Oral post-exercise garlic extract supplementation enhances glycogen replenishment but does not up-regulate mitochondria biogenesis mRNA expression in human-exercised skeletal muscle

PURPOSE

Garlic extract (GA) is purported to enhance antioxidant and anti-inflammatory activity and glucose regulation in humans. The present study investigated the effects of post-exercise GA supplementation on GLUT4 expression, glycogen replenishment, and the transcript factors involved with mitochondrial biosynthesis in exercised human skeletal muscle.

METHODS

The single-blinded crossover counterbalanced study was completed by 12 participants. Participants were randomly divided into either GA (2000 mg of GA) or placebo trials immediately after completing a single bout of cycling exercise at 75% Maximal oxygen uptake (VO2max) for 60 minutes. Participants consumed either GA (2000 mg) or placebo capsules with a high glycemic index carbohydrate meal (2 g carb/body weight) immediately after exercise. Muscle samples were collected at 0-h and 3-h post-exercise. Muscle samples were used to measure glycogen levels, GLUT4 protein expression, as well as transcription factors for glucose uptake, and mitochondria biogenesis. Plasma glucose, insulin, glycerol, non-esterified fatty acid (NEFA) concentrations, and respiratory exchange ratio (RER) were also analyzed during the post-exercise recovery periods.

RESULTS

Skeletal muscle glycogen replenishment was significantly elevated during the 3-h recovery period for GA concurrent with no difference in GLUT4 protein expression between the garlic and placebo trials. PGC1-α gene expression was up-regulated for both GA and placebo after exercise (p < 0.05). Transcript factors corresponding to muscle mitochondrial biosynthesis were significantly enhanced under acute garlic supplementation as demonstrated by TFAM and FIS1. However, the gene expression of SIRT1, ERRα, NFR1, NFR2, MFN1, MFN2, OPA1, Beclin-1, DRP1 were not enhanced, nor were there any improvements in GLUT4 expression, following post-exercise garlic supplementation.

CONCLUSION

Acute post-exercise garlic supplementation may improve the replenishment of muscle glycogen, but this appears to be unrelated to the gene expression for glucose uptake and mitochondrial biosynthesis in exercised human skeletal muscle.

Garlic supplementation attenuates cycling exercise-induced oxidative inflammation but fails to improve time trial performance in healthy adults

BACKGROUND

Garlic extract has been shown to enhance antioxidant and anti-inflammation activities in humans. The present study investigated the effects of garlic supplementation on 40-km cycling time trial performance, exercise-induced oxidative stress, and inflammatory responses in healthy adults.

METHODS

Eleven healthy males were recruited to perform this single-blind crossover study. Participants were randomly assigned to either garlic (garlic extracts 1000 mg/d for 4 weeks) or placebo trials. Following 4-wks of supplementation, participants performed a 40-km cycling challenge. Total cycling performance time and respiratory exchange ratio (RER) were recorded. Blood samples were collected every 10 km to determine exercise-induced oxidative stress, inflammation, and muscle damage.

RESULTS

The 40-km cycling time trial performance was not improved following 4 weeks of garlic supplementation. However, 4-wk garlic supplementation significantly increased whole-body antioxidant capacity (total antioxidant capacity, TAC), and subsequently attenuated MDA, TNF-α, and LDH during the 40-km cycling exercise period (p < 0.05). There were no significant differences among the blood biomarkers glucose, NEFA, IL-6, UA, and CK respectively. The respiratory exchange ratio was similar between garlic and placebo trials.

CONCLUSION

Four-week oral garlic supplementation attenuates exercise-induced oxidative inflammation and muscle damage during a 40-km bout of cycling. However, it appeared that 4-wk oral garlic had no ergogenic effect on cycling performance in healthy males.

Effect of early interventions with manual lymphatic drainage and rehabilitation exercise on morbidity and lymphedema in patients with oral cavity cancer

BACKGROUND

There are clinical and statistical inconsistencies regarding early intervention with manual lymphatic drainage (MLD). The purpose of this study was to compare the short-term effect of early interventions with rehabilitation exercise versus MLD and rehabilitation exercise in terms of pain, range of motion (ROM) and lymphedema in patients with oral cancer after surgery.

METHODS

A total of 39 patients who underwent surgery from December 2014 to December 2018 participated in this randomized single-blind study. There were 20 patients in the rehabilitation (R) group and 19 in the MLD (M) plus rehabilitation group. The R group received 30 minutes of rehabilitation intervention; and the M group received 30 minutes of MLD, in addition to 30 minutes of rehabilitation intervention in a work day. Clinical measures, including the visual analog pain scale (VAS), ROM of the neck and shoulder, ultrasonography and face distance for lymphedema, and the Földi and Miller lymphedema scales, were assessed before surgery, before intervention and when discharged from the hospital.

RESULTS

The VAS pain score, ROM of the neck, and internal and external rotation of the right shoulder were significantly improved after the interventions. Right-face distance (P = .005), and skin-to-bone distance (SBD) of the bilateral horizontal mandible and left ascending mandibular ramus were significantly improved after the interventions. Left lateral flexion of the neck (P = .038) and SBD of the right ascending mandibular ramus (P < .001) in the MLD group showed more improvement than that of the rehabilitation group.

CONCLUSION

Early intervention with MLD and the rehabilitation program were effective in improving ROM of the neck and controlling lymphedema in acute-phase rehabilitation. The preliminary findings suggest a potential therapeutic role for early intervention with MLD, in addition to rehabilitation exercise, in that they yielded more benefits in lymphedema control and improvement of ROM of the neck in acute care.

Short-Term Oral Quercetin Supplementation Improves Post-exercise Insulin Sensitivity, Antioxidant Capacity and Enhances Subsequent Cycling Time to Exhaustion in Healthy Adults: A Pilot Study

Aim

Quercetin has been reported to have antioxidant and anti-inflammatory properties on health promotion in human studies. The main purpose of this study was to investigate the effect of short-term oral quercetin supplementation on post-exercise whole-body energy metabolism. This study also aimed to determine the effects of supplementation on oxygen stress, inflammation, muscle damage, and high-intensity cycling exercise performance.

Method

Twelve healthy participants, physically active students, were recruited to perform a randomized, single-blind crossover study. All subjects completed 7-days of quercetin (quercetin:1,000 mg per day for 7-days) and placebo supplementation in a randomized order. Supplement/placebo was combined with exercise consisting of 70% V̇O_2max cycling for 60-min, followed by 3-h of recovery, then a subsequent single bout of cycling exercise with 75% V̇O_2max to exhaustion. Time to exhaustion, indicators of muscle damage, as well as blood and gaseous parameters relating to energy metabolism, oxidative stress, inflammatory response, respectively, were determined.

Results

The results showed that 7-day quercetin supplementation significantly attenuated the post-exercise glucose-induced insulin response, increased total antioxidant capacity (TAC) and superoxidase dismutase (SOD) activities, and mitigated malondialdehyde (MDA) levels during the recovery period (p < 0.05). While subsequent 75% V̇O_2max cycling performance was significantly improved after quercetin treatment and accompanied by lower responses of interleukin 6 and creatine kinase at 24-h. However, it’s noted that there were no significant responses in glucose, respiratory exchange rate, tumor necrosis factor-α (TNF-α), myoglobin, and high sensitivity C-reactive protein between quercetin and placebo trials.

