertensive left ventricular hypertrophy (LVH), using simultaneous measurement of micromanometric left ventricular pressure and echocardiographic indexes. Although left ventricular end-diastolic pressure (LVEDP) at rest in the hypertensive LVH group was similar to that in the control normotensive group, who had no abnormality on echocardiography or cardiac catheterization, LVEDP showed a marked increase during exercise only in the hypertensive LVH group. The pressure-dimension relation was shifted upward during exercise in all patients with hypertensive LVH. We utilized a new index of regional diastolic myocardial stiffness, KDM, which is derived from the diastolic relation between the mean wall stress and the natural logarithm of the reciprocal of wall thickness. Although KDM at rest was similar in the two groups, KDM increased significantly during exercise, both in the septum and posterior wall in patients with hypertensive LVH. The present results imply that even low-grade exercise may have deleterious effects on regional myocardial performance in patients with hypertensive LVH.

The aim of this study was to clarify that the depressed mechanoenergetics in patients with idiopathic dilated cardiomyopathy (DCM) resulted from compensation for the decreased contractility. The study population consisted of eight control subjects, with normal left ventricular size and ejection fraction and 31 patients with DCM. Left ventricular end-systolic elastance (Ees), effective arterial elastance (Ea), external work (EW), and the pressure-volume area (PVA) were measured, using a dual-field volume conductance catheter equipped with a micromanometer-tipped catheter. Ea/Ees was evaluated as ventriculoarterial coupling. Normal hearts worked at almost optimal condition (defined as Ea/Ees = 1/2), while ventriculoarterial coupling was far from the optimum (EaEes) in patients with DCM. Ees in patients with DCM was less than that in control subjects; however, Ea was similar in the two groups. The mismatch of Ea/Ees observed in DCM leads to depressed mechanoenergetics as a result of the compensatory response to maintain adequate blood pressure. Volume enlargement plays an important role in maintaining adequate blood pressure and cardiac output in the course of chronic deterioration of contractility.

Cancer epidemiology in Japan has been led by the large-scale population based cohort studies. Permanent registration system has made follow-up easier and more efficient. Low cancer incidence and mortality rates led the researchers to investigate possible preventive factors in diet and life style, in addition to the study of risk factors. The on-going large sized prospective cohorts should be a fruitful resource for future cancer epidemiological studies. Various studies of cancer epidemiology are introduced from a methodological aspect.

In Japan, the number of lung cancer deaths has increased continuously since 1950, and in 1993 it was the leading cause of cancer deaths in males. This increase has been especially noteworthy among older people. In contrast, lung cancer deaths have started to decrease in the UK and the US, where anti-smoking activities have been strong since the 1970s. Obviously, smoking is the most important risk factor for lung cancer. Smoking can explain almost all case of squamous and small cell carcinoma. For adenocarcinoma, however, major unknown risk factors remain to be defined. Because the effectiveness of lung cancer screening is limited, it is necessary to integrate all available methods, including newly developed techniques, to prevent lung cancer deaths.

Hemodynamic effects of a newly developed calcium channel blocker, pranidipine, on dynamic exercise-induced angina were investigated. Ten patients with stable effort angina pectoris underwent symptom-limited bicycle ergometer exercise testings before and after a single oral administration of pranidipine, and effects of pranidipine on systemic, cardiac and coronary hemo-dynamics induced by dynamic exercise were evaluated invasively. Pranidipine administration reduced systemic vascular resistance (from 1,764 +/- 109 to 1,115 +/- 60 dynes.sec/cm5; p0.01 at test, and from 1,120 +/- 102 to 795 +/- 62 dynes.sec/cm5; p0.05 at peak exercise) and mean arterial pressure (from 93 +/- 5 to 76 +/- 3 mmHg; p0.01 at test, and from 85 +/- 7 to 72 +/- 6 mmHg; p0.05 at peak exercise) with the increase in heart rate and cardiac index throughout exercise. Pranidipine also decreased coronary vascular resistance from 1.29 +/- 0.21 to 0.89 +/- 0.17 mmHg/ml/min (p0.05) at resting condition. At peak exercise, rate-pressure product and myocardial oxygen consumption decreased (from 237 +/- 21 to 215 +/- 18 x 10(2); p0.05, and from 31.3 +/- 7.5 to 21.7 +/- 3.9 ml/min; p0.05, respectively), while coronary vascular resistance did not change significantly. Furthermore, pranidipine mitigated ST-segment depression and elevation of pulmonary artery wedge pressure at peak exercise (from 0.20 +/- 0.03 to 0.13 +/- 0.02 mV; p0.01, and from 25 +/- 3 to 11 +/- 2 mmHg; p0.01, respectively). These results suggest that the major therapeutic effects of pranidipine for dynamic exercise-induced angina would be to reduce myocardial oxygen demand by improving peripheral circulation and reducing preload and afterload.(ABSTRACT TRUNCATED AT 250 WORDS)

