Objective: To compare the outcomes of steroid-associated osteonecrosis of the femoral head in patients with systemic lupus erythematosus who underwent conservative treatment and concentrated autologous bone marrow aspirate transplantation

Methods: Osteonecrosis of the femoral head was classified according to the Japanese Investigation Committee system. Concentrated autologous bone marrow aspirate transplantation was performed by aspirating the bone marrow from both iliac crests and then transplanting it to the necrotic area after the core decompression. Patients with >2-year follow-up after the concentrated autologous bone marrow aspirate transplantation in our institution (Group I) and those with >2-year follow-up after the first hospital visit in a cooperative institution (Group II) were included in this study. After a randomized matching based on age, sex, type, stage, and etiology, the collapse rate in pre-collapsed stages and total hip arthroplasty conversion rate in all stages were compared between the two groups.

Results: After the matching adjustment, 33 pairs of hips were included. Preoperatively, 1, 2, 16, and 14 hips were classified as types A, B, C1, and C2, respectively, and 15, 13, 2, and 3 hips were classified as stages 1, 2, 3A, and 3B, respectively. The collapse rates in the pre-collapsed stages were 68% and 39% in Groups I and II, respectively. Total hip arthroplasty conversion rates were 33% and 45% in Groups I and II, respectively. However, Group I had significantly higher and lower conversion rates in stages 1 and 3, respectively (both P<0.05).

Conclusion: Conservative treatment may be preferable in stage 1 hips. In addition, concentrated autologous bone marrow aspirate transplantation may prevent further collapse in stage 3.

Objective: Osteoporotic vertebral fracture (OVF) is conventionally treated with conservative management such as bed rest, but a relatively prolonged bed rest has the potential risk of muscle disuse atrophy. This study aimed to examine whether the 2-week of rigorous bed rest affects muscle disuse atrophy in OVF patients.

Patients and Methods: A total of 54 OVF patients (16 males; 38 females; mean age, 80.2 ± 9.2 years) were treated with an initial 2-week rigorous bed rest by hospitalization with persistent rehabilitation. Cognitive function, swallowing function, grip strength, and lower extremity circumference were evaluated at three-time points (admission, end of bed rest, and discharge).

Results: Of the 51 patients who were able to walk independently before the injury, one patient (2.0%) had to use a wheelchair after the injury. During hospitalization, cognitive function decline was observed in 33.3% of patients, but not in patients with Revised Hasegawa’s Dementia Scale score ≥25 at admission. Swallowing function decline was observed in one patient, and none of the patients developed aspiration pneumonia during hospitalization. The grip strength significantly improved both at the end of bed rest (P=0.04) and discharge (P=0.02). Although the lower extremity circumference significantly decreased at the end of bed rest (P<0.01), it was recovered afterward. The lower extremity circumference did not significantly differ between the admission and discharge (P=0.17).

Conclusion: Our results suggested that conservative treatment of OVF through an initial 2-week rigorous bed rest with persistent hospital rehabilitation poses a low risk of muscle disuse atrophy. If cognitive dysfunction is observed on admission, close monitoring for exacerbation should be performed during the hospital stay.

Objective: This study aimed to examine differences in platelet-rich plasma (PRP) soak-loaded volumes of β-tricalcium phosphate (β-TCP) with or without a unidirectional porous structure.

Materials and Methods: Leukocyte-rich PRP was extracted from 15 healthy volunteers by centrifugation. Two types of artificial bones were soaked for either ten seconds or ten minutes. The volume ratios of PRP soak-loaded onto the artificial bone and soaked area ratios were evaluated. Statistical analyses were performed using the Tukey-Kramer HSD test and the Games-Howell method. A P-value of <0.05 was considered statistically significant.

Results: Regardless of the soaking time, the PRP soak-loaded volume ratio and soaked area ratio were significantly higher in the unidirectional porous β-TCP (UDPTCP) group than in the spherical porous β-TCP (SPTCP) group.

Conclusion: PRP can be soak-loaded faster and in larger amounts onto UDPTCP compared to SPTCP. Understanding the basic biology of β-TCP soak-loaded with PRP can help develop more novel and effective β-TCP treatments for orthopedic surgery.

Objectives: To evaluate the feasibility and efficacy of treatment for the recovery of knee joint function after total knee arthroplasty (TKA) using a robotic suit.

