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Objective: To investigate cardiovascular responses to orthostatic stress in patients with cerebrovascular accidents (CVA).Methods: Twelve male patients with CVA, 11 healthy elderly and 12 healthy young males participated in the present study. The CVA patients had suffered stroke with hemiplegia at least 11 months prior to the study, their medical conditions were stable, and no subjects were taking medications affecting the cardiovascular system. Heart rate (HR) was determined using RR intervals from the ECG. Stroke volume (SV) was estimated by an impedance method, and cardiac output (CO) was calculated by multiplying SV by HR. Blood pressure (BP) was determined by the auscultatory method. SV, HR, CO and BP were measured every 2 min before and during 7 min of 60-degree head-up tilt (HUT).Results: SV decreased and HR increased immediately after starting HUT in all groups. CO in healthy elderly and young subjects immediately decreased during HUT also, and the decrease was sustained throughout the head-up period. However, CO in CVA patients remained constant throughout the experiment. HUT immediately decreased SBP in all groups and the magnitude of initial SBP reduction in CVA patients was greater than that in the other groups.Conclusions: We identified an initial reduction of BP during HUT in CVA patients and the recovery of BP by 3 min of head-up tilt. We emphasize that adjustment to orthostatic stress in CVA patients should be practiced by HUT, as our findings showed that CVA patients maintained physiological orthostatic tolerance except for the initial fall in BP.

Purpose The inluence of closing wedge high tibial osteotomy (CW-HTO) with high valgus correction on its survival is unclear. This study aimed to conduct a 15-year follow-up cohort study to estimate the long-term survival rate of CW-HTO. Factors related to poor outcomes were investigated. Methods A total of 159 knees in 123 patients were followed up, and 120 knees in 96 patients were enrolled for statistical analysis. Femorotibial angles were measured by standing anterior-posterior radiographs of the knee. Clinical objective evaluation was performed by the Japanese orthopaedic association (JOA) score of the knee, and scores lower than 70 points deined the poor result (PR) group. The survival rate of OW-HTO was estimated. Logistic regression analyses were performed to determine the risk factors for PR and conversion to total knee arthroplasty (TKA). Results A total of 16 knees in 15 patients (13.3%) underwent TKA 14.0 ± 4.8 (4-20) years after CW-HTO. The 5-year survival rate was 99.2%, 10-year was 96.7%, 15-year was 92.5%, and 86.7% at inal follow-up (17.9 years). Based on the JOA score, 44 patients (35.8%) belonged to the PR group, and their risk factors were obesity (p = 0.018), low femorotibial angle (p = 0.019), low JOA score (p = 0.040), low knee extension angle (p = 0.045), and low knee lexion angle (p = 0.046). Conclusions The 15-year survival rate of CW-HTO was 92.5%. While higher scores of objective outcomes were kept over long-term follow-up, the risk factors for a worsening score or TKA conversion were obesity and severity of preoperative knee symptoms. KeywordsClosed wedge high tibial osteotomy • Survival rate • 15 years • JOA scores • Total knee arthroplasty conversion * Eiji Sasaki

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The histology of RA is characterized by marked proliferation of FLS. In this study, the synovial tissues of early OA with hydrarthrosis showed moderate FLS proliferation. They also expressed the cytokines that are detected in the synovial tissues of RA. We suggest long-term follow-up is needed because early OA with hydrarthrosis might progress to overt RA.