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Kenta Wakamatsu,1 Keishoku Sakuraba,1 Yoshio Suzuki,2 Asako Maruyama,2 Yosuke Tsuchiya,3 Jiro Shikakura,2 Eisuke Ochi31Department of Sports Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan; 2School of Health and Sports Science, Juntendo University, Chiba, Japan; 3Laboratory of Health and Sports Sciences, Meiji Gakuin University, Kanagawa, JapanBackground: Overuse injury including stress fracture is a serious problem for athletes. Recently, the importance of bone metabolism and quality as factors preventing overuse injury has been increasingly recognized. Hence, we hypothesized that markers of bone metabolism and quality are related to overuse injuries.Methods: The subjects, which were elite university lacrosse players (male, n = 35; age, 19.8 ± 1.1; female, n = 49; age, 20.0 ± 1.0), were divided into a stress fracture group and a control group. We measured the subjects’ physical characteristics (height, weight, body mass index, and body fat) and bone architecture was evaluated using quantitative ultrasound. Bone alkaline phosphatase, N-telopeptide cross-link of type I collagen, tartrate-resistant acid phosphatase 5b (TRAP-5b), homocysteine, and pentosidine were measured from blood samples obtained from all subjects.Results: No significant difference was observed between groups with respect to height, weight, body mass index, and body fat, as well as quantitative ultrasound. Further, there were no significant differences in the levels of bone alkaline phosphatase, N-telopeptide cross-link of type I collagen, or TRAP-5b between stress fracture and control groups in all subjects and in male subjects. However, a significant increase in TRAP-5b level was observed in the stress fracture group compared with the control in the female subjects (409.9 ± 209.3 and 318.6 ± 81.6 mU/dL, respectively; P < 0.05). Homocysteine and pentosidine did not differ between groups.Conclusion: These results suggest that osteoclast activity of female athletes with stress fractures may be enhanced by TRAP-5b.Keywords: overuse injury, stress fracture, TRAP-5b

In this study we aimed to clarify the effect of passive exercise with blood flow restriction on the cross-sectional area (CSA) and muscle strength around the knee joint. Seven male college swimmers (Age: 19.1±1.1 yr) volunteered to participate in this study. The right leg of all subjects was assigned to the control condition (CON) and the left leg was assigned to passive exercise with blood flow restriction conditions (PEB). In the PEB leg, passive exercise was performed 3 days per week for 8 weeks. The passive exercise consisted of 3 or 4 sets of repeated (150 times) passive knee extension and flexion using a Biodex unit, separated by 3-minute intervals. Before and after the experimental period, the knee extensor-flexor muscle strength was evaluated in the following settings: concentric contraction at angular speeds of 60, 180 and 300 deg⋅s-1 (CC60, 180 and 300), eccentric contraction at angular speeds of 60 and 180 deg⋅s-1, and isometric contraction. Both knee extensor and flexor muscle CSA was also analyzed with MRI before and after the experimental period. In the knee extensor torque, the extent of increase in strength at CC60 was significantly higher (p<0.05) in the PEB legs (16.1±11.5% than the CON legs (4.6±4.8%). Although the CSA of knee extensor and flexor muscles was significantly increased after the experimental period in the both legs (p<0.01, respectively), the percent changes in the CSA of the knee extensor muscles were significantly (p<0.05) higher in the PEB legs (5.2±2.5%) than the CON legs (2.5±1.5). Passive exercise with blood flow restriction could be an effective intervention to increase both muscle volume and strength. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate how WGH affects pitchers' muscle injuries during strength training. The subjects were five students who are expert athletic throwers (all them have won prizes on a national level). An amount of WGH hat provided a 27.0 g intake glutamine or placebo was taken on five consecutive days. The experiment had a double blind crossover design. To allow sufficient intake WGH or placebo, the examinees took it twice; the internal between the first and the second experiments had to belong enough. To investigate the muscle injury, subjects underwent biochemical examination of their blood (CK, GOT, GPT, LDH, WBC) when they were in a stable condition, immediately after exercise, and after 24 hours after strength training. The results showed that only in the placebo group was an increase and significant (p<0.05) difference in CK between the stable condition to 24 hours after the exercise confirmed. The GOT and GPT levels changed from the stable condition to 24 hours after exercise (GOT: p<0.01, GPT: p<0.05), and it was higher in the placebo group than the experimental group. There was also a significant (p<0.05) difference in the WBC from the stable condition to immediately after exercise, and it showed a higher result in the placebo group. As a consequence, the possibility that WGH intake is useful to control muscle injuries during throwers' strength training was proved. It was also proved that controlling the muscle injury would help improve the efficiency of the training. [ABSTRACT FROM AUTHOR]

