Cancer is a serious threat to human health worldwide. Attention to the quality of life (QoL) of cancer patients is increasingly recognized as an important component of and a fundamental task in cancer care. Recent studies illustrate that resilience is a key biological factor affecting cancer patients’ health status and QoL. However, few studies have focused on resilience during medical procedures of cancer patients from the perspective of nursing. In this study, we summarize recent literature exploring the clinical significance of resilience in oncology nursing, propose strategies for cancer care to improve the QoL of patients through interventions on resilience, and focus on emerging theories in oncology nursing. In summary, this will emphasize the importance of resilience in oncology nursing and benefit the clinical practices that improve patients’ QoL and reduce the social burden caused by cancer. J. Med. Invest. 70 : 1-6, February, 2023

Purpose : Obesity is associated with chronic low-grade inflammation in which is the key in the pathogenesis Insulin Resistance (IR) and Metabolic Syndrome (MetS). Homeostasis model assessment of insulin resistance (HOMA-IR) has been validated as a surrogate measure of IR. The combination of HOMA and adiponectin, known as HOMA-AD was proposed to measure IR in adults. However, study on these indicators in obese adolescents is still limited. This study aims to analyse METS-IR and HOMA-AD to determine MetS and IR in obese adolescents. Methods : A cross-sectional study was conducted on obese adolescents who looked healthy from secondary schools in Surabaya and Sidoarjo, East Java, aged 12-18 years. Subjects were selected randomly and grouped into 2, namely MetS and non-MetS based on IDF 2000. Anthropometric examination and blood measurements, such as fasting blood glucose levels, lipid profiles, insulin, and adiponectin level were carried out according to standards. HOMA-IR, HOMA-AD, AND METS-IR were calculated using formula. Spearman’s Rho correlation were conducted between assessment tools (METS-IR and HOMA-AD) to identify the correlation with MetS component (lipid profile, FBG, and blood pressures). A receiving operation curve (ROC) performed to find area under curve (AUC) and cut-off points based on the biggest Youden index. Result : A total of 250 subjects were enrolled the study, and found 103 subjects had MetS. METS-IR correlates with all lipid profile and blood pressures (p?<?0.05). While HOMA-AD correlated with TG (r?=?0.356, p?=?0.000), systolic-BP (r?=?0.188, p?=?0.003), and HDL-c levels (r=-0.249, p?=?0.000). Cut-off point for METS-IR to determines MetS in obese adolescents was???46.53 (sensitivity of 64.24% and specificity of 75.76%), while HOMA-AD was???0.43 (sensitivity of 71.52% and specificity of 59.60%). Cut-off point for METS-IR index to determines IR was???52.01 (sensitivity of 83.44% and specificity of 44.44%). Cut-off point for HOMA-AD to determine IR was???0.37 (sensitivity of 74.17% and specificity of 84.85%). Conclusion : METS-IR is better surrogate to determine MetS with cut-off point of???46.53, while HOMA-AD is better to determine IR with cut-off point???0.37 in obese adolescents. J. Med. Invest. 70 : 7-16, February, 2023

Outpatient ablation therapy with low-dose radioactive iodine (RAI) is applied to non-low-risk papillary thyroid cancer patients due to a chronic shortage of inpatient RAI treatment wards in Japan. We used the maximum dosage available for outpatient therapy of 30 mCi of RAI for ablation and diagnostic (Dx) whole-body scintigraphy (WBS). This study aimed to examine the significance of the second dose of 30 mCi. DxWBS was performed 6 months after ablation, and assessment of success or failure was performed 12 months after ablation. A second WBS was performed in the remaining RAI accumulation cases in the neck on DxWBS. The criteria for successful ablation was negative cervical accumulation on WBS, thyroid stimulating hormone-suppressed thyroglobulin (sup-Tg) below 1.0 ng?/?mL, and no increase in thyroglobulin antibody (TgAb) level. At the time of DxWBS, 35?/?68 cases met the successful criteria, and 45 cases achieved success at assessment. Sup-Tg values decreased significantly after ablation and decreased further after DxWBS in successful ablation cases, whereas those were not changed in ablation failure cases. Findings indicated that RAI used in DxWBS had therapeutic effects. It makes sense to use 30 mCi for DxWBS, given the current difficulty of inpatient ablation therapy with high-dose RAI. J. Med. Invest. 70 : 17-21, February, 2023

Background : Intravenous recombinant tissue plasminogen activator (IV rt-PA) and endovascular treatment have been performed for severe large vessel occlusion (LVO) and the results have been reported at high levels of evidence. However, acute treatment for LVO with mild symptom remains controversial. We retrospectively examined prognostic factors for LVO with mild symptoms. Method : We studied retrospectively the patients within 24 h of onset with large vessel occlusion with NIHSS score ??5. Outcomes were evaluated by modified Rankin Scale (mRS) at 90 days, with 0?2 defined as a good outcome and 3?6 as a poor outcome. Clinical characteristics of each case were examined. Result : Participants comprised 76 patients. Of the 76 patients. ICA occlusion showed good outcome in 17?/?19 cases (90%), whereas MCA occlusion showed good outcome in 36?/?54 cases (67%). Among the 14 cases showing positive results for distal intraarterial signal (d-IAS), outcomes were good in 6 cases (43%). On the other hand, the 32 d-IAS-negative cases showed good outcome in 28 cases (88%). Outcomes were thus significantly poorer for d-IAS-positive cases. Conclusion : MCA occlusion is associated with poor prognosis, even with NIHSS score ??5, and d-IAS may provide a predictor. J. Med. Invest. 70 : 22-27, February, 2023

Type 2 diabetes is a typical lifestyle disease. We aimed to identify the factors affecting glycemic control in 64 outpatients with type 2 diabetes over a 2-year period. We defined poor glycemic control using a change in glycosylated hemoglobin (?HbA1c) of ??0.5% over 2 years and/or HbA1c ??7.5% at the end of the study period. We used a questionnaire to collect information on oral health behavior and lifestyle, including eating and smoking habits, and analyzed the relationships between indices of diabetes control and responses to the questionnaire. The mean (SD) HbA1c of the participants was 6.87% (0.77%) at a baseline, and 6.93% (0.69%) after 2 years. Twenty-three participants (36.0%) had poor glycemic control. ?HbA1c and the change in body mass index (?BMI) correlated (Spearman’s rank correlation, r?=?0.350, p?<?0.01). The HbA1c at baseline was associated with eating slowly?/?chewing well, and ?BMI was associated with perceived oral symptoms. Binominal logistic regression analysis revealed that poor glycemic control was associated with ?BMI and a smoking habit (odds ratio : 1.62, 95% confidence interval : 1.08?2.42?;?and 4.01, 1.12?14.36, respectively). These findings imply that weight gain and a smoking habit are associated with poor glycemic control in patients with type 2 diabetes. J. Med. Invest. 70 : 28-33, February, 2023

