Relationship between coordination variability and Osgood-Schlatter disease in male junior youth soccer players -cross-sectional study using an inertial measurement unit

BACKGROUND

Osgood-Schlatter disease is a common overuse injury, and motor coordination is discussed as a risk factor; however, no reports have examined motor coordination in young soccer players with Osgood-Schlatter disease. This study aimed to investigate the difference in motor coordination between Osgood-Schlatter disease-affected and non-affected soccer players on a junior youth soccer team.

METHODS

This cross-sectional study investigated 35 young soccer players of 12-15 years of age, who completed a self-administered questionnaire covering general information, injury history, and athletic experience. An inertial measurement unit was attached to the participant's thoracic spine, lumbar spine, pelvis, thigh, and lower leg. The sagittal plane tilt angle of each body segment during squatting was analyzed. The continuous relative phase was calculated using the sagittal plane tilt angle. The mean absolute relative phase and continuous relative phase variabilities were calculated and compared between Osgood-Schlatter disease-affected and non-affected players.

FINDINGS

The sagittal plane tilt angle of each body segment during static standing and maximum flexion did not differ between the two groups. However, the Osgood-Schlatter disease group had significantly less continuous relative phase variability between the lumbar spine and pelvis (P < 0.01, Cohen's d = 0.91). The Osgood-Schlatter disease group had significantly fewer participants with other sports experience (P = 0.032, φ = 0.36).

INTERPRETATION

Dysfunctional lower trunk and hip muscles may be leading to Osgood-Schlatter disease. It is suggested that a variety of physical activities should be performed in the junior age group to allow players to acquire a variety of movement patterns.

Reactivation of previously controlled Vogt-Koyanagi-Harada disease more than 46 years following COVID-19 vaccination: a case study

We report a case of Vogt-Koyanagi-Harada (VKH) disease that recurred 46 years after initial treatment. A 59-year-old woman presented with a 2-month history of bilateral vision blurring. She had received her third dose of coronavirus disease 2019 (COVID-19) vaccination 4 months before the onset of blurring. The best-corrected visual acuity (BCVA) was 1.0 in the right eye and 0.15 in the left eye at the initial visit. Iritis and synechia were observed between the lens and iris bilaterally. A sunset glow fundus was found in both eyes with no serous retinal detachments or disc hyperemia. The patient had a history of VKH disease and had been treated with whole-body corticosteroid administration at another hospital when she was 13 years old. The patient was diagnosed with VKH disease recurrence, and oral corticosteroid therapy and corticosteroid eyedrop treatment were initiated. The treatment response was good. At the time of this writing, recurrence had not been observed for 14 months, and the BCVA was 1.0 in both eyes. To our knowledge, this case represents the longest recorded interval of VKH disease recurrence in the literature to date. COVID-19 vaccination might be the cause of long-term well-controlled disease recurrence.

Ultrasonographic appearance of the pronator quadratus muscle in high school baseball pitchers with and without elbow symptoms: a pilot study

PURPOSE

Earlier reports have described forearm flexor muscles as active stabilizers of the elbow to valgus stress during throwing motion. The pronator quadratus (PQ) muscle acts in coordination with the pronator teres muscle for forearm pronation. This study of high school pitchers was conducted to assess the association between sonographic appearance and a history of elbow symptoms.

METHODS

We examined 123 high school baseball pitchers, all of whom had completed a self-administered questionnaire, including items related to throwing-related elbow joint pain sustained during the prior year. Ultrasound examination was made of the pitchers with and without valgus stress of the medial aspect of the bilateral elbows. The sonographic appearance of the PQ was assessed on sagittal and axial images on the bilateral side. For participants with and without a history of elbow symptoms, we compared the maximum thickness of the PQ on sagittal and axial images of the throwing side.

RESULTS

Regarding maximum thickness of the PQ on the sagittal and axial images, a significant difference was found between the throwing and non-throwing sides (throwing side vs non-throwing side mean: sagittal 6.3 mm vs 5.7 mm, axial 8.2 mm vs 7.5 mm, 95% confidence interval: sagittal 0.41-0.70, p < 0.001, axial 0.53-0.82, p < 0.001). The maximum thickness of the PQ on axial images with elbow symptoms was significantly greater than the PQ thickness of those without elbow symptoms. Nevertheless, no association was found between elbow valgus instability and the maximum thickness of the PQ on sagittal and axial images of the throwing side.

CONCLUSION

Sonographic appearance of the PQ might be associated with elbow joint conditions in high school baseball players.

Epstein-Barr virus-associated inflammatory pseudotumor variant of follicular dendritic cell sarcoma of the liver: a case report and review of the literature

BACKGROUND

Follicular dendritic cell sarcoma is a rare stromal tumor with no standard treatment. However, some reports have revealed that follicular dendritic cell sarcoma has an inflammatory pseudotumor variant associated with Epstein-Barr virus infection that has a relatively good prognosis. In this report, we present a case of a resected inflammatory pseudotumor variant of follicular dendritic cell sarcoma of the liver, and have reviewed the literature on the clinicopathological, molecular, and genomic features of this tumor.