We aimed to examine the effects of blood flow restriction on changes in muscle strength and cross-sectional area (CSA) of the lower extremity. The left ankle of 10 healthy Japanese subjects (6 males and 4 females, age: 21.7±1.2 yrs) was immobilized with a cast and they were instructed to use crutches when walking to impose a no weight bearing situation on the lower extremities for two weeks. During this period, the subjects were divided into either the control (CON) group or the blood flow restriction (BFR) group. Before and after the experimental period, we evaluated knee extensor-flexor and ankle plantar flexor muscle strengths, and circumferences and muscle CSAs the lower extremity in the two groups. Knee extensor-flexor and ankle plantar flexor muscle strengths significantly decreased (p<0.05) in the CON group. Knee extensor and ankle plantar flexor muscle strengths also decreased significantly (p<0.05) in the BFR group, but the % decreases in both muscle strengths were significantly smaller in the BFR group than those in the CON group (p<0.05). The CSA of the knee extensor-flexor muscle significantly decreased (p<0.05) and that of the ankle plantar flexor muscle tended to decrease in the CON group, whereas the CSA of the knee flexor and ankle plantar flexor muscles did not decrease in the BFR group. The blood flow restriction prevented muscle weakness and atrophy induced by immobilization and no weight bearing in the flexor muscle, and diminished them in the knee extensor and ankle plantar flexor muscles. [ABSTRACT FROM AUTHOR]

We investigated risk factors of hamstring muscle strain injury in female university soccer players. Fifty-two female soccer players were measured during medical check-ups, and were classified into 12 legs with injury and 92 legs without injury. The range of motion (ROM) of the hip joint and muscle tightness tests were measured to identify risk factors of hamstring muscle strain injury. The results showed that the average range of hip external rotation in the hamstring muscle strain injury group was significantly higher than that in the control (p<0.05). In addition, heel to buttocks distance, which is one of the quadriceps muscle tightness tests, also showed significant difference (p<0.05). In conclusion, we suggest that the hip external rotation and the tightness of the quadriceps (HBD) are important risk factors of hamstring muscle strain injury. [ABSTRACT FROM AUTHOR]

