Association of Preoperative Osteoporotic Vertebral Compression Fractures with Muscle Atrophy in Lumbar Spinal Stenosis: A Retrospective Cohort Study

Objectives

Osteoporotic vertebral compression fractures (OVCFs) are common in older individuals and lead to pain, spinal deformities, and limited mobility. Paraspinal muscle function correlates with fracture severity, and this association may be more significant in patients with lumbar spinal stenosis (LSS). However, studies on the effects of OVCFs are lacking. This study aimed to investigate the relationship between OVCFs, fat infiltration, and muscle atrophy in patients with LSS.

Methods

This study included 177 patients with preoperative LSS, of whom 16 had OVCFs and 161 did not. Lumbar lordosis angle, fat infiltration, and paraspinal muscle atrophy were evaluated in these patients. Information on patient characteristics such as smoking, diabetes, hemodialysis, steroid use, American Society of Anesthesiologists score, and bladder or bowel dysfunction were obtained from medical records. Logistic regression analysis was conducted to identify factors independently associated with OVCF.

Results

Patients in the OVCF group were significantly older (P=0.006) than those without fractures, and a higher proportion of the OVCF group showed muscle atrophy (P=0.034). Significant variables and those with moderate effect sizes were included in the logistic regression analysis. Muscle atrophy (P=0.028) was independently associated with OVCF.

Conclusions

Muscle atrophy was associated with preoperative OVCFs in patients with LSS. Identifying OVCFs in these patients may underscore the importance of tailored treatment and rehabilitation strategies for the paraspinal muscles.

Effectiveness of an educational approach between adolescents and adults with patellofemoral pain syndrome: a scoping review with meta-analysis

[Purpose] This study aimed to compare the effectiveness of an educational approach between adolescents and adults with patellofemoral pain syndrome. [Participants and Methods] The PROSPERO protocol number is CRD42022362680. Four databases (PubMed, CINAHL, Scopus, Cochrane) were searched. Randomized control trials on the effectiveness of the educational approach for patellofemoral pain syndrome were compared between adolescents and adults. Two investigators independently screened eligible studies. Two randomized control trials proceeded through meta-analysis with a visual analogue scale in the mid-term (from 18 weeks to 6 months). [Results] The meta-analysis results indicated that no significant difference was observed between education and combined education with exercise. A tendency to improve in the intervention of combined education with exercise for adolescents was noted, whereas no effect of education for adults was observed. [Conclusion] Treatment strategies combining education with exercise for patellofemoral pain syndrome may differ between adolescents and adults.

Immediate Effects of Foam Roller and Stretching to the Lead Hip on Golfers Swing: A Randomized Crossover Trial

Golfers with decreased range of motion (ROM) of their leading hip internal rotation (IR) have increased lumbar rotation ROM and load. This study investigated the effects of foam roller (FR) applied to their leading hip muscles combined with stretching to the leading hip together with lumbar rotation ROM during the golf swing. The study design was a crossover design. Subjects were allocated to one of two groups comprising FR and dynamic stretching (FR + DS) or practice swing. Motion analysis was used to evaluate hip and lumbar angles during the golf swing. Data were compared using analysis of variance with Bonferroni correction using paired t-test's post hoc. The association between lead hip IR angle and lumbar spine left rotation (Lrot) angle was investigated using correlation analysis. Lead hip IR ROM during the golf swing was significantly greater in the FR + DS group (p = 0.034). The FR + DS group showed a moderate negative correlation between lead hip IR ROM and lower lumbar spine Lrot ROM during the golf swing (r = -0.522). The application of FR + DS might be useful to increase lead hip IR angle during the golf swing. Moreover, the application of FR + DS improves lead hip IR angle and may decrease lumbar spine rotation.

Effects of cross-training on motor function and length of stay after total hip arthroplasty: A randomized controlled trial

BACKGROUND

There is no consensus about which training methods will give better early outcomes after total hip arthroplasty (THA).

OBJECTIVE

To investigate the short-term effects of cross trainer exercise on physical function and walking ability following THA.

METHODS

Fifty patients who underwent THA were randomly allocated into two groups. The intervention program was started 3 days after surgery. The main physical function results were pain, hip range of motion, knee extensor strength, single-leg stance time, and walking performance test. In addition, the number of days of requiring to walk and the length of hospital stay were recorded.

RESULTS

In the comparison between groups at discharge, the patients in the cross trainer group had significantly less hip pain while walking, improvement in knee extensor strength, increased single-leg stance time, as well as increased walking speed and stride length at discharge. The number of days required to walk and length of stay were also significantly lower in the intervention group.

CONCLUSIONS

Conclusions: Cross trainer exercise commencing 3 days postoperatively improves physical function and walking ability after THA.

Mechanisms of EGFR-TKI-Induced Apoptosis and Strategies Targeting Apoptosis in EGFR-Mutated Non-Small Cell Lung Cancer

Homeostasis is achieved by balancing cell survival and death. In cancer cells, especially those carrying driver mutations, the processes and signals that promote apoptosis are inhibited, facilitating the survival and proliferation of these dysregulated cells. Apoptosis induction is an important mechanism underlying the therapeutic efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) for EGFR-mutated non-small cell lung cancer (NSCLC). However, the mechanisms by which EGFR-TKIs induce apoptosis have not been fully elucidated. A deeper understanding of the apoptotic pathways induced by EGFR-TKIs is essential for the developing novel strategies to overcome resistance to EGFR-TKIs or to enhance the initial efficacy through therapeutic synergistic combinations. Recently, therapeutic strategies targeting apoptosis have been developed for cancer. Here, we review the state of knowledge on EGFR-TKI-induced apoptotic pathways and discuss the therapeutic strategies for enhancing EGFR-TKI efficiency. We highlight the great progress achieved with third-generation EGFR-TKIs. In particular, combination therapies of EGFR-TKIs with anti-vascular endothelial growth factor/receptor inhibitors or chemotherapy have emerged as promising therapeutic strategies for patients with EGFR-mutated NSCLC. Nevertheless, further breakthroughs are needed to yield an appropriate standard care for patients with EGFR-mutated NSCLC, which requires gaining a deeper understanding of cancer cell dynamics in response to EGFR-TKIs.

