Shoulder pain is more common among survivors of natural disasters than the general population. This study aimed to examine the occurrence of shoulder pain, especially the association between prior and later shoulder pain episodes, in survivors living in coastal areas severely damaged by the Great East Japan Earthquake (GEJE) (n = 1,821) over a period of 5 years. The presence of shoulder pain was assessed at 2 (first period), 4 (second period), and 7 (third period) years after the disaster. Multiple logistic regression analyses were performed to assess the association between shoulder pain during the first and second periods and shoulder pain during the third period. Shoulder pain in the first period was significantly associated with shoulder pain in the third period [adjusted odds ratio (OR) 5.93; 95% confidence interval (CI) 4.06-8.66]. Furthermore, shoulder pain in the first and second periods was significantly associated with shoulder pain in the third period. With the absence of shoulder pain in both the first and second periods used as the reference, adjusted ORs for the presence of shoulder pain during each period and both periods were 4.58 (95% CI 3.17-6.62) and 15.54 (95% CI 8.38-28.84), respectively (P for trend < 0.001). Thus, prior shoulder pain was significantly associated with shoulder pain after 5 years among GEJE survivors, and the association was stronger as the number of prior shoulder pain episodes increased. This expertise should be shared with other expert teams to address the affected people and prepare for future disasters.
The incidence of breast cancer among Japanese women is substantially increasing. This study evaluated the effects of reproductive and lifestyle factors with respect to breast cancer overall and separately among pre- and postmenopausal women using data from the Three-Prefecture Cohort Study of Japan.A total of 33,410 women aged 40 to 79 years completed a self-administered questionnaire, which included items about menstrual and reproductive history and other lifestyle factors. The follow-up period was from 1984 to 1992 in Miyagi and 1985 to 2000 in Aichi Prefectures. We used Cox proportional hazards regression models to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounding factors.After 9.8 mean years of follow-up, 287 cases of breast cancer were recorded. In the overall analysis, later menarche (≥16 years) and parity were significantly associated with a decreased risk of breast cancer, with HRs of 0.69 (95% CI 0.48-0.99) and 0.72 (95% CI 0.52-0.99), respectively. Further, there was a significant decline in the risk of breast cancer with increasing number of birth among parous women (P for trend = .010). On the contrary, a family history of breast cancer in the mother was significantly associated with an increased risk of breast cancer (HR 3.22, 95% CI 1.52-6.84). Analyses based on menopausal status at baseline indicated that height (≥160 cm) and weight (≥65 kg) were significantly associated with an increased risk of postmenopausal breast cancer, with HRs of 1.34 (95% CI 0.72-2.50) and 3.13 (95% CI 1.75-5.60), respectively. Risk associated with BMI significantly differs by menopausal status.Our findings suggest the important role of reproductive factors in the development of breast cancer in Japanese women; however, body mass index (BMI) may have different effects on breast cancer in Japanese women compared with western women.
In partial liver transplantation for adults criteria for the extent of reconstruction of middle hepatic vein tributaries have not been clarified. After hepatic venous and portal anastomoses in living-donor liver transplantation using left liver graft without middle hepatic vein, color Doppler ultrasonography was applied to check venous and portal blood flow. Color Doppler ultrasonography demonstrated absent hepatic venous flow and reversed portal venous flow in the congested area of the left paramedian sector which had been drained by the divided branch of the middle hepatic vein. The area was darkly discolored before arterial reperfusion and under clamping of the artery. Reconstruction of the venous branch was added after arterial anastomosis. Color Doppler ultrasonography revealed restored normal venous outflow and portal inflow after venous reconstruction. Postoperative course of the recipient was uneventful with rapid recovery of liver function. We propose that middle hepatic vein tributaries should be reconstructed if color Doppler ultrasonography demonstrates absent venous flow and reversed portal flow, and if the liver volume excluding the discolored area under occlusion of the hepatic artery is estimated to be insufficient for postoperative metabolic demand.
It is unclear whether weight change during adulthood affects the risk of obesity-related cancers such as those of the esophagus, colorectum, pancreas, breast, endometrium, and kidney among Japanese, where obesity is less frequent and less severe. We examined the association between weight change during adulthood and the risk of obesity-related cancer among Japanese by conducting a pooled analysis of two prospective studies of residents in Miyagi Prefecture, Japan. A total of 78,743 persons (40,422 women and 38,321 men) aged 40-79 years participated in the Miyagi Cohort Study in 1990 and in the Ohsaki Cohort Study in 1994. Weight change since age 20 was divided into four categories (weight loss; stable weight; moderate weight gain; high weight gain). Cox proportional hazards regression analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for obesity-related cancer incidence. During 1,057,899 person-years of follow up, 4,467 cases of obesity-related cancer (women; 1,916 cases, men; 2,551cases) were identified. In women, compared to the stable weight, weight gain was associated with an increased risk of obesity-related cancer (moderate weight gain; HRs = 1.10, 95%CIs: 0.97-1.26, high weight gain; HRs = 1.29, 95%CIs: 1.14-1.47). The results indicate that weight gain since age 20 was associated with a significantly increased risk of obesity-related cancer among Japanese women. By contrast, in men, our study found that weight change is not associated with the incidence of obesity-related cancer.
Recent epidemiological studies of the association between coffee consumption and the risk of bladder cancer have yielded conflicting results. The aim of the present study was to examine the association between coffee consumption and the incidence of bladder cancer on the basis of pooled data from two cohort studies carried out in Miyagi Prefecture, northeastern Japan. We delivered self-administered questionnaires inquiring about the frequency of coffee consumption and other lifestyle factors in 1990 for the Miyagi Cohort Study and in 1994 for the Ohsaki Cohort Study. We followed 73 346 individuals from both cohorts and identified 274 cases of bladder cancer during 17.6 years for the Miyagi Cohort Study and 13.3 years for the Ohsaki Cohort Study. The multivariate-adjusted hazard ratios (95% confidence intervals) of bladder cancer incidence for the individuals who drank coffee occasionally, 1-2 cups/day, and 3 or more cups/day compared with never drinkers were 1.22 (0.90-1.66), 0.88 (0.61-1.26), and 0.56 (0.32-0.99), respectively (Ptrend=0.04). The inverse association remained even after stratification for smoking status. These data indicate that there is a significant inverse association between coffee consumption and the risk of bladder cancer.
Recent technical advances in ultrasonography, such as a frequency higher than 10MHz, has enabled its application to the skin and subcutaneous tissues. The pressure ulcer team at the University of Tokyo Hospital routinely uses the ECHOPAL II ultrasound scanner (Hitachi Medical Systems, Japan), which has a 10MHz probe, to assess superficial tissue damage during its wound-care rounds. It is especially useful for evaluating latent subcutaneous tissue damage underneath seemingly superficial pressure ulcers (National Pressure Ulcer Advisory Panel [NPUAP] stage I–II). Using the 10MHz probe, we can obtain a reasonable resolution of an image 20–30mm below the skin surface. The dermis and the subcutaneous fatty tissue can also be clearly detected in normal tissue (Fig 1a).
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