Lung cancer incidence figures in Japan were estimated as 30,000 for males and 11,000 for females for 1989 and represented the second and the fifth leading site of cancer, respectively, according to the Research Group for Population-based Cancer Registration in Japan. It is also estimated that lung cancer will steadily increase in the future. In relative frequencies of the major histological types, squamous cell carcinoma showed a decreasing trend, while small as well as large cell carcinomas showed an increasing trend in Osaka. In the distribution of clinical staging, the proportion of localized cases accounted for only 20% of the lung cancers in 1990. Five-year relative survival rates for lung cancer were 11.3% for all patients and 43.0% for localized cases in Osaka in 1984-1986. The rates were reported as 13.5% and 36.6% for total patients and localized cases, respectively, among caucasians from the SEER Program, a NCI project including 10 population-based cancer registries in the US. No noticeable difference was observed between Japan and the US. To control lung cancer in Japan it is considered vitally important and urgent to develop (1) new examination methods for diagnosing lung cancer in the earlier stage, (2) an efficient and effective cessation campaign for cigarettes smoking and (3) non-smoking based education.

e16566 Background: Breast cancer is the most frequently occurring cancer among women in Japan and in many parts of the world. Advances in breast cancer care are expected to reduce the burden of the...

e16542 Background: Although colorectal cancer is the third leading cause of cancer death in Japan, the quality of care provided for colorectal cancer patients remains largely unknown. Reports of va...

To assess the extent of overdiagnosis bias in lung cancer screening, clinical Stage I lung cancer cases detected by chest radiograph examination, with histologic or cytologic evidence of malignancy and not treated by surgical operation, were followed up for more than 10 years. Of 1297 screen-detected and 1297 symptom-detected cases collected from 20 institutions, 42 screen-detected and 27 symptom-detected cases satisfied the study criteria. In about half of the cases, the patients had no contraindication for surgical treatment, but they refused surgical procedure. All such patients from the screen-detected and symptom-detected groups died within 122 and 67 months, respectively, of diagnosis. Among the screen-detected and symptom-detected cases, 80% and 81%, respectively, of the patients died of lung cancer. The median survival time was 25 and 13 months for those in the screen-detected and symptom-detected groups, respectively. The difference in survival was statistically significant between the two groups, which indicated the effect of lead time and length-biased sampling. Analysis of the causes of death other than lung cancer showed that there was no difference in the observed cumulative rates of deaths of other causes between the two groups, and these figures were almost the same as those expected from the general population. This indicates that overdiagnosis bias would be minimal in screen-detected lung cancer cases detected by chest radiograph examination.

In order to evaluate the efficacy of lung-cancer screening, a case-control study was conducted using the data from 50 areas where population-based lung-cancer screening programmes have been operated by local municipalities. In most areas, chest X-ray examinations for all participants and sputum cytology for high-risk participants were offered annually. Case series consisted of 273 deceased lung-cancer cases. For each case, 2 to 5 controls (a total of 1,269 controls) were collected from those who were alive at the time of diagnosis of the corresponding case, matched by sex, age, smoking status and type of health insurance. Cases and controls were limited to a high-risk group for males and a non-high-risk group for females. Screening histories, which were obtained from the list of screenees, were compared between case and matched controls for the identical calendar period before the time of diagnosis of the case. The odds ratio of dying from lung cancer for those screened within 12 months vs. those not screened was 0.72 (95% confidence interval 0.50-1.03; p = 0.07). The odds ratio increased towards unity, as the length of time in which screening histories were compared increased. After adjusting for some other variables, which appeared to be associated with the opportunities of chest X-ray examination, the estimated odds ratio did not change. These results suggest some benefits from lung-cancer screening in terms of reduction of lung-cancer mortality and should be subject to further research.