Conclusion

Our findings concluded that 7-day oral quercetin supplementation enhances high-intensity cycling time to exhaustion, which may be due in part to the increase in whole-body insulin-stimulated glucose uptake and attenuation of exercise-induced oxygen stress and pro-inflammation. Therefore, quercetin may be considered an effective ergogenic aid for enhancing high-intensity cycling performance among young adults.

Effect of Capsinoids Supplementation on Fat Oxidation and Muscle Glycogen Restoration During Post-exercise Recovery in Humans

BACKGROUND

Capsinoids (CSN), the novel non-pungent capsaicin analogs have been reported to promote metabolic health and exercise tolerance. However, the effect of CSN on fat oxidation and changes in skeletal muscle glycogen levels during post-exercise recovery has not been investigated in humans.

PURPOSE

We examined the effect of CSN supplementation on energy reliance, glycogen resynthesis and molecular proteins in the skeletal muscle of young adults during post-exercise recovery.

METHODS

In this crossover-designed study, nine healthy adult male volunteers (aged 21.4±0.2 years, BMI 21.9±1.3 kg/m2) completed a 60-min cycling exercise at 70% VO2max. Participants consumed either CSN (12 mg, single dosage) or placebo capsules with a high-carbohydrate meal (2 g carb/kg bodyweight) immediately after exercise. Biopsied muscle samples (vastus lateralis), blood, and gaseous samples were obtained during 3h postexercise recovery period.

RESULTS

We found that oral CSN supplementation right after exercise significantly altered the energy reliance on fat oxidation during recovery. This was evidenced by lower respiratory exchange ratio (RER) and higher fat oxidation rate in CSN trial. Despite this, acute CSN dosage does not contribute in enhancing the glycogen replenishment in skeletal muscle during 3h recovery. We identified no significant differences in postprandial glucose and insulin area under the curve in both trials. Western blot data showed an increased muscle GLUT4 expression, but no significant response of p-Akt/Akt ratio with CSN during post-exercise recovery.

CONCLUSION

Our findings conclude that acute CSN intake could change energy reliance on fat oxidation but is unable to enhance muscle glycogen resynthesis during post-exercise recovery. Thus, ergogenic properties of CSN in relevance to muscle glycogen restoration following exercise needs to be further investigated in young adults.

Simultaneous study of antioxidant activity, DNA protection and anti-inflammatory effect of Vernonia amygdalina leaves extracts

Vernonia amygdalina (VA) has been reported to have antioxidant potential; however, its DNA protection and anti-inflammatory properties remain unclear. We aimed to investigate whether aqueous (WEVAL) and alcoholic (EEVAL) VA extracts exert similar antioxidant, DNA protection and anti-inflammatory effects and attempted to explore the mechanism underlying the anti-inflammatory effects. These results demonstrated that WEVAL had greater polyphenolic and flavonoid contents, as well as a stronger reducing power, DPPH radical scavenging and DNA protective activity. Moreover, both extracts reduced lipopolysaccharide (LPS)-induced expression of COX-II, iNOS, pro-inflammatory factors, including NO, TNF-α, IL-1β, and IL-10. Compared with WEVAL, EEVAL was a more potent inflammatory inhibitor. Both extracts similarly inhibited LPS-induced MAPK (p38) and NF-κB expression. Our findings indicate that WEVAL and EEVAL have diverse antioxidant and anti-inflammatory effects. WEVAL had a stronger antioxidant and DNA protection activity; contrastingly, EEVAL had a stronger anti-inflammatory ability. The anti-inflammatory activity involves reduced pro-inflammatory cytokines through NF-κB down-regulation and MAPK inhibition. These results demonstrated that production of WEVAL and EEVAL from VA leaves may provide a safe and efficacious source of pharmaceutical applications, with antioxidant, DNA protective and anti-inflammation activities.

A Pilot Study of Two Different Constraint-Induced Movement Therapy Interventions in Children With Hemiplegic Cerebral Palsy After Botulinum Toxin Injection During Preschool Education

Introduction: To establish a pilot study on applying two low dose (40 h) constraint-induced movement therapy (CIMT) interventions in children with hemiplegic cerebral palsy (CP) after botulinum toxin (BoNT-A) injection during preschool education. Methods: Five children with spastic CP (mean age: 5.31 years; Gross Motor Function Classification System level I and II) undergoing regular BoNT-A injections and rehabilitation programs were included. Participants were randomly allocated to one of two CIMT programs (40 h): a 2-week 4-hours/day CIMT program and a 4-week 2-hours/day CIMT program. One CIMT program was performed 1 month after a BoNT-A injection, and then the second program was implemented with the next injection. The outcomes were measured by changes in Goal Attainment Scaling (GAS), the grasp and Visual-Motor Integration (VMI) test in Peabody-Developmental Motor Scales (PDMS), the self-care scale on the Functional Skill Scale, and the Caregiver Assistance in Chinese Version of Pediatric Evaluation of Disability Inventory (PEDI-C), Anxiety and Oppositional Defiance Problems of Achenbach System of Empirically-Based Assessment before and after the CIMT interventions, and at every 2 months' follow-up thereafter. Results: The mean age of the participants was 5.31 years, BMI was 16.7 (kg/m²), VIQ was 86.4 ± 8.5, and dose of BoNT-A injection in the upper limb was 42 ± 26.6 units. Grasp, VMI, and self-care on the Functional Skill Scale were significantly better in the 4-week 2-hours/day CIMT program (p < 0.001, p = 0.001, p < 0.001). GAS, grasp, VMI, two 2 self-care scales of PEDI were significantly improved after the CIMT programs, and improvement continued for up to 4 months after the programs. There was no clinical evidence showing changes in the scores for anxiety and oppositional defiance problems during the study period. Conclusions: The preliminary findings, although limited, suggest a potential therapeutic role for the school-based CIMT program after BoNT-A injection. The 4-week 2-hours/day CIMT program might be better than a 2-week 4-hours/day program in terms of self-care and hand function when performed in kindergarten in this pilot study. Furthermore, this pilot study provides valuable information; therefore, it is crucial to include more CP children and blinded assessors for hand function and ADL in the future study.

