The detection of small bowel lesions and their discrimination from normal bowel tissue are the most elementary and important factors in the computed tomography (CT) diagnosis of focal small bowel lesions. The detection and characterization of small bowel lesions have recently improved with advances in CT technology. Post-contrast multiphasic multidetector CT (MDCT) aids in the assessment of the vascular features of focal small bowel lesions. Understanding the typical multiphasic MDCT features of focal small bowel lesions is valuable because CT features overlap, and the severity and associated complications need to be assessed. However, it is often difficult to accurately diagnose focal small bowel lesions on MDCT, and histological examination is required in many cases in clinical practice. Clinical applications have been recently developed to effectively utilize dual-energy CT in the image analysis of small bowel lesions. In addition, the challenge of evaluating small bowel lesions with the aid of artificial intelligence has attracted attention in recent years. This review aimed to provide a comprehensive guide for the relevant imaging features of different types of benign focal small bowel lesions. J. Med. Invest. 72 : 1-7, February, 2025

This review discusses the introduction of healthcare robots, such as those that provide transfer, toileting, bathing, and communication assistance, in Japanese facilities for older adults and considers these issues from the perspective of nursing ethics. Although healthcare robots can support older adults and their caregivers, they may cause ethical dilemmas when introduced in assisted living facilities. Nurses should make ethical decisions by considering different types of information to determine the best care for older adults ; they can resolve ethical dilemmas by referring to the 6 principles of nursing ethics. As healthcare robots are increasingly used in the care of older adults, nurses should protect patients’ rights and ensure patient safety. Further, engineers and medical professionals must discuss and share issues related to the use of healthcare robots to build improved robotic technology for older adults. J. Med. Invest. 72 : 8-13, February, 2025

Allergic rhinitis (AR) is a type I allergic disease characterized by sneezing, watery rhinorrhea, and nasal obstruction. An epidemiological survey found that approximately 50% of Japanese individuals have AR.Histamine is a major chemical mediator that induces AR symptoms through its binding to histamine H1 receptor(H1R). We demonstrated that antihistamines have a blocking effect on histamine signaling of H1R, and the suppressive effect on histamine-induced up-regulation of transcriptional activation, and the suppressive effect on basal transcription of H1R in the absence of histamine which may be part of the inverse agonist action of antihistamine. Sublingual immunotherapy (SLIT) with a standardized Japanese cedar (JC) pollen significantly improved nasal symptoms and AR-related sleep disturbance in patients with JC pollinosis. Dual SLIT with JC pollen and house dust mites (HDM) suppressed both JC pollen-induced seasonal and HDM-induced perennial nasal symptoms in bisensitized patients with AR. Dual SLIT was more effective in suppressing nasal obstruction at the peak JC pollen period than mono SLIT with JC pollen. Posterior nasal neurectomy (PNN) improved nasal symptoms and medication scores in patients with severe perennial AR. Herein, we describe recent advances in the management of AR. J. Med. Invest. 72 : 14-20, February, 2025

Community medical care faces challenges such as the uneven distribution of physicians, fluctuating medical demand, and the increased relative demand for physicians due to the increased specialization of medical fields. Hematologists primarily address issues, such as abnormal blood cell counts, lymphadenopathy, persistent fever, and coagulation abnormalities, which indicate hematological diseases. However, the emphasis on treating hematologic diseases within community medicine remains relatively low. Accurate and reliable differentiation and identification of hematological diseases with the cooperation of laboratory technicians and support of artificial intelligence is necessary. Significant advances have been made in the treatment of hematological diseases; however, small community hospitals often lack access to these treatments and are unable to conduct clinical trials that require specialized equipment such as for chimeric antigen receptor T-cell therapy. In the future, hematologists will need to focus on developing their careers within the community and further optimizing their practice to enhance patient care. J. Med. Invest. 72 : 21-25, February, 2025

