Language：English   Publishing type：Research paper (scientific journal)  

The functional role of the biceps femoris short head (BFsh) remains unclear. Clarifying the functional role of each biceps femoris head may provide useful insights into the reduction of biceps femoris long head (BFlh) injuries. This study aimed to clarify whether the passive tension in the BFlh would change with BFsh detachment using cadavers. The shear modulus of the BFlh and BFsh was measured using ultrasonic shear wave elastography as an index of passive tension in three tissue processing conditions (intact, removal of all tissues from skin to deep fascia, and BFsh detachment) in four limb positions, with hip [H0°, H90°] and knee [K0°, K90°] joint angles under each tissue processing condition. The measurement site was the distal 30 % of the line connecting the sciatic tuberosity (100 %) and fibular head (0 %). Three-way analysis of variance was conducted with muscles, tissue processing, and positions as factors, which revealed a significant interaction (P < 0.01). The post-test results indicated that the BFlh was significantly higher than the BFsh at H90° and K0° before tissue processing; however, no difference was observed between the muscles after skin and deep fascia removal. After BFsh detachment, the shear modulus of the BFsh decreased, whereas that of the BFlh significantly increased (P < 0.01), suggesting that the BFsh might be involved in the passive tension reduction of the BFlh in a lengthened position, as the shear modulus of the BFlh increased after detachment.

DOI： 10.1016/j.jbiomech.2024.112480

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study aimed to investigate intramuscular regional differences and task specificity of rectus femoris (RF) elasticity during isometric contraction. METHODS: Sixteen healthy males (aged 24.3 ± 4.1 years) participated in this study. The tasks included isometric hip flexion (HF) and knee extension (KE). The contractions were maintained at 0%, 30%, and 60% of their respective maximum voluntary isometric contraction (MVC) forces for 5 s each at 50˚ hip flexion and 90˚ knee flexion. RF elasticity was measured in two regions, proximal (33%) and distal (67%). The shear modulus (kPa), measured by shear wave elastography, was used to determine RF elasticity. RESULTS: A significant interaction effect was observed (intensity × region × task) (P = 0.01). Regarding regional differences during contraction, the proximal region exhibited a greater shear modulus than the distal region at 60% MVC in the hip flexion task (P = 0.001). Conversely, no regional differences were observed at either 30% MVC (P = 0.625) or 60% MVC (P = 0.568) in the knee extension task. DISCUSSION: Muscle shear modulus during contraction reflects active force, suggesting that mechanical stress can be applied primarily to the proximal region of the RF during the HF task.

DOI： 10.1016/j.jelekin.2024.102967

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jseint.2024.08.190

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study used ultrasound shear wave elastography (SWE) to evaluate the mechanical properties of hamstring muscles from cadaveric specimens with knee flexion contractures. METHODS: Hamstring muscles for tensile testing were harvested from Thiel soft-embalmed cadavers with and without knee flexion contracture. Muscle specimens were mounted on a testing machine. The initial load detected when a tensile load was applied to the distal end was used as the slack length. The cross-sectional areas of the muscle at slack length were measured at the proximal and distal sites using B-mode ultrasonography. Subsequently, the muscle specimen was elongated from the slack length to 8% strain, with the shear modulus measured using SWE. Young's modulus (stress/strain) was calculated based on the displacement and tensile force obtained from the tensile test. RESULTS: Regression analysis showed a significant positive linear relationship between the Young's and shear moduli for all specimens at all the sites (P < 0.01 and coefficient of determination: 0.95-0.99). The Young's and average shear moduli at the proximal and distal sites were higher in all hamstring muscles with contractures than in those without contractures. CONCLUSIONS: SWE can be used to estimate Young's moduli of hamstring muscles with contractures. Muscle specimens with contractures exhibited higher resistance to elongation, thereby indicating that their mechanical properties differed from those of muscles without contractures.

DOI： 10.7759/cureus.68343

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Abstract

Aims

The adverse effects of low daily protein intake (DPI) on clinical outcomes in patients with heart failure (HF) are known; however, an optimal DPI to predict event adverse outcomes remains undetermined. Moreover, whether protein restriction therapy for chronic kidney disease is applicable in patients with HF and renal dysfunction remains unclear.

Methods and results

In this single‐centre, ambispective cohort study, we included 405 patients with HF aged ≥65 years (mean age, 78.6 ± 7.5 years; 50% women). DPI was estimated from consumption over three consecutive days before discharge and normalized relative to the ideal body weight [IBW, 22 kg/m² × height (m)²]. The primary outcome was a composite of all‐cause mortality and HF‐related readmission within the 2 year post‐discharge period.

Results

During an average follow‐up period of 1.49 ± 0.74 years, 100 patients experienced composite events. Kaplan–Meier survival curves revealed a significantly lower composite event‐free rate in patients within the lowest quartile of DPI than in the upper quartiles (log‐rank test, P = 0.02). A multivariate Cox proportional hazards analysis after adjusting for established prognostic markers and non‐proteogenic energy intake revealed that patients in the lowest DPI quartile faced a two‐fold higher risk of composite events than those in the highest quartile [hazard ratio (HR), 2.03; 95% confidence interval (CI), 1.08–3.82; P = 0.03]. The composite event risk linearly increased as DPI decreased (P for nonlinearity = 0.90), with each standard deviation (0.26 g/kg IBW/day) decrease in DPI associated with a 32% increase in composite event risk (HR, 1.32; 95% CI, 1.10–1.71; P = 0.04). There was significant heterogeneity in the effect of DPI, with the possible disadvantage of lower DPI in patients with HF with cystatin C‐based estimated glomerular filtration rate &lt;30 mL/min/1.73 m². The cutoff value of DPI for predicting the occurrence of composite events calculated from the Youden index was 1.12 g/kg IBW/day. Incorporating a DPI &lt; 1.12 g/kg IBW/day into the baseline model significantly improved the prediction of post‐discharge composite events (continuous net reclassification improvement, 0.294; 95% CI, 0.072–0.516; P = 0.01).

Conclusions

Lower DPI during hospitalization is associated with an increased risk of mortality and HF readmission independent of non‐proteogenic energy intake, and the possible optimal DPI for predicting adverse clinical outcomes is &gt;1.12 g/kg IBW/day in older patients with HF. Caution is warranted when protein restriction therapy is administered to older patients with HF and renal dysfunction.

DOI： 10.1002/ehf2.14812

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jmbbm.2024.106473

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DOI： 10.1007/s10396-024-01436-w

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Exercise-induced increases in shear rate (SR) acutely improve peripheral endothelial function, but the presence of this mechanism in cerebral arteries remains unclear. Thus, we evaluated shear-mediated dilation of the internal carotid artery (ICA), which is an index of cerebrovascular endothelial function, before and after exercise. Shear-mediated dilation was measured with 30 s of hypercapnia in 16 young adults before and 10 min after 30 min of sitting rest (CON) or three cycling exercises on four separate days. The target exercise intensity was 80% of oxygen uptake at the ventilatory threshold. To manipulate the ICA SR during exercise, participants breathed spontaneously (ExSB, SR increase) or hyperventilated without (ExHV, no increase in SR) or with ([Formula: see text], restoration of SR increase) addition of CO2 to inspiratory air. Shear-mediated dilation was calculated as a percent increase in diameter from baseline. Doppler ultrasound measures ICA velocity and diameter. The CON trial revealed that 30 min of sitting did not alter shear-mediated dilation (4.34 ± 1.37% to 3.44 ± 1.23%, P = 0.052). ICA dilation after exercise compared with preexercise levels increased in the ExSB trial (3.32 ± 1.37% to 4.74 ± 1.84%, P < 0.01), remained unchanged in the ExHV trial (4.07 ± 1.55% to 3.21 ± 1.48%, P = 0.07), but was elevated in the [Formula: see text] trial (3.35 ± 1.15% to 4.33 ± 2.12%, P = 0.04). Our results indicate that exercise-induced increases in cerebral shear may play a crucial role in improving cerebrovascular endothelial function after acute exercise in young adults.NEW & NOTEWORTHY We found that 30-min cycling (target intensity was 80% of the ventilatory threshold) with increasing shear of the internal carotid artery (ICA) enhanced transient hypercapnia-induced shear-mediated dilation of the ICA, reflecting improved cerebrovascular endothelial function. This enhancement of ICA dilation was diminished by suppressing the exercise-induced increase in ICA shear via hyperventilation. Our results indicate that increases in cerebral shear may be a key stimulus for improving cerebrovascular endothelial function after exercise in young adults.

DOI： 10.1152/japplphysiol.00543.2023

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.numecd.2023.10.003

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Other Link： https://link.springer.com/article/10.1007/s00380-023-02308-y/fulltext.html

DOI： 10.1007/s00380-023-02308-y

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Aim

Osteoporosis is prevalent and is associated with poor prognosis in heart failure (HF) patients. However, bone mineral density (BMD) measurement by a dual-energy X-ray absorptiometry (DEXA) scan is not always available in a daily clinical setting and large-scale population-based studies.

Methods

A single-center, cross-sectional observational study was conducted with 387 patients (median age: 77 years [interquartile range: 68 to 83 years]; 37% women). BMDs were measured by DEXA scans, and osteoporosis was diagnosed as ≤ -2.5 standard deviation of the BMDs in healthy young adults. Osteoporosis risk assessment score (ORAS) was developed using significant predictors from a logistic regression model for osteoporosis and was subsequently validated.

Results

Osteoporosis was found in 103 (27%) of the 387 HF patients. Multivariate logistic regression analyses yielded the ORAS based on sex, BMI, handgrip strength, and anti-coagulant therapy utilization. The C-index of ORAS in the developmental set (0.796, 95% confidence interval: 0.747 to 0.845) was similar to the bootstrap validation of the prediction model (0.784), and tended to be higher than that of the Osteoporosis Self-Assessment Tool for Asians (OSTA). A nomogram of ORAS, established on the basis of the final logistic regression model, demonstrated 100% sensitivity at the lowest score (35 points), with an optimal cutoff point of 127 points, yielding 85% sensitivity and 62% specificity.

Conclusions

ORAS exhibits superior predictive performance to OSTA in predicting osteoporosis in HF patients, establishing itself as a valuable tool for early detection in both daily clinical practice and large-scale population-based studies.

DOI： 10.1093/eurjcn/zvad089

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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PURPOSE: Postprandial hyperglycemia is assumed to have a negative impact on flow-mediated dilation (FMD), an index of endothelial function, and blood flow of the peripheral conduit arteries. This study aimed to determine whether the enhancement of postprandial hyperglycemia by skipping breakfast accelerates endothelial dysfunction and reduces the blood flow in the brachial artery in young men. METHODS: Using a randomized cross-over design, ten healthy men completed two trials: with and without breakfast (Eating and Fasting trials, respectively). Venous blood sampling and brachial FMD tests were conducted before, 30, 60, 90, and 120 min after a 75-g oral glucose tolerance test (OGTT). RESULTS: Skipping breakfast boosted post-OGTT glucose levels than having breakfast (P = 0.01). The magnitude of the decrease in FMD via OGTT did not vary between trials (main effect of trial P = 0.55). Although brachial blood flow tended to decrease after OGTT in both trials (interaction and main effect of time P = 0.61 and P = 0.054, respectively), the decrease in blood flow following OGTT was greater in the Fasting trial than in the Eating trial (main effect of trial, mean difference =  - 15.8 mL/min [95%CI =  - 25.6 to - 6.0 mL/min], P < 0.01). CONCLUSION: Skipping breakfast did not enhance the magnitude of the decrease in FMD following glucose loading, but did accelerate hyperglycemia-induced reduction in brachial blood flow. Current findings suggest that even missing one breakfast has negative impacts on the blood flow regulation of the peripheral conduit arteries in young men who habitually eat breakfast.

