Injury data collection and utilisation practices in university sports teams: A cross-sectional study

OBJECTIVES

This study aimed to examine injury surveillance practices in a variety of university sports teams and barriers and facilitators for injury data collection and utilisation.

DESIGN

Cross-sectional study.

SETTING

University sports teams in Japan.

PARTICIPANTS

Medical, coaching, and other staff (non-medical/-coaching staff) of the university sports teams in Japan.

MAIN OUTCOME MEASURES

The survey included 31 questions that examined the barriers and facilitators for injury data collection, and the type of data on injury and exposure collected.

RESULTS

Injury data were collected during matches for 69 teams (48.3%) and training for 61 teams (42.7%). Injuries were primarily captured by athletic trainers in teams with medical staff, coaching staff and athletes in teams without medical staff. Common barriers in collecting and utilising injury data included limited funding for trained personnel and lack of time for medical staff to record data. Facilitating factors included clarification of the methods employed in recording and utilising injury data for teams with medical staff and the deployment of trained personnel to record injuries for teams without medical staff.

CONCLUSIONS

Approximately half of the Japanese university teams collected injury data. Considering barriers and facilitators is crucial to facilitate the collection and utilisation of injury data.

Health status of university football athletes through multidimensional screening

OBJECTIVE

Adequate conditioning results from various physical, environmental, and psychological factors in sports activities. In this study, we aimed to clarify the concurrence and relevance of injuries, psychological problems, and sleep disturbance in university football (soccer) players. Biomechanical characteristics and risk factors for those injuries were also investigated.

METHODS

Overall, 1,084 university football players participated in this cross-sectional study using a web-based health history questionnaire. Assessments were made via the presence of injuries for physical problems, the Athlete Psychological Strain Questionnaire (APSQ) for psychological problems, and the Athlete Sleep Screening Questionnaire (ASSQ) for sleep difficulties.

RESULTS

There were 200 (19%) athletes with injuries; 413 (38%) of these were APSQ-positive, 246 (23%) were ASSQ-positive, and 468 (43%) athletes had no physical, psychological, or sleep problems. APSQ-positive respondents were significantly more likely to have a current injury than those who were APSQ-negative. No significant difference was observed between the number of ASSQ-positive and -negative respondents and current injuries. Those with sleep problems were significantly more likely to have psychological problems.

CONCLUSION

More than 60% of university football players had one or more physical, psychological, or sleep problems. Players may have co-occurring problems, and it is important to address them for these athletes to reach peak performance.

Managing office worker presenteeism by providing financial aid for acupuncture therapy: a pragmatic multicenter randomized comparative study

To evaluate whether financial aid for acupuncture therapy is beneficial for non-manufacturing job workers (office workers) who are aware of reduced job performance due to health issues (presenteeism), a four-wk pragmatic multicenter randomized controlled trial was conducted with office workers who were aware of their presenteeism. The control group only implemented the workplace-recommended presenteeism measures, whereas the intervention group received financial aid for acupuncture therapy of up to 8,000 JPY (Japanese yen) in addition to implementing the presenteeism measures recommended by each workplace. The major outcome measure was the World Health Organization Health and Work Performance Questionnaire relative presenteeism score. A total of 203 patients were assigned to the intervention (n=103) and control (n=108) groups. The intervention group underwent a median of 1.0 (interquartile range [IQR], 1.0 to 2.0) sessions of acupuncture for neck disorders (64%), back disorders (16%), and depressed mood/anxiety/irritation (5%), among others. Results showed that the intervention group had slightly better job performance than the control group (effect size [r]=0.15, p=0.03). Financial aid for acupuncture therapy may help compensate for losses incurred by enterprises in the form of 14,117 JPY per worker a month.

Influence of Surveillance Methods in the Detection of Sports Injuries and Illnesses

Background

Epidemiological data on sports injuries and illnesses depend on the surveillance methodology and the definition of the health problems. The effect of different surveillance methods on the data collection has been investigated for overuse injuries, but not for other health problems such as traumatic injuries and illnesses.

Purpose

The purpose of this study was to investigate the new surveillance method developed by the Oslo Sports Trauma Research Center (OSTRC), which is based on any complaint definition (new method), to identify health problems compared with the traditional surveillance method, which is based on time loss definition.

Study design

Descriptive epidemiology study.

Methods

A total of 62 Japanese athletes were prospectively followed-up for 18 weeks to assess differences in health problems identified by both new and traditional methods. Every week, the athletes completed the Japanese version of the OSTRC questionnaire (OSTRC-H2.​JP), whereas the teams' athletic trainers registered health problems with a time loss definition. The numbers of health problems identified via each surveillance method were calculated and compared with each other to assess any differences between their results.

Results

The average weekly response rate to the OSTRC-H2.​JP was 82.1% (95% CI, 79.8-84.3). This new method recorded 3.1 times more health problems (3.1 times more injuries and 2.8 times more illnesses) than the traditional method. The difference between both surveillance methods' counts was greater for overuse injuries (5.3 times) than for traumatic injuries (2.5 times).

Conclusions

This study found that the new method captured more than three times as many health problems as the traditional method. In particular, the difference between both methods' counts was greater for overuse injuries than for traumatic injuries.

Level of evidence

2b.

Global Vertical Distribution of Water Vapor on Mars: Results From 3.5 Years of ExoMars-TGO/NOMAD Science Operations

We present water vapor vertical distributions on Mars retrieved from 3.5 years of solar occultation measurements by Nadir and Occultation for Mars Discovery onboard the ExoMars Trace Gas Orbiter, which reveal a strong contrast between aphelion and perihelion water climates. In equinox periods, most of water vapor is confined into the low-middle latitudes. In aphelion periods, water vapor sublimated from the northern polar cap is confined into very low altitudes-water vapor mixing ratios observed at the 0-5 km lower boundary of measurement decrease by an order of magnitude at the approximate altitudes of 15 and 30 km for the latitudes higher than 50°N and 30-50°N, respectively. The vertical confinement of water vapor at northern middle latitudes around aphelion is more pronounced in the morning terminators than evening, perhaps controlled by the diurnal cycle of cloud formation. Water vapor is also observed over the low latitude regions in the aphelion southern hemisphere (0-30°S) mostly below 10-20 km, which suggests north-south transport of water still occurs. In perihelion periods, water vapor sublimated from the southern polar cap directly reaches high altitudes (>80 km) over high southern latitudes, suggesting more effective transport by the meridional circulation without condensation. We show that heating during perihelion, sporadic global dust storms, and regional dust storms occurring annually around 330° of solar longitude (L _S) are the main events to supply water vapor to the upper atmosphere above 70 km.

