Mechanical Stress Via Muscle Contractile Exercise Suppresses Atrophic Alterations of Bone-microstructure in Immobilized Rat Femurs.

OBJECTIVES: This study aimed to determine whether mechanical stress via muscle contractile exercise with belt electrode-skeletal muscle electrical stimulation (B-SES) device effectively prevents immobilization-induced bone atrophy. METHODS: Wistar rats were randomly divided into the control (CON) group, immobilization (IM) group (immobilized treatment only), HES and LES groups (immobilized treatment and high or low-intensity electrical muscular stimulation through B-SES device). Bilateral femurs were used for X-ray micro-CT and biomechanical tests. RESULTS: The maximum load value was significantly lower in the IM and HES groups than in the CON group and significantly higher in the LES group than in the IM group. The maximum crushing load was significantly lower in the IM, HES, and LES groups than in the CON group, and significantly higher in the HES and LES groups than that in the IM group. In micro-CT, the mechanical stress by B-SES device did not affect degenerative microstructural changes in the cortical bone, but prevented those changes in the cancellous bone. CONCLUSIONS: Applying mechanical stress via B-SES device suppressed the loss of cancellous bone density and degenerative microstructural changes caused by immobilization, which in turn suppressed the reduction of bone strength. From these findings, muscle contractile exercise may be effective in preventing immobilization-induced bone atrophy.

Effects of low-level laser therapy on inflammatory symptoms in an arthritis rat model.

[Purpose] This study evaluated the effect of low-level laser therapy on inflammatory signs in an arthritis rat model as a foundation for elucidating the mechanism of the anti-inflammatory effect. [Materials and Methods] Eigteen Wistar rats were divided into three groups: group I (arthritis without low-level laser therapy), group II (arthritis with low-level laser therapy), and the control group (sham arthritis control). Arthritis was induced in the right knee by injecting a mixture of kaolin and carrageenan. Low-level laser therapy was continued for seven days after the onset of arthritis by 60 times of repeated irradiation for 10 seconds in the right knee joint area. The joint transverse diameter, pressure pain threshold in the affected knee joint, and mechanical paw withdrawal threshold at the distant site were evaluated the day before the injection and one, three, and seven days after the injection. Pathological changes were observed. [Results] Group II showed better improvement in swelling and pain in the affected knee joint and secondary hyperalgesia at the distance site when compared to group I. In group II, there was only mild infiltration of synovial cells, and the progression of arthritis was suppressed compared with that of group I. [Conclusion] Low-level laser therapy can mitigate swelling and inflammatory pain in the affected knee joint and prevent secondary hyperalgesia.

Myonuclear apoptosis via cleaved caspase-3 upregulation is related to macrophage accumulation underlying immobilization-induced muscle fibrosis.

INTRODUCTION/AIMS: Although macrophage accumulation plays a key role in the development of immobilization-induced muscle fibrosis, the underlying mechanisms remain unclear. Therefore, we focused on the alterations of myonuclear apoptosis via cleaved caspase-3, and investigated whether these changes may be related to macrophage accumulation. METHODS: Eight-week-old Wistar rats were divided into immobilization and control groups, and the soleus muscles were selected for analysis. RESULTS: The mRNA and protein expression of collagen and the number of CD11b-positive cells were significantly higher in the immobilized rats than in the control rats at 1 and 2 weeks. TdT-mediated dUTP nick end-labeling (TUNEL)-positive myonuclei counts in 1- and 2-week control rats were 0.2 ± 0.1 and 0.2 ± 0.5, whereas they were 1.0 ± 0.6 and 1.1 ± 0.5 in 1- and 2-week immobilized rats. The cleaved caspase-3 protein expressions in 1- and 2-week control rats were 0.2 ± 0.1 and 0.2 ± 0.1, whereas they were 0.5 ± 0.1 and 0.4 ± 0.2 in 1- and 2-week immobilized rats. TUNEL-positive myonuclei counts and cleaved caspase-3 protein expression were significantly higher in immobilized rats than in control rats at 1 and 2 weeks. The numbers of myonuclei in 1- and 2-week control rats were 2.8 ± 0.1 and 2.6 ± 0.4, whereas they were 2.2 ± 0.4 and 2.2 ± 0.2 in 1- and 2-week immobilized rats. The numbers of myonuclei were significantly lower in immobilized than in control rats at both time-points. DISCUSSION: Myonuclear apoptosis via the upregulation of cleaved caspase-3 might induce macrophage accumulation. These alterations are related to immobilization-induced muscle fibrosis.