DOI： 10.1007/s00421-023-05273-6

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Publishing type：Research paper (scientific journal)   Publisher：Japanese Circulation Society  

DOI： 10.1253/circrep.cr-23-0049

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Language：English   Publishing type：Research paper (scientific journal)  

The present study aims to assess the effect of the hip flexion angle on the shear modulus of the adductor longus (AL) muscle associated with passive hip abduction and rotation. Sixteen men participated in the study. For the hip abduction task, the hip flexion angles used were - 20, 0, 20, 40, 60, and 80°, and the hip abduction angles were 0, 10, 20, 30, and 40°. For the hip rotation task, the hip flexion angles used were - 20, 0, 20, 40, 60, and 80°, hip abduction angles were 0 and 40°, and hip rotation angles were 20° internal rotation, 0° rotation, and 20° external rotation. The shear modulus at 20° extension was significantly higher than that at 80° flexion for the 10, 20, 30 and 40° hip abduction (i.e., P < 0.05). The shear modulus at 20° internal rotation and 20° extension was significantly higher than that at 0° rotation and 20° external rotation, regardless of the hip abduction angle (i.e., P < 0.05). The mechanical stress of the AL muscle associated with hip abduction was higher in the extended position. Furthermore, the mechanical stress could increase with internal rotation only at the hip-extended position.

DOI： 10.1038/s41598-023-36698-w

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PURPOSE: Assessing muscle flexibility and architecture is important for hamstring strain injury (HSI) prevention. We investigated the relationship between shear modulus and passive force in hamstring muscles at different sites and the effect of muscle architecture on the slope of the shear modulus-passive force using shear wave elastography (SWE). METHODS: The biceps femoris long head (BFlh), semitendinosus (ST), and semimembranosus (SM) muscles were dissected from nine Thiel-embalmed cadavers and fixed to a custom-made mechanical testing machine. Calibrated weights (0-1800 g) were applied gradually in 150-g increments. The shear modulus and anatomical cross-sectional area (ACSA) were measured at proximal, central, and distal points using SWE. The muscle mass and length were measured before the loading test. The shear modulus-passive load relationship of each tested muscle region was analyzed by fitting a least-squares regression line. The increase in shear modulus slope per unit load was calculated and compared between the muscles before and after normalization by the muscle mass, length, and ACSA. RESULTS: The shear modulus and passive force for all hamstring muscles in each region showed a statistically significant linear correlation. Furthermore, the increase in shear modulus slope was greater for BFlh and ST than for SM (P < 0.05), but after normalization by the muscle length and ACSA, there were no significant differences among the muscles. CONCLUSION: The local mechanical properties of individual hamstring muscles can be indirectly estimated using SWE, and the slope of increase in shear modulus reflects characteristics of the muscle architecture.

DOI： 10.1007/s10396-023-01317-8

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Language：Japanese   Publisher：産業開発機構(株)  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The present study aimed to clarify the morphological patterns of the calcaneus and talus that are associated with hallux valgus angle (HVA) by quantifying the differences in the hindfoot bone morphology between left and right sides in HV patients with clear bilateral difference of HVA. METHODS: Three-dimensional (3D) computed tomography scans of 32 feet of 16 patients with HV who had right-to-left HVA differences of more than 5 degrees (68.8 ± 8.6 years) were enrolled, and 3D surface models of the calcaneus and talus were generated. A total of 556 and 430 landmarks were placed on the calcaneal and talar surfaces, respectively, to calculate the principal components (PCs) of shape variations. The PC scores were compared between the small and large HVA sides within an individual. RESULTS: The calcaneus in patients with a larger HVA (mean, 43.2 degrees) possessed slender calcaneal tuberosity, more medially oriented posterior articular surface in the coronal plane, and narrower and more concave anterior-middle articular surfaces compared to those with a small HVA (mean, 33.7 degrees). The talus with a larger HVA exhibited more medially oriented talar head in the transverse plane and more anteriorly protruded lateral region of the talar head compared to the small HVA. CONCLUSIONS: The morphological patterns of the calcaneus in patients with a larger HVA allows the hindfoot bones to easily rotate in the everting direction, while those of the talus could induce a larger internal rotation of the first metatarsal. These morphological patterns of the calcaneus and talus could be structural factors affecting the HV.

DOI： 10.1016/j.aanat.2023.152053

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Intramuscular heterogeneity exists in the shear modulus of the rectus femoris (RF) muscle. However, the underlying heterogeneity mechanisms are not entirely understood. Previous research has reported that detachment of superficial tissues reduces the shear modulus by 50%. The aim of this study was to examine the effects of the skin, deep fascia, and intermuscular connections on the shear modulus of the RF at multiple sites. MATERIALS AND METHODS: Eleven donors were fixed using the Thiel method. Measurements were performed at 0°, 60°, and 120° knee flexion in a neutral hip position. Tissue processing was performed under four conditions: superficial tissue (CONT), skin off (SKIN), deep fascia detachment (FASC), and intermuscular connections detachment (ALL). The shear modulus at the proximal, central, and distal regions were measured using ultrasound shear wave elastography. The study was approved by the Sapporo Medical University Ethical Committee. RESULTS: Three-way ANOVA revealed no significant interaction between treatment, site, and angle (P = 0.156), treatment and angle (P = 0.067), or site and angle (P = 0.441). There was a significant effect of treatment (P < 0.001), site (P = 0.010), and angle (P < 0.001) and interaction between treatment and site (P < 0.001). The proximal shear modulus was greater than the central for CONT. There were no significant differences between the measurement sites for SKIN. The distal shear modulus was greater than the proximal for FASC. The distal shear modulus was also greater than the proximal and central for ALL. CONCLUSIONS: Intramuscular regional differences that influence superficial tissue and intermuscular connections of RF elasticity heterogeneity were observed.

DOI： 10.1007/s40477-022-00769-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Frontiers Media SA  

Aims

Although the impact of physical frailty on prognosis and the effect of cardiac rehabilitation in HF patients has been well established, data for the prognostic impact of social frailty (SF) in HF patients are limited. In addition, the relative importance of each SF domain in clinical outcomes remains unclear. We aimed to get a new insight into the associations of SF with clinical outcomes in elderly hospitalized HF patients.

Methods

A single-center, retrospective cohort study was conducted using data from 310 in-hospital HF patients aged ≥ 65 years (mean age of 78 ± 8 years; 49% women). Makizako’s five questions, a self-reported questionnaire, were used to define SF. The primary outcome was composite events defined by all-cause death and cardiovascular events.

Results

Of the 310 elderly HF patients, 188 patients (61%) had SF. Seventy-five patients (24%) had composite events during a mean follow-up period of 1.93 ± 0.91 years. Kaplan-Meier curves showed that patients with SF had a significantly higher composite event rate than patients without SF. In multivariate Cox regression analyses, SF was independently associated with a higher composite event rate after adjusting for prognostic markers [adjusted hazard ratio (HR), 2.01; 95% confidence interval (CI), 1.07–3.78; p = 0.04]. Of the 5 questions for defining SF, an answer of yes to the question about not feeling helpful toward friends or family, which indicates loss of perceived social role, was an independent predictor of composite events (adjusted HR, 2.28; 95% CI, 1.36–3.82; p &amp;lt; 0.01). Inclusion of loss of perceived social role into the baseline prognostic model improved both the continuous net reclassification improvement (0.562; 95% CI, 0.298–0.827; p &amp;lt; 0.01) and integrated discrimination improvement (0.031; 95% CI, 0.006–0.056; p = 0.02).

Conclusion

Loss of perceived social role is associated with increased adverse event risk and provides additive prognostic information in elderly HF patients.

DOI： 10.3389/fcvm.2022.1051570

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Aims

The mechanism by which a sodium-glucose cotransporter inhibitor (SGLT2i) induces favorable effects on diabetes and cardiovascular diseases including heart failure (HF) remains poorly understood. Metabolomics including amino acid profiling enables detection of alterations in whole body metabolism. The aim of this study was to determine whether plasma amino acid profiles are modulated by SGLT2i use in HF patients with type 2 diabetes mellitus (T2DM).

Methods

We retrospectively examined 81 HF patients with T2DM (68 ± 11 years old; 78% male). Plasma amino acid concentrations in a fasting state after stabilization of HF were determined using ultraperformance liquid chromatography. To minimize potential selection bias in the retrospective analyses, the differences in baseline characteristics between patients receiving an SGLT2i and patients not receiving an SGLT2i were controlled by using an inverse probability of treatment weighting (IPTW)-adjusted analysis.

Results

Of amino acids measurable in the present assay, plasma β-aminoisobutyric acid (BAIBA), an exercise-induced myokine-like molecule also known as 3-aminoisobutyric acid or 3-amino-2-methyproponic acid, was detected in 77% of all patients and the proportion of patients in whom plasma BAIBA was detected was significantly higher in patients receiving an SGLT2i than in patients not receiving an SGLT2i (93% vs. 67%, p = 0.01). Analyses in patients in whom plasma BAIBA was detected showed that plasma BAIBA concentration was significantly higher in patients receiving an SGLT2i than in patients not receiving an SGLT2i (6.76 ± 4.72 vs. 4.56 ± 2.93 nmol/ml, p = 0.03). In multivariate logistic regression analyses that were adjusted for age and sex, SGLT2i use was independently associated with BAIBA detection. The independent association between BAIBA and SGLT2i use remained after inclusion of body mass index, HF with reduced ejection fraction, ischemic etiology, renal function, NT-proBNP, albumin, hemoglobin, and HbA1c into the Cox proportional hazards model. When the differences in baseline characteristics between patients receiving an SGLT2i and patients not receiving an SGLT2i were controlled by using an IPTW-adjusted analysis, least squares mean of plasma BAIBA concentration was significantly higher in patients receiving an SGLT2i than in patients not receiving an SGLT2i.

Conclusion

SGLT2i use is closely associated with increased circulating BAIBA concentration in HF patients with T2DM.

Other Link： https://link.springer.com/article/10.1186/s12933-022-01727-x/fulltext.html

DOI： 10.1186/s12933-022-01727-x

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Excessive arterial pressure elevation induced by resistance exercise (RE) attenuates peripheral vasodilatory function, but its effect on cerebrovascular function is unknown. We aimed to evaluate the effect of different pressor responses to RE on hypercapnia-induced vasodilation of the internal carotid artery (ICA), an index of cerebrovascular function. To manipulate pressor responses to RE, 15 healthy young adults (11M/4F) performed two RE: high intensity with low repetitions (HL) and low intensity with high repetitions (LH) dynamic knee extension. ICA dilation, induced by 3 min of hypercapnia, was measured before and 10 min after RE using Doppler ultrasound. HL exercise elicited a greater pressor response than LH exercise. In relaxation phases of RE, ICA blood velocity increased in both HL and LH trials. However, ICA shear rate did not significantly increase in either trial (P = 0.06). Consequently, neither exercise altered post-exercise hypercapnia-induced ICA dilation (HL, 3.9 ± 1.9% to 5.1 ± 1.7%; LH, 4.6 ± 1.4% to 4.8 ± 1.8%; P > 0.05 for all). When viewed individually, the changes in ICA shear rate were positively correlated with changes in end-tidal partial pressure of carbon dioxide (PETCO2) (r = 0.46, P < 0.01) than with mean arterial pressure (r = 0.32, P = 0.02). These findings suggest that the effects of RE-induced pressor response on cerebrovascular function may be different from peripheral arteries. An increase in PETCO2 during the relaxation phase may play a more crucial role than elevated pressure in increasing cerebral shear during dynamic RE.

