Search

[Purpose] Patients with chronic unilateral vestibular hypofunction show decreased postural stability and low levels of physical activity and also experience much anxiety. Physical activity is known to improve these symptoms; however, no study has reported any positive effects of physical activity, such as symptom reduction or improvement in function in these patients. In this study, we investigated the role of a walking program in improvement of dizziness, anxiety, and postural stability in this patient population. [Participants and Methods] This study included 21 patients with unilateral vestibular hypofunction and chronic dizziness. Patients were instructed to walk 30 min daily for 3 months. Physical activity levels and questionnaires for clinical symptoms, anxiety, and postural stability were evaluated before and after intervention. [Results] We observed significant differences in the amount of moderate-to-vigorous physical activity, clinical symptoms, and self-perceived handicap before and after the intervention. Additionally, anxiety levels were significantly reduced and postural stability was significantly improved in these patients. [Conclusion] A walking program improved physical activity levels, clinical symptoms, and postural stability and reduced self-perceived handicap and anxiety in patients with chronic unilateral vestibular hypofunction. These results highlight the effectiveness of a walking program for these patients and emphasize its role as a complementary vestibular rehabilitation strategy.

Accumulated evidence demonstrate that environmental stress affects the hippocampus, functioning in cognition and sociality, and causes various depressive symptoms. In addition, recent findings showed that environmental stress influenced the hippocampal activity correlated with neuroinflammation, and impaired the hippocampal sharp wave ripples (SWRs), pattens of spike sequences, and the theta rhythms, a strong oscillation observed in the hippocampus. The involvement of the electrophysiological alterations in the etiology of depression has not been appreciated especially in the hippocampus. Furthermore, the pathological markers associated with such alterations have not been identified. In the present study, therefore, the impairment of the SWRs and the theta rhythms in the hippocampus of the restraint stress-induced depression model of mice was analyzed. In the model mice the hippocampal SWRs and theta rhythms were impaired in depression, while physical exercise significantly reverted them. As previously reported, chronic stress induced inflammation in the affected hippocampus in parallel with defects of adult neurogenesis, on the other hand physical exercise ameliorated those pathological conditions of the bran in depression. In conclusion, this study demonstrated the implications of impairment of the hippocampal SWRs and theta rhythms in the etiology of depression and their usefulness as diagnostic markers of depression.

This study aimed to develop a Japanese version of the international PROMs "Vail Hip Score (Vail10)" and to establish its reliability, validity, and responsiveness with COSMIN check-list.The study was conducted from March 2016 to October 2017 and included 46 patients totaling 47 joints. Disorders included 30 cases of FAI (55%), 13 cases of DDH (28%), and 4 others (8%). We administered an identical set of PROMs (5 measures: Japanese-version iHOT12 (pilot draft), Japanese-version Vail10, Japanese-version Oxford Hip Score, JHEQ, and SF36) twice in these subjects. We determined interclass correlation coefficients for the first and second round [ICC(1,2)], as well as the Cronbach α coefficient for patient responses to each of the 10 items in Vail10. In addition, we determined Spearman rank correlation coefficients of Vail10, OHS, JHEQ, satisfaction VAS, the 8 subscales of SF36, and the 3 QOL summary scores.ICC for the total score of all 10 items in Vail10 was 0.96. Cronbach α coefficient was 0.96. Bland-Altman plot analysis showed a solid agreement. Regarding the validity, Spearman rank correlation coefficients, only satisfaction VAS, and SF36 subscales of PF and BP had r 0.45 (p 0.01 in both administration rounds). The SDC (1.32) was smaller than the MIC (8.14).After developing the Japanese version of Vail10, we examined its Reliability, validity, and responsiveness by administering the measure to patients with acetabular labral tear. Correlations were strong and demonstrated the efficacy of the Japanese version of Vail10.

