Prognostic impact of concomitant pH-regulating drugs in patients with non-small cell lung cancer receiving epidermal growth factor receptor tyrosine kinase inhibitors: the Tokushukai REAl-world Data project 01-S1.

PURPOSE: This study aimed to examine the prognostic impact of concomitant pH-regulating drug use in patients with epidermal growth factor receptor (EGFR)-mutation-positive non-small-cell lung cancer (NSCLC) receiving EGFR-tyrosine kinase inhibitors (TKIs). METHODS: We conducted a nationwide retrospective cohort study and reviewed clinical data of consecutive patients with NSCLC treated with the first-line EGFR-TKIs in 46 hospitals between April 2010 and March 2020. Cox regression analyses were conducted to examine the differences in overall survival (OS) between patients treated with and without concomitant pH-regulating drugs, including potassium-competitive acid blockers (P-CABs), proton pump inhibitors (PPIs), and H2-receptor antagonists (H2RAs). RESULTS: A total of 758 patients were included in the final dataset, of which 307 (40%) were administered concomitant pH-regulating drugs while receiving frontline EGFR-TKIs. After adjusting for basic patient characteristics, patients administered gefitinib, erlotinib, afatinib, and osimertinib with concomitant pH-regulating drugs had lower OS than those without concomitant pH-regulating drugs, with hazard ratios of 1.74 (with a 95% confidence interval of 1.34-2.27), 1.33 (0.80-2.22), 1.73 (0.89-3.36), and 5.04 (1.38-18.44), respectively. The 2-year OS rates of patients receiving gefitinib with or without concomitant pH-regulating drugs were 65.4 and 77.5%, those for erlotinib were 55.8 and 66.6%, and those for afatinib were 63.2 and 76.9%, respectively. The 1-year OS rates of patients receiving osimertinib with or without concomitant pH-regulating drugs were 88.1% and 96.9%, respectively. CONCLUSION: In addition to the first-generation EGFR-TKIs, the second- and third-generation EGFR-TKIs also resulted in OS deterioration in patients with EGFR mutation-positive NSCLC when used concurrently with pH-regulating drugs.

Stepwise prolongation of overall survival from first to third generation EGFR-TKIs for EGFR mutation-positive non-small-cell lung cancer: the Tokushukai REAl-world Data project (TREAD 01).

OBJECTIVE: The introduction of new-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has afforded promising overall survival outcomes in clinical trials for non-small-cell lung cancer. We aim to investigate the current adoption rate of these agents and the real-world impact on overall survival among institutions. METHODS: In a nationwide retrospective cohort study of 46 Tokushukai Medical Group hospitals in Japan, we analyzed clinical data of consecutive patients with non-small-cell lung cancer receiving EGFR-TKIs between April 2010 and March 2020. Univariate and multivariate Cox regression analyses examined the associations between overall survival and patient/tumor-related factors and first-line EGFR-TKIs. RESULTS: A total of 758 patients (58.5% females; median age, 73 years) were included. Of 40 patients diagnosed in 2010, 72.5% received gefitinib, whereas 81.3% of 107 patients diagnosed in 2019 received osimertinib as the first-line EGFR-TKI. With a median follow-up of 15.8 months, the median overall survival was 28.4 months (95% confidence interval, 15.3-31.0). In a multivariate Cox regression analysis, age, body mass index, disease status, EGFR mutational status and first-line epidermal growth factor receptor tyrosine kinase inhibitor were identified as significant prognostic factors after adjusting for background factors including study period, hospital volume and hospital type. The estimated 2-year overall survival rates for gefitinib, erlotinib, afatinib and osimertinib were 70.1% (95% confidence interval 59.7-82.4), 67.8% (95% confidence interval 55.3-83.2), 75.5% (95% confidence interval 64.7-88.0) and 90.8% (95% confidence interval 84.8-97.3), respectively. The median time to treatment failure of gefitinib, erlotinib, afatinib and osimertinib were 12.8, 8.8, 12.0 and 16.9 months or more, respectively. CONCLUSIONS: Our real-world data revealed that the swift and widespread utilization of newer-generation EGFR-TKIs in patients with EGFR mutation-positive non-small-cell lung cancer, and that these newer-generation EGFR-TKIs can prolong overall survival regardless of hospital volume or type. Therefore, osimertinib could be a reasonable first choice treatment for these patients across various clinical practice settings.

