The Journal of Medical Investigation
Online ISSN : 1349-6867
Print ISSN : 1343-1420
ISSN-L : 1343-1420
Volume 62 , Issue 3.4
Showing 1-34 articles out of 34 articles from the selected issue
Reviews
  • Yoichiro Takata, Toshinori Sakai, Kosaku Higashino, Tetsuya Matsuura, ...
    2015 Volume 62 Issue 3.4 Pages 103-108
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques,including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery. J. Med. Invest. 62: 103-108, August, 2015
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  • Naoto Suzue, Tetsuya Matsuura, Toshiyuki Iwame, Kosaku Higashino, Tosh ...
    2015 Volume 62 Issue 3.4 Pages 109-113
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding-Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular,and jumper's knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes. J. Med. Invest. 62: 109-113, August, 2015
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  • Hiroaki Yanagawa, Rumi Katashima, Noriaki Takeda
    2015 Volume 62 Issue 3.4 Pages 114-118
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    The first Japanese ethics committee for biomedical research involving human subjects was established at Tokushima University in 1982. Although this committee was not formed as a response to national directives, the government eventually developed ethical guidelines, such as the Ethical Guidelines for Clinical Studies that were established in 2003. The practical impact of such guidelines was a rapid increase in the number of protocols seeking ethics committee approval and, accordingly, an increase in the workload of ethics committees. This review describes the activity of the ethics committee at Tokushima University during the last thirty years and discusses the infrastructure that best supports the activities of this committee. In addition, we address the issues that ethics committees now face and discuss future directions. J. Med. Invest. 62: 114-118, August, 2015
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  • Yasuhiro Hamada
    2015 Volume 62 Issue 3.4 Pages 119-122
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Nutritional screening and assessment should be a standard of care for all patients because nutritional management plays an important role in clinical practice. However, there is no gold standard for the diagnosis of malnutrition or undernutrition, although a large number of nutritional screening and assessment tools have been developed. Nutritional screening and assessment tools are classified into two categories, namely, subjective global assessment (SGA) and objective data assessment (ODA). SGA assesses nutritional status based on the features of medical history and physical examination. On the other hand, ODA consists of objective data provided from various analyses, such as anthropometry, bioimpedance analysis (BIA), dual-energy X-ray absorptiometry (DEXA), computed tomography (CT), magnetic resonance imaging (MRI), laboratory tests, and functional tests. This review highlights knowledge on the performance of ODA methods for the assessment of nutritional status in clinical practice. J. Med. Invest. 62: 119-122, August, 2015
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Originals
  • Yoshiji Kanematsu, Tetsuya Matsuura, Shinji Kashiwaguchi, Takenobu Iwa ...
    2015 Volume 62 Issue 3.4 Pages 123-125
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Relatively few epidemiological studies have examined shoulder injuries. This study aimed to investigate the epidemiology of such injuries in young baseball players. A total of 2,055 players aged 9-12 years who participated in a regional championship between 1983 and 1985 were the subjects of this investigation. They were assessed by questionnaire and radiographic examination. Prevalence of shoulder pain was determined according to position, years of baseball playing experience, and training hours per week. Radiographic examination was recommended to all players who complained of shoulder pain. Of the 2,055 subjects, 275 (13.4%) reported episodes of pain in the throwing shoulder. Years of baseball experience, but not player position or training hours per week, was significantly associated with shoulder pain. Forty-one of the 275 subjects reporting shoulder pain agreed to undergo radiography and 15 exhibited findings of Little Leaguer's shoulder. Their lesions could be classified into three distinct grades based on radiographic findings: grade I, widening of the epiphyseal plate in the lateral area (n=9); grade II, widening at all areas of the epiphyseal plate and demineralization of the metaphysis (n=5); and grade III, a slipped epiphysis (n=1). J. Med. Invest. 62: 123-125, August, 2015
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  • Jin Temma, Munehide Matsuhisa, Toru Horie, Akio Kuroda, Hiroyasu Mori, ...
    2015 Volume 62 Issue 3.4 Pages 126-129
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Advanced glycation end-products (AGEs) are thought to play a major role in the pathogenesis of diabetic vascular complications. Skin autofluorescence (AF) was recently reported to represent tissue AGEs accumulation with a non-invasive method. The aim of the present study was to evaluate association between AF value and diabetic vascular complications, such as retinopathy, nephropathy and cervical atherosclerosis using the carotid intima-media thickness (IMT), an established marker of cardiovascular disease in patients with type 2 diabetes. A total of 68 patients with type 2 diabetes were enrolled in a cross-sectional manner. AGEs accumulation was measured with AF reader. Clinical parameters were collected at the time of AF and IMT measurement. Max-IMT was correlated with age and AF (r=0.407, p=0.001), but not with HbA1c, GA, and pentosidine. Also, AF was not correlated with HbA1c, GA and pentosidine, but was correlated with age (r=0.560, p<0.001), duration of diabetes (r=0.256, p<0.05). Multivariate regression analysis revealed that AF, but not age, was an independent determinant of max-IMT. In conclusion, AF might be a beneficial surrogate marker for evaluating carotid atherosclerosis in patients with type 2 diabetes non-invasively. J. Med. Invest. 62: 126-129, August, 2015
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  • Kei Enomoto, Kanako Watanabe-Susaki, Megumi Kowno, Hitomi Takada, Atsu ...
