Springer Science and Business Media LLC Acta Medica Okayama 1435-2451 411 1 2025 Surgical outcomes and patient selection in nonagenarians with colon cancer: a comparative multi-institutional study of laparoscopic and open approaches 21 EN Ryohei Shoji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoe Takanaga Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Ryo Inada Department of Surgery, Kochi Health Sciences Center Toshiaki Toshima Department of Surgery, Kagawa Rosai Hospital Tsuyoshi Ohtani Department of Surgery, Saiseikai Okayama Hospital Ryosuke Yoshida Department of Surgery, Okayama Rosai Hospital Naoto Hori Department of Surgery, Tottori Municipal Hospital Kaoru Shigemitsu Department of Surgery, Tsuyama Chuo Hospital Sumiharu Yamamoto Department of Surgery, Okayama City Hospital Tetsushi Kubota Department of Surgery, Kobe Red Cross Hospital Yuka Okano Department of Surgery, Onomichi City Hospital Tetsuji Nobuhisa Department of Surgery, Himeji Red Cross Hospital Fumitaka Taniguchi Department of Surgery, National Hospital Organization Iwakuni Clinical Center Wataru Ishikawa Department of Surgery, Fukuyama City Hospital Tatsuo Matsuda Department of Surgery, Matsuda Hospital Tatsuo Umeoka Department of Surgery, Matsuyama City Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Setouchi Colorectal Neoplasm Registration study group collaborators Purpose The appropriate surgical approach for colon cancer (CC) in nonagenarian patients remains a subject of clinical debate. This study aimed to compare the short-term outcomes of laparoscopic (Lap) versus open (Open) surgery in patients aged ≥ 90 years with resectable colon cancer.<br> Methods This multi-institutional retrospective cohort study included oldest-old patientswith pathological Stage II/III CC who underwent elective surgery at 15 hospitals between 2011 and 2022. Patients with rectal cancer, Stage 0/I/IV disease, or emergency surgery were excluded. To address selection bias, inverse-probability-weighted regression adjustment and stabilized inverse probability of treatment weighting (sIPTW) were applied. The primary outcome was postoperative complications; secondary outcomes included overall survival (OS).<br> Results Median age was 92 years in both groups. Before adjustment, the Lap group had a higher proportion of female patients (p = 0.038) and lower ASA scores (p = 0.01). Laparoscopic surgery was associated with a significantly longer operative time (220 vs. 171 min, p = 0.046) but less intraoperative blood loss (10 vs. 78 mL, p < 0.01). Postoperative complication rates were comparable (Lap: 31.8%, Open: 33.8%), while the Lap group had a significantly shorter hospital stay (13 vs. 17 days, p < 0.01). D3 lymph node dissection was more frequently performed in the Lap group (p < 0.01). After sIPTW, overall survival did not differ significantly between groups (p = 0.61).<br> Conclusion Both laparoscopic and open surgery are feasible options for selected nonagenarians with colon cancer. Laparoscopic surgery may offer benefits in terms of reduced blood loss and shorter hospitalization, despite longer operative times. Careful patient selection considering frailty and comorbidities is essential in determining the most appropriate surgical approach. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 2073-445X 15 2 2026 A Study on the Development of an Image Classification System for Urban Sprawl Areas in Japan 275 EN Ryota Hemmi Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Takehito Ujihara Faculty of Environmental, Life, Natural Science and Technology, Okayama University Ryosuke Ando National Institute for Land and Infrastructure Management, Ministry of Land, Infrastructure Transport and Tourism Seiji Hashimoto Faculty of Environmental, Life, Natural Science and Technology, Okayama University In Japan, unlike in many other countries, urbanization has progressed while original rural road structures have been retained, leading to distinctive urban sprawl areas with intermingling residential lots and farmland. Currently, much of Japan’s urban areas consist of urban sprawl areas, posing considerable challenges for infrastructure development. However, for such urban sprawl areas in Japan, it is difficult to say that methods have been established to identify their spatial distribution based on quantitative evaluation. Therefore, for this study, we used machine learning to investigate a system that extracts sprawling urban areas from aerial photographs divided into meshes. In the system’s design, we prioritized precision to ensure the reliable detection of urban sprawl areas. Consequently, the accuracy of identifying sprawl areas achieved precision of 0.81, recall of 0.63, and an F-score of 0.71. Examination of the classification results of sprawl areas revealed that most misclassifications occurred near class boundaries. By contrast, areas with particularly high levels of urban sprawl showed few misclassifications. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 80 1 2026 Kinesiophobia Is Associated with Disability, Poor Quality of Life, Psychological Morbidity, and Surgery Dissatisfaction in Patients with Lumbar Microdiscetomy: A Cross-Sectional Controlled Study 39 46 EN Nihal Tezel Department of Physical and Rehabilitation Medicine, Health Sciences University Aslı Gençay Can Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Ankara Yıldırım Beyazıt University Original Article 10.18926/AMO/70071 The study aimed to determine the prevalence of kinesiophobia in patients who had undergone lumbar microdiscectomy and to examine its associations with pain intensity, disability, quality of life, depression, anxiety, and satisfaction with surgery. Forty-eight patients with microdiscectomy and 48 healthy controls were enrolled. The Tampa Scale for Kinesiophobia (TSK), Roland-Morris Disability Index (RMDI), Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), and Short Form-36 Health Survey (SF-36) were administered to both groups. The scores of TSK, RMDI, HADS-A, and HADS-D were significantly higher and SF-36 scores were significantly lower in the microdiscectomy than the control group (p<0.001 for all). In the microdiscectomy group, median (min-max) RMDI, HADS-A, and HADS-D scores were 19 (4-34), 10 (0-18), and 9 (0-18), respectively, in kinesiophobic patients, and were significantly higher than 6 (2-20), 3 (0-11), 2.5 (0-11) in non-kinesiophobic patients (all p<0.001). The median (min-max) SF-36 PCS, SF-36 MCS, and VAS scores for surgery satisfaction were 36.5 (8.7-75), 52.1 (11-95), 5, 5 (0-10), respectively, in kinesiophobic patients and were significantly lower than 71 (28-95), 85.5 (9-93), 8.5 (3-10) in non-kinesiophobic patients (all p<0.05). TSK scores were significantly correlated with RMDI, HADS-A, HADS-D, SF-36, and surgery satisfaction scores (all p<0.05). Kinesiophobic patients with lumbar microdiscectomy therefore showed greater disability and psychological morbidity, poorer quality of life, and lower satisfaction with surgery. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 80 1 2026 The Preoperative Anterior Pelvic Plane Angle Predicts Cup Anteversion Changes at 1 Year after Total Hip Arthroplasty 31 37 EN Kyota Ishibashi Department of Orthopedic Surgery, Hachinohe City Hospital Hirotaka Oishi Department of Orthopedic Surgery, Hachinohe City Hospital Ryo Araki Department of Orthopedic Surgery, Hachinohe City Hospital Kosuke Kawamura Department of Orthopedic Surgery, Hachinohe City Hospital Isamu Sasaki Department of Orthopedic Surgery, Hachinohe City Hospital Eiji Sasaki Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine Hikaru Kamada Department of Orthopedic Surgery, Hachinohe City Hospital Masakazu Kogawa Department of Orthopedic Surgery, Hachinohe City Hospital Sunao Tanaka Department of Orthopedic Surgery, Hachinohe City Hospital Takuya Numasawa Department of Orthopedic Surgery, Hachinohe City Hospital Yasuyuki Ishibashi Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine Original Article 10.18926/AMO/70070 We investigated global alignment changes following total hip arthroplasty (THA) and predictive alignment parameters for increased cup anteversion (CA) by retrospectively analyzing the primary THA data of 75 patients treated at our hospital (49 women, 26 men; age 65.1±5.7 years, BMI 28.3±3.4 kg/m2). Global alignment parameters, i.e., the anterior pelvic plane angle (APPa) and proximal femoral shaft angle (PFSa) and other alignment parameters were measured. CA was evaluated based on the patients’ standing coronal radiographs. ΔCA was defined as the difference in CA from 2 weeks before to 1 year after each THA. We classified the cases as stable (S) (CA < 10°; n=63) and pelvic retroversion (R) (CA ≥ 10°; n=12) groups. Associations between ΔCA and alignment parameters were evaluated by linear regression and a receiver operating characteristic (ROC) analysis. A significant decrease in the PFSa occurred between the 2-week and 1-year post-THA timepoints (7.8±4.3° vs. 4.2±3.6°, p<0.001), with no notable change in other alignment parameters. At 1-year post-THA, the CA of 12 (16%) patients had increased to 4.5±4.4°. Only the preoperative APPa was positively associated with ΔCA (β=0.165, p=0.020). The ROC analysis revealed that the optimal cut-off value for increased CA in the APPa is 2.1° (area under the curve, 0.700; p=0.020; odds ratio, 4.80). The APPa change predicted increased CA, which emphasizes the importance of the use of preoperative standing radiography for identifying the optimal cup positioning for post-THA changes in CA. No potential conflict of interest relevant to this article was reported.

BMJ Acta Medica Okayama 2044-6055 15 12 2025 Effectiveness of education programme to increase competency of health cadres in Indonesia: a cluster non-randomised controlled trial e095428 EN Dewie Sulistyorini Graduate School of Biomedical and Health Sciences, Hiroshima University K A T M Ehsanul Huq Graduate School of Biomedical and Health Sciences, Hiroshima University Abdulfatai Olamilekan Babaita Graduate School of Biomedical and Health Sciences, Hiroshima University Sadia A Aivey Graduate School of Biomedical and Health Sciences, Hiroshima University Gao Huiying Graduate School of Biomedical and Health Sciences, Hiroshima University Kana Kazawa Faculty of Health Sciences, Okayama University Yasuko Fukushima Graduate School of Biomedical and Health Sciences, Hiroshima University Mayumi Kako Graduate School of Biomedical and Health Sciences, Hiroshima University Michiko Moriyama Graduate School of Biomedical and Health Sciences, Hiroshima University Objectives Health cadres, who assist midwives in supporting pregnant women in community settings, need to enhance their competencies in identifying risk factors and referring high-risk pregnant women to midwives for further care. Since the capabilities of these health cadres are influenced by maternal complications, an educational programme was implemented to strengthen their skills. Therefore, this study aimed to evaluate the competency of health cadres by providing a researcher-developed educational programme.<br> Design An open-label, cluster non-randomised controlled trial.<br> Setting and participants Health cadres with at least 1 year of work experience were recruited at six public health centres (PHCs) in Banjarnegara Regency, Indonesia.<br> Interventions Six PHCs were selected and allocated into intervention group (IG=3 PHCs) and control group (CG=3 PHCs) groups. A total of 133 female health cadres were enrolled across the selected PHCs. At each PHC, a systematic random sampling method was used to select the participants. The researchers and health professionals provided a 3-week period of theoretical and scenario-based simulations to the IG, while the CG received no education.<br> Outcome measures Researcher-developed questionnaires and checklists were used to assess the knowledge, skills (health assessment, communication, attitude) and confidence. The primary endpoint was competency, a total score of knowledge and skills. The outcome domains were compared between the two groups, and a linear mixed-effect model was used to account for cluster-level variation.<br> Results A total of 130 (97.7%) completed the study (IG:64, CG:66). The competency score showed significant improvement at endline (CG=49.5 and IG=52.5; p=0.002). The median scores for health assessment skills (CG=12 vs IG=14; p<0.001) and communication skills (CG=7 vs IG=8; p<0.001) were increased in the IG compared with the CG. Mixed-effect model indicated that groups (β (95% CI) 2.49 (0.57 to 4.41), p=0.012), baseline knowledge (β(95% CI) 0.73 (0.54 to 0.92), p<0.001) and midline health assessment skills (β (95% CI) 0.54 (0.25 to 0.82), p<0.001) were significant positive predictors, while age was negatively associated with competency (β (95% CI) −0.20 (−0.30 to −0.10), p<0.001)).<br> Conclusion Education effectively increased the competency of health cadres. A well-structured education programme is necessary for health cadres to improve and maintain their competencies in monitoring high-risk pregnant women.<br> Trial registration number NCT06134518. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 6 2025 COVID-19 and the Risks of Migraine and Headache: A Mendelian Randomization Study 413 419 EN Zhiyun Jiang Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University Ying Xi Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University Original Article 10.18926/AMO/69843 Several observational studies suggested that migraine headache attacks were associated with coronavirus disease 2019 (COVID-19). We investigated genetic causal links between COVID-19 phenotypes and the development of headache and migraine, including migraine with aura (MA) and migraine without aura (MO). We conducted a two-sample Mendelian randomization (MR) analysis to estimate the genetic association in European populations. The inverse-variance weighted (IVW) method was used as the main approach in the MR analyses, together with weighted median and MR-Egger methods. We also performed a series of sensitivity tests to assess the robustness of the MR results. The MR results demonstrated that COVID-19 severity, hospitalization, and susceptibility had no causal effect on the risks of headache, migraine, MA, or MO. No horizontal pleiotropy was detected, and the results were robust as supported by the sensitivity analysis findings. Our analyses identified no casual effect of COVID-19 severity, hospitalization, or susceptibility on the risks of headache or migraine in European populations. No potential conflict of interest relevant to this article was reported.

British Editorial Society of Bone & Joint Surgery Acta Medica Okayama 2633-1462 6 8 2025 Long-term functional and quality of life outcomes after cementless minimally invasive extendable endoprosthesis replacement in skeletally immature patients with bone sarcomas at the lower limb a Japanese Musculoskeletal Oncology Group (JMOG) study 954 963 EN Yusuke Tsuda Department of Orthopaedic Surgery, The University of Tokyo Hospital Yoshihiro Nishida Department of Rehabilitation, Nagoya University Hospital Akio Sakamoto Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University Koichi Ogura Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital Tomohiro Fujiwara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tetsuya Sekita Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital Hirotaka Kawano Department of Orthopaedic Surgery, Teikyo University School of Medicine Hiroshi Kobayashi Department of Orthopaedic Surgery, The University of Tokyo Hospital Aims<br> Extendable endoprostheses are utilized to reconstruct segmental defects following resection of bone sarcomas in skeletally immature children. However, there remains a paucity of data regarding long-term functional and quality of life outcomes.<br> Methods<br> We conducted a retrospective, multicentre study and reviewed 45 children who underwent cementless minimally invasive extendable endoprosthetic replacement. Anatomical sites included the distal femur (n = 29), proximal femur (n = 4), proximal tibia (n = 11), and total femur (n = 1). The mean follow-up period was 12 years. The mean age at extendable endoprosthetic replacement was ten years (5 to 15). Most patients (96%, 43/45) had reached skeletal maturity at the final follow-up.<br> Results<br> The ten-year endoprosthetic failure-free survival rate was 60%. Of the 45 patients, 25 (56%) had 42 complications which were frequently related to structural failure (45%, 19/42), with extension mechanism jamming being the most common (n = 7, 17%). Excluding lengthening procedures, 20 patients (44%) underwent additional surgery with a mean of two surgeries per patient. The mean limb-length discrepancy at the final follow-up was 2.3 cm. Limb salvage was achieved in 44 (98%) patients. The mean Musculoskeletal Tumor Society (MSTS) scores, Toronto Extremity Salvage Score (TESS), and EuroQol five-dimension five-level questionnaire (EQ-5D-5L) were 78%, 92%, and 92% at the last follow-up, respectively. Multiple additional surgeries (≥ 2 times) for complications were associated with worse MSTS scores compared with those without multiple additional surgeries (p = 0.009). Moreover, limb-length discrepancy > 3 cm showed significantly worse MSTS scores compared with those ≤ 3 cm (p = 0.019).<br> Conclusion<br> Extendable endoprostheses were associated with a high complication rate and need for additional surgeries over time, especially for structural-related complications. Despite this, successful limb salvage with reasonable function/quality of life and small limb-length discrepancy were achievable in the long term. Patients’ function in the long term depended on the experience of postoperative complications and limb-length discrepancy. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 0915-5635 2025 EUS-Guided Versus Percutaneous Transhepatic Drainage of Liver Abscesses: A Multicenter Endohepatology Study in Western Japan (EPIC-LA Study) EN Takeshi Ogura Pancreatobiliary Advanced Medical Center, Osaka Medical and Pharmaceutical University Hospital Taira Kuroda Gastroenterology Center, Ehime Prefectural Hospital Takanori Matsuura Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine Jun Kitadai Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine Koh Kitagawa Department of Gastroenterology, Nara Medical University Masahiro Itonaga Second Department of Internal Medicine, Wakayama Medical University Kotaro Takeshita Department of Gastroenterology, Tane General Hospital Tomoaki Matsumori Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine Tomoya Emori Department of Gastroenterology, Wakayama Rosai Hospital Mamoru Takenaka Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Graduate School of Medical Sciences Hajime Imai Department of Gastroenterology, Okanami General Hospital Koichiro Mandai Department of Gastroenterology, Kyoto Second Red Cross Hospital Shuhei Shintani Department of Gastroenterology, Shiga University of Medical Science Nao Fujimori Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University Hideyuki Shiomi Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University Masanori Asada Department of Gastroenterology and Hepatology, Japanese Red Cross Osaka Hospital Ryota Sagami Department of Gastroenterology, Faculty of Medicine, Oita University Hirotsugu Maruyama Department of Gastroenterology, Graduate School of Medicine, Osaka Metropolitan University Tsukasa Ikeura Division of Gastroenterology and Hepatology, Kansai Medical University Hospital Masaaki Shimatani Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center Hidefumi Nishikiori Department of Gastroenterology, Oita San-ai Medical Center Kazuyuki Matsumoto Department of Endoscopy, Okayama University Hospital Masahito Kokubu Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine Hideki Kamada Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University Yusuke Ishida Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University Akitoshi Hakoda 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University Masayuki Kitano Second Department of Internal Medicine, Wakayama Medical University Objective: Percutaneous transhepatic liver abscess drainage (PTAD) and endoscopic ultrasound-guided liver abscess drainage (EUS-LAD) have several limitations. Recently, because of technical improvements in echoendoscope maneuvers, EUS-guided access for the right hepatic lobe has been reported. The aim of this multicenter, retrospective study was to compare clinical outcomes of PTAD and EUS-LAD including the right hepatic lobe in West Japan.<br> Method: This retrospective, multicenter study included consecutive patients with liver abscesses between January 2019 and November 2024. The primary outcome in this study was the clinical success rate compared between EUS-LAD and PTAD.<br> Results: During the study period, 1012 consecutive patients developed liver abscesses. Of them, 734 patients were excluded, 43 underwent EUS-LAD and 235 patients underwent PTAD. After propensity score-matched analysis, the clinical success rate was significantly higher in the EUS-LAD group (97.7%, 42/43) than in the PTAD group (79.1%, 34/43) (p = 0.007). After a propensity score-matched analysis, 25 patients were included in each group. The clinical success rate was significantly higher in the EUS-LAD group (100%, 25/25) than in the PTAD group (84%, 21/25) (p = 0.037). Adverse events were also significantly higher in the PTAD group (16%, 5/25) than in the EUS-LAD group (p = 0.025). In addition, the median length of hospital stay was significantly shorter in the EUS-LAD group (15 days) than in the PTAD group (22 days) (p = 0.005).<br> Conclusions: EUS-LAD using a metal stent might be one of the options, but further randomized, controlled trials are needed. No potential conflict of interest relevant to this article was reported.

Spandidos Publications Acta Medica Okayama 1791-2997 33 1 2025 Protective impact of landiolol against acute lung injury following hemorrhagic shock and resuscitation in rats 22 EN Risa Sakamoto Department of Anesthesiology and Resuscitology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroko Shimizu Department of Anesthesiology and Resuscitology, Okayama University Medical School Ryu Nakamura Department of Anesthesiology and Resuscitology, Okayama University Medical School Yifu Lu Department of Human Anatomy, Shantou University Medical College Yaqiang Li Department of Anesthesiology and Resuscitology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Emiko Omori Department of Anesthesiology and Resuscitology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toru Takahashi Department of Anesthesiology, Okayama Saidaiji Hospital Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hemorrhagic shock and resuscitation (HSR) induces pulmonary inflammation, leading to acute lung injury (ALI). Notably, blocking β1 receptors can lead to organ protection through anti‑inflammatory and anti‑apoptotic effects. Additionally, although the β1 receptor pathway is blocked by the β1 blocker, the β2 receptor pathway may be preserved and activate the 5' adenosine monophosphate‑activated protein kinase (AMPK) pathway. The present study aimed to examine whether administration of the β1 blocker landiolol could achieve lung protection in a model of HSR‑ALI, alongside improvements in inflammation and apoptosis. Male Sprague‑Dawley rats underwent hemorrhage keeping their mean arterial pressure at 30 mmHg for 1 h. Resuscitation by reinfusion was initiated to restore blood pressure to pre‑hemorrhage levels for >15 min, followed by a 45‑min stabilization period to create the HSR‑ALI model. Landiolol (100 mg/kg/min) or saline was continuously administered after resuscitation. The lung tissues, which were collected for assessing inflammation and apoptosis‑related damage, underwent analyses, including histological examination, neutrophil count, assessment of lung wet/dry weight ratio, detection of the mRNA levels of tumor necrosis factor‑α (TNF‑α) and inducible nitric oxide synthase (iNOS), identification of terminal deoxynucleotidyl transferase dUTP nick‑end labeling (TUNEL)‑positive cells, and evaluation of caspase‑3 expression. In addition, phosphorylated AMPKα (pAMPKα) expression was tested via western blotting. Compared with the HSR/saline group, the HSR/landiolol group demonstrated a reduction in lung tissue damage score, and significant reductions in neutrophil count, lung wet/dry weight ratio, lung TNF‑α and iNOS mRNA levels, TUNEL‑positive cells and cleaved caspase‑3 expression. Furthermore, landiolol administration following HSR treatment increased pAMPKα expression. No significant hypotension occurred between the HSR/landiolol and HSR/saline groups; and blood loss did not differ significantly between the groups. In conclusion, landiolol administration after HSR reduced lung inflammation and apoptosis, suggesting a potential improvement in tissue damage. Furthermore, pAMPKα activation in the HSR/landiolol group may be the mechanism underlying the pulmonary protective effects of landiolol. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0913-8668 39 2 2025 T2 high-signal-intensity zone of the spinal cord dorsal horn in patients treated with spinal cord stimulation for herpes zoster-associated pain: a retrospective case–control study 273 281 EN Kyosuke Arakawa Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masayuki Nakagawa Department of Pain Management Clinic, NTT Medical Center Tokyo Yoichiro Abe Department of Pain Management Clinic, NTT Medical Center Tokyo Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Purpose In patients with herpes zoster-associated pain (ZAP), magnetic resonance imaging (MRI) has revealed T2 high-signal intensity zones (MRI T2 HIZ) in the dorsal horn of the spinal cord, associated with postherpetic neuralgia (PHN). We retrospectively analyzed the relationship between PHN and MRI T2 HIZ in patients with refractory ZAP in the subacute phase who underwent temporary spinal cord stimulation therapy (tSCS).<br> Methods This single-center, case–control study included patients who underwent tSCS for refractory ZAP between 2010 and 2018. MRIs were re-assessed for the presence of T2 HIZ in the dorsal horn of the spinal cord. Patients were divided into T2 HIZ( +) and T2 HIZ(−) groups. Patients with a numerical rating score (NRS) ≥ 3 at the last visit were defined as PHN. The NRS values and the incidence rate of PHN were compared between the two groups.<br> Results Of the 67 cases extracted, 38 were included in the analysis: 22 in T2 HIZ( +) group and 16 in T2 HIZ(−) group. No significant differences were observed in background factors between the two groups. However, the T2 HIZ( +) group had a significantly higher NRS at the final visit (T2 HIZ( +):3.8 ± 2.1, T2 HIZ(−):1.4 ± 1.5; P < 0.05) and had significantly more patients with PHN than the T2 HIZ(−) group (T2 HIZ( +) vs. T2 HIZ(−), 15/22 (68%) vs. 3/16 (19%); odds ratio = 8.67; 95% confidence interval, 1.7–63.3).<br> Conclusion T2HIZ is detected in more than half of refractory ZAP, and pain is more likely to remain after tSCS treatment in the T2HIZ( +) group. No potential conflict of interest relevant to this article was reported.

BMJ Acta Medica Okayama 2044-6055 15 8 2025 Neurological outcomes with hypothermia versus normothermia in patients with moderate initial illness severity following resuscitation from out-of-hospital cardiac arrest: protocol for a multicentre randomised controlled trial (R-CAST OHCA) e101809 EN Hiromichi Naito Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Mitsuaki Nishikimi Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University Yohei Okada Department of Preventive Services, School of Public Health, Graduate School of Medicine, Kyoto University Hiroki Maeyama Department of Emergency and Critical Care Medicine, Tsuyama Chuo Hospital Takeyuki Kiguchi Division of Trauma and Surgical Critical Care, Osaka General Medical Center Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kazuki Nishida Department of Biostatistics, School of Public Health, Graduate School of Medicine, Kyoto University Shigeyuki Matsui Department of Biostatistics, School of Public Health, Graduate School of Medicine, Kyoto University Yasuhiro Kuroda Emergency and Critical Care Center, TMG Asaka Medical Center Kei Nishiyama Division of Emergency and Critical Care Medicine, Niigata University Graduate School of Medical and Dental Science Taku Iwami Department of Preventive Services, School of Public Health, Graduate School of Medicine, Kyoto University Atsunori Nakao Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences JAAM R-CAST OHCA Trial Group Introduction Temperature control is a fundamental intervention for neuroprotection following resuscitation from cardiac arrest. However, evidence regarding the efficacy of hypothermia in post-cardiac arrest syndrome (PCAS) remains unclear. Retrospective studies suggest that the clinical effectiveness of hypothermia may depend on the severity of PCAS. The R-CAST OHCA trial aims to compare the efficacy of hypothermia versus normothermia in improving 30-day neurological outcomes in patients with moderately severe PCAS following out-of-hospital cardiac arrest.<br> Methods and analysis The multicentre, single-blind, parallel-group, superiority, randomised controlled trial (RCT) is conducted with the participation of 35 emergency and critical care centres and/or intensive care units at academic and non-academic hospitals. The study enrols moderately severe PCAS patients, defined as those with a revised post-Cardiac Arrest Syndrome for induced Therapeutic Hypothermia score of 5.5–15.5. A target number of 380 participants will be enrolled. Participants are randomised to undergo either hypothermia or normothermia within 3 hours after return of spontaneous circulation. Patients in the hypothermia group are cooled and maintained at 34°C until 28 hours post-randomisation, followed by rewarming to 37°C at a rate of 0.25°C/hour. Patients in the normothermia group are maintained at normothermia (36.5°C–37.7°C). Total periods of intervention, including the cooling, maintenance and rewarming phases, will occur 40 hours after randomisation. Other treatments for PCAS can be determined by the treating physicians. The primary outcome is a favourable neurological outcome, defined as Cerebral Performance Category 1 or 2 at 30 days after randomisation and compared using an intention-to-treat analysis.<br> Ethics and dissemination This study has been approved by the Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Ethics Committee (approval number: R2201-001). Written informed consent is obtained from all participants or their authorised surrogates. Results will be disseminated via publications and presentations.<br> Trial registration number jRCT1062220035. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2045-2322 15 1 2025 The significance of adding posterior decompression to spine stabilization in metastatic spinal surgery: a multicenter prospective study 27684 EN Hiroyuki Tominaga Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University Ichiro Kawamura Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University Hirofumi Shimada Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University Hiromi Sasaki Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University Noboru Taniguchi Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University Yuki Shiratani Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University Akinobu Suzuki Department of Orthopaedic Surgery, Osaka Metropolitan University Hidetomi Terai Department of Orthopaedic Surgery, Osaka Metropolitan University Takaki Shimizu Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University Kenichiro Kakutani Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine Yutaro Kanda Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine Masayuki Ishihara Department of Orthopaedic Surgery, Kansai Medical University Hospital Masaaki Paku Department of Orthopaedic Surgery, Kansai Medical University Hospital Yohei Takahashi Department of Orthopaedic Surgery, Keio University Toru Funayama Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba Kousei Miura Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba Eiki Shirasawa Department of Orthopaedic Surgery, Kitasato University School of Medicine Hirokazu Inoue Rehabilitation Center, Jichi Medical University Hospital Atsushi Kimura Department of Orthopaedics, Jichi Medical University Takuya Iimura Department of Orthopaedic Surgery, Dokkyo Medical University Hiroshi Moridaira Department of Orthopaedic Surgery, Dokkyo Medical University Hideaki Nakajima Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui Shuji Watanabe Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui Koji Akeda Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Norihiko Takegami Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Kazuo Nakanishi Department of Orthopaedic Surgery, Kawasaki Medical School Hirokatsu Sawada Department of Orthopaedic Surgery, Nihon University School of Medicine Koji Matsumoto Department of Orthopaedic Surgery, Nihon University School of Medicine Masahiro Funaba Department of Orthopaedics Surgery, Yamaguchi University Graduate school of Medicine Hidenori Suzuki Department of Orthopaedics Surgery, Yamaguchi University Graduate school of Medicine Haruki Funao Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital Tsutomu Oshigiri Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine Takashi Hirai Department of Orthopedic Surgery, Institute of Science Tokyo Bungo Otsuki Department of Orthopaedic Surgery, Kyoto University Hospital Kazu Kobayakawa Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University Koji Uotani Department of Orthopaedic Surgery, Okayama University Hospital Hiroaki Manabe Department of Orthopedics, Tokushima University Shinji Tanishima Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University Ko Hashimoto Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine Chizuo Iwai Department of Orthopaedic Surgery, Gifu University Hospital Daisuke Yamabe Department of Orthopaedic Surgery, Iwate Medical University Akihiko Hiyama Department of Orthopaedic Surgery, Tokai University School of Medicine Shoji Seki Department of Orthopaedic Surgery, University of Toyama Yuta Goto Department of Orthopaedic Surgery, Nagoya City University Masashi Miyazaki Department of Orthopaedic Surgery, Faculty of Medicine, Oita University Kazuyuki Watanabe Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine Toshio Nakamae Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Takashi Kaito Department of Orthopedic Surgery, Osaka University Graduate School of Medicine Hiroaki Nakashima Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine Narihito Nagoshi Department of Orthopaedic Surgery, Keio University Satoshi Kato Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University Shiro Imagama Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine Kota Watanabe Department of Orthopaedic Surgery, Keio University Gen Inoue Department of Orthopaedic Surgery, Kitasato University School of Medicine Takeo Furuya Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University The usefulness of spine stabilization for treating metastatic spinal tumors with tumor-induced instability has been reported. However, no reports have prospectively evaluated the effectiveness of adding posterior decompression to stabilization surgery for improving symptoms. This multicenter prospective study aimed to determine whether adding posterior decompression to spine stabilization surgery for metastatic spinal tumors affects postoperative outcomes and complications. A total of 263 patients who underwent spine stabilization with (n = 189) or without (n = 74) decompression were analyzed. Patient demographics, the Spinal Instability Neoplastic Score (SINS), and the Epidural Spinal Cord Compression (ESCC) score were recorded. The outcomes were assessed preoperatively and at 1 and 6 months postoperatively in terms of neurological status, the Barthel Index, the EQ-5D-5 L, and the visual analog scale (VAS). Decompression was primarily performed in patients with severe neurological deficits and high-grade ESCC. Both groups showed postoperative improvement. Propensity score matching was applied to adjust for baseline differences. After matching, there were no significant differences in functional improvement between the decompression and nondecompression groups, and the complication rates were comparable. In matched patients presenting primarily with spinal instability and pain, the addition of decompression did not appear to confer a significant functional benefit within 6 months postoperatively. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 5 2025 Immunoglobulin G4-related Disease Mimicking Portal Vein Tumor Thrombus 381 385 EN Atsunobu Sakurai Department of Radiology, NHO Iwakuni Clinical Center Takayuki Yabuki Department of Radiology, NHO Iwakuni Clinical Center Hideki Aoki Department of Gastroenterological Surgery, NHO Iwakuni Clinical Center Akiko Iseki Department of Pathology, NHO Iwakuni Clinical Center Case Report 10.18926/AMO/69439 We report the case of a 72-year-old Japanese man with an incidental portal vein mass that was surgically resected and diagnosed as immunoglobulin G4 (IgG4)-related disease. The mass was discovered during an atrial fibrillation examination. The patient had a history of gastric cancer and was also diagnosed with rectal cancer, raising concerns about metastasis. Due to technical challenges, a biopsy was not feasible. Imaging findings suggested portal vein tumor thrombosis, complicating the diagnosis. This case highlights a rare presentation of IgG4-related disease mimicking portal vein tumor thrombus. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 5 2025 A Review of the Endoscopic Treatment for Bile Leak Following Cholecystectomy and Hepatic Surgery 321 328 EN Taisuke Obata Department of Gastroenterology and Hepatology, Okayama University Hospital Kazuyuki Matsumoto Department of Gastroenterology and Hepatology, Okayama University Hospital Motoyuki Otsuka Department of Gastroenterology and Hepatology, Okayama University Hospital Review 10.18926/AMO/69432 Bile leak occurs in 2-25% of liver transplant, 3-27% of hepatic resection, and 0.1-4% of cholecystectomy cases. The clinical course of bile leak varies depending on the type of surgery that caused the fistula, as well as the type, severity, and timing of bile duct injury. Although infections resulting from bile leak can be life-threatening, the introduction of endoscopic treatment has enabled some patients to avoid reoperation and has reduced the negative impact on quality of life associated with external fistulas for percutaneous drainage. Endoscopic interventions, such as sphincterotomy and stent placement, reduce the pressure gradient between the bile duct and duodenum, facilitating bile drainage through the papilla and promoting the closure of the leak. We reviewed the literature from 2004 to 2024 regarding bile leak following cholecystectomy and liver surgery, examining recommended techniques, timing, and treatment outcomes. In cases of bile leak following cholecystectomy, clinical success was achieved in 72-96% of cases, while success rates for bile leak following liver surgery ranged from 50% to 100%. Although endoscopic treatment is effective, it is not universally applicable, and its limitations must be carefully considered. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 2590-1974 27 2025 Development of a technique to identify μm-sized organic matter in asteroidal material: An approach using machine learning 100277 EN Rahul Kumar The Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama University Katsura Kobayashi The Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama University Christian Potiszil The Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama University Tak Kunihiro The Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama University Asteroidal materials contain organic matter (OM), which records a number of extraterrestrial environments and thus provides a record of Solar System processes. OM contain essential compounds for the origin of life. To understand the origin and evolution of OM, systematic identification and detailed observation using in-situ techniques is required. While both nm- and μm-sized OM were studied previously, only a small portion of a given sample surface was investigated in each study. Here, a novel workflow was developed and applied to identify and classify μm-sized OM on mm-sized asteroidal materials. The workflow involved image processing and machine learning, enabling a comprehensive and non-biased way of identifying, classifying, and measuring the properties of OM. We found that identifying OM is more accurate by classification with machine learning than by clustering. On the approach of classification with machine learning, five algorithms were tested. The random forest algorithm was selected as it scored the highest in 4 out of 5 accuracy parameters during evaluation. The workflow gave modal OM abundances that were consistent with those identified manually, demonstrating that the workflow can accurately identify 1-15 μm-sized OM. The size distribution of OM was modeled using the power-law distribution, giving slope α values that were consistent with fragmentation processes. The shape of the OM was quantified using circularity and solidity, giving a positive correlation and indicating these properties are closely related. Overall, the workflow enabled identification of many OM quickly and accurately and the obtainment of chemical and petrographic information. Such information can help the selection of OM for further in-situ techniques, and elucidate the origin and evolution of OM preserved in asteroidal materials. No potential conflict of interest relevant to this article was reported.

