Influence of 1 year of androgen deprivation therapy on lipid and glucose metabolism and fat accumulation in Japanese patients with prostate cancer

BACKGROUND

We prospectively examined influence of androgen deprivation therapy (ADT) on lipid and glucose metabolisms in Japanese patients with prostate cancer.

METHODS

Patients with prostate cancer who were hormone-naive and scheduled to receive long-term ADT were recruited between 2011 and 2013. Body weight, abdominal circumference and blood testing associated with lipid and glucose metabolism were recorded every 3 months during 1 year of ADT. Computed tomography (CT) was performed to measure areas of subcutaneous and visceral fat before and after 1 year of ADT. ADT was limited to a luteinizing hormone-releasing hormone (LHRH) agonist with or without bicalutamide.

RESULTS

Of 218 patients registered, data were available from 177 patients who completed 1 year of ADT. Of these, CT was performed before and after 1 year of ADT in 88 patients. Median age was 75 years (range, 49-85 years). Median PSA before ADT was 16.7 ng ml(-1) (range, 0.3-3316). Clinical stage was B (54.2%), C (23.2%) and D (20.9%). Mean increases in body weight and abdominal circumference after 1 year of ADT were 2.9 and 3.0%, respectively. Mean increases in total, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides were 10.6, 14.3, 7.8 and 16.2%, respectively. Mean increases in fasting blood sugar and hemoglobin A1c (HbA1c) were 3.9 and 2.7%, respectively. Lipid alterations were noted in patients without comorbidities, whereas changes in HbA1c were noted in patients with diabetes mellitus at baseline. These lipid and glucose alterations were prominent in the early ADT period. Both visceral and subcutaneous fat, as measured by CT, increased by >20%. The increase in subcutaneous fat was significantly greater than that in visceral fat (P=0.028).

CONCLUSIONS

One year of ADT significantly changed lipid and glucose metabolism in Japanese patients with prostate cancer. Patient characteristics or comorbidities at baseline may be associated with ADT-induced metabolic changes.

LET distributions from CR-39 plates on Space Shuttle missions STS-84 and STS-91 and a comparison of the results of the CR-39 plates with those of RRMD-II and RRMD-III telescopes

The LET distributions during the Space Shuttle missions STS-84 (altitude 270-412 km, average 375 km; inclination angle, 51.6 degrees) and STS-91 (altitude 328-397 km, average 373 km; inclination angle, 51.6 degrees) were measured using CR-39 plastic nuclear track detectors. A correction for the dip-angle dependence of the track-formation sensitivity of the CR-39 plates was applied to the data analysis. The absorbed doses and the dose equivalents around RRMD Detector Units, estimated from the LET distributions in the LET region of 4-200 keV/micrometers, fluctuated with standard deviations of +/- 21% to +/- 35% in both flight experiments. The LET distributions obtained from the CR-39 plates agreed well with that obtained from RRMD-II in STS-91. However, the particle fluxes obtained from RRMD-III in STS-84 and STS-91 were two or three times higher than those obtained from RRMD-II and the CR-39 plates. It was concluded that the LET distributions obtained from RRMD-II and the CR-39 plates in the present flight experiments did not include the contribution of target-fragmented secondary heavy particles produced by low-LET particles, such as relativistic or semi-relativistic protons and helium ions, whereas RRMD-III was able to detect these secondary particles because of its low triggering level.

Measurements of LET distribution and dose equivalent onboard the Space Shuttle IML-2 (STS-65) and S/MM#4 (STS-79)