CASE PRESENTATION

The inflammatory pseudotumor variant of follicular dendritic cell sarcoma originates only in the liver or spleen, causes no symptoms, and is more common in middle-aged Asian women. It has no characteristic imaging features, which partially explains why the inflammatory pseudotumor variant of follicular dendritic cell sarcoma is difficult to diagnose. Pathologically, the inflammatory pseudotumor variant of follicular dendritic cell sarcoma has spindle cells mixed with inflammatory cells and is variably positive for follicular dendritic cell markers (CD21, CD23, and CD35) and Epstein-Barr virus-encoded RNA. On genetic analysis, patients with this tumor high levels of latent membrane protein 1 gene expression and extremely low levels of host C-X-C Chemokine Receptor type 7 gene expression, indicating that the inflammatory pseudotumor variant of follicular dendritic cell sarcoma has a latent Epstein-Barr virus type 2 infection.

CONCLUSIONS

The inflammatory pseudotumor variant of follicular dendritic cell sarcoma is an Epstein-Barr virus-associated tumor and a favorable prognosis by surgical resection, similar to Epstein-Barr virus-associated gastric cancer.

Ku-band multichannel frequency comb Doppler reflectometer on the GAMMA 10/potential control and divertor simulating experiment (PDX) tandem mirror

A Ku-band (12-18 GHz) multichannel Doppler reflectometer (DR) has been developed in the GAMMA 10/potential control and divertor simulating experiment (PDX) tandem mirror device to improve the applicability of DR measurement for simultaneous monitoring of velocity of electron density turbulence at different locations. Our previous single-channel DR circuit has been replaced by the multichannel microwave system using a nonlinear transmission line based comb generator with heterodyne technique. The multichannel DR system has been installed in the central cell of GAMMA 10/PDX. Initial results of application to GAMMA 10/PDX plasma are presented, showing Doppler frequency shifts during an additional ion cyclotron resonance frequency heating and gas-puffing experiment.

Developing clinical algorithm for identifying acute lumbar spondylolysis in elementary school children - Classification and regression tree analysis

OBJECTIVES

To develop a clinical algorithm for classifying acute lumbar spondylolysis from nonspecific low back pain in elementary school-aged patients using the classification and regression tree analysis.

METHODS

Medical records of 73 school-aged patients diagnosed with acute lumbar spondylolysis or nonspecific low back pain were retrospectively reviewed. Fifty-eight patients were examined for establishing an algorithm and 15 were employed for testing its performance. The following data were retrieved: age, gender, school grades, days after symptom onset, history of low back pain, days of past low back pain, height, weight, body mass index, passive straight leg raise test results, hours per week spent on sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Classification and regression tree analyses were performed 150 times using the bootstrap and aggregating method. Then, the results were integrated by majority vote, establishing an algorithm.

RESULTS

Lumbar lordosis angle, days after symptom onset, body mass index, and lumbosacral joint angle were the predictors for classifying those injuries.

CONCLUSION

The algorithm can be used to identify elementary school-aged children with low back pain requiring advanced imaging investigation, although a future study with a larger sample population is necessary for validating the algorithm.

POS0390 GENES OF “DEFENSE RESPONSE TO VIRUS” IN PERIPHERAL BLOOD OF ANTI-MDA5 POSITIVE DERMATOMYOSITIS WERE UPREGULATED AS COMPARE WITH OTHER FORMS OF DERMATOMYOSITIS. ~SUPPRESSING RIG-I LIKE RECEPTOR SIGNALING OR TYPE 1/2 INTERFERON SIGNALING WERE THE KEYS FOR SURVIVAL

Background

Anti-melanoma differentiation-associated gene 5–positive dermatomyositis (MDA5 DM) is a rare but distinct subtype of idiopathic inflammatory myopathy (IIM) that is characterized by high mortality due to rapid progressive interstitial lung disease (ILD). MDA5 is a cytosolic protein and a family of retinoic-acid inducible gene-I (RIG-I) like receptor, which functions as a virus RNA sensor and induces the production of type I interferons (IFN-I) and proinflammatory cytokines. This leads to the death of infected cells and the activation of the antigen-specific antiviral immune response. Although the pathogenesis of MDA5 DM is largely unknown, a hypothesis that pathogenic involvement of anti-MDA5 antibodies has been proposed. Recently, similarities have been noted between multifaceted features of COVID-19 and MDA5 DM, which suggests shared underlying autoinflammatory mechanisms.

Objectives

To detect the critical actors in the pathogenesis of MDA5 DM by gene expression analysis of peripheral blood.

Methods

Total of 31 DM cases were investigated, including anti-aminoacyl-tRNA synthetase positive (ARS) DM (n=12), MDA5 DM (n=7, survivor=3) and others (n=12). Peripheral blood was drawn at baseline and 2 to 3 months after treatments. Total RNAs were then extracted with using PAXgene miRNA kit. After quantifying the expressions of transcripts by multiplex sequencing. And then, hierarchical clustering analysis, enrichment analysis using gene ontology (GO) terms, single sample gene set enrichment analysis (ssGSEA) and weighted gene co-expression network analysis (WGCNA) were performed.

