Tokushima Municipal Hospital

We present six cases of post-traumatic osteoarthritis of proximal interphalangeal joint with swan neck deformity and ulnar deviation treated by surface replacement arthroplasty and soft tissue reconstruction using the radial slip of flexor digitorum superficialis tendon.

ABSTRACTElderly men with pleuritis, systemic inflammation, cytopenias, and bone‐marrow vacuolization may have VEXAS due to somatic UBA1 mutations. Pulmonary involvement, including pleuritis, can be a key presentation despite the absence of classic chondritis, and early recognition may enable timely initiation of corticosteroid therapy.

Sensory decline in older adults significantly affects quality of life and contributes to cognitive decline, depression, falls, and injuries. Although several studies exist in this area, most were focused on individual senses, with few being conducted on comprehensive assessments of all five senses. The aim of this study was to investigate the relationship between subjective sensory assessment and oral function, to developing health strategies. This study was conducted as part of the Mima-SONGS Study for examining relationships between oral, cognitive, and physical functions, social factors, nutrition, and health, in older adults living in a mountainous region of Japan. The cohort included 62 participants (40 women and 22 men; mean age: 80.8 yrs.) as of December 2023. Participants completed a questionnaire assessing sensory perception and eating enjoyment rated on a four-point scale. Oral health was evaluated based on the conditions of remaining teeth, tongue coating, oral dryness, occlusal force, oral diadochokinesis, and repetitive salivary swallow test. Sensory assessments indicated minimal overall issues, with auditory problems scoring the highest and taste/tactile issues scoring the lowest. Males scored higher in hearing and maximum occlusal force. Eating enjoyment was generally high and negatively correlated with olfactory and taste problems. Subjective sensory issues were less strongly associated with oral function and age. Most older adults were not subjectively aware of sensory problems, especially olfaction, taste, and tactile problems. Subjective sensory problems showed a moderate but meaningful association with oral health conditions and age. The findings might be valuable data developing future support measures.

A clinical survey was performed on 252 patients who underwent orthognathic surgery at the Department of Oral and Maxillofacial Surgery, Chubu Rosai Hospital, during the 7 years from April 1, 2017 to December 31, 2023.The results were as follows.1 During the 7 years, 252 patients (74 males and 178 females) with dentofacial deformities underwent orthognathic surgery.2 The average age of the patients was 27.7 7.4 years old (16-57) .Patients in their twenties accounted for the largest number (53.6) .3 The most common diagnosis was mandibular asym-metrymandibular prognathism (25.8) , followed by mandibular prognathism (21.0) .4 The most frequently performed operation was sagittal split ramus osteotomy (SSRO) , accounting for 133 cases (52.8) , followed by the combination of Le

In recent years, the Japanese neurosurgical field has been added to the guidelines for the appropriate use of antimicrobial agents for the prevention of surgical site infection; however, the awareness of neurosurgeons and specific methods for surgical site infection prevention in the Japanese neurosurgical field remains unclear. Therefore, we report a repeat survey conducted after the addition of guidelines on the appropriate use of antimicrobial agents for the prevention of surgical site infection and compare it with our previous survey on surgical site infection prevention conducted in 2018. A questionnaire-based survey was conducted via the Internet among members of the Japanese Neurosurgical Society and the Japanese Society of Chemotherapy. The survey response rate was 34.1% (270/792). More than 90% of the respondents were facility directors or specialists, and their institutions were universities and private hospitals. Cefazolin sodium was used in 88% of cases, and the percentage of cases started immediately before surgery increased to 85% (65% in the previous survey). Intraoperative administration intervals were most frequent every 3 hours (62%). Preoperative hair washing was performed by 76% of patients, a rate lower than that reported in the previous survey. Approximately 89% used partial removal, 75% used povidone-iodine for surgical field disinfection, double gloves were used by 46%, and antibacterial sutures by only 36% of surgeons. Compared with the 2018 survey, improvements were observed in the use of antibiotics for which guidelines were developed; however, other aspects of surgical site infection prevention need to be clarified, and guidelines for surgical site infection in the field of neurosurgery are necessary.