Inter-examiner reliability in identifying lumbar paraspinal muscle atrophy by lumbar paraspinal muscle atrophy index, a novel parameter

[Purpose] To evaluate the inter-examiner reliability of our novel parameter, the lumbar paraspinal muscle atrophy index, in identifying the lumbar paravertebral muscle atrophy. [Participants and Methods] The study group consisted of 225 adults, with a mean age of 64.7 (range, 21–89) years, who underwent posterior lumbar spinal surgery for degenerative spinal disease at our hospital between July 2013 and June 2017. Preoperative axial T2-weighted magnetic resonance images were used to evaluate the lumbar paraspinal muscle atrophy index and observe the presence or absence of severe lumbar paraspinal muscle atrophy. The lumbar paraspinal muscle atrophy index was calculated at each intervertebral level, from L1-2 through L4-5, once by two examiners, and the Cohen’s kappa statistic was used to calculate the inter-examiner agreement of the classification of the presence or absence of atrophy at each level. [Results] The agreement was high (kappa, 0.79–0.88) for the lumbar paraspinal muscle atrophy index at all levels, except at the L3-4 level (kappa, 0.49). The lower kappa statistic at L3-4 likely reflects the unique morphological characteristics at this level. [Conclusion] The lumbar paraspinal muscle atrophy index is a new, simple, easy-to-use, and sufficiently reliable parameter to identify lumbar paraspinal atrophy.

Effects of a Groin Pain Prevention Program in Male High School Soccer Players: A Cluster-Randomized Controlled Trial

Background

Groin pain is frequently reported by soccer players. A prevention program incorporating the Copenhagen adduction exercise (CAE) has been shown effective in decreasing adductor muscle injury in semi-professional soccer players. However, the effect of such programs on groin pain in high school soccer players is unknown. No reports have examined the effects of combining the CAE with other targeted exercises such as the Nordic hamstrings exercise (NHE).

Purpose

To evaluate the preventative effects of exercise on groin pain in high school soccer players in three groups comprising NHE alone, combined NHE and CAE, and a control group.

Design

Randomized Controlled Clinical Trial.

Methods

A cluster randomized controlled trial spanning 16 weeks was conducted on 202 high school soccer players from seven high schools in a Japanese under 18 Soccer League. Players were allocated to either group A (three schools, 66 players) receiving the CAE alone, or group B (two schools, 73 players) receiving the CAE and NHE, or control group C (two schools, 63 players) who performed their usual training. This study compared the number of injuries, injury rate, and severity of the injury of groin pain in these three groups.

Results

The number of players injured was less in group B (4 players) compared to C (18 players), and time-lost to soccer was less in groups A (6 players) and B (3 players) compared to group C (16 players). Injury rates were significantly lower in groups A and B, with the relative risk of injury compared to group C of 0.42 (95% CI 0.19% to 0.90%) in group A and 0.19 (95% CI 0.07 to 0.54) in group B.

Conclusion

A 16-week program incorporating the CAE in training sessions in high school soccer players reduced the incidence of groin pain and which may be related to injury severity according to time -lost to soccer, however the combination of both the CAE and NHE may be more effective than the CAE alone.

Level of Evidence

2b.

Determining a preventive strategy for ankle sprain injury through a questionnaire survey of coaches of junior high school basketball teams

[Purpose] The purpose of this study was to determine a preventive strategy for ankle sprain injury through a questionnaire survey of coaches of junior high school basketball teams. [Participants and Methods] The questionnaire comprised questions concerning coaches’ characteristics, prevention-related content, and collaboration with medical staff. We distributed the questionnaire to 108 coaches, of which 48 (41.7%) responded. [Results] The results revealed that none of the participant coaches had ever collaborated with medical staff. [Conclusion] Additional effort from medical staff is needed to hold seminars and contact coaches of junior high school teams in order to conduct an injury prevention program.

Risk Factor Analysis for Fat Infiltration in the Lumbar Paraspinal Muscles in Patients With Lumbar Degenerative Diseases

Introduction

This study aimed to investigate factors related to fat infiltration in patients with lumbar degenerative diseases (lumbar disc herniation and/or spinal stenosis), examining a wide range of potential risk variables.

Materials and methods

We studied consecutive adult patients who underwent posterior lumbar spinal surgery for degenerative diseases at our hospital between July 2013 and June 2017. Preoperative magnetic resonance imaging was used to evaluate the presence or absence of fat infiltration at the level of the L4-5 lumbar paraspinal muscles using Kjaer’s evaluation method. Patients without fat infiltration (0%–10%) were rated as grade 0, grade 1 for moderate fat infiltration (10%–50%), and grade 2 for severe fat infiltration (>50%). Patients were then divided into two groups: Group A (without fat infiltration, grade 0) and Group B (with fat infiltration, grade 1 or 2). Detailed patient clinical data were collected and analyzed.

Results

A total of 205 consecutive patients were enrolled; 54 (26.3%) patients were assigned to Group A and 151 (73.7%) to Group B. Logistic regression analysis revealed two independent risk factors for fat infiltration of the lumbar paraspinal muscles: female sex and older age (P < .001).

Discussion

Fat infiltration of the lumbar paraspinal muscles is reported to be associated with the development of pain and dysfunction of the lumbar region and postoperative complications of spinal instrumented fusion surgery. To the best of our knowledge, no previous studies have identified female sex and older age as independent risk factors for fat infiltration in the lumbar paraspinal muscles using multivariate analysis.

