Comparison of difficulty in stair ascent and descent after total knee replacement.

[Purpose] Although many studies have shown that patients have difficulty in climbing or descending stairs after undergoing total knee replacement, no study so far has compared the difficulty of stair ascent and descent based on objective indicators. This study compared stair ascending and descending processes based on three indicators and clarified which was more difficult. [Participants and Methods] We defined 1) movement method, 2) the necessity for handrail use, and 3) speed as objective indicators. Seventy-eight patients who underwent total knee replacement participated in this study. Three months after the surgery, we examined 1) whether the patients could ascend or descend in a step-over-step or step-by-step manner, 2) whether the patients required handrail support, and measured 3) the time required to ascend and descend for four steps. [Results] The step-by-step movement and handrail requirement rates associated with stair descent were higher than the corresponding rates associated with stair ascent. In addition, the time required for stair descent was greater than that required for ascent. [Conclusion] We found that stair descent was more challenging than stair ascent in terms of all three objective indices: movement method, handrail use, and speed. The results indicate that rehabilitation after total knee replacement should focus more on stair descent than on stair ascent.

Early Mobilization Using a Mobile Patient Lift in the ICU: A Randomized Controlled Trial.

OBJECTIVES: To ascertain whether a mobile patient lift facilitates early mobilization in ventilated ICU patients. DESIGN: A single-center, open-label, randomized controlled trial. SETTING: An academic ICU in Tokyo. PATIENTS: Eighty patients were admitted to ICU and expected ventilation for at least 48 hours. INTERVENTIONS: In the intervention group, in addition to the rehabilitation protocol received by the control group, patients were assisted in sitting, standing, transfers, and walking using the mobile patient lift. MEASUREMENTS AND MAIN RESULTS: The intervention group predominantly stood faster than the control group (1.0 vs. 3.0 d, p < 0.01). The Intervention group also had significantly higher Functional Status Score-ICU scores at ICU discharge. However, the Medical Research Council score and Barthel index at discharge, length of ICU stay, and number of ventilator-free days did not differ between the two groups. CONCLUSIONS: The use of mobile patient lifts facilitates the earlier standing of patients on ventilators. This may contribute to patients improved physical function in the ICU. TRIAL REGISTRATION: The study protocol was registered with the University Hospital Medical Information Network (UMIN) under the registration number UMIN000044965. Registered July 30, 2021.

Skipping breakfast does not accelerate the hyperglycemia-induced endothelial dysfunction but reduces blood flow of the brachial artery in young men.

PURPOSE: Postprandial hyperglycemia is assumed to have a negative impact on flow-mediated dilation (FMD), an index of endothelial function, and blood flow of the peripheral conduit arteries. This study aimed to determine whether the enhancement of postprandial hyperglycemia by skipping breakfast accelerates endothelial dysfunction and reduces the blood flow in the brachial artery in young men. METHODS: Using a randomized cross-over design, ten healthy men completed two trials: with and without breakfast (Eating and Fasting trials, respectively). Venous blood sampling and brachial FMD tests were conducted before, 30, 60, 90, and 120 min after a 75-g oral glucose tolerance test (OGTT). RESULTS: Skipping breakfast boosted post-OGTT glucose levels than having breakfast (P = 0.01). The magnitude of the decrease in FMD via OGTT did not vary between trials (main effect of trial P = 0.55). Although brachial blood flow tended to decrease after OGTT in both trials (interaction and main effect of time P = 0.61 and P = 0.054, respectively), the decrease in blood flow following OGTT was greater in the Fasting trial than in the Eating trial (main effect of trial, mean difference = - 15.8 mL/min [95%CI = - 25.6 to - 6.0 mL/min], P < 0.01). CONCLUSION: Skipping breakfast did not enhance the magnitude of the decrease in FMD following glucose loading, but did accelerate hyperglycemia-induced reduction in brachial blood flow. Current findings suggest that even missing one breakfast has negative impacts on the blood flow regulation of the peripheral conduit arteries in young men who habitually eat breakfast.

Age-related changes and sex differences in ankle plantarflexion velocity.