DOI： 10.1007/s00421-022-05096-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

AIMS: Reduction in appendicular skeletal muscle mass index (ASMI) assessed by dual-energy X-ray absorptiometry (DEXA) has been shown to be independently associated with a higher mortality rate in patients with heart failure (HF). However, DEXA is not suitable for measurement of muscle mass in a daily clinical setting and in large population-based studies. The aim of this study was to determine whether ASMI predicted from anthropometric indicators (predicted ASMI) serves as an alternative to DEXA-measured ASMI for predicting all-cause death in HF patients. METHODS AND RESULTS: Data for 539 HF patients who received a DEXA scan and measurements of calf circumferences (CC) and mid-arm circumferences (MAC) in our hospital were analysed. Predicted ASMI was calculated as we previously reported: predicted ASMI (kg/m2 ) = [0.214 × weight (kg) + 0.217 × CC (cm) - 0.189 × MAC (cm) + 1.098 (male = 1, female = -1) + 0.576]/height2 (m2 ). Low ASMI values were defined as <7.00 kg/m2 and <5.40 kg/m2 for men and women, respectively, according to the criteria of the Asian Working Group for Sarcopenia. The median follow-up period was 1.75 years (interquartile range, 0.96-2.37 years), and 79 patients (15%) died. Kaplan-Meier survival curves showed that patients with low DEXA-measured ASMI and patients with low predicted ASMI had significantly lower survival rates than those for patients with high ASMI. In multivariate Cox proportional hazard analyses adjusted for age, sex, logarithmic B-type natriuretic peptide, cystatin C based-estimated glomerular filtration rate, and gait speed, DEXA-measured ASMI [hazard ratio (HR), 0.982; 95% confidence interval (CI), 0.967-0.998; P = 0.026] and predicted ASMI (HR, 0.979; 95% CI, 0.962-0.996; P = 0.018) were independent predictors of all-cause mortality. Inclusion of predicted ASMI into the adjustment model significantly improved continuous net reclassification improvement (0.338; 95% CI, 0.103-0.572; P < 0.01) and integrated discrimination improvement (0.020; 95% CI, 0.004-0.035; P < 0.05) for predicting mortality after discharge. CONCLUSIONS: Predicted ASMI, as well as DEXA-measured ASMI, can predict all-cause death in HF patients, and calculation of predicted ASMI will be useful for detecting high-risk patients in a daily clinical setting and in large population-based studies.

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ehf2.14121

DOI： 10.1002/ehf2.14121

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

PURPOSE: The purpose of this study was to examine the effect of subcutaneous adipose tissue (SCAT) thickness and rectus femoris (RF) muscle thickness on RF and vastus intermedius (VI) echo intensity using human cadavers. METHODS: The echo intensity of the RF and VI was measured in 11 legs of seven cadavers under three conditions: intact condition (Model 1), SCAT removed (Model 2), and SCAT and RF removed (Model 3). RESULTS: RF echo intensity in Model 1 (69.2 ± 20.3 a.u.) was significantly lower than that in Model 2 (83.4 ± 15.9 a.u.) (P = 0.003). VI echo intensity in Models 1 to 3 showed similar results to RF echo intensity (P = 0.003 to 0.001). Regarding the relationship between VI echo intensity and VI muscle thickness, the regression lines shifted upward in a parallel fashion in the order Model 1, Model 2, and Model 3. Multiple regression analysis revealed that the variation in RF echo intensity was explained by RF muscle thickness (P = 0.036) and SCAT thickness (P = 0.001), while the variation in VI echo intensity was explained by RF muscle thickness (P = 0.035). CONCLUSION: These results suggest that SCAT thickness and RF muscle thickness induce lower RF echo intensity, while RF muscle thickness induces lower VI echo intensity.

Other Link： https://link.springer.com/article/10.1007/s40477-022-00696-x/fulltext.html

DOI： 10.1007/s40477-022-00696-x

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J03582&link_issn=&doc_id=20221017460004&doc_link_id=2020%2Ffiles%2F30-3%2F569-571&url=https%3A%2F%2Fwww.rinspo.jp%2Fjournal%2F2020%2Ffiles%2F30-3%2F569-571.pdf&type=%E6%97%A5%E6%9C%AC%E8%87%A8%E5%BA%8A%E3%82%B9%E3%83%9D%E3%83%BC%E3%83%84%E5%8C%BB%E5%AD%A6%E4%BC%9A%E8%AA%8C&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00032_3.gif

Ichushi

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BACKGROUND: A baseball pitcher with decreased scapular control may not be able to achieve suitable scapular motion at maximum shoulder external rotation (MER) of baseball pitching during the pitching action. It is common clinically to compare scapular control of the throwing and non-throwing arms to detect side-to-side differences. However, it remains unclear whether scapular control is different between the throwing and non-throwing arms. Moreover, no data exist on the relationship between scapular control and scapular motion at MER of pitching. Primarily, this study aimed to compare scapular control during isometric shoulder flexion between the throwing and non-throwing arms. Secondly, this study aimed to investigate the relationship between scapular control during isometric shoulder flexion and scapular motion at MER of pitching. METHODS: Fifteen healthy collegiate baseball pitchers (age, 20.2 ± 1.9 years; height, 1.76 ± 0.05 m; body mass, 73.3 ± 6.7 kg) were recruited. An optical motion tracking system was used to assess scapular motion. Scapular control was defined as the amount of change in the scapular internal rotation angle, downward rotation angle, and anterior tilt angle during isometric shoulder flexion. We assessed scapular position at MER of pitching. RESULTS: No significant differences were detected for any of the scapular angles during isometric shoulder flexion between the throwing and non-throwing arms. The amount of change in the scapular internal rotation angle, scapular downward rotation angle, and scapular anterior tilt angle during isometric shoulder flexion had a significant relationship with the scapular downward rotation angle at MER. CONCLUSIONS: No side-to-side difference was noted in scapular control during isometric shoulder flexion in healthy collegiate baseball pitchers at the group level. Further studies are required to understand the side-to-side differences at the individual level. Additionally, there was a relationship between scapular control during isometric shoulder flexion and scapular position at MER. These findings suggest that clinicians may consider using isometric shoulder flexion to assess scapular control in baseball pitchers.

DOI： 10.1186/s13102-022-00471-9

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We investigated the shear modulus-passive force relationship in the hip adductor longus (AL) muscles of human cadavers and explored the effect of muscle architecture on the elastic properties of the AL muscle using shear wave elastography (SWE). Nine AL muscles were harvested from a soft, embalmed cadaver. The AL muscles were affixed to a custom-built device comprising two clamps, a pulley, and a cable to provide passive loads, which were increased from 0 to 600 g in 60-g increments. The shear modulus of the AL muscle was measured in the proximal (Pro), middle (Mid), and distal (Dis) regions. The masses and anatomical cross-sectional areas (ACSAs) of the AL muscles were measured. The shear modulus-passive load relationship of each tested muscle region was analyzed by fitting a least-squares regression line. Moreover, the rate of increase in the shear modulus per unit load (s) was calculated. The shear modulus and passive force were linearly correlated for all AL muscles in each region (p < 0.01). The mean coefficients of determination (R2 ) for Pro, Mid, and Dis were 0.989, 0.986, and 0.982, respectively. The rate of increase in the shear modulus per unit load significantly correlated with the reciprocal of the muscle mass (r = 0.77, p = 0.02) and ACSA (r = 0.43, p = 0.03). Shear wave elastography can be used as an indirect measure of passive force in any region of the AL muscle. Additionally, the rate of increase in the shear modulus per unit load could be associated with muscle architectural parameters.

DOI： 10.1002/ca.23881

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J03582&link_issn=&doc_id=20220603480022&doc_link_id=%2Fdp2sport%2F2022%2F003002%2F025%2F0484-0491%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdp2sport%2F2022%2F003002%2F025%2F0484-0491%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Purpose: The aim of this study was to evaluate the short-term outcome of physiotherapy in patients with acetabular labral tears and to assess the effectiveness of physiotherapy according to the severity of the labral tear. Materials and Methods: Thirty-five patients who underwent physiotherapy for treatment of symptomatic acetabular labral tears were enrolled. We evaluated the severity of the acetabular labral tears, which were classified based on the Czerny classification system using 3-T MRI. Clinical findings of microinstability and extra-articular pathologies of the hip joint were also examined. The International Hip Outcome Tool 12 (iHOT12) was use for evaluation of outcome scores pre- and post-intervention. Results: The mean iHOT12 score showed significant improvement from 44.0 to 73.6 in 4.7 months. Compared with pre-intervention scores, significantly higher post-intervention iHOT12 scores were observed for Czerny stages I and II tears (all P<0.01). However, no significant difference was observed between pre-intervention and post-intervention iHOT12 scores for stage III tears (P=0.061). In addition, seven patients (20.0%) had positive microinstability findings and 22 patients (62.9%) had findings of extra-articular pathologies. Of the 35 patients, eight patients (22.9%) underwent surgical treatment after failure of conservative management; four of these patients had Czerny stage III tears. Conclusion: The iHOT12 score of patients with acetabular labral tears was significantly improved by physiotherapy in the short-term period. Improvement of the clinical score by physiotherapy may be poor in patients with severe acetabular labral tears. Determining the severity of acetabular labral tears can be useful in determining treatment strategies.

DOI： 10.5371/hp.2022.34.1.45

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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BACKGROUND: Posterior shoulder capsule tightness is one of the factors for shoulder injuries in overhead athletes. Recent studies have shown the posterior capsule of the dominant arm to be stiffer than that of the non-dominant arm in baseball players. However, whether posterior capsule tightness in the dominant arm is exclusive to overhead athletes remains unknown. This study aimed to investigate whether the posterior shoulder capsule of the dominant arm in baseball players is stiffer than that in non-throwing population. METHODS: Fifteen male collegiate asymptomatic baseball players (baseball-player group) and fifteen male college students who did not partake in overhead sports (non-throwing group) participated in this study. We measured the shear moduli of the middle and inferior posterior capsules, superior infraspinatus, inferior infraspinatus, teres minor, and posterior deltoid in the dominant arm using ultrasound shear wave elastography. We compared shear moduli between the two groups using an independent samples t-test and Mann-Whitney test. In addition, we investigated the correlation between the range of glenohumeral internal rotation and each shear modulus in each group using the Pearson correlation coefficient. RESULTS: The shear moduli in the baseball-player group were significantly higher than those in the non-throwing group in both the middle posterior capsule (baseball-players group: 36.1 ± 5.6 kPa vs. non-throwing group: 29.0 ± 8.6 kPa; p = 0.018) and inferior posterior capsule (37.1 ± 9.6 kPa vs. 27.9 ± 6.8 kPa; p = 0.002). However, no difference in the shear moduli of individual muscle groups was identified. The glenohumeral internal rotation range exhibited a statistically significant negative correlation with the shear modulus of the inferior posterior capsule in the baseball-player group (Pearson correlation coefficient = -0.586, p = 0.022). CONCLUSION: Our findings suggest that the posterior shoulder capsule of the dominant arm in baseball players is stiffer than that in non-throwing population.

