Trends in Hip Fracture Incidence in Japan: Estimates Based on Nationwide Hip Fracture Surveys From 1992 to 2017.

As of 2015, the aging population in Japan was the largest in the world. Although the National Database of Health Insurance Claims (NDB) was developed in 2012, long-term trends regarding hip fracture incidence in Japan remain unclear. In order to clarify the trend in hip fracture incidence from 1992 to 2017, we estimated the number of new hip fractures in 2017, the seventh in a series of nationwide hip fracture surveys performed every 5 years since 1987. We also investigated regional differences in hip fracture incidence. We collected data through a nationwide mail-in survey of orthopedic institutions in Japan and calculated hip fracture incidence by sex and age, as well as standardized incidence ratio (SIR) across 12 districts. The total number (95% confidence interval) of hip fractures in 2017 was estimated at 193,400 (187,300-199,500), occurring in 44,100 (42,700-45,500) males and 149,300 (144,500-154,100) females. Of all the hip fracture surveys from 1992 to 2017, the 5-year hip fracture increase rates from 2012 to 2017 was the lowest among female patients. In males, the 5-year rates from 2012 to 2017 were lower than those from 2007 to 2012. The age-adjusted incidence rates for patients in both sexes did not show significant change in the 25-year period. The estimated incidence rates in 2017 for patients aged 70 to 79 years in both sexes were lowest from 1992 to 2017, and declined significantly over the 25-year period. SIRs differed between northeast and southwest regions. Our findings were similar to those from a previous study in Japan using the NDB from 2012 to 2015. Progress in the development of osteoporosis medication may contribute to the continuous decline in the 70-year to 79-year age group. © 2020 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Collaborative study using common samples to evaluate the performance of anti-drug antibody assays constructed by different companies.

This study was undertaken to evaluate the performance of anti-drug antibody (ADA) assays constructed by each participating company using common samples including ADA, drug and human serum. The ADA assays constructed by each company showed good sensitivity and precision for evaluation of ADA. Cut points for screening and confirmatory assays and assay selectivity were determined by various calculation methods. In evaluations of blind ADA samples, nearly similar results were obtained by the study companies in determinations of whether samples were positive or negative except at the lowest sample concentration (5 ng/mL). In measurement of drug tolerance, for almost samples containing ADA and drugs, more positive results were obtained in assays using acid dissociation compared to those without acid dissociation. Overall, the performance of ADA assays constructed by the 10 companies participating in this study was acceptable in terms of sensitivity and reproducibility for detection and evaluation of immunogenicity in both patients and healthy subjects. On the other hand, based on results for samples containing ADA and drugs, validity of results for ADA assays conducted without acid dissociation was less meaningful and more difficult to evaluate. Thus, acid dissociation was confirmed to be useful for improving drug tolerance.

[Successful use of "juzen-taiho-to", a kampo medicine, for the treatment of perioperative anemia and hypoalbuminemia].

An 88-year-old woman suffering from femoral neck fracture was transported to the emergency room of a hospital. The patient and her family refused transfusion, despite anemia, stating their affiliation with Jehova's Witnesses. Surgery was performed under general anesthesia, and the following day, anemia (hemoglobin, 7.5 g x dl(-1)) and hypoalbuminemia (albumin, 2.7 g x dl(-1)) were observed, in addition to anorexia and general fatigue. The patient underwent nutritional treatment with a kampo medicine (Juzen-taiho-to), which was administered as a medication due to difficulties with swallowing the powdered form. On the 18th day after admission, anemia (hemoglobin, 8.9 g x dl(-1)) and hypoalbuminemia (3.6 g x dl(-1)) improved, as did anorexia and general fatigue. It is thought that the components Shimotsu-to, a component known to improve anemia, and Shikunshi-to, a vital energy supplementing component, were the main ingredients that conferred the improvements in anemia and hypoalbuminemia. These findings suggest that Chinese herbal medicine for the nutritional treatment of the elderly has minimal side effects.

Roughness and temperature effects on the filter media of a trickling filter for nitrification.

