Stabilization of postural sway on a sideward slope using cuboid support insoles.

[Purpose] The purpose of this study was to elucidate whether insoles alter postural sway on a sideward slope rather than on level ground. [Participants and Methods] This study involved 20 flat-footed individuals and 20 normal-footed individuals. The postural sway was determined based on the total length of the locus and the body sway area, which were measured using the Zebris system. The participants were divided into three groups: the BMZ insoles, Superfeet insoles, and no insole groups. These insoles were worn by the participants with their normal shoes worn daily. [Results] The total length of the locus of the BMZ group was significantly lower than those of the Superfeet and no-insole groups. The body sway area did not significantly differ based on the insole condition. [Conclusion] BMZ insoles improve postural sway in both normal-footed and flat-footed individuals on a sideward slope.

Comparison of flatfeet and normal feet using data of the gait cycle, contact area, and foot pressure.

Although the foot is involved in load-bearing and shock absorption, foot pressure (FP), ground contact area (CA), and gait cycle (GC) in flatfeet (FF) have not been examined in detail. We aimed to analyze the influence of FF on FP, CA, and GC. We included 20 and 21 women with FF and normal feet (NF), respectively. A Footscan plantar pressure plate (RsScan International, Belgium) was used to analyze FP, CA, and GC. FP was applied to the unit area of 10 compartments. GC analysis was performed using phase-time measurements by dividing the GC into four phases. In the analysis, FP and CA were compared between the FF and NF groups. A comparison of GC was similarly performed between the two groups. The data provided in this article will be useful when designing studies on the effect of foot shape on FP, CA, and GC during gait.

Relationship between Perceived Leg Length Discrepancy at One Month and Preoperative Hip Abductor Muscle Elasticity in Patients after Total Hip Arthroplasty.

OBJECTIVE: Preoperative factors related to perceived leg length discrepancy (PLLD) after total hip arthroplasty (THA) are not well studied. This study aimed to examine the preoperative factors, including hip abductor modulus, related to PLLD one month after THA. METHODS: The study included 73 patients diagnosed with osteoarthritis secondary to developmental dysplasia of the hip and a posterior approach to surgery. Multiple logistic regression analysis was performed using the presence or absence of PLLD as the dependent variable and preoperative hip abductor's modulus of elasticity, pain, hip abduction range of motion, hip abductor muscle strength and pelvic obliquity as the independent variable. Additionally, receiver operating characteristic curves were used for the extracted variables for calculating the cutoffs, sensitivity, specificity and area under the curve (AUC) to determine the presence or absence of PLLD. The significance level was set at p<0.05. RESULTS: The hip abductor modulus (odds ratio=1.13; 95% confidence interval=1.06-1.21; p<0.001) was selected as a preoperative factor. The cutoff value to determine the presence or absence of a PLLD was 16.32 kPa. The sensitivity and specificity were 81.8% and 72.5%, respectively, and the AUC was 0.8137. CONCLUSION: The hip abductor muscle elastic modulus affected PLLD one month after THA. If the preoperative hip abductor elastic modulus is higher than the cutoff value, it may affect the appearance of PLLD at one month postoperatively.

Effect of exercise at light loads with manipulative resistance on infraspinatus, trapezius (upper fiber) and deltoid (middle fiber) muscle activities in shoulder joint elevation.

[Purpose] To clarify rotator cuff muscular activity in the raised position of the closed kinetic chain (CKC) exercise. [Subjects] Twenty-nine cases were studied, 19 men and 10 women (average age 21.5 ±4.7 years old, average body weight 60.1 kg ±11.4). [Methods] To determine the effects of the closed kinetic chain exercise on the upper limb, we measured the surface EMG of the infraspinatus muscle, the trapezius (upper fiber) and the deltoid (middle fiber) with the arm elevated. [Results] Our results show that at an elevation angle of 150° in the scapular plane of the upper limb, with 5% body weight load, the EMG activities of the infraspinatus muscle are approximately 30% of maximum voluntary contraction (MVC). [Conclusion] The raised position of the CKC exercise is effective in physical therapy for functional recovery of the infraspinatus muscle.

Fluorescent nucleosides with 'on-off' switching function, pH-responsive fluorescent uridine derivatives.

