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Both quality and quantity of skeletal muscle are considered important for prognostic factors and clinical outcomes in solid cancers. However, few studies have examined both quality and quantity of skeletal muscle in patients with hematological malignancies. The aim of the present study was to clarify the prevalence of low skeletal muscle quantity and quality and their associated factors in patients before allogeneic hematopoietic stem cell transplantation (allo-HSCT). Pretransplant plain CT imaging at the third lumber vertebra level was used to measure the psoas muscle mass index (PMI) and the intramuscular adipose tissue content (IMAC) in 113 adult patients (age 47.1 ± 14.6 years) before HSCT. We analyzed the factors associated with PMI and IMAC, respectively. Although 62.8% of all patients had low skeletal muscle mass, only 8% had poor skeletal muscle quality. Multivariable logistic analysis showed that older age [odds ratio (OR) = 2.45, confidence interval (CI) = 1.04–5.76, P = 0.04], male (OR = 4.35, CI = 0.05–0.97, P = 0.04), and low BMI (OR = 0.83, CI = 0.71–0.97, P = 0.02) were independent risk factors for low PMI before HSCT. Only age (≤ 50 years) was significantly associated with muscle quality (modified OR = 0.07, CI = 0.00–0.43, P

Anterior cruciate ligament (ACL) reconstruction using hamstring tendons may involve harvesting of the gracilis tendon in addition to the semitendinosus tendon (ST) depending on the size of the ST graft. However, the effect of gracilis harvesting in addition to ST harvesting on muscle strength, such as the hamstring-to-quadriceps (HQ) ratio, remains unclear. Hence, this study aimed to investigate the effect of gracilis harvesting on subsequent knee muscle strength. Eighty-two patients who underwent ACL reconstruction were included in this retrospective study. They were divided into the following two groups depending on the tendon graft used for ACL reconstruction: the ST group (41 patients) and the semitendinosus tendon/gracilis tendon (STG) group (41 patients). The isokinetic peak torque of the knee extensor and flexor was measured using a BIODEX dynamometer at a velocity of 60°/s and 180°/s, respectively, 3 and 6 months after ACL reconstruction. The groups were compared in terms of the limb symmetry index (LSI) and HQ ratio. The significant difference in the knee flexor of the LSI at 6 months after ACL reconstruction was as follows: ST group, 120.3 ± 28.3 vs STG group, 105.6 ± 19.0 (p

Introduction The risk factors of noncontact anterior cruciate ligament (ACL) injury remain an enigma. The purpose of this study was to prospectively evaluate the risk factors for noncontact ACL injury in female high school basketball and handball players. Materials and Methods We conducted a 3-year prospective cohort study between 2009 and 2014, and it included 317 female high school athletes aged 15 years. At baseline, they underwent detailed examinations for various parameters that were documented during their first year of high school. The parameters assessed were height (cm), weight (kg), general joint laxity (points), navicular drop (mm), anterior laxity of the knee using the KT-1000 Knee Ligament Arthrometer (mm), angle of femoral anteversion (o), knee extensor/flexor muscle strength (Nm/kg), and hip abductor strength (Nm/kg). All ACL injuries that occurred during these 3 years were recorded. Results Of 317 players, 27 were excluded because they either had a history of ACL injury or could not complete the study. Thirty ACL tears occurred. Three of the ACL injuries were contact injuries, whereas the remaining 27 were noncontact injuries. Greater body weight (95% confidence interval [CI], 1.030–1.174; P = 0.004), a high hip abductor strength (95% CI, 1.462–4.827; P = 0.001), and small femoral anteversion (95% CI, 0.746–0.982; P = 0.027) were found to be risk factors in logistic regression analysis. Conclusion Greater body weight, a high hip abductor strength, and small femoral anteversion were risk factors for noncontact ACL injury in female high school basketball and handball players.

