Showa General Hospital

Domestic squalor (DS) is related to physical problems, living alone, family and neighbourhood problems and mental illnesses, especially dementia. However, methods to detect and treat older adults with DS remain unclear. We aimed to clarify the methods of appropriate intervention for older adults with DS. The Initial-phase Intensive Support Team for Dementia (IPIST) is a multidisciplinary outreach team in Japan that provides intensive support to people living at home with suspected dementia. We distributed a questionnaire to 50 IPISTs, specifically requesting the submission of 'two complex cases that were difficult to manage' regarding medical or long-term care. The questionnaire included sociodemographic characteristics, diagnosis, referral sources, and reasons for complexity. We compared cases with and without DS (DS+ vs. DS-), and DS cases living alone and those living with family (DS+ living alone vs. DS+ living with family). We received responses from 33 IPISTs and collected data from 70 complex cases. DS was selected as the reason for complexity in 24 cases, 14 of which were people living alone. Significantly fewer DS+ cases were referred by family (8.3% vs. 54.3%), while significantly more were referred by others (87.5% vs. 41.3%). The most common referral sources were neighbours and social workers. DS+ cases had significantly higher rates of self-neglect (87.5% vs. 13.0%). Those living alone were significantly younger (median (interquartile range): 78.5 (76.8-82.8) years) than those living with family (85.0 (78.8-89.8) years). Family members living with DS+ cases also had issues, including mental illness or maltreatment. In this study sample, many older adults with DS exhibited self-neglect and had limited family support. Our findings suggest that a comprehensive approach to both older adults with DS and their families is crucial for appropriate intervention. Therefore, IPISTs that have a multidisciplinary team with an outreach function may be effective.

Background: We measured soluble C-type lectin-like receptor 2 (sCLEC-2), which is a new biomarker of platelet activation, to investigate clinical implications in patients with acute ischemic stroke (AIS) and TIA (Trial registration numbers: NCT05579405, UMIN 000048954). Methods: Plasma levels of sCLEC-2 were measured by high-sensitivity chemiluminescent enzyme immunoassay in 377 patients with AIS and 62 patients with TIA. Results: sCLEC-2/D-dimer ratio (mean±SD) at baseline (Day 1) was higher in patients with non-cardioembolic stroke/TIA (n=111, 491.9±433.7) than in those with cardioembolic stroke/TIA (n=52, 220.6±287.9) (t-test, p<0.0001) (patients on antithrombotics at baseline were excluded). Baseline sCLEC-2 levels (mean±SD) were 248.8±161.6, 277.6±210.6 (n=50), and 324.0±266.3 pg/ml in mild (NIHSS<6) (n=283), moderate (NIHSS 6-14) (n=50), and severe (NIHSS>14) (n=42) patients with AIS, respectively, which were higher in patients with severe AIS than in those with mild AIS (Tukey test, p=0.031). sCLEC-2 (mean±SD) at baseline was higher in patients with medium/large infarcts (n=97, 282.4±192.8 pg/ml) than in those with small infarcts (n=117, 233.6±115.1 pg/ml) among patients with non-cardioembolic plus non-lacunar stroke (t-test, p=0.012), while it was lower in medium/large infarcts (n=63, 231.9±184.0 pg/ml) than in those with small infarcts (n=26, 341.9±347.0 pg/ml) among patients with cardioembolic stroke (t-test, p=0.003). Mean sCLEC-2 was increased in patients with worsening (recurrence or deterioration) (n=17, +84.4 pg/ml) and decreased in those without worsening (n=271, -10.3 pg/ml) between Day 1 and Day 7 (Welch-corrected t test, p=0.013). Poor outcome (mRS>1) at discharge was more common in patients with increased sCLEC-2 than in those with decreased sCLEC-2 between Day 1 and Day 7 (61.4% vs 39.1%, Fisher’s exact test, p=0.002). Poor outcome at 3 months was more common in patients with high sCLEC-2 levels (156 pg/ml or more) than in those with normal sCLEC-2 levels (<156 pg/ml) at Day 7 (36.1% vs 13.0%, Fisher’s exact test, p=0.024). Conclusions: sCLEC-2 was a promising biomarker for subtyping of AIS/TIA, accessing stroke severity, elucidating pathophysiology, and predicting outcomes in patients with AIS or TIA.