Japan Neurosurgical Society Acta Medica Okayama 0470-8105 65 9 2025 Real-world Experience of Embolization for Intracranial Tumors in Japan: Analysis of 2,756 Cases from Japanese Registry of NeuroEndovascular Therapy 4 396 406 EN Jun HARUMA Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenji SUGIU Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomohito HISHIKAWA Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuta SOUTOME Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki EBISUDANI Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryu KIMURA Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hisanori EDAKI Department of Neurosurgery, Kawasaki Medical School Masato KAWAKAMI Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi MURAI Department of Neurosurgery, Kawasaki Medical School Masafumi HIRAMATSU Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shota TANAKA Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tetsu SATOW Department of Neurosurgery, Kindai University Koji IIHARA Department of Neurosurgery, National Cerebral and Cardiovascular Center Hirotoshi IMAMURA Department of Neurosurgery, National Cerebral and Cardiovascular Center Akira ISHII Department of Neurosurgery, Juntendo University Graduate School of Medicine Yuji MATSUMARU Department of Neurosurgery, Institute of Medicine, University of Tsukuba Chiaki SAKAI Department of Neurosurgery, Kyoto University Shinichi YOSHIMURA Department of Neurosurgery, Hyogo Medical University Nobuyuki SAKAI Department of Neurological Surgery, Shimizu Hospital Japanese Registry of Neuroendovascular Therapy (JR-NET) Investigators Embolization of intracranial tumors is predominantly performed in Japan, primarily before neurosurgical resection. The Japanese Registry of NeuroEndovascular Therapy (JR-NET) Study Group, established in 2005, aims to clarify the factors influencing the outcomes of neuroendovascular treatment. Japanese Registry of NeuroEndovascular Therapy 4 is a nationwide, multicenter retrospective observational study that evaluates real-world data on intracranial tumor embolization in Japan. Japanese Registry of NeuroEndovascular Therapy 4 is based on data collected from 166 neurosurgical centers in Japan between January 2015 and December 2019. Of 63,230 patients, 2,664 (4.2%) with intracranial tumors underwent embolization. The primary endpoint was the proportion of patients with a modified Rankin scale (mRS) score of 0-2 at 30 days post-procedure. Secondary endpoints included procedure-related complications. Among the 2,664 patients, 61 records lacked sufficient data, leaving 2,603 patients (1,612 females, median age: 61 years [interquartile range 51-71]). The proportion of patients with mRS scores ≤2 at 30 days after the procedure was 86.9%. The overall incidence of procedure-related complications was 4.8%, with 1.8% hemorrhagic, 2.0% ischemic, and 1.0% classified as other complications. In the multivariate analysis, general anesthesia and embolization of vessels other than the external carotid artery were identified as risk factors for the development of complications. Meningioma cases had a complication rate of 4.3%, with major complications occurring in 3.5%. Hemangioblastoma cases had a 14.9% complication rate, with major complications at 9.9%. Japanese Registry of NeuroEndovascular Therapy 4 provides comprehensive real-world data on intracranial tumor embolization in Japan, identifying risk factors to inform and improve the safe practice of intracranial tumor embolization in neuroendovascular therapy. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2045-2322 15 1 2025 Prevalence of Streptococcus mutans harboring the cnm gene encoding cell surface protein Cnm in Japanese children 27047 EN Yuto Suehiro Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Makoto Okuda Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Masatoshi Otsugu Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Marin Ochiai Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Misato Takagi Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Fumikazu Tojo Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Yusuke Mikasa Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Shuhei Naka Department of Pediatric Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Michiyo Matsumoto-Nakano Department of Pediatric Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Jinthana Lapirattanakul Department of Oral Microbiology, Faculty of Dentistry, Mahidol University Rena Okawa Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Ryota Nomura Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University Kazuhiko Nakano Department of Pediatric Dentistry, Graduate School of Dentistry, The University of Osaka Dental caries is a highly prevalent infectious disease primarily caused by the pathogenic bacterium Streptococcus mutans, which has also been associated with systemic disease. A 120-kDa collagen-binding protein (Cnm) produced by S. mutans contributes to cardiovascular disease pathogenicity. Few studies have addressed the current prevalence of S. mutans and the cnm gene in Japanese children or examined caries pathology in relation to cnm presence. Here, we investigated the prevalence of S. mutans and the distribution of cnm-positive S. mutans among 490 children who visited two university hospitals in Japan. The caries experience index (dmft/DMFT) was calculated, and the collagen-binding ability of cnm-positive S. mutans strains was assessed. S. mutans was isolated from the oral cavities of 158 patients (36.8%); 10.1% (16/158) harbored cnm-positive S. mutans. When caries experience indices were compared across dentitions, patients harboring cnm-positive strains had significantly higher dmft/DMFT scores than those with cnm-negative strains (P < 0.05). Additionally, a positive correlation was observed between the collagen-binding capacity of cnm-positive S. mutans and the dmft/DMFT score (r = 0.601, P < 0.05). These findings suggest that cnm contributes to caries progression through collagen-mediated adherence to tooth surfaces. The presence of cnm-positive S. mutans may represent a risk factor for increased caries susceptibility in children. No potential conflict of interest relevant to this article was reported.

Korean Association for the Study of Intestinal Diseases Acta Medica Okayama 1598-9100 2025 Health-related quality of life, work productivity, and persisting challenges in treated ulcerative colitis patients: a Japanese National Health and Wellness Survey EN Sakiko Hiraoka Department of Gastroenterology, Okayama University Zhezhou Huang Cerner Enviza Fei Qin Cerner Enviza Fatima Megala Nathan Arokianathan Oracle Life Sciences Kiran Davé Bristol Myers Squibb Shweta Shah Bristol Myers Squibb Hyunchung Kim Bristol Myers Squibb Background/Aims Despite available treatments for ulcerative colitis (UC), unmet needs persist among patients in Japan. This study explored the health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), indirect cost, and unmet needs among treated UC patients in Japan.<br> Methods This cross-sectional, observational study utilized data from the online 2017, 2019, and 2021 Japan National Health and Wellness Survey. Respondents were aged ≥ 18 years and had undergone or were on UC treatment (5-aminosalicylic acid, steroids, immunomodulators/immunosuppressants, biologics/Janus kinase inhibitors [JAKi]). Demographic, general health, and clinical characteristics, medication adherence, HRQoL, WPAI, and indirect cost were collected and analyzed.<br> Results Among 293 treated UC patients, 83.6% were non-biologic/JAKi users, 29.0% had UC ≥ 15 years, 34.8% had moderate-to-severe disease severity, 55.3% experienced ≥ 1 persisting UC symptom, and 91.5% reported UC as bothersome to an extent. Patients reported EuroQoL visual analog scale score of 68.1 and ≥ 35% reported anxiety and depression. Mean work productivity loss was 29.3%, resulting in an annual mean indirect loss of 1.1 million JPY (45.3 thousand USD) per person. Higher WPAI (impairment) was associated with being male, moderate-to-severe disease severity, and low treatment adherence (P<0.05). Biologics/JAKi users had higher work impairment, and IM/IS users had higher activity impairment than 5-aminosalicylic acid users (P<0.05).<br> Conclusions Despite treatment, Japanese UC patients experienced high disease burden and persistent disease-related challenges. Overall HRQoL were lower than the mean healthy population and work productivity impairment led to high indirect costs. The findings suggest the importance of new interventions for optimizing UC outcomes. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 4 2025 Bloodstream Infections Caused by Gram-Negative Bacteria in Geriatric Patients: Epidemiology, Antimicrobial Resistance and The Factors Affecting Mortality 231 242 EN M Enes Kardan Department of Infectious Diseases, Faculty of Medicine, Namik Kemal University Ilknur Erdem Department of Infectious Diseases, Faculty of Medicine, Namik Kemal University Emre Yildiz Department of Infectious Diseases, Faculty of Medicine, Namik Kemal University Nuri Kiraz Department of Medical Microbiology, Faculty of Medicine, Namik Kemal University Aliye Çelikkol Department of Biochemistry, Faculty of Medicine, Namik Kemal University Original Article 10.18926/AMO/69148 Bloodstream infections (BSIs) are an important cause of morbidity and mortality in geriatric patients. We retrospectively analyzed the cases of geriatric patients who developed BSIs due to gram-negative bacteria in order to evaluate the epidemiology, antimicrobial resistance, and the factors affecting mortality. The cases of 110 patients aged ≥ 65 years admitted to our hospital between January 1, 2017, and December 31, 2022 were assessed; 70 (63.6%) of the BSIs were healthcare-associated BSIs. The urinary system was the most common detectable source of infection at 43.6%. The most frequently isolated bacteria were Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae, in that order. Carbapenem resistance was detected in 17 patients (15.5%), and extended-spectrum beta-lactamase (ESBL) production from Enterobacterales family members was detected in 37 (51.4%) patients. Multivariate analysis revealed that (i) the probability of mortality in the patients with total bilirubin was increased by approx. sixfold and (ii) the likelihood of mortality for those with a Pitt bacteremia score (PBS) ≥ 4 points was approx. 17 times higher. PBS and simplified qPitt scores can help predict mortality and manage geriatric patients. There is a significant increase in mortality among patients with procalcitonin (PCT) levels at ≥ 2 nm/ml. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2045-2322 15 1 2025 ADAR1 as a prognostic marker for patients with colorectal cancer and synchronous liver metastasis and a predictor of chemotherapy efficacy 26752 EN Kaori Nitta Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kunitoshi Shigeyasu Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yoshitaka Kondo Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hibiki Umeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiaki Takahashi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Moriwake Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuhiro Yoshida Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Sho Takeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuki Matsumi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hiroyuki Kishimoto Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masashi Kayano Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Shunsuke Nakamura Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hiroyuki Michiue Neutron Therapy Research Center, Okayama University Hideki Yamamoto Department of Clinical Genomic Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Nobuhiko Kanaya Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuhei Kondo Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Eiki Miyake Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yusuke Yoshida Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Ryohei Shoji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yoshihiko Kakiuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hiroshi Tazawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences RNA editing by adenosine deaminase acting on RNA (ADAR) enzymes plays a role in cancer progression. However, its clinical significance in metastatic colorectal cancer (CRC) remains unclear. This study aimed to evaluate whether ADAR1 expression predicts prognosis and treatment response in colorectal cancer (CRC) with synchronous liver metastasis. This study included 40 patients with stage IV CRC and synchronous liver metastases. ADAR1 expression in tumor tissues was evaluated using immunohistochemistry. Expression levels were quantified using the immunoreactive score, and associations with clinicopathological features, overall survival (OS), and chemotherapy response were examined. High ADAR1 expression was significantly associated with multiple liver metastases (P = 0.0206), lymph node metastasis (P = 0.0241), and reduced response to chemotherapy (P = 0.0224). Significantly shorter OS was observed in patients with high ADAR1 expression in the nucleus (P = 0.0458). ADAR1 expression was an independent prognostic factor comparable to the presence of extrahepatic metastases. Low ADAR1 expression was correlated with a higher likelihood of achieving a response to chemotherapy. ADAR1 expression can reflect tumor aggressiveness and chemotherapy resistance in patients with CRC and synchronous liver metastasis. ADAR1 has considerable potential as a dual-purpose biomarker for stratifying patients based on prognosis and optimizing treatment intensity. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2045-2322 15 1 2025 Survival days of patients with metastatic spinal tumors of lung cancer requiring surgery: a prospective multicenter study 24117 EN Takuya Takahashi Department of Orthopedic Surgery, Institute of Science Tokyo Takashi Hirai Department of Orthopedic Surgery, Institute of Science Tokyo Yuki Shiratani Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University Akinobu Suzuki Department of Orthopaedic Surgery, Osaka Metropolitan University Kenichiro Kakutani Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine Satoshi Kato Department of Orthopaedic Surgery Graduate School of Medical Sciences, Kanazawa University Hiroyuki Tominaga Department of Orthopedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University Hirokazu Inoue Rehabilitation Center, Jichi Medical University Hospital Hirokatsu Sawada Department of Orthopaedic Surgery, Nihon University School of Medicine Norihiko Takegami Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Kazuo Nakanishi Department of Orthopaedic Surgery, Kawasaki Medical School Hideaki Nakajima Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui Masayuki Ishihara Department of Orthopaedic surgery, Kansai Medical University Hospital Tsutomu Oshigiri Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine Toru Funayama Department of Orthopaedic Surgery Institute of Medicine, University of Tsukuba Takuya Iimura Department of Orthopaedic Surgery, Dokkyo Medical University Shinji Tanishima Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University Hiroaki Nakashima Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine Daisuke Yamabe Department of Orthopaedic Surgery, Iwate Medical University Ko Hashimoto Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine Koji Uotani Department of Orthopaedic Surgery, Okayama University Hospital Masahiro Funaba Department of Orthopaedics Surgery, Yamaguchi University Graduate school of Medicine Narihito Nagoshi Department of Orthopaedic Surgery, Keio University Kazu Kobayakawa Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University Toshitaka Yoshii Department of Orthopedic Surgery, Institute of Science Tokyo Kazuyuki Watanabe Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine Toshio Nakamae Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Takashi Kaito Department of Orthopedic Surgery, Osaka University Graduate School of Medicine Gen Inoue Department of Orthopaedic Surgery, Kitasato University School of Medicine Shiro Imagama Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine Kota Watanabe Department of Orthopaedic Surgery, Keio University Takeo Furuya Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University Surgery for metastatic spinal tumors has improved postoperative activities of daily living. A few studies reported on prognostic factors assessed in large multicenter prospective studies for metastatic spinal tumors of lung cancer origin. This study aimed to determine preoperative prognostic factors in patients undergoing surgery for metastatic spinal tumors associated with lung cancer. This prospective registry study included 74 patients diagnosed and operated with metastatic spine tumors derived from lung cancer in 39 high-volume cancer centers. We examined the postoperative survival period and the preoperative factors related to postoperative survival time. We conducted univariate and multivariate Cox regression analyses to determine preoperative prognostic factors. The mean postoperative survival period was 343 days. Multivariate Cox regression analysis revealed a higher feeding score of vitality index, indications for molecularly targeted therapy, and a higher mobility score of Barthel index as independent factors associated with postoperative survival time in metastatic spinal tumors derived from lung cancer. Patients with indications for molecular-targeted therapy and good vitality exhibited longer survival. These results may help in surgical selection for patients with metastatic spinal tumors derived from lung cancer. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 1648-9144 60 4 2024 A Novel Technique for Basilar Invagination Treatment in a Patient with Klippel–Feil Syndrome: A Clinical Example and Brief Literature Review 616 EN Masato Tanaka Department of Orthopaedic Surgery, Okayama Rosai Hospital Abd El Kader Al Askar Department of Orthopaedic Surgery, Okayama Rosai Hospital Chetan Kumawat Department of Orthopaedic Surgery, Okayama Rosai Hospital Shinya Arataki Department of Orthopaedic Surgery, Okayama Rosai Hospital Tadashi Komatsubara Department of Orthopaedic Surgery, Okayama Rosai Hospital Takuya Taoka Department of Orthopaedic Surgery, Okayama Rosai Hospital Koji Uotani Department of Orthopaedic Surgery, Okayama University Hospital Yoshiaki Oda Department of Orthopaedic Surgery, Okayama University Hospital Objectives and Background: To present a novel technique of treatment for a patient with basilar invagination. Basilar invagination (BI) is a congenital condition that can compress the cervicomedullary junction, leading to neurological deficits. Severe cases require surgical intervention, but there is debate over the choice of approach. The anterior approach allows direct decompression but carries high complication rates, while the posterior approach provides indirect decompression and offers good stability with fewer complications. Materials and Methods: A 15-year-old boy with severe myelopathy presented to our hospital with neck pain, bilateral upper limb muscle weakness, and hand numbness persisting for 4 years. Additionally, he experienced increased numbness and gait disturbance three months before his visit. On examination, he exhibited hyperreflexia in both upper and lower limbs, muscle weakness in the bilateral upper limbs (MMT 4), bilateral hypoesthesia below the elbow and in both legs, mild urinary and bowel incontinence, and a spastic gait. Radiographs revealed severe basilar invagination (BI). Preoperative images showed severe BI and that the spinal cord was severely compressed with odontoid process. Results: The patient underwent posterior surgery with the C-arm free technique. All screws including occipital screws were inserted into the adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year showed the following results: Manual muscle testing results and sensory function tests showed almost full recovery, with bilateral arm recovery (MMT 5) and smooth walking. The cervical Japanese Orthopedic Association score of the patient improved from 9/17 to 16/17. Postoperative images showed excellent spinal cord decompression, and no major or severe complications had occurred. Conclusions: Basilar invagination alongside Klippel–Feil syndrome represents a relatively uncommon condition. Utilizing a posterior approach for treating reducible BI with a C-arm-free technique proved to be a safe method in addressing severe myelopathy. This novel navigation technique yields excellent outcomes for patients with BI. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 1328-8067 67 1 2025 Avoidant/restrictive food intake disorder prognosis and its relation with autism spectrum disorder in Japanese children e70040 EN Chie Tanaka Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ayumi Okada Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mana Hanzawa Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Chikako Fujii Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshie Shigeyasu Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akiko Sugihara Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Makiko Horiuchi Clinical Psychology Section, Department of Medical Support, Okayama University Hospital Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hirokazu Tsukahara Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background: There is a lack of reported clinical factors associated with the outcomes of children and adolescents with avoidant/restrictive food intake disorder (ARFID) in Japan. This study aimed to identify these clinical factors and explore the relationship between ARFID and autism spectrum disorder (ASD).<br> Methods: This retrospective study analyzed data from 48 Japanese children and adolescents with ARFID who visited Okayama University Hospital between January 2011 and March 2022. Clinical characteristics were assessed using medical records and natural history questionnaires. The study compared patients with good and poor prognosis groups and used multiple logistic regression analysis to determine factors influencing prognosis.<br> Results: The study included 33 patients with good prognoses and 15 with poor prognoses. Comorbid ASD was more prevalent in the poor prognosis group (60%) compared to the good prognosis group (21%). Additionally, more than half of the ARFID patients with comorbid ASD were initially undiagnosed. Multivariate analysis revealed that older age at first visit (p = 0.022) and comorbid ASD (p = 0.022) were statistically significant factors associated with poor prognosis in ARFID patients. There were no significant differences in body mass index standard deviation score and maximal weight loss between the two groups.<br> Conclusions: The poor prognosis group had a higher prevalence of comorbid ASD diagnoses. Therefore, it is crucial to evaluate patient's developmental characteristics early in treatment and consider these characteristics throughout the course of care. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 2049-4173 2025 Novel Therapeutic Algorism in Patients With Anterior Cutaneous Nerve Entrapment Syndrome EN Yoshitaka Kondo Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuhiko Kanaya Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ami Kobayashi Department of Neurology, Brigham and Women's Hospital, Harvard Medical School Kyosuke Arakawa Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine Yoshikazu Matsuoka Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine Yudai Mimata Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiko Kakiuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kunitoshi Shigeyasu Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background: Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked as a cause of chronic abdominal pain. Trigger point injections (TPIs) serve as both a diagnostic and therapeutic tool. Although neurectomy is frequently chosen for patients with severe ACNES, its surgical outcomes remain unclear.<br> Aim: This study aims to evaluate both the short- and long-term outcomes for neurectomy and propose a novel therapeutic algorithm.<br> Methods: A cohort of postoperative patients presenting with ACNES between 2016 and 2023 was retrospectively evaluated. Patients received a single diagnostic TPI. When the pain subsided, an anterior neurectomy was performed using either an anterior or laparoscopic approach. Pain scores were assessed using the numeric rating scale (NRS).<br> Results: Among 37 patients (60% females, mean age 33.8 ± 3.4 years), 29 patients (78.4%) experienced pain recurrence following initial neurectomy. Of these, 22 patients underwent repeat neurectomies, resulting in complete remission in 15 patients and no benefit in 7 patients. Long-term outcomes showed that 62.2% achieved clinical remission (NRS = 0), whereas 8.1% reported reduced but persistent pain (NRS 1–2). Preoperative TPI effectiveness was a strong predictor of surgical success, with patients achieving post-TPI NRS (0–1) significantly more likely to attain remission (p = 0.0074). Older age was also associated with higher remission rates (p = 0.0476).<br> Conclusion: TPI is critical for predicting neurectomy success. These findings support the integration of preoperative TPI evaluation and tailored surgical strategies to optimize outcomes for patients with ACNES. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2075-4418 15 6 2025 Robustness of Machine Learning Predictions for Determining Whether Deep Inspiration Breath-Hold Is Required in Breast Cancer Radiation Therapy 668 EN Wlla E. Al-Hammad Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Masahiro Kuroda Radiological Technology, Graduate School of Health Sciences, Okayama University Jamal, Ghaida Al Jamal Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology Mamiko Fujikura Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ryo Kamizaki Radiological Technology, Graduate School of Health Sciences, Okayama University Kazuhiro Kuroda Radiological Technology, Graduate School of Health Sciences, Okayama University Suzuka Yoshida Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihide Nakamura Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Masataka Oita Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University Yoshinori Tanabe Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Sugimoto Radiological Technology, Graduate School of Health Sciences, Okayama University Irfan Sugianto Department of Oral Radiology, Faculty of Dentistry, Hasanuddin University Majd Barham Department of Dentistry and Dental Surgery, College of Medicine and Health Sciences, An-Najah National University Nouha Tekiki Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Miki Hisatomi Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Junichi Asaumi Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Background/Objectives: Deep inspiration breath-hold (DIBH) is a commonly used technique to reduce the mean heart dose (MHD), which is critical for minimizing late cardiac side effects in breast cancer patients undergoing radiation therapy (RT). Although previous studies have explored the potential of machine learning (ML) to predict which patients might benefit from DIBH, none have rigorously assessed ML model performance across various MHD thresholds and parameter settings. This study aims to evaluate the robustness of ML models in predicting the need for DIBH across different clinical scenarios. Methods: Using data from 207 breast cancer patients treated with RT, we developed and tested ML models at three MHD cut-off values (240, 270, and 300 cGy), considering variations in the number of independent variables (three vs. six) and folds in the cross-validation (three, four, and five). Robustness was defined as achieving high F2 scores and low instability in predictive performance. Results: Our findings indicate that the decision tree (DT) model demonstrated consistently high robustness at 240 and 270 cGy, while the random forest model performed optimally at 300 cGy. At 240 cGy, a threshold critical to minimize late cardiac risks, the DT model exhibited stable predictive power, reducing the risk of overestimating DIBH necessity. Conclusions: These results suggest that the DT model, particularly at lower MHD thresholds, may be the most reliable for clinical applications. By providing a tool for targeted DIBH implementation, this model has the potential to enhance patient-specific treatment planning and improve clinical outcomes in RT. No potential conflict of interest relevant to this article was reported.

岡山大学教師教育開発センター Acta Medica Okayama 2186-1323 15 2025 養護教諭のコーディネーション行動に及ぼすキャリア年数の影響 59 73 EN Kaoru SUZUKI Research student, United Graduate School of Education, Hyogo University of Teacher Education Yukari MIMURA Graduate School of Education, Okayama University 10.18926/CTED/68482 　本研究の目的は，養護教諭のコーディネーション行動に影響する要因やその因子の傾向をキャリア年数から捉え，これらとコーディネーション行動の生起プロセスとの関係について明らかにすることであった。分析対象は，公立小学校・中学校勤務695名とした。キャリア年数の影響は，コーディネーション行動と動機づけの段階に関わる要因の尺度得点や，因子の下位尺度得点の向上に見られた。また，キャリア年数とコーディネーション行動の生起プロセスに関わる因子間の関係からは，（1）キャリア年数に影響されない高い下位尺度得点を示す因子間相関による，協働を起点にした組織支援の基盤づくり，（2）キャリア年数により下位尺度得点が高まる動機づけ要因の因子間相関による，個別支援の取組推進へのつながり，（3）11年以上キャリア区分で見られるリーダー認知と個別支援の因子間相関，及び組織的支援のマネジメントへの広がり，の３つの特徴をもつことが示唆された。 No potential conflict of interest relevant to this article was reported.

岡山大学教師教育開発センター Acta Medica Okayama 2186-1323 15 2025 全学教職課程履修学生の教職課程イメージに関する研究 17 31 EN Tomotaka MISHIMA Center for Teacher Education and Development, Okayama University 10.18926/CTED/68479 　本研究の目的は，全学教職課程履修学生の教職課程イメージを検討することであった。研究１ではメタファー法を用いて全学教職課程履修学生を対象に教職課程イメージを調査し，19のカテゴリーが得られた。最も記述が多いカテゴリーは「教師になるための学びの場」であり，次いで「人としての成長の場」であった。また，1年生と4年生でいくつかのカテゴリーで有意差が見られた。研究２では，研究１を基に教職課程イメージを測定する尺度作成を試みると共に，1年生と4年生での比較を行った。調査の結果，教職課程イメージは「能動的な学びの場」「大変さ」など全11因子からなること，「被教育体験の振り返りの機会」「お得感」「長期的な学びの場」において1年生と4年生で有意差があること，が示唆された。本研究から全学教職課程履修学生の教職課程イメージの一端が明らかにされると共に，1年生と4年生で有しているイメージが部分的に異なる可能性が示唆された。 No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 1 2025 Could the Trabecular Bone Score Be a Complementary Tool for Evaluating Degenerative Lumbar Vertebrae? 39 45 EN Shinichiro Takao Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koji Uotani Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruo Misawa Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoko Tetsunaga Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kensuke Shinohara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kentaro Yamane Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiaki Oda Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hironori Tsuji Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuya Kajiki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/68360 Evaluating vertebral bone mass and quality in the elderly poses challenges due to degenerative changes. This study aims to elucidate the usefulness of the trabecular bone score (TBS) by examining the relationship between bone mineral density (BMD), TBS, and Hounsfield unit (HU) values. A retrospective analysis of 599 vertebrae from 152 patients (mean age 69.0 years; range 44-89; 74 males and 78 females) undergoing dual-energy X-ray absorptiometry (DXA) and CT scans was conducted. Vertebrae were categorized into three grades based on the degree of degeneration. The TBS was calculated from DXA images, and the HU value was measured by placing a region of interest on an axial image of the vertebral mid-body. One-way analysis of variance and Pearson’s correlation tests were employed to investigate the relationship between BMD and TBS or HU values. While lumbar BMD significantly increased (p<0.01) with degenerative changes, TBS and HU values showed no significant differences. The correlations between lumbar BMD and TBS values, and between BMD and HU values, were stronger without degenerative changes than with degenerative changes. Significantly different HU values were observed between the right and left sides of severely degenerated vertebrae. Severe degenerative changes, particularly those associated with sclerosis, may impact HU values. TBS exhibits greater potential than HU values as a complementary tool. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 1 2025 Prediction of Prostate Cancer Grades Using Radiomic Features 21 30 EN Yasuhiro Yamamoto Department of Radiology, Houshasen Daiichi Hospital Takafumi Haraguchi Department of Advanced Biomedical Imaging and Informatics, St. Marianna University School of Medicine Kaori Matsuda Department of Radiology, Houshasen Daiichi Hospital Yoshio Okazaki Department of Radiology, Houshasen Daiichi Hospital Shin Kimoto Department of Radiology, Houshasen Daiichi Hospital Nozomu Tanji Department of Urology, Houshasen Daiichi Hospital Atsushi Matsumoto Department of Urology, Houshasen Daiichi Hospital Yasuyuki Kobayashi Department of Medical Information and Communication Technology Research, St. Marianna University School of Medicine Hidefumi Mimura Department of Radiology, St. Marianna University School of Medicine Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/68355 We developed a machine learning model for predicting prostate cancer (PCa) grades using radiomic features of magnetic resonance imaging. 112 patients diagnosed with PCa based on prostate biopsy between January 2014 and December 2021 were evaluated. Logistic regression was used to construct two prediction models, one using radiomic features and prostate-specific antigen (PSA) values (Radiomics model) and the other Prostate Imaging-Reporting and Data System (PI-RADS) scores and PSA values (PI-RADS model), to differentiate high-grade (Gleason score [GS] ≥ 8) from intermediate or low-grade (GS < 8) PCa. Five imaging features were selected for the Radiomics model using the Gini coefficient. Model performance was evaluated using AUC, sensitivity, and specificity. The models were compared by leave-one-out cross-validation with Ridge regularization. Furthermore, the Radiomics model was evaluated using the holdout method and represented by a nomogram. The AUC of the Radiomics and PI-RADS models differed significantly (0.799, 95% CI: 0.712-0.869; and 0.710, 95% CI: 0.617-0.792, respectively). Using holdout method, the Radiomics model yielded AUC of 0.778 (95% CI: 0.552-0.925), sensitivity of 0.769, and specificity of 0.778. It outperformed the PI-RADS model and could be useful in predicting PCa grades, potentially aiding in determining appropriate treatment approaches in PCa patients. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 2079-9292 14 2 2025 A Proposal of In Situ Authoring Tool with Visual-Inertial Sensor Fusion for Outdoor Location-Based Augmented Reality 342 EN Komang Candra Brata Department of Information and Communication Systems, Okayama University Nobuo Funabiki Department of Information and Communication Systems, Okayama University Yohanes Yohanie Fridelin Panduman Department of Information and Communication Systems, Okayama University Mustika Mentari Department of Information and Communication Systems, Okayama University Yan Watequlis Syaifudin Department of Information Technology, Politeknik Negeri Malang Alfiandi Aulia Rahmadani Department of Information Technology, Politeknik Negeri Malang In location-based augmented reality (LAR) applications, a simple and effective authoring tool is essential to create immersive AR experiences in real-world contexts. Unfortunately, most of the current tools are primarily desktop-based, requiring manual location acquisitions, the use of software development kits (SDKs), and high programming skills, which poses significant challenges for novice developers and a lack of precise LAR content alignment. In this paper, we propose an intuitive in situ authoring tool with visual-inertial sensor fusions to simplify the LAR content creation and storing process directly using a smartphone at the point of interest (POI) location. The tool localizes the user’s position using smartphone sensors and maps it with the captured smartphone movement and the surrounding environment data in real-time. Thus, the AR developer can place a virtual object on-site intuitively without complex programming. By leveraging the combined capabilities of Visual Simultaneous Localization and Mapping(VSLAM) and Google Street View (GSV), it enhances localization and mapping accuracy during AR object creation. For evaluations, we conducted extensive user testing with 15 participants, assessing the task success rate and completion time of the tool in practical pedestrian navigation scenarios. The Handheld Augmented Reality Usability Scale (HARUS) was used to evaluate overall user satisfaction. The results showed that all the participants successfully completed the tasks, taking 16.76 s on average to create one AR object in a 50 m radius area, while common desktop-based methods in the literature need 1–8 min on average, depending on the user’s expertise. Usability scores reached 89.44 for manipulability and 85.14 for comprehensibility, demonstrating the high effectiveness in simplifying the outdoor LAR content creation process. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 6 2024 Partial versus Radical Nephrectomy for Small Renal Cancer: Comparative Propensity Score-Matching Analysis of Cardiovascular Event Risk 429 437 EN Risa Kubota Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kensuke Bekku Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi Katayama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takehiro Iwata Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shingo Nishimura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kohei Edamura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoko Kobayashi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuyuki Kobayashi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Motoo Araki Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/67868 Although partial nephrectomy (PN) is preferred over radical nephrectomy (RN) for preserving renal function in patients with cT1 renal cancer, its impact on cardiovascular events (CVe) remains controversial. This study aimed to compare PN and RN in regard to the occurrence of CVe, including cerebrovascular events and exacerbation of hypertension (HT). We retrospectively analyzed 418 consecutive patients who underwent PN or RN for cT1 renal cancer. Propensity score-matching analysis was used to adjust for imbalances between patients who underwent PN and RN, leaving 102 patients in each group. The 5-year probability of cumulative CVe incidence was 6% in the PN group and 12% in the RN group (p=0.03), with a median follow-up of 73.5 months. The statistical significance was retained after propensity score matching for patients without preoperative proteinuria (p=0.03). For all CVe including cerebrovascular events and exacerbation of HT analyzed, PN provided a lower probability of occurrence than RN in patients with small renal cancers. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2078-2489 15 10 2024 A Study of Exergame System Using Hand Gestures for Wrist Flexibility Improvement for Tenosynovitis Prevention 622 EN Yanqi Xiao Department of Information and Communication Systems, Okayama University Nobuo Funabiki Department of Information and Communication Systems, Okayama University Irin Tri Anggraini Department of Information and Communication Systems, Okayama University Cheng-Liang Shih Department of Information and Communication Systems, Okayama University Chih-Peng Fan Department of Information and Communication Systems, Okayama University Currently, as an increasing number of people have been addicted to using cellular phones, smartphone tenosynovitis has become common from long-term use of fingers for their operations. Hand exercise while playing video games, which is called exergame, can be a good solution to provide enjoyable daily exercise opportunities for its prevention, particularly, for young people. In this paper, we implemented a simple exergame system with a hand gesture recognition program made in Python using the Mediapipe library. We designed three sets of hand gestures to control the key operations to play the games as different exercises useful for tenosynovitis prevention. For evaluations, we prepared five video games running on a web browser and asked 10 students from Okayama and Hiroshima Universities, Japan, to play them and answer 10 questions in the questionnaire. Their playing results and System Usability Scale (SUS) scores confirmed the usability of the proposal, although we improved one gesture set to reduce its complexity. Moreover, by measuring the angles for maximum wrist movements, we found that the wrist flexibility was improved by playing the games, which verifies the effectiveness of the proposal. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1471-2393 24 1 2024 Evaluating the impact of a trial of labor after cesarean section on labor duration: a retrospective cohort study 542 EN Hikaru Ooba Department of Obstetrics and Gynecology, Okayama University Hospital Jota Maki Department of Obstetrics and Gynecology, Okayama University Hospital Hisashi Masuyama Department of Obstetrics and Gynecology, Okayama University Hospital Background Cesarean section (C-section) rates are increasing globally, and repeated C-sections are associated with increased maternal morbidity. Trial of labor after C-section (TOLAC) is an approach to reduce the recurrence of C-sections. However, limited research exists on the impact of cesarean scars on labor duration in TOLAC, considering the termination of labor through C-section and selection bias. This study aimed to investigate the impact of cesarean scars on labor duration in TOLAC participants, accounting for potential confounding factors and biases. <br> Methods This retrospective cohort study included 2,964 women who attempted vaginal birth at a single center in Japan from 2012 to 2021. The study categorized participants into TOLAC (n = 187) and non-TOLAC (n = 2,777) groups. Propensity scores were calculated based on 14 factors that could influence labor duration, and inverse probability of treatment weighting (IPTW) was applied. Cox proportional hazards regression analysis estimated hazard ratios (HRs) for labor duration, with and without IPTW adjustment. Sensitivity analyses used propensity score matching, bootstrapping, and interval censoring to address potential biases, including recall bias in the reported onset of labor.<br> Results The unadjusted HR for labor duration in the TOLAC group compared to the non-TOLAC group was 0.83 (95% CI: 0.70-0.98, P = 0.027), indicating a longer labor duration in the TOLAC group. After adjusting for confounding factors using IPTW, the HR was 0.98 (95% CI: 0.74-1.30, P = 0.91), suggesting no significant difference in labor duration between the groups. Sensitivity analyses using propensity score matching, bootstrapping, and interval censoring yielded consistent results. These findings suggested that the apparent association between TOLAC and longer labor duration was because of confounding factors rather than TOLAC itself.<br> Conclusions After adjusting for confounding factors and addressing potential biases, cesarean scars had a limited impact on labor duration in TOLAC participants. Maternal and fetal characteristics may have a more substantial influence on labor duration. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 4 2024 Effect of Recipient Age on Perioperative Complications after Pediatric Liver Transplantation: A Single-Center Retrospective Study 323 330 EN Akira Katayama Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi Kimura Department of Anesthesia, Kyoto University Hospital Takashi Matsusaki Department of Anesthesiology, Mie University Hospital Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/67548 It has not been clear how recipient age affects the incidence of serious complications after pediatric living donor liver transplantation (LDLT). We investigated the records of 42 pediatric patients receiving LDLT, dividing our sample into two groups: the infant group (aged < 1 year) and the non-infant group (aged ≥ 1 year and ≤15 years). The primary outcome was postoperative complications assessed using the Clavien-Dindo classification. Multivariate analysis using the Cox regression model was applied to adjust for confounding factors in assessing the incidence of Clavien-Dindo grade ≥ III (C-D ≥ III) complications. The incidence of C-D ≥ III complications was higher in the non-infant group (46.2%) than in the infant group (12.5%) (odds ratio 6.00, 95% confidence interval [CI] 1.13-31.88, p=0.03). In multivariate analysis using the Cox regression model, the Graft-to-Recipient Weight Ratio (GRWR) was independently associated with the incidence of C-D ≥ III complications (hazard ratio [HR] 0.62, 95%CI 0.40-0.95, p=0.03), but being an infant was not (HR 0.84, 95%CI 0.35-1.98, p=0.68). In conclusion, the incidence of C-D ≥ III complications was higher in the non-infant group than in the infant group, but this was largely a function of GRWR: multivariate analysis revealed that GRWR was independently associated with complications. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2077-0383 13 15 2024 Evolution and Effects of Ad Hoc Multidisciplinary Team Meetings in the Emergency Intensive Care Unit: A Five-Year Analysis 4324 EN Tetsuya Yumoto Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Takashi Hongo Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Takafumi Obara Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Kohei Ageta Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Toshiyuki Aokage Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Kohei Tsukahara Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Atsunori Nakao Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Hiromichi Naito Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Background: Multidisciplinary team meetings (MDTMs) are crucial in the ICU. However, daily rounds may not address all sensitive issues due to time constraints and the complexity of cases. This study aimed to describe detailed information and characteristics of ad hoc MDTMs in the ICU. Methods: This single-center, retrospective study analyzed adult emergency ICU admissions at Okayama University Hospital from 1 January 2019 to 31 December 2023. During this period, weekly regular multidisciplinary team ICU rounds were introduced in June 2020, and regular weekday morning MDTMs began in April 2022. A multiple logistic regression analysis was applied to determine the impact of these changes on the frequency of ad hoc MDTMs, adjusting for variables including annual changes. Results: The study analyzed 2487 adult EICU patients, with a median age of 66, and 63.3% of them male. MDTMs were held for 168 patients (6.8%), typically those with severe conditions, including higher COVID-19 prevalence and APACHE II scores, and longer ICU stays. Despite a constant total number of MDTMs, the likelihood of conducting ad hoc MDTMs increased annually (adjusted OR 1.19; 95% CI, 1.04-1.35). Of the 329 MDTMs conducted for these patients, 59.0% addressed end-of-life care, involving an average of 11 participants, mainly nurses and emergency and critical-care physicians. Conclusions: Changes in ICU round and meeting structures might be associated with a higher frequency of conducting ad hoc MDTMs, highlighting their evolving role and importance in patient care management. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 3 2024 The Role of the Lipid Profile and Oxidative Stress in Fatigue, Sleep Disorders and Cognitive Impairment in Patients with Multiple Sclerosis 259 270 EN Gonul Vural Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University Esra Demir Department of Neurology, Ankara City Hospital Sadiye Gumusyayla Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University Funda Eren Department of Clinical Biochemistry, Ankara City Hospital Serdar Barakli Department of Neurology, Ankara City Hospital Salim Neselioglu Department of Clinical Biochemistry, Ankara City Hospital Ozcan Erel Department of Clinical Biochemistry, Ankara City Hospital Original Article 10.18926/AMO/67201 The aim of this study is to investigate the relationship of the lipid profile, dysfunctional high-density lipoprotein, ischaemia-modified albumin and thiol–disulfide homeostasis with cognitive impairment, fatigue and sleep disorders in patients with multiple sclerosis. The cognitive functions of patients were evaluated with the Brief International Cognitive Assessment for Multiple Sclerosis battery. Fatigue was evaluated with the Fatigue Severity Scale and the Fatigue Impact Scale. The Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale were used to assess patients’ sleep disturbance. Peripheral blood samples were collected, and lipid levels and myeloperoxidase and paraoxonase activity were measured. The myeloperoxidase/paraoxonase ratio, which indicates dysfunctional high-density lipoprotein, was calculated. Thiol–disulfide homeostasis and ischaemia-modified albumin were measured.<br> We did not identify any relationship between dysfunctional high-density lipoprotein and the physical disability, cognitive decline, fatigue and sleep problems of multiple sclerosis. Thiol–disulfide homeostasis was associated with cognitive scores. The shift of the balance towards disulfide was accompanied by a decrease in cognitive scores. On the other hand, we did not detect any relationship between fatigue and sleep disorders and thiol–disulfide homeostasis. Our findings revealed a possible correlation between cognitive dysfunction and thiol–disulfide homeostasis in multiple sclerosis patients. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 2 2024 The Impact of Light Touch and Pin Prick on Functional Outcomes in Patients with Traumatic Spinal Cord Injury 163 170 EN Takayuki Deguchi Department of Rehabilitation, Kagawa Rosai Hospital Kanae Kanda Department of Public Health, Faculty of Medicine, Kagawa University Kazunari Furusawa Department of Rehabilitation Medicine, Kibikogen Rehabilitation Center for Employment Injuries Nlandu Roger Ngatu Department of Public Health, Faculty of Medicine, Kagawa University Tomohiro Hirao Department of Public Health, Faculty of Medicine, Kagawa University Original Article 10.18926/AMO/66925 A spinal cord injury (SCI) can cause severe lifelong functional disability and profoundly affect an individual’s daily life. We investigated the prediction of patients’ post-SCI functional outcomes by evaluating sensory scores rather than motor scores, as the latter’s association with functional outcomes is well established. We examined patients’ responses to a light touch (LT) and pin prick (PP) at admission and the response data’s usefulness as predictors of functional outcomes (i.e., ability to perform activities of daily living) at discharge. This exploratory observational study used data from the Japanese National Spinal Cord Injury Database (SCI-J). Data from 3,676 patients who met the inclusion criteria and were admitted for an SCI between 1997 and 2020 were analyzed. The motor score of the Functional Independence Measure (mFIM) at discharge was used as an index of functional outcome. A multiple regression analysis revealed that the mFIM was associated with both the LT response (β=0.07 (0.01), p<0.001) and the PP response (β=0.07 (0.01), p<0.001) at admission. The false discovery rate log-worth values for LT and PP were 6.6 and 8.5, respectively. Our findings demonstrate that LT and PP scores at admission can help predict patients’ functional outcomes after an SCI, although the magnitude of their contributions is not high. No potential conflict of interest relevant to this article was reported.

