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Recently, to evaluate dynamic balance ability, a stipulated tempo step test has been developed, and a step error between tempo and contact time of feet has been used as an evaluation variable. The step error, postural sway, and their relationships may differ between the slow tempo (40 bpm) and fast tempo (120 bpm). This study aimed to examine the aforementioned problem with 62 participant children (30 boys and 32 girls). The step error and postural sway variables (X-axis path length, Y-axis path length, total path length, peripheral area, and rectangular area) during stepping while matching both tempos were measured. Means of one minute and three intervals (0-20 sec, 20-40 sec, and 40-60 sec) for each variable were calculated in both tempos. The results of the paired t-test showed that means of all variables were larger in the 40 bpm tempo than in the 120 bpm tempo. In the multiple comparison tests after the results of the two-way repeated measures ANOVA, the means of three intervals in all variables were larger in the 40 bpm tempo than in the 120 bpm tempo; the means of the sway variables, excluding that of the X-axis path length, in the 40 bpm tempo were larger in the 0-20 sec interval than in the 20-40 sec interval or the 40-60 sec interval. Correlations between step errors and those between the step error and sway variables of both tempos were insignificant or under moderation. The correlations between the step error and sway variables in both tempos were insignificant or significant but low, and those among sway variables were high, except between the X- and Y-axis path lengths. The relationship between both axis path lengths differed according to the tempo. In conclusion, in the case of the stipulated tempo step test targeting children, the slow tempo has a greater step error and postural sway than the fast tempo, and the sway in the early step stage is greater in the slow tempo. The relationships between step errors and between the step error and sway variables of both tempos are low; hence, the ability related to the test may differ in both tempos. The relationships among sway variables in both tempos are high, except between the X- and Y-axis path lengths.

Background Hip fractures in older people result in increased mortality. Objective We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively. Design Retrospective study. Setting Multicenter. Participants Patients aged ≥65 years with hip fractures who underwent surgery between 2011 and 2021 were enrolled. Methods The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively. Results We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively. Conclusions We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients. [ABSTRACT FROM AUTHOR]

Background: Few reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan. Methods: The number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015–2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables. Results: The annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p < 0.001), 0.63 for hospitals (p < 0.001), and 0.62 for the ageing rate (p < 0.001); those by the incidence of cholecystectomy were 0.60 for general surgeon specialists (p < 0.001) and 0.59 for hospitals (p < 0.001). The number/incidence of orthopaedic surgeon specialists, hospitals, femur fracture surgery, and cholecystectomy, as well as the ageing rate, were significantly higher in rural prefectures than in urban prefectures (p < 0.05). Conclusions: Inter-prefectural regional disparity was small, although certain items were unevenly distributed in the rural prefectures, which is contrary to our expectations. Higher prevalence was recognised in rural prefectures due to the higher ageing rate; however, supply and demand are balanced. This study provides basic data for healthcare policy development in a medium-sized community. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: There are approximately 13 million patients with osteoporosis in Japan; however, only 20% of them receive treatment. This study compared the 4‐year continuation rates of osteoporosis drugs at different dosing intervals across throughout Japan. Materials and methods: Receipt data were analyzed to determine the continuation of osteoporosis medication in patients who began treatment at 210 hospitals throughout Japan between October 2016 and September 2017. Continuation rates were compared using Kaplan–Meier curves and log‐rank tests. Results: The 4‐year continuation rates of daily, weekly, monthly, semi‐annual, and yearly medications nationwide were 8.6%, 16.5%, 13.5%, 31.0%, and 26.0%, respectively. The 4‐year continuation rates for semi‐annual and yearly drugs were significantly higher than daily, weekly, monthly drugs. Conclusion: Throughout Japan, the 4‐year treatment continuation rates of daily, weekly, monthly, semi‐annual, and yearly osteoporosis drugs all decreased over time. However, the continuation rates of semi‐annual and yearly drugs in the fourth year were significantly higher than those for the other dosing regimens. Therefore, injectable drugs with dosing intervals ≥6 months may improve continuation rates of osteoporosis drugs. Geriatr Gerontol Int 2023; 23: 665–670. In various regions of Japan, the 4‐year treatment continuation rates of daily, weekly, monthly, semi‐annual, and yearly drugs of osteoporosis drugs with different dosing intervals decreased over time. However, the continuation rates of semi‐annual and yearly drugs in the fourth year were significantly higher than those of the other drugs. [ABSTRACT FROM AUTHOR]

