Predictors of flatfoot in 11-12-year olds: a longitudinal cohort study.

BACKGROUND: The structures around the navicular bones, which constitute the medial longitudinal arch, develop by 10 years of age. While navicular bone height is often emphasized in the assessment of flatfoot, three-dimensional (3D) evaluations, including those of structural parameters during inversion, have rarely been investigated. If the development of flatfoot during the growth process could be predicted, appropriate interventions could be implemented. Therefore, in this longitudinal cohort study, we developed a system, utilizing smartphones, to measure the 3D structure of the foot, performed a longitudinal analysis of changes in midfoot structures in 124 children aged 9-12 years, and identified factors influencing the height of the navicular bone. The foot skeletal structure was measured using a 3D system. RESULTS: Over 2 years, foot length and instep height increased during development, while navicular height decreased. The 25th percentile of the instep height ratio and navicular height ratio at ages 9-10 years did not exceed those at ages 11-12 years, with percentages of 17.9% and 71.6%, respectively, for boys, and 15.8% and 49.1%, respectively, for girls. As the quartiles of the second toe-heel-navicular angle (SHN angle) increased at ages 9-10 years, the axis of the bone distance (ABD) and SHN angles at ages 11-12 years also increased, resulting in a decrease in the navicular height ratio. A significant inverse correlation was found between changes in SHN angle and navicular height ratio. These findings indicate that the navicular bone rotation of the midfoot is a predictor of the descent of the navicular bone. CONCLUSIONS: This study revealed that some children exhibit decreases in navicular bone height with growth. As a distinct feature, the inversion of the navicular bone promotes flattening of the midfoot. Thus, this study provides insights into changes in midfoot development in children and provides an effective evaluation index.

The altered production and property of saliva induced by ingesting fermented food ingredients affect the oral microbiome composition in mice.

Oral functions are diverse and critical to human health. Therefore, insufficient secretion or poor quality of saliva, which is secreted into the oral cavity and plays various roles, could have a crucial influence on the oral microenvironment and be associated with systemic disease development. Here, we investigated the effects of food ingredients on saliva quantity and quality, including fermented ones. Through the in vitro submandibular glands' organ culture analyses, we found that "Yomo gyutto," fermented Japanese mugwort (Artemisia princeps), altered the expression of aquaporin-5, a water channel protein. We also found that Yomo gyutto increased saliva volume, along with the amount of α-amylase in mice, and caused changes in the oral microbiome composition of mice. These results suggested that by ingesting Yomo gyutto, we could directly and effectively manipulate the quantity and quality of saliva secreted from the salivary glands, potentially altering the oral microbiome composition for individual health.

Analysis of skeletal characteristics of flat feet using three-dimensional foot scanner and digital footprint.

BACKGROUND: Flat feet increase the risk of knee osteoarthritis and contribute to frailty, which may lead to worse life prognoses. The influence of the foot skeletal structure on flat feet is not yet entirely understood. Footprints are often used to evaluate feet. However, footprint-based measurements do not reflect the underlying structures of feet and are easily confounded by soft tissue. Three-dimensional evaluation of the foot shape can reveal the characteristics of flat feet. Therefore, foot shape evaluations have garnered increasing research interest. This study aimed to determine the correlation between the three-dimensional (3D) features of the foot and the measurement results of footprint and to predict the evaluation results of flat feet from the footprint based on the 3D features. Finally, the three-dimensional characteristics of flat feet, which cannot be revealed by footprint, were determined. METHODS: A total of 403 individuals (40-89 years) participated in this study. The proposed system was developed to identify seven skeletal features that were expected to be associated with flat feet. The loads on the soles of the feet were measured in a static standing position and with a digital footprint device. Specifically, two footprint indices were calculated: the Chippaux-Smirak index (CSI) and the Staheli index (SI). In the analysis, comparisons between male and female measurement variables were performed using the Student's t test. The relationships between the 3D foot features and footprint index parameters were determined by employing the Pearson correlation coefficient. Multiple linear regression was utilized to identify 3D foot features that were strongly associated with the CSI and SI. Foot features identified as significant in the multivariate regression analysis were compared based on a one-way analysis of variance (ANOVA) with Tukey's post hoc test. RESULTS: The CSI and SI were highly correlated with the instep height (IH) and navicular height (NH) of the 3D foot scanning system and were also derived from multiple regression analysis. In addition to the NH and IH, the indicators of the forefoot, transverse arch width, and transverse arch height were considered. In the flat foot group with CSI values above 62.7%, NH was 13.5% (p < 0.001) for males and 14.9% (p = 0.01) for females, and the axis of the bone distance was 5.3% (p = 0.05) for males and 4.9% (p = 0.10) for females. In particular, for CSI values above 62.7% and NH values below 13%, the axis of the bone distance was large and the foot skeleton was deformed. CONCLUSIONS: Decreased navicular bone height could be evaluated with the 3D foot scanning system even when flat feet were not detected from the footprint. The results indicate that the use of quantitative indices for 3D foot measurements is important when evaluating the flattening of the foot. Trial registration number UMIN000037694. Name of the registry: University Hospital Medical Information Network Registry. Date of registration: August 15, 2019.

