THU0208 AFFECTING COMMON BIOLOGICAL PROCESSES OR DISPARATE?: COMPARISON OF GENE-EXPRESSION MODIFICATION PROFILES AMONG TARGETING IL-6 AND TARGETING SPECIFIC JAK TREATMENTS

Background:

After accumulation of evidences, it is recognized that inhibition of IL-6 signaling is one of the most established strategies for rheumatoid arthritis (RA) treatment. Tocilizumab (TCZ), an anti-IL6 receptor monoclonal antibody, is the pioneer which blocks IL-6 signaling by preventing IL-6 from binding to both membrane-bound and soluble receptors. Tofacitinib (TOF) inhibits Janus kinase (JAK) 1, JAK3 and, to a lesser extent, JAK2. Recently, Baricitinib (BAR), JAK 1 and JAK2 selective kinase inhibitor, were also approved to treat RA. These JAK inhibitors are known to inhibit cytokine signaling including interleukin (IL)-6. It is very important for clinicians to know whether these treatments affect common biological processes or disparate, because it will provide a rationale for switching each other if one of these treatments resulted in lack of efficacy.

Objectives:

To compare the gene-expression modification profiles among TOF, BAR and TCZ treatments.

Methods:

Total of 38 RA cases were analyzed, including TOF (n=15: 6-20mg/d), BAR (n=10: 2-4mg/d) and TCZ (n=13: 8mg/kg/4w or 163mg/2w) treatment groups. Peripheral blood was drawn at just before (pre) and 3 months after (post) these treatments. Total RNAs were then extracted with using PAXgene miRNA kit. After constructing single-stranded, strand-specific libraries, multiplex sequencing was done. After quantifying the expressions of transcripts, differentially expressed genes (DEGs) were selected by paired comparison (post vs. pre), setting thresholds at 2-fold change up/down and less than P=0.05 in paired T-test. And then, hierarchical clustering analysis and enrichment analysis using gene ontology (GO) terms were performed.

Results:

From the comparison of post- vs. pre-treatment of TOF, BAR and TCZ, the 120 (up-regulated=25/down-regulated=95), 62 (up=20/down=42) and 193 (up=54/ down=139) genes were selected as DEGs respectively. It seems to be discrete depending on the treatment, because overlapped genes were only 1.0% in up-regulated and 5.7% in down-regulated genes. The hierarchical clustering with expression profiles of these DEGs showed major 4 clusters. 92.3% of TCZ and 70% of BAR cases were segregated into 1stand 3rdclusters respectively, while those of TOF cases fell into 2ndand 4thclusters. Disparate GO terms were enriched in each DEGs group. For example, genes relevant to viral defense including ‘response to type I interferon (IFN)’ were suppressed in TOF group. Meanwhile, down regulation of genes involved in phosphorylation process including ‘IL-7 signaling’ seemed to be significant in BAR group. It is noteworthy that terms related to wound healing such as ‘platelet activation’ were enriched in the down-regulated genes of TCZ group.

Conclusion:

It is speculated that the downstream biological cascade for TOF, BAR and TCZ treatment might be shared, as IL-6 signaling is mediated by JAK1/JAK2/TYK2 activation. However, the influence of these treatments over the transcriptome in the peripheral blood seems to be disparate. Enrichment analysis using GO terms also indicated that different biological processes were involved in the effect of each treatment. Our findings will support a rationale for switching each other if one of these treatments resulted in lack of efficacy. An increased risk of herpes zoster by a treatment with JAK inhibitors has been well recognized. It makes sense because IFN signaling is also mediated by JAK/STAT pathway. On the other hand, we have experienced a case with exacerbation of skin ulcer during TCZ treatment despite the activity of RA was absolutely under control. It is accounted for by the suppression of genes involved in wound healing after TCZ treatment.

