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This study is aimed to investigate the MRI findings and clinical course of semitendinosus muscle strain in professional soccer players. Between January 2008 and December 2009, twenty-one professional soccer players were diagnosed with hamstring muscle strain at our department. They were classified into two groups: the semitendinosus muscle strain group (Group A, n=7) and the other hamstring muscle strain group (Group B, n=14). Okuwaki's classification was used for MRI findings. All seven subjects in Group A had Type I MRI findings. In 14.3% (1/7) cases) in Group A, and 92.9% (13/14 cases) in Group B the onset of injury was clear. The injury situation was significantly more unclear in Group A than Group B (p<0.01). Concerning the average time required to return to the game, in Group A (8.1 days) it was significantly shorter than in Group B (23.3 days) (p<0.01). Semitendinosus muscle strain is characterized by unclear onset of injury, a high frequency of type I injury, and a short period required for recovery. [ABSTRACT FROM AUTHOR]

We investigated muscle strains that occurred in a team from the Japan Professional Football League. Numbers of muscle strains tended to rise in proportion to the increase in the number of matches played. Many muscle strains occurred by eccentric force. Proximal hamstring tendon injuries happened in hip flexion and knee extension position. From the MRI findings and the actual period of returning to training in each case, we learned to gauge the approximate period of returning to training. The cases of bleeding in the muscle or between the muscles or on the muscle fascia returned to training from several days to within 2 weeks. The cases of injury of the musculotendinous junction returned to training from 4 weeks to 3 months. The cases of injury of the aponeurosis of the semimembranous muscle returned to training from 4 to 10 weeks. And the cases of tendon rupture required at least 4 months after surgery. Prevention of muscle strains is becoming an increasingly important consideration for athletes. [ABSTRACT FROM AUTHOR]

Twelve men and 18 women with a mean age of 22(15-32)years who underwent anterior cruciate ligament(ACL) reconstruction using semitendinosus muscle tendon were studied. The quadriceps strength was isokinetically measured during concentric and eccentric contractions before and after ACL reconstruction. Before surgery, tilt injured Io uninjured ratio was 72.9% for eccentric contraction, which was significantly lower than the 81.4% for concentric contraction. For postoperative muscle, the injured to uninjured ratio was 98.6% for eccentric contraction and 80.6% for concentric contraction, showing better recovery of muscle strength for eccentric contraction. Observation of lower muscle strength fur eccentric contraction is more important than for concentric contraction in knees before ACL reconstruction because movements such as stop and turn become difficult due to ACL dysfunction. Thus, ACL deficient patients avoid exerting eccentric knee extension and contraction forces even in daily living activities. On the other hand, once the joint instability is improved by ACL reconstruction, patients do not need to avoid movements such as stop and climbing down stairs that require eccentric contraction strength. This may account for good recovery of the muscle strength for eccentric contraction. [ABSTRACT FROM AUTHOR]

The present study aimed to prove the effectiveness of low-load resistance muscular training under moderate restriction of blood flow. Twelve limbs of 6 healthy male adults were studied. In each subject, one lower limb was subjected to blood flow restriction (group R) and the other lower limb was not subjected to blood flow restriction (group N), and low-load resistance lower limb muscular training was conducted 3 times weekly for 8 weeks. Knee extensor torque, muscular discharge at the M. vastus lateral is and M. vastus medialis, and the cross-sectional area of the knee extensor muscle group were measured before training and after training for 8 weeks. and the results were evaluated. Results of knee extensor torque (isometric contraction at 60° knee flexion) showed significant augmentation (p<0.05) of muscular strength in group R compared to group N. In the M. vastus lateralis, a significant increase (p<0.05) in muscular discharge was observed in group R compared to group N. No significant difference in the pre- / post-training ratio of the muscular cross-sectional area was observed between the two groups. These results confirmed that low-load resistance muscular training under moderate restriction of blood flow is an effective muscular training for healthy adults without muscular atrophy. [ABSTRACT FROM AUTHOR]

