Objective: To investigate the effects of social restrictions imposed during the coronavirus disease 2019 (COVID-19) pandemic on postoperative functional recovery in patients who underwent surgery for degenerative musculoskeletal disorders. Methods: This longitudinal prospective cohort study included 291 patients categorized into pre-pandemic (surgery in 2018), early pandemic (2019), and late-pandemic (2020) groups based on their 1-year recovery period. The primary outcome was improvement in locomotive syndrome (LS) status 1 year after surgery. We analyzed the association between social limitations and LS improvement using multivariate logistic and segmented regression analyses. Results: The late-pandemic group exhibited the lowest LS improvement rate (50.6%) and the highest prevalence of postoperative social contact limitations (61.0%). Multivariate analysis identified the absence of postoperative social contact limitation as a highly potent independent predictor of LS improvement (odds ratio, 10.01; 95% confidence interval, 5.40–19.34; p<0.01). Segmented regression analysis revealed a time lag: social contact limitations peaked in March 2020, whereas the decline in LS improvement rates began in October 2020. Conclusion Prolonged social restrictions negatively impacted functional recovery, particularly during the late phase of the pandemic. Social participation, specifically direct social contact, could be a critical and independent component of postoperative rehabilitation. These findings underscore the need to integrate psychosocial assessments into standard postoperative care to optimize patient outcomes.

Objective: To examine back muscle activity and fatigue behavior in female patients with degenerative thoracolumbar kyphosis (DTK) using high-density surface electromyography (HDSEMG) and evaluate the effects of using a soft spinal orthosis. Methods: Seven female participants with DTK (mean age: 73.6 years) were assessed during static standing and a weighted holding task with and without a soft spinal orthosis. HDSEMG signals were obtained from the lumbar erector spinae using a 64-electrode array. Time to fatigue (TTF), spatial displacement, and directional consistency of muscle activation were analyzed using the spatial center of activity (SCoA) and circular variance (CV). Results: Orthosis use significantly reduced the sagittal vertical axis and low back pain. TTF was significantly prolonged during the weighted holding task with the orthosis (p=0.012), indicating delayed fatigue onset. SCoA displacement was significantly reduced in both tasks (p<0.001), whereas CV analysis demonstrated improved directional consistency of muscle activation. Conclusion HD-SEMG revealed early fatigue onset and unstable muscle activation patterns in patients with DTK, particularly during load-bearing tasks performed without orthotic support. Orthosis used improved endurance and neuromuscular efficiency by reducing spatial and directional variability in muscle recruitment. These findings underscore the utility of HDSEMG for elucidating the neuromuscular pathophysiology of DTK and support the use of spinal orthoses as a conservative treatment approach.

A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.

Methods: The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment. Results: Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4). Conclusions Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.

Purpose: Patients with head and neck cancer (HNC) who undergo dental procedures during radiotherapy (RT) face an increased risk of developing osteoradionecrosis (ORN). Accordingly, new tools must be developed to extract critical information regarding the dose delivered to the teeth and mandible. This article proposes a novel approach for visualizing 3-dimensional planned dose distributions on panoramic reconstruction computed tomography (pCT) images. Materials and Methods: Four patients with HNC who underwent volumetric modulated arc therapy were included. One patient experienced ORN and required the extraction of teeth after RT. In the study approach, the dental arch curve (DAC) was defined using an open-source platform. Subsequently, pCT images and dose distributions were generated based on the new coordinate system. All teeth and mandibles were delineated on both the original CT and pCT images. To evaluate the consistency of dose metrics, the Mann-Whitney U test and Student t-test were employed. Results: A total of 61 teeth and 4 mandibles were evaluated. The correlation coefficient between the 2 methods was 0.999, and no statistically significant difference was observed (P>0.05). This method facilitated a straightforward and intuitive understanding of the delivered dose. In 1 patient, ORN corresponded to the region of the root and the gum receiving a high dosage (approximately 70 Gy). Conclusion The proposed method particularly benefits dentists involved in the management of patients with HNC. It enables the visualization of a 3-dimensional dose distribution in the teeth and mandible on pCT, enhancing the understanding of the dose delivered during RT.

Background: The anti-programmed death 1 (PD-1) antibody has led to durable clinical responses in a wide variety of human tumors. We have previously developed the caninized anti-canine PD-1 antibody (ca-4F12-E6) and evaluated its therapeutic properties in dogs with advance-staged oral malignant melanoma (OMM), however, their therapeutic effects on other types of canine tumors remain unclear. Objective: The present clinical study was carried out to evaluate the safety profile and clinical efficacy of ca-4F12-E6 in dogs with advanced solid tumors except for OMM. Methods: Thirty-eight dogs with non-OMM solid tumors were enrolled prospectively and treated with ca-4F12-E6 at 3 mg/kg every 2 weeks of each 10-week treatment cycle. Adverse events (AEs) and treatment efficacy were graded based on the criteria established by the Veterinary Cooperative Oncology Group. Results: One dog was withdrawn, and thirty-seven dogs were evaluated for the safety and efficacy of ca-4F12-E6. Treatment-related AEs of any grade occurred in 13 out of 37 cases (35.1%).Two dogs with sterile nodular panniculitis and one with myasthenia gravis and hypothyroidism were suspected of immune-related AEs. In 30 out of 37 dogs that had target tumor lesions, the overall response and clinical benefit rates were 6.9% and 27.6%, respectively. The median progression-free survival and overall survival time were 70 days and 215 days, respectively. Conclusions The present study demonstrated that ca-4F12-E6 was well-tolerated in nonOMM dogs, with a small number of cases showing objective responses. This provides evidence supporting large-scale clinical trials of anti-PD-1 antibody therapy in dogs.

