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Background: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex., Methods: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan., Results: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score., Conclusion: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex., Competing Interests: Declaration of Competing Interest There are no conflicts of interest to declare., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background & Aims: Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD., Methods: Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complications, postoperative quality-of-life (QoR-40J), readmission, and medical cost., Results: Of 80 eligible patients, 74 were analyzed in intention-to-treat principles: 37 in the control group and 37 in the ERAS group. The mean length of stay in the ERAS group was significantly shorter than that in the control group (20.1 ± 5.4 vs 26.9 ± 13.5 days, P < 0.001). The ERAS group had a significantly lower percentage of postoperative complications (32.4% vs 56.8%, P = 0.034) and readmissions (0% vs 8.1%, P = 0.038). Quality-of-life was also significantly better in the ERAS group (184 ± 12.4 vs 177 ± 14.5, P = 0.022). The total medical cost was lower in the ERAS group, but not significantly ($25,445 ± 5065 vs $28,384 ± 9999, P = 0.085)., Conclusions: The optimization of ERAS protocols in patients undergoing PD is safe and accelerates perioperative recovery and quality-of-life, thereby reducing the length of stay. Morbidity was significantly decreased in the ERAS group without compromising surgical outcome., Registration Number: UMIN000014068., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: A facile electromyographic test in the outpatient clinic is needed to evaluate the outcome of screening for carpal tunnel syndrome. The purpose of the current prospective study was to compare the accuracy of Nervepace digital electroneurometer (Nervepace) and Dantec Neuromatic 2000M (Dantec) measurements of a wide range of distal motor latency (DML) of the median nerve., Methods: The DML values for 112 of 126 median nerves examined with Nervepace and conventional electromyography, Dantec were statistically analyzed in this prospective study. The 30 hands of 15 clinically healthy adults 20-24 years old served as the reference group. Sixty consecutive patients (96 hands) with idiopathic carpal tunnel syndrome provided a wider range of DML values. All of the patients had standard clinical tests and standard motor (Dantec and Nervepace) and sensory (Dantec) electrodiagostic tests before endoscopic carpal tunnel release., Results: The DML was measurable in all 30 hands of the reference group, in all 96 hands of the patients by Dantec, but in only 82 hands (52 patients) by Nervepace. Nervepace and Dantec DML values of 6.0 ms or less had high correlation and agreement., Conclusions: Correlation and agreement decreased significantly among values greater than 6.0 ms.

Recent clinical studies have investigated postural sway characteristics in anterior cruciate ligament (ACL)-deficient knees, but the relative contributions of vision and ACL remain unclear. In the current study, we measured and compared postural sway during one-leg standing with eyes open and closed to assess the difference between legs with and without ACL injury, and we discuss the contribution of the ligament relative to vision and to postural sway in patients. We examined 32 patients (17 males, 15 females) with ACL injury before surgery from March 2001 through January 2004. None presented obvious dysfunction in the lower limbs or central nervous system. Using a gravicorder, we measured locus length per time (LG) and environmental area (AR) as the factors of postural sway during two-leg and one-leg standing with eyes open or closed. In the ACL-injured knee, the amount of postural sway increased significantly during injured leg standing with eyes closed (LG, P < 0.0001; AR, P < 0.0001), but it did not increase significantly with eyes open. There were no significant differences with respect to sex or general joint laxity. There was no correlation between postural sway and the anterior translation of the tibia measured by arthrometer KT2000 or between the muscle strength around the knee. We concluded that the amount of postural sway in the ACL-injured knee increased significantly on injured leg standing with eyes closed, and that vision appears to be dominant in compensating for the decreased contribution of the injured ACL.