Sports Injury Surveillance Systems and Guidelines in Japan: A Systematic Review

This systematic review aimed to identify sports injury surveillance systems (ISSs) and injury surveillance guidelines (ISGs) developed and currently used in Japan. Additionally, the extent to which ISSs and ISGs developed overseas are employed in Japan was also examined. A systematic search of electronic databases was performed in March 2021. Prospective studies that investigated sports injuries and targeted Japanese athletes or sports in Japan were included to identify the following: (1) details of the ISSs or ISGs developed among sports in Japan, and (2) characteristics of studies focusing on sports in Japan employing ISSs or ISGs developed overseas and the method of use. A total of five ISSs developed among sports in Japan were included, most of which were based on insurance benefits or condolence payment systems. In total, 23 studies used ISSs or ISGs developed overseas, more than half of which were used as a resource for the development of other data collection tools or methods, indicating that the definition of injury and/or classification of items are modified based on the needs among sports in Japan. This review highlights the necessity of establishing club-based or organisational ISSs and ISGs that are appropriate for sports in Japan.

Injury pattern based on player positions in Japanese university handball: a cross-sectional study of 2056 players

BACKGROUND

Although it is evident that the risk of injury in handball varies according to player position, it is unclear whether the characteristics of these injuries also differ. The aim of this study was to characterise and compare the position-associated injury profiles of university handball players in Japan.

METHODS

A total of 2056 participants who played in the 2018 and 2019 Japanese National University Handball Championships were included in this cross-sectional study. A self-reported injury questionnaire regarding demographic and injury-related information was administered.

RESULTS

The overall prevalence of injury during the one-year period preceding the questionnaire was 44.1%, and back (47.9%) and line (49.2%) players exhibited a higher proportion of injuries than players in other positions (p < 0.001). The ankle, knee, and shoulder/clavicle were the most common body regions affected by traumatic injuries, and knee and shoulder/clavicle injuries differed based on player positions (p = 0.033). Conversely, overuse injuries predominantly affected the lumber spine/lower back, knee, and foot/toe, although there were no significant differences between player positions (p = 0.188). In terms of the injury mechanism, line players exhibited a higher proportion of contact injuries and goalkeepers had a higher proportion of non-contact injuries than that of other positions (p < 0.001).

CONCLUSIONS

Back and line players experienced more injuries than players in other positions. Depending on the player position, there were significant differences in the prevalence and patterns of injury. Therefore, injury prevention measures need to consider the characteristics of injuries based on player positions.

Injuries in Japanese university handball: a study among 1017 players

The aim of this study was to examine the injury profile of Japanese university handball players. In this cross-sectional study, a total of 1017 participants who played in the 2018 Japanese National University Handball Championship were followed. The incidence within the previous year was 0.59 [95% CI, confidence interval: 0.56-0.62] per player per year. The ankle (33.3%), knee (23.6%), and shoulder/clavicle (12.6%) were the body regions most affected by traumatic mechanisms, while the lumbar spine/lower back (26.0%), knee (15.7%), and shoulder (15.0%) were the body regions most affected by overuse mechanisms. Sprain (30.7%), ligamentous rupture (23.2%), and fracture (11.8%) were the main types of traumatic injuries, and stress fracture (25.0%) and lesion of meniscus or cartilage (25.0%) were the main types of overuse injuries. Female players were 1.5 times more likely (OR, odds ratio: 1.55 [95% CI: 1.20-2.01]) to experience an injury than their male counterparts, and line players were also 1.5 times more likely (OR: 1.49 [95% CI: 1.00-2.21]) to experience an injury than their wing counterparts. This study showed that there is a need for increased injury prevention efforts in Japanese handball, especially among female players.

The use of ultrasound in central vascular ligation during laparoscopic right-sided colon cancer surgery: technical notes

BACKGROUND

Complete mesocolic excision (CME) with central vascular ligation (CVL) requires the surgeon to sharply dissect the mesocolon and approach the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) for ligation of the supplying vessels relating to right-sided colon cancer at their origin. Even with preoperative images, it can still be challenging to identify these structures during laparoscopic surgery because of various intraoperative conditions. The aim of this study was to assess the efficacy of intraoperative ultrasound (IOUS) for identification of blood vessels during right-sided colon cancer surgery.

METHODS

We performed IOUS on 19 patients diagnosed with right-sided colon cancer at our institution, in January-October 2020. Preoperatively, a three-dimensional computed tomography (3D-CT) angiogram was obtained for the majority of patients to visualize the SMA, SMV, and their respective branches. The running position of the ileocolic artery (ICA) and right colic artery (RCA) related to the SMV and the presence of the middle colic artery were identified and compared using preoperative 3D-CT, IOUS, and intraoperative findings.

RESULTS

Nineteen patients [seven men and 12 women with a mean age of 73.9 ± 8.4 years (range 58-82 years)] were studied, including some with a body mass index of > 30 kg/m², locally advanced cancer, and severe adhesion. There were IOUSs that detected the SMA, SMV, and their tributaries in all patients. The positional relationships between the SMV and the ICA and RCA revealed by IOUS were consistent with the preoperative and intraoperative findings.

CONCLUSION

IOUS is a safe, feasible, and reproducible technique that can assist in detecting the branching of the SMA and SMV during CME with CVL in laparoscopic right-sided colon cancer surgery, regardless of individual conditions.

Differences in Muscle Activities and Kinematics between Forefoot Strike and Rearfoot Strike in the Lower Limb during 180° Turns

BACKGROUND

A forefoot strike (FFS) could be a safer landing technique than a rearfoot strike (RFS) during a cutting motion to prevent anterior cruciate ligament (ACL) injury.

