OBJECTIVE: To develop and validate a 3-year recurrence prediction score (RPS) system for predicting the baseline risk of recurrence of stage I–II endometrial carcinoma. METHODS: We reviewed 427 patients with International Federation of Gynecology and Obstetrics staging I–II endometrial carcinoma underwent surgery without any adjuvant therapy from 2005 to 2013. The patients were divided into 2 groups: the test cohort (n=251) comprising those who underwent surgery in odd-numbered years, and the validation cohort (n=176) comprising those who underwent surgery in even-numbered years. Multivariate analysis was performed using 7 candidate predictors to identify the risk factors for 3-year recurrence-free interval (RFI) in the test cohort. Each risk factor was scored based on logistic regression analyses of the test data set, and the sum of the risk factor scores was defined as the RPS system. We then applied the system in the validation cohort. RESULTS: Multivariate analysis revealed that the significant risk factors were age ≥60 years, pathological type II, positive cervical stromal invasion, and positive peritoneal cytology. In the test cohort, the 3-year RFI rates were 100%, 95.8%, 79.9%, and 33.3% for RPSs of 0, 1, 2, and 3, respectively. In the validation cohort, the 3-year RFI was significantly higher in the low-RPS group (RPS 0 or 1) than in the high-RPS group (RPS 2 or 3) (95.2% vs. 79.9%, p < 0.01). CONCLUSIONS: The RPS system shows significant reproducibility for predicting the baseline risk of recurrence. The system could potentially impact the choice of adjuvant therapy for stage I–II endometrial carcinoma.
Cohort Studies ; Dataset ; Endometrial Neoplasms* ; Female ; Gynecology ; Humans ; Logistic Models ; Multivariate Analysis ; Obstetrics ; Recurrence* ; Risk Factors

BACKGROUND: The Japan Environment and Children's Study (JECS) is a nation-wide birth cohort study investigating environmental effects on children's health and development. In this study, the exposure characteristics of the JECS participating mothers were summarized using two questionnaires administered during pregnancy. METHODS: Women were recruited during the early period of their pregnancy. We intended to administer the questionnaire during the first trimester (MT1) and the second/third trimester (MT2). The total number of registered pregnancies was 103,099. RESULTS: The response rates of the MT1 and MT2 questionnaires were 96.8% and 95.1%, respectively. The mean gestational ages (SDs) at the time of the MT1 and MT2 questionnaire responses were 16.4 (8.0) and 27.9 (6.5) weeks, respectively. The frequency of participants who reported "lifting something weighing more than 20 kg" during pregnancy was 5.3% for MT1 and 3.9% for MT2. The Cohen kappa scores ranged from 0.07 to 0.54 (median 0.31) about the occupational chemical use between MT1 and MT2 questionnaires. Most of the participants (80%) lived in either wooden detached houses or steel-frame collective housing. More than half of the questionnaire respondents answered that they had "mold growing somewhere in the house". Insect repellents and insecticides were used widely in households: about 60% used "moth repellent for clothes in the closet," whereas 32% applied "spray insecticide indoors" or "mosquito coil or an electric mosquito repellent mat." CONCLUSIONS We summarized the exposure characteristics of the JECS participants using two maternal questionnaires during pregnancy.
Adult ; Child Health ; Cohort Studies ; Female ; Gestational Age ; Humans ; Japan ; Maternal Exposure ; statistics & numerical data ; Mothers ; statistics & numerical data ; Pregnancy ; Surveys and Questionnaires ; Young Adult

