Effects of Nutritional Support Combined with Neuromuscular Electrical Stimulation on Muscle Strength and Thickness: A Randomized Controlled Trial in Healthy Young Adult Males.

In the management of post-injury patients with activity limitations, methods to prevent musculoskeletal disorders and hasten recovery are important. This randomized controlled, single-blinded study was a preliminary investigation of the combined effect of nutritional support with neuromuscular electrical stimulation (NMES) on muscle strength and thickness. Healthy young adult males (median age, 21 years) were enrolled; each of their hands was randomly assigned to one of the following four groups: Placebo, Nutrition, NMES, and Nutrition + NMES. All participants received whey protein or placebo (3x/week for 6 weeks) and NMES training (3x/week for 6 weeks) on the abductor digiti minimi (ADM) muscle of either the left or right hand. ADM muscle strength and thickness were analyzed at baseline and at week 7. We analyzed 38 hands (9 Placebo, 10 Nutrition, 9 NMES, 10 Nutrition + NMES). There was significantly greater muscle strengthening in the Nutrition + NMES group compared to the Placebo group or the NMES group, but no significant difference in gain of muscle thickness. The combined intervention may be effective in improving muscle strength. Future clinical trials targeting various muscles after sports-related injuries are warranted.

Heterogeneous intercalated metal-organic framework active materials for fast-charging non-aqueous Li-ion capacitors.

Intercalated metal-organic frameworks (iMOFs) based on aromatic dicarboxylate are appealing negative electrode active materials for Li-based electrochemical energy storage devices. They store Li ions at approximately 0.8 V vs. Li/Li+ and, thus, avoid Li metal plating during cell operation. However, their fast-charging capability is limited. Here, to circumvent this issue, we propose iMOFs with multi-aromatic units selected using machine learning and synthesized via solution spray drying. A naphthalene-based multivariate material with nanometric thickness allows the reversible storage of Li-ions in non-aqueous Li metal cell configuration reaching 85% capacity retention at 400 mA g-1 (i.e., 30 min for full charge) and 20 °C compared to cycling at 20 mA g-1 (i.e., 10 h for full charge). The same material, tested in combination with an activated carbon-based positive electrode, enables a discharge capacity retention of about 91% after 1000 cycles at 0.15 mA cm-2 (i.e., 2 h for full charge) and 20 °C. We elucidate the charge storage mechanism and demonstrate that during Li intercalation, the distorted crystal structure promotes electron delocalization by controlling the frame vibration. As a result, a phase transition suppresses phase separation, thus, benefitting the electrode's fast charging behavior.

Effect of protruding stickers enhancing plantar sensory feedback on control of the center of force trajectory during gait: A preliminary study.

BACKGROUND: Abnormal kinematics and kinetics in the lower extremity during gait may be improved by modulating the center of force trajectory of the foot. This study aimed to confirm whether short-interval training using plastic hemispherical protruding stickers (diameter: 5 mm; height: 2 mm) attached to the plantar surface of the foot to enhance plantar sensory feedback can help actively control the center of force trajectory during gait. METHODS: Twenty healthy female subjects underwent three-dimensional barefoot gait analysis under control conditions and two post-training conditions. Before the measurements under post-training conditions, the subjects underwent a 5-minute training to control the center of force trajectory with two protruding stickers attached to the plantar surface of the right foot. During training, the subjects were asked to put their weight on the stickers. The attachment positions of the stickers were the heel and either the first or fifth metatarsal head, which was randomly determined although both were tested. RESULTS: The center of pressure trajectory during the right stance phase of the gait shifted in the direction of the protruding stickers attached in the last training, although the stickers had already been removed. CONCLUSIONS: The study results confirmed that a 5-minute training with protruding stickers attached to the plantar surface of the foot can help actively control the center of pressure trajectory during gait.

[A Case of Primary Gastric Lymphoma with Spontaneous Perforation].