    2015 Volume 62 Issue 3.4 Pages 130-136
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Mammalian pluripotent stem cells possess properties of self-renewal and pluripotency. These abilities are maintained by the strict regulation of pluripotent stem cell-specific transcription factor network and unique properties of chromatin in the stem cells. Although these major signaling pathways robustly control the characteristics of stem cells, other regulatory factors, such as metabolic pathways, are also known to modulate stem cell proliferation and differentiation. In this study, we fractionated protein samples from mouse embryonic stem (ES) cells cultured with or without the leukemia inhibitory factor (LIF). Protein expression was quantified by 2-dimensional differential gel electrophoresis (2D-DIGE). In total, 44 proteins were identified as being differentially expressed in the pluripotent stem cells and the differentiated cells. Surprisingly, half of the identified proteins were the proteins localized in mitochondria, which supply cellular energy and regulate cell cycle, development, and cell death. Some of these identified proteins are involved in the metabolic function and the regulation of pluripotency. Further analysis of the identified proteins could provide new information for the manipulation of pluripotency in ES cells. J. Med. Invest. 62: 130-136, August, 2015
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  • Norio Kamemura, Miwa Takashima, Hideaki Morita, Kenji Matsumoto, Hiroh ...
    2015 Volume 62 Issue 3.4 Pages 137-144
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Background and aims: Measurement of secretory immunoglobulin A (SIgA) level is important to monitor various disease conditions. However SIgA in gut mucosa is degraded by pancreatic proteases and proteolytic enzymes from enteric microbiota. Currently, there is no reliable quantitation method that measures allergen-specific SIgA levels in stool of neonates, infants and toddlers. Methods: Allergen-specific SIgA levels in stool of 10 healthy neonates, infants and toddlers aged 0 to 36 months were measured by our new allergen microarray with densely carboxylated arms on a glass slide chip. Results: Protease activities in stool of 3-day-old neonates were low and no degradation of SIgA, IgA and allergens was detected. However, immunofluorescence signals of SIgA, IgA and allergen on the chip were markedly reduced by stool extracts obtained from infants and toddlers aged more than one month in dose- and time-dependent manners. Such reduction was almost completely inhibited by serine protease inhibitors, phenylmethylsulfonyl fluoride (PMSF) and partly by leupeptin, but not by a variety of other protease inhibitors tested. Conclusion: Allergen-specific SIgA levels in stool of neonates, infants and toddlers under 36 months of age could be analyzed using protease inhibitors, including PMSF and leupeptin. J. Med. Invest. 62: 137-144, August, 2015
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  • Masanari Watanabe, Jun Kurai, Sayaka Minato, Hisashi Noma, Hiroyuki Sa ...
    2015 Volume 62 Issue 3.4 Pages 145-148
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Background: Airborne particulate matter (PM) may stimulate production of pro-inflammatory cytokines, and thus exposure to PM affects pulmonary diseases. However, the effects of PM on pulmonary diseases have differed among studies. Methods: PM was collected from February 2 to 28 (winter) and June 1 to 17 (summer) in 2013 in Yurihama, Japan, using filters to separate particles with different aerodynamic diameters (1.1 to <2.2 μm, 2.2 to <3.3 μm, 3.3 to <7.0 μm, and 7.0 to <10 μm). Interleukin (IL)-8 transcriptional activity in THP-G8 cells was examined in response to winter and summer PM with different diameters. Results: IL-8 transcriptional activity induced by winter PM was significantly higher than that with summer PM for each diameter. For winter PM, IL-8 activity increased with an increased diameter, whereas this activity did not differ between a solvent control and each summer PM diameter. This indicates that summer PM does not stimulate production of IL-8 in THP-G8 cells. Conclusion: The effects of PM on production of pro-inflammatory cytokines differ with the season and PM diameter. This suggests that the compositions of PM differ on season, and the evaluation of compositions of PM is important in understanding the association of health with short-term exposure to PM. J. Med. Invest. 62: 145-148, August, 2015
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  • Mitsuhiro Yasuda, Hiroshi Saeki, Yuichiro Nakashima, Takafumi Yukaya, ...
    2015 Volume 62 Issue 3.4 Pages 149-153
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Purpose: The aim of this study was to clarify the usefulness of two-stage operation for the patients with esophageal cancer who have liver dysfunction. Methods: Eight patients with esophageal cancer concomitant with liver dysfunction who underwent two-stage operation were analyzed. The patients initially underwent an esophagectomy, a cervical esophagostomy and a tube jejunostomy, and reconstruction with gastric tube was performed after the recovery of patients' condition. Results: The average time of the 1st and 2nd stage operation was 410.0 min and 438.9 min, respectively. The average amount of blood loss in the 1st and 2nd stage operation was 433.5 ml and 1556.8 ml, respectively. The average duration between the operations was 29.8 days. The antesternal route was selected for 5 patients (62.5%) and the retrosternal route was for 3 patients (37.5%). In the 1st stage operation, no postoperative complications were observed, while, complications developed in 5 (62.5%) patients, including 4 anastomotic leakages, after the 2nd stage operation. Pneumonia was not observed through two-stage operation. No in-hospital death was experienced. Conclusion: A two-stage operation might prevent the occurrence of critical postoperative complications for the patients with esophageal cancer concomitant with liver dysfunction. J. Med. Invest. 62: 149-153, August, 2015
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  • Yasuyo Saijo, Hiroyuki Furumoto, Kanako Yoshida, Masato Nishimura, Min ...