Ankle plantar flexors play a vital role in the mobility of older adults. The strength and velocity of plantarflexion are critical factors in determining walking speed. Despite reports on how age and sex affect plantarflexion strength, basic information regarding plantarflexion velocity is still lacking. This cross-sectional observational study investigated age-related changes and sex differences in plantarflexion velocity by comparing them with plantarflexion strength. A total of 550 healthy adults were classified into four age groups for each sex: Young (< 40 years old), Middle-aged (40-64 years old), Young-old (65-74 years old), and Older-old (≧ 75 years old). We measured plantarflexion velocity and strength in the long-sitting position using a gyroscope and a hand-held dynamometer, respectively. Two-way analysis of variance revealed no interaction between age and sex for either plantarflexion velocity or strength. Plantarflexion velocity exhibited a significant decline with aging, as did the plantarflexion strength. We found no significant sex differences in plantarflexion velocity in contrast to plantarflexion strength. The results indicated a significant decrease with age and no difference in plantarflexion velocity between males and females characteristic plantarflexion velocity. Understanding the characteristics of plantarflexion velocity could contribute to preventing a decline in mobility in older adults.

Unencapsulated thymoma: a case report.

Thymomas, the most common mediastinal tumors, form capsules. Only a few reports have presented small thymomas without capsule formation, so-called microthymomas. Here, we report a case of an unencapsulated thymoma measuring 18 mm. A 42-year-old female presented with an anterior mediastinal tumor. Computed tomography revealed an 18-mm nodule in the anterior mediastinum. Magnetic resonance imaging revealed a solid tumor that was iso-intense on T1-weighted images and hypo-intense on T2-weighted images. Thoracoscopic partial thymectomy was performed. The histopathological diagnosis was a type B1 thymoma. The tumor was localized within the thymic tissue lacked a fibrous capsule and partially invaded the surrounding fat tissue. To our knowledge, this is the first report of an unencapsulated thymoma, except for microthymomas.

Vasotocin expression is associated with social preference development of the medaka fish.

The neurohypophysial peptide arginine vasotocin (VT) and its mammalian ortholog, arginine vasopressin, function in physiological and behavioral events. These functions have been identified in neuroendocrinological studies using adult animals; however, there is little information on whether VT is associated with social behavior development in fish. Here, we examined social preference in medaka fish of various ages and investigated how VT expression changes during development. The 1-, 2-, 4-, and 8-week post-hatching (wph) larvae, juveniles, and 5-month-old adults were individually introduced to the grouped fish of each age group, and the social preference index (SPI) was compared among ages based on the time spent in the interaction zone near the grouped fish in a test tank. The SPI was significantly higher in the 4-wph larvae, 8-wph juveniles, and adult fish than in the 1- and 2-wph larvae. VT expression increased with age from 1 to 4 wph. Similarly, the expression was high in 4-wph, 8-wph, and adult fish. Furthermore, it was also found that the SPI and the VT expression decreased in the socially isolated larva during the 4 weeks after hatching compared to the levels in the grouped 4-wph larvae. These findings suggest that social preference develops with age and that conspecifics are necessary for social development in medaka larvae. Furthermore, our results suggest that VT is associated with the development of social preferences in medaka.

Fatal case of subdural empyema caused by Campylobacter rectus and Slackia exigua.

We report a fatal subdural empyema caused by Campylobacter rectus in a 66-year-old female who developed acute onset of confusion, dysarthria, and paresis in her left extremities. A CT scan showed hypodensity in a crescentic formation with a mild mid-line shift. She had a bruise on her forehead caused by a fall several days before admission, which initially raised subdural hematoma (SDH) diagnosis, and a burr hole procedure was planned. However, her condition deteriorated on the admission night, and she died before dawn. An autopsy revealed that she had subdural empyema (SDE) caused by Campylobacter rectus and Slackia exigua. Both microorganisms are oral microorganisms that rarely cause extra-oral infection. In our case, head trauma caused a skull bone fracture, and sinus infection might have expanded to the subdural space causing SDE. CT/MRI findings were not typical for either SDH or SDE. Early recognition of subdural empyema and prompt initiation of treatment with antibiotics and surgical drainage is essential for cases of SDE. We present our case and a review of four reported cases.