岡山大学教師教育開発センター Acta Medica Okayama 2186-1323 14 2024 児童を対象とした強み介入の予備的検討 ―強みへの気付きを促す学級活動の授業を通して― 1 15 EN Tsuguyuki IZUMI Faculty of Education, Okayama University Akane TODA Shintoku Elementary School Hisashi OKURA Hayashima Kindergarten 10.18926/CTED/66768 　本研究の目的は，児童を対象とした強み介入の予備的検討のために実践した強みへの気付きを促す授業の効果について検討することである。対象者は小学６年生95名(男子50名，女子40名，不明５名)であった。本研究によって以下の３点が明らかになった。まず，生活充実感と被信頼感・受容感の事後の得点が有意に向上した。次に，自己の強みへの注目の変化量と被信頼感・受容感の変化量で有意な正の偏相関が確認された。さらに，強みへの注目が向上した児童と向上しなかった児童の学習の感想を計量テキスト分析で検証した。その結果，群ごとに有意な記述の偏りは確認されなかった。全体として，児童の多くはポジティブな感情に関する主観的経験について記述していた。最後に，課題として介入で実施する授業と研究デザインを取り上げ，今後の展望について議論した。 No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1471-2318 24 1 2024 Long-term, patient-centered, frailty-based outcomes of older critical illness survivors from the emergency department: a post hoc analysis of the LIFE Study 257 EN Takashi Hongo Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Tetsuya Yumoto Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Mototaka Inaba Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Shunsuke Taito Department of Clinical Practice and Support, Hiroshima University Hospital Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Atsunori Nakao Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Hiromichi Naito Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University the LIFE Study Investigators Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Background Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes.<br> Methods This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of < 4. Our primary outcome was patient-centered outcomes (QOL/ADL) measured by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Barthel Index six months post-ICU admission, comparing results from baseline. Secondary outcomes included exploration of factors associated with QOL/ADL six months post-ICU admission using multiple linear regression analyses.<br> Results Of 514 candidates, 390 participants responded to the EQ-5D-5L questionnaire, while 237 responded to the Barthel Index. At six months post-admission, mean EQ-5D-5L values declined in both the not frail and frail groups (0.80 to 0.73, p = 0.003 and 0.58 to 0.50, p = 0.002, respectively); Barthel Index scores also declined in both groups (98 to 83, p < 0.001 and 79 to 61, p < 0.001, respectively). Multiple linear regression analysis revealed that baseline frailty (β coefficient, -0.15; 95% CI, − 0.23 to − 0.07; p < 0.001) and pre-admission EQ-5D-5L scores (β coefficient, 0.14; 95% CI, 0.02 to 0.26; p = 0.016) affected EQ-5D-5L scores at six months. Similarly, baseline frailty (β coefficient, -12.3; 95% CI, − 23.9 to − 0.80; p = 0.036) and Barthel Index scores (β coefficient, 0.54; 95% CI, 0.30 to 0.79; p < 0.001) influenced the Barthel Index score at six months.<br> Conclusions Regardless of frailty, older ICU survivors from the emergency department were more likely to experience reduced QOL and ADL six months after ICU admission compared to baseline. No potential conflict of interest relevant to this article was reported.

Springer Nature Acta Medica Okayama 2234-2451 36 1 2024 Superior outcomes of pullout repairs for medial meniscus posterior root tears in partial tear compared to complete radial tear 8 EN Masanori Tamura Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yusuke Yokoyama Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Naohiro Higashihara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Koki Kawada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Purpose To reveal the outcomes of partial medial meniscus posterior root tears following transtibial pullout repair compared with the outcomes of complete radial meniscus posterior root tears. <br> Materials and methods We retrospectively evaluated 15 consecutive patients (male/female, 5/10; average age, 64.4 years) who underwent transtibial pullout repair for partial medial meniscus posterior root tears and compared their results with those of 86 consecutive patients who underwent the same surgery for complete medial meniscus posterior root tears. All patients underwent second-look arthroscopy on average 1 year postoperatively, and a semi-quantitative meniscal healing score (anteroposterior width, stability, and synovial coverage, total 10 points) was evaluated. Medial meniscus extrusion was evaluated preoperatively and at second-look arthroscopy. <br> Results Postoperative clinical scores were not significantly different in the short term. However, second-look arthroscopy revealed a significant difference in repaired meniscal stability (partial tear; 3.3 points, complete tear; 2.3 points, p < 0.001) and total meniscal healing scores (partial tear; 8.3 points, complete tear; 7.1 points, p < 0.001). Medial meniscus extrusion progression was significantly different (partial tear; 0.4 mm, complete tear; 1.0 mm, p < 0.001). <br> Conclusion Partial medial meniscus posterior root tears showed better meniscal healing and less medial meniscus extrusion progression following pullout repair than complete medial meniscus posterior root tears. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 2666-5204 15 2023 Comparison of outcomes of out-of-hospital cardiac arrest patients: Emergency calls placed from mobile phones vs. landline phones 100434 EN Takeshi Nishimura Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masafumi Suga Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takashi Hongo Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tetsuya Yumoto Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Atsunori Nakao Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Satoshi Ishihara Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center Hiromichi Naito Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background: Until recently, calls to the emergency medical service (EMS) from landline phones, which display the caller’s exact location at the dispatch center, had been common. Since the use of mobile phones has become widespread, many emergency calls are now made from mobile phones. Differences in outcomes of out-of-hospital cardiac arrest (OHCA) patients for whom EMS was called from mobile versus landline phones has not yet been fully elucidated.<br> Methods: We performed a retrospective, population-based analysis in Kobe, Japan to examine whether EMS calls from mobiles improved the prognosis of OHCA patients over EMS calls placed from landlines. The primary outcome was favorable neurological outcome, defined as Cerebral Performance Category (CPC) scores of 1 or 2 at discharge. Secondary outcomes were survival at one-month, survival at discharge, and time durations between call and EMS activities.<br> Results: Of 4,231 OHCA cases, 2,194 cases (706 landline cases vs. 1,488 mobile cases) were included in this study. The percentages of favorable neurological outcomes were 0.7% (5/706) in the landline group and 3.8% (56/1,488) in the mobile group. Adjusted multivariable logistic regression revealed that favorable neurological outcomes (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.12–8.17, p = 0.03) were better in the mobile group, while one-month survival (OR 1.30, 95% CI 0.80–2.14, p = 0.29) was not significantly different. Bystander CPR was more frequently administered in the mobile group (landlines 61.3% vs. mobiles 68.4%, p < 0.01). Time durations between call to EMS dispatch (184.5 [IQR 157–220 s] vs. 205 [IQR 174–248 s], p < 0.01) and EMS arrival (476.5 [IQR 377–599 s] vs. 491 [IQR 407.5–611.5 s], p < 0.01) were shorter in the landline group.<br> Conclusions: Although the landline caller location display system seems effective for shorter times between EMS call and EMS arrival, mobile phone use was associated with better neurological outcomes. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Comparison between Cases of Total Hip Arthroplasty Followed by Colonna Capsular Arthroplasty and Lorenz Cast Reduction in Patients with Developmental Dysplasia of the Hip 655 663 EN Hirosuke Endo Department of Bone and Joint Surgery, Kawasaki Medical School Kazuki Yamada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomonori Tetsunaga Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshifumi Namba Department of Bone and Joint Surgery, Kawasaki Medical School Yoshihisa Sugimoto Department of Bone and Joint Surgery, Kawasaki Medical School Shigeru Mitani Department of Bone and Joint Surgery, Kawasaki Medical School Eiji Nakata Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/66159 Most patients with developmental dysplasia of the hip (DDH) now receive closed-reduction treatment within 6 months after birth. The long-term outcomes of patients with late-detection DDH have remained unclear. We reviewed the clinical records of 18 patients who underwent Colonna capsular arthroplasty (n=8) or closed reduction (n=10) for developmental dysplasia of the hip as infants or young children and underwent total hip arthroplasty approximately in midlife. Both the Colonna capsular arthroplasty and closed reduction groups achieved good clinical results after total hip arthroplasty. However, the operating time was longer and the improvements of hip range of motion and clinical score were significantly worse in the Colonna capsular arthroplasty group than in the closed reduction group. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Trochanteric Claw Plate Fixation for Greater Trochanteric Fracture or Osteotomy in Total Hip Arthroplasty 619 625 EN Kenichi Oe Department of Orthopaedic Surgery, Kansai Medical University Hirokazu Iida Department of Orthopaedic Surgery, Kansai Medical University Shohei Sogawa Department of Orthopaedic Surgery, Kansai Medical University Fumito Kobayashi Department of Orthopaedic Surgery, Kansai Medical University Tomohisa Nakamura Department of Orthopaedic Surgery, Kansai Medical University Takanori Saito Department of Orthopaedic Surgery, Kansai Medical University Original Article 10.18926/AMO/66154 This study retrospectively evaluated 41 consecutive open reductions and internal fixations following primary or revision total hip arthroplasty, which required trochanteric claw plate fixation for greater trochanteric fracture or osteotomy between January 2008 and December 2020. The mean duration of clinical follow-up was 4.2 years (range, 1-13 years). The patients included 13 men and 28 women, with a mean age of 68 years (range, 32-87 years). The indications for intervention included trochanteric osteotomy, intraoperative fracture, and non-union including postoperative fracture in 6, 9, and 26 cases, respectively. The mean Merle d’Aubigné Clinical Score improved from 9.4 points (range, 5-15 points) pre-operatively, to 14.3 points (range, 9-18 points) at the last follow-up. Bone union occurred in 35 cases (85%), while implant breakage occurred in four cases. At the last follow-up, the mean Merle d’Aubigné Clinical Scores of bone union and non-union were 15.3 and 14.1, respectively (p=0.48). The Kaplan-Meier survival rate, with the endpoint being revision surgery for pain, non-union, dislocation, or implant breakage, at 10 years was 80.0% (95% confidence interval: 62.6-97.4%). Greater trochanteric fixation using a trochanteric claw plate yielded successful results. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 Associations among Preoperative Malnutrition, Muscle Loss, and Postoperative Walking Ability in Intertrochanteric Fractures: A Retrospective Study 511 516 EN Kohei Sato Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hironori Tsuji Department of Orthopedic Surgery, Japanese Red Cross Okayama Hospital Masanori Yorimitsu Department of Orthopedic Surgery, Okayama University Hospital Takenori Uehara Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Okazaki Department of Orthopedic Surgery, Tsuyama Chuo Hospital Shinichiro Takao Department of Orthopedic Surgery, Okayama Medical Center Toshiaki Hata Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shiro Fukuoka Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoyuki Noda Department of Orthopedic Surgery, Kawasaki Medical School, General Medical Center Hideyuki Kanda Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65973 Sarcopenia and malnutrition are increasing in older adults and are reported risk factors for functional impairment after hip fracture surgery. This study aimed to investigate the associations between skeletal muscle mass loss, malnutrition, and postoperative walking ability in patients with hip fracture. We retrospectively reviewed patients who underwent intertrochanteric fracture surgery at our institute. The psoas muscle index, controlling nutritional status score, and functional ambulation category (FAC) were used to evaluate skeletal muscle mass, nutritional status, and walking ability, respectively. Six months after surgery, walking ability was assessed as either “gait disturbance” or “independent gait”. Multivariate binomial logistic regression analysis, with skeletal muscle mass, nutritional status, and other factors, was used to predict the risk of being assigned to the gait disturbance group. This study included 95 patients (mean age, 85.2 years; 70 women). Sixty-six patients had low skeletal muscle mass, 35 suffered from malnutrition, and 28 had both. Malnutrition and low skeletal muscle mass were significantly associated with postoperative gait disturbance (FAC < 3). Preoperative low skeletal muscle mass and malnutrition were risk factors for postoperative poor walking ability. Further preventive interventions focusing on skeletal muscle mass and nutritional status are required. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 Participation in the Setouchi Triennale and the Health of Residents in Naoshima: A Cross-Sectional Study 491 497 EN Hiroshi Habu Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Soshi Takao Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Chikara Miyaji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naomi Matsumoto Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ken Aoo Graduate School of Humanities and Social Sciences, Okayama University Yosuke Nishita Graduate School of Humanities and Social Sciences, Okayama University Masao Tsuri Faculty of Economics, Musashi University Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65971 Arts festivals have become increasingly popular in various parts of Japan in recent years. The purpose of this study was to investigate the relationships between arts festival activities participation at the Setouchi Triennale and the health of residents in the town of Naoshima. This was a cross-sectional study. Questionnaires were distributed to all residents of Naoshima who were 20 years old or older (n=2,588). We analyzed responses from 708 people. The associations between arts festival activities participation and health (measured by self-rated health) were analyzed using logistic regression analysis as the primary outcome. Kessler’s psychological distress scale scores were also analyzed in the same manner as the primary outcome. The participating group had an adjusted odds ratio of 1.86 (95% confidence interval: 1.03-3.33) for higher self-rated health compared with those who did not participate. Kessler’s psychological distress scale results showed that the participating group had an adjusted odds ratio of 3.23 (95% confidence interval: 1.19-8.81) for lower psychological distress compared with those who did not participate. In conclusion, arts festival activities participation was associated with higher self-rated health and lower psychological distress. However, caution must be taken in regard to generalizability and causality when interpreting these results. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 Low Patient Weight and Long Intubation Time Are Key Factors for Pain during Colonoscopy 471 478 EN Shohei Oka Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keita Harada Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shumpei Yamamoto Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Eriko Yasutomi Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shoko Igawa Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masayasu Ohmori Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mami Hirai Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasushi Yamasaki Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshihiro Inokuchi Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideaki Kinugasa Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiro Takahara Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Sakiko Hiraoka Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Okada Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65969 Although the clinical usefulness of colonoscopy has been established, the procedure remains painful for many patients. This study was designed to clarify the factors predicting colonoscopy-related pain. We evaluated 283 consecutive patients who completed a first-ever, total colonoscopy without sedatives or analgesics. The severity of pain symptoms was evaluated by a numeric rating scale (NRS) in a questionnaire immediately after the colonoscopy. Patient backgrounds and endoscopic findings were analyzed to evaluate their association with pain. Out of 283 patients, 53 scored their pain 0-1 on the NRS while 48 scored it 6-10. We defined the colonoscopies of the former and latter patients as painless and painful, respectively, and compared the two. Multivariate analyses revealed that low body weight (OR 4.95, 95%CI 1.89-12.99) and longer intubation time (OR 3.63, 95%CI 1.46-9.03) were significant risk factors for painful colonoscopy. To identify factors contributing to the increased intubation time, we divided subjects into short- and long-intubation-time groups based on a median insertion time of 7 min. Older age (OR 2.28, 95%CI 1.31-3.98), previous abdominal surgery (OR 1.93, 95%CI 1.13-3.32) and findings of invasive cancer (OR 10.90, 95%CI 1.34-88.90) were significant factors for longer intubation time. No potential conflict of interest relevant to this article was reported.

VM Media SP. zo.o VM Group SK Acta Medica Okayama 1898-018X 29 3 2021 The number of circulating CD34-positive cells is an independent predictor of coronary artery calcification progression: Sub-analysis of a prospective multicenter study 423 431 EN Keishi Ichikawa Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Toru Miyoshi Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Kazuhiro Osawa Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital Takashi Miki Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Kunihisa Kohno Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Kazufumi Nakamura Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Yasushi Koyama Department of Cardiology, Sakurabashi Watanabe Hospital Hiroshi Ito Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Background: Decreases in circulating CD34-positive cells are associated with increases in cardiovascular events. We investigated the association between the number of CD34-positive cells and the progression of coronary artery calcification (CAC), a marker of atherosclerosis, in patients with hypercholesteremia under statin therapy in a sub-analysis of a multicenter study.<br> Methods: In the principal study, patients with CAC scores of 1–999 were treated with pitavastatin. Measurement of CAC by non-enhanced computed tomography and a blood test were performed at baseline and at 1-year follow-up. Patients were divided into two groups: CAC progression (change in CAC score > 0) and non-progression. The number of circulating CD34-positive cells was counted using flow cytometry.<br> Results: A total of 156 patients (mean age 67 years, 55% men) were included in this sub-analysis. CD34 positive cell numbers at baseline as a continuous variable was inversely correlated with annual change in the log-transformed CAC score (r = –0.19, p = 0.02). When patients were divided into high and low CD34 groups based on the median value of 0.8 cells/μL, the adjusted change in CAC score in the low-CD34 group was significantly greater than that in the high-CD34 group (54.2% vs. 20.8%, respectively, p = 0.04). In multiple logistic analysis, a low CD34-positive cell number was an independent predictor of CAC progression, with an odds ratio of 2.88 (95% confidence interval 1.28–6.49, p = 0.01).<br> Conclusions: Low numbers of CD34-positive cells are associated with CAC progression in patients with hypercholesterolemia under statin therapy. The number of CD34-positive cells may help to identify patients at increased cardiovascular risk. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Association of Tumor Necrosis Factor-Alpha with Psychopathology in Patients with Schizophrenia 395 405 EN Marko Pavlovic University Hospital Center Mostar, University of Mostar Dragan Babic University Hospital Center Mostar, University of Mostar Pejana Rastovic University Hospital Center Mostar, University of Mostar Jurica Arapovic University Hospital Center Mostar, University of Mostar Marko Martinac Health Care Center Mostar, University of Mostar Sanja Jakovac University Hospital Center Mostar, University of Mostar Romana Barbaric University Hospital Center Mostar, University of Mostar Original Article 10.18926/AMO/65750 We investigated the relationship between serum tumor necrosis factor-alpha (TNF-α) levels and psychopathological symptoms, clinical and socio-demographic characteristics and antipsychotic therapy in individuals with schizophrenia. TNF-α levels were measured in 90 patients with schizophrenia and 90 healthy controls matched by age, gender, smoking status, and body mass index. The Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of psychopathology in patients. No significant differences in TNF-α levels were detected between the patients and controls (p=0.736). TNF-α levels were not correlated with total, positive, negative, general, or composite PANSS scores (all p>0.05). A significant negative correlation was observed between TNF-α levels and the PANSS cognitive factor (ρ=−0.222, p=0.035). A hierarchical regression analysis identified the cognitive factor as a significant predictor of the TNF-α level (beta=−0.258, t=−2.257, p=0.027). There were no significant differences in TNF-α levels among patients treated with different types of antipsychotics (p=0.596). TNF-α levels correlated positively with the age of onset (ρ=0.233, p=0.027) and negatively with illness duration (ρ=−0.247, p=0.019) and antipsychotic treatment duration (ρ=−0.256, p=0.015). These results indicate that TNF-α may be involved in cognitive impairment in schizophrenia, and would be a potential clinical-state marker in schizophrenia. No potential conflict of interest relevant to this article was reported.