PURPOSE

This study aimed to determine the joint angles, ground reaction force (GRF), and muscle activity levels associated with FFS and RFS landings during 180° turns.

STUDY DESIGN

Cross-sectional study.

METHODS

Fourteen male soccer players from the University of Tsukuba football (soccer) club participated in this study. The FFS consisted of initial contact with the toes on the force plates followed by the rearfoot; meanwhile, the initial contact was performed with the heels on the force plates followed by the forefoot for the RFS. Ankle, knee, and hip joint angles were recorded using a three-dimensional motion capture system. GRFs were measured using a force plate. Gluteus medius (GM), rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST), biceps femoris (BF), tibialis anterior (TA), and lateral gastrocnemius (GL) activities were measured by electromyography.

RESULTS

The activities of GM, GL, and ST from initial contact to early periods during landing into the ground with the FFS are larger than those with RFS. In addition, the results showed significant differences in lower-limb angles and GRFs between the FFS and RFS.

CONCLUSION

These results suggest that there might be differences in ACL injury risk during a 180° turn between the FFS and the RFS pattern. An investigation into the grounding method that prevents injury is necessary in future studies.

LEVELS OF EVIDENCE

Level 3b.

InterCarb: A Community Effort to Improve Interlaboratory Standardization of the Carbonate Clumped Isotope Thermometer Using Carbonate Standards

Increased use and improved methodology of carbonate clumped isotope thermometry has greatly enhanced our ability to interrogate a suite of Earth-system processes. However, interlaboratory discrepancies in quantifying carbonate clumped isotope (Δ47) measurements persist, and their specific sources remain unclear. To address interlaboratory differences, we first provide consensus values from the clumped isotope community for four carbonate standards relative to heated and equilibrated gases with 1,819 individual analyses from 10 laboratories. Then we analyzed the four carbonate standards along with three additional standards, spanning a broad range of δ47 and Δ47 values, for a total of 5,329 analyses on 25 individual mass spectrometers from 22 different laboratories. Treating three of the materials as known standards and the other four as unknowns, we find that the use of carbonate reference materials is a robust method for standardization that yields interlaboratory discrepancies entirely consistent with intralaboratory analytical uncertainties. Carbonate reference materials, along with measurement and data processing practices described herein, provide the carbonate clumped isotope community with a robust approach to achieve interlaboratory agreement as we continue to use and improve this powerful geochemical tool. We propose that carbonate clumped isotope data normalized to the carbonate reference materials described in this publication should be reported as Δ47 (I-CDES) values for Intercarb-Carbon Dioxide Equilibrium Scale.

Male collegiate soccer athletes with severe ankle laxity display increased knee abduction during side-cutting tasks compared to those with only perceived ankle instability

This study aimed to examine lower limb kinematics during a side-cutting task in male collegiate soccer athletes with severe ankle laxity. Forty-seven participants with a history of ankle sprains and perceived ankle instability were categorized into non-laxity (n = 17), laxity (n = 19), and severe laxity (n = 11) groups using stress radiography tests. Three-dimensional kinematic data during the stance phase of a 45° side-cutting task were analysed. The frontal plane kinematics of the knee significantly differed between the three groups (p < 0.05). The severe laxity group exhibited a greater abduction angle than the non-laxity group (p < 0.05). The horizontal and sagittal plane kinematics of the rearfoot differed between the three groups during the end of the stance phase (p < 0.05). Our data suggest that collegiate soccer athletes with both perceived ankle instability and severe ankle laxity exhibit greater knee abduction movement during a 45° side-cutting task compared to those with only perceived ankle instability.

Injury pattern according to player position in Japanese youth handball: A cross-sectional study among 2377 players

OBJECTIVE

Although the incidence and pattern of injuries in youth handball have widely been investigated, it is unclear whether the characteristics of injuries differ on the basis of player position. This study aimed at revealing the player position-based injury profile in Japanese youth handball players.

DESIGN

Cross-sectional.

SETTING

Injury questionnaire.

PARTICIPANTS

Overall, 2377 participants who played in the 2018 and 2019 Japanese National High School Handball Championships were included.

MAIN OUTCOME MEASURES

Prevalence, body region, type, severity, and mechanism of injuries were collected through a questionnaire.

RESULTS

The overall prevalence of injury within the previous year was 46.7%, and the proportion of back players (52.8%) who sustained at least one injury was higher than that of players in other positions (p < 0.001). Differences in player positions were found among overuse injuries by body region, with a higher proportion of the lower leg and knee in wings and backs, respectively (p = 0.047). Among traumatic injuries, a higher proportion of ligamentous rupture in backs and fracture in lines were seen (p = 0.011).

CONCLUSION

There were significant differences in the prevalence and patterns of injuries between player positions. Therefore, injury prevention programmes should consider the characteristics of player positions.

An update of the Japanese Oslo Sports Trauma Research Center questionnaires on overuse injuries and health problems

Monitoring the health of athletes is important for their protection, and questionnaires such as those produced by the Oslo Sports Trauma Research Center (OSTRC) are a valuable tool in this process. In 2020, several changes were made to the OSTRC questionnaires (OSTRC-O, OSTRC-H), including changes to the wording, structure, and logic of the original questionnaires. In the present study, the Japanese versions of the OSTRC questionnaires (OSTRC-O.JP, OSTRC-H.JP) were revised to meet the requirements of the updated versions and to analyse new and previously collected data to illustrate the impact of the changes on Japanese athletes. Proposed changes were categorized as minor or more substantial; minor changes were effected to the questionnaire instructions and to the wording of all four questions, and more substantial changes were made to the wording of question 2. The updated questionnaires also included changes to questionnaire logic and answer categories. To assess the consequences of the changes to the wording of question 2, 101 athletes were asked to complete the OSTRC-H.JP, which included both the original and updated versions of question 2, over 10 consecutive weeks. We calculated the number of health problems identified when new gatekeeper logic was and was not applied, using 1585 OSTRC-H.JP responses to assess the consequences of the changes to the questionnaire logic. The kappa coefficient, which measures the level of agreement between the responses to question 2 of the original and updated versions, was high. By applying gatekeeper logic, there was a remarkable reduction in the number of injuries and illnesses among all health problems but less reduction in substantial health problems and time loss health problems. These changes will make it easier for Japanese athletes to complete the questionnaires and improve the quality of collected data.

