[Primary Leiomyosarcoma of the Epididymis : A Case Report].

A 63-year-old man presented with right scrotal swelling. A physical examination revealed a painless, palpable mass in the right scrotum. The mass was well defined and lobulated. Subsequently, a diagnosis of right epididymal tumor was made, and right high orchiectomy was performed. Hematoxylin-eosin and immunostaining revealed leiomyosarcoma of the epididymis. When a diagnosis of epididymal malignant tumor is made, the standard treatment is radical orchiectomy.

Posteroanterior Segmental Displacement of the Lumbar Spine: Assessment Using Ultrasound in Asymptomatic Men.

OBJECTIVE: This study aimed to assess posteroanterior (PA) segmental displacement of the lumbar spine using ultrasound (US). METHODS: Eight asymptomatic male participants (20.1 ± 0.4 years) were included in this study. The relative depth between the tip of the L4 and L3 spinous processes from the US probe (mm) was measured using US in the following 7 conditions, which were without PA force, applying PA force of 9.8 newton (N), 19.6 N, 29.4 N, 39.2 N, 49.0 N, and 58.8 N to both sides of the L4 costal processes. The measurements were repeated twice within a day. The intraclass correlation coefficient, standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. A repeated-measures analysis of variance was also used to determine the influence of PA force on the relative depth. RESULTS: The intraclass correlation coefficients for the intrarater reliability of the 7 conditions were 0.95 (SEM: 0.43 mm, MDC: 1.19 mm), 0.93 (SEM: 0.45 mm, MDC: 1.25 mm), 0.93 (SEM: 0.47 mm, MDC: 1.30 mm), 0.95 (SEM: 0.37 mm, MDC: 1.02 mm), 0.95 (SEM: 0.40 mm, MDC: 1.10 mm), 0.96 (SEM: 0.38 mm, MDC: 1.04 mm), and 0.95 (SEM: 0.42 mm, MDC: 1.15 mm), respectively. The intrarater reliability of the relative depth using US was reliable. There was no significant change in the relative depth among the 7 conditions (F = 0.88, P = .41). Incrementally greater PA force was not related to greater intersegmental translation. CONCLUSION: Our US method could not detect PA segmental displacement of the lumbar spine.

[A Case of Extragonadal Germ Cell Tumor Treated by Induction Therapy with A Reduced Bep Regimen].

A 21-year-old man with chief complaints of left hypochondriac and chest pain was shown to have multiple masses in the lung, a pleural effusion in the right cavum thoracis, a mediastinal mass, and lymphadenopathy detected by computed tomographic scan. He was diagnosed with an extragonadal germ cell tumor based on pathologic findings from lung biopsies and elevation of the serum total human chorionic gonadotropin. He underwent a reduced chemotherapy regimen consisting of bleomycin, cisplatin, and etoposide (reduced BEP) to lower the risk of acute respiratory distress syndrome (ARDS), a manifestation of choriocarcinoma syndrome, which occurs at induction chemotherapy with the full-dose BEP regimen. Choriocarcinoma syndrome did not develop during chemotherapy, and he has been disease-free since salvage chemotherapy and subsequent retroperitoneal lymph node dissection.

Tape measure-based real-time feedback during the abdominal draw-in maneuver facilitates isolated transverse abdominal contraction.

[Purpose] Although the abdominal draw-in maneuver improves delayed onset of transverse abdomen in patients with low back pain, it is difficult to perform. We investigated whether the maneuver with tape measure-based feedback was more effective in facilitating isolated transverse abdominal muscle contractions than that without feedback in healthy participants. [Participants and Methods] Twenty healthy males performed the maneuver without feedback (control condition) and then with feedback using a tape measure (tape measure condition) in the crook lying, sitting, and standing positions. A B-mode ultrasonography imaging system was used to determine lateral abdominal muscle thicknesses, the percent changes from before the maneuver were calculated for each condition, and the main effects and interactions for each tested muscle were determined. [Results] The percent change in the thickness of the transverse abdominal muscle was significantly greater under the tape measure condition than under the control condition. The percent change in internal oblique thickness during the maneuver was significantly greater in the standing position than in the crook lying or sitting positions. Significant condition-by-position interactions were not observed for any of the examined muscles. [Conclusion] The abdominal draw-in maneuver with tape measure-based feedback may be more effective at facilitating isolated transverse abdominal contractions in all the positions than that without feedback.