Conclusions

Female sex and older age were independent risk factors for fat infiltration in the lumbar paraspinal muscles. The results of the current study may provide useful information for the study of preventive measures for fat infiltration.

Effects of incorporating elliptical trainer exercise during rehabilitation on physical function and self-reported outcomes after total hip arthroplasty: a randomized controlled trial

[Purpose] To investigate the effects of incorporating elliptical trainer exercise in early rehabilitation after total hip arthroplasty on physical function and self-reported outcomes. [Participants and Methods] Participants with independent gait prior to total hip arthroplasty underwent conventional postoperative physiotherapy and were divided into two groups. The intervention group additionally underwent elliptical trainer exercise, while the control group underwent a walking program. The main outcomes were low back and hip region pain, lower limb muscle strength, single-leg stance time, Timed Up & Go Test results, 10 m walking test results, hip disability and osteoarthritis outcome score, and modified fall efficacy scale score. These outcomes were evaluated preoperatively, at discharge, and at 1 and 3 months postoperatively. [Results] Fifty participants (including 40 females; age, 68.3 ± 10.8 years) participated in this study. Physical function evaluations showed a significant improvement in hip region pain during walking at discharge. Knee extensor strength, single-leg stance time, stride length, and walking speed were significantly greater in the intervention group at discharge and at 1 and 3 months postoperatively. The modified fall efficacy scale score significantly improved in the intervention group 1 month postoperatively. [Conclusion] Elliptical trainer exercise and conventional physiotherapy in the early postoperative period contribute to improved physical function and walking ability and improvement in the fear of falling.

Predictive value of QRS duration normalized to left ventricular volume for responding to cardiac resynchronization therapy in patients with mid-QRS duration enrolled in the multicenter registry

Background

For cardiac resynchronization therapy (CRT), patients with chronic heart failure (HF) and wide (&gt;150msec) QRS duration (QRSd) received class I/A indication. However, its beneficial effect seemed to be limited for those with mid- (120–150msec) QRSd. Recent studies demonstrated that QRSd normalized to left ventricular end-diastolic volume (QRSd/ LVEDV) improved prediction of clinical outcome in patients with CRT. Therefore, we sought to investigate predictive value of QRSd/LVEDV for responding to CRT in patients with mid-QRSd.

Methods

This was retrospective multi-center observational cohort study. A total 506 consecutive patients who underwent CRT implantation in Tohoku University Hospital and National Cerebral and Cardiovascular Center were evaluated. Exclusion criteria were QRSd less than 120ms, upgrade procedures from other implanted non-CRT devices and bradycardia requiring pacing. We evaluated clinical variables, data of electrocardiogram and transthoracic echocardiography at baseline and 6 months after CRT implantation. Primary endpoint was a HF hospitalization after CRT implantation. Distribution of free from HF hospitalization during follow-up was calculated using Kaplan-Meier curves, and the effects of covariate on the time to endpoint were investigated using a Cox proportional hazards model.

Results

After 199 patients were excluded based on exclusion criterion, remaining 307 patients were included for the analysis. Mean age was 62±14 [SD] years, and 238 (77%) were male. Mean LVEF and LVEDV were 25±9% and 234±82ml, respectively, and 24% of patients had ischemic etiology of HF. During the median 948 days of follow-up, CRT patients with mid QRSd (n=126; 136±10msec), as compared with those with wide QRSd (n=181; 174±17msec), tended to have higher incidence of HF hospitalization (Wilcoxon p=0.03). Multivariate analysis showed that QRSd and QRSd/LVEDV were significant predictors for HF hospitalization in CRT patients with mid QRSd, and cut-off values (137msec of QRSd and 0.65 of QRSd/LVEDV), which was calculated by receiver operative curve analysis, was used for risk stratification. QRSd&lt;137msec was significant negative predictors for HF hospitalization (p=0.005), and Mid-QRSd patients with QRSd≥137msec demonstrated equivalent clinical outcome with those with wide QRSd. Moreover, patients with QRSd/LVEDV≥0.65 tended to have lower incidence of HF hospitalization as compared with those without it among patients with QRSd&lt;137msec (n=64, Figure).

Conclusion

The present study demonstrates that QRSd normalized to left ventricular end-diastolic volume (QRSd/ LVEDV) could be clinical value in predicting outcome in CRT patients with mid-QRSd. These findings indicate normalized QRSd reflects myocardial conduction properties and contribute to risk stratification.

Funding Acknowledgement

Type of funding sources: None.

Factors affecting early knee-flexion range of motion after total knee arthroplasty

[Purpose] To investigate the factors affecting the knee-flexion range of motion in the early period after total knee arthroplasty. [Participants and Methods] Ninety-nine patients who had undergone total knee arthroplasty at our hospital between 2016 and 2019 were allocated into two groups based on the presence of a 110° knee-flexion range of motion at 14 days post-surgery. From medical records, we extracted data for the participants’ basic attributes and preoperative/postoperative physical function (knee-flexion range of motion, Timed Up & Go Test results, resting/walking pain according to a numerical rating scale, and knee-extension muscle strength). Postoperative physical function was measured 14 days post-surgery. [Results] Preoperative knee-flexion range of motion, preoperative femorotibial angle, postoperative knee-extensor strength, and postoperative Timed Up & Go Test value differed significantly as factors related to achieving a 110° knee-flexion range of motion. Through further statistical analyses, we selected the preoperative knee-flexion range of motion, preoperative femorotibial angle, preoperative Timed Up & Go Test result, and postoperative knee-extension strength as factors affecting the knee-flexion range of motion at 14 days post-surgery. [Conclusion] Preoperative knee-flexion range of motion, preoperative femorotibial angle, preoperative Timed Up & Go Test result, and postoperative knee-extension strength influence knee-flexion range of motion at 14 days after total knee arthroplasty, and our findings indicate the effectiveness of active physiotherapy interventions.