Morphological divergence in the curvature of human femoral diaphyses: Tracing the central mass distributions of cross-sections.

The diaphysis of the human femoral bone has a physiological anterior curvature; additionally, there is a curvature to the medial side or lateral side. In addition to compression stress from gravity during standing, walking, and running, these bones are continuously exposed to complex stresses from the traction forces of the various strong muscles attached to them. The femoral diaphysis is subjected to these mechanical stresses, and the direction and size of its curvature are defined according to Wolff's law and the mechanostat theory of Frost. The purpose of this study was to quantitatively evaluate the curvature of the femoral diaphysis in Japanese skeletons by determining the curve connecting the central mass distributions (CMD) of cross-sectional images. A total of 90 right femora (46 males and 44 females) were randomly selected from modern Japanese skeletal specimens. Full-length images of these bones were acquired using a clinical computed tomography scanner. The range between the lower end of the lesser trochanter and the adductor tubercle of each femur was divided at regular intervals to obtain ten planes, and nine levels were analyzed. The CMD curve was determined by connecting the CMDs of each of the nine cross-sections. First, the CMD of a cross-section in each of the nine slices was calculated, and the nine trajectories were superimposed from above. Then, by converting the shape of the entire CMD curve to superimpose the coordinates of the endpoint on the starting point, a closed arc representing the curvature of the femur was determined. For both males and females, the patterns varied from mostly medial to largely lateral curvature. The size of the curvature also varied for individuals. By analyzing only the coordinates of the vertex of the CMD curve of each femoral bone, the outlines of the diaphyseal curvatures could be recognized. The femora were thereby divided into two groups: medial bending and lateral bending. Considering males and females together, the number in the lateral-curvature group (n = 51) was larger than that in the medial-curvature group (n = 39). Moreover, the average age of the lateral-curvature group was significantly higher than that of the medial-curvature group (p < 0.05). In males, with an increase in the cortical bone proportion of the cross-sectional area, the anterior vertex of diaphyseal bending tended to be more prominent. This cortical proportion was significantly higher in the medial-curvature groups than in the lateral-curvature group (p < 0.01). The phenomena observed in this study may be related to pathophysiologies such as atypical fractures of the femur and osteoarthritis of the knee joints.

Sodium Nitroprusside Enhances Absorption in the Rat Jejunum via the Transcellular Route.

It was reported that nitric oxide (NO) donors increased the permeability of water-soluble compounds across intestinal membrane with neither loss of cell viability nor release of lactate dehydrogenase. Therefore, the detail mechanism of action of NO donors on the gastrointestinal membrane has yet to be clarified. We previously reported the possibility of the enhancing effect of the NO donor on the membrane permeability via transcellular route. The purpose of this study is to clarify the mechanism of the membrane permeation-enhancing effect via the transcellular route by sodium nitroprusside (SNP), which is one of the NO donors. The effect of SNP on membrane permeation was examined by the in vitro sac method using rat jejunum. SNP increased the membrane permeation of rhodamine 123 same as using N-acetyl-L-cysteine and dithiothreitol which removes unstirred water layer (UWL). Moreover, SNP increased the membrane permeation of antipyrine and ß-naphthol, which are transcellular markers. And it was also investigated the expression levels of mucins (MUCs) which are construction component of UWL and the slight change of MUCs expression by SNP was shown. It was suggested that the expression balance of MUCs is necessary to regulate transcellular permeation, and SNP may affect to UWL. This finding was considered useful for highly lipophilic drugs for which membrane permeation is restricted by the UWL.

