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Purpose: Assessment for frailty is important as it enables timely intervention to prevent or delay poor prognosis in chronic obstructive pulmonary disease (COPD). The aims of this study, in a sample of outpatients with COPD, were to (i) assess the prevalence of physical frailty using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria and the Short Physical Performance Battery (SPPB) and the degree of agreement between the findings of the two assessments and (ii) identify factors associated with the disparity in the results obtained with these instruments., Patients and Methods: This was a multicenter cross-sectional study of individuals with stable COPD enrolled in four institutions. Frailty was assessed using the J-CHS criteria and the SPPB. Weighted Cohen's kappa (k) statistic was performed to investigate the magnitude of agreement between the instruments. We divided participants into two groups depending on whether there was agreement or non-agreement between the results of the two frailty assessments. The two groups were then compared with respect to their clinical data., Results: A total of 103 participants (81 male) were included in the analysis. The median age and FEV 1 (%predicted) were 77 years and 62%, respectively. The prevalence of frailty and pre-frail was 21% and 56% with the J-CHS criteria and 10% and 17% with the SPPB. The degree of agreement was fair (k = 0.36 [95% CI: 0.22-0.50], P<0.001). There were no significant differences in the clinical characteristics between the agreement group (n = 44) and the non-agreement group (n = 59)., Conclusion: We showed that the degree of agreement was fair with the J-CHS criteria detecting a higher prevalence than the SPPB. Our findings suggest that the J-CHS criteria may be useful in people with COPD with the aim of providing interventions to reverse frailty in the early stages., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Tanaka et al.)

The feeling of being dazzled is evoked by images consisting of an achromatic uniform center, surrounded by regions with luminance gradients. As the perceptual distinctness of the central region has been suggested to contribute to the feeling of being dazzled, we examined the effects of a gap between the central and surrounding regions on the feeling of being dazzled. The stimulus comprised a disk with uniform luminance surrounded by an annulus, of which the luminance was decreased from the inner boundary to the periphery. Three luminance profiles (linear, logistic, and inverse-logistic) of the surrounding luminance ramps were used. The distinctness of the disk decreased in the order of logistic, linear, and inverse-logistic profiles. The luminance of the disk, the maximum luminance of the annulus, and the gap size were also varied. When the luminance continuously transitioned from the disk to the annulus, the feeling of being dazzled was stronger for the inverse-logistic annulus luminance profile, compared with the logistic and linear profiles without a gap; however, it was not different for the three profiles with a gap. Further, the feeling of being dazzled increased when a gap was introduced for the logistic and linear profiles, but not for the inverse-logistic profile. These results suggest that the feeling of being dazzled was reduced by the perceptual indistinctness of the central disk for the logistic and linear annulus luminance profiles, while the gap restored the feeling of being dazzled by making the central disk perceptually distinct., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Hospital-acquired disability (HAD) in patients who undergo living donor liver transplantation (LDLT) is expected to worsen physical functions due to inactivity during hospitalization. The aim of this study was to explore whether a decline in activities of daily living from hospital admission to discharge is associated with prognosis in LDLT patients, who once discharged from a hospital., Methods: We retrospectively examined the relationship between HAD and prognosis in 135 patients who underwent LDLT from June 2008 to June 2018, and discharged from hospital once. HAD was defined as a decline of over 5 points in the Barthel Index as an activity of daily living assessment. Additionally, LDLT patients were classified into four groups: low or high skeletal muscle index (SMI) and HAD or non-HAD. Univariate and multivariate Cox proportional hazard models were used to evaluate the association between HAD and survival., Results: HAD was identified in 47 LDLT patients (34.8%). The HAD group had a significantly higher all-cause mortality than the non-HAD group (log-rank: p < 0.001), and in the HAD/low SMI group, all-cause mortality was highest between the groups (log-rank: p < 0.001). In multivariable analysis, HAD was an independent risk factor for all-cause mortality (hazard ratio [HR]: 16.54; P < 0.001) and HAD/low SMI group (HR: 16.82; P = 0.002)., Conclusion: HAD was identified as an independent risk factor for all-cause mortality suggesting that it could be a key component in determining prognosis after LDLT. Future larger-scale studies are needed to consider the overall new strategy of perioperative rehabilitation, including enhancement of preoperative physiotherapy programs to improve physical function., (© 2022. The Author(s).)

This study aimed to evaluate volatile compounds in exhaled breath as a non-invasive screening method to detect breast neoplasms. Exhaled breath samples were collected from patients with breast cancer (BC; n = 45) and non-breast cancer (NBC; n = 51) controls. Selected ion-flow tube mass spectrometry was used to quantify the volatile compounds. A multiple logistic regression (MLR) model was developed by combining multiple compounds to discriminate between BC and NBC samples. Amongst the 672 quantified peaks, 17 showed significant differences between BC and NBC samples ( P < 0.05 corrected by false discovery rate). Pathway analysis revealed a significant difference in glycerophospholipid metabolism. The MLR model showed an area under the receiver operating characteristic curve (AUC) of 0.719 (95% confidence interval: 0.615-0.822, P < 0.0002). Cross-validation under various conditions resulted in a slight fluctuation in the AUC values, indicating the high generalizability of the MLR model. The model showed a higher BC probability for advanced-stage subjects and higher Ki67 (⩾30) for BC subjects. This study suggests the potential of volatile compounds in exhaled breath as a noninvasive screening method for BC., (© 2022 IOP Publishing Ltd.)

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass, loss of muscle strength and/or reduced physical performance. Sarcopenia has repeatedly been reported as a strong predictor of both short- and long-term outcomes following surgical treatment for colorectal cancer. In this study, 86 primary colorectal cancer cases who received surgery at our hospital were examined. To evaluate which factor amongst muscle volume, muscle strength or physical performance would be important to avoid sarcopenia after surgery, we examined objective values of muscle volume, muscle strength and physical performance respectively. We also divided patients into groups by their ages or procedures of surgeries, then compared and analyzed within those groups. The results showed that most patients tended to lose their muscle volume of their legs and their physical performance after their surgeries. We also found patients who were equal or older than 75-year-old and patients who received open surgeries tended to lose their muscle volume or physical performance after their surgeries. These groups of patients have a potential risk to turn sarcopenia after surgeries. It would be important to observe each of 3 factors such as skeletal muscle volume, muscle strength and physical performance to evaluate precisely their condition of sarcopenia. Tailor-made peri-operative rehabilitation programs, especially for elderly patients or patients who received open surgeries, would be a possible solution to avoid sarcopenia after surgery for colorectal cancer.