DOI： 10.1016/j.jse.2022.01.119

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PURPOSE: This study aimed to investigate the time-course changes in the active stiffness of the supraspinatus muscle after arthroscopic rotator cuff repair. METHODS: Eight male patients (mean age 61.5 ± 9.4 years) who underwent arthroscopic rotator cuff repair for small to medium tears were recruited for this study. Movement tasks included 30° shoulder isometric abduction and maximal voluntary isometric contraction of shoulder abduction in the scapular plane. The stiffness of the supraspinatus (anterior superficial, anterior deep, posterior superficial, and posterior deep regions), upper trapezius, and middle deltoid muscles in bilateral shoulders was recorded using ultrasound shear wave elastography. For each subject, the measurement was performed preoperatively and 3, 6, and 12 months postoperatively. RESULTS: The stiffness of the affected anterior superficial region of the supraspinatus muscle 12 months postoperatively was significantly higher than that measured preoperatively and 3 months postoperatively (p < 0.05); it was significantly higher at 6 months postoperatively than at 3 months postoperatively (p < 0.05). Further, the maximal voluntary isometric contraction had significantly improved 12 months postoperatively compared to that measured preoperatively and 3 months postoperatively (p < 0.05). The stiffness of the affected upper trapezius and middle deltoid muscles 12 months postoperatively was significantly lower than that preoperatively (p < 0.05). CONCLUSION: The maximal voluntary isometric contraction 12 months postoperatively possibly increased because of improvement in the active stiffness of the anterior superficial region. Active stiffness of the anterior superficial region may improve 6 months rather than 3 months postoperatively because of the different stages of muscle force, structural repair tendon strength, and remodeling.

DOI： 10.1007/s10396-021-01168-1

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

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BACKGROUND: A strategy to predict mortality in elderly heart failure (HF) patients has not been established.Methods and Results:We retrospectively enrolled 413 HF patients aged ≥65 years (mean age 78 years) who had received comprehensive cardiac rehabilitation (CR) during hospitalization. Basic activities of daily life were assessed before discharge using the Barthel index (BI). Of 413 HF patients, 116 (28%) died during a median follow-up period of 1.90 years (interquartile range 1.20-3.23 years). An adjusted dose-dependent association analysis showed that the hazard ratio (HR) of mortality increased in an almost linear manner as the BI score decreased, and that a BI score of 85 corresponded to an HR of 1.0. Kaplan-Meier survival curves showed that the survival rate was lower for patients with a low BI (<85) than for those with a high BI (≥85; 65% vs. 74%, respectively; P=0.007). In multivariate Cox regression analyses, low BI was independently associated with higher mortality after adjusting for predictors, including B-type natriuretic peptide. Inclusion of the BI into the adjusted model improved the accuracy of the prediction of mortality. CONCLUSIONS: A BI score <85 at the time of discharge is associated with increased mortality independent of known prognostic markers, and achieving functional status with a BI score ≥85 by comprehensive CR during hospitalization may contribute to favorable outcomes in elderly HF patients.

DOI： 10.1253/circj.CJ-21-0584

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DOI： 10.1007/s00421-021-04785-3

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This study aimed to compare the effect of the load of the upper limb on the stiffness of supraspinatus muscle regions during isometric shoulder abduction in the scapular plane in healthy individuals and patients with a rotator cuff tear. Thirteen male patients were scheduled for arthroscopic rotator cuff repair, and 13 healthy male individuals were recruited. The movement task involved 30° isometric shoulder abduction in the scapular plane. The tasks included passive abduction, abduction with half-weight of the upper limb (1/2-weight), and full weight of the upper limb (full-weight). The stiffness of the supraspinatus muscle (anterior superficial, anterior deep, posterior superficial, and posterior deep regions) was recorded using ultrasound shear-wave elastography. The stiffness of the anterior superficial region on the affected side was significantly lower than that on the control side for the 1/2-weight and full-weight tasks. The stiffness of the anterior deep, posterior superficial, and posterior deep regions was not affected. This is the first study that investigated the mechanical effects of different loads on different supraspinatus muscle regions in rotator cuff tear patients. Our results indicate that the anterior superficial region in rotator cuff tear patients was mainly responsible for reduced active stiffness. This might be because this region contributes to force exertion and exhibits atrophy in rotator cuff tears. Hence, the anterior superficial region could be a focal point of quantitative dysfunction evaluation of the supraspinatus muscle in the case of a rotator cuff tear.

DOI： 10.1002/ca.23800

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/tsm2.282

DOI： 10.1002/tsm2.282

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PURPOSE: Exercise-induced increases in shear rate (SR) across different exercise intensities may differentially affect hypercapnia-induced vasodilation of the internal carotid artery (ICA), a potential index of cerebrovascular function. We aimed to elucidate the effects of exercise intensity on ICA SR during exercise and post-exercise hypercapnia-induced vasodilation of the ICA in young men. METHODS: Twelve healthy men completed 30 min of cycling at moderate [MIE; 65 ± 5% of age-predicted maximal heart rate (HRmax)] and high (HIE; 85 ± 5% HRmax) intensities. Hypercapnia-induced vasodilation was induced by 3 min of hypercapnia (target end-tidal partial pressure of CO2 + 10 mmHg) and was assessed at pre-exercise, 5 min and 60 min after exercise. Doppler ultrasound was used to measure ICA diameter and blood velocity during exercise and hypercapnia tests. RESULTS: SR was not altered during either exercise (interaction and main effects of time; both P > 0.05). ICA conductance decreased during HIE from resting values (5.1 ± 1.3 to 3.2 ± 1.0 mL·min-1·mmHg-1; P < 0.01) but not during MIE (5.0 ± 1.3 to 4.0 ± 0.8 mL·min-1·mmHg-1; P = 0.11). Consequently, hypercapnia-induced vasodilation declined immediately after HIE (6.9 ± 1.7% to 4.0 ± 1.4%; P < 0.01), but not after MIE (7.2 ± 2.1% to 7.3 ± 1.8%; P > 0.05). Sixty minutes after exercise, hypercapnia-induced vasodilation returned to baseline values in both trials (MIE 8.0 ± 3.1%; HIE 6.4 ± 2.9%; both P > 0.05). CONCLUSION: The present study showed blunted hypercapnia-induced vasodilation of the ICA immediately after high-intensity exercise, but not a moderate-intensity exercise in young men. Given that the acute response is partly linked to the adaptive response in the peripheral endothelial function, the effects of aerobic training on cerebrovascular health may vary depending on exercise intensity.

DOI： 10.1007/s00421-021-04721-5

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DOI： 10.1177/2047487320904236

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AIMS: Results of experimental studies have indicated the possibility of muscle and bone mass being negatively regulated by renin-angiotensin system (RAS) activation, but that possibility has not been analysed in patients with heart failure (HF). METHODS AND RESULTS: Data for HF patients who received a dual-energy X-ray absorptiometry scan in our hospital were reviewed. Propensity scores for the use of RAS inhibitors (RASIs) were calculated using a multivariate logistic regression model to minimize selection bias. One hundred sixty pairs of patients were extracted. Plasma aldosterone concentration was significantly lower in the RASIs group than in the no-RASIs group (119 [IQR 71-185] vs. 94 [IQR 60-131] pg/mL, P = 0.003), confirming RAS inhibition in the RASIs group. Skeletal muscle mass index tended to be higher in the RASIs group than in the non-RASIs group (15.6 [IQR 14.0-17.2] vs. 15.0 [IQR 13.3-16.6] pg/mL, P = 0.065). The proportion of patients with muscle wasting, defined as appendicular skeletal muscle mass indexes of <7.00 and <5.40 kg/m2 for males and females, respectively, was significantly lower in the RASIs group than in the non-RASIs group (53% vs. 64%, P = 0.041). Multivariate logistic regression analysis showed that the no use of RASIs was associated with presence of muscle wasting independently of age, presence of diabetes, renal function, and severity of HF. Bone mineral densities and proportions of patients with osteoporosis were similar in the two groups. CONCLUSIONS: Renin-angiotensin system inhibition is associated with a lower prevalence of muscle wasting in HF patients independently of established risk factors.

DOI： 10.1002/ehf2.13430

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OBJECTIVE: Malnutrition is associated with an increased risk of mortality in heart failure (HF) patients. Here, we examined the hypothesis that assessment of energy intake in addition to nutritional status improves the stratification of mortality risk in elderly HF patients. METHODS: We retrospectively examined 419 HF patients aged ≥ 65 years (median 78 years, 49% female). Nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF), and daily energy intake was calculated from intake during 3 consecutive days before discharge. RESULTS: During a median 1.52-year period (IQR 0.96-2.94 years), 110 patients (26%) died. Kaplan-Meier survival curves showed that patients with low tertile of daily energy intake had a higher mortality rate than did patients with high or middle tertile of daily energy intake. In multivariate Cox regression analyses, low daily energy intake was independently associated with higher mortality after adjustment for the model including age, sex, BNP, Charlson Comorbidity Index, history of HF hospitalization, and cachexia in addition to MNA-SF. Inclusion of both MNA-SF and energy intake into the adjustment model improved the accuracy of prediction of the mortality after discharge (continuous net reclassification improvement, 0.355, p = 0.003; integrated discrimination improvement, 0.029, p = 0.003). Results of a fully adjusted dose-dependent association analysis showed that risk of all-cause mortality was lowest among HF patients who consumed 31.5 kcal/kg/day of energy. CONCLUSIONS: Energy intake during hospital stay is an independent predictor of the mortality in elderly HF patients, and its assessment together with established predictors improves the mortality risk stratification.

DOI： 10.1007/s00392-020-01774-y

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PURPOSE: This study aimed to determine (1) intramuscular regional differences in the changes in the shear modulus of the rectus femoris (RF) muscle during passive knee flexion and (2) the relationship between shear modulus and passive knee extension torque. METHOD: The shear modulus maps as an index of muscle stiffness and the passive torque were obtained at seven regions during passive knee flexion at 2°/s within a knee joint range of motion of 0°-130° in 16 healthy males. RESULTS: The shear modulus of RF increased with the knee angle of flexion. The shear modulus of each longitudinal region was greater in the order of proximal, central, and distal region (p < 0.05). The relationship between the shear modulus and passive torque was highly fitted for all 16 subjects (p < 0.05). The mean coefficient of determination (R2) at second-order polynomial model per subject was 0.96 (± 0.03; range 0.61-0.99), and whole group was 0.58 (± 0.03; range 0.54-0.64) in all regions. CONCLUSIONS: The passive stiffness of RF was higher in the proximal region than in the other regions during passive knee flexion. Furthermore, the shear modulus-passive torque was related regardless of the measurement region within a muscle, and the results suggest that the passive knee extension torque reflects passive muscle stiffness of the RF.

DOI： 10.1007/s00421-021-04644-1

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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PURPOSE: Estimation of muscle passive force from elasticity using shear wave elastography (SWE) has been reported. However, the relationship between the elasticity and passive force of human muscles has not been elucidated. This study investigated the elastic modulus-passive force relationship in human skeletal muscles at multiple sites. METHODS: Four rectus femoris (RF) muscles were dissected from a human Thiel-embalmed cadaver. Calibration weights (0-600 g in 60-g increments) were applied to the distal tendon via a pulley system, and the shear elastic modulus as an index of elasticity was measured using SWE. The shear elastic modulus of the RF was measured at the proximal, central, and distal portions. RESULTS: The results demonstrated that the relationships between the elasticity in the longitudinal direction of the muscle and the passive force were nearly linear for all tested sites, with coefficients of determination ranging from 0.813 to 0.993. CONCLUSION: Shear wave elastography may be used as an indirect method to measure the changing passive force at any site within human muscles.

