Familial Wolff‐Parkinson‐White (WPW) syndrome is an autosomal dominant inherited disease and consists of a small percentage of WPW syndrome which exhibits ventricular pre‐excitation by development of accessory atrioventricular pathway. A series of mutations in PRKAG2 gene encoding gamma2 subunit of 5'AMP‐activated protein kinase (AMPK) has been identified as the cause of familial WPW syndrome. AMPK is one of the most important metabolic regulators of carbohydrates and lipids in many types of tissues including cardiac and skeletal muscles. Patients and animals with the mutation in PRKAG2 gene exhibit aberrant atrioventricular conduction associated with cardiac glycogen overload. Recent studies have revealed “novel" significance of canonical pathways leading to glycogen synthesis and provided us profound insights into molecular mechanism of the regulation of glycogen metabolism by AMPK. This review focuses on the molecular basis of the pathogenesis of cardiac abnormality due to PRKAG2 mutation and will provide current overviews of the mechanism of glycogen regulation by AMPK. J. Med. Invest. 65:1‐8, February, 2018

The prostate is surrounded by periprostatic adipose tissue. Although adipose tissue was thought to play limited physiological roles, it has recently been recognized as an active endocrine organ, secreting growth factors and adipokines. Epidemiologically, obesity is associated with prostate cancer progression. A major mechanism to explain the link between obesity and cancer includes the insulin and insulin‐like growth factor (IGF)‐1 axis, sex steroids, and adipokines. When prostate cancer cells invade periprostatic adipose tissue, adipose tissue contributes to create the tumor microenvironment, mainly via adipokine secretion. Furthermore, direct crosstalk between adipocytes and cancer cells can exist. We showed that fatty acid‐binding protein 4 (FABP4) released from adipocytes was taken up into prostate cancer cells and may act as a carrier of an energy source for the invasion. Bone is an adipocyte‐rich organ and is the common metastatic site of prostate cancer. In the microenvironment of bone metastases, tumor cells, osteoblasts, osteoclasts, adipocytes, and other stromal cells are interacting with one another and organizing a complex system. Thus, growing evidence implicates adipose tissue as a critical contributor to the development of prostate cancer. A deeper understanding of the mechanisms leads to more effective therapeutic strategies for prostate cancer. J. Med. Invest. 65:9‐17, February, 2018

Objective:Individuals with CP have a lower life expectancy than the general population. The objective of the study is to investigate the risk factor of mortality in Indonesian children with CP. Methods:An observational analytic study was conducted using medical records at pediatric ward Dr. Soetomo Hospital, Surabaya, Indonesia, from January 2014 to December 2016. Inclusion criteria was all of CP patients in that were hospitalized from 6 months to 14 year of age. Mortality information was obtained from annual computer and matched against the subjects with CP on the basis of name, date of birth, type of disability, degree of disability, nutritional status and the outcomes. Risk factors were counted using logistic regression. Result:Fifty five children were enrolled. The outcome revaled 12 patients (21.8%) were death. Pneumonia was the most common underlying disease cause of death (OR=5.185;95% CI 1.249 to 21.520;Psize 8 < 0.007). Other risk factors of mortality that significant were acute kidney injury (AKI) (OR=3.333;95% CI 1.317 to 8.436;Psize 8 < 0.03). and Gross Motor Functioning Classification System (GMFCS) more than level IV (OR=1.480;95% CI 1.184 to 1.850;Psize 8 < 0.006). Conclusion:Pneumonia, AKI and severe GMFCS level were risk factors of death in patients with CP. J. Med. Invest. 65:18‐20, February, 2018