Background : Leg length discrepancy (LLD) is a musculoskeletal condition in which leg length is asymmetric. LLD can adversely affect adjacent joints. A typical example is hip–spine syndrome. We aimed to investigate how LLD affects spinopelvic alignment and mobility, under conditions simulating LLD. Methods : Fifty healthy adults (31 women, 19 men ; mean age 37.1 ± 8.9 years) participated in this study. A shoe lift was applied under the left foot to simulate LLD of 1, 2, 3, and 4 cm. Spinopelvic alignment while standing upright and mobility in flexion, extension, and lateral bending were measured under conditions simulating LLD using a Spinal Mouse device. Results : Lumbar spine curvature in the frontal plane was significantly increased to the left as LLD increased. Sacral inclination angle in the frontal plane was significantly increased to the right by adding a lift. There was no significant difference in curvature of the thoracic spine in any parameters. Mobility of the lumbar spine during left lateral bending decreased as LLD increased. Inclination between T1 and S1 in the frontal plane when bending to the left decreased with increasing LLD. Conclusion : Simulating LLD affects spinopelvic alignment and mobility in the frontal plane, but not significantly in sagittal plane. J. Med. Invest. 72 : 26-33, February, 2025

Obesity-induced excess adipokine production is associated with malignancy and mortality in prostate cancer. We previously showed that fatty acid binding protein 4 (FABP4), a major adipokine of mature adipocytes, promotes the progression of prostate cancer cell growth and invasion. In this report, we present lipolysis-stimulated lipoprotein receptor (LSR) as a newly identified binding partner for FABP4. Their binding induced Akt phosphorylation, whereas LSR knockdown (KD) failed to phosphorylate Akt. Intraosseous injection of LSR-KD prostate cancer cells showed smaller areas of intraosseous tumor, lower Ki-67 labeling indices, and lower numbers of phospho-Akt-positive cancer cells compared with control prostate cancer cells. Moreover, the contact coculture of prostate cancer cells with bone marrow stromal cells (BMSCs) promoted FABP4 secretion by BMSCs. Our findings indicated that FABP4-mediated prostate cancer cell progression was regulated by cellular signaling via FABP4-LSR binding in the bone microenvironment. J. Med. Invest. 72 : 34-41, February, 2025

Water is the main component of cells, tissues, and organs, and plays vital roles in macronutrient hydrolysis and overall cell function regulation. While low water intake may be sufficient for hydration, several studies suggest that most children fail to meet water intake guidelines, leading to underhydration as indicated by elevated hydration biomarkers. We conducted a cross-sectional observational study to examine water intake and output among high school students, comparing non-athletes and athletes. We enrolled 26 non-athletes and 28 athletes in this study. Water balance was assessed by water intake from foods and beverages, metabolic water production, and non-renal water loss (NRWL). Moreover, urine was compared. Increases of total water intake from food and beverage consumption in athletes were significantly higher than those in non-athletes. Furthermore, urinary output was lower and NRWL was 2-3 times higher in athletes than non-athletes. These findings suggest that large NRWL induces hypohydration in athletes. J. Med. Invest. 72 : 42-46, February, 2025

The high rate of chronic hepatitis, including hepatitis B, C and D, in Mongolia creates a large health burden of advanced liver disease. This includes liver failure and the highest incidence rate of hepatocellular carcinoma (HCC) worldwide. In the present study, we histopathologically examined 69 recent cases of HCC from the Mongolian National Center for Pathology, which collects specimens from across the country. The background liver histology of HCC exhibited a bimodal distribution, with one peak corresponding to advanced liver fibrosis and another to mild liver fibrosis. The fibrosis severity negatively correlated with age. Additionally, the frequency of poorly differentiated tumors was significantly higher in the HCC with early stage of fibrosis. A comparison of the pathological characteristics of HCC in urban and rural areas showed that poorly differentiated tumors were highly prevalent in urban areas. The characteristics of HCC in Mongolia are different from those in other countries, suggesting that the causes of liver disease are not only related to viruses but also other factors that depend on the region. This study will provide insight into what research is needed next for liver cancer control in Mongolia. J. Med. Invest. 72 : 47-53, February, 2025

Background : Accelerating ammonium metabolism of hepatocyte like cells (HLCs) is critical for various functions of hepatocytes. The aim of the present study was to investigate whether Farnesoid X receptor (FXR) agonist, obeticholic acid (OCA), accelerated ammonium metabolism of HLCs, which was derived from adipose derived mesenchymal stem cells (ADSCs). Methods : Human ADSCs were seed in flat bottom plate, then our differentiation protocol was used for 21 days. OCA treatment had been performed in Step3 for 10days. Then, 1) hepatic maturation, 2) urea cycle genes, 3) urea production, and 4) ammonium metabolism was compared depend on the presence or absence of OCA. Results : HLCs had been successfully produced for 21 days. HLCs with OCA showed significantly higher mRNA expressions of AAT than those without OCA. HLCs with OCA showed significantly higher mRNA expressions of urea cycle genes such as SLC25A13, CPS1, and OTC. Urea production was also tended to be upregulated by OCA addition. HLCs with OCA showed significantly higher clearance of NH4Cl at 6hr and 24 hr after addition of NH4Cl. Conclusion : FXR agonist, OCA, accelerates ammonium metabolism of ADSCs derived HLCs. HLCs could be one of treatment options of hepatic encephalopathy of patients with liver failure or urea cycle disorder in the future. J. Med. Invest. 72 : 54-59, February, 2025

