Gait improvement in stroke patients by Gait Exercise Assist Robot training is related to trunk verticality

[Purpose] Various types of Gait Exercise Assist Robot (GEAR) have been developed recently, some of which have enabled early improvement in patients with stroke. However, none has yet resulted in independent walking in these patients. Hence, we conducted an exploratory study of the effect of GEAR on achieving independent walking in stroke patients. [Participants and Methods] The participants were 16 patients with severe stroke. We evaluated patients’ ability to walk independently after GEAR training. The outcome measure was Stroke Impairment Assessment Set (SIAS) motor score (Hip Flexion, Knee Extension, Foot Pat, Abdominal and Verticality). Differences in five SIAS motor scores were compared between the independent and non-independent walking groups. [Results] There was statistically significant difference between the groups in terms of Verticality among the 5 SIAS items used in the present research . Verticality of SIAS score of 1 was the cut-off value for distinguishing walking independence. [Conclusion] Verticality of SIAS may be a marker of potential walking independence that can be used in rehabilitation plans using walking-assist robots in patients with stroke.

Total sleep deprivation induces an acute and transient increase in NK cell activity in healthy young volunteers

STUDY OBJECTIVES

To investigate the effects of one night's total sleep deprivation (TSD) on NK cell activity, with rigorous control of circadian phase of sampling points as well as physical exercise level in association with sleep deprivation.

DESIGN

The mean sleep onset time of each subject before starting the study was defined as his 0000 h. This study was composed of a Sleep-Sleep session (sleep times, 00:00 h - 08:00 h and 24:00 h - 32:00 h) and a Sleep-Wake session (sleep time, 00:00 h - 08:00 h) with TSD (24:00 h - 32:00 h) placed in a cross-over design with 2-week interval between each session. In each session, the subjects were rested in the supine position under dim light from - 06:00 h to 36:00 h (for 42 hours).

SETTING

University-based sleep and chronobiology laboratory

PARTICIPANTS

10 healthy adult men (mean age, 20.9 y; age range, 19-23 y)

INTERVENTIONS

NA.

MEASUREMENTS AND RESULTS

NK cell activity was measured every 4 hours from 12:00 h. NK cell activity during TSD (at 28:00 h) has been revealed to significantly increase (p=0.01) compared with the corresponding value in the Sleep-Sleep session. This effect was weaker at their usual waking time 32:00 h (p=0.07), and disappeared until 36:00 h (4 hours after awakening). The circadian rhythm phases (dim light melatonin onset time) were coincident between the 2 sessions.

CONCLUSIONS

The present findings suggest that one night TSD induces an acute and transient increase in NK cell activity that is not influenced by the effects of circadian rhythm or the amount of physical exercise undertaken during TSD.

[Influences of uncommon isoenzymes on determination of alkaline phosphatase activity by dry-chemistry analyzers]

Dry-chemistry(DC) analysis may be influenced by some matrix effects for measuring uncommon isoenzyme forms. Placental and intestinal alkaline phosphatase(AP) are overestimated by the VITROS DC, compared with results obtained with the wet-chemistry(WC) method of Bretaudiere, et al. using 2-amino-2-methyl-1-propanol (AMP) buffer, however, no such discrepancy between AP results in any DC method and that with a routine WC method recommended by Japanese Society of Clinical Chemistry in that 2-ethylaminoethanol(EAE) buffer is used, has been demonstrated. The type of buffer used affects differently the rates of AP isoenzymes activities. We therefore examined whether the presence of uncommon AP isoenzyme forms in serum caused aberrant DC results for AP in comparison with a routine WC method using EAE buffer. Here, serum samples with only liver AP and bone AP(n : 32); high-molecular-mass AP(n : 11); placental AP(n : 12); intestinal AP(n : 13) and immunoglobulin (Ig) bound AP(n : 12) were analyzed for total AP activity on three different DC analyzers: VITROS 700XR, FUJIDRYCHEM 5000, SPOTCHEM 4410 and a WC analyzer: HITACHI 7350. Values obtained in all of the DCs for sera containing only liver/bone AP agreed with those with the WC method. For sera containing placental AP, the VITROS values were higher than those with the WC method, while the FUJIDRYCHEM values and the SPOTCHEM values were lower. The VITROS values and the FUJIDRYCHEM values for sera containing intestinal AP were lower than those with the WC method, while the SPOTCHEM values were higher. All of the DCs did not affect high-molecular-mass AP and Ig bound liver/bone AP types of macro AP, but underestimated Ig bound intestinal type. Ig bound intestinal AP may be sieved by DC multilayer elements.

