Methods: We analyzed data from 45 patients with T2OFs and 79 with sub-axial fractures, all aged ≥75 years. Hounsfield unit (HU) values at C2–C4, the prevalence of ankylosis, and degenerative changes were assessed via computed tomography. We performed sex-specific analysis and logistic regression to identify factors associated with T2OF. In addition, we used the Swedish Fracture Registry (SFR) to analyze the prevalence of spinal ankylosis among Swedish patients with T2OFs and sub-axial fractures. Results: Among patients with T2OFs, in comparison with those with sub-axial fractures, spinal ankylosis was less prevalent (2.2% vs. 31.6%, p<0.001), HU values were lower (p<0.05), atlanto-occipital degeneration was less prevalent (p=0.009), and facet joint degeneration was more prevalent (p=0.03). Logistic regression revealed that atlanto-occipital degeneration (odds ratio, 0.33; p=0.02) and spinal ankylosis (odds ratio, 0.06; p=0.01) were negative predictors of T2OF. Sex-specific analysis revealed that HU values were lower for women with T2OFs (p<0.05) and ankylosis was less prevalent among men with T2OFs (p<0.001) than among sex-matched patients with subaxial fractures. The SFR confirmed that ankylosis was less prevalent among patients with T2OFs (3.3%) than among those with sub-axial fractures (28.3%, p<0.0001). Conclusions Spinal ankylosis and atlanto-occipital degeneration are significant risk factors for T2OF. According to sex-specific analysis, spinal ankylosis was less prevalent among men with T2OFs than among those with sub-axial fractures, whereas C2–C4 HU values were significantly lower in among women with T2OFs.

Methods: A total of 209 patients with osteoporosis and 54 with adult spinal deformities were included. Patients were divided into two groups based on pelvic incidence–lumbar lordosis (PI–LL): <20° and ≥20° groups. The sagittal vertical axis (SVA), thoracic kyphosis, PI, pelvic tilt (PT), LL, sacral slope, and pelvic femoral angle (PFA) were measured. Health-related quality of life (HRQOL) was assessed in 86 patients using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A new index, PFA–(PI–LL), was defined as spinopelvic–hip mismatch. Correlation coefficients were calculated for each radiographic parameter, and the coefficient of determination (R2) for the relationship of each parameter with SVA was evaluated in both groups. The correlations between SVA, PT, PI–LL, PFA–(PI–LL), and JOABPEQ domain scores were also analyzed. Results: PI–LL correlated with PFA in the PI–LL <20° group (r=0.56, p<0.001) but not in the PI–LL ≥20° group. Among all parameters, PFA–(PI–LL) demonstrated the strongest association with SVA, indicating its superior ability to explain variations in sagittal alignment in both groups and across all patients (all patients, R2=0.77). Significant correlations were observed between the radiographic parameters and JOABPEQ scores across all domains. Conclusions PFA–(PI–LL), which represented spinopelvic–hip mismatch, was a reliable indicator of hip compensatory function in terms of anterior trunk inclination and HRQOL.

Supporting learners in difficulties is difficult. It is the responsibility of hospitals, universities and other medical education institutions to respond effectively. Traditionally, there has been a bias against focusing on the learner and a tendency to be persuaded by teachers’ beliefs. However, the factors that can lead to learners having difficulties in education include not only the learners but also the educators and the environment. There are also pedagogical, psychological, and cultural approaches to analyzing each factor. In the future, we would like to suggest that a single supporter have more than one perspective. However, because of the context in which supporters are placed, there is a limit to the number of perspectives that can be taken. Therefore, it is hoped that medical education institutions will be able to provide a support system in which multiple supporters, from multiple positions and with multiple perspectives, can ensure a broad perspective.

In this paper, as support for “students who are showing signs of academic underachievement”, a fictional case of a medical student will be examined from the following three perspectives. The first is a cognitive/neuropsychological perspective on the possibility of “incongruence between cognitive characteristics and learning strategies” and “higher brain dysfunction” . In support, it is important to identify the the student’s traits and adopt appropriate learning strategies. The second, from a clinical psychological perspective, discusses the possibility of “depression” due to tasks in “identity development”. Self-understanding and environmental coordination are required for support. Third, from the perspective of neurodevelopmental syndrome, the possibility of “specific learning disorder” is considered. In this case, too, it is necessary to devise learning strategies that match the student’s traits and provide continuous motivation. For individualized understanding as already mentioned, interdepartment collaboration is also expected.

In this paper, as support for “student who is not good at communication”, a fictional case of a pharmaceutical student will be examined from the followingthree perspectives. The first, from a developmental and social psychological perspective, is the possibility of “unlearning or mislearning of communication” and “discrepancy between the actual self, the ideal self, and the ought self.” In support, learning assertion skills can be effective. The second is from a clinical psychological perspective, in terms of “social anxiety disorder” and “narcissism”. In support, pharmacotherapy and cognitive behavioral therapy will be discussed. Third, from the perspective of neurodevelopmental syndrome, the possibility of “autism spectrum disorder” is considered. In this case, involvement that enhances self-understanding and self-affirmation will be important. Educators and supporters are required to make an accurate assessment of the cause of the difficulty.

In this paper, in order to understand “newly medical professionals who cannot do their jobs well in clinical practice”, we gave concrete fictitious cases, examined the reasons from three viewpoints, and showed supporting examples for each. The first is the possibility of “discrepancies between the learner’s personality and the environment” and “difficulties in the learner’s own environment” from the perspective of environmental factors. Also included is the importance of how to match the learner and the environment. The second is the possibility of “bipolar disorder” from the perspective of clinical psychology, which requires consultation with a specialist and specialized therapeutic intervention according to the diagnosis. The third possibility is attention deficit/hyperactivity disorder from the perspective of neurodevelopmental disorders. In addition, it is important to improve the work environment, including the surrounding staff.

The purpose of this study was to investigate heme oxygenase-1 (HO-1) mRNA expression and bilirubin concentration alteration in humans exposed to acute hypoxia. Fourteen healthy adult males were randomly assigned to a sea level group and a hypoxia group, and then exposed to normoxia (400 m, 20.0 %O₂) and hypoxia (3,000 m, 14.5 %O₂) respectively, in a hypoxic chamber for 3 hours. SpO₂ during hypoxia were significantly lower than those at sea level (P＜0.05). Indirect bilirubin levels after hypoxia were significantly higher than those at sea level (P＜0.05). However, HO-1 mRNA expression was unaltered by hypoxia. In conclusion, our data indicate that an acute exposure to hypoxia at resting state for 3 hours might lead to antioxidative cytoprotective response without any increase in HO-1 gene expression.