Objectives We investigated the prevalence of locomotive syndrome (LS) and related musculoskeletal diseases [osteoarthritis (OA), lumbar spondylosis, and spinal alignment] in Type 2 diabetes mellitus (DM) patients. Methods Clinical data were collected from 101 patients (55 males; 46 females) admitted to our hospital for diabetes education from October 2018 to April 2021. Patients underwent full-spine and whole-legs standing radiography and physical measurements (10-m walking and grip strength tests and three LS risk tests). Results The estimated prevalence of LS was 86.1% (Stage 1: 44.5%, Stage 2: 41.6%), lumbar spondylosis was 11.9%, and hip, knee, and ankle OA were 16.9%, 51.5%, and 12.9%, respectively. Multiple logistic regression analysis identified grip strength [odds ratio (OR) = 0.89, confidence interval (CI) = 0.83–0.94], diabetic retinopathy (OR = 5.85, CI = 1.64–20.78), knee OA (OR = 3.34, CI = 1.11–10.02), and a sagittal vertical axis >40 mm (OR = 3.42, CI = 1.13–10.39) as significantly associated risk factors for worsening LS in Type 2 DM patients. Conclusions This study clarified the epidemiological indicators of LS and associated factors in DM patients. Exercise therapy and DM management are effective strategies to reduce the occurrence and progression of LS.

This study aimed to investigate the effect of anterior cruciate ligament (ACL) reconstruction with an ultrasound-guided femoral nerve block (FNB) on knee extensor strength weakness 3 and 6 months, and graft rupture in the 1 year following ACL reconstruction.One hundred and seven patients who underwent ACL reconstruction were included in this retrospective study. The patients were divided into two groups stratified by the method of postoperative pain management. The FNB group included 66 patients, and there were 41 patients in the intravenous patient-controlled analgesia (iv-PCA) group. The isokinetic peak torque of knee flexor and extensor was measured preoperative, 3 and 6 months after ACL reconstruction. Muscle strength measurements were performed using the BIODEX dynamometer at a velocity of 60°/s and 180°/s. Peak torque of knee extensor and flexor strength, estimated pre-injury capacity (EPIC), body weight ratio (BW), and graft rupture incidence were compared between the two groups.There were no statistically significant differences in the knee extensor and flexor strength for all items at 3 and 6 months after ACL reconstruction. There was also not a statistically significant difference in the graft rupture incidence between the two groups: FNB group was two patients, 3.0% vs. iv-PCA group was one patient, 2.4% (p = 0.86).ACL reconstruction with ultrasound-guided FNB does not affect knee extensor strength at 6 months, nor graft rupture at 1 year postoperatively.

A cyst arising in the scapular supraspinous fossa may cause shoulder pain; subsequently, enlargement of the cyst may result in severe compression of the adjacent suprascapular nerve, leading to muscle weakness and sensory disorder. Decompression of the nerve through cyst removal is effective in resolving these symptoms. However, treatment can also be performed less invasively through arthroscopy. Insertion of an arthroscope without visual guidance could cause tissue damage and, consequently, would become an invasive procedure itself. The use of ultrasonography to guide the scope to the cyst decreases the invasiveness of the procedure. Here, we present the case of a patient with a cyst arising in the scapular supraspinous fossa, in whom we could relatively readily and safely observe the cyst by advancing an arthroscope under ultrasonographic guidance. The suprascapular nerve was decompressed via cyst removal.

Complaints of shoulder pain are very frequent in clinical practice. To relieve this type of pain, intra-subacromial bursa (SAB) injection therapy is commonly employed. Injection procedures include blind and ultrasound-guided injection. In clinical practice, blind injection is routinely performed. However, the SAB is a very thin tissue. Poor response to blind injection may be due to a misplaced injection. It is assumed that ultrasound-guided injections are more effective than blind injections. The purpose of this study was to compare pain-alleviating effects between ultrasound-guided injection and blind injection with lidocaine alone. The subjects were 16 patients (20 shoulders) in whom pain was possibly derived from inflammation of the SAB. Initially, ultrasound-guided injection was performed with 2 ml of 1% lidocaine. After 1 week, blind injection was conducted in the same patient. They subjectively expressed the grade of pain at each time point (before and 1, 5, 10, 15, 20, 25, and 30 min after injection) as pain scores. We calculated the amelioration rate by dividing differences between the scores at each time point and before injection by the pre-injection score. Pain scores of ultrasound-guided injection were lower than blind injection. Ultrasound-guided injection achieved higher mean amelioration rates compared to blind injection, showing significant differences at all time points (P