A Method of Calculating Functional Independence Measure at Discharge from Functional Independence Measure Effectiveness Predicted by Multiple Regression Analysis Has a High Degree of Predictive Accuracy.

BACKGROUND: Multiple linear regression analysis is often used to predict the outcome of stroke rehabilitation. However, the predictive accuracy may not be satisfactory. The objective of this study was to elucidate the predictive accuracy of a method of calculating motor Functional Independence Measure (mFIM) at discharge from mFIM effectiveness predicted by multiple regression analysis. METHODS: The subjects were 505 patients with stroke who were hospitalized in a convalescent rehabilitation hospital. The formula "mFIM at discharge = mFIM effectiveness × (91 points - mFIM at admission) + mFIM at admission" was used. By including the predicted mFIM effectiveness obtained through multiple regression analysis in this formula, we obtained the predicted mFIM at discharge (A). We also used multiple regression analysis to directly predict mFIM at discharge (B). The correlation between the predicted and the measured values of mFIM at discharge was compared between A and B. RESULT: The correlation coefficients were .916 for A and .878 for B. CONCLUSION: Calculating mFIM at discharge from mFIM effectiveness predicted by multiple regression analysis had a higher degree of predictive accuracy of mFIM at discharge than that directly predicted.

Comparison of abdominal muscle activity and peak expiratory flow between forced vital capacity and fast expiration exercise.

[Purpose] The purpose of this investigation was to compare the activities of the abdominal muscles and peak expiratory flow between forced vital capacity and fast expiration exercise. [Subjects and Methods] Fifteen healthy male participated in this study. Peak expiratory flow and electromyographic activities of the rectus abdominis, external oblique, and internal oblique/transversus abdominis muscles were measured during forced vital capacity and fast expiration exercise and then peak amplitude and its appearance time were obtained. [Results] Peak expiratory flow values were significantly higher during fast expiration exercise than during forced vital capacity. The internal oblique/transversus abdominis muscles showed significantly higher peak amplitude during fast expiration exercise than during forced vital capacity. However, there were no significant differences between forced vital capacity and fast expiration exercise in the rectus abdominis and external oblique muscles. There was no difference in the appearance time of the peak amplitude between forced vital capacity and fast expiration exercise in any muscle. [Conclusion] Fast expiration exercise might be beneficial for increasing expiratory speed and neuromuscular activation of the internal oblique/transversus abdominis muscles compared to forced vital capacity. These findings could be considered when recommending a variation of expiratory muscle strength training as part of pulmonary rehabilitation programs.

Influence of the ultrasound transducer tilt on muscle thickness and echo intensity of the rectus femoris muscle of healthy subjects.

[Purpose] This study aimed to assess the influence of ultrasound (US) transducer tilt on muscle thickness and echo intensity of the rectus femoris muscle (RF) in healthy subjects. [Subjects and Methods] Fourteen healthy male subjects (20.8 ± 0.8 years) participated in this study. Transducer tilt was measured during US, with a digital angle gauge. Muscle thickness and echo intensity were measured in 4 transducer tilt conditions: reference angle; +3°; +6°; and +9° cranial from the reference angle. [Results] All differences in transducer tilt relative to the reference condition were larger than the minimal detectable change (MDC) of the reference condition. All differences in muscle thickness relative to the reference condition were not larger than the MDC of the reference condition. All differences in the echo intensity relative to the reference condition, except between the reference and the +3° condition, were larger than the MDC of the reference condition. [Conclusion] Our results indicated that an examiner should maintain a precise transducer tilt during repeated US measurements to quantify the minimal change in the echo intensity of the RF.

Availability of the Two-step Test to evaluate balance in frail people in a day care service.

[Purpose] This study evaluated balance tests in users of a day care service who needed nursing care or support, and investigated the usefulness of the Two-step Test for evaluating balance. [Subjects and Methods] The subjects were users of a day care service, and had certified need for long-term care or support. All subjects were able to undergo the balance evaluations. Balance tests included the 3-m Timed Up and Go test (TUG), the one-leg standing time, and the Two-step Test. [Results] The Two-step Test and other balance tests were strongly correlated. [Conclusion] In this study of subjects who needed nursing care or support, the results were the same as in a previous study of subjects who did not need nursing care or support. The Two-step Test should be considered as an indicator of balance ability in elderly individuals requiring nursing care or support.

Effects of fast expiration exercises without pressure on the respiratory muscle strength of healthy subjects.

