Side branch embolization before endovascular abdominal aortic aneurysm repair to prevent type II endoleak: A prospective multicenter study.

PURPOSE: The purpose of the study was to evaluate the efficacy and safety of pre-emptive transcatheter arterial embolization (P-TAE) of aortic side branches to prevent type II endoleak in patients with abdominal aortic aneurysm after endovascular abdominal aneurysm repair (EVAR). MATERIALS AND METHODS: This multicenter, prospective, single-arm trial enrolled 100 patients with abdominal aortic aneurysm from nine hospitals between 2018 and 2021. There were 85 men and 15 women, with a mean age of 79.6 ± 6.0 (standard deviation) years (range: 65-97 years). P-TAE was attempted for patent aortic side branches, including the inferior mesenteric artery, lumbar arteries, and other branches. The primary endpoint was late type II endoleak incidence at 6 months post-repair. Secondary endpoints included changes in aneurysmal sac diameter at 6- and 12 months, complications, re-intervention, and aneurysm-related mortality. Aneurysm sac changes at 6- and 12 months was compared between the late and no-late type II endoleak groups. RESULTS: Coil embolization was successful in 80.9% (321/397) of patent aortic side branches, including 86.3% of the inferior mesenteric arteries, 80.3% of lumbar arteries, and 55.6% of other branches without severe adverse events. Late type II endoleak incidence at 6 months was 8.9% (8/90; 95% confidence interval: 3.9-16.8%). Aneurysm sac shrinkage > 5 mm was observed in 41.1% (37/90) and 55.3% (47/85) of the patients at 6- and 12-months post-EVAR, respectively. Patients with late type II endoleak had less aneurysm sac shrinkage than those without type II endoleak at 12 months (-0.2 mm vs. -6.0 mm; P = 0.040). No patients required re-intervention for type II endoleak, and no aneurysm-related mortalities occurred. CONCLUSION: P-TAE is safe and effective in preventing type II endoleak, leading to early sac shrinkage at 12 months following EVAR.

Pre-emptive Aortic Side Branch Embolization during Endovascular Aneurysm Repair Using the Excluder Stent-Graft System: A Prospective Multicenter study.

PURPOSE: To evaluate the effectiveness and safety of pre-emptive transcatheter arterial embolization (P-TAE) for aortic side branches (ASBs) to prevent Type 2 endoleaks (EL2) before endovascular aneurysm repair (EVAR) using the Excluder stent-graft system (Excluder). MATERIALS AND METHODS: In this prospective, multicenter study, 80 patients (mean age, 79.1 years [SD ± 6.7]; 85.0% were men; mean aneurysmal sac diameter, 48.4 mm [SD ± 7.4]) meeting the eligibility criteria were prospectively enrolled from 9 hospitals. Before EVAR, P-TAE was performed to embolize the patent ASBs originating from the abdominal aortic aneurysm. Contrast-enhanced computed tomography (CT) was performed at 1 month and 6 months after EVAR. The primary endpoint was EL2 incidence at 6 months, and the secondary endpoints were aneurysmal sac diameter changes at 6 and 12 months, P-TAE outcomes, adverse events related to P-TAE, reintervention, and aneurysm-related mortality. RESULTS: All patients successfully underwent P-TAE without serious. Coil embolization was successful in 81.6% of ASBs. EL2 incidence at 6 months was identified in 18 of 70 (25.7%) patients. Aneurysmal sac diameter shrinkage (≥5 mm) was observed in 30.0% of patients at 6 months and in 40.9% at 12 months. Only 1 patient required reintervention for EL2 within 1 year of EVAR; aneurysm-related deaths were not observed. CONCLUSIONS: P-TAE for ASBs before EVAR using Excluder is a safe and effective strategy. It aids in achieving early aneurysmal sac shrinkage and reduces EL2 reintervention at 1 year after EVAR.

Optimal index for detecting splenic involvement on 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in diffuse large B-cell lymphoma.

