The combination of strong immunohistochemical mtTFA expression and a high survivin index predicts a shorter diseasespecific survival in pancreatic ductal adenocarcinoma

Mitochondrial transcription factor A (mtTFA) plays a crucial role in both the transcription and maintenance of mitochondrial DNA. A high expression of mtTFA has been demonstrated in several solid tumors, and is closely associated with cancer cell survival/apoptosis and growth. However, its expression pattern in pancreatic ductal adenocarcinoma (PAC) remains to be elucidated. Additionally, our groups have recently revealed that a subset of apoptosis-related genes is strongly regulated by mtTFA, and that two putative mtTFA binding sites are present in the promoter region of the survivin gene, which is a member of the inhibitorof-apoptosis protein family. We therefore investigated the correlation of the immunohistochemical mtTFA expression and the survivin index with various clinicopathological variables and the prognosis, using 70 paraffin-embedded tumor samples from patients with surgically-resected PAC. The mtTFA expression or survivin index was considered to be strong or high when ≥30% or 10% of the PAC cells showed positive staining, respectively. Strong mtTFA expression and/or a high survivin index was revealed to have a significant relationship to a pathologically high tumor grading and advanced tumor stage. Moreover, mtTFA showed significantly high co-expression with survivin. Univariate and multivariate analyses demonstrated that both the strong mtTFA expression and high survivin index groups had significantly shorter survival rates, especially within the first two years postoperatively. The combination of strong mtTFA expression and a high survivin index may predict a poor prognosis in patients with PAC, and these new biomarkers might offer useful information for the early clinical management

