Effect of Gender and Load Conditions on Foot Arch Height Index and Flexibility in Japanese Youths.

Arch height index (AHI) and arch height flexibility (AHF) are useful methods for evaluating foot structure. Although foot structure may be linked to intrinsic factors such as gender and load conditions, information on AHI and AHF in consideration of these factors is lacking. This study aimed to examine the effect of gender and load conditions on AHI and AHF. One hundred Japanese youths (50 males, 50 females) were recruited in this study. Arch height and truncated foot length were measured with an AHI measurement system. AHI was calculated for each load condition using truncated foot length and arch height. AHF was defined as the change in arch height from 10% to 50% of weightbearing load, and from 10% to 90% of weightbearing load. To satisfy the assumption of independence, only measurements from the right foot were analyzed. A gender × load condition interaction was found in AHI. AHI in all load conditions showed significant differences between the genders (p < .001), and AHI of female participants was significantly less than that of male participants (p < .001). In contrast, no significant gender × load condition interaction was noted in AHF, and only the main effect of the load condition was found (p < .001). In AHI use, the effects of gender and load conditions must be considered, and AHF may be used considering only changes in load conditions. The results of this study provide useful information regarding which normative values of AHI and AHF should be used.

Spinal reciprocal inhibition in the co-contraction of the lower leg depends on muscle activity ratio.

The spinal reciprocal inhibition during co-contraction remains unclear. Reports on the reciprocal Ia and D1 inhibitions in the co-contraction are lacking, and a point about the muscle activity amount during co-contraction is unclear. This study aimed to clarify the influence of changes in the ratio of soleus (Sol) and tibialis anterior (TA) muscle activities in co-contraction on reciprocal Ia and D1 inhibitions. Twenty healthy adults were subjected to four stimulatory conditions: a conditioning stimulus-test stimulation interval (CTI) of - 2, 2, or 20 ms or a test stimulus without a conditioning stimulus (single). Co-contraction [change in (Sol)/(TA) activity] was examined at task A, 0%/0% maximal voluntary contraction (MVC); task B, 5%/5% MVC; task C, 15%/15% MVC; task D, 5%/15% MVC; and task E, 15%/5% MVC. At 2-ms CTI, the H-reflex amplitude value was significantly lower in tasks A, B, C, and D than in the single condition. Among the tasks, the H-reflex amplitude values were lower for A, B, C, and D than for E. At 20-ms CTI, the H-reflex amplitude was significantly lower in tasks A, B, C, D, and E. Among the tasks, the H-reflex amplitude was significantly lower from task A and B to task E. The change in the muscle activity ratio during co-contraction could modulate reciprocal Ia inhibition depending on the Sol/TA muscle activity ratio. D1 inhibition at rest did not differ significantly when the Sol/TA ratio was equal or when TA muscle activity was high. During co-contraction with high Sol muscle activity, D1 inhibition decreased from rest.

Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patients　- A Single-Center Experience of 5-Year Follow-up.

BACKGROUND: Little is known about palliative sedation in terminally ill heart failure (HF) patients.Methods and Results:We retrospectively reviewed terminally ill HF patients who received palliative sedation from September 2013 to August 2018. Among 95 terminally ill HF patients, 25 were prescribed dexmedetomidine and 12 were prescribed midazolam at the end of life. Richmond Agitation-Sedation Scale was significantly reduced (P<0.01), but blood pressure and heart rate were unaltered after treatment in both the dexmedetomidine and midazolam groups. CONCLUSIONS: Prescription of dexmedetomidine and/or midazolam might be feasible in selected terminally ill HF patients.

Relationships between differences in the number of fiber bundles of the anterior talofibular ligament and differences in the angle of the calcaneofibular ligament and their effects on ankle-braking function.