A prospective study was conducted to examine the effects of introducing low load muscular training under moderate restriction of blood flow during the first 16 weeks after anterior cruciate ligament (ACL)reconstruction. Forty-two subjects with a mean age of 29 years(18 to 52 years)were randomized into a group in which training under blood flow restriction (group R, n=22)was conducted and a group in which training under no restriction(group N, n=22) was conducted, with both groups following the same training schedule. Evaluations of knee extensor torque and knee flexor torque(isometric contraction at 60° knee flexion, isokinetic contraction at angular velocities of 60° and 180° per sec) before surgery and 16 weeks after surgery showed a significant increase in muscular strength in group R compared to group N. The preoperative 16-week postoperative ratio of the cross-sectional area of knee extensor muscles showed a significant enlargement in group R compared to group N. At week 16 after surgery, the short diameters of type 1 fibers and type 2 fibers of M. vastus lateralis tended to be larger in group R(n=8)compared to group N(n=8), although the differences were not significant. These results demonstrate that low-load resistance muscular training under moderate restriction of blood flow is an effective exercise method for early muscular training after ACL reconstruction. [ABSTRACT FROM AUTHOR]

The Long-Term Care Insurance System, revised in 2015, obliged utmost efforts to enforce community-based care meetings to establish the Community-based Integrated Care System. In Toyoake in Aichi Prefecture, Japan, the"Multidisciplinary Joint Care Conference,"a monthly community-based care meeting, has been held since April 2016. All participants have an equal relationship since no advisors are appointed. This conference is designed to share helpful knowledge about methods that can be applied in similar future cases instead of just reviewing the support methods used in previous cases. Continuing to hold this conference is expected to yield various satisfactory outcomes. Exchanging knowledge with experts in different fields has led to technology transfer among professions. Furthermore, sharing knowledge in areas where information was insufficient has allowed individuals to determine what they could contribute from their standpoint. They have cogitated about selecting cases and how the host progressed the conference. Because local governments' employees are often reshuffled, accurately taking over duties from their predecessors is a significant concern. As a result, to reduce such risks, the municipality decided to cooperate and manage the conference with a local university engaged in solving local problems. An online provision system was established early to continue conducting the meeting during the COVID-19 pandemic. Currently, this system is beneficial in accepting observation members from municipalities and professionals nationwide. We aspire to continue engaging in the Multidisciplinary Joint Care Conference. This allows individuals connected to the communities to share strategies and methods for achieving their goals and unite as a single problem-solving team.

We created a one-minute video titled "a simple method of eye-drop instillation" (video) for online instillation guidance, to compare the instillation method before and after study participants watch the video and verify the usefulness of watching the video. Moreover, we prepared a document questionnaire to investigate instillation habits and clarify instillation behavior. Study participants were randomly recruited from among students and faculty members via a poster posted at Tokushima Bunri University. The instillation behavior of the study participants was videotaped before and after they watched the video created by the authors. The images were played in a super slow motion, to confirm success or failure in instillation, drop sites, and eye-opening method. Of the 109 participants in the study, the successful instillation rate before and after watching the video was 55.0% and 69.7%, respectively. The use rate of wet wipes for finger disinfection before instillation increased from 0.0% before watching the video to 74.3% after watching the video. After watching the video, the blinking rate after instillation decreased from 95.4 to 45.0%, the rate of pressing the nasolacrimal duct increased from 2.8 to 77.1%, and the rate of wiping the drug solution spilled around the eyes increased from 89.9 to 98.2%. According to the questionnaire, 72.5% of the participants instilled one drop, 22.0% instilled two drops, and 5.5% instilled three drops or more. Watching the video significantly increased the successful instillation rate and improved instillation behavior. Thus, the video created by the authors can be used for online instillation guidance.

