Purpose: Decreased mechanical stress causes disuse bone atrophy characterized by reduced bone mass and weakened bone. However, few studies have measured the mechanism behind such changes in different areas of bone. The present morphological study investigated the effects of decreased mechanical stress on bone mineral density in different areas of the femur by measuring bone mineral density and assessing the microstructure of osteoblasts. Methods: Twenty-one 9-week-old male Sprague-Dawley rats were acclimatized for one week, and then were divided into control, exercise, and cast immobilization groups. The study was conducted over an 8-week period, from age 10 weeks to 17 weeks in the rats. Bone mineral density was measured by dual energy X-ray absorption (QDR-2000) in the proximal epiphysis/metaphysis, diaphysis, and distal epiphysis/metaphysis of the femur. The microstructure of osseous cells was examined by Scanning Electron Microscopy (SEM). Results: Bone mineral density of the distal epiphysis/metaphysis was significantly lower in the cast immobilization group than in the exercise or control groups (p<0.001). In the cast immobilization group, scanning electron microscopy of the distal epiphysis/metaphysis revealed no boundary between small osteoblast and smooth neighboring cells; however, in the exercise group, actively osteoblastic osteoblasts covered the bone surface, resembling a stone wall.Conclusion: Decreased mechanical stress caused a decrease in bone mineral density that varied in different areas of the femur. The largest decrease in density occurred in the distal epiphysis/metaphysis. Osteoblast microstructure played an important role.

Cross-sectional study.

Cross-sectional study.

Spinal cord stimulation (SCS) has been reported to be effective for complex regional pain syndrome (CRPS). This is a case report of a patient with CRPS who was successfully treated with a combination of temporary SCS lead placement and physical therapy. A 19-year-old man presented with severe pain for a few months since receiving plaster cast fixation as treatment for an ankle sprain injury at the previous hospital. At his first visit to our pain center, he could not walk without crutches because of severe pain accompanied by symptoms such as allodynia, decreased skin temperature, redness, edema, muscle weakness, and changes in the appearance of the affected area. The symptoms met the diagnostic criteria for CRPS. Temporary SCS lead placement was performed to alleviate the pain and peripheral circulatory disorder, along with physiotherapy to improve the flexibility and restore the normal appearance of the affected limb. The interdisciplinary treatment effectively improved our patient's leg edema and walking ability, which consequently led to pain relief.

Objective: This study aimed to characterize the muscle strength and skeletal muscle mass of patients with heart failure by investigating hand-grip strength, five times sit-to-stand (5STS) results, and skeletal muscle mass index (SMI).Materials and Methods: Muscle strength was assessed based on hand-grip strength and 5STS, while skeletal muscle mass was assessed using a bioelectrical impedance analyzer. Hierarchical logistic regression analysis was performed to explore the association between patients with heart failure and healthy elderly individuals.Results: Hierarchical logistic regression analysis was performed to examine the muscle strength and skeletal muscle mass characteristics in patients with heart failure. Hand-grip strength and 5STS responses but not SMI outcomes differed significantly between the two groups. The results of the hierarchical logistic regression analysis revealed that the hand-grip strength and 5STS were significant predictors of heart failure. The odds ratios for hand-grip strength and 5STS were 1.44 and 0.53, respectively.Conclusion: Our results suggested that upper and lower limb muscle strengths (handgrip strength and 5STS) in elderly patients with heart failure worsened significantly without a decrease in skeletal muscle mass.

Spinal cord stimulation (SCS) has been reported to be effective for complex regional pain syndrome (CRPS). This is a case report of a patient with CRPS who was successfully treated with a combination of temporary SCS lead placement and physical therapy. A 19-year-old man presented with severe pain for a few months since receiving plaster cast fixation as treatment for an ankle sprain injury at the previous hospital. At his first visit to our pain center, he could not walk without crutches because of severe pain accompanied by symptoms such as allodynia, decreased skin temperature, redness, edema, muscle weakness, and changes in the appearance of the affected area. The symptoms met the diagnostic criteria for CRPS. Temporary SCS lead placement was performed to alleviate the pain and peripheral circulatory disorder, along with physiotherapy to improve the flexibility and restore the normal appearance of the affected limb. The interdisciplinary treatment effectively improved our patient's leg edema and walking ability, which consequently led to pain relief.

