POS1391 DEEP LEARNING-BASED PANNUS LOCALIZATION SOFTWARE IN THE HANDS OF INFLAMMATORY ARTHRITIS USING TIME-INTENSITY CURVE (TIC) SHAPE CLASSIFICATION ON DYNAMIC MRI DATASET

Background

Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with significant functional impairment and disability, linked to inflammatory and structural articular and peri-articular damage [1]. Synovitis is a characteristic feature of RA, and is considered an important factor in disease activity and the best predictive marker of joint damage [2]. Therefore, accurate quantification of synovitis can play an important role in clinical evaluation and treatment serving as a biomarker. Pixel-by-pixel time–intensity curve (TIC) shape analysis is a dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) technique to help visualize differently shaped TICs [3]. Pixels having TIC shape type 4, which is characterized as early enhancement followed by washout phase, were regarded as synovitis pixel [4]. A deep residual network called ResNet-50 model, a convolutional neural network (CNN) that is 50 layers deep, might effectively classify TIC shapes.

Objectives

This study aimed to develop software that can automatically demonstrate the distribution of enhancing synovial pannus of patients with inflammatory arthritis on DCE-MRI.

Methods

Modified ResNet-50 was used on MATLAB. Two investigators drew regions of interest (ROIs) of muscle, bone, and synovitis under expert guidance and obtained TICs for each tissue on DCE-MRI of ten rheumatoid patients. Through cross-validation and batch evaluation, we verified the confusion matrices for the performance of the classifier. Then we identified the pixels of enhancing synovial pannus by image classification from the obtained pixel-by-pixel TIC shape and displayed them in color. The software performance was evaluated using a visual assessment on seven hand joints of one patient.

Results

150 ROIs for muscles, 150 ROIs for bones, and 59 ROIs for synovitis on DCE-MRI of the hand joints were drawn in ten patients and obtained 4049, 3825, and 1041 TIC shape images, respectively. The classifier’s accuracy, precision, sensitivity, and specificity were 99.6%, 99.3%, 98.4%, and 99.7%, respectively. Out of seven joints, four were assessed as good, two as fair, and one as fail.

Figure 1.

Software performance on contrast enhanced dynamic MRI of the wrist

Conclusion

Our classifier showed high accuracy, precision, sensitivity, and specificity. And through the comparison between manual outlining and the result of software, our software had relatively good performance. This automatic software developed using deep learning with CNN might accurately display the enhancing synovial pannus in RA.

References

[1]Micu MC, Fodor D. Concepts in monitoring the treatment in rheumatoid arthritis- the role of musculoskeletal ultrasound. Part I: synovitis. Med Ultrason. 2015;17(3):367-76.

[2]Carotti M, Galeazzi V, Catucci F, Zappia M, Arrigoni F, Barile A, et al. Clinical utility of eco-color-power Doppler ultrasonography and contrast enhanced magnetic resonance imaging for interpretation and quantification of joint synovitis: a review. Acta Biomed. 2018;89(1-s):48-77.

[3]Sakashita T, Kamishima T, Kobayashi Y, Sugimori H, Tang M, Sutherland K, et al. Accurate quantitative assessment of synovitis in rheumatoid arthritis using pixel-by-pixel, time-intensity curve shape analysis. Br J Radiol. 2016;89(1061):20151000.

[4]Kobayashi Y, Kamishima T, Sugimori H, Ichikawa S, Noguchi A, Kono M, et al. Quantification of hand synovitis in rheumatoid arthritis: Arterial mask subtraction reinforced with mutual information can improve accuracy of pixel-by-pixel time-intensity curve shape analysis in dynamic MRI. J Magn Reson Imaging. 2018.

Disclosure of Interests

None declared

Interobserver Reliability on Intravoxel Incoherent Motion Imaging in Patients with Acute Ischemic Stroke

BACKGROUND AND PURPOSE

Noninvasive perfusion-weighted imaging with short scanning time could be advantageous in order to determine presumed penumbral regions and subsequent treatment strategy for acute ischemic stroke (AIS). Our aim was to evaluate interobserver agreement and the clinical utility of intravoxel incoherent motion MR imaging in patients with acute ischemic stroke.

MATERIALS AND METHODS

We retrospectively studied 29 patients with AIS (17 men, 12 women; mean age, 75.2 [SD, 12.0 ] years; median, 77 years). Each patient underwent intravoxel incoherent motion MR imaging using a 1.5T MR imaging scanner. Diffusion-sensitizing gradients were applied sequentially in the x, y, and z directions with 6 different b-values (0, 50, 100, 150, 200, and 1000 seconds/mm²). From the intravoxel incoherent motion MR imaging data, diffusion coefficient, perfusion fraction, and pseudodiffusion coefficient maps were obtained using a 2-step fitting algorithm based on the Levenberg-Marquardt method. The presence of decreases in the intravoxel incoherent motion perfusion fraction and pseudodiffusion coefficient values compared with the contralateral normal-appearing brain was graded on a 2-point scale by 2 independent neuroradiologists. Interobserver agreement on the rating scale was evaluated using the κ statistic. Clinical characteristics of patients with a nondecreased intravoxel incoherent motion perfusion fraction and/or pseudodiffusion coefficient rated by the 2 observers were also assessed.

RESULTS

Interobserver agreement was shown for the intravoxel incoherent motion perfusion fraction (κ = 0.854) and pseudodiffusion coefficient (κ = 0.789) maps, which indicated almost perfect and substantial agreement, respectively. Patients with a nondecreased intravoxel incoherent motion perfusion fraction tended to show recanalization of the occluded intracranial arteries more frequently than patients with a decreased intravoxel incoherent motion perfusion fraction.

CONCLUSIONS

Intravoxel incoherent motion MR imaging could be performed in < 1 minute in addition to routine DWI. Intravoxel incoherent motion parameters noninvasively provide feasible, qualitative perfusion-related information for assessing patients with acute ischemic stroke.

Validity of the Framingham Risk Model Applied to Japanese Men

Objectives: To examine whether the Framingham Risk Model can appropriately predict coronary heart disease (CHD) events detected by electrocardiography (ECG) in Japanese men.

Methods: Using the annual health examination database of a Japanese company 5611 male workers, between the ages of 30 to 59, who were free of cardiovascular disease, were followed up to observe the occurrence of CHD events detected by ECG over a period of five to seven years. The probability of CHD was calculated for each individual from the equations of the Framingham risk model (with total cholesterol).

Results: The incidence of CHD increased with the estimated CHD risk. The Hosmer-Lemeshow goodness of fit test showed an adequate fit of the risk model to the data of the study subjects. In the receiver operating characteristic analysis, the area under the curve reached 0.67 which indicated an acceptable discriminatory accuracy of the risk model.