Background: Little is known whether sublingual immunotherapy using Japanese cedar pollen extract (cedar SLIT) is effective for not only Japanese cedar pollinosis but also Japanese cypress pollinosis. We investigated the prevalence rate of Japanese cypress pollinosis, efficacy of cedar SLIT on cypress pollinosis and patients' wish to receive cypress SLIT., Methods: We investigated a multi-center (31 institutions), cross-sectional survey using a self-administrated questionnaire with four questions for patients received cedar SLIT aged from 5 to 69 years old., Results: 2523 subjects were enrolled for analysis. 83.4% of them had pollinosis symptoms during cypress season before cedar SLIT. In such patients, 37.4% experienced lessened efficacy of cedar SLIT during cypress season. Both the prevalence of cypress pollinosis and the lessened efficacy of cedar SLIT on cypress pollinosis were significantly seen in western Japan as compared to eastern Japan. 76.1% of the subject having cypress pollinosis before SLIT wished to receive cypress SLIT if it is available., Conclusion: A lessened efficacy of cedar SLIT during cypress season was broadly seen in Japan, and further showed a regional difference. Together with the finding of high wish by patients, these results suggest a development of cypress SLIT is desirable.

Objectives: This study examined the characteristics of occupational mental disorders among those involved in the transport and postal activities in the trucking industry., Method: We examined 237 out of 3,517 cases of occupational mental disorders, compensated between the fiscal years 2010 and 2017. An assessment was made for sex, "life-or-death" status at compensation, age at the onset and suicide, the diagnosis according to the International Classification of Diseases, Tenth Revision, and other factors regarding occupational compensation. The participants were divided into two groups: truck drivers and non-truck drivers., Results: Men accounted for approximately 90% of the cases. Depressive episode (F32) was the most common diagnosis in drivers and non-drivers, thus constituting 65 out of 149 and 48 out of 88 cases, respectively. The next most common type of mental disorder was adjustment disorders (F43.2), with 34 out of 149 drivers and 24 out of 88 non-drivers reporting them. Furthermore, the majority of drivers that had posttraumatic stress disorder (24 out of 27 cases) reported that they "suffered a serious illness or injury" and "experienced or witnessed a terrible accident or disaster." Occupational disasters due to long working hours were 52.4% for drivers and 73.9% for non-drivers. A total of 30.8% of the drivers reported working long hours since they joined the company., Conclusion: Drivers' long working hours entail waiting at the origin and cargo destination site, handling cargo, and incidental tasks other than driving. Thus, the reduction in work hours regarding these tasks needs to be a fundamental goal, and measures that include mental health care for accidents and miserable experiences must be implemented. However, long working hours for non-drivers are likely linked to job expansion/increase and reassignment/relocation. These findings highlight that to prevent overwork-related mental disorders, appropriate actions should be taken considering different sources of exposure for drivers or non-drivers.

Objectives: Karoshi problems (overwork-related deaths and disorders caused by cerebrovascular and cardiovascular diseases) still occur in Japan. Truck drivers, who are in one of the riskiest occupations, are reported to show an increased prevalence of hypertension, obesity, hyperlipidemia, and diabetes, which are characteristic of Karoshi. Their health problems also include excessive fatigue. This cross-sectional study aimed to examine the association between work-life factors and health disorders/excessive fatigue among Japanese truck drivers., Methods: We distributed a questionnaire regarding work hours, health status, lifestyle, burden of driving, and excessive fatigue to 5,410 truck drivers and collected a total of 1,947 responses, all from males. The association between work-life factors and health outcomes was evaluated by multivariable logistic regression analysis adjusted for age, drinking, and smoking status., Results: The prevalence rates of obesity, hypertension, hyperlipidemia, diabetes, cardiovascular disease, cerebrovascular disease, and excessive fatigue were 22.2%, 19.3%, 8.5%, 5.6%, 2.5%, 0.7%, and 6.0%, respectively. Significant associations were observed for long-haul trips (two days or more) with obesity (adjusted odds ratio 1.5 [95% Confidence Interval 1.1-2.1]), local and night trips with hypertension (1.5 [1.0-2.2]), early morning awakening on workdays with obesity (1.5 [1.1-2.1]), being indoor-oriented on weekends with hypertension (1.5 [1.1-2.0]); and heavy burden of driving at night with hyperlipidemia (2.0 [1.3-3.0]). The adjusted odds ratios were significant for waking after sleep onset (2.6 [1.2-5.3]) and lack of sleep satisfaction (2.7 [1.4-5.1]) on workdays, less than six hours of sleep (2.8 [1.0-7.8]) and lack of sleep satisfaction (2.8 [1.5-5.2]) on weekends, 0-3 days off per month (3.6 [1.3-10.2]), and heavy burden of driving at night (2.2 [1.0-4.8]) with excessive fatigue., Conclusions: The present findings highlight that night and early morning work, heavy burden of night driving, and the resultant decreases in the quality and quantity of sleep may represent shared risk factors for health disorders and excessive fatigue among truck drivers. Adequate measures should be taken to limit the amount of night and early morning work, reduce the burden of night driving, and ensure days off for sleep opportunities and leisure activities, with the goal of preventing Karoshi.

