Hyogo Social Welfare Corporation

To identify differences in severe pain levels during prepregnancy to four months postpartum among groups along with risk factors for residual pain early in pregnancy. We examined 298 patients who participated in the questionnaire. Pain intensity was evaluated using a numerical rating scale (NRS) monthly postpartum. Four patterns emerged: recovery group (n = 200), with NRS 0-3 at 4 months postpartum; keep-high group (n = 20), with NRS ≥ 6 every month after delivery; worse group (n = 28), where NRS increased ≥ 3 during months 1-4; and mixed group (n = 50). Age, body mass index (BMI), history of back pain, breastfeeding, feeding posture, depression, and postpartum stress factors were compared. Overall, 15% patients had pain with NRS ≥ 4 before pregnancy and 33% at 4 months postpartum. NRS score of the keep-high group was the highest (4.18) before pregnancy, with a distinctive pain pattern. For participants with NRS ≥ 4 before pregnancy, the odds ratio of NRS ≥ 7 in the final month was 5.56 [95% confidence interval: 2.52-12.58, p < 0.001]. All three groups compared with the recovery group demonstrated significant differences in the questionnaires for depression (p < 0.01) and postpartum stress factors (p < 0.05). The combination of lower back and back pain was an early indicator of severe postpartum pain. Higher NRS scores before pregnancy and at multiple pain sites are early indicators of severe postpartum pain. All three groups, except the recovery group, showed a tendency for depression. However, the mixed group exhibited features similar to the recovery group.

• Simple respiratory training and management systems are required. • Visual respiratory biofeedback enhanced and reinforced respiratory awareness. • An infrared rangefinder can measure abdominal excursions externally without contact. This study aimed to verify whether abdominal excursion during diaphragmatic breathing is associated with real-time ventilation volume and whether visual respiratory biofeedback using an abdominal excursion-measuring device (AEMD) effectively increases ventilation volume. An AEMD and expiratory gas analyzer were used to simultaneously measure the maximum abdominal excursion (AE-max) and maximum inspiratory volume (IV-max), respectively, in 42 healthy adults under two conditions, with or without respiratory biofeedback, with visualization of the AEMD waveform (with-BF or no-BF). The results indicated a significant association between AE-max and IV-max (r = 0.456, P = 0.002). The estimated marginal mean ± SE of the IV-max significantly differed between the with-BF and no-BF conditions at 2350 ± 101 and 2274 ± 100 mL, respectively (mean difference [95 % confidence interval] = 76.3 [4.3, 148.3], p = 0.038, Cohen’s d = 0.338). Therefore, real-time abdominal excursion movements may help estimate ventilation volume, whereas real-time visual respiratory biofeedback with AEMD may increase ventilation volume. With further research, the visual respiratory biofeedback of abdominal excursion movements using AEMD is expected to be effective when respiratory visualization is required, such as during respiratory training.

To investigate factors associated with symptomatic urinary tract infection (sUTI) in persons with chronic spinal cord lesion (SCL) who were using single-use catheters for intermittent self-catheterization (ISC). Among respondents to an internet survey on the burden of illness on persons with SCL who were considered to be able to perform ISC, 111 persons using single-use catheters were included to examine factors associated with self-reported sUTI by univariate as well as multivariable analysis. The incidence of sUTI was significantly higher in males than in females (56.9% vs. 31.6%, p = .011), persons with stocks of antibiotics than those without it (82.9% vs. 28.6%, p < .011), and persons with more frequent bleeding during catheterization than those with less frequent bleeding (100% vs. 46.5%, p = .036). The incidence did not significantly differ between respective groups when various variables were evaluated by other characteristics of the participants, adherence to ISC procedures, and complications. On multivariable analysis, male gender and stocks of antibiotics were significant independent factors for sUTI. Male gender and stocks of antibiotics were associated with sUTI in persons with SCL who were performing ISC with single-use catheters.

Neuropsychiatric symptoms (NPS) in patients with dementia lead to caregiver burdens and worsen the patient's prognosis. Although many neuroimaging studies have been conducted, the etiology of NPS remains complex. We hypothesize that brain structural asymmetry could play a role in the appearance of NPS. This study explores the relationship between NPS and brain asymmetry in patients with Alzheimer's disease (AD). Demographic and MRI data for 121 mild AD cases were extracted from a multicenter Japanese database. Brain asymmetry was assessed by comparing the volumes of gray matter in the left and right brain regions. NPS was evaluated using the Neuropsychiatric Inventory (NPI). Subsequently, a comprehensive assessment of the correlation between brain asymmetry and NPS was conducted. Among each NPS, aggressive NPS showed a significant correlation with asymmetry in the frontal lobe, indicative of right-side atrophy (r = 0.235, p = 0.009). This correlation remained statistically significant even after adjustments for multiple comparisons (p < 0.01). Post-hoc analysis further confirmed this association (p < 0.05). In contrast, no significant correlations were found for other NPS subtypes, including affective and apathetic symptoms. The study suggests frontal lobe asymmetry, particularly relative atrophy in the right hemisphere, may be linked to aggressive behaviors in early AD. These findings shed light on the neurobiological underpinnings of NPS, contributing to the development of potential interventions.

Older participants identified as having decreased physical activity according to the Japanese version of the Cardiovascular Health Study criteria did not show a significant reduction in accelerometer-measured physical activity. Despite its widespread use in Japanese studies, the Japanese version of the Cardiovascular Health Study physical activity questionnaire may not effectively capture declines in physical activity.