The preliminary study analyzed the relationship between intraoperative navigation‐based kinematics and postoperative 2‐dimensional/3‐dimensional (2D/3D) image registration‐based kinematics in total knee arthroplasty (TKA). Six knees in 5 patients were analyzed. All TKA procedures were performed using an image‐free knee navigation system. Tibial internal rotation was assessed by intraoperative knee kinematics. At 1 year after surgery, tibial internal rotation was evaluated using a 2D/3D image registration technique under loaded and unloaded conditions. The correlation between intraoperative and postoperative data for the tibial internal rotation angle at 10 increments of knee flexion was then assessed. Difference in the knee flexion angle between the intraoperative and postoperative evaluations was adjusted to account for the sagittal cutting angle of the distal femur and proximal tibia. A correlation was found between the intraoperative and postoperative data for loaded knee flexion with this adjustment (Pearson's r = 0.725, p = 0.012). However, intraoperative kinematics was not significantly correlated with postoperative kinematics in the absence of loading. Larger adequately powered prospective studies are now needed to confirm our preliminary finding that postoperative loaded kinematics can be predicted by intraoperative evaluation. J. Med. Invest. 65:21‐26, February, 2018

Background:Surgical indication for hepatic resection is controversial in gastric cancer liver metastasis (GLM). The aim of this study is to clarify the effect of hepatic resection for GLM. Methodology:Ten patients who underwent hepatic resection for GLM between 2001 and 2013 were enrolled in this study. Six patients underwent synchronous hepatic resection and gastrectomy, and the remaining four patients underwent metachronous hepatic resection. Six patients had solitary liver metastasis, and 4 patients had multiple liver metastasis. The median follow‐up period was 12.4 months (the range being 0.5 months to 50 months). Result:The actual 1‐ year and 3‐year overall survival rates for the patients who underwent hepatic resection are 88.9% and 17.8%, respectively. The median survival time was 21.5 months. And the 1‐year recurrence free survival time was 20.0%. The median recurrence free survival rate was 4.7 months. Regarding post‐operative recurrence, synchronous hepatic resection tended to be a recurrence factor (p=0.08). Conclusion:Hepatic resection for GLM has an acceptable outcome. Metachronous hepatic resection tends to have a better outcome than synchronous hepatic resection for the treatment of GLM. J. Med. Invest. 65:27‐31, February, 2018

n emergency and critical care medical centers, tube administration is employed for patients who have difficulty swallowing oral drugs owing to decreased consciousness or mechanical ventilation. However, tube clogging due to drug injection is a concern. We compared the crushing method with the simple suspension method for the passage of amlodipine, an antihypertensive drug, in combination with rikkunshito, which has been used to treat upper gastrointestinal disorders such as functional dyspepsia and gastroesophageal reflux in emergency and critical care medical centers, to ascertain the effect of Kampo products on the passage of other drugs during tube administration. When the crushing method was employed, poorly water‐soluble solid products were formed, while a uniformly dispersed suspension was obtained using the simple suspension method. In addition, the passage rate of amlodipine through the tube was 64% and 93% in the crushing and simple suspension methods, respectively, thereby indicating that the simple suspension method provided more favorable than the crushing method. The results of this study suggested that the passage rate of amlodipine for patients who received Kampo products concurrently was higher when the simple suspension method was used, and an appropriate drug amount might well be able to administered to patients using this method. J. Med. Invest. 65:32‐36, February, 2018

Background:The treatment strategy for jaundiced patients with hilar cholangiocarcinoma (HC) is not well established. In this study, we evaluate the feasibility of our perioperative protocol for jaundiced patients with HC. Methods:Twenty patients with HC who underwent hepatic resection at our institute were enrolled, and patients were divided into icteric(n=6) and normal(n=14) group. As a perioperative protocol, Oral administration of Inchinkoto(ICKT), steroid and nafamostat mesilate were introduced. The evaluation of functional future remnant liver(FRL) by asiaroscintigraphy, and postoperative outcomes were retrospectively compared. Results:Indocyanine green dye retention rate at 15 minutes was higher, and LHL15 values was lower in icteric group. However, in the functional evaluation of FRL, which was the sum of GSA uptake of the future FRL, there was no significant difference of LHL15 values of the remnant liver functional reserve between the two groups. As results, according to the difference of liver function, serum AST level was not different between two groups. The number of patients with postoperative morbidity in the two groups was comparable. Conclusions:Even in HC patients with icteric liver, accurate assessment of liver functional reserve and effective perioperative treatment may attribute to successful hepatectomy and favorable post‐operative outcomes. J. Med. Invest. 65:37‐42, February, 2018