Results

The hierarchical clustering with expression profiles of peripheral blood at baseline showed major 3 clusters. Interestingly, ARS DM cases were segregated into right side of the 3rd cluster while MDA5 DM cases fell into 1st and 2nd clusters. ARS and MDA5 DM were clearly discriminated if differentially expressed genes (DEGs) between these subtypes of DM were analyzed. By GO enrichment analysis, the terms, such as related to “defense response to virus” including “type1 interferon signaling pathway” were found in the DEGs. In the MDA5 DM cases, ssGSEA revealed that genes of “Fcγ receptor mediated phagocytosis pathway” or “complement and coagulation cascade” were significantly enriched and WGCNA showed that pathways of “T-cell antigen receptor signaling” or “lung fibrosis” were significantly upregulated. Next, we also investigated the DEGs of peripheral blood at 2-3 months after treatment between survival and fatal cases in MDA5 DM. We found that suppressing RIG-I like receptor and type 1 and type 2 interferon (IFN) signaling were the keys for survival.

Conclusion

MDA5 is a key sensor of several RNA viruses including coronavirus families and then activate antiviral gene transcription such as type 1 IFN genes, leading to establish an antiviral host response. As the pulmonary damage of COVID-19 is known to be difficult to distinguish from the ILD associated with anti-MDA5 DM, the life-threating ILD of MDA5 DM may be caused by the over-activation of RIG-I like receptor signaling via MDA5. The hypothesis is supported by our findings that the defining features of MDA5 DM are activation of “type 1 IFN pathways” and antigen-specific antiviral immune responses including “Fcγ receptor mediated phagocytosis pathway” or “T-cell antigen receptor signaling”. As the levels of anti-MDA5 antibodies reported to be important prognostic parameter, it may be involved in pathogenesis of MDA5 DM. As we found that suppression of type 1 and type 2 IFN signaling were the keys for survival, it seems to be reasonable to use inhibitors of Janus Kinases (JAK) for treatment of MDA5 DM.

Disclosure of Interests

Yoshinobu Koyama Speakers bureau: Abbvie, Asahikasei, Ayumi, BMS, Eli-Lilly, Mitsubishi Tanabe, Grant/research support from: Abbvie, GSK, Yoshiharu Sato: None declared, Moe Sakamoto: None declared

Changes in immune system and intestinal bacteria of cows during the transition period

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Transitional high-energy diets reduce peripheral blood lymphocytes in dairy cows.

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High-energy diets upregulate IL-1β and IL-2 and downregulate IL-10 expression.

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Functional lactobacillus plantarum LP1 restores normal levels of lymphocytes subset.

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Lactobacillus plantarum LP1-added diets reduce inflammatory cytokine expression.

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LP1 mitigates immune response imbalances caused by transitional high energy diets.

High-yield dairy cows need high energy feed during periods of increased milk production. The transitional feeding to high energy feed increases the risk of developing a variety of metabolic disorders. Here, five Holstein cows were fed a four-stage feeding protocol (3 weeks for each stage) ranging from 54.9 to 73.7% total digestive nutrients (TDN). The purpose of the study was to investigate the effect of lactic acid bacteria on high-energy-fed cows associated with transitional feeding, and to evaluate the effects of probiotics on intestinal bacterial changes and inflammatory responses. Three feed transition periods were established for five cows, and Lactobacillus plantarum RGU-LP1 (LP1) was fed as a probiotic during the high-energy feeding period. The number of lymphocyte subsets such as CD3-, CD4-, and CD8 positive cells decreased in response to the high energy feed. Lipopolysaccharide (LPS)-induced cytokine (IL-1β and IL-2) gene expression in peripheral blood mononuclear cells (PBMCs) was shown to increase in those animals receiving the high energy feed. However, supplementation with LP1 resulted in an increase in the number of lymphocyte subsets and the expression of IL-1β and IL-2 were returned to the level at low energy diet. These results suggest that high energy diets induce inflammatory cytokine responses following LPS stimulation, and that the addition of LP1 mitigates these results by regulating the LPS-induced inflammatory reaction. Therefore, the functional lactic acid bacteria LP1 is expected to regulate inflammation resulting from high energy feeding, and this probiotic could be applied to support inflammatory regulation in high-yield dairy cows.

Risk Factors for Throwing-Related Shoulder and Elbow Pain in Adolescent Baseball Players: A Prospective Study of Physical and Developmental Factors

Background:

Throwing-related shoulder and elbow pain continues to be reported among adolescent baseball players. Few prospective studies have specifically examined the association between throwing-related shoulder and elbow pain and physical and developmental changes.

