The present study offers data that are useful for the diagnosis and treatment of patients with collagen diseases and liver abnormalities.

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Rectovaginal (RV) endometriosis presents with a nodular lesion composed of fibromuscular and endometriotic tissue, and the fibromuscular tissue is the major component in the severe stage. The purpose of our study was to examine the extending process of fibromuscular tissue in RV endometriosis. Histological examinations using immunostains, were performed in 90 RV tissue specimens from 37 women. Fibrosis was present in 89 specimens. In each specimen, the intensity of the fibrosis differed from area to area: in mildly fibrotic areas, the collagen fibers were present around the endometriotic tissue, and in severely fibrotic areas, the fibrosis widely extended into fat and connective tissus as well as within the endometriotic tissue. In the 60 specimens containing endometriotic tissue, the increase in the amount of endometriotic tissue significantly correlated to the increase in degree of fibrosis in the entire tissue. The presence of aggregated smooth muscles, unassociated with blood vessels, was defined as smooth muscle metaplasia (SMM), which was always present within the fibrotic areas, and was observed in 80 specimens. The degree of SMM in the entire tissue was significantly correlated with the degree of fibrosis. From these findings, the following was hypothesized. Initially, endometriotic tissue was present sporadically and fibrosis was present around the endometriotic tissue. Thereafter, proliferation of endometriotic tissue and an increase in fibrosis occur consecutively. The SMM was present within the fibrotic areas, and it became more severe, correlating with the increase in fibrosis. In conclusion, this is the first report describing the extending process of the fibromuscular tissue of RV endometriosis from a histological viewpoint, and we think that recognization of this process is useful for histological diagnosis and clinical management of RV endometriosis.

Mortality due to cardiovascular disease rises sharply in winter. Known as excess winter mortality, this phenomenon is partially explained by cold exposure-induced high blood pressure. Home blood pressure, especially in the morning, is closely associated with cardiovascular disease risk. We conducted the first large nationwide survey on home blood pressure and indoor temperature in 3775 participants (2095 households) who intended to conduct insulation retrofitting and were recruited by construction companies. Home blood pressure was measured twice in the morning and evening for 2 weeks. The relationship between home blood pressure and indoor temperature in winter was analyzed using a multilevel model with 3 levels: repeatedly measured day-level variables (eg, indoor ambient temperature and quality of sleep), nested within individual-level (eg, age and sex), and nested within household level. Cross-sectional analyses involving about 2900 participants (1840 households) showed that systolic blood pressure in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mm Hg increase/10°C decrease) than that in the evening (6.5 mm Hg increase/10°C decrease) in participants aged 57 years (mean age in this survey). We also found a nonlinear relationship between morning systolic blood pressure and indoor temperature, suggesting that the effect of indoor temperature on blood pressure varied depending on room temperature range. Interaction terms between age/women and indoor temperature were significant, indicating that systolic blood pressure in older residents and women was vulnerable to indoor temperature change. We expect that these results will be useful in determining optimum home temperature recommendations for men and women of each age group. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/index.htm . Unique identifier: UMIN000030601.