Kinematic analysis of upper limb coordination during a multi-directional reaching task: specific examination of shoulder girdle movement.

[Purpose] This study was conducted to show the directional specificity of a reaching motion and to verify the three-joint coordination of the sternoclavicular joint, shoulder joint, and elbow joint. [Participants and Methods] The participants in this study were 10 healthy adult males. A reaching task for the upper limbs in a horizontal plane was assessed and measured. The trajectory, joint angle, and joint range of motion were calculated using a three-dimensional motion analyzer. [Results] The joint angle changes of the three joints were related in a circular radiation pattern. The sternoclavicular joint and shoulder joint were related in a fan-shaped radiation pattern. On the other hand, the sternoclavicular joint and elbow joint were related in a linear functional relation except for T3 and T8. [Conclusion] The results suggest that the coordinated motion of the shoulder joint and elbow joint controls the direction and extent of the motion track, while the coordinated motion of the sternoclavicular joint and elbow joint finely regulates the track. There also is a degree of difficulty in motion depending on the direction, which is apparently defined by a combination of joint motions.

Treatment of post-operative infected nonunion distal radius fracture using the Darrach procedure and radioscapholunate fusion with volar locking plate.

There is no established standard treatment for post-operative infected nonunion distal radius fracture with severe damage to the joint surface. Herein, we report a case of post-operative infected nonunion distal radius fracture with severe articular damage, which was treated using a combination of the Darrach procedure and radioscapholunate fusion with a volar locking plate after implant removal and antibiotic treatment. A 61-year-old man underwent internal fixation with a volar locking plate for a distal radius fracture. Repeated post-operative infections caused distal radius nonunion, a bone defect in the lunate fossa of the radius, subluxation of the carpal bones on the palmar and ulnar sides, and significant limitation of rotation. Implant removal and wound debridement were performed to control infection. After oral antibiotic treatment, the Darrach procedure and radioscapholunate fusion with a volar locking plate combined with ulnar head bone grafting were performed. The patient was able to perform his activities of daily living without any problems after the two-stage surgery. This is the first report describing the treatment of post-operative infected nonunion distal radius fracture with severe damage to the radiocarpal and distal radioulnar joints.

Frozen vein wrapping for chronic nerve constriction injury reduces sciatic nerve allodynia in a rat model.

BACKGROUND: Autologous vein wrapping (VW) is used in the treatment of recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, use of autologous veins is limited by the inability to obtain longer veins of sufficient length for larger sites. Frozen allograft tissue has several advantages, including its availability for large grafts, avoidance of donor-site morbidity, and shorter operation time. Here, we investigated the effect of frozen vein wrapping (FVW) in Wistar rats as a model of sciatic nerve injury. RESULTS: The rats were grouped by treatment as (i) untreated after chronic constriction injury surgery (CCI; control group), (ii) treated with vein wrapping using freshly isolated vein (VW), and (iii) treated with vein wrapping using frozen vein (FVW). Mechanical allodynia was assessed with von Frey filaments on postoperative days (PODs) 1, 3, 5, 7, and 14. Gene expression of HO-1 was evaluated by quantitative polymerase chain reaction (qPCR). The response of heme oxygenase-1 gene, Hmox-1, expression to VW and FVW was assessed by RT-PCR. Both VW and FVW significantly increased withdrawal threshold levels compared to the untreated control group on POD 1, 3, and 5. Both VW and FVW also showed increased HO-1 expression compared to the CCI group. CONCLUSIONS: FVW increased the withdrawal threshold similar to VW in a rat CCI model for short periods. Frozen vein wrapping using vein allograft without donor site morbidity may be an alternative therapeutic option.

Hybrid surface measuring system for motion-blur compensation and focus adjustment using a deformable mirror.

The recent growth in automation and microfabrication has led to a need for faster, more accurate inspections. This in turn requires fast and accurate image capture methods. A system has previously been proposed to obtain images without motion blur by controlling the line of sight to follow a moving object with a mirror, thereby decreasing inspection time. However, as this system follows only the line of sight, it corresponds only to the plane parallel to the direction of movement. Here, we propose a system for measuring non-planar surfaces by simultaneously controlling the line of sight and focus using a deformable mirror. In addition, the proposed system requires only one deformable mirror, whereas those from previous studies require multiple devices to control the line of sight and focus. Therefore, our proposed system can be downsized and applied to various measurement systems. We tested our system by measuring surface images of objects with curved and uneven surfaces under movement at 20 mm/s, at a distance of about 140 mm in front of the mirror. The system successfully obtained motion-blur-free, all-in-focus images. Moreover, we validated the effectiveness of the proposed system by comparing the captured images to those obtained using existing methods.