The performance of trickling filters using two types of plastic media with the same material, the same shape and different roughness was evaluated during a temperature-decreasing period to understand the roughness and temperature effects on the filter media. Real restaurant wastewater was used for the experiments. The chemical oxygen demand (COD) removal and nitrification performance of plastic media with a rough surface (LT-15) was superior to that with a smooth surface (KT-15). Because the biomass of microorganisms attached on the LT-15 was twice that attached on the KT-15, the larger biomass attached on the LT-15 was thought to be responsible for the higher performance. During the operation, the COD loading and water temperature varied in the range from 0.37 to 1.9 kg m(-3) d(-1) and 17.0--10.0 degrees C, respectively. However, the COD removal performance was not dependent on the COD loading or water temperature. On the contrary, the COD loading and the water temperature influenced the nitrification performance. Although a nitrification efficiency of 100% was recorded at a COD loading of 0.37 kg m(-3) d(-1), it deteriorated to 17-28% at higher COD loading. Moreover, a decline in the water temperature decreased the nitrification performance. The temperature-activity coefficient for nitrification was estimated to be 1.096. Based on this value, it was inferred that the COD loading should be set at less than 0.20 kg m(-3) d(-1) for the complete nitrification of the restaurant wastewater in winter, when the water temperature usually drops to around 10 degrees C.

Joint effects of smoking and alcohol drinking on esophageal cancer mortality in Japanese men: findings from the Japan collaborative cohort study.

BACKGROUND: The purpose of our study was to elucidate the joint effects of combined smoking and alcohol intake on esophageal cancer mortality in Japanese men through a large cohort study with a 20-year follow-up period. MATERIALS AND METHODS: The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) was established in the late 1980s, including 46,395 men and 64,190 women aged 40 years and older and younger than 80. Follow-up of these participants was conducted until 2009. We used the Cox proportional hazards model to analyze data for 42,408 people excluding female participants, 411 people with histories of malignant neoplasms, and 3,576 with unclear smoking and drinking data. RESULTS: The joint effects of age at start of smoking and amount of alcohol consumed per day were compared with non-smokers and non-drinkers or those consuming less than one unit of alcohol per day. The mortality risk was 9.33 (95% confidence interval, 2.55-34.2) for those who started smoking between ages 10 and 19 years and drinking at least three units of alcohol per day. Regarding the joint effects of cumulative amount of smoking and alcohol intake, the risk was high when both smoking and alcohol intake were above a certain level. CONCLUSIONS: In this Japanese cohort study, increased cancer mortality risks were observed, especially for people who both started smoking early and drank alcohol. Quitting smoking or not starting to smoke at any age and reducing alcohol consumption are important for preventing esophageal cancer in Japan.

Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age.

Our aim in this study was to evaluate hyoid bone movement trajectories and the age-related changes during swallowing in healthy subjects by ultrasonography. Data were obtained from 30 healthy volunteers (15 men, 15 women) in three age groups (20-39, 40-59, 60-79 years). The subjects were examined while sitting in an upright position, with the back against a wall to control movement. The transducer was placed in a longitudinal scan above the larynx. The subjects were then given 5 mL of mineral water. The water bolus was held in their mouth until they were forced to do a rapid swallow. The imaging was repeated five times for averaging. The movement was divided into 4 phases: slowly ascending phase (A-B, Elevation); rapidly ascending phase (B-C, Anterior); temporary pause phase (position of maximum rise, Remain); and rapidly and slowly descending shifts toward the resting position phase (C-D, Return). We easily visualized the hyoid bone trajectory by using ultrasonography. In all cases, ultrasonographic analysis of the hyoid bone was confirmed to have a similar trajectory, as determined with videofluoroscopy. The average swallowing duration measurements increased with age. The measurement of the maximally elevated point of the hyoid bone decreased with age. The movement of the hyoid bone during swallowing can be visualized by US. The trajectory of the hyoid bone in sagittal section indicated the capability of swallowing, and may detect some anomalies in swallowing.

Characterization of iris pattern stretches and application to the measurement of roll axis eye movements.

Eye movements are utilized in many scientific studies as a probe that reflects the neural representation of 3 dimensional extrapersonal space. This study proposes a method to accurately measure the roll component of eye movements under the conditions in which the pupil diameter changes. Generally, the iris pattern matching between a reference and a test iris image is performed to estimate roll angle of the test image. However, iris patterns are subject to change when the pupil size changes, thus resulting in less accurate roll angle estimation if the pupil sizes in the test and reference images are different. We characterized non-uniform iris pattern contraction/expansion caused by pupil dilation/constriction, and developed an algorithm to convert an iris pattern with an arbitrary pupil size into that with the same pupil size as the reference iris pattern. It was demonstrated that the proposed method improved the accuracy of the measurement of roll eye movement by up to 76.9%.