OBJECTIVE: Though there are no evidences that postoperative therapy improves overall survival (OS) in stage I–II endometrial carcinoma, many women receive postoperative radiation or chemotherapy. This study aimed to investigate the baseline risk of recurrence after complete resection without any adjuvant therapies and to suppose the validity of postoperative therapy for stage I–II endometrial carcinoma. METHODS: Charts for patients with stage I–II endometrial carcinoma who underwent operation without postoperative therapy between January 2005 and December 2011 were retrospectively reviewed and the baseline risk of recurrence and prognosis were assessed. Risk classifications were performed according to European Society for Medical Oncology (ESMO) clinical practice guidelines and Japanese guideline written by Japan Society of Gynecologic Oncology Group. RESULTS: Among 374 patients who underwent complete resection, 311 were evaluable. Five-year recurrence rates by ESMO and Japanese were 2.6% and 3.1% in low-risk, 9.2% and 6.6% in intermediate-risk and 13.5% and 13.8% in high-risk group (p=0.003 and 0.015, respectively). High-risk group had worse OS compared with low- and intermediate-risk groups (5-year OS, low: 97.9% and 97.6%, intermediate: 97.9% and 98.8%, and high: 89.5% and 87.5%; p=0.003 and 0.008, respectively). Independent predictive factors of recurrence were age over 60 years, type 2 (estrogen-independent) and peritoneal cytology. CONCLUSION: ESMO and Japanese risk classification similarly stratify the baseline risk of recurrence. Patients with stage I–II endometrial carcinoma, especially low- and intermediate-risk diseases, have low recurrence rate and favorable OS, and the benefit of postoperative therapy might be small.
Asian Continental Ancestry Group ; Classification ; Drug Therapy ; Endometrial Neoplasms ; Female ; Humans ; Japan ; Medical Oncology ; Postoperative Care ; Prognosis ; Recurrence ; Retrospective Studies

OBJECTIVETo evaluate the acute effects of indoor and outdoor particulate matter on lung function and respiratory symptoms of college students in winter.

METHODSA panel of 37 college students aged 19-21 in Wuhan were included and the investigation was carried out from 12/23/2009 to 01/05/2010. Daily morning/evening forced expiratory volume in one second (FEV1) and respiratory symptoms (cough, phlegm and runny) were measured and reported by subjects, respectively. Meanwhile, daily data of indoors and outdoors PM10, PM2.5, temperature, and relative humidity were collected. Generalized Estimating Equations (GEEs) were used to estimate the association between particulate matters exposure and respiratory symptoms and FEV1).

RESULTSAverage daily concentrations of indoor, outdoor PM2.5 during the study period were (110.6 ± 42.3), (143.5 ± 51.2) µg/m³, (148.2 ± 43.2) and (239.1 ± 71.3) µg/m³ for indoor, outdoor PM10, respectively. Outdoor exposure to PM2.5 on lag 0 had little effect on evening FEV1). However, researchers observed a significant lagging effect (lag 1 d) and accumulative effect (lag 0-1 d and lag 0-2 d). A rise in the PM2.5 concentration of 10 µg/m³ resulted in the change of evening FEV1) of -0.28% (95% CI: -0.52%, -0.03%), -0.45% (95% CI: -0.81%, -0.08%) and -0.63% (95% CI: -1.15%, -0.11%), respectively. For respiratory symptoms of coughing up phlegm, 10 mg/m³ increase of indoor/outdoor PM2.5 concentration were associated with odds ratio of 1.18 (95% CI: 1.02-1.36) and 1.08 (95% CI: 0.97-1.19), respectively. Moreover, risk of coughing up phlegm increased with lagging time, and accumulative time of indoor and outdoor PM2.5 and PM10.

CONCLUSIONOur study suggested that short-term exposure to particulate matters in winter was significantly associated with acute changes of respiratory symptoms and FEV1) of college students in Wuhan. Moreover, the effects of particulate matters tended to be larger as the increase of lagged and accumulative days.

Air Pollutants ; Cough ; Forced Expiratory Volume ; Humans ; Humidity ; Mucus ; Particulate Matter ; Respiratory Tract Diseases ; Seasons ; Students ; Temperature

Objective To evaluate the acute effects of indoor and outdoor particulate matter on lung function and respiratory symptoms of college students in winter. Methods A panel of 37 college students aged 19-21 in Wuhan were included and the investigation was carried out from 12/23/2009 to 01/05/2010. Daily morning/evening forced expiratory volume in one second(FEV1) and respiratory symptoms (cough, phlegm and runny) were measured and reported by subjects, respectively. Meanwhile, daily data of indoors and outdoors PM10, PM2.5, temperature, and relative humidity were collected. Generalized Estimating Equations(GEEs) were used to estimate the association between particulate matters exposure and respiratory symptoms and FEV1. Results Average daily concentrations of indoor, outdoor PM2.5 during the study period were(110.6 ± 42.3),(143.5 ± 51.2) μg/m3,(148.2 ± 43.2) and(239.1 ± 71.3) μg/m3 for indoor, outdoor PM10, respectively. Outdoor exposure to PM2.5 on lag 0 had little effect on evening FEV1. However, researchers observed a significant lagging effect(lag 1 d) and accumulative effect(lag 0-1 d and lag 0-2 d). A rise in the PM2.5 concentration of 10μg/m3 resulted in the change of evening FEV1 of-0.28%(95%CI:-0.52%,-0.03%),-0.45%(95%CI:-0.81%,-0.08%) and-0.63%(95%CI:-1.15%,-0.11%), respectively. For respiratory symptoms of coughing up phlegm, 10 mg/m3 increase of indoor/outdoor PM2.5 concentration were associated with odds ratio of 1.18(95%CI:1.02-1.36) and 1.08(95%CI:0.97-1.19), respectively. Moreover, risk of coughing up phlegm increased with lagging time, and accumulative time of indoor and outdoor PM2.5 and PM10. Conclusion Our study suggested that short-term exposure to particulate matters in winter was significantly associated with acute changes of respiratory symptoms and FEV1 of college students in Wuhan. Moreover, the effects of particulate matters tended to be larger as the increase of lagged and accumulative days.