The purpose of this study is to justify the result of the modified Stand-Up test (MSUT) in Little League baseball players and to clarify the association with sports related disorders in the elbow.A total of 245 (240 boys and 5 girls) Little League baseball players aged 9 to 12 underwent physical examination, elbow ultrasonography and questionnaires during a routine medical checkup. In addition, the MSUT, based on the Japanese Orthopaedic Association (JOA)'s original Stand-Up test to evaluate the risk of Locomotive syndrome, was performed.Seventeen osteochondritis dissecans (OCD) of capitellum and 4 medial epicondylar fragmentation (MEF) cases were diagnosed with ultrasonography in 242 players. Based on the MSUT, five boys could not stand up from 40 cm platform with the single leg stance, two of whom complained of current elbow pain, three of whom diagnosed with a positive finding with ultrasonography. Odds ratio (95% confidence limits) of risk factors for failing to the 40 cm-MSUT with the single leg stance were: incidence of current elbow pain 5.7 (0.9-35.5); OCD (Grade 1b and 2) 8.2 (0.8-83); and MEF 19.5 (1.7-230).Two percent of Little League baseball players were unable to stand up from a 40 cm high platform/stool with the single leg stance by the MSUT and it was associated with an increase in MEF or OCD diagnosis by ultrasonography and presence of elbow pain. These results suggest that players who failed to the 40 cm-MSUT with the single leg stance are at risk of elbow disorders. Also, these results are consistent with previous research on throwing injuries that have associated poor control in the legs or trunk with pain and injury involving the upper extremities. MSUT, a relatively simple procedure, may be a helpful adjunct for screening to estimate readiness for resuming general physical activity in Little League baseball players.

The International Hip Outcome Tool 12 (iHOT12) was authorized by the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN). iHOT12 is increasingly being adopted in orthopedic studies to report patient outcomes. This study aimed to develop a Japanese version of the International Hip Outcome Tools "iHOT12J", and to establish its reliability, validity, and responsiveness.To assess test-retest reliability, an identical set of patients reported outcome measures with five qualitative scoring measures including iHOT12; these were filled out by each patient twice. Reliability was explored using Cronbachss alpha and intraclass correlation coefficient. The Bland-Altman plot was used to explore the absolute agreement. To evaluate validity, we examined the relationships between SF36 and iHOT12. Responsiveness was assessed by comparing the smallest detectable change to the minimal important change by applying an anchor-based approach.Fifty patients (51 joints) were analyzed from March 2016 to October 2017 in Japanese four facility. The Cronbach α coefficient was 0.90 and the average value of intraclass coefficient (ICC) was 0.89. Bland-Altman plot analysis showed a solid agreement. Regarding the validity, the Spearman rank correlation coefficients were strong with PF (r = 0.69, p 0.01), BP (r = 0.71, p 0.01) and PCS (r = 0.69, p 0.01). The smallest detectable change (3.19) was smaller than the minimum important change (12.40).We developed iHOT12J, which seems to show sufficient reliability, validity, and responsiveness. We believe that this patient reported outcome measure is beneficial in studying Japanese patients with femoroacetabular impingement.

Soft tissue coverage around the knee has persisted as a challenge for plastic and reconstructive surgeons. The distally-based anterolateral thigh flap is often used for coverage. Nevertheless, few anatomical studies have investigated the retrograde vascular pedicle. This report clarifies the anatomy of the connection between the descending branch of the lateral circumflex femoral artery and the lateral superior genicular artery. This study examined 38 lower limbs from cadavers and recorded the numbers and locations of perforating vessels. Proximal and distal pivot points were also recorded. The proximal pivot point was 1.0-12.1 cm (average = 6.0 cm) from the inguinal ligament. The distal pivot point, found under the vastus lateralis muscle in all 38 specimens, was 4.0-13.6 cm (average = 9.8 cm) from the lateral superior edge of the patella. The most distal perforator was 8.2-28.0 cm (average = 18.9 cm) from the proximal pivot point. The most proximal perforator was 3.0-19.5 cm (average = 8.7 cm) from the distal pivot point. Details of the anastomosis of the descending branch and the superior lateral genicular artery were clarified. The distally-based anterolateral thigh flap presents one option for reconstruction around the knee.

