Quantitative assessment of muscle activity of back and lower extremities, whole body sagittal alignment, body sway, and health-related quality of life in adult spinal deformity patients before and after spinopelvic correction surgery: From the standpoint of the "cone of economy".

BACKGROUND AND AIMS: Pain and muscle fatigue in the low back and lower extremity associated with adult spinal deformity (ASD) markedly limit daily activities and affect quality of life. This study aimed to clarify if spinal correction surgery decreases the muscle activity requirements in relation to alignment and balance parameters. METHODS: Integrated electromyogram (I-EMG) studies of the low back and lower extremity in addition to whole body alignment, body sway, and health-related quality of life (HRQOL) were evaluated in 16 patients with ASD before and after surgery. Sixteen healthy volunteers were included as control subjects. Muscle activities of the bilateral lumbar paravertebral, biceps femoris, rectus femoris, gastrocnemius, and tibialis anterior were measured using surface electromyogram in both resting and working standing positions. Surgical outcomes were based on improvements in muscle fatigue using the sum of the whole muscle I-EMGs and body sway. HRQOL was evaluated by SRS-22r, which measures 4 domains (function, pain, self-image, mental health) and subtotal scores. RESULTS: In controls, the sum of the 10 whole I-EMGs (mVms; mean ± SD) was 3316 ± 1247 in the resting standing position and 5625 ± 2065 in the working standing position. The I-EMG values were higher in ASD patients than in healthy subjects; in the resting standing position, the sum of the whole 10 I-EMGs significantly decreased from baseline (9125 ± 3529) to 3 (6088 ± 1793) and 6 (6381 ± 1776) months postoperatively (p < 0.01). In the working standing position, the sum in ASD patients also significantly decreased from baseline (14,160 ± 5474) to 3 (8085 ± 2540) and 6 (8557 ± 3025) months postoperatively (p < 0.01). I-EMG values did not differ significantly between the 3- and 6-month time points in either condition. Body sway was also improved postoperatively at 3 months and maintained at 6 months along with the amelioration of whole-body sagittal alignment, and 4 domains and subtotal SRS-22r scores significantly increased postoperatively. CONCLUSION: Following spinopelvic correction surgery, whole body sagittal alignment was improved, and muscle activity based on I-EMG and body sway were significantly decreased. The SRS-22r scores after surgery also indicated significant improvement, suggesting that muscle fatigue in the standing position was ameliorated, i.e., the "cone of economy" was normalized.

New Neuromuscular Training for Peripheral Nerve Disorders Using an Ankle Joint Hybrid Assistive Limb: A Case Series.

Peripheral nerve disorder of the lower extremities causes drop foot and disturbs the daily living activities of patients. The ankle joint hybrid assistive limb (HAL) provides voluntary ankle joint training using surface bioelectrical signals from the muscles of the lower extremities. We investigated the neurological effects of ankle joint HAL training in three patients. Sensory nerve action potentials (SNAPs) and compound muscle action potentials (CMAPs) were analyzed for the peroneal and tibial nerves prior to the first ankle joint HAL training session. Integrated surface electromyography EMG signals were recorded before and after the HAL training sessions to evaluate the effects of training for neuromuscular disorders. The patients were hospitalized to receive rehabilitation with HAL training for 2 weeks. The HAL training was performed daily with two 60 min sessions. All cases demonstrated severe neuromuscular impairment according to the result of the CMAP. All integrated EMG measurements of antagonistic muscle activities decreased after the ankle joint HAL training. The manual muscle testing (MMT) scores of each muscle were slightly increased after the HAL intervention for Case 2(tibialis anterior, from 2 to 2+; gastrocnemius muscles, from 2- to 2; extensor digitorum longus, and extensor hallucis longus, from 1 to 3). The MMT scores were also slightly increased except for gastrocnemius muscle for Case 3 (tibialis anterior, extensor digitorum longus, and extensor hallucis longus, from 2- to 2). These two patients demonstrated voluntary muscle contractions and nerve signals in the CMAP before the HAL training. Even though the amplitude of CMAPs was low, the HAL training may provide voluntary ankle joint movements by reducing the antagonistic muscle contraction via computer processing. The HAL training may enhance muscle movement and coordination through motor learning feedback.

Subjective Household Economic Status and Obesity in Toddlers: A Cross-Sectional Study of Daycare Centers in Japan.