[Evaluation of direct identification testing from positive blood culture bottles with MicroScan rapid identification panels]

We evaluated the direct identification method from growth-positive blood culture bottles using MicroScan Rapid ID panels (DADE BEHRING) for the purpose of rapid identification. The inoculum for Rapid ID panels were prepared using an isolation method from blood culture bottles by VACUTAINER (BD). McF 1.0 had a better result than McF 0.5 as the inoculum concentration for Rapid ID panels. Rapid ID panel identification results were effected by blood contamination for > or =0.3% of S. aureus and 0.9% of a strain of E. coli. Blood contamination from the bottle may cause an issue to the identification results. The accuracy of this direct identification testing was 72.0% (36 out of 50) for gram positives organisms and 88. 9% (80 out of 90) for gram negatives organisms. Although some strains including S. pyogenes, coagulase-negative staphylococci and non-Fermentative Gram Negative Rods had not identified correctly, this method provides a preliminary result within 3 hours and provides a fast turn around time. In conclusion, this method was considered as an effective method for routine testing.

Melatonin secretion rhythm disorders in patients with senile dementia of Alzheimer's type with disturbed sleep-waking

BACKGROUND

There is growing evidence that the dysregulation of circadian rhythms may play an important role in irregular sleep-waking in demented elderly. In this study, we investigated daily variation of the pineal hormone melatonin, which has been reported to possess hypnogenic and synchronizing effects, in patients with senile dementia of Alzheimer's type.

METHODS

Serum melatonin secretion rhythms in inpatients with senile dementia of Alzheimer's type (SDAT group, n = 10, average age = 75.7 years) with disturbed sleep-waking and nondemented elderly (ND group, n = 10, age = 78.3 years) without clinical sleep disorders in the same facility were monitored under a dim light condition without excessive physical exercise.

RESULTS

The SDAT group showed a significantly higher degree of irregularities in actigraphically recorded rest-activity (R-A) rhythm during the 7-day baseline period compared with the ND group. The SDAT group simultaneously showed significantly reduced amplitude, larger variation of peak times, and diminished amount of total secretion in the melatonin secretion rhythm compared with the ND group. There were significantly positive correlations between the severity of R-A rhythm disorder and the reduced amplitude as well as diminished amount of total melatonin secretion.

CONCLUSIONS

The SDAT patients with disturbed sleep-waking possessed melatonin secretion rhythm disorders that may play an important role in irregular sleep-waking in demented elderly.

[Effect of macro-creatine kinase in serum on dry chemistry methods results for total creatine kinase activity]

Most enzymes in serum that are measured in clinical laboratories can occur in macro-molecular forms in a significantly number of patients. Within dry chemistry (DC) multilayer film, physical barriers may prevent contact macro-molecular enzyme forms with the active reagent ingredients. Here, serum samples with macro-creatine kinase (macro-CK) type 1: CK-immunoglobulin complex or type 2: oligomer mitochondrial CK (CKm) were analyzed for total CK activity on three different DC analyzers: VITROS 700XR, FUJIDRYCHEM 5000, SPOTCHEM SP4410 and a classic wet chemistry (WC) analyzer: HITACHI 7350. Macro-CKs were detected and identified by electrophoresis on cellulose acetate. Serum with high amounts of oligomer CKm gave CK values by all of DC methods significantly lower than that by the WC method (p < 0.05). Oligomer CKm gradually converts into monomer forms in serum after storage. With increase in day after storage at 4 degrees C, there was a gradual shift in which percent of total CK activity for oligomer CKm decreased while the ratio of total CK activity, DC method/WC method increased. The principle of analytical method for CK activity determination is commonly to all of the DC methods, the WC method and the electrophoretic analysis. These suggest that oligomer CKm is sieved by DC multilayer film elements. In contrast, each of DC method produced highly corrected CK activities for sample containing CK-immunoglobulin complex. This difference in the effects of macro-CKs may depend upon physicochemical characteristics of analytical DC elements.

