Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 14 2026 A Self-Adaptive Framework for Deploying Machine Learning Systems Without Ground-Truth Data at Runtime 30309 30326 EN Kento Furukawa Graduate School of Information Science and Technology, Osaka University Hiroyuki Nakagawa Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Tatsuhiro Tsuchiya Graduate School of Information Science and Technology, Osaka University In recent years, the practical application of machine learning technology has rapidly progressed, accelerating its adoption across various fields. In this context, studies into the effective operation of machine learning systems in real-world environments have become essential. In actual operational settings, the distribution of input data often changes over time, leading to a significant decline in the predictive performance of models. Additionally, the lack of ground-truth data for test data during operation can sometimes make adaptation through retraining difficult. This study proposes a framework that autonomously adapts to changes in input data distribution, even in environments where ground-truth data for test data is unavailable during operation. This framework analyzes the distribution of input data and selects the appropriate predictive model based on the state of the distribution. To ensure optimal model selection, the framework employs two complementary approaches: 1) dynamically switching between multiple pre-trained models with different feature sets according to environmental changes and 2) building ensemble models based on the distribution of the test data. These approaches enable the framework to autonomously adapt to shifts in data distribution, even in operational settings where ground-truth data is unavailable. Evaluation experiments using both simulated and real-world data assessed the predictive performance of the proposed method through metrics such as R2, RMSE, and MAE. Compared to conventional single model predictions, the proposed method consistently demonstrated higher accuracy. These results indicate that the proposed approach effectively adapts to data distribution shifts in operational environments where ground-truth data is unavailable. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 14 2026 FEM-Based Design and Characterization of a Millimeter-Scale Piezoelectric Resonance Force Sensor 17960 17970 EN Aoto Yamazaki Department of Mechanical Engineering, Toyohashi University of Technology Takuma Akiduki Department of Mechanical Engineering, Toyohashi University of Technology Atsuo Honna Riccoh Company Ltd. Michiteru Kitazaki Department of Computer Science and Engineering, Toyohashi University of Technology Tomoaki Mashimo Graduate School of Natural Science and Technology, Okayama University This paper presents a millimeter-scale piezoelectric effect-based force sensor that uses the change in its resonant frequency as the detection principle for high sensitivity and a wide measurement range. Such characteristics are suited for robot hand applications that not only detect small forces but also handle large payloads. We develop a methodology to estimate the relationship between applied force and resonant frequency shift by combining classical contact theory and finite element method (FEM) analysis. Although this relationship is non-linear, the designability of sensitivity and measurement range is demonstrated by the simulation. The simulation results based on the method are verified, showing good agreement with the experimental results. The static characteristics, including sensitivity, standard deviation, and resolution, are evaluated using prototype sensors with characteristic lengths ranging from 1 mm to 4 mm. The 4-mm model has a measurement range of 77 mN to 300 N, and the smallest model, which is one of the smallest force sensors suitable for practical implementation, has a measurement range of 9 mN to 20 N. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2644-1349 6 2026 Ultrafast Time-Compressive CMOS Image Sensors Based on Multitap Charge Modulators for Filming Light-In Flight 47 60 EN Keiichiro Kagawa Research Institute of Electronics, Shizuoka University Daisuke Hayashi Graduate School of Integrated Science and Technology, Shizuoka University Arashi Takakura Faculty of Engineering, Shizuoka University Yuto Umeki Graduate School of Integrated Science and Technology, Shizuoka University Michitaka Yoshida Faculty of Environmental, Life, Natural Science and Technology, Okayama University Keita Yasutomi Research Institute of Electronics, Shizuoka University Shoji Kawahito Research Institute of Electronics, Shizuoka University Youngcheol Chae Department of Electrical and Electronic Engineering, Yonsei University Hajime Nagahara D3 Center, The University of Osaka Ultrafast time-compressive CMOS image sensors based on multitap charge modulators can capture light-in flight using coded exposure masks on the focal plane. Transient images can then be reconstructed using iterative methods or deep learning models. Although the image sensor is based on indirect time-of-flight (ToF) image sensors, the reconstructed images are equivalent to those captured by direct ToF (D-ToF) image sensors. Important design parameters of the image sensor include the pixel block size and the number of taps of the charge modulator. Several constraints regarding the charge transfer of the multitap charge modulator, the hamming distance between exposure codes at adjacent timings, and the minimal time window duration must be considered when designing exposure codes. The influence of these factors on the fidelity of the reconstructed images is analyzed numerically. The results show that a pixel block size of 4�~4 is optimal and that four or more taps are required for light detection and ranging (LiDAR) applications when 32 transient images of light-in flight are reconstructed. To demonstrate LiDAR in a scene with multipath interference, two objects were observed through a weakly diffusive sheet. The temporal resolution, as defined by the clock period of the exposure codes, was 1.65 ns. Multiple reflections were reconstructed using an iterative method (TVAL3) and a deep learning model (ADMM-Net). Although the waveforms of optical pulses reconstructed by TVAL3 are distorted, the amplitudes are more accurate. Conversely, although ADMM-Net reconstructs sharper optical pulses, the amplitudes are inaccurate. To achieve the shorter temporal resolution required for time-resolved diffuse optical tomography (DOT) and fluorescence lifetime imaging (FLIm), the feasibility of heterodyne compression was demonstrated through simulation. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 1347-9032 2025 Atezolizumab + Chemotherapy for Advanced Non-Small Cell Lung Cancer in Japanese Clinical Practice (J-TAIL-2) EN Hiroshige Yoshioka Department of Thoracic Oncology, Kansai Medical University Makoto Nishio Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research Kadoaki Ohashi Department of Respiratory Medicine, Okayama University Hospital Atsushi Osoegawa Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine Eiki Kikuchi Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Hideharu Kimura Department of Respiratory Medicine, Kanazawa University Hospital Yasushi Goto Department of Thoracic Oncology, National Cancer Center Hospital Junichi Shimizu Department of Thoracic Oncology, Aichi Cancer Center Hospital Eisaku Miyauchi Department of Respiratory Medicine, Tohoku University Hospital Ichiro Yoshino International University of Health and Welfare, Narita Hospital Toshihiro Misumi Department of Data Science, National Cancer Center Hospital East Yasutaka Watanabe Department of Thoracic Oncology, Saitama Cancer Center Akito Hata Division of Thoracic Oncology, Kobe Minimally Invasive Cancer Center Akira Kisohara Department of Respiratory Medicine, Kasukabe Medical Center Shoichi Kuyama Department of Respiratory Medicine, NHO Iwakuni Clinical Center Masafumi Yamaguchi Department of Thoracic Oncology, NHO Kyushu Cancer Center Asako Miwa Chugai Pharmaceutical Co., Ltd. Shunichiro Iwasawa Chugai Pharmaceutical Co., Ltd. Misa Tanaka Chugai Pharmaceutical Co., Ltd. Akihiko Gemma Nippon Medical School First-line atezolizumab combination therapies were approved for the treatment of metastatic non-small cell lung cancer (NSCLC) based on results from the global phase 3 trials IMpower130, IMpower132, and IMpower150. These trials reported 12-month overall survival (OS) rates of 60%–67% with atezolizumab combination therapy. J-TAIL-2 (NCT04501497), a prospective, multicenter, observational study, evaluated atezolizumab combination therapy in routine clinical practice in Japan. Patients ≥ 20 years old with NSCLC received atezolizumab plus carboplatin and nab-paclitaxel (atezo + CnP), atezolizumab plus carboplatin or cisplatin plus pemetrexed (atezo + PP), or atezolizumab plus bevacizumab plus carboplatin and paclitaxel (atezo + bev + CP) in clinical practice. The primary endpoint was the 12-month OS rate. Secondary endpoints included OS, progression-free survival, and subgroup analyses, including IMpower-unlike (did not meet the main eligibility criteria of each IMpower trial) and IMpower-like patients. In total, 814 patients were enrolled (atezo + CnP, n = 217; atezo + PP, n = 211; atezo + bev + CP, n = 386). The IMpower-unlike group included patients with Eastern Cooperative Oncology Group performance status ≥ 2, autoimmune disease, or interstitial lung disease. Twelve-month OS rates (95% confidence interval [CI]) were 62.9% (55.8–69.2), 72.1% (65.2–77.9), and 68.3% (63.2–72.9) with atezo + CnP, atezo + PP, and atezo + bev + CP, respectively. OS hazard ratios (95% CI) in the IMpower-unlike vs. -like subgroups were 1.36 (0.91–2.05), 1.08 (0.70–1.68), and 1.49 (1.09–2.06), respectively. No new safety signals were observed. Real-world efficacy and safety for each atezolizumab combination were comparable to those in the relevant IMpower trials. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8049 37 6 2025 Directed Poisoning Attacks on FRIT in Adaptive Cruise Control 1392 1399 EN Taichi Ikezaki Faculty of Environmental, Life, Natural Science and Technology, Okayama University Kenji Sawada Graduate school of Mechanical Engineering, The University of Osaka Osamu Kaneko Graduate School of Informatics and Engineering, The University of Electro-Communications Recent advances in connected-vehicle technologies have enabled the large-scale collection of driving data, facilitating the deployment of data-driven control schemes. Although these methods offer advantages by eliminating the need for explicit modeling, they also introduce vulnerabilities due to their reliance on stored data. This study investigates a class of targeted data poisoning attacks on fictitious reference iterative tuning, a widely used data-driven controller tuning approach. We present a method that allows an adversary to influence closed-loop dynamics by manipulating the training data so that the resulting controller behavior matches a maliciously defined reference response. This strategy differs from conventional poisoning attacks, which aim only to the degrade control performance. Instead, it enables deliberate alteration of control characteristics such as overshoot and convergence time. The proposed attack is formulated as a constrained optimization problem under bounded tampering signals. Through a numerical study involving adaptive cruise control with stop functionality, we show that minor data modifications, indistinguishable from sensor noise, can cause significant degradation in control behavior. These findings highlight the need for robust security mechanisms in data-driven control implementation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 6 2025 Frailty at 1 Month before ICU Admission Poses a Hospital Mortality Risk in Cancer Survivors whose Condition Has Deteriorated due to Medical Factors 437 444 EN Junya Matsumi Department of Anesthesiology and Intensive Care Medicine, National Cancer Center Hospital Tetsufumi Sato Department of Anesthesiology and Intensive Care Medicine, National Cancer Center Hospital Original Article 10.18926/AMO/69846 The optimal indications for intensive care unit (ICU) treatment for critically ill cancer survivors whose condition has deteriorated due to medical factors are unclear. To test our hypothesis that frailty before deterioration was associated with hospital mortality in this patient population, we retrospective analyzed the cases of the patients admitted to the ICU at the National Cancer Center Hospital, Japan (April 2014-March 2022). We excluded patients who underwent surgery within 28 days or were denied critical care within 24 h or admitted after cardiopulmonary arrest. Their Clinical Frailty Scale (CFS) scores at 1 month before ICU admission (Pre-ICU) were obtained. Frailty was defined as CFS scores ≥4 points. We analyzed 298 admissions and observed that the mortality rate at hospital discharge was significantly higher in the frailty group (n=119). A multivariate analysis demonstrated that the following factors were significantly associated with hospital mortality: Pre-ICU frailty (OR 2.00, 95%CI: 1.19-3.36, p=0.009), cancer type (hematological: OR 2.93, 95%CI: 1.42-6.05, p=0.004), and Sequential Organ Failure Assessment score at ICU admission (OR 0.88, 95%CI: 0.82-0.95, p=0.0008). Frailty retrospectively assessed using the CFS at 1 month pre-ICU admission is a risk factor for hospital mortality in these cancer survivors. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2158-4001 2025 A Linear Search Algorithm for Resource Allocation in Frequency Domain Non-Orthogonal Multiple Access EN Satoshi Denno Faculty of Environmental, Life, Natural Science and Technology, Okayama University Yuto Ohba Faculty of Environmental, Life, Natural Science and Technology, Okayama University Yafei Hou Faculty of Environmental, Life, Natural Science and Technology, Okayama University This paper proposes a linear search algorithm for resource allocation in frequency domain non-orthogonal multiple access based on the low-density signature (LDS). Although the proposed linear search enables the non-orthogonal multiple access to achieve superior transmission performance, the proposed linear search makes the resource allocation implemented with lower and fixed computational complexity. The performance of the non-orthogonal access based on the proposed linear search is evaluated by computer simulation. The proposed linear search algorithm makes the non-orthogonal multiple access achieve a gain of about 6 dB at the BER of 10–5 when the overloading ratio is set to 2. The complexity of the non-orthogonal access based on the proposed linear search algorithm is approximately half as much as that of the conventional low complexity resource allocation when the overloading ratio is 2, if the complexity is evaluated in terms of the number of additions. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 5 2025 Advantages of Single-Position Surgery over Posterior Fusion for Single-Level Degenerative Lumbar Diseases 359 368 EN Tomohiko Hirose Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Hisanori Ikuma Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Kazutoshi Otsuka Otsuka Orthopedic Clinic Keisuke Kawasaki Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Original Article 10.18926/AMO/69437 Single-position surgery with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screws (PPSs) is gaining attention for its reduced invasiveness. We developed SPAPS, a technique allowing two surgeons to perform anterior LLIF and posterior PPS insertion simultaneously in a single lateral decubitus position. This retrospective study compared SPAPS (SPAPS-LLIF, Group SL) and minimally invasive posterior/transforaminal lumbar interbody fusion (MIS-PLIF/TLIF, Group PT) in patients treated between 2016 and 2019 with a two-year follow-up. Operative time, estimated blood loss (EBL), length of hospital stay (LOS), JOABPEQ and VAS scores, segmental lordotic angle, lumbar lordotic angle, segmental Cobb�fs angle, PPS misplacement, PPS loosening, fusion status, and muscle cross-sectional areas were compared. Fifty-two patients were analyzed (Group SL: 25; Group PT: 27). SPAPS significantly reduced operative time (118.0 vs. 165.3 min, p <0.01) and estimated blood loss (8.6 vs. 164.1 mL, p<0.01). While clinical outcomes and hospital stay were comparable, Group SL had significantly lower PPS loosening (0% vs. 13%, p<0.01) and non-union rates (0% vs. 22.2%, p=0.02). Multifidus muscle atrophy was also less in Group SL (�|14.3 vs. �|121.5 mm2, p<0.01). SPAPS demonstrated advantages in reducing surgical invasiveness without compromising clinical efficacy, offering a promising alternative to conventional posterior fusion surgery. 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.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 1932-4537 22 5 2025 Topology-Driven Configuration of Emulation Networks With Deterministic Templating 3933 3946 EN Satoru Kobayashi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Ryusei Shiiba Department of Informatics, School of Multidisciplinary Sciences, The Graduate University of Advanced Studies, Sokendai Shinsuke Miwa StarBED Technology Center, Testbed Research, Development and Operations Laboratory, National Institute of Information and Communications Technology Toshiyuki Miyachi Strategic Planning Department, Strategic Planning Office, National Institute of Information and Communications Technology Kensuke Fukuda Department of Informatics, School of Multidisciplinary Sciences, The Graduate University of Advanced Studies, Sokendai Network emulation is an important component of a digital twin for verifying network behavior without impacting on the service systems. Although we need to repeatedly change network topologies and configuration settings as a part of trial and error for verification, it is not easy to reflect the change without failures because the change affects multiple devices, even if it is as simple as adding a device. We present topology-driven configuration, an idea to separate network topology and generalized configuration to make it easy to change them. Based on this idea, we aim to realize a scalable, simple, and effective configuration platform for emulation networks. We design a configuration generation method using simple and deterministic config templates with a new network parameter data model, and implement it as dot2net. We evaluate three perspectives, scalability, simplicity, and efficacy, of the proposed method using dot2net through measurement and user experiments on existing test network scenarios. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8022 19 5 2025 Study on an Effective Coolant Supply Method in the Side Plunge Grinding Process 939 948 EN Lingxiao Gao Graduate School of Natural Science and Technology, Okayama University Taichi Fujimoto Graduate School of Natural Science and Technology, Okayama University Hiroyuki Kodama Faculty of Environmental, Life, Natural Science and Technology, Okayama University Kazuhito Ohashi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Grinding is widely used for finishing components with journal and thrust surfaces, such as crankshafts. Side-plunge grinding enables the simultaneous finishing of thrust and cylindrical surfaces in a single plunge. However, compared to cylindrical grinding, it involves a larger contact area between the grinding wheel and the workpiece, leading to increased heat generation. In particular, poor coolant penetration near internal corners can degrade surface quality, potentially causing stress concentrations and cracks. To enhance coolant effectiveness in side-plunge grinding, this study installs a high-pressure nozzle that supplies coolant from the side of the grinding wheel. The effectiveness of this setup is experimentally verified. Additionally, the distribution of coolant flow within the contact area between the grinding wheel and the workpiece is measured to determine the optimal nozzle position for efficient coolant delivery. The nozzle�fs performance is evaluated by measuring the workpiece surface temperature using a wire/workpiece thermocouple, the amount of coolant discharged from the grinding wheel, and the residual stress distribution. The results show that coolant penetrates the grinding wheel and effectively reaches the grinding zone, enhancing the cooling effect. This study clarifies the relationship between effective coolant supply and the position of the side nozzle. Considering physical constraints, such as potential interference during grinding, the optimal nozzle location is as close as possible to both the edge of the grinding wheel and the workpiece. This positioning ensures maximum coolant delivery, reduces grinding temperature, and helps suppress drastic variations in residual stress. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1472-6831 25 1 2025 Phosphorylated pullulan as a local drug delivery matrix for cationic antibacterial chemicals to prevent oral biofilm 1333 EN Naoko Namba-Koide Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital Yasuhiro Yoshida Department of Biomaterials and Bioengineering, Faculty of Dental Medicine, Hokkaido University Noriyuki Nagaoka Advanced Research Center for Oral and Craniofacial Sciences, Okayama University Dental School Takumi Okihara Division of Applied Chemistry, Graduate School of Natural Science and Technology, Okayama University Yusuke Kawata Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital Masahiro Ito Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital Takashi Ito Center for Innovative Clinical Medicine, Okayama University Hospital Kazu Takeuchi-Hatanaka Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital Yuki Shinoda-Ito Department of Pathophysiology - Periodontal Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kazuhiro Omori Department of Pathophysiology - Periodontal Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tadashi Yamamoto Department of Pathophysiology - Periodontal Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shogo Takashiba Department of Pathophysiology - Periodontal Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Background Preventing oral infections, such as oral caries and periodontal disease, helps reduce the risks of various systemic diseases. In this study, the polysaccharide pullulan produced by the black yeast Aureobasidium pullulans was modified in combination with the cationic surfactant cetylpyridinium chloride (CPC) to create a local drug delivery system, and its antibacterial potential on oral bacteria was examined in vitro.<br> Methods Pullulan was phosphorylated at the CH2OH residue of ƒ¿6 in the maltotriose structure and mixed with CPC. Bacterial attachment of cariogenic Streptococcus mutans on hydroxyapatite plates (HAPs) treated with the phosphorylated pullulan (PP) and CPC compound (0.01% PP and 0.001– 0.03% CPC, and vice versa) was assessed by observing bacteria using a field emission scanning electron microscope (FE-SEM) and quantified through 16 S rRNA amplification via real-time polymerase chain reaction (PCR). Additionally, the quartz crystal microbalance (QCM) method was employed to evaluate the sustained release of CPC.<br> Results PP-CPC compound maintained significant bactericidal activity even at 0.01%, which is one-fifth of the conventional applicable concentration of CPC. Additionally, a residual mixture was detected by the hydroxyapatite sensor of the crystal oscillator microbalance detector, suggesting an unknown molecular interaction that enables the sustained release of CPC after attachment to hydroxyapatite.<br> Conclusions The combination of PP and CPC may contribute to the low concentration and effective prevention of oral infections, such as dental caries. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 0093-9994 61 5 2025 Impact of SMC Property on Axial-Flux Permanent Magnet Machine in Traction Applications 6848 6860 EN Ren Tsunata Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Masatsugu Takemoto Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Jun Imai Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Tatsuya Saito Sumitomo Electric Industries Ltd. Tomoyuki Ueno Sumitomo Electric Industries Ltd. This paper investigates the impact of soft magnetic composite (SMC) properties on an axial flux permanent magnet machine (AFPM) employing ferrite permanent magnet (PM) in traction applications. In general, the efficiency of an AFPM increases as the iron loss of the SMC decreases. However, the torque and output power of the AFPM also decrease at higher speed above the base speed due to the decrease in magnetic permeability because, typically, when the iron loss of an SMC decreases, the permeability also decreases. In this paper, many virtual SMC materials with different iron loss and permeability are used for finite element analysis of the proposed AFPM in order to clarify the sensitivity to SMC characteristics. First, the impact of the permeability on the torque and output power is investigated because the output power is very important in traction applications. Additionally, the total energy loss of AFPMs employing various SMCs is evaluated using the WLTC driving cycle. Furthermore, accuracy of simulation is evaluated using experiments of downscaled and actual size prototypes employing some SMC materials. Finally, this paper shows the newly developed SMC materials and discusses suitable SMC properties from the perspective of efficiency and output power in traction applications. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2644-1284 6 2025 Time-Efficient and Practical Design Method for Skewed PMSMs: Integrating Numerical Calculations With Limited 3-D-FEA 1370 1386 EN Ren Tsunata Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Yu Ichimura Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Masatsugu Takemoto Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Jun Imai Graduate School of Environmental, Life, Natural Science and Technology, Okayama University This article proposes a time-efficient and practical design method for determining appropriate skew structures for permanent magnet synchronous motors (PMSMs). Various PMSMs use skew to suppress torque ripple, but 3-D finite element analysis (3-D-FEA) is required in order to accurately determine an appropriate structure for skewed PMSMs, resulting in a long analysis time. Therefore, this article constructs a hybrid analysis method that combines numerical calculations and minimal 3-D-FEA. The aim of this method is to be practical and easy to use, even for novice designers, and to accurately and quickly design skewed PMSMs. In this article, the effectiveness of the proposed method is clarified through several case studies, and then, a skewed PMSM designed using the proposed method is verified experimentally. It is also revealed that suppression of voltage harmonics contributes to improving the performance of PMSMs in experiments. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 13 2025 Optimized Ensemble Deep Learning for Real-Time Intrusion Detection on Resource-Constrained Raspberry Pi Devices 113544 113556 EN Muhammad Bisri Musthafa Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Samsul Huda Interdisciplinary Education and Research Field, Okayama University Tuy Tan Nguyen School of Informatics, Computing, and Cyber Systems, Northern Arizona University Yuta Kodera Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Yasuyuki Nogami Graduate School of Environmental, Life, Natural Science and Technology, Okayama University The rapid growth of Internet of Things (IoT) networks has increased security risks, making it essential to have effective Intrusion Detection Systems (IDS) for real-time threat detection. Deep learning techniques offer promising solutions for such detection due to their superior complex pattern recognition and anomaly detection capabilities in large datasets. This paper proposes an optimized ensemble-based IDS designed specifically for efficient deployment on edge hardware. However, deploying such computationally intensive models on resource-limited edge devices remains a significant challenge due to model size and computational overhead on devices with limited processing capabilities. Building upon our previously developed stacked Long Short-Term Memory (LSTM) model integrated with ANOVA feature selection, we optimize it by integrating dual-stage model compression: pruning and quantization to create a lightweight model suitable for real-time inference on Raspberry Pi devices. To evaluate the system under realistic conditions, we combined with a Kafka-based testbed to simulate dynamic IoT environments with variable traffic loads, delays, and multiple simultaneous attack sources. This enables the assessment of detection performance under varying traffic volumes, latency, and overlapping attack scenarios. The proposed system maintains high detection performance with accuracy of 97.3% across all test scenarios, while efficiently leveraging multi-core processing with peak CPU usage reaching 111.8%. These results demonstrate the system�fs practical viability for real-time IoT security at the edge. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 13 2025 Security in Post-Quantum Era: A Comprehensive Survey on Lattice-Based Algorithms 89003 89024 EN Hien Nguyen School of Informatics, Computing, and Cyber Systems, Northern Arizona University Samsul Huda Interdisciplinary Education and Research Field, Okayama University Yasuyuki Nogami Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Tuy Tan Nguyen School of Informatics, Computing, and Cyber Systems, Northern Arizona University Lattice-based post-quantum cryptography (PQC) has attracted significant attention as a promising solution to the security challenges posed by quantum computing. Unlike traditional cryptographic algorithms, lattice-based schemes are expected to remain secure even in the presence of quantum attacks, making them essential for securing future data. Despite their strong theoretical foundations, lattice-based schemes face several practical challenges, particularly in optimizing performance and scalability for real-world applications. This survey provides a novel taxonomy that categorizes lattice-based PQC designs, with an emphasis on computational paradigms and security considerations. We systematically evaluate lattice-based PQC implementations across both software platforms, including central processing units and graphics processing units, as well as hardware platforms like field-programmable gate arrays and application-specific integrated circuits, highlighting their strengths and limitations. In addition, we explore the practical applications of lattice-based cryptography in fields such as secure communication, critical infrastructure, privacy-preserving data analytics, artificial intelligence, and trust and authentication systems. By offering a comprehensive overview of the current state of lattice-based PQC, this survey aims to provide valuable insights into the ongoing advancements and future research directions in the field as we transition to a post-quantum era. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8030 20 4 2025 High-Definition Topographic Archiving and Educational Applications in Regions Affected by the 2024 Noto Peninsula Earthquake 401 409 EN Takuro Ogura Graduate School of Education, Hyogo University of Teacher Education Hiroyuki Yamauchi Art Research Center, Ritsumeikan University Tatsuto Aoki Faculty of Regional Development Studies, Kanazawa University Nobuhisa Matta Graduate School of Education, Okayama University Kotaro Iizuka Center for Spatial Information Science, The University of Tokyo Yoshiya Iwasa Faculty of Education, University of Teacher Education Fukuoka Takayuki Takahashi International Research Institute of Disaster Science, Tohoku University Kiyomi Hayashi Faculty of Regional Development Studies, Kanazawa University Tsuyoshi Hattanji Institute of Life and Environmental Sciences, University of Tsukuba Takashi Oguchi Center for Spatial Information Science, The University of Tokyo The 2024 Noto Peninsula earthquake (Mw 7.5) caused extensive damage in Ishikawa Prefecture, Japan, and surrounding areas, with considerable coastal uplift and tsunami flooding. Past 100 years�f records show no earthquake above Mw 7.0 in the Noto Peninsula, so for everyone alive today, this event is truly without precedent. Therefore, we aimed to support disaster prevention education by developing teaching materials using unmanned aerial vehicles (UAVs) based on digitally archived topographic changes. High-definition topographic data collected from multiple UAV surveys were processed into digital and analog formats, including 3D models, spherical panorama images, and 3D printings. These materials were designed to provide detailed and intuitive representations of post-disaster landforms and were used as educational tools in schools. The learning materials were introduced during a workshop for disaster-affected teachers, featuring hands-on activities to help participants familiarize themselves with the materials, and explore their integration into geography and science classes. Feedback from participants indicated that these tools were highly effective in enhancing classroom learning. The results of this study are expected to contribute to preserving disaster records while enhancing disaster awareness in educational settings and local communities. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8049 37 1 2025 Fan-Shaped Pneumatic Soft Actuator that Can Operate Bending Motion for Ankle-Joint Rehabilitation Device 43 53 EN So Shimooka Faculty of Environmental, Life, Natural Science and Technology, Okayama University Hirosato Yokoya Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Masanori Hamada Department of Rehabilitation Medicine, Okayama University Hospital Shun Shiomi Department of Rehabilitation Medicine, Okayama University Hospital Takenori Uehara Department of Orthopaedic Surgery, NHO Okayama Medical Center Takahiro Hirayama Department of Emergency, Critical Care and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tetsushi Kamegawa Faculty of Environmental, Life, Natural Science and Technology, Okayama University Nowadays, owing to declining birthrates and an aging population, patients and the elderly requiring rehabilitation are not getting enough physical activity. In addressing this issue, devices for rehabilitating them have been researched and developed. However, rehabilitation devices are almost exclusively used for patients who can get up, rather than those who are bedridden. In this study, we aim to develop a rehabilitation device that can provide passive exercise for bedridden patients. The ankle joint was selected as the target joint because the patients who have undergone surgery for cerebrovascular disease remain bedridden, and early recovery in the acute stage is highly desirable. We proposed and tested a fan-shaped pneumatic soft actuator (FPSA) that can expand and bend stably at angles when supply pressure is applied as an actuator for a rehabilitation device to encourage patient exercise. However, the previous FPSA�fs movement deviates from the arch of the foot owing to increased supply pressure. In the ideal case, FPSA should push the arch of the foot in an arc motion. This study proposes and tests the FPSA that can operate a bending motion to provide passive exercise to the ankle joint using tensile springs and a winding mechanism powered by a servo motor. The proposed FPSA has a significant advantage of exhibiting no hysteresis in its pressure-displacement characteristics. The configuration and static analytical model of the improved FPSA are described. 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.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8022 19 3 2025 Study on the Grinding Temperature of Workpiece in Side Plunge Grinding Process 337 345 EN Lingxiao Gao Graduate School of Natural Science and Technology, Okayama University Motoki Kuida Graduate School of Natural Science and Technology, Okayama University Hiroyuki Kodama Faculty of Environmental, Life, Natural Science and Technology, Okayama University Kazuhito Ohashi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Grinding is used to finish thrust metal attachment parts, such as crankshafts, which have both journal and thrust surfaces. In side plunge grinding, a thrust surface and a cylindrical surface of a shaft workpiece with collars are finished in a single plunge grinding process. However, the surface quality near the ground internal corner, where grinding fluid may not penetrate, can deteriorate, causing high residual stress and cracks owing to grinding heat. While it has been reported that quality issues at the inner corners of the ground surface can be mitigated by reducing the grinding point temperature through efficient cooling fluid supply, the mechanisms of grinding phenomena and heat generation in side plunge grinding are not yet fully understood. In this study, the variations in the grinding temperature at the thrust surface of a workpiece with a collar were experimentally investigated using a wire/workpiece thermocouple to clarify these phenomena. The results revealed a significant increase in the grinding temperature at the corners of the grinding zone. However, it slightly decreases as the thermocouple output approaches the center of the workpiece, indicating a slight effect of the grinding speed. The surface temperature of the workpiece in side plunge grinding is primarily influenced by the wheel depth-of-cut in the thrust direction. Additionally, the effect of workpiece rotational speed and grinding infeed speed on temperature distribution has been demonstrated. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2832-1324 2023 Analyzing Post-injection Attacker Activities in IoT Devices: A Comprehensive Log Analysis Approach 292 297 EN Hervet Victor Okayama University Satoru Kobayashi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Toshihiro Yamauchi Faculty of Environmental, Life, Natural Science and Technology, Okayama University With the continuous proliferation of Internet of Things (IoT) devices, malware threats that specifically target these devices continue to increase. The urgent need for robust security measures is predicated on a comprehensive understanding of the behavioral patterns of IoT malware. However, previous studies have often overlooked the analysis of command sequences in Telnet logs. This study bridges this research gap by examining the post-injection behaviors of attackers. By analyzing a vast dataset comprising more than ten million logs collected from an IoT honeypot, we reveal three distinct post-injection activity patterns, each with unique characteristics. These patterns provide pivotal insights that not only help distinguish between legitimate operations and attempted attacks, but also drive the development of robust cybersecurity measures that effectively deter such behaviors. The nuances discovered in this study contribute significantly to IoT security by enhancing our understanding of malware tactics and informing targeted defense strategies. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2832-1324 2023 Prevention Method for Stack Buffer Overflow Attack in TA Command Calls in OP-TEE 274 278 EN Kaito Shiba Graduate School of Natural Science and Technology, Okayama University Hiroki Kuzuno Graduate School of Engineering, Kobe University Toshihiro Yamauchi Faculty of Environmental, Life, Natural Science and Technology, Okayama University TEE systems provide normal world and secure world. It is impossible to gain access to the secure world directly from the normal world. However, vulnerabilities in the secure world can cause attacks to compromise the secure world. In this study, we investigate the security features applied to trusted applications (TA) in OP-TEE and clarify the lack of protection against stack buffer overflow in TA command calls. We also propose a method for preventing attacks that exploit stack buffer overflows in TA command calls. In addition, the experimental results show that attacks on the vulnerable TAs can be prevented with the proposed method and the overhead can be evaluated. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2379-1896 2023 Evaluation of Effectiveness of MAC Systems Based on LSM for Protecting IoT Devices 161 167 EN Masato Miki Graduate School of Natural Science and Technology, Okayama University Toshihiro Yamauchi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Satoru Kobayashi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Numerous active attacks targeting Internet of Things (IoT) devices exist. They exploit the latest vulnerabilities discovered in IoT devices. Therefore, Mandatory Access Control (MAC) systems based on Linux Security Modules (LSM), such as SELinux and AppArmor, are effective security features for IoT devices because they can mitigate the impact of attacks even if software vulnerabilities are discovered. However, they are not adopted by most IoT devices. The existing approaches are insufficient for investigating the causes of this problem.In this study, we comprehensively investigated what factors can affect the applicability of MAC systems based on LSM in IoT devices. We focused on how frequently cases can occur where they cannot be adopted, owing to each factor. To increase the comprehensiveness of the factors affecting the adoption of MAC systems in IoT devices, we investigated the kernel version, CPU architecture, and support for BusyBox in addition to the investigation of resources, which conducted in previous studies. We also conducted simulated experiments based on the attack method of Mirai to investigate whether MAC systems can protect against IoT malware. Finally, we discuss the impact of a combination of these factors on MAC system adoption. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2833-2350 2023 Non Real-Time Data Transmission Performance Analysis of PROFINET for Assuring Data Transmission Quality 236 244 EN Takashi Norimatsu Graduate School of Natural Science and Technology, Okayama University Toshihiro Yamauchi Faculty of Environmental, Life, Natural Science and Technology, Okayama University The industrial Ethernet PROFINET supports three different data transmission modes: isochronous real-time (IRT), real-time (RT), and non real-time (NRT) transmitting data requiring hard, soft, and no real-time performances, respectively. The data transmission latency in the NRT increased with the amount of data transmission in the IRT, RT, and NRT. Therefore, the quality of data transmission in NRT may degrade as the amount of data transmission in IRT, RT, and NRT increases. In this study, we derived the average data transmission latency in an NRT with data transmission in IRT and RT by applying stochastic processes. This allowed us to maintain the quality of data transmission in the NRT by adjusting the number of devices connected to the network and the number of applications transmitting data in the NRT so that the average latency of data in the NRT does not exceed a certain value. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2832-1324 2023 Supporting Multiple OS Types on Estimation of System Call Hook Point by Virtual Machine Monitor 267 273 EN Masaya Sato Okayama Prefectural University Taku Omori Okayama Prefectural University Toshihiro Yamauchi Okayama University Hideo Taniguchi Okayama University Methods to hook system calls issued by a guest operating system (OS) running on a virtual machine using a virtual machine monitor are proposed. The address of the hook point is derived from the guest OS�fs source code and established prior to the kernel startup process. Due to changes in system call processing in OS updates and address space layout randomization, the addresses of these hook points cannot always be pre-determined before the kernel startup process. To address this challenge, a method for estimating the system call hook point is proposed in Linux by analyzing the guest OS memory on x86-64 CPUs rather than pre-calculation. Although the method supports Linux, the method can be extended to support other OS types. In this paper, we propose a method to extend the method to support additional OSes. Specifically, we present analysis results and a novel method for estimating hook points on FreeBSD, NetBSD, and OpenBSD. The effectiveness of our proposed method is also demonstrated through evaluation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 1 2025 Endothelial Cell Polarity in Health and Disease 1 7 EN Moe Thiha Department of Pathophysiology and Drug Discovery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hikita Department of Pathophysiology and Drug Discovery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masanori Nakayama Department of Pathophysiology and Drug Discovery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/68353 Endothelial cell polarity is fundamental to the organization and function of blood vessels, influencing processes such as angiogenesis, vascular stability, and response to shear stress. This review elaborates on the molecular mechanisms that regulate endothelial cell polarity, focusing on key players like the PAR polarity complex and Rho family GTPases. These pathways coordinate the front–rear, apical–basal and planar polarity of endothelial cells, which are essential for the proper formation and maintenance of vascular structures. In health, endothelial polarity ensures not only the orderly development of blood vessels, with tip cells adopting distinct polarities during angiogenesis, but also ensures proper vascular integrity and function. In disease states, however, disruptions in polarity contribute to pathologies such as coronary artery disease, where altered planar polarity exacerbates atherosclerosis, and cancer, where disrupted polarity in tumor vasculature leads to abnormal vessel growth and function. Understanding cell polarity and its disruption is fundamental not only to comprehending how cells interact with their microenvironment and organize themselves into complex, organ-specific tissues but also to developing novel, targeted, and therapeutic strategies for a range of diseases, from cardiovascular disorders to malignancies, ultimately improving patient outcomes. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 1745-1345 E108-B 1 2024 Overloaded MIMO Spatial Multiplexing Independent of Antenna Setups 1 13 EN Satoshi Denno Faculty of Environmental, Life, Natural Science and Technology, Okayama University Takumi Sugimoto Graduate School of Natural Science and Technology, Okayama University Koki Matoba Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Yafei Hou Faculty of Environmental, Life, Natural Science and Technology, Okayama University This paper proposes overloaded MIMO spatial multiplexing that can increase the number of spatially multiplexed signal streams despite of the number of antennas on a terminal and that on a receiver. We propose extension of the channel matrix for the spatial multiplexing to achieve the superb multiplexing performance. Precoding based on the extended channel matrix plays a crucial role in carrying out such spatial multiplexing. We consider three types of QR-decomposition techniques for the proposed spatial multiplexing to improve the transmission performance. The transmission performance of the proposed spatial multiplexing is evaluated by computer simulation. The simulation reveals that the proposed overloaded MIMO spatial multiplexing can implement 6 stream-spatial multiplexing in a 2�~2 MIMO system, i.e., the overloading ratio of 3.0. The superior transmission performance is achieved by the proposed overloaded MIMO spatial multiplexing with one of the QR-decomposition techniques. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8049 35 1 2023 Development of Automatic Inspection Systems for WRS2020 Plant Disaster Prevention Challenge Using Image Processing 65 73 EN Yuya Shimizu Okayama University Tetsushi Kamegawa Okayama University Yongdong Wang Okayama University Hajime Tamura Okayama University Taiga Teshima Okayama University Sota Nakano Okayama University Yuki Tada Okayama University Daiki Nakano Okayama University Yuichi Sasaki Okayama University Taiga Sekito Okayama University Keisuke Utsumi Okayama University Rai Nagao Okayama University Mizuki Semba Okayama University In this article, an approach used for the inspection tasks in the WRS2020 Plant Disaster Prevention Challenge is explained. The tasks were categorized into three categories: reading pressure gauges, inspecting rust on a tank, and inspecting cracks in a tank. For reading pressure gauges, the �gyou only look once�h algorithm was used to focus on a specific pressure gauge and check the pressure gauge range strings on the gauge using optical character recognition algorithm. Finally, a previously learned classifier was used to read the values shown in the gauge. For rust inspection, image processes were used to focus on a target plate that may be rusted for rust detection. In particular, it was necessary to report the rust area and distribution type. Thus, the pixel ratio and grouping of rust were used to count the rust. The approach for crack inspection was similar to that for rust. The target plate was focused on first, and then the length of the crack was measured using image processing. Its width was not measured but was calculated using the crack area and length. For each system developed to approach each task, the results of the preliminary experiment and those of WRS2020 are shown. Finally, the approaches are summarized, and planned future work is discussed. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 6 2024 C-arm Free Unilateral Biportal Endoscopic Discectomy: A Technical Note 475 483 EN Hongfei Xiang Department of Orthopaedic Surgery, Okayama Rosai Hospital Kajetan Latka Department of Orthopaedic Surgery, Okayama Rosai Hospital Praful Maste Department of Orthopaedic Surgery, Okayama Rosai Hospital Masato Tanaka 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 Yoshihiro Fujiwara Department of Orthopaedic Surgery, Okayama Rosai Hospital Takuya Taoka Department of Orthopaedic Surgery, Okayama Rosai Hospital Akiyoshi Miyamoto Department of Orthopaedic Surgery, Okayama Rosai Hospital Case Report 10.18926/AMO/67878 This report presents a new unilateral biportal endoscopic (UBE) technique for lumbar disc herniation without C-arm guidance. Lumbar disc herniation requires surgical intervention when conservative methods fail. Shifts towards minimally invasive percutaneous endoscopic lumbar discectomy, including uniportal and biportal approaches, have been hindered by challenges such as steep learning curves and reliance on radiation-intensive C-arm guidance. We here describe the use of standard intraoperative navigation in UBE to reduce radiation exposure and increase surgical accuracy. A 24-year-old man with low back and bilateral leg pain with gait disturbance was referred to our hospital. He had had conservative treatment for 12 months in another hospital before admission, but this proved unsuccessful. On admission he had low back pain (VAS 4/10) and bilateral leg pain (VAS 8/10), muscle weakness of the bilateral legs (manual muscle testing (MMT) grade of the extensor hallucis longus: 4/4), and numbness of the bilateral lower legs. Preoperative lumbar MRI showed L4/5 large central disc herniation. He underwent C-arm free UBE discectomy under the guidance of O-arm navigation. The surgery was successful, with postoperative lumbar MRI showing good decompression of the dural sac and bilateral L5 nerve roots. The MMT grade and sensory function of both legs had recovered fully on final follow-up at one year. The new UBE technique under navigation guidance was shown to be useful for lumbar disc herniation. This innovative technique was safe and accurate for the treatment of lumbar intervertebral disc herniation, and minimized radiation exposure to surgeons. 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.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8022 17 5 2023 Effect of Vibration Behavior in Low-Frequency Vibration Cutting on Surface Properties of Workpiece 434 448 EN Hiroyuki Kodama Okayama University Shota Matsuno Okayama University Naoyuki Shibata Okayama University Kazuhito Ohashi Okayama University �@The objective of this study was to determine the effect of vibration behavior on workpiece surface properties in low-frequency vibration cutting. The effects of the parameters that determine vibration behavior on surface roughness were quantitatively evaluated through a comparison with other cutting conditions. Furthermore, by clarifying how the surface properties of the workpiece, such as roughness, roundness, and cross-sectional curves, change depending on the vibration behavior, a search for optimal conditions for low-frequency vibration cutting was conducted. The best surface properties were obtained under the condition of spindle rotation per vibration E=4.5. By using a value close to the minimum possible spindle rotation R=0.5 when the workpiece is retracted, it is expected to be effective in suppressing the variation in surface roughness at each phase angle; this variation is characteristic of low-frequency vibration cutting. Workpieces machined under low-frequency vibration conditions such as (E=2.5, R=1.0) and (E=3.5, R=1.0) were found to form characteristic surface patterns on the workpiece surface owing to a phenomenon in which the depth of the cut to the workpiece changes. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 12 2024 Aromug: A Mug-Type Olfactory Interface to Enhance the Sweetness Perception of Beverages 78366 78378 EN Daiki Mayumi Graduate School of Science and Technology, Nara Institute of Science and Technology Yugo Nakamura Faculty of Information Science and Electrical Engineering, Kyushu University Yuki Matsuda Faculty of Environmental, Life, Natural Science and Technology, Okayama University Shinya Misaki Graduate School of Science and Technology, Nara Institute of Science and Technology Keiichi Yasumoto Graduate School of Science and Technology, Nara Institute of Science and Technology Sugary beverages are a significant contributor to sugar consumption, and their excessive consumption is associated with increased risks of elevated blood glucose levels and diabetes. Many individuals have a strong preference for sugary beverages and often find beverages with lower sugar content to be less satisfying. Attempts to switch to less sugary options are frequently short-lived, leading to a return to higher-sugar beverages. Recognizing that 75 – 95% of taste perception is influenced by scent, we investigated a scent-based approach to reduce sugar intake while preserving the perception of sweetness. This study introduces an olfactory interface in the form of a mug named �gAromug,�h designed to emit a sweet scent in sync with the drinking action. Aromug incorporates motion sensing and scent presentation functions to enhance the perceived sweetness of a beverage, thereby encouraging a gradual reduction in sugar intake. Our experiments, involving 33 participants, demonstrated that the combined scents of sugar-free coffee and chocolate increased the perception of sweetness (p =1.641�~10�|2 ). The study also found that the simultaneous presentation of scent and visual cues improved taste satisfaction and sweetness perception. Additionally, we observed variations in sweetness preference related to age and frequency of coffee consumption. It was particularly observed that people in their 20s and those who frequently drink coffee tend to perceive the taste of beverages as sweeter. This suggests a potential for Aromug to customize the scent experience based on individual preferences, offering a novel way to encourage healthier beverage choices. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 12 2024 A Protection Scheme With Speech Processing Against Audio Adversarial Examples 146551 146559 EN Yuya Tarutani Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University Taisei Yamamoto Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Yukinobu Fukushima Faculty of Environmental, Life, Natural Science and Technology, Okayama University Tokumi Yokohira Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University Machine learning technologies have improved the accuracy of speech recognition systems, and devices using those systems, such as smart speakers and AI assistants, are now in wide use. However, speech recognition systems have security vulnerabilities. In particular, a known machine learning vulnerability called audio adversarial examples (AAEs), which causes misrecognition in speech recognition systems, has become a problem. We propose a scheme for using speech processing to protect speech recognition systems from AAEs, preventing misrecognitions by slight processing of input speech that does not affect the recognition of normal speech. We use two kinds of processing: speed and frequency. Evaluation results show that the proposed scheme can reduce the success rate of attack speech to about 1% while maintaining about 85% recognition rates for normal speech. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 12 2024 MUSIC Spectrum Based Interference Detection, Localization, and Interference Arrival Prediction for mmWave IRS-MIMO System 142592 142605 EN Yafei Hou Faculty of Environmental, Life, Natural Science and Technology, Okayama University Kazuto Yano Wave Engineering Laboratories, Advanced Telecommunications Research Institute International Norisato Suga Wave Engineering Laboratories, Advanced Telecommunications Research Institute International Julian Webber Wave Engineering Laboratories, Advanced Telecommunications Research Institute International Satoshi Denno Faculty of Environmental, Life, Natural Science and Technology, Okayama University Toshikazu Sakano Wave Engineering Laboratories, Advanced Telecommunications Research Institute International For a millimeter wave (mmWave) intelligent re-configurable surface (IRS)-MIMO system, if it can correctly detect the interference occurrence and their locations, the patterns of interference signal can be collected and learned using machine learning for the prediction of interference arrival. With the information of interference location and activity pattern, the capacity of the system can be largely improved using many techniques such as beamforming, interference cancellation, and transmission scheduling. This paper aims to detect interference occurrence using a low-complexity MUSIC (MUSIC: multiple signal classification) spectrum-based method, and then localize their sources for mmWave IRS-MIMO system. The MUSIC spectrum of wireless system can be regarded as somehow the 'signature' related to the signals transmitted from different users or interference. We utilize such property to detect the occurrence of interference, and then localize their sources in a low-complexity way. Finally, the pattern of interference occurrence can be learned to predict the interference arrival from the collected data. This paper also proposed an efficient probabilistic neural network (PNN)-based predictor for the interference arrival prediction and showed its prediction accuracy. From simulated results, our proposed method can achieve the correct results with the accuracy near to 100% when the fingerprint samples is over 10. In addition, the localization error can be within 1 m with more than 65% and 43% for Y-axis and X-axis, respectively. Finally, based on the results of the interference occurrence, the proposed PNN-based predictor for the interference arrival prediction can capture correctly the similar distribution function of the coming continuous idle status. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 5 2024 Factors Affecting Dynamic Postural Control Ability in Adolescent Idiopathic Scoliosis 357 362 EN Ryoko Yamawaki Division of Physical Medicine and Rehabilitation, Okayama University Yoshiaki Oda Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shuhei Yamane Division of Physical Medicine and Rehabilitation, Okayama University Koji Uotani Department of Orthopaedic Surgery, Okayama University Haruo Misawa Ryusoh Orthopaedic Hospital Yoshimi Katayama Division of Physical Medicine and Rehabilitation, Okayama University Masanori Hamada Division of Physical Medicine and Rehabilitation, Okayama University Toshifumi Ozaki Division of Physical Medicine and Rehabilitation, Okayama University Original Article 10.18926/AMO/67655 Research on postural control in patients with adolescent idiopathic scoliosis (AIS) has focused on static postural control, with few studies assessing dynamic postural control. We aimed to identify factors affecting index of postural stability (IPS), a dynamic postural control parameter, in patients with AIS. The participants comprised 50 female patients with AIS. We measured the IPS using stabilometry to evaluate dynamic postural control ability. We investigated age of the participants, major curve position (thoracic or thoracolumbar/lumbar), Cobb angle, and coronal balance. We then assessed the relationships between stabilometry parameters and other variables. IPS was analyzed with a linear regression model. Coronal balance, major curve position, and age each correlated with dynamic postural control ability. The Cobb angle showed no correlation with any of the parameters. Our results offer new insights into the assessment of postural control in patients with AIS. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 12 2024 Adaptive Resonance Theory-Based Global Topological Map Building for an Autonomous Mobile Robot 111371 111385 EN Yuichiro Toda Faculty of Environmental, Life, Natural Science and Technology, Okayama University Naoki Masuyama Graduate School of Informatics, Osaka Metropolitan University 3D space perception is one of the key technologies for autonomous mobile robots that perform tasks in unknown environments. Among these, building global topological maps for autonomous mobile robots is a challenging task. In this study, we propose a method for learning topological structures from unknown data distributions based on competitive learning, a type of unsupervised learning. For this purpose, adaptive resonance theory-based Topological Clustering (ATC), which can avoid catastrophic forgetting of previously measured point clouds, is applied as a learning method. Furthermore, by extending ATC with Different Topologies (ATC-DT) with multiple topological structures for extracting the traversable information of terrain environments, a path planning method is realized that can reach target points set in an unknown environment. Path planning experiments in unknown environments show that, compared to other methods, ATC-DT can build a global topology map with high accuracy and stability using only measured 3D point cloud and robot position information. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 12 2024 Feasibility of Active Reactance Compensator for Autonomously Maximizing Repeater Coil Current of Wireless Power Transfer System Against Variations in Resonant Frequency and Magnetic Coupling Intensity 98175 98188 EN Masataka Ishihara Faculty of Life, Environment, Natural Science and Technology, Okayama University Kazuhiro Umetani Faculty of Life, Environment, Natural Science and Technology, Okayama University Akihiro Konishi Graduate School of Science and Engineering, Chiba University Eiji Hiraki Faculty of Life, Environment, Natural Science and Technology, Okayama University In resonant inductive coupling wireless power transfer systems, a repeater resonator is crucial in expanding the charging area, enabling efficient power supply to receivers, such as small Internet of Things (IoT) devices sparsely distributed in a wide area. However, the repeater current is highly susceptible to deviations in resonance frequency due to manufacturing tolerance and aging, as well as to the magnetic coupling between the transmitter and repeater coils, potentially leading to insufficient amplitude. Consequently, the magnetic field generated by the repeater decreases and the receiver may be difficult to obtain sufficient power from the transmitter via the repeater. To address this problem, this paper proposes a wireless power transfer system with active reactance compensators incorporated in the repeater and the transmitter. The proposed system can equivalently adjust the resonant frequencies of the transmitter and repeater to stably maximize the repeater coil current regardless of the variations in the resonant frequency and the magnetic coupling intensity. Experiments successfully verify that the proposed system can provide a more stable and larger repeater current and output power than the conventional system against the variations in the magnetic field intensity and the resonant frequency of the repeater, validating the feasibility of the proposed system for practical utilization of the repeater in expanding the charging area. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 0093-9994 60 3 2024 Designing and Prototyping an Axial-Flux Machine Using Ferrite PM and Round Wire for Traction Applications: Comparison With a Radial-Flux Machine Using Nd-Fe-B PM and Rectangular Wire 3934 3949 EN Ren Tsunata Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Kosuke Izumiya Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Masatsugu Takemoto Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Jun Imai Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Tatsuya Saito Sumitomo Electric Industries Ltd. Tomoyuki Ueno Sumitomo Electric Industries Ltd. This paper proposes a novel axial-flux permanent magnet machine (AFPM) employing ferrite permanent magnets (PMs) and round copper wire. The proposed AFPM adopts a novel rotor structure and uses tooth-tips with a suitable trapezoidal shape. These structures compensate for the low magnetomotive force of the round copper wire and ferrite PMs, achieving high performance at low cost. Additionally, compared with an off-the-shelf radial-flux permanent magnet machine (RFPM) using Nd-sintered PMs and rectangular copper wire, the proposed AFPM achieves the same output power and higher efficiency, despite using ferrite PMs and the round copper wire. Finally, a prototype of the proposed AFPM was manufactured and evaluated experimentally. The prototype achieved a high efficiency of over 95% across a wide operating area while maintaining required maximum torque, suggesting its potential for traction applications. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 3 2024 Assessment of a New Elbow Joint Positioning Method Using Area Detector Computed Tomography 215 225 EN Takuya Akagawa Department of Radiological Technology, Tokushima Red Cross Hospital Ryohei Fukui Department of Radiological Technology, Faculty of Health Sciences, Okayama University Katsuhiro Kida Department of Radiological Technology, Faculty of Health Sciences, Okayama University Ryutaro Matsuura Department of Radiological Technology, Faculty of Health Sciences, Okayama University Makoto Shimada Department of Radiology, Osaka International Cancer Institute Mitsuhiro Kinoshita Department of Radiology, Tokushima Red Cross Hospital Yoko Akagawa Department of Radiology, Tokushima Red Cross Hospital Sachiko Goto Department of Radiological Technology, Faculty of Health Sciences, Okayama University Original Article 10.18926/AMO/67196 We propose a sitting position that achieves both high image quality and a reduced radiation dose in elbow joint imaging by area detector computed tomography (ADCT), and we compared it with the �esuperman�f and supine positions. The volumetric CT dose index (CTDIvol) for the sitting, superman, and supine positions were 2.7, 8.0, and 20.0 mGy and the dose length products (DLPs) were 43.4, 204.7, and 584.8 mGy • cm, respectively. In the task-based transfer function (TTF), the highest value was obtained for the sitting position in both bone and soft tissue images. The noise power spectrum (NPS) of bone images showed that the superman position had the lowest value up to approx. 1.1 cycles/mm or lower, whereas the sitting position had the lowest value when the NPS was greater than approx. 1.1 cycles/mm. The overall image quality in an observer study resulted in the following median Likert scores for Readers 1 and 2: 5.0 and 5.0 for the sitting position, 4.0 and 3.5 for the superman position, and 4.0 and 2.0 for the supine position. These results indicate that our proposed sitting position with ADCT of the elbow joint can provide superior image quality and allow lower radiation doses compared to the superman and supine positions. 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�fs daily life. We investigated the prediction of patients�f post-SCI functional outcomes by evaluating sensory scores rather than motor scores, as the latter�fs association with functional outcomes is well established. We examined patients�f responses to a light touch (LT) and pin prick (PP) at admission and the response data�fs 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 (ƒÀ=0.07 (0.01), p<0.001) and the PP response (ƒÀ=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�f 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.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 2 2024 The Roles of Neuropeptide Y in Respiratory Disease Pathogenesis via the Airway Immune Response 95 106 EN Junko Itano Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuyuki Kiura Department of Allergy and Respiratory Medicine, Okayama University Hospital Yoshinobu Maeda Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuaki Miyahara Department of Allergy and Respiratory Medicine, Okayama University Hospital Review 10.18926/AMO/66912 The lungs are very complex organs, and the respiratory system performs the dual roles of repairing tissue while protecting against infection from various environmental stimuli. Persistent external irritation disrupts the immune responses of tissues and cells in the respiratory system, ultimately leading to respiratory disease. Neuropeptide Y (NPY) is a 36-amino-acid polypeptide and a neurotransmitter that regulates homeostasis. The NPY receptor is a seven-transmembrane-domain G-protein-coupled receptor with six subtypes (Y1, Y2, Y3, Y4, Y5, and Y6). Of these receptors, Y1, Y2, Y4, and Y5 are functional in humans, and Y1 plays important roles in the immune responses of many organs, including the respiratory system. NPY and the Y1 receptor have critical roles in the pathogenesis of asthma, chronic obstructive pulmonary disease, and idiopathic pulmonary fibrosis. The effects of NPY on the airway immune response and pathogenesis differ among respiratory diseases. This review focuses on the involvement of NPY in the airway immune response and pathogenesis of various respiratory diseases. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 1745-1345 E107-B 3 2024 Low Complexity Overloaded MIMO Non-Linear Detector with Iterative LLR Estimation 339 348 EN Satoshi Denno Faculty of Environmental, Life, Natural Science and Technology, Okayama University Shuhei Makabe Faculty of Environmental, Life, Natural Science and Technology, Okayama University Yafei Hou Faculty of Environmental, Life, Natural Science and Technology, Okayama University This paper proposes a non-linear overloaded MIMO detector that outperforms the conventional soft-input maximum likelihood detector (MLD) with less computational complexity. We propose iterative log-likelihood ratio (LLR) estimation and multi stage LLR estimation for the proposed detector to achieve such superior performance. While the iterative LLR estimation achieves better BER performance, the multi stage LLR estimation makes the detector less complex than the conventional soft-input maximum likelihood detector (MLD). The computer simulation reveals that the proposed detector achieves about 0.6 dB better BER performance than the soft-input MLD with about half of the soft-input MLD's complexity in a 6 �~ 3 overloaded MIMO OFDM system. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 12 2024 WLAN Channel Status Duration Prediction for Audio and Video Services Using Probabilistic Neural Networks 28201 28211 EN Yafei Hou Faculty of Environmental, Life, Natural Science and Technology, Okayama University Satoshi Denno Faculty of Environmental, Life, Natural Science and Technology, Okayama University Due to massive increase in wireless access from smartphones, IoT devices, WLAN is aiming to improve its spectrum efficiency (SE) using many technologies. Some interesting techniques for WLAN systems are flexible allocation of frequency resource and cognitive radio (CR) techniques which expect to find more useful spectrum resource by modeling and then predicting of channel status using the captured statistics information of the used spectrum. This paper investigates the prediction accuracy of busy/idle duration of two major wireless services: audio service and video service using neural network based predictor. We first study the statistics distribution of their time-series busy/idle (B/I) duration, and then analyze the predictability of the busy/idle duration based on the predictability theory. Then, we propose a data categorization (DC) method which categorizes the duration of recent B/I duration according the their ranges to make the duration of next data be distributed into several streams. From the predictability analysis of each stream and the prediction performance using the probabilistic neural network (PNN), it can be confirmed that the proposed DC can improve the prediction accuracy of time-series data in partial streams. No potential conflict of interest relevant to this article was reported.