We investigated the success rates of eyedrop instillation and the distance between the cornea and the dropper tip in 100 volunteers using high-speed digital video recording. Past eyedrop adherence studies assumed that instillation occurred without failure. The ideal distance between the cornea and dropper tip remained unclear, although the general estimate was approximately 2.54 cm (1 inch). This study was approved by the Institutional Review Boards of all participating medical institutions, and all volunteers provided written, informed consent. Successful instillation was defined as when 1 drop fell accurately into the eye on the first attempt. The instillation of ≥2 drops or drops delivered outside the eye was considered a failure. The distance between the eye and dropper tip was measured using still images from a paused digital video camera and a digital ruler. Forty percent of the volunteers instilled eyedrops without instructions from ophthalmologists, pharmacists, or other healthcare workers. When the images were analyzed, the success rate of the first instillation was 70.1%. When the eye was arbitrarily divided into 9 sections, most of the drop sites were the iris or the center of the eye. The distance between the dropper tip and cornea was 2.62±1.75 (median 2.20) cm. These results indicate that the generally recommended distance is usually followed. The successful instillation rate based on the distance from the dropper tip to the cornea was 77% at 1.6±0.88 cm and 54.9% at 4.8±1.25 cm.

Patients with HIV are at higher risk of developing thrombosis than the general population. We present a rare case of a 57-year-old Japanese man with HIV infection and a malignant lymphoma. He had fever with unknown origin and cervical lymph node swelling 2 months before his hospital visit. Because he was positive for the HIV antibody, he was referred to our HIV special outpatient section. HIV RNA level was found to be 846,680 copies/ml. Therefore, antiretroviral therapy of DTG/ABC/3TC was initiated. However, the high fever continued for 7 days after treatment initiation; moreover, renal dysfunction was progressive. After admission, antibiotic therapy was initiated, due to which the fever subsided. However, renal dysfunction continued to progress. Fourteen days later, he died due to acute renal failure with hyperkalemia. An autopsy revealed a large mass in the spleen, and histological findings revealed a diffuse large B cell lymphoma (DLBCL). Furthermore, thrombi were detected in the right and left ventricles, right atrium, iliac artery, and renal artery. Pathological findings revealed that the thrombus induced the renal failure. These thrombi contained fibrin with inflammatory cell infiltration but not tumor cells. Patients with HIV and malignant lymphoma are at a higher risk of thrombosis. It is important to consider thrombosis during the treatment of patients with HIV.

According to previous reports in our country, histiocytoid breast carcinoma is a very rare case of its tissue type, accounting for only 0.3% of all breast cancer cases. We have neither established a diagnostic standard nor a general idea for these tumors. Previously, its inherited pathology was assumed to be a sub-form of invasive lobular carcinoma. However, some researchers indicate the presence of components that are assumed to originate from milk ducts or differentiation in the apocrine gland. In this way, origins of pathologies for these tumors seem to be complex. Previous reports suggest cases of relatively long survival times without spreading to distant sites. Recently, we encountered one case of histiocytoid breast carcinoma accompanied by multiple axillary lymph node metastases.

