Preoperative Predictors of Instrumental Activities of Daily Living Disability in Older Adults 6 Months After Knee Arthroplasty.

OBJECTIVE: To investigate preoperative predictors of instrumental activities of daily living (IADL) disability in older adults 6 months after knee arthroplasty (KA). DESIGN: Prospective cohort study. SETTING: General hospital with an orthopedic surgery department. PARTICIPANTS: Two hundred twenty (N=220) patients 65 years or older with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: IADL status was evaluated for 6 activities. Participants chose "able," "need help," or "unable" according to their capacity of executing these IADL. If they chose "need help" or "unable" for 1 or more items, they were defined as "disabled." Their usual gait speed (UGS), range of motion for the knee, isometric knee extension strength (IKES), pain status, depressive symptoms, pain catastrophizing, and self-efficacy were evaluated as predictors. Baseline and follow-up assessments were conducted 1 month before and 6 months after KA, respectively. Logistic regression analyses with IADL status as the dependent variable were performed at follow-up. All models were adjusted using age, sex, severity of the knee deformity, operation type (TKA or UKA), and preoperative IADL status as covariates. RESULTS: In total, 166 patients completed the follow-up assessment, and 83 (50.0%) reported IADL disability 6 months after KA. Preoperative UGS, IKES on the non-operated side, and self-efficacy were statistically significantly different between those with a disability at follow-up and those who did not and were therefore included in logistic regression models as independent variables. UGS (odds ratio, 3.22; 95% CI, 1.38-7.56; P=.007) was determined as a significant independent variable. CONCLUSIONS: The present study demonstrated the importance of evaluating preoperative gait speed to predict the presence of IADL disability in older adults 6 months after KA. Patients with poorer preoperative mobility should be provided careful postoperative care and treatment.

Poorly differentiated adenocarcinoma of an unknown primary with a thyroid tumour and an aggressive course: thyroid or lung carcinoma?

Cancers of unknown primary (CUPs) are challenging for physicians to diagnose and treat. Metastases to the thyroid gland are rare, representing less than 1% of all thyroid malignancies. Here, we report a case of a 69-year-old Asian man who had both thyroid gland and lymph node enlargement in the neck and shoulders but no nodules/tumours in the lung field. The patient died 51 days after his first visit to our office, although pembrolizumab was administered on day 34 based on programmed cell death-ligand 1 (PD-L1) expression. Immunohistochemistry (IHC) with paired box 8 (PAX8) may be useful to diagnostically distinguish poorly differentiated lung adenocarcinomas from napsin A-positive thyroid carcinomas.

[Myelofibrosis ameliorated after treatment for nontuberculous mycobacterial infection].

A 42-year-old female was admitted to our hospital because of continuous fever, anemia, and immature myeloid cells in peripheral blood. Bone marrow biopsy revealed severe myelofibrosis (MF). We performed computed tomography and identified several swollen mediastinal lymph nodes and nodules in the right upper lung. Lymph node biopsy showed an infection with Mycobacterium intracellulare (M. intracellulare), a nontuberculous mycobacterium (NTM). Antituberculosis drugs led to remission of the NTM infection. Bone marrow biopsy revealed marked improvement in MF and red blood cell infusion was not required after therapy. No prior cases of concomitant NTM with M. intracellulare and MF have been reported. This is thus the first reported case showing improvement of myelofibrosis after NTM treatment. This case report offers valuable insights into the pathology of MF.

Intracranial arachnoid cysts in a chimpanzee (Pan troglodytes).

An intracranial arachnoid cyst was detected in a 32-year-old, 44.6-kg, female chimpanzee at the Primate Research Institute, Kyoto University. Magnetic resonance imaging (MRI) and computed tomography (CT) were performed and the cognitive studies in which she participated were reviewed. MRI revealed that the cyst was present in the chimpanzee's right occipital convexity, and was located in close proximity to the posterior horn of the right lateral ventricle without ventriculomegaly. CT confirmed the presence of the cyst and no apparent signs indicating previous skull fractures were found. The thickness of the mandible was asymmetrical, whereas the temporomandibular joints and dentition were symmetrical. She showed no abnormalities in various cognitive studies since she was 3 years old, except a different behavioural pattern during a recent study, indicating a possible visual field defect. Detailed cognitive studies, long-term observation of her physical condition and follow-up MRI will be continued.

A case of naturally occurring visual field loss in a chimpanzee with an arachnoid cyst.