Directions of single-leg landing affect multi-segment foot kinematics and dynamic postural stability in male collegiate soccer athletes

BACKGROUND

Understanding lower limb kinematics and postural control in different directions of single-leg landings is critical to evaluate postural control and prevent lower limb injuries. However, foot and ankle kinematics and postural control during single-leg landings in different directions are less known.

RESEARCH QUESTION

Does the difference in the direction of single-leg landing affect the foot kinematics on the frontal plane and dynamic postural stability?

METHODS

A cross-sectional study was conducted. Forty-nine male collegiate soccer players performed single-leg forward (FL), 45° lateral (LL), and medial (ML) direction landings. The lower limb, foot (rearfoot, midfoot, forefoot), and ankle kinematics during an impact phase were evaluated, and a curve analysis was performed using a statistical parametric mapping method to compare the three landings. The three landings were compared in terms of postural control parameters, including time to stabilization (TTS), peak of ground reaction forces (GRFs), root-mean-square of the mediolateral GRFs for 0-0.4 s (GRFML0.4), loading rate, and magnitude of horizontal GRFs from 0-0.4 s (HGRF-0.4), 0.4-2.4 s (HGRF-2.4), and 3.0-5.0 s.

RESULTS

Ankle and rearfoot kinematics in LL exhibited smaller eversion and pronation positions than FL and ML (p < 0.01). The TTS-mediolateral (TTS-ML) was longer in the LL than in FL and ML (p < 0.001). The GRFML0.4, HGRF-0.4, and -2.4 in the LL and ML were greater than those in the FL (p < 0.001).

SIGNIFICANCE

Directions of single-leg landing affect foot and ankle kinematics and postural stability. Specifically, the LL exhibits more inverted ankle and supinated rearfoot positions, and longer TTS-ML. Thus, the LL may induce stretching of the lateral ankle ligament. These findings can help understand foot kinematics and assess dynamic postural control.

Morphological lymphocytic reaction, patient prognosis and PD-1 expression after surgical resection for oesophageal cancer

BACKGROUND

Immune checkpoint inhibitors, such as antibody against programmed cell death protein (PD-1), have demonstrated antitumour effects in patients with malignancies, including oesophageal cancer. A lymphocytic reaction observed by pathological examination is a manifestation of the host immune response to tumour cells. It was hypothesized that a stronger lymphocytic reaction to tumours might be associated with favourable prognosis in oesophageal cancer.

METHODS

Using a database of resected oesophageal cancers, four morphological components of lymphocytic reactions (peritumoral, intranest, lymphoid and stromal) to tumours were evaluated in relation to clinical outcome, PD-1 expression by immunohistochemistry and total lymphocyte count in blood.

RESULTS

Resected oesophageal cancer specimens from 436 patients were included in the study. Among the four morphological components, only peritumoral reaction was associated with patient prognosis (multivariable P for trend <0·001); patients with a higher peritumoral reaction had significantly longer overall survival than those with a lower reaction (multivariable hazard ratio 0·48, 95 per cent c.i. 0·34 to 0·67). The prognostic effect of peritumoral reaction was not significantly modified by other clinical variables (all P for interaction >0·050). Peritumoral reaction was associated with total lymphocyte count in the blood (P < 0·001), supporting the relationship between local immune response and systemic immune competence. In addition, higher morphological peritumoral reaction was associated with high PD-1 expression on lymphocytes in tumours (P = 0·034).

CONCLUSION

These findings should help to improve risk-adapted therapeutic strategies and help stratify patients in the future clinical setting of immunotherapy for oesophageal cancer.

The clinical impact of preoperative body composition differs between male and female colorectal cancer patients

AIM

Patient body composition is an important indicator of metabolic status and is associated with cancer progression. Because body composition varies between men and women, we aimed to examine the difference in clinical impact of preoperative body composition according to sex.

METHOD

We used an integrated dataset of 559 colorectal cancer (CRC) patients. The association between preoperative body composition indices [body mass index (BMI), visceral to subcutaneous fat area ratio (VSR) and skeletal muscle index (SMI)] and patient outcome, clinicopathological factors and preoperative inflammation and nutritional status was analysed, comparing men and women.

RESULTS

Preoperative low BMI and low SMI in men was significantly associated with unfavourable overall survival (OS) [BMI: hazard ratio (HR) 2.22, 95% CI 1.28-4.14, P = 0.004; SMI: HR 2.54, 95% CI 1.61-4.07, P < 0.001] and high VSR in women was significantly associated with unfavourable OS (HR 1.79, 95% CI 1.03-3.02, P = 0.040). Additionally, low SMI in men was significantly associated with deeper tumour invasion and greater distant metastasis and high VSR in women was significantly associated with advanced age, right-sided tumour, lower total lymphocyte count and lower albumin levels. Interestingly, low BMI in men was significantly associated with deeper tumour invasion, but also with favourable inflammation and nutritional status (lower C-reactive protein and higher albumin).

CONCLUSION

The clinical impact of preoperative body composition differed between men and women: SMI in men and VSR in women were good prognosticators. Our findings may provide a novel insight for CRC treatment strategies.

P5508Impact of CD14++CD16+ monocytes on coronary plaque vulnerability assessed by optical coherence tomography in coronary artery disease patients

Background

Diabetes mellitus has been known as an important factor of coronary artery disease (CAD) progression despite of widespread with lipid-lowering therapy. Although we have reported that large glucose fluctuation is associated with the development of cardiovascular disease in both diabetes mellitus (DM) and non-DM patients, the underlying mechanisms remain unclear.