Caring demonstrates compassionate care for others through the process of “knowing person as caring” from the theoretical lens of Technological Competency as Caring in Nursing (TCCN). Physical therapists respect the individual needs and values of patients and builds deep relationships with patients and their families. In this process, it is essential to respect the dignity and humanity of the other person. This discussion paper aims to 1) extract the necessary elements of Locsin’s TCCN theory from a physical therapy practice perspective;2) consider the usefulness of Locsin’s TCCN theory in physical therapy practice using a narrative review process;3) examineknowing patients as caring in physical therapy using Carper’s fundamental ways of knowing through the fictional vignette;and 4) evaluate Donabedian’s structure, process, and outcome to assess the quality of healthcare as well as consider knowing patients and quality of caring regarding the mentioned fictional vignette. TCCN theory-based practice is essential for incorporating a caring attitude and the appropriate use of technology into the practice of physical therapy. Caring in physical therapy is the practice of patient-centered care through attentive learning and engagement with the patient. J. Med. Invest. 72 : 60-65 February, 2025

Aging and obesity trigger liver mitochondrial decline, impairing liver function and energy metabolism. Effective hepatic mitochondrial biogenesis helps maintain and restore hepatocyte function. The effects of bergenin, a polyphenol with various pharmacological effects, on hepatic mitochondrial biogenesis remain unclear. Therefore, we aimed to determine its effects on mitochondrial biogenesis in hepatocytes. We measured mitochondrial content in human HepG2 hepatocytes using MitoTracker Green FM ; intracellular ATP content using an ATP assay kit ; and mitochondrial DNA (mtDNA) using the ratio of mtDNA to nuclear DNA by qPCR. Protein levels were analyzed using immunoblotting. Nuclear translocation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) was assessed by immunofluorescence staining and immunoblotting. In human HepG2 hepatocytes, bergenin increased mitochondrial content, elevated mitochondrial DNA and constituent proteins, and enhanced intracellular ATP levels and PGC-1α nuclear translocation, possibly promoting mitochondrial biosynthesis. SIRT1 expression was induced in bergenin-treated cells and may be responsible for bergenin-inducible mitochondrial biogenesis, which was abolished by the SIRT1 inhibitor EX-527. Furthermore, bergenin activated AMP-activated protein kinase (AMPK). Compound C, an AMPK inhibitor, abolished bergenin-induced SIRT1 expression and mitochondrial biogenesis. Overall, bergenin activates hepatic mitochondrial biogenesis through the AMPK / SIRT1 axis, which could help to prevent and ameliorate serious aging- and obesity-related liver diseases. J. Med. Invest. 72 : 66-75, February, 2025

The study aimed to investigate the effectiveness of combining a protein and vitamin D-enriched menu with an exercise program to reduce frailty risk and enhance muscle performance. However, current evidence lacks accurate dosage and effectiveness information for this combination. This study involved Japanese men in their 60s who were randomly assigned to two groups : the ExN group, which received a 10-day exercise program along with enriched diet, and the Ex group, which underwent the exercise program alone. The effects of these interventions on muscle mass, strength, and serum vitamin D metabolite levels were assessed. The ExN intervention resulted in a significant increase in skeletal muscle mass and serum 25-hydroxyvitamin D3 (25(OH)D3) levels, while the Ex intervention did not yield the same effects. These results indicate that a combined program of exercise with protein and vitamin D-enriched meal improves serum 25(OH)D3 levels and skeletal muscle mass among older Japanese men. J. Med. Invest. 72 : 76-84, February, 2025