British Editorial Society of Bone & Joint Surgery Acta Medica Okayama 2633-1462 4 1 2023 Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old 19 26 EN Keiichiro Nishida Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihisa Nasu Department of Orthopaedic Surgery, Okayama University Hospital Kenzo Hashizume Department of Orthopaedic Surgery, Chugoku Central Hospital Shunji Okita Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital Ryuichi Nakahara Department of Orthopaedic Surgery, Okayama University Hospital Taichi Saito Department of Intelligent Orthopaedic System, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshifumi Ozaki Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hajime Inoue Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Aims<br> There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA).<br> Methods<br> We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal.<br> Results<br> The mean MEPS significantly improved from 47 (15 to 70) points preoperatively to 95 (70 to 100) points at final follow-up (p < 0.001). Complications were noted in six elbows (23%) in six patients, and of these, four with an ulnar neuropathy and one elbow with postoperative traumatic fracture required additional surgeries. There was no revision with implant removal, and there was no radiological evidence of loosening around the components. With any revision surgery as the endpoint, the survival rates up to 25 years were 78.1% (95% confidence interval 52.8 to 90.6) as determined by Kaplan-Meier analysis.<br> Conclusion<br> The clinical outcome of primary unlinked TEA for young patients with RA was satisfactory and comparable with that for elderly patients. A favourable survival rate without implant removal might support the use of unlinked devices for young patients with this disease entity, with a caution of a relatively high complication rate regarding ulnar neuropathy. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1751-0759 17 1 2023 Quality of life and physical/psychosocial factors in children and adolescents with orthostatic intolerance 23 EN Yoshie Shigeyasu Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ayumi Okada Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Chikako Fujii Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Chie Tanaka Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akiko Sugihara Clinical Psychology section, Department of Medical Support, Okayama University Hospital Makiko Horiuchi Clinical Psychology section, Department of Medical Support, Okayama University Hospital Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hirokazu Tsukahara Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background　Orthostatic intolerance (OI), which is common in children and adolescents, negatively impacts their quality of life (QOL) due to physical symptoms that limit work, school, and daily activities. The purpose of this study is to explore the association of physical and psychosocial factors with QOL scores in children and adolescents with OI.<br> Methods　A cross sectional observational study was conducted. The study participants included 95 Japanese pediatric patients of age 9-15 years who were diagnosed with OI from April 2010 to March 2020. The QOL scores and the QOL T-scores of children with OI assessed using the KINDL-R questionnaire at the initial visit were compared with conventional normative data. The associations of physical and psychosocial factors with the QOL T-scores were examined using multiple linear regression.<br> Results　Pediatric patients with OI had significantly lower QOL scores than healthy children in both elementary (50.7 +/- 13.5 vs. 67.9 +/- 13.4, p < 0.001) and junior high schools (51.8 +/- 14.6 vs. 61.3 +/- 12.6, p < 0.001). This finding was observed in the physical, mental, self-esteem, friends, and school domains. Total QOL scores were significantly associated with school nonattendance (beta = - 3.2, 95% confidence interval [CI] = - 5.8 to - 0.5, p = 0.022) and poor relationship with school (beta = - 5.0, 95% CI = - 9.8 to - 0.4, p = 0.035).<br> Conclusions　These results suggest that the assessment of QOL, including both physical and psychosocial aspects, especially school factors, needs to be implemented earlier in children and adolescents with OI. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2077-0383 12 10 2023 Manifestation of Headache Affecting Quality of Life in Long COVID Patients 3533 EN Kana Fujita Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuki Otsuka Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Naruhiko Sunada Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiroyuki Honda Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kazuki Tokumasu Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yasuhiro Nakano Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yasue Sakurada Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Mikako Obika Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hideharu Hagiya Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Fumio Otsuka Department of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Objectives: The present study aimed to elucidate the characteristics of long COVID patients with headaches. Methods: A single-center retrospective observational study was performed for long COVID outpatients who visited our hospital from 12 February 2021 to 30 November 2022. Results: A total of 482 long COVID patients, after excluding 6, were divided into two groups: the Headache group of patients with complaints of headache (113 patients: 23.4%) and the remaining Headache-free group. Patients in the Headache group were younger (median age: 37 years) than patients in the Headache-free group (42 years), while the ratio of females (56%) in the Headache group was nearly the same as that in the Headache-free group (54%). The proportion of patients in the Headache group who were infected in the Omicron-dominant phase (61%) was larger than the proportions of patients infected in the Delta (24%) and preceding (15%) phases, and that trend was significantly different from the trend in the Headache-free group. The duration before the first visit for long COVID was shorter in the Headache group (71 days) than in the Headache-free group (84 days). The proportions of patients in the Headache group with comorbid symptoms, including general fatigue (76.1%), insomnia (36.3%), dizziness (16.8%), fever (9.7%), and chest pain (5.3%) were larger than the proportions of patients in the Headache-free group, whereas blood biochemical data were not significantly different between the two groups. Interestingly, patients in the Headache group had significant deteriorations of scores indicating depression and scores for quality of life and general fatigue. In multivariate analysis, headache, insomnia, dizziness, lethargy, and numbness were shown to be involved in the quality of life (QOL) of long COVID patients. Conclusions: The manifestation of headaches related to long COVID was found to have a significant impact on social and psychological activities. Alleviation of headaches should be a priority for the effective treatment of long COVID. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 2 2023 Complications of Percutaneous Cryoablation for Renal Tumors and Methods for Avoiding Them 121 129 EN Toshihiro Iguchi Department of Radiology, Okayama University Hospital Yusuke Matsui Department of Radiology, Okayama University Hospital Koji Tomita Department of Radiology, Okayama University Hospital Mayu Uka Department of Radiology, Okayama University Hospital Noriyuki Umakoshi Department of Radiology, Okayama University Hospital Takahiro Kawabata Department of Radiology, Okayama University Hospital Kazuaki Munetomo Department of Radiology, Okayama University Hospital Shoma Nagata Department of Radiology, Okayama University Hospital Motoo Araki Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takao Hiraki Department of Radiology, Okayama University Hospital Review 10.18926/AMO/65141 Percutaneous cryoablation of renal tumors is widely used because of its high efficacy and safety. This high safety can be attributed, at least in part, to the visibility of the ablated area as an “ice ball”. This therapy has fewer complications (incidence, 0-7.2%) and is less invasive than surgery. Minor bleeding is inevitable in most kidney-related procedures, and indeed the most common complication of this therapy is bleeding (hematoma and hematuria). However, patients require treatment such as transfusion or transarterial embolization in only 0-4% of bleeding cases. Various other complications such as ureteral or collecting system injury, bowel injury, nerve injury, skin injury, infection, pneumothorax, and tract seeding also occur, but they are usually minor and asymptomatic. However, operators should know and avoid the various complications associated with this therapy. This study aimed to summarize the complications of percutaneous cryoablation for renal tumors and provide some techniques for achieving safe procedures. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2077-0383 12 5 2023 Serum sCD40L and IL-31 in Association with Early Phase of IgA Nephropathy 2023 EN Keiko Tanaka Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Hitoshi Sugiyama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Morinaga Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Masashi Kitagawa Department of Nephrology, National Hospital Organization Okayama Medical Center Yuzuki Kano Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Yasuhiro Onishi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Koki Mise Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Katsuyuki Tanabe Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Haruhito A. Uchida Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Background: IgA nephropathy (IgAN) is a major cause of chronic glomerulonephritis worldwide. T cell dysregulation has been reported to contribute to the pathogenesis of IgAN. Methods We measured a broad range of Th1, Th2 and Th17 cytokines in the serum of IgAN patients. We searched for significant cytokines, which were associated with clinical parameters and histological scores in IgAN patients. Results: Among 15 cytokines, the levels of soluble CD40L (sCD40L) and IL-31 were higher in IgAN patients and were significantly associated with a higher estimated glomerular filtration rate (eGFR), a lower urinary protein to creatinine ratio (UPCR), and milder tubulointerstitial lesions (i.e., the early phase of IgAN). Multivariate analysis revealed that serum sCD40L was an independent determinant of a lower UPCR after adjustment for age, eGFR, and mean blood pressure (MBP). CD40, a receptor of sCD40L, has been reported to be upregulated on mesangial cells in IgAN. The sCD40L/CD40 interaction may directly induce inflammation in mesangial areas and may therefore be involved in the development of IgAN. Conclusions: The present study demonstrated the significance of serum sCD40L and IL-31 in the early phase of IgAN. Serum sCD40L may be a marker of the beginning of inflammation in IgAN. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2072-6643 15 3 2023 Association between Cardiovascular Disease and Liver Disease, from a Clinically Pragmatic Perspective as a Cardiologist 748 EN Mitsutaka Nakashima Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kazufumi Nakamura Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takahiro Nishihara Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Keishi Ichikawa Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Rie Nakayama Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoichi Takaya Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Norihisa Toh Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Satoshi Akagi Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toru Miyoshi Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Teiji Akagi Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiroshi Ito Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Cardiovascular diseases and liver diseases are closely related. Non-alcoholic fatty liver disease has the same risk factors as those for atherosclerotic cardiovascular disease and may also be a risk factor for atherosclerotic cardiovascular disease on its own. Heart failure causes liver fibrosis, and liver fibrosis results in worsened cardiac preload and congestion. Although some previous reports regard the association between cardiovascular diseases and liver disease, the management strategy for liver disease in patients with cardiovascular diseases is not still established. This review summarized the association between cardiovascular diseases and liver disease. In patients with non-alcoholic fatty liver disease, the degree of liver fibrosis progresses with worsening cardiovascular prognosis. In patients with heart failure, liver fibrosis could be a prognostic marker. Liver stiffness assessed with shear wave elastography, the fibrosis-4 index, and non-alcoholic fatty liver disease fibrosis score is associated with both liver fibrosis in patients with liver diseases and worse prognosis in patients with heart failure. With the current population ageing, the importance of management for cardiovascular diseases and liver disease has been increasing. However, whether management and interventions for liver disease improve the prognosis of cardiovascular diseases has not been fully understood. Future investigations are needed. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 The Efficacy of Inflammatory and Immune Markers for Predicting the Prognosis of Patients with Stage IV Breast Cancer 37 43 EN Kosho Yamanouchi Department of Surgery, National Hospital Organization, Nagasaki Medical Center Shigeto Maeda Department of Surgery, National Hospital Organization, Nagasaki Medical Center Original Article 10.18926/AMO/64360 Systemic therapy for stage IV breast cancer is usually an initial treatment and is based on findings regarding biomarkers (e.g., hormone receptors and human epidermal growth factor receptor-2 [HER2]). However, the response to therapy and outcomes sometime differ among patients with similar prognostic factors including grade, hormone receptor, HER2, and more. We conducted retrospective analyses to evaluate the correlations between the overall survival (OS) of 46 stage IV breast cancer patients and (i) the peripheral absolute lymphocyte count (ALC) and (ii) composite blood cell markers. The peripheral blood cell markers included the neutrophil- to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), the systemic immune-inflammation index (SII), the systemic inflammation response index (SIRI), and the most recently introduced indicator, the pan-immune-inflammatory value (PIV). The SIRI and PIV showed prognostic impacts on the patients: those with a low SIRI or a low PIV showed significantly better OS than those with a high SIRI (5-year, 66.0% vs. 35.0%, p<0.05) or high PIV (5-year, 68.1% vs. 38.5%, p<0.05), respectively. This is the first report indicating the possible prognostic value of the PIV for OS in patients with stage IV breast cancer. Further studies with larger numbers of patients are necessary for further clarification. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Analysis of Phase Angle and Balance and Gait Functions in Pre-Frail Individuals: A Cross-Sectional Observational Study 21 27 EN Daisuke Homma Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences Izumi Minato Division of Orthopaedic Surgery, Niigata Rinko Hospital Norio Imai Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences Dai Miyasaka Division of Orthopaedic Surgery, Niigata Bandai Hospital Yoshinori Sakai Division of Orthopaedic Surgery, Niigata City General Hospital Yoji Horigome Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences Hayato Suzuki Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences Yoichiro Dohmae Division of Orthopaedic Surgery, Niigata Bandai Hospital Naoto Endo Division of Orthopaedic Surgery, Niigata Prefectural Tsubame Rosai Hospital Original Article 10.18926/AMO/64357 We measured the muscle mass and phase angle of each body part to evaluate the relationship between balance and gait functions in individuals with a pre-frailty status. This cross-sectional observational study determined the skeletal muscle mass-to-body weight ratio and phase angles of 21 control (robust) and 29 pre-frail subjects. Their Brief-Balance Evaluation Systems Test, Timed Up-and-Go (TUG) test, Life-Space Assessment, and Modified Fall Efficacy Scale scores plus the relationship between muscle mass, phase angle, and motor function were evaluated. In the pre-frailty group (three males, 26 females, aged 75.58±7.60 years), significant correlations were noted between the Brief-Balance Evaluation Systems Test score and lower-limb (r=0.614) and wholebody (r=0.557) phase angles, and between the TUG test score and lower-limb muscle mass-to-body weight ratio (r=−0.616), lower-limb phase angle (r=−0.616), and whole-body phase angle (r=−0.527). Evaluating the phase angle of the lower extremities of pre-frail patients and intervening accordingly may help clinicians maintain and improve these patients’ balance and gait functions. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1757-6512 14 1 2023 Synergistic therapeutic effects of intracerebral transplantation of human modified bone marrow-derived stromal cells (SB623) and voluntary exercise with running wheel in a rat model of ischemic stroke 10 EN Satoru Yabuno Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takao Yasuhara Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takayuki Nagase Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Satoshi Kawauchi Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Chiaki Sugahara Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yosuke Okazaki Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kakeru Hosomoto Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Susumu Sasada Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tatsuya Sasaki Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Naoki Tajiri Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medical Sciences and Medical School Cesar V. Borlongan Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida Isao Date Department of Neurological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Background　Mesenchymal stromal cell (MSC) transplantation therapy is a promising therapy for stroke patients. In parallel, rehabilitation with physical exercise could ameliorate stroke-induced neurological impairment. In this study, we aimed to clarify whether combination therapy of intracerebral transplantation of human modified bone marrow-derived MSCs, SB623 cells, and voluntary exercise with running wheel (RW) could exert synergistic therapeutic effects on a rat model of ischemic stroke.<br> Methods　Wistar rats received right transient middle cerebral artery occlusion (MCAO). Voluntary exercise (Ex) groups were trained in a cage with RW from day 7 before MCAO. SB623 cells (4.0 x 10(5) cells/5 mu l) were stereotactically injected into the right striatum at day 1 after MCAO. Behavioral tests were performed at day 1, 7, and 14 after MCAO using the modified Neurological Severity Score (mNSS) and cylinder test. Rats were euthanized at day 15 after MCAO for mRNA level evaluation of ischemic infarct area, endogenous neurogenesis, angiogenesis, and expression of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF). The rats were randomly assigned to one of the four groups: vehicle, Ex, SB623, and SB623 + Ex groups.<br> Results　SB623 + Ex group achieved significant neurological recovery in mNSS compared to the vehicle group (p < 0.05). The cerebral infarct area of SB623 + Ex group was significantly decreased compared to those in all other groups (p < 0.05). The number of BrdU/Doublecortin (Dcx) double-positive cells in the subventricular zone (SVZ) and the dentate gyrus (DG), the laminin-positive area in the ischemic boundary zone (IBZ), and the mRNA level of BDNF and VEGF in SB623 + Ex group were significantly increased compared to those in all other groups (p < 0.05).<br> Conclusions　This study suggests that combination therapy of intracerebral transplantation SB623 cells and voluntary exercise with RW achieves robust neurological recovery and synergistically promotes endogenous neurogenesis and angiogenesis after cerebral ischemia, possibly through a mechanism involving the up-regulation of BDNF and VEGF. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Posterolateral Floating Technique for the Thoracic Ossification of the Posterior Longitudinal Ligament with Navigation: A Technical Note 743 748 EN Masato Tanaka Department of Orthopaedic Surgery, Okayama Rosai Hospital Hardik Suthar Department of Orthopaedic Surgery, Okayama Rosai Hospital Dhvanit Desai Department of Orthopaedic Surgery, Okayama Rosai Hospital Taro Yamauchi Department of Orthopaedic Surgery, Okayama Rosai Hospital Shinya Arataki Department of Orthopaedic Surgery, Okayama Rosai Hospital Yoshihiro Fujiwara Department of Orthopaedic Surgery, Okayama Rosai Hospital Koji Uotani Department of Orthopaedic Surgery, Okayama Rosai Hospital Yoshiaki Oda Department of Orthopaedic Surgery, Okayama Rosai Hospital Haruo Misawa Department of Orthopaedic Surgery, Okayama University Hospital Case Report 10.18926/AMO/64126 We describe a floating technique via a posterolateral approach with intraoperative O-arm navigation to facilitate decompression of the spinal cord in thoracic myelopathy due to severe ossification of the posterior longitudinal ligament (OPLL). A 62-year-old man with myelopathy due to thoracic OPLL had left-leg muscle weakness, urinary disturbance, and spastic gait. Bilateral leg pain and gait disturbance had persisted for 2 years. He was successfully treated by the posterolateral OPLL floating procedure and posterior pedicle fixation under O-arm navigation. At a 2-year follow-up, manual muscle testing results and sensory function of the left leg had recovered fully. His cervical Japanese Orthopedic Association score had improved from 5/12 to 11/12. The novel intraoperative O-arm navigation-guided posterolateral floating procedure for thoracic OPLL is effective for achieving precise decompression and strong fixation with a posterior approach only and can provide an excellent result for severe thoracic OPLL without the risk of adverse events from intraoperative radiation. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 1422-0067 23 15 2022 Candidate Genes in Testing Strategies for Linkage Analysis and Bioinformatic Sorting of Whole Genome Sequencing Data in Three Small Japanese Families with Idiopathic Superior Oblique Muscle Palsy 8626 EN Toshihiko Matsuo Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Chaomulige Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Mary Miyaji Department of Medical Neurobiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Osamu Hosoya Department of Medical Neurobiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Akira Saito StaGen Co., Ltd. Kazuyuki Nakazono StaGen Co., Ltd. Idiopathic superior oblique muscle palsy is a major type of paralytic, non-comitant strabismus and presents vertical and cyclo-torsional deviation of one eye against the other eye, with a large vertical fusion range and abnormal head posture such as head tilt. Genetic background is considered to play a role in its development, as patients with idiopathic superior oblique muscle palsy have varying degrees of muscle hypoplasia and, rarely, the complete absence of the muscle, that is, aplasia. In this study, whole genome sequencing was performed, and single nucleotide variations and short insertions/deletions (SNVs/InDels) were annotated in two patients each in three small families (six patients in total) with idiopathic superior oblique muscle palsy, in addition to three normal individuals in one family. At first, linkage analysis was carried out in the three families and SNVs/InDels in chromosomal loci with negative LOD scores were excluded. Next, SNVs/InDels shared by the six patients, but not by the three normal individuals, were chosen. SNVs/InDels were further narrowed down by choosing low-frequency (&lt;1%) or non-registered SNVs/InDels in four databases for the Japanese population, and then by choosing SNVs/InDels with functional influence, leading to one candidate gene, SSTR5-AS1 in chromosome 16. The six patients were heterozygous for 13-nucleotide deletion in SSTR5-AS1, except for one homozygous patient, while the three normal individuals were wild type. Targeted polymerase chain reaction (PCR) and direct sequencing of PCR products confirmed the 13-nucleotide deletion in SSTR5-AS1. In the face of newly-registered SSTR5-AS1 13-nucleotide deletion at a higher frequency in a latest released database for the Japanese population, the skipping of low-frequency and non-registration sorting still resulted in only 13 candidate genes including SSTR5-AS1 as common variants. The skipping of linkage analysis also led to the same set of 13 candidate genes. Different testing strategies that consisted of linkage analysis and simple unintentional bioinformatics could reach candidate genes in three small families with idiopathic superior oblique muscle palsy. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0914-5087 80 3 2022 Innovative clinical pathway shortened the length of hospital stay and prevented readmission in patients with acute decompensated heart failure 232 239 EN Naofumi Amioka Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Atsushi Takaishi Department of Cardiology, Mitoyo General Hospital Kazufumi Nakamura Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toyohiro Endo Department of Cardiology, Mitoyo General Hospital Toshihiro Iida Department of Cardiology, Mitoyo General Hospital Tatsuya Yamaji Department of Cardiology, Mitoyo General Hospital Hisatoshi Mori Department of Cardiology, Mitoyo General Hospital Takao Kishinoue Department of Cardiology, Mitoyo General Hospital Kentaro Yasuhara Department of Cardiology, Mitoyo General Hospital Naoaki Matsuo Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masafumi Tanimoto Department of Cardiology, Mitoyo General Hospital Yukari Nakano Department of Cardiology, Mitoyo General Hospital Nobuhiko Onishi Department of Cardiology, Mitoyo General Hospital Masayuki Ueeda Department of Cardiology, Mitoyo General Hospital Hiroshi Ito Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background: With the rapidly aging population in Japan, the number of patients hospitalized for acute decompensated heart failure (ADHF) is increasing. Mitoyo General Hospital created an innovative clinical pathway (CP) for promoting early discharge in patients with ADHF. Major points of the CP were as follows: using tolvaptan as a standard therapy, completing the acute therapies within three days, and starting cardiac rehabilitation from the second day after admission. <br> Methods: We collected data for patients with ADHF who were admitted to our hospital before introduction of the CP (non-CP group) (April 2014-July 2015) and after introduction of the CP (CP group) (August 2015-July 2019). We investigated the impact of the CP on the length of hospital stay (LOHS) and readmission after discharge. <br> Results: After screening, 593 patients were enrolled in this study. After performing propensity score matching, 129 patients in the non-CP group and 129 patients in the CP group were analyzed. LOHS of patients in the CP group was significantly shorter than that of patients in the non-CP group [20 (14-28) days vs 12 (8-21) days] (p < 0.001) without an increase in mortality during hospitalization or an increase in the rate of readmission due to ADHF within 30 days. Use of the CP was an independent negative factor contributing to LOHS for patients with ADHF, even after adjustment of other factors including the use of tolvaptan (p < 0.001). The CP significantly decreased the proportion of patients readmitted to hospitals due to ADHF within 6 months [n = 32 (27%) vs n = 18 ( 15%), p = 0.026] and 1 year [n = 40 (34%) vs n = 23 ( 19%), p = 0.009] after discharge compared to the proportion in the non-CP group. <br> Conclusions: The CP significantly reduced the LOHS of patients without increasing the in-hospital mortality and it also reduced the risk of readmission in the mid-term and long-term. (c) 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1660-4601 19 15 2022 Relationship between Psychological Stress Determined by Voice Analysis and Periodontal Status: A Cohort Study 9489 EN Takayuki Maruyama Department of Preventive Dentistry, Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences Daisuke Ekuni Department of Preventive Dentistry, Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences Masakazu Higuchi Department of Bioengineering, Graduate School of Engineering, The University of Tokyo Eiji Takayama Department of Oral Biochemistry, Asahi University School of Dentistry Shinichi Tokuno Department of Bioengineering, Graduate School of Engineering, The University of Tokyo Manabu Morita Department of Preventive Dentistry, Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences In modern society, evaluation and management of psychological stress may be important for the prevention of periodontal disease. The purpose of this study was to examine the relationship between psychological stress (vitality and mental activity) evaluated by Mind Monitoring System (MIMOSYS) and periodontal status. Forty students of Okayama University underwent the oral examination and self-reported questionnaire on the first day (baseline) and the 14th day (follow-up). Voice recording was performed every day with the MIMOSYS app during the whole study period. The participants completed the Patient Health Questionnaire (PHQ)-9 and Beck Depression Inventory (BDI) at baseline and at follow-up. Spearman's rank correlation coefficient was used to determine the significance of correlations among variables. The PHQ-9 and BDI scores were negatively correlated with vitality in the morning. Change in vitality in the morning was significantly correlated with changes in periodontal inflammation. Mental activity was significantly correlated with change in mean probing pocket depth. This result shows that measurement of psychological stress using a voice-based tool to assess mental health may contribute to the early detection of periodontal disease. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2071-1050 14 15 2022 University-Industry Technology Transfer: Empirical Findings from Chinese Industrial Firms 9582 EN Jiaming Jiang Graduate School of Humanities and Social Science, Okayama University Yu Zhao School of Management, Department of Management, Tokyo University of Science Junshi Feng Graduate School of Humanities and Social Science, Okayama University The knowledge and innovation generated by researchers at universities is transferred to industries through patent licensing, leading to the commercialization of academic output. In order to investigate the development of Chinese university-industry technology transfer and whether this kind of collaboration may affect a firm's innovation output, we collected approximately 6400 license contracts made between more than 4000 Chinese firms and 300 Chinese universities for the period between 2009 and 2014. This is the first study on Chinese university-industry knowledge transfer using a bipartite social network analysis (SNA) method, which emphasizes centrality estimates. We are able to investigate empirically how patent license transfer behavior may affect each firm's innovative output by allocating a centrality score to each firm in the university-firm technology transfer network. We elucidate the academic-industry knowledge by visualizing flow patterns for different regions with the SNA tool, Gephi. We find that innovation capabilities, R&D resources, and technology transfer performance all vary across China, and that patent licensing networks present clear small-world phenomena. We also highlight the Bipartite Graph Reinforcement Model (BGRM) and BiRank centrality in the bipartite network. Our empirical results reveal that firms with high BGRM and BiRank centrality scores, long history, and fewer employees have greater innovative output. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 2 2022 Safety and Effectiveness of Perospirone in Comparison to Risperidone for Treatment of Delirium in Patients with Advanced Cancer: A Multicenter Prospective Observational Study in Real-World Psycho-Oncology Settings 195 202 EN Shinichiro Inoue Department of Neuropsychiatry, Okayama University Hospital Isseki Maeda Department of Palliative Care, Senri-Chuo Hospital Asao Ogawa Department of Psycho-Oncology Service, National Cancer Center Hospital East Kazuhiro Yoshiuchi Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo Seishi Terada Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihito Yamada Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63414 The clinical benefit of perospirone for treatment of delirium in patients with advanced cancer is not sufficiently clear. The objective of this study was to compare the safety and effectiveness of perospirone to those of risperidone for the treatment of delirium in patients with advanced cancer. This is a secondary analysis of a multicenter prospective observational study in nine psycho-oncology consultation services in Japan. The study used the Delirium Rating Scale (DRS) Revised-98 to measure effectiveness and the CTCAE (Common Terminology Criteria for Adverse Events) version 4 to assess safety. Data from 16 patients who received perospirone and 53 patients who received risperidone were analyzed. The mean age was 70 years in the perospirone group and 73 years in the risperidone group. Both groups showed a significant decrease in the total score of DRS-R-98 after three days of treatment (perospirone: 11.7 (7.9-15.4) to 7.0 (3.3-10.7), difference −4.7, effect size=0.72, p=0.003; risperidone: 15.5 (13.6-17.4) to 12.2 (10.1-14.2), difference −3.3, effect size=0.55, p=0.00). The risperidone group showed significant improvements in sleep-wake cycle disturbance, orientation, attention, and visuospatial ability. In the perospirone group, there was a significant improvement of sleep-wake cycle disturbance. The median daily dose of perospirone was 4 mg/day. There were fewer episodes of somnolence as an adverse event in the perospirone group. Low-dose perospirone was thus found to be effective for the treatment of delirium in patients with advanced cancer and may be associated with fewer episodes of over-sedation as an adverse event. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 2 2022 Grade of Subchondral Insufficiency Fracture of the Knee and the Presence of a Posterior Shiny-Corner Lesion are Correlated with Duration of Medial Meniscus Posterior Root Tear in Women 121 127 EN Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Kamatsuki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Eiji Nakata Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomonori Tetsunaga Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kentaro Yamane Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63405 Bone marrow edema (BME) after meniscus injury and risk factors for subchondral insufficiency fracture of the knee (SIFK) have been reported. However, their association with medial meniscus posterior root tear (MMPRT) remains unknown. We investigated the association of BME volume (BME-V), posterior shinycorner lesion (PSCL), and SIFK with MMPRT to examine the correlations between BME-V and medial meniscus extrusion (MME), PSCL and duration from injury to the time of magnetic resonance imaging (duration), and SIFK and duration. Twenty-nine patients who underwent surgery for MMPRT were included (mean age, 59.2; range, 39-84). The presence of PSCL, femoral BME-V (cm3), and SIFK grade (1-4) were evaluated. Preoperative factors, such as MME (mm) and duration (weeks), were investigated using multivariate linear/ logistic regression analyses. Multivariate linear regression analysis revealed duration as a significant factor for high-grade SIFK (p<0.01). Multivariate logistic regression analysis revealed duration as a significant factor for the presence of PSCL (odds ratio=0.94, p<0.05). A long duration of MMPRT leads to severe MME and highgrade SIFK (3 and 4), often resulting in knee arthroplasty. Early diagnosis of MMPRT and pullout repair can prevent severe MME and high-grade SIFK. No potential conflict of interest relevant to this article was reported.

Nature Portfolio Acta Medica Okayama 2045-2322 11 1 2021 Trajectory of body mass index and height changes from childhood to adolescence: a nationwide birth cohort in Japan 23004 EN Naomi Matsumoto Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshihide Kubo Department of Pediatrics, National Hospital Organization, Okayama Medical Center Kazue Nakamura Department of Pediatrics, National Hospital Organization, Okayama Medical Center Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Akihito Takeuchi Department of Pediatrics, National Hospital Organization, Okayama Medical Center Hirokazu Tsukahara Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takashi Yorifuji Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University To investigate the dynamics of body mass index (BMI) and height changes in childhood leading to obesity in adolescents. BMI Z-scores were calculated using the LMS (lambda-mu-sigma) method based on yearly height and weight information (age 1.5-15 years) from a nationwide Japanese birth cohort that started in 2001 (n = 26,711). We delineated the trajectories of BMI and height changes leading to obesity at age 15 years using mixed effect models. Children who became obese at the age of 15 years kept relatively high BMI z-scores through childhood for both genders, and had an increasing trend over time as opposed to the normal weight group, with an increasing slope during puberty. Early adiposity rebound was associated with overweight or obesity at the age of 15 years. Age at peak height velocity (APHV) occurred earlier in the obese/overweight group at age 15 years than in the normal weight group, and occurred later in the underweight group. Obese adolescents experienced early adiposity rebound timing and maintained a serial BMI z-score increase throughout childhood, with a greater slope at puberty. An earlier peak in height gain during puberty may have contributed to the observed patterns of BMI change. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 1347-9032 2021 First-line pembrolizumab vs chemotherapy in metastatic non-small-cell lung cancer: KEYNOTE-024 Japan subset EN Miyako Satouchi Department of Thoracic Oncology, Hyogo Cancer Center Kaname Nosaki Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center Toshiaki Takahashi Division of Thoracic Oncology, Shizuoka Cancer Center Kazuhiko Nakagawa Department of Medical Oncology, Faculty of Medicine, Kindai University Keisuke Aoe Department of Medical Oncology, National Hospital Organization Yamaguchi Ube Medical Center Takayasu Kurata Department of Thoracic Oncology, Kansai Medical University Hospital Akimasa Sekine Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center Atsushi Horiike Department of Thoracic Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tatsuro Fukuhara Miyagi Cancer Center Shunichi Sugawara Department of Pulmonary Medicine, Sendai Kousei Hospital Shigeki Umemura Department of Thoracic Oncology, National Cancer Center Hospital East Hideo Saka Department of Respiratory Medicine and Medical Oncology, National Hospital Organization Nagoya Medical Center Isamu Okamoto Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University Nobuyuki Yamamoto Internal Medicine III, Wakayama Medical University Hiroshi Sakai Department of Thoracic Oncology, Saitama Cancer Center Kazuma Kishi Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital Nobuyuki Katakami Division of Integrated Oncology, Institute of Biomedical Research and Innovation Hospital Hidehito Horinouchi Department of Thoracic Oncology, National Cancer Center Hospital Toyoaki Hida Department of Thoracic Oncology, Aichi Cancer Center Hiroaki Okamoto Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen’s Hospital Shinji Atagi Department of Thoracic Oncology, National Hospital Organization Kinki-Chuo Chest Medical Center Tatsuo Ohira Department of Surgery, Tokyo Medical University Shi Rong Han MSD K.K. Kazuo Noguchi MSD K.K. Victoria Ebiana Merck & Co., Inc. Katsuyuki Hotta Center for Innovative Clinical Medicine, Okayama University Hospital This prespecified subanalysis of the global, randomized controlled phase Ill KEYNOTE-024 study of pembrolizumab vs chemotherapy in previously untreated metastatic non-small-cell lung cancer without EGFR/ALK alterations and a programmed death-ligand 1 (PD-L1) tumor proportion score of 50% or greater evaluated clinical outcomes among patients enrolled in Japan. Treatment consisted of pembrolizumab 200 mg every 3 weeks (35 cycles) or platinum-based chemotherapy (four to six cycles). The primary end-point was progression-free survival; secondary end-points included overall survival and safety. Of 305 patients randomized in KEYNOTE-024 overall, 40 patients were enrolled in Japan (all received treatment: pembrolizumab, n = 21; chemotherapy, n = 19). The hazard ratio (HR) for progression-free survival by independent central review (data cut-off date, 10 July 2017) was 0.25 (95% confidence interval [CI], 0.10-0.64; one-sided, nominal P = .001). The HR for overall survival (data cut-off date, 15 February 2019) was 0.39 (95% CI, 0.17-0.91; one-sided, nominal P = .012). Treatment-related adverse events occurred in 21/21 (100%) pembrolizumab-treated and 18/19 (95%) chemotherapy-treated patients; eight patients (38%) and nine patients (47%), respectively, had grade 3-5 events. Immune-mediated adverse events and infusion reactions occurred in 11 patients (52%) and four patients (21%), respectively; four patients (19%) and one patient (5%), respectively, had grade 3-5 events. Consistent with results from KEYNOTE-024 overall, first-line pembrolizumab improved progression-free survival and overall survival vs chemotherapy with manageable safety among Japanese patients with metastatic non-small-cell lung cancer without EGFRIALK alterations and a PD-L1 tumor proportion score of 50% or greater. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Clinical Efficacy and Safety of Sitafloxacin 200 mg Once Daily for Refractory Genitourinary Tract Infections 763 766 EN Takehiro Iwata Department of Urology, Okayama University Hospital Takuya Sadahira Department of Urology, Okayama University Hospital Yuki Maruyama Department of Urology, Okayama University Hospital Takanori Sekito Department of Urology, Okayama University Hospital Kasumi Yoshinaga Department of Urology, Okayama University Hospital Shogo Watari Department of Urology, Okayama University Hospital Kentaro Nagao Department of Urology, Okayama University Hospital Tatsushi Kawada Department of Urology, Okayama University Hospital Yusuke Tominaga Department of Urology, Okayama University Hospital Shingo Nishimura Department of Urology, Okayama University Hospital Atsushi Takamoto Department of Urology, Okayama University Hospital Tomoko Sako Department of Urology, Okayama University Hospital Kohei Edamura Department of Urology, Okayama University Hospital Yasuyuki Kobayashi Department of Urology, Okayama University Hospital Motoo Araki Department of Urology, Okayama University Hospital Ayano Ishii Department of Urology, Okayama University Hospital Masami Watanabe Department of Urology, Okayama University Hospital Toyohiko Watanabe Department of Urology, Okayama University Hospital Yasutomo Nasu Department of Urology, Okayama University Hospital Koichiro Wada Department of Urology, Okayama University Hospital Clinical Study Protocol 10.18926/AMO/62820 The aim of this ongoing trial is to evaluate the clinical efficacy and safety of sitafloxacin (STFX) 200 mg once daily (QD) for 7 days in patients with refractory genitourinary tract infections, which include recurrent or complicated cystitis, complicated pyelonephritis, bacterial prostatitis, and epididymitis. The primary endpoint is the microbiological efficacy at 5-9 days after the last administration of STFX. Recruitment began in February 2021, and the target total sample size is 92 participants. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Non-Invasive Prenatal Genetic Testing (NIPT) Leading to Prenatal Diagnosis of Trisomy 21 Mosaicism and 18q Deletion Syndrome: Two Cases 745 750 EN Kei Hayata Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Sakurako Mishima Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Akiko Ohira Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Kazumasa Tani Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Jota Maki Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Eriko Eto Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Chikako Ogawa Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Hisashi Masuyama Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Case Report 10.18926/AMO/62816 NIPT is non-definitive testing to estimate the possibility that fetuses have trisomy 21, trisomy 18, or trisomy 13. However, in NIPT-positive and indeterminate cases, rare chromosomal disease may become apparent, requiring advanced genetic considerations and counseling skills. We experienced two such cases, a trisomy 21 mosaicism case triggered by NIPT-positive status and 18q deletion syndrome triggered by NIPT-indeterminate status. These cases have two clinical implications for NIPT. First, it was revealed that trisomy mosaicism might be found in NIPT-positive cases that have lower Z-Scores than those inferred from the fraction of fetal cfDNA in the case of standard trisomy. Second, it is possible that microdeletion syndrome could be the reason for an indeterminate NIPT result. Today’s genetic counseling requires more expertise in ethics and communication as well as genetic science because NIPT can lead to totally unexpected results. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Testosterone Recovery after Neoadjuvant Gonadotropin-Releasing Hormone Antagonist versus Agonist on Permanent Iodine-125 Seed Brachytherapy in Prostate Cancer Patients: A Propensity Score Analysis 705 711 EN Takehiro Iwata Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Maruyama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tatsushi Kawada Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Sadahira Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi Katayama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Atsushi Takamoto Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoko Sako Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichiro Wada Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kohei Edamura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuyuki Kobayashi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Motoo Araki Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masami Watanabe Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toyohiko Watanabe Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasutomo Nasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/62810 Optimal neoadjuvant hormone therapy (NHT) for reducing prostate cancer (PC) patients’ prostate volume pre-brachytherapy is controversial. We evaluated the differential impact of neoadjuvant gonadotropin-releasing hormone (GnRH) antagonist versus agonist on post-brachytherapy testosterone recovery in 112 patients treated pre-brachytherapy with NHT (GnRH antagonist, n=32; GnRH agonists, n=80) (Jan. 2007-June 2019). We assessed the effects of patient characteristics and a GnRH analogue on testosterone recovery with logistic regression and a propensity score analysis (PSA). There was no significant difference in the rate of testosterone recovery to normal levels (> 300 ng/dL) between the GnRH antagonist and agonists (p=0.07). The GnRH agonists induced a significantly more rapid testosterone recovery rate at 3 months post-brachytherapy versus the GnRH antagonist (p<0.0001); there was no difference in testosterone recovery at 12 months between the GnRH antagonist/agonists (p=0.8). In the multivariate analysis, no actor was associated with testosterone recovery. In the PSA, older age and higher body mass index (BMI) were significantly associated with longer testosterone recovery. Post-brachytherapy testosterone recovery was quicker with the neoadjuvant GnRH agonists than the antagonist, and the testosterone recovery rate was significantly associated with older age and higher BMI. Long-term follow-ups are needed to determine any differential effects of GnRH analogues on the quality of life of brachytherapy-treated PC patients. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 5 2021 Relationship between Pressure Ulcers in Elderly People and Physiological Indices of the Skin 557 565 EN Hiroko Takeshima Kohara Department of Nursing, University of Kochi Mitsunori Ikeda Department of Nursing, University of Kochi Masami Okawa Shiragikuen Hospital Original Article 10.18926/AMO/62768 This study examined the relationship between skin physiological indices and pressure ulcers in elderly people. The subjects were 55 bedridden elderly Japanese patients with a median age of 85 years. The following parame-ters were measured using non-invasive devices: skin surface temperature, moisture content in the stratum corneum, moisture content in the dermis, transepidermal water loss as an index of skin barrier function, skin erythema and skin elasticity. The sacral and 2 heel areas were observed as sites predisposed to pressure ulcers. Within one month after measuring the skin physiological indices, we confirmed pressure ulcers of National Pressure Ulcer Advisory Panel classification Stage II or worse based on medical records. Among the 55 patients, 4 (7.3%) prospectively developed a total of 5 pressure ulcers within 16 days. Only the skin erythema score was significantly higher with than without pressure ulcers (p < 0.001). We performed a binary logistic regression analysis and confirmed a significant relationship between pressure-ulcer development and the level of erythema (odds ratio = 1.026; 95% confidence interval: 1.011-1.042). Skin erythema increased before the development of pressure ulcers. Taken together, our results show that the high skin erythema score can be a predictive indicator of pressure ulcers. No potential conflict of interest relevant to this article was reported.

Elsevier Singapore Pte Ltd. Acta Medica Okayama 2214-6873 26 2021 Postoperative clinical outcomes of unicompartmental knee arthroplasty in patients with isolated medial compartmental osteoarthritis following medial meniscus posterior root tear 15 20 EN Takaaki Hiranaka Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Takayuki Furumatsu Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Yuki Okazaki Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Takaaki Tanaka Department of Orthopaedic Surgery, Sumitomo Besshi Hospital Masatsugu Ozawa Department of Orthopaedic Surgery, Sumitomo Besshi Hospital Kenji Masuda Department of Orthopaedic Surgery, Sumitomo Besshi Hospital Noritaka Seno Department of Orthopaedic Surgery, Sumitomo Besshi Hospital Haowei Xue Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Toshifumi Ozaki Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Background: Cartilage degradation progresses rapidly following medial meniscus posterior root tear (MMPRT). Unicompartmental knee arthroplasty (UKA) has been performed for medial compartmental osteoarthritis following MMPRT. We evaluated the clinical and radiographic outcomes of UKA for medial compartmental osteoarthritis after an untreated MMPRT. <br> Methods: Twenty-one patients who underwent UKA for isolated medial compartment osteoarthritis following MMPRT were retrospectively investigated. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score and knee range of motion. The posterior tibial slope and tibial component inclination were evaluated using plain radiographs. <br> Results: The mean follow-up periods were 25.5 +/- 13.8 months. Clinical outcomes improved significantly postoperatively. The mean postoperative knee extension angle was-1.1 degrees +/- 2.1 degrees, and the knee flexion angle was 134.3 degrees +/- 4.9 degrees. The posterior tibial slope angle decreased from 9.0 degrees +/- 2.0 degrees preoperatively to 5.4 degrees +/- 1.8 degrees postoperatively, and postoperative tibial component inclination at the final follow-up was 2.9 degrees +/- 1.1 degrees varus. No aseptic loosening or deep infections were observed. <br> Conclusion: UKA significantly improved clinical outcomes and could be a viable surgical option for treating isolated medial compartmental osteoarthritis accompanied by untreated MMPRT. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1471-227X 21 1 2021 Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study 104 EN Hiromichi Naito Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Tetsuya Yumoto Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Takashi Yorifuji Dentistry and Pharmaceutical Sciences, Department of Epidemiology, Okayama University Graduate School of Medicine Tsuyoshi Nojima Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Hirotsugu Yamamoto Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Taihei Yamada Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Kohei Tsukahara Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Mototaka Inaba Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Takeshi Nishimura Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Takenori Uehara Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Atsunori Nakao Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Background <br> Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA. <br> Methods <br> A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age >= 16, at least one trauma with Abbreviated Injury Scale score (AIS) >= 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival. <br> Results <br> Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36-70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22-41), and median transport time was 11 min (IQR 6-17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%. <br> Conclusion <br> The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 4 2021 Effects of Tablet Size and Head Posture on Drug Swallowing: A Preliminary Examination Using Endoscopy in Healthy Subjects 495 503 EN Shuntaro Sugiyama Division of Medically Compromised Geriatric Dentistry, Department of Critical Care Medicine and Dentistry, Kanagawa Dental University Hospital Graduate School of Dentistry Takatoshi Iida Division of Medically Compromised Geriatric Dentistry, Department of Critical Care Medicine and Dentistry, Kanagawa Dental University Hospital Graduate School of Dentistry Yoshinari Morimoto Division of Medically Compromised Geriatric Dentistry, Department of Critical Care Medicine and Dentistry, Kanagawa Dental University Hospital Graduate School of Dentistry Yuki Yamazaki Division of Medically Compromised Geriatric Dentistry, Department of Pharmacy, Kanagawa Dental University Hospital Lou Mikuzuki Division of Medically Compromised Geriatric Dentistry, Department of Critical Care Medicine and Dentistry, Kanagawa Dental University Hospital Graduate School of Dentistry Megumi Hayashi Division of Medically Compromised Geriatric Dentistry, Department of Critical Care Medicine and Dentistry, Kanagawa Dental University Hospital Graduate School of Dentistry Original Article 10.18926/AMO/62402 Tablet size and head posture have been reported to affect swallowing of medications, but no previous studies have evaluated their effects in detail. Our aim was to investigate for the first time the effect of tablet size and head posture on drug swallowing by endoscopic evaluation in healthy subjects. Round tablets (7 , 10 , 12, and 14 mm in diameter) were swallowed by 15 healthy adults with an endoscope inserted in the neutral, head flex-ion, and head extension positions. Evaluation of swallowing difficulty using a numeric rating scale (NRS), presence or absence of pharyngeal residue and its location, and tablet oral transit time (TOTT) were recorded. In the neutral position, the NRS score was higher with the 14 mm tablets than with the 7 mm tablets. The TOTT with the 7 mm tablets was significantly shorter in the head extension than in the neutral position. Swallowing difficulty increased when the tablet diameter was more than 7 mm. Residues were found in the epi-glottis, pyriform sinus, and tongue base. These findings suggest that head extension shortens the TOTT and assists oral-pharyngeal transport. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 3 2021 Baseline Neutrophil-to-Lymphocyte Ratio and Glasgow Prognostic Score are Associated with Clinical Outcome in Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma Treated with Nivolumab 335 343 EN Nobuyuki Chikuie Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Takao Hamamoto Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Tsutomu Ueda Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Takayuki Taruya Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Takashi Kono Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Hiromi Furuie Department of Otorhinolaryngology, Head and Neck Surgery, Kure Medical Center and Chugoku Cancer Center Takashi Ishino Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Sachio Takeno Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Original Article 10.18926/AMO/62228 Recurrent or metastatic head and neck squamous cell carcinoma (R/MHNSCC) has a poor prognosis. Although nivolumab is approved in Japan for treating R/MHNSCC, the response rate is low. Therefore, identifying pretreatment prognostic factors is necessary. This study assessed the utility of the neutrophil-to-lymphocyte ratio (NLR) and Glasgow Prognostic Score (GPS) as biomarkers of response to nivolumab. We retrospectively collected the data of 56 R/MHNSCC patients treated with nivolumab between May 2017 and December 2019. The Kaplan–Meier method and log-rank test were used to estimate overall survival (OS) and progression-free survival (PFS), and multivariate Cox hazard regression analysis was used to identify independent predictors of survival. Patients with a low pretreatment NLR had prolonged OS, and patients with a low pretreatment GPS had increased OS and PFS. A performance score (PS) of 0-1, development of immune-related adverse events, and GPS of 0-1 were significantly associated with OS in multivariate analysis. In summary, baseline pretreatment NLR and GPS are independently associated with OS in R/MHNSCC patients treated with nivolumab. Administration of nivolumab while maintaining the PS reflects a immune status of the host and leads to a good OS. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2075-4418 11 5 2021 Diagnostic Utility of SOX4 Expression in Adult T-Cell Leukemia/Lymphoma 766 EN Atsuko Nasu Division of Pathophysiology, Okayama University Graduate School of Health Sciences Yuka Gion Division of Pathophysiology, Okayama University Graduate School of Health Sciences Yoshito Nishimura Department of General Medicine, Okayama University Hospital Asami Nishikori Division of Pathophysiology, Okayama University Graduate School of Health Sciences Misa Sakamoto Division of Pathophysiology, Okayama University Graduate School of Health Sciences Yuria Egusa Division of Pathophysiology, Okayama University Graduate School of Health Sciences Azusa Fujita Division of Pathophysiology, Okayama University Graduate School of Health Sciences Tadashi Yoshino Department of Pathology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Yasuharu Sato Division of Pathophysiology, Okayama University Graduate School of Health Sciences Differentiation between adult T-cell leukemia/lymphoma (ATLL) and peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is often challenging based on pathological findings alone. Although serum anti-HTLV-1 antibody positivity is required for ATLL diagnosis, this information is often not available at the time of pathological diagnosis. Therefore, we examined whether the expression of SOX4 and p16 would be helpful for differentiating the two disease entities. We immunohistochemically examined SOX4 and p16 expression (which have been implicated in ATLL carcinogenesis) in 11 ATLL patients and 20 PTCL-NOS patients and classified them into four stages according to the percentage of positive cells. Among the ATLL cases, 8/11 (73%) were SOX4-positive, while only 2/20 (10%) PTCL-NOS cases expressed SOX4. The mean total score was 4.2 (standard deviation (SD): 0.61) in the ATLL group and 0.50 (SD: 0.46) in the PTCL-NOS group (p < 0.001). Positive expression of p16 was noted in 4/11 (36%) patients with ATLL and 3/20 (15%) patients with PTCL-NOS, with mean total scores of 1.9 (SD: 0.64) and 0.70 (SD: 0.48) in the ATLL and PTCL-NOS groups, respectively (p = 0.141). These results suggest that SOX4 may be strongly expressed in ATLL compared to PTCL-NOS cases. Therefore, it may be helpful to perform immunohistochemical staining of SOX4 when pathologists face challenges discriminating between ATLL and PTCL-NOS. No potential conflict of interest relevant to this article was reported.

