Objectives: Diagnosis and treatment of osteoporosis are instrumental in obtaining good outcomes of hip surgery.Measuring bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. However, due to limited access to DXA, there is a need for a screening tool to identify patients at a higher risk of osteoporosis. We analyzed the potential utility of the Osteoporosis Self-assessment Tool for Asians (OSTA) as a screening tool for osteoporosis. Methods: A total of 1378 female patients who underwent hip surgery at 8 institutions were analyzed. For each patient, the BMD of the proximal femoral region was measured by DXA (DXA-BMD), and the correlation with OSTA score (as a continuous variable) was assessed. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of OSTA score to predict osteoporosis. Lastly, the OSTA score was truncated to yield an integer (OSTA index) to clarify the percentage of patients with osteoporosis for each index. Results: DXA-BMD showed a strong correlation with OSTA (r = 0.683; P < 0.001). On ROC curve analysis, the optimal OSTA score cut-off value of − 5.4 was associated with 73.8% sensitivity and 80.9% specificity for diagnosis of osteoporosis (area under the curve: 0.842). A decrease in the OSTA index by 1 unit was associated with a 7.3% increase in the probability of osteoporosis. Conclusions OSTA is a potentially useful tool for screening osteoporosis in patients undergoing hip surgery. Our findings may help identify high-risk patients who require further investigation using DXA.

Methods: A total of 120 patients with AIS who underwent posterior spinal fusion from August 2006 to March 2017 at our facility and were followed up for 2 years or more were included. Radiological parameters were measured on whole-spine anteroposterior and lateral radiographs. Revised SRS-22 (SRS-22r) values were also recorded. Coronal trunk imbalance was defined as a deviation of ≥2.0 cm between the C7PL and the central sacral vertical line. Patients with and without coronal trunk imbalance at 2 years after surgery were defined as D (+) (decompensation type) and D (-), respectively. Mean SRS-22r values, including function, pain, self-image, mental health, and subtotal were compared between the D (+) and D (-) groups. Logistic regression analysis was performed to detect the preoperative factors related to D (+) using predictors, including curve type, maximum Cobb angle, and coronal trunk imbalance. Results: At 2 years after surgery, the D (+) group had a significantly lower self-image in the domain of SRS-22r scores compared with the D (-) group. Preoperative coronal trunk imbalance was significantly related to D (+) but not to significant changes in the postoperative SRS-22 score in any of the SRS-22 domains. Conclusions Postoperative C7PL deviation lowers the self-image in patients with AIS. Patients with preoperative coronal trunk imbalance were significantly more likely to be D (+).

Objective: Cardiac arrest (CA) has been observed in some patients with Takotsubo syndrome (TTS), most of whom had CA at the initial presentation of TTS. The objective of this report was to discuss the factors underlying the onset of this syndrome.Case presentation: A 72-year-old woman with refractory antineutrophil cytoplasmic autoantibody-associated lung disease was referred to our hospital. Twenty minutes after bronchoscopic examination, cardiopulmonary arrest suddenly occurred. Resuscitation immediately resumed her heartbeat and spontaneous breathing. Subsequent 12-lead electrocardiography, echocardiography, and left ventricular angiography revealed TTS.Conclusion: This case indicates that bronchoscopy can cause severe TTS, especially in patients with systemic inflammation.

The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.

This study was performed to assess the impact of sputum acid-fast bacilli (AFB) smear in predicting pulmonary tuberculosis (TB). We retrospectively identified sputum AFB smear specimens over a 6-year period in our hospital. A total of 1814 specimens were included: 26 were culture-positive for TB, and 116 were for nontuberculous mycobacterium (NTM). NTM were more frequently isolated than TB (odds ratio: 4.7, 95% confidence interval (95% CI); P <0.001). Sensitivity, specificity, and positive likelihood ratio of sputum AFB smear for TB were 42.3% (95% CI 23.4-63.1), 94.5% (95% CI 93.3-95.5), and 7.64 (95% CI 4.69-12.45), respectively. Although there was a statistical significance in the positive likelihood ratio, sputum smear test had a positive predictive value of 0.100 (95% CI 0.051-0.172). These data suggest that the diagnostic yield of sputum AFB smear for pulmonary TB might be substantially low in our clinical setting. Physicians should pay attention to interpretation of sputum smear results especially in areas with high prevalence of NTM.