Menopausal symptoms can significantly affect the performance of working women. The association between knowledge of symptoms, educational level and better coping with the symptoms has been found. However, no study has been performed about coping with menopausal symptoms among school teachers who have higher educational background in Japan. This cross-sectional study explored coping strategies used by female teachers experiencing menopausal symptoms and the factors influencing their healthcare-seeking behaviors. Data were collected via a self-administered questionnaire between December 5, 2022 and February 28, 2023. Participants included 278 female teachers aged 45–60 years working in public elementary and junior high schools, of whom 156 (56.1%) reported menopausal symptoms. More than 80% of those with symptoms used at least one coping strategy : gathering information (68.6%), self-coping (60.9%), seeking advice (57.1%), and medical consultation (26.3%). Higher somatic menopausal symptom scores were associated with seeking medical consultation or advice. A significant correlation was observed between symptom severity and number of coping strategies used. Additionally, prior knowledge of menopause significantly increased the likelihood of information gathering and self-coping. Our findings underscore the need for support systems that help teachers cope with menopausal symptoms effectively, such as improving access to care and providing educational opportunities about menopause. J. Med. Invest. 72 : 85-92, February, 2025

Life support robots in care settings must be able to read a person’s emotions from facial expressions to achieve empathic communication. This study aims to determine the degree of agreement between Multi-task Cascaded Convolutional Neural Networks (MTCNN) results and human subjective emotion analysis as a function to be installed in this type of robot. Forty university students talked with PALRO robot for 10 minutes. Thirteen area of interest videos were used to assess the validity identified by MTCNN was facial expression was happy or combination of happy and other emotions. Twenty university students and 20 medical professionals identified which of the 7 emotions (angry, disgust, fear, happy, sad, surprise, neutral) were present. Fleiss’ kappa coefficient was calculated. Kappa coefficients of the emotion analysis for seven emotions ranged from 0.21 to 0.28. Kappa coefficient for “Happy” was the highest (0.52 to 0.57) with moderate agreement. Among female university students, only “Surprise” had a moderate agreement with Fleiss’ kappa coefficient of 0.48. MTCNN emotion analysis and human emotion analysis were in moderate agreement for the identification of “Happy” emotions. The comparison of the agreement between the results of emotion analysis from facial expressions using non-contact MTCNN and subjective human facial expression analysis suggested that the use of MTCNN may be effective in understanding subjects’ happy feelings. J. Med. Invest. 72 : 93-101, February, 2025

Background : The COVID-19 pandemic has significantly impacted nursing students in urban settings. Understanding stress and coping in this population is essential for developing effective interventions for future pandemics and post-pandemic nursing education. Aims : This study assesses the interactions between demographic variables and stress responses, demonstrating these relationships through data sonification. Methods : A cross-sectional analytical study was conducted at an urban nursing college, with 195 participants completing modified versions of the Perceived Stress Scale, Physio-Psycho-Social Response Scale, and Coping Behavior Inventory. Structural equation modeling and data sonification were employed for analysis. Results : Nursing students reported moderate stress from academic demands and clinical responsibilities, utilizing coping strategies such as problem-solving and optimism. Structural equation modeling indicated a significant negative relationship between coping skills and physio-psycho-social stress (β = -0.301, p < .0001) and a negative association between age and perceived stress (β = -0.160, p = 0.035). Data sonification revealed synchronization between perceived stress and stress responses, with coping efforts peaking slightly after stress levels. Discussion : While students employ effective coping strategies, targeted interventions are needed to enhance stress management, especially for younger students. Conclusion : Stress and coping among nursing students in urban settings are complex, with data sonification providing deeper insights. J. Med. Invest. 72 : 102-116, February, 2025

Coronavirus disease 2019 (COVID-19) and associated lockdowns affected many people regardless of location, age, or gender. This study aimed to focus on school-aged children studying at a Japanese Language Supplementary School (JLSS) in the southwestern region of the United States and assessed the impact of COVID-19 on their lifestyle and physical activity (PA). An online-based cross-sectional survey was administered to students (age range : 6-18) enrolled in a JLSS as of June 11, 2021. Data were collected from 151 students. The questionnaire consisted of lifestyle and PA questions. A paired and Student t-test was used to test the differences in changes before COVID-19 and during COVID-19 among children. Chi-square tests were used for comparisons with descriptive analyses of frequencies. Level of statistical significance was set at p <.05. Screen time was significantly longer on weekdays (t = 8.71, p<.001) and weekends (t = 5.94, p < .001) than before COVID-19. The number of children who went to bed after 10 pm was significantly higher (χ2 = 4.06, p < 0.05) than before the new coronavirus infection. The frequency of PA per week was significantly higher (χ2 = 4.01, p < 0.05) in the group using digital devices. Findings suggested that the use of digital devices for PA can enhance PA frequency in JLSS students. J. Med. Invest. 72 : 117-123, February, 2025

