[Background] Heart failure with preserved ejection fraction (HFPEF) causes pulmonary hypertension (PH) in association with left ventricular diastolic dysfunction. Recent studies suggested that exercise-induced PH precedes the development of HEFPEF. Hypertension is one of the major risk factors for HFPEF. There are few studies regarding the impact of exercise on pulmonary artery pressure (PAP) in hypertensive patients. [Aim] The present study investigated the impact of exercise on pulmonary hemodynamics in hypertensive patients. [Methods and Results] We used exercise stress echocardiography to study 41 consecutive asymptomatic patients with essential hypertension and 30 healthy volunteers as controls. Resting PAP was similar between hypertensive patients and controls and was normal in both groups. PAP at peak exercise was significantly increased compared with resting PAP in both groups and was significantly higher in hypertensive patients compared with controls. None in either group had exercise-induced PH. PAP at peak exercise was significantly correlated with left ventricular diastolic dysfunction in hypertensive patients. [Conclusions] The present study suggests that an exercise-induced increase in PAP is exaggerated in its association with left ventricular diastolic dysfunction in asymptomatic patients with hypertension. Such an exaggerated response to exercise may be related to the future development of exercise-induced PH, and furthermore to HEFPEF. Further investigation is needed.

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[Background] We developed an inpatient fall predictive model (Saga Fall Risk Model 2 [SFRM2]) based on eight items (age, sex, emergency admission, inpatient department, use of hypnotic medications, history of falls, independence of eating, and Bedriddenness rank) at an acute care community hospital. The SFRM-2 has not been validated in a highly acute care hospital； therefore, the purpose of this study was to evaluate the accuracy of the model in a university hospital. [Methods] This single-center retrospective study involved patients aged 侒 20 years who were admitted to a university hospital from April 2017 to March 2019. The required information for validation was collected from the electronic medical records, and the modelʼ s accuracy was evaluated using the area under the curve. [Results] In total, the data of 16,025 patients were analyzed, and 194 (1.2%) fell. The median age was 68 years, and 49.4% were men. The area under the curve of the model was 0.703 (95% confidence interval：0.669-0.737, p ＜ 0.001). [Conclusions] The SFRM-2 showed high accuracy in external validation at a university hospital.

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Spontaneous retroperitoneal hematoma and rectus sheath hematoma (SRH/RSH) are rare hemorrhagic events. Some of the risk factors for SRH/RSH are similar to those of the severity of coronavirus disease 2019 (COVID-19) or associated with the management of COVID-19. Among 201 COVID-19 patients aged over 65 years who received anticoagulant therapy for COVID-19 between March 2020 and February 2022, 4 patients developed SRH/RSH during hospitalization. SRH/RSH occurred 6‒14 days after the initiation of anticoagulation therapy. All 4 patients developed SRH/RSH while under administration of a prophylactic dose of unfractionated heparin (UFH) and dexamethasone for severe COVID-19, within the target range of the activated partial thromboplastin time (APTT). All 4 patients discontinued UFH, 3 underwent transfusion therapy, and 1 underwent angiographic intervention with embolization；2 died：1 from disseminated intravascular coagulation and the other from respiratory failure due to COVID-19. The other 2 were discharged 66 and 38 days after the onset of SRH/RSH. SRH/RSH can occur even within the expected range of APTT and can contribute to poor outcomes in COVID-19 patients.

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Autoimmune hypothyroidism (Hashimotoʼ s thyroiditis) is a common disease in primary care. A 58-year-old woman with a history of gastric cancer was referred to our department with a 12-month history of high serum creatine phosphokinase (CPK) concentrations and dyslipidemia without subjective symptoms. Her voice had been hoarse for ＞ 10 years；however, she considered this an effect of smoking. Her vital signs were within normal ranges, and her physical examination findings were unremarkable, except for the hoarseness. Her blood test results showed that her anti-thyroid peroxidase antibody levels and macro-CPK type 1 exceeded the upper limit of the reference range. Other blood tests and whole-body contrast-enhanced computed tomography scan results showed no abnormal findings. She underwent hormone replacement therapy (HRT). Six months later, her serum CPK concentration had normalized, and macro-CPK type 1 was negative. Hashimotoʼs thyroiditis with macro-CPK can become negative after HRT. When Hashimoto's thyroiditis is diagnosed, prioritizing thyroid function treatment may be necessary, even in the presence of macro-CPK. Physicians should confirm thyroid function in patients with high serum CPK concentrations or dyslipidemia with no subjective symptoms.

