Second primary cancers following breast cancer in the Japanese female population

To assess the risk of developing second primary cancers following breast cancer in Japanese females, we performed a retrospective cohort study of 2786 patients who were newly diagnosed with breast cancer at our hospital between 1970 - 1994, until the end of 1995 (average follow-up period, 8.6 years). The expected number of each second primary cancer was calculated by multiplying the number of appropriate person-years at risk by the corresponding age- and calendar period-specific cancer incidence rates for women obtained from the Osaka Cancer Registry. One hundred and seventeen patients developed a second primary cancer other than subsequent breast cancer, yielding an observed-to-expected ratio (O / E) of 1.3 [95% confidence interval (CI) = 1.1 - 1.6]. The risk for developing a second primary cancer was significantly elevated during the first year following the diagnosis of breast cancer, and decreased with the passage of time to unity. A significantly increased risk was noted for the development of ovarian cancer (O / E = 2.4, 95% CI = 1.0 - 4.6), thyroid cancer (O / E = 3.7, 95% CI = 1.5 - 7.6) and non-Hodgkin's lymphoma (NHL) (O / E = 3.5, 95% CI = 1.4 - 7.1) among the breast cancer patients compared with the general population. Patients who received hormonal therapy as the breast cancer treatment showed a significantly increased risk for ovarian cancer (O / E = 5.5, 95% CI = 1.8 - 12.9). Patients who received chemotherapy as the breast cancer treatment had an increased risk for NHL (O / E = 5.0, 95% CI = 1.6 - 11.6). These findings indicate that Japanese female patients with breast cancer had a 30% higher risk of developing a second primary cancer than the general population, the higher risk being manifested in the early period following the diagnosis of breast cancer. Medical surveillance of breast cancer patients for NHL, as well as for ovarian cancer and thyroid cancer, is required.

Natural history of early gastric cancer: a non-concurrent, long term, follow up study

BACKGROUND

Controversy has arisen on the natural history of early gastric cancer (EGC). While some emphasise the effectiveness of early detection in reducing mortality from gastric cancer, others insist that EGC is a pseudo-cancer. AIMS/PATIENTS/METHODS: To elucidate the natural history of EGC, a non-concurrent, long term, follow up study was conducted in 71 patients who were diagnosed endoscopically as having EGC, which was confirmed as cancer on biopsy, but in whom surgical resection was not conducted or delayed by more than six months.

RESULTS

The natural course of EGC was observed in 56 cases. Over a period of 6-137 months, 20 remained in the early stage while 36 progressed to the advanced stage. The proportion remaining in the early stage consistently decreased with time. Median duration of those who remained in the early stage was estimated as 44 months. The cumulative five year risk for progressing to the advanced stage was 63.0%. In 38 cases there was no evidence for undergoing surgical resection for gastric cancer. The cumulative five year corrected survival was estimated as 62.8% among those unresected. Hazard rate ratio for gastric cancer mortality was 0.65 (p=0.34) for screening detected versus non-screening detected. Hazard rate ratio for gastric cancer mortality was 0.51, significantly lower for patients whose operations were delayed compared with those unresected.

CONCLUSIONS

Although EGC showed a relatively long natural history in general, it progressed to the advanced stage with time and led to death from gastric cancer for the most part if left untreated.

Tissue characterization of atherosclerotic plaques by intravascular ultrasound radiofrequency signal analysis: an in vitro study of human coronary arteries

BACKGROUND

Conventional gray-scale images of intravascular ultrasound (IVUS) cannot accurately differentiate histologic subtypes of sonolucent coronary plaques with or without a lipid core.

METHODS

We analyzed radiofrequency signals obtained in vitro from 24 regions of interest (ROI) of noncalcified (sonolucent) plaques in 10 atherosclerotic coronary artery specimens pressure-fixed by formalin. Radiofrequency signals were sampled with a 30-MHz IVUS catheter and digitized at 500 MHz in 8-bit resolution. The ROIs were histologically categorized into 12 plaques with a lipid core and 12 plaques without it. Integrated backscatter and statistical parameters of the radiofrequency envelope (mean/SD ratio [MSR], skewness, and kurtosis) within the ROI were calculated offline, and their ability to detect a lipid core was compared with visual analysis of the IVUS video images. In the group with lipid cores, percent area of a lipid core in each ROI was measured in a digitized histologic image by a computerized planimeter.

RESULTS

Sensitivity and specificity of MSR, skewness, and kurtosis for lipid core detection were substantially greater than visual video image analysis (83.3% and 91.7%, 100% and 91.7%, 100% and 91.7% vs 53.3% and 71.7%). Furthermore, the parameters of integrated backscatter, MSR, skewness, and kurtosis were significantly correlated to percent of core area (r = -0.64, -0.73, 0.78, and 0.63, respectively; P<.05).

CONCLUSIONS

Compared with IVUS video images, the parameters of radiofrequency signal analysis may be used to aid in more accurate detection and quantitative evaluation of a lipid core, which is one of the major factors of a vulnerable coronary plaque.

[The relationship between stages and biochemical markers of smoking. Workplace-based cross-sectional and longitudinal studies]

In order to clarify smokers' characteristics by "Stages of Change" based on Prochaska's transtheoretical model, we conducted cross-sectional and logitudinal studies with biochemical markers of smoking and smoking habits. In a workplace-based sample of 277 male smokers, we examined cross-sectionally the relationships between stages and biochemical markers of smoking which include expired carbon monoxide concentrations and urinary nicotine metabolite concentrations, and smoking habits which include the number of cigarettes smoked per day, yields of cigarettes, inhalation patterns, time to first morning cigarette, and quit attempts in the past. Additionally we examined longitudinally the relationship between stages and expired carbon monoxide concentrations, the number of cigarettes, and yields of cigarettes. In the cross-sectional study there were significant differences among stages on expired carbon monoxide concentrations (P = 0.006), urinary nicotine metabolite concentrations (P = 0.049), the number of cigarettes smoked per day (P = 0.001), and yields of cigarettes (P = 0.042) using analyses of variance. There were also significant differences among stages on time to first morning cigarette (P = 0.018) and quit attempts in the past (P < 0.001) using chi-square tests. In the longitudinal study for each level of elevation in stage during a one-year period, expired carbon monoxide concentrations decreased on an average of 2.3 ppm (P = 0.125) and the number of cigarettes smoked per day decreased on an average of 2.8 cigarettes per day (P = 0.07). However, the yields of cigarettes did not change during the one-year period.

