Kinesiophysiological analysis associated with changes in subjective intensities in belt electrode-skeletal muscle electrical stimulation: a prospective exploratory study.

[Purpose] Belt electrode-skeletal muscle electrical stimulation (B-SES) is a novel electrical muscle stimulation treatment that causes less pain and discomfort and induces contraction in a wider skeletal muscle area than conventional electrodes. However, the stimulation intensity depends on patients' subjectivity. In the present study, B-SES and an expiratory gas device were combined to analyze the kinesiophysiological data associated with changes in subjective intensity. [Participants and Methods] Seventeen healthy participants were recruited. The subjective intensities were set to four conditions (weak, normal, strong, and maximum tolerated intensity), and the stimulation was performed in each condition in the "metabolic mode" (frequency, 4 Hz; pulse width, 250 µs). The primary outcome was metabolic equivalents (METs), and this data were compared for each condition. [Results] METs generated by B-SES were 2.0 (1.0) for weak intensity, 2.7 (1.2) for normal intensity, 3.9 (1.3) for strong intensity, and 5.0 (1.3) for the tolerance limit intensity; differences detected between all subjective intensities were statistically significant. [Conclusion] These findings show that objective intensities of >3 METs, as recommended in rehabilitation prescriptions, can be achieved when the subjective intensity is set at strong or maximum tolerated. Treatment with B-SES may provide a viable alternative to therapeutic exercise.

Posterior Occipitocervical Fixation and Intrathecal Baclofen Therapy for the Treatment of Basilar Invagination with Klippel-Feil Syndrome: A Case Report.

Klippel-Feil syndrome (KFS) is characterized by the congenital fusion of the cervical vertebrae and is sometimes accompanied by anomalies in the craniocervical junction. In basilar invagination (BI), which is a dislocation of the dens in an upper direction, compression of the brainstem and cervical cord results in neurological defects and surgery is required. A 16-year-old boy diagnosed with KFS and severe BI presented with spastic tetraplegia, opisthotonus and dyspnea. CT scans showed basilar impression, occipitalization of C1 and fusion of C2/C3. MRI showed ventral compression of the medullocervical junction. Posterior occipitocervical reduction and fusion along with decompression were performed. Paralysis gradually improved postoperatively over 3 weeks. However, severe spasticity and opisthotonus persisted and intrathecal baclofen (ITB) therapy was initiated. Following this, opisthotonus disappeared and spasticity of the extremities improved. Rehabilitation therapy continued by controlling the dose of ITB. Five years after the surgery, self-propelled wheelchair driving was achieved and activities of daily life improved. The treatment strategy for patients with BI and congenital anomalies remains controversial. Posterior reduction and internal fixation using instrumentation were effective techniques in this case. Spasticity control achieved through a combination of surgery and ITB treatment enabled the amelioration of therapeutic efficacy of rehabilitation and the improvement of ADL.

One-Leg Robotic-Assisted Gait Training Efficiently Improves Gait Independence for Acute Stroke Hemiplegic Patients: A Prospective Pilot Study.

ABSTRACT: Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days from onset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional Independence Measure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measure walk score of 5 (supervision level). The primary outcome was improvement efficiency of Functional Independence Measure walk, which was the increase in Functional Independence Measure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 ( P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported during Welwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by starting Welwalk training in the early phase after stroke onset.

Wearable Integrated Volitional Control Electrical Stimulation Device as Treatment for Paresis of the Upper Extremity in Early Subacute Stroke Patients: A Randomized Controlled Non-inferiority Trial.

