The incredible speed at which research into the human genome has recently progressed has led to the widespread use of genomic data in clinical settings. The day will soon come when clinical practice that fails to utilize patients' genomic data will be considered outdated and will pose a high risk of legal action. In this lecture, I discuss several topics: 1.the progress of human genomic research, 2. Homo sapiens as just one of the many species on Earth; 3. the clinical applications of genomic research findings, with Kawasaki disease as an example;and 4.the current state of genomic research and its future prospects.
　　Medical researchers and doctors have long dreamed of a day when health care services based on each individual's genomic data will be a reality;this is usually referred to as “madeto-order medicine,” “tailor-made medicine,” “personalized medicine,” and most recently, “precision medicine.” Thanks to the recent rapid development of genomic analysis,such as next-generation sequencing,as well as that of statistical analysis methods, it has been said that individual genomic data were available at a cost as low as$1,000 in 2014.
　　Our planet is 4.6 billion years old, and life began 3.8 billion years ago. Since then,the Earth has witnessed the evolution of prokaryotic and eukaryotic unicellular organisms, followed by multicellular organisms, photosynthetic plants, the Cambrian explosion of marine life, and the emergence of land-dwelling creatures. Our mammalian ancestors appeared during the age of the dinosaurs, which suffered a mass extinction due to a dramatic change in climate caused by an asteroid impact. The small dinosaurs that survived evolved into today's birds while the mammals of that era evolved to successfully occupy a diverse array of ecological niches. The human family appeared about 2.5 million years ago in Africa. Archaic humans, such as Homo neanderthalensis, lived among our Homo sapiens ancestors, who appeared about 200,000 years ago. Now we know that 21%of the human genome has genes in common with prokaryotes and other eukaryotes. The difference between our genome and that of the gorilla and the chimpanzee is only 2% and 1%, respectively. Among Homo sapiens, the difference between any two individuals is only 0.2%, which manifests as differences in skin color, disease susceptibility, and other traits.
　　Kawasaki disease was identified by Dr.Tomisaku Kawasaki, who reported his findings in 1967. Since then, vigorous efforts have been made to identify the cause of the disease, but so far, nothing specific has been found. We therefore took a genome-based approach and identified several genes responsible for the development of Kawasaki disease. Because some of the identified genes are thought to participate in the Ca²⁺-NFAT signal transduction pathway, we hypothesized that cyclosporine A, which is known as a suppressor of this pathway, might be useful in the treatment of the disease. We performed an investigator-initiated clinical trial and confirmed our hypothesis. This was one of the first clinical applications based on human genome research.
　　Now, there are several large-scale genome-based projects, such as the UK Biobank, that are open to any researcher who would like to make use of their resources. They also contain clinical information and patient data, such as socioeconomic status, and educational background. With these kinds of resources at our disposal, we can expect great accomplishments in the not-too-distant future.

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　　Guardians' perceptions of the oral food challenge (OFC) test with 1-day hospitalization have not yet been investigated. In this study, a questionnaire survey on the OFC test was distributed to guardians of children who underwent the test for food allergies with 1-day or overnight hospitalization between April 2015 and May 2016. Patients who underwent the test at other hospitals and those with incomplete responses were excluded. A total of 164 patientguardian pairs were included in this study, and the valid response rate was 68% (112/164). Among negative aspects of OFC with overnight hospitalization, the response “visiting the next day” was the most frequent at 74%(83 guardians) and was significantly more frequent than the responses “anxiety at night,” “consultation and questions the next day are possible,” and “observation time is long” (all p<0.01). Among the positive aspects of OFC with 1-day hospitalization, the response “no next-day visit” was the most frequent at 87%(97 guardians) and was significantly more frequent than the responses “relief at night,” “cannot go to work the next day,” and “observation time is short” (all p<0.01). Among the negative aspects of OFC with 1-day hospitalization, the response “anxiety at night” was the most frequent at 45% (50 guardians) and was significantly more frequent than the responses “no next-day visit,” “cannot go to work the next day,” and “observation time is short”（p<0.01, each). The number of patients whose child underwent the OFC test with 1-day hospitalization was significantly higher than that with overnight hospitalization (87 guardians [78%] vs.8 guardians [7%] , p<0.01). These results suggested that majority of the guardians preferred that OFC be performed with 1-day hospitalization because there was no need to visit the hospital again the next day. However, many guardians had anxiety at night in OFC with 1-day hospitalization.

