Alcohol consumption, multiple Lugol-voiding lesions, and field cancerization

The development of multiple squamous cell carcinomas (SCC) in the upper aerodigestive tract, which includes the oral cavity, pharynx, larynx, and esophagus, is explained by field cancerization and is associated with alcohol consumption and cigarette smoking. We reviewed the association between alcohol consumption, multiple Lugol-voiding lesions, and field cancerization, mainly based on the Japan Esophageal Cohort study. The Japan Esophageal Cohort study is a prospective cohort study that enrolled patients with esophageal SCC after endoscopic resection. Enrolled patients received surveillance by gastrointestinal endoscopy every 6 months and surveillance by an otolaryngologist every 12 months. The Japan Esophageal Cohort study showed that esophageal SCC and head and neck SCC that developed after endoscopic resection for esophageal SCC were associated with genetic polymorphisms related to alcohol metabolism. They were also associated with Lugol-voiding lesions grade in the background esophageal mucosa, the score of the health risk appraisal model for predicting the risk of esophageal SCC, macrocytosis, and score on alcohol use disorders identification test. The standardized incidence ratio of head and neck SCC in patients with esophageal SCC after endoscopic resection was extremely high compared to the general population. Drinking and smoking cessation is strongly recommended to reduce the risk of metachronous esophageal SCC after treatment of esophageal SCC. Risk factors for field cancerization provide opportunities for early diagnosis and minimally invasive treatment. Lifestyle guidance of alcohol consumption and cigarette smoking for esophageal precancerous conditions, which are endoscopically visualized as multiple Lugol-voiding lesions, may play a pivotal role in decreasing the incidence and mortality of esophageal SCC.

Risk factors for the development of second primary esophageal squamous-cell carcinoma after endoscopic resection for esophageal squamous-cell carcinoma according to genetic polymorphisms related to alcohol and nicotine metabolism

BACKGROUND

Multiple development of esophageal squamous-cell carcinoma is explained by field cancerization and is associated with alcohol consumption and smoking. We investigated the association between the development of second primary esophageal squamous-cell carcinoma after endoscopic resection for esophageal squamous-cell carcinoma and genetic polymorphisms related to alcohol and nicotine metabolism.

METHODS

The study group comprised 56 patients with esophageal squamous-cell carcinoma after endoscopic resection. The main variables were the following: (i) cumulative incidence and total number of second primary esophageal squamous-cell carcinoma according to genetic polymorphisms in alcohol dehydrogenase 1B, aldehyde dehydrogenase 2 and cytochrome P450 2A6; and (ii) risk factors of second primary esophageal squamous-cell carcinoma identified using a multivariate Cox proportional-hazards model. The frequencies of alcohol dehydrogenase 1B, aldehyde dehydrogenase 2 and cytochrome P450 2A6 genetic polymorphisms in the buccal mucosa were analyzed.

RESULTS

The median follow-up was 92.8 months (range: 2.7-134.2). Slow-metabolizing alcohol dehydrogenase 1B was associated with a higher 7-year cumulative incidence of second primary esophageal squamous-cell carcinoma (fast-metabolizing alcohol dehydrogenase 1B vs slow-metabolizing alcohol dehydrogenase 1B: 20.5% vs 71.4%, P = 0.006). Slow-metabolizing alcohol dehydrogenase 1B (relative risk [95% confidence interval]: 3.17 [1.49-6.73]), inactive aldehyde dehydrogenase 2 (2.17 [1.01-4.63]) and poorly-metabolizing cytochrome P450 2A6 (4.63 [1.74-12.33]) had a significantly higher total number of second primary esophageal squamous-cell carcinoma per 100 person-years. In the multivariate Cox proportional-hazards model, slow-metabolizing alcohol dehydrogenase 1B was a significant risk factor of the development of second primary esophageal squamous-cell carcinoma (hazard ratio 9.92, 95% confidence interval: 2.35-41.98, P = 0.0018).

CONCLUSIONS

Slow-metabolizing alcohol dehydrogenase 1B may be a significant risk factor for the development of second primary esophageal squamous-cell carcinoma. In addition, inactive aldehyde dehydrogenase 2 and poorly-metabolizing cytochrome P450 2A6 may be important factors.

Trends in the prevalence of atrophic gastritis and Helicobacter pylori infection over a 10‑year period in Japan: The ROAD study 2005‑2015

Few large population-based studies have examined the prevalence of atrophic gastritis (AG) and Helicobacter pylori infection in Japan. The purpose of the present study was to estimate the prevalence of AG and H. pylori infection by age, in addition to investigating their change rates from 2005 to 2016 in Japan using data from a large population-based cohort. A total of 3,596 participants [1,690 in the baseline survey (2005-2006) and 1,906 at the fourth survey (2015-2016)] aged 18 to 97 years were included in the cohort. The prevalence of AG and H. pylori infection were examined at baseline and in the fourth survey based on serological tests for the H. pylori antibody titer and pepsinogen levels. The prevalence of AG and H. pylori infection were 40.1% (men, 44.1%; women, 38.0%) and 52.2% (men, 54.8%; women, 50.8%), respectively, at baseline. AG seropositivity rates showed a significant decrease from 40.1 to 25.8% in 10 years. H. pylori seropositivity rates decreased significantly from 52.2 to 35.5% in 10 years. Stratified for age, the prevalence of AG showed an increasing trend with age, whereas the prevalence of H. pylori infection increased with aging, except for in the elderly group, showing an inverted U-shaped association. In this population-based, cross-sectional study with a 10-year interval survey, the prevalence of AG and H. pylori infection decreased significantly. This change may influence the prevalence of H. pylori-related diseases, including extra-gastric disorders associated with H. pylori-induced systemic subclinical inflammation and hypochlorhydria, such as colorectal neoplasia and arteriosclerosis.

Epidemiology of locomotive syndrome using updated clinical decision limits: 6-year follow-ups of the ROAD study

INTRODUCTION

Locomotive syndrome (LOCOMO) is defined by the Japanese Orthopaedic Association (JOA) as a condition requiring nursing care due to a decline in mobility resulting from musculoskeletal disorders. In 2020, the JOA announced the new definition of LOCOMO stage 3 and revision of clinical decision limits in stages of LOCOMO. However, there are few reports on the epidemiological indices of LOCOMO. This prospective cohort study aimed to investigate the prevalence, incidence, and association of poor prognosis with LOCOMO stages.

MATERIALS AND METHODS

The third survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted during 2012-2013, examining a population-based cohort of 1575 participants (513 men and 1062 women, mean age 65.6 years). Three LOCOMO risk tests were performed, and patients were classified into LOCOMO stages 0, 1, 2, and 3. They were followed up for 6 years, and identical examination of LOCOMO was performed in 3- and 6-year follow-ups. Data on patients' prognoses, including disability and death, were collected.

RESULTS

The prevalence of LOCOMO stages 1, 2, and 3 was 41.3, 14.9, and 11.6%, respectively. The incidence of LOCOMO stages 1, 2, and 3 were 83.7, 23.0, and 18.6 per 1000 person-years, respectively. Compared with LOCOMO stage 0, logistic regression analysis showed that LOCOMO stage 3 significantly increased the risk of disability and mortality. In addition, each value of LOCOMO risk tests for LOCOMO stage 3 increased the risk of poor prognosis.

CONCLUSION

LOCOMO stage 3 is a sensitive indicator of future disability and mortality.