Conclusions: The Framingham risk model provides useful information on future CHD events in Japanese men.

Standard Protocol for Exchange of Health-checkup Data Based on SGML: The Health-checkup Data Markup Language (HDML)

Objectives: To develop a health/medical data interchange model for efficient electronic exchange of data among health-checkup facilities.

Results: A Health-checkup Data Markup Language (HDML) was developed on the basis of the Standard Generalized Markup Language (SGML), and a feasibility study carried out, involving data exchange between two health checkup facilities. The structure of HDML is described.

Results: The transfer of numerical lab data, summary findings and health status assessment was successful.

Conclusions: HDML is an improvement to laboratory data exchange. Further work has to address the exchange of qualitative and textual data.

Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: findings from a randomized controlled trial

STUDY QUESTION

What are the effects of fertility education on knowledge, childbearing desires and anxiety?

SUMMARY ANSWER

Providing fertility information contributed to greater knowledge, but increased anxiety.

WHAT IS KNOWN ALREADY

Past studies have found that exposure to educational material improved fertility awareness and changed desires toward childbearing and its timing. Existing educational websites with evidence-based medical information provided in a non-judgmental manner have received favorable responses from reproductive-aged men and women.

STUDY DESIGN, SIZE, DURATION

This three-armed (one intervention and two control groups), randomized controlled trial was conducted using online social research panels (SRPs) in Japan in January 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 1455 participants (726 men and 729 women) between 20 and 39 years of age who hoped to have (more) children in the future were block-randomized and exposed to one of three information brochures: fertility education (intervention group), intake of folic acid during pregnancy (control group 1) or governmental financial support for pregnancy and childbirth (control group 2). Fertility knowledge was measured with the Japanese version of the Cardiff Fertility Knowledge Scale (CFKS-J). Knowledge, child-number and child-timing desires, subjective anxiety (i.e. whether participants felt anxiety [primary outcome]), and scores on the State-Trait Anxiety Inventory were assessed immediately after exposure. Non-inferiority comparisons were performed on subjective anxiety with non-inferiority declared if the upper limit of the two-sided 95% confidence interval (CI) for risk difference did not exceed a margin of 0.15. This test for non-inferiority was only performed for subjective anxiety; all the other variables were tests of superiority.

MAIN RESULTS AND THE ROLE OF CHANCE

Posttest scores on the CFKS-J (mean, SD) were higher in the intervention group than that of the control groups: intervention versus Control 1 and versus Control 2: 52.8 (28.8) versus 40.9 (26.2) (P< 0.001) versus 45.1 (27.1) (P = 0.003) among men and 64.6 (26.0) versus 50.8 (26.9) (P< 0.001) versus 53.0 (26.4) (P< 0.001) among women.

The percentage of participants who felt subjective anxiety after exposure to the intervention brochure was significantly higher than that of the control groups: intervention versus Control 1 and versus Control 2: 32.6 versus 17.8% (risk difference [RD] = 0.149, 95% CI: 0.073–0.225) versus 14.5% (RD = 0.182, 95% CI: 0.108–0.256) among men, and 50.2 versus 26.3% (RD = 0.239, 95% CI: 0.155–0.322) versus 14.0% (RD = 0.362, 95% CI: 0.286–0.439) among women. Non-inferiority of the intervention was inconclusive (i.e. the CI included 0.15) among men whereas inferiority was declared among women. The incidence of anxiety was higher in the intervention group than that of the control groups especially among men aged 30 and older and among women aged 25 and older. No difference existed in childbearing desires between groups after exposure.

LIMITATIONS, REASONS FOR CAUTION

The possibility of selection bias associated with the use of SRPs (higher socioeconomic status and education) and volunteer bias toward those more interested in fertility may limit the generalizability of these findings.

WIDER IMPLICATIONS OF THE FINDINGS

In addition to education targeting a younger generation, psychological approaches are needed to alleviate possible anxiety caused by fertility information.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by National Center for Child Health and Development, Seiiku Medical Study Grant (24-6), the Daiwa Foundation Small Grants and Grant-in-Aid for JSPS Fellows (26-1591). No competing interest declared.

TRIAL REGISTRATION NUMBER

UMIN Clinical Trials Registry. Trial registration number, 000016168.

TRIAL REGISTRATION DATE

13 January 2015.

DATE OF FIRST PATIENT'S ENROLMENT

15 January 2015.

Comparison of recombinant human thrombomodulin and gabexate mesylate for treatment of disseminated intravascular coagulation (DIC) with sepsis following emergent gastrointestinal surgery: a retrospective study

PURPOSE

Recombinant thrombomodulin (rTM) has been available in Japan since 2008, but there is concern about its association with postoperative hemorrhage. The efficacy and safety of rTM were examined in patients with disseminated intravascular coagulation (DIC) caused by a septic condition after gastrointestinal surgery.

METHODS

Forty-two patients were emergently admitted to the intensive care unit after emergent gastrointestinal surgery in Kyushu University Hospital from May 2008 to April 2013. Of these patients, 22 had DIC (defined as an acute DIC score ≥ 4). All but three patients received treatment with gabexate mesylate (GM) (n = 9) or rTM (n = 10). The causes of sepsis were peritonitis with colorectal perforation, anastomotic leakage, and intestinal necrosis. Acute DIC score, sepsis-related organ failure assessment score, platelet count, and a variety of biochemical parameters were compared between rTM and GM recipients after treatment administration.

RESULTS

There were no significant differences between the groups for any parameter except C-reactive protein levels. The CRP level tended to be lower in the rTM group than in the GM group. Acute DIC score in the rTM group resolved significantly earlier than that in the GM group. No patient stopped the administration of rTM because of postoperative bleeding.

CONCLUSION

rTM may be an effective therapeutic drug for the treatment of septic patients with DIC following emergent gastrointestinal surgery.

