CAN WE DIAGNOSE SARCOPENIA USING ANTERIOR FEMORAL MUSCLE THICKNESS IN PATIENTS WITH CARDIOVASCULAR DISEASE?

Objective

Making the diagnosis of sarcopenia is not always easy and this is especially true for those with cardiovascular disease. The purpose of this study is to investigate whether it is possible to diagnose sarcopenia by using ultrasound-guided measurements of anterior femoral muscle thickness.

Methods

We investigated the utility of ultrasound-guided measurements of anterior femoral muscle thickness in 1075 hospitalized patients with cardiovascular disease (675 men). As a comparison, sarcopenia was assessed by skeletal muscle mass index using bioelectrical impedance analysis and the Asia Working Group for Sarcopenia criteria.

Results

When the receiver operating characteristic curve using muscle thickness was examined, we found this could be used to make the diagnosis of sarcopenia (men: cutoff value 2.425 cm, area under the curve 0.796; women: cutoff value 1.995 cm, area under the curve 0.746). The prevalence of sarcopenia according to the criteria with skeletal muscle mass index was 34.2% in men and 51.8% in women, while its prevalence according to the cutoff value of muscle thickness was 29.2% in men and 36.7% in women.

Conclusion

Ultrasound-guided measurement of the anterior femoral muscle thickness is a simple and useful method to help make the diagnosis of sarcopenia in patients with cardiovascular disease.

Histiocytic sarcoma of the palate: a case report

Histiocytic sarcoma is a malignant proliferation of cells that exhibit morphological and immunophenotypic features of mature histiocytes. Owing to its rarity, its clinical features and standard treatment have not yet been established. This report describes a case of histiocytic sarcoma of the palate that developed in a 76-year-old man, the first report of an intraoral histiocytic sarcoma. An extended resection was performed; however, establishing the excision line was extremely difficult because assessing the tumour boundary on imaging was challenging and the tumour underwent dynamic gross morphological changes following biopsy. Complete resection is required to obtain a favourable prognosis for high-grade tumours with indistinct borders. In this case, an intraoperative rapid examination with frozen section analysis was performed along the planned excision line to completely resect the tumours exhibiting such behaviour. At 28 months postoperatively, the patient demonstrated no recurrence or metastasis; however, he is under careful monitoring.

Desire for thinness among young Japanese women from the perspective of objective and subjective ideal body shape

I examined the actual situation of the desire to be thin among young Japanese women from the perspective of ideal body shape and actual measured body shape. In total, 90 young Japanese women were evaluated using a questionnaire (perceived body shape and desired body composition change) and assessments of sarcopenia (muscle strength, physical ability, and muscle mass). Participants were classified into the underweight (body mass index [BMI] < 18.5 kg/m2, 74%), normal-weight (18.5 ≤ BMI < 25 kg/m2, 20%), or obese (25 ≤ BMI < 30 kg/m2, 6%) groups. The normal-weight group needed to gain an average of 2.2 kg to reach the objective ideal weight, but participants desired to lose an average of 4.5 kg. The underweight group needed to gain an average of 10.3 kg to reach the objective ideal weight, but participants desired to maintain their current body weight. Data on muscle mass for the diagnosis of sarcopenia showed low values for the underweight group. Most participants were classified into the normal-weight and underweight groups, but these groups showed a high percentage of women with a desire to be thin. The body shape of young adult women should be carefully considered not only as a health issue of thinness during the fertile period but also as a countermeasure to sarcopenia (low skeletal muscle mass) during the aging process.

A Case of Closed Pilon Fracture Resulting in Soft-Tissue Necrosis and Treated with Reverse Sural Artery Flap and Circular External Fixation

Tibial pilon fractures are difficult to treat due to articular comminution and soft-tissue injuries caused by high-energy trauma. Open reduction and internal fixation is a commonly used method of treatment. However, it has a high risk of infection and soft-tissue complications due to the extensive detachment of soft tissue. We report on a case with a tibial pilon fracture and soft-tissue necrosis that we treated using limited internal fixation combined with a circular external fixator (LIFCEF) and reverse sural artery flap (RSAF) as part of an orthoplastic approach within the orthopedic surgery department alone, which obtained good results. A 51-year-old man was injured in a motorcycle accident and transported to a nearby hospital. X-rays at the time of injury showed tibial pilon fractures (AO Foundation/Orthopedic Trauma Association 43c3.3, Ruedi-Allgower: Type III). Soft-tissue necrosis with blisters on the medial side of the lower leg (AO soft-tissue classification: IC3-MT1-NV1) was observed. In addition, the patient was referred to our hospital on day 10 of the injury. LIFCEF was chosen for treating the fracture because plate fixation was accompanied by the risk of plate exposure, soft-tissue complications, and an increased skin defect area, and RSAF was chosen to reconstruct the soft tissue defect. Four years after the surgery, the American Orthopedic Foot and Ankle Score was 92 points. X-ray alignment evaluation showed mLDTA 93° and aADTA 91°. Stage 2 arthrosis was present according to the Takakura ankle osteoarthritis classification, but the patient was able to walk without pain. Tibial pilon fractures are difficult to treat due to articular comminution and soft-tissue injuries caused by high-energy trauma. The timing and choice of treatment are crucial concerning the soft tissue.

