Recently, several research groups have devised new methods that treat a foot as a multisegment structure to capture the foot movement precisely. The model reported by Leardini is thought to be superior in terms of reproducibility and validity. The foot strike pattern during running has attracted attention from researchers of biomechanics, but only a few researchers have studied the effect of the foot strike pattern using a multisegment foot model. In addition, most previous studies that examined foot kinematics during running did not take into consideration the influence of the running speed. Therefore, the purpose of this study was to reveal the effects of the foot strike pattern and speed on foot kinematics during running with Leardini’s multisegment foot model. The study included 10 healthy adults. They ran at 2 different speeds （110 and 140m/min） with rearfoot and forefoot strike. The three-dimensional kinematics of rearfoot, midfoot, and forefoot during running were evaluated. As a result, the effects of the foot strike pattern on the joint angles were detected in all the rotations （dorsiflexion-plantarflexion, inversion-eversion, and adduction-abduction） of model Bp, in dorsiflexion-plantarflexion and adduction-abduction of the model Bm, and in inversion-eversion and adduction-abduction of model Ba during the first half of the stance phase. The effects of speed were detected at the initial contact and toe-off in model Bp, at initial contact in model Ba, and at midstance in model Bm. Some of these results are new findings, and other results support the findings of previous studies, which suggests that these are useful in the accurate evaluation of foot motion during running.

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Post-extubation dysphagia causes high mortality, however under the present conditions systematic deglutition evaluation is not done in the critical care center. The purpose of this study was to inspect the predictive factor of post-extubation aspiration pneumonia （PAP） onset due to post-extubation. We conducted a retrospective study from Jan. 2016 to Mar. 2017 of patients who required mechanical ventilation for more than 48 hours in a critical care center. The data of 36 subjects （excluding tracheotomy and community-acquired pneumonia patients） with aspiration pneumonia before extubation were extracted. We classified subjects as PAP group （11） and Non-PAP group （25）. We carried out single variable analysis and multivariate analysis, and calculated a cut-off value of PAP onset. The PAP onset rate was 30.6％ （11/36）. PAP group had a significantly high age and APACHE Ⅱ score on admission at the critical care center, low MWST at the first ingestion, presence of delirium at the extubation, delayed ingestion starting day and out-of-bed starting day, low Functional Status Score for ICU and Barthel Index at the discharge of hospital and extended hospital length of stay （p＜0.05）. As a result of multivariate analysis, modified water swallowing test （partial regression coefficient －3.588, p＜0.05, OR: 1.028, 95％CI: 1.001-1.049） was extracted, and two points of cut-off value （sensitivity: 64％, specificity: 88％, p＜0.01, AUC＝0.875, 95％CI: 0.012-0.301） were calculated. The PAP patients had a decreased basic movement ability and activity daily living ability at discharge. Further inspection of swallowing evaluation, which is systematic regarding PAP prevention is necessary because this study did not enforce comprehensive swallowing screening examination.

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The descending serotonergic pathways originate from the nucleus raphe magnus （NRM） in the rostroventromedial medulla. These pathways mediate pronociceptive action in addition to antinociceptive action. Pain controlled by manipulating serotonin （5-hydroxytryptamine, 5-HT） neurons has not yet been evaluated in free-moving animals. In the present study, we used optogenetics to examine how the excitation of intrinsic 5-HT neurons in the NRM affects pain thresholds in free-moving mice exposed to intermittent cold stress （ICS group）. The mice （Tph2-tTA::tetO-ChR2[C128S]-EYFP） were anesthetized, and an optical fiber was implanted just above the NRM. After a recovery period of three to five days, the mice in the ICS group were housed at 4℃ for three nights, and exposed to room temperatures alternating between 24℃and 4℃ every 30 minutes for two days, to induce neurodegeneration. Pain was evaluated before and after blue light illumination to optogenetically stimulate 5-HT neurons in the NRM. The von Frey and hot plate tests were performed as mechanical- and thermal-pain tests, respectively. Blue light illumination increased the pain thresholds of mice in the sham ICS and ICS groups in the hot plate test, but did not affect their pain thresholds in the von Frey test. These findings suggest that 5-HT neurons in the NRM mediating the descending pain inhibitory system increased the thermal-nociceptive threshold.

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Recently there have been many new reports showing the relationship between gut microbiota and various diseases. In this study, we collected feces from kidney and urothelial cancer patients and examined whether the composition of gut microbiota affects metastasis and cancer type of patients with these cancers. We also investigated whether there are differences in the composition of the gut microbiota depending on the values of the neutrophil to lymphocyte ratio （NLR） and the platelet to lymphocyte ratio （PLR）. It is reported that NLR and PLR reflect the inflammatory response and the immune status, and it becomes a prognostic predictor in various cancer types. From April 2018 to September 2018, a total of 54 patients were enrolled in Showa University hospital. We analyzed gut microbiota using 16S ribosomal RNA gene by next generation sequencer. We found a significant difference between Clostridiaceae and Verrucomicrobiaceae in the comparison between kidney and urothelial cancer. Peptostreptococcaceae was significantly greater in the absence of metastasis of urothelial carcinoma. A significant difference was found in Rikenellaceae and Veillonellaceae in comparison with PLR ≧ 210 and PLR ＜210. The diversity of intestinal bacteria was poor in kidney and urothelial metastatic cancer compared without metastatic cancer. In this study, we found differences in the gut microbiota according to cancer type and the presence or absence of metastasis. Gut microbiota may be useful for the prevention of disease, treatment target, and prediction factor of a drug’s effects. Further accumulation of research on this topic is necessary.

