Activation of invariant natural killer T cells stimulates adipose tissue remodeling via adipocyte death and birth in obesity.

In obesity, adipose tissue undergoes dynamic remodeling processes such as adipocyte hypertrophy, hypoxia, immune responses, and adipocyte death. However, whether and how invariant natural killer T (iNKT) cells contribute to adipose tissue remodeling are elusive. In this study, we demonstrate that iNKT cells remove unhealthy adipocytes and stimulate the differentiation of healthy adipocytes. In obese adipose tissue, iNKT cells were abundantly found nearby dead adipocytes. FasL-positive adipose iNKT cells exerted cytotoxic effects to eliminate hypertrophic and pro-inflammatory Fas-positive adipocytes. Furthermore, in vivo adipocyte-lineage tracing mice model showed that activation of iNKT cells by alpha-galactosylceramide promoted adipocyte turnover, eventually leading to potentiation of the insulin-dependent glucose uptake ability in adipose tissue. Collectively, our data propose a novel role of adipose iNKT cells in the regulation of adipocyte turnover in obesity.

Successful interventional occlusion of muscular ventricular septal defect in a dog.

Ventricular septal defect (VSD) is a rare congenital heart disease in dogs. Hemodynamically important interventricular defects must be closed to improve the prognosis. This case report describes successful interventional transcatheter closure of a muscular VSD in a young Maltese and poodle mixed-breed dog with a large muscular interventricular defect (~5 mm in diameter) with a high rate of left-to-right shunt flow. The VSD was closed with a customized Amplatzer-type VSD occluder via a percutaneous transvenous (jugular) approach. We concluded that interventional occlusion of a muscular VSD with an Amplatzer-type occluder is a viable treatment option for dogs. A regular follow-up study for this dog is ongoing and has not detected complications. Key clinical message: Interventional occlusion of a muscular VSD with an Amplatzer-type occluder is a viable treatment option for dogs.

Occlusion interventionnelle réussie d'une communication interventriculaire musculaire chez un chien. La communication interventriculaire (VSD) est une maladie cardiaque congénitale rare chez le chien. Les anomalies interventriculaires hémodynamiquement importantes doivent être fermées pour améliorer le pronostic. Ce rapport de cas décrit la fermeture interventionnelle réussie par cathéter d'un VSD musculaire chez un jeune chien de race mixte (maltais et caniche) présentant un défaut interventriculaire musculaire important (~5 mm de diamètre) avec un débit de shunt élevé de gauche à droite. Le VSD a été fermé avec un obturateur VSD personnalisé de type Amplatzer via une approche trans-veineuse percutanée (jugulaire). Nous avons conclu que l'occlusion interventionnelle d'un VSD musculaire avec un obturateur de type Amplatzer est une option de traitement viable pour les chiens. Une étude de suivi régulière de ce chien est en cours et aucune complication n'a été détectée.Message clinique clé :L'occlusion interventionnelle d'un VSD musculaire avec un obturateur de type Amplatzer est une option de traitement viable pour les chiens.(Traduit par Dr Serge Messier).

GABA-stimulated adipose-derived stem cells suppress subcutaneous adipose inflammation in obesity.

Accumulating evidence suggests that subcutaneous and visceral adipose tissues are differentially associated with metabolic disorders. In obesity, subcutaneous adipose tissue is beneficial for metabolic homeostasis because of repressed inflammation. However, the underlying mechanism remains unclear. Here, we demonstrate that γ-aminobutyric acid (GABA) sensitivity is crucial in determining fat depot-selective adipose tissue macrophage (ATM) infiltration in obesity. In diet-induced obesity, GABA reduced monocyte migration in subcutaneous inguinal adipose tissue (IAT), but not in visceral epididymal adipose tissue (EAT). Pharmacological modulation of the GABAB receptor affected the levels of ATM infiltration and adipose tissue inflammation in IAT, but not in EAT, and GABA administration ameliorated systemic insulin resistance and enhanced insulin-dependent glucose uptake in IAT, accompanied by lower inflammatory responses. Intriguingly, compared with adipose-derived stem cells (ADSCs) from EAT, IAT-ADSCs played key roles in mediating GABA responses that repressed ATM infiltration in high-fat diet-fed mice. These data suggest that selective GABA responses in IAT contribute to fat depot-selective suppression of inflammatory responses and protection from insulin resistance in obesity.

Therapeutic effect of CT-P59 against SARS-CoV-2 South African variant.