Peripherally inserted central venous catheters(PICCs)are widely used given they have lower incidence of serious complications than central venous catheters. We evaluated the safety and usefulness of ultrasound-guided PICC placement for cancer patients in palliative care settings. We attempted to insert PICCs in 42 patients, and the insertion was successful in 40 (95.2%)patients. Complications occurred in 9(22.5%)patients, but none were severe. In 30 cases, PICCs were used for infusion and drug delivery until cancer death. The duration of catheterization was 25(1-126)days. Our results suggest that ultrasound-guided PICC represents a safe and usefultoolfor cancer patients in palliative care settings.

In this study, we considered the role of home care support clinics for patients who wanted to go back to their homes from a hospice, duringa pre-discharge conference. The subjects of our study were 8 patients, of which 7 of them had cancer. Two patients died after the conference. These patients were discharged from the hospice three days after the conference and caregivers from the home care support clinics visited their homes 24 hours after their discharge. The clinic has a role to fulfill in terms of medical treatment and support, based on their life style and power of caregiving. We considered an advancedmeetingwith family or caregiver benefits in the conference. Further, the clinic has a role of establishinga relationship with each multi-disciplinary care unit and cooperate with them as soon as possible when needed.

Palliative care for cancer patients requires information sharing, including prognoses, to fulfill the wishes of the patient and patient's family as well as to avoid wasting time. It is necessary to recognize the importance of the pre-discharge conference and home medical care to realize the wishes of the patient and the patient's family.

We jointly developed dedicated application with protective clothing manufacturers for the purpose of improving the diagnostic X-ray protective clothing inspection record and visualization of quality control. Also, we clearly distributed roles and responsibilities for managing protective clothing. Visualization of quality control could be realized by using a tablet as an inspection recording device. By establishing the criteria for unified X-ray protective clothing inspection, we were able to establish the X-ray protective clothing update procedure.

Recent remarkable advancements in cancer immunotherapy have rendered adoptive T cell therapy an option of clinical treatment of patients with cancer following the success of immune checkpoint inhibitors. In 2017, the FDA approved adoptive cell therapy with chimeric antigen receptor (CAR) gene-modified T cells as a treatment for patients with acute lymphocytic leukemia and diffuse large cell lymphoma. In February this year, it was announced that this therapy will also be approved in Japan soon. Adoptive therapy with T-cell receptor (TCR) gene-modified T cells is a promising therapy for patients with hematological malignancy and solid tumors that follow the success of CAR-T cell therapy. This review aims to summarize the recent progress and issues of TCR gene-modified T-cell therapy with the introduction of our recent study.

We report three cases of POEMS syndrome treated with lenalidomide and dexamethasone who presented with peripheral neuropathy. All of them had markedly elevated serum vascular endothelial growth factor (VEGF) levels treated with lenalidomide and dexamethasone for severe peripheral neuropathy, which normalized serum VEGF levels and improved peripheral neuropathy. The standard treatment of POEMS syndrome has not been established, but has been effectively treated with high-dose chemotherapy with autologous stem cell transplantation. Newer agents currently used for plasma cell dyscrasias include bortezomib and immunomodulatory drugs, such as thalidomide and lenalidomide. A randomized controlled trial on thalidomide plus dexamethasone for POEMS syndrome showed reduced serum VEGF levels after therapy; however, the incidence of peripheral neuropathy, a well-known side effect of both thalidomide and bortezomib, increased. Lenalidomide is associated with lower incidence of peripheral neuropathy compared to thalidomide and bortezomib, making it a reasonable treatment option for POEMS syndrome.

