Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome.

Previous history of medial tibial stress syndrome (MTSS) is a risk factor for MTSS relapse, which suggests that there might be some physical factors that are related to MTSS development in runners with a history of MTSS. The relationship between MTSS and muscle stiffness can be assessed in a cross-sectional study that measures muscle stiffness in subjects with a history of MTSS, who do not have pain at the time of measurement, and in those without a history of MTSS. The purpose of this study was to compare the shear elastic modulus, which is an index of muscle stiffness, of all posterior lower leg muscles of subjects with a history of MTSS and those with no history and investigate which muscles could be related to MTSS. Twenty-four male collegiate runners (age, 20.0±1.7 years; height, 172.7±4.8 cm; weight, 57.3±3.7 kg) participated in this study; 14 had a history of MTSS, and 10 did not. The shear elastic moduli of the lateral gastrocnemius, medial gastrocnemius, soleus, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus, and tibialis posterior were measured using shear wave elastography. The shear elastic moduli of the flexor digitorum longus and tibialis posterior were significantly higher in subjects with a history of MTSS than in those with no history. However, there was no significant difference in the shear elastic moduli of other muscles. The results of this study suggest that flexor digitorum longus and tibialis posterior stiffness could be related to MTSS.

Sagittal alignment and mobility of the thoracolumbar spine are associated with radiographic progression of secondary hip osteoarthritis.

OBJECTIVE: To identify predictors of radiographic progression of hip osteoarthritis (OA) over 12 months among functional hip impairments and spinal alignment and mobility. DESIGN: Fifty female patients with secondary hip OA, excluding those with end-stage hip OA, participated in this prospective cohort study. Joint space width (JSW) of the hip was measured at baseline and 12 months later. With radiographic progression of hip OA over 12 months (>0.5 mm in JSW) as dependent variable, logistic regression analyses were performed to identify predictors for hip OA progression among functional impairments of the hip and spine with and without adjustment for age, body mass index (BMI), and minimum JSW at baseline. The independent variables were hip pain, Harris hip score (HHS), hip morphological parameters, hip passive range of motion (ROM) and muscle strength, and alignment and mobility of the thoracolumbar spine at baseline. RESULTS: Twenty-one (42.0%) patients demonstrated radiographic progression of hip OA. Multivariable logistic regression analysis showed that larger anterior inclination of the spine in standing position (adjusted OR [95% CI], 1.37 [1.04-1.80]; P = 0.028) and less thoracolumbar spine mobility (adjusted OR [95% CI], 0.96 [0.92-0.99]; P = 0.037) at baseline were statistically significantly associated with radiographic progression of hip OA, even after adjustment for age, BMI, and minimum JSW. CONCLUSIONS: The findings suggest that spinal alignment and mobility should be considered when assessing risk and designing preventive intervention for radiographic progression of secondary hip OA.

Daily cumulative hip moment is associated with radiographic progression of secondary hip osteoarthritis.

OBJECTIVE: To investigate whether higher daily cumulative hip moment at baseline is associated with subsequent radiographic progression of hip osteoarthritis (OA) over 12 months. DESIGN: Fifty patients with secondary hip OA, excluding patients with end-stage hip OA, participated in this prospective cohort study. Joint space width (JSW) of the hip was measured at baseline and 12 months later. With radiographic progression of hip OA (>0.5 mm/year in JSW) as dependent variable (yes/no), univariable and multivariable logistic regression analyses were performed to assess the association between load-related parameters during gait (i.e., peak hip moment, hip moment impulse, and daily cumulative hip moment [product of hip moment impulse and mean steps/day]) and hip OA progression with and without adjustment for age, body weight, and minimum JSW. RESULTS: Of the 50 patients (47.4 ± 10.7 years old), 21 (42.0%) were classified into the progression group. The higher daily cumulative hip moment in the frontal plane at baseline was statistically significantly associated with radiographic progression of hip OA (adjusted odds ratio (OR) [95% confidence interval (CI)], 1.34 [1.06-1.70]; P = 0.013). The higher daily cumulative hip moment in the sagittal plane was also approaching significance in its association with hip OA progression (adjusted OR, 1.80 [0.99-3.26]; P = 0.052). CONCLUSIONS: In the female patients with secondary hip OA, higher daily cumulative hip moment, particularly in the frontal plane, was a predictor of radiographic progression of hip OA over 12 months. Reduction in daily cumulative hip moment by modification in gait and physical activity may potentially slow hip OA progression.