Efficacy of Low-Dose Aspirin in Colorectal Cancer Risk Prevention is Dependent on ADH1B and ALDH2 Genotype in Japanese Familial Adenomatous Polyposis Patients

Aspirin has gained great attention as a cancer preventive agent. Our previous study revealed that the low-dose aspirin prevents colorectal tumor recurrence in Japanese patients with colorectal adenomas and/or adenocarcinomas, whereas aspirin increases risks in smokers and has no effects on regular drinkers. Our recent study revealed that aspirin reduces polyp growth in Japanese patients with familial adenomatous polyposis (FAP). In this study, we have studied the association of genotypes of alcohol metabolizing enzymes (ADH1B and ALDH2) on aspirin's efficacy of suppressing polyp growth (≥5 mm) in a total of 81 Japanese patients with FAP. Our study revealed that aspirin showed significant preventive effects for patients with ADH1B-AA and AA+GA types [OR = 0.21; 95% confidence interval (CI), 0.05-0.95, and OR = 0.31; 95% CI, 0.10-0.95, respectively], and for patients with ALDH2-GG and GG+GA types (OR = 0.10; 95% CI, 0.01-0.92, and OR = 0.29; 95% CI, 0.09-0.94, respectively), but not for patients with ADH1B-GG and GA+GG types, and ALDH2-AA and GA+AA types. In addition, substantial preventive effects of aspirin were seen for patients with ADH1B-AA type who do not drink regularly (<3 times/week, OR = 0.11; 95% CI, 0.02-0.78), where a statistically significant interaction between aspirin and ADH1B was observed (P interaction = 0.036). Results from this exploratory study strongly indicate that aspirin is beneficial in prevention of polyp growth for patients with FAP with ADH1B-AA and AA+GA types, and ALDH2-GG and GG+GA types. Taken together, we propose ADH1B and ALDH2 as candidate markers for the personalized prevention by aspirin.

Significance

Aspirin is beneficial to patients with FAP with ADH1B-AA and AA+GA types or ALDH2-GG and GG+GA types. ADH1B and ALDH2 genotypes can be the markers for the personalized prevention of colorectal cancer by aspirin.

Different Effects of Polymorphic Flavin-Containing Monooxygenase 3 and Cytochrome P450 2A6 Activities on an Index of Arteriosclerosis as a Lifestyle-Related Disease in a General Population in Japan

BACKGROUND

The relationships between lifestyle-related diseases and polymorphic drug-metabolizing enzyme activities in the general population in Japan remain unclear.

OBJECTIVE

In this study, the relationships between an index of arteriosclerosis and the phenotypic activities of flavin-containing monooxygenase 3 (FMO3) and cytochrome P450 (P450) 2A6 were analysed.

METHODS

Subjects in a general population in Japan (age range 35-97 years, 640 men and 795 women, 12% were current smokers) who took part in a health check program were recruited.

RESULTS

Subjects were divided into two groups using the median ankle-brachial pressure index (ABI) score. Subjects harbouring P450 2A6 wild-type allele had a significant age-adjusted odds ratio of 1.3 (95% CI, 1.0-1.6) of having a lower than median ABI score compared with subjects for mutant P450 2A6. For subjects with wild-type FMO3, the odds ratio of 0.89 was not significant. The proportions of P450 2A6 extensive metabolizers varied significantly across the inter-quartile ranges of the ABI scores (p = 0.008). Furthermore, the proportion of subjects with low ABI scores was also dependent on the phenotypic P450 2A6 activity (p = 0.025) as estimated from the P450 2A6 genotype. These results suggest that in a general population in Japan, the ABI score, as a risk index for arteriosclerosis, is associated with the predicted P450 2A6 phenotype but is not associated with FMO3 function.

CONCLUSION

The P450 2A6 wild-type allele may be a possible candidate biomarker for arteriosclerosis in a general population in Japan with a variety of dietary habits.

Effects of polymorphic cytochrome P450 2A6 genotypes on chemoprevention against colorectal tumors in single Japanese cohort using daily low-dose aspirin: insights into future personalized treatments

BACKGROUND

A chemopreventive effect of low-dose aspirin against colorectal tumors was previously found in participants of two Japanese multicenter, double-blind, randomized, placebo-controlled clinical trials investigating the effects of daily aspirin (100 mg/day) for 0.7-2 years on tumor recurrence in colorectal cancer patients whose tumors were excised endoscopically.

METHODS

In the current study, chemopreventive data from single-center subsets having daily aspirin (100 mg/day) were reanalyzed with respect to variations in polymorphic cytochrome P450 2A6 (CYP2A6). From the J-CAPP study, 56 of 311 participants (47 men, 9 women; excluding patients with familial adenomatous polyposis) were genotyped for CYP2A6*1, *4 (whole-gene deletion), *7 (amino acid substitution), and *9 (upstream mutation), and from the J-FAPP IV study, 81 of 102 participants (43 men, 38 women; including patients with familial adenomatous polyposis) were also genotyped.

RESULTS

The chemopreventive effects of daily aspirin were found to be inversely dependent on the predicted enzyme activity of the CYP2A6 phenotype [based on normal genotypes (CYP2A6*1/*1,*7,*9) and impaired genotypes (CYP2A6*4,*7,*9/*4,*7,*9 and CYP2A6*1/*4)] among a nonsmoker Japanese cohort without familial adenomatous polyposis.

CONCLUSIONS

The CYP2A6 wild-type allele could be a candidate biomarker for reduced chemopreventive effects of daily aspirin in a population with wide-ranging CYP2A6 phenotypes with a high frequency of impaired activities resulting from variations and whole-gene deletions. The CYP2A6 genotypes could be applicable to future personalized treatments for colorectal tumor chemoprevention with daily aspirin.

Chemoprevention with low-dose aspirin, mesalazine, or both in patients with familial adenomatous polyposis without previous colectomy (J-FAPP Study IV): a multicentre, double-blind, randomised, two-by-two factorial design trial

BACKGROUND

The only established treatment for preventing colorectal cancer in patients with familial adenomatous polyposis (FAP) is colectomy, which greatly reduces patient quality of life. Thus, an alternative method is warranted. In this trial, we aimed to clarify the individual and joint effects of low-dose aspirin and mesalazine on the recurrence of colorectal polyps in Japanese patients with FAP.

METHODS

This was a randomised, double-blind, placebo-controlled, multicentre trial with a two-by-two factorial design done in 11 centres in Japan. Eligible patients were aged 16-70 years and had a history of more than 100 adenomatous polyps in the large intestine, without a history of colectomy. Before the study, patients underwent endoscopic removal of all colorectal polyps of at least 5·0 mm in diameter. Randomisation was done with a minimisation method with a random component to balance the groups with respect to the adjustment factors of sex, age (<30 years vs ≥30 years), or smoking status at the time of entry. Patients and researchers were masked to the treatment group. There were four groups: aspirin (100 mg per day) plus mesalazine (2 g per day), aspirin (100 mg per day) plus mesalazine placebo, aspirin placebo plus mesalazine (2 g per day), or aspirin placebo plus mesalazine placebo. Treatment was continued until 1 week before 8 month colonoscopy. The primary endpoint was the incidence of colorectal polyps of at least 5·0 mm at 8 months and was assessed in the intention-to-treat population. Safety was assessed in the ITT population. We also did a per-protocol analysis including only patients who took at least 70% of the allocated study drug. This trial is registered with the UMIN Clinical Trials Registry, number UMIN000018736, and is complete.

FINDINGS

Between Sept 25, 2015, and March 13, 2017, 104 patients were randomly assigned to receive either aspirin or aspirin placebo (n=52) or mesalazine or mesalazine placebo (n=52). Two patients withdrew from the aspirin plus mesalazine placebo group. 26 (50%) of 52 patients who received no aspirin had colorectal polyps of at least 5·0 mm at 8 months, as did 15 (30%) of the 50 patients who received any aspirin, 21 (42%) of the 50 patients who received no mesalazine, and 20 (38%) of the 52 patients who received any mesalazine. The adjusted odds ratio for polyp recurrence was 0·37 (95% CI 0·16-0·86) in the patients who received any aspirin and 0·87 (95% CI 0·38-2·00) in any who received mesalazine. The most common adverse events were grade 1-2 upper gastrointestinal symptoms in three (12%) of 26 patients who received aspirin plus mesalazine, one (4%) of 24 patients who received aspirin plus mesalazine placebo, and one (4%) of 26 patients who received mesalazine plus aspirin placebo. There was one grade 4 event in the mesalazine plus aspirin placebo group, but not related to the treatment.

INTERPRETATION

Low-dose aspirin safely suppressed the recurrence of colorectal polyps larger than 5·0 mm in patients with FAP. These results suggest an effect of low-dose aspirin for FAP and could be an alternative method for preventing colorectal cancer in FAP.