Vestibular and visual functions were evaluated in adult patients with congenital deafness. To evaluate the balance function, the one-leg standing test and stabilometry were conducted. For both tests, no significant difference from the normal subjects was noted when their eyes were open; but in many instances, the results were inferior to those of the normal subjects when the eyes were closed. To test the vestibular function, a caloric test and vestibular evoked myogenic potential test were conducted. Compromised function of the semicircular canal function was noted in 4 but the results had no correlation with those obtained from the vestibular function tests. The visual function was evaluated by using the lateral dynamic visual acuity test: it was found that the patients performed better than the normal subjects. It was concluded that adults with congenital deafness maximize their superior visual capability to compensate for their vestibular function: thus they are capable of high level athletic performances that are equal to those of normal subjects. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of body weight, body mass index (BMI), and lifestyle on bone mineral density (BMD) in post-menopausal females. Subjects were 774 post-menopausal females(mean age 61.3 ± 7.1 yr, mean age of menopause 50.2 ± 3.3yr). Dual energy x-ray absorptiometry (DEXA) was used to measure BMD. Also, height, weight, and BMI were measured, and all subjects answered a questionnaire about lifestyle including physical activity routine, nutrition, and luxury goods. As a result, significant positive interrelations between weight and BMD (r = 0.255, p<0.01) and between BMI and BMD (r = 0.142, p<0.05) were found. Also, by comparing the BMI in the underweight group, normal group, and overweight group, BMD was significantly higher in the overweight group than in the underweight group (p<0.05), but the overweight group was not significantly higher than the normal group. From the questionnaire on lifestyle, significant differences in consuming dairy products and drinking were detected (p<0.05). In conclusion, these results indicate that maintaining standard body weight is effective in preventing osteoporosis, and applying physical stress is effective supportively. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects of home exercises by watching VTR on QOL for middle-age and elderly persons. The subjects were 38 middle-age and elderly persons. All subjects attended a lecture and took the training session for health promotion. Then, they started stretching and training (the home exercises) by watching VTR 2 to 5 times a week repeatedly for 8 weeks. ADL test (one-legged standing with eyes close, one-legged standing with eyes open, sit-ups, and stand up and sit down) , range of motion of shoulder and knee joints, flexibility and bone metabolic marker (NTxCr) were measured on subjects before and after the home exercises for 8 weeks. Of all subjects, 68.4% continued the home exercises for 8 weeks, and 34.2% continued the exercises for 3 months. The result of the sit ups test and stand up and sit down test changed significantly between before and after the home exercises (p<0.001) . But bone metabolic marker did not change significantly between before and after the home exercises. In conclusion, these findings suggest that the home exercise by watching VTR is effective for QOL, but in order to continue the home exercises, we need to keep in contact with the subjects. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Prospective cohort study. OBJECTIVES: In this prospective cohort study of elite sprinters, muscle strength of the hip extensors, as well as of the knee extensors and flexors, was measured to determine a possible relationship between strength deficits and subsequent hamstring injury within 12 months of testing. The method used for testing muscle strength simulated the specific muscle action during late swing and early contact phases when sprinting. BACKGROUND: There have been no prospective studies in elite sprinters that examine the concentric and eccentric isokinetic strength of the hip extensors and the quadriceps and hamstring muscles in a manner that reflects their actions in late swing or early contact phases of sprinting. Consequently, the causal relationship between hip and thigh muscle strength and hamstring injury in elite sprinters may not be fully understood. METHODS AND MEASURES: Isokinetic testing was performed on 30 male elite sprinters to assess hip extensors, quadriceps, and hamstring muscle strength. The occurrence of hamstring injury among the subjects was determined during the year following the muscle strength measurements. The strength of the hip extensors, quadriceps, and hamstring muscles, as well as the hamstrings-quadriceps and hip extensors- quadriceps ratios were compared. RESULTS: Hamstring injury occurred in 6 subjects during the 1-year period. Isokinetic testing at a speed of 60 degrees /s revealed weakness of the injured limb with eccentric action of the hamstring muscles and during concentric action of the hip extensors. When performing a side-to-side comparison for the injured sprinters, the hamstring injury always occurred on the weaker side. Differences in the hamstrings-quadriceps and hip extensors-quadriceps strength ratios were also evident between uninjured and injured limbs, and this was attributable to deficits in hamstring strength. CONCLUSION: Hamstring injury in elite sprinters was associated with weakness during eccentric action of the hamstrings and weakness during concentric action of the hip extensors, but only when tested at the slower speed of 60 degrees /s.J Orthop Sports Phys Ther. 2008;38(8):457-464, published online 15 April 2008. doi:10.2519/jospt.2008.2575. [ABSTRACT FROM AUTHOR]

