[Objective] During the COVID-19 global pandemic, universal masking has been widely recognized as an important way to prevent the infection from spreading in both clinical and non- clinical settings. In addition to the quantity (wearing a mask at all times), the quality (wearing a mask as appropriate) should matter. In this study, we compared the quality of the universal masking among healthcare workers (HCWs) and non-medical personnel after the first wave of COVID-19. [Methods] In June 2020, we collected data on wearing mask among HCWs at Okayama University Hospital and that of non-medical personnel outside the hospital. Improper masking was defined as wearing a mask but having the nose or mouth uncovered. Data were stratified by place (in wards, outside wards, and outside the hospital) and subject (HCWs and non-medical personnel) for comparison. [Results] In total, we collected data on 1,359 subjects in- and 2,620 outside-hospital. The appropriate mask wearing rate among HCWs (86.0%) was significantly lower than that of non- medical personnel observed in-hospital (92.6%) and outside the hospital (91.4%). [Conclusions] Quality, as well as quantity, of masking should be highlighted more among HCWs to prevent the further spread of COVID-19.

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The effect of recovery-phase rehabilitation on the prognosis of very elderly patients with cerebrovascular disorders is unknown. A total of 418 patients (mean age 73 ± 12 years) with cerebrovascular disorders admitted to our hospital for recovery-phase rehabilitation were classified according to age, and their modified Rankin Scale (mRS) scores before onset and at discharge, functional independence measure (FIM) on admission and at discharge, and outcomes were compared. Pre-onset mRS scores were higher and FIM on admission were lower in older groups compared with younger groups. FIM at discharge showed significant improvement in older groups, but was significantly lower compared with younger groups. The home discharge rate decreased with age, and 7 patients (3%), only in older groups, had in-hospital deaths. Although there was no difference in the mRS score at discharge, it became more difficult to discharge patients to home as age increased. In very elderly patients with cerebrovascular disorders, it is necessary to understand the limitations of rehabilitation in their recovery phase, share the goals to be achieved at an early stage, and carefully judge the indications for inpatient treatment.

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Intravascular lymphoma (IVL) is a rare type of B-cell lymphoma of blood vessels. We encountered an IVL case diagnosed in a patient treated for shock in the intensive care unit. An 83-year-old man was transported to our hospital for shock with fever and was initially diagnosed with septic shock. However, we could not identify an infection source, and broad-spectrum antibiotics were ineffective. Blood tests performed on admission revealed a serum lactate dehydrogenase (LDH) level >800 IU/L. Based on these findings, we suspected IVL and performed a random skin biopsy of his senile hemangioma. Large lymphocytes were collected in the lumens of small vessels. Immunostaining findings indicated IVL. Hemophagocytic lymphohistiocytosis was diagnosed based on pathological assessment of bone marrow samples. In patients with septic shock-like hypotension with serum LDH levels > 800 IU/L, IVL should be considered. Random skin biopsy, a simple and minimally invasive procedure, can be performed at the bedside and is useful for IVL diagnosis. The standard treatment for IVL is a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone. We used hydrocortisone for relative adrenal insufficiency;afterwards, his condition improved. In septic-shock like conditions associated with IVL, steroids may be the keystone to recovery.

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[Background] Several vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are in use worldwide. However, their efficacy and safety in the elderly have not been fully assessed. [Methods] The SARS-CoV-2 IgG II Quant assay (Abbott Diagnostics;positive threshold 50 AU/mL) was used to measure the IgG antibod- ies against SARS-CoV-2 of 185 participants (79 nursing home residents or inpatients of long- term care units 60 years or older, 62 outpa- tients 60 years or older, and 44 medical staff younger than 60 years). Measurement was done before their first and second vaccinations and one month after the second vaccination. [Results] After the first vaccination, only half of the nursing home residents or inpatients became positive for IgG, while 80% of the outpatients and 100% of the medical staff became positive. After being fully vaccinated, 90% of the nursing home residents or inpatients became positive for IgG, as did 100% of the outpatients and medical staff. However, the median IgG level one month after the second vaccination in the nursing home residents or npatients was only 16% and that of the outpatients was only 38% that of the medical staff. [Conclusions] Vaccines against SARS-CoV-2 are less effective in the elderly;the continua- tion of infection prevention is necessary even after vaccination.

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