The hospital of the current study holds a flying disc （FD） game twice annually to improve the physical activity of patients with chronic obstructive pulmonary disease （COPD）. During the game, the patients throw the FD 10 times according to their own timing and are encouraged to rest when they complain of increased respiratory rate or dyspnea. Such games for COPD patients are conducted in several places throughout Japan. However, physical findings （e.g., oxygen saturation via pulse oximetry ［SpO2］） are usually not measured during the game. This study aims to measure physical findings before, during, and after the game to evaluate the degree of exercise load and examine whether the FD game can be safely held. This study enrolled seven patients with COPD. The FD game was held in November 2017 and SpO2 was monitored before, during, and after the game. Breathlessness and a feeling of fatigue were evaluated with the modified Borg scale before and after the game. The results were compared with those of the 6-min walk test performed during an outpatient visit before or after the day of the game. SpO2 was always ＞90％ in five patients, but it was transiently decreased to ＜90％ during the FD game in two patients. The Borg scale scores were always ＜5. In all patients, the minimum SpO2 during the FD game was greater than that obtained with the 6-min walk test. The results of the current study suggest that the FD game allows hypoxemia to be quickly detected and can be held safely if conducted according to the patients’ timing while the SpO2 is continuously measured. Thus, the FD game is useful to increase the physical activity of COPD patients.
After hospital discharge, patients with stroke continue to experience physical challenges in performing activities of daily living due to the unavailability of long-term rehabilitation services. Long-term walking maintenance is a particularly critical issue in stroke rehabilitation as it can significantly affect the ability to perform activities of daily living; therefore, an individualized home-based rehabilitation program was implemented with periodic intervention to maintain physical function and evaluated its impact on walking activity levels in patients with chronic stroke. Sixteen patients with chronic stroke （mean age, 61.6 years） who attended our outpatient clinic between September 2009 and August 2010 were included. They were assessed after being assigned to either the program or control group. The program group patients underwent personalized training and met the therapist every 2 weeks to reassess and modify the training program as appropriate, whereas the control group patients received the outpatient care only. A small pedometer/accelerometer was used as an indicator of walking activity, and caloric expenditure per hour of activity was measured and defined as the amount of walking activity. Preliminary measurements were conducted 3 months before starting the program, and then measurements were performed for 1 year. The measurement period was divided into four with 3-month intervals, and the rate of preliminary measurement changes was compared between the two groups. The exercise calories/activity hour change rates were statistically significant only in the fourth quarter （130.6％ ［127.4-160.4］ in the program group and 92.2％ ［76.1-128.3］ in the control group, P＝0.027）. A home-based rehabilitation program with periodic interventions provides patients with opportunities to continuously and independently discuss training content and effective implementation through periodic meetings, which potentially influences the walking activity of patients with chronic stroke after 1 year and leads to long-term maintenance of physical functions.
Corrective treatment with orthognathic surgery is indicated for skeletal malocclusion with marked misalignment of the maxilla and mandible. The goal of orthognathic surgery is not only to improve occlusal function but also to correct the morphological imbalance of the face. We evaluated the usefulness of a three-dimensional （3D） camera for faster 3D imaging in morphologically measuring the facial soft tissue of the patients before and after orthognathic surgery, without the need for radiation. We examined 10 women who underwent orthognathic surgery for a diagnosis of skeletal mandibular prognathism. Changes in facial soft tissue were calculated statistically. The width of the nasal alae and the nasolabial angle increased significantly, and the major axis of the nostrils decreased significantly. The morphological characteristics of the external nose changed as the jaw bones were moved. In future studies, preoperative simulation with cone-beam computed tomography should be combined with the 3D camera-based analysis and evaluation of the facial soft tissue to provide accurate corrective surgical treatment.
This study sought to clarify the characteristics of older community members who can be classified as frail. Furthermore, to evaluate community participation and social capital （SC）, which is considered an important health resource for older adults, we aimed to define the nature of the relationship among SC （the norms of trust and reciprocity in cognitive SC）, community participation, and frailty. We evaluated 843 individuals aged ≥65 years who had undergone special health checkups and/or health checkups for older adults. All participants provided consent to participate in this study. In this cross-sectional study, we conducted a self-administered questionnaire survey that evaluated the following topics: sex, age, family makeup, and basic attributes, such as subjective health, tendency to forget things, energy/liveliness, mood/anxiety disorders, food/choking, community participation （participation in community activities）, SC norms of trust and reciprocity, and “Kaigo-Yobo Check-List.” Out of the 843 individuals who consented to participate, 764 completed the questionnaire and were thus included for further analysis. Of the 764, 358 were male （46.9％）, 406 were female （53.1％）, and 102 （13.4％） were considered frail. Items that correlated significantly with frailty, as determined using the chi-square test, were as follows: eating alone, reduced frequency of going out compared with the previous year, financial comfort, community participation, SC-trust, and the norm of SC-reciprocity. After model selection using the log-linear model, a three-factor interaction was observed among SC-trust, community participation, and frailty, whereas two-factor interactions were observed between SC-reciprocity and SC-trust and between the norm of SC-reciprocity and frailty. Our findings suggest that SC-reciprocity increases SC-trust, encourages community participation, and prevents frailty among older community members.