    2015 Volume 62 Issue 3.4 Pages 154-160
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    To determine whether vascular endothelial growth factor (VEGF) expression and microvessel density are predictive of prognosis in cases of invasive cervical cancer, correlations among VEGF expression, microvessel density, and clinicopathological parameters were identified. VEGF expression was evaluated in 50 cervical cancer samples by immunohistochemical staining. Microvessel density was assessed by immunostaining for CD31-positive endothelial cells in the most vascularized areas of tumors. VEGF expression and microvessel density were significantly higher in adenocarcinomas than in squamous cell carcinomas. However, in cases of adenocarcinoma, no significant correlations were found among VEGF expression, microvessel density, and clinicopathological parameters. In contrast, for squamous cell carcinomas, microvessel density was significantly higher in cases at an advanced stage and in those with several other poor prognostic factors. The finding that cervical adenocarcinomas exhibited greater VEGF expression and microvessel density than squamous cell carcinomas may explain the poorer prognosis of adenocarcinoma compared with squamous cell carcinoma. Moreover, microvessel density in squamous cell carcinomas was significantly correlated with poor prognostic factors. Therefore, there is possibility that bevacizumab, a humanized monoclonal antibody against VEGF-A, may be useful in the initial treatment targeting angiogenesis for early-stage cervical cancer. J. Med. Invest. 62: 154-160, August, 2015
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  • Toshiaki Kogame
    2015 Volume 62 Issue 3.4 Pages 161-166
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    The technique of Mos1-mediated Single Copy Insertion (MosSCI) now has become the essential technique which facilitates transgenic experiments for Caenohabditis elegans (C. elegans). Gateway system which is adopted to MosSCI-compatible vectors offers an advantage of simultaneous cloning with entry vectors cloned in the Gateway system format. On the other hand, the format for MosSCI-compatible vectors restricts flexibility in designing the vectors to only 3-fragment integration. Thus, construct of complex transgene such as the expression vector for translational gene fusion is tedious work even with Gateway system. We have developed the new recombination format called LeGaSCI (Library-enhanced Gateway for MosSCI) to expand the conventional 3-fragment to 4-fragment format which still retains the capacity to accept Promoterome and 3'UTRome libraries of C. elegans. In the new recombination format, 2 different Gateway format were combined. Cloning reaction for the tissue-specific expression vector of GFP-tagged protein with 3'UTR successfully occurred without any expected insertion, deletion or frame-shift mutation. Moreover, The MosSCI transgenic line was successfully generated with the construct. Collectively, we established the new Gateway system format which allows us to assemble 4-fragment insertion with the widest variety of entry clone vectors from C. elegans libraries. J. Med. Invest. 62: 161-166, August, 2015
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  • Tamae Nishi, Emi Shuto, Mariko Ogawa, Miho Ohya, Misaki Nakanishi, Mas ...
    2015 Volume 62 Issue 3.4 Pages 167-172
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Excessive dietary phosphorus (P) has been speculated to be a risk factor for cardiovascular disease (CVD). Here, we performed a double-blinded crossover study to investigate the time- and dose-dependent effects of dietary P intake on endothelial function in healthy subjects. Sixteen healthy male volunteers were given meals containing 400, 800, and 1,200 mg P (P400, P800, and P1200 meals, respectively) with at least 7 days between doses. There were no differences in nutritional composition among the experimental diets except for P content. Blood biochemistry data and flow-mediated dilation (%FMD) of the brachial artery were measured while fasted, at 0 h, 1 h, 2 h, and 4 h after meal ingestion, and the next morning while fasted. The P800 and P1200 meals significantly increased serum P levels at 1-4 h after ingestion. A significant decrease in %FMD was observed between 1-4 h,while the P400 meal did not affect %FMD. We observed no differences among meals in serum P levels or %FMD the next morning. A significant negative correlation was observed between %FMD and serum P. These results indicate that excessive dietary P intake can acutely impair endothelial function in healthy people. J. Med. Invest. 62: 167-172, August, 2015
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  • Masakazu Goda, Osamu Jinnouchi, Tsukasa Takaoka, Koji Abe, Koich Tamur ...
