We investigated the rational placement of implants analyzing the stress based on a plate placement olecranon fracture using a finite element model. The intramedullary screw and subchondral screw models were compared to assess which achieved less postoperative displacement. Based on elbow joint CT scans, we prepared an olecranon fracture model and a plate placement model to serve as the finite element model. By changing the angle and length of one of the screws near the plate, we prepared two types of models that have: 1） a screw inserted parallel to the ulnar axis in the medullary cavity, and 2） an upward-facing screw passing through the subchondral bone. The stress distribution and displacement in the fractured part in the articular surface were obtained by combining the musculoskeletal modeling simulation and finite element analysis. At 150 degrees in elbow flexion where the joint reaction force near the olecranon becomes the strongest, high stress was exerted only on the upward-facing screw in the case of 2, whereas in the case 1, similar high stresses were also exerted on the three proximal screws and the plate. The magnitude of displacement on the articular surface was 0.292mm in case 1 and 0.007mm in case 2. Fixation force can be improved by inserting a screw to the fractured part through the subchondral bone near the articular surface.

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Traditional radial head prostheses have a cylindrical-shaped articular surface, which is inconsistent with the joint’s normal anatomy. This mismatch can create clinical problems such as deformation of the humeral capitellum and forearm pain. Recently, ellipsoid implants have been designed to reproduce the joint’s natural anatomical shape. These innovations should prove effective in increasing the contact area and reducing contact pressure on the radiocapitellar joint. However, failure to set the prosthesis at a correct angle with respect to the radial axis during installation can cause adverse effects, thereby negating the surgery’s benefits. The objective of the present study was to investigate whether the rotational alignment of an anatomical radial head prosthesis changes contact area with or pressure on the radiocapitellar joint. Contact area and pressure were measured using humerus and radius specimens obtained from teaching cadavers. A 100 N axial load was applied to the joints after prosthesis installation for five different insertion angles （0°; 15° and 30° anterior rotation; 15° and 30° posterior rotation）. The 0° rotation condition had the largest contact area and lowest mean contact pressure. Contact area tended to decrease with increasing rotation, whereas mean contact pressure tended to increase; however, these trends were non-significant. We observed that greater misalignment during the placement of an anatomical radial head prosthesis resulted in reduced contact area and increased contact pressure on the radiocapitellar joint; however, the severity of these changes was negligible. Ideally, surgeons should set these implants with as much precision as possible. However, even if rotational misalignment arises, it does not likely cause any appreciable change in the radiocapitellar contact area or pressure, at least over the range of angles tested in this study.

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In 2014, our hospital for patients requiring advanced acute stage medicine introduced a “Project to assess an appropriate approach for acute stage rehabilitation”. The project was aimed to increase rehabilitation staff, develop human resources, establish a suitable environment for acute stage rehabilitation, and promote rehabilitation intervention from the intensive care stages by providing professional training. To evaluate the project’s outcomes and determine its future course our study examined the changes in achievements before and after initiating the “Project to assess an appropriate approach for acute stage rehabilitation” at Showa University Fujigaoka Hospital. Patients who underwent physical therapy at the Showa University Fujigaoka Hospital were enrolled and divided into two groups. A total of 1,973 patients treated between April 2013 and March 2014 by a five-member physical therapist team formed the FY2013 group; and 2,286 patients treated between April 2015 and March 2016 by a ten-member physical therapists’ team formed the FY2015 group. Type of disease, place where physical therapy started, physical therapy time, and annual fees were retrospectively compared. Physical therapy time showed significant increases for emergency medicine, cardiology, cardiac surgery, pulmonology, gastroenterology, and neurology in the FY2015 group compared to the FY2013 group. Physical therapy that started at the intensive care unit or the advanced emergency medical center was also significantly increased. Physical therapy time per patient was increased per day and per year in the FY2015 group, and the annual fees increased by approximately 1.9-fold. The “Project to assess an appropriate approach for acute stage rehabilitation,” successfully organized a multifaceted initiative to increase rehabilitation staff members, improve human resource development of staff familiar with acute stage rehabilitation, and to train additional professionals. These factors contributed to the early rehabilitation of patients after hospitalization.

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Syphilis is a sexually transmitted disease caused by treponema pallidum infection. Induration, hard chancre, or indolent regional lymphadenopathy can occur in the infection site as an initial symptom during primary syphilis. In this study, we report a case of differentiation requirement of malignant tumor in an 87-year-old male who visited our institution with the chief complaints of a tumor on the dorsum of his tongue and cervical lymphadenopathy. Conspicuous enlargement of the cervical lymph node was found on CT and MRI examination. After the histopathologic examination and blood test for the purpose of tongue cancer and malignant tumor, a malignant tumor was histopathologically denied; therefore, we diagnosed it as oral syphilis with 185R.U. as a high syphilis RPR （rapid plasma reagin） level. Treatment was provided with oral administration of amoxicillin （AMPC） 1,500mg/day, and six weeks later, the tongue and enlargement of the cervical lymph node were resolved. At the 15th week, we finished treatment because of normalization to a RPR level of 3.9R.U.

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