Evaluation of the Anterior Cruciate Ligament Injury Risk During a Jump-Landing Task Using 3-Dimensional Kinematic Analysis Versus the Landing Error Scoring System.

Background: The Landing Error Scoring System (LESS) has been utilized on the field or in the clinic to identify patients with an increased risk for anterior cruciate ligament (ACL) injuries; however, its validity and efficacy have not been fully confirmed. Purpose: To assess the efficacy of the LESS in identifying the ACL injury risk by examining the correlation between the LESS score and motion patterns on 3-dimensional kinematic analysis. Study Design: Controlled laboratory study. Methods: The jump-landing motion was analyzed for 16 female basketball or badminton players who volunteered to participate in the study. All study participants were aged 19 or 20 years. The sequence of motion was evaluated with the LESS, while kinematic data were simultaneously acquired with a 3-dimensional motion analysis system utilizing the point cluster method. The correlation between the LESS score and knee kinematics was statistically analyzed. Results: When a LESS score ≥6 was defined to be a risk factor for ACL injuries, 7 of the 16 participants (43.8%) were found to exhibit risky motion patterns. Significant correlations were noted between the LESS score and knee valgus (r = 0.87; P < .0001) and internal tibial rotation (r = 0.57; P = .02) at landing. By contrast, a substantial variability was present in knee flexion, showing no correlation with the LESS score. Conclusion: Significant correlations were found between the LESS score and knee valgus and internal tibial rotation during a jump-landing task. Clinical Relevance: The LESS can be regarded as an effective measure to identify risky motion patterns that may increase the likelihood of ACL injuries.

Control of heart rate variability by cardiac parasympathetic nerve activity during voluntary static exercise in humans with tetraplegia.

Heart rate (HR) is controlled solely by via cardiac parasympathetic outflow in tetraplegic individuals, who lack supraspinal control of sympathetic outflows and circulating catecholamines but have intact vagal pathways. A high-frequency component (HF; at 0.15-0.40 Hz) of the power spectrum of HR variability and its relative value against total power (HF/Total) were assessed using a wavelet transform to identify cardiac parasympathetic outflow. The relative contribution of cardiac parasympathetic and sympathetic outflows to controlling HR was estimated by comparing the HF/Total-HR relationship between age-matched tetraplegic and normal men. Six tetraplegic men with complete cervical spinal cord injury performed static arm exercise at 35% of the maximal voluntary contraction until exhaustion. Although resting cardiac output and arterial blood pressure were lower in tetraplegic than normal subjects, HR, HF, and HF/Total were not statistically different between the two groups. When tetraplegic subjects developed the same force during exercise as normal subjects, HF and HF/Total decreased to 67-90% of the preexercise control and gradually recovered 1.5 min after exercise. The amount and time course of the changes in HF/Total during and after exercise coincided well between both groups. In contrast, the increase in HR at the start of exercise was blunted in tetraplegic compared with normal subjects, and the HR recovery following exercise was also delayed. It is likely that, although the withdrawal response of cardiac parasympathetic outflow is preserved in tetraplegic subjects, sympathetic decentralization impairs the rapid acceleration of HR at the onset of exercise and the rapid deceleration following exercise.

Importance of inhibitor of DNA binding/differentiation 2 in hepatic stellate cell differentiation and proliferation.

