Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals

Background: Pectoralis minor tightness may be seen in individuals with scapular dyskinesis, and stretching is used for the treatment of altered scapular motion in sports and clinical fields. However, few researchers have reported on the effects of pectoralis minor stiffness on scapular motion during arm elevation. This study investigated whether an acute decrease of pectoralis minor stiffness after stretching changes the scapular motion during arm elevation. Methods: The study allocated 15 dominant and 15 nondominant upper limbs in healthy men as control and interventional limbs, respectively. In the intervention limb group, the shoulder was passively and horizontally abducted at 150° of elevation for 5 minutes to stretch the pectoralis minor muscle. Before and after stretching, an electromagnetic sensor was used to examine 3-dimensional scapular motion during abduction and scaption. Ultrasonic shear wave elastography was used to measure pectoralis minor stiffness before and immediately after stretching and after arm elevation. Results: In the interventional limb, pectoralis minor stiffness decreased by 3.2 kPa immediately after stretching and by 2.5 kPa after arm elevation. The maximal changes in scapular kinematics after stretching were 4.8° of external rotation and 3.3° of posterior tilt in abduction, and 4.5° of external rotation and 3.7° of posterior tilt in scaption. Upward rotation in abduction or scaption did not change. Conclusions: Stretching for the pectoralis minor muscle increases external rotation and posterior tilt of the scapula during arm elevation

Mixing model of Phobos' bulk elemental composition for the determination of its origin: Multivariate analysis of MMX/MEGANE data

The formation process of the two Martian moons, Phobos and Deimos, is still debated with two main competing hypotheses: the capture of an asteroid or a giant impact onto Mars. In order to reveal their origin, the Martian Moons eXploration (MMX) mission by Japan Aerospace Exploration Agency (JAXA) plans to measure Phobos' elemental composition by a gamma-ray and neutron spectrometer called MEGANE. This study provides a model of Phobos' bulk elemental composition, assuming the two formation hypotheses. Using the mixing model, we established a MEGANE data analysis flow to discriminate between the formation hypotheses by multivariate analysis. The mixing model expresses the composition of Phobos in 6 key lithophile elements that will be measured by MEGANE (Fe, Si, O, Ca, Mg, and Th) as a linear mixing of two mixing components: material from Mars and material from an asteroid as represented by primitive meteorite compositions. The inversion calculation includes consideration of MEGANE's measurement errors ($E_P$) and derives the mixing ratio for a given Phobos composition, based on which the formation hypotheses are judged. For at least 65\% of the modeled compositions, MEGANE measurements will determine the origin uniquely ($E_P$ = 30\%), and this increases from 74 to 87\% as $E_P$ decreases from 20 to 10\%. Although the discrimination performance depends on $E_P$, the current operation plan for MEGANE predicts an instrument performance for $E_P$ of 20--30\%, resulting in ~70\% discrimination between the original hypotheses. MEGANE observations can also enable the determination of the asteroid type of the captured body or the impactor. The addition of other measurements, such as MEGANE's measurements of the volatile element K, as well as observations by other MMX remote sensing instruments, will also contribute to the MMX mission's goal to constrain the origin of Phobos.Comment: 34 pages, 7 figures, accepted for publication in Icaru

The X10 Flare on 2003 October 29: Triggered by Magnetic Reconnection between Counter-Helical Fluxes?

Vector magnetograms taken at Huairou Solar Observing Station (HSOS) and Mees Solar Observatory (MSO) reveal that the super active region (AR) NOAA 10486 was a complex region containing current helicity flux of opposite signs. The main positive sunspots were dominated by negative helicity fields, while positive helicity patches persisted both inside and around the main positive sunspots. Based on a comparison of two days of deduced current helicity density, pronounced changes were noticed which were associated with the occurrence of an X10 flare that peaked at 20:49 UT, 2003 October 29. The average current helicity density (negative) of the main sunspots decreased significantly by about 50. Accordingly, the helicity densities of counter-helical patches (positive) were also found to decay by the same proportion or more. In addition, two hard X-ray (HXR) `footpoints' were observed by the Reuven Ramaty High Energy Solar Spectroscopic Imager (RHESSI} during the flare in the 50-100 keV energy range. The cores of these two HXR footpoints were adjacent to the positions of two patches with positive current helicity which disappeared after the flare. This strongly suggested that the X10 flare on 2003 Oct. 29 resulted from reconnection between magnetic flux tubes having opposite current helicity. Finally, the global decrease of current helicity in AR 10486 by ~50% can be understood as the helicity launched away by the halo coronal mass ejection (CME) associated with the X10 flare.Comment: Solar Physics, 2007, in pres

Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle

Background: Stretching maneuvers for the pectoralis minor muscle, which involve shoulder horizontal abduction or scapular retraction, are performed in clinical and sports settings because the tightness of this muscle may contribute to scapular dyskinesis. The effectiveness of stretching maneuvers for the pectoralis minor muscle is unclear in vivo. The purpose of this study was to verify the effectiveness of stretching maneuvers for the pectoralis minor muscle in vivo using ultrasonic shear wave elastography. Methods: Eighteen healthy men participated in this study. Elongation of the pectoralis minor muscle was measured for 3 stretching maneuvers (shoulder flexion, shoulder horizontal abduction, and scapular retraction) at 3 shoulder elevation angles (30°, 90°, and 150°). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the 9 aforementioned stretching maneuver-angle combinations. Results: The shear elastic modulus was highest in horizontal abduction at 150°, followed by horizontal abduction at 90°, horizontal abduction at 30°, scapular retraction at 30°, scapular retraction at 90°, scapular retraction at 150°, flexion at 150°, flexion at 90°, and flexion at 30°. The shear elastic moduli of horizontal abduction at 90° and horizontal abduction at 150° were significantly higher than those of other stretching maneuvers. There was no significant difference between horizontal abduction at 90° and horizontal abduction at 150°. Conclusions: This study determined that shoulder horizontal abduction at an elevation of 90° and horizontal abduction at an elevation of 150° were the most effective stretching maneuvers for the pectoralis minor muscle in vivo

Daikenchuto accelerates the recovery from prolonged postoperative ileus after open abdominal surgery : a subgroup analysis of three randomized controlled trials

Purpose Prolonged postoperative ileus (POI) is a common complication after open abdominal surgery (OAS). Daikenchuto (DKT), a traditional Japanese medicine that peripherally stimulates the neurogenic pathway, is used to treat prolonged POI in Japan. To analyze whether DKT accelerates the recovery from prolonged POI after OAS, we conducted a secondary analysis of three multicenter randomized controlled trials (RCTs). Methods A secondary analysis of the three RCTs supported by the Japanese Foundation for Multidisciplinary Treatment of Cancer (project numbers 39-0902, 40-1001, 42-1002) assessing the effect of DKT on prolonged POI in patients who had undergone OAS for colon, liver, or gastric cancer was performed. The subgroup included 410 patients with no bowel movement (BM) before the first diet, a DKT group (n = 214), and a placebo group (n = 196). Patients received either 5 g DKT or a placebo orally, three times a day. The primary endpoint was defined as the time from the end of surgery to the first bowel movement (FBM). A sensitivity analysis was also performed on the age, body mass index and dosage as subgroup analyses. Results The primary endpoint was significantly accelerated in the DKT group compared with the placebo group (p = 0.004; hazard ratio 1.337). The median time to the FBM was 113.8 h in the placebo group and 99.1 h in the DKT treatment group. Conclusions The subgroup analysis showed that DKT significantly accelerated the recovery from prolonged POI following OAS

