The purpose of this study was to investigate the viscoelastic properties of tendon structures in humans. Elongation of the tendon and aponeurosis of medial gastrocnemius muscle (MG) was directly measured by ultrasonography, while subjects (N=12) performed ramp isometric plantar flexion up to the voluntary maximum, followed by a ramp relaxation. The relationship between estimated muscle force (Ff) and tendon elongation (dL) was fitted to a linear regression, the slope of which was defined as stiffness of the tendon structures. The hysteresis was calculated as the ratio of the area within the Ff-dL loop (elastic energy dissipated) to the area beneath the load portion of the curve (elastic energy input) . The resulting Ff-dL relationship was non-linear in form, as previously reported on animal and human tendons in vitro. The mean stiffness was 24.0±5.6 N/mm. However, there was a considerable inter-subject variability (15.8 to 36.8 N/mm) . The Young's modulus, i. e., the slope of the stress-strain curve, was 280 MPa, which tended to be lower than the previously reported values for human tendons. It was also found that the strain of the tendon structures was homogeneously distributed along its length. The mean hysteresis (energy dissipation) was 23.4±12.4%. However, again there was a considerable inter-subject variability (8.7 to 39.3%) . The present results indicated that the tendon structures of human MG was considerably compliant and its hysteresis was in accordance with previously reported values.

The present study aimed to investigate how the morphological and mechanical properties of Achilles tendon change in adolescent boys. Twenty-nine adolescent boys and 12 male adults participated. Ultrasonography was used to measure Achilles tendon elongation. The transition point, that is, the intersection point of the “Toe” and “Linear” regions was determined from tendon elongation-tendon force relationship, and the stiffness and Young’s modulus of the Achilles tendon were calculated from linear region. The hysteresis was calculated as the ratio of the area within the tendon elongation-tendon force loop to the area beneath the load portion of the curve. The stiffness, Young’s modulus and stress at transition point were greater in adults (544 ± 231 N/mm, 1.6 ± 0.7 GPa, 23 ± 6 MPa) than in adolescents (374 ± 177 N/mm, 1.1 ± 0.7 GPa, 19 ± 10 MPa). However, no differences were observed in the tendon length and the tendon cross-sectional area and stress at transition point between adolescents (174 ± 23 mm, 60 ± 11 mm², 6.1 ± 2.0 %) and adults (180 ± 30 mm, 63 ± 7 mm², 5.5 ± 2.2 %). The hysteresis in adolescents (20 ± 18 %) was greater than that of adults (12 ± 10 %). These results suggest that the morphological properties of Achilles tendon are similar between adolescents and adults, but that mechanical properties are altered with growth to become a stiffer and more spring-like structure.

The factors influencing ankle range of motion were investigated for 185 middle-aged and elderly subjects (116 women and 69 men, aged 48-86 years) . Each subject was seated with the right knee extended, and the ankle joint was passively dorsiflexed by a dynamometer with torque just tolerable for each subject, to measure the maximal dorsiflexion angle. During passive loading, elongation of muscle fibers in the gastrocnemius and Achilles tendon was determined in vivo by ultrasonography. There was a difference between women and men for the passive dorsiflexion angle (men smaller than women), which negatively correlated with muscle thickness of the posterior portion of the leg determined by ultrasonography. Both in women and men, the passive dorsiflexion angle negatively correlated with age, even after normalizing for maximal voluntary plantar flexion torque. Both elongation of muscle fibers and tendon was related to the passive dorsiflexion angle, and the ratio of tendon elongation to muscle fiber elongation positively correlated with the passive dorsiflexion angle. The active dorsiflexion angle, measured separately with the subject maximally dorsiflexing the ankle with no load, correlated with the passive dorsiflexion angle but not with age, and there was no gender difference. From the results it was suggested 1) that the mobility of the ankle joint is affected by elongation of both muscle fibers and tendon, but with the effect of the tendon being greater than that of muscle fibers, and 2) that muscle mass negatively affects passively-induced joint range of motion. Actively performed joint range of motion would be affected by elongation of the muscle-tendon corn plex and force-generating capability of the ankle. Gender difference in joint range of motion and the aging effect are related to these factors.

This study was conducted to examine the reliability of three-dimensional photonic image scanning (3DPS) for measuring body surface area (BSA), and formulate equations for predicting BSA based on 3DPS. The surface area (SA) of a cylinder with known SA and BSA of 7 males were repeatedly measured by 3DPS. BSA was determined by 3DPS for 122 subjects (25–76 yrs). BSA prediction equations for both genders were developed for the validation group (16 males and 45 females) using body height and mass as independent variables, and were cross-validated for the cross-validation group (16 males and 45 females). The standard error of measurement was 2.2cm² (0.16%). The coefficients of variation (CV) for repeated measurements of SA were less than 0.2%. The BSA of subjects did not differ significantly on any given day nor between days, with a CV of less than 1%. The coefficient of determination and standard error of estimation of the prediction equations were 0.98 and 183cm² (1.1%), respectively, for males and 0.98 and 204cm² (1.3%), respectively, for females. There was no significant difference between the predicted and measured values. In the cross-validation group, there was no significant difference between the predicted and measured values without systematic errors. These findings indicate that 3DPS is reliable for measuring BSA, and the formulated equations are valid and applicable to individuals within a wide age-range.

In this study, we examined applicability of existing equations to predicting the body surface area (BSA) of children, and newly developed prediction equations for the BSA of children. BSA of 87 children of both genders (7∼12 yr) was determined by the three-dimensional photonic image scanning (3DPS), which was used as reference. BSA predicted using existing equations yielded overestimation or underestimation and/or a systematic error with respect to the reference. BSA prediction equations for boys and girls were developed using height and body mass as independent variables for the validation group and cross-validated for another group. The standard errors of estimation of the prediction equations were 105 cm² (0.9 %) for boys and 158 cm²(1.4 %) for girls. In the cross-validation group, there was no significant difference between the predicted and measured values without systematic errors. These findings indicate that existing equations cannot accurately predict BSA of children, and that the newly developed prediction equations are capable of predicting BSA of children with adequate accuracy.

Objectives: Elucidate recognition of end-of-life care by nursing care staff in elderly care facilities, and factors influencing such recognition. Methods: We conducted an internet questionnaire with 500 nursing care staff working at elderly care facilities across Japan, and an interview with 10 nursing care staff out of 500. Results: In the questionnaire, facility policies (41%) and cooperation with medical staff (38%) were selected as facilities and systems that are important for end-of-life care, and as a concern, sudden change in the condition of the patient, leading to death (53%) was selected. The interview showed that nursing care staff had a certain level of anxiety regardless of their experience with end-of-life care, with participants discussing their thoughts on how systematic learning of, and actual experience in, end-of-life care changed end-of-life care. Conclusion: Our study showed that systematic learning and experience of end-of-life care were important factors in recognition of end-of-life care by nursing care staff when providing such care in elderly care facilities.