Surgical versus conservative treatment of greater trochanteric fractures with occult intertrochanteric fractures: Retrospective cohort study.

BACKGROUND: Greater trochanter (GT) fractures are rare and frequently associated with occult intertrochanteric (IT) fractures. No consensus has been reached regarding whether surgical or conservative treatment is preferred for such fractures. The purpose of this study was to evaluate the clinical outcomes of surgical versus conservative treatment for coexistent GT and occult IT fractures. MATERIALS AND METHODS: Between January 2006 and December 2021, we enrolled patients who were diagnosed with GT fracture on radiography or CT and underwent MRI to reveal occult IT fracture. Eligible patients were divided into two treatment groups: surgical and conservative treatment. The characteristics and outcomes of the patients were compared between the two groups. RESULTS: Fifty patients were included in this study. There were 29 patients (3 male, 26 female; mean age: 84.45 ± 10.68 years) in the surgical treatment group and 21 patients (3 male, 18 female; mean age: 83.33 ± 9.34 years) in the conservative group, respectively. The demographic and clinical characteristics of the two groups were comparable, including sex, age, body mass index (BMI), percentage of extension into the IT area, days from injury to diagnosis, and activities of daily living (ADL) before injury. All 50 patients healed without displaced fractures, regardless of the percentage of extension into the IT area. There were no significant differences in the modified functional ambulation category scores between the two groups at one week, one month, and three months following the start of the treatment intervention (P = 0.653, 0.923, and 0.577, respectively). The length of hospital stay was 48.4 ± 5.97 days in the surgical treatment group and 50.6 ± 7.55 days in the conservative treatment group (P = 0.422). There was no significant difference in one-year mortality between surgical and conservative treatments (P = 0.219). CONCLUSIONS: There were no significant differences in any outcome between the surgical and nonsurgical treatment groups. The results of the study suggested that coexistent GT and occult IT fractures may be managed conservatively without developing complete fractures, regardless of extension into the IT area.

Association between clinical symptoms and lateral thrust 12 months after high tibial osteotomy.

[Purpose] This study aimed to assess the correlation between lateral thrust and clinical symptoms after high tibial osteotomy and determine lower limb alignments that may decrease lateral thrust. [Participants and Methods] We included 54 patients (73 knees) who underwent high tibial osteotomy. Clinical symptoms, including the Japanese Orthopaedic Association score and the hip-knee-ankle angle measured via radiography, were assessed 12 months postoperatively. Lateral thrust was measured using three-dimensional motion analyses. Logistic regression was used to calculate the cut-off values with good Japanese Orthopaedic Association score and lateral thrust as dependent variables and both lateral thrust and hip-knee-ankle angle as independent variables. [Results] The lateral thrust cut-off was 3.1° (sensitivity: 0.83; specificity: 0.74; area under the curve: 0.76), while that of the hip-knee-ankle angle was 1.9° of valgus (sensitivity: 0.71; specificity: 0.81; area under the curve: 0.72). [Conclusion] Good clinical outcomes after high tibial osteotomy can be expected with a lateral thrust of ≤3.0°, indicating that the target hip-knee-ankle angle should be 2.0° valgus. In cases where valgus alignment is insufficient, lateral thrust may develop, which should be assessed using gait analysis.

Physical functions associated with health-related quality of life in older adults diagnosed with knee osteoarthritis.

[Purpose] The present study aimed to identify the physical functions associated with health-related quality of life in older adults with knee osteoarthritis. [Participants and Methods] A total of 132 participants were included in this study in two groups: the knee osteoarthritis group (n=66) and the control group (n=66). We compared the results of the Medical Outcomes Study 36-Item Short-Form Health Survey with the physical function measures related to health-related quality of life. In the knee osteoarthritis group, we examined the relationship between the degree of knee pain and health-related quality of life. [Results] The knee osteoarthritis group showed a significantly shorter one-leg standing time, lower maximum walking speed, and significantly longer time to complete the Sit-to-Stand-5 and Timed Up and Go tests than the control group. The knee osteoarthritis group had significantly lower 36-Item Short-Form Health Survey scores than the control group on seven subscales and significantly lower scores for physical component summary and role or social component summary. In the knee osteoarthritis group, physical component summary and role or social component summary were correlated with Sit-to-Stand-5, Timed Up and Go, and maximum walking speed. We observed a correlation between physical component summary and knee pain on joint loading. [Conclusion] In older adults with knee osteoarthritis, rehabilitation approaches aimed at achieving a smooth transition from sitting to standing may increase social participation and improve health-related quality of life.

