Risk factors that hinder locomotive syndrome improvement following surgery for musculoskeletal diseases in older patients: A multicentre prospective study.

OBJECTIVES: This study aimed to evaluate preoperative and post-operative locomotive syndrome (LS) in older adults undergoing surgical treatment for musculoskeletal diseases of the lumbar spine and lower extremities and identify risk factors that impede LS improvement after surgery. METHODS: The baseline evaluation included 471 patients 65 years or older [276 in the pre-old-age (65-74 years) group; 195 in the old-age (75 years or older) group] and examined the preoperative and post-operative LS data. The second evaluation performed to identify risk factors, including anthropometric measurements, comorbidity, and frailty, that hinder LS improvement after surgery included 378 patients with preoperative LS Stage 3. RESULTS: Preoperatively, 80% of the patients had LS Stage 3; this rate decreased to 40% post-operatively. Half of the patients exhibited post-operative LS improvement. The LS improvement rate was higher in the pre-old-age group than in the old-age group. According to the multiple logistic regression analysis, old age, high body mass index, weak hand grip strength, and high 5-factor modified frailty index score were significant risk factors that hinder LS improvement after surgery. CONCLUSIONS: Ageing, obesity, weak muscle strength, and frailty can hinder LS improvement in older patients who undergo surgery.

Evaluation of locomotive syndrome in patients receiving surgical treatment for degenerative musculoskeletal diseases: A multicentre prospective study using the new criteria.

OBJECTIVES: This study aimed to evaluate the condition of patients with locomotive syndrome (LS) and their improvement after undergoing surgery for degenerative musculoskeletal diseases using the new criteria, including stage 3. METHODS: In total, 435 patients aged ≥40 years (167 middle-aged and 268 older) were divided into four groups based on the disease location: the lumbar (n = 118), hip (n = 191), knee (n = 80), and foot and ankle (n = 46) groups. Patients were evaluated by pre- and 1 year postoperative LS risk tests, including the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. RESULTS: The pre- and postoperative prevalence of LS stage 3 were 78% and 29%, respectively. The postoperative LS stage improved in 62% of patients (77% and 53% in the middle-aged and older groups, respectively). Overall, the knee group showed the worst results, and the foot and ankle groups showed the best pre- and postoperative results. The pre- and postoperative prevalence of LS stage 3 according to the 25-Question Geriatric Locomotive Function Scale were comparable to those based on the total assessment. CONCLUSIONS: The new LS stage criteria are appropriate, and the 25-Question Geriatric Locomotive Function Scale is a good option for evaluating patients requiring surgery.

The efficacy of surgical treatment on locomotive syndrome and physical function in patients with lumbar spinal canal stenosis.

BACKGROUND: Locomotive syndrome is a condition of reduced mobility due to problems with locomotive organs. Although lumbar spinal canal stenosis is one of the major diseases constituting locomotive syndrome, only few studies have focused on the association between the two pathologies. We aimed to investigate the effect of surgery on lumbar spinal canal stenosis with respect to locomotive syndrome using various physical function tests, including locomotive syndrome risk tests, before and after surgery. METHODS: Clinical data of 101 consecutive patients (male = 46; female = 55; mean age, 69.3 years) who underwent surgery for lumbar spinal canal stenosis at our institute were prospectively collected. Results of physical function tests, including stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale, and the sagittal vertical axis were evaluated before and 1 year after surgery. The association between several parameters and improvement of risk level in locomotive syndrome was evaluated. RESULTS: In the total assessment, 93.1% of cases were in stage 2 and 6.9% in stage 1 preoperatively, while 72.4% were in stage 2, 22.4% in stage 1, and 5.2% in stage 0 at 1 year postoperatively. Postoperative improvement in the total assessment was observed in 28.7% of cases. Several physical function tests and sagittal vertical axis showed significant improvement after surgery. On multiple logistic regression analysis, age >75 years (odds ratio = 10.9, confidence interval = 1.09-109) and postoperative sagittal vertical axis >40 mm (odds ratio = 17.8, confidence interval = 1.78-177) were significant risk factors associated with non-improvement in risk level of locomotive syndrome. CONCLUSIONS: Surgical treatment for lumbar spinal canal stenosis improved physical function, including locomotive syndrome. Risk factors associated with non-improvement of locomotive syndrome were later-stage elderly and postoperative sagittal balance impairment.

Perfluorodioxolane Polymers for Gas Separation Membrane Applications.

