Peer Support for Patients With Heart Failure: A Systematic Review and Meta-Analysis.

Peer support, which is given by people with similar life experiences and experiential knowledge, has been shown to be effective for patients with diabetes and mental illness. However, the impact of such peer support on patients coping with heart failure remains indeterminate. The objective of this systematic review and meta-analysis is to scrutinize the potential benefits of peer support for patients with heart failure. We included randomized controlled trials (RCTs) evaluating the effectiveness of peer support for patients with heart failure in contrast to those without peer support. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov until October 2022. We pooled the data on mortality, readmission rate, and quality of life (QoL) as primary outcomes. The certainty of evidence was evaluated by the grading of recommendations assessment, development, and evaluation (GRADE) approach. We included three studies with 390 patients with heart failure. Peer support may have resulted in a slight increase in mortality (risk ratio (RR)=1.16, 95% confidence interval (CI)=0.61-2.21; low certainty of the evidence) and in a reduction in the readmission rate (RR=0.93, 95% CI=0.74-1.17; low certainty of the evidence). The evidence was very uncertain about the effect of peer support on QoL (standardized mean difference 2.03 higher in the intervention group, 95% CI=1.79 lower to 5.84 higher; very low certainty of the evidence). Despite that the certainty is low or very low, the extant data available evidence suggests that peer support may not yield substantial improvements in critical outcomes for patients with heart failure. Consequently, endorsing peer support for patients with heart failure currently seems unjustifiable.

The feasibility of Gazefinder under 12 months of age infants.

Eye-tracking to evaluate gaze patterns has developed as an assessment tool for children with autism spectrum disorder (ASD). Gazefinder is one of Eye-tracking devices and few studies have investigated whether it can measure the gaze data of infants under 12 months of age. We conducted a prospective cross-sectional study from April 2019 to March 2020 in a periodic health checkup in Ohchi County, Shimane, Japan. Participants included infants between 4 and 11 months of age who were not suspected the presence of developmental problems. Ninety-three participants' datapoints were analyzed. The mean age was 6.5 months and mean developmental quotient was 88%. The mean fixation time percentage of all sequences was 81.0% (standard deviation; 4.4), and there was no significant difference in each age group. Infants in all groups showed a significantly higher predilection for eyes than for mouths. There was a positive association of age with human gaze and a negative association with geometric gaze. Moreover, we confirmed that joint attention skills were enhanced in accordance with their growth process. The eye-tracking data were almost corresponding to previous studies' data of infant with typical development and Gazefinder could be applied to infants starting at 4 months of age.

Predicting factors of elderly patients' discharge to home after rehabilitation in rural Japan: a retrospective cohort study.

INTRODUCTION: The aging of society continues to progress in Japan. As aging is more pronounced in rural than in urban societies, rehabilitation can contribute to rural elderly patients' discharge to home after hospitalization for various causes. The relationship between rural elderly patients' improvement of motor and cognitive function in relation to activities of daily life (ADL) through rehabilitation and their discharge to home has not been clarified in rural communities. The purpose of this study was to clarify whether an improvement of ADL can enable elderly hospitalized patients to discharge to their homes in a rural community. METHODS: This retrospective cohort study included 783 consecutive patients aged over 65 years with frailty and multimorbidity who were admitted with acute diseases and underwent active rehabilitation at a rural community hospital. This study was conducted from April 2016 to March 2020. The following patient data were collected from the electronic medical records: age, sex, body mass index, serum albumin, diagnosis on admission, the Charlson Comorbidity Index, living with family or alone, duration of disease from the onset of symptoms to the start of rehabilitation, duration of rehabilitation, care level based on the Japanese insurance system, cognitive and motor components of the functional independence measure (FIM) as the measurement of the level of ADL at both admission and discharge, change in these components of the FIM, and the place to which patients were discharged (home or facility). Two groups of patients were distinguished based on whether the discharge was to home or a facility. Logistic regression was performed to investigate the relationships between patients' characteristics and the effects of rehabilitation determined as a change in the FIM on one hand and to where patients were discharged on the other. The variables with statistically significant differences in the logistic regression were further analyzed to calculate sensitivity, specificity and likelihood ratio with the area under the curve for predicting discharge to home. RESULTS: Patients' average age was 82.1 years, and 33.5% were male. A high score in the motor component of the FIM after rehabilitation and short duration of rehabilitation were statistically related to discharge to home. The cognitive component of the FIM was not associated with discharge to home. The motor-FIM cutoff after rehabilitation was calculated to be 60, resulting in sensitivity, specificity and positive likelihood ratio to predict discharge to home of 0.86, 0.78, and 4.00, respectively. CONCLUSION: This study showed that elderly patients' motor aspect of ADL after rehabilitation in rural community hospitals might predict discharge to home in rural settings. Rehabilitation in rural community hospitals can be effective in rural elderly patients with frailty and multimorbidity. The improvement in physical abilities was more important than cognitive functions for the effective discharge of the elderly patients in this study to their rural homes. By respecting patients' and their families' desires, effective rehabilitation may enable elderly patients to live at home.

Elbow Brace Promotes Postoperative Rehabilitation of Osteochondral Graft in Young Athletes with Osteochondritis Dissecans of the Humeral Capitellum.