Functional performance of female patients more than 6 months after total hip arthroplasty shows greater improvement with weight-bearing exercise than with non-weight-bearing exercise. Randomized controlled trial.

BACKGROUND: Impaired functional performance and decreased muscle strength and muscle atrophy generally persist for a long period after total hip arthroplasty (THA). AIM: To investigate the effects of weight-bearing (WB) and non-weight-bearing (NWB) exercises on functional performance, Harris hip score (HHS), muscle strength and muscle thickness in women after THA. DESIGN: A randomised, controlled trial. SETTING: Community. POPULATION: Sixty-five women who had undergone unilateral or bilateral THA at least 6 months before enrolment in the study. METHODS: Participants were randomly allocated to the following groups: WB (n = 22), NWB (n = 21) and control (n = 22) groups. Participants in the WB and NWB groups performed daily home exercise programs for 8 weeks. Functional performance (timed up and go, sit-to-stand, stair climbing, walking speed and 3-min walk test), HHS, isometric muscle strength of the hip and knee muscle and gluteus and quadriceps muscle thickness were measured at baseline and after 8 weeks. RESULTS: An intention-to-treat analysis revealed that both the intervention groups exhibited significant improvements in almost all functional performance measures compared with the control group. Furthermore, the WB group showed significantly greater pre-post changes in the sit-to-stand and 3-min walk test compared with the NWB group. In terms of HHS, only the WB group showed significantly greater improvement compared with the control group. Relative to the control group, improvements in all isometric strength measures were observed in both the intervention groups. Significant improvement in quadriceps muscle thickness was observed in the WB group compared with the control group. However, no significant difference was observed among the three groups in pre-post changes in gluteus muscle thickness. CONCLUSION: WB and NWB home exercise programs were both effective for improving functional performance and muscle strength in women after THA. However, the WB exercise was more effective than the NWB exercise for improving sit-to-stand ability and walking endurance. CLINICAL REHABILITATION IMPACT: In this study, we demonstrated that the WB exercise was more effective than the NWB exercise for improving functional performance in patients after THA.

Development of multichannel array transducer of displacement mechanical-myogram.

The myoelectric signal (EMG) recorded on the skin surface is a time-related and spatial aggregate of the action potentials of motor units of skeletal muscle, and it indicates the input information for muscle contraction. The mechano-myographic signal (MMG) is a vibration of skin/muscle surface caused by muscle contraction and it directly reflects the activity of muscle contraction. The two-dimensional generation mechanism of MMG is still n ot clarified in detail. In this study, the displacement MMGs were recorded at 25 measuring points using 5 × 5 displacement MMG array transducer within 50× 50 mm, while the motor point of the biceps brachii was electro-stimulated. The spatial propagation map of twitch waveform of displacement MMG was drawn.

Characteristics of flexed knee gait and functional outcome of a patient who underwent knee reconstruction with a hingeless prosthesis for bone tumor resection: a case report with gait analysis and comparison with healthy subjects.

We report on a patient after knee reconstruction for osteosarcoma in the distal femur using a hingeless prosthesis K-MAX KNEE system K-5 who walked without ipsilateral knee extension in the latter half of the stance phase (flexed knee gait). We evaluated the patient using three-dimensional gait analysis and isokinetic knee strength measurement, and compared the patient with five healthy subjects. The Musculoskeletal Tumor Society (MSTS) score was also used for evaluation. The patient kept his operated knee flexed during mid stance. The maximal ankle plantarflexion internal moment was lower on the ipsilateral side than on the contralateral side, and lower than in the healthy subjects. The negative ankle power during the stance phase was generally stronger on the ipsilateral side than on the contralateral side, and also in the healthy subjects. Unusual contralateral hip flexion occurred after the initial contact, indicating increased joint load on the ipsilateral ankle and the contralateral hip. The ratios of the peak knee extension/flexion torque were 0.7 on the ipsilateral side, 1.9 on the contralateral side, and 1.7 in the healthy subjects. The MSTS score of the patient was 23/30 (76.6%). Flexed knee gait might account for the reduction of ipsilateral hip flexion and ankle plantarflexion moment during the late stance phase. These results suggest the importance of focusing more on the ipsilateral ankle joint and the contralateral hip joint to maintain the function of the entire limb joints of the patients with flexed knee gait.

