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1.
J Orthop Sci ; 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39227231

RESUMO

BACKGROUND: A vibration roller is an effective tool for reducing muscle soreness and improving damaged muscle function. However, its efficacy in reducing hip pain and improving function after total hip arthroplasty is unclear. We investigated the effect of lower limb vibration using a vibration roller on postoperative hip pain and function after total hip arthroplasty in a randomized controlled clinical trial. METHODS: Thirty patients scheduled for total hip arthroplasty were randomly assigned to vibration and control groups. The patients in the vibration group performed lower limb vibration using a vibration roller. The patients in the control group performed sham therapy using a hot pack. Patients performed both interventions for 10 min daily on postoperative days 1-7, in addition to regular physical therapy. Primary outcome was hip pain intensity as measured using a visual analog scale. Secondary outcomes were pain-pressure threshold and serum creatine kinase and C-reactive protein levels. We also assessed physical functions, including the Harris Hip Score, range of motion of the hip joint, muscle strength, gait velocity, and timed up-and-go test. The effects of the interventions on outcome measurements in the groups were compared using a split-plot design variance analysis. RESULTS: After one week of the intervention and three weeks of follow-up, the vibration group showed statistically significant improvement in the exercise-induced hip pain, pain-pressure threshold of lateral thigh, and serum creatine kinase compared to the control group (p = 0.006, 0.003, and 0.012, respectively). No statistically significant differences were found between the groups regarding the physical functions. CONCLUSIONS: Lower limb vibration using a vibration roller after total hip arthroplasty was an effective intervention to reduce exercise-induced hip pain and improve serum creatine kinase, but there was no synergistic effect on the physical functions.

2.
J Orthop Sci ; 28(3): 577-582, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35063335

RESUMO

BACKGROUND: Patients who undergo total hip arthroplasty have an increased risk of falls during the first postoperative year. However, it is unclear whether patients after total hip arthroplasty will continue to be at high risk of falls more than 1 year postoperatively. To better understand whether the risk of falls changes after a 1-year period, we investigated the incidences and circumstances of falls in women patients for 5 years after total hip arthroplasty. METHODS: This longitudinal prospective cohort study analyzed 65 women with severe hip osteoarthritis who underwent total hip arthroplasty. The incidences and circumstances of falls before total hip arthroplasty and at 1, 2, and 5 years postoperatively were investigated. We assessed the Harris Hip Score and evaluated hip pain and ambulatory ability using a self-administered questionnaire. RESULTS: The incidences of at least one fall were 30.8%, 26.2%, 23.1%, and 30.8% before and 1, 2, and 5 years after surgery, respectively. Among the circumstances of falls from pre-surgery to 5 years post-surgery, there was a significant difference in the direction of falls; however, there were no significant differences in the location, time, cause, and type of injury. Most falls occurred indoors by tripping or loss of balance during the daytime. Among the participants who had falls almost half sustained injuries, and approximately 10% of falls resulted in fractures each year. Although self-reported hip pain, ambulation, and the Harris Hip Score significantly improved in women after total hip arthroplasty compared to pre-surgery, there was no significant difference in the incidences of falls from 1 to 5 years post-surgery. CONCLUSION: Women who underwent total hip arthroplasty continued to have an increased risk of falls and fall-induced injuries for 5 years postoperatively. Preventive measures against falling to reduce fall-induced injuries in the long term are required for women after total hip arthroplasty.


Assuntos
Acidentes por Quedas , Artroplastia de Quadril , Humanos , Feminino , Artroplastia de Quadril/efeitos adversos , Seguimentos , Incidência , Estudos Prospectivos , Fatores de Risco , Dor/etiologia
3.
NMR Biomed ; 35(9): e4752, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35483967

