[Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data].

Objectives　This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods　A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results　Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3)higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions　In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Intrahepatic splenosis with severe iron deposition presenting with atypical magnetic resonance images.

An intrahepatic mass was incidentally found in a 41-year-old man with a history of a traffic accident injury which resulted in removal of a ruptured spleen. Hepatic splenosis was considered in the differential diagnosis but magnetic resonance imaging showed hypointensity on T2-weighted images, atypical for normal spleen. Histologically, the mass showed sinusoidal structures and lymphoid follicular aggregates. Immunohistochemical study showed that the phenotype of the vascular lining cells was CD8-positive, CD31-positive, and CD34 negative, the pattern diagnostic for ectopic spleen. In addition, severe iron deposition was histologically demonstrated, which was considered as the cause of the hypointense T2-weighted images.

Intestinal pseudo-obstruction in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) associated with phenytoin therapy.

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is most commonly associated with a mitochondrial DNA A to G point mutation at nucleotide 3243 (A3243G) and individuals with the disorder present a wide range of multisystemic symptoms. Seizures in MELAS patients are often intractable and require multiple antiepileptic drugs. Here we report a MELAS patient who presented with acute intestinal pseudo-obstruction following the administration of phenytoin (PHT) as an antiepileptic treatment. She presented with the first stroke-like episode at the age of 6 years and mitochondrial DNA analysis revealed A3243G with 94% mutation load in skeletal muscle. Despite treatment with phenobarbital and clobazam at the age of 16 years, she developed status epilepticus which ceased following PHT infusion. Thereafter, she was started on PHT treatment. One month later, however, she was readmitted because of remarkable abdominal distention. Although abdominal CT showed acute ileus with hepatic portal venous gas mimicking surgical emergency, the abdominal distention gradually recovered over several days following the discontinuation of PHT. Our clinical observations suggest the possibility that intestinal pseudo-obstruction in this patient related to PHT therapy. Careful clinical observation including gastrointestinal symptoms is required in the management of epilepsy in MELAS patients.

Development of on-bed lower extremity exercise system for use with networked virtual space.

A virtual space locomotion interface device using lower limb motion at supine position has been developed to allow the users to exercise and communicate each other at home. The velocity control performance, muscle activity and the energy consumption while using the developed device were evaluated. It was demonstrated that the developed device reflects the user's subjectivity adequately and the virtual space walking distance is to be set as three times of the actual distance to obtain the same exercise effect.

Influence of attention and predictive visual cue on motion perception and sickness in immersive virtual environment.

Relieving motion sickness and enhancing self-motion perception are required for the public application of immersive visual display system. The effects of user attention and predictive visual cue have been experimentally evaluated in this study. A viewpoint moving visual stimulus was applied to eighteen healthy adults. The subjective evaluation presumably suggested that a predictive visual cue enhances self-motion perception and relieves motion sickness at a same time.

Development of automatic immediate fitting socket system for artificial leg socket modeling using fuzzy control.

Automatic immediate fitting socket (AIFS) system was developed to shorten the long length of time for making an artificial leg, by applying powder technology. AIFS is constructed of an outer shell, a particle containing bag, which the rigidity can be controlled by the application of negative air pressure and three airbags between the outer shell and the particle bag to adjust the shape by controlling the compression. A fuzzy controller was applied for the real-time automatic control of the shape based on the subjective evaluation of the amputee. The surface contact pressure was evaluated during AIFS walking as well as the walking with the conventional socket. The peak pressure at the tibia end was 30 kPa in AIFS walking while 90 kPa with conventional socket. The pressure distribution among medial condyle, fibula head and tibia end was more uniform with AIFS. The shape modeling performance was evaluated by measuring the circumferences of four amputees' stumps. The modeling error was 6%. The shape modeling including test walking was completed in 10 minutes in all four amputees and practical shapes were obtained.