Tapioca milk tea, the most popular beverage in Taiwan, is consumed a lot by Taiwanese which contributed to their daily sugar intake. Our study purpose is to investigate whether limiting intake of tapioca milk tea is useful for the control of sugar intake in Taiwanese. The study was conducted in questionnaires selected 38 subjects, 20‐24 y, from 341 university students in Kaohsiung City, Taiwan. Subjects were match‐paired by sex, age, department, and randomly divided into two groups for cross‐over design in which each group had 1 week with or without tapioca milk tea. Other beverages and foods were allowed freely in both periods. Each group member recorded their own daily sugary intake for two weeks and was confirmed by researchers the next day. The average sugar intakes with or without tapioca milk tea were similar between the two treatments (p 0.05), 58.4 23.2 g/day and 56.5 22.2 g/day (glucose 25%, fructose 19%, sucrose 53%, lactose 3%). With or without tapioca milk tea, 85% of sugar intakes came from beverages. Even by limiting tapioca milk tea, the subjects took the same sugar amount from other beverages, suggesting that an established sugar intake level is hard to change. J. Med. Invest. 65:43‐49, February, 2018

Refeeding syndrome (RFS) is characterized by the metabolic and clinical changes that occur following aggressive nutritional supplementation in malnourished patients. Hypophosphatemia is the hallmark of RFS and is key to its prevention and treatment in clinical practice. However, the mechanism of hypophosphatemia during RFS is unclear because of the lack of an animal model. In this study, we developed a rat RFS model as a first step to clarifying the molecular mechanism. After establishing the parenteral route, rats were fasted for 5 days and refeeding was started using total parenteral nutrition. The animals were infused with a high calorie solution with or without insulin administration. Results showed that plasma phosphate levels did not decrease in rats infused with the high calorie solution alone;in contrast, a 20% reduction compared to baseline was observed in rats administered insulin. In addition, rats infused with the high calorie solution containing added phosphate did not present with hypophosphatemia. Thus, we developed a rat RFS model with hypophosphatemia by tube feeding and insulin administration, and demonstrated the importance of phosphate in preventing refeeding hypophosphatemia. J. Med. Invest. 65:50‐55, February, 2018

Low back pain (LBP) often occurs in baseball players;however, the characteristics of the location of their LBP with respect to their throwing and hitting sides have not been clarified. In order to clarify the left‐right asymmetry of LBP that occurs in baseball players, we surveyed 247 university baseball players using an LBP questionnaire. The main investigational items were:throwing and hitting side, position at the time of LBP experience, and LBP location. Based upon the indication of their throwing and hitting side, subjects were classified into unilateral rotational (UR) or bilateral rotational (BR) types. Subjects were also classified into categories of LBP location as described by ipsilateral or contralateral to dominant side of throwing or hitting. Chi‐square test or Fisher exact test were used to compare LBP location side by rotational type (UR/BR) in all subjects and by position (pitcher/fielder). We found that among fielders, LBP occurring contralateral to the hitting side in UR was significantly more frequent than that in BR. We conclude that LBP occurred in baseball fielders with a left‐right asymmetry, which suggests that high frequency unilateral rotation causes the lumbar region contralateral to the dominant hitting side to be subject to a high load. J. Med. Invest. 65:56‐59, February, 2018

Aim:To evaluate the anatomical changes in the ciliary body (CB) during naturally stimulated accommodation in children using anterior segment optical coherence tomography (OCT). Methods:This study was a prospective, observational, noncomparative case series included 18 eyes of 9 children (8 males and 1 female) aged from 4 to 10 years. Ciliary body thickness (CBT) was measured temporally by Anterior OCT at 1, 2 and 3 mm posterior to the scleral spur. Measurements were performed in the accommodated state and the unaccommodated state (with cycloplegia). Results:The mean CBT significantly increased by accommodation at 1 mm posterior to the scleral spur from 751 42 to 818 40 μm (P 0.001) and significantly decreased at 2 and 3 mm from 506 66 to 445 59 μm and from 290 54 to 240 50 μm respectively (P 0.001). Conclusion:During accommodation, the anterior portion of the ciliary body thickens, while the posterior portion decreases in thickness. These findings imply that the circular ciliary muscles are mainly involved in accommodation and not the longitudinal muscles. J. Med. Invest. 65:60‐63, February, 2018

