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Background: It is known that age-related brain symptoms (gait difficulty and dementia) increase the likelihood of fall-related surgery. In contrast, it is not known which types of brain disease underlie such symptoms most. Objective: The aim of this study was to correlate brain diseases with the types of surgeries performed at our hospital for patients who had fallen. Methods: This was a retrospective study at a multifaculty university hospital in Japan, with a 12-month recruiting period, a follow-up period of 3.0 ± 2.5 weeks, and ≥1×/week visits. We assembled a neurogeriatric team to diagnose brain diseases with the use of brain imaging to the extent possible and correlated the diagnoses with types of fall-related surgery. Results: Fall-related surgery was conducted by the orthopedics (OP) and neurosurgery (NS) faculties (total n = 124) at a ratio of about 2 to 1. The underlying brain diseases differed by faculty; for OP, surgery was most commonly performed in patients with a combination of white matter disease (WMD) and Alzheimer’s disease (AD) (79%) followed by dementia with Lewy bodies. In contrast, for NS, the most common surgery was for patients with alcoholism (50%) followed by a combination of WMD and AD. Conclusion: Fall-related surgery was performed by the OP and NS faculties at a 2 to 1 ratio. The major underlying brain diseases were a combination of WMD and AD (79%) for OP and alcoholism (50%) for NS.

Waon therapy is a form of thermal treatment in a dry sauna developed by Tei. Although Waon therapy is reportedly effective for chronic heart failure (CHF) patients, not all patients respond to the therapy. The reason for this ineffectiveness has not been fully clarified. The cardio-ankle vascular index (CAVI) is an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle, and it is thought to reflect some of the afterload of the left ventricle. We investigated the effects of Waon therapy on CAVI and plasma brain natriuretic peptide (BNP) level to clarify the usefulness of CAVI during Waon therapy.CHF patients (n = 21) treated with Waon therapy (2 weeks of 10 sessions) were divided into two groups: responders with an improved BNP level (n = 11) and nonresponders with no improvement in BNP (n = 10). CAVI was measured using Vasela 1500.A significant decrease in CAVI (median and interquartile range) was observed in the responder group (from 10.3 [9.6, 11.6] to 9.6 [8.6, 10.3], P = 0.021), whereas no change was observed in the nonresponder group (from 9.6 [8.6, 10.5] to 9.5 [9.1, 11.2], P = 0.919). The incidence of rehospitalization or cardiac death due to heart failure was significantly higher in patients in whom Waon therapy was ineffective at 12 months of follow-up (log-rank P = 0.001).The effectiveness of Waon therapy in CHF patients may be reflected by the improvement in CAVI.

Introduction Reactive oxygen metabolites (ROMs) are metabolite hydroperoxides in the blood, and their serum levels were associated with the disease activity score 28 (DAS28) in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether ROMs would be predictive of the clinical disease activity index (CDAI) remission, simplified disease activity index (SDAI) remission, or Boolean remission. Materials and methods Fifty-one biologic agents (BA)-naïve RA patients were included in this observational study. Associations between ROMs, C-reactive protein, matrix metalloproteinase-3, DAS28-erythrocyte sedimentation rate (ESR), CDAI, SDAI, and health assessment questionnaire (HAQ) at 12 weeks and the DAS28, CDAI, SDAI, and Boolean remission rates at 52 weeks were investigated. Results The DAS28, CDAI, SDAI, and Boolean remission rates at 52 weeks were 66.7, 52.9, 54.9, and 54.9%, respectively. A multivariate logistic regression analysis revealed that ROMs and HAQ at 12 weeks were associated with the CDAI, SDAI, and Boolean remission at 52 weeks. Receiver operating characteristic analyses demonstrated that the cut-off value for CDAI, SDAI, and Boolean remission was 389.5 U.Carr. Conclusion Reactive oxygen metabolites at 12 weeks of initial treatment with BAs was a predictor for CDAI, SDAI, and Boolean remission at 52 weeks. Serum levels of ROMs may be a useful biomarker in the current treatment strategy aiming at early remission of RA.

