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Objective: The aim of the study is to clarify the interactive combinations of clinical factors associated with knee extension strength 2 yrs after total knee arthroplasty., Design: A retrospective cohort study was conducted on 264 patients who underwent total knee arthroplasty. Knee extension strength was assessed preoperatively, 3 wks, and 2 yrs after total knee arthroplasty. Physical functions were measured with 10-m walking test, Timed Up and Go test, one-leg standing time, isometric knee flexion strength, knee joint stability, knee pain, femora-tibial angle, and passive knee extension and flexion angle before surgery as a baseline and 3 wks after total knee arthroplasty as acute phase. Regression tree analysis was conducted to clarify the interactive combinations that accurately predict the knee extension strength 2 yrs after total knee arthroplasty., Results: Operational side knee extension strength (>1.00 Nm/kg) at acute phase was the primal predictor for the highest knee extension strength at 2 yrs after total knee arthroplasty. Acute phase Timed Up and Go test (≤10.13 secs) and baseline 10-m walking test (≤11.72 secs) was the second predictor. Acute phase nonoperative side knee extension strength (>0.90 Nm/kg) was also selected as the predictor., Conclusions: This study demonstrated that knee extension strength or Timed Up and Go test in the acute phase and 10-m walking test before total knee arthroplasty are useful for estimating the knee extension strength after total knee arthroplasty. The results will help determine specific postoperative rehabilitation goals and training options., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: The purpose of this study is to investigate the predictive factors of home discharge for rehabilitation patients with cancer bone metastasis.Cancer patients with bone metastasis who underwent rehabilitation between April 2014 and March 2017 were retrospectively enrolled. Data on discharge destination were collected from medical records as outcomes. Multiple regression analyses were carried out to investigate the predictive factors of home discharge.Ninety-eight patients (mean age: 68.6 years, 42 females and 56 males) were included. Fifty patients were discharged home, 38 patients were discharged to other facilities, and 10 patients died. There were no skeletal-related events among these patients during their hospital stay. The receiver-operating curve for the predictive factors for home discharge of the Barthel Index at admission, Eastern Cooperative Oncology Group Performance Status at admission, and number of immediate family members living at home were 60 points (area under the curve [AUC] = 0.74, sensitivity = 0.6400, 1-specificity = 0.2766), 2 score (AUC = 0.65, sensitivity = 0.5400, 1-specificity = 0.2222), and 1 family member (AUC = 0.65, sensitivity = 0.9592, 1-specificity = 0.7222), respectively.In order to plan for cancer patients with bone metastasis to be discharged home, it is important to take into consideration the patients' Barthel Index and Performance Status at the time of hospital admission and the number of immediate family members living at home., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: The aim of this study was to identify which aspect of the preoperative lower limb functions is most likely to affect the functional mobility at 6 mos after total hip arthroplasty., Design: The study subjects included 125 women who underwent total hip arthroplasty. Hip flexion and abduction angles, hip abductor and knee extensor strengths, and lower limb load were measured preoperatively. The Timed Up and Go test was performed 6 mos postoperatively. Then, patients were divided into fast or slow groups as per the comparison with the Timed Up and Go score of healthy women., Results: Hip abductor strength and lower limb load on the nonoperative side were revealed as significant measurements that affected functional mobility after total hip arthroplasty according to stepwise multiple logistic regression analysis. Moreover, receiver operating characteristic curve analyses showed that the postoperative functional mobility was predicted by the lower limb load of the nonoperative side (cutoff point, 8.97 N/kg; sensitivity, 62.3%; specificity, 82.8%; and area under the curve, 77.5%)., Conclusions: This study revealed that patients with preoperative hip abductor strength of greater than 0.66 Nm/kg and lower limb load of greater than 8.97 N/kg on the nonoperative side could achieve better functional mobility at 6 mos postoperatively than healthy women of the same age group., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Cognitive impairments are among the nonmotor symptoms in patients with Parkinson disease. Understanding the cognitive impairments in patients with Parkinson disease may be critical for developing effective rehabilitation interventions. The aims of this study were to assess cognitive function in patients with Parkinson disease using the Wechsler Adult Intelligence Scale Third Edition, and the Wechsler Memory Scale Revised and to investigate how cognitive impairments relate to progression of disease in patients with Parkinson disease according to the Hoehn and Yahr stages., Design: Seventy-eight patients with Parkinson disease participated in the present study. Our study consisted of patients in the following Hoehn and Yahr groups: 1 (no disability, n = 11), 2 (mild, n = 34), 3 (moderate, n = 26), and 4 and 5 (severe, n = 7). Cognitive function was assessed using the Wechsler Adult Intelligence Scale Third Edition, and the Wechsler Memory Scale Revised., Results: The verbal memory was significantly higher in group 1 (106.4 ± 12.0) than in the other groups (2: 90.5 ± 14.0, 3: 89.9 ± 16.9, 4 and 5: 89.6 ± 11.4). Visual memory and delayed recall were similar to the results seen with verbal memory; however, the differences between groups were not statistically significant. The full-scale IQ was not significantly different (1: 107.3 ± 8.1, 2: 96.9 ± 18.2, 3: 96.7 ± 14.8, 4 and 5: 91.7 ± 9.5)., Conclusions: These results suggest that a comprehensive assessment focused on memory impairments is important for applying the appropriate interventions in patients with early-stage Parkinson disease.