Effects of dietary lysine levels on the concentrations of selected nutrient metabolites in blood plasma of late-stage finishing pigs

Lysine is the first-limiting amino acid (AA) in typical swine diets and plays very important roles in promoting growth performance of pigs. This research was conducted to study the effects of dietary lysine on blood plasma concentrations of protein, carbohydrate, and lipid metabolites of pigs. Eighteen crossbred finishing pigs (nine barrows and nine gilts; initial BW 92.3 ± 6.9 kg) were individually penned in an environment controlled barn. Pigs were assigned to three dietary treatments according to a randomized complete block design with gender as block and pig as experimental unit (6 pigs/treatment). Three corn and soybean meal-based diets were formulated to contain total lysine at 0.43%, 0.71%, and 0.98% (as-fed basis) for Diets I (lysine deficient), II (lysine adequate), and III (lysine excess) respectively. After 4 weeks on trial, jugular vein blood was collected and plasma was separated. The plasma concentrations of total protein, albumin, urea nitrogen (UN), triglyceride, total cholesterol, and glucose were determined using an ACE Clinical Chemistry System (Alfa Wassermann, Inc., West Caldwell, NJ, USA). Data were analysed using the GLM Procedure with PDIFF (adjust = T) option of SAS. No differences (p > 0.10) were found between barrows and gilts for any of the metabolites measured. While there were no differences (p > 0.10) between pigs fed Diets II and III in plasma concentrations of UN, albumin, and total cholesterol, the concentration of albumin in these pigs was higher (p < .05) than that of pigs fed Diet I, and the concentrations of UN and total cholesterol in these pigs were lower (p < .05) than that of pigs fed Diet I. There were no differences (p > 0.10) among the three dietary treatments in plasma concentrations of total protein, triglycerides, and glucose. These findings indicated that the plasma metabolite profile can be affected by changing dietary lysine content only. Thorough understanding how the plasma metabolite profile is alternated by dietary lysine will facilitate nutrient management for more sustainable swine production.

Gene expression profiling indicates an increased capacity for proline, serine, and ATP synthesis and mitochondrial mass by the liver of steers grazing high vs. low endophyte-infected tall fescue

Grazing -infected forages results in a variety of reduced animal performance parameters, collectively known as "fescue toxicosis." The initial, limited evaluations of hepatic mechanisms affected by fescue toxicosis have used transcriptomic expression profiling of experimental phenotypes developed by short-term feeding of concentrated ergot alkaloids or fescue seeds to rodents and steers. To assess the effects of fescue toxicosis in growing cattle using a commercially relevant phenotype, we induced fescue toxicosis in beef steers by summer-long grazing (89 to 105 d) of a single high toxic endophyte-infected tall fescue pasture (HE; 0.746 μg/g ergot alkaloids; 5.7 ha; = 10; BW = 267 ± 14.5 kg) vs. a low toxic endophyte tall fescue-mixed pasture (LE; 0.023 μg/g ergot alkaloids; 5.7 ha; = 9; BW = 266 ± 10.9 kg). High toxic endophyte tall fescue-mixed pasture steers had decreased BW (313 vs. 338 kg) and an increased potential for hepatic gluconeogenesis from AA-derived carbons. To gain a greater perspective into fescue toxicosis-induced hepatic metabolism and identify candidate regulatory mechanisms, the goal of the current research was to examine liver samples for changes in gene (mRNA) expression profiles using a Bovine Affymetrix microarray and selected reverse-transcription PCR and immunoblot analyses. The expression (false discovery rate < 10%; < 0.01) of 147 genes was increased (7 to 268%) and that of 227 was decreased (4 to 87%) in livers of HE vs. LE steers. The top (1) functional gene category was cell-mediated immune response (33 genes; ≤ 0.012), (2) canonical cell signaling pathway was primary immunodeficiency signaling (8 genes; ≤ 0.0003), and (3) canonical metabolic pathways were oxidative phosphorylation (5 genes; ≤ 0.016) and purine metabolism (8 genes; ≤ 0.029). High toxic endophyte tall fescue-mixed pasture steers had increased ( ≤ 0.022) expression of genes critical for increased (1) Pro () and Ser () synthesis, (2) shunting of AA carbons into pyruvate () and ATP synthesis (, , , COX4, , and ), and (3) mitochondrial mass (COX4). Targeted reverse-transcribed PCR or immunoblot assays corroborated ( ≤ 0.035) these latter microarray findings for , , , , and COX4. Moreover, network analysis identified glucocorticoid receptor-mediated signaling as the most probable mechanism to coordinate the above findings. These results greatly extend our knowledge of the consequences of summer-long grazing of endophyte-infected tall fescue to the hepatic metabolism of growing steers.

Feeding glycerol-enriched yeast culture improves lactation performance, energy status, and hepatic gluconeogenic enzyme expression of dairy cows during the transition period

This study aimed to evaluate the effects of feeding glycerol-enriched yeast culture (GY) on feed intake, lactation performance, blood metabolites, and expression of some key hepatic gluconeogenic enzymes in dairy cows during the transition period. Forty-four multiparous transition Holstein cows were blocked by parity, previous 305-d mature equivalent milk yield, and expected calving date and randomly allocated to 4 dietary treatments: Control (no additive), 2 L/d of GY (75.8 g/L glycerol and 15.3 g/L yeast), 150 g/d of glycerol (G; 0.998 g/g glycerol), and 1 L/d of yeast culture (Y; 31.1 g/L yeast). All additives were top-dressed and hand mixed into the upper one-third of the total mixed ration in the morning from -14 to +28 d relative to calving. Results indicated that the DMI, NE intake, change of BCS, and milk yields were not affected by the treatments ( > 0.05). Supplementation of GY or Y increased milk fat percentages, milk protein percentages, and milk protein yields relative to the Control or G group ( < 0.05). Cows fed GY or G had higher glucose levels and lower β-hydroxybutyric acid (BHBA) and NEFA levels in plasma than cows fed the Control ( < 0.05) and had lower NEFA levels than cows fed Y ( < 0.05). On 14 d postpartum, cows fed GY or G had higher enzyme activities, mRNA, and protein expression of cytosolic phosphoenolpyruvate carboxykinase (PEPCK-C; < 0.05); higher enzyme activities ( < 0.05) and a tendency toward higher mRNA expression ( < 0.10) of glycerol kinase (GK); and a tendency toward higher enzyme activities of pyruvate carboxylase (PC) in the liver ( < 0.10) when compared with cows fed Control or Y. The enzyme activities, mRNA, and protein expression of PEPCK-C, PC, and GK did not differ between cows fed GY and G ( > 0.10). In conclusion, dietary GY or Y supplementation increased the milk fat and protein content of the cows in early lactation and GY or G supplementation improved the energy status as indicated by greater plasma glucose and lower plasma BHBA and NEFA concentrations and upregulated the hepatic gluconeogenic enzymes of dairy cows during the transition period. Feeding cows with a GY mixture in the peripartum period combined the effects of yeast on lactation performance and the effects of glycerol on energy status in dairy cows.

