Analysis of the characteristics of anticipatory postural adjustments in older adults using smartphones: Association between cognitive and balance functions

OBJECTIVES

Using smartphones, we aimed to clarify the characteristics of anticipatory postural adjustments (APA) in older adults and examine the relationship between cognitive and balance functions.

METHODS

The study participants were 10 young and 13 older adults. An accelerometer built into a smartphone was attached to the lower back (L5) of the participant, and acceleration in the mediolateral direction was measured using a one-leg stance (OLS). As APA features, we analyzed the time to the peak value in the stance direction (peak latency [PL]) and the amount of displacement to the peak value in the stance direction (peak magnitude [PM]). Additionally, the measured PL was divided by PM for each group to obtain the APA ratio (APAr). We investigated the relationship between the APAr and Mini-BESTest subitems.

RESULTS

Older adults showed delayed PL and decreased PM levels (p < 0.01). While in the Mini-BESTest sub-items, deductions were most common in the order of dual-task and single-leg standing, and most participants with low APAr scores were degraded in APA of sub-items. The correlation was observed between APAr and both TUG and dual-task cost (DTC) (r= -0.56, r= -0.67). According to the receiver operating characteristic curve, the APAr value was 1.71 in the older age group.

CONCLUSIONS

Older adults showed delayed PL and decreased PM, and APAr was associated with cognitive and locomotor functions. By evaluating the APAr at the initiation of movement, it may be possible to distinguish the APA of the older adluts from the possible to the impossible of OLS movement.

New quantitative evaluation of anticipatory postural adjustments using a smartphone in patients with Parkinson's disease

OBJECTIVE

To investigate a smartphone-enabled quantitative evaluation of anticipatory postural adjustments (APA) during one-leg stance (OLS) movements among individuals with Parkinson's disease (PD).

METHODS

This cross-sectional study included 10 young controls, 10 older individuals, and 13 individuals with PD. A smartphone and accelerometer were attached to the participants' lower back (L5), and the movements of the lower back toward the stance side during OLS were measured. For acceleration, the time to the peak value in the stance direction (peak latency [PL]) and the amount of displacement to the peak value in the stance direction (peak magnitude [PM]) were analyzed as APA characteristics. Additionally, the measured PL was divided by the PM for each group to obtain the APA ratio (APAr) as a new index.

RESULTS

Individuals with PD showed a delayed PL and decreased PM (vs. young controls: p = .002 for PL, p < .001 for PM) (vs. older individuals: p = .022 for PL, p = .001 for PM). The APAr clustered the young controls, older individuals, and individuals with PD. According to the receiver operating characteristic curve the APAr value was 0.95, and individuals in the PD group were identified (i.e. area under the curve: 0.98; sensitivity: 85.0%; specificity: 100%). Moreover the APAr was correlated with severity and balance ability in individuals with PD (p = .015 for NFOG-Q, p = .028 for UPDRS, p = .036 for TUG, p = .015 for Mini-BESTest, p = .018 for OLS time).

CONCLUSIONS

This smartphone-based evaluation using the APAr index was reflective of disease severity and decreased balance ability among individuals with PD. The facilitation of this measurement can help clinicians and physiotherapists quantitatively evaluate the APA of individuals with PD at laboratories and hospitals as well as in home environments.

Reliability and validity of quantitative evaluation of anticipatory postural adjustments using smartphones

[Purpose] This study aimed to investigate the reliability and validity of the quantitative evaluation of anticipatory postural adjustments using smartphones. [Participants and Methods] The study included 10 young control participants who underwent a one-legged stance with an accelerometer and a smartphone that were simultaneously attached to their lower back (L5). Acceleration was measured as the mediolateral component of the lumbar movement toward the stance side. The peak value of the time (peak latency) and the amount of displacement (peak magnitude) in the stance side direction of the lumbar acceleration were analyzed as anticipatory postural adjustment features. Intra-rater reliability was calculated for both accelerometer and smartphone measurements, while inter-rater reliability was calculated for smartphone measurements by two examiners. Validity was determined for both accelerometer and smartphone measurements. [Results] In this study, the intra-rater reliability of the peak latency and peak magnitude in accelerometer and smartphone measurements was confirmed, as was the inter-rater reliability in smartphone measurements. The intra-rater reliability was confirmed through re-testing, while the validity of the accelerometer and smartphone measurements was also confirmed. [Conclusion] The findings of this study suggest that the use of smartphones to measure anticipatory postural adjustments is highly reliable and valid, making it a useful clinical balance index. The method is simple and can be used for continuous patient monitoring.

Measurements of the centre of pressure of individual legs reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in patients with post-stroke hemiplegia

Objectives

To determine whether individual measurements of the centre of pressure for the stance and stepping legs can reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in post-stroke hemiplegic patients.

Methods

Subjects included 30 stroke patients and 10 healthy age-matched controls. The acceleration of the trunk, and the centre of pressure of each leg, were measured during gait initiation, 3 times each with the paretic and non-paretic legs leading. Anticipatory postural adjustments were characterized using trunk acceleration and centre of pressure displacement data.

