It is considered that hepatitis C virus (HCV) infection may be a pathogenic factor in cryoglobulinemia and glomerulonephritis. The purpose of this study was to determine whether there is any relation between the presence of hepatic disorder due to HCV infection and the association with cryoglobulinemia and urinary abnormalities, i. e. proteinuria and/or hematuria, in HCV-infected patients. Cryoglobulinemia was found in 11.4% of our HCV patients. However, seropositivity of cryoglobulin detected in all the patients was low. The prevalence of the association with cryoglobulinemia in patients with hepatic disorder was significantly higher than that in patients without hepatic disorder. Urinary abnormalities were found in 10.0% of the HCV patients. No significant difference was observed in the prevalence of urinary abnormalities between patients with and without hepatic disorder. In addition, there was no significant difference in the prevalence of urinary abnormalities between the association with and without cryoglobulinemia. These results suggest the close relation between the presence of hepatic disorder due to HCV infection and the association with cryoglobulinemia. However, renal involvement may have no relation with the presence of hepatic disorder and cryoglobulinemia.

It has been known that access recirculation is positively related to dialyzer blood flow and is negatively related to access blood flow in the vascular access in hemodialysis patients. The present study was designed to examine whether an increase in access recirculation generated by an increase in dialyzer blood flow is related to access blood flow. All patients had native end-to-side arteriovenous anastomoses at the radial site. We measured access recirculation at two different dialyzer blood flow rates (85 and 170 ml/min) using a three-needle technique. Access blood flow rates (mean 668 ml/min ranging from 493 to 1038 ml/min) were measured using Doppler ultrasound sonography. We confirmed that an increase in dialyzer blood flow rate led to an increase in access recirculation (5.4±1.1 vs. 9.9±1.9%, p<0.05), and that access recirculation was negatively related to the access blood flow rate (y=-30.78x+972.20, r=-0.79, p<0.05). We further found a negative correlation between the increase in access recirculation generated by the increase in dialyzer blood flow rate and access blood flow rate (y=-33.88x+821.57, r=-0.75, p<0.05). These results suggested that dialyzer blood flow less affects access recirculation when access blood flow is higher.

It is a big problem to cope with elderly patients who are increasing in a community in Niigata which has already been heavily populated by those people over 65 years of age. Aging is not a disease. However, the actual situation of patients with hematological and solid tumors in the aging community is little known. In this communication, we analyzed 293 patients (AML/ALL: 52, NHL: 112, MDS: 75, MM: 40, and others: 14) and 127 dead with hematological malignancies treated in our hospital for the past 10 years or 80 to clarify the actual changes in the trend of patients with hematological malignancies and compared them with those of patients who died of solid tumors. The population movements over the last 20 years in the Kashiwazaki area were also studied.Our analysis showed that the number of patients who died of solid tumors increased (1.6 times) in step with the increases in the aged population for there 20 years in the Kashiwazaki area. In addition, the incidence of gastric cancer markedly decreased for the past 20 years, while that of colorectal cancer rapidly increased (5 times). The incidence of hematological malignancies also increased with its peak shiftted to the latter haf of the 7th decade of age for the past 10 years. In addition to the increased incidence, patients with NHL and MDS increased in number by 1.5 times over the last 10 years. Especially, patients with MM showed an increase of 3 times, while the incidence of AML was not changed, even decreasing in number.In conclusion, the incidence of hematological malignancies as well as solid tumors has steadily been increasing with the increases in the aged population in the Kashiwazaki area, and the number of the aged patients over 70 years of age also increased. Such aged patients, however, are not available for hematopoietic stem cell transplantation. Therefore, it is urgently necessary for us to cope with the increases in the number of aged patients with hematological malignancies.
Malignant Neoplasms ; incidence of cases ; seconds ; Solid tumor ; Aging

