Chiba Hospital

Background/Objectives: Foot impairments are common in older adults, but the independent associations of specific foot indices with locomotive syndrome (LS) severity remain unclear. We examined hallux valgus angle (HV), navicular height (NH), and passive ankle dorsiflexion (ADF). Methods: This cross-sectional study included 119 community-dwelling older adults classified into LS stages 0-3. Bilateral measures were summarized as maximum HV and minimum NH/ADF, reflecting the worst-affected side. Proportional-odds ordinal logistic regression modeled LS stage (0-3) with foot indices and covariates (age, sex, body mass index [BMI]). Extended models additionally adjusted for Timed Up and Go (TUG), gait speed, or single-leg stance (SLS). Sensitivity analysis used binary logistic regression (LS ≥ 2 vs. <2). Results: Greater ADF was independently associated with lower LS severity (OR per 1°, 0.91; 95% CI, 0.85-0.98; p < 0.01), whereas higher BMI was associated with greater LS severity (OR per 1 kg/m2, 1.15; 95% CI, 1.01-1.30; p < 0.05). HV and NH were not significant. After adjustment for TUG, gait speed, or SLS, ADF remained inversely associated with LS severity (ORs, 0.92-0.93; p < 0.05), while the BMI association was attenuated. In binary logistic regression, greater ADF was associated with lower odds of LS ≥ 2 (OR per 1°, 0.85; 95% CI, 0.76-0.94; p < 0.005). Conclusions: Reduced passive ankle dorsiflexion is independently associated with greater LS severity, robust after accounting for key mobility and balance measures. Interventions targeting ankle mobility may represent a potentially modifiable factor and warrants confirmation in longitudinal and interventional studies.

In recent years, the misuse of over-the-counter (OTC) medications has been increasing in psychiatric clinical settings in Japan. This study aimed to compare individuals who misuse codeine (COD) with those who misuse dextromethorphan (DXM) to clarify the clinical characteristics of DXM misusers and to consider the support measures needed for this population. We used data from the 2024 National Survey on Drug-Related Disorders in Psychiatric Inpatient Facilities. Individuals who primarily misused OTC containing COD (COD group) and DXM (DXM group) were extracted from the database. We examined demographic characteristics, ICD-10 subcategories, and comorbid psychiatric disorders and compared the two groups using Fisher's exact test. Factors associated with DXM misuse were further analyzed using multivariable logistic regression. The study included 160 individuals in the COD group and 72 in the DXM group. Compared with the COD group, the DXM group had higher proportions of females and younger individuals, as well as higher rates of drug use within the past year and a history of self-harm or suicide attempts. The DXM group also showed significantly higher comorbidity rates of "acute intoxication" and "mood disorders (F3)" based on ICD-10. In the multivariable logistic regression analysis, younger age (AOR = 2.558, 95% CI: 1.218-5.371), acute intoxication (AOR = 2.73, 95% CI: 1.254-5.942), and comorbid mood disorders (AOR = 2.201, 95% CI: 1.146-4.227) were significantly associated with DXM misuse. These findings highlight the importance of acute-phase management, assessment of comorbid psychiatric disorders, and interventions that include suicide-risk evaluation in supporting individuals who misuse DXM. Furthermore, preventive education incorporating perspectives on mental-health-focused suicide prevention, as well as regulatory measures for OTC medication sales, are urgently needed.

Background:Orthopedic infections, including fracture-related infection and periprosthetic joint infection (PJI), remain difficult to eradicate because bacteria within biofilms exhibit high tolerance to systemic antibiotics. Conventional antibacterial strategies based on minimum inhibitory concentration often fail in the biofilm environment, where substantially higher antimicrobial concentrations are required. Continuous local antibiotic perfusion (CLAP) has emerged as a technique that enables sustained delivery of high local antibiotic concentrations directly to the infected site while providing continuous drainage using negative pressure wound therapy.Methods:This narrative review summarizes the principles, technical aspects, clinical indications, and reported outcomes of CLAP. A literature search of the MEDLINE database was conducted up to July 2025 using the term “continuous local antibiotic perfusion.” Clinical studies describing the use of CLAP in orthopedic infections, including case reports, case series, and retrospective studies, were reviewed. Perfusion strategies (iMAP, iSAP, iJAP, and TRAP), antibiotic regimens, safety considerations, and current limitations were analyzed.Results:CLAP enabled delivery of high local antibiotic concentrations exceeding the minimum biofilm eradication concentration while maintaining relatively low systemic exposure. Favorable outcomes for infection control, implant retention, and fracture union, were reported across various intractable infections, including fungal PJI. Complications such as transient elevations in serum antibiotic levels and renal dysfunction were reported but appeared to be infrequent. Although CLAP has shown potential utility in refractory infections, further high-quality studies with rigorous safety evaluations are required to strengthen the evidence base.Conclusion:CLAP is a promising adjunctive strategy for challenging orthopedic infections, offering targeted high-concentration antibiotic delivery with effective drainage. However, current evidence is limited to low-level studies. Prospective trials, standardized protocols, and long-term safety evaluations are needed to define its role in clinical practice.

