Misasa Onsen Hospital

The Coronal Plane Alignment of the Knee (CPAK) is a classification that evaluates the joint line obliquity (JLO) and hip-knee-ankle angle (HKA) in osteoarthritis of the knee. The primary aim of this study was to evaluate whether changes in CPAK classification between pre- and postoperative states in patients who underwent robotic-assisted (RA) bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) with a 3-degree varus inclination affected patient reported outcome measurements (PROMs). This retrospective study involved 149 patients treated with bi-cruciate stabilized (BCS) TKA between 2019 and 2023 following a physiological alignment strategy and using image-free robotic-assisted (RA) technique. Pre- and postoperative CPAK classifications were compared, along with changes in arithmetic HKA (aHKA), JLO, and PROMs including the 2011 Knee Society Score, Western Ontario and McMaster Universities Arthritis Index score, Forgotten Joint Score 12, and Patella score were collected at a mean 1.95years (range:1-5) postoperatively. CPAK classification matched pre and postoperatively in 59.1% of cases. Regardless of CPAK classification matching, there were no significant differences in any of these PROMs. aHKA matching was observed in 71.8% of cases, and JLO matching in 81.2%. Comparisons of changes in aHKA and JLO also revealed no significant differences in PROMs. Robotic-assisted "Physiological alignment" BCS TKA with 3-degree varus inclination does not affect PROMs, regardless of pre-arthritic CPAK classification matching. The pre- and postoperative CPAK classifications do not always correspond accurately.

A 60-year-old man with a history of radiation therapy 28 years ago for a benign disease (an aneurysmal bone cyst) was admitted with dyspnea and dysphagia. Computed tomography showed an 8-cm tumor invading the trachea and esophagus. His condition declined rapidly, and he died on day 27 of hospitalization. Autopsy revealed radiation-induced osteosarcoma. Radiation-induced sarcoma can develop even after radiotherapy for benign diseases, in which case the latency period might be longer. Furthermore, the prognosis depends on the location of the resectable tumor. Therefore, longer-term internal imaging follow-up should be performed after radiotherapy for benign diseases to detect early-stage sarcoma.

Evaluasi program dalam layanan bimbingan konseling biasanya dilakukan oleh guru bimbingan konseling. Proses evaluasi program dilakukan untuk melihat program yang perlu dikembangkan dan perbaikan program bimbingan konseling. Penelitian ini bertujuan untuk membahas evaluasi program layanan bimbingan dan konseling di SMA N 2 Takengon. Motode penelitian menggunakan jenis penelitian deskriptif kualitatif. Teknik pengumpulan data melalui wawancara, observasi, dan dokumentasi. Data primer diperoleh dari guru Bimbingan Konseling di sekolah tersebut dan data sekunder dari hasil telaah, buku, referensi atau dokumentasi . Hasil penelitian menemukan bahwa evaluasi program bimbingan konseling dilakukan dua kali dalam setahun, dengan fokus pada capaian melalui penilaian Laiseg, Laijapen, Laijapang dan kendala yang dihadapi dalam evaluasi program BK yaitu keterbatasan waktu serta upaya guru BK dalam mengatasi kendala dalam proses evaluasi program BK. Kesimpulan bahwa evaluasi program bimbingan konseling memberikan gambaran yang jelas tentang pencapaian program bimbingan konseling serta area yang perlu ditingkatkan dalam meningkatkan program bimbingan untuk masa depan yang akan datang untuk perkembangan peserta didik

This study focused on mental health and fatigue in elite university student-athletes competing in badminton at the national level, comparing them with control university students and examining related factors. Among university athletes, anxiety and depression showed a moderately negative correlation with life satisfaction outside of sports, as determined by partial correlation tests adjusted for fatigue. Athletes demonstrated a 47% rate of anxiety and a 30% rate of depression. These values showed no significant difference from those of the anxiety (29%) and depression (21%) rates in a non-athlete university student sample. In addition, this study suggested that the evaluation of fatigue using a checklist of individual strength might produce low reliability and validity for elite university student-athletes in badminton. These exploratory findings highlight the importance of focusing on athletes’ overall life satisfaction and suggest the potential need for effective mental health interventions beyond sports. However, because of the exploratory nature of this study and the small sample size, further research is necessary to confirm these results.

