Shinonoi General Hospital

Additionally, the concept of cognitive frailty is "a combination of decline in physical function and mild cognitive decline equivalent to mild cognitive impairment (MCI)". 4Because a diagnosis is required in the pre-dementia stage, the clinical dementia rating (CDR) and the Montreal Cognitive Assessment (MoCA) are used.general, the Mini-Cognitive Assessment Instrument (Mini-Cog) is not used for cognitive frailty.Therefore, "Cognitive" and Mini-Cog should be removed from Table 9.We do hope that the authors correctly address how to assess frailty in patients with heart failure.

Fracture Liaison Service (FLS) programs are beneficial for reducing the frequency of subsequent fractures and mortality in post-hip fracture patients. The aim of this study was to investigate recent changes in the rate of pharmaceutical treatment for osteoporosis in post-hip fracture surgery patients in the absence of FLS programs compared to the previous 10 and 20years, and whether introduction of a new reimbursement scheme in hip fracture care, launched in 2022 by the Japanese government, improved the pharmaceutical treatment rate after surgical intervention. Study 1 included 1490 post-hip fracture patients in seven hospitals without an FLS program. Study 2 included 396 osteoporosis patients who were covered by the new reimbursement scheme at five of the seven hospitals. Treatment-related variables and the number of patients who received the different pharmaceutical treatments at 0, 3, 6 and 12months after discharge from the hospital were examined. Two hundred and thirty-two of 1474 patients received anti-osteoporotic medication at hospital discharge, which was not a significant improvement in the rate of pharmaceutical treatment in comparison with that in our previous studies over 20years. On the other hand, introduction of the new reimbursement scheme at hospitals significantly improved the rate of pharmaceutical treatment, with 263 of the 391 patients receiving anti-osteoporotic medication at discharge, as well as a significant improvement. We demonstrated a significant improvement in the pharmaceutical treatment rate for osteoporosis in post-hip fracture surgery patients after introduction of the new reimbursement scheme launched by the Japanese government.

Systemic capillary leak syndrome (SCLS) is a rare and life-threatening disorder. A man in his 60s presented for emergency care because of fatigue, decreased urine output and difficulty in moving his body. On admission, he was conscious, afebrile and had relative hypotension. Blood tests and urinary analysis revealed the following: white blood cell count, 19 500/μl; haematocrit, 64.5%; creatinine, 2.16 mg/dl; albumin, 3.3 g/dl; and 0.2% for fractional excretion of sodium. The patient was diagnosed with prerenal acute kidney injury (AKI) and was treated with intravenous fluid administration of more than 2 l/day. His kidney function gradually recovered after 4 days and creatinine decreased (1.15 mg/dl). However, he developed two more attacks of prerenal AKI during hospitalization, one of which needed intensive care unit management. Specific findings of hypotension, haemoconcentration, and hypoalbuminaemia were observed during all AKI attacks. Finally, he was diagnosed as idiopathic SCLS and was treated with intravenous immunoglobulin. SCLS might remain undiagnosed because of its rarity, but it can rapidly progress and lead to severe complications in absence of treatment. Clinicians need to consider this disease as a differential diagnosis when encountering patients who present with frequent prerenal AKI attacks accompanied by hypotension, haemoconcentration and hypoalbuminaemia.

Long hospital stay is associated with high costs and poor quality of life in elderly patients with heart failure (HF). This study aimed to investigate the association of early administration of tolvaptan with length of hospital stay among elderly patients with HF. The cohort included elderly patients (age ≥ 75 years) admitted to Shinonoi General Hospital between July 2016 and December 2018 with a primary diagnosis of acute decompensated HF treated with tolvaptan. Patients who died during hospitalization, patients who had acute coronary syndrome, patients who required treatment in the intensive care unit, and patients who had already taken tolvaptan before admission were excluded. Patients were divided into two groups according to the median duration of admission to tolvaptan administration: those who received tolvaptan within 1 day (24 h) after admission (early treatment group) and those for whom tolvaptan was prescribed after 1 day (24 h) or more from hospitalization (add-on group). We compared the length of hospital stay between the two groups and investigated the relationship between early tolvaptan administration and length of hospital stay. Of 110 enrolled patients (median age 85 years), 56 (51%) received tolvaptan within 1 day (24 h) after admission. The median length of hospital stay was 22 [14-35] days. The length of hospital stay was significantly shorter in the early treatment group (16 [11-22] days vs. 30 [21-46] days, p < 0.001). On multivariable regression analysis, early tolvaptan was associated with shorter hospital stay after adjusting for age, sex, serum creatinine, B-type natriuretic peptide, continuous dobutamine, and whether they live alone (partial regression coefficient -16.213, p < 0.001). Linear regression analysis showed a positive relationship between time of tolvaptan administration and length of hospital stay (R2 = 0.564, p < 0.001). Early tolvaptan administration was associated with reduced length of hospital stay in elderly HF.