Monocytes play a key role for atherosclerotic plaque formation. Monocytes in human peripheral blood are divided into three subsets: CD14++CD16− monocytes, CD14++CD16+ monocytes, and CD14+CD16++ monocytes. The CD14++CD16+ monocyte subset has recently received attention because it is reported to be associated with future cardiovascular events such as acute myocardial infarction. However, their impact on coronary plaque vulnerability in coronary artery disease (CAD) patients with or without DM remains unclear.

Purpose

The aim of this study was to investigate the impact of CD14++CD16+ monocyte levels on coronary plaque vulnerability and glucose fluctuation in stable CAD patients with well-regulated lipid levels.

Methods

This prospective observational study included 50 consecutive patients with CAD (DM [n=22], Non-DM [n=28]), receiving lipid-lowering therapy and undergoing coronary angiography and optical coherence tomography (OCT). Patients were divided into 3 tertiles according to the CD14++CD16+ monocyte percentages assessed by flow cytometry. Standard OCT parameters including lipid arc, lipid length, fibrous cap thickness (FCT) on lipid rich plaque, were assessed for 97 angiographically intermediate lesions (diameter stenosis: 30–70%). The presence of thin-cap fibroatheroma (TCFA), defined as a thin fibrous cap (<65μm) overlying a lipid-rich plaque (>90°), was also assessed. Daily glucose fluctuation assessed by using continuous glucose monitoring system was analyzed by measuring the mean amplitude of glycemic excursion (MAGE).

Results

CD14++CD16+ monocytes negatively correlated with FCT on lipid rich plaque (r=0.508, p<0.01) (Figure. 1). The presence of thin-cap fibroatheroma (TCFA) was increased stepwise according to the tertile of CD14++CD16+ monocytes (0 [tertile 1] vs. 5 [tertile 2] vs. 10 [tertile 3], p<0.01). CD14++CD16+ monocytes were a significant determinant of TCFA (OR 1.279, p=0.001). Although CD14++CD16+ monocytes were not significantly correlated with MAGE in DM patients (r=0.259, p=0.244), a significant relationship was found between CD14++CD16+ monocytes and MAGE in non-DM patients (r=0.477, p=0.018) (Figure 2).

Conclusions

CD14++CD16+ monocytes were associated with coronary plaque vulnerability in CAD patients with well-regulated lipid levels both in DM and non-DM patients. Cross-talk between glucose fluctuation and CD14++CD16+ monocytes may enhance plaque vulnerability, particularly in non-DM patients. CD14++CD16+ monocytes could be a possible therapeutic target for coronary plaque stabilization.

1436Overexpression of Cytotoxic T-Lymphocyte Associated Antigen-4 suppresses aortic immunoinflammatory responses and prevents angiotensin II-induced abdominal aortic aneurysm formation in mice

Aims

Vascular inflammation via T-cell-mediated immune responses has been shown to be critically involved in the pathogenesis of abdominal aortic aneurysm (AAA). T-cell coinhibitory molecule cytotoxic T-lymphocyte–associated antigen-4 (CTLA-4) is known to act as a potent negative regulator of immune responses. However, the role of this molecule in the development of AAA remains completely unknown. In the present study, we determined the effects of CTLA-4 overexpression on experimental AAA.

Methods and results

We continuously infused 12-week-old CTLA-4 transgenic (CTLA-4-Tg)/apolipoprotein E–deficient (Apoe−/−) mice (n=35) or control Apoe−/− mice (n=40) fed a high-cholesterol diet with angiotensin II by implanting osmotic mini-pumps and evaluated the development of AAA. Ninety percent of angiotensin II-infused mice developed AAA, with 50% mortality because of aneurysm rupture. Overexpression of CTLA-4 significantly reduced the incidence (66%), mortality (26%), and diameter (18%) of AAA (incidence: P=0.0104; mortality: P=0.031; diameter: P=0.011). These protective effects were associated with a decreased number of effector CD4+ T cells and the downregulated expression of costimulatory molecules CD80 and CD86, ligands for CTLA-4, on CD11c+ dendritic cells in lymphoid tissues. In addition, by performing in situ zymography of the abdominal aortic aneurysm lesions, we observed a trend toward a decrease in MMP activity in the aneurysmal lesion following overexpression of CTLA-4. Finally, CTLA-4-Tg/Apoe−/− mice had reduced macrophage and CD4+ T cell accumulation and MMP activity in the aneurysmal lesion, leading to attenuated aortic inflammation, preserved vessel integrity, and decreased susceptibility to AAA and aortic rupture.

Conclusion

Our findings suggest that CTLA-4 protects against AAA by suppressing immunoinflammatory responses and could be an attractive therapeutic target for AAA.

T cell-specific STAT3 deficiency abrogates lupus nephritis

Signal transducer and activator of transcription (STAT) 3 is a regulator of T-cell responses to external stimuli, such as pro-inflammatory cytokines and chemokines. We have previously shown that STAT3 is activated (phosphorylated) at high levels in systemic lupus erythematosus (SLE) T cells and mediates chemokine-induced migration and T:B cell interactions. Stattic, a small molecular STAT3 inhibitor, can partially ameliorate lupus nephritis in mice. To understand the role of STAT3 better in T-cell pathophysiology in lupus nephritis and its potential as a treatment target, we silenced its expression in T cells using a cd4-driven CRE-Flox model. We found that lupus-prone mice that do not express STAT3 in T cells did not develop lymphadenopathy, splenomegaly, or glomerulonephritis. Moreover, the production of anti-dsDNA antibodies was decreased in these mice compared to controls. To dissect the mechanism, we also used a nephrotoxic serum model of nephritis. In this model, T cell-specific silencing of STAT3 resulted in amelioration of nephrotoxic serum-induced kidney damage. Taken together, our results suggest that in mouse models of autoimmune nephritis, T cell-specific silencing of STAT3 can hamper their ability to help B cells to produce autoantibodies and induce cell tissue infiltration. We propose that STAT3 inhibition in T cells represents a novel approach in the treatment of SLE and lupus nephritis in particular.

Effects of postoperative dietary intake on functional recovery of patients undergoing cardiac surgery

BACKGROUND AND AIM

Among elderly patients undergoing cardiac surgery, malnutrition is very common and related to muscle wasting known as sarcopenia. Cardiac surgery causes a further decline of nutritional status due to reduced dietary intake (DI); however, the impact of postoperative DI on functional recovery is unclear.

