Acute stroke rehabilitation aims to prevent disuse muscle atrophy and early resumption of daily activities. However, to the best of our knowledge, no study has simultaneously investigated the differences and changes in muscle strength and muscle mass based on the degree of motor paralysis. In this study, we examined whether muscle strength and mass changes occur at different degrees of motor paralysis during the initial stages of stroke rehabilitation. The study included 20 patients who experienced an index stroke and divided them into mild and moderate groups based on the motor function in the paralytic side at the beginning of rehabilitation （initial 3 weeks）, and were assessed using all the lower extremity items of the Stroke Impairment Assessment Set. Two-way analysis of variance was used to compare the changes in thigh muscle thickness and knee extension muscle strength before and after rehabilitation. After 3 weeks of rehabilitation, the knee extensor muscle strength increased regardless of the degree of motor paralysis. In contrast, thigh muscle thickness reduced on both sides from the start of the rehabilitation, with a significant decrease in the patients with moderate paralysis. Regarding bilateral muscle strength, knee extensor strength on the paralyzed side was significantly lower in the moderate paralysis group than in the mild paralysis group; however, these differences were not present on the nonparalyzed side. Therefore, increasing exercise intensity alone in acute stroke rehabilitation may be insufficient to avert the loss of lower extremity muscle mass. However, increasing the frequency of exercise sessions by physical therapists and improving the level of activity in the hospital ward may help prevent the loss of muscle mass.

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Detection technology for measurable residual disease in multiple myeloma （MM） has improved over the years. High detection sensitivity for polymerase chain reaction （PCR）-based identification of immunoglobulin （Ig） region has been obtained using allele-specific oligonucleotide primer; however, certain limitations regarding the complexity of Ig region sequencing or specific PCR primer designing still remain. We herein performed BIOMED-2 PCR, which was developed in 2003, using the RNA extracted from bone marrow samples of patients with MM as a template and confirmed the success rate of Ig region decoding via sequencing after TA-cloning. BIOMED-2 PCR, performed using cDNA as a template, demonstrated a success rate of 58.1％ with IHGV-J-specific primers. Further, univariate and multivariate analyses indicated significantly higher PCR success rates in IgG and IgA types than Bence Jones protein （BJP） type. The low success rate in the BJP type may be due to reduced RNA expression and abnormal IgH reconstitution. BIOMED-2 PCR was effectively performed using cDNA that was prepared from the RNA sample extracted from long-term stored specimens, regardless of plasma cell percentage during specimen collection or nucleic acid concentration during extraction.

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The operating theater is mainly occupied by major surgical departments; as a result, it is sometimes difficult to appoint a surgical theater for nonregular departments, such as oral surgery. Dental anesthesia cases in Showa University Fujigaoka Hospital have increased ＞4-fold in the past 6 years; however, no regular operating room is allocated for dental surgery. This study aimed to identify the factors influencing the increase in dental anesthesia cases in this hospital. The contributing factors were retrospectively examined by reviewing dental anesthesia cases, including intravenous sedation or general anesthesia, from 2016 to 2021. A total of 465 cases were eligible for study inclusion, of which ＞95％ of the patients underwent minor dental surgery. The time required for anesthesia significantly decreased from 49 ± 21 to 35 ± 9min in intravenous sedation and from 119 ± 38 to 93 ± 27min in general anesthesia （p＜0.001）. An experienced oral surgeon and a full-time dental anesthesiologist were appointed during this period. Patients who received intravenous sedation or general anesthesia were sustained at 〜20％ annually. Thus, a certain demand for dental anesthesia cases sustainably exists. In conclusion, dental anesthesia cases can be increased by the cooperation between a dental anesthesiologist and an oral surgeon; consequently, efficient anesthetic and surgical management can be achieved.

