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1.
Medicine (Baltimore) ; 101(1): e28476, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-35029896

RESUMO

RATIONALE: Thymic carcinoma (TC) is a malignant mediastinal tumor, and there are no established treatments for pre-treated patients with advanced TC. Recently, lenvatinib was approved for such patients in Japan, ahead of other countries. Higher dose lenvatinib may be more efficacious than conventional treatments, although many patients experience grade 3 hypertension. Therefore, lenvatinib dose reduction remains controversial in terms of efficacy and tolerability. PATIENT CONCERNS: Case 1 involves a 72-year-old woman who underwent complete resection of TC and was taking cilnidipine and azilsartan for hypertension. Six years later, multiple lung metastases were observed, and lenvatinib was started. Case 2 involves a 60-year-old man with TC, and was taking amlodipine for hypertension. A chest computed tomography showed progression in primary and metastatic lesions, and the patient started lenvatinib. DIAGNOSES: In both patients, grade 3 hypertension was observed after the administration of lenvatinib. INTERVENTIONS: In Case 1, lenvatinib dose was reduced 3 times because lenvatinib was not interrupted despite grade 3 hypertension. In contrast, in Case 2, lenvatinib was interrupted when grade 3 hypertension occurred and was resumed after a decrease in blood pressure to baseline. OUTCOMES: In Case 2, higher tumor regression may have been achieved because of the maintenance of a high dose of lenvatinib compared with that in Case 1. LESSONS: Lenvatinib is a promising agent for advanced TC; however, hypertension should be addressed cautiously, especially at the outset of administration. Lenvatinib may have to be appropriately interrupted and resumed as soon as the blood pressure is controlled to maximize efficacy and minimize toxicity.

2.
Respir Physiol Neurobiol ; 295: 103788, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34555525

RESUMO

The association between airflow obstruction and bronchial dilation has been researched in bronchiectasis. However, the impact of bronchial wall thickening on airflow obstruction has not been thoroughly investigated. This study assessed the underlying mechanism of airflow obstruction in bronchiectasis due to abnormal bronchial wall thickening using oscillometry. A total of 98 patients with bronchiectasis were retrospectively reviewed. At the time of diagnosis, spirometric and oscillometric parameters, high-resolution computed tomography scores, and clinical characteristics were collected. The bronchial diameter, bronchial wall thickness, and extent of emphysema were evaluated semi-quantitatively. Correlations between patient data and characteristics were analyzed. Thirty-three patients with airflow obstruction showed higher respiratory resistance, more negative respiratory reactance (Xrs) at 5 Hz (X5), and higher bronchial wall thickness score than those without airflow obstruction. The bronchial wall thickness score negatively affected forced expiration volume in 1 s /forced vital capacity and X5. Abnormal bronchial wall thickening might make Xrs more negative and progress airflow obstruction in bronchiectasis.

3.
Prog Rehabil Med ; 6: 20210046, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34888428

RESUMO

Objective: The objectives of this study were to investigate whether student athletes with anterior cruciate ligament (ACL) injuries who returned to sports (RTS) without reconstruction could continue their sporting activities until the end of the season and whether there was an increase in secondary damage associated with knee instability. Methods: Altogether, 288 skeletally mature patients aged <25 years with new-onset isolated primary ACL injuries were included. Of these, 20 student athletes continued playing sports without ACL reconstruction to try to finish the season and were classified as the early return to sports (ERS) group; the remaining 268 patients, who immediately quit sports and underwent surgery, were classified as the non-ERS group. Knee symptoms and sporting performance for the rest of the season were assessed for the ERS group. The presence of secondary damage, e.g., meniscus injuries and chondral lesions, associated with instability were compared between the two groups. Results: Fourteen ERS-group athletes (70%) indicated that their knees had given way during sporting activities, and seven athletes (35%) were unable to complete the season. In the ERS group, the mean self-estimated performance level after injury was 3.8 ± 2.5 (numeric rating scale 0-10). Despite the RTS period being relatively short, medial meniscus tears (P <0.001) significantly increased in the ERS group, and three patients experienced locking of the medial meniscus and required immediate surgery. Conclusions: Although ERS without reconstruction to complete the season may be a reasonable strategy for ACL injury, patients' self-estimated performance level was low and meniscal and cartilage injury rates significantly increased.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34845859