The risk for second primaries in gastric cancer patients: adjuvant therapy and habitual smoking and drinking

STUDY PURPOSE

To examine whether adjuvant therapy for gastric cancer increases the risk for second primaries, and whether smoking and drinking increase the risk.

SUBJECTS AND METHODS

1,631 patients who were newly diagnosed with gastric cancer and underwent curative operation at Osaka Medical Center for Cancer and Cardiovascular Diseases during 1978-92. Incidence of second primaries were examined through linkage to Osaka Cancer Registry as of the end of December 1995. Observed number of second primaries (O) was compared with the expected according to the incidence in general population (E). Proportional hazards model was used to estimate hazard rate ratio (HR) for second primaries.

RESULTS

149 second primaries were observed. Seventeen cases, detected within 2 months after diagnosis of gastric cancer, were excluded. O/E ratio was 1.13 for adjuvant chemotherapy, 0.93 for immuno-chemotherapy, and 0.78 for immunotherapy, while 1.14 for operation only (not significant). Age-, sex-, and stage-adjusted HR was 1.02 (95% C.I. 0.69-1.50) for chemotherapy, 0.80 (0.41-1.57) for immuno-chemotherapy, and 0.60 (0.08-4.34) for immunotherapy, as compared with the risk for operation only. Among males, HR for current smokers vs. never smokers was 1.82 (1.02-3.26).

CONCLUSIONS

Adjuvant therapy for gastric cancer did not significantly increase the risk for second primaries, while smoking elevated it.

Effect of interferon therapy on the incidence of hepatocellular carcinoma and mortality of patients with chronic hepatitis C: a retrospective cohort study of 738 patients

The effect of interferon on the long-term clinical outcome of patients with chronic hepatitis C remains unclear. This study included 594 patients with chronic hepatitis C who received interferon-alpha therapy (Interferon group) and 144 patients with chronic hepatitis C who did not receive interferon (Control group). The patients in the Interferon group were classified into the following three groups based on the response of the serum aminotransaminase level of the patient during and after completion of the therapy protocol: sustained responders (n = 175), transient responders (n = 165), and non-responders (n = 254). The age, sex, serum aminotransaminase level, platelet count, histological staging, hepatitis C virus (HCV) subtype, and HCV concentration at baseline were adjusted with the Cox proportional hazards model. The length of follow-up for assessment of the risk for developing hepatocellular carcinoma (HCC) was 57.2 +/- 13.9 months in the Interferon group and 67.7 +/- 28.7 months in the Control group. Multivariate analysis showed that interferon therapy decreased the risk for developing HCC by 48% compared with that in the Control group (P = 0.064). The older the age, being male, having a low platelet count, and higher histological stage were independent factors associated with the development of HCC. The hazard rate ratio for development of HCC in the sustained responders, transient responders, and non-responders was 0.16 (95% confidence interval [CI]: 0.04-0.62), 0.27 (95% CI: 0. 09-0.79), and 0.74 (95% CI: 0.37-1.48), respectively. During follow-up, 18 patients in the Interferon group died (10 from liver-related diseases) and 17 patients in the Control group died (10 from liver-related diseases). No sustained responder or transient responder in the Interferon group died of liver-related disease. The cumulative survival rates of the Interferon and Control groups were nearly identical during the first 5 years following diagnosis. Thereafter, the cumulative survival rate of the Control group declined, resulting in an 8-year survival rate in the Interferon and Control groups of 97% and 81%, respectively (P = 0. 061). Similar trends were seen in the survival analysis of those who had died of liver disease: the 8-year survival rates of the Interferon and Control groups were 98% and 88%, respectively (P = 0. 32). Our study demonstrated that interferon therapy significantly lowered the incidence of HCC among patients with chronic hepatitis C who showed sustained normalization and among patients who showed transient normalization of the serum aminotransferase level after completion of interferon therapy. The survival analyses and determination of cause of death suggested that interferon therapy improves the long-term survival of chronic hepatitis C patients who respond to this therapy, possibly by decreasing mortality from liver-related diseases.

Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study

BACKGROUND

Intravascular ultrasound (IVUS) can assess stent geometry more accurately than angiography. Several studies have demonstrated that the degree of stent expansion as measured by IVUS directly correlated to clinical outcome. However, it is unclear if routine ultrasound guidance of stent implantation improves clinical outcome as compared with angiographic guidance alone.

METHODS AND RESULTS

The CRUISE (Can Routine Ultrasound Influence Stent Expansion) study, a multicenter study IVUS substudy of the Stent Anti-thrombotic Regimen Study, was designed to assess the impact of IVUS on stent deployment in the high-pressure era. Nine centers were prospectively assigned to stent deployment with the use of ultrasound guidance and 7 centers to angiographic guidance alone with documentary (blinded) IVUS at the conclusion of the procedure. A total of 525 patients were enrolled with completed quantitative coronary angiography, quantitative coronary ultrasound, and clinical events adjudicated at 9 months for 499 patients. The IVUS-guided group had a larger minimal lumen diameter (2.9+/-0.4 versus 2.7+/-0. 5 mm, P<0.001) by quantitative coronary angiography and a larger minimal stent area (7.78+/-1.72 versus 7.06+/-2.13 mm(2), P<0.001) by quantitative coronary ultrasound. Target vessel revascularization, defined as clinically driven repeat interventional or surgical therapy of the index vessel at 9 month-follow-up, occurred significantly less frequently in the IVUS-guided group (8.5% versus 15.3%, P<0.05; relative reduction of 44%).

