Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV) -aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.

Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV)-aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.

Mouthwash is used to support brushing because it is distributed throughout the oral cavity. In this study, we examined the efficacy of a mixture of three hot water extracts (from Hordeum vulgare L, Apocynum venetum L, and Brasenia schreberi J. F. Gmel) for the purpose of developing an effective mouthwash. The mixture suppressed enhanced tumor necrosis factor α and matrix metalloproteinase 3 gene expression by Porphyromonas gingivalis lipopolysaccharide stimulation in human gingival fibroblasts. Furthermore, human studies using a mouthwash containing the plant extracts (MW) improved gingival index and bleeding on probing in the gum, and reduced the concentration of methyl mercaptan, which causes bad breath, in the mouth. These findings suggest that continued use of MW has positive effects on gingival inflammation and halitosis, and is useful for maintaining oral health.

Background/Aims: Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients. Methods: From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course. Results: Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2 , 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care. Conclusion CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.

Objective: Two types of symbols have been established as industry standards in terms of two-dimensional (2D) symbols with prescription information: one for objects to be printed on prescriptions and the other for electronic versions of medication diaries. However, no studies have investigated the system for using 2D symbols in pharmacies and hospitals/clinics as well as the quality of the information actually stored in these 2D symbols. Therefore, we conducted a survey to clarify the current status and problems pertaining to prescription information sharing via 2D symbols.Methods: We distributed questionnaires to community pharmacies through the Fukui Pharmaceutical Association and asked them to cooperate with us during the survey. The list of items in the survey　included the installation status of devices necessary for reading 2D symbols at each pharmacy, receipt computer in use, and status of the support issued by hospitals/clinics for reading 2D symbols. At the same time, we received 2D symbols created by community pharmacies and conducted reading tests to examine issues related to the collection of prescription information via 2D symbols at medical institutions.Results: The response rate for the survey was 21.8%. Among the 57 stores that responded to the survey, 26 (45.6%) answered that they could read prescription symbols, and 22 of them had actually used the system till date. In addition, 38 community pharmacies were able to provide the 2D symbols for medication diaries. Of the 30 provided symbols for medication diaries, 16 (53.3%) could be read as Japanese data by the barcode reader used.Conclusions: It has become clear that the 2D symbols with stored prescription information are not being completely utilized at present, as both community pharmacies and hospitals/clinics face several issues such as hardware maintenance, software updates, and time and effort required for the usage.

BACKGROUND: Remnant-like particle cholesterol (RLP-C) is highly atherogenic, which is associated with atherosclerosis. However, RLP-C has not been routinely measured in the clinical practice. We estimated RLP-C levels using conventional lipid profiles and examined the association between estimated RLP-C and related factors including nutrient intake. METHODS: This study was performed in Uku town, Nagasaki prefecture, Japan in 2019. A total of 225 subjects were enrolled and directly measured RLP-C levels. Estimated RLP-C levels were defined as the following formula [total cholesterol - (LDL-cholesterol) - (HDL-cholesterol)]. Multivariate analyses were used to assess the relationship between estimated RLP-C and atherogenic factors. We calculated cut-off values on dichotomized RLP-C (< 7.5 mg/dL vs. ≥ 7.5 mg/dL) by receiver operating characteristic (ROC) curve. RESULTS: The mean values of directly measured RLP-C levels and estimated RLP-C were 4.0 mg/dL and 16.4 mg/dL, respectively. In the multiple stepwise linear regression analysis, directly measured and estimated RLP-C levels were independently and commonly associated with apolipoprotein E, triglycerides, and vegetable fat intake (inversely). Using ROC curves, we found the cut-off value of estimated RLP-C was 22.0 mg/dL. CONCLUSION We demonstrated that the estimated RLP-C levels using conventional lipid profiles may substitute for directly measured RLP-C and these levels were independently and inversely associated with vegetable fat intake in the community-dwelling Japanese population.
Aged ; Aged, 80 and over ; Cholesterol/blood* ; Dietary Fats/blood* ; Female ; Humans ; Japan ; Lipids/blood* ; Lipoproteins/blood* ; Male ; Middle Aged ; Triglycerides/blood* ; Vegetables

