Saitama Municipal Hospital

Background: Serum albumin and prealbumin are increasingly recognized as biomarkers of inflammation rather than nutritional status. Because prealbumin responds more rapidly to acute inflammatory and catabolic stress than albumin, the albumin-to-prealbumin ratio (APR) may better reflect inflammatory burden. However, its prognostic significance in elderly patients with sepsis remains unclear. Methods: This single-center retrospective observational study included 84 patients aged ≥75 years hospitalized with sepsis between April 2023 and March 2024. APR was calculated using serum albumin and prealbumin levels at admission, and patients were categorized into low- and high-APR groups based on the median value. The primary outcome was 28-day mortality. Multivariable logistic regression analysis was performed to evaluate the independent association between APR and 28-day mortality after adjustment for the Sequential Organ Failure Assessment score, maximum serum lactate level, and Mini Nutritional Assessment-Short Form. Subgroup analyses were conducted according to median serum albumin level (<2.9 vs. ≥2.9 g/dL). Results: Twenty-eight-day mortality was significantly higher in the high-APR group than in the low-APR group (40.5% vs. 7.1%, p = 0.001), with significantly poorer survival (log-rank p = 0.003). A high APR remained independently associated with increased 28-day mortality (odds ratio 10.2, 95% confidence interval 2.3-45.1). In subgroup analyses, APR was associated with mortality only among patients with relatively preserved albumin levels. Conclusions: APR is a useful prognostic marker of 28-day outcomes in elderly patients with sepsis and may provide prognostic information beyond conventional severity indices.

Inclusion body myositis (IBM) and immune-mediated necrotising myopathy (IMNM) are inflammatory myopathies characterized by specific clinical and pathological features. IBM is associated with human immunodeficiency virus (HIV) infection, whereas IMNM is extremely rare in individuals positive for HIV. To date, no reports have described the coexistence of IMNM and IBM-like pathological features in patients positive for HIV. Herein, we report a rare case of a 40-year-old man with HIV-associated subacute progressive myopathy presenting with simultaneous proximal and distal muscle weakness, dysphagia, and markedly elevated creatine kinase levels. Serological testing revealed strong positivity for anti-signal recognition particle antibodies. Muscle biopsy revealed coexisting pathological features suggesting both IMNM and IBM. The patient showed insufficient response to antiretroviral therapy and glucocorticoids; however, intravenous immunoglobulin therapy resulted in a marked clinical response. This case highlights the possible coexistence of IMNM and IBM-like pathology in the context of HIV infection and provides insights into the pathophysiology of HIV-associated myopathy. Furthermore, this report suggests the potential effectiveness of intravenous immunoglobulin treatment in such cases.

Studies on the association between chest computed tomography (CT) findings of extensive pulmonary involvement and long-term pulmonary and extrapulmonary coronavirus disease 2019 (COVID-19) sequelae are lacking. This study aimed to investigate the relationship between the severity of pneumonia on admission and residual pulmonary and extrapulmonary complications at three months post-hospitalization. Using data from the Japan COVID-19 Task Force database, we conducted quantitative analysis of CT scans of 164 patients obtained at admission and three months later. The parameters included pneumonia volume, total lung volume, and area and density of the pectoralis muscle (PM), subcutaneous and epicardial adipose tissue, and vertebral bone density. Patients with extensive pneumonia on admission had high residual pneumonia volumes, reduced lung volumes, and decreased area and density of PM at three months. No significant differences were observed in the adipose tissue or bone parameters. The severity of pneumonia at admission was independently associated with PM atrophy. CT-based quantification of pneumonia extent during the acute phase of COVID-19 may be useful in predicting long-term pulmonary sequelae and muscle wasting. This approach may allow the objective evaluation of Long COVID and facilitate the identification of potential therapeutic targets.