目的：除痛を目的とした肩峰下滑液包（subacrominal bursa: SAB）注射に関して，超音波装置を利用して注射した場合と盲目的に行った場合とで，効果に差が出るかを調査した．対象と方法：肩関節痛の原因が肩峰下滑液包炎に由来すると考えられる症例を対象とした．症例は10例13肩で，平均年齢は57.6歳であった．SABへの注射は盲目的注射と超音波ガイド下注射とも肩峰の前外側よりSABへ向けて1％ lidocaineを2ml注入した．施行者は卒後12年目の日本整形外科学会専門医一人で，まず超音波ガイド下に注射を行い，その1週間後同一患者に盲目的注射を行った．評価方法は注射前，注射1分後，注射5分後，注射10分後，注射15分後，注射20分後，注射25分後，注射30分後に疼痛の出る肢位を再現してもらい，疼痛の程度を0‐10まで0.5刻みに21段階に点数表示した疼痛スケールを用いて，各評価時間の疼痛を点数として示してもらった．注射前と各評価時間での点数の差を出して，その値を注射前の点数で除した数値を軽快率として算出し比較検討した．結果：軽快率の平均値は全ての時間帯で超音波ガイド下注射が盲目的注射に勝っており，1分後，5分後，10分後，20分後，25分後，30分後の軽快率において有意差を認めた（P＜0.05）．結論：除痛を目的にSABへ注射する場合は，盲目的ではなく超音波ガイド下に注射する方が効果を出し易い．

The purpose of this study is to evaluate the magnetic resonance imaging (MRI) following Putti-Platt procedure for recurrent anterior dislocation of the shoulder. Six shoulders of six patients who had received Putti-Platt procedure were evaluated by the MRI before and after operation. After the Putti-Platt procedure the subscapularis tendon was thickened and an increased signal area on T2-weighted images were observed in four patients. The area of subscapularis tendons after operation was increased maximally 3.46-fold and the volume was increased on average 1.51-fold. The course of subscapularis muscle fiber before operation was described as a mild arc, but changed to a straight line after the procedure in five patients. The findings in this study suggest that the Putti-Platt procedure leads to a remarkable increase in strength of subscapularis tendon and an improvement of laxity of subscapularis muscle. In conclusion, there is a good possibility that this procedure will increase the stability of the glenohumeral joint and be a successful treatment for recurrent anterior dislocation of the shoulder.

Surface electromyography was performed for both heads of the biceps brachii in 11 healthy men while the muscles were under 30% maximum isometric shoulder flexion and abduction. Elbow related biceps activity was minimized by using a brace locked in neutral forearm rotation. Electromyographic activity was normalized as a percentage of maximal muscle contraction during 24 shoulder motions. Electromyographic activity was detected in all motions examined, suggesting that the biceps muscle acts as a flexor and an abductor of the shoulder. Both heads of the biceps muscle had higher activities during external rotation than during internal rotation for most motions. Activities of both heads increased with arm elevation, but showed little dependence on elbow position. The long head was still active during internal rotation of the shoulder. These findings also suggest that the biceps muscle is a flexor and an abductor of the shoulder, and that the long head can act as a humeral head stabilizer in superior and anterior directions. Muscle fatigue of the biceps and the deltoid muscle also was determined at 30% of maximum isometric flexion. All muscles had significantly decreased mean power frequency and turns count, and increased amplitude and integrated electromyography. The rate of decrease in mean power frequency was larger for the biceps than for the deltoid muscle, and the rate of increase in amplitude was larger for the long head of the biceps than for the short head or for the deltoid muscle. These findings suggest that the long head of the biceps must increase its mechanical output to keep the arm in elevation to a greater extent than do the short head and the deltoid muscle. This may be one of the causes of tendinitis or rupture of the long head.