[Purpose] The aim of this investigation was to determine the effects of 4 weeks of fast expiration exercises performed without pressure on respiratory muscle strength. [Subjects and Methods] Respiratory muscle strength of the training group that performed fast expiration exercises (n=12) was compared with that of a control group that performed no exercises (n=12). The fast expiration exercises were performed using a peak expiratory flow meter device and consisted of 20 fast expiration exercises performed 3 times per week for 4 weeks. Maximal expiratory and inspiratory pressures were evaluated as respiratory muscle strength using a spirometer pre- and post- intervention. [Results] There were significant increases in maximal expiratory pressure from 76.9 ± 29.1 to 96.1 ± 37.5 cmH2O and maximal inspiratory pressure from 80.8 ± 36.6 to 95.3 ± 37.6 cmH2O in the training group, but there was no significant difference in respiratory muscle strength between pre- and post-intervention in the control group. [Conclusion] Fast expiration exercises may be beneficial for increasing respiratory muscle strength. The findings of this study should be considered when prescribing a variation of the expiratory muscle strength training, as part of a pulmonary rehabilitation program.

Real-time air monitoring of mustard gas and Lewisite 1 by detecting their in-line reaction products by atmospheric pressure chemical ionization ion trap tandem mass spectrometry with counterflow ion introduction.

A new method enabling sensitive real-time air monitoring of highly reactive chemical warfare agents, namely, mustard gas (HD) and Lewisite 1 (L1), by detecting ions of their in-line reaction products instead of intact agents, is proposed. The method is based on corona discharge-initiated atmospheric pressure chemical ionization coupled with ion trap tandem mass spectrometry (MS(n)) via counterflow ion introduction. Therefore, it allows for highly sensitive and specific real-time detection of a broad range of airborne compounds. In-line chemical reactions, ionization reactions, and ion fragmentations of these agents were investigated. Mustard gas is oxygenated in small quantity by reactive oxygen species generated in the corona discharge. With increasing air humidity, the MS(2) signal intensity of protonated molecules of mono-oxygenated HD decreases but exceeds that of dominantly existing intact HD. This result can be explained in view of proton affinity. Lewisite 1 is hydrolyzed and oxidized. As the humidity increases from zero, the signal of the final product, namely, didechlorinated, dihydroxylated, and mono-oxygenated L1, quickly increases and reaches a plateau, giving the highest MS(2) and MS(3) signals among those of L1 and its reaction products. The addition of minimal moisture gives the highest signal intensity, even under low humidity. The method was demonstrated to provide sufficient analytical performance to meet the requirements concerning hygienic management and counter-terrorism. It will be the first practical method, in view of sensitivity and specificity, for real-time air monitoring of HD and L1 without sample pretreatment.

Correlation Between Abdominal Muscle Thickness and Maximal Expiratory Pressure.

OBJECTIVES: The activity of abdominal muscles mainly produces high expiratory pressure. These include the rectus abdominis, external oblique, internal oblique, and transverse abdominis muscles. The purpose of this study was to determine whether maximal expiratory pressure is associated with each abdominal muscle thickness at rest. METHODS: Thirty-nine healthy male volunteers (mean age ± SD, 20.7 ± 2.7 years) participated in the study. The thickness of the right rectus abdominis, external oblique, internal oblique, and transverse abdominis muscles was measured by B-mode sonography in the supine position. The maximal expiratory pressure was obtained with a spirometer in the sitting position. The correlations between each abdominal muscle thickness and maximal expiratory pressure were determined by the Pearson correlation coefficient. RESULTS: The correlation coefficient between the rectus abdominis muscle and maximal expiratory pressure was 0.571 (P< .001). Correlation coefficients between the external oblique, internal oblique, and transverse abdominis muscles and maximal expiratory pressure were 0.297 (P = .066), 0.267 (P = .100), and 0.022 (P = .894), respectively. CONCLUSIONS: Our results indicate that the rectus abdominis muscle thickness might be more highly correlated with expiratory pressure production than the external oblique, internal oblique, and transverse abdominis muscle thickness.

Investigation of effect of leg support elevation timing on the horizontal force acting on the buttocks in a reclining wheelchair.