Summary: Surgeons have traditionally believed that swallowing is mainly dependent on gravity after total glossolaryngectomy. However, swallowing function after total glossolaryngectomy varies widely among patients, and a thorough analysis is lacking. The authors aimed to clarify the swallowing function after total glossolaryngectomy and determine whether it is primarily dependent on gravity. The authors retrospectively analyzed videofluorographic examinations of patients who underwent total glossolaryngectomy and free or pedicle flap reconstruction. The authors enrolled 20 patients (12 male; mean age, 61 years; age range, 43 to 89 years). All patients demonstrated constriction of the reconstructed pharynx to some degree, and no patient's ability to swallow was dependent on gravity alone. Videofluorography showed excellent barium clearance in eight patients and poor clearance in 12. All patients with excellent clearance showed strong constriction of the posterior pharyngeal wall, whereas only 8.3 percent of the patients with poor clearance showed adequate constriction, which was significantly different ( p = 0.0007). Velopharyngeal closure and lip closure also contributed significantly to excellent clearance ( p = 0.041). The shape of the reconstructed pharynx (depressed, flat, protuberant) showed no statistically significant association with excellent clearance. Contrary to previous understanding, constriction of the remnant posterior pharyngeal wall played an important role in swallowing after total glossolaryngectomy, and gravity played a secondary role. Dynamic posterior pharyngeal wall movement might result from the increased power of the pharyngeal constrictor muscle and compensate for the immobility of the transferred flap. A well-functioning pharyngeal constrictor muscle and complete velopharyngeal and lip closures can contribute to excellent barium clearance in patients after total glossolaryngectomy., Clinical Question/level of Evidence: Therapeutic, III., (Copyright © 2022 by the American Society of Plastic Surgeons.)

The symbiotic hydra Hydra viridissima has a stable symbiotic relationship with the green alga Chlorella . This hydra appears to cospeciate with the symbiotic alga, and some strains are known to have strain-specific host/symbiont combinations. To investigate the mechanism of the specificity between host and symbiont, we explored the effect of the removal or exchange of symbionts in two distantly related H. viridissima strains (K10 and M9). In the K10 strain, severe morphological and behavioural changes were found in symbiont-removed and symbiont-exchanged polyps. Interestingly, both polyps showed a similar gene expression pattern. The gene ontology (GO) enrichment analysis revealed that the removal or exchange of symbionts caused the downregulation of genes involved in the electron transport chain and the upregulation of genes involved in translation in the K10 strain. On the other hand, symbiont-removed and symbiont-exchanged M9 polyps showed modest changes in their morphology and behaviour compared with the K10 strain. Furthermore, the patterns of the gene expression changes in the M9 strain were quite different between the symbiont-removed and symbiont-exchanged polyps. Our results suggested that the regulation of energy balance is one of the crucial mechanisms for maintaining symbiotic relationships in green hydra, and this mechanism differs between the strains., (© 2022 The Authors.)

The patient was a 72-year-old man with a chief complaint of abdominal pain. We performed laparoscopic left hemicolectomy of the colon after descending colon cancer ileus stenting, and postoperative pathology was pT4aN0M0, pStage Ⅱb. In 1.5 years postoperatively, 2 liver metastases and 1 lymph node metastasis were found, and each was resected. Chemotherapy was initiated for multiple lung metastases. Genetic testing was positive for BRAF V600E mutation, and the patient received 8 mFOLFOXIRI plus bevacizumab therapy courses. After 15 5-FU plus LV plus bevacizumab courses, the patient had a brain infarction and lung metastasis reincreased. Chemotherapy was changed to encorafenib plus binimetinib plus cetuximab. On day 2, visual impairment was observed, and serous retinal detachment CTCAE Grade 2 was diagnosed. On day 7, the symptoms improved and one-step dose reduction was resumed. On day 2 of re-treatment, serous retinal detachment recurred and treatment was discontinued. On day 4 of re-treatment, the symptoms improved, another dose reduction was performed, and treatment was resumed. Since subjective MEK inhibitor-induced ocular symptoms are often minor, conducting an interview and early ophthalmologic diagnosis is recommended.

There are various interventions of rehabilitation on the bed, but these are time-consuming and cannot be performed for all patients. The purpose of this study was to identify the patients who require early mobilization based on the level of sedation. We retrospectively evaluated the data of patients who underwent physical therapy, ICU admission of > 48 h, and were discharged alive. Sedation was defined as using sedative drugs and a Richmond Agitation-Sedation Scale score of < - 2. Multiple regression analysis was performed using sedation period as the objective variable, and receiver operating characteristic (ROC) curve and Spearman's rank correlation coefficient were performed. Of 462 patients admitted to the ICU, the data of 138 patients were analyzed. The Sequential Organ Failure Assessment (SOFA) score and non-surgery and emergency surgery cases were extracted as significant factors. The ROC curve with a positive sedation period of more than 3 days revealed the SOFA cutoff score was 10. A significant positive correlation was found between sedation period and the initial day on early mobilization. High SOFA scores, non-surgery and emergency surgery cases may be indicators of early mobilization on the bed in the ICU., (© 2022. The Author(s).)

This study aimed to evaluate the procedures of reconstruction surgery for chronic lateral ankle instability. We compared single anterior talofibular ligament reconstruction to simultaneous reconstructions of the anterior talofibular and calcaneofibular ligaments. From 2015 to 2019, 14 consecutive patients diagnosed with chronic lateral ankle instability underwent arthroscopic anterior talofibular ligament reconstruction with or without calcaneofibular ligament reconstruction after conservative treatment. Seven patients underwent single anterior talofibular ligament reconstruction (group AT), and 7 patients underwent simultaneous reconstructions of the anterior talofibular ligament and calcaneofibular ligament (group AC). The Japanese Society for Surgery of the Foot scale scores and Karlsson scores significantly improved in all patients 1 year postoperatively. The radiographic measurement of the talar tilt angle and the talar anterior drawer distance at 1 year after surgery were also significantly improved compared to preoperative values. The postoperative talar tilt angle was significantly greater in group AT (median 6°, range 3°-7°) than that in group AC (median 3°, range 2°-5°; p = .038). The postoperative talar anterior drawer distance, Japanese Society for Surgery of the Foot scale score, and Karlsson score were not significantly different between the 2 groups. We found that although the clinical outcomes after the anterior talofibular ligament reconstruction with or without the calcaneofibular ligament reconstruction for chronic lateral ankle instability were good, instability of the talar tilt angle at 1 year postoperatively in patients who underwent single anterior talofibular ligament reconstruction was greater than that in patients who underwent simultaneous anterior talofibular and calcaneofibular ligament reconstructions., (Copyright © 2021 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

This study examined the relationship between origami performance, personality traits, and spatial ability. The researchers asked 43 Japanese university students (19 women and 24 men) to fold three models of origami (paper folding). Their performance was assessed by the number of successes in correctly folding the paper to make the models. They also answered the personality inventory NEO-FFI and completed the block-design test of the Wechsler Adult Intelligence Scale IV, which measures the spatial ability of people. The results showed that although origami performance demonstrated no significant relation with neuroticism, openness to experience, agreeableness, or conscientiousness, it improved as introversion tendency and spatial ability increased. There were no differences based on sex in origami performance. The findings suggest that performing origami requires spatial ability, which supports the view that origami is a potential educational material for training and enhancing spatial ability, and that introversion is advantageous to origami performance., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hanada.)