In Japan, hyperuricemia is on the rise. The guideline for the management of hyperuricemia and gout recommends lifestyle changes before beginning drug therapy. This study aimed to evaluate the effectiveness of dietary counseling following the guideline. Thirty-three subjects (24 men and 9 women) with asymptomatic hyperuricemia underwent dietary counseling for 6 months based on the following recommendations : (1) prevent excessive purine intake, (2) prevent excessive fructose intake, (3) limit alcohol drinking, and (4) drink sufficient water. Obese subjects were counseled on adequate energy intake. Blood sampling, anthropometric measurements, dietary surveys, and 24-h urine collection were performed at baseline and at 6 months. Serum uric acid (S-UA) levels were significantly lower at 6 months compared to baseline. Water intake and urine volume were considerably higher at 6 months than at baseline. When compared to baseline, urine UA (U-UA) levels were significantly lower, and renal fractional excretion of UA (FEUA) was significantly higher at 6 months. Changes in renal function (serum creatinine, estimated glomerular filtration rate, and FEUA) were significantly associated with ?S-UA level. In this study, S-UA level was significantly decreased by dietary counseling in line with the guideline. This study illustrates the effectiveness of dietary counseling for asymptomatic hyperuricemia. J. Med. Invest. 70 : 34-40, February, 2023

Background : We sought to compare the outcomes of patients receiving combination therapy of diuretics and neurohormonal blockers, with a matched cohort with monotherapy of loop diuretics, using real-world big data. Methods : This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). After exclusion criteria, we identified 78,685 patients who were first hospitalized with heart failure (HF) between April 2015 and March 2017. Propensity score (PS) was estimated with logistic regression model, with neurohormonal blockers (angiotensin-converting enzyme inhibitor : ACEi or angiotensin receptor blocker : ARB, ?-blockers and mineralocorticoid receptor antagonists : MRA) as the dependent variable and 24 clinically relevant covariates to compare the in-hospital mortality between monotherapy of loop diuretics and combination therapies. Results : On PS-matched analysis, patients with ACEi?/?ARB, ?-blockers, and MRA had lower total in-hospital mortality and in-hospital mortality within 7 days, 14 days and 30 days. In the sub-group analysis, regardless of clinical characteristics including elderly people and cancer, patients treated with a combination of loop diuretics and neurohormonal blockers had significantly lower in-hospital mortality than matched patients. Conclusions : Our data indicate the benefits of guideline-directed medical therapy to loop diuretics in the management of HF. J. Med. Invest. 70 : 41-53, February, 2023

Background : The roles of serum leptin in knee joint inflammation are unclear. The objective of this study was to identify any associations of serum leptin level with intra-articular inflammatory cytokine levels in acute arthritic and nonarthritic knees of mice. Methods : Acute arthritis was induced by intra-articular injection of 2% carrageenan. Three groups (leptin-deficient ob/ob, wild-type (WT) and high-fat diet (HFD)-fed WT) were made. Serum leptin and inflammatory cytokines in the infrapatellar fat pad and synovium were measured before and 24 hr after injection. Affected knee joints were excised for histology 24 hr after injection. Results : The HFD-WT group had significantly higher serum leptin than the ob/ob and WT groups before and after carrageenan injection. The HFD-WT group had significantly higher IL-1? and IL-6 in the infrapatellar fat pad and synovium than ob/ob and WT before injection but significantly lower IL-1?, IL-6 and TNF-? than the ob/ob group at 24 hr. Conclusions : Hyperleptinemia induced by a HFD is involved in low-grade intra-articular inflammation in nonarthritic knee joints. In contrast, leptin deficiency causes excessive intra-articular inflammation in carrageenan-induced acute arthritis. Leptin alleviates acute arthritis, while chronic hyperleptinemia is involved in low-grade inflammation in normal knee joints. J. Med. Invest. 70 : 54-59, February, 2023

Goishi tea is a unique Japanese post-fermented tea produced in Kochi prefecture. The aim of this study was to investigate whether the supplementation of energy-restricted diet with Goishi tea leaves affects body weight, visceral fat accumulation, and fecal lipids in diet-induced obese rats. 18 male Wistar rats were fed a high-fat diet for 12 weeks. Subsequently, the diet-induced obese rats were fed a low-energy diet containing 1% (G1 group) or 3% (G3 group) of Goishi tea leaf powder, or without any tea extracts (C group) for 4 weeks. After 4 weeks, body weight and body fat ratio were significantly lower in the G3 group than in the C group. Plasma insulin levels were significantly higher in the C group than in the G1 and G3 groups, whereas plasma leptin levels were significantly lower in the G3 group than in the C group. In addition, the lipid absorption rate was significantly lower in the G3 group than in the C and G1 groups. In conclusion, the administration of Goishi tea leaves under dietary restrictions might contribute to body weight reduction and inhibition of lipid absorption, as a diet therapy to help prevent obesity and metabolic syndrome. J. Med. Invest. 70 : 60-65, February, 2023

Background : Non-alcoholic steatohepatitis (NASH) is associated with a higher risk of hepatocellular carcinoma (HCC), and the importance of the gut?liver axis has been recognized in NASH-associated HCC. We investigated the effect of TU-100 on the intestinal microbiome and hepatocarcinogenesis in a NASH model. Methods : Seven-week-old Tsumura Suzuki obese diabetes mice, a model that shows the spontaneous onset of NASH and HCC, were used. They were divided into a TU-100 treated group and a control group. Mice were sacrificed at 24 and 48 weeks to evaluate hepatic steatosis, fibrosis, carcinogenesis, cytokine expression, and microbiome abundance. Results : At 24 weeks, the TU-100 group showed significantly lower expression of IL6, IL1B, and ACTA2 mRNA in the liver (P?<?0.05). At 48 weeks, the TU-100 group showed significantly lower levels of serum alanine aminotransferase. The TU-100 group also showed a lower rate of NASH than the control group (28% vs 72%?;?P?=?0.1). Tumor diameter was significantly smaller in the TU-100 group compared with that in the control group (P?<?0.05). Regarding the intestinal microbiome, the genera Blautia and Ruminococcus were increased in the TU-100 group (P?<?0.05), whereas Dorea and Erysipelotrichaceae were decreased in the TU-100 group (P?<?0.05). Conclusions : TU-100 regulates the intestinal microbiome and may suppress subsequent hepatocarcinogenesis in the NASH model. J. Med. Invest. 70 : 66-73, February, 2023

Purpose : We evaluated the effect of 10-min prewarming on core temperature maintenance during general anesthesia. Patients : We randomized 40 women scheduled for breast cancer surgery into 10-min Prewarming and Control groups. In the Prewarming group, a forced-air warming system was used to warm the patients at 43℃ for 10 min immediately before general anesthesia induction. In the Control group, the patients were kept warm using cotton thermal blankets for 10 min. We measured tympanic temperature every 15 min from anesthesia induction for 90 min. Findings : Since two patients deviated from the protocol, we used the data of 38 patients (Prewarming [n?=?18] and Control [n?=?20]). There was a significant between-group difference in changes in core temperature (P?=?0.03), including a significant difference in core temperature decrease during the first 60 min from anesthesia induction (Prewarming : −0.3 [0.3] ℃ vs. Control : −0.6 [0.2] ℃, P=0.02). In addition, the duration of normal core temperature maintenance was significantly longer in the Prewarming group (66 [34] min vs. 39 [32] min, P?=?0.01). Conclusions : Ten-min prewarming decreases core temperature loss and contribute to maintaining normal core temperature during breast surgery. J. Med. Invest. 70 : 74-79, February, 2023

