静岡県における肺がんの損失生存年数とその関連要因

論文Original Paper静岡県の男性の肺がん死亡を損失生存年数を用いて算出し、74市町村の地域差を明らかにした。県東部でYPLL率の高い市町村が多く、県西部で低い市町村が多く分布していた。また、損失生存年数と肺がん関連要因との関連を評価し、結核の受療率と肺がん検診受診率との関連が示された。これらの結果から、肺がん予防のために必要とされる保健サービスが明らかになった

Association of food access and neighbor relationships with diet and underweight among community-dwelling older Japanese

Background: Food access is important for maintaining dietary variety, which predicts underweight. The aim of this study was to examine the association of food access and neighbor relationships with eating and underweight.Methods: We analyzed cross-sectional data from 102,869 Japanese individuals aged 65 years or older. The perceived availability of food was assessed using the presence or absence of food stores within 1 km of the home. Level of relationships with neighbors was also assessed. The odds ratios (ORs) and 95% confidence intervals (CIs) for infrequent food intake and underweight were determined using logistic regression analysis.Results: The proportion of men and women having low access to food was 25-30%. Having low food access (OR 1.18; 95% CI, 1.12-1.25 for men and OR 1.26; 95% CI, 1.19-1.33 for women) and a low level of relationship with neighbors (OR 1.38; 95% CI, 1.31-1.45 for men and OR 1.57; 95% CI, 1.48-1.67 for women) was associated with infrequent intake of fruits and vegetables in both sexes. Association between low food access and infrequent intake of fruits and vegetables was higher among men with low levels of neighbor relationship (OR 1.34; 95% CI, 1.23-1.46) than among men with high levels of relationship (OR 1.10; 95% CI, 1.03-1.18).Conclusions: Low perceived availability of food is a risk factor for low dietary variety among older people. Furthermore, high levels of relationship with neighbors may relieve the harmful effect of low food access.　　　© 2017 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/ by/4.0/)

Renoprotective effect of statin: a ischemia-reperfusion animal model

OBJETIVO: A lesão renal aguda isquêmica, de causa multifatorial, apresenta morbidade e mortalidade alarmantes. A estatina, inibidor de HMG-CoA redutase, tem demonstrado papel renoprotetor, com componente antioxidante, antiinflamatório e vascular. A atividade de heme oxigenase-1 pode ser mediadora desses efeitos pleitrópicos da estatina sobre o rim, ou seja, independente da ação de redução de lipídio. Esse estudo visou avaliar se o efeito renoprotetor da estatina pode ter mecanismo heme de proteção em ratos. MÉTODOS: O modelo isquêmico foi obtido por meio do clampeamento dos pedículos renais bilaterais por 30 minutos, seguido de reperfusão. Foram utilizados ratos Wistar, machos, pesando entre 250-300g, distribuídos nos seguintes grupos: SHAM (controle, sem clampeamento renal); Isquemia; Iquemia+Estatina (sinvastatina 0,5 mg/kg, via oral por 3 dias); Isquemia+Hemin (indutor de HO-1, 1 mg/100g, intraperitoneal 24h antes da cirurgia); Isquemia+SnPP (inibidor de HO-1, 2μmol/kg intraperitoneal 24h antes da cirurgia); Isquemia+Estatina+Hemin e Isquemia+Estatina+SnPP. Foram avaliados a função renal (clearance de creatinina, Jaffé), osmolalidade urinária, peróxidos urinários e a imunohistoquímica para ED-1. RESULTADOS: Os resultados mostraram que a estatina melhorou a função renal, a osmolalidade urinária, reduziu a excreção de peróxidos urinários e a infiltração de macrófagos em rins de animais submetidos à isquemia renal. O indutor da heme oxigenase-1 e a sua associação com sinvastatina reproduziram o padrão de melhora determinado pela sinvastatina. CONCLUSÃO: O estudo confirmou o efeito renoprotetor da estatina, com ação antioxidante e antiinflamatória, e sugere que esse efeito tenha interface com o sistema heme de proteção renal.OBJECTIVE: Ischemic acute kidney injury (iLRA), with multifatorial cause, presents alarming morbidity and mortality. Statin, HMG-CoA inhibition reductase has shown a renoprotective effect, with antioxidant, antiinflamatory and vascular actions. The heme oxygenase-1 (HO-1) can be involved in these pleitropic effects of statin on the renal function. This study was performed in order to evaluate if the renoprotective effect of the statin is a heme mechanism of protection in rats. METHODS: The ischemic model was reproduced by through clamping the bilateral renal pedicles for 30 minutes followed by reperfusion. Adult Wistar rats, weighting from 250-300g, were divided into the following groups: SHAM (control); Ischemia (30 minutes renal ischemia); Ischemia+Statin (sinvastatin 0.5mg/kg,orally (v.o.) for 3 days); Ischemia+Hemin (Hemin, 1.0mg/100g, intraperitoneal (i.p.), 24 hours before surgery); Ischemia+SnPP (SnPP 2μmol/kg, i.p., 24 hours before surgery ); Ischemia+Statin+Hemin; Ischemia+Statin+SnPP. RF (clearance of creatinine, Jaffé method), urinary peroxides (UP), urinary osmolality (UO) and immunohistochemical for ED-1 were evaluated. RESULTS: Results showed that sinvastatin ameliorated RF, urinary osmolality, reduced the UP excrection and the macrophage infiltration in rats submitted to renal ischemia. The inducer of HO-1 and its association with sinvastatin induced a similar pattern of improvement of renal function. CONCLUSION: the study confirmed the renoprotective effect of the statins on renal function, with antioxidant and antiinflamatory actions, and it suggests that this effect can have an interface with the heme system of renal protection

