Association of bone health by calcaneal quantitative ultrasound with quadriceps strength and function one year after unilateral total knee arthroplasty.

Introduction: Although total knee arthroplasty (TKA) effectively improves knee pain and functional decline due to knee osteoarthritis, hip fractures are more likely to occur in the first year after surgery. Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) decreases in the first year after TKA, but it is not clear whether BMD measured by quantitative ultrasound (QUS) also shows a decrease. This study aimed to evaluate the change in QUS parameters before and 1 year after TKA and to investigate the association of QUS parameters with quadriceps strength and function 1 year after TKA. Methods: This prospective cohort study included 30 patients scheduled for their unilateral TKA. We assessed BMD using QUS before and 1 year after surgery. Quadriceps strength was assessed using a hand-held dynamometer, and function was assessed using a self-reported questionnaire. A linear mixed model estimated the mean difference in QUS parameters before and 1 year after TKA. A general linear model was also used to examine the association of QUS parameters with quadriceps strength and self-reported function at 1 year after surgery. Results: We found no significant decrease in the QUS parameters on either the surgical or non-surgical side at 1 year postoperatively compared to preoperatively. The QUS parameters were not associated with quadriceps strength or self-reported function on either the surgical or non-surgical side at 1 year postoperatively. Conclusions: QUS alone may not be sufficient to detect changes in BMD from before surgery to 1 year after TKA. Clinicians should evaluate BMD preoperatively to identify patients at high risk for hip fractures and develop a program to prevent postoperative hip fractures. Level of evidence: Level 3, Cohort study.

Assessing the Performance of GPT-3.5 and GPT-4 on the 2023 Japanese Nursing Examination.

Purpose The purpose of this study was to evaluate the changes in capabilities between the Generative Pre-trained Transformer (GPT)-3.5 and GPT-4 versions of the large-scale language model ChatGPT within a Japanese medical context. Methods The study involved ChatGPT versions 3.5 and 4 responding to questions from the 112th Japanese National Nursing Examination (JNNE). The study comprised three analyses: correct answer rate and score rate calculations, comparisons between GPT-3.5 and GPT-4, and comparisons of correct answer rates for conversation questions. Results ChatGPT versions 3.5 and 4 responded to 237 out of 238 Japanese questions from the 112th JNNE. While GPT-3.5 achieved an overall accuracy rate of 59.9%, failing to meet the passing standards in compulsory and general/scenario-based questions, scoring 58.0% and 58.3%, respectively, GPT-4 had an accuracy rate of 79.7%, satisfying the passing standards by scoring 90.0% and 77.7%, respectively. For each problem type, GPT-4 showed a higher accuracy rate than GPT-3.5. Specifically, the accuracy rates for compulsory questions improved from 58.0% with GPT-3.5 to 90.0% with GPT-4. For general questions, the rates went from 64.6% with GPT-3.5 to 75.6% with GPT-4. In scenario-based questions, the accuracy rates improved substantially from 51.7% with GPT-3.5 to 80.0% with GPT-4. For conversation questions, GPT-3.5 had an accuracy rate of 73.3% and GPT-4 had an accuracy rate of 93.3%. Conclusions The GPT-4 version of ChatGPT displayed performance sufficient to pass the JNNE, significantly improving from GPT-3.5. This suggests specialized medical training could make such models beneficial in Japanese clinical settings, aiding decision-making. However, user awareness and training are crucial, given potential inaccuracies in ChatGPT's responses. Hence, responsible usage with an understanding of its capabilities and limitations is vital to best support healthcare professionals and patients.

[Classification of community-dwelling older people based on their physical, mental, cognitive, and oral functions and comorbidities and its relationship with the fall history].