An 85-year-old female patient presented to the emergency department with the chief complaint of sudden upper abdominal pain. The patient suffered from anorexia and epigastric pain for a month, and a local physician suspected a diagnosis of gastric ulcer. An abdominal computed tomography(CT)scan showed intraperitoneal free air as well as irregular thickening and thinning of the gastric wall. Gastric ulcer perforation was suspected, and an emergency operation was performed. Surgical findings showed thickening of the gastric wall in the pylorus and gastric corpus but partial thinning of areas of the anterior wall of the gastric corpus with a perforation measuring 5 mm. A distal gastrectomy and reconstruction were performed using the Billroth Ⅱ method. The histopathological diagnosis was malignant gastric lymphoma(diffuse large B- cell lymphoma). Considering the patient's age and general condition, chemotherapy was not administered after surgery. The patient was alive without recurrence 8 months after the operation.

[Resectable Pancreatic Cancer Successfully Treated with Neoadjuvant Chemotherapy Regimen Change to Modified FOLFIRINOX-A Case Report].

A 72-year-old woman presented with obstructive jaundice. Computed tomography revealed a 12-mm low-density mass in the head of the pancreas. She was diagnosed as having pancreatic cancer by endoscopic ultrasound-guided fine-needle aspiration. She received gemcitabine plus nab-paclitaxel as preoperative chemotherapy. After 2 courses, hepatoduodenal lymph node metastasis appeared and was accompanied by increased tumor marker levels. The regimen was changed to modified FOLFIRINOX. After 5 courses, the lymph node metastasis was reduced in size and the tumor marker levels were decreased, so subtotal stomach-preserving pancreaticoduodenectomy was performed. Adjuvant chemotherapy was administered postoperatively. The patient was alive and well without recurrence 2 years and 9 months after the surgery, but died of sepsis. Nevertheless, this case highlights that when preoperative chemotherapy for resectable pancreatic cancer appears to be ineffective, a change in regimen may be useful.

Classification of medial longitudinal arch kinematics during running and characteristics of foot muscle morphology in novice runners with pronated foot.

BACKGROUND: Novice runners with pronated feet are at an increased risk of running-related injuries. However, not all runners with pronated feet have increased foot pronation during running. Moreover, although foot muscle morphology is related to static foot alignment, the relationship between foot muscle morphology and foot kinematics during running remains unclear. We aimed to determine foot kinematic patterns during running among novice runners with pronated feet and the presence of a relationship between these foot kinematic patterns and foot muscle morphology. METHODS: Twenty-one novice runners with pronated feet participated in this study, and data on 39 lower limbs were collected. Data on foot kinematics during running (rearfoot strike) were collected using a three-dimensional motion capture system in terms of navicular height (NH) at initial contact and dynamic navicular drop (DND). A hierarchical cluster analysis method was used to identify the optimal number of clusters based on these two foot-related kinematic variables. Following identification of the clusters, differences in cluster variables and cross-sectional areas of selected foot muscles assessed using ultrasonography in each cluster were examined. The muscles of interest included the abductor hallucis, flexor hallucis brevis and longus, flexor digitorum brevis and longus, and peroneus longus. RESULTS: Three subgroups were identified based on foot kinematics during running: cluster 1, lowest NH at initial contact and larger DND; cluster 2, moderate NH at initial contact and smaller DND; and cluster 3, highest NH at initial contact and larger DND. Clusters 1 and 3 had a larger abductor hallucis compared with cluster 2, and cluster 3 had a larger flexor hallucis brevis compared with cluster 2. SIGNIFICANCE: These subgroups may differ in terms of resistance to and type of running-related injury. Moreover, foot kinematics during running is possibly impacted by the morphology and function of medial intrinsic foot muscles.

[A Case of Pancreatic Invasive Micropapillary Carcinoma That Survived Seven Years after Resection and Chemotherapy].

