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.

The patient was a 63-year-old man. He underwent total arch replacement for Stanford type A acute aortic dissection. Eleven years after surgery, blood tests showed anemia, elevated LDH and direct bilirubin levels, and a visual blood test detected crushed red blood cells, leading to a diagnosis of hemolytic anemia. The Computed tomography showed a highly kinked graft, and the catheter test showed an increase in the pressure gradient before and after the kinked graft, suggesting that the patient had hemolytic anemia caused by the kinked graft. Because he also had moderate aortic regurgitation and a patent foramen ovale, he underwent resection of the kinked graft, ascending aortic replacement, aortic valve replacement, and closure of the foramen ovale. The postoperative course was good, and hemolytic anemia was not observed.

Objective: To investigate the influence of calcium carbonate supplementation on cognitive function in mice. Methods: Mice were fed diets containing 1.0% calcium carbonate for 8 weeks, following which they were evaluated for memory function using object recognition, Y-maze, and Barnes maze tests. Next, the expression levels of cAMP response element binding protein (CREB) and phosphorylated CREB, which is involved in the memory process were investigated in both the hippocampus and cerebral cortex using western blotting methods. Results: Mice fed on a diet containing calcium carbonate showed memory impairments in object recognition, Y-maze, and Barnes maze tests with respect to the mice that were on a control diet. Further, mice that were fed a diet containing calcium carbonate and a nimodipine (an L-type calcium channel antagonist), reversed calcium carbonate-induced memory impairments, thus suggesting that excessive entry of calcium in cells may cause memory impairments. A study using western blot revealed that expression of CREB and phosphorylated CREB in hippocampus and cerebral cortex was significantly lower in the calcium carbonate-fed mice than in the control-diet-fed mice. Conclusions: These results suggest that a calcium carbonate diet may cause memory impairment by decreasing CREB expression. This is the first report of calcium carbonate supplementation causing memory impairment. This simple animal model may be useful as a novel cognitive impairment model for drug development.

Objective: To investigate whether the extract from the nacreous layer of pearl oysters (nacre extract) improves impairments in memory caused by scopolamine administration in rodents. Methods: Nacre extract was prepared from the inner shell layer of pearl oyster. Effects of nacre extract on scopolamine-induced memory impairment were estimated using novel object recognition test, Y-maze test, and Barnes maze test. Effect of nacre extract on mRNA expressions which are genes associated with memory in the hippocampus was investigated using semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) analysis. Results: Administration of nacre extract led to the protection against scopolamine-induced impairments in object recognition, short-term memory, and spatial memory. Treatment with nacre extract reversed the mRNA expression of brain-derived neurotrophic factor (BDNF) and Homer protein homolog 1 (Homer-la) in the hippocampus, which decreased with the treatment of scopolamine. Conclusions: These results suggest that nacre extract has attenuating effects on memory impairments induced by scopolamine through the increase in mRNA expression of BDNF and Homer-1a.

PURPOSE: Opioids improve pain from knee and hip osteoarthritis (OA) and decrease the functional impairment of patients. However, there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients, thereby inducing the progression of OA changes in these patients. The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids. MATERIALS AND METHODS: Two hundred knee or hip OA patients were evaluated in the current prospective, randomized, active-controlled study. Patients were randomized 1:1:1 into three parallel treatment groups: loxoprofen, tramadol/acetaminophen, and transdermal fentanyl groups. Medication was administered for 12 weeks. Pain scores and progressive OA changes on X-ray films were evaluated. RESULTS: Overall, pain relief was obtained by all three groups. Most patients did not show progressive OA changes; however, 3 patients in the transdermal fentanyl group showed progressive OA changes during the 12 weeks of treatment. These 3 patients used significantly higher doses than others in the transdermal fentanyl group. Additionally, the average pain score for these 3 patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group. CONCLUSION: Fentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol.
Aged ; Aged, 80 and over ; Analgesics, Opioid/*adverse effects/therapeutic use ; Disease Progression ; Female ; Fentanyl/*adverse effects/therapeutic use ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/*drug therapy/radiography ; Osteoarthritis, Knee/*drug therapy/radiography ; Pain/drug therapy