Characteristics of flexed knee gait and functional outcome of a patient who underwent knee reconstruction with a hingeless prosthesis for bone tumor resection: a case report with gait analysis and comparison with healthy subjects.

We report on a patient after knee reconstruction for osteosarcoma in the distal femur using a hingeless prosthesis K-MAX KNEE system K-5 who walked without ipsilateral knee extension in the latter half of the stance phase (flexed knee gait). We evaluated the patient using three-dimensional gait analysis and isokinetic knee strength measurement, and compared the patient with five healthy subjects. The Musculoskeletal Tumor Society (MSTS) score was also used for evaluation. The patient kept his operated knee flexed during mid stance. The maximal ankle plantarflexion internal moment was lower on the ipsilateral side than on the contralateral side, and lower than in the healthy subjects. The negative ankle power during the stance phase was generally stronger on the ipsilateral side than on the contralateral side, and also in the healthy subjects. Unusual contralateral hip flexion occurred after the initial contact, indicating increased joint load on the ipsilateral ankle and the contralateral hip. The ratios of the peak knee extension/flexion torque were 0.7 on the ipsilateral side, 1.9 on the contralateral side, and 1.7 in the healthy subjects. The MSTS score of the patient was 23/30 (76.6%). Flexed knee gait might account for the reduction of ipsilateral hip flexion and ankle plantarflexion moment during the late stance phase. These results suggest the importance of focusing more on the ipsilateral ankle joint and the contralateral hip joint to maintain the function of the entire limb joints of the patients with flexed knee gait.

Influence of whipping temperature on the whipping properties and rheological characteristics of whipped cream.

The effects of whipping temperature (5 to 15 degrees C) on the whipping (whipping time and overrun) and rheological properties of whipped cream were studied. Fat globule aggregation (aggregation ratio of fat globules and serum viscosity) and air bubble factors (overrun, diameter, and surface area) were measured to investigate the mechanism of whipping. Whipping time, overrun, and bubble diameters decreased with increasing temperature, with the exception of bubble size at 15 degrees C. The aggregation ratio of fat globules tended to increase with increasing temperature. Changes in hardness and bubble size during storage were relatively small at higher temperatures (12.5 and 15 degrees C). Changes in overrun during storage were relatively small in the middle temperature range (7.5 to 12.5 degrees C). From the results, the temperature range of 7.5 to 12.5 degrees C is recommended for making whipped creams with a good texture, and a specific temperature should be decided when taking into account the preferred overrun. The correlation between the whipped cream strain hardness and serum viscosity was high (R(2)=0.906) and persisted throughout the temperature range tested (5 to 15 degrees C). A similar result was obtained at a different whipping speed (140 rpm). The multiple regression analysis in the range of 5 to 12.5 degrees C indicated a high correlation (R(2)=0.946) in which a dependent variable was the storage modulus of whipped cream and independent variables were bubble surface area and serum viscosity. Therefore, fat aggregation and air bubble properties are important factors in the development of cream hardness. The results of this study suggest that whipping temperature influences fat globule aggregation and the properties of air bubbles in whipped cream, which alters its rheological properties.

Modeling of the effect of freezer conditions on the hardness of ice cream using response surface methodology.

The effect of conventional continuous freezer parameters [mix flow (L/h), overrun (%), drawing temperature ( degrees C), cylinder pressure (kPa), and dasher speed (rpm)] on the hardness of ice cream under varying measured temperatures (-5, -10, and -15 degrees C) was investigated systematically using response surface methodology (central composite face-centered design), and the relationships were expressed as statistical models. The range (maximum and minimum values) of each freezer parameter was set according to the actual capability of the conventional freezer and applicability to the manufacturing process. Hardness was measured using a penetrometer. These models showed that overrun and drawing temperature had significant effects on hardness. The models can be used to optimize freezer conditions to make ice cream of the least possible hardness under the highest overrun (120%) and a drawing temperature of approximately -5.5 degrees C (slightly warmer than the lowest drawing temperature of -6.5 degrees C) within the range of this study. With reference to the structural elements of the ice cream, we suggest that the volume of overrun and ice crystal content, ice crystal size, and fat globule destabilization affect the hardness of ice cream. In addition, the combination of a simple instrumental parameter and response surface methodology allows us to show the relation between freezer conditions and one of the most important properties-hardness-visually and quantitatively on the practical level.