Disclosure of Interests: :

Yoshinobu Koyama Grant/research support from: Eli-Lilly and Mochida., Speakers bureau: BMS, Ayumi, Chugai, Ono, Mitsubishi Tanabe, Abbvie and Eisai., Yoshiharu Sato: None declared, Moe Sakamoto: None declared, Hiroshi Iijima: None declared, Toshie Higuchi: None declared

Fact-finding survey regarding judo-related injuries of judokas in developing country

[Purpose] The purpose of this study was to investigate sports-related injuries among judokas in Mongolia which is classified in the lower-middle income country. This study may help prevent future sports-related injuries. [Participants and Methods] We studied 75 judokas affiliated to the judo club in Ulaanbaatar, Mongolia. The questionnaire survey included questions regarding current and past judo-related injuries. [Results] Out of 75 judokas, 39% judokas had current judo-related injuries, and 25% judokas had past injuries. The injuries were most commonly located in the shoulder/clavicular, followed by that in the ankle and knee. The most frequent injury was a sprain/ligament injury, followed by a fracture and a dislocation. Seventy-three percent of current injuries and 88% of the past injuries received medical attention. Self-management was carried out for 35% of the injuries. The time lost from judo matches and training was 0–1,095 days for current injuries and 0–545 days for past injuries. [Conclusion] In this study, the injury rate for judokas was higher than that reported in previous studies. In addition, numerous severe injuries were noted. It is observed that, despite medical attention and self-management, the recovery periods are prolonged. Additionally, we believe that the judokas are unable to return to competition without problems.

Analysis of lower extremity side-reaching motion in junior high school baseball players

[Purpose] The aim of this study was to clarify the movement pattern of the pelvis and trunk of junior high school baseball players based on the lateral reach motion of the lower limb, which is related to poor pitching movement. [Participants and Methods] Twenty-five male students belonging to a baseball club participated in this study. Each participant performed the lower limb side reach movement in the standing position, during which the movements of the knee joint, hip joint, pelvis, and trunk were analyzed. [Results] A significant correlation was found between reach distance and reach leg hip abduction, supporting leg hip abduction, trunk side bending, and trunk tilt. We found a significant correlation between reach leg hip abduction and pelvic tilt and trunk side bending and between supporting leg hip abduction and pelvic tilt, knee valgus, and trunk side bending. Furthermore, we found a significant correlation between knee valgus and lower leg tilt and trunk tilt and between trunk side bending and pelvic tilt. [Conclusion] This study suggests that in the standing position movement at this age, the hip and trunk movements are related to and affect performance.

Flexor pronator muscles' contribution to elbow joint valgus stability: ultrasonographic analysis in high school pitchers with and without symptoms

Background

Few researchers have examined the different contributions of flexor-pronator muscles to valgus stress in high school baseball pitchers with and without elbow symptoms. This study used ultrasonography to assess these muscles' dynamic contributions to elbow valgus joint stability in high school pitchers.

Methods

A self-administered questionnaire on throwing-related elbow joint pain sustained during the prior year was completed by 89 high school baseball pitchers. Gravity stress ultrasonographic elbow examinations with 30° of flexion were done before and after isometric contraction of the flexor-pronator muscles. For study participants with and without a history of elbow symptoms, we compared differences of ulnohumeral joint space without gravity stress and isometric contraction of the flexor-pronator muscles and with gravity stress only and with isometric contraction of the flexor-pronator muscles under gravity stress.

Results

For each pitcher, the ulnohumeral joint space in the condition with valgus stress was significantly larger than in the condition without valgus stress. Also, the ulnohumeral joint space in the condition with valgus stress was significantly larger than in the condition with valgus stress and flexor-pronator isometric muscle contraction. Participants with and without elbow symptom history showed no differences of ulnohumeral joint space in the unloaded and loaded flexor-pronator muscle contracted conditions.

Conclusion

Ultrasonographic assessment demonstrated that flexor-pronator muscles contribute to elbow valgus stability. No difference was found in the flexor-pronator muscle contribution in high school baseball pitchers with and without elbow symptom history.