We synthesized various pH-responsive fluorescent deoxyuridine derivatives (1a-g). These fluorescent nucleosides exhibited distinctive fluorescence at 470-600 nm in aqueous solvents containing methanol only at acidic to neutral pH values. In particular, 1f exhibited strong fluorescence only at pH range of 3.1-7.2 with a pK(a) of 6.1. Such pH-sensitive fluorescent nucleosides can be used as 'on-off' fluorescence switch for monitoring pH change in biological systems, particularly for cancer cell detection.

Stretching positions for the coracohumeral ligament: Strain measurement during passive motion using fresh/frozen cadaver shoulders.

BACKGROUND: Contracture of the coracohumeral ligament is reported to restrict external rotation of the shoulder with arm at the side and restrict posterior-inferior shift of the humeral head. The contracture is supposed to restrict range of motion of the glenohumeral joint. METHODS: To obtain stretching position of the coracohumeral ligament, strain on the ligament was measured at the superficial fibers of the ligament using 9 fresh/frozen cadaver shoulders. By sequential measurement using a strain gauge, the ligament strain was measured from reference length (L0). Shoulder positions were determined using a 3 Space Tracker System. Through a combination of previously reported coracohumeral stretching positions and those observed in preliminary measurement, ligament strain were measured by passive external rotation from 10° internal rotation, by adding each 10° external rotation, to maximal external rotation. RESULTS: Stretching positions in which significantly larger strain were obtained compared to the L0 values were 0° elevation in scapula plane with 40°, 50° and maximum external rotation (5.68%, 7.2%, 7.87%), 30° extension with 50°, maximum external rotation (4.20%, 4.79%), and 30° extension + adduction with 30°, 40°, 50° and maximum external rotation (4.09%, 4.67%, 4.78%, 5.05%)(P < 0.05). No positive strain on the coracohumeral ligament was observed for the previously reported stretching positions; ie, 90° abduction with external rotation or flexion with external rotation. CONCLUSIONS: Significant strain of the coracohumeral ligament will be achieved by passive external rotation at lower shoulder elevations, extension, and extension with adduction.

Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?

Limitation of ankle motion is in many cases treated by joint mobilization (JM), a kind of manual physical therapy technique. Until now, the JM approach has mainly focused on the talocrural joint, with less attention to the distal tibiofibular joint. We applied cyclic loading to the lateral malleolus as in JM in order to clarify the relationship between the dorsiflexion angle and the excursion of the lateral malleolus. Seven normal, fresh-frozen cadaver legs were used. To each specimen, cyclic loading with a 30N force was applied 1000 times to the lateral malleolus at a speed of 15N/s. The displacement of the lateral malleolus was measured with a magnetic tracking system. The maximum dorsiflexion angle was measured before and after cyclic loading. After the first 100 and 1000 times of cyclic loading, the tibia was displaced 0.44+/-0.30mm and 0.75+/-0.36mm, respectively, and the fibula was displaced 0.44+/-0.28mm and 0.92+/-0.39mm, respectively. The average dorsiflexion angle increased from 14.36+/-7.51 degrees to 16.74+/-7.21 degrees after cyclic loading (P<0.05). Movement of the distal tibiofibular joint led to a significant increase in the range of ankle dorsiflexion. These results suggest that tibiofibular JM would be effective for limitation of ankle dorsiflexion.

Lengthening of the pectoralis minor muscle during passive shoulder motions and stretching techniques: a cadaveric biomechanical study.

BACKGROUND AND PURPOSE: Lengthening of the pectoralis minor muscle (PMi) during passive shoulder motions and the effect of stretching techniques for this muscle are unclear. The purposes of this study were: (1) to investigate the amount and pattern of the lengthening between passive shoulder motions and (2) to determine which stretching technique effected the greatest change in PMi length. METHODS: Nine fresh cadaveric transthoracic specimens were used. Lengthening in the lateral and medial fiber group of the PMi was directly measured during 3 passive shoulder motions (flexion, scaption, and external rotation at 90 degrees of abduction) and 3 stretching techniques (scapular retraction at 0 degrees and 30 degrees of flexion and horizontal abduction) for this muscle. The measurement was conducted by using a precise displacement sensor. RESULTS: Although the length of the PMi linearly increased during all shoulder motions, lengthening during flexion and scaption was steeper and significantly larger than that during external rotation at 90 degrees of abduction. For the stretching techniques, scapular retraction at 30 degrees of flexion and horizontal abduction stretched the PMi more than scapular retraction at 0 degrees of flexion. In comparison with lengthening at 150 degrees of flexion, scapular retraction at 30 degrees of flexion significantly stretched the medial fiber group of the muscle. DISCUSSION AND CONCLUSION: The extensive lengthening of the PMi is necessary during shoulder motions, especially flexion and scaption. Scapular retraction at 30 degrees of flexion makes the greatest change in PMi length. This study suggests the importance of the PMi in shoulder motion and provides anatomical and biomechanical evidence that might guide appropriate selection of stretching techniques.