DOI： 10.1007/s10396-020-01076-w

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Language：Japanese   Publisher：(株)文光堂  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01715&link_issn=&doc_id=20210401050003&doc_link_id=%2Fag9rsige%2F2021%2F003804%2F004%2F0370b0374%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fag9rsige%2F2021%2F003804%2F004%2F0370b0374%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

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The force-length relation of the skeletal muscles is an important factor influencing the joint torque at a given joint angle. We aimed to clarify the relationship between the resting sarcomere length and knee joint angle in the vastus intermedius (VI) and to compare it with that of the vastus lateralis (VL). The left and right legs were fixed at knee joint angles of 0° and 90°, respectively, in seven cadavers (age at the time of death: 70-91 years). Muscle tissues were dissected by necropsy of the VL and the VI, and electron microscopy images were obtained to calculate the sarcomere length. At knee joint angles of 0° and 90°, the VL sarcomere length was 2.28 ± 0.49 μm and 2.30 ± 0.48 μm, respectively, and the VI sarcomere length was 2.19 ± 0.35 μm and 2.46 ± 0.53 μm, respectively, with a significant difference between the two (p = 0.028). The magnitude of sarcomere length changes with knee joint angle changes was significantly greater for the VI (0.27 ± 0.20 μm) than for the VL (0.02 ± 0.09 μm) (p = 0.009). Thus, knee joint angle changes may affect the passive and active tension produced by the VI more than those produced by the VL.

DOI： 10.14814/phy2.14771

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Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J05805&link_issn=&doc_id=20210319280015&doc_link_id=%2Fch1thrpy%2F2020%2F002301%2F015%2F0117-0122%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch1thrpy%2F2020%2F002301%2F015%2F0117-0122%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：(公社)日本理学療法士協会  

Ichushi

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Language：Japanese   Publisher：(公社)日本理学療法士協会  

Ichushi

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Language：Japanese   Publisher：(公社)日本理学療法士協会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

This study aimed to elucidate the effects of change in estrogen during the menstrual cycle and menopause on shear-mediated dilation of the internal carotid artery (ICA), a potential index of cerebrovascular endothelial function. Shear-mediated dilation of the ICA and serum estradiol were measured in 11 premenopausal (Pre-M, 21 ± 1 yr), 13 perimenopausal (Peri-M, 49 ± 2 yr), and 10 postmenopausal (Post-M, 65 ± 7 yr) women. Measurements were made twice within the Pre-M group at their early follicular (EF, lower estradiol) and late follicular (LF, higher estradiol) phases. Shear-mediated dilation was induced by 3 min of hypercapnia (target PETCO2 + 10 mmHg from individual baseline) and was calculated as the percent rise in peak diameter relative to baseline diameter. ICA diameter and blood velocity were simultaneously measured by Doppler ultrasound. In Pre-M, shear-mediated dilation was higher during the LF phase than during the EF phase (P < 0.01). Comparing all groups, shear-mediated dilation was reduced across the menopausal transition (P < 0.01), and Pre-M during the LF phase showed the highest value (8.9 ± 1.4%) compared with other groups (Pre-M in EF, 6.4 ± 1.1%; Peri-M, 5.5 ± 1.3%; Post-M, 5.2 ± 1.9%, P < 0.05 for all). Shear-mediated dilation was positively correlated with serum estradiol even after adjustment of age (P < 0.01, r = 0.55, age-adjusted; P = 0.02, r = 0.35). Collectively, these data indicate that controlling the menstrual cycle phase is necessary for the cross-sectional assessments of shear-mediated dilation of the ICA in premenopausal women. Moreover, current findings suggest that a decline in cerebrovascular endothelial function may be partly related to the reduced circulating estrogen levels in peri- and postmenopausal women.NEW & NOTEWORTHY The present study evaluated the effects of the menstrual cycle and menopause stages on the shear-mediated dilation of the ICA, a potential index of cerebrovascular endothelial function, in pre-, peri-, and postmenopausal women. Shear-mediated dilation of the ICA was increased from the low- to high-estradiol phases in naturally cycling premenopausal women and was reduced with advancing menopause stages. Furthermore, lower estradiol was associated with reduced shear-mediated dilation of the ICA, independent of age.

DOI： 10.1152/ajpheart.00810.2020

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This study examined the effect of hip flexion angle on the stiffness of the adductor longus (AL) muscle during isometric hip flexion. Seventeen men were recruited. Ten participants performed submaximal voluntary contraction at 0%, 25%, 50%, and 75% of maximal voluntary contraction (MVC) during isometric hip flexion after performing MVC at 0°, 40°, and 80° of hip flexion. Seven participants performed submaximal voluntary tasks during isometric hip extension in addition to hip flexion task. The shear modulus of the AL muscle was used as the index of muscle stiffness, and was measured using ultrasound shear-wave elastography during the tasks at each contraction intensity for each hip flexion angle. During hip flexion, the shear modulus of the AL muscle was higher at 0° than at 40° and 80° of hip flexion at each contraction intensity (p < 0.016). Conversely, a significant effect was not found among hip flexion angle during hip extension at 75% of MVC (p = 0.867). These results suggest that mechanical stress of the AL muscle may be higher at 0° of hip flexion during isometric hip flexion.

DOI： 10.1016/j.jelekin.2020.102493

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Language：Japanese   Publisher：(一社)日本スポーツ理学療法学会  

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Language：Japanese   Publisher：(一社)日本スポーツ理学療法学会  

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BACKGROUND: The clinical significance of osteoporosis in chronic heart failure (CHF) remains unclear.Methods and Results:A total of 303 CHF patients (75 years, [interquartile range (IQR) 66-82 years]; 41% female) were retrospectively examined. Bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by using dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when the BMD at any of the 3 sites was <70% of the Young Adult Mean percentage (%YAM). The prevalence of osteoporosis in CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74-86] vs. 72 [IQR, 62-80] years), included a large percentage of females, had slower gait speed and had a lower body mass index. Multivariate logistic regression analysis indicated that sex, BMI, gait speed, loop diuretics use and no use of direct oral anticoagulants (DOACs) were independently associated with osteoporosis. Kaplan-Meier survival curves showed that the rate of death and heart failure hospitalization was higher in patients with osteoporotic BMD at 2 or 3 sites than in patients without osteoporosis (hazard ratio 3.45, P<0.01). In multivariate Cox regression analyses, osteoporotic BMD at 2 or 3 sites was an independent predictor of adverse events after adjustment for prognostic markers. CONCLUSIONS: Loop diuretics use and no DOACs use are independently associated with osteoporosis in CHF patients. Osteoporosis is a novel predictor of worse outcome in patients with CHF.

DOI： 10.1253/circj.CJ-20-0593

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

The high prevalence of foot pathologies in women and the elderly could be associated with gender and age difference in the morphology of the foot, particularly the morphology of the keystone of the foot, the talus. The present study investigated the orientation and curvature of the three articular surfaces of the talus in relation to sex and age based on computer tomography (CT), to identify possible morphological factors of the higher prevalence of foot disorders in women and elderly. Fifty-six participants were included in this study. The orientations of the talocrural, subtalar, and talonavicular joints were quantified three-dimensionally by calculating normal and principal axes of the articular surfaces defined by planar approximation. The curvature radii of the articular surfaces were quantified by cylindrical and spherical approximations. The talonavicular surface was significantly more twisted in the frontal plane and less adducted in the transverse plane in females than in males. With aging, the subtalar articular surface was significantly facing more posteriorly. Moreover, it was found that the curvature radii of the trochlea and navicular articular surfaces significantly increased with aging, indicating a flattening of these surfaces. The identified changes in the talar morphology with aging could potentially lead to a higher prevalence of foot disorders in the elderly.

Other Link： http://link.springer.com/article/10.1007/s12565-020-00585-5/fulltext.html

DOI： 10.1007/s12565-020-00585-5

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BACKGROUND: In the general population, the flexor hallucis longus (FHL) often has tendinous slips to lesser toes and the number of FHL slips varies between individuals. The purpose of this study was to investigate the relationship between the number of FHL tendinous slips in an individual foot and its toe flexor strength. METHODS: Forty healthy men were included in the study. The FHL branch test was used to assess each subject for the number of FHL tendinous slips. Toe flexor strength in each toe was measured using a force gauge. A two-way ANOVA was used to compare toe flexor strength between groups classified according to the number of FHL slips. RESULTS: The group of subjects with FHL branching to the second toe was the most common (20/40). The toe flexor strength ratio of the third toe was significantly lower in feet lacking FHL branching to the third toe than in those feet which did have branching to the third toe (P = 0.005). CONCLUSIONS: Toe flexor strength was affected by FHL tendinous slips. Considering the number of the FHL tendinous slips an individual foot has may be useful in clinical practice for rehabilitation or training of toe flexor muscles.

DOI： 10.1016/j.fas.2020.11.002

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BACKGROUND: Stretching is often used to prevent and treat posterior shoulder capsule tightness; however, the most effective stretching positions are not clearly defined. The purpose of this study was to identify the stretching positions that specifically applied the greatest passive tension on the posterior shoulder capsule by evaluating the elastic characteristics of posterior capsules and muscles in various stretching positions using ultrasound shear wave elastography (SWE). METHODS: We evaluated 9 fresh-frozen shoulders (mean age 86.6 ± 7.7 years) without osteoarthritis or rotator cuff tears. All posterior shoulder tissues were preserved intact. Shear moduli of the middle and inferior posterior shoulder capsules and the posterior shoulder muscles were evaluated using SWE. We obtained shear modulus measurements in 9 stretching positions using a combination of glenohumeral elevation planes and angles (frontal, sagittal, scapular; -30°, 0°, 30°, 60°, respectively). A 4-Nm torque for shoulder internal rotation or horizontal adduction was applied in each position. We also measured shear moduli in the resting position (0° elevation with neutral shoulder internal/external rotation). We compared the shear moduli of all stretching and resting positions using 1-way repeated measures analysis of variance (P < .05). In addition, we compared the shear modulus in 2 positions (ie, resting and each stretching) among tissues (ie, capsules and muscles) with repeated measures using 2-way analysis of variance (P < .05). RESULTS: Shear modulus values for the middle posterior capsules in "internal rotation at 30° in scapular plane elevation" (28.7 ± 14.3 kPa, P = .01) and in "horizontal adduction at 60° of elevation" (31.1 ± 13.1 kPa, P < .001) were significantly higher than that of the resting position (11.0 ± 7.3 kPa). The shear modulus value for the inferior posterior capsule in "internal rotation at 30° of flexion" was significantly higher than that of the resting position (39.0 ± 17.3 vs. 15.4 ± 13.9 kPa, respectively; P = .004). Additionally, the shear modulus values for the posterior capsules in "internal rotation at 30° in scapular plane elevation and flexion" were significantly higher than that of the posterior shoulder muscles. CONCLUSION: Effective middle posterior shoulder capsule stretching positions were shoulder "internal rotation at 30° of scapular plane elevation" and "horizontal adduction at 60° of elevation." Shoulder "internal rotation at 30° of flexion" was the most effective position for the inferior posterior shoulder capsule. Stretching in these positions could relieve posterior shoulder capsule tightness and contribute to the prevention and treatment of throwing injuries of the shoulder.