Pulmonary Function Improves in Patients with Adolescent Idiopathic Scoliosis who Undergo Posterior Spinal Fusion Regardless of Thoracoplasty: A Mid-Term Follow-Up.

INTRODUCTION: The purpose of the present study was to determine, in a mid-term follow-up 5 years or more after surgery, the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and expiratory flow in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) with or without thoracoplasty. METHODS: The subjects were 134 patients with AIS who underwent PSF between 2004 and 2013. Forty-five patients agreed to participate in the study. We divided the patients into two groups as follows: 24 patients who underwent PSF with thoracoplasty from 2004 to 2010 in the TP group and 21 patients who underwent PSF without thoracoplasty from 2011 to 2013 in the non-TP group. We evaluated whole spine X-ray imaging and pulmonary function tests (PFTs) in these patients. PFTs measured FVC, FEV1, peak expiratory flow (PEF), maximum expiratory flow at 50% FVC (V50), maximum expiratory flow at 25% FVC (V25), and the ratio of V50 to V25 (V50/V25). RESULTS: The main thoracic curves were 53.6 ± 10.1° before surgery, 19.8 ± 7.6° 1 week after surgery, 22.3 ± 8.3° 2 years after surgery, and 23.3 ± 7.6° at the most recent observation. Compared with preoperative values, FVC, FEV1, and % FEV1 were improved significantly at the most recent observation. No significant difference was observed between % FVC before surgery and at the most recent observation. Compared with preoperative values, PEF, V50, and V25 were improved significantly at the most recent observation. V50/V25 did not change significantly. The changes in PFT values in the TP group and the non-TP group were compared. No significant differences were observed in FVC, % FVC, FEV1, % FEV1, PEF, V50, or V25. CONCLUSIONS: Regardless of whether thoracoplasty was performed or not, FVC, FEV1, and expiratory flow were improved 5 years or later after PSF.

Prophylactic efficacy of enteral antifungal administration of miconazole for intestinal perforation, especially for necrotizing enterocolitis: a historical cohort study at a single institution.

PURPOSE: Despite improvements in neonatal intensive care, the outcomes of extremely-low-birth-weight infants (ELBWIs) with surgical diseases remain to be improved. We started administering enteral miconazole (MCZ) to ELBWIs from 2002 to prevent fungal infection. Since then, the incidence of intestinal perforation has significantly decreased. We investigated this prophylactic effect of MCZ against necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) and explored a new prophylactic concept against intestinal perforation. METHODS: We designed a historical cohort study to evaluate the effect of MCZ for intestinal perforation in ELBWIs who underwent treatment in our neonatal intensive-care unit between January 1998 and December 2005. We divided these cases into two groups: the Pre-MCZ group and the Post-MCZ group. We compared the morbidity, clinical outcomes and pathological features of NEC and FIP. RESULTS: The rate of intestinal perforation with NEC was significantly reduced after the introduction of MCZ (p = 0.007, odds ratio; 3.782, 95% confidence interval; 1.368-12.08). The pathological findings of NEC specimens showed that the accumulation of inflammatory cells was significantly reduced in the Post-MCZ group when compared with the Pre-MCZ group (p < 0.05). CONCLUSIONS: The efficacy of the enteral administration of MCZ on intestinal perforation with NEC highlights a new prophylactic concept in the clinical management of ELBWIs.

Anchor type at upper instrumented vertebra and postoperative shoulder imbalance in patients with Lenke type 1 adolescent idiopathic scoliosis.