Hypoxia‐induced plasma levels of VEGF and sFlt‐1 are responsible for increased vascular permeability occurred in both brain and pulmonary edema. Currently, it remains unclear the exact roles of VEGF and sFlt‐1 in High Altitude Pulmonary Edema (HAPE) pathogenesis. In this study, plasma levels of VEGF and sFlt‐1 from 10 HAPE and 10 non‐HAPE subjects were measured and compared. The results showed that plasma levels of both VEGF and sFlt‐1 in HAPE patients were significantly increased as compared to the non‐HAPE group. Interestingly, increased plasma levels of these two protein factors were markedly reduced after treatments. As compared to VEGF, sFlt‐1 was much more affected by hypoxia and treatments, suggesting this factor was a key factor contributed to HAPE pathogenesis. Importantly, the ratio of sFlt‐1 and VEGF in group of either non‐HAPE or HAPE after recovery was significantly lower than the ratio in HAPE patients prior to treatments. Our findings suggested that sFlt‐1 was a key factor that involved in HAPE pathogenesis and the sFlt‐1/VEGF ratio could be used as a sensitive diagnostic marker for HAPE. J. Med. Invest. 65:64‐68, February, 2018

Robot‐assisted laparoscopic radical prostatectomy (RALRP) is commonly performed in the surgical treatment of prostate cancer. However, the steep Trendelenburg position (25) and pneumoperitoneum required for this procedure can sometimes cause hemodynamic changes. Although blood pressure is traditionally monitored invasively during RALRP, the ClearSight system (BMEYE, Amsterdam, The Netherlands) enables a totally noninvasive and simple continuous blood pressure and cardiac output monitoring based on finger arterial pressure pulse contour analysis. We therefore investigated whether noninvasive continuous arterial blood pressure measurements using the ClearSight system were comparable to those obtained invasively in patients undergoing RALRP. Ten patients scheduled for RALRP with American Society of Anesthesiologists physical status I‐II were included in this study. At each of the seven defined time points, noninvasive and invasive blood pressure measurements were documented and compared in each patient using Bland‐Altman analysis. Although the blood pressure measured with the ClearSight system correlated with that measured invasively, a large difference between the values obtained by the two devices was noted. The ClearSight system was unable to detect blood pressure accurately during RALRP, suggesting that blood pressure monitoring using this device alone is not feasible in this small patient population. J. Med. Invest. 65:69‐73, February, 2018

Epidemiological investigations have shown that consumption of soybeans or soy foods reduces the risk of the development of cardiovascular disease, cancer and osteoporosis. The aim of this study was to determine the associations between different soy foods and inflammatory markers, including high‐sensitivity C‐reactive protein (hs‐CRP), interleukin (IL)‐6, and IL‐18, in Japanese workers. The cross‐sectional study included 1,426 Japanese workers (1,053 men and 373 women) aged 20 to 64 years. Intake of 12 soy foods was estimated by a validated food frequency questionnaire. Associations of total soy foods, fermented soy food, non‐fermented soy food, soy isoflavone with hs‐CRP, IL‐6, and IL‐18 levels were examined by general linear model regression analysis. We found that total fermented soy food intake was inversely associated with multivariable‐adjusted geometric concentration of IL‐6 in men (Q1:1.03 pg/mL, Q5:0.94 pg /mL;P for trend = 0.031). Furthermore, it was shown that IL‐6 concentrations were inversely associated with miso intake (β = ‐0.068;p = 0.034) and soy sauce intake in men (β = ‐0.074;p = 0.018). This study suggests that intake of total fermented soy food, miso and soy sauce be associated with IL‐6 concentrations in Japanese men. J. Med. Invest. 65:74‐80, February, 2018

