The purpose of this study was to examine the risk factors of stress fractures in terms of training distance and intensity in young male Japanese high school long-distance runners. Nine hundred and twenty-five runners from high schools, colleges, and work teams responded to our questionnaire. Our analysis of the questionnaire found that the onset rates of stress fractures in males were 25.0%, 40.2%, and 55.3% in high school runners, collegiate runners, and work team runners, respectively, suggesting that young Japanese long-distance runners are more likely to suffer from stress fractures than European and American runners. Stress fractures occurred in male high school and collegiate runners after training that had increased running distance (24.7% and 33.1%, respectively) or running intensity (17.0% and 9.6%), or both increased running distance and increased running intensity (29.8% and 34.6%), suggesting that an increase in running distance at moderate intensity might be a major risk factor in stress fractures in young male long-distance runners. Data from college and work team runners that ran all three years of high school show that stress fractures are most likely to occur in May of the high school freshman year. These results suggested a need to reconsider training programs for freshmen to prevent stress fractures in young runners.

Headaches caused by metastatic brain tumors result from dural tension and traction of the sites of nociceptive nerves that originates from displacement of cerebral vessels and intracranial hypertension caused by the tumor. Causes of such headaches also include meningeal irritation resulting from intrathecal dissemination of tumor and carcinomatous meningitis.Treatment of headaches resulting from intracranial hypertension involves alleviation of cerebral edema and reduction of intracranial pressure using hyperosmolar therapy and steroid administration, but treatment is often complicated by a lack of pressure reduction. We encountered 2 cases of headaches with intracranial hypertension that did not improve following hyperosmolar therapy and steroid administration, but resolved with increased opioid dose.In cases where intracranial pressure does not decrease, or for headaches attributed to direct stimulus of intracranial nociceptive nerves rather than intracranial hypertension, attempts to treat the patient with initiation or increased dosage of opioids may prove effective from a clinical standpoint.

Purpose: This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection. Methods: We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined. Results: The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001). Conclusion Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.