SERMs (selective estrogen receptor modulator), acting as estrogen receptor ß agonists in hepatocellular carcinoma cells, inhibit the transforming growth factor-α-induced migration via specific inhibition of AKT signaling pathway.

Selective estrogen receptor modulator (SERM) interacts with estrogen receptors and acts as both an agonist or an antagonist, depending on the target tissue. SERM is widely used as a safer hormone replacement therapeutic medicine for postmenopausal osteoporosis. Regarding hepatocellular carcinoma (HCC), accumulating evidence indicates gender differences in the development, and that men are at higher morbidity risk than premenopausal women, suggesting that estrogen protects against HCC. However, it remains unclear whether SERM affects the HCC progression. Previously, we have shown that transforming growth factor (TGF)-α promotes the migration of HCC cells via p38 mitogen-activated protein kinases (MAPK), c-Jun N-terminal kinase and AKT. In the present study, we investigated whether SERM such as tamoxifen, raloxifene and bazedoxifene, affects the HCC cell migration using human HCC-derived HuH7 cells. Raloxifene and bazedoxifene but not tamoxifen, significantly suppressed the TGF-α-induced HuH7 cell migration. ERB041 and DPN, estrogen receptor (ER) ß agonists, inhibited the TGF-α-induced cell migration whereas PPT, an ERα agonist, did not show the suppressive effect on the cell migration. ERB041 attenuated the TGF-α-induced phosphorylation of AKT without affecting the phosphorylation of p38 MAPK and c-Jun N-terminal kinase. Raloxifene and bazedoxifene also inhibited the phosphorylation of AKT by TGF-α. Furthermore, PHTPP, an ERß antagonist, significantly reversed the suppression by both raloxifene and bazedoxifene of the TGF-α-induced cell migration. Taken together, our results strongly indicate that raloxifene and bazedoxifene, SERMs, suppress the TGF-α-induced migration of HCC cells through ERß-mediated inhibition of the AKT signaling pathway.

Aberrant resting-state functional connectivity of major depressive disorder with higher risk of suicide.

Aim: Suicide prevention for depressive patients is an important clinical issue in psychiatry. However, not all depressive patients plan or attempt suicide. In this study, we investigated the differences of functional brain networks between a high-risk group and a low-risk group for suicide by comparing resting-state functional connectivity (rsFC). Methods: The subjects were 29 patients with major depressive disorder, nine of whom had attempted suicide. The suicidal ideation of all subjects was assessed with the Columbia-Suicide Severity Rating Scale, then the subjects were divided into two groups based on the most severe suicidal ideation (MSI) in their lifetime. We compared rsFC between the two groups. Results: Of the 29 subjects, 16 were in the severe MSI group. We found that the severe MSI group members had significantly smaller rsFC in two networks: one comprised the right dorsolateral prefrontal cortex and the default-mode network, and the other comprised the left rostrolateral prefrontal cortex and the striatum, amygdala, and hippocampus. These regions are reported to be associated with rumination, retrieval suppression, and delay discounting (DD). Conclusion: Our results suggest that functional networks related to rumination, retrieval suppression, and DD might be impaired in depressive patients with severe suicidal ideation. It might be beneficial for psychiatrists to assess these characteristics in terms of suicide prevention for depressive patients.

GLP-1 reduces the migration of hepatocellular carcinoma cells via suppression of the stress-activated protein kinase/c-Jun N-terminal kinase pathway.

Incretins, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are hormones secreted from small intestine accompanied with oral intake. We previously showed that transforming growth factor (TGF)-α stimulates the migration of hepatocellular carcinoma (HCC) cells via mitogen-activated protein (MAP) kinases, AKT and Rho-kinase. However, it remains to be elucidated whether incretins affect HCC cell functions. In the present study, therefore, we investigated whether incretins affect the migration of HCC cells using human HCC-derived HuH7 cells. GLP-1, but not GIP, reduced both TGF-α- and hepatocyte growth factor (HGF)-induced cell migration. IBMX, an inhibitor of cyclic nucleotide phosphodiesterase, enhanced the suppressive effect of GLP-1. GLP-1 attenuated the phosphorylation of stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) by TGF-α and HGF. Our results strongly suggest that GLP-1 suppresses TGF-α- and HGF-induced migration of HCC cells through inhibiting the SAPK/JNK signaling pathway, and that the inhibition by GLP-1 is due to cAMP production.

Cellular Functions of Small Heat Shock Proteins (HSPB) in Hepatocellular Carcinoma.