This report presents our experience in using a dual-lumen catheter with a Dacron cuff as longterm vascular access for homodialysis in an elderly patient. The female patient who at first treated with continuous ambulatory peritoneal dialysis for chronic renal failure, but the treatment could not be continued because she developed inveterate peritonitis. Thereafter, hemodialysis was performed. However, a lot of blood access troubles occurred and consequently peripheral access was exhausted. Therefore, we placed the catheter into a right internal jugular vein. This procedure made it possible to secure enough and stable blood flow during the hemodialysis session. Thus, the clearence ratios of blood urea nitrogen and serum creatinine and the value of KT/V increased. No complications have been observed since then. We further examined whether the placement of the catheter would affect hemodynamics in brain and upper extremities, using transcranial Doppler ultrasound and plethysmography. No remarkable difference in blood flow between right and left ophthalmic arteries and decrease in arterial blood flow of right finger tips were observed. Furthermore, venous dilatation, swelling in neck and right upper extremities, and facial edema were not found. The catheter, therefore, represents a significant advance, providing immediate, durable and relatively safe access for hemodialysis after repeated blood access troubles and exhausted peripheral access.

We performed a physio-psychological research on the mental, physical relaxation and health-keeping effect of Shinrin-yoku (forest walking) in Kawaba village. Eleven male and 8 female healthy elderly residents in Kawaba village, whose average age was 74.0±3.5 years old for male and 74.9±2.9 years old for females volunteered for this experiment. All members walked for one hour in the Kawaba Forest on August 17 under cloudy skies, 30-32°C temperature, 58-60% humidity, and, 0-2m/sec wind condition and walked again for another one hour in a non-forest rural agricultural area on August 21 under almost the same weather conditions. Phytoncides in the air, Profile of Mood State (POMS) test, blood pressure (BP), heart rate (HR), fasting levels of serum natural killer cell activity (NK), plasma catecholamine (adrenaline, noradrenalin and dopamine), plasma cortisol, and serum adiponectin were measured before and after walking. Phytoncides were detected in the forest and non-forest, all members showed a decrease of POMS total scale, BP, adrenalin and serum cortisol. Six (3 male and 3 female subjects) of them expressed an increase of serum NK cell activity after the forest-walking. One female showed a high serum NK cell activity after both forest and non-forest rural walking.
Our experiment on the forest-walking in Kawaba village indicated that its relaxation and health-keeping effects, probably due to walking in the fresh forest air.

Physical training has been shown to improve glucose tolerance and insulin action in peripheral tissues. In the present study, regular (R) and high (H) -dose euglycemic clamp procedures were performed to determine the effects of different types of physical training on insulin action (sensitivity/responsiveness) in 10 long-distance runners (LR), 10 weight-lifters (WL) and 12 healthy controls (HC), The amount of infused glucose (glucose metabolism, GM) during euglycemic clamping is a measure of the peripheral tissue sensitivity and/or responsiveness to insulin. For R clamping, when GM was calculated per unit body weight (BW), GM in LR (11.92±1.22 mg/kg BW·min) and WL (9.28±0.63 mg/kg BW·min) was significantly (P<0.05) higher than that in HC (7.44±0.39 mg/kg BW·min) . When calculated per unit lean body mass (LBM), LR (15.07±1.56 mg/kg LBM·min) differed from HC (9, 15±0.59 mg/kg LBM·min, P<0.05), whereas the value in WL (11.50±0.93mg/kg LBM·min) was identical to that in HC. For H clamping, there was no significant change in these three groups when GM was calculated per unit BW or LBM. These results suggest that enhancement of insulin action by physical training is due to an increase in insulin sensitivity, rather than to an increase in insulin responsiveness, and that aerobic exercise, for example long-distance running, is more effective for the improvement of decreased sensitivity to insulin, which is observed in patients with simple obesity and diabetes, than anaerobic exercise such as weight-lifting.

