Introduction: Far fewer opioids are prescribed in Japan than in the United States. Methods: We conducted an online physician survey assessing attitudes and perceptions that might influence prescribing. A Japanese version was distributed to members of the Japan Primary Care Association and an English version to members of the American Academy of Family Physicians practicing in Oregon. Results: We received 461 Japanese responses and 198 from the United States, though overall response rates were low (Japan: 10.1%, United States: 18.5%). Japanese respondents reported far less opioid prescribing than US respondents, especially for acute pain (acute pain: 49.4% vs 97.0%; chronic pain: 63.7% vs 90.9%; P < .001 for both). Almost half of respondents from both countries indicated that patient expectations and satisfaction were important factors that influence prescribing. US respondents were significantly more likely to identify medical indication and legal expectation as reasons to prescribe opioids for acute pain. Most US respondents (95.4%) thought opioids were used too often, versus 6.6% of Japanese respondents. Conclusions: Lower opioid use was reported in Japan, especially for acute pain, which may help minimize long-term use. Patient expectations and satisfaction seem to influence opioid prescribing in both countries. The United States could learn from Japanese regulatory and cultural perspectives.

Objective: An ultrasound-guided interfascial injection, which targets the space between the epimysia, is often performed for myofascial neck and shoulder pain. However, the relationship between the injection volume and clinical effectiveness has been controversial. We conducted an anatomical study with cadavers to measure the distribution of a small amount of pigment solution injected into the interfascial space. Design: An experimental cadaveric study. Setting: An institutional clinical anatomy laboratory. Methods: We performed 20 ultrasound-guided injections with pigment solutions of 1.0 mL each into the space between the trapezius muscle and rhomboid muscle bilaterally on 10 cadaver specimens. Cadavers were then dissected and macroscopically evaluated for pigment distribution on the fascia of the muscular surfaces. The pigment distribution area of each injection site was visually confirmed and calculated using automatic area calculation software. Results: Pigment solution exclusively within the interfascial space was visually confirmed in 95% (19/20) of injection sites. The median pigmented surface area (interquartile range) was 24.50 (16.17–30.76) cm2 on the deep side of the trapezius muscle and 18.82 (13.04–24.79) cm2 on the superficial side of rhomboid muscle; these measurements were statistically significantly different (P = 0.033). Conclusions: A pigment solution comprising as little as 1.0 mL injected under ultrasound guidance separated two adjacent muscles and spread to the wide area within the interfascial space. The difference in the pigment distribution area between the two adjacent muscles can be explained by the path made by the injection needle and several layers of fascia between the epimysium.

Using scanning tunneling microscopy (STM), the behavior of Mg submonolayers on a Si(100)2×1 surface has been studied during deposition at room temperature (RT) and upon annealing at 250°C and 400°C. RT-deposited Mg forms meandering chains of features that run roughly perpendicular to the substrate Si dimer rows and, at saturation, tend to form the arrays of the 2×2 reconstruction. Annealing at 250°C transforms the chains to random groups of Mg clusters. Subsequent annealing at 400°C induces Si redistribution at the surface and results in the formation of straight chains of features that are again aligned perpendicular to the Si dimer rows. These high-temperature (HT) features are plausibly composed of 1 Si atom and 1–2 Mg atoms. The spacing of the HT features within the chain is 2a (a=3.84 Å) and stacking of the chains produces the domains of 2×2, 2×3 and other 2×n reconstructions. At saturation, almost the entire surface is occupied by the 2×2 reconstruction. At higher Mg coverages, the growth of a silicide occurs both at RT deposition and upon annealing.

Co/Pt multilayered films were evaporated on glass substrates that were heated up to 500°C. Perpendicular magnetic anisotropy K _⊥ was found to increase with the elevation of substrate temperature T _s, reaching a maximum at T _s=300°C. The surface anisotropy component also increased with elevating T _s while the volume component hardly depended on T _s. The coercivity of the perpendicular magnetization curve, H _c⊥, greatly increased with the elevation of T _s, exceeding 4 kOe at T _s=300 and 400°C. The layered structure was found to deteriorate considerably at T _s=300°C, becoming indistinct at T _s=400°C and higher. On the other hand, the (111) preferred orientation normal to the film plane became more pronounced with the elevation of T _s. The average grain size <d _g > was found to increase with the elevation of T _s. It was also found that H _c⊥ had a close relationship to <d _g >, reaching a maximum at <d _g >=250-300 Å.

This is a narrative conceptual paper, not a systematic review. Ultrasound-guided fascial hydrorelease (FHR) has been reported to provide sustained pain relief in patients with chronic musculoskeletal pain; however, its underlying biological mechanisms remain incompletely understood. In this paper, we propose the “Fascial Memory Reset Hypothesis” as an integrative framework linking mechanobiology, extracellular matrix (ECM) remodeling, peripheral nociception, microcirculatory dynamics, and ultrasound imaging findings. Mechanobiological research has demonstrated that increased tissue stiffness activates YAP/TAZ signaling, promoting fibroblast activation, ECM deposition, and mechano-epigenetic regulation. These mechanically driven processes can stabilize pathological tissue phenotypes without DNA sequence alterations. The “Fascial Memory Reset Hypothesis” proposes that targeted mechanical interventions such as FHR may partially reverse these mechanically maintained states by restoring tissue mobility and modifying stiffness-dependent mechanotransduction. We propose that “stacking fascia” (observed as layered hyperechoic bands on ultrasound) represents the macroscopic structural phenotype of mechano-epigenetic memory formed through sustained mechanical stress. Integrating molecular mechanotransduction pathways, mechano-epigenetic mechanisms, neural sensitization, and vascular factors, we propose that FHR may hypothetically partially normalize pathological fascial states by mechanically restoring tissue mobility and modifying stiffness-dependent signaling. Although direct molecular evidence of the effect of FHR in human fascia remains limited, this hypothesis provides a biologically plausible link between mechanical stress, ultrasound-visible structural alterations, and sustained clinical improvement.

Background: Acute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis. Although pocket-sized ultrasound (PsUS) offers several advantages over other imaging modalities, there is limited information regarding its use in diagnosing femoral proximal fractures or acute hip arthritis. Thus, we aimed to validate the diagnostic accuracy of PsUS for both disorders. Methods: In this prospective observational study, outpatients with acute hip pain were diagnosed according to a fixed procedure of the PsUS probe handling. We verified the diagnostic accuracy of PsUS findings (cortical discontinuity and joint fluid retention) and compared it with that of radiography, computed tomography, and magnetic resonance imaging. Results: Our study included 52 outpatients (mean age, 78.0 years; female, 88.5%). Of 26 patients diagnosed with femoral proximal fractures, 14 had femoral neck fractures and 12 had femoral trochanteric fractures. The sensitivity and specificity for identifying cortical discontinuity in femoral proximal fractures were 0.96 and 0.92, respectively. The sensitivity for identifying either cortical discontinuity or joint fluid retention in femoral proximal fractures or acute hip arthritis was 0.97. Conclusions: Negative PsUS findings of cortical discontinuity and joint fluid retention in the hip are useful for ruling out femoral proximal fractures and acute hip arthritis. PsUS and radiography have comparable diagnostic accuracies, and PsUS could aid in the initial assessment of acute hip pain among the elderly in primary care settings.