This study aimed to characterize physical function and functional capacity related to low muscle mass and sarcopenia in older women with low bone mass. In the study, 122 older women with bone loss were included and divided into three groups according to the presence or absence of muscle loss and sarcopenia; bone loss only, bone loss and muscle loss, and bone loss and sarcopenia groups. Multinomial logistic regression analysis was conducted using the three groups as dependent variables. Body mass index (BMI) (odds ratio; 0.566, 95% confidence interval; 0.431-0.742), Kihon checklist of “motor function” (odds ratio; 2.230, 95% confidence interval; 1.179-4.217), and “homebound” (odds ratio; 5.123, 95% confidence interval; 1.122-23.391) were extracted as relevant factors in the bone loss and sarcopenia group. In addition to low BMI, sarcopenia in older women with reduced bone mass is associated with lower “motor function” and “homebound” functional capacity.

This study aimed to determine whether the distance between the medial epicondyles of the femur is useful as a screening test for varus knee. The participants were 53 community-dwelling older adults. First, a receiver operating characteristic (ROC) curve analysis was performed to obtain the cutoff value for the distance between the medial epicondyles of the femur. The cutoff values and femorotibial angle (FTA) were used to compare body composition and physical function between the groups. The cutoff value for the distance between the medial epicondyles of the femur was 2.75 cm. The intergroup comparison based on the FTA revealed significant differences in lower-limb muscle mass, grip strength, and quadriceps muscle strength. The results of the cutoff value-based comparison showed significant differences in skeletal and lower-limb muscle mass, grip strength, and quadriceps muscle strength, all of which were consistent with each other. Measuring the distance between the medial epicondyles of the femur is a useful screening test for varus knees in community-dwelling older adults.

Striking advances in systemic therapy for unresectable advanced hepatocellular carcinoma (HCC) have improved the average prognosis of patients with HCC. As a result, the guidelines for the treatment of HCC have changed significantly. However, various issues have emerged in clinical practice. First, there is no established biomarker that can predict response to systemic therapy. Second, there is no established treatment regimen after primary systemic therapy, including combined immunotherapy. Third, there is no established treatment regimen for intermediate-stage HCC. These points make the current guidelines ambiguous. In this review, we present the Japanese guidelines for the diagnosis and treatment of HCC based on the latest evidence; introduce various efforts mainly in Japanese real-life practice to update these guidelines; and present our perspectives on future guidelines.

Purpose: In this study, we performed a longitudinal examination of the occurrence of homeboundness among community-dwelling elderly individuals and changes in associated factors, including the sense of coherence (SOC).Methods: A questionnaire survey was conducted targeting community-dwelling elderly individuals to evaluate homebound status, a basic checklist (CL), and SOC. Among these individuals, frail elderly people who maintained a non-homebound state were extracted and a follow-up survey was carried out one year later. Those who maintained the non-homebound state one year later were classified into the maintenance group and those who became socially withdrawn were classified into the transition group. Factors predicting the homebound state one year later were examined using multiple logistic regression analysis. Furthermore, the changes in CL and SOC between the transition and maintenance groups were compared.Results: In the transition group, motor function, cognitive function, and sense of manageability on the initial survey were significantly lower than those in the maintenance group. Significant correlations were noted in the homebound transition group with lack of money management (OR: 3.04, 95% CI: 1.19-7.82) and a declined sense of manageability (OR: 0.82, 95% CI: 0.69-0.99). Depression and the sense of manageability had also significantly deteriorated one year later compared with those in the maintenance group.Conclusion: This study suggests that individuals who transition to a state of homeboundness have a slightly lower SOC than those who maintain their non-homebound status.

Persistent massive air leak after pediatric cardiac surgery is a rare and possibly life-threatening complication which is difficult to treat. We report a 3-month-old boy with hypoplastic left heart syndrome that underwent Glenn take-down, suffered from pulmonary hemorrhage during surgery and needed mechanical ventilation with high airway pressure that caused bilateral pneumothorax. After pulmonary hemorrhage improved, pneumothorax with persistent air leaks did not resolve under prolonged chest tubes. This patient underwent an autologous “blood patch” pleurodesis on postoperative day 32. The procedure was repeated a second time 48 h after the application of the first blood patch. After these procedures, air leaks dramatically ceased. The patient was successfully weaned from the ventilator on postoperative day 70. Pleurodesis with an autologous blood patch is a safe and an effective technique for the treatment of persistent air leaks, even for a 3-month-old boy with hypoplastic left heart syndrome.