RESUMO

Here, we report on the development and performance of a robust 3-T single-voxel proton magnetic resonance spectroscopy (1 H MRS) experimental protocol and data analysis pipeline for quantifying brain metabolism during cardiopulmonary bypass (CPB) surgery in a neonatal porcine model, with the overall goal of elucidating primary mechanisms of brain injury associated with these procedures. The specific aims were to assess which metabolic processes can be reliably interrogated by 1 H MRS on a 3-T clinical scanner and to provide an initial assessment of brain metabolism during deep hypothermia cardiac arrest (DHCA) surgery and recovery. Fourteen neonatal pigs underwent CPB surgery while placed in a 3-T MRI scanner for 18, 28, and 37°C DHCA studies under hyperglycemic, euglycemic, and hypoglycemic conditions. Total imaging times, including baseline measurements, circulatory arrest (CA), and recovery averaged 3 h/animal, during which 30-40 single-voxel 1 H MRS spectra (sLASER pulse sequence, TR/TE = 2000/30 ms, 64 or 128 averages) were acquired from a 2.2-cc right midbrain voxel. 1 H MRS at 3 T was able to reliably quantify (1) anaerobic metabolism via depletion of brain glucose and the associated build-up of lactate during CA, (2) phosphocreatine (PCr) to creatine (Cr) conversion during CA and subsequent recovery upon reperfusion, (3) a robust increase in the glutamine-to-glutamate (Gln/Glu) ratio during the post-CA recovery period, and (4) a broadening of the water peak during CA. In vivo 1 H MRS at 3 T can reliably quantify subtle metabolic brain changes previously deemed challenging to interrogate, including brain glucose concentrations even under hypoglycemic conditions, ATP usage via the conversion of PCr to Cr, and differential changes in Glu and Gln. Observed metabolic changes during CPB surgery of a neonatal porcine model provide new insights into possible mechanisms for prevention of neuronal injury.


Assuntos
Ponte Cardiopulmonar , Creatina , Animais , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Ponte Cardiopulmonar/métodos , Creatina/metabolismo , Glucose/metabolismo , Ácido Glutâmico/metabolismo , Glutamina/metabolismo , Hipoglicemiantes/metabolismo , Fosfocreatina/metabolismo , Espectroscopia de Prótons por Ressonância Magnética , Suínos
4.
Hepatol Res ; 51(5): 538-547, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33749100

RESUMO

AIM: Studies regarding changes in antibodies to hepatitis E virus (HEV) after HEV infection in organ transplant patients are limited. This study aimed to clarify HEV infection trends in organ transplant patients who contracted HEV using data from a previous Japanese nationwide survey. METHODS: This study was undertaken from 2012 to 2019. Among 4518 liver, heart, and kidney transplant patients, anti-HEV immunoglobulin G (IgG) antibodies were positive in 164; data were collected from 106 of these patients, who consented to participate in the study. In total, 32 liver transplant patients, seven heart transplant patients, and 67 kidney transplant patients from 16 institutions in Japan were examined for IgG, IgM, and IgM antibodies to HEV and the presence of HEV RNA in the serum. The χ2 -test was used to determine the relationship between the early and late postinfection groups in patients with anti-HEV IgG positive-to-negative conversion rates. The Mann-Whitney U-test was used to compare clinical factors. RESULTS: Anti-HEV IgG positive-to-negative conversion occurred in 25 (23.6%) of 106 organ transplant patients. Of eight patients with hepatitis E who tested positive for HEV RNA, one (14.0%) had anti-HEV IgG positive-to-negative conversion. Twenty-four (24.5%) of 98 patients negative for HEV RNA had anti-HEV IgG positive-to-negative conversion. CONCLUSIONS: This study revealed, for the first time, the changes in HEV antibodies in organ transplant patients. Loss of anti-HEV IgG could often occur unexpectedly in organ transplant patients with previous HEV infection.