BACKGROUND/AIM: In liver fibrosis, activated hepatic stellate cells (HSC) are transformed into myofibroblasts. Helix-loop-helix (HLH) transcriptional factors such as MyoD regulate the differentiation of myocytes, and the inhibitor of DNA binding/differentiation (Id) family comprises dominant negative HLH transcriptional regulators that inhibit differentiation and promote cell proliferation. In the present study, we investigated how the Id family proteins regulate HSC. METHODS: In primary rat HSC, inhibitor of DNA binding/differentiation (Id)2 and alpha-smooth muscle actin (alpha-SMA) mRNA expression increased 4 days after isolation. Next we established Id2 expressing HSC (HSC-T6-Id2-green fluorescent protein (GFP)) using HSC-T6 cells with retrovirus that expressed GFP-tagged Id2. RESULTS: HSC-T6-Id2-GFP increased cell proliferation with cyclin D1 expression. In contrast, alpha-SMA expression wassuppressed. Real-time reverse transcription-polymerase chain reaction analysis showed Id2 induction significantly suppressed alpha-SMA, collagen-1, matrix metalloproteinase (MMP)-2, and MMP-9 mRNA (P < 0.05) but had no effect on tissue inhibitor of metalloproteinase or transforming growth factor-beta1 levels. CONCLUSION: These findings suggest Id2, an HLH transcriptional regulator, plays an important regulatory role in the proliferation and differentiation of HSC.

Vastus lateralis oxygenation during prolonged cycling in healthy males.

This study examined the relationship between acute cardiorespiratory and muscle oxygenation and blood volume changes during prolonged exercise. Eight healthy male volunteers (mean maximum oxygen uptake VO(2max) = 41.6 +/- 2.4 mL/kg/min) performed 60 min submaximal cycling at 50% VO(2max). Oxygen uptake VO(2) was measured by indirect spirometry, cardiac output (CO) was estimated using a Portapre, and right vastus lateralis oxyhemoglobin/ myoglobin (oxyHb/Mb), deoxyhemoglobin/myoglobin (deoxyHb/Mb), and total hemoglobin/myoglobin (total Hb/Mb) were recorded using near-infrared spectroscopy (NIRS). After 40 min of exercise, there was a significant increase in VO(2) due to a significantly higher arteriovenous oxygen difference ((a - v)O(2diff). After 30 min of exercise CO remained unchanged, but there was a significant decrease in stroke volume and a proportionate increase in heart rate, thus indicating the occurrence of cardiovascular drift. During the first few minutes of exercise, there was a decline in oxyHb/Mb and total Hb/Mb, whereas deoxyHb/Mb remained unchanged. Thereafter, oxyHb/Mb and total Hb/Mb increased systematically until the termination of exercise while deoxyHb/Mb declined. After 40 min of exercise, these changes were significantly different from the baseline values. There were no significant correlations between the changes in the NIRS variables and systemic VO(2) or mixed (a - v)O(2)diff during exercise. These results suggest that factors other than localized changes in muscle oxygenation and blood volume account for the increased VO(2) during prolonged submaximal exercise.

D-Penicillamine improved laparoscopic and histological findings of the liver in a patient with Wilson's disease: 3-year follow-up after diagnosis of Coombs-negative hemolytic anemia of Wilson's disease.

We report a 13-year-old girl who presented with hepatic failure and hemolytic anemia. Laboratory findings showed a normal serum copper level (104 microg/dl), high urinary copper level (2370 microg/dl), and low serum ceruloplasmin level (14.3 microg/dl). Slit-lamp examination revealed Kayser-Fleischer rings on her cornea, and she was diagnosed with Wilson's disease. Plasma exchange and continuous hemodiafiltration relieved the serious condition, after that laparoscopic examination was performed. Administration of D-penicillamine and restriction of dietary copper (<1 mg/day) were started, leading to a normalized serum alanine amino transferase (ALT) level. After 3 years, she again underwent laparoscopic examination, and the laparoscopic and histological findings of her liver were obviously improved. Management of the copper level can reverse severe liver fibrosis in Wilson's disease.

Percutaneous radiofrequency ablation with cooled electrodes combined with hepatic arterial balloon occlusion in hepatocellular carcinoma.