Objective : There have been no studies on the effectiveness of raloxifene as an antiresorptive agentfollowing discontinuation of romosozumab. The aim of this study was to investigate the potential effectiveness of raloxifene following a romosozumab therapy. Methods : This study had an observational pre-post design and included 23 patients. Romosozumab 210 mg was administered subcutaneously once every 4 weeks for 12 months, after which all patients received raloxifene 60 mg/day for 24 months. We investigated the incidence of new fractures, safety, and bone mineral density (BMD). Results : We found no new fractures or adverse events. After the treatment with romosozumab, percent changes from baseline in BMD at the spine and total hip in treatment-naïve patients with primary osteoporosis (the Naïve-P group) were 12.3% and 4.6%, respectively. After subsequent administration of raloxifene, spinal and total hip BMD in the Naïve-P group decreased to baseline levels at 36 months and 30 months, respectively. Six months after switching to raloxifene, the respective percent changes from baseline in spinal and total hip BMD were 12.0% and 5.8%. Conclusion : Romosozumab followed by raloxifene is acceptable for use for only 6 months in the Naïve-P group. However, more aggressive use of this agent is not recommended. J. Med. Invest. 72 : 124-133, February, 2025

Background : The oral and gut microbiomes are linked to prognosis in colorectal cancer patients undergoing surgery, chemotherapy, or radiotherapy. Dysbiosis in the oral microbiome can lead to tooth decay, periodontitis, and gingivitis, resulting in tooth loss. This study examined the relationship between tooth count and chemotherapy outcomes in colorectal cancer patients. Method : This retrospective cohort study involved 42 patients receiving chemotherapy for unresectable advanced or metastatic colorectal cancer at Tokushima University Hospital between October 2016 and December 2021. Prior to chemotherapy, dental panoramic radiographs were taken to determine tooth count. Patients were grouped based on the number of teeth (≥17 vs. ≤16), and overall survival (OS), progression-free survival (PFS), and adverse events were compared. Results : Patients with ≤16 teeth had significantly worse OS than those with ≥17 teeth (p = 0.024). PFS tended to be worse in patients with ≤16 teeth, albeit without significance (p = 0.097). The incidence of various adverse events did not differ between the groups. Anemia was the most common adverse event in patients with ≤16 teeth. Conversely, neutropenia was the most common adverse event in patients with ≥17 teeth. Conclusion : The number of teeth could be easily examined prognostic factor for chemotherapy in colorectal cancer. J. Med. Invest. 72 : 134-138, February, 2025

Purpose : We aimed to determine the association between sarcopenia and frailty in Japan’s hyperaged society. Methods : We investigated the incidence of sarcopenia and frailty among 423 community-dwelling older adults (304 women and 119 men ; mean age : 77.0 years). Interviews, Kihon Checklist (KCL) assessments, physical function tests, and anthropometric measurements were performed at baseline. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria, with a KCL score of ≥7 indicating frailty. Results : Eight patients (1.9%) had sarcopenia alone, 113 (26.7%) had frailty alone, and 26 (6.1%) had both sarcopenia and frailty. The instrumental activities of daily living (IADL) scores were significantly higher in all groups. Logistic regression analysis showed the association of sarcopenia and frailty with IADL. The receiver operating characteristic curves of the total KCL and IADL scores were analyzed to determine the cutoff value for assessing sarcopenia with frailty. The cutoff value for the total KCL score was 7.000, while that for the KCL-IADL score was 2.000. Conclusion : Approximately 6.1% of patients were diagnosed with sarcopenia with frailty using the KCL. These conditions were found to impair IADL. Hence, interventions addressing both frailty and sarcopenia may help prevent the decline in IADL. J. Med. Invest. 72 : 139-147, February, 2025

The aim of this study was to investigate the association between phase angle (PhA) at admission and functional outcomes at discharge in patients with acute ischemic stroke. This single-center, prospective cohort study measured PhA and skeletal muscle index (SMI) in patients with acute ischemic stroke using bioelectrical impedance analysis (BIA). Functional outcomes were assessed using the modified Rankin Scale (mRS) at discharge, with mRS scores of 3–5 difined as poor functional outcomes. The association between PhA or SMI and poor functional outcomes was analyzed for male and female patients. This study included 287 patients (195 males, 92 females). Logistic regression indicated that PhA, but not SMI, was independently correlated with poor functional outcomes at discharge (males : OR : 0.58, 95% confidence interval [CI] : 0.34–0.98, p = 0.041, females : OR : 0.31, 95% CI : 0.12–0.80, p = 0.015). Receiver operating characteristic curve analysis determined PhA cutoff values for poor functional outcomes : 4.70 in males (sensitivity : 0.627, specificity : 0.680, area under curve [AUC] : 0.674) and 3.70 in females (sensitivity : 0.467, specificity : 0.830, AUC : 0.712). PhA was identified an independent predictor of poor functional outcomes at discharge in patients with acute ischemic stroke, and it was superior to SMI in this regard. J. Med. Invest. 72 : 148-155, February, 2025