Massachusetts Medical Society Acta Medica Okayama 0028-4793 384 2021 Pegcetacoplan versus Eculizumab in Paroxysmal Nocturnal Hemoglobinuria 1028 1037 EN Peter Hillmen the Department of Haematology, St. James’s University Hospital Jeff Szer the Department of Clinical Haematology, Peter MacCallum Cancer Center and Royal Melbourne Hospital Ilene Weitz Jane Anne Nohl Division of Hematology, Keck School of Medicine of USC Alexander Röth the Department of Hematology, West German Cancer Center University Hospital Essen, University of Duisburg-Essen Britta Höchsmann the Institute of Transfusion Medicine, University of Ulm and Institute of Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Transfusion Service and University Hospital Ulm Jens Panse the Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen Kensuke Usuki the Department of Hematology, NTT Medical Center Tokyo Morag Griffin the Department of Haematology, St. James’s University Hospital Jean-Jacques Kiladjian Centre d’Investigations Cliniques, Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Université de Paris Carlos de Castro the Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Hisakazu Nishimori the Department of Hematology and Oncology, Okayama University Hospital Lisa Tan Lisa Tan Pharma Consulting Mohamed Hamdani Apellis Pharmaceuticals Pascal Deschatelets Apellis Pharmaceuticals Cedric Francois Apellis Pharmaceuticals Federico Grossi Apellis Pharmaceuticals Temitayo Ajayi Apellis Pharmaceuticals Antonio Risitano the Hematology and BMT Unit, AORN San Giuseppe Moscati Régis Peffault de la Tour the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Université de Paris Background</br> Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease characterized by chronic complement-mediated hemolysis. C5 inhibition controls intravascular hemolysis in untreated PNH but cannot address extravascular hemolysis. Pegcetacoplan, a pegylated peptide targeting proximal complement protein C3, potentially inhibits both intravascular and extravascular hemolysis.</br> Methods</br> We conducted a phase 3 open-label, controlled trial to assess the efficacy and safety of pegcetacoplan as compared with eculizumab in adults with PNH and hemoglobin levels lower than 10.5 g per deciliter despite eculizumab therapy. After a 4-week run-in phase in which all patients received pegcetacoplan plus eculizumab, we randomly assigned patients to subcutaneous pegcetacoplan monotherapy (41 patients) or intravenous eculizumab (39 patients). The primary end point was the mean change in hemoglobin level from baseline to week 16. Additional clinical and hematologic markers of hemolysis and safety were assessed.</br> Results</br> Pegcetacoplan was superior to eculizumab with respect to the change in hemoglobin level from baseline to week 16, with an adjusted (least squares) mean difference of 3.84 g per deciliter (P<0.001). A total of 35 patients (85%) receiving pegcetacoplan as compared with 6 patients (15%) receiving eculizumab no longer required transfusions. Noninferiority of pegcetacoplan to eculizumab was shown for the change in absolute reticulocyte count but not for the change in lactate dehydrogenase level. Functional Assessment of Chronic Illness Therapy–Fatigue scores improved from baseline in the pegcetacoplan group. The most common adverse events that occurred during treatment in the pegcetacoplan and eculizumab groups were injection site reactions (37% vs. 3%), diarrhea (22% vs. 3%), breakthrough hemolysis (10% vs. 23%), headache (7% vs. 23%), and fatigue (5% vs. 15%). There were no cases of meningitis in either group.</br> Conclusions</br> Pegcetacoplan was superior to eculizumab in improving hemoglobin and clinical and hematologic outcomes in patients with PNH by providing broad hemolysis control, including control of intravascular and extravascular hemolysis. (Funded by Apellis Pharmaceuticals; PEGASUS ClinicalTrials.gov, NCT03500549. opens in new tab.) No potential conflict of interest relevant to this article was reported.

Japanese Society of Internal Medicine Acta Medica Okayama 0918-2918 58 8 2019 Improving Anxiety in Subacute Myelo-optico-neuropathy (SMON) after an Automated Telephone Call Service 1081 1085 EN Yasuyuki Ohta Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Nozomi Hishikawa Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kota Sato Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Mami Takemoto Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toru Yamashita Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shinji Doutare Doutare Medical Clinic Koji Abe Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Objective We evaluated the clinical effects of a telephone call service for psychological symptoms such as anxiety, depression or apathy in subacute myelo-optico-neuropathy (SMON) patients living alone or with a single caregiver. </br> Methods Up to 16 SMON patients (4 men, 12 women) and 32 control subjects were evaluated by the geriatric depression scale (GDS), apathy scale (AS) and state and trait anxiety inventory (STAI) forms X-I, including the P and A values for depression, apathy and state anxiety including disturbed peace of mind and enhanced anxiety, respectively, before (pre) and three months after (post) the telephone call service. </br> Results The SMON patients, especially women, had significantly worse baseline scores in GDS (depression), AS (apathy) and STAI (state anxiety) than control subjects. The automated telephone call service significantly improved the high baseline STAI scores, including the P and A scores (disturbed peace of mind and enhanced anxiety), of SMON patients but not the GDS or AS scores. </br> Conclusion SMON patients, especially women, living alone or with a single caregiver showed higher baseline depression, apathy and anxiety scores than the control subjects. The present automated telephone call service proved to be a useful care tool for improving the anxiety of SMON patients with high STAI P and A scores. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 1 2021 Volumetric PET Parameters Predict Prognosis after Definitive Chemoradiotherapy with Cisplatin/Docetaxel for Stage III Non-Small Cell Lung Cancer 15 23 EN Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takeshi Ogata Department of Radiology, Iwakuni Clinical Center Akihiro Tada Department of Radiology, Okayama Diagnostic Imaging Center Soichi Sugiyama Department of Radiology, Okayama University Hospital Kotaro Yoshio Department of Radiology, Okayama University Hospital Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Katsuyuki Kiura Allergy and Respiratory Medicine, Okayama University Hospital Yoshinobu Maeda Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichi Toyooka General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/61429 The aim of this study was to investigate whether volumetric positron emission tomography (PET) parameters are prognostic predictors in stage III non-small cell lung cancer patients receiving definitive concurrent chemo-radiotherapy (CCRT) with cisplatin/docetaxel. Cases involving definitive CCRT were reviewed retrospectively, and the maximum standardized uptake value, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated. The relationships between these PET parameters and prognosis were analyzed. MTV and TLG were significant predictors of distant metastasis-free survival (DMFS) (p = 0.0003 and 0.0005, respectively) and progression-free survival (PFS) (p = 0.001 and 0.0007, respectively). The three-year DMFS rates in patients with low and high MTV were 13.3% and 64.6%, respectively, and the corresponding values in those with low and high TLG were 13.3% and 65.2%, respectively. The three-year PFS rates in patients with low and high MTV were 13.3% and 57.8%, respectively, and the corresponding values in patients with low and high TLG were 13.3% and 57.8%, respectively. However, MTV and TLG were not predictors of local control or overall sur-vival. We demonstrated that volumetric PET parameters were predictors of patients receiving definitive CCRT. Our findings contradict the findings of previous reports and warrant further research to validate them. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 1 2021 Clinical Characteristics of Low Androgen Status in Males with Type 2 Diabetes Mellitus 1 8 EN Jun Hamahara Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Honda Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichiro Yamamoto Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuki Tokumasu Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihisa Hanayama Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideharu Hagiya Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikako Obika Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keigo Ueda Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masayuki Kishida Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/61424 To determine the clinical characteristics of low androgen status in adult males with diabetes, we retrospectively analyzed the medical records of patients with type 2 diabetes mellitus in whom serum free testosterone (FT) levels were examined for 1 year. Among the 46 patients (56 ± 1.5 years old), decreases in serum FT levels to < 8.5 pg/ml (indicating the occurrence of late-onset hypogonadism [LOH]) were detected in 18 (39%). The per-centages of patients with low FT levels were high in the ≥ 50 years age group (83%), the HbA1c < 7% group (67%), and the 25 ≤ BMI < 30 kg/m2 group (56%). The serum FT levels tended to decrease age-dependently. The level of HbA1c was significantly correlated with the Heinemann Aging Male Symptoms (AMS) score (R = 0.47). The low-FT group had decreased levels of hemoglobin. Of note, the serum FSH level (R = −0.32) was negatively correlated with the serum FT level, whereas the serum TSH level (R = 0.36) was positively correlated with the serum FT level. Collectively, these results revealed that many diabetic males may have low FT levels and that the AMS score is related to the HbA1c level. A slightly anemic condition, thyroid dysfunction, and obesity (class 1) might be involved in LOH in middle-aged diabetic males. No potential conflict of interest relevant to this article was reported.

岡山大学大学院社会文化科学研究科 Acta Medica Okayama 1881-1671 50 2021 インターンシップから感じる学生の職務満足分析 217 231 EN Shouji Nigo 10.18926/61341 　本研究では、国立大学の大学生を対象に質問紙調査データを用い、大学生がインターンシップの経験から感じた職務満足の要因を分析した。分析は、顧客満足度調査などで用いられるCS分析を活用し、各要因を数値化して、満足度の判断を分かりやすくするために偏差値で表し、CSグラフで可視化をした。結果、最も満足度の高い重点維持項目の要因は「人としての成長」となり、 最も改善度が高い最優先改善項目の要因は「フィードバック」となった。また、成長を感じるには、5つの職務特性と内発的モチベーションの度合いを図るMPS（Motivating Potential Score）が関係している。 　今後、企業が職務満足度の高いインターンシップを実施していくには、MPSを上げながら成長のできるプログラムを軸に考え、最も改善度の高いフィードバックを見直すことで職務満足度の向上につながると推測される。企業にとって大学生を採用につなげていくインターンシップは、今後の採用戦略として重要な位置づけとなってくる。 No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 6 2020 Reality of Gastric Cancer in Young Patients: The Importance and Difficulty of the Early Diagnosis, Prevention and Treatment 461 466 EN Yoshiyasu Kono Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiromitsu Kanzaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masaya Iwamuro Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Kawano Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiro Kawahara Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/61204 Gastric cancer usually arises in middle-aged to older patients, and is rarely found in younger patients. The clin-ical characteristics, etiology, prognosis, preventive methods and treatment of gastric cancer in young patients have not been fully investigated because of its low prevalence. In this review, we discuss the current under-standing and clinical problems associated with gastric cancer in young patients. Helicobacter pylori (H. pylori), which is a major cause of gastric cancer, especially in older populations, is closely associated with gastric cancer in young patients as well as in older patients. Gastric cancer in young patients tends to be diagnosed at an advanced stage with alarm symptoms. However, young patients with advanced gastric cancer tend to have a favorable general condition and organ function, so they can tolerate intensive systematic chemotherapy. Unfortunately, the prognosis of gastric cancer in young patients with an advanced stage is not favorable. We should not take this rare disease lightly, given its poor prognosis if patients are diagnosed at an unresectable stage. The evaluation of the H. pylori infection status and performance of H. pylori eradication therapy to prevent gastric cancer in young patients as well as the development of more intensive chemotherapy regimens for unre-sectable gastric cancer in young patients are warranted. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 1068-9265 28 2020 A Simple Prognostic Benefit Scoring System for Sarcoma Patients with Pulmonary Metastases: Sarcoma Lung Metastasis Score 3884 3890 EN Haruchika Yamamoto Department of Thoracic Surgery, Okayama University Hospital Hiromasa Yamamoto Department of Thoracic Surgery, Okayama University Hospital Junichi Soh Department of Thoracic Surgery, Okayama University Hospital Etsuji Suzuki Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kei Namba Department of Thoracic Surgery, Okayama University Hospital Ken Suzawa Department of Thoracic Surgery, Okayama University Hospital Kentaroh Miyoshi Department of Thoracic Surgery, Okayama University Hospital Shinji Otani Department of Thoracic Surgery, Okayama University Hospital Mikio Okazaki Department of Thoracic Surgery, Okayama University Hospital Seiichiro Sugimoto Department of Thoracic Surgery, Okayama University Hospital Masaomi Yamane Department of Thoracic Surgery, Okayama University Hospital Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuhito Takahashi Center for Multidisciplinary Treatment of Sarcoma, Department of Sarcoma Medicine, Kameda Medical Center Shinichi Toyooka Department of Thoracic Surgery, Okayama University Hospital Background</br> Pulmonary metastasectomy could be considered one of the treatment options for disease control in sarcoma patients with pulmonary metastases; however, there is little consensus regarding the suitable criteria for predicting the likely outcomes in these patients. The aim of this study was to establish a prognostic benefit scoring system based on preoperatively examined prognostic factors for sarcoma patients with pulmonary metastases.</br> Methods</br> This was a single-center, retrospective cohort study conducted in a cohort of 135 sarcoma patients who underwent a first pulmonary metastasectomy at Okayama University Hospital between January 2006 and December 2015. Based on the results of a multivariable logistic regression analysis performed to determine the factors influencing 3-year mortality, a Sarcoma Lung Metastasis Score was created and its correlation with 3-year survival was analyzed.</br> Results</br> The results of the multivariate analysis revealed significant differences in the disease-free interval (< 2 years vs. ≥ 2 years; odds ratio (OR) 4.22, 95% confidence interval (CI) 1.67–10.70), maximum tumor diameter (≥ 15 mm vs. < 15 mm; OR 3.86, 95% CI 1.75–8.52), and number of pulmonary metastases (≥ 6 vs. < 6; OR 2.65, 95% CI 1.06–6.620). The Sarcoma Lung Metastasis Score, which was defined as the total score of these three factors, reliably predicted 3-year survival (score: 0, 89.5%; 1, 63.2%; 2, 39.0%; 3, 10.5%).</br> Conclusions</br> Our newly proposed simple Sarcoma Lung Metastasis Score appears to be a useful prognostic predictor for sarcoma patients with pulmonary metastases, in that it could be helpful for the selection of appropriate treatments for these patients. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 0915-5635 33 2020 Efficacy of low dose rectal diclofenac for preventing post‐endoscopic retrograde cholangiopancreatography pancreatitis: Propensity score‐matched analysis 656 662 EN Takeshi Tomoda Department of Gastroenterology and Hepatology, Okayama University Hospital Hironari Kato Department of Gastroenterology and Hepatology, Okayama University Hospital Kazuya Miyamoto Department of Gastroenterology and Hepatology, Okayama University Hospital Akihiro Matsumi Department of Gastroenterology and Hepatology, Okayama University Hospital Eijiro Ueta Department of Gastroenterology and Hepatology, Okayama University Hospital Yuuki Fujii Department of Gastroenterology and Hepatology, Okayama University Hospital Yousuke Saragai Department of Gastroenterology and Hepatology, Okayama University Hospital Tatsuhiro Yamazaki Department of Gastroenterology and Hepatology, Okayama University Hospital Daisuke Uchida Department of Gastroenterology and Hepatology, Okayama University Hospital Kazuyuki Matsumoto Department of Gastroenterology and Hepatology, Okayama University Hospital Shigeru Horiguchi Department of Gastroenterology and Hepatology, Okayama University Hospital Koichiro Tsutsumi Department of Gastroenterology and Hepatology, Okayama University Hospital Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Hospital Background</br> Acute pancreatitis is a major adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Rectal administration of non‐steroidal anti‐inflammatory drugs (NSAIDs) decreases the incidence of post‐ERCP pancreatitis (PEP). However, the efficacy of low dose rectal NSAIDs for preventing PEP remains controversial.</br> Methods</br> We performed a retrospective study of 301 patients with native papilla and a body weight of <50 kg who underwent ERCP between September 2010 and October 2019. After July 2016, a 25 mg dose of rectal diclofenac was routinely administered within 15 min before ERCP (NSAIDs group, n = 72) and the control group (n = 229) consisted of patients undergoing ERCP before this date without treatment. We compared the incidence of PEP between the two groups using propensity score matching. </br> Results</br> A total of 66 pairs of patients in each group were selected. The patients and procedural‐related factors were similar in both groups. In total, 15 patients (11.4%) developed PEP: 12.1% (8/66) in the NSAIDs group and 10.6% (7/66) in the control group (Odds ratio (OR) 1.2; 95% confidence interval (CI) 0.4–3.5; P = 0.78). There was no significant difference in incidence of other adverse events related to ERCP between the two groups. </br> Conclusions</br> Prophylactic administration of a 25 mg dose of rectal diclofenac did not reduce the incidence of PEP in patients with a native papilla and a body weight of <50 kg in this study and a certain dose of rectal NSAIDs, such as a 100‐mg dose, should be administered regardless of body weight to prevent PEP. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 5 2020 Combined Laparoscopic and CT Monitoring of the Ice-Ball Margin during Cryoablation for Renal Cell Carcinoma Associated with von Hippel-Lindau Disease: First Case 443 448 EN Takanori Sekito Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Motoo Araki Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mayu Uka Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyuki Komaki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Matsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshihiro Iguchi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi Katayama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kasumi Yoshinaga Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shogo Watari Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Maruyama Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yosuke Mitsui Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Risa Kubota Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Sadahira Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shingo Nishimura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichiro Wada Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Atsushi Takamoto Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kohei Edamura Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoko Sako Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuyuki Kobayashi Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toyohiko Watanabe Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasutomo Nasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/60806 We report a 47-year-old Japanese female with 10 previous treatments for multiple bilateral renal cell carcinoma (RCC) associated with von Hippel-Lindau disease. The 14-mm right lower pole renal tumor was in contact with the right ureter. Laparoscopic cryoablation was performed to protect the ureter wrapped with gauze. Computed tomography (CT) monitoring was used to confirm the precise ≥ 6 mm ice-ball margin. There was no local progression at 6-months post-surgery. The serum creatinine has been stable. This is apparently the first report of combined laparoscopic and CT monitoring of an ice-ball formation and its margin during cryoablation for RCC. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 5 2020 Three-dimensional Evaluation of Abnormal Gait in Patients with Hip Osteoarthritis 391 399 EN Daisuke Homma Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences Izumi Minato Division of Orthopedic Surgery, Niigata Rinko Hospital Norio Imai Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences Dai Miyasaka Division of Orthopedic Surgery, Niigata Bandai Hospital Yoshinori Sakaif Division of Orthopedic Surgery, Niigata General Hospital Yoji Horigome Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences Hayato Suzuki Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences Hayato Shimada Division of Orthopedic Surgery, Mito Saiseikai General Hospital Yoichiro Dohmae Division of Orthopedic Surgery, Niigata Bandai Hospital Naoto Endo Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences Original Article 10.18926/AMO/60798 Indexes for objectively evaluating abnormal gait in hip osteoarthritis (OA) patients and determining effective interventions are unclear. We analyzed the abnormal gait of hip OA patients by focusing on movements of the trunk and pelvis to establish an effective evaluation index for each direction of motion. We studied 28 patients with secondary hip OA due to developmental dysplasia of the hip and 16 controls. The trunk and pelvic movements during gait were measured in the medial-lateral (x), vertical (y), and back-and-forth (z) directions by a triaxial angular accelerometer. Gait speed, steps, step length, muscle strength, range of motion, and timed up-and-go (TUG) test performance were measured. We determined the correlations between physical function and the index of abnormal gait in the hip OA patients. Movements other than trunk and pelvic motions in the y-direction indicated abnormal gait in the patients. Significant correlations were found between abnormal gait and range of motions (extension, internal rotation), TUG score, stride length, and steps. The TUG test, stride length and steps were important for evaluating abnormal gait in hip OA patients. Individual interventions for each movement direction are required. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 1749-799X 15 1 2020 Short-term outcomes of mirogabalin in patients with peripheral neuropathic pain: a retrospective study 191 EN Tomoko Tetsunaga Department of Orthopedic Surgery, Okayama University Hospital Tomonori Tetsunaga Department of Orthopedic Surgery, Okayama University Hospital Keiichiro Nishida Department of Orthopedic Surgery, Okayama University Hospital Haruo Misawa Department of Orthopedic Surgery, Okayama University Hospital Tomoyuki Takigawa Department of Orthopedic Surgery, Okayama University Hospital Kentaro Yamane Department of Orthopedic Surgery, Okayama University Hospital Hironori Tsuji Department of Orthopedic Surgery, Okayama University Hospital Yoshitaka Takei Department of Orthopedic Surgery, Kurashiki Municipal Hospital Toshifumi Ozaki Department of Orthopedic Surgery, Okayama University Hospital Background</br> Mirogabalin, which is approved for the treatment of peripheral neuropathic pain in Japan, is a ligand for the α2δ subunit of voltage-gated calcium channels. Both pregabalin and mirogabalin act as nonselective ligands at the α2δ-1 and α2δ-2 subunits. Mirogabalin has a unique binding profile and long duration of action. Pregabalin has been reported to produce intolerable adverse effects in some patients. This study investigated outcomes associated with mirogabalin administration in patients with peripheral neuropathic pain who ceased treatment with pregabalin.</br> Methods</br> We retrospectively assessed peripheral neuropathic pain using the neuropathic pain screening questionnaire (NeP score) in 187 patients (58 men, 129 women) who were treated with mirogabalin. All patients had switched from pregabalin to mirogabalin due to lack of efficacy or adverse events. Differences in the treatment course (i.e., numeric rating scale (NRS) scores) were compared using one-way analysis of variance with Bonferroni post hoc tests.</br> Results</br> The mean age of the patients was 72.3 years (range, 30–94 years), and the mean duration of disease was 37 months (range, 3–252 months). After treatment with mirogabalin for 1 week, NRS scores significantly decreased compared with baseline and continued to decrease over time. After 8 weeks, NRS scores improved by ≥ 30% from baseline in 113 patients (69.3%). Twenty-four patients (12.8%) stopped mirogabalin treatment due to adverse events. Somnolence (26.7%), dizziness (12.3%), edema (5.9%), and weight gain (0.5%) were noted as adverse events of mirogabalin.</br> Conclusions</br> The results of this investigation indicate that mirogabalin is safe and effective for reducing peripheral neuropathic pain. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 The Late Phase/Early Phase Ratio of Pancreatic CT Values as a Novel Predictor of Pancreatic Fistula after Distal Pancreatectomy 351 358 EN Masashi Utsumi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Hideki Aoki Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Takayuki Yabuki Department of Radiology, National Hospital Organization, Iwakuni Clinical Center Seiichi Nagahisa Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Seitaro Nishimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yuta Une Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yuji Kimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Megumi Watanabe Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Fumitaka Taniguchi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Takashi Arataa Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Koh Katsuda Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Kohji Tanakaya Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yumiko Sato Department of Pathology, National Hospital Organization, Iwakuni Clinical Center Original Article 10.18926/AMO/60374 Post-operative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy (DP). In this retrospective study, we reviewed the data from patients who underwent DP between 2008 and 2019 in our institute to determine whether the late phase/early phase ratio (L/E ratio) by preoperative computed tomography (CT) scan in the pancreas could predict POPF occurrence after DP. We examined the relationship between preoperative or intraoperative factors and the occurrence of POPF after DP using statistical methods in 23 males and 21 females with a mean age of 73. The mean L/E ratio was significantly lower in the POPF group than the non-POPF group (p=0.035). The L/E ratio had moderate diagnostic accuracy, with a calculated optimal cutoff value of 0.77. In univariate analysis, a significant association was noted between POPF and stump thickness ≥ 16.9, body mass index ≥ 27.5, and L/E ratio ≤ 0.77. In the multivariate analysis, the L/E ratio (odds ratio, 5.96; p=0.036) was an independent risk factor for POPF. Our findings suggest that the pancreatic L/E ratio may predict the occurrence of POPF after DP. This measure may be useful in preoperative risk stratification, patient counseling, and perioperative patient management, improving clinical outcomes after DP. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Preoperative Use of Alpha-1 Receptor Blockers in Male Patients Undergoing Extracorporeal Shock Wave Lithotripsy for a Ureteral Calculus 293 299 EN Takashi Yoshioka Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University Kenji Omae Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University Tatsushi Kawada Department of Urology, Onomichi Municipal Hospital Yosuke Inoue Department of Urology, Onomichi Municipal Hospital Morito Sugimoto Department of Urology, Onomichi Municipal Hospital Tadashi Oeda Department of Urology, Onomichi Municipal Hospital Shinya Uehara Department of Urology, Kawasaki Medical School General Medical Center Motoo Araki Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunichi Fukuhara Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University Original Article 10.18926/AMO/60367 In this retrospective single-center cohort study, we investigated the impact of preoperative use of an alpha-1 adrenergic receptor (AR) blocker on the outcome of single-session extracorporeal shock wave lithotripsy (SWL) in 193 male patients who underwent SWL for a single ureteral calculus between 2006 and 2016. We reviewed their medical records to obtain the data on the preoperative use of alpha-1 AR blockers. The primary outcome was treatment success after single-session SWL. We performed a multivariable logistic regression analysis adjusting for clinically important confounders to examine the association between preoperative use of alpha-1 AR blockers and the treatment success of SWL. Among the 193 patients, 15 (7.8%) were taking an alpha-1 AR blocker preoperatively. A multivariable analysis showed that preoperative use of an alpha-1 AR blocker was a significant negative predictor for treatment success of SWL (adjusted odds ratio 0.17; 95% confidence intervals, 0.04-0.74). Our findings suggest that the preoperative use of an alpha-1 AR blocker was a negative predictor of treatment success of SWL in male patients with a single ureteral calculus. Clinicians should pay more attention to the preoperative drug use in determining an appropriate stone therapy modality. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Decreased Serum Antioxidant Marker is Predictive of Early Recurrence in the Same Segment after Radical Ablation for Hepatocellular Carcinoma 275 283 EN Taiko Muro Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichiro Nakamura Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akinobu Takaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideki Onishi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nozomu Wada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tetsuya Yasunaka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Daisuke Uchida Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Atsushi Oyama Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Adachi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hidenori Shiraha Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/60364 Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is a promising method for controlling tumors, although it does not entirely eliminate recurrence. Oxidative stress is associated with the progression of hepatocarcinogenesis, while also acting as an anticancer response. The objective of the present study was to investigate the factors influencing post-RFA outcomes. We recruited 235 newly diagnosed HCC patients who received RFA for single tumors. The patients with recurrence were sub-grouped into early and segmental recurrence groups. The characteristics of the sub-grouped patients were evaluated, including by measuring oxidative stress marker reactive oxygen metabolites and antioxidant marker OXY-adsorbent tests. The factors associated with poor survival were a high Child-Pugh score and early recurrence within 2 years in the same segment. The patients who experienced recurrence within 2 years in the same segment showed a larger tumor diameter than did others. According to a multivariate analysis, the OXY values were also significantly low in these patients. In conclusion, maintaining the antioxidant reservoir function with a high OXY value might be necessary to prevent early recurrence within the RFA-treated segment. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Factors Predicting a Favorable Disease Course Without Anti-TNF Therapy in Crohn’s Disease Patients 265 274 EN Toshihiro Inokuchi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Sakiko Hiraoka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Eriko Yasutomi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shohei Oka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasushi Yamasaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideaki Kinugasa Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiro Takahar Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Kawano Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keita Harada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Kato bDepartment of Gastroenterology, Mitsui Memorial Hospital Original Article 10.18926/AMO/60363 Determining factors that predict a favorable disease course without anti-tumor necrosis factor (TNF) agents would help establish a more cost-effective strategy for Crohn’s disease (CD). A retrospective chart review was performed for CD patients with disease durations > 10 years who had not received anti-TNF agents as first-line therapy. Patients were divided into 2 groups: those who received neither anti-TNF agents nor bowel resection (G1), and those who had received an anti-TNF agent and/or bowel resection (G2). The patient backgrounds, therapies and clinical courses were compared between the groups. A total of 62 CD patients met the inclusion criteria (males: 71%; median duration of follow-up: 19 years). Six patients were included in G1; they were significantly less likely to have upper gastrointestinal lesions than G2 (p=0.007). A multivariate analysis revealed that the significant factors for avoidance of bowel resection without anti-TNF treatment were non-stricturing and non-penetrating behaviors, and absence of upper gastrointestinal lesions at the diagnosis (hazard ratios 0.41 and 0.52; p=0.004 and 0.04, respectively). In consideration of the long treatment course of CD, patients with non-stricturing and non-penetrating behaviors and no upper gastrointestinal lesions should not be treated with anti-TNF agents as first-line therapy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 3 2020 Exploring the Issues of Advance Directives in Patients with Mild Dementia in Taiwan 215 220 EN Hsi-Hsien Chou School of Medicine, Chung-Shan Medical University Original Article 10.18926/AMO/59952 Due to cultural traditions, most Taiwanese do not have an advance directive or healthcare proxy. We explored how patients with mild dementia in Taiwan may still make self-determined decisions concerning advance directives for their healthcare and end-of-life care choices as the disease progresses. We examined 260 respondents with mild dementia at a Taiwan medical center: 199 patients who agreed (and 61 patients who disagreed) with the concept of advance directives completed a structured questionnaire. Multiple logistic regression models to determine the between-group differences revealed that the following were positively associated with approval of end-of-life directives: maintaining one’s quality of life (adjusted odds ratio [AOR], 2.44; 95% CI: 1.07-5.53), discussion with family members (AOR, 3.50; 95% CI: 1.49-8.26), and friend support networks (AOR, 3.36; 95% CI: 1.34-8.43). Cardiopulmonary resuscitation (AOR, 0.27; 95% CI: 0.09-0.79) was negatively associated with approval. There was also a positive association between the support of the legal validity of end-of-life directives (OR, 1.93; 95% CI: 1.07-3.48), without other confounding factors. In Taiwanese society, we remain mindful of cultural influences that may impact patients, including maintaining one’s quality of life, discussion with family members, and friend/support networks. These influences may help dementia patients complete their advance directives. No potential conflict of interest relevant to this article was reported.