This study aimed to examine the causes of injuries by comparing the contents of practice in high school baseball teams in each region. 683 coaches of high school baseball teams in five different prefectures were selected as the subjects of this study, and the number of valid answers were 223(32.7%). The questionnaire provided to the subjects included a team profile as well as the contents of practice, and history of injuries in players. The 223 subjects were divided into two regions such as the Kanto region and Tohoku-Koshinetsu region by the annual amount of snow fall. The results revealed no significant difference in the length of regular practice time in school days between the regions: however, warm-up time in the Kanto region was significantly shorter than in the Tohoku-Koshinetsu region throughout one year (p<0.001) . Also, the practice time during the fall and winter season in the Tohoku-Koshinetsu region was significantly shorter than the time in the Kanto region (p<0.001). Moreover, the result shows that the injuries in the shoulder (28.7%). elbow (24.1%), and lower back (15.5%) were the most typical injuries in high school baseball players. However, it also showed that players in different regions tended to have different injuries in different body parts. For instance, players in the Kanto region tended to have injuries due to overuse such as chronic injuries in the lower back and ankles. On the other hands, players in the Tohoku-Koshinetsu region tended to hurt their hamstrings and quadriceps mainly as muscle strain. The possible reasons for this result are different circumstances such as the contents of practice, length of practice time. and different school systems because of the different weather and climate in each region. Therefore, guidance on injury prevention has to fit each region in order to be more effective in high school baseball players. [ABSTRACT FROM AUTHOR]

PURPOSE The aim of this study is to compare injury patterns, the incidence of snowboard and skiboard injuries with those of ski injuries in 2000-2005. SUBJECTS & METHODS: The subjects were skiers (1,240 cases), snowboarders (2,220 cases) and skiboarders (132 cases) who were injured in two ski resorts located in Niigata prefecture in Japan and visited our clinics in both ski resorts between 2000 and 2005. On visiting the clinic, patients completed a questionnaire reviewing the circumstances surrounding the injury event and an attitude survey on helmets and protectors, and doctors documented the diagnosis. RESULTS: Injury rates, which were based on all the lift-tickets purchased, in snowboarding were decreased gradually, though were still twice as high as those in skiing. Snowboarding and skiboarding have a higher rate of serious injury, fracture and dislocation, and a four times higher stunt injury rate than that in skiing. Interestingly the characteristics of skiboarding injuries were a lower head and neck injury rate and collision injury rate than any other snow sport. CONCLUSIONS: Injury-prevention strategy should focus on coaching correct and safe methods of performing stunts for snowboarders and skiboarders attending the snowboard park. [ABSTRACT FROM AUTHOR]

This study investigated the effect of isokinetic training under restricted blood flow conditions with pressure. Subjects were 21 athletes of the track and field club of Juntendo University. The subjects were classified into four training groups: A group/High speed under restricted blood flow conditions with pressure), B group (Low speed under restricted blood flow conditions with pressure), C group (High speed without restricted blood flow conditions) and D group (Low speed without restricted blood flow conditions). The training session consisted of three sets and ten times of knee extension and flexion using an isokinetic training machine (BIODEX system 3). The training period was 4 weeks and regular training twice a week was conducted in this period. Before and after the training period, subjects' quadriceps muscular strength of concentric contraction (CC) and eccentric contraction (EC) were measured by isokinetic contraction, thigh diameter and MRI inspection only in the group with restricted blood flow conditions with pressure. As the rate of quadriceps muscular strength increased, a significant difference between A group and C group, and between C group and D group was revealed in part of the velocity degree. In the muscular volume measurement by MRI, there was no significant difference in A group and also B group. There was no significant increase even in the comparison between A group and B group. These results indicate that isokinetic resistance training with high speed and restricted blood flow conditions with pressure has an effect on muscular strength improvement. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine the effect of low-load muscular training on the quadriceps under restriction of blood flow at various pressure levels. The subject were 21 healthy men. They were classified into four groups depending upon the pressure applied to the thigh, Group A (no pressure), Group B(pressure level of 50mmHg), Group C (pressure level of 150mmHg), and Group D (pressure level of 250mmHg). Three kinds of low-load isometric training were conducted three times a week for eight weeks. The knee extensor torque under isometric and isokinetic contraction and the knee extensor fatigue under isokinetic contraction were measured before and after training for eight weeks. Also, cross sectional areas (CSA)of the quadriceps of the pressure groups were measured. In addition, ratings of perceived exertion (RPE) were investigated. The knee extensor torque was significantly higher in Group B after the training. These results were of trained in concentric contractions (CC)at 180 and 300 degrees per second (deg/sec)and eccentric contractions at 60 deg/sec (p<0.01, p<0.05). CC at 180 and 300 deg/sec and isometric contractions increased significantly in Groups C and D (p<0.01, p<0.05). Group A, however, did not show any differences. In the knee extensor fatigue tests, there were no significant differences. Both Groups B and C tended to show increases in muscle work. Groups B and C showed significantly greater increases than Group A in the rate of increasing knee extensor torque (CC180 deg/sec) (p<0.05). No significant changes were observed in the CSAs of quadriceps after training. RPE scores of Groups B and C were lower than that of Group D. These results show that low-load muscular training at low pressure is a more effective and safer muscular training modality. [ABSTRACT FROM AUTHOR]