Deficits in the occipital cortex have varying consequences among mammalian species. Such variations are indicative of evolutionary transitions in the striate cortical contribution to visually guided behavior. However, little is known about the role of the striate cortex in visually guided behavior in chimpanzees due to ethical concerns about invasive experiments and methodological limitations such as the inability to monitor gaze movements. We had the opportunity to study the behavioral consequences of a deficit in the occipital cortex in a chimpanzee with a naturally occurring arachnoid cyst in her right occipital lobe. We assessed the chimpanzee's ability to detect a small light probe (0.5 visual degree, Michelson contrast > 0.9) presented at several locations in the visual field while monitoring gaze direction using an infra-red remote eye-tracker recently introduced to studies of great apes. The results showed the chimpanzee was unable to detect the probe in the lower left quadrant of the visual field, suggesting severe loss of contrast sensitivity in a part of hemivisual field that is retinotopically corresponded to the hemisphere of the cyst. A chimpanzee with a naturally occurring deficit in the right striate cortex and the availability of remote eye-tracking technology presented a unique opportunity to compare the role of the occipital lobe in visually guided behavior among various primate species.

Depressive symptoms after treatment in hepatocellular carcinoma survivors: prevalence, determinants, and impact on health-related quality of life.

OBJECTIVE: The purposes of this study were to investigate the prevalence and determinants of depressive symptoms among hepatocellular carcinoma (HCC) survivors and to evaluate the impact of depressive symptoms on health-related quality of life (HRQOL). METHODS: A cross-sectional study was conducted on 128 consecutive patients attending an outpatient clinic in Japan 1 year or more after curative treatment. To assess depressive symptoms and HRQOL, the participants were asked to complete the Center for Epidemiologic Studies Depressive Symptoms Scale, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and EORTC QLQ-HCC18, respectively. Multiple logistic regression models were used to identify factors associated with depressive symptoms. EORTC QLQ-C30 and EORTC QLQ-HCC18 scores were compared between participants with and without depressive symptoms. RESULTS: The prevalence of depressive symptoms among the HCC survivors was 28.3%. The multiple logistic regression analysis revealed that the determinants of depressive symptoms included poor Karnofsky performance status (odds ratio [OR] = 4.59, 95% CI = 1.03-20.55, p = 0.04), poor liver function (OR = 3.22, 95% CI = 1.11-10.0, p = 0.03), living alone (OR = 6.87, 95% CI = 2.53-18.63, p = 0.0002), and unemployment (OR = 5.18, 95% CI = 1.73-15.54, p = 0.003). Survivors with depressive symptoms had poorer HRQOL in almost all domains compared with survivors with no depressive symptoms. CONCLUSIONS: This study suggests that after treatment, many HCC survivors experience depressive symptoms that are strongly associated with poorer HRQOL.

Validation of the Japanese version of the EORTC hepatocellular carcinoma-specific quality of life questionnaire module (QLQ-HCC18).

BACKGROUND: This Study Examined The Measurement Properties Of The Japanese Version Of The European Organisation for Research and Treatment of Cancer (EORTC) Hepatocellular Carcinoma-Specific Quality of Life Questionnaire (QLQ-HCC18). METHODS: EORTC quality of life (QOL) translation guidelines were followed to create a Japanese version of the EORTC QLQ-HCC18. This was then administered to 192 patients with hepatocellular carcinoma along with the EORTC QLQ-C30 and FACT-Hep questionnaires. Tests for reliability and validity were conducted including comparison of scores between the EORTC and FACT questionnaire and detailed assessment of the new scales and items in clinically distinct groups of patients. RESULTS: Multi-trait scaling analysis confirmed three putative scales in the QLQ-HCC18, fatigue, fever and nutrition. Cronbach's alpha for these scales were between 0.68 and 0.78. The QLQ-HCC18 scales correlated with scales measuring similar items in the FACT-Hep and the questionnaire was stable over time with an intra-class correlation score of 0.70 for almost all scales. The questionnaire had the ability to distinguish between patients with different Karnofsky Performance Status, and Child-Pugh liver function class. CONCLUSIONS: The Japanese version of EORTC QLQ-HCC18 is a reliable supplementary measure to use with EORTC QLQ-C30 to measure QOL in Japanese patients with hepatocellular carcinoma.

Pericarditis associated with Epstein-Barr virus reactivation in a patient following allogeneic peripheral blood stem cell transplantation from an HLA genotypic 1-locus mismatched sibling donor.

A 31-year-old woman with acute myeloblastic leukemia (AML) underwent allogeneic peripheral blood stem cell transplant (PBSCT). On day +274 following transplantation, the patient had severe chest pain, high-grade fever, and general fatigue. Electrocardiographic examination revealed ST segment elevation, and echocardiographic examination revealed an obvious pericardial. The diagnosis of pericarditis was made. We could not exclude the possibility of a combination of chronic GVHD involving the liver, because biochemistry examination revealed altered liver dysfunction, but liver biopsy was not performed. The patient underwent empirical treatment for bacterial or viral infection, and was given prednisolone for chronic GVHD. Retrospective serologic examination revealed that EBV reactivation had occurred at this time. This is the first reported case of pericarditis associated with EBV reactivation after allogeneic-stem cell transplantation (allo-SCT).