Determination of uric acid in scalp hair for non-invasive evaluation of uricemic controls in hyperuricemia

The uric acid concentration in blood has been widely accepted as a diagnostic indicator of hyperuricemia and gout, and its assay method is well established. In the present study, we developed a simple and rapid method for the determination of uric acid in hair, which can be obtained non-invasively. The concentration (nmol/mg hair) of uric acid extracted from 10-20 mg hair with 0.1 M potassium hydroxide was determined by an enzymatic method using uricase. The concentration of uric acid (nmol/mg hair, mean+/-S.D.: 0.49+/-0.157, n=16) in hair from hyperuricemic patients was significantly higher than that (0.26+/-0.107, n=8) in healthy volunteers (p<0.01). The within-run and between-day precision (CVs) of the assay was 9.6-10.3% (n=10 each) and 11.6-16.3% (n=7 each), respectively. The concentration (nmol/mg hair, y) of uric acid in hair correlated well with that in serum (mg/l, x): y=0.09x-0.12 (r=0.75, Syx=0.122, n=23). Changes in the concentration of uric acid in the hair of antihyperuricemic drug-treated patient paralleled that in serum, suggesting that the concentration of uric acid in hair is a reliable indicator of the metabolic control in hyperuricemia.

Preparation of useful synthetic intermediates of Taxol analogs, cyclooctenone derivatives

Stereoselective syntheses of omega-(alpha-bromoketo) octanals and nonanal with oxygenated functions and formation of the corresponding eight-membered carbocyclic aldols by subsequent samarium(II)-mediated cyclization are demonstrated. Cyclooctenones deoxygenated at the C2 or C10 position in the taxane framework are prepared by dehydration of the above aldols.

[Determination of uric acid in scalp hair for non-invasive estimation of uricemic control in hyperuricemia]

Uric acid in blood has been widely accepted as a reliable indicator of hyperuricemia and gout, and its assay method has been established. In the present study, we developed a simple and non-invasive rapid method for the determination of uric acid in hair. Concentration(nmol/mg hair) of uric acid extracted from 10-20 mg of hair(95% < extractability; 0.1N KOH, 37 degrees C, 2 hr) was determined by an enzymatic method using uricase. The concentration of uric acid(nmol/mg hair, mean +/- SD: 0.489 +/- 0.157, n = 16) in hair from hyperuricemic patients was significantly higher than that(0.258 +/- 0.107, n = 8) from healthy volunteers(p < 0.01). Within-run and between-day precisions(reproducibilities, CVs) for the assay were 9.6-10.3%(n = 10 each) and 11.6-16.3%(n = 7 each), respectively. The concentration(y, nmol/mg hair) of uric acid in hair correlated well with that in blood(x, g/l): y = 8.770x-0.123(r = 0.746, Syx = 0.122, n = 23). Changes in the concentration of uric acid in hair of hyperuricemic patient treated with allopurinol paralleled to those in blood. In conclusion, it was confirmed that the concentration of uric acid in hair reflected that in blood, suggesting that measuring uric acid in hair can be available for the metabolic control in hyperuricemia.

[The ABO blood groups-dependent reference intervals for serum alkaline phosphatase isozymes and total activity in individuals 20-39 years of age]

Reference intervals of the activity of serum alkaline phosphatase isozymes (AP-IZ: high molecular-, liver-, bone- and intestinal-types) were determined according to the ABO (blood type) system in 200 healthy subjects aged 20-39 years. AP activity was determined according to the JSCC method. AP-IZ was stained by the formazan method after isolation by TITANIII-Lipo plate electrophoresis. For the electrophoresis, treated serum with neuraminidase and untreated one were concomitantly used for detecting liver AP and bone AP respectively. As a result of comparison of mean AP-IZ activity among the groups divided according to the ABO system, total AP, intestinal AP and liver AP activities in the type B and O persons were significantly higher than in the type A and AB persons. It is well known that the activities of total AP and intestinal AP in type B and O persons are higher than in type A and AB persons, but there have been no reports showing that the activity of liver AP in type B and O persons is higher than in type A and AB persons. Furthermore, in the type B and O persons there was a low correlation (r = 0.195, p < 0.05) between the activities of liver AP and intestinal AP. The present assessment included subjects in the age group (20-39 years) considered not to show fluctuations in the activity of bone AP, which is influenced by age. The above findings should be investigated in regard to other age groups.