An analog-AI chip for energy-efficient speech recognition and transcription

Models of artificial intelligence (AI) that have billions of parameters can achieve high accuracy across a range of tasks1,2, but they exacerbate the poor energy efficiency of conventional general-purpose processors, such as graphics processing units or central processing units. Analog in-memory computing (analog-AI)3-7 can provide better energy efficiency by performing matrix-vector multiplications in parallel on 'memory tiles'. However, analog-AI has yet to demonstrate software-equivalent (SWeq) accuracy on models that require many such tiles and efficient communication of neural-network activations between the tiles. Here we present an analog-AI chip that combines 35 million phase-change memory devices across 34 tiles, massively parallel inter-tile communication and analog, low-power peripheral circuitry that can achieve up to 12.4 tera-operations per second per watt (TOPS/W) chip-sustained performance. We demonstrate fully end-to-end SWeq accuracy for a small keyword-spotting network and near-SWeq accuracy on the much larger MLPerf8 recurrent neural-network transducer (RNNT), with more than 45 million weights mapped onto more than 140 million phase-change memory devices across five chips.

Post-traumatic Aeromonas hydrophila Osteomyelitis caused by an Infected Gustilo-Anderson Grade 3B Tibial Fracture: A Case Report with a 7-year Follow-up

Introduction

Post-traumatic osteomyelitis (OM) is often caused by Staphylococcus aureus. However, occasionally, it is caused by an infection with a rare bacterium. A case of OM caused by Aeromonas hydrophila was first reported in 1975. Since then, only nine cases have been reported, making it a rare disease. Here, we report a case of rare A. hydrophila OM that developed following open tibial fracture (classified as Gustilo-Anderson 3B) caused by an injury in a river.

Case Report

The patient was a 50-year-old male who got injured in a river and was diagnosed with open tibial fracture. Debridement in the first surgery happened at a leisurely pace. Purulent discharge from the wound persisted despite external fixation; however, no bacterium was detected in the bacterial culture. The patient underwent multiple debridement procedures; A. hydrophila was detected in the bone marrow. Despite the appropriate administration of antibacterial drugs and debridement, infection persisted until radical bone resection and tissue reconstruction were performed. In the present case, OM following an open fracture caused by an injury in a river was suspected, which was caused by the rare bacterium A. hydrophila.

Conclusion

In cases of OM occurring after underwater trauma, A. hydrophila should be considered as a causative pathogen. In addition, in cases of post-traumatic OM accompanied by bone and soft-tissue defects, the orthoplastic approach is required.

Introducing AI to the molecular tumor board: one direction toward the establishment of precision medicine using large-scale cancer clinical and biological information

Since U.S. President Barack Obama announced the Precision Medicine Initiative in his New Year's State of the Union address in 2015, the establishment of a precision medicine system has been emphasized worldwide, particularly in the field of oncology. With the advent of next-generation sequencers specifically, genome analysis technology has made remarkable progress, and there are active efforts to apply genome information to diagnosis and treatment. Generally, in the process of feeding back the results of next-generation sequencing analysis to patients, a molecular tumor board (MTB), consisting of experts in clinical oncology, genetic medicine, etc., is established to discuss the results. On the other hand, an MTB currently involves a large amount of work, with humans searching through vast databases and literature, selecting the best drug candidates, and manually confirming the status of available clinical trials. In addition, as personalized medicine advances, the burden on MTB members is expected to increase in the future. Under these circumstances, introducing cutting-edge artificial intelligence (AI) technology and information and communication technology to MTBs while reducing the burden on MTB members and building a platform that enables more accurate and personalized medical care would be of great benefit to patients. In this review, we introduced the latest status of elemental technologies that have potential for AI utilization in MTB, and discussed issues that may arise in the future as we progress with AI implementation.

Nail insertion points in semi-extended nailing of tibial fractures and their influence on alignment: A retrospective cohort study comparing two nail insertion techniques

INTRODUCTION

Semi-extended tibial nailing techniques include the extra-articular technique (EAT) and the patellar eversion technique (PET). These approaches differ regarding the exposure of the patellar retinaculum and the size of the surgical field. This study compared the postoperative alignment and intramedullary nailing entry points between the EAT and PET for tibial fractures.

PATIENTS AND METHODS

A total of 54 patients (aged ≥18 years) who had undergone intramedullary nailing by the EAT (n = 29) or PET (n = 25) for a tibial shaft fracture were evaluated. The intramedullary nailing entry point and postoperative alignment were measured, and the 1-year postoperative follow-up results were compared.

RESULTS

For the EAT and PET, the intramedullary nailing entry point was located at a mean distance of 4.04 mm medial to the optimal entry point and 0.27 mm lateral to the optimal entry point, respectively. The mean angular deformation observed in anteroposterior radiographs following surgery using the EAT and PET were 2.49° and 0.32° valgus, respectively.

CONCLUSION

The intramedullary nailing entry point affected postoperative alignment. Intramedullary nailing may result in malalignment while performing the EAT due to the interference of the patella at the time of nailing.

A Rare Bone Erosion due to Fibroma of the Tendon Sheath

Introduction

Fibroma of the tendon sheath (FTS) is a soft-tissue tumor strongly attaches to the tendon sheath. The most common tumor which causes bone erosion is giant cell tumor of the tendon sheath while the erosion is quite rarely caused by FTS.

Case Report

A 50-year-old housewife presented a swelling around the A1 pulley of the right third finger as well as bone erosion and a trigger finger. Against our preoperative suspect as GTTS, the pathological findings showed FTS. The snapping disappeared after the surgery. At 2.5 years postoperatively, we found no recurrence.

Conclusion

FTS can be added to one of the differential diagnoses for tumor presenting bone erosion in fingers though our case is rare.