The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to assess the correlations between the detection of stress-associated hormone/oxidative stress markers in umbilical cord blood (CB) and the physical condition of the mother and neonate. Methods: CB units collected from normal vaginal deliveries were analyzed for various biochemical markers, some stress-associated hormones, such as progesterone, cortisol, adrenocorticotropic hormone (ACTH), corticotrophin releasing factor (CRF) and oxidative stress marker 8-hydroxy-deoxyguanosine (8-OHdG), respectively. Results: The progesterone concentration closely correlated with Apgar score, hemoglobin, maternal smoking and insulin concentration, respectively. In particular, its concentration in the non-smoker group and Apgar score 10 points group was significantly lower in comparison to the smoker group and Apgar score 8 points group, respectively. Cortisol concentration correlated significantly with the number of parities, pre-pregnancy body mass index (BMI), and increase of neonatal weight and height per day, respectively. In particular, its concentration in deliveries of males and first babies was significantly higher in comparison to female deliveries and second babies, respectively. In addition, a significant correlation was observed between the duration between spontaneous/artificial membrane rupture time and delivery time and the ACTH concentration. However, no significant relationship was observed between maternal/neonatal factors and CRF concentration and 8-OHdG concentration, respectively. A significant negative correlation was observed between cortisol and 8-OHdG concentration. Conclusion: CB stress-associated hormone/oxidative stress markers strongly reflect maternal and neonatal condition at the time of delivery. [ABSTRACT FROM AUTHOR]

Background: The Japanese Orthopaedic Association (JOA) hip score has been widely used in Japan as a method to assess hip joint diseases. The JOA hip score consists of four subcategories: pain (Pain), range of motion (ROM), ability to walk (Gait), and activities of daily life (ADL). We present the first report to verify the reliability and validity of the JOA hip score. Methods: A total of 123 patients with osteoarthritis of a unilateral hip and 29 patients with osteonecrosis of a unilateral hip were investigated. The JOA hip score was recorded by orthopedic surgeons in their offices. On the same day, each patient answered a Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (Japanese version 1.2) by himself or herself. The SF-36 survey measures eight subscales. The internal-consistency reliability of the JOA hip score was evaluated by Cronbach’s coefficient alpha. The validity of the JOA hip score was tested by Spearman’s correlation coefficients between the four subcategories of the JOA hip score and the eight SF-36 subscales. Results: When patients with osteoarthritis with conservative treatment were assessed by the JOA hip score, Cronbach’s coefficient alpha was 0.70, demonstrating internal-consistency reliability. However, when the JOA hip score was used for other groups, Cronbach’s coefficient alpha was <0.70, demonstrating the lack of internal-consistency reliability. Significant correlations were observed between Pain and bodily pain ( r = 0.63), between Gait and physical functioning (PF) ( r = 0.70), and between ADL and PF ( r = 0.81), but not in any other combinations. Conclusions: We found that the JOA hip score is a reliable system only for patients with osteoarthritis of the hip with conservative treatment. The JOA hip score is a scaling system with convergent and discriminant validity for the assessment of physical function and pain. [ABSTRACT FROM AUTHOR]

Aim: Placental/umbilical cord blood (CB) has been used increasingly not only for transplantations, but also in the field of life science research. However, little information is available on the biological characteristics of CB units collected in rural areas because no medical facilities are affiliated with CB banks. Little attention has been paid to the collection of CB units in rural areas compared to CB collected in metropolitan areas. CB is a precious source for life science research due to the recent low birth rate in Japan. Therefore, to efficiently utilize CB units, the purpose of the present study was to investigate the optimum obstetric factors associated with a higher yield of mononuclear/CD34+ cells per CB unit. Methods: CB units were collected at a single hospital (Hirosaki National Hospital). A total of 126 CB units from 105 vaginal deliveries and 21 cesarean section deliveries were available for cell separation within 24 h. Mononuclear low-density (LD) cells were separated using Ficoll-Paque and then processed for CD34+ cell enrichment using magnetic cell sorting. Associations between the maternal/neonatal factors and the yield of LD/CD34+ cells were analyzed. Results: Despite the larger net weight of CB collected from cesarean section deliveries, the total number of LD cells collected from vaginal deliveries was significantly higher than that collected from cesarean section deliveries. The total number of LD cells per CB unit from primigravidae was significantly higher compared with that collected from from multigravidae. Conclusion: CB units from vaginal deliveries of primigravidae may be more favorable because they contain a higher yield of mononuclear cells. [ABSTRACT FROM AUTHOR]

Epidemiological studies on hallux valgus (HV) are challenging owing to differences in sampling and diagnostic criteria across studies. This study aimed to indirectly clarify HV epidemiology using a national database. The age- and sex-stratified annual number rate of HV correction (RHVC) per 100,000 people in Japan during 2014–2019 were examined. The average annual RHVC was 3.0. RHVC had unimodal (peak, 65–79 years) and bimodal (peaks, 15–19 and 70–74 years) distributions among males and females, respectively, and increased over time in males aged 50–54 and 75–79 years and females aged 80–84 years. RHVC increases with increasing age and occurs commonly in female teens. The recent RHVC in Japan was lower than that reported in Europe and the United States, with an increasing trend among elderly people. III [ABSTRACT FROM AUTHOR]