Accurate clinical staging is important in diffuse large B-cell lymphoma (DLBCL) to adapt to optimal therapy. Splenic involvement of DLBCL has been recently more detectable with the advancement of a diagnostic scan by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). Our clinical question is whether splenic involvement was adequately diagnosed by FDG-PET/CT imaging. This retrospective study aimed to determine the optimal index for evaluating splenic involvement in patients with DLBCL. Patients with newly diagnosed DLBCL who were examined with FDG-PET/CT at diagnosis and the end of induction chemotherapy (EOI) was enrolled. The splenic involvement with the splenic FDG uptake value higher than that of the liver at diagnosis or with the decrease of splenic uptake at EOI by visual evaluation was evaluated as positive. The calculative evaluation of splenic involvement, based on the data of standardized uptake value (SUV) of the spleen, used maximum SUV (SUVmax), mean SUV (SUVmean), spleen total lesion glycolysis (spleen TLG), and spleen length. A change in each index following induction chemotherapy was expressed as an index. Receiver operating characteristic analysis was used to set the cutoff value for each index. This study included 52 patients. Spleen TLG (0.904) showed the best accuracy, followed by SUVmax (0.885) and SUVmean (0.885), among the 5 indexes for splenic involvement at diagnosis. Splenic involvement was predicted with a higher accuracy level (0.923) when selecting the cases with values higher than the cutoff level on both spleen TLG and SUVmax. The decision at EOI was more suitable by selecting both positive cases of ∆ TLG and ∆ SUVmax. Obtaining both the positive spleen TLG and SUVmax is recommended at diagnosis to predict splenic involvement. The assessment by ∆ spleen TLG and ∆ SUVmax seems to be optimal.

Observing an expert's action swapped with an observer's face increases corticospinal excitability during combined action observation and motor imagery.

This study aimed to examine whether observing an expert's action swapped with an observer's face increases corticospinal excitability during combined action observation and motor imagery (AOMI). Twelve young males performed motor imagery of motor tasks with different difficulties while observing the actions of an expert performer and an expert performer with a swapped face. Motor tasks included bilateral wrist dorsiflexion (EASY) and unilateral two-ball rotating motions (DIFF). During the AOMI of EASY and DIFF, single-pulse transcranial magnetic stimulation was delivered to the left primary motor cortex, and motor-evoked potentials (MEPs) were obtained from the extensor carpi ulnaris and first dorsal interosseous muscles of the right upper limb, respectively. Visual analogue scale (VAS) assessed the subjective similarity of the expert performer with the swapped face in the EASY and DIFF to the participants themselves. The MEP amplitude in DIFF was larger in the observation of the expert performer with the swapped face than that of the expert performer (P = 0.012); however, the corresponding difference was not observed in EASY (P = 1.000). The relative change in the MEP amplitude from observing the action of the expert performer to that of the expert performer with the swapped face was positively correlated with VAS only in DIFF (r = 0.644, P = 0.024). These results indicate that observing the action of an expert performer with the observer's face enhances corticospinal excitability during AOMI, depending on the task difficulty and subjective similarity between the expert performer being observed and the observer.

Effect of two weeks of training cessation on concentric and eccentric knee muscle strength in highly trained sprinters.

Athletes often experience short-term training cessation because of injury, illness, post-season vacation, or other reasons. Limited information is available about the effect of short-term (less than four weeks) training cessation on muscle strength in athletes. Sprinting athletes must maintain knee extension and flexion strength to reduce the risk of sprint-type hamstring strain injury. This study aimed to identify whether and to what extent knee extension and flexion torque in concentric and eccentric contractions is reduced by two weeks of training cessation in sprinters. Before and after the training cessation, maximal voluntary isokinetic knee extension and flexion torque in slow and fast concentric (60 and 300°/s) and slow eccentric (60°/s) contractions were assessed in 13 young male highly trained sprinters (average World Athletics points = 978). Knee flexion torque during the bilateral Nordic hamstring exercise (NHE) was also measured. After the training cessation, isokinetic concentric at 300°/s and eccentric torque were significantly reduced in both knee extension and flexion. There was no difference in the magnitude of reduction between isokinetic knee extension and flexion torques in all conditions. The relative changes were more notable in eccentric (-15.0%) than in concentric contraction at 60°/s (-0.7%) and 300°/s (-5.9%). Knee flexion torque during the NHE also declined (-7.9% and -9.9% in the dominant and non-dominant legs, respectively). There was no significant correlation between the relative reductions in isokinetic knee flexion torque and knee flexion torque during the NHE. The findings suggest that sprinters and their coaches should focus on recovering fast concentric and slow eccentric knee extension and flexion strength after two weeks of training cessation.