OBJECTIVE: The aim of the present study was to assess prognostic factors for patients with locally advanced cervical cancer treated with radiotherapy as the primary treatment and to assess the posttreatment cut-off levels of squamous cell carcinoma antigen (SCC-Ag) to predict three-year overall survival (OS) rates. METHODS: One hundred and twenty-eight patients with cervical squamous cell carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage IIB-IVA) treated using radiotherapy or concurrent chemoradiotherapy were identified. Of these patients, 116 who had SCC-Ag levels >1.5 ng/mL prior to treatment were analyzed retrospectively. RESULTS: Median age was 68 years (range, 27 to 79 years). The complete response rate was 70.7% and the three-year OS rate was 61.1%. The median levels of pretreatment and posttreatment SCC-Ag were 11.5 ng/mL (range, 1.6 to 310.0 ng/mL) and 0.9 ng/mL (range, 0.4 to 41.0 ng/mL), respectively. Multivariate analysis showed that pretreatment anemia (p=0.041), pelvic lymph node metastasis (p=0.016) and posttreatment SCC-Ag levels (p=0.001) were independent prognostic factors for three-year OS. The SCC-Ag level cut-off point for three-year OS rates, calculated using a receiver operating characteristic curve, was 1.15 ng/mL (sensitivity, 80.0%; specificity, 74.0%). CONCLUSION: Pretreatment anemia and pelvic lymph node metastasis are poor prognostic factors in locally advanced cervical cancer. Furthermore, posttreatment SCC-Ag levels <1.15 ng/mL predicted better three-year OS rates.
Anemia ; Antigens, Neoplasm ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Gynecology ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; ROC Curve ; Sensitivity and Specificity ; Serpins ; Uterine Cervical Neoplasms

  The positive healthy physiological effects of shinrin-yoku in elderly persons were studied. Shinrin-yoku or forest bathing is considered to promote physical relaxation and to have physical and mental health benefits. In this experiment the subjects were elderly 24 male (65.5±2.5years) and 24female (65.0±3.0years) persons who participated in three measurements of shinrin-yoku effects from 2008 to 2010. All the subjects were healthy and volunteered for the experiment. The subjects participated in the shinrin-yoku measurements three times of two hours each on Wednesday in the third week of August in each year. The weather at the time of the three measurements was clear, with temperature of 30°C-32°C, humidity of 58%-60% and wind velocities of 0m/sec-2m/sec. Non-shinrin-yoku measurements were also performed on a different day in an indoor resting environment with the same subjects under the same conditions. For both the shinrin-yoku and non-shinrin-yoku measurements, the subjects were divided into three groups of 8 male and 8 female subjects equally. One was for the visual isolation group in which subjects wore eye masks, another was for the smell isolation group in which subjects wore masks, and the other was the control group in which subjects wore non-isolation material. The concentration of phytoncides in the air was measured using gas chromatography mass spectroscopy. Heart rate (HRs), blood pressure (BP), fasting levels of plasma catecholamine (adrenaline, noradrenalin and dopamine), plasma cortisol and circulating natural killer (NK) cell activity were measured before and after shinrin-yoku. Three kinds of phytoncides derived from trees were detected at the forest-bathing measurement spot in this study. The mean HRs for male subjects under shinrin-yoku and non-shinrin-yoku were 89bpm and 85bpm respectively. The mean HRs for female subjects under shinrin-yoku and non-shinrin-yoku were 86bpm and 85bpm respectively. In the smell isolation group and the control group, systric blood pressure for male and female subjects decreased significantly after shinrin-yoku. In the smell isolation group and the control group, diastolic blood pressure for male subjects decreased significantly after shinrin-yoku. In the smell isolation group and the control group, adrenaline levels for male and female subjects decreased significantly after shinrin-yoku. Among the male under the control and the female under the smell isolation and the control, noradrenaline levels decreased significantly after shinrin-yoku. Similarly, under the smell isolation, and the control, the male and female subjects showed significant decreases in the cortisol level. The NK cell activity of male and female subjects and had no significant change after shinrin-yoku. The BP, catecholamine level, cortisol level, and NK cell activity of male and female subjects showed no significant change after non-shinrin-yoku. The authors believe that this issue, and the general topic of shinrin-yoku and other environments with natural health benefits merit further study. It has been pointed out that the phytoncides and green forest environment in shinrin-yoku have a relaxing effect on the human body. As physical effects of shinrin-yoku, this study of male and female elderly subjects suggested the possibility of physiological effects in which appear within a short time and consist of multiple elements related to the human five senses, including the effects of phytoncides.   Future issues include accumulation of study results on the linkage between physiological/psychological responses and quantitative/qualitative data on odor and the visual sense.

