Three-dimensional analysis of the characteristics of joint motion and gait pattern in a rodent model following spinal nerve ligation.

BACKGROUND: The spinal nerve ligation (SNL) rat is well known as the most common rodent model of neuropathic pain without motor deficit. Researchers have performed analyses using only the von Frey and thermal withdrawal tests to evaluate pain intensity in the rat experimental model. However, these test are completely different from the neurological examinations performed clinically. We think that several behavioral reactions must be observed following SNL because the patients with neuropathic pain usually have impaired coordination of the motions of the right-left limbs and right-left joint motion differences. In this study, we attempted to clarify the pain behavioral reactions in SNL rat model as in patients. We used the Kinema-Tracer system for 3D kinematics gait analysis to identify new characteristic parameters of each joint movement and gait pattern. RESULTS: The effect of SNL on mechanical allodynia was a 47 ± 6.1% decrease in the withdrawal threshold during 1-8 weeks post-operation. Sagittal trajectories of the hip, knee and ankle markers in SNL rats showed a large sagittal fluctuation of each joint while walking. Top minus bottom height of the left hip and knee that represents instability during walking was significantly larger in the SNL than sham rats. Both-foot contact time, which is one of the gait characteristics, was significantly longer in the SNL versus sham rats: 1.9 ± 0.15 s vs. 1.03 ± 0.15 s at 4 weeks post-operation (p = 0.003). We also examined the circular phase time to evaluate coordination of the right and left hind-limbs. The ratio of the right/left circular time was 1.0 ± 0.08 in the sham rats and 0.62 ± 0.15 in the SNL rats at 4 weeks post-operation. CONCLUSIONS: We revealed new quantitative parameters in an SNL rat model that are directly relevant to the neurological symptoms in patients with neuropathic pain, in whom the von Frey and thermal withdrawal tests are not used at all clinically. This new 3D analysis system can contribute to the analysis of pain intensity of SNL rats in detail similar to human patients' reactions following neuropathic pain.

Reproducibility of the modified Neer classification defining displacement with respect to the humeral head fragment for proximal humeral fractures.

BACKGROUND: Although the Neer classification is widely used for the assessment of proximal humeral fractures, its reproducibility has been challenged. The purpose of this study was to evaluate the reproducibility of the conventional Neer classification and a modified classification that defined fracture displacement with respect to the humeral head fragment. METHODS: The fracture patterns in 80 cases of proximal humeral fractures were independently assessed by 6 observers. The cases were grouped according to the conventional Neer classification using radiographs followed by computed tomography (CT) scans by each examiner twice with a 1-month interval. The fractures were then classified with the modified Neer classification, which defined displacement of the fragment as separation of more than 1 cm or angulation of more than 45° from the humeral head fragment, twice with a 1-month interval. Kappa coefficients of the conventional and modified Neer classifications were compared. RESULTS: The modified classification showed significantly higher intra-observer agreement than the conventional classification, both for radiographs (P = .028) and for CT scans (P = .043). Intra-observer agreement was also significantly higher for the modified classification than for the conventional classification, both for radiographs (P = .001) and for CT scans (P < .001). CONCLUSIONS: The present study showed that agreement for the Neer classification could be improved when fracture displacement was defined as separation or angulation from the humeral head. Considering vascularity to the humeral head, furthermore, the modified method might be more helpful for predicting patients' prognosis than the conventional Neer classification.

Cerclage Wiring Fixation for the Treatment of Long Oblique Fractures of the Distal Clavicle: A Report of 2 Cases.

CASE: A 49-year-old man and a 37-year-old man with long oblique fractures of the distal clavicle were successfully treated with cerclage wiring fixation without detachment of the trapezius and deltoid muscles and exposure of the fracture site. CONCLUSIONS: Long oblique fractures with the acromioclavicular and coracoclavicular ligaments being intact and attached to the distal fragment are relatively rare among distal clavicle fractures. Cerclage wiring fixation is a viable treatment option for the fixation of long oblique fractures of the distal clavicle, with good clinical results and rapid recovery of shoulder function.

The effects of toe grip training on physical performance and cognitive function of nursing home residents.

BACKGROUND: Toe grip-related training requires individuals to actively exercise muscles that are not frequently used; therefore, it may improve not only toe grip strength but also cognitive function. The purpose of this study was to examine the effects of toe grip-related training on predictors of physical performance and cognitive function in nursing home residents. METHODS: A total of 35 nursing home residents (35 left and 35 right feet; mean age, 82.1 ± 7.9 years) were included in this study. The participants were divided into two groups: a training group and a control group. The Mini-Mental State Examination (MMSE) was used to assess the cognitive function of the participants, and the Fall Risk Index (FRI) was used to evaluate the risk of falls. Toe grip-related physical function was also assessed. Baseline endpoints were evaluated and the effects of toe grip-related training were examined following a 12-week training intervention. RESULTS: The training group showed significant improvements in MMSE score, FRI score, toe grip strength, and the toe skill (TS) test; however, the control group did not show these changes. The training group showed significant increases in Δ MMSE, Δ toe grip strength, and Δ TS (right foot) than the control group. Stepwise regression analysis revealed that Δ toe grip strength is an independent factor of Δ MMSE. CONCLUSIONS: Toe grip training improves not only toe grip strength itself, but also cognitive function. Furthermore, change in toe grip strength was an independent factor of change in MMSE in those populations. TRIAL REGISTRATION: UMIN, UMIN000027437 . Registered on 26 May 2017.

