We conducted a retrospective observational study of the present conditions of the lung cancer examination by low-dose CT screenings at Ningen Dock of Showa University Northern Yokohama Hospital. From among 2,275 people （1,728 men, 547 women） who underwent a lung cancer examination in the period from April 2006 to March 2018, the rate of subjects that needed close inspections was 3.8％ （87/2,275）, the result revelation rate was 63.2％ （55/87）, the number of the discovery of lung cancer was six （including for each one cancer of unknown origin and thymoma）, and the number of the excision lung cancer was four （including one thymoma）. In addition, the percentage that received close inspection was 89.7％（78/87）, the cancer detection rate was 0.18％（4/2,275）, and the positive-predictive value by close inspection was 4.7％（4/86）. These rates were all higher in comparison with the national data surveillance of the lung cancer examination values. The usefulness of this lung cancer examination by low-dose CT screenings at Ningen Dock of Showa University Northern Yokohama Hospital was shown.

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Signals coming from muscle spindles located in limb muscles are used to determine the perceived limb position. We examined whether the sense of shoulder rotation position is altered by increases in muscle spindle signals in the external rotation muscles and internal rotation muscles of the shoulder in healthy, young male subjects （n＝16）. To increase muscle spindle discharge, we applied 70-80 Hz muscle vibration to those muscles in the right arm. Subjects were asked to match the position of their unseen right arm to that of a visible dummy arm while either the external rotation muscles or the internal rotation muscles were vibrated. Position sense illusions in the vibrated shoulder in this matching task were compared between conditions in which the muscles were vibrated or not vibrated. The felt position of the right shoulder was influenced by vibration of the external rotation muscles and the internal rotation muscles. When the external rotation muscles were vibrated, subjects felt their right shoulder to be more internally rotated than it was. Conversely, when the internal rotation muscles were vibrated, they felt their right shoulder to be more externally rotated than it was. In addition, the illusory sensation of the shoulder internal rotation caused by vibration of the external rotation muscles was more obvious when the shoulder was positioned in a more internally rotated position. However, the illusory sensation of the shoulder external rotation caused by vibration of the internal rotation muscles was more obvious when the shoulder was positioned in a less internally rotated position. To conclude, the present study shows that signals coming from muscle spindles located in shoulder rotation muscles contribute to the sense of shoulder position.

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This study surveyed cases that required emergency care after climbing Mount Fuji. Cases included 24 patients ［10 male and 14 female; mean age: 48 （16-73） years］ who received emergency medical treatment in the period of the Mount Fuji climbing season in 2018. Among the injured patients, 13 had no previous experience in climbing Mount Fuji, whereas 6 had previously climbed it 1-3 times, 1 had climbed it 4-5 times, and 4 had climbed it ≥10 times. Overall, 16 assessed their mountain-climbing skill level as beginner, 5 as intermediate, and 3 as advanced. This was the first mountain-climbing experience for 3 of the 16 who assessed themselves as beginners. In terms of the number of sleep hours before injury, two patients had taken a nap, two slept approximately 1 hour, three slept approximately 3 hours, one slept approximately 4 hours. Overall, 6 patients assessed their level of fatigue when they were injured as very tired, 10 as somewhat tired, 2 as having some energy, and 6 as having a lot of energy. The disease or injuries comprised bruise/contusion on the head or face in five patients; lower back contusion or acute lower back pain in two; extremity sprain or open bruise in five; dislocation or fracture in seven; altitude sickness, dehydration, or heat stroke in three; bladder infection in one; and aspiration of foreign object in one. Results showed that the injured patients who visited our hospital were typically beginners in mountain climbing who had exercised for a long duration without sufficient sleep. This suggested that such beginners should have an increased awareness of the risks of mountain climbing without adequate training and preparation.

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Carnitine deficiency is highly prevalent among hemodialysis patients due to the decreased biosynthesis of carnitine in injured kidney tissue and its removal by dialysis therapy. Many studies have reported that carnitine deficiency is significantly associated with various uremia-related complications, including erythropoietin-resistant anemia, left ventricular dysfunction, and muscular cramps. In this cross-sectional study, we evaluated the current status of altered carnitine metabolism in outpatients on regular hemodialysis who had been enrolled in a prospective observational study investigating the efficacy of intravenous carnitine administration. We assessed factors contributing to serum-free carnitine concentrations （F） and the serum acylcarnitine concentrations/serum-free carnitine concentrations ratio （A/F）, known indices of carnitine metabolism, in a total of 501 patients in Showa University Northern Yokohama Hospital and its affiliated hospitals. The prevalence of the deficient group （F＜20µmol/l） was only 8.4％. The percentage of patients who had A/F＞0.4µmol/l was as high as 98.8％. These facts suggested that nearly all patients receiving regular hemodialysis had altered carnitine metabolism. Multivariable analysis demonstrated that the following were significantly associated with a lower F: female, longer hemodialysis, and higher normalized protein catabolic rate （nPCR）. On the contrary, female, longer hemodialysis, lower levels of serum albumin and phosphate, and higher nPCR were significantly associated with a higher A/F. In conclusion, we found that the prevalence of carnitine disorder was extremely high among outpatients on regular hemodialysis, and that nPCR and SUN, which are nutritional parameters, were significantly associated with F or A/F. However, the association between those nutritional parameters and carnitine disorder was paradoxical in the present study, although the reason for this remains uncertain. Further investigations are necessary to elucidate the pathophysiology of carnitine disorder among dialysis patients.

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In Japan, most cases of thumb polydactyly undergo the primary operation at around the age of 1 year old. This is a report of a rare case of bilateral thumb polydactyly who underwent the primary operation at the age of 6 years old. The patient, a 6-year-old boy, had untreated bilateral thumb polydactyly of Wassel type Ⅴ and Ⅵ. He first visited our department at the age of 5 years old, and the operation was subsequently performed at the age of 6. On the right side, we removed the lesser ulnar digit. There was no necessity for transition of any tendons. However, the residual axis deviation at the interphalangeal joint that existed preoperatively had functional and cosmetic issues. Revision surgery of correction of the axis by osteotomy is considered. On the left side, we removed the radial digit and transferred the abductor pollicis brevis muscle to the ulnar digit. It had good function and appearance. Compared with treatment in infancy, we could easily perform perioperative assessment and the operation. Considering the development of motor skills and psychosocial aspect, however, it is necessary to educate patients to receive the best treatment at optimal timing.

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