Evaluation of stretching position by measurement of strain on the ilio-femoral ligaments: an in vitro simulation using trans-lumbar cadaver specimens.

The ilio-femoral ligament is known to cause flexion contracture of the hip joint. Stretching positioning is intended to elongate the ilio-femoral ligaments, however, no quantitative analysis to measure the effect of stretching positions on the ligament has yet been performed. Strains on the superior and inferior ilio-femoral ligaments in 8 fresh/frozen trans-lumbar cadaveric hip joints were measured using a displacement sensor, and the range of movement of the hip joints was recorded using a 3Space Magnetic Sensor. Reference length (L(0)) for each ligament was determined to measure strain on the ligaments. Hip positions at 10 degrees adduction with maximal external rotation, 20 degrees adduction with maximal external rotation, and maximal external rotation showed larger strain for the superior ilio-femoral ligament than the value obtained from L(0), and hip positions at 20 degrees external rotation with maximal extension and maximal extension had larger strain for the inferior ilio-femoral ligament than the value obtained from L(0) (p<0.05). Superior and inferior ilio-femoral ligaments exhibited positive strain values with specific stretching positions. Selective stretching for the ilio-femoral ligaments may contribute to achieve lengthening of the ligaments to treat flexion contracture of the hip joint.

Influence of elbow flexion angle on mobilization of the proximal radio-ulnar joint: a motion analysis using cadaver specimens.

The purpose of this study was to determine the most effective elbow joint flexion angle for mobilization of the proximal radio-ulnar joint. Five fresh-frozen cadaveric elbows were used to measure displacement of the radial head in the antero-medial and postero-lateral directions by traction force of 2kgf and 4kgf, respectively. Simulation of the gliding of the proximal radio-ulnar joint was performed at four elbow flexion angles (0 degrees , 30 degrees , 60 degrees , 90 degrees). Data obtained from those flexion angles were compared using one-way repeated measures analysis of variance. Radial head displacement at 60 degrees and 90 degrees during antero-medial gliding were significantly greater than those at 0 degrees and 30 degrees (p<0.05) There were no significant differences in radial head displacement among four elbow flexion angles during postero-lateral gliding at 2kgf and 4kgf. Our findings suggest that proximal radio-ulnar joint mobilization in the antero-medial direction can be performed effectively at 60 degrees and 90 degrees elbow flexion.

Stretching positions for the posterior capsule of the glenohumeral joint: strain measurement using cadaver specimens.

BACKGROUND: Various stretches have been introduced for the posterior shoulder; however, little quantitative analysis to measure stretching of the posterior capsule has been performed. HYPOTHESIS: The current shoulder stretching program is not sufficient to stretch the entire posterior capsule. STUDY DESIGN: Controlled laboratory study. METHODS: Using 8 fresh-frozen cadaver shoulders (average age, 82.4 years), 8 stretching positions for the posterior capsule were simulated by passive internal rotation. Stretching positions of 0 degrees , 30 degrees , 60 degrees , and 90 degrees of elevation in the scapular plane; 60 degrees of flexion; 60 degrees of abduction; 30 degrees of extension; and 60 degrees of flexion and horizontal adduction were adopted. Strain was measured in the upper, middle, and lower parts of the capsule. The measurement of strain was instituted from reference length. RESULTS: With internal rotation, mean strain on the upper capsule was 3.02% at 0 degrees of elevation and 3.35% at 30 degrees of extension. Strain on the middle capsule at 0 degrees and 30 degrees elevation was 0.78% and 4.77%, respectively; on the lower capsule, it was 5.65% and 2.24% at 30 degrees and 60 degrees of elevation, respectively, and 2.88% at 30 degrees of extension. Increase in strains of the upper, middle, and lower capsule with internal rotation at 0 degrees , 30 degrees , and 60 degrees of elevation were statistically significant, respectively (P < .01). Other shoulder positions demonstrated no positive strain values. CONCLUSIONS: Based on the results of this cadaver study, large strains on the posterior capsule of the shoulder were obtained at a stretching position of 30 degrees of elevation in the scapular plane with internal rotation for the middle and lower capsule, while a stretching position of 30 degrees of extension with internal rotation was effective for the upper and lower capsule. CLINICAL RELEVANCE: The current posterior capsule stretching program of the shoulder was not sufficient to stretch the entire posterior capsule.