Mechanisms of cold-induced immunity in plants.

Overwintering plants acquire substantial levels of freezing tolerance through cold acclimation or winter hardening. This process is essential for the plants survival to harsh winter conditions. In the areas where persistent snow cover lasts several months, plants are protected from freezing but are, however, exposed to other harsh conditions, such as dark, cold, and high humidity. These conditions facilitate the infection of psychrophilic pathogens, which are termed "snow molds." To fight against infection of snow molds, overwintering plants develop disease resistance via the process of cold acclimation. Compared with pathogen-induced disease resistance, the molecular mechanisms of cold-induced disease resistance have yet to be fully elucidated. In this review, we outline the recent progress in our understanding of disease resistance acquired through cold acclimation.

Management of Adult Atlantoaxial Rotatory Fixation: Case Series with Literature Review.

Background: Atlantoaxial rotatory fixation (AARF) is extremely rare in adults, and there is no consensus on the ideal treatment of adult AARF because of its rarity. We presented a case series of three adult AARFs and reviewed the literature on adult AARFs. We suggest treatment guidelines for the injury based on the literature review. Methods: We compiled a series of three adult AARFs seen in our hospital. We also utilized the NCBI library to retrieve literature on adult AARF from 2000 to 2021. We included articles on adult AARF, which described the number of days from injury to diagnosis, Fielding classification, occurrence of associated cervical injuries, and details of treatment and the results. Results: Thirty adult AARFs reports fulfilled the criteria and 32 patients were analyzed. Eighteen patients had Fielding Type 1 AARF and were diagnosed within 1 month of injury. Among them, 13 cases healed with conservative treatment. Patients with acute AARF of Fielding Type 1 who underwent manual reduction healed successfully. All patients that required more than 1 month from injury to diagnosis underwent surgery. All cases with AARF Fielding Types 2, 3, and 4 failed conservative treatment. Conclusion: The case series and literature review suggest that early diagnosis of adult AARF is essential for successful closed reduction, and the Fielding classification may help determine treatment strategy. Furthermore, this study showed that not only traction but also manual reduction may be a useful treatment for early diagnosed AARF Fielding Type 1 without complications. Level of Evidence: III.

The effects of cognitive tasks on the frequency of non-MTC gait cycle during walking in healthy older and young adults.

[Purpose] To investigate the effects of cognitive tasks on the non-minimum toe clearance gait cycles (nMTC) frequency during walking in healthy older and young adults. [Participants and Methods] This study included 20 healthy older and 20 young adults. The participants performed 3 min preferred-speed walking under a single-task and three dual-tasks (DTs) consisting of verbal, subtraction, and recall tasks. We determined the nMTC, which could not detect a trough in the toe trajectory during the swing phase. We evaluated the nMTC frequency (the cases of nMTC / total gait cycles) and compared them among the tasks and between groups. [Results] The results of the two-way analysis of variance revealed that there were no differences among the tasks, while the nMTC frequency in the older group was higher than that in the young group. The DT cost (DTc), which was used as an indicator of cognitive-motor interference (CMI), was higher in the subtraction and recall tasks in the older group than those in the young group. [Conclusion] This study showed that adding a cognitive task while walking increased in the nMTC frequency in older adults. These results suggest that the nMTC frequency under DT would reflect the increased CMI in healthy older adults.

Association between cognitive function and olfactory identification ability in community-dwelling older individuals.