AIM: To prevent falls among older adults, healthcare professionals need to assess these individuals from multiple perspectives. This study aimed to group community-dwelling older Japanese people based on their physical, mental, cognitive, and oral functions and comorbidities, and compare the history of falling in these groups. METHODS: Data were obtained from a cross-sectional survey conducted in 2015 among older residents of a ward of Tokyo. For the survey, a questionnaire was distributed to all residents aged ≥65 years without a certificate of long-term care (n = 132,005). Questions were posed concerning respondents' physical, mental, cognitive, and oral functions; comorbidities; and experience with falling in the past year. Cluster and logistic regression analyses were performed. RESULTS: A total of 70,746 participants (53.4%) were included in the analysis. The mean age was 73.6 years old, and 44.9% were male. Four groups were identified in the cluster analysis: the "good general condition group" (n = 37,797, 52.4%), "poor mental function group" (n = 10,736, 14.7%), "moderate physical function group" (n = 13,461, 19.0%), and "poor general condition group" (n = 9,122, 12.9%). A logistic regression analysis with adjusting for socio-demographic characteristics, health behaviors, and fear of falling showed that the odds ratios for the experience of falling within the past year were 1.44 (95% confidence interval: 1.34-1.53), 1.54 (1.44-1.65), and 2.52 (2.34-2.71) in the poor mental function, moderate physical function, and poor general condition groups, respectively, with the good general condition group as the reference. CONCLUSIONS: We classified community-dwelling older adults into four groups based on multiple functions and found possible variations in the risk of falling by group. These findings suggest that such classification may be useful for the prevention of falls.

Differences in gait kinetics and kinematics between patients with rotating hinge knee and cruciate-retaining prostheses: a cross-sectional study.

[Purpose] Rotating hinge knee prostheses are often used in primary total knee arthroplasty. However, the biomechanics resulting from this treatment remain unexplored. This cross-sectional study compared patient data on gait kinetics and kinematics to assess the efficacy of primary total knee arthroplasty using a rotating hinge knee or other prostheses. [Participants and Methods] Thirty-three participants were assigned to the following groups: rotating hinge knee (n=7); cruciate-retaining prosthesis (n=7); untreated osteoarthritis (n=10); and young adults as a reference group (n=9). Participant data on biomechanical and spatiotemporal parameters were analyzed. [Results] The postoperative course of the rotating hinge knee group was not significantly longer than that of the cruciate-retaining prosthesis group. The knee varus angle and adduction moment of the rotating hinge knee group were significantly smaller than those of the untreated osteoarthritis group. Gait kinetics and kinematics were not different between the rotating hinge knee and cruciate-retaining prosthesis groups. [Conclusion] Participants who had undergone primary total knee arthroplasty with a rotating hinge knee prosthesis had worse preoperative conditions and demonstrated a similar postoperative gait as those who had undergone total knee arthroplasty with other prostheses. Our findings may be used to tailor rehabilitation programs for participants who have undergone total knee arthroplasty with a rotating hinge knee implant.

Quantitative Ultrasound of the Heel in Women With Knee Osteoarthritis.

The prevalence of multiple falls is higher in older women, and knee pain is associated with multiple falls in women; thus, it is important to detect individuals at risk of fractures among women with knee osteoarthritis. We aimed to clarify the association between knee osteoarthritis and the quantitative ultrasound (QUS) parameter, and investigate the clinical relevance of the QUS parameter with osteoarthritis-related characteristics in women with knee osteoarthritis. This was a cross-sectional study. We recruited 101 women with knee osteoarthritis at a local orthopedic hospital and 102 healthy individuals from the community. Heel QUS measurements were performed using the QUS device, measuring the stiffness index. We also assessed knee pain, quadriceps strength, and physical activity in women with knee osteoarthritis. We fitted a multiple regression model to estimate the association between knee osteoarthritis and the stiffness index. We also fitted 3 multiple regression models to investigate the clinical relevance of the QUS parameter with osteoarthritis-related characteristics in women with knee osteoarthritis. Compared with the control group, individuals with grade 2 osteoarthritis did not demonstrate a significant difference in stiffness index (p = 0.68); however, those with grade 3 osteoarthritis (p < 0.001) and 4 (p < 0.001) showed a lower stiffness index than that of the control group. Additionally, although the QUS parameter did not show an association with knee pain score (p = 0.70) or quadriceps strength (p = 0.11), we found a significant association between the QUS parameter and physical activity (p = 0.003). Our results demonstrate that women with moderate or severe knee osteoarthritis showed lower QUS parameters compared to healthy women, and the QUS parameter was associated with physical activity in women with knee osteoarthritis.

