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Some studies have reported that upper limb tightness is a risk factor for shoulder/elbow pain in high school baseball pitchers; but there has been insufficient research on the relationship between lower limb tightness and shoulder and elbow pain in pitchers. This study aimed to clarify the correlation among pre-season hip range of motion (ROM) and shoulder and elbow disorders in high school baseball pitchers. We surveyed 125 high school pitchers. Hip ROM was measured in the supine and prone positions. After the season, based on their answers to the self-recorded questionnaire, a “shoulder or elbow injury” was defined as any condition resulting in the pitcher being considered disabled for ≥ 8 days. An independent t-test and logistic regression analysis were used for statistical analysis. Eleven disabled pitchers (9%) were identified during the season. In the injured group, the ROM of the plant side hip with 90° flexed external rotation was smaller than that in the non-injured group. Preseason limited ROM in the plant side hip with 90° flexed external rotation was a risk factor for the occurrence of shoulder/elbow pain in the season.

In Japan, comprehensive genome profiling (CGP) as a companion diagnostic (CDx) has been covered by public insurance since June 2019, but the proportion of patients with cancer who actually received drug therapy based on CGP data is low. In the present study, we attempted to use CGP as a starting point for tumor‐informed circulating tumor DNA (ctDNA) monitoring. We retrospectively validated 219 patients with malignant tumors who underwent CGP at Iwate Medical University Hospital between October 2019 and April 2023 in terms of patient demographics, genetic analysis, drug recommendations, and drug administration rate. The 219 cancer cases analyzed by CGP for 27 target organs, including prostate (n = 27, 12.3%), colorectal (n = 25, 11.4%), lung (n = 19, 8.7%), and other neoplasms (n = 148, 67.6%). Among the cohort, only 14 cases (6.4%) subsequently were able to undertake the recommended action by Molecular Tumor Board. Of patients who underwent ctDNA monitoring based on somatic mutations identified by CGP (n = 11), clinical validity was confirmed in terms of early relapse prediction (n = 5, 45.5%), treatment response evaluation (n = 10, 90.9%), and no relapse/regrowth corroboration (n = 2, 18.2%) whereas 90.9% (n = 10) of patients obtained information with at least one source of the clinical validity. Although the current rate of CGP contributing to a drug recommendation is low, CGP results can be an alternate resource for tumor‐informed longitudinal ctDNA monitoring to provide information concerning early relapse prediction, treatment response evaluation, and no relapse/regrowth corroboration. The number of patients who can be recommended for treatment after CGP was limited, but the genomic data may be effectively applicable for tumor‐informed ctDNA monitoring. The clinical validity of CGP in determining early relapse prediction, treatment efficacy evaluation, and no relapse/regrowth corroboration was also confirmed in this study.

Asymptomatic elbow abnormalities are relatively common in young baseball players, but the factors responsible are unclear. To prospectively identify risk factors related to symptom manifestation in asymptomatic elbow abnormalities, we recruited 573 baseball players (age: 7–14 years) at a pre-participation medical/physical examination in the preseason who were right-handed and had asymptomatic medial elbow abnormalities on ultrasound (US). Baseline preseason and postseason participant characteristics were assessed. A “symptomatic” elbow was defined as an elbow with medial elbow joint problems that prevented ball throwing for ≥ 8 days. After exclusions, 82 players were enrolled, of whom 22 (26.8%) developed a symptomatic elbow. In univariate analyses, the external and internal rotation strengths of the dominant shoulder were significantly greater in the symptomatic group than in the asymptomatic group ( P  = 0.021). Multivariate logistic regression analysis showed that the internal rotation strength of the dominant shoulder was a significant independent risk factor (odds ratio = 1.091, P  = 0.027) for developing a symptomatic elbow. In young asymptomatic baseball players with abnormalities in the medial elbow region of the dominant arm on US, stronger preseason internal rotation strength of the dominant shoulder was a significant independent risk factor for the development of a “symptomatic” elbow.

Pitching motion requires whole-body coordination; therefore, poor control of the lower extremities, pelvis and trunk may cause shoulder and elbow injuries. However, few studies have described the relationship between the shoulder joint function and low back injury in high-school baseball pitchers. A total of 128 healthy high school pitchers underwent pre-season medical checkups, where their shoulder range of motion and shoulder strength were measured. The participants completed a self-recorded daily questionnaire regarding the presence of low back pain. Pitchers were divided into injured and non-injured groups. Low back injury was observed in 13 participants (13.4%). In the injured group, horizontal adduction on the dominant shoulder was significantly less than in the non-injured group. A logistic regression analysis showed that horizontal adduction on the dominant side was a significant independent risk factor for low back injury during the season. It is important to recognize that restriction of the shoulder function not only causes shoulder and elbow injuries but can also risk low back injury.