5.
Pediatr Cardiol ; 42(4): 821-831, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33515091

RESUMO

BACKGROUND: Surgical management has not been encouraged in patients with trisomy 18 (T18) and congenital heart diseases due to poor survival. This study aimed to investigate (1) the appropriateness of palliative surgeries followed by intracardiac repair (ICR) (i.e., two-stage ICR) for patients with a large ventricular septal defect (VSD) and T18, and (2) its impact on their long-term outcomes. METHODS: Medical charts of patients with VSD and T18 who underwent two-stage ICR at the Japanese Red Cross Medical Center between January 2005 and December 2019 were retrospectively reviewed. Demographic data, timing, and types of palliative surgeries, information related to ICR, peri- and postoperative clinical information, postoperative survival, and cause of death were collected. The long-term prognosis of patients treated with two-stage ICR was compared with that of patients treated with primary ICR and palliative surgery without ICR. RESULTS: Overall, 18 (2 male, 16 female) patients underwent two-stage ICR. Pulmonary artery banding was the initial palliative surgery in all patients after a median duration of 19.5 (range 6-194) days of life. The median age and the mean body weight at the time of ICR were 18.2 (7.6-50.7) months and 6.0 ± 1.0 kg, respectively. The mean pulmonary artery pressure and pulmonary vascular resistance index before ICR were 19.1 ± 7.3 mmHg and 3.4 ± 2.0 U m2, respectively. Overall, 17/18 (94%) patients were discharged after ICR. Fourteen (78%) patients were alive during data collection. None of the patients died of cardiac insufficiency, and the median duration of survival was 46.3 (14.3-186.4) months since birth. Most patients required cardiac medications rather than pulmonary vasodilators at the last follow-up. During the study period, three patients underwent primary ICR, and 46 underwent palliative surgery without ICR. Of those who underwent primary ICR, two died in the hospital on the first and 48th day following ICR, and the third died 179 days after the ICR. The Log-rank test revealed a significantly longer survival for the patients treated with two-stage ICR compared with those treated with palliative surgery without ICR (P = 0.003). CONCLUSION: Two-stage ICR improves the long-term survival of patients with VSDs and T18. This safe surgical strategy can also prevent pulmonary hypertension in such patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Síndrome da Trissomía do Cromossomo 18/cirurgia , Pré-Escolar , Feminino , Cardiopatias Congênitas/cirurgia , Comunicação Interventricular/mortalidade , Humanos , Hipertensão Pulmonar/prevenção & controle , Lactente , Recém-Nascido , Masculino , Cuidados Paliativos/métodos , Alta do Paciente , Período Pós-Operatório , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Síndrome da Trissomía do Cromossomo 18/mortalidade
6.
J Pharmacol Sci ; 141(1): 56-63, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31611176

RESUMO

Concomitant heart failure is associated with poor clinical outcome in dialysis patients. The arteriovenous shunt, created as vascular access for hemodialysis, increases ventricular volume-overload, predisposing patients to developing cardiac dysfunction. The integral function of mitochondrial respiration is critically important for the heart to cope with hemodynamic overload. The involvement, however, of mitochondrial activity or reactive oxygen species (ROS) in the pathogenesis of ventricular-overload-induced heart failure has not been fully elucidated. We herein report that disorganization of mitochondrial respiration increases mitochondrial ROS production in the volume-overloaded heart, leading to ventricular dysfunction. We adopted the murine arteriovenous fistula (AVF) model, which replicates the cardinal features of volume-overload-induced ventricular dysfunction. Enzymatic assays of cardiac mitochondria revealed that the activities of citrate synthase and NADH-quinone reductase (complex Ⅰ) were preserved in the AVF heart. In contrast, the activity of NADH oxidase supercomplex was significantly compromised, resulting in elevated ROS production. Importantly, the antioxidant N-acetylcysteine prevented the development of ventricular dilatation and cardiac dysfunction, suggesting a pathogenic role for ROS in dialysis-related cardiomyopathy. A cardioprotective effect was also observed in metformin-treated mice, illuminating its potential use in the management of heart failure complicating diabetic patients on dialysis.


Assuntos
Acetilcisteína/uso terapêutico , Antioxidantes/uso terapêutico , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/etiologia , Mitocôndrias/metabolismo , Terapia de Alvo Molecular , Miócitos Cardíacos/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Acetilcisteína/farmacologia , Animais , Antioxidantes/farmacologia , Cardiomiopatias/metabolismo , Modelos Animais de Doenças , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Masculino , Camundongos Endogâmicos C57BL
7.
Int Heart J ; 57(6): 769-772, 2016 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-27829640

RESUMO

Although some patients with fulminant myocarditis can be rescued owing to the improvements in mechanical circulatory support therapy, there are few reports providing evidence of cardiac rehabilitation during mechanical circulatory supports, particularly among pediatric patients. We treated two pediatric patients who underwent aggressive cardiac rehabilitation during mechanical support. Five days after the initiation of extracorporeal membrane oxygenation therapy aggressive cardiac rehabilitation was started in a 10-year-old girl with fulminant myocarditis. After explantation of the device, she was discharged on postoperative day 23. A 6-year-old girl with fulminant myocarditis started receiving cardiac rehabilitation two days after the initiation of an extracorporeal left ventricular assist device, despite having hemiplegia due to a recent broad stroke. She achieved an exercise capacity of supported walking for 280 meters after 127 days of cardiac rehabilitation and then went abroad to undergo heart transplantation when she was in the best physical condition possible. Early initiation of cardiac rehabilitation may be safe and effective for successful pediatric mechanical circulatory support therapy; this acts as a bridge to explantation or heart transplantation.