Purpose : This study aimed to analyze the impact of patients’ nutritional status and changes in body composition on the prognosis of metastatic renal cell carcinoma (mRCC) patients who received systemic therapy with tyrosine kinase inhibitors (TKIs). Methods : A total of 57 mRCC patients who received systemic therapy with TKIs as first-line therapy at our facility between November 2004 and October 2018 were included. The Prognostic Nutritional Index (PNI) was used to evaluate their nutritional status. The volumes of skeletal muscle mass and fat tissue were calculated using the SYNAPSE VINCENT system. The effects of nutritional status and body composition of mRCC patients on progression-free survival (PFS) and overall survival (OS) were analyzed using Cox regression methods. Results : Low PNI at the start of systemic therapy was a significant prognostic predictor for OS (HR 3.807 [95% CI 1.205-12.027], P=0.046), and it was related to loss of muscle mass three months after systemic therapy. Although the loss of muscle mass at the start of systemic therapy was not associated with OS, loss of muscle mass during treatment predicted worse OS. Conclusions : Nutritional status of mRCC patients may predict changes in body composition and be associated with their prognosis. J. Med. Invest. 70 : 80-87, February, 2023

This study aimed to examine the reliability and validity of the Japanese version of the Chronic Pain Acceptance Questionnaire (CPAQ-8J). A total of 108 outpatients with chronic pain completed the CPAQ-8 questionnaire, along with the Acceptance and Action Questionnaire-II, Hospital Anxiety and Depression Scale, Pain Disability Assessment Scale, Numerical Rating Scale, and EuroQol 5 dimensions 5-level. Confirmatory factor analyses examined the factor structure. Results indicated that the CPAQ-8J comprised a two-component factor structure. Correlations between the CPAQ-8J and each variable were as expected, except between the “pain willingness” subscale and other scales ; thus, the CPAQ-8J had a certain degree of convergent validity. Internal consistency and test-retest reliability suggest that the CPAQ-8J is reliable. The psychometric properties of the CPAQ-8J meet a certain standard ; meanwhile, some issues must be addressed for its practical application. Further research should consider the influence of cultural characteristics in practical application. J. Med. Invest. 70 : 88-93, February, 2023

Platelets play an important role in physiological hemostatic mechanisms. In contrast, platelet activation has been implicated in pathological conditions, such as atherosclerosis, angiogenesis, and inflammation. Thrombin is considered to be of particular pathological importance as a platelet-activating substance, and thrombin-activated platelets are detected in the blood of patients with advanced occlusive arterial disease. Ca²⁺ acts as a second messenger in platelet activation, and the regulation of intracellular Ca²⁺ concentrations ([Ca²⁺]i) is important for controlling platelet functions. However, changes in [Ca²⁺]i by antiplatelet agents remain unclear. Therefore, we herein investigated the relationship between [Ca²⁺]i and the intensity of platelet aggregation after a thrombin stimulation, the relationship between [Ca²⁺]i and the intensity of platelet aggregation by antiplatelet agents, and the effects of antiplatelet agents on thrombin-activated platelets as a surrogate platelet model for arterial occlusive disease. Fura2-loaded platelets were treated with phosphate-buffered saline or a low concentration of thrombin (0.005 U/mL), followed by antiplatelet agents (aspirin or cilostazol), and changes in [Ca²⁺]i and the intensity of platelet aggregation by the thrombin stimulation were measured using fluorescence spectrophotometry. Changes in [Ca²⁺]i and the intensity of platelet aggregation after the thrombin stimulation as well as the relationship between [Ca²⁺]i and the intensity of platelet aggregation by antiplatelet agents indicated that cilostazol exerted stronger antiplatelet effects than aspirin and also that antiplatelet effects may be attenuated in thrombin-activated platelets. The present results also suggest the utility of thrombin-activated platelets as a surrogate platelet model for arterial occlusive disease. These results may contribute to future drug development for antiplatelet therapy. J. Med. Invest. 70 : 94-100, February, 2023

Aims : The most common postoperative complication when treating a pressure ulcer with a flap or primary closure is early wound dehiscence. In this study, we aimed to investigate the cause of early wound dehiscence and its associated risk factors. Early wound dehiscence was defined as the wound dehiscence within the post operation period where no weight or tension is applied to the wound. Methods : We conducted a retrospective study of 40 patients with pressure ulcers (69 sites). We calculated the significant difference in the incidence of wound dehiscence between the groups for the following 15 factors : age, obesity, emaciation, diabetes mellitus, smoking, ulcer site, musculocutaneous flap, methicillin-resistant Staphylococcus aureus, presence of two or more types of bacteria, albumin level, C-reactive protein level, white blood cell count, hemoglobin level, operative time, and ulcer size. Results : Bacteria were detected in all wounds with early dehiscence, which was found in 28 (40.6%) of the 69 cases. C-reactive protein level, albumin level, musculocutaneous flap, and operative time were found to be risk factors for early wound dehiscence using the χ2-test and t-test. (P?=?0.011, 0.045, 0.018, and 0.003, respectively). Conclusion : The cause of dehiscence was considered to be surgical site infection. C-reactive protein level, albumin level, musculocutaneous flap, and operative time may be risk factors of the occurrence of early wound dehiscence. J. Med. Invest. 70 : 101-104, February, 2023

Background : Several reports have shown the high mortality rate of pancreatic resection in patients with hemodialysis (HD), however, its long-term outcome remains unclear. In this study, we examined cases of pancreatic resection in patients with HD and conducted a literature review. Methods : Four patients with HD who underwent pancreatic resection from 2004 to 2019 were enrolled. To compare the clinicopathological variables of HD and non-HD patients, 161 non-HD patients who had undergone surgical resection for pancreatic cancer were enrolled. Results : Among four cases of pancreatic resection with HD, three cases were malignant diseases. All patients with HD had some co-morbidities (100% in HD group, 45.3% in the non-HD group) and postoperative complications (100% in the HD group, vs 46.6% in the non-HD group). Although one patient had severe postoperative complications and length of postoperative hospital stay was longer, the 30- and 90-day mortality rates were both 0% in patients with HD. However, three cases in the HD group (75%) died approximately 6 months after surgery, including one cancer-related death. Conclusions : Pancreatic surgery in patients with HD should be carefully indicated, especially pancreaticoduodenectomy or total pancreatectomy, because of the poor prognosis induced by non-cancer-related causes of death. J. Med. Invest. 70 : 105-109, February, 2023

