Evaluation of high-density lipoprotein cholesterol levels in Japanese women.

OBJECTIVE: The aim of the present study was to clarify the significance of high levels of high-density lipoprotein cholesterol (HDL-C) in Japanese women receiving an annual health check-up. METHODS: A total of 1879 women who were not taking medication for hypertension, diabetes or dyslipidemia, with no prior history of ischemic heart disease, cerebrovascular disease or chronic renal failure were analyzed. First, the association between HDL-C and homeostasis model assessment of insulin resistance (HOMA-IR) was studied. Next, the association between HDL-C and the number of metabolic syndrome (MetS) risk factors, including HOMA-IR, was determined. In addition, clinical parameters including HOMA-IR, number of MetS risk factors, smoking, exercise, and alcohol consumption habits were compared according to HDL-C level. RESULTS: HOMA-IR was lower in subjects with elevated HDL-C. Additionally, a lower body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides (TG) were observed in subjects with higher HDL-C. Moreover, the proportion of subjects who were obese, or those who had high FPG, high TG, and a high number of MetS risk factors was lower in subjects with higher HDL-C. Both obesity and smoking were associated with reduced HDL-C levels. Increasing levels of alcohol consumption, from < 25 g/day, to 25 -< 50 g/day, to 50 -< 75 g/day, were associated with a progressive increase in HDL-C level, but a progressive reduction in HOMA-IR. However, this apparent benefit of alcohol intake on HDL-C and HOMA-IR disappeared in subjects who drank ≥ 75 g/day. CONCLUSIONS: Female subjects who were not obese, did not smoke, and drank < 75 g alcohol/day had elevated HDL-C levels, which were associated with improved insulin sensitivity. Drinking alcohol in excess of 75 g/day appeared to provide no advantages in terms of HDL-C or HOMA-IR levels. Thus, it might be important for females to keep their alcohol intake below 75 g/day.

Long-term detraining increases the risk of metabolic syndrome in Japanese men.

OBJECTIVE: The aim of the present study was to examine the effect of long-term detraining on metabolic syndrome (MetS). METHODS: 1109 Japanese men were categorized by their exercise habits. Clinical data, number of MetS risk factors, and differences in lifestyle-related behaviors of the non-training group (n = 233) and the detraining group (n = 483) were compared with those of the training group (n = 87). RESULTS: Waist circumference and body mass index were significantly higher in the non-training group and the detraining group than in the training group, and also higher in the detraining group than in the non-training group. High-density lipoprotein cholesterol (HDL-C) was lower and low-density lipoprotein cholesterol (LDL-C) was higher in the non-training group and the detraining group than in the training group. Both the non-training group and the detraining group had more MetS risk factors than the training group. The odds ratio for smoking was higher in the detraining group than in the training group. CONCLUSIONS: Detraining results in similar degrees of obesity, low HDL-C, high LDL-C, and high MetS risk as non-training. To prevent lifestyle-related diseases, it is particularly important not only to encourage adults to become physically active, but also discourage active young people from discontinuing physical exercise.

Significance of high HDL cholesterol levels in Japanese men with metabolic syndrome.

OBJECTIVE: The objective was to clarify the significance of high high-density lipoprotein cholesterol (HDL-C) levels in the metabolic syndrome (MetS). The evaluation focused on insulin resistance as an indicator of early-stage MetS. METHODS AND SUBJECTS: Of 2705 men who first underwent an annual health check-up at Tokai University Hachioji Hospital, 2129 men were included in this study, after exclusion of those on medication for hypertension, diabetes or dyslipidemia, and those with a prior history of ischemic heart disease, cerebrovascular disease or chronic renal failure. MetS risk factors include the following five parameters: waist circumference, blood pressure, plasma glucose, triglycerides and HDL-C. The correlations between HDL-C and number of MetS risks with homeostasis model assessment of insulin resistance (HOMA-IR) were analyzed. HOMA-IR, number of risks, habits of smoking, exercise and drinking alcohol, stratified by HDL-C levels, were compared in MetS subjects. RESULTS: In cases with ≤2 risk factors, the higher the HDL-C, the lower the HOMA-IR. However, with ≥3 risk factors for MetS, the HOMA-IR increased when HDL-C was ≥90 mg/dL. In MetS subjects, the rate of alcohol intake ≥75 g/day was high when HDL-C was ≥90 mg/dL. CONCLUSION: In MetS subjects with high HDL-C levels, insulin resistance was increased. Therefore, in persons with high HDL-C levels, it is important to monitor the amount of alcohol consumption and reduce alcohol consumption to <75 g/day.

