Kazuhiko Yamashita

Background and objective Tongue pressure (TP) is an objective and quantitative measure of tongue function, and low TP is recognized as a component of oral hypofunction. In this cross-sectional study, we aimed to estimate the proportion of community-dwelling older adults who met the existing cutoff for low TP and to examine associations between TP, lower-limb muscle strength, BMI, and muscle mass. Methods This study included 447 independently ambulatory adults aged ≥ 70 years. TP was measured with a standardized tongue-pressure device. Lower-limb muscle strength was assessed using toe gap and knee gap force, and muscle mass was evaluated using a body composition analyzer. Participants were stratified by fall-risk classification (based on lower-limb muscle strength) and muscle mass relative to the sample mean. Group comparisons were conducted using analysis of variance and independent-samples t-tests. Results More than half of the participants (53.0%) had low TP (<30 kPa). Participants at fall risk based on low toe or knee gap force had significantly lower TP than those not at risk. TP was higher in participants with muscle mass above the mean, and this difference was significant in males. Although lower BMI was associated with low TP, TP differences were more consistent across muscle mass and lower-limb strength classifications. Conclusions Low TP was associated with decreased muscle mass and lower-limb muscle strength in community-dwelling older adults. These findings suggest that TP may be related to systemic muscle function rather than oral function alone.

Frailty in older adults often leads to foot issues, increasing fall-related fracture risk. Mechanoreceptors, the pressure receptors in the foot sole, are pivotal for postural control. Foot problems can impair mechanoreceptor function, compromising balance. This study aimed to examine the effect of foot care on postural control in frail older adults. Forty-eight participants underwent a five-month monthly foot care intervention. Measurements were taken before and after this intervention. Participants stood for 45 s in a static, open-eyed position on a stabilometer. Center-of-pressure (CoP) analysis included total trajectory length, integrated triangle area, rectangular area, and range of motion in anterior-posterior and medio-lateral directions. Results indicated that foot care significantly increased toe ground contact area by 1.3 times and improved anterior-posterior motion control during static standing. Enhanced postural control resulted from improved skin condition due to foot care that intensified mechanoreceptor signal input and improved postural control output. These findings underscore the potential for reducing fracture risks in older adults through proactive foot care. The study highlights the vital role of foot care in enhancing postural control, with broader implications for aging population well-being and safety.

Background. Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. Methods. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Results. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 μA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. Conclusion. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.

Chronic diseases such as diabetes, hypertension, and hyperlipidemia increase the medical costs for middle-aged and elderly people, thus requiring preventive intervention. Monitoring, maintaining, or increasing the number of steps walked per day could be expected to effectively reduce medical costs. We evaluated the medical costs for chronic diseases after the implementation of a step count monitoring system with an information communication technology that we hypothesized would efficiently decrease medical costs. We enrolled 342 subjects in the intervention group. An additional 1,025 subjects were selected as controls by matching with the intervention group for age, gender, and total medical costs accumulated in the year prior to the study. The subjects in the intervention group were provided with pedometers that were used with reading devices stationed throughout the city. The duration of the intervention was 18 months. The subjects were given health points based on their activity performance improvements such as the number of steps they walked. The medical costs for the 18 months before and afer the intervention were compared. The effect of cost reduction was evaluated by comparing the percent increase in medical cost from before to after intervention between the control group and the intervention group. After the intervention period, the medical costs increased in the control group but not in the intervention group. The step counts for the first three months and the last three months of the intervention period were assessed, and the results showed that an average step count of 8000 steps was maintained throughout the intervention period. Assuming that the control group showed a natural increase in medical costs, the results suggest that the natural increase in medical costs was suppressed in the intervention group during the intervention period as a result of using the pedometer technology and health points. Therefore, we found that encouraging the participants to proactively participate in walking was an effective strategy.

Abnormalities in the feet and toenails are common among the elderly and may increase the risk of falls. This study aimed to investigate the changes in toe-gap force, knee-gap force, foot pressure distribution, the ability to perform activities of daily living, subjects’ feelings and behaviors, and physical function resulting from daily lifestyle modification and foot care. The study participants included 74 elderly adults (mean age 80.3 ± 7.5 years) with foot problems who had been divided into three groups based on Japan’s nursing care insurance system levels: certified ineligible for support, eligible for support, or eligible for long-term care. Additionally, a control group of 106 elderly adults in good health was recruited. The differences between the intervention and control groups was examined using the Student’s t-test, and differences between the three intervention subgroups and the control group were examined using one-way analysis of variance. After intervention, abnormalities in the participants’ feet and toenails improved. Significant increases in lower-limb muscle strength were observed, and foot pressure distribution had improved. The foot-care intervention significantly improved lower-limb muscle strength and decreased the risk of falling, even in elderly adults whose physical function had deteriorated. In frail elderly adults, care of the feet and toenails can improve lower-limb muscle strength and foot pressure distribution. In addition, the individuals’ social participation increased, and their behavior improved. University hospital Medical Information Network- Clinical Trials (UMIN-CTR) with the number: UMIN000034742 . Registration date: 11/01/2018.

偽痛風は高齢者によく発症する結晶性関節炎である。今回，偽痛風の急性発作に対して防風通聖散と黄連解毒湯の併用が有効であったので報告する。症例は87歳男性であり，左手関節痛があり経過をみていたが疼痛が続くため発症2日目に当院を受診した。理学所見では左手関節の圧痛を認めた。左手関節単純レントゲンで軽度の石灰化を認め，血液検査で炎症所見があり，手関節の偽痛風による急性発作と診断した。防風通聖散と黄連解毒湯を併用して投与したところ徐々に症状が軽快していった。初診3日後には左手関節痛が消失し，初診9日後には炎症所見も正常化した。防風通聖散と黄連解毒湯の併用は偽痛風の急性発作に対して有効であると考えられた。

Background. Surgical instrument retention and instrument breakage compromise surgery quality and lead to medical malpractice. We developed an instrument tracking system that could alert surgeons to instrument retention during surgery and monitor instrument use to reduce the risk of breakage. Methods. This prospective, experimental clinical trial included 15 patients undergoing inguinal hernia surgery or lumpectomy under general anesthesia at Saiseikai Kurihashi Hospital. Radiofrequency identification (RFID)-tagged surgical instruments were used, and a detection antenna was placed on a mayo stand during the operation. We analyzed the 1-loop detection ratio (OLDR)—that is, the capability of the antenna to detect devices in a single reading—and the total detection rate (TDR)—that is, the data accumulated for the duration of the operation—of the RFID-tagged instruments. Results. Data analysis revealed that the OLDR was 95% accurate, whereas the TDR was 100% accurate. The antenna could not detect the RFID tag when there was interference from electrocautery noise radiation, and 6% of instrument movement was undetected by the antenna; however, the TDR and instrument use were detected at all times. Conclusions. Surgical instruments can be tracked during surgery, and this tracking can clarify the usage rate of each instrument and serve as a backup method of instrument counting. However, this study was conducted on a small scale, and RFID tags cannot be attached to small surgical instruments used in complex operations such as neurosurgery. Further efforts to develop a tracking system for these instruments are warranted.