Deadlifting strongly influences autonomic response, as this intensive strength-training activity taxes the body through a progression of lifting heavy weights across three separate attempts. We sought to study this autonomic response after deadlifting, and the potential effect of wearing a mouthguard during deadlifting. Ten healthy male volunteers aged 30.0±15.0 years were recruited. The deadlifting weight for each study subject was selected based on 90％ of the individual’s maximum weight （90％max; 153.3±31.4kg）. The electrocardiographic R-R interval variabilities （CVRRs） were analyzed using the Kiritsu Meijin （Crosswell Co., Yokohama, Japan） autonomic nerve activity analysis software by measuring electrocardiogram activity. We measured the subjects’ CVRRs while sitting for 2min, immediately upon standing, and after standing for 1min immediately after deadlifting. We monitored the five autonomic parameters at three different weights of 90％max±5kg and then the effect of wearing custom-made mouthguards （CMGs） at 2mm and 4mm thickness with 90％max weight. Individualized CMGs were fabricated by a thermoforming device using an ethyl vinyl acetate sheet. Statistical analysis was performed using analysis of variance, and multiple comparisons of the Bonferroni correction were employed. Changes in heart rate （ΔHR） by deadlifting with 90％max±5kg increased alongside the increasing weight, and we found that ΔHR with 90％max＋5kg was significantly increased （p＝0.039） compared to that with 90％max −5kg. Wearing a 4mm CMG resulted in marginally significantly higher （p＝0.072） ccvHF values than without CMG. The ccvHF value is an index of parasympathetic activity, and a higher value is considered to be related to physical resilience; therefore, wearing a 4mm CMG may reduce fatigue in individuals in deadlifting and similarly intensive exercise.
To develop “Specific Medical Practices” for visiting nurses, we studied the medical practice of visiting nurses based on the life model. We conducted a semi-structured interview survey of eight visiting nurses in prefecture A focusing on “nursing based on the life model required for medical practice” using a qualitative and inductive approach. We identified and grouped the medical practice of visiting nurses into the following five categories: “Patient assessment based on their life,” “Assessment and support of the patient’s family,” “Specific instructions in accordance with the abilities of the patient’s family,” “Nursing care and improving the environment for patient health,” and “Cooperation with related professionals for medical practice.” Visiting nurses provide various types of nursing care to patients before and after medical practice not only to promote patients’ physical recovery but also to maintain their quality of life and increase the satisfaction of patients and their families. The specific medical care system can be further developed by considering nursing based on the life model.
A characteristic facial appearance and congenital heart diseases are the most common clinical features of patients with 22q11.2 deletion syndrome, many of whom are diagnosed in early childhood. Approximately 70％-90％ of adolescent patients develop developmental disorders. Hence, early diagnosis is vital to accurately determine their clinical status and provide effective treatment and support. However, some patients are not properly diagnosed and treated due to nonspecific clinical features. Here, we report the case of a 13-year-old boy who presented with convulsion accompanied by rhabdomyolysis, signs that ultimately led to a diagnosis of hypocalcemia and 22q11.2 deletion syndrome. In patients with convulsions due to hypocalcemia, 22q11.2 deletion syndrome should be considered as a differential diagnosis, despite the adolescent age and absence of any other specific complications.
Late-onset group B streptococcus （GBS） infection in neonates often causes meningitis or bacteremia, but cellulitis or osteoarthritis may also develop in 5％-10％ of cases. We report a case of a preterm infant who developed submandibular cellulitis, bacteremia, and meningitis due to late-onset GBS infection and had airway obstruction resulting from submandibular cellulitis. At the age of 61 days, the infant had presented with frequent apnea and lethargy. His treatments included tracheal incubation, mechanical ventilation, and antibiotic administration. The following day, fever, swelling of the entire mandible, and redness from the parotid region to the submandibular region were observed. GBS was detected in the cerebrospinal fluid and blood cultures, confirming a diagnosis of meningitis and bacteremia with submandibular cellulitis. The possibility of infection via breast milk was considered but was excluded when GBS was not detected in the breast milk culture. Extubation was attempted at 66 days of age, but stridor was observed immediately afterward, prompting reintubation. After the swelling of the submandibular region subsided, the patient was successfully extubated at 72 days of age. He was subsequently discharged from the neonatal intensive care unit at 94 days of age without relapse of airway obstruction. Submandibular cellulitis due to late-onset GBS infection is a rare condition. This case confirms that GBS can cause airway obstruction when inflammation spreads around the airways. Additionally, since cellulitis due to late-onset GBS infection is frequently complicated with bacteremia and meningitis, blood and cerebrospinal fluid cultures should be performed immediately.
There are several opportunities to treat patients presenting with malocclusion with congenitally missing permanent teeth in clinical orthodontics. Several methods have been suggested for treating congenitally missing permanent teeth, such as enabling tooth movement and using prostheses. In many cases, however, it is challenging to close up the spaces caused by multiple congenitally missing teeth using orthodontic treatment alone, and thus a comprehensive treatment plan including the use of prosthetics is necessary. A 19-year-old male presented with multiple congenitally missing teeth and a crossbite from another clinic. The patient presented with an Angle I malocclusion, skeletal Cl.Ⅲ （ANB −0.2°） and had a mild concave facial type. This case was would realistically require surgical orthodontic treatment and camouflage treatment, However, we decided to perform a nonsurgical orthodontic treatment considering the following points:（1） the patient was able to take edge to edge bites, （2） there was no significant deformation of the mandible （3） there was no inclination of the occlusal plane in the orthognathic facial evaluation from a CBCT, and （4） taking the patient’s opinion into account. To treat the areas of congenitally missing teeth, we used prosthetics for the maxillary bilateral premolars and orthodontics for the mandibular bilateral second premolars to close the spaces and achieve a closer occlusion. This case report described the nonsurgical treatment of a patient with morphological malocclusion, which resulted in an improved functional occlusion.