[Modification of enzyme molecules due to naturally-occurring immunoglobulins linking]

The appearance of circulating enzyme-linked immunoglobulin complexes (E-Ig), that are thought to be formed because of specific interaction between circulating immunoglobulins and normal serum isoenzymes. The presence of E-Ig in an individual is regarded as a benign phenomenon, although the presence of E-Ig may result in altered enzyme activity in serum and interfere with the measurement of isoenzymes, and is thus of diagnostic importance. The present paper deals with the isoenzyme specificities of immunoglobulins isolated from E-Igs and electrophoretically abnormal enzyme components due to E-Igs. The immunoglobulins react with a single isoenzyme, certain isoenzymes only or all the isoenzymes of a given enzyme. E-Igs thus formed are themselves heterogeneous, giving rise to many different electrophoretically abnormal enzyme components.

[Serum IgD concentrations in normal individuals 20-39 years of age]

Immunoglobulin D(IgD) concentration in serum of normal individuals varies widely, and the reference interval for the concentrations remains to be defined. In the present study, IgD concentrations were determined in serum from 637 normal individuals 20-39 years of age by the latex nephelometric immunoassay. The IgD concentrations ranged from < 0.20 to 71.5mg per deciliter, and the median and the 95% range as reference intervals were 1.99 and < 0.20 to 17.3mg/dl, respectively. There was difference of serum IgD concentration between female 20-29 years of age and female 30-39 years of age (p < 0.05), but not on sex. The correlation between serum IgD concentration and serum IgA concentration was significant (p < 0.001).

The first report of a case with acute myocardial infarction showing familial deficiency of creatine kinase

A 46-year-old male patient was diagnosed as suffering from acute myocardial infarction, but his serum creatine kinase (CK) level was extremely low and no CK isozymes were detected in the serum. The total CK activities in the skeletal muscle amounted to only 2% of that of the control. Electrophoresis of the CK isozymes in the skeletal muscle showed that CK-MM was absent but the CK-BB and abnormal isozyme bands were present. There was no evidence of myocardial ischemia, although the exercise treadmill test revealed ST segment depression in the chest leads. One of the patient's sisters had an extremely low serum CK level suggesting inheritance of this abnormality. This is the first report of a case showing familial deficiency of CK.

Separation and characterization of sialic acid-containing salivary-type amylase from patients' sera with immunoglobulin A-type myeloma

Isoamylases, with an abnormal anodic migration, were detected by an electrophoretic technique in the sera from two patients with immunoglobulin A-type myeloma. The abnormal isoamylase bands migrate towards the anode faster than the salivary isoamylase (S2) band and were stained more strongly than the S2 sub-band. The abnormal isoamylase could be separated from patients' sera by using size-exclusion high-performance liquid chromatography. The serum abnormal isoamylases were showed to be sialic acid residues containing amylase, after the study of treatment with neuraminidase (EC 3.2.1.18), and to be salivary-type amylase, after the study of reaction with human salivary monoclonal antibody. The abnormal bands were not detected in the saliva from one patient. The two patients had no detectable malignancies except myeloma. These findings strongly suggest that the sialic acid-containing salivary-type amylases were produced ectopically from myeloma cells. In this regard the ectopic amylase production by myeloma cells is discussed.

Electrophoretic analysis of enzyme-linked immunoglobulins and their clinical significance

The appearance of circulating enzyme-linked immunoglobulin complexes (E-Ig) is common for most enzymes used in clinical biochemical tests. The presence of E-Ig may result in altered enzyme activity in serum and interfere with the measurement of isoenzymes, and is thus of diagnostic importance. E-Ig can be identified by confirming that the binding protein is an immunoglobulin by its reaction with specific anti-human immunoglobulin antibodies. Currently, the presence of E-Ig in an individual is regarded as a benign phenomenon, not indicative of any particular disease process. However, it is becoming clear that E-IgG are closely associated with autoimmune states.

