Contrasting alteration patterns of different cartilage plates in knee articular cartilage after spinal cord injury in rats.

STUDY DESIGN: Experimental, controlled trial, animal study. OBJECTIVE: To assess morphologic changes in different cartilage plates after spinal cord injury and identify the localization of these alterations. SETTING: Saitama, Japan. METHODS: A total of 16 Wistar rats were used. Eight rats underwent a spinal cord injury and eight rats had no intervention as control. The cartilage alterations of the knee joint were evaluated with radiography and histomorphometric analysis. To quantify cartilage alterations, we selected the histologic characteristics: thickness of the articular cartilage, number of chondrocytes, matrix staining to toluidine blue as a reflection of proteoglycan content and surface irregularity. RESULTS: No differences in knee joints were found between the groups by radiography. In the medial knee joint, cartilage thickness of spinal-cord-injured knees increased at the anterior femoral region and decreased at the tibial and posterior femoral regions; however, in the lateral knee, that of spinal cord injuries did not change compared with control knees. Spinal cord injuries decreased the number of chondrocytes, especially at the anterior femoral regions. Matrix staining increased partially at the tibial regions. Surface irregularity of spinal-cord-injured knees was comparable to that of control knees in all cartilage plates. CONCLUSION: The present findings exhibit characteristics of the cartilage after spinal cord injury. These alterations were different in nature between the medial and lateral regions. Future studies should assess separately different cartilage plates, to overestimate these severities when the changes at the medial knee were examined and to underestimate when the changes at the lateral knee were examined.

Alteration in articular cartilage of rat knee joints after spinal cord injury.

OBJECTIVE: Mechanical forces are crucial for the maintenance of the morphologic and functional integrity of articular cartilage. The alteration of the articular cartilage after spinal cord injury (SCI) has been described in relation to a suppression of mechanical forces, since the joint is unloaded and restricted in movement. However, the morphological and biochemical characteristics of the cartilage after SCI are still poorly understood. We identified the localization of cartilage alterations after SCI and verified the influence of mechanical forces on the articular cartilage. METHOD: A total of 32 Wistar rats were used. Sixteen animals underwent an SCI and 16 animals served as control. The articular cartilage of the knee joint was assessed, respectively, at 4, 8, 10, and 12 weeks after intervention by histochemical, histomorphometric, immunohistochemical, and biochemical analyses. RESULTS: Cartilage thickness of spinal cord-injured knees decreased at the tibial and posterior femoral (FP) regions and increased at the anterior femoral (FA) region. Spinal cord injuries decreased the number of chondrocytes at the anterior regions and decreased the cartilage matrix staining only at the tibial regions. Immunolabeling to collagen type II was noted comparably in the superficial layer but noted weakly from the middle to deep layer. Collagen type I existed excessively at the cartilage surface and the pericellular regions. CONCLUSION: Cartilage alterations after SCI would not be explained by only a suppression of mechanical forces by unloading and immobilization, but there may be influences on the cartilage in addition to the change in mechanical forces.

Comparison of muscular and articular factors in the progression of contractures after spinal cord injury in rats.

STUDY DESIGN: Experimental, controlled trial. OBJECTIVES: To identify the relationship between the muscular and articular factors in the progression of contractures after spinal cord injury (SCI). SETTING: Hiroshima University, Hiroshima, Japan. METHODS: In total, 48 female Wistar rats were used. The 24 experimental rats that underwent a spinal cord transection and the other 24 control rats that underwent a sham-operation were assessed at 2, 4, 8, 12, 16, or 24 weeks postsurgery. Knee joint motion was measured for flexion and extension. Myotomy of the transarticular muscles was then performed and range of motion was measured again. The degree of contractures was assessed by goniometry measuring the femorotibial angle before and after the myotomies. RESULTS: The spinal cord-injured rats demonstrated flaccid paralysis during the first few days postsurgery and thereafter spastic paralysis. Intra- and inter-rater reliabilities for all measurements were >0.814. Knee flexion contractures developed in the all experimental rats, and progressed for the first 12 weeks and plateaued thereafter. Both the muscular (48+/-5%) and articular (52+/-5%) factors contributed almost equally to the overall progression of the contracture. CONCLUSION: The present findings may shed light on the underlying pathophysiology of contractures and should help guide research towards finding the elucidation of contracture development after SCI.

[A modified administrated schedule for combination therapy with irinotecan and cisplatin as a neoadjuvant chemotherapy in locally advanced cervical cancer--a report of 2 cases as a pilot study].