RESUMO

BACKGROUND: Methods that facilitate muscle quality measurement may improve the diagnosis of sarcopenia. Current research has focused on the phase angle (PhA) obtained through bioelectrical impedance analysis (BIA) as an indicator of cellular health, particularly cell membrane integrity and cell function. The current study therefore aimed to evaluate the relationship between the PhA and muscle quality and muscle-related parameters and to determine factors associated with the PhA. Moreover, we attempted to determine the cut-off value of PhA for predicting sarcopenia. METHODS: First-year university students (830 male students, 18.5 ± 0.6 years old; 422 female students, 18.3 ± 0.5 years old) and community-dwelling elderly individuals (70 male individuals, 74.4 ± 5.5 years old; 97 female individuals, 73.1 ± 6.4 years old) were included. PhA and other body composition data were measured using BIA, while muscle quality was calculated by dividing handgrip strength by upper limbs muscle mass. The relationship between PhA and the aforementioned parameters were then analysed, after which the cut-off value of PhA for predicting sarcopenia was examined. RESULTS: Multiple linear regression analysis revealed that age, skeletal muscle mass index (SMI), and muscle quality were independently associated with PhA in both sexes [male (age: standardized regression coefficient (ß) = -0.43, P < 0.001, SMI: ß = 0.61, P < 0.001, muscle quality: ß = 0.13, P < 0.001) and female (age: ß = -0.56, P < 0.001, SMI: ß = 0.52, P < 0.001, muscle quality: ß = 0.09, P = 0.007)]. Participants with sarcopenia had a significantly lower PhA compared with those without it (sarcopenia vs. non-sarcopenia: young male participants, 5.51 ± 0.41° vs. 6.25 ± 0.50°, P < 0.001; young female participants, 4.88 ± 0.16° vs. 5.37 ± 0.44°, P = 0.005; elderly female participants: 4.14 ± 0.29° vs. 4.63 ± 0.42°, P = 0.009). Although no significant findings were observed in elderly male participants, the same tendency was noted. Receiver operating characteristic (ROC) curve analysis indicated that PhA had good predictive ability for sarcopenia in young male, elderly male, young female, and elderly female participants (area under the ROC curve of 0.882, 0.838, 0.865, and 0.850, with cut-off PhA values of 5.95°, 5.04°, 5.02°, and 4.20° for predicting sarcopenia, respectively). CONCLUSIONS: The PhA reflected muscle quality and exhibited good accuracy in detecting sarcopenia, suggesting its utility as an index for easily measuring muscle quality, which could improve the diagnosis of sarcopenia.

5.
Hum Mov Sci ; 81: 102908, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34826664

RESUMO

Conventionally, hitting movements in response to different advanced kinematic information have been investigated from the perspective of chronometric analysis, such as measuring the timing of movements. This is the first study to investigate the effect of manipulating advanced kinematic information on the hitting movement pattern organization based on both kinematics and kinetic analyses in addition to the conventional chronometric analysis. Specifically, the hitting movement of experienced batters in response to visual stimuli consisting of different pitching movement speeds with the same ball trajectory information was measured by an optical motion capture camera system and a foot force sensor inside the shoes. The occurrence timings of specific events (e.g., movement initiation), some kinematic parameters (e.g., maximum rotate angle of the shoulder and hip), and the balance of the ground reaction force between the ball of the big and small toes of both feet were compared between experimental conditions. This was done to test the hypothesis that the hitting movement is coupled with the visual information given to batters based on an expert anticipatory model. The results indicated that for a faster pitching speed, the batter tended to react with a significantly smaller preparatory movement (e.g., smaller weight shift and shoulder rotate angle during backswing) and put significantly larger weight on the rear foot during the swing execution phase. The situation was exactly reverse in the case of a slower pitching movement. These results suggest for the first time that manipulating advanced kinematic information not only affects the timing of the movement, but also the whole-body kinematics and lower body kinetics. The results also indicate that the hitting movement pattern of experienced batters is highly dependent on the advanced kinematic information.