Objective To evaluate the acute effects of indoor and outdoor particulate matter on lung function and respiratory symptoms of college students in winter. Methods A panel of 37 college students aged 19-21 in Wuhan were included and the investigation was carried out from 12/23/2009 to 01/05/2010. Daily morning/evening forced expiratory volume in one second(FEV1) and respiratory symptoms (cough, phlegm and runny) were measured and reported by subjects, respectively. Meanwhile, daily data of indoors and outdoors PM10, PM2.5, temperature, and relative humidity were collected. Generalized Estimating Equations(GEEs) were used to estimate the association between particulate matters exposure and respiratory symptoms and FEV1. Results Average daily concentrations of indoor, outdoor PM2.5 during the study period were(110.6 ± 42.3),(143.5 ± 51.2) μg/m3,(148.2 ± 43.2) and(239.1 ± 71.3) μg/m3 for indoor, outdoor PM10, respectively. Outdoor exposure to PM2.5 on lag 0 had little effect on evening FEV1. However, researchers observed a significant lagging effect(lag 1 d) and accumulative effect(lag 0-1 d and lag 0-2 d). A rise in the PM2.5 concentration of 10μg/m3 resulted in the change of evening FEV1 of-0.28%(95%CI:-0.52%,-0.03%),-0.45%(95%CI:-0.81%,-0.08%) and-0.63%(95%CI:-1.15%,-0.11%), respectively. For respiratory symptoms of coughing up phlegm, 10 mg/m3 increase of indoor/outdoor PM2.5 concentration were associated with odds ratio of 1.18(95%CI:1.02-1.36) and 1.08(95%CI:0.97-1.19), respectively. Moreover, risk of coughing up phlegm increased with lagging time, and accumulative time of indoor and outdoor PM2.5 and PM10. Conclusion Our study suggested that short-term exposure to particulate matters in winter was significantly associated with acute changes of respiratory symptoms and FEV1 of college students in Wuhan. Moreover, the effects of particulate matters tended to be larger as the increase of lagged and accumulative days.

OBJECTIVETo evaluate the effects of indoor and outdoor PM2.5 (fine particulate matter, particulate matter with an aerodynamic diameter ≤ 2.5 µm) on lung function of college students in autumn and winter in Wuhan.

METHODSIn this panel study, 37 college students (excluded subject of respiratory disease and smoking history) aged 19 - 21 were investigated by cluster sampling in a university in Wuhan. The follow-up study lasted for 28 days in total, including two study periods, Oct. 29 to Nov. 11, 2009 (autumn) and Dec. 23, 2009 to Jan.5, 2010 (winter), the peak expiratory flow (PEF) of the college students were measured daily in the morning and evening in the university. PM10 and PM2.5 were monitored indoors and outdoors. The effects of PM on lung function of college students were analyzed by using generalized estimating equation (GEE).

