Patellofemoral Osteoarthritis Progression After Open-Wedge High Tibial Osteotomy Does Not Affect the Clinical Outcomes or Survivorship at Minimum 7 Years' Follow-Up.

PURPOSE: To evaluate the clinical and radiologic outcomes of open-wedge high tibial osteotomy (OWHTO) with respect to the patellofemoral joint and to assess the effects of patellofemoral osteoarthritis (OA) progression after OWHTO on clinical outcomes at minimum 7 years' follow-up. METHODS: We retrospectively reviewed 95 knees that underwent OWHTO and at least 7 years of follow-up. Clinical parameters including anterior knee pain, Japanese Orthopedic Association score, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, Hospital for Special Surgery patella score, and Knee Injury and Osteoarthritis Outcome Score-patellofemoral subscale were evaluated. Radiologic outcomes were evaluated preoperatively and at final follow-up. Patellofemoral OA progressions were evaluated using Kellgren-Lawrence grade, and we divided the patients into 2 groups (progression group and non-progression group) to evaluate the effect of patellofemoral OA progression after OWHTO on long-term clinical outcomes. RESULTS: The mean follow-up period was 10.8 ± 2.6 years (range: 7.6-17.3 years). The mean Japanese Orthopedic Association score significantly improved (from 64.4 ± 11.6 to 90.9 ± 9.3, P < .001), and the mean Oxford Knee Score at final follow-up was 40.4 ± 8.3. Due to medial OA progression, 5 cases were converted to total knee arthroplasty, and the survival rate was 94.7% at 10.8 years of follow-up. Radiologically, patellofemoral OA progression was observed at final follow-up in 48 knees (50.5%). However, there were no significant differences in all clinical outcomes at final follow-up between the progression and non-progression groups. CONCLUSIONS: Patellofemoral OA progression may progress over long-term follow-up after OWHTO. Related symptoms are minimal and this does not affect the clinical outcomes or survivorships at minimum 7 years follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Adverse Metabolic Effects on Glucose in Patients Receiving Anamorelin Using a Japanese Claims Database.

BACKGROUND: Anamorelin is the first drug approved for the treatment of cancer cachexia, a debilitating condition characterized by weight loss, anorexia, and muscle mass depletion. Cachexia negatively affects a patient's quality of life, survival, and response to chemotherapy. Studies describing anamorelin use are currently limited to a small number of pancreatic cancer cases. OBJECTIVES: We aimed to examine the incidence and risk factors of adverse metabolic effects on glucose levels in cachexia patients with various carcinomas treated with anamorelin. METHOD: We used real-world data of patients who received anamorelin between August 2021 and July 2022 and were registered in the JMDC claims database. We investigated the impact of metabolic adverse effects on glucose in patients receiving anamorelin with respect to the following factors: sex (male), age (>75 years), types of carcinoma, history of diabetes mellitus (DM), and concomitant use of steroids. RESULTS: The incidence of adverse metabolic effects on glucose was 12.3%, and pancreatic cancer and history of DM were associated with adverse metabolic effects on glucose. The median onset of adverse metabolic effects on glucose was 17 days after anamorelin treatment. CONCLUSIONS: This study highlights the need to monitor and manage hyperglycemia in cachexia patients receiving anamorelin, especially in those with pancreatic cancer and a history of DM.

Evidence that only EWS among the FET proteins acquires a low partitioning property for the hyperosmotic stress response by O-GlcNAc glycosylation on its low-complexity domain.

FET proteins (FUS, EWS, and TAF15) share a common domain organization, bind RNA/DNA, and perform similarly multifunctional roles in the regulation of gene expression. Of the FET proteins, however, only EWS appears to have a distinct property in the cellular stress response. Therefore, we focused on the relationship between hyperosmotic stress response and post-translational modifications of the FET proteins. We confirmed that the hyperosmotic stress-dependent translocation from the nucleus to the cytoplasm and the cellular granule formation of FET proteins, and that EWS is less likely to partition into cellular granules in the cytoplasm than FUS or TAF15. The domain involved in the less partitioning property of EWS was found to be its low-complexity domain (LCD). Chemoenzymatic labeling analysis of O-linked ß-N-acetylglucosamine (O-GlcNAc) residues revealed that O-GlcNAc glycosylation occurs frequently in the LCD of EWS. A correlation was observed between the glycosylation of EWS and the less partitioning property under the hyperosmotic stress. These results suggest that among the FET proteins, only EWS has acquired the unique property through O-GlcNAc glycosylation. The glycosylation may play an essential role in regulating physiological functions of EWS, such as transcriptional activity, in addition to the property in cellular stress response.