6.
Lung Cancer ; 162: 175-184, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34823108

RESUMO

OBJECTIVE: Several studies have demonstrated that anti-angiogenic agents (AAs) have the ability to regulate immune-related cells in the tumor microenvironment and may affect the clinical effect of immune checkpoint inhibitors (ICIs). Therefore, we investigated the drug interaction between ICI and AA for advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: We systematically searched PubMed-MEDLINE, Embase-Scopus, and ISI Web of Science before August 23, 2021. ICI and AA therapy included the concomitant and sequential use of ICIs and AAs. The objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) of patients who received ICI and AA therapy were evaluated and compared to those of patients who received either monotherapy. Subgroup analyses were performed to clarify the cause of heterogeneity; the timing and sequence of ICI and AA administration were predefined as the subgroups. RESULTS: Thirteen studies involving 2414 patients were included in the meta-analysis. ICI and AA therapy had significantly higher ORR than either monotherapy (OR [95% CI]: 0.61 [0.50-0.74]; p < 0.001; I2 = 29%). PFS and OS were favorable benefits in ICI and AA therapy; however, significant heterogeneity was identified in these analyses (I2 = 80% and 59%, respectively). According to the administration timing and sequence, ICI immediately after AA showed no PFS and OS benefits compared to ICI monotherapy (HR [95 % CI]: 1.54 [1.14-2.08] and 1.50 [1.04-2.15], respectively), whereas favorable PFS and OS were demonstrated when AA was concomitantly administered with ICI (HR [95 % CI]: 0.57 [0.43-0.76] and 0.80 [0.61-1.05], respectively) or when AA was administered immediately after ICI (HR [95 % CI]: 0.58 [0.34-1.00] and 0.56 [0.40-0.80], respectively). CONCLUSION: ICI and AA therapy can provide favorable clinical effects compared to either monotherapy; however, ICI administered immediately after AA may not show survival benefits.

7.
Allergy Asthma Clin Immunol ; 17(1): 118, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34794492

RESUMO

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows. METHODS: This retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed. RESULTS: Baseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7-18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2-9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse. CONCLUSIONS: The ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.

8.
Orthop J Sports Med ; 9(11): 23259671211051308, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34778480

RESUMO

Background: The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial. Purpose: To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared. Results: The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group (P = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; P = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group (P = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group (P = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity (P = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group (P = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group (P ≥ .999). Conclusion: All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.

9.
Biosci Microbiota Food Health ; 40(4): 204-211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34631332

RESUMO

We investigated bacteria that have a nutritional symbiotic relationship with respect to milk oligosaccharides in gut microbiota of suckling rats, with specific reference to sialyllactose (SL) degrading Enterococcus gallinarum. Our next generation sequencing analysis of the colonic contents of 12-day-old suckling rats revealed that almost half of the bacteria in the microbiota belonged to the Lactobacillaceae family. Major Lactobacillus species in the contents were identified as L. johnsonii, L. murinus, and L. reuteri. We then monitored changes in numbers of the above Lactobacillus species, E. gallinarum, and the bacteria belonging to the family Enterobacteriaceae (i.e., enterobacteria) in the colonic contents of infant rats at 7, 12, 21, 28, and 35 days of age by using real-time PCR assays targeting these bacterial groups. The 7-day-old infant rats had a gut microbiota in which enterobacteria were predominant. Such dominance was replaced by L. johnsonii and the concomitant E. gallinarum markedly increased in those of 12 and 21 days of ages. During this period, the number of enterobacteria declined dramatically, but that of L. reuteri surged dramatically. Our separate in vitro experiment showed that supplementation of culture media with SL promoted the growth of L. johnsonii and E. gallinarum, with marked production of lactic acid. These findings revealed possible milk oligosaccharide-mediated cross-feeding between E. gallinarum and L. johnsonii, with the former degrading SL to release lactose to be utilized by the latter.