Dysplasia of the hip, the most common cause of secondary coxarthrosis, has a relatively high prevalence in Japan. Rotational acetabular osteotomy (RAO) is an interventional strategy that seeks to reduce the abnormal amount of high stress concentration in the acetabulum and thereby to prevent the development of coxarthrosis. Long-term clinical results have been reported, but functional evaluations of the gait before and after RAO are underreported. The aim of our recently initiated long-term prospective study is to assess the effect of RAO on the gait characteristics of patients using quantitative gait analysis. Thus far 22 patients (1 male, 21 females; mean age 30 years, range 15-43 years) have been enrolled, treated, and completed the preoperative and postoperative gait analyses. Hip pain during walking decreased in all patients after the RAO. The postoperative hip extension motion angle on the treated side increased significantly and correlated positively with the improvement in the Japanese Orthopaedic Association (JOA) pain score. The current study shows that coxalgia and gait function improved after RAO.

Oxygen dynamics were measured in both sides of the paraspinal muscles of patients with degenerative lumbar scoliosis. The objective was to investigate the extent of stress by measuring the changes in oxygenation and blood flow volume using near-infrared spectroscopy. There were 44 patients with degenerative lumbar scoliosis (7 men, 37 women) and 11 controls with no scoliosis (2 men, 9 women). The measured recovery time for deoxyhemoglobin indicated the recovery from energy deficit after exercise. The average recovery time of the 11 control subjects was 2.4 +/- 0.7 s on the right and 2.4 +/- 0.8 s on the left. Among the 44 patients the average recovery time was 3.8 +/- 1.8 s on the convex side and 2.1 +/- 1.1 s on the concave side. There was a significant difference between the two groups. The recovery time on the concave side in patients was faster than that on the convex side. The results of the current study support the theory that stretching the muscles at the convex side results in chronic increases in the intramuscular compartment and reduced muscular blood flow.

Nerve conduction studies performed between 1994 and 1996 on the median nerves of 204 hands of 113 patients [20 patients in hemodialysis (HD) with diabetic nephropathy, 27 without diabetes mellitus in HD for 10 years or more, 18 without diabetes mellitus in HD for less than 10 years, and 48 with diabetes mellitus not undergoing HD] were reviewed retrospectively to develop a discriminating tool that would better inform treatment selection for patients with carpal tunnel syndrome (CTS) in HD. Scatter diagrams were drawn from the results of this study, and a regression formula was obtained. Among the long-term HD patients without diabetic nephropathy, distal motor latency (DML) tended to increase without a significant concomitant reduction in motor nerve conduction velocity (MCV) in the forearm. In contrast, in HD patients with diabetic nephropathy, DML tended to increase and MCV was significantly lower despite shorter HD periods. The study showed that in HD patients, in whom the MCV(m/s) > 11[9 - DML(ms)], the surgical results might be excellent or good. The formula was tested against the results of the 30 surgical cases. The sensitivity of this formula was 0.84, and the specificity was 1.00. The formula produced a predictor of surgical results when used in conjunction with other criteria for CTS in HD patients, especially those with diabetic nephropathy.

The grading system of Hashizume and Hirooka for carpal tunnel syndrome (CTS) was modified to refine the system for surgical treatment selection for specific subsets of CTS in patients with rheumatoid arthritis (RA). The grading system uses clinical signs and symptoms of CTS, including pain indications, to identify surgical subsets of patients to facilitate treatment selection. Retrospective analysis of the system included radiographic and electromyographic findings. Twenty-nine hands of 21 adult patients with CTS in RA were graded in the current study. Eight hands with mild synovitis received conservative treatment only. Endoscopic carpal tunnel release (ECTR), using Okutsu's universal subcutaneous endoscopic system with a clear cannula, was performed in 11 hands with moderate synovitis. Open carpal tunnel release (OCTR) combined with flexor tenosynovectomy was performed in 9 hands with severe synovitis. One more hand required OCTR after ECTR when malignant RA was diagnosed. Clinical results, evaluated using Kelly's criteria, were: excellent in 19 hands, good in 5, fair in 4, and poor in the 1 patient with malignant RA. Clinical symptoms of CTS improved in all but the latter patient. Although the sample size in the current study is small, the results appear to warrant further study to determine the clinical utility of the grading system.