[Feasibility study of locomotion training in a home-visit preventive care program].

AIM: To evaluate the feasibility of locomotion training (single-leg standing and squats) in a home-visit preventive care program for the elderly. METHODS: We invited 246 people who were not attending any preventive care programs within the long-term care insurance system. Among these, 60 participated in the current program. We administered a hearing survey, measured the single-leg stance time with eyes open, and subjects underwent locomotion training. Each participant was asked to repeat 1 set of training exercises 3 times per day at home. One set consists of standing on each leg for 1 minute and squatting 5 to 6 times. We telephoned the participants regularly during the 3 month program (locomo call). At the end of the program, we visited the participants and measured the single-leg stance time with eyes open. RESULTS: A total of 60 elderly adults participated in the program (15 men, 45 women). Among subjects secondary prevention of musculoskeletal (n=313), 67 were participating in site-visit preventive care programs conducted by the local authorities (21.4%). Among these 313, 127 were participating in site-visit preventive care programs or locomotion training (40.6%). It shows the increasing of the participation rate 21.4% to 40.6%. The continuance rate was 91.7%. The single-leg stance time improved for both men (16.2±17.7 sec, p<0.05) and women (57.2±79.7 sec, p<0.01) compared to the baseline. Similarly, improvement was observed in the single-leg stance time for both the young-old (62.2±67.9 sec, p<0.01) and the old-old (39.2±73.8 sec, p<0.01). CONCLUSIONS: We consider that the locomotion training program which we introduced in the current home-visit preventive care program was effective and highly feasible for the elderly who have not previously responded conventional site-visit preventive care programs.

Double clavicular fractures associated with scapular neck and coracoid process fractures.

We report a 38-year-old man with a combination of fractures in his left shoulder involving the middle and distal clavicle, the scapular neck, and the coracoid process, associated with scapulothoracic dissociation and an upper brachial plexus injury. The middle clavicular fracture was fixed with a plate, whereas the distal clavicular fracture was fixed with tension band wiring. Internal fixation for fractures of the scapular neck and coracoid process was not performed, as they were in an acceptable position after fixation of the clavicular fractures. At the 14-month follow-up, the range of motion of the left elbow, the wrist, and all fingers had recovered fully, whereas that of the left shoulder was limited to 35º abduction, 20º flexion, and 20º external rotation. The strength of the left shoulder abduction, flexion, and external rotation was M2. Elbow flexion, wrist extension, and finger extension strength had recovered to normal (M5). Sensation corresponding to the C5-6 dermatome had also improved to almost normal.

Involvement of tachykinins and NK1 receptor in the joint inflammation with collagen type II-specific monoclonal antibody-induced arthritis in mice.

Rheumatoid arthritis (RA) is a chronic multisystem disease characterized by persistent joint inflammation associated with severe pain. Because RA is an immune-mediated joint disease and because type II collagen is considered an autoantigen, rodent models of arthritis using collagen type II-specific monoclonal antibodies are valuable for studying the pathogenesis of autoimmune arthritis and for evaluating therapeutic strategies. The tachykinin family peptides, substance P (SP) and hemokinin-1 (HK-1), are expressed in the nervous systems and in many peripheral organs and immunocompetent cells and activate tachykinin NK1 receptors with similar affinities. NK1 receptors are involved in the inflammation and hyperalgesia associated with a variety of inflammatory diseases. In the present study, we examined the involvement of SP and HK-1 in the joint inflammation and hyperalgesia in a collagen antibody-induced arthritis (CAIA) model in mice. The messenger RNA expression levels of the TAC1 gene encoding SP and of the TAC4 gene encoding HK-1 were decreased in the dorsal root ganglia and spinal cord at the peak of the inflammatory symptoms in CAIA. Systemic injection of an NK1 receptor antagonist, WIN 51708, significantly inhibited the joint swelling, but not the mechanical allodynia, on day 7 in CAIA mice. The messenger RNA expression levels of TAC1 and TAC4 in the dorsal root ganglia and dorsal spinal cord were unaffected by treatment with WIN 51708. These findings suggest that tachykinins and NK1 receptors play a key role in joint inflammation, rather than in nociceptive sensitization, in CAIA.

