No abstract

SUMMARY Age-and sex-adjusted mortality rates of gastric cancer and stroke in the years 1974-6 for 46 prefectures and 12 regions in Japan were related to regional differences of average per capita daily intake of salt during the period Observing the similarity of the world-wide geographical distribution for the two diseases and of the secular trends, Joossens proposed that gastric cancer and stroke might be aetiologically linked and that excessive salt intake might be a common cause. [4][5][6] In fact, salt has so far been the most probable candidate for the cause of raised blood pressure despite the controversy over it4 (R 0 Cummins, unpublished observations). Although evidence is limited, salt has also been claimed as a predisposing factor for gastric cancer in some epidemiological studies7-9In view of the massive impact of stomach cancer and stroke on public health in Japan, Joossens's hypothesis could have a potential value in preventing the two diseases. This paper tests Joossens's hypothesis more directly by comparing geographical distribution of these two diseases with salt intake in Japan. Materials and methodsNumbers of deaths from gastric cancer (8th ICD 151) and stroke (8th ICD 430-438), by sex, five-year age group, and prefecture during 1974-6 were used with the 1975 census population to calculate average annual death rates."0 11 Since data of salt intake were not available at the level of prefecture but of region (fig 1), prefectural mortality data were also amalgamated for each region. The age range 45-74 years was included here because deaths from gastric cancer and stroke are few below 45 years of age, andHokkaido (1) Tohoku (2) Hokuriku (5) Kirki-1 (7) North Kyushu -Kanto-11 (4) >Y~7;:) v~9~T ohkai (6)

Primary aldosteronism (PA) is associated with an increased risk of cardiometabolic diseases, especially in unilateral subtype. Despite its high prevalence, the case detection rate of PA is limited, partly because of no clinical models available in general practice to identify patients highly suspicious of unilateral subtype of PA, who should be referred to specialized centers. The aim of this retrospective cross-sectional study was to develop a predictive model for subtype diagnosis of PA based on machine learning methods using clinical data available in general practice. Overall, 91 patients with unilateral and 138 patients with bilateral PA were randomly assigned to the training and test cohorts. Four supervised machine learning classifiers; logistic regression, support vector machines, random forests (RF), and gradient boosting decision trees, were used to develop predictive models from 21 clinical variables. The accuracy and the area under the receiver operating characteristic curve (AUC) for predicting of subtype diagnosis of PA in the test cohort were compared among the optimized classifiers. Of the four classifiers, the accuracy and AUC were highest in RF, with 95.7% and 0.990, respectively. Serum potassium, plasma aldosterone, and serum sodium levels were highlighted as important variables in this model. For feature-selected RF with the three variables, the accuracy and AUC were 89.1% and 0.950, respectively. With an independent external PA cohort, we confirmed a similar accuracy for feature-selected RF (accuracy: 85.1%). Machine learning models developed using blood test can help predict subtype diagnosis of PA in general practice.

SUMMARY A cohort study was done on 1396 deaths seen among 4352 Japanese male Zen priests during a follow up period from 1 January 1955 to 31 December 1978. Standardised mortality ratios were computed for major causes of death by comparing with the counterparts of the general Japanese male population. The SMR for all causes of death was 082 (p<0001) and the SMR values for cerebrovascular diseases, pneumonia and bronchitis, peptic ulcer, liver cirrhosis, cancer of the respiratory organs, and cancer of the lung were all significantly smaller than unity. Taking regional mortality differences into account, a similar computation was made dividing the cohort into two subcohorts-that is, the priests living in eastern Japan and those in western Japan. Both subcohorts showed a highly significantly smaller SMR than unity for all causes of death. With the exception of only a few causes of death for which the observed number of deaths was small, they also showed such reduced SMRs for nearly all of the causes of death tested. A questionnaire survey on the current life style of active priests showed that they smoke less, eat less meat and fish as they follow the more traditional Japanese dietary habits, and live in less polluted areas, but their drinking habits do not differ much from that of the average Japanese adult man. Possible reasons for their reduced mortality are discussed.

No abstract