Coping strategies and risk of cardiovascular disease incidence and mortality: the Japan Public Health Center-based prospective Study.

AIMS: Coping strategies may be significantly associated with health outcomes. This is the first study to investigate the association between baseline coping strategies and cardiovascular disease (CVD) incidence and mortality in a general population cohort. METHODS AND RESULTS: The Japan Public Health Center-based prospective Study asked questions on coping in its third follow-up survey (2000-04). Analyses on CVD incidence and mortality included 57 017 subjects aged 50-79 without a history of CVD and who provided complete answers on approach- and avoidance-oriented coping behaviours and strategies. Cox regression models, adjusted for confounders, were used to determine hazard ratios (HRs) according to coping style. Mean follow-up time was 7.9 years for incidence and 8.0 years for mortality.The premorbid use of an approach-oriented coping strategy was inversely associated with incidence of stroke (HR = 0.85; 95% CI, 0.73-1.00) and CVD mortality (HR = 0.74; 95% CI, 0.55-0.99). Stroke subtype analyses revealed an inverse association between the approach-oriented coping strategy and incidence of ischaemic stroke (HR = 0.79; 95% CI, 0.64-0.98) and a positive association between the combined coping strategy and incidence of intra-parenchymal haemorrhage (HR = 2.03; 95% CI, 1.01-4.10). Utilizing an avoidance coping strategy was associated with increased mortality from ischaemic heart disease (IHD) only in hypertensive individuals (HR = 3.46; 95% CI, 1.07-11.18). The coping behaviours fantasizing and positive reappraisal were associated with increased risk of CVD incidence (HR = 1.24; 95% CI, 1.03-1.50) and reduced risk of IHD mortality (HR = 0.63; 95% CI, 0.40-0.99), respectively. CONCLUSION: An approach-oriented coping strategy, i.e. proactively dealing with sources of stress, may be associated with significantly reduced stroke incidence and CVD mortality in a Japanese population-based cohort.

A multifactorial model of masticatory performance: the Suita study.

Previous studies have identified various factors related to masticatory performance. This study was aimed to investigate variations and impacts of factors related to masticatory performance among different occlusal support areas in general urban population in Japan. A total of 1875 Japanese subjects (mean age: 66·7 years) were included in the Suita study. Periodontal status was evaluated using the Community Periodontal Index (CPI). The number of functional teeth and occlusal support areas (OSA) were recorded, and the latter divided into three categories of perfect, decreased and lost OSA based on the Eichner Index. Masticatory performance was determined by means of test gummy jelly. For denture wearers, masticatory performance was measured with the dentures in place. The multiple linear regression analysis showed that, when controlling for other variables, masticatory performance was significantly associated with sex, number of functional teeth, maximum bite force and periodontal status in perfect OSA. Masticatory performance was significantly associated with number of functional teeth, maximum bite force and periodontal status in decreased OSA. In lost OSA, masticatory performance was significantly associated with maximum bite force. Maximum bite force was a factor significantly influencing masticatory performance that was common to all OSA groups. After controlling for possible confounding factors, the number of functional teeth and periodontal status were common factors in the perfect and decreased OSA groups, and only sex was significant in the perfect OSA group. These findings may help in providing dietary guidance to elderly people with tooth loss or periodontal disease.

Modification of the excess risk of coronary heart disease due to smoking by seafood/fish intake.