The Application of Sulfur Influences Microbiome of Soybean Rhizosphere and Nutrient-Mobilizing Bacteria in Andosol.

This study aimed to determine the effect of sulfur (S) application on a root-associated microbial community resulting in a rhizosphere microbiome with better nutrient mobilizing capacity. Soybean plants were cultivated with or without S application, the organic acids secreted from the roots were compared. High-throughput sequencing of 16S rRNA was used to analyze the effect of S on microbial community structure of the soybean rhizosphere. Several plant growth-promoting bacteria (PGPB) isolated from the rhizosphere were identified that can be harnessed for crop productivity. The amount of malic acid secreted from the soybean roots was significantly induced by S application. According to the microbiota analysis, the relative abundance of Polaromonas, identified to have positive association with malic acid, and arylsulfatase-producing Pseudomonas, were increased in S-applied soil. Burkholderia sp. JSA5, obtained from S-applied soil, showed multiple nutrient-mobilizing traits among the isolates. In this study, S application affected the soybean rhizosphere bacterial community structure, suggesting the contribution of changing plant conditions such as in the increase in organic acid secretion. Not only the shift of the microbiota but also isolated strains from S-fertilized soil showed PGPB activity, as well as isolated bacteria that have the potential to be harnessed for crop productivity.

Umbilical cord-derived mesenchymal stromal cell therapy to prevent the development of neurodevelopmental disorders related to low birth weight.

Low birth weight (LBW) increases the risk of neurodevelopmental disorders (NDDs) such as attention-deficit/hyperactive disorder and autism spectrum disorder, as well as cerebral palsy, for which no prophylactic measure exists. Neuroinflammation in fetuses and neonates plays a major pathogenic role in NDDs. Meanwhile, umbilical cord-derived mesenchymal stromal cells (UC-MSCs) exhibit immunomodulatory properties. Therefore, we hypothesized that systemic administration of UC-MSCs in the early postnatal period may attenuate neuroinflammation and thereby prevent the emergence of NDDs. The LBW pups born to dams subjected to mild intrauterine hypoperfusion exhibited a significantly lesser decrease in the monosynaptic response with increased frequency of stimulation to the spinal cord preparation from postnatal day 4 (P4) to P6, suggesting hyperexcitability, which was improved by intravenous administration of human UC-MSCs (1 × 105 cells) on P1. Three-chamber sociability tests at adolescence revealed that only LBW males exhibited disturbed sociability, which tended to be ameliorated by UC-MSC treatment. Other parameters, including those determined via open-field tests, were not significantly improved by UC-MSC treatment. Serum or cerebrospinal fluid levels of pro-inflammatory cytokines were not elevated in the LBW pups, and UC-MSC treatment did not decrease these levels. In conclusion, although UC-MSC treatment prevents hyperexcitability in LBW pups, beneficial effects for NDDs are marginal.

Expression of prosaposin and its G protein-coupled receptor (GPR) 37 in mouse cochlear and vestibular nuclei.

Prosaposin is a precursor of lysosomal hydrolases activator proteins, saposins, and also acts as a secretory protein that is not processed into saposins. Prosaposin elicits neurotrophic function via G protein-coupled receptor (GPR) 37, and prosaposin deficiency causes abnormal vestibuloauditory end-organ development. In this study, immunohistochemistry was used to examine prosaposin and GPR37 expression patterns in the mouse cochlear and vestibular nuclei. Prosaposin immunoreactivity was observed in neurons and glial cells in both nuclei. GPR37 immunoreactivity was observed in only some neurons, and its immunoreactivity in the vestibular nucleus was weaker than that in the cochlear nucleus. This study suggests a possibility that prosaposin deficiency affects not only the end-organs but also the first center of the vestibuloauditory system.