This study was undertaken to evaluate incomplete tears of the subscapularis tendon that occur in conjunction with small or medium-sized tears of the supraspinatus tendon. Fifty-two shoulders were examined in 26 embalmed cadavers. The average age at the time of death was 76.3 years. Rotator cuff tears were observed in 32 (61.5%) shoulders. Six (11.5%) shoulders had massive rotator cuff tears and were excluded from the study, leaving 46 shoulders for study. Twenty shoulders had a tear of the supraspinatus tendon, and 17 had a tear of the subscapularis tendon. All tears of the subscapularis tendon were articular-side incomplete tears. On histologic examination most pathologic changes of the subscapularis tendon were observed on the articular side of the upper portion. Lesions of the long head of the biceps brachii were identified in 14 (30.4%) shoulders. A statistically significant correlation was found between tears of the subscapularis tendon and the presence of lesions of the long head of the biceps brachii (P=.0014). In addition, the results of preoperative magnetic resonance imaging of 15 patients (average age, 62.9 years) with a surgically confirmed diagnosis of incomplete tears of the subscapularis tendon in conjunction with tears of the supraspinatus tendon were also evaluated. Incomplete tears of the subscapularis tendon could be identified on magnetic resonance imaging as an area of high signal intensity on axial T2-weighted images in all 15 shoulders studied.

Morphologic changes in the long head of the biceps brachii (LHB) and bicipital groove associated with cuff tears were studied in 170 cadavers. In specimens with minimum or moderate cuff tears, the primary finding was relative stenosis at the bicipital groove induced by enlargement of the LHB. However, this stenosis was not apparent in specimens with massive cuff tears and in these specimens, the medial wall of the groove exhibited wear and tear, a potential cause of LHB instability. We suggest that the long head of the biceps brachii muscle can potentially compensate for inadequate rotator cuff function. This increasing activity could lead to enlargement of the tendon and cause deterioration of the bicipital gliding mechanism.

This study was undertaken to identify and quantitate neural elements in the human subacromial bursa. Biopsy specimens of subacromial bursae were obtained from patients with rotator cuff tears and from cadavers of patients with no history of shoulder disorder (controls). We used a modified gold chloride method to characterize neural elements within the subacromial bursa. The population of intrabursal neural elements was calculated by computerized image analysis. The subacromial bursa demonstrated an extensive neural network: four morphological types of mechanoreceptors and many free nerve endings were identified. In general, there was an inverse relationship between the population density of neural elements and the extent of cuff tear. The population density of neural elements of the subacromial bursa associated with massive cuff tear was significantly lower than that observed in control shoulders. With regard to clinical symptoms, a significant correlation was established between the population density of neural elements in the subacromial bursa and shoulder pain at rest. Our investigation strongly suggests that the subacromial bursa is intimately involved in the perception of shoulder pain, providing an anatomical basis for afferent neural input in proprioceptive reflex arcs.