BACKGROUND: Although lower household economic status is known to be a risk factor for obesity among school-age children, such an association among toddlers remains unclear. The present study investigated the association between household economic status and obesity in toddlers. DESIGN: We conducted a cross-sectional study of children aged 4 years attending daycare centers in Japan. Information on subjective household economic status ["affluent", "neither", "less affluent", or "non-affluent"] was collected via questionnaire from the children's guardians in 2015. Based on measured values of height and weight, obesity was defined using the International Obesity Task Force cut-offs of overweight (BMI ≥17.47 for boys and ≥17.19 for girls). We used the logistic regression model to investigate the association between household economic status and obesity. RESULTS: Among 1,848 respondents, the prevalence of obesity was 6.8%. Non-affluent household economic status was associated with a significantly higher probability of obesity in toddlers; the multivariate adjusted odds ratio for "non-affluent" households was 2.31 (95% confidence interval, 1.23-4.33) compared with "affluent" households. CONCLUSION: Perception of non-affluent economic status by the guardian was associated with a higher probability of toddler obesity. This result suggests that non-affluent household economic status is associated with obesity in toddlers.

Discovery of Novel Indazole Derivatives as Orally Available ß3-Adrenergic Receptor Agonists Lacking Off-Target-Based Cardiovascular Side Effects.

We previously discovered that indazole derivative 8 was a highly selective ß3-adrenergic receptor (ß3-AR) agonist, but it appeared to be metabolically unstable. To improve metabolic stability, further optimization of this scaffold was carried out. We focused on the sulfonamide moiety of this scaffold, which resulted in the discovery of compound 15 as a highly potent ß3-AR agonist (EC50 = 18 nM) being inactive to ß1-, ß2-, and α1A-AR (ß1/ß3, ß2/ß3, and α1A/ß3 > 556-fold). Compound 15 showed dose-dependent ß3-AR-mediated responses in marmoset urinary bladder smooth muscle, had a desirable metabolic stability and pharmacokinetic profile (Cmax and AUC), and did not obviously affect heart rate or mean blood pressure when administered intravenously (3 mg/kg) to anesthetized rats. Thus, compound 15 is a highly potent, selective, and orally available ß3-AR agonist, which may serve as a candidate drug for the treatment of overactive bladder without off-target-based cardiovascular side effects.

[Comparison of intensive and moderate individual life-style intervention programs for overweight or obese persons with fasting glucose levels of 95-125 mg/dl in Japan].

OBJECTIVES: There are considerable differences in individual health education programs for persons at high risk of type 2 diabetes between ordinary Japanese life-style modification programs and the Diabetes Prevention Program in the US, the former being relatively moderate and the latter more intensive. We therefore compared the effectiveness of intensive and moderate intervention, focusing on the frequency of individual educational classes. METHODS: The subjects were men and women aged 44-69 years living in Nishiaizu town, Fukushima prefecture in Japan. Their fasting plasma glucose concentration was between 95 and 125 mg/dl at health examinations conducted in 2002 or 2003. They also had a body mass index (BMI) of 23.0 or higher, a fasting plasma glucose concentration of 125 mg/dl or lower and a post-load plasma glucose concentration (2 h) of 199 mg/dl or lower in the 2004 survey. We assigned the subjects according to their residences to an intensive life-style intervention group (two education classes per month; n = 11) or a moderate intervention group (one education class per month; n = 14). The main outcome measure was the change in body weight after 6 months of intervention. RESULTS: The loss of body weight was -3.5 kg (P< .0001) in the intensive intervention group and -1.8 kg (P = 0.02) in the moderate group, and the net difference in body weight loss between the groups was -2.0 kg (95% confidence interval -4.0 to -0.05; P = 0.045) after adjustment for age, sex, and baseline body weight. BMI and subcutaneous fat area showed similar results. The post-load plasma glucose concentration (2 h) and other tested values showed no significant net change between the two groups. CONCLUSIONS: Intensive and moderate intervention both reduced body weight in overweight or obese persons at high risk of type 2 diabetes. The intensive intervention, two sessions of individual education classes per month, was significantly more effective than the moderate one for reducing body weight.

[Evaluation of great gene variations in methicillin-resistant Staphylococcus aureus--controlled study in 363 strains from 192 patients].

BACKGROUND: We tested a hypothesis that major gene variations of methicillin-resistant Staphylococcus aureus (MRSA) are detectable in a single patient. METHODS: We isolated 363 strains of MRSA in 192 patients diagnosed as having MRSA infection in Yamagata University Hospital. By an established pulsed-field gel electrophoresis method, all strains were analysed by Sma I macrorestriction patterns of genomic DNA. RESULTS: A total of 54 different electrophoresis was observed, (8 major types each of which has 5-8 subtypes). Two or more strains could be isolated in 68 patients. Out of these patients 2-4 different gene variations were detected in a single patient. CONCLUSIONS: Our results suggest that gene variations can be detectable in a single patient and that caution should be paid for diagnosis of MRSA cross infection.