The role of manipulation under anesthesia (MUA) without arthroscopic capsular release in patients with preoperative stiffness undergoing arthroscopic rotator cuff repair (ARCR) remains unclear. Additionally, the association between shoulder stiffness and tendon healing after ARCR is still controversial. This study aimed to compare the clinical outcomes and retear rates between patients with preoperative stiffness treated by MUA alone and those without stiffness. Methods: This retrospective study included 322 patients who underwent ARCR for full-thickness tears between January 2012 and May 2022 with a minimum 2 years of follow-up. Clinical outcomes—including passive range of motion (ROM); the Japanese Orthopedic Association (JOA) score; and the University of California, Los Angeles (UCLA) score—were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients were divided into the stiffness group (MUA completed) and the non-stiffness group. Retears were evaluated using magnetic resonance imaging at 6 months postoperatively, and retear rates were analyzed by tear size (medium vs. large/massive). Results: Eighty-eight patients with stiffness and 234 without stiffness met the study inclusion criteria. Preoperative ROM, JOA, and UCLA scores were significantly lower in the stiffness group. Both groups showed significant improvements at final follow-up, with greater gains in the stiffness group. Final outcomes were comparable, except for external rotation. In medium-sized tears, the retear rate was significantly lower in the stiffness group (1.9%) than in the non-stiffness group (10.8%) (P=0.042). No significant difference was observed for large/massive tears. Conclusions: Patients with preoperative stiffness treated with MUA alone achieved comparable outcomes to those without stiffness, with improved tendon healing in medium-sized tears. Level of evidence: III

Case Report: The patient was a 70-year-old man with a chief complaint of impaired consciousness. He had visited a hot spring in Yamagata Prefecture. While he was bathing in a hot spring, he lost consciousness and nearly drowned. There was no eye witness. Other guests discovered him floating in the bathtub. He was not breathing and received chest compression by a guest. Subsequently, the patient resumed spontaneous respiration. When the emergency medical team arrived, and Japan Coma Scale (JCS) was 300 and Glasgow Coma Scale (GCS) was E1V1M1. The patient was transported to our hospital, and JCS was 200 at admission. Plain chest x-ray and CT imaging revealed infiltrative opacities in the bilateral lungs, suggesting pneumonia. Head CT imaging was unable to identify the underlying cause of loss of consciousness and showed no hypoxic changes. He continued to have impaired consciousness after arrival at the hospital, and it was determined that he had postresuscitation hypoxic encephalopathy. He was immediately treated with cerebral hypothermia. Midazolam was used for sedation, fentanyl for analgesia, and vecuronium for prevention of shivering. In the emergency room, the patient underwent gastric lavage with cold water and infusion of cold fluid. An Arctic Sun® was placed on the patient after admission to the ICU. A target body temperature of 34°C was reached approximately 4 hours after arrival. His temperature was maintained at 34°C for 24 hours and warmed to 36°C in the next 48 hours. Lung disorder caused by aspiration of hot spring water was treated with antibiotics (tazobactam/piperacillin and azithromycin) and positive-pressure ventilation by a mechanical ventilator. This treatment prevented the lung disorder from increasing in severity. Sedation was discontinued after the body temperature was warmed. Subsequently, the patient’s state of consciousness was improved to the premorbid level, and he eventually was able to return to his normal life. Discussion: When patients nearly drown in a hot spring, their body temperatures are often elevated because they have been in hot water for a long time. Their body temperatures must be lowered quickly to a target level using various cooling methods. Immunity is lowered in a hypothermic state, and pneumonia will inevitably develop due to aspiration of hot spring water. Thus, appropriate management is necessary, including the use of antibiotics. Conclusion: Cerebral hypothermia was effective for postresuscitation hypoxic encephalopathy caused by near drowning in a hot spring.

Risk factors for developing hemolytic uremic syndrome among patients with enterohemorrhagic Escherichia coli O157: H7 (EHEC) infection include age. The young, especially those under the age of five, face an increased risk, as do the elderly. In the present study, we evaluated the protective effects of Hochu-ekki-to (HET) on intraperitoneal infection with EHEC, using immunosuppressant, dexamethasone (Dex)-treated mice.
It was found that HET induced improvement of Dex-induced leukopenia. Similarly, the IgM-plaque forming cell responses to sheep red blood cell (SRBC) were restored by the administration of HET to the normal-mice level in Dex-treated mice. Consequently, HET was administered orally into the Dex-treated mice before infection with EHEC to observe the therapeutic effect. With the oral administration of 500mg/kg/head of HET into the Dex-treated mice, prolonged survival was shown: the 50% survival time in the HET-administered mice was four days, compared with one day in the non-administered controls. In addition, the number of bacteria in the liver was reduced by the administration of HET in the Dex-treated mice.
The results indicate that orally administered-HET protects against EHEC infection in Dex-treated mice, and such protective effects appear to be due to the restorative effects of HET against the Dex-induced immunosuppression.