PURPOSE: The aim was to clarify the relationships between differences in the number of fiber bundles of the anterior talofibular ligament (ATFL) and differences in the angle of the calcaneofibular ligament (CFL) with respect to the long axis of the fibula and their effects on ankle braking function. METHODS: The study sample included 110 Japanese cadavers. ATFLs were categorized as: Type I with one fiber bundle; Type II with two fiber bundles with incomplete separation and complete separation; and Type III with three fiber bundles. The CFLs were categorized according to the angles of the CFLs with respect to the long axis of the fibula and the number of fiber bundles. Six categories were established: CFL10° (angle of the CFL with respect to the long axis of the fibula from 10° to 19°); CFL20° (range 20°-29°); CFL30° (range 30°-39°); CFL40° (range 40°-49°); CFL50° (range 50°-59°); and CFL2 (CFLs with two crossing fiber bundles). RESULTS: ATFL was Type I in 34 legs (31%), Type II in 66 legs (60%), and Type III in 10 legs (9%). Five CFL categories were identified: CFL10° in 4 feet (3.7%); CFL20° in 23 feet (20.9%); CFL30° in 34 feet (30.9%); CFL40° in 33 feet (30%); CFL50° in 15 feet (13.6%); and CFL2 in one foot (0.9%). Type III contained mainly CFL40° and CFL50° (7 of 10 feet). CONCLUSIONS: ATFL and CFL appear to cooperate in the ankle joint braking function.

The relationships between the quadratus plantae and the flexor digitorum longus and the flexor hallucis longus.

PURPOSE: The purpose of this research was to clarify the relationships between quadratus plantae (QP) and flexor digitorum longus (FDL) and flexor hallucis longus (FHL) using large-scale specimens. METHODS: This study examined 116 legs from 62 Japanese cadavers. The QP was classified as: Type I, formed by the lateral and medial heads; Type II, the lateral head is absent; and Type III, the medial head is absent. The FHL branches to the lesser toes were classified as: Type A, connection from FHL to toe 2; Type B, connection from FHL to toes 2 and 3; Type C, connection from FHL to toes 2-4. Next, the relationships between QP and FHL and FDL were observed. RESULTS: Type I accounted for 87%, Type II for 10%, and Type III for 3%. Type A accounted for 33%, Type B for 53%, and Type C for 14%. Regarding the relationship between QP and FDL, regardless of the classification of the connections of the FHL tendon slip to the lesser toes, QP attachments to FDL branching to toes 2, 3, and 4 were seen in 47-59%. Furthermore, QP attachments to FDL branching to toes 2, 3, 4, and 5 were seen in 41-47%. CONCLUSIONS: QP appears to function strongly to counter the oblique pull of FDL and FHL and as a lesser digit plantar flexor.

The effect of differences in the number of fiber bundles of the anterior tibial ligament on ankle braking function: a simulation study.

PURPOSE: The aim was to clarify the effect of differences in the number of fiber bundles of the anterior tibial ligament (ATFL) on ankle braking function. METHODS: The study sample included 81Japanese cadavers. ATFLs were categorized as: Type I with one fiber bundle; Type II with two fiber bundles that were completely separated; and Type III with three fiber bundles. Three-dimensional reconstructions of a single specimen from each category were then created. These were used to simulate and calculate ATFL strain during dorsiflexion (20°) and plantarflexion (30°) on the talocrural joint axis and inversion (20°) on the subtalar joint axis. RESULTS: Almost all types of superior fiber lines were stretched with dorsiflexion and plantarflexion. Regardless of Type, the inferior fiber line was shortened with plantarflexion and stretched with dorsiflexion. The inferior fiber bundle of Type III was shortened only at plantarflexion 30° and inversion 20°, but in all others it was stretched. CONCLUSIONS: The results suggest that Type III was weaker than Type I and Type II in terms of ankle plantarflexion and inversion braking function.

Differences in the strain applied to Achilles tendon fibers when the subtalar joint is overpronated: a simulation study.

PURPOSE: The purpose of this study was to investigate the strain applied to each of the tendon fiber bundles of the medial head of the gastrocnemius (MG), the lateral head of the gastrocnemius (LG), and the soleus muscle (Sol) that compose the Achilles tendon (AT) when the subtalar joint is pronated and supinated. METHODS: Three AT twist types (least, moderate, extreme) were investigated. Using the MicroScribe system, the AT and the talocrural and subtalar joints were digitized to reconstruct three-dimensional models. Using this system, subtalar joint rotations in the pronation (20°) and supination (20°) directions were simulated, and the degrees of strain (%) on each tendon were calculated. RESULTS: For all twist types, when the subtalar joint was pronated, MG, LG, and Sol stretched, and when supinated, MG, LG, and Sol shortened. In particular, the least and severe twist types had large degrees of strain of Sol when the subtalar joint was pronated, and furthermore, each tendon fiber composing Sol had different degrees of strain. CONCLUSIONS: The study results suggest that the degree of strain applied within the AT with subtalar joint pronation is not constant, and that, especially in least and extreme twist types, the risk of developing AT disorders may increase.

