Assessing the impacts of smoking cessation and resumption on back pain risk in later life.

BACKGROUND: This study aimed to assess the impacts of smoking cessation and resumption over 4 years on the risk of back pain at the 6-year follow-up among older adults in England. METHODS: We analysed 6467 men and women aged ≥50 years in the English Longitudinal Study of Aging. Self-reported smoking status, assessed in waves 4 (2008-2009) and 6 (2012-2013), was used as exposure for the study, whereas self-reported back pain of moderate or severe intensity, assessed in wave 7 (2014-2015), was used as the outcome. A targeted minimum loss-based estimator was used with longitudinal modified treatment policies to adjust for baseline and time-varying covariates. RESULTS: Regarding the estimation of the effects of changes in smoking status on the risk of back pain, during the follow-up, individuals who resumed smoking within 4 years had a higher risk of back pain than those who avoided smoking for over 4 years, and the relative risk (RR) (95% confidence interval [CI]) was 1.536 (1.214-1.942). Regarding the estimation of effects of smoking cessation on the risk of back pain, smoking cessation over 4 years was associated with a significantly lower risk of back pain, as indicated by the originally observed data, and the RR (95% CI) was 0.955 (0.912-0.999). CONCLUSIONS: Older adults who avoided smoking for over 4 years had a lower risk of back pain. However, those who resumed smoking within 4 years had a higher risk of back pain. SIGNIFICANCE: Older adults who avoided smoking for over 4 years had a lower risk of back pain. However, those who resumed smoking within 4 years had a higher risk of back pain. Our study data suggest the importance of maintaining smoking cessation to reduce the risk of back pain in the older population.

Effects of the different periods and magnitude of COVID-19 infection spread on cancer operations: Interrupted time series analysis of medical claims data.

BACKGROUND: No clear evidence exists regarding the effects of the different periods and magnitude of spread of the COVID-19 infection on cancer treatments. This study investigated the effects of the different periods and magnitude of COVID-19 infection spread on in-hospital cancer operations. METHODS: Medical claims data from 17 hospitals where in-hospital operations for patients with malignant neoplasms were performed between 1 April 2017 and 31 March 2021 in Yamagata were extracted and analyzed. The critical time points as exposure used to evaluate the impact of different COVID-19 infection spread periods on cancer operations were (1) April 2020 (emergency declaration introduced by the government) and (2) December 2020 (the second wave). From April to November 2020 and December 2020 to March 21, the number of confirmed COVID-19 cases was 130 and 840, respectively. The 17 hospitals were classified into intervention or control groups based on whether in-hospital treatments for patients with COVID-19 were provided. RESULTS: The interrupted time series analysis reported that the difference in the trend of pre-COVID-19 and postsecond wave (March 2020 to December 2020) periods was statistically significant between groups, with 50.67 fewer operations (95% confidence interval [CI] = 12.19-89.15) performed per month in the intervention group compared with the control group. Moreover, the immediate change in the number of operations in April 2020 (beginning of the first wave) was statistically significant between groups, with 80.14 operations (95% CI = 39.62-120.67) less immediately after the first wave in the intervention group compared with the control group. CONCLUSION: Our findings suggest that a statement of emergency by the government and the COVID-19 infection spread are both associated with the number of cancer operations performed in the Yamagata prefecture during the COVID-19 pandemic.

Outcomes of a telemedicine smoking cessation programme for heated tobacco product users in Japan: a retrospective cohort study.