Assuntos
Reabilitação Cardíaca/métodos , Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Miocardite/terapia , Fatores Etários , Criança , Feminino , Humanos
8.
J Vasc Surg ; 61(1): 231-3, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24103408

RESUMO

Helicobacter cinaedi infection is rarely encountered in nonimmunocompromised patients. We report the case of an 85-year-old man who presented with axillobifemoral bypass graft infection caused by Helicobacter cinaedi. The patient was not immunocompromised. We successfully treated him by iliac stenting of the native iliac artery, with near-total removal of the infected graft. At present, 48 months later, the patient is doing well at home, with no evidence of infection. To the best of our knowledge, this is the first report of infection of a prosthetic graft caused by Helicobacter cinaedi.


Assuntos
Artéria Axilar/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Artéria Femoral/cirurgia , Infecções por Helicobacter/microbiologia , Helicobacter/patogenicidade , Infecções Relacionadas à Prótese/microbiologia , Idoso de 80 Anos ou mais , Angiografia Digital , Angioplastia com Balão/instrumentação , Antibacterianos/uso terapêutico , Artéria Axilar/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Desbridamento , Remoção de Dispositivo , Artéria Femoral/diagnóstico por imagem , Helicobacter/classificação , Helicobacter/isolamento & purificação , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/terapia , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Reoperação , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Kyobu Geka ; 68(5): 375-8, 2015 May.
Artigo em Japonês | MEDLINE | ID: mdl-25963787

RESUMO

An 81-year-old woman presented with dyspnea and chest pain. A plain chest X-ray revealed widening of the mediastinum and a contrast-enhanced chest computed tomography showed dilatation of the ascending aorta without any specific findings of aortic dissection. Transesophageal echocardiography revealed severe aortic regurgitation (AR). We planned an aortic valve replacement on the 34th day after admission because of the severe AR. During the operation, we found an entry in the intima of the ascending aorta 5 mm above the aortic valve and she was diagnosed with DeBakey type II aortic dissection. Therefore, we decided to perform Bentall's operation and the operation was successful.


Assuntos
Dissecção Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos , Erros de Diagnóstico , Feminino , Humanos , Tomografia Computadorizada por Raios X
10.
Ann Vasc Surg ; 28(8): 1939-45, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25048807

RESUMO

BACKGROUND: Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare and potentially fatal disease. Several therapeutic options are available, including conservative therapy, endovascular repair, and open surgery. Herein, we report our experiences in the treatment of SIDSMA. METHODS: Between February 2009 and June 2013, 17 patients were diagnosed as having SIDSMA. We retrospectively reviewed and analyzed their clinical characteristics, medical history, risk factors, symptoms, diagnostic imaging modality, treatment, and outcome. The lesions were categorized according to the modified Sakamoto's classification. If no evidence of bowel necrosis or arterial rupture was present in the patients with symptomatic SIDSMA, we first performed conservative therapy, even if the patients had abdominal pain. RESULTS: The subjects included 15 men and 2 women, with a median age of 62.8 years. Eight patients were symptomatic and 9 were asymptomatic. Conservative therapy included the use of antithrombotic agents in 3 patients but not in 5 patients. During the follow-up period (mean, 21.1 months), all the patients were discharged without any significant complications, and none of the patients showed the progression of the dissection on follow-up computed tomography angiography examinations. CONCLUSIONS: Conservative therapy without antithrombotic agents should be the primary treatment for SIDSMA. Endovascular repair for SIDSMA is associated with several risks, thus the procedure might occasionally be useful and necessary.


Assuntos
Dissecção Aórtica/terapia , Artéria Mesentérica Superior , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/classificação , Angiografia , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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