Influence of Behavioral and Environmental Factors on the Development of Obesity in Three-year-old Children -A Case-Control Study Based on Toyama Study-

Obesity in children seems to be a risk factor for chronic diseases in adulthood. From the viewpoint of preventive medicine, factors influencing the development of obese children should be removed early in life.The purpose of this study was to the elucidate relationship between obesity in 3-year-old children and both behavioral and environmental factors by conducting a case-control study. Subjects were selected from the Toyama study. Matched-pair comparisons were performed between obese children whose Kaup's index was 18 or more (N=117) and control children (N=234) . Multivariate stepwised logistic regression analysis also applied to assess influence of confounding factors.The results indicated that the following 6 factors significantly influenced the development of obese 3-year-old children in exact Fisher's method analysis (p<0.05): person other than the mother responsible for taking care of the child, short sleep duration (9 hours or less), physical inactivity, eating snacks irregularly, overweight father (BMI≥24), and overweight mother (BMI≥24). For both sexes, after adjusting for confounders by multivariate stepwise logistic analysis, overweight mother (OR 2.54, 95 % CI 1.64-3.95), birth overweight (birth weight≥3,500g; OR 1.76, 95 % CI 1.15-2.69), the mother not responsible for taking care of the child (OR 1.65, 95% CI 1.10-2.48), overweight father (OR 1.62, 95%CI 1.09-2.40), eating snacks irregularly (OR 1.56, 95% CI 1.04-2.33), and gender (female;OR 0.51, 95% CI 0.34-0.77) had significant relationships with obesity in childhood. For boys, overweight mother (OR 2.53, 95 % CI 1.47-4.35), birth overweight (OR 2.03, 95%CI 1.22-3.39), eating snacks irregularly (OR 1.94, 95 %CI 1.19-3.18), and birth month (36-41 months; OR 0.47, 95 % CI 0.23-0.96) had significant relationships. For girls, overweight mother (OR 2.62, 1.28-5.35), and short sleep duration (OR 2.24, 1.11-4.52) had significant relationships. In neither Fisher's exact method nor multivariate logistic models, time to wake up, bedtime, duration of playing outdoors, regularity of meals, care about salty food, or frequency of eating snacks had significant relations with obesity in 3-year-old children (p<0.05).

Effect of long-term physical exercise of peripheral nerve: comparison of nerve conduction study and ultrasonography

AIM

The aim of this study was to assess the effects of long-term physical exercise on peripheral nerve using both nerve conduction study (NCS) and ultrasonography (US).

METHODS

The authors measured nerve conduction study and ultrasonography in 15 male (mean, 20±1.5 years) handball players and 13 male (mean, 21.3±1.9 years) control subjects. Cross-sectional area of the median nerve was evaluated using ultrasonography at the carpal tunnel and 6 cm proximal to the wrist, and the ulnar nerve at 6 cm proximal to the wrist crease, 2 cm proximal to the medial epicondyle, the epicondyle, and 2 cm distal to epicondyle.

RESULTS

US shows significantly increased cross-sectional area of both median and ulnar nerve in the players compared with that in the controls, and the latency times in both nerves were significantly delayed in the players compared with that in the controls. Cross-sectional area of the median nerve showed a significant correlation with latency (r=0.330, P<0.01).

CONCLUSION

This study suggests that the players have a tendency toward having both median and ulnar motor nerve damage in the wrist or elbow region although they are asymptomatic.

NAD(P)H oxidase p22phoxC242T polymorphism and ischemic stroke in Japan: the Fukuoka Stroke Registry and the Hisayama study

The C242T polymorphism of p22phox, a component of NAD(P)H oxidase, may have an impact on cardiovascular diseases; however, the association between this polymorphism and brain infarction is not fully understood. Here, we investigate the relationship between the C242T polymorphism and brain infarction in Japan. We recruited 1055 patients with brain infarction and 1055 control subjects. A chi-squared test revealed that the T-allele frequency was lower in patients with cardioembolic infarction (5.6%) than in control subjects (11.0%, P < 0.001); however, allele frequencies in patients with lacunar and atherothrombotic infarction (11.2%) were not significantly different from those in control subjects (11.0%). A multivariate-adjusted conditional logistic regression analysis also revealed no association between CT + TT genotype, and lacunar and atherothrombotic infarction (odds ratio = 0.97, 95% confidence interval: 0.72-1.32). To investigate the functional effects of the C242T polymorphism, we examined superoxide production in COS-7 cells cotransfected with Nox4 and p22phox of each genotype. The superoxide-producing activity in those cells expressing p22phox with the T allele was not significantly different from that in cells expressing p22phox with the C allele. The present results suggest that the p22phox C242T polymorphism may have a protective effect against cardioembolic infarction, but is not related to lacunar and atherothrombotic infarction in Japan.

Hematopoietic stem cell transplantation for natural killer-cell lineage neoplasms

Neoplasms of natural killer (NK)-lineage are rare. Their prognosis is generally poor except for cases of solitary nasal NK-cell lymphoma. The NK-cell Tumor Study Group performed a survey in Japan on patients diagnosed between 1994 and 1998. Of 228 patients selected for analysis, 40 underwent HSCT (15 allografts and 25 autografts). The underlying diseases were myeloid/NK cell precursor acute leukemia (n = 4), blastic NK-cell lymphoma (n = 11), aggressive NK-cell leukemia (n = 3), and nasal-type extranodal NK-cell lymphoma (n = 22). At the time of HSCT, 22 patients were in complete remission (CR), 11 were in relapse, and seven were primary refractory. All patients received myeloablative conditioning regimens including total-body irradiation. Sixteen died of disease progression, and six of treatment-related causes. Overall, 4-year survival was 39% with a median follow-up of 50 months; this was significantly better than that of patients who did not undergo HSCT (21%, P = 0.0003). For patients transplanted in CR, the 4-year overall survival was 68%, which was significantly better than that of patients who went into CR but did not undergo HSCT (P = 0.03). These findings suggest that the HSCT is a promising treatment strategy for NK-cell lineage.

[Cor triatriatum diagnosed in adulthood; report of a case]

Cor triatriatum is a rare congenital cardiac anomaly especially in adulthood. A 68-year-old female was diagnosed as a cor triatriatum classified to Lucas-Schmidt IA, severe degree of mitral regurgitation and atrial fibrillation. Resection of the abnormal diaphragm in the left atrium and miral valve replacement were performed. Although the reason of sudden death of this patient after discharge is unknown, surgical intervention for atrial fibrillation should have performed to prevent a thromboembolism in such cases.

Aggressive natural killer-cell leukemia revisited: large granular lymphocyte leukemia of cytotoxic NK cells

Aggressive natural killer-cell leukemia (ANKL) is a rare form of large granular lymphocyte leukemia, which is characterized by a systemic proliferation of NK cells. The clinical features of 22 ANKL cases were analyzed. Hepatomegaly (64%), splenomegaly (55%) and lymphadenopathy (41%) were also frequently observed. Leukemic cells were identified as CD1-, CD2+, surface CD3-, CD4-, CD5-, CD7+, CD8+/-, CD10-, CD11b+/-, CD13-, CD16+, CD19-, CD20-, CD25-, CD33(-), CD34-, CD38+, CD56+, CD122+, HLA-DR+ and TCR-. Two of the 16 cases examined for CD57 were positive and three of the seven cases examined for cytoplasmic CD3. Epstein-Barr virus was detected in the tumor cells of 11 of the 13 cases examined. No common cytogenetic abnormalities were identified and 6q anomaly was detected in only one. Three of 13 patients treated with chemotherapy containing anthracycline/anthraquinone attained complete remission, in contrast to none of the eight who were treated with regimens without anthracycline. Although the overall prognosis was poor with a median survival of 58 days, those who attained remission showed better prognosis (P=0.005). These findings suggest that ANKL is an entity of mature cytotoxic NK-cell neoplasms with distinct phenotype and disease presentations. Intensive treatment for ANKL may result in a better prognosis.