OBJECTIVES: Japan is one of the largest markets for heated tobacco products (HTPs), and the number of HTP users, including dual users, is growing. However, it is not yet clear whether a telemedicine smoking cessation programme is effective for nicotine-dependent HTP users to quit smoking. We assessed the outcomes of a telemedicine smoking cessation programme in terms of continuous smoking cessation among smokers who had used HTPs compared with those who used exclusively cigarettes. DESIGN: A retrospective cohort study to assess the outcomes of the telemedicine smoking cessation programme provided by Linkage, Japan, comparing the success rates of smoking cessation between exclusively cigarette group (as reference) and HTP user groups (exclusively HTPs or dual use of both cigarettes and HTPs). SETTING: Linkage telemedicine smoking cessation programme database, covering programme participants in Japan. PARTICIPANTS: Programme participants from between August 2018 and October 2020. OUTCOME MEASURES: Continuous abstinence rates (CARs) from 9 to 24 weeks (CAR9-24) and 9 to 52 weeks (CAR9-52). Adjusted ORs (aORs) with 95% CIs for CAR were calculated to compare the exclusively cigarette group with exclusively HTP and dual use groups. RESULTS: We analysed 733 telemedicine smoking cessation programme participants. Exclusively HTP users had higher CARs than the exclusively cigarette group for CAR9-24 (aOR 1.12, 95% CI 1.02 to 1.23; p=0.02) and CAR9-52 (1.09, 0.99 to 1.19; p=0.08). Conversely, dual users had lower CARs than the exclusively cigarette group for CAR9-24 (0.85, 0.76 to 0.95; p=0.004) and CAR9-52 (0.88, 0.79 to 0.97; p=0.01). CONCLUSIONS: Exclusive HTP users achieved higher CARs, whereas dual users had lower CARs than exclusively cigarette users over short-term and long-term periods. A telemedicine smoking cessation programme may be a reasonable option for exclusive HTP users.

Maintaining Moderate or Vigorous Exercise Reduces the Risk of Low Back Pain at 4 Years of Follow-Up: Evidence From the English Longitudinal Study of Ageing.

Few studies have examined whether maintaining moderate or vigorous physical activity (PA) reduces the risk of low back pain in older people. This study aimed to examine the magnitude of the associations of changes in PA on the risk of low back pain at 4 years of follow-up. We analyzed 4,882 participants in the English Longitudinal Study of Ageing who were initially free from low back pain (mean age, 65.6 ± 8.9 years at baseline). Self-reported PA, which was assessed at wave 6 (2012-2013) and wave 7 (2014-2015), was used as the exposure. The PA of the respondents was categorized into "no PA at all," "up to moderate PA," and "up to vigorous PA" groups. Self-reported moderate/severe low back pain assessed at 4 years of follow-up (2016-2017) was used as the outcome. Maintaining moderate (relative risk [RR], 0.59; 95% confidence interval [CI], 0.36-0.99) or vigorous (RR, 0.46; 95% CI, 0.27-0.77) PA at least 1-3 times a month was negatively associated with prevalence of low back pain compared with no PA at all. Interventions for maintaining either moderate or vigorous PA might be beneficial in preventing the incidence of low back pain in the older population. PERSPECTIVE: This study examined the magnitude of the association between changes in physical activity over time and the risk of low back pain. The findings suggest that encouraging people to maintain at least moderate physical activity over 2 years is useful for reducing the risk of low back pain at 4 years of follow-up.

Examining the associations between oral health and social isolation: A cross-national comparative study between Japan and England.

In Western countries, the most important part of the face in communication is the mouth, whereas it is the eyes in Asian countries; thus oral health could be more important in social interactions in Western countries. Our aim was to examine differences in the association between oral health status and social isolation among older people by comparing Japan and England. We used cross-sectional information obtained from adults aged 65+ in two ongoing prospective cohort studies: The Japan Gerontological Evaluation Study (JAGES, N = 120,195) and the English Longitudinal Study of Ageing (ELSA, N = 3,958). The dependent variable, social isolation score (SIS) was calculated from five factors (marital status, social support from children, social support from family, social support from friends, and social participation). The independent variables were self-reported number of remaining teeth (0, 1-9, 10-19, ≥20) and denture use (≥20 teeth, 10-19 teeth with denture, 10-19 teeth without denture, 0-9 teeth with denture, 0-9 teeth without denture), while the covariates in the model were: sex, age, educational attainment, self-rated health, number of comorbidities, household annual equivalized income, mental health status, daily living activities, and smoking status. We examined associations between oral health status and SIS by applying an ordered logit model by country. Compared to England, more Japanese participants were socially isolated (1.4% vs. 5.8%), but fewer were edentulous (13.1% vs. 7.7%). In both countries, poorer oral health further increased the odds of being socially isolated. Pooled analysis of the ordered logit model with an interaction term showed that the association of number of remaining teeth with SIS was stronger in edentulous participants and in England (odds ratio = 1.50, 95% Confidence interval:1.26-1.80). In both countries, oral health was associated with social isolation; this association could be stronger in England than in Japan.