FUNDING

Japan Agency for Medical Research and Development.

[Liver Fibrosis is Associated with Loss of Skeletal Muscle Mass in Community-Dwelling Older Adults with No History of Liver Diseases]

OBJECTIVES

In this study, we aimed to examine the possible association between liver fibrosis and loss of skeletal muscle mass (SM) in community-dwelling older adults with no history of liver diseases.

METHODS

A total of 2,028 older adults (mean age, 69.8 ± 5.2 years) who had not received any treatment for liver diseases and had participated in a comprehensive health survey for community residents in Wakayama, Japan were included in this study. We carried out bioelectrical impedance analysis to estimate the SM of the whole body including the arms, legs, and trunk of the subjects. Liver fibrosis was evaluated by calculating the Fib4 index based on the subject's age, AST level, ALT level, and platelet counts.

RESULTS

The subjects were divided into three groups according to cutoff values of the Fib4 index (low: <1.30, medium: 1.30-2.66, high: ≥2.67). The SM index (kg/m²) was the lowest among subjects in the high-Fib4-index category, followed by the medium- and low-Fib4-index categories. This dose-response reduction in the SM index was more pronounced among individuals with lower blood albumin level (low nutrition) and in those with more sedentary behavior (physical inactivity). Among the selected 262 subjects who underwent SM measurement twice with an interval of 3 years, the subjects with a high Fib4 index showed greater reduction in the SM index than those with medium and low Fib4 indices. Multiple regression analysis revealed that the Fib4 index was significantly associated with the SM index, independent of age, sex, albumin level, sedentary behavior, diabetes mellitus, alcohol intake, and smoking status.

CONCLUSIONS

The present findings suggest that the potential progression of liver fibrosis is associated with the excessive loss of SM among apparently healthy older adults without any treatment for liver diseases.

Association of serum uric acid with subsequent arterial stiffness and renal function in normotensive subjects

Serum uric acid (SUA) is correlated with an increased risk of not only gout but also cardiovascular diseases. The present study aimed to longitudinally evaluate the effects of SUA level on renal function and arterial stiffness in a population-based sample of normotensive subjects. The subjects completed a health checkup in 2002 at baseline and in 2011 or 2012 at the end of the follow-up period. A total of 407 normotensive subjects (171 men and 236 women) aged 26-66 years were enrolled in this study. We measured blood pressure (BP), brachial-ankle pulse wave velocity (baPWV), central BP, intima-media thickness, SUA level and estimated glomerular filtration rate (eGFR). We divided the subjects into four subgroups according to the SUA quartile at baseline and compared renal function and arterial stiffness after the follow-up. The cutoff values were 3.6, 4.4, 5.6 and 9.6 mg dl^-1. The SUA levels associated with baPWV (Q1, 1324; Q2, 1457; Q3, 1442; Q4, 1489 cm s^-1), systolic BP (SBP) (Q1, 110.9; Q2, 110.1; Q3, 112.8; Q4. 116.1 mm Hg) and eGFR (P for trend <0.001). There was a significant difference in the incidence of arterial stiffness in women. Multivariate regression analyses showed that after adjusting for potential confounders, including age, sex, body mass index, SBP and lipids, SUA was a significant determinant of baPWV (β=0.117; P<0.05) and eGFR (β=-0.335, P<0.001). The results of this study suggest that elevated SUA levels may be associated with a higher risk of increased arterial stiffness and reduced renal function in normotensive subjects.

Relationships between Lifestyle, Living Environments, and Incidence of Hypertension in Japan (in Men): Based on Participant's Data from the Nationwide Medical Check-Up

This study aims to investigate factors that contribute to the differences in incidence of hypertension between different regions in Japan, by accounting for not only individual lifestyles, but also their living environments. The target participants of this survey were individuals who received medical treatment for hypertension, as well as hypertension patients who have not received any treatment. The objective variable for analysis was the incidence of hypertension as data aggregated per prefecture. We used data (in men) including obesity, salt intake, vegetable intake, habitual alcohol consumption, habitual smoking, and number of steps walked per day. The variables within living environment included number of rail stations, standard/light vehicle usage, and slope of habitable land. In addition, we analyzed data for the variables related to medical environment including, participation rate in medical check-ups and number of hospitals. We performed multiple stepwise regression analyses to elucidate the correlation of these variables by using hypertension incidence as the objective variable. Hypertension incidence showed a significant negative correlation with walking and medical check-ups, and a significant positive correlation with light-vehicle usage and slope. Between the number of steps and variables related to the living environment, number of rail stations showed a significant positive correlation, while, standard- and light-vehicle usage showed significant negative correlation. Moreover, with stepwise multiple regression analysis, walking showed the strongest effect. The differences in daily walking based on living environment were associated with the disparities in the hypertension incidence in Japan.

Urinary 8-iso-prostaglandin F2α as a marker of metabolic risks in the general Japanese population: The ROAD study

OBJECTIVE

To determine whether 8-iso-prostaglandin F2α (8-iso-PGF2α) is a reliable biomarker of the accumulation of metabolic risks [e.g., overweight, hypertension, impaired glucose tolerance (IGT), and dyslipidemia].

METHODS

This was a cross-sectional study of the baseline characteristics of a Japanese general population cohort study: Research on Osteoarthritis/Osteoporosis Against Disability (ROAD). Of 1,690 participants, 1,527 fulfilled all questionnaires and examinations. Free and conjugated urinary 8-iso-PGF2α levels and metabolic syndrome (MetS) components including blood pressure, HbA1c, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and non-HDL-C were analyzed. The data were analyzed by ANCOVA, multiple regression analysis, and multinomial logistic analysis.

RESULTS

8-iso-PGF2α was significantly associated with HbA1c and significantly inversely associated with total cholesterol and non-HDL-C. Notably, IGT with an HbA1c cut-off of 5.5% was significantly associated with 8-iso-PGF2α level in participants aged ≤50 years. Multinomial logistic regression analysis revealed 8-iso-PGF2α level was significantly associated with a greater number of MetS risks present; this association was stronger in younger participants. In participants aged ≥71 years, 8-iso-PGF2α was significantly associated with a greater number of MetS risks with higher IGT cut-offs.

CONCLUSIONS

Urinary 8-iso-PGF2α can be a reliable marker of IGT and the accumulation of MetS risks, especially in younger people.

Genetic alcohol sensitivity regulated by ALDH2 and ADH1B polymorphisms is strongly associated with depression and anxiety in Japanese employees

BACKGROUND

Although alcohol-related disorders (ARD) have been shown to be accompanied by comorbid depressive and anxiety disorders, and alcohol metabolic enzyme genes, ADH1B and ALDH2 polymorphisms, have been associated with an increased risk of ARD, no studies have been conducted to evaluate the associations between these genetic polymorphisms and anxiety or depression.

METHOD

A total of 1944 Japanese workers were interviewed regarding their depressive and anxiety disorders, including suicidality, by a brief psychiatric structured interview (MINI). We investigated the relationship of ADH1B rs1229984 and ALDH2 rs671 polymorphism combinations with mental disorder risks. Logistic regression analysis was used to evaluate the associations between those polymorphisms and anxiety/depressive disorders, adjusting for sex, age, and job rank. The degree of alcohol sensitivity was classified into five groups according to the combination of two enzyme genotypes (Group I-V, in order from the lowest alcohol sensitivity).

RESULTS

Those with ALDH2(*)1/(*)1 and ADH1B(*)1/(*)1 were likely to be at an increased risk of depressive and anxiety disorders as well as ARD. This tendency was more apparent among non-drinkers (OR 9.20, 95% CI 1.66-50.89). No adverse effects of ALDH2 or ADH1B alone were observed with mental disorder risks. Likewise, analyses conducted combining job rank and genetic alcohol sensitivity showed no material associations with such risks.

CONCLUSIONS

Genetic alcohol sensitivity, especially that with the genotype combination of ALDH2(*)1/(*)1 and ADH1B(*)1/(*)1, was significantly associated with an increased risk of depressive and anxiety disorders as well as ARD.