Inter-rater reliability between two examiners with different professional roles in the evaluation of fat infiltration in the lumbar paraspinal muscles using magnetic resonance imaging

[Purpose] To clarify the inter-rater reliability of the evaluation criteria for paraspinal muscle fat infiltration on magnetic resonance images between two examiners with different professional roles in interdisciplinary physical therapy teams. [Participants and Methods] In this retrospective study, we reviewed the clinical data of 225 patients with degenerative lumbar diseases who underwent posterior lumbar surgery at our hospital. A physical therapist and a spinal surgeon visually quantified fat infiltration of the multifidus muscles at the level of L4/5 on the preoperative magnetic resonance images of the patients using Kjaer's criteria (Grade 0: 0-10%, Grade 1: 10-50%, and Grade 2: >50%). We used the kappa coefficient to assess inter-rater reliability. [Results] The participants included 142 males and 83 females (mean age, 64.7 years; range, 21-89 years). The number of patients with grades 0/1/2 were 50/160/15, respectively, for examiner 1; and 59/155/11, respectively, for examiner 2. The kappa coefficient was 0.69, indicating a substantial agreement. [Conclusion] Our study, which is the first to assess the inter-rater reliability of Kjaer's criteria between examiners with different medical occupations, revealed that these criteria could be a reliable tool for evaluating fat infiltration in the multifidus muscles and sharing information between interdisciplinary physical therapy teams.

Effects of functional movement screen training in high-school baseball players: A randomized controlled clinical trial

BACKGROUND

In recent years, the functional movement screen (FMS) and FMS training have attracted attention as a means of preventing injury, but no studies have examined the effect of such training in high-school baseball players. The aim of this study was to clarify the effect of FMS training on FMS score, physical function and baseball performance in high-school baseball players.

METHODS

Subjects in this randomized controlled clinical trial were high-school male baseball players assigned to either an FMS training group (intervention group) or a control group. The intervention group performed FMS training 4 times per week for 12 weeks. FMS ability, physical function, and baseball performance were measured prior to the intervention, 8, 12, and 24 weeks after the intervention in the subjects' school environment.

RESULTS

A total of 71 baseball players aged 15 to 17 years were recruited and assigned to either an intervention group (n = 37) or control group (n = 34). There was no significant difference in the characteristics of participants between the 2 groups. Most FMS scores improved to 12 weeks after continued training. In the intervention group compared with the control group, deep squat, hurdle step, inline lunge, active straight leg raise, trunk stability push-up and rotary stability FMS score, total FMS score and eyes closed single leg stance time significantly increased after 8 weeks of training. While hurdle step, inline lunge, active straight leg raise, trunk stability push-up, total FMS score, and eyes closed single leg stance time significantly increased, pitching ball speed significantly decreased at the end of the 12 week training period. Eyes closed single leg stance time and feeling of fatigue significantly improved 12 weeks after training. The number of subjects who scored less than 14 for the total FMS score in the intervention group compared with control group were significantly less after 8 and 12 weeks of FMS training.

CONCLUSION

FMS training for 8 weeks contributes to improving FMS scores for high-school baseball players, but FMS scores go down if FMS training is not continued.

TRIAL REGISTRATION

University Hospital Medical Information Network Center, Tokyo, Japan: UMIN000027553. Registered on May 30, 2017.

A Novel, Circulating Tumor Cell Enrichment Method Reduces ARv7 False Positivity in Patients with Castration-Resistant Prostate Cancer

BACKGROUND

The AR-V7 splice variant is a cause of castration-resistant prostate cancer (CRPC). However, testing for the presence of AR-V7 by real-time polymerase chain reaction (RT-PCR) shows AR-V7 positivity in healthy individuals. We hypothesized that the positivity reflects contamination by hematopoietic cells. We tried a novel circulating tumor cell (CTC) enrichment instrument, using Celsee, to clear hematopoietic cells.

METHODS

We tested whole blood or Celsee-enriched samples for AR-V7 by RT-PCR, and included samples from 41 CRPC patients undergoing sequential therapy. We evaluated the associations between AR-V7 status and clinical factors. We evaluated factors affecting AR-V7 positivity.

RESULTS

AR-V7 positivity was lower in Celsee-enriched than in whole blood specimens. AR-V7 and clinical factors did not predict the therapy effectiveness. We found no significant differences in the effectiveness of enzalutamide/abiraterone (Enz/Abi) upon AR-V7 evaluation. All AR-V7 positive patients had resistance to Enz/Abi. Docetaxel (DTX), cabazitaxel (CBZ), and Radium223 treatment showed no significant difference in the treatment effectiveness, regardless of AR-V7 presence. AR-V7 was more frequently positive than Extent of disease (EOD) 2 in cases with bone metastases.

CONCLUSION

Celsee CTC enrichment suppresses AR-V7 false positivity. All AR-V7 positive patients presented resistance to Enz/Abi. DTX, CBZ, and Radium223 were effective and remain treatment options. AR-V7 positivity should progressively appear in patients with advanced bone metastases.

