Pedometer-Based Behavioral Change Program Can Improve Dependency in Sedentary Older Adults: A Randomized Controlled Trial

BACKGROUND

Recent studies suggested that pedometer-based walking programs are applicable to older adults.

OBJECTIVES

The purpose of this study was to evaluate the use of pedometer in sedentary older adults to improve physical activity, fear of falling, physical performance, and leg muscle mass.

DESIGN

This was a pilot randomized controlled trial (RCT).

SETTING AND PARTICIPANTS

Eighty-seven community dwelling sedentary older adults living in Japan.

INTERVENTION

The intervention group (n=43) received a pedometer-based behavioural change program for 6 months, while the control group (n=44) did not. The participants in the intervention group were instructed to increase their mean daily steps by 10% each month. Thus, at the end of 6 months, participants in the intervention group were expected to have 77 % more daily steps than their baseline step counts. Written activity logs were monthly averaged to determine whether the participants were achieving their goal.

MEASUREMENTS

Outcome measures were physical activity, fear of falling, physical performances, and leg muscle mass.

RESULTS

In this 6-month trial 40 older adults (93%) completed the pedometer protocol with good adherence. In the intervention group, average daily steps were increased by 83.4% (from 20311323 to 3726 1607) during the study period, but not in the control group (from 20471698 to 22671837). The pedometer-based behavioral change program was more effective to improve their physical activity, fear of falling, locomotive function, and leg muscle mass than control (P<0.05).

CONCLUSION

These results suggested that the pedometer-based behavioral change program can effectively improve the physical activity, fear of falling, physical performance, and leg muscle mass in sedentary older adults.

Subchondral plate porosity colocalizes with the point of mechanical load during ambulation in a rat knee model of post-traumatic osteoarthritis

OBJECTIVE

This study investigated the association between spatiotemporal cartilage-subchondral bone plate alterations and mechanical load during ambulation in an experimental rat model of destabilized medial meniscus (DMM).

DESIGN

Twelve-week-old Wistar rats (n = 38) underwent DMM surgery on the right knee and sham surgery on the left knee. At 2 and 4 weeks after surgery, subchondral bone changes were evaluated via micro-computed tomography with various knee flexion angles to simulate weight-bearing during rat ambulation under a 3-dimensional motion capture apparatus. Additionally, the biomechanical properties, histology, and ultrastructure of the medial tibia and femoral condyle were evaluated.

RESULTS

Focal subchondral bone plate perforations were confirmed in the medial tibia within 2 weeks after surgery and were aggravated rapidly 2 weeks later. This subchondral plate porosity colocalized with articular cartilage lesions as confirmed by histology and scanning electron microscopy, and coincided with the likely point of contact between the posterior femoral condyle and tibial plateau during ambulation. Biomechanical properties were confirmed at the medial tibia, at which stiffness was reduced to approximately half that of the sham-operated knee at 4 weeks after surgery.

CONCLUSIONS

Cartilage-subchondral bone plate alterations localized in the region of the point of mechanical load during ambulation in DMM-operated knees, at which the mechanical integrity of cartilage was impaired. These results indicate that DMM-induced increases in mechanical load play an important role in the pathogenesis of early post-traumatic osteoarthritis (OA), and it might accelerate the development of the disease via cartilage-subchondral bone plate crosstalk through increased subchondral plate perforations.

The relationship between the daily step counts and low back pain during pregnancy

PURPOSE

To investigate the relationship between the change of daily step counts and low back pain (LBP) during pregnancy. Materials and

METHODS

Pregnant women at less than eight weeks of gestation (WG) were recruited. Daily step counts were measured with a pedometer. To assess LBP, the Oswestry disability index (ODI) score was recorded. Thirty-six individuals were divided into the LBP and non-LBP groups. The effect of step counts on LBP between the two groups was analyzed.

RESULTS

At 16-19 WG, step counts were not considerably changed in the non-LBP group but were significantly increased in the LBP group. At 24-27 and 32-35 WG, step counts were increased in the non-LBP group but were significantly decreased in the LBP group.