Genetic alcohol sensitivity regulated by ALDH2 and ADH1B polymorphisms as indicator of mental disorders in Japanese employees

AIMS

Alcohol-related disorders (ARD) have been shown to be accompanied by a variety of other comorbid mental disorders. This study evaluated the associations between a variety of mental disorders and genetic alcohol sensitivity.

METHODS

A total of 1944 Japanese workers were interviewed regarding their mental disorders by the Mini-International Neuropsychiatric Interview (M.I.N.I.). We investigated the relationship of ADH1B rs1229984 and ALDH2 rs671 polymorphisms' combination with mental disorder risks. Logistic regression analysis was used to evaluate the associations between those polymorphisms and mental disorders, adjusting for sex, age, and job rank.

RESULTS

The degree of alcohol sensitivity was classified into five groups according to the combination of ADH1B and ALDH2 genotypes (Group I-V in order starting from the lowest alcohol sensitivity). Those with ALDH2 *1/*1 and ADH1B *1/*1 or with ALDH2 *1/*1 and ADH1B *1/*2,*2/*2 (low sensitivity) were significantly or nearly significantly associated with an increased risk of ARD compared with those with ALDH2 *1/*2 and ADH1B *1/*2,*2/*2 as a reference. Those with ALDH2 *1/*1 and ADH1B *1/*1 were also likely to be at an increased risk of any mental disorder except ARD, as well as disorders without comorbid ARD. This tendency was more apparent among women (OR 11.94, 95% CI 0.73-195.63) and non-drinkers (OR 5.43, 95% CI 1.05-28.23).

CONCLUSION

The genotype combination of ALDH2 *1/*1 and ADH1B *1/*1 is significantly associated with an increased risk of any mental disorder, especially ARD. Non-drinkers or women with ALDH2 *1/*1 and ADH1B *1/*1 are likely to suffer from any mental disorder except ARD.

Roles of the ALDH2 and ADH1B genotypes on the association between alcohol intake and serum adiponectin levels among Japanese male workers

BACKGROUND

Adiponectin secreted from adipose tissue is assumed to mediate protective effects on development of metabolic syndrome (MetS) and MetS-related diseases such as cardiovascular diseases and cancer. Relationship between alcohol intake and circulating adiponectin levels is not consistent among the several previous studies. In the present study, we investigated effects of alcohol intake and the alcohol-related polymorphisms on serum adiponectin levels among Japanese male workers.

METHODS

We conducted a cross-sectional design study with 541 male workers aged 51.5 ± 5.9 (mean ± SD) years in a Japanese plant. Information on alcohol intake and other lifestyles was obtained by a self-administered questionnaire. Serum total adiponectin (T-Ad), high-molecular-weight adiponectin (HMW-Ad), medium-molecular-weight adiponectin (MMW-Ad), and low-molecular-weight adiponectin (LMW-Ad) levels were measured by the enzyme-linked immune assay system kit. Two genotypes in the alcohol dehydrogenase-1B (ADH1B) and aldehyde dehydrogenase-2 (ALDH2) genes were determined using blood sample. In multivariate regression analyses, we adjusted for age, body mass index, smoking, and physical exercise.

RESULTS

Among all subjects, high alcohol consumption of 12 units (1 unit contains 22.9 g of ethanol) a week or more was negatively associated with T-Ad levels in the multivariate model, although not significant. When we performed analyses separately for each genotype, high alcohol consumption was negatively associated with T-Ad, HMW-Ad, and LMW-Ad levels only in those with ADH1B *2/*2. Such relationships were not observed in each ALDH2 genotype group.

CONCLUSIONS

High alcohol consumption was inversely associated with T-Ad, HMW-Ad, and LMW-Ad levels in those with ADH1B *2/*2 genotype, but not in those with the other ADH1B genotypes. To our knowledge, this is the first study that reports combined effects of the alcohol-related polymorphisms and alcohol intake on serum adiponectin levels. Additional studies are required to confirm the present finding.

Relationship between coffee consumption and prevalence of metabolic syndrome among Japanese civil servants

Background

Metabolic syndrome has become a major worldwide public health problem. We examined the relationship between coffee consumption and the prevalence of metabolic syndrome among Japanese civil servants.

Methods

The study participants were 3284 employees (2335 men and 948 women) aged 20 to 65 years. Using data from their 2008 health checkup records, we analyzed the relationship between coffee consumption and the prevalence of metabolic syndrome. Metabolic syndrome was defined according to the Japanese criteria.

Results

Metabolic syndrome was diagnosed in 374 of the 2335 men (16.0%) and 32 of the 948 women (3.4%). In univariate and multiple logistic regression analyses, the odds ratios (ORs) among men for the presence of metabolic syndrome were 0.79 (95% CI: 0.56–1.03) and 0.61 (0.39–0.95), respectively, among moderate (≥4 cups of coffee per day) coffee drinkers as compared with non-coffee drinkers. Among all components of metabolic syndrome, high blood pressure and high triglyceride level were inversely associated with moderate coffee consumption in men, after adjusting for age, body mass index, smoking status, drinking status, and exercise. However, in women, moderate coffee consumption was not significantly associated with the prevalence of metabolic syndrome or its components.

Conclusions

Moderate coffee consumption was significantly associated with lower prevalence of metabolic syndrome in Japanese male civil servants.

[Effects of kakisu (persimmon vinegar) on plasma antioxidant power and urinary 8-isoprostane level]

OBJECTIVES

To clarify the antioxidative effects of kakisu (persimmon vinegar), plasma antioxidant power and urinary oxidative stress level in healthy subjects were measured using enzyme immunological assays.

METHODS

Eighty-one subjects (age 30-69, 58.4 +/- 0.8) were randomly divided into two groups using a crossover design. Group A drank kakisu for 56 days starting in March, whereas group B drank kakisu for 54 days starting in June. Copper reducing equivalent level in plasma was measured as antioxidant power, and urinary 8-isoprostane (8-iso-prostaglandin F2alpha) level was measured as oxidative stress marker.

RESULTS

Baseline plasma antioxidant power and urinary 8-isoprostane level showed no significant correlation among the subjects in this study. By drinking kakisu for 8 weeks, total antioxidant power significantly increased, and urinary 8-isoprostane level decreased. Total antioxidant power increased more markedly in group A than in group B. In contrast, urinary oxidative stress level decreased more markedly in group B than in group A. Smoking habits significantly correlated with urinary 8-isoprostane level. Males were more sensitive to the antioxidative effects of kakisu than females.

CONCLUSIONS

Kakisu has antioxidative effects that increase plasma antioxidant power and reduce urinary 8-isoprostane level. Further study is needed to clarify the influence of season and gender on such antioxidative effects.

Antimutagenicity of cinnamaldehyde and vanillin in human cells: Global gene expression and possible role of DNA damage and repair

Vanillin (VAN) and cinnamaldehyde (CIN) are dietary flavorings that exhibit antimutagenic activity against mutagen-induced and spontaneous mutations in bacteria. Although these compounds were antimutagenic against chromosomal mutations in mammalian cells, they have not been studied for antimutagenesis against spontaneous gene mutations in mammalian cells. Thus, we initiated studies with VAN and CIN in human mismatch repair-deficient (hMLH1(-)) HCT116 colon cancer cells, which exhibit high spontaneous mutation rates (mutations/cell/generation) at the HPRT locus, permitting analysis of antimutagenic effects of agents against spontaneous mutation. Long-term (1-3 weeks) treatment of HCT116 cells with VAN at minimally toxic concentrations (0.5-2.5mM) reduced the spontaneous HPRT mutant fraction (MF, mutants/10(6) survivors) in a concentration-related manner by 19-73%. A similar treatment with CIN at 2.5-7.5microM yielded a 13-56% reduction of the spontaneous MF. Short-term (4-h) treatments also reduced the spontaneous MF by 64% (VAN) and 31% (CIN). To investigate the mechanisms of antimutagenesis, we evaluated the ability of VAN and CIN to induce DNA damage (comet assay) and to alter global gene expression (Affymetrix GeneChip) after 4-h treatments. Both VAN and CIN induced DNA damage in both mismatch repair-proficient (HCT116+chr3) and deficient (HCT116) cells at concentrations that were antimutagenic in HCT116 cells. There were 64 genes whose expression was changed similarly by both VAN and CIN; these included genes related to DNA damage, stress responses, oxidative damage, apoptosis, and cell growth. RT-PCR results paralleled the Affymetrix results for four selected genes (HMOX1, DDIT4, GCLM, and CLK4). Our results show for the first time that VAN and CIN are antimutagenic against spontaneous mutations in mammalian (human) cells. These and other data lead us to propose that VAN and CIN may induce DNA damage that elicits recombinational DNA repair, which reduces spontaneous mutations.

