Japanese Red Cross Kanazawa Hospital

The authors declare no conflicts of interest. Research data are not shared.

ObjectivesHome discharge is a crucial goal for stroke patients in convalescent rehabilitation wards. While previous studies have identified relationships between Functional Independence Measure (FIM) scores and home discharge outcomes using conventional statistical methods, these analyses have limitations in visualizing combinations of independent FIM items. This study aimed to identify combinations of independent motor FIM items associated with home discharge in stroke patients using UpSet plots.MethodsWe analyzed 205 stroke patients admitted to a convalescent rehabilitation ward between April 2018 and March 2021. Independence in motor FIM items was defined as a score of 6 or higher. We used UpSet plots to visualize combinations of independent motor FIM items at discharge and identified major combinations (occurring in >7% of cases) in the home discharge group.ResultsAmong 136 patients discharged to home, four major combinations of independent motor FIM items were identified: independence in all 13 items (22 patients, or 16.2%), independence in 12 items excluding stairs (18 patients, or 13.2%), independence in 10 items excluding bathing, tub transfer, and stairs (14 patients, or 10.3%), and dependence in all items (11 patients, or 8.1%). These combinations accounted for 47.8% of home discharge cases.ConclusionsThe visual analysis using UpSet plots revealed that, while higher levels of activities of daily living (ADL) independence increased the likelihood of home discharge, complete independence was not required. Dependence on specific items, such as bathing, tub transfer, and stairs, could be compensated through care services and environmental modifications. These findings provide practical insights for developing rehabilitation strategies and discharge planning.

Differential diagnosis of pancytopenia with bone marrow (BM) hypoplasia represented by aplastic anemia (AA) is often challenging for physicians, because no laboratory tests have been established, until recently, to distinguish immune-mediated BM failure, which includes acquired AA (aAA) and a subset of low-risk myelodysplastic syndrome (MDS), from non-immune BM failure, which is primarily caused by genetic abnormalities in hematopoietic stem cells (HSCs). HSCs of healthy individuals often undergo somatic mutations, and some acquire phenotypic changes that allow them to escape immune attack against themselves. Once an immune attack against HSCs occurs, HSCs that undergo somatic mutations survive the immune attack and continue to produce their progenies with the same genetic or phenotypic changes. The presence of mature blood cells derived from mutated HSCs in the peripheral blood serves as evidence of the immune-mediated destruction of HSCs. Glycosylphosphatidylinositol-anchored protein-deficient (GPI[-]) blood cells and HLA class I allele-lacking (HLA[-]) leukocytes are two major aberrant cell types that represent the immune mechanism underlying BM failure. This review focuses on the importance of identifying immune mechanisms using laboratory markers, including GPI(-) cells and HLA(-) leukocytes, in the management of BM failure.

Since 2013, equine-like G3 rotavirus (eG3) strains have been detected throughout the world, including in Japan, and the strains were found to be dominant in some countries. In 2016, the first eG3 outbreak in Japan occurred in Tomakomai, Hokkaido prefecture, and the strains became dominant in other Hokkaido areas the following year. There were no significant differences in the clinical characteristics of eG3 and non-eG3 rotavirus infections. The eG3 strains detected in Hokkaido across 2 years from 2016 to 2017 had DS-1-like constellations (i.e. G3-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2), and the genes were highly conserved (97.5-100 %). One strain, designated as To16-12 was selected as the representative strain for these strains, and all 11 genes of this strain (To16-12) exhibited the closest identity to one foreign eG3 strain (STM050) seen in Indonesia in 2015 and two eG3 strains (IS1090 and MI1125) in another Japanese prefecture in 2016, suggesting that this strain might be introduced into Japan from Indonesia. Sequence analyses of VP7 genes from animal and human G3 strains found worldwide did not identify any with close identity (>92 %) to eG3 strains, including equine RV Erv105. Analysis of another ten genes indicated that the eG3 strain had low similarity to G2P[4] strains, which are considered traditional DS-1-like strains, but high similarity to DS-1-like G1P[8] strains, which first appeared in Asia in 2012. These data suggest that eG3 strains were recently generated in Asia as mono-reassortant strain between DS-1-like G1P[8] strains and unspecified animal G3 strains. Our results indicate that rotavirus surveillance in the postvaccine era requires whole-genome analyses.