Glutamine synthetase and alanine transaminase expression are decreased in livers of aged vs. young beef cows and GS can be upregulated by 17β-estradiol implants

Aged beef cows (≥ 8 yr of age) produce calves with lower birth and weaning weights. In mammals, aging is associated with reduced hepatic expression of glutamine synthetase (GS) and alanine transaminase (ALT), thus impaired hepatic Gln-Glu cycle function. To determine if the relative protein content of GS, ALT, aspartate transaminase (AST), glutamate transporters (EAAC1, GLT-1), and their regulating protein (GTRAP3-18) differed in biopsied liver tissue of (a) aged vs. young (3 to 4 yr old) nonlactating, nongestating Angus cows (Exp. 1 and 2) and (b) aged mixed-breed cows with and without COMPUDOSE (17β-estradiol) ear implants (Exp. 3), Western blot analyses were performed. In Exp. 1, 12 young (3.62 ± 0.01 yr) and 13 aged (10.08 ± 0.42 yr) cows grazed the same mixed forage for 42 d (August-October). In Exp. 2, 12 young (3.36 ± 0.01 yr) and 12 aged (10.38 ± 0.47 yr) cows were individually fed (1.03% of BW) a corn-silage-based diet to maintain BW for 20 d. For both Exp. 1 and 2, the effect of cow age was assessed by ANOVA using the MIXED procedure of SAS. Cow BW did not change ( ≥ 0.17). Hepatic ALT (78% and 61%) and GS (52% and 71%) protein content (Exp. 1 and 2, respectively) was decreased ( ≤ 0.01), whereas GTRAP3-18 (an inhibitor of EAAC1 activity) increased ( ≤ 0.01; 170% and 136%) and AST, GLT-1, and EAAC1 contents did not differ ( ≥ 0.17) in aged vs. young cows. In Exp. 2, free concentrations (nmol/g) of Glu, Ala, Gln, Arg, and Orn in liver homogenates were determined. Aged cows tended to have less ( = 0.10) free Gln (15.0%) than young cows, whereas other AA concentrations did not differ ( 0.26). In Exp. 3, 14 aged (> 10 yr) cows were randomly allotted ( = 7) to sham or COMPUDOSE (25.7 mg of 17β-estradiol) implant treatment (TRT), and had ad libitum access to alfalfa hay for 28 d. Blood and liver biopsies were collected 14 and 28 d after implant treatment. Treatment, time after implant (DAY), and TRT × DAY effects were assessed by ANOVA using the MIXED procedure of SAS. Cow BW was not affected ( ≥ 0.96). Implant increased ( ≤ 0.02) total plasma estradiol by 220% (5.07 vs. 1.58 pg/mL) and GS protein by 300%, whereas the relative content of other proteins was not altered ( ≥ 0.16). We conclude that hepatic expression of ALT and GS are reduced in aged vs. young cows, and administration of 17β-estradiol to aged cows increases plasma estradiol and hepatic GS, but not that of other proteins that support hepatic Glu metabolism.

Lymphedema Characteristics and the Efficacy of Complex Decongestive Physiotherapy in Malignant Lymphedema

The aim of this study is to identify the lymphedema characteristics and the efficacy of complex decongestive physiotherapy (CDP) in 29 patients with malignant lymphedema. After CDP, total decreased volume of lymphedema was 306 mL, percentage of excess volume (PEV) changed from 43.4% to 22.7%, and lymphedema severity improved from severe to moderate status. The CDP efficacy-percentage reduction in excess volume (PREV) was 46.6%. The stage of lymphedema ( P = .004), range of motion ( P < .001), pain, heaviness, and tension scores ( P < .001) were significantly improved after CDP. This shows that CDP is efficacious and useful in malignant lymphedema.

Effects of dietary supplementation of selenium-enriched probiotics on production performance and intestinal microbiota of weanling piglets raised under high ambient temperature

This study was designed to evaluate the efficacy of selenium-enriched probiotics (SeP) on production performance and intestinal microbiota of piglets raised under high ambient temperature. Forty-eight cross-bred weanling piglets (28 days old), randomly allotted into 12 pens (four piglets/pen) and four dietary treatments (three pens/treatment group), were fed ad libitum for 42 days a basal diet (Con) or the basal diet supplemented with probiotics (Pro), sodium selenite (ISe) or a SeP preparation. Blood and faecal samples were collected on days 0, 14, 28 and 42 post-treatment. The SeP group had higher final BW (p < 0.05), greater ADG (p < 0.05) and lower FCR (p < 0.01) than the Pro, ISe or Con group. The diarrhoea incidence rate of either SeP or Pro group was lower (p < 0.01) than the ISe or Con group. Blood Se concentration and GSH-Px activity were both higher (p < 0.01) in the SeP than in the Pro, ISe or Con group. On days 28 and 42, the serum concentrations of T3 were higher (p < 0.01) and T4 lower (p < 0.01) in the SeP than in the ISe group, and the T3 and T4 concentrations in the ISe group, in turn, were higher (p < 0.05) and lower (p < 0.01), respectively, than in the Pro or Con group. Also on days 28 and 42, the faecal counts of lactobacillus bacteria were higher (p < 0.01) while Escherichia coli lower (p < 0.01) in the SeP or Pro group as compared to the ISe or Con group. The results of RFLP showed that the faecal microbial flora in the SeP group changed the most (numerically) as compared to the Pro or ISe group. These results suggest that the SeP product may serve as a better alternative to antibiotics than the solo probiotics for using as a growth promoter for weanling piglets.

Cognitive development in children with language impairment, and correlation between language and intelligence development in kindergarten children with developmental delay

We performed a retrospective review of 65 children with developmental delay. The male-to-female ratio was 2.25 : 1, and the mean age was 5.8 years; performance IQ was 94.8, verbal IQ was 83, and full-scale IQ was 87.4. Twenty-three (35%) children had normal language development, 13 (20%) had below average language development, and 29 (45%) had developmental language disorder. Performance IQ was significantly better than verbal IQ in all children (P < .001), and there was no difference within the 3 language groups. The performance IQ (P = .007) of children with developmental language disorder and specific language impairment was significantly lower than that of children with normal language development. Performance IQ was found to be correlated with language score (r = .309, P = .012). The children with language impairment were associated with lower IQ scores. The discrepancy between performance IQ and verbal IQ persisted in children with developmental delay, not only in children with language disorder.

[Design of traditional Chinese medicines with antihypertensive components based on medicinal property combination modes]

Multi-component traditional Chinese medicines are an innovative research mode for traditional Chinese medicines. Currently, there are many design methods for developing multi-component traditional Chinese medicines, but their common feature is the lack of effective connection of the traditional Chinese medicine theory. In this paper, the authors discussed the multi-component traditional Chinese medicine design methods based on medicinal property combination modes, provided the combination methods with the characteristics of traditional Chinese medicine for the prescription combinations, and proved its feasibly with hypertension cases.