Development of a Surgical Sponge Counting System Using Radiographic Images.

Background. Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. Methods. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Results. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 µA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. Conclusion. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.

Improvements in lower-limb muscle strength and foot pressure distribution with foot care in frail elderly adults: a randomized controlled trial from Japan.

BACKGROUND: Abnormalities in the feet and toenails are common among the elderly and may increase the risk of falls. This study aimed to investigate the changes in toe-gap force, knee-gap force, foot pressure distribution, the ability to perform activities of daily living, subjects' feelings and behaviors, and physical function resulting from daily lifestyle modification and foot care. METHODS: The study participants included 74 elderly adults (mean age 80.3 ± 7.5 years) with foot problems who had been divided into three groups based on Japan's nursing care insurance system levels: certified ineligible for support, eligible for support, or eligible for long-term care. Additionally, a control group of 106 elderly adults in good health was recruited. The differences between the intervention and control groups was examined using the Student's t-test, and differences between the three intervention subgroups and the control group were examined using one-way analysis of variance. RESULTS: After intervention, abnormalities in the participants' feet and toenails improved. Significant increases in lower-limb muscle strength were observed, and foot pressure distribution had improved. The foot-care intervention significantly improved lower-limb muscle strength and decreased the risk of falling, even in elderly adults whose physical function had deteriorated. CONCLUSION: In frail elderly adults, care of the feet and toenails can improve lower-limb muscle strength and foot pressure distribution. In addition, the individuals' social participation increased, and their behavior improved. TRIAL REGISTRATION: University hospital Medical Information Network- Clinical Trials (UMIN-CTR) with the number: UMIN000034742 . Registration date: 11/01/2018.

Long-term efficacy of comprehensive multidisciplinary antibiotic stewardship programs centered on weekly prospective audit and feedback.

OBJECTIVE: To evaluate the long-term effects of comprehensive antibiotic stewardship programs (ASPs) on antibiotic use, antimicrobial-resistant bacteria, and clinical outcomes. DESIGN: Before-after study. SETTING: National university hospital with 934 beds. INTERVENTION: Implementation in March 2010 of a comprehensive ASPs including, among other strategies, weekly prospective audit and feedback with multidisciplinary collaboration. METHODS: The primary outcome was the use of antipseudomonal antibiotics as measured by the monthly mean days of therapy per 1000 patient days each year. Secondary outcomes included overall antibiotic use and that of each antibiotic class, susceptibility of Pseudomonas aeruginosa, the proportion of patients isolated methicillin-resistant Staphylococcus aureus (MRSA) among all patients isolated S. aureus, the incidence of MRSA, and the 30-day mortality attributable to bacteremia. RESULTS: The mean monthly use of antipseudomonal antibiotics significantly decreased in 2011 and after as compared with 2009. Susceptibility to levofloxacin was significantly increased from 2009 to 2016 (P = 0.01 for trend). Its susceptibility to other antibiotics remained over 84% and did not change significantly during the study period. The proportion of patients isolated MRSA and the incidence of MRSA decreased significantly from 2009 to 2016 (P < 0.001 and = 0.02 for trend, respectively). There were no significant changes in the 30-day mortality attributable to bacteremia during the study period (P = 0.57 for trend). CONCLUSION: The comprehensive ASPs had long-term efficacy for reducing the use of the targeted broad-spectrum antibiotics, maintaining the antibiotic susceptibility of P. aeruginosa, and decreasing the prevalence of MRSA, without adversely affecting clinical outcome.

Evaluation of Surgical Instruments With Radiofrequency Identification Tags in the Operating Room.