PURPOSE: To clarify the impact of anchor type at upper instrumented vertebra (UIV) on postoperative shoulder imbalance in patients with Lenke type 1 adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion. METHODS: Subjects were 81 patients with Lenke type 1 AIS who underwent posterior spinal fusion between 2004 and 2013. Twenty-five patients agreed to participate in the study. We divided the patients into two groups: Hook group (15 patients with hooks at UIV who underwent surgery between 2004 and 2011) and PS group (ten patients with pedicle screws at UIV who underwent surgery between 2012 and 2013). To evaluate shoulder balance, first thoracic vertebra tilt angle (T1 tilt), clavicle angle (CA), and radiographic shoulder height (RSH) were measured. RESULTS: There were no significant differences in preoperative T1 tilt, CA, or RSH between the both groups. The postoperative 1-week, 2-year, and most recently observed T1 tilts were significantly smaller in the Hook group than in the PS group. There were no significant differences in postoperative 1-week, 2-year, and most recently observed CAs between the two groups. Although there were no significant differences in 1-week postoperative RSH between the groups, the 2-year postoperative RSH was significantly smaller in the Hook group than in the PS group. The most recently observed RSH tended to be smaller in the Hook group than in the PS group, but the difference was not significant. CONCLUSIONS: In the PS group, poor shoulder balance remained over the long term. The hooks at UIV adjusted postoperative shoulder balance.

A Rare Case of Chronic Subdural Hematoma Coexisting With Metastatic Tumor.

BACKGROUND: Incidence of chronic subdural hematoma (CSH) associated with metastases of extraneural malignancies is rare. We report a rare case of CSH wherein most of the CSH cavity was occupied with metastatic cancer cells; in addition, we review the literature. CASE DESCRIPTION: A 68-year-old man with a history of gastric cancer presented to our hospital with dysarthria and shoulder paralysis; CSH was diagnosed from preoperative imaging findings. When the hematoma was removed via a small craniotomy, besides the hematoma, we observed an abnormal mass of tissue in the capsule. Pathologically, the mass was consistent with the findings of metastatic gastric cancer. Although the symptoms immediately disappeared postoperatively, a symptomatic acute subdural hematoma with midline shift was observed on postoperative day 27. Emergency craniotomy and hematoma and tumor removal were performed. Pathologic examination showed hemorrhagic necrosis in the tumor, which had not been initially observed. The postoperative course progressed without hematoma recurrence. CONCLUSIONS: To the best of our knowledge, this is the first report of a CSH accompanied by tumor metastasis in most of the CSH cavity. Although rare, if a patient with cancer has CSH, the CSH should be treated considering the possibility of metastasis.

Morphological characteristics of infected subdural hematoma: Comparison with images of chronic subdural hematoma.

OBJECTIVES: Infected subdural hematoma (ISH) is a rare type of subdural empyema, with fewer than 50 cases reported to date. Its radiological features have not been adequately described, making diagnosis challenging. At our institution, two adults presented with ISH, which exhibited a characteristic shape on preoperative imaging. PATIENTS AND METHODS: This study examined ISH cases and chronic subdural hematoma (CSH) cases that underwent surgery at the Ishikawa Prefectural Central Hospital between January 2016 and March 2018. To distinguish ISH from CSH, we focused on three specific radiological features: the biconvex shape of the hematoma, presence of a high-density region at the lower end of the hematoma on plain computed tomography (CT), and presence of a hyper-intense signal within the hematoma on diffusion weighted imaging (DWI). RESULTS: We analyzed 30 ISH (current and previously reported) and 102 CSH cases in our study. We found no statistically significant associations between the hematoma type (ISH or CSH) and the presence of a high-density region at the lower end of the hematoma on plain CT (p = 0.13) or the presence of hyperintensity in the hematoma on DWI (p = 1.00). Conversely, a statistically significant association was found between the hematoma type and the biconvex shape of the hematoma (p < 0.01). CONCLUSION: These results suggest that the shape of the hematoma on imaging provides valuable information that can be used to differentiate ISH from CSH and optimize therapeutic approaches.

Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years.