Enzyme-linked immunoglobulins and their clinical significance

Most of the enzymes used in routine biochemical tests have been detected in circulating enzyme-linked immunoglobulin (Ig) complexes (E-Ig). The complexes often cause unexplained hyperenzymemia and give anomalous patterns on isozyme electrophoresis. However, E-Ig does not appear to be associated with any pathological conditions. The present study was undertaken to determine the clinical characteristics of patients with E-Ig. More than 42,000 patients selected at random and 10,000 blood donors were screened for lactate dehydrogenase (LDH)-linked Ig complexes (LDH-Ig), amylase (Amy)-linked Ig complexes (Amy-Ig), alkaline phosphatase (AP)-linked Ig complexes (AP-Ig) and creatine kinase (CK)-linked Ig complexes (CK-Ig). LDH-Ig and Amy-Ig were screened by electrophoresis for routine isozyme analysis and identified by precipitin reactions. AP-Ig and CK-Ig were screened and identified by counter immunoelectrophoresis. The incidence of all E-Ig ranged from 0.18% to 0.61% in patients and from 0.03% to 0.23% in blood donors. The incidence curves of E-Ig were age-related, generally increasing with age. The curves of E-IgG's for different enzymes resembled each other in shape but those of E-IgA's did not. A positive correlation between E-IgG and autoimmune diseases was present. Consequently, it is concluded that both autoimmune diseases and age are the common clinical factors involved in E-IgG. No specific diseases were found for cases with E-IgA. However, it is suggested that some CK-IgA, but not all, is caused by elevated serum CK activity.

[Urinary excretion of cadmium, copper and zinc in workers exposed to cadmium]

Changes in urinary cadmium, copper and zinc excretion in workers who had considerable exposure to cadmium oxide fumes were investigated over a 5-year period following the cessation of exposure. The 22 male subjects aged 22 to 55 had been welders on automobile parts for periods ranging from 7 months to 23 years, using silver solder which contained cadmium. They were divided into three groups according to levels of urinary cadmium in the first medical examination in 1975: 5 in the high excretion group, 11 in the moderate group, and 6 in the low group. Renal tubular dysfunctions were indicated in most workers in the high excretion group but not in the other two groups. The high and moderate groups showed a rapid decrease in the levels of urinary-excreted cadmium, with biological half-times of 1.42 and 1.21 years, respectively. Excreted cadmium levelled off in the two groups about 1.7 and 1.5 years after the last exposure. Urinary copper excretion in the high cadmium excretion group was about twice that in the moderate and low groups, the difference being statistically significant in comparison with the controls. Urinary zinc excretion was high in all subjects immediately after cessation of exposure but decreased rapidly. After three years it was found that the reduction of urinary zinc was greatest in the high cadmium group. Urinary cadmium showed significant correlations with both copper and zinc. Urinary copper showed a negative correlation with zinc excretion in the high cadmium excretion group and a significant positive correlation in the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pulmonary functions observed by means of flow-volume curve in welders exposed to ozone (author's transl)]

Pulmonary functions were observed by the flow-volume curve method on 68 healthy welders who had been exposed to comparatively high levels of ozone while engaged in arc welding process shielded by inert gas. The welders between 20 and 29 years of age were selected as subjects and classified into five groups according to ozone concentrations of the workshops. Results of pulmonary function tests were analyzed with reference to working experiences, dust concentrations of the workshops, smoking habits and air pollution levels of the location of factories. An attempt were made to evaluate the possible effects of prolonged exposure to ozone produced by welding upon the health or workers. The results obtained were as follows. 1. Values of both peak flow rate and maximum expiratory flow rate at 75% of vital capacity (V75) were decreased slightly in welder groups, but relationships between the observed values and ozone concentrations were not recognized. 2. Values of maximum expiratory flow rate at 25% of vital capacity (V25) of welders who had been exposed to ozone in concentration of 1.05 ppm or more were decreased significantly compared with groups exposed to ozone under 1.05 ppm. 3. In addition, values of both V25 and forced vital capacity (FVC) of the workers who had been engaged in welding for 4 years or more were significantly lower than those of the workers for less than 4 years of exposure. However, the relationship between the lung function values and smoking habits were not significant in both groups. 4. The decreases in V25 values were observed in several workers who had been exposed even to 0.46 ppm or higher (but under 1.05 ppm) ozone concentrations. 5. Relationships between the lung function values and either smoking habits or air pollutant levels of locations were not significant in all groups.