Purpose:

To evaluate the changes in physical and developmental characteristics during 1 year with respect to throwing-related shoulder and elbow pain in adolescent baseball players.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

This 1-year prospective follow-up study investigated 164 baseball players aged 7 to 13 years. Player data (age, height, weight, field position, and pitch count), lower extremity muscle tightness, and range of motion (ROM) of the shoulder, elbow, and hip joints were assessed during the 2016 and 2017 preseason medical examinations. After the 2016 season, the participants completed questionnaires related to throwing-related shoulder and elbow pain, defined as an inability to play for ≥1 week because of elbow or shoulder difficulties. For study participants with and without throwing-related shoulder or elbow pain during the 2016 season, we conducted univariate and multivariate logistic regression analysis to identify risk factors for throwing-related shoulder or elbow pain.

Results:

Overall, 21 players (12.8%) reported a shoulder pain episode, 56 players (34.1%) had an elbow pain episode, and 70 players (42.7%) reported having experienced shoulder and/or elbow pain during the 2016 season. In multivariate logistic regression analysis, (1) shoulder pain was associated with 2016 preseason height (odds ratio [OR], 1.06; 95% CI, 1.01-1.11; P = .01) and change in dominant-side elbow extension ROM from 2016 to 2017 (OR, 1.12; 95% CI, 1.02-1.24; P = .02); (2) elbow pain was associated with change in weight from 2016 to 2017 (OR, 1.21; 95% CI, 1.04-1.41; P = .014); and (3) throwing-related shoulder and/or elbow pain was associated with greater 2016 preseason height (OR, 1.04; 95% CI, 1.003-1.68; P = .03) and an increase in height from 2016 to 2017 (OR, 1.17; 95% CI, 1.01-1.35; P = .03).

Conclusion:

Our results indicated that adolescent baseball players who were taller in the preseason and those with an increase in height over the 1-year study period faced significant risks for developing throwing-related shoulder and/or elbow pain.

Prognostic grade for resecting hepatocellular carcinoma: multicentre retrospective study

BACKGROUND

Surgical treatment for hepatocellular carcinoma (HCC) is advancing, but a robust prediction model for survival after resection is not available. The aim of this study was to propose a prognostic grading system for resection of HCC.

METHODS

This was a retrospective, multicentre study of patients who underwent first resection of HCC with curative intent between 2000 and 2007. Patients were divided randomly by a cross-validation method into training and validation sets. Prognostic factors were identified using a Cox proportional hazards model. The predictive model was built by decision-tree analysis to define the resection grades, and subsequently validated.

RESULTS

A total of 16 931 patients from 795 hospitals were included. In the training set (8465 patients), four surgical grades were classified based on prognosis: grade A1 (1236 patients, 14.6 per cent; single tumour 3 cm or smaller and anatomical R0 resection); grade A2 (3614, 42.7 per cent; single tumour larger than 3 cm, or non-anatomical R0 resection); grade B (2277, 26.9 per cent; multiple tumours, or vascular invasion, and R0 resection); and grade C (1338, 15.8 per cent; multiple tumours with vascular invasion and R0 resection, or R1 resection). Five-year survival rates were 73.9 per cent (hazard ratio (HR) 1.00), 64.7 per cent (HR 1.51, 95 per cent c.i. 1.29 to 1.78), 50.6 per cent (HR 2.53, 2.15 to 2.98), and 34.8 per cent (HR 4.60, 3.90 to 5.42) for grades A1, A2, B, and C respectively. In the validation set (8466 patients), the grades had equivalent reproducibility for both overall and recurrence-free survival (all P < 0.001).

CONCLUSION

This grade is used to predict prognosis of patients undergoing resection of HCC.

Identifying Acute Lumbar Spondylolysis in Young Athletes with Low Back Pain: Retrospective Classification and Regression Tree Analysis

STUDY DESIGN

Case-control study.

OBJECTIVE

The aim of this study was to establish an algorithm to distinguish acute lumbar spondylolysis (LS) from nonspecific low back pain (NSLBP) among patients in junior high school by classification and regression tree (CART) analysis.

SUMMARY OF BACKGROUND DATA

Rapid identification of acute LS is important because delayed diagnosis may result in pseudarthrosis in the pars interarticularis. To diagnose acute LS, magnetic resonance imaging (MRI) or computed tomography is necessary. However, not all adolescent patients with low back pain (LBP) can access these technologies. Therefore, a clinical algorithm that can detect acute LS is needed.

METHODS

The medical records of 223 junior high school-aged patients with diagnosed acute NSLBP or LS verified by MRI were reviewed. A total of 200 patients were examined for establishing the algorithm and 23 were employed for testing the performance of the algorithm. CART analysis was applied to establish the algorithm using the following data; age, sex, school grades, days after symptom onset, history of LBP, days of past LBP, height, passive straight leg raising test results, hours per week spent in sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Sensitivity and specificity of the algorithm and the area under the ROC curve were calculated to assess algorithm performance.

RESULTS

The algorithm revealed that sex, days after symptom onset, days of past LBP, hours per week spent in sports activities, and existence of spina bifida were key predictors for identifying acute LS versus NSLBP. Algorithm sensitivity was 0.64, specificity was 0.92, and the area under the ROC curve was 0.79.

CONCLUSION

The algorithm can be used in clinical practice to distinguish acute LS from NSLBP in junior high school athletes, although referral to MRI may be necessary for definitive diagnosis considering the algorithm's sensitivity.Level of Evidence: 4.