Smoking, alcohol drinking and esophageal cancer: findings from the JACC Study.

BACKGROUND: Using a large-scale cohort of about 110,000 people established in 45 areas throughout Japan from 1988 through 1990, the study attempted to uncover the joint effects of combined smoking and alcohol intake on esophageal cancer mortality. METHODS: A cohort established from 1988 through 1990 included 46,465 men and 64,327 women aged 40 years and older and younger than 80. The number of female smokers and drinkers was low, and women were excluded from the analysis for that reason. In addition, 308 people with histories of malignant neoplasm, and 3,579 with unclear smoking and drinking data were also excluded, resulting in 42,578 people available for analysis. A follow-up of these individuals was conducted until 1999. Cox proportional hazards model was used for the analysis. RESULTS: The joint effects of number of cigarettes and amount of alcohol consumed per day were compared with non-smokers and non-drinkers or those consuming less than one unit of alcohol per day. An increased synergistic esophageal cancer mortality risk (3.88) for both smoking and drinking was observed for those smoking 20 cigarettes or less per day and drinking one unit of alcohol or more but less than three units per day, with the risk rising (6.30) for those smoking at least 21 cigarettes and drinking at least three units of alcohol per day. Even in non-smokers with increased alcohol consumption, and in non-drinkers or those drinking at most one drink per day with increased smoking, no increased risk was observed. CONCLUSIONS: In this cohort study of a Japanese population, increased esophageal cancer mortality risk was observed only when both factors of alcohol and tobacco intake were present simultaneously.

Characteristics and course of bone mineral densities among fast bone losers in a rural Japanese community: the Miyama Study.

The aim of this study was to clarify and compare the temporal course of bone mineral density (BMD) between fast bone losers and normal residents in Miyama Village, a rural Japanese community. BMD was measured over a 10-year period in a cohort study in Miyama Village, Wakayama Prefecture, Japan, to provide information on rate of bone loss in the mature and elderly population. Subjects ( n=400) were selected by sex and age stratum from the full list of residents born in 1910-1949, with 50 men and 50 women in each age decade. Baseline BMD of the lumbar spine and proximal femur was measured using dual energy X-ray absorptiometry in 1990, 1993, 1997 and 2000. In the cohort, 171 men and 189 women completed the follow-up survey performed in 1993. After calculating the rate of bone loss between 1990 and 1993, the greatest tertile from the distribution of bone loss was categorized as fast bone losers, with the remainder considered as normal subjects. Changes in BMD were compared between normal subjects and fast bone losers over the 10-year period. Mean rate of change for BMD at both lumbar spine and femoral neck in fast bone losers recovered to levels similar to those in normal subjects over 7 years of observation. By contrast, BMD at the lumbar spine and femoral neck decreased steeply over the 10-year period in both groups, and mean BMD for fast bone losers was significantly lower than that of normal subjects ( P<0.05). These differences were apparent only at the lumbar spine in both men and women, even after adjusting for age. These results indicate that fast bone loss is a transient phenomenon rather than a fixed status, although individuals who have been categorized as fast bone losers at some stage continue to display low BMD in the lumbar spine.

Impact of elevated blood pressure on mortality from all causes, cardiovascular diseases, heart disease and stroke among Japanese: 14 year follow-up of randomly selected population from Japanese -- Nippon data 80.

The objectives of the study were to clarify the relationship between blood pressure and mortality from stroke, heart disease, cardiovascular diseases and all causes of death among representative population of Japanese and to estimate category-specific excess mortality from stroke due to blood pressure (BP) level. The study design comprised a retrospective cohort study using the 1980 National Survey on Cardiovascular Diseases and identification of underlying causes of death using national vital statistics data. In 1994, a 14-year follow-up cohort study was conducted among participants of the National Survey on Cardiovascular Diseases in 1980, randomly selected from the Japanese population. With a collaboration of 300 public health centres, which had conducted the original survey in 1980, 91.4% of the participants of the original survey could be followed up. Total observed person-years were 53948 for men and 70932 for women. During follow-up, 1327 deaths were observed. BP levels were significantly related to mortality from strokes, cardiovascular diseases and all causes of death for both sexes (P<0.001). Heart disease mortality was significantly related to BP levels among men (P<0.05) while not among women. Estimated excess mortality was 130% for men and 42% for women and chiefly observed among moderate hypertensives (48% for men and 16% for women). In conclusion, high blood pressure was a risk factor for mortality from all causes as well as those from cardiovascular diseases, stroke and heart disease among Japanese. Since the major part of excess mortality was due to mild hypertension, a population strategy to reduce blood pressure should be encouraged.