Morphological characteristics of the lateral talocalcaneal ligament: a large-scale anatomical study.

PURPOSE: The purpose of this study is to clarify the morphological characteristics of the lateral talocalcaneal ligament (LTCL). METHODS: This study examined 100 legs from 54 Japanese cadavers. The LTCL was classified into three types: Type I, the LTCL branches from the calcaneofibular ligament (CFL); Type II, the LTCL is independent of the CFL and runs parallel to the calcaneus; and Type III, the LTCL is absent. The morphological features measured were fiber bundle length, fiber bundle width, and fiber bundle thickness. RESULTS: The LTCL was classified as Type I in 18 feet (18%), Type II in 24 feet (24%), and Type III in 58 feet (58%). All LTCLs were associated with the anterior talofibular ligament at the talus. There was no significant difference in morphological characteristics by Type for each ligament. CONCLUSIONS: The LTCL was similar to the CFL in terms of fiber bundle width and fiber bundle thickness.

The Role of Endogenous Neurogenesis in Functional Recovery and Motor Map Reorganization Induced by Rehabilitative Therapy after Stroke in Rats.

BACKGROUND AND OBJECTIVE: Endogenous neurogenesis is associated with functional recovery after stroke, but the roles it plays in such recovery processes are unknown. This study aims to clarify the roles of endogenous neurogenesis in functional recovery and motor map reorganization induced by rehabilitative therapy after stroke by using a rat model of cerebral ischemia (CI). METHODS: Ischemia was induced via photothrombosis in the caudal forelimb area of the rat cortex. First, we examined the effect of rehabilitative therapy on functional recovery and motor map reorganization, using the skilled forelimb reaching test and intracortical microstimulation. Next, using the same approaches, we examined how motor map reorganization changed when endogenous neurogenesis after stroke was inhibited by cytosine-ß-d-arabinofuranoside (Ara-C). RESULTS: Rehabilitative therapy for 4 weeks after the induction of stroke significantly improved functional recovery and expanded the rostral forelimb area (RFA). Intraventricular Ara-C administration for 4-10 days after stroke significantly suppressed endogenous neurogenesis compared to vehicle, but did not appear to influence non-neural cells (e.g., microglia, astrocytes, and vascular endothelial cells). Suppressing endogenous neurogenesis via Ara-C administration significantly inhibited (~50% less than vehicle) functional recovery and RFA expansion (~33% of vehicle) induced by rehabilitative therapy after CI. CONCLUSIONS: After CI, inhibition of endogenous neurogenesis suppressed both the functional and anatomical markers of rehabilitative therapy. These results suggest that endogenous neurogenesis contributes to functional recovery after CI related to rehabilitative therapy, possibly through its promotion of motor map reorganization, although other additional roles cannot be ruled out.

High oxygen modifies vasodilator effect of cysteine via enhanced oxidative stress and thromboxane production in the rat mesenteric artery.