    2015 Volume 62 Issue 3.4 Pages 173-176
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Objective: Efficacy of percutaneous endoscopic gastrostomy (PEG) on unplanned treatment interruption and nutritional status was examined in patients undergoing chemoradiotherapy (CRT) for advanced head and neck cancer. Methods: We retrospectively reviewed hospital charts of 44 patients with advanced head and neck cancer who were treated with CRT. Results: CRT-induced mucositis of grade 3 or worse and inadequate oral intake of less than one third of their usual intake developed in 33 patients who were recommended PEG placement, but not in 11 patients. Thirteen patients accepted PEG placement and then completed CRT (compliant group). However, among 20 patients who refused both PEG and nasogastoric tube (NGT) placements (non-compliant group), 10 required unplanned interruptions of CRT at a radiation dose around 30-40 Gy (UI-CRT group) while 10 others could complete CRT without interruption (C-CRT group) CRT. Total serum protein levels were significantly decreased after CRT in all patients. Discussion: It is suggested that therapeutic PEG placement is useful for preventing unplanned interruption of CRT in patients with advanced head and neck cancer. After severe mucositis and inadequate oral intake have developed during CRT, PEG placement should be considered before the radiation therapy dose of 30 Gy. J. Med. Invest. 62: 173-176, August, 2015
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  • Rie Hashimoto, Atsuko Sakai, Masumi Murayama, Arisa Ochi, Tomoki Abe, ...
    2015 Volume 62 Issue 3.4 Pages 177-183
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Background: In recent years, the number of bedridden people is rapidly increasing due to aging or lack of exercise in Japan. This problem is becoming more serious, since there is no countermeasure against it. In the present study, we designed to investigate whether dietary proteins, especially soy, had beneficial effects on skeletal muscle in 59 volunteers with various physical activities. Methods: We subjected 59 volunteers with various physical activities to meal intervention examination. Persons with low and high physical activities were divided into two dietary groups, the casein diet group and the soy diet group. They ate daily meals supplemented with 7.8 g of powdered casein or soy protein isolate every day for 30 days. Bedridden patients in hospitals were further divided into three dietary groups: the no supplementation diet group, the casein diet group and the soy diet group. They were also subjected to a blood test, a urinalysis, magnetic resonance imaging analysis and muscle strength test of the knee before and after the meal intervention study. Results: Thirty-day soy protein supplementation significantly increased skeletal muscle volume in participants with low physical activity, compared with 30-day casein protein supplementation. Both casein and soy protein supplementation increased the volume of quadriceps femoris muscle in bedridden patients. Consistently, soy protein significantly increased their extension power of the knee, compared with casein protein. Although casein protein increased skeletal muscle volume more than soy protein in bedridden patients, their muscle strength changes by soy protein supplementation were bigger than those by casein protein supplementation. Conclusions: The supplementation of soy protein would be one of the effective foods which prevent the skeletal muscle atrophy caused by immobilization or unloading. J. Med. Invest. 62: 177-183, August, 2015
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  • Mitsuhiro Yasuda, Toru Ikegami, Daisuke Imai, Huanlin Wang, Yuki Bekki ...
    2015 Volume 62 Issue 3.4 Pages 184-187
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Introduction. Living donor liver transplantation (LDLT) using ABO-incompatible (ABOi) graft for acute liver failure (ALF) is a developing treatment modality. Methods. We reviewed the changes in our treatment strategies in applying ABOi LDLT for FH over our fourteen years of experience. Results. Five patients with ALF received LDLT in adults using ABOi grafts, with different but gradually renewed protocols. The etiologies for acute liver failure included autoimmune hepatitis (n=3) and unknown (n=2). The desensitization protocol for ABOi barrier included Case #1; local infusion (portal vein)+plasma exchange (PE), Case #2; local infusion (hepatic artery)+rituximab+PE, Case #3 and #4; rituximab+PE, and Case #5; rituximab+PE under high-flow continuous hemodiafiltration. Local infusion was abandoned since Case #3, because Case #1 had portal vein thrombosis resulting in graft necrosis and Case #2 had hepatic artery dissection. The patients (Case #2 and #3), who received rituximab within 7 days before LDLT, experienced antibody-mediated rejection. Thus, the most recent protocol for ABOi-LDLT is that rituximab is given 2 weeks before LDLT, followed by high-flow continuous hemodiafiltration to obstacle hepatic encephalopathy until LDLT. The four patients except Case #1 are doing well with good graft function over 3.8±3.7 years. Conclusion. Rituximab-based ABOi-LDLT, most-recently under high-flow hemodiafiltration for treating encephalopathy, is a feasible option for applying LDLT for ALF. J. Med. Invest. 62: 184-187, August, 2015
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  • Hitomi Kamo, Seiki Tashiro, Kazuo Yoshioka, Yuko Sumise, Natsu Okitsu, ...
    2015 Volume 62 Issue 3.4 Pages 188-194
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Purposes: Pancreatoduodenectomy (PD) was performed for 6 periampullary cancer patients by using methods verified by quality randomized controlled trials (RCT) in a low-volume center (LVC). The purpose of this study was to verify the clinical results. Methods: No-touch pylorus-resecting pancreatoduodenectomy (PrPD), antecolic gastrojejunostomy, pancreatico-jejunostomy with a lost stent tube to the main pancreatic duct, and early removal of a prophylactic drain were performed. Results: The drain could be removed 4 days after operation, and no pancreatic fistula was observed in all cases. Solid food could be started on POD4 after removing the drain. Furthermore, postoperative systemic chemotherapy could be started earlier. Conclusion: Although we have only a few PD cases a year in our institution, PD can be conducted safely without complications by using the methods verified by quality RCTs. J. Med. Invest. 62: 188-194, August, 2015
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  • Chisato Tomida, Kana Aibara, Naoko Yamagishi, Chiaki Yano, Hikaru Naga ...