[Experimental pneumoconiosis induced by cemented tungsten and sequential concentrations of cobalt and tungsten in the lungs of the rat (author's transl)]

Experimental pneumoconiosis was induced by intratracheal injection of dusts of presintered cemented tungsten carbide, G2 (WC : Co=98 : 2) and TX20 (WC : Co : TiC : TaC=64 : 16 : 6 : 14) into the lungs of rats in order to document the pathological changes in lung tissues associated with environmental cobalt and tungsten. The following results were obtained. 1) Six months after the administration of G2 and TX20 dusts, marked fibrotic foci were noted and tungsten was detected in the lung tissues of all of the experimental animals. 2) Twelve months after the administration of both dusts, both the fibrotic changes and the tungsten levels were reduced in both test groups, but the reduction was more notable in the G2 group. The cases with fibrotic changes were relatively concomitant with the cases in which tungsten was detected. 3) On examination of tissue levels of cobalt derived from the dust, the cobalt levels in the lungs and bone tissues were less influenced by the dust of the G2 group at any point of investigation, whereas only the pulmonary cobalt levels at six months after the administration of the TX20 group showed a remarkable influence from the dust cobalt (p less than 0.01). 4) In the cases where tungsten was detected six months after the administration of both groups and twelve months after the administration of the TX20 group, pulmonary cobalt levels had not reached the value that should have been gained by the addition of expected values (dust cobalt levels calculated from the tungsten levels) to the control values. 5) The above results indicate that both G2 and TX20 dusts induced marked fibrotic changes in rat pulmonary tissues. However, these changes were reversible to some extent. In addition, a portion of the dust cobalt was dissolved in the body fluid and disappeared from the pulmonary fields.

Effects of cemented tungsten carbide dust on rat lungs following intratracheal injection of saline suspension

In order to examine the effect of cemented tungsten carbide dust on the animal lung, saline suspensions were intratracheally administered into the lungs of rats in a single dosage. About one-fifth of the animals died during the first three days. The acute response of the lungs was hemorrhagic edema with intense alveolar congestion. The animals killed at six months all presented pulmonary lesions of patchy fibrosis in the vicinity of the deposited dusts, occasionally associated with focal traction emphysema and bronchobronchiolar ectasia. At twelve months, two-third of the animals had neither fibrosis nor dust deposition, although the remaining animals showed pulmonary lesions similar to those seen in the six-months responders. Fibrosis of the lungs seemed to consist of collapsed alveoli with condensation of the preexistent reticulin fibers, but without noticeable collagenization. It is supposed that both the early toxic and the late fibrogenic effects of the carbide dust are attributable to the cytotoxic action of cobalt present in the dust particles. It is possible that recovery of the pulmonary lesions results from removal of the dusts from the lesions.

Cemented tungsten carbide pneumoconiosis

An autopsy case of cemented tungsten carbide pneumoconiosis, the first lethal case in our country, is presented. A 28-year-old woman, who had been engaged in grinding presintered metallic matrix for four years, developed respiratory symptoms. X-ray examinations were indicative of interstitial pulmonary fibrosis. Corticosteroid therapy revealed only little effect. She expired five years after the onset of the symptoms. Postmortem examination showed nonspecific interstitial pneumonitis resulting in marked lung fibrosis. Ultrastructurally, crystals were observed in cytoplasm of presumable macrophages in the fibrotic lung tissue. Electron probe microanalysis of the lung tissue showed the presence of tungsten and other constituents of tungsten carbide except for cobalt. Metal analysis demonstrated a large amount of tungsten in the lung. Cobalt was detected tenfold of the normal value in the bone. In pathogenesis of the pneumoconiosis in the cemented tungsten carbide workers, toxicity of cobalt is most suspectable, and in addition, individual susceptibility may be also important.