The patient was a man in his 80s. PCR test was performed after he developed a fever, and the result was positive for SARS-CoV-2 infection. On admission, CT showed ground-glass opacities and consolidation in both lung fields, leading to a diagnosis of COVID-19 pneumonia. The fever promptly resolved after starting treatment with dexamethasone 6.6 mg injection, but high fever returned the day after discontinuing dexamethasone. We considered bacterial pneumonia as a complication, but antibiotics were ineffective. We suspected cytokine storm and began steroid pulse therapy. The fever temporarily resolved but returned when the steroid dose was reduced. In the differential diagnosis, we considered opportunistic infections such as fungal infection and cytomegalovirus infection, pulmonary tuberculosis, and non-infectious lung diseases such as idiopathic organizing pneumonia. Examination and treatment were performed with these in mind. Finally, we diagnosed pulmonary tuberculosis and cytomegalovirus infection, and treatment was started for each. He was subsequently transferred to a treatment facility for patients with tuberculosis. Steroids are a key drug in the treatment of COVID-19, but they may reduce immune function and increase susceptibility to infection, so caution is required for various infectious diseases.

Purpose: In this multicenter retrospective observational study, we examined the early effects of romosozumab in patients with severe osteoporosis in terms of time-course changes in bone metabolism marker, improvement in bone density, and adverse effects. Materials and Methods: Patients with severe osteoporosis were included. We investigated the progress of TRACP 5b and P1NP before and 1–2 months after the administration of romosozumab. We also investigated the bone density of lumbar spine, femoral neck, and the entire femur, measured by the DXA method, before and 5–7 months after the administration of romosozumab. Results: A total of 70 patients (7 males and 63 females, age 75.0±3.6 years) participated in this study. Significant improvements in TRACP 5b and P1NP levels were observed before and 1–2 months after romosozumab administration. The average bone density of lumbar spine, femoral neck, and the entire femur were measured before and 5–7 months after romosozumab administration;and a significant increase only observed in the lumbar spine. Conclusion Consistent with the findings of previous clinical studies, romosozumab has both bone formation-enhancing and bone resorption effects (dual effect). In addition, romosozumab also demonstrated improvement in bone density from the early phase after the administration, though the result was only seen in the lumbar spine.

Purpose: In this multicenter retrospective observational study, we examined the early effects of romosozumab in patients with severe osteoporosis in terms of time-course changes in bone metabolism marker, improvement in bone density, and adverse effects. Materials and Methods: Patients with severe osteoporosis were included. We investigated the progress of TRACP 5b and P1NP before and 1–2 months after the administration of romosozumab. We also investigated the bone density of lumbar spine, femoral neck, and the entire femur, measured by the DXA method, before and 5–7 months after the administration of romosozumab. Results: A total of 70 patients (7 males and 63 females, age 75.0±3.6 years) participated in this study. Significant improvements in TRACP 5b and P1NP levels were observed before and 1–2 months after romosozumab administration. The average bone density of lumbar spine, femoral neck, and the entire femur were measured before and 5–7 months after romosozumab administration;and a significant increase only observed in the lumbar spine. Conclusion Consistent with the findings of previous clinical studies, romosozumab has both bone formation-enhancing and bone resorption effects (dual effect). In addition, romosozumab also demonstrated improvement in bone density from the early phase after the administration, though the result was only seen in the lumbar spine.

STUDY DESIGN: Multicenter, prospective study. PURPOSE: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. OVERVIEW OF LITERATURE: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. METHODS: The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. RESULTS: JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. CONCLUSIONS: Poor glycemic control might prevent postoperative functional recovery of the spinal cord.
Asian Continental Ancestry Group ; Blood Glucose ; Diabetes Mellitus ; Electromyography ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Longitudinal Ligaments ; Lower Extremity ; Neck ; Prospective Studies ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Tibial Nerve ; Treatment Outcome ; Urinary Bladder

BACKGROUND/AIMS: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy.METHODS: We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups.RESULTS: There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group.CONCLUSIONS: Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.
Aluminum ; Endoscopy ; Hemorrhoids ; Humans ; Potassium ; Recurrence ; Retrospective Studies ; Sclerotherapy ; Tannins