A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.

A 38-year-old female with systemic lupus erythematosus (SLE) initiated belimumab treatment. One month later, she presented with a reddish painful swelling on her right lower leg.She was treated with ceftriaxone and vancomycin. However, novel erythematous papules and indurated nodules appeared on both her lower legs. Skin biopsy revealed microabscess formation with mixed cell granuloma surrounded by inflammatory cell infiltration within the dermis with subcutaneous fat tissue. A large number of acid-fast bacilli were observed with Ziehl–Neelsen staining. DNA sequencing of both the hsp65 and the 16S rRNA sequences showed a 100% match with the corresponding region of Mycobacterium haemophilum. Mycobacterial culture revealed satellite growth enhancement on Middlebrook 7H11 agar plates around a paper strip containing hemin. She was treated with levofloxacin, rifabutin, and ethambutol. Within 13 months, her cutaneous lesions improved markedly without any side effects. The B cell-targeted biologic belimumab, a fully humanized IgG1γ monoclonal antibody that inactivates B lymphocyte stimulator, has been considered to be beneficial for active SLE. However, this therapy could increase the risk for the development of biologic therapy-associated mycobacterial infections, both tuberculosis and nontuberculous mycobacteria infections.

Purpose: Patients with hematological malignancies are at an increased risk of severe infection with coronavirus disease 2019 (COVID-19). However, developing an adequate immune response after vaccination is difficult, especially in patients with lymphoid neoplasms. Since the long-term effects of the BNT162b2 vaccine are unclear, the humoral immune response 5 months after the two vaccinations in patients with hematological disorders was analyzed. Materials and Methods: Samples were collected from 96 patients vaccinated twice with BNT162b2 and treated with at least one line of an antitumor or immunosuppressive drug in our hospital from November 2021 to February 2022. Serum anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) spike (S) antibody titers were analyzed. Patients were age- and sex-matched using propensity matching and compared with a healthy control group. Patients with serum anti-SARS-CoV-2 S antibodies were defined as ‘responder’ if >50 U/mL. The patients had B-cell non-Hodgkin lymphoma (B-NHL), multiple myeloma, chronic myeloid leukemia, etc. Results: Patients had significantly low antibody levels (median, 55.3 U/mL vs. 809.8 U/mL; p<0.001) and a significantly low response rate (p<0.001). Multivariate analysis showed that patients with B-NHL, aged >72 years, were associated with a low response to vaccination. There were no significant differences between patients with chronic myeloid leukemia and healthy controls. Conclusion Our study shows that patients with hematological disorders are at risk of developing severe COVID-19 infections because of low responsiveness to vaccination. Moreover, the rate of antibody positivity differed between the disease groups. Further studies are warranted to determine an appropriate preventive method for these patients, especially those with B-NHL.

Methods: This study included 50 patients with CSM and 39 with C-OPLL who underwent multi-segment laminoplasty. Decreased CL was defined as the difference between preoperative and 2-year postoperative neutral C2–7 Cobb angles. Radiographic parameters included preoperative neutral C2–7 Cobb angles, C2–7 sagittal vertical axis (SVA), T1 slope (T1S), dynamic extension reserve (DER), and range of motion. The radiographic risk factors were investigated for decreased CL in CSM and C-OPLL. Additionally, the Japanese Orthopedic Association (JOA) score was assessed preoperatively and 2 years postoperatively. Results: C2–7 SVA (p =0.018) and DER (p =0.002) were significantly correlated with decreased CL in CSM, while C2–7 Cobb angle (p =0.012) and C2–7 SVA (p =0.028) were correlated with decreased CL in C-OPLL. Multiple linear regression analysis revealed that greater C2–7 SVA (B =0.22, p =0.026) and small DER (B =−0.53, p =0.002) were significantly associated with decreased CL in CSM. By contrast, greater C2–7 SVA (B =0.36, p =0.031) was significantly associated with decreased CL in C-OPLL. The JOA score significantly improved in both CSM and C-OPLL (p <0.001). Conclusions C2–7 SVA was associated with a postoperative decreased CL in both CSM and C-OPLL, but DER was only associated with decreased CL in CSM. Risk factors for decreased CL slightly differed depending on the etiology of the condition.