Identifying preventative measures against frailty, locomotive syndrome, and sarcopenia in young adults: a pilot study

[Purpose] The purpose of this study was to propose potential preventive measures against future mobility impairments and muscle loss in healthy young adults by comprehensively evaluating their status of frailty, locomotive syndrome, and sarcopenia. [Participants and Methods] A total of 83 Japanese young adults were enrolled in this study and evaluated using the diagnostic criteria for frailty (Japanese version of the Cardiovascular Health Study), locomotive syndrome (calculated as scores of the LOCOMO-25, the stand-up test, and two-step test), and sarcopenia (handgrip strength, usual gait test, skeletal muscle index). [Results] The prevalence of frailty-prefrailty (45.9%) was higher than that of presarcopenia (22.3%) and locomotive syndrome (14.1%). The prevalence of combinations of frailty-prefrailty and presarcopenia; frailty-prefrailty and locomotive syndrome; and frailty-prefrailty, locomotive syndrome, and pre-sarcopenia was 9.4%, 4.7%, and 3.5%, respectively. [Conclusion] Only 40% of the participants did not meet the three diagnostic criteria. On the other hand, there were not many participants with sarcopenia and/or locomotive syndrome diagnoses, suggesting that the improvement in intrinsic skeletal muscle mass rather than physical function is important for healthy Japanese young adults and could possibly be protective against future mobility or muscle-loss disorders.

Is blood flow-restricted training effective for rehabilitation of a pianist with residual neurological symptoms in the upper limbs? A case study

[Purpose] We investigated whether blood flow-restricted training known as KAATSU training, was effective for rehabilitation of a pianist with residual neurological symptoms in the upper limbs. [Participant and Methods] A pianist with residual neurological symptoms in the upper body played “Revolutionary Etude” under two conditions: piano performance with (Piano-blood flow-restricted) and without (Piano-control) the restriction of blood flow to the upper limbs. In the Piano-blood flow-restricted exercise, a pressure of 130–170 mmHg was applied around the most proximal portion of both arms. The changes in upper limb circumference and muscle strength were measured before, immediately after, and 15 min after the performance. The impression of the piano performance was recorded after the Piano-blood flow-restricted exercise. [Results] Immediately after the piano performance, the forearm and upper arm circumferences had increased significantly in both arms, and the change was greater in the Piano-blood flow-restricted than in the Piano-control condition. The handgrip strength for the right arm also showed greater changes in the former than the latter. However, there were no significant differences between the two conditions regarding the handgrip strength of the left arm. [Conclusion] There is a high possibility that blood flow-restricted training is effective for rehabilitation of the pianist with residual neurological symptoms in the upper limbs.

Odderon Exchange from Elastic Scattering Differences between pp and pp[over ¯] Data at 1.96 TeV and from pp Forward Scattering Measurements

We describe an analysis comparing the pp[over ¯] elastic cross section as measured by the D0 Collaboration at a center-of-mass energy of 1.96 TeV to that in pp collisions as measured by the TOTEM Collaboration at 2.76, 7, 8, and 13 TeV using a model-independent approach. The TOTEM cross sections, extrapolated to a center-of-mass energy of sqrt[s]=1.96  TeV, are compared with the D0 measurement in the region of the diffractive minimum and the second maximum of the pp cross section. The two data sets disagree at the 3.4σ level and thus provide evidence for the t-channel exchange of a colorless, C-odd gluonic compound, also known as the odderon. We combine these results with a TOTEM analysis of the same C-odd exchange based on the total cross section and the ratio of the real to imaginary parts of the forward elastic strong interaction scattering amplitude in pp scattering for which the significance is between 3.4σ and 4.6σ. The combined significance is larger than 5σ and is interpreted as the first observation of the exchange of a colorless, C-odd gluonic compound.

Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients: A Pilot Study

We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 ± 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5-7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.

Simplified morphological evaluation of skeletal muscle mass and maximum muscle strength in healthy young women: Comparison between thigh and calf

Objectives:

The purpose of this study was to examine the prediction of skeletal muscle mass and maximum muscle strength using simplified morphology evaluation in young Japanese women from the thigh and calf perspective.

Methods:

A total of 249 Japanese young women (aged 18–25 years) were used for data analyses in this study. Thigh and calf girths were measured using a tape measure at 50% of thigh length and at 30% proximal of calf length, respectively. Muscle thickness was measured using B-mode ultrasound at the anterior and posterior thigh (at 50% of thigh length) and at the posterior lower leg (at 30% proximal of calf length), respectively. The measurements were carried out on the right side of the body while the participants stood with their elbows extended and relaxed. A stepwise multiple regression analysis (method of increasing and decreasing the variables; criterion set at p < 0.05) was performed for skeletal muscle index (defined by appendicular skeletal muscle mass/height²), handgrip strength, or sit-to-stand test and five variable factors (girth (thigh and calf) and muscle thickness (anterior and posterior thigh and posterior calf)).

Results:

Unlike the sit-to-stand test, skeletal muscle index or handgrip strength was correlated (p < 0.001) with the girth or muscle thickness for both thigh and calf. Unlike the sit-to-stand test, the prediction equations for skeletal muscle index and handgrip strength estimation showed significant correlations with multiple regression analysis of data obtained from the calf girth and muscle thickness. In both skeletal muscle index and handgrip strength, calf girth was adopted as a Step 1, respectively.

Conclusion:

Our results indicated that skeletal muscle index and handgrip strength could be evaluated by the simplified morphology methods, especially that for the calf girth measurement, which may be a good indicator of screening/preventing for sarcopenia in healthy Japanese young women.

