Introduction: The objective of this study was to examine the current state of early rehabilitation in the intensive care unit (ICU) for older patients and the factors affecting one-year mortality after ICU admission.

Methods: This study included older patients aged ≥75 years who were admitted to our ICU from 2018 to 2020 and for whom early rehabilitation protocols were implemented. Clinical characteristics, disease severity, blood test data, rehabilitation program, and length of ICU stay were retrospectively reviewed and compared using medical records. Severity of illness was assessed using the Sequential Organ Failure Assessment Score (SOFA score) at the time of ICU admission. Survival analysis was conducted using the Kaplan-Meier method, with ICU admission date as the starting point and death within one year as the end point. To investigate associations with one-year mortality after ICU admission, Cox proportional hazards analysis was performed using death within one year after ICU admission as the objective variable, and significant variables identified on univariate analysis were used as explanatory variables, considering multicollinearity.

Results: The study included 125 patients. Of these, 24 patients died within one year after ICU admission, yielding a one-year mortality rate of 19.2%. Independent factors predicting one-year mortality after ICU admission were the SOFA score ≤9 (p <0.001; hazard ratio [HR], 0.143; 95% confidence interval [CI], 0.063-0.325) and a standing or ambulation rehabilitation program during ICU admission (p = 0.007; HR, 0.188; 95% CI, 0.056-0.631).

Conclusions: In older patients requiring intensive care, the SOFA score and a standing or ambulation rehabilitation program during ICU admission are independent predictors of one-year mortality after ICU admission.

Introduction: Fracture-related infections and implant-associated infections are major post-operative challenges encountered by orthopedic surgeons in their clinical practice. The occurrence of biofilm-forming bacteria on surgical implants is a serious problem that needs to be addressed post-surgically. Continuous local antibiotic perfusion (CLAP) using gentamicin (GM) for bone and soft tissue infections has been reported. This study aimed to elucidate the role of insulin-like growth factor 1 (IGF-1) in reducing the cytotoxicity associated with GM use in CLAP. In addition, we sought to assess the effectiveness of IGF-1 in facilitating the recovery of osteoblasts following CLAP treatment.

Methods: Osteoblasts were treated with 1,000, 2,500, or 5,000 μg/mL GM, and the changes in cell number; alkaline phosphatase (ALP) activity; and gene expression levels of collagen type 1, ALP, and RUNX2 were determined. These drug concentrations were used to simulate the concentrations used in clinical practice. After the 10-day GM treatment, the cells were treated with or without IGF-1, and the changes in cell number; ALP activity; and gene expression levels of collagen type 1, ALP, and RUNX2 were determined.

Results: GM treatment decreased the cell number, altered cell morphology, decreased ALP activity, and affected the expression of osteogenesis-related genes. Subsequent treatment with IGF-1 attenuated the GM-induced effects in the osteoblasts and partially recovered the cell number, morphology, ALP activity, and the expression of osteogenesis-related genes in GM-damaged cells.

Conclusions: IGF-1 administration promoted the recovery of osteoblasts and attenuated GM-induced toxicity in osteoblasts.

ABSTRACT: Incarcerated rectal prolapse (IRP) is a critical condition because it requires emergency surgery, which results in stoma creation for most patients. We encountered a case in which we successfully repositioned the IRP using a 50% glucose solution and were eventually able to perform curative surgery for advanced sigmoid colon cancer that had caused the IRP.

A 69-year-old woman visited the hospital complaining of lower abdominal pain. IRP was identified on visual inspection. Manual reduction was difficult, so gauze soaked in 50% glucose solution was applied to alleviate the edematous prolapsed rectum. The incarceration was reduced within 15 minutes. Subsequently, colonoscopy for screening revealed advanced sigmoid colon cancer, which was suspected to be the cause of the IRP. Initially, laparoscopic anterior resection for the sigmoid colon cancer with coexisting rectal prolapse was planned; however, Hartmann's procedure was ultimately performed based on an informed choice. In cases of IRP, simply applying a high-concentration glucose solution may help patients avoid emergency surgery.