Results

Latency of the posterior displacement peak of the paretic leg centre of pressure with either the paretic or non-paretic leg leading was significantly longer in stroke patients compared with controls, and was also longer than that of the non-paretic leg. The magnitude of the posterior displacement peak of the paretic leg centre of pressure was smaller than that of the non-paretic leg. Peak latency of the paretic stepping leg centre of pressure correlated with the clinical measures of motor dysfunction, postural balance, and gait ability.

Conclusion

Measurements of the latency and magnitude of centre of pressure displacement peak individually for the paretic and non-paretic legs can help elucidate the mechanism behind reduced anticipatory postural adjustments. This information will be useful in designing new treatment strategies for stroke patients.

Separated center-of-pressure measurements reveal new characteristics of reduced anticipatory postural adjustments during gait initiation in patients with Parkinson's disease

Background and Objective: Accelerations, ground reaction force data, and other quantitative data obtained from kinematic analyses of gait initiation serve as measures of dyskinesia in patients with Parkinson's disease. The objective of this study was to determine whether a separate center of pressure information could reveal new characteristics of reduced anticipatory postural adjustments in patients with Parkinson's disease. Methods: Ten healthy elderly subjects and 10 patients with Parkinson's disease participated in this study. Motions at gait initiation in response to a light signal to begin the task were analyzed. Anticipatory postural adjustments were characterized using trunk acceleration data and center of pressure displacement data. Results: The separated center of pressure in patients with Parkinson's disease showed longer peak latency (p < .01) and larger peak magnitude (p < .01) in the stance leg than in the stepping leg. In patients with Parkinson's disease, the displacement peak latency of the stance leg center of pressure correlated negatively with the Timed Up and Go time (r = -0.46, p < .05), while displacement peak latency of the stepping leg center of pressure correlated negatively with Unified Parkinson's Disease Rating Scale (r=  -0.47, p < .05), and positively with Berg Balance Scale score (r = 0.50, p < .05). Conclusions: Patients with Parkinson's disease experience asymmetry between the stance leg and stepping leg at gait initiation. These findings may help clinicians understand the changes to motor function in patients with Parkinson's disease and suggest strategies for improved rehabilitation training.

Life-Space Mobility and Relevant Factors in Community-dwelling Individuals with Stroke in Japan: A Cross-sectional Study

Objective

Individuals with stroke frequently experience mobility deficits and limited community reintegration. This study aimed to investigate life-space mobility and relevant factors in community-living individuals with stroke.

Methods

This was a cross-sectional study of 46 community-dwelling individuals with chronic stroke in Japan (mean age 72.7 ± 7.4 years; mean time post-stroke 63.6 ± 43.3 months; 26 men/20 women). We measured life-space mobility using a Japanese translation of the Life-Space Assessment. The following factors that might affect life-space mobility were assessed: the ability to perform activities of daily living, physical performance, fear of falling, and cognitive function.

Results

A total of 41 participants (89.1%) had restricted life-space mobility (Life-Space Assessment score <60 points). A multiple linear regression analysis showed that limitations in activities of daily living, walking speed, and Falls Efficacy Scale-International scores were independently related to Life-Space Assessment scores. This model explained 51.3% of the variance in Life-Space Assessment scores.

Conclusions

Most individuals with stroke had restricted life-space mobility. Life-space mobility was associated with the ability to perform activities of daily living, walking speed, and fear of falling. These findings could contribute to the development of rehabilitation interventions for regaining life-space mobility in individuals with stroke.

Utility of Dynamic Balance Measurements in Discriminating Community Ambulation Levels Among Individuals with Stroke: A Cross-sectional Study

OBJECTIVE

To examine the association between dynamic balance measurements and community ambulation levels among individuals with chronic stroke.

METHODS

This cross-sectional study was performed in 2-day care facilities for older adults located in urban areas. Forty-seven community-dwelling poststroke adults who could walk independently were participated. Community ambulation performance was assessed using the Functional Ambulation Classification of the Hospital at Sagunto (FACHS). Dynamic balance and mobility were measured with the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Timed Up and Go (TUG) test, and 10 m maximum walking speed.

RESULTS

Participants were classified into 3 groups according to FACHS scores: household (n = 15), neighborhood (n = 19), and community walkers (n = 13). Neighborhood and community walkers scored significantly higher on the Mini-BESTest and had a shorter TUG test time than household walkers. Community walkers had a significantly faster walking speed than household walkers, whereas neighborhood walkers did not have a faster walking speed than household walkers. Ordinal logistic regression analyses revealed the Mini-BESTest score (odds ratio [OR] 1.24; 95% confidence interval [CI]: 1.07-1.44) and the TUG test time (OR .91; 95% CI: .85-.98) were significantly associated with ambulation levels after adjusting for confounders.

CONCLUSIONS

Dynamic balance measurement tools may have better responsiveness in detecting community ambulation levels among individuals with chronic stroke than walking speed.

[Successful Multidisciplinary Treatment Accomplished by Collaboration of Multiple Clinical Departments for Synchronous Quadruple Cancer]

A 60-year-old man consulted a clinic complains of sore throat. Squamous cell carcinoma of the hypopharynx and adenocarcinoma of the stomach were pointed out and he was refered to our hospital. As a result of detailed systemic examination, squamous cell carcinoma of the esophagus and squamous cell carcinoma of the right lung were also pointed out, which led to a diagnosis of synchronous quadruple cancer. On the basis of discussions among multiple clinical departments, systemic chemotherapy with cisplatin(CDDP), fluorouracil (5-FU) and docetaxel(DTX) was preceded locolegional therapies. After that, complete thoracoscopic right lower lobectomy and then a laparoscopic distal gastrectomy was performed. Radiation therapy was applied for hypopharyngeal cancer. Finally, endoscopic submucosal dissection for esophageal cancer was performed. Twenty months have passed since the last treatment, the patient is alive with a relapse-free condition.