The global circulation of newly emerging variants of SARS-CoV-2 is a new threat to public health due to their increased transmissibility and immune evasion. Moreover, currently available vaccines and therapeutic antibodies were shown to be less effective against new variants, in particular, the South African (SA) variant, termed 501Y.V2 or B.1.351. To assess the efficacy of the CT-P59 monoclonal antibody against the SA variant, we sought to perform as in vitro binding and neutralization assays, and in vivo animal studies. CT-P59 neutralized B.1.1.7 variant to a similar extent as to wild type virus. CT-P59 showed reduced binding affinity against a RBD (receptor binding domain) triple mutant containing mutations defining B.1.351 (K417N/E484K/N501Y) also showed reduced potency against the SA variant in live virus and pseudovirus neutralization assay systems. However, in vivo ferret challenge studies demonstrated that a therapeutic dosage of CT-P59 was able to decrease B.1.351 viral load in the upper and lower respiratory tracts, comparable to that observed for the wild type virus. Overall, although CT-P59 showed reduced in vitro neutralizing activity against the SA variant, sufficient antiviral effect in B.1.351-infected animals was confirmed with a clinical dosage of CT-P59, suggesting that CT-P59 has therapeutic potential for COVID-19 patients infected with SA variant.

The in vitro and in vivo efficacy of CT-P59 against Gamma, Delta and its associated variants of SARS-CoV-2.

The SARS-CoV-2 variant is rapidly spreading across the world and causes to resurge infections. We previously reported that CT-P59 presented its in vivo potency against Beta variants, despite its reduced activity in cell experiments. Yet, it remains uncertain to exert the antiviral effect of CT-P59 on Gamma, Delta and its associated variants (L452R). To tackle this question, we carried out cell tests and animal studies. CT-P59 showed neutralization against Gamma, Delta, Epsilon, and Kappa variants in cells, with reduced susceptibility. The mouse challenge experiments with Gamma and Delta variants substantiated in vivo potency of CT-P59 showing symptom remission and virus abrogation in the respiratory tract. Collectively, cell and animal studies showed that CT-P59 is effective against Gamma and Delta variants infection, hinting that CT-P59 has therapeutic potential for patients infected with Gamma, Delta and its associated variants.

Perilipin 1 (Plin1) deficiency promotes inflammatory responses in lean adipose tissue through lipid dysregulation.

Lipid droplets are specialized cellular organelles that contain neutral lipid metabolites and play dynamic roles in energy homeostasis. Perilipin 1 (Plin1), one of the major lipid droplet-binding proteins, is highly expressed in adipocytes. In mice, Plin1 deficiency impairs peripheral insulin sensitivity, accompanied with reduced fat mass. However, the mechanisms underlying insulin resistance in lean Plin1 knockout (Plin1-/-) mice are largely unknown. The current study demonstrates that Plin1 deficiency promotes inflammatory responses and lipolysis in adipose tissue, resulting in insulin resistance. M1-type adipose tissue macrophages (ATMs) were higher in Plin1-/- than in Plin1+/+ mice on normal chow diet. Moreover, using lipidomics analysis, we discovered that Plin1-/- adipocytes promoted secretion of pro-inflammatory lipid metabolites such as prostaglandins, which potentiated monocyte migration. In lean Plin1-/- mice, insulin resistance was relieved by macrophage depletion with clodronate, implying that elevated pro-inflammatory ATMs might be attributable for insulin resistance under Plin1 deficiency. Together, these data suggest that Plin1 is required to restrain fat loss and pro-inflammatory responses in adipose tissue by reducing futile lipolysis to maintain metabolic homeostasis.

Effects on inequality in life expectancy from a social ecology perspective.