Patients and Methods: Knee joint extension exercise sessions were started with a robotic suit (single-joint hybrid assistive limb [HAL-SJ, Cyberdyne, Inc., Tsukuba, Japan]) in one group of patients after TKA. Patients who underwent standard rehabilitation were enrolled in the control group. To evaluate feasibility and safety, we assessed the adverse events, the number of training sessions, and training time. We compared the changes in knee joint pain and extension lag (°) between the groups.

Results: The average age was 71.3 ± 6.2 years in the HAL-SJ group and 74.9 ± 8.7 years in the control group. There were no severe adverse events. In the HAL-SJ group, training was performed 2.9 times, on average, and lasted 18.8 min. In the HAL-SJ group, there was a reduction in the visual analog scale (VAS) for pain after training, which was not significant. In the control group, the VAS score worsened after the sessions. The extension lag significantly improved in the HAL-SJ group after the 2nd and 3rd sessions, and this was more due to improvements in their active extension range of motion than their passive extension range of motion.

Conclusions: HAL-SJ-based training is safe and effective, and leads to instantaneous improvement of extension lag, without worsening knee joint pain. HAL-SJ-based knee extension training could represent a viable novel post-TKA rehabilitation modality.

Objective: This study aimed to clarify the assertiveness of psychiatric day care users with schizophrenia.

Patients and Methods: We examined 1,179 psychiatric day care center users and 916 psychiatric hospital outpatients with schizophrenia between September 2008 and February 2009 using a questionnaire survey based on the Japanese version of the Rathus Assertiveness Schedule and the Functioning Scale. The questionnaires were distributed and collected by post by the director of each participating facility.

Results: Of the 1,179 users (Users) and 916 outpatients (Patients) targeted, 366 (31.0%) and 78 (8.5%) were enrolled in this study. The mean assertiveness score of Users (–7.1 ± 20.2) was significantly higher than that of Patients (–17.3 ± 20.9; P<0.01). Assertiveness scores were higher in Users who performed housework compared with those who did not. High functioning was a background factor that improved assertiveness scores in Users. Additionally, Users could maintain a suitable assertiveness score with support from a psychiatric day care center.

Conclusion: This study revealed that Users had a greater ability to self-assert than Patients; this was largely the result of being able to live in society.

Objective: Causes and risk factors of neurodevelopmental disorders originate in the prenatal and perinatal periods. Several studies have demonstrated a relationship between prenatal and perinatal medical records, including maternal and paternal age at pregnancy, and the neurodevelopmental disorders, especially attention deficit/hyperactivity disorder and autism spectrum disorder. However, previous studies showed an association between specific learning disorders and environmental toxins such as lead and tobacco smoke, but not parental age.

Patients and Methods: This study included 993 university freshmen, and their prenatal and perinatal medical data was collected from maternal and child handbooks. A mental health assessment questionnaire consisting of 24 items covering symptoms associated with neurodevelopmental disorders was administered, corresponding to aspects of attention deficit/hyperactivity disorder, autism spectrum disorder, and learning disorders. The relationship between prenatal and perinatal medical data and questionnaire results was statistically analyzed.

Results: The number of available records was 881 (88.7%). Using Spearman’s rank correlation coefficient analysis and trend analysis, a weak but statistically significant relationship was confirmed between paternal age at pregnancy and the score for learning disorder difficulties.

Conclusion: Error accumulation in meiosis during spermatogenesis may be one of the risk factors of learning disorders.

Objective: The present study aims to investigate the factors related to self-rated ikigai (purpose in life) among older residents participating in hillside residential community-based activities in Nagasaki City.

Methods: A self-administered anonymous questionnaire survey was carried out with older residents participating in two hillside residential community-based activities in Nagasaki City, Japan. The questionnaire included questions on sociodemographic information (age, sex, family structure, education, and self-rated economic satisfaction), self-rated health, mental health status measured using Geriatric Depression Scale-15 (GDS-15), and self-rated ikigai score that was estimated using a visual analog scale.

Results: A total of 32 older residents (7 males, 25 females) participated in the questionnaire survey. Although self-rated ikigai score was not associated with sociodemographic factors, there were associations between the score, self-rated health (P=0.001), and mental health (GDS-15) (P=0.015). Statistically significant correlations between self-rated ikigai score and social participation (ρ=0.426, P=0.017), self-rated health (ρ=−0.485, P=0.007), and mental health (GDS-15) (ρ=−0.523, P=0.007) were observed.

Conclusion: Increasing social participation may increase individual ikigai, preventing poor self-rated health and low mental health status in older people. Maintaining their social participation in the community might be effective for the health promotion of older residents in hillside residential areas of Nagasaki City.