症例は64歳，女性。前医にて変形性膝関節症に対し，人工関節置換術を施行された。術後1日目に創部腫脹の増大と右下肢の神経症状も出現したため，緊急筋膜切開を施行された。しかし，その後も創部ドレーンからの出血が持続したため当院へ紹介となった。造影CT検査の結果，膝窩動脈からの活動性出血を認めたため，緊急でVIABAHNを用いた血管内治療で止血した。術後2年が経過したが，経過は良好である。

The purpose of this study was to investigate the optimal spatial resolution and temporal resolution of dynamic improved motion-sensitized driven-equilibrium steady-state free precession for visualization of respiratory-driven cerebrospinal fluid (CSF) dynamics. We investigated the differences in the visualization using the midsagittal cross-sections of nine healthy volunteers by three imaging conditions. (A: spatial resolution 0.49×0.49×5 mm, temporal resolution 1000 ms; B: 0.49×0.49×5 mm, 430 ms; and C: 0.78×0.78×5 mm, 200 ms). First, we calculated the CSF of the third and fourth ventricles and the signal-to-noise ratio (SNR) of the pons. Next, we calculated the signal intensity ratio (SIR) of the CSF flowing at 10 cm/s or more and the CSF flowing at 10 cm/s or less due to respiration. We also calculated the difference between the inspiration and expiration SIR. Furthermore, 1) the presence of flow in the third and fourth ventricles centered on the cerebral aqueduct and 2) the change in flow due to respiration was investigated by a three-point scale visual assessment by seven radiological technologists. The SNR was the highest in A, the next highest in B, and the lowest in C in all cases. There were significant differences between A and B, and A and C in CSF of the third and fourth ventricles. However, there was no significant difference between B and C. The CSF signal intensity changed with respiration. The SIR of the third ventricle was higher on inspiration and lower on expiration. Conversely, the SIR of the fourth ventricle was lower on inspiration and higher on expiration. There was a significant difference between A and C and B and C in each SIR (p<0.05). The difference between inspiration and expiration SIR was the highest in B, the next highest in A, and the lowest in C in both the third and fourth ventricles. Significant differences were found between A and C, and between B and C (p<0.05). There was no significant difference in the presence of flow in the third and fourth ventricles centered on the cerebral aqueduct (p=0.264). On the other hand, there was a significant difference between the imaging conditions in the change in flow due to respiration, with B having a higher value than the others (p<0.001). The optimal spatial and temporal resolutions were 0.49×0.49×5 mm and 430 ms, respectively. The results also suggest that it is important to carefully set the imaging conditions for the spatial and temporal resolutions because of the use of phase dispersion in this method.

Adult-onset Still’s disease (AOSD)—a systemic inflammatory disease—often occurs at a young age. Recently, elderly onset patient proportion has been increasing; however, data are limited. To evaluate the characteristics of elderly patients with AOSD in a multicenter cohort, we retrospectively analyzed 62 patients with AOSD at five hospitals during April 2008–December 2020. Patients were divided into two groups according to age at disease onset: younger-onset (≤ 64 years) and elderly onset (≥ 65 years). Clinical symptoms, complications, laboratory findings, treatment, and outcomes were compared. Twenty-six (41.9%) patients developed AOSD at age ≥ 65 years. The elderly onset group had a lower frequency of sore throat (53.8% vs. 86.1%), higher frequency of pleuritis (46.2% vs. 16.7%), and higher complication rates of disseminated intravascular coagulation (30.8% vs. 8.3%) and macrophage activation syndrome (19.2% vs. 2.8%) than the younger onset group. Cytomegalovirus infections were frequent in elderly onset patients (38.5% vs. 13.9%) but decreased with early glucocorticoid dose reduction and increased immunosuppressant and tocilizumab use. Elderly AOSD is not uncommon; these patients have different characteristics than younger-onset patients. Devising a way to control disease activity quickly while managing infections may be an important goal in elderly AOSD.

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.

Demand for erectile dysfunction treatments has increased not only in elderly patients but also in young patients. Reports indicate that frequent causes of erectile dysfunction in Japan are organic disorders in elderly patients and psychogenetic disorders in young patients. We defined patients under the age of 40 as young erectile dysfunction patients, and those over 65 as elderly erectile dysfunction patients. We divided these two groups and conducted a retrospective comparative study based on medical questionnaires. We selected 215 cases of patients under the age of 40, and 176 cases of patients over the age of 65, and created a group of young patients and a group of elderly patients. We implemented the erectile hardness score, Sexual Health Inventory for Men, and sexual encounter profile questions 2 and 3 as the patient's daily clinical journal. The median age of young patients was 36 years, and that of elderly patients was 70 years. With respect to Sexual Health Inventory for Men, the average score was a significantly higher score in the young patients (9.26 vs 7.10, P < 0.001). Concerning erectile hardness score, young patients showed significantly higher scores in erectile hardness score (3.15 vs 2.06, P < 0.001). In terms of sexual encounter profile question 2, 50.9% of young patients responded "yes," but 24.3% of elderly patients responded, thus indicating a significantly higher score in young patients. In terms of sexual encounter profile question 3, 6.1% of young patients responded "yes," and 0.7% of elderly patients responded "yes," indicating a significantly higher in young patients. The results showed that many young patients with erectile dysfunction were able to perform insertion, but were unable to maintain erection.