Optimal reference interval for homeostasis model assessment of insulin resistance in a Japanese population.

The aim of the present study was to establish a reference interval for homeostasis model assessment of insulin resistance (HOMA-IR) in a Japanese population based on the C28-A3 document from the Clinical and Laboratory Standards Institute (CLSI). We selected healthy subjects aged 20-79 years, with fasting plasma glucose < 100 mg/dL, body mass index < 25 kg/m(2) and alanine aminotransferase < 31 U/L. HOMA-IR values were log transformed, values beyond mean ± 3 standard deviations (SD) were truncated, and the mean ± 2 SD of log HOMA-IR values were taken as the upper and lower reference limits of HOMA-IR. We selected 2173 subjects as reference individuals, and 2153 subjects were used for analysis. The reference interval for HOMA-IR was established as between 0.4 and 2.4. This represents the first reference interval study for HOMA-IR that applies the stringent CLSI C28-A3 document. HOMA-IR ≥ 2.5 should be considered a reasonable indicator of insulin resistance in Japanese. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00113.x, 2011).

[Hepatic lymph-node involvement in patients with synchronous liver metastasis from colorectal cancer-a correlation with the grading system for liver metastasis].

This retrospective study was performed to clarify the frequency and clinical significance of hepatic lymph-node metastasis in patients with synchronous liver metastasis from colorectal cancer, in relation to the grading system of liver metastasis classified by the 7th Edition of General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus. Hepatic lymph-node metastasis was histologically examined in 61 patients with synchronous liver metastasis whose primary lesion was resected. The incidence of hepatic lymph-node metastasis for all patients was 26%. The frequency was 8% in Grade A (n=13), 20% in Grade B (n=15), and 36% in Grade C (n=33) (p=0.09). Among patients classified in Grade A/Grade B, the patients with hepatic lymph-node metastasis showed a shorter survival time than those without metastasis (p<0.01). Among patients in Grade C, there was no significant difference in survival times between the patients with hepatic lymph-node metastasis and those without metastasis (p=0.59). In conclusion, the incidence of hepatic lymph-node metastasis should be considered regardless of the Grade of liver metastasis from colorectal cancer.

[Prognosis of patients undergoing resection of both hepatic and pulmonary metastases from colorectal cancer].

This retrospective study evaluated the prognosis of patients undergoing resection of both hepatic and pulmonary metastases from colorectal cancer. The subjects were 14 patients who underwent resection of both hepatic and pulmonary metastases from colorectal cancer between January 1991 and January 2008. The range of patient age at first metastatectomy was 48- 73-years-old (median 59). The ratio of males to females was 4 to 3. Hepatic metastatectomy proceeded to pulmonary metastatectomy in 10 cases, while pulmonary metastatectomy was performed first in 4 cases. The median duration of relapse-free survival and overall survival after the second metastatectomy was 11.2 months and 20.4 months, respectively. The overall survival after the second metastatectomy tended to correlate with the relapse-free survival after the first metastatectomy (rs=0.55, p=0.08). In conclusion, relapse-free survival after the first metastatectomy should be considered when a second metastatectomy is scheduled in patients with both hepatic and pulmonary metastases from colorectal cancer.

[The validity of full administration of 5-fluorouracil, irinotecan, and oxaliplatin to unresectable or recurrent colorectal cancer].