Space radiation dosimetry measurements have been made onboard the Space Shuttle STS-65 in the Second International Microgravity Laboratory (IML-2: 28.5 degrees x 300 km: 14.68 days) and the STS-79 in the 4th Shuttle MIR mission (S/MM#4: 51.6 degrees x 300-400km: 10.2 days). In these measurements, three kinds of detectors were used; one is a newly developed active detector telescope called "Real-time Radiation Monitoring Device (RRMD-I for IML-2 and RRMD-II with improved triggering system for S/MM#4)" utilizing silicon semi-conductor detectors and the other detectors are conventional passive detectors of thermoluminescence dosimeters (TLDs) and CR-39 plastic track detectors. The main contribution to dose equivalent for particles with LET > 5.0 keV/micrometer (IML-2) and LET > 3.5 keV/micrometer (S/MM#4) is seen to be due to galactic cosmic rays (GCRs) and the contribution of the South Atlantic Anomaly (SAA) is less than 5% (IML-2: 28.5 degrees x 300 km) and 15% (S/MM#4: 51.6 degrees x 400 km) in the above RRMD LET detection conditions. For the whole LET range (> 0.2 kev/micrometer) obtained by TLDs and CR-39 in these two typical orbits (a small inclination x low altitude and a large inclination x high altitude), absorbed dose rates range from 94 to 114 microGy/day, dose equivalent rates from 186 to 207 microSv/day and average quality factors from 1.82 to 2.00 depending on the locations and directions of detectors inside the Spacelab at the highly protected IML-2 orbit (28.5 degrees x 300 km), and also, absorbed dose rates range from 290 to 367 microGy/day, dose equivalent rates from 582 to 651 microSv/day and average quality factors from 1.78 to 2.01 depending on the dosimeter packages around the RRMD-II "Detector Unit" at the S/MM#4 orbit (5l.6 degrees x 400km). In general, it is seen that absorbed doses depend on the orbit altitude (SAA trapped particles contribution dominant) and dose equivalents on the orbit inclination (GCR contribution dominant). The LET distributions obtained by two different types of active and passive detectors, RRMDs and CR-39, are in good agreement for LET of 15 - 200 kev/micrometer and difference of these distributions in the regions of LET < 15 kev/micrometer and LET > 200 kev/micrometer can be explained by considering characteristics of CR-39 etched track formation especially for the low LET tracks and chemical etching conditions.

The Relative Association of Collective Efficacy in School and Neighborhood Contexts With Adolescent Alcohol Use

Background

It is unclear whether either neighborhood collective efficacy or school collective efficacy is associated with adolescent alcohol use. This study aimed to examine the relative contributions of collective efficacy, both in school and in the neighborhood contexts, to alcohol use among Japanese adolescents.

Methods

A cross-sectional study was conducted in public high schools across Okinawa and Ibaraki Prefectures in Japan in 2016. The study participants consisted of 3,291 students in grades 10 through 12 cross-nested in 51 schools and 107 neighborhoods. Alcohol use was measured as current alcohol drinking, which was defined as self-reported drinking on at least 1 day in the past 30 days. Collective efficacy was measured using scales of social cohesion and informal social control in school and the neighborhood. Contextual-level collective efficacy was measured using aggregated school-level and neighborhood-level individual responses, respectively. We used non-hierarchical multilevel models to fit the cross-nested data.

Results

Significant variation in alcohol use was shown between schools but not between neighborhoods. After adjusting for covariates, school collective efficacy at individual- and contextual-levels was protectively associated with alcohol drinking (odds ratio [OR] for the increase of one standard deviation from the mean 0.72; 95% confidence interval [CI], 0.63–0.82 and OR 0.61; 95% CI, 0.49–0.75, respectively), whereas neighborhood collective efficacy at individual- and contextual-levels was not associated with alcohol consumption.

Conclusion

The school-level associations of collective efficacy with adolescent alcohol use may have the greater impact than the neighborhood-level associations. Adolescent drinking prevention efforts should include enhancing school collective efficacy.