Objective: Carotid stenosis may occur as a late complication following cervical radiation therapy(RT);however, it may also progress in the early post-RT period. This study aimed to characterize the clinical features associated with the early progression of post-RT carotid stenosis., Methods: We retrospectively reviewed clinical records of 30 patients who had undergone unilateral or bilateral cervical RT between January 2010 and November 2014. We analyzed the pre- and post-RT stenosis of their carotid arteries using contrast-enhanced computed tomography images. The arteries were classified as progressive or non-progressive according to the presence or absence of stenosis progression within five years after RT. Using univariate and multivariate analyses, we evaluated the following potential clinical risk factors:age;gender;history of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, or smoking habit;antiplatelet or statin use;radiation dose;and prior presence of carotid stenosis before RT., Results: In total, we reviewed 57 irradiated carotid arteries and identified 9 with early post-RT progression. Carotid stenosis before RT was observed in 88.9% of arteries in the progressive group but only 2% of arteries in the non-progressive group and it predicted progression(univariate and multiple logistic regression analyses, p<0.0001). No other clinical characteristics had a significant association with the progression of carotid stenosis., Conclusion: Prior presence of carotid stenosis may be a risk factor for its early progression after RT. Pre-RT screening of cervical arteries may be useful, and strict management of carotid stenosis is critical in patients with cervical radiation therapy.

Segmental arterial mediolysis(SAM)is a rare non-inflammatory and non-atherosclerotic arteriopathy associated with the occurrence of multiple aneurysms such as intracranial and intraperitoneal aneurysms. We report a case of intraperitoneal hemorrhage that occurred during the acute stage of subarachnoid hemorrhage(SAH). An 82-year-old woman presented with a sudden onset of loss of consciousness with a diagnosis of SAH. Digital subtraction angiography demonstrated two consecutive vertebral artery-posterior inferior cerebellar artery aneurysms. The larger aneurysm, which seemed to be ruptured, was successfully treated by coil embolization. On the 9th day after the onset of SAH, she developed aphasia secondary to the cerebral vasospasm. After selective intra-arterial infusion of fasudil hydrochloride, she was observed to maintain elevated systolic blood pressure. Her aphasia improved; however, on the 14th day, she suddenly developed hemorrhagic shock. An abdominal computed tomography scan demonstrated intraperitoneal hemorrhage secondary to a ruptured fusiform aneurysm of the right gastroepiploic artery. The lesion was successfully treated by coil embolization, although she became bedridden. Although a histopathological examination was not performed, her clinical, radiological, and serological presentation met the criteria of the clinical diagnosis of SAM. Elevated systolic blood pressure and excessive release of catecholamines in the acute stage of SAH might have caused the intraperitoneal hemorrhage. Non-saccular ruptured intracranial aneurysms should be considered among the differential diagnoses of SAM. In such cases, identifying and monitoring intraperitoneal aneurysms might be useful for earlier diagnosis and treatment of SAM, especially in the acute stage after SAH.

We report the case of a 50-year-old female survivor of Hodgkin lymphoma (HL), who developed dropped head syndrome (DHS). The patient was diagnosed with HL at 20 years of age, and underwent chemo-radiotherapy, which led to complete remission. Undergoing supplemental therapy for post-radiation hypothyroidism, she had twin babies. She noticed white stains on her neck at the age of 30, and the decolored area gradually expanded. Sixteen years after the radiotherapy (RT), her posterior neck muscle strength began to decline. She had to make considerable efforts to keep her neck straight, and came to experience a severe pain in the neck and shoulders. The patient visited our department due to DHS at the age of 50. She had leukoderma, muscle weakness, and muscle atrophy in the neck and para-spinal region, which were consistent with the area of RT. The strength was preserved in the other parts of the muscle, including the proximal upper limbs. Sensory nerve disorder was not detected. The serum creatine kinase level was slightly elevated. Cervical spine or cervical cord disease that can cause DHS was not detected by MRI examination. The MRI and CT images revealed marked atrophy in the posterior neck and para-spinal muscles. The electromyogram revealed myopathic changes, and the cause of her DHS was diagnosed as radiation-induced myopathy. DHS is a well-known late-onset radiation injury, and Japanese cases have been reported in elderly persons with laryngeal or lung cancer. However, there have been no Japanese case reports of radiation-induced DHS due to RT against HL in younger persons. The patient had visited several clinics and hospitals before she came to our hospital, but RT-induced DHS had been overlooked. Greater recognition and consideration is required for DHS as one of the various issues arising after long passage of HL survivors.

