We report surgically treated case of tricuspid valve endocarditis in a non-drug addict. A 35-year-old man with no history of cardiac disease was admitted to our institution for persistent fever. His blood culture was positive for methicillin-sensitive Staphylococcus aureus (MSSA). Echocardiography showed friable vegetations attached to the tricuspid valve with moderate tricuspid regurgitation. No other valves were affected. Chest computed tomography revealed multiple septic pulmonary emboli in both lungs. The infection was uncontrollable, so despite 6 weeks' of appropriate intravenous antibiotics therapy, he required surgery. Infected lesions had extended to parts of the septal leaflet and the posterior leaflet of the tricuspid valve. Valve repair with the resection-suture technique was performed. Half of the septal leaflet and a part of the posterior leaflet were excised with the vegetations, and the remaining septal leaflet was sutured to the posterior leaflet after annular plication without implanting an artificial ring. The postoperative course was uneventful, without further tricuspid regurgitation or stenosis. He was discharged after additional antibiotic administration for 4 weeks postoperatively, and he has remained free from endocarditis for over 1 year.

A 10-day-old male neonate underwent repair of mixed-type total anomalous pulmonary venous connection. The left upper pulmonary vein connected to the left innominate vein by way of a vertical vein. The other veins converged to form a common pulmonary vein and drained to the coronary sinus. As the common pulmonary vein was not stenotic, normal coronary sinus unroofing was undertaken and the postoperative course was uneventful. Five months later pulmonary vein stenosis (PVS) occurred at the junction of the common pulmonary vein and coronary sinus. At reoperation the common pulmonary vein was deeply incised to the point near the pulmonary venous orifice, and the stenotic tissue was resected. Although he was discharged from the hospital on the 10th postoperative day, PVS recurred at age 9 months and a second reoperation was undertaken. This time, the common pulmonary vein was excised and the anterior wall of each pulmonary vein was incised to drain independently and directly to the left atrium without causing turbulence. The left upper pulmonary vein was anastomosed to the left atrial appendage. Pulmonary angiography 18 months after the second reoperation revealed the pulmonary venous pathway to be nonstenotic.

We performed a prospective study to determine whether the walking pattern of children with flatfoot can be influenced by using shoes and custom-modeled insoles. One hundred and thirty-two children (mean age ; 4.20±2.53) who had been referred by a physiatrist, and who were diagnosed with flatfoot at the brace clinic in our institute, were assigned to three groups : The first group was asked to walk barefoot, the second one to walk with shoes without insoles and the last one to walk with shoes with insoles. We measured walking speed, cadence, step length, step width, the duration of right and left stance phases, both double-limb stance phases, both swing phases, walking angle, and toe angle using a 2.4 m sheet-type Gait Analyzer, the Walk Way MW-1000 ^TM, at the individual's self-selected speed. Compared with the barefoot group, a significant increase was observed in the group using shoes with custom-modeled insoles in both walking speed and step length on both sides, and there were reductions in swing phase and walking angle on both sides (paired t-test ; p<0.002).

Objectives: Despite the fact that the total energy intake of Japanese people has decreased, the percentage of obese people has increased.This suggests that the timing of meals is related to obesity.
The purpose of the study was to investigate the relationship between the timing of meals and obesity, based on analyses of physical measurements, serum biochemical markers, nutrient intake, and lifestyle factors in the context of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents of Toon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medical examinations between 2011 and 2013. These medical examinations included. (1) physical measurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers (total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors such as family structure and daily habits (22 issues), exercise and eating habits (28 issues), alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups (FFQg);and (5) a questionnaire concerning the times at which meals and snacks are consumed.
Results: The values for body mass index (BMI) and waist circumference were higher for participants who ate dinner less than three hours before bedtime (<3-h group) than those who ate more than three hours before bedtime (>3-h group). The Chi-square test showed that there was a significant difference in eating habits, e.g., eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after 9 p.m., between the <3-h group and the >3-h group.
Multiple linear regression analysis showed that skipping breakfast significantly influenced both waist circumference (β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed only influenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waist circumference and BMI than eating dinner <3-h before going to bed.