BACKGROUND: Surgical instrument retention and instrument breakage compromise surgery quality and lead to medical malpractice. We developed an instrument tracking system that could alert surgeons to instrument retention during surgery and monitor instrument use to reduce the risk of breakage. METHODS: This prospective, experimental clinical trial included 15 patients undergoing inguinal hernia surgery or lumpectomy under general anesthesia at Saiseikai Kurihashi Hospital. Radiofrequency identification (RFID)-tagged surgical instruments were used, and a detection antenna was placed on a mayo stand during the operation. We analyzed the 1-loop detection ratio (OLDR)-that is, the capability of the antenna to detect devices in a single reading-and the total detection rate (TDR)-that is, the data accumulated for the duration of the operation-of the RFID-tagged instruments. RESULTS: Data analysis revealed that the OLDR was 95% accurate, whereas the TDR was 100% accurate. The antenna could not detect the RFID tag when there was interference from electrocautery noise radiation, and 6% of instrument movement was undetected by the antenna; however, the TDR and instrument use were detected at all times. CONCLUSIONS: Surgical instruments can be tracked during surgery, and this tracking can clarify the usage rate of each instrument and serve as a backup method of instrument counting. However, this study was conducted on a small scale, and RFID tags cannot be attached to small surgical instruments used in complex operations such as neurosurgery. Further efforts to develop a tracking system for these instruments are warranted.

Management of surgical instruments with radio frequency identification tags.

PURPOSE: To prevent malpractices, medical staff has adopted inventory time-outs and/or checklists. Accurate inventory and maintenance of surgical instruments decreases the risk of operating room miscounting and malfunction. In our previous study, an individual management of surgical instruments was accomplished using Radio Frequency Identification (RFID) tags. The purpose of this paper is to evaluate a new management method of RFID-tagged instruments. DESIGN/METHODOLOGY/APPROACH: The management system of RFID-tagged surgical instruments was used for 27 months in clinical areas. In total, 13 study participants assembled surgical trays in the central sterile supply department. FINDINGS: While using the management system, trays were assembled 94 times. During this period, no assembly errors occurred. An instrument malfunction had occurred after the 19th, 56th, and 73 th uses, no malfunction caused by the RFID tags, and usage history had been recorded. Additionally, the time it took to assemble surgical trays was recorded, and the long-term usability of the management system was evaluated. ORIGINALITY/VALUE: The system could record the number of uses and the defective history of each surgical instrument. In addition, the history of the frequency of instruments being transferred from one tray to another was recorded. The results suggest that our system can be used to manage instruments safely. Additionally, the management system was acquired of the learning effect and the usability on daily maintenance. This finding suggests that the management system examined here ensures surgical instrument and tray assembly quality.

Apoptotic Effects of the Extracts of Cordyceps militaris via Erk Phosphorylation in a Renal Cell Carcinoma Cell Line.

Cordyceps militaris (CM) is gaining attention as a traditional medicinal food, but its molecular biological mechanisms for anti-cancer activity are not identified or clarified. We aimed to elucidate the synthesizing apoptotic effects of CM extracts and to determine the biological effects of CM extract against cordycepin alone in a renal cell carcinoma (RCC) cell line. CM extract showed higher effects of growth inhibition, apoptotic effect, and cell cycle arrest than cordycepin alone. Moreover, CM extract activated extracellular signal-regulated kinase (Erk) highly more than cordycepin alone. We suggest that cordycepin and CM extract induced apoptosis via the activation of Erk dominantly and AMP-activated protein kinase slightly; CM extract has more potent effects on apoptotic effects associated with Erk activation than cordycepin alone.

Improvement of postural control in the frail older adults through foot care: A pre- and post-intervention study.

Frailty in older adults often leads to foot issues, increasing fall-related fracture risk. Mechanoreceptors, the pressure receptors in the foot sole, are pivotal for postural control. Foot problems can impair mechanoreceptor function, compromising balance. This study aimed to examine the effect of foot care on postural control in frail older adults. Forty-eight participants underwent a five-month monthly foot care intervention. Measurements were taken before and after this intervention. Participants stood for 45 s in a static, open-eyed position on a stabilometer. Center-of-pressure (CoP) analysis included total trajectory length, integrated triangle area, rectangular area, and range of motion in anterior-posterior and medio-lateral directions. Results indicated that foot care significantly increased toe ground contact area by 1.3 times and improved anterior-posterior motion control during static standing. Enhanced postural control resulted from improved skin condition due to foot care that intensified mechanoreceptor signal input and improved postural control output. These findings underscore the potential for reducing fracture risks in older adults through proactive foot care. The study highlights the vital role of foot care in enhancing postural control, with broader implications for aging population well-being and safety.

Valid Indicators for Predicting Falls in Community-Dwelling Older Adults Under Ongoing Exercise Intervention to Prevent Care Requirement.

