BACKGROUND:Total knee arthroplasty (TKA) is a common intervention for treating end-stage knee osteoarthritis (OA). Postoperatively, altered biomechanics may increase the risk of OA progression in the contralateral knee. Knee adduction moment (KAM) is a key indicator of medial knee joint loading and is associated with OA progression. Walking aids are often prescribed to reduce joint stress during walking; however, their comparative effects on KAM in patients undergoing TKA remain unclear. This study aimed to evaluate the effects of different walking aids (double canes [D-canes], rollators without forearm support [rollators], and rollators with forearm support [F-rollators]) on KAM peak and impulse in both the operated and contralateral knees of patients after TKA using gait analysis. METHODOLOGY:A cross-sectional study was conducted on eight women who underwent unilateral TKA. Participants walked under four conditions: no aid, D-canes, rollators, and F-rollators. A three-dimensional motion capture system measured the lower limb kinematics and kinetics. The primary outcomes were KAM peak and impulse for both knees. Secondary outcomes included ground reaction force in the vertical direction (GRF Z), forward trunk tilt angle, and lower limb joint angles. A two-way repeated-measures measures analysis of variance (ANOVA) was used for statistical comparisons. RESULTS:Walking aids significantly reduced the KAM peak and impulse in both the operated and contralateral knees compared with unaided walking (P < 0.001). In the operated knee, the KAM peak decreased by approximately 20% with all aids, whereas in the contralateral knee, reductions were 6% for D-canes, 16% for rollators, and 24% for F-rollators. Rollators and F-rollators more effectively reduced contralateral knee loading than D-canes (P < 0.001). A significant negative correlation was found between trunk forward tilt angle and GRF Z (ρ= -0.74, P < 0.001), suggesting that increased forward lean with rollators and F-rollators enhanced lower limb offloading. No significant changes were observed in knee varus angle or walking speed across conditions. CONCLUSIONS:Walking aids, particularly F-rollators, effectively reduce KAM and offload the contralateral knee in patients after TKA. These findings suggest potential benefits for patients at risk of OA progression in non-operated knees.

The study aims to compare the effectiveness of muscle strength training at full range of motion (ROM) and partial ROM as an aid for developing an effective muscle strength training method. We included 14 and 11 participants in the full and partial ROM groups, respectively. The participants were instructed to perform knee flexion and extension muscle training using an isokinetic dynamometer. The participants in the full and partial ROM groups performed knee flexion exercises from 130° to 0° and from 90° to 0°, respectively. The exercise protocol in both the groups was 300°/s for three sets, twice per week, over a total exercise period of 8 weeks. Maximum torque (Nm) per 1 kg of body weight was measured before and after the intervention. Statistical analyses results indicated that both the groups exhibited muscle strengthening after the intervention. No significant between-group difference was observed in the degree of muscle strengthening achieved. Partial ROM training exerts the same degree of effect as full ROM training.

Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its invasiveness, limitations, sampling errors, etc. Therefore, many alternative approaches to assess liver fibrosis are gaining more popularity and have assumed great importance, and many data on such approaches are being generated. The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The first consensus guidelines of the APASL recommendations on hepatic fibrosis were published in 2009. Due to advances in the field, we present herein the APASL 2016 updated version on invasive and non-invasive assessment of hepatic fibrosis. The process for the development of these consensus guidelines involved review of all available published literature by a core group of experts who subsequently proposed consensus statements followed by discussion of the contentious issues and unanimous approval of the consensus statements. The Oxford System of the evidence-based approach was adopted for developing the consensus statements using the level of evidence from one (highest) to five (lowest) and grade of recommendation from A (strongest) to D (weakest). The topics covered in the guidelines include invasive methods (LB and hepatic venous pressure gradient measurements), blood tests, conventional radiological methods, elastography techniques and cost-effectiveness of hepatic fibrosis assessment methods, in addition to fibrosis assessment in special and rare situations.

Background: Urinary incontinence seriously affects the social aspects of women's quality of life. Many cases of urinary incontinence involve stress urinary incontinence, and pelvic floor muscle (PFM) exercises are often performed as treatment. However, the PFMs are deeply located within the body, making conscious PFM contraction difficult. The inner unit muscles include the PFMs, transverse abdominis (TrA), lumbar multifidus (LM), and diaphragm, all of which are actively coordinated.

Early diagnosis of non-alcoholic steatohepatitis (NASH) is highly desired because NASH can lead to cirrhosis or even to hepatocellular carcinoma in some severe cases. Towards non-invasive diagnosis with ultrasound, we studied free fatty acids (FFAs) present in the liver, which is the organ most likely to be affected by the disease. As a preclinical study, we performed acoustic-impedance measurements of five kinds of FFAs in solvent or in cultured Huh7 cells. To measure the acoustic impedance, a concave transducer with an 80-MHz center frequency was incorporated in a scanning acoustic microscopy system. One-way ANOVA showed statistically-significant differences (p<0.05) in acoustic impedance among the FFAs in FFA solvent and with cultured Huh7 cells. These results suggest that each of the FFAs, especially PA, OA and PAOA could be distinguished from each other regardless of whether they were in solution or in absorbed by cells.

Early diagnosis for non-alcoholic steatohepatitis (NASH) is desired because it may progress to cirrhosis or finally hepatocellular carcinoma in the severe case. To propose the possible noninvasive diagnosis using ultrasound, we aim to summarize the change of the tissue property. As a basic study, this report demonstrates the acoustic impedance of mouse livers in case of the normal, the liver cirrhosis and the NASH model using bio-acoustic microscopy. To measure the acoustic impedance, a transducer with 80-MHz center frequency, which is incorporated in a bio-acoustic microscopy system, was employed. The value could be calculated based on the analysis of the echo amplitude, and 2D image of acoustic impedance can be obtained by scanning the transducer. The 2D image demonstrated that the tissue structure is homogeneous in normal liver. In contrast, the pattern of random granular texture like lipid droplet was found in NASH liver. Based on statistical analysis, it was found that the acoustic impedance in case of NASH is lowest among all models.