We previously showed that reactive oxygen metabolites (ROM) serum levels were associated with the DAS28 in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether ROM would be predictive of the CDAI-, SDAI- or Boolean-remission. Fifty-one biologic agents (BA)-naïve RA patients were included in this observational study. Associations between ROM, C-reactive protein (CRP), MMP (matrix metalloproteinase)-3, DAS28-ESR, CDAI, SDAI, and health assessment questionnaire (HAQ) at 12 weeks and the DAS28-, CDAI-, SDAI-, and Boolean-remission at 52 weeks were investigated. The DAS28-, CDAI-, SDAI- and Boolean-remission rates at 52 weeks were 66.7, 52.9, 54.9 and 54.9%, respectively. A multivariate logistic regression analysis revealed that ROM and HAQ at 12 weeks were associated with the CDAI-, SDAI- and Boolean-remission at 52 weeks. Receiver operating characteristic (ROC) analyses demonstrated that the cut-off value for CDAI remission was 389.5 U.Carr, and that for SDAI and Boolean remission was 389.5 U.Carr. ROM at 12 weeks of initial treatment with BAs was a predictor for the CDAI-, SDAI-, and Boolean-remission at 52 weeks. Serum levels of ROM may be a useful biomarker in the current treatment strategy aiming at the early remission of RA.

Objectives: Little information is available regarding long-term follow-up of radiographic progression of damage (RPD) to large joints during treatment of rheumatoid arthritis (RA) with biological disease-modifying antirheumatic drugs (bDMARDs). We evaluated 3- to 4-year follow-up results and the associations between RPD and patient background and Larsen grade (LG) of joints.Methods: Seventy-one RA patients receiving bDMARDs for 3 to 4 years or who achieved bDMARD-free status were included. The mean age and disease duration at the start of bDMARDs were 62.4 years and 10.8 years, respectively. A total of 314 joints, including shoulders, elbows, hips, knees, and ankles, were evaluated to determine whether RPD was present by comparing radiographs before and after treatment.Results: RPD was observed in 24 patients (33.8%) and 34 joints (10.8%). Joints with an LG of III or higher had significantly higher rates of RPD than those with LGs I and II. Multivariate logistic regression analysis revealed that stage and health assessment questionnaire (HAQ) score at 18-months were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 7.222 for stage; cut-off value: 0.9375, odds ratio: 6.278 for HAQ at 18-months).Conclusion: Stage, HAQ at 18-months, and LG at the start of bDMARDs were predictive of RPD after 3 to 4 years. bDMARDs should be started before both stage and LG exceed III and the therapeutic strategy should be determined so that HAQ does not exceed 1.0 during treatment.

Young-onset (< 65 years) dementia is a challenging clinical problem. A 61-year-old man visited our clinic because of a 2-year history of mild cognitive impairment of the executive disorder type. He was initially suspected of having young-onset Alzheimer’s disease due to the lack of motor signs or hippocampal atrophy by conventional brain MRI. However, he proved to have anosmia, erectile dysfunction, hypersexuality, constipation, REM sleep behavior disorder, and emotional lability; imaging findings included positive brain perfusion SPECT, nigrosome MRI, DAT scan, and MIBG myocardial scintigraphy. All these clinical imaging features led to the correct diagnosis of young-onset dementia with Lewy bodies (YOD-DLB). It is hoped that this case report will help facilitate a future prospective study to diagnose and follow YOD-DLB patients with the aim of determining appropriate management and care.

Background To verify whether serum levels of reactive oxygen metabolites (ROM) are predictive of future clinical remission in patients with rheumatoid arthritis (RA) receiving tocilizumab (TCZ) therapy. Methods A total of 46 patients with RA receiving TCZ therapy were enrolled in this study. Patients were divided into remission and non-remission groups based on disease activity score 28 (DAS28)-erythrocyte sedimentation rate (ESR) or clinical disease activity index (CDAI) at 52 weeks. Associations between serum levels of ROM, C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3) at 4 and 12 weeks and the remission by DAS28-ESR and CDAI at 52 weeks were investigated. Results There were no significant differences in CRP and MMP-3 between DAS- or CDAI-remission and non-remission groups at 12 weeks. However, ROM in DAS-remission group were significantly lower than those in the non-remission group. For ROM, the area under the curve of the receiver operating characteristic curve was 0.735 and the cut-off value that distinguished DAS-remission group from non-remission group was 305.5 U. Carr (sensitivity: 70.0%, specificity: 72.2%). A multivariate logistic regression analysis revealed that ROM at 12 weeks was associated with DAS-remission at 52 weeks (odds ratio: 6.067, 95% confidence interval: 1.305–28.203). Conclusion Serum levels of ROM at 12 weeks during TCZ therapy may be predictive of DAS-remission at 52 weeks in patients with RA.