Phase Angle as an Indicator of Sarcopenia, Malnutrition, and Cachexia in Inpatients with Cardiovascular Diseases

Malnutrition is associated with sarcopenia, cachexia, and prognosis. We investigated the usefulness of phase angle (PhA) as a marker of sarcopenia, cachexia, and malnutrition in 412 hospitalized patients with cardiovascular disease. We analyzed body composition with bioelectrical impedance analysis, and nutritional status such as controlling nutritional status (CONUT) score. Both skeletal muscle mass index (SMI) and PhA correlated with age, grip strength and knee extension strength (p < 0.0001) in both sexes. The SMI value correlated with CONUT score, Hb, and Alb in males. Phase angle also correlated with CONUT score, Hb, and Alb in males, and more strongly associated with these nutritional aspects. In females, PhA was correlated with Hb and Alb (p < 0.001). In both sexes, sarcopenia incidence was 31.6% and 32.4%; PhA cut-off in patients with sarcopenia was 4.55° and 4.25°; and cachexia incidence was 11.5% and 14.1%, respectively. The PhA cut-off in males with cachexia was 4.15°. Multivariate regression analysis showed that grip strength and brain natriuretic peptide (BNP) were independent determinants of SMI, whereas grip strength, BNP, and Hb were independent determinants of PhA. Thus, PhA appears to be a useful marker for sarcopenia, malnutrition, and cachexia in hospitalized patients with cardiovascular disease.

AB1137 CLASSIFICATION OF THE EARLY STAGE OF RAPIDLY DESTRUCTIVE COXOPATHY ACCORDING TO THE FEMORAL HEAD DESTRUCTION

Background:

Rapidly destructive coxopathy (RDC) is an unusual subset of osteoarthritis of the hip characterized by rapid chondrolysis with progressive loss of the joint space as the first manifestation of the disease. Because rapid progression of RDC makes it difficult to obtain sequential radiographs in its early stage, the process of disease progression in the early stage remains unclear. Although the pathogenesis of RDC is still unclarified, the potential causes of RDC include subchondral insufficiency fracture of the femoral head resulting from osteoporosis, pelvic posterior inclination in RDC as a mechanical factor, and increased serum levels of matrix metalloproteinase (MMP)-3 as a biological factor.

Objectives:

This study aimed to differentiate the process of disease progression in the early stage of RDC and provide its new classification system.

Methods:

This monocentric retrospective study included 42 female patients who met the criteria of RPOH, chondrolysis >2 mm during 12 months from the onset of hip pain based on a series of radiographs and computed tomography (CT). This study also included 9 female patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH), who demonstrated chondrolysis >2 mm during 12 months from the onset of hip pain. Cortical thickness index (CTI) correlated with bone mineral density of the hip, pelvic tilt, and serum concentrations of matrix metalloproteinase (MMP)-3 were analyzed.

Results:

RDC were classified into two types based on the absence (type 1, n=17) and presence (type 2, n=25) of subsequent femoral head destruction shown by CT within 12 months after the onset of hip pain. MMP-3 significantly increased in RDC type 2 compared with type 1 and DDH. Increased posterior pelvic tilt was found in RDC type 2 compared with DDH. Logistic regression and receiver operating characteristic curve analyses indicated that MMP-3 may be associated with differentiation between RDC types 1 and 2. No difference was found in CTI between RDC types and DDH.

RDC type 2 hips developed partial (type 2A) and massive (type 2B) femoral head destruction within the first 12 months. Whereas partial destruction showed <20% collapse ratio, massive destruction demonstrated >40% collapse ratio. Increased posterior pelvic tilt was found in massive destruction. Femoral head destruction started earlier within the first 6 months in massive destruction compared with that in partial destruction. From receiver operating characteristic curve analysis, pelvic tilt differentiated the femoral head destruction types using the initial radiograph at the onset before first demonstration of femoral head destruction. No difference was found in CTI or MMP-3 between the two subtypes.

Conclusion:

Disease progression of RDC during 12 months after the onset of hip pain could be classified into two distinct types based on the absence (type 1) and presence (type 2) of femoral head destruction in association with MMP-3 and pelvic tilt as biological and mechanical factors, respectively. MMP-3 may be helpful to differentiate those two types in the early stage of RPOH. The extent of femoral head destruction could further differentiate RDC type 2 into two subtypes based on pelvic tilt.

Acknowledgments :

This study was supported by the Japan Hip Joint Foundation.

Disclosure of Interests:

None declared

Muscle Thickness of Anterior Mid-Thigh in Hospitalized Patients: Comparison of Supine and Standing Postures

Objectives

To compare the magnitude changes in muscle thickness (MTH) of the anterior mid-thigh between the supine and standing postures.

Design

Experimental.

Setting

University hospital laboratory.

Participants

Inpatients (N=283) between the ages of 29 and 93 years (193 men, 90 women) with cardiovascular disease who volunteered for this study.

Interventions

Not applicable.

Main Outcome Measures

MTH of the anterior mid-thigh was measured with a 10 MHz ultrasound probe while the participants stood or lay supine in a relaxed position with their arms extended and by their sides.

Results

Age and percentage of body fat were greater (P<.01) in women than in men (74.3±12.3 vs 67.7±12.1y and 32.6±10.3% vs 27.4±7.4%, respectively), but standing height, body weight, and body mass index were greater (P<.01) in men than in women (164.9±6.3 vs 149.1±7.5 cm, 65.4±12.7 vs 49.5±11.1 kg, and 23.8±3.9 vs 22.1±4.4 kg/m², respectively). Correlations were found between the standing posture and supine position in the anterior-mid thigh MTH for both men (r=0.85; P<.01) and women (r=0.82; P<.01). In the anterior-mid thigh for men and women, MTH was greater in the standing posture (3.7±1.0 vs 2.5±0.7 cm) than in supine position (3.1±0.8 vs 2.1±0.7 cm) (both P<.01).