The government&amp;apos;s new regulatory standards for commercial nuclear power plants stipulate that the standard seismic motion for nuclear power plants is determined by the acceleration response spectrum. This approach treats large earthquakes as a collection of smaller ones and calculates the strength of each frequency of seismic waves reaching a nuclear power plant. The error of this approach is easily apparent when considering the changes that occur as seismic waves travel through geological strata. When seismic waves travel through hard rock, their propagation speed is fast (e.g., 3,000 m/s), resulting in intense vibrations, a short period, and a small Gal number. However, when they enter softer strata, their propagation speed slows (e.g., 200 m/s), resulting in intense vibrations, a long period, and a large Gal number. This is because the distance attenuation formula does not hold. Both the period and Gal number of seismic waves are most affected by the properties of the strata through which they travel. It is surprising that such a simple error has gone unnoticed until now. Even more surprising is the use of the Matsuda formula to determine the design basis earthquake motion (seismic resistance standards) for nuclear power plants. A quick look at Matsuda&amp;apos;s graph reveals that the answer is the average value of the Matsuda formula. If the seismic resistance standards were determined based on the average value, half of future earthquakes would exceed the design basis earthquake motion. The design basis earthquake motion for nuclear power plants was exceeded five times in just seven years, from 2005 to 2011. It has been proven five times that if the design basis earthquake motion is determined using the Matsuda formula, future earthquakes will definitely exceed this value. Seismologists not only lack a basic understanding of regression analysis, which first-year university students learn, but they also cannot properly read graphs. For over 50 years, they have been engaged in child&amp;apos;s play called research, resulting in the loss of many lives through flawed disaster prevention measures. University research misconduct prevention committees continue to suppress opinions that point out their errors and publish dangerous disaster prevention measures. It is scientifically impossible to establish design basis earthquake motion for nuclear power plants. There is no way to guarantee that nuclear power plants are earthquake-safe. If a nuclear accident were to occur, Japan would become uninhabitable. Nuclear power plants must be shut down and decommissioned as soon as possible.

This retrospective cohort study aimed to emulate the ADVANCE trial population and directly compare the Endurant and Excluder using propensity score matching. Patients were included if endovascular aneurysm repair was performed for abdominal aortic aneurysm using either Endurant or Excluder at 10 hospitals in Japan between January 2012 and July 2022. Cases were selected according to the modified ADVANCE trial inclusion and exclusion criteria. To minimize selection bias and simulate a randomized controlled trial setting, propensity score matching was performed using patient and anatomical characteristics. The primary outcome measure was the proportion of patients with sac regression ≥ 5mm at 1year. The secondary outcome measures were rates of freedom from late complications, T1aEL, sac enlargement ≥ 5mm, and overall survival. Outcomes were first analyzed in patients within the instructions for use (IFU) and then in all matched patients including outside IFU patients. After matching, the within-IFU group included 124 pairs and the total cohort of 266 pairs. The primary outcome measures for Endurant and Excluder were met in 38.9% and 36.6% (p = 0.74) in the within-IFU group and 33.5% and 35.0% (p = 0.74) in the total cohort, respectively. No significant differences were observed in any secondary outcome measures. However, T2EL and use of additional proximal cuff were significantly more frequent for Excluder in both the within-IFU and total cohort. Furthermore, T1b and T5ELs occurred significantly more for Endurant in the total cohort. There were no significant differences in all clinical outcome measures between Endurant and Excluder. Level IV, multicenter retrospective cohort study.

BACKGROUND:Stroke patients can have various somatosensory abnormalities and a practice–research gap exists among various measurements and treatments. Integrating case reports that bridge this gap may provide a solution to addressing this issue.PURPOSE:This systematic review integrates case reports detailing the physiotherapy management of stroke patients with recognized somatosensory impairments and determines the characteristics related to somatosensory measures, clinical symptoms, and treatments.METHODS:This systematic review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, using PubMed, Cochrane Library, PEDro, CINAHL, and MEDLINE databases for articles published up to February 2024. Two independent authors performed a methodological quality assessment of the case reports.RESULTS:This review included 11 articles of low methodological quality, comprising 13 cases. Physiotherapists used 11 types of somatosensory measures and conducted 11 types of somatosensory training. However, all articles lacked clinical decision-making, causing inadequate accuracy, transparency, and usefulness in the case reports and physiotherapy management.CONCLUSION:Physiotherapy for stroke patients with somatosensory impairments is characterized by a lack of standard somatosensory measures and an unclear effect of somatosensory impairments on motor function, making recovery prediction difficult and causing an unclear process in treatment practices. Addressing this issue requires case reports and clinical research, highlighting the process from somatosensory examination to diagnosis.