Non-invasive evaluation of autonomic responses in patients with rotator cuff tear-related nocturnal pain.

[Purpose] We aimed to determine the autonomic response in patients with rotator cuff tear-related nocturnal pain using nonlinear analysis of heart rate variability. [Participants and Methods] Twenty-eight patients with nocturnal pain who were diagnosed with a rotator cuff tear and received steroid injections, and whose nocturnal pain improved, were divided into a control group (14 patients) and a failure group (14 patients). Pulse wave was measured continuously using BACS Advance equipment (TAOS Co.) for a total of 17 min: 5 min before isometric hand grip, 2 min during isometric hand grip, 5 min after isometric hand grip, and 10 min after isometric hand grip. The autonomic nervous system activity was assessed using detrended fluctuation analysis and approximate entropy. [Results] The α1 values obtained from the detrended fluctuation analysis were significantly higher in the failure group than in the control group at each measurement period. The approximate entropy was normal in 12 (85%) patients in the control group and six (42%) patients in the failure group; it was abnormal in two (15%) patients in the control group and eight (58%) patients in the failure group. [Conclusion] Among patients experiencing nocturnal pain, several have abnormal autonomic response during isometric hand grip.

Characteristics of ulnar neuropathy in baseball players: Focusing on the entrapment point of the ulnar nerve and valgus instability.

Background: The region where the ulnar nerve (UN) is swollen in baseball players with ulnar neuropathy is not apparent. This study investigated the UN's cross-sectional area (CSA) at each entrapment point in baseball players. We also aimed to clarify the relationship between valgus instability and the CSA of the UN. Methods: Forty baseball players were separated into healthy and ulnar neuropathy groups. The CSA and valgus instability were measured using ultrasonography (US). Relative to the medial epicondyle (MEC), the arcade of Struthers (SA) was 5 cm proximal, the cubital tunnel was the posterior part, and Osborne's ligament was defined as 3 cm distal. The ulnohumeral joint space was imaged as a low-echo space between the distal-medial corner of the trochlea and the proximal edge of the sublime tubercle. Results: The UN in the ulnar neuropathy group had significant swelling in the cubital tunnel and Osborne's ligament. We found a weak positive correlation between the CSA and ulnohumeral joint space, and the ulnohumeral joint space at rest and valgus stress. Conclusion: Evaluation and treatment of UN, especially cubital tunnel and Osborne's ligament, are necessary for the rehabilitation of baseball players presenting with ulnar neuropathy and valgus instability.

Effects of low-intensity pulsed ultrasound on the infrapatellar fat pad in knee osteoarthritis: a randomized, double blind, placebo-controlled trial.

[Purpose] We investigated the effects of low-intensity pulsed ultrasound (LIPUS) irradiation of the infrapatellar fat pad (IFP) combined with therapeutic exercise for management of knee osteoarthritis (knee OA). [Participants and Methods] The study included 26 patients with knee OA, who were randomized into the LIPUS group (patients underwent LIPUS + therapeutic exercise) and the therapeutic exercise group (patients underwent sham LIPUS + therapeutic exercise). We measured changes in the patellar tendon-tibial angle (PTTA) and in IFP thickness, IFP gliding, and IFP echo intensity after 10 treatment sessions to determine the effects of the aforementioned interventions. We additionally recorded changes in the visual analog scale, Timed Up and Go Test, the Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores, as well as range of motion in each group at the same end-point. [Results] Compared with patients in the therapeutic exercise group, those in the LIPUS group showed significant post-treatment improvements in PTTA, VAS, and Kujala scores, as well as in range of motion. [Conclusion] The combined use of LIPUS irradiation of the IFP and therapeutic exercise is a safe and effective modality to reduce IFP swelling, relieve pain, and improve function in patients with knee OA.

Evaluation of autonomic nervous system responses during isometric handgrip exercise using nonlinear analysis of heart rate variability.

[Purpose] The purpose of this study was to examine, using a plethysmogram of the fingertips, autonomic responses at motor intensities of 30% or 50% of maximum voluntary contraction (MVC) during isometric handgrip exercise (IHG). [Participants and Methods] The participants of this study were 15 healthy persons. The finger volume pulse wave of each participant was measured continuously, using a BACS Advance equipment (TAOS Co.), for a total of 17 minutes: 5 minutes before IHG (Pre), 2 minutes during IHG (IHG), the first 5 minutes after IHG (Post 5), and then the second 5 minutes after IHG (Post 10). To evaluate autonomic nervous system activity, we used the Detrended fluctuation analysis (DFA) and Approximate Entropy (ApEn). [Results] During IHG, the pulse rate was significantly higher and the ApEn value was significantly lower than during the other periods of measurement. Compared to other analyzed parameters, ApEn decreased during IHG, but returned to its initial Pre period level during the Post 5 period. The α1 value derived from the DFA analysis remained at a value of 1 during each measurement time point, indicating the absence of malfunctions in autonomic response. [Conclusion] Isometric handgrip exercise with 30% MVC seemed to be useful for the assessment of autonomic nervous system response.

Effects of isometric contraction of the quadriceps on the hardness and blood flow in the infrapatellar fat pad.

