Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction

[Purpose] Kinesiophobia after anterior cruciate ligament reconstruction has been identified as an inhibitor of return to sports. This study aimed to clarify the relationship between kinesiophobia and knee function 6 months after anterior cruciate ligament reconstruction when the patient intends to return to sports. [Participants and Methods] A total of 66 patients who underwent primary anterior cruciate ligament reconstruction (mean age 17.3 ± 2.6 years, 17 males and 49 females, Tegner activity score ≥7) were included in the study. The 11-item version of Tampa scale of kinesiophobia was used to evaluate kinesiophobia 6 months postoperatively. Knee function was evaluated with knee extension muscle strength, tibial anterior displacement, heel buttock distance, heel height difference, anterior knee pain score, and single-leg hop test. The relationship between Tampa scale of kinesiophobia, patient characteristics, and knee function was investigated. [Results] A low Anterior knee pain score and low single-leg hop test, male gender, and age were significant factors associated with kinesiophobia. [Conclusion] Kinesiophobia was associated with a low anterior knee pain score and low single-leg hop test 6 months after anterior cruciate ligament reconstruction. Patients with a low single-leg hop test score or severe pain may need rehabilitation to reduce kinesiophobia.journal articl

Immediate Effects of Myofascial Release for Peripatellar Soft Tissue on the Knee Function of Patients with Knee Osteoarthritis: A Randomized Controlled Trial

東京都立大学Tokyo Metropolitan University博士（理学療法学）doctoral thesi

Immune Response following Liver Transplantation Compared to Kidney Transplantation: Usefulness of Monitoring Peripheral Blood CD4+ Adenosine Triphosphate Activity and Cytochrome P450 3A5 Genotype Assay

Seventy living donor liver transplantation (LDLT) and 39 kidney transplantation (KT) patients were randomly screened by using the peripheral blood CD4+ adenosine triphosphate activity (ATP) assay (IMK assay). The patients were divided into 2 groups in each organ transplantation with low IMK ATP level (225) (LT-L: n=23, KT-L: n=19, LT-H: n=47, and KT-H: n=20, resp.). The incidence of bacterial and/or viral infection was significantly higher in LT-L group than in LT-H group (74.0 versus 8.5%: P<0.001). Occurrence of total viral infection in KT-L was also significantly higher than that in KT-H (36.8 versus 10%: P=0.046). The sensitivity and specificity of the IMK assay for identifying risk of infection was 0.810 and 0.878 in LDLT patients and 0.727 and 0.607 in KT patients. The percentage of LDLT patients with cytochrome P450 3A5 (CYP3A5) *1/*1 or *1/*3 genotype (expressors) was significantly higher in LT-L group than in LT-H group (53.8 versus 20.7%: P=0.032). In both LDLT and KT patients, the IMK assay can be useful for monitoring immunological aspects of bacterial and/or viral infection. CYP3A5 expressors in LT-L group are related to postoperative infections

生体肝移植時のカルシニューリン阻害薬の体内動態制御におけるマイクロRNAの役割

application/pdf腎移植術後早期にCYP3A5の遺伝子型が欠損型の患者では、免疫抑制薬であるタクロリムスの血中濃度が一過性に上昇することが明らかとなり、その要因としてインターロイキン-6を介したCYP3A4発現量の低下が関与している可能性が示唆された。一方で、臓器移植患者における免疫抑制薬の体内動態の個人差に有意な影響を及ぼすマイクロRNA（miRNA）を同定することができず、miRNAを指標として個別化薬物療法の実現に向け、今後さらなる検討が必要である。Our study demonstrates that blood concentrations of tacrolimus (an immunosuppressant) are transiently elevated in patients with poor metabolizer of CYP3A5 in the early postoperative period of renal transplantation, and this is attributable to decreased CYP3A4 level via interleukin-6. On the other hand, microRNAs (miRNAs) affecting individual variations in the pharmacokinetics of immunosuppressant after organ transplantations was not identified in the present study. Further study is needed to achieve personalized pharmacotherapy with miRNAs.2014年度～2016年度科学研究費補助金(基盤研究(C))研究成果報告書2646019

Immunological Aspects in Late Phase of Living Donor Liver Transplant Patients: Usefulness of Monitoring Peripheral Blood CD4+ Adenosine Triphosphate Activity

Aim. To evaluate whether the combination of the peripheral blood CD4+ adenosine triphosphate activity (ATP) assay (ImmuKnow assay: IMK assay) and cytochrome P450 3A5 (CYP3A5) genotype assay is useful for monitoring of immunological aspects in the patient followup of more than one year after living donor liver transplantation (LDLT). Methods. Forty-nine patients, who underwent LDLT more than one year ago, were randomly screened by using IMK assay from January 2010 to December 2011, and the complete medical records of each patient were obtained. The CYP3A5 genotypes were examined in thirty-nine patients of them. Results. The mean ATP level of the IMK assay was significantly lower in the patients with infection including recurrence of hepatitis C (HCV) () than in those without infection (): 185 versus 350 ng/mL (), while it was significantly higher in the patients with rejection () than in those without rejection (): 663 versus 306 ng/mL (). The IMK assay showed favorable sensitivity/specificity for infection (0.909/0.842) as well as acute rejection (1.0/0.911). CYP3A5 genotypes in both recipient and donor did not affect incidence of infectious complications. Conclusions. In the late phase of LDLT patients, the IMK assay is very useful for monitoring immunological aspects including bacterial infection, recurrence of HCV, and rejection

Myofascial Release on the Patella Alters the Thickness of the Fat Pad and Range of Motion of Knee Osteoarthritis Patients

[Purpose] We performed myofascial release on the patella for knee osteoarthritis (OA) patients and investigated the changes in the knee joint flexion range of motion and infrapatellar fat pad (IFP). [Participants and Methods] This study included 25 medial type primary knee osteoarthritis patients: 70.9 ± 9.9 years old, OA grade 2.1 ± 1.0. The heel buttock distance (HBD) and the thickness of the IFP measured using ultrasonography were measured before and after the treatment. Three myofascial release methods (patella separation release, infra, and supra patella release) were conducted for three minutes. [Results] After the treatment, HBD improved from an average of 14.2 cm to 10.1 cm, and the thickness of IFP decreased from an average of 21.6 mm to 20.7 mm. [Conclusion] Myofascial release on the patella was effective at reducing the HBD. The clinical significance of the change in IFP thickness needs to be further investigated.〔目的〕変形性膝関節症患者の膝蓋骨周囲へ筋膜リリースを実施し，膝関節屈曲可動域および膝蓋下脂肪体（IFP）の厚みの変化を検討した．〔対象と方法〕対象は膝関節屈曲可動域制限を有する高齢女性の内側型変形性膝関節症患者25例（年齢は70.9 ± 9.9歳，OA gradeは2.1 ± 1.0）とした．評価方法は介入前後に殿踵間距離（HBD）を測定し，IFPの厚みは超音波画像による短軸像にて計測した．介入方法は膝蓋骨離開リリース，膝蓋骨上方・下方リリースを各3分間実施した．〔結果〕HBDは平均14.2 cmから10.1 cmと改善し，IFPの厚みは，平均21.6 mmから20.7 mmと減少した．〔結語〕膝蓋骨周囲への筋膜リリースはHBDの改善に有効であった．IFPの厚みの変化による臨床的意義に関しては，今後さらなる検討が必要である．東京都立大学学位論文甲第1249号　副論文journal articl