CONCLUSIONS

Acute increase of daily step counts in early pregnancy is a risk for LBP, and gradual increases of step counts after mid-pregnancy is recommended for women.

Self-assessment of Rheumatoid Arthritis Disease Activity Using a Smartphone Application. Development and 3-month Feasibility Study

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation".

BACKGROUND

Rheumatoid arthritis (RA) is a progressive inflammatory disease that causes damage to multiple joints, decline in functional status, and premature mortality. Thus, effective and frequent objective assessments are necessary. Then, we developed a self-assessment system for RA patients based on a smartphone application.

OBJECTIVE

The purpose of this study was to investigate the feasibility of a self-assessment system for RA patients using a smartphone application.

METHODS

We measured daily disease activity in nine RA patients who used the smartphone application for a period of three months. A disease activity score (DAS28) predictive model was used and feedback comments relating to disease activity were shown to patients via the smartphone application each day. To assess participants' RA disease activity, the DAS28 based on the C-reactive protein level was measured by a rheumatologist during monthly clinical visits.

RESULTS

The disease activity measured by the application correlated well with the patients' actual disease activity during the 3-month period, as assessed by clinical examination. Furthermore, most participants gave favourable responses to a questionnaire administered at the end of the 3-month period containing questions relating to the ease of use and usefulness of the system.

CONCLUSIONS

The results of this feasibility study indicated that the DAS28 predictive model can longitudinally predict DAS28 and may be an acceptable and useful tool for assessment of RA disease activity for both patients and healthcare providers.

Effects of short-term gentle treadmill walking on subchondral bone in a rat model of instability-induced osteoarthritis

OBJECTIVE

Subchondral bone cyst (SBC) growth, caused by osteoclast activity during early knee osteoarthritis (OA) pathogenesis, should be treated to prevent further progressions of OA. In the present study, we evaluated the effects of gentle treadmill walking on subchondral bone and cartilage changes in an experimental rat model of destabilized medial meniscus (DMM).

METHOD

Twelve-week-old Wistar rats underwent DMM surgery in their right knee and sham surgery in their left knee and were assigned to either the sedentary group or walking group (n = 42/group). Animals in the walking group were subjected to treadmill exercise 2 days after surgery, which included walking for 12 m/min, 30 min/day, 5 days/week for 1, 2, and 4 week(s). Subchondral bone and cartilage changes were evaluated by micro-CT analysis, histological analysis, and biomechanical analysis.

RESULTS

Treadmill walking had a tendency to suppress SBC growth, which was confirmed by micro-CT (P = 0.06) and positive staining for tartrate-resistant acid phosphatase (TRAP) activity for the osteoclast number per bone surface (P = 0.09) 4 weeks after surgery. These changes coincide with the prevention of cartilage degeneration as evaluated by the Osteoarthritis Research Society International (OARSI) score (P < 0.05) and biomechanically softening (P < 0.05). Furthermore, treadmill walking could suppressed increasing osteocyte deaths (P < 0.01), which was positively correlated with the OARSI score (r = 0.77; P < 0.01).

CONCLUSION

These results indicate biomechanical and biological links exist between cartilage and subchondral bone; preventive effects of treadmill walking on subchondral bone deterioration might be partly explained by the chondroprotective effects.

Risk factors for elbow pain in Little League baseball players: a cross-sectional study focusing on developmental factors

AIM

The incidence of Little League elbow is increasing. However, the risk factors for Little League elbow, especially those related to development have not previously been investigated. The purpose of this study was to investigate the risk factors for elbow pain in Little League baseball players while focusing on the developmental factors.

METHODS

A total of 654 baseball players aged 6-12 years, all male, participated in this study. Participants completed an original questionnaire that included items assessing demographic data, developmental factors (increase in height and increase in weight over the preceding 12 months), and baseball-related factors. Multiple regression analysis was used to identify the risk factors for elbow pain during the 12 months prior to the study.