Background: The Asian Working Group for Sarcopenia 2019 (AWGS 2019) is the gold standard diagnostic criteria for sarcopenia in Asian populations. The calf circumference (CalF), the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) and the SARC-CalF questionnaires for sarcopenia screening have been used by AWGS 2019. The aim of this study was to assess accuracy of these three sarcopenia screening tools in patients with interstitial lung disease., Methods: In this cross-sectional study, stable patients with interstitial lung disease were enrolled. The SARC-F, SARC-CalF, and CalF, used in patients with interstitial lung disease, were compared to the diagnostic criteria proposed by AWGS 2019. The accuracy of screening tools was compared using sensitivity and specificity. Moreover, areas under the receiver operating characteristic curves (AUC) were computed., Results: Seventy eight patients were analyzed, and sarcopenia was identified in 25 (32.1%) patients with interstitial lung disease by the AWGS 2019 criteria. The sensitivity of the CalF was highest (96%) of the three screening tools, while the specificity was 60%. The sensitivity of SARC-F and SARC-CalF were 24% and 68%, while the specificity were 92% and 66%, respectively. The AUCs of CalF, SARC-F, and SARC-CalF in all patients were 0.78, 0.58, and 0.67, respectively., Conclusions: The CalF is most suitable for screening sarcopenia in patients with interstitial lung disease, while SARC-F and SARC-CalF are not., (© 2022. The Author(s).)

We report a rare carcinoma of the permanent ileostomy site developing 20 years or more after total proctocolectomy (TPC)in a 65-year-old woman with familial adenomatous polyposis(FAP). She underwent TPC for rectal cancer associated with FAP in her 40th at other institution. She also underwent pancreas-sparing total duodenectomy for duodenal mucosal cancer associated with severe duodenal polyposis at 59 years at our institution. She was referred to our hospital again complaining of the mass of the ileostomy site, 10 cm in diameter. Though biopsy revealed no definite malignancy, serum CA19-9 was elevated(98 U/mL), leading to a preoperative diagnosis to be ileal carcinoma. The involved bowel was widely resected. Histological examination demonstrated Stage ⅡA ileal carcinoma. Postoperative course was uneventful and she is well without recurrence 7 months after the ileal resection. This case seems valuable in that long-term surveillance including ileal carcinoma is important in the management of FAP patients whose colorectal cancer and duodenal cancer have been already well controlled.

Physical deconditioning often occurs during the acute phase after cardiovascular surgery, and unassisted walking is required to achieve independence, to manage cardiac diseases, and to prevent recurrences. This study aims to investigate the characteristics of independent walking after cardiovascular surgery. We conducted a retrospective cohort study in patients who underwent cardiovascular surgeries (total of 567 patients): 153 in the coronary artery bypass grafting (CABG) group, 312 in the heart valve surgery group, and 102 in the aortic surgery group. We evaluated the effect of each surgery group on the cardiac rehabilitation (CR) progression. The factors associated with independent walking were age, renal diseases, intensive care unit (ICU) length of stay, and post-operative respiratory complications in the CABG group. In the heart valve surgery group, the factors were New York Heart Association functional classification, renal and respiratory diseases, ICU length of stay, duration of mechanical ventilatory support, and post-operative cardiovascular and respiratory complications. In the aortic surgery group, these were ICU length of stay and acute kidney injury. The CR progression in patients who underwent aortic surgery was significantly longer than those who underwent CABG and heart valve surgery ( p < 0.001). New intervention strategies are needed for patients with prolonged ICU stays.

Background: Anastomotic or perianastomotic ulcers present with symptoms such as chronic anaemia and occult bleeding as long-term complications of bowel resection performed in infancy., Case Presentation: Herein, we describe a 15-year-old girl with a history of surgery for meconium obstruction without mucoviscidosis in infancy who was hospitalized with chief complaints of presyncope and convulsions. Seven hours after admission, she developed melena and went into shock. An emergency laparotomy was performed, and a Dieulafoy lesion was detected near the site of ileal anastomosis from the surgery that had been performed during infancy., Conclusions: Although overt massive lower gastrointestinal bleeding necessitating emergency care is rare in the long term after infant bowel resection, Dieulafoy lesions can cause serious bleeding, requiring rapid life-saving haemostatic procedures., (© 2021. The Author(s).)

This study is the first to evaluate the chemical composition and impacts of four different edible insects, Acheta domesticus (A.d), Brachytrupes portentosus (B.p), Gryllus bimaculatus (G.b), and Bombyx mori (B.m), on the digestibility, rumen fermentation, and methane production when used as a substitute for 25% of the soybean meal (SBM) in a ruminant diet through in vitro incubation. The dietary treatments were 100% grass hay, 60% grass hay + 40% SBM, 60% grass hay + 30% SBM + 10% A.d, 60% grass hay + 30% SBM + 10% B.p, 60% grass hay + 30% SBM + 10% G.b, and 60% grass hay + 30% SBM + 10% B.m. The experiment was conducted as a short-term batch culture for 24 h at 39 °C, and the incubation was repeated in 3 consecutive runs. Chemical analysis of the insects showed that they were rich in fat (14-26%) with a high proportion of unsaturated fatty acids (60-70%). Additionally, the insects were rich in protein (48-61%) containing all essential amino acids and the amino acid profiles of the insects were almost the same as that of SBM. The inclusion of insects did not affect nutrient digestibility or the production of volatile fatty acids but did increase the production of ammonia-nitrogen. The addition of G.b and B.m led to decrease in methane production by up to 18% and 16%, respectively. These results reveal that substitution of 25% SBM in the diet with the tested insects had no negative impacts, and their potential to reduce methane production is an environmental benefit.

Background: Patients with malnutrition have a high risk of postoperative complications in total knee arthroplasty (TKA). Previously, serum albumin and total lymphocyte count were considered preoperative nutritional assessment measures. Prognostic nutritional index (PNI) is calculated by a combination of serum albumin and total lymphocyte count. This study aimed to identify the risk factors for postoperative complications after TKA, including preoperative nutritional assessment, and evaluated preoperative PNI as a predictor of postoperative complications., Methods: One-hundred and sixty patients (234 knees) who underwent primary TKA were enrolled consecutively from 2010 to 2018. The serum albumin (g/dL) and total lymphocyte count (/mm 3 ) were examined within 3 months before TKA; thereafter, the PNI was calculated. Postoperative aseptic wound problems, such as skin erosion and dehiscence within 2 weeks and periprosthetic joint infection after TKA were examined., Results: Periprosthetic joint infections occurred in 14 knees (6.0%). Postoperative aseptic wound problems within 2 weeks were significant risk factors of periprosthetic joint infection (odds ratio; 5.10, 95% confidence interval [CI]; 1.438-18.093, p = 0.012). No significant differences were noted in the patient demographics, such as age, sex, body mass index (BMI), and comorbidities between the positive and negative groups for periprosthetic joint infection, except for the rate of aseptic operative wound problems. Furthermore, postoperative aseptic wound problems were influenced by high BMI (odds ratio; 1.270, 95% CI; 1.111-1.453, p = 0.000) and low PNI (odds ratio; 0.858, 95% CI; 0.771-0.955, p = 0.015)., Conclusions: Preoperative nutritional status, indicated by PNI and BMI, was associated with postoperative wound problems within 2 weeks. Periprosthetic joint infection after TKA was associated with early postoperative aseptic wound problems., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

