Nagano Matsushiro General Hospital

Engaging in meaningful occupations at high levels of performance is associated with self-related health. However, there is a dearth of studies examining the relationship between health-related quality of life (HRQOL) and meaningful occupations among community-dwelling older adults. Clarifying the relationship between good HRQOL and the characteristics of meaningful occupations would provide new insights into occupational therapy strategies for healthy ageing in community-dwelling older adults. This study aimed to determine the categories of meaningful occupations and the relationship between performance and satisfaction with HRQOL in older adults living in rural areas. A cross-sectional analysis was conducted on 1600 older adults in a rural Japanese community. Participants responded to demographic questions, the Japanese version of the EuroQol 5-Dimension 5-Level (EQ-5D-5L), categories of meaningful occupations, and levels of performance and satisfaction. Multiple regression analysis was used to examine the association between meaningful occupations and HRQOL. The results of multiple regression analysis adjusted for covariates showed that performance and satisfaction with meaningful occupations were significantly associated with HRQOL as measured by the EQ-5D-5L (performance: β = 0.117, p < 0.001; satisfaction: β = 0.142, p < 0.001). It is suggested that performance and satisfaction with meaningful occupations should be considered in occupational therapy strategies for HRQOL in older adults.

The safety and outcome of breast reconstruction after radiotherapy are controversial, and the aesthetic aspects have not been studied extensively. We compared the results of vascular anastomosis, the incidence of postoperative complications, and aesthetic appearance between patients who had and had not received radiotherapy who then had undergone delayed breast reconstruction with autologous free flaps from the abdomen, thighs, and buttocks. In total, 257 flaps in 241 patients were investigated; 194 and 63 flaps implanted in patients who did not receive radiotherapy and who received radiotherapy before breast reconstruction, respectively. Of the 257 flaps, 221, 20, 14, and 2 came from the abdomen, thighs, buttocks, and other anatomic locations, respectively. We evaluated aesthetic outcomes in 105 patients who had not received radiotherapy and 35 who had. We found no significant differences between the two groups in the incidence of vascular reanastomosis, the time required for anastomosis, or the incidence of unplanned reoperation. Complications such as flap necrosis were rare in both groups. Aesthetic outcomes were significantly better in the patients who had not received radiotherapy. Breast reconstruction with autologous free flaps can be performed safely in patients who have received radiotherapy, but the aesthetic result is slightly inferior to that in patients who had not received radiotherapy.

This study aimed to examine the effects of flooding due to Typhoon Hagibis on the incidence of cardiovascular/cerebrovascular events in Nagano City. The SAVE trial retrospectively enrolled 2426 patients hospitalized for cardiovascular/cerebrovascular disease in 5 hospitals in Nagano City from October 1 to December 31 in 2017 and 2018 (pre-disaster period) and in 2019 (post-disaster period). From these, 280 patients who were hospitalized in a district flooded in 2019 were recruited for the same period (October 12 to December 31) over the 3 years. The baseline characteristics of and the incidence of cardiovascular/cerebrovascular disease in cases from the flooded district in 2019 were compared with those of cases in the flooded district in 2017 and 2018. The total number of patients with acute myocardial infarction did not differ significantly between the post- and pre-disaster periods. The incidence of unstable angina pectoris was significantly higher in 2019 (n = 4, 5.1%) than in 2017 and 2018 (n = 0, 0.0%) (P = 0.001). This study did not prove the impact of flood due to a typhoon on the incidence of cardiovascular/cerebrovascular events.