OBJECTIVE: To investigate the effect of a wearable integrated volitional control electrical stimulation (WIVES) device that has been developed as more compact and simpler to use in daily life compared with conventional integrated volitional control electrical stimulation (IVES) devices. DESIGN: Randomized controlled non-inferiority trial. SETTING: Convalescent rehabilitation ward. PARTICIPANTS: Patients with paresis of the upper extremity (UE) after early subacute stroke (N=20). INTERVENTIONS: Eligible patients were randomized to receive IVES treatment or WIVES treatment for 8 hours per day for 28 days in daily living, in addition to standard rehabilitation treatment. In both groups, the extensor digitorum communis on the affected side was the target muscle for stimulation. MAIN OUTCOME MEASURE: Primary outcomes were assessed with Fugl-Meyer Assessment of the UE (FMA-UE) before and after treatment. Non-inferiority was determined with a specified margin of non-inferiority. RESULTS: Twenty patients completed the trial (IVES group: n=10, WIVES group: n=10). FMA-UE improved in both groups. The mean change in FMA-UE was 4.7 for the IVES group and 6.0 for the WIVES group (P>.05, 95% confidence interval: -6.73 to 4.13). The mean difference between the groups was 1.3, and the upper 95% confidence interval did not exceed the non-inferiority margin. CONCLUSION: The effectiveness of WIVES treatment is non-inferior to that of IVES treatment. As a portable device, IVES may facilitate the use of affected upper extremities in daily living and may help improve paresis of the UE.

Accurate diagnosis of sarcopenia without using a body composition analyzer in a convalescent rehabilitation ward.

Hishikawa N, Sawada K, Shono S, Sakurai M, Yokozeki M, Maeda H, Ohashi S, Ueshima K, Mikami Y. Accurate diagnosis of sarcopenia without using a body composition analyzer in a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 26-32. Objective: The Asian Working Group for Sarcopenia 2019 recommends diagnosing sarcopenia without using a body composition analyzer and initiating treatment early. The present study aimed to investigate the accuracy of diagnosing sarcopenia without a body composition analyzer in a convalescent rehabilitation ward. Methods: Eighty-five patients admitted to a convalescent rehabilitation ward were included, and sarcopenia diagnoses were performed with and without a body composition analyzer. To assess the accuracy of diagnosing sarcopenia without using a body composition analyzer, sensitivity, specificity, positive predictive value, and negative predictive value were calculated relative to sarcopenia diagnoses made using a body composition analyzer. Results: The sensitivity of the technique for diagnosing sarcopenia was 0.94, specificity was 0.77, positive predictive value was 0.86, and negative predictive value was 0.90. Conclusion: The accuracy of diagnosing sarcopenia without using a body composition analyzer was high. However, this technique may miss sarcopenia cases in patients with increased calf circumference due to adipose tissue and/or edema.

Feasibility of Seated Stepping and Handshaking as a Cardiopulmonary Exercise Testing: A Pilot Study.

Cardiopulmonary function is usually assessed by cardiopulmonary exercise testing (CPX) using a cycle ergometer (CE-CPX) or a treadmill, which is difficult in patients with lower extremity motor dysfunction. A stepping and handshaking (SHS) exercise has been developed that can be performed safely and easily while sitting on a chair. This study compared peak oxygen uptake (peak V.O2) between CE-CPX and SHS-CPX in healthy adults and investigated the safety and validity of SHS-CPX. Twenty young adults (mean age 27.8 ± 4.4 years) were randomly assigned to perform CE-CPX or SHS-CPX, with the other test to follow 1-2 weeks later. The peak V.O2, respiratory exchange ratio (RER), peak heart rate, blood pressure, and test completion time were compared between CE-CPX and SHS-CPX. All subjects completed the examination and met the criteria for peak V.O2. SHS-CPX and CE-CPX showed a strong correlation with peak V.O2 (r = 0.85, p < 0.0001). The peak V.O2 (40.4 ± 11.3 mL/min/kg vs. 28.9 ± 8.0 mL/min/kg), peak heart rate (190.6 ± 8.9 bpm vs. 172.1 ± 12.6 bpm), and test completion time (1052.8 ± 143.7 s vs. 609.1 ± 96.2 s) were significantly lower in the SHS-CPX (p < 0.0001). There were no adverse events. The peak V.O2 with SHS-CPX was equivalent to about 70% of that with CE-CPX despite the exercise being performed in a sitting position, suggesting its suitability as a submaximal exercise test.

