Characteristics of gene expression in frozen shoulder

Severe frozen shoulder (FS) is often resistant to treatment and can thus result in long-term functional impairment. However, its etiology remains unknown. We hypothesized that gene expression of FS would vary by synovial location. The synovial tissues of patients with FS were collected prospectively and analyzed for the expression of 19 genes. Synovial tissues from patients with rotator cuff tear (RCT) or shoulder instability (SI) were also analyzed as controls. A total of 10 samples were analyzed from each group. The specimens were arthroscopically taken from three different locations: rotator interval (RI), axillary recess (AX), and subacromial bursa (SAB). Total RNA was extracted from the collected tissues and was analyzed by real-time polymerase chain reaction for the following genes: matrix metalloproteinases (MMPs); tissue inhibitors of metalloproteinases (TIMPs); inflammatory cytokines (IL1B, TNF, and IL6); type I and II procollagen (COL1A1 and COL2A1); growth factors (IGF1 and TGFB1); neural factors (NGF and NGFR); SOX9; and ACTA2. Site-specific analysis showed that MMP13, IL-6, SOX9, and COL1A1 were increased in all three sites. Four genes (MMP3, MMP9, COL2A1, and NGFR) were increased in the AX, MMP3 in the RI, and NGFR in the SAB were increased in the FS group than in the RCT and SI groups. In the FS group, there was a correlation between the expression of genes related to chondrogenesis (MMP2, IGF1, SOX9, COL2A1, NGF, and NGFR) or fibrosis (MMP9, TGFB1, and COL1A1). The expression levels of numerous MMPs, pro-inflammatory cytokines, and collagen-related genes were increased in the FS group, suggesting that catabolic and anabolic changes have simultaneously occurred. In addition, genes related to chondrogenesis or fibrosis were highly expressed in the FS group, which might have affected the range of motion limitation of the shoulder. Compared to RI and SAB, the AX was the most common site of increased expression in FS. Analyzing the lower region of the shoulder joint may lead to the elucidation of the pathogenesis of FS.


大学生における遺伝子教育の効果

大学生における遺伝子教育の効果


Knee Pain Experienced by Amateur Cyclists and Factors Affecting It

アマチュアサイクリストの膝痛とその影響因子について

Japanese Journal of Clinical Sports Medicine

日本臨床スポーツ医学会誌


Muscle thickness and echo-intensity in the vastus intermedius after anterior cruciate ligament injury

前十字靭帯損傷後の中間広筋の筋厚と筋輝度 ∼超音波診断装置による解析∼

日本臨床スポーツ医学会誌


Survey on Athletic Performance after lower limbs stress fracture among mid- and long-distance athletes

下肢疲労骨折後の競技力の調査∼男子高校生及び大学生の中長距離選手における検討∼

日本臨床スポーツ医学会誌


Characteristics of muscle stiffness in the lower limb skeletal muscles of healthy individuals Analysis of muscle stiffness with the application of ultrasound elastography

健常者における下肢骨格筋の筋硬度の特性∼超音波エラストグラフィを利用した筋硬度の解析∼

Objective:To investigate the lower limb skeletal muscle stiffness in healthy individuals.

Methods:Using ultrasonographic elastography, we measured the degree of stiffness of the rectus femoris and medial head of the gastrocnemius in healthy individuals and investigated the relationships between muscle stiffness and thickness, a quantitative measure of muscles, and between muscle stiffness and brightness, a qualitative measure of muscles. Furthermore, relationships between muscle stiffness and age, body weight, and body mass index (BMI) were also studied.

Results:Rectus femoris stiffness was positively correlated with muscle thickness. Rectus femoris stiffness had a weak negative correlation with muscle brightness and a weak positive correlation with body weight and BMI. Stiffness of the medial head of the gastrocnemius showed no correlation with any of the study variables. Muscle stiffness did not correlate with age in either of the muscles. No sex-related difference was found in the degree of muscle stiffness.

Conclusion:Although rectus femoris stiffness was associated with muscle thickness and brightness, these relationships were not observed for muscle stiffness of the medial head of the gastrocnemius. The data suggested that rectus femoris stiffness reflects the quantitative and qualitative states of the muscle, and the presence of such relationships may depend on the location of the muscle.