Arsenite induces delayed mutagenesis and transformation in human osteosarcoma cells at extremely low concentrations

Arsenite is a human multisite carcinogen, but its mechanism of action is not known. We recently found that extremely low concentrations (</=0.1 microM) of arsenite transform human osteosarcoma TE85 (HOS) cells to anchorage-independence. In contrast to other carcinogens which transform these cells within days of exposure, almost 8 weeks of arsenite exposure are required for transformation. We decided to reexamine the question of arsenite mutagenicity using chronic exposure in a spontaneous mutagenesis assay we previously developed. Arsenite was able to cause a delayed increase in mutagenesis at extremely low concentrations (</=0.1 microM) in a dose-dependent manner. The increase in mutant frequency occurred after almost 20 generations of growth in arsenite. Transformation required more than 30 generations of continuous exposure. We also found that arsenite induced gene amplification of the dihydrofolate reductase (DHFR) gene in a dose-dependent manner. Since HOS cells are able to methylate arsenite at a very low rate, it was possible that active metabolites such as monomethylarsonous acid (MMA(III)) contributed to the delayed mutagenesis and transformation in these cells. However, when the assay was repeated with MMA(III), we found no significant increase in mutagenesis or transformation, suggesting that arsenite-induced delayed mutagenesis and transformation are not caused by arsenite's metabolites, but by arsenite itself. Our results suggest that long-term exposure to low concentrations of arsenite may affect signaling pathways that result in a progressive genomic instability.

Reduction of spontaneous mutagenesis in mismatch repair-deficient and proficient cells by dietary antioxidants

Cells lacking mismatch repair (MMR) exhibit elevated levels of spontaneous mutagenesis. Evidence exists that MMR is involved in repair of some DNA lesions besides mismatches. If some oxidative DNA lesions are substrates for MMR, then the excess mutagenesis in MMR(-) cells might be blocked by dietary antioxidants. Effects of the dietary antioxidants ascorbate, alpha-tocopherol, (-)-epigallocatechin gallate (EGCG) and lycopene on spontaneous mutagenesis were studied using mismatch repair-deficient (hMLH1(-)) human colon carcinoma HCT116 cells and HCT116/ch3 cells, in which normal human chromosome 3 has been added to restore mismatch repair. HCT116 cells have a 22-fold higher spontaneous mutation rate compared with HCT116/ch3 cells. HCT116 cells cultured in 1% fetal bovine serum (FBS) have twice the spontaneous mutation rate of those cultured in 10% FBS, most likely due to reduction in serum antioxidants in the low serum medium. As expected, alpha-tocopherol (50 microM) and ascorbate (284 microM) reduced spontaneous mutagenesis in HCT116 cells growing in 1% serum more dramatically than in cells cultured in 10% serum. The strongest antimutagenic compound was lycopene (5 microM), which reduced spontaneous mutagenesis equally (about 70%) in HCT116 cells growing in 10 and 1% FBS and in HCT116/ch3 cells. Since lycopene was equally antimutagenic in cells growing in low and high serum, it may have another antimutagenic mechanism in addition to its antioxidant effect. Surprisingly, EGCG (10 microM) was toxic to cells growing in low serum. It also reduced spontaneous mutagenesis equally (nearly 40%) in HCT116 and HCT116/ch3 cells. The large proportion of spontaneous mutagenesis that can be blocked by antioxidants in mismatch repair-deficient cells support the hypothesis that a major cause of their excess mutagenesis is endogenous oxidants. Blocking spontaneous mutagenesis, perhaps with a cocktail of antioxidants, should reduce the risk of cancer in people with a genetic defect in mismatch repair as well as other individuals.

Effect of the Hanshin-Awaji earthquake on posttraumatic stress, lifestyle changes, and cortisol levels of victims

In 1995, the Hanshin-Awaji area in Japan was damaged severely by a major earthquake. In this study, the authors administered questionnaires and obtained blood samples to analyze the relationships among lifestyle, psychological stress, and plasma cortisol levels of victims. The authors questioned 107 male inhabitants of Awaji Island about their lifestyles before and after the earthquake, presence of any symptoms of posttraumatic stress disorder, and demographic variables. Plasma cortisol levels were determined with enzyme immunoassay. Cortisol level was correlated strongly with change in lifestyle. The highest cortisol levels were found in the group characterized by a high posttraumatic stress disorder score and by a very profound lifestyle change. This group also contained the highest percentage of subjects who had poor health. In summary, the psychological stress induced by the Hanshin-Awaji earthquake was associated with mean cortisol level; however, this relationship was affected by adjustment of lifestyle.

Validation study of the in vitro micronucleus test in a Chinese hamster lung cell line (CHL/IU)

We conducted a collaborative validation study, under the auspices of the Japanese Ministry of Labour, on the in vitro micronucleus test to see if it could be used as an alternative to the in vitro chromosome aberration test for evaluation of chemical safety. We used the Chinese hamster lung cell line (CHL/IU), which is the most widely used system for the latter test in Japan, and evaluated 66 chemicals, including clastogens and polyploidy inducers. The cytochalasin B cytokinesis blocking method, which is commonly used in human lymphocyte culture, was applied to the established cell line, but did not improve the detection of chemically-induced micronuclei in continuously growing cells. The highest micronucleus frequencies were obtained at 48 or 72 h continuous treatments. In short treatments (6 h), a 42 h recovery time yielded the best responses. Concordance between the results of the micronucleus test and the chromosomal aberration test was satisfactorily high (88.7%), and we concluded that the in vitro micronucleus test could be used in place of the chromosomal aberration test as a simple and rapid method for detecting clastogens and aneugens in vitro. We also propose a protocol for the test.

Posttraumatic stress and change in lifestyle among the Hanshin-Awaji earthquake victims

BACKGROUND

In 1995, Japan's Hanshin-Awaji area was severely damaged by a major earthquake. Lifestyle factors, sometimes associated with physical health and mortality, have also been known to be associated with mental health status. This report examines the relationship between the subsequent change in lifestyle and the psychological stress induced by the earth quake.

METHOD

An investigation was made of 108 male inhabitants of Awaji Island as to their individual lifestyle before and after the great earthquake, any posttraumatic stress disorder (PTSD) symptoms, and their demographic variables.

RESULTS

The mean PTSD score was higher in the worse lifestyle group than in the no/better lifestyle change group. Category B or D of PTSD scores were higher in the worse lifestyle group than in the no/better lifestyle change group. The percentage of subjects who lived in temporary public housing was higher in the worse lifestyle group than in the no/better lifestyle change group.

CONCLUSIONS

Worse change in lifestyle might be associated with high PTSD score in victims of Hanshin-Awaji earthquake.

Heavy cigarette smokers show higher mutagenicity in urine

We examined the mutagenicity of cigarette smoker's urine in 32 healthy male cigarette smoker and 37 healthy male non-smoker. Twenty-four-hour urine specimens were subjected to blue rayon extraction which selectively adsorb polycyclic compounds, after which the elutions were fractionated by carboxymethyl cellulose column chromatography for removing antimutagenic compounds. The mutagens were measured by using an S9-mediated Salmonella mutagenicity test on strain TA98. Compared with those with non-smokers, smokers' urine showed a significantly higher urinary level of mutagens in the acid-elutable and in the sum of all chromatography fractions. A similar tendency was also seen in the alkali-elutable fraction. The subjects were classified into three groups according to the number of smoked cigarettes. Heavy smokers, who smoked more than 20 cigarettes per day, showed a significantly higher urinary level of mutagens than both non-smokers and light smokers especially in the acid-elutable and in the sum of all chromatography fractions. Our findings suggest that smokers are exposed to a great amount of polycyclic carcinogens and mutagens by cigarette smoking. These results also suggest that urinary level of mutagens measured by using blue rayon extraction combined with carboxymethyl cellulose chromatography could be a good index for estimating the exposure to carcinogens and mutagens such as polycyclic compounds.