家庭血圧測定実施状況と関連する生活習慣行動および基本的特性の探索的検討：職域横断研究

目的：我が国の一般集団における家庭血圧測定実施状況はほとんど報告されていない．本研究は職域集団において家庭血圧測定の実施状況と家庭血圧測定を実施している者の生活習慣行動および基本的特性を探索的に明らかにすることを目的とした．方法：総合小売業の単一職域集団において2018年に実施された定期健康診断データを用い，40–65歳の4,664名を対象とした．降圧薬服用の有無別，性別に家庭血圧計保有の有無と測定頻度を算出し，多変量ロジスティック回帰分析より家庭血圧測定実施と基本特性，生活習慣行動との関連を検討した．独立変数は年齢，血圧，雇用形態，同居者有無，喫煙習慣，飲酒習慣，食習慣，運動習慣，歩行速度，脂質異常症治療有無，糖尿病治療有無とし，従属変数は降圧薬非服用者では家庭血圧測定機会あり（家庭血圧測定頻度が月2回以上），服用者では家庭血圧測定習慣あり（家庭血圧測定頻度がほぼ毎日）とした．結果：降圧薬非服用者で家庭血圧測定機会のある者は男性8.7％，女性12.4％で，男女とも年齢（1歳上昇毎のオッズ比：男性1.11，女性1.06）と血圧（＜130/80 mmHgと比較した ≥ 140/90 mmHgのオッズ比：男性7.42，女性：4.71）が家庭血圧測定機会と正に関連した．さらに女性では脂質異常症治療を受けている者（受けていない者と比較してオッズ比1.77），歩く速度が速い者（遅い者と比較してオッズ比：1.49），運動習慣のある者（ない者と比較してオッズ比：1.79）で測定機会ありのオッズ比が有意に高く，夕食後の間食の回数が多い者（少ない者と比較してオッズ比：0.65）で有意に低かった．降圧薬服用者で家庭血圧測定習慣ありの者は男性21.6％，女性25.5％であった．男性では糖尿病治療を受けている者（受けていない者と比較してオッズ比：0.23）で測定習慣ありのオッズ比が有意に低かった．女性では，脂質異常症の治療を受けている者（受けていない者と比較してオッズ比：0.53），血圧管理不良者（＜130/80 mmHgと比較した ≥ 140/90 mmHgのオッズ比：0.58），飲酒習慣のある者（ない者と比較してオッズ比：0.60），就寝前2時間以内の夕食回数が多い者（少ない者と比較してオッズ比：0.54）で測定習慣ありのオッズ比が有意に低く，独居者（同居者がいる者と比較してオッズ比：2.43）で有意に高かった．結論：降圧薬非服用者で家庭血圧測定機会ありの者は約10％で，男女とも年齢と血圧が，女性では加えて健康的な生活習慣が正に関連していた．降圧薬服用者で家庭血圧測定習慣ありの者は約25％で，他の生活習慣病治療や女性では血圧管理不良，不健康な生活習慣が負に関連した．Objectives:The current status of home blood pressure (HBP) measurement is unknown at a Japanese worksite. We aimed to calculate the proportion of individuals who periodically measured HBP and to explore the demographic and lifestyle characteristics of these workers.Methods:The study included 4,664 employees aged 40-65 years who worked at a retail company and underwent health check-ups in 2018. Multivariable logistic regression models were used to estimate odds ratios (ORs) of participant\u27s demographics and lifestyle characteristics and habits for HBP measurement by sex and medical treatment for hypertension. Periodic HBP measurement was defined as HBP measurements performed two times or more per month (opportunistic HBP measurement) among participants not being treated for hypertension, and daily measurement of HBP (everyday HBP measurement) among participants treated for hypertension.Results:The percentages of opportunistic HBP measurement were 8.7% in males and 12.4% in females not being treated for hypertension. In both sexes, age (ORs per 1-year increment: 1.11 in males and 1.06 in females) and blood pressure (ORs of ≥ 140/90 mmHg: 7.42 in males and 4.71 in females compared with < 130/80 mmHg) were positively associated with opportunistic HBP measurement. Females treated for dyslipidemia (OR: 1.77), who had a self-described fast walking speed (OR: 1.49), and who exercised habitually (OR: 1.79) had significantly high ORs for opportunistic HBP measurement. Females who frequently consumed snacks after dinner had significantly lower ORs (0.65) than those who did not. The percentages of workers who did everyday HBP measurement were 21.6% in males and 25.5% in females treated for hypertension. Males treated for diabetes (OR: 0.23) had significantly lower OR than those who did not. Females treated for dyslipidemia (OR was 0.53), who had uncontrolled hypertension (OR: 0.58), consumed alcohol (OR: 0.60), and frequently ate within two hours before bed (OR: 0.54) had significantly lower ORs. Females who lived alone had significantly higher ORs (2.43) than those who did not.Conclusion:Approximately 10% of individuals not treated for hypertension periodically measured HBP. Age and blood pressure in males and females, and healthy lifestyles in females, were associated with having opportunistic HBP measurement. Approximately 25% of individuals treated for hypertension measured HBP every day. Individuals treated for dyslipidemia or diabetes and females with unhealthy lifestyle and uncontrolled hypertension were less likely to measure HBP every day

Cluster-randomized controlled trial for the early promotion of clinic visits for untreated hypertension.

Despite clear evidence of the benefits of lowering blood pressure among patients with hypertension, the treatment rate remains <40% worldwide. In the present trial, we aimed to investigate the effects of the early promotion of clinic visits among patients with untreated hypertension detected during annual health checkups. This was a worksite-based, parallel group, cluster-randomized trial with blinded outcome assessment. Employees of 152 Japanese supermarket stores found to have untreated hypertension (blood pressure levels ≥ 160/100 mmHg) during health checkups were assigned to an early promotion group (encouraged to visit a clinic in face-to-face interviews and provided with a referral letter to a physician as well as a leaflet) or a control group (received usual care), according to random assignment. The primary outcome was the completion of a clinic visit within 6 months. Odds ratios with 95% confidence intervals for the early promotion group versus the control group were estimated using multilevel logistic regression with random effects of clusters. A total of 273 participants (mean age 50.3 years, 55% women) from 107 stores were assigned to the early promotion group (138 from 55 stores) or control group (135 from 52 stores). During the 6-month follow-up, 47 (34.1%) participants in the early promotion group visited a clinic, as did 26 (19.3%) in the control group (odds ratio 2.33, 95% confidence interval 1.12-4.84, P = 0.024). Early promotion using a referral letter during health checkups significantly increased the number of clinic visits within 6 months completed by participants with untreated hypertension (UMIN000025411)