This report presents a patient with Legionella pneumonia (LP), initially presented with fever and mild hypoxemia, with subsequent progression to severe pneumonia during hospitalization. Despite multiple negative urinary antigen tests using Ribotest® Legionella, the diagnosis was confirmed via the loop-mediated isothermal amplification method of lower respiratory tract secretions. This case highlights the diagnostic limitations of Ribotest® Legionella and emphasizes the importance of a comprehensive diagnostic strategy, incorporating nucleic acid amplification tests or culture in suspected patients with LP. Early recognition of these diagnostic challenges is critical for optimizing patient outcomes.

Teicoplanin is used to treat serious Gram-positive bacterial infections. However, the optimal trough concentrations for pediatric patients remain unclear owing to the lack of monitoring guidelines. This study aimed to determine the optimal teicoplanin trough concentration for treating Gram-positive bacterial infections in children. A systematic review was conducted using 4 databases. Stepwise cutoffs within the range of 10-30 mcg/mL were used for efficacy and safety. Studies were included if they reported treatment success rates and/or all-cause mortality, nephrotoxicity, hepatotoxicity, and thrombocytopenia according to the trough concentration. The meta-analysis included 12 studies involving 830 pediatric patients. Teicoplanin cutoff values of 10, 15, 20, and 30 mcg/mL were reported in 9, 8, 9, and 2 studies, respectively. Trough concentrations <10 mcg/mL significantly reduced the treatment success rate, with an odds ratio of 0.07 and a 95% confidence interval ranging from 0.01 to 0.40. The overall treatment success rate was 50.0% versus 95.7% observed at concentrations ≥10 mcg/mL. However, no significant difference was observed at the 15-, 20-, and 30-mcg/mL cutoffs, when compared with lower concentrations. Trough concentrations <20 mcg/mL were associated with a decreased risk of nephrotoxicity (odds ratio = 0.21; 95% confidence interval, 0.08-0.55). However, hepatotoxicity and thrombocytopenia showed no significant associations with trough concentration ranges between 10 and 30 mcg/mL. Although further prospective studies are required for validation, the authors' findings suggest that 10- to 20-mcg/mL teicoplanin is the optimal trough concentration for enhanced clinical success and reduced toxicity in pediatric patients.

右冠動脈肺動脈起始（ARCAPA）は稀な先天性心疾患である．体重増加不良の経過観察中に原因検索の一環として行った心臓超音波検査で診断した1歳2カ月の女児を経験した．心臓超音波検査で左冠動脈主幹部はやや太く，右冠動脈の起始部が不明であり，カラードプラで心室中隔に複数の血流シグナルを認めた．冠動脈CTで右冠動脈が主肺動脈から起始しておりARCAPAと診断を確定した．心臓カテーテル検査による左冠動脈造影では左冠動脈から側副血行路を介し右冠動脈に造影剤が流れ込み主肺動脈が造影された．心臓超音波検査での心室中隔の複数の血流シグナルは左冠動脈から右冠動脈への側副血行路であった．ARCAPAは心筋梗塞や突然死を来すことがあり，本例も右冠動脈の大動脈への再移植が行われた．特長的な所見を示す本症の診断には心臓超音波検査が有用であった．

Background: Observational studies of intermittent hemodialysis therapy have reported that the excess decrease in K+ concentration in plasma (KP) during treatment is associated with the destabilization of cardiac function. Elucidating the mechanism by which the decrease in KP impairs myocardial excitation is indispensable for a deeper understanding of prescription design. Methods: In this study, by using an electrophysiological mathematical model, we investigated the relationship between KP dynamics and cardiomyocyte excitability for the first time. Results: The excess decrease in KP during treatment destabilized cardiomyocyte excitability through the following events: (1) a decrease in KP led to the prolongation of the depolarization phase of ventricular cells due to the reduced potassium efflux rate of the Kr channel, temporarily enhancing contraction force; (2) an excess decrease in KP activated the transport of K+ and Na+ through the funny channel in sinoatrial nodal cells, disrupting automaticity; (3) the excess decrease in KP also resulted in a significant decrease in the resting membrane potential of ventricular cells, causing contractile dysfunction. Avoiding an excess decrease in KP during treatment contributed to the maintenance of cardiomyocyte excitability. Conclusions: The results of these mathematical analyses showed that it is necessary to implement personal prescription or optimal control of K+ concentration in dialysis fluid based on predialysis KP from the perspective of regulatory science in dialysis treatment.