CONCLUSIONS

These data suggest that ultrasound guidance of stent implantation may result in more effective stent expansion compared with angiographic guidance alone.

The differential ACTH responses to combined dexamethasone/CRH administration in major depressive and dysthymic disorders

In a preliminary study, we performed the combined dexamethasone/CRH test on patients with major depressive and dysthymic disorders as well as healthy controls. The ACTH response was significantly enhanced in the major depression group compared to the control group and tended to be heightened compared to the dysthymia group. The cortisol response was not significantly different among the three groups. We assume that major depression and dysthymia are neuroendocrinologically distinct disorders, although whether the difference is quantitative or qualitative remains to be examined.

Effectiveness of interferon therapy for reducing the incidence of hepatocellular carcinoma among patients with type C chronic hepatitis

STUDY PURPOSE

To evaluate the effect of interferon treatment for reducing the incidence of hepatocellular carcinoma among patients with type C chronic hepatitis.

METHODS

Retrospective cohort study was conducted on 923 patients with type C chronic hepatitis, who were identified through databases of Osaka Medical Center for Cancer and Cardiovascular Diseases. Two hundred and twenty-four of those had undergone interferon treatment, while the other 699 patients had not. Kaplan-Meier method and the proportional hazards model were used for statistical analysis.

RESULTS

Five-years' cumulative incidence of hepatocellular carcinoma was 2.2% among the interferon treated patients, while 9.5% among the interferon untreated. Difference between the 2 curves of the cumulative incidence was statistically significant (p=0.0015). After adjustment for possible confounders, hazard rate ratio of hepatocellular carcinoma was 0.31 in the interferon treated group, significantly lower than that in the untreated (p=0.015). Hazard rate ratio for death from causes other than hepatocellular carcinoma and liver diseases was also lower among the interferon treated group than that among the untreated, although not significant.

CONCLUSIONS

Interferon treatment is suggested to reduce the risk of hepatocellular carcinoma among patients with type C chronic hepatitis, and not to increase the risk for death from causes other than hepatocellular carcinoma and liver diseases.

Effects of calcium and calcium chelators on growth and morphology of Escherichia coli L-form NC-7

Growth of a wall-less, L-form of Escherichia coli specifically requires calcium, and in its absence, cells ceased dividing, became spherical, swelled, developed large vacuoles, and eventually lysed. The key cell division protein, FtsZ, was present in the L-form at a concentration five times less than that in the parental strain. One interpretation of these results is that the L-form possesses an enzoskeleton partly regulated by calcium.

Regional cerebral blood flow in the patients with depressive disorders

Regional Cerebral blood flow (rCBF) and metabolism in major depression have been studied intently. Those studies are expected to reveal the mechanisms of the mood disorders, and also to give us valuable informations that the specific brain regions participating mood regulation. However, the data still have been inconsistent. In the present study we measured rCBF in patients with major depression and depressive state using xenon-CT CBF method. There is a tendencies that the rCBF values of normal control is the highest, and those of major depression is the lowest in most of the regions. The rCBF values in the patients with major depression are significantly lower than those in normal control in the right anterior frontal cortex, temporal cortex, putamen and thalamus. We also measured rCBF before and 90 minutes after giving calcium antagonist nilvadipine (4 mg, p.o.) in those subject. There is a tendency that nilvadipine increased in rCBF in normal control, however, it decreased in rCBF in major depression.

Serial automated three-dimensional intravascular ultrasound analysis of the self-expanding Radius stent

Automated 3-dimensional intravascular ultrasound (IVUS) analysis was used to assess status of the treated coronary artery immediately and 6 months after placement of a self-expanding Radius stent in 15 patients. Serial 3-dimensional IVUS analysis demonstrated gradual stent expansion that countered neointimal proliferation and preserved the lumen.

Reproducibility of diagnosis and its influence on the distribution of lung cancer by histologic type in Osaka, Japan

The histologic types of lung cancer cases diagnosed in 1979-1980 (n=799) and 1987 (n=587) were independently reviewed by two pathologists in order to investigate the reproducibility of the diagnosis of the histologic type when the WHO classification (1981) was used. The specimens from 354 surgical cases and biopsy or cytology specimens from 1032 non-surgical cases were reviewed. The inter-observer agreement was 87.9% (kappa=0.79) for surgical cases and 81.4% (kappa=0.72) for non-surgical cases. When compared to the original diagnosis, the agreement was 86.8% (kappa=0.78) for surgical and 86.4% (kappa=0.79) for non-surgical cases in 1979-1980 and the agreement was 92.8% (kappa=0.87) for surgical and 89.1% (kappa=0.83) for non-surgical cases in 1987. By histologic type, no difference in the agreement was observed except for large cell carcinoma. The distribution of histologic types after the review differed only slightly (less than 6%) from the original distribution. This suggests that in Osaka, Japan, the diagnosis based on the WHO classification (1981) had only a limited influence on the distribution of histologic types, and is not a major reason for the changing trends in lung cancer incidence by histologic type.

The 11 A resolution projection map of Na+/K+-ATPase calculated by application of single particle analysis to two-dimensional crystal images

Two-dimensional (2D) crystals of Na+/K+-ATPase were vitrified and observed with an electron cryo-microscope that allowed specimen observation at liquid helium temperature. Images showing 19 A spots on the optical diffraction patterns were digitized and processed by a crystallographic method. After optimization of parameters for the image processing, the locally averaged images revealed that each 2D crystal contained heterogeneous molecules. Single particle analysis was therefore applied to the 2D crystal images to select homogeneous molecule images, and averaging the selected images significantly improved map quality. Five major peak densities were clearly resolved in the new projection map, while two were found previously.

