Search

Introduction/AimsDuchenne muscular dystrophy (DMD) presents with skeletal muscle weakness, followed by respiratory and cardiac muscle involvement. Recently, with the development of treatments, the need for a natural history to serve as a control for determining treatment efficacy in clinical trials has increased dramatically, however, few large-scale studies have investigated changes in these symptoms. The present study examined the natural history of Japanese DMD patients as a whole and individual patient with genetic mutations eligible for exon skipping therapy.MethodsMedical records of 337 patients with DMD who visited Kobe University Hospital over a period of 30 years from their first visit until 20 years of age were examined.ResultsSerum creatine kinase levels showed a stair-step pattern of decline, with extremely high values until 6 and a rapid decline from 7 to 12 years of age. Both the median 10-meter run/walk velocity and rise-from-floor velocity peaked at the age of 4 years and declined with age. The values for respiratory function declined from the age of 11 years. The median left ventricular ejection fraction was >60% until the age of 12 years and rapidly declined from 13 to 15 years of age. Examination of the relationship between gene mutations eligible for exon-skipping therapy and natural history revealed no characteristic findings.DiscussionWe found that creatine kinase levels and motor, respiratory, and cardiac functions each exhibited unique changes over time. These findings will be useful in developing new therapeutic agents for DMD and in determining their efficacy in clinical trials.

Background Few studies have examined patient satisfaction with playing pre-injury sports after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate patient satisfaction with playing pre-injury sport and identify factors associated with satisfaction. Methods A total of 97 patients underwent unilateral ACL reconstruction using a hamstring autograft and returned to pre-injury sports 1 year after surgery. Patient satisfaction with playing pre-injury sport was assessed by a visual analog scale (VAS) and an ordinal four-grade scale. Problems related to the operated knee were also assessed. Knee muscle strength, single leg hop distance, knee laxity, subjective knee pain, and fear of movement/reinjury using Tampa Scale for Kinesiophobia-11 (TSK-11) were measured. Multivariate linear regression analysis was performed to determine the factors associated with patient satisfaction with playing pre-injury sport 1 year after surgery. Results The average VAS score for patient satisfaction with playing pre-injury sports 1 year after surgery was 77.8 ± 20.2. Of the 97 patients, 87 patients (89.7%) answered “satisfied” or “mostly satisfied”, whereas 51 patients (52.6%) had one or more problems. Multivariate linear regression analysis identified that the TSK-11 score was associated with patient satisfaction with playing a pre-injury sport 1 year after surgery. Conclusion Most of the patients who returned to pre-injury sports were satisfied with their outcomes. In contrast, approximately half of the patients had one or more problems after returning to play pre-injury sports. In particular, fear of movement/reinjury was significantly associated with patient satisfaction with playing pre-injury sport 1 year after surgery.

Background: The relationship between meeting return-to-sport criteria and psychological readiness after anterior cruciate ligament (ACL) reconstruction is unknown. Purposes: To examine (1) whether patients who met 1 of the criteria for return to sport had higher psychological readiness than those who did not meet any of the criteria and (2) if those who met more criteria had higher psychological readiness. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included 144 patients who underwent unilateral ACL reconstruction. All patients had regularly participated in some sport activities before an ACL rupture. At 12 months postoperatively, each patient completed 3 knee function tests (isokinetic quadriceps strength, isokinetic hamstring strength, and single-leg hop distance) and 2 self-reported measures (International Knee Documentation Committee [IKDC] 2000 subjective form and ACL–Return to Sport after Injury [ACL-RSI] scale); the ACL-RSI scale was used to measure psychological readiness to return to sport. The 4 criteria for return to sport were a limb symmetry index (LSI) ≥90% for each of the 3 function tests in addition to an IKDC score ≥90. Multivariate regression analysis was used to determine the association between meeting the individual criteria and the ACL-RSI score. In addition, the patients were divided into 5 groups according to the number of criteria met, and the Kruskal-Wallis and Steel-Dwass tests were used to compare the ACL-RSI scores among the groups. Results: Overall, 23 patients (16.0%) met none of the criteria for return to sport, 27 (18.7%) met 1 of the criteria, 34 (23.6%) met 2 criteria, 35 (24.3%) met 3 criteria, and 25 (17.4%) met all 4 criteria. Meeting the criteria for the hamstring strength LSI ( P = .002), single-leg hop distance LSI ( P = .004), and IKDC subjective score ( P < .001) was each associated with higher ACL-RSI scores. Significant differences in ACL-RSI scores were found between patients who met none versus 2, 3, and 4 of the return-to-sport criteria ( P < .001 for all) and between patients who met 1 versus 4 criteria ( P < .001). Conclusion: Meeting return-to-sport criteria was positively associated with psychological readiness, and the patients who met multiple criteria had higher psychological readiness.