We present the case of a 47-year-old man who underwent a subtotal stomach-preserving pancreaticoduodenectomy for pancreatic head cancer. Histopathological diagnosis revealed that the majority of the cancer was an invasive micropapillary carcinoma(IMPC). Postoperative adjuvant chemotherapy using S-1 was continued for 4 years, at the end of which, multiple lymph node metastases were identified. Therefore, gemcitabine plus S-1 therapy was initiated. The treatment reduced the lymph node in size and resulted in the maintenance of a partial response for a year and a half. However, increased lymph node metastases recurred, and multiple lung metastases were noted. The patient died 7 years and 2 months after the resection of the primary lesion. Although pancreatic IMPC has a poor prognosis, long-term survival may be achieved by resection of the primary region, the administration of adjuvant chemotherapy and management of recurrent lesions by chemotherapy.

[Total Pancreatectomy for Remnant Pancreatic Cancer with Positive Washing Cytology after Conversion to Negative Cytology Following Gemcitabine plus Nab-Paclitaxel Therapy-A Case Report].

A 53-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)for resectable pancreatic cancer after neoadjuvant chemotherapy. Postoperatively, she received hepatic arterial infusion of 5-FU and S-1 chemotherapy. Two years after SSPPD, abdominal computed tomography showed a 2-cm mass in the remnant pancreas, which was diagnosed as recurrence of cancer by endoscopic ultrasound-guided fine-needle aspiration. Staging laparoscopy was performed and peritoneal washing cytology(CY)was positive. She then received gemcitabine plus nab-paclitaxel chemotherapy for 8 months. After that, staging laparoscopy was performed again and negative CY was confirmed. A total remnant pancreatectomy with splenectomy was performed. She received chemotherapy after pancreatectomy and is now alive and well without recurrence 2 years and 1 month after the second surgery. Although positive CY is a poor prognostic factor, surgery combined with perioperative chemotherapy may contribute to prolonged survival for some patients who have recurrence in the remnant pancreas with positive CY.

Accuracy of Temporo-Spatial and Lower Limb Joint Kinematics Parameters Using OpenPose for Various Gait Patterns With Orthosis.

A cost-effective gait analysis system without attachments and specialized large environments can provide useful information to determine effective treatment in clinical sites. This study investigates the capability of a single camera-based pose estimation system using OpenPose (OP) to measure the temporo-spatial and joint kinematics parameters during gait with orthosis. Eleven healthy adult males walked under different conditions of speed and foot progression angle (FPA). Temporo-spatial and joint kinematics parameters were measured using a single camera-based system with OP and a three-dimensional motion capture system. The limit of agreement, mean absolute error, absolute agreement (ICC2, 1), and relative consistency (ICC3, 1) between the systems under each condition were assessed for reliability and validity. The results demonstrated that most of the ICC for temporo-spatial parameters and hip and knee kinematics parameters were good to excellent (0.60 - 0.98). Conversely, most of the ICC for ankle kinematics in all conditions were poor to fair (< 0.60). Thus, the gait analysis using OP can be used as a clinical assessment tool for determining the temporo-spatial, hip, and knee sagittal plane angles during gait.

Low-Resistance Mechanism of Nanoflake Crystalline Aromatic Dicarboxylates with Selective Defects for Safe and Fast Charging Negative Electrodes.

Low resistance of Li-intercalated negative electrodes is important for the safe and fast charging required for large-scale batteries. Here, we demonstrated that nanosized two-dimensional crystalline aromatic dicarboxylate negative electrode materials synthesized via spray drying exhibit low internal resistances at approximately 0.7 V vs Li/Li+, while retaining flat potential profiles. The spray-dried sample with a hollow structure is crushed into nanoflakes during ink preparation for electrode coating and forms a uniform and highly dispersed electrode structure. The charge-discharge evaluation indicates that the nanoflake sample showed smaller charge-discharge polarization than the bulk sample with stable cycling characteristics, resulting in significant high-rate property enhancement. Charge-transfer resistance of the nanoflake sample exhibits the lowest value (ca. 2.2 Ω cm2) among those reported for existing intercalation electrodes (5.2 to 235 Ω cm2). In comparison of the negative electrodes, the estimated maximum current density without Li deposition (ca. 316 mA cm-2) is more than 1 order of magnitude higher than that for currently used graphite (ca. 11 mA cm-2) and is also higher than those for high-rate oxides (137-298 mA cm-2). The resistance-crystal correlation using multiple regression analysis predictions and its verification reveal that this low resistance is owing to an improved Li acceptability associated with selective structural defects induced by the loss of incorporated crystallized water during drying. The crystal plane exposed by the selective structural defects is perpendicular to electronic and ionic conduction directions inside the solid, resulting in improved kinetics. Therefore, the proposed negative electrode allows safe and fast charging, with easy scale-up and sustainable resources.