Time trends of incidence for cutaneous melanoma among the Japanese population: an analysis of Osaka Cancer Registry data, 1964-95

Cutaneous malignant melanoma occurs much less frequently among non-white populations than among white populations. Little is known of the descriptive epidemiology of melanoma among Japanese. We investigated time trends of incidence of invasive cutaneous malignant melanoma using data from the Osaka Cancer Registry (Japan) among 321 men and 313 women diagnosed between 1964-95. Average, annual, age-standardized incidence rates per 1,000,000 population were 2.45 (95% confidence interval (CI): 2.17-2.72) for men and 2.04 (95% CI: 1.81-2.28) for women. The age-standardized rate ratio among men from 1964-71 as a reference was almost constant during the study period, whereas that among women increased up to 1.8 fold (95% CI: 1.25-2.56) in 1980-87 and seems to have reached a plateau recently. Among men, the ratio for head and neck lesions decreased to 0.5 fold (95% CI: 0.26-0.99) in 1988-95. Among women, the ratio for lesions of the extremities steeply increased up to 4.7 fold (95% CI: 2.68-8.35) in 1980-87 from the reference period of 1964-71, whereas a slight increase for trunk lesions and no increase for head and neck lesions were noted during the same period. Possible explanations for the subsite-specific time trends are discussed.

Feasibility of in vivo intravascular ultrasound tissue characterization in the detection of early vascular transplant rejection

BACKGROUND

Unprocessed ultrasound radiofrequency (RF) signal analysis has been shown to distinguish different tissue structures more reliably than gray-scale interpretation of conventional ultrasound images.

METHODS AND RESULTS

The objective of this study was to test the feasibility of in vivo intravascular ultrasound (IVUS) RF signal analysis in an animal model of allograft rejection. Six cynomolgus monkeys underwent transplantation of 3-cm aortic allograft segments distal to the renal arteries from immunologically mismatched donors. IVUS imaging with a 30-MHz system was performed 84 to 105 days after the operation. RF signals were acquired from cross sections of the recipient and the allograft aortas in real time with a digitizer at 500 MHz with 8-bit resolution. Sixty-five cross sections and 68 regions of interest (31 in host aorta and 37 in allograft) were analyzed in the adventitial layer with a total number of 8568 vectors processed. For each region of interest, a weighted-average attenuation was calculated on the basis of the attenuation and length for each individual vector. Histological examination was performed at every cross section imaged by IVUS. When the gray-scale images of conventional IVUS scored by an independent observer were compared, no distinction between adventitia of the native aorta and allograft was possible. Analysis of the average RF backscatter power also showed no significant difference (70.32+/-3.55 versus 70.72+/-3.38 dB). However, the average attenuation of allografts was significantly lower than that of the host aortas (2.64+/-1.38 versus 4.02+/-1.16 dB/mm, P<0.001). Histology demonstrated a marked adventitial inflammatory response in all allografts, with no inflammation observed in the host aortas.

CONCLUSIONS

In vivo IVUS tissue characterization can be performed during routine imaging. In this model of transplant vasculopathy, RF attenuation measurements were more sensitive than visual or quantitative gray-scale analysis.

Impact of cilostazol on clinical and angiographic outcome after primary stenting for acute myocardial infarction

Cilostazol, an antiplatelet drug that also may inhibit smooth muscle proliferation, was given together with aspirin after primary stenting to treat patients with acute myocardial infarction. In a randomized controlled trials of 50 patients, clinical and angiographic outcome at 6 months was significantly improved with cilostazol, depicting a significantly smaller late loss and/or loss index.

Treatment guidelines for geriatric mood disorders

The authors reviewed the literature on the pharmacotherapy of geriatric mood disorders. Based on the evidence available, we have proposed: (i) that although any antidepressant is assumedly equal in antidepressive efficacy, ones with weak anticholinergic and antialpha1 effects are preferable in geriatric patients; (ii) that augmentation therapy with lithium and methylphenidate has modest evidence of efficacy in this population; (iii) that modified electroconvulsive therapy is safe and effective for severe and psychotic depression in the elderly; and (iv) that lithium remains the first choice for geriatric bipolar disorder, although its optimal serum level may be lower than in younger adults.

Questionnaire survey on the prescribing practice of Japanese psychiatrists for mood disorders

The answers to a questionnaire on the practical prescription in mood disorders from 298 Japanese psychiatrists was obtained. As the first-line treatment, a majority of respondents chose newer tricyclic agents (TCA) or non-TCA for moderate depression and older TCA for severe depression both with and without psychotic features. Combination therapy with antidepressants and anxiolytics was fairly popular in moderate depression, while antidepressant/neuroleptic combination was more common in severe psychotic depression. Sulpiride was the most favored drug for dysthymia. Although lithium was the most popular for bipolar mania, respondents were divided on the treatment of bipolar depression.

[Development of a smoking cessation program during health checkups. Preliminary study to evaluate the usefulness of this program]

Development of a simple and effective smoking cessation program is needed to provide cessation counseling during health checkups. A new cessation program, which consists of brief individual counseling and 4 follow-up telephone calls, was developed based on the stage model for life-style change. This program was performed during health checkups in the town of Nose to evaluate its usefulness. Smoking status questionnaires were completed to assess the smoking habits of subjects and to evaluate their smoking stage before the counseling session. Then, stage-matched cessation counseling was provided using a self-help guide. During the counseling, carbon monoxide measurement of expired air and Health Risk Appraisal feedback were performed to enhance self-perception of smoking. Follow-up calls were provided for only those clients who set a quit date during the individual counseling. It was easy to implement this program, and it required between 15 and 20 minutes to conduct. The cessation rate was 19% at 8 months after the health checkups. This result was more effective than data for other programs reported previously. Therefore, this program was effective and could be used at health checkups. This trial had no control group, so further studies are needed to clarify the efficacy and effectiveness of this program. In addition, training courses for health professionals must be developed to disseminate this program into general use.