Heat shock proteins (HSPs) play an essential role as molecular chaperones in proteostasis. Small HSPs are a group of low-molecular-weight HSPs in the range of 12- 43 kDa and are classified as HSPB. Within the ten members of the family, HSPB1(HSP27), HSPB5 (αB-crystallin), HSPB6 (HSP20), and HSPB8 (HSP22) ubiquitously exist in various tissues, including liver tissue. These small HSPs undergo phosphorylation as a post-translational modification, and their functions are modulated. Hepatocellular carcinoma (HCC) is one of the most frequent cancers and the fourth leading cause of cancer-related death worldwide. HSPs play a cytoprotective role as molecular chaperones. Thus, HSPB has been generally considered to protect HCC cells and help the progression of HCC. On the other hand, recent studies from our laboratories have demonstrated suppressive roles of phospho-HSPB1, HSPB6, and HSPB8 in the progression of HCC. These findings may provide a basis for a novel defense system by HSPB against HCC progression. This review focuses on the cellular functions of HSPB in HCC and summarizes the current research.

Heat shock protein 70 positively regulates transforming growth factor-α-induced hepatocellular carcinoma cell migration via the AKT signaling pathway.

Heat shock proteins (HSPs) are induced in response to extracellular stress and manage the quality of proteins as molecular chaperones. HSP70, a highly conserved HSP, has been reported to correlate with the proliferation and migration of human cancer cells, such as oral, prostate, lung and liver cancer. Regarding hepatocellular carcinoma (HCC), the HSP70 levels in the tumor tissues from patients are significantly higher than those in the normal liver tissues. HSP70 reportedly upregulates the migration and invasion of HCC. The AKT, p38 mitogen-activated protein kinase (MAPK), c-jun N-terminal kinase (JNK) and Rho-kinase signaling pathways regulate the transforming growth factor (TGF)-α-induced migration of human HCC-derived HuH7 cells. However, the exact mechanism underlying the role of HSP70 in growth factor-induced HCC migration remains unclear. Therefore, in the present study, the mechanism underlying the involvement of HSP70 in TGF-α-induced HCC cell migration was investigated. Treatment with the HSP70 inhibitors VER155008 and YM-08 and the downregulation of HSP70 protein were confirmed to significantly suppress the TGF-α-induced cell migration of HuH7 cells. Both VER155008 and YM-08 reduced the TGF-α-induced phosphorylation of AKT without affecting the phosphorylation of p38 MAPK, JNK or Rho-kinase. These results strongly suggest that HSP70 positively regulates the TGF-α-induced migration of HCC cells via the AKT signaling pathway.

Quercetin suppresses the migration of hepatocellular carcinoma cells stimulated by hepatocyte growth factor or transforming growth factor-α: Attenuation of AKT signaling pathway.

Flavonol, which is found abundantly in plants such as fruits and vegetables, belongs to the family of flavonoid, natural polyphenols. Quercetin, one of the flavonol, reportedly has anti-cancer effects and prevents the proliferation of various cancer cells, including hepatocellular carcinoma (HCC). However, the effects of quercetin on HCC cells migration have not yet been clarified. We have previously shown that the migration of human HCC-derived HuH7 cells induced by hepatocyte growth factor (HGF) or transforming growth factor-α (TGF-α) is mediated through p38 MAPK and AKT. In this study, we investigated whether quercetin affects the HGF- or TGF-α-induced migration of HuH7 cells. Quercetin significantly suppressed both HGF- and TGF-α-induced migration of HuH7 cells in a dose-dependent manner. In addition, myricetin, another flavonol, also showed significant inhibition of the cell migration. Each HGF- and TGF-α-induced autophosphorylation of receptors were not affected by quercetin or myricetin. Quercetin did not suppress HGF- or TGF-α-induced p38 MAPK phosphorylation. On the contrary, quercetin and myricetin inhibited the growth factors-induced phosphorylation of AKT. Our results strongly suggest that quercetin suppresses the growth factor-induced migration of HCC cells by inhibiting the signaling pathway of AKT but not p38 MAPK.

[Selection of Operative Procedure for Breast Cancer in Carriers of BRCA VUS in Japan].