Since the discovery of polytetrafluoroethylene (PTFE) in 1938, fluorinated polymers have drawn attention in the chemical and pharmaceutical field, as well as in optical and microelectronics applications. The reasons for this attention are their high thermal and oxidative stability, excellent chemical resistance, superior electrical insulating ability, and optical transmission properties. Despite their unprecedented combination of desirable attributes, PTFE and copolymers of tetrafluoroethylene (TFE) with hexafluoropropylene and perfluoropropylvinylether are crystalline and exhibit poor solubility in solvents, which makes their processability very challenging. Since the 1980s, several classes of solvent-soluble amorphous perfluorinated polymers showing even better optical and gas transport properties were developed and commercialized. Amorphous perfluoropolymers exhibit, however, moderate selectivity in gas and liquid separations. Recently, we have synthesized various new perfluorodioxolane polymers which are amorphous, soluble, chemically and thermally stable, while exhibiting much enhanced selectivity. In this article, we review state-of-the-art and recent progress in these perfluorodioxolane polymers for gas separation membrane applications.

Improvement of locomotive syndrome with surgical treatment in patients with degenerative diseases in the lumbar spine and lower extremities: a prospective cohort study.

BACKGROUND: The epidemiology, risk factors, and prevention of locomotive syndrome (LS) have been reported. However, the number of clinical studies about the efficacy of LS treatment, including surgery, has been limited. This study aimed to evaluate LS and its improvement in patients undergoing surgeries for degenerative disease of the lumbar spine and lower extremities, and to discuss the effects of surgery on LS and the issues of LS assessment in these patients. METHODS: We enrolled 257 patients aged ≥60 years that underwent surgery for degenerative diseases of the lumbar spine and lower extremities and agreed to participate in the preoperative and 6- and 12-month postoperative LS examinations. According to the disease location, patients were divided into the lumbar (n = 81), hip (n = 106), knee (n = 43), and foot and ankle (n = 27) groups. Patients underwent LS risk tests, including the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale (GLFS-25) assessment. RESULTS: The preoperative prevalence of LS stage 2 was 95%. Only the hip group showed significant improvements in the stand-up test. The knee group showed the worst results in the stand-up and two-step tests at all time points. All four groups had significant improvements in GLFS-25 scores. Approximately 40% of all patients had improvement in their LS stage postoperatively. However, > 90% of the patients in the knee group had LS stage 2 postoperatively. CONCLUSION: Nearly all elderly patients requiring surgeries for degenerative diseases of the lumbar spine and lower extremities had advanced conditions (LS stage 2). Surgeries could be beneficial in alleviating LS. The LS stage 3 criteria should be established, and the use of the GLFS-25 assessment can be appropriate for advanced LS patients with severe musculoskeletal diseases requiring surgeries.

A nitrogen-containing bisphosphonate inhibits osteoblast attachment and impairs bone healing in bone-compatible scaffold.

Compromised osteoblast attachment on hydroxyapatite could be involved in the development of bone healing failure. We developed a bone-compatible scaffold that mimics bone structure with sub-micron hydroxyapatite (HA) surfaces, so that we could evaluate the effects of nitrogen-containing bisphosphonate (N-BP) on osteoblast behavior and bone healing. Human osteoblasts were seeded onto the bone-compatible scaffold with or without N-BP, and cell attachment and spreading behavior were evaluated 4 and 24 h after seeding. Then, mineralization was evaluated at 7 and 14 days. The osteoconductive activity of the scaffold was evaluated by implantation for 3 and 6 weeks into a rat cranial bone defect. The numbers of osteoblasts and their diameters were significantly less in N-BP-binding scaffolds than in untreated scaffolds at 4 and 24 h. Mineralization were also significantly less in the N-BP-binding scaffolds than in controls at 7 and 14 days. In vivo study revealed bone formation in N-BP-binding scaffolds was significantly less than in untreated scaffolds at 3 and 6 weeks. These results suggest that N-BP-binding to HA inhibited osteoblast attachment and spreading, thereby compromising bone healing process in the injured bone defect site.

Highly Permeable Perfluorinated Sulfonic Acid Ionomers for Improved Electrochemical Devices: Insights into Structure-Property Relationships.

Rapid improvements in polymer-electrolyte fuel-cell (PEFC) performance have been driven by the development of commercially available ion-conducting polymers (ionomers) that are employed as membranes and catalyst binders in membrane-electrode assemblies. Commercially available ionomers are based on a perfluorinated chemistry comprised of a polytetrafluoroethylene (PTFE) matrix that imparts low gas permeability and high mechanical strength but introduces significant mass-transport losses in the electrodes. These transport losses currently limit PEFC performance, especially for low Pt loadings. In this study, we present a novel ionomer incorporating a glassy amorphous matrix based on a perfluoro(2-methylene-4-methyl-1,3-dioxolane) (PFMMD) backbone. The novel backbone chemistry induces structural changes in the ionomer, restricting ionomer domain swelling under hydration while disrupting matrix crystallinity. These structural changes slightly reduce proton conductivity while significantly improving gas permeability. The performance implications of this trade-off are assessed, which reveal the potential for substantial performance improvement by incorporation of highly permeable ionomers as the functional catalyst binder. These results underscore the significance of tailoring material chemistry to specific device requirements, where ionomer chemistry should be rationally designed to match the local transport requirements of the device architecture.

