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 45-year-old man with no history developed pain and paralysis in his left lower extremity. When he visited his previous physician, CT was performed, which showed Stanford type A aortic dissection with an aberrant right subclavian artery and Kommerell's diverticulum and narrowing of the true lumen of the left common iliac artery. He was accompanied by lower limb symptoms. He was then rushed to our hospital for emergency surgery. The operation was planned and performed in two stages. A median sternotomy was conducted, and cardiopulmonary bypass using the right common femoral artery, left axillary artery, and right atrium was initiated. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion were performed. The tear's entry was located in the distal arch of the aorta. The aortic arch was transected between the left common carotid and left subclavian arteries. We inserted an open stent graft to cover the diverticulated origin of the right subclavian artery. The left subclavian artery was reconstructed using a fenestration technique. The ascending aorta, aortic arch, and right and left common carotid arteries were reconstructed using a 4-branch prosthesis graft. The right subclavian artery was reconstructed through the thoracic cavity. On the day after the surgery, we performed percutaneous embolization of the right subclavian artery distal to the Kommerell's diverticulum. Postoperative CT showed no endoleakage or blood flow to the Kommerell's diverticulum. The patient's postoperative course was uneventful.

Introduction: Patients with vertebral compression fractures are likely to decrease physical function and activities of daily living (ADL) due to pain and inactivity. In this study, we examined the effect of the amount of rehabilitation provided on functional prognosis in patients with vertebral compression fracture.Methods: We included 18,174 vertebral compression fracture patients aged 65 years or older in the JMDC multicenter data. Barthel index (BI) gains, BI efficiency, ADL independence at discharge (BI≧95), and discharge home were compared between patients who received an average of at least 1 unit of rehabilitation during hospitalization (high-provider group) and those who received less than 1 unit per day (low-provider group).Results: There were 4,145 patients in the high-provider group and 14,029 in the low-provider group. The high-provider group had higher BI gain and BI efficiency, as well as a higher percentage of patients with independent ADLs at discharge (41.6%) and a higher percentage of patients discharged home (79.2%). In multiple regression analysis, the high-provider group had higher BI gain (regression coefficient: 2.423) and BI efficiency (regression coefficient: 0.043). Multiple logistic regression analysis showed that the high-provider group had a higher rate of discharge home (odds ratio: 1.26) and a higher rate of ADL independence at discharge (odds ratio: 1.17).Conclusion: In patients with vertebral compression fractures, the amount of rehabilitation provision may have an impact on functional prognosis.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease causing dyspnea on exertion, exercise intolerance, decline in quality of life, and physical inactivity. The patient is a 78-year-old male. He complained of quadriplegia and was diagnosed with a C7/Th1 cervical epidural abscess. After treatment with antibiotics, he was transferred to our hospital. He had tetraplegia, which corresponded to the ASIA impairment scale D, and his Functional Independence Measure (FIM) motor score was 35 points. In addition, he had severe COPD; the Medical Research Council (MRC) dyspnea scale was grade 5, and the COPD assessment test (CAT) score was 26 points. He complained of dyspnea on exertion with low intensity movements. Despite rehabilitation, improvement in ADL and physical function was poor, his FIM motor score was 43 points and the Berg balance scale (BBS) score was 21 points at the 30th day. Therefore, we started assist use of a short-acting β2 agonist (SABA) before rehabilitation on the 33rd day, and his dyspnea on exertion, physical activity, and respiratory dysfunction improved. On the 83rd day, the improvement was as follows: the MRC dyspnea scale was grade 4, the CAT score was 18 points, his 6-minute walk distance was 110 m, and his BBS score was 40 points. He was weaned from continuous oxygen therapy and discharged on day 112, at which time his FIM motor score was 69 points. We considered that the assist use of SABA before rehabilitation improved his respiratory status and physical activity without worsening his respiratory function or limb muscle weakness due to dyspnea and quadriplegia.

Introduction: Patients with vertebral compression fractures are likely to decrease physical function and activities of daily living (ADL) due to pain and inactivity. In this study, we examined the effect of the amount of rehabilitation provided on functional prognosis in patients with vertebral compression fracture.Methods: We included 18,174 vertebral compression fracture patients aged 65 years or older in the JMDC multicenter data. Barthel index (BI) gains, BI efficiency, ADL independence at discharge (BI≧95), and discharge home were compared between patients who received an average of at least 1 unit of rehabilitation during hospitalization (high-provider group) and those who received less than 1 unit per day (low-provider group).Results: There were 4,145 patients in the high-provider group and 14,029 in the low-provider group. The high-provider group had higher BI gain and BI efficiency, as well as a higher percentage of patients with independent ADLs at discharge (41.6%) and a higher percentage of patients discharged home (79.2%). In multiple regression analysis, the high-provider group had higher BI gain (regression coefficient: 2.423)and BI efficiency (regression coefficient: 0.043). Multiple logistic regression analysis showed that the high-provider group had a higher rate of discharge home (odds ratio:1.26) and a higher rate of ADL independence at discharge (odds ratio: 1.17).Conclusion: In patients with vertebral compression fractures, the amount of rehabilitation provision may have an impact on functional prognosis.

