Volume 9

Relationship between Blood Ammonia and Plasma free Amino Acids Concentration in Adult-Onset Citrullinemia Type 2: A Case Report

Case Report

1. Abstract
1.1. Aim: Elevated plasma citrulline (Cit) concentration is a characteristic finding in adult-onset type II citrullinemia (CTLN2). However, the plasma free amino acids (PFAA) profile associated with ammonia detoxification has not been fully analyzed.
1.2. Methods: We evaluated the relationship between blood ammonia (B-NH3) and the PFAA concentrations through a 50-year-old man with CTLN2 following for over 8 years without liver transplantation.

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Medial Compartment Osteoarthritis with a Large Subchondral Geode of Medial Femoral Condyle Treated with Unicondylar Knee Arthroplasty: A Case Report

Case Report

1. Abstract
Osteoarthritis (OA) with a large subchondral geode of medial femoral condylar is not common. The treatment options of this lesion vary according to the location of the cyst and the severity of osteoarthritis, with less invasive procedures such as calcium phosphate cement injection to a joint arthroplasty. In the past decade, unicondylar knee arthroplasty (UKA) has been extremely successful in the treatment of medial compartment OA, with a survival rate of 97% at 10 years. In this paper UKA was applied to an elderly patient with moderate medial compartment OA and a large subchondral geode of medial femoral condyle for the first time. In our patient, both knee function and pain after UKA greatly improved. In those elderly patients with a large geode and articular surface damage UKA should be considered as one of treatment options if conservative management fails to ameliorate symptoms.

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Streptococcus Mutans in the Oral Cavity as a Risk Factor for Threatened Miscarriage

Letter to Editor

1. Letter to Editor
Dear Editor,
we have found that the presence of Streptococcus mutans in the oral cavity of a pregnant woman may be a risk factor for miscarriage. We observed that Streptococcus mutans is significantly more widespread in the oral cavity of women with threatened abortion than in those undergoing a healthy pregnancy.

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GeneXpert MTB/RIF: A Useful Tool for Rapid and Accurate Diagnosis of Tuberculosis and Rifampicin Resistance

Review Article

1. Abstract
1.1. Aim
The primary objective of this study was to show the usefulness and importance of GeneXpert MTB/RIF, a rapid test that simultaneously detects Mycobacterium tuberculosis complex (MTBC) and resistance to rifampicin (RIF) in less than 2 hours.

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Walking Rehabilitation Using Hybrid Assistive Limb (HAL) and Computer-Controlled Long-Leg Orthosis (C-Brace) for an Individual with Chronic Incomplete Spinal Cord Injury: A Case Report

Case Report

1. Abstract
Many individuals with spinal cord injury (SCI) hope to restore walking function irrespective of their impairment. We present a case with chronic incomplete cervical SCI who could regain community ambulation by gait training with hybrid assistive limb (HAL), followed by fitting and training of microprocessor-controlled knee ankle foot orthosis (C-Brace). The walking and balance ability continuously improved in the course of rehabilitation. The combination therapy of HAL and C-Brace could be a novel, effective therapeutic strategy for walking rehabilitation in chronic incomplete SCI patients.

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Therapeutic Perspective of the Multisensory Interior Garden for the Older People

Review Article

1. Abstract
1.1. Introduction: The conceptualization of the inherent relationship between man and nature is called biophilia which refers to the belief that humans are genetically predisposed to be attracted to nature. Science has strengthened the hypothesis contributing to its expansion in various fields such as medicine and psychotherapeutic interventions.

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DNA Methylation and Epigenetic Events Underlying Renal Cell Carcinomas

Review Article

1. Abstract
Renal cell carcinoma (RCC) refers to a group of tumors that develop from the epithelium of the kidney tubes, including clear cell RCC, papillary RCC, and chromophobe RCC. Most clear cell renal carcinomas have a large histologic subtype, genetic or epigenetic genetic von Hippel-Lindau (VHL). A comprehensive analysis of the genetic modification genome suggested that chromosome 3p loss and chromosome gains 5q and 7 may be a significant copy defect in the development of clear kidney cell cancer. A more potent renal cell carcinoma may develop if chromosome 1p, 4, 9, 13q, or 14q is also lost. Renal carcinogenesis is not associated with chronic inflammation or histological changes. However, regional hypermethylation of DNA in CpG C-type islands has already accumulated in cancer-free kidney tissue, implying that the presence of malignant kidney lesions may also be detected by modified DNA methylation. Modification of DNA methylation in cancerous kidney tissue may advance kidney tissue to epigenetic mutations and genes, leading to more serious cancers and even determining a patient’s outcome. Recently, the number of gene-related genes silenced by DNA hypermethylation has increased. The genetic and epigenetic profile provides accurate predictors for patients with kidney cancer. New genetic and epigenetic analysis technologies will help to speed up the identification of vital cells for kidney cancer prevention, diagnosis, and treatment.