Suicide risk among cancer patients: experience at one medical center in Japan, 1978-1994

In order to identify the risks, methods and locations of suicide among Japanese cancer patients, we followed up 23,979 cancer patients aged 15 years and older, who were newly diagnosed at one medical center between 1978-94. Suicide risk was evaluated by comparing the observed number (O) with the expected number (E), which was calculated from the suicide mortality rate among Osaka residents. By the end of 1994, there were 48 suicide death among 109,374 person-years of follow-up. Suicide risk was significantly increased within the first five years following cancer diagnosis (male: O/E=1.62, 95% confidence interval (CI)=1.03-2.43, female: O/E=2.13, 95% CI=1.22-3.47), and decreased to unity after five years had elapsed following the cancer diagnosis. Patients in their fifties (O/E=1.93, 95% CI=1.48-4.37), diagnosed between 1978-85 (O/E=1.93, 95% CI=1.19-2.95), having remote metastasis at their initial diagnosis (O/E=4.66, 95% CI=2.12-8.84), the site being in the female genital organs (O/E=3.58, 95% CI=1.54-7.06) or in the male genital organs (O/E= 5.86, 95% CI=1.58-15.05), had a significantly higher suicide risk within five years following cancer diagnosis. The highest suicide mortality was observed between the third and fifth months after cancer diagnosis (O/E=4.35, 95% CI=1.87-8.58); most of these suicides (7/8) occurred soon after discharge from hospital. Among the 39 patients who committed suicide within five years after their diagnosis, the most common method among those who took their lives while in hospital was by jumping to their death (10/16), and that among those who committed suicide in other locations was by hanging (14/23). These findings indicate that Japanese patients with cancer run the highest risk of suicide soon after having been discharged from hospital. Clinicians should assess cancer patients' psychological distress and potential risk of suicide before approving discharge from hospital.

Hypothesis: hyperstructures regulate bacterial structure and the cell cycle

A myriad different constituents or elements (genes, proteins, lipids, ions, small molecules etc.) participate in numerous physico-chemical processes to create bacteria that can adapt to their environments to survive, grow and, via the cell cycle, reproduce. We explore the possibility that it is too difficult to explain cell cycle progression in terms of these elements and that an intermediate level of explanation is needed. This level is that of hyperstructures. A hyperstructure is large, has usually one particular function, and contains many elements. Non-equilibrium, or even dissipative, hyperstructures that, for example, assemble to transport and metabolize nutrients may comprise membrane domains of transporters plus cytoplasmic metabolons plus the genes that encode the hyperstructure's enzymes. The processes involved in the putative formation of hyperstructures include: metabolite-induced changes to protein affinities that result in metabolon formation, lipid-organizing forces that result in lateral and transverse asymmetries, post-translational modifications, equilibration of water structures that may alter distributions of other molecules, transertion, ion currents, emission of electromagnetic radiation and long range mechanical vibrations. Equilibrium hyperstructures may also exist such as topological arrays of DNA in the form of cholesteric liquid crystals. We present here the beginning of a picture of the bacterial cell in which hyperstructures form to maximize efficiency and in which the properties of hyperstructures drive the cell cycle.

Improvement of survival over time for colon cancer patients by anatomical sub-sites

The aims of this study are to describe and to evaluate improvement of survival over time for colon cancer patients by anatomical sub-sites. Data on 661 patients newly diagnosed as having colon cancer at Osaka Medical Center for Cancer and Cardiovascular Diseases from 1978 to 1991 were examined in this study. Corrected survival was calculated with the Kaplan-Meier method according to the period of diagnosis: early period (1978-84) and later period (1985-91). Factors concerning the difference in survival between the two periods were examined with the Cox proportional hazards regression model according to sub-site. Five-year corrected survival of the patients with left colon cancer improved significantly (60 to 72%; P < 0.01), probably due to advances in treatment, while that of patients with transverse colon cancer also improved significantly (39 to 67%; P < 0.01), mainly because of progress in diagnosis. The five-year corrected survival of those with right colon cancer did not increase (57 to 46%; P = 0.14), owing to lack of improvement in stage at diagnosis. Among the three sub-sites, the right showed the worst five-year survival in the later period. We concluded that survival of patients with right colon cancer, differing from the other anatomical sub-sites, did not improve, possibly because of lack of symptoms. The screening programs for colon cancer introduced in Japan in 1992 may be expected to improve the survival of patients with colon cancer, including that of the right colon.

Lung cancer incidence rates by histologic type in high- and low-risk areas; a population-based study in Osaka, Okinawa, and Saku Nagano, Japan

We investigated lung cancer incidence by histologic type using the data from population-based cancer registries in high-risk (Osaka and Okinawa) and low-risk (Saku Nagano) areas. Since the proportion of cases with histologic types identified was not sufficiently high, sex- and age-specific incidence rates by histologic type were estimated assuming that the distribution of histologic types was the same across the same sex and age groups regardless of reporting status. Compared to Saku in Nagano Prefecture, the cumulative risk of lung cancer incidence rates in Osaka and Okinawa were 1.3 and 1.5 times higher for males and 1.3 and 1.2 times higher for females, respectively. When divided by histologic type, male adenocarcinoma and small cell carcinoma were 1.6-2.1 times higher in Osaka and Okinawa, while squamous cell carcinoma was 1.6 times higher only in Okinawa compared to Saku Nagano. In females, squamous cell carcinoma and small cell carcinoma were 2.5-3.3 times higher in Osaka and Okinawa compared to Saku Nagano, while adenocarcinoma was almost equal in the 3 areas. These results indicate that the pattern of incidence of lung cancer by histologic type may differ between high- and low- risk areas.