BACKGROUND: Inequality in life expectancy (ILE) is defined as inequality in the distribution of expected span of life-based on data from survival tables estimated using the Atkinson inequality index. ILE can be influenced by socio-ecological indicators including the Gini coefficient, secondary education, output per worker, and old age pension. This study examined the effects on ILE from a social ecology perspective. METHODS: This analysis is based on ILE data from 108 countries obtained from the United Nations Development Programme. Data on socio-ecological indicators were obtained from the United Nations database. The associations between socio-ecological indicators and ILE were assessed using correlation coefficients and multiple regression models. RESULTS: Significant correlations were evident between ILE and the following indicators from a socio-ecological perspective: Gini coefficient (GC: r = 0.335, p = 0.001) as an indicator of income inequality, female population with at least some secondary education (FSE: r = - 0.757, p = 0.001), male population with at least some secondary education (MSE: r = - 0.741, p = 0.001), output per worker as a measure of labor productivity (OPW: r = - 0.714, p = 0.001), and number of old age pension recipients (OPR: r = - 0.641, p = 0.001). In multivariate regression, the ILE predictors were higher GC and lower levels of FSE, MSE, OPW, and OPR (R2 = 0.648, p < 0.001). CONCLUSIONS: Socio-ecological factors have an important effect on ILE. Policies that address ILE should consider targeted socio-ecological factors, such as the Gini coefficient of income inequality, that give a personal perspective of economic deprivation, attainment of at least a secondary education by both females and males that gives a social environment perspective, output per worker that indicates labor productivity, and the number of old age pension recipients that indicates social security from a public policy perspective.

Kudzu Leaf Extract Suppresses the Production of Inducible Nitric Oxide Synthase, Cyclooxygenase-2, Tumor Necrosis Factor-Alpha, and Interleukin-6 via Inhibition of JNK, TBK1 and STAT1 in Inflammatory Macrophages.

Kudzu (Pueraria montana var. lobata (Willd.) Sanjappa & Pradeep) is a perennial leguminous vine, and its root and flower have been used for herbal medicine in Asia for a long time. Most dietary flavonoids are reported to be concentrated in its root, not in its aerial parts including leaves. In this study, we investigated whether kudzu leaf and its major constituent, robinin (kaempferol-3-O-robinoside-7-O-rhanmoside) possessed anti-inflammatory activity. To test this hypothesis, we used peritoneal macrophages isolated from BALB/c mice and stimulated the cells with lipopolysaccharide (LPS) or LPS plus interferon (IFN)-γ. Compared with kudzu root extract, its leaf extract was more potent in inhibiting the production of inducible nitric oxide synthase (iNOS), cyclooxygenase-2, tumor necrosis factor-α, and interleukin-6. Kudzu leaf extract decreased LPS-induced activation of c-Jun N-terminal kinase (JNK) and TANK-binding kinase 1(TBK1) with no effects on nuclear factor-κB and activator protein 1 transcriptional activity. Also, kudzu leaf extract inhibited LPS/IFN-γ-induced signal transducer and activator of transcription 1 (STAT1) activation partly via an altered level of STAT1 expression. Robinin, being present in 0.46% of dry weight of leaf extract, but almost undetected in the root, decreased iNOS protein involving modulation of JNK and STAT1 activation. However, robinin showed no impact on other inflammatory markers. Our data provide evidence that kudzu leaf is an excellent food source of as yet unknown anti-inflammatory constituents.

Socio-ecological perspective of older age life expectancy: income, gender inequality, and financial crisis in Europe.

BACKGROUND: Population is aging rapidly in Europe. Older age life expectancy (OLE) can be influenced by country-level depth of credit information (DCI) as an indicator of financial crisis, gross national income (GNI) per capita, and gender inequality index (GII). These factors are key indicators of socio-ecological inequality. They can be used to develop strategies to reduce country-level health disparity. The objective of this study was to confirm the relationship between socio-ecological factors and OLE in Europe. METHODS: Data were obtained from World Bank, WHO, and UN database for 34 Europe countries. Associations between socio-ecological factors and OLE were assessed with Pearson correlation coefficients and three regression models. These models assumed that appropriate changes in country-level strategies of healthy aging would produce changes in GNI per capital as personal perspective, GII in social environment perspective, and DCI in public policy perspective to implement socio-ecological changes. Hierarchal linear regression was used for final analysis. RESULTS: Although OLE (women and men) had significant negative correlation with GII (gender inequality index, r = - 0.798, p = 0.001), it had positive correlations with GNI (gross national income per capita, r = 0.834, p = 0.001) and DCI (depth of credit information index, r = 0.704, p = 0.001) levels caused by financial crisis. Higher levels GNI and DCI but lower GII were found to be predictors of OLE (women and men) (R2 = 0.804, p < 0.001). CONCLUSIONS: Factors affecting older age life expectancy in Europe were identified from socio-ecological perspective. Socio-ecological indicators (GII, GNI, and DCI) in Europe appear to have a latent effect on OLE levels. Thus, country-level strategies of successful aging in Europe should target socio-ecological factors such as GII, GNI, and DCI value.

