Analysis of effectiveness of therapeutic exercise for knee osteoarthritis and possible factors affecting outcome

Background

There are numerous reports and evidences to suggest that exercise therapy is effective for knee osteoarthritis (knee OA). However, there is a lack of sufficient research concerning the factors influencing its application and effectiveness. The purposes of this study were to evaluate effects of the mode of treatment delivery on the improvement of symptoms in knee OA, and to analyze potential risk factors affecting improvement after exercise therapies.

Methods

The 209 women applicants diagnosed with knee OA were randomly allocated into either a group performing group exercise in a class or a group performing home exercise. The 90 min exercise program was performed under the guidance of physiotherapists as a group exercise therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of the subjects of both groups before and after intervention was compared to examine the effect of exercise therapy. In addition, body mass index, knee range of motion (ROM), the femorotibial angle from radiographs, OA severity from Kellgren–Lawrence grade, and meniscus abnormality and subchondral bone marrow lesions from MRI findings were statistically analyzed as factors that may affect exercise therapy.

Results

A significantly greater improvement in WOMAC was observed in the subjects of group exercise (81 subjects) as compared with the subjects of home exercise (122 subjects). There was a significantly high proportion of subjects with knee flexion contracture among the subjects participating in group exercise that showed only minor symptom improvement (p < 0.05). In addition, exercise therapy proved to be highly effective for subjects with limited quadriceps muscle strength (p < 0.05).

Conclusions

When prescribing exercise therapy for knee OA, evaluation of a subject’s ROM and muscle strength is important in deciding whether to commence exercise therapy and what type of exercise therapy to apply; it is also important in predicting the effect of exercise therapy.     

Cervical Lymph Node Dissection for Clinically Submucosal Carcinoma of the Thoracic Esophagus

Background

The purposes of this study were to clarify the risk factors for supraclavicular lymph node (SCLN) metastasis and the survival benefit from cervical lymph node (LN) dissections in patients with clinically submucosal (cT1b) carcinoma of the thoracic esophagus.

Methods

A total of 86 patients with this disease who underwent esophagectomy with 3-field lymph node dissection were retrospectively reviewed. Multivariate logistic regression and Cox proportional hazard model were used to identify the independent risk factors for SCLN metastasis and prognostic factors, respectively. An index calculated by multiplying the frequency of metastasis at nodal basin and the 5-year overall survival rate of patients with metastasis at that basin were used to assess the therapeutic outcomes.

Results

A total of 40 patients (47 %) were found to have pathological LN metastasis. Also, 13 patients (15 %) had cervical LN metastasis: 6 and 7 with carcinoma of the upper and mid-thoracic esophagus, respectively. SCLN metastasis was found in 6 patients (7 %); however, there was no independent risk factor for SCLN metastasis. The 5-year overall survival rate was 72.5 %. Cervical LN metastasis was an independent prognostic factor (p = .04; odds ratio 2.55; 95 % confidence interval 1.03–6.31); however, there was no significant difference in survival between patients with SCLN metastasis and those without (p = .06). The calculated index of estimated benefit from cervical LN dissections was 6.9, following upper mediastinal LN of 15.6 and perigastric LN of 8.3.

Conclusions

We could not identify risk factors to predict SCLN metastasis. Cervical LN dissection should not be omitted in patients with cT1b carcinoma, especially of the upper and mid-thoracic esophagus.     

Influence of age and gender on trigeminal sensory function and magnetically evoked masseteric exteroceptive suppression reflex

ObjectiveThe present study explored the effect of age and gender on trigeminal sensory function and masseteric exteroceptive suppression (ES) reflex responses.MethodsYoung healthy men (n = 12) and women (n = 12) (age: 23.5 ± 3.0 years) and older healthy men (n = 12) and women (n = 12) (age: 58.5 ± 5.2 years) participated. Sensory function was assessed on the skin overlying the mental foramen using mechanical stimuli. Surface EMG was recorded from the left masseter muscle to assess ES reflex responses evoked by a magnetic stimulus applied to the skin above the left mental nerve.ResultsThe older group had significantly higher tactile detection thresholds. Early ES1 was present in all subjects. Onset latency of ES1 was significantly delayed in older subjects. ES2 was present in all young subjects, but only in 5 of the 12 men and 8 of the 12 women in the older group. Significant gender differences were found for sensory and pain thresholds to mechanical stimuli as well as for duration of ES.ConclusionsAgeing affects tactile detection thresholds, onset latency of ES1 responses, and appearance of ES2. The present results indicate that trigeminal sensory function and brainstem reflex responses differ between genders and age groups. These findings may have implications for assessment of craniofacial pain conditions.     

Maxillary sensory nerve responses induced by different types of dentures

PurposeThe purpose of this study was to investigate whether different types of dentures induced different responses to stimulations in sensory nerve underlying the denture-supporting mucosa using current perception threshold (CPT).Materials and methodsThe study population comprised 45 complete denture wearers with a mean age of 69.7 years (CD), 30 partial denture wearers (PD) with a mean age of 67.1 years, and 40 dentulous participants with a mean age of 69.0 years (Dent). Current perception threshold (CPT) on the greater palatine nerve at 2000 Hz, 250 Hz, and 5 Hz, corresponding to A-beta, A-delta, and C fibers respectively, were measured by the Neurometer^® NS3000 device. The differences CPTs among CD, PD, and Dent groups were analyzed by Kruskal–Wallis test and Mann–Whitney U test with adjusting the multiple comparisons’ inflation of type 1 error rate by a Bonferroni correction.ResultsCPTs of CD, PD, and Dent group at 2000 Hz were 61.5 ± 45.8, 53.5 ± 25.3, 33.0 ± 11.4 (10^?2 mA) respectively. CPTs of CD, PD, and Dent group at 250 Hz were 29.2 ± 28.2, 20.1 ± 13.2, 14.3 ± 5.9 (10^?2 mA) respectively. CPTs of CD, PD, and Dent group at 5 Hz were 28.9 ± 23.4, 17.8 ± 12.2, 12.2 ± 5.6 (10^?2 mA) respectively. The CPTs at all frequencies increased in the following order: Dent < PD < CD wearer. The statistical analyses showed that the different types of dentures significantly affected CPTs at 2000 Hz (p < 0.0001), 250 Hz (p < 0.0001), and 5 Hz (p < 0.0001).ConclusionThe different types of dentures induce different responses to stimulations in the sensory nerve underlying the denture-supporting mucosa.