Clinical outcomes of retrograde intra-arterial chemotherapy concurrent with radiotherapy for elderly oral squamous cell carcinoma patients aged over 80 years old.

BACKGROUND: The aim of this retrospective observational study was to evaluate toxicities, overall survival, and locoregional control in elderly oral squamous cell carcinoma patients who had undergone retrograde intra-arterial chemotherapy combined with radiotherapy. METHODS: Thirty-one elderly patients over 80 years old with oral squamous cell carcinoma were enrolled in present study. The treatment schedule consisted of intra- arterial chemotherapy (docetaxel, total 60 mg/m2; cisplatin, total 150 mg/m2) and daily concurrent radiotherapy (total, 60 Gy) for 6 weeks. RESULTS: The median patient age was 82.5 years old (range, 80-88 years). Of the 31 patients, six (19%) had stage II, 6 (19%) had stage III, 17 (55%) had stage IVA, and 2 (6%) had stage IVB. The median follow-up period for all patients was 37 months (range, 7-86 months). The 3-year overall survival and locoregional control rates were 78% and 81%, respectively. The major acute grade 3 adverse events were oral mucositis in 22 (71%) patients, neutropenia in 16 (52%), and dermatitis in 11 (35%). With respect to late toxicities, 1 patient (3%) developed grade 3 osteoradionecrosis of the jaw. No grade 4 or higher toxicities were observed during the treatment and follow-up periods. CONCLUSIONS: Retrograde intra-arterial chemotherapy combined with radiotherapy was effective in improving overall survival and locoregional control even for elderly patients.

The effect of kyphotic deformity because of vertebral fracture: a finite element analysis of a 10° and 20° wedge-shaped vertebral fracture model.

BACKGROUND CONTEXT: Kyphotic deformity associated with vertebral fracture is believed to be a significant risk factor for additional vertebral fractures. However, previously published research is limited. PURPOSE: The purpose of this study was to estimate the biomechanical stresses that kyphotic deformity, with an initial vertebral fracture, place on adjacent vertebrae using three-dimensional finite element (FE) of the spine, head, and ribs. STUDY DESIGN: This study is based on the basic science. METHODS: Total Human Model for Safety, a three-dimensional FE model of the human body, was used and adjusted to represent an elderly osteoporotic woman. The 12th thoracic vertebra (T12), which is a frequent site of osteoporotic vertebral fractures, was transformed to a wedge shape at 0°, 10°, and 20° to create a normal model, a 10° kyphosis model, and a 20° kyphosis model. Additionally, compensated postures were created for the 10° and 20° kyphosis models. Thus, five models were created: (A) a normal model, (B) a 10° kyphosis model, (C) a 20° kyphosis model, (D) a 10° kyphosis model with compensated posture, and (E) a 20° kyphosis model with compensated posture. Compressive principal stresses (CPSs) on T1-L5 in each model were calculated. RESULTS: The highest CPS value was 7.78 MPa placed on the anterior part of the T10 vertebra in the 20° kyphosis model. In the 20° kyphosis model, the higher CPS values showed bimodal peaks at T6 and T7 in the midthoracic spine and at T10 and T11 in the two superior adjacent vertebrae. The maximum CPS values in the A, B, C, D, and E models at T10 were 3.12, 6.74, 7.78, 6.61, and 5.78 MPa. At T11, they were 1.70, 4.41, 6.45, 4.07, and 4.79 MPa. CONCLUSIONS: The existence of an initial vertebral fracture at T12 caused an increase in stress on adjacent vertebrae. Higher CPS values showed bimodal peaks in midthoracic vertebrae and in two superior adjacent vertebrae when T12 was transformed to a wedge shape in the 20° kyphosis model.

Database for exchangeable gene trap clones: pathway and gene ontology analysis of exchangeable gene trap clone mouse lines.

