Search

Oral frailty (OF) is a form of frailty. Laughter and social communication such as talking and participating in community activities, contribute to extending healthy life expectancy by reducing stress and increasing physical activity. However, limited research exists on the association between laughter and social communication and OF. This cross-sectional study aimed to explore the association of laughter and social communication with the risk of developing OF using the eight-item OF Index among Fukushima residents. In 2020-2021, 916 residents aged 60-79 were surveyed regarding OF and psychosocial factors. Binomial logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for psychosocial factors associated with the OF prevalence. The OF prevalence was 41.5%. The sex- and age-adjusted ORs (95% CIs) for psychosocial factors associated with OF prevalence were 0.38 (0.26-0.57) for daily laughter, 0.51 (0.35-0.76) for laughter 1-5 times/week, 0.42 (0.20-0.89) for daily talking, 0.40 (0.22-0.72) for participating in community activities more than once/week, and 0.29 (0.20-0.43) for no depressive symptoms. After multivariate adjustment, only daily laughter and no depressive symptoms were associated with OF. As a public health strategy, increasing laughter and social communication frequencies, along with reducing depressive symptoms, may enhance healthy life expectancy through improved frailty., (© 2024. The Author(s).)

Background: Ultrasound-guided central venous catheterization (CVC) has become the standard of care. However, providers use a variety of approaches, encompassing the internal jugular vein (IJV), supraclavicular subclavian vein (SupraSCV), infraclavicular subclavian vein (InfraSCV), proximal axillary vein (ProxiAV), distal axillary vein (DistalAV), and femoral vein., Objective: This review aimed to compare the first-pass success rate and arterial puncture rate for different approaches to ultrasound-guided CVC above the diaphragm., Methods: In May 2023, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform were searched for randomized controlled trials (RCTs) comparing the 5 CVC approaches. The Confidence in Network Meta-Analysis tool was used to assess confidence. Thirteen RCTs (4418 participants and 13 comparisons) were included in this review., Results: The SupraSCV approach likely increased the proportion of first-attempt successes compared to the other 4 approaches. The SupraSCV first-attempt success demonstrated risk ratios (RRs) > 1.21 with a lower 95% confidence interval (CI) exceeding 1. Compared to the IJV, the SupraSCV approach likely increased the first-attempt success proportion (RR 1.22; 95% confidence interval [CI] 1.06-1.40, moderate confidence), whereas the DistalAV approach reduced it (RR 0.72; 95% CI 0.59-0.87, high confidence). Artery puncture had little to no difference across all approaches (low to high confidence)., Conclusion: Considering first-attempt success and mechanical complications, the SupraSCV may emerge as the preferred approach, while DistalAV might be the least preferable approach. Nevertheless, head-to-head studies comparing the approaches with the greatest first attempt success should be undertaken., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Backpack syndrome (BS) is a term used to describe symptoms such as shoulder and back pain that are believed to be caused by carrying a backpack. Few studies have investigated the changes in walking and running parameters with and without backpacks., Objective: The present study aimed to investigate the differences in walking and running parameters with and without backpacks in primary school children with and without BS., Methods: This cross-sectional study included 51 children (average age 9.3 years, 6- 12 years). Two questions were asked beforehand: whether the respondents had shoulder or back pain when going to school and present; those who answered that they had pain in both cases were defined as the BS group, while the others were the control group. Walking and running at comfortable speeds and walking and running with a 6 kg backpack on their backs were measured., Results: During walking, there were main effects for speed, cadence, and strike angle with and without the backpack, but no interactions were identified for any of the parameters. In running, however, there were main effects for speed, stride length, strike angle, and lift-off angle, and an interaction effect was observed for speed and stride length., Conclusions: During walking, carrying a 6 kg backpack increased cadence and walking speed. During running, carrying a backpack caused a decrease in stride length and running speed in the BS group, whereas there was no change in the control group, suggesting that the control and BS groups may respond differently.

Background: Hallux valgus occurs more frequently in women as they age; therefore, it is beneficial to prevent hallux valgus in younger women. The purpose of this study was to clarify the characteristics of hindfoot morphology and the range of motion of the ankle joint with hallux valgus in young women., Methods: The participants were 140 young women (mean age 18.8 ± 0.6 years). A three-dimensional footprint automatic measurement apparatus was used to measure the hallux valgus angle in the standing position and the arch-height ratio and heel-floor angle (HFA) in the standing and chair-sitting positions. The amount of change in foot morphology owing to differences in posture was calculated. The range of motion of the ankle joint dorsiflexion, plantarflexion, inversion, and eversion was measured. Participants were classified into two groups according to the presence of hallux valgus. Statistical analysis was used to compare hindfoot morphology and range of motion between the two groups, and the correlation between foot morphology and range of motion was investigated depending on the presence of hallux valgus., Results: With hallux valgus, the HFA tilted inwards (p = 0.010), and the change in the arch-height ratio due to the difference in posture was large (p = 0.021). There was no difference in the range of motion of the ankle joints with or without hallux valgus. In women with hallux valgus, the amount of change in arch height and HFA was correlated with the range of motion of eversion (r = 0.391, p = 0.027; r = -0.362, p = 0.042)., Conclusions: With hallux valgus, the hindfoot pronated, and the arch height decreased from sitting to standing. Furthermore, the amount of change in the hindfoot and midfoot due to posture was related to the range of motion of eversion., (© 2023. The College of Podiatry and the Australasian Podiatry Council.)