[A Case of Surgical Resection of Anaplastic Carcinoma of the Pancreas(Pleomorphic Cell Type)with Poor Response to Neoadjuvant Chemotherapy].

A 62-year-old man was incidentally found to have a pancreatic tumor by CT. He was diagnosed with pancreatic cancer by EUS-FNAB. Gemcitabine(GEM)plus nab-paclitaxel(PTX)was started as neoadjuvant chemotherapy(NAC)for resectable pancreatic cancer. However, after the end of the second course, the tumor grew rapidly and invaded the stomach, so NAC was discontinued, and surgery was performed. The pathological diagnosis was anaplastic ductal carcinoma of the pleomorphic cell type, and the histological response was Grade 1a. Multiple liver metastases appeared during adjuvant chemotherapy with S-1, so GEM plus nab-PTX and modified FOLFIRINOX were administered, but the therapeutic response was poor, the patient died 9 months after surgery. Anaplastic carcinoma has a poor response to chemotherapy and may be included with cancers showing treatment resistance to NAC, as seen in our case. It is necessary to pay attention to anaplastic carcinoma during the course of NAC for pancreatic cancer.

Effect of Varying Soft Actuator Band Positions of a Wearable Assist Device on Gait Simulation of Lower Limb Muscle Force.

The purpose of this study is to investigate the effect of changing the application points and directions of the soft actuator band of a wearable hip assist device on muscle force and joint kinematics during gait. Healthy adult participants walked under four conditions with varying band positions of a soft wearable hip assist device. The three-dimensional coordinates of markers and ground reaction force data were measured during gait. Lower limb muscle forces and joint angles were calculated using a musculoskeletal model. Our results showed that the position and running direction of the soft actuator band decreased the forces of the iliopsoas and hamstring muscles.

Effects of Varying Plantarflexion Stiffness of Ankle-Foot Orthosis on Achilles Tendon and Propulsion Force During Gait.

An ankle-foot orthosis (AFO) with a plantarflexion resistance function, improves post-stroke gait. An AFO with a plantarflexion resistance function not only affects the first rocker function and the weight acceptance but also the late stance phase. Achilles tendon extension is important for ankle joint function and for forward propulsion during the late stance phase; however, the effect of an AFO with a plantarflexion resistance function on the Achilles tendon is unclear. The purpose of this study was to investigate the effect of plantarflexion resistance on the extension of the Achilles tendon and the forward-propulsive force. Herein, 10 healthy adult males participated who walked under three different conditions: a no-AFO condition and two AFO conditions that had different levels of plantarflexion resistance (P1 and P2). The stiffness value of the P1 and P2 conditions was 0.56 and 1.47 Nm/°, respectively. A three-dimensional (3D) motion analysis system and a musculoskeletal model were used to assess the tendon-length change, the ground reaction force, kinematics, and kinetics data. The change in Achilles tendon length was significantly lower in the P1 and P2 conditions than the no-AFO condition. Furthermore, changes in the length of the Achilles tendon significantly decreased in the P2 condition when compared with that in the P1 condition. The peak anterior ground reaction force was significantly lower in the P2 condition than the no-AFO condition. These results suggest that excessive assist provided by an AFO prevents efficient gait by decreasing both the forward-propulsive force and tendon function.

Syncytial variant of classic Hodgkin lymphoma: Four cases diagnosed with the aid of CD274/programmed cell death ligand 1 immunohistochemistry.