Risk classification and clinical management of the DNA variant of unknown significance(VUS)in BRCA 1/2 remains unestablished. The Japanese hereditary breast and ovarian cancer(HBOC)consortium and myriad genetics reported that the VUS rate of BRCA is 6.5% in Japanese patients, but is <2% in the USA. The types of mutation supposedly differ between Asian and European ethnicities. Breast-conserving therapy(BCT)is not recommended in HBOC breast cancer, according to the 2017 Japanese guidelines by the Ministry of Health, because of the risk of ipsilateral breast recurrence(IBR)and carcinogenesis by radiation. In our hospital, we recommend an initial mastectomy and breast reconstruction with an implant for patients with HBOC breast cancer, considering future surgery on the contralateral side and symmetry of the reconstructed breast. However, the risk of IBR after BCT is not significantly high in patients with HBOC breast cancer, and BCT is a reasonable option even for definite HBOC breast cancer under low risk conditions. Hence, BCT is feasible for treating breast cancer in carriers of VUS following decision-making and informed consent from the patients.

Olive oil polyphenols suppress the TGF-α-induced migration of hepatocellular carcinoma cells.

Oleuropein and 3-hydroxytyrosol (3-HT) are natural polyphenols present in olive oil that are known to exhibit potent anti-oxidant activities and exert protective effects against a number of human diseases. In the liver, olive oil polyphenols have been demonstrated to prevent hepatocellular carcinoma (HCC) cell growth. However, little is known about their effects against HCC cell migration. Therefore, the present study investigated whether or not oleuropein and 3-HT were involved in the suppression of transforming growth factor-α (TGF-α)-induced migration of human HCC cells using human HCC-derived HuH7 cells. The TGF-α-induced migration of HuH7 cells was significantly and dose-dependently suppressed by oleuropein and 3-HT. This study group demonstrated previously that the TGF-α-induced activation of AKT and stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) were involved in HuH7 cell migration. In addition to these protein kinases, the present study examined the involvement of TGF-α-induced activation of extracellular signal-regulated kinase (ERK), p38 mitogen-activated protein kinase (MAPK) and Rho kinase in HuH7 cell migration. TGF-α-induced HuH7 cell migration was decreased by SB203580, a p38 MAPK inhibitor, and Y27632, a Rho kinase inhibitor. However, PD98059, an inhibitor of the upstream kinase activating ERK, did not suppress the TGF-α-induced migration of HuH7 cells. Although AKT, SAPK/JNK, p38 MAPK and Rho kinase pathways were suggested to be involved in the TGF-α-induced migration of HuH7 cells, 10-30 µM 3-HT did not exhibit any suppressive effect on the TGF-α-stimulated activities of these kinases. The results of the present study suggest that olive oil polyphenols suppressed the TGF-α-induced migration of HCC cells.

Sphingosine 1-phosphate (S1P) reduces hepatocyte growth factor-induced migration of hepatocellular carcinoma cells via S1P receptor 2.

A bioactive lipid, sphingosine 1-phosphate (S1P), acts extracellularly as a potent mediator, and is implicated in the progression of various cancers including hepatocellular carcinoma (HCC). S1P exerts its functions by binding to five types of specific receptors, S1P receptor 1 (S1PR1), S1PR2, S1PR3, S1PR4 and S1PR5 on the plasma membrane. However, the exact roles of S1P and each S1PR in HCC cells remain to be clarified. In the present study, we investigated the effect of S1P on the hepatocyte growth factor (HGF)-induced migration of human HCC-derived HuH7 cells, and the involvement of each S1PR. S1P dose-dependently reduced the HGF-induced migration of HuH7 cells. We found that all S1PRs exist in the HuH7 cells. Among each selective agonist for five S1PRs, CYM5520, a selective S1PR2 agonist, significantly suppressed the HGF-induced HuH7 cell migration whereas selective agonists for S1PR1, S1PR3, S1PR4 or S1PR5 failed to affect the migration. The reduction of the HGF-induced migration by S1P was markedly reversed by treatment of JTE013, a selective antagonist for S1PR2, and S1PR2- siRNA. These results strongly suggest that S1P reduces the HGF-induced HCC cell migration via S1PR2. Our findings may provide a novel potential of S1PR2 to therapeutic strategy for metastasis of HCC.

First molecular detection of Sarcocystis ovalis in the intestinal mucosa of a Japanese jungle crow (Corvus macrorhynchos) in Hokkaido, Japan.