A home-based low-intensity resistance exercise programme with supervision for secondary sarcopenia in a patient with established rheumatoid arthritis: A case report.

Patients with established rheumatoid arthritis (RA) are at risk of developing secondary sarcopenia. Both pharmacological and exercise interventions are essential for treatment. However, for such patients, exercise loads may lead to the progression of joint destruction and worsening of pain. The purpose of this report was to assess the feasibility of a home-based, low-intensity resistance exercise programme. The case was a 70-year-old female patient with sarcopenia secondary to RA. She was diagnosed with RA at 57 years of age and began medication, maintaining remission of disease activity. However, she did not exercise habitually and was relatively inactive in her daily life. Furthermore, she had kinesiophobia associated with her RA-related symptoms. We suggested implementing a home-based low-intensity resistance exercise programme >3 months, with the goal of exercising the lower extremities daily. The patient was asked to self-monitor using an exercise diary and attend monthly outpatient visits for repeat counselling and feedback. As a result, she was able to perform the exercise programme safely with high compliance, improving her kinesiophobia as well as physical inactivity, although her skeletal muscle mass did not change. Regular exercise and increased physical activity may help prevent the onset of sarcopenia. These results demonstrate the feasibility of implementing our exercise programme and support its potential for preventing the progression of sarcopenia. While questions remain in terms of treating sarcopenia, we believe that our findings will lead to the establishment of an exercise programme for patients with sarcopenia secondary to established rheumatoid arthritis.

A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey.

There seems to be a lack of consistency of maintenance/community-based rehabilitation through long-term care insurance. We aimed to clarify whether consistent rehabilitation can be performed through long-term care insurance by questionnaires. Materials and Methods: This study was a cross-sectional study in a nationwide survey among rehabilitation staff and care recipients who completed disease-specific rehabilitation and required maintenance/community-based rehabilitation through long-term care insurance. Consistency of rehabilitation was compared using Fisher's exact tests. The concordance of the rehabilitation evaluation and treatment conducted under medical and long-term care insurance was assessed using the κ coefficient. Results: Six hundred questionnaires from care recipients and staff were analyzed. Of the rehabilitation staff, 264 (44%) obtained rehabilitation plans from medical institutions. There was a significant difference between the responses of "referral from the same medical corporation" and "obtaining the rehabilitation plan" by Fisher's exact test (odds ratio: 3.242; P<0.001). Most rehabilitation treatments under medical insurance comprised walking or training with parallel rods/canes [498 patients (83%)], and 454 patients (76%) received stretching and range-of-motion training for the limbs and spine for long-term care insurance. Muscle strength evaluation was the most frequently conducted under medical and long-term care insurance [383 (73%) and 487 (83%), respectively]. The concordance of the evaluation and treatment content, except for disease-specific evaluation, was low (κ coefficient≤0.6). Conclusions: The rate of provision of rehabilitation plans was low, and evaluation and treatment content under medical and long-term care insurance was inconsistent. Our results draw attention to the need for consistent rehabilitation plans between disease-specific and maintenance/community-based rehabilitation.

Comparative Study of Muscle Hardness during Water-Walking and Land-Walking Using Ultrasound Real-Time Tissue Elastography in Healthy Young People.

Compared with land-walking, water-walking is considered to be beneficial as a whole-body exercise because of the characteristics of water (buoyancy, viscosity, hydrostatic pressure, and water temperature). However, there are few reports on the effects of exercise in water on muscles, and there is no standard qualitative assessment method for muscle flexibility. Therefore, we used ultrasound real-time tissue elastography (RTE) to compare muscle hardness after water-walking and land-walking. Participants were 15 healthy young adult males (24.8 ± 2.3 years). The method consisted of land-walking and water-walking for 20 min on separate days. The strain ratio of the rectus femoris (RF) and medial head of gastrocnemius (MHGM) muscles were measured before and immediately after walking using RTE to evaluate muscle hardness. In water-walking, the strain ratio significantly decreased immediately after water-walking, with p < 0.01 for RF and p < 0.05 for MHGM, indicating a significant decrease in muscle hardness after water-walking. On the other hand, land-walking did not produce significant differences in RF and MHGM. Muscle hardness after aerobic exercise, as assessed by RTE, was not changed by land walking but was significantly decreased by water walking. The decrease in muscle hardness induced by water-walking was thought to be caused by the edema reduction effect produced by buoyancy and hydrostatic pressure.