10.
Am J Ophthalmol ; 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34648775

RESUMO

PURPOSE: To investigate the trend of seasonal variation of intraocular pressure (IOP) in normal-tension glaucoma (NTG) patients over a 20-year period by retrospectively analyzing the Kyoto Prefectural University of Medicine Glaucoma Registry (KPUM-GR) database as real-world data. DESIGN: Retrospective cohort study. METHODS: From the medical records of 1,774 NTG patients (665 males and 1,109 females; mean age: 59.8 ± 14.4 years; mean observation period: 5.6 ± 4.4 years) seen over the 20-year period, 49,007 data points were retrospectively extracted. We first calculated the mean IOP from all available data of each month from January 1997 through December 2016. The data was then categorized into 5 groups of 4 consecutive years each (1997-2000, 2001-2004, 2005-2008, 2009-2012, and 2013-2016), and the mean IOP of each month within the group was calculated. Seasonal variation of IOP over the 20-year study period and in the 5 consecutive groups was then investigated via nonlinear multiple regression analysis. RESULTS: A continuous decrease of IOP throughout the 20-year period was detected (P<0.001) with distinct seasonal variation. The annual mean IOP was highest (13.9 ± 2.7 mmHg) in the oldest group (1997-2000), with a gradual decrease in each subsequent group, finally becoming lowest (12.3 ± 2.7 mmHg) in the most recent group (2013-2016) (P<0.001), and all of them were accompanied by distinct seasonal variation (P<0.001). CONCLUSIONS: Based on the KPUM-GR real-world longitudinal data, our findings revealed a continuous decrease and distinct seasonal variation of IOP in NTG patients throughout the 20-year study period.

11.
Surg Today ; 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34697683

RESUMO

PURPOSE: During the perioperative period, coagulofibrinolytic activation occurs, which occasionally results in thromboembolic complications. However, natural perioperative coagulofibrinolytic responses have not been well investigated. The present study examined perioperative coagulofibrinolytic changes and their association with the development of venous thromboembolism (VTE). METHODS: We retrospectively analyzed the changes in coagulofibrinolytic markers for 7 days in 70 patients undergoing elective colorectal surgery. To explore the natural coagulofibrinolytic response, we investigated patients not undergoing perioperative chemical thromboprophylaxis. RESULTS: Coagulation activation occurred from just after surgery to postoperative day (POD) 1, followed by a gradual decrease, but persisted to even POD 7. Fibrinolytic activity showed a tri-phasic response: activation, shutdown and reactivation. Consequently, fibrin/fibrinogen degradation product (FDP) and D-dimer levels continued to increase until POD 7. The development of deep vein thrombosis (DVT) was observed in 11 patients (15.7%). Postoperative sustained hyper-coagulation [soluble fibrin (SF) or thrombin-antithrombin complex (TAT) values on POD 7 > their normal limits] was significantly associated with the development of DVT (SF, p < 0.001; TAT, p = 0.001). CONCLUSION: We found initial coagulation activation and a tri-phasic response of fibrinolytic activity after colorectal surgery. Thus, physicians need to pay attention to these responses when attempting to prevent or treat VTE.

12.
J Med Virol ; 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34708883

RESUMO

Systemic corticosteroid therapy is frequently used to treat coronavirus disease 2019 (COVID-19). However, its maximum duration without secondary infections remains unclear. We aimed to evaluate the utility of monitoring cytomegalovirus (CMV) infection in patients with COVID-19 and estimate the maximum duration of systemic corticosteroid therapy without secondary infections. We included 59 patients with severe COVID-19 without CMV infection on admission to the intensive care unit (ICU). All patients received systemic corticosteroid therapy under invasive mechanical ventilation, with examination for plasma CMV-deoxyribonucleic acid (DNA) levels during the ICU stay. We analyzed the correlations among patient characteristics, CMV infection, diseases, and patient mortality. CMV infections were newly identified in 15 (25.4%) patients; moreover, anti-CMV treatment was administered to six (10.2%) patients during the ICU stay. Four (6.8%) patients had secondary infection-related mortality. The cumulative incidences of CMV infection and anti-CMV treatment during the ICU stay were 26.8% (95% confidence interval [CI], 15.8%-39.0%) and 12.3% (95% CI, 4.8%-23.4%), respectively. Furthermore, the median duration of systemic corticosteroid therapy without CMV infection was 15 days (95% CI, 13-16 days). The presence of CMV infection was associated with mortality during the ICU stay (p = 0.003). Monitoring plasma CMV-DNA levels could facilitate the detection of secondary CMV infection due to prolonged systemic corticosteroid therapy. The duration of systemic corticosteroid therapy for COVID-19 should be limited.