Clinicopathological features of intraoperative pleural lavage cytology for non-small cell lung cancer

OBJECTIVE

The significance of clinicopathological features of pre- and post-resection pleural lavage cytology (PLC) for non-small cell lung carcinoma (NSCLC) currently remains unknown.

METHODS

Between January 2010 and December 2012, pre- and post-resection PLC were performed for NSCLC in 565 patients at Tohoku University, Miyagi Cancer Center, or Sendai Medical Center. The relationship between the clinicopathological features and patient outcomes was analyzed.

RESULTS

Twenty-two patients (3.9%) had positive findings from pre- or post-resection PLC. Both PLC were correlated with pT and pl factors, while only post-resection PLC was correlated with pN factor (p < 0.005). The 5-year disease-free survival (DFS) rate of the positive pre-resection PLC was significantly poorer than that of negative (26.7% vs. 76.9%, p < 0.0001). In addition, the 5-year DFS of the positive post-resection PLC was also poorer than that of negative (14.3% vs. 76.0%, p < 0.0001). Multivariate analyses revealed that both PLC were not independent prognostic factors in our study.

CONCLUSIONS

A significant association of post-resection PLC with N factor is considered to be characteristics of post-resection PLC different from pre-resection PLC. A prognostic impact of post-resection PLC and its detailed difference from pre-resection PLC should be clarified by further investigations.

[Oral Rehydration Therapy in Thoracic Surgery]

The purpose of this study is to evaluate the safety and the efficacy of preoperative oral rehydration therapy comparison with infusion therapy in thoracic surgery. Eighty-four patients scheduled for thoracic surgery were assigned to an oral rehydration group or an infusion group. We checked the amount of their urine and performed blood and urine test. And we carried out questionnaire concerning preoperative therapies to these patients. No morbidity concerned with preoperative therapies was encountered. There was no significant difference in blood and urine test in 2 groups. The answer of questionnaire showed more difficulties in the preoperative period in the infusion therapy group. Present study showed that the preoperative oral rehydration therapy could be done as safely as the infusion therapy with less difficulties compared to the infusion therapy even in the field of thoracic surgery.

Quantification of trunk segmental coordination and head stability in laterally unstable sitting identifies aging and cerebellar ataxia

BACKGROUND

We quantified trunk segmental coordination and head stability in unstable sitting and investigated whether it can discriminate postural control, age-related differences and presence of coordination disorder.

METHODS

Subjects were a healthy younger group (n = 7), a healthy elderly group (n = 7), and a cerebellar ataxia group (n = 8). The motion sensors and surface electrodes were located on the trunk and/or head segments to measure angle displacements, acceleration and electromyograms in unstable sitting during a lateral tilt task. Trunk lateral angle cross-correlation and electromyogram cross-correlation for the trunk segmental coordination, head root mean square (RMS) for the head stability, clinical performance scales, and gait parameters (velocity, coefficient of variation, and RMS ratio) were analyzed.

FINDINGS

Trunk lateral angle cross-correlation showed a significantly negative correlation in the healthy younger group compared with the two other groups (p < 0.01). Head RMS showed a significantly larger value in the cerebellar ataxia group compared with the two other groups (p < 0.01). Trunk lateral angle cross-correlation had moderate correlation with the clinical performance scale of ataxia and gait parameters; however, it was not correlated with head RMS. Classification using trunk lateral angle cross-correlation and head RMS was validated by discriminant analysis and hierarchical cluster analysis.

INTERPRETATION

We found that trunk lateral angle cross-correlation reflected age-related differences and head RMS characterized the pathology of cerebellar ataxia. Trunk segmental coordination and head stability, as two aspects of sitting postural control, can be used to discriminate the degree of aging and cerebellar ataxia.

Slower Reorientation of Trunk for Reactive Turning while Walking in Hemiparesis Stroke Patients

We examined the behavioral characteristics of reactive turning in hemiplegic stroke patients when they were informed of the turning direction just before turning was required at an unpredictable time. Eleven stroke patients and 20 healthy elderly control people were asked to initiate a turn as soon as a visual cue to inform them of the turning direction was activated unpredictably using a foot switch. Both the segmental reorientation and stepping type when turning 90° while walking were measured. The results indicated preserved segmental reorientation of the head and pelvis in stroke patients. Stroke patients showed delays in pelvic turning but not in head turning. Their delayed pelvic movement might be due to motor dysfunction and the time taken to ensure stability when deciding when to turn.

Muscle synergies underlying sit-to-stand tasks in elderly people and their relationship with kinetic characteristics

BACKGROUND

Physiological evidence suggests that the nervous system controls motion by using a low-dimensional synergy organization for muscle activation. Because the muscle activation produces joint torques, kinetic changes accompanying aging can be related to changes in muscle synergies.

OBJECTIVES

We explored the effects of aging on muscle synergies underlying sit-to-stand tasks, and examined their relationships with kinetic characteristics.