Mediating effect of aerobic fitness on the association between physical activity and academic achievement among adolescents: A cross-sectional study in Okinawa, Japan

The purpose of this study was to examine the potential role of aerobic fitness (AF) as a mediator of the association between physical activity (PA) and academic achievement (AA) among Japanese junior high school students. A cross-sectional data was collected from 608 7th grade students enrolled at five public junior high schools in two suburban municipalities in Okinawa, Japan. Self-reported PA was assessed using the Patient-Centred Assessment and Counselling for Exercise plus Nutrition questionnaire. The 20-meter shuttle run test was performed to determine AF. AA was evaluated using the overall grade point average. Family structure, parental education level, and achievement motives were the self-reported covariates. The results of the bootstrapped mediation analysis indicated that PA had a direct effect on AF, which in turn influenced the AA among boys. After adjusting for AF, the association between PA and AA disappeared while the association of AF with AA still remained. However, neither PA nor AF was associated with the AA of girls. Therefore, the hypothesis that AF might mediate the relationship between PA and AA was supported for boys. Promoting AF, as a result of engaging to PA could positively influence AA particularly in boys.

Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008-2016: a repeated cross-sectional study

Background

Smoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016.

Methods

We conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated.

Results

Smoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time.

Conclusions

Smoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.

[Clinical study on Fournier's gangrene--value of "through and through drainage"]

From 1991 to 1994, we experienced 5 patients with Fournier's gangrene. Their age, associated diseases, etiology, area of the disease, microbiologic findings, treatment and prognosis were reviewed. Patient age ranged from 25 to 72 years, with a mean age of 47 years. An associated disease process could be identified in all patients. Two patients had diabetes mellitus, 1 systemic lupus erythematosus, 1 chronic alcoholism and 1 multiple myeloma. The etiology of the infectious process was presumed to be wound infection in 2 patients and indwelling urethral catheter in 2 patients. All patients were treated with broad-spectrum antibiotics. Extensive débridement with later skin graft was done in 2 patients. Multiple Penrose-drains were placed subcutaneously after limited removal of necrotic tissue in 3 patients. In these 3 patients, redness and swelling reduced quickly, the wound was cured without defects of skin except 1 patient who had multiple myeloma and was in a very serious condition. Although inflammation reduced after the placement of drains, the patient with multiple myeloma died of sepsis and DIC. The majority of patients with Fournier's gangrene are immunocompromised. Although extensive débridement is commonly performed as the surgical treatment, defects of the skin seem to have some disadvantages, such as the need for the skin graft and the chance of secondary wound infection. In the narrow excision of necrotic tissue and drainage of involved areas by multiple Penrose-drains, skin defects are minimum, and the effectiveness of the surgical management seems to be competitive with the wide débridement.(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in current alcohol use among Japanese adolescents by sociodemographic groups

Background

Alcohol is the most commonly used substance among Japanese adolescents, although its use has been declining recently. However, little is known whether the declining trend in adolescent drinking can be found across all sociodemographic characteristics. This study explored time trends in alcohol use among Japanese adolescents by sociodemographic characteristics between 2008 and 2016.

Methods

A repeated cross-sectional study was conducted using data from three prefectural-wide surveys of public high schools in Okinawa Prefecture, Japan, in 2008, 2012, and 2016. The study participants comprised 7,807 students in grades 10 to 12 (15-18 years). Alcohol use was defined as drinking one or more alcoholic beverages on at least one day in the past month. Demographic characteristics included grade, sex, and region, and socioeconomic status (SES) was assessed by family structure, parental education, and school type. Time trends in alcohol use over time by each sociodemographic group were assessed by the Cochran-Armitage test for trend.

Results

The overall prevalence of adolescent alcohol use significantly reduced from 20.7% (95% CI 19.1-22.3%) in 2008 to 9.5% (95%CI 8.4-10.6%) in 2016. Similar reducing trends in adolescent alcohol use were found across all of the demographic characteristics as well as the SES groups (all P for trends &lt;0.001). During the survey periods, there were no sex differences in alcohol use prevalence, while alcohol use was more prevalent among old graders. Alcohol use was also more prevalent among low SES groups than high SES groups. However, family structure in 2016 did not show significant differences in alcohol use.

Conclusions

Alcohol use among Japanese adolescents has been declining over time and this downward trend was similar for all demographic and socioeconomic subgroups. Further adolescent drinking prevention efforts should be implemented across all population subgroups. Moreover. monitoring of adolescent alcohol use should be continued.