Seafood/fish intake has been regarded as a protective factor for coronary heart disease (CHD), while smoking is a strong risk factor. To examine whether associations between smoking and risk of CHD are modified by seafood/fish intake, we studied 72,012 Japanese men and women aged 45-74 years who completed 2 food frequency questionnaires, 5 years apart, during the period 1995-2009. After 878,163 person-years of follow-up, 584 incident cases of CHD (101 fatal and 483 nonfatal), including 516 myocardial infarctions, were documented. There was a clear dose-response association between smoking and CHD risk among subjects with a low seafood/fish intake (<86 g/day) but not among those with a high seafood/fish intake (≥86 g/day). Compared with never smokers, the multivariable hazard ratios in light (1-19 cigarettes/day), moderate (20-29 cigarettes/day), and heavy (≥30 cigarettes/day) smokers were 2.39 (95% confidence interval (CI): 1.60, 3.56), 2.74 (95% CI: 1.90, 3.95), and 3.24 (95% CI: 2.12, 4.95), respectively, among low seafood/fish eaters and 1.13 (95% CI: 0.64, 1.99), 1.29 (95% CI: 0.95, 2.04), and 2.00 (95% CI: 1.18, 3.51), respectively, among high seafood/fish eaters. Compared with heavy smokers with a low seafood/fish intake, light smokers with a high seafood/fish intake had substantially reduced risk of CHD (hazard ratio = 0.57, 95% CI: 0.32, 0.98). High seafood/fish intake attenuated the positive association between smoking and risk of CHD.

Effect of surface treatments on the bond strengths of facing composite resins to zirconia copings.

The present study evaluated and compared the bond strength between zirconia and facing composite resin using different surface conditioning methods before and after thermocycling. Four primers, three opaque resins, and two facing composite resins were used, and 10 surface treatment procedures were conducted. The bond strength was measured before and after 4,000 cycles of thermocycling. The mean values of each group were statistically analyzed using one-way analysis of variance (ANOVA). The bond strengths of facing composite resins to zirconia after various treatments varied depending on the primers, opaque resins, body resins, and thermocycling. The application of primers and opaque resins to the zirconia surface after sandblasting is expected to yield strong bond strength of the facing composite resin (Estenia CG&B) even after thermocycling.

Body mass index, weight change and risk of stroke and stroke subtypes: the Japan Public Health Center-based prospective (JPHC) study.

OBJECTIVE: The Japan Public Health Center-based prospective Study examined the association of body mass index (BMI) and weight change with incident stroke in Japanese individuals, for whom BMI levels are generally low. METHODS: We used initial data from 1990 to 1994 and 5-year follow-up surveys from 1995 to 1999. We calculated weight change over a 5-year period for 32,847 men and 38,875 women, aged 45-74 years, with no history of cardiovascular disease or cancer. Subjects were followed from the 1995-1999 survey to the end of 2005, and hazard ratios of self-reported BMI levels and weight change for incident stroke were estimated using Cox's proportional hazard models adjusted for potential confounders. RESULTS: During the follow-up period (median 7.9 years) there were 2019 incident strokes, including subtypes. Multivariable-adjusted hazard ratios for all stroke events by BMI levels of 27.0-29.9 and ≥ 30 kg m(-2) versus 23.0-24.9 kg m(-2) were 1.09 (95% confidence interval 0.88, 1.36) and 1.25 (0.86, 1.84) in men (P for trend=0.22), and 1.29 (1.01, 1.65) and 2.16 (1.60, 2.93) in women (P for trend <0.001), respectively. A weight change of ≥ 10% in the previous 5 years was associated with total strokes and ischemic strokes in women. CONCLUSION: Higher BMI levels and a weight gain of ≥ 10% over 5 years were associated with an increased risk of stroke in women, whereas this association was weak in men.

Five-year clinical evaluation of In-Ceram crowns fabricated using GN-I (CAD/CAM) system.

This study prospectively evaluated the clinical performance of computer-assisted design and computer-assisted manufacturing (CAD/CAM)-generated In-Ceram Alumina core crowns in Japanese patients for up to 5 years. A total of 101 In-Ceram crowns with aluminium copings fabricated using the GN-I system were placed in Japanese patients. The crowns were evaluated using a California Dental Association (CDA) quality assessment system at baseline and at all follow-up examinations. Gingival condition was assessed using plaque and bleeding scores. The survival of anterior and posterior crowns was analysed according to the Kaplan-Meier method. The scores of gingival condition were compared between restored crowns and contralateral teeth using a t-test. During the observation period, six crowns were lost to follow-up. Five crowns were fractured from the copings and removed, and four crowns were removed for other reasons. Chipping within the porcelain was detected in three crowns, which were then polished. The cumulative survival rates after 60 months were 96·9% for anterior crowns and 87·7% for posterior ones, and there were no significant differences between anterior and posterior crowns. According to the CDA criteria, most of the crowns were rated as satisfactory during the observation period. There were significant differences in soft tissue conditions between In-Ceram crowns and control teeth at 2- and 5-year examinations. Despite the five fractures from copings, In-Ceram Alumina crowns with copings fabricated using the CAD/CAM (GN-I system) for replacing both anterior and posterior teeth showed predictable results during a 5-year observation period.