To shorten the treatment term of neoadjuvant chemotherapy (NAC) for locally advanced cervical cancer, a combination of irinotecan (CPT-11) and cisplatin was administered on a modified administrated schedule for 2 eligible patients as a pilot study. CPT-11 70 mg/m2 was administered (div) on days 1 and 8, followed by cisplatin 70 mg/m2 given (div) on day 1. Treatment was repeated every 3 weeks for a total of two cycles. Both patients showed a complete clinical response. No severer toxicities were observed than with the usual regimen, and both cases could undergo radical hysterectomy after NAC. The results suggest that this modified regimen of combination of CPT-11 and cisplatin can be effective as an NAC in cases of locally advanced cervical cancer, especially in terms of shortening treatment term. This regimen is worthy of further study.

Rapid cardiac adaptation to exercise demand signal and execution of maximal leg muscle contraction.

We investigated the neural regulation of the cardiac interval to an exercise demand signal and to a repeated exercise in 20 healthy human subjects. Electrocardiogram (ECG), muscle torque, and electromyogram (EMG) were simultaneously measured and their time relationships compared before and during the exercise. The R-R interval of ECG was directly increased by the exercise demand signal itself before the onset of EMG but not reflexly by muscle contraction. The cardiac interval decreased at the onset of exercise. Under the condition of repeated maximum eccentric training, the resting cardiac interval decreased prior to the exercise, whereas the brief increase in cardiac interval to the exercise demand signal remained unchanged. These results suggested that when autonomic nerve activity to the pacemaker is activated by the exercise demand signal, an initial effect of vagal nerve activity appears, and an effect of vagal nerve withdrawal and/or sympathetic nerve activity then appears. The responses of the heart and leg skeletal muscle at the onset of exercise are not synchronized, and the cardiac interval is controlled by vagal and sympathetic nerve activities to effect a transition to a high heart rate as quickly and smoothly as possible.

Time course of influence by ovariectomy and calcium diet on bone properties in mice.

This study was investigated the influence by ovariectomy (OVX) and calcium diet on bone properties in eighty-one female ICR strain mice with age of 5 weeks. The animals were randomly assigned to sham operation (SHAM), OVX, SHAM+low Ca intake (L.Ca) and OVX+L.Ca group. They were euthanized with lethal dose of pentobarbital sodium at day 50, 100 and 140 post-operatively. For determining the bone properties, both femur and tibial bones were excised from the hind limb, and removed off surrounding tissues. Thereafter, bone length, bone dry weight, and also mechanical strength and ash content of the bones were determined. The bone length on both femur and tibia was significantly longer in OVX group than in the other groups after 50 day of experiment, this situation was continued to the end of the experiment. Bone dry weight, mechanical strength, and ash content were significantly decreased by OVX and L.Ca over the time of the experiment, and those of OVX+L.Ca group were the lowest in all groups. OVX and L.Ca have a great potential for weakening the mechanical strength and have an additive effect when combined. OVX and L.Ca block the gain of bone mass.

Three-dimensional measurement of rolling in tetraplegic patients.

OBJECTIVE: To investigate the differences between traumatic tetraplegic patients who can roll and those who cannot. DESIGN: Motion analysis using 3-dimensional measurement. SETTING: Rehabilitation centers in southwestern Japan. PARTICIPANTS: Nineteen male participants, all of whom had traumatic C6 complete injury. METHODS: We used an electromagnetic device to examine the degree of spinal movement in axial rotation during rolling (shifting from supine to side lying). This system (3-Space Win) measures the position and orientation of sensors in space. Two sensors were mounted on a subject over the spinous process of T1 and L5. RESULTS: The spinal rotation of patients who could not roll was significantly lower than that of patients who could roll. (The average rotation of non-rollers was 31.5+/-17.5 degrees, while the average rotation of rollers was 66.3+/-17.3degrees). In this study, there were no statistically significant differences in the members of the two groups in terms of age, height, weight or time after injury. CONCLUSION: Rolling requires greater and adequate flexibility in the back of tetraplegic patients.

The effect of low calcium diet on bone in ovariectomized mice.