Emerald Acta Medica Okayama 2046-8253 13 1 2024 The authorship of teachers: jissen kiroku as the core of professionalism in Japanese jugyo kenkyu EN Yuichi Miyamoto Graduate School of Education, Okayama University Purpose<br> This paper aims to discuss the significance of teacher authorship (jissen kiroku) developed during jugyo kenkyu. Specifically, it explores the structural conditions of jugyo kenkyu that enabled the flourishing of jissen kiroku.<br> <br> Design/methodology/approach<br> To find how jissen kiroku developed in jugyo kenkyu, this paper settled triad of authors-text-readers as the analytical perspective. Disputes through 1960s–1980s are adequate to inquire because it can elucidate how readers read jissen kiroku, which is typically challenging to observe.<br> <br> Findings<br> Jissen kiroku is a powerful tool for semantically preserving, reconstructing and consolidating professional values and knowledge in jugyo kenkyu with deepening connoisseurship. Voluntary educational research associations (VERAs) encourage teachers to write and read jissen kiroku to develop their professionalism, which also helped develop exclusive semantics within the field. These developments were possible due to the public nature of jissen kiroku, disseminated to lesson study (LS) actors, thereby strengthening discussions both inside and outside VERAs.<br> <br> Research limitations/implications<br> The paper proposes shift in views on educational science and emphasizes authorship as authority in that professionalism of teaching can be protected and elevated through authoring.<br> <br> Originality/value<br> The significant roles of writing practice have not been explored enough. This paper finds the value of authorship in terms of public nature and openness to all teachers which enable the enhancement of professionalism of the LS field. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 11 2023 A Proposal of an Axial-Flux Permanent-Magnet Machine Employing SMC Core With Tooth-Tips Constructed by One-Pressing Process: Improving Torque and Manufacturability 109435 109447 EN Ren Tsunata Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Masatsugu Takemoto Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Jun Imai Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Tatsuya Saito Sumitomo Electric Industries Ltd. Tomoyuki Ueno Sumitomo Electric Industries Ltd. This study aims to improve the torque performance and manufacturability of axial-flux permanent magnet (AFPM) machines. Hence, we propose a novel AFPM machine that employs a soft magnetic composite (SMC) core with tooth-tips constructed by a one-pressing process and die. In this paper, the proposed AFPM machine is compared to two conventional AFPM machines using an SMC core. One of them has open-slot structure without tooth-tips. Another model employs an SMC core with tooth-tips pressed by a conventional pressing process that requires multiple operations and dies. As a result of the comparison, the proposed AFPM machine realizes a much higher torque than the two conventional machines. Additionally, the manufacturability of an SMC core with tooth-tips pressed by the proposed method is superior to the conventional one because the proposed structure can be realized by the one-pressing process and die. Furthermore, two prototypes of the proposed AFPM machine and the conventional one with an open-slot structure are fabricated, and then, they are compared by experiments. Consequently, the proposed AFPM machine achieves a 15.7% higher torque than that of the conventional machine using an open-slot structure. Finally, this paper presents an improved design of an AFPM machine with SMC cores using the proposed pressing process. As a result, the proposed AFPM realizes a 20% larger torque than that of a conventional model employing an open-slot structure. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 0093-9994 59 3 2023 Comparison of Thermal Characteristics in Various Aspect Ratios for Radial-Flux and Axial-Flux Permanent Magnet Machines 3353 3367 EN Ren Tsunata Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Masatsugu Takemoto Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Jun Imai Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Tatsuya Saito Sumitomo Electric Industries Ltd Tomoyuki Ueno Sumitomo Electric Industries Ltd This paper proposes an axial-flux permanent magnet machine (AFPM) that uses a neodymium-bonded permanent magnet (Nd-bonded PM) and a coreless rotor structure and assesses how it performs in industrial applications requiring high efficiency and low cost. The AFPM is able to achieve high efficiency in high-speed regions because its Nd-bonded PM can restrain eddy current loss. Additionally, the AFPM can continuously function at the rated operating point without a cooling system, so the expenses for one can be eliminated. Hence, the AFPM can simultaneously achieve high efficiency and low-cost mass production. In this paper, a comprehensive comparison including the thermal characteristics of the proposed AFPM and a conventional radial-flux permanent magnet machine (RFPM) is shown. Furthermore, this paper also focuses on how the aspect ratio influences the thermal characteristics of both machines. Finally, the effectiveness of the proposed AFPM in industrial applications is assessed using 3D-FEA and experimental results. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8030 17 1 2022 COVID-19 and Spanish Flu, the Representative Pandemics of the 21st and 20th Centuries 65 72 EN Sumio Shinoda Collaborative Research Center for Infectious Diseases in India, Okayama University We are still in the early stage of 21st century and the two pandemics Spanish flu and COVID-19 are the presentative pandemics in 20th and 21st centuries, respectively. The Spanish flu pandemic raged from 1918 to 1920, just after World War I. It was the first influenza pandemic worldwide; since then, humankind has experienced many such pandemics. Spanish flu is caused by a virus. However, since virology was not well established at that time, the new clinical system was needed to cope with �gunknown pathogen�h; during the pandemic, high infection rates were recorded, but our predecessors managed to somehow tackle the situation. With respect to the ongoing COVID-19 pandemic, both the virus and its genome were clarified quickly. Nonetheless, it has turned out to be quite an intriguing infectious disease, with the high rates in developed countries, such as the US and those in Europe, which have aging societies, and low rates in developing countries such as those in Africa, where the population is largely young. Here, I compared and discuss the two pandemics, COVID-19 and Spanish flu. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8049 34 2 2022 Development of a Spiral Shaped Soft Holding Actuator Using Extension Type Flexible Pneumatic Actuators 373 381 EN So Shimooka Graduate School of Natural Science and Technology, Okayama University Tetsuya Akagi Department of Intelligent Mechanical Engineering, Okayama University of Science Shujiro Dohta Department of Intelligent Mechanical Engineering, Okayama University of Science Takashi Shinohara Design and Manufacturing Center, Organization for Research Development and Outreach, Okayama University of Science Takumi Kobayashi Department of Intelligent Mechanical Engineering, Okayama University of Science Recently, several pneumatic soft actuators have been applied to wearable and welfare devices to provide nursing care and physical support for the elderly and disabled. In this study, as a wearable soft actuator for holding body, a spiral shaped soft holding actuator that can wrap a user according to their body shape was proposed and tested. The construction and operating principle of the tested soft actuator with circumferential restraint mechanism using three extension type flexible pneumatic actuators (EFPAs) has been discussed. As a result, it was found that the tested actuator could hold elbows and knees when the joint is in motion. An analytical model of the spiral actuator was also proposed to achieve an optimal design. It can be confirmed that the proposed analytical model can predict the shape of the actuator when various EFPAs are pressurized. No potential conflict of interest relevant to this article was reported.