We report a 16-year-old Japanese male with mugwort pollinosis in whom ingestion of wild grape juice and various vegetables caused recurrent general urticaria, abdominal pain, dyspnea, and loss of consciousness. A skin prick test demonstrated positive reactions to a wide variety of both non-heated and heated vegetables and fruits such as wild grape, bell pepper, onion, Chinese cabbage, tomato, eggplant, and broccoli. The serum immunoglobulin E levels (ImmunoCAP ISAC ® ) for Art v 3, Pla a 3, Pru p 3, and Jug r 3, which are lipid transfer protein (LTP) homologs, were positive but those for Bet v 1 and Bet v 2 were negative. We diagnosed the patient as having LTP syndrome, a condition in which additional factors such as exercise, non-steroidal anti-inflammatory drugs, or alcohol may trigger an allergic reaction. Wild grapes contain a large amount of salicylic acid, and in our patient ingestion of wild grape juice led to immediate loss of consciousness in the absence of exercise. This suggests that salicylic acid contained in fruits and vegetables may act as an important cofactor in LTP syndrome. Although sensitization to LTP is rarely reported in Asia, LTP are considered to be potentially life-threatening food allergens, and therefore warrant attention., (© 2021 Japanese Dermatological Association.)

A double-barreled fibular graft was used to reconstruct both forearm bones and the humeroradial joint after tumor resection. The patient had a tumor of radius that invaded the ulna and extensor groups. After a wide tumor resection, vascularized fibular autograft and soft tissue reconstruction was performed. A fibular graft were placed as a double barrel in the proximal ulnar and radial defects including the radial head and fixed using two locking plates. Simultaneously, reconstruction of the humeroradial joint and wrist dorsiflexion was performed. Two years postoperatively, the patient is satisfied with his elbow function while performing activities of daily living. Although amputation was one of the options considered during the preoperative planning in this case, the affected limb could be preserved by grafting a double-barreled fibula and tendon transfer, which could maintain the function of his upper left limb.

A Pd-catalyzed domino reaction of 1,8,13-tribromo-9-methoxytriptycenes is reported. Under conventional Suzuki coupling conditions, the triptycenes underwent multiple transformations to give 1,9-bridged triptycenes. Based on mechanistic investigations, a single Pd catalyst functions as Pd 0 , Pd II and Pd IV species to catalyze four distinct processes: (1) aryl to alkyl 1,5-Pd migration, (2) intramolecular arylation, (3) homocoupling of phenylboronic acid and (4) Suzuki coupling. DFT calculations revealed that 1,5-Pd migration likely proceeds via both concerted Pd II and stepwise Pd IV routes. Asymmetric synthesis of the chiral triptycenes, as well as optical resolution, and further transformation are also reported., (© 2021 Wiley-VCH GmbH.)

The length of hospital stay is an important outcome measure in patients who have undergone pancreaticoduodenectomy. Although postoperative complications are known to adversely affect the length of hospital stay (LOS), the influence of early mobilization on LOS has not been clarified yet. This study aimed to examine the impact of the initial ambulation day, which is one of the components of early mobilization, on LOS after pancreaticoduodenectomy. We retrospectively enrolled patients who underwent pancreaticoduodenectomy between January 2013 and December 2017. Postoperative complications were evaluated using the Clavien-Dindo classification (CDC) system. Patients were divided into two groups based on the median LOS (early and late-discharge groups) and compared to determine their characteristics. Multivariate logistic regression analysis was performed with LOS as the dependent variable. Patients in the late-discharge group were significantly older, had an initial ambulation delay, and had higher rates of advanced disease stages and a CDC grade ≥ IIIa than those in the early discharge group. In the multivariate logistic regression analysis, CDC grade ≥ IIIa, initial ambulation day, and age were found to be significant independent factors associated with LOS. Our results demonstrated that not only postoperative complications, but also the initial ambulation day, could affect LOS after pancreaticoduodenectomy, emphasizing the importance of early ambulation for patients who undergo this surgery.

Background: Lymphatic diseases due to lymph vessel injuries in the pelvis and groin require immediate clinical attention when conventional treatments fail. We aimed to clarify the effectiveness of and indications for lymphaticovenular anastomosis (LVA) to treat these lymphatic diseases., Methods: We retrospectively evaluated six patients who underwent LVA for lymphatic diseases due to lymph vessel injuries in the pelvis and groin. Specific pathologies included groin lymphorrhea (N = 3), chylous ascites (N = 2), and retroperitoneal lymphocele (N = 1). The maximum lymphatic fluid leakage volume was 150-2600 mL daily. Conventional treatments (compression, drainage, fasting, somatostatin administration, negative pressure wound therapy, or lymph vessel ligation) had failed to control leakage in all cases. We performed lower extremity LVAs after confirming the site of lymph vessel injury using lymphoscintigraphy. We preferentially placed LVAs in thigh sites that showed a linear pattern by indocyanine green lymphography. Postoperative lymphatic fluid leakage volume reduction was evaluated, and leakage cessation was recorded when the drainage volume approached 0 mL., Results: LVA was performed at an average of 4.3 sites (range, 3-6 sites) in the thigh and 2.7 sites (range, 0-6 sites) in the lower leg. Lymphatic fluid leakage ceased in all cases after a mean of 6 days (range, 1-11 days) postoperatively. No recurrence of symptoms was observed during an average follow-up of 2.9 (range, 0.5-5.5) years., Conclusions: LVA demonstrates excellent and rapid effects. We recommend lower extremity LVA for the treatment of lymphatic diseases due to lymph vessel injuries in the pelvis and groin., (© 2021 Wiley Periodicals LLC.)

Purpose: Several clinical studies have demonstrated that angiotensin-converting enzyme inhibitors, but not angiotensin II receptor blockers (ARBs), reduce the risk of non-fatal myocardial infarction and cardiovascular mortality. We found that ARBs inhibited the activity of various cytochrome enzymes in arachidonic acid metabolism, resulting in decreased in vitro production of epoxyeicosatrienoic acids (EETs), which exhibit vasodilation and anti-inflammatory effects, and their subsequent metabolites, dihydroxyeicosatrienoic acids (DHETs). The present study examined the effects of ARBs on serum levels of EETs and DHETs in patients admitted to a cardiovascular center., Methods: A total of 223 patients were enrolled, of which 107 were exposed to ARBs in this study. ARB-free individuals were defined as the control group (n = 116). Serum levels of EETs and DHETs were measured by liquid chromatography-tandem mass spectrometry. Multiple linear regression analyses were carried out to identify covariates for total serum levels of EETs and DHETs., Results: A significant negative association was observed between ARB use and serum EET and DHET levels (p = 0.034), whereas a significant positive association was observed between the estimated glomerular filtration rate (eGFR) and serum EET and DHET levels (p = 0.007). The median serum total EET and DHET level in the ARB group tended to become lower than that in the control group, although the difference was not significant., Conclusion: ARB use and eGFR were significantly associated with total serum levels of EETs and DHETs. Our results suggest that ARBs could affect the concentration of EETs in vivo.