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Autism spectrum disorder （ASD）is a neurodevelopmental disorder characterized by a pattern of impairments in social communication and repetitive behaviors. There are only a few studies concerning repetitive behaviors, especially in adults with ASD. The Repetitive Behavior Scale Revised （RBS-R）is used to measure the breadth of repetitive behavior in children, adolescents, and adults with ASD. In Japan, the Japanese version of the RBS-R has been tested for validity in children but, not in adults. We examined the repetitive behaviors in adults with ASD, using the Japanese version of the RBS-R in adults. There were 30 participants in the ASD group （18 men and 12 women）and the control group consisted of 22 individuals （13 men and 9 women）. Clinicians scored them on the RBS-R, based on the participant’s self-report. We compared the RBS-R overall number of items endorsed and overall score between ASD group and the control group. Then we analyzed correlation between the RBS-R overall number of items endorsed/overall score and patient background. In the total and all subscales, both the RBS-R overall number of items endorsed and overall score were significantly higher in the ASD group than in the control group. The highest scoring rate of the subscale was restricted behavior, and the lowest was self-injurious behavior. AQ was correlated with the score of the total and subscales except for stereotypical behavior and self-injurious behavior. We found that the Japanese version of the RBS-R is useful for adult ASD. But the RBS-R overall number of items endorsed and overall score in this study was higher than in previous studies with scoring on the RBS-R based on the participant’s parental reports. These results suggest the participant’s self-report is more useful than the participant’s parental reports for measuring the repetitive behaviors of adult ASD on the RBS-R.

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It has been found in recent years that RANKL is involved in osteoarticular destruction in patients with rheumatoid arthritis. Reports of clinical trials of denosumab administration have been increasing in number, and it has been reported that denosumab improves bone metabolism. However, to date there is not sufficient clinical research data, and in particular reports concerning cartilage metabolism are necessary. We measured bone density and bone and cartilage metabolism in patients with rheumatoid arthritis who received denosumab, and examined the treatment effect. In total, 44 cases of rheumatoid arthritis and 12 cases of primary osteoporosis were studied; bone density, bone metabolism markers, and cartilage metabolism markers were evaluated before dosage administration, at three months after, six months after, and twelve months after the start of denosumab administration. Bone density of lumbar vertebra was significantly increased, and a significant decrease was observed in bone metabolism markers. A significant decrease was also observed in cartilage metabolism markers, but no difference in the rate of decrease was observed between patients with rheumatism and those without it. Our study indicates that denosumab does not directly have a cartilage destruction-suppressing effect, but there is a possibility that it has secondary suppressing effect.

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Inappropriate prostheses in the oral cavity of aged or middle-aged patients with untreated dentofacial deformity are often seen. Currently, the condition of such patients has been improved, and they are reviewed regularly, supporting evidence that the occlusions and aesthetic conditions are maintained as stable. This report describes the case of a 48-years-old woman with mandibular protrusion, facial asymmetry, missing teeth and an unfitted prosthesis. The treatment objectives were to establish a Class I molar relationship, and to obtain proper interdigitation and an ideal overbite and overjet. Orthodontic treatment involved the extraction of the lower right lateral incisor, the use of an edgewise appliance and orthognathic surgery. Occlusal function and facial balance were improved by treatment with a comprehensive approach involving orthodontic, crown restoration, and periodontal management. Post-treatment records after 2 years showed good results with stable occlusion. However, it is also important to note the observation of stable occlusion.

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The congenital absence of teeth may result in malocclusion such as the inclination of adjacent teeth, protrusion of opposing teeth, and deviation of the midline of the maxillary and mandibular teeth. Moreover, in many cases, when performing orthodontic treatment for patients with absence of teeth, the maxillomandibular occlusal relationship, the growth and development of the jaws, discrepancies, and aesthetic issues have to be considered. This makes it difficult to determine the treatment policy and treatment method. Further, prosthetic treatment is often required to avoid the load on the roots and periodontal tissues associated with the movement of teeth over long distances. In the present case, a girl aged 11 years and 1 month at the beginning of treatment, presented with congenital absence of certain teeth and visited our clinic with the hope that the permanent teeth would grow in good occlusion. After examination, the patient received a diagnosis of skeletal class I and angle classⅡ malocclusion with congenital absence of bilateral maxillary first premolars and bilateral mandibular second premolars. The deciduous maxillary first molars had been lost early, but the deciduous bilateral mandibular second molars were still present. It was difficult to decide whether to close the gap after extraction or to make a future prosthesis, because the bilateral mandibular second molars could come into contact with the distal part of the first molars and cause eruption-related problems. The bilateral deciduous mandibular second molars were extracted and the second molars erupted while the first molars were moving in the mesial direction. As a result, after dynamic treatment spanning 4 years and 4 months, we report that good occlusion was achieved only by orthodontic treatment without requiring prosthetic treatment

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