Introduction: Patients with vertebral compression fractures are likely to decrease physical function and activities of daily living (ADL) due to pain and inactivity. In this study, we examined the effect of the amount of rehabilitation provided on functional prognosis in patients with vertebral compression fracture.Methods: We included 18,174 vertebral compression fracture patients aged 65 years or older in the JMDC multicenter data. Barthel index (BI) gains, BI efficiency, ADL independence at discharge (BI≧95), and discharge home were compared between patients who received an average of at least 1 unit of rehabilitation during hospitalization (high-provider group) and those who received less than 1 unit per day (low-provider group).Results: There were 4,145 patients in the high-provider group and 14,029 in the low-provider group. The high-provider group had higher BI gain and BI efficiency, as well as a higher percentage of patients with independent ADLs at discharge (41.6%) and a higher percentage of patients discharged home (79.2%). In multiple regression analysis, the high-provider group had higher BI gain (regression coefficient: 2.423)and BI efficiency (regression coefficient: 0.043). Multiple logistic regression analysis showed that the high-provider group had a higher rate of discharge home (odds ratio:1.26) and a higher rate of ADL independence at discharge (odds ratio: 1.17).Conclusion: In patients with vertebral compression fractures, the amount of rehabilitation provision may have an impact on functional prognosis.

Introduction: Patients with vertebral compression fractures are likely to decrease physical function and activities of daily living (ADL) due to pain and inactivity. In this study, we examined the effect of the amount of rehabilitation provided on functional prognosis in patients with vertebral compression fracture.Methods: We included 18,174 vertebral compression fracture patients aged 65 years or older in the JMDC multicenter data. Barthel index (BI) gains, BI efficiency, ADL independence at discharge (BI≧95), and discharge home were compared between patients who received an average of at least 1 unit of rehabilitation during hospitalization (high-provider group) and those who received less than 1 unit per day (low-provider group).Results: There were 4,145 patients in the high-provider group and 14,029 in the low-provider group. The high-provider group had higher BI gain and BI efficiency, as well as a higher percentage of patients with independent ADLs at discharge (41.6%) and a higher percentage of patients discharged home (79.2%). In multiple regression analysis, the high-provider group had higher BI gain (regression coefficient: 2.423) and BI efficiency (regression coefficient: 0.043). Multiple logistic regression analysis showed that the high-provider group had a higher rate of discharge home (odds ratio: 1.26) and a higher rate of ADL independence at discharge (odds ratio: 1.17).Conclusion: In patients with vertebral compression fractures, the amount of rehabilitation provision may have an impact on functional prognosis.

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.

Objectives: Locomotive syndrome (LS) leads to reduced physical function and a high risk of becoming bedridden.Grip strength serves as an indicator of upper limb and overall physical function. Rheumatoid arthritis (RA) patients with reduced grip strength frequently show finger and wrist joint inflammation. The purpose of this study was to verify grip strength as an evaluation tool for physical function and LS in RA patients. Methods: As part of an ongoing multicenter observational study, 591 consecutive RA patients whose background information was available, including data for the 25-question Geriatric Locomotive Function Scale (GLFS-25) and grip strength, were examined. LS was defined as a GLFS-25 score ≥ 16 points. Finger and wrist joint inflammation were defined as tender or swollen joints. Results: Among the 591 patients, 244 (41.3%) patients had LS, and 167 (28.3%) were male. Receiver operating characteristic curve analysis yielded cut-off values of grip strength for LS of 24 kg (specificity 72.2%; sensitivity 62.7%) for males and 17 kg (specificity 65.7%; sensitivity 67.6%) for females. Multivariable logistic regression analysis revealed a significant association of grip strength with LS, even after adjusting for finger and wrist joint inflammation. Conclusions LS was significantly associated with grip strength, even after adjusting for the presence of finger and wrist joint inflammation. We recommend adopting grip strength measurement as a screening tool for evaluating LS and guiding interventions.