Greater task difficulty during unilateral motor tasks changes intracortical inhibition and facilitation in the ipsilateral primary motor cortex in young men.

This study aimed to clarify the changes in short-interval intracortical inhibition (SICI) and facilitation (ICF) in the ipsilateral primary motor cortex (iM1) when the task difficulty during unilateral force-matching tasks was manipulated. Twelve young male adults matched their left index finger abduction force to a displayed target force. Task difficulty was manipulated by varying the acceptable force range of the mean target force (5% MVC). Briefly, unilateral force-matching tasks with lesser and greater task difficulty (EASY and DIFF, respectively) were assigned acceptable force ranges of ± 7% and ± 0% of the target force, respectively. To evaluate SICI and ICF in iM1, paired-pulse transcranial magnetic stimulation with 2-ms and 10-ms interstimulus intervals was applied to correct motor-evoked potentials (MEPs) from the first dorsal interosseous muscle during each task. Test stimulus intensity to evoke the MEP with a peak-to-peak amplitude of approximately 0.5-1.5 mV for each task was lower in DIFF than in EASY (P = 0.001), indicating that DIFF increased corticospinal excitability of the ipsilateral hemisphere compared with EASY. The MEPs in SICI and ICF were significantly larger in DIFF than in EASY (P < 0.050). These results suggest that greater corticospinal excitability in the ipsilateral hemisphere during DIFF is associated with reduced SICI and increased ICF.

Predictive Factors for Limb Salvage and Foot Ulcer Recurrence in Patients with Chronic Limb-Threatening Ischemia After Multidisciplinary Team Treatment: A 6-Year Japanese Single-Center Study.

Chronic limb-threatening ischemia (CLTI) is associated with a short-term risk of limb loss. Multidisciplinary teams are often involved in CLTI treatment; however, in Asian countries, multidisciplinary teams that include podiatrists specializing in foot wounds and vascular surgeons who can perform distal bypass surgery are lacking. We investigated predictive factors for limb salvage and foot ulcer recurrence in patients with CLTI treated by a Japanese single-center intensive multidisciplinary team over 6 years. We retrospectively investigated 84 patients with CLTI and foot ulcers who had undergone revascularization and wound treatment between October 2013 and December 2019. Following postrevascularization treatment, including undertaking minor amputations, the healing rate was 77.8%, and the average wound healing time was 75 ± 68 days. To achieve adequate blood supply, 17.7% of patients were treated using a combination of endovascular revascularization and bypass surgeries. Thirty-three (44%) patients had wound recurrence and there was wound recurrence within 6 months in 58.9% of these patients. Multivariate logistic regression analysis showed that postrevascularization skin perfusion pressure was significantly associated with wound healing (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.033-1.243, P = .0078). Diabetes mellitus (OR 9.72, 95% CI 1.855-50.937, P = .0071), and heart disease (OR 3.51, 95% CI 1.052-11.693, P = .0411) were significantly associated with wound recurrence (P < .05). Treatment within a single-center intensive multidisciplinary team resulted in good patient outcomes. Our study indicates that the revascularization endpoint of CLTI treatment should be marked by attainment of adequate blood supply and wound healing. The timing of revascularization and debridement is of utmost importance for the successful treatment of CLTI wounds.

Genetic polymorphisms related to muscular strength and flexibility are associated with artistic gymnastic performance in the Japanese population.