[Purpose] The purpose of this study was to investigate the effect of the timing of leg support elevation on the horizontal force acting on the buttocks in a reclining wheelchair. [Subjects and Methods] The participants were 17 healthy men. Two experimental conditions were tested: the leg-down and leg-up conditions. The back support was reclined at increasing angles, from the initial upright position (IUP), proceeding to the fully reclined position (FRP), and returned to the upright position (RUP). The posterior inclination phase was from IUP to FRP, and the returning inclination phase was from FRP to RUP. [Results] The horizontal force under the leg-up condition was significantly higher than that under the leg-down condition in all positions of back support. [Conclusion] The leg supports should be positioned downward before reclining the back support of a wheelchair.

Effect of abduction and external rotation of the hip joint on muscle onset time during prone hip extension with knee flexion.

[Purpose] This study investigated the effect of hip position on muscle onset time during prone hip extension with knee flexion. [Subjects] The study included 21 healthy male volunteers. [Methods] Muscle onset times of the right gluteus maximus, right hamstrings, bilateral lumbar erector spinae, and bilateral lumbar multifidus were measured using surface electromyography during right hip extension with knee flexion in the prone position. Measurements were made with the hip in 3 positions: (1) neutral, (2) abduction, and (3) abduction and external rotation. [Results] Gluteus maximus onset relative to the hamstrings was significantly earlier with hip abduction and with hip abduction and external rotation compared with that with the hip in the neutral position. Gluteus maximus onset relative to the hamstrings was significantly earlier with hip abduction and external rotation compared with that with hip abduction. The bilateral multifidus and left lumbar erector spinae onset times relative to the hamstrings were significantly earlier with hip abduction and external rotation compared with those with hip abduction and with the hip in the neutral position. [Conclusion] Abduction and external rotation of the hip during prone hip extension with knee flexion is effective for advancing the onset times of the gluteus maximus, bilateral multifidus, and contralateral lumbar erector spinae.

Sensitive and comprehensive detection of chemical warfare agents in air by atmospheric pressure chemical ionization ion trap tandem mass spectrometry with counterflow introduction.

A highly sensitive and specific real-time field-deployable detection technology, based on counterflow air introduction atmospheric pressure chemical ionization, has been developed for a wide range of chemical warfare agents (CWAs) comprising gaseous (two blood agents, three choking agents), volatile (six nerve gases and one precursor agent, five blister agents), and nonvolatile (three lachrymators, three vomiting agents) agents in air. The approach can afford effective chemical ionization, in both positive and negative ion modes, for ion trap multiple-stage mass spectrometry (MS(n)). The volatile and nonvolatile CWAs tested provided characteristic ions, which were fragmented into MS(3) product ions in positive and negative ion modes. Portions of the fragment ions were assigned by laboratory hybrid mass spectrometry (MS) composed of linear ion trap and high-resolution mass spectrometers. Gaseous agents were detected by MS or MS(2) in negative ion mode. The limits of detection for a 1 s measurement were typically at or below the microgram per cubic meter level except for chloropicrin (submilligram per cubic meter). Matrix effects by gasoline vapor resulted in minimal false-positive signals for all the CWAs and some signal suppression in the case of mustard gas. The moisture level did influence the measurement of the CWAs.

Effect of rotational axis position of wheelchair back support on shear force when reclining.

[Purpose] The purpose of this study was to investigate the influence of the rotational axis position of a reclining wheelchair's back support on fluctuations in the shear force applied to the buttocks while the back support is reclined. [Subjects] The subjects were 12 healthy adult men. [Methods] The shear force applied to the buttocks was measured using a force plate. This study used two different experimental conditions. The rotational axis of the back support was positioned at the joint between the seat and the back support for the rear-axis condition, and was moved 13 cm forward for the front-axis condition. [Results] With the back support fully reclined, the shear forces were 11.2 ± 0.8%BW and 14.1 ± 2.5%BW under the rear-axis and front-axis conditions, respectively. When returned to an upright position, the shear forces were 17.1 ± 3.1%BW and 13.8 ± 1.7%BW under the rear-axis and front-axis conditions, respectively. Significant differences appeared between the two experimental conditions (p < 0.01). [Conclusion] These results suggest that the shear force value could be changed by altering the position of the back support's rotational axis during reclining.

Correlation between Peak Expiratory Flow and Abdominal Muscle Thickness.