Prenatal dental examinations were performed from June 2012 to May 2013 in the Republic of Kiribati as a Japan International Cooperation Agency support program. We analyzed the examination data and compared it with Japanese data retrospectively to clarify the oral health condition of pregnant women in the Republic of Kiribati. We recorded the DMF index, gingival status, and calculus attachment, analyzed data of 512 pregnant women. We also compared the city and the rural group data. The average number of present teeth, decayed teeth, missing teeth and filled teeth was 26.9, 2.5, 1.1, 0.2, respectively. Pregnant Kiribati women had significantly more decayed teeth and fewer filled teeth, more severe periodontal condition, more calculus deposition, and more severe gingival swelling than pregnant Japanese women. No significant difference was found in missing and filled teeth, but pregnant women in the city group had significantly more decayed teeth and tooth stumps than those in the rural group. Our findings indicate that pregnant women in Kiribati have more decayed teeth, more missing teeth, fewer filled teeth, and more severe periodontal problems than their counterparts in Japan. Additionally, the oral health status of pregnant women in Kiribati could be subject to regional variations. J. Med. Invest. 70 : 110-114, February, 2023

Background and Purpose: Jumping to conclusion (JTC)—a cognitive bias in thinking processes—leads to drawing conclusions based on little information, and could be related to psychosis and paranoia. While it has recently been pointed out that it could accompany the autism spectrum disorder (ASD), no interventions targeting this bias in adolescents with ASD have been reported. Therefore, this exploratory study investigated the effects of a group social cognition program on JTC bias in adolescents with ASD. Patients and Methods : Group rehabilitation using social cognition and interaction training (SCIT) was conducted for 12- to 18-year-old adolescents with ASD. An SCIT program comprehensively targets social cognitive functions, including interventions for JTC bias, and examines changes before and after the SCIT intervention, social cognitive functioning tasks, and subjective quality of life (QOL). Results : Thirteen adolescents with ASD participated in this program ; 10 (76.9%) stayed through it. The proportion of participants with JTC bias decreased significantly before and after SCIT (before : 7/10 ; after : 1/10 ; p = 0.041), and subjective QOL increased significantly (p=0.014). Conclusion : The results show that a group social cognition program with a JTC bias approach improves the JTC bias and increases subjective QOL in adolescents with ASD. J. Med. Invest. 70 : 115-122, February, 2023

Purpose : This study aimed to reveal the clinical features requiring sacroiliac joint (SIJ) arthrodesis, which was performed for patients who complain of severe SIJ pain. Methods : The differences in clinical features between a surgical treatment group (n=20) and a conservative treatment group (n=66) were investigated. All patients were definitively diagnosed with SIJ pain by the use of SIJ injections. Results : Six significant features were identified in the surgical treatment group, namely, sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and any accident that induced SIJ pain (P<0.01). Univariate logistic regression analysis revealed that sitting tolerance <15 minutes (odds ratio : 31.73), pain in the supine position (13.07), and pain while lying on the painful side (18.30) showed a high odds ratio. Conclusions : Sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and a history of any accident that induced SIJ pain may be considered as indicators for surgery after >?6 months of continued substantial conservative treatment. J. Med. Invest. 70 : 123-128, February, 2023

Geographic maldistribution of physicians is a serious problem in Japan, resulting in a few physicians in remote areas. We distributed questionnaires to 396 medical students at Tokushima University from 2013 to 2016. We examined the intensity of medical students toward medicine in remote areas by using a visual analog scale and investigated what medical specialty they chose after two years of clinical training. The intensity of interest in medicine and the intensity of willingness to contribute to it in remote areas were statistically higher among medical students who intended to choose general medicine. After graduation, only five participants chose to specialize in general medicine. Of the 14 medical students who originally chose general medicine, six chose internal medicine, three chose general medicine, and the others chose surgery, neurosurgery, anesthesiology, orthopedics, or emergency medicine. This study demonstrated that medical students who intend to choose general medicine have a higher intensity of willingness to contribute to medicine in remote areas, indicating that the support program for these students to become general practitioners after graduation increases the number of physicians in remote areas. J. Med. Invest. 70 : 129-134, February, 2023

Purpose : To evaluate segmental mobility with degenerative lumbar spondylolisthesis (DLS), upright lateral flexion-extension radiographs (FE) are widely used. However, some authors have described that a combination of lateral radiographs in the standing position and supine sagittal image (SS) reveal more segmental mobility than FE. The purpose of this study was to investigate the optimal method for evaluating segmental mobility with DLS. Methods : We included 92 consecutive Japanese patients diagnosed with DLS. Sagittal translation (ST) determined by FE and SS were compared. Pathological instability was defined as ST more than 8% of the upper vertebra. Patients were divided into those diagnosed with pathological instability in FE (PI-FE) and those diagnosed with SS (PI-SS), and lumbar lordosis (LL) in the standing position in each group were compared. Results : ST in FE was significantly greater than in SS. Of 92 patients, 31 had pathological instability in FE or SS ; 17 patients had PI-FE, and 10 patients had PI-SS. LL in the standing position in PI-FE was significantly smaller than in PI-SS. Conclusions : ST in FE was greater than that in SS, contrary to previous studies’ reports on Caucasians. Since Japanese individuals have smaller LL than Caucasians, FE tends to reveal more segmental mobility than SS. J. Med. Invest. 70 : 135-139, February, 2023

Purpose : The aim was to investigate the impact of the neutrophil-lymphocyte ratio (NLR) in sleeve gastrectomy (SG). Methods : 15 obese patients were enrolled in this study ; mean body weight (BW) 127.5kg ; mean body mass index (BMI) 46.7kg/m². 10 of these were diabetics who underwent a SG. The impact of the pre-operative NLR on the percentage of excess weight loss (%EWL) and remission of diabetes 1 year post-operative were examined. Results : The %EWL at 1 year post-operative were 46.3%. Improvements were also evident in the diabetes at 1 year post-operative : complete remission (CR) 40%, partial remission (PR) 20% and Improve 40%. Comparing pre-operative NLR in %EWL<50% and ≧50% in 1 year post-operative, <50% was 2.64 and ≧50% was 2.03. The NLR in CR and PR was significantly lower than that in Improve. Conclusions : The pre-operative NLR may be a predictive marker of weight loss and improving diabetes after SG. J. Med. Invest. 70 : 140-144, February, 2023

Polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome are common inflammatory rheumatic diseases in the elderly. In this study, we investigated the difference of the therapeutic responses between patients with PMR and RS3PE syndrome. Twenty-four patients with PMR and 12 patients with RS3PE syndrome were treated with initial dosages of 10-20 mg per day oral prednisolone, and the dosages were then tapered. Percentages of patients with negative c-reactive protein (CRP) after 8-week treatment were significantly more in RS3PE syndrome than in PMR. Percentages of patients with relapse during one-year treatment were less likely to be in RS3PE syndrome than in PMR. These differences observed between the two disorders were not associated with the level of initial CRP. There was no significant difference in percentages of patients with prednisolone-free remission after two-year treatment between PMR and RS3PE syndrome. These results indicate that the early response to the treatment is greater in RS3PE syndrome than in PMR. J. Med. Invest. 70 : 145-149, February, 2023

