Background The female preponderance in heart failure with preserved ejection fraction (HFpEF) is a distinguishing feature of this disorder, but the association of sex with degree of diastolic dysfunction and clinical outcomes among individuals with HFpEF remains unclear. Methods and Results We conducted a prospective, multicenter, observational study of patients with HFpEF (PURSUIT‐HFpEF [Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction]: UMIN000021831). Between 2016 and 2019, 871 patients were enrolled from 26 hospitals (follow‐up: 399±349 days). We investigated sex‐related differences in diastolic dysfunction and postdischarge clinical outcomes in patients with HFpEF. The echocardiographic end point was diastolic dysfunction according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. The clinical end point was a composite of all‐cause death and heart failure readmission. Women accounted for 55.2% (481 patients) of the overall cohort. Compared with men, women were older and had lower prevalence rates of hypertension, coronary artery disease, and chronic kidney disease. Women had diastolic dysfunction more frequently than men (52.8% versus 32.0%, P <0.001). The incidence of the clinical end point did not differ between women and men (women 36.1/100 person‐years versus men 30.5/100 person‐years, P =0.336). Female sex was independently associated with the echocardiographic end point (adjusted odds ratio, 2.839; 95% CI, 1.884–4.278; P <0.001) and the clinical end point (adjusted hazard ratio, 1.538; 95% CI, 1.143–2.070; P =0.004). Conclusions Female sex was independently associated with the presence of diastolic dysfunction and worse clinical outcomes in a cohort of elderly patients with HFpEF. Our results suggest that a sex‐specific approach is key to investigating the pathophysiology of HFpEF. Registration URL: https://upload.umin.ac.jp ; Unique identifier: UMIN000021831.

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Cervical cancer remains among the most common cancers in women worldwide and can be prevented by vaccination. The Ministry of Health, Labour and Welfare of Japan suspended active recommendation of regular human papillomavirus (HPV) vaccines in 2013 because of various symptoms including chronic pain and motor impairment. This nationwide case‐control study from April 2013 to March 2017 targeted women aged 20‐24 years old at cervical screening. We compared HPV vaccination exposure between those with abnormal and normal cytology. Abnormal cytology was classified based on the results of histological test and we calculated the odds ratio (OR) and 95% confidence interval (CI) of the above endpoints and vaccination exposure using the conditional logistic regression model and estimated vaccine effectiveness using the formula (1 – OR) × 100. A total of 2483 cases and 12 296 controls (one‐to‐five matching) were eligible in 31 municipalities in Japan. The distribution of histological abnormalities among cases was 797 CIN1 (including dysplasia) (32.1%), 165 CIN2 (6.7%), 44 CIN3 (1.8%), and eight squamous cell carcinoma (SCC) (0.3%). The OR of HPV vaccination compared with no vaccination for abnormal cytology, CIN1+, CIN2+, and CIN3+ versus controls was 0.42 (95% CI, 0.34‐0.50), 0.42 (95% CI, 0.31‐0.58), 0.25 (95% CI, 0.12‐0.54), and 0.19 (95% CI, 0.03‐1.15), respectively, equating to a vaccine effectiveness of 58.5%, 57.9%, 74.8%, and 80.9%, respectively. Eight patients had SCC, none was vaccinated. This nationwide case‐control study in Japan demonstrated a substantial risk reduction in abnormal cytology and CIN among women who did versus those who did not receive HPV vaccination.

BackgroundJapanese rice cake (“mochi”) is a major cause of food-choking accidents in Japan. However, the epidemiology of out-of-hospital cardiac arrests (OHCAs) due to suffocation caused by rice cakes is poorly understood.MethodsOHCA data from 2005 to 2012 were obtained from the population-based OHCA registry in Osaka Prefecture. Patients aged ≥20 years who experienced OHCA caused by suffocation that occurred before the arrival of emergency-medical-service (EMS) personnel were included. Patient characteristics, prehospital interventions, and outcomes were compared based on the cause of suffocation (rice cake and non-rice-cake). The primary outcome was 1-month survival after OHCA.ResultsIn total, 46 911 adult OHCAs were observed during the study period. Of the OHCAs, 7.0% (3,294/46,911) were due to suffocation, with choking due to rice cake as the cause in 9.5% of cases (314/3,294), and of these, 24.5% (77/314) occurred during the first 3 days of the New Year. In crude analysis, 1-month survival was 17.2% (54/314) in those with suffocation caused by rice cake and 13.4% (400/2,980) in those with suffocation due to other causes. In the multivariable analysis for all-cause suffocation, younger age, arrest witnessed by bystanders, and earlier EMS response time were significantly related to better 1-month survival.ConclusionApproximately 10% of OHCAs due to suffocation were caused by rice-cake choking, and 25% of these occurred during the first 3 days of the New Year. Further efforts for establishing preventive measures as well as improving the early recognition of choking and encouraging bystanders to call EMS sooner are needed.

Background: Acrylamide has been classified as a probable human carcinogen based chiefly on laboratory evidence. However, the influence of dietary acrylamide intake on risk of esophageal, gastric, and colorectal cancer has not been extensively studied. We aimed to evaluate the association between dietary acrylamide intake and esophageal, gastric, and colorectal cancer using data from the Japan Public Health Center-based Prospective Study. Methods: Our study included 87,628 participants who completed a food-frequency questionnaire at enrollment in 1990 and 1993. We used Cox proportional hazards regression models to estimate hazards ratios and 95% confidence intervals (CI) after adjusting for confounding factors. Results: After 15.5, 15.3, and 15.3 mean years of follow-up for esophageal, gastric, and colorectal cancer, we identified and analyzed 391 esophageal, 2,218 gastric, and 2,470 colo-rectal cancer cases, respectively. Compared with the lowest quintile of acrylamide intake, the multivariate HR for the highest quintile was 0.86 (95% CI, 0.53-1.39; P trend ¼ 0.814), 0.84 (95% CI, 0.69-1.01; P trend ¼ 0.301), and 0.93 (95% CI, 0.79-1.08; P trend ¼ 0.165) for esophageal, gastric, and colorectal cancer, respectively, in the multivariableadjusted model. Furthermore, no significant associations were observed when the participants were stratified by cancer subsites. Conclusions: In conclusion, this study demonstrated that dietary acrylamide intake was not associated with increased risk of esophageal, gastric, or colorectal cancer among the Japanese population. Impact: It is the first time to assess the effect of dietary acrylamide intake on risk of digestive system cancer in Asian populations.