The wide variations in patient demographics and concomitant injuries make the prediction of which patients will regain strength quickly following anterior cruciate ligament (ACL) reconstruction challenging. This study aimed to identify the dominant factor affecting quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft and to construct a predictive model for quadriceps strength recovery using decision tree analysis.Three hundred and eighty-six patients who underwent ACL reconstruction with a hamstring tendon autograft were included in this study. The isokinetic quadriceps strength at 60°/s was measured preoperatively and at 6 months after surgery. The quadriceps strength index (QSI) was calculated by normalising the peak torque of the involved leg with the uninvolved leg and multiplying it by 100. A stepwise multiple linear regression and a decision tree analysis were performed to assess whether or not the following parameters affect quadriceps strength recovery at 6 months: socio-demographic data and maximum isokinetic quadriceps strength.The preoperative QSI, age, and pre-injury Tegner activity scale were independently correlated with quadriceps strength recovery at 6 month after surgery. The decision tree analysis demonstrated that patients were expected to have a QSI ≥85% at 6 months after surgery if they met one of the following conditions: (1) age23 years with a preoperative QSI ≥78.8%, (2) age ≥29 years with a preoperative QSI ≥98.0%, or (3) age16 years with a preoperative QSI58.5% and pre-injury Tegner activity scale ≥9. By contrast, patients ≥29 years with a preoperative QSI98.0% were likely to achieve a quadriceps strength index70% at 6 months after surgery.Based on the results of the decision tree analysis, younger patients could achieve good quadriceps recovery even if they have a lower preoperative QSI, whereas patients ≥29 years need a higher preoperative QSI to obtain good muscle recovery.

Few long-term cohort studies have addressed changes in the ambulatory capacity of patients with Duchenne muscular dystrophy (DMD), and no reports have evaluated the factors associated with ambulatory capacity in Japanese.The longitudinal changes in 10-meter run/walk ability and associated factors were retrospectively investigated using general practice data. The factors associated with loss of this ability before the age of 10 years were explored by logistic regression analysis using parameters of genetic mutations, corticosteroid use, the manual muscle test (MMT), and the joint range of motion (ROM). Explanatory variables of MMT grade included hip flexors, knee flexors, and knee extensors; ROM included hip extension, knee extension, and ankle dorsiflexion.Among 418 patients diagnosed with DMD, 145 patients underwent the 10-meter run/walk test between March 1999 and July 2015. The median age at loss of 10-meter walking ability was 10.4 (interquartile range: 9.2-11.3) years. The 10-meter run/walk speed began to decline 3 years before the loss of 10-meter walking ability, and the median was1 m/s 1 year before the loss of 10-meter walking ability. MMT grade for knee flexors and ROM for hip and knee extension were identified as independent predictors. Based on the change over time of these three items, limitation of the hip extension ROM preceded knee flexor weakness and limitation of the knee extension ROM.This knowledge can be used in optimizing rehabilitation programs and evaluating effect of treatment for DMD patients.

