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This prospective observational cohort study was performed to investigate the physical function and mental health trajectories of novel coronavirus disease 2019 (COVID-19) patients requiring invasive mechanical ventilation (IMV) after discharge from the intensive care unit (ICU). The study population consisted of 64 patients (median age, 60 years; 85.9% male; median IMV duration, 9 days). At ICU discharge, 28.1% of the patients had Medical Research Council (MRC) sum score

Background Children receiving home medical care need special attention to prevent unexpected death. The aim of this study was to clarify the factors contributing to death in children receiving home medical care from the child death review database. Methods Children receiving home medical care were enrolled from the child death review database from 2014 to 2016 in Aichi prefecture, Japan, with a population of one million children. Types of medical care and factors contributing to death were examined. Results Of the 631 children who died, 40 children (6%) were receiving home medical care (21: tracheostomy; 19: ventilator; 26: suctioning of naso-oral secretions; 19: oxygen inhalation; 32: tube feeding; 6: urethral catheterization; and 1: peritoneal dialysis). The death rate was 50 times that in the general population of children. Ten children had contributory factors that seemed to be preventable. In four children, the families could not replace the tracheostomy tubes during an accident. In three, oxygen saturation or ventilator alarms were not set appropriately. In two, an oxygen cylinder became empty. One child fell down from a seat in a car. Conclusions Improvement of devices and correct guidance to caregivers may reduce the death rate in children receiving home medical care. Impact Children receiving home medical care, such as tracheostomy care, mechanical ventilation, or tube feeding, need special attention to prevent unexpected death. In this population-based child death review, 6% of children received home medical care, and it was estimated that 1 of 100 children receiving home medical care died per year. One-quarter of the deaths could be preventable by caregiver education or development of devices.

Background: Repetitive pitching is thought to restrict the physiological derotation process of the humeral head. Some studies have reported that side-to-side differences in the humeral retrotorsion angle (ΔHRA) occur between the ages of 9 and 11 years in baseball players. However, it remains unclear whether the ΔHRA in Asian baseball players depends on pitching skill or competitive level. Purpose: To evaluate the ΔHRA in Asian collegiate and professional baseball players and to determine the effects of pitching activity on the physiological derotation process of the humeral head. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We evaluated 128 shoulders in 64 Asian baseball players who were stratified into 4 groups as follows: 13 professional pitchers; 9 professional fielders; 8 collegiate pitchers; and 34 collegiate fielders. The throwing and nonthrowing side HRA was assessed using an ultrasound-assisted technique, and the ΔHRA was compared among the 4 groups. In addition, Pearson correlation analysis was used to assess the relationship between ΔHRA and glenohumeral range of motion, baseball starting age, and fastball velocity in pitchers. Results: The HRA was significantly greater in the throwing arm than in the nonthrowing arm in each group, with no significant differences among the groups. There was no correlation between ΔHRA and range of motion or fastball velocity. There was a significant negative correlation between baseball starting age and ΔHRA in professional fielders ( r = –0.633; P = .036). Conclusion: The findings of the present study provide evidence that in Asian baseball players, the HRA was significantly greater in the throwing arm than in the nonthrowing arm. There were no clear associations between HRA and pitching ability or competitive level.

【要旨】管理栄養士養成課程学生を対象として調理技能調査および質問紙調査を実施し，4年間の切砕技術の変容を調査した。調理技能調査の結果，1，2 年次には制限時間内に切り終わらない学生もいたが，4年次では全員が制限時間内に切り終えていた。切断物の評価は，どの年次でも「やや不揃い」，「不揃い」の学生が多かった。4 年間通して一人暮らしであった学生のうち半数以上が週 3～4 回以上食事作りをしていた。自炊を始めたことにより自身の切砕技術が向上したと考えている学生が多かった。日常の食事で「野菜そのものを買う」学生が多く，野菜を切るときに速さや均一さを「意識していない」学生が多かった。キャベツのせん切りをするときの包丁の持ち方は，全握式を選択した学生が多かった。均一さを備えた技術の習得には，切り方に応じた包丁の持ち方の指導，日常の食事作りにおいても速さや均一さの意識を持たせること，家庭で繰り返し練習させる課題の工夫が必要と考える。, Students from a registered dietitian training program were administered questionnaires and cooking skills examinations to determine changes in their knife skills over the course of their four-year program. Examination of cooking skills revealed that, while all fourth-year students were able to complete a chopping task within the designated time limit, some first and second-year students were unable to do so. Evaluations of the chopped items found many students’ work to be “unevenness” or “a little unevenness,” regardless of year group. Of those students who lived alone during the four-year program, more than half cooked meals at least three or four times a week. Many students believed that their knife skills had improved as a result of them starting to cook for themselves. Many reported buying unprocessed vegetables for everyday meals, while a high number stated that they did not pay attention to speed or evenness when chopping vegetables. When choosing a knife grip for julienning cabbage, many students selected whole grip style. To allow students to master the skills needed to chop evenly, we must provide guidance on the knife grips appropriate to each cutting technique; encourage their awareness of the speed and evenness of their chopping, even in the preparation of their own daily meals; and devise tasks that will allow them to practice through repetition at home.