BACKGROUND: We have reported that percutaneous radiofrequency ablation (RFA) with balloon occlusion of the hepatic artery (balloon-occluded RFA), using an expandable electrode, increases the coagulation area. In this study, we investigated the efficacy of balloon-occluded RFA and balloon-microcatheter-occluded RFA, using a cool RF single electrode. METHODS: We studies 41 patients with 47 hepatocellular carcinoma (HCC) lesions. We treated 28 patients (32 nodules) with balloon-occluded RFA, 5 patients (6 nodules) with balloon-microcatheter-occluded RFA, and 8 patients (9 nodules) with standard RFA. Initial therapeutic efficacy was evaluated with dynamic computed tomography performed 1 week after one session of treatment. RESULTS: One session of treatment was done for 20 nodules (62.5%) in the balloon-occluded RFA group and for 4 nodules (66.7%) in the balloon-microcatheter-occluded RFA group. We compared the coagulation diameter for balloon-occluded RFA (7 nodules), balloon-microcatheter-occluded RFA (6 nodules), and standard RFA (9 nodules) after one application cycle (12 min). The greatest dimension of the area coagulated by balloon-occluded RFA was significantly larger (greatest long-axis dimension, 47.6 +/- 7.8 mm; greatest short-axis dimension, 33.4 +/- 7.5 mm) than that coagulated by standard RFA (greatest long-axis dimension, 35.3 +/- 4.7 mm; greatest short-axis dimension, 25.9 +/- 3.7 mm; P = 0.002 for greatest long-axis dimension; P = 0.041 for greatest short-axis dimension). However, there was significant difference only in the greatest short-axis dimension of the area coagulated comparing balloon-microcatheter-occluded RFA and standard RFA. CONCLUSIONS: We consider balloon-occluded RFA using a cool RF electrode to be superior to standard RFA for the treatment of HCC, especially when larger coagulation volumes are required.

Prognostic factors in patients with advanced hepatocellular carcinoma receiving hepatic arterial infusion chemotherapy.

BACKGROUND: The prognosis of patients with advanced hepatocellular carcinoma (HCC) is poor. We aimed to clarify the prognostic factors in patients with advanced HCC receiving hepatic arterial infusion chemotherapy (HAIC). METHODS: Forty-four HCC patients were treated with HAIC, using low-dose cisplatin (CDDP) and 5-fluorouracil (5-FU) with/without leucovorin (or isovorin). Of these 44 patients, 15 received low-dose CDDP and 5-FU, and 29 received low-dose CDDP, 5-FU, and leucovorin or isovorin. Prognostic factors were evaluated by univariate and multivariate analyses of patient and disease characteristics. RESULTS: Of all patients, 5 and 12 patients respectively, exhibited a complete response (CR) and a partial response (PR) (response rate, 38%). The response rate (48.3%) in the low-dose CDDP and 5-FU with leucovorin/isovorin group was significantly better than that (20%) in the low-dose CDDP and 5-FU group (P = 0.002). The 1-, 2-, 3-, and 5-year cumulative survival rates of the 44 patients were 39%, 18%, 12%, and 9%, respectively. The regimen using low-dose CDDP and 5-FU with leucovorin/isovorin tended to improve survival rates (P = 0.097). Univariate and multivariate analyses showed the same variables--the Child-Pugh score (P = 0.013, P = 0.018), alpha-fetoprotein (AFP) level (P = 0.010, P = 0.009), and therapeutic effect after HAIC (P = 0.003, P = 0.01), respectively, to be significant prognostic factors. CONCLUSIONS: Patients who had advanced HCC with favorable hepatic reserve capacity and a lower AFP level were suitable candidates for HAIC. Moreover, the regimen using low-dose CDDP and 5-FU with leucovorin/isovorin may be suitable for advanced HCC patients, because of the improvement in the response rate and survival compared with the low-dose CDDP and 5-FU regimen without leucovorin/isovorin.

Cardiovascular control during voluntary static exercise in humans with tetraplegia.