METHODS AND RESULTS

We enrolled 250 consecutive patients undergoing cardiac surgery. Daily DI was measured between postoperative days 3 and 7. Patients were categorized as having sufficient or insufficient DI based on whether their DI met or was less than estimated total energy requirements. Functional capacity was measured using the 6-minute walking distance (6MWD) preoperatively and at discharge. Mean postoperative DI was 22.4 ± 3.0 kcal/kg/day, and postoperative DI was insufficient in 92 patients (36.8%). The prevalence of sarcopenia was not different by postoperative DI. Although there was no significant difference in preoperative 6MWD results (P = 0.65), the sufficient DI group had longer 6MWD at discharge than the insufficient DI group (P = 0.04). In multivariate regression analysis, preoperative poor nutritional status (β = -0.29), duration of surgery (β = -0.18), and postoperative DI (β = 0.40) remained statistically significant predictors for improvement of 6MWD (P < 0.0001, adjusted R² = 0.41).

CONCLUSIONS

Postoperative DI was independently associated with functional recovery, but preoperative sarcopenia was not. Regardless of preoperative nutritional status or the presence of sarcopenia, aggressive nutritional intervention in the early stage after surgery helps support functional recovery.

The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer

AIM

Preoperative anaemia is associated with adverse outcomes in colorectal cancer (CRC). To clarify the reason for this we aimed to comprehensively assess the association of preoperative anaemia with tumour characteristics, host systemic inflammation and nutrition status, and perioperative blood transfusion.

METHOD

We used an integrated database of 592 CRC patients. The association of preoperative anaemic subtype, calculated from haemoglobin and erythrocyte mean corpuscular volume levels, with patient outcome, preoperative serum data relating to systemic inflammation and nutrition and perioperative blood transfusion was analysed.

RESULTS

Preoperative anaemia was significantly associated with poorer overall survival and relapse-free survival (RFS); in particular microcytic anaemia had a trend to poorer RFS than other forms of anaemia (P = 0.0648). In addition, preoperative anaemia was significantly correlated with right-sided tumours, greater depth of tumour invasion, use of neoadjuvant chemotherapy, poorer prognostic nutritional index and higher modified Glasgow Prognostic Score (mGPS). Microcytic anaemia in particular had a strong association with a greater depth of tumour invasion (P = 0.0072) and higher mGPS (P = 0.0058) than other causes of anaemia. Perioperative blood transfusion for CRC patients with anaemia was associated with adverse outcomes.

CONCLUSIONS

Preoperative anaemia, especially microcytic anaemia, was associated with poor patient outcomes, possibly due to poor systemic inflammatory and nutritional status, and it was not improved by perioperative blood transfusion. Our data suggest that preoperative anaemia and the anaemic subtype may serve as an easily available predictor of outcome in CRC.

Itching in a trichophytin contact dermatitis mouse model and the antipruritic effect of antifungal agents

BACKGROUND

Tinea is an infectious disease by dermatophytes, of which Trichophyton species accounts for the overwhelming majority of case. Tinea often causes itching with inflammation. In terms of pruritus by fungal infection, however, tinea has not been investigated sufficiently to date.

AIM

To evaluate itch caused by Trichophyton infection and the effect of antifungal agents on the infection, by measuring scratch behaviour and profiles of inflammatory cytokines and chemokines.

METHODS

We used a previously established mouse model of contact hypersensitivity induced by trichophytin, a crude extract from Trichophyton mentagrophytes. Scratching behaviour was recorded using a counting device that measured an electric current induced in a coil by movement of magnets that had been inserted into the hind paws of each animal. We investigated expression of various genes in lesional skin of mice and in normal human epidermal keratinocytes. We also investigated the antipruritic effects of the corticosteroid dexamethasone (DEX) and three antifungal agents: ketoconazole (KCZ), terbinafine (TBF) and liranaftate (LNF).

RESULTS

Biphasic peaks of scratching were observed at 1 h and at 6-7 h during an observation period of 14 h after trichophytin induction. For lesional skin, RNA was extracted 24 h after trichophytin challenge, and increased expression was seen in the genes for interleukin (IL)-17A, interferon-γ, tumour necrosis factor (TNF)-α, macrophage inflammatory protein (MIP)-2 and Dectin-1, whereas there was no obvious change in the genes for IL-31 and prostaglandin (PG)E2. Furthermore, KCZ inhibited histidine decarboxylase (HDC) expression in vitro and in vivo, and inhibited scratching in the very early phase. LNF inhibited expression of thymic stromal lymphopoietin (TSLP) and IL-8 in vitro, and TSLP, TNF-α, IL-1α and MIP2 in vivo, and also scratching in the early phase. TBF did not induce any significant alterations in either gene expression or scratching. DEX suppressed expression of all the chemical mediators except HDC in vitro and in vivo, and inhibited scratching.

CONCLUSION

Antifungals can inhibit itching induced by fungal infection through different mechanisms.

Clinical utility of exhaled carbon monoxide in assessing preoperative smoking status and risks of postoperative morbidity after esophagectomy

Whereas smoking constitutes a significant risk factor for postesophagectomy morbidity, there is no reliable method to assess the smoking status of patients prior to the procedure. Since exhaled carbon monoxide (CO) is an indicator of recent smoking, this paper hypothesizes that this is a useful parameter in assessing current smoking status and may help predict morbidity following esophagectomy. Sixty-nine patients, who had undergone elective three-incision esophagectomy with two- or three-field lymphadenectomy for esophageal cancer, were prospectively studied between February 2015 and September 2017. At surgical admission, they were asked about their smoking history, their exhaled CO levels were evaluated, and they were grouped into three based on their CO levels. These were 0 parts per million (ppm), >0 and <7 ppm, and ≥7 ppm. Their postoperative morbidity was also assessed. Approximately 13.5% of the patients showed high levels of exhaled CO ≥ 7 ppm, despite preoperatively reporting smoking cessation for over a month. Morbidities of the Clavien-Dindo classification (CDc) ≥ II increased as exhaled CO levels increased and severe morbidity of CDc ≥ IIIb frequently was observed in patients with exhaled CO levels ≥7 ppm. The logistic regression analysis showed that exhaled CO level ≥7 ppm was an independent risk factor for severe postesophagectomy morbidity. Overall, the results of this study suggest that exhaled CO levels may be useful in estimating current smoking status and that it may also help give an estimation of the risk of postesophagectomy morbidity.