Royal Society of Chemistry (RSC) Acta Medica Okayama 2046-2069 12 6 2022 Flame retardance-donated lignocellulose nanofibers (LCNFs) by the Mannich reaction with (amino-1,3,5-triazinyl)phosphoramidates and their properties 3300 3308 EN Fumiaki Ono Okayama Biomass Innovation Creative Center Takumi Okihara Graduate School of Natural Science and Technology, Okayama University Noboru Osaka Faculty of Science, Okayama University of Science Noriyuki Nagaoka Advanced Research Center for Oral and Craniofacial Science, Okayama University Dental School Yuji Kameoka Marubishi Oil Chemical Co., Ltd Akira Ishikawa Marubishi Oil Chemical Co., Ltd Hironari Ooki Gen Gen Corporation Takumi Ito Gen Gen Corporation Daisuke Todome Faculty of Science, Okayama University of Science Shinya Uemoto Okayama Biomass Innovation Creative Center Mitsuaki Furutani Okayama Biomass Innovation Creative Center Tsutomu Inokuchi Graduate School of Natural Science and Technology, Okayama University Kenji Okada Department of Life Science, Kurashiki University of Science & the Arts Nitrogen/phosphorus-containing melamines (NPCM), a durable flame-retardant, were prepared by the successive treatment of ArOH (Ar = BrnC6H5�|n, n = 0, 1, 2, and 3) with POCl3 and melamine monomer. The prepared flame-retardants were grafted through the CH2 unit to lignocellulose nanofibers (LCNFs) by the Mannich reaction. The resulting three-component products were characterized using FT-IR (ATR) and EA. The thermal behavior of the NPCM-treated LCNF fabric samples was determined using TGA and DSC analyses, and their flammability resistances were evaluated by measuring their Limited Oxygen Index (LOI) and the UL-94V test. A multitude of flame retardant elements in the fabric samples increased the LOI values as much as 45 from 20 of the untreated LCNFs. Moreover, the morphology of both the NPCM-treated LCNFs and their burnt fabrics was studied with a scanning electron microscope (SEM). The heat release lowering effect of the LCNF fabric against the water-based paint was observed with a cone calorimeter. Furthermore, the mechanical properties represented as the tensile strength of the NPCM-treated LCNF fabrics revealed that the increase of the NPCM content in the PP-composites led to an increased bending strength with enhancing the flame-retardance. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 11 2023 Design and Analysis of Hybrid-Excitation Variable Flux Memory Motor for Traction Applications: Improving Output Power in High-Speed Area During Six-Step Operation Mode 82024 82036 EN Ren Tsunata Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Keito Yokomichi Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Masatsugu Takemoto Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Jun Imai Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Variable flux motors with adjustable magnetic flux have been gaining attention because of their capability to simultaneously achieve a high torque density and high efficiency. In addition, the output power characteristic, which is related to acceleration performance, in high-speed areas is important in traction applications. However, typical traction motors have lower output power in high-speed areas. In this paper, a Hybrid-Excitation Variable Flux Memory Motor (HE-VFMM) is therefore proposed to enhance output power characteristics under six-step operation mode in high-speed area. The proposed HE-VFMM can perform magnetic flux adjustment with two components: field winding and variable flux permanent magnet (VPM), thus dramatically increasing flux adjustment range. The simulation results show the proposed HE-VFMM achieves 23.7% higher output power at 17,000 rpm than that of an existing traction motor in Prius 4th generation that has the same size while maintaining high efficiency in the frequently used operating area. Additionally, it was found that variable magnetic flux is very effective in enhancing the output power, especially in the high-speed region because the magnetic saturation in the stator core is mitigated by field-weakening control. Consequently, as the rotational speed increases, an increase ratio of the output power caused by the adjustable magnetic flux becomes higher. This paper shows that the proposed HE-VFMM is an effective method for improving the problem of low output power in high-speed regions in traction motors. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Immunohistochemical Expression of Placental Vitamin D Receptors in Pregnancies Complicated by Early and Late-Onset Preeclampsia 415 422 EN Dzenis Jelcic Department of Gynecology and Obstetrics, University Hospital of Split Velibor Puzovic General Hospital Dubrovnik, Department of Pathology and Cytology Benjamin Benzon University of Split School of Medicine Ivan Palada University Department of Health Studies of the University of Split Jelena Jerković Department of Gynecology and Obstetrics, University Hospital of Split Marko Vulic Department of Gynecology and Obstetrics, University Hospital of Split Original Article 10.18926/AMO/65752 The aim of our study was to determine whether the immunohistochemical expression of placental vitamin D receptors is altered in pregnancies complicated by preeclampsia. Vitamin D receptor expression was immunohistochemically analysed in the placentas of three groups: a control group, and early- and late-onset preeclampsia groups. Total immunohistochemical intensity staining of placentas showed that the control group had a median vitamin D receptor (VDR) expression significantly higher than the placentas of mothers with early- and late-onset preeclampsia. There was no difference among the three groups in a semiquantitative analysis of VDR staining of the stroma only. Vitamin D receptors showed lower median expression in preeclampsia-affected pregnancies, especially early-onset preeclampsia. Therefore, Vitamin D receptor expression may be an important marker for normal placentation and preeclampsia onset. 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-ƒ¿) levels and psychopathological symptoms, clinical and socio-demographic characteristics and antipsychotic therapy in individuals with schizophrenia. TNF-ƒ¿ 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-ƒ¿ levels were detected between the patients and controls (p=0.736). TNF-ƒ¿ 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-ƒ¿ levels and the PANSS cognitive factor (ƒÏ=�|0.222, p=0.035). A hierarchical regression analysis identified the cognitive factor as a significant predictor of the TNF-ƒ¿ level (beta=�|0.258, t=�|2.257, p=0.027). There were no significant differences in TNF-ƒ¿ levels among patients treated with different types of antipsychotics (p=0.596). TNF-ƒ¿ levels correlated positively with the age of onset (ƒÏ=0.233, p=0.027) and negatively with illness duration (ƒÏ=�|0.247, p=0.019) and antipsychotic treatment duration (ƒÏ=�|0.256, p=0.015). These results indicate that TNF-ƒ¿ 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.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 GATA4 rs61277615, rs73203482, and rs35813172 in Newborns with Transposition of the Great Arteries 365 370 EN Elena Moldovan Pediatric Intensive Care Unit, Cardiovascular and Transplant Emergency Institute of Târgu Mureș Claudia Bănescu George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș Manuela Cucerea George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș Valeriu Moldovan Târgu Mureș County Emergency Clinical Hospital Liliana Gozar George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș Lucian Pușcașiu George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș Original Article 10.18926/AMO/65745 Congenital heart disease is the most common malformative pathology in newborns, with a worldwide incidence at 0.4-5%. We investigated the possible relationship between variations in nucleotide sequences and specific cardiac malformations in the GATA-binding factor 4 (GATA4) exon 1 region by using Sanger sequencing. Forty-four newborns from a third-level neonatal intensive care unit who were diagnosed with nonsyndromic, ductal-dependent congenital heart disease (i.e., transposition of the great arteries or ductal-dependent coarctation of the aorta) were enrolled. Their DNA was extracted using commercial methods and tested using the multiplex ligation-dependent probe amplification (MLPA) technique. The Sanger sequencing for GATA4 exon 1 in the newborns�f DNA identified rs61277615, rs73203482, and rs35813172 variants not reported in the ClinVar archive of human variations in newborns previously diagnosed with transposition of the great arteries (n=5) and coarctation of the aorta (n=1). The identification of these novel variants in newborns with transposition of the great arteries or ductal-dependent coarctation of the aorta may be the first step in determining the variants�f contribution to the occurrence of congenital heart disease. However, these results may be inconclusive, since the observed variants within GATA4 gene were not previously reported. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8030 17 1 2022 Questionnaire Survey on COVID-19 Vaccination at Okayama University in Japan: Factors Promoting Vaccination Among Young Adults 21 30 EN Chigusa Higuchi Okayama University Health Service Center Naomi Matsumoto Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshiaki Iwasaki Okayama University Health Service Center Takashi Yorifuji Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Junichiro Yamazaki Okayama University Yasutomo Nasu Okayama University Hirofumi Makino Okayama University COVID-19 has been prevalent worldwide since 2019. Increasing COVID-19 vaccination coverage is an important measure to combat the disease. An online survey was conducted with university students and personnel who were vaccinated against COVID-19 at a mass vaccination event to examine the factors promoting vaccination among young adults. The online survey was conducted with persons vaccinated at Okayama University from June 5 to September 27, 2021. Although the number of those who had fever >37.5�‹C increased after the second vaccination compared to the first, the vaccinated persons got more satisfied after the second shot. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8030 17 1 2022 Effectiveness of and Immune Responses to SARS-CoV-2 mRNA Vaccines and Their Mechanisms 7 20 EN Eiichi Gohda Okayama University Following the online publication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome in January 2020, two lipid nanoparticle-encapsulated mRNA vaccines, BNT162b2 and mRNA-1273, were rapidly developed and are now being used worldwide to prevent coronavirus disease 2019 (COVID-19). The mRNA of both vaccines encodes the full-length spike protein of SARS-CoV-2, which binds to the host cell receptor angiotensin-converting enzyme 2 and is believed to mediate virus entry into cells. After intramuscular injection of the vaccine, the spike protein is produced in the cells. Both humoral and cellular immune responses to the spike protein are elicited for protection against COVID-19. The efficacy of the two mRNA vaccines against COVID-19 with wild-type SARS-CoV-2 is more than 90% and is slightly decreased with the Delta variant, which is currently the predominant variant in many countries. In this review, the effectiveness of and immune responses to COVID-19 mRNA vaccines and their mechanisms are summarized and discussed. Potential waning immunity and an additional dose of COVID-19 mRNA vaccines are also discussed. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 11 2023 Stargazer: Long-Term and Multiregional Measurement of Timing/ Geolocation-Based Cloaking 52750 52762 EN Shota Fujii Graduate School of Natural Science and Technology, Okayama University Takayuki Sato Research and Development Group, Hitachi Ltd. Sho Aoki Research and Development Group, Hitachi Ltd. Yu Tsuda National Institute of Information and Communications Technology Nobutaka Kawaguchi Research and Development Group, Hitachi Ltd. Tomohiro Shigemoto Research and Development Group, Hitachi Ltd. Masato Terada Research and Development Group, Hitachi Ltd. Malicious hosts have come to play a significant and varied role in today's cyber attacks. Some of these hosts are equipped with a technique called cloaking, which discriminates between access from potential victims and others and then returns malicious content only to potential victims. This is a serious threat because it can evade detection by security vendors and researchers and cause serious damage. As such, cloaking is being extensively investigated, especially for phishing sites. We are currently engaged in a long-term cloaking study of a broader range of threats. In the present study, we implemented Stargazer, which actively monitors malicious hosts and detects geographic and temporal cloaking, and collected 30,359,410 observations between November 2019 and February 2022 for 18,397 targets from 13 sites where our sensors are installed. Our analysis confirmed that cloaking techniques are widely abused, i.e., not only in the context of specific threats such as phishing. This includes geographic and time-based cloaking, which is difficult to detect with single-site or one-shot observations. Furthermore, we found that malicious hosts that perform cloaking include those that survive for relatively long periods of time, and those whose contents are not present in VirusTotal. This suggests that it is not easy to observe and analyze the cloaking malicious hosts with existing technologies. The results of this study have deepened our understanding of various types of cloaking, including geographic and temporal ones, and will help in the development of future cloaking detection methods. No potential conflict of interest relevant to this article was reported.

Sciendo Acta Medica Okayama 1898-0309 29 2 2023 Objective evaluation method using multiple image analyses for panoramic radiography improvement 85 91 EN Satoshi Imajo Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Yoshinori Tanabe Department of Radiological Technology, Faculty of Health Sciences, Okayama University Nobue Nakamura Division of Radiology, Medical Support Department, Okayama University Hospital Mitsugi Honda Division of Radiology, Medical Support Department, Okayama University Hospital Masahiro Kuroda Department of Radiological Technology, Faculty of Health Sciences, Okayama University Introduction: In the standardization of panoramic radiography quality, the education and training of beginners on panoramic radiographic imaging are important. We evaluated the relationship between positioning error factors and multiple image analysis results for reproducible panoramic radiography.<br> Material and methods: Using a panoramic radiography system and a dental phantom, reference images were acquired on the Frankfurt plane along the horizontal direction, midsagittal plane along the left-right direction, and for the canine on the forward-backward plane. Images with positioning errors were acquired with 1-5 mm shifts along the forward-backward direction and 2-10 degrees rotations along the horizontal (chin tipped high/low) and vertical (left-right side tilt) directions on the Frankfurt plane. The cross-correlation coefficient and angle difference of the occlusion congruent plane profile between the reference and positioning error images, peak signal-to-noise ratio (PSNR), and deformation vector value by deformable image registration were compared and evaluated.<br> Results: The cross-correlation coefficients of the occlusal plane profiles showed the greatest change in the chin tipped high images and became negatively correlated from 6 degrees image rotation (r = -0.29). The angle difference tended to shift substantially with increasing positioning error, with an angle difference of 8.9 degrees for the 10 degrees chin tipped low image. The PSNR was above 30 dB only for images with a 1-mm backward shift. The positioning error owing to the vertical rotation was the largest for the deformation vector value.<br> Conclusions: Multiple image analyses allow to determine factors contributing to positioning errors in panoramic radiography and may enable error correction. This study based on phantom imaging can support the education of beginners regarding panoramic radiography. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 3 2023 Current Femoral Stem Fixation Selection in Hip-Fracture Bipolar Hemiarthroplasties, and Factors Affecting Surgeons�f Confidence in Their Ability to Teach about Cemented Stems: A Questionnaire in a Region of Japan with Super-Aged Patients 311 318 EN Takanori Miura Department of Orthopedic Surgery, Tazawako Hospital Hiroaki Kijima Akita Hip Research Group, Akita University Graduate School of Medicine Hiroshi Tazawa Akita Hip Research Group, Akita University Graduate School of Medicine Naohisa Miyakoshi Akita Hip Research Group, Akita University Graduate School of Medicine Original Article 10.18926/AMO/65496 Japan�fs hip fracture management guidelines now recommend the use of cemented stems in cases of bone fragility. However, the current stem selection practices in bipolar hemiarthroplasty (BHA) in a super-aging area in Japan remain unclear. This study aimed to examine the stem selection policies, the surgeons�f concerns about cemented stems, and factors affecting their confidence in their ability to coach others on cemented stem procedures. Ninety-four orthopedic surgeons (27 facilities) responded to our web-based questionnaire conducted in January/February 2022. Cementless stem was the first choice of 97.8% of the surgeons; <15% of the respondents expected to increase their use of cemented stems in the future. The cement technique was the greatest concern; almost half of the surgeons described having insufficient experience with cemented stems. The factor that most affected the surgeons�f expertise in using cemented stems is the number of surgeries they had conducted with a cemented stem (multivariable analysis odds ratio 8.42, p=0.001). Greater experience was associated with increased expertise of the surgeons in using cemented stems, with a threshold of 11 cases showing sensitivity of 41.7% and specificity of 98.3% for their confidence to instruct cemented stems. No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠw—�Šw•”’n‹…‰ÈŠw‰È Acta Medica Okayama 1340-7414 29 1 2023 ’ù�³�F’nŒ`‚ð�l—¶‚µ‚½—¤ŠC“��‡3ŽŸŒ³’n�k”g‘¬“x�\‘¢ƒ‚ƒfƒ‹‚ð—p‚¢‚½‘啪Œ§Žü•Ó‚Ì’·ŽüŠú’n�k“®ƒVƒ~ƒ…ƒŒ�[ƒVƒ‡ƒ“ 65 66 EN Tatsuya OKUNAKA Formerly Department of Earth Sciences, Okayama University Masanao KOMATSU Department of Earth Sciences, Okayama University Hiroshi TAKENAKA Department of Earth Sciences, Okayama University Masayuki YOSHIMI Geological Survey of Japan, National Institute of Advanced Industrial Science and Technology Takeshi NAKAMURA Formerly Japan Agency for Marine-Earth Science and Technology Taro OKAMOTO Department of Earth and Planetary Sciences, School of Science, Tokyo Institute of Technology No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 11 2023 Artificial Neural Network Based Audio Reinforcement for Computer Assisted Rote Learning 39466 39483 EN Parisa Supitayakul Graduate School of Natural Science and Technology, Okayama University Zeynep Yücel Graduate School of Natural Science and Technology, Okayama University Akito Monden Graduate School of Natural Science and Technology, Okayama University The dual-channel assumption of the cognitive theory of multimedia learning suggests that importing a large amount of information through a single (visual or audio) channel overloads that channel, causing partial loss of information, while importing it simultaneously through multiple channels relieves the burden on them and leads to the registration of a larger amount of information. In light of such knowledge, this study investigates the possibility of reinforcing visual stimuli with audio for supporting e-learners in memorization tasks. Specifically, we consider three kinds of learning material and two kinds of audio stimuli and partially reinforce each kind of material with each kind of stimuli in an arbitrary way. In a series of experiments, we determine the particular type of audio, which offers the highest improvement for each kind of material. Our work stands out as being the first study investigating the differences in memory performance in relation to different combinations of learning content and stimulus. Our key findings from the experiments are: (i) E-learning is more effective in refreshing memory rather than studying from scratch, (ii) Non-informative audio is more suited to verbal content, whereas informative audio is better for numerical content, (iii) Constant audio triggering degrades learning performance and thus audio triggering should be handled with care. Based on these findings, we develop an ANN-based estimator to determine the proper moment for triggering audio (i.e. when memory performance is estimated to be declining) and carry out follow-up experiments for testing the integrated framework. Our contributions involve (i) determination of the most effective audio for each content type, (ii) estimation of memory deterioration based on learners' interaction logs, and (iii) the proposal of improvement of memory registration through auditory reinforcement. We believe that such findings constitute encouraging evidence the memory registration of e-learners can be enhanced with content-aware audio incorporation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 2 2023 Personalized Preclinical Training in Dental Ergonomics and Endodontics in Undergraduate Dentistry Students (Pilot Study) 147 159 EN Zulema Arias Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Stephanie Haines Department of Health Tadashi Yamamoto Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kazu Hatanaka Department of Periodontics and Endodontics, Okayama University Hospital Keisuke Yamashiro Department of Periodontics and Endodontics, Okayama University Hospital Norihiro Sonoi Department of Periodontics and Endodontics, Okayama University Hospital Shogo Takashiba Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65144 The curriculum at the Department of Pathophysiology in the Periodontal Sciences program at Okayama University includes normative preclinical training (NPT) using phantoms. NPT is given to the whole class of 5 th year students divided in groups of 8 students/instructor. In 2019, an innovative personalized preclinical training (PPT) pilot study was implemented for this group of students whereby two students, each with their own dental unit, were coached by one instructor. The main topics covered were dental ergonomics and endodontics. We aimed to evaluate the effectiveness of PPT in dental ergonomics and endodontics toward increasing the knowledge and future clinical skills of students who had already undergone NPT. A test on endodontics was taken before and after PPT. A questionnaire was completed to assess their perception of improvement regarding the above-mentioned topics. Test scores and questionnaire results both showed that the students�f level of knowledge and awareness of future clinical skills was significantly higher after PPT. This pilot study demonstrated that PPT increased the students�f knowledge and future clinical skills. As preclinical training forms the foundation for clinical practice, investment in future research regarding this personalized approach is likely to enhance students�f understanding and clinical performance. No potential conflict of interest relevant to this article was reported.