RESULTS

The data collected for 392 players without omissions or blank answers were submitted to statistical analysis. We found that 19.1% of Little League baseball players had experienced elbow pain in the 12 months leading up to the study. The analysis revealed that height (Odds Ratio [OR], 1.10; 95% confidence interval [95%CI], 1.03-1.17) and increase in height (OR, 1.16; 95%CI, 1.00-1.34) were risk factors that increased the risk of elbow pain after adjustment for demographic data, developmental data, and baseball-related factors.

CONCLUSION

Our results suggested that an increase over height in the last 12 months may predispose young baseball players to elbow pain.

Analysis of factors affecting time in therapeutic range control after warfarin administration

The protective efficacy of warfarin for cardiogenic cerebral embolism has been established. However, warfarin is generally administered to only approximately 35% of the atrial fibrillation patients who required warfarin therapy. It has been reported that international normalized ratio (INR) control was carried out appropriately in < 50% of such patients. Therefore, from the viewpoint of prevention of the onset and recurrence of embolism, the maintenance of a stable anticoagulant level is necessary. In warfarin therapy, in addition to INR control, time in therapeutic range (TTR) also markedly affects the efficacy of warfarin therapy. Therefore, we classified patients into two groups on the basis of the cutoff TTR ≥ 65% at which the inhibitory effect of warfarin on stroke has been observed. We aimed to examine the association between INR and TTR with the correction of the therapeutic efficacy of warfarin by analyzing the factors leading to poor TTR control. The most valuable finding of this study is that marked fluctuations of brain natriuretic peptide levels in patients with complication of heart failure was a risk factor for poor TTR control. Identification of the factors leading to the poor TTR control is useful for making the decision to switch to other anticoagulants, such as dabigatran or apixaban, or to continue warfarin by correcting risk factors in atrial fibrillation patients receiving long-term warfarin therapy.

A New Statistical Model Identified Two-thirds of Clinical T1 Gastric Cancers as Possible Candidates for Endoscopic Treatment

BACKGROUND

Clinical T1 gastric cancer has low metastatic potential to lymph nodes and is generally curable by local treatment. Endoscopic resection can preserve the whole stomach and does not impair the patient's quality of life; however, its indication is strictly limited to the subset of patients without nodal metastasis. The study was designed to predict reliably the patients without nodal metastasis based only on the clinical information.

METHODS

We examined patients with clinical T1 disease who were treated with surgery. The clinically available information was evaluated for its ability to predict nodal metastasis by logistic regression model. Then, the predictive ability of the logistic regression model using the risk factors for nodal metastasis was evaluated by a receiver operating characteristic curve.

RESULTS

A total of 511 patients were entered into this study. The clinical depth (cT1a or cT1b), maximal tumor diameter, and pathological type were confirmed to be significantly different between patients with and without nodal metastasis. The cutoff value of the tumor diameter differed depending on the histology and clinical depth: 79 mm for differentiated type and 48 mm for undifferentiated type in cT1a tumors, and 43 mm for differentiated type and 11 mm for undifferentiated type in cT1b tumors. According to these criteria, 348 of the 511 patients (68.1 %) were classified to have predictive N0 status. The negative predictive value was 95.7 % (95 % confidence interval 94.0-97.5 %).

CONCLUSIONS

The predictive criteria based on the multivariate logistic model identified that almost two-thirds of the patients with clinical T1 gastric cancer were possible candidates for endoscopic treatment.

Ambipolar organic field-effect transistors based on solution-processed single crystal microwires of a quinoidal oligothiophene derivative

A simple and versatile solution-processing method based on molecular self-assembly is used to fabricate organic single crystal microwires of a low bandgap quinoidal oligothiophene derivative. Individual single crystal microwire transistors present well-balanced ambipolar behaviour with hole and electron mobilities as high as 0.4 and 0.5 cm(2) V(-1) s(-1), respectively.