This In Vitro study was conducted to investigate the impact of plant-bioactives extract (PE), a combination of garlic powder and bitter orange extract, on methane production, rumen fermentation, and digestibility in different feeding models. The dietary treatments were 1000 g grass/kg ration + 0 g concentrate/kg ration (100:0), 80:20, 60:40, 40:60, and 20:80. The PE was supplemented at 200 g/kg of the feed. Each group consisted of 6 replicates. The experiment was performed as an In Vitro batch culture for 24 h at 39 °C. This procedure was repeated in three consecutive runs. The results of this experiment showed that supplementation with PE strongly reduced methane production in all kinds of feeding models ( p < 0.001). Its efficacy in reducing methane/digestible dry matter was 44% in the 100:0 diet, and this reduction power increased up to a 69.2% with the inclusion of concentrate in the 20:80 diet. The PE application significantly increased gas and carbon dioxide production and the concentration of ammonia-nitrogen, but decreased the pH ( p < 0.001). In contrast, it did not interfere with organic matter and fiber digestibility. Supplementation with PE was effective in altering rumen fermentation toward less acetate and more propionate and butyrate ( p < 0.001). Additionally, it improved the production of total volatile fatty acids in all feeding models ( p < 0.001). In conclusion, the PE combination showed effective methane reduction by improving rumen fermentation characteristics without exhibiting adverse effects on fiber digestibility. Thus, PE could be used with all kinds of feeding models to effectively mitigate methane emissions from ruminants.

Interstitial lung disease (ILD) is a diverse group of chronic lung conditions characterized by dyspnea, exercise-induced hypoxemia (EIH), and exercise intolerance. Since activity limitations and impaired health-related quality of life (HRQoL) in ILD are similar to those in other chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation is also indicated for patients with ILD. This rehabilitation program mainly comprises exercise training and self-management education. Exercise training is the most important component of pulmonary rehabilitation. It significantly improves dyspnea and enhances exercise capacity and HRQoL in patients with ILD. The standard exercise prescription used for COPD is also effective for ILD. However, considering that disease progression and exercise-limiting factors are different in patients with COPD is necessary. Severe EIH, the adverse effects of corticosteroid administration, and comorbidities often lead to difficulty in employing a sufficient exercise intensity. Some modifications in the exercise prescription for individual patients or strategies to minimize EIH and dyspnea are required to optimize training intensity. Since EIH is common and severe in patients with ILD, supplemental oxygen should be provided. In advanced and more severe patients, who have difficulty in performing exercises, energy conservation techniques and the use of energy-saving devices to improve and maintain the patients' activities of daily living may be effective．., Competing Interests: Authors have no conflicts of interest to disclose., (2021, JAPANESE PHYSICAL THERAPY ASSOCIATION.)

Background: Liver cirrhosis is the irreversible fibrosis of the liver and causes refractory ascites and hepatic encephalopathy, which might not respond to treatment. Living donor liver transplantation (LDLT) is an effective treatment for patients with cirrhosis. However, post-LDLT patients are prone to muscle atrophy and sarcopenia. Therefore, physiotherapy of post-LDLT patients is essential for preventing the progression of sarcopenia. Recently, rehabilitation using neuromuscular electrical stimulation (NMES) has been reported to be useful for preventing the progression of sarcopenia. Similarly, nutrition therapy is essential for post-LDLT patients because these patients frequently experience malnutrition. However, the effects of combined NMES and nutrition therapy on post-LDLT patients remain unknown., Methods/design: This open-label, randomized, parallel-group study will compare the effects of combined therapy with NMES and branched-chain amino acids (BCAA) with those of NMES alone in patients with decompensated cirrhosis after LDLT. After LDLT, 50 patients with decompensated cirrhosis will be randomly assigned to receive NMES with BCAA or NMES without BCAA. The duration of the intervention will be 3 months. To analyze the change in skeletal muscle mass, InBody 770 body composition and body water analysis and ultrasonography will be performed before LDLT and 4 weeks and 12 weeks post-LDLT. The primary endpoint is changes in the skeletal muscle mass from baseline to 3 months. Important secondary endpoints are the changes in the skeletal muscle mass from baseline to 1 month and changes in the quadriceps strength from baseline to 1 month., Discussion: The results of this study are expected to provide evidence regarding the effect of NMES combined with BCAA therapy on the skeletal muscle of post-LDLT patients., Trial Registration: Japan Registry of Clinical Research jRCTs071190051 . Registered on February 26, 2020.

Introduction: This study evaluated the relationship between postoperative knee flexion angles and the position of femoral and tibial components in unicompartmental knee arthroplasty (UKA)., Materials and Methods: Eighteen patients (a total of 22 knees: three men, four knees; 15 females, 18 knees) who underwent navigation-assisted UKA were included. Pre- and postoperative computed tomography images were applied on 3D software, which were matched and used to calculate the position of femoral and tibial components. Correspondingly, we investigated the relationship between the knee range of motion (ROM) at 1-year postoperative follow-up and the position of femoral and tibial components., Results: At 1-year post-UKA, the knee flexion angle was associated with the posterior flexion angle of tibial components. This particular angle was significantly greater in the group with equal or greater postoperative knee ROM compared to preoperative ROM (5.2 ± 2.1°) than in the group with less postoperative knee ROM compared to preoperative ROM (2.6 ± 1.6°, p < 0.01). There was no significant difference between both groups in the femoral component position, preoperative posterior slope of the medial tibial plateau, change in the pre- to postoperative posterior tibial slope, and postoperative knee society score., Conclusion: The posterior flexion angle of the tibial component affected the improvement/deterioration of the postsurgery knee flexion angle in navigation-assisted UKA. For improved outcomes after UKA using navigation systems, surgeons should aim to achieve a 5° to 8° posterior flexion angle of the tibial component.

Methane mitigation strategies have a two-sided benefit for both environment and efficient livestock production. This preliminary short-term in vitro trial using Mootral (garlic and citrus extracts), a novel natural feed supplement, was conducted to evaluate its efficacy on rumen fermentation characteristics, methane production, and the bacterial and archaeal community. The experiment was performed as a batch culture using rumen fluid collected from sheep, and Mootral was supplemented in three concentrations: 0% (Control), 10%, and 20% of the substrate (50% Grass:50% Concentrate). The rumen fermentation data and alpha diversity of microbial community were analyzed by ordinary one-way analysis of variance. The relative abundance and statistical significance of families and operational taxonomic units (OTUs) among the groups were compared by Kruskal-Wallis H test using Calypso software. After 24-h incubation at 39°C, Mootral in a dose-dependent manner improved the production of total volatile fatty acids and propionate while it reduced the acetate proportion and acetate/propionate ratio. The total produced gas was two times higher in the Mootral-supplemented groups than control ( P < 0.01), while the proportion of methane in the produced gas was reduced by 22% ( P < 0.05) and 54% ( P < 0.01) for 10 and 20% Mootral, respectively. Mootral did not change pH, digestibility, and ammonia-nitrogen. Microbial community analyses showed that Mootral effectively changed the ruminal microbiome. The bacterial community showed an increase of the relative abundance of the propionate-producing family such as Prevotellaceae ( P = 0.014) and Veillonellaceae ( P = 0.030), while there was a decrease in the relative abundance of some hydrogen-producing bacteria by Mootral supplementation. In the archaeal community, Methanobacteriaceae was decreased by Mootral supplementation compared with control ( P = 0.032), while the Methanomassiliicoccaceae family increased in a dose-dependent effect ( P = 0.038). The results of the study showed the efficacy of the new mixture to alter the ruminal microbial community, produce more propionate, and reduce microbial groups associated with methane production, thus suggesting that Mootral is a promising natural mixture for methane reduction from ruminants., Competing Interests: DK was employed by company Mootral GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ahmed, Yano, Fujimori, Kand, Hanada, Nishida and Fukuma.)