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A 79-year-old Japanese immunocompetent woman was admitted with high fever and left hip pain. T2-weighted magnetic resonance imaging showed fluid retention around the left hip. Salmonella enterica subspecies arizonae (S. arizonae) was detected in the puncture fluid of the left hip joint. After treatment with antimicrobials, the patient recovered well. Human infections with S. arizonae have been reported mostly in the southern United States, where contact with reptiles is common. Since 2000, only 6 cases of S. arizonae infection have been reported in Japan, non- endemic area. Although the patient had a history of reptile-contaminated food intake, the relation between the history of reptile-contaminated food intake and S. arizonae infection was unclear. Further accumulation of cases is important to elucidate the pathogenesis of S. arizonae infection in non-endemic areas.

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A 104-year-old man was admitted to our hospital with a complaint of dyspnea. He was diagnosed as having congestive heart failure associated with complete atrioventricular (AV) block and had a heart rate (HR) of 40 beats/min. Pacemaker implantation was offered but declined by the patient. Cilostazol was started in addition to oxygen and diuretics to increase his HR. Although the dyspnea improved, diuresis and HR elevation were inadequate. On day 14 after admission, dl-isoprenaline hydrochloride was added to increase HR further. HR increased to 50- 60 beats/min with an increase in ventricular escape beats. The heart failure gradually improved and administration of oxygen was discontinued on hospital day 38. On day 81, due to low blood pressure, we discontinued amlodipine, which the patient had been taking before admission. Complete AV block persisted thereafter, but on day 87, first-degree AV block with HR of 80-100 beats/min was observed. The first-degree AV block persisted even after discontinuation of cilostazol. The patient was discharged on day 101. This report describes our experience in this case of a very elderly patient who recovered to first-degree AV block after approximately 3 months of complete AV block.

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A 65-year-old woman was transferred to our hospital with fever, shoulder pain, and back pain. She was diagnosed as purulent facet joint arthritis (L1-2 spine) and omarthritis. Streptococcus pneumoniae was detected from the blood, and a diagnosis of invasive pneumococcal disease (IPD) was made. Ceftriaxone 4 g/day was used for 4 weeks and the condition improved. IPD can occur even in immunocompetent persons.

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Diffuse fasciitis is a disease associated with scleroderma-like induration and thickening of the skin. We report herein a case of diffuse fasciitis associated with ulcerative colitis. The patient was a 19-year-old woman with no underlying diseases. She presented with acute pain and purpura in both lower extremities. There was no obvious history of exercise or trauma, but physical examination revealed induration of the skin on both lower extremities. There was no induration of the skin of the fingers or toes, and a simple MRI of both lower legs showed inflammatory findings in the adipose tissue and fascia, leading to a diagnosis of diffuse fasciitis. A colonoscopy led to a diagnosis of a severe form of ulcerative colitis. High-dose prednisolone was administered, and induration of the skin, pain, and purpura improved. Both diffuse fasciitis and purpura were considered possible extraintestinal complications of ulcerative colitis. In diffuse fasciitis and its analog, eosinophilic fasciitis, immune abnormalities are involved in their pathogenesis. In such cases, complications associated with immune abnormalities, such as ulcerative colitis, should be considered.

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Early recognition of high-risk patients whose conditions could deteriorate rapidly in acute emergency care settings is critical to provide appropriate care. This article aimed to compare previous predictive models of the prognosis of emergency inpatients in acute care hospitals with our predictive model and to clarify the characteristics of the models. Using PubMed, we performed a narrative review of previous studies of the prediction of the prognosis of emergency inpatients admitted to acute care hospitals. We investigated the outcomes, subjects’ backgrounds, and methods of evaluation of the models. We also compared our original predictive model for emergency patients with other models and discussed the characteristics of the models. The predictive models for outcomes of emergency inpatients in numerous previous studies involved issues such as variable background of the subjects, lengthy evaluation time, and low accuracy. In contrast, our predictive model for emergency inpatients aged ≥ 65 years with endogenous diseases was easy to use and beneficial;the model includes only four items, which can be assessed on admission.

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