Objective: This study aimed to investigate Japanese cancer patients’ perceptions of the scope of palliative care and factors that affect those perceptions. Methods: An anonymous, self-administered questionnaire was distributed to hospitalized patients and outpatients in designated cancer care hospitals in Japan. Data were first summarized using descriptive statistics. Then, using a χ² test followed by multiple logistic regression analysis, we compared patients who recognized palliative care as terminal care with those who viewed it as care that is relevant earlier in the disease course. Results: Of 3,622 questionnaires, 1,981 were completed (response rate: 54.7%). A total of 1,187 (59.9%) respondents perceived palliative care as care that could be implemented early in the disease course, whereas 414 (20.9%) respondents perceived palliative care as only relevant for the end-of-life stage. Respondents who had received palliative care for symptoms were significantly less likely to recognize it as terminal palliative care only than those who perceived that they were not the subject in the scope of care for symptoms. A diagnosis of advanced cancer and being under 40 years old were factors significantly related to the perception of palliative care as terminal only. Discussion and Implications: Our findings suggest that health care providers should be conscious of the possibility that palliative care practices affect patients’ perceptions of palliative care. Providing information about palliative care before occurring painful symptoms can help promote patients’ access to and understanding of it.

BACKGROUND: There is little data on the association between the lower nutrition represented by serum albumin levels and related factors in a general population. The present study aimed to determine whether the albumin level positioned as some kind of biomarker with frailty measures, trace elements, and an inflammation marker. METHODS: In 2018, we performed an epidemiological survey in 1368 subjects who resided in Tanushimaru, Japan, in which we examined the blood chemistry including albumin, trace elements, hormone levels, and carotid ultrasonography. Albumin levels were categorized into 4 groups (G1 [3.2-3.9 mg/dL], G2 [4.0-4.3 mg/dL], G3 [4.4-4.6 mg/dL], and G4 [4.7-5.3 mg/dL]). The participants underwent measurements of handgrip strength and were tested by asking to walk 5 m. Their cognitive functions were evaluated by the mini-mental state examination (MMSE). RESULTS: Multiple stepwise regression analysis demonstrated that albumin levels were significantly and independently associated with age (inversely), systolic blood pressures, estimated glomerular filtration rate (eGFR), MMSE score, frailty measures (handgrip strength), an inflammation marker (high-sensitivity C-reactive protein), hormones (growth hormone (inversely) and insulin-like growth factor-1), and trace elements (calcium, magnesium, iron, and zinc), with a linear trend. CONCLUSIONS Lower albumin levels, even in the normal range, were found to be related factors of frailty measures, trace elements, and an inflammation marker in a general population.
Aged ; Albumins/metabolism* ; Biomarkers/blood* ; Cross-Sectional Studies ; Female ; Frailty/physiopathology* ; Hand Strength/physiology* ; Humans ; Inflammation/blood* ; Japan ; Male ; Trace Elements/blood*

Crowned dens syndrome (CDS) is a pseudogout of the cervical vertebra, which shows calcification around the dens of the axis. We report a case of CDS that was successfully treated with daiobotampito and shimotsuto. An 83-year-old woman visited our clinic because of neck pain. She was diagnosed with CDS and was initially administered daiobotampito and eppikajutsuto. Her neck pain improved slightly, but recurred. She was then administered daiobotampito and shimotsuto, after which her neck pain disappeared. We considered that daiobotampito and shimotsuto were effective for this prolonged illness based on persistent stasis and blood deficiency according to her treatment course and laboratory findings.

Painful orthopedic diseases are sometimes aggravated because of weather changes ; this is referred to as meteorological pain. We report two cases of great occipital neuralgia (GON) due to traffic accident in patients whose pain was aggravated by weather changes. Case 1 involved a 41-year-old woman who developed lumbago and cervical pain following a traffic accident. Two months after the accident, she had irregular occipital pain. Three months after the accident, a great typhoon occurred, and she suffered from severe occipital pain since that morning. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Case 2 involved a 31-year-old woman who developed cervical pain following a traffic accident. Three months after the accident, she experienced severe occipital pain due to weather changes. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Goreisan is dramatically effective for GON as meteorological pain caused by cervical sprain.