Functional fitness may be related to life satisfaction in older Japanese adults.

The relationship between functional fitness status and life satisfaction was assessed in older Japanese people from the perspective of quality of life (QOL). A total of 123 older men and women (M = 74.3 years, SD = 5.4) participated in the study. The questionnaire contained 21 questions covering eight structural factors pertaining to the feelings of life satisfaction in older people. The functional fitness test consisted of nine items representing the following five areas of fitness: muscular strength, agility, coordination, balance, and flexibility. The analysis revealed no overall correlation between the total fitness and the total life satisfaction scores, but some of the life satisfaction factors were significantly related to some functional fitness items (P < .01). The results suggest it is important for older people to maintain their functional fitness in order to manage a high quality of life.     

A randomized open-label observational study to compare the efficacy and tolerability between topiramate and valproate in juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy (JME) is managed with valproate in most patients; however, valproate is an antiepileptic drug that has relatively severe adverse effects, especially in women. We performed a prospective, open-label, randomized observational study for comparison of efficacy and tolerability between topiramate and valproate in patients with JME. The inclusion criteria were patients with newly diagnosed JME or previously diagnosed JME with a history of a poor response or adverse effects to other antiepileptic drugs. The primary endpoint of this study was percentage of patients who were free of myoclonic seizures for 24 weeks in the two groups. The frequency and severity of adverse effects were also assessed. Sixteen patients were randomized to topiramate and 17 to valproate. In the topiramate arm, 11 of 16 patients (68.9%) completed 24-week maintenance therapy and seven of the 11 (64%) were seizure-free. In the valproate arm, 16 of 17 patients (94.1%) completed 24-week follow-up and nine of 16 (56%) were seizure-free. The difference (64% topiramate versus 56% valproate) did not reach statistical significance in this study group (p = 0.08, Fisher’s exact test). However, the severity of adverse effects was significantly different. Only 1 of 10 adverse effects from topiramate was ranked moderate-to-severe (10%), in comparison with severe rankings for 10 of 17 adverse effects from valproate (59%) (p = 0.018, Fisher’s exact test). In summary, the efficacy of topiramate and valproate was not different, but the severity of adverse effects was favourable for topiramate. Our findings suggest that valproate may be replaced with topiramate, especially for the patients with JME who do not tolerate valproate.     

High prevalence of depression and sleep–wake disorders among female emergency medicine residents in South Korea

BackgroundDepression and sleep–wake disorders are recognized as one of the major problems among emergency physicians. While depression is more common in females than in males, the associated factors linking depression and sleep–wake disorders in emergency physicians, particularly females, remain unknown.ObjectiveTo analyze the prevalence of depression and sleep–wake problems among emergency medicine (EM) residents in South Korea and to identify the gender differences and situations that adversely predispose female residents to mental health problems.MethodsWe conducted a cross-sectional analysis using the data collected from the 2019 National EM Residents Wellness Survey targeting all of 630 EM residents in South Korea. The survey included variables potentially influencing depression and sleep–wake problems, such as personal characteristics, work-related stress, and extrinsic environment. Information regarding medical conditions, depression, job stress, and sleep deprivation was obtained using the self-administered Patient Health Questionnaire (PHQ-9), the Apgar Wellness Score (AWS), and the Epworth Sleepiness Scale (ESS). We analyzed the data using IBM SPSS Statistics version 25 and MedCalc version 17.ResultsA total of 384 residents participated in the survey. Overall, 27.5% of the EM residents met the criteria for at least moderate depression and 36.9% of the EM residents had sleep-related problems. We found that difficulty in trading the shift schedule and frequent night shifts was associated with depression (p = .001, p = .005; respectively). Female residents demonstrated an increased risk of depression and sleepiness compared to their male counterparts (odds ratio [OR] 1.95, OR 1.81; respectively). In addition, logistic regression analysis revealed significant differences by gender in depression with regards to flexibility of trading shifts (p = .005), level of training in the emergency medical centre (p = .035), and frequent night shifts (p = .010).ConclusionsApproximately, one-third of EM residents report depression and sleep–wake problems, with female residents showing a higher risk than male residents. Several risk factors were identified, and future strategies should be aimed to address these issues to improve the training environment and overall wellbeing of EM residents.