Key messages

This study found that adolescent alcohol use in Japan has been decreasing over time across all population subgroups. The finding is a desired outcome from the viewpoint of the public health impact.

Adherence to 24-hour movement guidelines among Japanese elementary and junior high school students

Background

For optimal health benefits, the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5-17 years) recommend an achievement of ≥ 60 minutes of moderate-to-vigorous physical activity (MVPA), &lt;2 h of recreational screen time (ST), and 9-11 h for 5-13 years or 8-10 h for 14-17 years of sleep time (SLT) each day. There is little evidence showing the proportion of the recommendation in Japan, so we need to investigate. The aim of this study thus was to reveal the compliance to the recommendation with a large sample of Japanese elementary and junior high school children.

Methods

This study included 2408 students enrolled in fifth grade (aged 10-11 years) in 31 elementary schools, and 4360 students enrolled in eighth grade (aged 13-14 years) in 30 junior high schools. Each behaviour was assessed by a self-reported questionnaire. To analyze the differences in adherence to the recommendation between the school-aged group, we conducted a chi-analysis.

Results

Overall, only 4% of participants complied with all three recommendations, and 20% of the students did not comply with any of the recommendations (χ2=1390.87;p&lt;.001). Compared with MVPA and ST, SLT had a trend to be likely to achieve the recommendation in each school-age group. Elementary school students had a higher percentage of non-adherence to all recommendations (39%) than junior high school students (10.3%). The adherence to the recommendation of the ST & SLT simultaneously had no differences in each age group (11.5% for elementary schoolers and 12.7% for junior high schoolers). However, adherence to the recommendation of MVPA only, ST only, and MVPA & ST were higher in elementary schoolers, and the adherence to the recommendation of SLT only and MVPA & SLT were higher in junior high schoolers.

Conclusions

The proportion of adherence to at least one of the three recommendations is better in junior high school students than elementary school students in Okinawa, Japan.

Key messages

Health behaviour required improvement may differ by age group. It is necessary for particularly elementary school children in Okinawa to take proper countermeasures to improve the movement behaviours.

Impact of the COVID-19 Pandemic on the Socioeconomic Inequality of Health Behavior Among Japanese Adolescents: A 2-Year Repeated Cross-Sectional Survey

BACKGROUND

Although disparities in socioeconomic status in health behaviors have been highlighted globally, they are not well understood in Japanese adolescents. The purpose of this study was to clarify the changes in socioeconomic disparities in adolescents' fundamental health behaviors, such as physical activity, screen time (ST), sleep, breakfast intake, and bowel movement before and during COVID-19.

METHODS

This was a repeated cross-sectional study which used data from the 2019 and 2021 National Sports-Life Survey of Children and Young in Japan. Data of 766 and 725 participants in 2019 and 2021, respectively, were analyzed. Favorable health behaviors were defined as daily moderate to vigorous physical activity (MVPA) of at least 60 minutes, ST of less than 2 hours, sleep of 8 to 10 hours, daily breakfast intake, and bowel movement frequency of at least once in every 3 days. We calculated the slope index of inequality and relative index of inequality in each health behavior for equivalent household income levels for assessing absolute and relative economic inequalities.

RESULTS

Compliance with MVPA and ST recommendation significantly declined from 20.1% and 23.0% in 2019 to 11.7% and 14.9% in 2021, respectively. The slope index of inequality and relative index of inequality increased in MVPA for income levels, but decreased in daily breakfast in 2019 to 2021. Although the widening and narrowing of the disparity were inconclusive for ST, it exacerbated for the higher-income groups.

CONCLUSIONS

Our study revealed widening of economic disparities in the achievement of recommended MVPA and narrowing of it in breakfast intake among adolescents before and during COVID-19.

Study of factors related to social and emotional skills in early childhood in Japan

Background

There are numerous reports that social and emotional skills in early childhood have profound influence on lifelong health. The aim of this research is to determine the relation between the lifestyle and the social and emotional skills among children in present day Japan.