This study examined the relationship between riding posture and muscle activities during passive exercise on horseback-riding simulation equipment. The effects of passive training on the prototypes were also determined. Three prototypes with tilted seat (A110, A130, and A140) were developed with an attempt to change the angle between trunk and leg to 110, 130, and 140 degrees, respectively. Twelve female aged 42.7±2.3 years performed passive exercise on the three prototypes and isometric maximal voluntary contraction (MVC) tests. Electromyogram of nine muscles in the trunk and lower limb were recorded. On A110, back muscle showed the largest activity (22%MVC ; p<0.01 ; repeated measures ANOVA). Contrastingly on A140, abdominal muscle and knee extensor showed the largest activity (40%MVC and 26%MVC ; p<0.01). Passive training on the prototypes for 30 minutes/day, 4 times/week, 8 weeks produced enhancement of muscle strength in trunk and hip. Riding posture is an effective factor to control physical effects without increasing the velocity on horseback-riding simulation equipment.

[Objective] In this study, the pain of receiving acupuncture was evaluated with or without individual finger stalls.
[Design] In a randomized, subject- and operating person-blind, controlled study.
[Methods] Sixteen acupuncturists and same number of normal volunteers participated in this study. Two needles were inserted into each side of the lumbar muscles. The trials were carried out twice using finger stalls and with bare fingers. These trials were performed in random order. Right after the insertion of needles and at the beginning of electrical stimulation, the subjects were asked to answer a questionnaire about the severity and quality of pain on receiving acupuncture. Durations of procedures were measured. We asked the acupuncturists whether they felt any difficulty in performing acupuncture using finger stalls.
[Result] The majority of acupuncturists reported that using the finger stalls during treatment was inconvenient. Although the severity of pain of acupuncture did not significantly differ between that with and that without finger stalls, the average value was slightly higher with finger stalls. The qualities of pain on receiving acupuncture did not significantly differ between the two methods, however, the numbers of selected words differed on some items. The subjects could not recognize the use of individual finger stalls. The use of finger stalls did not influence the duration of the procedure.
[Conclusion] In this study, the qualities of pain on receiving acupuncture did not significantly differ between that with and that without finger stalls. The subjects could not recognize the use of individual finger stalls.

Bell's palsy, most frequently occurring in peripheral facial paralysis, is a well-recoverable disease showing spontaneous healing in 70% of patients. This chronic patient of Bell's palsy has persisted for more than two years. Many medical institutes have diagnosed that it was very difficult to remedy completely. The rating score was 24 (full score : 40 points), having sequelae of synkinesis, facial spasm, crocodile tears and other problems. By thermography, the temperature difference between the normal side and the paralyzed side was 0.9°C, and the paralyzed side's temperature was lower. To improve microcirculation on the paralyzed side, electro-acupuncture treatment has been applied to the facial nerve and facial expression muscles.
After evaluating mainly the score for facial paralysis and thermography, the score was increased with disappearance of the temperature difference between the normal side and the paralyzed side. Subjectively, it also became easier to move facial expression muscles, and the phenomenon of crocodile tears was decreased. Long-term electro-acupuncture treatment is considered to be effective for improving the microcirculation and enhancing the QOL of the patient.

Meige syndrome is a disease which is characterized by blepharospasm. We report thefavorable effects of Electro-acupuncture therapy (EAT) on a patient with Meige syndrome.
This patient, a 56-year-old female, received standard medical treatments for 3 months, however the treatementsdid not relieve her from the distress of blepharospasm.
After three months, EAT treatments was included. EAT was applied to the orbicularis ocule muscles and thefacial nerves. The treatment indexes of both the average number of blinks and the Jankovic score were improvedafter EAT, though there had been no changes in the indexes in the first three months without the additional EATtreatment.
The results suggest that EAT is an effective treatment for Meige syndrome.