DOI： 10.1016/j.jse.2020.08.021

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

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PURPOSE: The relevance of each ligament comprising the lateral ankle ligament complex, including the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), has not been sufficiently elucidated; therefore, we aimed to clarify the morphological characteristics and relevance of these ligaments. METHODS: Total 152 legs from 152 Japanese cadavers were investigated. The lengths and widths of the ATFL, CFL, and PTFL were measured using a caliper. The ATFL was classified according to the number of fiber bundles (Types I, II, and III corresponded to one, two, and three fiber bundles, respectively), and the lengths and widths of the three ligaments were compared between the Type groups. In addition, the ratio of each ligament's length and width to the tibial length was calculated, and the correlation of the ratio of ligament length and width between the ATFL, CFL, and PTFL was examined about 34 legs. RESULTS: The ATFL, CFL, and PTFL were found to connect at the anterior/inferior tip of the lateral malleolus each other. The Type II group of the ATFL was most common (54.6%) in our investigated specimens. However, there were no significant inter-group differences in the lengths and widths of the CFL and PTFL. CONCLUSIONS: This study demonstrates that the lateral ankle ligaments may stabilize the ankle joint through interconnections.

DOI： 10.1007/s00276-020-02461-3

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INTRODUCTION: The shape of the talus determines the positional and kinematic features of the subtalar, talonavicular, and talocrural joints during walking. Thus, detailed knowledge of the pattern of sexual dimorphism of the human talus may be useful for revealing the pathogenetic mechanism of foot and knee disorders, which are more prevalent in females. The aim of this study was to characterize and visualize the three-dimensional shape variations of the talus in relation to sex and age using geometric morphometrics. MATERIALS AND METHODS: Computed tomography images of 56 ft without talar injuries or disorders were used in this study. Thirty-seven anatomical landmarks were identified on a bone model of the talus to calculate principal components (PCs) of shape variations among specimens. PC scores were compared between sexes, and their correlations with age were also investigated. RESULTS: The female talus had a longer neck and narrower head width than the male talus. The superior trochlea was tilted more laterally in the frontal plane in females. Furthermore, the female talar head was more twisted and was more elongated in the dorsoplantar direction. CONCLUSIONS: Morphological features of the talus in females could alter the subtalar and talonavicular joint kinematics during walking and could be a structural factor in the pathogenetic mechanism underlying foot and knee disorders. This study contributes to the comprehensive understanding of shape variations in the human talus. This article is protected by copyright. All rights reserved.

DOI： 10.1002/ca.23588

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STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to investigate sacral table angle (STA) values in early-stage spondylolysis. Several studies suggested that the STA of patients with L5 spondylolysis or spondylolisthesis was significantly lower than that of healthy controls. Separation of the pars interarticularis creates shear stress between the upper sacral end plate and L5 vertebra. This was considered the cause of low STA in patients with spondylolysis or spondylolisthesis. However, if a low STA value is obtained in the early stage of L5 spondylolysis, it suggests that low STA does not result in the remodeling of the sacral end plate. METHODS: Patients with L5 spondylolysis and those with low back pain without pars defect were retrospectively identified from a hospital database in 2014-2016. Pars defect of the spondylolysis was classified into three categories based on CT and MRI results: early, progressive, or terminal stage. The STA difference between groups was calculated using one-way analysis of variance and Scheffe F test, which were used for post hoc testing. RESULTS: A total of 84 cases of L5 spondylolysis and 70 cases of low back pain were identified. No significant difference was found between the STAs of the early- or progressive-stage spondylolysis and the terminal-stage L5 spondylolysis and low back pain patients. The STA of the terminal-stage L5 spondylolysis was significantly lower than that of low back pain patients. CONCLUSIONS: In conclusion, patients with early- or progressive-stage spondylolysis do not have low STA. Low STA is seen only in patients with terminal-stage spondylolysis, suggesting that low STA is associated with remodeling changes in response to shear force after onset of spondylolysis. STA value might not important as a prognostic parameter about development of the spondylolysis. LEVEL OF EVIDENCE: Level IV.

DOI： 10.1007/s43390-020-00043-2

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BACKGROUND: The prevalence of foot pathologies, such as flatfoot deformity and hallux valgus, is higher in women and increases with age. It has been reported that these types of foot disorders may also be linked to excessive mobility of the subtalar joint to the eversion direction during weight bearing. Given that the mobility of the joint is determined by its articular morphology, sex- and age-related variations in the subtalar articular surface morphology are possible. The purpose of this study was to investigate the orientation and the curvature radii of the talar articular facets of the calcaneus in relation to age and sex using three-dimensional computer tomography. METHODS: Fifty-six feet without subtalar injuries or disorders were included in this study. The orientations of the talar articular surfaces of the calcaneus were quantified in the sagittal and coronal planes. The curvature radii of the articular surfaces of the calcaneus were also assessed based on the approximations of the sphere surfaces. RESULTS: The talar articular surface was oriented more anteriorly and medially in the females than in the males. The curvature radius of the calcaneal posterior facet in the females exhibited a positive correlation with age, indicative of increased articular surface flattening. CONCLUSIONS: The morphological features of the female calcaneus could induce excessive eversion and could lead to a higher prevalence of foot disorders, including flatfoot and hallux valgus, in elderly females. This study contributes to an understanding of the sexual dimorphism of the articular surfaces of the calcaneus and provides insight into the mechanisms that underline various foot disorders.

DOI： 10.1016/j.aanat.2020.151468

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DOI： 10.1016/j.jbiomech.2019.109498

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PURPOSE: This study aimed to test our hypothesis that acute hypotension attenuates brachial flow-mediated dilation (FMD) as an index of endothelial function in healthy humans. METHODS: Twelve healthy men (21.8 ± 1.6 years, body mass index; 22.2 ± 1.6 kg/m2) participated in this study. Brachial FMD was measured in three trials: standardized FMD protocol (control trial), abrupt decrease in blood pressure (BP) via thigh cuff inflation-deflation (hypotension trial) and decrease in shear rate (SR) via a shortened forearm occlusion time (SR reduction trial). Brachial diameter and blood velocity were measured using Duplex ultrasound. RESULTS: Mean arterial pressure during reactive hyperaemia showed a marked decrease in the hypotension trial (- 23.7 ± 6.0 mmHg), but not in the control and SR reduction trials. SR area under the curve was attenuated in the SR reduction trial (P < 0.001), but not in the control and hypotension trials (P = 0.316). Consequently, FMD was attenuated in the hypotension and SR reduction trials compared with that in the control trial (P = 0.003 and P = 0.043, respectively), and was attenuated to a greater extent in the hypotension trial compared with the SR reduction trial (P = 0.006; control, 6.9 ± 3.5%; hypotension, 3.5 ± 1.7%; SR reduction, 5.0 ± 2.2%). After adjusting FMD using SR, FMD remained attenuated in the hypotension trial (P = 0.014), but not in the SR reduction trial. CONCLUSION: Our findings indicate that arterial pressure as well as sympathetic nervous system activation could be an important determinant of FMD. Blunted FMD of peripheral arteries may be a rational response to restore BP and/or prevent further reduction of BP following acute hypotension in healthy humans.

DOI： 10.1007/s00421-019-04260-0

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Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

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The shape of the calcaneus determines the mechanical interaction of the foot with the ground during the heel-strike in human walking. Detailed knowledge of the pattern of sexual dimorphism of the human calcaneus could help to clarify the pathogenetic mechanism of foot and knee disorders, which are more prevalent in females. Therefore, the aim of this study was to characterize and visualize the three-dimensional shape variations of the calcaneus in relation to sex and age using geometric morphometrics. Computed tomography images of 56 feet without subtalar injuries or disorders were used in this study. Thirty-seven anatomical landmarks were identified on the bone model of the calcaneus to calculate principal components (PCs) of shape variations among specimens. The PC scores were compared between males and females, and their correlations with age were also analyzed. The female calcaneus was longer in length and shorter in height than that of males. The medial process of the calcaneal tuberosity in females was more inferiorly projected and the tuberosity was shifted more laterally. Also, the calcaneus was wider and the sustentaculum tali thickened with aging. Female structural features of the calcaneus alter the kinematics of the foot during walking and could be a structural factor in foot and knee disorders. This study contributes to a comprehensive understanding of shape variations in the human calcaneus. Clin. Anat., 33:751-758, 2020. © 2019 Wiley Periodicals, Inc.

DOI： 10.1002/ca.23501

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

BACKGROUND: The flexor hallucis longus (FHL) muscle often has a tendinous slip with a variable number of branches. We aimed at developing the FHL branch test to determine the number of FHL branches. METHODS: In anatomical validation study, 6 intact cadavers were used. The toe flexion angles were measured while the FHL and flexor digitorum longus (FDL) were manually pulled individually. For electrophysiological studies, 4 healthy men participated. The FHL was electrically stimulated, and electromyography (EMG) of the FHL and FDL were recorded during the FHL branch test. RESULTS: The toe flexion angles' changes in the FHL pulling condition were equivalent with pulling FDL in toes with FHL branching. The electrical stimulation of the FHL produced similar flexion as the FHL branch test. EMG of the FHL was higher than FDL during the FHL branch test (p=0.036). CONCLUSIONS: The FHL branch test could be used to evaluate the number of FHL branches.

DOI： 10.1016/j.fas.2019.08.003

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PURPOSE: Neuromuscular activation of the adductor longus (AL) and adductor magnus (AM) muscles at different hip flexion angles during hip flexion and extension has not been clarified. This study aimed to compare the relationship between hip flexion angle and the electromyogram of the AL muscle with that of the AM muscle during isometric hip flexion and extension. METHODS: Fifteen healthy young men were included in this study. Participants performed maximal voluntary contractions during hip flexion and extension at six different hip flexion angles: - 20°, 0°, 20°, 40°, 60°, and 80°. The surface electromyograms of the AL and AM muscles were recorded. The root mean square (RMS) was calculated and normalized by the RMS during hip adduction for each individual muscle. RESULTS: The normalized RMS of the AL muscle was significantly higher than that of the AM muscle at a hip flexion angle of - 20° during hip flexion (P < 0.05). The mean normalized RMS of the AM muscle was significantly higher than that of the AL muscle during hip extension (P < 0.01). CONCLUSION: These results suggest that the AL muscle is recruited specifically at the hip-extended position during hip flexion, and that the AM muscle is recruited regardless of the hip position during hip extension. Thus, the AL and AM muscles may have different functional roles in different hip flexion angles.