Advance care planning is important in end-of-life decision making in home-based palliative care for both cancer patients and non-cancer patients.

A 77-year-old man suffering from back and arm pain was referred for anemia to the hospital by an orthopedic clinic. Serum examination of the patient revealed monoclonal IgA, and he consulted the Sapporo Medical University Hospital, where he was diagnosed with multiple myeloma complicated with AL amyloidosis. He was then enrolled for a randomized double-blind study aimed to compare between melphalan-prednisone (MP) and thalidomide-melphalan-prednisone (MPT) treatments, which revealed the patient to be in the MP arm. This treatment induced a temporary partial response. After progression, he was treated with three variable combinations: 1) bortezomib and MP, 2) lenalidomide and dexamethasone, and 3) pomalidomide and dexamethasone. However, none of these treatments provided a stable response. Further, thalidomide in combination with bortezomib and dexamethasone was provided as the fifth-line treatment. After four cycles of this treatment, he achieved VGPR that lasted for 11 months. Our case report suggests that because there is a lack of a standard strategy for MM that is refractory to several agents, treatment should be selected on the basis of previous treatments and general condition of patients.

Immune-checkpoint inhibitors have shown their efficacy in the treatment of patients with many kinds of progressive/relapsed cancers. However, the efficacy remains as 10-40%of the patients in most type of cancers, suggesting that the development of new therapy for patients resistant to the therapy is an urgent unmet need. Adoptive therapy with tumor-specific T cells is a promising therapy that can be effective in patients who are not benefited from the immune-checkpoint inhibitors. The T cell therapy with genetic engineering in T cell receptor(TCR)is expected to be a universal therapy because this therapy can be applicable for patients with many kinds of cancers. This review outlines the recent clinical development of cancer immunotherapy utilizing TCR-gene engineered T cells and discusses the issues that should be improved in the near future for the safer and more effective TCR-T cell therapy of the broad range of cancer patients.

A 61-year-old woman with an abnormal radiograph shadow in her anterior mediastinum was admitted to our hospital and underwent an extended thymectomy. The pathological diagnosis of the tumor was a non-papillary adenocarcinoma of the thymus in pathological stage IV b using the Masaoka classification owing to mediastinal lymph node metastasis. We found parasternal lymph node metastases 5 months after her first operation, and subsequently, she underwent surgery and adjuvant radiotherapy. We found systemic lymph node metastases and metastatic lesions in distant organs, including her lungs, brain, and kidney 27 months after her first operation. Systemic chemotherapy, such as carboplatin plus paclitaxel and an ADOC regimen were not very effective, so we performed immunohistochemical staining of the primary thymic adenocarcinoma. The levels of both thymidylate synthase and dihydropyrimidine dehydrogenase were low; therefore, we started S-1 100mg/body (2 weeks of administration, 1 week of withdrawal)31 months after her first operation. She entered complete remission 6 months after the initiation of S-1. We surgically resected her solitary lung metastasis 13 months after initiation of S-1, and then continued the S-1 treatment. There was no recurrence for more than 2 years after the lung surgery. We believe that when the expression levels of thymidylate synthase or dihydropyrimidine dehydrogenase are low in cases of recurrent thymic adenocarcinoma, S-1 may be able to induce an effective response.