P6332Prevalence and prognostic impact of sarcopenia identified according to Asia Working Group for Sarcopenia definition in non-dependent elderly patients with heart failure

Background

Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and muscle function. As the population ages, there is a growing worldwide interest in the intersection of sarcopenia and heart failure (HF). However, estimates of the prevalence of sarcopenia in HF vary widely because of difference in diagnostic criteria. Although the Asian Working Group of Sarcopenia (AWGS) has announced a consensus on the diagnostic criteria of sarcopenia in Asian people, the prevalence and prognostic impact of sarcopenia based on AWGS criteria in patients with HF remains unclear.

Purpose

The aim of this study was to investigate the prevalence and predictive value of sarcopenia identified according to AWGS definition in non-dependent elderly patients with HF.

Methods

This study was a prospective, single-center cohort study in Japan. We consecutively enrolled 274 patients, aged 65 years or older, hospitalized due to acute HF or acute exacerbation of chronic HF and who were able to walk at least 20 m at discharge. Patients with severe cognitive or psychiatric disorders were excluded. Patients with implantable cardiac pacemaker or cardioverter defibrillator were also excluded because skeletal muscle mass was estimated by using bioimpedance analysis. At hospital discharge, we collected data on age, gender, left ventricular ejection fraction, brain natriuretic peptide, estimate glomerular filtration rate, body mass index and sarcopenia. Sarcopenia was diagnosed according to the AWGS criteria: low skeletal muscle index (<7.0 kg/m2 in men, <5.7 kg/m2 in women) and either slow usual walking speed (<0.8 m/s) or low handgrip strength (<26 kg in men, <17 kg in women). Study outcome was rehospitalization for worsening HF within 180 days after discharge. We assessed the independent association between sarcopenia and HF rehospitalization by using multivariate Cox proportional hazards regression analysis.

Results

In this study, a total of 199 patents (43.4%) fulfilled sarcopenia criteria at discharge. During follow-up, 57 patients (20.8%) readmitted for HF. Kaplan-Meier survival curves showed that patients with sarcopenia had significantly lower event-free survival than those without sarcopenia (Figure). After adjusting for other prognostic factors, sarcopenia was independently associated with HF rehospitalization (hazard ratio: 2.31, 95% confidence interval: 1.20–4.53).

Conclusion

Based on AWGS criteria, sarcopenia is highly prevalent even among non-dependent elderly HF patients, and is an independent strong predictor of rehospitalization for worsening HF. AWGS criteria for sarcopenia may be useful for risk prediction in HF.

Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries

Background

A 9-valent human papillomavirus-6/11/16/18/31/33/45/52/58 (9vHPV) vaccine extends coverage to 5 next most common oncogenic types (31/33/45/52/58) in cervical cancer versus quadrivalent HPV (qHPV) vaccine. We describe efficacy, immunogenicity, and safety in Asian participants (India, Hong Kong, South Korea, Japan, Taiwan, and Thailand) from 2 international studies: a randomized, double-blinded, qHPV vaccine-controlled efficacy study (young women aged 16–26 years; NCT00543543; Study 001); and an immunogenicity study (girls and boys aged 9–15 years; NCT00943722; Study 002).

Methods

Participants (N = 2519) were vaccinated at day 1 and months 2 and 6. Gynecological samples (Study 001 only) and serum were collected for HPV DNA and antibody assessments, respectively. Injection-site and systemic adverse events (AEs) were monitored. Data were analyzed by country and vaccination group.

Results

9vHPV vaccine prevented HPV-31/33/45/52/58–related persistent infection with 90.4%–100% efficacy across included countries. At month 7, ≥97.9% of participants seroconverted for each HPV type. Injection-site AEs occurred in 77.7%–83.1% and 81.9%–87.5% of qHPV and 9vHPV vaccine recipients in Study 001, respectively, and 62.4%–85.7% of girls/boys in Study 002; most were mild to moderate.

Conclusions

The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Asian participants. Data support 9vHPV vaccination programs in Asia.

Clinical Trials Registration

NCT00543543; NCT00943722.

