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Although understanding the status of sports participation is essential for preventing injuries in young athletes, the level of specialization and relevant information in Japan is unknown. This study aimed to clarify the status of sports specialization and examine the relationships between specialization and training status in Japanese young soccer players. Four hundred Japanese young male soccer players were included. The players’ parents completed a web questionnaire that consisted of three-point questions regarding specialization and training status (year, days of playing soccer, age when starting soccer). The level of specialization and accompanying information were calculated, and data were compared by specialization status. Of the participants, 53.8% demonstrated a high level of specialization. In addition, 74.5% considered soccer more important than other sports, 89.0% trained in soccer for more than 8 months of the year, and 74.0% had quit other sports to focus on soccer or played only soccer. The proportion of participants who played only soccer was significantly higher in the high-specialization group (37.6%) than in the moderate-specialization (22.5%; P < .01) and low-specialization (7.1%; P < .01) groups. By specialization status at grades 4 to 6 (9–12 years), 40.3% of participants demonstrated a high level of specialization. Young Japanese soccer players tend toward early specialization. Factors contributing to the high specialization level are being active throughout the year and rarely playing other sports. Training volume should be controlled, and an environment allowing young soccer players to participate in other sports simultaneously is needed, with early specialization being avoided.

Fluid retention presenting as effusions in body cavities is sometimes encountered following allogeneic stem cell transplantation (allo-HSCT). It is unclear whether cavity effusions at independent sites may serve as cumulative correlates of fluid overload and whether a higher number of effusion sites are associated with a worse prognosis. Here, we comprehensively reviewed pleural, peritoneal, and pericardial effusions in 178 first allo-HSCT recipients retrospectively. A total of 123 (69.1%) patients developed effusions in any cavity. New pleural, peritoneal, and pericardial effusions were found after allo-HSCT in 106, 88, and 53 patients, at a median of 38.0 (range, 2–2950), 22.5 (range, 2–1324), and 40 (range, 2–945) days, respectively. The cumulative incidence at day 100 was 41.0%, 40.4%, and 20.8%, respectively. Of the 92 patients who presented with effusions by day 100, 28 patients presented with effusion in a single cavity, 39 in two cavities, and 25 in all three cavities. The 2-year overall survival rates of patients with effusions in zero, one, two, and three cavities by day 100 were 86.1%, 60.0%, 59.6%, and 18.8%, respectively, showing an additive adverse association with outcome. Prospective studies to further characterize fluid dynamics following allo-HSCT are warranted.

Determining the effects of early specialization in a specific sport is difficult. Therefore, it is necessary to investigate its effects based on the type of sports. The purpose of this study was to investigate the proportion of participants who had been participating in a single sport, in individual or team sports from an early age and to compared the prevalence of acute and overuse injuries among these participants. A total of 1377 adult participants (team sports = 700, individual sports = 637) retrospectively completed a questionnaire assessing sports participation from elementary school to high school and injury history (acute and overuse) at high school age. The proportions of the specialized / nonspecialized groups per sport type were compared, and differences in acute or overuse injury prevalence were examined. The proportion of the specialized group participants who continued to play the same single sport from elementary school age to high school age was greater in team sports (33.6%) than that in individual sports (19.2%) (p < 0.01). The specialized group participating in team sports had a greater prevalence of overuse injury at high school age than the nonspecialized group (p < 0.05) who previously participated in several sports. However, the prevalence of overuse injury at high school did not significantly differ between the specialized and nonspecialized groups participating in individual sports. More children who continued to play only one sport from elementary school age to high school age played in team sports in Japan. They also had a higher prevalence of overuse injuries when they were at high school age. It is necessary to consider the environment to play multi sports before high school age, especially in team sports.