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Insomnia is a common sleep disorder and is usually treated with long-term administration of benzodiazepine receptor agonists, which have concerning adverse effects. Although various measures for psychotropic drug administration are available, in clinical practice, cases of sleeping pill overdose have been reported. In this study, which was based on medical record review, we report our real-world experience on sleep medication use among patients admitted to the psychiatric emergency ward of Showa University Northern Yokohama Hospital between January 2014 and December 2021. Herein, we discuss factors associated with polydrug use among patients who use sleeping pills. We recorded the age, sex, diagnosis, and duration of illness of the patients. We compared patients with and without sleeping pill prescriptions and performed multivariate logistic regression analysis of the group that was prescribed two or more sleeping pills. In ＞50％ of patients, sleeping pills were written on their last prescription. Compared with the single drug group, the multiple drug group had longer durations of illness and treatment, more frequent hospitalizations, higher rates of alcohol consumption and smoking, and greater use of disability pensions. Patients with bipolar disorder were prescribed a relatively large number of sleeping pills. The number of hospitalizations, prevalence of bipolar disorder and attention deficit hyperactivity disorder （ADHD）, and discharge to the patient’s home were positively associated with the use of two or more sleep medications. This study suggests that smoking, number of hospitalizations, bipolar disorder, ADHD, and discharge to home are associated with sleeping pill polypharmacy among patients who are admitted to the psychiatric emergency ward.

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Overuse caused by repeated pitching is a crucial factor in pitching disorders. However, only a few studies have investigated changes in magnetic resonance （MR） images of elbow joints before and after pitching. This study examined MR images of elbow joints of 11 healthy baseball players before and after 100 pitches. Echography was used to measure the medial elbow joint space gapping, whereas a hand-held dynamometer was used to measure the upper-limb muscle strength. Kinematic and kinetic data during the pitching motion were measured using wearable sensors. MR images taken before and after pitching were used to investigate abnormalities in the medial collateral ligament （MCL）. Mean values were compared using paired Student t-test or the Wilcoxson test. MR images showed no abnormalities in the MCL before and after pitching. However, we observed a significant increase in the medial elbow joint space gapping and a significant decrease in the shoulder external rotation muscle strength in the zero position （Zero ER） after pitching. After throwing 100 pitches, the MCL showed no brightness or morphological changes on MR imaging. However, we noted an increase in the medial elbow joint space gapping and a decrease in Zero ER. The significant enlargement in the medial interspace distance before and after pitching suggests the development of MCL loosening. No brightness or morphological changes were observed on MR images, and none of the patients developed pain.

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Primary benign skull base tumors rarely extend into the temporal bone. In this case study, we examine two rare cases of benign skull base tumor extending into the temporal bone. Case 1 involved a 55-year-old woman. Approximately 30 years ago, she became aware of hearing loss in her left ear and thereby visited a nearby doctor for left adhesive otitis media. A mass was observed in her left tympanum; thus, an exploratory tympanotomy with biopsy was performed. Pathological diagnosis of the resected tumor revealed meningioma. Case 2 involved a 46-year-old woman. The patient became aware of hearing loss in her left ear and was diagnosed by a nearby doctor with otitis media with effusion. She underwent left tympanic ventilation tube placement; however, her left conductive hearing loss showed no improvement. Imaging revealed a mass at the base of the left skull, which was suspected to be a giant cell tumor. Thus, a neurosurgeon was requested to perform tumor embolization and then excision of the tumor via craniotomy. Pathological examination of the resected tumor revealed a giant cell tumor of the bone. Both the patients are currently being followed up, with no noticeable complications. For intractable hearing loss, not only examination by an otolaryngologist but also imaging tests and cooperation with a neurosurgeon are necessary.

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Genomic medicine, along with the inclusion of cancer gene panel testing in insurance claims was started in Japan in June 2019. Showa University Hospital in Tokyo, Japan started cancer gene panel testing in July 2020 and accumulated 160 cases by December 2022. Of the 159 cases that reached the expert panel （EP）, 84 （52.8％） were recommended gene mutation-based treatment, whereas 15 （18％） were managed with medical therapy. Unfortunately, of the 84 patients were offered the recommended treatment, 15 （9.4％） died within 3 months after reaching the EP. Of the 19 patients （68％） who received genetic counseling, 11 （39％） underwent genetic testing, and 6 （21％） were positive for genetic mutations. These results suggested that a comprehensive treatment strategy and appropriate timing of testing are essential for early initiation of treatment. Moreover, identification of possible genetic disorders is crucial for patients and their families, for timely access to care. To achieve these goals and improve the medical care system, recruitment and training of specialists on drugs, clinical trials, and genetics are necessary.

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