Modeling of the effect of freezer conditions on the principal constituent parameters of ice cream by using response surface methodology.

A systematic analysis was carried out by using response surface methodology to create a quantitative model of the synergistic effects of conditions in a continuous freezer [mix flow rate (L/h), overrun (%), cylinder pressure (kPa), drawing temperature ( degrees C), and dasher speed (rpm)] on the principal constituent parameters of ice cream [rate of fat destabilization (%), mean air cell diameter (mum), and mean ice crystal diameter (mum)]. A central composite face-centered design was used for this study. Thirty-one combinations of the 5 above-mentioned freezer conditions were designed (including replicates at the center point), and ice cream samples were manufactured and examined in a continuous freezer under the selected conditions. The responses were the 3 variables given above. A quadratic model was constructed, with the freezer conditions as the independent variables and the ice cream characteristics as the dependent variables. The coefficients of determination (R(2)) were greater than 0.9 for all 3 responses, but Q(2), the index used here for the capability of the model for predicting future observed values of the responses, was negative for both the mean ice crystal diameter and the mean air cell diameter. Therefore, pruned models were constructed by removing terms that had contributed little to the prediction in the original model and by refitting the regression model. It was demonstrated that these pruned models provided good fits to the data in terms of R(2), Q(2), and ANOVA. The effects of freezer conditions were expressed quantitatively in terms of the 3 responses. The drawing temperature ( degrees C) was found to have a greater effect on ice cream characteristics than any of the other factors.

Chemotherapy induces or increases expression of multidrug resistance-associated protein in malignant melanoma cells.

BACKGROUND: Human malignant melanoma is notoriously resistant to chemotherapeutic agents. Melanoma-derived cell lines are often markedly chemoresistant, suggesting that cellular mechanisms mediate generation of the multidrug resistance (MDR) phenotype. This phenotype is often due to P-glycoprotein (Pgp) and the MDR-associated protein (MRP), which are drug transporter proteins associated with resistance to a broad spectrum of lipophilic drugs. OBJECTIVES: To determine the relationships between the expression of the MDR gene MDR-1 (the product of which is Pgp) or the MRP gene, and clinical chemoresistance of malignant melanoma. METHODS: We examined changes in the expression of MDR-1 and MRP genes at the mRNA level before and after chemotherapy by reverse transcription-polymerase chain reaction (RT-PCR) analysis using formalin-fixed, paraffin-embedded sections of 18 specimens taken from eight melanoma patients. mRNA expression of the MDR-1 and MRP gene-specific PCR products was quantitatively determined by densitometry and compared with that of an internal standard (beta-actin). RESULTS: Five of seven primary melanomas were found to express the MRP gene to a certain extent even before chemotherapy. After first and second courses of chemotherapy, six patients had an increased ratio of MRP mRNA to beta-actin mRNA compared with the prechemotherapy levels in the same patients. None of the cases of melanoma expressed MDR-1. CONCLUSIONS: These results suggest that a significant mRNA level of MRP gene was intrinsically present in malignant melanoma even before exposure to chemotherapeutic drugs and increased in its expression after chemotherapy, suggesting that MRP plays a part in increasing the chemoresistance of malignant melanoma during chemotherapy.

Loss of heterozygosity of adenomatous polyposis coli gene in cutaneous tumors as determined by using polymerase chain reaction and paraffin section preparations.