Fatal case of subdural empyema caused by Campylobacter rectus and Slackia exigua

ABSTRACT We report a fatal subdural empyema caused by Campylobacter rectus in a 66-year-old female who developed acute onset of confusion, dysarthria, and paresis in her left extremities. A CT scan showed hypodensity in a crescentic formation with a mild mid-line shift. She had a bruise on her forehead caused by a fall several days before admission, which initially raised subdural hematoma (SDH) diagnosis, and a burr hole procedure was planned. However, her condition deteriorated on the admission night, and she died before dawn. An autopsy revealed that she had subdural empyema (SDE) caused by Campylobacter rectus and Slackia exigua. Both microorganisms are oral microorganisms that rarely cause extra-oral infection. In our case, head trauma caused a skull bone fracture, and sinus infection might have expanded to the subdural space causing SDE. CT/MRI findings were not typical for either SDH or SDE. Early recognition of subdural empyema and prompt initiation of treatment with antibiotics and surgical drainage is essential for cases of SDE. We present our case and a review of four reported cases.

Improved Neurological Outcome of Perampanel for Hypoxic-Ischemic Encephalopathy in Patients After Out-of-Hospital Cardiac Arrest Resuscitation.

BACKGROUND: Although the resuscitation rate for out-of-hospital cardiac arrest (OHCA) patients in Japan is increasing due to the widespread use of automated external defibrillators, the proportion of patients who can return to society remains low at approximately 7%. Many patients have poor neurological outcomes and cannot return to society because of post-resuscitation hypoxic-ischemic encephalopathy. While the resumption of cardiac rhythm is important for patients with OHCA, improving neurological outcomes and returning to society are also important. OBJECTIVES: To investigate whether perampanel, an antiepileptic drug that provides neurological protection against stroke and head injury, could improve neurological outcomes in patients resuscitated after OHCA. METHODS: The participants included 33 patients with OHCA admitted to our hospital from January 2021 to June 2022 and 33 patients admitted before that time. Perampanel was administered to the patients in the intervention group immediately after resuscitation. We defined a Cerebral Performance Category (CPC) score of 1.2 as a good neurological outcome. RESULTS: There was no significant difference in neurological outcomes at intensive care unit discharge between the intervention and non-intervention groups (number of CPC 1.2: 16/33 vs. 9/33); however, neurological outcomes at hospital discharge were significantly better in the intervention group (number of CPC 1.2: 19/33 vs. 9/33 P = 0.01). CONCLUSION: The α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor inhibitory and neuronal protective effects of perampanel may have inhibited the progression of hypoxic-ischemic encephalopathy, which develops after the resumption of cardiac rhythm, and suppressed neuronal damage. Early administration of perampanel after resuscitation of patients with OHCA may improve neurological outcomes.

Maximum knee extension velocity without external load is a stronger determinant of gait function than quadriceps strength in the early postoperative period following total knee arthroplasty.

OBJECTIVE: Quadriceps weakness is considered the primary determinant of gait function after total knee arthroplasty (TKA). However, many patients have shown a gap in improvement trends between gait function and quadriceps strength in clinical situations. Factors other than quadriceps strength in the recovery of gait function after TKA may be essential factors. Because muscle power is a more influential determinant of gait function than muscle strength, the maximum knee extension velocity without external load may be a critical parameter of gait function in patients with TKA. This study aimed to identify the importance of knee extension velocity in determining the gait function early after TKA by comparing the quadriceps strength. METHODS: This prospective observational study was conducted in four acute care hospitals. Patients scheduled for unilateral TKA were recruited (n = 186; age, 75.9 ± 6.6 years; 43 males and 143 females). Knee extension velocity was defined as the angular velocity of knee extension without external load as quickly as possible in a seated position. Bilateral knee function (knee extension velocity and quadriceps strength), lateral knee function (pain and range of motion), and gait function (gait speed and Timed Up and Go test (TUG)) were evaluated before and at 2 and 3 weeks after TKA. RESULTS: Both bilateral knee extension velocities and bilateral quadriceps strengths were significantly correlated with gait function. The knee extension velocity on the operation side was the strongest predictor of gait function at all time points in multiple regression analysis. CONCLUSION: These findings identified knee extension velocity on the operation side to be a more influential determinant of gait function than impairments in quadriceps strength. Therefore, training that focuses on knee extension velocity may be recommended as part of the rehabilitation program in the early postoperative period following TKA. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000020036.

