In recent years, osteoporosis has become a serious concern in developed countries. Romosozumab, launched in 2019, is a relatively new osteoporosis medication that enhances bone mineral density and inhibits development of new fractures. Contraindications to romosozumab administration include hypocalcemia. It should also be administered with caution to patients at a high risk of cardiovascular disorders. To maximize its effects, it is preferable to administer romosozumab before initiation of other osteoporosis medications. Currently, no clinical reports have discussed the ability of romosozumab to promote fracture healing. Combination therapy using romosozumab and other drugs may be useful in patients with osteoporosis.

Over the course of 40 years, the distribution of liver diseases has changed dramatically with changes in the environment and diet, and with advances in medicine. The hepatitis C virus (HCV) was discovered in 1989. During 1980-2000, HCV was the major etiology of hepatocellular carcinoma (HCC) in Japan. However, its assay method has been established and anti-direct viral drugs have been developed, because of which, HCV is being eradicated. Conversely, fatty and alcoholic liver diseases have been increasing in Japan because of the westernization of eating habits and increasing female drinkers. Recently, these liver diseases have become the major causes of HCC. We have identified clinical features of nonalcoholic fatty liver disease-HCC and the genomic background of its occurrence and progression. We should pay attention to changes in disease distribution and research its pathogenesis for application in treatments.

A 37-year-old ambidextrous man was admitted to our hospital with right upper and lower limb paralysis. Brain magnetic resonance imaging (MRI) revealed acute cerebral infarction in the left lateral striatum and severe stenosis of the distal portion of M1 as well as the inferior trunk of M2 in the right middle cerebral artery. At 25 h after receiving intravenous thrombolytic therapy, the patient experienced occlusion of the descending branch of the right M2 middle cerebral artery, resulting in loss of consciousness. On day 4 of hospitalization, the patient developed tachycardia, high fever, diaphoresis, hypertension, limb muscle hypertonia, and paroxysmal sympathetic hyperactivity (PSH). Despite undergoing treatment with various medications, the patient's condition did not improve; therefore, the patient was transferred to another hospital with a modified Rankin Scale score of 5. PSH is a condition frequently observed in young patients following severe head trauma or hypoxic encephalopathy. Although there are limited reports on PSH caused by cerebral infarction, the patient developed PSH due to severe damage to bilateral cortical and hypothalamic communication fibers, despite the relatively limited extent of damage. Young patients with multiple cerebral infarctions may experience complications arising from PSH, which can result in severe outcomes.