心不全を合併した心房細動患者のカテーテルアブレーション後の長期予後 : 左室駆出率に基づいた心不全のサブタイプ間における比較

Aims: Heart failure (HF) prognosis has been reported similar in patients with preserved vs. reduced left ventricular ejection fraction (LVEF). This study compared the long-term prognosis of HF patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). Methods and results: Among 5010 patients undergoing RFCA in Kansai Plus AF registry, 656 patients (13.1%) with a documented history of HF were enrolled in the study before RFCA. The primary endpoint was a composite of all-cause death, HF hospitalization, and stroke or systemic embolism. Patients with reduced (<40%), mid-range (40-49%), and preserved (≥50%) LVEF were 98 (14.9%), 107 (16.3%), and 451 (68.8%) patients, respectively. The prevalence of ischaemic heart disease and cardiomyopathies was higher among patients with reduced as compared with preserved LVEF (27.6% vs. 10.0%, P < 0.05 and 36.7% vs. 15.3%, P < 0.05, respectively). The median follow-up period was 2.9 years. The 3-year cumulative risk for the primary endpoint was higher in patients with reduced LVEF (32.7%) compared to those with mid-range (11.7%) or preserved (11.6%) LVEF (P < 0.001). Reduced LVEF was the most significant independent risk factor for primary endpoint (hazard ratio, 2.83; 95% confidence interval 1.74-4.61, P < 0.001). The 3-year arrhythmia recurrence rate was similar among the groups (48.2%, 42.8%, and 47.3%, respectively, P = 0.75). Conclusion : This study raises hypothesis that patients with HFrEF and AF had approximately three times higher risk for a composite of all-cause death, HF hospitalization, and stroke or systemic embolism after AF ablation compared with patients with HFmrEF or HFpEF.博士（医学）・甲第802号・令和3年12月21日Copyright: © Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021.This is a pre-copyedited, author-produced version of an article accepted for publication in Europace following peer review. The version of record "Europace Online ahead of print (2021 Aug 31;euab201) is available online at: https://doi.org/10.1093/europace/euab201.発行元が定める登録猶予期間終了の後、本文を登録予定（2022.08

Protocol for a multicentre, prospective, cohort study to investigate patient satisfaction and quality of life after immediate breast reconstruction in Japan: the SAQLA study

Introduction The aim of breast reconstruction (BR) is to improve patients' health-related quality of life (HRQOL). Therefore, measuring patient-reported outcomes (PROs) would clarify the value and impact of BR on a patient's life and thus would provide evidence-based information to help decision-making. The Satisfaction and Quality of Life After Immediate Breast Reconstruction study aimed to investigate satisfaction and HRQOL in Japanese patients with breast cancer who undergo immediate breast reconstruction (IBR). Methods and analysis This ongoing prospective, observational multicentre study will assess 406 patients who had unilateral breast cancer and underwent mastectomy and IBR, and were recruited from April 2018 to July 2019. All participants were recruited from seven hospitals: Okayama University Hospital, Iwate Medical University Hospital, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Showa University Hospital, University of Tsukuba Hospital, Osaka University Hospital and Yokohama City University Medical Center. The patients will be followed up for 36 months postoperatively. The primary endpoint of this study will be the time-dependent changes in BREAST-Q satisfaction with breast subscale scores for 12 months after reconstructive surgery, which will be collected via an electronic PRO system. Ethics and dissemination This study will be performed in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects published by Japan's Ministry of Education, Science and Technology and the Ministry of Health, Labour and Welfare, the modified Act on the Protection of Personal Information and the Declaration of Helsinki. This study protocol was approved by the institutional ethics committee at the Okayama University Graduate School of Medicine, Dentistry, on 2 February 2018 (1801-039) and all other participating sites. The findings of this trial will be submitted to an international peer-reviewed journal

Infliximab 治療中のクローン病にStreptococcus intermedius による肝膿瘍と膿胸を合併した1例

症例は31歳女性．クローン病再燃に対して抗TNF-α抗体製剤であるInfliximab治療中に，Streptococcus intermediusによる肝膿瘍と膿胸を発症し，治療に難渋するも抗菌薬治療，経皮経肝膿瘍ドレナージにて軽快した．Infliximab投与は，易感染性により様々な感染症を合併する可能性があるが，肝膿瘍の合併は非常にまれながら診断・治療の遅れが重篤になりやすく注意が必要である