Rehabilitation in the long-term care insurance domain: a scoping review.

PURPOSE: Since the enactment of the long-term care insurance (LTCI) act in 2000, the number of LTCI users has increased annually. However, evidence regarding what is being carried out as rehabilitation treatment under LTCI is lacking. In this study, a scoping review was performed to bridge this knowledge gap. METHODS: Articles related to rehabilitation in connection with LTCI published between April 2000 and November 2020 were searched for in PubMed, CINAHL, CENTRAL (Cochrane Central Register of Controlled Trials), Ichushi Web Ver.5, and CiNii and randomized controlled trials (RCTs) of rehabilitation provided under LTCI were examined. RESULTS: Of the 15,572 publications identified, 15 RCTs, including rehabilitation treatment by physiatrists and therapists, met the eligibility criteria of our review and were included. The rehabilitation trials in the 15 RCTs varied and included balance training, exercise therapy, cognitive tasks, and activities such as singing and dancing. The results allowed us to focus on three categories: fall prevention, dementia, and theory and tools interventions related to occupational therapy practice. CONCLUSION: The focal points of attention in the rehabilitation treatment of LTCI were identified. However, the physical function, quality of life, and activities of daily living (ADL) of those who "need support" vary from person to person. Therefore, the consolidation of evidence on rehabilitation treatment of LTCI must be continued.

High-rate settlement and unconsciousness with shime-waza in young judo athletes from a video analytic study in Judo World Championships.

OBJECTIVES: We aimed to investigate the incidence rate of unconsciousness related to shime-waza and the accompanying symptoms by age categories using video analysis of the Judo World Championships. DESIGN: Observational retrospective study. METHODS: We included 6918 elite judo athletes and 7426 bouts from the Judo World Championships between 2015 and 2021. Incidence rates of matches settled using shime-waza and unconsciousness were calculated by age categories: cadet, junior, and senior. Furthermore, in cases of unconsciousness resulting from shime-waza, the duration of choking initiation and release, unconsciousness, and awareness were recorded from video analysis and compared by the presence of post-awareness symptoms. A relationship between the duration of shime-waza and the post-awareness symptoms was investigated using receiver operating characteristic analysis. RESULTS: Shime-waza was used to settle 307 (4.1 %) bouts comprising 6.0 %, 4.4 %, and 3.0 % of the cadet, junior, and senior bouts, respectively (p < 0.001). The unconsciousness rates were 18.9 %, 14.6 %, and 4.3 % in the cadet, junior (p = 0.008), and senior bouts (p < 0.001), respectively. Among the 39 unconsciousness cases, 24 (61.5 %) showed convulsions or staggers after awareness. The duration from unconsciousness to choking release in cases with and without symptoms was 5.0 ±â€¯3.5 s and 2.4 ±â€¯2.0 s, respectively (p = 0.009); moreover, this duration was significantly correlated with the duration from unconsciousness to awareness (ρ = 0.480, p = 0.002). The cut-off point for symptom occurrence was a duration from unconsciousness to choking release of ≥4 s (area under the curve = 0.746, p = 0.003, odds ratio = 6.7). CONCLUSIONS: Considering the risk of unconsciousness and accompanying symptoms resulting from shime-waza, appropriate education and responses are required.

Effect of Foot Orthosis Treatment on Quality of Life in Secondary Sarcopenia Patients with Rheumatoid Arthritis-Related Foot Impairment.