< MRI for stress fracture > Early diagnosis and treatment for stress fractures are important to enable a return to full athletic activities as soon as possible. We investigated the early diagnostic efficacy of MRI for stress fractures. Subjects were 38 patients (39 limbs)whose ages ranged from 12 to 27 years(mean, 20 years). Each patient was examined by MRI, plain radiography, and bone scintigraphy during the same period. The signal change was more evident in the femur and lateral malleolus and tarsal navicular bone, but, signal changes of tibia stress fractures were varied. The subjects examined by MRI within 2 weeks from onset showed obvious signal change, but their plain radiograms at the same time revealed no abnormalities. These subjects diagnosed in the early stage by MRI could return to sports earlier than those diagnosed 4 or more weeks after onset. < Bone metabolism markers(BMM)and bone mineral density(BMD)for stress fracture > We investigated the bone metabolism markers(BMM)and bone mineral density(BMD)in female long-distance runners of a university. Subjects were 14 female runners. As BMM, we investigated PICP, osteocalcin, AL-P(bone), DPD, and NTx. As BMD, femoral neck, knee and lumber vertebrae were investigated at the stage between rest and hard training. In runners with amenorrhea or with stress fracture, NTx was markedly higher and BMD was lower than in female runners with normal menstruation. These factors are good markers for studying the condition of female runners. [ABSTRACT FROM AUTHOR]

The present study aimed to prove the effectiveness of low-load resistance muscular training under moderate restriction of blood flow. Twelve limbs of 6 healthy male adults were studied. In each subject, one lower limb was subjected to blood flow restriction (group R) and the other lower limb was not subjected to blood flow restriction (group N), and low-load resistance lower limb muscular training was conducted 3 times weekly for 8 weeks. Knee extensor torque, muscular discharge at the M. vastus lateral is and M. vastus medialis, and the cross-sectional area of the knee extensor muscle group were measured before training and after training for 8 weeks. and the results were evaluated. Results of knee extensor torque (isometric contraction at 60° knee flexion) showed significant augmentation (p<0.05) of muscular strength in group R compared to group N. In the M. vastus lateralis, a significant increase (p<0.05) in muscular discharge was observed in group R compared to group N. No significant difference in the pre- / post-training ratio of the muscular cross-sectional area was observed between the two groups. These results confirmed that low-load resistance muscular training under moderate restriction of blood flow is an effective muscular training for healthy adults without muscular atrophy. [ABSTRACT FROM AUTHOR]

A prospective study was conducted to examine the effects of introducing low load muscular training under moderate restriction of blood flow during the first 16 weeks after anterior cruciate ligament (ACL)reconstruction. Forty-two subjects with a mean age of 29 years(18 to 52 years)were randomized into a group in which training under blood flow restriction (group R, n=22)was conducted and a group in which training under no restriction(group N, n=22) was conducted, with both groups following the same training schedule. Evaluations of knee extensor torque and knee flexor torque(isometric contraction at 60° knee flexion, isokinetic contraction at angular velocities of 60° and 180° per sec) before surgery and 16 weeks after surgery showed a significant increase in muscular strength in group R compared to group N. The preoperative 16-week postoperative ratio of the cross-sectional area of knee extensor muscles showed a significant enlargement in group R compared to group N. At week 16 after surgery, the short diameters of type 1 fibers and type 2 fibers of M. vastus lateralis tended to be larger in group R(n=8)compared to group N(n=8), although the differences were not significant. These results demonstrate that low-load resistance muscular training under moderate restriction of blood flow is an effective exercise method for early muscular training after ACL reconstruction. [ABSTRACT FROM AUTHOR]

