Objective: The wrong dose of high-risk drugs such as oral steroids is a serious issue that needs to be addressed. This study aims to determine the appropriate upper tolerable dose threshold and to develop a multi-variable logistic regression model to detect dose-errors in oral prednisolone tablets.Methods: Data on Prednisolone prescriptions were obtained from a single center. Out of the data collected, positive cases consisted of cases where dose-related modifications were made. A univariate logistic regression model was developed with the current daily dose. In the model, the Youden Index was used to determine the upper tolerable dose threshold. The investigation was done to determine whether the performance of the multivariate model was improved by adding clinical department and previous prescription information as variables.Results: Univariate models (AUC: 0.645) with only current daily doses and estimated optimal thresholds of 6 mg/day or 11 mg/day, respectively were determined to be appropriate. Including variables improved the performance of the predictive model; the best performing model (AUC: 0.840) was derived when the following variables were entered: “current daily dose,” “current prescription days,” “clinical department,” “daily dose of the previous prescription,” and “prescription days of the previous prescription”.Conclusion: A single upper tolerance limit is insufficient to determine dose adequacy for prednisolone tablets owing to their broad clinical dose range. Itmay be possible to develop a high-performance dose audit support model by adding information.

COVID-19 spread from Wuhan City, People's Republic of China, in December 2019, followed by an explosion of infections worldwide. The number of infected people has also risen dramatically in Japan and has become a major social problem. Patients with severe disease require a long period to return to society due to significant physical weakness even after recovery. We report a patient in his 40s with a history of nephrectomy who was infected with COVID-19 and became critically ill.After being diagnosed with COVID-19 by PCR test, the patient was admitted to our hospital. His respiratory status rapidly worsened and he was temporarily managed by ECMO in the intensive care unit. At the time of his first contact with us (day 31 post-hospitalization), he was unable to hold himself in a standing position for a long time and required a walker. Initially, from the perspective of preventing the spread of infection, we instructed him in self-directed training rather than individual therapy. From day 49, he began to receive physical therapy. He was discharged on day 53 with independence in outdoor walking. He was instructed to consume protein after exercising and he was managed on an outpatient basis. He returned to work. His skeletal muscle mass increased by BIA and his respiratory and motor functions were restored.He received instructions on recovering from severe illness after COVID-19 infection, which focused on nutrition, voluntary training, and monitored individual therapy in accordance with rehabilitation therapy. He was able to return to society with no sequelae.

We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.

Methods: A total of 14 patients with unilateral radicular symptoms and five healthy subjects were subjected to simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement signaling (SHINKEI-Quant) using a 3-Tesla magnetic resonance imaging. The Visual Analog Scale (VAS) score for neck pain and upper arm pain was used to evaluate clinical symptoms. T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus were measured bilaterally from C4 to C8 in patients with radicular symptoms and from C5 to C8 in healthy controls. The T2 ratio was calculated as the affected side to unaffected side. Results: When comparing nerve roots bilaterally at each spinal level, no significant differences in T2 relaxation times were found between patients and healthy subjects. However, T2 relaxation times of nerve roots in the patients with unilateral radicular symptoms were significantly prolonged on the involved side compared with the uninvolved side (p<0.05). The VAS score for upper arm pain was not significantly correlated with the T2 relaxation times, but was positively correlated with the T2 ratio. Conclusions In patients with cervical radiculopathy, the SHINKEI-Quant technique can be used to quantitatively evaluate the compressed cervical nerve roots. The VAS score for upper arm pain was positively correlated with the T2 ratio. This suggests that the SHINKEI-Quant is a potential tool for the diagnosis of cervical nerve entrapment.

Methods: We included 62 patients who underwent combined LLIF surgery and PPS fixation for degenerative lumbar spondylolisthesis with spinal canal stenosis. We compared the patient demographics and the accuracy of fluoroscopy-guided PPS placement between two groups: patients who remained in the lateral decubitus position for the pedicle screw fixation (single-position surgery [SPS] group) and those who were turned to the prone position (dual-position surgery [DPS] group). Results: There were 40 patients in the DPS group and 22 in the SPS group. Of the 292 PPSs, only 12 were misplaced. In other words, 280/292 screws (95.9%) were placed correctly in the pedicle’s cortical shell (grade 0). PPS insertion did not cause neurological, vascular, or visceral injuries in either group. The breach rates for the DPS and SPS groups were 4.1% (grade 1, 5 screws; grade 2, 3 screws; grade 3, 0 screw) and 4.1% (grade 1, 2 screws; grade 2, 2 screws; grade 3, 0 screw), respectively. Although there were no statistically significant differences, the downside PPS had more screw malpositioning than the upside PPS. Conclusions We found that PPS insertion with the patient in the decubitus position under fluoroscopic guidance might be as safe and reliable a technique as PPS insertion in the prone position, with a misplacement rate similar to that previously published.