RESULTSAverage daily concentrations of indoor, outdoor PM2.5 in autumn were (91.3 ± 43.7) and (104.2 ± 49.4) µg/m(3) respectively, while in winter the concentrations of indoor and outdoor PM2.5 were (110.6 ± 42.3) and (143.5 ± 51.2) µg/m(3). The single pollutant model showed that in winter, the evening PEF decrement was significantly associated with increasing outdoor PM2.5. With an increase of 10 µg/m(3) outdoor PM2.5, the PEF measured in the evening decreased 1.27 L/min (95%CI: 0.02 - 2.52 L/min, respectively). Meanwhile, the results showed that 2-days lagged outdoor PM2.5 was also significantly associated with morning PEF. An increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 caused the decrease of 1.82 L/min (95%CI: -3.53 - -0.11 L/min) of PEF measured in the morning. Controlling the influence of gaseous pollutants and building the two pollutants models, the results indicated that no significant changes of PEF of students being exposed to PM2.5 on same day (lag 0) were observed. However, under consideration of SO2 effect, significant association between an increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 and changes of morning PEF (-1.81 L/min, 95%CI: -3.51 - -0.11 L/min, P = 0.037) was found. The relationship between changes of concentrations and PEF was not observed in autumn in this study.

CONCLUSIONIn our panel study, exposure to outdoor PM2.5 is significantly associated with PEF among college students in winter, but not in autumn.

Air Pollutants ; China ; epidemiology ; Environmental Exposure ; Female ; Humans ; Male ; Maximal Midexpiratory Flow Rate ; Particulate Matter ; Respiratory Function Tests ; Seasons ; Students ; Young Adult

Mediastinitis following graft replacement of the ascending and total arch aorta is a fatal complication of cardiac surgery. When graft infection is suspected, one choice of treatment is to remove the infected prosthesis and replace it with a new one. However such a procedure seems to be very risky. We report 2 successfully treated cases of mediastinitis following graft replacement of the ascending and total arch aorta. In one case, we treated with primary sternal closure after debridement and omental flap implant. In another case, the wound was left open and irrigation with iodine solution was undertaken for 6 days. The sternum was closed with pectoralis major muscle flap implantation. When graft infection is not suspected, primary sternal closure with implantation of tissue flaps is recommended. When graft infection is strongly suspected, we prefer secondary sternal closure after open irrigation.

A 44-year-old man underwent total arch replacement for acute type A aortic dissection. He was treated postoperatively in the intensive care unit for acute renal failure and respiratory failure. Although recovery of organ functions was seen, an unexpected fall in platelet count (PLT) occurred abruptly on postoperative day (POD) 7. The patient was treated with gabexate mesilate and platelet transfusion because disseminated intravascular coagulation (DIC) was initially suspected. Nevertheless, PLT dropped rapidly below 1.0×10⁴/μl. We suspected heparin-induced thrombocytopenia (HIT) and stopped all heparin administration including flush solution for pressure monitoring lines. The platelet factor 4-reactive HIT antibody test was performed and we began to give intravenous argatroban, 60mg/day. However, PLT did not increase at all. Multiple organ failure developed and metabolic acidosis deteriorated rapidly resulting in death on POD 15. HIT antibody was positive on POD 13 and a definitive diagnosed of HIT was made. For those patients treated with heparin continuously or repeatedly, HIT may occur and increase the mortality risk if the diagnosis is delayed.

The incidence of fluorosis, believed to arise from the burning of coal, has been frequently reported in the highlands in the southern part of China. With a lot of rain and a climate of low temperature, the hilly region produces coal and inhabitants use it as a fuel for cooking and heating. The fossil fuel used by them is mostly powdery. It is mixed with dirt and rolled up into bolls. In that way,the people make the briquettes that burn a long time.Ordinary houses have no chimneys to belch forth smoke, so that it stagnates indoors for a while. Soot and smoke, before flowing out via the openings in the roof shingle of the loft, spoils farm produce stored there. Because the smoke contains high concentrations of fluoride derived from coal and dirt, it is believed that eating farm produce exposed to the smoke is one of the major factors for fluoride poisoning. Many researchers have thus far analyzed farm products for fluoride content and confirmed that high levels of fluoride were contained in their samples.In the present study, we measured fluoride concentrations in some samples of corn and capsicum produced in a rural area of Sichuan, China on one hand and on the other examined the water-solubility of fluoride. Furthermore, screening tests for chronic endemic dental fluorosis were performed on students to survey the fluoride contamination in the past as compared with the present state.Incidentally, indoor air-borne fluoride concentrations in this area averaged out at0.047mg F/m3 (15 times as high as the mean in a community that was free of fluoride contamination). The fluoride content of the drinking water from a spring in the nearby hill, measured with use of a fluoride-specific electrode method,was within the range from 0.2 to 0.3μg/ml.
Fluorides ; Fluoride measurement ; China ; Coal ; Levels