Closed radial wedge osteotomy for Preiser's disease: a report of four cases.

PURPOSE: To investigate the clinical outcome of closed radial wedge osteotomy (CRWO) for Preiser's disease. METHODS: CRWO was performed for four patients with Preiser's disease between 2000 and 2005. All patients were diagnosed by X-ray and magnetic resonance imaging (MRI) scans. Separation gaps in the radioscaphoid joint were observed to evaluate the decompression in the area. Clinical evaluation was performed using Cooney's scoring system. RESULTS: Although wrist pain persisted in patients with radioscaphoid arthritis change, marked mitigation of wrist pain was confirmed in three patients. The average clinical score was 66, with good in one, fair in two, and poor in one. Restriction of wrist movement by CRWO caused lower clinical scores. No patients had wrist arthrodesis at the last follow-up evaluation. CONCLUSIONS: Short-term observation showed disappointing clinical results; however, for relief of wrist pain, this method is a potential surgical procedure for Preiser's disease under limited conditions.

Characteristics of the electrophysiological activity of muscles attached to the transverse carpal ligament in carpal tunnel syndrome.

The main cause of carpal tunnel syndrome (CTS) remains unknown. Stiffness of the subcutaneous area of the volar aspect of the carpal tunnel is present in many patients and suggests that the stiffness of muscles attached to the transverse carpal ligament is increased. We performed an electrophysiological study to investigate muscle activities and to clarify whether the stiffness of muscles attached to the transverse carpal ligament is involved in the pathogenesis of CTS. The subjects of this study included 16 patients with early CTS showing no motor dysfunction. Both thenar muscles (opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis) and hypothenar muscles (opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis) were investigated. Surface electrodes were placed on each muscle, and maximum voluntary contractions with the thumb and little finger in opposition were maintained for 3 seconds in all patients and in 7 control subjects. Electromyographs were subjected to fast Fourier transform analysis, and the root mean square (RMS) and the mean power frequency (MPF) were determined for each muscle. The RMS of the opponens pollicis was significantly less in hands affected by CTS (292.8 µV) than in healthy hands (405.9 µV). The RMS did not differ between affected hands and healthy hands for the other 2 thenar muscles but did differ significantly for the hypothenar muscles. The MPF did not differ between affected hands and healthy hands for any muscle. The results show that electrophysiological differences are present among muscles innervated by the median nerve and that hypothenar muscles originally unrelated to median nerve dysfunction are also affected in early CTS. These results suggest that modulation of muscles attached to the transverse carpal ligament is involved in the pathogenesis of CTS.

Electrophysiological and histological investigation on the gradual elongation of rabbit sciatic nerve.

A basic study using animal models was performed to investigate whether the sciatic nerve retains physiological functions and normal morphology after the gradual elongation associated with adjacent bone elongation. Electrophysiological and histological studies were performed on the elongated sciatic nerve of rabbit accompanied by the femur bone elongation. Compound action potentials evoked by electrical stimulation of the sciatic nerve were recorded and histological specimens of elongated nerve fibers were obtained immediately after final bone elongation from 4 rabbits (immediate group). Three rabbits were allowed to recover for 8 weeks after the bone elongation (maintained group). Three rabbits without bone elongation were used as controls of the immediate and maintained groups (control group). In the immediate group, the average amplitude of evoked nerve potentials were 30.38 ± 1.58 mV before elongation and diminished significantly to 18.35 ± 1.25 mV immediately after elongation (P<0.01). The amplitude of evoked potentials was not significantly different between before (30.30 ± 0.61 mV) elongation and after elongation (27.47 ± 1.63 mV) in the maintained group. The axonal area of the myelinated nerve fibers of the proximal region of the sciatic nerve in the immediate group was significantly decreased after elongation (P<0.01). The decrease in the area of the distal region was greatest in the control group and was followed by that in the maintained group and the immediate group (P<0.05, 0.01). These results suggest that the sciatic nerve shows dysfunction immediately after elongation, but can recover electrophysiologically and histologically several weeks after elongation.

