Tracheal tube cuff damage usually requires tube replacement; however, in patients with a difficult airway, tube exchange can pose significant risks. We report a case in which cuff damage was successfully managed using an automatic cuff pressure controller. 　The patient was a man in his 70s who was scheduled for posterior decompression and fusion for cervical spondylotic myelopathy while wearing an external spinal fixation device. Awake nasotracheal intubation was performed using a flexible bronchoscope, during which cuff damage was identified. The tracheal tube was exchanged with a Tube Exchanger® but cuff damage recurred, requiring a second exchange using the same method. Although no cuff leak was observed immediately afterward, a gradual decrease in tidal volume developed after repositioning the patient to the prone position. Because the cuff leak was relatively minor, an automatic cuff pressure controller was connected, which maintained tidal volume without further decreases and allowed completion of the surgery. In situations where tube exchange carries high risk, an automatic cuff pressure controller may serve as a temporary rescue measure for cuff damage. The cause of cuff damage in this case was considered to be a nasal septal spur combined with the relatively large tube size.

Deep neck abscess can cause upper airway stenosis and obstruction, and sometimes emergency airway management is required. Here we present a case of deep neck abscess in which awake intubation with a video laryngoscope (McGRATH™ MAC) was more useful than with flexible bronchoscope. A man in his 80s was transported to our hospital with throat and chest pain. Contrast-enhanced computed tomography revealed a deep neck abscess (right peritonsillar abscess). The otolaryngologist attempted drainage by puncture, but this was ineffective. There was a risk of upper airway obstruction, and emergency airway management was required. First, we attempted endotracheal intubation with a flexible bronchoscope but could not secure the field of view because of the upper airway edema and stenosis. Next, we attempted tracheal intubation using a video laryngoscope, which ultimately was successful. The blade of the video laryngoscope compressed and lifted the soft tissue and then it secured the space of the upper airway.

Background: The Quality of Recovery-15 (QoR-15) and 12-item World Health Organization Disability Assessment Schedule 2.0 scales are post-surgery patient-reported outcome measures. We aimed to evaluate the association between immediate in-hospital postoperative recovery and mid-term disability-free survival (DFS) after discharge. Methods: We conducted a prospective observational study at a university hospital and enrolled 260 patients aged ≥ 65 years with cancer who were undergoing elective major abdominal surgery. The association between poor postoperative recovery, defined as a QoR-15 score < 90 on postoperative day (POD) 2, and the DFS three months later was assessed using Fisher’s exact test. The odds ratio of poor recovery on POD 2 to DFS was calculated using multiple logistic regression analysis adjusted for prominent factors (age, preoperative frailty, preoperative DFS, surgical duration, and intraoperative blood loss volume). Results: A total of 230 patients completed the 3-month follow-up. On POD 2, 27.3% of the patients (63/230) had poor recovery. A greater number of patients without poor recovery on POD 2 had DFS at three months after surgery (79.6%) than those with poor recovery (65.1%) (P = 0.026). The adjusted odds ratio of poor recovery on POD 2 to DFS at three months was 0.481 (95% CI [0.233, 0.994]). Conclusions Patients with poor recovery on POD 2 were less likely to have DFS three months after abdominal surgery. These findings may allow for early and effective interventions to be initiated based on each patient’s condition after abdominal surgery.

The importance of off the job training in surgical education are widely recognized. The Japanese Board of Cardiovascular Surgery has required a board candidate to do at least 30 hours of off the job training from 2017. U-40 Basic Lecture Course are held annually for young cardiovascular surgeon to learn about basic surgical skills. U-40 Advanced Lecture Course was started to provide opportunity to have more advanced hands-on lecture for young cardiovascular surgeon. However, after the COVID-19 pandemic, the opportunity to hold hands-on seminars are highly limited. In such circumstances, we held a hybrid hands-on seminar. We report details about the hybrid hands-on seminar.

This study was carried out in order to compare stride time (gait) variability of walking not only between young and older adults, but also between “fallers” and “non-fallers”. Moreover, this study aimed to clarify the relationship between stride time variability, balance ability, muscular strength and fall experience. The subjects were 12 young women aged 21.2±2.2 years (young group) and 27 older women aged 66.6±4.4 years (older group). The older group included 14 fallers and 13 non-fallers. They wore an accelerometer on their back and walked at a slow, preferred or fast pace. The time of heel contact was detected by acceleration waveform, and stride time was estimated. The stride time variability was computed by the coefficient of variance (CV) of stride time. The subjects underwent balance tests and muscular strength tests. The CV of stride time at the preferred and fast pace were significantly larger in the older group than in the young group, even though there was no difference in any of the gait speeds between the two. The CV of stride time was significantly larger in fallers than in non-fallers at the fast pace. Path analysis showed that fall experience was affected by an increase in the CV of stride time and decreased balance ability, but less affected by decreased muscular strength. Therefore, this study suggested that stride time variability when walking fast is useful as an early assessment of fall risk in middle-aged and elderly people and that fall experience was affected by stride time variability and balance ability.

This study was to investigate the effects of balance exercises on among static, dynamic and reactive balance ability in community-dwelling older women. Participants comprised 26 community-dwelling older women in Japan, randomized for age and gait speed to the exercise group (n=13) or the control group (n=13). The exercise group performed structured balancing exercises on the sponge and the G ball, once weekly for 24 weeks. The control group performed stretching exercises once per month. Static balance ability was assessed by measuring postural sway and standing on one leg; dynamic balance ability was assessed by measuring functional reach, timed up and go, and gait; and reactive balance ability was assessed using the EquiTest. We also measured knee and ankle strength using an isokinetic machine.At baseline, the two groups were well matched in physical characteristics and in all balance ability and strength tests. After 24 weeks, step length of preferred speed walking (p=0.049) only improved, and peak torque of knee flexion (p=0.050) tended to improve in the exercise group. Any correlations were not found between step length of preferred speed walking and knee flexion strength.These results suggest that these structured balance exercises are effective in improving dynamic, but not static or reactive balance ability. Improvements in dynamic balance ability were not dependent on improved muscle strength.

The aim of this study was to compare co-contraction of ankle muscles between older and young adults performing a voluntary sway task, and identify any relationships between co-contraction, balance ability and muscular strength. The task involved displacement of the center of mass backwards and forwards continually during upright stance under three amplitude conditions, large, small and preferred, with sway speeds of slow, medium and fast. The participants comprised 17 older (64.1±2.9 years) and 14 young (21.3±3.3 years) women. Electromyographic recordings were obtained from the tibialis anterior and the medial gastrocnemius muscles during task performance to calculate the co-contraction index (CCI) and evaluate the relative level of co-contraction of antagonist muscle. Additional measurements were obtained from balance tests including body sway tests, functional reach, gait tests, and the EquiTest (Neurocom), and also muscular strength of plantar flexion and dorsiflexion. The CCI was highest under large sway amplitude, but did not differ among sway speeds. The CCI was higher in the older group (23%) than in the young group (15%). Multiple regression analysis revealed that the CCI correlated with body sway in the EquiTest and functional reach, and dorsiflexion strength. Therefore, this study suggested that co-contraction of ankle muscles increased with aging and related to not only static and dynamic balance abilities, but also ankle dorsiflexor strength.