Mechanisms underlying immobilization-induced muscle pain in rats.

INTRODUCTION: We investigated the mechanisms underlying immobilization-induced muscle pain in rats. METHODS: In rat skeletal muscle, pressure pain threshold (PPT) of the gastrocnemius muscle was measured, and nerve growth factor (NGF) level, peripheral nerve fiber density, macrophage number, and interleukin-1ß (IL-1ß) mRNA expression were examined. An NGF receptor inhibitor was injected intramuscularly to assess the relationship between PPT and NGF levels. RESULTS: Immobilization resulted in a decrease in PPT and increases in NGF level, C-fiber density, M1 macrophage number, and IL-1ß mRNA expression. Injection of NGF receptor inhibitor reversed the decrease in PPT. DISCUSSION: NGF upregulation may be a major contributor to immobilization-induced muscle pain. The increases in C-fiber density, M1 macrophage number, and IL-1ß mRNA expression may be related to immobilization-induced muscle pain.

Factors associated with muscle function in patients with hematologic malignancies undergoing chemotherapy.

PURPOSE: Muscle dysfunction such as loss of muscle mass and decreased muscle strength is often observed in patients with hematologic malignancies. However, specific factors associated with muscle function have not been identified. The purpose of this study was to identify significant factors affecting muscle function in patients with hematologic malignancies. METHODS: This was a cross-sectional, observational study. Eighty-eight inpatients with hematologic malignancies undergoing chemotherapy were recruited. Participants were evaluated for muscle thickness and isometric knee extensor strength as indicators of muscle function, physical activity, physical symptoms, psychological distress, and self-efficacy at the start date of rehabilitation. Multiple regression analysis with muscle function as the dependent variable and clinical information and other evaluation items as explanatory variables was performed. RESULTS: Lymphocyte count, the geriatric nutritional risk index, and physical activity were significant factors associated with muscle thickness, while physical activity and self-efficacy were significant factors associated with isometric knee extensor strength. CONCLUSIONS: Nutritional status, physical activity, and self-efficacy were significant factors associated with muscle function in patients with hematologic malignancies. Rehabilitation intervention focusing on improving physical activity and nutritional status should be considered necessary for enhancing muscle function in patients with hematologic malignancies.

Characteristics of muscle function and the effect of cachexia in patients with haematological malignancy.

OBJECTIVE: In this study, we investigated the muscle function of patients with haematological malignancy and healthy controls and examined the effect of cachexia on muscle function. METHODS: Seventy-one patients with haematological malignancy, hospitalised for chemotherapy, and 71 healthy controls underwent examination of skeletal muscle mass (SMM; total body and upper and lower limbs), handgrip strength and isometric knee extensor strength. Patients with haematological malignancy were divided into three groups based on Glasgow Prognostic Score: non-cachexia (n = 31), pre-cachexia (n = 23) and cachexia (n = 17) groups. The evaluation items were compared among the groups. RESULTS: Patients with haematological malignancy had lower SMM of the total body and lower limbs, handgrip strength and isometric knee extensor strength than healthy controls. There was no significant difference in SMM of the upper limbs among the groups. When classifying patients with haematological malignancy according to GPS, there was no significant difference among the three groups for any of the evaluation items. CONCLUSIONS: In patients with haematological malignancy, although significant muscle wasting and weakness were observed in the lower limbs, the effect of cachexia was minimal. The reduction in muscle function involved disuse syndrome, which accompanied a decline in physical activity.

Three-dimensional morphological analysis of the human sacroiliac joint: influences on the degenerative changes of the auricular surfaces.