Validity of the Framingham risk model applied to Japanese men

OBJECTIVES

To examine whether the Framingham Risk Model can appropriately predict coronary heart disease (CHD) events detected by electrocardiography (ECG) in Japanese men.

METHODS

Using the annual health examination database of a Japanese company 5611 male workers, between the ages of 30 to 59, who were free of cardiovascular disease, were followed up to observe the occurrence of CHD events detected by ECG over a period of five to seven years. The probability of CHD was calculated for each individual from the equations of the Framingham risk model (with total cholesterol).

RESULTS

The incidence of CHD increased with the estimated CHD risk. The Hosmer-Lemeshow goodness of fit test showed an adequate fit of the risk model to the data of the study subjects. In the receiver operating characteristic analysis, the area under the curve reached 0.67 which indicated an acceptable discriminatory accuracy of the risk model.

CONCLUSIONS

The Framingham risk model provides useful information on future CHD events in Japanese men.

Standard protocol for exchange of health-checkup data based on SGML: the Health-checkup Data Markup Language (HDML)

OBJECTIVES

To develop a health/medical data interchange model for efficient electronic exchange of data among health-checkup facilities.

RESULTS

A Health-checkup Data Markup Language (HDML) was developed on the basis of the Standard Generalized Markup Language (SGML), and a feasibility study carried out, involving data exchange between two health checkup facilities. The structure of HDML is described.

RESULTS

The transfer of numerical lab data, summary findings and health status assessment was successful.

CONCLUSIONS

HDML is an improvement to laboratory data exchange. Further work has to address the exchange of qualitative and textual data.

Application of the updated Framingham risk score to Japanese men

Few tools for risk assessment of coronary heart disease (CHD) have yet been made available in Japan. This study aims to examine the validity of the updated Framingham risk score as applied to a Japanese male population. Using the annual health examination database of a Japanese company, we followed-up 5,611 male subjects, aged 30 to 59 years, who had initially recorded neither history of cardiovascular disease nor electrocardiographical ischemic changes, in order to observe the occurrence of CHD over a period of 5 to 7 years. The total score calculated by the Framingham risk score sheet (the Framingham point score) was used as an indicator of CHD risk for the subject individually. The mean of the Framingham point score for 80 CHD cases was significantly higher than that for 5,531 non-CHD cases. The incidence of CHD gradually increased with the Framingham point score. In the receiver operating characteristic analysis, the area under the curve reached 0.71. At 6 points, the curve came closest to the upper left-hand corner, with a specificity of 0.74 and sensitivity of 0.59. On the other hand, multivariable-adjusted relative risks associated with old age, high blood pressure, low HDL cholesterol and smoking in the Japanese male population were different from those in the Framingham population. Despite the low incidence of CHD, the updated Framingham risk score could provide a reasonable rank ordering of CHD risk and could identify Japanese men (and possible other individuals) at high risk for CHD with considerable accuracy. However, further study of Japanese populations may be required to reappraise several coefficients of risk factor in the risk scoring model.

A minor E-selectin ligand, CD65, is critical for extravascular infiltration of acute myeloid leukemia cells

Adhesive ligands on acute myeloid leukemic (AML) blasts may mediate transmigration and extravascular infiltration. In this study, 30 AML samples were examined for expression and density of adhesion antigens. By univariate analysis, four patients with extravascular infiltration showed significantly higher expression of CD2, CD11a, CD11b, CD11c, CD15, CD65, CD86, and HLA-DR as compared with patients without infiltration. These four patients also showed significantly higher density of CD11a, CD11b, CD11c, CD15 and CD65 expression. By multivariate analysis, CD65 expression was the only significant independent risk factor for infiltration, suggesting that this is a critical adhesion molecule for extravascular AML infiltration.

Analysis of heart rate variability of an anencephalic fetus using a new method to determine a fractal dimension of non-stationary time-serial data

Human fetal heart rate (HR) variabilities were analyzed using the QIS-A, which we devised to determine a fractal dimension of non-stationary time series. Fifteen 10-min HR data of an anencephalic fetus at 23 weeks and 3 days of gestation and those of 10 normal fetuses at the same weeks of gestation were obtained by ultrasonic cardiography. The anencephalus preserved the spinal cord, medulla and partial anterior hypothalamus. The fractal scaling exponent alpha of the anencephalus was compared with that of each normal fetus by Student's t-test. In results, the scaling relationship in each case had a crossover pattern characterized by alpha(s) and alpha(l), which were slopes above and below a crossover point, respectively. Differences in mean alpha(s) and mean alpha(l) between the anencephalus and each normal fetus were significant (P < 0.01): mean alpha(s), 1.0 +/- 0.1 (+/-SD) (1/f fluctuation) and 1.6 +/- 0.2 (+/-SEM); mean alpha(l), 1.6 +/- 0.2 (+/-SD) and 1.4 +/- 0.1 (+/-SEM). There were six significant differences in mean crossover point between the anencephalus and each normal fetus: 13.8 +/- 5.7 s (+/-SD) and 15.3 +/- 5.6 s (+/-SEM). These results reveal the relationship between fractal structure of fetal HR variability and the developing central nervous system (CNS). In particular, the 1/f fluctuation of HR variability in an anencephalic fetus from the 1.25 to 13.8 s time scale might have a strong relation to the defect of the CNS.

Validity and reliability of single-item questions about physical activity

The Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study) included in its self-administered questionnaires some single-item questions concerning physical activity. We examined the validity of the questions among 1,730 Japanese adults and the reliability of the questions among 1,075 Japanese adults. The validity of the sports and physical exercise questions was estimated by comparing the self-administered questionnaire responses with the time spent on the activity and the energy expenditure index for the previous 12-month period, elicited by the interviewing method used in the Japan Lifestyle Monitoring Study with a minor modification. The Spearman's rank correlation coefficients ranged from 0.43 to 0.60, showing moderate correlations. On the other hand, test-retest reliability was estimated by comparing the responses from two separate surveys conducted roughly one year apart. Weighted kappa coefficients of sports and physical exercise questions, classified according to sex and age, ranged from 0.39 to 0.56, showing moderate reliability; and those of a question about walking ranged from 0.25 to 0.39, showing fair reliability. We suggest that measuring physical activity level with these single-item questions may be appropriate for establishing baseline data that reflects long-term physical activity in a large-scale cohort study targeting lifestyle-related diseases.