Effects of Nordic Hamstring Exercise on Hamstring Injuries in High School Soccer Players: A Randomized Controlled Trial

We evaluated a range of physical characteristics related to hamstring injuries, as well as the Nordic Hamstring Exercise compliance rate, and whether this influenced the rate hamstring injury. Subjects comprised 259 male soccer players from seven high schools randomly clustered into two groups, a Nordic Hamstring Exercise group and a control group. Training and match time were logged, as well as details of hamstring injury, and subsequent time lost to hamstring injury recorded over a period of 27 weeks. The Nordic Hamstring Exercise compliance rate, injury rate per 10000 playing hours and time-lost-to-sport-injury rate were calculated. The relative risk and hamstring injury severity were also calculated. The hamstring injury rate was 1.04/10 000 h in the control group and 0.88/10 000 h in the intervention group. The relative risk for hamstring injury was 1.14. The time-lost to injury rate was 1116.3/10 000 h in the control group and 113.7/10 000 h in the intervention group; with relative risk 9.81. The Nordic Hamstring Exercise in high school soccer players significantly reduced hamstring injury severity compared to a control intervention. Our results indicate that the time-lost to injury rate should be taken into account when analyzing the severity of hamstring injury.

Three-Dimensional Motion Analysis of the 2nd Cervical Spinous Process at End Range Cervical Rotation in Different Scapular Positions Using 3D Digitizer

OBJECTIVE

The study used a 3D digitizer to determine three-dimensional motion analysis of the 2nd cervical (C2) spinous process at end range cervical rotation with the scapula in different positions.

METHODS

30 healthy adults participated in this study. Different scapula positions were adopted bilaterally and positioned passively at normal resting, depression, adduction, and abduction. Under each scapula position, bilateral end range cervical rotation and displacement of the C2 spinous process were analyzed by a 3D digitizer.

RESULTS

Displacement of the C2 spinous process relative to the occiput was significantly correlated with range of cervical rotation under all scapular positions (p<0.05). However, there were no significant differences between end range cervical rotation and displacement of the C2 spinous process relative to the occiput in any scapular position.

CONCLUSION

These results suggest that measurement of upper cervical mobility using the 3D digitizer is a reliable method that holds promise in the evaluation of people with cervical spine disorders.

Enhancement of IL-2-induced cytotoxicity by interferon-alpha in renal cell carcinoma

Metastatic renal cell carcinoma (mRCC) treatment consists of molecular targeted agents and cytokines that have fundamentally different mechanisms of action. Clinical responses also differ; complete response is rare with molecular targeted agents but is sometimes achieved with cytokine therapies. Because of the relatively high efficacy of combination therapy with low-dose interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) against mRCC, it is important to reevaluate cytokine therapies in vitro. Here, we show that when IL-2 is administered in combination with IFN-alpha, a stronger cytotoxic effect of PBMCs on RCC cell lines is observed than when IL-2 is administered alone. The upregulation of TNF-related apoptosis-inducing ligand on NK cell by IL-2 and suppression of regulatory T cells (Tregs) by IFN-alpha were recognized at the same time when cytotoxicity of peripheral blood mononuclear cells (PBMCs) was enhanced. IL-2 is known to activate natural killer cell cytotoxicity; however, IL-2 also stimulates Treg expansion, which enhances immunosuppression. On the other hand, IFN-alpha negatively regulates Treg cells, thereby increasing the function of immune effector cells. Our in vitro results may explain, at least in part, the clinical efficacy of combination low-dose IL-2 and IFN-alpha therapy against mRCC.

Caregiver psychological characteristics predict discontinuation of care for disabled elderly at home

OBJECTIVE

This study sought to determine the predictors of discontinuation of care for the disabled elderly at home using multivariate regression analysis.

METHODS

In January to February 2005, using a self-administered questionnaire, data were collected from 193 caregivers of frail elderly listed on a roster for utilization of day service or short stay service from two Home Visit Nursing Care Stations. Family caregivers were defined as co-resident family members who provided a minimum of 1 h of daily care for at least 3 months. Multiple stepwise logistic regression analysis was performed to detect predictors of a discontinuation for the disabled elderly at home.

RESULTS

The mean age of caregivers was around 59.0 years, accounting for about 80% of the women among caregivers. Of those caregivers, the proportion of desire to institutionalization (high DI) (56.8%) was higher than that of desire to care at home (low DI) (43.2%). Among the following three factors selected by multivariate stepwise logistic regression analysis, the strength of the relationship was stronger in frequent mood swings and irritability as carerecipient characteristic (adjusted OR = 5.93; 95% CI, 2.09-16.8) than in no advanced or skilled care (adjusted OR = 3.13; 95% CI, 1.41-7.14) and a high caregiver burden (adjusted OR = 1.12; 95% CI, 1.03-1.23) as caregiver's one.

CONCLUSIONS

Our results suggest that the carerecipients' psychological characteristics may be more strongly related to the decision to continue care for disabled elderly at home than that of the caregivers'.

Induction of matrix metalloproteinase gene expression in an endothelial cell line by direct interaction with malignant cells

Mouse endothelial TKD2 cells in monolayers were cocultured with various human cell lines for 24 h, and the expression of several secreted matrix metalloproteinases (MMP) and cell adhesion molecules was examined by real-time reverse transcription-polymerase chain reaction using mouse-specific primers. Coculture with normal fibroblasts did not elicit the expression of these molecules, but coculture with cancer cells induced the expression of MMP-3, MMP-9 and MMP-10 mRNA in endothelial cells, and in normal mouse embryonic fibroblasts. The induction of MMP mRNA was dependent on direct cell adhesion, as separate culture of A549 cells in Boyden chambers did not induce MMP mRNA, and neutralizing antibody against VLA-4 abolished the induction. An inhibitor of phosphatidylinositol-3-phosphate kinase strongly suppressed the induction of MMP-3, MMP-9 and MMP-10 mRNA, and expression of the dominant-negative mutant of phosphatidylinositol-3-phosphate kinase also decreased the induction. It was suggested that intracellular reactive oxygen species (ROS) levels were increased in TKD2 cells following adhesion to cancer cells. ROS scavengers decreased the levels of MMP induction, and roterone, an inhibitor of mitochondrial complex I, strongly suppressed the induction of MMP-3, MMP-9 and MMP-10. The depletion of mitochondria in TKD2 cells decreased the induction of MMP-9, but the induction of MMP-3 and MMP-10 was not affected. These results indicate that the adhesion of cancer cells to endothelial cells activates several distinct signaling pathways to induce MMP gene expression, and the pathways for MMP-3, MMP-9 and MMP-10 are partly different. For the induction of MMP-9, mitochondria participate in induction, possibly through the production of ROS.

