Effects of Different Types of Contraction Exercises on Shoulder Function and Muscle Strength in Patients with Adhesive Capsulitis.

Although several studies have reported the effect of exercise therapy for adhesive capsulitis (AC), studies on the comparison of different exercise types on shoulder muscle strength and function in patients with AC are lacking. This study aimed to investigate the effect of different exercise types on shoulder muscle strength and function in patients with AC. Thirty female patients with AC were categorized into an eccentric contraction exercise group (ECG, n = 15; age, 51.53 ± 4.73 years) and a concentric contraction exercise group (CCG, n = 15; age, 52.40 ± 4.03 years). The participants in each group performed a different exercise program three times per week for 60 min per session for 12 weeks. The range of motion (ROM) of the shoulder joint, visual analog scale, shoulder muscle strength, and Constant-Murley score (CMS) were measured before the intervention and after 12 weeks of the exercise intervention. Shoulder ROM in flexion (increase of 31%) and external rotation (ER) (increase of 54%) showed a significant improvement in the ECG (p < 0.05). Muscle strength in ER was significantly different between the two groups (p < 0.05). Pain severity showed improvement in the ECG (decrease of 61%) after the intervention (p < 0.01). The CMS in the ECG (increase of 48%) showed a greater improvement than that in the CCG after the intervention (p < 0.01). This study showed that eccentric contraction exercise had a more beneficial effect than concentric contraction exercise for improving shoulder muscle strength and function in females with AC.

Notch signaling alters sensory or neuronal cell fate specification of inner ear stem cells.

Multipotent progenitor cells in the otic placode give rise to the specialized cell types of the inner ear, including neurons, supporting cells, and hair cells. The mechanisms governing acquisition of specific fates by the cells that form the cochleovestibular organs remain poorly characterized. Here we show that whereas blocking Notch signaling with a γ-secretase inhibitor increased the conversion of inner ear stem cells to hair cells by a mechanism that involved the upregulation of bHLH transcription factor, Math1 (mouse Atoh1), differentiation to a neuronal lineage was increased by expression of the Notch intracellular domain. The shift to a neuronal lineage could be attributed in part to continued cell proliferation in cells that did not undergo sensory cell differentiation due to the high Notch signaling, but also involved upregulation of Ngn1. The Notch intracellular domain influenced Ngn1 indirectly by upregulation of Sox2, a transcription factor expressed in many neural progenitor cells, and directly by an interaction with an RBP-J binding site in the Ngn1 promoter/enhancer. The induction of Ngn1 was blocked partially by mutation of the RBP-J site and nearly completely when the mutation was combined with inhibition of Sox2 expression. Thus, Notch signaling had a significant role in the fate specification of neurons and hair cells from inner ear stem cells, and decisions about cell fate were mediated in part by a differential effect of combinatorial signaling by Notch and Sox2 on the expression of bHLH transcription factors.

Bone marrow mesenchymal stem cells are progenitors in vitro for inner ear hair cells.

Stem cells have been demonstrated in the inner ear but they do not spontaneously divide to replace damaged sensory cells. Mesenchymal stem cells (MSC) from bone marrow have been reported to differentiate into multiple lineages including neurons, and we therefore asked whether MSCs could generate sensory cells. Overexpression of the prosensory transcription factor, Math1, in sensory epithelial precursor cells induced expression of myosin VIIa, espin, Brn3c, p27Kip, and jagged2, indicating differentiation to inner ear sensory cells. Some of the cells displayed F-actin positive protrusions in the morphology characteristic of hair cell stereociliary bundles. Hair cell markers were also induced by culture of mouse MSC-derived cells in contact with embryonic chick inner ear cells, and this induction was not due to a cell fusion event, because the chick hair cells could be identified with a chick-specific antibody and chick and mouse antigens were never found in the same cell.

Prevention of postoperative meatal stenosis with anteriorly and inferiorly based periosteal flaps in congenital aural atresia surgery.

OBJECTIVE: The objective of this study was to evaluate postoperative meatal stenosis after surgery for congenital aural atresia using anteriorly and inferiorly based periosteal flaps (AIPFs). These were compared with the groups that did not use these flaps. STUDY DESIGN: This was a retrospective clinical study. SETTING: The study was conducted at the tertiary referral hospital. PATIENTS: There were 133 patients (151 ears) who had undergone surgical correction for congenital aural atresia from November 1987 to March 1999. INTERVENTION: The anterior approach surgical method was used to correct the congenital aural atresia. MAIN OUTCOME MEASURE: A comparison between the 2 groups, 1 using the AIPFs and the other that did not use the AIPFs, was performed to evaluate both the incidence and the interval of postoperative meatal stenosis. The correlation between the age of the first operation to correct congenital aural atresia and the incidence of postoperative meatal stenosis was also investigated. RESULTS: Meatal stenosis was the most common postoperative complication (23.8%) found. The incidence of meatal stenosis was much lower in the group using AIPFs (n = 105) than in the group that did not (n = 46) (19.0% versus 35.0%). The interval for the development of postoperative meatal stenosis showed similar distribution in both groups. In age distribution, the younger the age of the first operation, the more frequent the occurrence of postoperative meatal stenosis. CONCLUSION: AIPF is an effective surgical method for reducing the incidence of postoperative meatal stenosis.