[Purpose] To identify preoperative factors influencing Japan Orthopaedic Association (JOA) scores after opening wedge high tibial osteotomy (OWHTO). [Participants and Methods] Seventy-seven knees of 68 patients, who had undergone OWHTO at Nagano Matsushiro General Hospital, were included to examine the following items: diagnosis, sex, age, Body Mass Index, femorotibial angle (FTA), range of motion (ROM), and knee isokinetic strength before surgery, and JOA scores before and 1 year after it. The knees were divided into full- and non-full-JOA-score groups to compare the preoperative factors between them. [Results] The full-JOA-score group’s rate of knee osteonecrosis (ON) as a diagnosis was significantly higher, preoperative FTA was significantly smaller, and preoperative knee flexion ROM was significantly greater. [Conclusion] The postoperative JOA scores of patients, in whom a diagnosis of knee ON led to surgery, and the degrees of varus deformity and loss of flexion were mild before it, were favorable.

Recurrent varicose veins are a common problem after endovascular laser ablation (EVLA). The major sources of recurrence after EVLA of the great saphenous vein (GSV) include recanalization and reflux into the tributaries near the junction. Neovascularization is less common after EVLA than high ligation and stripping (HLS). There are few studies investigating longterm outcomes of EVLA for small saphenous vein (SSV) insufficiency. Compared with HLS of the SSV, better short-term results of EVLA of the SSV are shown despite of the higher rate of recurrence possibly related to anatomical variations. Further investigations are needed to confirm long-term results and late recurrence after EVLA of the SSV.

下肢静脈瘤に対する大・小伏在静脈の血管内レーザー焼灼術（EVLA，波長980 nm）後3年の手術成績から，本邦における再発率や再発様式の調査を行った．149肢（経過観察率83%），141例に対し，1年毎に行った下肢静脈エコーを用いた経過観察の結果を後ろ向きに解析した．大伏在静脈（GSV）に対するEVLA127肢では，副伏在静脈（ASV）不全が術後1年で3肢（2%），2年で5肢（4%），3年で7肢（6%），大腿部穿通枝（Dodd）不全が1年で3肢（2%），2年で5肢（4%），3年で7肢（6%），逆流を伴う再疎通が1年で0肢（0%），2年で2肢（2%），3年で3肢（2%），逆流を伴う血管新生が1年で0肢（0%），2年で1肢（1%），3年で1肢（1%）に認められた．小伏在静脈（SSV）に対するEVLAでは，接合部（SPJ）の逆流が1年で1肢（3%），2年で6肢（21%），3年で8肢（28%）に認められた．3年間で再手術となったのは2例で，それぞれASVとDoddのEVLAを行った．EVLAの再発原因として，ASV不全，Dodd不全，GSV再疎通，SPJ不全が重要と考えられた．

Spinocerebellar ataxia type 21 (SCA21) is a rare subtype of autosomal dominant cerebellar ataxias, which was first identified in a French family and has been reported almost exclusively in French ancestry so far. We here report the first Japanese family with SCA21, in which all affected members examined carried a heterozygous c.509C > T:p.Pro170Leu variant in TMEM240. Their clinical features were summarized as a slowly progressive ataxia of young-adult onset (5-48years) associated with various degree of psychomotor retardation or cognitive impairment. The MR images revealed atrophy in the cerebellum, but not in the cerebrum or brainstem. These clinical findings were consistent with those in the original French families with SCA21. Neuropathological findings in one autopsied patient showed a prominent decrease of cerebellar Purkinje cells, but no specific abnormalities outside the cerebellum.

BackgroundEpithelioid hemangioendothelioma (EHE) of the thyroid is an extremely rare disease; only three cases have been reported in the English literature to date. Here, we describe a case involving a patient with thyroid EHE successfully treated with curative surgery.Case presentationA 74-year-old woman presented with a right thyroid mass. The nodule was approximately 2 cm in size and was diagnosed as an indeterminate lesion by fine needle aspiration cytology. She was treated with thyroid lobectomy. The histopathological and immunohistochemical findings indicated an EHE of the thyroid. At the latest follow-up, 3 years postoperatively, the patient showed no signs of recurrence.ConclusionThere is currently no standard therapy for EHE; however, our case suggests that curative resection represents an effective treatment.