Retention of zirconia copings on zirconia implant abutments cemented with provisional luting agents.

The purpose of this study is to measure and compare the retentive force of zirconia-based all-ceramic crowns cemented on zirconia abutments using five provisional luting agents. In addition, the effect of sandblasting and thermocycling on the retentive force was evaluated. Two hundred zirconia abutments and copings were fabricated (Procera system; Nobel Biocare) and divided into five groups. Hy bond temporary cement hard (Hard), Hy bond temporary cement soft (Soft), experimental temporary cement (New), Tempbond NE (Temp) and Freegenool temporary pack (Pack) were used according to the manufacturers' instructions. Each group was divided into two groups, one with and one without sandblasting. Furthermore, thermocycling up to 2000 cycles was conducted on half of each group. After 24 h and thermocycling, the retentive force was measured using a universal testing machine. The data were subjected to analysis of variance, and comparisons of the means were performed with a Games-Howell test at a level of 95%. As a result, Hard showed the highest retentive force, sandblasting was effective for improving the durability, and no effect of sandblasting was detected in the others. New showed stability of the retentive force even after thermocycling. The retentive force of Temp and Pack decreased significantly after thermocycling even with sandblasting. The retentive forces were different from the provisional cement and sandblasting, and Temp and Pack may not be appropriate for the retention of single-tooth zirconia abutments and coping restorations.

Calcium pyrophosphate dehydrate crystal deposition in the ligamentum flavum of the cervical spine: histopathological and immunohistochemical findings.

OBJECTIVE: To investigate the histopathological and immunohistochemical properties of degenerative changes in the ligamentum flavum of the cervical spine with calcium crystal deposition. METHODS: Sections of the calcified ligamentum flavum harvested from 26 patients who required cervical decompression were examined by scanning electron microscopy (SEM), energy dispersive X-ray microanalysis, immunohistochemical staining [for transforming growth factor (TGF)-Beta, vascular endothelial growth factor (VEGF), Sox9, and Msx2] and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labelling (TUNEL) method (for cell apoptosis). RESULTS: Energy dispersive x-ray microanalysis and SEM confirmed the deposited calcium to be calcium pyrophosphate dihydrate (CPPD) crystals. The calcified ligamentum flavum showed disorganisation of the elastic fibre bundles together with increased collagen fibrils in the matrix. Abundant hypertrophic chondrocytes were noted around the calcified lesions, which were strongly immunoreactive to TGF-Beta and VEGF. Staining for Sox9 was positive in metaplastic chondrocytes but negative in hypertrophic chondrocytes. Both chondrocytes and mesenchymal cells were positive for Msx2. TUNEL-positive hypertrophic chondrocytes were significantly more noticeable in nodular than diffusely scattered type of CPPD deposition. CONCLUSIONS: Calcium crystal deposition in the cervical ligamentum flavum seems to progress with reduction in elastic fibres, increase in collagen fibrils in the matrix, and migration of metaplastic hypertrophic chondrocytes, whose differentiation is controlled by cytokines and transcriptional factors, and potentially regulate crystal formation. The presence of abundant TUNEL-positive hypertrophic chondrocytes around CPPD deposition suggests that materials from apoptotic cells play some role in crystal deposition.

Clinical evaluation of Procera AllCeram crowns in Japanese patients: results after 5 years.