COUNTRY-LEVEL SOCIOECONOMIC INDICATORS ASSOCIATED WITH SURVIVAL PROBABILITY OF BECOMING A CENTENARIAN AMONG OLDER EUROPEAN ADULTS: GENDER INEQUALITY, MALE LABOUR FORCE PARTICIPATION AND PROPORTIONS OF WOMEN IN PARLIAMENTS.

This study confirms an association between survival probability of becoming a centenarian (SPBC) for those aged 65 to 69 and country-level socioeconomic indicators in Europe: the gender inequality index (GII), male labour force participation (MLP) rates and proportions of seats held by women in national parliaments (PWP). The analysis was based on SPBC data from 34 countries obtained from the United Nations (UN). Country-level socioeconomic indicator data were obtained from the UN and World Bank databases. The associations between socioeconomic indicators and SPBC were assessed using correlation coefficients and multivariate regression models. The findings show significant correlations between the SPBC for women and men aged 65 to 69 and country-level socioeconomic indicators: GII (r=-0.674, p=0.001), MLP (r=0.514, p=0.002) and PWP (r=0.498, p=0.003). The SPBC predictors for women and men were lower GIIs and higher MLP and PWP (R 2=0.508, p=0.001). Country-level socioeconomic indicators appear to have an important effect on the probability of becoming a centenarian in European adults aged 65 to 69. Country-level gender equality policies in European counties may decrease the risk of unhealthy old age and increase longevity in elders through greater national gender equality; disparities in GII and other country-level socioeconomic indicators impact longevity probability. National longevity strategies should target country-level gender inequality.

Relationship Between the Remaining Years of Healthy Life Expectancy in Older Age and National Income Level, Educational Attainment, and Improved Water Quality.

The remaining years of healthy life expectancy (RYH) at age 65 years can be calculated as RYH (65) = healthy life expectancy-aged 65 years. This study confirms the associations between socioeconomic indicators and the RYH (65) in 148 countries. The RYH data were obtained from the World Health Organization. Significant positive correlations between RYH (65) in men and women and the socioeconomic indicators national income, education level, and improved drinking water were found. Finally, the predictors of RYH (65) in men and women were used to build a model of the RYH using higher socioeconomic indicators (R(2 )= 0.744, p < .001). Overall country-level educational attainment, national income level, and improved water quality influenced the RYH at 65 years. Therefore, policymaking to improve these country-level socioeconomic factors is expected to have latent effects on RYH in older age.

Labor force participation and secondary education of gender inequality index (GII) associated with healthy life expectancy (HLE) at birth.

BACKGROUND: What is the factor that affects healthy life expectancy? Healthy life expectancy (HLE) at birth may be influenced by components of the gender inequality index (GII). Notably, this claim is not tested on the between components of the GII, such as population at least secondary education (PLSE) with ages 25 and older, labor force participation rate (LFPR) with ages 15 and older, and the HLE in the world's countries. Thus, this study estimates the associations between the PLSE, LFPR of components of the GII and the HLE. METHODS: The data for the analysis of HLE in 148 countries were obtained from the World Health Organization. Information regarding the GII indicators for this study was obtained from the United Nations database. Associations between these factors and HLE were assessed using Pearson correlation coefficients and regression models. RESULTS: Although significant negative correlations were found between HLE and the LFPR, positive correlations were found between HLE and PLSE. Finally, the HLE predictors were used to form a model of the components of the GII, with higher PLSE as secondary education and lower LFPR as labor force (R(2) = 0.552, P <0.001). CONCLUSIONS: Gender inequality of the attainment secondary education and labor force participation seems to have an important latent effect on healthy life expectancy at birth. Therefore, in populations with high HLE, the gender inequalities in HLE are smaller because of a combination of a larger secondary education advantage and a smaller labor force disadvantage in male-females.

Factors affecting the survival probability of becoming a centenarian for those aged 70, based on the human mortality database: income, health expenditure, telephone, and sanitation.