Objectives: Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients' long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL. Methods: Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment. Results: Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02-0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09-0.21). Foot pain and activities of daily living significantly improved (P = 0.01-0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00). Conclusions: FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.

Prosthetic walking after bilateral transfemoral amputation in a patient with dilated cardiomyopathy: a case report.

In this study, we present a case of a 14-year-old adolescent boy who developed rhabdomyolysis and underwent bilateral transfemoral amputation after cardiopulmonary resuscitation for cardiac arrest because of dilated cardiomyopathy (DCM). Patients with bilateral transfemoral amputation have slower walking velocity and greater oxygen consumption during walking. Rehabilitation of such patients may be demanding especially if they have DCM, one of the major causes of advanced heart failure. The patient was admitted to our hospital on postoperative day (POD) 206. At first, we started with residuum compression. Simultaneously, resistance training and range-of-motion exercise were performed. He started the walking training with short stubbies prostheses on POD 262. Then, we used two types of knee joint prostheses, microprocessor-controlled prosthetic knee (MPK) and non-MPK. We chose MPK for his bilateral knee joints because it was easier for him to walk with MPK than with non-MPK. MPK also has the advantage of high stability and less burden on the heart. He achieved to walk with the prosthesis using T-canes with both hands on POD 374. Furthermore, he was able to return to school after discharge. In patients with transfemoral amputations and DCM with exercise restrictions, MPK is preferred because it reduces cardiac load during physical activity.

The Efficacy of Health Surveys and Polymerase Chain Reaction Tests Prior to Judo Tournaments During the COVID-19 Pandemic.

Background As of October 2021, sports activities require preventive measures against coronavirus disease 2019 (COVID-19) infection. Judo, a close-contact sport, demands careful prevention with great consideration to the risk of infection. The All Japan Judo Federation Medical Science Committee (AJJF) designed COVID-19 prevention protocols from a medical perspective and developed policies for safe regular practices and tournaments. Objective and Methods We aim to examine the efficacy of health surveys and polymerase chain reaction (PCR) tests prior to judo tournaments, as mandated by the tournament policy. Infection prevention managers were installed prior to tournaments. Two weeks prior to each tournament, these managers drafted health inventory forms for athletes and related parties to check for COVID-19-associated symptoms. Although PCR testing prior to tournaments was not required by policy, the AJJF conducted them (directly and by mail) prior to six tournaments from October 2020 to September 2021 for athletes whose health inventory forms listed no symptoms. Results One of the athletes was not tested and was unable to participate in a tournament due to the symptoms indicated in their health inventory form. Testing began in October 2020 and was conducted until September 2021 for 2,073 athletes over the duration of six tournaments. The SARS-CoV-2 virus was detected in 11 (0.29%) athletes. In tournaments held until April 2021, SARS-CoV-2 was detected in only one of the 1,173 (0.08%) athletes tested. However, prior to tournaments held from July 2021 onward, when variants became prevalent, SARS-CoV-2 was detected in 10 (1.1%) of the 900 athletes tested (p < 0.05). No clusters were reported in association with any tournament. Conclusion We believe that drafting health inventory forms two weeks prior to judo tournaments was essential and kept the participants alert. However, as variants emerged, some participants who were positive could not be detected through their inventory forms; this demonstrates the need for caution when relying on health inventory forms alone.

Clinical outcomes after medial patellofemoral ligament reconstruction: an analysis of changes in the patellofemoral joint alignment.