Development of age-specific Japanese head phantoms for dose evaluation in paediatric head CT examinations

In this study, the authors developed age-specific physical head phantoms simulating the physique of Japanese children for dose evaluation in paediatric head computed tomography (CT) examinations. Anatomical structures at 99 places in 0-, 0.5-, 1- and 3-y-old Japanese patients were measured using DICOM viewer software from CT images, and the head phantom of each age was designed. For trial manufacture, a 3-y-old head phantom consisting of acrylic resin and gypsum was produced by machine processing. Radiation doses for the head phantom were measured with radiophotoluminescence glass dosemeters and Si-pin photodiode dosemeters. To investigate whether the phantom shape was suitable for dose evaluation, organ doses in the same scan protocol were compared between the 3-y-old head and commercially available anthropomorphic phantoms having approximately the same head size. The doses of organs in both phantoms were equivalent. The authors' designed paediatric head phantom will be useful for dose evaluation in paediatric head CT examinations.

High-temperature-required protein A2 as a predictive marker for response to chemotherapy and prognosis in patients with high-grade serous ovarian cancers

Background:

High-temperature-required protein A2 (HtrA2), a protein relating with apoptosis in a caspases-dependent and non-dependent manner, has been reported to be associated with chemosensitivity in several human cancers.

Methods:

Tissue microarrays made from 142 patients with high-grade serous ovarian adenocarcinoma were evaluated to assess whether HtrA2 expression was related with several clinical parameters.

Results:

Negative HtrA2 expression was observed in 36 cases (25%) of the patients, and related with significantly lower response rates of primary chemotherapy than those with positive HtrA2 expression (56% vs 83%, P<0.01). In addition, negative HtrA2 expression was identified as an independent worse prognostic factor for progression-free survival and overall survival by multivariate analyses. Furthermore, HtrA2 downregulation modulated sensitivity to platinum in serous ovarian cancer cells in vitro.

Conclusions:

HtrA2 expression was a predictor for sensitivity to chemotherapy, and could be a candidate of molecular target in the treatment of high-grade serous ovarian cancers.

Three-dimensional reconstruction of rat knee joint using episcopic fluorescence image capture

OBJECTIVE

Development of the knee joint was morphologically investigated, and the process of cavitation was analyzed by using episcopic fluorescence image capture (EFIC) to create spatial and temporal three-dimensional (3D) reconstructions.

METHODS

Knee joints of Wister rat embryos between embryonic day (E)14 and E20 were investigated. Samples were sectioned and visualized using an EFIC. Then, two-dimensional image stacks were reconstructed using OsiriX software, and 3D reconstructions were generated using Amira software.

RESULTS

Cavitations of the knee joint were constructed from five divided portions. Cavity formation initiated at multiple sites at E17; among them, the femoropatellar cavity (FPC) was the first. Cavitations of the medial side preceded those of the lateral side. Each cavity connected at E20 when cavitations around the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were completed.

CONCLUSION

Cavity formation initiated from six portions. In each portion, development proceeded asymmetrically. These results concerning anatomical development of the knee joint using EFIC contribute to a better understanding of the structural feature of the knee joint.

Destabilization of the medial meniscus leads to subchondral bone defects and site-specific cartilage degeneration in an experimental rat model

OBJECTIVE

This study aimed to investigate subchondral bone changes using micro-computed tomography (micro-CT) and regional differences in articular cartilage degeneration, focusing on changes of cartilage covered by menisci, in the early phase using a destabilization of the medial meniscus (DMM) model.

METHOD

The DMM model was created as an experimental rat osteoarthritis (OA) model (12 weeks old; n = 24). At 1, 2, and 4 weeks after surgery, the rats were sacrificed, and knee joints were scanned using a Micro-CT system. Histological sections of the medial tibial plateau, which was divided into inner, middle, and outer regions, were prepared and scored using the modified OARSI scoring system. The cartilage thickness was also calculated, and matrix metalloproteinase 13 (MMP13), Col2-3/4c, and vascular endothelial growth factor (VEGF) expression was assessed immunohistochemically.

RESULTS

Subchondral bone defects were observed in the middle region, in which the cartilage thickness decreased over time after surgery, and these defects were filled with MMP13- and VEGF-expressing fibrous tissue. The OARSI score increased over time in the middle region, and the score was significantly higher in the middle region than in the inner and outer regions at 1, 2, and 4 weeks after surgery. Col2-3/4c and MMP13 expression was observed primarily in the meniscus-covered outer region, in which the cartilage thickness increased over time.