The aim of this study was to evaluate the benefits of a ternary amorphous solid dispersion (ASD) that was designed as an immediate-release tablet with a high drug load (e.g., 40% w/w) to produce heightened maintenance of drug supersaturation during dissolution testing, which will be henceforth referred to as the "maintenance ability". Ternary ASD granules were produced by hot melt extrusion (HME) and were comprised of itraconazole (ITZ) 50%, hypromellose (HPMC) 20%, and mesoporous silica (XDP) 30%, where amorphous ITZ incorporated into HPMC was efficiently absorbed in XDP pores. The ternary ASD granules containing a high-viscosity HPMC (AF4M) produced a significantly heightened maintenance ability of drug supersaturation in neutral pH dissolution media in which crystalline ITZ solubility is below 1 μg/mL. The final tablet formulation contained 80% w/w of the ASD granules (40% w/w ITZ), had an acceptable size, and exhibited both sufficient tablet hardness and disintegration. The dissolution behavior of the ternary ASD tablet exhibited a supersaturation maintenance ability similar to that of the ASD granules. Under neutral conditions, the ternary ASD tablet showed immediate and higher ITZ release compared with the binary ASD tablets, and this phenomenon could be explained by the difference in ITZ/AF4M particle size in the tablet. In high-resolution scanning electron microscopy (SEM), it was observed that ITZ and AF4M in the ternary formulation could easily form nano-sized particles (<1 μm) during the absorption process into/onto XDP pores prepared by HME, which contributed to the immediate ITZ release from the ternary ASD tablet under neutral pH conditions. Therefore, the ternary ASD containing high-viscosity HPMC and mesoporous silica prepared by HME made it possible to design a high ASD content, small-size tablet with an ideal dissolution profile in biorelevant media, and we expect that this technology can be applied for continuous HME ASD manufacturing.

This study investigated consecutive fluctuations in serum activities of bone-specific alkaline phosphatase (ALP) isoenzyme 3 (ALP3) in 11 clinically healthy Holstein heifers during the first 18 months of life. ALP3 activities at the first sampling time point after weaning (3 months) were significantly lower than those at multiple time points during the pre-weaning period. Those activities increased from a minimum at 3 months to a peak at 6 months during the post-weaning period. In the anthropometric data, daily body weight and wither height gains appeared to be below the public data at 4 months and 4-5 months, respectively. The data suggested that serum ALP3 activity can be used to monitor skeletal growth of heifers at weaning.

Background: Interstitial lung diseases (ILDs) patients receiving steroid treatment tend to be immobilized by dyspnea and muscle weakness as the disease progresses. We therefore expected that steroid treatment for ILDs would have a greater effect on muscle function under severe dyspnea. To test this hypothesis, we evaluated whether the effect of corticosteroid treatment on peripheral muscle force and exercise capacity varied according to patients' dyspnea severity., Methods: In this retrospective cross-sectional study of 87 ILD patients enrolled between 2008 and 2017, quadriceps force (QF), handgrip force (HF), and 6-min walk distance (6 MWD) were compared between a low (grades 0-2) and a high (grades 3-4) modified-Medical Research Council (mMRC) dyspnea scale score group., Results: In patients with lower levels of dyspnea, corticosteroid treatments were associated with lower QF and HF (20.0 vs. 30.0 kgf, p = 0.01; 22.5 vs. 28.4 kgf, p = 0.03, respectively) values; however, no significant differences were observed between the corticosteroid and control subgroups in the high mMRC group (QF: 18.5 vs. 17.3 kgf, p = 0.64; HF: 21.0 vs. 17.1 kgf, p = 0.24, respectively). Analysis of covariance indicated that both corticosteroid treatment and mMRC dyspnea scale interacted with QF, HF, and 6 MWD. The effects of the corticosteroid treatment varied according to the level of dyspnea (interaction β = 7.52, p = 0.034; interaction β = 8.78, p = 0.048; interaction β = 131.08, p < 0.001)., Conclusions: Muscle weakness and exercise capacity in ILD patients in the low mMRC group were associated with corticosteroid treatment., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

In Japan, the radiocesium activity concentration in milk must be less than 50 Bq/kg-fresh to meet shipping standards, and the radiocesium concentration of the diet fed to dairy cattle must be less than 500 Bq/kg-dry. After the Fukushima nuclear accident in 2011, we conducted two experiments to investigate whether Prussian blue (PB) could suppress the radiocesium ( 134 Cs +  137 Cs) activity concentration in Japanese cattle' milk. In experiment 1, four cattle were fed a diet with a radiocesium activity concentration of 175 Bq/kg-dry, with or without PB supplementation. The PB intake ranged from 0 to 3.0 g/day, and the average radiocesium intake was 3.42 kBq/day in all treatments. The radiocesium activity concentration in milk decreased from 16.4 to 8.6 Bq/kg-fresh, and the transfer coefficient of radiocesium from diet to milk (Fm) decreased from 4.77 × 10 -3 to 2.61 × 10 -3 with increased PB intake. In experiment 2, three cattle were fed another diet including a radiocesium activity concentration of 927 Bq/kg-dry of with or without PB supplementation. The PB intake ranged from 0 to 18.9 g/day, and the average radiocesium intake was 15.2 kBq/day in all treatments. The milk's radiocesium activity concentration decreased from 24.3 to 4.2 Bq/kg-fresh, and the Fm decreased from 1.68 × 10 -3 to 0.28 × 10 -3 with increased PB intake. Our results suggest that both the radiocesium activity concentration in milk and Fm can be reduced by PB, and that Fm is affected by diet. We recommend cattle should be fed absorbents such as PB to minimize the risk of milk radiocesium activity concentration exceeding 50 Bq/kg-fresh even if the diet has a radiocesium activity concentration of less than 500 Bq/kg-dry., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: This study evaluated the relationship between preoperative and postoperative knee kinematics, moreover, investigated tibial rotational position and the extent of tibial internal rotation from knee extension to flexion as factors to obtain significant knee flexion after total knee arthroplasty (TKA)., Methods: Fifty-four patients (60 knees total; 15 males, 16 knees; 39 females, 44 knees) who underwent posterior-stabilized TKA using a navigation system were included. Intraoperative knee kinematics involving tibial rotational position relative to the femur and the extent of tibial internal rotation were examined at two time points: 1) after landmarks registration (pre-TKA) and 2) after skin closure (post-TKA). The relationship between the knee flexion angle at one year postoperatively and intraoperative tibial rotational position, or the extent of tibial rotation among several knee flexion angles calculated with a navigation system were investigated., Results: The postoperative knee flexion angle was positively associated with the preoperative flexion angle and intraoperative knee kinematics at post-TKA involving tibial external position relative to the femur at knee extension and the extent of tibial internal rotation from extension to 90° of flexion or to maximum flexion. There was a positive relationship between the extent of tibial internal rotation at pre-TKA and that at post-TKA., Conclusions: The intraoperative kinematics of the extent of tibial internal rotation at post-TKA was influenced by that at pre-TKA. The greater external position of the tibia relative to the femur at knee extension and the greater extent of tibial internal rotation at post-TKA might lead to good knee flexion angle., Competing Interests: Declaration of competing interest Mitsuru Hanada, Kensuke Hotta, Hiroki Furuhashi, Hiroshi Koyama, and Yukihiro Matsuyama declare that they have no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To measure the medial opening gap and examine a technique for preserving the tibial posterior slope (TPS) in open-wedge high tibial osteotomy (OWHTO) using computer-simulated three-dimensional (3D) surgery., Materials and Methods: This study included 24 symptomatic knees from 20 patients (7 men and 13 women; mean age, 67.9 years; range 54-89 years). Digital imaging and communications from computed tomography examination were applied to a 3D picture software program, and several anatomical landmarks were registered. Then, computer simulation of OWHTO as a virtual surgery was performed: the correction angle was decided to make the femorotibial angle 170°, and the TPS did not differ between pre- and postplanification. The distance between the proximal and distal cortices of the medial tibia was measured at three points, which were the anterior (AD), posterior (PD), and longest (LD) distance sites in the sagittal plane, using the 3D view, and the ratios of AD/PD and AD/LD were measured. The anteromedial opening gap was compared to the posteromedial gap and the longest distance gap at the osteotomy site. Spearman's rank correlation coefficient test was used in statistical analysis., Results: Mean AD/PD was 0.740 ± 0.051 (range 0.651-0.850), and mean AD/LD was 0.652 ± 0.040 (range 0.571-0.768). The correction angle was not associated with the values of both AD/PD and AD/LD., Conclusions: Difference in AD/PD and AD/LD between each patient was regarded as a significant variation. Therefore, preoperative planification with 3D computer simulation to measure AD/PD and AD/LD may be helpful to avoid a significant increase in TPS.

