Anticoagulation management in cardiac surgery can be difficult in patients with heparin-induced thrombocytopenia (HIT). We report a patient who underwent reoperation of cardiopulmonary bypass (CPB) using argatroban in combination with nafamostat mesilate. A bolus of 0.25 mg/kg argatroban was administered, followed by continuous infusion of 5-10 μg/kg/min argatroban and 100 mg/h nafamostat mesilate. No complications such as thrombosis were observed during either CPB or the perioperative period. Although we used argatroban and nafamostat mesilate, which has a shorter half-life than argatroban, the anticoagulant effect was prolonged, and the patient had an uneventful postoperative course despite requiring substantial blood transfusion.

Purpose: To determine whether performing a feint in team handball with a wide foot stance leads to a greater knee valgus angle and/or knee valgus moment.Methods: Eight women handball players performed a feint with 4 different foot stances (free and 30%, 40%, and 50% of their body height). Three-dimensional kinematics and ground reaction forces were measured during the feints. Hip abduction angle at first contact, peak vertical ground reaction force, peak knee valgus angle, and peak external knee valgus moment during the first 20% of the feint cycle were compared among the stances at 30%, 40%, and 50% of body height (ANOVA, P<0.05). In the free feint, we investigated intrasubject correlations among foot stance and hip abduction angle at first contact, peak knee valgus angle, and peak external knee valgus moment were then conducted (P<0.05).Results: When performing a feint with foot stances at 40% and 50% of body height, the subjects had significantly greater peak external knee valgus moment. Hip abduction angle at first contact was significantly correlated to peak knee valgus angle and peak external knee valgus moment.Conclusion: Training athletes to avoid wide foot stance and large hip abduction angle may reduce the risk of sustaining noncontact anterior cruciate ligament injuries.

Background: Rapid diagnostic tests (RDTs) are used widely in the diagnosis of malaria. Although the effectiveness of RDTs for malaria has been described in many previous studies, the low performance of RDT particularly for Plasmodium ovale malaria in traveller has rarely been reported. Methods: This was a retrospective cohort study conducted on Japanese travellers diagnosed with malaria at the National Center for Global Health and Medicine between January 2004 and June 2013. The diagnosis of malaria was confirmed by microscopic examination, RDT, and polymerase chain reaction in all patients. The RDTs used in our study were Binax NOW Malaria (Binax Inc., Scarborough, Maine, USA) (BN) and SD Malaria Antigen Pf/Pan (Standard Diagnostics Inc., Korea) (SDMA). We compared the sensitivity of the RDTs to P. ovale malaria and Plasmodium vivax malaria. Results: A total of 153 cases of malaria were observed, 113 of which were found among Japanese travellers. Nine patients with P. ovale malaria and 17 patients with P. vivax malaria undergoing RDTs were evaluated. The overall sensitivity of RDTs for P. ovale malaria and P. vivax malaria was 22.2% and 94.1%, respectively (P < 0.001). The sensitivity of SDMA for P. ovale malaria and P. vivax malaria was 50% and 100%, respectively. The sensitivity of BN for P. vivax malaria was 90.0%, but it was ineffective in detecting the cases of P. ovale malaria. Conclusions: The sensitivity of RDTs was not high enough to diagnose P. ovale malaria in our study. In order not to overlook P. ovale malaria, therefore, microscopic examination is indispensable.

Background: Rapid diagnostic tests (RDTs) have widely been used in the diagnosis of malaria. Although the effectiveness of RDTs for malaria has previously been described in many reports, the low performance of RDTs particularly for Plasmodium ovale malaria in travellers have rarely been reported. Methods: This was retrospective cohort study conducted among Japanese travellers who were diagnosed with malaria at the National Center for Global Health and Medicine between January 2004 and June 2013. Diagnosis of malaria by microscopic examination, RDT, and polymerase chain reaction were performed for all the patients. The RDTs used in our study were Binax NOW Malaria (Binax Inc., Scarborough, Maine, USA) (BN) and SD Malaria Antigen Pf/Pan (Standard Diagnostics Inc., Korea) (SDMA). We compared the sensitivity of the RDTs of P. ovale malaria with that of Plasmodium vivax malaria. Results: A total of 153 cases of malaria were observed, of which 113 patients were Japanese travellers. Nine patients with P. ovale malaria and 17 patients with P. vivax malaria performing RDTs were evaluated. The overall sensitivity of RDTs for P. ovale malaria was 22.2% and that for P. vivax malaria was 94.1% (P < 0.001). The sensitivity of SDMA for P. vivax malaria was 100% and that for P. ovale malaria was 50%. The sensitivity of BN for P. vivax malaria was 90.0%; however, it was unable to detect the cases of P. ovale malaria. Conclusions: The sensitivity of RDTs was not high enough to diagnose P. ovale malaria in our study. Thus, microscopic examination is indispensable not to overlook P. ovale malaria.