Injury of the anterior cruciate ligament (ACL) occurs frequently in female gymnasts and basketball players. However, there is no effective method for preventing ACL injury. Recently, a fatigue phenomenon of the ligament tissue has been considered to be the main causative factor in ACL injury.
The present study was done to investigate the relationship between knee laxity and general joint looseness in 34 female college basketball players at an orthopedic medical check-up.
Knee laxity was evaluated in terms of the anterior displacement (AD) value measured by a KT-2000 knee ligament arthrometer at 20 lb. General joint looseness was evaluated in terms of the general joint laxity (GL) score including six major joints and the spine.
There was a significant correlation between the AD value and GL score, the correlation coefficients being 0.48 (p<0.01) at the right knee and 0.54 (p<0.01) at the left knee.
The ACL of athletes with a higher AD would always be exposed to higher anterior stress than in athletes with a lower AD, thus possibly leading to a fatigue state. Therefore, we consider that athletes with a high AD are at greater risk of ACL injury. Our results suggest that the easy GL test is an effective screening method for differentiating those with a high AD and a greater risk of ACL injury.

Papillary muscle rupture after acute myocardial infarction (AMI) is an infrequent but fatal complication. We report a case of mitral valve repair performed in a patient with partial papillary muscle rupture after AMI. An 85-year-old man was admitted to our hospital for AMI with cardiac shock. Emergency coronary angiography revealed triple-vessel disease, and percutaneous coronary intervention for the culprit lesion of the left circumflex artery was successfully performed. Eleven days after the onset of the AMI, the pulmonary artery pressure abruptly increased to 60 mmHg and a pansystolic murmur was detected. Transesophageal echocardiography showed severe mitral regurgitation (MR) with flail in the A1—A2 region of the anterior mitral leaflet. We demonstrated erratic motion of the ruptured anterior head in the left ventricle, and this was diagnosed as partial rupture of the posterior papillary muscle. Intra-aortic balloon pumping (IABP) was performed to maintain the systemic circulation. Four days after the onset of acute MR (15 days following AMI), we performed mitral valve repair with coronary artery bypass grafting. We reattached the ruptured head to the viable posterior head with pledget sutures and performed annuloplasty using Carpentier-Edwards classical ring M28. Postoperative echocardiography showed no MR, and the patient was uneventfully discharged on the 45th postoperative day.

A 79-year-old man developed congestive heart failure. He was given a diagnosis of severe mitral regurgitation with calcification of the posterior mitral annulus and secondary tricuspid regurgitation. He had a history of esophageal resection with retrosternal gastric tube reconstruction about 20 years previously. We replaced the mitral valve with a mechanical prosthesis and performed tricuspid ring annuloplasty through a right parasternal approach. We did not risk resecting the calcified annulus, but fixed the prosthesis and annulus with the equine pericardium in between as a cushion and collar, to prevent perivalvular leakage. The postoperative course was uneventful.

Although decreased dorsiflexion range of motion (DROM) is linked to ankle inversion sprains and other lower limb injuries, the mechanisms underlying these links are not well understood. The purpose of this study was to examine the relationships between DROM and the ankle dorsiflexion and inversion, and the foot progression angles during a sidestep cutting maneuver. Nineteen healthy subjects participated in this study. The loaded DROM in a flexed- knee position was measured. The foot and ankle motions were assessed during the sidestep cutting maneuver using a 3D motion analysis system. The low DROM group displayed smaller dorsiflexion and inversion angles, and greater external foot rotation, and performed the task using a significantly greater percent of their DROM than the high DROM group during the sidestep cutting maneuver. In addition, the smaller DROM was associated with smaller dorsiflexion angles, greater external foot rotation, and greater maximum dorsiflexion angles as a percentage of DROM during the sidestep cutting maneuver. The decreased DROM may prevent the ankle from becoming stable during the sidestep cutting maneuver, therefore the ankle may be vulnerable position to an inversion sprain. The kinematic patterns displayed by individuals with a decreased DROM may be a compensatory strategy for dorsiflexion deficits, which may be associated with ankle and knee injuries.

It has been demonstrated that excellent athletes usually have, not only a higher exercise capacity but also higher ability to maintain equilibrium which is important for assuming the various body postures required in different sports. It is thought that a method of training which enhances the sense of equilibrium will also increase the ability to perform certain of sports.
Many sensory organs and the central nervous system, which integrates these organs, are integrated to the maintenance of equilibrium. To maintain equilibrium, vestibular, visual and bathyesthetic inputs are integrated centrally (in the brainstem, cerebellum, etc.) and necessary commands are other tissues.
A series of studies which we performed demonstrated that the ability to maintain equilibrium was lower in individuals with imbalanced occlusion than in individuals with normal occlusion.
Imbalanced occlusion can be corrected by the appropriate use of rejin sprints. We recently examined the effects of such sprints on the equilibrium of athletes with imbalanced occlusion, using a gravity fluctuation analyzer. In this study, we raised the bite only within the amount of existing free way spce.
From these results, gravity fluctuation in athletes with imbalanced occlusion was greater than that in individuals with normal occlusion.However, when imbalanced occlusion was corrected by the use of rejin sprints, gravity fluctuation tended to decrease.
It these findings from the present study are combined with the knowledge that the exercise capacity of athletes has a positive correlation with their equilibrium maintenance ability. It appears that correction of imbalanced occlusion and the appropriate use of mouth protectors would contri-bute to improving the performance of athletes.