Background and Aims: Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient discomfort. Whether the supraclavicular (SC) or infraclavicular (IC) approach is more effective for SVC is unclear in the previous systematic review. This updated review is designed to search the efficacy and safety of both approaches adopting the Grading of Recommendations Assessment, Development and Evaluation approach., Methods: In May 2022, we explored the databases of Embase, MEDLINE, CENTRAL, ClinicalTrials.gov and WHO-ICTRP for randomised controlled trials to compare the two approaches., Results: Seventeen trials (2482 cases) were included. In the primary outcomes, the SC approach likely reduces the failure proportion (relative risk [RR], 0.63; 95% confidence interval [CI], 0.47-0.86; I 2 = 5%) and the incidence of malposition (RR, 0.23; 95% CI, 0.13-0.39; I 2 = 0%) with moderate evidence and may slightly reduce the incidence of arterial puncture and pneumothorax (RR, 0.59; 95% CI, 0.29-1.22; I 2 = 0%) with low evidence. In the secondary outcomes, the SC approach may decrease the access time and may increase the first-attempt success proportion., Conclusion: The SC approach for SVC should be selected after considering the clinician's expertise., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Anaesthesia.)

Background: Hallux valgus is a foot deformity that may affect gait, thus increasing the risk of falls among older people. We investigated the relationship between foot morphology, muscle strength, and physical performance., Methods: In this study, community-dwelling older people aged ≥65 years were included. A three-dimensional footprint automatic measurement apparatus was used to measure the hallux valgus angle, arch height ratio, and heel-floor angle. Furthermore, the toe flexor strength and ankle plantar flexion strength were measured. Physical performance tests included the five-repetition sit-to-stand test, one-leg standing time, maximal step length, functional reach test, and 5-m fastest walking time (walking time). The relationship between the hallux valgus angle and foot morphology and muscle strength was examined. In addition, factors affecting physical performance testing were assessed. Two-group comparisons, correlation, and multiple comparisons were used for statistical analyses., Results: Of the 133 women (age 77.7 ± 6.2 years), 57 had hallux valgus and 76 had no hallux valgus. There was a significant difference in the arch height ratio and heel-floor angle between women with and without hallux valgus (p < 0.001). A correlation was found between the hallux valgus angle and the heel-floor angle (r = 0.468, p < 0.001) and arch height ratio (r = - 0.337, p < 0.001), respectively. Multiple regression analysis showed that the hallux valgus angle was related to functional reach (β = - 0.162, p = 0.042), and toe flexor strength was related to five-repetition sit-to-stand (β = - 0.182, p = 0.036), maximal step length (β = 0.328, p < 0.001), and walking time (β = - 0.219, p = 0.006)., Conclusions: A relationship was found between the hallux valgus angle, arch height rate, and inward inclination angle of the calcaneus. Functional reach was predicted based on the hallux valgus angle, whereas the five-repetition sit-to-stand, maximal step length, and walking time were predicted based on toe flexor strength. Hallux valgus predicted not only the forefoot but also the foot morphology and was related to physical performance. From the perspective of motor function and fall prevention, efforts should be made to better understand and prevent the onset and progression of hallux valgus., (© 2022. The Author(s).)

Background: The effects of physical fitness and age on motor function in older adults who continue to exercise remain unclear. This study aimed to examine the effects of participation in self-management exercise groups in adults aged ≥65 years., Methods: The motor functions of 372 citizens who participated in a self-management exercise group for 1 year were examined. The motor functions were assessed by measuring grip strength, five-repetition sit-to-stand test, 5-m fastest walking time (walking time) and timed up and go test. The participants were grouped according to their baseline grip strength (low or high grip strength groups). The baseline parameters were compared to those assessed 1 year after group participation. In addition, the rates of long-term care/support need certification were examined at 2-year follow-up., Results: In the low grip strength group aged ≥75 years, the grip strength of men, and grip strength and five-repetition sit-to-stand test results of women improved after 1 year. In the high grip strength group, the five-repetition sit-to-stand and timed up and go test results of men aged 65-74 years and five-repetition sit-to-stand test results of men aged ≥75 years improved. Among women in the high grip strength group, grip strength, five-repetition sit-to-stand test, walking time, and timed up and go test results improved in the participants aged 65-74 and ≥ 75 years. The number of new long-term care/support need certifications was comparable in both groups., Conclusions: Participation in self-management exercise groups led to maintaining or improving physical fitness among community-dwelling-older adults. Furthermore, higher baseline grip strength was associated with improvements in many motor functions; therefore, participation in self-management exercise groups before the onset of functional decline is desirable., (© 2022. The Author(s).)