PURPOSE: Medial patellofemoral ligament (MPFL) reconstruction using the hamstring tendon is widely performed to treat recurrent patellar dislocation. MPFL reconstruction includes a post-operative process of necrosis and reperfusion of the hamstring tendon graft. We hypothesise that the patella gradually shifts laterally because of this process, ultimately affecting the patellofemoral joint alignment. This study aimed to analyse the chronological changes in the patellofemoral joint alignment and the outcomes of MPFL reconstruction. METHODS: In this retrospective case-series study, the Knee Society, Lysholm, and Kujala scores were evaluated in 24 consecutive patients (27 knees). To evaluate patellar tracking defects, radiographic indices including the tilting angle, the lateral shift ratio, and the congruence angle were measured before, immediately after, and three, 12, and 36 months after MPFL reconstruction. RESULTS: Post-operative Kujala, Knee Society, and Lysholm scores for the study population significantly improved relative to the pre-operative scores. The tilting and congruence angles at three months after the operation significantly increased relative to those recorded immediately after the operation. The tilting and congruence angles were not significantly different at three, 12, and 36 months after the operation. CONCLUSIONS: The post-operative outcomes of MPFL reconstruction for recurrent patellar dislocation were favourable. Insufficient union between the bone tunnel and tendon graft, along with an elongation of the necrotic tendon graft, may change the alignment of the patellofemoral joint within three months after the operation. Therefore, we believe it is necessary to refrain from knee rotation that places lateral stress on the patella until three months after the operation.

A nationwide survey on the incidence and characteristics of traumatic spinal cord injury in Japan in 2018.

STUDY DESIGN: Retrospective epidemiological study. OBJECTIVES: Since the causes and incidences of traumatic spinal cord injury (TSCI) in each country change over time, up-to-date epidemiological studies are required for countermeasures against TSCI. However, no nationwide survey in Japan has been conducted for about 30 years. The purpose of this study was therefore to investigate the recent incidence and characteristics of TSCI in Japan. SETTING: Japan METHODS: Survey sheets were sent to all hospitals (emergency and acute care hospitals) that treated TSCI persons in Japan in 2018 and case notes were retrospectively reviewed. Frankel grade E cases were excluded from analysis. RESULTS: The response rate was 74.4% (2804 of 3771 hospitals). The estimated annual incidence of TSCI excluding Frankel E was 49 per million, with a median age of 70.0 years and individuals in their 70s as the largest age group. Male-to-female ratio was 3:1. Cervical cord injuries occurred in 88.1%. Frankel D was the most frequent grade (46.3%), followed by Frankel C (33.0%). The most frequent cause was fall on level surface (38.6%), followed by traffic accident (20.1%). The proportion of fall on level surface increased with age. TSCI due to sports was the most frequent cause in teenagers (43.2%). CONCLUSIONS: This nationwide survey in Japan showed that estimated incidence of TSCI, rate of cervical cord injury, and incomplete injury by falls appear to be increasing with the aging of the population.

Hepatocyte growth factor regulates HIF-1α-induced nucleus pulposus cell proliferation through MAPK-, PI3K/Akt-, and STAT3-mediated signaling.

Intervertebral discs are important for maintaining mobility and offer support to the body trunk. If these discs lose their biomechanical features, lower back pain can occur. We previously reported that hepatocyte growth factor (HGF) promotes cell proliferation and suppresses apoptosis, inflammation, and matrix degradation in nucleus pulposus (NP) cells. In the present study, we investigated the molecular mechanisms of how HGF promotes the proliferation of NP cells in hypoxic conditions. Hypoxic stimulation promoted modest cell proliferation, which was further upregulated by HGF. Expression of hypoxia-inducible factor (HIF-1α) protein, which contributes to the maintenance of homeostasis in NP cells, was also upregulated in hypoxia-treated cell groups; HGF further increased HIF-1α expression in NP cells. Additionally, knockdown of HIF-1α expression significantly reduced the proliferation of NP cells. An MAPK inhibitor inhibited the expression of HIF-1α and pERK, as well as cell proliferation in a dose-dependent manner. Similarly, inhibiting the PI3K/Akt and STAT3 pathways also decreased the expression of HIF-1α and cell proliferation. These results show that under hypoxic conditions, HGF promotes NP cell proliferation via HIF-1α-, MAPK-, PI3K/Akt-, and STAT3-mediated signaling which is involved in this pathway. The control of these signaling pathways may be a target for potential therapeutic strategies for the treatment of disc degeneration in hypoxic conditions.