Feeding glycerol-enriched yeast culture improves performance, energy status, and heat shock protein gene expression of lactating Holstein cows under heat stress

This study was conducted to evaluate the effects of supplemental common yeast culture (CY) and glycerol-enriched yeast culture (GY) on performance, plasma metabolites, antioxidant status, and heat shock protein 70 (HSP70) mRNA expression in lactating Holstein cows under heat stress. During summer months, 30 healthy multiparous lactating cows (parity 3.25 ± 0.48; 60 ± 13 d in milk [DIM]; 648 ± 57 kg BW; an average milk yield of 33.8 ± 1.6 kg/d) were blocked by parity, previous milk yield, and DIM and randomly allocated to 3 dietary treatments: no supplemental yeast culture (Control), 1 L/d of CY (33.1 g yeast) per cow, and 2 L/d of GY (153.2 g glycerol and 31.6 g yeast) per cow. During the 60-d experiment, values of air temperature and relative humidity inside the barn were recorded hourly every 3 d to calculate temperature-humidity index (THI). Weekly rectal temperatures (RT) and respiration rates and daily DMI and milk yield were recorded for all cows. Milk and blood samples were taken twice monthly, and BW and BCS were obtained on d 0 and 60. In this experiment, THI values indicated cows experienced a moderate heat stress. Cows supplemented with CY and GY had greater yields of milk, energy-corrected milk and milk fat, and milk fat percent but lower HSP70 mRNA expression in peripheral blood lymphocytes than Control cows (P < 0.05). Supplementing CY and GY tended (P < 0.15) to decrease RT at 1400 h, increase milk protein yield and erythrocyte glutathione, and reduce plasma urea nitrogen compared with Control. Lower plasma NEFA concentration and HSP70 mRNA expression in peripheral blood lymphocytes (P < 0.05) and tendencies towards greater plasma glucose concentration (P = 0.11) but less BW loss (P = 0.14) were observed in GY relative to CY cows. In conclusion, either CY or GY supplementation partially mitigated the negative effects of heat stress on performance and HSP70 mRNA expression of lactating cows, and GY supplementation provided additional improvements in energy status and HSP70 gene expression of lactating cows.

The effect of long-term conventional physical therapy and independent predictive factors analysis in children with cerebral palsy

OBJECTIVES

This study evaluated the effect of long-term conventional physical therapy (PT) on cerebral palsy (CP) children and to identify the predictors of therapy's response.

METHODS

We performed a retrospective review of CP children treated with PT, and their motor function was assessed every 3 months between 2008 and 2011.

RESULTS

Fifty-six children with a mean age of 4.2 ± 2.8 years, gross motor function classification system (GMFCS) levels were level I (n = 14), level II (n = 20), level III (n = 5), level IV (n = 8), and level V (n = 9). In the generalized estimating equations model, there was a significant improvement in the Gross Motor Function Measure (GMFM-66) score (p < 0.001); the improvement was different in five GMFCS levels (p < 0.001) and GMFCS level II had faster progression. The younger CP children had better PT efficacy, and the GMFM-66 score continued improving until 8.4 years old in the older group.

CONCLUSION

The long-term conventional PT is effective even in older CP children, and PT was most efficient in younger children and GMFCS level II.

Case Report: Manual Lymphatic Drainage and Kinesio Taping in the Secondary Malignant Breast Cancer-Related Lymphedema in an Arm With Arteriovenous (A-V) Fistula for Hemodialysis

Lymphedema is a dreaded complication of breast cancer treatment. The standard care for lymphedema is complex decongestive physiotherapy, which includes manual lymphatic drainage (MLD), short stretch bandaging, exercise, and skin care. The Kinesio Taping could help to improve lymphatic uptake. We reported a patient with unilateral secondary malignant breast cancer-related lymphedema and arteriovenous (A-V) fistula for hemodialysis happened in the same arm, and used kinesio taping, MLD, and exercise to treat this patient because no pressure could be applied to the A-V fistula. The 12-session therapy created an excellent effect. We do not think the kinesio taping could replace short stretch bandaging, but it could be another choice for contraindicating pressure therapy patients, and we should pay attention to wounds induced by kinesio tape.

Bovine neuronal vesicular glutamate transporter activity is inhibited by ergovaline and other ergopeptines

l-Glutamate (Glu) is a major excitatory neurotransmitter responsible for neurotransmission in the vertebrate central nervous system. Vesicular Glu transporters VGLUT1 and VGLUT2 concentrate (50mM) Glu [Michaelis constant (measuring affinity), or K(m),=1 to 4mM] into synaptic vesicles (SV) for subsequent release into the synaptic cleft of glutamatergic neurons. Vesicular Glu transporter activity is dependent on vacuolar H(+)-ATPase function. Previous research has shown that ergopeptines contained in endophyte-infected tall fescue interact with dopaminergic and serotoninergic receptors, thereby affecting physiology regulated by these neuron types. To test the hypothesis that ergopeptine alkaloids inhibit VGLUT activity of bovine cerebral SV, SV were isolated from cerebral tissue of Angus-cross steers that were naive to ergot alkaloids. Immunoblot analysis validated the enrichment of VGLUT1, VGLUT2, synaptophysin 1, and vacuolar H(+)-ATPase in purified SV. Glutamate uptake assays demonstrated the dependence of SV VGLUT-like activity on the presence of ATP, H(+)-gradients, and H(+)-ATPase function. The effect of ergopeptines on VGLUT activity was evaluated by ANOVA. Inhibitory competition (IC(50)) experiments revealed that VGLUT-mediated Glu uptake (n=9) was inhibited by ergopeptine alkaloids: bromocriptine (2.83±0.59μM)<ergotamine (20.5±2.77μM)<ergocornine (114±23.1μM)<ergovaline (137±6.55μM). Subsequent ergovaline kinetic inhibition analysis (n=9; Glu=0.05, 0.10, 0.50, 1, 2, 4, 5mM) demonstrated no change in apparent K(m). However, the maximum reaction rate (V(max)) of Glu uptake was decreased when evaluated in the presence of 50, 100, and 200μM ergovaline, suggesting that ergovaline inhibited SV VGLUT activity through a noncompetitive mechanism. The findings of this study suggest cattle with fescue toxicosis may have a decreased glutamatergic neurotransmission capacity due to consumption of ergopeptine alkaloids.

A cross-ethnic comparison on incidence of suicide

BACKGROUND

Suicide rates vary widely across nations and ethnic groups. This study aims to explore potential factors contributing to inter-ethnic differences in suicide rates.

METHOD

Study subjects came from a case-control psychological autopsy study conducted in Taiwan, including 116 consecutive suicides from two aboriginal groups and Taiwanese Han; 113 of them each matched with two living controls. Gender-, age- and method-specific suicide rates, population attributable fraction (PAF) of suicide for five major risk factors, help-seeking before suicide and emergency medical aid after suicide were compared between the three ethnic groups.

RESULTS

One aboriginal group (the Atayal) had significantly higher adjusted rate ratios (RR) of suicide than the other aboriginal group (the Ami) [RR 0.20, 95% confidence intervals (CI) 0.12-0.34] and the Han (RR 0.26, 95% CI 0.16-0.40). Such differences can be explained by higher PAFs of suicide for three major risk factors (substance dependence, PAF 47.6%, 95% CI 25.5-64.2; emotionally unstable personality disorder, PAF 52.7%, 95% CI 32.8-69.0; family history of suicidal behaviour, PAF 43.5%, 95% CI 23.2-60.2) in this group than in the other two groups. This higher suicide rate was substantially reduced from 68.2/100 000 per year to 9.1/100 000 per year, comparable with the other two groups, after stepwise removal of the effects of these three risk factors. Suicide rates by self-poisoning were also significantly higher in this group than in the other two groups.