No reports of vasovagal reflex activity during robotic-assisted laparoscopic hysterectomy (RALH) exist. We present a case of a woman who underwent a RALH for a uterine myoma with uterine adenomyosis. A lack of tactile feedback and a traction force sensor create unique risks of robot-assisted surgery. Anesthesiologists should be aware of these risks., Competing Interests: The authors declare that they have no competing interests associated with this manuscript., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Increased left ventricular (LV) afterload in patients with aortic stenosis consists of valvular and vascular loads; however, the effects of vascular load induced by arterial stiffness on clinical outcomes after transcatheter aortic valve replacement (TAVR) remain unclear. This study evaluated the prognostic value of brachial-ankle pulse wave velocity (baPWV) after TAVR., Methods: A retrospective study including 161 consecutive patients who underwent TAVR with a pre-procedural baPWV assessment was conducted. We investigated the association between baPWV and the 1-year composite outcome comprising all-cause death and rehospitalization related to heart failure. Echocardiographic measurements including the LV mass index (LVMi) and LV diastolic function at 1, 6, and 12 months after TAVR were assessed., Results: Of the 161 patients, 31 patients experienced composite outcome within 1 year after TAVR. The receiver operating characteristic curve analysis revealed that the discriminating baPWV level to discern 1-year composite outcome was 1,639 cm/s, and all subjects were allocated to two groups based on the result. Baseline characteristics were comparable between the high baPWV (n = 72) and low baPWV groups (n = 89). The Kaplan-Meier curve revealed a significantly higher cumulative 1-year composite outcome in the high baPWV group than in the low baPWV group (31% vs. 10%; log-rank test, p<0.001). High baPWV was an independent predictor of the 1-year composite outcome (adjusted hazard ratio, 3.42; 95% confidence interval, 1.62-7.85; p = 0.002). Furthermore, post-procedural echocardiography revealed that the high baPWV group had less LVMi regression and higher E/e' after TAVR compared to the low baPWV group. The delayed reversal in LVMi and diastolic function attributable to arterial stiffness might be linked to impaired clinical outcomes after TAVR., Conclusions: Higher baPWV could be associated with adverse clinical outcomes and delayed reverse LV remodeling after TAVR., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Left ventricular hypertrophy (LVH) develops with both structural and electrical remodeling in response to elevated afterload due to aortic stenosis (AS). This study evaluated the prognostic value of electrocardiographic LVH (ECG LVH) after transcatheter aortic valve replacement (TAVR)., Methods: A retrospective study including 157 consecutive patients who underwent TAVR was conducted. ECG LVH was defined as Sokolow-Lyon voltage (S in V 1  + R in V 5/6 ) before TAVR was ≥3.5mV. We investigated the association between ECG LVH and the 1-year composite outcome comprising all-cause death and rehospitalization related to heart failure. ECG and echocardiographic measurements at 1, 6, and 12 months after TAVR were assessed., Results: The baseline characteristics were comparable between the ECG LVH (n = 74) and non-ECG LVH groups (n = 83). The ECG LVH was associated with a significantly greater reduction of Sokolow-Lyon voltage and LV mass index than the non-ECG LVH after TAVR. The absence of ECG LVH was an independent predictor of the 1-year composite outcome [adjusted hazard ratio (HR), 2.27; 95% confidence interval (CI), 1.01 - 5.60; p = 0.04]. Furthermore, a reduction of Sokolow-Lyon voltage from baseline to 1-month follow-up, but not a reduction of LV mass index, was associated with a lower cumulative composite outcome from 1 month to 1 year (adjusted HR, 0.36; 95% CI, 0.15 - 0.86; p = 0.02)., Conclusions: ECG LVH was associated with a low incidence of adverse clinical outcomes and greater reverse LV remodeling after TAVR. Preprocedural and serial LVH assessment by ECG might be useful in AS patients undergoing TAVR., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Hallux valgus, lesser toe deformity, and muscle weakness of the toe flexors contribute to falls in older people. This study aimed to examine the differences in toe flexor strength and foot morphology in older people requiring long-term care due to changes in the way they mobilize in everyday life., Methods: This study included 84 people aged ≥70 years without motor paralysis who underwent rehabilitation. They were divided into those who could mobilize without a wheelchair (walking group, n = 54) and those who used a wheelchair to mobilize (wheelchair group, n = 30). The presence or absence of diseases was confirmed, and hand grip strength, toe flexor strength, and foot morphology using the foot printer were measured. The presence of diseases, hand grip strength, toe flexor strength, and foot morphology were compared between the two groups. Multiple logistic analysis was performed with wheelchair dependence as the dichotomous outcome variable, and the percentages of each strength measure observed in the wheelchair group to the average hand grip and toe flexor strength measures in the walking group were compared., Results: No significant between-group difference in foot morphology was found. The factors related to the differences in ways of ambulating in daily life were history of fracture, heart disease, and toe flexor strength. After comparing the muscle strength of the wheelchair group with the mean values of the walking group, we found that the toe flexor strength was significantly lower than the hand grip strength., Conclusions: Older people who used a wheelchair to mobilize have significantly less toe flexor strength than those who do not despite no significant difference in foot morphology. Use of a wheelchair is associated with a reduction in toe flexor strength.