Cross-sectional Study of the Hip Joint Condition in Young Baseball Players

Objective

The hip joint is a crucial part of the kinetic chain for throwing baseball pitches. Nevertheless, few reports have described assessments of the functional development of the hip joint in young baseball players.

Methods

We examined 315 young baseball players, 7-14 years old, all of whom had completed a self-administered questionnaire including items related to the dominant side and throwing-related hip joint pain sustained during the previous year. We measured the hip ranges of motion (ROMs: external and internal rotation and flexion) and hip muscle strengths (external and internal rotation) on the dominant and non-dominant sides. The differences of hip ROMs and muscle strengths between the dominant and non-dominant sides and between age groups were investigated. Correlations were calculated between the players ages and hip ROMs and muscle strengths.

Results

No baseball player reported hip pain. The hip external rotation on the dominant side was smaller than that on the non-dominant side, whereas the hip internal rotation on the dominant side was greater than that on the non-dominant side. However, no significant difference was found between the dominant and non-dominant sides in terms of the hip muscle strength. Significant positive associations were found between the player's age and hip muscle strengths, whereas significant negative associations were found between the age and hip ROMs.

Conclusions

Our data concerning the relationship between age and hip joint development could be useful for supporting strategies for the prevention and rehabilitation of throwing injuries; however, hip injuries might be rare among young baseball players.

POS0881 DETECTION OF THE GENE EXPRESSIONS IN PERIPHERAL BLOOD INVOLVED IN THE PROGRESSION OF PULMONARY VESSEL DISEASE AT THE SUBCLINICAL STAGE OF PULMONARY HYPERTENSION ASSOCIATED WITH SYSTEMIC SCLEROSIS

Background:

Pulmonary hypertension (PH) is prominent as a vascular involvement of systemic sclerosis (SSc), which remains a leading cause of death in spite of current best treatments. Recently, hemodynamic definition of PH was updated from mPAP≥25mmHg to mPAP>20mmHg and PVR≥3WU. Although new definition may improve the prognosis of PH associated with SSc by giving a chance to start management early, it may be insufficient as more than 2/3 of the pulmonary circulation is already impaired by the time of meeting the definition. Therefore, the ideal therapeutic intervention should be started at the subclinical stage of PH in SSc patients, but little is known about underlying pathological mechanisms at the stage. In this study, we investigate progression to exercise-induced PH (exPH)1), which is considered subclinical PH, in the prospective registry of high-risk population for developing PH associated with SSc.

Objectives:

To detect the gene expressions in peripheral blood involved in the progression of pulmonary vessel disease (PVD) at the subclinical stage of PH associated with SSc.

Methods:

Total of 180 patients who had not met PH criteria with Raynaud phenomenon, skin sclerosis or SSc-related autoantibody was registered. To detect the early PVD, exercise Doppler echocardiography (exDE) was carried out every 6 or 12 months for up to 6 years. The definition of exPH was maximum sPAP>40mmHg or increase in sPAP>20mmHg estimated by exDE during exercise. For gene expression analysis, total RNAs from whole peripheral blood cells were extracted by PAXgene system, and then multiplex sequencing was done. To identify candidate genes involved in the progression to exPH, random forest machine learning method was employed. Volcano plots, a scatter plots to visualize fold-changes and p-values of differentially expressed genes (DEGs) between exPH and others (exN), were also used for seeking the important genes for disease progression.

Results:

At the time of registration, 34.4% of patients met exPH criteria, and 15.6% of patients developed exPH during follow-up period (35.0±18.1 months). Expression of TNF gene was selected as the most useful genes to predict progression to exPH by random forest, and the accuracy of the model was about 87%. Volcano plots indicated that expressions of TMEM176A and TMEM176B were prominent (fold-change >2.4 and -log10 p-value >3.5) in exPH patients. The accuracy was improved to 90% if the expression of TNF and TMEMA/B were used for the prediction of progression to exPH. We found that statistically significant increase in the expression of TNF was eliminated at the time of fulfilling the exPH criteria, while increase in expressions of TMEM A/B were still kept.

Conclusion:

It was reported that TNFα drives pulmonary arterial hypertension by suppressing the BMP type-II receptor and altering NOTCH signalling2). Our findings suggest that TNFα plays important role only in the period of pre-exPH. On the other hand, increase in expressions of TMEM A/B were observed through the period of pre-exPH to post-exPH. It suggests that there are multiple phases before developing PH associated with SSc. It is very important to understand the phases for the precise treatment to arrest the progression of PVD.

References:

[1]R. Naeije et al., Am J resp and critical care med 187, 576-583 (2013). 2) LA. Hurst et al., Nat Commun. 13;8:14079 (2017).