目的:健常者における下肢骨格筋の筋硬度の特性について調査すること．

方法:超音波エラストグラフィを利用して，健常者の大腿直筋と腓腹筋内側頭の筋硬度を計測し，筋硬度と筋の量的指標である筋厚，筋の質的指標である筋輝度との関係性を調査した．また，筋硬度と年齢・体重・BMIとの関係性についても検討した．

結果:大腿直筋の筋硬度は，筋厚と正の相関があり，筋輝度とは弱い負の相関がみられた．また，体重やBMIとは弱い正の相関がみられた．一方，腓腹筋内側頭では，筋硬度と相関する因子はなかった．いずれの筋も筋硬度と年齢に相関はなかった．また，筋硬度に性差はなかった．

結論:大腿直筋の筋硬度は，筋厚および筋輝度と関係していたが，腓腹筋内側頭では，それらの関連性はみられなかった．大腿直筋における筋硬度は，骨格筋の量および質的状態を反映することが示唆されたが，このような関係性は筋の部位によって異なる可能性がある．

The Japanese Journal of Rehabilitation Medicine


持久性運動後の血糖変動から糖尿病リスクを検出できるか?

持久性運動後の血糖変動から糖尿病リスクを検出できるか?


【筋から始まるからだの適応】 骨格筋再生を加速させる温熱負荷法の可能性

【筋から始まるからだの適応】 骨格筋再生を加速させる温熱負荷法の可能性

Journal of Health, Physical Education and Recreation


Effects of continuous mild changes in temperature on myogenesis in human skeletal myoblasts

筋損傷を科学する 持続的温度変化がヒト筋芽細胞の増殖・分化へ与える効果とその分子メカニズム

The Journal of the Japanese Orthopaedic Association


α5β1 integrin induces the expression of noncartilaginous procollagen gene expression in articular chondrocytes cultured in monolayers.

The result of this study has shown, for the first time, that 51 integrin may be responsible for the induction of non-cartilaginous collagen expression in chondrocytes undergoing dedifferentiation. Again, this study has shown that the inhibition of ligand ligation to integrins may be an effective strategy to inhibit phenotypic change of cultured chondrocytes, and to improve the quality of matrix synthesized by primary cultured chondrocytes.


Distinct and additive effects of sodium bicarbonate and continuous mild heat stress on fiber type shift via calcineurin/NFAT pathway in human skeletal myoblasts.

Ingestion of sodium bicarbonate (NaHCO3) is known to enhance athletic performance, probably via increased extracellular buffering capacity. At present, little is known about the direct effects of NaHCO3 on myogenesis, especially in vitro. Here, we examined the effects of NaHCO3 and the combined effects of NaHCO3 and continuous mild heat stress (CMHS) at 39°C on the differentiation of human skeletal muscle myoblasts (HSMMs). Levels of myosin heavy chain (MyHC) type I mRNA increased with increasing NaHCO3 concentrations; in contrast, those of MyHC IIx decreased. The NaHCO3-induced fast-to-slow shift was additively enhanced by CMHS. Likewise, intracellular calcium levels and expression of three factors, nuclear factor of activated T cells c2 (NFATc2), NFATc4, and peroxisome-proliferator-activated receptor-γ coactivator-1α, were upregulated with increasing NaHCO3 concentrations; moreover, these effects of NaHCO3 were additively enhanced by CMHS. Overexpression experiments and small interfering RNA-mediated knockdown experiments confirmed that NFATc2 and NFATc4 were involved in MyHC I regulation. The present study provided evidence that NaHCO3 and CMHS distinctly and additively induced a fast-to-slow fiber type shift through changes in intracellular calcium levels and the modulation of calcium signaling.

American Journal of Physiology, Cell Physiology


αvβ5 integrin promotes dedifferentiation of monolayer-cultured articular chondrocytes.

When cultured in monolayers, articular chondrocytes undergo an obvious phenotypic change. Although the involvement of integrins has been suggested, the exact mechanisms of the change have not been determined. This study was undertaken to clarify the mechanisms underlying the loss of chondrocyte phenotype early after plating. Primary cultured human articular chondrocytes were used for the experiments. Involvement of respective integrins in the phenotypic change was investigated in RNA interference (RNAi) experiments. A signaling pathway involved in the change was identified in experiments using specific inhibitors and adenoviruses encoding mutated genes involved in the pathway. Adenoviruses carrying mutated GTPases were used to determine the involvement of small GTPases in the process. In monolayer-cultured chondrocytes, suppression of αv or β5 integrin expression by RNAi inhibited morphologic changes in the cells and increased (or prevented a reduction in) the expression of various cartilage matrix genes. Consistent results were obtained in experiments using a blocking antibody and a synthetic inhibitor of αvβ5 integrin. The decrease in cartilage matrix gene expression in chondrocytes after plating was mediated by ERK signaling, which was promoted primarily by αvβ5 integrin. In articular chondrocytes, the affinity of αvβ5 integrin for ligands was regulated by the small GTPase R-Ras. R-Ras was gradually activated in monolayer-cultured chondrocytes after plating, which caused a gradual decline in cartilage matrix gene expression through enhanced αvβ5 integrin activation and the subsequent increase in ERK signaling. Our findings indicate that αvβ5 integrin may be involved in the change that occurs in monolayer-cultured chondrocytes after plating.