Conclusions

In this study, MTH of the anterior mid-thigh during prolonged hospitalization was approximately 16% higher in men than in women regardless of posture, and was approximately 32% higher in standing posture than in the supine position regardless of sex.

A Long-standing Monteggia Fracture in a Child who underwent Bone Lengthening and Annular Ligament Reconstruction: A Case Report

Introduction:

Monteggia fractures are rare and account for 1% of all pediatric forearm fractures. Dislocation of the radial head with plastic deformation of the ulna is particularly rare and can be overlooked, thereby resulting in long effects. Here, we report the treatment of a case of a long-standing Monteggia fracture in a child.

Case Report:

A 6-year-old girl who was injured by a fall was examined by a local physician. 4 weeks later, she was referred to our hospital. Plain X-ray and computed tomography revealed a long-standing Monteggia fracture. Ulnar osteotomy was performed; however, complete realignment was not achieved. Scar tissue and the annular ligament remained intact, thereby hindering complete reduction. The scar tissue surrounding the radial head was surgically removed, and subluxation was reduced. The annular ligament was reconstructed, and the ulna was lengthened by external fixation. 1 year postoperatively, the patient’s elbow range of motion is good, and there has been no recurrence of radial head dislocation.

Conclusions:

The patient achieved good progress through the use of annular ligament reconstruction and ulnar osteotomy to straighten and anatomically realign the ulna. Post-operative repeat dislocation was avoided by reducing radial head dislocation, removing the scar tissue, and reconstructing the annular ligament.

Blood Flow Restriction Increases the Neural Activation of the Knee Extensors During Very Low-Intensity Leg Extension Exercise in Cardiovascular Patients: A Pilot Study

Blood flow restriction (BFR) has the potential to augment muscle activation, which underlies strengthening and hypertrophic effects of exercise on skeletal muscle. We quantified the effects of BFR on muscle activation in the rectus femoris (RF), the vastus lateralis (VL), and the vastus medialis (VM) in concentric and eccentric contraction phases of low-intensity (10% and 20% of one repetition maximum) leg extension in seven cardiovascular patients who performed leg extension in four conditions: at 10% and 20% intensities with and without BFR. Each condition consisted of three sets of 30 trials with 30 s of rest between sets and 5 min of rest between conditions. Electromyographic activity (EMG) from RF, VL, and VM for 30 repetitions was divided into blocks of 10 trials and averaged for each block in each muscle. At 10% intensity, BFR increased EMG of all muscles across the three blocks in both concentric and eccentric contraction phases. At 20% intensity, EMG activity in response to BFR tended to not to increase further than what it was at 10% intensity. We concluded that very low 10% intensity exercise with BFR may maximize the benefits of BFR on muscle activation and minimize exercise burden on cardiovascular patients.

Anthropometric, body composition, and somatotype characteristics of Japanese young women: Implications for normal-weight obesity syndrome and sarcopenia diagnosis criteria

Aims

The purpose of this study was to examine the anthropometric, body composition, and somatotype characteristics of Japanese young women and to focus on normal-weight obesity syndrome and sarcopenia diagnosis criteria.

Methods

A total of 124 Japanese university freshmen women were measured at body mass index (BMI), percent body fat and skeletal muscle index (SMI), usual gait test, and handgrip strength. The subjects were divided into obesity (≥30% body fat; BMI: ≥25.0 kg/m²), normal-weight obesity (≥30% body fat; BMI: 18.5–24.9 kg/m²), sarcopenia (handgrip, <18 kg; gait speed: ≤0.8 m/s; SMI: <5.7 kg/m²), or presarcopenia (SMI: <5.7 kg/m²). There were no subjects below the sarcopenia diagnosis criteria in usual gait speed, but not for handgrip (0.8%) and SMI (36.3%).

Results

The prevalence of presarcopenia group (36.3%) is higher than in the normal-weight obesity (16.9%) and obesity (4.8%) groups. Anthropometry and sarcopenia diagnosis assessments were significantly higher in normal-weight obesity and standard groups compared with presarcopenia group.

Discussion

The number of young women was higher in the presarcopenia group than in the normal-weight obesity group, suggesting that the improvement of intrinsic skeletal muscle mass rather than fat mass is important for Japanese young women.

Ultrasound and MRI measured changes in muscle mass gives different estimates but similar conclusions: a Bayesian approach

The purpose of this paper was to use a Bayesian approach to compare the relative change in muscle size between magnetic resonance imaging (MRI) and ultrasound measured muscle thickness (MTH) following 6 weeks of concentric and eccentric blood flow restricted exercise. Changes at each site were as follows: concentric 50% site (MRI: 10.2%, MTH: 8.7%), concentric 10 cm site (MRI: 12%, MTH: 4.5%), eccentric 50% site (MRI: -1.7%, MTH: 2.6%), and eccentric 10 cm site (MRI: 5.2%, MTH: 0.5%). When testing the difference between estimates using a default prior of 0.707, we provided evidence that the estimate at the 50% site of the concentric arm was similar between ultrasound and MRI [Median % (95% credible interval): -1.1 (-8.2, 5.8)]. However, evidence for other sites suggested differences or a degree of uncertainty. Both methods produce similar conclusions about the presence of growth but the magnitude of that change appears different at most sites.