Background Several studies have demonstrated that prehabilitation helps reduce the incidence of postoperative complications. In this study, we investigated the safety and efficacy of enhanced prehabilitation (EP) in the hospital for patients with esophageal cancer. Methods We retrospectively reviewed the data of 48 consecutive patients who underwent radical esophagectomy with gastric tube reconstruction between September 2015 and June 2019. EP program had been introduced in August 2017. In the EP group, patients received the EP program during hospitalization 7 days before surgery in addition to conventional perioperative rehabilitation. The EP program consisted of aerobic exercise and muscle strength training in the morning and afternoon. Operative outcomes were compared between patients who received EP (EP group; 23 patients) and patients who did not receive EP (control group; 25 patients). Results The preoperative (EP group vs. control group, 492.9 ± 79.7 vs. 418.9 ± 71.8 m, p  < 0.001) and postoperative (EP group vs. control group, 431.5 ± 80 vs. 378 ± 68.7 m, p  < 0.001) 6-min walk distance was significantly higher in the EP group than in the control group. The respiratory complications rate was significantly lower in the EP group (4.3%) than in the control group (36%) ( p  = 0.007). The incidence of atelectasis was particularly significantly lower in the EP group (0%) than in the control group (24%) ( p  = 0.012). Conclusions EP was performed safely for patients before esophagectomy. EP improved the exercise tolerance of the patients before esophagectomy and might be useful in preventing respiratory complications.

We prospectively evaluated the effects of a prevention program on the incidence of shoulder and elbow injuries in high school baseball pitchers. Ninety-two pitchers participated in this study and were taught to perform stretching and strength exercises aimed at improving shoulder external rotation strength in the preseason. The pitchers freely chose to participate in one of four groups [SM-group: performed both exercises, S-group: performed stretching exercise only, M-group: performed strength training only, and N-group: performed neither intervention]. Injury was defined as inability to play for ≥8 days because of shoulder/elbow symptoms. Kaplan-Meier survival curves were generated and hazard ratios (HRs) for injury occurrence were calculated using multivariate Cox regression. Log-rank test was used for between-group comparisons of survival distributions. The injuries occurred in 25, 35, and 57% of participants and median times to injury were 89, 92, and 29.5 days in the S- (n = 32), SM- (n = 46), and N- (n = 14) group, respectively. Nobody chose M-group. HRs were 0.36 and 0.47 for the S- and SM-group, respectively, based on the N-group. The incidence of injury was significantly lower in the S-group than in the N-group ( p  = 0.04). Daily posterior shoulder stretching may reduce the incidence of the injuries in high school baseball pitchers.

Background Metastatic melanoma originating from the choroidal membrane is extremely rare. Here, we report a case of laparoscopic distal pancreatectomy for malignant melanoma that developed after heavy-particle therapy for malignant choroidal melanoma. Case presentation A 43-year-old Japanese woman underwent 70 Gy heavy-particle radiotherapy for a right choroidal malignant melanoma. Positron emission tomography-computed tomography examination was performed 4 years after treatment, when contrast accumulation was observed on the posterior wall of the stomach. Endoscopic ultrasonography and computed tomography showed a mass with contrast enhancement in contact with the stomach wall. Based on the imaging findings, a gastrointestinal stromal tumor of the posterior wall of the lower gastric corpus with extramural growth was suspected. Laparoscopic surgery was performed under general anesthesia. A black-pigmented tumor originating from the pancreas was discovered. Following an intraoperative diagnosis of metastasis of malignant melanoma, a laparoscopic distal pancreatectomy was performed. The pathological diagnosis was pancreatic metastasis of malignant melanoma. The patient was treated with adjuvant immune checkpoint inhibitors and chemotherapy after surgery, which led to long-term survival. Conclusions Including this case, only eight case reports on pancreatic resection for metastatic ocular malignant melanoma have been reported. The ocular malignant melanoma with distant metastasis has a poor prognosis. Therefore, in our case, careful follow-up is required. A single pancreatic metastasis from a malignant melanoma of the choroid can be successfully managed by laparoscopic radical resection of the pancreas, and molecularly targeted adjuvant chemotherapy.

