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Methods@#This study included 46 patients who underwent spinal reconstruction surgery for thoracolumbar osteoporotic vertebral fractures and kyphosis and were followed up for 1 year postoperatively. DJK was defined as an advanced kyphosis angle >10° between the LIV and one lower vertebra. The patients were divided into groups with and without DJK. The risk factors of the two groups, such as patient background, surgery-related factors, radiographic parameters, and clinical outcomes, were analyzed. @*Results@#The DJK and non-DJK groups included 14 and 32 patients, respectively, without significant differences in patient background. Those with instability in the distal adjacent LIV disc had a significantly higher risk of DJK occurrence (28.6% vs. 3.2%, p=0.027). DJK occurrence significantly increased in those with the sagittal stable vertebra not included in the fixation range (57.1% vs. 18.8%, p=0.020). Other preoperative radiographic parameters were not significantly different. Instability in the distal adjacent LIV disc (adjusted odds ratio, 14.50; p=0.029) and the exclusion of the sagittal stable vertebra from the fixation range (adjusted odds ratio, 5.29; p=0.020) were significant risk factors for DJK occurrence. @*Conclusions@#Regarding spinal reconstruction surgery in patients with osteoporotic vertebral fractures, instability in the distal adjacent LIV disc and the exclusion of the sagittal stable vertebra from the fixation range were risk factors for DJK occurrence in the short term.
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The patient was a 36 year-old woman with cold sensitivity who had repeated episodes of herpes labialis. Her average sleep time was 13 h, and she experienced problems in her daily life when she could not get enough sleep, so she was diagnosed as having hypersomnia. She gave birth to her first child at the age of 35 years. She had herpes labialis at 1 month after birth, and lochia continued for 3 months. She also experienced repeated episodes of herpes labialis and continuation of lochia after giving birth to her second child at the age of 36 years. In the examination, abdominal tension was low, and because she reported frequent fatigue and infections, she was diagnosed as having Qi deficiency. Hochuekkito was started internally, and after 2 weeks, she had less lochia and the herpes labialis disappeared. In addition, as her symptoms of hypersomnia improved, she became able to maintain her physical strength without excessive daytime sleepiness even after sleeping for only 5 h. Hochuekkito, which is often used to treat Qi deficiency, may improve Qi deficiency-related symptoms and contribute to improving daily life by shortening the sleep time of people with hypersomnia.
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Methods@#We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed. @*Results@#In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI. @*Conclusions@#FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.
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Methods@#We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed. @*Results@#In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI. @*Conclusions@#FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.
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Purpose：This study examined functional outcomes and discharge disposition in patients with and without indwelling urethral catheters, who were admitted to a convalescent (Kaifukuki) rehabilitation ward (KRW) following an acute care hospital stay.Subjects and Methods：We retrospectively reviewed the medical records of 113 patients with cerebrovascular disease and traumatic brain injury who had indwelling urethral catheters at the time of admission to the KRW of our hospital between April 1, 2012 and March 31, 2015. We studied the motor score of the Functional Independence Measure (FIM-M) and discharge disposition from our KRW in patients without indwelling urethral catheters.Results：The ratio of patients without indwelling urethral catheters was 75.2％ (85 cases：catheter-free group). The catheter-free group had higher FIM-M scores and a higher rate of living at home, compared to the 28 patients with indwelling urethral catheters. The average duration until urination independence after catheter removal was 17.3 (standard deviation：21.1) days. Urination independence recovered in 80.9％ of the catheter-free group within 4 weeks after catheter removal.Conclusion：Indwelling urethral catheter should be removed to enable discharge to home.
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The purpose of this study was to confirm the causal structure model of muscle, motor and living functions utilizing structural equation modeling (SEM) . As subjects, 103 community-dwelling older men and women, aged 65.7±6.9years of age, participated in the study to measure muscle cross-sectional area, maximum voluntary contractions, muscle power, 4 physical performance tests, and 16 questionnaires regarding ability of activities of daily living. The causal structure model of muscle, motor and living functions was hypothesized to be a hierarchical causal structure. The causal structure model of muscle function was hypothesized to be a hierarchical causal structure consisting of 3 sub-domains of muscle mass, muscle strength, and muscle power. Data analysis procedures were as follows : a) testing of construct validity of muscle function variables using confirmatory factor analysis (CFA) in SEM ; b) testing of causal structure using SEM ; c) testing of factor invariance using multi-group analysis for gender. The highest goodness of fit indices was obtained in the causal structure model of muscle, motor and living functions (NFI= .928, CFI= .978, RMSEA =.061) . The causal coefficient of muscle function to motor function was .98 (<I>p</I><.05), followed by.34 for motor function to living function. From the results of multi-group analysis, the measurement invariance model indicated the highest goodness of fit indices (TLI=.968, CFI .977) . It was concluded that the hierarchical causal relation was among muscle, motor and living functions, and in which muscle function was consisted of 3 sub-domains.
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The purpose of this study was to confirm the reliability and validity of a physical fitness questionnaire (PFQ) with self-rating for elderly people applying structural equation modeling (SEM) . As subjects, 105 community-dwelling older men and women aged 67.1±6.1 years participated in the study to measure 13 PFQ items and 13 performance tests. The data analysis procedures were as follows : a) testing reliability of PFQ ; b) testing of construct validity of PFQ using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) ; c) testing of criterion-related validity of PFQ to the performance tests using SEM ; d) testing of correlations of the PFQ to walking ability using SEM. Cronbaeh's alpha coefficient for consistency reliability of the PFQ was .83. Four common factors of muscle strength-power, endurance, coordination, and flexibility were extracted in EFA. The high and enough goodness of fit indices were obtained in the confirmatory factor structure model, and in each sub-domain of criterion-related validity to performance tests and correlation to walking ability models. The criterion-related validity coefficient of muscle strength and power was .77, followed by .66 for endurance, .59 for coordination and .82 for flexibility. The correlation coefficient of muscle strength and power to walking ability was -.51, followed by -.58 for coordination, - .43 for endurance and - . 28 for flexibility. These results indicated that the PFQ consisting of 13 items and 4 sub-domains satisfied reliability and construct validity although criterion related validity to performance tests was insufficient. It was concluded that the PFQ is of useful for physical fitness checking of elderly people.
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The purpose of this study was to confirm the causal effect model of strength on walking ability development as a result of exercise participation among elderly people in a community, utilizing the latent curve model (LCM) in structural equation modeling (SEM) . Twenty-six male and 57 female subjects, 83 in total, aged 67.8±5.7, 63.9±7.1 and 65.1±6.9 in a pooled sample participated in the exercise program which lasted for two years. Grip strength and sit-ups used in the Japan Fitness Test were measured for muscular strength, 10-m hurdle walk and 6-min walk for walking ability, and the fitness test score for physical ability. The data analysis procedures were as follows : a) analysis of test-retest reliability and construct validity of measurement items, b) analysis of causal structure model of aging, muscular strength and walking ability, c) analysis of variance for repeated measurement of walking performance by sex, age and year, d) analysis of LCM for walking performance development. The highest goodness-of-fit indices of SEM were obtained in the LCM of 10-m hurdle walk performance development (GFI=0.989, AGFI=0.920, CFI=0.998, RMSEA=0.038) . The path coefficient of sit-ups at pre-test effect on the intercept of 10-m hurdle walk performance development was significant (<I>p</I><0.05) . The path coefficients of age to intercept and slope of 10-m hurdle walk development were also significant (<I>p</I><0.05) . It was concluded that walking ability development through participation in exercise age and strength level was more effective for maintaining walking ability in older age.