Chronic graft-versus-host disease (cGVHD) is a long-term complication of allogeneic hematopoietic stem cell transplantation. The clinical importance of long-term corticosteroid dependency in steroid-responsive cGVHD is undetermined. We retrospectively reviewed the data of 120 consecutive patients who received systemic steroid therapy for cGVHD between January 2007 and December 2018 at three institutions. Among patients with steroid-responsive cGVHD, those who successfully tapered off corticosteroids within 1 year were defined as the early withdrawal group (EW-cGVHD) and others were defined as the dependent group (Dp-cGVHD). Twenty-six patients were classified as EW-cGVHD and 55 as Dp-cGVHD. The proportion of men was significantly higher and performance status was significantly better in EW-cGVHD. The 5-year overall survival and cGVHD recurrence-free survival rates were significantly higher in EW-cGVHD than Dp-cGVHD (96% vs. 68%, p  = 0.017 and 84% vs. 41%, p  = 0.002, respectively). While the relapse-free survival rate did not differ significantly (84% vs. 65%, p  = 0.15), the proportion of patients requiring readmission, mainly due to cGVHD recurrence or infection, was significantly increased in Dp-cGVHD (38% vs. 84%, p  < 0.001). In summary, steroid dependency in cGVHD for more than 1 year was significantly associated with poor transplant outcomes.

Recent studies showed that machine learning models such as gradient-boosting decision tree (GBDT) can predict diabetes with high accuracy from big data. In this study, we asked whether highly accurate prediction of diabetes is possible even from small data by expanding the amount of data through data collaboration (DC) analysis, a modern framework for integrating and analyzing data accumulated at multiple institutions while ensuring confidentiality. To this end, we focused on data from two institutions: health checkup data of 1502 citizens accumulated in Tsukuba City and health history data of 1399 patients collected at the University of Tsukuba Hospital. When using only the health checkup data, the ROC-AUC and Recall for logistic regression (LR) were 0.858 ± 0.014 and 0.970 ± 0.019, respectively, while those for GBDT were 0.856 ± 0.014 and 0.983 ± 0.016, respectively. When using also the health history data through DC analysis, these values for LR improved to 0.875 ± 0.013 and 0.993 ± 0.009, respectively, while those for GBDT deteriorated because of the low compatibility with a method used for confidential data sharing (although DC analysis brought improvements). Even in a situation where health checkup data of only 324 citizens are available, the ROC-AUC and Recall for LR were 0.767 ± 0.025 and 0.867 ± 0.04, respectively, thanks to DC analysis, indicating an 11% and 12% improvement. Thus, we concluded that the answer to the above question was “Yes” for LR but “No” for GBDT for the data set tested in this study.

Myeloid sarcoma is a rare clinical entity that presents as an isolated proliferation of leukemic cells, concurrently with or at relapse of acute myeloid leukemia (AML), myelodysplastic syndromes/neoplasms (MDS), chronic myeloid leukemia (CML), and myeloproliferative neoplasm (MPN). Myeloid sarcoma disrupts the normal architecture of its surrounding tissues. When it forms in long bones, it can cause their pathological fracture. We recently experienced a rare case of MDS presenting with myeloid sarcoma in the femur that eventually resulted in its pathological fracture. Detailed chromosomal analysis of the bone marrow cells suggested emergence of myeloid sarcoma during the fast-paced progression of MDS just after acquiring trisomy 22. A comprehensive review of previous cases of myeloid sarcoma-associated pathological fracture indicated possible involvement of structural rearrangements of chromosomes 9 and 22. Management of myeloid sarcoma should continue to improve, and clinicians should note that myeloid sarcoma with specific chromosomal alterations needs extra medical attention to prevent pathological fracture.

Bacterial meningitis is a rare but severe infectious complication after hematopoietic stem cell transplantation. However, its clinical features were previously not clear. We reviewed the cases of 7 patients diagnosed with bacterial meningitis with a positive cerebrospinal fluid culture among 1147 patients who underwent cord blood transplantation (CBT) at our institution between September 2007 and September 2020. The diagnosis was made on day + 5– + 45, and 5 patients developed bacterial meningitis before neutrophil engraftment. The causative organisms were all Gram-positive cocci: Enterococcus faecium and Enterococcus gallinarum (2 patients each), and Staphylococcus haemolyticus, Streptococcus mitis/oralis, and Rothia mucilaginosa (1 patient each). Six patients developed bacterial meningitis secondary to prior or concomitant bacteremia caused by the same bacterium. Five patients had received anti-MRSA agents at onset: vancomycin in 3, teicoplanin in 1, and daptomycin in 1. After diagnosis of bacterial meningitis, linezolid was eventually used for 6 patients. Two patients with E. gallinarum were alive at day + 1380 and + 157 after CBT, respectively, whereas 5 patients died 17–53 (median 43) days after the onset of bacterial meningitis. Breakthrough meningitis in CBT can occur even during the use of anti-MRSA drugs, and intensive antibiotic treatment is necessary.