A 62-year-old man presented with hemoptysis and hoarseness. He was diagnosed with an aortopulmonary fistula due to a thoracic aortic aneurysm rupture and was referred to our department. Emergency in-situ reconstruction of the aorta and pulmonary lobectomy were performed. Nine days postoperative, he developed empyema. Intrapleural urokinase and antibiotic therapy were selected as management instead of a video-assisted thoracoscopic debridement and decortication due to his worsening condition. The treatment was successful, and he was discharged from the hospital without any further complications. This study highlights the benefit of intrapleural administration of urokinase and antibiotics in patients with acute empyema, when surgical treatment is inappropriate.

Objective: To examine the association between the mobilization level during intensive care unit (ICU) admission and independence in activity of daily living (ADL), defined as Barthel Index (BI)≥70. Methods: This was a post-hoc analysis of the EMPICS study involving nine hospitals. Consecutive patients who spend >48 hours in the ICU were eligible for inclusion. Mobilization was performed at each hospital according to the shared protocol and the highest ICU mobility score (IMS) during the ICU stay, baseline characteristics, and BI at hospital discharge. Multiple logistic regression analysis, adjusted for baseline characteristics, was used to deter-mine the association between the highest IMS (using the receiver operating characteristic [ROC]) and ADL. Results: Of the 203 patients, 143 were assigned to the ADL independence group and 60 to the ADL dependence group. The highest IMS score was significantly higher in the ADL independence group than in the dependence group and was a predictor of ADL independence at hospital discharge (odds ratio, 1.22; 95% confidence interval, 1.07–1.38; adjusted p=0.002). The ROC cutoff value for the highest IMS was 6 (specificity, 0.67; sensitivity, 0.70; area under the curve, 0.69). Conclusion These results indicate that, in patients who were in the ICU for more than 48 hours, that patients with good function in the ICU also exhibit good function upon discharge. However, prospective, multicenter trials are needed to confirm this conclusion.

Objective: Breast cancer susceptibility gene 1 (BRCA1)-associated ovarian cancer patients have been treated with A poly (ADP-ribose) polymerase (PARP) inhibitor, extending the progression-free survival; however, they finally acquire therapeutic resistance. Interleukin (IL)-34 has been reported as a poor prognostic factor in several cancers, including ovarian cancer, and it contributes to the therapeutic resistance of chemotherapies. IL-34 may affect the therapeutic effect of PARP inhibitor through the regulation of tumor microenvironment (TME). Methods: In this study, The Cancer Genome Atlas (TCGA) data set was used to evaluate the prognosis of IL-34 and human ovarian serous carcinoma. We also used CRISPR-Cas9 genome editing technology in a mouse model to evaluate the efficacy of PARP inhibitor therapy in the presence or absence of IL-34. Results: We found that IL34 was an independent poor prognostic factor in ovarian serous carcinoma, and its high expression significantly shortens overall survival. Furthermore, in BRCA1-associated ovarian cancer, PARP inhibitor therapy contributes to anti-tumor immunity via the XCR1+ DC-CD8+ T cell axis, however, it is canceled by the presence of IL-34. Conclusion These results suggest that tumor-derived IL-34 benefits tumors by creating an immunosuppressive TME and conferring PARP inhibitor therapeutic resistance. Thus, we showed the pathological effect of IL-34 and the need for it as a therapeutic target in ovarian cancer.