New developments in intravascular ultrasound

Intravascular ultrasound (IVUS) is a dynamic imaging modality that provides real-time in vivo visualization of atherosclerosis and other vascular pathology. The tomographic image presentation of IVUS permits detailed assessment of plaque morphology and its corresponding responses to interventional therapy. IVUS studies have confirmed vascular remodeling in vivo, have proposed a high-pressure stent implantation strategy and have shown two key mechanisms of restenosis after angioplasty: plaque proliferation and vessel shrinkage (negative remodeling). IVUS also provides accurate quantitative information regarding lumen size, vessel size and plaque burden. These observations, essential to achieving improved outcomes, have drastically changed the understanding of atherosclerotic artery disease and interventional procedures. IVUS has matured into an essential complement to daily peripheral and coronary interventional practice and is routinely incorporated as part of the interventional arsenal in the catheterization laboratory. A variety of new imaging techniques are currently being designed and tested. These include combined therapeutic devices, further miniaturization, 3-D applications and tissue characterization. These techniques may evolve to provide increased favorable clinical outcomes and more accurate information of vessel geometry and plaque composition.

[Aggressive diagnostic and therapeutic approach for acute coronary syndrome]

The purpose of this article is to propose an "aggressive strategy" in the treatment of patients with acute coronary syndrome (ACS), especially unstable angina. The indication and timing of emergent coronary angiography in patients with ACS remains to be validated. The results of TIMI III B trial, a randomized, controlled trial about this issue, show that an early invasive strategy reduced the average length of initial hospitalization and the incidence of rehospitalization within 6 weeks. However, the same kind of clinical trial named VANQWISH reported that no benefit was obtained from such an aggressive strategy. It is of paramount importance to note that these 2 studies were performed in the era of plain old balloon angioplasty. Now we can use many kinds of coronary stent which impart both excellent radial strength and flexibility. Recent studies have demonstrated that culprit lesions of ACS can be treated at the same success rate as those of stable effort angina. In our hospital, use of coronary stents in patients with ACS dramatically reduced the recurrence of ACS and the incidence of angiographic restenosis with the same initial procedure success rate. Since the mid-nineties, the radial artery has been used as a vascular access site of coronary intervention. The major advantage of this technique is lesser access site-related complications and increased patient comfort, which reduced hospital stay and cost. Recently it was demonstrated that ad-hoc transradial intervention can be applied in patients with unstable angina or even those with acute myocardial infarction by trained angioplasters. Thus, we would like to conclude that the best strategy in the management of ACS is to perform emergent coronary angiography from the radial artery as soon as possible after admission, and to do ad-hoc intervention using coronary stents suitable for the lesion anatomy.

Risk factors for breast cancer in Japan, with special attention to anthropometric measurements and reproductive history

BACKGROUND

Breast cancer incidence has increased rapidly in Japan recently, but there have been only a few studies on the risk factors for breast cancer in Japan. A case-control study was conducted to evaluate the roles of anthropometric and reproductive factors in the etiology of breast cancer in Osaka.

METHODS

Based on information from a self-administered questionnaire at Osaka Medical Center for Cancer and Cardiovascular Diseases, body mass index, body weight and height were compared between 376 cases and 430 controls, together with other factors such as age at menarche, age at first delivery and family history of breast cancer by menopausal status. Logistic regression analysis was employed for adjusting confounding factors and estimating odds ratios with their 95% confidence interval for breast cancer.

RESULTS

A body mass index of >25 was significantly associated with the risk among post-menopausal women (age-adjusted odds ratio: 1.90, 95% confidence interval: 1.10-3.24) as compared with the risk for a body mass index of < or = 20. A weight of > or =58 kg showed significantly increased risk compared with a weight of < or = 47 kg among post-menopausal women (1.83, 1.10-3.01), while height of > or = 159 cm showed a significantly elevated risk than height of < or = 149 cm among pre-menopausal women (2.51, 1.17-5.39). Age at menarche of < or = 13 years resulted in a higher risk of breast cancer among post-menopausal women, while age at first delivery of > or = 28 years was associated with the risk among pre-menopausal women. Family history of breast cancer was associated with the risk for breast cancer.

CONCLUSIONS

These results were all very consistent with findings observed in western countries.

Trends of lung cancer incidence by histologic type: a population-based study in Osaka, Japan

We investigated trends of lung cancer incidence from 1974 to 1993 by histologic type, using data from the population-based cancer registry in Osaka, Japan. Since the proportion of cases with histologic types identified was not sufficiently high, sex- and age-specific incidence rates by histologic types were estimated assuming that the distribution of histologic types was the same across the same sex and age group regardless of reporting status. Cumulative risk from 0 to 74 years old for total lung cancer increased 1.3-fold from the period 1974-77 to 1986-89 and then plateaued in the period 1990-93 for both males and females. When divided into histologic types, cumulative risk for incidence of squamous cell carcinoma was almost constant during the study period for both males and females. During the same period, adenocarcinoma increased up to 1.4-fold for both males and females. This increase seemed to have reached a plateau recently for males, but not for females. Small cell carcinoma increased monotonously up to 1.6- to 1.7-fold for both males and females. Large cell carcinoma showed over 2-fold increase for both males and females; however, the estimates fluctuated due to the small number of cases. This study provides further evidence of a relative increase of adenocarcinoma compared to squamous cell carcinoma. Recent trends of tapering increase of lung cancer incidence should be confirmed by further observation.