We reported a case of bronchial atresia requiring differentiation from the intralobar sequestration. A 42-year-old man was referred to our institution with suspicion of intralobar sequestration, based on a 3-dimensional computed tomography (CT) angiography that showed abnormal blood vessels from the right inferior phrenic artery flowing into the right lower lobe. CT revealed a lesion between S9 and S10 wherein there were refluxed blood vessels from A9 without an accompanying bronchus, with polycysts and emphysematous changes. Ventilation-perfusion scintigraphy revealed a reduction in uptake in the same sites. He was diagnosed as congenital bronchial atresia preoperatively, and we performed a right basal segmentectomy. Pathological examination confirmed the bronchiectasis and emphysematous changes in the lung parenchyma, but malignant findings were not confirmed.

Immune checkpoint inhibitor therapy has achieving a sensational success in the treatment of patients with progressive cancers. However, the efficacy remains as 10-30% of the pa- tients in most type of cancers, suggesting that the development of new treatments for pa- tients resistant to the therapy is an important challenge of the field. It is likely that the patients without the induction of tumor-specific lymphocytes in the body will not respond to immune checkpoint inhibitor. Therefore, adoptive cell therapy with gene-modified tumor- specific T cells will be one promising treatment of the patients resistant to checkpoint inhibitor therapy. This review summarizes the recent progress in the clinical development of gene- modified T cell therapy and discusses the issues that should be improved in the near future.

Elder populations have been increasing in Japan and estimated 24 million people have knee osteoarthritis(OA). Recently, people have diverse sociological background and demand for participating sports has been growing. People may participate sports to prevent some diseases such as locomotive syndrome. According to the recent studies, excessive high impact sports increase the risk of OA, while daily life exercise decrease the risk. Epidemiological approach demonstrated that reduced knee extension muscle strength increases the risk of OA. We reviewed and discussed the recent topics including efficacy of physical therapy for knee OA and how much sports activities could be beneficial after knee surgery.

In Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Gender dysphoria (GD) is defined as a marked incongruence between one's experienced/expressed gender and assigned gender. Clinical pictures of GD in children show marked diversity. Because of their limited ability to express themselves verbally, children with GD might not be able to describe their discomfort or distress about this incongruence. In contrast to GD in adulthood, GD in children could be alleviated in the natural course. Thus, the clinical diagnosis of GD in children should be made carefully. Distortion of gender identity is equal to prominent confusion of identity, and has a huge psychological burden on children with GD. In addition to the distress due to dysphoria about gender, children with GD could suffer from bullying at school, loneliness among school peers or even in their family, and feelings of disgust about their physical appearance that could cause decreased self-esteem and a sense of worthlessness. In 2015, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) in Japan encouraged all school teachers to provide appropriate support at school to sexual minor- ity students, including students with GD. Furthermore, MEXT published a manual for school teachers to promote necessary interventions for such students at school. There are several papers reporting child cases of GD and comorbid psychiatric disorders. Among them, autism spectrum disorder (ASD) is one of the common comorbidities. Reflecting these conditions, recent review articles discuss possible associations between GD and ASD. In this paper, based on the first author's clinical experience, we describe the clinical symp- toms and diagnosis of GD in children, the relationship between GD and ASD, gender-related manifestations observed in ASD, and practical support for children with GD entering primary school.

We report a rare case of a 67-year-old man who underwent resection of carcinoma in situ and minimally invasive carcinoma of the pancreas. The patient presented with upper abdominal and back pain. No definite pancreatic mass was detected on abdominal ultrasonography, computed tomography, magnetic resonance imaging (MRI), or endoscopic ultrasonography (EUS). However, EUS and MRI demonstrated stenosis of the main pancreatic duct (MPD) in the body and post-stenotic dilatation, resulting in mild dilatation of MPD in the tail. Serial pancreatic juice aspiration cytology after endoscopic nasopancreatic drainage was suggestive of pancreatic adenocarcinoma. Examination of the distal pancreatectomy specimen demonstrated carcinoma in situ in MPD and branches, with multiple intraepithelial neoplastic lesions in the background pancreas and an additional focus of minimally invasive carcinoma.