Objective : First bite syndrome is a complication of surgical resection of parapharyngeal space tumors and the development of cramping pain in the parotid region with the first bite of a meal. The present study aimed to identify the potential risk factors for the development of first bite syndrome. Methods : We retrospectively reviewed 30 consecutive patients with parapharyngeal space tumors who had been surgically treated between August 2003 and December 2015 at our department. Results : The tumor site (prestyloid or retrostyloid) and surgical approach (transcervical-parotid, transparotid, or transcervical) were not correlated with the development of first bite syndrome. Ligation and mobilization of the external carotid artery was significantly correlated with the development of first bite syndrome. Moreover, patients with complete resection of the parotid gland did not experience first bite syndrome. Discussion : The present findings suggest that concomitant surgical settings of 1) sympathetic denervation of the parotid gland with ligation of the external carotid artery or injury of the sympathetic nerve plexus around the external carotid artery during its mobilization, and 2) residual parotid gland tissue are risk factors for the development of first bite syndrome after surgical resection of parapharyngeal space tumors. J. Med. Invest. 70 : 150-153, February, 2023

In Japan, cancer genome profiling (CGP) for cancer patients without standard treatment has been covered by public insurance since June 2019. This study analyzed data of 122 patients with gastrointestinal tumors who underwent CGP to clarify cancer genome medicine’s current status and possible problems at the Tokushima University Hospital. The major types of cancer included pancreatic (n=30), colorectal (n=25), biliary tract (n=15), gastric (n=11), and hepatocellular carcinoma (n=8). CGP tests included F1CDx in 70 patients (57%), F1LCDx in 36 (30%), TSO500 in 14 (11%), and NCC Oncopanel in 2 (2%). Actionable gene alterations were identified in 72 patients (59%), but only 5 patients (4%) were treated for pancreatic (n=1), colorectal (n=3), and small bowel cancers (n=1). The main reasons for not receiving genotype-matched therapy included the lack of appropriate drugs or clinical trials that matched the actionable gene alterations (n=40) and the inability to participate in clinical trials (n=10). There is still not a sufficient number of patients receiving genotype-matched treatment for gastrointestinal cancers. To promote cancer genome medicine in regional areas, attempts to improve access to genotype-matched therapies are required, as well as to promote the development of new molecular-targeted drugs and clinical trials for these drugs. J. Med. Invest. 70 : 154-159, February, 2023

Background : Amino acid transporters, such as L-type amino acid transporter 1 (LAT1), have an effect on tumor growth, metastasis, and survival of various solid tumors. However, the role of LAT1 in patients with intrahepatic cholangiocarcinoma (IHCC) remains unknown. Methods : Forty-six patients who had undergone initial hepatic resection for IHCC at Tokushima University Hospital were enrolled in this study. Immunohistochemical analysis of LAT1 and phosphorylated Akt (p-AKT) was performed using resected specimens. Clinicopathological factors, including prognosis, were analyzed between LAT1-high and LAT1-low groups. Results : The LAT1-high group showed a higher proportion of periductal infiltrating type and higher carcinoembryonic antigen/carbohydrate antigen 19-9 levels compared with the LAT1-low group. Multivariate analysis revealed that LAT1-high expression was an independent prognostic factor for disease-free survival. Furthermore, the proportion of p-AKT positivity was higher in the LAT1-high group than in the LAT1-low group. Conclusions : LAT1 expression was associated with poor prognosis of IHCC and higher p-Akt expression. J. Med. Invest. 70 : 160-165, February, 2023

We examined the effects of polymethoxyflavonoids (PMFs) on T helper (Th) 17 cell differentiation in vitro and in vivo. Five different PMFs including nobiletin (NOB), sudachitin (SUD), demethoxysudachitin, heptamethoxyflavone and natsudaidain were used for the in vitro study, and effects of those flavonoids on Th17 responses were investigated. NOB and heptamethoxyflavone significantly suppressed the proliferation response, but SUD, demethoxysudachitin and natsudaidain did not suppress the proliferation response. All of the five flavonoids decreased IL-17A production. Mice with experimentally induced autoimmune encephalomyelitis were used as an in vivo Th17 differentiation model. We focused on two flavonoids, NOB and SUD, and examined the effects of those flavonoids. NOB significantly suppressed Th17 cell proliferation and cytokine responses, but SUD only decreased proliferation responses. The results suggest that the suppressive effect of NOB on Th17 response in vivo is stronger than that of SUD. J. Med. Invest. 70 : 166-170, February, 2023

This study aimed to develop a Childcare Literacy Scale for Mothers with Infants and Children (CLMIC) and verify its reliability and validity. Using a 28-item childcare literacy measurement scale proposed after a preliminary survey, an anonymous self-administered questionnaire survey was conducted. Participants were mothers who came to the city’s infant health checkups ; 211 people were included in the analysis. Cronbach’s ? was used to verify reliability. To verify the validity, exploratory factor analysis was performed as construct validity.

Following factor analysis of 28 items on the childcare literacy measurement scale, 4 factors and 24 items were adopted. For all factors, Cronbach’s ? were greater than or equal to .80. CLMIC and Communicative and Critical Health Literacy, Health Literacy Scale for Women of Reproductive Age, and Japanese Short-Form-8-Item Health Survey showed significant positive correlations. CLMIC and Japanese Parenting Stress Index Short Form indicated a significant negative correlation. The reliability and validity of the developed CLMIC were confirmed. It was shown to be a useful scale that can contribute to health behaviors that protect against child-rearing stress and promote child safety and security, valuing the unique perspective of child-rearing that is appropriate for Japanese mothers. J. Med. Invest. 70 : 171-179, February, 2023

Background : Heineke-Mikulicz (HM) strictureplasty is commonly used to treat short stenoses in Crohn’s disease. However, the degree to which intestinal motility is maintained remains unclear. We compared the peristalsis and transport capacity of the sutured intestines with HM configuration and transverse (TS) and longitudinal (LS) incisions. Methods : The intestinal diameter, intraluminal pressure, and bead transit time of each sutured group were compared with that of the non-treatment (NT) group in the isolated proximal colon of rats. Propulsive contractions were induced using hydroxy-?-sanshool (HAS), a constituent of Japanese pepper. Results : There was no change in the intestinal diameter between HM, TS, and NT groups ; however, it was significantly narrowed at the suture site and its distal side in the LS group. After HAS administration, the intestinal diameter at the suture site in the HM group was higher than that in the LS group. The intraluminal pressure was higher and the transit time was shorter in the HM group compared to those in the LS group. Conclusions : The HM configuration, which widens the incision site and distal diameter and shortens the cut surface of the circular muscle in the longitudinal direction, may help maintain basal and HAS-induced intestinal peristalsis and motility. J. Med. Invest. 70 : 180-188, February, 2023

Background : Several reports have shown a high mortality rate in patients with liver cirrhosis (LC) who undergo pancreaticoduodenectomy, however, there are few reports on its long-term prognosis. Methods : Twelve patients with LC who had undergone pancreatic resection were enrolled. To compare clinicopathological variables, 159 non-LC patients who had undergone resection for pancreatic cancer were enrolled. Results : Pancreaticoduodenectomy (PD) was performed in 5 LC patients and distal pancreatectomy (DP) was performed in 7 LC patients. Patients in the LC group had more co-morbidities, lower platelet counts and higher Fib4 index than the non-LC group. The postoperative complication rate was higher in the LC group (83.3% vs 47.8%). While the postoperative hospital stay and 30-day mortality rate were not different, the 90-day mortality rate was higher in the LC group (25.0% vs 2.5% ; p<0.01). Comparison by operative procedure showed no significant differences of postoperative outcomes in DP cases. However, in PD cases, postoperative complications were more frequent (100% vs 42.3%) and 90-day mortality was higher (40.0% vs 2.9% ; p<0.01) in the LC group. Conclusions : PD resulted in higher postoperative morbidity and mortality rates in patients with LC compared with non-LC patients. DP could be tolerated in the LC patients. J. Med. Invest. 70 : 189-194, February, 2023