Radiographic progression of damage to the small joints in patients with rheumatoid arthritis (RA) is well known; however, it has not been studied fully in the large joints. In this study, we looked at the prevalence of radiographic progression of large joint damage in patients with RA treated with biological disease-modifying anti-rheumatic drugs (bDMARDs).A total of 273 large joints in the upper and lower extremities of 67 patients with RA treated with bDMARDs were investigated. Radiographs for tender and/or swollen large joints were taken at least twice during the study period (mean 18.6 months), and the progression of damage was evaluated.Progressive damage was found in 20.9% of patients and 6.2% of joints. A multivariate analysis revealed that the Larsen grade (LG) alone was a risk factor for progressive damage. The LG cutoff value was determined to be 2.5 (sensitivity: 0.529, specificity: 0.805).The only factor to predict progressive damage was the LG of the joints with symptoms, and the damage must be stopped within LG II. Regular radiographic examinations for large joints should be performed in addition to routine examinations for small joints, such as the hand and foot.

Background Limited attention has been paid to the relationship between bladder dysfunction and motor disorder in multiple system atrophy (MSA). Objective We aimed to correlate pressure-flow urodynamic parameters with video-gait analysis parameters in MSA. Methods We recruited 34 patients with MSA: 20 men, 14 women; age 64.0 + − 7.9 years; disease duration 2 years (1–4 years). Nineteen cases had the cerebellar form, and 15 had the parkinsonian form; the patients were taking levodopa 300 mg/day (100–400 mg). All patients underwent pressure-flow urodynamics (parameters: detrusor overactivity [noted in 72%] and Watts factor) and video-gait analysis (parameters: time and the number of strides taken to walk 5 m (simple task) and time for timed up and go (complex task). Statistical analysis was done using Student's t-test to analyze the relation between detrusor overactivity and gait, and Spearman's rank correlation coefficient test to analyze the relation between the remaining parameters and gait. Results We found no relation between filling-phase urodynamics (detrusor overactivity) and video-gait analysis parameters. Also, we found no relation between voiding-phase urodynamics (Watts factor, reflecting detrusor power) and all three video-gait analysis parameters in our MSA patients. Conclusion The fact that neither detrusor overactivity nor the Watts factor was related with motor disorders in the present study suggests that bladder dysfunction occurs independently from motor disorder in MSA.

Background Although damage to large joints such as the shoulder, elbow, hip, knee, and ankle has a substantially larger impact on functional ability than damage to the small joints of the hand and foot,1 2 large joints are not routinely monitored for progressive damage in patients with rheumatoid arthritis (RA). Furthermore, a little information is available regarding long-term follow-up results of radiographic progression of damage (RPD) to the large joints during treatment with biological disease-modifying antirheumatic drugs (bDMARDs). Objectives We investigated ratios of RPD to the large joints in RA patients treated with bDMARDs for 3 to 4 years and analysed association between RPD and patient backgrounds or Larsen grades of individual large joint. Methods Sixty-eight patients (naive: 42, switch: 26) receiving bDMARDs (IFX: 5, ETN: 9, ADA: 7, GLM: 3, CZP: 5, TCZ: 28, ABT: 11) for 3 to 4 years or achieving bDMARDs-free status were included in this study. The mean age and disease duration at the start of bDMARDs was 62.7 year-old and 10.7 years, respectively, and baseline DAS28-ESR and HAQ was 4.61 and 1.014, respectively. A total of 311 joints including shoulder, elbow, hip, knee, and ankle were evaluated whether there was RPD during the observation period by comparing radiographs before and after the treatment. Results RPD was found in 22 patients (31.4%) and 32 joints (10.0%), and it occurred during the former half period in 17 joints and during the latter half period in 15 joints. Joints with Larsen grade (LG) III or more had significantly higher ratios of RPD than those with LG II or less (p Conclusions The stage and baseline HAQ were associated with RPD to the large joints, and progressive damage is expected to increase when the stage exceeds III and/or functional disability exceeds an HAQ score of 1.5. Progressive damage also increases when LG exceeds III. Treatment with bDMARDs should be started before stage, HAQ, and LG exceed III, 1.5, and III, respectively. References [1] Drossaers-Bakker KW, Kroon HM, Zwinderman AH, Breedveld FC, Hazes JM. Radiographic damage of large joints in long-term rheumatoid arthritis and its relation to function. Rheumatology (Oxford)2000;39:998–1003. [2] Kuper HH, van Leeuwen MA, van Riel PL, Prevoo ML, Houtman PM, Lolkema WF, van Rijswijk MH. Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability. Br J Rheumatol1997;36:855–60. Disclosure of Interest None declared