Procera AllCeram crowns were prospectively evaluated clinically in both anterior and posterior regions in Japanese. One-hundred and one crowns were fabricated for 57 patients at the Tsurumi University Dental Hospital from August 2001 to October 2002 and evaluated according to the California Dental Association (CDA) quality evaluation system at baseline and annually at all follow-up examinations for 5 years. The plaque index (PI) and gingival index (GI) were recorded, and chipping and fracture were checked at the same time as well. A total of 75 Procera AllCeram crowns were evaluated, and the cumulative survival rate was 90.2% over the 5-year clinical trial. Six crowns experienced fractures within the veneering porcelain and from aluminium oxide coping, all of which occurred on the premolar and molar regions, and they had to be removed. Small chipping was observed on three crowns. According to the CDA criteria, 98% of Procera AllCeram crowns were rated as satisfactory, and PI and GI were comparable to those of control teeth during the observation period.

Factors Influencing the Changes in Masticatory Performance: The Suita Study.

INTRODUCTION: Although previous studies have identified various factors related to masticatory performance, which factors affect longitudinal changes in masticatory performance have not been clarified. OBJECTIVES: We aimed to clarify factors involved in changes to masticatory performance and construct models from factors related to masticatory performance in a longitudinal study of a general urban population in Japan. METHODS: A total of 1,005 Japanese subjects (411 men, 594 women; mean age at baseline, 65.7 ± 7.7 years; mean follow-up period, 5.0 ± 0.9 years) were included in the Suita study. These subjects participated in dental checkups both at baseline (June 2008-December 2011) and at follow-up (June 2013-January 2017). The number of functional teeth and occlusal support areas was recorded and the latter assessed using the Eichner index. Subjects' periodontal status was evaluated based on the Community Periodontal Index. Masticatory performance was determined using test gummy jelly. Factors affecting masticatory performance at follow-up and the degree of their effect were investigated by multiple linear regression analysis. RESULTS: In multiple linear regression analysis with masticatory performance at follow-up as the dependent variable, baseline age, masticatory performance, number of functional teeth, and maximum bite force were significant independent variables. The results of multiple linear regression analyses by occlusal support at baseline identified only maximum bite force at baseline in subjects who were Eichner A and baseline age, masticatory performance, and number of functional teeth in subjects who were Eichner B as significant independent variables concerning masticatory performance at follow-up. CONCLUSION: Our study showed a relationship between longitudinal changes in masticatory performance and age, number of functional teeth, and maximum bite force and furthermore showed that the effects of these factors vary according to the residual number of occlusal support areas. KNOWLEDGE TRANSFER STATEMENT: Patients and clinicians should recognize the importance of objective and quantitative assessment for chewing efficiency and understand that various factors are related to longitudinal changes in masticatory performance. The results of this study can provide basic data for preventing or improving the decline in masticatory performance for elderly people with varying numbers of occlusal support areas.

Plasma protein S activity correlates with protein S genotype but is not sensitive to identify K196E mutant carriers.

BACKGROUND: Protein S (PS) is an anticoagulant protein that functions as a cofactor for activated protein C (APC), and congenital PS deficiency is a well-known risk factor for the development of deep vein thrombosis (DVT). Recently, we and others identified the K196E missense mutation in the second epidermal growth factor-like domain of PS as a genetic risk factor for DVT in the Japanese population. The incidence of this mutation is high in the Japanese population. OBJECTIVES: In the present study, we investigated the relationship between plasma PS activity and the presence of the K196E mutation. PATIENTS AND METHODS: We measured PS activity as a cofactor activity for APC in 1,862 Japanese individuals and determined the PS K196E genotype in this population. RESULTS: Individuals heterozygous for the mutant E-allele had lower plasma PS activity than wildtype subjects (mean +/- SD, 71.9 +/- 17.6%, n = 34 vs. 87.9 +/- 19.8%, n = 1,828, P < 0.0001). However, the PS activity of several heterozygous individuals (n = 8) was greater than the population average. In contrast, multiple wildtype subjects (n = 26) had PS activity less than 2 SD below the population mean, indicating that other genetic or environmental factors affect PS activity. CONCLUSIONS: Plasma PS activity itself is not suitable for identifying PS 196E carriers and other methods are required for carrier detection.