CONCLUSIONS

Higher rates of specific risk factors and use of highly lethal pesticides for suicide contributed to the higher suicide rate in one ethnic group in Taiwan. These findings have implications for developing ethnicity-relevant suicide prevention strategies.

Ruminal and abomasal starch hydrolysate infusions selectively decrease the expression of cationic amino acid transporter mRNA by small intestinal epithelia of forage-fed beef steers

Although cationic amino acids (CAA) are considered essential to maximize optimal growth of cattle, transporters responsible for CAA absorption by bovine small intestinal epithelia have not been described. This study was conducted to test 2 hypotheses: 1) the duodenal, jejunal, and ileal epithelia of beef cattle differentially express 7 mRNA associated with 4 mammalian amino acid (AA) transport activities: y(+) (CAT1), B(0,+) (ATB(0,+)), b(0,+) (b(0,+)AT and rBAT), and y(+)L (y(+)LAT1, y(+)LAT2, and 4F2hc), and 2) the expression of these mRNA is responsive to small intestinal luminal supply of AA substrates (derived from ruminal microbes) or glucose-derived energy (from starch hydrolysate, SH), or both. Eighteen ruminally and abomasally catheterized Angus steers (body weight = 260 +/- 17 kg) fed an alfalfa cube-based diet at 1.33 x net energy for maintenance requirement were assigned to 3 treatments (n = 6): ruminal and abomasal water infusion (control); ruminal SH and abomasal water infusion; and ruminal water and abomasal SH infusion. The dosage of SH infusion amounted to 20% of metabolizable energy intake. After 14 or 16 d of infusion, steers were slaughtered, duodenal, jejunal, and ileal epithelia were harvested, and total RNA was extracted. The relative amounts of mRNA expressed by epithelia were quantified using real-time reverse transcription-PCR. All 7 mRNA species were expressed by the epithelium from each region, but their abundance differed among the regions. Specifically, duodenal expression of CAT1 and ATB(0,+) mRNA was greater than jejunal or ileal expression; ileal expression of b(0,+)AT, rBAT, and y(+)LAT1 mRNA was greater than jejunal or duodenal expression, whereas the expression of y(+)LAT2 and 4F2hc mRNA did not differ among the 3 epithelia. With regard to SH infusion effect, ruminal infusion down-regulated or tended to down-regulate the jejunal expression of CAT1, rBAT, y(+)LAT2, and 4F2hc mRNA. Abomasal infusion down-regulated the jejunal expression of y(+)LAT2 mRNA and tended to down-regulate the jejunal expression of 4F2hc mRNA. This study characterized the pattern of CAA transporter mRNA expressed by growing beef cattle fed an alfalfa-based diet. Moreover, this study demonstrated that increasing the luminal supply of microbe-derived AA (by ruminal supplementation of SH) results in a reduced capacity of apical and basolateral membrane to transport of CAA, whereas increasing luminal glucose supply (by abomasal supplementation of SH) reduces only the basolateral transport capacity, assuming that CAA transporter mRNA content represents functional capacity.

Basal expression of nucleoside transporter mRNA differs among small intestinal epithelia of beef steers and is differentially altered by ruminal or abomasal infusion of starch hydrolysate

In ruminants, microbial-derived nucleic acids are a major source of N and are absorbed as nucleosides by small intestinal epithelia. Although the biochemical activities of 2 nucleoside transport systems have been described for cattle, little is known regarding the regulation of their gene expression. This study was conducted to test 2 hypotheses: (1) the small intestinal epithelia of beef cattle differentially express mRNA for 3 concentrative (CNT1, 2, 3) and 2 equilibrative (ENT1, 2) nucleoside transporters (NT), and (2) expression of these NT is responsive to small intestine luminal supply of rumen-derived microbes (hence, nucleosides), energy (cornstarch hydrolysate, SH), or both. Eighteen ruminally and abomasally catheterized Angus steers (260 +/- 17 kg of BW) were fed an alfalfa cube-based diet at 1.33x NE(m) requirement. Six steers in each of 3 periods were blocked by BW (heavy vs. light). Within each block, 3 steers were randomly assigned to 3 treatments (n = 6): ruminal and abomasal water infusion (control), ruminal SH infusion/abomasal water infusion, or ruminal water infusion/abomasal SH infusion. The dosage of SH infusion amounted to 20% of ME intake. After a 14-or 16-d infusion period, steers were slaughtered, and duodenal, jejunal, and ileal epithelia were harvested for total RNA extraction and the relative amounts of mRNA expressed were determined using real-time RT-PCR quantification methodologies. All 5 NT mRNA were found expressed by each epithelium, but their abundance differed among epithelia. Specifically, jejunal expression of all 5 NT mRNA was higher than that by the ileum, whereas jejunal expression of CNT1, CNT3, and ENT1 mRNA was higher, or tended to be higher, than duodenal expression. Duodenal expression of CNT2, CNT3, and ENT2 mRNA was higher than ileal expression. With regard to SH infusion treatments, ruminal infusion increased duodenal expression of CNT3 (67%), ENT1 (51%), and ENT2 (39%) mRNA and ileal expression of CNT3 (210%) and ENT2 (65%) mRNA. Abomasal infusion increased (54%) ileal expression of ENT2 mRNA and tended to increase (50%) jejunal ENT2 mRNA expression. This study has uniquely characterized the pattern of NT mRNA expression by growing beef cattle and found that the mRNA abundance for CNT3, ENT1, and ENT2 in small intestinal epithelia can be increased by increasing the luminal supply of nucleotides (CNT3, ENT1, ENT2) or glucose (ENT2).

The effect of feeding low-phytate barley-soybean meal diets differing in protein content to growing pigs on the excretion of phosphorus and nitrogen

An experiment was conducted with growing pigs to determine the excretion of P and N in 4 barley-based diets formulated to contain 18 or 15% CP by using a normal barley (NB) or a low-phytate barley (LPB). The NB contained 0.31% total P and 0.19% phytate P; the LPB contained 0.32% total P and 0.01% phytate P. The diets were supplemented, when so required, with lysine, methionine, threonine, and tryptophan to meet their apparent ileal digestible supplies according to the NRC (1998). The diets containing NB were supplemented with inorganic P to meet the NRC (1998) recommendation for available P (0.23%). The diets containing LPB were not supplemented with inorganic P because these contained sufficient available P (0.27%). Eight barrows with an average BW of 20.9 kg were assigned to the 4 dietary treatments according to a repeated 4 x 4 Latin square design. The diets were fed at a rate of 2.5 times the ME requirement for maintenance. The barrows were fed twice daily, at 0800 and 1500, equal amounts each meal. Water was added to the feed at a ratio of 2.5:1. Each experimental period consisted of a 7-d adaptation period followed by a 5-d collection of feces and urine. The substitution of NB with LPB decreased (P < 0.001) the total P excretion by 38 and 43% for the 18 and 15% CP diets, respectively. Reducing the CP content from 18 to 15% decreased (P < 0.001) the N excretion by 29 and 32% for the NB and LPB diets, respectively. With the reduction in CP content, there was a decrease (P < 0.001) in the amount of N retained. The N:P ratio in manure of pigs fed the LPB diets was greater (P < 0.001) than from pigs fed the NB diets. These data indicate that P and N excretion can be greatly reduced by substitution of NB by LPB, and also by the reduction of the CP content, in diets for growing pigs.