Disclosure of Interests:

Yoshinobu Koyama Speakers bureau: Asahikasei, Ayumi, BMS, Mitsubishi Tanabe, Shin-nihon, Paid instructor for: Asahikasei, Asteras, BMS, Grant/research support from: Eli-Lilly, Yoshiharu Sato: None declared, Tatsuma Shoji: None declared, Soichiro Fuke: None declared, Takatsune Umayahara: None declared, Moe Sakamoto: None declared

Measurement of axial phase difference of density fluctuations owing to spontaneously excited waves by using microwave reflectometer on GAMMA 10/PDX

In the GAMMA 10/PDX tandem mirror, plasma with strong ion-temperature anisotropy is produced by using the ion cyclotron range of frequency waves. This anisotropy of ion temperature causes several Alfvén-Ion-Cyclotron (AIC) waves to spontaneously excite in the frequency range just below the ion cyclotron frequency. In addition, difference-frequency (DF) waves are excited in the radial inner region of the plasma by wave-wave coupling among the AIC waves. The radial density profiles were measured at multi-axial positions using a frequency-modulation reflectometer with an axial array of microwave antennas, and an axial variation of the density was found to be significant. In addition, a relative phase difference of the DF wave between axially separated two points was first obtained by finely choosing the probing frequency of the reflectometers with a maximum coherence used as a measure, indicating that the DF wave is a propagating wave, while the pump AIC waves are standing waves in the axial region of measurement.

Improvement in multipass Thomson scattering system comprising laser amplification system developed in GAMMA 10/PDX

The multipass Thomson scattering (MPTS) technique is one of the most useful methods for measuring low-electron-density plasmas. The MPTS system increases Thomson scattering (TS) signal intensities by integrating all multipass (MP) signals and improving the TS time resolution by analyzing each pass signal. The fully coaxial MPTS system developed in GAMMA 10/potential-control and diverter-simulator experiments has a polarization-based configuration with image-relaying optics. The MPTS system can enhance Thomson scattered signals for improving the measurement accuracy and megahertz-order time resolution. In this study, we develop a new MPTS system comprising a laser amplification system to obtain continuous MP signals. The laser amplification system can improve degraded laser power and return an amplified laser to the MP system. We obtain continuous MP signals from the laser amplification system by improving the laser beam profile adjuster in gas scattering experiments. Moreover, we demonstrate that more MP signals and stronger amplified MP signals can be achieved via multiple laser injections to the laser amplification system in the developed MP system comprising a laser amplification system.

The impact of the foot contact position and cutting angle during cutting on the risk of anterior cruciate ligament injury

[Purpose] This study aimed to clarify the impact of the foot contact position and cutting angle on the risk of anterior cruciate ligament injury during cutting. [Participants and Methods] Seven healthy males performed cuttings under four tasks by changing the foot contact position and cutting angle. A three-dimensional motion analysis system and force plates were used for taking measurements. The peak vertical ground reaction force and loading rate were calculated. The pelvic, hip, and knee joint angles were measured at the peak vertical ground reaction force. [Results] The loading rate was significantly higher in the lateral foot contact than in the anterior foot contact when the cutting angle was large. The knee flexion angle at the peak vertical ground reaction force was significantly smaller in the lateral foot contact than in the anterior foot contact when the cutting angle was large, similar to the pelvic forward inclination angle, regardless of the foot contact position. [Conclusion] As the cutting angle increased, the knee flexion and pelvic forward inclination angles decreased, resulting in an increase in the loading rate during cutting with the lateral foot contact. Therefore, an increase in the cutting angle can increase the risk of anterior cruciate ligament injury.

A case of hip joint septic arthritis due to haematogenous infection, which was misdiagnosed sternoclavicular joint septic arthritis as SAPHO syndrome

Anterior chest pain associated with sternoclavicular arthritis has been considered a symptom specific to SAPHO syndrome. Differentiating aseptic arthritis of the SAPHO syndrome from infectious sternoclavicular joint (SCJ) arthritis is often difficult. We reported a 55-year-old woman with left hip joint and right SCJ pain. Diagnosis and treatment were delayed because she was misdiagnosed with SAPHO syndrome, and haematogenous infection spread to the hip joint septic arthritis. She was diagnosed promptly after presenting to our hospital and underwent early debridement, and her hip joint and SCJ was found to have almost no dysfunction. Differentiation between sternoclavicular arthritis of the SAPHO syndrome and sternoclavicular septic arthritis is clinically important and requires careful attention.

Extracorporeal high-pressure therapy (EHPT) for malignant melanoma consisting of simultaneous tumor eradication and autologous dermal substitute preparation

Surgical resection of skin tumors leads to large defects in surrounding normal tissues, which should be reconstructed thereafter using the patient's own tissues taken from the other site. Our challenge is to solve this problem in dermal malignant melanoma (MM) by a novel process, named extracorporeal high pressure therapy (EHPT), in which the tissue containing tumor is resected and pressurized, and the treated tissue is re-transplant back to the same position as a tumor-free autologous dermal substitute. The key points are complete tumor death and preservation of native extra cellular matrix (ECM) by the hydrostatic pressure. We found that high hydrostatic pressure at 200 MPa for 10 min at room temperature is completely cytocidal against MM cells in suspension form, in monolayer form, and even in the solid tumor form. MM tumor-bearing nude mice were established by injected human MM cells intradermally and treated by EHTP. The denaturation of the dermal extra cellular matrices was so mild that the pressurized skin was well engrafted as tumor free autologous dermal tissues, resulting in the complete eradication of the MM without any unnecessary skin reconstruction surgery. This very simple and short pressing treatment was proved to make the tumor tissue to the transplantable and tumor-free autologous dermal substitute, which can be applicable to the other temporally resectable tissues.