Objective : ACE ratio in the serum is a more sensitive indicator of zinc nutrition than serum zinc concentration. In this study, we examined the effects of zinc supplementation in combination with difructose anhydride (DFA) that enhances zinc absorption in the intestine on serum zinc concentration and ACE ratio in patients with refractory taste impairment. Methods : Twenty patients with refractory taste impairment were enrolled. The patients received 34 mg of zinc in combination with 2.0 g of DFA orally every day for three months. Taste impairment was evaluated using visual analogue scale (VAS). Results : After zinc supplementation with DFA (zinc with DFA), ACE ratio was significantly decreased, but serum zinc concentration was not increased in patiens with refractory taste impairment. Although VAS score was not changed in the patients after zinc with DFA, we divided the patients into two groups : 14 responders and 6 non-responders. ACE ratio in responders, but not in non-responders was significantly decreased after zinc with DFA. However, serum zinc concentration was not changed in both responders and non-responders after zinc with DFA. Conclusion : The present findings suggest that malabsorption of zinc in the intestine is the primary cause of zinc deficiency in patients with refractory taste impairment. J. Med. Invest. 72 : 156-160, February, 2025

Sarcoma Meth A is widely used in the field of immunology and oncology study. We found that a mutant cell line, Meth A (mMeth A), was rejected in an in vivo subcutaneous challenge in BALB / c mice. mMeth A cells were not rejected in athymic BALB / c-nu / nu mice and CD8+ cell-depleted BALB / c mice, suggesting that CD8+ cells are required for rejection of mMeth A cells. Microarray analysis showed that melanoma antigen (MAg) was one of the most elevated genes in mMeth A cells. Indeed, quantitative gene expression analysis showed that the expression level of MAg in mMeth A cells was one hundred-times higher than that in Meth A cells. We constructed two types of expression vector coding the MAg gene sequence corresponding to 788–1257 and 1611-2043 and immunized mice with these genes by intramuscular injection. Immunization of a plasmid expressing the Mag 788-1257 gene protected the mice from in vivo Meth A challenge as evaluated by tumor volume and survival rate. The results reveal that MAg is a potential vaccine candidate antigen against Meth A tumors. J. Med. Invest. 72 : 161-166, February, 2025

Nutrition and exercise have effects on the body. The aim of the present study was to assess vitamin D status (serum 25-hydroxyvitamin D [25(OH)D] levels) and investigate its associations with muscle mass and function, as well as the effects of vitamin D supplementation on muscle function in high school athletes. Twenty-one high-school athlete students (6 males and 15 females) participated in this study. The serum 25(OH)D levels of 15 athletes (71.4%) with vitamin D insufficiency (VDI)/vitamin D deficiency (VDD) were and those of six athletes (28.6%) with vitamin D sufficiency (VDS) were 24.2 (22.3–27.0) ng/mL and 35.8 (33.0–38.9) ng/mL, respectively. Serum 25(OH)D concentration was significantly associated with total power in the male, female, and total athlete groups. Daily 1,000 IU vitamin D supplementation for 6 months increased serum vitamin D levels from 27.0 (22.9–32.1) ng/mL to 37.9 (28.9–40.9) ng/mL and improved muscle function in the total athlete group. Our findings suggest that daily 1,000 IU vitamin D supplementation should be recommended to optimize maximal aerobic power in high school athletes. J. Med. Invest. 72 : 167-171, February, 2025

Neurological immune-related adverse events can manifest as paraneoplastic neurological syndrome (PNS), especially in patients with small-cell lung cancer (SCLC). We herein report a 73-year-old man with SCLC treated with an immune checkpoint inhibitor (ICI) combined with chemotherapy. Although the chemo-immunotherapy induced a favorable response to SCLC, he later developed acute cerebellar ataxia. He was diagnosed with paraneoplastic cerebellar degeneration associated with anti-Sry-like high mobility group box 1 (SOX1) autoantibody. The antibody was also identified in serum collected at the diagnosis of SCLC and before ICI administration, which retrospectively suggested that the patient was at risk of ICI-induced PNS. J. Med. Invest. 72 : 172-176, February, 2025