The body’s water balance is changed by food and beverage intake, metabolism, and excretion. In this study, we performed a cross-sectional study that investigated the changes of water intake and water output in healthy Japanese young and elderly people and handicapped adults. Water balance was assessed by water intake from foods and beverages, metabolic water production, non-renal water losses (NRWL), and urine volume. Most of the parameters did not change with aging in healthy adults. Estimated total water intake (ml/kg/day) increased with aging. In the healthy men, healthy women, and handicapped adults, daily water intake (median [interquartile range]) accounted for 49.4 (41.4-59.9) ml/kg, 42.9 (38.7-51.8) ml/kg, and 50.9 (43.8-74.0) ml/kg, respectively. Water loss from the kidney accounted for 19.2 (16.2-29.2) ml/kg, 22.0 (16.2-26.6) ml/kg, and 27.5 (22.7-47.2) ml/kg, respectively. NRWL accounted for 26.6 (18.5-35.2) ml/kg, 22.4 (16.2-28.8) ml/kg, and 23.5 (19.8-28.5) ml/kg, respectively. Our findings suggest that a daily total water intake of more than 50-55 ml/kg is required to prevent dehydration in healthy and handicapped adults. J. Med. Invest. 70 : 195-199, February, 2023

The purpose of study was to clarify the psychological adjustment and related factors in lung cancer patients with recurrence/metastasis after curative surgery. Forty-one with lung cancer who were informed of a recurrence/metastasis after curative surgery completed a questionnaire comprised of the Mental Adjustment to Cancer Scale (MAC), Psychological Adjustment scale for Cancer Survivors (PACS), and information pertaining to demographic variables. When healthcare providers intervene in patients with lung cancer that has recurred/metastasized after curative surgery, it is necessary to assess patients’ psychological adjustment based on demographic information, such as age, sex, marital status, and employment status, and to provide effective support promptly. Factors associated with psychological adjustment with recurrent/metastatic lung cancer after curative surgery were 1) female, 2) having a job, 3) over 65 years of age, 4) having a spouse, and 5) advanced-stage cancer. There was no difference in psychological adjustment between treatment and the period from cancer incidence to recurrence/metastatic. J. Med. Invest. 70 : 200-207, February, 2023

Background : The KOJI AWARENESS� screening test is a self-administered screening tool for assessment of mobility, stability, and strength. It provides corrective exercises corresponding to the individual’s answers to the KOJI AWARENESS� test questions. However, there is no evidence of the effectiveness of corrective exercises in improving KOJI AWARENESS� screening test scores and activity-related pain. Methods : Twenty-six healthy subjects (11 female and 15 male ; age 20?50 years) were selected for participation. In a controlled laboratory setting, subjects were administered the KOJI AWARENESS� test and were provided with individualized exercise programs based on the results of this first test. KOJI AWARENESS� results were checked on the first day immediately after the first exercise session, and then again after the two-week program. Pain intensity was also assessed during daily training using a numerical rating scale. Results : Compared to pre-intervention, KOJI AWARENESS� scores were significantly higher immediately after the first corrective exercise session and after 2 weeks of intervention (p<0.001). Moreover, pain intensity was significantly lower after 2 weeks of intervention (p<0.001). Conclusions : Individualized KOJI AWARENESS� corrective exercises were effective immediately on the first day and also after the two-week program in improving the KOJI AWARENESS� score and reducing pain intensity during daily training. J. Med. Invest. 70 : 208-212, February, 2023

In this paper the effectiveness of the support system which predicts the risk of the repetitive brain concussion is studied biomechanically. In the risk prediction system, the accident that caused the concussion is reconstructed by analyzing the game video via multibody dynamics and the resulting brain injury is calculated in detail by the finite element method. In order to calculate the aggravation of the brain injury by the repeated brain concussion, the following two methods are examined. In the first method, the material properties of the part of the brain damaged by the1st impact are changed in the simulation of the 2nd impact. In the second method, each brain damage caused by the repeated impacts is accumulated. The system was applied to the real-life accidents that occurred during Judo and American football games. As a result of the simulations, the aggravation of the brain damage due to repetitive concussion was determined numerically in terms of the maximum strain of the brain and the brain damage rate of the whole brain. The biomechanical process of the collision accidents and the resulting brain damage were reconstructed based on the video and the results are effective to prevent the future repeated concussion accidents. J. Med. Invest. 70 : 213-220, February, 2023

With an aging population, the number of older adults admitted to nursing homes has increased. Diapers are often used to manage nursing home resident urinary incontinence, yet only one-third of these required assistance from caregivers to urinate. Unnecessary diaper use was reported in 23.9% of peop1e, mostly for precautionary purposes. In this study, the Diaper-zero program caregivers asked residents regularly (every 2-3 h) whether they required voiding and prompted them to void. Over 11 months, the effects on 38 nursing home residents’ diaper use, nursing care level, physical activity, daily energy, and water intake were measured. A higher rate of diaper wearing was initially observed with lower daily energy and water intakes at the beginning of the Diaper-zero program, but this association was not observed after 11 months of the program. The diaper usage rate decreased significantly from 71.1% to 47.4% after 11 months. During this period, for all subjects, nursing care level, physical activity, and total daily intakes of energy and water were unchanged. In conclusion, this program enhances the desire to void, minimizing diaper usage, thus protecting the human dignity of nursing home residents. J. Med. Invest. 70 : 221-225, February, 2023

Aneurysmal subarachnoid hemorrhage (SAH) is a serious clinical event associated with high mortality and, among survivors, serious morbidity. Maintaining the muscle volume in SAH patients is essential, as rehabilitation is often required after intensive care. In this study, we investigated whether proper nutritional administration improved clinical outcomes based on patients laboratory data and level of activities of daily living. This retrospective study was carried out on 250 consecutive SAH patients who underwent craniotomy within 72 hours of onset from February 2005 to June 2018. Finally, 75 patients with a BMI < 22 kg/m² were included. We compared postoperative energy and protein intake in relation to measures of biochemical parameters and modified Rankin Scale at discharge. Serum Alb concentrations at 25-35 hospital days was significantly improved by postoperative energy intake of ≧25 kcal/kg and protein intake of ≧0.8 g/kg per day beginning 3 days. High serum Alb concentrations at 25-35 hospital days following the start of this intake were independent factors for good prognosis. This study suggests that the minimum postoperative nutritional intake per day for SAH patients undergoing aneurysmal clipping is 25 kcal/kg of energy and 0.8 g/kg of protein. Higher serum Alb concentrations corresponded to improved long-term functional outcome. J. Med. Invest. 70 : 226-230, February, 2023

