Yumi Kuwamura

Effectiveness of Mammographic Screening for Breast Cancer in Women Aged over 50 Years in Japan

The optimal age for effective screening of subjects for breast cancer by mammography in Japan was studied based on the results of two mammograpbic screening systems (systems I and II) in Tokushima Prefecture, System I consisted of visit screening using a bus equipped with a mammographic apparatus. System II consisted of central screening performed at Tokushima Health Screening Center. The examinees numbered 2,500 and 3,707 in systems I and II, respectively. There was a significant difference between the two screening systems in the age distribution of the examinees. The detection rates of breast cancer were 0.6% and 0.24% in systems I and II, respectively, which are 2–5 times higher than that (0.12%) obtained by conventional screening using physical examination alone. The detection rate increased especially in the sixth and seventh decades of life. The sensitivity of mammography screening was 93.3% in system I and 81.1% in system II. Higher sensitivity (100%) than that (73%) of screening by physical examination was obtained in women aged over 50. The proportion of stage I was 60% in system I and 66.7% in system II, compared with 32–65% in the United States and Europe. The rates of no nodal involvement were high, being 77.8% and 83.3% in systems I and II, respectively, compared with 57–71% in other countries. Breast‐conserving therapy was applied to 18 of the 24 patients with breast cancer detected by the two screening systems. In addition, in Wolfes classification of mammograms, the proportion of DY (mammary dysplasia) pattern was remarkably low, being 3.2% in the sixth decade and 0.8% in the seventh decade, compared with 16.6% in women aged 49 years. These results indicate that mammographic screening is effective in women aged over 50 years in Japan, as has been found in other countries.

Cut-Off Value of Total Adiponectin for Managing Risk of Developing Metabolic Syndrome in Male Japanese Workers

Aim To determine the optimal cut-off value of serum total adiponectin for managing the risk of developing metabolic syndrome (MetS) in male Japanese workers. Methods A total of 365 subjects without MetS aged 20–60 years were followed up prospectively for a mean of 3.1 years. The accelerated failure-time model was used to estimate time ratio (TR) and cut-off value for developing MetS. Results During follow-up, 45 subjects developed MetS. Age-adjusted TR significantly declined with decreasing total adiponectin level (≤ 4.9, 5.0–6.6, 6.7–8.8 and ≥ 8.9 μg/ml, P for trend = 0.003). In multivariate analyses, TR of MetS was 0.12 (95% CI 0.02–0.78; P = 0.03) in subjects with total adiponectin level of 5.0–6.6 μg/ml, and 0.15 (95% CI 0.02–0.97; P = 0.047) in subjects with total adiponectin level ≤ 4.9 μg/ml compared with those with total adiponectin level ≥ 8.9 μg/ml. The accelerated failure-time model showed that the optimal cut-off value of total adiponectin for managing the risk of developing MetS was 6.2 μg/ml. In the multivariate-adjusted model, the mean time to the development of MetS was 78% shorter for total adiponectin level ≤ 6.2 μg/ml compared with > 6.2 μg/ml (TR 0.22, 95% CI: 0.08–0.64, P = 0.005). Conclusion Our findings suggest that the cut-off value for managing the risk of developing MetS is 6.2 μg/ml in male Japanese workers. Subjects with total adiponectin level ≤ 6.2 μg/ml developed MetS more rapidly than did those with total adiponectin level > 6.2 μg/ml.

Associations between intake of dietary fermented soy food and concentrations of inflammatory markers: a cross‐sectional study in Japanese workers

Epidemiological investigations have shown that consumption of soybeans or soy foods reduces the risk of the development of cardiovascular disease, cancer and osteoporosis. The aim of this study was to determine the associations between different soy foods and inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and IL-18, in Japanese workers. The cross-sectional study included 1,426 Japanese workers (1,053 men and 373 women) aged 20 to 64 years. Intake of 12 soy foods was estimated by a validated food frequency questionnaire. Associations of total soy foods, fermented soy food, non-fermented soy food, soy isoflavone with hs-CRP, IL-6, and IL-18 levels were examined by general linear model regression analysis. We found that total fermented soy food intake was inversely associated with multivariable-adjusted geometric concentration of IL-6 in men (Q1:1.03 pg/mL, Q5:0.94 pg /mL;P for trend = 0.031). Furthermore, it was shown that IL-6 concentrations were inversely associated with miso intake (β = -0.068;p = 0.034) and soy sauce intake in men (β = -0.074;p = 0.018). This study suggests that intake of total fermented soy food, miso and soy sauce be associated with IL-6 concentrations in Japanese men. J. Med. Invest. 65:74-80, February, 2018.

Changes in the thickness of leg muscles before and after laparotomy

Following surgery, patients are likely to experience muscle fatigue 1-3) and reduced muscle strength because surgical invasion facilitates the destruction of proteins in skeletal muscles4). Currently, various measures are taken to shorten the length of hospital stay, resulting in greater numbers of patients being discharged who still require nursing care to facilitate postoperative recovery. Moreover, while it is generally desirable for postoperative patients to mobilize early, long-term bed rest is required in some cases to prevent the onset of postoperative complications or to treat such complications. Therefore, from the standpoint of nursing, it is necessary to minimize the negative impact of postoperative recumbency and to achieve independence in activities of daily living as quickly as possible. The lower limb muscles account for a Introduction large portion of the systemic skeletal musculature and play the most important role in walking. While maintaining lower limb muscle strength is important for achieving early independence in walking, few nursing studies in Japan have focused on these muscles 5,6). Several bedside techniques for assessing muscle tissue and strength have been reported: 1) measuring maximum voluntary muscle strength using a dynamometer 7-9); 2) estimating the cross-sectional area of muscles based on subcutaneous fat thickness and circumference of the extremity 5,10). However, when these methods are applied postoperatively, accuracy is low 11) because patients cannot exert maximum effort due to wound pain 10). In order to gather the basic data for designing an effective postoperative recovery program, the present study was conducted to ascertain an objective and In order to establish an objective and convenient technique to assess postoperative recovery following laparotomy, in particular activities of daily living, we measured the thickness of muscle tissues by ultrasound sonography. In the present study, the following four muscular compartments were selected: rectus femoris, biceps femoris, extensor digitorum longus, and soleus. These account for a large portion of the systemic skeletal musculature and are important for locomotion. Subjects were 28 patients who underwent moderately invasive surgery for stomach or colon cancer. The results showed that muscle thickness decreased significantly in all four compartments. Rectus femoris exhibited the greatest reduction in thickness and was most affected by short-term or long-term recumbency. Furthermore, for soleus, the tendency was that the longer the recumbency, the greater the wasting. These findings suggest that, of the four areas of the lower limb, rectus femoris is most affected by short-term recumbency and is most suited for objectively assessing postoperative recovery. The results of the present study suggest that it would be effective to design a recovery program focused on maintaining the femoral extensor muscles, which are most affected by short-term recumbency following laparotomy. Changes in the thickness of leg muscles before and after laparotomy