【要旨】A 大学栄養学科 2016 年度入学生を対象に記名自記式質問紙調査を実施し，一人暮らしの者 20 名（女性 17 名，男性 3 名）の回答より 1～2 年次から 4 年次までの食事作りへの意識・実践の変化を分析した。食事作り意識の変化として，何も見ずに作ることができると考える料理が 35 項目中 5 項目有意に増加し（p＜0.05），食事の「栄養バランス」「料理・味付けの組み合わせ」等に気を付けている者が増加した。また各年次で共通して，食品選択で重視していることに「価格」，食事作りで気を付けていることに「作り方が簡単」「短時間で 食事を準備」，料理の参考に「インターネット」「高校までの家庭料理」と回答する者が多く，大学での習得知 識や教科書等を参考とする者は少なかった。食事作り実践の変化として，泡立て器，スケール，おろし器，ゴムベラの調理器具所有者は有意に増加した（p＜0.05）一方，月 1 回以上作る料理の種類は減少が見られた。食事作りを「ほぼ毎日」する者は 5 割，主食・主菜・副菜の揃った食事を「毎食食べる」者は 3 食いずれも 15% 以下と年次による大きな変動はなかった。4 年次までに料理のレパートリーの広がりや食事バランスへの意識 向上が見られた反面，実際の食事作り実践や食事内容へ反映する者は少ないことが課題として示されたことから，学生の生活状況等を考慮し，日常において継続的な食事作りと食事内容の充実に繋がる教育上の工夫が必要と考えられる。, A self-administered questionnaire survey was conducted on students enrolled in the Department of Nutrition at University A in 2016. On the basis of the answers provided by 20 students living alone (17 women, 3 men), in first and second year and then to the fourth year, we analyzed changes in awareness of and practice around meal preparation. As a change in awareness of meal preparation, the number of students who believe they can cook meals without using a recipe increased significantly for 5 out of 35 dishes (p

This is a case study focused on the development of LOVOT, a consumer home robot that went on sale in 2019. Since its unveiling in 2018, approximately 20,000 people have visited the LOVOT demonstration event as of the end of July 2019. In practical terms, LOVOT lives at home with the user long-term, similar to a companion animal; LOVOT performs continuous natural motion for user comfort. We applied movements using professional animator techniques based on the principles of traditional animation to LOVOT. We have identified specific practical techniques in home robot animation through iterative prototyping in our synergetic development of character animation techniques and tools. In this paper, we introduce our practical methods to develop many behaviors in a single robotic agent and is the collaborative efforts of a group of people with diverse professional backgrounds. Furthermore, we summarize how traditional techniques of character animation were applied, and new techniques were required from the perspective of professional animators.

スーパーグローバルハイスクール（SGH）の取り組み Practices of Super Global High School (SGH) Programs

Bone cement enhancement by percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures remains unapproved, as it has not been fully evaluated in Japan. The current multicenter study was conducted in Japan to verify the safety and efficacy of PVP in patients with painful osteoporotic vertebral fractures.In this retrospective study, we referred to previous studies to evaluate the non-inferiority of PVP to balloon kyphoplasty (BKP). We reviewed consecutive patient data from April 2017 to March 2018 from four institutions based on the medical records of the intervention. We statistically investigated the adverse events due to cement leakage or other factors associated with PVP, and new vertebral compression fractures after PVP were evaluated for safety, pain relief, and gait improvement.This study included 485 patients; most of whom were in the middle- to oldest- age groups (mean age, 81.4 years). No serious adverse events were reported in patients available for safety evaluation (n = 485). Cement leakage and new vertebral compression fractures occurred in 35.7% and 18.6% (26.2%-38.4% and 8.9%-20.7%) of the patients undergoing PVP, respectively, both of which were also judged to be equivalent to those of BKP. The pain score improved in those undergoing PVP, and this improvement was maintained during a one-year follow-up. Of the 206 patients who had difficulty walking at baseline, 156 had restored walking at discharge.PVP was shown to be a safe and effective treatment, even in elderly patients with painful osteoporotic vertebral fractures.

A 37-year-old man diagnosed with diffuse large B-cell lymphoma two weeks previously, visited our emergency department with sudden dyspnea. He had a severe respiratory failure with saturated percutaneous oxygen at 80% (room air). Chest radiography showed a large amount of left pleural effusion. After 1000 mL of the effusion was urgently drained, reexpansion pulmonary edema (RPE) occurred. Despite ventilator management, oxygenation did not improve and venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated in the intensive care unit. The next day, contrast-enhanced computed tomography showed a massive thrombus in the right pulmonary artery, at this point the presence of pulmonary thromboembolism (PTE) was revealed. Fortunately, the patient’s condition gradually improved with anticoagulant therapy and VV-ECMO support. VV-ECMO was successfully discontinued on day 4, and chemotherapy was initiated on day 8. We speculated the following mechanism in this case: blood flow to the right lung significantly reduced due to acute massive PTE, and blood flow to the left lung correspondingly increased, which could have caused RPE in the left lung. Therefore, our observations suggest that drainage of pleural effusion when contralateral blood flow is impaired due to acute PTE may increase the risk of RPE.