Pathogenesis of calcium crystal deposition in the ligamentum flavum correlates with lumbar spinal canal stenosis.

OBJECTIVE: To investigate the histological and immunohistochemical properties of degenerative changes and calcium crystal deposition in the lumbar ligamentum favum. METHODS: We examined the ligamentum flavum harvested from 119 surgical cases with symptomatic lumbar spinal stenosis. Sections of the ligament were examined by scanning electron microscopy (SEM), energy dispersive X-ray micro-analysis, and were immunostained for S-100 protein, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and CD34. The results were compared with those of ligament tissue harvested from 10 cases of lumbar disc herniation. RESULT: The elastic fibres of the ligamentum favum showed regular, or sometimes irregular, and fragmented fibre bundles. Large areas of fibrosis with reduced elastic component and increased collagenous tissue were frequently seen in the degenerated ligaments. Calcium crystal deposits were observed in these fibrous ligaments, associated with many hypertrophic chondrocytes, and with small blood vessel formation. These chondrocytes stained positively for S-100 protein, VEGF and bFGF Calcium pyrophosphate dihydrate crystals were identified in the calcium deposit area. CONCLUSION: We believe that rupture of elastic fibre bundles is the first change to occur in degeneration of the ligamentum favum. Calcium crystal deposition was seen within these fibrous and chondrometaplastic areas. Hypertrophic chondrocytes regulate crystal formation and tissue reconstruction by secreting cytokines.

Serum vitamin C concentration was inversely associated with subsequent 20-year incidence of stroke in a Japanese rural community. The Shibata study.

BACKGROUND AND PURPOSE: Epidemiological evidence suggests that vitamin C may decrease the risk of stroke. The purpose of the present study was to examine the association of serum vitamin C concentration with the subsequent incidence of stroke. METHODS: In a Japanese rural community, a cohort of 880 men and 1241 women aged 40 years and older who were initially free of stroke was examined in 1977 and followed until 1997. The baseline examination included a measurement of serum vitamin C concentration. The incidence of stroke was determined by annual follow-up examinations and registry. RESULTS: During the 20-year observation period, 196 incident cases of all stroke, including 109 cerebral infarctions and 54 hemorrhagic strokes, were documented. Strong inverse associations were observed between serum vitamin C concentration and all stroke (sex- and age-adjusted hazard ratios were 0.93, 0.72, and 0.59, respectively, for the second, third, and fourth quartiles compared with the first quartile; P for trend=0.002), cerebral infarction (0.71, 0.59, and 0.51; P for trend=0.015), and hemorrhagic stroke (0.89, 0.75, and 0. 45; P for trend=0.013). Additional adjustments for blood pressure, serum total cholesterol, body mass index, physical activity, smoking, alcohol drinking, antihypertensive medication, atrial fibrillation, and history of ischemic heart disease did not attenuate these associations markedly. CONCLUSIONS: Serum vitamin C concentration was inversely related to the subsequent incidence of stroke. This relationship was significant for both cerebral infarction and hemorrhagic stroke. Additional mechanistic hypotheses may be required to explain our findings.

Accumulation of neurofilaments and SOD1-immunoreactive products in a patient with familial amyotrophic lateral sclerosis with I113T SOD1 mutation.

OBJECTIVE: To report neuropathologic features of argyrophilic inclusions in the anterior horn cells, motor cortex Betz cells, and neurons of the medullary reticular formation, spinal posterior horn, and Clarke column in a Japanese case of familial amyotrophic lateral sclerosis with I113T substitution in exon 4 of the copper-zinc superoxide dismutase (SOD1) gene. METHODS AND RESULTS: These inclusions were stained pale pink on the hematoxylin-eosin stain and dark on the Bielschowsky stain. They were positive for antibodies to phosphorylated neurofilaments, ubiquitin, and SOD1. On electron microscopy, they consisted of abundant intermediate filaments of 10 to 20 nm in diameter with disordered array indicating neurofilaments. CONCLUSION: These findings suggest that the I113T mutation induces accumulation of neurofilaments and SOD1 in the central nervous system neurons.