[Purpose] This study aimed to clarify the influence of the isometric contraction of the quadriceps (ICQ) with low intensity on the circulation in the infrapatellar fat pad (IFP). [Participants and Methods] The participants were 7 males and 5 females, with an average age of 21.5 ± 1.4 years. IFP hardness was measured using shear wave ultrasound elastography and Biodex. Tissue oxygenation was measured via near-infrared spectroscopy using oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (cHb) as indices. The mean values were calculated for three periods: 1 min of rest immediately before the exercise task (before ICQ), the lower limit of the 10 sets during the exercise task (during ICQ), and 3-4 min after the exercise task (after ICQ). IFP hardness was compared between resting conditions and ICQ, and tissue oxygenation was compared before, during, and after ICQ. [Results] ICQ significantly increased IFP hardness. Tissue hemoglobin, O2Hb, and cHb decreased significantly during ICQ and increased after ICQ compared to that before ICQ. HHb decreased during ICQ and recovered significantly after ICQ. [Conclusion] In healthy participants, low-intensity ICQ increases the hardness and oxygenation of the IFP. This study may partly explain the unknown pain relief mechanism of exercise therapy.

Characteristics of the descending genicular artery blood flow velocity in patients with knee osteoarthritis.

BACKGROUND: In patients with knee osteoarthritis (KOA), the descending genicular artery (DGA) showed abnormal angiogenesis. However, the non-invasive assessment method of DGA remains unclear. The aim of this study was to clarify the characteristics of blood flow velocity of the DGA in patients with KOA and to examine the factors involved in the changes. METHODS: The KOA group included 22 knees of 22 patients with KOA (4 males, 18 females; mean age, 72.3 ± 7.5 years) and the control group included 22 knees (4 males, 18 females; mean age, 71.3 ± 5.4 years) of 22 healthy adults. The peak systolic blood flow velocity (PSV) in each group was measured using ultrasonography. The KOA group was classified into the effusion group and the non-effusion group based on observed effusion, and the PSV was compared between the two groups. The relationships between PSV and suprapatellar bursa intracavitary distance, pain, femorotibial angle, Japanese Knee Osteoarthritis Measure were also investigated. RESULTS: The PSV in the KOA group (51.5 ± 12.9 cm/s) was significantly higher than that in the control group (29.3 ± 4.4 cm/s) (P < 0.01). In the KOA group, PSV in the effusion group (55.5 cm/s (51.2-59.4 cm/s)) was significantly higher than that in the non-effusion group (39.1 cm/s (35.1-44.4 cm/s)) (P < 0.01). The PSV was positively and significantly correlated with both suprapatellar bursa intracavitary distance (r = 0.81: P < 0.01) and pain (r = 0.48: P < 0.05). CONCLUSIONS: The PSV measurement in the DGA is useful for the evaluation of non-invasive synovitis of patients with KOA.

Phosphoenolpyruvate, a glycolytic intermediate, as a cytoprotectant and antioxidant in ex-vivo cold-preserved mouse liver: a potential application for organ preservation.

OBJECTIVES: The aim of this study was to examine the effect of phosphoenolpyruvate (PEP), a glycolytic intermediate, on organ damage during cold preservation of liver. METHODS: An ex-vivo mouse liver cold-preservation model and an in-vitro liver injury model induced by hydrogen peroxide in HepG2 cells were leveraged. KEY FINDINGS: PEP attenuated the elevation of aminotransferases and lactate dehydrogenase leakage during organ preservation, histological changes and changes in oxidative stress parameters (measured as thiobarbituric acid reactive substance and glutathione content) induced by 72 h of cold preservation of the liver. The effects were comparable with the University of Wisconsin solution, a gold standard organ preservation agent. The decrease in ATP content in liver during the cold preservation was attenuated by PEP treatment. PEP prevented the cellular injury and increases in intracellular reactive oxygen species in HepG2 cells. In addition, PEP scavenged hydroxyl radicals, but had no effect on superoxide anion as evaluated by an electron paramagnetic resonance spin-trapping technique. CONCLUSIONS: PEP significantly attenuated the injury, oxidative stress and ATP depletion in liver during cold preservation. The antioxidative potential of PEP was confirmed by in-vitro examination. We suggest that PEP acts as a glycolytic intermediate and antioxidant, and is particularly useful as an organ preservation agent in clinical transplantation.

Comparative Effects of Phosphoenolpyruvate, a Glycolytic Intermediate, as an Organ Preservation Agent with Glucose and N-Acetylcysteine against Organ Damage during Cold Storage of Mouse Liver and Kidney.

We evaluated the usefulness of phosphoenolpyruvate (PEP), a glycolytic intermediate with antioxidative and energy supplementation potentials, as an organ preservation agent. Using ex vivo mouse liver and kidney of a static cold storage model, we compared the effects of PEP against organ damage and oxidative stress during cold preservation with those of glucose or N-acetylcysteine (NAC). Lactate dehydrogenase (LDH) leakage, histological changes, and oxidative stress parameters (measured as thiobarbituric acid reactive substance and glutathione content) were determined. PEP (100 mM) significantly prevented an increase in LDH leakage, histological changes, such as tubulonecrosis and vacuolization, and changes in oxidative stress parameters during 72 h of cold preservation in mouse liver. Although glucose (100 mM) partly prevented LDH leakage and histological changes, no effects against oxidative stress were observed. By contrast, NAC inhibited oxidative stress in the liver and did not prevent LDH leakage or histological changes. PEP also significantly prevented kidney damage during cold preservation in a dose-dependent manner, and the protective effects were superior to those of glucose and NAC. We suggest that PEP, a functional carbohydrate with organ protective and antioxidative activities, may be useful as an organ preservation agent in clinical transplantation.