Congenital distal tibiofibular synostosis is quite a rare disease, and little is known about its optimal management. A 6‐year‐old girl presented to our institution with a deformity of her left lower leg. After years of careful observation, the patient underwent partial resection of a laterally protruding portion of the distal diaphysis of the fibula at age 10 for cosmetic reasons. Since the recurrence of lateral prominence of the distal lower leg was observed following the initial surgery, complete resection of the protruding portion of the distal diaphysis of the fibula was performed at age 14. Although mild varus deformity of the ankle was observed, the ankle joint congruity was good, and there were no associated symptoms or functional limitations. Therefore, we decided to perform a simple resection of the distal fibular diaphysis only for cosmetic improvement. At 1‐year follow‐up, no recurrence of lateral prominence of the distal lower leg has been observed. There was no difference in ankle range of motion between the left and right sides. The patient reported no pain and was able to participate in sports activities. In patients with preserved ankle function and few complaints about their daily activities, waiting until skeletal maturity and removing only the affected area may provide sufficient outcomes without risking growth potential or ankle function in the treatment of congenital distal tibiofibular synostosis.

Background and ObjectivesLeigh syndrome is an important manifestation of childhood-onset primary mitochondrial disease. Panel sequencing and whole exome sequencing are cost-effective for diagnosing mitochondrial diseases; however, more than half of mitochondrial disease cases remain genetically undiagnosed. This study aimed to demonstrate that combining whole genome sequencing (WGS) and RNA sequencing (RNA-seq) analyses can identify disease-causing variants that would otherwise be missed.MethodsWe performed WGS and RNA-seq on a patient with Leigh syndrome. Chromosomal phasing using Sanger sequencing of parental and patient blood samples was conducted to confirm compound heterozygous variants. RNA-seq data were analyzed for splicing abnormalities. Overexpression studies of wild-type NDUFA3 in patient-derived fibroblasts were performed to assess restoration of mitochondrial function.ResultsWe discovered compound heterozygous intronic variants (c.86-16_86-15del in intron2 and c.164-362G>A in intron3) of the NDUFA3 gene. RNA-seq data analysis revealed intron retention and exonization in NDUFA3. Exonization was related to a variant involving the mobile element Alu that resulted in complex abnormal splicing events. Overexpression of wild-type NDUFA3 restored mitochondrial dysfunction in patient-derived fibroblasts, confirming NDUFA3 as a Leigh syndrome causative gene.DiscussionThis study highlights the importance of combining WGS and RNA-seq and provides new insights into detecting abnormalities in deep intronic regions, particularly those involving mobile elements, such as Alu. This approach can play a crucial role in identifying genetic variations and elucidating transcriptional control mechanisms that are not readily achieved by conventional methods, especially in the context of mobile element-induced complexities.

Surgery remains the mainstay of treatment for retroperitoneal sarcoma (RPS); however, definitive therapeutic strategies for patients with insufficient surgical margins and unresectable disease owing to locally advanced RPS remain unclear. Carbon ion radiotherapy (CIRT) has been employed in patients with unresectable RPS. This study aimed to evaluate the effectiveness of CIRT in this patient population. A retrospective analysis was conducted in 76 patients with unresectable RPS treated with CIRT. Of these, 95% had a confirmed prognosis until 2022. In 74 patients, the prescribed relative biological effectiveness dose was 70.4 Gy, delivered in 16 fractions over 4 weeks. Respiratory gating was used, and spot scanning irradiation has been performed in all patients since 2016. The 3- and 5-year overall survival rates for the entire cohort were 68.3% and 49.4%, respectively, with a median overall survival time of 58.1 months. The 3- and 5-year local control rates were 79.0% and 72.0%, respectively. Among 47 naïve patients with treatment-naïve tumors, the 3- and 5-year abdominal recurrence-free survival rates were 51.1% and 29.1%, respectively. Late adverse events of grade 3 or higher occurred in 4 (5.2%) patients. CIRT represents a definitive treatment option for patients with unresectable RPS. In the future, multicenter studies should be conducted to evaluate the effectiveness of CIRT for RPS in larger patient cohorts.