Methods

The object of analysis was a total of 110 parents of kindergarten students (56 boys, 48 girls,6 gender unknown) from 3 kindergartens in central Okinawa Island. The survey was conducted in mid-December 2019. Regarding the content of the survey, parents were asked to answer on a five-point scale, based on their subjective opinion, how good is their child, as compared to other children, in each of the 9 sub-scales of the social and emotional skills proposed in the 2015 OECD report, namely “perseverance,” “self-control,” “passion for goals,” “sociability,” “respect,” “caring,” “self-esteem,” “optimism,” “confidence.” Additionally, other question items were set, mainly to ask about the child's own lifestyle.

Results

The results of multivariate logistic regression analysis are following. As for “achieving goals:” 3 items for perseverance - “there are few likes and dislikes about food (OR:2.67, 95％CI:1.03～6.94, p=.043),” “Time for playing games on smartphone is determined (OR:3.21, 95％CI:1.19～8.68, p=.021),” “Eat more fruits (OR:3.03, 95％CI:1.24～8.26, p=.016),” are statistically significant. [Other results are omitted in this abstract]

Conclusions

It became clear that the acquisition of social and emotional skills during early childhood generally involves regular lifestyle and “discipline” at home as a whole. Besides, it is important for parent and child to do various activities together, including those aiming to increase cognitive skills. This study is considered to be a powerful evidence for the development of future intervention programme, aimed at acquiring social and emotional skills in early childhood.

Key messages

In early childhood family and kindergarten have to cooperate to foster social and emotional skills, important for lifelong health. This study is considered to be a powerful evidence for the development of future intervention programme, aimed at acquiring social and emotional skills in early childhood.

Associations between 24-h movement behaviors and self-rated health: a representative sample of school-aged children and adolescents in Okinawa, Japan

OBJECTIVES

This study aimed to determine the associations between adherence to 24-h movement behavior guidelines and self-rated health (SRH) among Japanese adolescents according to their age group.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Probability proportional sampling data, which were collected from six regions of Okinawa Prefecture, Japan, considering the number of schools, included 2408 fifth-grade students (aged 10-11 years) in 31 elementary schools and 4360 eighth-grade students (aged 13-14 years) in 30 junior high schools. SRH, moderate-to-vigorous physical activity (MVPA), screen time (ST), sleep duration, and confounding factors (sex, weight status, family affluence, parental support, school satisfaction, and school demands) were self-reported.

RESULTS

The logistic regression models showed that adherence to ST and sleep recommendations in elementary school students was associated with a high prevalence of good health only, whereas adherence to only MVPA, only sleep, ST and sleep, MVPA and sleep, and all three recommendations were associated with a high prevalence of good health among junior high school students. All combinations that included achievement of the recommended sleep duration were associated with SRH.

CONCLUSIONS

Achieving 24-h movement behavior guidelines, particularly sleep recommendations, is associated with better perceived health in school-aged children, especially in adolescents.

[Histopathological prognostic factors in 146 patients with renal cell carcinoma: comparison between incidental and non-incidental cases]

To characterize the prognostic factors among pathological structural pattern, cell type, infiltration, and incidental or non-incidental renal cell carcinoma (RCC), we reviewed the records of 146 patients with RCC who underwent nephrectomy at our institute. The patients were 26 to 86 years old (mean age 58). The men-to-women ratio was 3.2:1. The tumor originated in the right kidney in 83 patients and in the left in 63. The solid pattern was associated with poorer survival than other patterns (p < 0.01). Spindle or pleomorphic cell type had poorer survival than common type (p < 0.01). The number of incidentally discovered RCC has increased since 1986, and survival is better than in non-incidental RCC, because of smaller tumor size, low stage tumor (stages 1, 2; 83.6%), and fewer papillary or solid type. In addition, there were no spindle or pleomorphic cell type, grade 3 or INF gamma-positive case. Survival is good even when the tumor is large.