A 76-year-old female was admitted with complaints of dyspnea on exertion and lower leg edema. She had undergone an aortic valve replacement thirty-nine years before and a redo aortic valve replacement and mitral valve replacement twenty-eight years before. She also had hemolytic anemia with jaundice. Echocardiography showed severe paravalvular leakage in the aortic and mitral valves, and a blood flow in the aortic annulus that flows from the aortic side into the left atrium. We diagnosed heart failure and hemolytic anemia due to paravalvular leakage and decided to perform a double-valve replacement for the third time. On operation, after removing the aortic valve through aortotomy, aorto- mitral fibrous continuity was extensively calcified and perforated, and its strength was not enough to sew the prosthetic valve to it. Therefore, we decided to perform the Commando procedure. Aortotomy was extended between the noncoronary aortic sinus and the left coronary aortic sinus until it reached the dome of the left atrium. After the prosthetic mitral valve was excised, annuloplasty of the posterior mitral annulus was performed using a bovine pericardial patch, and the new prosthesis mitral valve was implanted. The anterior part of the annulus corresponding to the aorto-mitral fibrous continuity was reconstructed by sewing the base of a two-tongued triangular bovine pericardial patch to the sewing cuff of the mitral prosthesis. After closing the left atrial ceiling with the posterior patch, the aortic prosthesis was secured to the aortic annulus and the pericardial patch. The anterior patch was used to close the right side of the aortotomy. The postoperative course was uneventful, and postoperative echocardiography revealed no paravalvular leakage.

OBJECTIVE: To analyze whether sufficient energy intake (EI) improves performance of activities of daily living (ADL) in patients with hip fracture admitted to rehabilitation hospitals. The adequate amount of EI for improving performance of ADL in patients with hip fracture remains unknown. METHODS: This retrospective cohort study included all patients with hip fracture (n=234) admitted to rehabilitation hospitals in Japan. The inclusion criteria for this study were age >65 years and body mass index <30.0 kg/m². Patients who were transferred to an acute hospital and those with missing case data were excluded. According to the amount of EI, the patients were classified into energy sufficiency and shortage groups (EI/total energy expenditure ≥1.0 and <1.0, respectively). The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. Finally, FIM gain was calculated as the discharge FIM score minus the admission FIM score. RESULTS: The final analysis targeted 202 patients—53 (26.2%) were in the energy shortage group and 149 (73.8%) were in the energy sufficiency group. The energy sufficiency group had a greater FIM gain than the energy shortage group (mean, 25.1±14.2 vs. 19.7±16.4; p=0.024). Furthermore, sufficient EI in the first week since admission (β=0.165; 95% confidence interval, 0.392–5.230; p=0.023) was an independent factor of FIM gain. CONCLUSION: Among elderly patients with hip fracture admitted to rehabilitation hospitals in Japan, the amount of EI during the first week after admission was an independent factor of FIM gain.
Activities of Daily Living ; Aged ; Body Mass Index ; Cohort Studies ; Energy Intake ; Energy Metabolism ; Femoral Fractures ; Hip ; Humans ; Japan ; Nutritional Support ; Recovery of Function ; Rehabilitation ; Retrospective Studies

BACKGROUND/AIMS: Fundic gland polyps (FGPs), hyperplastic polyps (HPs), and xanthomas (XTs) are common benign gastric lesions that can be diagnosed by endoscopic appearance alone in most cases. The aim of this study was to evaluate associations between gastric cancer and these benign lesions. METHODS: Two expert endoscopists reviewed a series of gastroscopy images. FGPs, HPs, and XTs were diagnosed by endoscopic appearance, whereas all gastric cancers were confirmed pathologically. RESULTS: Of the 1,227 patients reviewed, 114 (9.3%) had a concurrent or past history of gastric cancer. The overall prevalences of FGPs, HPs and XTs were 9.4%, 6.3% and 14.2%, respectively. HPs and XTs coexisted in 1.6% of patients, whereas other combinations were rarer. XTs were observed in 39.3% and 11.5% of patients with and without gastric cancer, respectively (p<0.001). In contrast, no gastric cancer patients had FGPs, whereas 10.4% of patients without cancer had FGPs (p<0.001). The prevalence of HPs was similar between the two groups (8.8% and 6.0% of patients with and without cancer, respectively, p=0.29). Multivariate and Mantel-Haenszel analyses demonstrated that XTs were positively associated and FGPs were negatively associated with gastric cancer. CONCLUSIONS: XTs and FGPs might be useful as endoscopic risk indicators for monitoring gastric cancer.
Gastroscopy ; Humans ; Polyps ; Prevalence ; Stomach Neoplasms ; Xanthomatosis