Whether high oxygen is harmful to the vascular function is unclear. The present study examined if high oxygen modifies vasodilator effect of cysteine via enhanced oxidative stress and thromboxane production. Rat mesenteric arteries with endothelium at 95 or 50 % oxygen were subjected to isometric force recordings, measurement of thromboxane B2 levels, determination of superoxide and peroxynitrite levels and evaluation of NADPH oxidase subunit protein expression, respectively. L-cysteine (0.01-3 mM) constricted or dilated arteries at 95 and 50 % oxygen, respectively. Thromboxane receptor antagonist SQ-29,548 (1 µM) abolished the constriction at 95 % oxygen. L-cysteine (3 mM) increased levels of thromboxane B2 in arteries upon 95 % oxygen application. L-cysteine relaxed arteries treated with superoxide inhibitor tiron (2 mM) or NADPH oxidase inhibitor gp91ds-tat (1 µM) irrespective of the oxygen concentration while ATP-sensitive K(+) channel inhibitor glibenclamide (1 µM) and cystathionine-γ-lyase (CSE) inhibitor DL-propargylglycine (10 mM) similarly abolished the relaxation. L-cysteine (3 mM) with 95 % oxygen augmented levels of superoxide as well as nitrotyrosine within the artery, concomitantly with enhanced membrane protein expression of NADPH oxidase subunit p47phox. The higher concentration of oxygen attenuates L-cysteine-induced vasodilation via superoxide production mediated by NADPH oxidase along with thromboxane A2 production, resulting in vasoconstriction. The increased levels of superoxide, as well as peroxynitrite, coexist with the impaired vasodilation related to ATP-sensitive K(+) channels and CSE. Higher oxygen with plasma cysteine may cause oxidative stress and vasoconstrictor prostanoid production in blood vessels.

Exercise in the Early Stage after Stroke Enhances Hippocampal Brain-Derived Neurotrophic Factor Expression and Memory Function Recovery.

BACKGROUND: Exercise in the early stage after stroke onset has been shown to facilitate the recovery from physical dysfunction. However, the mechanism of recovery has not been clarified. In this study, the effect of exercise on spatial memory function recovery in the early stage was shown, and the mechanism of recovery was discussed using a rat model of brain embolism. METHODS: Intra-arterial microsphere (MS) injection induced small emboli in the rat brain. Treadmill exercise was started at 24 hours (early group) or 8 days (late group) after MS injection. The non-exercise (NE) and sham-operated groups were included as controls. Memory function was evaluated by the Morris water maze test, and hippocampal levels of brain-derived neurotrophic factor (BDNF) were measured by enzyme-linked immunosorbent assays. To further investigate the effect of BDNF on memory function, BDNF was continuously infused into the hippocampus via implantable osmotic pumps in the early or late stage after stroke. RESULTS: Memory function significantly improved only in the early group compared with the late and the NE groups, although hippocampal BDNF concentrations were temporarily elevated after exercise in both the early and the late groups. Rats infused with BDNF in the early stage exhibited significant memory function recovery; however, rats that received BDNF infusion in the late stage showed no improvement. CONCLUSION: Exercise elevates hippocampal BDNF levels in the early stage after cerebral embolism, and this event facilitates memory function recovery.

Risk Factors in the Pediatric Ward Recognized by Students Before Pediatric Nursing Practice －Basic Data for Medical Safety Education Based on Student's Learning Readiness－.

The purpose of this study was to extract the risk factors recognized by students before pediatric nursing practice in order to conduct medical safety education based on student's learning readiness. Third-year nursing students of A nursing college used the P-mSHELL model to find the risk factors in a simulated pediatric hospital room, and the researchers analyzed the contents. The students recognized four categories of risk factors: "burden on the family", "characteristics of the infant", "characteristics of children with disease", and "the family's cognition and understanding". There were three categories of risk factors related to "the environment": "environment that can cause a dangerous action", "unsafe environment", and "sickroom as a living space". There were four categories of risk factors related to "the student": "students' own physical/mental condition", "anxiety caused by pediatric nursing practice", "learning process in nursing practice" and "students' understanding of pediatric nursing". The students recognized that there were various risk factors in the child, the family, and the environment, and, by the P-mSHELL model, they recognized that they themselves could become a risk factor. Based on the risk factors that students extracted, teachers should think about what kind of preparation is necessary for students in pediatric nursing practice, and it is important to conduct medical safety education.

Kynurenine causes vasodilation and hypotension induced by activation of KCNQ-encoded voltage-dependent K(+) channels.