Anthracyclines, small-molecule inhibitors of hypoxia-inducible factor-1 alpha activation

Hypoxia-inducible factor-1 (HIF-1) is a central mediator of cellular responses to low oxygen and has recently become an important therapeutic target for solid tumor therapy. To identify small molecule inhibitors of the HIF-1 transcriptional activation, we have established a high through-put assay system using a stable transformant of mammalian cells that express the luciferase reporter gene construct containing a HIF-1 binding site. Using this system, we screened 5000 cultured broths of microorganisms, and we found that cinerubin (1-hydroxy aclacinomycin B) showed a significant inhibition of the reporter activity induced by hypoxic conditions. In addition, we demonstrated that aclarubicin also inhibited the HIF-1 transcriptional activity under hypoxic conditions, but neither doxorubicin nor daunorubicin inhibited it. Consistent with these results, cinerubin and aclarubicin inhibited the hypoxic induction of the vascular endothelial growth factor (VEGF) protein in HepG2 cells, but neither doxorubicin nor daunorubicin affected it. Thus, our results suggested that some anthracyclines are also acting as angiogenesis inhibitors.

Inhibition of angiogenesis and HIF-1alpha activity by antimycin A1

We identified antimycin A1 as an inhibitor of the hypoxia-response element (HRE) from screening using a reporter under the control of HRE under hypoxic conditions. Antimycin A1 was effective at 20 pg/ml in inhibiting the reporter activity. The expression of vascular endothelial growth factor (VEGF) mRNA during hypoxia was also inhibited by antimycin A1. Angiogenesis induced by implantation of mouse sarcoma-180 cells was significantly inhibited by non-toxic doses of antimycin A1. Hypoxia inducible factor (HIF)-1alpha protein levels were significantly decreased by antimycin A1, but its mRNA level was not affected. Antimycin A1 is known to be an inhibitor of mitochondrial electron transport system, and depletion of mitochondria abolished antimycin A1-effect, at least in part. Inhibitors of proteasome or protein synthesis did not affect the decrease in HIF-1alpha level induced by antimycin A1. These results indicate that antimycin A1 inhibited angiogenesis through decrease in VEGF production caused by inhibition of HIF-1alpha activation.

Parental Control of the Personal Domain and Adolescent Symptoms of Psychopathology: A Cross-National Study in the United States and Japan

One hundred seventy U.S. (M=16.1 years) and 125 middle-class Japanese (M=16.6 years) adolescents completed a questionnaire assessing perceptions of who (adolescent or parent) controls the personal, conventional, prudential, and overlapping domain behaviors of the adolescent. Participants also completed an inventory assessing self-reported psychological symptoms. Adolescents in both countries indicated that they should have more say over personal issues and that parents should have more say over conventional and prudential issues. Self-reports of internalizing symptoms were positively correlated with amount of perceived control over personal issues for U.S. and Japanese students and for parental control over overlapping domain issues for Japanese students. There were no associations between parental control of conventional or prudential behaviors and psychological symptoms.

Specific Inhibition of Hypoxia-inducible Factor (HIF)-1.ALPHA. Activation and of Vascular Endothelial Growth Factor (VEGF) Production by Flavonoids

Screening using a reporter under the control of the hypoxia-response element (HRE) identified several flavonoids and homoisoflavonoids that inhibit the activation of HRE under hypoxic conditions. Among various compounds, isorhamnetin, luteolin, quercetin, and methyl ophiopogonanone B (MOB) were effective at 3 to 9 microg/ml in inhibiting the reporter activity. The expression of vascular endothelial growth factor (VEGF) mRNA during hypoxia was also inhibited by MOB in HepG2 cells, but the effective doses were 10 to 20 microg/ml. MOB caused destabilization of hypoxia-inducible factor (HIF)-1alpha, as revealed by Western blotting, that was dependent on proteasome activity and the tumor suppressor, p53. The tubular formation and migration of human umbilical vein endothelial cells was also inhibited by MOB. MOB is expected to act as an inhibitor of angiogenesis.

Initial fermentation of sea sludge using aerobic and thermophilic microorganisms in a mangrove soil

As sea sludge has the potential to cause eutrophication and red tide resulting in the death of shellfish and offensive odors, an effective method to treat it is needed. It was found that adding soil taken from a mangrove swamp to sea sludge promoted an initial fermentation of the sludge constituents. The result suggested that certain microorganisms that were thought to inhabit the sub-tropical mangrove soil had the potential to play a significant role in the fermentation and that the use of the microorganisms in the mangrove soil might be useful for composting sea sludge.

[Percutaneous cryosurgery for liver tumors]

A new cryoprobe developed in our department makes it possible to perform percutaneous cryoablation for small liver tumors. This cryoprobe is placed into each lesion using an ultrasonic guidance technique. In this study there were 10 patients with hepatocellular carcinoma and 5 patients with liver metastases from colorectal carcinoma. In 6 cases the tumor size was below 2 cm, in 6 cases between 2 and 3 cm, and in 3 cases over 3 cm. Using a cryoprobe of 3 mm in diameter, each lesion was frozen using liquid nitrogen for 15 or 20 minutes then thawed for 10 minutes, and repeated. The ice ball was found to enlarge to 3 cm in 20 minutes and 5 cm in 60 minutes experimentally. Six cases were CR, 5 PR, 2 NC and 2 PD. After cryoablation, liver function did not change and there were no complications. However, as the size of the ice ball was small (about 3 cm), this method was insufficiently effective in some cases. Percutaneous cryoablation using this probe should be performed for tumors smaller than 3 cm.