Algorithm for the treatment of mood disorders in Japan

In order to establish algorithms for mood disorders in Japan, over 300 psychiatrists completed a questionnaire. They were asked to recommend various drug treatments for particular cases. The order in which the drugs were recommended was taken into consideration. References were made to the randomized double blind study conducted by the working group. Evidence was ranked according to its probability, with the addition of case reports and medical opinions, since conclusions derived from the randomized double blind study alone did not give a full representation. Japanese documentation was referred to as much as possible in order to represent Japanese characteristics. Algorithms were made for eight subtypes; acute mania, bipolar depression, mild or moderate, severe major depression, psychotic depression, rapid cycling bipolar disorder, dysthymic disorder and major depression with advanced cancer. Major depression and bipolar disorder algorithms are discussed in this paper. Clinical psychopharmacological evidence in Japan was insufficient to generate these algorithms for mood disorders. These algorithms may need revision according to future advances in clinical psychopharmacology. (Int J Psych Clin Pract 1999; 3: 277-285).

Effects of mass screening for neuroblastoma on incidence, mortality, and survival rates in Osaka, Japan

OBJECTIVES

To evaluate the effects of mass screening for neuroblastoma, time trends of incidence, mortality, and survival of neuroblastoma in Osaka Prefecture were analyzed.

METHODS

Data for this analysis was obtained from the population-based Osaka Cancer Registry. Time trends of incidence and mortality rates were analyzed by calendar year and by birth cohort. Survival was compared between before and after the introduction of systematic screening.

RESULTS

From 1970-94, 457 cases of neuroblastoma and 182 deaths from neuroblastoma were observed in Osaka. The annual age-standardized incidence rate per million children increased from 7.5 in 1970-84 to 20.5 in 1985-94, while the mortality rates did not differ between these two periods. Analysis by birth cohort showed that the incidence rate at 0 year of age per 100,000 live births increased from 2.30 in 1970-79 (unscreened) to 19.80 in 1988-89 (screening by high-performance liquid chromatography, HPLC). The incidence rate in children 1 and 2-4 years of age also increased according to the introduction of HPLC. The mortality rate in children 1-4 years of age per 100,000 live births slightly decreased from 3.87 in 1970-79 to 3.30 in 1988-89, which was presumed to be derived from the improvement in survival due to the progress in treatment.

CONCLUSIONS

It is strongly suggested that mass screening for neuroblastoma causes harm because of overdiagnosis, and it has little effect on decreasing the incidence and the mortality of neuroblastoma at 1-4 years of age.

The risk of hepatitis C virus infection among blood donors in Osaka, Japan

To estimate the risk of hepatitis C virus (HCV) infection among blood donors, we conducted a retrospective cohort study with 448,020 HCV-seronegative donors who donated blood more than once between February 1992 and July 1997 in Osaka (a total of 2,676,738 allogeneic blood donations). The donors were divided into four age groups according to the age at the initial donation: Group A (16-24 years), Group B (25-34 years), Group C (35-49 years) and Group D (50-64 years). Fifty-nine donors became infected with HCV among the 448,020 HCV-seronegative donors who donated blood more than once within a period of approximately five years. In a total of 1,095,668 person-years of observation (PYO), the incidence rate was 5.38 per 105 PYO, with the 95% confidence interval (95% C.I.) being 4.10 to 6.95. There was no significant difference in the incidence rate between males and females. Young donors between the ages of 16 and 24 (8.89; 95% C.I., 6.04 to 12.61) had a significantly higher incidence rate of HCV infection than donors between the ages of 35 and 49 (1.81; 0.67 to 3.95). The cumulative risk of HCV infection among donors between the ages of 16 and 64 was estimated to be 0.27% (95% C.I., 0.16 to 0.39) for males and 0.27% (95% C.I., 0.15 to 0.38) for females. Based on the recent age-specific incidence rate, the cumulative risk of HCV infection among blood donors was estimated to be about 0.3% in the Osaka district of Japan. The incidence rate differed among age groups, indicating that HCV infection is associated with age-related behaviors and the need for further epidemiological research towards the eradication of community-acquired HCV infection.

[Index for evaluating completeness of registration in population-based cancer registries and estimation of registration rate at the Osaka Cancer Registry between 1966 and 1992 using this index]

The quality of population-based cancer registries has been measured by the indices of the proportion of total incident cases (DCO%) registered by death certificate only (DCO), and the ratio of incidence to mortality (I/D ratio). Recently it has been recommended that DCO% should be used as an index for the reliability of diagnosing cancers and that the proportion of cases first notified via death certificate (DCN, DCN%) be used as an index for the completeness of registration. Parkin introduced a method to estimate the registration rate, the estimated proportion of the "true incidence" that are registered in population-based registries. We recommend a modified method for estimating the registration rate for cancer registries where DCN% is relatively high, as it is in Japan, as Parkin's method may overestimate the registration rate. The method is as follows: the registration rate = (1-DCN% x 1/D ratio)/(1-DCN%). The registration rates at the Osaka Cancer Registry between 1966 and 1992 were estimated using our method. During this period, the yearly registration rate was 74.6-78.4% for males and 69.1-73.3% for females. When the cancer cases were looked at according to site, the yearly registration rate was 74.2-81.6% for stomach cancer, 81.2-89.3% for lung cancer, and 71.3-76.9% for uterine cancer. These results show that the registration rate is high for cancers that have an unfavorable prognosis and low for cancers that have a favorable prognosis. We recommend that all cancer registries in Japan calculate the completeness of registration by utilizing DCN defined as the sum of DCO plus cases not reported as cancer but with supportive clinical information of such obtained through survey of the registry for DCN.