METHODS

Four younger and three older adults performed the sit-to-stand task at two speeds. Subsequently, we extracted the muscle synergies used to perform these tasks. Hierarchical cluster analysis was used to classify these synergies. We also calculated kinetic variables to compare the groups.

RESULTS

Three independent muscle synergies generally appeared in each subject. The spatial structure of these synergies was similar across age groups. The change in motion speed affected only the temporal structure of these synergies. However, subject-specific muscle synergies and kinetic variables existed.

CONCLUSIONS

Our results suggest common muscle synergies underlying the sit-to-stand task in both young and elderly adults. People may actively change only the temporal structure of each muscle synergy. The precise subject-specific structuring of each muscle synergy may incorporate knowledge of the musculoskeletal kinetics.

[Vacuum-assisted Closure Therapy for Residual Space after Open Window Thoracotomy for Pleural Empyema due to Bronchopleural Fistula]

A 73-year-old man underwent right middle-lower bilobectomy for lung adenocarcinoma. He suffered from pneumonia followed by empyema due to bronchopleural fistula. On day 19 after the operation, an open window thoracostomy was created. Then the pleural space was treated conservatively with saline irrigation and petrolatum gauze packing. Progressive formation of healthy granulation tissue was observed around the bronchopleural fistula and the adjacent pulmonary artery, resulting in a complete closure of the bronchopleural fistula. And then we applied vacuum-assisted closure (VAC) therapy to the residual pleural cavity. At 4 weeks after the initiation of VAC therapy, the pleural cavity was completely filled with granulation tissue and re-expanded residual lung. In conclusion, VAC therapy is a safe and effective treatment for residual space after open window thoracostomy for empyema due to bronchopleural fistula, if it is applied after closure of bronchopleural fistula and adequate granulation tissue formation on the great vessels.

Frequency analysis of ultrasonic echo intensities of the skeletal muscle in elderly and young individuals

Background

The skeletal muscle echo intensity (EI) during ultrasound imaging has been investigated to evaluate the muscle quality. However, EI fluctuates according to the scanning conditions.

Methods

The motor functions and ultrasound images of 19 elderly (73±3.2 years) and 19 young (22±1.5 years) individuals were investigated and an EI frequency component was assessed for more reliable evaluations. Healthy elderly and young subjects participated in this study. The motor functions were assessed during walking and according to the knee extension muscle strength. The muscle thicknesses of rectus femoris (RF), vastus intermedius (VI), and quadriceps femoris (QF) were investigated. EIs were calculated and the mean frequencies of the regions of interest (MFROIs) for RF and VI were analyzed.

Results

EIs and MFROIs were greater in elderly subjects than in young subjects (P<0.01 for RF, and P<0.001 for VI, in EIs; and P<0.01 for RF, and P<0.05 for VI, in MFROIs). In young subjects, EI of RF was greater than that of VI; however, there was no difference between the RF and VI MFROIs in both elderly and young subjects. EIs of VI exhibited a significantly negative correlation with the QF thickness in both elderly and young subjects. RF MFROIs negatively correlated with the QF thickness and positively correlated with EI of VI in elderly subjects alone.

Conclusion

These findings suggest that MFROIs of elderly individuals would have a larger value than those of young individuals; moreover, MFROIs did not fluctuate greatly with the tissue depth and scanning conditions. MFROIs might be thus useful for further investigations of muscle quality and applications for the early prevention of age-related motor functional decline.

The prognostic significance of eukaryotic elongation factor 1 alpha-2 in non-small cell lung cancer

BACKGROUND

Eukaryotic elongation factor 1 alpha-2 (eEF1A2) has been recently shown to be a putative oncogene of lung cancer.

MATERIALS AND METHODS

We analyzed the expression and prognostic significance of eEF1A2 in 69 primary non-small cell lung cancer (NSCLC) cases. We also suppressed eEF1A2 expression using RNA interference and then analyzed cell proliferation, migration and invasion of five adenocarcinoma cell lines.

RESULTS

eEF1A2 protein expression was positive in 84.1%. Negative immunostaining for eEF1A2 was shown to be an independent prognostic factor and significantly correlated with lymph node metastasis. There was no significant correlation between eEF1A2 protein and mRNA expression levels. Among the five examined cell lines, transfection of eEF1A2 siRNA inhibited cell migration in only one cell line while it did not change cell proliferation and invasion.

CONCLUSION

Negative immunostaining of eEF1A2 predicted for poor prognosis of NSCLC. The mechanism of this result could not be elucidated by cell proliferation, migration and invasion assays.

[Evaluation for medical management on catamenial pneumothorax]

Catamenial pneumothorax (CP) is one of the clinical manifestations of endometriosis, therefore the systemic hormonal therapy is indispensable and should be the 1st choice for CP treatment. However, it is refractory and repeats a recurrence, so that a combined or sequential adjuvant treatment becomes necessary. From 2003 to 2009, 5 patients with CP were treated at our institution. All patients had right-sided pneumothorax and the history of pelvic endometriosis. By thoracoscopic examination, diaphragmatic abnormalities, such as defect, pinhole, or brown spot, were identified in all patients. We performed hormonal therapy combined with chemical pleurodesis using OK-432, as an initial treatment. Two patients have been free of recurrence for 24 and 53 months, respectively. Three patients who refused or interrupted hormonal therapy caused a recurrence, but were successfully managed with the addition of pleurodesis and continuing hormonal therapy. At present, all patients are asymptomatic with 13 to 92 months recurrence-free period. From the long-term results, our therapeutic strategy consisted of hormonal therapy and chemical pleurodesis is considered appropriate.