Retinoic acid and interferon-alpha effects on cell growth and differentiation in cervical carcinoma cell lines

OBJECTIVE

To investigate and compare the efficacy of all-trans retinoic acid (RA) and/or interferon-alpha (IFN-alpha) on premalignant and malignant models of cervical cancer.

METHODS

Cell growth rate was examined after treatment for 4, 7, and 10 days with RA and/or IFN-alpha of human papillomavirus type 18 (HPV 18)-immortalized endo- and ectocervical cells, nontransformed serum-adapted cells, transformed cells, three adenocarcinoma, and three squamous cell carcinoma cell lines. The effect on epithelial differentiation by RA and IFN-alpha was examined in organotypic culture. Induction of apoptosis was examined by modified terminal transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL) and DNA fragmentation.

RESULTS

Cell growth rate was inhibited by RA, 84-96% in HPV 18-immortalized endocervical cells, SiHa, and ME180, 0% in OMC-4, and 18-62% in other cell lines; and by IFN-alpha about 75% in SiHa and ME180 and 14-40% in the other cell lines. Combining RA and IFN-alpha increased the antiproliferative effect in premalignant cell lines and some cancer cell lines except OMC-4, SiHa, and HT-3. In rafts, RA treatment reversed human endocervical cell metaplasia and HPV 18-immortalized endo- and ectocervical cell dysplastic epithelial differentiation. Interferon-alpha, not RA, treatment of HPV 18-immortalized endo- and ectocervical cells induced apoptosis.

CONCLUSION

Cell growth inhibition by treatment with RA, IFN-alpha, and their combination differentially depends on treatment type and time, cell origin, cell line, and oncogenic state. In a premalignant model of cervical carcinoma, RA reduces dysplastic differentiation and IFN-alpha induces apoptosis. These data confirm that these treatments may be effective for preventing or treating premalignant cervical lesions.

Transcranial doppler sonography and ambulatory blood pressure monitoring in patients with hypertension

To appraise the value of transcranial Doppler sonography (TCD) for assessment of hypertensive cerebrovascular damage, the relationship between ambulatory blood pressure (BP) and indices of cerebral circulation determined by TCD was investigated. Subjects were 55 inpatients with or without hypertension, including 13 patients with histories of cerebrovascular attacks. Mean flow velocity (MFV) in the middle cerebral artery was measured by TCD, then the cerebrovascular resistance index (CVRI; mean BP/MFV) and the Fourier PI1 (pulsatility index of the first Fourier harmonic of the flow-velocity waveform) were determined as indices of cerebrovascular resistance. CO2 reactivity of MFV was estimated as an index of cerebrovascular flow reserve. CVRI positively correlated with both daytime and nighttime BP as well as with age (p<0.01). Fourier PI1 positively correlated with nighttime BP and age (p<0.01). CO2 reactivity did not correlate with any of the ambulatory BP parameters, but negatively correlated with age (p<0.01). LV mass index significantly correlated with ambulatory BP parameters, CVRI, and Fourier PI1 but did not correlate with CO2 reactivity. Multiple regression analyses showed that nighttime systolic BP was a significant correlate for CVRI and Fourier PI1, but not for CO2 reactivity, and that history of cerebrovascular attack was significant for CVRI and CO2 reactivity. We conclude that cerebrovascular resistance determined by TCD accords with the results of ambulatory BP and LVMI, and thus could be successfully used to detect the early stage of hypertensive cerebrovascular change. Cerebrovascular flow reserve would be relatively preserved in hypertensive patients without cerebrovascular diseases.

[Risk factors for hypertension. A longitudinal study of middle-aged Japanese male workers]

OBJECTIVE

To identify factors related to the development of hypertension among middle-aged Japanese men.

METHODS AND RESULTS

A cohort of normotensive male workers aged 30-59 years (n = 6,306) were followed from 1991 through 1998 to observe the development of hypertension, using data from annual health checkups in a Japanese company. With hypertension defined as initiation of antihypertensive therapy or a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher, the incidence rate was 33.4/1000 person-years in the 30-39 year old group, 63.8/1000 person-years in the 40-49 year old group, and 75.4/1000 person-years in the 50-59 year old group. Multivariate analysis by using Cox's proportional hazard model indicated that high-normal blood pressure at baseline, obesity (body mass index > or = 25 kg/m2), drinking 5 days/week or more, and no regular exercise were independent factors related to the development of hypertension. Although each age group had a different pattern of risk factors, high-normal blood pressure at baseline was the strongest risk factor in all cases. Glucose intolerance was significantly observed as a hazard only in the 30-39 year old group, hazard rations for obesity and physical inactivity also being highest in this younger age group.

CONCLUSIONS

High-normal blood pressure, obesity, glucose intolerance, regular alcohol intake, and physical inactivity are risk factors for hypertension among middle-aged Japanese men. Insulin resistance may play an important role in the development of hypertension in young males.

A new method to analyze basic rest-activity cycle

A new method was proposed to analyze a basic rest-activity cycle (BRAC), termed BRAC-A. This method calculates a significant cycle length by chi-squared method and the starting points of a resting phase and an active one by analysis of the array consisting of the segmented time series in the same length. Using 20 3-day computer-simulated time series of standard deviation in fetal heart rate fluctuation with known periodicity of the BRAC, we demonstrated that the BRAC-A was a useful tool to reveal the characteristics of the BRAC.

Changes in fractal structure of heart rate variability during a nap in one case

The objective of the present study was to analyze fractal structures of adult heart rate (HR) variability during a nap. Fractal analysis was carried out in one case over consecutive 10-min time series of HR, which were simultaneously recorded with electroencephalogram. Scaling relationships showed cross-over patterns characterized by alphas and alphal (i.e. slopes above and below a cross-over point). The alphas and alphal were black and white noise at Stage 4 of NREM sleep, and black and 1/f noise in REM sleep. Cross-over points changed from the first to second sleep cycle. We demonstrate the multifractal structures of HR variability during a nap in the present case.