Public Library of Science Acta Medica Okayama 1932-6203 15 1 2020 Podocyte autophagy is associated with foot process effacement and proteinuria in patients with minimal change nephrotic syndrome EN Ayu Ogawa-Akiyama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hitoshi Sugiyama Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masashi Kitagawa Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keiko Tanaka Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuzuki Kano Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koki Mise Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nozomu Otaka Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuyuki Tanabe Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Morinaga Division of Medical Informatics,Okayama University Hospital Masaru Kinomura Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruhito A. Uchida Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Autophagy is a cellular mechanism involved in the bulk degradation of proteins and turnover of organelle. Several studies have shown the significance of autophagy of the renal tubular epithelium in rodent models of tubulointerstitial disorder. However, the role of autophagy in the regulation of human glomerular diseases is largely unknown. The current study aimed to demonstrate morphological evidence of autophagy and its association with the ultrastructural changes of podocytes and clinical data in patients with idiopathic nephrotic syndrome, a disease in which patients exhibit podocyte injury. The study population included 95 patients, including patients with glomerular disease (minimal change nephrotic syndrome [MCNS], n = 41; idiopathic membranous nephropathy [IMN], n = 37) and 17 control subjects who underwent percutaneous renal biopsy. The number of autophagic vacuoles and the grade of foot process effacement (FPE) in podocytes were examined by electron microscopy (EM). The relationships among the expression of autophagic vacuoles, the grade of FPE, and the clinical data were determined. Autophagic vacuoles were mainly detected in podocytes by EM. The microtubule-associated protein 1 light chain 3 (LC3)-positive area was co-localized with the Wilms tumor 1 (WT1)-positive area on immunofluorescence microscopy, which suggested that autophagy occurred in the podocytes of patients with MCNS. The number of autophagic vacuoles in the podocytes was significantly correlated with the podocyte FPE score (r = -0.443, p = 0.004), the amount of proteinuria (r = 0.334, p = 0.033), and the level of serum albumin (r = -0.317, p = 0.043) in patients with MCNS. The FPE score was a significant determinant for autophagy after adjusting for the age in a multiple regression analysis in MCNS patients (p = 0.0456). However, such correlations were not observed in patients with IMN or in control subjects. In conclusion, the results indicated that the autophagy of podocytes is associated with FPE and severe proteinuria in patients with MCNS. The mechanisms underlying the activation of autophagy in association with FPE in podocytes should be further investigated in order to elucidate the pathophysiology of MCNS. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 0968-0160 27 3 2020 The distance between the tibial tunnel aperture and meniscal root attachment is correlated with meniscal healing status following transtibial pullout repair for medial meniscus posterior root tear 899 905 EN Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Hospital Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Hospital Yusuke Kamatsuki Department of Orthopaedic Surgery, Kochi Health Science Center Shinichi Miyazawa Department of Orthopaedic Surgery, Okayama University Hospital Yoshiki Okazaki Department of Orthopaedic Surgery, Okayama University Hospital Shin Masuda Department of Orthopaedic Surgery, Okayama University Hospital Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Hospital Yuya Kodama Department of Orthopaedic Surgery, National Hospital Organization Iwakuni Clinical Center Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Hospital Background</br> To investigate the relationship between tibial tunnel aperture location and postoperative meniscal healing.</br> Methods</br> We enrolled 25 patients (20 women and five men, mean age: 62.5 years) who underwent transtibial pullout repair for medial meniscus (MM) posterior root repair. The expected MM posterior root attachment center (AC) and tibial tunnel center (TC) were identified using three-dimensional computed tomography, and the minimum AC–TC distance was calculated. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period: 15 months) using a previously reported scoring system (meniscal healing score; range: 0–10). The association between AC–TC distance and meniscal healing score was investigated using univariate linear regression models. The optimal AC–TC distance cut-off for improved MM healing score (≥ 7) was determined using receiver operating characteristic analysis.</br> Results</br> The AC–TC distance and meniscal healing score were significantly associated (y = − 0.42x + 9.48, R2 = 0.342; P = 0.002), with the optimum AC–TC distance being 5.8 mm. This cut-off had a sensitivity of 100% and specificity of 53%.</br> Conclusions</br> This study demonstrates that AC–TC distance is significantly correlated with postoperative meniscal healing. Anatomical repair within 5.8 mm of the AC may result in improved meniscal healing. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 The Efficacy of Mirabegron for the Relief of Ureteral Stent-Related Symptoms 145 150 EN Hideo Otsuki Department of Urology, Abiko Toho Hospital Tomoya Yamasaki Department of Urology, Abiko Toho Hospital Shunsuke Hori Department of Urology, Abiko Toho Hospital Hiroshi Aoki Department of Urology, Abiko Toho Hospital Takeo Kosaka Department of Urology, Keio University Shinya Uehara Department of Urology, Kawasaki Medical School General Medical Center Kei Fujio Department of Urology, Abiko Toho Hospital Original Article 10.18926/AMO/58273 To investigate the efficacy of mirabegron for lower urinary tract symptoms in patients with an indwelling ureteral stent after ureterorenoscopic lithotripsy. This was a prospective follow-up study of 76 patients with stent-related symptoms (SRSs). Patients with upper urinary calculi who were pre-stented for > 2 weeks before lithotripsy were examined for the presence of SRSs by tests including the International Prostate Symptom Score (IPSS), OAB Symptom Score (OABSS), and urinary bother and pain measured by a Visual Analogue Scale (VAS) before lithotripsy. Mirabegron (50 mg/day) was prescribed post-lithotripsy for 2 weeks. SRSs were assessed at the time of stent removal. The IPSS scores improved significantly from 16.2 to 14.3 (p<0.001) and the IPSS-QoL scores decreased significantly from 5.0 to 4.6 (p=0.012). The OABSS scores improved significantly from 7.7 to 6.8 (p=0.006), and the urinary urgency scores (OABSS-Q3) decreased significantly from 3.24 to 2.68 (p<0.001). The number of nocturia episodes decreased significantly from 2.5 to 2.2 (p=0.045). Urinary bother and pain assessed by the VAS declined from 4.2 and 3.1 to 3.8 (p=0.15) and 2.5 (p=0.075), respectively. Mirabegron significantly improved SRSs and the number of nocturia episodes due to a ureteral stent. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 The Diagnostic Capacity of Pre-treatment 18F-FDG PET/CT for Predicting the Extranodular Spread of Lymph Node Metastases in Patients with Oral Squamous Cell Carcinoma 123 128 EN Ryuichiro Fukuhara Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayoshi Shinya Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Shogo Fukuma Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Nanako Ogawa Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Yoshihisa Masaoka Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Takehiro Tanaka Department of Pathology, Okayama Diagnostic Imaging Center, Okayama university Hospital Hidenori Marunaka Department of Otolaryngology-Head & Neck Surgery, Okayama Diagnostic Imaging Center, Okayama university Hospital Tadashi Arioka Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Takao Hiraki Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Mitsumasa Kaji Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Susumu Kanazawa Department of Radiology, Okayama Diagnostic Imaging Center, Okayama university Hospital Original Article 10.18926/AMO/58270 The aim of this study was to evaluate the ability of pretreatment 90-min 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict the extranodular spread of lymph node metastases in oral squamous cell carcinoma. We retrospectively reviewed the cases of 56 patients who underwent pretreatment 18F-FDG PET/CT and surgery with neck dissection. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were measured for the 56 primary sites and maximum standardized uptake value was measured for 115 lymph node levels. Extranodular spread was present at 9 lymph node levels in 7 patients. Significant differences were found in metabolic tumor volume and total lesion glycolysis of the primary site, and in lymph node maximum standardized uptake value, between patients with and without extranodular spread (p<0.05). Combining primary site total lesion glycolysis and lymph node maximum standardized uptake volume at their respective optimal cutoffs, the sensitivity, specificity, and accuracy for predicting extranodular spread were 89%, 92%, and 92%, respectively. Pretreatment 18F-FDG PET/CT is useful for predicting extranodular spread in patients with oral squamous cell carcinoma. The combined use of primary site total lesion glycolysis and lymph node maximum standardized uptake value showed greater predictive value than either predictor singly. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1661-7827 16 21 2019 Quasi-Randomized Trial of Effects of Perioperative Oral Hygiene Instruction on Inpatients with Heart Diseases Using a Behavioral Six-Step Method E4252 EN Chie Omori Department of Preventive Dentistry, Okayama University graduate School of Medicine, Dentistry and Pharmaceutical Sciences Daisuke Ekuni Department of Preventive Dentistry, Okayama University graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yumiko Ohbayashi Department of Oral and Maxillofacial Surgery, Kagawa University Hospital Minoru Miyake Department of Oral and Maxillofacial Surgery, Kagawa University Hospital Manabu Morita Department of Preventive Dentistry, Okayama University graduate School of Medicine, Dentistry and Pharmaceutical Sciences The assessor-blinded, parallel-design, quasi-randomized study (alternating allocation) aimed to determine the effects of the six-step method on postoperative numbers of oral bacteria, periodontal status, and atrial fibrillation (AF) among inpatients with heart diseases and periodontitis. Seventy inpatients who received preoperative periodontal treatment were quasi-randomly assigned to intervention and control groups at University Hospital. The intervention group received intensive oral hygiene instruction using a six-step method for 15 minutes per week and the control group received routine oral hygiene instruction. Significantly fewer oral bacteria were identified on the tongue at discharge compared with baseline in the intervention than the control group (ANCOVA) (large effect size, p = 0.02). Changes in scores for self-efficacy, plaque scores, probed pocket depth, and bleeding on probing between baseline and discharge were significantly greater in the intervention, than in the control group (p < 0.05). The period of postoperative AF (days) was significantly shorter in the intervention, than in the control group (p = 0.019). In conclusion, oral hygiene instruction using the six-step method decreased the numbers of oral bacteria on the tongue and improved self-efficacy, oral health behaviors, oral hygiene status, periodontal status, and period of postoperative AF among inpatients with periodontitis and heart diseases. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 1 2020 Clinical Relevance of Blood Glucose and Gastroesophageal Reflux Symptoms to Depressive Status in Patients with Type 2 Diabetes Mellitus 33 40 EN Hiroyuki Honda Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihisa Hanayama Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikako Obika Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kou Hasegawa Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Hamahara Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masayuki Kishida Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideharu Hagiya Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroko Ogawa Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hitomi Kataoka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/57950 A relationship between diabetes and depression is apparent. To clarify the clinical relevance of diabetic patients’ gastroesophageal symptoms to their psychological status, we retrospectively analyzed the data from a Selfrating Depression Scale (SDS) and a Frequency Scale for Symptoms of Gastroesophageal reflux disease (FSSG) among 143 type 2 diabetic patients who visited a general medicine department. Among the 45 Japanese patients enrolled, the group with relatively high SDS scores (≥ 36) showed higher (FSSG) dysmotility symptom scores versus the low-SDS (< 36) group, although the 2 groups’ characteristics and laboratory data were not significantly different. Positive correlations of postprandial plasma glucose (PPG) levels with FSSG scores (R=0.321, p<0.05), particularly with reflux scores (R=0.455, p<0.01) were revealed. PPG and HbA1c levels were not correlated with SDS scores. The patients’ SDS scores were significantly correlated with their FSSG scores (R=0.41, p<0.01), suggesting that depressive status is linked to GERD-related manifestations. Considering that the patients’ PPG levels were correlated with GERD-related symptoms, diabetic patients’ blood glucose levels are associated with depressive status. Collectively, key symptoms related to GERD and glucose level values would be helpful No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 1 2020 Relationship between a High-inspired Oxygen Concentration and Dorsal Atelectasis in High-energy Trauma Patients 17 26 EN Kenzo Ishii Department of Anesthesiology and Oncological Pain Medicine, Fukuyama City Hospital Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazumi Ono Department of Anesthesiology and Oncological Pain Medicine, Fukuyama City Hospital Koji Miyasho Department of Critical Care and Emergency Medicine, Fukuyama City Hospital Original Article 10.18926/AMO/57948 We performed a retrospective cohort study of 911 high-energy trauma patients who underwent chest CT scans at least twice after admission. We hypothesized that in high-energy trauma patients, a high-inspired oxygen concentration delivered after admission results in dorsal atelectasis. The study’s primary outcome was dorsal atelectasis formation diagnosed based on CT images. We defined dorsal atelectasis as the presence of atelectasis at ≥ 10 mm thick on CT images. We defined high-inspired oxygen concentration as >60% oxygen delivered between two CT scans. Four hundred sixty-five patients (51.0%) developed atelectasis according to the second CT scan, and 338 (37.1%) received a high-inspired oxygen concentration. A univariate analysis showed that the rate of the high-inspired oxygen concentration in the atelectasis group was significantly higher than that in the non-atelectasis group (43.4% vs. 30.1%, p<0.001). However, a logistic regression analysis showed that there was no significant relationship between the oxygen concentration and the formation of dorsal atelectasis (OR: 1.197, 95%CI: 0.852-1.683, p=0.30). Age, the Injury Severity Score, BMI, and smoking were found to be risk factors of dorsal atelectasis formation in high-energy trauma patients. There was no relationship between the oxygen concentration and atelectasis formation in our series of high-energy trauma patients. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 1 2020 Ten-Year Outcomes of Total Hip Arthroplasty Using Fit-and-Fill Type Cementless Collared Straight Stem Implants: Relationship between the Initial Contact Status and Stress Shielding 7 15 EN Tomoaki Sanki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hirosuke Endo Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomonori Tetsunaga Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuki Yamada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/57947 We investigated the relationship between the initial contact status and stress shielding in total hip arthroplasty (THA) using fit-and-fill type straight-stem implants. In addition we evaluated the clinical and radiographic outcomes. Subjects were 100 hips of 94 patients who underwent THA and were followed-up for ≥10 years. Contact areas with the femoral cortical bone were investigated according to the zonal distribution of Gruen using postoperative CT images. Depending on the number of contact areas, the patients were classified into high contact [HC], medium contact [MC], and low contact [LC] groups. Radiographic and clinical outcomes were evaluated. In the HC group (20 hips), severe stress shielding was observed in 12 hips, which was statistically significant (p=0.008). In the LC group (29 hips), mild stress shielding was observed in 27 hips which was statistically significant (p<0.001). No significant differences were observed among the 3 groups in clinical outcomes, Harris hip score (p=0.719) or Japanese Orthopedic Association (JOA) score (p=0.301). In insertion of cementless collared fit-and-fill type straight-stem implants, severe late stress shielding of the femoral bone may occur if high contact of the femoral component is achieved. However, the degree of stress shielding does not result in adverse clinical outcomes. No potential conflict of interest relevant to this article was reported.

Lippincott, Williams & Wilkins Acta Medica Okayama 0009-921X 477 8 2019 Temporary External External Fixation Can Stabilize Hip Transposition Arthroplasty After Resection of Malignant Periacetabular Bone Tumors 1892 1901 EN Toshiyuki Kunisada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomohiro Fujiwara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Joe Hasei Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Eiji Nakata Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masuo Senda Department of Rehabilitation, Okayama University Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background: The choice of reconstructive procedure to restore limb function is challenging after internal hemipelvectomy. Hip transposition arthroplasty, also known as resection arthroplasty, removes a malignant or aggressive tumor of the pelvis and acetabulum after which the remaining femoral head is moved proximally to the lateral surface side of the sacrum or the underside of the resected ilium after internal hemipelvectomy. It may provide reasonable functional results and have some advantages such as lowering the risk of an infected implant compared with other reconstructions because no foreign implants are used. Hip transposition is generally managed with prolonged bed rest or immobilization postoperatively to stabilize the soft tissue surrounding the remaining femur. Because enabling patients to be mobile while the soft tissues heal might be advantageous, we reviewed our experience with an external fixation for this procedure.<br/> Questions/purposes: (1) Does temporary external fixation facilitate postoperative physiotherapy in patients who undergo hip transposition arthroplasty? (2) What functional Musculoskeletal Tumor Society (MSTS) scores were achieved at short term in a small series of patients treated with hip transposition and temporary external fixation? (3) What were the complications of using external fixation in a small series of patients who received it for malignant tumors?<br/> Methods: Between 2008 and 2012, we treated seven patients (three men and four women; median age, 37 years; age range, 18-53 years) with acetabular resection for malignant bone tumors; all were managed with a hip transposition, initially stabilized using external fixation. No other types of procedures were used for this indication in this period. Minimum followup in this retrospective study was 45 months, except for one patient who died at 18 months (range of followup duration, 18-90 months; median followup, 57 months), and no patients were lost to followup. The pins for external fixation were inserted into the affected side of the femur and the healthy contralateral ilium. External fixation was removed 6 weeks postoperatively and weightbearing was started at that time. Preoperative chemotherapy was administrated in four patients, but postoperative chemotherapy was delayed since it was given after external fixation removal in three patients. The postoperative rehabilitation course and functional results were assessed by chart review, functional results were determined using MSTS scores, tallied by physiotherapists who were not part of the surgical team, and complications were ascertained through chart review. Major complications were defined as complications that were treated with additional operations, such as deep infection, or ones that could cause severe postoperative dysfunction, such as nerve injury.<br/> Results: With temporary external fixation, standing next to a bed was achieved in median 7 days (range, 6-9 days) postoperatively, transferring to a wheel chair in median 8 days (range, 6-28 days), and gait training using parallel bars in median 15 days (range, 7-48 days). At most recent followup, three patients could walk without a crutch or cane, three could walk with a cane, and one could walk with a crutch. The median MSTS score at most recent followup (median, 57 months) was 63%. Two patients had complications that resulted in reoperations; one had a wound dehiscence, and one had an abdominal herniation that gradually developed, and which was reconstructed using polypropylene mesh 2 years after pelvic resection. Two patients had nerve palsies that recovered by the end of the first year. All patients had pin tract infections that resolved with nonsurgical approaches.<br/> Conclusions: Hip transposition with temporary external fixation can stabilize the bone soft tissue after pelvic resection. Although we did not have a comparison group of patients, we believe that external fixation facilitates early postoperative physiotherapy and rehabilitation and provides good functional results without major surgical complications. Because it delays the resumption of chemotherapy, more patients with longer followup are needed to determine whether this will be associated with poorer oncologic results. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 6 2019 Time to Bone Union after Hybrid Closed-Wedge High Tibial Osteotomy 511 516 EN Yasuhiro Takahara Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hirotaka Nakashima Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Satoru Itani Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Makoto Nakamura Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Yoichiro Uchida Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Hisayoshi Kato Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Yoshitaka Tsujimura Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Yuichi Iwasaki Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Nobuaki Ochi Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital Original Article 10.18926/AMO/57715 Medial open- and lateral closed-wedge high tibial osteotomy (hybrid CWHTO) can overcome the limitations of conventional CWHTO and open-wedge HTO (OWHTO) for medial compartmental osteoarthritis (OA) of the knee. Hybrid CWHTO increases stability by using a rigid locking plate and allows early full weight-bearing. However, the literature contains no information about time to bone union after this new procedure. The aim of this study is to evaluate the time to bone union after hybrid CWHTO. We reviewed 44 knees treated with hybrid CWHTO. Patients were able to stand on both legs on the day after surgery and walked with full weight-bearing within 4 weeks of the procedure. The time to achievement of bone union at the osteotomy site was defined as the number of months until bone union was confirmed on radiographic imaging. The mean time to radiographic confirmation of bone union was 4.5±1.5 months after surgery. Eleven knees (25.0%) required 6 months or more. Radiographic analysis and JOA score improved significantly between before and 1 year after surgery (p<0.01). Hybrid CWHTO is a very useful method for treating medial OA, but radiographic bone union requires 4.5 months on average. We must be aware of bone union after hybrid CWHTO. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 6 2019 Correlations between Depressive Condition and Gastroesophageal Reflux Symptoms in Patients Visiting a Department of General Medicine 479 486 EN Yu Suganami Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kosuke Oka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihisa Hanayama Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Honda Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Hamahara Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikako Obika Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuya Kariyama Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masayuki Kishida Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/57711 To clarify the potential relevance of patients’ chief complaints at a general medicine department to their self-rating depression scale (SDS) and frequency scale for symptoms of gastroesophageal reflux disease (GERD) (FSSG) scores, we analyzed data of 478 patients who visited our general medicine department. The chief complaints (553 symptoms of 447 patients) were categorized into major symptom-based groups: respiratory (31%), circulatory (3%), gastrointestinal (GI) tract (26%), neurology (8%), orthopedic and skin (10%), and systemic (22%) symptoms. The SDS score tended to be higher in females and younger patients. The FSSG score did not differ by gender but was higher in younger patients. The patients receiving social welfare had higher SDS and FSSG scores. A close inter-relationship between the FSSG (including both degrees of reflux and dysmotility) and SDS was observed in all patients. Although the averages of the SDS and FSSG scores were not significantly different among the symptom-based categories, we observed significantly positive correlations between the FSSG and SDS in each category, suggesting that depressive status may be closely related to GERD-related symptoms regardless of the patients’ chief complaints. An initial checkup of patients’ psychological condition and/or GERD-like symptoms could help screen for latent disorders in outpatients with uncertain complaints. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Risk Factors for Low Bone Mineral Density Determined in Patients in a General Practice Setting 403 411 EN Akemi Ando Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Mitsugi Honda Division of Radiology, Department of Medical Technology, Okayama University Hospital Yoshihisa Hanayama Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kou Hasegawa Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikako Obika Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hitomi Kataoka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/57370 Osteoporosis increases the risk of bone fractures. It is diagnosed based on an individual’s bone mineral density (BMD) or a fracture without trauma. BMD is usually measured by the dual energy X-ray absorptiometry (DXA) method. Here we investigated factors for the earliest possible prediction of decreased BMD by examining the relationships between patients’ BMD values and changes in the patients’ physical and laboratory values. We retrospectively reviewed the medical records of 149 patients who visited our department in 2014-2015 for a variety of reasons and underwent an area BMD examination by DXA. We analyzed the relationships between decreasing BMD and the patients’ gender, age, body mass index (BMI), medical background, hemoglobin, electrolytes, and thyroid function. Thirty-nine of the patients were diagnosed with osteoporosis based on their T-scores. An adjusted analysis showed that female gender, aging, and increased serum calcium level were significantly related to decreasing femoral BMD, whereas high BMI was associated with an increase in femoral BMD. Collectively the results indicate that for the early detection of low BMD, it is important for general-practice physicians to consider conducting a BMD checkup when treating female and elderly patients with a low BMI and/or elevated serum calcium level. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Developing Microsurgery through Experience in Yangon General Hospital, Myanmar 393 401 EN Department of Plastic, Maxillofacial and Oral Surgery, Yangon General Hospital, University of Medicine (1) Myitzu Win Department of Plastic, Maxillofacial and Oral Surgery, Yangon General Hospital, University of Medicine (1) Moe Thuzara Department of Plastic, Maxillofacial and Oral Surgery, Yangon General Hospital, University of Medicine (1) Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kiyoshi Yamada Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Michael Leung Department of Plastic and Reconstructive Surgery, Monash Health Original Article 10.18926/AMO/57369 Although many surgical centers perform microsurgery routinely in developed countries, performing microsurgery is challenging in resource-poor developing countries, such as Myanmar. With the establishment of educational training programs and the assistance of volunteer plastic surgical teams, local plastic surgeons can learn the techniques of microsurgery and apply them clinically. The purpose of this study was to establish baseline data and define the challenges of performing microsurgery in Yangon General Hospital, Myanmar. Sixty-four patients underwent reconstruction with free flaps from January 2015 to January 2018. All clinical records of these cases were assessed. The number of free flap reconstructions performed increased from 11 in the first year to 24 in the third year. The anterolateral thigh flap was the most commonly used (42%). The most common sites of reconstruction were mandible and intraoral defects. Total flap survival occurred in 58 of 64 patients (89%). The total salvageable flap rate for revision surgery was 66.6%; the successful revision rate was highest in 2017, with fewer complications. The flap salvage rates increased and the operative duration decreased as clinical experience improved. Establishing a microsurgical center requires a strong multidisciplinary team, clinical experience, continuous learning, sensible clinical application, and effective interdepartmental and intradepartmental cooperation. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 0949-2658 24 2 2019 Mini-open excision of osteoid osteoma using intraoperative O-arm/Stealth navigation 337 341 EN Tomohiro Fujiwara Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyuki Kunisada Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Ken Takeda Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Joe Hasei Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Eiji Nakata Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yusuke Mochizuki Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masahiro Kiyono Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Aki Yoshida Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background</br> Although osteoid osteomas have traditionally been treated by surgical excision, radiofrequency ablation (RFA) has gained favor as a less invasive procedure. However, RFA is contraindicated for osteoid osteomas close to the skin or crucial neurovascular structures, and is not covered by national health insurance in Japan. The aim of the present study was to evaluate the efficacy of surgical excision of osteoid osteomas using intraoperative navigation.</br> Methods</br> We performed a retrospective review of five patients with osteoid osteoma who underwent a mini-open excision using O-arm/Stealth navigation at our institution. The osteoid osteomas were excised using a cannulated cutter or curetted out with the assistance of navigation.</br> Results</br> Complete excision was achieved in all patients, which was confirmed by pathological examination. The mean skin incision was 2.1 cm (range, 1.5 to 3.0 cm) and the mean duration required for setup three-dimensional image was 15 min (range, 12 to 20 min). Although the mean visual analog scale score was 7 (range, 4 to 8) before surgery, all patients experienced relief from their characteristic pain immediately after surgery, with the mean scores of 2.2 (range, 1 to 3) and 0 at 2 days and 4 weeks after surgery, respectively. There was no intra-operative complication related to the navigation and no recurrence was observed during the mean follow-up period of 25 months (range, 13 to 33 months).</br> Conclusions</br> Mini-open excision using intraoperative O-arm/Stealth navigation is a safe and accurate procedure for patients with osteoid osteoma, which could cover the limitation of RFA. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 4 2019 Tuberosity-overlapping Fixation of the Humeral Shaft in Humeral Head Replacement Surgery 299 305 EN Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Keiichiro Nishida Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Taizo Konishiike Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Motohiko Mikasa cDepartment of Orthopaedic Surgery, Matsudo Orthopaedic Hospital Original Article 10.18926/AMO/56931 The fixation technique of bony fragments is crucial for the bone union of the tuberosities after humeral head replacement (HHR) for a comminuted fracture of the proximal humerus. To increase the bone union rate, we reduce tuberosities to overlap on the humeral shaft by approx. 1 cm and fix them with cable wire. Herein, we retrospectively investigated the clinical and radiographic outcomes of our procedure. Twenty-six patients who underwent cementless HHR for the treatment of comminuted fractures of the proximal humerus were investigated. The Constant-Murley score, active shoulder mobility, and bone union rate were evaluated. The mean duration of follow-up was 56.3 months (range 24-197). At the final follow-up, the average Constant-Murley score was 58 (range 40-76). Forward elevation was 126° on average (range 35°-180°). Twenty-three cases (88%) showed bone union between the tuberosities and the shaft at an average follow-up of 4.1 months (range 4-5 months) after surgery. Non-union was noted in 1 case, and bone resorption was noted in 2 cases. The bone union rate and the clinical outcome of our procedure were relatively favorable No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Simultaneous Integrated Boost Volumetric Modulated Arc Therapy for Middle or Lower Esophageal Cancer Using Elective Nodal Irradiation: Comparison with 3D Conformal Radiotherapy 247 257 EN Kotaro Yoshio Department of Radiology, Kagawa Prefectural Central Hospital Akihisa Wakita Division of Medical Physics, Euro MediTech Co. Ltd Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Takahiro Kitayama Department of Radiology, Kagawa Prefectural Central Hospital Kento Hisazumi Department of Radiology, Kagawa Prefectural Central Hospital Daisaku Inoue Department of Radiology, Kagawa Prefectural Central Hospital Nobuhisa Tajiri Department of Radiology, Kagawa Prefectural Central Hospital Tsuyoki Shiode Department of Radiology, Kagawa Prefectural Central Hospital Shiro Akaki Department of Radiology, Kagawa Prefectural Central Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital Original Article 10.18926/AMO/56868 We investigated the feasibility of simultaneous integrated boost (SIB) volumetric modulated arc therapy (VMAT) using elective nodal irradiation (ENI) for middle or lower esophageal cancer and compared it with three-dimensional conformal radiotherapy (3D-CRT). The study included 15 patients. The prescribed doses included a standard dose (50.4 Gy) and a high dose (60 Gy) for the planning target volume (PTV) of the involved lesions. The objective of the whole lung volume receiving ≥ 20 Gy (V20Gy) was < 30%, and the mean lung dose (MLD) was < 20 Gy. The volumes of the lung receiving 5 Gy (V5Gy) and the heart receiving 30-50 Gy (V30-50Gy) were kept as low as reasonably achievable. As a result, SIB-VMAT showed superior dose conformity for the PTV (p<0.001). Although the lung V5Gy was significantly increased (p<0.001), the V20Gy and MLD showed no significant increase. The heart V30-50Gy showed a > 20% reduction in the mean against 3D-CRTs. Our results demonstrate the feasibility of SIB-VMAT for the treatment of middle or lower esophageal cancer with ENI. Although attention should be paid to the low-dose area of the lungs, SIB-VMAT would be a promising treatment option with improved outcomes for esophageal cancer. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Safety of Surgical Treatment for Elderly Patients with Gallbladder Carcinoma 241 246 EN Masashi Utsumi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Hideki Aoki Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Seitaro Nishimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yuta Une Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Hajime Kashima Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yuji Kimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Fumitaka Taniguchi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Takashi Arata Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Koh Katsuda Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Kohji Tanakaya Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Original Article 10.18926/AMO/56867 Gallbladder carcinoma (GBC) is a common malignancy with a poor prognosis. With the average life expectancy increasing globally, the incidence of GBC is predicted to increase as well. We investigated the safety and feasibility of surgical treatment for elderly patients with GBC. We retrospectively compared clinical pathological data and treatment outcomes in 45 consecutive GBC patients (23 patients ≥ 75 years [elderly group] and 22 patients < 75 years [younger group]) who underwent curative resection at the Iwakuni Center from January 2008 to December 2017. The proportion of preoperative comorbidities and anticoagulant use was significantly higher in the elderly group. The American Society of Anesthesiologists score was higher in the elderly versus the younger group, and the elderly group had significantly shorter operation times. Reduced activities of daily living was more common in the elderly versus younger group. The percentage of radical resection and overall 3-year survival (66.6% younger vs. 64.4% elderly) were similar between the groups. Controlling Nutritional Status (CONUT) score ≥ 3 and R0 resection were identified as prognostic factors for overall survival rate among all patients. After careful patient selection, No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Post-traumatic Articular Cartilage Lesions Increase at Second-look Arthroscopy Following Primary Anterior Cruciate Ligament Reconstruction 223 228 EN Kazuhisa Sugiu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuya Kodama Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Kamatsuki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/56864 Anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL rupture improves the instability of the knee joint and decreases mechanical stress to the meniscus and articular cartilage. However, there are reports that post-traumatic osteoarthritis (PTOA) is observed over time following ACLR. In this study, we assessed changes in cartilage lesions by arthroscopic findings following anatomical double-bundle ACLR and at post-operative second-look arthroscopy about 14 months later. We retrospectively evaluated 37 knees in cases with patients <40 years of age who had undergone an anatomical double-bundle ACL reconstruction <1 year after ACL rupture injury from March 2012 to December 2016. Clinical results and arthroscopic cartilage/meniscal lesion were evaluated and compared between a cartilage lesion-detected group and intact-cartilage group. Surgery improved anteroposterior laxity and other clinical measures; however, cartilage lesions were detected at 11 sites during ACLR and at 54 sites at second-look arthroscopy. The periods from injury to second-look arthroscopy and from ACLR to second-look arthroscopy were significantly longer in the cartilage-lesion group (n=23) than in the intact-cartilage group (n=14). Conversely, 96% of meniscal damage observed during ACLR was cured at the time of second-look arthroscopy. Knee articular cartilage lesions after ACL rupture cannot be completely suppressed, even using the anatomical ACL reconstruction technique. This study suggested that articular cartilage lesions can progress to a level that can be confirmed arthroscopically at approximately 17 months after ACL injury. Therefore, in ACLR patients, the possibility of developing knee articular cartilage lesions and PTOA should be considered. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Geriatric Trauma in Patients ≧85 Years Old in an Urban District of Japan 197 203 EN Takeshi Nishimura Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiromichi Naito Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shigenari Matsuyama Hyogo Emergency Medical Center Satoshi Ishihara Hyogo Emergency Medical Center Atsunori Nakao Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichi Nakayama Hyogo Emergency Medical Center Original Article 10.18926/AMO/56861 Japan's population has been skewing toward the elderly, but the outcomes of advanced elderly trauma are not clear. Here we compared the outcomes of very elderly trauma patients (≧85 years old) with those of 65- to 84-year-old trauma patients. We retrospectively reviewed the medical records of patients treated at Hyogo Emergency Medical Center from August 2010 to August 2016; 631 patients were entered in the study. We divided them into the younger geriatrics (YG group, 65-84 years old: n=534) and older geriatrics (OG group, ≧85 years old: n=97). The group’s patient characteristics, mortality, 1-year survival rate, and Barthel index were tabulated and compared. The patients’ mean age was 75.6±7.5 years. There was no significant difference in mortality between the YG and OG groups (9.6% vs. 15.1%, odds ratio [OR] 1.73; 95% confidence interval [CI] 0.93-3.23, p=0.083). The 1-year survival rate (94.4% vs. 77.8%, OR 0.19, 95% CI 0.07-0.51; p<0.01) and Barthel index (Median score; 100 (IQR: 85-100) vs. 80 (IQR: 15-95), OR 0.98, 95% CI 0.97 to 0.99, p<0.01) differed significantly between the groups. Our study did not find a significant difference in-hospital mortality between patients in the YG group and those in the OG group. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Psychiatry 189 195 EN Shinji Sakamoto Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroki Kawai Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuko Okahisa Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ko Tsutsui Department of Neuropsychiatry, Akita University Graduate School of Medicine Takashi Kanbayashi Department of Neuropsychiatry, Akita University Graduate School of Medicine Keiko Tanaka Department of Animal Model Development, Brain Research Institute, Niigata University Yutaka Mizuki Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Manabu Takaki Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihito Yamada Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/56860 Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently-discovered autoimmune disorder in which antibodies target NMDAR in the brain. The number of reported cases of anti-NMDAR encephalitis has increased rapidly. Anti-NMDAR encephalitis can be mistakenly diagnosed as psychiatric disorders because many patients present with prominent psychiatric symptoms and visit psychiatric institutions first. Thus, psychiatrists should cultivate a better understanding of anti-NMDAR encephalitis. In this review, we present the mechanisms, epidemiology, symptoms and clinical course, diagnostic tests, treatment and outcomes of patients with anti-NMDAR encephalitis. Furthermore, we discuss the diversity of clinical spectra of anti-NMDAR encephalitis, and demonstrate a differential diagnosis of psychiatric disease from the perspective of psychiatry. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 2 2019 Salvage Haploidentical Transplantation Using Low-dose ATG for Early Disease Relapse after First Allogeneic Transplantation: A Retrospective Single-center Review 161 171 EN Sachiyo Okamoto Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Ken-ichi Matsuoka Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Maiko Sakamoto Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Yoshiaki Usui Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Yuki Fujiwara Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Takumi Kondo Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Katsuma Tani Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Kyosuke Saeki Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Yusuke Meguri Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Noboru Asada Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Daisuke Ennishi Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Hisakazu Nishimori Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Keiko Fujii Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Nobuharu Fujii Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Yoshinobu Maeda Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences Original Article 10.18926/AMO/56652 Second allogeneic stem cell transplantation (allo-SCT) is a potentially curative therapy for patients who relapse after first allo-SCT. Human leukocyte antigen (HLA)-haploidentical related donors provide the broad opportunity to conduct second SCT at the appropriate time, but the efficacy of second SCT from haploidentical donors after relapse has not been established. We retrospectively analyzed the records of 33 patients who underwent second SCT. Twenty patients underwent haplo-SCT with low-dose antithymocyte globulin (ATG), and the other 13 patients underwent conventional- SCTs, including HLA-matched related peripheral blood, unrelated bone marrow or cord blood. Three years after the second SCT, the overall survival (OS) and progression-free survival (PFS) of all patients were 32.5% and 23.9%. Multivariate analyses indicated that non-complete response at second SCT, less than 1-year interval to relapse after first- SCT, and total score ≥ 3 on the hematopoietic cell transplantation-specific comorbidity index were significantly associated with a lower PFS rate. The haplo- and conventional- SCT groups showed equivalent results regarding OS, PFS, cumulative incidences of relapse, non-relapse mortality and graft-versus-host disease. The neutropenic period after transplantation was significantly shorter in haplo- SCT than conventional- SCT (10.5 days vs. 16 days, p=0.001). Our analysis revealed that haplo-SCT could be an alternative therapeutic option for relapsed patients after first SCT. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 1 2019 Reduction of Postoperative Pain by Addition of Intravenous Acetaminophen after Total Hip Arthroplasty: A Retrospective Cohort Study 7 14 EN Norio Fukumori Community Medical Support Institute, Faculty of Medicine, Saga University Motoki Sonohata Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Masaru Kitajima Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Shunsuke Kawano Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Tsuyoshi Kurata Community Medical Support Institute, Faculty of Medicine, Saga University Yuta Sakanishi Community Medical Support Institute, Faculty of Medicine, Saga University Takashi Sugioka Community Medical Support Institute, Faculty of Medicine, Saga University Masaaki Mawatari Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Original Article 10.18926/AMO/56453 We evaluated the analgesic effects of multimodal pain control in which intravenous acetaminophen (IV APAP) was added to the standard protocol for Japanese patients who had undergone a total hip arthroplasty (THA). We performed a retrospective cohort study of 180 patients aged 66.4±10.5 years (30% male) who had undergone a THA (Oct. 2014 to Feb. 2015) at our hospital. The control patients were administered the standard analgesic protocol: flurbiprofen axetil as a continuous intravenous infusion and oral celecoxib (NAPAP; n=109). The patients in the new analgesic protocol group received IV APAP in addition to the standard analgesic protocol (APAP; n=71). The primary outcome was the maximum value of postoperative pain the patients reported on a numerical rating scale (NRS) during the first 24 h post-surgery. A univariate analysis and multivariate analyses adjusted for age, sex, the stage of hip osteoarthritis, preoperative pain, and surgical time showed that the maximum postoperative pain NRS scores during the first 24 h after surgery was significantly lower when the APAP protocol was used. The addition of IV APAP to the current standard multimodal analgesia protocol for Japanese patients who have undergone a THA may decrease the patients’ postoperative pain. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 72 1 2018 Total Hip Arthroplasty for Patients with Residual Poliomyelitis at a Mean Eight Years of Follow-up 17 22 EN Mayumi Sonekatsu Department of Orthopaedic Surgery, Wakayama Medical University Motoki Sonohata Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Masaru Kitajima Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Shunsuke Kawano Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Masaaki Mawatari Department of Orthopaedic Surgery, Faculty of Medicine, Saga University Original Article 10.18926/AMO/55658 In patients with poliomyelitis, degenerative arthritis of the hip may be encountered in the paralytic or normal contralateral limb because of leg length discrepancy, pelvic obliquity, or severe deformities of the affected hip. Although total hip arthroplasty (THA) is one of the most common orthopedic procedures, there are few reports of THA in adult patients with residual poliomyelitis. From March 2001 to January 2011, 5 patients with residual poliomyelitis (6 hips) underwent THA using uncemented implants at our hospital. We retrospectively evaluated the Japanese Orthopedic Association (JOA) hip rating score, complications, and radiographs. All five patients’ follow-up information was available: 4.5 years minimum, 8.4 years average, range 4.5-15 years. Surgery was done at the same side of the paralytic limb in 2 hips and contralateral to the paralytic limb in four hips. All patients had pain relief and improvement in function; JOA hip rating score improved significantly from the mean of 45 preoperatively to 78 at the last follow-up (p=0.0313). There was no loosening or osteolysis in this series, and no cases of dislocation, infection or nerve palsy. These findings can contribute to decisions regarding treatment for arthritic hips in adults with residual poliomyelitis. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 129 1 2017 骨盤臓器脱に対するTVM 手術前後の性機能に関する検討 17 22 EN Yuko Matsumoto Department of Urology, Okayama University Graduate School of Medicne, Dentistry and Pharmaceutical Sciences We prospectively assessed sexual function before and after a tension-free vaginal mesh ( TVM) procedure for pelvic organ prolapse ( POP) . From April 2007 to March 2009, a total of 42 patients, who reported having an active sex life preoperatively underwent TVM for POP. Female sexual function was evaluated with the self-reporting, multiple-domain Female Sexual Function Index (FSFI) . We administered the FSFI to all of the patients before and at 3, 6, and 12 months after surgery. The mean age at surgery was 61.3±7.1 years. Before the TVM surgery, the FSFI score was very low ( 12.5±9.0) . The total FSFI score was improved significantly at 12 months after surgery ( 17.4±7.7) . The Arousal, Lubrication and Orgasm domains were significantly improved at 12 months after surgery. POP appears to have a significant negative impact on female sexual function. Our findings indicate that TVM for POP improved sexual function in a group of Japanese women with POP. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 2 2016 Diminished Gastric Resection Preserves Better Quality of Life in Patients with Early Gastric Cancer 119 130 EN Hiroshi Isozaki Sasau Matsumoto Shigeki Murakami Takehiro Takama Tatuo Sho Kiyohiro Ishihara Kunihiko Sakai Masanori Takeda Koji Nakada Toshiyoshi Fujiwara Original Article 10.18926/AMO/54191 Using the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45, we compared the surgical outcomes and the quality of life (QOL) between patients undergoing limited gastrectomies and those undergoing conventional gastrectomies. In Oomoto Hospital between January 2004 and December 2013, a total of 124 patients who met the eligibility criteria were enrolled. Using the main outcome measures of PGSAS-45, we compared 4 types of limited gastrectomy procedures (1/2 distal gastrectomy [1/2DG] in 21 patients; pylorus-preserving gastrectomy [PPG] in 15 patients; segmental gastrectomy [SG] in 26 patients; and local resection [LR] in 13 patients) with conventional gastrectomy (total gastrectomy [TG] in 24 patients and 2/3 or more distal gastrectomy [WDG] in 25 patients). The TG group showed the worst QOL in almost all items of the main outcome measures. The 1/2DG, PPG, and SG groups showed better QOL than the WDG group in many of the main outcome measures, including the body weight ratio, total symptom score, ingested amount of food per meal, and the dissatisfaction for daily life subscale. The LR group showed a better intake of food than the 1/2DG, PPG, and SG groups. The body weight ratio of the LR group was better than that of the SG group. Diminished gastric resection preserved better QOL in patients with early gastric cancer. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 69 1 2015 Comparison of Urinary Levels of 8-Hydroxy-2’-deoxyguanosine between Young Females with and without Depressive Symptoms during Different Menstrual Phases 45 50 EN Tadayuki Iida Ken Inoue Yasuhiro Ito Hiroaki Ishikawa Miwa Kagiono Ryoji Teradaira Chiho Chikamura Toshihide Harada Satoko Ezoe Hiroshi Yatsuya Original Article 10.18926/AMO/53121 This study aimed to clarify the association between depressive symptoms and a marker of oxidative stress-induced DNA damage in young females. Since the menstrual cycle may confound or modify this association, depressive symptoms and urinary levels of 8-hydroxy-2ʼ deoxyguanosine (8-OHdG) were evaluated during each menstrual phase. A total of 57 female fourth-year students (aged 21.6±0.8) from a Japanese health science university were studied. The menstrual cycle was divided into 3 phases:menstrual (days 1 to 3 after the onset of menses);proliferative (days 13 to 15);and secretory (days 24 to 26). Depressive symptoms were assessed by the self-rating depression scale (SDS). Positive depressive symptoms were defined as a score of 53 or more during 2 different menstrual phases. The association between the presence of depressive symptoms and 8-OHdG levels adjusting for the menstrual cycle was examined by two-way analysis of variance with the menstrual cycle (menstrual, proliferative, and secretory phases) as the within-individual factor. The menstrual cycle did not show a significant correlation with urinary 8-OHdG levels. On the other hand, the menstrual cycle-adjusted 8-OHdG level was significantly higher in those with depressive symptoms (7.01ng/mL) than in those without them (3.98ng/mL). The ROC curve analysis showed that urinary 8-OHdG levels had reasonably high discriminative performance throughout all the menstrual cycles (0.73-0.81;all p＜0.05). These results indicated the presence of oxidative stress in subjects with depressive symptoms independent of the menstrual cycle. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 68 6 2014 Mental Health Status among Japanese Medical Students: A Cross-Sectional Survey of 20 Universities 331 337 EN Tadahiro Ohtsu Yoshitaka Kaneita Yoneatsu Osaki Akatsuki Kokaze Hirotaka Ochiai Takako Shirasawa Hinako Nanri Takashi Ohida Original Article 10.18926/AMO/53022 The purposes of this study were to evaluate the mental health status of Japanese medical students and to examine differences based on gender, as well as on university type and location, using the results of a nationwide survey. Between December 2006 and March 2007, we conducted a questionnaire survey among fourth-year medical students at 20 randomly selected medical schools in Japan. The data from 1,619 students (response rate:90.6%;male:1,074;female:545) were analyzed. We used the Japanese version of the 12-item General Health Questionnaire (GHQ-12) to measure mental health status. Poor mental health status (GHQ-12 score of 4 points or higher) was observed in 36.6% and 48.8% of the male and female medical students, respectively. The ratio of the age-adjusted prevalence of poor mental health status in female versus male medical students was 1.33 (95% confidence interval:1.10-1.62). The universities were categorized into two groups based on the university type (national/public:15 vs. private:5) or location (in a large city:7 vs. in a local city:13 cities). The prevalence of poor mental health status in both men and women differed between these groups, although not significantly. The GHQ-12 scores in men significantly differed between the categorized groups of universities. These results suggest that adequate attention must be paid to the mental health of medical students, especially females, and that a system for providing mental health care for medical students must be established in the context of actual conditions at each university. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 5 2013 Inhibitory Function and Working Memory in Attention Deficit/Hyperactivity Disorder and Pervasive Developmental Disorders:Does a Continuous Cognitive Gradient Explain ADHD and PDD Traits? 293 303 EN Akihito Takeuchi Tatsuya Ogino Kaoru Hanafusa Teruko Morooka Makio Oka Takashi Yorifuji Yoko Ohtsuka Original Article 10.18926/AMO/51865 To clarify the relationship between attention deficit/hyperactivity disorder (AD/HD) and pervasive developmental disorders (PDD), we investigated the common features and differences of these disorders in neuropsychological profiles. The subjects were 4 groups of Japanese boys aged 6 to 15 years, categorized by diagnosis:AD/HD (n＝20), PDD with comorbid AD/HD (PDD＋:n＝16), PDD without comorbid AD/HD (PDD−:n＝8), and typically developing (n＝60). We evaluated executive function (EF) through verbal and visuospatial memory tasks, the Go/NoGo task, and the color-word matching Stroop task. We performed a categorical analysis to estimate the effects of the 3 disorders on EF and a dimensional analysis to estimate the effects of symptom scales on EF. We found that the AD/HD and PDD＋ subjects had negative effects on verbal working memory and intra-individual response variability. The severity of these impairments was positively correlated with the inattentiveness score. The subjects with a PDD＋ or PDD− diagnosis had poorer scores on interference control;the severity of this impairment was correlated with the PDD symptom score. Impairments in visuospatial working memory were detected in the AD/HD and PDD− groups but not in the PDD＋ group. Impairments in inhibition of the pre-potent response were noted in all 3 categories. AD/HD and PDD share neuropsychological features, though each disorder has a specific impairment pattern. Our findings partially support the idea that AD/HD and PDD are on a spectrum. No potential conflict of interest relevant to this article was reported.

