Tanji Hoshi

Fibrosis and smooth muscle metaplasia in rectovaginal endometriosis

Rectovaginal (RV) endometriosis presents with a nodular lesion composed of fibromuscular and endometriotic tissue, and the fibromuscular tissue is the major component in the severe stage. The purpose of our study was to examine the extending process of fibromuscular tissue in RV endometriosis. Histological examinations using immunostains, were performed in 90 RV tissue specimens from 37 women. Fibrosis was present in 89 specimens. In each specimen, the intensity of the fibrosis differed from area to area: in mildly fibrotic areas, the collagen fibers were present around the endometriotic tissue, and in severely fibrotic areas, the fibrosis widely extended into fat and connective tissus as well as within the endometriotic tissue. In the 60 specimens containing endometriotic tissue, the increase in the amount of endometriotic tissue significantly correlated to the increase in degree of fibrosis in the entire tissue. The presence of aggregated smooth muscles, unassociated with blood vessels, was defined as smooth muscle metaplasia (SMM), which was always present within the fibrotic areas, and was observed in 80 specimens. The degree of SMM in the entire tissue was significantly correlated with the degree of fibrosis. From these findings, the following was hypothesized. Initially, endometriotic tissue was present sporadically and fibrosis was present around the endometriotic tissue. Thereafter, proliferation of endometriotic tissue and an increase in fibrosis occur consecutively. The SMM was present within the fibrotic areas, and it became more severe, correlating with the increase in fibrosis. In conclusion, this is the first report describing the extending process of the fibromuscular tissue of RV endometriosis from a histological viewpoint, and we think that recognization of this process is useful for histological diagnosis and clinical management of RV endometriosis.

Prevalence and characteristics of older community residents with mild cognitive decline

Background:  Cognitive impairment is a major health issue, but epidemiological data on mild cognitive decline have been almost absent in Japan.

Analysis of response to radiation therapy of patients with cervical adenocarcinoma compared with squamous cell carcinoma. MIB-1 and PC10 labeling indices.

The MIB‐1 monoclonal antibody is a marker of cycling cells and the PC10 monoclonal antibody is a marker of proliferating cell nuclear antigen in paraffin sections. This study was conducted to elucidate the difference in response to radiotherapy (RT) between cervical adenocarcinomas and squamous cell carcinomas, focusing on cell proliferation.

Relationships between Plasma β-Amyloid Peptide 1–42 and Atherosclerotic Risk Factors in Community-Based Older Populations

Background: Recent studies have suggested that atherosclerosis contributes to the development of dementia of the Alzheimer’s type (DAT). Convenient and valid biochemical markers of DAT are needed to control risk factors for this disease. The aims of the present study were thus (1) to determine the distribution of plasma β-amyloid peptide1–42 (Aβ1–42) levels in an older population and (2) to investigate factors correlating with plasma levels of this amyloid peptide. Our data support the hypothesis that atherosclerosis plays a role in the pathogenesis of DAT. Methods: 759 Japanese community residents participated in a municipal medical health evaluation; a subset of 280 was selected at random for the measurement of physiological, psychosocial and life-style variables, together with the analysis of blood specimens for cell counts, hematocrit, Aβ1–42, and other biochemical markers. Results: Log-transformed plasma Aβ1–42 concentrations showed a Gaussian distribution. Quartiles of log10 (Aβ1–42) concentrations correlated significantly with age categories, but not with other sociopsychological and life-style variables. Plasma Aβ1–42 was significantly correlated with systolic and diastolic blood pressure (DBP; r = 0.19, p = 0.002 and r = 0.16, p = 0.007, respectively), pulse pressure (r = 0.13, p = 0.036), total cholesterol (r = 0.15, p = 0.011), log10 (triacyl glycerol) (r = 0.14, p = 0.021), and log10 (hemoglobin A1c) [log10 (HbA1c)] (r = 0.14, p = 0.020). Stepwise multiple regression analysis showed significant independent effects of DBP, and log10 (HbA1c) on plasma Aβ1–42 concentrations. Conclusions: Our findings suggest that conventional atherosclerotic risk factors are associated with plasma Aβ1–42 levels. This observation may be important in the detection and prevention of DAT.