The purpose of the present study was 1) to investigate whether an increase in heart rate (HR) at the onset of voluntary static arm exercise in tetraplegic subjects was similar to that of normal subjects and 2) to identify how the cardiovascular adaptation during static exercise was disturbed by sympathetic decentralization. Mean arterial blood pressure (MAP) and HR were noninvasively recorded during static arm exercise at 35% of maximal voluntary contraction in six tetraplegic subjects who had complete cervical spinal cord injury (C(6)-C(7)). Stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) were estimated by using a Modelflow method simulating aortic input impedance from arterial blood pressure waveform. In tetraplegic subjects, the increase in HR at the onset of static exercise was blunted compared with age-matched control subjects, whereas the peak increase in HR at the end of exercise was similar between the two groups. CO increased during exercise with no or slight decrease in SV. MAP increased approximately one-third above the control pressor response but TPR did not rise at all throughout static exercise, indicating that the slight pressor response is determined by the increase in CO. We conclude that the cardiovascular adaptation during voluntary static arm exercise in tetraplegic subjects is mainly accomplished by increasing cardiac pump output according to the tachycardia, which is controlled by cardiac vagal outflow, and that sympathetic decentralization causes both absent peripheral vasoconstriction and a decreased capacity to increase HR, especially at the onset of exercise.

Pioglitazone prevents hepatic steatosis, fibrosis, and enzyme-altered lesions in rat liver cirrhosis induced by a choline-deficient L-amino acid-defined diet.

Non-alcoholic steatohepatitis (NASH) may progress to liver cirrhosis, and NASH patients with liver cirrhosis have a risk of development of hepatocellular carcinoma. Peroxisome proliferator-activated receptor (PPAR) gamma ligand has recently been reported to have improved the condition of patients with NASH. The aim of this study was to investigate whether pioglitazone, a PPARgamma ligand, has any influence on the animal model of NASH as well as isolated hepatic stellate cells. In vivo, the effects of pioglitazone were examined using the choline-deficient L-amino acid-defined (CDAA)-diet liver fibrosis model. After two weeks, pioglitazone improved hepatic steatosis, prevented liver fibrosis, and reduced preneoplastic lesions in the liver after 10 weeks. Pioglitazone reduced the expression of TIMP-1 and TIMP-2 mRNA without changing MMP-13 mRNA expression compared to the liver fed a CDAA diet alone. In vitro, pioglitazone prevented the activation of hepatic stellate cells resulting in reducing the expression of type I procollagen, MMP-2, TIMP-1, and TIMP-2 mRNA with increased MMP-13 mRNA expression. These results indicate that pioglitazone may be one of the candidates for the benefit drugs for the liver disease of patients with NASH.

Decreased cortical excitability during motor imagery after disuse of an upper limb in humans.

OBJECTIVE: The present study investigated the effect of joint immobilization on corticomotoneuronal excitability to only intracortical input from a hierarchical level above the primary motor cortex. METHODS: Motor evoked potentials (MEPs) and H-reflexes in the flexor carpi radialis muscle were elicited from 8 orthopedic patients with splints and 8 healthy volunteers. Each patient was examined on the day of splint removal (disuse stage) and 2 months after that day (recovery stage). Both potentials were recorded under 3 conditions: at rest, while imagining motor movement (during motor imagery), and during 10% of maximum voluntary contraction (10% MVC). RESULTS: In the patient group, the amplitude of surface electromyography during voluntary maximum wrist flexion was lower at the disuse stage than at the recovery stage, although the supra-maximum M-wave amplitude did not change between stages. Compared to both the patient group at the recovery stage and the control group, patients at the disuse stage recorded significantly lower MEPs, but only during motor imagery. In contrast, the H-reflex amplitudes were not significantly changed under any of the 3 conditions for both patients and control. CONCLUSIONS: The present results indicated a strict parallelism between motor execution (the reduction of electromyography during mvc after immobilization) and motor imagery (the reduction of MEP-amps after immobilization). This parallelism suggests that a functional reorganization or decreased excitability in the cerebral cortex area involved in executing movement likely decreases the motor capability to produce voluntary muscular output after immobilization.