[Emergency anterior approach for decortication with right pneumonectomy in a patient with chronic expanding hematoma]

The patient was a 68 year-old woman who had a history of treatment of pulmonary tuberculosis 35 years ago. She has experienced dyspnea and hemosputa since several years ago and has been followed up as having chronic empyema. She was admitted to our hospital due to recent exacerbation of symptoms. X-ray films and computed tomography scans of the chest showed the right thoracic cavity to be totally filled with a mass and the shift of mediastinum to the left side. After several days from admission, she needed mechanical ventilation support due to dyspnea exacerbation. Emergency decortication with right pneumonectomy through median sternotomy with anterolateral incision was performed. Postoperative course was uneventful. Pathlogical diagnosis was chronic expanding hematoma.

Prevalence of intestinal parasites and genotyping of Giardia intestinalis in pet shop puppies in east Japan

The current study examined the prevalence of intestinal parasites and genotypes of Giardia intestinalis in puppies from nine pet shops in east Japan. Fresh fecal samples from 1794 puppies (≦3 months old) were collected on one occasion. Giardia spp. was examined for specific coproantigen using ELISA kit (SNAP®Giardia, IDEXX Laboratories, Inc., USA). Other intestinal parasites were detected microscopically using the formalin-ethyl acetate sedimentation technique. Genotyping was determined for the random 29 stool samples identified as Giardia spp. positive using PCR and direct sequencing of the glutamate dehydrogenase (gdh) gene. Overall prevalence of protozoan Giardia spp. and Cystoisospora spp. revealed 23.4% and 11.3%, respectively. Prevalence of ascarids, Strongyloides spp. and hookworms were recorded 1.8%, 1.1% and 0.1%, respectively. Protozoan Giardia spp. and Cystoisospora spp., thus, represent important pathogens among pet shop puppies. All genotyped G. intestinalis isolates were belonged to assemblage C or D, identified as dog-specific genotypes. Zoonotic assemblage A and B were not demonstrated. The result suggests that the risk of zoonotic transmission of G. intestinalis from pet shops puppies to humans may be quite low in Japan.

[The fluorodeoxyglucose-positron emission tomography (FDG-PET) findings and surgical strategy for pulmonary sclerosing hemangioma]

The pulmonary sclerosing hemangioma is a comparatively rare lung tumor. We operated on 7 patients of the pulmonary sclerosing hemangioma during January, 2009 from December, 2001. We collected the information such as preoperative image findings, surgical methods, and the postoperative course. FDG-PET was performed in 4 patients preoperatively, and there was FDG uptake in 2 patients, and no FDG uptake in 2 patients. In 2 cases with FDG uptake, there was a tendency to increase the tumor diameter during preoperative follow-up. Among 7 patients, 1 patient underwent tumor enucleation, 2 patients underwent partial resection, and 2 patients underwent thoracoscopic lobectomy. Lung biopsy was performed in remaining 2 cases. Because a tumor was located in pulmonary hilum in 1 case, we underwent lung needle biopsy under thoracoscopy. Because another case was a multiple case, and the resection of all lesions was impossibile, we performed lung biopsy (partial resection). In all cases, the recurrence or exacerbation of the tumor was not detected postoperatively. We thought that the findings of FDG-PET reflected proliferation potency of the pulmonary sclerosing hemangioma. The clinical features of the pulmonary sclerosing hemangioma are various. Therefore, the surgical treatment should be determined in each case carefully while considering the FDG-PET findings.

[Experience of a vascular stent placement under bronchoscopy for a severe airway stenosis like a pinhole]

The patient was a 32-year-old woman. She suffered repeated hemoptysis due to a congenital right pulmonary artery deficiency and underwent right pneumonectomy at 19 years of age. Immediately after the operation, postpneumonectomy syndrome appeared. The left main bronchus was compressed and almost obstructed, and so metallic stent was urgently installed. However, she subsequently suffered from repeated stenosis due to granulation and repeated obstructive pneumonia. She underwent 7 stent installations, laser therapy, low dose radiotherapy, and ballooning to treat her airway stenosis. However, her left main bronchus gradually became a severe stenosis like a pinhole. When she admitted to our hospital due to obstructive pneumonia last time, it was impossible to install usual airway stents because of extreme kinking of airway and severe stenosis. Therefore, a vascular stent for iliac artery was chosen to treat her airway stenosis and the stent was placed to regain good patency. As a result of the treatment, she had immediate relief of symptoms and survived obstructive pneumonia.