6547 Background: In Japan, growing concern that patients do not receive optimum care led to the enactment of the Cancer Control Act in 2006, which mandates the government to undertake initiatives in ensuring the quality of cancer care. Here, we evaluated the current status of breast cancer care in Japan using process-of-care quality indicators (QIs) for breast cancer care. Methods: Combining clinical evidence and expert opinion, we developed 45 QIs covering the continuum of breast cancer care from initial evaluation to follow-up. Each QI describes standards of a particular aspect of care, and its score is calculated as the percentage of applicable patients who received the recommended care (adherence score). Of the 45 QIs, 7 could be scored using data in the Japanese Breast Cancer Registry, which covers about 40% of all Japanese breast cancer patients and has been continuously maintained since 1975. Results: The study population included 15,227 patients registered by 224 facilities in 2005. On average, patients received 72.1% of recommended care. However, substantial variation in adherence was seen across QIs (21–98%). Adherence score was less than 85% in five of seven QIs. Variation across facilities was observed in six QIs. Conclusions: The quality of breast cancer care in Japan has room for improvement in many aspects of care. Although the amount of data in the cancer registry suitable for quality assessment is limited, it is useful in detecting quality problems. [Table: see text] No significant financial relationships to disclose.

The relationship of technetium-99m(Sn)-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) uptake by hepatic tumors to survival was studied in 162 cases of hepatocellular carcinoma (HCC). The median survival of 82 patients in whom hepatic tumors showed increased uptake in delayed 99mTc-PMT imaging was 1013 days, which was significantly longer than the survival time of 398.5 days of 80 patients in whom hepatic tumors did not show increased uptake of radioactivity (p less than 0.002). The relationship between the ability of hepatic tumors to take up 99mTc-PMT and survival was also analyzed in patients with HCC showing filling defects in 99mTc-colloid liver images and, in relation to the therapy, serum values of bilirubin and alpha-fetoprotein. Results indicated that the degree of 99mTc-PMT uptake by hepatic tumors is closely correlated with the prognosis of patients with HCC.

A hospital-based case-control study was conducted at 8 hospitals in Osaka in order to clarify risk factors among non-smoking women. A total of 129 lung cancer cases and 519 controls were investigated. An elevated risk was observed for women who had used wood or straw as cooking fuels at 30 years of age. Maternal smoking in childhood also seemed to raise the risk. No elevated risks were observed for husband smoking and use of heating apparatus so far.

A hospital-based case-control study was carried out in order to evaluate the risk of adenocarcinoma of the lung associated with cigarette smoking according to grade of differentiation and subtype. The cases studied were 238 patients with adenocarcinomas of the lung (158 males and 80 females) that were surgically resected at the Center for Adult Diseases, Osaka. For each case, 2 controls were chosen at the same hospital from outpatients who had not been diagnosed as having smoking-related diseases, matched by sex, age, and year of first visit. When the male cases with adenocarcinoma were classified according to the grade of differentiation, the odds ratios (ORs) associated with exsmokers and current smokers were: 1.0, 2.1 for well-differentiated; 4.1, 7.7 for moderately differentiated; and 8.5, 7.9 for poorly differentiated adenocarcinoma. The OR associated with current smokers for poorly and moderately differentiated adenocarcinoma combined was significantly higher than that for well differentiated adenocarcinoma. Approximately the same pattern of ORs was observed in females. For poorly and moderately differentiated adenocarcinoma, a significant dose-response relationship was observed in males. Comparison between the ORs for papillary type and tubular type showed no difference.

The 150 male patients exposed to Thorotrast who were confirmed by a 1975-1978 national survey with diagnostic X rays of 50,860 war-wounded soldiers were followed up between 1979 and 1998 (Aichi series or second series). Age-adjusted rate ratios of deaths from all causes were 3.0 times higher in Thorotrast patients compared to controls; this was statistically significant. Rate ratios for liver cancer, liver cirrhosis and leukemia were 35.0, 7.5 and 18.2, respectively.