The sacroiliac joint (SIJ) is responsible for weight transmission between the spine and lower extremity. However, details of the structure and function of the SIJ remain unclear. In a previous study, we devised a method of quantitatively evaluating the level of degeneration of the SIJ using an age estimation procedure for the auricular surface of the ilium. Our results in that study suggested that the degree of degeneration of the joint surface may be associated with the morphology of the auricular surface of the ilium. In that study, however, the morphology of the auricular surface of the ilium was simplified for analysis, meaning that more detailed investigations were required in future. In the present study, we focused on individual differences in the shape of SIJ and carried out three-dimensional quantitative evaluation of the morphology of the auricular surface of the ilium to ascertain its association with joint degeneration. We produced three-dimensional images of the right auricular surfaces of the ilium of 100 modern Japanese men (age 19-83), and obtained the three-dimensional rectangular coordinates of 11 defined measurement points. We then calculated 16 parameters indicating the morphological characteristics of the auricular surfaces of the ilium from the three-dimensional rectangular coordinates of these measurement points, and used these to perform principal component analysis to investigate trends in the morphology of the auricular surface of the ilium. We found that the morphology of the auricular surface of the ilium could be characterized in terms of (i) size, (ii) concavity of the posterior border and (iii) amount of undulation. An investigation of the correlation between these parameters and age suggested that the amount of undulation of the auricular surface of the ilium tends to diminish with advancing age. In an investigation of the association between morphology of the auricular surface of the ilium and degeneration of the articular surface when the subjects were divided into a high-degeneration group (n = 55) and a low-degeneration group (n = 45) and the 16 parameters were compared, there was a significant difference in the amount of undulation of the auricular surface of the ilium. In an investigation limited to older subjects aged ≥ 60 (n = 47) at the time of death, there were significant differences between the high-degeneration group (n = 27) and low-degeneration group (n = 20) in terms not only of the parameters indicating the amount of undulation of the auricular surface of the ilium but also of those indicating the amount of the concavity of the posterior border. These results suggested that the amount of undulation of the auricular surface of the ilium may affect the degree of degeneration of the articular surface. In addition, in older subjects, the degree of concavity of the posterior border of the SIJ may also affect the degree of degeneration of the articular surface. It is thus likely that differences in the morphology of the auricular surface of the ilium may affect degenerative changes in the SIJ.

Relationship between extensibility and collagen expression in immobilized rat skeletal muscle.

INTRODUCTION: This study investigated longitudinal changes in muscle extension and collagen expression in an immobilized rat soleus muscle, and assessed the relationship between both elements. METHODS: Soleus muscles of the control and immobilization groups (1, 2, 4, 8, and 12 weeks) were used for analysis of muscle extensibility and collagen expression. RESULTS: The slope value/physiological cross-sectional area (PCSA; a parameter for muscle extensibility) and hydroxyproline (a parameter for collagen expression) were significantly higher in the immobilization group than in the control group for all experimental time points. In the immobilization group, both factors were significantly higher at 4, 8, and 12 weeks than at 1 and 2 weeks after immobilization. A significant positive correlation was observed between the slope value/PCSA and hydroxyproline expression. DISCUSSION: The present study indicated that a decrease in muscle extensibility depended on collagen overexpression in immobilized rat soleus muscles. Muscle Nerve 57: 672-678, 2018.

Low-intensity exercise therapy with high frequency improves physical function and mental and physical symptoms in patients with haematological malignancies undergoing chemotherapy.

This study aimed to investigate the effects of low-intensity exercise therapy (LIET) on the physical and mental symptoms and functions in patients with haematological malignancies undergoing chemotherapy. Forty-four patients hospitalised for chemotherapy performed LIET. The exercise intensity of LIET was defined as achieving <40% of the predicted maximum heart rate calculated using the Karvonen formula. LIET consisted of aerobic and resistance training, which was carried out on weekdays. The intervention was omitted in the case of poor general health status and strong patient refusal. Muscular and physical function, activities of daily living (ADLs), psychological distress and quality of life (QOL) were evaluated upon initiation of rehabilitation and at discharge. Participants were divided into high- and low-frequency groups according to their LIET frequency. Two-way repeated-measures analysis of variance was used for statistical analysis. In the high-frequency group, muscle function was maintained, while physical function, ADLs, psychological distress and QOL were significantly improved. However, in the low-frequency group, muscle function of the lower limb was significantly reduced and no other improvement was observed. Low-intensity exercise therapy could be a potential treatment strategy for patients with haematological malignancies undergoing chemotherapy who are unable to perform mid- or high-intensity exercise.

Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients.

INTRODUCTION: Referred pain in the anterior knee joint is the most common symptom in hip disease patients. The development of referred pain is considered to be related to dichotomizing peripheral sensory fibers. However, no gross anatomical findings identify any dichotomizing fibers innervating both the hip and knee joints. We dissected the femoral and obturator nerves in human cadavers to investigate the distribution of the articular branches in the hip and knee joints. Fourteen embalmed left lower limbs from 14 Japanese adult cadavers (five from females, nine from males, average age 73.8 ± 14.1 years) were observed macroscopically. The articular branches of the femoral and obturator nerves were dissected at the anterior margin of the groin toward the thigh region. After dissections of the articular nerves of the hip joints, the femoral and obturator nerves were exposed from proximally to distally to identify the articular nerves of the knee joints. The branching pattern of the articular branches in the hip and knee joints was recorded. In six of 14 limbs (42.9%), the femoral nerve supplied articular branches to the anteromedial aspect of both the hip and knee joints. These articular branches were derived from the same bundle of femoral nerve. These gross anatomical findings suggested that dichotomizing peripheral sensory fibers innervate the hip and knee joints and these could relate to the referred pain confirmed in the anterior knee joints of patients with hip disease. Clin. Anat. 31:705-709, 2018. © 2018 Wiley Periodicals, Inc.

Design of a prototype split-and-delay unit for XFEL pulses, and their evaluation by synchrotron radiation X-rays.

A prototype split-and-delay unit (SDU) for X-ray free-electron laser (XFEL) pulses is proposed based on the Graeff-Bonse four-Bragg-reflection interferometer by installing 12.5° slopes. The SDU can continuously provide a delay time from approximately -20 to 40 ps with a resolution of less than 26 fs. Because the SDU was constructed from a monolithic silicon crystal, alignment is straightforward. The obtained thoroughputs of the SDU reached 0.7% at 7.46 keV and 0.02% at 14.92 keV. The tunability of the delay time using the proposed SDU was demonstrated by finding the interference effects of the split X-rays, and the time resolution of the proposed SDU was evaluated using the width of the interference pattern recorded on the X-ray charge-coupled device camera by changing the energy, i.e. longitudinal coherence length, of the incident X-rays. It is expected that the proposed SDU will be applicable to XFEL experiments using delay times from tens of femtoseconds to tens of picoseconds, e.g. intensity correlation measurements.

Cyclic muscle twitch contraction inhibits immobilization-induced muscle contracture and fibrosis in rats.

We investigated the effects of cyclic muscle twitch contraction caused by neuromuscular electrical stimulation (NMES) on immobilization-induced muscle contracture and fibrosis in rats. Twenty-nine rats were divided into control, immobilization, and immobilization with muscle contraction groups. The ankle joints of the immobilization and muscle contraction rats were fixed in full plantar flexion with a plaster cast for 4 weeks. In the muscle contraction group, cyclic muscle twitch contraction of the soleus muscle was induced using a commercial device (1 Hz, 4 ± 2 mA, 60 min/day, 5 times/week) with the ankle joint immobilized. The dorsiflexion range of ankle joint motion in the muscle contraction group was significantly greater than that in the immobilization group. The expressions of fibrosis-related genes (i.e., hypoxia inducible factor-1α, transforming growth factor-ß1, α-smooth muscle actin, and types I and III collagen) were significantly decreased in the muscle contraction group compared to the immobilization group. The fluorescence intensities of type I and type III collagen in the perimysium and endomysium in the muscle contraction group were significantly decreased compared to the immobilization group. These results suggest that cyclic muscle twitch contraction induced by NMES might alleviate skeletal muscle fibrosis, reducing immobilization-induced muscle contracture.

Development and progression of immobilization-induced skin fibrosis through overexpression of transforming growth factor-ß1 and hypoxic conditions in a rat knee joint contracture model.