Background Patients often localize pain in the anterior shoulder; however, this patient-localized pain does not necessarily correlate to the location of disease. Unguided shoulder injections are common in clinical practice. The accuracy of unguided biceps tendon sheath injections has not been studied. Patient management may be aided by the knowledge of injection accuracy. This study compared the accuracy of ultrasound-guided biceps tendon sheath injection with unguided injection. Materials and methods The study comprised 30 patients (30 shoulders) with reported anterior shoulder pain who had a primary diagnosis of tenosynovitis or tendinitis of the biceps tendon, or both. Shoulders were randomly allocated into ultrasound-guided and unguided injection groups. Computed tomography (CT) imaging was performed immediately after a contrast agent was injected into the biceps tendon sheath. The locations of contrast seen on CT scan were classified into 3 types: only within the tendon sheath (type 1); inside the tendon, tendon sheath, and surrounding area (type 2); and only the area outside the tendon sheath (type 3). Results Ultrasound-guided injections resulted in 86.7% type 1 and 13.3% type 2 locations. Unguided injections resulted in 26.7% type 1, 40.0% type 2, and 33.3% type 3 locations. The difference for each location type was significant ( P .05). Conclusion Injection into the tendon sheath of the long head of the biceps brachii can be more accurately performed using ultrasound guidance than by the blind method.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are major causes of gastric mucosal lesions. In Japan, histamine-2 receptor antagonists are frequently prescribed, but the literature regarding their efficacy is limited. In this study, we compare the effects of famotidine and rebamipide on NSAID-associated gastric mucosal lesions using upper gastrointestinal endoscopy.This study examined 112 patients taking NSAIDs for either gastric hemorrhage or erosion. Before treatment, the patients were assessed by endoscopy. Using blind randomization, patients were divided into two groups: group F (famotidine, 20 mg/day) and group R (rebamipide, 300 mg/day). Efficacy was examined 4 weeks later using endoscopy.After treatment, the Lanza score decreased significantly in group F (P0.001) but not in group R (P = 0.478). The change in the Lanza score in group F was significantly greater (P = 0.002) than that in group R.Famotidine was superior to rebamipide in treating NSAID-associated mucosal lesions.

The relationship between the solid surface produced and the required energy in the vibration of ball milling has been obtained by direct measurement of the torque value of the mill shaft. There the real Rittinger number, ηr0' and the differential Rittinger number ηr(=ds/dE) are defined, and the relationship between them is found experimentally as follows.ηr0-ηr=aSnwAnd it is proved that this equation, which is for the first time proposed in this report as a fundamental equation of size reduction, includes Rittinger's equation and also Tanaka's equation.Though the values of ηr0 are affected by several grinding conditions, they have close connection with Bond's work index, Wi. The values of n have not been precisely obtained in this experiment, but they are known to come in the range of 1-3.The boundary of the region is also showed, in which the above mentioned relation can be found, and out of this boundary, the S-shaped grinding curves have been observed as Rose has pointed out in the vibration of the milling.

There are few measurements on tension imposed on warp while shooting or hauling trawl. The present paper describes the results which were measured by a tension meter set on the Kaiyo-maru, the biggest experimental research vessel in Japan, operated at rough sea and calm one. The structure of the otter boards and trawl net used for the experiment is shown in Figs. 1 and 2. 1. Warp tension while shooting trawl. Tension of 4-5tons each warp was recorded while shooting (vessel speed 6knots; shooting speed 100m/min.) at rough sea. That increased to 10-12tons when shooting was braked every 100-200m for the extension of trawl net. The values of tension were nearly equal to those measured at calm sea. 2. Warp tension while pulling and hauling. At calm sea tension of 5-6tons each warp was recorded while pulling (warp length 500m; pulling depth 124m; towing speed 4knots), and that decreased to 3-4tons when pulling was changed into hauling (hauling speed 90m/min.; towing speed 0.5-1.0knots). Tension while hauling was not changed particularly when the otter boards and net left the sea bottom. It was measured at rough sea that each tension of warps fluctuated from 4tons to 8tons in pulling (warp length 600m; pulling depth 150m; towing speed 4.2knots). When the otter boards and net left the bottom by hauling, the fluctuation of warp tension became violent suddenly, and 23tons on one of the paired warps and 38tons on both ones were recorded at the maximum.

Seventeen patients who had recalcitrant chronic adhesive capsulitis were operated on between 1979 and 1986 and were followed for an average of 6.8 years. At operation, the major cause of the restricted glenohumeral movement was found to be contracture of the coracohumeral ligament and rotator interval. Release of the contracted structures relieved pain and restored motion of the shoulder in all patients. Histological study showed fibrosis, hyalinization, and fibrinoid degeneration in the contracted connective tissues, as well as fibrosis of the subsynovial tissue and an absence of the synovial cell layer on the joint side of the rotator interval. The contracture of the coracohumeral ligament and rotator interval appears to be the main lesion in chronic adhesive capsulitis. Resection of these structures, combined with appropriate exercise, will relieve pain and restore motion to the shoulder.