Relation between grip and pinch strength and pitch type in high school pitchers with and without elbow symptoms

OBJECTIVE

Gripping and pinching a ball is a fundamentally important part of the kinetic chain for throwing baseball pitches of various types. This study of high school pitchers was conducted to assess the association between grip and pinch strength, the pitch type, and the history of elbow symptoms.

METHODS

We examined 133 high school baseball pitchers, all of whom had completed a self-administered questionnaire including items related to pitch type throwing ratios, the age at starting each pitch type, and throwing-related elbow joint pain sustained during the prior 3 years. We measured grip strength and the bilateral side tip, key, and palmar pinch strengths. Comparisons were made between the participants with and without an elbow symptom history to assess the grip and each pinch strength, throwing ratio of pitch type, and the age at starting to throw each pitch type.

RESULTS

Pitchers with an elbow symptom history exhibited less difference between the grip strength on the throwing side than those with no elbow symptom history (p = 0.04). No difference was found between participants with and without an elbow symptom history in terms of pinch strength, the throwing ratios of pitch types, or the age at starting to throw pitches of each type. Positive significant association was found between pinch strength on the pitching side and the forkball and screwball throwing ratio (r = 0.27, p = 0.002).

CONCLUSION

Grip strength might influence high school baseball pitcher elbow conditions. The frequency of certain pitch types might develop pinch strength in high school baseball pitchers.

Anatomic characterisation of the parietal branches arising from the internal iliac artery in the foetal pig (Sus scrofa domestica)

BACKGROUND

It is critical for surgeons to have a full understanding of the complex courses and ramifications of the human internal iliac artery and its parietal branches. Although numerous anatomical studies have been performed, not all variations at this site are currently understood. Therefore, we characterised these blood vessels in foetal pigs to provide additional insight from a comparative anatomical perspective.

MATERIALS AND METHODS

Eighteen half-pelvis specimens from foetal pigs were dissected and examined on macroscopic scale.

RESULTS

Among our findings, we identified the internal iliac artery as a descending branch of the abdominal aorta. A very thick umbilical artery arose from the internal iliac artery. The superior gluteal, inferior gluteal, and internal pudendal arteries formed the common arterial trunk. Although the superior gluteal artery emerged from the common trunk from inside the pelvis, the inferior gluteal and internal pudendal arteries bifurcated at deep layer within the gluteus muscles after leaving pelvic cavity. We were unable to detect an typical obturator artery emerging from the internal iliac artery. A branch supplying the hip adductors was identified as arising from the inferior epigastric artery which itself was derived from the distal end of the external iliac artery.

CONCLUSIONS

We identified the anatomic characteristics of the internal iliac artery and its parietal branches in the foetal pig. Our findings provide new insight into the comparative anatomy of the internal iliac artery and will promote understanding of related morphogenetic processes.

The relationship between the deep squat movement and the hip, knee and ankle range of motion and muscle strength

[Purpose] We examined and clarified the relationship between the maximum squat depth and the range of motion of the ankle, knee, and hip joints, and the knee and hip muscle strength. [Participants and Methods] Nine healthy males participated in this study and performed a deep squat with the upper extremities raised; the movement was analyzed by two-dimensional motion analysis. We measured the ankle dorsiflexion, hip flexion, and knee flexion ranges of motion, as well as the knee extension and hip flexion muscle strengths and analyzed the relationship between the squatting motion, the range of motion, and the muscle strength of each joint. [Results] The right ankle dorsiflexion range of motion was a significant predictor of the ankle dorsiflexion angle on both sides. The right knee flexion range of motion was a significant predictor of the knee flexion angle, and the left knee flexion range of motion was a significant predictor of the trunk anterior tilt angle on both sides. The right ankle dorsiflexion range of motion was a significant predictor of the right hip flexion angle and vice versa. [Conclusion] This study reveals that movement on one side affects contralateral movement, which is important when evaluating the deep squat motion as a functional test.

SAT0119 PARADOXICAL NEUTROPHIL ACTIVATION BY ANTI-IL6 THERAPY: TRANSCRIPTOME ANALYSIS SHOWS A RATIONALE FOR DERMATOLOGICAL ADVERSE REACTIONS AND DECREASED NEUTROPHIL COUNTS AFTER TOCILIZUMAB TREATMENT

Background:

Skin rashes as a side effect of Tocilizumab therapy (TCZ- Tx) has not been paid much attention, because the incidence was only 1~2% in the drug information sheets. However, we experienced several RA cases with development of various skin rashes associated with neutrophil activation after TCZ-Tx. On the other hand, it is well known that the neutrophil counts in peripheral blood decreases after TCZ-Tx, whereas it does not affect the rate of serious infections. The detailed mechanism is still unclear.