Multicenter retrospective cohort study. To evaluate the impact of abscess presence and type on treatment duration and clinical outcomes in patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. Surgical management is increasingly favored for pyogenic spondylitis. Abscesses, particularly epidural and iliopsoas, have been linked to poorer prognoses, and empyema, though uncommon, tends to be particularly severe. However, the effect of specific abscess types on surgical outcomes remains unclear. This study included 92 patients who underwent minimally invasive posterior fixation across 10 centers between 2014 and 2024. Patients were classified into an abscess group (epidural, iliopsoas, empyema, or other) and a non-abscess group. Clinical outcomes, including total duration of intravenous antibiotics and unplanned additional surgeries, were compared. Subgroup and regression analyses were conducted to assess the impact of specific abscess type. Abscesses were present in 65 patients (71%): epidural (n=51), iliopsoas (n=38), and empyema (n=3), with some overlap. Compared with the non-abscess group (n=27; 29%), there were no significant differences in antibiotic duration or rates of unplanned additional surgery. However, iliopsoas abscess was associated with longer antibiotic duration (8.1 weeks vs. 6.6 weeks, p =0.044), while all empyema cases required additional surgery for poor infection control (p =0.000). Regression analysis identified iliopsoas abscess and age ≥65 years as independent predictors of prolonged antibiotic use, whereas epidural abscess was associated with shorter antibiotic duration. Iliopsoas abscesses were associated with longer antibiotic courses, while empyema was linked to poor infection control and a higher likelihood of additional surgery.

ABSTRACTSubtle neurological symptoms, such as mild hemiparesis, may represent the earliest signs of acute disseminated encephalomyelitis (ADEM) in infants. This case illustrates how caregiver‐recorded videos can provide crucial diagnostic clues by capturing functional changes that might otherwise remain unnoticed during routine clinical observations.

Physical activity during pregnancy is established to be a safe and effective strategy to improve maternal and neonatal health. The objective of this article was to investigate the effects of physical activity on the mother, foetus and delivery outcomes. We reviewed literature on physiological adaptations to exercise during pregnancy, maternal and foetal outcomes, and the influence of physical activity on labour duration, mode of delivery, oxytocin administration, perineal trauma, and other perinatal parameters. The findings suggest that regular, moderate physical activity may reduce the risk of gestational complications such as diabetes and hypertension, shorten labour duration, decrease the risk of operative delivery, reduce the need for analgesia and have a beneficial effect on the foetus. Further randomized controlled trials are required to confirm the association between physical activity and pregnancy outcomes, possibly including the differentiation between exercises of various intensity, as well as to provide standardized recommendations.

To investigate patients with prolonged (≥9 months) super-refractory anti-NMDAR encephalitis (NMDARe).

Enfortumab vedotin (EV) currently plays a predominant role in the evolving treatment paradigm of metastatic urothelial carcinoma (mUC). However, large-scale real-world data on EV remain limited. This multicenter retrospective study comprehensively evaluated treatment outcomes and prognostic factors of EV monotherapy for mUC. A total of 115 consecutive patients with mUC who received EV monotherapy between 2021 and 2023 were analyzed. Baseline characteristics and treatment outcomes were collected. Progression-free survival (PFS), over-all survival (OS), best overall response, treatment-related adverse events (TRAEs), and prognostic factors associated with PFS and OS were analyzed. The median age was 74 years, and 18 patients (16%) had an performance status (PS) of ≥2. During the median follow-up of 7.1 months, median PFS was 6.7 months and median OS was 12.9 months. Eighty-six patients (74%) experienced interruption or dose reduction of EV, resulting in a median relative dose intensity (RDI) of 77.4%. The objective response rate was 49%, and the disease control rate was 69%. Eighty-eight patients (77%) experienced TRAEs, including cutaneous AEs observed in 58 patients (50%). In multivariable analysis using pretreatment factors, PS≥1, liver metastasis, and low albumin level were associated with shorter PFS and OS. With RDI and AEs incorporated in the models, the presence of cutaneous AE was independently associated with longer PFS and OS. This real-world study demonstrated comparable treatment efficacy and acceptable TRAEs compared to clinical trials. The presence of cutaneous AE is a potentially favorable prognostic factor for mUC patients treated with EV.

None of the authors has any financial/conflicting interests to disclose.The aim of this study was to report a surgical technique of cyclopexy, wherein two laps of encircling continuous sutures are placed around the limbus to treat refractory extensive cyclodialysis. This study employed swept-source optical coherence tomography for anterior segment, color fundus photography, and spectral-domain optical coherence tomography for the macula. Previous attempts, including indirect cyclopexy and direct external cyclopexy with gas injection, failed to successfully resolve the severe cyclodialysis and associated hypotonic maculopathy. In the third surgery, two laps of encircling continuous sutures were placed around the limbus at the distances of 2-3 mm and 3-4 mm, respectively, along with phacoemulsification, intraocular lens implantation, and capsular tension ring placement. After surgery, hypotony and hypotonic maculopathy were effectively resolved, resulting in a significant improvement in VA that has been maintained over a year. The described surgical technique of encircling continuous sutures may be a viable option for the treatment of severe cyclodialysis.