Numazu City Hospital

Coronal shear fracture (CSF) of the distal humerus is rare, accounting for approximately 1% of elbow fractures; cases combined with olecranon fracture are even rarer. This study aimed to clarify the relationship between surgical methods and clinical outcomes in this uncommon injury. Between 2017 and 2025, we retrospectively reviewed 8 patients (8 elbows) with CSF associated with olecranon fracture who underwent open reduction and internal fixation in a multicenter case series and were followed for more than 6 months. Patient demographics, fracture classifications, surgical methods, postoperative complications, additional surgeries, elbow range of motion, and Mayo Elbow Performance Score at the final follow-up were analyzed descriptively. The mean age was 64 years (range, 51-79 years), and the mean follow-up was 27 months (range, 10-96 months). Dubberley classification was type 2A in 2 cases, type 3A in 2, and type 3B in 4. A posterolateral extended approach was used in 6 patients and a combined lateral-posterior approach in 2. Postoperative complications included elbow release in 2 cases and ulnar neuropathy in 2. At final follow-up, the mean Mayo Elbow Performance Score was 92.5 (range, 75-100), and the mean range of motion was -21°/121.3°. Outcomes of CSF with concomitant olecranon fracture appeared to depend on CSF severity, and complications were more frequent than in isolated CSF. Given the small sample size and observational design, these findings should be regarded as preliminary and hypothesis-generating rather than definitive evidence favoring any particular method.

This multicenter, 6-month naturalistic observational study investigated the time from as-needed (PRN) administration of psychotropic medications to the onset of calming in patients with acute psychotic disorders. Newly admitted patients exhibiting moderate to marked agitation on the Agitation-Calmness Evaluation Scale (ACES) and requiring PRN treatment were included, and 170 first agitation episodes were analyzed. The primary outcome was time to onset of effect, defined as achieving ACES = 3. Medication refusal at baseline was far more frequent in patients with injectable formulations than those with oral or sublingual agents (65.5% vs. 4.3%). Kaplan-Meier estimates showed mean onset times (minutes) for oral/sublingual drugs as follows: asenapine sublingual, 30.0; olanzapine orally disintegrating tablet, 31.9; quetiapine, 46.6; and risperidone oral solution, 34.5. Using Cox proportional hazards models with asenapine as reference, quetiapine demonstrated a significantly lower hazard of achieving calming (hazard ratio 0.39), while risperidone showed a nonsignificant trend. For injectable antipsychotics, mean onset times were: olanzapine intramuscular, 36.3; haloperidol intramuscular, 47.5; and haloperidol intravenous, 45.0, with no significant differences among them. No serious adverse events were observed. The findings suggest that asenapine sublingual may offer faster calming in patients without refusal, and that future studies with shorter assessment intervals are warranted.

BackgroundThe post-discharge period following psychiatric hospitalization is a high-risk period for suicide attempts. This risk is substantially higher for patients admitted for suicidal behavior. Despite the urgent need for effective countermeasures, evidence-based interventions specifically designed to prevent suicide reattempts in this high-risk population remain limited. Although assertive case management is recognized as an effective intervention, its feasibility, safety, and efficacy for patients in psychiatric hospitals remain uninvestigated. The ACTION-JP study aims to evaluate the feasibility, safety, and efficacy of such an intervention adapted for patients in Japan admitted to psychiatric hospitals following a suicide attempt.MethodsThe ACTION-JP study is a multicenter, single-arm clinical trial. A total of 220 adult patients admitted to participating psychiatric hospitals following a suicide attempt will be enrolled. The intervention comprises two main components: a psychoeducation program conducted during hospitalization and an 18-month structured assertive case management follow-up. The primary outcome is the change from baseline in the Columbia-Suicide Severity Rating Scale total score at the 6-month follow-up. Secondary outcomes include the incidence of suicide reattempts and self-harm, as well as changes in Beck Depression Inventory-II and Global Assessment of Functioning Scale scores.DiscussionThis study protocol describes the essential first step in developing an evidence-based suicide prevention strategy for psychiatric inpatients. This study will provide important data on the intervention’s feasibility, safety, and efficacy. The findings are expected to offer important insights into the potential effectiveness of assertive case management for reducing suicide risk post-discharge. The successful implementation of this study will provide the necessary basis for designing a future large-scale randomized controlled trial that may help to establish a new standard of care in psychiatric hospitals.Trial registrationThis trial was registered on the University Hospital Medical Information Network clinical trials registry: UMIN000057009 (Date of registration: April 1, 2025) and the Japan Registry for Clinical Trials: jRCT1010250041 (Date of registration: October 20, 2025).Supplementary informationThe online version contains supplementary material available at 10.1186/s12888-025-07554-0.