13.
Angiogenesis ; 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34591203

RESUMO

We report a unique case of advanced non-small cell lung cancer that exhibited the opposite response to its unilateral choroidal metastases upon ramucirumab plus docetaxel treatment. A combination of cisplatin, pemetrexed, and pembrolizumab was administered as first-line treatment, resulting in shrinkage of all the lesions. However, although the patient was continued on a course of pembrolizumab, all the lesions had recurred approximately two months later. Ramucirumab plus docetaxel, administered as sequential treatment, resulted in maintained shrinkage of the choroidal lesions, yet all the other lesions progressed. Ramucirumab may be a suitable therapy for choroidal metastases, especially if administered immediately after immunotherapy.

14.
Chem Pharm Bull (Tokyo) ; 69(8): 768-772, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34334520

RESUMO

A facile and reliable fluorescence method for the quantification of urinary uracil concentration is proposed herein. The assay utilizes a specific fluorescence (FL) derivatization reaction for uracil using 3-methylbenzamidoxime as a fluorogenic reagent. Although the presence of urine inhibited the FL reaction, 10 µL of urine was sufficient for the detection of urinary uracil. The uracil derivative was successfully separated from other fluorescent impurities using simple reversed-phase LC with FL detection. Urinary uracil concentrations from 16 people were compared with the concentrations obtained by the traditional column-switching liquid chromatographic analysis with UV detection. The FL derivative of uracil appeared as a single peak in the chromatograms of all samples. However, several samples showed an additional peak overlapping the uracil peak when using the column-switching method because of UV-active impurities. These results indicated that that the present method is not affected by interfering substances in urine and affords a precise determination of urinary uracil. We expect the proposed method to be applicable for diagnosing dihydropyrimidine dehydrogenase deficiency in 5-fluorouracil chemotherapy.


Assuntos
Benzamidinas/química , Fluorescência , Corantes Fluorescentes/química , Uracila/urina , Cromatografia Líquida de Alta Pressão , Humanos , Estrutura Molecular
17.
J Pain Res ; 14: 2449-2458, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34413679

RESUMO

Purpose: Knee pain is associated with osteoarthritis (OA) and increases during this condition; however, its correlation with central sensitization (CS) in arthritis patients requires greater understanding. The present cross-sectional cohort study to explore the prevalence of knee OA, nocturnal knee pain and disability in general population and to examine the association of CS with sleep quality in Japanese general population. Patients and Methods: From among 1056 community-dowelling volunteers, 942 were enrolled as participants in this study. Bilateral weight-bearing anterior-posterior knee radiographs were classified by the Kellgren-Lawrence grade. Nocturnal knee pain and disability were assessed with self-reported questionnaires. Using the CS inventory with nine items (CSI-9), CS was defined as 10 points or higher. Sleep quality was scored using the Pittsburgh Sleep Quality Index (PSQI). Linear regression analysis, adjusted by age, sex, body mass index, Kellgren-Lawrence grade, nocturnal knee pain, and lifestyle habits, was performed to investigate the association of CS with PSQI. Results: The prevalence of OA, nocturnal knee pain, and disability was 37.9%, 7.6%, and 6.2%, respectively. The mean CSI-9 score was 4.9 ± 4.4, with a CS prevalence of 14.0%. The mean PSQI score was 3.9 ± 2.4, which was correlated with the CSI-9 value. CS was not correlated with OA severity; however, nocturnal knee pain prevalence increased from 13.3% to 25.5% in knee OA patients with CS. The CSI-9 value correlated with PSQI total score and subscales. Conclusion: Knee OA severity correlated with nocturnal pain and disability; however, its association with CS was unproven. The combined effect of knee OA and CS elevated nocturnal pain and disability, resulting in diminished sleep quality.