The Seirei dysphagia screening questionnaire (namely, Seirei dsq) has been used to screen for oropharyngeal dysphagia (OD). Some of the questions in the questionnaire are difficult for people with cognitive decline to answer. We selected 10 items from the Seirei dsq that could be assessed by others, such as care workers (named Swallow-10). This study aims to verify the validity of the scoring method used in Swallow-10. The dataset used in this study was the one used in the development of Seirei dsq : 50 patients with cerebrovascular disease who were diagnosed with OD, 145 patients with cerebrovascular disease who did not have OD, and 170 healthy subjects. Among the answer choices, “A” for severe symptom, “B” for mild symptom and “C” for no symptom were scored with 4, 1 and 0 points respectively. Factor analysis extracted two factors : one related to pharyngeal function and another related to oral function. In addition, the Cronbach’s alpha coefficient was 0.84. ROC analysis indicated that optimal cutoff value was 5 points, with a sensitivity of 90.0% and a specificity of 88.5%. These results suggest that Swallow-10 may be useful as an OD screening tool for subjects with cognitive decline J. Med. Invest. 70 : 231-235, February, 2023

Objectives : Osteomyelitis (OM) and septic arthritis (SA) in childhood might cause complications, sequelae, or even death if diagnosis and treatment are delayed. Here, we examined the outcomes of OM/SA at a pediatric emergency core hospital in Japan. Methods : This was a single-center, retrospective, observational cohort study at a pediatric emergency core hospital in Japan. Pediatric outpatients who underwent magnetic resonance imaging at the hospital in the period 2012?2020 were recruited. Primary outcomes were sequelae, recurrent symptoms, chronicity, and death. Results : Fifteen OM/SA patients (9 OM, 4 SA, 2 OM+SA) were recruited. The identified major pathogens included methicillin-susceptible Staphylococcus aureus (40.0 %, n=6) and methicillin-resistant S. aureus (13.3 %, n=2). Mean time from onset to first hospital visit, hospitalization, and initiation of effective antibiotics was 2 days, 3.9?±?1.8 days, and 4.9±2.2 days, respectively. All OM/SA patients recovered without complications or sequelae. Conclusions : In this study, all patients with OM/SA showed a good prognosis. Despite the small sample size, this pilot study suggests that the pediatric emergency core system in Japan provides early treatment and a good prognosis for patients diagnosed with OM/SA. J. Med. Invest. 70 : 236-240, February, 2023

Objective : Dysgeusia is a serious problem in patients with diabetes because it often leads to overeating, which is associated with disease progression. This study aimed to investigate the association between taste sensitivity, eating habits, and the oral environment. Subjects and methods : In this cross-sectional study of 75 subjects with diabetes, gustatory function was assessed using the whole-mouth method, and lingual taste receptor gene expression was measured by real-time PCR. Food intake was evaluated using a food frequency questionnaire based on food groups. The oral environment was assessed using xerostomia and periodontal comprehensive examination. Results : In total, 45.3%, 28.0%, and 18.7% of subjects showed lower umami taste sensitivity, low sweet taste sensitivity, and low salt taste sensitivity, respectively. Lower umami sensitivity correlated with lower estimated glomerular filtration rate and higher energy-source food intake. Subjects with diabetes with higher plaque control record showed significantly higher T1R3 gene expression than those with lower plaque control record. Conclusion : Reduced umami taste sensitivity is associated with decreased renal function and high energy food intake in diabetes. Subjects with diabetes with higher plaque control record showed significantly higher T1R3 gene expression, suggesting that the oral environment affects taste gene expression. J. Med. Invest. 70 : 241-250, February, 2023

Background : Epidermoid cysts in intrapancreatic accessory spleen (ECIPAS) are a rare lesion. Its pathogenesis, including the origin of cystic epithelium, is not well established. We aimed to elucidate new aspects of the pathological features of ECIPAS to clarify its pathogenesis. Methods : Six cases of ECIPAS were included in this study. As well as histopathological analysis, to elucidate the features and nature of cystic epithelial cells, immunohistochemical analysis including Pbx1 and Tlx1 and imaging mass spectrometry was performed. Results : Histologically, the cysts were covered by either monolayered or multilayered epithelium. Immunohistochemistry revealed that the epithelial cells in multilayered epithelium exhibited different attributes between the basal and superficial layers. Few epithelial cells had abundant clear cytoplasm and were immunohistochemically positive for adipophilin, suggesting lipid-excreting function. The intracystic fluid contained cholesterol clefts and foamy macrophages, and imaging mass spectrometry revealed the accumulation of lipids. Immunohistochemical analysis indicated that the epithelial cells were positive for Pbx1 in some cases. Conclusion : Novel histological features of epithelial cells of ECIPAS were indicated. Although more cases need to be evaluated, we propose that the cause of ECIPAS may be different from that of pancreatic ductal origin. J. Med. Invest. 70 : 251-259, February, 2023

Background : Inorganic phosphate (Pi) binders are the only pharmacologic treatment approved for hyperphosphatemia. However, Pi binders induce the expression of intestinal Pi transporters and have limited effects on the inhibition of Pi transport. EOS789, a novel pan-Pi transporter inhibitor, reportedly has potent efficacy in treating hyperphosphatemia. We investigated the properties of EOS789 with comparison to a conventional Pi binder. Methods : Protein and mRNA expression levels of Pi transporters were measured in intestinal and kidney tissues from male Wistar rats fed diets supplemented with EOS789 or lanthanum carbonate (LC). 32Pi permeability was measured in intestinal tissues from normal rats using a chamber. Results : Increased protein levels of NaPi-2b, an intestinal Pi transporter, and luminal Pi removal were observed in rats treated with LC but not in rats treated with EOS789. EOS789 but not LC suppressed intestinal protein levels of the Pi transporter Pit-1 and sodium/hydrogen exchanger isoform 3. 32Pi flux experiments using small intestine tissues from rats demonstrated that EOS789 may affect transcellular Pi transport in addition to paracellular Pi transport. Conclusion : EOS789 has differing regulatory effects on Pi metabolism compared to LC. The properties of EOS789 may compensate for the limitations of LC therapy. The combined or selective use of EOS789 and conventional Pi binders may allow tighter control of hyperphosphatemia. J. Med. Invest. 70 : 260-270, February, 2023

Despite the relatively short follow-up period in our previous study, we had reported that increased cough reflex sensitivity (CRS) may predict the efficacy of bronchial thermoplasty (BT) for treating asthma. Herein, we examined whether CRS predicts the efficacy of BT 2 years after the final BT treatment. We also investigated the influence of BT on CRS. We reviewed 10 patients 2 years after their final BT treatment. CRS, asthma-related symptoms, asthma exacerbations, and cough-related quality of life were assessed at baseline and 2 years after BT. Five patients responded positively to BT (BT responders) and their asthma control improved. No significant difference in CRS at baseline was detected between the BT responders and nonresponders. In contrast, BT responders exhibited significant improvements in CRS 2 years after BT. CRS at baseline could not predict the BT efficacy after 2 years. This is the first report demonstrating BT desensitized CRS in consecutive case series. J. Med. Invest. 70 : 271-275, February, 2023