Evaluation of diagnostic imaging.To comprehend anatomic relationships between the internal carotid artery (ICA) and bicortical purchase of C1 lateral mass screws from the perspective of avoiding ICA injury.No studies have evaluated safety trajectory of atlantal lateral mass screw that would avoid the ICA injury in relation to its location, although previous studies have indicated concern about ICA injury by the screw tip at the anterior surface of the lateral mass of the atlas.From 149 of 177 human 3-dimensional computed tomography reconstruction images, 6 distance and 2 angle parameters related to both atlas and ICA were measured on the plane 15 degrees cephalad to the transverse plane. In addition, angle of error during screw insertion from intended trajectory was checked.The ICA was located in front of the C1 lateral mass in 64.4% of cases and faced the lateral one third of the C1 lateral mass in 54.6% of cases. None were located in front of the medial one third of the C1 lateral mass. The maximum inward screw trajectory that would violate the ICA was 8.6 degrees . Mean angle of preoperative C1/2 rotation and angle of error from intended trajectory was about 5 degrees , respectively.The possibility of ICA injury can be excluded by correct insertion of the screw 10 degrees inward. Although bicortical purchase with adequately medially angulated trajectory might be safe enough, we must remember the possibility to violate the ICA in bicortical purchase, because the intended screw trajectory never be assured.

The arthroscopic surgical procedures reported previously for a rheumatic hip joint have been primarily performed as diagnostic procedures. Only a few studies have reported the success of arthroscopic surgery in hip joint preservation. We encountered a special case in which joint remodeling was seen in a patient with rheumatoid arthritis treated with biological drugs after hip arthroscopic synovectomy and labral repair. We report the case of a 39-year-old woman with rheumatism, which was controlled with tocilizumab, prednisolone, and tacrolimus. The hip joint showed Larsen grade 3 destruction, and the Harris Hip Score was 55 points. Because of the patient's strong desire to undergo a hip preservation operation, we performed hip arthroscopic synovectomy and repair of a longitudinal labral tear. After 2.5 years, the joint space had undergone rebuilding with improvement to Larsen grade 2, and the Harris Hip Score had improved to 78 points; the patient was able to return to work with the use of 1 crutch. It is possible to perform hip arthroscopic surgery for rheumatoid arthritis with a hip preservation operation with biological drugs.

Background The canal flare index (CFI; the ratio of the diameter of the femoral canal at the isthmus in the anteroposterior(A–P) view to the diameter of the medullary canal 20 mm above the lesser trochanter) is often used as a canal characteristic. Clinically, however, CFI measurements are sometimes untrustworthy because of femoral rotation and, especially, greater anteversion among Japanese patients. Our objectives were to analyze femoral geometry, by use of 3D CAD models, to evaluate the effects of rotational error, and to seek an index less affected by rotation. Methods Computed axial tomography (CAT) scan data from 60 femurs were used. By use of CAD software, 3D femoral models were created. The outside of the femur and the inside canal width 20 mm (P20) and 10 mm proximal (P10), and 10 mm (D10), 20 mm (D20), 30 mm (D30), and40 mm (D40) distal from the center of the lesser trochanter, and at the isthmus were measured for different angles of femoral rotation. CFI, FFI (femoral flare index; the ratio of the extra-cortical diameters at the same levels as for the CFI), and other canal ratios (P20/D10, P20/D20, P20/D30, and P20/D40) were then calculated and the effect of rotational errors was investigated. Results Mean CFI, FFI, P20/D10, P20/D20, P20/D30, and P20/D40 were 4.29, 2.08, 2.05, 2.49, 2.85, and 3.09 inthe position without rotational error. CFI was not related to anteversion but had a negative correlation with isthmus canal width (only). In contrast FFI was almost constant at approximately 2.1 for different anteversion and age. Withregard to the effect of rotational error, CFI changed by 1.31, FFI by 0.40, P20/D10 by 0.41, P20/D20 by 0.40, P20/ D30 by 0.59, and P20/D40 by 0.80 for a variety of rotational angles. Conclusion Outside femoral shape was little different for any person; as a result, FFI was almost constant. Incontrast, CFI was revealed to be affected by canal width at the isthmus only. With regard to the effect of rotation, P20/ D20 was much less affected by rotation than CFI; it could, therefore, be an appropriate index for expressing proximal canal shape.