[Purpose] We aimed to clarify the characteristics of age-related changes based on the body composition data of old and super-old nursing home residents. [Participants and Methods] This cross-sectional study included 53 female nursing home residents aged 75 years and above (mean age: 89.4 years; standard deviation: 5.6 years). They were divided into the old and super-old groups. The old group consisted of 24 participants aged between 75 and 89 years (mean age: 84.4 years; standard deviation: 3.7 years). The super-old group consisted of 29 participants aged 90 years and above (mean age: 93.5 years; standard deviation: 2.7 years). The parameters such as phase angle, skeletal muscle mass index, skeletal muscle mass, body fat percentage, body mass index, and Barthel index were examined in the two groups. The relationship between age and phase angle was determined, and the partial correlation coefficient was analyzed using the items for which a significant difference was found between the two groups as adjustment variables. [Results] The overall phase angle was 3.2 degrees, and that of the super-old group alone was 2.6 degrees. Age-related difference was observed in the phase angle and Barthel index. A significant correlation of -0.53 was observed between age and phase angle. The Barthel index-adjusted partial correlation coefficient between age and phase angle was -0.35. [Conclusion] The results of this study indicated that phase angle is an indicator of physical condition associated with aging in female nursing home residents aged 75 to 100 years.

We treated two patients with COVID-19 pneumonia requiring mechanical ventilation. Case 1 was a 73-year-old Japanese man. Computed tomography (CT) revealed ground-glass opacities in both lungs. He had severe respiratory failure with a partial pressure of oxygen in arterial blood/fraction of inspiratory oxygen ratio (P/F ratio) of 203. Electrocardiogram showed a heart rate (HR) of 56 beats/min, slight ST depression in leads II, III, and aVF, and mild saddle-back type ST elevation in leads V1 and V2. High-sensitivity cardiac troponin T (cTnT) level was slightly elevated. Despite a high fever and hypoxemia, his HR remained within 50-70 beats/min. Case 2 was a 52-year-old Japanese woman. CT revealed ground-glass opacities in the lower left lung. Electrocardiogram showed a HR of only 81 beats/min, despite a body temperature of 39.2 °C, slight ST depression in leads V4, V5, V6, and a prominent U wave in multiple leads. She had an elevated cTnT and a P/F ratio of 165. Despite a high fever and hypoxemia, her HR remained within 50-70 beats/min. Both patients had a poor compensatory increase in their HR, despite their critical status. Relative bradycardia could be a cardiovascular complication and is an important clinical finding in patients with COVID-19. .

Background Novel coronavirus disease 2019 (COVID-19) refers to infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen, and has spread to pandemic levels since its inception in December 2019. While several risk factors for severe presentation have been identified, the clinical course for end-stage renal disease (ESRD) patients on maintenance hemodialysis with COVID-19 has been unclear. Previous studies have revealed that some antiviral agents may be effective against COVID-19 in the general population, but the pharmacokinetics and pharmacodynamics of these agents in ESRD patients remain under investigation. Favipiravir, an antiviral agent developed for treatment of influenza, is one candidate treatment for COVID-19, but suitable dosages for patients with renal insufficiency are unknown. Here we provide a first report on the efficacy of favipiravir in a patient with ESRD undergoing hemodialysis. Case presentation The case involved a 52-year-old woman with COVID-19 who had been undergoing maintenance hemodialysis three times a week for 3 years due to diabetic nephropathy. She had initially been treated with lopinavir/ritonavir and ciclesonide for 5 days, but developed severe pneumonia requiring invasive positive-pressure ventilation. Those antiviral agents were subsequently switched to favipiravir. She recovered gradually, and after 2 weeks was extubated once the viral load of SARS-CoV-2 fell below the limit of detection. Although concentrations of several biliary enzymes were elevated, no major adverse events were observed. Conclusion Favipiravir may be an effective option for the treatment of COVID-19-infected patients with ESRD.

The aim of this study was to evaluate the joint contact area of the dominant side and that of the non-dominant side without valgus instability in symptomatic pitchers. Ten symptomatic elbow medial ulnar collateral ligament (UCL) deficient baseball pitchers participated in this study. Computed tomography (CT) data from the dominant and non-dominant elbows were obtained with and without elbow valgus stress. The CT imaging data of each elbow joint were reconstructed using a 3D reconstruction software package, and the radiocapitellar and ulnohumeral joint contact areas were calculated. The center of the contact area and the translation from the position without stress to the position with valgus stress were also calculated. With elbow valgus stress, the contact area changed, and the center of the radiocapitellar joint contact area translated significantly more laterally in the dominant elbow than in the non-dominant elbow (P = 0.0361). In addition, the center of the ulnohumeral joint contact area translated significantly more posteriorly in the dominant elbow than in the non-dominant elbow (P = 0.0413). These changes in contact areas could be the reason for cartilage injury at the posterior trochlea in pitchers with UCL deficiency.

スーパーグローバルハイスクール（SGH）の取り組み Practices of Super Global High School (SGH) Programs