[Purpose] We investigated whether olfactory identification ability may be useful for early detection of cognitive decline. [Participants and Methods] The study included 55 community-dwelling older individuals without a history of mild cognitive impairment or dementia, who were capable of living independently. Cognitive function was evaluated using the Japanese versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment tools. The olfactory identification ability was evaluated using the Odor Stick Identification Test for the Japanese. We also investigated the association between olfactory identification ability and cognitive function. [Results] Based on the Japanese version of the Mini-Mental State Examination, all participants were categorized into the noncognitive decline group, and based on the Japanese version of the Montreal Cognitive Assessment tool, 21 participants were categorized into the cognitive decline group. With regard to olfactory discrimination ability, we observed a significant difference between participants with and without cognitive decline based on the Japanese version of the Montreal Cognitive Assessment scores. Furthermore, we observed a significant positive correlation between the Japanese version of the the Montreal Cognitive Assessment scores and the Odor Stick Identification Test for the Japanese scores, although no significant correlation was observed between the Japanese version of the Mini-Mental State Examination and the Odor Stick Identification Test for the Japanese scores. [Conclusion] Olfactory identification ability may be useful to detect early-stage cognitive decline in community-dwelling older individuals.

Physical function and health-related quality of life of community-dwelling older adults with locomotive syndrome and pre-frailty.

[Purpose] To consider the effective rehabilitation approaches for locomotive syndrome (LS) and pre-frailty, we examined the characteristics of physical function and health-related quality of life (HRQoL) in community-dwelling older adults. [Participants and Methods] Eighty-three individuals (age 71.8 ± 5.5 years, 29 males and 54 females) were divided into robust (R), LS, and locomotive syndrome with pre-frailty (LSP) groups. We compared the subscale and summary scores of the 36-Item Short-Form Health Survey (SF-36) as HRQoL indices. The grip strength, five-chair stand up test (SS-5), and normal walking speed were the physical function indices. [Results] The LS group had lower two-step scores and normal walking speed but there was no significant difference in the SF-36. The two-step score and 25-question geriatric locomotive function scale, SS-5, seven SF-36 subscales, and mental component summary (MCS) scores were lower in the LSP group. Compared to that of the LS group, the LSP group did not show significant difference in physical function but showed lower values in overall health, vitality, mental health, and MCS in the SF-36 subscales. [Conclusion] The subjective evaluation of one's health was lower than that of the deterioration of physical function as a characteristic of the LSP.

Effects of cognitive tasks on center-of-foot pressure displacements and brain activity during single leg stance: comparison in community-dwelling healthy older and young people.

[Purpose] This study aimed to investigate the effect of cognitive tasks on the center-of-foot pressure (COP) displacements and brain activity during single leg stance (SLS) in older people. [Participants and Methods] This study included 25 healthy older (age, 68.8 ± 4.9 years) and 25 young (age, 21.0 ± 0.9 years) participants. Participants performed SLS for 35 s under a single-task (ST) and three dual-tasks (DTs), namely verbal, subtraction, and recall tasks. We measured the total length of COP (COP_ TL ) and change in oxygenated hemoglobin (HbO2) levels during SLS under four tasks. [Results] There were no differences in COP_ TL and HbO2 levels in the young group, whereas COP_ TL in the recall task was significantly longer than in ST in the older group. In the comparisons of the DTc (the relative change of DT to ST), no differences were found among three DTs in the young group, whereas the DTc of COP_ TL in the recall task was significantly higher than that in the verbal task in the older group. Regarding HbO2, no differences were observed among the four tasks in both groups. [Conclusion] These results suggest that SLS combined with a recall task may be useful for fall risk screening in healthy older individuals.

An Apoplastic Defensin of Wheat Elicits the Production of Extracellular Polysaccharides in Snow Mold.

TAD1 (Triticum aestivum defensin 1) is a plant defensin specifically induced by low temperature in winter wheat. In this study, we demonstrated that TAD1 accumulated in the apoplast during cold acclimation and displayed antifungal activity against the pink snow mold fungi Microdochium nivale. When M. nivale was treated with TAD1, Congo red-stainable extracellular polysaccharides (EPS) were produced. The EPS were degradable by cellulase treatment, suggesting the involvement of ß-1,4 glucans. Interestingly, when the fungus was treated with FITC-labeled TAD1, fluorescent signals were observed within the EPS layer. Taken together, these results support the hypothesis that the EPS plays a role as a physical barrier against antimicrobial proteins secreted by plants. We anticipate that the findings from our study will have broad impact and will increase our understanding of plant-snow mold interactions under snow.