Continuous mild heat stress induces differentiation of mammalian myoblasts, shifting fiber type from fast to slow.

Local hyperthermia has been widely used as physical therapy for a number of diseases such as inflammatory osteoarticular disorders, tendinitis, and muscle injury. Local hyperthermia is clinically applied to improve blood and lymphatic flow to decrease swelling of tissues (e.g., skeletal muscle). As for muscle repair following injury, the mechanisms underlying the beneficial effects of hyperthermia-induced muscle repair are unknown. In this study, we investigated the direct effects of continuous heat stress on the differentiation of cultured mammalian myoblasts. Compared with control cultures grown at 37 degrees C, incubation at 39 degrees C (continuous mild heat stress; CMHS) enhanced myotube diameter, whereas myotubes were poorly formed at 41 degrees C by primary human skeletal muscle culture cells, human skeletal muscle myoblasts (HSMMs), and C2C12 mouse myoblasts. In HSMMs and C2C12 cells exposed to CMHS, mRNA and protein levels of myosin heavy chain (MyHC) type I were increased compared with the control cultures. The mRNA level of MyHC IIx was unaltered in HSMMs and decreased in C2C12 cells, compared with cells that were not exposed to heat stress. These results indicated a fast-to-slow fiber-type shift in myoblasts. We also examined upstream signals that might be responsible for the fast-to-slow shift of fiber types. CMHS enhanced the mRNA and protein levels of peroxisome proliferator-activated receptor-gamma coactivator (PGC)-1alpha in HSMMS and C2C12 cells but not the activities of MAPKs (ERK1/2 and p38 MAPK) in HSMMs and C2C12 cells. These data suggest that CMHS induces a fast-to-slow fiber-type shift of mammalian myoblasts through PGC-1alpha.


Age-related increase of insoluble, phosphorylated small heat shock proteins in human skeletal muscle.

Among mammalian heat shock proteins (Hsps), small Hsps (sHsps) are constitutively expressed in skeletal muscles. We investigated age-related changes of phosphorylation and cellular distribution of representative sHsps (Hsp27 and alphaB-crystallin) in human vastus lateralis muscle under resting conditions. We also examined upstream kinases which may be responsible for phosphorylation of sHsps, namely p38 mitogen-activated protein kinase (MAPK), MAPK-activated protein kinase-2, and extracellular signal-regulated kinase-1/2. The study groups consisted of nine young (15-38 years old) and nine aged (51-79 years old) patients who underwent orthopedic surgery. sHsps protein levels were higher in the insoluble fraction of aged muscles. The phosphorylated states of sHsps were enhanced in both the soluble and insoluble fraction of aged patients. The phosphorylated form of each upstream kinase was elevated in aged patients. Ubiquitinated proteins accumulated in the insoluble fractions of aged muscles. Aging mechanisms may affect the activation process of MAPKs, and the phosphorylation and accumulation of sHsps.

The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences


A Case of Femoral Neck Fracture Due to Amyloid Bone Cyst of a Patient Undergoing Long-Term Hemodialysis

長期血液透析患者に生じたAmyloid Bone Cystによる大腿骨頸部骨折の一例

We report a case of femoral neck pathological fracture due to amyloid bone cyst. The patient was a 45-year-old female who had been undergoing hemodialysis for 24 years, who developed large amyloid bone cysts of the femoral neck and acetabulum. She visited our hospital after experiencing hip pain while riding a bus.She was diagnosed with a femoral neck pathological fracture and treated with non-cemented prosthetic replacement of the femoral neck, curettage and bone grafting of the acetabulum cyst. Pathological study of the tissue revealed amyloid deposits. Diagnosis of femoral neck fractures due to amyolid bone cyst, should be considered when examining patients under going long-term hemodyalisis with hip pain.


後外側構成体における膝窩筋の運動学的意義について 解剖学的検索

後外側構成体における膝窩筋の運動学的意義について 解剖学的検索

九州·山口スポーツ医·科研究会誌

九州·山口スポーツ医·科研究会誌


全身性エリテマトーデスに合併したKienboeck病の1例

全身性エリテマトーデスに合併したKienboeck病の1例


Kienboeck病に合併した手根管症候群の1例

Kienboeck病に合併した手根管症候群の1例


The Relationship Between the Range of Motion in the Ankle and Body Mass Index

Japanese Journal of Orthopaedic Sports Medicine


Osteitis fibrosa cystica generalizata with adult T-cell leukaemia: a case report.