Although several reports have highlighted neoplastic PD-L1 (nPD-L1) expression in classic Hodgkin lymphoma (CHL), some have addressed associations between its expression and detailed histopathologic features. Here we describe four cases of syncytial variant of CHL (SV-CHL), with and without Epstein-Barr virus (EBV) association, and highlight the diagnostic utility of PD-L1 (clone SP142) immunohistochemistry. The patients were a 61-year-old male, 45-year-old male, 85-year-old female, and 89-year-old female. All presented with cervical or axillary lymphadenopathy, which on biopsy had the established histopathologic features of SV-CHL with a biphasic pattern of cohesive sheets of large tumor cells and typically scattered distribution of Hodgkin and Reed-Stenberg (HRS) cells. These tumor cells showed identical immunophenotypic findings for CD15, CD30, Fascin, PAX5, OCT2, BOB1 and EBV harboring, regardless of location. The exception was absent or decreased expression of nPD-L1 from tumor cells in the confluent sheets, contrasting with HRS cell positivity in typical areas of CHL. These findings offer the first suggestion of possible downregulation of nPD-L1 expression in association with the histopathologic progression of CHL. The results may be relevant for recognizing 'confluent' sheets in the diagnostic workup for SV-CHL.

[A case of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis in an elderly woman].

An 84-year-old woman who had diabetes mellitus and atrial fibrillation presented to our hospital with appetite loss and difficulty in standing up. Her cervical, axillary, and mediastinal lymph nodes were swollen. At first, malignant lymphoma was suspected, but positron emission tomography-computed tomography and cervical lymph node biopsy did not support this diagnosis. She was admitted to our hospital 41 days after the first consultation because of appetite loss and fever. We suspected a disorder related to Epstein-Barr virus infection because Epstein-Barr virus-encoded small RNAs were found in the lymph node. She was diagnosed with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) based on the diagnostic criteria of the Japanese Society for Pediatric Infectious Diseases. Her symptoms, including appetite loss and fever, were alleviated after the administration of prednisolone (20 mg per day). She was discharged 90 days after admission. At two weeks after discharge, she was readmitted for respiratory failure, and died five days after readmission.To the best of our knowledge there are no previous reports of EBV-HLH in patients over 80 years of age, and the optimal treatment strategy is unknown. This case suggested that prednisolone may alleviate the symptoms of EBV-HLH. When a patient presents with swollen lymph nodes, clinicians should keep the possibility of EBV-HLH in mind.

Particular protrusion perception arising from plantar sensory input and task guidance enhances lower limb joint dynamics during gait.

[Purpose] To assess the influence of plantar sensory input and task guidance produced by a protrusion on lower limb joint dynamics during gait by changes in muscle activity and two-dimensional motion analysis. The protrusion seals on the soles of the feet, named "Perceptual Stimulus Protrusion" were used in this study. [Participants and Methods] In this study, 40 and 42 healthy adults were recruited for muscle activity and two-dimensional analysis, respectively. In addition to walking without perceptual stimulus protrusion ("Control" condition), the testing conditions included attachment of the protrusion to the heel ("Heel Condition") and the hallucal ("Hallucal Condition"). As task guidance, participants were orally instructed how to walk for each conditions. The muscle activities of the rectus femoris, vastus medialis, tibialis anterior, and medial head of the gastrocnemius were measured. The two-dimensional analysis was compared with the angle of ankle dorsiflexion and plantarflexion, the toe height during the swing phase between the test conditions, respectively. [Results] In the Heel Condition, the tibialis anterior and vastus medialis activity in the stance and swing phases, toe height, and angle of ankle dorsiflexion and plantarflexion increased. In the Hallucal Condition, tibialis anterior activity during the stance and swing phases, gastrocnemius activity during the stance phase, toe height, and angle of ankle plantarflexion increased. [Conclusion] Plantar sensory input and task guidance using perceptual stimulus protrusion influences active motion control. Therefore, the application of this procedure can be expected to support motion guidance, such as gait and load practice.

Effects of altering plantar flexion resistance of an ankle-foot orthosis on muscle force and kinematics during gait training.