Falls cause injuries such as fractures, skin lacerations, bleeding, and head injury, and could result in more severe medical conditions in hospitalized patients. We retrospectively investigated the incidence and characteristics of falls among hospitalized patients in an acute care hospital from incident reports by hospital staff between January and June 2013. There were 154 falls in 135 patients, 2 of which resulted in fracture. The average age of patients who fell was 63.9 (range 0 to 91) years. Many falls occurred at the bedside (68.2%). Approximately half of all falls were related to elimination (46.6%). The most common time of discovery of falls was 2:00‐2:59 AM (14/154;9.1%), followed by early in the morning when patients would actively move. Fall rates in our hospital were 1.39 falls per 1,000 patient days. The department of respiratory medicine and rheumatology had the highest fall rate (3.08 falls per 1,000 patient days), followed by the departments of neurosurgery and neurology (2.98 falls per 1,000 patient days). This study revealed the characteristics of falls in an acute care hospital, and suggests that their notification in the hospital might help reduce the incidence of falls in hospitalized patients. J. Med. Invest. 65:81‐84, February, 2018

Ligamentum flavum (LF) hypertrophy is one of the main factors of lumbar spinal canal stenosis (LSCS). The primary object of this study is to clarify the existence of epiligament in the LF and its role in hypertrophy, and to develop an LF hypertrophy animal model. A cadaveric spine from a 30‐year‐old man was used to investigate the existence of epiligament in LF. Five LF samples from LSCS patients were obtained to evaluate hypertrophied LF. To create a rat model, we destabilized the lumbar spine. Each LF was sagittally cut for histological evaluation. The epiligament was clearly evident in normal LF specimens, which stained pink on Elastica van Gieson and green on Masson Trichrome. One layer was observed on the dural side and another on the dorsal side of the LF. LSCS patients had an enlarged dorsal epiligament, at around 30 times that of the regular thin epiligament on the dural side. The destabilized rat model showed an enlarged dorsal epiligament, with a mean thickness 8‐fold that of the control. LF hypertrophy may be due to enlargement of the dorsal epiligament. Mechanical loading of the LF is an important factor for inducing hypertrophy in the rat model. J. Med. Invest. 65:85‐89, February, 2018

Background:Adjuvant chemotherapy with uracil tegafur (UFT) improved survival among patients with completely resected stage I lung adenocarcinoma. S‐1, an oral dihydropyrimidine dehydrogenase (DPD)‐inhibitory 5‐fluorouracil, is a more potent DPD inhibitor than UFT;therefore, we hypothesized that postoperative adjuvant chemotherapy with S‐1 would be effective for advanced non‐small cell lung cancer (NSCLC). We conducted a feasibility study of S‐1 as postoperative adjuvant chemotherapy in patients with curatively resected pathological stage bold I back 10 bold I and bold I back 10 bold I back 20 bold I A NSCLC. Methods:Adjuvant chemotherapy consisted of 9 courses (4‐week administration, 2‐week withdrawal) of S‐1 at 80‐120 mg/body per day. Twenty‐four patients with completely resected NSCLC were enrolled in this study from November 2007 through December 2010. The primary endpoint was the rate of completion of the scheduled adjuvant chemotherapy. The secondary endpoints were safety, overall survival, and relapse‐free survival. Results:Five patients were censored because of disease recurrence. The planned 9 courses of S‐1 were administered to completion in 8 patients. Twelve patients completed more than 70% of the planned courses. Grade 3 adverse reactions, such as elevated total bilirubin (4.2%) and pneumonitis (4.2%), were observed, but there were no Grade 4 adverse reactions. Patients who completed more than 70% of the 9 courses demonstrated better overall survival than those who completed less than 70%. Conclusion:Postoperative administration of S‐1 may be possible with few severe adverse events as adjuvant chemotherapy for patients with curatively resected pathological stage bold I back 10 bold I ‐bold I back 10 bold I back 20 bold I A NSCLC. J. Med. Invest. 65:90‐95, February, 2018