Socioeconomic Status, Comorbidity, Activity Limitation, and Healthy Life Expectancy in Older Men and Women A 6-Year Follow-Up Study in Japan

This study aimed to explore the structural contributions of socioeconomic status (SES), comorbidity, and activity limitation to the healthy life expectancy (HALE) of Japanese suburban elderly. A questionnaire survey was distributed to all residents aged 65 years and older in Tama City, Tokyo, in 2001; a follow-up study was conducted in 2004; and individual vital status data from the municipal residents’ registry were tracked until 2007. In all, 7,905 respondents were included for analysis. Data analysis was performed by structural equation modeling (SEM). The data were well fit by the models, and HALE was found to be well explained by SES, comorbidity, and activity limitation (R2 = .59 for men and R2 = .71 for women). In conclusion, elderly people with higher SES were more likely to live longer with good self-rated health, via living with less chronic diseases and better performance in daily living activities, especially for elderly women.

Structural analysis of the effects of dietary and lifestyle habits, socio-economic status, and three health-related factors on urban elderly in Japan

This study aimed to reveal the causal relationships of dietary and lifestyle habits with socio-economic status (SES) and three health-related factors (physical, mental and social health) in elderly urban dwellers in Japan. All the elderly urban dwellers aged 65 years or more in an urban area of Tokyo were surveyed using a self-administered questionnaire in September 2001. There were 13,195 respondents with a response rate of 80.2%. And then, two follow-up surveys were conducted in 2004 and 2007, respectively. Finally, 8162 respondents were included as analysis subjects. Data analysis was performed using factor analysis and structural equation modelling (SEM). As a result of an exploratory factor analysis, three latent variables (‘dietary and lifestyle habits in 2004’, ‘SES in 2001’ and ‘three health-related factors in 2001’) were defined and applied in the SEM. From the best-fit models, dietary and lifestyle habits in 2004 were well explained by SES and three health-related factors in 2001 (R2 = 0.44 for elderly men and R2 = 0.61 for elderly women). The results showed that dietary and lifestyle habits in 2004 were not only directly affected by SES and the three health-related factors in 2001, but also indirectly by SES via the three health-related factors. Moreover, the causal relationships between the three latent variables depended on sex and age. In conclusion, SES as a basic determinant – enough income, high education level and good physical, mental and social health – favoured both directly and indirectly the practice of healthy or desirable lifestyle habits of the elderly late in life. It will be necessary to construct a model with higher external validity in a future study.

Dietary quality and its structural relationships among equivalent income, emotional well-being, and a five-year subjective health in Japanese middle-aged urban dwellers

BackgroundAlthough dietary quality in middle-age and the prime age of a person’s work career might be determined by positive emotional well-being based on socioeconomic status (SES), causation among determinants of dietary quality still remains unclear. Our purpose was to elucidate the structural relationships among five-year prior dietary quality, equivalent income, emotional well-being, and a five-year subjective health by sex and age group separately.MethodsIn 2003, 10,000 middle-aged urban dwellers aged 40-64 years, who lived in ward A in the Tokyo metropolitan area, were randomly selected and a questionnaire survey was conducted by mail. In 2008, we made a follow-up survey for dwellers, and were able to gather their survival status. A total of 2507, middle-aged men (n = 1112) and women (n = 1395), were examined at baseline. We created three latent variables for a structural equation modeling (SEM), five-year subjective health reported in 2003 and in 2008, dietary quality of principle food groups diversity and eating behavior in 2003, and emotional well-being constructed by enjoyment & ikigai (meaning of life) and by close people in 2003. Equivalent income in 2003 was calculated as SES indicator.ResultsIn the SEM analysis of both men and women, there was an indirect effect of the equivalent income on dietary quality and on five-year subjective health, via emotional well-being explained by ikigai and having comforting people close to the individuals, significantly. There tended to be a larger direct effect of emotional well-being on the dietary quality in men than in women, and also a larger effect accompanying with aging. In women, there was a large direct effect of equivalent income on dietary quality than in men. When examined comprehensively, there appeared to be a larger effect of five-year prior equivalent income on subjective health during five-year in men than in women.ConclusionThis study suggests that it is necessary to support the improvement of dietary quality in middle age by considering the characteristics of sex and age group and also by providing supportive environment to enhance emotional well-being based on equivalent income, cooperating different field professionals to provide such as employment or community support program.