An amendment to this paper has been published and can be accessed via the original article.

Background: The prevalence of hallux valgus (HV) increases with age in females. Several studies have investigated the relationship between foot problems, including HV, and falls in older individuals. This study aimed to examine whether HV causes a decline in functional activity in young females and also evaluate the relationship between HV angle, functional activity, toe flexor strength, and plantar pressure., Methods: We assessed 94 females (mean age, 19.6 ± 1.3 years; mean body mass index, 21.2 ± 2.0 kg/m 2 ) not currently receiving treatment for lower limb disease. HV angle was determined using their footprint. Functional reach (FR) and maximum step length (MSL), toe flexor strength, and plantar pressure were measured. Plantar pressure was measured during walking. We also calculated FR and the pressure in eight regions (first toe, second through fifth toes, first metatarsal, second through fourth metatarsals, fifth metatarsal, midfoot, medial heel, and lateral heel)., Results: There were 39 and 55 participants in the HV and no HV groups, respectively. FR and MSL did not differ significantly between the HV and no HV groups. Toe flexor strength was significantly different between the HV and no HV groups (26.69 ± 9.68 vs. 32.19 ± 8.55, respectively) (p = 0.002, β = 0.206). During walking, plantar pressure was significantly lower in the second through fifth toes in the HV group (p = 0.005, β = 0.187). During FR, plantar pressure was significantly greater in the first metatarsal in the HV group (p = 0.016, β = 0.338). HV angle was negatively correlated with toe flexor strength (r = - 0.315, p = 0.002, β = 0.121) and plantar pressure during walking in the second through fifth toes (r = - 0.362, p < 0.001, β = 0.047), and positively correlated with plantar pressure during FR in the first metatarsal (r = 0.308, p = 0.002, β = 0.137). Toe flexor strength was negatively correlated with plantar pressure during FR in the second through fourth metatarsals (r = - 0.318, p = 0.002, β = 0.115), and there was a positive correlation with MSL (r = 0.330, p = 0.001, β = 0.092)., Conclusions: This study confirmed that HV reduces toe flexor strength and affects forefoot pressure during walking and FR in young females. Moreover, the toe flexor strength affects MSL. Efforts to prevent the onset and deterioration of HV from a young age might help reduce the risk of falling when older.

Objective: To evaluate the effects of analgesia by sacral surface electrical stimulation on lower abdominal pain in women with primary dysmenorrhoea., Design: Explorative study., Participants: Eleven female university students, who regularly experience difficulty in their university work due to menstrual pain, or who use analgesics for more than one day each month, were recruited., Methods: Sacral surface electrical stimulation, 5 Hz for 15 min, was performed after the onset of menstruation. Electrodes were placed on the skin, directly above the second and fourth sacral foramina. Visual analogue scale and degree of pain (calculated by using a low current to assess pain) were determined before and after electrical stimulation., Results: Visual analogue scale score and degree of pain decreased significantly immediately after electrical stimulation ( p < 0.001). A correlation was observed between visual analogue scale score and degree of pain before and after electrical stimulation (r=0.516, p <0.001). No side-effects were observed in any participant., Conclusion: Sacral surface electrical stimulation may provide immediate pain relief in women with dysmenorrhoea and lower abdominal pain., Competing Interests: The authors have no conflicts of interest to declare., (Journal Compilation © 2020 Foundation of Rehabilitation Information.)