We report on a 62-year-old female initially suffering from extreme pain in both her lower extremities. Plain radiographs revealed multiple osteolytic lesions. Laboratory analyses indicated high levels of serum calcium and parathyroid hormone related protein (PTHrP) and detected HTLV-1 antibody. Histological examination of biopsied specimens which were obtained from osteolytic lesions indicated osteitis fibrosa cystica (OFC) without tumour cells. After the initial biopsy, a subcutaneous mass developed in the left thigh. Microsections of the biopsied mass disclosed adult T-cell leukaemia (ATL) neoplastic cells. Immunohistochemical findings revealed that PTHrP secreted from ATL neoplastic cells induced the OFC.


Results of Cementless Total Hip Arthroplasty using Osteonics Prosthesis

Osteonics型人工股関節の術後成績 : ステム側について

We present the results of 42 total hip arthroplasties using Osteonics femoral components with a mean follow-up period of 25 months (range, 12 to 60 months). Femoral components with arc deposition (AD) have been evaluated in 14 patients, while those with hydroxyapatite (HA) coating in 28 patients. The clinical results of both femoral components were excellent. The average Japan Orthopaedic Association hip score increased from 44 prior to the operation to 90 at the time of the last follow-up. All radiographs of both groups were measured to examine the presence of reactive line, cancellous condensation and subsidence. The reactive line occurred in 2 hips (14%) of the AD group at zones I and VII which contain a porous coating of the stem, but none in the HA group after 1 to 2 years. Cancellous condensation occurred in the HA group, more than the AD group, significantly at zone II. Our radiological results show that the HA coating can provide durable implant fixation.


Clinical Results of Implant Arthroplasty for Avascular Necrosis of Femoral Head

大腿骨頭壊死に対する人工関節手術の予後

We investigated the operative results of 26 patients (34 hips) treated by hemiarthroplasty (Prosthesis)or total hip arthroplasty (THA) for avascular necrosis of the femoral head (ANF) classified according to the etiology.Clinical results using JOA hip score averaged 79.7 points in prosthesis and 91.2 points in THA after surgery. There was no correlation between them.On X-ray findings, the rate of loosening was shown for 23.1% of prosthesisind-ucedusing of steroid and 30.0% of prosthesis induced alcohol drinking. There was no loosening in THA.It is important to prevent loosening in prosthesis in ANF induced-steroid and induced-drinking.


Operative Treament of Hip Disease in Patients with Renal Failure

腎不全患者における股関節疾患の治療経験

We experienced 10 cases with hip disease for renal failure for 5 years. 10 patients with an average age of 54.3 years underwent operative treatment. They consisted of 3 hip fractures, 2 avascular necrosis of the femoral head, 2 coxarthrosis' and 3 ectopic calcification of the hip joint. The average hemodialysis period was 9.3 years, and the average follow-up period was 2.9 years.1 femoral neck fracture case showed nonunion after fixation with screws, for which we performed cemented bipolar hemiart-hroplasty. Revision was however required due to osteolysis around the prosthesis. Because the ratio of loosening due to hemodialys is still high, further tmprorement of the operation is neccessary.


外傷性股関節後方脱臼に合併した骨頭骨折の治療成績

外傷性股関節後方脱臼に合併した骨頭骨折の治療成績


中高年者への水中運動・水泳に伴う障害の予防対策の検討

中高年者への水中運動・水泳に伴う障害の予防対策の検討


ソフトボールピッチャーに生じた尺骨茎状突起骨折

ソフトボールピッチャーに生じた尺骨茎状突起骨折


A Case of Adult T-cell Leukemia with a Pathological Fracture

病的骨折を呈した成人T細胞白血病の1例

A 62 year-woman was admitted with pain in the chest, lower back and both lower extremities in January 1995. Clinical findings revealed osteolytic lesions and hypercalcemia. She sustained a subtrochanteric fracture of the left femur after a fall. We treated the fracture with an intramedullary nail. Biopsy of the osteolytic lesions around the fracture demonstrated osteitis fibrosa cystica with no surrounding tumor cells. After the operation, we demonstrated positive HTLV-1 antisera and a high level of CD4, CD4/CD8 and CD25. In June, a subcutaneous tumor appeared in the left thigh. The biopsy demonstrated a T-cell lymphoma, and we confirmed a diagnosis of ATL. Serum PTHrP was high and serum intact PTH low, suggesting that the cause of the osteolytic lesions was PTHrP originating from the ATL tumor cells.