Shoulder and elbow pain in junior high school baseball players: Results of a nationwide survey

BACKGROUND

Despite proposals and guidelines to prevent baseball injuries in young players by societies and organizations, many shoulder and elbow injuries continue to occur among junior high school baseball players. In order to investigate the training conditions of junior high school baseball players and the risk factors for shoulder and elbow pain in the players, we conducted a questionnaire survey among junior high school baseball players throughout the country.

METHODS

The questionnaire survey was conducted among junior high school baseball players in September 2016.

RESULTS

A total of 11,134 junior high school baseball players belonging to 495 teams responded to the survey. Among these, 4004 players trained every day of the week and 1151 players played baseball games every month with no off-season. Among 9752 players who did not have shoulder and/or elbow pain in the spring and summer of 2015, 19.2% of players experienced elbow pain over the course of one year, 13.6% of players experienced shoulder pain, and 28.0% complained of shoulder and/or elbow pain. The frequency of elbow pain was more than that of shoulder pain. At risk for shoulder pain were pitchers and catchers and second-year students, while risk factors for elbow pain were playing pitcher and catcher positions, pitching or throwing ≥300 balls per week, playing ≥10 games on average per month and being left-handed.

CONCLUSION

Risk factors for shoulder pain were different from those for elbow pain. To prevent elbow pain, coaches should pay attention to pitchers and catchers and left-handed players and not allow players to pitch or throw ≥300 full-power balls per week or participate in ≥10 games per month. They should also pay attention to pitchers and catchers and second-year students to prevent shoulder pain. It is important for coaches to train multiple pitchers and catchers.

Identification of eyes at risk of acute primary angle-closure in elderly Japanese patients

Purpose: To identify from the anterior segment the structural variables of the eyes that can be used to distinguish acute primary angle-closure (APAC) eyes or primary angle-closure suspect (PACS) eyes from normal eyes.

Patients and methods: We used a Pentacam scanner to measure participants’ anterior eye segments. We assessed each anterior segment structure variable on the basis of receiver operating characteristic curves using the area under the curve (AUC).

Results: AUCs for eyes in men with APAC were 1.000 for central anterior chamber depth (ACD), 0.982 for peripheral ACD, 0.916 for anterior chamber angle (ACA), and 0.992 for anterior chamber volume (ACV). AUCs for eyes in women with APAC were 0.997 for central ACD, 0.942 for peripheral ACD, 0.922 for ACA, and 0.946 for ACV. AUCs for eyes in men with PACS were 0.933 for central ACD, 0.930 for peripheral ACD, 0.887 for ACA, and 0.937 for ACV. AUCs for eyes in women with PACS were 0.960 for central ACD, 0.957 for peripheral ACD, 0.937 for ACA, and 0.937 for ACV. The negative predictive values (%) in men with APAC were 100 for all the four variables (central ACD, peripheral ACD, ACA, and ACV). The negative predictive values (%) in women with APAC were 100 for central ACD, 98.7 for peripheral ACD, 97.1 for ACA, and 97.9 for ACV. The negative predictive values (%) in men with PACS were 98.6 for central ACD, 100 for peripheral ACD, 98.5 for ACA, and 99.4 for ACV. The negative predictive values (%) in women with PACS were 100 for central ACD, 98.7 for peripheral ACD, 97.1 for ACA, and 97.9 for ACV.

Conclusions: The central ACD, peripheral ACD, ACA, and ACV measurements seem to be excellent markers to identify eyes without APAC or PACS.

Intra-rater reliability and criterion-related validity of using an accelerometer to measure the impact force and knee joint sway during single-leg drop landing

[Purpose] This study aimed to clarify the reliability and validity of the impact force and knee joint sway measurement during single-leg drop landing by using a motion sensor with two built-in accelerometers. [Participants and Methods] Ten healthy college students (4 males and 6 females) who joined a basketball club participated in this study. Peak vertical acceleration, time between initial contact and peak vertical acceleration, and knee joint mediolateral sway were measured using the accelerometer during the landing motion. Reliability of the measurement with the accelerometer and the criterion-related validity between the accelerometer and force plate data were examined. [Results] The intraclass correlation coefficients indicated a peak vertical acceleration of 0.88, time between initial contact and peak vertical acceleration of 0.96, and knee joint mediolateral sway of 0.62. The magnitude and timing of the peak values between both measurement instruments showed high validity. [Conclusion] The measurement method using a motion sensor for the evaluation of the impact force and knee joint sway during landing has a moderate to high reliability and criterion-related validity. A motion sensor measurement might be a useful and easy method for evaluating landing impact force and knee joint stability.

