Methods: We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2–8), and maxVB (9–18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. Results: Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2–8) group had less A4 and more B1 and B2 fractures. The maxVB (9–18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2–8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9–18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9–18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. Conclusions The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.

Objective：The Clinical Trunk Control Test (CTCT) is used to assess trunk function worldwide, particularly for patients with spinal cord injury (SCI), with good reliability and validity. In Japan, trunk function evaluation methods specialized for patients with SCI are scarce. The aim of the present study was to create a Japanese version of CTCT (CTCT-J) and verify its reliability.Methods：CTCT-J was created using the double-back translation format. The inter-rater reliability was calculated based on the total CTCT-J score and intraclass correlation coefficient (ICC) for each item. The weighted kappa coefficient was calculated for each subtest. To verify internal consistency, Cronbach's alpha coefficient was calculated for the CTCT-J total score and each item.Results：We enrolled 12 patients with SCI, including ten men and two women, with an average age of 51.9 ± 17.8 years. Nine and three patients had cervical and thoracic SCI, respectively. The ICC for inter-rater reliability ranged from 0.995 to 1.000 (p ＜0.05). The weighted kappa coefficient for each subtest ranged from 0.756 to 1.000 (p ＜0.05). In the internal consistency test, the Cronbach's alpha coefficient for all items was 0.995 (p ＜0.05).Conclusion：We created the CTCT-J with double back translation and verified its reliability. Good inter-rater reliability and internal consistency were observed, indicating its applicability in Japan.

Objective：The Clinical Trunk Control Test (CTCT) is used to assess trunk function worldwide, particularly for patients with spinal cord injury (SCI), with good reliability and validity. In Japan, trunk function evaluation methods specialized for patients with SCI are scarce. The aim of the present study was to create a Japanese version of CTCT (CTCT-J) and verify its reliability.Methods：CTCT-J was created using the double-back translation format. The inter-rater reliability was calculated based on the total CTCT-J score and intraclass correlation coefficient (ICC) for each item. The weighted kappa coefficient was calculated for each subtest. To verify internal consistency, Cronbach's alpha coefficient was calculated for the CTCT-J total score and each item.Results：We enrolled 12 patients with SCI, including ten men and two women, with an average age of 51.9 ± 17.8 years. Nine and three patients had cervical and thoracic SCI, respectively. The ICC for inter-rater reliability ranged from 0.995 to 1.000 (p ＜0.05). The weighted kappa coefficient for each subtest ranged from 0.756 to 1.000 (p ＜0.05). In the internal consistency test, the Cronbach's alpha coefficient for all items was 0.995 (p ＜0.05).Conclusion：We created the CTCT-J with double back translation and verified its reliability. Good inter-rater reliability and internal consistency were observed, indicating its applicability in Japan.

Background: Arbekacin (ABK) is an aminoglycoside that exhibits anti-methicillin-resistant Staphylococcus aureus (MRSA) and anti-Pseudomonas aeruginosa activities. Therefore, for patients with febrile neutropenia (FN) and concurrent pneumonia suspected to be caused by MRSA, ABK may be sufficiently effective even as a single agent. Materials and Methods: Patients with hematologic malignancies treated with ABK who met the following criteria were included: 1) fever during neutropenia or functional neutropenia, 2) FN complicated by pneumonia, and 3) possible infection by antimicrobial-resistant Grampositive cocci. Results: This study encompassed 22 episodes involving 19 patients, of which, 15 (68.2%) were successfully treated with ABK. Of the nine episodes showing inadequate response to other anti-MRSA drugs, eight were successfully treated with ABK. Grade 2 or worse adverse events included acute kidney injury (13.6%) and increased transaminase levels (9.1%). Conclusion The present study demonstrated that ABK is effective and safe in patients with FN and concurrent pneumonia caused by antimicrobial-resistant Gram-positive cocci. ABK may also be effective in patients who are unresponsive to other anti-MRSA drugs. Therefore, ABK may be beneficial in the treatment of pneumonia caused by antimicrobial-resistant Gram-positive cocci in patients with FN.

Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has been shown to provide a sustained virologic response (SVR) rate of >97% in patients with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese data. However, a recently published study showed that the treatment was often discontinued in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis. Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of age, the population density of which is high in “rural” regions.Patients and Methods: We conducted a multicenter study to assess the efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in Japan.Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was 97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants, 56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses, respectively. Of 308 patients enrolled, adverse events were observed in 74 patients (24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in any grade and grade ≥3 adverse events between the old-aged group and the rest of the study participants. Only one patient discontinued the treatment because of adverse events.Conclusion: G/P therapy is effective and safe for old-aged patients.

Methods: PLIF using closed-box spacers without filling the autologous bone was performed in 78 (88 levels) consecutive patients. Surgical procedures included PLIF using traditional pedicle screw fixation (PLIF, n=37), PLIF using cortical bone trajectory screw fixation (CBT-PLIF, n=30), and transforaminal lumbar interbody fusion with traditional pedicle screw fixation (TLIF, n=11). Lateral dynamic radiography and computed tomography findings were investigated, and the relationship between the union status and variables that may be related to the risk of non-union was tested statistically. Results: The overall bone union rates at 12 and 24 months were 68.0% and 88.5%, respectively. Incidences of bone cyst formation, subsidence, and retropulsion of spacers were 33.3%, 47.4%, and 14.1%, respectively. Union rates at 24 months were 94.6% in PLIF, 80.0% in CBT-PLIF, and 90.9% in TLIF. Multivariate logistic regression analyses showed that at 12 months postoperatively, the risk factor for non-union was age >75 years (p =0.02). In contrast, no significant risk factor was observed at 24 months. Conclusions These findings demonstrated the efficacy of interbody closed-box spacers for PLIF without the need to fill the spacer with autologous bone. However, the risk of non-union should be considered in elderly patients, especially intra-operatively and during the early postoperative stage.