Secular changes in the incidence rate of hip fractures were estimated to vary by fracture type, i.e., femoral neck or trochanteric fractures, age, and sex, in urban or rural areas in Kyoto Prefecture, Japan from 2008 to 2017., Purpose: Our survey in Kyoto Prefecture from 2008 to 2017 showed that the incidence rate of femoral neck fractures is generally increasing. We investigated the differences between urban and rural areas in the changes of the incidence rate over time of femoral neck and trochanteric fractures during the same period., Methods: Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The ratio of sick beds for acute-term care at the investigated hospitals to total number of beds in the urban area was 16.5% (1863/11,158) and 30.6% (1863/5623) in the rural area. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015., Results: There were 3559 and 6474 hip fractures in the urban and rural areas, respectively. Femoral neck fractures were 1936 (54.4%) and 2813 (43.5%) in each area. The increase of the population-adjusted numbers was marked by neck fractures in males, in both areas. In women, there was a significant increase in femoral neck fractures in the urban area in those aged 85 years and over. For trochanteric fractures, a significant increase was only found in women aged 65 to 74 years in the rural area., Conclusion: A regional difference in the secular changes in incidence rate of hip fractures was found in women, not in men, mostly because neck fractures in women increased in the over 85 group in the urban area., (© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.)

In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013-2017 compared to 2008-2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85., Purpose: The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017., Methods: Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015., Results: The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65-74, and a decrease in trochanteric fractures in the age group 75-84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85., Conclusion: In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013-2017) compared to the first half (2008-2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

Background: Nontraumatic osteonecrosis of the femoral head (ONFH) is one of the complications that may occur after renal transplantation. We investigated the relationship between the incidence of ONFH and polymorphisms in the genes for plasminogen activator inhibitor (PAI)-1, which is one of the major regulatory proteins of the fibrinolytic system, and 5,10-methylenetetrahydrofolate reductase (MTHFR), which is associated with the plasma levels of homocysteine in Japanese subjects., Methods: Thirty-one patients with postrenal transplant ONFH and 106 patients without ONFH were selected. Genotypes of PAI-1 4G/5G and MTHFR C677T were determined by direct sequencing of genomic DNA. In addition, plasma PAI-1 antigen (Ag) levels and plasma total homocysteine (tHcy) levels at the steady state were measured. The relationships between the incidence of ONFH and these genotypes, as well as plasma levels of the gene products, were investigated., Results: Plasma PAI-1 Ag levels were the highest in patients with the 4G/4G genotype, and plasma tHcy levels were the highest in patients with TT genotypes of MTHFR C677T. However, the relationship between the incidence of ONFHH and PAI-1 4G/5G or MTHFR C677T was not observed. The relationship between the incidence of ONFH and plasma levels of PAI-1 Ag or tHcy was not observed., Conclusions: Genotypes of PAI-1 4G/5G and MTHFR C677T or plasma concentrations of PAI-1 Ag and tHcy had no effect on the incidence of ONFH in Japanese subjects, unlike the results of studies performed in white subjects. The effect of genetic background on the pathologic conditions that developed in patients with postrenal transplant ONFH may differ according to race.

Advances in transplantation technology have brought about great benefits to patients suffering from organ failure, but the problem still remains of complications induced by steroids used for post-transplant immunosuppression. Among the side-effects caused by steroids, non-traumatic osteonecrosis of the femoral head (ONF) constitutes a serious problem. The same protocol for steroid administration induces ONF in some patients, but not in others, indicating the presence of individual difference in steroid sensitivity. We hypothesized that this difference might be mediated by the drug-transport protein, P-glycoprotein (P-gp), and investigated the relationship between single nucleotide polymorphisms in the multidrug resistance gene 1 (ABCB1, MDR1) encoding P-gp and ONF. Subjects comprised 136 patients receiving kidney transplantation. Thirty patients developed post-transplant ONF. Genomic DNA was extracted from peripheral blood, and genotypes of ABCB1 C3435T (exon 26) and G2677T/A (exon 21) were determined by direct sequencing. Multivariate analyses based on clinical information were performed to determine the relationship between ABCB1 genotypes and ONF. The dose/concentration (D/C) ratios of tacrolimus were also determined to estimate the activity of P-gp in patients with different genotypes of ABCB1 C3435T (CC, CT, TT), and in those who did and did not develop ONF. The ABCB1 3435TT genotype showed a significantly lower incidence of ONF (adjusted odds ratio = 0.10, P = 0.034). The D/C ratio in the 3435TT genotype was significantly higher than that in the 3435CC genotype. The D/C ratio in patients developing ONF was significantly higher than in those patients who did not develop ONF. The results suggest increased activity of P-gp in patients with the 3435TT genotype and in those who did not develop ONF. The ABCB1 2677 homozygous variant type also showed a lower incidence of ONF (adjusted odds ratio = 0.26, P = 0.056). The 3435T and 3435C alleles were in linkage disequilibrium with the 2677T and the 2677G alleles, respectively, in the study population. An assessment of C3435T and G2677T/A polymorphisms preceding steroid treatment could be useful for predicting the resistance to ONF development., (Copyright 2003 Lippincott Williams & Wilkins)