Segregation energies of impurity ions and oxygen vacancies at grain boundaries in Y 2 O 3 -doped ZrO 2 as calculated from atomistic simulations using energy minimization and Monte Carlo methods are reported. Based on these energies, local defect equilibrium concentrations have been estimated. It is found that it is more energetically favorable for an yttrium ion to be accompanied by an oxygen vacancy at grain boundaries, although decrease in energy when associated with an oxygen vacancy differs from boundary to boundary. The segregation energy for a neutral defect complex consisting of a two yttrium ions and an oxygen vacancy at infinitely dilute concentration is highly correlated with the coordination environment of each site in the vicinity of the grain boundary (GB), and, in turn, GB energy. Although the estimated local equilibrium concentrations of these defects are similar, detailed analysis of the atomic coordination and defect distributions in the vicinity of a GB reveal that defect distributions, especially of oxygen vacancies, are dependent on the characteristics of the particular GB and that segregation in effect reduces lattice strains at the GB. Equilibrium concentration distributions of yttrium at grain boundaries are also given as a function of spatial resolution, and are useful for interpretation of experimental results.

Purpose With the advent of a new program for postgraduate medical students in 2004, the number of applicants choosing surgical careers in Japan has been declining. We conducted this study to evaluate the impact of preclinical clerkship and how it affects students’ attitudes toward a surgical career. Methods The subjects of our study were fifth-year medical students who participated in a clinical clerkship in general surgery in our department between April 2021 and March 2022. We conducted pre- and post-preclinical clerkship surveys to assess the perceived image of surgeons and the impact of clerkship on surgical career interest. Results Among 132 medical students (77 men and 55 women) who rotated through preclinical clerkship in our department, 125 participated in the survey and 66% expressed interest in a surgical career. In the post-clerkship survey, an increased interest in a surgical career was expressed by 79% of the students; notably, including those who initially expressed interest. Approximately 77% of students were satisfied with the practical skill training they received. Conclusion Engaging medical students early in surgical experience through a preclinical clerkship for general surgery appears to promote their interest in a surgical career.

This systematic review was performed to investigate the superiority of proton beam therapy (PBT) to photon-based radiotherapy (RT) in treating esophageal cancer patients, especially those with poor cardiopulmonary function. The MEDLINE (PubMed) and ICHUSHI (Japana Centra Revuo Medicina) databases were searched from January 2000 to August 2020 for studies evaluating one end point at least as follows; overall survival, progression-free survival, grade ≥ 3 cardiopulmonary toxicities, dose-volume histograms, or lymphopenia or absolute lymphocyte counts (ALCs) in esophageal cancer patients treated with PBT or photon-based RT. Of 286 selected studies, 23 including 1 randomized control study, 2 propensity matched analyses, and 20 cohort studies were eligible for qualitative review. Overall survival and progression-free survival were better after PBT than after photon-based RT, but the difference was significant in only one of seven studies. The rate of grade 3 cardiopulmonary toxicities was lower after PBT (0–13%) than after photon-based RT (7.1–30.3%). Dose-volume histograms revealed better results for PBT than photon-based RT. Three of four reports evaluating the ALC demonstrated a significantly higher ALC after PBT than after photon-based RT. Our review found that PBT resulted in a favorable trend in the survival rate and had an excellent dose distribution, contributing to reduced cardiopulmonary toxicities and a maintained number of lymphocytes. These results warrant novel prospective trials to validate the clinical evidence.