Evaluation of a smoking cessation program implemented in the workplace

This paper evaluates the effectiveness of a smoking cessation program, known as "Smoke Busters." A quasi-experimental design was used. The experimental group consisted of 35 workers (33 males and 2 females) who smoked and volunteered to take part in the program held at a chemical company. Thirty five age-, sex-, and job category-matched smokers who did not participate in the program were used as controls. The program consisted of 6 sessions held over a period of 6 months. The sessions were organized in a workshop style, with 6 groups, each consisting of 5-6 participants, meeting for 2 hr during working hours. The effectiveness of the program was evaluated by the abstinence rate among the participants at one year after the start of the program. The abstinence rates of the experimental group and control group were 22.9% and 5.7%, respectively. Thus net abstinence rate was 17.2%. Given that 13% is considered as a reasonable benchmark for assessing the effectiveness of smoking cessation programs based on the results of the studies conducted in North America, one-year abstinence rate of 17% in this study, though not statistically significant (0.05 < p < 0.1) encourages larger experiments.

[Analysis of adenovirus type 7 hexon hypervariable region]

The isolation of adenovirus type 7 (Ad7) has been rare in Japan in the past. However since April, 1995, many isolates of Ad 7 have been reported. In order to find the cause of Ad 7 re-emergence in Japan, we investigated the genome sequences of Ad 7 by analyzing the hexon hypervariable regions (HVRs). HVRs of genomes isolated before and after this prevalence showed little change and were closely related with each other. It was concluded that adenovirus hexon which contains HVRs is conserved in the same serotype of any genome type. At present, virus genome typing seems more suitable for comparing the differences of genomes than sequencing.

[Smoking behavior and cognition for smoking cessation after diagnosis of head and neck cancer or stomach cancer]

This study aims at describing smoking behavior and cognition for smoking cessation among Japanese men after the diagnosis of cancer. Subjects were 144 patients with head and neck cancer (oral cavity, pharynx and larynx without requirement of total laryngectomy) and 104 patients with stomach cancer who were current or ex-smokers at time of diagnosis. A self-administered questionnaire was mailed at least 1.5 years alter diagnosis. Response was by mail and 72% (248/344) of completed questionnaires were returned. Among 164 patients who were smokers at the time of diagnosis, 59(36%) reported that they continued to smoke after the diagnosis of cancer. Stomach cancer patients (53%) had significantly higher (p < 0.01) continuance rate of smoking than head and neck cancer patients (24%), and patients in fifties (53%) had the highest continuance rate of smoking in the study participants. Among 105 patients who were abstinent, 83(79%) had stopped smoking within 6 months after the diagnosis of cancer. Interest in smoking cessation among the current smokers was high (83%), and they preferred a smoking cessation class with multiple participants to "person to person" counseling provided by health care practitioners.

[Two cases of dermatophytosis of the external auditory meatus]

We report two cases of dermatophytosis of the external auditory meatus. Case 1: A 44-year-old man suffered from severe itching in the right external auditory meatus for a year, and had also had tinea unguium for several years. He visited our outpatient clinic because of scaly erythema which had developed on the auricle. Otoscopic examination revealed yellow-brown dry cerumen and redness from the cartilaginous to the bony portion of the external auditory meatus. Case 2: A 14-year-old boy, the son of Case 1, suffered from severe itching in the left external auditory meatus. He scratched the auditory meatus with an earpick which his father had used. Otoscopic examination revealed a similar lesion as in the father's case, although he had no history of dermatophytosis elsewhere on his body, including the auricle. Direct examination using a KOH method of the cerumen from both cases demonstrated numerous fungal elements. Fungal culture identified Trichophyton rubrum. Both cases were successfully treated with oral itraconazole. We suggest that infection from father to son was transferred by the earpick.

[GM1-gangliosidosis knockout mouse]

We generated a beta-galactosidosis mouse by gene targeting in an embryonic stem cell. Clinical, pathological, and biochemical analyses revealed that this mouse is a useful animal model to study the pathogenesis and therapy of human GM1-gangliosidosis.

Maturation and degradation of beta-galactosidase in the post-Golgi compartment are regulated by cathepsin B and a non-cysteine protease

Lysosomal beta-galactosidase precursor is processed to a mature form and associated with protective protein in lysosomes. In this study we used two cysteine protease proinhibitors, E64-d for cathepsins B, S, H, and L, and CA074Me for cathepsin B. They are converted intracellularly to active forms, E-64c and CA074, respectively. Both active compounds inhibited maturation of the exogenous beta-galactosidase precursor, but E-64c did not inhibit further degradation to an inactive 50-kDa product. We concluded that cathepsin B participated exclusively in maturation of beta-galactosidase, and a non-cysteine protease was involved in further degradation and inactivation of the enzyme molecule.

Up-regulation of oxygen-derived free radicals by interleukin-1 in hepatic ischemia/reperfusion injury

BACKGROUND

Oxygen-derived free radicals (FRs) are critical mediators of ischemia/reperfusion injury. Inflammatory cytokines have been shown to play important roles in tissue injury. To examine the relationship between FRs and interleukin-1 (IL-1) in hepatic ischemia/reperfusion injury, we used interleukin-1 receptor antagonist (IL-1ra) to block endogenous IL-1 production in a rat model of hepatic ischemia/reperfusion.

METHODS

Female SD rats were subjected to 30 min of hepatic ischemia followed by reperfusion. The animals were divided into two groups, control group and IL-1ra-treated group, according to the rinse solution. In both groups, FR production, histological changes, and interactions between leukocytes and endothelial cells were analyzed in the course of reperfusion.

RESULTS

In the control group, production of FRs increased significantly after 60 min of reperfusion. After 60 and 180 min of reperfusion, histological examination showed atrophy and degeneration of hepatocytes. Hepatic microcirculation demonstrated a marked increase in the number of leukocytes adherent to endothelial cells and of injured cells after reperfusion. In the IL-1ra-treated group, IL-1ra pretreatment markedly reduced FR production after 60 min of reperfusion, the number of leukocytes adherent to endothelial cells, and tissue injury.

CONCLUSION

These data clearly show an important role for IL-1 in the induction of FR production, leukocyte adhesion, and tissue injury after hepatic ischemia/reperfusion injury.