Incomplete Posture Adjustment during Rapid Arm Movement

It is not well understood how posture (nonfocal joints) is stabilized during rapid joint movements. Interaction torque arising at the joints due to the movement of the adjacent joints will disturb the nonfocal joint unless it is compensated by muscle torque. The aim of this study was to clarify the mechanism underlying the incomplete stabilization of nonfocal posture during two types of fast single-joint flexion tasks, i.e., elbow flexion and shoulder flexion, with and without a hand-held weight. Participants were 5 men and 4 women ( M age = 22.2 yr., SD = 4.8). The relationship between interaction torque and muscle torque and between angular displacement and torque components of the nonfocal joints were examined. The anticipatory muscle activity at the nonfocal joint produced compensatory muscle torque during the early phase of the rapid movement. However, nonfocal joints displayed a consistent displacement pattern, i.e., an initial extension followed by a flexion during the movement. The initial extension was in the direction of the interaction torque and its magnitude was related to the onset delay of the muscle torque against the interaction torque. The flexion movement of the nonfocal joints during the task was in the direction of the overcompensating muscle torque against interaction torque. This mechanism may have certain implications for anticipatory postural adjustment problems.

Interaction torque contributes to planar reaching at slow speed

Background

How the central nervous system (CNS) organizes the joint dynamics for multi-joint movement is a complex problem, because of the passive interaction among segmental movements. Previous studies have demonstrated that the CNS predictively compensates for interaction torque (INT) which is arising from the movement of the adjacent joints. However, most of these studies have mainly examined quick movements, presumably because the current belief is that the effects of INT are not significant at slow speeds. The functional contribution of INT for multijoint movements performed in various speeds is still unclear. The purpose of this study was to examine the contribution of INT to a planer reaching in a wide range of motion speeds for healthy subjects.

Methods

Subjects performed reaching movements toward five targets under three different speed conditions. Joint position data were recorded using a 3-D motion analysis device (50 Hz). Torque components, muscle torque (MUS), interaction torque (INT), gravity torque (G), and net torque (NET) were calculated by solving the dynamic equations for the shoulder and elbow. NET at a joint which produces the joint kinematics will be an algebraic sum of torque components;

NET = MUS - G - INT.

Dynamic muscle torque (DMUS = MUS-G) was also calculated. Contributions of INT impulse and DMUS impulse to NET impulse were examined.

Results

The relative contribution of INT to NET was not dependent on speed for both joints at every target. INT was additive (same direction) to DMUS at the shoulder joint, while in the elbow DMUS counteracted (opposed to) INT. The trajectory of reach was linear and two-joint movements were coordinated with a specific combination at each target, regardless of motion speed. However, DMUS at the elbow was opposed to the direction of elbow movement, and its magnitude varied from trial to trial in order to compensate for the variability of INT.

Conclusion

Interaction torque was important at slow speeds. Muscle torques at the two joints were not directly related to each other to produce coordinated joint movement during a reach. These results support Bernstein's idea that coordinated movement is not completely determined by motor command in multi-joint motion. Based on the data presented in this study and the work of others, a model for the connection between joint torques (muscle and passive torques including interaction torque) and joint coordination is proposed.

Evaluation of plasma C-terminal atrial natriuretic peptide in healthy cats and cats with heart disease

BACKGROUND

The clinical implications of evaluating C-terminal atrial natriuretic peptide (ANP) concentration in cats are still controversial.

HYPOTHESIS

The objective of this study was to investigate the relationship between plasma C-terminal ANP concentration and left atrial pressure (LAP) in healthy cats with volume overload (study 1), and to compare plasma C-terminal ANP in normal cats and cats with cardiomyopathy (study 2).

ANIMALS

Five healthy adult cats were used in study 1, and clinically healthy cats (n=8) and cats with cardiomyopathy (n=14) were used in study 2.

METHODS

In study 1, cats were anesthetized and given acetated Ringer's solution (100 mL/kg/h for 60 minute) via the cephalic vein. Hemodynamic measurements and blood samples, collected from the jugular vein, were performed at 10-min intervals. In study 2, blood samples from normal cats and cats with cardiomyopathy were collected from the cephalic vein. The plasma C-terminal ANP concentration was determined by radioimmunoassay for human alpha-ANP.

RESULTS

In study 1, volume overload significantly increased the C-terminal ANP concentration and LAP from baseline. The C-terminal ANP concentration was strongly correlated with the mean LAP. In study 2, age, E wave velocity, and the ratios of the left atrium to aorta were significantly higher in the cats with cardiomyopathy compared with the normal cats. The C-terminal ANP concentration was significantly higher in the cats with cardiomyopathy compared with the normal cats.

CONCLUSIONS AND CLINICAL IMPORTANCE

Our results suggest that the measurement of plasma C-terminal ANP in cats may provide additional information for the diagnosis of heart disease.

[Problems in donor lung evaluation for transplantation with regard to airway infection]

The shortage of donor organs has been 1 of the major obstacles to solid organ transplantation. Typical lung donor criteria include clear lung field on chest radiograph, adequate oxygenation, acceptable lung compliance, and satisfactory bronchoscopic findings. To extend usage of available donors, liberalization of donor lung selection criteria has been facilitated, however, marginal donor lungs must be used with discretion, because donor lung injury, especially that related to infection, has a potential leading to early post-operative death of the recipient. From March 2000 to December 2006, we evaluated 15 braindead donors and at least 1 of the lungs from 9 donors was judged suitable for transplantation. One of 9 recipients developed severe pneumonia cased by carbapenems-resistant Pseudomonas aeruginosa possibly originating from the donor lungs, eventually leading to death. The chest radiograph and oxygenation of the donor had been satisfactory, however, a moderate amount of mucopurulent secretions was observed by bronchoscopic inspection and the donor had been given a cefozopran for 9 days before the procurement operation. Remaining 8 recipients were free from air-way infection in the early postoperative period. We discuss the status and problems of donor lung evaluation for transplantation with regard to donor lung infection.