Objective: Despite the fact that the total energy intake of Japanese peoplehas decreased, the percentage of obese people has increased. This suggests that the timingof meals is related to obesity. The purpose of the study was to investigate therelationship between the timing of meals and obesity, based on analyses of physicalmeasurements, serum biochemical markers, nutrient intake, and lifestyle factors in thecontext of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents ofToon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medicalexaminations between 2011 and 2013. These medical examinations included. (1) physicalmeasurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers(total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors suchas family structure and daily habits (22 issues), exercise and eating habits (28 issues),alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups(FFQg); and (5) a questionnaire concerning the times at which meals and snacks areconsumed.
Results: The values for body mass index (BMI) and waist circumference werehigher for participants who ate dinner less than three hours before bedtime (<3-hgroup) than those who ate more than three hours before bedtime (>3-h group). TheChi-square test showed that there was a significant difference in eating habits, e.g.,eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after9 p.m., between the <3-h group and the >3-h group. Multiple linear regressionanalysis showed that skipping breakfast significantly influenced both waist circumference(β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed onlyinfluenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waistcircumference and BMI than eating dinner <3-h before going to bed.

There were some mistakes in the numerical values of the graphs.

STUDY DESIGN: Retrospective study. PURPOSE: We conducted a study to investigate the time course changes in bone metabolic markers after the administration of the anti-receptor activator of nuclear factor-kappa B ligand (RANKL) antibody and to assess drug compliance among osteoporotic patients. OVERVIEW OF LITERATURE: The anti-RANKL antibody is expected to provide an improvement in those with a bone metabolism disorder. However there are only a few clinical reports available on the effect of treatment. METHODS: We included 40 post-menopausal osteoporotic patients who received the anti-RANKL antibody. To determine the time course changes in the bone metabolic markers, we measured the serum tartrate-resistant acid phosphatase 5b (TRACP 5b; a bone resorption marker) and the serum N-terminal propeptide of type 1 collagen (P1NP; a bone formation marker) levels prior to and 1 month after administrating the anti-RANKL antibody. To evaluable drug compliance, we assessed the dropout rate during treatment and at 6 months after treatment. RESULTS: The average TRACP 5b level significantly decreased from 574.8 mU/dL before treatment to 153.2 mU/dL 1 month after treatment (p<0.05). There was no significant difference in the average P1NP level, which was 56.9 microG/L and 35.1 microG/L before and 1 month after treatment, respectively (p>0.05). As for drug compliance, we did not have any dropouts during the treatment or after 6 months (dropout rate: 0%). CONCLUSIONS: Our study suggests that anti-RANKL antibody treatment suppresses bone resorption and maintains bone formation.
Acid Phosphatase ; Bone Resorption ; Collagen Type I ; Compliance* ; Humans ; Metabolism ; Osteogenesis ; Osteoporosis* ; Patient Dropouts ; RANK Ligand ; Retrospective Studies

Background/Aims: Although risk factors of reflux esophagitis (RE) have been investigated in numerous cross-sectional studies, little is known about predictive factors associated with future onset of RE. We investigated time courses of clinical parameters before RE onset by a longitudinal case-control study using health checkup records. Methods: We used health checkup records between April 2004 and March 2014 at 9 institutions in Japan. A multivariate logistic regression analysis was performed to evaluate associations of baseline clinical parameters with RE. The time courses of the clinical parameters of RE subjects were compared with those of non-RE subjects by the mixed-effects models for repeated measures analysis or longitudinal multivariate logistic analysis. Results: Initial data were obtained from 230 056 individuals, and 2066 RE subjects and 4132 non-RE subjects were finally included in the analysis. Body mass index, alanine aminotransferase, smoking, acid reflux symptoms, hiatal hernia, and absence of atrophic gastritis at baseline were independently associated with RE. The time courses of body mass index, fasting blood sugar, triglyceride, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, percentages of acid reflux symptoms, feeling of fullness, and hiatal hernia in the RE group were significantly worse than in the non-RE group. Conclusions The RE group displayed a greater worsening of the clinical parameters associated with lifestyle diseases, including obesity, diabetes, hyperlipidemia, and fatty liver for 5 years before RE onset compared with the non-RE group. These results suggest that RE is a lifestyle disease and thus lifestyle guidance to at-risk person may help to prevent RE onset.