We report a case of successful management of a massive pulmonary embolism (PE) with simultaneous hepatic arterial injury using anticoagulation and interventional radiology (IVR). The patient, with pre-existing muscle atrophy, decreased lower extremity mobility, and spinal stenosis, developed bilateral PE during rehabilitation. Following cardiopulmonary arrest, chest compressions for resuscitation resulted in hepatic hemorrhage. The patient was treated with intravenous heparin, transcatheter arterial embolization, thrombectomy, and blood transfusion, leading to full recovery without neurological complications. This case highlights the importance of assessing PE risk in hospitalized patients and highlights the efficacy of IVR in complex cases. J. Med. Invest. 72 : 177-181, February, 2025

Objective : Identified genetic mutation in the patient with unexplained decreased fibrinogen activity. Methods : We conducted a detailed examination of the patient’s fibrinogen activity level, antigen level, and genomic sequence. Results : The patient’s fibrinogen activity level was 80 mg / dL and the antigen level was 131 mg / dL. Upon sequencing of the fibrinogen gene, a novel heterozygous c.Bβ227G > T mutation was detected in Bβ-chain, which results in the cysteine residue at position 76 in exon 3 being converted to a phenylalanine residue. Conclusions : This mutation reduces fibrinogen activity and antigen levels, but the pathophysiology of this mutation remains unclear. J. Med. Invest. 72 : 182-184, February, 2025

A 75-year-old woman presented with scalp and cranial defects caused by implant exposure, infection,and cranial necrosis following multiple craniotomies. To reduce the risk of complications after cranioplasty, weplanned a two-stage cranial reconstruction. A wide bipedicled scalp flap with a long longitudinal axis above the cranium covered the scalp defect after debridement, and skin grafting was performed on the periosteum after flap harvesting during the first surgery. A custom-made titanium plate was implanted under the bipedicled flap during the second cranioplasty 4 months after the initial surgery. The patient had no complications during the two surgeries, and her clinical course was uneventful for 6 months after the last surgery. Although a two-stage approach, our technique is relatively safe for patients who have previously undergone multiple surgeries and decreases the risk of postoperative complications due to the shorter exposure time of the titanium plate during the second surgery. J. Med. Invest. 72 : 185-188, February, 2025

We report a case of delayed gastric conduit emptying (DGCE) after surgery for esophageal cancer. A 67-year-old man who visited a hospital because of dysphagia and was referred for a diagnosis of esophageal cancer. Contrast-enhanced computed tomography (CT) showed wall thickening of the middle thoracic esophagus and an enlarged abdominal lymph nodes and a spiculated pulmonary shadow 25×20 mm in size in right lower lobe that was highly suspected as a primary lung cancer. Preoperative chemotherapy was introduced due to advanced esophageal cancer, both the esophageal tumor and the pulmonary lesion were found to be shrunk. Even after a detailed examination, the shadow in the right lower lobe of the lung could not be ruled out for malignancy, a simultaneous surgery was conducted. The patient underwent S10 segmentectomy followed by subtotal esophagectomy and the posterior mediastinal route reconstruction using a gastric conduit. Gastrografin radiography revealed stasis of the reconstructed gastric conduit on postoperative day (POD) 8. CT and upper gastrointestinal endoscopy showed that the gastric conduit was pulled into the right thoracic cavity caused by pulmonary resection and developed inflammatory changes, causing DGCE. The DGCE eventually improved with conservative treatment and the patient was discharged on POD 68. J. Med. Invest. 72 : 189-193, February, 2025