[Bronchoplasty without lung resection for the complete transection of the left main bronchus due to blunt trauma]

Blunt bronchial injury is rare but crucial injury. A 17-year-old female was admitted due to traumatic injury. She was diagnosed with bilateral lung contusion, multiple rib fractures, spleen damage and the suspicion about the complete transection of the left main bronchus on X-ray and computed tomography (CT). She was brought to our hospital at 30 hours later from injury. Bronchoscopy revealed the complete transection and the edema of the left main bronchus. She underwent a resection of the disrupted portion and end-to-end anastomosis of left main bronchus without lung resection. We should be an immediate and accurate diagnosis of tracheobronchial disruption by X-ray, CT and bronchoscopy whenever we evaluate patients with blunt chest trauma.

Changes of immunological response after experimentally ozonated autohemoadministration in calves

Changes in subsets of peripheral blood mononuclear cells and lymphocyte blastogenesis reaction were observed after ozonated autohemoadministration (OAHA) in calves. Ten healthy calves were used in this study. After OAHA, CD8+ cells, CD14+ cells and WCl+cells increased (p<0.05). The level of lymphocyte blastogenesis stimulated by PHA decreased after OAHA. A significant increase in serum IL-6 activity was observed in OAHA calves. These results suggested that OAHA induced immunological changes in calves.

Relationship between serum TNF activity and insulin resistance in dairy cows affected with naturally occurring fatty liver

To clarity the relationship between tumor necrosis factor (TNF) and insulin resistance in dairy cows affected with fatty liver, naturally occurring cases were investigated. The affected cows were classified into following three groups according to histopathologic findings of the liver: mild fat droplet deposition (group 1; n=11), severe fat droplet deposition (group 2; n=10), and cloudy swelling (group 3; n=8). Serum TNF activities in Group 2 (8.67 +/- 2.16 U/ml) and Group 3 (11.65 +/- 1.92 U/ml) were significantly higher than that in Group 1 (3.57 +/- 0.81 U/ml) (p<0.05). The insulin-tolerance tests showed that the insulin-stimulated glucose disposal rates (GDR) in Group 2 (27.6 +/- 7.8%) and Group 3 (15.8 +/- 9.1%) were significantly lower than that in Group 1 (41.7 +/- 9.8%). There was a significant negative correlation between serum TNF activity and GDR in affected cows (r=-0.56, p<0.01). These results indicate that serum TNF activity is correlated with insulin resistance in cows with fatty liver.

Acute phase response in naturally occurring coliform mastitis

Changes in the activities of serum cytokines and in acute phase response were observed in dairy cows with naturally occurring coliform mastitis. Seven cows with severe mastitis showed systemic and mammary inflammatory response throughout the observation period, and 11 cows with mild mastitis recovered and were able to be milked within 3 days of onset of mastitis. Serum interleukin (IL)-I and tumor necrosis factor (TNF) activities were higher in the severe group than in the mild group at the first appearance of symptoms. Elevated IL-1 activity was evident in the severe group throughout the observation period. Serum alpha-1-acidglycoprotein (alpha1AG) concentration began to rise with the beginning of mastitis in the severe group, and peaked at 9 days. Serum haptoglobin (Hp) concentrations peaked at 3 days, and decreased gradually after 3 days in the severe group. These results showed that there are dynamic changes in serum IL-1 activity and in serum alpha1AG and Hp concentrations in cows with severe coliform mastitis.

Determination of canine beta2-microgloblin in plasma and urine by enzyme-linked immunosorbent assay

An enzyme-linked immunosorbent assay was developed for the determination of canine beta2-microglobulin (beta2-m) in plasma and urine. The detectable sensitivity for pure canine beta2-m was 0.05 microg/l and the analytical range was 0.1 to 50 microg/l. The mean analytical recovery when pure canine beta2-m was added to normal plasma was 101.9%. The mean analytical recovery in the urine was 102.1%. The intra-day variation coefficient was 3.1% in plasma, 4.3% in serum and 1.9% in urine. No difference was found between the concentration of beta2-m in plasma and serum (n=17). The concentration of beta2-m in the plasma of normal dogs was 1.82 +/- 0.57 mg/l (n=31). The mean excretion in 24 hr urine collected from normal dogs was 17.6 +/- 9.2 microg/l, 0.22 +/- 0.12 microg/kg of body weight or 14.2 +/- 9.4 microg/g of urine creatinine. The beta2-m creatinine index of random urine samples was 23.5 +/- 16.6 microg/g (n=26). There was a close correlation between the beta2-m creatinine index of 24 hr urine samples and that of random urine samples (r=0.872).

Purification of bovine urinary beta2-microglobulin and its biochemical characteristics

In this study, bovine beta2-m was purified from urine by ion-exchange chromatography and gel chromatography, and the characteristics were compared with those of colostral beta2-m by the immunological reactivity, isoelectric points, peptide map, and amino acid sequence. The characteristics of purified urinary beta2-m were consistent with those of the colostral beta2-m. The urinary and colostral beta2-m possessed the same polypeptide chain consisting of 98 amino acids, and its molecular weight is 11.8 kDa. Furthermore, four isoforms of beta2-m were found. The isoelectric points were different from each other.

