城戸 顕

BACKGROUND: In haemophilia, recurrent joint bleeding often results in joint destruction, which in turn leads to reduced physical activity (PA) and decreased quality of life (QOL). While maintaining high PA levels is important in the care of people with haemophilia (PwH), it remains unclear whether PwH without joint disease can maintain adequate activity levels. AIM: This descriptive cross-sectional study sought to compare moderate-to-vigorous physical activity (MVPA) levels among 19 PwH with haemophilic arthropathy (HA), 12 PwH without HA, and 15 non-PwH. METHODS: A total of 46 males wore a triaxial accelerometer (wGT3X-BT, ActiGraph) during daily activities for seven consecutive days. A bout of MVPA was defined as at least 10 consecutive minutes of moderate-intensity or higher activity. MVPA was expressed as the percentage of the total wear time spent in MVPA, and the total number of MVPA bouts was also recorded. RESULTS: Both PwH groups demonstrated significantly lower MVPA percentages and fewer MVPA bouts than the controls (p < 0.01). No MVPA bouts were recorded among 52.6% of PwH with HA versus 25% of PwH without HA. No significant differences were observed in sedentary or light activity between the PwH groups. CONCLUSIONS: PA levels were significantly reduced in PwH, regardless of joint status, suggesting that factors beyond joint damage, such as fear of bleeding or behavioural avoidance, may play a role. These findings highlight the need for individualized, evidence-based interventions to safely promote physical activity and improve long-term health outcomes in PwH.

BACKGROUND: Recent advancements in haemophilia treatment have dramatically reduced the frequency of symptomatic bleeding. However, minor, asymptomatic bleeding may contribute to the progression of joint damage and decrease quality of life. Detecting small amounts of blood with minimal flow is difficult using existing testing methods, necessitating the development of new diagnostic approaches. AIM: To determine whether tiny amounts of blood injected subcutaneously, intramuscularly, and intra-articularly can be detected in a pig to assess the feasibility of detecting microbleeds in people with haemophilia. METHODS: Pig whole blood was injected subcutaneously, intramuscularly, and intra-articularly into the isolated hind limbs of pigs. Photoacoustic imaging (PAI) was performed using an Acoustic X device (CYBERDYNE INC, Tsukuba, Japan) to detect blood signals. RESULTS: Following the injection of 200 µL of blood, conventional ultrasound imaging revealed no discernible changes, such as echo-free spaces. Conversely, on PAI, a signal indicating the presence of blood was detected. CONCLUSIONS: We have demonstrated that even very small amounts of nonflowing blood injected into the subcutaneous tissue, muscle, and joint of the hind limbs of pigs can be detected using PAI. We believe that the results of this study show the potential of this technique for detecting microbleeds in people with haemophilia. TRIAL REGISTRATION: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12959-026-00852-x.

Background Previous studies have reported the characteristics of rehabilitation therapy and physical restraint use in patients with neurocognitive disorders during the acute phase, based on three years of clinical records from dementia care team rounds at our hospital. The incidence of neurocognitive disorders varies by disease group, and the degree of physical restraint is significantly associated with the intensity of the rehabilitation therapy. Among the disease groups addressed in this study, we were particularly interested in cardiovascular diseases. In patients with cardiovascular disease, which is associated with high clinical acuity and disease severity, the presence of neurocognitive disorders may affect the prognosis. This study aimed to clarify the incidence of neurocognitive impairment (including delirium) in patients with cardiovascular disease and its characteristics with respect to rehabilitation therapy and physical restraint. Methods We examined data from dementia care team rounds conducted between July 1, 2021, and October 7, 2024, to identify relationships between clinicopathological characteristics, rehabilitation therapy, and physical restraint status. Cardiovascular diseases were classified into nine subgroups: ischemic diseases; arrhythmia; heart failure; valvular heart disease; acute pericarditis; aortic diseases; peripheral vascular diseases; and renal, carotid, and subclavian artery diseases. The treatment modalities were categorized as conservative management, pacemaker implantation (PM), percutaneous coronary intervention (PCI), minimally invasive surgery (MIS; including endovascular aneurysm repair and endovascular thoracic aortic repair), thoracotomy, and laparotomy. Cognitive function was assessed weekly, and patients whose neurocognitive disorders improved sufficiently were excluded from the dementia care team. Chi-square (χ²) tests were used to assess the associations between the variables. Results A total of 101 patients with cardiovascular disease underwent 379 rounds. Significant differences in treatment selection were observed between the disease groups (p < 0.0001). Significant differences in the number of dementia rounds were also observed between treatment groups, with more rounds occurring in patients who received invasive treatment (p = 0.019). No significant differences in the number of neurocognitive disorder episodes, training intensity, or physical restraint intensity were identified between the treatment groups. Patients who received stronger physical restraints generally underwent high-intensity training (p = 0.015). Conclusions Patients with cardiovascular diseases who received more invasive treatments generally received more dementia care team rounds, suggesting a possible association with prolonged neurocognitive disorders. Most patients who were subjected to stronger physical restraints could undergo intensive rehabilitation, suggesting that increased staffing levels could reduce the need for physical restraints.