Effects of Superoxide Dismutase and Catalase on Disseminated Intravascular Coagulation In Rats

The effects of superoxide dismutase (SOD) and catalase on endotoxin-induced experimental disseminated intravascular coagulation (DIC) were studied in rats. Experimental DIC was induced by a 4 hr sustained infusion of endotoxin at a dose of 100 mg/kg. The rats were subcutaneously injected with SOD at 0.5, 5.0 or 50.0 mg/kg, or catalase at 0.01, 0.1 or 1.0 mg/kg, followed by the continuously infusion of 100 mg/kg/4hr of endotoxin. A preventive effect against DIC was noted in all the parameters, such as fibrinogen and fibrin degradation products, fibrinogen level, prothrombin time, partial thromboplastin time, platelet count and the number of renal glomeruli with fibrin thrombi, in the rats treated with 50.0 mg/kg of SOD or 1.0 mg/kg of catalase. When 50.0 mg/kg of SOD or 1.0 mg/kg of catalse was injected subcutaneously at 1, 2 or 3 hr after the initiation of the endotoxin-infusion, the protective effect against DIC was noted in all the parameters.

Minimally invasive esophagectomy may contribute to long-term respiratory function after esophagectomy for esophageal cancer

Evidence suggests that minimally invasive esophagectomy has several advantages with regard to short-term outcomes, compared to open esophagectomy in esophageal cancer patients. However, the impact of minimally invasive esophagectomy on long-term respiratory function remains unknown. The objective of this study is to assess the association between use of the minimally invasive esophagectomy and long-term respiratory dysfunction in esophageal cancer patients after esophagectomy. This retrospective single institution study using prospectively collected data included 87 consecutive esophageal cancer patients who had undergone esophagectomy. All patients underwent a respiratory function test before, and one year after esophagectomy. Logistic regression analysis was used to compute the hazard ratio for long-term respiratory dysfunction. Minimally invasive esophagectomies were performed in 53 patients, and open esophagectomies in 34 patients. The two groups showed no significant differences in terms of postoperative complications and postoperative course. Nor were any differences observed between the two groups in terms of volume capacity (L) and forced expiratory volume 1.0 (L) before esophagectomy (P > 0.34). However, one year after esophagectomy, the decreases in volume capacity and forced expiratory volume 1.0 were significantly less in the minimally invasive esophagectomy group than in the open esophagectomy group (P = 0.04 and P = 0.007, respectively). Multivariate analyses revealed that minimally invasive esophagectomy was an independent favorable factor for maintenance of forced expiratory volume 1.0 (hazard ratio = 0.17, 95% confidence interval 0.04-0.71; P = 0.01). Minimally invasive esophagectomy may be an independent favorable factor for maintenance of long-term respiratory function in esophageal cancer patients after esophagectomy.

Comparison of osseous healing after sagittal split ramus osteotomy and intraoral vertical ramus osteotomy

The sagittal split ramus osteotomy (SSRO) is generally associated with greater postoperative stability than the intraoral vertical ramus osteotomy (IVRO); however, it entails a risk of inferior alveolar nerve damage. In contrast, IVRO has the disadvantages of slow postoperative osseous healing and projection of the antegonial notch, but inferior alveolar nerve damage is believed to be less likely. The purposes of this study were to compare the osseous healing processes associated with SSRO and IVRO and to investigate changes in mandibular width after IVRO in 29 patients undergoing mandibular setback. On computed tomography images, osseous healing was similar in patients undergoing SSRO and IVRO at 1year after surgery. Projection of the antegonial notch occurred after IVRO, but returned to the preoperative state within 1year. The results of the study indicate that IVRO is equivalent to SSRO with regard to both bone healing and morphological recovery of the mandible.

Pyloroplasty may reduce weight loss 1 year after esophagectomy

Weight loss after esophagectomy is common and is associated with unfavorable prognosis. However, the clinical features and surgical methods that influence postesophagectomy weight loss are not well characterized. This study aims to determine those features (especially the surgical methods) that may affect postoperative weight loss. We reviewed 221 esophageal cancer patients who had undergone esophagectomy at Kumamoto University Hospital (Kumamoto, Japan) between November 2012 and June 2015. Among these, we recruited 106 patients who had undergone transthoracic esophagectomy with gastric conduit reconstruction, had no cancer recurrence within 1 year, and no missing follow-up data. We tabulated the body weight changes and risk factors associated with weight loss exceeding 10% at 1-year postesophagectomy. The mean body weights at baseline and 1-year postsurgery were 60.3 kg (standard error (SE): 0.91) and 52.6 (SE: 0.91), respectively. One year postsurgery, the body weights had changed as follows: mean: -12.2%; median: -12.9%; standard deviation: 9.06; range: -36.1-18.56%; interquartile range: -10.5 to -14.0%. In the multivariate logistic regression analysis, the absence of pyloroplasty was the sole risk factor for more than 10% weight loss (OR: 3.22; 95% CI: 1.08-11.9; P = 0.036). Our data suggest that pyloroplasty with esophagectomy can overcome the post-surgical weight loss.