Key factor governing the physicochemical properties and extent of proton transfer in protic ionic liquids: ΔpKa or chemical structure?

A series of protic ionic liquids (PILs) are prepared by neutralisation of bis(trifluoromethanesulfonyl)amide acid (H[NTf₂]) with various amines, and the properties (especially thermal stability and ionicity) are compared with those of PILs from 1,8-diazabicyclo[5.4.0]-7-undecene (DBU) and various acids.

Effect of Addition of Styrene-Ethylene/Butylene-Styrene and the Type of Mica on the Mechanical Properties of Mica-Filled Polyethylene/Polypropylene Blends

The mechanical properties of polyethylene (PE)/polypropylene (PP)/styrene-ethylene/butylene-styrene (SEBS)/mica composites were investigated as a model composition. Four types of mica with different particle sizes and different aspect ratios were used. These composites were extruded by a twin-screw extruder and subsequently injection molded, and their mechanical properties, including their tensile, bending, and impact properties were evaluated. The addition of mica to PE/PP/SEBS effectively improved its mechanical properties; the addition of SEBS as a compatibilizer likewise enhanced the mechanical properties compared with those of PE/PP composites without SEBS. The use of larger average particle size and higher aspect ratio mica, such as M-35, M-27, and P-33, effectively increased the tensile and bending properties of the PE/PP/SEBS/mica composites. The morphologies of the composites with an added mica as observed by scanning electron microscopy, showed good dispersion between the matrix polymer and the mica.

Muscle hypertrophy following blood flow-restricted, low-force isometric electrical stimulation in rat tibialis anterior: role for muscle hypoxia

Low-force exercise training with blood flow restriction (BFR) elicits muscle hypertrophy as seen typically after higher-force exercise. We investigated the effects of microvascular hypoxia [i.e., low microvascular O2 partial pressures (P mvO2)] during contractions on muscle hypertrophic signaling, growth response, and key muscle adaptations for increasing exercise capacity. Wistar rats were fitted with a cuff placed around the upper thigh and inflated to restrict limb blood flow. Low-force isometric contractions (30 Hz) were evoked via electrical stimulation of the tibialis anterior (TA) muscle. The P mvO2 was determined by phosphorescence quenching. Rats underwent acute and chronic stimulation protocols. Whereas P mvO2 decreased transiently with 30 Hz contractions, simultaneous BFR induced severe hypoxia, reducing P mvO2 lower than present for maximal (100 Hz) contractions. Low-force electrical stimulation (EXER) induced muscle hypertrophy (6.2%, P < 0.01), whereas control group conditions or BFR alone did not. EXER+BFR also induced an increase in muscle mass (11.0%, P < 0.01) and, unique among conditions studied, significantly increased fiber cross-sectional area in the superficial TA ( P < 0.05). Phosphorylation of ribosomal protein S6 was enhanced by EXER+BFR, as were peroxisome proliferator-activated receptor gamma coactivator-1α and glucose transporter 4 protein levels. Fibronectin type III domain-containing protein 5, cytochrome c oxidase subunit 4, monocarboxylate transporter 1 (MCT1), and cluster of differentiation 147 increased with EXER alone. EXER+BFR significantly increased MCT1 expression more than EXER alone. These data demonstrate that microvascular hypoxia during contractions is not essential for hypertrophy. However, hypoxia induced via BFR may potentiate the muscle hypertrophic response (as evidenced by the increased superficial fiber cross-sectional area) with increased glucose transporter and mitochondrial biogenesis, which contributes to the pleiotropic effects of exercise training with BFR that culminate in an improved capacity for sustained exercise.

NEW & NOTEWORTHY We investigated the effects of low microvascular O2 partial pressures (P mvO2) during contractions on muscle hypertrophic signaling and key elements in the muscle adaptation for increasing exercise capacity. Although demonstrating that muscle hypoxia is not obligatory for the hypertrophic response to low-force, electrically induced muscle contractions, the reduced P mvO2 enhanced ribosomal protein S6 phosphorylation and potentiated the hypertrophic response. Furthermore, contractions with blood flow restriction increased oxidative capacity, glucose transporter, and mitochondrial biogenesis, which are key determinants of the pleiotropic effects of exercise training.

Measurement of the Effective Weak Mixing Angle in pp[over ¯]→Z/γ^{*}→ℓ^{+}ℓ^{-} Events

We present a measurement of the effective weak mixing angle parameter sin^{2}θ_{eff}^{ℓ} in pp[over ¯]→Z/γ^{*}→μ^{+}μ^{-} events at a center-of-mass energy of 1.96 TeV, collected by the D0 detector at the Fermilab Tevatron Collider and corresponding to 8.6  fb^{-1} of integrated luminosity. The measured value of sin^{2}θ_{eff}^{ℓ}[μμ]=0.23016±0.00064 is further combined with the result from the D0 measurement in pp[over ¯]→Z/γ^{*}→e^{+}e^{-} events, resulting in sin^{2}θ_{eff}^{ℓ}[comb]=0.23095±0.00040. This combined result is the most precise measurement from a single experiment at a hadron collider and is the most precise determination using the coupling of the Z/γ^{*} to light quarks.

Free Functional Gracilis Muscle Transfer for Reconstruction during Forearm Reimplantation in a Patient with Deep Venous Thrombosis

Background Free muscle transfer is the gold standard procedure for functional upper extremity reconstruction. The gracilis muscle is one of the most commonly used donor muscles due to the reduced morbidity of its harvest.