This study aimed to explore the relationship between toe flexor strength and the daily activity levels in 56 Japanese older women aged between 70 and 88 years. The activity levels were measured as the average number of steps/day using a pedometer and the life space assessment (LSA) scores. The Mann-Whitney U test was used to compare toe flexor muscle strength and the LSA scores between those with fewer than and more than 6,000 steps/day. Spearman's correlation coefficient was used to investigate the relationship between toe grip strength according to age and each variable. The LSA scores were significantly higher in the group with >6,000 steps/day (β = 0.188, p < .05). A correlation was found between the number of steps/day and toe flexor strength (r = .424, β = 0.419, p < .05) and the LSA scores (r = .417, β = 0.435, p < .05) in the participants in their 80s. Increasing the number of steps/day may benefit women in their 80s.

Objective: We examined the toe flexor strength, foot morphology, and falls in community-dwelling elderly women who could walk outdoors independently without aids., Methods: The presence or absence of falls in 1 year, the toe flexor strength, and foot morphology were recorded in 70 women. Hallux valgus was defined as a first phalangeal angle ≥16°. Falls were compared based on the presence or absence of hallux valgus using the chi-squared test. The toe flexor strength, arch height ratio (medial longitudinal arch), and spread ratio (lateral arch) were compared using the Mann-Whitney U-test according to the presence or absence of hallux valgus. Spearman's correlation coefficient was used to compare toe flexor strength and foot morphology., Results: No difference in the fall rate was noted between those with hallux valgus on at least one foot and those without hallux valgus. No difference in toe flexor strength was noted between feet with and without hallux valgus. Correlations were found between the hallux valgus angle and the arch height (r=-0.228, P<0.01) and spread ratios (r=0.494, P<0.001)., Conclusions: Among community-dwelling elderly women who can walk independently outdoors without aids, the presence or absence of hallux valgus does not affect the incidence of falls. The lack of correlation between toe flexor strength and foot morphology may support this conclusion., Competing Interests: CONFLICTS OF INTEREST: The authors declare that there are no conflicts of interests., (©2019 The Japanese Association of Rehabilitation Medicine.)

Severe aortic stenosis (AS) is considered as an independent risk factor for perioperative cardiac complications of non-cardiac surgery. Surgical aortic valve replacement should be considered before non-cardiac surgery in patients with symptomatic severe AS. However, recently, transcatheter aortic valve replacement (TAVR) has emerged as an alternative approach for selected AS patients. We sought to determine the safety and efficacy of TAVR in preparation for major non-cardiac surgery. From our retrospective database, seven patients who underwent TAVR in preparation for major non-cardiac surgery were identified, and their clinical and hemodynamic data were collected. After TAVR, a significant reduction in the mean transaortic pressure gradient from 54.0 (Interquartile range (IQR) 47.5-64.5) to 18.0 (IQR 12.5-19.0) mmHg (p = 0.016) and an increase in the calculated aortic valve area from 0.6 (IQR 0.6-0.7) to 1.3 (IQR 1.1-1.5) cm 2 (p = 0.022) were noted. Non-cardiac surgery included lung segmentectomy and lymph node dissection, lung lobectomy, ileocecal resection, partial colectomy, partial nephrectomy, nephroureterectomy, laparoscopic nephrectomy, and laparoscopic nephroureterectomy. All the initial non-cardiac surgeries were performed without cardiac complications, under general anesthesia, 37 (IQR 32-74) days after TAVR. Two of the patients eventually needed additional non-cardiac surgery, which was performed uneventfully without the need for additional AS treatment. TAVR was an effective and safe procedure that might reduce the risk of general anesthesia and major non-cardiac surgery in severe AS.

Background: Objective nutritional indexes have been shown to predict prognoses in some clinical settings. We aimed to investigate the prognostic values of these indexes in patients undergoing transcatheter aortic valve implantation (TAVI)., Methods: We retrospectively analyzed 95 consecutive patients who underwent TAVI at our institution from December 2013 to February 2017. As objective nutritional indexes, a controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were calculated at baseline. The optimal cut-off values were determined using receiver operating characteristic curve analysis. According to the cut-off values, we investigated the association of these indexes with 1-year clinical outcomes including all-cause mortality and re-hospitalization due to heart failure., Results: In the Kaplan-Meier analysis, patients with a higher CONUT score and lower PNI had significantly higher incidence rates of 1-year mortality (26.9% vs. 2.9%; p<0.001, 17.4% vs. 2.0%; p=0.011, respectively) and composite outcome of mortality and re-hospitalization due to heart failure (38.5% vs. 13.0%; p=0.006, 39.3% vs. 11.9%; p=0.002, respectively). On Cox hazard analysis, CONUT score and PNI were significantly associated with 1-year mortality [hazard ratio (HR): 1.91; 95% confidence interval (CI): 1.27-2.88; p=0.002, HR: 0.86; 95% CI: 0.75-0.99; p=0.031, respectively] and the composite outcome (HR: 1.49; 95% CI: 1.11-2.00; p=0.007, HR: 0.88; 95% CI: 0.80-0.97; p=0.011, respectively)., Conclusions: The CONUT score and PNI are associated with 1-year clinical outcomes especially with 1-year all-cause mortality in patients undergoing TAVI. Moreover, the CONUT score and PNI might have better predictive values than GNRI., (Copyright © 2019. Published by Elsevier Ltd.)