Urinary liver-type fatty acid-binding protein: A hemodynamic index during extracorporeal membrane oxygenation.

We discuss a case in which urinary L-FABP measurements were used to manage a 46-year-old male patient receiving V-A ECMO support. His mean blood pressure was ≥75 mmHg for the first 24 h after the initiation of V-A ECMO, and he experienced a rapid decrease in urinary L-FABP levels.

Examination of the Impact of Strength and Velocity of the Knee and Ankle on Gait Speed in Community-Dwelling Older Adults.

The muscle strength of the knee extension and plantarflexion plays a crucial role in determining gait speed. Recent studies have shown that no-load angular velocity of the lower limb joints is essential for determining gait speed. However, no reports have compared the extent to which lower limb functions, such as knee extension strength, knee extension velocity, plantarflexion strength, and plantarflexion velocity, impact gait speed in a single study. Therefore, this study aimed to examine the relative importance of maximum strength and no-load angular velocity on gait speed. Overall, 164 community-dwelling older adults (72.9 ± 5.0 years) participated in this study. We measured the gait speed and lower limb function (the strength and velocity of knee extension and plantarflexion). Strength was measured with a hand-held dynamometer, and velocity with a gyroscope. A multiple regression analysis was performed with gait speed as the dependent variable and age, sex, and lower-limb function as independent variables. Plantarflexion velocity (ß = 0.25) and plantarflexion strength (ß = 0.21) were noted to be significant predictors of gait speed. These findings indicate that no-load plantarflexion velocity is more important than the strength of plantarflexion and knee extensions as a determinant of gait speed, suggesting that improvement in plantarflexion velocity may increase gait speed.

Clostridioides difficile Infection in a Japanese Tertiary Children's Hospital.

Purpose: Toxins produced by Clostridioides difficile infection (CDI) can cause enteritis and diarrhea. Although the number of pediatric CDI cases is increasing, the clinical management of pediatric CDI, including patient characteristics and prognosis, remains unclear. This study aimed to elucidate the background and clinical course of patients with CDI and evaluate the reliability of diagnostic tests in a tertiary pediatric hospital in Japan. Methods: We retrospectively analyzed the clinical data of children diagnosed with CDI between 2011 and 2021 at the Saitama Children's Medical Center in Saitama, Japan. Results: During the study period, 1,252 C. difficile antigen/toxin tests were performed, and 37 patients were diagnosed with CDI. The main underlying diseases among the patients were hematological and malignant disorders and gastrointestinal diseases, including inflammatory bowel disease (IBD) (59.4%). Two patients (5.4%) had an unremarkable medical history. Among the 37 patients, 27 (73.0%) were immunocompromised, 25 (67.6%) had a history of antibiotic use within the past two months, and 6 (16.2%) were negative on the initial test but were positive on the second test. Finally, 28 patients (75.7%) required primary antibiotic therapy only, and two patients with IBD required additional antibiotic therapy as secondary treatment. Conclusion: The number of pediatric patients with CDI is increasing. Both a comprehensive interview, including underlying diseases and history of antibiotic use, and an understanding of the features of clinical examinations should be emphasized to appropriately diagnose and treat CDI.

A Case of Ruptured Decidualized Ovarian Endometrioma: Usefulness of Serial MRI for Determining Adequate Management.