Intra-articular administration of tachykinin NK1 receptor antagonists reduces hyperalgesia and cartilage destruction in the inflammatory joint in rats with adjuvant-induced arthritis.

Persistent pain associated with inflammatory arthritis is an aggravating factor that decreases patients' quality of life. Current therapies for joint pain have limited effectiveness and produce unwanted negative side effects. Although the involvement of substance P and its cognate tachykinin receptor, NK(1), in joint inflammation has been extensively documented through animal experiments, the development of oral tachykinin NK(1) receptor antagonists against arthritis-induced pain has been unsuccessful in humans to date. To explore the possibility of using tachykinin NK(1) receptor antagonists as local therapeutic agents for inflammatory arthritis, we examined the effects of tachykinin NK(1) receptor antagonists administered into the rat ankle joint on hyperalgesia in complete Freund's adjuvant (CFA)-induced inflammatory monoarthritis. Administration of the tachykinin NK(1) receptor antagonist WIN 51708 or GR 82334 into the affected ankle joint at day 3 following intra-articular CFA injection reduced the mechanical hyperalgesia 12 h after the tachykinin NK(1) receptor antagonist injection and their analgesic effects persisted for at least 2 days. Histological examinations revealed that intra-articular WIN 51708 reduced the CFA-induced destructive changes in the cartilage. These findings suggest that intra-articular injection of tachykinin NK(1) receptor antagonists is a promising strategy for relieving the hyperalgesia that occurs in inflammatory arthritis.

Autofluorescence assessment of extracellular matrices of a cartilage-like tissue construct using a fluorescent image analyser.

For the assessment of tissue-engineered cartilage, easy and precise evaluation methods are anticipated. We have investigated the use of a fluorescent image analyser and the application of fluorescence intensity measurements to describe and evaluate a tissue-engineered cartilage-like tissue construct. We evaluated the matrix production of a tissue-engineered cartilage-like tissue (TCL) construct in vitro using the image analyser. The autofluorescence intensity of the TCL construct was determined using the image analyser driven by a software program after 1, 2, 3 and 4 weeks of culture. The autofluorescence intensity of the TCL construct gradually increased with increasing culture time. However, there was very little change in the autofluorescence intensity of gels without articular chondrocytes as controls. The relationship between the autofluorescence intensity of the TCL construct and the hydroxyproline content, reflecting the collagen content, was investigated. There was a significant correlation between the two items. Our findings demonstrate the ability of a commercial fluorescent image analyser to evaluate the matrix production of the TCL construct in vitro on the basis of objective data, such as the autofluorescence intensity. Therefore, the image analyser can be used to judge the success or failure of the in vitro culture process of TCL construct without a biopsy. Copyright © 2010 John Wiley & Sons, Ltd.

Myositis ossificans of the supinator muscle causing posterior interosseous nerve palsy: a case report.

Some tumors or tumorous conditions causing posterior interosseous nerve palsy are well documented, but myositis ossificans causing the palsy of this nerve has not been described. We present a case of posterior interosseous nerve palsy caused by myositis ossificans of the supinator muscle.

Simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws.

We present a new method for treating a fracture of the hook of the hamate with a percutaneous screw using a dorsal approach. Through this small incision, the fracture may be fixed easily and safely while avoiding damage to the blood supply of the hamate and the surrounding soft tissue.

Recurrence of fibrous hamartoma of infancy excised 14 years after the primary surgery.