Regulatory factors of medical care expenditures for older people in Japan--analysis based on secondary medical care areas in Hokkaido.

For the purpose of clarifying determinants of medical care expenditure for older people in Japan, we analyzed the data on medical care expenditure for older people in 21 secondary medical care areas in Hokkaido, the second largest island of Japan. The annual amount of medical expenditure per insured older person can be reduced into three components: annual number of medical care bills per insured older person days of hospitalization or visits per medical care bill and amount of medical expenditure per day and per insured older person. The 21 secondary medical care areas in Hokkaido showed large differences in per capita amount of both inpatient and outpatient medical expenditures for older people. Per capita inpatient medical expenditure for men and women correlated positively with the days of hospitalization per bill and the per capita number of inpatient medical care bills per year, but inversely with the per capita amount of expenditure per day of hospitalization. The same held true for outpatient medical expenditure for men, but for women outpatient medical expenditure correlated positively with all three components. Multiple regression analysis indicated the more powerful effects of medical care demand or supply on inpatient medical expenditure, on the other hand, not much powerful effects of every index were indicated on outpatient medical expenditure.

Self-Rated Health and Social Factors ii the Urban Japanese—A Study of Structural Equation Modeling (SEM)

Self-rated health is one of the most common measures of health status in the health sciences. However, little is known about its social and psychological background. In the present study, we evaluated a total of 13,034 subjects identified from a 2001 survey in Tama City, Japan. The study design was cross-sectional and targeted individuals aged 65 years or older. Data, including medication use, socio-economic factors, lifestyle and instrumental ADL were collected via self-administered questionnaires. A decrease in self-rated health with age was noted both in men and women. Factor analyses showed these factors clustered into 4 unrelated groups in men and 5 groups in women. A theoretical model with four latent and 14 manifest variables was formulated by AMOS 5.0 (SPSS, Japan). There were four latent variables. In the present study, relationships between these four latent variables were examined. The findings showed that decreases in yearly income, daily activity, and poor social support could disrupt the balance of health in elderly populations. The structural equation models (SEMs) could comprise schematically a new ordered nature of self-rated health and social circumstances.

Association between socioeconomic status (SES), mental health and need for long-term care (NLTC)—A Longitudinal Study among the Japanese Elderly

This study was carried out to explore the relationship between the SES, mental health and the NLTC of the Japanese elderly, with the aim of providing useful information to lower the NLTC. A longitudinal survey was carried out in Tama City, Tokyo in 2001 and 2004. Data were collected from the urban-dwelling older adults, aged 65 years old and above, through self-reported questionnaires, which was participated by 7905 respondents (47.6% male and 52.4% female). Chi-square test, Kendall tau-b correlation analysis and structural equation modeling (SEM) were used to identify the association between SES, mental health and NLTC. The results of the SEM analysis indicated that mental health would exert a negative effect on NLTC for both the elderly men and the elderly women, while the effect was stronger for the elderly women; SES was significantly and negatively associated to NLTC, both for the elderly men and elderly women; a significant and positive relationship was observed between SES and mental health for both genders, but slightly stronger for the elderly men. These findings have implications for targeting the interventions that are aimed to delaying the NLTC and the financing of LTC system.