De Gruyter Acta Medica Okayama 2193-3677 11 1 2023 Attributable fraction and related measures: Conceptual relations in the counterfactual framework EN Etsuji Suzuki Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Eiji Yamamoto Okayama University of Science The attributable fraction (population) has attracted much attention from a theoretical perspective and has been used extensively to assess the impact of potential health interventions. However, despite its extensive use, there is much confusion about its concept and calculation methods. In this article, we discuss the concepts of and calculation methods for the attributable fraction and related measures in the counterfactual framework, both with and without stratification by covariates. Generally, the attributable fraction is useful when the exposure of interest has a causal effect on the outcome. However, it is important to understand that this statement applies to the exposed group. Although the target population of the attributable fraction (population) is the total population, the causal effect should be present not in the total population but in the exposed group. As related measures, we discuss the preventable fraction and prevented fraction, which are generally useful when the exposure of interest has a preventive effect on the outcome, and we further propose a new measure called the attributed fraction. We also discuss the causal and preventive excess fractions, and provide notes on vaccine efficacy. Finally, we discuss the relations between the aforementioned six measures and six possible patterns using a conceptual schema. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Scattered Tiny Whitish Protrusions in the Stomach Are a Clue to the Diagnosis of Autoimmune Gastritis 75 80 EN Masaya Iwamuro Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takehiro Tanaka Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenta Hamada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences 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 Seiji Kawano Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiro Kawahara Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/64365 Herein, we report two patients with autoimmune gastritis who had undergone multiple esophagogastroduodenoscopy procedures for 17 and 9 years, respectively, before their diagnosis. Instead, they had been diagnosed with and treated for Helicobacter pylori-associated gastritis. The correct diagnosis was made when scatterings of tiny whitish protrusions in the gastric mucosa were detected on esophagogastroduodenoscopy. Our findings suggest that scattered tiny whitish bumps may be a clue to the diagnosis of autoimmune gastritis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Graphene Oxide-based Endodontic Sealer: An in Vitro Study 715 721 EN Mohammed Zahedul Islam Nizami Department of Pathophysiology – Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Melahat Gorduysus Department of Pathophysiology – Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuki Shinoda-Ito Department of Pathophysiology – Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tadashi Yamamoto Department of Pathophysiology – Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuta Nishina Research Core for Interdisciplinary Sciences, Okayama University Shogo Takashiba Research Core for Interdisciplinary Sciences, Okayama University Zulema Arias Department of Pathophysiology – Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Original Article 10.18926/AMO/64122 The failure of endodontic treatment is directly associated with microbial infection in the root canal or periapical areas. An endodontic sealer that is both bactericidal and biocompatible is essential for the success of root canal treatments. This is one of the vital issues yet to be solved in clinical dental practice. This in vitro study assessed the effectiveness of graphene oxide (GO) composites GO-CaF2 and GO-Ag-CaF2 as endodontic sealer materials. Dentin slices were coated with either the GO-based composites or commonly used root canal sealers (non-eugenol zinc oxide sealer). The coated slices were treated in 0.9% NaCl, phosphate-buffered saline (PBS), and simulated body fluid (SBF) at 37˚C for 24 hours to compare their sealing effect on the dentin surface. In addition, the radiopacity of these composites was examined to assess whether they complied with the requirements of a sealer for good radiographic visualization. Scanning electron microscopy showed the significant sealing capability of the composites as coating materials. Radiographic images confirmed their radiopacity. Mineral deposition indicated their bioactivity, especially of GO-Ag-CaF2, and thus it is potential for regenerative application. They were both previously shown to be bactericidal to oral microbes and cytocompatible with host cells. With such a unique assemblage of critical properties, these GO-based composites show promise as endodontic sealers for protection against reinfection in root canal treatment and enhanced success in endodontic treatment overall. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Intraoperative Hypothermia Is Not Associated with Surgical Site Infections after Total Hip or Knee Arthroplasty 651 660 EN Bright Osman Abugri Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Matsusaki Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Wanxu Ren Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/64115 Maintaining perioperative normothermia decreases the post-surgery surgical site infection (SSI) rate. We investigated whether SSI is associated with intraoperative hypothermia in total hip (THA) and total knee (TKA) arthroplasties by retrospectively analyzing 297 THA and TKA cases. The patients�f intraoperative core body temperature (BT) was measured by bladder catheter or forehead sensor. We evaluated the associations between SSI and intraoperative BT and other variables and patient characteristics. Fifty-six patients (18.8%) had hypothermia (BT <36�‹C); 43 developed SSI (14.5%); only five had hypothermia (11.6%). Intraoperative hypothermia and SSI were not significantly associated. The SSI group had more men (34.9% vs. 18.1%) and THA patients (77.4%), a longer mean surgical duration (174.3 vs. 143.5 mins), and a higher average BT (36.4�‹C vs. 36.2�‹C) than the no-SSI group. The SSI patients had a higher intraoperative BT. A multivariable analysis revealed that SSI was associated with male sex (OR 2.3, 95%CI: 1.031-4.921, p=0.042), longer surgery (OR, 1.01, 95%CI: 1.003-1.017, p=0.004), THA (OR 3.6, 95%CI: 1.258-10.085, p=0.017), and intraoperative BT >36.0�‹C (OR 3.6, 95%CI: 1.367-9.475, p=0.009). Intraoperative hypothermia was not associated with SSI in adults who underwent THA or TKA. These results suggest that hypothermia might not be the problem for SSI. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Artificial Intelligence-based Detection of Epileptic Discharges from Pediatric Scalp Electroencephalograms: A Pilot Study 617 624 EN Katsuhiro Kobayashi Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Shibata Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroki Tsuchiya Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoyuki Akiyama Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/64111 We developed an artificial intelligence (AI) technique to identify epileptic discharges (spikes) in pediatric scalp electroencephalograms (EEGs). We built a convolutional neural network (CNN) model to automatically classify steep potential images into spikes and background activity. For the CNN model�f training and validation, we examined 100 children with spikes in EEGs and another 100 without spikes. A different group of 20 children with spikes and 20 without spikes were the actual test subjects. All subjects were ≥ 3 to < 18 years old. The accuracy, sensitivity, and specificity of the analysis were >0.97 when referential and combination EEG montages were used, and < 0.97 with a bipolar montage. The correct classification of background activity in individual patients was significantly better with a referential montage than with a bipolar montage (p=0.0107). Receiver operating characteristic curves yielded an area under the curve > 0.99, indicating high performance of the classification method. EEG patterns that interfered with correct classification included vertex sharp transients, sleep spindles, alpha rhythm, and low-amplitude ill-formed spikes in a run. Our results demonstrate that AI is a promising tool for automatically interpreting pediatric EEGs. Some avenues for improving the technique were also indicated by our findings. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 5 2022 Viral Sequences Are Repurposed for Controlling Antiviral Responses as Non-Retroviral Endogenous Viral Elements 503 510 EN Hirohito Ogawa Department of Virology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tomoyuki Honda Department of Virology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Review 10.18926/AMO/64025 Eukaryotic genomes contain numerous copies of endogenous viral elements (EVEs), most of which are considered endogenous retrovirus (ERV) sequences. Over the past decade, non-retroviral endogenous viral elements (nrEVEs) derived from ancient RNA viruses have been discovered. Several functions have been proposed for these elements, including antiviral defense. This review summarizes the current understanding of nrEVEs derived from RNA viruses, particularly endogenous bornavirus-like elements (EBLs) and endogenous filovirus-like elements (EFLs). EBLs are one of the most extensively studied nrEVEs. The EBL derived from bornavirus nucleoprotein (EBLN) is thought to function as a non-coding RNA or protein that regulates host gene expression or inhibits virus propagation. Ebolavirus and marburgvirus, which are filoviruses, induce severe hemorrhagic fever in humans and nonhuman primates. Although the ecology of filoviruses remains unclear, bats are believed to be potential reservoirs. Based on the knowledge from EBLs, it is postulated that EFLs in the bat genome help to maintain the balance between filovirus infection and the bat�fs defense system, which may partially explain why bats act as potential reservoirs. Further research into the functions of nrEVEs could reveal novel antiviral systems and inspire novel antiviral approaches. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 5 2022 Current Insights into Mesenchymal Signatures in Glioblastoma 489 502 EN Yuji Matsumoto Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomotsugu Ichikawa Department of Neurological Surgery, Kagawa Prefectural Central Hospital Kazuhiko Kurozumi Department of Neurosurgery, Hamamatsu University Hospital Isao Date Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Review 10.18926/AMO/64024 Glioblastoma (GBM) is a fatal primary malignant brain tumor in adults. Despite decades of research, the prognosis for GBM patients is still disappointing. One major reason for the intense therapeutic resistance of GBM is inter- and intra-tumor heterogeneity. GBM-intrinsic transcriptional profiling has suggested the presence of at least three subtypes of GBM: the proneural, classic, and mesenchymal subtypes. The mesenchymal subtype is the most aggressive, and patients with the mesenchymal subtype of primary and recurrent tumors tend to have a worse prognosis compared with patients with the other subtypes. Furthermore, GBM can shift from other subtypes to the mesenchymal subtype over the course of disease progression or recurrence. This phenotypic transition is driven by diverse tumor-intrinsic molecular mechanisms or microenvironmental factors. Thus, better understanding of the plastic nature of mesenchymal transition in GBM is pivotal to developing new therapeutic strategies. In this review, we provide a comprehensive overview of the current understanding of the elements involved in the mesenchymal transition of GBM and discuss future perspectives. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 Molecular-targeted Therapy for Metastatic Renal Cell Carcinoma As First-line Therapy: A Single Institution 13-year Experience 465 472 EN Kensuke Bekku Department of Urology, Hiroshima City Hiroshima Citizens Hospital Takuji Tsugawa Department of Urology, Hiroshima City Hiroshima Citizens Hospital Kazuma Tsuboi Department of Urology, Hiroshima City Hiroshima Citizens Hospital Gaku Noda Department of Urology, Hiroshima City Hiroshima Citizens Hospital Yousuke Inoue Department of Urology, Hiroshima City Hiroshima Citizens Hospital Wataru Murao Department of Urology, Hiroshima City Hiroshima Citizens Hospital Shin Ebara Department of Urology, Hiroshima City Hiroshima Citizens Hospital Original Article 10.18926/AMO/63906 We aimed to identify the role of first-line monotherapy with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI) in patients with metastatic RCC. Eligible patients were categorized into three groups (favorable, intermediate, and poor risk) according to the International Metastatic RCC Database Consortium risk criteria. Overall survival (OS) was the primary endpoint. Survival was compared using the log-rank test. A total of 108 patients were retrospectively analyzed. The numbers of patients in the favorable-, intermediate-, and poor-risk groups were 32 (30%), 66 (61%), and 10 (9%), repestively. The median OS values in the entire cohort was 36 months (95% confidence interval [CI] 29-53). The median OS in the favorable, intermediate, and poor risk groups were 94 months (95% CI: 43-Not reached), 30 months (95% CI: 20-38), and 8 months (95% CI: 0-Not reached), respectively (p<0.05). Prior nephrectomy, clear cell histology, clinical T stage ≤2, no metastasis at the time of diagnosis, nivolumab beyond first-line therapy, and objective response to VEGFR-TKIs were factors significantly prolonging OS on univariate analysis. VEGFR-TKI monotherapy as first-line therapy was an effective treatment option for patients with metastatic clear cell RCC with favorable risk. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 The Association between Preoperative Blood Pressure Elevations and Postoperative Adverse Outcomes after Non-cardiac Surgery: A Single-center Retrospective Observational Study 429 437 EN Yusuke Yamadori Department of Anesthesiology, Faculty of Medicine, Kagawa University Tomohiro Hirao Department of Public Health, Faculty of Medicine, Kagawa University Nlandu R. Ngatu Department of Public Health, Faculty of Medicine, Kagawa University Kanae Kanda Department of Public Health, Faculty of Medicine, Kagawa University Syed Mahfuz Al Hasan Department of Public Health, Faculty of Medicine, Kagawa University Akitsu Murakami Department of Anesthesiology, Faculty of Medicine, Kagawa University Yukinori Mashima Department of Public Health, Faculty of Medicine, Kagawa University Gotaro Shirakami Department of Anesthesiology, Faculty of Medicine, Kagawa University Original Article 10.18926/AMO/63902 Blood pressure (BP) often rises before surgery. This study investigated whether BP elevation immediately before surgery was associated with adverse outcomes. Medical records of 11,732 patients (average age: 61 years; male: 47.4%) who underwent non-cardiac elective inpatient surgery under general anesthesia at Kagawa University Hospital between January 2011 and June 2019 were reviewed. Differences between the first BP values measured on the day before surgery and the first BP values in the operating room were defined as Ģ systolic BP (ĢSBP) and Ģ diastolic BP (ĢDBP). The relationships between ĢSBP/ĢDBP and 30-day mortality, 30-day readmission, and over-the-standard length of hospital stay (OSLOS) were assessed. OSLOS was defined as a hospital stay longer than mean+2 standard deviations and was calculated using the Japanese Diagnosis Procedure Combination data. In univariate analysis, the differences in ĢSBP and ĢDBP between the OSLOS and standard LOS groups were both 2 mmHg. In multivariate logistic regression analysis, only ĢDBP was associated with OSLOS. The adjusted odds ratio (95% confidence interval) for the largest quartile was 1.31 (1.02-1.69) (p<0.05). ĢDBP was associated with OSLOS; however, there may be little need to worry about large ĢSBPs and ĢDBPs in clinical practice. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 Therapeutic Approaches Targeting miRNA in Systemic Lupus Erythematosus 359 371 EN Sumie Hiramatsu-Asano Department of Nephrology, Rheumatology, Endocrinology and Metabolism, 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 Review 10.18926/AMO/63887 Systemic lupus erythematosus (SLE) is a potentially fatal systemic autoimmune disease, and its etiology involves both genetic and environmental factors such as sex hormone imbalance, genetic predisposition, epigenetic regulation, and immunological factors. Dysregulation of microRNA (miRNA) is suggested to be one of the epigenetic factors in SLE. miRNA is a 22-nucleotide single-stranded noncoding RNA that contributes to post-transcriptional modulation of gene expression. miRNA targeting therapy has been suggested to be useful for the treatment of cancers and other diseases. Gene knockout and miRNA targeting therapy have been demonstrated to improve SLE disease activity in mice. However, these approaches have not yet reached the level of clinical application. miRNA targeting therapy is limited by the fact that each miRNA has multiple targets. In addition, the expression of certain miRNAs may differ among cell tissues within a single SLE patient. This limitation can be overcome by targeted delivery and chemical modifications. In the future, further research into miRNA chemical modifications and delivery systems will help us develop novel therapeutic agents for SLE. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1010-660X 58 5 2022 Mechanical Study of Various Pedicle Screw Systems including Percutaneous Pedicle Screw in Trauma Treatment 565 EN Yoshiaki Oda Department of Orthopaedic Surgery, Okayama University Hospital Tomoyuki Takigawa Department of Orthopaedic Surgery, Kobe Red Cross Hospital Yasuo Ito Department of Orthopaedic Surgery, Kobe Red Cross Hospital Haruo Misawa Department of Orthopaedic Surgery, Okayama University Hospital Tomoko Tetsunaga Department of Orthopaedic Surgery, Okayama University Hospital Koji Uotani Department of Orthopaedic Surgery, Okayama University Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw-rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt-chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Evaluation of Fast Diffusion Kurtosis Imaging Using New Software Designed for Widespread Clinical Use 297 305 EN Masahiro Kuroda Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Konishi Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Sugimoto Radiological Technology, Graduate School of Health Sciences, Okayama University Yuuki Yoshimura Radiological Technology, Graduate School of Health Sciences, Okayama University Kentaro Hamada Radiological Technology, Graduate School of Health Sciences, Okayama University Abdullah Khasawnehc Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Majd Barham Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nouha Tekiki Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Irfan Sugianto Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Babatunde O. Bamgbose Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hinata Ishizaka Radiological Technology, Graduate School of Health Sciences, Okayama University Yudai Shimizu Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Nakamitsu Radiological Technology, Graduate School of Health Sciences, Okayama University Wlla E. Al-Hammad Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Kamizaki Radiological Technology, Graduate School of Health Sciences, Okayama University Akira Kurozumi Central Division of Radiology, Okayama University Hospital Toshi Matsushita Central Division of Radiology, Okayama University Hospital Seiichiro Ohno Central Division of Radiology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Junichi Asaumi Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63739 Clinical research using restricted diffusion-weighted imaging, especially diffusion kurtosis (DK) imaging, has been progressing, with reports on its effectiveness in the diagnostic imaging of cerebral infarctions, neurodegenerative diseases, and tumors, among others. However, the application of DK imaging in daily clinical practice has not spread because of the long imaging time required and the use of specific software for image creation. Herein, with the aim of promoting clinical research using DK imaging at any medical facility, we evaluated fast DK imaging using a new software program. We developed a new macro program that produces DK images using general-purpose, inexpensive software (Microsoft Excel and ImageJ), and we evaluated fast DK imaging using bio-phantoms and a healthy volunteer in clinical trials. The DK images created by the new software with diffusion-weighted images captured with short-time imaging sequences were similar to the original DK images captured with long-time imaging sequences. The DK images using three b-values, which can reduce the imaging time by 43%, were equivalent to the DK images using five b-values. The DK imaging technique developed herein might allow any medical facility to increase its daily clinical use of DK imaging and easily conduct clinical research. No potential conflict of interest relevant to this article was reported.

“ú–{‚Ì�푈�Ó”CŽ‘—¿ƒZƒ“ƒ^�[ Acta Medica Okayama 13437348 26 1999 �푈•ß—¸–â‘è‚Ì”äŠr•¶‰»“I�lŽ@�F�u�H�v‚Ì–â‘è‚ð’†�S‚É(‰º) 77 84 EN Tomoyo Nakao Okayama University No potential conflict of interest relevant to this article was reported.

“ú–{‚Ì�푈�Ó”CŽ‘—¿ƒZƒ“ƒ^�[ Acta Medica Okayama 13437348 23 1999 �푈•ß—¸–â‘è‚Ì”äŠr•¶‰»“I�lŽ@�F�u�H�v‚Ì–â‘è‚ð’†�S‚É(’†) 27 39 EN Tomoyo Nakao Okayama University No potential conflict of interest relevant to this article was reported.

“ú–{‚Ì�푈�Ó”CŽ‘—¿ƒZƒ“ƒ^�[ Acta Medica Okayama 13437348 22 1998 �푈•ß—¸–â‘è‚Ì”äŠr•¶‰»“I�lŽ@�F�u�H�v‚Ì–â‘è‚ð’†�S‚É(�ã) EN Tomoyo Nakao Okayama University No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 1 2022 Cystic Intracranial Recurrence of Olfactory Neuroblastoma without Accumulation on Fluorine-18-fluorodeoxyglucose Positron Emission Tomography 93 98 EN Yukitomo Ishi Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Shigeru Yamaguchi Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Kanako C. Hatanaka Department of Surgical Pathology, Hokkaido University Hospital Emi Takakuwa Department of Surgical Pathology, Hokkaido University Hospital Hiroaki Motegi Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Taishi Honda Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hiroyuki Kobayashi Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Shunsuke Terasaka Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Akihiro Homma Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Miki Fujimura Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Kiyohiro Houkin Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Case Report 10.18926/AMO/63218 A 66-year-old man underwent multimodal treatment for olfactory neuroblastoma (ONB). When he was 72 years old, a cystic intracranial lesion without accumulation on fluorine-18-fluorodeoxyglucose positron emission tomography was detected. Surgical resection was performed when the patient was 73 years old. The pathological examination revealed recurrence of ONB, and the patient underwent focal irradiation. At age 81, he presented with a second recurrence in the right occipital lobe with radiological and pathological findings similar to the prior recurrence. This case suggests that pathological confirmation should be considered in cases with atypical radiological findings following the treatment of ONB. No potential conflict of interest relevant to this article was reported.

Springer International Publishing Acta Medica Okayama 0302-9743 12835 2021 (Short Paper) Evidence Collection and Preservation System with Virtual Machine Monitoring 64 73 EN Toru Nakamura KDDI Research, Inc. Hiroshi Ito Graduate School of Natural Science and Technology, Okayama University Shinsaku Kiyomoto KDDI Research, Inc. Toshihiro Yamauchi Graduate School of Natural Science and Technology, Okayama University In a system audit and verification, it is important to securely collect and preserve evidence of execution environments, execution processes, and program execution results. Evidence-based verification of program processes ensures their authenticity; for example, the processes include no altered/infected program library. This paper proposes a solution for collection of evidence on program libraries based on Virtual Machine Monitor (VMM). The solution can solve semantic gap by obtaining library file path names. This paper also shows a way to obtain hash values of library files from a guest OS. Furthermore, this paper provides examples of evidence on program xecution and the overhead of the solution. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 9 2021 Mitigation of Kernel Memory Corruption Using Multiple Kernel Memory Mechanism 111651 111665 EN Hiroki Kuzuno 1Intelligent Systems Laboratory, SECOM Company Ltd. Toshihiro Yamauchi 2Graduate School of Natural Science and Technology, Okayama University Operating systems adopt kernel protection methods (e.g., mandatory access control, kernel address space layout randomization, control flow integrity, and kernel page table isolation) as essential countermeasures to reduce the likelihood of kernel vulnerability attacks. However, kernel memory corruption can still occur via the execution of malicious kernel code at the kernel layer. This is because the vulnerable kernel code and the attack target kernel code or kernel data are located in the same kernel address space. To gain complete control of a host, adversaries focus on kernel code invocations, such as function pointers that rely on the starting points of the kernel protection methods. To mitigate such subversion attacks, this paper presents multiple kernel memory (MKM), which employs an alternative design for kernel address space separation. The MKM mechanism focuses on the isolation granularity of the kernel address space during each execution of the kernel code. MKM provides two kernel address spaces, namely, i) the trampoline kernel address space, which acts as the gateway feature between user and kernel modes and ii) the security kernel address space, which utilizes the localization of the kernel protection methods (i.e., kernel observation). Additionally, MKM achieves the encapsulation of the vulnerable kernel code to prevent access to the kernel code invocations of the separated kernel address space. The evaluation results demonstrated that MKM can protect the kernel code and kernel data from a proof-of-concept kernel vulnerability that could lead to kernel memory corruption. In addition, the performance results of MKM indicate that the system call overhead latency ranges from 0.020 ƒÊs to 0.5445 ƒÊs, while the web application benchmark ranges from 196.27 ƒÊs to 6, 685.73 ƒÊs for each download access of 100,000 Hypertext Transfer Protocol sessions. MKM attained a 97.65% system benchmark score and a 99.76% kernel compilation time. No potential conflict of interest relevant to this article was reported.

Seron Jiho-sha Co., Ltd. Acta Medica Okayama 1341-2051 26 6 2019 Treatment of Bucco-Accessory Root Canal of a Maxillary Incisor with a Combination of Cone Beam Computed Tomography and Continuous Supersonic Wave Condensation 510 512 EN Zulema Arias Faculty of Dentistry, University Mayor of San Andres Ivana Cazas Private Dental Office Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Keisuke Yamashiro Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Shogo Takashiba Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Mohammad Khursheed Alam College of Dentistry, Jouf University Objective: A novel treatment for bucco-accessory root canal (bARC), which is difficult to treat by regular endodontic therapy, is discussed.<br> Clinical Presentation and Intervention: A bARC in the maxillary right incisor with symptomatic irreversible pulpitis was detected using cone beam computed tomography (CBCT) after conventional dental radiography. The pulp was extirpated and the canal enlarged using rotary files and chemo-mechanical reagents. The main root canal and bARC were obturated with thermoplastic gutta-percha using continuous wave condensation. Postoperative CBCT revealed a completely treated bARC.<br> Conclusion: A combination of CBCT and continuous wave condensation is ideal for bARCs in incisors. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Sublingual Gland Carcinoma Revealed by Choroidal Metastasis 741 744 EN Tetsuro Morita Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Shiode Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuhei Kimura Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mio Hosokawa Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichiro Doi Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kosuke Takahashi Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Matoba Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Kanzaki Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiro Tabata Center for Clinical Oncology, Okayama University Hospital Yuki Morizane Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/62815 A 65-year-old man presented with a 1-week history of left eye distortion. An elevated choroidal lesion covering 6 disc diameters was found in the posterior retina of the left eye. Systemic examination revealed sublingual gland carcinoma and multiple lung metastases, and the diagnosis was choroidal metastasis from sublingual gland carcinoma. Following chemotherapy and radiation therapy, the choroidal lesion shrunk and the patient�fs visual acuity improved. The patient died 23 months after his first visit. To the best of our knowledge, this is the first reported case of choroidal metastasis from sublingual gland carcinoma. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Guideline-based Treatment of Glucocorticoid-induced Osteoporosis in Patients with Rheumatoid Arthritis: A Retrospective Study with the AORA Registry 699 704 EN Tetsuya Kawano Department of Orthopedic Surgery, Akita University Graduate School of Medicine Naohisa Miyakoshi Department of Orthopedic Surgery, Akita University Graduate School of Medicine Hiroyuki Tsuchie Department of Orthopedic Surgery, Akita University Graduate School of Medicine Takeshi Kashiwagura Department of Orthopedic Surgery, Akita City Hospital Moto Kobayashi Department of Orthopedic Surgery, Hiraka General Hospital Yokote City Hiroshi Aonuma Department of Orthopedic Surgery, Ogachi Central Hospital Yuzawa City Yusuke Sugimura Department of Orthopedic Surgery, Nakadori General Hospital Akita City Yoichi Shimada Department of Orthopedic Surgery, Akita University Graduate School of Medicine Original Article 10.18926/AMO/62809 Glucocorticoid-induced osteoporosis (GIOP) is one of the side effects associated with glucocorticoid (GC) therapy. In 2014, the Japanese Society for Bone and Mineral Research (JSBMR) provided new guidelines for the management and treatment of GIOP. The aim of the present study was to clarify the prevalence of patients with rheumatoid arthritis (RA) requiring treatment according to the new guidelines and to identify risk factors associated with lack of treatment in these patients. Patients in the 2018 Akita Orthopedic group on Rheumatoid Arthritis (AORA) database were enrolled. Of 2,234 patients with RA in the database, 683 (30.6%) met the 2014 JSBMR guideline treatment criteria, and 480 (70.3%) had been treated. The untreated group included a larger number of males, younger patients, and patients treated in clinics rather than hospital (p<0.001, p=0.015, and p<0.001, respectively). Multivariate analyses found that male sex, younger age, and clinic-based RA care were significant risk factors associated with lack of treatment (p<0.001, p=0.013, and p<0.001, respectively). Thus, male sex, younger age, and clinic-based care were identified as risk factors No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 5 2021 Relation Between Identity Disclosure to Family Members and Mental Health in Japanese Transgender People 611 623 EN Yu Zhou Graduate School of Health Sciences, Okayama University Michiyo Furutani Graduate School of Health Sciences, Okayama University Rukmali Athurupana Graduate School of Health Sciences, Okayama University Mikiya Nakatsuka Graduate School of Health Sciences, Okayama University Original Article 10.18926/AMO/62774 Family members are critical mediators of the experiences of transgender people. We studied whether transgen-der subjects had disclosed their identity to their families and their families�f reactions after the disclosure. We also evaluated the subjects�f mental state and its association with disclosure status. Transgender people were recruited for this anonymous questionnaire survey in the Okayama University Hospital gender clinic. Subjects disclosed their identity to family members at the following rates: 68.7% to the father, 89.1% to the mother, 59.1% to a brother, 77.8% to a sister, and 47.6% to grandparents. Fathers had the lowest rate (26.7%) of posi-tive reactions, while over 50% of fathers showed an ambiguous response. Approximately 20% of parents showed a negative response. The majority of parents agreed to hormonal treatment and sex-reassignment sur-gery and that the transgender child should live with the gender they wanted to express. However, the rate of subjects with mood and anxiety disorders according to the Kessler 6 scale was significantly higher in those who experienced negative or ambiguous reactions from family members compared to those who experienced posi-tive reactions. Educational and mental health professionals should support the disclosure process of transgen-der people as well as their family members. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 5 2021 The Effect of Peer Instruction Lectures on Learning Attitudes in Epidemiology Education 601 609 EN Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Original Article 10.18926/AMO/62773 Research suggests that the fundamental concepts of epidemiology cannot be sufficiently learned in traditional lectures, and interactive learning is necessary. However, few studies have investigated interactive epidemiology education in general, or peer instruction (PI) in particular. This study investigated the effect of PI. Study par-ticipants were fourth-year medical students. The attitude of participants in regard to PI learning was examined in a non-PI and a PI group. The Survey of Attitudes Toward Statistics (SATS) (containing six sub-categories) was conducted as a learning-attitudes index. The pre- and post-lecture scores were compared between the non-PI and PI groups using double robust (DR) estimation. The non-PI and PI groups consisted of 20 and 121 student participants, respectively. In DR estimation, affect exhibited the lowest SATS score changes, at �|0.51 (95% confidence interval �|0.78 to �|0.24; p-value < 0.001), whereas effort exhibited the highest score changes of 0.01 (95% confidence interval �|0.30 to 0.32; p-value = 0.952). The epidemiology lecture with PI did not increase the SATS scores. This might be due to issues related to the experimental design. Further research investigating the effects of interactive epidemiology education, it will be necessary to develop tools for assessing the learning of epidemiological concepts and to improve the research design. 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.

Conference Publishing Services, IEEE Computer Society Acta Medica Okayama 2021 Analysis of commands of Telnet logs illegally connected to IoT devices 913 915 EN Toshihiro Yamauchi Graduate School of Natural Science and Technology Okayama University Ryota Yoshimoto Graduate School of Natural Science and Technology Okayama University Takahiro Baba Graduate School of Natural Science and Technology Okayama University Katsunari Yoshioka Graduate School of Environment and Information Sciences / Institute of Advanced Sciences Yokohama National University Mirai is an active malware that targets and poses constant threats to IoT devices. IoT malware penetrates IoT devices illegally, makes them download other malware such as bots, and infects them. Therefore, to improve the security of IoT devices, it is important to analyze the behaviors of IoT malware and take countermeasures. In this study, to analyze the behaviors of IoT malware after entering IoT devices and propose new security functions for operating systems to prevent activities such as IoT malware infection, we analyze Telnet logs collected by a honeypot of IoT devices. Thereafter, we report the analysis results regarding IoT malware input commands. The results show that many commands related to shell execution, file download, changing file permissions, and file transfer, are often executed by IoT malware. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 3 2021 Effects of Gram-negative Rod Blood Stream Infection on Acute GVHD in Allogeneic Hematopoietic Stem Cell Transplantation: A Single-institute Analysis 279 287 EN Masa-aki Nishinohara Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hisakazu Nishimori Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideaki Fujiwara Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Noboru Asada Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Daisuke Ennishi Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ken-ichi Matsuoka Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keiko Fujii Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuharu Fujii Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshinobu Maeda Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/62219 A bloodstream infection (BSI) is the most common serious infectious complication of hematopoietic stem cell transplantation (HSCT). BSI promotes an inflammatory state, which exacerbates acute graft-versus-host disease (GVHD). We investigated whether a Gram-negative rod bloodstream infection (GNR-BSI), which develops early after allo-HSCT, affected the onset or exacerbated acute GVHD in 465 patients who underwent allo-HSCT from 1995 through 2015 at a single institution. Eighty-eight patients (19%) developed BSI during the study period. Among the cultures, 50 (57%) were Gram-positive cocci (GPC) and 31 (35%) were GNR. Of the 465 patients, 187 (40%) developed acute GVHD of grade II or higher within the first 100 days post-allogeneic HSCT: 124 (27%) had acute GVHD grade II, 47 (10%) had grade III, and 16 (3%) had grade IV. Multivariate analysis revealed that GNR-BSI was a significant risk factor for grade II-IV acute GVHD (grade II-IV: hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.03-2.97; grade III-IV: HR 2.37, 95% CI 1.03-5.43). These results suggest that GNR-BSI may predict the onset and exacerbation of acute GVHD. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 3 2021 Dental Treatment for Special Needs Patients Under General Anaesthesia: A 14-year Experience from South Bosnia and Herzegovina 261 268 EN Lidija Lasic Arapovic Health Care Center Mostar, University of Mostar Zoran Karlovic School of Medicine, University of Mostar Valentina Rajic Brzovic School of Medicine, University of Mostar Amer Bukvic Primary Health Care Center Novi Travnik Anka Coric Health Care Center Mostar, University of Mostar Katarina Vukojevic School of Medicine, University of Mostar Zeljko Verzak School of Medicine, University of Mostar Original Article 10.18926/AMO/62217 We conducted a retrospective analysis of records of special needs patients (SNPs) who received dental treatment under orotracheal-intubation general anaesthesia (OIGA) at Caritas Centre St. Family in Mostar, Bosnia and Herzegovina during the 14-year period from January 2005 to December 2018. Of the 7,085 SNPs who received dental treatment, 1,220 (17.2%) received dental treatment under OIGA: 829 (67.9%) males and 391 (32.1%) females. The patients�f mean age was 18.3�}10.9 years (747 paediatric and 473 adult patients). Mental retardation and psychiatric problems were the most common medical conditions (81.22%). The most common indication for dental treatment under OIGA was behaviour management (87.21%), and 81% of the patients had an urgent need for treatment. Many of the patients had restorative treatment (3,833) and tooth extractions (3,681). From 2011 onwards, the number of tooth extractions decreased significantly. Annual trends revealed a rapid increase of patients every year. The mean dental treatment duration was 95.3�}12.1 min; the mean time under OIGA was 98�}8.5 min. No serious adverse effects occurred. There was increase of annual trend of SNP in OIGA. The number of extractions decreased while the number of preventive and restorative dental treatments increased. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 An Unusual Case of Drunk Driving in Japan: Alcohol-Related Sleepwalking 255 259 EN Ayako Himemiya-Hakucho Department of Legal Medicine, Yamaguchi University Graduate School of Medicine Tatsuya Fujimiya Department of Medical Education, Yamaguchi University Graduate School of Medicine Case Report 10.18926/AMO/61910 Alcohol has been identified as a potential precipitating factor for parasomnia, particularly sleepwalking (SW). We report an unusual case of a Japanese drunk driver who may have experienced alcohol-related SW, based on the statements of the suspect, pharmacokinetic analyses of the suspect�fs breath alcohol concentration, testimonies of witnesses, driving recorder data, and medical records. The existence of sleep-related criminal acts performed while a suspect experiences memory loss under the influence of alcohol has not been sufficiently recognized, and awareness of such acts should be raised among the police, public prosecutors, and the general public in Japan. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Endogenous Bacterial Endophthalmitis Caused by Iliopsoas Abscess 249 253 EN Weiying Sun Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Shiode Department of Ophthalmology, 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 Shuhei Kimura Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mio Hosokawa Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichiro Doi Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kosuke Takahashi Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Matoba Department of Ophthalmology, 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 Yuki Morizane Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/61909 A 79-year-old woman presented to our hospital with a 10-day history of gradually worsening binocular vision and severe backache. Further investigations revealed poor bilateral best-corrected visual acuities (BCVA), bilateral vitreous opacities, gray-white lesions scattered throughout the retina, and a left iliopsoas abscess on CT that later grew out methicillin-sensitive S. aureus. The abscess was drained and intravenous antibiotics were initiated, but the left eye additionally required intravitreal vancomycin. BCVA for both eyes normalized within 1 year. Intramuscular abscess should be considered as a possible primary lesion in cases of endogenous bacterial endophthalmitis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Lactoferrin-like Immunoreactivity in Distinct Neuronal Populations in the Mouse Central Nervous System 153 167 EN Shigeyoshi Shimaoka Department of Anatomy and Cell Biology, Division of Life Sciences, Osaka Medical and Pharmaceutical University Hitomi Hamaoka Department of Anatomy and Cell Biology, Division of Life Sciences, Osaka Medical and Pharmaceutical University Junji Inoue Department of Anatomy and Cell Biology, Division of Life Sciences, Osaka Medical and Pharmaceutical University Masato Asanuma Department of Medical Neurobiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ikuo Tooyama Molecular Neuroscience Research Center, Shiga University of Medical Science Yoichi Kondo Molecular Neuroscience Research Center, Shiga University of Medical Science Original Article 10.18926/AMO/61894 Lactoferrin (Lf) is an iron-binding glycoprotein mainly found in exocrine secretions and the secondary granules of neutrophils. In the central nervous system (CNS), expression of the Lf protein has been reported in the lesions of some neurodegenerative disorders such as Alzheimer�fs disease, Parkinson�fs disease, and amyotrophic lateral sclerosis, as well as in the aged brain. Lf is primarily considered an iron chelator, protecting cells from potentially toxic iron or iron-requiring microorganisms. Other biological functions of Lf include immunomodulation and transcriptional regulation. However, the roles of Lf in the CNS have yet to be fully clarified. In this study, we raised an antiserum against mouse Lf and investigated the immunohistochemical localization of Lf-like immunoreactivity (Lf-LI) throughout the CNS of adult mice. Lf-LI was found in some neuronal populations throughout the CNS. Intense labeling was found in neurons in the olfactory systems, hypothalamic nuclei, entorhinal cortex, and a variety of brainstem nuclei. This study provides detailed information on the Lf-LI distribution in the CNS, and the findings should promote further understanding of both the physiological and pathological significance of Lf in the CNS. No potential conflict of interest relevant to this article was reported.