Case We performed a free gracilis muscle flap transfer for functional reconstruction of a forearm after reimplantation in a 62-year-old man with a known deep venous thrombosis (DVT).

Result Perioperative DVT is a potentially fatal complication due to the risk of pulmonary embolism. There were many risk factors in this case for venous thromboembolism around the time of free flap transfer including the length of the operation, intraoperative position changes, and perioperative suspension of anticoagulants. We divided the operation into two stages to reduce operative times, chose a donor site that did not require intraoperative position changes, placed an indwelling temporary filter in the inferior vena cava preoperatively, and continued administration of anticoagulant intraoperatively.

Conclusion With these measures, we safely and successfully performed free gracilis muscle transfer in a patient with DVT.

Combined Forward-Backward Asymmetry Measurements in Top-Antitop Quark Production at the Tevatron

The CDF and D0 experiments at the Fermilab Tevatron have measured the asymmetry between yields of forward- and backward-produced top and antitop quarks based on their rapidity difference and the asymmetry between their decay leptons. These measurements use the full data sets collected in proton-antiproton collisions at a center-of-mass energy of sqrt[s]=1.96  TeV. We report the results of combinations of the inclusive asymmetries and their differential dependencies on relevant kinematic quantities. The combined inclusive asymmetry is A_{FB}^{tt[over ¯]}=0.128±0.025. The combined inclusive and differential asymmetries are consistent with recent standard model predictions.

Thigh muscle size and vascular function after blood flow-restricted elastic band training in older women

We examined the effect of elastic band training with blood flow restriction (BFR) on thigh muscle size and vascular function in older women. Older women were divided into three groups: low-intensity elastic band BFR training (BFR-Tr, n = 10), middleto high-intensity elastic band training (MH-Tr, n = 10), and no training (Ctrl, n = 10) groups. BFR-Tr and MH-Tr groups performed squat and knee extension exercises using elastic band, 2 days/week for 12 weeks. During BFR-Tr exercise session, subjects wore pressure cuffs around the most proximal region of both thighs. The following measurements were taken before (pre) and 3-5 days after (post) the final training session: MRI-measured muscle cross-sectional area (CSA) at mid-thigh, maximum voluntary isometric contraction (MVIC) of knee extension, central systolic blood pressure (c-SBP), central-augmentation index (c-AIx), cardio-ankle vascular index testing (CAVI), ankle-brachial pressure index (ABI). Quadriceps muscle CSA (6.9%) and knee extension MVIC (13.7%) were increased (p < 0.05) in the BFR-Tr group, but not in the MH-Tr and the Ctrl groups. Regarding c-SBP, c-AIx, CAVI and ABI, there were no changes between pre- and post- results among the three groups. Elastic band BFR training increases thigh muscle CSA as well as maximal muscle strength, but does not decrease vascular function in older women.

Amphoteric water as acid and base for protic ionic liquids and their electrochemical activity when used as fuel cell electrolytes

Amphoteric water was mixed with equimolar amounts of a super-strong acid, trifluoromethanesulfonic acid (TfOH), and a super-strong base, 1,8-diazabicyclo[5.4.0]-7-undecene (DBU). Bulk physicochemical and electrochemical properties of the mixtures were compared with those of the best ever reported protic ionic liquid (PIL), diethylmethylammonium trifluoromethanesulfonate ([dema][TfO]), which has excellent physicochemical properties as a fuel cell electrolyte. The acidic mixture ([H₃O][TfO]) behaved as a protic ionic liquid, while the basic mixture ([DBU]OH) showed incomplete proton transfer. The Walden plot indicated that [H₃O][TfO] behaves as a good PIL, similar to [dema][TfO], whereas [DBU]OH behaves as a poor PIL. [H₃O][TfO] showed excellent H₂/O₂ fuel cell performance at 80 °C; however, the performance deteriorated as the bulk water content increased, because of the retardation of the electrode kinetics due to the oxidation of Pt in the presence of bulk water. On the other hand, [DBU]OH exhibited very poor performance possibly because of the existence of neutral species in the system.

A Gustilo Type 3B Open Tibial Fracture Treated with a Proximal Flexor Hallucis Longus Flap: A Case Report

Introduction:

In the treatment of Gustilo Type 3B open tibial fractures, it is important to perform soft tissue reconstruction and bone reconstruction simultaneously. Gastrocnemius muscle and soleus muscle flaps are generally used as rotational flaps for the tibia. The distal third of the tibia can often not be covered with the gastrocnemius muscle and soleus muscle flaps. Treatment distal to the distal third of the tibia is difficult because fewer flap options are available. In the present report, we describe our experience with a Gustilo Type 3B open tibial fracture treated by gastrocnemius muscle and soleus muscle flaps, along with an additional proximally based flexor hallucis longus flap, which is a rare procedure.

Case Report:

The participant was a 17-year-old male who injured his left tibia in a motorcycle traffic accident. Physical examination revealed a wound of 13 cm × 7 cm extending from the medial lower leg to the posterior aspect, with extensive skin loss. There was no nerve or vascular injury. The tibia was exposed, with detachment of the periosteum. The radiograph revealed a tibial shaft fracture. The AO/OTA classification was 42-A3.3, and it was classified as a Gustilo-Anderson Type 3B fracture. Gastrocnemius muscle and soleus muscle flaps were lifted in the area of the soft-tissue defect and then, placed over the tibia. Despite this, the distal portion of the tibia remained uncovered. Therefore, a flexor hallucis longus flap was lifted and placed over the distal portion of the tibia. On day 7 after the injury, the external fixation device was removed and the tibial shaft was fixated with two Ender nails (4.5 mm in diameter). The clinical course was satisfactory, and the skin graft and flap were successful. Bone union was achieved without infection, and the resulting range of motion was normal.