Decidualization can originate in ovarian endometrioma by elevated serum progesterone levels during pregnancy, which mimics malignancy on ultrasonography. Moreover, decidualized ovarian endometrioma may rupture and cause acute abdominal pain during pregnancy. Magnetic resonance imaging (MRI) is reportedly useful in differentiating decidualized ovarian endometriomas from malignancies. However, to our knowledge, serial MRI of decidualized ovarian endometrioma before and after rupture has not been reported. Herein, we report the case of a 39-year-old woman with a ruptured decidualized ovarian endometrioma in which serial MRI was useful for adequate management. She had a history of right ovarian endometrioma. Transvaginal ultrasonography at 20 weeks of gestation showed the known right ovarian endometrioma with mural nodules that were not evident before pregnancy. MRI for further evaluation showed ovarian endometrioma with mural nodules with signals similar to those of the placenta. Based on the MRI findings, we diagnosed a decidualized ovarian endometrioma. At 27 weeks of gestation, she complained of sudden abdominal pain, for which MRI was performed. MRI showed disappearance of the ovarian endometrioma and bloody ascites, based on which we diagnosed a ruptured ovarian endometrioma. The abdominal pain subsided immediately, and a conservative observational treatment approach was taken. At 37 weeks of gestation, right ovarian cystectomy was performed simultaneously with an elective cesarean section, which revealed a ruptured decidualized ovarian endometrioma. Our findings demonstrate that the accurate diagnosis of a ruptured decidualized ovarian endometrioma on serial MRI can contribute to its management.

Early mobilisation using a mobile patient lift in the intensive care unit: protocol for a randomised controlled trial.

INTRODUCTION: It is important to prevent the deterioration of activities of daily living to improve the long-term prognoses of patients in the intensive care unit (ICU). The patients' conditions, along with the lack of human and technical resources, often become barriers to achieving early mobilisation after the introduction of mechanical ventilation. We plan to verify the usefulness of a mobile patient lift for early mobilisation. METHODS AND ANALYSIS: We will conduct a single-centre, open-label, randomised controlled trial. The inclusion criteria are as follows: age ≥18 years, independent walking before admission and expected mechanical ventilation for at least 48 hours. The participants will be randomly divided into groups with (intervention group) or without (control group) a mobile lift protocol. A mobile lift will be used in the intervention group. The primary endpoint will be the number of days required to achieve an ICU mobility scale of ≥4 (standing position). The results of the two groups will be analysed using the Student's t-test. ETHICS AND DISSEMINATION: This study will be conducted in accordance with the Declaration of Helsinki and with the approval of the Toho University Omori Medical Center Ethics Committee (approval number M20259). The results of this study will be presented internationally at academic conferences and published in the literature. TRIAL REGISTRATION NUMBER: UMIN000044965.

[Effective Treatment for Empyema with Fistula by Negative Pressure Wound Therapy:Report of a Case].

A 54-year-old male with alcoholic cirrhosis and diabetes mellitus was referred to our hospital for the treatment of right pleural empyema with fistula. Despite performing a simple suture closure of the pulmonary fistula, air leakage occurred one week after surgery. Hence, we covered the fistula with a pediculed muscle flap associated with an open window thoracostomy. After 32 days of gauze drainage, negative pressure wound therapy( NPWT) was introduced for reducing the residual pleural space. A chest computed tomography( CT) scan showed almost the full expansion of the lung after undergoing 98 days of NPWT. The patient was discharged from the hospital four months after thoracostomy.

Immediate Effects of Single-Session High-Velocity Training for Lateral Trunk Movement on Gait Function in Early Postoperative Patients after Total Hip Arthroplasty: A Nonrandomized Controlled Trial.

BACKGROUND: Total Hip Arthroplasty (THA) is an effective method for relieving pain and improving gait function. However, THA patients demonstrate slow gait speed at discharge. Rehabilitation programs after THA require the immediate improvement of gait speed early in the postoperative period. To examine the immediate effects of seated side tapping training (SSTT), which focuses on lateral trunk movement and movement velocity, on gait function in early postoperative THA patients, the methods were as follows: The SSTT group performed five repetitions of a task in which they moved their trunks laterally to alternately touch markers to their left and right side as quickly as possible 10 times in a seated position. One set of SSTT lasted approximately 3 min. The control group rested in a seated position for 10 min. RESULTS: Significant interactions were observed for gait speed, stride time, and stride time coefficient of variability. The SSTT group demonstrated significant pre-post-intervention improvement in gait speed, stride time, and coefficient of variability. CONCLUSIONS: SSTT improved both gait speed and gait stability and can be performed easily and safely. Therefore, single-session high-velocity trunk training may be an effective method to improve gait function immediately in early postoperative THA patients.