PURPOSE: The purpose of this study was to investigate the pathology and mechanism of immobilization-induced skin fibrosis in a rat joint contracture model. METHODS: Rats were randomly divided into control and immobilization groups. In the immobilization groups, knee joints of the rats were immobilized for 1, 2, and 4 weeks. After each immobilization, skin was dissected. To assess fibrosis in the skin, the thickness and area of adipocytes and connective tissue fibers were measured. Myofibroblasts were analyzed by immunohistochemistry by using anti-α-SMA as a marker. Gene expression levels of type I and III collagen, TGF-ß1, and HIF-1α were measured by using RT-PCR. RESULTS: One week after immobilization, there was a marked increase in the area of connective tissue fibers in the immobilization group. Type I and type III collagen were significantly increased with prolonged immobilization. Higher numbers of α-SMA-positive cells were noted in the immobilized group at 2 and 4 weeks after immobilization. The expression level of TGF-ß1 mRNA in the immobilization group increased after one week of immobilization. In contrast, the expression level of HIF1-α mRNA increased after 2 weeks of immobilization, and a greater increase was seen at 4 weeks after immobilization. CONCLUSIONS: These results suggest that immobilization induces skin fibrosis with accumulation of types I and III collagen. These fibrotic changes may be evoked by upregulation of TGF-ß1 after one week of immobilization. Additionally, upregulation of HIF-1α may relate to skin fibrosis by accelerating the differentiation of fibroblasts to myofibroblasts starting at 2 weeks after immobilization.

Sex differences of dental pathology in early modern samurai and commoners at Kokura in Japan.

So-called "Ohaguro", teeth blackening, in the married females was a general custom regardless of class in the early modern period. As a result, Ohaguro was thought to have enhanced the acid resistance of tooth substance and tightened gingiva and prevented tooth morbidity due to periodontal disease. For investigation into the influence of Ohaguro, the skeletal remains of early modern samurai and commoners at Kokura were examined for differences in the dental pathology based on sex. Though females from archeological sites have significantly more carious teeth and antemortem tooth loss (AMTL) than males in the previous studies, the prevalence of caries and AMTL in males was higher than in females among the early modern samurai and commoners in Kokura. The efficacies of Ohaguro may influence the good dental health of females. On the other hand, as females were considered inferior to males under the feudal system in Japan, males, including children, might tend to consume more nutritious foods compared to females. However, those foods are certainly not better with regard to dental health, since those foods are more highly cariogenic. These factors may have caused higher caries and AMTL prevalence among males compared to females in early modern Kokura.

Upregulation of interleukin-1ß/transforming growth factor-ß1 and hypoxia relate to molecular mechanisms underlying immobilization-induced muscle contracture.

INTRODUCTION: In this study we investigated the molecular mechanism underlying muscle contracture in rats. METHODS: The rats were divided into immobilization and control groups, and soleus muscles of the right and left sides were selected for analyses. RESULTS: The levels of CD11b and α-SMA protein, IL-1ß, and TGF-ß1 mRNA, and type I and III collagen protein and mRNA were significantly greater in the immobilization group than in the control group at all time-points. HIF-1α mRNA levels were significantly higher in the immobilization group at 4 weeks. Moreover, HIF-1α, α-SMA, and type I collagen levels were significantly higher at 4 weeks than at 1 and 2 weeks in the immobilization group. CONCLUSIONS: In the early stages of immobilization, upregulation of IL-1ß/TGF-ß1 via macrophages may promote fibroblast differentiation that could affect muscle contracture. The soleus muscle became hypoxic in the later stages of immobilization, suggesting that hypoxia influences the progression of muscle contracture.

Investigation and macroscopic anatomical study of referred pain in patients with hip disease.