Monitoring sputum culture in resected esophageal cancer patients with preoperative treatment

Pneumonia is a major cause of postesophagectomy mortality and worsens the long-term survival in resected esophageal cancer patients. Moreover, preoperative treatments such as chemotherapy or chemoradiotherapy (which have recently been applied worldwide) might affect the bacterial flora of the sputum. To investigate the association among preoperative treatments, the bacterial flora of sputum, and the clinical and pathological features in resected esophageal cancer patients, this study newly investigates the effect of preoperative treatments on the bacterial flora of sputum. We investigated the association among preoperative treatments, the bacterial flora of sputum, and clinical and pathological features in 163 resected esophageal cancer patients within a single institution. Pathogenic bacteria such as Candida (14.1%), Staphylococcus aureus (6.7%), Enterobacter cloacae (6.1%), Haemophilus parainfluenzae (4.9%), Klebisiella pneumoniae (3.7%), Methicillin-resistant Staphylococcus aureus (MRSA) (3.7%), Pseudomonas aeruginosa (2.5%), Escherichia coli (1.8%), Streptococcus pneumoniae (1.8%), and Haemophilus influenzae (1.2%) were found in the sputum. The pathogen detection rate in the present study was 34.3% (56/163). In patients with preoperative chemotherapy and chemoradiotherapy, the indigenous Neisseria and Streptococcus species were significantly decreased (P= 0.04 and P= 0.04). However, the detection rates of pathogenic bacteria were not associated with preoperative treatments (all P> 0.07). There was not a significant difference of hospital stay between the sputum-monitored patients and unmonitored patients (35.5 vs. 49.9 days; P= 0.08). Patients undergoing preoperative treatments exhibited a significant decrease of indigenous bacteria, indicating that the treatment altered the bacterial flora of their sputum. This finding needs to be confirmed in large-scale independent studies or well-designed multicenter studies.

Measurement of thickness of film deposited on the plasma-facing wall in the QUEST tokamak by colorimetry

After several experimental campaigns in the Kyushu University Experiment with Steady-state Spherical Tokamak (QUEST), the originally stainless steel plasma-facing wall (PFW) becomes completely covered with a deposited film composed of mixture materials, such as iron, chromium, carbon, and tungsten. In this work, an innovative colorimetry-based method was developed to measure the thickness of the deposited film on the actual QUEST wall. Because the optical constants of the deposited film on the PFW were position-dependent and the extinction coefficient k₁ was about 1.0-2.0, which made the probing light not penetrate through some thick deposited films, the colorimetry method developed can only provide a rough value range of thickness of the metal-containing film deposited on the actual PFW in QUEST. However, the use of colorimetry is of great benefit to large-area inspections and to radioactive materials in future fusion devices that will be strictly prohibited from being taken out of the limited area.

A Biomechanical Comparison Among Three Kinds of Rebound-Type Jumps in Female Collegiate Athletes

BACKGROUND

Single-legged drop jumps (SDJ), single-legged repetitive jumps (SRJ), and single-legged side hops (SSH) are often used as plyometric training and functional performance tests. Differences in the kinetics and kinematic characteristics of lower extremity joints during these jumps are unclear.

HYPOTHESIS/PURPOSE

The purpose of this study was to investigate the joint motion and mechanical work of the takeoff leg from foot contact to foot-off during SDJ, SRJ, and SSH in the sagittal and frontal planes in female athletes. It was hypothesized that the joint motion and mechanical work of the lower extremity joints during the SDJ and SRJ would be larger than the SSH in the sagittal plane, those during the SSH would be larger than the SDJ and SRJ in the frontal plane, and during SRJ would be larger than SDJ.

STUDY DESIGN

Cross-sectional study.

METHODS

Seventeen female collegiate athletes participated and performed the SDJ (0.15-m box height), and SRJ and SSH (by crossing two lines 0.3 m apart). Three-dimensional coordinate data and ground reaction forces were collected. Contact time, jump height, jump index (i.e., the jump height divided by the contact time) of the SDJ and SRJ, and the total times of the SSH were calculated. Range of motion (ROM) from touchdown to the lowest center of mass, and the positive and negative (mechanical) work from touchdown to foot-off were analyzed.

RESULTS

There were no significant differences in jump performance variables. Compared to the SSH, the SDJ and SRJ had significantly larger ankle and knee ROM and positive and negative work at the lower extremity joints, except for positive work at the hip joint, in the sagittal plane (p < 0.05). Compared to the SDJ and SRJ, the SSH had a significantly larger ankle ROM and positive work at the knee joint in the frontal plane (p < 0.05). Compared to the SDJ, the SRJ had a significantly larger ROM and negative work at each lower extremity joint in the frontal plane (p < 0.05).

CONCLUSION

Although there were no significant differences in the jump performance variables, different characteristics of the takeoff leg ROM and mechanical work were found between three kinds of rebound-type jump tests. These findings may help clinicians choose jump methods to assess lower extremity function and to design plyometric training programs in sports and clinical fields.

LEVEL OF EVIDENCE

3b.

Effects of electroacupuncture to the trigeminal nerve area on the autonomic nervous system and cerebral blood flow in the prefrontal cortex

BACKGROUND

The autonomic nervous system and trigeminal nerve are involved in adjusting flow through diverging cerebral arteries in the prefrontal cortex. The purpose of this study was to examine the effect of 100 Hz electroacupuncture (EA) to the trigeminal nerve area on cerebral blood flow and autonomic nervous system function.

METHOD

This was a randomised crossover study of 16 healthy volunteers who were assigned to an EA or control group. Stimulation (in the EA group) was performed five times, each after 1 min of rest. Needles were inserted at the inner edge of the eyebrows and 1 cm from the front hairline midpoint. We used high-frequency (HF) and low-frequency (LF) components of heart rate (HR) variability to assess autonomic nervous system function. HF and LF/HF ratio were taken as indicators of parasympathetic and sympathetic nervous system activity, respectively. We measured cerebral blood flow using a two-channel near-infrared spectroscope.

RESULTS

In the EA group, HR significantly decreased (p=0.004) and HF significantly increased (p=0.006) relative to baseline. By contrast, there were no significant changes in HR or HF within the control group (p>0.05). Accordingly, HR tended to be lower (p=0.087) and HF greater (p=0.071) in the EA group versus the control group. There were no significant differences in LF/HF ratio within/between groups. Compared with the control group, cerebral blood flow was significantly greater in the left (p=0.048) and right (p=0.016) prefrontal cortex in the EA group.

CONCLUSIONS

Delivery of 100 Hz EA to the trigeminal nerve area reduces HR and increases parasympathetic nervous activity and cerebral blood flow.