This study investigates the effects of Ca on bone in the ovariectomized mice. Twenty-six female ICR mice aged 5 weeks were used. They were ovariectomized (OVX) or sham-operated (SHAM) and fed standard mouse diet (SF) or special low calcium diet (L.Ca), respectively. All animals were sacrificed at day 100 after operation. Mechanical strength of the left femur and tibia was measured by the three-point bending strength test. The bones were dried, weighed and burned to ash. Correlation between mechanical strength and ash content was found. A specimen of the right tibia was prepared. Mechanical strength, ash content and ratio of dry bone weight to body weight of the femur and tibia in OVX and L.Ca mice were significantly less than in SHAM and SF mice. SHAM/SF mice and OVX/L.Ca group showed highest and lowest values in all cases. The values for the femur and tibia in OVX/SF mice were lower than in SHAM/SF group and in OVX/L.Ca group were less than in OVX/SF mice. Correlation coefficients for mechanical strength and ash content were 0.704 and 0.776 for the femur and tibia. Ca is thus related to inhibition of bone loss and maintenance of bone mass and effective prevention of osteoporosis.

Modification of postural response caused by footwear conditions.

The purpose of this study was to clarify the effect of changing footwear conditions on postural response against postural perturbation. Twenty-three healthy subjects participated in this study. Postural response was induced by moving a platform forward, hereafter referred to as forward-perturbation of a platform. The center of pressure (COP) from the force plate and the electromyograms (EMG) of the tibialis anterior (TA) and quadriceps femoris (QUAD), which are both agonists of the response, were measured. The effect of plantar material and shape of footwear on postural response was examined as footwear condition. Changing plantar materials had an effect on integrated EMG of the agonists (IEMG) but not on the response pattern. On the other hand, the shape of footwear had an effect on the response pattern but not on IEMG. It was supposed from this result that changes in somatosensory input, caused by coupling of plantar material and shape of footwear, modifies postural response variously.

Possibility of independence in ADL (Activities of Daily Living) for patients with cervical spinal cord injuries--an evaluation based on the Zancolli Classification of Residual Arm Functions.

For patients with cervical spinal cord injuries to become independent in their ADL (Activities of Daily Living), residual arm function is very important. Also, age, sex, physical strengths, obesity, spasticity, pain, contracture and motivation are related. We investigated the possibility of independence in ADL for patients with cervical spinal cord injuries, carrying out our evaluation based on the Zancolli Classification of Residual Arm Functions. Zancolli classification C6BII is taken as the boundary level for ADL independence. Rehabilitation is not only controlled by the patients with cervical spinal cord injuries themselves but also by the ability of the rehabilitation staff. This implies that taking responsibility in rehabilitation important.

Spinal cord injures in children observed over many years.

The known salient features of spinal cord injuries in children are that 1) plane X-rays may not show dislocations or fractures, 2) many of these injuries are complete transections, 3) many injuries are located at the level of upper thoracic spine, and 4) the duration of spinal shock is short. Complications such as pressure sores occur just as easily in children as in adults and the injuries tend to be just as intractable. Complications characteristic in children with spinal cord injuries are spinal deformity and hip dislocation. In this paper, we describe a case involving a C7 spinal cord injury caused by a fall when the patient was 3 years old. We have observed the physical complications for 15 years following that injury. We also report on other observed cases of spinal cord injury.

Spinal cord injury in a child: a long term follow-up study. Case report.

The main features of spinal cord injuries in children are known to be that (1) plain radiographs do not show the bony injury; (2) many of the injuries are complete spinal cord injuries; (3) many involve the upper thoracic spine; and (4) the duration of spinal shock is short. Complications such as pressure sores occur just as easily in children as in adults and the injuries are intractable. Typical complications in children with spinal cord injuries are spinal deformity and hip dislocation. We discuss a patient with a C7 spinal cord injury caused by a fall when the patient was 3 years old, and the physical complications occurring during the 15 years following the injury.

Below-knee amputation for Charcot joint developing 40 years after spinal cord injury. Case report.

A Charcot joint developed following a spinal cord injury in a patient who had sustained a fracture-dislocation of the 12th thoracic vertebra and a spinal cord injury in a cave-in accident in a coal mine 40 years previously, and had since been assisted in walking with the aid of a short leg brace and a cane. Recently, the patient developed Charcot joints of the right knee and ankle, and the right ankle joint also became infected with a refractory open wound necessitating a below-knee amputation.

Ultrasonography and Doppler studies in twin-to-twin transfusion syndrome.