Background:Factors such as exposed bones or tendons can inhibit wound healing and make it a lengthy process unless aggressive debridement or vascularized flap surgery are performed. We have developed a new procedure involving simultaneous application of a skin graft and perifascial areolar tissue (PAT) and negative pressure wound therapy. Methods:Of 8 patients with wounds, bones, tendons, and thick fascia were exposed in 4, 2, and 2 cases, respectively. These wounds were adequately covered with PAT, and split‐thickness skin grafts were applied simultaneously on the PAT with a VACsize 4.9 bigcirc size 3.5 back 115 up 4 roman R device. Results:In 6 of 8 cases, the skin graft and PAT were successful, and epithelialization was achieved within 4 weeks. PAT adapted but skin graft was unsuccessful in one case, and both the skin graft and PAT failed to adapt of a pressure ulcer. Using the PAT to overlap more than 400% of the exposed areas resulted in better adaptation. Conclusions:This procedure contributed to reducing the burden on the patients because we were able to use a skin graft on the exposed areas, without the need for removal of bone or tendons. This potentially means patients avoid loss of function in the affected areas and achieve better outcomes. J. Med. Invest. 65:96‐102, February, 2018

Geranylgeranylacetone (GGA) is a chaperon inducer that protects various types of cell and tissue against stress. We examined whether GGA modulated energy intake and expenditure under stressful conditions. After mice were untreated or treated orally with GGA (0.16 g per kg body weight per day) for 10 days, they were subjected to 2‐h restraint stress once or once a day for 5 consecutive days. GGA administration did not affect corticosterone response to the stress. Restraint stress rapidly decreased plasma leptin levels in control mice. GGA significantly increased circulating leptin levels without changing food intake and prevented the stress‐induced decline of circulating leptin. However GGA‐treated mice significantly reduced food intake during the repeated stress, compared with control mice. GGA prevented the stress‐induced decline of leptin mRNA and its protein levels in epidydimal adipose tissues. We also found that GGA decreased ghrelin mRNA expression in gastric mucosa before the stress, whereas GGA‐treated mice recovered the ghrelin mRNA expression to the baseline level after the repeated stress. Leptin and ghrelin are now recognized as regulators of anxiety and depressive mood. Our results suggest that GGA may regulate food intake and relief stress‐induced mood disturbance through regulating leptin and ghrelin secretions. J. Med. Invest. 65:103‐109, February, 2018

Capsid (CA) protein is a major virion‐constituent of all retroviruses including human immunodeficiency virus type 1 (HIV‐1), and is essential for early and late phases in viral replication cycle through interaction with numerous cellular factors. In particular, N‐terminal domain (NTD) of HIV‐1 CA has been frequently and well reported to bind to various host cell proteins that considerably affect viral replication potential. In this study, in order to better define biological bases of the CA‐NTD for HIV‐1 replication, we performed an extensive mutational analysis in an unprecedented manner. By aligning CA‐NTD sequences derived from representative infectious molecular clones of HIV‐1, HIV‐2, and simian immunodeficiency virus isolated from the rhesus macaque (SIVmac), a number of amino acids specific to HIV‐1 were selected, and were replaced with those from SIVmac at the corresponding sites. Mutant viruses thus generated were then examined for multi‐cycle infectivity, single‐cycle infectivity, and ability to produce progeny virions. While some CA‐NTD mutations affected viral replication ability to varying degrees, those in helix 7 abolished viral growth potential without exception. These results highlight functional importance of non‐conserved amino acids in helix 7, and give new insights into functionality of HIV‐1 CA‐NTD. J. Med. Invest. 65:110‐115, February, 2018