Bilateral shoulder joint disorders caused by rheumatoid arthritis significantly impair daily functioning owing to a lack of contralateral compensation. In Japan, reverse shoulder joint prostheses were approved in 2014. This was expected to improve the surgical outcomes of rheumatoid shoulder arthroplasty. We report two patients with rheumatoid arthritis who underwent bilateral reverse shoulder arthroplasty. This study aims to evaluate their postoperative clinical outcomes and activities of daily living. The patients were women in their 70s with stage III class 2 rheumatoid arthritis. Their treatment and postoperative activities of daily living were retrospectively reviewed. The first patient underwent the inlay type and experienced a residual limitation of external rotation postoperatively; therefore, she was restricted to dress with front-open clothes. However, she was able to undress after the lining of the garment was changed to a slippery material. The second patient underwent the onlay type and showed almost no limitations in postoperative activities of daily living. She was able to undress with an external rotation of 40–50°. Bilateral reverse shoulder arthroplasty improved range of motion, the Japanese Orthopaedic Association shoulder score, and functional outcomes. Only a few difficulties were encountered in the activities of daily living.

A certain period of time has passed since the transition to the General Medicine residency system under the Japanese Medical Specialty Board and Family Medicine specialist training system by the Japan Primary Care Association. We have summarized the needs of residents identified in the survey, and detailed the activities to date and prospects of the Japanese Association of Family Physician Trainees, a self-help support organization, which is an official subcommittee of the Japan Primary Care Association, from the viewpoint of the residents. We believe that this paper will serve as a resource for the training of residents, help guide them under the new system, and help to improve the training system, considering evidence suggesting that information may not be reaching residents who need support.

Objectives: This study aimed to determine the relationship between the number of board-certified physiatrists and the amount of inpatient rehabilitation delivered.Materials and Methods: We analyzed open data from 2017 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan and compared the volume of inpatient rehabilitation services between prefectures to examine regional disparities. We also examined the relationship between the volume of rehabilitation services provided and the number of board-certified physiatrists.Results: The population-adjusted number of inpatient rehabilitation units per prefecture ranged from a maximum of 659,951 to a minimum of 172,097, a disparity of 3.8-fold. The population-adjusted number of board-certified physiatrists was 4.8 in the highest region and 0.8 in the lowest region, a disparity of 5.8-fold. The population-adjusted number of board-certified physiatrists was significantly correlated with the population-adjusted total number of inpatient rehabilitation units (r=0.600, P<0.001). Correlations were between the number of board-certified physiatrists and the number of rehabilitation units in cerebrovascular and orthopedic services, but not in cardiovascular, respiratory, or oncology services.Conclusion: Large regional disparities manifested in the amount of inpatient rehabilitation provided in Japan. An association was found between the number of board-certified physiatrists and rehabilitation units delivered. It may be necessary to train more BCPs in regions with fewer units to eliminate these disparities.

BACKGROUND: Ballooned hepatocytes (BH) are a key histological hallmark of nonalcoholic steatohepatitis (NASH), yet their consequences for liver-specific functions are unknown. METHODS: In our previous study, an experimental model of human induced-BHs (iBH) has been successfully developed based on cell sheet technology. This study aimed to determine the functions of iBHs in the primary human hepatocyte/ normal human dermal fibroblast (PHH/NHDF) co-culture cell sheets. Normal hepatocytes in the PHH/3T3-J2 co-culture cell sheets were set as a control, since 3T3-J2 murine embryonic fibroblasts have exhibited previously long term maintenance of PHH functions. RESULTS: It was found that, albumin secretion was not affected in iBHs, but urea synthesis as well as cytochrome P450 enzyme (CYP) activities including CYP1A2 and CYP3A4, were significantly reduced in iBHs. Besides, loss of bile canaliculi was observed in iBHs. These findings are consistent with clinical studies of human NASH. In addition, PHH/ NHDF cell sheets demonstrated two fold higher TGF-b1 secretion compared with PHH/3T3-J2 cell sheets. Furthermore, treatment with a TGF-b inhibitor and a semi-synthetic bile acid analogue (obeticholic acid, phase 3 trial of NASH therapy) ameliorated the histological appearance of established iBHs. CONCLUSION In summary, this study demonstrates the priority of iBHs in recapitulating not only histology but also clinically relevant hepatic dysfunctions in human NASH and suggests TGF-b and bile acid related signal pathway may play important roles in the formation of iBHs.