A 56-year-old woman was referred to our hospital because of an abnormal finding in the right pulmonary hilum on chest X-ray. Enhanced chest computed tomography showed hyperplastic bronchial arteries dilating and winding around the trachea and bronchi. A racemose hemangioma of the bronchial artery with multiple bronchial artery aneurysms (diameter <20mm) was seen displacing the trachea and both main bronchi. Bronchoscopy showed submucosal tumor-like lesions at the distal trachea and in both main bronchi, and a dusky-red elevated pulsatile lesion at the orifice of the left B3b＋c. We performed coil embolization of the bronchial artery aneurysm to prevent abrupt rupture of the bronchial aneurysm.

STUDY DESIGN: Retrospective and comparative study. PURPOSE: We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. OVERVIEW OF LITERATURE: OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF. METHODS: Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively. RESULTS: Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group. CONCLUSIONS: Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.

A 3-month alcoholism rehabilitation program at psychiatric hospitals is common in Japan for patients with alcohol use disorder (AUD). However, many AUD patients are often hospitalized for the treatment of digestive disorders due to alcohol-related liver diseases and pancreatitis. In this sense, AUD patients need to be better supported by professionals and departments in general hospitals. Here we analyzed the problems in alcohol-related medical care in Japan and examined the measures to be taken at general hospitals.

Background : Left atrial reverse remodeling occurs when the left atrial load is reduced after mitral valve repair for mitral valve regurgitation. However, several reports demonstrate mitral valve stenosis after mitral valve repair with a mitral ring, which leads to impaired left atrial reverse remodeling. Objective : To examine the effect of ring size and body size on left atrial reverse remodeling after mitral valve repair. Patients and Methods : Sixty patients underwent transthoracic echocardiography before and after mitral valve repair for mitral valve regurgitation in our hospital. The left atrial volume (LAV) was compared pre- and postoperatively. Ring-size/BSA (mm/m2) was defined as values to express the mismatch between ring-size and body size after mitral valve repair with a mitral ring. In addition, we examined which factors correlated with the left atrial volume reduction rate including ring-size/BSA. The mean ring size was 28 mm. The study interval was 17±6 months. Result : LAV changed from 82±37 ml to 47±20 ml postoperatively. The left atrial volume reduction rate was 39.8±18.6%. The peak pressure gradient measured from the transmitral flow (TMF p-PG) was 7.5±3.0 mmHg. Ring size showed a stronger correlation with body height than BSA. The ring-size/BSA was 17.7±2.1 mm/m2. Multivariate analysis shows that correlates of the LAV reduction rate were ring-size/BSA, pre LAV and age. Ring-size, TMF p-PG, ring annuloplasty only and postoperative TRPG did not show a strong correlation with the LAV reduction rate. Conclusion : A mismatch between body size and ring size is a negative factor for left atrial reverse remodeling after mitral valve repair with a mitral ring. The ring-size/BSA may be a useful factor to express grade of the mismatch.

The purpose of the present study was to examine the associations of replacing accelerometer-measured sedentary behavior (SB) with physical activity (PA) and depression in a sample of Japanese frail older adults using an Isotemporal Substitution (IS) model. Among 139 frail older adults, accelerometer was utilized to identify the daily average time spent in SB, light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA). Depression was assessed using the Geriatric Depression Scale-Short Version-Japanese (GDS-S-J). The relationship between SB, LPA, and MVPA with depression was examined with three models of multiple regression analysis: single factor model, partition model, and IS model. As results, LPA times was negatively associated with GDS-S-J scores in the single factor model (B = -0.09, p = 0.007) and the partition model (B = -0.13, p < 0.001). In the IS model, replacement of 10 minutes of SB with an equal amount of LPA time showed a significant negative association with GDS-S-J scores (B = -0.09, p=0.003). These results suggest that replacing a small amount of SB with LPA may be associated with an improvement in depression in frail older adults.

Drug therapy is necessary to treat metastatic and recurrent breast cancer. In Japan, two types of cyclin-dependent kinases (i.e., CDK4/6 inhibitors) are covered under the national healthinsurance system: palbociclib (since December 2017) and abemaciclib (since November 2018). Although there are many reports on the use and side effects of palbociclib in clinical practice, there are few such reports on abemaciclib. Therefore, we investigated the rate of neutropenia and associated background factors in patients taking abemaciclib. Of the 39 patients taking abemaciclib recruited for the study, 22 satisfied the inclusion criteria. Of these, 7 developed Grade 3 or higher neutropenia and had a significantly lower body weight and body mass index (BMI). Furthermore, the white blood cell and neutrophil counts before administration were significantly lower in the expression group compared with the non-expressing group. To predict the development of Grade 3 or higher neutropenia, the receiver operating characteristic (ROC) curve was used to calculate a BMI cut-off value of 23.9 (specificity 85.7%, sensitivity 73.3%, area under the ROC curve 0.80). Based on this cut-off value, BMI was divided into two groups (<23.9 and ≥23.9) and Fisher's exact test was performed. Patients with a low body mass index were more likely to develop Grade 3 or higher neutropenia as a result of increased dosage per kilogram body weight, while among patients with BMI < 25, those with BMI < 23.9 were at high risk of developing Grade 3 or higher neutropenia. Accordingly, caution is required in the treatment of such patients.

