The immune-stromal cell interactions play a key role in health and diseases.In periodontitis,the most prevalent infectious disease in humans,immune cells accumulate in the oral mucosa and promote bone destruction by inducing receptor activator of nuclear factor-κB ligand(RANKL)expression in osteogenic cells such as osteoblasts and periodontal ligament cells.However,the detailed mechanism underlying immune-bone cell interactions in periodontitis is not fully understood.Here,we performed single-cell RNA-sequencing analysis on mouse periodontal lesions and showed that neutrophil-osteogenic cell crosstalk is involved in periodontitis-induced bone loss.The periodontal lesions displayed marked infiltration of neutrophils,and in silico analyses suggested that the neutrophils interacted with osteogenic cells through cytokine production.Among the cytokines expressed in the periodontal neutrophils,oncostatin M(OSM)potently induced RANKL expression in the primary osteoblasts,and deletion of the OSM receptor in osteogenic cells significantly ameliorated periodontitis-induced bone loss.Epigenomic data analyses identified the OSM-regulated RANKL enhancer region in osteogenic cells,and mice lacking this enhancer showed decreased periodontal bone loss while maintaining physiological bone metabolism.These findings shed light on the role of neutrophils in bone regulation during bacterial infection,highlighting the novel mechanism underlying osteoimmune crosstalk.

The patient was a 66-year-old man who presented to our hospital with intermittent abdominal pain. Abdominal ultrasound showed a mass presenting as a target sign in the right abdomen, suggesting intussusception. Subsequent computed tomography (CT) and lower gastrointestinal endoscopy revealed a 5 cm lipoma in the ascending colon. The intussusception had resolved spontaneously, so the patient was followed up on an outpatient basis. Although endoscopic treatment was considered for the lipoma, due to its large size, the patient was referred to our department for surgery 1 month later. A follow-up CT scan revealed a recurrence of the intussusception. Because the patient tolerated oral intake, had normal bowel movements without symptoms of bowel obstruction, and experienced only mild abdominal pain, conservative outpatient observation was continued until laparoscopic-assisted ileocecal resection was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 8 without any complications. Colonic lipoma causing intussusception is relatively rare. Since lipoma is a benign disease, it is a good candidate for laparoscopic surgery, which offers excellent cosmetic outcomes and rapid postoperative recovery. Even in cases with intussusception, when there is no bowel obstruction and the abdominal pain is mild, elective surgery within 1-3 months can be considered a viable option.

Metronidazole is an effective antibacterial agent against anaerobic bacteria, and its use in the gastrointestinal field, particularly in patients with intra-abdominal infections, has increased with the availability of injectable formulations. However, a known side effect of metronidazole is central nervous system impairment, namely, metronidazole-induced encephalopathy. Here, we present a case of a 68-year-old man who underwent laparoscopic abdominoperineal resection for rectal cancer in March of year X. Postoperatively, metronidazole was administered for pelvic dead space infection and perineal wound infection, and the patient continued the oral medication after discharge. In May of year X, the patient was referred to our institution near his home for postoperative adjuvant chemotherapy. In February of year X+1, the patient developed dysarthria, and a FLAIR (fluid-attenuated inversion recovery) image on head magnetic resonance imaging revealed bilaterally symmetric hyperintense lesions in the dentate nuclei of the cerebellum. Suspecting metronidazole-induced encephalopathy based on the medication history, metronidazole was discontinued, leading to symptom improvement within approximately 3 days. We diagnosed metronidazole-induced encephalopathy based on the imaging findings and clinical observations. When using metronidazole, we should pay attention to the dosage and duration of administration and make efforts to detect side effects early.

Splenic rupture can be divided into traumatic and atraumatic forms. Causes of atraumatic splenic rupture include hematologic disease, malignancy, and infection, all of which are extremely rare. An 80-year-old man complaining of left upper abdominal pain was referred to our hospital for further examination and treatment. On arrival, his vital signs were stable, but contrastenhanced computed tomography showed a discontinuity of the splenic membrane and fluid accumulation in the perisplenic area and pelvic floor, suggestive of a hematoma. There was no history of trauma, and suspecting atraumatic splenic rupture, we performed an emergency splenectomy. The patient had a good postoperative course and was discharged on postoperative day 11. He had no previous hematologic disease, and there were no clinical findings suspicious of viral infection. Pathological diagnosis was also negative for malignancy, and idiopathic splenic rupture was diagnosed. We describe here this case of splenectomy for spontaneous splenic rupture.

Objective: This study aimed to clarify the details of inpatient cancer rehabilitation interventions provided by designated cancer hospitals in Japan. Methods: This questionnaire-based survey asked specialists regarding the outline of their facilities’ inpatient cancer rehabilitation, Dietz classification, disease, and intervention details. Results: Restorative interventions were the most common, and the most common cancer was lung cancer followed by colorectal cancer; hematologic malignancy; gastric cancer; and liver, gallbladder, and pancreatic cancer. Intervention proportions for colorectal and gastric cancer were significantly higher in general hospitals than in university hospitals and cancer centers; in contrast, those for hematological malignancy were significantly higher in university hospitals than in general hospitals. For bone and soft tissue sarcomas, intervention proportions in cancer centers were significantly higher than those in university and general hospitals; and for oral, pharyngeal, and laryngeal cancers, they were significantly higher in university hospitals and cancer centers than in general hospitals. The most common intervention was walking training, followed by resistance training, basic motor training, activities of daily living training, and respiratory rehabilitation. Respiratory rehabilitation was performed significantly more frequently in university and general hospitals than in cancer centers.Conclusion: The diseases had differed according to the characteristics of the facilities, and the interventions were considered accordingly. In future, it will be necessary to verify the effectiveness of inpatient cancer rehabilitation according to facility characteristics and to disseminate information on inpatient cancer rehabilitation.