Arterial infusion chemotherapy using cisplatin, 5-fluorouracil, and isovorin for patients with advanced hepatocellular carcinoma, pilot study: Is a high dose of the biochemical modulator effective?

The authors report the efficacy of arterial infusion chemotherapy using cisplatin (CDDP), 5-fluorouracil (5-FU), and leucovorin (LV) for patients with advanced hepatocellular carcinoma (HCC). In this study, we evaluated the efficacy of our regimen with high-dose LV, using isovorin (IV) (high dose group), comparing the previous regimen (low-dose LV; low dose group). This is a retrospective, historical, and non-controlled trial. In the high dose group (n=15), one course of chemotherapy consisted of the daily administration of CDDP (10 mg/1 h, for 5 days) and IV (12.5 mg/10 min, for 5 days) followed by 5-FU (250 mg/5 h, for 5 days). In the low dose group (n=9), changing to the administration of LV (12 mg/day), the same regimen was employed. In principle, we did this 20 times. In the high dose group, complete response (CR) was found in two patients, and partial response (PR) in six patients. Thus, the response rate was 53%. In the low dose group, CR was found in two patients, and PR in three patients. Thus, the response rate was 56%. There were no significant differences in the response rate (P=0.71), the survival rate (P=0.29) and the toxicity between the two groups. We considered the recommended dose of LV to be 12 mg/day in our regimen, although this is a preliminary study.

Electromechanical delay after ACL reconstruction: an innovative method for investigating central and peripheral contributions.

OBJECTIVES: The purpose of this study was to investigate the electromechanical properties of atrophied muscle in patients with anterior cruciate ligament (ACL) reconstruction and to examine the relationship of changes in these properties for a voluntarily elicited maximal isometric contraction and peripherally stimulated twitch contraction. BACKGROUND: It is not known if, following ACL reconstruction, a prolonged reaction time to a sudden stimulus is due to impaired proprioception in the knee joint, a prolonged processing interval in the central nervous system, or a greater elasticity in the series elastic component of the quadriceps femoris. METHODS: Seventeen patients were recruited 2 to 3 months following a unilateral ACL reconstruction. Both the involved leg (ACL-invo group) and the uninvolved leg (ACL-uninvo group) were studied. Twenty-two athletes (training group) and 18 control subjects (control group) were also tested. These subjects performed voluntary maximal isometric contraction (MVC) of the quadriceps femoris. Maximal twitch response was also elicited by a supramaximal electrical stimulation to the femoral nerve, and surface electromyograms were recorded from the vastus lateralis in all four groups. RESULTS: Total reaction time for MVC in the ACL-invo group (250.47 ms) was prolonged compared to that of the control and training groups. Twitch response in the ACL-invo group (25.26 ms) was prolonged compared to that of the other three groups. Premotor time during both MVC and twitch response did not differ among the four groups. Electromechanical delay during MVC (53.62 ms) and the evoked electromechanical delay in twitch response (20.04 ms) were prolonged in the ACL-invo group as compared to the other three groups. CONCLUSIONS: Prolonged electromechanical delay in twitch response may be due to peripheral physiological disruptions (eg, stiffness of the series elastic component, changes of peripheral muscle fiber-type composition, or a decrease in function of the excitation-contraction coupling process). A prolonged electromechanical delay in twitch response can also explain the prolonged electromechanical delay observed for MVC. These findings suggest that prolonged total reaction time in MVC, when secondary to a visual stimulus in atrophied human quadriceps femoris muscle after ACL reconstruction, may be principally due to prolongation of electromechanical delay produced by peripheral physiological alterations. However, the contribution of premotor time to prolonged total reaction time was not revealed. Our results do not completely eliminate the possibility that central nervous system processing time and other neural factors are involved in the prolongation of reaction time.