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Objective: This study aims to clarify the relationships between foot strike patterns and dynamic parameters during running. Methods: The study included 25 participants (17 males and 4 females; mean ± SD age, 21.1 ± 0.3 years; weight, 60.0 ± 6.6 kg; and height, 166.7 ± 7.4 cm) who had no reported foot or ankle injuries in the past 6 months. Dynamic parameters were collected with a 9-camera motion capture system using a Plug-in Gait full-body marker set, dynamic navicular drop marker set, and 3 force plates (sampling rate, 200 Hz). The participants each completed five running trials. Dorsiflexion angle during initial contact (IC) and ankle moment (AM) and dynamic dorsiflexion range of motion (DDR) peak values were calculated. Furthermore, dynamic navicular drop (DND) was determined by calculating the difference between the navicular height at heel contact and minimum navicular height during the stance phase. Pearson correlation coefficients were calculated between the IC and other variables, with p-value of <0.05 considered as statistically significant. This study was approved by the Ethics Committee for Human Research, Gunma Paz University, Takasaki, Japan. Results: A significant positive correlation was found between IC and DDR during running (p = 0.026, r = 0.444). There were no significant correlations between IC and AM (p = 0.609, r = -0.018) or DND (p = 0.165, r = -0.285). Conclusion: A relationship was found between IC and DDR, indicating that further the IC occurs into plantar flexion, the greater the decrease in dorsiflexion. However, IC was not associated with AM or arch. Clinical implications: It may be possible to determine dynamic dorsiflexion during the stance phase in running based on IC. It should be determined whether this variable is a risk factor, taking the other physiotherapy assessments into consideration. [ABSTRACT FROM AUTHOR]

[Purpose] This study aimed to calculate the windlass mechanism in one walking cycle (WC) using the medial longitudinal arch (MLA) height and compare its mechanism with joint moments, angles, and center of gravity movement. [Participants and Methods] The study analyzed the gait of 20 healthy adults (14 males, six females) using a three-dimensional motion analyzer to calculate several parameters. [Results] In the terminal stance, the MLA height reached 20.6 ± 6.0 mm (minimum value) at 49% WC. Simultaneously, the ankle dorsiflexion angle, ankle internal plantarflexion moment, and forward shift of the center of gravity reached the maximum values. At 62% WC, the MLA height was 26.8 ± 4.8 mm and reached maximum during the stance phase, indicating a windlass mechanism. Additionally, the MLA height was 61.7 ± 22.7 mm at 69% WC, indicating an MLA spiking phenomenon. [Conclusion] The MLA height was lowest at 49% WC due to reverse windlass mechanism. Although the windlass mechanism was activated at 62% WC, it was functionally equivalent to the swing phase. Push-off was impossible during the swing phase. At 69% WC, the swing phase showed a second windlass mechanism., Competing Interests: Authors declare no conflicts of interest associated with this manuscript., (2024©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Case: A 14-year-old adolescent girl sustained an open fracture of the foot after jumping off a building. Initial radiographs revealed large bone defect in the distal metaphysis of the comminuted tibia. The comminuted distal tibia was reconstructed by external fixation and internal fixation with bridge plating, followed by the Masquelet technique. After 12 months, the fracture healed without infection, and the patient could walk independently., Conclusion: In the case of a comminuted fracture of the contaminated distal tibia with a large bone defect, plate fixation and the Masquelet technique produced good outcomes., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C12)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by homozygous deletion or intragenic mutation of the SMN1 gene. It is well-known that high copy number of its homologous gene, SMN2, modifies the phenotype of SMN1-deleted patients. However, in the patients with intragenic SMN1 mutation, the relationship between phenotype and SMN2 copy number remains unclear., Methods: We have analyzed a total of 515 Japanese patients with SMA-like symptoms (delayed developmental milestones, respiratory failures, muscle weakness etc.) from 1996 to 2019. SMN1 and SMN2 copy numbers were determined by quantitative polymerase chain reaction (PCR) method and/or multiplex ligation-dependent probe amplification (MLPA) method. Intragenic SMN1 mutations were identified through DNA and RNA analysis of the fresh blood samples., Results: A total of 241 patients were diagnosed as having SMA. The majority of SMA patients showed complete loss of SMN1 (n = 228, 95%), but some patients retained SMN1 and carried an intragenic mutation in the retaining SMN1 (n = 13, 5%). Ten different mutations were identified in these 13 patients, consisting of missense, nonsense, frameshift and splicing defect-causing mutations. The ten mutations were c.275G > C (p.Trp92Ser), c.819&#95;820insT (p.Thr274Tyrfs*32), c.830A > G (p.Tyr277Cys), c.5C > T (p.Ala2Val), c.826 T > C (p.Tyr276His), c.79C > T (p.Gln27*), c.188C > A (p.Ser63*), c.422 T > C (p.Leu141Pro), c.835-2A > G (exon 7 skipping) and c.835-3C > A (exon 7 skipping). It should be noted here that some patients with milder phenotype carried only a single SMN2 copy (n = 3), while other patients with severe phenotype carried 3 SMN2 copies (n = 4)., Conclusion: Intragenic mutations in SMN1 may contribute more significantly to clinical severity than SMN2 copy numbers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Background and Aim: Spinal muscular atrophy (SMA) is a lower motor neuron disease with autosomal recessive inheritance caused by homozygous SMN1 deletions. Although SMA has been considered as incurable, newly developed drugs improve life prognoses and motor functions of patients. To maximize the efficacy of the drugs, SMA patients should be treated before symptoms become apparent. Thus, newborn screening for SMA is strongly recommended. In this study, we aim to establish a new simple screening system based on DNA melting peak analysis. Materials and Methods: A total of 124 dried blood spot (DBS) on FTA ® ELUTE cards (51 SMN1 -deleted patients with SMA, 20 carriers, and 53 controls) were punched and subjected to direct amplification of SMN1 and CFTR (reference gene). Melting peak analyses were performed to detect SMN1 deletions from DBS samples. Results: A combination of allele-specific polymerase chain reaction (PCR) and melting peak analyses clearly distinguished the DBS samples with and without SMN1 . Compared with the results of fresh blood samples, our new system yielded 100% sensitivity and specificity. The advantages of our system include (1) biosafe collection, transfer, and storage for DBS samples, (2) obviating the need for DNA extraction from DBS preventing contamination, (3) preclusion of fluorescent probes leading to low PCR cost, and (4) fast and high-throughput screening for SMN1 deletions. Conclusion: We demonstrate that our system would be applicable to a real-world newborn screening program for SMA, because our new technology is efficient for use in routine clinical laboratories that do not have highly advanced PCR instruments.