Springer Nature Acta Medica Okayama 2056-5968 7 1 2021 Antenna arrangement and energy-transfer pathways of PSI-LHCI from the moss Physcomitrella patens 10 EN Qiujing Yan Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Liang Zhao State Key Laboratory of Membrane Biology, Beijing Advanced Innovation Center for Structural Biology & Frontier Research Center for Biological Structure, School of Life Sciences, Tsinghua University Wenda Wang Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Xiong Pi State Key Laboratory of Membrane Biology, Beijing Advanced Innovation Center for Structural Biology & Frontier Research Center for Biological Structure, School of Life Sciences, Tsinghua University Guangye Han Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Jie Wang Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Lingpeng Cheng State Key Laboratory of Membrane Biology, Beijing Advanced Innovation Center for Structural Biology & Frontier Research Center for Biological Structure, School of Life Sciences, Tsinghua University Yi-Kun He College of Life Sciences, Department of Chemistry, Capital Normal University, Tingyun Kuang Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Xiaochun Qin School of Biological Science and Technology, University of Jinan Sen-Fang Sui State Key Laboratory of Membrane Biology, Beijing Advanced Innovation Center for Structural Biology & Frontier Research Center for Biological Structure, School of Life Sciences, Tsinghua University Jian-Ren Shen Research Institute for Interdisciplinary Science, and Graduate School of Natural Science and Technology, Okayama University, Plants harvest light energy utilized for photosynthesis by light-harvesting complex I and II (LHCI and LHCII) surrounding photosystem I and II (PSI and PSII), respectively. During the evolution of green plants, moss is at an evolutionarily intermediate position from aquatic photosynthetic organisms to land plants, being the first photosynthetic organisms that landed. Here, we report the structure of the PSI-LHCI supercomplex from the moss Physcomitrella patens (Pp) at 3.23 angstrom resolution solved by cryo-electron microscopy. Our structure revealed that four Lhca subunits are associated with the PSI core in an order of Lhca1-Lhca5-Lhca2-Lhca3. This number is much decreased from 8 to 10, the number of subunits in most green algal PSI-LHCI, but the same as those of land plants. Although Pp PSI-LHCI has a similar structure as PSI-LHCI of land plants, it has Lhca5, instead of Lhca4, in the second position of Lhca, and several differences were found in the arrangement of chlorophylls among green algal, moss, and land plant PSI-LHCI. One chlorophyll, PsaF-Chl 305, which is found in the moss PSI-LHCI, is located at the gap region between the two middle Lhca subunits and the PSI core, and therefore may make the excitation energy transfer from LHCI to the core more efficient than that of land plants. On the other hand, energy-transfer paths at the two side Lhca subunits are relatively conserved. These results provide a structural basis for unravelling the mechanisms of light-energy harvesting and transfer in the moss PSI-LHCI, as well as important clues on the changes of PSI-LHCI after landing. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 1 2021 Minimally Invasive Spinal Stabilization with Denosumab before Total Spondylectomy for a Collapsing Lower Lumbar Spinal Giant Cell Tumor 95 101 EN Keitaro Minato Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Toru Hirano Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Hiroyuki Kawashima Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Tetsuro Yamagishi Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Keigo Watanabe Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Masayuki Ohashi Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Akira Ogose Department of Orthopedic Surgery, Uonuma Kikan Hospital Naoto Endo Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Case Report 10.18926/AMO/61442 A 21-year-old man consulted our hospital for treatment of a spinal giant cell tumor (GCT) of Enneking stage III. Lower lumbar-spine tumors and severe spinal canal stenosis are associated with high risk for surgical mor-bidity. Stability was temporarily secured with a percutaneous pedicle screw fixation in combination with deno-sumab, which shrank the tumor. Total en bloc spondylectomy was then performed 6 months after initiation of denosumab, and the patient was followed for 3 years. There was no local recurrence, and bony fusion was obtained. Minimally invasive surgery and denosumab allowed safer and easier treatment of a collapsing lower lumbar extra-compartmental GCT. No potential conflict of interest relevant to this article was reported.

Frontiers Media Acta Medica Okayama 1664-462X 11 2020 Postharvest Properties of Ultra-Late Maturing Peach Cultivars and Their Attributions to Melting Flesh (M) Locus: Re-evaluation of M Locus in Association With Flesh Texture 554158 EN Ryohei Nakano Experimental Farm of Graduate School of Agriculture, Kyoto University Takashi Kawai Graduate School of Environmental and Life Science, Okayama University Yosuke Fukamatsu Graduate School of Environmental and Life Science, Okayama University Kagari Akita Graduate School of Environmental and Life Science, Okayama University Sakine Watanabe Graduate School of Environmental and Life Science, Okayama University Takahiro Asano Graduate School of Environmental and Life Science, Okayama University Daisuke Takata Faculty of Food and Agricultural Sciences, Fukushima University Mamoru Sato Faculty of Food and Agricultural Sciences, Fukushima University Fumio Fukuda Graduate School of Environmental and Life Science, Okayama University Koichiro Ushijima Graduate School of Environmental and Life Science, Okayama University The postharvest properties of two ultra-late maturing peach cultivars, "Tobihaku" (TH) and "Daijumitsuto" (DJ), were investigated. Fruit were harvested at commercial maturity and held at 25 degrees C. TH exhibited the characteristics of normal melting flesh (MF) peach, including rapid fruit softening associated with appropriate level of endogenous ethylene production In contrast, DJ did not soften at all during 3 weeks experimental period even though considerable ethylene production was observed. Fruit of TH and DJ were treated with 5,000 ppm of propylene, an ethylene analog, continuously for 7 days. TH softened rapidly whereas DJ maintained high flesh firmness in spite of an increase in endogenous ethylene production, suggesting that DJ but not TH lacked the ability to be softened in response to endogenous and exogenous ethylene/propylene. DNA-seq analysis showed that tandem endo-polygalacturonase (endoPG) genes located at melting flesh (M) locus, Pp-endoPGM (PGM), and Pp-endoPGF (PGF), were deleted in DJ. The endoPG genes at M locus are known to control flesh texture of peach fruit, and it was suggested that the non-softening property of DJ is due to the lack of endoPG genes. On the other hand, TH possessed an unidentified M haplotype that is involved in determination of MF phenotype. Structural identification of the unknown M haplotype, designated as M-0, through comparison with previously reported M haplotypes revealed distinct differences between PGM on M-0 haplotype (PGM-M-0) and PGM on other haplotypes (PGM-M-1). Peach M haplotypes were classified into four main haplotypes: M-0 with PGM-M-0; M-1 with both PGM-M-1 and PGF; M-2 with PGM-M-1; and M-3 lacking both PGM and PGF. Re-evaluation of M locus in association with MF/non-melting flesh (NMF) phenotypes in more than 400 accessions by using whole genome shotgun sequencing data on database and/or by PCR genotyping demonstrated that M-0 haplotype was the common haplotype in MF accessions, and M-0 and M-1 haplotypes were dominant over M-2 and M-3 haplotypes and co-dominantly determined the MF trait. It was also assumed on the basis of structural comparison of M haplotypes among Prunus species that the ancestral haplotype of M-0 diverged from those of the other haplotypes before the speciation of Prunus persica. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 6 2020 C-Arm-Free Minimally Invasive Cervical Pedicle Screw Fixation (MICEPS): A Technical Note 551 556 EN Masato Tanaka 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 Venkatesh Kadiri Department of Orthopaedic Surgery, Okayama Rosai Hospital Taro Yamauchi Department of Orthopaedic Surgery, Okayama Rosai Hospital Case Report 10.18926/AMO/61216 A minimally invasive posterolateral approach designed to avoid the lateral misplacement of midcervical pedicle screws was reported, but there is no technical report that describes this technique without C-arm fluoroscopy. We report the results of a 2.5 years follow-up of a 62-year-old female patient with C4 metastatic breast cancer. The patient suffered from severe neck pain and impending quadriplegia for 2 months after radiation therapy. We performed C-arm-free minimally invasive cervical pedicle screw fixation (MICEPS). The patient was suc-cessfully treated with surgery, and her neck pain was well controlled. She had neither neurological deficits nor neck pain at the final (2.5-year) follow-up. C-arm-free MICEPS is a useful technique; in addition, the sur-geons and staff have no risk of radiation exposure, there is a reduced need for postoperative imaging, and a decreased revision rate can be expected with C-arm-free MICEPS. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 6 2020 Soft Tissue Myoepithelioma of the Shoulder 531 535 EN Kazuhiko Hashimoto Department of Orthopedic Surgery, Kindai University Hospital Shunji Nishimura Department of Orthopedic Surgery, Kindai University Hospital Takaaki Chikugo Department of Pathology, Kindai University Hospital Ryosuke Kakinoki Department of Orthopedic Surgery, Kindai University Hospital Masao Akagi Department of Orthopedic Surgery, Kindai University Hospital Case Report 10.18926/AMO/61213 Soft tissue myoepitheliomas are often misdiagnosed due to their rarity. Herein, we describe a case of soft tissue myoepithelioma of the shoulder. A 72-year-old woman had a suspected sarcoma on her shoulder and under-went open biopsy. She was referred to our hospital, where the tumor was widely resected and the diagnosis of myoepithelioma was histologically confirmed. No recurrence has been observed in the 3 years since the sur-gery. Careful and prompt planning is necessary for the effective treatment of myoepithelioma. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 6 2020 Potential of Artificial Intelligence for Estimating Japanese Fetal Weights 483 493 EN Yasunari Miyagi Medical Data Labo Takahito Miyake Department of Obstetrics and Gynecology, Miyake Clinic Original Article 10.18926/AMO/61207 We developed an artificial intelligence (AI) method for estimating fetal weights of Japanese fetuses based on the gestational weeks and the bi-parietal diameter, abdominal circumference, and femur length. The AI comprised of neural network architecture was trained by deep learning with a dataset that consists of �} 2 standard devia-tion (SD), �} 1.5SD, and �} 0SD categories of the approved standard values of ultrasonic measurements of the fetal weights of Japanese fetuses (Japan Society of Ultrasonics in Medicine [JSUM] data). We investigated the residuals and compared 2 other regression formulae for estimating the fetal weights of Japanese fetuses by t-test and Bland-Altman analyses, respectively. The residuals of the AI for the test dataset that was 12.5% of the JSUM data were 6.4 �} 2.6, �|3.8 �} 8.6, and �|0.32 �} 6.3 (g) at �|2SD, +2SD, and all categories, respectively. The residu-als of another AI method created with all of the JSUM data, of which 20% were randomized validation data, were �|1.5 �} 9.4, �|2.5 �} 7.3, and �|1.1 �} 6.7 (g) for �|2SD, +2SD, and all categories, respectively. The residuals of this AI were not different from zero, whereas those of the published formulae differed from zero. Though vali-dation is required, the AI demonstrated potential for generating fetal weights accurately, especially for extreme fetal weights. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 5 2020 Clinical Relevance of Serum Prolactin Levels to Inflammatory Reaction in Male Patients 381 389 EN Koichiro Yamamoto 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 Kou Hasegawa 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 Tomoko Miyoshi 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 Mikako Obika Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichi Itoshima Department of Laboratory Medicine, Okayama University Hospital Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/60797 To clarify the relevance of prolactin (PRL) to clinical parameters in patients who visited our general medicine department, medical records of 353 patients in whom serum PRL levels were measured during the period from 2016 to 2018 were retrospectively reviewed. Data for 140 patients (M/F: 42/98) were analyzed after excluding patients lacking detailed records and patients taking dopaminergic agents. Median serum PRL levels were significantly lower in males than females: 6.5 ng/ml (IQR: 4.2-10.3) versus 8.1 ng/ml (5.9-12.9), respectively. Pain and general fatigue were the major symptoms at the first visit, and past histories of hypertension and dyslipidemia were frequent. Male patients with relatively high PRL levels (≥ 10 ng/ml) had significantly lower levels of serum albumin and significantly higher levels of serum LDH than those with low PRL (< 10 ng/ml). There were significant correlations of male PRL level with the erythrocyte sedimentation rate (R=0.62), serum LDH level (R=0.39) and serum albumin level (R=�|0.52), while the level of serum CRP (R=0.33) showed an insignificant but weak positive correlation with PRL level. Collectively, these results show that PRL levels had gender-specific relevance to various clinical factors, with PRL levels in males being significantly related to inflammatory status. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 0094-0496 47 3 2020 Elite Malay Polygamy: Wives, Wealth and Woes in Malaysia. Koktvedgaard Zeitzen, Miriam. New York: Berghahn, 2018. 268 pp. 343 344 EN Ayami Nakatani Okayama University 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�fs 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�fs 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 A Randomized Phase 2 Trial of Antibiotic Prophylaxis Versus No Intervention for Muscle Biopsy in A Neurology Department 261 264 EN Keiichi Nakahara Department of Neurology, Graduate School of Medical Sciences, Kumamoto University Tokunori Ikeda Department of Clinical Investigation, Kumamoto University Hospital Koutaro Takamatsu Department of Neurology, Graduate School of Medical Sciences, Kumamoto University Nozomu Tawara Department of Neurology, Graduate School of Medical Sciences, Kumamoto University Kentaro Hara Department of Neurology, Graduate School of Medical Sciences, Kumamoto University Yuki Enokida Department of Pharmacy, Kumamoto University Hospital Naomi Tanoue Department of Pharmacy, Kumamoto University Hospital Sawana Narita Department of Clinical Investigation, Kumamoto University Hospital Akiko Fujii Department of Clinical Investigation, Kumamoto University Hospital Yoshinori Yamanouchi Department of Clinical Investigation, Kumamoto University Hospital Jun Morinaga Department of Clinical Investigation, Kumamoto University Hospital Satoshi Yamashita Department of Neurology, Graduate School of Medical Sciences, Kumamoto University Clinical Study Protocol 10.18926/AMO/59961 Muscle biopsy can be used to confirm the diagnosis of neuromuscular diseases. However, it is unclear whether antibiotic prophylaxis prior to muscle biopsy is needed to prevent surgical site infection (SSI). We are conducting a phase 2, single-center, open-labeled, prospective randomized trial to clarify the need for antibiotic prophylaxis in patients at low risk for SSI undergoing muscle biopsy. Patients will be randomized to an antibiotic prophylaxis group or a control group, and the incidence of SSI will be compared between the groups. Our findings will clarify the need for antibiotic prophylaxis in this patient population. No potential conflict of interest relevant to this article was reported.

The Japanese Society for Horticultural Science Acta Medica Okayama 21890102 89 1 2020 Effect of Defoliation on Blossom-end Rot Incidence and Calcium Transport into Fruit of Tomato Cultivars Under Moderate Water Stress 22 29 EN Annah Khatenje Indeche Graduate School of Environmental and Life Science, Okayama University Yuichi Yoshida Graduate School of Environmental and Life Science, Okayama University Tanjuro Goto Graduate School of Environmental and Life Science, Okayama University Ken-ichiro Yasuba Graduate School of Environmental and Life Science, Okayama University Yoshiyuki Tanaka Graduate School of Environmental and Life Science, Okayama University The translocation of calcium (Ca) within the tomato plant and the causes of Ca deficiency, a factor associated with blossom-end rot (BER) in fruit, are still a matter of conjecture. The objective of this study was to determine the effect of defoliation on BER incidence and Ca transport into different size tomato fruit cultivars. Four experiments were conducted. The start and end dates for each experiment were; 14 March–2 May, 22 July–23 August, 30 August–7 October 2017, and 20 May–25 June 2018, for experiments 1, 2, 3, and 4, respectively. Five tomato cultivars including one large (�eMomotaro fight (MF)�f, ≥ 200 g), three medium (�eLui 60 (L60)�f, �eTio cook (TC)�f, and �eCindy sweet (CS)�f, 30–80 g), and one small (�ePepe (PP)�f, ≤ 20 g) fruit cultivars, respectively, were grown under moderate water stress controlled by a combination of root zone restriction and solar mediated fertigation. Leaf area of plants was reduced by 20–30% by removing alternate leaflets on all leaves. Defoliation significantly reduced BER in all experiments. In experiment 4, no BER was observed in defoliated plants of L60 and PP, and in MF and TC, BER incidence decreased to a quarter of the control. Defoliation increased the fruit growth rate (FGR) in experiment 1, in which the temperature was the lowest, by a ratio of 1.42 and by 1.39 in experiment 4, in which the radiation was strongest and day length longest. Defoliation increased the rate of daily Ca transport into fruit (CTR) in MF, L60, TC, CS, and PP by average ratios of 1.64, 1.55, 1.35, 1.30, and 1.13, respectively. The increase in CTR in defoliated plants was highest in experiment 4 with a ratio of 1.68 followed by 1.37, 1.33, and 1.28 in experiments 1, 3, and 2, respectively. Defoliation increased both FGR and CTR and there were significant linear relationships between them. However, the degree of increase was larger in CTR than that in FGR, especially in the BER-sensitive large fruit cultivar MF, and defoliation increased the total Ca concentration in fruit accordingly. We conclude that under moderate water stress by root zone restriction and certain other BER inductive conditions, defoliation could be a promising approach to reduce BER incidence by improving Ca nutrition in susceptible large fruit cultivars. 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 Software to Help Patients Understand Drug for Adjuvant Treatment for Breast Cancer: A Pilot Randomized Controlled Trial 95 101 EN Sayaka Kuba Department of Surgery, Nagasaki University Graduate School of Biomedical Science Kosho Yamanouchi Department of Surgery, Nagasaki University Graduate School of Biomedical Science Michi Morita Department of Surgery, Nagasaki University Graduate School of Biomedical Science Chika Sakimura Department of Surgery, Nagasaki University Graduate School of Biomedical Science Eiko Inamasu Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science Toshiko Hatachi Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science Ryota Otsubo Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science Megumi Matsumoto Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science Hiroshi Yano Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science Junya Miyamoto Department of Clinical Research Center, Nagasaki University Graduate School of Biomedical Science Shuntaro Sato Department of Clinical Research Center, Nagasaki University Graduate School of Biomedical Science Hiroo Nakagawa Department of Pharmacy, Nagasaki University Graduate School of Biomedical Science Kengo Kanetaka Department of Surgery, Nagasaki University Graduate School of Biomedical Science Mitsuhisa Takatsuki Department of Surgery, Nagasaki University Graduate School of Biomedical Science Takeshi Nagayasu Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science Susumu Eguchi Department of Surgery, Nagasaki University Graduate School of Biomedical Science Original Article 10.18926/AMO/58266 We assessed the usefulness of ChemoCalc, a software package for calculating drug costs, in helping patients understand these costs. We randomly assigned, in a 1 : 1 ratio, 20 women who had undergone surgery for early breast cancer to a group that discussed adjuvant treatment with their physicians using the ChemoCalc software (ChemoCalc group) or a group that discussed adjuvant treatment without ChemoCalc (Usual Explanation group). The participants completed a five-grade evaluation questionnaire after these discussions. The primary endpoint was the intergroup comparison of the questionnaire scores regarding participants�f understanding of their treatment-associated drug costs. Median age was not significantly different between the ChemoCalc group and Usual Explanation group (57 vs. 50, respectively; p=0.27). Patients in the ChemoCalc group had a significantly higher perceived level of understanding of the drug cost than those in the Usual Explanation group (5 [4-5] vs. 2.5 [1-5], respectively; p=0.002). Scores related to the patients�f perception that understanding drug costs is an important part of breast cancer treatment were also higher in the ChemoCalc group than the Usual Explanation group (5 [2-5] vs. 3 [1-5], respectively; p=0.049). ChemoCalc was found to be useful for understanding drug costs. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 6 2019 Foveal Structural Analysis of Amblyopic Eyes with Two Types of Fixation Behavior by Spectral-Domain Optical Coherence Tomography 487 494 EN Fumiko Kishimoto Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Phamaceutical Sciences Chiaki Fujii Division of Ophthalmology, Ibara Municipal Hospital Toshio Okanouchi Division of Ophthalmology, Kurashiki Medical Center Hiroshi Ohtsuki Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Phamaceutical Sciences Original Article 10.18926/AMO/57712 We used spectral-domain optical coherence tomography (SD-OCT) to compare the foveal and parafoveal structures of 19 subjects aged 16-58 years (8 men, 11 women): 6 amblyopic patients with eccentric fixation, 5 amblyopic patients with central fixation, and 8 visually normal controls. We obtained foveal horizontal line scans using SD-OCT on all of the patients and controls. The total and layer thicknesses at foveal areas were analyzed. The mean (SD) ages of individuals in the eccentric fixation, central fixation, and control groups were 43.0 (13.9), 42.2 (16.3), and 38.5 (15.5) years, respectively. We observed no significant differences in the foveal or parafoveal retinal thicknesses at 500 and 1,500 ƒÊm from the foveal center among the 3 groups or between the amblyopic and fellow eyes. No significant differences were observed in the thickness of the ganglion cell complex layer or outer retinal layer at 500 and 1,500 ƒÊm from the foveal center among the three groups or between the two eyes. Overall, our SD-OCT analyses revealed no characteristic structural change in foveal regions in amblyopic eyes irrespective of the fixation behavior. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Twist Knot: A New Sliding Noose in Adjustable Suture Strabismus Surgery 463 468 EN Kiyo Shibata Department of Ophthalmology, Okayama University Hospital Ichiro Hamasaki Department of Ophthalmology, Okayama University Hospital Takehiro Shimizu Department of Ophthalmology, Okayama University Hospital Reika Kono Department of Ophthalmology, Okayama University Hospital Hiroshi Ohtsuki Department of Ophthalmology, Okayama Saiseikai General Hospital Yuki Morizane Department of Ophthalmology, Okayama University Hospital Fumio Shiraga Department of Ophthalmology, Okayama University Hospital Case Report 10.18926/AMO/57378 To permit noose movement without fraying the sutures following strabismus surgery, we designed a new sliding noose, the �gtwist knot�h and investigated its advantages and disadvantages. We measured the tensile strength required to move the twist knot in a tightly tied state (134�}19 gf) and in a loosened state (21�}7 gf), and that required to move the conventional sliding noose in a tightly tied state (48�}14 gf), and used the Kruskal-Wallis test to compare them. A significant difference was observed among the three tensile strengths (p<0.001). The twist knot technique allowed easy sliding without the multifilament braided suture becoming frayed and a knot to be firmly fixed without slipping. However, if the 2 strings of the pole sutures exit from the sclera at 2 widely separated positions, the sliding noose may become slack. Therefore, the distance between the pole sutures should be small. The simple twist knot technique was found to be an effective approach following adjustable surgery of strabismus. 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.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 4 2019 Impact of Disease Complexity on Cardiovascular Events after the Transition to an Adult Congenital Heart Disease Specialized Medical Unit 307 313 EN Sho Takahashi Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Teiji Akagi Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihisa Toh Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoichi Takaya Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koji Nakagawa Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuhiro Nishii Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Ito Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/56932 The follow-up of patients with adult congenital heart disease (ACHD) at a specialized medical unit is necessary for the patients�f appropriate medical care. However, limited information is available about cardiovascular events among ACHD patients. Here we investigated the type and frequency of cardiovascular events in ACHD patients in relation to disease complexity. We retrospectively analyzed the cases of 535 patients (median age 35 years) referred to our ACHD center between 2014 and 2017. We divided the patients into 3 groups based on their disease complexity. To evaluate the relationship between disease complexity and cardiovascular events, we performed univariate and multivariate survival analyses. The Simple, moderate, and complex disease groups accounted for 62%, 19%, and 19% of the patients, respectively. Apart from events related to atrial septal defect (ASD) trans-catheter treatment, the frequency of cardiovascular events was dependent on the disease complexity (event-free survival rates at 3 years were 85%, 65%, and 58%, respectively). The hazard ratios were 4.0 and 5.1 in the moderate and complex groups, respectively. With the exception of scheduled transcatheter intervention, cardiovascular events were strongly related to the disease complexity of original heart disease. However, cardiovascular events were not rare even in the simple ACHD group. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Improvement of Open Bite and Stomatognathic Function in an Axenfeld- Rieger Syndrome Patient by Orthodontic Sectional Arch Mechanics: Clinical Considerations and the Risk of Orthodontic Tooth Movement 255 262 EN Daisuke Seki Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry Nobuo Takeshita Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry Masahiro Seiryu Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry Toru Deguchi Division of Orthodontics, The Ohio State University College of Dentistry Teruko Takano-Yamamoto Department of Biomaterials and Bioengineering, Faculty of Dental Medicine, Hokkaido University Case Report 10.18926/AMO/56869 Orthodontists need to understand the orthodontic risks associated with systemic disorders. Axenfeld-Rieger syndrome (ARS) is a rare autosomal dominant disorder with genetic and morphological variability. The risks of orthodontic treatment in ARS patients have been unclear. Here we describe the correction of an anterior open bite in a 15-year-old Japanese female ARS patient by molar intrusion using sectional archwires with miniscrew implants. An undesirable development of external apical root resorption (EARR) was observed in all intrusive force-applied posterior teeth during the patient�fs orthodontic treatment, suggesting that ARS patients have a higher risk of EARR than the general population. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Prevalence of and Risk Factors for the Progression of Upper Cervical Lesions in Patients with Rheumatoid Arthritis 235 240 EN Masahiro Horita Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keiichiro Nishida Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenzo Hashizume Department of Rehabilitation, Japan Labour Health and Walfare Organization, Okayama Rosai Hospital Yoshihisa Sugimoto Department of Orthopaedic Surgery, Okayama City Hospital Yoshihisa Nasu Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryuichi Nakahara Department of Intelligent Orthopaedic ystem, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryozo Harada 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/56866 We investigated the prevalence of and risk factors for the progression of upper cervical lesions (UCLs) in patients with rheumatoid arthritis (RA). A retrospective analysis of 49 patients with RA (4 males, 45 females) was conducted. The UCLs included atlanto-axial subluxation and vertical subluxation. We investigated the clinical factors including the Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and the modified Health Assessment Questionnaire-Disability Index as well as radiographic changes between the baseline (at May 2010 to April 2013) and final follow-up. Forty patients (81.6%) were classified as the non-progressive group, and the other 9 patients (18.4%) comprised the progressive group. The progressive group�fs final CRP values, baseline or final MMP-3 levels, DAS28-CRP, and rate of pre-existing lesions at baseline were all significantly higher than those of the non-progressive group (p=0.017, p=0.043, p=0.002, p=0.008, p<0.001, and p=0.008 respectively). A multivariate logistic regression analysis demonstrated that DAS28-CRP at baseline was a risk factor for radiographic progression (p=0.018, odds ratio: 2.54, 95% confidence interval: 1.17-5.51). Our findings indicate that higher disease activity might influence the progression of UCLs in patients with RA. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Spiral Trajectory Modulation of Rheotaxic Motile Human Sperm in Cylindrical Microfluidic Channels of Different Inner Diameters 213 221 EN Saori Nishina Cardiovascular Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koji Matsuura Department of Biomedical Engineering, Faculty of Engineering, Okayama University of Science Keiji Naruse Cardiovascular Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/56863 We investigated the relationship between human sperm rheotaxis and motile sperm trajectories by using poly-(dimethylsiloxane) (PDMS)-based cylindrical microfluidic channels with inner diameters of 100 ƒÊm, 50 ƒÊm, and 70 ƒÊm, which corresponded to the inner diameter of the human isthmus, the length of a sperm and a diameter intermediate between the two, respectively. We counted the number of rheotaxic sperm and sperm with spiral motion. We also analyzed motile sperm trajectories. As the cylindrical channel diameter was decreased, the percentage of sperm cells exhibiting rheotaxis, the percentage of sperm cells exhibiting spiral motion, the frequency-to-diameter ratio of the sperm cells�f spiral trajectories, and the surface area of the microfluidic channel increased, while the flagellar motion at the channel wall decreased. The percentage of sperm exhibiting a spiral trajectory and the frequency-to-diameter ratio of the sperm cells�f spiral trajectories were thus affected by the channel diameter. Our findings suggest that the oviduct structure affects the swimming properties of sperm cells, guiding them from the uterus to the ampulla for egg fertilization. These results could contribute to the development of motile sperm-sorting microfluidic devices for assisted reproductive technologies. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 1 2019 Efficacy of Oral Care Provided by Interprofessional Collaboration for a Patient with Esophageal Cancer Associated with Post-polio Syndrome during Neoadjuvant Chemotherapy 71 76 EN Keiko Takahashi-Arimasa Dental Hygienist Team, Division of Medical Technology, Okayama University Hospital Reiko Kohno-Yamanaka Division of Hospital Dentistry, Central Clinical Department, Okayama University Hospital Yoshihiko Soga Division of Hospital Dentistry, Central Clinical Department, Okayama University Hospital Rumi Miura Dental Hygienist Team, Division of Medical Technology, Okayama University Hospital Manabu Morita Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/56461 Preoperative oral care is helpful to prevent postoperative complications in patients who are undergoing esophagectomy. Here, we report the case of an 81-year-old Japanese man with an upper limb disability caused by post-polio syndrome who was receiving neoadjuvant chemotherapy for esophageal cancer. He had poor oral health status and developed oral complications as a side effect of chemotherapy. He could not brush his teeth by himself. However, infection control by oral care provided by an interprofessional collaboration successfully improved his oral hygiene, and his follow-up involved no severe complications. Interprofessional collaboration is useful especially for patients with upper limb disability. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 1 2019 Congenital Multiple Ocular Motor Nerve Palsy Complicated by Splitting of the Lateral Rectus Muscle 67 70 EN Reika Kono Department of Ophthalmology, Okayama University Hospital Takehiro Shimizu Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Ohtsuki Division of Ophthalmology, Okayama Saiseikai General Hospital Ichiro Hamasaki Department of Ophthalmology, Okayama University Hospital Kiyo Shibata Department of Ophthalmology, Okayama University Hospital Fumiko Kishimoto Division of Ophthalmology, Ibara City Hospital Yuki Morizane Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Shiraga Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/56460 We report a case of congenital multiple ocular motor nerve palsy combined with splitting of the lateral rectus muscle (LR). A 59-year-old Japanese female was investigated for worsening esotropia after corrective surgery. She presented with left hypertropia (35Ģ) and esotropia (45-50Ģ). Orbital magnetic resonance imaging (MRI) showed reduced belly sizes in the superior rectus, inferior rectus, and superior oblique muscles and splitting of the LR, extending from the origin to the belly, in the left eye. Splitting of the LR belly was detected on MRI in a case of congenital multiple ocular motor nerve palsy. No potential conflict of interest relevant to this article was reported.

