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.

Malabaricone C derived from nutmeg inhibits arachidonate 5-lipoxygenase activity and ameliorates psoriasis-like skin inflammation in mice.

As pro-inflammatory lipid mediators, leukotrienes have pathophysiological activities in several inflammatory diseases, including psoriasis. In the biosynthesis of leukotrienes from arachidonic acid, 5-lipoxygenase catalyzes the first two steps. In the present study, we showed that nutmeg (Myristica fragrans) strongly inhibited the catalytic activity of 5-lipoxygenase. To characterize the bioactive component(s) of nutmeg, we performed 5-lipoxygenase inhibitory activity-guided fractionation of aqueous ethanol extract of nutmeg, resulting in the isolation of malabaricone C having antioxidant activity. Malabaricone C exhibited potent competitive inhibition of 5-lipoxygenase with an IC50 value of 0.2 µM. In mice with imiquimod-induced psoriasis-like skin lesions, topical application of 2 mM malabaricone C significantly ameliorated hyperplasia and inflammatory cell infiltration, and suppressed the expression of the psoriasis-associated genes S100a9, Krt1, Il17a, and Il22. Lipid metabolome analysis of these psoriasis-like skin lesions showed that malabaricone C markedly decreased the level of leukotriene B4 but did not significantly increase the other pro-inflammatory lipid mediators. These findings suggest that malabaricone C decreases LTB4 by the 5-lipoxygenase inhibition and ameliorates the symptoms of psoriasis-like skin inflammation.

Effects of sodium-glucose cotransporter 2 inhibitor (dapagliflozin) on food intake and plasma fibroblast growth factor 21 levels in type 2 diabetes patients.

The objective of this study was to investigate whether sodium-glucose cotransporter 2 inhibitors (SGLT2i) treatment in patients with type 2 diabetes induced compensatory hyperphagia by reducing fibroblast growth factor 21 (FGF21) secretion. This prospective study was performed in 26 type 2 diabetes patients treated with dapagliflozin (5 mg/day). Hormonal factors associated with glucose metabolism, dietary intakes estimated by brief self-administered diet-history questionnaire (BDHQ), body weight (BW), and body composition were measured at baseline, and 4 and 12 weeks after dapagliflozin. At 12 weeks, HbA1c levels and BW decreased significantly (both p < 0.0001). BMI at baseline was predictive to baseline log10 (FGF21) (p = 0.037). This study showed no change in FGF21, but insulin and glucagon levels decreased significantly (both p < 0.05). Although hyperphagia was found in 10 patients (38.5%), defining hyperphagia as >20% increase in carbohydrate intake, dapagliflozin treatment induced no hyperphagia, when analyzed by all subjects, and there was no significant association between changes in FGF21 levels and carbohydrate intake. On the other hand, a positive correlation between changes in FGF21 levels or carbohydrate intake and BW was observed (both p < 0.005). Taken together, this study demonstrates that the intervention to maintain the reduced levels in FGF21 is beneficial for BW reduction in type 2 diabetes patients treated with SGLT2i.

Sex Differences in the Residual Patellar Tendon After Harvesting Its Central Third for Anterior Cruciate Ligament Reconstruction.

OBJECTIVES: Some studies have found that sex can affect the clinical results after anterior cruciate ligament reconstruction. We hypothesized that sex would significantly affect the healing of the postoperative patellar tendon. This study evaluated the patellar tendon after bone-patellar tendon-bone autograft harvest, specifically with regard to sex-dependent differences. METHODS: At 6 months postoperatively, an ultrasonographic evaluation was performed. We measured the residual donor site gap width between tendon tissues and the thickness of newly formed nontendinous tissue in the gap. In addition, the cross-sectional area of tendon tissue was measured. The ratios between the operated and contralateral sides were calculated, and the sexes were compared. A paired Student t test was performed, with P < .05 considered statistically significant. RESULTS: The population of 52 patients (32 male and 20 female) had a mean age ± SD of 23 ± 8 years. We observed no significant sex-dependent differences in the residual donor site gap and the thickness of newly formed nontendinous tissue when calculating ratios to the contralateral tendon. The mean cross-sectional area of tendon tissue was 101 ± 26 mm2 (male, 114 ± 26 mm2 ; female, 80 ± 16 mm2 ). When the ratios to the contralateral tendon were calculated, male patients had significantly higher cross-sectional area ratios than female patients (male, 124% ± 20%; female, 100% ± 19%, P = .024). CONCLUSIONS: We have reported a dramatic increase in the cross-sectional area of patellar tendon tissue during the first 6 months after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft, which was more prominent in male patients than in female patients. This difference might have contributed to the sex-dependent variation in clinical outcomes.