A 69-year-old woman underwent 4 months of imatinib mesylate chemotherapy for a diagnosed gastrointestinal stromal tumor of the esophagus. This treatment was suspended because of its side effects and because radiological examinations showed that the tumor had not changed or had even increased slightly in size. Thus, we performed esophagectomy via left thoracotomy and removed a tumor that measured 18 × 17 × 10 cm. Immunohistochemical examination revealed positive reactions for c-kit and CD34, suggestive of a high-risk malignancy. The patient was discharged from hospital on postoperative day 30, and has remained well with no sign of tumor recurrence for more than 5 years, without adjuvant chemotherapy.

Purpose: Reconstruction with free jejunal graft (FJG) has been widely accepted for patients undergone pharyngo-cervical esophageal resection. Those patients often suffer variety of complications regarding postoperative peros function. We investigated risk factors especially focused on the development of dysphagia after FJG reconstruction., Methods: A retrospective analysis was conducted using clinical chart review of 30 consecutive patients who underwent reconstruction with a FJG after pharyngo-laryngoesophagectomy from 1995 to 2010. Mortality, morbidity, and postoperative dysphagia were investigated. Dysphagia was defined when the patients required enteral nutrition until later than 1 month postoperatively without any other complications, including anastomotic leakage, anastomotic stricture, FJG ischemic necrosis, and hospital death. Data on potential clinical factors were extracted and the relation of these variables to postoperative dysphagia was examined by univariate and multivariate analysis., Results: There was one patient with hospital death over total 30 patients who deceased due to fatal postoperative bleeding from arterial anastomosis of FJG. Postoperative complications occurred in 14 patients (46.7%) those included respiratory complication in 5, anastomotic leakage 3, FJG ischemic necrosis 2, paralytic ileus 2, ischemic change of tracheostomy 2, anastomotic stricture 1 and dysphagia 9. Dysphagia was the most frequent in this series. Multivariate analysis demonstrated induction radiation (≥60 Gy) was independently significant factors for postoperative dysphagia., Conclusion: FJG reconstruction may be safe and functionally satisfactory surgical option after pharyngo-laryngo-esophagectomy. Postoperative dysphagia may be induced prior radiation therapy.

Background/aims: The aim of the present study was to clarify the results and feasibility of surgical approaches for cancer, which is mainly occupied by squamous cell carcinoma (SCC), of the lower esophagus., Methodology: Forty-four patients (34 men, 10 women) with cancer located at the lower esophagus were enrolled in this study. SCC was diagnosed in 36 cases and adenocarcinoma (ADC) in 8 cases. Thirteen patients underwent transhiatal esophagectomy, 18 underwent lower thoracic esophagectomy by left thoracotomy, and 13 underwent esophagectomy with a right thoracic approach by open thoracotomy or thoracoscopy., Results: Ten cases (ADC, n = 2; SCC, n = 8) showed involvement of mediastinal lymph nodes, although lymph node dissection varied with each surgical approach. Five-year survival rates were 75% for ADC and 31.9% for SCC, and ADC tended to be associated with a more favorable prognosis than SCC (p = 0.058). Transhiatal esophagectomy was performed more often in older patients (p < 0.05), but no other clinicopathological parameters appeared to affect the selection of surgical approach. No significant prognostic differences existed between surgical approaches (p = 0.35), even though the examination was limited to SCC (p = 0.98)., Conclusions: No significant prognostic differences were identified between transhiatal and left and right transthoracic approaches for lower esophageal cancer.