Foot orthosis treatment improves physical activity but not muscle quantity in patients with concurrent rheumatoid arthritis and sarcopenia.

OBJECTIVES: Foot impairment in rheumatoid arthritis (RA) may exacerbate sarcopenia from physical inactivity because of foot pain while walking. The present study aimed to investigate the prevalence of sarcopenia in patients with RA-associated foot impairment, and whether treatment with a foot orthosis improved physical activity and muscle quantity. METHODS: Thirty-two patients with RA were diagnosed as sarcopenic or nonsarcopenic, and the prevalence of sarcopenia was determined. Eleven patients with sarcopenia were treated with a foot orthosis. The following parameters were compared between baseline and after 6 months of treatment: physical activity (walking, moderate-intensity activity, and vigorous-intensity activity), foot pain while walking, Health Assessment Questionnaire (HAQ) score, and body composition parameters, including muscle quantity. RESULTS: Sarcopenia was present in 25/32 patients (78.1%). The use of a foot orthosis improved walking activity (p = .02), foot pain while walking (p = .02), and HAQ score (p = .02). However, there were no significant changes in moderate- or vigorous-intensity activities or body composition parameters, including muscle quantity. CONCLUSION: Patients with RA-associated foot impairment had a high rate of sarcopenia. Treatment with a foot orthosis increases light-intensity physical activity such as walking, but does not enhance moderate-to-vigorous-intensity activities or increase muscle quantity.

Revascularization to the bone tunnel wall after anterior cruciate ligament reconstruction may relate to the distance from the vessels.

PURPOSE: We use magnetic resonance angiography to evaluate the difference of vascular ingrowth to the bone tunnel on the anterior and posterior walls quantitatively after anterior cruciate ligament reconstruction. MATERIALS AND METHODS: One hundred patients underwent anterior cruciate ligament reconstruction with multi-stranded semitendinosus tendons. They were retrospectively divided into those who underwent magnetic resonance angiography 2, 3, 4 to 6, and ≥ 7 months after surgery. The mean signal-to-noise ratios of the bone tunnel walls in the femur and tibia from the digital data were measured and compared for the anterior and posterior walls. RESULTS: The signal-to-noise ratio of the posterior wall of the femoral bone tunnel was significantly higher than that of the anterior wall in each group. On the tibial side, the signal-to-noise ratio of the anterior wall was significantly higher than that of the posterior wall at ≥4 months after surgery. CONCLUSIONS: This study showed that the blood flow after anterior cruciate ligament reconstruction to the femoral bone tunnel is maintained from the posterior wall, and is maintained to the tibial side from the anterior wall 4 months postoperatively. Revascularization to the bone tunnel wall after anterior cruciate ligament reconstruction may relate to the distance from the vessels.

Relationship of alignment in the lower extremity with early degeneration of articular cartilage after resection of the medial meniscus: Quantitative analysis using T2 mapping.

The objective of this study was to examine the relationship between cartilage degeneration early after partial medial meniscectomy and abnormal alignment in the lower extremity.The subjects were 34 patients (37 knees) with medial meniscal tear who underwent arthroscopic partial meniscectomy. MRI was performed before and 6 months after surgery. T2 mapping images in sagittal sections of medial femoral condyle were produced and 10 regions of interest were set at intervals of 10° in the articular cartilage in the femur. Subjects with an increase in T2 of ≥6% at a flexion angle of 30° were assigned to the degeneration group. Patient background, hip-knee-ankle (HKA) angle, and total resection of meniscal segments were compared between this group and the other patients to identify factors involved in degeneration of articular cartilage.T2 values 6 months after surgery in 3 ROIs at flexion angles of 30° to 50° were significantly longer than those before surgery. The preoperative HKA angle was significantly higher in the degeneration group. T2 values in articular cartilage of the femoral condyle increased earlier after meniscectomy with abnormal alignment in the lower extremity.Meniscectomy in cases with abnormal alignment may have a risk of early onset of osteoarthritis.Level of evidence: Level IV.