Nadogaya Hospital

Branch atheromatous disease (BAD) often progresses during the acute phase. During acute rehabilitation, clinicians should prioritize monitoring neurological symptom progression. We treated a patient with right-sided, finger-limited motor paralysis and frequent transient motor paralysis fluctuations due to BAD by implementing early upper-limb occupational therapy while maintaining rigorous risk management. Occupational therapy included standard upper limb functional training, continuous neuromuscular electrical stimulation, and repetitive facilitation exercises. During occupational therapy, blood pressure was carefully monitored, and neurological symptoms were regularly assessed. Any symptom changes were promptly communicated among occupational therapists, rehabilitation specialists, and neurosurgeons. Although transient motor paralysis occurred five times, timely treatment, including medication adjustments, prevented further neurological deterioration. Additionally, upper-limb function and object manipulation ability improved over time. Risk management is critically important in occupational therapy for acute BAD. This case demonstrated that repetitive facilitation exercises combined with continuous neuromuscular electrical stimulation can be safely initiated in the early stages of stroke, potentially improving upper limb dysfunction.

This study aimed to clarify the trends in the prevalence of knee osteoarthritis (OA) and symptomatic knee OA among the general population using population-based cohort data from baseline and a survey 10 years later. The baseline survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted from 2005 to 2007; 3040 participants (1061 men and 1979 women; mean age 70.3 years) completed all OA examinations, including a questionnaire of medical information in the present/past and radiographic examination. The fourth survey was performed from 2015 to 2016; 2893 individuals (895 men and 1998 women, mean age 68.9 years) completed assessments identical to those at the baseline survey. Knee OA was defined using the Kellgren-Lawrence grading system. The prevalence of knee OA was 54.6​% (men, 42.0​%; women, 61.5​%) at the baseline survey and 39.3​% (men, 26.9​%; women, 44.9​%) at the fourth survey, with a significant decrease (p​<​0.0001). The prevalence of symptomatic knee OA was 24.3​% (men, 16.9​%; women, 28.3​%) at the baseline survey and 20.6​% (men, 14.2​%; women, 23.5​%) at the fourth survey, showing a similar decrease (p​<​0.0001). Thus, the prevalence of knee OA and symptomatic knee OA was lower at the fourth survey than at the baseline survey (p​<​0.01). In the population-based survey with a 10-year interval, the prevalence of knee OA and symptomatic knee OA decreased significantly. This preferable change in OA may suggest rejuvenation in the current population and could contribute to a decrease in the occurrence of disabilities in the future.

Osteoanabolic drugs are sometimes prescribed off-label for "fracture healing and spinal fusion." This study examines the scientific validity of such practices by analyzing existing clinical reports. The purported bone union-promoting effect of teriparatide in fracture cases has been refuted in clinical trials. While teriparatide shows efficacy in accelerating spinal fusion after surgery for patients with osteoporosis, there is no scientific justification for its off-label use in patients without osteoporosis. For osteoporosis patients, no clear evidence suggests that teriparatide is superior to antiresorptive drugs, making the rationale for switching from antiresorptive drugs to teriparatide weak. The efficacy in postoperative spinal fusion may primarily be attributed to systemic improvements in bone quality and quantity, enhancing the mechanical engagement of implants. The clinical evidence for the off-label use of romosozumab, another osteoanabolic drug, in fracture healing and spinal fusion is insufficient to support its efficacy. In conclusion, osteoanabolic drugs, like antiresorptive drugs, primarily have systemic functions in osteoporosis patients, with limited evidence supporting their role in promoting localized bone formation in fractures or spinal fusions.

O presente artigo tem por escopo trazer à baila o conflito de direitos entre a prerrogativa do indivíduo transexual/transgênero de utilizar seu nome social inclusive para fins de registro post mortem, de forma que conste em seus obituários e em sua lápide, e a vontade da família desse indivíduo de utilizar o nome originariamente elegido para fins de registro civil para realização de seu sepultamento. Tais desdobramentos podem acarretar diversas repercussões no âmbito do indivíduo transgênero, pois o debate encontra-se vinculado à legitimidade do uso de seu nome social para fins de registro em conflito com a vontade de sua família no momento posterior à sua morte. A metodologia utilizada para análise do tema é a pesquisa de jurisprudência nacional e dos conceitos jurídicos trazidos pela doutrina para entender como se dá o exercício do direito ao uso do nome, enquanto direito da personalidade e direito fundamental do indivíduo trans, bem como suas diversas repercussões na esfera civil. O objetivo aqui é responder à pergunta: qual direito deve prevalecer, o direito do indivíduo de utilizar seu nome social após a morte ou o direito da família de realizar o sepultamento conforme sua própria vontade? Da mesma forma, o presente trabalho possui o objetivo de apresentar possíveis dispositivos e ferramentas jurídicas a serem utilizados para garantir o exercício do direito ao uso do nome social.

Odorants are detected by olfactory sensory neurons, which are covered by olfactory mucus. Despite the existence of studies on olfactory mucus, its constituents, functions, and interindividual variability remain poorly understood. Here, we describe a human study that combined the collection of olfactory mucus and olfactory psychophysical tests. Our analyses revealed that olfactory mucus contains high concentrations of solutes, such as total proteins, inorganic elements, and molecules for xenobiotic metabolism. The high concentrations result in a capacity to capture or metabolize a specific repertoire of odorants. We provide evidence that odorant metabolism modifies our sense of smell. Finally, the amount of olfactory mucus decreases in an age-dependent manner. A follow-up experiment recapitulated the importance of the amount of mucus in the sensitive detection of odorants by their receptors. These findings provide a comprehensive picture of the molecular processes in olfactory mucus and propose a potential cause of olfactory decline.

Transient global amnesia (TGA) is a clinical syndrome of reversible anterograde amnesia that occurs in the middle-aged and elderly individuals. The etiology is obscure, and many underlying factors have been reported. We describe an 83-year-old man with postherpetic neuralgia (PHN) for which he received pregabalin, fentanyl, and a serotonin-norepinephrine reuptake inhibitor (SNRI). Pain intensity on a numeral rating scale (NRS) was 8/10. He had no history of vascular disease or epilepsy.On November 28th 20XX he visited our hospital and underwent intercostal nerve block with phototherapy as usual. He was slightly feverish and had a body temperature of 37.8°C with no other symptoms. After 15 minutes rest, he left our hospital and tried to return to his home, but he was unsure which train to take. About 4 hours later, he suddenly knew where he was and got back to his home uneventfully. He had been amnetic for several hours. Two weeks later, he was referred to a neurologist, and the episode was diagnosed as TGA. Brain magnetic resonance imaging (MRI) showed non-specific cerebral atrophy with signs of aging at that point. Differential diagnoses include ischemia, migraine, epileptic seizures, and thromboembolic cerebrovascular disease. The cause of TGA remains controversial. However, drugs such as GABAergic drugs, SNRIs, and opioids are known to have effects on cognitive function. Polypharmacy can result in substantial drug-drug interactions, especially in elderly patients. The trigger of this episode in our patient is unclear, but multiple analgesics might have been a causal factor of his symptoms of TGA.