Ceftriaxone is one of the easily administrative antibiotics, but little is known about their role in palliative care settings. The aim of this study is to show the effect and the safety of ceftriaxone subcutaneous infusion to infection among advanced cancer patients. Consecutive patients who received ceftriaxone subcutaneous infusion at the Seirei Hospice from January 2013 to January 2014 were enrolled in this retrospective analyses. Primary outcome was the response rate of ceftriaxone, determined by improvement of symptoms within 3 days of ceftriaxone use. Secondary outcomes are inflammatory site reaction, and a comparison of the response rate between ceftriatone and other antibiotics. Among a total of 100 admitted patients, 10 patients used ceftriaxone subcutaneous infusion (4 for urinary tract infection, 4 for pneumonia, 2 for soft tissue infection). The response rate was 70% (95% confidence interval, 39－89). There was no inflammatory symptom at the insertion site observed. For comparisons, 16 patients used other antibiotics with the response rate of 74% (51－88).In conclusion, subcutaneous infusion of ceftriaxone can be useful in the treatment of infections of end－of－life cancer patients, and randomized controlled trial is promising.

Purpose and Methods: Infection and neoplastic fever is one of the common complication in patients with advanced cancer. To develop a novel method to differentiate neoplastic fever from infection, we performed a retrospective study of hospitalized terminally ill cancer patients at Seirei Hospice from April 2009 to August 2011. Results: We identified a consecutive sample of 12 patients with neoplastic fever and 12 patients with infection as a control. We extracted demographic data, laboratory data, vital signs and symptoms from medical charts. We found significant differences in difference in C-reacive protein value between afebrile and febrile period (p＜0.001), difference of white blood cell count between afebrile and febrile period (p=0.0017), percentages in neutrophil counts (p=0.023), percentages in lymphocyte counts at base line (p=0.011) and the presence of delirium (p=0.012). Conclusion: These findings suggest that we might differentiate neoplastic fever from infection with common laboratory data and their longitudinal change.

Objective: Snapping finger is the result of gliding disorder of the superficial and deep digital flexor tendon and the flexor pollicis longus muscle tendon at the synovial and ligamentous tendon sheath (A1 pulley). In this study, acupuncture was performed at the A1 pulley of the affected finger to determine its effect on pain during snapping and the degree of the snapping phenomenon. Methods: Acupuncture was performed on 19 fingers of 15 patients. No control group of untreated patients was included in the study, and the same acupuncture treatment was used for all of the patients. The acupuncture needles were inserted in the radial and ulnar sides of the flexor tendon (left inserted for 10 min) at the A1 pulley of the affected finger. Treatment was performed a maximum of 5 times (once every 5 to 7 days). Before and after each treatment, the pain during snapping and the degree of the snapping phenomenon were evaluated using a visual analogue scale (VAS) ranging from 0 mm (no symptoms) to 100 mm (intolerable symptoms). Symptoms before the first treatment and before the fifth treatment were compared to determine the degree of change, taking a 50% improvement as the criterion for judging whether there was an improvement or not, and the relationship between improvement or lack of improvement and the duration of the disorder was examined. Results: VAS evaluation showed a significant improvement in pain during snapping and the degree of the snapping phenomenon with scores before the first treatment and before the fifth treatment of 57.1±22.2 (mm, mean±SD)→26.0±29.8, 61.2±23.1→26.1±27.6 respectively. VAS evaluation directly after the first treatment also showed a significant improvement in pain and the degree of the snapping phenomenon with scores of 40.8±19.6 and 44.3±23.9 respectively. Furthermore, by the fifth treatment, pain and the snapping phenomenon were observed to have completely disappeared in 4 and 6 fingers respectively. In patients showing an improvement in pain and the snapping phenomenon, the duration of the disorder was significantly short. Discussion: It is unlikely that acupuncture had an influence on the degeneration and thickening of the ligament tendon sheath. Improvement in the snapping phenomenon is thought to be the result of acupuncture treatment changing regional blood flow and thereby exerting a favorable influence on inflammatory swelling. The alleviation of pain during snapping is believed to be the result of improved flexor tendon gliding as well as the involvement of acupuncture in activation of the pain inhibitory system. Since no control group of untreated patients or sham treatment group were included in the study, the possibility of a placebo effect influencing the results cannot be completely excluded. However, because a difference was observed in the efficacy of the treatment depending on the duration of the disorder, the view is that acupuncture at the impaired A1 pulley could be effective treatment for snapping finger when the main cause is inflammatory swelling of the synovial membrane of the tendon sheath and when the duration of the disorder is short.