Background: Throwing-related shoulder and elbow pain continues to be reported among adolescent baseball players. Few prospective studies have specifically examined the association between throwing-related shoulder and elbow pain and physical and developmental changes. Purpose: To evaluate the changes in physical and developmental characteristics during 1 year with respect to throwing-related shoulder and elbow pain in adolescent baseball players. Study Design: Case-control study; Level of evidence, 3. Methods: This 1-year prospective follow-up study investigated 164 baseball players aged 7 to 13 years. Player data (age, height, weight, field position, and pitch count), lower extremity muscle tightness, and range of motion (ROM) of the shoulder, elbow, and hip joints were assessed during the 2016 and 2017 preseason medical examinations. After the 2016 season, the participants completed questionnaires related to throwing-related shoulder and elbow pain, defined as an inability to play for ≥1 week because of elbow or shoulder difficulties. For study participants with and without throwing-related shoulder or elbow pain during the 2016 season, we conducted univariate and multivariate logistic regression analysis to identify risk factors for throwing-related shoulder or elbow pain. Results: Overall, 21 players (12.8%) reported a shoulder pain episode, 56 players (34.1%) had an elbow pain episode, and 70 players (42.7%) reported having experienced shoulder and/or elbow pain during the 2016 season. In multivariate logistic regression analysis, (1) shoulder pain was associated with 2016 preseason height (odds ratio [OR], 1.06; 95% CI, 1.01-1.11; P = .01) and change in dominant-side elbow extension ROM from 2016 to 2017 (OR, 1.12; 95% CI, 1.02-1.24; P = .02); (2) elbow pain was associated with change in weight from 2016 to 2017 (OR, 1.21; 95% CI, 1.04-1.41; P = .014); and (3) throwing-related shoulder and/or elbow pain was associated with greater 2016 preseason height (OR, 1.04; 95% CI, 1.003-1.68; P = .03) and an increase in height from 2016 to 2017 (OR, 1.17; 95% CI, 1.01-1.35; P = .03). Conclusion: Our results indicated that adolescent baseball players who were taller in the preseason and those with an increase in height over the 1-year study period faced significant risks for developing throwing-related shoulder and/or elbow pain.

Circulating tumor DNA (ctDNA) is released from tumor cells into blood in advanced cancer patients. Although gene mutations in individual tumors can be diverse and heterogenous, ctDNA has the potential to provide comprehensive biomarker information. Here, we performed multi-region sampling (three sites) per resected specimen from 10 gastric cancer patients followed by targeted sequencing and proteomic profiling using reverse-phase protein arrays. A total of 126 non-synonymous mutations were identified from 30 samples from 10 tumors. Of these, 16 (12.7%) were present in all three regions and were designated as founder mutations. Variant allele frequencies (VAFs) of founder mutations were significantly higher than those of non-founder mutations. Phylogenetic analysis also demonstrated a good concordance between founder and truncal mutations, defined as mutations shared by all simulated clones at the trunk of the tumor phylogenetic tree. These findings led us to prioritize founder mutations for quantitative ctDNA monitoring by digital PCR with individually-designed primer/probe sets. In preoperative plasma, the average ctDNA VAF of founder mutations was significantly higher than that of non-founder mutations (p = 0.039). Proteomic heterogeneity was present across the tumor regions both within and between patients independent of mutational status. Our results suggest that, in practice, mutations having high VAF identified without multi-regional sequencing may be immediately useful for quantitative ctDNA monitoring but do not provide sufficient information to predict the proteomic composition of tumors.

Background: This study was designed to investigate whether psychological status is associated with upper-extremity health status in an elderly general population. Methods: Using Quick Disabilities of the Arm, Shoulder, and Hand of the Japanese Society for Surgery of the Hand (QuickDASH-JSSH), we evaluated 200 Japanese elderly people (76 men, 124 women; mean age, 71.6 years, 60-98 years) to assess their upper-extremity-specific health status. Each had completed a self-administered questionnaire including gender and dominant hand items. As an indicator of hand muscle function, we measured their bilateral hand grip. Study participants were assessed for depressive symptoms using the Geriatric Depression Scale Short-Japanese Version (GDS-S-J). Statistical analyses were applied to clarify associations between self-assessed upper-extremity dysfunction and screening results for depressive symptoms in an elderly general population. Results: Those reporting no complaint of an upper extremity were 72 (36 men and 36 women) (36.0%). The GDS-J score was found to have significant positive correlation with age (r = 0.20, P= 0.0045) and the QuickDASH score (r = 0.25, P = 0.0004). The GDS-J score was found to have significant negative correlation with dominant grip (r = −0.15, P = 0.04) and non-dominant grip strength (r = −0.21, P = 0.004). For all participants, multiple regression analysis revealed the QuickDASH score as associated with the GDS-J score. Conclusion: Self-administered upper-extremity health condition as assessed using QuickDASH is correlated with depressive symptoms in elderly people. Objective pathophysiology and subjective illness behavior must be identified in daily clinical practice. A biopsychosocial approach must be used when advising and treating patients.