BACKGROUND: What are the factors that affect the survival probability of becoming a centenarian for those aged 70? Do the factors include income, health expenditure, the use of mobile telephones, or sanitation? The survival probability of becoming a centenarian (SPBC) is defined as an estimate of the production of centenarians by a population. The SPBC (70) is the survival probability of becoming a centenarian for those aged 70. This study estimates the associations between the SPBC (70), and the gross national income, health expenditure, telecommunications, and sanitation facilities in 32 countries. METHODS: The socioeconomic indicators for this study were obtained from the database of the United Nations Development Programme. In addition, the data for the analysis of centenarians in 32 countries were obtained from the Human Mortality Database, which is maintained by the Department of Demography at the University of California, Berkeley, USA, and the Max Planck Institute for Demographic Research in Rostock, Germany. Associations between socioeconomic indicators and SPBC (70) were assessed using Pearson's correlation coefficients and multiple regression models. RESULTS: Significant positive correlations were found between the SPBC (70), and the socioeconomic factors of gross national income (GNI), public expenditure on health as a percentage of gross domestic product (PEHGDP), fixed and mobile telephone subscribers (FMTS) as the standard of living, and improved sanitation facilities (ISF). Overall, the SPBC (70) of female and male predictors were used, in order to form a model production of centenarians, with higher GNI and PEHGDP, as well as higher FMTS and ISF as the socioeconomic factors (R²= 0.422, P< 0.001). CONCLUSIONS: The socioeconomic level in all 32 countries appears to have an important latent effect on the production of centenarians in both females and males. This study has identified the following four important aspects of socioeconomic indicators in the survival probability of becoming a centenarian for those aged 70: higher overall economic development level, public expenditure on health, mobile telephone subscribers as the standard of living, and the use of improved sanitation facilities for healthy aging. Thus, the socioeconomic level seems to affect an important on the survival probability of becoming a centenarian.

Serial assessment of weight-bearing lower extremity alignment radiographs after open-wedge high tibial osteotomy.

PURPOSE: The purpose of this study was to perform a serial assessment of the radiologic parameters of the mechanical axis (MA) and the weight-bearing line (WBL) using a weight-bearing anteroposterior (AP) long-standing view of the lower extremity to determine whether the postoperative MA and WBL change with time. METHODS: A total of 90 consecutive lower limbs were examined retrospectively from a weight-bearing AP long-standing view of the lower extremity obtained from 120 patients who underwent open-wedge high tibial osteotomy (OWHTO). A total of 30 patients were excluded because of (1) complications (7 patients) such as bone graft collapse or broken screws, malunion, or nonunion arising after surgery and (2) no acquisition of a regular series of weight-bearing AP long-standing views of the lower extremity (23 patients). The AP long-standing view of the lower extremity was taken, and weight-bearing AP long-standing views of the lower extremity at 1 month, 6 months, 1 year, and 2 years postoperatively were used for assessment of serial change. The Picture Archiving Communication System (Marotech, Inc, St-Augustin-de-Desmaures, Quebec, Canada) was used for radiologic measurements of the WBL ratio and MA. Serial changes were compared between 1 month, 6 months, 1 year, and 2 years postoperatively. RESULTS: The WBL ratio progressively shifted medially, with significant changes at all time points until 1 year postoperatively (1 month to 6 months, P = .04; 6 months to 1 year, P = .04; 1 year to 2 years, P = .22). Even though the MA angle showed a similar decreasing trend, it showed no statistical difference (P > .05). CONCLUSIONS: This study showed that after OWHTO, the WBL shifts progressively medially until 1 year postoperatively. LEVEL OF EVIDENCE: Level IV, diagnostic study.

Evaluation of health factors on artificial intelligence and the internet of things-based older adults healthcare programmes.

Objective: This study evaluates Artificial intelligence and the Internet of Things-based older adults' healthcare programmes (AI·IoT-OAHPs), which offer non-face-to-face and face-to-face health management to older adults for health promotion. Methods: The study involved 146 participants, adults over 60 who had registered in AI·IoT-OAHPs. This study assessed the health factors as the outcome of pre- and post-health screening and health management through AI·IoT-OAHPs for six months. Results: Preand post-health screening and management through AI·IoT-OAHPs were evaluated as significant outcomes in 14 health factors. Notably, the benefits of post-cognitive function showed a twofold increase in older female adults through AI·IoT-OAHPs. Adults over 70 showed a fourfold increase in post-walking days, a threefold in post-dietary practice, and a twofold in post-cognitive function in the post-effects compared with pre via AI·IoT-OAHPs. Conclusions: AI·IoT-OAHPs seem to be an effective program in the realm of face-to-face and non-face-to-face AI·IoT-based older adults' healthcare initiatives in the era of COVID-19. Consequently, the study suggests that AI·IoT-OAHPs contribute to the upgrade in health promotion of older adults. In future studies, the effectiveness of AI·IoT-OAHPs can be evaluated as a continuous project every year in the short term and every two years in the long term.