INTRODUCTION: Despite preserving lumbar disc mobility, spinal sagittal, and/or coronal alignment might ultimately impede surgical success. The purpose of this study was to elucidate the effects of spinal alignment on lumbar disc degeneration after 5 or more years in adolescent idiopathic scoliosis (AIS) patients who underwent spinal fusion. METHODS: Subjects were 49 AIS patients who underwent posterior spinal fusion without lumbar curve fusion. The inclusion criteria were the following: 1) Lenke type 1A, 1B, 2A or 2B, 2) age 10 to 19 years at the time of operation, and 3) minimum 5-year follow-up. The exclusion criteria were the following: 1) diagnosed as other than AIS, 2) history of lumbar disc herniation and spondylolysis, 3) subsequent surgery, and 4) history of surgery before AIS surgery. Nineteen patients agreed to participate in this research. X-rays, lumbar MRI, and questionnaires were evaluated. Disc degeneration in non-fused segments was defined as Pfirrmann grade 3 or higher. Patients with disc degenerations at the final observation (DD[+] group) were compared to those without disc degenerations (DD[-] group). RESULTS: There were no significant differences in the preoperative or postoperative 1-week X-ray parameters between both groups. The lumbar curve was significantly larger in the DD[+] group compared with the DD[-] group at the final observation (DD[+]: 16.8 degrees, DD[-]: 10.4 degrees, p = 0.035). The sagittal vertical axis (SVA) was significantly larger in the DD[+] group compared with the DD[-] group at the final observation (DD[+]: -4.4 mm, DD[-]: -34.3 mm, p = 0.006). SRS-22 function, self-image, and satisfaction scores were lower in the DD [+] group compared with the DD[-] group at the final observation. CONCLUSIONS: The patients with DD had significantly larger lumbar curve and SVA with lower SRS-22 function, self-image, and satisfaction scores at the final observation. Even though the non-fused segments were preserved, spinal alignments of non-fused lumbar curve affect the DDs.

MRI evaluation of dural sac enlargement by interspinous process spacers in patients with lumbar spinal stenosis: Does it play a role in the long term?

BACKGROUND: To investigate dural sac enlargements and spinal alignments in patients who underwent indirect decompression with interspinous spacers. METHODS: The subjects were 20 patients who underwent indirect decompression using an interspinous spacer (X-STOP) without laminectomy. Of these 20 patients, 1 patient underwent implant removal surgery 1 month after X-STOP surgery and two patients dropped out. Ultimately, 17 patients were included in this study. MRI and X-ray images were investigated before surgery, 1 week after surgery, 3 months after surgery, and 2 years after surgery. RESULTS: On MRI, the mean cross-sectional areas of the dural sac were 52.7 mm2 before surgery, 73.2 mm2 1 week after surgery, 62.4 mm2 3 months after surgery, and 58.3 mm2 2 years after surgery. There was a significant 37% increase at 1 week postoperatively compared with that before surgery, but there were no significant differences between 3 months postoperatively and 2 years postoperatively. The disc angle in an extension posture was significantly decreased at 1 week after surgery compared with that before surgery, but there were no significant differences between before surgery, 3 months after surgery, and 2 years after surgery. CONCLUSIONS: The interspinous process spacer increased the dural sac area by 37% 1 week after surgery, but the enlargement was not maintained at 3 months or 2 years after surgery. The use of interspinous process spacers produced an enlargement of the dural sac by limiting extension of the stenotic level only. However, its effect diminished 2 years after surgery.

Thoracic Deformity Correction and Changes of Vital Capacity, Forced Expiratory Volume in 1 Second, and Expiratory Flow in Adolescent Idiopathic Scoliosis Five Years or More after Posterior Spinal Fusion with Thoracoplasty.

INTRODUCTION: The purpose of this study is to investigate thoracic deformity correction and pulmonary function changes in patients with adolescent idiopathic scoliosis (AIS) five years or more after undergoing posterior spinal fusion with thoracoplasty for correction of a thoracic deformity. METHODS: Subjects were 57 patients with AIS who underwent posterior spinal fusion between 2004 and 2010. 24 patients who had undergone thoracoplasty at least five years earlier agreed to participate in this research. X-rays, pulmonary function tests, and thoracic cage computed tomography (CT) were performed, and the Scoliosis Research Society Outcomes Questionnaire (SRS-22) was administered. CT axial images were used at the apex of the main thoracic (MT) curve. Apical vertebral rotation was evaluated using rotation angle to the sagittal plane (RAsag). Thoracic deformities were evaluated using the rib hump index (RHi) and the posterior hemithoracic symmetry ratio (PHSr). RESULTS: There were no significant differences between the preoperative and the final observation forced vital capacity (FVC) or the preoperative and the final observation %FVC. The forced expiratory volume in 1 s (FEV1) and %FEV1 were significantly improved at the final observation: FEV1 (preoperative: 1.88 L, final observation: 2.05 L, p = 0.045) and %FEV1 (preoperative: 57.1%, final observation: 66.2%, p = 0.001). FEV1/FVC was also significantly improved at the final observation (preoperative: 83.0%, final observation: 86.4%, p = 0.019). The peak expiratory flow (PEF) was significantly improved at the final observation (preoperative: 3.67 L/s, final observation: 4.38 L/s, p = 0.029). On the CT assessment for thoracic deformities, there were no significant changes in RAsag or RHi. PHSr was significantly increased at the final observation compared with the preoperative period. CONCLUSIONS: With posterior spinal fusion in combination with thoracoplasty for AIS, although the correction of deformities was limited, the pulmonary function testing demonstrated the preservation of vital capacity (VC) and improvements in the forced expiratory volume in 1 s and expiratory flow.