[Purpose] The purpose was to clarify the relationship between foot morphology and toe muscle strength in female university students. [Participants and Methods] Data from 103 female university students (age, 20.4 ± 1.6 years) on height, body weight, pain in the foot and toes, heel height (cm) of shoes worn in everyday life, and the number of times (per week) shoes with heels ≥3 cm were worn were collected. The hallux valgus angle and medial longitudinal arch height ratio of the foot were measured, and toe muscle strength was evaluated according to the strength of the toe flexor and abductor hallucis muscles. [Results] Arch height ratio was significantly lower with hallux valgus angle ≥16°. In the 206 feet, a very weak negative correlation was found between hallux valgus angle and arch height ratio. In 150 feet with hallux valgus angle <16°, a very weak correlation was found between toe flexor strength and arch height ratio. [Conclusion] Body mass index was within the normal range, and the period of wearing high-heeled shoes was short; these factors have no effect on hallux valgus angle. Hallux valgus may be prevented by increasing toe flexor strength to prevent downward movement of the navicular and first cuneiform bones., Competing Interests: None.

Background: Obesity has previously been identified as an indicator of good prognosis in patients undergoing transcatheter aortic valve implantation (TAVI), an association known as the "obesity paradox". We investigated whether abdominal total fat area (TFA), visceral fat area (VFA), or subcutaneous fat area (SFA) are prognostic indicators of long-term clinical outcome in patients undergoing TAVI., Methods and results: We retrospectively analyzed 100 consecutive patients who underwent TAVI between December 2013 and April 2017. TFA, VFA, and SFA were measured from routine pre-procedural computed tomography (CT). Patients were divided into 2 groups according to median TFA, VFA, or SFA, and we investigated the association of abdominal fat area with adverse clinical events, including all-cause death and re-hospitalization due to worsening heart failure. At a median follow-up of 665 days, patients with higher SFA had significantly lower incidence of the composite outcome and all-cause death compared with patients with lower SFA (15.0% vs. 37.7%, P=0.025; and 8.9% vs. 23.7%, P=0.047, respectively). In contrast, patients with higher TFA or VFA did not show significant reduction in the incidences of the composite outcome or all-cause mortality., Conclusions: CT-derived SFA had prognostic value in patients undergoing TAVI.

An 82-year-old woman with symptomatic severe aortic stenosis (AS) developed an obstructive ileus caused by colon cancer. Colectomy was considered a high-risk surgery due to both the severe AS and obstructive ileus. Therefore, we planned placement of a colonic stent for the obstructive ileus. After stenting, we performed transcatheter aortic valve implantation (TAVI) instead of surgical aortic valve replacement (SAVR), because of the risk of bleeding during extracorporeal circulation and the perioperative risk of AVR (Society of Thoracic Surgery predicted risk of mortality: 7.4%). Successful colonic stenting and TAVI allowed a safer colectomy. The period from TAVI to colectomy was 12 days. TAVI could be useful for symptomatic severe AS in high-risk patients prior to non-cardiac surgery, especially for malignant tumors. < Learning objective: In patients with symptomatic severe aortic stenosis, aortic valve replacement is recommended prior to non-cardiac surgery. However, in patients with a malignancy, the complications due to the tumor and the risk of extracorporeal circulation remain a challenge in surgical aortic valve replacement. In such cases, transcatheter aortic valve implantation may be a useful option to reduce the incidence of complications and the time to surgery for the malignancy.>.

The safety of non-cardiac surgery is uncertain for asymptomatic patients with very severe aortic stenosis (AS). Herein, we describe a case involving an elderly and frail patient with asymptomatic, very severe AS. The patient was considered a high-risk candidate for aortic valve replacement (AVR); thus, transcatheter aortic valve implantation (TAVI) was planned. On perioperative examination, an abdominal aortic aneurysm (AAA) was observed, which required endovascular aneurysm repair (EVAR). To reduce the risks involved with sequential procedures, TAVI and EVAR were performed simultaneously. In patients with severe AS who are high-risk candidates for AVR, TAVI can be considered as an alternative therapy before non-cardiac surgery. In addition, the combined TAVI and EVAR procedure can reduce the risks associated with the perioperative period. < Learning objective: For patients with severe aortic stenosis who are high-risk candidates for aortic valve replacement (e.g. elderly patients with comorbidities), transcatheter aortic valve implantation (TAVI) can be considered as an alternative therapy before non-cardiac surgery. In addition, combining TAVI and endovascular aneurysm repair can reduce the perioperative risks compared with those for sequential procedures. However, additional research is needed.>.

