Twenty years ago, the prognosis of multiple myeloma has been extremely poor, and myeloma was known as incurable disease. However, the treatment performance of myeloma improved by the development of novel agents, including immunomodulatory drugs such as thalidomide, proteasome inhibitor such as bortezomib, and anti-myeloma monoclonal antibody such as daratumumab, and the plateau of survival curve was obtained now. In addition to the improvement of treatment, the new inspection methods of minimal residual disease were developed, and the accuracy of determination of treatment efficacy improved. According to these advances, we now came to be able to make precise therapeutic strategy. Hereafter, the strong immune-therapy including the CAR-T may be introduced in clinical practice, it’s no exaggeration to say that I can expect the cure of myeloma.

Background & Aims: To determine the effect of prior coitus on CT findings of ruptured corpus luteum.

Methods: The subjects were female patients complaining of acute lower abdominal pain, who underwent CT examination. Patients meeting the following criteria were diagnosed with ruptured corpus luteum: 1) an adnexal cystic mass with thick wall, 2) high density ascites (≥20 Hounsfield Units [H.U.]), 3) no CT evidence of acute abdominal diseases, 4) no pregnancy, 5) no prior history of chronic lower abdominal pain, and 6) relief of pain within two weeks. These patients were classified into two groups: with and without coitus within three days before the onset. Then, CT findings were evaluated.

Results: A total of 18 patients fulfilled the criteria. Patients with prior coitus (n＝9) showed a larger maximum diameter of the adnexal cyst (38.8 vs 23.5 mm, p＝0.005), higher attenuation of ascites (41 vs 25 H.U., p＝0.017), and a larger amount of ascites (pelvis-limited or beyond pelvis) (p＝0.015), compared to the others (n＝9).

Conclusions: Prior coitus affected CT findings such as a larger amount of ascites with higher attenuation.

Objective: The purpose of this study was to evaluate the range of motion (ROM) and muscle strength as physical function after total hip arthroplasty (THA) using a posterolateral approach in hip osteoarthritis patients.

Methods: Fourteen patients undergoing THA were assessed before, and 1 and 2 weeks after THA.　Their ROM and isometric muscle strength were examined.

Results: The preoperative ROM was significantly lower on the operative side than on the non-operative side, excluding hip adduction, but there was no significant difference 2 weeks after THA.　The hip abduction ROM significantly improved 1 and 2 weeks after THA.　The muscle strength before and 2 weeks after THA was lower on the operative side than on the non-operative side.　There was a significant decrease in muscle strength during hip flexion and extension 1 week after THA, but it significantly improved 2 weeks after THA.

Conclusion: The ROM on the operative side became similar to that on the non-operative side 2 weeks after THA.　The muscle strength on the operative side recovered to the preoperative level 2 weeks after THA, but it was significantly lower than that on the non-operative side.　Physical therapy should take into consideration that muscle strength 1 week after THA is lower than that before THA.

Purpose: Historically, mountain worship was popular in the Gunma and Joetsu areas.　Many monks called “Shugen-ja” were active in the area.　Studying their practices and knowledge can help us understand medical and health consciousness of local residents.

Methods: Stone monuments and statues in several mountains in Gunma prefecture, known as sacred zones, were surveyed on-site.　Classical documents stored in a Shugen temple, “Chouken-ji”, were examined for medical and pharmaceutical information.　Contents of the ancient documents called “Denpo-juunikan” were examined and compared to modern medical knowledge.

Results: There are many stone monuments in the mountains in Gunma prefecture.　The Chouken-ji documents contained several pharmaceutical suggestions.　In the “Denpo-juunikan”, there are 16 sections describing medicine and/or health related issues.　These descriptions included treatments for injures and burns, techniques for pharyngeal foreign body removal, methods to propagate infection or cause physical symptoms, and obstetric intervention and treatment regarding fertility, contraception and abortion.

Discussion: Mountain worship has been popular in the Kitakanto area since ancient times, and its practitioners have significantly influenced the medical and health consciousness of local residents.

Background & Aim: Wearing seat belt is an effective tool to protect both pregnant women and their unborn babies. Pregnant women are more likely to use seat belt if they have acquired knowledge on how to wear seat belt correctly during pregnancy. This study aims to examine the association between exposure to information on seat belts and usual seat belt use in daily life during pregnancy.

Methods: We employed a descriptive analysis of cross-sectional survey data collected through self-administered questionnaires at seven obstetric facilities in Maebashi City, a provincial city in Japan. Between October and December 2013, 1,278 pregnant women completed questionnaires, containing items such as the frequency of rear seat belt use and the sources from which they had received information on the issue.