Effect of phytase supplementation to a low- and a high-phytate diet for growing pigs on the digestibilities of crude protein, amino acids, and energy1,2,3

Supplementation of microbial phytase usually improves the digestibility and utilization of phosphorus in feedstuffs of plant origin. The effect of phytase supplementation on the digestibilities of AA also has been examined, but the results have been inconsistent. This study was carried out to determine the effect of phytase (Natuphos) supplementation, at a rate of 2,000 phytase units/kg, to two basal diets on the apparent ileal digestibilities (AID) of GE, CP, and AA, and on the apparent total-tract digestibilities (ATTD) of CP and GE. The basal diets contained 18% CP and were formulated (as-fed basis) to contain either a low (0.22%) or high content (0.48%) of phytate P. The high-phytate diet contained 20% rice bran, which is a rich source of phytate and has low intrinsic phytase activity. Eight barrows (average initial BW = 40.6 kg), fitted with a simple T-cannula at the distal ileum, were fed the four diets according to a replicated 4 x 4 Latin square design. The pigs were fed twice daily at 0800 and 2000, equal amounts each meal, at a rate of 2.4 times the daily maintenance requirement for ME. Each experimental period comprised 14 d. Ileal digesta were collected from 0800 to 2000 on d 12, 13, and 14. Feces were collected from 0800 on d 8 until 0800 on d 12. Chromic oxide was used as the digestibility marker. The AID of GE, CP, and AA and the ATTD of CP and GE were less in the high- than in the low-phytate diet (P < 0.01). With the exception of glutamic acid, phytase supplementation did not affect (P > 0.10) the AID of CP and AA. There was no effect (P > 0.05) of phytase on the ATTD of CP and GE. These results show that if a response occurs to phytase supplementation, it is independent of the dietary phytate content.

Effect of postexercise carbohydrate supplementation on glucose uptake-associated gene expression in the human skeletal muscle

We previously found that the exercise-induced elevation in GLUT4 mRNA of rat muscle can be rapidly down-regulated when glucose is given immediately following exercise. The purpose of this study was to determine the effect of postexercise carbohydrate diet on GLUT4 and hexokinase (HK) II mRNA levels in the human skeletal muscle. Eight untrained male subjects (age, 20.7+/-3.1 years) exercised for 60 min on a cycle ergometer at a 70-75% maximal oxygen consumption. The postexercise dietary treatment was performed in a crossover design. Immediately after the exercise, a diet with 70% carbohydrate content (1 g per kilogram of body weight; 356+/-19.8 kcal) was given to half of the subjects (eaten in 10 min) followed by a 3-h recovery, while the control subjects remained unfed for 3 h. Biopsies were performed on the deep portion of the vastus lateralis muscle of all subjects immediately after the exercise and 3 h after the carbohydrate ingestion. Blood glucose and serum insulin concentrations were measured every 30 min for 3 h. At the end of the 3-h recovery, blood glucose and serum insulin levels were not different from control levels, indicating that the oral carbohydrate was mostly disposed in the body within 3 h. In addition, GLUT4 and HK II mRNA levels were significantly lowered in the exercised human skeletal muscle in subjects receiving the carbohydrate diet. In conclusion, the present study demonstrates that GLUT4 mRNA and HK II mRNA in the exercised human skeletal muscle were significantly lowered by a high-carbohydrate diet.

Effect of phytase supplementation to diets for weanling pigs on the digestibilities of crude protein, amino acids, and energy1,2,3

Four experiments were conducted with weanling pigs fitted with a simple T-cannula at the distal ileum, to determine the effect of phytase supplementation to four diets on the apparent ileal digestibilities (AID) of CP and AA, and the apparent total-tract digestibilities (ATTD) of CP and DE. Phytase (Natuphos, DSM Food Specialties, Delft, The Netherlands) was supplemented at rates of 0, 500 or 1,000 FTU/kg to the four diets. A 20% CP (as-fed basis) corn-soybean meal diet was used in Exp. 1; a 20% CP wheat-soybean meal diet in Exp. 2; a 20% CP wheat-soybean meal-canola meal diet in Exp. 3; and a 19% CP barley-peas-canola meal diet in Exp. 4. In each experiment, six barrows, fitted with a simple T-cannula at the distal ileum, were fed the basal plus phytase-supplemented diets according to a repeated 3 x 3 Latin square design. Each experimental period comprised 14 d. The piglets were at fed 0800 and 2000 daily, equal amounts for each meal, at a daily rate of at least 2.4 times the maintenance requirement for ME. Feces were collected from 0800 on d 8 until 0800 on d 12 of each experimental period. Ileal digesta were collected from 0800 to 2000 on d 12, 13, and 14. Chromic oxide was used as the digestibility marker. The average initial and final BW (average of all experiments) were 7.9 and 16.5 kg, respectively. Phytase supplementation did not improve the AID of CP and AA in Exp. 1, 2, and 4; however, there were improvements (P < 0.05) or tendencies (P < 0.10) toward improvements in the AID of CP and AA or the ATTD of CP and the content of DE with phytase supplementation in Exp. 3. These results suggest that the AA response factor to microbial phytase supplementation depends on diet composition.

Temporal differences in relative phasing of gait initiation and first step length in patients with cervical and lumbosacral spinal cord injuries

STUDY DESIGN

Comparison group design.

OBJECTIVE

To compare the temporal distance factors during gait initiation between patients with incomplete cervical spinal cord injury, incomplete lumbosacral spinal lesion, and unimpaired control adults.

SETTING

Human performance and movement analysis laboratory, Taiwan.

PARTICIPANTS

Five patients with an incomplete cervical spinal cord injury (Group 1), five patients with an incomplete lumbosacral spinal lesion (Group 2) and nine unimpaired control adults (Group 3).

METHODS

Subjects underwent a three-dimensional gait analysis. The total gait initiation period, reaction time, each relative phasing of gait initiation and the length of the first step were identified by using the kinematic measurement system.

MAIN OUTCOME MEASURES

The total gait initiation period (start of the auditory cue for gait initiation to heel-strike of the first swing leg); each relative phasing of gait initiation indicated that the duration of the preparatory phase (start of auditory cue for gait initiation to heel-off of the first swing leg), the duration of the push-up phase (heel-off to toe-off of the first swing leg), and the duration of the single-stance phase (toe-off to heel-strike of the first swing leg) established by the total gait initiation period; and the length of the first step.

RESULTS

The gait initiation period was greater in Groups 1 and 2 than that of Group 3 (P<0.05). Each relative phasing including the duration of the preparatory phase, the push-up phase, and the swing phase relative to the total gait initiation period, did not differ among Groups 1-3 (P>0.05). The length of the first step, measured while the nonpreferred leg stepped first in Groups 1 and 2, was shorter than that of Group 3 (P<0.05).