Intravenous basic fibroblast growth factor produces a persistent reduction in infarct volume following permanent focal ischemia in rats

Basic fibroblast growth factor (bFGF) is a polypeptide with potent survival-promoting and protective effects on brain cells. In previous studies, we showed that intravenous administration of bFGF reduced infarct volume in models of focal cerebral ischemia in rats, mice, and cats. In these previous studies, infarct volume was measured within 1-7days of the onset of ischemia. The current study was undertaken to determine whether the reduction in infarct volume by bFGF was persistent beyond the first week after stroke. Mature male Sprague-Dawley rats received an intravenous infusion of bFGF (50 microg/kg per h) or vehicle during 0.5-3.5h after permanent proximal middle cerebral artery occlusion. We found a 27% reduction in infarct volume in bFGF- compared to vehicle-treated animals at three months after infarction (P<0.05). The data show that intravenous bFGF treatment produces a persistent reduction in infarct volume, at least up to three months following focal stroke.

Intravenous basic fibroblast growth factor (bFGF) decreases DNA fragmentation and prevents downregulation of Bcl-2 expression in the ischemic brain following middle cerebral artery occlusion in rats

In previous studies, we showed that basic fibroblast growth factor (bFGF) reduced infarct volume when infused intravenously in animal models of focal cerebral ischemia. In the current study, we examined the potential mechanism of infarct reduction by bFGF, especially effects on apoptosis within the ischemic brain. We found that bFGF decreased DNA fragmentation in the ischemic hemisphere, as assessed by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) histochemical methods combined with morphological criteria. bFGF also prevented reduction of immunoreactivity of the anti-apoptotic protein Bcl-2 in the ischemic hemisphere, but did not alter immunoreactivity of the pro-apoptotic proteins Bax, Caspase-1, or Caspase-3. These changes in TUNEL histochemistry and Bcl-2 immunoreactivity were especially prominent in cortex at the borders ('penumbra') of infarcts, spared by bFGF treatment. We conclude that the infarct-reducing effects of bFGF may be due, in part, to prevention of downregulation of Bcl-2 expression and decreased apoptosis in the ischemic brain.

A new method to determine a fractal dimension of non-stationary biological time-serial data

We devised a new analysis using quartile deviation of integrated and subtracted fluctuation, termed QIS-A, to determine a fractal dimension of non-stationary fluctuation. In the algorithm, computations of the quartile deviation, Q(n), of all integrated and subtracted fluctuations are repeated over all scales (n). The fractal scaling exponent is determined as a slope of the line relating log Q(n) to log n. Comparison of the QIS-A and a spectral analysis using 20 computer-simulated fractional Brownian motions demonstrates robustness of the QIS-A to non-stationary fluctuations.

Telomerase activity in Papanicolaou smear-negative exfoliated cervical cells and its association with lesions and oncogenic human papillomaviruses

OBJECTIVE

The goal of this study was to evaluate telomerase activity in exfoliated cervical cells and its association with cytology, pathology, and human papillomavirus (HPV).

METHODS

Telomerase activity and HPV DNA sequences were examined in the exfoliated cervical cells from a general population of 245 women aged more than 30 years undergoing routine cervical screening by Papanicolaou smear. The women who were found to have telomerase activity or abnormal cytology in their exfoliated cervical cells were examined for cervical lesions by colposcopy and biopsy.

RESULTS

Cytology for our population (mean, 56 years) revealed only one abnormal smear (1/245, 0.4%), in which a cervical intraepithelial neoplasia grade I (CIN I) lesion was found. The exfoliated cervical cells used to prepare the smear were negative for telomerase and contained low-risk HPV DNA. Telomerase activity was found in 16 exfoliated cell samples (16/245, 6.5%); high-risk HPV DNA was found in 9 of these samples (9/16, 56%) and 9 of the biopsy specimens that could be evaluated from patients testing positive for telomerase revealed CIN I lesions (9/11, 82%).

CONCLUSIONS

Telomerase activity is often associated with high-risk HPV infection and it is suggested that telomerase assay can help to detect occult cervical lesions.

A new periodogram using one-way analysis of variance for circadian rhythms

A new periodogram was proposed using one-way analysis of variance (ANOVA), termed ANOVA periodogram, in order to reveal a precise significant periodicity. Thirty 3-day complex computer-simulated time series with known periodicity (24 h) and three 2-h data-missing occurring periodically (23 h, 20 min) were used to compare the ANOVA periodogram with Enright's one. In results, the ANOVA periodogram was superior to Enright's periodogram in the accuracy of assessing the major periodicity.

Dynamic changes in the middle cerebral artery perfusion in normal full-term human fetuses in relation to the timing of behavioral state

Our aim is to evaluate serial changes in normal full-term fetal cerebral circulation according to the behavioral states. Flow velocity waveforms in the middle cerebral artery and fetal heart rate (FHR) were well recorded in ten of 19 cases by pulsed Doppler ultrasonography and actocardiography over 45 min, respectively. Behavioral states were classified as resting or active phase by FHR patterns. Resistance indices (RIs) were calculated every 5 s as an average of two consecutive waveforms, and median RI was chosen in each 2-min segment. In order to evaluate changes in median RI from active-to-resting transition to resting-to-active one statistically, differences in RI between two 2-min segments were examined using Mann-Whitney U-test. As a result, median RI was decreased to the minimum one in the active-to-resting transition for 12 min in all cases: significant decrease to the 2-min segment with the minimum one (P<0.01). Various types of increase to the maximum median RI during resting phase followed the minimum one: significant increase from the 2-min segment with the minimum one to that with the maximum one in all cases (P<0.001 in eight cases, P<0.01 in two cases). Thereafter, median RI was decreased from the end of resting phase in the resting-to-active transition for 12 min in all cases: significant decrease from the last 2-min segment of resting phase in all cases (P<0.01). We reveal that fetal cerebral circulation changes dynamically in relation to the timing in each behavioral state.

Serum carotenoids and vitamins and risk of cervical dysplasia from a case-control study in Japan

The relationships between risk of cervical dysplasia and dietary and serum carotenoids and vitamins were investigated in a case-control study. Cases were 156 women who attended Papanicolaou test screening in nine institutes affiliated with Japan Study Group of Human Papillomavirus (HPV) and Cervical Cancer and had cervical dysplasia newly histologically confirmed. Age-matched controls were selected from women with normal cervical cytology attending the same clinic. Blood sample and cervical exfoliated cells were obtained for measuring serum retinol, alpha-carotene, beta-carotene, zeaxanthin/lutein, cryptoxanthin, lycopene and alpha-tocopherol and for HPV detection. Higher serum level of alpha-carotene was significantly associated with decreased risk of cervical dysplasia after controlling for HPV infection and smoking status (odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.04-0.62 for the highest as compared with the lowest tertile). Decreased risk for the highest tertile of serum lycopene (OR = 0.28) was marginally significant. Decreased risks observed for the highest tertiles of beta-carotene (OR = 0.65) and zeaxanthin/lutein (OR = 0.53), were not statistically significant.

Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients

Orthostatic hypotension is a serious problem in patients with diabetes mellitus (DM) undergoing hemodialysis (HD). To evaluate cerebral circulation during orthostasis in patients with DM, we examined changes in mean blood flow velocity in the middle cerebral artery (VMCA) during 60 degrees head-up tilt for 5 minutes in patients with DM (six men, two women; age, 57 +/- 3 years [mean +/- SEM]; HD duration, 47 +/- 27 months) before and after bicarbonate HD by using transcranial Doppler sonography. The findings were compared with those in HD patients without diabetes (non-DM; 12 men, 5 women; age, 47 +/- 3 years; HD duration, 82 +/- 23 months). Mean blood pressure (MBP) in the supine position, hematocrit (Hct), plasma fibrinogen, and volume of fluid removed by HD were not significantly different between the two groups (MBP, 106 +/- 6 versus 103 +/- 4 mm Hg; Hct, 26% +/- 1% versus 28% +/- 1%; fibrinogen, 355 +/- 37 versus 357 +/- 27 mg/dL; fluid, 2.5 +/- 0.2 versus 2.3 +/- 0.2 L). Percentage of change in VMCA (% VMCA) during tilt was compared between the groups before and after HD. Before HD, MBP decreased significantly to 93 +/- 5 mm Hg during tilt only in patients with DM. The degree of MBP reduction was -13 +/- 2 mm Hg in DM and -2 +/- 2 mm Hg in non-DM patients (P < 0.01). % VMCA equally decreased during tilt; DM, -12% +/- 3%, and non-DM, -12% +/- 2%. After HD; MBP decreased by 36 +/- 7 mm Hg in patients with DM, which was significantly greater than before HD. VMCA also decreased in both groups after HD, and % VMCA in DM (-32% +/- 5%) was significantly greater than before HD (P < 0.01) and in non-DM patients (-13% +/- 2%; P < 0.01). % VMCA positively correlated with the percentage of change ratio of MBP during tilt in both groups after HD (DM, r = 0. 87, P < 0.01; non-DM, r = 0.61, P < 0.01). Our results showed a significant decrease in cerebral blood flow velocity during tilt of equal magnitude in both groups before HD despite differences in the level of hypotension, whereas reduction in cerebral blood flow velocity and decrease in MBP were more marked in DM after HD. Orthostasis could thus cause hemodynamically mediated brain damage after HD, especially in patients with DM.

The grading of lymphovascular space invasion in endometrial carcinoma

BACKGROUND

This study was conducted to elucidate the prognostic significance of a three-grade system for lymphovascular space invasion (LVSI).

METHODS

The prognostic significance of the grading of LVSI as compared with other pathologic variables was evaluated in a study of 303 Japanese women with endometrial carcinoma. The criteria for determining the grade of LVSI were as follows: none (no LVSI), mild (a focus of LVSI was recognized around a tumor), and severe (diffuse or multifocal LVSI were recognized around the tumor or in the myometrium regardless of the degree of myometrial invasion). Both univariate and multivariate regression analyses were performed. The effects of different surgical methods and adjuvant therapies on survival were also examined.

RESULTS

A univariate survival analysis showed that survival significantly correlated with surgical stage, histologic grade, depth of myometrial invasion, LVSI, cervical invasion, ovarian metastasis, and tubal metastasis. Of the three grades of LVSI, survival showed the most difference between the mild and severe groups. In multivariate analysis, the highest correlation with survival was observed for LVSI (P = 0.0008). Lymph node metastasis was also significantly associated with LVSI (P = 0. 0001). The correlation between histologic variables and survival was only slightly influenced by the differences in surgical methods and adjuvant therapies.

CONCLUSIONS

The grading of LVSI was found to be an important histologic prognostic variable. The severe degree of LVSI also was found to be a good indicator of lymph node metastasis. It is therefore important to evaluate the grade of LVSI based on a histologic examination of at least one cut surface of the hysterectomy specimen that macroscopically shows the deepest myometrial invasion.

Cervical adenocarcinoma, a novel combination chemotherapy with mitomycin C, etoposide, and cisplatin for advanced or recurrent disease

We review the cases of 31 patients with stage IVb or recurrent cervical adenocarcinoma who were treated with combination chemotherapy utilizing mitomycin C, etoposide, and cisplatin (MEP). The total response rate was 16.1% (95% confidence intervals (CIs), 5. 5 to 33.7%) with 4 patients having a complete response (CR) and 1 having a partial response. In patients with no prior chemotherapy, the response rate was 26.7% (95% CIs, 7.8 to 55.1%) with 2 of these CR patients surviving over 3 years, 1 a disease-free survival. A marked response was found in distant recurrent lesions. The major toxicity was myelosuppression. Forty-five percent of patients had leukocytopenia above grade 3; thrombocytopenia and anemia were not common. In patients with cervical adenocarcinoma and no prior chemotherapy, there was a moderate response to MEP therapy.

[Relationship of dietary habits pattern and body build of parents to child obesity]

Patterns of eating habits were analyzed to elucidate its relationship to the temporal change of body build from childhood through school age in subjects of the Toyama study. Survey questionnaires at the time of entrance to elementary school were used. Subjects were 6,452 (males 3,293, and females 3,159). Subjects were classified into 6 clusters among the males, 8 clusters among females based on the results of cluster analysis of eating habits. The cluster in males that preferred egg, milk, dairy products, fats, fish and shellfish, soybeans, fruits, green yellow vegetables indicated more frequent subjects whose BMI were less that 14. The cluster in girls that preferred fats indicated more frequent subjects whose BMI were more or equal to 18. The ANOVA showed significant relation of parental body build on their children. Even after grouping by parental body build, the cluster based on patterns of eating habits showed different frequencies of obese children. Preference for intake of milk indicated less frequent obese children among the similar parental body build for boys, while preference for intake of fats indicated more frequent obese children among a similar parental body build for girls. In conclusion, the obesity of a school child has a close relationship to parent's body build. However, the temporal changes of obesity were seen among eating habits clusters even if body builds of their parents are the same. It was shown that patterns of eating habit are important in school children's obesity development.

Sclerosing stromal tumor of the ovary: radiologic findings

Sclerosing stromal tumor is a rare ovarian neoplasm. We describe the radiologic findings of sclerosing stromal tumor in two patients. In both patients, MR and CT images showed a large mass in the left adnexal region. On dynamic contrast-enhanced images, the tumors showed early peripheral enhancement with centripetal progression.

Apoptosis and Ki-67 expression in adenomyotic lesions and in the corresponding eutopic endometrium

OBJECTIVE

To examine biologic and proliferative properties of adenomyotic lesions and to determine whether adenomyotic lesions originate in the basal layer of the eutopic endometrium.