Study Design: Large cohort study of volunteers., Purpose: The purpose of this study was to investigate the relationship between the severity of knee osteoarthritis, assessed using the Kellgren-Lawrence (KL) grading scale, and spinopelvic sagittal alignment in older adult volunteers., Overview of Literature: The relationship between spinopelvic alignment in the sagittal plane and knee osteoarthritis in the coronal plane is unclear., Methods: Volunteers over 50 years of age underwent radiographic analysis. Radiographic parameters including pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis, and sagittal vertical axis (SVA) were measured. The the three Scoliosis Research Society-Schwab sagittal modifiers (PT, SVA, PI-LL) were categorized and the KL grade was assessed. Differences in spinopelvic parameters and Oswestry Disability Index (ODI) scores among KL grades were evaluated., Results: A total of 396 volunteers (160 men, 236 women; mean age, 74.4 years) were analyzed. PI-LL and PT in KL4 were significantly higher compared to that in the other KL grades. However, there were no significant group differences in SVA. In women, but not in men, higher frequencies of the worst modifier grade (++) were observed for PI-LL and PT in the KL3 and KL4 groups compared to those for the other KL grades. In women, the ODI score in KL4 was worse compared to that in the other KL grades., Conclusions: Individuals over 50 years of age with severe knee osteoarthritis had poor lumbo-pelvic sagittal alignment. Moreover, the progression severity of knee osteoarthritis had more impact onstronger relationship with lumbo-pelvic malalignment and disability-related low back pain in women than in men.

We propose a characterization of quantum many-body chaos: given a collection of simple operators, the set of all possible pair correlations between these operators can be organized into a matrix with a random-matrix-like spectrum. This approach is particularly useful for locally interacting systems, which do not generically show exponential Lyapunov growth of out-of-time-ordered correlators. We demonstrate the validity of this characterization by numerically studying the Sachdev-Ye-Kitaev model and a one-dimensional spin chain with random magnetic field (XXZ model).

Osteoprotegerin (OPG) inhibits osteoclast (OC) differentiation. TRAP5b (tartrate-resistant acid phosphatase 5b) secreted by OCs reflects the numbers of mature OCs. This study assessed these OC-related markers around parturition in cows of different parities and in cows with milk fever (MF). The blood OPG and TRAP5b concentrations, as well as the ratio of OPG to TRAP5b (O/T), were measured beginning 3 weeks before (-21 d) and over a few days after calving in 49 Holstein Friesian cows at first (n = 8), second (n = 17), third (n = 12), and fourth or greater (n = 12) parities. The ratio of O/T at -21 d to O/T at calving (PreCOT) was also calculated. In the third and greater parities, seven cows developed MF (non-MF, n = 17). Regardless of the development of MF, the serum OPG started to decline in the last week of gestation only in the cows entering the second lactation, while the blood TRAP5b increased at calving in all cows. O/T decreased toward parturition only in multiparous cows. The decrease in O/T at caving was less pronounced in MF cows. PreCOT was negatively correlated with lactation number only in multiparous cows (n = 41, ρ = -0.50, P < .01). This study implied that OC differentiation toward calving was tapered in cows with advanced parities, and these indexes predict the risk of MF., Competing Interests: Declaration of Competing Interest The authors declare no conflicts on interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Surgical site infection (SSI) and periprosthetic joint infection are the most important problems after total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study aimed to examine the risk factors for intraoperative bacterial contamination in THA and TKA., Methods: One hundred and seven hips underwent THA, while 74 knees underwent TKA. After the implant was placed, a swab sample for bacterial culture was collected around the skin incision. At the time of specimen collection, patients were separated into two groups based on whether the iodine-containing drape remained adhered to the skin (group DR) or the iodine-containing drape was peeled off (group ND). Patient characteristics, including age, height, body weight, body mass index, operative duration, intraoperative blood loss, surgical procedures, and condition of the iodine-containing drape, were compared between patients with positive and negative bacterial cultures., Results: In THA, which had a shorter operative duration than TKA (p < 0.001), there was one case of bacterial contamination. In TKA, there were ten cases of positive bacterial contamination, all in group ND. Postoperative SSI occurred in one case. The binomial logistic regression analyses confirmed that TKA [OR 16.562 (95% CI 2.071 to 132.430), p < 0.01] was a high risk factor of bacterial contamination compared to THA and the group ND [OR 0.000 (95% CI 0.000), p < 0.001] had a low risk of bacterial contamination compared to the group DR. In TKAs, operative duration was the risk factor of bacterial contamination [OR 1.026 (95% CI 1.000 to 1.054), p < 0.01]., Conclusions: Intraoperative bacterial contamination increases in procedures with long operating time and may be suppressed by proper use of an iodine-containing drape.