Physical exercise interventions to prevent falls for older adults at risk of falling are widespread in many countries; however, there is insufficient knowledge of the impact of long-term exercise on the fall discriminating ability of existing fall-prediction indicators. This study measured physical and cognitive indicators of the fall risk, including the timed up and go (TUG), walking speed (WS), and plantar tactile threshold (PTT), in 124 community-dwelling older adults with care needs who were continuing an exercise program. Logistic regression analyses were used to determine factors associated with falls in the 87 participants who could adhere to the exercise continuously for 12 months. The PTT was significantly higher in fallers, while the TUG and WS did not differ significantly between fallers and non-fallers. The only index significantly associated with falls was the PTT (OR = 1.20). The fall identification ability was better for PTT (AUC = 0.63), whereas TUG (AUC = 0.57) and WS (AUC = 0.52) were lower than previously reported scores. In conclusion, long-term exercise was found to improve scores on the fallprediction indicators by physical performance, but to decrease their ability to identify future falls. PTT may complement the ability to identify falls in such elderly populations.

Effect of COVID-19 on the Activity Level of Elderly people with Dementia.

Measures against physical and social frailty after the COVID-19 epidemic in elderly people with dementia are required. However, there are no studies that have systematically examined the level of activity maintained by elderly people with dementia. In this study, we developed an ICT-based steps monitoring system and investigated changes in the number of steps taken by 13 community-dwelling elderly people with dementia from before the COVID-19 epidemic to during the epidemic. Six of the thirteen subjects maintained approximately 7,000 steps, which was the same level as that before the epidemic. However, some subjects showed a significant decrease in their frequency of going out. This system indicated the construction of a health promotion strategy based on quantitative daily step count data for community-dwelling elderly people with dementia.

Thixotropic ß-Chitin Nanofiber Hydrogel with a Living Body-Responsive Self-Hardening Property and Its Application as a Sprayable Antiadhesion Barrier.

Considering recent advances in surgical techniques, sprayable antiadhesion barriers that are compatible with minimally invasive procedures are needed. However, the relatively low mechanical stiffness of the current thixotropic reversible sol-to-gel transition hydrogels has hindered their medical application. Herein, we show a thixotropic sprayable ß-chitin nanofiber hydrogel that spontaneously lost the thixotropic property in response to the environments within the living body. Furthermore, interactions between hydrogels and the biological environment result in a significant increase in mechanical stiffness. Due to these advantageous properties, ß-chitin nanofiber hydrogels administered by spray prevent postoperative abdominal adhesions and are thus promising sprayable antiadhesion barriers.

Foot-surface-structure analysis using a smartphone-based 3D foot scanner.

BACKGROUND: A thorough understanding of the influence of the foot skeletal structure on hallux valgus (HV) is required for HV prevention. We developed a system using a 3D foot scanner on a smartphone to clarify the relationships between foot features and HV risk. METHODS: Two-dimensional video images were recorded on a smartphone, sent to a computer or cloud server, and used to construct a 3D foot-feature model, considering 10 foot features associated with HV. The participants (419 individuals, aged 40-89 years) stood with their toes 12 cm apart and heels 8 cm apart during video recording. The height and weight were measured for body-mass index calculation. RESULTS: Age-dependent foot-feature variations were observed slightly for males and distinctively for females. For females, the great toe-first metatarsal head-heel (GFH) angle associated with HV increased with age, i.e., the GFH angle increased with age, suggesting that HV increased with age. Multiple regression analysis revealed that the features determining the GFH angle are the second toe-heel-navicular angle, bone distance axis, and transverse arch length and height. The adjusted coefficients of determination were 0.54 and 0.52 for males and females, respectively. CONCLUSION: This approach enables simple foot structure assessment for HV risk evaluation.

Is there any difference in human pupillary reaction when different acupuncture points are stimulated?

OBJECTIVES: To determine if there is any difference in pupillary response among different acupuncture stimulation sites. METHODS: The subjects were 14 healthy males who had no known eye diseases or abnormality in their pupils. They received five different interventions: no acupuncture stimulation (hereinafter 'no-stimulation') and acupuncture stimulation at four sites (TE5, ST7, CV12 and ST36). The Latin square design was used to allocate stimulation order. For all acupuncture stimulation interventions, a disposable acupuncture needle was inserted superficially at the acupuncture point. Gentle repetitive tapping stimulation was applied manually during the subject's exhalation phase of respiration, for 90 s. The pupil diameter was continuously measured for 2 min before stimulation, during stimulation and for 2 min after stimulation. Statistical analysis was conducted on serial changes in pupil diameter during acupuncture stimulation on each respective site and during non-stimulation session by analysis of variance and Fisher (least significant difference) multiple comparison, with linear analysis using a mixed model. RESULTS: Pupil diameter reduction occurred at 30 s after stimulation on ST7 (p=0.008) and 60 s after stimulation (p=0.014) compared with pre-stimulation. The decrease of pupillary diameter occurred 60 s after stimulation on TE5 (p=0.028) compared with pre-stimulation. On ST36, CV12 and during the non-stimulation intervention, no significant change in the pupil diameter was observed. CONCLUSIONS: Pupillary reaction varies depending on the different stimulation sites.