There is currently no research in super-elderly patients with source of infections that require invasive treatment We retrospectively examined the impact on outcomes of performing or not performing such procedures in super-elderly patients with infection sources The subjects were patients aged 80 years or older who were transported by ambulance to Numazu City Hospital and diagnosed with "infections requiring source control" in the emergency department during the six-year period. Infections requiring source control were generally defined as infections for which procedures such as drainage, debridement, or surgical resection to physically reduce the bacterial load at the source were necessary There were 201 patients were enrolled. The average age was 87.0 years. There were 175 cases where procedures were performed, and 24 cases (11.9 %) resulted in death. Hepatobiliary diseases were the most common, accounting for 153 cases, followed by renal infections with 25 cases. Compared to the surviving group, the fatal group had a statistically significantly lower rate of source control, shorter hospital stays, and higher Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores. Among them, only source control was identified as an independent factor related to survival by multivariate analysis This study suggests that performing source control in patients, even those aged 80 years and older, might increase survival rates

This study aimed to assess the effects of thienopyridine-class antiplatelet agents (including ticlopidine, clopidogrel, and prasugrel) on bleeding complications in patients who underwent robot-assisted radical prostatectomy. This cohort study used a database for robot-assisted radical prostatectomy at 23 tertiary centers nationwide between 2011 and 2022. Patients who received thienopyridines (thienopyridine group) were compared with those who received aspirin monotherapy (aspirin group). The primary outcome was the incidence of bleeding complications. High-grade complications were defined as Clavien-Dindo grade III or higher. The risks of these outcomes were evaluated using inverse probability of treatment weighted regression models. The study results demonstrated that thienopyridine therapy was associated with a higher risk of overall bleeding complications (OR: 3.62, 95%CI 1.54-8.49). The increased risks of the thienopyridine group were detected for low-grade bleeding complications (OR: 3.20, 95%CI 1.23-8.30) but not for high-grade bleeding complications (OR: 5.23, 95%CI 0.78-34.9). The increased risk of bleeding complications was not observed when thienopyridine was discontinued (OR: 2.52, 95%CI 0.83-7.70); however, it became apparent when it was continued perioperatively (OR: 4.35, 95%CI 1.14-16.61). In conclusion, thienopyridine increased the incidence of bleeding complications, particularly low-grade bleeding complications, following robot-assisted radical prostatectomy. These bleeding effects emerged when thienopyridine was continued perioperatively.

Background and aim The prevalence and characteristics of physical complaints related to bad weather among the general population remain poorly understood. This study aimed to elucidate the characteristics of subjective physical symptoms related to bad weather. Methods A cross-sectional survey was conducted by using self-reported health-related questionnaires obtained from individuals undergoing annual medical check-ups at a municipal hospital in Japan. Participants were asked about the presence and details of physical symptoms related to bad weather, together with other health-related questions. Results Among the 133 participants, 42 (32%) (95%CI 24-40) reported experiencing physical conditions related to bad weather. Among these 42 patients, the most common ailment was headache (67%; n=28), followed by low back pain (21%; n=9), fatigue (19%; n=8), and stiff neck/shoulder discomfort (12%; n=5). Comparison between individuals with and without bad weather-related conditions revealed that those affected were younger (p=0.0014) and exhibited higher numerical rating scale scores for gastrointestinal problems (p=0.0027), irritability/agitation (p<0.0001), and sleep disorders (p=0.0295). These associations were confirmed even after adjusting for age and sex. Conclusions Physical conditions related to bad weather, represented by headache, fatigue, and back pain, can be seen in 25-40% of the general population, especially in younger age groups. Individuals with these conditions are more likely to experience irritability/agitation, gastrointestinal problems, and sleep disorders.

Live two-way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real-world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video using smartphones and other devices, which are currently the primary means of telecommunication. This randomized controlled trial compared two-way video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder in the subacute/maintenance phase during a 24-week period. Adult patients with the above-mentioned disorders were allocated to either a two-way video group (≥50% video sessions) or a face-to-face group (100% in-person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. A total of 199 patients participated in this study. After 24 weeks of treatment, two-way video treatment was found to be noninferior to face-to-face treatment regarding SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all-cause discontinuation, treatment efficacy, and satisfaction. Two-way video treatment using smartphones and other devices, was noninferior to face-to-face treatment in real-world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care.

迷走神経刺激（VNS）は薬剤抵抗性てんかんに有効な治療であり症例数は増加傾向にあるが、刺激調節は認定医による診察を要するため、専門施設から遠方の地方在住症例は適応困難となりやすい。この課題に対し、我々はWeb会議システムを用いた遠隔診療による刺激調整に取り組んできた。その運用実際と安全性、効果の評価、今後の課題の抽出を目的として後方視的検討を行ったので報告する。刺激調整はWeb上のてんかん専門医の指導下に現地医師が行った。刺激調整の完遂、システムトラブルの有無、副作用聴取と対応、臨時連絡の有無をカルテから抽出し、さらに現地医師に問題点のアンケートを行った。12回（3症例）の遠隔診療が行われ、刺激調整は全例で完遂し、システムトラブル、副作用聴取対応への問題、臨時連絡は認めなかった。VNS調整は認定医の直接診察下でなくとも安全に遂行でき、認定医の少なさや地理的障壁を解決しうる手段と考えられる。