It has been suggested that an alteration in the adenomatous polyposis coli (APC) gene, which is a tumor suppressor gene, is one of the earlier events in carcinogenesis of some adenocarcinomas. We undertook this study to determine the prevalence of loss of heterozygosity (LOH) of the APC gene in several kinds of cutaneous tumors. Fifty-seven unrelated Japanese patients were examined for analysis of the APC gene. The 57 cases consisted of extramammary Paget's disease, squamous cell carcinoma (SCC), eccrine poroma and porocarcinoma, metastatic tumor of rectal adenocarcinoma and malignant melanoma. DNA was extracted from the tumor and normal portions dissected from the formalin-fixed paraffin-embedding sections and amplified with the use of the PCR. The amplified DNA was examined for LOH in the APC gene. Seven samples of 32 heterozygous persons of APC gene (three out of seven eccrine poromas, two eccrine porocarcinomas and two metastatic tumors of rectal adenocarcinoma) showed for LOH in the APC gene. None of the heterozygous samples from the extramammary Paget's disease (11), SCC (five) and melanoma (five) showed LOH. These results suggest that tumor or tumor suppressor genes, other than the APC gene, may be responsible for extramammary Paget's disease and SCC and that LOH involving APC may have some relevance to the formation and progression of eccrine tumors as in rectal tumors.

Prevalence of normal-tension glaucoma and primary open-angle glaucoma in patients with collagen diseases.

PURPOSE: To investigate the prevalence of normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) in patients with collagen diseases and determine whether an immunocompromised condition is present in a subset of glaucoma patients. METHODS: Three glaucoma specialists prospectively examined patients with collagen diseases. The diagnostic process included applanation tonometry, slit-lamp examination, gonioscopy, direct ophthalmoscopy, and automated static perimetry. Twenty-four-hour intraocular pressure monitoring was done when necessary. Using the results of a population-based survey conducted in Japan, we calculated an expected number of cases of NTG and POAG, and compared these with the actual number of cases. RESULTS: Of the 153 patients with collagen diseases examined, we found 6 patients with NTG and 2 patients with POAG. Of these 8 patients, 2 with progressive systemic sclerosis (PSS), one with NTG, and the other, POAG, had a history of being on systemic steroidal therapy. The prevalence of NTG and POAG was significantly higher in women patients having collagen diseases as compared with normal women (P = .027). CONCLUSION: Women patients with collagen diseases are highly susceptible to NTG and POAG.

Evaluation of functional deficits determined by four different hop tests in patients with anterior cruciate ligament deficiency.

The purpose of this study was to analyze the validity of the newly designed functional ability test (FAT) for the normal population and patients with deficiency of the anterior cruciate ligament (ACL). The FAT consists of four tests: the figure-of-eight hop, the up-down hop, the side hop, and the single hop. Sixty control subjects and 50 patients with unilateral ACL deficiency were tested. In the control group, the values measured were significantly different between males and females in all of the tests. On the other hand, when left/right difference values were compared, no significant difference was found between males and females in any of the tests. More than 95% of control group exhibited symmetrical function in each part of the FAT, whereas in the ACL-deficient group, the percentage of patients who showed abnormal symmetry was 68% in the figure-of-eight hop, 58% in the up-down hop, 44% in the side hop, and 42% in the single hop. The percentage of ACL-deficient patients with functional asymmetry in at least one of the four tests was 82%. The FAT was found to be useful in evaluating lower limb function in ACL-deficient patients.

The effect of electrical acupuncture-stimulation therapy using thermography and plasma endothelin (ET-1) levels in patients with progressive systemic sclerosis (PSS).

In all 11 patients with progressive systemic sclerosis (PSS; Barnett type I, 2; type II, 5; type III, 4 cases; male 1; female 10 cases; 45.2 +/- 10.2 years-old), 6 cases of scleroderma spectrum disorders (SSD, male 1; female 5 cases; 51.2 +/- 13.2 years-old) and 7 healthy controls (HC, male 1; female 6 cases; 43.1 +/- 8.4 years-old) were entered to be examined. The plasma endothelin-1 (ET-1) levels of PSS, SSD and HC were 1.98 +/- 0.69, 1.76 +/- 0.39 and 1.15 +/- 0.38 pg/ml, respectively. After the stimulation with the low frequency electrical current, electrical acupuncture, for unilateral side of hand/arm (30 min), the plasma ET-1 levels decreased in 10 cases of PSS treated (1.61 +/- 0.45 pg/ml), but no change of plasma serotonin levels. In 4 of 6 cases of SSD, plasma ET-1 levels increased (2.06 +/- 0.39 pg/ml), however, nitrate levels increased and serotonin decreased in 3 of 5 cases of SSD. In 6 cases of HC treated with the electrical acupuncture, the plasma ET-1 levels increased (1.72 +/- 0.58 pg/ml). Thermographically, 9 of 11 cases of PSS and 5 of 6 cases of SSD showed temporally temperature-elevation of hand/fingers not only in treated sides, but also in non treated sides, although none of 7 HC showed temperature-elevation of hands/fingers. The decrease in plasma ET-1 levels due to the electrical acupuncture was thought to induce the vasodilatation and elevate the surface temperature in patients with PSS. These results will provide an excellent basis to study the efficacy of electrical acupunctural stimulation.