Urinary mutagens and lifestyle factors

BACKGROUND

Lifestyle determines the amount of exposure to environmental carcinogens/mutagens. We examined the relationship between various lifestyle factors and the urinary level of mutagens, which reflects both exposure dose and metabolism of these carcinogens/ mutagens.

METHODS

Twenty-four-hour urine specimens obtained from 69 males were subjected to blue rayon extraction, after which the elutions were fractionated by carboxymethyl cellulose column chromatography. The mutagens were measured by using an S9-mediated Salmonella mutagenicity test. The subjects were classified into three groups according to their total scores on a questionnaire regarding eight health practices: cigarette smoking, alcohol drinking, nutritional balance, eating breakfast, sleeping hours, working hours, physical exercise, and mental stress.

RESULTS

Compared with those with "poor" health practice, subjects with "good" health practice showed a significantly lower urinary level of mutagens in all chromatography fractions, as well as in the acid- and alkali-elutable fractions. Cigarette smoking and nutritional balance were the most highly correlated factors.

CONCLUSIONS

Our findings show that poor health practices increase the urinary level of mutagens, suggesting that a healthy lifestyle reduces exposure to carcinogens/ mutagens and may reduce cancer risk.

Genotoxic potentials of lifestyles assessed by urinary mutagenicity

The relationships between lifestyles and urinary mutagenicity were investigated by using blue rayon extraction from 33 healthy male workers' urine. Subjects were classified into three groups, as "good", "moderate", and "poor" according to their responses on a questionnaire regarding eight health practices (cigarette smoking, alcohol consumption, eating breakfast, hours of sleep, hours of work, physical exercise, caring about nutritional balance, mental stress). The better lifestyle groups exhibited the lower mutagenicity. Subjects in a "good" group showed significantly lower urinary mutagenicity than those both in a "moderate" (p < 0.05) and a "poor" (p < 0.05) groups at fraction number 1 to 3 that were given after ingesting fried beef. These tendencies also found at fraction number 8 to 9 that were given after smoking, although not significant. The lifestyles were significantly associated with the urinary mutagenicity, and the results suggested that not only particular lifestyle factor but also some combinations with smoking significantly enhanced with the urinary mutagenicity.

Evaluation of 8-hydroxydeoxyguanosine, a typical oxidative DNA damage, in human leukocytes

8-Hydroxydeoxyguanosine (8-OHdG) is a typical form of oxidative DNA damage which causes mutation in vitro and in vivo. We investigated potential factors confounding 8-OHdG determination and, based on the results, then determined the 8-OHdG levels in human peripheral blood leukocytes. 8-OHdG was detected electrochemically after extraction of DNA from the cells without the use of phenol by a DNA extractor under helium. In the preliminary experiments, the mononuclear leukocytes (MN) in blood samples obtained from 19 laboratory workers and students were separated from the polymorphonuclear leukocytes (PMN) with Mono-Poly resolving medium. The 8-OHdG in the MN (1.157 +/- 0.414 molecules per 10(5) deoxyguanosine) did not differ significantly from that in PMN (1.131 +/- 0.418). The effect of red blood cells (RBC) on 8-OHdG formation during DNA extraction was then examined by adding RBC to the human lymphoblastoid cell line FA72. Addition of RBC at ratios of up to 4 RBC per FA72 cell did not increase 8-OHdG levels, while addition at a RBC/FA72 cell ratio of 20 increased the 8-OHdG level 1.43-fold over that without RBC. The potential effect of histidine, a scavenger of both hydroxyl radicals and singlet oxygen, on reduction of artificial 8-OHdG formation during DNA extraction was examined during DNA extraction in the human promyelocytic leukemia cell line HL60. Addition of His decreased the 8-OHdG level dose-dependently (30% reduction at 30 mM His concentration). Based on these results, we determined the 8-OHdG levels in human leukocyte samples obtained from 79 healthy male factory workers aged 24-59 years. The leukocyte fraction containing both MN and PMN was separated from RBC with Mono-Poly resolving medium and DNA was extracted from the leukocytes in the presence of 30 mM His. The mean 8-OHdG level in these samples was 1.072 +/- 0.230. To evaluate the reliability of the assay, FA72 was used as a standard sample in all assay determinations and the 8-OHdG levels of both the leukocyte samples and the FA72 sample(s) were measured in each determination. The inter- and intra-assay coefficients of variation (CV) were calculated to be 14.4% (n = 14) and 3.9-13.5% (n = 3-5 per assay) respectively. The 8-OHdG level was measured twice in 19 leukocyte samples; the value at the first determination was not correlated with that at the second determination. The range of 8-OHdG levels in the samples was relatively small compared with the CV of the assay.(ABSTRACT TRUNCATED AT 400 WORDS)

Chromosome alterations in peripheral lymphocytes as indices of lifestyle and genotoxicity

Short-term cultures of human lymphocytes were used to investigate the in vitro metabolism of benzene and its genotoxicity, and to monitor genetic health effects of lifestyles. Metabolic (S9) activation of benzene and its metabolites, catechol, hydroquinone, and phenol, caused an increase in sister-chromatid exchanges (SCEs) with different optimal concentrations of S9 mix for converting each compound into further reactive forms. The data indicate that catechol and hydroquinone can be optimally metabolized to produce reactive species, presumably benzo(semi)quinones, under conditions of lower metabolic activity than those necessary for phenol and benzene. We have further investigated the correlations between chromosome alterations (SCEs, structural aberrations and micronuclei) in peripheral lymphocytes and individual lifestyles. Healthy lifestyles, or "good health practices" examined were 1) not smoking, 2) not drinking too much alcohol, 3) doing physical exercise regularly, 4) sleeping more than 6 h per night, 5) keeping nutritional balance in meals, 6) not snacking, 7) having breakfast everyday, and 8) not having too much perceived stress. The persons were categorized into 3 groups having good, moderate and poor lifestyles by the number of good health practices they do. Mean frequencies of chromosome alterations in lymphocytes from men with poor lifestyles have been shown to be significantly higher than those in cells from men having good lifestyles.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study on flomoxef in the perinatal period]

The placental passage and the the therapeutic efficacy of flomoxef (FMOX, 6315-S) were studied in patients in the perinatal period. A summary of the obtained results is as follows: 1. Concentrations of FMOX in maternal serum, umbilical cord serum and amniotic fluid obtained upon one-shot intravenous injections to 12 patients were compared with those obtained upon 1 hour drip infusions to 9 patients. It was found that the former means of administration gave higher concentrations that the latter. 2. Concentrations of FMOX in maternal serum, umbilical cord serum and amniotic fluid at 1 to 6 hours after administration through either method were all higher than MIC80's of recognized bacteria. 3. Clinical efficacies were evaluated in 10 patients with puerperal intrauterine infection, 7 patients with endometritis, 2 patients with pyelonephritis and 1 patient each with endo-cervicitis, amniotic fluid infection, mastitis and perineal wound infection. Clinical efficacies were excellent in 5 patients (21.7%), good in 17 patients (73.9%) and poor in 1 patient (4.4%), thus the overall efficacy rate was 95.7%. 4. Eradication of causative bacteria were obtained in all 8 cases tested, hence the eradication rate was 100%. 5. Mild diarrhea in 1 patient was the only side effect observed. No abnormal clinical laboratory test results were found in any patients.

