Statistical model of trajectories of reduced mobility in older people with locomotive disorders: a prospective cohort study with group-based trajectory model.

BACKGROUND: Today we experience "Super-aged society", and a drastic increase in the number of older people needing assistance is an urgent matter for everyone from medical and socio-economical standpoints. Locomotive organ dysfunction due to musculoskeletal disorders is one of the main problems in these patients. Although the concepts of frailty and sarcopenia have been proposed for functional decline, pain remains the main and non-negligible complaint in these of such disorders. This prospective cohort study aimed to observe the changes of reduced mobility in patients with locomotive disorders and to determine the risk factors for functional deterioration of those patients using statistical modeling. METHODS: A cohort of older adults with locomotive disorders who were followed up every 6 months for up to 18 months was organized. Pain, physical findings related to the lower extremities, locomotive function in performing daily tasks, and Geriatric Locomotive Function Scale-25 (GLFS-25) score were collected to predict the progress of deterioration. Group-based trajectory analysis was used to identify subgroups of changes of GLFS-25 scores, and multinomial logistic regression analysis was performed to investigate potential predictors of the GLFS-25 trajectories. RESULTS: Overall, 314 participants aged between 65 and 93 years were included. The participants were treated with various combinations of orthopedic conservative treatments on an outpatient basis. The in-group trajectory model analysis revealed a clear differentiation between the four groups. The mild and severe groups generally maintained their GLFD-25 scores, while the moderate group included a fluctuating group and a no change group.　This study showed that comorbidity of osteoporosis was related to GLFS-25 score over 18 months. Age was a weak factor to be moderate or severe group, but gender was not. In addition, the number of pain locations, number of weak muscles, one-leg standing time, grip strength and BMI significantly contributed to the change in GLFS-25 score. CONCLUSIONS: This study proposes an effective statistical model to monitor locomotive functions and related findings. Pain and comorbid osteoporosis are significant factors that related to functional deterioration of activities. In addition, the study shows a patient group recovers from the progression and their possible contributing factors.

[Eight cases of calcific retropharyngeal tendinitis/retropharyngeal calcific tendinitis].

Calcific retropharyngeal tendinitis/retropharyngeal calcific tendinitis is an inflammation of the longus colli muscle caused by calcium hydroxyapatite crystal depositon in the longus colli muscle tendon. The three major symptoms are neck pain, limitations of neck movement, and swallowing pain. We treated 8 cases of calcific retropharyngeal tendinitis/ retropharyngeal calcific tendinitis. Each patient complained of neck pain, limitations of neck movement, and swallowing pain. The only local finding was the smooth swelling of the posterior pharyngeal wall. CT imaging showed calcification of the tendon of the longus colli muscle and a low density area in the retropharyngeal space without ring enhancement, suggesting a retropharyngeal abscess. MR imaging showed the smooth swelling of the retropharyngeal space and an increased signal intensity on T2-weighted MR imaging. Calcific retropharyngeal tendinitis heals spontaneously, and treatment is not usually required. However, the clinical outcomes are similar and can be confused with retropharyngeal abscess and pyogenic spondylitis, so antibiotics are administrated in many cases. In our report, 7 patients were hospitalized and were treated with the intravenous administration of antibiotics, while 1 patient who refused hospitalization was treated with an oral antibiotic. Steroids were administrated in 2 cases. The 7 patients who were hospitalized were cured within 6 to 10 days.

[Re-treatment with epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)for lung adenocarcinoma].

BACKGROUND: EGFR-TKI yields a long survival period in cases of non-small cell lung cancer (NSCLC), especially those with EGFR gene mutations, but the effect is limited. The later treatment strategy is still a large problem. Efficacy by re-treatment with EGFR-TKI is sometimes reported, but its clinical significance is not clear. METHODS: We reviewed retrospectively 22 cases (gefitinib 11 cases and erlotinib 11 cases) of NSCLC re-treated with EGFR-TKI in our hospital from August 2004 to August 2009. RESULTS: After re-treatment with gefitinib, four cases showed disease control. Efficacy of erlotinib was recognized in the cases in which disease control was obtained by initial treatment with gefitinib. The disease control rate was 36% (4/11) in the gefitinib group and 45% (5/11) in the erlotinib group. Median survival time was 212 days and 292 days from re-treatment with EGFR-TKI, respectively. CONCLUSION: Re-administration of EGFR-TKI was effective, and therefore is considered one of the treatment options for patients who once respond to gefitinib, until new anti-cancer drugs are available.

[Treatment of malignant pericardial effusion].

Cardiac tamponade is an emergency situation that warrants immediate evacuation of the pericardial fluid. Since the fluid tends to recur only by pericardiocentesis, various agents have been instilled into the pericardium to promote adhesion and obliteration of the cavity. Comparative studies of sclerosing agents for the management of malignant pericardial effusion include that comparing the Bleomycin group and non-administered group (JCOG) and another comparing bleomycin and doxycycline in 1996. Both studies recommended Bleomycin to control malignant pericardial effusion. Although instillation of drugs into the pericardium are reportedly safe, paracentesis or tube pericardiostomy are sometimes associated with an incidence of complications, some of which are fatal. These complications are assumed to occur in about 3% of the cases, even if an experienced physician proceeds using an echo guide. Though bleomycin is the recommended drug for the initial sclerosing agent in malignant pericardial effusion, physicians should consider the status and the prognosis of each case in the treatment of malignant pericardial effusion.