Toe grip strength in middle-aged individuals as a risk factor for falls.

BACKGROUND: Toe grip strength is the force of a toe on a surface. The objective of this study was to investigate the relationship between falls in middle-aged individuals and physical strength factors such as toe grip strength and knee extension strength. METHODS: The subjects were 194 middle-aged individuals (388 feet) who were independent in daily life, received no nursing care, and participated in a health sports event organized by a sports club. We evaluated the body composition, blood pressure, vascular age, systemic response, bone density, knee extension strength, and toe grip strength, and examined their relationship using a self-administered questionnaire survey. RESULTS: The fall, near-fall, and no fall groups included 7, 36, and 151 subjects, respectively; the high and low risk groups included 43 and 151 subjects, respectively. Logistic regression analysis was performed with risk of falls as the dependent variable, and factors that showed a significant difference in the comparison of the high and low risk groups as independent variables. In this analysis, toe grip strength and diastolic blood pressure were identified as independent risk factors for a fall. CONCLUSIONS: Toe grip strength is an independent risk factor for falls, and improvement of toe grip strength might prevent falls.

High-sensitivity cardiac troponin I detection for 2 types of drug-induced cardiotoxicity in patients with breast cancer.

BACKGROUND: Breast cancer treatment with trastuzumab, a monoclonal antibody that targets human epidermal growth factor receptor type 2 (HER2), has largely been successful in improving the prognosis of HER2-positive disease. However, a critical issue associated with trastuzumab treatment is its cardiotoxic adverse effects, including cardiac insufficiency. METHODS: We measured levels of cardiac troponin I, a marker of myocardial damage, with a highly sensitive method (hs-cTnI) using a fully automated chemiluminescent immunoassay system (ADVIA Centaur(®) XP) in breast cancer patients and examined the relationship between administration of trastuzumab and epirubicin and concentrations of hs-cTnI. RESULTS: The coefficient of variation for within-run repeatability was 1.34-5.93 %, using plasma pools and controls of 3 concentrations, and that for between-run reproducibility was 3.99-8.79 %, indicating high precision of the assay. In a dilutional linearity test with highly concentrated specimens, hs-cTnI values could be measured up to 50 ng/mL with linearity. No influence from coexisting substances was observed. The concentration of hs-cTnI was at or above the reference range (0.04 ng/mL) in 9 of 214 total breast cancer cases (4.2 %). The hs-cTnI concentration was at or above the reference range in 4 of 49 cases (8.2 %) that were administered trastuzumab, and in 5 of 165 cases (3.0 %) that were not. Trastuzumab did not cause elevation of hs-cTnI when not administered in combination with epirubicin. CONCLUSIONS: These results suggest that epirubicin and trastuzumab cause cardiotoxicity through different mechanisms. Epirubicin can cause myocardial necrosis, while trastuzumab can cause cardiomyopathy without myocardial necrosis.

A comparative clinical evaluation of the assay of serum extracellular domain of HER2 protein using a chemiluminescent immunoassay method in breast cancer patients with or without HER2 protein expression in immunohistochemistry.

OBJECTIVE: The human epidermal growth factor receptor type 2 (HER2) protein has been used as a biomarker for breast cancer. A new method based on chemiluminescent immunoassay for measuring the serum levels of the extracellular domain of HER2 protein (sHER2-ECD) has been developed. Its clinical usefulness has not been clearly established. We studied the clinical usefulness of sHER2-ECD in monitoring breast cancer patients. METHODS: We examined the clinical effectiveness of sHER2-ECD using the ADVIA Centaur XP System in comparison with conventional tumor markers (CA15-3 and CEA) in 148 patients with breast cancer with or without trastuzumab treatment. RESULTS: The positive rate for sHER2-ECD, CA15-3, and CEA in trastuzumab patients (36) was 25.0%, 19.4%, and 16.7%, and that in non-trastuzumab patients (112) was 20.5%, 22.3%, and 22.3%, respectively. Twenty-three out of 112(20.5%) non-trastuzumab patients were found positive for sHER2-ECD in spite of the negative IHC. Measurement of sHER2-ECD and CA15-3 showed no difference in the expression profile among different clinical stages. During long-term observation in patients negative for HER2 protein by immunohistochemistry, sHER2-ECD was found to be a relatively sensitive indicator of metastasis to distant organs, such as liver and bone, as compared with CA15-3. CONCLUSION: sHER2-ECD testing may be a useful tumor marker for monitoring breast cancer patients, even in those with negative IHC for the HER2 protein.

Shelf syndrome of the knee in elderly people: a report of three cases.

Shelf syndrome occurs mainly in younger people (particularly athletes) and rarely in elderly people. We report on 3 elderly patients with a medial synovial plica causing severe pain and locked knees. They had had no symptoms in their early or middle life. After removal of the shelf, the symptoms improved considerably. Although shelf syndrome is rare in the elderly, it should be suspected whenever severe pain and a locked knee are present.