Fibrous hamartoma of infancy is a rare, benign, superficial soft-tissue mass. It usually occurs within the first 2 years of life at the axial regions, upper arms, and external genital areas. There have been some recurrences within the 1st year of the surgery, although no cases have been reported to recur after 1 year. The authors present a recurrent case of fibrous hamartoma of infancy 14 years after the primary surgery, and they show the clinical and histopathological findings.

Closing radial wedge osteotomy for Preiser's combined with Kienbock's disease: two case reports.

Avascular necrosis involving more than one carpal bone is rare, and the appropriate treatment for this condition has not yet been established. In this report, two patients with concomitant Preiser's and Kienböck's disease who also had severe wrist pain without obvious traumas were treated by closing radial wedge osteotomy (CRWO). Clinical evaluation showed that CRWO was effective against both conditions and indicated that it is more suitable for early stage than stage II diseases of the Hebert and Lichtman classifications.

Clinical usefulness of assessing lumbar somatosensory evoked potentials in lumbar spinal stenosis. Clinical article.

OBJECT: The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS). METHODS: The latencies of lumbar SSEPs were recorded in 40 patients with central LSS, including 16 men and 24 women. The mean age of the patients was 67.3 +/- 7.4 years. The diagnosis was LSS in 23 cases and LSS associated with degenerative spondylolisthesis in 17 cases. The average duration of symptoms was 43.8 +/- 51.2 months. Twenty-two cases had bilateral and 18 cases had unilateral leg symptoms. Thirty-seven cases were associated with neurogenic intermittent claudication and the mean walking distance of patients with this condition was 246.8 +/- 232.7 m. The mean Japanese Orthopedic Association scale score, as well as the visual analog scale (VAS) scores of low-back pain, leg pain, and numbness, were 16.5 +/- 3.5, 6.0 +/- 2.5, 6.9 +/- 2.1, and 7.8 +/- 2.2, respectively. The minimal cross-sectional area of the dural sac on MR imaging was 0.44 +/- 0.21 cm(2). Thirty-nine cases of cervical spondylotic myelopathy without lumbar and peripheral neuropathy were chosen as the control group. RESULTS: The latencies of lumbar SSEPs in patients with LSS and in the control group were 23.0 +/- 2.0 ms and 21.6 +/- 1.9 ms, respectively. There was a statistically significant difference between the LSS and control groups (p < 0.05). The latency of lumbar SSEPs was significant correlated with the VAS score of leg numbness (p < 0.05). The latency of lumbar SSEPs in LSS was clearly delayed when the VAS score of leg numbness was > or = 8 (p < 0.05). CONCLUSIONS: Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.

Clinical value of motor evoked potentials with transcranial magnetic stimulation in the assessment of lumbar spinal stenosis.

The objective of this study was to evaluate the clinical usefulness of assessing motor evoked potentials (MEP) in lumbar spinal stenosis (LSS). Twenty-three LSS patients were enrolled. The preoperative data of MEP latency (MEPLT), clinical symptoms, Japanese Orthopaedic Association (JOA) scores for low back pain, visual analogue scale (VAS) for back pain, leg pain and numbness, walking distance and the minimal cross-sectional area (mCSA) of the dural sac were evaluated. The mean MEPLT was 42.1 +/- 2.8 ms. Fourteen patients had bilateral leg symptoms. The mean walking distance and mCSA were 302.1 +/- 302.8 m and 0.4 +/- 0.2 cm(2), respectively. The mean JOA score and VAS scores for back pain, leg pain and numbness were 15.9 +/- 4.8, 6.0 +/- 2.9, 7.7 +/- 1.9 and 7.3 +/- 3.0, respectively. MEPLT was related to the walking distance, limb symptoms and the VAS for numbness. MEPLT was significantly delayed in patients who showed a walking distance less than 500 m. MEP is useful in LSS assessment. It can reflect the subjective severity of motor disturbance and predict the neurological deficit prior to appearance.

New mathematical approach for approximating the baseline of F-waves using spreadsheet software.