STUDY DESIGN: Retrospective cohort study. PURPOSE: To assess bone mineral density (BMD) and bone metabolism ≥27 years after surgery in female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) during adolescence and to determine their associations with physical performance. OVERVIEW OF LITERATURE: There are no studies investigating postsurgical BMD in middle-aged AIS patients. METHODS: This study included 23 patients who provided informed consent among 229 female patients with AIS who underwent spinal fusion from 1968 until 1988. Average age at the time of observation was 48.8 years. BMD was measured at the left femoral neck, and the levels of two bone metabolism markers–procollagen type 1 N-terminal propeptide (P1NP) and tartrate-resistant acid phosphatase 5b (TRACP-5b)–were measured from blood samples. Physical performance was measured using grip strength, sit-ups, sit-and-reach, side step, and standing long jump. RESULTS: Mean BMD was 0.784 g/cm2. According to the World Health Organization diagnostic criteria, one subject (4.3%) had osteoporosis, whereas nine subjects (39.1%) had osteopenia. In patients with osteoporosis or osteopenia, P1NP and TRACP-5b levels were high, and BMD loss was because of high metabolic turnover. All calculated standard scores for physical performance were lower in the study cohort than in healthy individuals. There was a positive correlation between BMD and the standard score for grip strength, whereas there were weak positive correlations between BMD and the standard scores for side step and standing long jump. CONCLUSIONS: In female AIS patients who underwent spinal fusion in adolescence, 4.3% and 39.1% had osteoporosis and osteopenia, respectively, ≥27 years after surgery. Exercise performance of these patients was poor compared with the national standards. In these patients, increased physical activity should be encouraged to prevent BMD loss in middle age.
Acid Phosphatase ; Adolescent* ; Bone Density* ; Bone Diseases, Metabolic ; Cohort Studies ; Female* ; Femur Neck ; Hand Strength ; Humans ; Informed Consent ; Metabolism ; Middle Aged ; Motor Activity ; Osteoporosis ; Retrospective Studies ; Scoliosis* ; Spinal Fusion ; World Health Organization

[Background] Although we have demonstrated the clinical effect of acupuncture therapy with epidermal stimulation by needle penetration, its neurophysiological mechanisms are unclear. To investigate the clinical effects of epidermal stimulation by needle penetration on muscle tone, we tested the Hoffmann's reflex (Hreflex) of the soleus muscle during epidermal needle stimulation.
[Methods] Eighteen healthy participants were recruited. We tested the soleus H-reflex elicited by tibial nerve stimulation before and after epidermal stimulation by needle penetration. Epidermal stimulation was performed at several points on the Achilles tendon by needle penetration. We analyzed the amplitude ratio of H/M obtained from the waveforms of the soleus muscle before and after epidermal stimulation.
[Results] The amplitude ratio of H/M was significantly decreased during stimulation when compared with ratio during rest (p < 0.05). Each participant demonstrated a decrease in soleus muscle amplitude ratio of H/M during epidermal stimulation by needle penetration as compared with the ratio during rest.
[Discussion] Epidermal stimulation of the muscle by needle penetration activated the inhibitory interneurons of the dermatome at the stimulation site. Therefore, epidermal stimulation by needle penetration was considered as a possible method to induce muscle relaxation.
[Conclusion] It is suggested that epidermal stimulation by needle penetration for 2 minutes for the insertion of the Achilles tendon results in an inhibitory effect by stimulating the spinal cord neural mechanisms that correspond to the soleus muscle.

  In view of the situation where an increasing number of old women as well as old men have health problems associated with drinking, some measures should be taken in terms of setting sensible limits of alcoholic intake for these people to keep to, the Report of Kenko (Health) Nippon 21 for 2011 warned. It also suggested that further studies be made to amass necessary data in order to introduce effective measures and give a right assessment to the situation.
  The present study was carried out with the aim of providing fundamental pieces of information usable in primary prevention of alcohol-related health problems among the aged. For this purpose, we looked into the drinking habits as well as the numerical data of vital and liver functions tests of old people in a rural area in Yokote, Akita Prefecture. A total of 448 old people (206 men, 242 women) were involved in this study. Nineteen items out of 25 in the Kihon-Checklist, which was designed to reduce the need for nursing care, revealed notable decreases in vital functions in those men who took in over 21 grams of alcohol per day. Of those men specially categorized as individuals who are 65 and older and who are regarded as very likely to need nursing care in the near future, 88.9% took in 21 grams of alcohol. In women, there was no relation between drinking habits, BMI and liver functions. However, it was found that daily alcoholic consumption was greater in those specially categorized group of women at high risk for institutional care than in the other women.
  Our study made it clear that drinking habits, which were found to bear on liver and vital functions, could serve as a yardstick for judging whether the old people are at high risk for institutional care. We concluded that it is necessary to spread the knowledge about the adverse effects of alcohol among the elderly and advise them to act their age and drink in moderation even before they enter advanced age.