Foot care to improve physical function and prevent falling of frail elderly adults with and without dementia.

Feet and toenail abnormalities are common among the elderly and can increase the risk of falls. We examined the changes in physical function after feet and toenails care for frail elderly adults and elderly adults with dementia. As a result, the abnormalities in the subject's feet and toenails improved, and the individuals' physical function and social participation increased.

Development of a quantitative measurement system for three-dimensional analysis of foot morphology using a smartphone.

Existing techniques for measuring foot morphology are invasive or cumbersome. A new technique was developed using a smartphone, which can measure foot morphology to within 1 mm. This is shown to be applicable to the prediction of hallux valgus, which allows for early intervention.

Effect of walking on depression prevalence for diabetes using information communication technology: Prospective study.

AIM: This study aimed to evaluate the prevention of diabetic depression and its impact on medical costs through the implementation of a step count monitoring system using information and communication technology. METHODS: This study carried out a longitudinal analysis of a prospective cohort. A total of 296 participants were enrolled in the intervention group and 882 participants in the control group. The participants in the intervention group were provided with pedometers, which each participant was asked to scan using devices stationed throughout the city. Activity data were stored in real time by a cloud system. The experiment lasted 30 months. RESULTS: None of the diabetes patients in the intervention group was diagnosed with depression during the study period, compared with 4.09% in the control group. Thus, the intervention suppressed the increase in medical costs for the people who did not develop depression in the diabetic group. CONCLUSIONS: The prevalence rate of depression among the participants with diabetes was lowered significantly. The medical costs of the participants who did not have diabetes were also reduced by implementing the step count monitoring system with information and communication technology. This shows that the use of an information and communication technology pedometer system can have favorable effects in terms of preventing depression in diabetes patients and further benefits for non-diabetic people. Geriatr Gerontol Int 2019; 19: 1147-1152.

Corrosion Generation and Cleaning Effect on Surgical Instruments with Attached Radiofrequency Identification Tags in Long-Term Usage.

Background: Faulty cleaning of surgical instruments may lead to corrosion damage and a higher risk of surgical site infection. We have developed a method in which each instrument has an attached radiofrequency identification (RFID) tag for individual management. However, because of the structure of the instruments, a risk of corrosion from poor cleaning exists; therefore, observation during long-term usage is necessary. Methods: The cleaning effect at the jig of the RFID tag was verified by the amount of residual protein left by various cleaning methods. In our investigation of long-term usage, we examined 94 surgical instruments with RFID tags used in the operating room for 50 months employing a microscope to identify any corrosion at the jig. Results: The method using a washer disinfector (WD) was found to be highly effective. From observation after long-term usage, friction by the RFID tag occurred in about 70% of the jigs. However, no pitting or general corrosion was seen. Conclusions: When WD is used properly, there is only a minor risk of residual protein, and corrosion does not occur even with long-term use. By using surgical instruments with RFID tags, it is possible to determine the number of uses and the history at the individual level. This facilitates operation of safe surgical instruments by limiting the number of times a particular instrument is used.

Effect of acidity on the physicochemical properties of α- and ß-chitin nanofibers.

We have investigated whether acidity can be used to control the physicochemical properties of chitin nanofibers (ChNFs). In this study, we define acidity as the molar ratio of dissociated protons from the acid to the amino groups in the raw chitin powder. The effect of acidity on the physicochemical properties of α- and ß-ChNFs was compared. The transmittance and viscosity of the ß-ChNFs drastically and continuously increased with increasing acidity, while those of the α-ChNFs were not affected by acidity. These differences are because of the higher ability for cationization based on the more flexible crystal structure of ß-chitin than α-chitin. In addition, the effect of the acid species on the transmittance of ß-ChNFs was investigated. The transmittance of ß-ChNFs can be expressed by the acidity regardless of the acid species, such as hydrochloric acid, phosphoric acid, and acetic acid. These results indicate that the acidity defined in this work is an effective parameter to define and control the physicochemical properties of ChNFs.