Radiographic progression of damage (RPD) to large joints in patients with rheumatoid arthritis (RA) has not been fully studied. We previously demonstrated that Larsen grade of the large joints was associated with RPD of large joints in patients treated with biological disease-modifying anti-rheumatic drugs (bDMARDs); however, no factors associated with background characteristics of patients were identified.A total of 400 large joints in the upper and lower extremities, including the shoulder, elbow, knee, and ankle, of 88 patients with RA treated with bDMARDs for 1-3 years were investigated. Radiographs of tender and/or swollen large joints were acquired at least twice during the study period (mean, 16.4 months), and the RPD was evaluated.A multivariate analysis revealed that health assessment questionnaire-disability index (HAQ-DI) score at the start of bDMARD treatment was associated with RPD. The cutoff value that discriminated progression from non-progression, determined by a receiver operating characteristic (ROC) curve, was 1.4375 (sensitivity: 0.778, specificity: 0.894).HAQ-DI score at the start of bDMARD treatment was associated with RPD to large joints during a therapeutic period of 1-3 years. Progressive damage is expected to increase when functional disability exceeds an HAQ-DI score of 1.5.

which is important for the prevention of LBP in people who are engaged in daily repetitive lowering tasks. Purpose: The purpose of this study was to investigate the relationship between lowering tasks and the PLS extension and to provide essential evidence for prevention of LBP. Methods: Eight healthy subjects participated (body height, 1.69± 0.62m; body weight, 65.0± 7.2 kg; age, 22.3± 1.3 years). The task was to set down a 5-kg box with the knee extended for 2 s. The subjects performed two different sitting postures for 10min. First was to keep the spine in a natural curve during sitting (NS condition), and the other was to keep the pelvis in a posterior tilt and the spine inflexion (FS condition). The subjects performed the lowering task three times before and after each sitting condition, and measurements under the two conditions were done on separate days. We recorded the coordinates of 48 retro-reflective markers pasted on anatomical landmarks using a three-dimensional motion analysis system (Vicon). Ground reaction forces were recorded by four force plates (Tec Gihan). Joint angles, joint moments and joint powers were calculated using the BodyBuilder (Vicon). All data were calculated as differences in parameters from the pre-sitting trial to the post-sitting trial between the NS and FS conditions. Statistical analyses were executed using SPSS ver. 22.0 (IBM Japan) and investigated the normality of the data using the Shapiro-Wilk test. Then, a paired t-test or theWilcoxon signed-rank test was performed. This studywas approved by the institutional ethics committee prior to the study. Results:The change in the peak lumbar extensionmoment in the FS condition was significantly larger than that in the NS condition (P< 0.05). There was no significant difference in the changes of joint angles, integral joint moments and integral joint powers between two conditions. Conclusion(s): These results suggest that extending the PLS while sitting caused a higher peak lumbar extension moment during the lowering task. Therefore, it is important to avoid extending the PLS while sitting to prevent LBP in individuals who are engaged in daily repetitive lowering tasks. Implications: In physical therapy for LBP, it is important to note sitting postures of patients. In addition, it is essential to ensure that the work environment is properly managed in accordance with healthcare considerations.

Limited attention has been paid to the relationship between urinary symptoms or urodynamic findings and motor disorders in Parkinson's disease (PD). We aimed to correlate pressure-flow urodynamic parameters with video-gait analysis parameters in PD. We recruited 41 patients with PD (25 men and 16 women; age, 70.6 ± 8.5 years; HY motor grading: 2 [range, 1-3]; disease duration: 4 years [range, 1-7]; taking levodopa 300 mg/day [range, 100-400]). All patients underwent pressure-flow urodynamics (parameters: first sensation, bladder capacity, detrusor overactivity [noted in 24 patients], and Watts factor [WF]) and video-gait analysis (parameters: time and number of strides for 5-m gait [simple task] and time for timed up and go [complex task]). Statistical analysis was made by Mann-Whitney's U-test for analyzing the relation between detrusor overactivity and gait as well as Spearman's rank-correlation coefficient test for analyzing the relation between the remaining parameters and gait. We found no relation between filling-phase urodynamics (detrusor overactivity, first sensation, and bladder capacity) and video-gait analysis parameters. By contrast, we found a significant relation between voiding-phase urodynamics (WF, reflecting detrusor power) and all three video-gait analysis parameters (reflecting lower-half bradykinesia and loss of postural reflex) in our PD patients (P0.01). The close relation between the WF and motor disorders in the present study suggests that, though clinically mild, a weak detrusor in PD might have a central origin. We should follow postvoid residual volume carefully in PD patients with advanced gait disorder, because postvoid residual volume might increase in such patients.