Objectives:

To detect the characteristics of the changes in gene expressions of peripheral blood associated with TCZ-Tx and the development of skin rashes as its side effect.

Methods:

Total of 14 RA patients with TCZ-Tx were included. Among them, 4 patients developed TCZ-related rashes (group S) and 10 patients did not show any side effects (group C). Peripheral whole blood at just before (pre) and 3 months after (post) TCZ-Tx from each patient were subjected to the analysis. Total RNAs were extracted with PAXgene miRNA kit and analyzed with next-generation sequencing. First, group C was investigated for the normal response to TCZ-Tx. Differentially expressed genes (DEGs) were selected by paired comparison (post vs. pre). And then, enrichment analysis using gene ontology (GO) terms were performed. Second, to explore the characteristics of group S, all expressed genes in 14 cases at just before TCZ-Tx were subjected to a hierarchical clustering analysis. The DEGs (group S vs. C and post vs. pre) were also investigated with weighted gene co-expression network analysis (WGCNA) and GO analysis. Meanwhile, the total eigengene expressions of the important modules identified by WGCNA in each cases were also calculated.

Results:

Surprisingly, 8 out of the top 10 enriched GO terms in the up-regulated genes were relevant to leukocyte activation such as ‘neutrophil migration” by the analysis of DEGs (post vs. pre) in group C. The cluster analysis of ‘pre’ genes confirmed that the patterns of gene expression between group S and C was different. WGCNA analysis of DEGs (group S vs. C) revealed that genes related to acute inflammation such as ‘leukocyte mediated immunity’ were activated in group S. Interestingly, it was not correlated with disease activity score (DAS) of RA. By the analysis of DEGs (post vs. pre) of upregulated genes, we found that the total eigengene expressions of the module enriched with genes related to ‘cell adhesion’ or ‘leukocyte migration’ were significantly increased in all cases of group S.

Conclusion:

This is the first evidence that the genes associated with neutrophil migration is significantly activated after TCZ-Tx. It is noteworthy that the gene activation was observed in cases without any side effects. The decreased neutrophil counts in peripheral blood have been known after initiation of TCZ-Tx, which did not affect the rate of serious infections. Recently, It was reported that TCZ affects neutrophil trafficking to the bone marrow1). Our findings will provide a rationale for its cause. On the other hand, we experienced several RA cases with development of various skin rashes associated with neutrophil activation after TCZ-Tx. However, majority of patients do not develop the side effect, even though genes related to ‘neutrophil migration’ are activated. In group S, our findings indicate that the genes related to ‘leukocyte mediated immunity’ was already activated at the initiation of treatment without correlating to DAS of RA, furthermore, the gene upregulation related to ‘leukocyte migration’ was more prominent after TCZ-Tx. Although it is difficult to predict the patients developing skin rashes before TCZ-Tx, we do not recommend to use TCZ for the patients with neutrophilic dermatosis which is often associated with RA.

References: :

[1]Lok LSCet al.,Eur J Clin Invest. 47(10):736-745 (2017).

Disclosure of Interests: :

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Disclosure of Interests: :

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

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

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

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

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

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

Background

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

Methods

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

Results

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

Conclusion

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

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

Background

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

Purpose

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

Methods

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

Results

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

Conclusion

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Clinical Trials Registration

NCT00543543; NCT00943722.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

OBJECTIVES

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

DESIGN AND SETTING

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

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

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

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

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

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

Aqueous and Vitreous Penetration of Levofloxacin after Topical and/or Oral Administration

PURPOSE

To investigate the aqueous and vitreous penetration of levofloxacin, the drug was administered topically and/or orally to patients undergoing vitrectomy.

METHODS

Thirty-six patients undergoing initial vitrectomy with phacoemulsification and aspiration (PEA) were enrolled, and were divided randomly into three groups. Group 1 was treated with topical application of levofloxacin (three times on the day before surgery and seven times on the day of surgery), Group 2 received oral administration of levofloxacin (200 mg twice on the day before surgery and 200 mg at 3 hours before surgery), and Group 3 received both topical and oral levofloxacin according to the above schedules. The concentration of levofloxacin was measured in aqueous humor and vitreous fluid samples obtained during surgery.

RESULTS

In Groups 1, 2, and 3, the mean levofloxacin concentration in aqueous humor was 0.765+/-0.624 micro g/mL, 1.279+/-0.440 micro g/mL, and 1.823+/-0.490 micro g/mL, respectively, while the mean levofloxacin concentration in vitreous fluid was <0.02 micro g/mL, 1.455+/-0.445 micro g/mL, and 1.369+/-0.530 micro g/mL, respectively.

CONCLUSIONS

Oral administration of levofloxacin at a dose of 400 mg/day was sufficient for the prophylaxis of ocular infections, because the drug concentrations in both aqueous humor and vitreous fluid were higher than the MIC90 values for major ocular pathogens. Topical application of levofloxacin achieved adequate drug levels in aqueous humor, but not in vitreous fluid, while combined topical and oral administration had an additive effect on the drug concentration in aqueous humor.