STUDY DESIGN: Retrospective, observational, single-center study. PURPOSE: To investigate the long-term outcomes of in situ fusion procedures for treating dysplastic spondylolisthesis. OVERVIEW OF LITERATURE: In situ fusion performed in patients with dysplastic spondylolisthesis avoids the development of nerve complications. METHODS: In total, 12 of 28 patients who underwent in situ fusion for treating dysplastic spondylolisthesis at Chiba University Hospital from 1974 to 2004 were followed up in August 2013. Surgical complications were evaluated. Low back pain and leg pain were assessed using a visual analog scale (VAS). Vertebral alignment, including the lumbosacral angle and lumbar lordosis angle measurement on radiographic images (profile view in the neutral standing position), was evaluated during preoperative, postoperative, and final examinations. RESULTS: The mean follow-up duration, patient age at the final examination, and patient age at operation were 20.0±7.2, 42.3±13.3, and 22.3±11.4 years, respectively. No complications were reported. Mean VAS scores for low back pain and leg pain were significantly lower at the final examination than at the preoperative examination (p<0.05). At the preoperative, postoperative, and final examinations, the mean lumbosacral angle was 32.3°±14.2°, 33.7°±11.8°, and 36.5°±16.4°, while the mean lumbar lordosis angle was 51.0°±14.8°, 48.6°±18.8°, and 49.6°±15.5°, respectively. No significant differences were noted among these values across the different time periods (p<0.05). CONCLUSIONS: In situ fusion performed in patients with dysplastic spondylolisthesis avoids the development of nerve complications such as nerve paralysis that may occur after repositioning operation and maintains appropriate long-term sagittal alignment, even 20 years after operation.
Animals ; Follow-Up Studies ; Humans ; Leg ; Lordosis ; Low Back Pain ; Paralysis ; Retrospective Studies ; Spondylolisthesis* ; Visual Analog Scale

STUDY DESIGN: Prospective study. PURPOSE: To examine the long-term effects of interspinous ligament injections of local anesthetics and steroids for the treatment of Baastrup's diseases. OVERVIEW OF LITERATURE: Baastrup's disease is associated with axial low back pains. Baastrup's disease has been more recently described as the "kissing spinous processes" disease. Several authors have reported methods for the diagnosis and treatment of the disease. However, there has been only one report of patients receiving interspinous ligament injections of agents for the treatment of Baastrup's disease. METHODS: Seventeen patients showed severe low back pains between spinous processes at L3-L4 or L4-L5. X-ray imaging, computed tomography, and magnetic resonance imaging revealed kissing spinous processes, consolidation of spinous process, or inflammation of an interspinous ligament. Pain reliefs after lidocaine and dexamethasone administration into interspinous ligament as therapy for low back pains were being examined and followed up. RESULTS: Low back pain scores significantly improved immediately after injection of the agents into interspinous ligaments. At final follow-up (1.4 year), low back pain scores significantly improved as compared with before the treatment. CONCLUSIONS: Findings from the current study indicate that lidocaine and dexamethasone administration into interspinous ligament in patients diagnosed with Baastrup's disease is effective for managing the pain associated with this disease.
Anesthetics, Local ; Dexamethasone ; Diagnosis ; Follow-Up Studies ; Humans ; Inflammation ; Lidocaine* ; Ligaments* ; Low Back Pain ; Magnetic Resonance Imaging ; Prospective Studies ; Steroids