[Pharmacokinetic, bacteriological and clinical studies of cefuzonam in the field of obstetrics and gynecology. Study group of cefuzonam in the field of obstetrics and gynecological infections]

A multi-center open study was conducted to investigate cefuzonam (CZON, L-105) regarding to its pharmacokinetic, bacteriological and clinical aspects in the field of obstetrics and gynecology with the participation of 31 medical institutions and the related facilities. The results are summarized as follows. 1. Peak MICs of CZON for Staphylococcus aureus, coagulase (-) staphylococci, Escherichia coli, Klebsiella pneumoniae, Bacteroides fragilis group, Peptostreptococcus spp. isolated from obstetrical and gynecological infections with relatively high frequencies were 0.39, 0.20, 0.024, 0.024-0.05, 12.5, 0.20 microgram/ml, respectively, with an inoculum size of 10(6) CFU/ml. 2. When 1 g of CZON was given through bolus injection, the maximum concentration (Cmax) of CZON in pelvic dead space exudate was 18.7 micrograms/ml at 60.9 minutes (Tmax) after the injection; Cmax's in all female genital tissues were observed at 0.6-27.9 minutes and ranged from 11.9-26.3 micrograms/g. The Cmax 8.3 micrograms/ml, in the pelvic dead space exudate was noted at 97.0 minutes after the end of the intravenous drip infusion of 1 g over 1 hour, and Cmax's in genital tissues were 14.3-30.0 micrograms/g at the end of infusion. With 1 hour drip infusion of 2 g, Cmax's in genital tissues were 35.0-53.9 micrograms/g at the end of infusion. 3. The clinical efficacy of CZON was evaluated in 206 evaluable patients with obstetric and gynecologic infections. Efficacy rates classified by types of infections were 97.1% (67/69) for intrauterine infections, 81.6% (31/38) for intrapelvic infections, 91.8% (45/49) for adnexitis, 95.2% (20/21) for infections of the external genital organs and 86.2% (25/29) for other infections. 4. Side effects were observed in 7 of the 262 patients: eruption in 6 cases, itching in 2, diarrhea in 1. Abnormal laboratory test values were noted in 9 of the 256 patients. Most of them were slight elevation of hepatic function values. CZON showed satisfactory clinical efficacy and potent antibacterial activity, hence it appears that CZON will be a very useful antibiotic for obstetric and gynecologic infections.

Apoenzyme of aspartate aminotransferase isoenzymes in maternal plasma during labor and following delivery

In eight normal mothers the effects of pyridoxal 5'-phosphate (PLP) addition on the plasma activities of aspartate aminotransferase isoenzymes (AST-s and AST-m) during labor and following delivery were investigated. The AST-s activities with and without reactivation by PLP appeared to increase immediately after delivery and they were even higher on the 4th day postpartum. On the other hand, there were significant elevations in both the AST-m activities immediately and at 2 h after delivery, but not on the 4th day postpartum. Of AST isoenzymes measured in the nonstress test, only the relative activation rate of AST-m by PLP added was significantly higher than the control value. The present study may come to the following conclusions: 1) The relative activation rate of plasma AST-m activity by PLP may be a reliable index of vitamin B6 nutritional status during pregnancy. 2) The increases in AST-m activity with and without PLP added during labor suggest a minimal damage of mitochondria in skeletal, cardiac and uterine muscle cells. 3) The AST-s isoenzyme determinations with and without PLP may be especially useful as sensitive indication of erythrocyte and/or liver damage after delivery.

[Basic and clinical studies on ceftriaxone in perinatal infections]

Basic and clinical investigations were conducted on ceftriaxone (CTRX), a cephem antibiotic with a wide antibacterial spectrum and with especially high activity against Gram-negative bacteria. The results obtained are summarized as follows: 1. CTRX, following intravenous drip infusion of 1 g, had a serum half-life of 5.8 hours, which is longer than that of any other existing cephem antibiotics. 2. The level of CTRX in the umbilical cord serum 6 hours after intravenous drip infusion of 1 g was at a satisfactory level, 15 micrograms/ml. 3. The CTRX was remarkably effective or effective in 9 cases, and the activity was high even in cases where penicillin or other third-generation cephems were ineffective. These results seem to indicate that CTRX may be effective in perinatal and intrauterine fetal infections.

Maternal blood distribution of zinc and copper during labor and after delivery

In 15 normal mothers the stress effects of labor on zinc and copper distributions in erythrocytes and plasma were investigated. Lower levels of total zinc and of zinc derived from both carbonic anhydrase isoenzymes (CA-I and CA-II), especially from CA-I, in erythrocytes were obtained immediately after delivery. On the other hand, there was a significant increase in total plasma zinc concentration only on admission to hospital in labor, although albumin-bound zinc concentration remained elevated throughout the entire labor. These results suggest that there are unexplained disparities between the changes in zinc levels in maternal erythrocytes and plasma during labor.

[Clinical and laboratory evaluations of ceftazidime in perinatal use. A study of ceftazidime in the perinatal co-research group]

Efficacy and safety of ceftazidime (CAZ) in women during the perinatal period and their neonates were evaluated by a perinatal co-research group, and the results obtained were summarized as follows. Following an intravenous bolus injection or a drip infusion of CAZ from 1 g to 2 g, CAZ was transferred to maternal serum, umbilical cord serum and amniotic fluid rapidly and effectively. In 31 cases of perinatal infections, clinical efficacy was excellent in 10 cases, good in 18 and poor in 3, with an efficacy rate of 90.3%. In 85 cases given CAZ for prophylaxis of infections accompanying premature rupture of the membrane or following cesarean section, prophylactic effects were noted in 81 cases (efficacy rate: 95.3%). Neither adverse effects, nor abnormal laboratory findings were observed in any case. Also, no abnormalities in total serum bilirubin were observed in any neonates. From the above results, CAZ is considered to be a safe and useful drug for infections in women in perinatal period, usually in a unit dose of 1 g twice daily, or if necessary, 2 g twice daily.

[Fundamental and clinical evaluation of ceftazidime in perinatal studies]

In a chemotherapy of perinatal infections, the safety of mothers and their neonates and the transfer of a drug to amniotic fluid and fetus as well as its bacteriological efficacy are some of the important factors. In the present study, the authors have carried out a pharmacokinetic evaluation on the transfer of ceftazidime (CAZ), a new cephalosporin, to amniotic fluid and umbilical cord serum, and also a clinical study on its efficacy and safety in 3 cases of perinatal infections. Transfer ratios of CAZ to umbilical serum and to amniotic fluid were 25.3-46.5% and 0.6-17.5% (of maternal serum), respectively, after 1 g of CAZ was administered by bolus intravenous injection, and 24.3-85.8% and 1.6-17.5% (of maternal serum), respectively, after 2 g of CAZ was administered by bolus intravenous injection. These levels were high enough to expect that CAZ is an effective antibiotic both for treatment and prophylaxis of intrauterine fetal infections. Out of the 3 cases treated with CAZ, clinical efficacy was good in 2 cases which did not respond to other antibiotics. CAZ was considered to be clinically effective, although the number of cases treated was small. No abnormalities were observed at all either in subjective symptoms or objective findings in laboratory findings such as hepatic and renal functions of mothers, or neonates. This confirmed the high safety of CAZ. As earlier reports indicate, CAZ has a broad-spectrum of antibacterial activity against various bacteria including Gram-negative organisms and anaerobes, and shows a good transfer into intrauterine tissues, and high clinical efficacy in the field of obstetrics and gynecology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Penetration of imipenem/cilastatin sodium into the tissues of the female reproductive organs]

A new combined preparation, imipenem/cilastatin (MK-0787/MK-0791), was evaluated its penetration into the plasma and tissues with the following results: After an intravenous drip infusion of 500 mg/500 mg of MK-0787/MK-0791, the plasma concentration of drug achieved in the uterine artery was almost equal to that in the antecubital vein, showing good penetration of the drug. After an intravenous drip infusion of 500 mg/500 mg of MK-0787/MK-0791, favorable concentrations were achieved in all of the adnexal and uterine tissues studied. From the results obtained, it is expected that MK-0787/MK-0791 will be highly effective in the field of obstetrics and gynecology.