Results: We found that 444 participants (34.7%) received information on seat belt use during pregnancy mainly from magazines or administrative bodies, while 834 (65.3%) did not. We also found that pregnant women who received more information from more sources were more likely to wear seat belts while sitting in the rear seat.

Conclusions: These findings suggest that increased information on the correct method of wearing seat belts during pregnancy may increase the number of pregnant women who wear seat belts. Our study has implications for protecting the safety of both pregnant women and their children.

Objectives: To investigate patients with injuries from skiing and snowboarding who were admitted to the Department of Emergency Medicine, Gunma University Hospital.

Methods: We examined injured sites, injury severity, and the clinical course of patients who were injured while skiing and snowboarding and were admitted to our department between January 2002 and December 2018.

Results: Among the 5,448 patients admitted to our department during this period, there were 23 cases (0.42%) with injuries from skiing (n=8, 35%) and snowboarding (n=15, 65%). Injury to the abdomen and pelvic organs (14 cases) was most common. The medians of the revised trauma score, injury severity score, and possibility of survival were 7.8408, 9, and 0.9942, respectively. Emergent procedures such as operation or transcatheter arterial embolization were performed in 4 cases. The median duration of hospitalization was 6.0 days and all 23 patients improved and left our hospital or transferred to other hospitals uneventfully.

Conclusion: Injury from skiing and snowboarding can be severe, therefore, treatment in a suitable medical institution is required.

Background: There have been no studies on the prevalence of disordered eating attitudes (DEAs) in Mongolia. This study aims to determine the prevalence of DEAs and the associated risk factors among university students in Ulaanbaatar, Mongolia.

Methods: In 2016, a cross-sectional survey was conducted among 483 female students studying at School of Nursing, Mongolian National University of Medical Sciences in Ulaanbaatar. The Eating Attitudes Test (EAT-26) was used to determine the prevalence of DEAs among the students. Body height and weight measurements were collected by team members after obtaining participants’ consent. SPSS version 25 was used for statistical analyses. Chi-square, Fisher’s exact, and Mann-Whitney U tests were used to analyze ordinal and numeric values.

Results: In this study 5.4% of the participants presented high score on EAT-26. Through multivariate logistic regression analysis, the number of breakfasts per week, perception of healthy meals, and previous and present dieting were found to be associated with a high score on the EAT-26.

Conclusions: The prevalence of DEA is relatively low among Mongolian female students. The number of breakfasts per week, past and current experience of dieting, and perception of healthy meals were influential factors in the development of DEAs.

Aim: The evaluation of foods would change under various psychological situations, for example indulgent foods and sweeteners are wanted under severe and difficult situations. Here we examined the reasons for choosing foods after recalling memories.

Methods: Twenty-seven college students were asked, “What food do you choose because they are delicious”, “fashionable”, “nutritional balanced” or “good for health”． Among more than 100 foods, three healthy foods and three indulgent foods were selected. Finally, 93 students performed writing to recall happy, neutral or regrettable memories. Then the intensities of reasons for the selections were answered on a nine-point scale.

Results: Descriptions of regrettable memories lowered the values of healthy three foods. Description of happy memories increased the value of all six foods.

Conclusion: Regrettable memory description lowered the intensities for deliciousness. Happy memory description enhanced food selection reason for both indulgent and healthy foods. Adapting these results for nutrition counselling would support care for malnutrition.

Objectives: In Japan, the incidence of COVID-19 infection was extremely varied among prefectures. Population-related factors may be related to the incidence of COVID-19.

Methods: Proportions of persons infected with COVID-19 and factors such as concentration of population, population density, number of passenger cars, and ratio of those who use public transportation for commuting, were examined by prefecture. Patients whose infection pathways were unknown were also examined.

Results: By univariate analysis, both the number of COVID-19 patients and the number of patients whose infection pathways were unknown significantly correlated with all factors. Using multivariate analysis, the incidence of infection was independently correlated with population density. The incidence of patients whose infection pathways were unknown independently correlated with population density and ratio of those who use the public transportation for commuting.

Conclusion: The proportions of persons infected with COVID-19 were significantly correlated with population-related factors. These factors may be related to “crowding” and “close contact”. In the post- and with- COVID-19 era, establishment of new life styles, avoiding “crowding” and “close contact” might be important.