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　　In this study, we classified twin pregnancy cases over the past 7 years at our hospital into a trial of labor (TOL) group and a planned cesarean section group, and retrospectively investigated complications in the mothers and neonates at delivery. We also compared safety between the two groups. Subjects included 74 of 159 cases of twin pregnancy who underwent delivery at our hospital over the 7-year period from January 2009 to December 2015. In total, 45 cases of diamniotic-monochorionic twins and 40 cases of emergent caesarean section due to maternal or fetal complications were excluded. The planned cesarean section group included 56 cases (76%), while the vaginal delivery group included 18 cases (24%). Eleven cases of TOL were successful, while 7 cases failed. There were no significant between-group differences in the backgrounds of the mothers such as age, height, body mass index, and gestational age, excluding the number of multiparous cases. No significant differences in neonatal prognosis were noted between firstborn and second-born in terms of birth weight, umbilical arterial blood pH, Apgar score, number of tracheal intubation cases, and the number of neonatal deaths.The success rate of vaginal delivery was higher in multiparous women than primiparas. All vaginal deliveries were successful among multiparous women, regardless of whether delivery was cephalic. There were no significant differences in the neonatal prognosis between successful/failed cases of vaginal delivery. The success/failure of vaginal delivery for twin pregnancy did not result in an increase in the incidence of neonatal complications. The success rate of vaginal delivery for twin pregnancy was higher among multiparous women.

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　　Cough is one of the most common respiratory complaints leading to medical consultation. Fractional exhaled nitric oxide (FeNO) testing detects eosinophilic inflammation of the airway. We evaluated the diagnostic efficacy of FeNO testing in patients with cough. Patients who presented to the respiratory medicine department of our hospital with a chief complaint of cough and underwent FeNO testing were included in this study and divided into asthma and non-asthma groups. Patients with confounding factors such as allergic rhinitis and atopic predispositions were also identified and those with and without confounding factors, respectively, were further divided into the asthma and non-asthma groups. Median FeNO in the asthma and non-asthma groups was respectively 31 and 19 ppb in all patients and 31 and 18 ppb in those without confounding factors, with significant differences between the groups in both populations. The corresponding values in patients with confounding factors were 46 and 23 ppb, with no significant difference between the groups. A cut-off of 27 ppb differentiated between the asthma and non-asthma groups with sensitivity of 0.603 and specificity of 0.776. These results suggest FeNO testing is effective in the differential diagnosis of cough in patients without confounding factors.

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　　We report a case of ureteral endometriosis thought to have developed following relapse of pelvic peritoneal endometriosis after laparoscopic surgery. The patient was a woman in her late 40s who had undergone laparoscopic right adnexectomy for an endometrial cyst 5 years earlier. Electrocoagulation was performed for residual endometriosis of adherent cyst wall on the right sacrouterine ligament. The normal left ovary was preserved and she received no postoperative hormonal therapy. She developed right back pain during menstruation 5 years after the surgery. Pyeloureterography revealed stenosis of the ureter to the right of the uterus. Urinary cytology revealed endometrial cells with no atypia. Conservative management was opted for because malignant transformation of endometriosis was considered unlikely and she was expected to reach menopause within a few years. She is now doing well 24 months after initiation of progestin treatment with placement of a ureteral stent. Postoperative hormonal therapy is recommended for patients who are considered to have possible lesions of residual endometriosis and for whom ovarian function is preserved.

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