Validity and reliability of the Simple Motor Competence-check for Kids (SMC-Kids)

OBJECTIVES

To examine the validity and reliability of the Simple Motor Competence-check for Kids (SMC-Kids), which was developed to assess motor development in preschool children.

DESIGN

A cross-sectional and repeated-measures design.

METHODS

To assess validity, 71 children aged 4-6 years completed the Test of Gross Motor Development-3 (TGMD-3) and SMC-Kids (10 m shuttle run and paper ball throw). For inter-rater reliability, 91 children aged 3-6 years performed the SMC-Kids test, twice, by two different raters. To evaluate intra-rater reliability and quantify improvements beyond measurement error, 53 participants were reassessed by the same rater 7-10 days later.

RESULTS

Spearman's rho between the 10 m shuttle run and the TGMD-3 locomotor score was -0.51 (95 % CI: -0.31, -0.66), and between the paper ball throw and TGMD-3 ball skill score was 0.80 (95 % CI: 0.70, 0.87). Confirmatory factor analysis showed strong associations of the 10 m shuttle run and paper ball throw with latent variables of locomotor and object control skills, with factor loadings of -0.97 and 0.88, respectively. Both tests showed good-to-excellent inter-rater (ICC = 0.898-0.96) and intra-rater reliabilities (ICC = 0.882-0.974). The smallest worthwhile changes were 0.25 s for the 10 m shuttle run and 0.42 m for the paper ball throw, with double coefficients of variation of 0.46 s and 0.99 m, and MDC 95 of 0.82 s and 1.52 m, respectively.

CONCLUSIONS

SMC-Kids is a simple tool to quickly measure preschooler locomotor and object control skills without the need for special equipment or large spaces.

Local environment perceived in daily life and urban green and blue space visits: Uncovering key factors for different age groups to access ecosystem services

Inequality in access to green and blue spaces is a major issue in the field of environmental justice. Various factors significantly influence visitations to these spaces, including residential, commuting, and shopping areas. However, studies have mainly focused on residential environments. Analyzing the coupling of environmental and socioeconomic factors, including age, income, and childhood experience, and examining the direct and indirect effects of these factors for different age groups are needed to better understand the detailed context of inequalities in access to ecosystem services. We conducted a questionnaire survey and analysis to address these needs in an urban setting. The results demonstrate that several land use categories (i.e., agricultural lands in residential areas, grasslands near shopping areas, and deciduous forests near commuting destinations) positively correlated with visitation frequency, suggesting the lack thereof may be the cause of access inequalities. In particular, the perimeter per unit area of some land cover types, which shows the complexity of the form of each land cover category, was found to be a significant factor. We identified inequality in nature experience to be the key factor correlated with inequality in nature visits among the young age group. For the middle-aged and old age groups, nature-relatedness was positively correlated with visitation frequency. Proper design of the local environment, such as through land use planning, can be an effective measure for all age groups. For instance, long-bordered green areas in the Monsoon Asian region are an attractive traditional landscape, with high accessibility and a comfortable thermal environment. The key factors for each age group should be considered in spatial design and inclusive information-sharing to reduce inequality in access to ecosystem services.

[A case report of complete inversion of the bladder in an old woman]

A 77-year-old Japanese woman was admitted to our hospital complaining of small urinary volume. Physical examination revealed a light red, edematous, pyriform mass, approximately 7 cm in diameter at the vulva. An orifice posterior to the base of the mass was catheterized and 20 ml of urine was obtained. Roentgenograms of contrast material injection to the orifice demonstrated a space of 20 ml. A diagnosis of complete inversion of the bladder was made. Under epidural anesthesia, attempts were made to reduce the mass through the urethra. The manual reduction proved to be difficult, but was successful by manual compression of the bladder wall and squeezing it back through the urethra, which took approximately 60 minutes. Complete transurethral inversion of the bladder is so rare that not much of the pathogenesis is clarified. In our patient, senility, obesity, multiple labor and surgeries are assumed to have resulted in laxity of the pelvic wall which would be one of the major risk factors for this condition.