Objective: Most cases of severe metabolic alkalosis have many causes that may result in renal failure and death. Therefore, these should be treated promptly for successful recovery.

Patient: A 61-year-old man was hospitalized due to an acute kidney injury (creatinine level of 4.36 mg/dL) after a 3-month history of anorexia and recurrent vomiting. He had been treated for tuberculosis in the past.

Results: Blood gas analysis revealed severe metabolic alkalosis with pH=7.66, HCO₃=94 mmol/L, and pCO₂=82.0 mmHg. Routine biochemical examination revealed severe hypokalemia (K 2.9 mEq/L) that was associated with prolonged QTc interval (0.52 seconds) on the electrocardiogram. Gastrofiberscopic examination also revealed severe stenosis and ulcerated scarring of the gastric pylorus and severe esophagitis. Intravenous hydration and correction of hypokalemia improved renal function and resolved metabolic alkalosis. An investigation that was repeated after 6 days revealed a creatinine level of 1.58 mg/dL, pH=7.47, HCO₃=23.4 mmol/L, K=3.6 mEq/L, and QTc of 0.45 seconds. The patient underwent gastrectomy and adenocarcinoma was observed.

Conclusion: We described a resolved case of severe metabolic alkalosis and acute kidney injury in a rural medical setting following conservative management.

Introduction: Unidirectional porous β-tricalcium phosphate (UDPTCP) consists of a novel porous artificial bone that is structurally different from conventional artificial bone comprised of spherical porous β-tricalcium phosphate (SPTCP).

Case presentation: We present our first four clinical cases of opening-wedge high tibial osteotomy (OWHTO) using UDPTCP and SPTCP together. The patients’ mean age was 54.5 ± 5.9 years, and the mean observation period was 20.8 ± 2.8 months. In OWHTO, two wedge shaped pieces of UDPTCP and SPTCP were cut to fit the gap and implanted parallel to each other in the anterior and posterior parts, respectively. We evaluated the correction loss and bone remodeling for UDPTCP and SPTCP over time using radiography and computed tomography, and evaluated the clinical outcomes.

Conclusion: There was no correction loss reported in any case, and early bone remodeling was observed with UDPTCP. All patients achieved satisfactory clinical results with no adverse events.

Objective: Lumbar spondylolysis, caused by stress fracture of the pars interarticularis may lead to a bony defect or spondylolisthesis. In adolescents, its surgical treatment employs the smiley face rod method for direct reduction of pseudoarthrotic spondylolysis and spondylolisthesis. Clinical outcomes of this treatment have been occasionally described; however, implant removal has not been discussed previously. We present a patient with lumbar spondylolysis with grade 1 slip at the 5th lumbar vertebra (L5) per the Meyerding classification.

Patient: A 14-year-old boy presented with chronic severe lower back pain. Since conservative therapy did not resolve pain or enable resuming sports activities, the smiley face rod repair was performed 7 months after the initial treatment.

Result: Anterior slippage of the L5 was surgically reduced. The patient wore a brace for 3 months postoperatively, and partial bone fusion was noted 6 months postoperatively. He resumed his sports activity 8 months postoperatively, and absolute bone fusion was confirmed 18 months postoperatively. Implant removal was performed 3 years postoperatively. Grade 1 slip was corrected with absolute bone fusion, and long-term follow-up revealed good results in terms of healing and rehabilitation.

Conclusion: Smiley face rod method that allows for implant removal after bone fusion is suitable for adolescents.

Objective: Scrub typhus is a relatively common life-threating disease; its symptoms are non-specific and similar to those of other viral infections. Therefore, scrub typhus might be underdiagnosed.

Patient: Herein, we report a patient with scrub typhus whose clinical course mimicked that of infectious mononucleosis. A 63-year-old male patient with hypertension presented to our hospital complaining of symptoms including prolonged fever, pharyngeal discomfort, and a mild headache. He showed the appearance of a rash after amoxicillin administration. At the same time, he did not show a crusted rash on his body surface.

Results: After a comprehensive examination, Epstein-Barr virus and cytomegalovirus infections were ruled out. We suspected that this patient suffered from scrub typhus on the basis of his usual lifestyle. Finally, polymerase chain reaction analysis showed a positive result for deoxyribonucleic acid of Orientia tsutsugamushi in his blood sample. Fortunately, he recovered naturally with only supportive treatment during his hospitalization.

Conclusion: We should observe and monitor patients with infectious mononucleosis-like symptoms and emphasize the importance of a clinical interview.