This report describes an elderly severe aortic stenosis (AS) patient, who had a history of coronary artery bypass grafting and endovascular repair for an abdominal aortic aneurysm (AAA). Type II endoleak with enlargement of AAA was diagnosed and ligation of inferior mesenteric artery (IMA) was recommended. Because aortic valve replacement (AVR) was high risk, we planned transcatheter aortic valve implantation (TAVI). Considering risks of IMA ligation under dual antiplatelet therapy, increased blood pressure after TAVI, and general anesthesia, we performed combined TAVI and IMA ligation. TAVI could be useful for AS patients who are at high risk for AVR before non-cardiac surgery.

Background: Serratus-intercostal plane block (SIPB) is a novel ultrasound-guided thoracic wall nerve block reported recently. We performed SIPB for perioperative analgesia together with general anesthesia in patients undergoing partial mastectomy., Methods: We chose the patients with breast cancer of upper to lower lateral quadrant or subareolar region. The patients received general anesthesia followed by ultrasound-guided SIPB. The needle was introduced in the midaxillary line at the level of the fourth or fifth rib. Under continuous ultrasound guidance, we injected 30 ml of ropivacaine 0.375-0.5% between the serratus anterior and the external intercostal muscles., Results: After the partial mastectomy, the area of sensory loss obtained by skin prick was extended from five to six as the number of intercostal spaces. Analgesic effect was obtained for 12 to 24 hours. The cephalad dermatomal paresthesia was T2. More than 20 patients received SIPB, and no one acquired the sensory loss at T1 of dermatomal distribution., Conclusions: SIPB provides effective analgesia for breast surgery of upper to lower lateral quadrant and/or subareolar region. However, it should be administered with other additional analgesic agents when axillary dissection is performed, because sensory loss of T1 is difficult to achieve.

We introduced a system that uses re-useable linens for surgical operations in 2008. After 3 years from introduction we were able to reduce the expense of about yen 4,340,000 per year and CO2 production of 9,548 kg CO2 x m(-2) per year. We were convinced of the effect on reducing the expense of surgical operations and of decreasing the level of CO2 production that leads to global warming.

A 4-year-old girl with perforating appendicitis developed abdominal compartment syndrome (ACS). Appendicitis in children of preschool age is highly likely to rupture, resulting in serious condition. Although we gave priority to systemic management in this ACS case since the child showed disturbed consciousness due to intracranial hypertension as well as hypercytokinemic encephalopathy. However, we should have performed abdominal decompression by laparotomy early. ACS causes progressive multiple organ failure through compromising the respiratory and circulatory systems and injuring multiple organs, leading to generalized inflammatory reactions. We should, therefore, manage ACS patients systemically sharing a notion that they must be treated early with abdominal decompression by laparotomy.

We detected congenital aqueductal stenosis from CT images taken for the differential diagnosis of a post-dural puncture headache. A history of multiple spinal taps for anesthesia and the nature of headaches led us to a suspected diagnosis of headache caused by intracranial hypotension at variance with image findings diagnostic of hydrocephalus, perplexing us in the differential diagnosis. Hydrocephalus was of congenital type, having no causal relationship with past multiple spinal taps. Congenital aqueductal stenosis varies in severity from infancy-onset one to accidental one diagnosed from images like the current case. Since treatment may differ between hydrocephalus and intracranial hypotension which are diametrically opposite to each other in pathophysiology, it is essential to differentiate a headache in an overall view of a history, physical examination, and image findings.

Propofol (2,6-diisopropylphenol) is administered intravenously for induction and maintenance of anesthesia; however, cases of progressive myocardial failure (propofol syndrome) related to the use of propofol have been reported. In the present study, the individual differences in pharmacokinetics and/or pharmacodynamics of propofol were investigated in patients who were genotyped for CYP2B6 and UGT1A9. Fifty-one patients treated with propofol in St. Marianna University Hospital were recruited for this study and provided written informed consent. The following parameters were analyzed: awakening time as a pharmacodynamic parameter, duration of propofol infusion, drug concentration in plasma after treatment, genotypes of CYP2B6 and UGT1A9, and age (42-84 years, mean of 65 years). Propofol was rapidly cleared from the blood of the subjects as a result of distribution and elimination. The awakening time after stopping propofol infusion was significantly correlated with the duration of infusion and the maximum concentration of propofol in these subjects. The maximum plasma concentration of propofol after normalizing with the duration of infusion was affected by the CYP2B6 G516T variant (related to impaired function) and was significantly affected by a propofol risk index score that incorporated CYP2B6 G516T and UGT1A9 I399C>T (high expression) genotypes and advanced age. These results provide important information indicating that the genotypes of the two enzymes studied and advanced age are combinative determinant factors of the pharmacokinetics and/or pharmacodynamics of propofol.