This study aimed to examine how genetic polymorphisms related to muscular strength and flexibility influence artistic gymnastic performance in an attempt to identify a novel polymorphism associated with flexibility. In study 1, the passive straight-leg-raise (PSLR) score and aromatase gene CYP19A1 rs936306 polymorphism, a key enzyme for estrogen biosynthesis, were assessed in 278 individuals. In study 2, athletes (281 gymnasts and 1908 other athletes) were asked about their competition level, and gymnasts were assessed using the difficulty score (D-score) for each event. Muscular strength- (ACTN3 R577X rs1815739 and ACE I/D rs4341) and flexibility-related (ESR1 rs2234693 T/C and CYP19A1 rs936306 C/T) genetic polymorphisms were analyzed. In study 1, males with the CYP19A1 CT + TT genotype showed significantly higher PSLR scores than those with the CC genotype. In study 2, male gymnasts with the R allele of ACTN3 R577X showed a correlation with the floor, rings, vault, and total D-scores. In addition, male gymnasts with the C allele of ESR1 T/C and T allele of CYP19A1 C/T polymorphisms were correlated with the pommel horse, parallel bars, horizontal bar, and total D-scores. Furthermore, genotype scores of these three polymorphisms correlated with the total D-scores and competition levels in male gymnasts. In contrast, no such associations were observed in female gymnasts. Our findings suggest that muscular strength- and flexibility-related polymorphisms play important roles in achieving high performance in male artistic gymnastics by specifically influencing the performance of events that require muscular strength and flexibility, respectively.HighlightsEstrogen-related CYP19A1 polymorphism is a novel determinant of flexibility in males.Muscular strength- and flexibility-related polymorphisms play important roles in high performance in male artistic gymnastics.Genotypes of ACTN3 R577X, ESR1 rs2234693, and CYP19A1 rs936306 may contribute to training plan optimization and event selection in artistic gymnastics.

Passive Muscle Stiffness of Biceps Femoris is Acutely Reduced after Eccentric Knee Flexion.

Eccentric hamstring exercises reportedly prevent hamstring strain injury in the biceps femoris long head (BFlh). However, information on the favorable adaptive responses in the BFlh to eccentric hamstring exercises is limited. We aimed to examine the acute effect of maximal isokinetic eccentric knee flexion on passive BFlh stiffness as a potential risk factor for the hamstring strain injury using ultrasound shear wave elastography. Ten young participants randomly performed both tasks involving five consecutive repetitions of isokinetic concentric and eccentric knee flexion with maximal effort on different legs. Passive BFlh shear modulus was taken before and 30, 60, 90, and 120 s after each task. Passive BFlh shear modulus was significantly reduced at all time points after eccentric knee flexion, whereas there was no significant change in passive BFlh shear modulus after the concentric task. The present findings indicate that passive BFlh stiffness would reduce specifically after low-volume, slow-velocity eccentric knee flexion exercise. The findings may help provide practitioners with a basis to develop more effective exercise programs for preventing HSI.

Age-related changes in mechanical properties of semitendinosus tendon used for anterior cruciate ligament reconstruction.

BACKGROUND: Hamstring tendons are a popular choice for autografts in anterior cruciate ligament (ACL) reconstruction. However, there is increasing evidence that hamstring tendon autografts carry a high risk of revision and residual instability in young patients. To elucidate the reasons for the inferior outcome of the reconstructed ACL with hamstring tendon autografts in young patients, we investigated the Young's modulus and the extent of cyclic loading-induced slackening of the semitendinosus tendon used for ACL reconstruction across a broad range of ages. METHODS: Twenty-six male patients (aged 17-53 years), who were scheduled for ACL reconstruction surgery using the semitendinosus tendon autograft, participated in this study. The distal portion of the harvested semitendinosus tendon, which was not used to construct the autograft, was used for cyclic tensile testing to calculate the Young's modulus and the extent of slackening (i.e., increase in slack length). RESULTS: Spearman correlation analysis revealed that the Young's modulus of the semitendinosus tendon was positively correlated with the patient's age (ρ = 0.559, P = 0.003). In contrast, the extent of tendon slackening did not correlate with the patient's age. CONCLUSIONS: We demonstrated that the Young's modulus of the semitendinosus tendon increases with age, indicating that the semitendinosus tendon used for ACL reconstruction is compliant in young patients.