A case of AIDS manifesting pruritic papular eruptions and psoriasiform lesions: an immunohistochemical study of the lesional dermal infiltrates.

A 63-year-old man was referred to our department on September 14, 1992, because of multiple red papules with severe itching. Pruritic papular eruption (PPE) in a human immunodeficiency virus (HIV)-infected patient was diagnosed based on the histological findings, the reduction in CD4, and positive results for HIV antibody. In September of 1993, papules and erythematous plaques with scales appeared on both the palms and soles. The erythema was pruritic and spread gradually to the extremities and trunk. These plaques with erythema and scales are similar to those of the psoriatic lesions seen in Reiter's syndrome, although the HLA typing was not B27. Immunohistopathological findings of the papules of PPE and plaques of psoriasiform lesions showed that perivascularly infiltrated cells in the dermis were mostly lymphocytes. The lymphocytes in PPE were positive for CD45 and negative for CD3, CD43, and CD45RO, but the lymphocytes in psoriasiform lesions were positive for CD45, CD3, and CD43. Moreover, 20-30% of these lymphocytes were also intensely positive for CD45RO. These observations were similar to those obtained in the lesional skin of HIV-negative psoriasis, suggesting that there were no significant immunohistopathological differences in the abnormality of local cellular immunity related to the formation of psoriasiform lesions in HIV-negative psoriasis and HIV-positive psoriasis.

Weakness of thigh muscles in individuals sustaining anterior cruciate ligament injury.

The purpose of this study was to assess the quadriceps and hamstrings muscle strength deficits at different knee flexion angles (30 degrees and 60 degrees) in individuals who had sustained anterior cruciate ligament (ACL) injury, who had never had thigh muscle strengthening exercise. Isometric (0 degree/sec) and isokinetic (60 degrees/sec and 180 degrees/sec) torque measurements were performed on sixty-six patients (29 males and 37 females) with chronic ACL insufficiency. Significant strength deficits of the quadriceps and hamstrings muscles in injured knees were found at both 30 degrees and 60 degrees of knee flexion in three testing conditions (0 degree/sec, 60 degrees/sec, and 180 degrees/sec). In the comparison of torque production at 30 degrees and 60 degrees knee flexion angles, for the male group, significantly greater deficits of the quadriceps torque were found at 60 degrees knee flexion than at 30 degrees knee flexion in the isometric and isokinetic 60 degrees/sec testing modes. For the female group, significantly greater deficit of the quadriceps torque was found at 60 degrees knee flexion than at 30 degrees knee flexion only in isokinetic 60 degrees/sec. There was no significant difference of the hamstrings torque deficit between 30 degrees and 60 degrees knee flexion in any testing modes. In the comparison of isometric and two isokinetic testing modes (60 degrees/sec and 180 degrees/sec), for the male group, significantly greater deficits of the quadriceps torque were found at 30 degrees knee flexion in isokinetic 180 degrees/sec and at 60 degrees knee flexion in isokinetic 60 degrees/sec as compared to the isometric test. There was no statistical difference in the hamstrings torque values. For the female group, significantly greater deficits of the quadriceps and hamstrings torque were found at 30 degrees knee flexion in isokinetic 60 degrees/sec and at 60 degrees in isokinetic 60 degrees/sec and 180 degrees/sec as compared to the isometric test. It was concluded that long lasting instability without any muscle exercises may result in the weakness of not only the quadriceps muscle but also even hamstrings muscle, and that the quadriceps strength might be more susceptible to ACL insufficiency at 60 degrees knee flexion angle than at 30 degrees knee flexion angle, whereas, the hamstrings did not show any angular-specific torque deficits. These findings might resulted from characteristics of torque-curves of the quadriceps and hamstrings muscles.(ABSTRACT TRUNCATED AT 400 WORDS)