Conclusion:

For the treatment of Gustilo-Anderson Type 3B open tibial fractures, early treatment of the soft-tissue defect is vital. We surgically treated a Gustilo-Anderson Type 3B open tibial fracture with gastrocnemius muscle and soleus muscle flaps, along with an additional proximally based flexor hallucis longus flap, which is a rare procedure. In the event of a soft-tissue defect in the distal third of the tibia, the use of a proximally based flexor hallucis longus flap is an effective surgical approach.

Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint

Intramedullary nail fixation is a common treatment for tibial-shaft fractures, and it offers a better functional prognosis than other conservative treatments. Currently, the primary approach employed during intramedullary nail insertion is the semiextended position is the suprapatellar approach, which involves a vertical incision of the quadriceps tendon Damage to the patellofemoral joint cartilage has been highlighted as a drawback associated with this approach. To avoid this issue, we perform surgery using the patellar eversion technique and a soft sleeve. This method allows the articular surface to be monitored during intramedullary nail insertion. We arthroscopically assessed the effect of this technique on patellofemoral joint cartilage. The patellar eversion technique allows a direct view and protection of the patellofemoral joint without affecting the patella. Thus, damage to the patellofemoral joint cartilage can be avoided.

Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation

[Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity morphological evaluation in cardiovascular disease patients. [Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular disease were recruited from inpatient and outpatient facilities and assigned to separate experimental groups. Twelve age-matched healthy volunteers were assigned to a control group. SPPB test was used to assess balance and functional motilities. The test outcomes were compared with level of care (inpatient vs. outpatient), physical characteristics, strength and lower extremity morphology. [Results] Total SPPB scores, strength tests (knee extensor muscle strength), and lower extremity morphological evaluation (muscle thickness of anterior and posterior mid-thigh and posterior lower-leg) were greater in healthy subjects and outpatients groups compared with inpatients. To predict total Short Physical Performance Battery scores, the predicted knee extension and anterior mid-thigh muscle thickness were calculated. [Conclusion] The SPPB is an effective tool as the strength tests and lower extremity morphological evaluation for middle-aged and older adult cardiovascular disease patients. Notably, high knee extensor muscle strength and quadriceps femoris muscle thickness are positively associated with high SPPB scores.

Application of Ionic Liquids to Energy Storage and Conversion Materials and Devices

Ionic liquids (ILs) are liquids consisting entirely of ions and can be further defined as molten salts having melting points lower than 100 °C. One of the most important research areas for IL utilization is undoubtedly their energy application, especially for energy storage and conversion materials and devices, because there is a continuously increasing demand for clean and sustainable energy. In this article, various application of ILs are reviewed by focusing on their use as electrolyte materials for Li/Na ion batteries, Li-sulfur batteries, Li-oxygen batteries, and nonhumidified fuel cells and as carbon precursors for electrode catalysts of fuel cells and electrode materials for batteries and supercapacitors. Due to their characteristic properties such as nonvolatility, high thermal stability, and high ionic conductivity, ILs appear to meet the rigorous demands/criteria of these various applications. However, for further development, specific applications for which these characteristic properties become unique (i.e., not easily achieved by other materials) must be explored. Thus, through strong demands for research and consideration of ILs unique properties, we will be able to identify indispensable applications for ILs.

Multicenter randomized phase II study of cisplatin and fluorouracil plus docetaxel (DCF) compared with cisplatin and fluorouracil plus Adriamycin (ACF) as preoperative chemotherapy for resectable esophageal squamous cell carcinoma (OGSG1003)

BACKGROUND

This phase II trial evaluated the efficacy of cisplatin and fluorouracil (CF)-based combination neoadjuvant chemotherapy on the outcome of patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC). We compared the recurrence-free survival (RFS) associated with CF plus Adriamycin (ACF) with that associated with CF plus docetaxel (DCF) to select an alternative regimen in a new phase III trial investigating the optimal neoadjuvant treatment of patients with ESCC.

PATIENTS AND METHODS

Patients with resectable advanced ESCC were randomly assigned to either ACF (Adriamycin 35 mg/m2, cisplatin 70 mg/m2 i.v. on day 1, fluorouracil 700 mg/m2 continuous infusion for 7 days) every 4 weeks or DCF (docetaxel 70 mg/m2, cisplatin 70 mg/m2 i.v. on day 1, fluorouracil 700 mg/m2 continuous infusion for 5 days) every 3 weeks. Surgery was scheduled after completion of two cycles of chemotherapy. The primary end point was RFS, analyzed by the intention-to-treat.

RESULTS

Between October 2011 and October 2013, 162 patients at 10 institutions were enrolled in the study, all of whom were eligible and randomly assigned to the two groups (81 to the ACF group and 81 to the DCF group). The R0 resection rates for the ACF and DCF groups were equivalent (95.9% versus 96.2%, P = 0.93). The 2-year RFS and overall survival rates for DCF versus ACF were 64.1% versus 42.9% (hazard ratio 0.53, 95% confidence interval 0.33-0.83, P = 0.0057) and 78.6% versus 65.4% (P = 0.08), respectively.

CONCLUSION

Compared with ACF, DCF chemotherapy was associated with prolonged RFS for patients with resectable advanced ESCC. Thus, DCF chemotherapy has potential as a standard neoadjuvant therapy for resectable ESCC.

CLINICAL TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry of Japan (identification number UMIN000004555/000004616).