Geographical distribution of amyotrophic lateral sclerosis with neurofibrillary tangles in the Kii Peninsula of Japan.

Between 1984 and 1996 we histopathologically examined 26 autopsy cases of amyotrophic lateral sclerosis (ALS) from the Mie Prefecture in eastern and southern Kii Peninsula, which includes the Hohara ALS focus. Four of the individuals had a moderate number of neurofibrillary tangles in the locus coeruleus, substantia nigra, raphe nucleus, periaqueductal grey and hippocampus in addition to the histological changes of ALS. All four came from the vicinity of Hohara; symptoms of ALS developed in 1979, 1987, 1991 and 1993. Two had family history of ALS, and one, of parkinsonism-dementia. These findings confirm that Kii type ALS occurs continuously in and near the Hohara focus.

Some characteristic findings of isotope cisternograms in children.

The authors describe the characteristic pattern in the isotope cisternograms of normal children and emphasize that, in interpreting isotope cisternograms, the age of the patient must be taken into account.

A comparison of Listeria monocytogenes serovar 4b isolates of clinical and food origin in Japan by pulsed-field gel electrophoresis.

Pulsed-field gel electrophoresis (PFGE) patterns of 102 L. monocytogenes serovar 4b isolates from patients and foods examined in Japan were compared with 16 isolates from foodborne listeriosis episodes which occurred in North America or Europe. Using a combination of PFGE patterns with the restriction enzymes SmaI, ApaI, AscI and Sse8387I, 82 clinical isolates from Japan were categorized into 45 PFGE types: the largest group of 17 isolates (20.7%) were of the same PFGE type as cultures from the large foodborne outbreaks which occurred in California (1985) and Switzerland (1983-1987). Twenty cultures from foods on retail sale in Japan were classified into 12 PFGE types: four isolates were of three PFGE types also recognized among isolates of clinical origin from Japan, including the predominant clinical type.

Prevalence and contamination levels of Listeria monocytogenes in retail foods in Japan.

Retail foods in Japan were surveyed for the presence and contamination levels of L. monocytogenes. It was isolated from 12.2, 20.6, 37.0 and 25.0% of 41 minced beef, 34 minced pork, 46 minced chicken and 16 minced pork-beef mixture samples, respectively. MPN values were higher than 100/g in five (10.9%) minced chicken samples, but lower than 100/g in all minced beef, pork and pork-beef mixture samples. The organism was also isolated from 5.4% of the 92 smoked salmon samples at MPN values lower than 10/g, and from 3.3% of 213 ready-to-eat raw seafood samples at MPN values from lower than 0.3 to higher than 100/g. None of the 285 vegetable samples were contaminated with L. monocytogenes. These findings indicate that ready-to-eat raw seafoods are relatively high risk among the foods surveyed in this study.

Digital image processing: a path to better pictures.

Digital image processing can be used to provide enhanced performance in scanning electron column instruments. Improved visualization, reduced specimen damage, and quantization can be achieved. The system described here provides hardware for digitization and storage of multiple images simultaneously, and multimode scan generation. System software provides easy scan control, image digitization, automatic prescale adjust on acquisition, grey scale histogram generation, grey scale compression or expansion, image filtering, smoothing, and random color assignment to grey levels. Image digitization and processing was done using the EG&G ORTEC Image Master Microanalyzer in conjunction with a JEOL 100CX TEMSCAN and a JEOL JSM 35. Examples of image processing of bright and dark field STEM images of biological specimens are shown. An example of X-ray image processing using a two-dimensional filter function to reduce image noise is also shown.