The patient was a 75-year-old man with advanced rectal cancer underwent abdominoperineal resection and lymph node dissection as conversion surgery after chemotherapy. Intraoperatively, lateral lymph node metastasis was evident in internal iliac vasculature and was deemed unresectable, so chemotherapy was continued after the operation. Due to an elevation in tumor markers and the appearance of lung metastasis, S-1 + irinotecan + bevacizumab therapy was performed as third-line therapy. On day 22 of the third course, he was transported to our hospital with abdominal pain and nausea. Contrast-enhanced computed tomography revealed adhesive bowel obstruction, and chemotherapy was discontinued. Restlessness and diplopia appeared after admission, and magnetic resonance imaging showed a high-intensity area on T2-fluid attenuated inversion recovery images, mainly in the occipital lobe. Because neurological symptoms and imaging findings improved with symptomatic treatment, we diagnosed him with posterior reversible encephalopathy syndrome. Although this disease can develop in association with chemotherapy and, for example, eclampsia, sepsis, renal failure, and autoimmune disease, it is rare and we report this case together with a review of the literature.

An 85-year-old woman was transported to our hospital because of nausea and abdominal pain. Contrast-enhanced computed tomography revealed type IV hiatal hernia with incarcerated necrotic transverse colon. Emergency laparotomy was performed. When the incarcerated stomach and transverse colon were returned to the abdominal cavity, the transverse colon was resected and anastomosed due to necrosis. After the hiatal defect was closed, the Toupet method was also performed. No regurgitation or obstruction was observed after the operation, and the patient was discharged 63 days postoperatively. Here we report this rare case of intestinal necrosis due to type IV hiatal hernia and review the literature.

Information pertaining to self-regulated learning strategies for nurses in distance learning is scarce, There is also insufficient information regarding suitable learning support. We conducted a survey, exploring the demographic data and self-regulated learning strategies of 183 nurses who used distance learning; 159 nurses responded. In this study, nurses tended to use “asking peers” as their primary learning support. Additionally, “developing learning plans,” “devising learning methods,” and “reflecting on learning methods” showed a positive correlation. “Developing learning plans,” “devising learning methods,” and “rewarding oneself” also showed a positive correlation. Finally, a positive correlation was found between “asking peers” and “rewarding oneself.” A bulletin board for exchanging opinions among learners and the implementation of a pre-course were suggested as ways to support distance learning for nurses.

Since fiscal year 2015, our hospital has conducted regular hospital inspections by a medical engineer (ME). About 1 year after the start of this inspection, fungi and common bacteria were detected, so we searched for the cause and report here successful cleanup of the incubator. When the incubator was cleaned during a periodic inspection, the ME discovered that dirt mainly adhered to the fan and the bed rest. Also, fungi were detected from the fans, so the ME cleaned and disinfected all the fans and then switched to a process of washing the central supply room. Following this process, bacteria were no longer detected from inside the incubator, but they have been consistently detected from the fans. We have no reported cases of patient infection, and we believe this is because the ME is responsible for periodic cleaning against bacteria and for conducting inspections. This demonstrates that successful cleaning of the incubator led to control of the spread of infectious diseases.

OBJECTIVES: One of the important risk factors of falling is decreased muscle mass and muscle strength. Recently, there has been an increasing concern on the role of vitamin D in muscle strength and physical activity. Aim of our study is to examine the relationships between vitamin D status and muscle mass and muscle strength in middle-aged healthy adults. METHODS: Subjects were 40 healthy volunteers aged 42.0 ± 10.6 years old. Evaluation was made for serum vitamin D₃ metabolites including 25-hydroxyvitamin D₃ [25(OH)D₃] and 24,25-dihydroxyvitamin D₃ [24,25(OH)₂D₃] concentrations, lower limb muscle strength, and dietary intake by food frequency questionnaire. Body composition was measured by dual-energy X-ray absorptiometry (DXA), and appendicular skeletal mass index (ASMI) was calculated as skeletal muscle mass/squared height. RESULTS: 70% of the subjects had vitamin D insufficiency/deficiency (serum total 25(OH)D < 20 ng/mL), and female subjects had significantly lower serum total 25(OH)D level compared with males. Vitamin D insufficiency/deficiency group had significantly higher body fat, lower SMI and muscle strength, probably reflecting higher percentage of female subjects. Serum vitamin D₃ metabolites levels were significantly correlated with whole and site-specific ASMI, and lower limb muscle strength, except for the correlation between serum 24,25(OH)₂D₃ concentration and lower limb muscle strength. In addition, serum 25(OH)D₃ level was a positive significant predictor for both ASMI and lower limb muscle strength, while serum 24,25(OH)₂D₃ level was not their significant predictor. CONCLUSIONS: Serum 25(OH)D₃ level was significantly correlated with both skeletal muscle mass and lower limb muscle strength.
Absorptiometry, Photon ; Accidental Falls ; Adipose Tissue ; Adult ; Asian Continental Ancestry Group* ; Body Composition ; Calcifediol* ; Female ; Healthy Volunteers ; Humans ; Lower Extremity* ; Male ; Motor Activity ; Muscle Strength* ; Muscle, Skeletal* ; Risk Factors ; Vitamin D ; Vitamins