KEY MESSAGES

• The prevalence of depression and sleep-related problems were, respectively, 1.95 and 1.81 times higher in female residents compared to their male colleagues.
• The associated risk factors for depression were flexibility of shift trade, level of training in the emergency medical centre, and frequency of night shifts.
• Improving the training environment and facilities, as well as offering more flexible duty trading options can provide potential opportunities to reduce the risk.

     

Lavage solution temperature influences depth of chondrocyte death and surface contouring during thermal chondroplasty with temperature-controlled monopolar radiofrequency energy

BACKGROUND: Although radiofrequency energy can smooth and contour cartilage surface, it has deleterious effects on chondrocyte viability. HYPOTHESIS: Monopolar thermal chondroplasty in a 37 degrees C lavage solution, as compared with a 22 degrees lavage solution, will reduce chondrocyte death and result in greater smoothing of the articular cartilage surface. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen chondromalacic samples from patients undergoing total knee arthroplasty were divided into two groups: 22 degrees C and 37 degrees C lavage solution. Each sample was divided into two equal parts and half of each group was treated for 10 seconds and the other half for 15 seconds. RESULTS: Confocal laser microscopy demonstrated that the depth of chondrocyte death in the 37 degrees C lavage solution group was significantly less (range, 200 to 340 microm) than that in the 22 degrees C solution group for both 10- and 15-second treatment times. Scanning electron microscopy demonstrated that the cartilage surface in the 37 degrees C lavage solution group was smoother than that in the 22 degrees C solution group for the 10-second treatment time. Energy delivery power in the 37 degrees C lavage solution group was significantly lower than in the 22 degrees C solution group for both treatment times. CONCLUSIONS: Thermal chondroplasty with 37 degrees C lavage solution resulted in less depth of chondrocyte death and produced smoother surfaces than with 22 degrees C solution for 10 seconds of treatment. CLINICAL RELEVANCE: Less chondrocyte death would permit increased use of thermal chondroplasty.     

A comparison of 99 consecutive vaginal reconstructions: an outcome study

This study compares the outcome of Singapore flap, vertical rectus abdominis musculocutaneous flap (VRAM), and gracilis musculocutaneous flap vaginal reconstruction. A retrospective review of 99 consecutive patients with complete vaginal defects was conducted at the Mayo Clinic from January 1988 to October 2001. All possible complications were determined for each of the 3 reconstructive techniques, along with the effects of radiation and smoking on the respective complication rates. Preoperative and postoperative sexual function and adequacy were compared between each group. Ninety-nine patients ranging in age from 19 to 80 years (mean, 51.6 years) were compared, with a mean follow-up of 28.9 months. Forty-one VRAM, 13 gracilis, and 45 modified Singapore flaps were used for vaginal reconstruction. The majority was due to acquired vaginal defects due to recurrent pelvic malignancy. The overall complication rate was lower following VRAM than either gracilis or Singapore flap reconstructions (13/41, 31.7%; 8/13, 61.5%; and 21/45, 46.7%, respectively). The flap specific complication rate was least in the VRAM group (9/41, 22%; 7/13, 53.8%; and 17/45, 37.8%, respectively). The VRAM had a significant protective effect against the development of postoperative small bowel obstruction. Preoperative sexual activity predicted postoperative activity in 75 of 88 patients (85.2%) and was not affected by the type of reconstruction, although more patients with a Singapore flap required vaginal dilatation to maintain patency. In conclusion, the VRAM has a lower overall and flap-related complication rate compared with either gracilis or Singapore flap reconstruction. It has become our vaginal reconstructive flap of choice.