This research analyzes muscle soreness and serum CK activity between maximal running and supramaximal running, which sprinters regularly perform in their training program. Subjects (n=16) were asked to perform maximal running on the first week of the session and supramaximal running on the second week. Subjective sensations of muscle soreness and serum CK activity were assessed before, immediately after, 1day and 2days after running each week. All subjects had regularly undergone tow training to improve stride frequency during training-season. Supramaximal running was performed by using an isotonic motor-driven towing-system. Following maximal running, significant muscle soreness was reported at immediately after, 1day and 2days after, and the relative value for serum CK activity was significantly increased at immediately after (136%), 1day (160%) and 2days after(131%). Following supramaximal running, significant muscle soreness was reported at immediately after, 1day and 2days after, and the relative value for serum CK activity was significantly increased at immediately after (134%)and 1day after (125%). Between maximal and supramaximal running, there were no significant differences for muscle soreness and serum CK activity at immediately after, 1day and 2days after running. Data do not show that supramaximal running has a positive effect on muscle soreness and serum CK activity to be increased for the sprinters and training program in this study. In conclusion, this research shows that tow training has no negative effects on muscle soreness and serum CK activity for sprinters who are accustomed to supramaximal running. [ABSTRACT FROM AUTHOR]

This study aimed to examine the effects of restriction of blood flow on disuse muscular atrophy and weakness around the knee joint by non-weight bearing. The subjects were 15 healthy men. They were divided into three groups : Group A (restriction of blood flow), Group B (isometric training), Group C (control). We monitored the changes in their muscular strengths and circumferences of the femoral regions for two weeks. In Group A, the muscular strength of the knee extensor and flexor did not significantly change between before and after the experiment. The percent of decrease in muscular strengths was significantly smaller in Group A than those of Group B and C. The decrease in circumferences of the femoral regions after two weeks in Group A tended to be smaller than those of Group B and C. In conclusion, these findings suggest that the restriction of blood flow is an effective method of rehabilitation. [ABSTRACT FROM AUTHOR]

Human salivary amylase secretion increases in response to stress; the activity has been reported to rise significantly with high-intensity exercise. The human salivary amylase gene (AMY1) has copy number variation, with the copy number correlating with salivary amylase activity. However, the relationship between individual AMY1 copy number and salivary amylase activity in response to exercise remains unclear. In this study, we investigated AMY1 copy number and fluctuations in amylase activity in 42 healthy university students (25 males and 17 females). Participants engaged in intermittent round-trip interval training on a basketball court. Saliva samples were collected pre- and post-exercise to measure amylase activity. DNA was extracted from the oral mucosa, and AMY1 copy number was quantified using RT-PCR. Results showed a significant increase in amylase activity postexercise. Additionally, amylase activity pre- and post-exercise was positively correlated with AMY1 copy number. The generalize linear model showed that the exercise-induced increase in amylase activity per AMY1 gene was negatively related to the AMY1 copy number and aerobic fitness. Gender has no effect on amylase activity. These results suggest a different mechanism for the constitutive and exercise-induced amylase secretion, while aerobic fitness may be independently involved in the secretion., (© 2024 The Author(s). Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Objectives: The current study compared the outcome after orthopaedic surgeries in patients with rheumatoid arthritis receiving Janus kinase inhibitors (JAKis) versus biologic disease-modifying anti-rheumatic drugs (bDMARDs)., Methods: This was a retrospective observational study of Japanese patients with rheumatoid arthritis. Sixty-two patients with rheumatoid arthritis using JAKi preoperatively underwent orthopaedic surgeries. Using propensity score matching, these 62 patients were matched with 62 patients using bDMARDs preoperatively. The number of adverse events was counted. We also examined whether the drug-withholding period in the JAKi-treated group was associated with the occurrence of major postoperative adverse events, namely inflammatory flares and delayed wound healing., Results: JAKi-treated patients had a higher incidence of postoperative flares than bDMARD-treated patients (29% versus 12.1%, P = .01). The incidences of postoperative complications other than flares were not significantly different between the two groups. Among the JAKi-treated group, a longer perioperative drug-withholding period (≥11 days) was associated with a higher incidence of postoperative flares (P = .04). The incidences of delayed wound healing and surgical site infection were not associated with the duration of the JAKi-withholding period., Conclusions: JAKi-treated patients had a higher incidence of postoperative flares than bDMARD-treated patients. A total of ≥11 days of drug withdrawal was associated with postoperative flares., (© Japan College of Rheumatology 2024. Published by Oxford University Press.)