In 40 twin pregnancies, the evaluation of hemodynamics by ultrasound was performed during the period January 1986 through September 1991. The blood flow velocities' waveforms in the umbilical artery, umbilical vein and tricuspid valve, and the total cardiac dimension, were obtained by ultrasonography in conjunction with 3.5 MHz pulsed Doppler ultrasound. Six patients with twin pregnancies were identified as having twin-to-twin transfusion syndrome (TTS), on the basis of like-sex twins with monochorionic diamniotic placentation, vascular anastomosis in the placenta, and umbilical cord venous blood hemoglobin difference exceeding 5 g/dl at delivery. No distinctive findings for TTS were revealed by the measurement of umbilical artery blood flow velocity waveforms. However, cardiomegaly in 5 recipient fetuses and tricuspid regurgitation and biphasic umbilical vein waveforms in 3 recipient fetuses constituted characteristic features of TTS. Ultrasonography and a Doppler study might be beneficial in diagnosing TTS and evaluating the hemodynamics in a recipient fetus.

Umbilical artery blood flow velocity waveforms in pregnancy complicated by diabetes mellitus.

Umbilical artery blood velocity waveforms were recorded by a pulsed Doppler system in the third trimester of pregnancy in 16 diabetic women (12 class B, 1 class C, 3 class D) and the waveforms were analysed for resistance index (RI = peak systolic velocity minus end diastolic velocity/peak systolic velocity). There was no significant correlation between the RI values and either serum glucose (r = 0.385) or fructosamine levels (r = 0.380). However, the RI values were raised in two cases with serum glucose levels of over 300 mg/dl. With a fall in serum glucose levels, the RI values returned to the normal range. No abnormal umbilical artery velocity waveforms were found when the serum glucose level was below 200 mg/dl.

Power spectral analysis of heart rate variability in traumatic quadriplegic humans.

This study investigated the spontaneous beat-to-beat variabilities in R-R intervals of six traumatic neurologically complete quadriplegic (QP) males and six age-matched healthy males (control) while they were at rest in the supine position in a climatic chamber (temperature 30 degrees C, relative humidity 60%) by means of autoregressive power spectral analysis. As shown by earlier studies, in the control group there were two major spectral components, a high-frequency (HF) component [center frequency 0.30 +/- 0.02 (SE) Hertz equivalent (Hz eq), power 767.5 +/- 384.6 ms2] and a low-frequency (LF) component (0.11 +/- 0.01 Hz eq, 707.5 +/- 198.8 ms2). On the contrary, in the QP group, only the HF component was observed (0.30 +/- 0.02 Hz eq, 421.8 +/- 134.7 ms2). The results suggest that 1) the disappearance of the LF component in the QP subject is presumably caused by the interruption of the spinal pathways linking supraspinal cardiovascular centers with the peripheral sympathetic outflow, and 2) the cervical spinal sympathetic pathways may be instrumental in the genesis of the LF component in humans.

[The influence of green tea upon the improvement of iron deficiency anemia with pregnancy treated by sodium ferrous citrate].

Green tea is indispensable to our everyday life. In Japan it has long been common knowledge that the ingestion of green tea should be avoided before and after the intake of iron preparations. There have recently been some reports, however, that deny the effect of green tea on iron preparations. A study was conducted on pregnant patients with anemia, using sodium ferrous citrate (Ferromia). The drug was administered to a group of patients taking green tea and a group taking water. Our results can be summarized as follows. 1. Hemoglobin, serum iron and total iron binding capacity were markedly improved after the administration of the iron preparation, and there was no difference between these parameters in the two groups of patients. 2. There was a tendency for patients with hypochromia to show a more marked improvement in hemoglobin in both groups. 3. Anemia cured in 96.7% of patients in the green tea group and in 93.4% of patients in the water group after the oral administration of the iron preparation. 4. The incidence of side effects stood at 18.3% for the green tea group and 21.9% for the water group, there being no significant difference. No serious side effects were elicited in the present study.

Cerebral artery blood flow velocity waveforms in normal and small for dates fetuses.

Middle cerebral artery (MCA) blood flow velocity waveforms were recorded by a pulsed Doppler system in normal and small for dates (SFD) fetuses. Eighty four normal growth fetuses and 15 SFD fetuses were studied between the 28th and 40th gestational week. The flow velocity waveforms were analysed to determine the resistance index (RI = peak systolic velocity minus end diastolic velocity/peak systolic velocity). The results obtained were as follows: 1. The mean values of RI in the MCA had a peak of 0.802 +/- 0.049 at 32-33 gestational weeks and decreased gradually to a level of 0.686 +/- 0.087 at 40 gestational weeks. 2. In 8 asymmetrical SFD fetuses, the RI values for the MCA were below the normal range (mean -1.5 SD) in 6 cases and normal in 2 cases. 3. The RI values for MCA in all 7 symmetrical SFD fetuses were in the normal range.