Patients typically return to sports activities 6–12 months after anterior cruciate ligament (ACL) reconstruction, and quadriceps strength has been used as one of the criteria to return to sports activities. The purpose of this study is to identify the factors that affect quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft 6 months after surgery. Isokinetic quadriceps strength at 60°/s was measured preoperatively and 6 months after surgery in 193 athletes who underwent ACL reconstruction with a hamstring tendon autograft. The quadriceps strength index was calculated by normalizing the peak torque of the involved leg with the uninvolved leg. The subjects were divided into two groups according to the quadriceps strength index 6 months after surgery: at least 85 % (n = 84) or less than 85 % (n = 109). Multivariate logistic regression analysis and a receiver operating curve analysis were performed. The preoperative quadriceps strength index [odds ratio (OR) 1.02; 95 % confidence interval (CI) 1.01–1.03], age (OR 0.92; 95 % CI 0.86–0.98), sex (OR 2.45; 95 % CI 1.19–5.18), and knee pain (OR 0.17; 95 % CI 0.04–0.52) were independently associated with quadriceps strength recovery. The cut-off value of the preoperative quadriceps strength index was 70.2 % to obtain at least 85 % quadriceps strength index 6 months after surgery. To achieve sufficient quadriceps strength recovery at the timing of return to sports activities following ACL reconstruction using a hamstring tendon autograft, preoperative quadriceps strength, age, sex, and knee pain should be considered. III.

A 46-year-old woman with the complaint of hypermenorrhea underwent hysterectomy for a presumed uterine myoma. The solid tumor in the myometrium was gray in color, was 4 cm in diameter, and showed hemorrhage and necrosis. Histologically, the tumor consisted of round or polygonal cells arranged in cords and nests, and its histological features closely resembled those of plexiform tumor which has been reported as a benign, epithelioid smooth muscle tumor of the uterus. In the tumor in our patient, however, mild nuclear atypia and two to three mitoses/10 high-power fields were present. Two months after the hysterectomy, the patient was found to have metastatic foci in the lumbar vertebrae and iliac bone, which contained tumor cells with the same histological features. Accordingly, the present tumor might be interpreted as a malignant plexiform tumor of the uterus, an unusual variant of epithelioid leiomyosarcoma.

ACL再建術後患者35例を対象に，術後6ヵ月時のCybex IIによる膝屈伸筋力評価，KT-1000による膝の安定性評価を行った。Cybex IIの結果では，60°/secにおける膝伸展筋力の体重比が65%以上の者(A群)は14例，65%未満の者(B群)は21例であった。KT-1000の結果では，A群では左右差の平均値は2.7±2.8mm，B群では左右差の平均値は0.8±2.7mmであった。A群については，さらに下肢の機能的運動能力テスト(FAT)である片脚8の字跳躍，片脚横跳びおよび片脚幅跳びを行った。その結果では，FATの3つのテスト全てが正常の者は3例，FATの3つのテストのうち少なくとも1つが異常を示した者はn例であった。ACL再建術後6カ月時点での評価として，膝の安定性や膝屈伸筋力の評価だけでなく，FATのような運動能力評価を行う必要があると考えられた。

It can be essential in the new-generation content services to predict the potential demands of people, which they themselves have not recognized or cannot express precisely. Social graphs representing the relationships between people are used for predicting demand in current Internet-based services. However, these graphs cannot represent the relationships of two users residing in common communities or common places. We propose representing not only a person but also things like communities and social events together as a single node in a social graph. This representation allows us to estimate who shares potential interests with a given person. We evaluated the estimation accuracy of our representation using an actual relational dataset from an academic database. Results show that our representation can estimate if two people share common interests that cannot be found with conventional methods that only use human nodes for estimation, and it can estimate the relations without using human nodes.

To predict the efficacy of cisplatin and radiation therapy for maxillary squamous cell carcinoma, we examined the mRNA expression of 14 cisplatin-resistant genes and p53 mutation in specimens biopsied from patients prior to initiation of therapy. Five of 10 patients had mutations in the p53 gene, of whom four had residual tumors pathologically following chemoradiotherapy (p=0.0476). Of 14 genes examined, the mRNA expression of ATP7B was significantly lower in cases that were resistant to chemoradiotherapy. Six genes including multidrug resistance protein 1 (MDR-1), multidrug resistance associated protein 1 (MRP-1), Cu++ transporting, beta polypeptide (ATP7B), xeroderma pigmentosum, complementation group A (XPA), excision repair cross-complementing rodent repair deficiency, complementation group 1 (ERCC-1) and B-cell CLL/lymphoma 2 (BCL2) were down-regulated in cases of recurrent cancers. These results show that the evaluation of p53 mutation provides the most useful predictor of therapeutic effects. In responder cases, the drug-resistant genes that were determined in cell lines by culture do not necessarily translate into clinical relevance.