Isolated adrenocorticotropic hormone deficiency (IAD) is a rare pituitary disorder that can cause adrenal insufficiency. However, due to its nonspecific symptoms, its diagnosis is often difficult and may be delayed. Patients with IAD require lifelong glucocorticoid (GC) replacement therapy. Contrastingly, GC-induced secondary adrenal insufficiency is a reversible condition that arises when patients receiving GC therapy reduce their GC dosage or discontinue therapy. Differentiating between IAD and GC-induced secondary adrenal insufficiency is clinically crucial. We report a unique case that required differentiation between these two conditions. A 71-year-old Japanese woman presented with symptoms of adrenal insufficiency after discontinuation of GC therapy for eosinophilic esophagitis. We conducted detailed interviews and repeated the endocrinological examinations. We concluded that her symptoms were owing to IAD rather than GC-induced secondary adrenal insufficiency. She began a lifelong hydrocortisone replacement therapy. This case suggests that when caring for patients undergoing GC therapy, it is important to consider the possibility of coexisting IAD and arrange endocrinological examinations if signs of adrenal insufficiency arise during the gradual reduction of GC treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Iwamura et al.)

We studied the effects of rheumatoid arthritis (RA) autoantibodies that target malondialdehyde-acetaldehyde protein adducts (anti-MAA) on inflammation and macrophage functions. We detected a profound reprogramming of gene expressions and the production of chemokines, such as CCL22 and CCL24, in anti-MAA exposed macrophages. Moreover, anti-MAA pretreatment promoted a more inflammatory cytokine profile upon TLR activation. Although anti-MAA are typically multi-reactive, we observed a prominent clonal diversity in inducing macrophage activation. Anti-MAA antibodies were not arthritogenic in mice, but altered a set of cytokine and growth factor encoding genes in the joints. In individuals at risk of RA anti-MAA IgG levels correlated with circulating inflammatory mediators prior to and at arthritis onset. Certain IgG anti-MAA clones may thus contribute to an inflammatory priming of the joint prior to the onset of systemic inflammation via inducing FcγR-mediated macrophage pre-activation and setting the stage for augmented responses to subsequent inflammatory stimuli., Competing Interests: Declaration of competing interest The authors have no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Synovial tissue-resident macrophages (STRMs) maintain normal joint homeostasis in a steady state. However, it is unclear whether STRMs still play homeostatic roles or change the functions in the joint of rheumatoid arthritis (RA), where infiltrating peripheral blood monocyte-derived macrophages (PBMoMs) play proinflammatory roles. In the present study, we examined changes in the phenotypes and functions of STRMs in response to RA-related stimuli in vitro . STRMs were prepared from non-inflammatory osteoarthritis (OA) joint synovium, which is histologically indistinguishable from normal joint synovium. PBMoMs were prepared and used for comparison. After stimulation with plate-bound IgG, which mimics anti-citrullinated protein antibody immunocomplex formed in RA joints, or with combinations of RA-related inflammatory mediators, namely tumor necrosis factor-α (TNF-α) and prostaglandin E2 or interferon-γ, PBMoMs downregulated surface markers and genes associated with anti-inflammatory macrophages, and upregulated cytokine and marker genes of proinflammatory macrophages in RA. On the other hand, STRMs hardly changed the expression of surface molecules and marker genes but altered the pattern of cytokine gene expression after stimulation like PBMoMs. Furthermore, in vitro stimulated STRMs promote proinflammatory functions of cocultured synovial fibroblasts. Thus, STRMs might play proinflammatory roles in RA joints, while maintaining their phenotypes in the steady state.