Effectiveness of early high-intensity balance training for early home life independence after total knee arthroplasty: a pseudo-randomized controlled trial.

OBJECTIVE: In Japan, the number of elderly individuals living alone is increasing, leading to an increase in hospital medical expenses attributed to total knee arthroplasty (TKA). Improvement in balance and functional performance is a priority in the early postoperative stages after TKA. However, there are no reports on the effectiveness of balance training (BT) for inpatients in the early postoperative period. Thus, we aimed to evaluate the effectiveness of early high-intensity BT for early home-life independence after TKA. METHOD: This pseudo-randomized controlled trial included 49 inpatients who underwent TKA and had osteoarthritis. Inpatients were categorized into the BT or typical training (TT) group. The BT program began on post-TKA day 4, with 12-14 sessions between day 7 and 10 (i.e., 1-2 sessions per day). The effect of the intervention was assessed using balance ability as the main outcome. Sub-outcomes included evaluation of motion function. The differences in each variable before and after intervention were compared, including covariance analysis adjusted for age and sex. RESULTS: The mean (standard deviation) balance ability indexes in the left and right directions were BT, pre 4.5 (0.8) and post 4.4 (0.8); TT, pre 4.8 (0.9) and post 4.4 (0.8), and those in the forward and backward directions were BT, pre 4.7 (1.7) and post 5.1 (2.1); TT, pre 6.3 (2.6) and post 5.9 (2.0). No significant differences were found between the preoperative and postintervention scores in the two groups for any measured outcome. CONCLUSION: BT did not appear to improve balance ability or functional performance.

Real-world monitoring of direct oral anticoagulants in clinic and hospitalization settings.

BACKGROUND: The monitoring of the effects of direct oral anticoagulants may be beneficial during emergencies and adverse events. We aimed to explore direct oral anticoagulant monitoring in "real-world" settings, in which monitoring methods are limited and loading time can be estimated based on only patient reports. METHODS: In 164 patients, plasma anti-Xa activity was assessed using a STA®-Liquid Anti-Xa reagent (Diagnostica Stago, Asnieres, France), and prothrombin time was measured using HemosIL® RecombiPlasTin 2G (Instrumentation Laboratory, Bedford, MA, USA). The loading time was calculated according to the previous dosing time reported by the patient. In the clinic setting, rivaroxaban and apixaban were administered to 103 patients with atrial fibrillation and a blood sample was tested once during a clinic visit. In the hospitalization setting, edoxaban was administered to 61 patients undergoing arthroplasty for prophylaxis of a venous thrombosis and blood samples were tested 3 and 18 h after the last intake. RESULTS: Plasma Xa activity in the clinical setting ranged widely (rivaroxaban: 1.1-424.4 ng/mL, apixaban: 15.4-469.2 ng/mL) during the 11.7 ± 7.0 h following the previous dose. The values varied over a wide range (up to a factor of 2) at the same loading time, especially around the peak period. The plasma anti-Xa activity of rivaroxaban and apixaban showed linear correlations with prothrombin time (R2 = 0.828 and 0.717, respectively). Edoxaban administration prolonged the prothrombin time by only 1.6 ± 1.1 s from the trough to the peak, to a degree that was negatively correlated with age, but not with plasma creatinine level, creatinine clearance, or body mass index. CONCLUSION: In real-world settings, plasma anti-Xa monitoring should be interpreted considering the wide variations in data, reflecting the variability in patient-reported loading time and interpatient variability.