Determination of bovine beta2-microglobulin and albumin in urine by a reversed-phase high-performance liquid chromatography

Reversed-phase high-performance liquid chromatography (HPLC) was used to analyze beta2-microglobulin and albumin in bovine urine. The urine samples were chromatographed on TSK-gel ODS-120T column with an acetonitrile gradient. Urinary beta2-m and albumin were detected at 220 nm. For the pre-treatment, there were two steps proceeding injection: dialysis of urine with distilled water overnight, followed by concentration by solid-phase extraction method using a Sep-Pak cartridge. The retention times of beta2-microglobulin and albumin were 25.35 +/- 0.85 and 32.20 +/- 0.20 minutes (n=5), respectively. The mean analytical recoveries of beta2-microglobulin and albumin added to 0.1 ml of urine samples were 94.5 and 100.5%, respectively. The within-run coefficients of variation ranged from 1.5 to 5.3% for beta2-microglobulin and from 2.3 to 7.0% for albumin. The sensitivity for quantification of each protein was 0.5 microg in 100 microl injected urine samples. Urine samples from healthy cows and from cows with different types of proteinuria were analyzed by this reversed-phase HPLC. Results revealed albumin was remarkable in the urine from a cow with glomerulonephritis, and beta2-microglobulin was, in the urine from a cow with tubular dysfunction.

The complete amino acid sequence of dog beta2-microglobulin

Dog beta2-microglobulin was purified from the urine of dogs with potassium dichromate induced tubular damage. It was purified by sequential use of anion exchange chromatography, gel filtration chromatography, and reversed-phase high performance liquid chromatography. Comparisons of the amino acid sequence of the dog protein with human, mouse, and rabbit beta2-microglobulin, indicated a high degree of similarity. The dog protein was very similar to human beta2-microglobulin in that it had a molecular weight of 11.8 kDa and contained two half-cystinyl residues. Dog and human beta2-microglobulin were demonstrably different at 24 of the 99 positions compared. The data supported the conclusion that the purified protein was dog beta2-microglobulin and that all four proteins from dog, human, mouse, and rabbit were closely related.

Purification of bovine beta 2-microglobulin from colostrum and its complete amino acid sequence

Bovine beta 2-microglobulin (beta 2-m) was purified from colostrum milk in two chromatographic steps: anion-exchange chromatography, and gel filtration. The amino acid sequence was determined to confirm that the purified protein was beta 2-m. A molecular weight of 11.8 kDa beta 2-m was estimated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Bovine beta 2-m consists of 98 amino acid residues and contains one disulfide linkage connecting residues 25 and 79. The amino acid sequence determined by this study is different from a previously published sequence at three sites, but agrees with the amino acid sequence from cDNA. Thus, we can conclude that the amino acid sequence determined in this study is correct.

Development of Babesia gibsoni in the salivary glands of the larval tick, Rhipicephalus sanguineus

The development of Babesia gibsoni in the salivary glands of larval Rhipicephalus sanguineus ticks was morphologically studied for 4 days of feeding of tick on rabbits. Babesia gibsoni showed two forms (sporont and sporozoite) in the budding process. Sporozoites were formed in the acinar cells of salivary glands and released from the hollow cytoplasmic area of these cells by day 4 of feeding. The morphology of B. gibsoni in the salivary glands of R. sanguineus shows a close similarity to those of B. gibsoni in Haemaphysalis longicornis.

Application to cows and horses of Spotchem, a dry-chemistry blood analyzer for use in veterinary clinics

The usefulness of a dry-chemistry blood analyzer, Spotchem SP-4410 (SP-4410) in a veterinary clinic for analysis of bovine and equine blood chemistry was studied. We quantitated total protein (TP), albumin (Alb), total bilirubin (T-Bil), blood urea nitrogen (BUN), total cholesterol (T-Cho), glucose (Glu), calcium (Ca), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), creatinine phosphokinase (CPK), and alkaline phosphatase (ALP) in bovine sera. Each sample was assayed with both the SP-4410 and an automated blood analyzer which served as a wet-chemistry reference system, and the data were analyzed with regression analysis. The correlation coefficient for AST was 0.997 being the highest for all the parameters, and all the correlation coefficients were 0.93 or higher. The coefficients of variation were lower than 5.0 except in the case of bovine T-Bil where it was 5,756. The ranges of normal reference values measured by SP-4410 were the same as those reported by other investigators in most cases, but those for GGT and CPK were slightly higher. The strongest interference was observed with hemoglobin. It seems that dry-chemical-analysis of blood serum using the SP-4410 is useful for analysis of bovine and equine blood.

Development of Babesia ovata in the salivary glands of the nymphal tick, Haemaphysalis longicornis

The development of Babesia ovata in the salivary glands of nymphal Haemaphysalis longicornis ticks was morphologically studied for 4 days of feeding of tick on rabbits. Babesia ovata showed two forms (sporont and sporozoite) in the budding process. Sporozoites were formed in the acinar cells of salivary glands and released from the hollow cytoplasmic area of these cells by day 4 of feeding.