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Transcatheter Closure of an Anastomotic Leak after the Bentall Procedure with the Guidance of 3-Dimensional Printing

Research Article

1. Abstract
1.1. Objective: We describe the use of 3-dimensional (3D) printing technology to guide the occlusion of an anastomotic leak (AL) in the ascending aorta.
1.2. Case Report: A 67-year-old woman underwent a Bentall procedure a year ago for an ascending aortic aneurysm. However, the patient recovered slowly after the surgery. Two months ago, the patient developed palpitations, shortness of breath, chest tightness, and chest pain after activities, and the symptoms continued to worsen. Transthoracic echocardiography showed an AL after the Bentall procedure. Computed tomography angiography showed a 4-mm AL distal to the ascending aortic prosthesis. After a comprehensive discussion among the surgeons, a 3D printing preoperative evaluation and digital subtraction angiography were used to guide the closure of the AL. After the procedures, postoperative digital subtraction angiography showed that the endoleak was completely isolated and the false lumen had disappeared. At the 30-day follow-up, the 3D printed model showed the ideal effect of the occlusion.

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Risk Analysis of Secular Trends for a Later Age at MPV of Weight in an Earthquake Disaster Environment

Research Article

1. Abstract
The Great East Japan Earthquake occurred in 2011, bringing unprecedented damage to the Tohoku region of Japan. Today, after 11 years, the scars from that tremendous damage remain. The health damage to young school children has been particularly great. One may imagine a slowing trend in physical growth from the effects of that disaster, but no clear findings have been reported. Certain trends for obesity and decreased physical strength due to a lack of physical exercise have been reported, but there are no clear reports for the entire disaster area. In this study, we analyzed the delay in the age at MPV of weight due to the poor and stressful environment following the Great East Japan Earthquake from the relationship between the ages at maximum peak velocity (MPV) for height and weight, which are thought to be natural growth mechanisms, and examined the risk to physical growth that emerges as a result of earthquake disasters. We first conducted an analysis using data on national averages for height and weight since before World War 2, and height and weight growth data from age 6 to 17 from 1955 to 2011 for Miyagi and Iwate prefectures, which were both affected by the earthquake, which were published in the School Health Statistics Research Reports. We then identified the age at MPV of height and weight and, by analyzing the secular trends in age at MPV of weight, investigated the slowing trend in the MPV age for weight that emerged in the earthquake disaster environment. The results showed that in the national average the age at MPV gradually become younger overall for both boys and girls, while in Miyagi and Iwate prefectures the age at MPV of weight tended to be somewhat delayed starting in the 2000s for both boys and girls. This trend was particularly noticeable in boys. From this, one of the effects of the earthquake is conjectured to have been an unnatural weight gain caused by the stress and lack of activity resulting from the disaster.
2. Introduction
In Japan, cross-sectional data on physical growth (height, weight) from age 6 (first grade of elementary school) to 17 (final year of high school) have been published in School Health Statistics Research from 1900 to 2022. While the results are averages, they are derived from 700,000 pieces of data gathered from across the nation, and are recognized to have sufficient meaning for analyses of cross-sectional data. In the past, Kawahata [1] and Matsuura [2] analyzed these data and examined the age at the maximum growth velocity in height (age at the pubertal peak) and the postwar growth acceleration phenomenon. Kudo et al [3] arranged these average data into cohorts and examined the trends over time in the age at the pubertal peak for height based on cohort data. Similarly, in recent years Fujii [4] applied the wavelet interpolation method and identified the age at the maximum growth velocity during puberty (maximum peak velocity; MPV) from the described height growth velocity curve, and examined the secular trends from before World War 2 until around 1990. He reported that during the war the age at MPV was considerably later and that after the war a trend was seen for earlier maturity together with high economic growth, which then slowed from around 1990. From these trends one may conjecture that in Japan the poor wartime environment had the effect of significantly inhibiting physical growth, and that there was acceleration in physical growth from a postwar catch-up phenomenon with the development of infrastructure associated with high economic growth.

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Successful Management of a Broken Stylet Retained in Tracheobronchial Tree: A Case Report

Case Report

1. Abstract
In Covid-19 pandemic, the use of video laryngoscope for tracheal intubation is highly recommended due to the increasing distance between patient’s airway and operator. An endotracheal tube with an intubating stylet has been proposed to facilitate tracheal tube insertion, especially when video laryngoscope was used. Thus in routine anesthesia practice intubating stylet is used as an aid in tracheal intubation for confirmed or suspected Covid-19 infected patients. At the present time, the disposable plastic covered or plastic bougie is more recommended but in some institutes, the malleable aluminum stylets are still in use. Though shearing of part of the stylet has been reported in past but we report a case with as unrecognized broken piece of stylet into his right main bronchus, which was later extracted immediately and successfully before causing adverse symptoms or hurts.

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