This report presents a case of infectious mononucleosis (IM) caused by coinfection of Epstein-Barr virus (EBV) and Cytomegalovirus (CMV).　A previously healthy 3-year-old girl was admitted to our hospital due to frequent vomiting for 14 days and fever for 2 days.　Physical examination showed bilateral cervical lymphadenopathy and hepatosplenomegaly.　Laboratory values were abnormal, including a white blood cell count of 36,560/μL, lymphocytes 43.5%， atypical lymphocytes 23%， aspartate aminotransferase (AST) 1,474 IU/L, alanin aminotransferase (ALT) 1,673 IU/L.　IgM antibodies to EBV VCA and CMV were positive.　PCR assays detected both EBV and CMV.　She was diagnosed as IM with both EBV and CMV.　Although the levels of AST (2,545 IU/L) and ALT (2,395 IU/L) were markedly elevated, they became normal at the 2-month follow-up without antiviral agents.　A limited number of studies have reported on EBV and CMV coinfection in healthy children detected by PCR assays.　Further investigations and case series would be required to establish the clinical entity of EBV and CMV coinfection.

We report a case of ruptured fusiform aneurysm in the distal posterior inferior cerebellar artery (PICA) treated by endovascular trapping in the acute phase.

A 52-year-old male was transported to our hospital with a chief complaint of sudden headache, dizziness, and vomiting. Subarachnoid hemorrhage was found due to rupture of a fusiform aneurysm with a size of 5.2 mm×4 mm, suspected to result from dissection of the telovelo tonsillar segment in the left PICA. Parent artery coil embolization endovascular treatment preserved the parent artery with no obvious adverse events or complications after the operation. Aneurysms of the distal PICA excluding the vertebral artery bifurcation are very rare, and endovascular treatment has been widely performed in recent years. Endovascular treatment may be the first choice for aneurysm treatment after appropriately evaluating the anatomical characteristics.

A 76-year-old man visited our hospital complaining of anorexia and abdominal bloating. At the first visit, there was no tenderness in the abdomen. Blood tests showed a slight increase in inflammatory response and LDH, and a significant increase in soluble IL-2 receptor, and abdominal CT showed a very large mass in the lower abdomen that was irregularly and unevenly enhanced. The mesentery, including the superior mesenteric artery and vein, was compressed by the mass. This is called the sandwich sign. From this characteristic finding, we diagnosed it as a mesenteric malignant lymphoma. Contrast-enhanced CT revealed ischemia in the small intestine. Abdominal pain worsened after hospitalization, and emergency surgery was performed. The ileum was necrosed over 20 cm, and the ileocecum and about 100 cm of the ileum were resected together with the tumor. The pathological diagnosis was diffuse large B-cell lymphoma (DLBCL). According to clinical guidelines, treatment of DLBCL is based on chemotherapy and radiation therapy. However, as in this case, rapid tumor growth may restrict intestinal blood flow and may require emergency surgery.

A 60-year-old man who was receiving warfarin potassium for chronic atrial fibrillation and was being followed for non-functioning adrenocortical adenoma, complained of abdominal pain and was transferred to our hospital for detailed examination and treatment of right adrenal hemorrhage. On arrival at our hospital, his physical state was stable, and he was not anemic. His international normalized ratio of prothrombin time (PT-INR) was 1.85. On contrast-enhanced computed tomography (CECT) performed at our hospital, the hematoma was not larger compared with that observed on CECT performed at the previous hospital, and the patient was treated with rest and a warfarin antagonist. His adrenocortical hormone level was normal. CECT performed on the 6^th hospital day showed no expansion of adrenal hemorrhage. We changed warfarin potassium to a direct oral anticoagulant on the 7^th hospital day because he had suffered a hemorrhagic event even though his PT-INR was maintained in the therapeutic range. He was discharged on the 11^th hospital day. A coagulation disorder or adrenal gland neoplasm can cause atraumatic adrenal hematoma, but hemorrhage of adrenal cortical adenoma is rare compared to other adrenal tumors. Hemorrhage of adrenal cortical adenoma can be treated conservatively if the patient is hemodynamically stable.

We present a rare case of primary tracheal adenoid cystic carcinoma (ACC) in which pulmonary metastases developed 14 years after the initial surgery. A 69-year-old woman underwent a radical tracheal resection with tracheoplasty for tracheal ACC. At a checkup 14 years later, computed tomography revealed three solid nodules in the lungs. We performed video-assisted thoracoscopic lung resection of the bilateral masses. Histologically, we observed ACC that was compatible with the previously resected primary lesion. The patient has had no recurrence 24 months after metastasectomy (198 months after the initial surgery).