    2015 Volume 62 Issue 3.4 Pages 195-198
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    A number of anti-angiogenic drugs targeting vascular endothelial growth factor receptors (VEGF-R) have developed and enabled significant advances in cancer therapy including colorectal cancer. However, acquired resistance to the drugs occurs, leading to disease progression, such as invasion and metastasis. How tumors become the resistance and promote their malignancy remains fully uncertain. One of possible mechanisms for the resistance and the progression may be the direct effect of VEGF-R inhibitors on tumor cells expressing VEGF-R. We investigated here the direct effect of a VEGF-R-targeting agent, regorafenib, which is the first small molecule inhibitor of VEGF-Rs for the treatment of patients with colorectal cancer, on phenotype changes in colon cancer HCT116 cells. Treatment of cells with regorafenib for only 2 days activated cell migration and invasion, while vehicle-treated control cells showed less activity. Intriguingly, chronic exposure to regorafenib for 90 days dramatically increased migration and invasion activities and induced a resistance to hypoxia-induced apoptosis. These results suggest that loss of VEGF signaling in cancer cells may induce the acquired resistance to VEGF/VEGF-R targeting therapy by gaining two major malignant phenotypes, apoptosis resistance and activation of migration/invasion. J. Med. Invest. 62: 195-198, August, 2015
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  • Yumiko Miyatake, Tetsuya Shiuchi, Tomoyo Ueta, Yasuko Taniguchi, Akari ...
    2015 Volume 62 Issue 3.4 Pages 199-203
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Enhancing exercise motivation is the best way to prevent obesity and diabetes. In this study, we examined whether adiponectin affects locomotion activity in Wister and Spontaneously-Running Tokushima-Shikoku (SPORTS) rats using two types of behavioral assays: home cage and wheel running activity. SPORTS rats were established from an original line from Wister strain that had shown high level of wheel running activity in our laboratory. Injection of adiponectin into the lateral ventricle of Wister rats and SPORTS rats decreased home cage activity, but no change was observed in the food intake and oxygen consumption. This result indicates the possibility that adiponectin can reduce non-exercise activity thermogenesis (NEAT) and physical activity via the central nervous system. In contrast, injection of adiponectin did not change wheel running activity in SPORTS rats. We produced hypothalamus-destructed model rat using monosodium glutamate (MSG) to elucidate the regulation site of adiponectin. Injection of adiponectin into MSG-treated SPORTS rats did not change amount of home cage activity and food intake, suggesting that adiponectin action on home cage activity was in the hypothalamic area. These results suggest that adiponectin regulates locomotion activity through mediobasal hypothalamus. J. Med. Invest. 62: 199-203, August, 2015
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  • Atsuko Aki, Masahito Tomotake
    2015 Volume 62 Issue 3.4 Pages 204-208
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Aims: The purpose of the present study was to evaluate the changes of levels of depression and quality of life in adolescent students after receiving short-term cognitive behavioral educational program in health class for stress management. Methods: Subjects were 176 middle school students aged 12 to 14 years. They completed the Depression Self-Rating Scale for Children (DSRS-C) and the Revised Children Quality of Life Questionnaire (Kiddo-KINDLR) before, after and 6-months after the program. The three-session program consisted of psychoeducation and learning skills of cognitive restructuring and problem solving. Results: The total scores of the DSRS-C and the Kiddo-KINDLR in all subjects did not significantly change after the completion of program. However, as for the high risk group (score of the DSRS-C≥16), significant improvement in the two scales was found after the program. Especially, depression level in the high risk group significantly decreased and the improvement was maintained 6-months later. Conclusion: These results suggest that this type of approach may be effective for adolescents with high risk of depression in terms of improving not only depressive symptom but also quality of life. J. Med. Invest. 62: 204-208, August, 2015
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  • Yuji Shiozaki, Hiroko Segawa, Saori Ohnishi, Akiko Ohi, Mikiko Ito, Ic ...
    2015 Volume 62 Issue 3.4 Pages 209-218
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    NaPi-IIc/SLC34A3 is a sodium-dependent inorganic phosphate (Pi) transporter in the renal proximal tubules and its mutations cause hereditary hypophosphatemic rickets with hypercalciuria (HHRH). In the present study, we created a specific antibody for opossum SLC34A3, NaPi-IIc (oNaPi-IIc), and analyzed its localization and regulation in opossum kidney cells (a tissue culture model of proximal tubular cells). Immunoreactive oNaPi-IIc protein levels increased during the proliferative phase and decreased during differentiation. Moreover, stimulating cell growth upregulated oNaPi-IIc protein levels, whereas suppressing cell proliferation downregulated oNaPi-IIc protein levels. Immunocytochemistry revealed that endogenous and exogenous oNaPi-IIc proteins localized at the protrusion of the plasma membrane, which is a phosphatidylinositol 4,5-bisphosphate (PIP2) rich-membrane, and at the intracellular vacuolar membrane. Exogenous NaPi-IIc also induced cellular vacuoles and localized in the plasma membrane. The ability to form vacuoles is specific to electroneutral NaPi-IIc, and not electrogenic NaPi-IIa or NaPi-IIb. In addition, mutations of NaPi-IIc (S138F and R468W) in HHRH did not cause cellular PIP2-rich vacuoles. In conclusion, our data anticipate that NaPi-IIc may regulate PIP2 production at the plasma membrane and cellular vesicle formation. J. Med. Invest. 62: 209-218, August, 2015
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  • Ichiro Tonogai, Mitsuhiko Takahashi, Takahiko Tsutsui, Tomohiro Goto, ...