In order for pharmacists to be collaboratively involved with patients in pharmacotherapy, there is a need to improve patients’ understanding of pharmacists’ involvement in extended pharmacotherapy, i.e., their interpersonal work. This study explores the factors that affect patients’ perceptions of pharmacists’ interpersonal work. A survey on patients’ perceptions of pharmacists’ interpersonal work was conducted among 450 patients aged 20 years or older who visited a pharmacy. Logistic regression analysis was performed with low and high patient perceptions of pharmacists’ interpersonal work as the objective variables. Valid responses were obtained from 350 participants. More than half of the respondents did not understand the nature of the interpersonal work of pharmacists. Patients who were unaware of pharmacists checking for side effects were more prevalent than those who were unaware of other interpersonal work. Explanations from the family pharmacist (OR＝2.25, P＝0.033) and trust in the pharmacist (OR＝1.11, P＝0.001) had a positive influence on patients’ perceptions of the pharmacist’s interpersonal tasks. As pharmacy pharmacists are increasingly becoming more involved with patients’ drug treatment and to ensure safe drug treatment practices for patients, it is considered important for pharmacists to actively explain their involvement in drug treatment to patients. This will be conducive to building trusting relationships, and for pharmacists to fulfil their function as family pharmacists.

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.

Osteoclasts are bone-specific multinucleated cells generated by the differentiation of monocyte/macrophage lineage precursors. Regulation of osteoclast differentiation is considered an effective therapeutic approach to the treatment of bone-lytic diseases. Periodontitis is an inflammatory disease characterized by extensive bone resorption. In this study, we investigated the effects of sodium fluoride (NaF) on osteoclastogenesis induced by Porphyromonas gingivalis, an important colonizer of the oral cavity that has been implicated in periodontitis. NaF strongly inhibited the P. gingivalis-induced alveolar bone loss. That effect was accompanied by decreased levels of cathepsin K, interleukin (IL)-1β, matrix metalloproteinase 9 (MMP9), and tartrate-resistant acid phosphatase, which were up-regulated during P. gingivalis-induced osteoclastogenesis. Consistent with the in vivo anti-osteoclastogenic effect, NaF inhibited osteoclast formation caused by the differentiation factor RANKL (receptor activator of nuclear factor κB ligand) and macrophage colony-stimulating factor (M-CSF). The RANKL-stimulated induction of the transcription factor nuclear factor of activated T cells (NFAT) c1 was also abrogated by NaF. Taken together, our data demonstrate that NaF inhibits RANKL-induced osteoclastogenesis by reducing the induction of NFATc1, ultimately leading to the suppressed expression of cathepsin K and MMP9. The in vivo effect of NaF on the inhibition of P. gingivalis-induced osteoclastogenesis strengthens the potential usefulness of NaF for treating periodontal diseases.
Acid Phosphatase ; drug effects ; Alveolar Bone Loss ; microbiology ; prevention & control ; Animals ; Anti-Bacterial Agents ; therapeutic use ; Anti-Inflammatory Agents ; therapeutic use ; Bacteroidaceae Infections ; microbiology ; prevention & control ; Bone Density Conservation Agents ; therapeutic use ; Cathepsin K ; drug effects ; Interleukin-1beta ; drug effects ; Interleukin-6 ; analysis ; Interleukin-8 ; drug effects ; Isoenzymes ; drug effects ; Macrophage Colony-Stimulating Factor ; drug effects ; Male ; Matrix Metalloproteinase 9 ; drug effects ; Osteoclasts ; drug effects ; Periodontitis ; microbiology ; prevention & control ; Porphyromonas gingivalis ; drug effects ; RANK Ligand ; drug effects ; Rats ; Rats, Sprague-Dawley ; Sodium Fluoride ; therapeutic use ; Tartrate-Resistant Acid Phosphatase ; Transcription Factors ; drug effects ; X-Ray Microtomography ; methods