Determination of the reference range for semi-quantified elasticity of healthy supraspinatus muscles using real-time tissue elastography and its clinical use in patients after rotator cuff repair.

BACKGROUND: The quantitative assessment of healthy supraspinatus muscle elasticity may provide clinically useful preliminary information after rotator cuff repairs. We aimed to determine the reference range for supraspinatus muscle semi-quantified elasticity and describe how it can be used clinically after rotator cuff repair. METHODS: The elasticity of healthy bilateral supraspinatus muscles in 43 participants aged between 24 and 75 years (categorized into two subgroups: <50 and ≥ 50 years) was measured as a strain ratio at 0° and 60° of shoulder abduction using real-time tissue elastography. The reference and modified reference ranges calculated by excluding outliers for elasticity were determined using normal distribution methods for logarithmically transformed data. The modified reference range was applied to eight cases of rotator cuff repair. FINDINGS: Strain ratios under and over 50 years of age were 1.63 vs. 2.21 at 0° of shoulder abduction (P = 0.028) and 0.92 vs. 1.29 at 60° of shoulder abduction (P = 0.002), respectively. Modified reference ranges for under and over 50 years of age were 0.72-4.17 and 0.98-4.50 at 0° of shoulder abduction and 0.38-1.95 and 0.56-2.76 at 60° of shoulder abduction, respectively. Among eight cases, two showed strain ratios above the reference range at 1 month postoperatively, and rehabilitation protocols were adjusted. INTERPRETATION: A strain ratio above the reference range, especially above the upper limit at 0° of shoulder abduction, may indicate increased passive stiffness of the musculotendinous unit. Clinically, the reference range has the potential to be used as a baseline after rotator cuff repairs.

Providing safe and effective rehabilitation by assessing supraspinatus muscle elasticity using ultrasound real-time tissue elastography after rotator cuff repair: A case series.

INTRODUCTION: Although surgical techniques have advanced to avoid a postoperative re-tear after rotator cuff surgery, it remains unclear how to directly evaluate the risk of a re-tear. OBJECTIVE: To describe how muscle elasticity with real-time tissue elastography could be used to avoid re-tear in individual cases after rotator cuff repair. CASE DESCRIPTION: This case series included four patients, two per tear size (small and large/massive), with contrasting changes in muscle elasticity of the supraspinatus muscle. All patients underwent primary arthroscopic or open rotator cuff repair. The elasticity of the supraspinatus muscle was evaluated at relaxed and elongated positions of 0° and 60° shoulder abduction angles, respectively. The change in muscle elasticity at 1 month after surgery was characteristically different, and we predicted that a greater elasticity in the elongated position indicated a higher risk of re-tear. The cases with high risk underwent careful rehabilitation to avoid re-tear, and no re-tears were recorded in this report. CONCLUSION: Our findings suggested that evaluation of muscle elasticity using real-time tissue elastography, which provides an indication of the risk of re-tear, in the clinical setting might be useful for therapists, who could adjust the intensity of rehabilitation, and for patients.

Desiccation-induced fibrous condensation of CAHS protein from an anhydrobiotic tardigrade.

Anhydrobiosis, one of the most extensively studied forms of cryptobiosis, is induced in certain organisms as a response to desiccation. Anhydrobiotic species has been hypothesized to produce substances that can protect their biological components and/or cell membranes without water. In extremotolerant tardigrades, highly hydrophilic and heat-soluble protein families, cytosolic abundant heat-soluble (CAHS) proteins, have been identified, which are postulated to be integral parts of the tardigrades' response to desiccation. In this study, to elucidate these protein functions, we performed in vitro and in vivo characterizations of the reversible self-assembling property of CAHS1 protein, a major isoform of CAHS proteins from Ramazzottius varieornatus, using a series of spectroscopic and microscopic techniques. We found that CAHS1 proteins homo-oligomerized via the C-terminal α-helical region and formed a hydrogel as their concentration increased. We also demonstrated that the overexpressed CAHS1 proteins formed condensates under desiccation-mimicking conditions. These data strongly suggested that, upon drying, the CAHS1 proteins form oligomers and eventually underwent sol-gel transition in tardigrade cytosols. Thus, it is proposed that the CAHS1 proteins form the cytosolic fibrous condensates, which presumably have variable mechanisms for the desiccation tolerance of tardigrades. These findings provide insights into molecular strategies of organisms to adapt to extreme environments.

Introduction of the Purdue Pegboard Test for fine assessment of severity of cervical myelopathy before and after surgery.