Hooks at the Upper Instrumented Vertebra Can Adjust Postoperative Shoulder Balance in Patients with Adolescent Idiopathic Scoliosis: 5 Years or More of Follow-up.

Study Design: A retrospective cohort study. Purpose: This study aims to investigate postoperative shoulder imbalance (PSI) ≥5 years postoperatively in patients who underwent posterior spinal fusion using hooks at the upper instrumented vertebra (UIV) for Lenke type 1 adolescent idiopathic scoliosis (AIS). Overview of Literature: Studies have reported PSI due to excessive correction of the main thoracic curve. Methods: We examined 56 patients with AIS who underwent a posterior spinal fusion with hooks at the UIV from 2004 to 2010. Of these, we enrolled 14 patients who underwent surgery, at least, 5 years ago. X-rays and Scoliosis Research Society-22 (SRS-22) questionnaire were administered. To evaluate the shoulder balance, T1 vertebral tilt angle (T1 tilt), clavicle angle, and radiographic shoulder height (RSH) were measured. PSI was considered as the absolute value of the postoperative RSH being ≥20 mm. Based on radiographs obtained immediately postoperatively, we divided patients into two groups as follows: the balanced group (absolute value of RSH <20 mm) and imbalanced group (absolute value of RSH ≥20 mm). Results: The frequency of PSI was 28.6% immediately postoperatively, 0% 2 years postoperatively, and 7.1% at the last follow-up. In the balanced group, PSI did not occur even at 2 years postoperatively or at the last follow-up. In the imbalanced group, PSI was improved in all patients 2 years postoperatively and all patients, except one patient, at the last follow-up. No significant differences were noted in the frequency of distal adding-on at 2 years postoperatively or the last follow-up between the balanced group and the imbalanced group. We observed moderate negative correlations between the absolute value of T1 tilt and the SRS-22 pain and satisfaction at the last follow-up. Conclusions: Hooks at the UIV could adjust the shoulder balance to avoid long-term PSI in patients with AIS.

Wrapping With Basic Fibroblast Growth Factor-Impregnated Collagen Sheet Reduces Rat Sciatic Nerve Allodynia.

Autologous vein wrapping is used to treat recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, its use is restricted due to the inability to obtain sufficiently long veins for larger grafts. We previously reported that vein-derived basic fibroblast growth factor (bFGF) promotes heme oxygenase-1 (HO-1), which reduces allodynia via its anti-inflammatory properties. To mimic vein wrapping, we developed a collagen sheet impregnated with bFGF. Chronic constriction injury (CCI) was induced in male Wistar rats as a model of sciatic nerve injury, and the rats were divided into three groups: (i) untreated after CCI surgery (control group), (ii) treated with a collagen sheet wrap impregnated with phosphate-buffered saline (PBS/CS group), and (iii) treated with a collagen sheet wrap impregnated with bFGF (bFGF/CS group). Pain behavior (von Frey test) was evaluated on postoperative days (PODs) 1, 5, 7, and 14. Quantitative polymerase chain reaction was conducted on sciatic nerve RNA to quantify HO-1 gene, Hmox1, expression. Enzyme-linked immunosorbent assay were used to determine HO-1 protein levels on POD 1. von Frey testing showed significantly greater pain hypersensitivity in the control and PBS/CS groups than the bFGF/CS group. In the bFGF/CS group, Hmox1 messenger RNA and HO-1 protein levels were significantly increased in the sciatic nerve compared with the control and PBS/CS groups on PODs 1 and 5 and POD 1, respectively. The bFGF/CS group showed decreased allodynia and HO-1 induction, as observed with vein wrapping. Therefore, local application of bFGF may be an alternative treatment strategy for compressive neuropathy and peripheral nerve trauma in clinical settings. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2258-2263, 2019.