Squamous cell carcinoma (SCC) is known to have less brain metastasis, but the reasons are not well established. Herein, we report the case of an 82-year-old man with recurrent cerebral hemorrhage of unknown cause ; upon brain biopsy, SCC was diagnosed infiltrating peripheral blood vessels of the brain and that it was state of micro-metastasis. It is possible that the blood-brain barrier blocked the infiltration of SCC into the brain parenchyma, and it did not form a mass in the brain parenchyma. In addition, because it did not form a mass, it could not be diagnosed as a metastatic brain tumor by contrast-enhanced magnetic resonance imaging or contrast-enhanced computed tomography. Among cases of recurrent cerebral hemorrhage of unknown cause in a short period, there may be cases of vascular infiltration without crossing the blood-brain barrier. Thus, if similar cases of recurrent cerebral hemorrhage of unknown cause is observed, it is necessary to distinguish metastatic brain tumors even if there is no evidence of suspected tumor on contrast-enhanced magnetic resonance imaging scan. J. Med. Invest. 70 : 276-280, February, 2023

A 33-year-old woman admitted to our hospital for further examination of severe non-productive cough lasting for about two months. Her symptom did not ameliorate by treatments including long acting β₂ agonists. She had a medical history of drug allergy to non-steroidal anti-inflammatory drugs. At the initial visit, she could not speak at all and communicated with us in writing. Chest auscultation revealed no wheezes, rhonchi and other crackles. Laboratory findings showed a mild eosinophilia with normal total and specific serum immunoglobulin E. The results of an electrocardiogram, a chest X-ray and a chest CT were unremarkable. A fractional exhaled nitric oxide value was within normal limit. Based on these observations, a diagnosis of atopic cough (AC) was suspected, and we started treatment with a histamine H₁ receptor antagonist (H₁-RA). She had become able to speak again in association with complete disappearance of cough by eight-weeks after treatment initiation, and her symptoms did not recur even after cessation of treatment. By the confirmation of remarkable clinical improvement in response to a H₁-RA, a diagnosis of AC was made. To the best of our knowledge, this is the first report of an AC patient who presented severe cough with aphonia. J. Med. Invest. 70 : 281-284, February, 2023

Laparoscopic pancreaticoduodenectomy (LPD) has been widely adopted in institutions with sufficiently skilled practitioners. This technique requires attentive dissection around the superior mesenteric vein (SMV) and artery. Dissection around the SMV and Henle’s trunk is one of the key aspects of right hemicolectomy (RHC) ; adhesions and fibrosis around these vessels may impede LPD in patients with a history of RHC. We encountered three cases of periampullary tumors in patients with a history of RHC who were successfully treated with LPD. Cases 1, 2, and 3 were of 60-, 73-, and 74-year-old men with periampullary tumors. The operative durations in cases 1, 2, and 3 were 316, 267, and 265 min, respectively. The estimated blood loss volumes in cases 1, 2, and 3 were 20, 50, and 720 mL, respectively. The postoperative hospital stay durations in cases 1, 2, and 3 were of 13, 35, and 15 days, respectively. In conclusion, LPD following RHC may be safely completed with laparoscopy. J. Med. Invest. 70 : 285-289, February, 2023

Complete decapitation due to suicide by hanging is rare. We report the case of a decapitated man who was found in the sea near an estuary. A polyethylene rope was tied to the handrail of the bridge across a strait near the site of the body. The rope was 12 mm in diameter and 19 m in length from the handrail. It ended with a slip knot noose, and skin and mustache-like hair fragments were attached to it. The decapitated head was not found. The deceased weighed 82 kg and was 152 cm long without the head. The autopsy revealed coarse abrasions and intramuscular hemorrhage around the severed edge. The third cervical spine was not fractured. We reviewed the literature and suggested the conditions of body weight, fall height, rope diameter, and number of rolls in cases of decapitation by hanging. We calculated the hanging decapitation index (HDI) as the fall height (m) multiplied by the body weight (kg), divided by the rope diameter (mm), divided by the number of rolls ; and discussed the differences between complete and incomplete decapitation cases. J. Med. Invest. 70 : 290-293, February, 2023

Pediatric ulcerative colitis is likely to be more severe than adult ulcerative colitis. Failure to thrive should be considered during therapy. A 10-year-old boy was diagnosed with ulcerative colitis based on his clinical presentation and colonoscopy and biopsy results. The administration of 5-aminosalicylic acid and prednisolone resulted in remission ; however, the symptoms reappeared after the discontinuation of prednisolone. Then, infliximab was administered ; however, the patient was resistant to it and appeared to be dependent on prednisolone. Vedolizumab, a monoclonal antibody against ?4?7 integrin, was administered, which resulted in rapid remission. A steady decrease in prednisolone followed, and remission was maintained even after prednisolone discontinuation. Vedolizumab may be effective in pediatric patients with moderate-to-severe refractory ulcerative colitis. Vedolizumab prevents lymphocytes from binding to MAdCAM-1, which is selectively expressed in the gastrointestinal submucosa, leading to the mitigation of the systemic side effects of immunosuppression, such as infections. In Japan, vedolizumab use is not yet approved for use in children, but its effectiveness and safety in children is expected to be investigated in the future. J. Med. Invest. 70 : 294-297, February, 2023

Migraine is a chronic neurological disorder characterized by headaches and extracephalic symptoms. We report a 73-year-old male patient with a history of migraines as well as several other chronic conditions including abdominal pain accompanied by nausea and vomiting, pain and ecchymosis of the limbs, dysmetropsia, syncope, and melena due to telangiectasia of the sigmoid colon. After a thorough evaluation of the migraine condition, we hypothesized that the patient’s melena due to telangiectasia of the sigmoid colon might in fact be a migraine-related phenomenon. In this report, we discuss a possible mechanism for melena due to telangiectasia in migraine patients, as well as “tips” for identifying subtle and/or unreported clinical features of migraine conditions. J. Med. Invest. 70 : 298-300, February, 2023

Background : This report describes a case of dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy that led to repeated post-operative extubation failure. Case presentation : A 43-year-old woman who had undergone tracheostomy 25 years previously was admitted to our intensive-care unit (ICU) after coronary artery bypass graft surgery. On postoperative day (POD) 0, she was extubated, but stridor was observed. We suspected upper airway obstruction and she was therefore reintubated. Before reintubation, urgent laryngotracheoscopy revealed dynamic inspiratory airway collapse and obstruction concomitant with subglottic stenosis. Preoperative computed tomography showed mild subglottic stenosis. Although intravenous corticosteroids were administered to prevent tracheal mucosal edema and a cuff leak test was confirmed to be negative, she developed extubation failure on POD6. On POD12, we performed tracheostomy to reduce mechanical irritation from the endotracheal tube. Mechanical ventilation was withdrawn and she discharged from the ICU. On POD33, her tracheostomy tube was removed and she remained clinically asymptomatic. Conclusions : We should be aware of the history of tracheostomy, especially at high tracheostomy sites, even in the absence of respiratory symptoms as risk factors for dynamic inspiratory airway collapse concomitant with subglottic stenosis contributing to repeated respiratory failure after extubation. J. Med. Invest. 70 : 301-305, February, 2023