Loose Bodies in the Bursa around the Shoulder Joint:A report of two cases

肩関節における滑液包内遊離体の2例

The shoulder joint is a relatively rare site for loose bodies of the synovium. In this study we present two cases with loose bodies in the bursa around the shoulder joint.Case 1: A 42-year-old male who had swelling and discomfort with limitation of motion of the right shoulder. Roentgenogram and CT scan showed destruction of the acromion and retention of fluid on the subacrominal brrsa. Operative findings revealed numerous loose bodies. A definite diagnosis of tuberculous bursitis was revealed by histological examination due to the presence of granulation and caseous necrosis.Case 2: An 88-year-old female had been suffering from right shoulder pain for 7 years. Roentgenogram showed numerous radiodense bodies in the right shoulder joint. CT scan and MRI also revealed the same findings. Numerous loose bodies removed from the shoulder were found to be a combination of cartilage and bony tissue. Histologically, this case was diagnosed as synovial osteochondromatosis.In both cases, the lesion was treated by removal of the loose bodies and a partial synovectomy with satisfactory results. From this study, it can be concluded that in cases with loose bodies around the joints, the final diagnosis can be made after histological examination.


Clinical Experience of Two Cases of Synovial Osteochondromatosis of the Hip.

股関節の synovial osteochondoromatosis 2症例の治療経験

We experienced two cases of synovial osteochondromatosis of the hip.Case 1, a 12-year old boy complained of limitation in his right hip motion. Roentgenograms showed many small calcified or ossified particles in the right hip joint. We performed synovectomy, and found the hip joint to be filled with more than two hundred calcified loose bodies. Range of motion of the hip recovered after surgery. Microscopic examination, revealed the synovium to have an osseous and cartilaginous lesion.Case 2, a 24-year-old man complained of right coxalgia and limitation of right hip motion since he was 20 years old. Roentgenograms showed right hip joint space narrowing and osteoporosis. Hip tuberculosis or pigmented villonodular synovitis was Suspected. However, gadolinium (Gd) enhanced MRI with fat suppression showed enhanced hypertrophic synovium and no enhanced nodular lesion in the synovium. Therefore, this case was diagnosed as synovial oeteochondromatosis of the hip joint. Synovectomy revealed hypertrophy of the synovium, and osteochondromatosis were seen matted within the synovium. There were no loose bodies in the joint space. However, this case achieved only a small improvement in his range of motion post-operatively. Microscopic examination, the synovium had many cartilaginous lesions, but there was few ossiferous lesion.We consider that Gd enhanced MRI with fat suppression is useful for the early diagnosis of synovial osteochondromatosis that has not been ossified.


Limb Function after Wide Resection of Quadriceps Muscle for Soft Tissue Sarcomas.

大腿四頭筋を広範囲切除した悪性軟部腫瘍症例の患肢機能

We studied the relationship between quadriceps muscular defects and limb functions in 12 patients with soft tissue sarcomas around the thigh who had undergone wide resections. To determine the degree of muscular defects, we divided the quadriceps muscle into 4 compartments, namely, rectus femoris, vastus medialis, vastus intermedius and vastus lateralis. The lower limb function was evaluated according to the criteria of the Musculo-Skeletal Tumor Society, Japan Orthopaedic Association. Twelve patients were divided into the following 3 groups, Group 1; 1 compartment, Group 2; 2 compartments, and Group 3; 3 and 4 compartments. Of 12 patients, Group 1, 2, and 3 included 6, 3 and 3 patients, respectively.The average total scores in Group 1, 2 and 3 were 24, 22 and 17 points out of 25 points, respectively. The decrease in the average total scores with the increase in muscular defects was affected by the scores in function, walking ability and gait appearance. This study suggests that limb function after resection of the quadriceps can be predicted.


高齢大腸がん患者における腹腔鏡下切除術の術後炎症に関与する因子

高齢大腸がん患者における腹腔鏡下切除術の術後炎症に関与する因子


慢性関節リウマチ患者に対するInsall-Burstein II型人工膝関節置換術の治療成績

Medical Journal of Nagasaki-Chuo National Hospital

国立長崎中央病院医学雑誌


慢性関節リウマチ患者における人工膝関節置換術後のQOL評価

慢性関節リウマチ患者における人工膝関節置換術後のQOL評価

国立長崎中央病院医学雑誌