We sought to examine long-term results of the total cavopulmonary connection with an extracardiac lateral tunnel using expanded polytetrafluoroethylene graft and the outside of right atrial wall, with special attention to angiographic evaluation of serial changes of the tunnel geometry. Of 113 patients subjected to the Fontan operation between April 2003 and April 2022, 65 patients who opted for the extracardiac lateral tunnel technique were retrospectively analyzed. Of these, 35 patients who had at least two postoperative catheterizations (mean 0.7 ± 0.4 and 6.6 ± 3.5years post-op) were analyzed for changes in tunnel diameter. There was one case (1.5%) of 30-day death, and three late deaths. The cumulative survival rate at 14years after the surgery was 91.2%. There was one case (1.5%) which required conversion to total cavopulmonary connection with an extracardiac conduit. Angiographically, Fontan route diameter increased significantly at both the level of inferior vena cava anastomosis (11.0 ± 2.4 to 14.9 ± 3.4mm, P < 0.001), the middle level of Fontan route (11.0 ± 2.5 to 12.9 ± 3.2mm, P < 0.001), and the level of pulmonary artery anastomosis (10.0 ± 2.5 to 13.6 ± 4.9mm, P < 0.001), whereas the diameter indexed to the normal inferior vena cava remained over 100%. Long-term results of the Fontan operation with extracardiac lateral tunnel using half cut expanded polytetrafluoroethylene graft and outside of the right atrium were favorable. Proportional increase of conduit size was demonstrated, suggesting a potential of the conduit to grow and that the growth might correlate with somatic growth.

BackgroundCorticosteroids (CSs) are widely used to treat autoimmune diseases, allergic conditions, and cancers, but they are often associated with psychiatric side effects, such as insomnia, anxiety, depression, mania, and psychosis. Comprehensive evaluations of psychiatric risks, including acute and long-term effects, as well as their associations with dose and cumulative exposure, remain limited. Understanding these relationships is crucial for optimizing therapeutic strategies and minimizing psychiatric risks.Aims & ObjectivesThis study aimed to systematically evaluate the psychiatric risks associated with corticosteroid use, focusing on both acute and long-term settings. The primary objectives included assessing the risks of depression, mania, and psychosis, and examining their associations with dose, and duration.MethodA systematic literature search was conducted in MEDLINE and Embase databases up to March 22, 2024, using keywords related to corticosteroids and psychiatric symptoms. Observational studies with clearly defined psychiatric outcomes and quantifiable data were included. Data were analyzed using a random-effects model, and heterogeneity was assessed with the I² statistic. For studies reporting multiple non-independent outcomes, we conducted a three-level meta-analysis to account for the dependency between effect sizes within studies. In addition, qualitative data were synthesized to explore patterns of symptom progression and their relationship with treatment characteristics. The risk of bias was evaluated using the Newcastle-Ottawa Scale.ResultsA total of 69 studies were included, comprising cross-sectional, cohort, pre-post, case-control, and other observational study designs. The three-level meta-analysis of depressive symptoms, based on six studies with seven groups and 10 effect sizes, revealed a pooled standardized mean difference (SMD) of 1.01 (95%Confidence Interval (CI)=0.40–1.61, p<0.01) with significant heterogeneity (I²=84%). Six acute-phase studies on mania and depressive symptoms demonstrated that mania was more frequently reported than depressive symptoms, with a pooled odds ratio (OR) of 2.37 (95%CI=1.52–3.69, p<0.01) and low heterogeneity (I²=0%). For psychosis, a meta-analysis of six studies reported a pooled proportion of 3.0% (95%CI=1.0%–8.6%), with high heterogeneity (I²=92%) indicating variability across studies. Qualitative assessments suggested that high doses and prolonged use of CSs were consistently associated with an increased risk of psychiatric symptoms. Acute symptoms, such as mania and psychosis, were often reported within 3–14 days of treatment initiation, whereas depressive symptoms were more frequently associated with long-term exposure.Discussion & ConclusionsThis meta-analysis highlighted the differential risks of psychiatric symptoms associated with CS use. Mania and psychosis were more frequent during acute treatment, particularly at high doses, while depression was predominantly observed in long-term use. These findings underscore the importance of early monitoring and individualized treatment strategies, especially for patients receiving high-dose or prolonged CS treatment. The high heterogeneity observed in studies on depression and psychosis reflects the complexity of these risks and the need for further research to explore contributing factors. This study provides new insights into the dose- and time-dependent effects of CS-induced psychiatric symptoms, offering effective risk management strategies.