PURPOSE: This retrospective study was performed to evaluate a survival benefit of the full administration of 5-fluorouracil (5-FU), irinotecan (CPT-11), and oxaliplatin (L-OHP) to patients with unresectable or recurrent colorectal cancer. PATIENTS AND METHODS: The subjects are 145 patients with unresectable or recurrent colorectal cancer who were given CPT-11 and/or L-OHP in addition to 5-FU. The overall survival times of these patients were evaluated. RESULTS: The median survival time (MST) was significantly longer in patients treated with three drugs (n=72) than patients treated with two drugs (n =73) (31.6 months versus 18.4 months, p<0.01). When analysis was restricted to patients treated with three drugs, there was no significant difference in MST between patients who were given L-OHP followed by CPT-11 (n=18) and those treated with these two drugs in reverse order (n=54) (p=0.67). CONCLUSIONS: Compared with the use of 5-FU in combination with CPT-11 or L-OHP, a full administration of three drugs may have a more beneficial impact on patients' survival and irrespective of the order of administering CPT-11/L-OHP.

[Clinical significance of chemotherapy and chemo-radiotherapy in patients with metastatic esophageal cancer].

PURPOSE: We investigated the clinical significance of chemo-radiotherapy (CRT) and chemotherapy (CT) in patients with primary metastatic esophageal cancer. PATIENTS AND METHODS: Twenty-six patients with esophageal cancer received CRT (n =21) or CT alone (n=5) as a first treatment for para-aortic lymph node and/or hematogenous metastases. The therapeutic effect, duration of treatment, changes in performance status before and after treatment, and survival were analyzed retrospectively. RESULTS: The median duration of treatment was 2.9 months for CRT and 2.3 months for CT. The response rate was 76% in patients who underwent CRT and 20% in patients who underwent CT. In 18 patients (69%), the level of performance status showed no change after treatment in comparison with that before treatment. The median survival time was 5.6 months after CRT and 5.8 months after CT (p=0.91). CONCLUSION: These results suggest that the majority of patients with extremely advanced esophageal cancer can tolerate CRT or CT well without compromising their performance status within their limited life expectancy.

[Relationship between the size and metastasis of hepatic lymph nodes in patients with synchronous liver metastasis of colorectal cancer].

BACKGROUND AND PURPOSE: This retrospective study was performed to examine the relationship between the size and metastasis of hepatic lymph node in patients with liver metastasis of colorectal cancer. PATIENTS AND METHODS: We analyzed a total of 163 hepatic lymph nodes that were removed during surgery from 55 patients with synchronous liver metastasis of colorectal cancer, who underwent resection of primary tumor without any residual lesions except for liver metastasi (e) s. The relationship between the size and metastasis was examined on paraffin-embedded specimens. RESULTS: The maximal and minimal diameters were significantly greater in positive lymph nodes (n=35) than in negative lymph nodes (n=128). The area under the curve of receiver operating curve for predicting metastasis by size was 0.69. The sensitivity, specificity, and accuracy were 62.9%, 60.9%, and 61.4%, respectively, when the cutoff value was set at 7 mm. CONCLUSION: These findings suggest that selecting patients with hepatic lymph node metastasis based on the size of lymph nodes would be difficult.

[A case of pseudomyxoma peritonei successfully treated with multidisciplinary treatment including modified FOLFOX6 regimen].

We report a case of pseudomyxoma peritonei caused by carcinoma of the appendix, which was successfully treated with multidisciplinary treatment including modified FOLFOX6 regimen. A 45-year-old man was diagnosed as having peritoneal dissemination associated with cancer of the cecum or appendix. Seven cycles of mFOLFOX6 treatment resulted in a marked decrease in ascites and serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9. At laparotomy, a diagnosis of pseudomyxoma peritonei caused by cancer of the appendix was made. Intraperitoneal lavarge with 10,000 mL 5% glucose was performed after right hemicolectomy, omentectomy and removed of mucinous peritoneal nodules. Intraperitoneal chemotherapy comprised of 3000 mL low molecule dextran and 80 mg cisplatin was added on postoperative days 7 and 14. Modified FOLFOX6 regimen was started again two months postoperatively and reached 28 cycles. The patient does not show any sign of recurrence 12 months postoperatively.