Analysis of factors associated with patients' global impression of change scores in inpatients with peripheral facial palsy: A retrospective study at a Korean Medicine Hospital.

The incidence of peripheral facial palsy is on the rise, with psychological issues influencing quality of life due to visible symptoms. Consequently, patient-reported outcome measures are critical in assessing the disease burden and the treatment efficacy of peripheral facial palsy from patients' perspective. This study examines factors influencing patients' global impression of change (PGIC) scores, a type of patient-reported outcome measure, in hospitalized patients with peripheral facial palsy. This retrospective study analyzed the electronic medical records of 200 patients with peripheral facial palsy who were admitted to the Korean Medicine Hospital, Kyung Hee University Medical Center from May 1, 2022 to April 30, 2023. Impact of demographic, electrophysiological, intervention, and clinical factors on PGIC scores were evaluated. Descriptive statistics showed that the length of hospitalization (P = .020), time from disease onset to hospitalization (P = .022), lacrimal disorders (P = .002), House-Brackmann (HB) grade evaluated at admission (P = .016) and at discharge (P < .001), improvement in HB-grade from admission to discharge (P = .002), and total facial disability index (FDI) score at discharge (P < .001) were significantly associated with PGIC scores. In multivariate logistic regression analysis, HB-grade at admission (OR: 13.89, 95% CI: 2.18-113.60), length of stay (OR: 0.27, 95% CI: 0.07-0.92), time from disease onset to hospitalization (OR: 5.55, 95% CI: 1.36-24. 77), tear-related symptoms (OR: 0.41, 95% CI: 0.17-0.96), total FDI score (OR: 0.45, 95% CI: 0.20-0.98), and greater improvement in HB-grade at discharge compared to admission (OR: 0.08, 95% CI: 0.02-0.31) were significantly associated with PGIC scores. Patients with milder initial disease severity, hospitalization period exceeding 7 days, shorter time from disease onset to hospitalization, improvement of lacrimal symptoms, total FDI score, and HB-grade between admission and discharge experienced more significant subjective improvement in peripheral facial palsy.

Social factors associated with centenarian rate (CR) in 32 OECD countries.

BACKGROUND: Over the last fifty years, the number of centenarians has dramatically increased. The centenarian rate (CR) is representative of the general longevity prevalent in a nation; it indicates the number of individuals aged 100 years or above at a given date divided by the size of the corresponding cohort of a given age. Two important attributes of the CR (50-54) are that it reflects both unchanged age-specific fertility and the absence of migration in populations. It can generally be used in longevity-based evaluations of the broader concept of successful ageing. As such, this retrospective analysis of the social factors that contribute to the CR (50-54) may help to identify the factors associated with successful ageing.This study estimates the CR (50-54) and elucidates the influence of social factors on successful ageing and the CR (50-54), examining 32 member countries of the Organization for Economic Co-operation and Development (OECD). METHODS: The social indicators for this study were obtained from the United Nations database. The data for the analysis of centenarians in the 32 OECD countries were obtained from the world population prospects conducted by the United Nations. Associations between social factors and CR (50-54) were assessed using Pearson correlation coefficients and regression models. RESULTS: Significant positive correlations were found between the CR (50-54) and the social factors of expenditure on health as a percentage of gross domestic product (HEGDP: r = 0.411, p < 0.021), general government expenditure on health as a percentage of total government expenditure (GGEH: r = 0.474, p < 0.006), the proportion of fixed-telephone subscriptions in the population (FTS: r = 0.489, p < 0.005), and the human development index (HDI: r = 0.486, p < 0.005). Finally, these CR (50-54) predictors were used to form a model of successful ageing, with higher HEGDP and GGEH as health expenditure, higher FTS as standard of living, and higher HDI as social well-being (R2 = 0.573, P < 0.025). CONCLUSIONS: The findings suggest that an increased CR (50-54) is affected by multiple social factors involved in successful ageing. Therefore, if they wish to improve their country's CR (50-54), governments must strengthen their existing support services for the elderly through making improvements to standards of living, social well-being and through increased financing of the health sector.

Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients.