Spandidos Acta Medica Okayama 1019-6439 50 6 2017 Induction of IL-17 production from human peripheral blood CD4+ cells by asbestos exposure 2024 2032 EN Megumi Maeda Department of Biofunctional Chemistry, Division of Bioscience, Okayama University Graduate School of Natural Science and Technology Ying Chen Department of Hygiene, Kawasaki Medical School Suni Lee Department of Hygiene, Kawasaki Medical School Naoko Kumagai-Takei Department of Hygiene, Kawasaki Medical School Kei Yoshitome Department of Hygiene, Kawasaki Medical School Hidenori Matsuzaki Department of Hygiene, Kawasaki Medical School Shoko Yamamoto Department of Hygiene, Kawasaki Medical School Tamayo Hatayama Department of Hygiene, Kawasaki Medical School Miho Ikeda Department of Hygiene, Kawasaki Medical School Yasumitsu Nishimura Department of Hygiene, Kawasaki Medical School Takemi Otsuki Department of Hygiene, Kawasaki Medical School We have previously reported that chronic, recurrent and low-dose exposure to asbestos fibers causes a reduction in antitumor immunity. Investigation of natural killer (NK) cells using an in vitro cell line model and comprising in vitro activation using freshly isolated NK cells co-cultured with chrysotile fibers, as well as NK cells derived from asbestos-exposed patients with pleural plaque (PP) or malignant mesothelioma (MM), revealed decreased expression of NK cell activating receptors such as NKG2D, 2B4 and NKp46. An in vitro differentiation and clonal expansion model for CD8+ cytotoxic T lymphocytes (CTLs) showed reduced cytotoxicity with decreased levels of cytotoxic molecules such as granzyme B and perforin, as well as suppressed proliferation of CTLs. Additionally, analysis of T helper cells showed that surface CXCR3, chemokine receptor, and the productive potential of interferon (IFN)ƒÁ were reduced following asbestos exposure in an in vitro cell line model and in peripheral CD4+ cells of asbestos-exposed patients. Moreover, experiments revealed that asbestos exposure enhanced regulatory T cell (Treg) function. This study also focused on CXCR3 expression and the Th-17 cell fraction. Following activation with T-cell receptor and co-culture with various concentrations of chrysotile fibers using freshly isolated CD4+ surface CXCR3 positive and negative fractions, the intracellular expression of CXCR3, IFNƒÁ and IL-17 remained unchanged when co-cultured with chrysotile. However, subsequent re-stimulation with phorbol 12-myristate 13-acetate (PMA) and ionomycin resulted in enhanced IL-17 production and expression, particularly in CD4+ surface CXCR3 positive cells. These results indicated that the balance and polarization between Treg and Th-17 fractions play an important role with respect to the immunological effects of asbestos and the associated reduction in antitumor immunity. No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 128 3 2016 3 ”NŠÔ‚Ì“àŽ‹‹¾�ŠŒ©‚̕ω»‚ðŠÏŽ@‚Å‚«‚½�H“¹ˆÙ�Š�«”玉‘B‚Ì1 —á 201 205 EN Masaya Iwamuro 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 Keita Harada Department of Endoscopy, Okayama University Hospital Hiromitsu Kanzaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keisuke Hori Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahide Kita Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Kawano Department of Endoscopy, Okayama University Hospital Yoshiro Kawahara Department of Endoscopy, Okayama University Hospital Takehiro Tanaka Department of Pathology, Okayama University Hospital Kazuhide Yamamoto Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences A 43-year-old Japanese woman was diagnosed with ectopic sebaceous glands in the esophagus by esophagogastroduodenoscopy and biopsy. At the age of 46, typical ectopic sebaceous glands were recognized in the upper esophagus, whereas yellowish white granules were faintly observed in the lower esophagus. Esophagogastroduodenoscopy examinations were repeated when she was 47 and again at 50 years old, and the lesions in the lower esophagus had become more evident over the ensuing 3 years. Esophageal ectopic sebaceous glands are relatively infrequent, and there have been few case reports describing the progression of the endoscopic features. We also report the clinical and endoscopic features of the five similar cases with pathologically proven ectopic sebaceous glands in the esophagus. No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 128 3 2016 ƒvƒŒƒKƒoƒŠƒ““à•ž�¢“ï‚Æ‚È‚Á‚½Œã‚ɃŠƒhƒJƒCƒ“‰–Ž_‰–�Ã’�‚ª‘tŒ÷‚µ‚½ “]ˆÚ�«Šà�Z��‚É‚æ‚é�_Œo�áŠQ�«áu’ɂ̈ê—á 197 199 EN Mitsuhisa Kunisue Tsubasa Clinic Okayama The concomitant administration of adjuvant analgesics is recommended for neuropathic pain due to metastatic invasive cancer, because such pain may respond poorly to analgesic agents such as non-opioid analgesics and opioids. We report the case of a 44-year-old female patient with severe pain caused by a lumbosacral plexus injury associated with a failure of oral pregabalin�i 200 mg daily for 2 weeks�j. We administered lidocaine hydrochloride�i drip infusion 960 mg/day�j, which successfully relieved the pain. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2016 Non–Small Cell Lung Cancer Cells Acquire Resistance to the ALK Inhibitor Alectinib by Activating Alternative Receptor Tyrosine Kinases EN Hideko Isozaki No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 128 2 2016 Šg‘å“àŽ‹‹¾ŒŸ�¸‚É‚ÄŒ`‘ԕω»‚ðŠÏŽ@‚µ‚¦‚½�\“ñŽw’°àh–E�«ƒŠƒ“ƒpŽî‚Ì1—á 111 116 EN Masaya Iwamuro Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuyoshi Takata Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Kawano Department of Endoscopy, Okayama University Hospital Yoshiro Kawahara Department of Endoscopy, Okayama University Hospital Tadashi Yoshino Department of Pathology, 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 �@A 63-year-old Japanese woman was diagnosed with duodenal follicular lymphoma. The initial esophagogastroduodenoscopic examination with magnifying observation revealed opaque white spots and enlarged whitish villi. Nine months later, esophagogastroduodenoscopy showed that the size of the lymphoma lesion decreased, and only opaque white spots were visible. The histological analysis of biopsy samples obtained during the initial endoscopy examination showed both neoplastic follicles and an inter-follicular infiltration of lymphoma cells, whereas the biopsy samples obtained at the endoscopy performed 9 months later showed only neoplastic follicle formation. These results suggest that the magnifying endoscopic features may reflect the underlying pathological mechanisms : enlarged whitish villi are probably due to lymphoma cell infiltration in the inter-follicular area, and opaque white spots are probably caused by neoplastic follicle formation. No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠw•¶Šw•” Acta Medica Okayama 23 2016 �u“yŽYŽÊ�^’Ÿ�v‚ÉŒ©‚é�A–¯’n�uƒrƒ‹ƒ}�v‚̃Cƒ��[ƒW 41 102 EN Yoshinari Watanabe No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠw•¶Šw•” Acta Medica Okayama 23 2016 �oŒ»‚·‚é‚Ù‚Æ‚¯�\–§‹³ŒoŠé‹O‚Ì‹L�Ú‚ð’†�S‚É 15 27 EN Moritoshi Sasaki No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 3 2016 Structure of a New Palatal Plate and the Artificial Tongue for Articulation Disorder in a Patient with Subtotal Glossectomy 205 211 EN Ken-ichi Kozaki Department of Dental Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shigehisa Kawakami Department of Occlusal and Oral Functional Rehabilitation, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Konishi Division of Physical Medicine and Rehabilitation, Okayama University Hospital Keiji Ohta Dental Laboratory Division, Okayama University Hospital Jitsuro Yano Department of Occlusal and Oral Functional Rehabilitation, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoo Onoda Department of Otolaryngology-Head and Neck Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuyoshi Mizukawa Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazunori Nishizaki Department of Otolaryngology-Head and Neck Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Iida Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akio Gofuku Graduate School of Natural Science and Technology, Okayama University Masanobu Abe Department of Computer Science, Okayama University Shogo Minagi Department of Occlusal and Oral Functional Rehabilitation, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Dream Speech Project Case Report 10.18926/AMO/54420 A palatal augmentation prosthesis (PAP) is used to facilitate improvement in the speech and swallowing functions of patients with tongue resection or tongue movement disorders. However, a PAPʼs effect is limited in cases where articulation disorder is severe due to wide glossectomy and/or segmental mandibulectomy. In this paper, we describe speech outcomes of a patient with an articulation disorder following glossectomy and segmental mandibulectomy. We used a palatal plate (PP) based on a PAP, along with an artificial tongue (KAT). Speech improvement was evaluated by a standardized speech intelligibility test consisting of 100 syllables. The speech intelligibility score was significantly higher when the patient wore both the PP and KAT than when he wore neither (p��0.013). The conversational intelligibility score was significantly improved with the PP and KAT than without PP and KAT (p��0.024). These results suggest that speech function can be improved in patients with hard tissue defects with segmental mandibulectomy using both a PP and a KAT. The nature of the design of the PP and that of the KAT will allow these prostheses to address a wide range of tissue defects. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2016 Identification of cell surface markers from multidimensional microarray data utilizing spherical Self Organizing Maps EN Yu Sugii No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2016 A neutrophil elastase inhibitor improves lung function during ex vivo lung perfusion EN Masaki Harada No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2015 Hyaluronan suppresses mechanical stress-induced expression of catabolic enzymes by human chondrocytes via inhibition of IL-1ƒÀ production and subsequent NF-ƒÈB activation EN Masatsugu Ozawa No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 127 2 2015 •½�¬26”N“x‰ªŽRˆãŠw‰ï�Ü ‚ª‚ñŒ¤‹†�§—ã�Ü�i—ÑŒ´�Ü�EŽR“c�Ü�j 91 94 EN Shuya Yano No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠw•¶Šw•” Acta Medica Okayama 22-2 2015 —·�s‹L�E�í‹L‚ÉŒ©‚é�uƒ~ƒƒƒ“ƒ}�[�iƒrƒ‹ƒ}�j�v‚Ì•—Œi�@-18�¢‹IŒã”¼�`19�¢‹I‘O”¼‚̃CƒMƒŠƒX�l‚Ì‹L�q‚ð’†�S‚Æ‚µ‚Ä- 27 72 EN Yoshinari Watanabe No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 127 1 2015 ‰Æ‘°�«‘å’°‘BŽî�Ç�iFAP�j‚É�‡•¹‚µ‚½“¯Žž�«‚T‘½”­‘å’°Šà‚ɑ΂µ‚ăŠƒ“ƒp�ߊs�´‚𔺂¤• �o‹¾‰º‘å’°‘S“E�p‚ðŽ{�s‚µ‚½‚P—á 25 29 EN Hiroshi Kato Masahiro Oishi Masahito Kodera Masao Yamamura Hideaki Ikeda Kenji Mizuno Yutaka Yamashita �@A 49-year-old Japanese man visited our hospital with chief complaints of difficulty with and bleeding during defecation. After a detailed examination, he was diagnosed with familial adenomatous polyposis (FAP) with multiple (five) colorectal cancers. The tumors were located in the right-sided, left-sided, and sigmoid colon, and the lower rectum. Regional lymph node involvement was observed, but no metastasis to other organs was detected. We, therefore, performed a laparoscopic total colectomy with superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) lymph node dissection. We were able to perform minimally invasive and cosmetically acceptable surgery using laparoscopy instead of highly-invasive open abdominal surgery. Our search of the literature revealed no reported cases of laparoscopic total colectomy with lymph node dissection for FAP with multiple colorectal cancers, making the present case the first to be reported in the literature. No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 127 1 2015 ‰ªŽR‘åŠw‹Î–±ˆãŽt‚É‚æ‚é”ñ�í‹Î‹Î–±‚ð’Ê‚µ‚½’nˆæˆã—ÃŽx‰‡‚ÌŒ»�ó’²�¸ 13 17 EN Sanae Teshigawara Toshihide Iwase Tatsuya Kanamori Tomoko Kawabata Masaru Sato Hitomi Usui Kataoka �@We investigated the situation of how physicians at Okayama University support local medical institutions by serving as a part-time worker, and analyzed the difference between the five medical districts of Okayama prefecture and other prefectures. Many physicians (actual number of physicians, full-time equivalent number of physicians) served in the southeastern region of the Okayama prefecture (339, 82.2). On the other hand, fewer physicians (42, 11.4) served in Takahashi�ENiimi in the northwestern region of Okayama. Many physicians also served in Hiroshima prefecture (193, 48.8), Hyogo prefecture (109, 26.7), and the four prefectures of Shikoku Island (81, 23.6). �@It has been clarified that many physicians at Okayama University are working on a part-time basis to support local and community medical institutions in the wide area of Okayama prefecture, Hiroshima prefecture, Hyogo prefecture and the four prefectures of Shikoku Island. No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 126 3 2014 ƒŠƒEƒ}ƒ`�«Ž¾Š³‚É‚¨‚¯‚镪Žq•W“IŽ¡—à 227 230 EN Hiroshi Wakabayashi No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠw–@Šw‰ï Acta Medica Okayama 0386-3050 57 3 2008 Kaiyan Homi Kaikobad, Interpretation and Revision of International Boundary Decisions (Cambridge University Press, 2007, ‡]‡]vi + 364 pp.) 634 626 EN D. Tamada No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠw–@Šw‰ï Acta Medica Okayama 0386-3050 55 2 2006 Aïda Azar, L'exécution des décisions de la Cour internationale de justice (Bruylant, Université de Bruxelles, 2003, xx + 329 pp.) 332 326 EN D. Tamada No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠw–@Šw‰ï Acta Medica Okayama 0386-3050 55 1 2005 Leonardo Nemer Caldeira Brant, L'autorité de la chose jugée en droit international public (L.G.D.J., 2003, xi + 396 pp.) 190 181 EN D. Tamada No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 125 2 2013 �\“ñŽw’°àh–E�«ƒŠƒ“ƒpŽî‚ÍAID‚Ì”­Œ»‚ðŒ‡‚­‚ªBACH2‚Ì”­Œ»‚ð—L‚µmemoryB�×–E‚Æ‚µ‚Ä‚Ì�«Ž¿‚ð—L‚·‚é 103 107 EN Katsuyoshi Takata Yasuharu Sato Naoya Nakamura Mami Tokunaka Yukari Miki Yara Yukie Kikuti Kazuhiko Igarashi Etsuro Ito Hideo Harigae Seiichi Kato Eiko Hayashi Takashi Oka Yoshinobu Hoshii Akira Tari Hiroyuki Okada ABD Alkader Lamia Mohamado Yoshinobu Maeda Mitsune Tanimoto Tomohiro Kinoshita Tadashi Yoshino No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2013 Design of Wearable Power Assist Wear for Low Back Support Using Pneumatic Actuators EN Xiangpan Li No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 125 1 2013 ”xŠà‚Æ•ªŽq•W“I–ò 57 66 EN Katsuyuki Kiura Mitsune Tanimoto No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 0032-0889 156 1 2011 Comprehensive Sequence Analysis of 24,783 Barley Full-Length cDNAs Derived from 12 Clone Libraries 20 28 EN Takashi Matsumoto Tsuyoshi Tanaka Hiroaki Sakai Naoki Amano Hiroyuki Kanamori Kanako Kurita Ari Kikuta Kozue Kamiya Mayu Yamamoto Hiroshi Ikawa Nobuyuki Fujii Kiyosumi Hori Takeshi Itoh Kazuhiro Sato Full-length cDNA (FLcDNA) libraries consisting of 172,000 clones were constructed from a two-row malting barley cultivar (Hordeum vulgare 'Haruna Nijo') under normal and stressed conditions. After sequencing the clones from both ends and clustering the sequences, a total of 24,783 complete sequences were produced. By removing duplicates between these and publicly available sequences, 22,651 representative sequences were obtained: 17,773 were novel barley FLcDNAs, and 1,699 were barley specific. Highly conserved genes were found in the barley FLcDNA sequences for 721 of 881 rice (Oryza sativa) trait genes with 50% or greater identity. These FLcDNA resources from our Haruna Nijo cDNA libraries and the full-length sequences of representative clones will improve our understanding of the biological functions of genes in barley, which is the cereal crop with the fourth highest production in the world, and will provide a powerful tool for annotating the barley genome sequences that will become available in the near future. No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 124 3 2012 ‘å‹K–Í�ЊQ‚É‚¨‚¯‚é�ЊQˆã—à 265 267 EN Hiroyuki Doi No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 124 3 2012 �‡�¬ƒŒƒ`ƒmƒCƒhAm80‚ÍTh1‚ÆTh17‚ð—}�§‚·‚邱‚Æ‚É‚æ‚è–��«ˆÚ�A•Ð‘Î�hŽå•a‚ð‰ü‘P‚·‚é 197 201 EN Hisakazu Nishimori Yoshinobu Maeda Mitsune Tanimoto No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 124 2 2012 –ò•¨‘ŠŒÝ�ì—p(24�\ICU‚Å‚Ì’�ˆÓ‚·‚ׂ«–ò•¨‘ŠŒÝ�ì—p�j 167 173 EN Yusuke Nishimiya Toshimitsu Konuma Ken Tasaka Toshiaki Sendo No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 124 1 2012 “–‰@‚É‚¨‚¯‚é‘å’°Šà“¯Žž�«ŠÌ“]ˆÚ�Ç—á‚Ì—Õ�°•a—�Šw“IŒŸ“¢ 47 51 EN Hideaki Miyasou Kazuhide Iwakawa Masaru Inagaki Yuuji Kimura Manabu Nishie Ryousuke Hamano Naoyuki Tokunaga Yousuke Tunemitsu Shinya Otsuka Hiromi Iwagaki This study was aimed to clarify the prognostic factors in colorectal cancer patients with synchronous liver metastasis. Fifty-four patients were assessed to evaluate prognoses according to various clinico-pathological factors and therapeutic procedures. The patients' survival was significantly related to extrahepatic distant metastasis and therapeutic procedures. Regarding therapeutic procedures, the liver resection group showed significantly improved survival compared with the chemotherapy group, especially in liver metastasis Grade B. For colorectal liver metastases, it is clear that liver resection is the most effective treatment at present. Further improvement of patient prognoses is expected to be achieved by future research on combination chemotherapy. No potential conflict of interest relevant to this article was reported.

�î•ñ�ˆ—�Šw‰ï Acta Medica Okayama 09196072 2005 94 2005 •ª—Þ‚Ì�ª‹’‚𖾎¦‚µ‚½“®ŽŒŒêœbŠT”O�\‘¢Ž«�‘‚Ì�\’z 123 130 EN Koichi Takeuchi Kentaro Inui Atsushi Fujita Nao Takeuchi Shuya Abe –{Œ¤‹†‚Å‚ÍŒêœbŠT”O�\‘¢‚ð—˜—p‚µ‚½“®ŽŒ‚ÌŽ«�‘ƒf�[ƒ^ƒx�[ƒX‚ð�\’z‚·‚é�DŒêœbŠT”O�\‘¢‚Í�\•¶�ã‚Å‚ÌŒê‚Ì�U‚é•‘‚¢‚ðŠî‚ɈӖ¡�\‘¢‚ð‹L�q‚·‚é‚à‚Ì‚Å�C‚±‚¤‚µ‚½Ž«�‘ƒf�[ƒ^‚ÍŒ¾Œê�ˆ—�‚É‚¨‚¢‚Ä“Á‚ÉŒ¾Œê�¶�¬�C—Ⴆ‚Ζ|–ó‚⌾‚¢Š·‚¦�C—v–ñ‚Æ‚¢‚Á‚½‰ž—p‚É•K�{‚ƂȂ錾ŒêŽ‘Œ¹‚Å‚ ‚é�D’ñˆÄ‚·‚鎫�‘ƒf�[ƒ^‚ÍŒêœbŠT”O�\‘¢‚Ì‚Ý‚ð‹L�q‚·‚é‚Ì‚Å‚Í‚È‚­�CŒêœbŠT”O�\‘¢‚Ì•ª�Í‚Å–¾‚ç‚©‚É‚·‚éŒê‚Ì�U‚é•‘‚¢�C‚È‚ç‚Ñ‚É•ª�Í‚ÌŠî‚Æ‚È‚é“�ŒêƒeƒXƒg‚ð‹L�q‚·‚邽‚ß�C•ª—Þ�ª‹’‚ª‚í‚©‚è‚â‚·‚­“§–¾�«‚Ì�‚‚¢Ž«�‘ƒf�[ƒ^‚ƂȂ邱‚Æ‚ªŠú‘Ò‚Å‚«‚é�D No potential conflict of interest relevant to this article was reported.

�î•ñ�ˆ—�Šw‰ï Acta Medica Okayama 09196072 2006 94 2006 –¼ŽŒ‚ÌŠT”O‘ÌŒn‚ð—˜—p‚µ‚½‹K‘¥‚ÉŠî‚­ˆÓ–¡–ðŠ„•t—^ƒ‚ƒfƒ‹‚Ì�\’z 13 20 EN Takuya Shimomura Koichi Takeuchi –{�e‚Å‚Í–¼ŽŒ‚ÌŠT”O‘ÌŒnŽ«�‘‚Æ�qŒê‚Ì‚à‚ÂŒê‚ÌŠT”O�\‘¢‚ð—p‚¢‚½‹K‘¥ƒx�[ƒX‚̈Ӗ¡–ðŠ„•t—^ƒ‚ƒfƒ‹‚Ì�\’z‚ð’ñˆÄ‚·‚é�DˆÓ–¡–ðŠ„‚Í–¼ŽŒ‚Æ�qŒê‚Æ‚ÌŠÖŒW‚©‚猈’肳‚ê‚邱‚Æ‚©‚ç,–{Œ¤‹†‚Å‚Í�qŒê‚ÌŽ�‚ƒCƒxƒ“ƒg�\‘¢‚Æ�qŒê‚ª‚Æ‚é–¼ŽŒ‚Ƃ̊Ԃɂǂ̂悤‚ȃ�ƒJƒjƒYƒ€‚ª‘¶�Ý‚·‚é‚Ì‚©‚𖾂炩‚É‚·‚邱‚Æ‚ð–Ú•W‚Æ‚·‚é.�V•·ƒR�[ƒoƒX‚ð‘Î�Û‚Æ‚µ‚½•]‰¿ŽÀŒ±‚©‚ç,–¼ŽŒŠÔ‚ÌŠT”O‚Ì—ÞŽ—“x‚ð�³‚µ‚­Œv‚邱‚Æ,‹@”\Œê‚Ì’PˆÊ‚ð�³‚µ‚­Žæ‚è�o‚·‚±‚Æ‚ª�¸“xŒü�ã‚ւ̃|ƒCƒ“ƒg‚Å‚ ‚邱‚Æ‚ª–¾‚ç‚©‚É‚È‚Á‚½�D No potential conflict of interest relevant to this article was reported.

�î•ñ�ˆ—�Šw‰ï Acta Medica Okayama 09196072 2006 94 2006 •¡�‡–¼ŽŒ‚É’…–Ú‚µ‚½WebŒŸ�õŒ‹‰Ê‚̃Nƒ‰ƒXƒ^ƒŠƒ“ƒO 35 42 EN Kazuki Hirao Koichi Takeuchi –{�e‚Å‚Í•¡�‡–¼ŽŒ‚É’…–Ú‚µ‚½WebŒŸ�õŒ‹‰Ê‚̃Nƒ‰ƒXƒ^ƒŠƒ“ƒOŽè–@‚ð’ñˆÄ‚·‚é�D–{Žè–@‚Å‚ÍŒŸ�õŒ‹‰Ê‚̃^ƒCƒgƒ‹‚Æ—v–ñ‚ð—˜—p‚µ�CŠK‘w“I‚ňê‚‚̌Ÿ�õŒ‹‰Ê‚ª•¡�”‚̃Nƒ‰ƒXƒ^‚ÉŠÜ‚Ü‚ê‚邱‚Æ‚ð”F‚ß‚éƒNƒ‰ƒXƒ^ƒŠƒ“ƒO‚ð�s‚¤�D–{Žè–@‚ÍŽŸ‚Ì‚Q‚‚̉¼�à‚ÉŠî‚¢‚Ä‚¢‚é�D1)•¡�‡–¼ŽŒ‚͌ŗL‚ÌŠT”O‚ð•\‚·‚½‚ß�C•¶�‘‚ð“Á’¥•t‚¯‚â‚·‚¢�D2)•¡�‡–¼ŽŒŠÔ‚ÌŒê�\�¬ŠÖŒW‚ð—˜—p‚µ‚Ä�C•”•ª•¡�‡‚É‚æ‚é—ÞŠT”O�C‚¨‚æ‚Ñ�ãˆÊ‰ºˆÊŠÖŒW‚̃Nƒ‰ƒXƒ‰ƒxƒ‹‚ð�ì�¬‚·‚邱‚Æ‚ÅŒ©’Ê‚µ‚Ì—Ç‚¢‚v‚…‚‚•¶�‘‚Ì•ª—Þ‚ª‚Å‚«‚é�DŽÀŒ±‚ÌŒ‹‰Ê�C•¡�‡–¼ŽŒ‚Ì�\‘¢‚Í•ª‚©‚è‚â‚·‚¢ƒNƒ‰ƒXƒ^�\‘¢‚ÌŒ`�¬‚É—˜—p‚Å‚«�C‚Ü‚½Ž©‘R‚ȃ‰ƒxƒ‹•t‚¯‚É—LŒø‚Å‚ ‚Á‚½�D‚±‚Ì‚±‚Æ‚©‚ç�C•¡�‡–¼ŽŒ‚ÍŒŸ�õŒ‹‰Ê‘S‘Ì‚ðŒ©“n‚·‚½‚ß‚Ì‚æ‚¢ƒCƒ“ƒfƒbƒNƒX‚Å‚ ‚é‚ÆŒ¾‚¦‚é�D No potential conflict of interest relevant to this article was reported.