Enlargement of Langerhans cell histiocytosis of the hypothalamus with progression into the basal ganglia and white matter.

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare disease that may affect the central nervous system; it is caused by dendritic cell proliferation, and typically occurs in children. LCH frequently appears in the pituitary stalk and rarely results in multiple enhanced lesions in the brain parenchyma. CASE DESCRIPTION: We present a case of a 40-year-old woman who deveolped panhypopituitarism and central diabetes insipidus in the postpartum period requiring hormone replacement therapy. At first, magnetic resonance imaging only revealed thickening of the pituitary stalk; while 6 months later, a single enhanced mass lesion was detected in the hypothalamus. Another 5 months later, the lesion had enlarged with appearance of multiple, enhanced satellite lesions in the basal ganglia and white matter. The patient underwent successful craniotomy to obtain a biopsy sample; LCH of the hypothalamus was definitively diagnosis by histopathological examination. Steroids were administrated and resulted in significant reduction of all lesions. CONCLUSIONS: Definitive histopathological diagnosis and subsequent appropriate therapy, such as steroid administration, are required when LCH lesions in the hypothalamus become progressively enlarged and new lesions appear in the brain parenchyma.

Motor coordination during body rotation while standing in healthy participants.

[Purpose] To describe the nature of multi-joint motor coordination during body rotation while in the standing position. [Participants and Methods] The participants were 22 healthy adults with no visual problems or history of diseases that could compromise their ability to execute body rotation. The position facing forward in an upright standing position was defined as 0°, and targets were placed at the following five points on concentric circles: 30°, 60°, 90°, 120°, and 150°. The participants always turned to the right. A three-dimensional motion analyzer consisting of six infrared cameras was used to measure the spatial coordinates of the infrared reflective markers. [Results] A main effect was found for all body segments. For all the target angles, the start of movement was approximately equal, and the angular change of the craniocervical joint was the largest. A nonlinear relationship was observed between the craniocervical and thoracolumbar joints for all target angles. However, a linear relationship was found between the thoracolumbar and pelvic joints. [Conclusion] The results of this study demonstrate that various regions such as the craniocervical and thoracolumbar junctions and the pelvis coordinate during such move to achieve optimal locomotive patterns.

Vein wrapping promotes M2 macrophage polarization in a rat chronic constriction injury model.

Although the therapeutic potential of vein wrapping (VW) for recurrent compressive neuropathy has been widely reported, the mechanisms underlying this technique have not been characterized. M2 macrophages induced by interleukin-4 (IL-4) or interleukin-10 (IL-10) have an anti-inflammatory function and play an important role in peripheral nerve repair. To evaluate whether VW promotes M2 polarization, we divided chronic constriction injury (CCI) rats into untreated and VW (CCI + VW)-treated groups. Pain withdrawal thresholds in both groups were evaluated using von Frey filaments. Expression of the anti-inflammatory cytokines IL-4 and IL-10 in vein and nerve were quantified using real time polymerase chain reaction (RT-PCR), and expression of the anti-inflammatory M2 macrophage markers CD206 and arginase-1 (Arg1) after VW was assessed by RT-PCR and immunohistochemistry. To evaluate the effect of exogenous IL-4 or IL-10 on M2 macrophage-marker expression, CD11b-positive macrophages isolated from sciatic nerve were stimulated with recombinant IL-4 and IL-10. VW significantly increased the pain withdrawal threshold. IL-4 and IL-10 mRNA expression was higher in veins than in the sciatic nerve. VW significantly increased CD206 and Arg1 mRNA expression compared to the CCI group. The number of CD206- and Arg1-immunoreactive cells in nerve bundles was twofold higher in the CCI + VW than CCI group. Application of exogenous IL-4 doubled CD206 and Arg1 mRNA expression in CD11b-positive macrophages. These results show that vein-derived IL-4 potentiates the benefit of VW through the activation of M2 macrophages in the sciatic nerve. Our results may help to optimize current procedures for treating recurrent compressive neuropathy. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Vein wrapping facilitates basic fibroblast growth factor-induced heme oxygenase-1 expression following chronic nerve constriction injury.