Although cysts of Sarcocystis spp. have been detected in domestic and wild animals throughout Japan, their natural definitive hosts have not been fully elucidated. Additionally, in Hokkaido, several Sarcocystis spp. are highly prevalent among wild sika deer (Cervus nippon yesoensis), one of which is S. ovalis. The life cycle of S. ovalis is maintained in corvid birds. To identify the definitive host for S. ovalis in Hokkaido, we investigated its prevalence among corvid birds (Corvus macrorhynchos and C. corone). A total of 42 crow carcasses were collected during August 2015-July 2016 in southern Hokkaido. Examination for coccidian sporocysts in rectal feces and intestinal mucosa, detection of Sarcocystis DNA (18S rRNA gene) from intestinal mucosa samples, and histological observation of intestinal tissue were conducted. No Sarcocystis sporocysts were detected in fecal and mucosal samples by flotation. DNA from intestinal mucosa was positive in one crow (C. macrorhynchos). Phylogenetic analysis demonstrated the isolate clustered with S. ovalis and was closely related to isolates obtained from sika deer in Hokkaido. Histologically, S. ovalis gamogenesis (gamonts or gametes) and oocyst production were observed in the villi of the crow positive for S. ovalis DNA. However, the crow was negative for other coccidian parasites, such as Eimeria, by fecal examination. Our results suggested that crows harbor S. ovalis in the intestine and may serve as a definitive host of S. ovalis in Hokkaido. To our knowledge, this is the first report on a natural definitive host for Sarcocystis spp. prevalent among sika deer in Japan.

An Introspective Approach to Nursing Intimate Partner Violence Victims in Japan.

BACKGROUND AND AIMS: The number of intimate partner violence (IPV) cases has been increasing in Japan since the 1990s. Many victims tend to hide their victimization and conceal their clinic or hospital visits. In these cases, nurses face feelings of incongruity toward patients. We aimed to explore if the process of introspection can provide better care for patients who have experienced IPV and prevent burnout in nurses. We hypothesized that introspection training would have a positive effect on nursing interventions. METHODS: We interviewed Japanese nurses who handled IPV cases between 2006 and 2009 and analyzed responses on the Emotional Question Scale (EQS). We used a modified grounded theory approach to analyze narratives from 20 nurses. RESULTS: We found that nurses experienced difficulties in coping with their incongruence toward patients, did not always feel capable of IPV care, and lacked experience in caring for patients experiencing IPV. Introspection training did not lead to significant differences in EQS scores, although scores on the self-management, interpersonal management, and situation management subscales were correlated significantly. This indicated that utilizing the introspection process would result in EQS improvement. CONCLUSION: We concluded that the process of objectification of incongruity is effective in detecting hidden IPV and helpful in identifying negative feelings, thus preventing burnout in nurses.

Effects of aromatherapy massage on face-down posture-related pain after vitrectomy: a randomized controlled trial.

Postoperative face-down posturing (FDP) is recommended to optimize the effects of intraocular gas tamponade after vitrectomy. However, patients undergoing FDP usually experience physical and psychological burdens. This 3-armed, randomized, single-center trial investigated the effects of aromatherapy on FDP-related physical pain. Sixty-three patients under FDP were randomly allocated to one of three treatment groups: aromatherapy massage with essential oil (AT), oil massage without essential oil (OT), and a control group. The AT and OT groups received 10 minutes of massage by ward nurses trained by an aromatherapist, while the control group received usual care. Outcomes were assessed as short-term (pre- to post-intervention) and long-term (first to third postoperative day) changes in physical pain in five body regions using face-scale. The AT and OT groups both revealed similar short-term pain reductions after intervention, compared with the control group. Regarding long-term effects, neither group experienced significant effects until the second day. Significantly more pain reduction compared with usual care occurred on the third day, mainly in the AT group, though there were few significant differences between the AT and OT groups. In conclusion, this study suggests that simple oil massage is an effective strategy for immediate pain reduction in patients undergoing FDP, while aromatherapy may have a long-term effect on pain reduction.

Test-retest paradigm of the forced swimming test in female mice is not valid for predicting antidepressant-like activity: participation of acetylcholine and sigma-1 receptors.

The forced swimming test (FST) in mice is widely used to predict the antidepressant activity of a drug, but information describing the immobility of female mice is limited. We investigated whether a prior swimming experience affects the immobility duration in a second FST in female mice and whether the test-retest paradigm is a valid screening tool for antidepressants. Female ICR mice were exposed to the FST using two experimental paradigms: a single FST and a double FST in which mice had experienced FST once 24 h prior to the second trail. The initial FST experience reliably prolonged immobility duration in the second FST. The antidepressants imipramine and paroxetine significantly reduced immobility duration in the single FST, but not in the double FST. Scopolamine and the sigma-1 (σ1) antagonist NE-100 administered before the second trial significantly prevented the prolongation of immobility. Neither a 5-HT1A nor a 5-HT2A receptor agonist affected immobility duration. We suggest that the test-retest paradigm in female mice is not adequate for predicting antidepressant-like activity of a drug; the prolongation of immobility in the double FST is modulated through acetylcholine and σ1 receptors.