PURPOSE: The purpose of this study was to determine the accuracy, sensitivity, specificity, and predictive values of a single event of painful popping in the presence of a posterior root tear of the medial meniscus in middle-aged to older Asian patients. METHODS: We conducted a retrospective review of medical records of 936 patients who underwent arthroscopic surgeries for an isolated medial meniscus tear between January 2000 and December 2010. There were 332 men and 604 women with a mean age of 41 years (range, 25 to 66 years). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of a painful popping sensation for a posterior root tear of the medial meniscus were calculated. RESULTS: Arthroscopy confirmed the presence of posterior root tears of the medial menisci in 237 of 936 patients (25.3%). A single event of a painful popping sensation was present in 86 of these 936 patients (9.1%). Of these 86 patients with a painful popping sensation, 83 (96.5%) were categorized as having an isolated posterior root tear of the medial meniscus. The positive predictive value of a painful popping sensation in identifying a posterior root tear of the medial meniscus was 96.5%, the negative predictive value was 81.8%, the sensitivity was 35.0%, the specificity was 99.5%, and the diagnostic accuracy was 77.9%. CONCLUSIONS: A single event of painful popping can be a highly predictive clinical sign of a posterior root tear of the medial meniscus in the middle-aged to older Asian population. However, it has low sensitivity for the detection of a posterior root tear of the medial meniscus. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus.

PURPOSE: This study examined, at second-look arthroscopy, the results of open-wedge high tibial osteotomy (HTO) focusing on root tear of the medial meniscus posterior horn (RTMMP). METHODS: Among 31 consecutive patients who underwent HTO without a meniscectomy or pullout repair for RTMMP, 20 patients were available for second-look arthroscopic evaluation. All patients had medial unicompartmental arthritis. The healing status of the RTMMP was classified as complete, incomplete, and no healing. The difference in the weight bearing line from presurgery to the last follow-up was evaluated. Osteoarthritis and chondral lesions were evaluated, as were clinical results. Correlations between healing status and other variables (weight bearing line, cartilage status, and clinical scores) were assessed. The healed (10 patients) and nonhealed (incomplete 6 patients + no healing 4 patients) groups were also evaluated with respect to other variables. RESULTS: There were 10 (50%) cases with complete healing, 6 (30%) with incomplete healing, and 4 (20%) with no healing. Kellgren-Lawrence grade did not improve according to the standing plain radiograph (P = .09). Progression of chondral lesions was not observed at second-look arthroscopy; some improvement was even observed (P = .002). The median Lysholm score improved from 58 preoperatively to 88.5 at the last follow-up. The median Hospital for Special Surgery (HSS) score also increased significantly from 62.4 (range, 50 to 76) to 87.2 (range, 80 to 92; P = .003). The comparison between healed and nonhealed groups revealed no statistical differences in all variables. CONCLUSIONS: This study revealed a high rate of healing of RTMMP after HTO without attempted repair. Healing of the meniscus was not associated with an improved clinical outcome. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Does press-fit technique reduce tunnel volume enlargement after anterior cruciate ligament reconstruction with autologous hamstring tendons? A prospective randomized computed tomography study.

PURPOSE: The purpose of this prospective, randomized, computed tomography-based study was to investigate whether the press-fit technique reduces tunnel volume enlargement (TVE) and improves the clinical outcome after anterior cruciate ligament reconstruction at a minimum follow-up of 1 year compared with conventional technique. METHODS: Sixty-nine patients undergoing primary ACL reconstruction using hamstring autografts were randomly allocated to either the press-fit technique group (group A) or conventional technique group (group B). All patients were evaluated for TVE and tunnel widening using computed tomography scanning, for functional outcome using International Knee Documentation Committee and Lysholm scores, for rotational stability using the pivot-shift test, and for anterior laxity using the KT-2000 arthrometer at a minimum of 1-year follow-up. RESULTS: There were no significant differences in TVE between the 2 groups. In group A, in which the press-fit technique was used, mean volume enlargement in the femoral tunnel was 65% compared with 71.5% in group B (P = .84). In group A, 57% (20 of 35) of patients developed femoral TVE compared with 67% (23 of 34) of patients in group B (P = .27). Both groups showed no significant difference for functional outcome (mean Lysholm score P = .73, International Knee Documentation Committee score P = .15), or knee laxity (anterior P = .78, rotational P = .22) at a minimum follow-up of 1 year. CONCLUSIONS: In a comparison of press-fit and conventional techniques, there were no significant differences in TVE and clinical outcome at short-term follow-up. LEVEL OF EVIDENCE: Level II, therapeutic study, prospective randomized clinical trial.