18.
BMJ Open ; 11(7): e050938, 2021 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-34301667

RESUMO

OBJECTIVES: There have been concerns that patients with chronic conditions may be avoiding in-person physician visits due to fear of COVID-19, leading to lower quality of care. We aimed to investigate changes in physician visits and medication prescriptions for chronic diseases before and during the COVID-19 pandemic at the population level. DESIGN: Retrospective cohort study. SETTING: Nationwide claims data in Japan, 2018-2020. PARTICIPANTS: Working-age population (aged 18-74 years) who visited physicians and received any prescriptions for major chronic diseases (hypertension, diabetes and dyslipidaemia) before the pandemic. OUTCOME MEASURES: The outcomes were the monthly number of physician visits, the monthly proportion of physician visits and the monthly proportion of days covered by prescribed medication (PDC) during the pandemic (April-May 2020, as the first state of emergency over COVID-19 was declared on 7 April, and withdrawn nationally on 25 May). RESULTS: Among 10 346 patients who visited physicians for chronic diseases before the pandemic, we found a temporary decline in physician visits (mean number of visits was 1.9 in March vs 1.7 in April; p<0.001) and an increase in the proportion of patients who did not visit any physicians during the pandemic (15% in March vs 24% in April; p<0.001). Physician visits returned to the baseline in May (the mean number of visits: 1.8, and the proportion of patients who did not visit any physicians: 9%). We observed no clinically meaningful difference in PDC between before and during the pandemic (eg, 87% in March vs 87% in April; p=0.45). A temporary decline in physician visits was more salient in seven prefectures with a larger number of COVID-19 cases than in other areas. CONCLUSIONS: Although the number of physician visits declined right after the COVID-19 outbreak, it returned to the baseline one month later; patients were not skipping medications during the pandemic.


Assuntos
COVID-19 , Médicos , Adolescente , Adulto , Idoso , Doença Crônica , Prescrições de Medicamentos , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Adulto Jovem
19.
Prog Rehabil Med ; 6: 20210029, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34316523

RESUMO

Objective: The aim of this study was to demonstrate the non-inferiority of S-flurbiprofen plaster (SFPP) monotherapy for treating knee osteoarthritis compared with the combination of conventional oral and topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: A total of 222 participants (114, SFPP group; 108, control group) were treated for 4 weeks. The primary endpoint was the change in the degree of pain felt while rising from a chair after 2 and 4 weeks of treatment as determined using the visual analog scale (VAS) . The secondary endpoint was the change in functional scores and test results. Safety was evaluated in terms of the adverse effects. Results: The VAS score significantly decreased in both groups after 2 and 4 weeks of treatment. Non-inferiority in the VAS score was established only at 2 weeks. There were no significant differences in the secondary endpoints between the groups. Skin disorders were more frequent in the SFPP group; however, there was no difference in gastrointestinal (GI) adverse effects. Conclusions: The therapeutic efficacy of SFPP monotherapy for knee OA, with respect to changes in the VAS, was not shown to be non-inferior to conventional treatment at 4 weeks; however, non-inferiority was established at 2 weeks. The functional improvement in the SFPP group was comparable to that of the control group. No severe GI adverse effects associated with SFPP administration were observed; however, it is necessary to pay more attention to the occurrence of skin disorders with SFPP than with conventional topical NSAIDs.

20.
Sci Rep ; 11(1): 15179, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34312418

RESUMO

We investigated the prevalence of magnetic resonance imaging (MRI) findings and their relationship with knee symptoms in women without radiographic evidence of knee osteoarthritis (KOA). This cross-sectional cohort study included 359 Japanese women without radiographic evidence of KOA (Kellgren‒Lawrence grade < 2). All participants underwent T2-weighted fat-suppressed MRI of their knees. Structural abnormalities (cartilage damage, bone marrow lesions [BMLs], subchondral cysts, bone attrition, osteophytes, meniscal lesions, and synovitis) were scored according to the whole-organ MRI score method. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Score. Participants were divided into early and non-KOA groups based on early KOA classification criteria. Logistic regression analysis was performed to evaluate the relationship between MRI abnormalities and knee symptoms. Cartilage damage was the most common abnormality (43.5%). The prevalences of cartilage damage, BMLs, subchondral cysts, bone attrition, meniscal lesions, and synovitis were higher in patients with early KOA than in those without. Synovitis (odds ratio [OR] 2.254, P = 0.002) and meniscal lesions (OR 1.479, P = 0.031) were positively associated with the presence of early KOA. Synovitis was most strongly associated with knee pain and might be a therapeutic target in patients with early KOA.


Assuntos
Osteoartrite do Joelho/diagnóstico por imagem , Adulto , Idoso , Cistos Ósseos/diagnóstico por imagem , Medula Óssea/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Japão , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Dor/fisiopatologia , Sinovite/diagnóstico por imagem , Lesões do Menisco Tibial/diagnóstico por imagem
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