Maternal plasma concentrations of catecholamines and cyclic nucleotides during labor and following delivery

In plasma obtained from seven mothers before, during, and after normal labor and delivery, catecholamine and cyclic nucleotide concentrations were investigated. Dopamine concentration showed a significant elevation on admission to hospital in labor and there were marked increases in norepinephrine and epinephrine concentrations during labor at 10 cm cervical dilatation and immediately after delivery, respectively. No significant change in dopa, cAMP, or cGMP was found during the experimental period. However, since the van Beaumont quotient (J.Appl. Physiol. 34, 102-106) for cAMP did not follow the reduction in plasma volume, the concentration appeared to rise during labor. Positive correlations were observed between epinephrine on one hand, and heart rate and systolic blood pressure on the other, as well as between norepinephrine and cAMP, respectively, during labor. The diminution of epinephrine on the fourth day postpartum might reflect a reduction of emotional stress concomitant with labor. cAMP was found to be quickly cleared from the bloodstream within 2 hours after delivery. These results suggest that plasma concentrations of epinephrine and cAMP, especially epinephrine, are indices of maternal psychological and physiological stress during labor and following delivery.

Serum immunosuppressive substance in patients with gynecologic malignancies and in pregnant women

The presence of serum immunosuppressive substance (IS) was determined in 134 patients with malignant gynecologic tumors (105 cervical cancers, 15 endometrial cancers, and 14 ovarian cancers), 45 patients with benign gynecologic tumors (33 uterine myomas and 12 ovarian tumors), 10 patients with severe inflammatory diseases, 326 pregnant women, and 48 healthy controls. The mean levels and percentages of positive levels (greater than 750 micrograms/ml) in both the groups of cancer patients and the group of patients with severe inflammatory diseases were significantly higher than those in the groups of patients with benign tumors or the control group. In pregnant women, however, the majority of serum levels were within a normal range, showing relatively elevated levels in the first trimester. In the patients with malignancies (cervical, endometrial, and ovarian cancers), extremely elevated levels (greater than 1000 micrograms/ml) suggested an active or a progressive state of the malignancies. It became clear that serial IS determinations are valuable for monitoring the disease state or judging the effect of therapy.

[Fundamental and clinical studies on aztreonam in obstetrics and gynecology]

Aztreonam (AZT), a monobactam antibiotic, is known to have a high activity against Gram-negative bacteria. Fundamental and clinical studies were carried out on AZT with the following results. Following 1 g of bolus intravenous injection, the transfer of AZT to uterine artery and internal genital organs was found to be satisfactory. The levels of the drug in uterine artery showed 34.28, 4.50 micrograms/ml at approximately 2, 6 hours, and those in internal genital organs showed 3-34 micrograms/g at 2 hours. Clinical efficacy was; excellent in 4 cases, good in 13 cases and poor in 1 case, with the very high overall efficacy rate of 94.4%. Abnormal laboratory findings and side effects due to the drug were not noted.

[Fundamental and clinical studies on cefpimizole in the field of obstetrics and gynecology]

Fundamental and clinical studies on cefpimizole (AC-1370), a new cephalosporin derivative, in the field of obstetrics and gynecology have been investigated, and the following results were obtained. High concentrations of AC-1370 in internal genital organs were detected after intravenous administration of 1.0 g of AC-1370. In the treatment of 14 cases of infection, the therapeutic effects were excellent or good in 11 cases and overall efficiency rate excluding 1 case with side effects was 84.6% (11/13). No serious side effect was observed except 1 case of nausea and vomiting.

Distribution of zinc and copper in maternal and cord blood at delivery

For 17 normal births, the concentrations of trace metals (zinc and copper) and related metalloenzymes, i.e., carbonic anhydrase isoenzymes (CA-I and CA-II) and Cu2Zn2 superoxide dismutase (SOD1) were simultaneously determined in maternal and cord blood at delivery. Eleven healthy nonpregnant women served as controls. CA-I concentration in maternal erythrocytes was higher than in controls (p less than 0.05), whereas the concentrations of both CA isoenzymes in cord erythrocytes were in the range of one seventh to one ninth of those in controls. On the other hand, the erythrocyte SOD1 concentration was constant. A very low total zinc concentration was noted in cord erythrocytes, and this was due to the low concentrations of both CA isoenzymes. Total copper concentration in maternal erythrocytes was significantly lower than in controls (p less than 0.05); in contrast, that in cord erythrocytes was significantly higher than in controls (p less than 0.05). Thus, variations in erythrocyte copper concentrations are due to changes in other forms of copper (not SOD1-derived). Copper concentration in maternal plasma was about three times higher than in controls, while copper concentration in cord plasma was less half of that in control plasma. Conversely, zinc concentration in cord plasma was significantly higher than in controls (p less than 0.05). The concentrations of these metals in maternal erythrocytes and plasma were significantly different from the respective concentrations in cord erythrocytes and plasma. Likewise, the concentrations of these metals in maternal and cord erythrocytes contrasted with the corresponding concentrations in their plasma.

[Studies on combined effect of hyperthermia and MTX to choriocarcinoma cell line (BeWo)]

Changes in cell growth and hormone production of the choriocarcinoma cell line BeWo were studied to determine the manner in which the change in the cell cycle due to antimetabolite MTX affects heat sensitivity. First of all, BeWo was treated with 10(-7)M-MTX for 48 hrs. on day 4. And heat (43 degrees C for 1 h.) was applied at various stages after MTX removal on day 6. At the same time, the change in the cell cycle induced by MTX was studied by autoradiography. The labeling index (L.I.), which was increasing until 90% by MTX exposure, still remained more than 80% up to 5 hrs. after MTX removal and then decreased to about 43% at 9 hrs. after MTX removal. The greatest effect on cell growth and HCG production was seen when heat was applied within 5 hrs. after MTX removal. And these 5 hrs. corresponded to the time when the L.I. was as high as 80 to 90%. When heat was applied more than 6 hrs. after MTX removal, the heat sensitivity was reduced in proportion to the degree of decrease in the L.I. These findings suggest that the change in the cell cycle induced by MTX has the greatest effect on the heat sensitivity of BeWo. It is therefore possible to conclude that synchronization of BeWo with S phase by using MTX or possibly other antimetabolites is very important in the application of hyperthermia.

[Experimental and clinical evaluation on ceftriaxone in the field of obstetrics and gynecology]

Ceftriaxone (CTRX), a new cephalosporin antibiotic, was evaluated in the field of obstetrics and gynecology and the following results were obtained. The concentration of CTRX after an intravenous injection with 1 g was determined in the uterine artery, cubital vein and in the intrapelvic genital tissues such as the oviduct, ovary, endometrium, myometrium, cervix uteri and portio vaginalis. The peak level was 160 micrograms/ml at 26 minutes after injection both in the uterine arterial serum and cubital venous serum, 48 and 38 micrograms/g at 1 hour and 18 minutes in the tissues of oviduct and ovary, respectively, 54 and 50 micrograms/g at 48 minutes in the myometrium and cervix uteri, respectively, while 46 micrograms/g at 39 minutes in the portio vaginalis. The mean level 18 to 24 hours after administration was 19 micrograms/ml in the uterine arterial serum and cubital venous serum and 6.3 micrograms/g in the intrapelvic genital tissues. A case of intrapelvic infection clinically showed an excellent response without any side effects by intravenous drip infusion with 2 g divided as twice a day for 7 days. The above results show that CTRX is useful in the field of obstetrics. and gynecology.

[Effect of methotrexate on cell growth and the production of hCG, beta-hCG and SP-1 in cultured choriocarcinoma cell lines]

Three choriocarcinoma cell lines (BeWo, GCH-2 and SCH) cultured in MTX or MTX-free medium were investigated with respect to cell growth and production of hCG, beta-hCG and specific beta-1-glycoprotein (SP-1). MTX was administered at the concentration of 10(-8), 10(-7), 10(-6), 10(-5)M for 24 hours, 72 hours and 168 hours from the fourth day of culture. Each cell line demonstrated that the cell growth and production of hCG and beta-hCG were dose, rather than time, dependent. 10(-6)M or more of MTX had a distinct effect, but 10(-7) or less of MTX had little effect. SP-1 was produced at a low level during culture regardless of the medium used. The ratio of the extra- to the intracellular hCG level was shown to be about 100:1 after the administration of MTX to BeWo and GCH-2. It is, therefore, possible that the temporary elevation of the hCG level observed in vitro after treatment with MTX is the result of an increase in secretion of hCG, rather than cellular damage.