The therapeutic effect of artificial CO₂ pack on pressure sores of five patients with neurological diseases was confirmed using an infrared thermometer.
The artificial CO₂ pack was prepared by dissolving a 5-g KAO-BABU tablet in 250ml of water at 50°C.
It was proven that the pressure sore recovered faster after treatment with artificial CO₂ hot-pack than that with plain water hot-pack.
In addition, the skin temperature in the area around the pressure sore became lower than the temperature just before the treatment presumably because of the steal phenomenon of blood flow under the skin.

The effect of the artificial CO₂-bathing on the blood pressure in patients with Parkinson's disease with autonomic disorder was investigated and the conclusions were obtained as follows;
1. Regardless of the extent of the autonomic disorder and the contents in the bath, the slight increase in the blood pressure was observed immediatly after the bathing.
2. Systolic blood pressure within 100-150mmHg before the bathing decreased gradually during the bathing and the degree of the decrease was proportional to the extent of the autonomic disorder. The variation of the blood pressere during the bathing was within 30mmHg.
3. Furthermore, when the artificial CO₂-bathing liquid was used, the decrease in the blood pressure after the bathing was salient in proportion to the extent of the autonomic disorder and it was observed that the restoration of the blood pressure to the level before the bathing was remarkably delayed compared with the tap water bathing. This phenomenon was similar in patient with Shy-Drager syndrome characterized by severe autonomic disorder.
4. From the above results, it was suggested that the close management of the blood pressure and the attention to the change of position are necessary during and after the artificial CO₂-bathing in patient with Parkinson's disease with severe autonomic disorders and patients with Shy-Drager syndrome.

Purpose
To investigate the effect of CO₂-inhalation on the cerebral circulation of CVA patients during artificial CO₂-bathing, controlled examinations were made with ^99mTc-hexamethyl propyleneamine oxime SPECT (hereinafter abbreviated as HM-PAO-SPELT).
Subject and Methods
HM-PAO-SPECT was conducted on four CVA patients without CO₂-inhalation as a control. 0.5g of artificial CO₂-bath tablet (Kao Bub^®) was them added to 2l of hot tapwater at 40°C to provide an ordinary bathing concentration. The patients inhaled the CO₂ generated for 3min at a height of 20cm above the water level, which was immediately followed by HM-PAO-SPECT. Similar examinations were performed at a higher bathing concentration provided by adding 50g of artificial CO₂-bath tablet (Kao Bub^®) to 2l of water. To compare results with systemic circulation, blood pressure and blood gas were measured before and after the CO₂-inhalation.
Results
HM-PAO-SPECT showed a remarkable increase in blood flow in two of the four patients when 0.5g of artificial CO₂-bath tablet was used to provide an ordinary bathing concentration. At a concentration 100 times higher than ordinary concentration using 50g of artificial CO₂-bath tablet, obvious increase in blood flow was found in three of the patients. At both concentrations, the remaining patient showed a decrease on blood flow, with no change in blood pressure or blood gas.
Discussion
CO₂ is considered as one of the most potent factors involved in cerebral blood flow. In these examinations, the effect of CO₂-inhalation from artificial CO₂-bath tablet in increasing blood flow was confirmed by means of HM-PAO-SPECT. Its usefulness was thus proven. The subject who showed a decrease in blood flow may have been in a period of steal phenomenon, or luxury perfusion, when he underwent the examination. Future studies must be performed on the relationship between the increase in blood flow and the improvement of symptom, timing of artificial CO₂ bathing, and between the effect of artificial bathing and the CO₂ concentration.

Objective: To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment. Methods: An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors. Results: The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006). Conclusion Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

Objective: To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment. Methods: An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors. Results: The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006). Conclusion Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

Objective: To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment. Methods: An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors. Results: The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006). Conclusion Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.