Effects of Quercetin Glycoside Supplementation Combined With Low-Intensity Resistance Training on Muscle Quantity and Stiffness: A Randomized, Controlled Trial.

Objective: Aging of skeletal muscle is characterized not only by a decrease of muscle quantity but also by changes in muscle quality, such as an increase in muscle stiffness. The present study aimed to investigate the effects of supplementation with quercetin glycosides (QGs), well-known polyphenolic flavonoids, combined with resistance exercise on muscle quantity and stiffness. Materials and Methods: A randomized, controlled trial was conducted in community-dwelling, Japanese people aged 50-74 years who were randomly allocated to exercise with placebo or 200 or 500 mg of QG supplementation. All participants performed low-intensity resistance training mainly targeting thigh muscles with 40% of 1-repetition maximum, 3 days per week for 24 weeks. Muscle cross-sectional area (CSA), lean mass, and vastus lateralis (VL) muscle stiffness were measured before and after the 24-week intervention. Results: Forty-eight subjects completed the 24-week intervention. There were no significant group × time interactions in thigh CSA for primary outcome, as well as lean mass. VL muscle stiffness in the stretched position was significantly lower in both the 200 mg and 500 mg QG groups than in the placebo group after the 24-week intervention (p < 0.05). No significant correlation was observed between changes of VL muscle CSA and stiffness during the 24-week intervention. Conclusion: Quercetin glycoside supplementation combined with low-intensity resistance exercise improved passive muscle stiffness independently of muscle quantity. Clinical Trial Registration: [www.umin.ac.jp/ctr/], identifier [UMIN000037633].

Effects of resistance training intensity on muscle quantity/quality in middle-aged and older people: a randomized controlled trial.

BACKGROUND: A sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality under the 2018 revised definition by the European Working Group on Sarcopenia in Older People 2. Imaging methods [i.e. magnetic resonance imaging (MRI)], dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance analysis are tools to evaluate muscle quantity or quality. The present study aimed to investigate whether and how low-intensity and moderate-intensity resistance training improved both muscle quantity and quality measured by MRI, DXA, and segmental bioelectrical impedance spectroscopy (S-BIS) in middle-aged and older people. METHODS: A single-blind, randomized, controlled trial was conducted. Community-dwelling people aged 50-79 years were randomly allocated to no exercise (no-Ex), low-intensity exercise (low-Ex), and moderate-intensity exercise (moderate-Ex) groups. Participants in the exercise groups performed resistance training for 24 weeks, with loads of 40% and 60% of one repetition maximum in the low-Ex and moderate-Ex groups, respectively. Cross-sectional area (CSA), lean mass, and muscle electrical properties on S-BIS were used to determine the effects of training interventions on muscle quantity and quality of the lower limbs. RESULTS: Fifty participants (no-Ex 17, age 63.5 ± 8.5 years, women 47.1%; low-Ex 16, age 63.6 ± 8.1 years, women 50.0%; moderate-Ex 17, age 63.5 ± 8.3 years, women 52.9%) completed the 24 week exercise intervention. For the primary outcome, significant intervention effects were found in thigh muscle CSA on MRI between the moderate-Ex and no-Ex groups (+6.8 cm2 , P < 0.01). Low-Ex for 24 weeks only increased quadriceps CSA (+2.3 cm2 , P < 0.05). The per cent change of thigh muscle CSA (+7.0%, P < 0.01) after 24 week moderate-Ex was higher than that of leg lean mass on DXA (+2.3%, P = 0.088). Moderate-Ex for 24 weeks also improved S-BIS electrical properties related to muscle quantity and quality, including the intracellular resistance index (+0.1 cm2 /Ω, P < 0.05), membrane capacitance (+0.7 nF, P < 0.05), and phase angle (+0.3 deg, P < 0.05); their changes were positively correlated with that of thigh muscle CSA (P < 0.01). CONCLUSIONS: Resistance exercise with moderate intensity improved muscle quantity and quality measured by MRI and S-BIS, whereas that with low intensity only increased muscle quantity in middle-aged and older people. The comparisons among the responses to exercise between the assessment methods indicate the greater value of MRI and S-BIS to measure changes of muscle quantity and quality than of lean mass measured by DXA for assessing the local effects of resistance training.