OBJECTIVE: To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital. METHODS: This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver. RESULTS: The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72. CONCLUSION: The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.
Activities of Daily Living ; Asian Continental Ancestry Group* ; Baths ; Humans ; Mortality ; Neoplasm Metastasis* ; Rehabilitation ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Treatment Outcome

Objective：To assess the effects of immobilization on the three-dimensional microstructure of cortical and cancellous bone.

Methods：Eight-week-old specific-pathogen-free Wistar rats were divided into two groups：the control (n＝12) and immobilized group (n＝12). The hind limbs of the rats in the immobilized group were fixed using orthopedic casts for 4 weeks. The cortical bone at the mid-shaft and the cancellous bone at the distal metaphysis of the femur were analyzed using micro-computed tomography.

Results：The values of total cross-sectional area, cortical bone area, and cortical thickness in the immobilized group were significantly lower than those in the control group. Meanwhile, the relative bone volume (bone volume/total volume) and mean trabecular thickness in the immobilized group decreased and the structure model index significantly increased compared with the values in the control group (P＜0.05).

Conclusion：Our rat model can evaluate the effects of load-permitting immobilization. The results of this study indicate that structural changes in immobilized osteopenia-affected bone arise mainly from thinning of the cortex and reduction of cancellous bone volume caused by a reduction of trabecular width.

The aim of the present study was to evaluate the relation between basal metabolic rate (BMR) and body composition in 29 Japanese elite male athletes (age 25.6±3.7y, height 175.6±7.0cm, body weight 74.7±12.8kg, fat-free mass (FFM) 64.9±9.3kg). The subjects were classified into three groups according to their FFM. There was a significant difference in BMR/FFM between S-group (less than 0.5SD of average FFM) and L-group (more than 0.5SD). The parcentage of RM to body weight in S-group was significantly higher than in L-group. In conclusion, high basal metabolic rate/fat-free mass ratio in Japanese elite male athletes can be attributed to body composition.

Background: Although previous reports have shown a lower proportion of the ACTN3 XX genotype (R577X nonsense polymorphism) in sprint/power athletes compared with controls, possibly attributed to the importance of skeletal muscle function associated with alpha-actinin-3 deficiency, the findings on association between endurance athlete status and R577X genotype are equivocal. Purpose: The present study was undertaken to examine association of ACTN3 R577X genotype with elite Japanese endurance athlete status. Subjects and Methods: Subjects comprised 79 elite Japanese endurance runners (E) who participated in competition at national level and 96 Japanese controls (C). We divided endurance runners into two groups, i.e., 42 national level runners (E-N) and 37 international level runners (E-I) who had represented Japan in international competition. R577X genotype (rs1815739) was analyzed by direct sequencing. Frequency differences of polymorphisms between athletes and controls were examined by Chi-square tests. Result: The R allele frequency tended to be higher in E group than in C group (P=0.066). When we divided E into two groups, the R allele frequency in E-I group was significantly higher than that in C group (P=0.046); whereas there were no significant differences between E-N and C groups (p=0.316). Then, the three genetic models were tested. In the additive genetic model (RR>RX>XX), there were significantly differences between E-I and C (P=0.038), but not the dominant (RR vs. RX+XX) and the recessive (RR+RX vs. XX) genetic models. Conclusion: R allele of the R577X genotype in the ACTN3 gene was associated with elite Japanese endurance athlete status.

This report presents the case of a patient demonstrating multicentric Castleman's disease (MCD) with a lung lesion that was successfully treated with an anti-interleukin-6 receptor antibody, tocilizumab in combination with corticosteroid and tacrolimus. A 43-yr-old female with abnormal shadows on a chest X-ray was referred to the hospital for further examination. She was diagnosed as having MCD based on the characteristic pathology of inguinal lymph node, lung lesions, laboratory data, and undifferentiated arthritis. Corticosteroid and rituximab therapy did not fully ameliorate the symptoms; thus, the therapeutic regimen was changed to include tocilizumab, oral corticosteroid and tacrolimus. This regimen resulted in clinical remission and the dose of tocilizumab and corticosteroid could be tapered. Tocilizumab in combination with corticosteroid and tacrolimus may therefore be a beneficial treatment regimen for lung lesions associated with MCD.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Antibodies, Monoclonal/*therapeutic use ; Drug Therapy, Combination ; Female ; Giant Lymph Node Hyperplasia/*diagnosis/drug therapy/radiography ; Humans ; Immunosuppressive Agents/therapeutic use ; Lung Diseases, Interstitial/*drug therapy/pathology ; Lymph Nodes/pathology ; Receptors, Interleukin-6/antagonists & inhibitors ; Tacrolimus/therapeutic use ; Tomography, X-Ray Computed