Association Between Social Isolation and Smoking in Japan and England.

BACKGROUND: Existing evidence suggest that those who are socially isolated are at risk for taking up or continuing smoking. This study investigated country-based differences in social isolation and smoking status. METHODS: We performed a repeated cross-sectional study using two waves of data from two ongoing aging studies: the English Longitudinal Study of Ageing and the Japan Gerontological Evaluation Study. Participants from both studies aged ≥65 years were included. We applied a multilevel Poisson regression model to examine the association between social isolation and smoking status and adjusted for individual sociodemographic characteristics. We used the social isolation index which comprises the following domains: marital status; frequency of contact with friends, family, and children; and participation in social activities. Interaction terms between each country and social isolation were also entered into the mode. RESULTS: After exclusion of never smokers, we analyzed 75,905 participants (7,092 for ELSA and 68,813 for JAGES, respectively). Taking ex-smokers as the reference, social isolation was significantly associated with current smoking; the prevalence ratios (PRs) were 1.06 (95% credible interval [CrI], 1.05-1.08) for men and 1.08 (95% CrI, 1.04-1.11) for women. Taking Japan as a reference, the interaction term between country and social isolation was significant for both sexes, with increased PRs of 1.32 (95% CrI, 1.14-1.50) for men and 1.30 (95% CrI, 1.11-1.49) for women in England. CONCLUSIONS: Older people who were less socially isolated were more likely to quit smoking in England than in Japan, possibly explained by the strict tobacco control policies in England.

Verification of the effectiveness of fucosylated haptoglobin as a pancreatic cancer marker in clinical diagnosis.

BACKGROUND: Fucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL) that had specificity for fucose α1-6 was reported as an effective biomarker for several gastrointestinal diseases. The aim of this study was to verify Fucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL-HP) as a pancreatic cancer (PC) marker using a new method of PhoSL-ELISA. METHODS: PhoSL-HP in sera from 98 PC patients and 158 non-PC samples including 32 intraductal papillary mucinous neoplasm (IPMN) patients, 21 chronic pancreatitis (CP) patients and 105 non-pancreatic disease controls (NPDC) were measured. We compared sensitivities, specificities and areas under the curves (AUC) of PhoSL-HP, CA19-9 and CEA as single markers. We also evaluated PhoSL-HP as combination marker by comparing AUC of CA19-9 combined with PhoSL-HP or CEA. RESULTS: The sensitivities of PhoSL-HP, CA19-9 and CEA for PC were 58%, 76% and 42%, respectively. Although the specificity of PhoSL-HP for NPDC was inferior to both of CA19-9 and CEA, that for pancreatic diseases was higher than both of CA19-9 and CEA. Combined CA19-9 with PhoSL-HP, the AUC was significantly higher at 0.880 than single use of CA19-9 at 0.825 in case of distinguishing PC from other pancreatic diseases. In contrast, the AUC of CA19-9 was not elevated significantly when combined with CEA. CONCLUSION: PhoSL-HP would be a useful marker for PC and have sufficient complementarity for CA19-9.

Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases-meta-analytic assessment.