Gene trapping in embryonic stem (ES) cells is a proven method for large-scale random insertional mutagenesis in the mouse genome. We have established an exchangeable gene trap system, in which a reporter gene can be exchanged for any other DNA of interest through Cre/mutant lox-mediated recombination. We isolated trap clones, analyzed trapped genes, and constructed the database for Exchangeable Gene Trap Clones (EGTC) [http://egtc.jp]. The number of registered ES cell lines was 1162 on 31 August 2013. We also established 454 mouse lines from trap ES clones and deposited them in the mouse embryo bank at the Center for Animal Resources and Development, Kumamoto University, Japan. The EGTC database is the most extensive academic resource for gene-trap mouse lines. Because we used a promoter-trap strategy, all trapped genes were expressed in ES cells. To understand the general characteristics of the trapped genes in the EGTC library, we used Kyoto Encyclopedia of Genes and Genomes (KEGG) for pathway analysis and found that the EGTC ES clones covered a broad range of pathways. We also used Gene Ontology (GO) classification data provided by Mouse Genome Informatics (MGI) to compare the functional distribution of genes in each GO term between trapped genes in the EGTC mouse lines and total genes annotated in MGI. We found the functional distributions for the trapped genes in the EGTC mouse lines and for the RefSeq genes for the whole mouse genome were similar, indicating that the EGTC mouse lines had trapped a wide range of mouse genes.

Epidural inflammatory pseudotumor in the thoracic spine in a patient with polymyalgia rheumatica.

BACKGROUND CONTEXT: Only six previous cases of epidural inflammatory psedotumor in the spine have been reported. None of them were seen in the course of polymyalgia rheumatica (PMR). PURPOSE: To describe a rare case of epidural inflammatory pseudotumor in the thoracic spine in a patient with PMR. STUDY DESIGN: Case report. METHODS: A 63-year-old man had a 6-year history of PMR treated with prednisone and cyclosporine. He presented with gait disturbance. Magnetic resonance imaging on the 12th day after the onset of the symptoms showed spinal cord compression caused by a posterior epidural mass at the T5-T6 level. RESULTS: The patient underwent a T5-T6 laminectomy and a total excision of the mass, which involved the ligament flavum and epidural adipose tissue and firmly attached to the dura mater. Histopathologic examination revealed severe lymphoplasmacytic infiltration with fibrosis in the entire specimen and no evidence of hematomas or tumorous lesions. After surgery, the patient's neurologic symptoms disappeared immediately. Two years after surgery, the patient is neurologically normal and has not had a recurrence. CONCLUSIONS: This report identifies a rare case of epidural inflammatory pseudotumor in the thoracic spine in a patient with PMR.

Cervical flexion myelopathy in a patient showing apparent long tract signs: a severe form of Hirayama disease.

We describe an 18-year-old male with cervical flexion myelopathy with Hirayama disease-like features who showed apparent long tract signs. He first experienced insidious-onset hand muscle weakness and atrophy at the age of 15. Subsequently, he developed sensory disturbance in his lower limb. Neurological examination revealed atrophy and weakness in the right hand and forearm, pyramidal signs in the right lower extremity, and disturbance of superficial sensation in the lower left half of the body. Cervical magnetic resonance images and computed tomographic myelography revealed anterior displacement with compression of the cervical cord in flexion that was more apparent in the right side. The right side of the cervical cord showed severe atrophy. The mechanisms of myelopathy in our patient appeared to be same as that of "tight dural canal in flexion," which has been reported to be the mechanism of juvenile muscular atrophy of the unilateral upper extremity (Hirayama disease). Patients with Hirayama disease generally show minimal sensory signs and no pyramidal signs. An autopsy case of Hirayama disease revealed confined necrosis of the cervical anterior horn without obvious changes in the white matter. Our patient's disease progression suggests that cervical flexion myelopathy patients with severe cervical cord compression in flexion may develop extensive cervical cord injury beyond the anterior horn.

Intracellular redox status affects transplasma membrane electron transport in pulmonary arterial endothelial cells.

Pulmonary arterial endothelial cells possess transplasma membrane electron transport (TPMET) systems that transfer intracellular reducing equivalents to extracellular electron acceptors. As one aspect of determining cellular mechanisms involved in one such TPMET system in pulmonary arterial endothelial cells in culture, glycolysis was inhibited by treatment with iodoacetate (IOA) or by replacing the glucose in the cell medium with 2-deoxy-D-glucose (2-DG). TPMET activity was measured as the rate of reduction of the extracellular electron acceptor polymer toluidine blue O polyacrylamide. Intracellular concentrations of NADH, NAD(+), NADPH, and NADP(+) were determined by high-performance liquid chromatography of KOH cell extracts. IOA decreased TPMET activity to 47% of control activity concomitant with a decrease in the NADH/NAD(+) ratio to 34% of the control level, without a significant change in the NADPH/NADP(+) ratio. 2-DG decreased TPMET activity to 53% of control and decreased both NADH/NAD(+) and NADPH/NADP(+) ratios to 51% and 55%, respectively, of control levels. When lactate was included in the medium along with the inhibitors, the effects of IOA and 2-DG on both TPMET activity and the NADPH/NADP(+) ratios were prevented. The results suggest that cellular redox status is a determinant of pulmonary arterial endothelial cell TPMET activity, with TPMET activity more highly correlated with the poise of the NADH/NAD(+) redox pair.