Protein-energy wasting (PEW) is a common syndrome in patients undergoing haemodialysis (HD) and is associated with poor prognosis. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is useful for predicting PEW, but sex and age need to be considered. We aimed to reveal sex-specific cut-off values of PA predicting PEW in HD patients aged ≥65. This two-centre retrospective cohort study included patients on HD who underwent BIA. PEW was detected using the International Society of Renal Nutrition and Metabolism (ISRNM) criteria as a reference. The PA was measured using a multifrequency bioimpedance device. Sex-specific cut-off values of PA predicting PEW were detected by receiver-operator characteristic analysis. We investigated the association between PEW determined using sex-specific cut-off values for PA and all-cause mortality. This study included 274 patients undergoing HD, with a median age of 75 (70-80) years, mean PA of 3.8 ± 1.1° and PEW of 43%. Over a median follow-up duration of 1095 (400-1095) days, 111 patients died. Cut-off values of PA predicting PEW were as follows: female, 3.00° (sensitivity, 87.3%; specificity, 77.5%), and male, 3.84° (sensitivity, 77.6%; specificity, 71.4%). The kappa coefficient between sex-specific cut-off values of the PA and ISRNM criteria had a moderate coincidence level of 0.55. PEW detected by PA was independently associated with all-cause mortality (hazard ratio: 2.40; 95% confidence interval: 1.51-3.85; p < .001). Sex-specific cut-off values for PA in older HD patients may be useful as a screening tool for predicting PEW and mortality.

Background:In recent years, sodium-glucose cotransporter 2 (sGLT2) inhibitors, a new treatment for diabetes mellitus (DM), are associated with an increased risk of urinary tract infections, particularly in older patients and women[1]. While 20% of patients with rheumatoid arthritis (RA) also require DM treatment[2], the impact of infection risk concerns on their treatment choices, especially in the context of risk, including glucocorticoids (GCs) and immunosuppressive drugs, remains unclear.Objectives:To analyze the transition in DM treatment among Japanese patients with RA complicated since the launch of sGLT2 inhibitors, utilizing an administrative claims database.Methods:Our study had a cross-sectional design and used data from the Medical Data Vision (MDV) hospital database (2015–2023). Patients were included if they had: 1) one or more claims for RA (ICD-10 code M05, 06) with prescribed disease-modifying anti-rheumatic drugs (DMARDs); 2) one or more claims for DM (ICD-10 code E11, 12, 13, 14 and N18) with prescribed anti-diabetic agents. Patients treated with insulin or diagnosed with type 1 DM were excluded. Data from January through March of each year (2015-2023) was used to assess annual patient characteristics (age, sex) and medication usage for RA and DM.Results:Of the 534,189 patients with one or more claims for RA, 5766 patients met inclusion criteria in 2023. In 2023, the median age of the enrolled patients in 2023 was 74 years (interquartile range [IQR], 67-80), with 59% (3394 patients) being female. The most commonly used antidiabetic agents were dipeptidyl peptidase 4 (DPP4) inhibitors (37%), biguanide (21%), and sGLT2 inhibitors (20%). The use of sGLT2 inhibitors increased (from 0.3% in 2015 to 20% in 2023), while the use of DPP4 inhibitors and sulfonylureas decreased (DPP4 inhibitors from 41% in 2015 to 37% in 2023; sulfonylurea from 16% in 2015 to 5% over the same period) (Figure 1).DDP4 inhibitors was used more frequently in patients with glucocorticoids (GCs) compared to those without (40% in the patients with GCs and 34% in those without), while sGLT2 inhibitors was used less frequently (19% in the patients with GCs and 21% in those without) (Figure 2).Conclusion:The increasing use of sGLT2 inhibitors in RA patients with DM highlights a need for further evaluation of their safety.REFERENCES:[1] Lin Y-H, Lin C-H, Huang Y-Y, et al. Risk factors of first and recurrent genitourinary tract infection in patients with type 2 diabetes treated with SGLT2 inhibitors: A retrospective cohort study. Diabetes Res Clin Pract 2022;186:109816.[2] Albrecht K, Luque Ramos A, Hoffmann F, et al. High prevalence of diabetes in patients with rheumatoid arthritis: results from a questionnaire survey linked to claims data. Rheumatology 2018;57:329–36.Figure 1.Figure 2.Acknowledgements:NIL.Disclosure of Interests:None declared.