Comparison of Outcomes and Complications Among Patients with Different Indications of Acute/Subacute Complicated Stanford Type B Aortic Dissection Treated by TEVAR: Data from the JaPanese REtrospective multicenter stuDy of ThoracIc Endovascular Aortic Repair for Complicated Type B Aortic Dissection (J-Predictive Study).

PURPOSE: To investigate the relationships between indications for thoracic endovascular aortic repair for acute/subacute complicated Stanford type B aortic dissection and clinical outcomes, and complications specific to thoracic endovascular aortic repair. MATERIAL AND METHODS: The J-predictive study retrospectively collected data of patients treated with thoracic endovascular aortic repair for complicated Stanford type B aortic dissection at 20 institutions from January 2012 to March 2017. From the database, those treated for acute/subacute complicated Stanford type B aortic dissection were extracted (n = 118; 96 men; average age, 66.1 years; standard deviation, ± 13) and classified into groups 1, 2, and 3 according to thoracic endovascular aortic repair indications (rupture, superior mesenteric artery malperfusion, and renal or lower extremity malperfusion, respectively). Primary and secondary measures were mortality (overall and aortic-related) and complications related to thoracic endovascular aortic repair, respectively. For each outcome, the risks of being in groups 1 and 2 were statistically compared with that of being in group 3 as a control using Fisher's exact test. RESULTS: Mortality rate (odds ratio, 5.22; 95% confidence interval [CI], 1.33-20.53) and prevalence of paraparesis/paraplegia (odds ratio, 30.46; confidence interval, 1.71-541.77) were higher in group 1 than in group 3. Compared to group 3, group 2 showed no statistically significant differences in mortality or complications related to thoracic endovascular aortic repair. CONCLUSIONS: Rupture as an indication for thoracic endovascular aortic repair for type B aortic dissection was more likely to result in worse mortality and high prevalence of spinal cord ischemia. LEVEL OF EVIDENCE: Level 4, Case series.

Passive and active muscle elasticity of medial gastrocnemius is related to performance in sprinters.

PURPOSE: Limited information is available on the association between muscle material properties and sprint performance. We aimed to identify whether and how the elasticity of passive and active muscle of the medial gastrocnemius (MG) is related to sprint performance. METHODS: MG shear wave speed was measured under passive and active (20%, 50%, 80% of maximal voluntary contraction [MVC]) conditions, with ultrasound shear wave elastography, in 18 male sprinters. Passive and active ankle joint stiffness was assessed by applying a short-range fast stretch during 0%, 20%, 50%, and 80% MVC of plantar flexion. Additionally, rate of torque development (RTD) during explosive plantar flexion was measured. RESULTS: Passive and active MG shear wave speed was negatively correlated with 100-m race time. Passive MG shear wave speed was positively correlated with RTD, and RTD was negatively correlated with 100-m race time. MG shear wave speed at 50% and 80% MVC showed a positive correlation with ankle joint stiffness at the corresponding contraction level, and ankle joint stiffness at 50% and 80% MVC showed negative correlations with 100-m race time. These correlations were significant even after controlling for MVC torque. CONCLUSION: Our findings indicate that passive and active muscle elasticity of plantar flexor is important to achieve superior sprint performance. Specifically, high elasticity of passive MG could be related to superior sprint performance through high explosive torque production. In contrast, high elasticity of active MG at moderate-to-high intensity is likely related to high sprint performance through high ankle joint stiffness.

Characteristics of the Passive Muscle Stiffness of the Vastus Lateralis: A Feasibility Study to Assess Muscle Fibrosis.