The purpose of this study is to investigate the degenerative change of the cervical spine in American football (AF) players. The subjects were 27 collegiate AF players who had an annual radiological examination of the cervical spine. X-ray films of the lateral view were read by digital scanner and the anterior and posterior height of each spine (C 3-C 6) was measured. The subjects were divided into two groups based on experience of AF in high school (inexperienced and experienced) or the position played (lines and backs) .
Although the anterior height did not change from the first grade to fourth grade, the posterior height of C 4, C 5 and C6 significantly increased (P <0.05) . The experienced group showed a faster increase in the rate of posterior height than the inexperienced group. Also, the backs group showed a faster increase in the rate of posterior height than the lines group. The increased posterior height, which sometimes includes bony spur, results in kyphotic change of cervical alignment and impingement of the cervical nerve root. The faster growth rate in experienced or backs groups suggests that higher mechanical stress to the cervical spine and younger start of AF caused degeneration.

Purpose
  The purpose of this study is to clarify the impressions that elderly people requiring care have when exposed to a “rooftop forest-like field.”
Methods
Experimental sites : (1) The rooftop forest-like area: It covers an area of 122 m² on the 3rd story rooftop of a health service facility. It has 140 cm undulations, and a murmuring stream 7 m long and 58 cm deep flowing through the center. Fifty-one species of trees and 33 species of weeds, herbs, and grasses have been planted. Nearby is a mountain from which some birds come to the area. This mountain formed the background to this landscape. (2) The outdoor parking area: Control area was an area of 170 m² next to the same facility. Cars were prevented from entering during the study.
Subjects:The subjects were 30 females aged from 71 to 95 (mean ± SD: 81.7 ± 5.6). They were residents of the facility or attended to the facility for day care. They were divided into two groups, A and B, consisting of 15 females each. The groups were matched for age and cerebral vascular disorders (CVD). No patients with dementia were included. Experimental design : On the first day of The experiment, group A was sent to the rooftop forest-like area, and group B was sent to the open-air parking area. On the second day, each group went to the other area to eliminate the order effect. The subjective impression was measured using the semantic differential (SD) method. Patients sat still in a wheelchair and watched the scenery for 7 minutes and then answered the questionnaire.
Results and Discussion
  The rooftop forest-like field was perceived as a “beautiful,” “refreshing,” “orderly,” “enjoyable,” “comfortable” “secure,” “healthy,” “calm,” “soothing,” “friendly,” “quiet,” and a “holy” area. It was similar to the impression made by natural coniferous forests or natural rice fields. More than 80% of subjects expressed subjective relaxed state, as “most enjoyable,” “most comfortable,” and “most secure” as their impressions of the rooftop forest-like area. The impression of rooftop forest like area was characterized by high scores for both space and sensory factors using the SD method. Compared with previous reports, this forest-like area may have a relaxing effect on elderly people requiring care which is subjectively perceived.
Conclusion
  It was demonstrated that the rooftop forest-like field was perceived as a “comfortable”, “healthy”, and “relaxing” space by elderly people requiring care.

Background/Aims: Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited. Methods: We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC. Results: A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees. Conclusions Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.

Background/Aims: Several fine-needle biopsy (FNB) needles are available for endoscopic ultrasound (EUS)-guided tissue acquisition. However, there is disagreement on which type of needle has the best diagnostic yield. The aim of this study was to compare the performance and safety of two commonly used EUS-FNB needles. Methods: We retrospectively analyzed consecutive patients who underwent EUS-FNB between June 2016 and March 2020 in our hospital. Two types of needles were evaluated: a 20-gauge Menghini needle with a lateral forward bevel and a 22-gauge Franseen needle. Rapid on-site evaluation was performed in all the cases. A multivariate analysis was performed to clarify the negative predictive factors for obtaining a histological diagnosis. Propensity score matching was performed to compare the diagnostic yields of these two needles. Results: We analyzed 666 patients and 690 lesions. The overall diagnostic rate of histology alone was 88.8%, and the overall adverse event rate was 1.5%. Transduodenal access and small lesions (≤2 cm) were identified as negative predictive factors for obtaining a histological diagnosis. After propensity score matching, 482 lesions were analyzed. The diagnostic accuracy rates of histology in the M and F needle groups were 89.2% and 88.8%, respectively (p=1.00). Conclusions Both the needles showed high diagnostic yield, and no significant difference in performance was observed between the two.

Background/Aims: Several fine-needle biopsy (FNB) needles are available for endoscopic ultrasound (EUS)-guided tissue acquisition. However, there is disagreement on which type of needle has the best diagnostic yield. The aim of this study was to compare the performance and safety of two commonly used EUS-FNB needles. Methods: We retrospectively analyzed consecutive patients who underwent EUS-FNB between June 2016 and March 2020 in our hospital. Two types of needles were evaluated: a 20-gauge Menghini needle with a lateral forward bevel and a 22-gauge Franseen needle. Rapid on-site evaluation was performed in all the cases. A multivariate analysis was performed to clarify the negative predictive factors for obtaining a histological diagnosis. Propensity score matching was performed to compare the diagnostic yields of these two needles. Results: We analyzed 666 patients and 690 lesions. The overall diagnostic rate of histology alone was 88.8%, and the overall adverse event rate was 1.5%. Transduodenal access and small lesions (≤2 cm) were identified as negative predictive factors for obtaining a histological diagnosis. After propensity score matching, 482 lesions were analyzed. The diagnostic accuracy rates of histology in the M and F needle groups were 89.2% and 88.8%, respectively (p=1.00). Conclusions Both the needles showed high diagnostic yield, and no significant difference in performance was observed between the two.