This study examined perceptual dimensions of food texture using Japanese onomatopoeic words. Photographs of 56 foods were presented to the participants, and they reported onomatopoeic (mimetic) words suitable for the texture of the foods. The participants' responses were collated into a contingency table of photographs by onomatopoeic words. Correspondence analysis was applied to the table, and 15 dimensions were extracted. The biplot of the configurations was rotated by the technique of sparse coding. The obtained dimensions were smoothness/sounds in slurping noodles; adhesiveness; crumbliness/dryness/fluffiness of breads; popping/juiciness of spherical-shaped foods; soft elasticity/smoothness of gel, wateriness/creaminess; bendability of sticky foods; crispness/crunchiness of snacks; crispness of fruits; elasticity; crunchiness of vegetables; breakability of rod-like foods; sizzle (high temperature and oiliness); and two dimensions specifically expressing textures of lemon and pickled plum. These are considered to be basic food-texture dimensions expressed by Japanese onomatopoeic words., (© 2019 Wiley Periodicals, Inc.)

This study aimed to examine the factors affecting the clinical outcomes of anterior talofibular ligament (ATFL) repair surgery with arthroscopy for chronic lateral ankle instability (CLAI). From 2015 to 2018, 18 consecutive patients diagnosed with CLAI after conservative treatment for ≥3 months underwent arthroscopic ATFL repair surgery using the Broström-Gould technique. Clinical scores at 1 year postoperatively on the Karlsson scoring scale (median, 85 points) and the Japanese Society for Surgery of the Foot scale (median, 90 points) were significantly improved compared with preoperative scores (median, 50 and 66 points; p < .001 and <.001, respectively). The median period to start jogging was 2 and 6 months for patients without (n = 11) and with (n = 7) cartilage damage, respectively, showing a significant difference (p = .006). Four patients with cartilage damage could not return to preinjury sports within 1 year after surgery. In the stress radiographs, the talar tilt angle (TTA) significantly improved from a median of 6° preoperatively to a median of 3.5° postoperatively (p = .002). Talar anterior drawer distance (TAD) significantly improved from a median of 6.5 mm preoperatively to a median of 4.1 mm postoperatively (p < .001). There was no significant difference in TTA or TAD between patients without and with cartilage damage. The period to start jogging postoperatively was significantly correlated with postoperative TTA and TAD. It is suggested that the postoperative period to start activities was delayed because of the larger postoperative TTA and TAD. According to our results, the postoperative period to start activities may depend on cartilage damage and instability remaining postoperatively., (Copyright © 2019 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease associated with significant dyspnea and limited exercise capacity. This systematic review aimed to synthesize evidence of exercise interventions during pulmonary rehabilitation that aim to improve exercise capacity, dyspnea, and health-related quality of life (HRQL) in IPF patients., Methods: Searches were performed in MEDLINE, Embase, CENTRAL, SPORTDiscus, PubMed and PEDro from inception to January 2019 using search terms for: (I) participants: 'IPF or interstitial lung disease'; (II) interventions: 'aerobic training or resistance training or respiratory muscle training'; and (III) outcomes: 'exercise capacity or dyspnea or health-related quality of life'. Two reviewers independently screened titles, abstracts and full texts to identify eligible studies. Methodological quality of studies was assessed using the Downs and Black checklist and meta-analyses were performed., Results: Of 1,677 articles identified, 14 were included (four randomized controlled trials and 10 prospective pre-post design studies) that examined 362 patients receiving training and 95 control subjects. Exercise capacity was measured with the 6-minute walk distance, peak oxygen consumption, peak work rate, or endurance time for constant work rate cycling, which increased after exercise [aerobic exercise; aerobic and breathing exercises; aerobic and inspiratory muscle training (IMT) exercises] compared to the control groups. Dyspnea scores improved after aerobic and breathing exercises. HRQL also improved after aerobic exercise training alone or combined with breathing exercises. Aerobic training alone or combined with IMT or breathing exercises improved exercise capacity., Conclusions: Breathing exercises appears to complement exercise training towards improved dyspnea and HRQL in patients with IPF., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)

Purpose: We investigated, in patients who underwent lung resection for non-small cell lung cancer (NSCLC), the magnitude of early limitation in functional exercise capacity and the associations with pre- and postoperative factors. Methods: Consecutive patients with preoperative clinical stage I to IIIA NSCLC who underwent lung resection were prospectively enrolled. We measured functional exercise capacity (6-minute walk distance [6MWD]) and skeletal muscle strength (handgrip [HF] and quadriceps force [QF]) within 2 days prior to surgery and on day 7 postoperatively. Results: Two hundred eighteen participants were recruited (median age 69 years) of whom 49 developed postoperative complications (POCs). 6MWD was markedly decreased (514 m vs 469 m, P < .001); HF and QF were slightly decreased following surgery. Multiple linear regression showed that preoperative vital capacity ( P < .01), QF ( P < .05), the duration of chest tube drainage ( P < .001), and presence of POCs ( P < .05) were significant predictors. However, intraoperative factors were not significantly associated with the decline in 6MWD. Conclusions: These results suggest that patients with preoperative impairments in pulmonary function and muscle strength, and those who require prolonged chest tube drainage or develop POCs are likely to have impaired exercise capacity. Therefore, individual assessment and follow-up of patients with such factors is indicated.

Elderly patients awaiting lung resection surgery often have poor physical function, which puts them at a high risk of postoperative pulmonary complications. The aim of this study was to investigate the impact of preoperative physical performance on postoperative pulmonary complications in patients awaiting lung resection surgery. In this prospective multicenter cohort study, the characteristics of patients and postoperative pulmonary complications were compared between subjects with low (<10) and high (≥10) Short Physical Performance Battery (SPPB) scores. Postoperative pulmonary complications were defined as over grade II in Clavien-Dindo classification system. We estimated the effects of physical performance on postoperative pulmonary complications using multivariable hierarchical logistic regression. The postoperative pulmonary complications were compared between 331 patients in the high and 33 patients in the low SPPB group. Patients in the low SPPB score group had a significantly higher rate of postoperative pulmonary complications (p < 0.001). Low SPPB score was associated with a higher risk of postoperative pulmonary complications (odds ratio, 8.80; p < 0.001). The SPPB is a clinically useful evaluation tool to assess surgical patients' physical performance. The low physical performance indicated by the SPPB may be predictive of postoperative pulmonary complications after lung resection surgery. Trial registration: Clinical Trials. University hospital Medical Information Network Center (UMIN-CTR) UMIN000021875.

We investigated the effect of parity number on the dry matter intake (DMI) of cows during the first week after calving. Eighty-three cows were evaluated from 14 days before to 7 days after calving. DMI and milk yield were measured for 7 days after calving, and the calving score was measured. Blood samples were collected throughout the experiment. The average DMI during the first week after calving was reduced in the first-lactation heifers and high-parity number cows. A quadratic relationship between the parity number and the DMI was observed. The first-lactation heifers had lower prepartum serum total protein (TP) concentration and milk yield, higher prepartum serum nonesterified fatty acid (NEFA) concentration and calving score than the multiparous cows. The recovery rate of serum calcium (Ca) after calving was slow in the cows in the parity 6. The DMI was positively affected by the serum Ca concentration after calving, milk yield, and prepartum serum TP concentration and was negatively affected by the calving score and prepartum serum NEFA concentration. We conclude that the DMI immediately after calving tends to be lower in first-lactation heifers and high-parity number cows, but factors that reduce the DMI differ according to parity number., (© 2019 Japanese Society of Animal Science.)