Anatomical variations in stylopharyngeus muscle insertions suggest interindividual and left/right differences in pharyngeal clearance function of elderly patients: a cadaveric study.

The stylopharyngeus plays a critical role in the clearance of the piriform recess. We dissected 78 sides of the pharynx from 55 donated cadavers and observed histology of another seven sides of the pharynx from seven cadavers. The stylopharyngeus consistently comprised (1) a descending muscle bundle surrounding the piriform recess and (2) an additional short sheet inserting into the tonsillar bed. Histologically, the former bundle connected to a thick fascia providing the lateral glossoepiglottic fold, extending along the submucosa of the piriform recess, and covering the thyroid cartilage, whereas the latter sheet intermingled with other pharyngeal wall muscles at and near the tonsillar bed. Notably, in 44.4% of female specimens, the additional sheet occupied a greater proportion in cross section than the descending muscle bundle. Given the different directions, the additional sheet seemed to check clearance function of the descending bundle for the piriform recess. Thus, particularly in women, interindividual differences in pharyngeal clearance were likely to depend on whether the additional sheet is strong or weak. Chin down in combination with tilting and rotating the head may represent effective exercises of the stylopharyngeus that could compensate for the disadvantages of additional insertion.

A cadaveric study of strain on the subscapularis muscle.

OBJECTIVES: To measure the strain on 3 fiber groups of the subscapularis muscle at various glenohumeral joint positions and to determine the appropriate shoulder position for subscapularis muscle stretching. DESIGN: Repeated-measures design. SETTING: Biomechanics laboratory. SPECIMENS: Nine frozen-thawed glenohumeral joints obtained from 9 fresh cadavers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The strain on the upper, middle, and lower fiber groups of the subscapularis were measured by precise displacement sensors during 14 different glenohumeral joint positions. RESULTS: The glenohumeral joint position that showed the largest strain varied among the 3 fiber groups. Although no position showed significantly large strain on the upper and middle fiber groups, external rotation at 30 degrees , 60 degrees , and 90 degrees of elevation, abduction, flexion, and horizontal abduction revealed significantly greater strain on the lower fiber groups (P<.005). Additionally, except for external rotation at 0 degrees of elevation, the strain on the lower fiber group was significantly greater than that on the upper and middle fiber groups in external rotation (P<.005). CONCLUSIONS: The stretching position of each fiber group of the subscapularis differs depending on the glenohumeral joint position. External rotation at 30 degrees to 60 degrees of glenohumeral elevation, abduction, flexion, and horizontal abduction can significantly stretch the lower fiber group of the subscapularis muscle.

Strain on the repaired supraspinatus tendon during manual traction and translational glide mobilization on the glenohumeral joint: a cadaveric biomechanics study.

There has been no report on the mechanical effects of joint mobilization on rotator cuffs. The purpose of this study was to determine whether it is safe to use grade 3 joint mobilization techniques after rotator cuff repair. Nine fresh frozen cadaveric shoulders were used in this study. The strains on the artificially repaired supraspinatus tendon during joint mobilization were measured at 0 degrees and 30 degrees of shoulder abduction and were compared with those at the maximal stretching position and relaxing position. Additionally, gap distances were measured during this experiment. The strain at 30 degrees of abduction of the repaired tendon during each joint mobilization was significantly smaller than that at 0 degrees abduction (P<0.05). At 30 degrees of abduction, the strain during joint mobilization was not statistically different from that of the shoulder in the relaxing position, except during the inferior glide technique. Gap distances were 0mm at 30 degrees , while the distances were 1.06-1.46 mm at 0 degrees. Our findings suggest that joint mobilization techniques, except inferior glide, can be performed safely without significantly straining the repaired tendon at 30 degrees of abduction, if rotator cuff repair is performed at 0 degrees of abduction.

