Epimuscular myofascial force transmission between the levator scapulae muscle and the upper fiber of the serratus anterior or rhomboid minor muscles

BACKGROUND

This study investigated the epimuscular myofascial force transmission between the levator scapulae, serratus anterior, and rhomboid minor muscles.

METHODS

The participants included 10 healthy males (a total of 20 shoulders). Differences in the shear moduli of the levator scapulae, serratus anterior, and rhomboid minor muscles were measured in the resting and levator scapulae stretching positions using shear wave elastography. The correlation between the rates of change for each muscle was also verified.

FINDINGS

The results demonstrated a notable increase in the shear modulus from the resting to stretching positions for levator scapulae (42.9 ± 17.6 kPa vs. 52.4 ± 15.2 kPa) and serratus anterior (32.8 ± 12.9 kPa vs. 58.4 ± 18.5 kPa) (P = 0.02, P < 0.01). However, there was no significant difference in the shear modulus for the rhomboid minor between the resting (44.0 ± 19.2 kPa) and stretching (41.0 ± 20.2 kPa) positions (P = 0.40). Moreover, a significant positive correlation was observed between rates of change for the levator scapulae and serratus anterior muscles (P = 0.04, r = 0.459).

INTERPRETATION

These findings indicate that the shear modulus of the serratus anterior increased with the stretching of the levator scapulae, suggesting the occurrence of epimuscular myofascial force transmission between these two muscles with different muscle insertions.

Changes in blood flow in the dorsal scapular artery and relationship to shoulder joint function in rotator cuff tears

Background

One of the pain-related factors in rotator cuff tears (RCTs) is abnormal scapular motion, which is thought to be related to the levator scapulae muscle activation. Additionally, attention has recently focused on the peak systolic velocity (PSV) as one of the causes of pain, but blood flow outside of the vessels supplying the rotator cuff has not been clarified. This study aimed to determine the difference in PSV in the dorsal scapular artery (DSA), which is the vessel that supplies the levator scapulae muscles, and the association between PSV and pain and shoulder function in patients with RCTs between the tear and nontear sides.

Methods

This study included 31 patients with RCTs with tear and nontear sides. Magnetic resonance imaging and radiographic examinations included Cofield classification, Goutallier classification, thickening of the coracohumeral ligament, and measurement of the acromiohumeral interval. Clinical evaluation included an automatic range of motion (ROM) for flexion, abduction, and external rotation (ER), a visual analog scale, and the Shoulder36. PSV was evaluated using ultrasound pulsed Doppler mode to assess PSV of DSA. The PSV of DSA on the first rib was drawn in the medial aspect of the suprascapular angle in the long axis, and the maximum PSV waveform was measured three times. The average value was used for further analysis.

Results

The PSV in the DSA was significantly higher (P = .04, 95% confidence interval: 0.2-7.6) on the tear (22.6 ± 7.4 cm/s) than the nontear sides (18.9 ± 6.9 cm/s). In addition, a significant negative correlation (r = -0.46, P = .0087) was found between PSV in DSA and ER on the tear side.

Conclusion

This study revealed a significantly increased PSV in the DSA on the tear side in RCTs and negatively correlated with ER ROM. The results suggest that increased PSV in the DSA may contribute to ER ROM limitation in the glenohumeral joint.

Evaluation of the Antiobesity Effects of an Amino Acid Mixture and Conjugated Linoleic Acid on Exercising Healthy Overweight Humans: A Randomized, Double-blind, Placebo-controlled Trial

This single-centre, randomized, double-blind, placebo-controlled trial investigated the effects of administering a mixture of four amino acids (lysine, proline, alanine and arginine) with or without conjugated linoleic acid to healthy overweight humans before and after exercising. Forty-one healthy subjects (body mass index ≥ 23 to < 30 kg/m2) completed the study following randomization to receive either placebo or one of three test supplements: amino acid mixture 0.76 g/day; amino acid mixture 1.52 g/day; or amino acid mixture 1.52 g/day coadministered with conjugated linoleic acid 1.6 g/day. Each of the study treatments was administered 30 min before and immediately after a period of daily exercise, which was delivered by an exercise expert, for a period of 12 weeks. When compared with the placebo group, several indicators, such as waist and hip circumferences, were found to have significantly decreased in the test supplement groups compared with the placebo. These results suggest that ingestion of these supplements might enhance the fat-burning effects of exercise.

Payment systems and considerations of case mix--are diagnosis-related groups applicable in Japan?

OBJECTIVE

Cost containment is a large concern. Japanese medical institutions operate on a fee-for-service basis, giving few incentives for healthcare providers to control the number of procedures performed or to save the healthcare costs. Thus, the objective of this study was to determine the feasibility of applying diagnosis-related groups (DRGs) in Japan, since systems that employ DRGs provide these incentives.

DESIGN AND SETTING

Three types of data (patient discharge, hospital cost and hospital characteristics data) were collected from 17 acute general hospitals in Japan. These data were used to calculate variance (R2) for length of stay for each of 3 US-based DRG systems [health care financing administration (HCFA)-DRG, all-patient (AP)-DRG, all-patient refined (APR)-DRG] in order to determine which of the systems is most appropriate for use in Japan to classify patients. We also examined the financial impact for hospitals through budget simulations when DRG is used as a payment tool.

MAIN OUTCOME MEASURES AND RESULTS

Of the DRG alternatives examined, we have found that the AP-DRGs are the preferred alternative. The data in Japan are not sufficiently complete to support the APR-DRGs, and we believe that the HCFA-DRGs are not as clinically sophisticated as the AP-DRGs and may not be as well accepted by the medical community. As there is a clear intention in Japan of developing Japanese-specific DRGs, the AP-DRGs represent a sound starting point for this effort. Our work demonstrates that basing payments on DRGs is partially feasible for Japan. This means that the treated case was found to be feasible as the unit of payment.

CONCLUSION

Changing to a prospective payment system in Japan will give hospitals powerful incentives to become more efficient. This, in turn, will open hospital capacity, which should assist Japan in providing the care needed by an aging population in a cost-effective way.

Health care expenditure and hospital management

The article briefly describes the health financing system of Japan and then proceeds to analyse expenditure. The focus, however, of the paper is to express concern at the poor level of management in the hospital systems in Japan. The author urges hospital directors to engage in a much more pro-active management approach.