Constraint-induced movement therapy (CIMT) has been a well-established rehabilitative method for upper limb paralysis in patients post-stroke. In recent years, its application to lower limb paralysis (Lower limb CIMT, L-CIMT) has been reported. However, the reported intensive lower limb trainings do not seem enough to target behavioral modifications in an individual's daily life. In this study, we investigated the effects of L-CIMT including the transfer package to induce behavioral transformation in normal daily life of patients with lower limb paralysis. The L-CIMT including the transfer package was administered to three patients with chronic-phase stroke without any constraint on the healthy lower limb for 3.5 hours a day, 5 days a week for 3 weeks. As a result, standing balance and walking ability were improved immediately and within 6 months after the intervention, respectively. All three cases experienced increased daily opportunities for standing and walking. We believe that L-CIMT including the transfer package can bring both short- and long-term improvements in standing balance and walking ability. This can lead to an increase in the frequency of standing and walking in daily living, along with an expanded range of action in ADL and IADL in patients with chronic-phase stroke.

Constraint-induced movement therapy (CIMT) has been a well-established rehabilitative method for upper limb paralysis in patients post-stroke. In recent years, its application to lower limb paralysis (Lower limb CIMT, L-CIMT) has been reported. However, the reported intensive lower limb trainings do not seem enough to target behavioral modifications in an individual's daily life. In this study, we investigated the effects of L-CIMT including the transfer package to induce behavioral transformation in normal daily life of patients with lower limb paralysis. The L-CIMT including the transfer package was administered to three patients with chronic-phase stroke without any constraint on the healthy lower limb for 3.5 hours a day, 5 days a week for 3 weeks. As a result, standing balance and walking ability were improved immediately and within 6 months after the intervention, respectively. All three cases experienced increased daily opportunities for standing and walking. We believe that L-CIMT including the transfer package can bring both short- and long-term improvements in standing balance and walking ability. This can lead to an increase in the frequency of standing and walking in daily living, along with an expanded range of action in ADL and IADL in patients with chronic-phase stroke.

Recent studies showed that high biocompatibility and reduction of uremic toxin contributed to the improvement of freatment outcome in hemodialysis patients.Therefore, a high-flux membrane dialyzer, especially polysulfone (PS) membrane, was generally used in dialysis. However, it was suggested that the higher efficiency of reduction in uremic toxins might cause an increase in the albumin leakage through the dialyzer membrane during dialysis, resulting in a decrease in serum albumin concentration. In this study, we used two different dialyzer membranes with high biocompatibility, namely, ethylenevinylalcohol (EVAL) membrane and improved PS membrane with a very lower leakage of serum albumin. After using these two types of mambrane of six straight months, we examined the effect of each dialyzer membrane characteristic on the serum total protein and albumin concentration. The reduction rates of each uremic solute and serum total protein concentration were significantly higher. The serum albumin concentration and its rate of change with the passing of time tended to increase in the case of the PS membrane. But in the case of EVAL membrane, these values tended to decrease. These results suggested that the differences in the changes in the serum total protein and albumin concentration might result from the differences in the efficiency of the reduction of uremic toxins. Therefore, it is necessary to consider the usage of the dialyzer membrane with a higher reduction of uremic solutes and a lower leakage of serum albumin to add to the higher biocompatibility specially in hemodialysis patients with hypoproteinemia.
Membranes ; Concentration ; Reduction (chemical) ; Serum Albumin ; Hemodialysis

Attentional disturbance following brain damage is usually evaluated by several neuropsychological tests. In a rehabilitation setting, however, the primary concern is not task performance, but rather functional real-world behavior. To address this requirement, a new assessment system for attentional behavior, BAAD (Behavioral Assessment of Attentional Disturbance), has been developed. This assessment is generally completed by the patient's therapist (occupational therapist, OT) during therapy. The aim of this study was to investigate whether BAAD completed by the family at home (BAAD-FM) yields results that are comparable to BAAD completed by an OT during occupational therapy (BAAD-OT). The subjects were 53 patients with brain damage. BAAD consists of six items thought to be associated with attentional behaviors. Each item is rated (0 to 3) based on the frequency with which the problem behaviors appeared during daily living at home and daily sessions of occupational therapy. The intraclass-correlation coefficient of the total score between BAAD-FM and BAAD-OT was 0.89. The mean (SD) values of the total scores were 3.7 (3.7) and 3.7 (3.6), respectively. Similarly, there were no significant differences in any of the item scores between BAAD-FM and BAAD-OT. The coincidence rate between the two BAAD tests on an item-by-item basis was over 64% for all items but one (43%). In conclusion, the total BAAD-FM score seemed comparable to the total BAAD-OT score and valuable for detecting attentional disturbance.