Interaction between functional capability and sleep quality at midterm after total knee arthroplasty: a Japanese retrospective cohort study.

No report has clarified the frequency and interacting factors affecting sleep disturbance among Asian patients at midterm after total knee arthroplasty (TKA). This study aimed to evaluate the frequency of sleep disturbance at midterm after TKA in a Japanese cohort and to identify intervening factors for sleep. We hypothesized that residual knee pain and decreased functional capability negatively interact with sleep quality after TKA. A total of 209 Japanese participants (average age: 77.1 ± 8.3 years; postoperative follow-up period: 4.5 ± 1.9 years) who underwent primary TKA for knee osteoarthritis were included in this study. Sleep quality, satisfaction, pain, functional capability, joint awareness, and mental condition were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Knee Society Score (KSS) 2011, Forgotten Joint Score (FJS)-12, and 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS). Multivariable analysis was performed to determine the influencing factors on PSQI. The scores for the PSQI, satisfaction with pain level while lying in bed, pain during level walking, functional activity category in the KSS 2011, awareness of the artificial joint in bed at night in the FJS-12, and SF-12 MCS were 6.7 ± 3.0, 5.8 ± 1.8, 1.6 ± 2.3, 62 ± 22, 1.5 ± 1.4, and 56 ± 9.3 on average, respectively. Sleep disturbance (PSQI ≥ 5.5) occurred in 54% of the Japanese participants. Multivariable analysis revealed that high functional capability was a significant factor associated with sleep quality improvement (p < 0.05). Decreased functional capability, not residual knee pain, negatively interacted with sleep quality. The sleep disturbance rate was high during the middle postoperative period after TKA in the Japanese cohort.

Osteoporotic Thoracolumbar Vertebral Fractures With Neurological Deficit Treated by Balloon Kyphoplasty Augmented with Newly Developed Minimally Invasive Posterior Hook Stabilization.

Most osteoporotic vertebral fractures (OVFs) are treated conservatively, but surgery is often indicated for residual pain, neuropathy, or severe deformity. OVFs tend to develop in elderly patients, so less invasive surgery is desirable. Surgery is mainly performed to stabilize the fractured vertebral body. Percutaneous cement augmentation, such as via balloon kyphoplasty (BKP), has produced satisfactory results as a surgical method for managing OVFs. Posterior fixation with implants is often performed with or without cement augmentation when stronger fixation is considered necessary for OVFs with local kyphosis and angular instability. Pedicle screws (PSs) are widely used as an implant for posterior fixation, but given the risk of backing out in bones with severe osteoporosis, several measures have been taken to increase the strength such as by adding hooks. In cases of osteoporosis, hooks that can use cortical bone as an anchor are considered more useful than PS but are rarely used in minimally invasive surgery. We developed a minimally invasive posterior hook stabilization approach to directly stabilize the posterior spinal components as a new augmentation method for BKP and applied it to four cases of thoracolumbar OVF with neurological symptoms. The operation time was about 60 minutes, including BKP, and the estimated blood loss was about 10 ml. No postoperative implant problems occurred, and in all cases, neurological symptoms, such as buttocks and leg pain, were alleviated at an early stage after surgery. One patient had a postoperative adjacent vertebral body fracture that was conservatively treatable. Minimally invasive posterior hook stabilization, which we developed as a way of augmenting BKP, was considered useful for managing vertebral body fractures of the thoracolumbar spine with local kyphosis and angular instability.

Subjectivity of the Anomalous Sense of Self Is Represented in Gray Matter Volume in the Brain.

The self includes complicated and heterogeneous functions. Researchers have divided the self into three distinct functions called "agency," "ownership," and "narrative self". These correspond to psychiatric symptoms, behavioral characteristics and neural responses, but their relationship with brain structure is unclear. This study examined the relationship between the subjectivity of self-related malfunctions and brain structure in terms of gray matter (GM) volume in 96 healthy people. They completed a recently developed self-reported questionnaire called the Embodied Sense of Self Scale (ESSS) that measures self-related malfunctions. The ESSS has three subscales reflecting the three distinct functions of the self. We also determined the participants' brain structures using magnetic resonance imaging (MRI) and voxel-based morphometry (VBM). Multiple regression analysis revealed a significant negative correlation between ownership malfunction and the insular cortex GM volume. A relationship with brain structure could thus only be confirmed for the ESSS "ownership" subscale. This finding suggests that distinct brain structures feel ownership and that the ESSS could partly screen for distinct brain structures.