Smoking cessation in the elderly as a sign of susceptibility to symptomatic COVID-19 reinfection in the United States.

Background: We aimed to clarify the relationship between coronavirus disease 2019 (COVID-19) reinfection and basic disease and smoking status. Methods: The electronic health records of 165,320 patients with COVID-19 from January 1, 2020, to August 27, 2021, were analyzed. Data on age, race, sex, smoking status (never, current, former), and basic disease were analyzed using Cox proportional hazard models. Results: In total, 6,133 patients (3.7%) were reinfected. The overall reinfection rate for never, current, and former smokers was 4.2, 3.5, and 5.7%, respectively. Although the risk of reinfection was highest among former smokers aged ≥65 years (7.7% [422/5,460]), the reinfection rate among current smokers aged ≥65 years was 6.2% (341/5,543). Among reinfected patients, the number of basic diseases was higher in former smokers (2.41 ± 1.16) than in current (2.28 ± 1.07, P = 0.07) and never smokers (2.07 ± 1.05, P < 0.001). Former smokers who are older may have been exposed to factors that increase their risk of symptomatic COVID-19 reinfection.

Orthogeriatric co-management at a regional core hospital as a new multidisciplinary approach in Japanese hip fracture operation.

BACKGROUND: This study aimed to evaluate the effects of orthogeriatric co-management of hip fractures at a regional core hospital. METHODS: This study included patients with proximal hip fracture. Patients were divided into two groups, conventional multidisciplinary group I including patients attending the hospital between April 2015 and March 2016 and orthogeriatric group II including patients attending the hospital between April 2016 and March 2017, which were compared etrospectively. In the control group, the conventional multidisciplinary team treated patients as whole-body controls. In the intervention group, the newly recruited geriatricians performed physical examinations, laboratory tests, radioactive imaging, and physiological tests. Furthermore, they consulted ward pharmacists, rigorously conducted positive polypharmacy interventions , and evaluated the type and number of mediated drugs on admission. RESULTS: The number of medicated drugs significantly decreased from 6.03 ± 4.3 on admission to 5.50 ± 3.59 on discharge in group II, whereas group I did not show a significant decrease. Despite the more number of hospitalized patients in group II (166 patients) than in group I (126 patients), the recovery rate from postoperative urinary retention increased significantly from 57.8% (19/30) in group I to 84.3% (32/59) in group II (p = 0.049), while the incidence of aspiration pneumonia decreased from 7.1% (9/126) in group I to 2.49% (4/166) in group II (p = 0.08). The patients received six or more prescribed drugs on admission, and the number remained constant. However, the number of medicated drugs on discharge showed a marginally significant decrease from 6.03 ± 4.3 in group I to 5.50 ± 3.59 in group II (p < 0.05). CONCLUSIONS: Compared to the conventional multidisciplinary group, the orthogeriatric team contributed to reducing the number of multi-effect drugs and perioperative complications without negatively affecting mortality despite the increased number of patients. The in-hospital mortality rate did not change between the groups. The orthogeriatric program succeeded in preventing and treating perioperative complications.

Postoperative Urinary Retention in Japanese Elderly Males with a Femoral Neck or Trochanteric Fracture.

We assessed risk factors for postoperative urinary retention (UR) in elderly males with femoral bone fractures: 169 Japanese males (mean age 81.95 ± 1.19 years) who had undergone hip surgery at a municipal hospital (Toyama, Japan). A multiple logistic regression analysis was used to test possible risk factors for UR: age, body mass index, serum albumin, cognitive impairment, activities of daily living (ADL), and history of diabetes mellitus (DM). UR occurred in 24 (14.2%) of the 169 patients. A multivariate logistic regression analysis with age adjustment showed that ADL (odds ratio [OR] 3.88; 95% confidence interval [CI]: 1.2-12.5, p=0.023) was significantly associated with the development of UR, and a history of DM showed marginal significance for UR occurrence (OR 0.36, 95%CI: 0.11-10, p=0.064). These results suggests that ADL is a risk factor for UR development in elderly males who have undergone surgery for femoral neck or trochanter fractures.

Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience.

INTRODUCTION: Japan is a super-aging society, the geriatric care system establishment for hip fractures is at an urgent task. This report described our concept of multidisciplinary care model for geriatric hip fractures and 5-year outcomes at the Toyama City Hospital, Japan. METHODS: In this retrospective cohort study, a multidisciplinary treatment approach was applied for elderly patients with hip fracture since 2014. These patients (n = 678, males: n = 143, mean age: 84.6 ± 7.5 years), were treated per the multidisciplinary care model. Time to surgery, length of hospital stays, complications, osteoporosis treatment, mortality, and medical costs were evaluated. RESULTS: The mean time to surgery was 1.7 days. Overall, 78.0% patients underwent surgery within 2 days. The mean duration of hospital stay was 21.0 ± 12.4 days. The most frequent complication was deep venous thrombosis (19.0%) followed by dysuria (14.5%). Severe complications were pneumonia 3.4%, heart failure 0.8% and pulmonary embolism 0.4%. The in-hospital mortality rate was 1.2%. The 90-day, 6-month, and 1-year mortality rates were 2.5%, 6.7%, and 12.6%, respectively. The pharmacotherapy rate for osteoporosis at discharge was 90.7%, and the continuation pharmacotherapy rate was 84.7% at 1-year follow-up. The total hospitalization medical cost per person was lower than about 400 other hospitals' average costs every year, totaled 14% less during the 5-year study period. CONCLUSION: We have organized a multidisciplinary team approach for geriatric hip fracture. This approach resulted in a shorter time to surgery and hospital stay than the national average. The incidence of severe complications and mortality was low. The multidisciplinary treatment has maintained a high rate of osteoporosis treatment after discharge and at follow-up. Furthermore, the total medical cost per person was less than the national average. Thus, the multidisciplinary treatment approach for geriatric hip fractures was effective and feasible to conduct in Japan.

Mortality and the Risk Factors in Elderly Female Patients With Femoral Neck and Trochanteric Fractures.

BACKGROUND: The main purpose of this study is to exhaustively explore risk factors, including age, gender, and several clinical indices, for mortality in elderly patients with femoral neck fracture and to evaluate some of them using survival analyses. METHODS: This was a retrospective study tracking 1 year for vital prognosis. Data were collected at post-operation from medical records of the cases. Survival analysis was conducted to investigate the risk factors for death, including albumin, urinary retention, activity of daily living (ADL), and cognitive disorder. RESULTS: We recruited 318 patients with a history of hip surgery carried out at Toyama Municipal Hospital, in which 39 patients died for 1 year after discharge. The results showed a significant decrease in survival rate in low albumin, positive urinary retention, and low ADL (P < 0.01, by log-rank test). The hazard ratios (95% confidence interval) of albumin, urinary retention, ADL, and cognitive disorder were 0.36 (0.19 - 0.69), 0.4 (0.2 - 0.8), 0.29 (0.15 - 0.58) and 0.65 (0.32 - 1.29), respectively. CONCLUSIONS: This study demonstrated that albumin, urinary retention and ADL were the important risk factors for mortality, and suggested that the postoperative management of albumin, urinary retention and ADL is important, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures.

Effects of pharmacist intervention on polypharmacy in patients with type 2 diabetes in Japan.

OBJECTIVE: Investigation of polypharmacy in patients with type 2 diabetes revealed that medications administered according to the patient's symptoms and complaints strongly contributed to polypharmacy. We explored the effects of clinical ward pharmacy service, which evaluated the need for symptomatic treatment, therefore minimizing polypharmacy by reducing inappropriate medications. RESULTS: The number of drugs (hospitalization vs. discharge: 9 [1-17] vs. 7 [1-16], P < 0.001) and rate of polypharmacy (hospitalization vs. discharge: 75.4% vs. 61.1%, P < 0.001) were significantly lower at discharge. Since hospital admission, the number of drugs increased (n = 6, 11%), remained unchanged (n = 15, 28%), decreased by 1 drug (n = 4, 8%), decreased by 2 drugs (n = 3, 6%), and decreased by more than 2 drugs (n = 25, 47%). Daily drug costs were significantly reduced (hospitalization vs. discharge: $8.3 vs. $6.1, P < 0.001).

Timing of Surgery for Pediatric Supracondylar Humerus Fractures and Early Postoperative Results.