Background : Appendiceal goblet cell adenocarcinomas (GCA) are rare. Most patients who undergo appendectomy have acute appendicitis. The detection of synchronous colorectal cancer (SCRC) has increased with advances in diagnostic imaging and endoscopic examinations. However, only two cases of SCRC, including appendiceal GCA, have been reported to date. We recently encountered an extremely rare case of SCRC, involving appendiceal GCA, ascending colon cancer (ACC), and sigmoid colon cancer (SCC). Herein, we present this case and provide a discussion on the relevant literature. Case presentation : A 69-year-old man presented to our hospital with right lower abdominal pain. Based on contrast-enhanced computed tomography (CE-CT), the patient was diagnosed with SCRC and acute appendicitis caused by appendiceal neoplasm and ACC. The patient underwent emergency laparotomy, and right colectomy with lymph node dissection (LD). Intraoperatively, we palpated the remaining segment of the colorectum whenever possible and incidentally detected SCC. Therefore, sigmoid resection with LD was suggested. Conclusion : When treating acute appendicitis, it is important to consider the possibility of an extremely rare appendiceal tumor as the cause. If possible, CE-CT should be performed to ensure appropriate image interpretation during an unlikely SCRC event. J. Med. Invest. 72 : 194-201, February, 2025

The diagnosis of pleuritis caused by mycobacteria is not always easy. Ziehl-Nielsen staining utilizing cell blocks (CBs) of lower respiratory samples was reported to be useful in the diagnosis of pulmonary tuberculosis. However, CBs of pleural effusion (PE) are not commonly used in the differential diagnosis of benign pleuritis. A 100-year-old woman was transferred to our emergency department due to respiratory failure. The patient had massive right PE and an elevated serum carbohydrate antigen 125 level, but no tumor lesions were identified. Mycobacterial examinations using the usual procedures for PE did not lead to a definitive diagnosis. However, Ziehl-Nielsen staining detected several accumulations of acid-fast bacilli in paraffin-embedded PE-CB sections. Finally, sequence analysis of the 16S rRNA gene using the remaining PE-CB showed high homology (99.79%) to that of Mycobacterium goodii. This case suggests that analysis of PE-CBs may be useful for diagnosing suspected cases of mycobacteria-induced pleuritis with negative acid-fast bacilli smears for PE. J. Med. Invest. 72 : 202-206, February, 2025

We report a case of a 14-year-old male sprinter with bilateral fatigue fractures of the proximal phalanges in the great toes. The patient and his guardian wished for an early return to sports; therefore, focused extracorporeal shockwave therapy (FSW) was administered instead of the traditional surgical treatment for bilateral cases. Four weeks after starting treatment, tenderness had disappeared, and he was able to return to sports. Computed tomography at 24 weeks after starting FSW revealed bone healing, and there was no recurrence of the fatigue fractures at the 48-week follow-up. The lesson learned from this case is that FSW offers a novel, less invasive treatment option for athletes with bilateral fatigue fractures of the proximal phalanges in the great toes who wish for an early return to sports without surgery. FSW has analgesic effects and promotes bone healing, resulting in optimal treatment outcomes. FSW should be considered a standard treatment option for this type of fracture. J. Med. Invest. 72 : 207-210, February, 2025

AsisTIVA is total intravenous anesthesia support software for syringe pump control. It remains the only automated program to have achieved both practical and commercial viability. AsisTIVA has been certified for use at Tokushima University, Tohoku University, and at its developer institution, Fukui University. We conducted our initial anesthesia management with AsisTIVA at Tokushima University. This initial experience was successful, with no adverse effects. AsisTIVA controls propofol and remifentanil concentrations to maintain a Bispectral index of 45 and adjusts rocuronium concentrations to maintain a Train Of Four value of 1. By managing these anesthetics, AsisTIVA allows anesthesiologists to focus on other aspects of anesthesia management. Its use is expected to expand further. J. Med. Invest. 72 : 211-216, February, 2025

This study examined the mental health and related factors such as social comparison orientation, self-compassion, and perfectionism of 57 graduate trainees aspiring to become psychologists in comparison with 80 graduate students with other majors. The results showed that “Opinion comparison” subscale of social comparison orientation was significantly higher among trainees than among non-trainees, and higher among women than among men in both trainees and non-trainees. Social comparison orientation positively affects depressive symptoms, anxiety symptoms, and social function impairment among trainees but has no effect among non-trainees. Perfectionism was higher among first-year trainees than among second-year trainees, whereas no gradebased differences existed among non-trainees. Perfectionism positively affected social function impairment among non-trainees but not among trainees. However, self-compassion negatively affected depressive symptoms, anxiety symptoms, and social function impairment among both trainees and non-trainees. Furthermore, 89% of the trainees blamed themselves during practical training, expressing that both the trigger and content of selfblame were related to hesitation, anxiety, and lack of confidence. Overall, the results suggest that trainees should aim for personal growth over perfection, enhance their self-compassion rather than blaming themselves, and should not engage in social comparison. J. Med. Invest. 72 : 217-223, February, 2025