Objective：Studies on upper extremity functional interventions for patients with spinal cord infarction are limited, and the effectiveness of the interventions for upper limb paresis in such patients have not been elucidated. This case report describes evidence-based spinal cord injury interventions that improved upper extremity function in a patient with spinal cord infarction.Methods：A man in his 60s presented with mild right hemiplegia because of right anterior spinal artery infarction in the C5 medullary segment. Upon admission, the patient had an American Spinal Injury Association Impairment Scale of D, lacked cognitive impairment, and demonstrated independence indoors with ambulation. The intervention included a combination of robotic therapy and electrical stimulation, adherence-enhancing behavioral strategies (Transfer Package), and typical occupational therapy. We recorded the following upper extremity functional scores：①Active Range of Motion of the shoulder, ②Passive Range of Motion of the shoulder, ③Manual Muscle Test, ④Grip strength, ⑤Pinch strength, ⑥Action Research Arm Test, ⑦Simple Test for Evaluating Hand Function, and ⑧Motor Activity Log.Results：After intervention therapy for 39 days, upper extremity function and the degree and quality of arm use in daily activities improved.Conclusion：These results suggest that evidence-based interventions for spinal cord injury could improve upper extremity function and the degree and quality of arm use in daily activities in patients with cervical spinal cord infarction.

Objective：Studies on upper extremity functional interventions for patients with spinal cord infarction are limited, and the effectiveness of the interventions for upper limb paresis in such patients have not been elucidated. This case report describes evidence-based spinal cord injury interventions that improved upper extremity function in a patient with spinal cord infarction.Methods：A man in his 60s presented with mild right hemiplegia because of right anterior spinal artery infarction in the C5 medullary segment. Upon admission, the patient had an American Spinal Injury Association Impairment Scale of D, lacked cognitive impairment, and demonstrated independence indoors with ambulation. The intervention included a combination of robotic therapy and electrical stimulation, adherence-enhancing behavioral strategies (Transfer Package), and typical occupational therapy. We recorded the following upper extremity functional scores：①Active Range of Motion of the shoulder, ②Passive Range of Motion of the shoulder, ③Manual Muscle Test, ④Grip strength, ⑤Pinch strength, ⑥Action Research Arm Test, ⑦Simple Test for Evaluating Hand Function, and ⑧Motor Activity Log.Results：After intervention therapy for 39 days, upper extremity function and the degree and quality of arm use in daily activities improved.Conclusion：These results suggest that evidence-based interventions for spinal cord injury could improve upper extremity function and the degree and quality of arm use in daily activities in patients with cervical spinal cord infarcti.

Introduction: We experienced a case of lung cancer in which arthrocentesis and radiation were effective in treating pain caused by malignant joint fluid. Case: An 80-year-old man was referred to our hospital because of right shoulder pain and difficulty in raising his right hand. Whole body computed tomography (CT) showed right lung tumor, multiple liver metastases and multiple bone metastases. There were also bone metastases in the right scapula and joint fluid accumulation in the right shoulder joint. He was irradiated for bone metastases in the right scapula, but the pain remained, although it had not worsened. Therefore, an arthrocentesis of the right shoulder joint was performed and pain was alleviated. In addition, the diagnosis of non-small cell carcinoma was made by joint fluid cytology. A biopsy was also taken from the right lung tumor, and as the histological diagnosis was similar to that of the joint fluid, chemotherapy was started. CT after the start of treatment showed a decrease in the right shoulder joint fluid and no progression of right scapular metastases. Conclusion: In case of malignant joint fluid associated with bone metastases, a severe prognosis is expected, but arthrocentesis and irradiation can reduce pain.

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.