Background: Pediatric supracondylar humerus fracture (PSHF) is one of the most common fractures of the elbow seen among boys aged between 5 and 7 years. The timing of surgical treatment for this type of fracture is still controversial. Thus, we aimed to investigate whether the timing of surgery for PSHFs affects the incidence of early postoperative complications and reduction of PSHFs. Methods: We retrospectively reviewed the medical records of PSHF patients who underwent surgery at our hospital between January 2007 and March 2019. We classified patients who underwent surgery within 12 h and more than 12 h after the fracture as the early and delayed groups, respectively. The outcome measures compared between the two groups were the incidence of postoperative early complications such as neurological deficits, including iatrogenic ulnar nerve injury, vascular compromise, compartment syndrome, K-wire migration, and unplanned returns to the operating room. We also examined surgical time, reduction procedure, and perioperative radiographic parameters. Results: There was no significant difference in the incidence of early complications between the early and delayed groups for either modified Gartland type II or type III fractures. There was also no significant difference in surgical time, reduction procedure, or perioperative radiographic parameters between the two groups. Conclusions: Delayed surgery was not associated with an increased rate of postoperative early complications in either type II or type III fractures. The timing of surgery does not affect the difficulty or quality of reduction.

Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan.

BACKGROUND: The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan. METHODS: This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient's possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications. RESULTS: Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50-<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period. CONCLUSIONS: We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50-<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.

Polypharmacy and oral antidiabetic treatment for type 2 diabetes characterised by drug class and patient characteristics: A Japanese database analysis.

Polypharmacy (PP) occurs in patients with type 2 diabetes (T2DM) owing to multimorbidity. We evaluated concomitant PP and medication adherence in T2DM 3 years after initiation of administration of a hypoglycaemic agent using a nationwide claim-based database in Japan. Factors associated with medication PP and imperfect adherence were identified using multivariable logistic regression. PP was defined as using ≥6 medications. Patients with proportion of days covered (PDC) of <80% were defined as having poor medication adherence. A total of 884 patients were analysed. Multivariate analysis revealed that age, total number of consultations and body mass index (BMI) are factors that influence PP. Factors associated with PDC < 80% were 2-3, 4-5 and ≥ 6 medications compared with 1 medication, male sex, <17 consultations and age 50-59 and ≥ 60 years compared with <40 years. In conclusion, older age, high total number of consultations and BMI ≥ 25 kg/m2 are risk factors for PP. PP influenced good medication adherence at the end of the observation period.

Hemi-resurfacing versus total resurfacing for osteonecrosis of the femoral head.

PURPOSE: To compare mid-term outcomes of hemi-resurfacing arthroplasty (HRA) and total resurfacing arthroplasty (TRA). METHODS: Seven men and 5 women (16 hips) aged 33 to 72 (mean, 50) years underwent HRA, whereas 7 men and 3 women (16 hips) aged 23 to 52 (mean, 40) years underwent metal-on-metal TRA; all were for osteonecrosis of the femoral head. In the HRA and TRA groups respectively, 10 and 8 hips were steroid-induced, whereas 6 and 8 hips were related to alcohol abuse. Surgery for 12 and 4 hips entailed the posterolateral approach, whereas 4 and 12 hips entailed the Hardinge approach. Usually, HRA was performed for early stages of the disease, and TRA for more advanced stages. 12 and 6 hips were classified as JOA stages 1 to 3A, whereas 4 and 10 hips as stages 3B to 4. All the hips were JOA types C1 or C2. RESULTS: In the HRA and TRA groups respectively, the mean follow-up period were 6.5 and 5.5 years. The mean total JOA hip scores were 57 and 54 preoperatively, 93 and 97 at one year, and 84 and 96 at the final follow-up (p<0.01). The higher score in the TRA patients was mainly attributed to improvement in the pain score. In the HRA group, 12 hips developed groin pain or groin discomfort while walking, though only 4 of them showed apparent joint-space narrowing. Five patients underwent revision surgeries (conversion to total hip arthroplasty) owing to a femoral neck fracture, acetabular protrusio, osteoarthritic change, and severe groin pain. Patients having TRA had no revision surgery and did not complain of groin pain. Implants in both groups were radiographically stable. CONCLUSION: TRA were superior to HRA in terms of pain relief and implant survival, even though the former procedure was used for more advanced cases.