BACKGROUND: It is well known that the incidence of developing hepatocelluler carcinoma (HCC) is increased in liver cirrhosis of different etiologies. However, comparison of HCC incidence in various liver diseases has not yet been estimated. We surveyed this comparison. METHODS: The PubMed database was examined (1989-2017) for studies published in English language regarding the prospective follow-up results for the development of HCC in various liver diseases. A meta-analysis was performed for each liver disease. RESULTS: The annual incidence (%) of HCC in the non-cirrhotic stage and cirrhotic stage, and the ratio of HCC incidence in the cirrhotic stage/non-cirrhotic stage were as follows. (a) hepatitis B virus liver disease: 0.37%→3.23% (8.73-fold), (b) hepatitis C virus liver diseases: 0.68%→4.81% (7.07-fold), (c) primary biliary cholangitis (0.26%→1.79%, 6.88-fold), (d) autoimmune hepatitis (0.19%→0.53%, 2.79-fold), and (e) NASH (0.03%→1.35%, 45.00-fold). Regarding primary hemochromatosis and alcoholic liver diseases, only follow-up studies in the cirrhotic stage were presented, 1.20% and 2.06%, respectively. CONCLUSIONS: When the liver diseases advance to cirrhosis, the incidence of HCC is markedly increased. The development of HCC must be closely monitored by ultrasonography, magnetic resonance imaging, and computed tomography, irrespective of the different kinds of liver diseases.

Chronic Hepatitis E Infection in a Persistently Immunosuppressed Patient Unable to Be Eliminated after Ribavirin Therapy.

Recent case reports have shown that hepatitis E virus (HEV) infection can cause chronic hepatitis in immunosuppressed or immunocompromised patients. A 37-year-old woman suffered from prolonged elevation of aminotransferases after chemotherapy for Burkitt's lymphoma and was diagnosed with chronic hepatitis E due to a transfusion during chemotherapy. After an 8-month administration of ribavirin, complete HEV clearance was not achieved, likely due to prolonged hypogammaglobulinemia. This case indicates that HEV infection should be ruled out during liver dysfunction in immunosuppressed or immunocompromised patients and suggests that an alternative therapeutic strategy for such patients will be needed.

[Undifferentiated carcinoma of the jejunum producing granulocyte colony-stimulating factor].

An 80-year-old man presented with abdominal fullness and vomiting. Laboratory data revealed severe anemia, an inflammatory response, and elevated white blood cell counts. Abdominal computed tomography indicated ileus caused by a jejunal tumor measuring 8cm in diameter. Although small-bowel endoscopy enabled visualization of the tumor, adequate biopsy specimens could not be obtained for accurate diagnosis. The patient's condition rapidly deteriorated, because of which surgical treatment could not be initiated. The patient died approximately 3 weeks after admission. High serum granulocyte colony-stimulating factor (G-CSF) levels were detected at autopsy. Immunohistochemical staining of the autopsy specimen indicated positive G-CSF levels in the jejunal tumor. On the basis of these findings, a final diagnosis of undifferentiated carcinoma of the jejunum producing G-CSF was made.

Histological diagnosis of follicular lymphoma by biopsy of small intestinal normal mucosa.

Due to advances in double-balloon endoscopy, various types of malignant lymphoma of the small intestine have been observed at very early stages. We report here that after remission of diffuse large B-cell lymphoma, follicular lymphoma recurred in the mucosa of the small intestine. Furthermore, these lesions were diagnosed by biopsy from normal mucosa as diminutive erosions and reddish looking. If a small intestinal lesion is suspected of being a malignant lymphoma, a double-balloon endoscopy should be carried out, and a biopsy should be taken and inspected.

Randomized phase II study of gemcitabine and S-1 combination versus gemcitabine alone in the treatment of unresectable advanced pancreatic cancer (Japan Clinical Cancer Research Organization PC-01 study).