Retrospective survey of sport climbing injuries and self-care in the Gunma prefecture

[Purpose] This study aimed to investigate sport climbing injuries among users of a climbing gym to identify the characteristics of the injuries and preventive measures. [Participants and Methods] Participants with at least 6 months of sport climbing experience at least once a week were included in the study. They provided basic information with regard to climbing, medical history, and self-care of climbing-related injuries. [Results] Of 113 validated respondents, 85 reported a history of climbing-related injuries. The injury occurrence rate by location was highest in the fingers, followed by the wrist, shoulder and ankle, knee, and elbow. All the ankle injuries had sudden onset. Moreover, the occurrence rates of the injuries with both sudden and gradual onsets tended to be higher in the fingers and wrists. With regard to the self-care status, warming up was performed by 88.5% of the participants; and cooling down, by only 25.7%. [Conclusion] This study found a high incidence of injuries involving the fingers, wrists, and ankles, which suggests the need for prevention by self-care.

Relationship between foot alignment and floating toes classified in static and dynamic conditions in females

[Purpose] This study aimed to investigate the plantar contact condition in females and to clarify the relationship between the foot alignment and floating toes classified in static and dynamic conditions. [Participants and Methods] The participants were 122 females. We evaluated the plantar contact condition, calculated the floating toe score, and classified the floating toes of the participants. The floating toes were classified into improvable and unimprovable floating toe groups based on the floating toe score measured in dynamic conditions. Furthermore, foot alignment was evaluated in 35 participants randomized and extracted from the contact toe and the improvable and unimprovable floating toe groups. [Results] The Arch Height Index in the unimprovable floating toe group was significantly smaller than that in the improvable floating toe group. The digitus minimus varus angle in the unimprovable floating toe group was significantly larger than that in the improvable floating toe group. No significant differences were observed in other items. [Conclusion] This study revealed that the foot alignment between the improvable and unimprovable floating toe groups has different features. However, no significant difference was found in the foot alignment between the contact and floating toe groups. Henceforth, it is necessary to evaluate and classify floating toes considering the functional aspects.

Effect of toe contact condition during forward stepping on the ground reaction forces during turning movement

[Purpose] This study aimed to classify the plantar contact condition during forward stepping by focusing on the medial and lateral toes and to elucidate the relationship between the classification and turning movement. [Participants and Methods] The participants were 38 females. The plantar contact condition during forward stepping was evaluated for all participants, and the results were used for the group classification. In all the classified participants, the ground reaction force (GRF) during turning movement was measured. [Results] At sidestep (SS) and cross-step (CS), the peak medial-lateral GRF was significantly smaller in the medial floating toe (MFT) group than in the contact toe (CT) group. At SS, the peak times of the medial-lateral GRF in the MFT and lateral floating toe groups were significantly lesser than those in the CT group. At CS, the push-off peak time of the anterior-posterior GRF was significantly lesser in the MFT group than in the CT group. [Conclusion] The results of this study confirmed that each group classified according to the floating toe classification during forward stepping has different characteristics with respect to the ground reaction force during the turning movement, particularly the medial-lateral ground reaction force and its peak time.

Self-Feeding Ability as a Predictor of Mortality Japanese Nursing Home Residents: A Two-Year Longitudinal Study

OBJECTIVES

To examine the ability of different elements of the Self-Feeding Assessment Tool for Elderly with Dementia (SFED) to predict mortality risk in nursing home residents.