Incidence of Parkinson disease in Wakayama, Japan.

To estimate an accurate annual incidence of Parkinson disease in Wakayama, a mail survey was conducted in 1998. A questionnaire was delivered to each clinic where Parkinson disease would be potentially diagnosed. The survey was conducted in February 1998 by the Research Committee on Parkinson disease of Wakayama. A total of 792 clinics and 87 hospitals were listed as candidates. Physicians in these 879 medical facilities were asked and instructed to register all newly diagnosed patients with Parkinson disease in 1997 according to the diagnostic criteria proposed by the Japanese Research Committee on Neuro-degenerative Diseases. Of 879 facilities, 873 ones including 81 hospitals replied (response rate: 99%). A total of 229 patients were reported as newly diagnosed cases in 1997. Of these cases, 183 cases were classified as Yahr I to III. The annual incidence rate was 16.9 per 100,000 population (95% confidence interval: 14.5-19.3). Male-to-female ratio was 1:1.4 as a whole, and the dominant age stratum was 70 to 79 years old. When Parkinson disease incidence was observed from northern part of Wakayama to south by district, crude rates (95% CIs) were 15.9(12.9-18.9), 18.1(12.0-24.2), and 19.3(13.4-25.2). After age-adjustment using the Japanese Model Population in 1985, differences of Parkinson disease incidence became attenuated and adjusted rates (95% CIs) turned to 10.8(9.1-12.7), 10.4(8.6-12.2), and 9.9(6.9-12.9), respectively.

The relationship between endogenous estrogen, sex hormone-binding globulin, and bone loss in female residents of a rural Japanese community: the Taiji Study.

The aim of this study was to clarify the relationship between endogenous estrogen, sex hormone-binding globulin (SHBG), and bone loss in pre-, peri-, and postmenopausal female residents of Taiji, a rural Japanese community. From a list of inhabitants aged 40 to 79 years, 200 participants-50 women in each of four age decades-were randomly selected, and baseline bone mineral density (BMD) at the lumbar spine and proximal femur were measured by dual-energy X-ray absorptiometry in 1993. Total estradiol (total E2) and SHBG were measured, and SHBG-unbound E2 (UBE2) was calculated using SHBG and the percent SHBG-unbound fraction ratio. BMD was measured again 3 years later, in 1996. Participants with ovariectomy or hysterectomy were excluded, and the remaining participants were categorized into four groups: premenopausal ( n = 38), perimenopausal ( n = 14), postmenopausal group 1 (5 years or less since menopause; n = 18), and postmenopausal group 2 (6 years or more since menopause; n = 74). The mean value of total E2 was highest in the premenopausal group (49.1 pg/ml), followed by the perimenopausal group (26.4 pg/ml), and the postmenopausal groups (0.83 pg/ml in postmenopausal group 1 and 0.96 pg/ml in postmenopausal group 2). The means for UBE2 showed the same pattern across the groups. After the multiple regression analysis of BMD at follow-up and endogenous estrogens, in premenopausal women, there were no significant associations between BMD at follow-up and serum total E2 and UBE2. In perimenopausal women, however, serum total E2 and UBE2 were significantly correlated with trochanteric BMD at follow-up ( P < 0.05); and in postmenopausal group 2, they were significantly correlated with lumbar spine and Ward's triangle BMD at follow-up ( P < 0.001 at lumbar spine, P < 0.05 at Ward's triangle). Concerning the association between BMD at follow-up and SHBG, in the premenopausal group, serum levels of SHBG were negatively correlated with BMD at the femoral neck ( P < 0.05). In regard to partial regression coefficients for the change rates of BMD over 3 years and serum estrogens and SHBG concentrations, in perimenopausal women, UBE2 was correlated with the change rate of BMD at Ward's triangle ( P < 0.05), and in postmenopausal group 1, serum levels of SHBG were significantly negatively related to change in BMD at the trochanter ( P < 0.01). No other relationships with change in BMD were observed at any sites. These findings suggest that serum E2, UBE2, and SHBG levels differentially predict BMD levels in groups of differing menstrual status. It would, however, be difficult to predict bone loss in middle-aged and elderly Japanese women over a 3-year period using these indices alone.