Identification of antidepressant-like ingredients in ginseng root (Panax ginseng C.A. Meyer) using a menopausal depressive-like state in female mice: participation of 5-HT2A receptors.

RATIONALE: After reports of adverse effects with hormone replacement therapy, such as reproductive and breast cancer and coronary heart disease, much attention has been given to the development of new remedies to alleviate menopausal depression in women, but methods for their preclinical evaluation have not been clarified. We previously developed a procedure to predict the drug effect on the menopausal depressive-like state in female mice. OBJECTIVES: We attempted to identify psychoactive components from ginseng root, one of the earliest known materials for menopausal disorder, and to clarify the possible mechanism involved. METHODS: As an index of a depressive-like state, we used the prolongation of immobility time induced by an ovariectomy during the forced swimming test. Chronic treatment with the candidate substance began the day after ovariectomy and continued for 14 days. To examine whether the 5-HT(2A) receptor antagonist ritanserin antagonized the antidepressant-like effect of ginsenoside Rb(1), ritanserin was given as pretreatment 15 min before the daily administration of ginsenoside Rb(1) and the antagonistic effect was compared with ginsenoside Rb(1) alone. RESULTS: Ginsenoside Rb(1) and compound K were active ingredients that dose-dependently prevented the prolongation of immobility time induced by ovariectomy. Co-administration of ritanserin, a 5-HT(2A)-receptor antagonist, antagonized the effect of ginsenoside Rb(1). CONCLUSIONS: We suggest that ginsenoside Rb(1) and its metabolite, compound K, are antidepressant-like components of the ginseng root, and that 5-HT(2A) receptors may play an important role in mediating the antidepressant-like effect of ginsenoside Rb(1).

[Clinical analysis of 12 cases of pneumothorax during intensive chemotherapy for malignant neoplasms].

Twelve cases of pneumothorax during intensive chemotherapy for malignant neoplasms were found in a retrospective study of patients being treated at our hospital in the period 2001-2009. All of the patients were men, and their diseases were lung cancer (9 cases), gastric cancer (2 cases) and esophageal cancer (one case). Operation for pneumothorax was performed 9 times in 7 patients(twice in two patients). Thoracoscopic surgery was done in 6 patients, and one patient with severe pulmonary emphysema was performed by open thoracotomy. Pleurodesis was performed 5 times using OK-432 only or OK-432 and minocyclin. Five patients died during the treatment for pneumothorax. The causes of death were interstitial pneumonia after pleurodesis (one case), and progression of cancer during interruption of chemotherapy (4 cases). Development of pneumothorax during intensive chemotherapy should be recognized and treated as soon as possible because it may hinder the treatment for malignant tumors and lead to severe pulmonary dysfunction.

[Determinants of chilliness among young women and their application to psychopharmacological trials].

Chilliness is a common complaint among menopausal women. Increasing evidence indicates that young women also suffer from chilliness, resulting in decreased learning, motivation, and concentration. Neither diagnostic criteria nor drug therapies exist for chilliness, and thus, young women suffer from insomnia, fatigue, and mood disturbance. Because chilliness is correlated with hormonal changes observed during premenstrual, postpartum, and menopausal periods, reproductive hormones are likely involved. Recently, we elucidated methodological issues related to identifying young women with chilliness. We used a new questionnaire to determine complaint severity with regard to chills and assessed physical parameters (BMI, body fat ratio, basal metabolism, blood pressure), peripheral circulation, and recovery of skin surface temperature after mild cold-water finger immersion. Using a discriminant analysis (hit ratio, 84.5%), we demonstrated that four parameters (blood flow, difference between underarm and surface temperature, recovery rate after mild cold exposure, and score for chilliness-related complaints) were important determinants of chilliness. Among traditional candidate substances for alleviating chilliness, Piper longum and royal jelly showed significant effects. Additionally, we investigated seasonal change in the experience of chilliness and found that young women suffer from chilliness during the summer. These findings have important implications for understanding chilliness in women.