Pleasant odors attenuate the blood pressure increase during rhythmic handgrip in humans

We have investigated the effects of inhaling odors of preference on physiological responses to physical exercise in college students. Rhythmic handgrip, maintaining a mercurial pressure by repetitive compression, increased blood pressure. In the participants exercised with inhaling odors of their choice, such as rose, jasmine and lavender, the increase in diastolic blood pressure during exercise was reduced by 24%. In contrast, the blood pressure increase during static handgrip, maintaining the power 30-40% of maximum, was not affected by the existence of favorite odors. Since the blood pressure increase during static handgrip is a lower brainstem reflex, the present result shows that the inhalation of favorite odors suppresses the muscle sympathetic vasoconstrictor activity and attenuates the blood pressure increase by affecting the central nervous system higher than the midbrain.

Pentoxifylline inhibition of vasculogenesis in the neonatal rat retina

PURPOSE

The zeta isozyme of protein kinase C (PKC) is essential for activation of the transcription factor nuclear factor (NF)kappaB and transcription of vascular endothelial growth factor (VEGF). This study examined the antiangiogenic potential of an existing drug, pentoxifylline (PTX), which inhibits PKC-dependent activation of NFkappaB and is reported to prevent hypoxia-induced expression of VEGF.

METHODS

Neovascularization was induced by maintaining neonatal rats for 10 full days in 80% oxygen, interrupted daily by 30 minutes in room air followed by a progressive return to 80% oxygen. On experimental day 11, they were placed in room air until they were killed on day 17. Daily intraperitoneal injections of PTX in saline (25 or 75 mg/kg per day), or saline alone, were administered from day 6 through day 16. Retinal neovascularization was scored, and avascular areas (AVAs) were measured in ADPase stained retinas.

RESULTS

PTX inhibited radial extension of retinal vessels, causing increases in AVA of 65% (P < 0.01) and 33% (P < 0.15) at the lower and upper doses, respectively. A significant increase in mean neovascular score was seen at the lower dose (P < 0.0001), but analysis of variance indicated that neovascularization was strongly and positively influenced by the AVA (P < 0.0001) and only weakly stimulated by PTX (P < 0.05).

CONCLUSIONS

Systemic PTX significantly inhibited VEGF-mediated retinal vasculogenesis, but was not effective in reducing neovascularization in the oxygen-exposed neonatal rat.

A comparison of distilled water and normal saline as diluents for endobronchial administration of epinephrine in the dog

We compared the effects of distilled water and normal saline as diluents for the endobronchial administration of epinephrine in anesthetized dogs by using a cross-over design. Six dogs received 2 mL of either normal saline or distilled water into the bronchus, and the other solution was administered 1 wk later. Eight dogs received 0.02 mg/kg epinephrine diluted in either distilled water (E + water) or normal saline (E + saline) to a total volume of 2 mL into the bronchus, and the other solution was administered 1 wk later. Normal saline or distilled water without epinephrine did not affect the plasma epinephrine concentration, mean arterial pressure (MAP), and PaO(2). The peak plasma epinephrine concentration was significantly larger after treatment with E + water (26.5 +/- 7.9 ng/mL) than after E + saline (2.1 +/- 0.7 ng/mL). E + water caused an increase in MAP of 91 +/- 24 mm Hg, whereas E + saline did not affect MAP. The maximal decrease in PaO(2) after the administration of E + water (14 +/- 5 mm Hg) was significantly greater than after E + saline (7 +/- 2 mm Hg). In conclusion, distilled water as the diluent for endobronchially administered epinephrine to a total volume of 2 mL allowed better absorption of epinephrine compared with normal saline without a serious detrimental effect on PaO(2).

IMPLICATIONS

Using a small volume of distilled water as the diluent for endobronchial epinephrine administration significantly increased epinephrine absorption and arterial pressure in comparison with normal saline, without having a serious detrimental effect on PaO(2), in an anesthetized, noncardiopulmonary, resuscitation dog model.

Eicosapentaenoic acid release from the red alga Pachymeniopsis lanceolata by enzymatic degradation

Forty-eight species of seaweeds from Japanese waters were screened for the valuable polyunsaturated fatty acids eicosapentaenoic acid (EPA). The eight species that contained the highest levels of these compounds were analyzed in detail. Of all species tested the red alga Pachymeniopsis lanceolata contained the highest EPA concentration, and it was present as both the free and bound forms. EPA constituted 38.7% of total fatty acids, and polar lipids were the main constituent of the total lipids in P. lanceolata. EPA was obtained from the marine algae P. lanceolata by enzymatic hydrolysis of the total lipids extract using phospholipase A2 (PLA2). The release of EPA reached a plateau after 10 min of enzymatic treatment. These results suggest that P. lanceolata is a useful natural source of EPA and that PLA2 treatment is a convenient method for obtaining EPA from the red alga.

Highly sensitive flow detection of uric acid based on an intermediate regeneration of uricase

The principle of the signal amplification of a uric acid sensor based on dithiothreitol (DTT)-mediated intermediate regeneration of uricase was applied to a flow-injection system with an immobilized uricase reactor and a DTT-containing carrier. Highly sensitive detection for nM to microM order of uric acid was achieved when 10 mM TRIS-HCl buffer (pH 10.0) containing 20 mM DTT was used as a carrier at 0.6 ml min-1 and 37 degrees C. The sensitivity of the uric acid was much improved over a batch method using a uricase membrane-coupling electrode, and the detection limit (ca. peak current 8 nA) of uric acid was found to be down to 3 x 10(-10) M (amplification factor; more than 10,000). This chemically amplified flow-system is very useful for the direct assay of uric acid in highly diluted biological fluids (urine and serum) without complicated pretreatment of the samples, because this sensor has the potential to detect trace amounts (nM to microM) of uric acid in highly diluted body fluids in which the concentration of interfering constituents was decreased to negligible levels. Good correlation was observed between this system and conventional spectrophotometry. The immobilized uricase reactor could be re-used for at least 4 months of repeated analysis without loss of activity and was stable if stored at 4 degrees C in 10 mM TRIS-HCl buffer, pH 9.0.