[Purpose] The aim of this study was to examine the incidence and patterns of referred pain in patients with hip disease, as well as the nerve distribution in the hip and knee joints of 2 cadavers. [Subjects and Methods] A total of 113 patients with hip joint disease were included in the investigation. The incidence of regional pain and referred pain patterns were evaluated before and after arthroplasty. Two cadavers were macroscopically observed to verify the nerve innervation of the hip and knee joints. [Results] Anterior knee pain was observed preoperatively in 13.3% (in resting) and 33.6% (in motion) of the patients, which was comparable with the incidence of greater trochanter pain. In addition, the preoperative incidence rates of knee pain in resting and motion markedly decreased postoperatively. Of note is the remarkable incidence of pain radiating to the ventral lower limb. An anteromedial innervation was determined in the cadavers by the articular branches of the obturator and femoral nerve, which supply small branches to the knee joints. [Conclusion] Our results suggest that the distribution of the incidence of pain among the patients with hip disease is diverse owing to the sensory distribution of the femoral and obturator nerves.

Low-intensity pulsed ultrasound phonophoresis with diclofenac alleviated inflammation and pain via downregulation of M1 macrophages in rats with carrageenan-induced knee joint arthritis.

Objective: This study aimed to investigate the effects of low-intensity pulsed ultrasound (LIPUS) phonophoresis with diclofenac on inflammation and pain in the acute phase of carrageenan-induced arthritis in rats. Design: 60 male Wistar rats were randomly divided into the arthritis, diclofenac, LIPUS, phonophoresis, and sham-arthritis control groups. LIPUS and transdermal diclofenac gel were applied to the lateral side of the inflamed knee for 7 days, initiated postinjection day 1. In the phonophoresis group, diclofenac gel was rubbed onto the skin, followed by LIPUS application over the medication. Knee joint transverse diameters, pressure pain thresholds (PPTs), and paw withdrawal thresholds (PWT) were evaluated. The number of CD68-, CD11c-, and CD206-positive cells, and IL-1ß and COX-2 mRNA expression were analyzed 8 days after injection. Results: In the phonophoresis group, the transverse diameter, PPT, PWT significantly recovered at the day 8 compared to those in the LIPUS and diclofenac groups. The number of CD68- and CD11c-positive cells in the phonophoresis group was significantly lower than that in the LIPUS and diclofenac groups, but no significant differences were observed among three groups in CD206-positive cells. IL-1ß and COX-2 mRNA levels were lower in the phonophoresis group than in the arthritis group, although there were no differences among the LIPUS, diclofenac, and phonophoresis groups. Conclusion: LIPUS phonophoresis with diclofenac is more effective to ameliorate inflammation and pain compared to diclofenac or LIPUS alone, and the mechanism involves the decrease of M1 macrophages.

Effects of Isometric Quadriceps Muscle Exercise with Visual and Auditory Feedback at 1 Year after Total Knee Arthroplasty.

OBJECTIVE: To examine the effect of isometric quadriceps exercises with visual and auditory feedback after total knee arthroplasty (TKA). METHODS: The sample included 41 patients from our previous study who could be followed up for 1 year after TKA. Patients in the intervention group performed isometric quadriceps exercises with visual and auditory feedback using the quadriceps training machine from the 2nd to the 14th day after TKA, whereas those in the control group underwent standard postoperative rehabilitation (without visual or auditory feedback during isometric quadriceps exercises) in the hospital. Patients were evaluated for pain intensity, timed up and go test (TUG) score, 10-m gait speed, 6-minute walking distance (6MWD), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score 1 year after TKA. Additionally, exercise habits and responses to the International Physical Activity Questionnaire (IPAQ) were investigated. RESULTS: Pain intensity was significantly lower in the intervention group than in the control group. Greater improvements in the TUG test scores, 10-m gait speed, 6MWD, and WOMAC scores were observed in the intervention group. Walking activity, as recorded by the IPAQ, and the proportion of patients with exercise habits were significantly higher in the intervention group than in the control group. CONCLUSIONS: These results suggest that performing isometric quadriceps exercise with visual and auditory feedback using the quadriceps training machine has good effects, such as pain reduction, physical function improvement, exercise tolerance, and increased physical activity at 1 year after TKA.