[Purpose] The purpose of this study was to determine whether forced expiration is correlated with abdominal muscle thickness. [Subjects] Twenty-three healthy male volunteers participated in this study. [Methods] The peak expiratory flow (PEF) was obtained using a peak flow meter with subjects in the sitting position. The thicknesses of the right rectus abdominis, external oblique, internal oblique, and transverse abdominis muscles were measured using B-mode ultrasonography at the end of a relaxed expiration in the supine position. [Results] Among the abdominal muscles, only the thickness of the external oblique muscle displayed a significant correlation with PEF. [Conclusion] It appears that the thickness of the external oblique muscle might be associated with PEF during forced expiration.

Slow Expiration Reduces External Oblique Muscle Activity during Maximum Trunk Flexion.

[Purpose] The purpose of this study was to demonstrate the effects of expiration on abdominal muscle activity during maximum trunk flexion. [Subjects] Twenty-one healthy university students (10 men, 11 women) participated in this study. [Methods] Electromyography (EMG) was used to quantify the activity of the right rectus abdominis, external oblique, and internal oblique muscles. The paired t-test was used to examine the significance of differences in the abdominal muscles between maximum trunk flexion with breath holding and slow expiration. [Results] There was a significantly lower EMG activity in the external oblique muscle during maximum trunk flexion with slow expiration. [Conclusion] The results of this study indicate that slow expiration reduces external oblique muscle activity during maximum trunk flexion performed by healthy young subjects.

Influence of Hip Joint Position on Muscle Activity during Prone Hip Extension with Knee Flexion.

[Purpose] This study investigated the selective activation of the gluteus maximus during a prone hip extension with knee flexion exercise, with the hip joint in different positions. [Subjects] The subjects were 21 healthy, male volunteers. [Methods] Activities of the right gluteus maximus, right hamstrings, bilateral lumbar erector spinae, and bilateral lumbar multifidus were measured using surface electromyography during a prone hip extension with knee flexion exercise. Measurements were made with the hip joint in each of 3 positions: (1) a neutral hip joint position, (2) an abduction hip joint position, and (3) an abduction with external rotation hip joint position. [Results] Gluteus maximus activity was significantly higher when the hip was in the abduction with external rotation hip joint position than when it was in the neutral hip joint and abduction hip joint positions. Gluteus maximus activity was also significantly higher in the abduction hip joint position than in the neutral hip joint position. Hamstring activity was significantly lower when the hip was in the abduction with external rotation hip joint position than when it was in the neutral hip joint and abduction hip joint positions. [Conclusion] Abduction and external rotation of the hip during prone hip extension with knee flexion exercise selectively activates the gluteus maximus.

Kinetic resolution of planar-chiral 1,2-disubstituted ferrocenes by molybdenum-catalyzed asymmetric intraannular ring-closing metathesis.

Planar chirality: Ring-closing metathesis of 1,2-diallylmetallocenes afforded the corresponding 4,7-dihydroindenyl species in high yields. The metallocenes are planar chiral with two different allylic substituents, and kinetic resolution of the racemic 1,2-diallylmetallocene derivatives was realized by molybdenum-catalyzed asymmetric ring-closing metathesis with excellent enantioselectivity (see scheme).

Rapid Destructive Arthropathy of the Knee in Parkinson's Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome.

The changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson's disease (PD; Hoehn-Yahr stage IV) had severe knee pain with moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II). Conservative therapy had no effect at all, and the knee developed destructive osteoarthritis rapidly without any traumatic episodes. The radiographic findings progressed to Kellgren-Lawrence grade IV within a month. Magnetic resonance imaging revealed partial depression of the joint surface, including shredded ossicles and substantial amounts of synovial fluid. The imaging findings were considered to be caused by a subchondral insufficiency fracture (SIF). Total knee arthroplasty was performed using a semiconstrained prosthesis. The alignment of her lower extremity improved, and the patient could walk without knee pain. The patient had Pisa syndrome, a lateral flexion of the trunk, which is a postural deformity of the trunk secondary to long-standing PD. The postural deformity in PD is not based on spinal deformity itself but on the loss of postural reflexes and the imbalance of muscle tonus. Her left knee pain appeared 1 month after L1-L4 posterior lumbar interbody fusion (PLIF) as the Pisa syndrome to her left side worsened. The more the trunk tilts to the lateral side, the center of the gravity axis will shift and pass through more lateral points of the knee and result in higher knee load. The stress concentration from the spine to the lateral joint of the knee caused lateral knee osteoarthritis, namely, knee-spine syndrome. When patients undergo correction surgery for adult spinal disorder with impairment of postural reflexes, they need to be followed up carefully regarding not only the spinal alignment but also the lower extremities.