Kynurenine is a potential contributor to hypotension in animal and human sepsis. The present study was designed to examine whether the voltage-dependent K(+) channels encoded by the KCNQ gene family (Kv7 channels) mediate vasodilator effects of kynurenine and whether modulation of these channels ameliorates hypotension caused by this compound. Rat aortas and mesenteric arteries or human omental arteries without endothelium were used. Some rings were incubated with the selective Kv7 channel inhibitor linopirdine (10 µM). l-Kynurenine (10 µM-1 mM) induced concentration-dependent relaxation in rat aortas and mesenteric arteries as well as human omental arteries, whereas linopirdine abolished the relaxation. l-Kynurenine (1 mM) produced hyperpolarization of vascular smooth muscle, which was reversed by linopirdine (10 µM). Wistar rats received l-kynurenine (1 mM) iv and subsequent linopirdine (10 µM) iv under 3% sevoflurane inhalation. l-Kynurenine iv caused hypotension, whereas linopirdine iv partially reversed it. In conclusion, kynurenine dilates arteries from rats as well as humans via Kv7 channels in the vascular smooth muscle. In rats, this tryptophan metabolite causes hypotension, which is partly counteracted by Kv7 channel inhibition. These results suggest that modulation of Kv7 channels may be a novel strategy to treat hypotension induced by the kynurenine.

[Implementation of Objective Structured Clinical Examination I of the Department of Nursing--Introduction of Simulation-Based Education].

The Department of Nursing of the university revised its curriculum for students admitted in 2012 or later, including the introduction of integrated subjects. With the aim of improving the practical clinical skills of students and integrating knowledge, skills, and techniques, the following integrated subjects: Objective Structured Clinical Examination (OSCE) I held in the first term of the third-year (15 hours as one credit), and OSCE II held in the second term of the fourth year (30 hours as one credit), were adopted, and simulation-based education was introduced. In this report, we summarized our experience of a simulation education system for nursing students in the year 2014 aiming to improve students' skill of wheelchair transfer of a patient with left hemiplegia and patient's living environment. Many positive responses, such as usefulness in future nursing training, were obtained upon the introduction of the simulation education system. Issues to be addressed in the future, including lack of sufficient time to practice and availability of rooms, were also noticed.

[Achievements in the objectives of a practicum as seen through changes in awareness of nursing and care techniques in a basic nursing practice].

This study aims to elucidate the level of achievement and the challenges in a basic nursing practicum for second-year nursing students through the association method. Analysis revealed various descriptions of learning through the practicum training experiences in terms of understanding the healthcare environment, planning and implementing daily life assistance, and involvement in building a supportive relationship with a care recipient. In this sense, we can assume that the goal of the practicum was achieved. The students' attitude toward learning showed an emphasis on knowledge, basics, reasoning, and acquisition of knowledge through experience. At the same time, however, we did not observe descriptions of developing the healthcare environment, understanding the methods of developing healthcare plans, or respect for privacy, thus not indicating whether the goal was achieved. In the future, it is necessary to additionally examine specific details of students' learning through analyzing their reports.

Lifestyle Changes and Baseball Activity among Youth Baseball Players before and during the First COVID-19 Pandemic in Japan.

This cross-sectional study aimed to clarify the changes in lifestyle and baseball activity before and during the COVID-19 pandemic among youth baseball players. Participants were 99 youth baseball players (ages 9.6 ± 1.5 years, height 137.8 ± 9.4 cm, weight 35.3 ± 12.4 kg) in Japan. They completed an online survey between April 6 and 20, 2021, on their demographic characteristics, lifestyle (recreational screen, sleep, and study times), and baseball activity (frequency of team practice time and voluntary exercise-related baseball) at two-time points: before the pandemic (before March 2020) and during the state of emergency declared in Japan (from April to May 2020). The changes in outcomes between the two-time points were evaluated for significance. Recreational screen time and sleeping time during the state of emergency were significantly increased compared to those before the pandemic (p < 0.001). The frequency of team practice time on weekends during the state of emergency was significantly reduced, and voluntary exercise-related baseball was significantly increased compared to that before the pandemic (p < 0.01). We found that the COVID-19 pandemic changed behaviors concerning activities and exercise among youth baseball players and recommended that such behavioral changes be carefully monitored.

Physical functions, to be or not to be a risk factor for osteochondritis dissecans of the humeral capitellum?