OBJECTIVE: The aim of this study was to see if curved baselines of F-waves could be mathematically approximated with universal spreadsheet software. METHODS: The subjects were 3 healthy persons and 3 patients with cervical myelopathy. Supramaximal electrical stimuli were applied 200 times to the median nerve at the wrist. Compound muscle action potentials (CMAPs) of the abductor pollicis brevis were recorded. To make polynomial approximation equations that represent latter part of the M-waves, records without F-waves were analyzed. RESULTS: There were 193 CMAPs without F-waves out of all 1,200 records. Polynomial equations were made for each record. Determinant coefficients for all the approximation equations were greater than 0.998, and the overall standard deviation of the difference between original data and approximated value was 3.05 microV. CONCLUSIONS: Curved baselines of F-waves were represented by approximation curves. Baselines of the F-waves could be approximated as flat lines by subtracting calculated values from the original data. SIGNIFICANCE: This method was useful for analyzing waveforms of F-waves.

[Diagnosis of musculoskeletal ambulation disability symptom complex (MADS)].

It was described to diagnosis of Musculoskeletal Ambulation Disability Symptom Complex (MADS). The definition of MADS is an person of advanced years with lower leveled balance and walking ability, high risk for fall, and who is keeping to the house. The diagnosis of MADS was decided to a history of 11 musculoskeletal disorders and evaluation of balanced and walking function. The determination method of time of one leg standing and 3 m timed timed up and go test were described.

Epidemiological study of low back pain and occupational risk factors among taxi drivers.

A survey of taxi drivers was conducted to determine the actual situation of drivers' low back pain (LBP). The survey was carried out in October 2002, the target drivers were asked to complete a questionnaire which contains questions regarding physique of drivers, demographic features, working conditions, office environment, health conditions, the presence of low back pain, the level of low back pain based on Visual Analogue Scale and Roland-Morris Disability Questionnaire score. As a result, the total number of valid responses was 1,334 and the response rate was 71 percent, and the 1-wk prevalence of LBP was 20.5 percent of respondents. Regarding 275 subjects with LBP, Visual Analogue Scale (VAS) averaged 4.3. There was a positive weak correlation between VAS and Roland-Morris Disability Questionnaire score (R=0.41). And Logistic regression analysis was performed to examine the relationship between LBP and occupational factors, the results suggested following items as risk factors; such as history of LBP, suffering from fatigue, diseases other than LBP and smoking habit.

Comparison of osteogenic ability of rat mesenchymal stem cells from bone marrow, periosteum, and adipose tissue.

Mesenchymal stem cells (MSCs) reside in many types of tissue and are able to differentiate into various functional cells including osteoblasts. Recently, adipose tissue-derived MSCs (AMSCs) have been shown to differentiate into many lineages, and they are considered a source for tissue regeneration. The purpose of this study was to compare the osteogenic differentiation capability of MSCs from bone marrow (BMSCs), MSCs from periosteum (PMSCs), and AMSCs using in vitro culture and in vivo implantation experiments. We harvested these MSCs from 7-week-old rats. The cells were seeded and cultured for 7 days in primary culture to assay a colony-forming unit. The frequency of the unit was the smallest in the BMSCs (P < 0.001). After primary culture, subculture was performed under osteogenic differentiation conditions for 1 and 2 weeks to detect mineralization as well as the bone-specific proteins of alkaline phosphatase and osteocalcin as osteogenic markers. BMSCs and PMSCs showed distinct osteogenic differentiation capability in comparison with other MSCs (P < 0.001). For the in vivo assay, composites of these cells and hydroxyapatite ceramics were subcutaneously implanted into syngeneic rats and harvested after 6 weeks. Micro-computed tomographic (CT) and histological analyses demonstrated that new bone formation was detected in the composites using BMSCs and PMSCs, although it was hard to detect in other composites. The CT analyses also demonstrated that the bone volume of BMSC composites was more than that of AMSC composites (P < 0.001). These results indicate that BMSCs and PMSCs could be ideal candidates for utilization in practical bone tissue regeneration.