Quick lateral movements of the trunk in a seated position reflect mobility and activities of daily living (ADL) function in frail elderly individuals.

A novel and safe performance test for measuring mobility is described. The test, which we have named the Seated Side Tapping test (Side Tapping test), requires the subjects to move their bodies laterally to the left and right in turn as quickly as possible whilst remaining in a seated position. We examined the associations between the results of the new test and those of other mobility tests, ADL, and the use of walking aids. The participants were 75 frail elderly people who were receiving rehabilitation services. Gait speed and the timed up and go (TUG) test were employed as mobility tests, and the participants' use of walking aids was recorded. The ADL score was assessed using the Barthel Index. Significant correlations were found between the side tapping test and gait speed (r=-0.59, p<0.01), and TUG (r=0.63, p<0.01). This test also revealed significant relationships with the ADL scores and the use of walking aids. These results indicate that an ability to perform quick lateral trunk movements in a seated position reflects their mobility during standing. Thus, we concluded that since the side tapping test is simple and safe, it is useful for detecting mobility impairments, ADL levels, and the need for walking aids, especially in frail elderly individuals.

Tooth loss is associated with mild memory impairment in the elderly: the Fujiwara-kyo study.

It has been reported that tooth loss is associated with Alzheimer's disease (AD) and dementia. The purpose of this study was to investigate the association between tooth loss and mild memory impairment (MMI) among the elderly. We examined 3,061 community residents aged 65 years or older who had a score of 24 or more on the Mini-Mental State Examination. The subjects were divided according to their score for the three-word delayed recall test into control (score: 3 or 2) and MMI (score: 1 or 0) subjects. The subjects underwent a dental examination, an interview to determine their medical history, a self-administered questionnaire (inclusive of higher-level functional capacity, drinking and smoking habits, and frequency of going out), and a 10-m walking test. Fewer remaining teeth, going out once a week or less frequently, and a slow walking speed on a 10-m walking test were found at a significantly higher prevalence in the MMI group (n=101) than in the control group (n=2,960), after adjustment for sex, age, and the level of education. Multiple logistic regression analysis using these items revealed that the odds ratio of 0-10 remaining teeth for MMI was 1.71 (95% CI 1.05-2.78), compared to individuals with 22-32 remaining teeth. A significant increase was also found in a trend test to examine the increasing odds ratios of 22-32, 11-21, and 0-10 remaining teeth. We consider that tooth loss is associated with MMI later in life.

Orthodontic rehabilitation for anterior teeth lost due to trauma with crowding malocclusion.

Herein, we describe orthodontic management for an adolescent girl with traumatic loss of the upper central incisors and maxillary protrusion. The central incisors were immediately replaced and fixed with application of a semi-rigid splint for 12 days, then endodontically treated. Severe root resorption and degeneration of periodontal tissue were noted after 4 years and the teeth were extracted, while the patient had also developed maxillary protrusion with severe crowding in the lower arch. The treatment objectives were to close the spaces by mesial movement of the buccal segment in the upper arch and eliminate crowding by extraction of the lower bicuspids. Favorable occlusion was achieved as was substitution with the lateral incisors for the lost central teeth.

Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the Fujiwara-kyo study.

BACKGROUND: This cross-sectional study investigated the relationship between the number of remaining teeth to mild memory impairment (MMI), which is a preclinical stage of dementia, and to cognitive impairment. METHODS: The subjects were aged 65 years or older and were grouped according to their score for the Mini-Mental State Examination (MMSE), the three-word delayed recall test in the MMSE, and the Geriatric Depression Scale into the control group (n = 3,696), the MMI group (n = 121), and the low MMSE score (23 or lower) group (n = 214). We collected data on the number of remaining teeth, the length of the edentulous period, health-related lifestyle, medical history, blood pressure, height, and body weight. Fasting venous blood samples were also obtained. RESULTS: Multiple logistic regression analysis, adjusted for depressive symptoms, age, sex, length of education, and other explanatory variables, revealed that the odds ratios of 0-10 remaining teeth to 22-32 remaining teeth were 1.679 (95% CI 1.073-2.627) for MMI and 2.177 (95% CI 1.510-3.140) for a low MMSE score. A significant relationship was also found between the length of the edentulous period and the risk of a low MMSE score (odds ratio 3.102, 95% CI 1.432-6.720) (15 years or more/less than 15 years). CONCLUSIONS: Our findings suggest that tooth loss is associated with cognitive function.