The clinical efficacy of autologous vein wrapping for recurrent compressive neuropathy has been demonstrated; however, the underlying mechanisms of this technique remain unclear. Rats were divided into chronic constriction injury (CCI) and CCI + vein wrapping (CCI + VW) groups. Mechanical allodynia was evaluated using von Frey filaments. To identify the neuroprotective factors released from veins, basic fibroblast growth factor (bFGF) mRNA expression in veins was compared to that in the sciatic nerve. The response of heme oxygenase-1 (HO-1) expression to vein wrapping was evaluated by RT-PCR and enzyme-linked immunosorbent assays. The effects of exogenous bFGF on HO-1 expression were evaluated using a sciatic nerve cell culture. Vein wrapping significantly increased the withdraw threshold levels compared to the untreated CCI group. bFGF mRNA expression in veins was higher than that in untreated sciatic nerves. HO-1 mRNA expression was induced at higher levels in sciatic nerve cells in the presence of exogenous bFGF compared to untreated control cells. HO-1 mRNA and protein expression in the sciatic nerve were also higher in the CCI + VW group compared with the CCI group. Our results suggest that vein-derived bFGF contributes to the therapeutic benefit of vein wrapping through the induction of HO-1 in the sciatic nerve. Vein wrapping is a useful technique for reducing neuropathic pain. Further understanding of the neurotrophic factors released from veins may help to optimize current procedures for treating recurrent compressive neuropathy and traumatic peripheral nerve injury, and lead to the development of new therapeutic methods using recombinant neurotrophic factors. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:898-905, 2018.

Frequency analysis of the center of pressure in tandem stance in community-dwelling elderly.

[Purpose] The present study aimed to clarify the effects of balance control on the pronation and supination movements of the talocrural joint in community-dwelling elderly women by conducting a frequency analysis of the center of pressure during tandem stance. [Subjects and Methods] The study participants were 18 subjects who maintained tandem stance for 20 s and 11 who had difficulty maintaining tandem stance for 20 s. The frequency-power spectra were computed and classified into three frequency bands. Each power spectral value was divided by the sum of the power spectral values to obtain the %power. [Results] Significant differences in high-frequency band %power value for the center of pressure in both the mediolateral and anteroposterior components were evident between the groups. [Conclusion] A markedly significant difference was observed, particularly in high frequency band %power, depending on balance control. The present findings indicated that elderly participants with diminished balance control had difficulty with rapid adjustment centered on the ankles, suggesting that rapid joint movement involving interlimb coordination centered on the ankles is required to maintain tandem stance.

Relation between muscle fiber conduction velocity and exerted dynamic characteristics of muscular tension in patients with hemiplegia caused by stroke.

[Purpose] The aim of this study was to clarify the relationships among muscle fiber conduction velocity, time-force characteristics of muscle force production, and voluntary movement in patients with hemiplegia. [Subjects and Methods] The participants in the present study were 13 patients with hemiplegia. Muscle fiber conduction velocity, deep temperature of muscles and muscle thickness were measured for the tibialis anterior, and a time force curve was obtained from dorsiflexion of the ankle and lower thigh girth (maximum, minimum) for both sides. The maximum torque rate of change and maximum torque were calculated from the force-time curve. In addition, Brunnstrom Recovery Stage was used to evaluate the function of the hemiplegic side. [Results] In all the measurement items, significant differences were observed between the hemiplegic side and the healthy side. The maximum torque rate of change and Brunnstrom Recovery Stage showed a high degree of correlation. The muscle fiber conduction velocity and maximum torque rate of change or maximum torque showed a medium degree of correlation. However, muscle fiber conduction velocity was not significantly correlated with Brunnstrom Recovery Stage. [Conclusion] Brunnstrom Recovery Stage was good as a determination factor for the maximum torque rate of change. In addition, in patients with hemiplegia, it became clear that relationship is between muscle fiber conduction velocity and time-force characteristics of muscle force production as in healthy persons.