Objective: This study aimed to identify the characteristics of cases in which walking level improves even in the later stages of convalescent rehabilitation, and to predict such cases.Methods: The Walking LEVEL Scale (WaLS) was measured over time in 192 patients (brain-related and orthopedic diseases) admitted to a convalescent rehabilitation ward. The “delayed recovery group (DR)” was defined as the group showing improvement of WaLS in the later period, while the “non-delayed recovery group (NDR)” was defined as the group for whom improvement of WaLS did not extend into the same period. Then, changes in WaLS over time and each factor were compared to identify differences between DR and NDR. Using receiver operating characteristic analysis, cutoff values, sensitivity and specificity, likelihood ratios for the relevant factors were calculated and examined for the predictability of DR utilizing Bayesian estimation.Results: WaLS temporal changes showed a sigmoid curve only in the DR of brain-related disease. Other groups showed logarithmic curves. The WaLS score at admission was selected as a significant variable. The positive and negative likelihood ratios for the score at cutoff values of 4 or less were 2.00 and 0.19 for brain-related disease, and 1.49 and 0.63 for orthopedic disease, respectively. Adopting the DR frequency of the participants in this study as the prior probability, the DR posterior probability of brain-related disease was calculated to be 5% using the negative likelihood ratio.Conclusion: The negative likelihood ratio of the WaLS score at admission is useful for predicting DR for brain-related disease.

Objective: This study investigated and compared the responsiveness of the Walking LEVEL Scale (WaLS), Functional Independence Measure (FIM)-walk item, and Functional Ambulation Category (FAC) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Methods: One hundred three patients participated in this study. Physical or occupational therapists assessed the three scales at two times of admission and discharge to determine the responsiveness. The amount of change, ceiling and floor effect, Effect Size (ES), and Standardized Response Mean (SRM) determined the responsiveness to change from admission to discharge. Their analysis was by severity and disease.Results: The amount of change in WaLS was larger than that of the FIM-walk item and FAC, except for the moderate gait disability group. More ceiling and floor effects were observed in FIM-walk item evaluation. Regardless of severity or disease, all rating scales showed moderate or better responsiveness (ES > 0.5). When ceiling or floor effects were observed, ES tended to be overestimated. The SRM of WaLS was larger than that of the other scales, except for the mild gait disability group.Conclusion: The results support WaLS as the most suitable instrument to detect walking level changes over time for patients in CRW.

PURPOSE: This study aimed to investigate anterior knee symptoms in patients who underwent anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft followed by implantation of a beta-tricalcium phosphate (β-TCP) block as a bone void filler. MATERIALS AND METHODS: We retrospectively reviewed 84 cases of synthetic bone grafting using a β-TCP block for the patellar bone defect in ACL reconstruction with a BPTB autograft. Computed tomography of the operated knee was performed immediately after the surgery to evaluate whether the grafted β-TCP block protruded forward from the anterior surface of the patella. On the basis of the results, the cases were divided into a protrusion group (n=31) and a non-protrusion group (n=53). Anterior knee symptoms at 12 months postoperatively and absorption of the grafted β-TCP block were compared between the two groups. RESULTS: Except for patellofemoral crepitus, there was no significant difference in anterior knee symptoms between the two groups (p>0.05). The incidence of patellofemoral crepitus was significantly lower in the protrusion group than in the non-protrusion group (p=0.027). The groups showed no significant difference in β-TCP absorption. CONCLUSIONS: The present study demonstrated that the protrusion of β-TCP that was used as a bone void filler had no adverse effects.
Absorption ; Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; Bone Transplantation ; Bone-Patellar Tendon-Bone Grafts ; Humans ; Incidence ; Knee ; Patella ; Retrospective Studies ; Tissue Donors ; Transplants

Effects of three plant extracts (Hordeum vulgare L., Apocynum Venetum L., Brasenia schreberi J.F.G mel.) on human gingival fibroblasts were examined. As a result, we observed the promoting effect of the extract of Hordeum vulgare L. and the extract of Apocynum Venetum L. respectively on FGF2 and FGF7 production. Moreover, the mixture of the three plant extracts showed the effect of improving the changes in type I collagen gene expression and matrix metalloproteinase 1 gene expression by LPS addition. Next, a dentifrice containing the three plant extracts was subjected to human efficacy trials. We measured periodontal pocket depth, attachment level, bleeding on probing and saliva TNFα as an indicator of periodontal disease. The results suggest that the dentifrice formulated with the three plant extracts were effective for the improvement of periodontal disease.

[Objective] We performed a multi-center randomized controlled trial using sham acupuncture as a control in the 11 institutions of Aichi and Shizuoka prefecture at which we practice our original acupuncture method.
[Design · Methods] Patients were randomly allocated to four groups : A group, “Taikyoku-Ryoho” (whole body acupuncture method) pole treatment combined with low frequency electroacupuncture; B group, “TaikyokuRyoho” pole treatment; C group, low frequency electroacupuncture; D group, sham acupuncture. Therapeutic effectiveness was evaluated using a visual analogue scale (VAS) and criteria of the Japanese Orthopedic Association for low back pain (JOA score). After these evaluations, patients in B group received low frequency electroacupuncture and patients in C group received “Taikyoku-Ryoho” pole treatment. Patients in D group received both therapies. Thus, all patients eventually received the entire series of therapies. [Results] Significant improvement (P<0.05) in VAS and JOA scores was recognized after one acupuncture treatment in A, B and C groups, but not in D group. There were no differences in terms of the effectiveness among A, B and C groups.
[Conclusion] Our original acupuncture method of “Taikyoku-Ryoho” combined with low frequency electroacupuncture was superior to sham acupuncture. However, the definition of sham acupuncture needs to be more clearly defined in future research.

We report our experience with percutaneous endoscopic gastrostomy (PEG) to assess the safety and usefulness of the PEG. We reviewed 21 cases (mean age, 72 years), including 20 patients with neurological impairment and one patient with cancer of the stomach.
Though two minor complications (wound infection and bleeding from the stomach) occurred, wound infection healed with antibiotics and bleeding stopped spontaneously. Six of these patients died (3 died from pneumonia, 2 from respiratory failure, and 1 from stomach cancer), but there were no PEG-related deaths. After PEG procedure, serum protein, albumin and cholesterol improved significantly. PEG was not only safe but also effective for the nutritional support and the 4-year survival rate was 56%. By this method, moreover, half of the patients could leave hospital and return home.
In conclusion, PEG, is thought to be the procedure of choice for the long-term enteral nutrition.