DESIGN AND SETTING

Data from 387 residents in five nursing homes for the elderly in Japan were obtained using a baseline survey. This measure's ability to predict mortality risk was examined over a two-year observation period. Participants and Measurement: Demographic information (sex, age, height, weight, medical history) on 387 initial participants was gathered. A total of 10 individuals were excluded from the analysis because of the inability to eat by mouth at baseline, while 36 were excluded owing to missing mortality data during the observation period. The resulting 341 residents were divided into a death group or survival group according to whether they were still alive after two-year observation period. In addition to basic information and the SFED, the baseline survey included the Barthel Index (BI), Clinical Dementia Rating (CDR), and Mini Nutritional Assessment-Short Form (MNA®-SF). The ability of SFED to predict time-to-event mortality was examined using Cox proportional hazards regression analysis, including other measures associated with mortality as confounding variables.

RESULTS

In total, 129 participants (37.8%) died during the observation period, and their mean SFED score was significantly lower than that of surviving ones (11.1 ± 6.7 vs. 15.0 ± 5.6, P<0.001). SFED score was significantly associated with two-year mortality in the Cox proportional hazards regression analysis after adjusting for sex, age, medical history, BI, CDR, and MNA®-SF (hazard ratio = 0.941, 95% confidence interval = 0.898-0.985, P = 0.010). Additionally, three SFED categories were significantly associated with mortality risk: movement ("able to eat without dropping food"), concentration ("able to maintain attention to meal"), and safety ("able to swallow without choking, with no change in vocal quality after eating").

CONCLUSIONS

Self-feeding ability as measured by SFED score was associated with long-term mortality in elderly living in nursing homes. Accordingly, adjusting feeding assistance based on regular SFED-based assessments may help maintain self-feeding ability and enhance quality of life in this population, as well as providing evidence for end-of-life care options and greatly improving care quality.

Characteristics of counter-movements in sport climbing: a comparison between experienced climbers and beginners

[Purpose] This study aimed to evaluate the movement characteristics of sport climbing on the basis of the difference in basic movements between experienced climbers and beginners. [Participants and Methods] Eighteen healthy men participated in this study, including 9 experienced climbers and 9 beginners. A two-dimensional motion analysis was conducted with two digital cameras. The motion tasks were the counter-movements, including before and after each movement, which was classified into 5 phases. In each phase, the joint angles of the shoulder, elbow, hip, knee, and trunk were calculated. In the frontal plane, the center of gravity (COG) trajectory, motion speed, and motion time were calculated, which were compared between the climbers and the beginners in each phase. [Results] A significant difference was observed in the horizontal direction of the COG movement width. The beginners tended to have smaller shoulder flexion and abduction, and larger elbow flexion on the supporting side, and smaller hip flexion and abduction and knee flexion on the support side than the climbers. [Conclusion] This study suggests that climbers adopt a strategy to reduce the burden on the upper extremities by efficiently using the trunk and lower extremities to move their COG.

Development of a laser amplification system for the multi-pass Thomson scattering system for GAMMA 10/PDX

The multi-pass Thomson scattering (MPTS) system is a useful technique for increasing the Thomson scattering (TS) signal intensities and improving the TS diagnostic time resolution. The MPTS system developed in GAMMA 10/PDX has a polarization-based configuration with an image relaying system. The MPTS system has been constructed for enhancing the Thomson scattered signals for the improvement of measurement accuracy and the megahertz sampling time resolution. However, in the normal MPTS system, the MPTS signal intensities decrease with the pass number because of the damping due to the optical components. Subsequently, we have developed a new MPTS system with the laser amplification system. The laser amplification system can improve the degraded laser power after six passes in the multi-pass system to the initial laser power. For the first time worldwide, we successfully obtained the continued multi-pass signals after the laser amplification system in the gas scattering experiments.