Rehabilitation after radical gastrectomy or esophagectomy for upper gastrointestinal cancer can improve physical function and quality of life; however, objective day-to-day measures of psychological change are lacking. We aimed to test whether facial emotion analysis can quantitatively evaluate patients' emotional responses before and after each rehabilitation session and whether these changes relate to conventional subjective/physiological stress markers and discharge physical outcomes. We conducted a single-center prospective observational study of 32 patients who underwent radical gastrectomy or esophagectomy between August 2024 and February 2025. Immediately before and after each rehabilitation session, 30 s iPad video interviews (median, six per patient) were recorded and analyzed using MAL Face Emotion software to obtain normalized scores (0%-100%) for Neutral, Happy, Sad, Angry, and Surprised emotions. Subjective stress (0-100 mm visual analog scale) and salivary α-amylase activity were collected concurrently; discharge physical function was assessed using the 6 min walk distance and Five Times Sit-to-Stand tests. Pre- and post-session values were compared using Wilcoxon signed-rank tests, and associations were examined with age-adjusted regression and Spearman correlation. Thirty-one patients completed the study without adverse events. After rehabilitation, the Happy score increased (median +3.5%, p = 0.013) and stress decreased (-1.5 mm, p = 0.025), whereas salivary α-amylase and other emotions were unchanged. Changes in the Happy score (p = 0.21) and stress (p = 0.19) did not predict discharge physical function, whereas changes in the Sad score correlated moderately with changes in salivary α-amylase (ρ = 0.45). The findings of this single-center study provide preliminary evidence supporting the feasibility of facial emotion analysis as a non-invasive, quantitative tool for real-time psychological monitoring during postoperative rehabilitation. Furthermore, our results demonstrate its potential to support a more personalized delivery of cancer rehabilitation.

BACKGROUND: Haemophilia, caused by deficiencies in factor VIII or IX, leads to deep tissue bleeding and haemophilic arthropathy. Bleeding, arthropathy, and the perioperative period of surgery for arthropathy are associated with severe pain. To avoid this pain, patients may compensate by overloading other parts of the body, potentially resulting in pain or secondary damage in areas distant from the primary site. This study investigates the use of infrared thermography (IRT) to monitor whole-body surface temperatures in people with haemophilia and to explore the potential of infrared thermography for early detection of compensatory overload. METHODS: A cross-sectional study involved 24 people with haemophilia aged 6-76 years old, experiencing pain after bleeding, post-orthopaedic surgery, or haemophilic arthropathy. Thermal images were captured with IRT and analyzed using software that utilises deep learning for whole-body temperature mapping. RESULTS: Increases in temperature indicative of overload were observed in areas distant from the affected site, either on the same side (vertical pattern) or on the opposite side (diagonal pattern) relative to the site of pain. These patterns were observed in 13 of 14 participants with haemophilic arthropathy, all post-orthopaedic surgery participants, and 5 of 6 after bleeding. CONCLUSIONS: Temperature increases occurred in areas beyond the painful area, suggesting strain even in asymptomatic regions. People with haemophilia experiencing pain may require careful monitoring and treatment of surrounding areas. Our findings could aid in diagnosing haemorrhage and local inflammation while informing treatment decisions. CLINICAL TRIAL REGISTRATION: Not applicable.