CONCLUSION

Loss of meniscal function caused cartilage degeneration and subchondral bone defects in the early phase site-specifically in the middle region. Furthermore, our results might indicate cartilage covered by menisci is easily degraded resulting in osmotic swelling of the cartilage in early OA.

Diagnostic value of computed tomography for staging of clinical T1 gastric cancer

BACKGROUND

T1 gastric cancer can be diagnosed only by endoscopy and is almost curable by local treatment. It has been unclear how a multidetector-row computed tomography (CT) evaluation is valuable for clinical T1 patients.

METHODS

Patients with clinical T1 disease, as diagnosed by endoscopy and treated with endoscopic submucosal dissection (ESD) or surgery between October 2000 and October 2007, were examined. The efficacy of CT was evaluated by the reversal rate of endoscopic T1 by CT, the incidence of clinical M1 disease, and the accuracy of diagnosing pathological N+ disease in patients who received surgery. To confirm metachronous distant and nodal metastases, the disease-free survival (DFS) also was evaluated.

RESULTS

A total of 761 patients, 236 treated by ESD and 525 treated with surgery, were examined. None of the patients had an endoscopic diagnosis of clinical T1 reversed by CT. No clinical M1 disease was found. Among the 525 patients who underwent surgery, 8 showed clinical N+ disease (1.5 %), while 47 demonstrated pathological N+ disease (8.9 %). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive values were 90.3, 4.3, 98.7, 25, and 91.3 %, respectively. The 5-year DFS rate was 93.6 % (95 % confidence interval 91.4-95.8 %).

CONCLUSIONS

The present study suggests that diagnostic value of CT is limited for staging of clinical T1 gastric cancer patients, because the reversal rate of endoscopic T1 by CT was very low, clinical M1 disease was rare, the diagnosis of N+ status was unreliable, and metachronous M1 and N+ findings were rare.

12 INTRAUTERINE CHITOSAN INJECTION ADVANCES THE OESTROUS RETURN DATE AFTER DELIVERY IN JAPANESE BLACK COWS

Shortened parturition interval is very profitable for beef cattle production. Chitosan is made by treating shrimp and other crustacean shells with alkali sodium hydroxide, a linear polysaccharide composed of randomly distributed β-(1–4)-linked D-glucosamine and N-acetyl-D-glucosamine, and has been utilised as an antibacterial agent. Intrauterine injection of chitosan, as an antibacterial agent, is expected to stimulate immune functions and to improve uterine recovery. The aim of the present study was to evaluate whether intrauterine chitosan injection shortened oestrous return after parturition in Japanese black cows. Chitosan powder was dissolved in water (5 g L–1), sterilized, and stored in a freezer at –20°C until use. At 30 days after delivery, chitosan solution was injected (50 mL/head) into the uterine body from the vagina via the cervix of cows. Heat detection was performed daily with a pedometer wirelessly connected to a computer. When heat-specific increased steps and standing heat were observed, we considered the cow to be in heat. In total, 9 cows were injected chitosan from December 2012 to June 2013, and those data were compared by ANOVA with control data collected from 42 cows from December 2011 and November 2012. Mean durations when oestrus was first returned after parturition shortened significantly in the chitosan-injected group (45.3 ± 4.9 days) than in controls (62.4 ± 2.7 days). Six females that showed oestrus after treatment with chitosan became pregnant following AI at the oestrus or the next cycle, and three others were waiting to be checked for pregnancy after AI. These preliminary data indicate that chitosan injection after parturition may shorten the oestrous return and improves reproductive efficiency. However, a large number of observations are necessary to reach further conclusions.

Photophysical, amplified spontaneous emission and charge transport properties of oligofluorene derivatives in thin films

We investigate the charge transport, photophysical and amplified spontaneous emission properties of a series of monodisperse solution-processable oligofluorenes functionalized with hexyl chains at the C9 position of each fluorene unit.