Objectives: A majority of older adult acetabular fracture patients have a fracture of the anterior component, and repair of the acetabular anterior component with infra-acetabular screw (IAS) fixation is crucial. The aim of this study was to clarify the sex-specific differences in the secure infra-acetabular corridor for safe IAS placement.

Methods: Three-dimensional pelvic computed tomography (CT) images of 50 males and 50 females with an average age of 77.5 years were analyzed. The secure insertion path of IAS was simulated on the ZedHip system (Lexi Co., Ltd., Japan), and length, angle, and diameters of the infra-acetabular corridor were measured.

Results: The lengths of the corridors were 99.0±4.6 mm in males and 91.5±5.3 mm in females (p<0.01). The angle of the corridor to Y axis in the axial plane on the functional pelvic plane (FPP) was 5.1±4.9° in males and 8.6±5.3° in females (p<0.01). However, in 32% of the cases it was deemed that a IAS could not be inserted because the diameters of the corridor were too narrow to insert the screw.

Conclusions: On simulation, the corridor length was shorter and corridor angle was larger in females. In one third of cases the infra-acetabular corridor simulation showed it was impossible to insert the IAS, so it is crucial to scrutinize the infra-acetabular corridor on CT images during preoperative planning for IAS insertion in acetabular fractures.

Objective: We compared post-thoracotomy pain syndrome (PTPS) incidence in patients who underwent uniportal or multiportal video-assisted thoracoscopic surgery (VATS).

Methods: We included 223 patients who underwent either uniportal or multiportal VATS between January 2017 and October 2018 (pulmonary lobectomies and pulmonary segmentectomies—uniportal: n=19, multiportal: n=133; wedge lung resections—uniportal: n=16, multiportal: n=55). We retrospectively studied incidences of PTPS in all subgroups.

Results: Incidences of PTPS were significantly less for uniportal procedures for both the pulmonary lobectomy/segmentectomy group (P=0.024) and the wedge lung resection group (P=0.0315) than for multiportal procedures.

Conclusion: Patients who underwent uniportal VATS procedures had lower incidences of PTPS than the multiportal VATS group. The uniportal VATS approach is therefore beneficial for patients.

Objective: Precise prediction of postoperative pulmonary function is extremely important for accurately evaluating the risk of perioperative morbidity and mortality after major surgery for lung cancer. This study aimed to compare the accuracy of a single-photon emission computed tomography/computed tomography (SPECT/CT) method that we recently developed for predicting postoperative pulmonary function versus the accuracy of both the conventional simplified calculating (SC) method and the method using planar images of lung perfusion scintigraphy.

Methods: The relationship between the postoperative observed % values of the forced expiratory volume in 1 second (FEV₁) or diffusing capacity for carbon monoxide (DL_CO or DL_CO’) and the % predicted postoperative (%ppo) values of FEV₁, DL_CO, or DL_CO’ calculated by the three methods were analyzed in 30 consecutive patients with lung cancer undergoing lobectomy.

Results: The relationship between the postoperative observed % values and %ppo values calculated by the three methods exhibited a strong correlation (Pearson r>0.8, two-tailed p<0.0001). The limits of agreement between the postoperative % values and %ppo values did not differ among the three methods. The absolute values of the differences between the postoperative % values and %ppo values for FEV₁ and DL_CO’ were comparable among the three methods, whereas those for DL_CO of SPECT/CT were significantly higher than those of the planar method. Conversely, in patients with preoperative %DL_CO’ of <80% predicted, the absolute values of the differences between the postoperative %DL_CO’ and %ppoDL_CO’ of SPECT/CT tended to be smaller than those of the SC and planar methods.

Conclusion: The accuracy of SPECT/CT for predicting postoperative pulmonary function is comparable with that of conventional methods in most cases, other than in some patients with diffusion impairment.

Objectives: Although numerous studies have examined activities of daily living (ADL) in stroke rehabilitation, there has been little focus on impairment, despite its close relationship to ADL. Therefore, we evaluated the change in impairment from admission to discharge of patients with stroke in comprehensive inpatient rehabilitation wards using the Stroke Impairment Assessment Set (SIAS).

Methods: Data from 3279 patients with first stroke who were admitted to comprehensive inpatient rehabilitation wards between 2004 and 2016 were analyzed. A scattergram of the items showing the percentage of the highest score on admission and the percentage of patients whose score improved during hospitalization was plotted. The items of the SIAS were grouped by their location on the scattergram.

Results: Three clusters could be discriminated on the scattergram. The upper right group, showed an improved score during hospitalization in combination with a high percentage of patients with the highest score on admission. This group consisted of the verticality, unaffected-side quadriceps, visuospatial, and pain items of the SIAS. The upper left group improved during hospitalization, but only contained a small percentage of patients with a high score on admission, and consisted of motor function items. The lower group was characterized by poor improvement during hospitalization and consisted of sensory, tone, range of motion, speech, and grip power items.

Conclusions: Understanding the change in impairment during hospitalization using the three groups described above will facilitate design of a plan for stroke rehabilitation on admission.

Objectives: Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by abnormal and potentially violent behaviors during REM sleep, typically observed in older adult subjects. Previous reports have described a high risk for neurodegeneration in patients with iRBD; however, to date, no published study has analyzed an adequate number of Japanese patients. We retrospectively analyzed the incidence of neurodegenerative disorders among patients diagnosed with iRBD in our department.

Methods: The data were retrospectively collected from patients’ medical records. The patients included in the study were diagnosed with iRBD using polysomnography in our department, from May 1, 2005 to November 30, 2018, with a follow-up of ≥6 months. Using the Kaplan–Meier (KM) method, we estimated the incidence of later diagnoses of neurodegenerative disorders among this cohort of patients with iRBD.

Results: Among 57 consecutive patients diagnosed with iRBD, 14 (24.6%) were later diagnosed with neurodegenerative disorders. Using the KM method, we estimated that the incidence was as high as 18.5% and 68.1% at 5 and 10 years, respectively. Of the 14 patients who developed neurodegenerative disorders, 12 (85.7%) had α-synucleinopathies (Parkinson’s disease in eight patients, Lewy body dementia in three, Alzheimer’s-type dementia in two, and multiple system atrophy in one).

Conclusions: The results of this study suggest the high likelihood that iRBD may subsequently progress to neurodegenerative disorders in Japanese patients, a finding similar to those previously reported by studies performed overseas. Further studies using standardized prospective evaluation methods must be performed in Japan.