Dorsal specification in blastoderm at the blastula stage in the goldfish, Carassius auratus

The teleost dorsoventral axis cannot be morphologically distinguished before gastrulation. Previous studies by the current authors have shown that localized dorsalizing activity in the yolk cell (YC) induces the dorsal tissues in the overlying blastoderm. In order to examine whether or not dorsal blastomeres are committed to their dorsal fate before the gastrula stage, a variety of transplant operations were performed in goldfish blastoderms at the mid- to late-blastula stages. When the blastoderm was cut from the YC, rotated horizontally at 180 degrees, and recombined with the YC, the blastoderm frequently developed two axes, indicating that dorsal blastomeres of the blastula had already acquired the ability to differentiate into the organizer in the absence of dorsalizing signals from the YC. This result was further confirmed by experiments using ventralized embryos in which no dorsal structures formed: the axis formation was frequently observed in the normal blastoderm combined with the ventralized YC at the blastula stage. However, the axes formed in the absence of dorsal information from the YC exhibited a lower dorso-anterior index. Furthermore, the dorsal specification was not stably maintained when the dorsal cells were located far from the YC. These results suggest that the inductive and permissive influence of the YC may be required for the blastoderm to undergo full dorsal differentiation.

Effects of skin surface temperature distribution of thermal manikin on clothing thermal insulation

Effects of the distribution of skin surface temperature were investigated on thermal insulation of clothing for whole and each body part. The experiments were carried out with a thermal manikin in a climatic chamber. The two types of clothing ensemble were measured. The measurement with nude thermal manikin were also conducted. The three variations of skin temperature distribution were set with the thermal manikin. The values of the thermal insulation of nude skin surface (Ia), the total thermal insulation of clothing (It) and the basic thermal insulation of clothing (Icl) were measured with this thermal manikin under each skin temperature distribution. As a result, the values of Ia and It were not affected by skin temperature distributions of the range of typical experimental conditions. However, It is necessary to carefully use the values of the thermal insulation of clothing for the body parts, because these values were more influenced by the skin temperature distribution than those for the whole body.

Specific and amplified current responses to histidine and histamine using immobilized copper-monoamine oxidase membrane electrode, based on novel ascorbate oxidase activity induced by exogenous ligands

Upon the addition of histidine and histamine, the copper containing monoamine oxidase (MAO) catalyzes the oxidation of L-ascorbic acid (AsA) by dissolved oxygen, in which the consumed oxygen was finally converted to hydrogen peroxide, according to Michaelis-Menten kinetics (Km) = 1.97 mM, upon the addition of 5 x 10(-5) M L-histidine at 35 degrees C and pH 8.5). The amount of oxygen consumption depended on the amount of histidine and histamine added, and specific responses over other amines were observed when the oxygen electrode modified with immobilized MAO membrane was used in the 0.1 M Tris buffer containing AsA. The calibration curves of L-histidine and histamine at 4 mM AsA exhibit linearity in the concentration range from 5 x 10(-7) to 5 x 10(-5) M L-histidine and 5 x 10(-6) to 1 x 10(-8) M histamine, with detection limit of 3 x 10(-7) M L-histidine and 3 x 10(-6) M histamine, respectively. The ESR signal of copper(II) in active site of MAO at 77K was apparently changed upon the addition of L-histidine and histamine indicating that exogenous histidine and histamine bound to the copper site of enzyme and lead to the structural change in active site.

Microbial cyanide sensor for monitoring river water

A microbial cyanide sensor using Saccharomyces cerevisiae for monitoring a river water is described. This sensor is based on the inhibition of S. cerevisiae's respiration by cyanide. This sensor is a reactor type flow system and composed of two oxygen electrodes and a reactor which contains S. cerevisiae immobilized beads. The S. cerevisiae's respiration activity is measured using the oxygen electrodes. The sensor showed a linear response in the range from 0 to 15 microM and maintained stable response for 9 days at ambient temperature. The sensor was optimized for the monitoring of river water and was applied to river water analysis.

Usefulness of R-R interval and its variability in evaluation of thermal comfort

The use of R-R interval and the coefficient of variation in R-R intervals (CVR-R) for the evaluation of thermal comfort was investigated. The experiments were carried out with ten male subjects but data from one were excluded from the analysis. Thermal sensation, comfort, and tolerance of environmental conditions were reported and mean skin temperature, R-R interval and CVR-R were monitored during a 3 h period in a climatic chamber with the operative temperature set at 26, 20, or 30 degrees C. Relative humidity was maintained at ca. 50% in each case. At the operative temperature of 20 degrees C, the mean skin temperature was significantly lower, the cold sensation was significantly more intense, and discomfort was significantly greater than at 26 degrees C and R-R interval was increased significantly. Seven of the nine subjects were unable to tolerate this thermal environment. The R-R interval and CVR-R were increased in five and four of those seven subjects, respectively. At the operative temperature of 30 degrees C, the mean skin temperature was significantly higher, and the sensation of warmth was significantly more intense than at 26 degrees C. Seven of the nine subjects felt discomfort, and four of the seven reported an inability to tolerate this thermal environment. The R-R interval and CVR-R were decreased in four and three of these four subjects, respectively. At the operative temperature of 20 degrees C CVR-R was significantly greater than that at 30 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)