Both skeletal muscle mass and muscle quality are important predictors of poor prognosis in older patients. However, the effects of muscle mass and muscle quality estimated by the phase angle (PhA) on functional outcomes in older patients undergoing rehabilitation have yet to be reported. This study aimed to investigate whether appendicular skeletal muscle index (SMI) and muscle quality estimated by PhA were independently associated with activities of daily living (ADL) and physical function in older patients undergoing rehabilitation. This prospective cohort study included older patients in a subacute rehabilitation hospital (n = 443). Baseline SMI and PhA were measured using bioelectrical impedance analysis, and low SMI or low PhA were determined using each cutoff value. The primary outcomes were ADL abilities measured using the functional independence measure for motor function (FIM-M) score and physical function measured using the short physical performance battery (SPPB) score at hospital discharge. Association between low SMI and low PhA and FIM-M or SPPB scores at discharge were determined using multiple regression analysis adjusted for confounding factors. There were significant differences between the normal- and low-PhA groups in the FIM-M and SPPB scores at discharge (P < 0.001). In multiple regression analysis, low PhA was independently associated with FIM-M (β = -0.109, P = 0.013) and SPPB scores (β = 0.535, P < 0.001) at discharge; however, low SMI was not independently associated with these functional outcomes. Decreased muscle quality estimated by the PhA was independently associated with poor ADL abilities and poor physical function in older patients undergoing rehabilitation.

Gait-balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH). However, the rehabilitation effects of cerebrospinal fluid (CSF) shunting along with other treatment or no further treatment (natural course [NC]) for iNPH are unknown. This study evaluated whether dynamic equilibrium gait training (DEGT) can improve gait-balance functions after CSF shunting of patients with iNPH compared to standard exercise (SE) and NC. Furthermore, it investigated the incidence of falls. A total of 70 patients with iNPH who underwent CSF shunting were randomly assigned to 6weeks of DEGT (n = 23), 6weeks of SE (n = 23), or NC (n = 24). Evaluation was performed at baseline (preoperatively) and at 1week, 7weeks (postintervention), and 6months postoperatively (follow-up). Outcomes were measured using the functional gait assessment (FGA), 10-m walk test, timed up-and-go test, life-space assessment (LSA), and fall incidence. A total of 65 participants completed the study. During the intention-to-treat analysis, the DEGT group demonstrated significant recovery of gait-balance functions according to only the FGA at postintervention and follow-up compared to the SE and NC groups; however, recovery of the SE group did not differ from that of the NC group. The DEGT group had a significantly lower fall incidence than the other groups at follow-up. Significantly better LSA results were observed for all groups at follow-up compared to baseline; however, no difference in LSA results were observed between groups. DEGTin addtion toCSF shunting can facilitate the recovery of gait-balance function and reduce the fall incidence of iNPH patients.

Abstract BackgroundIdiopathic normal pressure hydrocephalus (iNPH) is a slowly progressive syndrome caused by the excessive accumulation of cerebrospinal fluid and is typically characterized by the triad of cognitive, gait, and urinary disturbances and ventricular dilation. In addition to this triad of symptoms, apathy is frequently observed in iNPH and worsens the cognitive impairment and gait disturbance. Although apathy is an important symptom in iNPH, its neurological basis remains unknown.ObjectivesThis study aimed to analyze and elucidate the brain regions associated with apathy in iNPH using statistical imaging analysis and to investigate regional cerebral blood flow and regional gray matter volume, which indicates gray matter compression, in a whole-brain study.MethodsTwenty seven patients with iNPH were assigned to two groups based on their scores on the Neuropsychiatric Inventory items related with apathy; 18 patients were assigned to the group with apathy (iNPH + APA) and 9 to the group without apathy (iNPH - APA). The magnetic resonance images and cerebral blood flow single-photon emission computed tomography data of the two groups were compared using statistical parametric mapping 12. ResultsThe regional gray matter volume of the right precuneus was significantly larger in the iNPH + APA group than in the iNPH − APA group, but the and regional cerebral blood flow in any region of the brain was not significantly different between the two groups.ConclusionThese results suggested that compression of the precuneus might be involved in apathy in iNPH and the importance of brain compression in iNPH symptoms. In addition, this study also shows that VBM is useful for indicating the degree of brain compression.

Fundic gland polyps (FGPs) are the most frequent gastric polyps and have long been thought to be benign lesions with limited malignant potential, except in the setting of familial adenomatous polyposis. However, the prevalence of FGPs has risen in recent years, paralleling the widespread and frequent use of proton pump inhibitors (PPIs). There have been a few reports of sporadic FGPs with dysplasia or carcinoma (FGPD/CAs) so far. In this review, we aimed to evaluate the clinical and endoscopic characteristics of sporadic FGPD/CAs and propose a management strategy of sporadic FGPs. The majority of patients with sporadic FGPD/CAs were middle-aged women on PPI medication who were not infected with Helicobacter pylori (H. pylori). The majority of sporadic FGPD/CAs were sessile and tiny, with a mean size of 5.4 mm, and occurred in the gastric body. During white light observation, the sporadic FGPs with cancer displayed redness, irregular surface structure, depression, or erosion, and irregular microvessels on the lesion surface during magnification narrow-band imaging. Furthermore, even with dysplasia, sporadic FGPs are likely to proceed slowly to malignancy. As a result, patients with sporadic FGPs do not require frequent endoscopy. If endoscopic findings other than conventional FGPs are found, regardless of their size, histological investigation is required. The prevalence of FGPs is projected to rise in the future, owing to the widespread and frequent use of PPIs and the decreasing H. pylori infection rate. It is currently unknown whether FGPD/CAs will increase at the same rate as FGPs. However, the patterns of these lesions suggest that they should be studied more in the future.