DOI： 10.1007/s00421-019-04150-5

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DOI： 10.1249/01.mss.0000562428.61775.10

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Language：Japanese   Publisher：日本心臓核医学会  

Ichushi

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BACKGROUND: A dynamic postural stability deficit has been suggested to be present in individuals with chronic ankle instability (CAI). Interventions to improve postural control in individuals with CAI have been reported, but they required a long period of and compliance with interventions. PURPOSE: To examine the effect of novel ankle-realigning socks on dynamic postural stability in individuals with CAI using the star excursion balance test (SEBT). STUDY DESIGN: Case-control study. METHODS: Twenty-eight control and 22 subjects with CAI (who were tested in both barefoot and with socks) were enrolled. The weight-bearing ankle dorsiflexion range of motion (DF-ROM) and SEBT were measured in the control group, the barefoot CAI group, and the CAI with socks group. In addition, subjective ankle instability during SEBT was measured using a visual analog scale (0 - 100). RESULTS: DF-ROM was 48.3 ± 7.4 º in the control group, 43.3 ± 8.0 º in the barefoot CAI group, and 45.7 ± 6.8 º in the CAI with socks group. DF-ROM was significantly less in the barefoot CAI group than in the control group. The SEBT scores were significantly less in the barefoot CAI group than in the control group in all directions. The SEBT score was significantly larger in the CAI with socks group than in the barefoot CAI group in the posteromedial, posterior, and posterolateral directions. In addition, there were no significant differences between the control group and the CAI with socks group in six directions. CONCLUSION: Wearing the novel ankle-realigning socks immediately improved dynamic postural stability as measured by the SEBT and subjective ankle instability in individuals with CAI. LEVEL OF EVIDENCE: Level 3b.

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J03582&link_issn=&doc_id=20190530350019&doc_link_id=%2Fdp2sport%2F2019%2F002702%2F020%2F0300-0307%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdp2sport%2F2019%2F002702%2F020%2F0300-0307%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：Japanese   Publisher：札幌医科大学保健医療学部  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05973&link_issn=&doc_id=20190613510003&doc_link_id=%2Ffc8hoken%2F2019%2F000008%2F003%2F0013-0020%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffc8hoken%2F2019%2F000008%2F003%2F0013-0020%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：Japanese   Publisher：札幌医科大学保健医療学部  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05973&link_issn=&doc_id=20190613510004&doc_link_id=%2Ffc8hoken%2F2019%2F000008%2F004%2F0021-0026%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffc8hoken%2F2019%2F000008%2F004%2F0021-0026%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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PURPOSE: The coupled behavior of talocrural joint motion is primarily determined by the morphological features of the talar trochlea and tibiofibular mortise. Features of the radius of curvature of the talocrural joint, however, remain unclear. The objectives of this study were to evaluate the radius of curvature at the mid, medial, and lateral regions of both the talar trochlea and the tibial plafond, and to estimate subject-specific kinematics of the talocrural joint. METHODS: Computed tomography images of 44 subjects with healthy talocrural joints were assessed by creating three-dimensional bone models. The radii of curvature of the anterior and posterior regions at the mid, medial, and lateral regions of both the talar trochlea and the tibial plafond were calculated. Hypothetical dorsiflexion and plantarflexion axes of the talocrural joint were estimated from the shape of the talar trochlea. Orientations and distances of these axes were calculated. RESULTS: At both the talar trochlea and the tibial plafond, the anteromedial and posteromedial radii exhibited the largest coefficients of variation. The anterior-to-posterior radius ratio (APRR) of the medial talar trochlea significantly correlated with the mid APRR, anterior medial-to-lateral radius ratio (MLRR), and posterior MLRR of the trochlea (r = 0.45, 0.52, - 0.60, respectively, and all P < 0.01). CONCLUSIONS: The asymmetric shape of the medial talar trochlea seems to determine a fixed or changing axis of rotation at the talocrural joint. This subject-specific rotational axis of the talocrural joint should be considered in the management of patients with ankle injuries.

DOI： 10.1007/s00276-018-2098-x

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OBJECTIVES: We describe the medical services provided and report the injuries and illnesses that occurred at the eighth Asian Winter Games 2017. METHODS: A total of 2010 athletes and team officials from 32 National Olympic Committees and 2 guest countries attended this event; medical services were provided for 16 days. Medical data (medical care and physiotherapy) were collected for the same period by the organising committee for athletes and non-athletes (team officials, workforce, media and spectators) and recorded on the electronic medical record system at the medical rooms in the venues and the team residences. RESULTS: We recorded 745 medical encounters (medical care, 443; physiotherapy, 302), of which 549 (74%) were among athletes. There were 214 injuries as well as 144 illnesses and other medical conditions. Of the 1164 athletes, 549 (47%) utilised the services. Ice hockey, snowboarding and alpine skiing had high rate of medical encounters. More than half of the delegations were not accompanied by team doctor, and rate of medical encounters was high in these teams. The vast majority of patients transferred to hospital for further care were mostly athletes (n=36 out of 41), mostly alpine skiers and ice hockey players. CONCLUSION: Injuries and illnesses varied depending on NOC medical staffing and sport events. These data will serve organisers of medical and physiotherapy services in the Asian Winter Games and similar large events.

DOI： 10.1136/bjsports-2018-099061

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Society of Physical Therapy Science (Rigaku Ryoho Kagakugakkai)  

DOI： 10.1589/rika.34.193

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STUDY DESIGN: Retrospective study. PURPOSE: This study aimed to investigate whether segmental lumbar hyperlordosis of the affected vertebra in patients with spondylolysis occurs only at L5 or also occurs at L4. OVERVIEW OF LITERATURE: To the best of our knowledge, increase in segmental lordosis of the spondylolytic vertebrae has only been investigated in bilateral L5 spondylolysis; it has not been examined at different levels of bilateral spondylolysis. According to the characteristics of segmental lordosis in bilateral L5 spondylolysis, patients with bilateral L4 spondylolysis may also have increased segmental lordosis of the L4 vertebra. METHODS: Patients with bilateral spondylolysis of the L5 or L4 vertebra in 2013-2015 were retrospectively identified from the hospital database. Standing lateral lumbar radiographs were assessed for the angle of segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis. The differences in segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis were determined using non-paired Student t-test. RESULTS: Overall, 15 cases of bilateral L4 spondylolysis and 41 cases of bilateral L5 spondylolysis satisfied the inclusion and exclusion criteria. Lordosis of the L4 vertebra was significantly greater in the bilateral L4 spondylolysis group (24.2°±7.0°) than that in the L5 spondylolysis group (20.3°±6.1°, p=0.047). Lordosis of the L5 vertebra was significantly lower in the L4 spondylolysis group (27.7°±8.2°) than that in the L5 spondylolysis group (32.5°±7.3°, p=0.040). The sacral slope and lumbar lordosis did not significantly differ between the groups. CONCLUSIONS: Adolescent patients with bilateral spondylolysis have segmental hyperlordosis of the affected vertebra not only at the L5 level but also at the L4 level.

DOI： 10.31616/asj.2018.12.6.1037

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Language：Japanese   Publisher：日本基礎理学療法学雑誌編集委員会  

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DOI： 10.1002/tsm2.44

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The purpose of this study was to investigate differences in the acute effects of passive knee extension (PKE) and active knee extension (AKE) stretching on the shear elastic modulus of the hamstrings. In 20 healthy men, maximum knee extension (maximum range of motion [ROM]) and shear elastic modulus of the hamstrings (biceps femoris long head, semitendinosus, semimembranosus) were measured before (Pre) and after (Post) AKE and PKE stretching. The maximum ROM during stretching was measured. In both stretching methods, maximum ROM increased and the shear elastic modulus decreased (p<0.01), but no difference was found between the procedures. No significant difference was observed in the maximum ROM during stretching between the procedures (p=0.06). The shear elastic modulus was significantly lower in the biceps femoris long head and semimembranosus than in the semitendinosus muscle (p<0.05). Static stretching with PKE and AKE stretching showed an increase in maximum ROM and a decrease in hamstring elasticity, but no difference was found between the methods. Both stretching protocols were effective for reducing elasticity of the biceps femoris long head and semimembranosus.

DOI： 10.1055/a-0733-6957

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[This corrects the article DOI: 10.1055/a-0733-6957.].

DOI： 10.1055/a-0822-3474

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：金原出版(株)  

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Ichushi

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The in vitro unconstrained Achilles tendon is nearly straight, while in vivo experiments reveal that the proximal region of the Achilles tendon, adjacent to Kager's fat pad, bends ventrally during plantarflexion but remains nearly straight during dorsiflexion. Tendon bending is an important factor in determining the displacement of the foot compared to the shortening of the muscle fibers. The objective of this study was to elucidate the various mechanisms that could cause tendon bending, which currently remain unknown. Examination of Thiel-embalmed cadavers, with preservation of native articular joint mobility, revealed that the Achilles tendon still bent ventrally even when its surrounding tissues, including the skin surface, Kager's fat pad, and distal portions of the soleus muscle were removed. Shear modulus and collagen fiber orientation were distributed homogeneously with respect to the longitudinal line of the tendon, minimizing their causative contributions to the bending. Given that tendon bending is not caused by either the nature of the deformations of the tissues surrounding the Achilles tendon or its physical properties, we conclude that it results from the geometric architecture of the Achilles tendon and its configuration with respect to the surrounding tissues.

DOI： 10.1038/s41598-018-22661-7

PubMed

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J03582&link_issn=&doc_id=20180207440017&doc_link_id=%2Fdp2sport%2F2018%2F002601%2F017%2F0109-0114%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdp2sport%2F2018%2F002601%2F017%2F0109-0114%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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OBJECTIVES: Orthopaedic surgery of the knee joint results in functional deterioration of the quadriceps femoris muscle. However, little is known about quadriceps femoris muscle dysfunction in the early postsurgical period. Therefore, we examined the stiffness of the quadriceps femoris muscle in the early postsurgical period. METHODS: Seven patients and seven healthy controls performed quadriceps contraction exercises. In resting and contraction conditions, the shear modulus, muscle thickness and pennation angle were measured for the vastus medialis (VM), vastus lateralis (VL) and the rectus femoris (RF) using ultrasound elastography. RESULTS: The shear moduli of the VM, VL and RF in the control group did not significantly interact, while the shear moduli in the patient group did show a significant interaction. In the resting condition, there was no difference between the unaffected and affected sides in the patient group, but the shear moduli of the VM and VL in the contraction condition was significantly lower on the affected side than the unaffected side.The contraction ratios between muscles by limbs did not significantly interact. However, there were main effects due to muscle and limb factors. The VM and VL had a significantly higher contraction ratio than the RF, and the control and unaffected limbs had a higher contraction ratio than the affected limb. CONCLUSION: The results demonstrated a decrease in muscle stiffness during contraction in patients with quadriceps femoris dysfunction. Measurement of the shear modulus has potential as a new evaluation index and with high sensitivity to decreases in muscle contraction.

DOI： 10.1136/bmjsem-2018-000381

PubMed

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Language：Japanese   Publisher：日本整形外科超音波学会事務局  

CiNii Research

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Language：Japanese   Publisher：日本整形外科超音波学会事務局  

CiNii Research

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00221-017-5057-6

Web of Science

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Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05805&link_issn=&doc_id=20171201340009&doc_link_id=%2Fch1thrpy%2F2017%2F002002%2F009%2F0061-0069%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch1thrpy%2F2017%2F002002%2F009%2F0061-0069%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Three-dimensional (3D) movement of the clinical subtalar joint (CSTJ) is primarily determined by the morphology of the articular surfaces of the talus. The purposes of this study were to assess the 3D orientation of the CSTJ facets of the talus and the talar head and to determine the tri-axial angular relationship. METHODS: Fifty dry tali were scanned using computed tomography to create a 3D bone model of the talus. The tri-axial angles of the anterior, middle, and posterior facets and the talar head were calculated. A correlation analysis between the angles of the posterior facet and the talar head was also performed. RESULTS: The transverse angle at both the posterior facet and the talar head was significantly correlated with the sagittal angle (r = -0.441, p < 0.001; and r = -0.694, p < 0.001, respectively). The sagittal angle of the posterior facet was significantly correlated with that of the talar head (r = 0.478, p < 0.001). CONCLUSIONS: When the posterior facet of the talus and the talar head exhibits a greater downward and lesser medial orientation, a greater inversion/eversion at the CSTJ should be induced, while an opposite orientation should induce greater plantarflexion/dorsiflexion and medial/lateral rotation at the CSTJ. Our findings will be useful for planning rehabilitation programs and surgical interventions to correct the subtalar joint orientation in clinical settings.