OBJECTIVE: Treatment of large advanced osteochondritis dissecans (OCD) of the elbow in young athletes is challenging. METHODS: We retrospectively reviewed the results in 9 baseball players (mean age, 13.7 years; range, 12-15 years) who were followed up for a mean 21.1 months (range, 12-36 months) after osteochondral autograft. In this operation, cylindrical osteochondral plugs were harvested from a lateral femoral condyle and transferred to the lesion in humeral capitellum. After immobilizing the elbow by a splint for 2 weeks, the patients were encouraged to do range of motion exercises using an elbow brace with a hinge for 2 months. The elbow brace was applied to avoid excess stress to the implants on the capitellum and to the lateral collateral ligament. Patients were clinically assessed by the Japanese Orthopaedic Association elbow score (JOA score) and morphologically by radiographs as well as by magnetic resonance imaging (MRI). RESULTS: Patients started playing catch at 3 months and returned to baseball at competitive level at around 6 months postoperatively. The average JOA score was 68.0 points before operation and improved to 98.7 points at follow-up. Bony fusion between the implants and host bone was observed radiographically at 3 months. MRI confirmed a durable load-bearing articular surface of the capitellum at 1 year. CONCLUSIONS: Osteochondral autograft with postoperative rehabilitation using an elbow brace is a reasonable treatment for young athletes with an advanced lesion of OCD of the elbow who desire a relatively quick return to their pre-injury sports activity level.

Role of the periosteal flap in chondrocyte transplantation: an experimental study in rabbits.

To determine the role of the periosteal flap in chondrocyte transplantation for the treatment of articular cartilage defects, a cartilage defect was created on the patellar groove of the rabbit knee. The defect was filled with chondrocytes cultured in collagen gel, and was covered with a periosteal flap the cambial layer of which was facing the patella (P group), or facing down against the bone marrow (M group). The same defect was covered with a periosteal flap that was frozen and thawed three times (F group), and an artificial collagen film (C group). At 3 and 6 months, the defects were filled with reparative tissues that showed a smooth surface and resembled hyaline cartilage in the P, M, and F groups. There were no significant differences between the reparative tissues in the three groups histologically, immunohistochemically, biochemically, and biomechanically, although the collagen film fell down into the defect and the reparative tissue had a fibrous tissue-like appearance. These results showed that the periosteal flap does not have a beneficial humoral or cellular effect on the formation of reparative tissue, suggesting that the periosteal flap might act as a mechanical barrier to prevent leakage of grafted chondrocytes.

Optimum combination of monolayer and three-dimensional cultures for cartilage-like tissue engineering.

The autologous chondrocyte transplantation technique has been introduced for the repair of articular cartilage defects. The advantage of transplanting chondrocytes cultured in suspension includes the in vitro expansion of cell numbers. However, the disadvantages include the potential leakage of cells from defects, dedifferentiation of cellular phenotype, and uneven distribution of cells. Transplantation of chondrocytes cultured in collagen gel resolves those problems. However, the expansion of cells in three-dimensional culture is more difficult than in monolayer culture, and for practical reasons only limited numbers of chondrocytes can be obtained from an unloaded area of the knee. To develop a method for the production of high-quality cultured grafts, we investigated the combination of monolayer culture for cell expansion and three-dimensional culture for maintenance of cell phenotype. Articular chondrocytes from rabbits were divided into four groups, exposed to various combinations of culture conditions, and cultured for a total of 3 weeks. Each group was evaluated histologically, biochemically, and biomechanically. Our findings showed that the combination of 2 weeks of monolayer culture followed by 1 week of three-dimensional culture resulted in the highest chondroitin sulfate levels, sufficient cell numbers, and adequate stiffness of the chondrocyte-collagen composites, giving optimal graft preparation.

Effects of neurotrophic factors on chemokinesis of Schwann cells in culture.

Schwann cells are support cells in the peripheral nervous system and are responsible for migration, adhesion, production of the extracellular matrix, and myelination. Migration is considered to be essential for nerve regeneration after transsection. We have examined the chemokinetic effects of nerve growth factor (NGF), brain derived growth factor (BDNF), and neurotrophin-3 (NT-3) on Schwann cells in vitro using a chemotaxis chamber. The chemokinetic activity of Schwann cells was strongly accelerated by NGF, but was not influenced by BDNF. NT-3 at a concentration of 1 ng/ml had a stimulatory effect on chemokinesis. These data suggest that NGF is a chemoattractant for Schwann cells in vitro. Giving exogenous NGF might stimulate both migration of Schwann cells and the formation of Büngner's bands after peripheral nerve injuries in animal models.

Effects of different embedding gels on periostealchondrogenesis in vitro.

To develop a more useful organ culture model for periosteal chondrogenesis in vitro, we compared the effects of the embedding of explants in agarose versus collagen gels. Chondrogenic differentiation was examined by means of histological observation and in terms of the expression of mRNA encoding two cartilage markers, Type II collagen and Aggrecan. Periosteal explants were derived from the tibiae of rabbits. These explants were embedded in either agarose gel or collagen gel and cultured for 6 weeks. Histological examinations revealed that in the agarose gel, cells were neither present in the explants nor in the gel. In the collagen gel, cells migrated from the explanted tissues into the gel, and some cells were round. However, no explants showed safranin-O staining. Only 10% of 10 surviving explants in the agarose gel expressed the Type II collagen gene and the Aggrecan gene. On the other hand, of 25 surviving explants in the collagen gel, the expression of the Type II collagen gene was detected in 18 explants (72%) and that of the Aggrecan gene was detected in 21 explants (84%). In conclusion, we demonstrated that the periosteum exerts chondrogenesis in certain circumstances and its chondrogenesis is closely related to the culture material.