�î•ñ�ˆ—�Šw‰ï Acta Medica Okayama 09196072 2008 4 2008 —pŒêƒNƒ‰ƒXƒ^ƒŠƒ“ƒO‚ÉŠî‚­•”•ªŒ¤‹†—̈æ�„’è‚Æ—pŒê•ª—Þ 87 92 EN Teruo Koyama Koichi Takeuchi Œ¤‹†�´˜^ƒeƒLƒXƒgƒR�[ƒpƒX‚©‚ç’Š�o‚³‚ꂽ—pŒêŒó•â‚ð‘ÌŒn“I‚É�®—�‚·‚éˆê‚‚̗L—Í‚È•û–@‚Æ‚µ‚Ä�A•”•ªŒ¤‹†—̈æ‚ÉŠÖ˜A•t‚¯‚½—pŒê‚Ì•ª—Þ‚ð�l‚¦‚邱‚Æ‚ª‚Å‚«‚é�B–{Œ¤‹†‚Å‚Í�A“®ŽŒŠT”O‚Æ‚Ì‹¤‹N‚ÉŠî‚­—pŒêƒNƒ‰ƒXƒ^ƒŠƒ“ƒO‚É‚æ‚Á‚Ä�A“Á’茤‹†•ª–ì‚Ì‚¢‚­‚‚©‚Ì•”•ªŒ¤‹†—̈悪“¯’è‚Å‚«‚邱‚Æ‚ðŽ¦‚·‚Æ‚Æ‚à‚É�A“¯’肳‚ꂽ•”•ª—̈æ‚Æ‚ÌŠÖ˜A‚É‚æ‚è�AƒeƒLƒXƒgƒR�[ƒpƒX‚©‚ç’Š�o‚³‚ꂽ—pŒêŒó•â‚Ì•ª—Þ‚ª‰Â”\‚Å‚ ‚邱‚Æ‚ðŽ¦‚·�B No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 123 3 2011 Ž„‚ÌŒ¤‹†ŠT—ª‚ƉªŽR‘åŠwˆãŠw•”‚Ì‚Q�l‚Ì‘å�æ”y�\2011”N“xŽO–Ø‹L”O�Ü‚ðŽó�Ü‚µ‚Ä�\ 253 257 EN Masayoshi Namba No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 123 3 2011 “î•”Žîá‡�f—ÃKƒCƒhƒ‰ƒCƒ“ 231 235 EN Yuki Morimoto Toshifumi Ozaki No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 123 3 2011 ƒ‰ƒbƒg’†‘å”]“®–¬•Â�Ç�E�ğ󗬃‚ƒfƒ‹‚É‚¨‚¯‚é�RHMGB1’PƒNƒ��[ƒ“�R‘Ì‚ÌŒŒ‰t�\”]ŠÖ–å‚Ì•ÛŒìŒø‰Ê 185 189 EN Jiyong Zhang No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 123 2 2011 �¬�lŠú‚É’B‚µ‚½Dravet�ÇŒóŒQ‚Ì’·ŠúŒo‰ß‚ÉŠÖ‚·‚錤‹† 91 95 EN Mari Akiyama Katsuhiro Kobayashi Harumi Yoshinaga Yoko Ohtsuka No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 2 2011 For Vol. 64, No. 1 pp 27-31 Prognostic Factors Influencing Survival after ephroureterectomy for Transitional Cell Carcinoma of the Upper Urinary Tract 143 149 EN Yasuyuki Kobayashi Takashi Saika Daisuke Manabe Yasutomo Nasu Hiromi Kumon Corrected and Republished Article 10.18926/AMO/45274 We analyzed the prognostic factors influencing survival after surgeries for upper urinary tract urothelial carcinoma (UUT-UC) with longer follow-up periods than in previous studies. Between January 2000 and December 2004, 386 patients underwent nephroureterectomy for UUT-UC. The data for the 221 patients with UUT-UC were retrospectively reviewed. Nine variables were evaluated for association with the survival outcomes of cause-specific survival. The prognostic significance was tested univariately with the log-rank test. The simultaneous effects of multiple prognostic factors were estimated by multiple regression analysis using the Cox proportional hazards model. The median follow-up was 38.4 months. The 5-year over all survival was 62.3%. Significant prognostic factors for disease-specific survival rate on univariate analysis were pathological stage (p0.0001), tumor grade (p0.0324), and venous invasion (p0.0001). Multivariate analysis revealed that only venous invasion was significant for disease-specific survival rate (p0.0205). Venous invasion was the only independent prognostic factor in pathologically localized UUT-UC. No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠwŒo�ÏŠw‰ï Acta Medica Okayama 0386-3069 21 3 1989 ’†‘º�@�G’˜ �wŽ‘‹àŒvŽZŽj˜_�x �XŽR�‘“X�C�º˜a61”N�ipp. v, 197.�j 227 234 EN Michimasa Satoh No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠwŒo�ÏŠw‰ï Acta Medica Okayama 0386-3069 24 4 1993 �â–{’‰ŽŸ�E’†‘º—Ç•½•Ò’˜ �w�£ŒË‘å‹´‚Æ’nˆæŒo�Ï�EŠÂ‹«–â‘è�x �iŽR—z�V•·ŽÐŠ§�Dpp�D239�D1992”N3ŒŽ25“ú�j�\�£ŒË‘å‹´‰Ë‹´‚̎ЉïŒo�Ï“I‰e‹¿‚ÉŠÖ‚·‚é•ïŠ‡“I‚È‘�Š‡‚Ö‚Ì�Ú‹ß�\ 215 230 EN Ryoichi Hashimoto No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠwŒo�ÏŠw‰ï Acta Medica Okayama 0386-3069 28 2 1996 Amos Golan, George Judge and Douglas Miller, MAXIMUM ENTROPY ECONOMETRICS : ROBUST ESTIMATION WITH LIMITED DATA John Wiley and Sons, Chichester, 1996, pp. xvi +307 255 263 EN Toshimi Fujimoto No potential conflict of interest relevant to this article was reported.

‰ªŽR‘åŠwŒo�ÏŠw‰ï Acta Medica Okayama 0386-3069 28 2 1996 ’†‘º—Ç•½�@’˜ �w‚¢‚Ü“sŽs‚ª‘I‚΂ê‚é�\‹£‘ˆ‚ƘAŒg‚ÌŽž‘ã‚Ö�\�x �iŽR—z�V•·ŽÐ�j 1995”N11ŒŽ�@pp�D245 239 242 EN Yoshizō Hashimoto No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 102 3-4 1990 ‘å—ʃtƒFƒ“ƒ^ƒj�[ƒ‹‚É‚æ‚é’P�ƒ’´’á‘̉·–ƒ�ŒŽž‚Ì�zŠÂ“®‘Ô‚ÆŒŒ’†ƒJƒeƒRƒ‰ƒ~ƒ“”Z“x‚ÉŠÖ‚·‚éŽÀŒ±“IŒ¤‹† 435 452 EN Mikiko Wake Six adult dogs were anesthetized by deep hypothermia with a combination high dose fentanyl and PGE1 (F group). The circulatory system and blood catecholamine concentration were determined. Another 6 adult dogs were anesthetized by deep hypothermia with a combination ether and PEG1 (E group) for a comparison with the F group. Before cooling under anesthesia, the PAP, PVRI and Pp/Ps showed a significant difference in the E group. During cooling, the MAP was 74% and 56% of the control values in the F and E groups, respectively and there were significant differences between the F and E groups. The peak dp/dt/IP was significantly different between the F and E groups at the lowest temperature (46% and 27% of the conrol values, respectively). The CI was 34% and 25% of control values at the lowest temperature in both groups. EP or NE did not significantly increase during cooling or rewarming in the F group. The EP had a tendency to increase during rewarming and NE significantly increased in comparison with the control values during cooling and warming in the E group. Combination anesthesia with high dose fentanyl and PGE1 inhibits the circulatory systems to a lesser degree, resulting in easier maintenance of the circulatory system. This combination system is also more stable than that with ether and PGE1 or with ether and TFP. No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 122 3 2010 èò•”èò“®–¬‹·�ó�Ç 265 267 EN Yu Okuma No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 122 2 2010 “–‰@‚É‚¨‚¯‚鉺•”’_ŠÇŠàŽè�p�Ç—á‚ÌŽ¡—Ã�¬�Ñ 189 194 EN Ryosuke Hamano Masaru Inagaki Manabu Nishie Naoyuki Tokunaga Yosuke Tsunemitsu Shinya Ohtsuka Kazuhide Iwakawa Hiromi Iwagaki Hiroshi Sonobe We experienced 20 patients with distal bile duct carcinoma from May, 1997 to December, 2007. The male/female ratio was 11/9 and the average age was 69.6 years. The operative procedures were as follows�Fpancreaticoduodenectomy (PD), 9�Gpyrolus preserving pancreaticoduodenectomy (PPPD), 8�Gsubtotal stomach preserving pancreaticoduodenectomy (SSPPD), 2 and hepatico-jejunostomy without resection, 1. We performed a clinicopathological study on 16 patients with distal bile duct carcinoma, excluding 3 operation-related deaths and 1 unresectable case. The cumulative survival rate was 70% at 3 years and 11% at 5 years. The 3-year survival rates at fStage‡U, fStage‡Wa and fStage‡Wb were 100%, 80% and 0%, respectively. Log-rank analysis revealed that pathological pancreatic and duodenal invasion and curative resectability may be prognostic factors, while lymph node metastasis and perineural and stump invasion did not affect prognosis. Six recurrences in the 11 curative resection cases (54.5%) were observed�Gtherefore, postoperative systemic chemotherapy is warranted to curtail recurrence in advanced distal bile duct carcinoma. No potential conflict of interest relevant to this article was reported.

‰ªŽRˆãŠw‰ï Acta Medica Okayama 0030-1558 122 2 2010 •Ö’†ƒ�ƒ`ƒ‹‰»DNAŒŸ�o‚É‚æ‚é�Á‰»Ší‚ª‚ñƒXƒNƒŠ�[ƒjƒ“ƒO�F�Á‰»Ší‚ª‚ñ‚ð”ñ�N�P“I‚ɃXƒNƒŠ�[ƒjƒ“ƒO‚·‚邱‚Ƃ͉”\‚©�H 107 112 EN Takeshi Nagasaka Noriaki Tanaka Dong-Sheng Sun Yoshio Naomoto Nagahide Mastubara Takahito Yagi Toshiyoshi Fujiwara No potential conflict of interest relevant to this article was reported.

Japan Society for Bioscience, Biotechnology, and Agrochemistry Acta Medica Okayama 0916-8451 71 4 2007 Evidence for new beta 1-3 galactosyltransferase activity involved in biosynthesis of unusual N-glycan harboring T-antigen in Apis mellifera 1111 1114 EN Yoshinobu Kimura Sho Sakamura Takayuki Ushijima Yoichiro Hama Hiroyuki Kajiura Kazuhito Fujiyama Kiyoshi Okihara Ken Hashimoto Hiroyuki Sugimoto Hideo Yamada In a previous study (Y. Kimura et al., Biosci. Biotechnol Biochem., 70, 2583-2587, 2006), we found that new complex type N-glycans harboring Thomsen-Friedenreich antigen (Ga1 beta 1-3GalNAc) unit occur on royal jelly glycoproteins, suggesting the involvement of a new beta 1-3galactosyltransferase in the synthesis of the unusual complex type N-glycans. So far, such beta 1-3galactosyltransferase activity, which can transfer galactosyl residues with the beta 1-3 linkage to beta 1-4 GalNAc residues in N-glycan, has not been found among any eucaryotic cells. But using GalNAc(2)GlcNAc(2)Man(3)-GlcNAc(2)-PA as acceptor N-glycan, we detected the beta 1-3 galactosyltransferase activity in membrane fraction prepared from honeybee cephalic portions. This result indicates that honeybee expresses a unique beta 1-3 galactosyltransferase involved in biosynthesis of the unusual N-glycan containing a tumor related antigen in the hypopharyngeal gland. No potential conflict of interest relevant to this article was reported.

Academic Press Acta Medica Okayama 0006-291X 366 1 2008 Inhibition of tumor-stromal interaction through HGF/Met signaling by valproic acid 110 116 EN Yohsuke Matsumoto Takahiro Motoki Satoshi Kubota Masaharu Takigawa Hirohito Tsubouchi Eiichi Gohda Hepatocyte growth factor (HGF), which is produced by surrounding stromal cells, including fibroblasts and endothelial cells, has been shown to be a significant factor responsible for cancer cell invasion mediated by tumor-stromal interactions. We found in this study that the anti-tumor agent valproic acid (VPA), a histone deacetylase (HDAC) inhibitor, strongly inhibited tumor-stromal interaction. VPA inhibited HGF production in fibroblasts induced by epidermal growth factor (EGF), platelet-derived growth factor, basic fibroblast growth factor, phorbol 12-myristate 13-acetate (PMA) and prostaglandin E-2 without any appreciable cytotoxic effect. Other HDAC inhibitors, including butyric acid and trichostatin A (TSA), showed similar inhibitory effects on HGF production stimulated by various inducers. Up-regulations of HGF gene expression induced by PMA and EGF were also suppressed by VPA and TSA. Furthermore, VPA significantly inhibited HGF-induced invasion of HepG2 hepatocellular carcinoma cells. VPA, however, did not affect the increases in phosphorylation of MAPK and Akt in HGF-treated HepG2 cells. These results demonstrated that VPA inhibited two critical processes of tumor-stromal interaction, induction of fibroblastic HGF production and HGF-induced invasion of HepG2 cells, and suggest that those activities serve for other anti-tumor mechanisms of VPA besides causing proliferation arrest, differentiation, and/or apoptosis of tumor cells. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 279 3 2008 Modulation of defense signal transduction by flagellin-induced WRKY41 transcription factor in Arabidopsis thaliana 303 312 EN Kuniaki Higashi Yasuhiro Ishiga Yoshishige Inagaki Kazuhiro Toyoda Tomonori Shiraishi Yuki Ichinose <p>Flagellin, a component of the flagellar filament of Pseudomonas syringae pv. tabaci 6605 (Pta), induces hypersensitive reaction in its non-host Arabidopsis thaliana. We identified the WRKY41 gene, which belongs to a multigene family encoding WRKY plant-specific transcription factors, as one of the flagellin-inducible genes in A. thaliana. Expression of WRKY41 is induced by inoculation with the incompatible pathogen P. syringae pv. tomato DC3000 (Pto) possessing AvrRpt2 and the non-host pathogens Pta within 6-h after inoculation, but not by inoculation with the compatible Pto. Expression of WRKY41 was also induced by inoculation of A. thaliana with an hrp-type three secretion system (T3SS)-defective mutant of Pto, indicating that effectors produced by T3SS in the Pto wild-type suppress the activation of WRKY41. Arabidopsis overexpressing WRKY41 showed enhanced resistance to the Pto wild-type but increased susceptibility to Erwinia carotovora EC1. WRKY41-overexpressing Arabidopsis constitutively expresses the PR5 gene, but suppresses the methyl jasmonate-induced PDF1.2 gene expression. These results demonstrate that WRKY41 may be a key regulator in the cross talk of salicylic acid and jasmonic acid pathways.</p> No potential conflict of interest relevant to this article was reported.

Japan Society for Bioscience, Biotechnology, and Agrochemistry Acta Medica Okayama 0916-8451 71 4 2007 Three antinematodal diterpenes from Euphorbia kansui 1086 1089 EN Jian-Xiao Shi Zhi-Xuan Li Teruhiko Nitoda Minoru Izumi Hiroshi Kanzaki Naomichi Baba Kazuyoshi Kawazu Shuhei Nakajima Three compounds, 20-O-acetyl-[3-O-(2'E,4'Z)-deca-dienoyl]-ingenol (1), 20-O-acetyl-[5-O-(2'E,4'Z)-decadienoyl]-ingenol (2) and 3-O-(2'E,4'Z)-decadienoylingenol (3), were isolated from Euphorbia kansui under the bioassay-guided method. Each compound showed the same antinematodal activity against the nematode, Bursaphelenchus xylophilus, at a minimum effective dose (MED) of 5 mu g/cotton ball. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 143 4 2008 Selenite Assimilation into Formate Dehydrogenase H Depends on Thioredoxin Reductase in Escherichia coli 467 473 EN Muneaki Takahata Takashi Tamura Katsumasa Abe Hisaaki Mihara Suguru Kurokawa Yoshihiro Yamamoto Ryuhei Nakano Nobuyoshi Esaki Kenji Inagaki <p>Escherichia coli growing under anaerobic conditions produce H-2 and CO2 by the enzymatic cleavage of formate that is produced from pyruvate at the end of glycolysis. Selenium is an integral part of formate dehydrogenase H (FDHH), which catalyses the first step in the formate hydrogen lyase (FHL) system. The genes of FHL system are transcribed only under anaerobic conditions, in the presence of a sigma(54)-dependent transcriptional activator Fh1A that binds formate as an effector molecule. Although the formate addition to the nutrient media has been an established procedure for inducing high FDHH activity, we have identified a low-salt nutrient medium containing &#60;0.1% NaCl enabled constitutive, high expression of FDHH even without formate and D-glucose added to the medium. The novel conditions allowed us to study the effects of disrupting genes like trxB (thioredoxin reductase) or gor (glutathione reductase) on the production of FDHH activity and also reductive assimilation of selenite (SeO32-) into the selenoprotein. Despite the widely accepted hypothesis that selenite is reduced by glutathione reductase-dependent system, it was demonstrated that trxB gene was essential for FDHH production and for labelling the FDHH polypeptide with Se-75-selenite. Our present study reports for the first time the physiological involvement of thioredoxin reductase in the reductive assimilation of selenite in E. coli.</p> No potential conflict of interest relevant to this article was reported.

Japan Society for Bioscience, Biotechnology, and Agrochemistry Acta Medica Okayama 0916-8451 71 3 2007 Glucosylation of Sucrose Laurate with Cyclodextrin Glucanotransferase 826 829 EN Katsuhide Okada Haisuo Zhao Minoru Izumi Shuhei Nakajima Naomichi Baba Sucrose monolauroyl esters were found to serve as substrates for cyclodextrin glucanotransferase (CGTase)-catalyzed transglucosidation reactions, affording new sucrose esters that have an additional 1-3 glucose residues on the pyranose ring of the sucrose moiety in the ester. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 279 4 2008 Gac two-component system in Pseudomonas syringae pv. tabaci is required for virulence but not for hypersensitive reaction 313 322 EN Mizuri Marutani Fumiko Taguchi Yujiro Ogawa Mijan Md. Hossain Inagaki Yoshishige Kazuhiro Toyoda Tomonori Shiraishi Yuki Ichinose <p>Pseudomonas syringae pv. tabaci 6605 causes wildfire disease on host tobacco plants. To investigate the regulatory mechanism of the expression of virulence, Gac two-Component system-defective mutants, Delta gacA and Delta gacS, and a double mutant, Delta gacA Delta gacS, were generated. These mutants produced smaller amounts of N-acyl homoserine lactones required for quorum sensing, had lost swarming motility, and had reduced expression of virulence-related hrp genes and the algT gene required for exopolysaccharide production. The ability of the mutants to cause disease symptoms in their host tobacco plant was remarkably reduced, while they retained the ability to induce hypersensitive reaction (HR) in the nonhost plants. These results indicated that the Gac two-component system of P. syringae pv. tabaci 6605 is indispensable for virulence on the host plant, but not for HR induction in the nonhost plants.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 27 24 2008 Drosophila blimp-1 is a transient transcriptional repressor that controls timing of the ecdysone-induced developmental pathway 8739 8747 EN Yasuo Agawa Moustafa Sarhan Yuji Kageyama Kazutaka Akagi Masayoshi Takai Kazuya Hashiyama Tadashi Wada Hiroshi Handa Akihiro Iwamatsu Susumu Hirose Hitoshi Ueda <p>Regulatory mechanisms controlling the timing of developmental events are crucial for proper development to occur. ftz-fl is expressed in a temporally regulated manner following pulses of ecdysteroid and this precise expression is necessary for the development of Drosophila melanogaster. To understand how insect hormone ecdysteroids regulate the timing of FTZ-F1 expression, we purified a DNA binding regulator of ftz-fl. Mass spectroscopy analysis revealed this protein to be a fly homolog of mammalian B lymphocyte-induced maturation protein 1 (Blimp-1). Drosophila Blimp-1 (dBlimp-1) is induced directly by 20-hydroxyecdysone, and its product exists during high-ecdysteroid periods and turns over rapidly. Forced expression of dBlimp-1 and RNA interference analysis indicate that dBlimp-1 acts as a repressor and controls the timing of FTZ-F1 expression. Furthermore, its prolonged expression results in delay of pupation timing. These results suggest that the transient transcriptional repressor dBlimp-1 is important for determining developmental timing in the ecdysone-induced pathway.</p> No potential conflict of interest relevant to this article was reported.

Japan Society for Bioscience, Biotechnology, and Agrochemistry Acta Medica Okayama 0916-8451 71 4 2007 Synthesis of lipid derivatives of pyrrole polyamide and their biological activity 1078 1082 EN Masahiko Yamamoto Changjin Zhu Lui Yi Zheng Rong Yoshie Miura Minoru Izumi Shuhei Nakajima Ken-ichi Tanamoto Sakayu Shimizu Naomichi Baba Novel fatty acyl and phospholipid derivatives of pyrrole polyamide were synthesized. Their cytotoxicity against a cancer cell line of MT-4 cells and those infected by human immunodeficiency virus (HIV) was examined. Although no anti-HIV activity was found, their cytotoxicitty against the cancer cells was significantly enhanced by introducing a lipophilic group into the pyrrole polyamide. No potential conflict of interest relevant to this article was reported.

Elsevier Inc. Acta Medica Okayama 0009-9120 41 3 2008 Association of elevated plasma B-type natriuretic peptide levels with paroxysmal atrial fibrillation in patients with nonobstructive hypertrophic cardiomyopathy 134 139 EN Hiroko Matsuura Takashi Murakami Kazuyoshi Hina Keizo Yamamoto Hiroshi Kawamura Taiji Sogo Ryoko Shinohata Shinichi Usui Yoshifumi Ninomiya Shozo Kusachi <p>Objectives: To investigate the relationship between the plasma B-type natriuretic peptide (BNP) level and the occurrence of atrial fibrillation (AF) in nonobstructive hypertrophic cardiomyopathy (HCM) patients.<br /> Methods: Patients (n=97) were classified into chronic AF (CAF; n=14), paroxysmal AF (PAF; n=18) and normal sinus rhythm (NSR; n=65) groups. The plasma BNP values were analyzed with logarithmic transformation.<br /> Results: The PAF group showed significantly higher plasma BNP levels than the NSR group [mean (range; -1 SD and +1 SD); 248.3 (143.5, 429.5) vs. 78.2 (27.9, 218.8 ng/L), p<0.0001]. The CAF group also showed significantly higher plasma BNP levels than the NSR group [291.1 (161.4, 524.8 ng/L), p<0.0001]. Multivariate analysis with other clinical factors selected association of PAF as one of the factors that increased the plasma BNP level.<br /> Conclusions: The present study indicated that plasma BNP level is clinically useful for identification of nonobstructive HCM patients who have a risk of PAF.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 126 3 2008 Expression of monocyte chemoattractant protein-1 in idiopathic dilated cardiomyopathy 427 429 EN Makoto Kobayashi Kazufumi Nakamura Kengo Fukushima Kusano Yoichi Nakamura Keiko Ohta-Ogo Satoshi Nagase Satoru Sakuragi Tohru Ohe <p>Immunological factors have been involved in the pathogenesis of dilated cardiomyopathy (DCM). The cytotoxic action of macrophages is one of the main factors causing cardiac myocyte damage. Monocyte chemoattractant protein-1 (MCP-1) is a major signal for the accumulation of monocytes/macrophages. We examined whether MCP-1 was expressed in the myocardium of DCM patients and whether the expression level was correlated with the degree of impairment of cardiac function. The expression of MCP-1 in the myocardium was determined by immunohistochemistry in endomyocardial biopsy samples from 13 patients. The expression of MCP-1 was found in all myocardial samples from DCM patients but not in those from control subjects. Positive staining for MCP-1 was distinct in cardiac myocytes, interstitium and infiltrating cells. Semi-quantitative analysis revealed that the expression of MCP-1 was inversely correlated with left ventricular ejection fraction. In conclusion, the expression level of MCP-1 in the myocardium was correlated with the degree of impairment of cardiac function in patients with DCM.</p> No potential conflict of interest relevant to this article was reported.

Elsevier Ltd. Acta Medica Okayama 0969-8043 66 5 2008 Radioactivity and radon emanation fraction of the granites sampled at Misasa and Badgastein 648 652 EN Akihiro Sakoda Katsumi Hanamoto Yu Ishimori Tomohiro Nagamatsu Kiyonori Yamaoka The chemical composition was analyzed and the radioactivity, radon exhalation rate and emanation fraction were measured to investigate the characteristics of the granites sampled at Misasa and Badgastein, world famous for radon therapy. The Misasa granite was probably composed of quartz, albite and microcline. The Badgastein granite was probably composed of quartz and muscovite. The radon exhalation rates and emanation fractions of the Misasa granite were much higher than those of the Badgastein granite, regardless of the Ra-226 activity concentrations. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 64 24 2008 RhCl3/amine-catalyzed [2+2+2] cyclization of alkynes 5800 5807 EN Kenta Yoshida Ichiro Morimoto Koichi Mitsudo Hideo Tanaka <p>The RhCl3-3H(2)O/i-Pr2NEt-catalyzed [2+2+2] cyclotrimerization of alkynes has been achieved. The reaction can be widely used for various alkynes and provides tri- OF hexa-substituted benzenes regioselectively in high yields. The [2+2+2] cycloaddition of diynes and alkynes is also developed, and it affords benzene derivatives in moderate to high yields.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 24 2008 Synthesis and regioselective N- and O-alkylation of 1H- or 3H-[1,2,3]triazolo[4,5-d]pyrimidine-5,7(4H,6H)-diones (8-azaxanthines) and transformation of their 3-alkyl derivatives into 1-alkyl isomers 4167 4179 EN Rafiqul Islam Tomohisa Nagamatsu <p>Several alkylating agents, for example alkyl halides and dimethyl sulfate, were employed in aprotic Solvents Under a variety of conditions for the alkylation of mono- and disubstituted 1H- or 3H-[1,2,3]triazolo[4,5-d]pyrimidine-5,7(4H,6H)-diones, which were prepared by cyclization of the appropriate 5,6-diaminouracils with nitrous acid. The alkylation on the triazole ring in the presence of anhydrous potassium carbonate took place simultaneously at the 1- and 2-positions, with alkylation at the 2-position taking priority. Similar alkylation on the pyrimidine ring with an equivalent alkylating reagent took place only at the 4-position. The alkylation of 3,6-disubstituted derivatives at room temperature led to 5-O-alkylation accompanied by 4-N-alkylation, but at high temperature only 4-N-alkylation took place. Reaction of 3,4,6-trisubstituted derivatives with excess alkylating agent at high temperature leads to the formation of 1,4,6-trisubstituted derivatives with elimination of the 3-substituent.</p> No potential conflict of interest relevant to this article was reported.

Pergamon-Elsevier Science Ltd. Acta Medica Okayama 0968-0896 16 2 2008 Antitumor studies. Part 4: Design, synthesis, antitumor activity, and molecular docking study of novel 2-substituted 2-deoxoflavin-5-oxides, 2-deoxoalloxazine-5-oxides, and their 5-deaza analogs 922 940 EN Hamed I. Ali Noriyuki Ashida Tomohisa Nagamatsu Various novel 10-alkyl-2-deoxo-2-methylthioflavin-5-oxides and their 2-alkylamino derivatives were prepared by facile nitrosative cyclization of 6-(N-alkylanilino)-2-methylthiopyrimidin-4(3H)-ones followed by nucleophilic replacement of the 2-methylthio moiety by different amines, and acidic hydrolysis of the 2-methylthio moiety afforded the corresponding flavin derivatives. 2-Deoxo-2-methylthio-5-deazaalloxazines and 2-deoxo-2-methylthioalloxazine-5-oxides were also prepared by Vilsmeier reaction and by nitrosation of 6-anilino-2-methylthiopyrimidin-4(3H)-ones, respectively. Then, they were subjected to nucleophilic replacement with appropriate amines to produce the corresponding 2-alkylamino derivatives. Regiospecific N-3-alkylation of 2-deoxo-2-methylthioalloxazine-5-oxides was carried out with various alkylating agents in the usual way, The antitumor activities against CCRF-HSB-2 and KB tumor cells have been investigated in vitro, and many compounds showed promising antitumor activities. Furthermore, AutoDock molecular docking into PTK (PDB: 1t46) has been done for lead optimization of the aforementioned compounds as potential PTK inhibitors. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 49 2008 A cross-metathesis approach to the stereocontrolled synthesis of the AB ring segment of ciguatoxin 3643 3647 EN Isao Kadota Takashi Abe Miyuki Uni Hiroyoshi Takamura Yoshinori Yamamoto <p>Synthesis of the AB ring segments of ciguatoxin is described. The present synthesis includes a Lewis acid mediated cyclization of allylstannane with aldehyde, cross-metathesis reaction introducing the side chain, and Grieco-Nishizawa dehydration on the A ring.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 49 15 2008 Facile synthetic procedure for and electrochemical properties of hexa(2-thienyl)benzenes directed toward electroactive materials 2363 2365 EN Kenta Yoshida Ichiro Morimoto Koichi Mitsudo Hideo Tanaka <p>In the presence of RhCl3 center dot 3H(2)O and i-Pr2NEt, the cyclotrimerization of di(2-thienyl)acetylenes proceeded smoothly to afford hexa(2-thienyl)benzenes. CV analysis of the hexa(2-thienyl)benzenes showed that they may be useful as electroactive materials.</p> No potential conflict of interest relevant to this article was reported.

Pergamon-Elsevier Science Ltd. Acta Medica Okayama 0968-0896 15 1 2007 Antitumor studies. Part 1: Design, synthesis, antitumor activity, and AutoDock study of 2-deoxo-2-phenyl-5-deazaflavins and 2-deoxo-2-phenylflavin-5-oxides as a new class of antitumor agents 242 256 EN Hamed I.. Ali Keiichiro Tomita Eiichi Akaho Hiroto Kambara Shinji Miura Hiroyuki Hayakawa Noriyuki Ashida Yutaka Kawashima Takehiro Yamagishi Hisao Ikeya Fumio Yoneda Tomohisa Nagamatsu Novel 2-deoxo-2-phenyl-5-deazaflavins and 2-deoxo-2-phenylflavin-5-oxides were prepared as a new class of antitumor agents and showed significant antitumor activities against NCI-H 460, HCT 116, A 431, CCRF-HSB-2, and KB cell lines. In vivo investigation, 2-deoxo-10-methyl-2-phenyl-5-deazaflavin exhibited the effective antitumor activity against A 431 human adenocarcinoma cells transplanted subcutaneously into nude mouse. Furthermore, AutoDock study has been done by binding of the flavin analogs into PTK pp60(c-src), where a good correlation between their IC50 and AutoDock binding free energy was exhibited. In particular, 2-deoxo-2-phenylflavin-5-oxides exhibited the highest potential binding affinity within the binding pocket of PTK. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 74 2008 New dimeric flavans from gambir, an extract of Uncaria gambir 595 605 EN Shoko Taniguchi Kayo Kuroda Naomi Yoshikado Kou-ichi Doi Masahiro Tanabe Takashi Shibata Takashi Yoshida Tsutomu Hatano <p>Three new dimeric flavans, catechin-(4 alpha -&#62; 8)-ent-epicatechin (7), gambirflavan D1 (8), and gambirflavan D2 (9), were isolated from gambir (an extract from the leaves and young twigs of Uncaria gambir), and their structures were determined based on spectroscopic and chemical data.</p> No potential conflict of interest relevant to this article was reported.