Effect of two load escalation methods using a supine ergometer on the cardiorespiratory system and lower limb muscle activity.

[Purpose] This study aimed to determine the effects of two load escalation methods, such as pedal weight increasing method and pedal speed raising method using a supine ergometer, on the cardiorespiratory system and lower limb muscle activity. [Participants and Methods] The study included 20 healthy adult males (age: 21 ± 1 years). Two different parameters were modulated during exercise intervention. Pedal load progression was applied in the load group (28.9 N, 72.3 N, 101.3 N), and pedal rate progression was applied in the speed group (60 rpm, 80 rpm, 100 rpm). Each group performed 5 minutes of exercise at their respective level of progression, for a total duration of 15 minutes. [Results] Oxygen consumption, carbon dioxide output, and minute ventilation were significantly increased as exercise intensity increased in both groups. Significant differences in muscle activity were found between the highest exercise intensities (101.3 N and 100 rpm). The activities of the biceps femoris and gastrocnemius were significantly higher with exercise at 100 rpm than at 101.3 N. [Conclusion] Increasing the number of revolutions per minute may significantly increase the activity of the lower limb muscles at comparable exercise intensities, despite the low work load.

Visualization of rotator cuff tear morphology by radial magnetic resonance imaging.

The objective of this study was to investigate whether rotator cuff tear morphology could be visualized using radial MRI. We retrospectively investigated 52 shoulders that underwent preoperative MRI and arthroscopy for a complete rotator cuff tear. The tear length and width were measured using oblique coronal, axial, and radial MRI. Arthroscopic findings were compared with the tear morphology. Tear morphology was visualized using oblique coronal and axial MRI for 24 of the 52 shoulders (46%), and radial MRI for all 52 shoulders. Radial MRI data for 49 of 52 shoulders (94%) were concordant with the arthroscopic findings.

The temporal relationship of thresholds between muscle activity and ventilation during bicycle ramp exercise in community dwelling elderly males.

[Purpose] To compare the appearance time of the ventilatory threshold point and the electromyographic threshold in the activity of the vastus lateralis, rectus femoris, biceps femoris long head and gastrocnemius lateral head muscles during ramp cycling exercise in elderly males. [Subjects and Methods] Eleven community dwelling elderly males participated in this study. Subjects performed exercise testing with an expiratory gas analyzer and surface electromyography to evaluate the tested muscle activities during ramp exercise. [Results] The electromyographic threshold for rectus femoris was not valid because the slope after electromyographic threshold was not significant as compared to that before electromyographic threshold. The slope of the regression line for vastus lateralis was significantly decreased after electromyographic threshold while biceps femoris and gastrocnemius were increased. The electromyographic threshold appearance times for vastus lateralis and gastrocnemius were significantly earlier than ventilatory threshold point. There were no difference in electromyographic threshold appearance times among three muscles. [Conclusion] These results suggest that the increase in the slope of the regression line after electromyographic threshold for vastus lateralis was decreased, possibly indicating to postpone muscular fatigue resulting from the activation of biceps femoris and gastrocnemius as biarticular antagonists. This recruitment pattern might be an elderly-specific strategy.

The cold-induced defensin TAD1 confers resistance against snow mold and Fusarium head blight in transgenic wheat.

TAD1 (Triticum aestivum defensin 1) is induced during cold acclimation in winter wheat and encodes a plant defensin with antimicrobial activity. In this study, we demonstrated that recombinant TAD1 protein inhibits hyphal growth of the snow mold fungus, Typhula ishikariensis in vitro. Transgenic wheat plants overexpressing TAD1 were created and tested for resistance against T. ishikariensis. Leaf inoculation assays revealed that overexpression of TAD1 confers resistance against the snow mold. In addition, the TAD1-overexpressors showed resistance against Fusarium graminearum, which causes Fusarium head blight, a devastating disease in wheat and barley. These results indicate that TAD1 is a candidate gene to improve resistance against multiple fungal diseases in cereal crops.