DOI： 10.1007/s00276-017-1851-x

PubMed

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Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：北海道整形災害外科学会  

Ichushi

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Language：Japanese   Publisher：(一社)理学療法科学学会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02929&link_issn=&doc_id=20170425450017&doc_link_id=%2Fca8ryoho%2F2017%2F003202%2F017%2F0249-0254%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca8ryoho%2F2017%2F003202%2F017%2F0249-0254%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：Japanese   Publisher：理学療法科学学会  

DOI： 10.1589/rika.32.249

Ichushi

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Other Link： http://ir.cc.sapmed.ac.jp/dspace/handle/123456789/6984

DOI： 10.15114/sjhs.6.7

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会  

<p>【はじめに，目的】膝関節屈筋は坐骨神経支配であり，電気刺激を用いて坐骨神経を介した最大張力の測定が困難である。我々は磁気刺激によって坐骨神経を刺激し，膝関節屈曲力を誘発する試みを行っている。これまでに磁気刺激によって坐骨神経の最大上刺激ができる対象者とできない対象者が存在することを報告した。磁気刺激は対象までの距離が結果に影響を及ぼすため，刺激部位における坐骨神経の走行と磁気刺激によって得られる誘発収縮力には関係性がある可能性がある。本研究では，殿部での坐骨神経の深度が，経皮的磁気刺激によって誘発される収縮力に及ぼす影響を明らかにすることを目的とした。</p><p></p><p>【方法】健康な成人男性に対して左殿部に経皮的に磁気刺激を行った。磁気刺激は大型円形コイルを磁気刺激装置に接続し，コイル辺縁を刺激部位上に配置して実施した。被験者の姿勢は，ベッド上で股関節，膝関節を屈曲90°とした四つ這い位となり，腹部に台を入れて支持した肢位とした。左殿部を磁気刺激部位とし，坐骨結節と大腿骨大転子を指標に15mm間隔で格子を作成し，絶対座標系を定義した。経皮的磁気刺激は，直径20cmの大型円形コイルを磁気刺激装置に接続し，コイル辺縁を刺激部位上に配置し，末梢方向に誘導電流を流した。刺激部位・条件の決定は我々が報告した方法で実施した。磁気刺激によって誘発される膝関節屈曲力が最大となる刺激部位を探索し，得られた屈曲力を誘発収縮力とした。その後，超音波画像診断装置を用いて刺激部位の坐骨神経を撮像し，体表からの深度を計測した。坐骨神経の深度と得られた誘発収縮力について相関関係を求めた。</p><p></p><p>【結果】坐骨神経の深度と誘発収縮力の間には，有意な負の相関関係があった。</p><p></p><p>【結論】磁気刺激を用いた坐骨神経刺激では，対象者の坐骨神経の深度を確認することで最大上刺激できる対象者を推定できる可能性がある。</p>

DOI： 10.14900/cjpt.2016.0497

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Language：Japanese   Publisher：The Society of Physical Therapy Science  

[Purpose] This study aimed to clarify the effects of the semitendinosus muscle (ST) and biceps femoris muscle (BF) on lower limb kinematics during the late swing phase of sprinting under selective muscle fatigue conditions. [Subjects and Methods] Seven healthy young adults participated in this study. Sprinting trials were performed before and after selective ST and BF muscle fatigue. Torque and median power frequency were analyzed using surface electromyography of voluntary contraction trials to evaluate selective muscle fatigue. Knee/hip flexion angle and knee extension angular velocity were analyzed in sprinting trials during the late swing phase. [Results] Only the ST and BF were tested under selective muscle fatigue conditions. Lower limb kinematics showed no change before and after the sprinting trials. [Conclusion] The ST and BF had no effect on lower limb kinematics during the late swing phase of sprinting.

DOI： 10.1589/rika.32.639

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/ca.22785

PubMed

Web of Science

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Language：Japanese   Publisher：(一社)日本肩関節学会  

Ichushi

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

Ichushi

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Language：Japanese   Publisher：日本基礎理学療法学会学術誌局  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05805&link_issn=&doc_id=20161128310005&doc_link_id=%2Fch1thrpy%2F2016%2F001902%2F005%2F0029-0038%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch1thrpy%2F2016%2F001902%2F005%2F0029-0038%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05805&link_issn=&doc_id=20161128310009&doc_link_id=%2Fch1thrpy%2F2016%2F001902%2F009%2F0065-0071%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch1thrpy%2F2016%2F001902%2F009%2F0065-0071%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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Language：Japanese   Publisher：医学書院  

Other Link： http://search.jamas.or.jp/link/ui/2016258450

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ultrasmedbio.2015.11.022

PubMed

Web of Science

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Language：Japanese  

Other Link： http://ir.cc.sapmed.ac.jp/dspace/handle/123456789/6746

DOI： 10.15114/sjhs.5.45

Ichushi

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Language：Japanese  

DOI： 10.18888/J00767.2016167422

J-GLOBAL

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Language：Japanese   Publisher：金原出版(株)  

Other Link： http://search.jamas.or.jp/link/ui/2016167422

DOI： 10.18888/J00767.2016167422

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Korean Society of Spine Surgery  

DOI： 10.4184/asj.2016.10.5.886

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1142/S0218957716500123

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Other Link： http://ir.cc.sapmed.ac.jp/dspace/handle/123456789/6743

DOI： 10.15114/sjhs.5.19

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J-GLOBAL

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Other Link： http://search.jamas.or.jp/link/ui/2016096406

Ichushi

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Language：Japanese   Publisher：日本基礎理学療法学会学術誌局  

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J05805&link_issn=&doc_id=20160118420009&doc_link_id=%2Fch1thrpy%2F2015%2F001802%2F009%2F0061-0069%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch1thrpy%2F2015%2F001802%2F009%2F0061-0069%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Ichushi

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J-GLOBAL

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本体力医学会  

Ichushi

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Language：Japanese  

Ichushi

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

Ichushi

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Publishing type：Research paper (international conference proceedings)  

DOI： 10.1249/01.mss.0000493756.02885.26

Web of Science

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jelekin.2014.01.003

PubMed

Web of Science

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jelekin.2013.08.010

PubMed

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Other Link： http://search.jamas.or.jp/link/ui/2014040708

Ichushi

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Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(株)文光堂  

Ichushi

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Language：English   Publishing type：Research paper (international conference proceedings)  

Web of Science

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Language：English   Publishing type：Research paper (international conference proceedings)  

Web of Science

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Language：Japanese   Publisher：Japanese Physical Therapy Association (JPTA)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Tokyo  

DOI： 10.1007/s00776-013-0443-9

PubMed

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DOI： 10.1016/j.neulet.2013.02.009

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s12565-011-0117-7

PubMed

Web of Science

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Language：English   Publishing type：Research paper (international conference proceedings)  

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J-GLOBAL

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Language：Japanese   Publisher：全日本病院出版会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1519/JSC.0b013e3181ec86d5

PubMed

Web of Science

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J-GLOBAL

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Other Link： http://ir.cc.sapmed.ac.jp/dspace/handle/123456789/6376

DOI： 10.15114/bshs.13.117

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本体力医学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Web of Science

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Publishing type：Research paper (scientific journal)  

Other Link： http://orcid.org/0000-0003-2832-3656

DOI： 10.1142/S0218957710002466

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Society of Physical Therapy Science (Rigaku Ryoho Kagakugakkai)  

DOI： 10.1589/rika.25.499

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.math.2009.01.003

PubMed

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Language：Japanese   Publisher：文光堂  

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J-GLOBAL

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Language：English   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：全日本病院出版会  

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J-GLOBAL

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Language：Japanese   Publisher：文光堂  

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DOI： 10.15114/bshs.10.11

J-GLOBAL

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Ichushi

J-GLOBAL

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1123/jsr.16.1.2

PubMed

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Language：Japanese   Publisher：文光堂  

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Language：Japanese   Publisher：北海道整形災害外科学会  

Ichushi

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J-GLOBAL

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Human Kinetics Publishers Inc.  

DOI： 10.1123/jsr.15.2.144

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J-GLOBAL

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Language：Japanese   Publisher：医学書院  

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本医療マネジメント学会  

DOI： 10.11191/jhm2000.5.541

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DOI： 10.15114/bshs.8.107

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本医療マネジメント学会  

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Language：Japanese   Publisher：杏林書院  

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Web of Science

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Language：Japanese   Publisher：公益社団法人日本理学療法士協会  

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Language：Japanese  

DOI： 10.11477/mf.1551105587

J-GLOBAL

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Language：English   Publisher：札幌医科大学  

DOI： 10.15114/bshs.3.51

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Language：Japanese   Publisher：札幌医科大学保健医療学部  

Ichushi

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J-GLOBAL

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Language：Japanese   Publisher：北海道スポ-ツ医・科学研究会  

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J-GLOBAL

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DOI： 10.11477/mf.1551104499

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：医学書院  

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J-GLOBAL

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Publishing type：Research paper (international conference proceedings)  

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Total pages：672   Language：Japanese  

CiNii Books

ASIN

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Total pages：251   Language：Japanese  

CiNii Books

ASIN

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Total pages：230   Language：Japanese  

CiNii Books

ASIN

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Other Link： http://mol.medicalonline.jp/library/ebooks/detail?id=4923

Total pages：250   Language：Japanese  

CiNii Books

ASIN

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Other Link： http://mol.medicalonline.jp/library/ebooks/detail?id=4910

Total pages：468   Language：Japanese  

CiNii Books

ASIN

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Total pages：304  

ASIN

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Total pages：246  

ASIN

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Total pages：622   Language：Japanese  

CiNii Books

ASIN

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Total pages：243  

ASIN

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Total pages：263   Language：Japanese  

CiNii Books

ASIN

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Total pages：64   Language：Japanese  

CiNii Books

ASIN

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Total pages：303   Language：Japanese  

CiNii Books

ASIN

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Other Link： http://mol.medicalonline.jp/library/ebooks/detail?id=3873

Total pages：190  

ASIN

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Total pages：150  

ASIN

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Language：Japanese   Publisher：(公社)日本整形外科学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(公社)日本整形外科学会  

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：(公社)日本超音波医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Ichushi

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Language：Japanese   Publisher：北海道整形災害外科学会  

Ichushi

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Language：Japanese   Publisher：日本臨床スポーツ医学会  

CiNii Research

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本足の外科学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

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Language：Japanese   Publisher：(公社)日本整形外科学会  

Ichushi

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：日本整形外科超音波学会  

Ichushi

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Language：Japanese   Publisher：日本カイロプラクティック科学学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

Ichushi

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Language：Japanese   Publisher：(公社)日本整形外科学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本循環器学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本体力医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本スポーツ理学療法学会  

Ichushi

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Language：English   Publisher：(一社)日本基礎理学療法学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本基礎理学療法学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi

researchmap

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

Ichushi