The production of nitric oxide (NO) by inducible NO synthase (NOS) and carbon monoxide (CO) by inducible heme oxygenase (HO) contributes greatly to endotoxemia. Reciprocal relationships have been proposed between the NO/NOS and CO/HO systems. However, the interaction between these systems during endotoxemia is unclear, and it is unknown whether the interactive behavior differs among organs. Using endotoxic rats, we studied the effects of the inducible NOS (iNOS) inhibitor L-canavanine (CAN), and the HO inhibitor zinc protoporphyrin (ZPP) on gene expression and protein levels of iNOS, endothelial NOS (eNOS), inducible HO (HO-1), and constitutive HO (HO-2) in the brain, lung, heart, liver and kidney tissue. Intravenous injection of LPS significantly increased iNOS and HO-1 gene expression in all organs. The effects of LPS on eNOS gene expression differed among organs, with increased expression in the liver and kidney, and no change in the lung, brain and heart. ZPP administration down-regulated the LPS-induced increase in HO-1 expression and produced a further increase in iNOS expression in all organs. These data suggest that the CO/HO system modifies the NO/NOS system in endotoxic organs, and that there were only minor organ-specific behaviors in terms of the relationship between these systems in the organs examined.

Electroconvulsive therapy (ECT) is an effective and safe treatment for a variety of neuropsychiatric disorders. Premedication with atropine has been recommended in order to avoid bradycardia and transient asystole induced by ECT. In contrast, some other arrhythmias can happen such as atrial flutter and fibrillation. But ventricular tachycardia is rare. Reported herein is a case of incessant non-sustained ventricular tachycardia, possibly triggered by atropine premedication.

Combined spinal epidural anesthesia is widely used for Caesarean section. Bolus administration of an epidural initial dose introduces the risk of drug flux from the epidural space to the subarachnoid space, and the volume effect of the initial dose may cause epidural top-up and extension of subarachnoid blockade. These problems may be avoided if the initial dose is not administered. This study investigated whether epidural continuous infusion without an initial dose (continuous group) can decrease postoperative pain as well as an epidural continuous infusion with an initial dose (initial dose group). Sixty-one patients undergoing elective Caesarean section were randomly assigned to the initial dose group or the continuous group. Twenty patients undergoing emergency Caesarean section with spinal anesthesia (spinal group) were also investigated to confirm that epidural block is effective for postoperative pain. Data in this study were obtained retrospectively from each patient's records. Between the initial dose group and the continuous group, there was no significant difference in the number of times flurbiprofen or pentazocine were used for postoperative pain relief. However, the number of times that pentazocine was used was significantly higher in the spinal group than in other groups. This finding suggests that an epidural initial dose is unnecessary for postoperative pain relief in combined spinal epidural anesthesia for Caesarean section.

Objective: To describe the effects and indications of sacral surface therapeutic electrical stimulation (SS-TES) for refractory urinary incontinence., Design: Evaluation before and after therapy., Setting: On clinical site and at nursing home., Subjects: Seven neurogenic bladder, five unstable bladder and six nocturia cases were investigated. Twelve were outpatients and six were residents., Interventions: Surface electrodes were placed at the posterior sacral foramens of S2 and S4. Stimulation conditions were duration 0.3 ms, frequency 20 Hz and maximum intensity. The stimulation was continued for 15 min twice daily for over one month., Main Outcome Measures: Therapeutic effects were evaluated on the basis of voiding charts as subjective findings and urodynamic study as objective findings before and after therapy., Results: Subjective findings showed incontinence frequency significantly decreased from 2.3 +/- 1.4 times/day before therapy to 1.3 +/- 2.0 times/day after therapy (p < 0.01); 55.5% of patients were improved or greatly improved. Objective findings showed that maximum vesical capacity (MVC) significantly increased from 208.2 +/- 94.5 ml before therapy to 282.1 +/- 66.8 ml (p < 0.001). Uninhibited contraction significantly decreased from 40.4 +/- 31.4 cmH2O before therapy to 25.7 +/- 23.9 cmH2O (p < 0.01); 44% of patients were improved or greatly improved. This therapy was effective in particular for cases whose MVC was small before applying SS-TES., Conclusion: SS-TES was effective in some patients with refractory urinary incontinence.