Background: Physical risk factors for osteochondritis dissecans (OCD) of the humeral capitellum in young baseball players have not been fully elucidated. We aimed to identify the risk factors for capitellar OCD in baseball players aged 8-14 years. Methods: Between December 2018 and December 2019, young baseball players were recruited from 8 regional baseball leagues. Ultrasonography and physical assessments were performed preseason and at the end of the study period. Bilateral passive ranges of motion (ROM) of horizontal adduction of the shoulders, internal rotation (IR) of the hips, and the thoracic kyphosis angle were measured. 1-year follow-ups were scheduled to determine the occurrence of OCD. Players with OCD were categorized into an OCD group; those without OCD and any elbow pain for one year were categorized into a non-injured group. The players' baseline data (age, sex, position in baseball, and Rohrer's Index) were analyzed using univariate analyses. Their physical parameters were analyzed using two-way analysis of variance with repeated measures to investigate OCD-related risk factors. Results: In total, 3651 baseball players attended the 1-year follow-up. Of these, 71 (1.9%) players had OCD of the humeral capitellum. In the OCD group, a significant association was found at baseline and at the end of the study period between a higher Rohrer index at the baseline and a smaller hip IR ROM on the nondominant side. Conclusions: Loss of hip IR ROM on the nondominant side is a newly discovered risk factor related to physical function in the development of OCD.

Roles of COMM-domain-containing 1 in stability and recruitment of the copper-transporting ATPase in a mouse hepatoma cell line.

A novel function of COMMD1 {COMM [copper metabolism MURR1 (mouse U2af1-rs1 region 1)]-domain-containing 1}, a protein relevant to canine copper toxicosis, was examined in the mouse hepatoma cell line Hepa 1-6 with multi-disciplinary techniques consisting of molecular and cellular biological techniques, speciation and elemental imaging. To clarify the function of COMMD1, COMMD1-knockdown was accomplished by introducing siRNA (small interfering RNA) into the cells. Although COMMD1-knockdown did not affect copper incorporation, it inhibited copper excretion, resulting in copper accumulation, which predominantly existed in the form bound to MT (metallothionein). It is known that the liver copper transporter Atp7b (ATP-dependent copper transporter 7beta), localizes on the trans-Golgi network membrane under basal copper conditions and translocates to cytoplasmic vesicles to excrete copper when its concentration exceeds a certain threshold, with the vesicles dispersing in the periphery of the cell. COMMD1-knockdown reduced the expression of Atp7b, and abolished the relocation of Atp7b back from the periphery to the trans-Golgi network membrane when the copper concentration was reduced by treatment with a Cu(I) chelator. The same phenomena were observed during COMMD1-knockdown when another Atp7b substrate, cis-diamminedichloroplatinum, and its sequestrator, glutathione ethylester, were applied. These results suggest that COMMD1 maintains the amount of Atp7b and facilitates recruitment of Atp7b from cytoplasmic vesicles to the trans-Golgi network membrane, i.e. COMMD1 is required to shuttle Atp7b when the intracellular copper level returns below the threshold.

Curdione Plays an Important Role in the Inhibitory Effect of Curcuma aromatica on CYP3A4 in Caco-2 Cells.

Curcuma aromatica is a plant belonging to genus Curcuma of family Zingiberaceae and is widely used as supplements in Japan. Rhizomes of C. aromatica have curcumin as a major yellow pigment and curdione as a main ingredient of essential oils. In this study, we investigated the affect of C. aromatica on CYP3A4 using 1α,25-(OH)(2)-D(3)-treated Caco-2 clone cells. Caco-2 cells were treated with methanol extract (0.1 mg ml(-1)), its hexane soluble fraction (0.1 mg ml(-1)), curcumin (4 µM) and curdione (20 µM) for 72 hours. Nifedipine was used as a substrate of CYP3A4. Methanol extract, hexane fraction and curdione inhibited the formation of oxidized nifedipine by 50-70%, and curcumin showed no effect. The IC50s of methanol extract, hexane fraction and curdione to oxidized nifedipine formation were 21, 14 and 3.9 µg ml(-1) (16.9 µM), respectively. The content of curdione in methanol extract was 11.4%. Moreover, all of methanol extract, hexane fraction and curdione decreased CYP3A4 protein expression but had no affect on CYP3A4 mRNA expression. Our results showed that these drugs further decreased the CYP3A4 protein expression level after the protein synthesis was inhibited by cychroheximide. These findings suggest that curdione plays an important role in the CYP3A4 inhibitory activity of C. aromatica and curdione might inhibit the activity by accelerating the degradation of CYP3A4.