[Purpose] To evaluate the severity of symptoms before and after cervical myelopathy surgery using the Simple Test for Evaluating hand Function. Because a test ceiling effect was observed in patients with less severe forms of myelopathy, we investigated the correlation between and accuracy of several different tests in order to clarify the usefulness of the Purdue Pegboard Test for evaluation of one or both hands. [Participants and Methods] Thirty-four patients (6 females and 28 males; mean age, 64.5 years) were examined, and scores were determined for each of the following tests: Purdue Pegboard Test; Simple Test for Evaluating hand Function; Japanese Orthopedic Association assessment; and Disabilities of the Arm, Shoulder, and Hand assessment. Correlations between scores of different tests were then determined. The cut-off values used for the Purdue Pegboard Test and the Simple Test for Evaluating hand Function were determined using the area under the receiver operating characteristic curve to assess the use of chopsticks. [Results] The Purdue Pegboard Test assembly task correlated moderately with the Japanese Orthopedic Association and Disabilities of the Arm, Shoulder, and Hand scores. In the receiver operating characteristic curve analyses, the Purdue Pegboard Test cut-off value was 11 and the Simple Test for Evaluating hand Function cut-off value was 90. [Conclusion] The Purdue Pegboard Test is useful for evaluating manual dexterity and coordination in both hands in patients with cervical myelopathy.

Development of the modified simple test for evaluating hand function (modified STEF): Construct, reliability, validity, and responsiveness.

STUDY DESIGN: Clinimetric evaluation study. INTRODUCTION: Despite the availability of numerous performance tests to measure finger dexterity, there is no international consensus on hand function evaluation. PURPOSE OF THE STUDY: To evaluate the reliability, validity, and responsiveness of the modified version of the simple test for evaluating hand function (STEF), which is widely used in Japan. METHODS: The intrarater (n = 40) and inter-rater (n = 32) reliability of the modified STEF was evaluated by calculating the intraclass correlation coefficient (ICC), models (1,1) and (2,1), respectively, in healthy individuals. The criterion validity of the modified STEF (n = 50) was evaluated by calculating the Pearson correlation coefficient relative to the STEF, the Purdue pegboard test (PPT), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The standardized response mean of the scores was calculated to determine responsiveness (n = 35). The modified STEF was used prospectively to measure the change in hand function in a cohort of patients with hand trauma injuries and inflammatory diseases (n = 30), as well as in a cohort of patients with cervical spondylosis (n = 20), from preoperative baseline to 1 and 3 months postoperatively. RESULTS: ICC1.1 and ICC2.1 values were ≥0.80, indicative of high intrarater and inter-rater reliability. All correlation coefficients were significant (P < .05): STEF (r = 0.89), PPT (r = 0.69), and DASH (r = -0.34). The standardized response mean indicated greater responsiveness of the modified STEF (0.89) than the STEF (0.71) and PPT (0.68) but a lower responsiveness than the DASH (1.11). DISCUSSION: It must be mentioned that modified STEF and DASH cannot be compared without caution. The two types of tools should complement each other when measuring someone's activity and participation level. CONCLUSIONS: The modified STEF is a reliable measurement tool, with a moderate positive correlation with the PPT and a greater responsiveness than the STEF and PPT.

Nutrient intake of highly competitive male and female collegiate karate players.

Nutrient intake of 29 male (M Group) and 16 female (F Group) highly competitive collegiate karate players were compared. The results were also compared with the daily energy expenditure (DEE), Japanese recommended dietary allowances (RDAs) or adequate dietary intakes (ADIs). Dietary information was collected using a 3-weekday diet record. Although the M Group showed significantly higher mean %RDAs or %ADIs in iron, vitamin B1, phosphorus, magnesium, and sodium than the F Group, many of the mean %RDAs or %ADIs were below RDAs or ADIs in both groups. The subjects who skipped meals tended to show lower mean %DEE, Japanese %RDAs or %ADIs in minerals and vitamins than the subjects who did not skip in both M and F Groups. The consumption of green and other vegetables and milk and dairy products in both M and F Groups were low. It is concluded that the male and female highly competitive karate players studied in the present study may be at risk of sub-optimal nutrient intake, which increases the potential for nutrient deficiency. The subjects were advised not to skip meals, and to consume a balanced high-carbohydrate, moderate-protein, low-fat diet with increasing green and other vegetables and milk and dairy products to increase mineral, vitamin and dietary fiber intakes.