岡山大学大学院教育学研究科 Acta Medica Okayama 1883-2423 153 2013 ３年間にわたる子どもの体力縦断的変化が形態,生活習慣,心身の健康指標におよぼす影響 81 87 EN Minoru Adachi Haruko Sako Kensaku Sasayama 10.18926/bgeou/51109 In this study we examined the association between longitudinal changes in schoolchildren�Vs physical strength with their build, health habits, and psychophysical health index scores. Students (n= 195) were followed for three years, from the fifth to the eighth grade. Setting as a baseline the students�V results on the Ministry of Education, Culture, Sports, Science and Technology�Vs new physical strength test, we extracted data on those students whose physical strength relatively improved (improved group: 28 boys, 53 girls) and on those whose strength relatively declined (declined group: 15 boys, 16 girls). Build, health habits, and psychophysical health index scores were compared between the two groups. It was found that, although there were no significant differences in eating habits or sleeping habits between the two groups, compared to the improved group, the declined group was more likely to be either obese or underweight, have short durations of intense exercise and total exercise, and longer duration of watching television or videos. The declined group also showed poorer psychological health status, such as lower self-efficacy and higher anxiety. 　These findings indicate that children with good exercise habits, such as consistently engaging in a adequate physical activities that include intense exercise, will have improved physical strength outcome over time, whereas those children with few regular exercise habits and whose strength will not improve over time, will show outcomes such as polarization of body weight (obesity and underweight tendencies) and poorer psychological health status. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 67 4 2013 Comparison of 7 α1-adrenoceptor Antagonists in Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia:A Short-term Crossover Study 245 251 EN Tohru Araki Koichi Monden Motoo Araki Original Article 10.18926/AMO/51069 A crossover study was conducted to identify the best α1-adrenoceptor (α1AR) antagonist for individual patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). One hundred thirteen patients (mean age 70.8 years) were enrolled. All patients met BPH clinical study guidelines. Seven agents were utilized:tamsulosin 0.2mg, silodosin 8mg, urapidil 60mg, naftopidil 50mg, prazosin 1mg, terazosin 2mg, and doxazosin 1mg. Patients were initially prescribed tamsulosin or silodosin for a week and then urapidil for a week. Two weeks later, they were prescribed the better of the 2 agents for a week and a new agent for the next week. This cycle was repeated until all 7 agents were tested. Efficacy was evaluated with the International Prostate Symptom Score. The agent rankings were doxazosin (25 [22%]), silodosin (22 [19%]), urapidil (19 [17%]), naftopidil (17 [15%]), terazosin (12 [11%]), tamsulosin (11 [10%]), prazosin (7 [6%]). Only 12 patients (11%) changed agents after the crossover study was completed. The major reason was adverse events (83%). We found that each of the 7 α1AR antagonists has its own supporters. Further, the one-week crossover study was useful in identifying the best agent for the treatment of each individual with LUTS. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 2 2012 小児難聴に対する取り組み―岡山から全国への発信― 155 159 EN Yuko Kataoka Kunihiro Fukushima Akiko Sugaya Kazunori Nishizaki No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 1 2012 医療人育成の現況と課題 41 45 EN Hitomi U Kataoka No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 57 3 2003 Genome-wide search for strabismus susceptibility loci. 109 116 EN Hirotake Fujiwara Toshihiko Matsuo Masako Sato Takashi Yamane Mizue Kitada Satoshi Hasebe Hiroshi Ohtsuki Article 10.18926/AMO/32833 <p>The purpose of this study was to search for chromosomal susceptibility loci for comitant strabismus. Genomic DNA was isolated from 10mL blood taken from each member of 30 nuclear families in which 2 or more siblings are affected by either esotropia or exotropia. A genome-wide search was performed with amplification by polymerase chain reaction of 400 markers in microsatellite regions with approximately 10 cM resolution. For each locus, non-parametric affected sib-pair analysis and non-parametric linkage analysis for multiple pedigrees (Genehunter software, http://linkage.rockefeller.edu/soft/) were used to calculate multipoint lod scores and non-parametric linkage (NPL) scores, respectively. In sib-pair analysis, lod scores showed basically flat lines with several peaks of 0.25 on all chromosomes. In non-parametric linkage analysis for multiple pedigrees, NPL scores showed one peak as high as 1.34 on chromosomes 1, 2, 4, 7, 10, 15, and 16, while 2 such peaks were found on chromosomes 3, 9, 11, 12, 18, and 20. Non-parametric linkage analysis for multiple pedigrees of 30 families with comitant strabismus suggested a number of chromosomal susceptibility loci. Our ongoing study involving a larger number of families will refine the accuracy of statistical analysis to pinpoint susceptibility loci for comitant strabismus.&#60;/P&#62;</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 58 1 2004 Chromosomal instability and double minute chromosomes in a breast cancer patient. 51 58 EN Hrvoje Lalic Crtomir Volavsek Biserka Radosevic-Stasic Article 10.18926/AMO/32120 <p>Cytogenetic analysis was performed in peripheral blood lymphocytes (PBL) of a woman with ductal breast carcinoma, who as a hospital employee was exposed professionally for 15 years to low doses of ionizing radiation. The most important finding after the chemotherapy in combination with radiotherapy was the presence of double minutes (DM) chromosomes, in combination with other chromosomal abnormalities (on 200 scored metaphases were found 2 chromatid breaks, 10 dicentrics, 11 acentric fragments, 2 gaps, and 3 double min chromosomes). In a repeated analysis (after 6 months), DM chromosomes were still present. To rule out the possibility that the patient was overexposed to ionizing radiation at work, her blood test was compared with a group of coworkers as well as with a group of professionally unexposed people. The data rejected this possibility, but the retroactive analysis showed that the patient even at the time of employment had a moderately increased number of chromosomal aberrations (3.5%) consisting of 3 isochromatids and 4 gaps, suggesting that her initial genomic instability enhanced the later development. The finding of a continuous presence of rare DM chromosomes in her PBL (4 and 10 months after radiochemotherapy) was considered as an indicator of additional risk, which might have some prognostic significance.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 55 4 2001 Concentration of nitric oxide (NO) in spinal fluid of chronic spinal disease. 219 228 EN Yasuamasa Yumite Kazuhiro Takeuchi Yoshiaki Harada Norio Ogawa Hajime Inoue Article 10.18926/AMO/31996 <p>We studied total nitric oxide (nitrite + nitrate) (NO) levels in cerebrospinal fluid (CSF) of chronic spinal diseases in nonsmokers (133 patients: 76 men and 57 women; mean age, 63 years; range, 15-92 years) by the Griess method to clarify the role of NO in different spinal diseases. The extent of compression in terms of numbers of disc level at the compressed spinal nerve and neurological evaluation were also assessed according to the Japanese Orthopaedic Association scores. The spinal diseases included cervical myelopathy and radiculopathy (cervical disease group), ossification of yellow ligament (thoracic disease group), and lumbar disc herniation, lumbar canal stenosis and lumbar spondylolisthesis (lumbar disease group). NO levels in the spinal disease groups (4.98+/-2.28 micromol/l: mean +/- SD) were significantly higher than that in the control group (2.53+/-0.94 micromol/l). An inverse correlation was detected between the elevated levels of NO and the grade of clinical symptoms in the cervical disorders. The number of disc level at the compressed spinal nerve was positively correlated with elevated NO levels in CSF in the cervical and lumbar disorder groups. These results indicate that nerve compression may elevate NO levels in CSF, and that NO concentration in the CSF might be a useful marker of damage to nervous system in spinal disorders.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 51 2 1997 New evaluation method for postoperative scar redness 101 104 EN Koki Nakamura Hiroyuki Irie Shunji Sano Article 10.18926/AMO/30777 <p>Even after successful operations, ugly postoperative skin scars are often distressing to patients and their parents. To judge the success of surgical methods and postoperative treatment, postoperative scars should be evaluated using a quantitative system. Height and width are easily measured, but scar redness is not. We have developed a simple and effective method for evaluating scar redness. According to the color definitions employed in computer graphics, each color can be expressed as RGB (red, green or blue) coordinates (r, g, b): 0 &#8806; r, g, b &#8806; 10. The degree of scar redness is defined by the following formula: redness score (RS) = (r₁ - r₀)² + (g₁ - g₀)² + (b₁ - b₀)². Here, (R₁, g₁, b₁) = coordinates of the scar color and (r₀, g₀, b₀) = coordinates of the surrounding skin color. RS was evaluated in 59 children (35 males, 24 females; ages 1 month to 12 years old) who had scar redness after congenital cardiac surgery. For each patient, scar color and surrounding skin color was identified on the color sample table. Scar redness was also evaluated by the conventional grading method: 1 = mild, 2 = moderate and 3 = severe. The RS of the colored scars ranged from 4 to 100 (38 ± 27). By the conventional grading method, 44 scars were grade 1, 15 grade 2 and none grade 3. RS was significantly higher among grade 2 than grade 1 patients, 52 ± 25 and 33 ± 27, respectively (P &#60; 0.05). Given its subjectivity, the conventional grading method yields variable data; surrounding skin color, moreover, is not considered. Our new evaluation method using RS effectively and accurately defines scar and skin colors, and allows quantitative studies of these factors.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 50 6 1996 Continuous Measurement of Tissue Oxygen and Carbon Dioxide Gas Tensions in Dog Liver in Ischemia/Reperfusion 285 292 EN Atsushi Urakami Ryuji Hirai Tetsuya Ota Hiroyuki Soga Sugato Nawa Nobuyoshi Shimizu Article 10.18926/AMO/30481 An experiment was conducted to determine whether the oxygen and carbon dioxide gas tensions in liver tissue (PtO2 and PtCO2, respectively) reflect the state of microcirculation and/or metabolism in the ischemic liver. Subjects were divided into three groups: group 1, 30 min ischemia; group 2, 60 min ischemia; group 3, four times of intermittent 15 min ischemia after every 10 min of reperfusion. PtO2, PtCO2 and tissue blood flow (TBF) were measured by mass spectrometry, comparatively studied with the serum GOT level as an indicator of liver tissue damage. Furthermore, the time point at which the PtCO2 increase for 1 min initially became less than 1/2 of the maximum value was located on the transit curve of PtCO2, referred to as the critically anaerobic (CA) point, with which new indices of critically anaerobic score (CAS) and time (CAT) (see details in text) were developed. The profiles of PtO2 and PtCO2 during ischemia and reperfusion were clearly demonstrated, and the CA point was observed 12.7 +/- 2.9 min after induction of ischemia. PtO2 was positively correlated with TBF and negatively with the serum GOT level. Furthermore, not only CAS but also CAT were significantly correlated with PtO2, TBF, and the serum GOT level. It was concluded that PtCO2 reflects the state of anaerobic tissue metabolism during ischemia and PtO2 reflects the magnitude of microcirculatory disturbance and tissue injury caused by ischemia/reperfusion. Therefore, continuous monitoring of not only PtO2 but also PtCO2 is beneficial for patients undergoing hepatic surgery with ischemia. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属環境病態研究施設, 岡山大学医学部附属病院三朝分院 Acta Medica Okayama 09133771 60 1989 ユスリカ喘息に関する臨床的検討 ―HD陽性例および陰性例の比較検討― 54 60 EN Hikaru Kitani Hiroyuki Araki Michiyasu Sudo Yoshiro Tanizaki Sinya Tada Kiyoshi Takahashi Ikuro Kimura Hiroyuki Matsuoka Akira Ishii 10.18926/19805 近年ユスリカが気管支喘息の原因抗原となり得ることが報告されている。しかし，その臨床的特徴はいまだ明らかにされていない。このユスリカ抗原の特徴を検討する目的で，気管支喘息症例163例をHD（ハウスダスト）に感作されたRAST　score2＋以上の陽性例82例とscore1＋以下の陰性例81例とに分けて比較検討を行なった。その結果皮膚反応，ヒスタミン遊離，CTT抗原を用いた特異的IgE抗体いずれの検討においても，HDに感作された症例が，よりユスリカ抗原にも感作されやすいことが明らかになった。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属環境病態研究施設, 岡山大学医学部附属病院三朝分院 Acta Medica Okayama 09133771 60 1989 非アトピー型喘息におけるIgE系反応 47 53 EN Yoshiro Tanizaki Michiyasu Sudo Hikaru Kitani Hiroyuki Araki 10.18926/19802 気管支喘息の発症にIgE抗体がどの程度関与しているのかを中心に若干の検討を加えた。1．若年発症型喘息（発症；20才以下，現年齢；30才以下）では，非難治例15例の血清IgE値は947±656IU／mℓで，HDのRASTが陽性を示した症例は12例（80％），難治例12例では血清IgE値214±102IU／mℓで，HDのRAST陽性は6例（50.0％）であった。2．一方，中高年発症型喘息（発症；40才以後）では，非難治例15例の血清IgE値は388±324IU／mℓで，HDのRAST陽性は6例（40％）であったが，難治例15例ではIgE値253±82IU／mℓで，HDのRASTは全例陰性であった。これらの結果から，いずれの群においても，IgE系反応が弱い場合に喘息が重症化しやすいことが示された。3．アトピー型，健康人，非アトピー型におけるI1gE系反応（皮内反応，血剤IgE，特異的IgE，ヒスタミン遊離）の陽性率や強度は，それぞれ異なっていたが，非アトピー型においてもIgE系反応が低下ないし抑制された状態で関与している可能性が示唆された。 No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 82 3-4 1970 難聴児の言語発達に関する研究 第2編 難聴学級児童の言語発達について 55 68 EN Hiroshi Ohue Of the 17 handicapped pupils, 15 of them were sensori-neural and 2 of them were mixed type hearing loss, all having 42-82 db hearing loss in average of speech range and educated in the special class for hard of hearing over one year. Examinations were made as to their past history, audiometry, effects of hearing aid with lipreading, intelligibility of monosyllables, words and sentences, and hearing acuity, conversation intelligibility, sentence structure and training effect, and those results were compared with those in preceding one year. Principal findings are summarized as follows: 1) Articulation score of monosyllables of the pupils educated for over one year in the special class for hard of hearing was found to be 92.0% in maximum, 38.7% in minimum and 65.9% in average of the total pupils, in contrast to 85.0% in maximum, 26.7% in minimum and 52.4% in average of the total pupils in previous one year. 2) The articulation score at the first examination was in such an order as the articulation score of monosyllables 52.4% in average, of sentences 71.8% and of words 74.1%, and in the second year examination, the articulation score of monosyllables 65.9%, of words 81.0% and of sentences 84.5% . From the above results, it seems to be clear that articulation score can be improved with the hearing and speech training even in the perceptive deaf children. 3) In the all 17 pupils examined including 5 pupils who educated for one year at the special class, the articulation score of monosyllables have a inverse correlation with the level of hearing loss, and this is more marked in only the 12 pupils with over 2 years' education. 4) The pupils whose articulation score of sentences were found to be 100% had showed their average hearing in speech range in 42-67 db loss, and their articulation score of monosyllables were in 56.0% -75.3%. 5) It is found that those pupils with over three years' speech and language training could master themselves to utilize fully their articulation capabilities in pproportion to their hearing level. 6) It is concluded that for the children with impaired hearing the basic training for speech accompanied by language training should be started by the age of 3 years at the latest and completed before entering the primary school, and in the special class for such children the emphasis should be placed more on phrases and sentences rather than on monosyllbales and words. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 83 5-6 1971 白血病の亜鉛代謝に関する研究 第2編 原子吸光分析法による白血病患者の血清,尿,血球ならびに臓器亜鉛量について 195 206 EN Kimio Saito With object of studying Zinc metabolism in leukemic patients the Zinc score in granulocytes was estimated by Mc Nary's method in Part 1. In the present experiment attempts were made to determine by atomic absorpiton spectrophotometry the serum Zinc content what is thought to be closely associated with Zinc metabolism, and the study was also made on changes in the Zinc levels according to types of diseases and to the results of treatment. Also Zinc contents in the urine and organs were estimated, though the cases studied were only a few in number. The relationship between Zinc score and serum protein picture was also investigated. Materials and Methods The subjects were all the patients admitted to the Second Department of Internal Medicine, Okayama University. They consisted of 9 cases of acute myelogenous leukemia (AML), 9 cases of acute lymphocytic leukemia (ALL), 4 cases of monocytic leukemia (MoL), 15 cases of chronic myelogenous leukemia (CML), 2 cases of chronic lymphocytic leukemia (CLL), and I case of erythrocytic leukemia (EL), to the total of 40 cases, as well as 6 cases of malignant lymphoma as related disease. For the control group 12 adult males and 15 adult females to the total of 27 healthy persons were selected. Results and Conclusion 1) It has been found that serum Zinc levels in healthy persons proves to be 134±12.2 mcg/dl in males and 113.8±16.4 mcg/dl in females, average being 119.2±16.5 mcg/dl. 2) The serum Zinc levels according to types of leukemia prove to be 106.9±31 mcg/dl in AML; 93.±32 mcg/dl in ALL, 81.7 mcg/dl in Mol, 111.1±31 mcg/dl in CML, 98.0±18 mcg/dl in GLL, and 62.5 mcg/dl in EL. 3) The serum Zinc score in leukemic patients is found to be low before treatment and at the time of aggravation in ALL and CLL, but it tends to recover to its normal level as the condition improves in both ALL and CLL. 4) There can be observed no significant correlations among the serum Zinc content, Zinc score of granulocytes, and alkaline phosphatase of neutrophils of the same leukemic individual. 5) There are also no significant correlations among the serum Zinc content, serum protein contents and their fractions in the same leukemic patient. 6) In studying (65)Zn-uptake by each protein fraction of leukemic patient serum after labeling it in vitro with (65)Zn, it has been demonstrated that the uptake by albumin is 52.7%, by α(1)-globulin 15.53%, by α(2)-globulin 18.62%, by β-globulin 9.19% and by γ-globulin to be 3.62%, indicating that the albumin fraction has taken up the major portion of (65)Zn, which is followed by the uptake of α(2)-globulin and α(1)-globulin. 7) In the study of absorption test and quantitative analysis of urinary Zinc contents after the administration of Zinc difference from the results with normal healthy control. 8) In estimating Zinc contents of erythrocytes, and leukocytes as well as Zinc contents in the liver, spleen, bone marrow and kidneys there can be observed no significant difference from the results with the normal control group. 9) It is assumed that disturbance of Zinc absorption and acceleration of its excretion, and the decrease in serum protein and albumin fractions are not mainly responsible for the mechanism of decreasing Zinc content in the serum of leukemic patient, but rather it is dependent upon other complex factors. No potential conflict of interest relevant to this article was reported.

岡山大学工学部 Acta Medica Okayama 0475-0071 14 2 1980 The Analysis of Vocational Aptitude Changing with Age 1 12 EN 10.18926/15737 The assumption that vocational aptitude changed with age and with the kind of occupation was examined from the tendency of the fitted curve for the score of the aptitude test. 9 vocational aptitudes were measured by the general vocational aptitude test by Japan Labor Ministry. Subjects were 382 male workers (design engineers, turners, welders, can manufacturing workers, and crane operators) of from 20 to 59 years old, and 348 male and female students (junior high school, vocational school, and university) of from 15 to 19 years old. The design engineers' aptitudes advanced along the quadratic curve until 31 years old, but almost all the aptitudes of the other workers fell along the linear curve with age. The design engineers preserved various aptitudes until 52 years old, the turners 44, and the welders, the can manufacturing workers, and the crane operators 37. The students' aptitudes were equal to those of the workers of from 15 to 25 years old. The workers preserved Spatial aptitude and Numerical aptitude until 45 years old. This could be said in all the occupations here. Further it was made clear from the micromotion study that the influence of age was caused by therbligs No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0913-3771 63 1992 Bronchial asthma in the elderly. Relationship to allergic reaction and airway inflammation 39 43 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuhiro Kusaura Koji Ochi Hideo Harada Ikuro Kimura 10.18926/15316 Clinical features of bronchial asthma in the elderly were analyzed by observlng IgE-mediated allerglc reactions evaluated by immediate skin reaction and specific IgE antibodies to allergens, ventilatory function and cellular composition in bronchoalveolar lavage (BAL) fluid. 1. The frequency of positive immediate skin reaction and positive RAST score to allergens was in general low in the elderly patients over age 70. 2. Ventilatory function was widely variegated, and fifteen cases (60%) of the 25 Subjects showed considerably high values of FEV(l.0%), % PEFR, % MMF, % V(50) and % V(25), and the mean value of FEV(1.0%) in these cases was 71.3%. 3. The decreased value of % V(25) was related to BAL neutrophilia in 2 cases, but any correlation was not found between BAL neutrophilia and decreased value of % V(25) in 9 csese of the eleven subjects who had the BAL examination. The results show that in asthma of elderly patients, IgE-mediated allergic reactions are weak, and that a decreased value of % V(25) can be observed without BAL neutrophilia. No potential conflict of interest relevant to this article was reported.

岡山大学医療技術短期大学部 Acta Medica Okayama 0917-4494 9 1 1998 外来透析者のQOLの傾向 15 21 EN Yuu Kobayashi Yuko Hayashi Naomi Kanao 10.18926/15271 本研究の目的は,外来透析者の主観的な評価によりQOLを測定し,そのQOLの傾向を明らかにすることである。対象者は,名古屋･大阪･岡山･広島の4施設における外来透析者で,研究に同意を得られた341名とし,研究方法は,自己記入式質問紙法を用いた｡測定用具は,Ferrans & PowersのQuality of Life Index (QLI)を翻訳して用い,データ分析はプロマックス法による因子分析を行なった｡QLI項目を因子分析した結果,｢社会･経済的な機能｣｢家族･他者からの支え｣｢心の安寧｣｢身体の健康｣｢医療と教育｣の5因子が抽出された｡そして,｢家族･他者からの支え｣および｢医療と教育｣はQLI得点が高く,｢社会･経済的な機能｣および｢身体の健康｣は低いことが明らかになった｡従って,QOLを高めるためには,社会的側面や身体面をより重視して看護していくことが重要であると考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部保健学科 Acta Medica Okayama 1345-0948 15 1 2004 血液透析患者のストレッサーと対処 15 21 EN Akiko Hara Yuko Hayashi 10.18926/15192 本研究の目的は,血液透析患者のストレッサ-と対処について明らかにすることである｡対象者は岡山市内の二カ所の病院において,研究参加に同意が得られた外来透析患者65名であり,透析ストレッサ一,対処,人口統計学的や医学的な情報などについて質問紙法による調査を行った｡その結果,以下のようなことが明らかになった｡(1)透析ストレッサ-は｢将来への不安｣が最も高く,そして｢治療時間の長さ｣や｢身体的活動の制限｣などの精神的ストレッサ-が続いていた｡(2)対処は,消極的回避的および積極的前向き対処が問題解決的対処よりも上位を占めていた｡今日､医学や透析機器などの改良で透析治療は 進歩を遂げてきているが,透析患者は将来への不安や時間の拘束などの制約や負担を抱えている｡しかしながら,そのようなストレスフルな状況に対して,運命として引き受けるという感情を持ちながらもその思いをマイナスとしてだけに捉えるのではなく,前向きに対処をしていることが伺えた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部保健学科 Acta Medica Okayama 1345-0948 17 1 2007 看護学生のストレスに影響を及ぼす要因 17 26 EN Tamie Kobayashi Yoshimi Hyodo 10.18926/15169 看護学専攻の大学生1〜4年生を対象に,ストレッサ一,ストレス反応におけるHealth Locus of Controlとソーシャルサポートの効果等に関する質問紙調査を行った結果,次の点が明らかになった｡ 1. ストレス反応(全体),不安･怒り･抑うつに関して,いずれもHLCの高群のほうが,低群よりも心身の健康度が高いことが明らかになった｡ 2. ソーシャルサポートの高低によるストレス反応に,有意な差は認められなかった｡また,ストレス反応に対する直接的影響も見られなかった｡しかしながら,下位項目である母親サポートについては,ストレス反応の抑制に効果のあることが明らかになった｡ 3. ストレッサ-では,1・2年生はクラブ活動が最も多く,次に学業が多かった｡3・ 4年生も学業が最も多かった｡ 4. サポート源では,4年生が他の学年より教員サポート人数において,高い値を示していた｡それに対し,1・2年生と教員の関わりは少ないということが明らかになった｡ No potential conflict of interest relevant to this article was reported.