Objectives: The treatments for rheumatoid arthritis (RA) have been greatly improved, and the tight control of disease activity yields superior clinical outcomes. This study aimed to elucidate the accompanying changes in hip destruction following the implementation of a treat-to-target strategy for patients with RA., Methods: We extracted 190 hips over two periods, i.e. the early period (1998-2003) and the late period (2013-19), with 103 and 87 hips, respectively. The observed rheumatic changes, such as inward migration, upward migration, and femoral head collapse, were quantitatively evaluated, while osteoarthritic changes, such as the formation of a capital drop, were investigated from radiographs before primary total hip arthroplasty., Results: A comparison of the two periods' data showed that the degree of inward migration (-3.44 vs. -7.45 mm; P < .001) and upward migration (+4.3 vs. +0.95 mm; P < .001) significantly decreased in the late-period group. The collapse of the femoral head was not significantly different. The incidence of capital drops was significantly higher in the late-period group (7.8% vs. 27.5%; P < .001)., Conclusions: The degree of inward and upward migration representative of rheumatic changes reduced, whereas the frequency of capital drops as osteoarthritic changes increased during the late period., (© Japan College of Rheumatology 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: The study aimed to comprehend the clinical features and outcomes of surgical treatments for spinal disorders in patients with ankylosing spondylitis (AS)., Methods: This retrospective study enrolled patients with AS who underwent spine surgery between 2000 and 2019 in our facility., Results: Thirteen patients with AS underwent spine surgeries. The mean age was 56.2 years, and the mean disease duration was 25.1 years at the time of surgery. Nine patients had vertebral fracture, two had kyphotic deformity, and two had myelopathy due to the spinal ligament ossification. Fracture cases included five patients with secondary pseudarthrosis/delayed palsy due to conservative treatment failure. Spinal fixation was performed in all patients. Pedicle subtraction osteotomy for kyphosis and laminectomy for myelopathy were also conducted. All patients improved after surgeries. One patient with kyphotic deformity underwent additional surgery of bilateral hip prosthesis, which resulted in better spine alignment. Four cases of perioperative complications were observed., Conclusion: Myelopathy was newly found as the aetiology requiring surgery in patients with AS. This summarized case series could help physicians to identify patients with surgically treatable spinal disorders among patients with AS., (© Japan College of Rheumatology 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Recently, microneedling as a cosmetic product has attracted attention as one way to improve skin barrier function and moisturizing function to reduce wrinkle formation. However, some cases of erythema and edema have been reported as side effects. In order to develop safer microneedle cosmetics, we investigated whether microneedles can improve skin barrier function and moisturizing function even when applied in a non-invasive manner that does not penetrate the stratum corneum. We established the condition of non-penetrating microneedle application on reconstructed human full-thickness skin models and examined the effect on the skin models when microneedles were applied under this condition. Microneedle application increased the gene expression of serine palmitoyltransferase long chain base subunit (SPTLC) 3, filaggrin, and transglutaminase 1. The amount of ceramide produced by SPTLC was also increased by microneedle application. Gene expression of filaggrin-degrading enzymes and the amount of free amino acids, a product of filaggrin degradation, were also increased by microneedling. These results suggest that non-invasive microneedle application can improve skin barrier function and moisturizing function by increasing the amount of ceramide and natural moisturizing factors.