Objective:This study aimed to determine the perioperative predictors of contrast medium‐induced nephropathy (CIN) after endovascular aortic repair (EVAR). Materials and Methods:The data of 203 consecutive patients who underwent elective EVAR for thoracic and abdominal aortic aneurysm between January 2014 and September 2014 were retrospectively analyzed. CIN was defined according to the diagnostic criteria of the European Society of Urogenital Radiology. Results:Fourteen patients (6.9%) developed CIN after EVAR. Contrast medium volume (CV), preoperative serum creatinine, estimated glomerular filtration rate (eGFR), and the CV/eGFR ratio were significantly related with CIN development after EVAR. The CV/eGFR ratio was significantly higher in patients with CIN than those without CIN. Receiver operator characteristic curve analysis showed that the area under the curve of the CV/eGFR ratio was 0.782, indicating that it was the most important predictor. The appropriate CV/eGFR ratio cutoff was 1.62. Sensitivity and specificity were 85.7% and 65.6%, respectively. Conclusions:The CV/eGFR ratio was a useful predictor of contrast medium‐induced nephropathy after EVAR. It is possible that the score can be used in patients when managing the EVAR techniques and contrast medium volume. J. Med. Invest. 65:116‐121, February, 2018

By using 24 hour urinary creatinine levels, skeletal muscle mass (kg), its rate (%) of body weight and creatinine height index (%) were determined in old Japanese women suffering from walking difficulty in nursing home and compare with those of young university students. Those of old subjects showed approximately 30‐50%, 36‐44% and 44‐46% of young subjects, respectively. It is suggested that these values are important and useful biomarkers for the planning and the achievement of rehabilitation program for the maintaining and restoring skeletal muscle mass and for the careful support by registered care workers to aged persons. J. Med. Invest. 65:122‐125, February, 2018

Purpose:To identify predisposition to spondylolysis and physical characteristics associated with “bone union" following conservative spondylolysis treatment among pediatric and adolescent athletes. Methods:We retrospectively analyzed pediatric and adolescent athletes with spondylolysis who underwent conservative treatment and rehabilitation for three or more consecutive months following sports activity cessation. Patients with terminal spondylolysis or who did not discontinue sports activities were excluded. We compared physical fitness factors in the union and nonunion groups and examined the association between bone union and spondylolysis severity by logistic regression analysis. Results:Of 183 patients with spondylolysis who underwent rehabilitation over a four‐year period, 127 patients with 227 defects were included in the final analysis. Bone union was achieved in 66.5% (151/227) of the pars interarticularis defects and 70.1% (89/127) of the patients. On multivariate analysis, stage of pars interarticularis defect (odds ratio [OR], 0.26;p = 0.0027), stage of contralateral pars interarticularis defect (OR, 0.51;p = 0.00026), and straight leg‐raising test (OR, 1.06;p = 0.028) were significantly associated with bone union. Conclusions:High defect stage, stage of the contralateral pars interarticularis defect, and poor flexibility were negative prognostic factors of bone healing in athletes with spondylolysis. J. Med. Invest. 65:126‐130, February, 2018

Clostridium difficile (C. difficile)‐associated diarrhea (CDAD) is a challenging nosocomial infectious disease. C. DIFF Quik Chek Complete assay is widely used to detect glutamate dehydrogenase (GDH) antigen and toxin A/B of C. difficile simultaneously. However, the interpretation of GDH positive/toxin negative results is problematic. We performed a retrospective study of patients with GDH positive/toxin negative results to determine the probability of detecting toxigenic C. difficile and its risk factors. Between April 2012 and March 2017, we investigated cultures of fecal specimens followed by toxin detection tests. The clinical histories of patients with and without toxigenic C. difficile were compared using univariate‐ and multivariate‐analyses. In total, 2675 patients were examined using C. Diff Quik Chek Complete assay. Among 356 GDH positive/toxin negative patients, cultures were performed in 220 cases and toxigenic C. difficile was recovered from 139 (63.2%) specimens. Patients with toxigenic C. difficile had significantly lower body mass index than those without. Over half the GDH positive/toxin negative patients were infected with toxigenic C. difficile. Lower BMI was a CDAD risk factor in this patient population. These data can be utilized to initiate isolation and clinical interventions before confirmatory test results are available. J. Med. Invest. 65:131‐135, February, 2018