IEEE SMC Hiroshima Chapter Acta Medica Okayama 1883-3977 2008 1 2008 Web Design that is Friendly to Older Adults – Effects of Perceptual, Cognitive and Motor Functions and Display Information on Web Navigation Time – 103 110 EN Atsuo Murata Rina Takahashi Older internet users are increasing more and more world widely. The information accessibility standard for Web contents (JIS X 8341-3) had been established. Although many researchers are pursuing the usability of Web site, we cannot design a usable Web site only by improving Web pages. One of the reasons is inferred that we didn’t consider perceptual, cognitive, and motor functions especially of older adults in the design of Web pages. The aim of this study was to propose a method to evaluate perceptual, cognitive, and motor ability and to explore the effect of perceptual, cognitive and motor abilities, and display information on Web navigation. We proposed a method to calculate display information on the basis of number of links. It was explored how display information, age, and the test score of perceptual, cognitive, and motor abilities influenced Web navigation time. This effect was examined using a multiple regression analysis. Display information influenced Web navigation performance for both young and older adults. The more the quantity of display information was, the longer the Web navigation time was. In addition to this tendency, the depth of display layer was found to affect the Web navigation time especially for older adults. We found that the perceptual, cognitive, and motor abilities of older adults, in particular, the spatial memory, spatial rotation ability, and mouse operation ability, led to longer Web navigation time. These results implies the necessity of designing Web site for older adults that considers the decline of perceptual, cognitive, and motor ability. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 4 1991 気管支喘息におけるリンパ球機能に関する研究 第1編 気管支喘息におけるBAL 液中並びに末梢血中リンパ球の吸入抗原に対する幼若化反応の検討 387 397 EN Sho Takada Various antigens such as mite and fungi have been known to provoke bronchoconstriction in patients with bronchial asthma. The allergic mechanisms of asthmatic attack induced by these antigens were analyzed to clarify the role of cellular immunity in the pathogenesis of bronchial asthma. Mite and Candida antigens were applied to lymphocyte blastogenesis in asthmatic patients. Both lymphocytes in bronchoalveolar lavage fluid (BALF) and in peripheral blood of asthmatic patients responded significantly to mite and Candida antiten. Furthermore, BALF lymphocytes of patients with non-atopic and intractable asthma showed higher responses against Candida antigen than those of patients with atopic and non-intractable asthma, while peripheral blood lymphocytes showed a higher response against mite antigen in patients with atopic and non-intractable asthma. These findings indicate that lymphocytes in lugns sensitized with Candida antigen might play an important role in the pathogenesis of non-atopic and intractable asthma. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 102 1-2 1990 小児における下部食道内pH動態の研究―24時間食道内pH monitoring による解析― 7 22 EN Yasuhiro Watanabe Twenty-four-hour esohageal pH monitoring in infants and children has been performed to clarify pH dynamics of the lower esophagus using a pH histogram and acid clearance value in addition to pH score. A pH histogram showing the total state of pH dynamics in the lower esophagus ia constructed with whole pH data obtained by 24-hour pH monitoring. An acid clearance value indication the clearance ability of the esophagus is calculated by pH curves. 1) The normal acid clearance value is under 100. 2) Lower-side-tail of the pH histograms has been analyzed with an acid clearance value and other parameters of gastric acid reflux into the esophagus. Several characteristic pH dynamics are observed in cases of apparently normal patterns and mild gastroesophageal reflux (GER) which were diagnosed by a conventional manner : (a) moderate reflux with good clearance ability, (b) prolonged running status between pH 3 and 4, and (c) mild and pathological reflux with impaired clearance cbility. 3) pH histograms of the GER type are divided into 2 subtypes : The flattened subtype, which indicates ture GER with incompetence of the lower esophageal sphincter (LES), and the peaked subtype, which is often observed in cases of hypertrophic pyloric stenosis and has a well-functioning LES without pathologic GER. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 5-6 1992 慢性関節リウマチにおける全人工股関節置換術長期成績に関する研究 639 649 EN Kazuhiko Oosaki A long-term follow up study was performed on 125 total hip replacements (THR) in 95 rheumatoid patients. The average follow up time was 8 years and 5 months, ranging from 5 to 17 years. Except in 26 cases of death or 9 incomplete histories at the follow-up, 62 cases were investigated both clinically and radiologically. For the operations, two types of prostheses (Charnley and C-Muller ) were used. According to the Japan Orthopaedic Association (JOA) hip score, the preoperative score improved from 32.9 to 57.1 points at the final postoperative evaluation. In the radiological assessment using the method by Nagaya and Uno, a clear zone was seen around the acetabular cup in 82.2% of the hips and around the femoral stem in 53.2%. Rate of loosening corresponding to stage �V and �W was 20.2% in the acetabular side and 32.9% in the femoral side. Charnley-type group was better than C-Muller type both in clinical and radiological assessments. Twelve cases had lost walking ability. As postoperative complications, deep infections occurred in 4 hips, femoral shaft fracture in 4 hips, dislocation in 1 hip and revision due to aseptic loosening in 4 hips. THR may be useful for rheumatoid patients and improve the quality of life in the case of long-term disease if careful pre-and post-operative care is provided. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 5-6 1992 僧帽弁狭搾症に対する後尖温存術式後の左心機能―心筋変性度との関連― 591 599 EN Takeshi Shichijo Postoperative cardiac function was evaluated by dynamic exercise echocardiography in 36 cases with mitral stenosis, and electron microscopic examination of the LV myocardial cells was also carried out. Ultrastructual changes of the LV myocardial cells were graded into scores (EM-score). EM-scores correlated with % FS (r=-0.54), mVcf (r=-0.60) at rest and % FS (r=-0.54), mVcf (r=-0.50) after exercise. In 36 cases, 25 cases underwent conventional MVR (group �T) and 11 underwent MVR with preservation of the posterior mitral apparatus (group �U). When postoperative cardiac function was compared in 13 cases less than 4 of EM-score in group �T because EM-scores were less than 4 in all cases in group �U, no difference was observed in two groups except for mVcf at rest. The vaulues of % △FS and % △mVcf in group �T were better than those in group �U. This suggests that preservation of the hypertrophic and sclerotic subvalvular tissue in mitral stenosis disturebs the LV diastolic wall motion. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 1-2 1991 夜尿症の脳波学的研究 65 76 EN Hideo Inoue To clarify the pathophysiology of nocturnal enuresis and to establish its rational classification and treatment, clinical and electroencephalographic studies were made on 404 enuretic children, including an overnight polysomnographic investigation on 55 cases. EEG was normal in only 76 cases(18.8%). Background EEG abnormalities were observed in 226 cases(55.9%). This suggested the presence of brain immaturity or dysmaturity in enuretic children. Epileptic discharges were detected in 94 cases(23.3%), but not concomitant with the enuretic events. The epileptic mechanism may not play a primary role in the manifestation of enuresis. Specific EEG patterns of subcortical origin, i.e., 6 c/s wave-and-spike phantom, 14&6 c/s positive epikes, anterior theta burst, and mu rhythm, were detected in as many as 188 cases(46.5%). This indicates the importance of subcortical brain dysfunction in enuresis. During overnight polysomnographic recordings, 38 enuretic episodes were observed in 30 cases. Twenty eight episodes appeared in light sleep, 8 episodes in deep sleep, but only 2 episodes in REM sleep. According to the arousal response at the time of enuresis, enuretics were properly classified into arousal type(12 cases) and non-arousal type(18 cases). Prognosis was favourable in the cases whose enuresis appeared in light sleep and also in the arousal type enuretics. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 1-2 1991 小児期における脳底動脈血流速度の発達的変化および生理的変動に関する研究 19 29 EN Isaac Horiuchi Developmental change of blood flow velocity and pulsatility index (PI) of the basilar artery (BA) were studied, using transcranial Doppler sonography on 137 healthy subjects (68 males and 69 females) from 1 month to 30 years old. Blood flow velocity of the basilar artery increased with age during infancy and childhood, reached the maximum at the age of 5, and then gradually decreased. It ratio to blood flow velocity of the middle cerebral artery (MCA) i.e. MCA/BA showed a constant value irrespective of age. On the other hand, PI of the basilar artery showed a maximum value at infancy, and decreased during 1-2 years of age thereafter, it showed a constant value. Physiological variation of the blood flow velocity of MCA and BA during natural sleep and hyperventilation was also investigeted. There is a close correlation between the optimal pulsed signal depth for the measurement of blood flow velocity of the basilar artery and head circumference, or occipito-frontal diameter. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 5-6 1992 難治性喘息の発症病態に関する研究　第2編　中高年発症型難治性喘息の臨床像について 445 455 EN Kengo Nakayama To clarify the pathogenesis of late onset intractable asthma (LOIA), 102 asthmatics were classified into early (<40y.o.) and late onset asthma (>40y.o.), or intractable and non-in-tractable asthma. Clinical and allergic examinations were evaluated in each asthma group. Sixty nine percent of the late onset asthmatics had perennial type attacks. IgG-as well as IgE-mediated allergic reactions were suggested by the findings of immediate skin reaction, IgE RIST and RAST score to Candida allergen and reactivity of basophils to anti-immunoglobulin antisera in LOIA. Neutrophils in bronchoalveolar lavage fluid increased significantly in LOIA as compared with the early onset intractable asthma (EOIA) groups (p<0.05). In the pulmonary function test, a striking fall of % V25 was observed in both EOIA ans LOIA. The chest X-ray film frequently revealed microndular shadows in LOIA. Marked morphological changes in the transbronchial lung biopsied specimens were observed in the late onset asthmatics. These findings suggest that a non-IgE reaction, neutrophil infiltration in the local allergic site and histolpgical changes of lung tissue lead to LOIA. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 5-6 1992 難治性喘息の発症病態に関する研究　第1編　難治性喘息の臨床的検討 433 443 EN Kengo Nakayama To clarify the pathogenesis of intractable asthma, clinical features, allergic examinations, pulmonary functions and histological finding were evaluated in 27 intractable asthmatics compared with 33 non-intractable asthmatics. Almost all of the intractable asthmatics had chronic and perennial asthma attacks and also had highly frequent episodes of respiratory infection. IgG-as well as IgE-mediated allergic reactions were proved by the findings of skin reaction, IgE RAST score, precipitating antibody and reactivity of basophils to anti-immunoglobulin antisera in the intractable asthmatics but not in the non-intactable asthmatics. Neutrophils of BALF and peripheral blood increased markedly in the intractable asthmatics as compared with the non-intractable asthmatics. The fall of % V(25) on flow volume curve in the intractable asthmatics, indicated small air way obstruction. Micronodular shadows on the chest X-ray film were frequently seen in the intractable asthmatics. Many histological findings were shown on lung specimens obtained by TBLB in the intrac-table asthmatics. These findings indicate that multiple factors of allergic reaction mediated by IgG, migrated neutrophils and organic changes of lung tissue lead to severe and intractable asthma attack. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 7-8 1991 大動脈弁閉鎖不全症における左室心筋の組織構造変化と安静時心機能との関連に対する研究 993 1003 EN Hisashi Tsuji We collected tissue samples from the left ventricular myocardium in 20 patients with aortic regurgitation, examined the correlation between myocardial ultrastructure and cardiac function at rest and obtained the following results. The extent of fibrosis in the myocardium and ultrastructural changes in the myocardial cells were respectively expressed in LM-Score and EM-Score. Furthermore, the myofibril changes expressed by the EM-Score were added to the LM-Score (Myo＋LM-Score), and each score was calculated and compared with the parameters of cardiac function. There was no significant correlation between EM-Score and parameters of cardiac function. LM-Score was correlated with Max dv/dt at r＝−0.471 (p<0.05) and with endodiastole (D/L) at r＝−0.567 (p<0.01) significantly, showing a negative linear correlation. Myo＋LM-Score was correlated with EF at r＝−0.574 (p<0.01) and with△ D at r＝−0.577 (p<0.01) significantly, showing a negative linear correlation. Among the cardiac functions at rest in patients with AR, the morphologic and diastolic parameters were closely related with the extent of fibrosis, and the contractility was closely related both with a change in myofibrils and with the extent of fibrosis. Thus, the cardiac functions at rest in patients with AR were correlated with the myocardial factors. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 7-8 1991 三歳児健康診査の評価―検尿の意義と判定方法― 983 992 EN Katsuko Tanaka This study focuses on the health examination programs for 3 year old children from a public health point of view. The methodology, items tested, criteria and follow-up systems of urine examination were evaluated. Results of urine examinations of 8,615 children(male : 4,490, female : 4,125), who had been in the health examination program from 1980 to 1985, were studied in the area of K-ku in Y-city. Moreover a follow-up study was performed to discuss the significance of urine examination as mass screening. In the health examination program for 3 year old children, it is efficient to classify those with a score of more than “one plus” into the high risk group with regard to proteinuria and hematuria. It is possible to reduce the false positive rate by checking first morning urine at re-examination. A bettr information net work system must be established to utilize the results of mass health examinations for three year old children. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 11-12 1992 Tl-201心筋シンチグラフィーを用いた心臓弁膜症における心筋性状及び心予備能の評価 1059 1068 EN Shunju Indo This study was performed to clarify whether the extent-score (Ex-Score) calculated by Tl-201 myocardial scintigraphy is a reliable indicator of the severity of myocardial damage and cardiac residual capacity in valvular heart diseases. The subjects consisted of 38 patients (10 with aortic regurgitation (AR), 4 with aortic stenosis (AS), 13 with mitral regurgitation (MR) and 11 with mitral stenosis (MS)). Ex-Score were significantly correlated with the severity of myocardial damage found in biopsied specimens obtained intraoperatively (correlation efficiency to Ex-Score with cell diameter in AR, % fibrosis in AR, cell diameter in AS, electron microscopic score in MR and % fibrosis in MS was 0.873, 0.734, 0.970, 0.913 and 0.659, respectively). Ex-Score were also correlated with cardiac residual capacity determined by radioisotope angiography (correlation efficiency to Ex-Score with % �� ejection fraction in AR, % �� end-systolic volume in MR, % �� end-diastolic volume in MS was -0.764, 0.790 and -0.763, respectively). These results suggest that the severity of myocardial damage and cardiac residual capacity can be estimated by Tl-201 myocardial scintigraphy (Ex-Score) in valvular heart diseases. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 1-2 1992 肺切除術における術後心肺合併症発生予測のための指数設定及びその臨床的有用性の検討 165 176 EN Yuichi Kobashi Two indicators (Risk score and Resection Index) for pulmonary and cardiac complications after lung resection were evaluated on 182 patients with bronchogenic carcinoma by quantita-tive technetium 99m macroaggregation albumin (MAA) perfusion scanning preoperatively and who then underwent lung resection. After surgerg, the correlations between preoperative lung function and the development of postoperative pulmonary and cardiac complications (PPCC) were examined in each case. The Risk score consisted of eight parameters (% FVC, FEV 1.0%, % MVV, % MMF, V50/HT, V25/HT, % peak flow, and % DLco), and a value of from 0 to 8 was assigned. In the patients with a Risk score of 0, PPCC occurred in 5 of the 71 cases, while complications were noted in 26 of the 94 patients with a Risk score from 1 to 5 and in 14 of the 17 patients with a score of over 6. The Resection Index was calculated from the predicted postoperative FEV 1.0 from the quantitative 99m Tc MAA perfusion scan and the predicted FEV 1.0, PPCC occurred in 20 of the 27 patients with a Resection Index of below 40%, 25 of the 131 patients with an index of 40% to 65%, and none of the 24 with an index over 65%. Both indicators had a good correlation with the occurrence of PPCC. These two indicators, the Risk score and the Resection Index, were clincally useful for predicting PPCC preoperatively and may help reduce the incidence of PPCC. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 1-2 1992 精神障害の対する態度―日本, ブラジルの看護婦, 看護士の態度の比較研究― 97 106 EN Katsuko Takenami Attitude of nureses and attendants toward mental disorders was studied by using question-naire in Japan and Brazil. By factor analysis, three factors, negative attitude toward mental disorders and misunder-standing, positive attitude toward mental disorders and mental health ideology were extracted. The score of negative attitude toward mental disorders and misunderstanding was high in Brazil. This was suspected to be caused by poor knowledge about mental disorders. The score of positive attitude toward mental disorders was similar in Japan and Brazil. The score of mental health ideology was high in Japan. Mental health ideology is important to improve the attitude toward mental disorders both Japan and Brazil. It is important to spread knowledge about mental disorders in Brazil. In Japan, it is important to increase the interest in mental disorders. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 5-6 1993 高齢高血圧患者における認知機能と運動機能との関連 575 587 EN Hiroaki Matsuoka This study examined the correlation between decline in cognitive and motor functions in elderly patients with hypertension. The Mini-Mental State Examination (MMSE) and the Motor Age Test (MOA) were administered to 185 outpatients with hypertension aged 65 or older. In multiple regression analysis, increasing age and history of cerebrovascular disease were significantly related to lower performance on MMSE and MOA. Fewer years of education were also associated with lower performance on MMSE. Vertebral deformity had a significant negative effect on MOA. After controlling other variables, there was a significant correlation between performances of MMSE and MOA. The correlation between cognitive and motor function, which was independent of increasing age and cerebrovascular disease, may indicate common pathogenic mechanisms underlying cognitive and motor deterioration in elderly patients with hypertension. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 5-6 1993 成人気管支喘息の臨床病態の特徴―臨床分類と関連して 569 574 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Ryo Soda Shinya Tada Kiyoshi Takahashi Ikuro Kimura Two asthma calssification systems associated with the pathophysiology of the airways were evaluated in 30 adult patients with bronchial asthma. The systems were classification by clinical symptoms (clinical diagnosis) and classification by a score calculated from clinical findings and examinations (score diagnosis). Thirty subjects were classified into 15 patients with Ia. simple bronchoconstriction type, 6 with Ib. bronchoconstriction+hypersecretion type and 9 with II. bronchiolar obstruction type by clinical diagnosis. Fifteen subjects with type Ia comprised 10 patients with expectoration of 0-49 ml/day and 5 of 50-99 ml/day. The patients with expectoration of 50-99 ml/day were classified as type Ib by score diagnosis. The value of FEV1.0% was significantly lower in patients with type II than in those with type Ia. The value of % V25 was significantly lower in patients with type II asthma compared with type Ia and type Ib subjects. No significant difference was observed in the values of % FEV1.0% and % V25 between patients classified by clinical diagnosis and score diagnosis. The proportion of neutrophils in BAL fluid was significantly higher in patients with type II compared to those with types Ia ad Ib by both classification systems. The proportion of eosinophils in BAL fluid was significantly higher in types Ia-2 and Ib by clinical diagnosis and in type Ib by score diagnosis than those classified as type Ia-1 by both systems. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 3-4 1993 気管支喘息患者における食物抗原の関与 251 256 EN Fumihiro Mitsunobu Takashi Mifune Hikaru Kitani Morihiro Okazaki Yoshiro Tanizaki Both inhalant allergens and food allergens are reported to induce symptoms of asthma. However, food may play a minor role in respiratory allergy, and allergy to food may contribute to respiratory symptoms by increasing bronchial hyperresponsiveness. In this study, we examined serum levels of specific IgE antibodies to food allergens and inhalant allergens in bronchial asthma patients. Rice, wheat, soybean, corn and potato were selected as food allergens in this study. The positive ratio of IgE RAST (radioallergosorbent test) to potato was highest and that to rice was lowest among the five food allergens tested. High positivities of specific IgE antibodies to food allergens did not correlate to patient age or age at onset, and were found in patients with high levels of serum IgE. Positive IgE RAST to food allergens was detected only in patients with specific IgE antibodies to inhalant allergens. Positive ratio of specific IgE antibodies to food allergens tended to be higher in asthmatics with other allergic disease than in those without allergic disease. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 11-12 1993 Myelodysplastic syndrome (MDS) における好中球スーパーオキサイド産生能に関する研究 919 932 EN Noritoshi Inagaki Myelodysplastic syndrome (MDS) are hematological disorders with the potential of progressing to acute leukemia. MDS patients occasionally die of infection despite the absence of severe pancytopenia prior to overt leukemia. Superoxide anion (O(2)(−)) production leads to intracellular bactericidal activity by neutrophils, particularly in an oxygen-dependent system. In this paper, O(2)(−) production by neutrophils in 15 MDS patients [11 patients with refractory anemia with excess of blasts (RAEB) and 4 patients with RAEB in transformation (RAEB-t)] was examined to evaluate possible causes of enhanced susceptibility to infection and to gain information concerning the pathophysiology and prognosis. The following results were obtained : (1) The O(2)(−) production by neutrophils (O(2)(−) production) in 15 MDS patients was lower than that in healthy controls (3.75±2.93 vs 6.20±1.53 nmol/min/10(6) neutrophils, p<0.05). Three of the 15 MDS patients showed little O(2)(−) production. (2) There was inverse correlation between O(2)(−) production and the percentage of leukemic cells in the marrow in acute leukemia (r=0.55, p<0.01), but not in MDS. (3) The O(2)(−) production in 5 MDS patients showing morphological anomalies in a high percentage of neutrophils significantly lower than that in 10 MDS patients showing morphological anomalies in a low percentage of neutrophils (1.04±1.37 vs 5.15±2.50 nmol/min/10(6) neutrophils, p<0.05). (4) The O(2)(−) production in 5 patients with frequent fever (≧38℃) -episodes was significantly lower than that in 10 MDS patients with infrequent fever-episodes (2.22±2.15 vs 4.49±2.83 nmol/min 10(6) neutrophils, p<0.05). (5) Comparison of the O(2)(−) production between MDS patients with and without progression to overt leukemia showed no significant difference (4.25±3.26 vs 3.28±2.76 nmol/min/10(6) neutrophils). These findings suggest that impaired O(2)(−) production by neutrophils, probably due to the faulty differentiation from abnormal hematopoietic clones, is one possible cause of enhanced susceptibility to infection in MDS, and may provide clues for clinical management of infection, but is not useful for early detection of progression to overt leukemia. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 1-2 1993 リウマチ性僧帽弁膜症に合併する三尖弁閉鎖不全症における右室心筋微細構造の研究 135 151 EN Shigeo Imai The Pathogenesis of the tricuspid regurgitation (TR) accompanying the rheumatic mitral valvular disease was examined. In 42 patients (29 were rheumatic, 13 were non-rheumatic), the right ventricular myocardial biopsy specimens were obtained during surgery, with which the fraction of interstitial fibrosis (% Fib.) was calculated by light microscopy and myofibrillar degeneration was evalated and scored by electron microscopy (EM-score). The relationship between the right ventricular morphology (% Fib. and EM-score) and the grade of TR was examined. 1) % Fib. was significantly higher in the rheumatic group than in the non-rheumatic group. 2) In the rheumatic group, % Fib. and EM-score were higher in proportion to the preoperative severity of TR. 3) After the change of the grade of TR was estimated in the early and distant postoperative periods in the rheumatic group, the patients were diveded into two subgroups, one with worsened TR and on without worsened TR. Both % Fib. and EM-score were significantly higher in the worsened group. These finding show that the right ventricular myocardial ultrastructural changes correlate significantly with the preoperative grade of TR and the postoperative change of TR. TR accompanying rheumatic mitral valvular disease may be caused not only by the secondary effect of back-pressure overloading to the right ventricle, but by the right ventricular myocardial ultrastructural changes due to the rheumatic disease itself and furthermore pressure and volume overloading to the right ventricular myocardium. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 1-2 1993 24時間保存心における心筋エネルギー代謝と同所性移植後心機能 ―浸漬保存と灌流保存の比較および PFC 液の有用性について― 107 117 EN Shingo Seno To assess the vability of canine hearts after prolonged ex-vivo heart perservation, we evaluated the myocardial metabolism by determining the high energy phosphate(HEP)levels and respiratory function of isolated mitochondria(MRF). Furthermore, we calculated the mitochondrial score(MS) for semi-quantitative analysis of ultrastructural changes. These three indicators were compared with the left ventricular function(LVF) following orthotopic heart transplantation(H-TX). Forty two hearts, harvested from mongrel dogs, each weighing 8.5kg〜15kg, were divided into 3 groups : 24-hour immersion in modified Collins solusion(MC) (group A), 24-hour perfusion with MC(group B) and 24-hour perfusion with MC containing perfluorochemicals(PFC)(group C). After the 24-hour preservation, biopsies were obtained from 7 hearts in each group and HEP levels, MRF and MS were determined. The HEP levels, MRF and MS were significantly higher in group C than in group B and significantly higher in group B than group A. The cardiac function after H-TX revealed a similar tendency. These findings indicate that continuous hypothermic perfusion provides better protection than simple hypothermic immersion and that perfusion with an intracellular solution containing PFC preserves and protects an organ sufficiently before clinical heart transplantation. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 9-10 1993 施設入所中の精神遅滞男性における脆弱X症候群の頻度とその臨床心理学的特徴 847 858 EN Masae Murakami To determine the prevalence and psychological features of fragile X syndrome among Japanese, cytogenetic and psychological studies were conducted on 183 institutionalized male retardates. The induction of fra (X) (q27) by MEM-FA medium or fluorodeoxyuridine treatment revealed that 6 (3.3%) patients had fragile X syndrome. Psychological tests in the 6 patients with fragile X syndrome [Fra (X)], 6 control subjects with autism [AU] and 6 with simple mental retardation [MR] showed the following results : (1) on SM social maturity test, overall scores of social skills in Fra (X) were between those in AU and those patients in MR. Behavioral autonomy was much better in Fra (X) than in AU patients ; (2) on CLAC-�U behavior evaluation, Fra (X) patients had a tendency toward lower developmental levels in verbal and nonverbal expression as well as in handling compared to AU patients ; (3) on DSM-�V-R test, 3 of the 6 Fra (X) males met the criteria for autism. Fra (X) patients had fewer failures in recognizing others' existence or emotions, to develop relationships with others and to use language appropriately compared to AU patients, but had more defects in imitation of others and adaptation to environmental changes than MR patients. The similarity in the prevalence of the fragile X syndrome in the Japanese male retardates to that reported in Caucasians suggests that Fra (X) is a common genetic disorder affecting all ethnic populations. From the psychological findings, we concluded that Fra (X) patients have strong social aversion and defects in verbal and nonverbal expression which sometimes lead to autism. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 7-8 1993 アレルギー性胃腸症の診断に関する研究　第2編　腸音分析法を用いたアレルギー性胃腸症の診断に関する検討 751 758 EN Katuhiro Miyashita Oral challenge with specific allergens is generally used to diagnose allergic gastroenteropathy, but no evaluation criteria have yet been established. Therefore, we examined allergological tests (skin tests, IgE RAST score), oral challenge tests with causative allergens and oral administration tests using sorbitol as a nonspecific stimulator or distilled water as a control. Phonoenterograms were recorded intermittently for up to 5 hours after the tests and analyzed by a pulse density program. The results showed that it is possible to classify allergic gastroenteropathy into six subgroups by the allergological tests, symptoms and intestinal motility analyzed by phonoenterography. Increase of bowel sounds with or without positive allergological test and symptoms indicates a high suspicion of allergic gastroenteropathy. These data suggest that phonoenterography is useful in the diagnosis of this disease. It should also be possible to diagnose latent cases of allergic gastroenteropathy by non IgE-mediated allergic reactions. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 9-10 1994 気管支喘息における病態に基づく新しい病型分類に関する研究 1025 1033 EN Kazuhi Kimura To establish a new classification in bronchial asthma, antigen-induced immediate asthmatic response (IAR) and late asthmatic response (LAR) to mite and Candida were compared with antigen specific IgE antibody (IgE RAST) and lymphocyte blastogenesis (Ly-BL) in asthmatics. Half of asthmatics with a high score on mite IgE RAST could not be provoked to IAR, although almost all of patients with house dust-induced IAR showed a high score on mite IgE RAST. However, asthmatics with enhanced Ly-BL following exposure to mite and Candida showed highly provoked LAR by antigen inhalation, and LAR patients showed significantly enhanced Ly-BL by both antigens (p<0.01). Bronchial asthmatics were classified into the following 4 groups using those parameters ; A group (IgE RAST+, Ly-BL-), B group (IgE RAST+, Ly-BL+), C group (IgE RAST-, Ly-BL+), D group (IgE RAST-,Ly-BL-). Half of the patients with IAR belonged to the A and B groups, and almost all of the LAR patients were in the B or C group. Patients in the A group predominantly showed early onset, however patients in the B and C groups showed late onset. A and B group patients were mild or moderate asthmatics, but severe asthmatics belonged to the C and D groups. These data suggest that the C group showed only Ly-BL led LAR by "cell-mediated allergy" in late onset severe asthma. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 9-10 1994 骨髄異形成症候群における melphalan 少量療法の検討 947 962 EN Seiji Takaba Myelodysplastic syndrome (MDS) is a disorder of multipotential hematopoietic stem cells. There is no effective therapy for MDS, especially for MDS associated with an excess of blasts, such as refractory anemia with excess blasts (RAEB) or RAEB in transformation (RAEBt). We previously reported the effect of K-18 (a human IgG-melphalan conjugate) in 15 patients with RAEB or RAEBt. The overall response rate was not high, but no side effects were noted. Although the mode of action of K-18 is not certain, it was suggested that the effect was associated with the activity of melpahlan itself. Therefore, low-dose melphalan therapy was initiated in eldery patients with RAEB or RAEBt. Six patients with RAEB and 12 patients with RAEBt received 2mg oral administration daily. Median age of the patients was 64. Six patients achieved complete remission (CR), one patient showed a partial response and four patients had a minor response. Total dosage of melpahlan for patients who achieved CR was 143±18 mg. Median duration of CR was 14.5 months. Serious toxicity was not encountered in any case and neither marrow suppression nor pancytopenia were observed in cases that achieved CR during the administration of melphalan. Changes in cell surface markers (CD34, CD33, CD13) were examined during the time course of CR in two cases. CD34 + cells decreased rapidly during the first two weeks and CD34-CD33+cells increased after four weeks of melpahlan administration. Studying the clinical course of CR with cell surface marker analysis provided evidence that melphalan therapy induced differentiation of transformed hemopoietic precursors. We conclude that daily chronic administration of melpahlan is a useful therapy for elderly patients with RAEB or RAEBt. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 1-2 1994 低形成型白血病に関する臨床的研究―血球形態異常と化学療法効果との関連― 93 102 EN Shunichi Fukuda The effect of chemotherapy on dysplasia of bone marrow cells was studied in 10 patients with hypoplastic leukemia. Patients were all previously untreated, and ages ranged from 40 to 81 years old (median : 70). Male to female ratio was 1 : 1. Morphologic features studied were pseudo-Pelger neutrophils, absence or decreased Azur granules in the neutrophilis, multinu-cleated erythroblasts, megaloblastoid changes in erythroblasts, micromegakaryocytes, mononuclear megakaryoctes and megekaryocytes with multiple small separated nulei. Although 8 patients with chemotherapeutic effect showed little evidence of dysplasia, 2 patients without chemotherapeutic effect showed severe dysplasia in two or three blood cell lineages. These findings sre thought to indicate that a part of hypoplastic leukemia develops from myelodysplasia with hypoplastic marrow. The establishment of an optimal treatment for hypoplastic leukemia should be sytudied by stratification of bone marrow dysplasia. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 108 11-12 1997 急速破壊型股関節症の病態に関する研究 333 342 EN Hiromitsu Iwasaki Clinical and radiological studies were performed on 25 hips of 25 patients with rapidly destructive coxopathy within 3 years after the onset. The mean age at the time of onset was 68.3 years. Two patients were males, and the other 23 were females ; many patients were aged females. The mean Japanese Orthopaedic Association hip score for pain was 13/40 while that for the range of motion (flexion) was 9.4/12. Inspite of marked pain, the motion range was relatively good. The mean disease duration was 10.3 months in the group showing an increased blood sedimentation rate and 20.8 months in the group with a normal sedimentation rate, being shorter in the former showing positive inflammatory reactios. Hypertension was observed in 44%. Radiographic examination showed osteoporosis in all patients. According to Singh's classification, the disease duration was shorter in patients with advanced osteoporosis. The Center-Edge angle and Acetabular-Head Index as the acetabular covering rate were below the mean value in 65%, showing slight dysplasia of hip joint. Histopathological examination revealed exposure of eburnated bone on the surface of the capital lesion in many patients, but only slight proliferative changes. In the synovial membrane, villous hyperplasia and cell proliferation were observed in the surface layer in most of patients. Free fragments of the cartilage and bone were phagositized with nonspecific inflammatory findings in the deep layer. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 108 1-2 1996 SH型全人工股関節の開発 1 12 EN Kunihiro Araki We compared the conventional hip prosthesis with a newly developed SH-type hip prosthesis by examining the degree of true roundness, sphericality, and surface roughness of the joint, as well as evaluating the metal stem properties. The roundness, sphericality and surface roughness were evaluated using Ogawa's criteria. Ogawa classified these values into 3 cate-gories, A (5 points), B (3 points), and C (1 point), and the overall scores into 4 categories, A (21 points or more), B (20-18 points), C (17-15 points), and D (14 points or less). In class A, roundness was less than 0.1μm and for the femoral head and less than 20μm for the acetabular cup, sphericality was less than 5μm and less than 50μm, and surface roughness less than 0.1μm and less than 0.5μm (maximal roughness of the cup was 5μm), respectively. Applying these criteria, the total score for the SH-type hip prosthesis placed it in class A. The strength and micro-cleanliness of the stem itself were sufficiently satisfactory. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 7-8 1994 気管支喘息の発症に関する研究　第1編　喘息患者における HLA による遺伝的要因の検討 731 742 EN Makoto Okamoto Heredity has long been suspected to play an important role in the occurrence of bronchial asthma. Recently familial and twin sibling studies demonstrated the role of genetic factors in asthma. Therefore, we measured HLA antigens of 53 asthmatics and analyzed the relationship to clinical parameters to elucidate the role of HLA in the occurrence of bronchial asthma. Four major findings were obtained. 1) Study of the HLA system in asthmatics showed a significantly higher frequency of DR53 and DQ3 and lower frequency of DQ1, DQ6 (1) and DQ7(3). This suggests that DR molecules demonstrate positive associations and DQ molecules negative associations with bronchial asthma. 2) DQ1 was associated with IgE production in asthmatics. 3) B39(16) positively associated with RAST score of Candida. 4) The study of late onset asthmatics, intractable asthmatics and the high responder group of in vitro lymphocyte reaction to Candida allergen showed a cooperatively and significantly higher frequency of DR53(P<0.05). These findings suggest that DR53 has a positive association with onset of late onset intractable asthma. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 107 7-8 1995 前頭―中心部導出視覚誘発電位の関する研究 121 129 EN Eita Minakuchi To elucidate the developmental changes in the visual evoked potentials of fronto-central derivation, 137 normal subjects between 0 month 37 years of age were examined. The latencies of early components (N60, P75) showed a gradual decrease up to 1 year of age. The N130 latency of late components showed a rapid decrease in 8 months, and afterwards, showed a gradual decrease until 10 years of age. The P190 latency showed a rapid decrease in 6 months, and afterwards, showed a gradual decrease until 15 years of age. All four components (N60, P75, N130 and P190) showed a tendency of low amplitudes, up to 8 months of age. During the sleep stages 1, 2 and REM, N130 and P190 latencies were prolonged, and amplitudes decreased, compared with those in the waking state. During sleep stages 3 and 4, these components disappeared. Late components of visual evoked potentials at fronto-central derivations showed signifi-cant developmental changes, and the results of this study can be considered useful in the objective evaluation of brain development. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 112 3-8 2000 鏡視下滑膜切除術を行った慢性関節リウマチの膝MRI 29 37 EN Yasuyuki Katoh The effectiveness of arthroscopic synovectomy (A-S) for the knee of rheumatoid arthritis (RA) patients was assesssd by comparing the severity of synovial proliferation on MRI before and after the surgery. Twenty-five patients (30 knees) were studied. The mean duration of RA was 6 years and 7 months and the mean age at the time of A-S was 49.0 years. The mean follow-up period was 19 months (range:6-39 months). The preoperative Larsen's classification from grade �Tto �W was 8, 13, 6, and 3 knees, resectively. Synovial proliferation was evaluated by the modified Takeuchi's classification (MRI score). The MRI score was investigated in relationships with the radiographic grade, wet weight of excised tissue, treatment score for RA knees of the Japanese Orthopaedic Association (JOA score), and the CRP value. The MRI score, JOA score, and CRP all significantly improved during follow-up. The radiographic grade showed less progression, the JOA score improved more, and CRP was lower during follow-up in patients with a postoperative MRI score less than 5. The wet weight of excised tissue showed no related with the MRI score. These results suggest that the effectiveness of A-S can be determined by evaluation of improvement of the MRI score. No potential conflict of interest relevant to this article was reported.

岡山大学医学部保健学科 Acta Medica Okayama 1345-0948 11 1 2000 Development of a dental implant movement checker 25 34 EN Hisao Oka Koichi Ono Keiji Saratani Takayoshi Kawazoe 10.18926/11709 Evaluation of dental implantation is very important because it gives useful information for both planning the dental treatment and evaluating of prognosis. This study aimed at improving our previously developed Tooth Mobility (TM) tester and developing a dental implant movement (IM) checker. The measuring probe included a bimorph transducer of two piezoelectric elements. It was actuated by single frequency and detected tooth acceleration. The acceleration signal was processed and the IM score was calculated in PC. Two artificial implant models in which IMZ implant was buried with different elasticity of surrounding (molteno(@)) were used to examine the performance of the IM checker. The IM scores obtained in the models were 29 and 58. The measurement time was below 15 seconds. The average of measurement variation of one operator was below 6% and the average variation among five operators was below also 6%. The IM checker reduced a measurement variation by 51% and a measuring time by 61% compared with those of the TM tester in natural teeth. The newly developed IM checker had sufficient measuring reliability and we could objectively estimate the implant movement in dental clinics. No potential conflict of interest relevant to this article was reported.

岡山大学環境理工学部 Acta Medica Okayama 1341-9099 12 1 2007 合成変数の推定を利用した項目選択とその数値的検討 29 40 EN Yuichi Mori Kaoru Fueda Masaya Iizuka 10.18926/fest/11429 A variable selection method using global score estimation is proposed, which is applicable as a selection criterion in any multivariate method without external variables such as principal component analysis. This method selects a reasonable subset of variables so that the global scores, e.g. principal component scores, which are computed based on the selected variables, approximate the original global scores as well as possible in the context of the least squares. Three computational steps are proposed to estimate the scores according to how to satisfy the restriction that the estimated global scores are mutually uncorrelated. Three different examples are analyzed to demonstrate the performance and usefulness of the proposed method numerically, in which three steps are evaluated and the results obtained using four cost-saving selection procedures are compared. No potential conflict of interest relevant to this article was reported.

岡山大学資源生物科学研究所 Acta Medica Okayama 0916-930X 2 1 1994 Geographic Differentiation of Barley Powdery Mildew Fungus(Erysiphe graminis DC. f. sp. hordei) 103 110 EN Takeo Konishi Hideo Heta Fifteen cultures of barley powdery mildew fungus (Erysiphe graminis DC. f. sp. hordei) isolated in different regions of the world were inoculated to 120 barley varieties. Infection scores varied among the cultures and barley varieties, and their interactions were observed. Principal component analysis of the infection scores revealed that the cultures could be classified into three groups by first and second components (contributing 40.2% and 15.6% of the total variance, respectively), and that two Japanese cultures could be distinguished from the others isolated in Europe and North America. This indicates that the fungus is geographically differentiated in the reaction of the barley varieties to the cultures. Furthermore, East Asian barley varieties differed from European ones in their reactions to the culltures, while barley varieties from regions between East Asia and Europe showed a large genetic diversity in their reactions. No potential conflict of interest relevant to this article was reported.

岡山大学教育学部 Acta Medica Okayama 0471-4008 134 2007 肥形態と体組成を組み合わせて評価した肥満・やせ分類による中学生の体力について 75 84 EN Minoru Adachi Ryo Ando Kiyoshi Maeda 10.18926/bgeou/10999 The purpose of this study was to clarify physical fitness(PF) characteristics of obese and lean adolescent classified by combining somatotype, and body composition. Somatotype were measured by obesity index from weight and height measurement. Body composition given as percentage body fat was calculated by measuring skinfold thickness. The measurement of PF consisted of 12 tests. In addition, comparison were made in each somatotype group between the high percentage body fat group and the normal group. PF were lower in overweight or underweight group than in normalweight group. At overweight and normalweight groups, the high percentage body fat group attained scored lower in most PF test items. However, at underweight group, normal percentage body fat group attained scored lower in 6-7 items. No potential conflict of interest relevant to this article was reported.

岡山大学農学部 Acta Medica Okayama 0474-0254　 95 1 2006 スギ人工林の斜面に沿った土壌窒素動態の空間的変動 93 95 EN Muneto Hirobe Spatial variabillity of soil nitrogen(N) dynamics was examined along a slope in a 45-year-old Cryptomeria japonica D.Don plantation in the southeastern paet of Shiga Prefecture. Net N mineralization showed no clear gradient along the slope, while net nitrification and percent nitrification were high at lower positions,and very low at upper positions of the slope. Principal component(PC) analysis showed soil properties were divided into three groups which were PC1(water content and pH), and PC3(total C and N). Regressions of net soil N transformations against PCs scores suggested net N mincralization was mainly regulated by PC3, while net nitrification and percent nitrification were mainly regulated by PC1 and PC2. The difference in the main form of inorganic N was expected to affect soil N availability for plants through the difference in the mobility in negatively changed forest soil. We evaluated the soil N availability that reflebted the ion mobility factors by ion exchange resins and found that greater mobility of nitrate lead to greater soil N availability at lower positions of the slope. In addition, gross N transformations were directly measured using ¹⁵N isotope dilution, and the influence of microbial caebon (C) availability on the internal soil N cycles were examined by long-term laboratory incubation. Gross nitrifivation was detected in both soils taken at upper and lower positions on the slope, suggesting that nitrification was also an important process at upper positions where almost no net nitrification was detected. Changes in net and gross N transformations, the organic C and N pools, and microbial respiration suggested that start of rapid net nitrifibation might be affected not only by the availability of C for microbial biomass, but also by the relative availability of C and N. No potential conflict of interest relevant to this article was reported.

岡山大学農学部 Acta Medica Okayama 0474-0254 37 1 1971 サイレージの調製法に関する研究(第16報) サイレージの品質に対する材料の日乾ならびに細切の影響 61 73 EN Senji Uchida Hiroshi Sutoh Kuniyoshi Shibata Two experiments were carried out to investigate the relationship between the dry matter level or physical form of forage and the quality of silage. One experiment was carried out to find the effect of the dry matter content of forage on the quality of resultant silage. Namely, green oats, of which dry matter was adjusted to five levels (15％, 24％, 33％, 410％ and 61％) by means of wilting or adding of water, were stored in the experimental silos, respectively. Each silo was opened after 158 days and the fermentative quality and the dry matter loss of silages produced were estimated. And the other experiment was carried out to confirm the relationship between the form of forage and the quality of silage. In this experiment, Italian ryegrass, of which a part was chopped at the length of 1 cm, 2 cm, 3 cm, 5 cm and 10cm and the rest. was lacerated and bruised after chopped at 2cm length, were stored in laboratory miniature-sealed silos, respectively, and then each silo was sealed completely. Of resulant silage, fermentative quality and carotene content were estimated. The results obtained are summarized as follows : 1) The score by Flieg's appraisal method of the silages was 15 in the silage of 15％ dry matter, 58 in the silage of 24％ dry matter, 70 in the silage of 33％ dry matter and 95 in both silages of 41％ and 61％ dry matter. And a positive significant correlation, r = +0.880 (p<0.05), was found between the dry matter level of forage and score by Flieg's appraisal method of silage. 2) The invisible loss of dry matter during storage was more in a low dry matter silage than in a high dry matter silage and the dry matter loss by top spoilage of silage was more in a high dry matter silage than in a low dry matter silage. Therefore, no significant difference of the conservation ratios of edible dry matter between silages was found. 3) The fermentative quality of silages made from fine-chopped grass (1-2cm) was better than that of silages made from rough-chopped grass(5-10cm), and the preserved carotene in the silage was increased by chopping grass. 4) The silages made from lacerated and bruised grass were superior in quality to the chopped silage, and contained the carotene of high level, when compared with the chopped silages. These data suggest that the quality of the silage in affected remarkably by dry matter level and physical form of forage. No potential conflict of interest relevant to this article was reported.