An RNA chaperone, AtCSP2, negatively regulates salt stress tolerance.

Cold shock domain (CSD) proteins are RNA chaperones that destabilize RNA secondary structures. Arabidopsis Cold Shock Domain Protein 2 (AtCSP2), one of the 4 CSD proteins (AtCSP1-AtCSP4) in Arabidopsis, is induced during cold acclimation but negatively regulates freezing tolerance. Here, we analyzed the function of AtCSP2 in salt stress tolerance. A double mutant, with reduced AtCSP2 and no AtCSP4 expression (atcsp2-3 atcsp4-1), displayed higher survival rates after salt stress. In addition, overexpression of AtCSP2 resulted in reduced salt stress tolerance. These data demonstrate that AtCSP2 acts as a negative regulator of salt stress tolerance in Arabidopsis.

Arabidopsis cold shock domain protein 2 influences ABA accumulation in seed and negatively regulates germination.

The cold shock domain (CSD) is the most conserved nucleic acid binding domain and is distributed from bacteria to animals and plants. CSD proteins are RNA chaperones that destabilize RNA secondary structures to regulate stress tolerance and development. AtCSP2 is one of the four CSD proteins in Arabidopsis and is up-regulated in response to cold. Since AtCSP2 negatively regulates freezing tolerance, it was proposed to be a modulator of freezing tolerance during cold acclimation. Here, we examined the function of AtCSP2 in seed germination. We found that AtCSP2-overexpressing lines demonstrated retarded germination as compared with the wild type, with or without stress treatments. The ABA levels in AtCSP2-overexpressing seeds were higher than those in the wild type. In addition, overexpression of AtCSP2 reduced the expression of an ABA catabolic gene (CYP707A2) and gibberellin biosynthesis genes (GA20ox and GA3ox). These results suggest that AtCSP2 negatively regulates seed germination by controlling ABA and GA levels.

TaSK5, an abiotic stress-inducible GSK3/shaggy-like kinase from wheat, confers salt and drought tolerance in transgenic Arabidopsis.

A novel cold-inducible GSK3/shaggy-like kinase, TaSK5, was isolated from winter wheat using a macroarray-based differential screening approach. TaSK5 showed high similarity to Arabidopsis subgroup I GSK3/shaggy-like kinases ASK-alpha, AtSK-gamma and ASK-epsilon. RNA gel blot analyses revealed TaSK5 induction by cold and NaCl treatments and to a lesser extent by drought treatment. TaSK5 functionally complemented the cold- and salt-sensitive phenotypes of a yeast GSK3/shaggy-like kinase mutant, △mck1. Transgenic Arabidopsis plants overexpressing TaSK5 cDNA showed enhanced tolerance to salt and drought stresses. By contrast, the tolerance of the transgenic plants to freezing stress was not altered. Microarray analysis revealed that a number of abiotic stress-inducible genes were constitutively induced in the transgenic Arabidopsis plants, suggesting that TaSK5 may function in a novel signal transduction pathway that appears to be unrelated to DREB1/CBF regulon and may involve crosstalk between abiotic and hormonal signals.

A redox-sensitive cysteine residue regulates the kinase activities of OsMPK3 and OsMPK6 in vitro.

Two subgroup A rice mitogen-activated protein kinases (MAPKs), OsMPK3 and OsMPK6, have been implicated in multiple stress responses. However, the redox-control of the kinase activity of these proteins remains unknown. Here, immunoprecipitated OsMPK3 and OsMPK6 were initially activated in 15min, and this activation transiently increased in rice seedlings under H2O2 stress. Among the six conserved cysteine residues, only the fourth cysteine residues in the kinase domain VII, Cys(179) and Cys(210), were required for the in vitro kinase activities of OsMPK3 and OsMPK6, respectively. Moreover, the substitution of these specific cysteine residues with serine abrogated in vitro kinase responses to redox conditions. These results suggest a novel redox-control mechanism for the kinase activities of these MAPKs in vivo.