    2015 Volume 62 Issue 3.4 Pages 219-222
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Radioulnar length discrepancy causes pain and decreases function of the wrist, forearm, and elbow. Limb lengthening, which has been used in the treatment of various deformities of the forearm, is necessary to restore balance between the ulna and radius. We treated 5 limbs in 3 patients (2 boys, 1 girl; mean age 9.3 years old) with radioulnar length discrepancy by distraction osteogenesis of either the ulna or radius using external fixators. We dissected the interosseous membrane between the ulna and radius in 3 limbs in 2 cases and did not do so in 2 limbs of 1 case. These cases include 2 cases with hereditary multiple exostoses, and 1 case with multiple epiphyseal dysplasia. The results were investigated and evaluated in this study, using appropriate clinical and radiographic parameters, noting the state of the interosseous membrane, which has an important role in forearm stability. The mean fixation period was 113 days. The mean distraction distance was 22.8 mm. The mean follow-up period was 637.7 days. The mean ulnar shortening and radial articular angle respectively improved from 7.4 mm and 30.2° preoperatively to -0.1 mm and 34.8° postoperatively. Balance between the ulna and radius was restored, and the results showed significant improvements in range of motion of the joints. However, 2 unintended radial head subluxations occurred in 2 limbs without dissection of the interosseous membrane. In addition, a keloid remained in 1 limb due to pin site infection. Forearm lengthening by distraction osteogenesis was useful in our cases. It is important to recognize the function of the interosseous membrane when lengthening is performed by osteotomy of the proximal ulna by gradual distraction with an external fixator. J. Med. Invest. 62: 219-222, August, 2015
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  • Jun Higashijima, Mitsuo Shimada, Takashi Iwata, Kozo Yoshikawa, Toshih ...
    2015 Volume 62 Issue 3.4 Pages 223-227
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Background: Lymph nodes (LNs) dissection around inferior mesenteric artery (IMA) with left colic artery (LCA) preservation is difficult due to the anatomical feature of IMA. The aim of this study is to evaluate the usefulness of new ports placement inserted from a suprapubic region in laparoscopic LNs dissection around IMA with LCA preservation for sigmoid colon and ractal cancer. Methods: Twenty-two patients who underwent laparoscopic colectomy for sigmoid colon and recal cancer were included. The new ports placement group (n=15, new group) was compared with the basic ports placement group (n=7, basic group). Average number of harvested LNs, total operation time, central LNs dissection time, intraoperative blood loss were compared. Results: There was no significant difference in the average number of harvested LNs. The mean of intraoperative blood loss of new group was significantly lower than that of the basic group (40.0±39.8 ml vs 95.7±81.0 ml, p<0.05). In addition, the mean of operation time of the new group was significantly shorter than that of the basic group (250.0±55.7 min vs 353.4±80.2 min, p<0.05). Conclusions: The new ports placement is useful in laparoscopic LNs dissection around IMA with LCA preservation for sigmoid colon and rectal cancer. J. Med. Invest. 62: 223-227, August, 2015
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  • Naoya Doi, Yosuke Sakai, Yasuyuki Miyazaki, Akio Adachi, Masako Nomagu ...
    2015 Volume 62 Issue 3.4 Pages 228-232
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    We recently constructed two rhesus macaque-tropic human immunodeficiency virus type 1 (HIV-1rmt) clones with CXCR4 or CCR5 tropism, but a CCR5-tropic HIV-1rmt clone grew more poorly than a CXCR4-topic clone. It has been demonstrated that interaction between viral Gag-matrix (MA) and Env-gp41 cytoplasmic tail is important for virion-incorporation of Env. Concordantly, Gag-MA mutations (62QR and 66SR) that rescue defects in virion-incorporation of Env/viral replication were reported. In this study, we analyzed effects of these Gag-MA mutations on R5-tropic HIV-1rmt replication potentials. While introduction of 62QR into three HIV-1rmt clones tested reduced their multi-cycle replication ability in rhesus lymphocytes or abolish single-cycle infectivity for luciferase reporter cells, three R5-tropic HIV-1rmt clones carrying 66SR exhibited similar growth kinetics to those of their parental clones. One such clone, 66SR+5gtu, appeared to induce stronger cytopathic effects than parental clone 5gtu. We therefore investigated effects of 66SR mutation on viral replication in more detail. Single-cycle infectivity of 66SR+5gtu was enhanced relative to that of 5gtu, but 66SR+5gtu virion production was significantly decreased compared to the 5gtu level. Gag-MA 66SR mutation may be useful to improve growth potentials of the R5-tropic HIV-1rmt clones. J. Med. Invest. 62: 228-232, August, 2015
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  • Masanari Watanabe, Jun Kurai, Hiroyuki Sano, Eiji Shimizu
    2015 Volume 62 Issue 3.4 Pages 233-237
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Background: Epidemiological investigations indicate that an Asian dust storm (ADS) can aggravate respiratory disorders. However, the effects of ADS on airway inflammation remain unclear. The aim of this study was to investigate the association of exposure to ADS with airway inflammation. Methods: The subjects were 33 adult patients with asthma who measured daily peak flow expiratory (PEF) from March to May 2012. Fractional exhaled nitric oxide (FeNO) was measured before and after ADS. Results: The FeNO values were 13.8±13.7 ppb before the ADS and 20.3±19.0 ppb after the ADS, with no significant difference. There was also no significant association of PEF with ADS exposure. However, the increase of FeNO after ADS exposure was proportional to the decrease of PEF (R=-0.78, P<0.0001). Conclusion: These results suggest that airway inflammation aggravated by ADS exposure may induce a decrease in pulmonary function in some adult patients with asthma. J. Med. Invest. 62: 233-237, August, 2015
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Case reports
  • Mitsunobu Abe, Yoichiro Takata, Kosaku Higashino, Toshinori Sakai, Tet ...