Herein, we describe the operative procedure for combined resection of re‐recurrent lateral lymph nodes and the external iliac vein. There is no consensus on the clinical implications of resection of locally re‐recurrent colorectal tumors, as the operative procedure is extremely difficult. We present the case of a 52‐year‐old woman who underwent abdominoperineal resection. About one year later, we excised a recurrent lymph node in the left lateral obturator area through an extraperitoneal approach. About 18 months later, lymph node re‐recurrence in the left external iliac area was observed. Re‐recurrent lymph nodes directly invade the left external iliac vein. We removed the re‐recurrent lymph node with combined, radical segmental resection of the left external iliac vein, left obturator artery and vein, and left obturator nerve. J. Med. Invest. 65:136‐138, February, 2018

We investigated the effectiveness of the ClearSight system for hemodynamic management during kidney transplantation for a recipient. The recipient was to receive a kidney transplant from his mother under general anesthesia. We used continuous noninvasive finger‐cuff‐based monitoring of blood pressure, provided by the ClearSight system, and stroke volume variation to predict fluid responsiveness. We used of a balanced anesthetic technique and stringent monitoring standards to ensure a successful outcome for the patient. This case demonstrated that ClearSight has the potential to improve patient monitoring in hemodynamically stable patients who received kidney transplantation under general anesthesia. J. Med. Invest. 65:139‐141, February, 2018

We report the case of a 77‐year‐old man who presented to our hospital with cecal cancer, lung metastasis, and liver metastasis in January 2013. After four courses of modified infusional intravenous fluorouracil and levofolinate with oxaliplatin (mFOLFOX 6) + bevacizumab, there was no new metastatic lesion and lung metastasis reduction was observed. Ileocecal resection was performed in May, left lower lung lobectomy in August, and extended right posterior segmentectomy + S8 partial liver resection was performed in December. The tumor marker declined initially;thereafter, it gradually increased. Computed tomography (CT) performed in April 2014 revealed right inguinal mass around the mesh‐plug prosthesis. A positron emission tomography‐CT (PET‐CT) also revealed a high 2‐fluoro‐2‐deoxy‐D‐glucose (FDG) uptake at the same site. Right inguinal tumor resection was performed in July. Cancer tissues were confirmed by performing intraoperative rapid pathological diagnosis, and R0 resection could be achieved. Previous studies have reported malignant tumor metastases to the mesh‐plug prosthesis, and this was believed to one of the sites that cancer cells can easily engraft. In particular, in patients with a history of advanced malignant tumors, if mass formation around the artifact insertion site is observed, the possibility of peritoneal metastasis should be considered. J. Med. Invest. 65:142‐146, February, 2018

A 65‐year‐old female had been treated rheumatoid arthritis (RA), interstitial pneumonia (IP) and nephrotic syndrome with prednisolone and cyclosporine. She was emergently admitted to our hospital due to the worsening exertional dyspnea and severe hypoxemia. Chest computed tomography (CT) showed new diffuse ground‐glass opacities (GGOs) with slight consolidations along with bronchovascular bundle were observed in addition to pre‐existing reticular shadows in both lungs with lower lobe‐predominance. An acute exacerbation (AE) of pre‐existing IP triggered by an infection was suspected, and the treatment with antibiotics and corticosteroid pulse therapy improved her general condition and chest radiological findings. Because some auto‐antibodies associated with acute/subacute onset IP have recently become available in clinic, we examined those including anti‐aminoacyl tRNA synthetase (ARS) antibodies, and found that she was positive for anti‐PL‐7 antibody. We diagnosed her anti‐synthetase syndrome (ASS) without symptom of myositis, and her IP was considered to be ASS‐related. The careful consideration is necessary to precisely diagnose and treat the patients with RA‐associated interstitial lung diseases as the several etiologies may be overlapped in the same patient. J. Med. Invest. 65:147‐150, February, 2018