Pergamon-Elsevier Science Ltd. Acta Medica Okayama 0968-0896 15 19 2007 Antitumor studies. Part 3: Design, synthesis, antitumor activity, and molecular docking study of novel 2-methylthio-, 2-amino-, and 2-(N-substituted amino)-10-alkyl-2-deoxo-5-deazaflavins 6336 6352 EN Hamed I. Ali Noriyuki Ashida Tomohisa Nagamatsu Various novel 10-alkyl-2-deoxo-2-methylthio-5-deazaflavins have been synthesized by reaction of 6-(N-alkylanilino)-2-methylthiopyrimidin-4(3H)-ones with Vilsmeier reagent. The similar 2-(N-substituted amino) derivatives were prepared by nucleophilic replacement reaction of the 2-methylthio moiety by appropriate amines. The 2-oxo derivatives (i.e., 5-deazaflavins) were obtained by acidic hydrolysis of the 2-methylthio derivatives. The antitumor activities against CCRF-HSB-2 and KB cells and the antiviral activities against HSV-1 and HSV-2 have been investigated in vitro, and many compounds showed promising antitumor activities. Furthermore, AutoDock molecular docking into PTK has been done for lead optimization of these compounds as potential PTK inhibitors. Whereas, the designed 2-deoxo-5-deazaflavins connected with amino acids at the 2-position exhibited the good binding affinities into PTK with more hydrogen bonds. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 149 6 2008 Aldosterone breakthrough caused by chronic blockage of angiotensin II type 1 receptors in human adrenocortical cells: Possible involvement of bone morphogenetic protein-6 actions 2816 2825 EN Hiroyuki Otani Fumio Otsuka Kenichi Inagaki Jiro Suzuki Tomoko Miyoshi Yoshihiro Kano Junko Goto Toshio Ogura Hirofumi Makino <p>Circulating aldosterone concentrations occasionally increase after initial suppression with angiotensin II (Ang II) converting enzyme inhibitors or Ang II type 1 receptor blockers (ARBs), a phenomenon referred to as aldosterone breakthrough. However, the underlying mechanism causing the aldosterone breakthrough remains unknown. Here we investigated whether aldosterone breakthrough occurs in human adrenocortical H295R cells in vitro. We recently reported that bone morphogenetic protein (BMP)-6, which is expressed in adrenocortical cells, enhances Ang II-but not potassium-induced aldosterone production in human adrenocortical cells. Accordingly, we examined the roles of BMP-6 in aldosterone breakthrough induced by long-term treatment with ARB. Ang II stimulated aldosterone production by adrenocortical cells. This Ang II stimulation was blocked by an ARB, candesartan. Interestingly, the candesartan effects on Ang II-induced aldosterone synthesis and CYP11B2 expression were attenuated in a course of candesartan treatment for 15 d. The impairment of candesartan effects on Ang II-induced aldosterone production was also observed in Ang II- or candesartanpretreated cells. Levels of Ang II type 1 receptor mRNA were not changed by chronic candesartan treatment. However, BMP-6 enhancement of Ang II- induced ERK1/2 signaling was resistant to candesartan. The BMP-6-induced Smad1, -5, and -8 phosphorylation, and BRE-Luc activity was augmented in the presence of Ang II and candesartan in the chronic phase. Chronic Ang II exposure decreased cellular expression levels of BMP-6 and its receptors activin receptor-like kinase-2 and activin type II receptor mRNAs. Cotreatment with candesartan reversed the inhibitory effects of Ang II on the expression levels of these mRNAs. The breakthrough phenomenon was attenuated by neutralization of endogenous BMP-6 and activin receptor-like kinase-2. Collectively, these data suggest that changes in BMP-6 availability and response may be involved in the occurrence of cellular escape from aldosterone suppression under chronic treatment with ARB.</p> No potential conflict of interest relevant to this article was reported.

Pergamon-Elsevier Science Ltd. Acta Medica Okayama 0008-6223 47 8 2009 The use of graphite oxide to produce mesoporous carbon supporting Pt, Ru, or Pd nanoparticles 2120 2124 EN Kazuma Gotoh Koji Kawabata Eiji Fujii Kunimitsu Morishige Taro Kinumoto Yuki Miyazaki Hiroyuki Ishida Mesoporous carbon having platinum, ruthenium or palladium nanoparticles on exfoliated graphene sheets were produced from graphite oxide (GO) and metal complexes. The Pt included carbon was made by heating of the intercalation compound including tetraammineplatinum (II) chloride monohydrate. Samples having Ru or Pd are producible by heating in nitrogen gas atmosphere using hexaammineruthenium (III) chloride or tetraamminepalladium (II) chloride monohydrate instead of Pt complex. The particle sizes of platinum, ruthenium, and palladium were, respectively, 1–3, 1–2, and 3–7 nm. The platinum- or palladium-containing sample showed catalytic activity for oxygen reduction. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 456 4 2008 Barley plasma membrane intrinsic proteins (PIP aquaporins) as water and CO2 transporters 687 691 EN Maki Katsuhara Yuko T. Hanba <p>We identified barley aquaporins and demonstrated that one, HvPIP2;1, transports water and CO2. Regarding water homeostasis in plants, regulations of aquaporin expression were observed in many plants under several environmental stresses. Under salt stress, a number of plasma membrane-type aquaporins were down-regulated, which can prevent continuous dehydration resulting in cell death. The leaves of transgenic rice plants that expressed the largest amount of HvPIP2;1 showed a 40% increase in internal CO2 conductance compared with leaves of wild-type rice plants. The rate of CO2 assimilation also increased in the transgenic plants. The goal of our plant aquaporin research is to determine the key aquaporin species responsible for water and CO2 transport, and to improve plant water relations, stress tolerance, CO2 uptake or assimilation, and plant productivity via molecular breeding of aquaporins.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 8 3 2008 Induction of cytolytic activity and interferon-gamma production in murine natural killer cells by polymyxins B and E 508 513 EN Ming Zhong Yusuke Kadota Yoshio Shimizu Eiichi Gohda <p>Natural killer (NK) cells are the primary effector cells of the innate immune system and have well-established roles in tumor rejection and resistance to viruses, bacteria and certain parasites. There is a need for more specific immune modulators of NK cell activity that tack the wide-ranging side effects of NK cell-stimulatory interleukins. The polycationic antibiotic polymyxin B (PMB) has been shown to have a unique ability to enhance activities of some immune cells, independent of its antibiotic properties. Here we report that both PMB and its analog potymyxin E (PME) markedly enhanced the activity of NK cells enriched from the murine spleen. Maximal activation of NK cell activity was obtained after 24 h of incubation with PMB at a dose of 300 mu g/ml. PMB nonapeptide, one of the two PMB domains, and PME methanesulfonate, the negatively charged derivative of PME, had little effect on NK cell activity. PMB induced interferon (IFN)-gamma and tumor necrosis factor-a production in NK cells. Proliferation of NK cells in vitro was significantly stimulated by being incubated with PMB. Administration of PMB to mice for 7 consecutive days stimulated splenic NK cell activity and increased NK cell populations in the spleen. These results suggest that the polycationic antibiotics PMB and PME may up-regulate innate and adaptive immune responses by induction of NK cell activity and IFN-gamma production.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 71 22 2005 Metallic phase in the metal-intercalated higher fullerene Rb8.8(7)C84 EN Yoshie Rikiishi Yoko Kashino Haruka Kusai Yasuhiro Takabayashi Eiji Kuwahara Yoshihiro Kubozono Takashi Kambe Taishi Takenobu Yoshihiro Iwasa Naomi Mizorogi Shigeru Nagase Susumu Okada <p>A new material of higher fullerene, RbxC84, was synthesized by intercalating Rb metal into C-84 crystals. The RbxC(84) crystals showed a simple cubic (sc) structure with lattice constant, a, of 16.82 (2) angstrom at 6.5 K, and 16.87 (2) angstrom at 295 K. The Rietveld refinements were achieved with the space group, Pa (3) over bar, based on a model that the C-2 axis of D2d-C84 aligned along [111]. The sample composition was determined to be Rb-8.8(7) C-84. The ESR spectrum at 303 K was composed of a broad peak with peak-to-peak linewidth Delta H-pp of 220 G, and a narrow peak with Delta H-pp of 24 G. Temperature dependence of the broad peak clearly showed a metallic behavior. The metallic behavior was discussed based on a theoretical calculation. This finding of new metallic phase in a higher fullerene is the first step for a development of new types of fullerene materials with novel physical properties such as superconductivity.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 401 2008 Formation of low-resistivity region in p-Si substrate of SiGe/Si episystem by remote-hydrogen plasma treatment 218 221 EN Yoshifumi Yamashita Yoshifumi Sakamoto Yoichi Kamiura Takeshi Ishiyama <p>We have studied effects of hydrogen treatment on the resistivity profile of the SiGe/Si episystem by spreading resistance (SR) method. In this paper, we present experimental findings that hydrogen treatment reduces the resistivity at a specific part in the Si substrate region. This position was confirmed to be under the interface between SiGe and Si that emerged on the bevel surface during hydrogen treatment. We investigated the depth of resistivity-reduced regions which was formed by various hydrogenating conditions and found that the region was extended to the same depth as the penetration depth of hydrogen. We concluded that the low-resistivity region was formed under the influence of hydrogen introduced from bevel surface. We attributed this resistivity reduction to formation of some defects which originally existed at the interface and diffused into Si substrate with hydrogen.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 57 3 2008 The evaluation of control measures against Schistosoma mekongi in Cambodia by a mathematical model EN Naoto Hisakane Masashi Kirinoki Yuichi Chigusa Muth Sinuon Duong Socheat Hajime Matsuda Hirofumi Ishikawa <p>We constructed a mathematical model for the transmission of Schistosoma mekongi in Cambodia. The simulation of the model will be instrumental in planning schistosomiasis control measures. The model includes two definitive hosts, humans and dogs, as animal reservoirs. Dogs are recognized to play an important role in schistosomiasis transmission in Cambodia. For the purpose of dealing with age-specific prevalence and intensity of infection, the human population was classified into eight age categories in the model. To describe the seasonal fluctuation of the intermediate host population of S. mekongi, the "Post-Spate Survival" hypothesis was adopted for the population dynamics of Neotricula aperta present in the Mekong River. We carried out simulations to evaluate the effect of universal treatment (UT) and targeted mass treatment (TT) with praziquantel on the reduction in prevalence of S. mekongi. The simulations indicated that biyearly UT for 8 years or yearly TT for 5 years after three courses of yearly UT could reduce the prevalence to below 5% when a UT or TT coverage of 85% of inhabitants was achieved. The simulation suggested that the suppression of S. mekongi in Cambodia would be possible by UT or TT with a high coverage rate.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 73 4 2007 N-terminal domain including conserved flg22 is required for flagellin-induced hypersensitive cell death in Arabidopsis thaliana 281 285 EN Naito Kana Ishiga Yasuhiro Toyoda Kazuhiro Shiraishi Tomonori Ichinose Yuki <p>Flagellin in Pseudomonas syringae is a potent elicitor of defense responses including hypersensitive cell death in dicot plants. The oligopeptides flg22 consisting of 22 conserved amino acids near the N-terminus of flagellins is reported to induce plant defense responses. Because glycosylation of the central domain of flagellin affects its elicitor activity, we investigated whether any peptide sequence in addition to flg22 is required for flagellin-induced hypersensitive reaction. A study of recombinant flagellin polypeptides indicated that the N-terminal domain including the conserved flg22 is required for flagellin-induced hypersensitive cell death in Arabidopsis thaliana.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 55 2008 Mathematical modeling of Echinococcus multilocularis transmission EN Hirofumi Ishikawa <p>A mathematical model for the transmission cycle of Echinococcus multilocularis would be useful for estimating its prevalence, and the model simulation can be instrumental in designing various control strategies. This review focuses on the epidemiological factors in the E. multilocularis transmission cycle and the recent advances of mathematical models for E. multilocularis transmission.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 18 2 2007 Elicitin-responsive lectin-like receptor kinase genes in BY-2 cells 152 159 EN Michiko Sasabe Kana Naito Hiroko Suenaga Takako Ikeda Kazuhiro Toyoda Yoshishige Inagaki Tomonori Shiraishi Yuki Ichinose <p>The inhibition of elicitor-induced plant defense responses by the protein kinase inhibitors K252a and staurosporine indicates that defense responses require protein phosphorylation. We isolated a cDNA clone encoding Nicotiana tabacum lectin-like receptor protein kinase 1 ( NtlecRK1), an elicitor-responsive gene; in tobacco bright yellow ( BY-2) cells by a differential display method. NtlecRK forms a gene family with at least three members in tobacco. All three NtlecRK genes potentially encode the N-terminal legume lectin domain, transmembrane domain and C-terminal Ser/Thr-type protein kinase domain. Green fluorescent protein ( GFP) fusion showed that the NtlecRK1 protein was located on the plasma membrane. In addition, NtlecRK1 and 3 were responsive to INF1 elicitin and the bacterial elicitor harpin. These results indicate that NtlecRKs are membrane-located protein kinases that are induced during defense responses in BY-2 cells.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 190 2 2008 Effects of glycosylation on swimming ability and flagellar polymorphic transformation in Pseudomonas syringae pv. tabaci 6605 764 768 EN Fumiko Taguchi Satoshi Shibata Tomoko Suzuki Yujiro Ogawa Shin-Ichi Aizawa Kasumi Takeuchi Yuki Ichinose <p>The role of flagellin glycosylation on motility was investigated in Pseudomonas syringae pv. tabaci. The swimming activity of glycosylation-defective mutants was prominently decreased in a highly viscous medium. The mutants showed differences in polymorphic transitions and in the bundle formation of flagella, indicating that glycosylation stabilizes the filament structure and lubricates the rotation of the bundle.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 133 2 2008 Analysis of response mechanism of a proton-pumping gate FET hydrogen gas sensor in air 538 542 EN Tomiharu Yamaguchi Masanori Takisawa Toshihiko Kiwa Hironobu Yamada Keiji Tsukada <p>Two different types of hydrogen response signals (DC and AC) of a proton-pumping gate FET with triple layer gate structure (Pd/proton conducting polymer/Pt) were obtained. The proton-pumping gate FET showed good selectivity against other gases (CH₄, C₂H₆, NH₃, and O₂). For practical use, the hydrogen response characteristics of the proton-pumping gate FET were investigated in air (a gaseous mixture of oxygen and nitrogen). The proton-pumping gate FET showed different hydrogen response characteristics in nitrogen as well as in air, despite the lack of oxygen interference independently. To clarify the response mechanism of the proton-pumping gate FET, a hydrogen response measurement was performed, using a gas flow system and electrochemical impedance spectroscopy. Consequently, the difference in response between nitrogen and air was found to be due to the hydrogen dissociation reaction and the interference with the proton transfer caused by the adsorbed oxygen on the upper Pd gate electrode</p> No potential conflict of interest relevant to this article was reported.

Department of Mathematics, Faculty of Science, Okayama University Acta Medica Okayama 0030-1566 2 2 1953 Quelques Généralisations des Théorémes Concernant aux Produits Directs Des Espaces Linéaires Localement Convexes 185 189 EN Ichiro Amemiya 10.18926/mjou/33170 <p>Les deux théorèmes, qui sont établis dans &#34;Sur les espaces linéaires localement convexes&#34; par O. Takenouchi (qui a paru dans ce même Journal, tom. 2, n�‹1, pp. 57-84), et qui insistent que le produit direct des espaces de chacune de deux espèces c.-à-d. &#34;bornologique&#34; et &#34;tonnelé&#34; est encore l'un de la même espèce, sont vrais sous les conditions moins restrictives. À savoir, Concernant au théorème 14: La restriction d'être complet n'est pas nécessaire. Concernant au théorème 15: La puissance d'ensemble des composants du produit peut être tenue encore plus grand.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 68 3 2005 Kinetic-spectrophotometric method for the determination of trace amounts of bromide in seawater 951 956 EN Kanchana Uraisin Toshio Takayanagi Mitsuko Oshima Duangjai Nacapricha Shoji Motomizu <p>A novel simple, sensitive and rapid kinetic-spectrophotornetric method is proposed for the determination of trace amounts of bromide. The method is based on its catalytic effect on the oxidation of methylene blue (MB) by hydrogen peroxide in strongly acidic solution. The oxidation reaction is activated by large amounts of chloride and can be monitored spectrophotometrically by measuring the decrease in the absorbance of MB at 746 run. The determination of bromide is performed by a fixed-time method at the first 100 s from the initiation of the reaction. Unlike other kinetic-spectrophotornetric methods for the determination of bromide, the proposed method does not require heating the solution. Bromide can be determined in the range from 80 to 960 mu g l(-1) with the detection limit of 35 mu g l(-1). The relative standard deviation of ten replicate determination of 480 mu g l(-1) bromide was 1.4%. The influence of potential interfering ions was studied. The proposed method was satisfactorily applied to the determination of bromide in seawater without interfering effect from chloride ion.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 68 2 2005 On-line preconcentration using dual mini-columns for the speciation of chromium(III) and chromium(VI) and its application to water samples as studied by inductively coupled plasma-atomic emission spectrometry 388 393 EN Takashi Sumida Tamami Ikenoue Kazuhide Hamada Akhmad Sabarudin Mitsuko Oshima Shoji Motomizu <p>On-line preconcentration system for the selective, sensitive and simultaneous determination of chromium species was investigated. Dual minicolumns containing chelating resin were utilized for the speciation and preconcentration of Cr(III) and Cr(VI) in water samples. In this system, Cr(III) was collected on first column packed with iminodiacetate resin. Cr(VI) in the effluent from the first column was reduced to Cr(III), which was collected on the second column packed with iminodiacetate resin. Hydroxyammonium chloride was examined as a potential reducing agent for Cr(VI) to Cr(III). The effects of pH, sample flow rate, column length, and interfering ions on the recoveries of Cr(III) were carefully studied. Five millilitres of a sample solution was introduced into the system. The collected species were then sequentially washed by 1 M ammonium acetate, eluted by 2 M nitric acid and measured by ICP-AES. The detection limit for Cr(III) and Cr(VI) was 0.08 and 0.15 mu g l-1, respectively. The total analysis time was about 9.4 min. The developed method was successfully applied to the speciation of chromium in river, tap water and wastewater samples with satisfied results. </p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 68 2 2005 Determination of trace amounts of bromide by flow injection/stopped-flow detection technique using kinetic-spectrophotometric method 274 280 EN K. Uraisin D. Nacapricha S. Lapanantnoppakhun K. Grudpan Shoji Motomizu <p>A simple, sensitive and selective method for the determination of bromide in seawater by using a flow injection/stopped-flow detection technique was examined. The detection system was developed for a new kinetic-spectrophotometric determination of bromide in the presence of chloride matrix without any extraction and/or separation. The detection was based on the kinetic effect of bromide on the oxidation of methylene blue (MB) with hydrogen peroxide in a strongly acidic solution. Large amounts of chloride could enhance the sensitivity of the method as an activator. The decolorisation of the blue color of MB was used for the spectrophotometric determination of bromide at 746 nm. A stopped-flow approach was used to improve the sensitivity of the measurement and provide good linearity of the calibration over the range of 0-3.2 p,g ml(-1) of bromide. The relative standard deviation was 0.74% for the determination of 2.4 jig ml(-1) bromide (n=5). The detection limit (3 sigma) was 0.1 mu g ml(-1) with a sampling frequency of 12 h(-1). The influence of potential interfering ions was studied. The proposed method was applied to the determination of bromide in seawater samples and provided satisfactory results. </p> No potential conflict of interest relevant to this article was reported.

Elsevier Science B.V. Acta Medica Okayama 0003-2670 558 1-2 2006 Synthesis of a chitosan-based chelating resin and its application to the selective concentration and ultratrace determination of silver in environmental water samples 246 253 EN Rosi Ketrin Katarina Toshio Takayanagi Mitsuko Oshima Shoji Motomizu A novel chelating resin using chitosan as a base material, ethylenediamine-type chitosan, has been synthesized for the first time in the present study, and applied to the collection/concentration of ultratrace amounts of silver in environmental water samples. In the present study, ultratrace amounts of silver collected on the resin were eluted and determined by ICP-MS. The resin packed in a 1 mL mini column could adsorb silver selectively and quantitatively at a flow rate of 2 mL min(-1) in the wide pH range from 1 to 8, and silver adsorbed on the resin could be easily recovered by passing 1 M nitric acid as an eluent into the column. High adsorption capacity for silver at pH 5, 0.37 mmol mL(-1) of the resin, was achieved, and t(1/2) of the adsorption is less than 5 min. The effect of chloride on the collection of silver was examined by varying chloride concentrations from 10(-4) to 0.75 M; the results showed that the present resin can be used for the collection/concentration of ultratrace amounts of silver in natural waters, as well as seawater. To ensure the accuracy and the precision of the method, CASS-4 near shore seawater reference material from the NRCC has been analyzed. This is not a certified SRM for silver, but has been used for comparative silver analysis by several groups, who report very similar results to those that are reported here. The developed method using ethylenediamine-type chitosan resin gives 0.7 pg mL(-1) of the detection limit when 50-fold enrichment was used. The proposed method was successfully applied to the determination of silver in tap, river, and seawater samples. No potential conflict of interest relevant to this article was reported.

The Japan Society for Analytical Chemistry Acta Medica Okayama 0910-6340 21 3 2005 Trace and ultratrace analysis of purified water samples and hydrogen peroxide solutions for phosphorus by flow-injection method 263 268 EN Zenhai Li Mitsuko Oshima Akhmad Sabarudin Shoji Motomizu <p>A highly sensitive fluorescence-quenching method for the determination of phosphorus based on the formation of an ion associate between molybdophosphate and Rhodamine B (RB) was developed. A simple flow-injection system coupled with a fluorescence detector was used to measure the fluorescence intensity at 560 nm and 580 nm as an excitation and an emission wavelength, respectively. The calibration graph for phosphorus showed a good linearity in the range of (0-1) x 10(-7) M (1 M = 1 mol L-1), and a detection limit of I x 10(-9) M (SIN = 3). The proposed method was successfully applied to the determination of ultratrace amounts of phosphorus in ultrapurified and purified water samples, and to the determination of trace amounts of phosphorus in commercially-available hydrogen peroxide solutions with satisfactory results. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 60 6 2003 Novel flow injection-fluorometric method for the determination of trace silicate and its application to ultrapurified water analysis 1277 1285 EN Akhmad Sabarudin Mitsuko Oshima Naoe Ishii Shoji Motomizu <p>A highly sensitive fluorescence quenching method for the determination of silicate based on the formation of an ion associate between molybdosilicate and Rhodamine B (RB) in nitric acid medium was developed. A flow injection system coupled with a fluorescence detector was used for the measurement of fluorescence intensity at 560 and 580 nm as excitation and emission wavelengths, respectively. The calibration graph for Si showed a linear range of 0.1-5 ng cm(-3) with correlation coefficient of 0.9999, and the detection limit of 0.06 ng cm(-3). The proposed method was successfully applied to the determination of silicate in ultrapurified water with satisfactory results.</p> No potential conflict of interest relevant to this article was reported.

Elsevier Science B.V. Acta Medica Okayama 0003-2670 581 2 2007 Functionalization of chitosan with 3,4-dihydroxybenzoic acid for the adsorption/collection of uranium in water samples and its determination by inductively coupled plasma-mass spectrometry 214 220 EN Akhmad Sabarudin Mitsuko Oshima Toshio Takayanagi Lukman Hakim Koji Oshita Yun Hua Gao Shoji Motomizu A chitosan resin derivatized with 3,4-dihydroxybenzoic acid moiety (CCTS-DHBA resin) was newly synthesized for the collection/concentration of trace uranium by using cross-linked chitosan (CCTS) as base material, and the adsorption behavior of uranium as well as 60 elements on the resin was examined by passing the sample solutions through a mini-column packed with the resin. After the elution of the collected elements on the resin with 1M HNO3, the eluates were measured by inductively coupled plasma-mass spectrometry (ICP-MS). The CCTS-DHBA resin can adsorb several metal cations and several oxoanionic elements at appropriate pH. Among these metal ions, uranium shows an excellent adsorption behavior on this resin. Uranium as UO22+ species can be adsorbed on the resin by chelating mechanism with adsorption capacity of 330 mg g(-1) resin. Through the column treatment, the complete removal of large amounts of alkali and alkaline earth matrices without any loss of adsorption efficiency over prolonged usage were achieved with this resin. The CCTS-DHBA resin was applied to the adsorption/collection of uranium in tap water, river water and seawater samples with satisfactory results. The validation of the proposed method was carried out by analyzing uranium in the standard reference materials of SLRS-4, CASS-4, and NASS-5 after passing through the CCTS-DHBA resin, and the results showed good agreement with the certified values. No potential conflict of interest relevant to this article was reported.

Elsevier Science B.V. Acta Medica Okayama 0003-2670 588 1 2007 Synthesis of novel chitosan resin derivatized with serine diacetic acid moiety and its application to on-line collection/concentration of trace elements and their determination using inductively coupled plasma-atomic emission spectrometry 73 81 EN Hakim Lukman Akhmad Sabarudin Mitsuko Oshima Shoji Motomizu A novel chelating resin functionalized with serine diacetic acid moiety was synthesized by using chitosan as base material, and applied to the collection/concentration of trace elements in environmental water samples, followed by the determination using inductively coupled plasma-atomic emission spectrometer (ICP-AES). The synthesized resin, crosslinked chitosan serine diacetic acid (CCTS-SDA), showed good adsorption behavior toward trace amounts of Cd, Pb, Cu, Ni, V, Ga, Sc, In, and Th in a wide pH range. Additionally, rare earth elements also can be retained on the resin at neutral pH region. The adsorbed elements can be easily eluted with 1 mol L-1 of nitric acid, and their recoveries were found to be 90-100%. The CCTS-SDA was packed in a mini-column, which was then installed in a cornputer-controlled auto-pretreatment system (Auto-Pret System) for on-line trace elements collection and determination with ICP-AES. Experimental parameters which related to the improvement of sensitivity and reproducibility were optimized. The limits of detection (LOD) for 13 elements were found to be in sub-ppb level. The proposed method with CCTS-SDA resin was successfully applied to the determination of trace elements in river water samples. The method was validated by determining a certified reference material of river water, SLRS-4. No potential conflict of interest relevant to this article was reported.

Elsevier Science B.V. Acta Medica Okayama 0003-2670 532 1 2005 Slope comparison method (SCM) for the determination of trace amounts of silicate in ultrapurified water 27 35 EN Akhmad Sabarudin Mitsuko Oshima Shoji Motomizu A sensitive analytical method for the determination of trace amounts of silicate in ultrapurified water was developed. The method is based on the formation of an ion associate of molybdosilicate with malachite green (MG) and the collection of the ion associate on a tiny membrane filter (diameter: 5 mm, and effective filtering diameter: 1 mm). The ion associate formed on the membrane filter is dissolved together with the membrane filter in 1 ml of methyl cellosolve (MC) and the absorbance of MC solution is measured at 627 nm by a flow injection-spectrophotometric detection technique. In this method, silicate in the original sample (ultrapurified water) is concentrated as the ion associate into a small volume of MC to get high sensitivity. As sample concentration takes place, the small amounts of silicate contained in the reagents used also become concentrated as the ion associate into MC. The original sample volumes are varied and evaporated to an identical volume. Therefore, the reagent added is fixed to the same volume. The absorbance increase linearly with increase in the original sample volume will be due only to silicate in the original samples (ultrapurified water). The resulting slopes obtained by varying the sample volumes are compared with the slope of the calibration graph, and thus named the slope comparison method (SCM). The SCM facilitates a more sensitive and accurate evaluation of silicate concentration in the samples than either common calibration method (CCM) or standard addition method (SAM) because it compensates for the influence of trace amounts of silicate contained in chemicals, reagent solution and solvent used. The calibration graph was constructed from 0 to 0.25 ng ml(-1) of Si and the detection limit was 10 pg ml(-1) (ppt) when 30 ml of samples was used. The standard deviation and relative standard deviation from six measurements of the reagent blanks were 0.0012 and 3.5%, respectively. No potential conflict of interest relevant to this article was reported.

Elsevier Science B.V. Acta Medica Okayama 0003-2670 542 2 2005 Synthesis of chitosan resin possessing 3,4-diamino benzoic acid moiety for the collection/concentration of arsenic and selenium in water samples and their measurement by inductively coupled plasma-mass spectrometry 207 215 EN Akhmad Sabarudin Koji Oshita Mitsuko Oshima Shoji Motomizu A chitosan resin functionalized with 3,4-diamino benzoic acid (CCTS-DBA resin) was newly synthesized by using a cross-linked chitosan (CCTS) as base material. The adsorption behavior of trace amounts of elements on the CCTS-DBA resin was examined by the pretreatment with a mini-column and measurement of the elements by inductively coupled plasma-Mass spectrometry (ICP-MS). Arsenic(V) could be retained on the CCTS-DBA resin at pH 3 as an oxoanion of H(2)ASO(4)(-). Selenium(VI) is strongly adsorbed at pH 2 and pH 3 as an oxoanion of SeO42-. while selenium(IV) as HSeO3- is adsorbed on the resin at pH 3. The sorption capacities are 82, 64, and 88 mg g(-1) resin for As(V), Se(IV), and Se(VI), respectively. The effect of common anions and cations on the adsorption of As(V), Se(IV), and Se(VI) were studied; there was no interference from such anionic matrices as chloride, sulfate, phosphate, and nitrate up to 20 ppm, as well as from such artificial river water matrices as Na, K, Mg, and Ca after passing samples through the mini-column containing the resin. The CCTS-DBA resin was applied to the collection of arsenic and selenium species in bottled drinking water, tap water, and river water. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 72 5 2007 Flow-Injection Spectrofluorometric Determination of Trace Amounts of Formaldehyde in Water after Derivatization with Acetoacetanilide 1675 1680 EN Qiong Li Mitsuko Oshima Shoji Motomizu <p>A novel fluorophotometric method for formaldehyde determination in environmental waters was developed: the method does not require any enrichment procedures. A flow-injection analysis method for the spectrofluorometric determination of formaldehyde in waters, which is based on the reaction of formaldehyde with acetoacetanilide and ammonia, is proposed. The proposed method shows a good linearity from 0.50 to 40 x 10(-7) M, and the limit of detection (LOD) of 3 x 10(-9) M (0.09 ppb) is achievable. The sample throughput is 15 h(-1). One of the main advantages in the proposed method is that the reaction can be carried out at room temperature without any heating system. The effect of various interferences possibly present in the real water samples was investigated. Most cations and anions, as well as organic compounds, do not interfere with the determination of formaldehyde in environmental water samples. The proposed method is very simple, rapid, less expensive, and highly sensitive, and can be applied to the environmental water samples, such as rain, tap water and river water, at low concentration levels without any enrichment procedure. </p> No potential conflict of interest relevant to this article was reported.