We present a patient with myasthenia gravis in whom sugammadex failed to restore the train-of-four ratio (TOFR) sufficiently. When the patient's TOFR count had recovered to 2, we administered 2 mg/kg of sugammadex. However, the TOFR did not recover to the preoperative value. An additional 2 mg/kg of sugammadex also had no effect. We then administered 30 μg/kg of neostigmine which restored the TOFR to more than the preoperative value. We speculate that exacerbation of myasthenia symptoms during surgery interfered with recovery of TOFR after sugammadex administration.

The aim of this study was to evaluate the utility of lymph node metastasis classification based on the number of positive stations in patients undergoing surgical management of esophageal cancer. Of 257 patients who underwent curative esophagectomy, 126 patients with lymph node involvement underwent assessment of nodal metastasis mode according to the 7th edition of the TNM classification (UICC), and the Japanese Guidelines for the Clinical and Pathological Studies on Carcinoma of the Esophagus. Lymph node metastasis mode was divided into single station (S) and multi-station (M) groups. The S group was subclassified into single-node-single-station (SS) or multi-node-single-station (MS), and the M group was subclassified into multi-station in pN1 (2 metastasis positive nodes; MM-pN1) or multi-station in pN2 or 3 (MM-pN2,3) by TNM classification, multi-station-single-area (MMS) or multi-station-multi-areas (MMM). The correlation between prognosis and lymph node metastasis mode was assessed. A total of 47 patients were classified as S (MS, n=11; SS, n=36), and 79 patients were classified as M (MM-pN1, n=12; MM-pN2,3, n=67; MMM, n=55; MMS, n=24). Prognosis was poorer among the M- than in the S-classified patients (p=0.0035), whereas prognosis was not significantly different between the subgroups. In conclusion, lymph node metastasis classification based on the number of metastasis-positive stations is a useful predictor of prognosis in patients undergoing surgical management of esophageal cancer. This system relies on a simple classification method that combines the Japanese classification based on lymphatic spread and the TNM classification based on the number of positive lymph nodes.

Interleukin-10 (IL-10) is an inhibitory cytokine produced by various cell types. It exhibits strong sequence homology to BCRF-1 (viral IL-10, vIL-10), an open reading frame in the Epstein-Barr-virus (EBV) genome. Using in situ hybridization (ISH), polymerase chain reaction (PCR) and immunohistochemistry, we checked 41 cases of nasopharyngeal carcinoma (NPC), to study the presence of EBV in the tumor cells, as well as to clarify the relationship between IL-10 expression of the tumor cells and the response of cytotoxic T cells. IL-10 expression was studied by immunohistochemistry; as a result, 29 of 41 cases expressed EBER-1 RNA of EBV by ISH. In addition, 19 of the 29 with EBV and 9 of 12 without EBV cases expressed IL-10 in the tumor cells. The number of cytotoxic T cells increased in the tumor tissue, and the increase in the intratumoral stroma was stronger than in the remaining normal epithelia. The number of cytotoxic T cells also significantly increased in the cases with EBV. On the other hand, in the IL-10-positive series, the number of cytotoxic T cells decreased significantly more than in IL-10-negative series. In view of the established inhibitory effects of IL-10, expression of IL-10 may therefore be one of the mechanisms for NPC cells as well as EBV to counter local immune defense. However, we could not conclude whether or not IL-10 expression was directly induced by EBV.

A rare case of spindle cell carcinoma (SpCC) of the breast occurring in a 51-year-old Japanese woman is reported. A firm and well-circumscribed tumor, measuring 9 x 8.5 x 8.5 cm, was located on the upper lateral region of the right breast. Microscopically, the tumor consisted of sheets of both malignant spindle cells and poorly differentiated ductal carcinoma containing squamoid islands with gradual transition to the spindle cell component. The immunocytochemical expression of epithelial markers was recognized in the spindle cells, as well as in the carcinomatous cells. Moreover, the spindle cell component expressed vimentin, alpha-smooth muscle actin and S-100 protein. Ultrastructurally, in addition to the features of adenocarcinoma, squamous or myoepithelial differentiation was confirmed in the spindle cell component. These findings thus suggest an epithelial origin with squamous differentiation and myoepithelial participation in the genesis of SpCC. In a comparative study, the expression of p53 protein and Ki-67 as a proliferation marker in each component of this tumor was also investigated. The mean p53 labeling index (LI) in both the carcinomatous and spindle cell area was similar, however the mean MIB-1 LI in the spindle cell area was significantly higher than that in the carcinomatous area. The results indicate that p53 overexpression is involved in the tumorigenesis of both components in the SpCC, and the spindle cell component shows a higher degree of proliferative activity than the carcinomatous component.