Prospective Study of the Effect of the 21-Gene Assay on Adjuvant Clinical Decision-Making in Japanese Women With Estrogen Receptor-Positive, Node-Negative, and Node-Positive Breast Cancer

AbstractBackgroundIn this study we investigated if the 21-gene assay result affects adjuvant decision-making in Japanese women with ER+ invasive EBC.Patients and MethodsA total of 124 consecutive eligible patients with ER+, HER2-negative EBC and 0 to 3 positive lymph nodes were enrolled. Treatment recommendations, physicians' confidence and patients' decisional conflict before and after knowledge of the Recurrence Score results of the 21-gene assay were recorded.ResultsOne-hundred four patients (84%) had N0 disease, including micrometastases, and 20 (16%) had N+ disease. Overall, recommendations changed in 33% (95% CI, 24%-43%) of N0 and 65% (95% CI, 41%-85%) of N+ patients. In 27 of 48 (56%) of N0 and 13 of 15 (87%) of N+ patients an initial recommendation for chemohormonal therapy was revised to only hormonal therapy after assay results, and in 7 of 56 (13%) of N0 and 0 of 5 N+ patients from only hormonal to combined chemohormonal therapy. Decisions appeared to follow the Recurrence Score results for low and high values. For patients with intermediate Recurrence Score values, overall recommendations for chemohormonal treatment tended to decrease after assay results. Physicians' confidence increased in 106 of 124 (85.5%; 95% CI, 78%-91%) cases. Patients' decisional conflict significantly improved as indicated by changes in the total score and the 5 defined subscores (P = .014 for Informed Subscore; P < .001 for all others).ConclusionResults from this prospective study in a Japanese population confirm an effect of the 21-gene assay results on adjuvant treatment decision-making, consistent with reported experiences from the United States and Europe

中国の病院の現状および看護体制について : 第三軍医大学西南病院・新橋病院を訪問して

その他Miscellaneou近年、中華人民共和国の発展はめざましく、医療・保健・福祉に対する政策的な改革も進んでいる。2006年3月、本学と交流協定を結んでいる重慶市の第三軍医大学附属医院である西南病院と新橋病院を訪問し、中国の病院の現状や看護体制などを知る機会を得た。日本とは異なる医療保険制度をもつ中国の看護に触れた研修の学びを、文献分析を加えて報告する

Insulin receptor substrate-2 maintains predominance of anabolic function over catabolic function of osteoblasts

Insulin receptor substrates (IRS-1 and IRS-2) are essential for intracellular signaling by insulin and insulin-like growth factor-I (IGF-I), anabolic regulators of bone metabolism. Although mice lacking the IRS-2 gene (IRS-2−/− mice) developed normally, they exhibited osteopenia with decreased bone formation and increased bone resorption. Cultured IRS-2−/− osteoblasts showed reduced differentiation and matrix synthesis compared with wild-type osteoblasts. However, they showed increased receptor activator of nuclear factor κB ligand (RANKL) expression and osteoclastogenesis in the coculture with bone marrow cells, which were restored by reintroduction of IRS-2 using an adenovirus vector. Although IRS-2 was expressed and phosphorylated by insulin and IGF-I in both osteoblasts and osteoclastic cells, cultures in the absence of osteoblasts revealed that intrinsic IRS-2 signaling in osteoclastic cells was not important for their differentiation, function, or survival. It is concluded that IRS-2 deficiency in osteoblasts causes osteopenia through impaired anabolic function and enhanced supporting ability of osteoclastogenesis. We propose that IRS-2 is needed to maintain the predominance of bone formation over bone resorption, whereas IRS-1 maintains bone turnover, as we previously reported; the integration of these two signalings causes a potent bone anabolic action by insulin and IGF-I