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Weight training (WT) is the most common method of maintaining and increasing muscle strength. WT, however, is not always useful as it requires the external resistance and stabilization. We have developed a "hybrid training" (HYB) approach that avoids these problems by using electrically stimulated muscles to provide resistance to the motion of a muscle undergoing training. Here we report the efficacy of HYB compared with conventional WT for increasing the muscle strength around the knee at both slow and fast joint speeds (at 30 and 180°/sec). Two matched groups, each of 8 healthy men aged 22 years, exercised 3 times/week for six weeks. Both groups showed significantly increased strength in concentric torque at 30°/sec (HYB +28%, WT +33%) and at 180°/sec (HYB +33%, WT +38%), and also in eccentric torque at 30°/sec (HYB +25%, WT +24%) and at 180°/sec (HYB +19%, WT +30%) ( p < 0.001). HYB is comparable with WT exercising with the exception of high-speed contractions, while HYB has a clear advantage in not needing external resistance equipment or stabilization. HYB is therefore considered a useful approach for strengthening muscles when a person is restricted to bed rest or during space flight. rehabilitation; exercise; electrical stimulation; knee extension; strength © 2006 Tohoku University Medical PressExercise is essential in the maintenance of health and strength. Current approaches with weights and resistance devices are effective and are capable of increasing the strength of sedentary or de-conditioned people by 25 to 100% over a period as short as a few months (Fiatarone et al. 1994;Rall et al. 1996;Kuge et al. 2005). However, conventional weight training (WT) is not feasible and an alternative is needed when a person is restricted to bed rest or during space

Aims: Sarcopenia and physical disability assessed by a 6-min walking test (6MWT) are associated with poor prognosis of patients with chronic liver disease (CLD). However, CLD patients with hepatocellular carcinoma (HCC) mostly rest in bed during hospitalization. We aimed to investigate the effects of therapeutic exercise on liver function, 6MWT, and skeletal muscle mass during HCC treatment in patients with CLD. Methods:We enrolled 54 CLD patients with HCC (median age, 76 years). During hospitalization, patients performed a combination of stretching, strength training, balance practice, and endurance training (2.5-4 metabolic equivalents/20 min/day). Primary outcomes were changes from admission to discharge in ChildPugh class, 6MWT, and skeletal muscle mass. Furthermore, factors associated with skeletal muscle atrophy were analyzed by a decision-tree analysis.Results: Exercise did not worsen the Child-Pugh class. On discharge, the 6MWT ambulation distance was maintained, and heart rate variability during the 6MWT was significantly improved compared to that on admission (area under the curve 50.3 vs. 39.0 arbitrary units; P = 0.0027). Although skeletal muscle mass was significantly reduced (20.6 kg vs. 20.0 kg, P = 0.0301), branched-chain amino acid (BCAA) treatment was identified as the most distinguishable factor for minimizing muscle mass atrophy (À1.1 kg vs. À0.5 kg/hospitalization).Conclusions: Therapeutic exercise improved physical ability without worsening liver function during hospitalization for HCC treatment in CLD patients. Although exercise did not completely prevent skeletal muscle atrophy, BCAA treatment minimized the skeletal muscle atrophy. Thus, exercise with BCAA treatment may be important for the management of CLD patients with HCC.

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Background and Aim Sarcopenia is a prognostic factor in hepatocellular carcinoma (HCC) patients. HCC patients who underwent transcatheter arterial chemoembolization (TACE) are at a risk of muscle atrophy. We aimed to investigate the effects of in‐hospital exercise on muscle mass and factors associated with muscle hypertrophy in HCC patients who underwent TACE. Methods We enrolled 209 HCC patients who underwent TACE. Patients were classified into either an exercise (n = 102) or control (n = 107) group. In the exercise group, patients were treated with in‐hospital exercise (median 2.5 metabolic equivalents/20–40 min/day). The effects of exercise on muscle mass were evaluated by changes in skeletal muscle index (ΔSMI) between before and after TACE. Factors associated with an increase in SMI were analyzed by logistic regression and decision‐tree analyses. Results There was no significant difference in serum albumin and bilirubin levels between the two groups. ΔSMI was significantly higher in the exercise group than in the control group (0.28 cm2/m2 vs −1.11 cm2/m2, P = 0.0029). In the logistic regression analysis, exercise was an independent factor for an increase in SMI (hazard ratio 2.13; 95% confidence interval 1.215–3.846; P = 0.0085). Moreover, the decision‐tree analysis showed that exercise was the initial divergence variable for an increase in SMI (the ratio of increased SMI: 53% in the exercise group vs 36% in the control group). Conclusions In‐hospital exercises increased muscle mass in HCC patients who underwent TACE. In addition, exercise was an independent factor for muscle hypertrophy. Thus, in‐hospital exercise may prevent sarcopenia in HCC patients who underwent TACE.

Hybrid training of voluntary and electrical muscle contractions improved hepatic steatosis and reduced insulin resistance and serum IL-6 levels in NAFLD patients who are resistant to lifestyle counseling.

BackgroundRecent studies have shown effective clinical results after arthroscopic Bankart repair (ABR) but have shown several risk factors for re-dislocation after surgery. We evaluated whether patients are at a risk for re-dislocation during the first year after ABR, examined the recurrence rate after ABR, and sought to identify new risk factors.MethodsWe performed ABR using bioabsorbable suture anchors in 102 consecutive shoulders (100 patients) with traumatic anterior shoulder instability. Average patient age and follow-up period was 25.7 (range, 14–40) years and 67.5 (range, 24.5–120) months, respectively. We evaluated re-dislocation after ABR using patient telephone interviews (follow-up rate, 100%) and correlated re-dislocation with several risk factors.ResultsRe-dislocation after ABR occurred in nine shoulders (8.8%), of which seven sustained re-injuries within the first year with the arm elevated at 90° and externally rotated at 90°. Of the remaining 93 shoulders without re-dislocation, 8 had re-injury under the same conditions within the first year. Thus, re-injury within the first year was a risk for re-dislocation after ABR (P < 0.001, chi-squared test). Using multivariate analysis, large Hill-Sachs lesions (odds ratio, 6.77, 95% CI, 1.24–53.6) and <4 suture anchors (odds ratio, 9.86, 95% CI, 2.00–76.4) were significant risk factors for re-dislocation after ABR.ConclusionsThe recurrence rate after ABR is not associated with the time elapsed and that repair strategies should augment the large humeral bone defect and use >3 anchors during ABR.

Although pyogenic spondylitis is an infrequent infection, its incidence is increasing because of the growing number of elderly people and immunocompromised patients. Diagnosis is often difficult and appropriate imaging, blood cultures and/or biopsy are essential in making an early diagnosis. Most of the cases can be treated non-operatively. Surgical treatment is indicated in patients with spinal cord or cauda equine compression with progressive neurological deficits and/or patients who have failed conservative treatment. Early and accurate diagnosis of pyogenic spondylitis is important for timely and effective management, in order to reduce the occurrence of spinal deformity and dysfunction.