Ankle-foot orthosis (AFO) can improve gait in stroke patients. Addition of plantar flexion resistance (PFR) can improve the first foot rocker function. However, the effect of changing the PFR on the ankle muscle force during gait training is unclear. This study aimed to determine the effect of changing the PFR of an AFO on spatiotemporal parameters (speed, bilateral step length, and cadence), peak angle of ankle plantar flexion and knee flexion, and muscle force (tibialis anterior [TA], medial head of the gastrocnemius [MGAS], and soleus) during early stance using a musculoskeletal model. Ten healthy adult men walked under five conditions: a no-AFO condition and PFR conditions 1-4. Spatiotemporal parameters and peak joint angles during the early stance phase were measured from experimental data, with muscle force estimated from simulations of a musculoskeletal model. Increasing the PFR of the AFO decreased TA muscle force and increased MGAS muscle force but had no influence on spatiotemporal parameters and joint angles. Adjustment of the PFR modifies the muscle force around the ankle, which can maximize the effect of AFO during gait training.

Effect of electromyographic biofeedback on learning the short foot exercise.

BACKGROUND: The short foot (SF) exercise is a strengthening exercise for the intrinsic foot muscles that is difficult to master. OBJECTIVE: To examine the effect of three different electromyographic (EMG) biofeedback methods on learning the SF exercise. METHODS: Thirty-six healthy subjects were randomly allocated to the control group (CTG), EMG-controlled electrical stimulation group (ESG), visual EMG biofeedback group (VSG), and combination EMG-controlled electrical stimulation with visual EMG biofeedback group (CBG). The CTG practiced the SF exercise for 5 minutes using the conventional method. The other groups each used the EMG biofeedback method and the conventional method. The EMG activity of the abductor hallucis (ABH), the medial longitudinal arch (MLA) angle, and the foot length during the SF exercise were measured before and after 5 minutes of practice. RESULTS: The EMG activity of the ABH in the VSG and CBG was significantly higher than that before practice. There were no intergroup differences in MLA morphology. CONCLUSIONS: These results suggest that visual EMG biofeedback is an effective method of increasing the EMG activity of the ABH during the SF exercise in a short practice time.

Estimation of compressive tibiofemoral force using over resistance of ankle-foot orthosis on gait.

The purpose of this study was to investigate the effect of changing the plantar flexion resistance (PFR) of an ankle-foot orthosis (AFO) on the compressive tibiofemoral force, knee muscle forces, and knee joint angle. We measured and estimated knee flexion angle, knee muscle force, and the compressive tibiofemoral force in healthy adult males. The results showed that the first peak compressive tibiofemoral force, peak knee flexion angle, and peak quadriceps muscle force increased in the strong PFR condition compared with the no-AFO condition. These results suggest that over-PFR caused various knee troubles.

Estimation of knee joint reaction force based on the plantar flexion resistance of an ankle-foot orthosis during gait.

[Purpose] The purpose of this study was to investigate the effect of changing the plantar flexion resistance of an ankle-foot orthosis on knee joint reaction and knee muscle forces. Furthermore, the influence of an ankle-foot orthosis with an over-plantar flexion resistance function on knee joint reaction force was verified. [Participants and Methods] Ten healthy adult males walked under the following three conditions: (1) no ankle-foot orthosis, and with ankle-foot orthoses with (2) a strong and (3) a weak plantar flexion resistance (ankle-foot orthosis conditions). The knee flexion angle, quadricep muscle force, hamstring muscle force, and knee joint reaction force during the stance phase were measured using a motion analysis system, musculoskeletal model, and ankle-foot orthosis model. [Results] The peak knee joint reaction force, knee flexion angle, and quadricep muscle force in the early stance phase significantly increased in the strong plantar flexion resistance condition in comparison with the "no ankle-foot orthosis" condition. [Conclusion] Increased knee joint reaction force with over-plantar flexion resistance suggests that over-plantar flexion resistance causes various knee problems such as knee pain and knee osteoarthritis.