    2015 Volume 62 Issue 3.4 Pages 238-241
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen. J. Med. Invest. 62: 238-241, August, 2015
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  • Takahiko Tsutsui, Tomohiro Goto, Daisuke Hamada, Ichiro Tonogai, Kazua ...
    2015 Volume 62 Issue 3.4 Pages 242-244
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Periprosthetic femoral fractures with implant loosening are difficult to treat, especially when accompanied by severe bone loss. We report here the treatment outcomes of 4 patients (1 man, 3 women; age range 69-86 years) with periprosthetic femoral fractures and implant loosening after bipolar hemiarthroplasty. Fractures were classified according to the Vancouver classification as type B2 and B3, with adequate or compromised bone stock, respectively. One patient was initially treated conservatively but symptoms due to implant loosening persisted and revision surgery was required. All patients underwent revision using a long-stem cementless implant with interlocking screws as well as a cancellous allograft to augment the bone stock. At final follow-up (mean, 25 months), all patients had stable implant fixation, bony union of the fracture, and marked recovery of the proximal femoral bone stock through allograft use. This revision procedure achieved implant fixation and fracture healing with reconstitution of the femur even in the short term and even in cases with severe bone deficiency. J. Med. Invest. 62: 242-244, August, 2015
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  • Kosuke Sugiura, Naoto Suzue, Tetsuya Matsuura, Daisuke Hamada, Tomohir ...
    2015 Volume 62 Issue 3.4 Pages 245-247
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    A ganglion cyst is a cystic lesion containing myxoid matrix and lined by a pseudomembrane. A ganglion cyst arising from the infrapatellar fat pad is very rare, with only a few reports appearing in the literature, and the present case is the first report of this lesion in a child. A 10-year-old boy presented with right knee pain that showed no improvement despite resting from sports activity for 1 month. Magnetic resonance imaging revealed a multilobular mass between the infrapatellar fat pad and anterior cruciate ligament. Arthroscopic excision of the mass was performed. The mass was noted to arise from the infrapatellar fat pad and was filled with myxoid matrix. The histological diagnosis was a ganglion cyst. In active pediatric patients with pain or limited range of motion in the knee, physicians should consider the possibility of a ganglion cyst from the infrapatellar fat pad, despite its rarity. J. Med. Invest. 62: 245-247, August, 2015
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  • Yasuyuki Omichi, Ichiro Tonogai, Shinsuke Kaji, Teruaki Sangawa, Koich ...
    2015 Volume 62 Issue 3.4 Pages 248-250
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Meralgia paresthetica (MP) causes tingling, stinging or a burning sensation in the anterolateral part of the thigh, usually as a result of entrapment of the lateral femoral cutaneous nerve (LFCN) at the inguinal ligament (IL) due to mechanical or iatrogenic injury. However, there are few reports on MP caused by entrapment of the LFCN at a more distal site from the IL. We report here a rare case of MP caused by entrapment of the LFCN at the fascia lata of the thigh level. A 23-year-old man felt numbness and sharp pain at the anterolateral aspects of both thighs soon after direct repair surgery for L5 isthmic spondylolisthesis. Although his symptoms were relieved a few days later, numbness and sharp pain in the right thigh recurred 6 months after the surgery. A diagnosis of MP was made, and decompression of the LFCN was performed because conservative treatment for MP was inadequate. Intraoperatively, it was noted that the LFCN was entrapped underneath the fascia lata of the thigh, not at the IL level. His symptoms disappeared after LFCN was released. This case demonstrates that it is necessary to consider the possibility of entrapment of the LFCN at the fascia lata at the thigh level in MP. J. Med. Invest. 62: 248-250, August, 2015
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  • Kazuhiro Kishi, Akihiko Fujisawa, Minoru Horikita, Yoshihiro Nakai, Ka ...