Skeletal muscle fibrosis occurs with aging and has been suggested to impair muscle performance, thereby decreasing quality of life. Recently, muscle stiffness, a surrogate measure of muscle fibrosis, was noninvasively quantified as the shear modulus using ultrasound shear wave elastography (SWE) in humans. We aimed to investigate thigh muscle stiffness in females and males, respectively, across a broad range of ages by using SWE. Eighty-six community-dwelling Japanese people who were aged 30 to 79 years and did not regularly exercise participated in this study. The vastus lateralis (VL) shear modulus was measured at three different knee joint angles: full extension, 90° of flexion, and full flexion. There were no significant main effects of sex or age on the VL shear modulus in full extension or 90° of flexion of the knee. However, the VL shear modulus in knee full flexion was significantly smaller in females than in males and increased with age from 47.9 years. The results suggest that the accelerated increase in VL stiffness that occurs after an individual passes their late 40s may be an important therapeutic target for developing effective treatments and programs that preserve and improve quality of life.

Site-specific features of active muscle stiffness and proximal aponeurosis strain in biceps femoris long head.

Limited information is available on site-specific features of muscle stiffness and aponeurosis strain of the biceps femoris long head (BFlh) during contractions. Therefore, understanding of the mechanics and etiology of hamstring strain injuries remains difficult. As a first step to gain further insight into them, the present study aimed to identify whether active muscle stiffness and proximal aponeurosis strain during contractions are varied along the long axis of the BFlh. The BFlh muscle shear wave speed (proxy for stiffness) was measured in the proximal, central, and distal sites during 20%, 50%, and 80% of maximal voluntary isometric contraction (MVC) of knee flexion exerted with the hip and knee joints flexed at 40° and 30°, respectively, using ultrasound shear wave elastography. Further, a segmental strain of the BFlh proximal aponeurosis was assessed in the proximal, central, and distal sites during isometric knee flexion, using B-mode ultrasonography. The shear wave speed was significantly higher in the distal site than the proximal and central sites at 20% MVC (p ≤ .002, with a large effect size), whereas no significant difference was found between the three sites at 50% and 80% MVC. The BFlh proximal aponeurosis strain showed no significant difference between the proximal, central, and distal sites at any contraction intensity. These findings indicate that site-specific differences in muscle stiffness and proximal aponeurosis strain are substantially small and that muscle stiffness and proximal aponeurosis strain of the BFlh at moderate-to-high contraction intensity is not exceptional in the site where a sprinting-type hamstring strain typically occurs.

Association between medial gastrocnemius muscle-tendon unit architecture and ankle dorsiflexion range of motion with and without consideration of slack angle.

Joint flexibility is theoretically considered to associate with muscle-tendon unit (MTU) architecture. However, this potential association has not been experimentally demonstrated in humans in vivo. We aimed to identify whether and how MTU architectural parameters are associated with joint range of motion (RoM), with a special emphasis on slack angle. The fascicle length, pennation angle, tendinous tissue length, MTU length, and shear modulus of the medial gastrocnemius (MG) were assessed during passive ankle dorsiflexion using ultrasound shear wave elastography in 17 healthy males. During passive dorsiflexion task, the ankle joint was rotated from 40° plantar flexion to the maximal dorsiflexion joint angle at which each subject started experiencing pain. From the ankle joint angle-shear modulus relationship, the angle at which shear modulus began to rise (slack angle) was calculated. Two dorsiflexion RoMs were determined as follows; 1) range from the anatomical position to maximal angle (RoManat-max) and 2) range from the MG slack angle to maximal angle (RoMslack-max). The MTU architectural parameters were analyzed at the anatomical position and MG slack angle. The resolved fascicle length (fascicle length × cosine of pennation angle) and ratios of resolved fascicle or tendinous tissue length to MTU length measured at the MG slack angle significantly correlated with the RoMslack-max (r = 0.491, 0.506, and -0.506, respectively). Any MTU architectural parameters assessed at the anatomical position did not correlate with RoManat-max or RoMslack-max. These results indicate that MTUs with long fascicle and short tendinous tissue are advantageous for joint flexibility. However, this association cannot be found unless MTU architecture and joint RoM are assessed with consideration of muscle slack.