METHODS

We examined eutopic and ectopic endometria from 23 patients with adenomyosis. To obtain evidence for the induction of programmed cell death, apoptotic cells were identified using a modified terminal deoxynucleotidyltransferase-biotin nick end-labeling method. To evaluate cell death repressor activity, bcl-2 gene expression was examined using immunohistochemical staining. As a proliferative marker, Ki-67 expression was also examined immunohistochemically.

RESULTS

In the eutopic endometrium, apoptosis was most frequently observed in epithelial cells during mid- to late secretory phases, although it was rarely found during early proliferative through early secretory phases (P<.01). In contrast, bcl-2 gene expression inversely correlated with the appearance of apoptosis. A similar tendency was observed in stromal cells. In the ectopic endometrium of adenomyosis, endometrial dating revealed that secretory change was rare, even in the secretory phase, and that induction of apoptotic cells as well as bcl-2 gene expression showed no cyclic change. In stromal cells of the ectopic endometrium, apoptosis was more frequent than was seen in the eutopic endometrium, in all menstrual phases (P<.05). Ki-67 was constantly expressed in the glandular epithelium of the ectopic endometrium, irrespective of the menstrual phases, whereas in the secretory phase it was less expressed in the eutopic endometrium of functional and basal layers (P<.01).

CONCLUSION

The induction of apoptosis seems to be regulated by hormonal changes in the eutopic endometrium and has an inverse correlation with bcl-2 gene expression. The ectopic endometrium in adenomyosis is rarely influenced by hormonal change and has different biologic and proliferative properties than events observed in the eutopic endometrium findings, which strongly suggest that the adenomyotic lesion does not originate in the basal endometrium.

Temporal course of the development of obesity in Japanese school children: a cohort study based on the Keio Study

OBJECTIVE

To demonstrate the temporal course of obesity development in Japanese school children by conducting a school-site cohort study over 12 years.

METHODS

From 1981 to 1984, height and weight of 479 subjects (343 boys and 136 girls) were measured every year from entrance into primary school until graduation from high school in Tokyo. Obese children were defined as those with a body mass index (BMI) at or above the age-sex-specific standard value, derived from Japanese nationwide data.

RESULTS

Approximately 50% of the children who were obese in the primary school period were obese at age 17. Likewise, 40% who were obese in the junior high school period and 70% who were obese in the high school period were obese at age 17. Among 44 children who were obese at age 17, 14 showed tracking of obesity from the preschool period, 14 showed tracking from ages 7 to 11 years, 10 showed tracking from the junior high school period, and 6 showed tracking from the high school period.

CONCLUSIONS

Among children who were obese at age 17, most tracked from the primary school age or earlier. The earlier the tracking commenced, the greater the BMI at age 17. This indicates the importance of conducting health education for school children at an early age.

Human papillomavirus infection and other risk factors for cervical intraepithelial neoplasia in Japan

Various risk factors were investigated in 167 cervical intra-epithelial neoplasia (CIN) case and control pairs in Japan. CIN cases showed evidence of nine known risk factors including smoking and sexual behaviour. However, after adjustment for papillomavirus infection, the highest determinant, the only remaining risk factors were: being married, early age at first pregnancy and multiparity.

Prognostic significance of progesterone receptor immunohistochemistry for lymph node metastases in endometrial carcinoma

OBJECTIVE

The aim of this study was to determine whether progesterone receptor (PR), estrogen receptor (ER), p53 protein, and proliferating cell nuclear antigen (PCNA) expression constitute independent prognostic factors for lymph node metastases in endometrial carcinoma using immunohistochemical techniques on hysterectomy and biopsy specimens.

METHODS

We evaluated the correlation between lymph node metastases and PR/ER immunohistochemistry, p53/PCNA expression, age, tumor grade, myometrial tumor invasion, cervical involvement, and ovarian metastases in a series of 99 cases of primary endometrial carcinoma surgically staged with systemic pelvic lymphadenectomy and para-aortic lymph node biopsy.

RESULTS

Lymph node metastases from endometrial carcinoma were statistically correlated with negative PR immunohistochemistry (P = 0.001), intense p53 expression (66% or more of the tumor cells stained, P = 0.003), deep myometrial tumor invasion (greater than one-half, P = 0.001), and cervical involvement (P = 0.001). Tumor grade showed borderline statistical significance for lymph node metastases (P = 0.058). On multivariate analysis, negative PR, intense p53 expression, and cervical involvement were significant prognostic variables for lymph node metastases (P = 0.0001, 0.0023, and 0.002, respectively). Immunohistochemical study indicated that the PR status on preoperative biopsy specimens and hysterectomy specimens was in good agreement, but p53 status was not. Age, ovarian metastases, ER immunohistochemistry, and PCNA expression were not significantly related to lymph node metastases.

CONCLUSION

PR immunohistochemistry appeared to be the most powerful prognostic factor associated with lymph node metastases in endometrial carcinoma, independent of other clinicopathological parameters.

Influence factors on the development of obesity in 3-year-old children based on the Toyama study

BACKGROUND

Obesity in childhood increases the risk of obesity in adulthood. Obesity in adulthood is a risk factor for chronic diseases such as hypertension and atherosclerosis. Therefore, it is important to eliminate factors influencing the development of obesity in children from the viewpoint of preventive medicine. The purpose of this study is to elucidate the relationship between obesity and lifestyle in 3-year-old children in a case-control study.

METHODS

Subjects were selected from the Toyama study at health checkups for 3-year-old children which are done routinely by local governments in Japan on all children of that age. A special questionnaire consisting of items on lifestyle and environmental factors of the children and past histories of parents was distributed to the Toyama study participants beforehand and was collected at the checkup. Matched-pair comparisons were performed between obese children whose body mass index was 18 or more (N = 427) and control children (N = 854) matched by sex and birth month. Multivariate stepwise conditional logistic regression analysis was also applied to assess the influence of confounding factors.

RESULTS

The following six factors significantly influenced the development of obese 3-year-old children using the Mantel-Haenszel method: the mother's job, limited playtime outdoors (1 hour or less), snacking irregularity, an overweight father (body mass index >/= 24), an overweight mother (body mass index >/= 24), and overweight at birth (birth weight >/= 3,500 g). An overweight mother or father, limited playtime outdoors, overweight at birth, and snacking irregularity were significantly related to obesity in 3-year-old children after adjusting for confounding factors by multivariate stepwise conditional logistic regression analysis.

CONCLUSIONS

We have suggested several factors influencing the development of obesity in 3-year-old Japanese children: parental overweight and overweight at birth as host factors, physical inactivity and snacking irregularity as behavioral factors, the mother's job as an environmental factor.