Objective: To examine the effectiveness of progestin re-treatment for recurrent endometrial intraepithelial neoplasia (EIN), atypical endometrial hyperplasia (AH) and endometrial cancer (EC) following initial fertility-sparing treatment. Methods: A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Endometrial Cancer Committee. Multiple search engines, including PubMed/MEDLINE and the Cochrane Database, were searched in December 2021 using the keywords “Endometrial neoplasms,” “Endometrial hyperplasia,” “Endometrial intraepithelial neoplasia,” “Fertility preservation,” “Progestins,” AND “Recurrence.” Cases describing progestin re-treatment for recurrent EIN, AH and EC were compared with cases that underwent conventional hysterectomy. The primary outcomes were survival and disease recurrence, and the secondary outcome was pregnancy. Results: After screening 238 studies, 32 with results for recurrent treatment were identified. These studies included 365 patients (270 received progestin re-treatment and 95 underwent hysterectomy). Most progestin re-treatment involved medroxyprogesterone acetate or megestrol acetate (94.5%). Complete remission (CR) following progestin re-treatment was achieved in 219 (81.1%) cases, with 3-, 6- and 9-month cumulative CR rates of 22.8%, 51.7% and 82.6%, respectively. Progestin re-treatment was associated with higher risk of disease recurrence than conventional hysterectomy was (odds ratio [OR]=6.78; 95% confidence interval [CI]=1.99–23.10), and one patient (0.4%) died of disease. Fifty-one (14.0%) women became pregnant after recurrence, and progestin re-treatment demonstrated a possibility of pregnancy (OR=2.48; 95% CI=0.94–6.58). Conclusion This meta-analysis suggests that repeat progestin therapy is an effective option for women with recurrent EIN, AH and EC, who wish to retain their fertility.

Background: Craniofacial disharmony in cases of jaw deformity associated with abnormal lateral deviation of the jaw mostly involves both the maxilla and mandible. However, it has been still difficult to capture the jaw deviation aspect in a 3-dimensional and quantitative techniques. In this study, we focused on 3-dimensional mandibular morphology and position of the condylar head in relation to the base of the skull in patients with mandibular prognathism, one of the most common jaw deformities. We used cluster analysis to quantify and classify deviation and clarified its characteristics. We also investigated the degree of correlation between those findings and menton (Me) deviation measured on frontal cephalograms, which is a conventional indicator of jaw deformity. Results: Findings obtained from 100 patients (35 men, 65 women) were classified into the following three groups based on mandibular morphology and condylar position relative to the skull base. Then, reclassification using these parameters enabled classification of cluster analysis findings into seven groups based on abnormal jaw deviation characteristics. Comparison among these seven groups showed that the classification criteria were ramus height, mandibular body length, distance from the gonion to the apex of the coronoid process, and the lateral and vertical positions of the mandible. Weak correlation was also found between Me deviation on frontal cephalograms and each of the above parameters measured on 3D images. Conclusions Focusing on mandibular morphology and condylar position relative to the skull base in patients with mandibular prognathism, we used cluster analysis to quantify and classify jaw deviation. The present results showed that the 3D characteristics of the mandible based on mandibular morphology and condylar position relative to the skull base can be classified into seven groups. Further, we clarified that Me deviation on frontal cephalograms, which has been used to date, is inadequate for capturing jaw deviation characteristics.