Female Athletes Genetically Susceptible to Fatigue Fracture Are Resistant to Muscle Injury: Potential Role of COL1A1 Variant.

PURPOSE: We aimed to investigate the hypothesis that type I collagen plays a role in increasing bone mineral density (BMD) and muscle stiffness, leading to low and high risks of fatigue fracture and muscle injury, respectively, in athletes. As a potential mechanism, we focused on the effect of the type I collagen alpha 1 chain gene (COL1A1) variant associated with transcriptional activity on bone and skeletal muscle properties. METHODS: The association between COL1A1 rs1107946 and fatigue fracture/muscle injury was evaluated in Japanese athletes. Effects of the polymorphism on tissue properties (BMD and muscle stiffness) and type I collagen α1/α2 chain ratios in muscles were examined in Japanese nonathletes. RESULTS: The C-allele carrier frequency was greater in female athletes with fatigue fracture than in those without (odds ratio = 2.44, 95% confidence interval [CI] = 1.17-5.77) and lower in female athletes with muscle injury than in those without (odds ratio = 0.46, 95% CI = 0.24-0.91). Prospective validation analysis confirmed that in female athletes, muscle injury was less frequent in C-allele carriers than in AA genotype carriers (multivariable-adjusted hazard ratio = 0.27, 95% CI = 0.08-0.96). Among female nonathletes, the C-allele of rs1107946 was associated with lower BMD and lower muscle stiffness. Muscle biopsy revealed that C-allele carriers tended to have a larger type I collagen α1/α2 chain ratio than AA genotype carriers (2.24 vs 2.05, P = 0.056), suggesting a higher proportion of type I collagen α1 homotrimers. CONCLUSION: The COL1A1 rs1107946 polymorphism exerts antagonistic effects on fatigue fracture and muscle injury among female athletes by altering the properties of these tissues, potentially owing to increased levels of type I collagen α1 chain homotrimers.

No Association of Plantar Aponeurosis Stiffness with Medial Longitudinal Arch Stiffness.

Lower stiffness of the medial longitudinal arch is reportedly a risk factor for lower leg disorders. The plantar aponeurosis is considered essential to maintaining the medial longitudinal arch. It is therefore expected that medial longitudinal arch stiffness is influenced by plantar aponeurosis stiffness. However, this has not been experimentally demonstrated. We examined the relationship between the plantar aponeurosis stiffness and medial longitudinal arch stiffness in humans in vivo. Thirty young subjects participated in this study. The navicular height and shear wave velocity (an index of stiffness) of the plantar aponeurosis were measured in supine and single-leg standing positions, using B-mode ultrasonography and shear wave elastography, respectively. The medial longitudinal arch stiffness was calculated based on body weight, foot length, and the difference in navicular height between the supine and single-leg standing conditions (i. e., navicular drop). Shear wave velocity of the plantar aponeurosis in the supine and single-leg standing positions was not significantly correlated to medial longitudinal arch stiffness (spine: r=-0.14, P=0.45 standing: r=-0.16, P=0.41). The findings suggest that the medial longitudinal arch stiffness would be strongly influenced by the stiffness of foot structures other than the plantar aponeurosis.

Aortic Rupture due to Co-localization of Aortic Intimal Myofibroblastic Sarcoma and Urothelial Carcinoma: A Unique Case Report.

We herein report a unique case of aortic rupture due to co-localization of aortic intimal myofibroblastic sarcoma (IMFS) and urothelial carcinoma (UC). A 76-year-old man who was being followed up after surgery for UC 5 years earlier developed aortic rupture and underwent emergency surgery. Intraoperatively, a tumorous mass on the luminal side of the aortic arch was found near the rupture. A histopathological analysis of the mass revealed aortic IMFS. Furthermore, co-localization of IMFS and UC cells was found near the rupture. The fragility of the aortic wall due to co-localization of IMFS and UC was believed to contribute to the aortic rupture.