Dupuytren's pathologic tissue usually involves the palmar skin and rarely infiltrates into the dorsal skin. In this study, we hypothesized that transplantation of a vascularized cutaneous flap harvested from the dorsum of the hand to the palmar skin, under which the pathologic cord existed might be useful for blocking reformation of the pathologic cords and for decreasing the recurrence rate. After removal of the pathologic tissue under the palmar skin, we harvested 2 types of skin islands nourished by the dorsal digital arterial network including the dorsal perforating arteries arising from the palmar digital arteries. The skin islands were transplanted into skin defects in the palm of the fingers and hand that had been created after correction of flexion contracture of the fingers. We performed this surgical maneuver on 24 fingers in 24 patients who exhibited severe flexion contracture because of Dupuytren disease. During the mean 40-month follow-up, only 1 patient experienced metacarpophalangeal joint flexion contracture ≥20 degrees in the operated finger. The recurrence rate was 4.2%, which was almost similar to that for a dermofasciectomy followed by a large full-thickness skin graft.

Background: We showed recently that limb allograft survival could be enhanced by administration of alloantigen (Ag)-pulsed immature dendritic cells (DC) after transplantation. Since indefinite graft survival was not achieved, we have further modified the DC by pharmacologic (rapamycin; Rapa) conditioning and ascertained their influence on graft survival, without continued immunosuppressive therapy., Methods: We compared the ability of donor Ag-pulsed, Rapa-conditioned rat myeloid DC (Rapa DC) and control DC (CTR DC) to inhibit alloreactive T-cell responses after limb transplantation in antilymphocyte serum (ALS)-treated recipients given a short postoperative course of cyclosporine (CsA)., Results: Both DC populations expressed similar levels of major histocompatibility complex (MHC) II, CD40 and CD54, but Rapa DC expressed lower CD86. After toll-like receptor activation, both populations produced minimal interleukin (IL)-12p70, but Rapa DC secreted lower levels of IL-6 and IL-10. The capacity of DCs to stimulate T-cell proliferation in mixed leukocyte reactions was very low. Pulsing of the DC with donor Ag did not alter their phenotype or function. Interestingly, posttransplant administration of donor Ag-pulsed Rapa DC to rats given perioperative ALS and 21 days CsA significantly delayed graft rejection and promoted long-term (>125 days) graft survival. AlloAg-pulsed Rapa DC induced T-cell hyporesponsiveness and promoted the generation of IL-10-secreting CD4 T cells upon ex vivo challenge., Conclusions: Infusion of donor Ag-pulsed, Rapa-conditioned DC after composite tissue transplantation can prevent rejection of the grafts, including skin, across a full MHC mismatch and in the absence of continued immunosuppressive therapy.

Background: We previously demonstrated the successful 1-month storage of peripheral nerve segments in a green tea polyphenol extract. We investigated whether this method could reduce the donor-host immune reaction associated with peripheral nerve allotransplantation., Methods: Sciatic nerve segments (20 mm long) were harvested from Dark Agouti (DA) rats, stored in polyphenol solution (1 mg/mL) for 1 month, and transplanted into recipient major histocompatibility complex-mismatched Lewis rats to bridge 15-mm-long sciatic nerve gaps (polyphenol-treated allograft group). The controls were an isograft group (nerve segments harvested from Lewis rats were immediately transplanted into Lewis rats), a polyphenol-treated isograft group (nerve segments harvested from Lewis rats were treated by polyphenol in the same method and transplanted into Lewis rats), and a fresh allograft group (nerve segments harvested from DA rats were transplanted into Lewis rats without storage). To investigate the origins of the cells in the transplanted nerves, sciatic nerve segments harvested from the male DA rat donors were transplanted into female Lewis rat recipients; genomic DNA was extracted from each nerve segment and amplified by polymerase chain reaction using primers specific for the rat sex-determining region of the Y-chromosome (Sry)., Results: Nerve regeneration in the polyphenol-treated allograft group was similar to that in the isografted group. Sry-specific bands were detected in all samples in the sex-mismatched polyphenol-treated allograft specimens despite their major histocompatibility complex incompatibility., Conclusions: Storage in green tea polyphenol solution can reduce both ischemic damage to nerve tissue and donor-host immune reactions after allotransplantation.