    2015 Volume 62 Issue 3.4 Pages 251-257
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Gastric neuroendocrine tumor (NET) is sometimes found as a submucosal tumor on upper gastrointestinal endoscopy. Gastric NET with malignant profile and neuroendocrine carcinoma (NEC) show various forms which are difficult to distinguish from gastric cancer and other disease. We report a case of a cauliflower-shaped NET of the stomach. A 61-year-old man was referred to our hospital with a complaint of abdominal fullness. Upper gastrointestinal endoscopic examination revealed an unusual, whitish cauliflower-shaped tumor that belongs to Borrmann type I on the lesser curvature of the gastric antrum. Histological examination of the biopsy specimen revealed NET G2, because the tumor cells were CD56- and synaptophysin-positive by immunohistochemical analysis. A distal gastrectomy with D2 lymphadenectomy was performed. A recurrence in the liver was revealed by follow up computed tomography after 11 months from operation. Combined chemotherapy with irinotecan (CPT-11) plus cisplatin (CDDP) was treated. The patient achieved a partial response, but he died after 31 months from gastrectomy. There is no independent, large-scaled prospective study and no standard treatment for gastric NETs with distant metastases. Our case is reported with a literature review of the treatment of metastatic gastric NET G2. J. Med. Invest. 62: 251-257, August, 2015
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  • Kazuma Wada, Naohito Hibino, Kenji Kondo, Shinji Yoshioka, Tomoya Tera ...
    2015 Volume 62 Issue 3.4 Pages 258-260
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon. J. Med. Invest. 62: 258-260, August, 2015
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  • Shingo Hama, Daisuke Hamada, Tomohiro Goto, Takahiko Tsutsui, Ichiro T ...
    2015 Volume 62 Issue 3.4 Pages 261-263
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    In this report, we present a case of a 64-year-old woman who underwent revision of knee arthroplasty after failed unicompartmental knee arthroplasty (UKA). She underwent UKA (Biomet Oxford Phase 3) for right localized medial knee pain at the age of 53 and the postoperative course had been uneventful. Eight years after UKA, she had right knee pain that gradually worsened. Tenderness was present over the medial femorotibial and patellofemoral (PF) joints. Plain radiograph showed small osteophytes on the intercondylar eminence and in the lateral compartment. However, these findings were not severe. Although several causes of knee pain after UKA have been reported, none of those causes were found in this case, so the diagnosis of unexplained pain was made. We performed knee arthroscopy and it revealed severe osteoarthritis of the PF joint, bone attrition and exposure of subchondral bone of the medial part of the lateral condyle together with severe synovitis. Revision surgery was performed in the same operation. The postoperative course was excellent and the severe knee pain resolved after surgery. Several registries revealed that revision for unexplained pain was more common after UKA than after total knee arthroplasty. We pointed out the possible causes of unexplained pain including pathological conditions, which were present in our case. Revision surgery may be unsuccessful if the cause of failure is not adequately considered. J. Med. Invest. 62: 261-263, August, 2015
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  • Seiya Inoue, Takanori Miyoshi, Mariko Aoyama, Naoki Hino, Shinichi Yam ...
    2015 Volume 62 Issue 3.4 Pages 264-267
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    We report the case of a 50-year-old female Jehovah's Witness with advanced esophageal cancer who underwent esophagectomy following induction chemotherapy. She visited our hospital complaining of dysphagia and was diagnosed of advanced esophageal cancer by upper endoscopy. She refused allogeneic transfusion. Induction chemotherapy was performed. Severe anemia occurred as an adverse event. A subtotal esophagectomy was performed after her anemia improved. During the surgery, a large volume of replacement fluid was injected, the blood was diluted, and intraoperative bleeding was relatively reduced. Intraoperative blood salvage was made using Cell Saver. The postoperative course were stable by using autologous blood and albumin infusion. The patient was discharged on postoperative day 27. Jehovah's Witnesses with gastrointestinal malignancies can be treated safely by performing surgical therapy based on blood replacement therapy and autologous blood transfusion. J. Med. Invest. 62: 264-267, August, 2015
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  • Mariko Aoyama, Shinichi Yamasaki, Masaru Tsuyuguchi
    2015 Volume 62 Issue 3.4 Pages 268-271
    Published: 2015
    Released: September 18, 2015
    JOURNALS FREE ACCESS
    This is a case of a woman who was diagnosed with resistance to thyroid hormone after total thyroidectomy for thyroid cancer. Preoperative laboratory examination revealed the syndrome of inappropriate secretion of TSH, however, the patient had no thyrotoxic symptoms and no family history. Based on the results of ultrasonography and fine needle aspiration, she was diagnosed with papillary thyroid carcinoma and underwent total thyroidectomy. After the surgery, she received L-T4 therapy, but her TSH levels remained elevated. MRI was performed on the brain, but no lesions were found in the pituitary gland. Therefore, she was tested for TRβ gene, and a previously defined mutation, P453S, was detected. Ultimately, she was diagnosed as RTH and treated with L-T4. In this case, the dose of L-T4 needed to be increased to suppress her TSH levels to the normal range or less, and to prevent stimulating malignant cells. Currently, her dose of L-T4 has been increased, and her TSH levels are still lower than normal, however, she has no thyrotoxic symptoms, recurrence or metastasis of thyroid cancer. The patient is currently under careful observation regarding her circulatory and physiological status. In addition, the results of treatment still need to be monitored and evaluated. J. Med. Invest. 62: 268-271, August, 2015
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