An amendment to this paper has been published and can be accessed via the original article.

BackgroundAtypical fractures may occur due to the combined effect of severely suppressed bone turnover (SSBT) caused by long-term bisphosphonate treatment and chronic repetitive bone microdamage. Atypical fracture of the ulna due to SSBT is a rare entity; there is no standardized treatment strategy for this condition. We successfully treated a patient with atypical fracture of the ulna. Herein, we present this patient, review the relevant literature, and discuss the treatment strategy.Case presentationAn 84-year-old woman presented with atypical fracture of the left ulnar shaft due to SSBT. She had a history of bisphosphonate therapy (ibandronate and alendronate) since more than 10 years; her bone turnover was severely suppressed. We performed open reduction and internal fixation (ORIF) using dual plate with some additional treatments. These included drilling and decortication, use of autogenous bone graft, low-intensity pulsed ultrasound (LIPUS) treatment, and administration of teriparatide. Finally, bone union was observed at 11 months after surgery.ConclusionsBased on the literature review and our experience with this case, ORIF alone may not be adequate to achieve bone union; drilling, decortication, and use of cancellus bone graft is important to achieve favorable outcomes. Administration of teriparatide and LIPUS may facilitate early bone union, although further studies are required to provide more definitive evidence. Furthermore, ORIF using dual plate may help avoid implant failure owing to the long time required for bone union.

None declared.

In recent years, the intervention of pharmacists in the proper use of eye drops in the elderly has led to improved adherence. It is also said to have been effective in preventing postoperative complications, preventing infections and avoiding adverse events. However, confirmation of eye drops adherence is subjective patient information. For this reason, it is often impossible to confirm the actual procedure, and it is not clear whether it was used correctly. Therefore, we conducted questionnaire surveys of patients undergoing cataract surgery to confirm the instillation status. In addition, we measured the weight of the ophthalmic solution after use and considered the relationship with the questionnaire. The subjects of the questionnaire were elderly people aged over 70 years old. The eye drops techniques were the upper and lower opening method (44.3％), the lower eyelid drooping method (42.3％), and others (13.4％). Subjects replied that they were generally properly instilled. As a result of measuring the solution weight, the actual value of the Moxifloxacin ophthalmic solution was significantly less than the appropriate value (P < 0.01). In addition, as a result of multivariate analysis, the factor that decreased the eye drops weight by more than 5％ was the patient who answered, “I can't apply well” (OR: 5.98, 95％CI: 1.31 - 35.29, P = 0.021). The subjective information of the elderly may be unreliable. Therefore, we need to conduct detailed interviews about the situation of instillation. In addition, training of techniques and periodic re-evaluation will lead to optimization and improvement of eye drops adherence.

There has been no specific study on the quantitative morphological changes that occur in the infrapatellar fat pad (IPFP) after anterior cruciate ligament (ACL) reconstruction. We used ultrasonography to evaluate the dynamics of the IPFP in knees after ACL reconstruction using the contralateral knees as controls. We enrolled 31 patients 3months after they underwent ACL reconstruction. The thickness of the superficial part of the IPFP was measured using longitudinally oriented ultrasound images of the anterior part of both knees at 90° and 10° flexion. We then used these data to calculate the ratio of the change in thickness. At 90° knee flexion, the superficial part of the IPFP was significantly thinner in the reconstructed knees (9.3 ± 3.4mm) than in the contralateral knees (11.8 ± 4.6mm). The thickness change ratio was significantly smaller in the reconstructed knees (188.6 ± 64.7%) than in the contralateral knees (249.7 ± 73.8%). When assessed 3months after ACL reconstruction, the thickness of the superficial part of the IPFP at 90° knee flexion and the thickness change ratio of the IPFP were both significantly lower in the reconstructed knees than in the contralateral knees.