Objective：We aimed to examine the clinical validity of the Wechsler Adult Intelligence Scale (WAIS)-III for resuming automobile driving in patients with brain injury.Methods：A total of 71 patients who requested to resume driving after brain injuries were included, with 43 and 28 patients categorized in the resumed and non-resumed driving groups, respectively. Statistical analysis was performed by comparing the sub-items of the WAIS-III between the groups. The reference value of accurate determinants was estimated using receiver operating characteristic (ROC) curve analysis.Results：The results of the ROC curve analysis showed that the areas under the curves for full-scale intelligence quotient (FIQ), performance IQ (PIQ), and perceptual organization index (POI) were higher than 0.7 (with moderate predictive accuracy). The cutoff values were as follows with high specificity and low sensitivity：PIQ, 98.5；FIQ, 107；and PO, 107.Conclusion：The cutoff values of the FIQ, PIQ, and POI of the WAIS-III were inadequate predictors for resumption of driving in patients with brain injury. However, if patients had all three scores less than 70, it was suggested that they refrain from driving.

COVID-19 spread from Wuhan City, People's Republic of China, in December 2019, followed by an explosion of infections worldwide. The number of infected people has also risen dramatically in Japan and has become a major social problem. Patients with severe disease require a long period to return to society due to significant physical weakness even after recovery. We report a patient in his 40s with a history of nephrectomy who was infected with COVID-19 and became critically ill.After being diagnosed with COVID-19 by PCR test, the patient was admitted to our hospital. His respiratory status rapidly worsened and he was temporarily managed by ECMO in the intensive care unit. At the time of his first contact with us (day 31 post-hospitalization), he was unable to hold himself in a standing position for a long time and required a walker. Initially, from the perspective of preventing the spread of infection, we instructed him in self-directed training rather than individual therapy. From day 49, he began to receive physical therapy. He was discharged on day 53 with independence in outdoor walking. He was instructed to consume protein after exercising and he was managed on an outpatient basis. He returned to work. His skeletal muscle mass increased by BIA and his respiratory and motor functions were restored.He received instructions on recovering from severe illness after COVID-19 infection, which focused on nutrition, voluntary training, and monitored individual therapy in accordance with rehabilitation therapy. He was able to return to society with no sequelae.

We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.

Objective：We aimed to examine the clinical validity of the Wechsler Adult Intelligence Scale (WAIS)-III for resuming automobile driving in patients with brain injury.Methods：A total of 71 patients who requested to resume driving after brain injuries were included, with 43 and 28 patients categorized in the resumed and non-resumed driving groups, respectively. Statistical analysis was performed by comparing the sub-items of the WAIS-III between the groups. The reference value of accurate determinants was estimated using receiver operating characteristic (ROC) curve analysis.Results：The results of the ROC curve analysis showed that the areas under the curves for full-scale intelligence quotient (FIQ), performance IQ (PIQ), and perceptual organization index (POI) were higher than 0.7 (with moderate predictive accuracy). The cutoff values were as follows with high specificity and low sensitivity：PIQ, 98.5；FIQ, 107；and PO, 107.Conclusion：The cutoff values of the FIQ, PIQ, and POI of the WAIS-III were inadequate predictors for resumption of driving in patients with brain injury. However, if patients had all three scores less than 70, it was suggested that they refrain from driving.

BACKGROUND: Previous studies have suggested that exposures to heavy metals (arsenic, cadmium, lead, and selenium) may be associated with differences in blood pressure. However, the findings of these studies have been inconsistent. This study was performed to examine the associations between urinary heavy metal concentrations and blood pressure among residents of four Asian countries (Bangladesh, Indonesia, Nepal, and Vietnam). METHODS: This cross-sectional study examined 1899 adults in four Asian countries. Urinary concentrations of heavy metals were measured by inductively coupled plasma mass spectrometry. A questionnaire survey was administered regarding individual characteristics. Anthropometric measurements (height and weight) were performed. Systolic and diastolic blood pressures were measured after a short rest. Multiple linear regression models were applied to investigate associations between urinary heavy metal concentrations and blood pressure after adjustments for age, sex, and body mass index. RESULTS: The geometric means of the urinary concentrations of arsenic, cadmium, lead, and selenium were 84.6, 0.885, 2.09, and 16.5 μg/g creatinine, respectively. The urinary arsenic concentrations were slightly higher than those typically reported in non-polluted populations, while urinary cadmium, lead, and selenium concentrations were equivalent or slightly lower. The urinary lead concentrations were positively associated with both systolic and diastolic blood pressure, but urinary selenium concentrations were negatively associated with them. CONCLUSIONS Variations in the urinary concentrations of lead and selenium were associated with blood pressure at low levels of exposure/intake.
Adult ; Arsenic/urine* ; Bangladesh ; Blood Pressure ; Cadmium/urine* ; Cross-Sectional Studies ; Environmental Exposure ; Female ; Humans ; Indonesia ; Lead/urine* ; Linear Models ; Male ; Metals, Heavy/urine* ; Middle Aged ; Nepal ; Selenium/urine* ; Vietnam