PURPOSE: To evaluate the efficacy and safety of the combination of gemcitabine (GEM) and S-1 (GS) in comparison to GEM alone (G) for unresectable pancreatic cancer. METHODS: In this multicenter randomized phase II study, we randomly assigned unresectable pancreatic cancer patients to either the GS group or the G group. The GS group regimen consists of intravenous 1,000 mg/m(2) GEM during 30 min on days 1 and 8, combined with 80 mg/m(2) oral S-1 twice daily on days 1-14, repeated every 3 weeks. On the other hand, the G group regimen consists of intravenous 1,000 mg/m(2) GEM on days 1, 8, and 15, repeated every 4 weeks. The primary endpoint was objective response rate (ORR). Secondary end points included treatment toxicity, clinical response benefit, progression-free survival (PFS), and overall survival. RESULTS: We registered 117 patients from 16 institutions between June 2007 and August, 2010. The ORR of the GS group was 28.3%, whereas that of the G group was 6.8%. This difference was statistically significant (P = 0.005). The disease control rate was 64.2% in the GS group and 44.1% in the G group. Median PFS was 6.15 months in the GS group and 3.78 month in the G group. This was also statistically significant (P = 0.0007). Moreover, the median overall survival (OS) of the GS group was significantly longer than that of the G group (13.7 months vs. 8.0 months; P = 0.035). The major grade 3-4 adverse events were neutropenia (54.7% in the GS group and 22.0% in the G group), thrombocytopenia (15.1% in the GS group and 5.1% in the G group), and skin rash (9.4% in the GS group). CONCLUSIONS: The GS group showed stronger anticancer activity than the G group, suggesting the need for a large randomized phase III study to confirm GS advantages in a specific subset.

Genetic background of primary iron overload syndromes in Japan.

The different prevalences of iron overload syndromes between Caucasians and Asians may be accounted for by the differences in genetic background. The major mutation of hemochromatosis in Celtic ancestry, C282Y of HFE, was reported in a Japanese patient. Five patients of 3 families with the hepatic transferrin receptor gene (TFR2)-linked hemochromatosis were found in different areas of Japan, suggesting that TFR2 is a major gene in Japanese people. Three patients with mutations in the hemojuvelin gene, HJV, showed also middle-age-onset hemochromatosis. A heterozygous mutation in the H ferritin gene, FTH1, was found in a family of 3 affected patients. Another autosomal dominant SLC40A1-linked hyperferritinemia (ferroportin disease) was found in 3 patients of 2 families. Two patients with hemochromatosis were free from any mutations in the genes investigated. In conclusion, the genetic backgrounds of Japanese patients with primary iron overload syndromes were partially clarified, showing some phenotype-genotype correlations.

Enhancement of mitochondrial gene expression in the liver of primary biliary cirrhosis.

Primary biliary cirrhosis (PBC) is one of the most important autoimmune liver diseases but the etiology and pathogenesis remain unknown. In this study, we analyzed differential mRNA expression in the liver of a patient with PBC using suppression subtractive hybridization to identify overexpressed genes. Overexpression of mRNA transcripts from mitochondrial DNA was observed in the PBC liver, compared to normal liver. To explore the mechanism of increased mitochondrial transcription, we investigated the mRNA levels of nuclear DNA-encoded regulator molecules of mitochondrial gene expression in 60 liver biopsy samples from various diseases, including PBC, using competitive RT-PCR. Increased expression of mitochondrial transcriptional factor A (mtTFA) and mitochondrial nuclear respiratory factor 1 (NRF-1) mRNA was demonstrated in PBC liver compared to other liver diseases, while NRF-1 coactivator 1, PGC-1 was suppressed. Mitochondrial DNA-encoded mRNA molecules are overexpressed in the PBC liver, and this is associated with up-regulation of mitochondrial transcription factor mtTFA and its transactivator NRF-1. Further studies are needed to focus on the relevance of this perturbation of mitochondrial gene expression in the pathogenesis of PBC.