The effect of arm position on stretching of the supraspinatus, infraspinatus, and posterior portion of deltoid muscles: a cadaveric study.

BACKGROUND: The stretching of the supraspinatus and infraspinatus muscles is important to prevent shoulder injuries. Although several authors have advocated various stretching techniques, a general opinion has not been reached owing to the lack of quantitative analysis. METHODS: Nine fresh cadaveric shoulders were used to measure the strain on the supraspinatus, the middle and inferior portions of the infraspinatus, and the posterior portion of the deltoid muscles during eleven arm positions. The strain on the muscles was measured by precise displacement sensors attached to the center of each muscle belly. FINDINGS: In case of the supraspinatus muscle, abduction at extension showed significantly larger strain than that in the neutral position (P < 0.05). Internal rotation at extension showed significantly larger strain in the middle portions of the infraspinatus (P < 0.05). Internal rotation at 30 degrees and 60 degrees elevation as well as extension showed significantly larger strain in the inferior portion of the infraspinatus (P<0.05). Adduction at 60 degrees elevation did not show large strain in the infraspinatus muscle; however, significantly larger strain was observed in the posterior portion of the deltoid muscle. INTERPRETATION: Shoulder stretching techniques that are based on these experimental data can enhance the selective stretching of the corresponding muscles. Application of these techniques is considered to be useful for the prevention and treatment of shoulder injuries.

Tensile properties and biological response of poly(L-lactic acid) felt graft: an experimental trial for rotator-cuff reconstruction.

Poly(L-lactic acid) felt (PLLA felt) was prepared for reconstruction of the rotator cuff in animal models. Small changes were found in the tensile strength of both the cultured PLLA felt and the PLLA felt implanted on the paravertebral muscle of rabbits up to 16 postoperative weeks. The stiffness of the felt implanted on the muscle from 6 to 16 weeks showed a statistically significant increase. When the infraspinatus tendons of beagle dog were reconstructed with the PLLA felt, the ultimate strength of PLLA felt increased threefold, and the stiffness increased fivefold by 16 postoperative weeks compared to that of the initial PLLA felt. They were statistically significant (p < 0.01). All the implanted specimens ruptured at the junction between the bone and the PLLA felt. Histological examination demonstrated infiltration of fibrous tissue into the interstices of the PLLA felt fibers. Connection between the infraspinatus tendon and the PLLA felt was tight with the formed scar tissue, but the connective tissue between the bone and PLLA felt fibers was sparse even at 16 and 32 postoperative weeks. A few deteriorated PLLA felt fibers were observed at 32 postoperative weeks. It was concluded that the degradation rate of PLLA felt was low and the tensile recovery of the PLLA felt graft in beagle dogs was excellent. Thus, PLLA felt might be a useful bioabsorbable material for rotator-cuff reconstruction.

Microbial synthesis of trans isomer of eicosapentaenoic acid (EPA) from the chemically synthesized trans isomer of linolenic acid by a delta12 desaturase-defective mutant of Mortierella alpina 1S-4.

The mono trans geometrical isomer of eicosapentaenoic acid, 5c,8c,11c,14c,17t-eicosapentaenoic acid (20:5delta5c,8c,11c,14c,17t), was synthesized by fatty acid microbial conversion using a delta12-desaturase defective mutant of an arachidonic acid (AA)-producing fungus, Mortierella alpina 1S-4. The substrate for the bioconversion, a geometrical isomer of linolenic acid, was prepared by isomerization of linseed oil methyl ester by the nitrous acid method, followed by purification on a AgNO3-silica gel column. The structure and double bond geometry were identified after hydrazine reduction followed by permanganate oxidation to 20:5delta5c,8c,11c,14c,17t. The biosynthetic route from 18:3delta6c,9c,12t to 20:5delta5c,8c,11c,14c,17t was presumed to mimic the route from linoleic acid to arachidonic acid.