Effect of genetic polymorphisms of azathioprine-metabolizing enzymes on response to rheumatoid arthritis treatment

Azathioprine (AZA) is increasingly being prescribed to rheumatoid arthritis (RA) patients. Following oral administration, AZA is converted into its active form. Inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE) patients with low thiopurine (S)-methyltransferase (TPMT) activity tend to respond well to AZA therapy. In a previous study of Japanese SLE patients under low-dose AZA therapy, the group with the 94C>A mutation in inosine triphosphatase (ITPA) showed greater improvement in their disease activity index. However, it is not yet clear how genotypes relate to responsiveness to RA treatment. The genotypes ITPA 94C>A, TPMT*3C, NUDT15 595C>T, GST-M1, GST-T1 and MRP4/ABCC4 2269G>A of Japanese patients with RA were determined. The relationship between these genotypes and response to AZA therapy was evaluated using the Disease Activity Score 28 (DAS28) and various medical data. Of the 22 patients 15 had the ITPA 94C/C genotype, 7 had the ITPA 94C/A genotype, none had the TPMT*3C mutation, 4 had the NUDT15 595C>T mutation, 8 had the GST-M1 and T1 null genotypes and 9 had the MRP4/ABCC4 2269G>A mutation. Changes in DAS28 at 6 months after baseline were similar in both ITPA genotype groups. However, the maintenance dose of AZA was significantly lower in the C/A group than in the C/C group (0.85±0.30 mg/kg/day vs. 1.2±0.46 mg/kg/day, respectively; p = 0.043). The ITPA 94C/A group showed the same response to RA treatment as the C/C group, but at a lower dose. This demonstrates that RA patients with the ITPA 94C>A mutation are more responsive to AZA.

Three-dimensional kinematic analysis of glenohumeral, scapular, and thoracic angles at maximum shoulder external rotation associated with baseball shadow pitching: comparison with normal pitching

[Purpose] The glenohumeral, scapular, and thoracic angles at maximum shoulder external rotation during shadow pitching were evaluated and compared with those observed during normal pitching. [Participants and Methods] Our study included 13 healthy males with experience in pitcher activity. All participants performed both, shadow pitching using a towel and normal pitching using a ball. The external rotation of the glenohumeral joint, scapular posterior tilting, and thoracic extension angles in the cocking phase were measured using a 3-dimensional motion analysis system. The ratios of the glenohumeral external rotation angle to the scapular posterior tilting and/or thoracic extension angle were calculated to evaluate the contribution of the scapulothoracic joint at maximum external rotation during throwing/pitching activity. [Results] The glenohumeral external rotation angle at maximum shoulder external rotation was significantly smaller during shadow pitching than during normal pitching. The ratio of the glenohumeral external rotation angle to the scapular posterior tilting and/or thoracic extension angle showed no statistically significant difference. [Conclusion] We conclude that shadow pitching can reduce the external rotation motion of the glenohumeral joint compared to that during normal pitching and might be a useful pre-throwing program beneficial in the rehabilitation of those presenting with throwing injuries.

Patient Registration and Treatment Allocation in Multicenter Clinical Trials Using a FAX-OCR System

This article describes the design and results of implementation of an automated patient registration and freatment allocation system (RETAS) used in multicenter clinical trials. RETAS was developed using a FAX-OCR system by which handwritten Japanese and English characters, as well as numericals and forms with check boxes, are sent from participating institutions by Fax, processed using an optical character reader, and then transmitted to a host computer at a statistical center. Based on the facsimile data, RETAS can automatically review eligibility, collect patient identification data and provide a randomized treatment allocation. RETAS permits uninterrupted, unattended operation at a statistical center, 24 hours a day, 7 days a week. Therefore, it drastically decreases the workload of personnel at the statistical center needed to support central telephone registration coverage. Consequently, staff members are free to focus on patient registration, treatment allocation, and follow-up of patients. The treatment allocation procedure in this system is based on Pocock and Simon’s minimization method combined with Zelen’s method for institution balancing. By this system it was possible to balance treatment numbers for each level of various prognostic factors over an entire trial and, at the same time, balance the allocation of treatments within an institution. The system currently supports the protocol of a clinical trial for Adjuvant Chemo-Endocrine Therapy for Breast Cancer in West Japan.