CONCLUSIONS

Patients with incomplete cervical spinal cord injuries or lumbosacral spinal lesions took more time in gait initiation than unimpaired control adults. The first step length also reduced in these patients while the nonpreferred leg stepped first, as compared to unimpaired control adults. The data indicated that centrally programmed gait initiation might be preserved in ASIA-D spinal patients who, in this study, executed gait initiation with varying temporal distance strategies to compensate for peripheral impairments, as compared to unimpaired control adults.

Spinal cord repair with acidic fibroblast growth factor as a treatment for a patient with chronic paraplegia

STUDY DESIGN

We present a case of a patient with chronic paraplegia with a complete spinal cord gap resulting from a stabbing injury 4 years ago recovering after an innovative surgical strategy.

OBJECTIVES

To demonstrate the clinical outcome of surgical repair with sural nerve graft with fibrin glue containing acidic fibroblast growth factor in a patient with chronic spinal cord injury.

SUMMARY OF BACKGROUND DATA

Spinal cord injury usually causes permanent disability, and there had been not effective surgical technique to obtain satisfactory functional motor recovery, particularly in chronic patients. Previous studies have revealed that acidic fibroblast growth factor could promote axonal regeneration and reduce neuronal death in adult rats with spinal cord injury.

METHODS

The spinal cord gap at T11 level was bridged with 4 sural nerve grafts that redirected specific pathways from white to gray matter. The grafted area was stabilized with fibrin glue containing acidic fibroblast growth factor.

RESULTS

Before the operation, the paraplegia was identified as ASIA-C, with a motor score for the right and left legs of 12 and 0, respectively, a pinprick score of 77, and 77 on a light touch of left side limbs. His functional status improved from being wheelchair-bound to being able to ambulate independently with a walker 2-and-a-half years after surgery. At this stage, paraplegia was ASIA-D, with motor scores for the right and left legs of 15 and 12, respectively, 86 for a pinprick, and 86 for a light touch of left side limbs.

CONCLUSIONS

This case demonstrated significant motor recovery attained in a patient with chronic paraplegia following a repair surgery with nerve graft and growth factor.

Complex decongestive physiotherapy for patients with chronic cancer-associated lymphedema

BACKGROUND AND PURPOSE

Lymphedema of the limbs after cancer therapy is the most common cause of lymphedema in developed countries. There is no cure for chronic cancer-associated lymphedema. Multidisciplinary complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. This prospective study assessed the efficacy of intensive CDP treatment in chronic cancer-associated lymphedema.

METHODS

Thirty women who had unilateral upper or lower limb chronic lymphedema after breast or pelvic cancer therapy were enrolled in the study. All patients received CDP once per day, in consecutive full treatment sessions, which took place between 4 and 21 times. Assessment of the results of therapy included measuring the circumference, calculated volume, and edema ratio (excess volume/unaffected side volume) of the limb volume. The main outcome measure was the percentage reduction in excess limb volume.

RESULTS

The pretreatment edema ratio demonstrated a high correlation with the patient's age (r = 0.508, p = 0.004) and the duration of the lymphedema (r = 0.634, p < 0.000). After the intensive CDP, the limb circumference, calculated volume, and edema ratio were significantly reduced compared with their pretreatment values (p < 0.000). The mean percentage reduction of excess volume was 67.8 +/- 33.2% in all patients.

CONCLUSIONS

Intensive CDP was effectively able to reduce the limb volume of patients with chronic cancer-associated lymphedema. Further follow-up study is needed to confirm the effectiveness of CDP in the maintenance phase, and its long-term effectiveness in Taiwanese.

The challenge of diagnosing psoas abscess

Diagnosing psoas abscess in patients with low back pain might be hampered by their atypical symptoms. We describe a case in which a 39-year-old retired provost marshal presented to our emergency facility with acute onset of low back pain following an episode of lumbar strain during a flight. His initial computed tomography of lumbar spine and abdominal sonography were inconclusive. Two weeks later, he was admitted to our rehabilitation unit for similar symptoms. One day later, leukocytosis and elevated c-reactive protein following rising body temperature were found. Fever of unknown origin (FUO) was impressed after series of laboratory studies. However, an inflammatory gallium scan performed 2 weeks later due to persistent fever revealed active infection in the L4 vertebra and soft tissue of the L5 paraspinal region. MRI was then performed and demonstrated abnormal enhancement at the bodies of the L2 and L3 vertebrae, prevertebral soft tissue and bilateral psoas muscles. A CT-guided percutaneous aspiration of 10 cc yellowish pus was attained, which yielded no pathogens. His symptoms subsided 1 week after being given appropriate antibiotics. This case showed the importance of nuclear scanning and MRI in patients with low back pain and FUO. It also suggests that repeated imaging study and/or other modality should be considered when the initial imaging result is not compatible with the clinical presentation of psoas abscess, which was initially missed by image studies.

Differences in seated postural control in children with spastic cerebral palsy and children who are typically developing

OBJECTIVE

To quantitatively evaluate the difference of posture control in sitting position between children with spastic cerebral palsy and normal subjects.

DESIGN

Twenty children with spastic cerebral palsy who could sit independently and 20 age- and sex-matched normal children were enrolled. The Chatteex Balance System was used to evaluate static and dynamic posture control as the subjects were sitting on a bench. The sway distance in sagittal and lateral directions, sway ratio, and sway index in both the static and dynamic sitting positions were recorded by the Chatteex Balance System.

RESULTS

There was a significantly lower static and dynamic sway ratio and a greater static sway index and dynamic lateral sway distance in the study group. The dynamic sway index in the study group was greater than the index in the control group, although it did not reach statistical significance.

CONCLUSIONS

Children with diplegic cerebral palsy did perform significantly worse in sitting posture control compared with normal subjects of similar chronological age. The sway index and sway ratio proved to be the objective and sensitive indicators that can be used to distinguish children with cerebral palsy from normal peer groups.

Electrophysiologic evaluation of autonomic function in cerebral palsy

The presence of clinical autonomic dysfunction in patients with neurologic diseases, such as multiple sclerosis, Parkinson's disease, and cerebrovascular accident, has become increasingly recognized in the past decade. Very few autonomic tests have been done on pediatric patients thus far. The purpose of this study was to investigate the autonomic function in patients with cerebral palsy using two noninvasive tests: sympathetic skin response (SSR) and R-R interval variation (RRIV). Twenty-four patients with cerebral palsy and 24 control subjects between the ages of 4 and 12 yr were enrolled in this study. There was no significant difference of mean latency, amplitude, or amplitude ratio of SSR between the two groups under electric stimulus, startling stimulus, and deep breathing conditions. No significant difference in frequency of absent response and asymmetric response was also noted. Mean heart rate under relaxed sitting condition was significantly higher in the study group. Significant negative correlation between heart rate and age was noted in the control group but was not present in the study group. Also, there was no statistical difference of mean RRIV between the two groups. No objective evidence of autonomic disturbance in patients with cerebral palsy was found in this study.